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DocuSign Envelope ID:4FF28E49-EE56-4A40-9331-F55AA8A05998 <br /> EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 2. AGENCY INFORMATION (Be Very Brief and Concise) <br /> Please provide the following information about your agency (2 pages OR LESS): <br /> a) Years in Operation, Date of Incorporation (Month/Year): September, 2009 <br /> b) Agency's Purpose/Mission (no more than a few sentences): The Art Therapy <br /> Institute is an organization of masters-level mental health professionals dedicated to <br /> the healing power of the arts. We provide affordable clinical art therapy services to <br /> diverse populations and empower clients to develop their identities and strengths. We <br /> commit to community-based work in order to meet clients where they are, ensuring <br /> access to critical mental health services. In addition to our clinical services, we offer <br /> training to allied professionals and seek to raise awareness in the general public about <br /> the benefits of art therapy. <br /> c) Types of Services the Agency Provides (bullet format): ATI provides art therapy to <br /> the following populations (and is always open to expanding our client base!): <br /> • Refugees and Immigrants from over 25 countries worldwide <br /> • Children with intellectual and physical disabilities <br /> • Adults with severe and persistent mental illness <br /> • Children receiving bone marrow transplants or treatment for cancer <br /> • Elderly patients with Alzheimer's and dementia <br /> • Veterans <br /> • Victims of domestic violence <br /> • Families experiencing homelessness <br /> • Private clients from all backgrounds <br /> ATI also: <br /> • Provides continuing education workshops, supervision, and internships for allied <br /> mental health providers and graduate level students <br /> • Hosts monthly art shows for the broader public <br /> • Conducts ethical, culturally-appropriate research and evaluation to ensure program <br /> effectiveness. <br /> d) Agency's History with Providing These Services: <br /> ATI's Newcomer Art Therapy Program (NATP) began in 2008, serving 13 adolescents <br /> from Burma. We now work with approximately 225 refugee and immigrant children and <br /> adults annually from over 25 countries worldwide. This tremendous growth over the past <br /> decade has occurred with substantial input from community members, clients, and key <br /> stakeholders. ATI continues to monitor and evaluate NATP to ensure effectiveness, altering <br /> goals, research interventions, and desired outcomes to meet clients' needs as they shift. <br /> ATI's first art therapy program was started by one of the co-founders of ATI, Kristin <br /> Linton, who began an art therapy program for students with exceptional needs in the <br /> Chapel Hill/Carrboro schools in 2005. The contract was brought in house to ATI a few <br /> years later, and we currently serve the majority of self-contained EC classrooms in the <br /> district, providing art therapy to over 125 students annually. We work closely with the <br /> administration, teachers, and other staff to deliver art therapy services that enhance the <br /> growth, development, and opportunity for success for all EC students. <br /> Our other programs, while smaller in scope, are equally important to ATI. We bring <br /> weekly art therapy sessions to children in pediatric oncology and bone marrow transplant <br /> units at Duke and UNC Hospitals. We serve elders in memory care units at assisted living <br /> Agency Information 1/23/2018 10:01:04 AM Page 9 of 24 <br />