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DocuSign Envelope ID:8C3AC364-20A8-477A-92A7-8FBD4923E2D0 <br /> AGENCY INFORMATION <br /> Please provide the following information about your agency: <br /> 1. Date of Incorporation (Month/Year): Se. mber 2009 <br /> 2. Agency's Purpose/Mission (no more than a few sentences): <br /> To advance the well-being and mental health of diverse North Carolinians through <br /> accessible, strengths-based, culturally responsive art therapy; to further support our <br /> communities through local events and professional development opportunities; to <br /> contribute to and uphold research, theory, and practice of the creative arts therapies. <br /> 3. Please provide a brief description of your organization's past achievements in <br /> carrying out similar projects and evidence of successful record of meeting <br /> proposed budgets and timetables (no more than 100 words). <br /> The Arts & Peer Support Group has successfully met all proposed budgets and <br /> timetables since its inception in 2011. We have secured and successfully implemented <br /> grants from various foundations, including the Mary Duke Biddle Foundation, the Strowd <br /> Roses Foundation, Duke's Doing Good Fund, and the American Endowment <br /> Foundation, among others, to help support this arts- and community-based program for <br /> adults living with severe and persistent mental illness. Our careful stewardship of funds <br /> over the past nine years has enabled us to run one of the only free, weekly, non- <br /> insurance-based arts groups for adults living with mental illness in Orange County, <br /> 4. Living Wage Does this agency pay permanent employees a minimum living <br /> wage-? (Yes/No) Yes <br /> If yes, is this agency an (Jrarlae County Living Wage Certified Employer?Yes <br /> If no, please briefly explain. <br /> Schedule of Positions: # of FTE — Full-Time Paid Positons: A <br /> # of FTE—Part-Time Paid Positions: 7 <br /> PROGRAM INFORMATION <br /> *Please submit for each program if applying for funding for more than one program. <br /> 5. Program Name: Arts and Peer Support Group <br /> Program Primary Contact and Title: Hillary Rubesin, Executive Director <br /> Telephone Number: 610-348-7253 <br /> E-Mail: hrubesi ncati.ora <br /> _..._. ....................._.__..... ......................._........-...................... .... ........._.... <br /> Program information P a g e 9 o f 2 2 <br />