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DocuSign Envelope ID: E7F88FC1-7C61-4E68-8AF9-5870F711DEBC it A continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 3. PROJECTIPROGRAM INFORMATION <br /> Agency & Program Name: A Hering Hand 1 Senior Companion Care <br /> a) Check the type of funding request for this application package submittal and complete the <br /> required application and required supplemental sections (Parts) as specified below: <br /> Z Human Services (Main Application~ Only) <br /> ❑ CDBG Non-Construction —(Main Application AND Part A) <br /> Q CDBG Construction — (Main Application AND Part A AND Part B) <br /> ❑ HOME CHDO Set-aside —(Main Application AND Part A) <br /> ❑ HOME Other — (Main Application AND Part A AND Part B) <br /> Indicate the type of program for which you are requesting funding: <br /> Disabled Public Housing <br /> Program Category Youth Adult Elderly (not elderly) Neighborhoods/Residents <br /> Education <br /> Health and Nutrition X <br /> Jab Training <br /> Sports and Arts <br /> Activities <br /> Pre-School Activities <br /> After-School <br /> Activities <br /> Mentorin <br /> Transportation X <br /> Housing <br /> Other: Please <br /> specify <br /> Pro9raL13JPro81F,1 D i (Label your responses as outlined below; not to exceed 3 pages.) <br /> Please provide the following information about the proposed program/project: <br /> b) Summarize the program services proposed and how the program will address the chosen <br /> Town/County priority? <br /> Provide non-medical independent living services for senior citizens and adults with <br /> disabilities, regardless of their ability to pay. Services include escorted "door-through-door" <br /> transportation, in-home assistance including light housekeeping and meal preparation, <br /> companionship, and respite care. <br /> c) Describe the local need or problem to be addressed in relation to the Consolidated <br /> Plan or other community priorities (i.e. Council/Board Goals). Cite local data to <br /> support the need far this program and the population being served. <br /> Main Application 1/25/2016 1:23:46 PM P c1 g e 7 of 26 <br />