2017-706-E Finance - ArtsCenter outside agency agreement

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DocuSign Envelope ID:C4C09F35-022B-45DE-8313-4A1ED7AF458B XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: The ArtsCenter- Youth Department (Orange County) (A separate request for General Support will be sent to the Towns of Carrboro & Chapel Hill) Program Primary Contact and Title: Julie Tomkovick Telephone Number: 919-929-2787 x 213 E-Mail: development(c-)artscenterlive.org a) Indicate the type of Human Service Needs Priority, if program applicable: ❑ Priority Area #1: safety-net services for disadvantaged residents ® Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges ❑ Priority Area #3: programs aimed at improving health and nutrition of needy residents b) Indicate the type of program for which you are requesting funding (Check all that apply to this program) Program Category Youth Adult Elderly Disabled Public Housing Neighborhoods/Residents Affordable Housing Affordable Healthcare Education X X X X X Family Resources Jobs/Jobs Training Food Transportation Other: Art Exhibits & Performances X X X X X c) Provide a bulleted list of other agencies, if any, with which your agency coordinates/collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, briefly describe the coordinated/collaborative efforts. • Chapel Hill Carrboro City Schools (Youth programs planning and participants) • Orange Co. Schools (Youth programs planning and participants) • Orange Co Human Services (Youth programs planning and funder) • Chapel Hill-Carrboro PTA (Youth programs planning and funder) • OCAC (Youth programs and theater funder) PROGRAM INFORMATION 2/8/2017 5:24:23 PM Page 12 of 20