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DocuSign Envelope ID: 717C8AE2- 4D6E- 4E46- A9A7- F4213973D039 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />2. AGENCY INFORMATION (Be Very Brief and Concise) <br />Please provide the following information about your agency (2 pages OR LESS): <br />a) Years in Operation, Date of Incorporation (Month/Year): August/2004 <br />Club Nova was founded July 1, 1987. Our founding members were at the core of our <br />inception. Club Nova has been in operation for almost 30 years, operating for 19 years <br />under the auspices of OPC Area Authority. Club Nova Community, Inc. incorporated on <br />August 23, 2004. On May 21, 2006, Club Nova was divested and came under the <br />governance of Club Nova Community, Inc. We have operated as a private non - profit for <br />over 10 years. <br />b) Agency's Purpose /Mission (no more than a few sentences): <br />Club Nova provides opportunities for individuals living with severe and persistent <br />mental illness to lead meaningful and productive lives of their choice in the community. <br />Club Nova focuses on members' strengths and potential rather than their illness. <br />c) Types of Services the Agency Provides (bullet format): <br />• The Basic Components of Clubhouse: Community Support <br />• Members get help with acquiring and keeping affordable and dignified homes. <br />• Members get help with government disability and pension benefits. <br />• The Basic Components of Clubhouse: Supported Housing <br />o Club Nova is committed to securing a range of choices of safe, decent and <br />affordable housing including independent living opportunities for all members. <br />o Members choose the location of their housing and their roommates. <br />o The level of support increases or decreases in response to the changing needs of <br />the members. <br />The Basic Components of Clubhouse: Health and Wellness <br />• Club Nova provides 13 affordable, nutritious meals each week. <br />• Members receive help accessing and navigating the social and healthcare services <br />they require. <br />• Members get help with averting crisis and crisis intervention. <br />• Members have opportunities to participate in weekly wellness programming. <br />The Basic Components of Clubhouse: Outreach <br />o Reach -out call or visit is made when a member does not attend or is hospitalized. <br />o Outreach provides an early warning system for members experiencing difficulties. <br />o Through routine contact, a crisis, hospitalization or worse, is often prevented. <br />The Basic Components of Clubhouse: The Work Ordered Day <br />• Members and staff work together as colleagues to carry out all the critical work <br />necessary to sustain Clubhouse functions. <br />• Through participating and contributing, members regain skills, a sense of purpose, <br />self- worth, and confidence working in the Clubhouse <br />• The Basic Components of Clubhouse: The Employment Programs <br />o People with SMI have the lowest employment rates of any disability. <br />o Return to paid employment is a right of membership and a priority of Clubhouse <br />o Members are given opportunities for paid employment in integrated work settings. <br />Agency Information 1/23/2018 1:58:29 PM Page 10 of 31 <br />