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DocuSign Envelope ID:9F461F1C-C86C-42DC-B78C-50FC18D204DF <br /> EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) <br /> Program Name: The Arc of the Triangle Community Programs and Individual Services <br /> Program Primary Contact and Title: Jennifer Pfaltzgraff, Executive Director <br /> Telephone Number: 919 942-5119 x117 E-Mail: jpfaltzgraff(a_arctriangle.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 youth facing a <br /> 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 /> c) P Program Category Youth Adult Elderly Disabled Public Housing <br /> r Neighborhoods/Residents <br /> o Affordable Housing <br /> v Affordable Healthcare <br /> d <br /> Education X <br /> e Family Resources X <br /> a Jobs/Jobs Training X <br /> b Food X <br /> u Transportation <br /> II Other: Please specify <br /> e <br /> t <br /> ed list of other agencies, if any, with which your agency coordinates/collaborates to accomplish or <br /> enhance the Projected Results in the Program(s) to be funded. For each, briefly describe the <br /> coordinated/collaborative efforts. <br /> • The North Carolina Division of Vocational Rehabilitation (VR) - persons recommended to The <br /> Arc from VR find gainful work with Arc Supported Employment Specialists. <br /> • Cardinal Innovations Health Care Solutions- families and individuals are recommended to The <br /> Arc to receive Home and Community Support, Respite Care, Supported Employment, Social <br /> and Volunteer opportunities. <br /> • Meals on Wheels (MOW)—Arc participants volunteer weekly delivering and preparing meals for <br /> Chapel Hill and Carrboro Meals on Wheels recipients. Once a month the Arc's cooking class <br /> bakes and donates thirty-six desserts to local MOW recipients. <br /> • Whole Foods — donates hundreds of beautiful fresh flowers every Wednesday for the Petals <br /> with a Purpose program. <br /> • Extraordinary Ventures (EV) — Arc participants are hired and employed at EV for a variety of <br /> jobs including Office Solutions, EV Laundry, EV Candle making, EV Pet sitting, as well as <br /> partnering in Friday Night Live a weekly evening at EV for friendship and fun for teens and <br /> adults with or without intellectual/developmental disabilities. <br /> • EZ Rider and Public Transportation —Arc participants use the free public bus system to access <br /> the community for their employment, education and social activities. <br /> PROGRAM INFORMATION 1/20/2018 3:58:40 PM Page 13 of 24 <br />