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DocuSign Envelope ID:380F50AD-C98D-426B-80DC-9Al34EB8DA24 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Human Services — Town Of Chapel Hill <br /> In 1982, the Town established local funding to support local nonprofit organizations that carry <br /> out human service work throughout the community. <br /> Applications are accepted once a year and reviewed by the Town's Human Services Advisory <br /> Board, which makes a recommendation for funding to the Town Council for final approval. <br /> For more information about the Town of Chapel Hill Human Services program, see here. <br /> Questions and submittals should be directed to: <br /> Jackie Thompson <br /> 405 Martin Luther King Jr. Blvd. <br /> Chapel Hill, NC 27514 <br /> 919-969-5081 <br /> jthompson(a�townofchapelhilLorg <br /> Submission: <br /> ➢ We strongly encourage applications to be single-spaced, with 12-point arial font <br /> and normal margins. <br /> ➢ Application: Two (2) paper copies of the application with ORIGINAL <br /> signatures must be hand delivered or mailed to Jackie Thompson, 405 <br /> Martin Luther King, Jr. Blvd., Chapel Hill, NC 27514; AND <br /> ➢ Attachments: The application submittal must be accompanied by a flash drive <br /> with the application and all attachment files in electronic format. Any .pdf <br /> files must be accompanied by the original file format of .doc, .xIs, etc. <br /> Human Services— Orange County <br /> For more information about the Orange County Human Services program, see here. <br /> Questions and submittals should be directed to: <br /> Allen Coleman <br /> PO Box 8181 <br /> Hillsborough, NC 27278 <br /> (919) 245-2151 <br /> acoleman(a_orangecountync.gov <br /> Submission: <br /> ➢ Email application and ALL Attachments prior to the deadline. Any .pdf files <br /> must be accompanied by the original file format of .doc, .xIs, etc. Please <br /> request a delivery receipt of email with application and attachments. <br /> DO NOT SUBMIT THIS PAGE 1/31/2017 3:01:12 PM Page 4 of 18 <br />