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DocuSign Envelope ID:C70973D3-D989-4F31-A95E-3BCC099C95E7 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br /> Program Name: Newcomer's Art Therapy Program <br /> Program Primary Contact and Title: Kristin Linton <br /> Telephone Number:919-381-6068 E-Mail: klinton(a).ncati.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 <br /> 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 Youth Adult Elderly Disabled Public Housing <br /> Neighborhoods/Residents <br /> Affordable Housing <br /> Affordable Healthcare x x x x <br /> Education <br /> Family Resources x x x <br /> Jobs/Jobs Training x <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 <br /> Program(s) to be funded. For each, briefly describe the coordinated/collaborative <br /> efforts. <br /> • Cardinal Innovations is a managed care organization that contracts with ATI to provide <br /> services to many of our clients who have Medicaid. They also provide a stipend for our <br /> work at the Carrboro Community Health Center, a women's group, some of our <br /> uninsured students, and some translation services. <br /> • The Carrboro Community Health Center/Piedmont Health provides comprehensive <br /> health services and education to all segments of the community, with special emphasis <br /> on vulnerable populations. They refer clients to ATI, sign medical service orders for art <br /> therapy, and provide space for ATI to provide weekly individual art therapy for adults. <br /> • Chapel Hill-Carrboro City Schools: The ESL Director, the EC Program Director, <br /> counselors, ESL and EC teachers, and social workers are all dedicated to partnering <br /> PROGRAM INFORMATION 2/8/2017 3:01:12 PM Page 10 of 20 <br />