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ti ► Q 1 <br /> DocuSign Envelope ID: D90F57F1-8076-4358-9941-F62552053F84 <br /> COVER.PAGE <br /> Applicant Contact Information <br /> Applicant Organization's Legal Name: Chapel Hill Training Outreach Project, Inc. <br /> Applicant Organization's Physical Address: 800 Eastowne Dr., Suite 105, Chapel Hill, NC <br /> 27514 <br /> Applicant Organization's Mailing Address: 800 Eastowne Dr., Suite 105, Chapel Hill, NC <br /> 27514 <br /> Applicant Organization's Web Address: www.CHTOP.orq <br /> Executive Director: Terry David <br /> Telephone Number: 919-490-5577 E-Mail: TDayid(a_)chtop.orq <br /> Tax ID Number: 58-204362 <br /> Funding Request <br /> Please list all Fiscal Year 2021 Human Services (HS) funding requested for all programs and <br /> the proposed use of funds (please list ro rain name only) <br /> Program Carrboro- Chapel Orange Total <br /> HS Hill - HS County-HS <br /> KidSCope Outreach Therapy $3,000 $5,000 $96,000 $104,000 <br /> Operations and Personnel <br /> KidSCope Outreach Consultation $50,000 $50,000 <br /> Operations and Personnel <br /> Totals $3,000 $55,000 $96,000 $154,000 <br /> Briefly explain your proposed use of Rinds: <br /> KidSCope proposes the use of funds to support staff and program expenses for the <br /> following services: <br /> • Customized assessment and evaluation for children ages birth to 5, and their familieE <br /> to determine strengths and needs, <br /> • Social-emotional/behavioral health services using researched, evidence-based <br /> treatment and consultation modalities providing both home visiting, school-based, an <br /> office-based options. These programs are designed to give children a healthy <br /> start in the early years when relationships and experiences influence brain <br /> development the most. <br /> • Parent education that encourages and supports positive family relationships and <br /> interactions, particularly in the early years. <br /> ___. .............__. ........ <br />