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DocuSign Envelope ID: CCFF6125- AA47- 438A- 98CA- B42519499D42 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br />Program Name: Carrboro Community Health Center <br />Program Primary Contact and Title: Jen Cunningham, Data Analyst <br />Telephone Number: 919 - 013 -1097 <br />E -Mail: cunningj@piedmonthealth.org <br />a) Indicate the type of Human Service Needs Priority, if program applicable: <br />® Priority Area #1: safety -net services for disadvantaged residents <br />❑ Priority Area #2: education, mentorship, and afterschool programming for <br />youth facing a variety of challenges <br />® Priority Area #3: programs aimed at improving health and nutrition of needy residents <br />b) Indicate the type of program for which you are requesting funding <br />(Check all that apply to this program) <br />Program Category <br />Youth <br />Adult <br />Elderly <br />Disabled <br />Public Housing <br />Neighborhoods /Residents <br />Affordable Housing <br />Affordable Healthcare <br />X <br />X <br />X <br />X <br />X <br />Education <br />Family Resources <br />Jobs /Jobs Training <br />Food <br />Transportation <br />Other: Please specify <br />c) Provide a bulleted list of other agencies, if any, with which your agency <br />coordinates /collaborates to accomplish or enhance the Projected Results in the Program(s) <br />to be funded. For each, briefly describe the coordinated /collaborative efforts. <br />Refugee Health: The Orange County Health Department conducts the initial health screening <br />(communicable disease - focused) of all refugees referred to them by local resettlement <br />agencies (e.g. Lutheran Family Services, USCRI, World Relief, Church World Service). When <br />the initial assessment is complete, refugees are referred to PHS for on -going primary care. <br />PHS also has worked closely with UNC's (Josh Hinton) refugee health program. <br />Low - income, uninsured: UNC is PHS' primary referral center for specialty and inpatient care. <br />PHS works closely with UNC's SHAC Free Clinic, providing its Carrboro Community Health <br />Center at no cost for operation of the SHAC free clinic on Wednesday evenings. It also <br />participates in UNC's Carolina Health Net Program for the Uninsured, accepting unassigned <br />uninsured patients identified at UNC. Second, PHS works closely with the IFC, with PHS <br />medical and dental staff collocated at the IFC Community House delivering care. PHS also <br />collaborates with the health department on the Family Success Alliance project and the WIC <br />program. NC Prevent Blindness, Susan G Komen for the Cure, Book Harvest, and Strowd <br />Roses also support population health projects at our Carrboro Community Health Center. <br />PROGRAM INFORMATION 1/23/2018 11:00:54 AM Page 14 of 23 <br />