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DocuSign Envelope ID: EE049453-18E5-41 D0-B66D-B62773A7BC09 <br /> EXHIBITA: Provider's Outside Agency Application <br /> 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br /> Program Name: Spoke'n Revolutions <br /> Program Primary Contact and Title: Kevin Hicks, Executive Director <br /> Telephone Number:919-452-2272 E-Mail: kevin(cDtrianglebikeworks.orq <br /> a) Indicate the type of Human Service Needs Priority, if program applicable: <br /> ❑ Priority Area #1: safety-net services for disadvantaged residents <br /> X❑ 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 <br /> Healthcare <br /> Education X <br /> Family Resources <br /> Jobs/Jobs Training <br /> Food <br /> Transportation X <br /> Other: Please <br /> 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 /> • Youth Forward is a youth organization that provides technical assistance and <br /> program funding. <br /> • YouthWorx on Main is a nonprofit collaborative for youth-serving organizations that <br /> houses the Triangle Bikeworks office. <br /> • The Chapel Hill Carrboro City Schools provide assistance with youth recruitment. <br /> • The Blue Ribbon Mentor-Advocate program is a support program designed to <br /> improve the achievement of students of color. They assist TBW with recruitment <br /> efforts. <br /> PROGRAM INFORMATION 1/23/2018 1:34:47 PM P a g e 1 4 o f 2 6 <br />