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DocuSign Envelope ID: 717C8AE2- 4D6E- 4E46- A9A7- F4213973D039 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />• Three types of employment programs: Transitional, Supported, and Independent <br />• Employment is at the employer's place of business and pays the prevailing wage <br />for the required work. <br />The Basic Components of Clubhouse: Education <br />• Often education has been interrupted by SMI. Our Supported Education assists <br />with admissions, financial aid, and utilization of disability offices. <br />• The Clubhouse provides opportunities and assistance helping members complete <br />or start their certificate or degree programs at colleges and universities. <br />• The Basic Components of Clubhouse: Evening, Weekend, Holiday Program <br />o Evening, Weekend, Holiday Program reduces isolation and gives members a <br />sense of social connectedness and belonging. <br />+ The Basic Components of Clubhouse: Transportation <br />• Access is essential for members' participation in Club Nova's full range of <br />opportunities. <br />• Transportation operates morning and evening routes throughout Orange County. <br />d) Agency's History with Providing These Services: <br />Club Nova offers solutions to the challenges our members and our community face on a <br />daily basis. For 30 years, Club Nova has been saving and changing lives and making a <br />positive impact on the health of our community. <br />We have 30 years of experience in providing the full range of supports and opportunities <br />that define the Model and are in our funding request. The Model operates on proven <br />standards and has been replicated effectively with over 320 Clubhouses worldwide. A <br />rigorous accreditation process assures fidelity to the standards of the Model. Club Nova <br />holds a 3 Year Accreditation and is one of six accredited Clubhouses in North Carolina. <br />The Clubhouse Model is included in the Substance Abuse and Mental Health Services <br />Administration (SAMHSA) registry for Evidence -Based Practices. In 2017 the Conrad N. <br />Hilton Foundation, one of the world's most prestigious humanitarian prizes, chose the <br />Clubhouse International /Fountain House Clubhouse Model as the answer to alleviating <br />worldwide human suffering for individuals living with mental illness. Our dedication to our <br />members and this community have earned Club Nova the 2016 GlaxoSmithKline Impact <br />Award and Employee Choice Award, 2016 Chamber of Commerce Business Excellence <br />Award for Community Impact, 2016 Faith Connections Community Servant Award and <br />recognition by Towns of Carrboro and Chapel Hill for being a Model of Excellence in mental <br />health. With Club Nova's current plans for expansion, we look forward to the next 30 years. <br />e) Other Pertinent Agency Information (Ex. Has the agency experienced any major changes <br />in the past year? Is there a new Executive Director? Are there new initiatives?) <br />While Club Nova has not experienced any major changes in the past year, we have <br />continued to provide employment services despite elimination of state funds - as well as <br />retaining members who receive other services which Club Nova cannot be reimbursed for <br />(ACTT services) despite the two services' being complementary of each other. While no <br />major changes have occurred, we are always aware the Medicaid state funds could shift <br />without much notice. <br />Agency Information 1/23/2018 1 :58.291 PM P a g e 1 1 o f 3 1 <br />