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DocuSign Envelope ID: D3ADCOFO-56OB-45AA-A3EA-B65E3A3AO6DE XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br /> Program Name: Weekend Meal Backpack Program <br /> Program Primary Contact and Title: Laura Dille <br /> Telephone Number: 919-636-4860 E-Mail: Idille@tablenc.org <br /> a) Indicate the type of Human Service Needs Priority, if program applicable: <br /> Priority areas explained in Program Description <br /> M 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 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 <br /> Education <br /> Family Resources <br /> Jobs/Jobs Training <br /> Food X X <br /> Transportation <br /> Other: Please specify <br /> Nutrition Education X <br /> c) Provide a bulleted list of other agencies, if any, with which your agency <br /> coordinatesicollaborates 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 /> • McDougle Elementary School: Provide information/support to feed attending kids. <br /> • Frank Porter Graham Elementary School: Provide information/support to feed <br /> attending kids. <br /> • Ephesus Elementary School: Provide information/support to feed attending kids. <br /> • Estes Hills Elementary School: Provide information/support to feed attending kids. <br /> • Mary Scroggs Elementary School: Provide information/support to feed attending <br /> kids. <br /> • Rashkis Elementary School: Provide information/support to feed attending kids. <br /> • Seawell Elementary School: Provide information/support to feed attending kids. <br /> • Carrboro Elementary School: Provide information/support to feed attending kids. <br /> PROGRAM INFORMATION 1/30/2017 4:15:08 PM Page 11 of 19 <br />