Orange County NC Website
DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 <br /> {outside Agencies/Human Services <br /> Please;use they drop down menu below e:,select vvKjcbt function area best aligns with your agency <br /> I <br /> a'nd programs)in which-you'are requesting funding. Please select only one from the drop down <br /> rmeriei`fieloav: <br /> ' .Behayigr'Health ' <br /> t 4f yois.si lkkbad'other, please tell us what'Function area best aligns with your organization: <br /> Please indicate three program goals/performance measures below. <br /> A few notes: <br /> • if you use percentages, please put the actual number equivalence. <br /> • Please ensure your performance measures are outcome based and not outputs. <br /> ..0 ' - , � ,t tt t I ",: ': , ?�i „ .T t r{L L... -.. 'xS tI f�`•I t� I'.: <br /> �` i`' ,i li �R �l�l S}riS€:j;i t{71 ;I ' (r�'l i '' ;. �,� j., I y� � , .,';1�•�w''� Lail�'`::r <br /> h I i! '{ ! Jij):� t�' 11� s�}!!ii'€t€ }il j•!S t j 'i ��;u!�I , il;+,�+,}'I?• ' �I,i I, a !t�,I`��s i i r'!,<!�l�4 iifllt3 n y. li i's€!I; €,.fi,;'', 14"i,'€ �..J�%JV;In ' <br /> I, S'1 ,A'' 1 ,,, r 11 1!t.._! <br /> a y? i�.y'._, ;'i3!if roll+tl•, II f tt trl,y,!lri,@{� '�I,G rdll�i,lk.:� <br /> ,�,��,'i�'�'� �:t.:I,�,{lt;:1�l�!�,, '!y!`;F! �y -€,i1�3� �. ' €J�'•tJ. �i �`,N( � <br /> ,i�!I�� �t: <br /> r'if -{r'i•�"J!f���!' ' �y1 '(€ +' i€€Sr "1:) t'r,{N9!hilt y I yu`� k•h'N>rr ix;![titti: r•',rF !:'TLiVS tiil:'a„r r:!'a•tl a!Gu; �•. <br /> �!� , lfl ii t yli'1 nr r It y! r!t '� •�' 1! � l!:: � � !;iY'.,:s:G}lilt: <br /> r3i- y ;(y +l 1 � 31 �, i �� +� +••„.,,,� �� t rJir::I.,,',; <br /> i+,s n' U i+ ,7 t r:, !�f..; !li���t,€t.4 � }!i t!,€•? ( ...tl '�€r-{ lli €J• Ji[' J!1 pj .�ti €''LIIJF' �'.�t�,. IhJn'.;�J{l.ti€...r't'�`',t�'�I.i i'..:I't!...! <br /> rt71� fir`..,! .1�.r.. €,y'T, r u, 1' , r} � ! € ':, ,,•!!.i .((!k�.t{{{{� i;j, t��+!• t�...i r �o si st, H;.,{tl.n:ity�i;:,;, <br /> N._.N! o._I:.rofrt€ .!§-� .tl€rlli Sti4!i€Rlidt3:lS_iJll€€Il�ll. y�n� .tt,,,l I ,tlo11. I!li 6 !.!! !.1i;11,t,!llllxll it ltil Itarl u!lll:,tlJ JS:ir�list'€:�'•�1�.'.n'r,:'i.t.,ilniji!;';t>::i' <br /> • ��;•',.1;rld': i Yt4•('" a t 'll,,'f t:rr,'y '' yy .'iE!.y,, ,, .t„ ,� i:,.Y,:•: , t;t•:},' t";x'€1='reel'rr:'?r.,aa.,'It,t{• I?, : :r.;I�r�stt:ll;. <br /> ! <br /> tJJ:Jh ,t€ � ,v 'IhUi ri S6W ( €)� 1 E rll I S�J (It ! ��e �' '�1!� n•�' `����G. }� � -t <br /> !r . u.+_ :1?:�{.,; �,llaa.' t'� r'1,:1• ,; u!sr'r'.,�s•,r�_,,;: <br /> cc €" <br /> r,��k ,I(! '�J`' �` ill ,iJl;l:l , , i ill ``l;�'}{•,R ,I°-r•4.1' � €!4 !t'_ li ! � <br /> ,� 1 r } € € �I k;., ,�ti': •lil`- �!mil.!j!!J Nf<rr I�€ d 1 €i � !H:r�!�'{I� :I.>�-t i'Err;tia'� I :tip::,..,, <br /> -,, r+�t „ , �' � ��� � � 1 to• !.„� J i. y , 1,ll ii,,t'€ 1 €,( V! !• � ,!"tlii,.r.,,, ,:, <br /> . . ,„�,y,,' ,� ,y., c!w'it�i Ifl�i�tr i i'�j1;�1 � ��€tl f!�t ( �) ,� � '�' '[�,•t, ,��:. �q; t"� �A'�I'�I'�`!' <br /> 'I� �R I,uhtt � i!�, IJ 71.,I� 1, )!7�,ju .',t�• •! I ,€1�'' €!{It IJE7'°i,'41f y! '�''€€•:!t„tr i3�i�+l l�l!•YS.r';FSE�i� r �.'. .' <br /> € , 'P i '."" }€ [,I't 1 IJ,, i 1 l { I t, r f€.!sdi)r y l'r!,t t,r;;;a•:ri;(sdt:tir <br /> i}7iEIPj+'y!ll.l�il`il�lt#il;llit�€,! <br /> y ��•Is ! t f �i �!s <br /> Ai!S�{ <br /> '" �{i�r.,..,41 i4,i,,r�,eU!...€€,s!16.,is•.r�;€,s!:,7r,�::�. <br /> Y., - I s r-t I' Ill"'f-!'M)' au^t t {• it p I t` '1• n"e,I ,, �+�,€!ll <br /> ' �€ �•I,! ' � 1} ��� l� ;I�l !<Ijit� i,i {1 !}J�'=•"N(�t�l J}y x�JI€5��, i J€!. !,.7 �€n!�'•��y�y C!l.yrE�!•,�h�,nt!I y@!a€?c��!€tl <br /> (�+€I tl €€, •j! I,t.Ij, ,[i� �l!I'u�:'n€11'i` ,x J�I l E,� i�€ �� ! I,`., .{��1E' I , !.��,• ���'�E'6r'•i '€ ,: ��rA�s '4r�.;; li�i;, <br /> u€� t'I� n y r� I?' €�I.f_ '! `� p € t l!y! ' I N!€u1611 �m t 'y Ji,>.!,,, di l u!,is,€q(,t€y it>•rE � , l€;•fiil{,�y�!;:,u I�',,,. <br /> . .!�,� J l �;el!�!.4 !!' 3 }�. €}�� (i I I��, 1 ! F 7 i J 11t•€'�1.: •,.:!;is -,.,1�,y � i:!,u <br /> !`t��[lt. I J iVI,U t'l+f i !',--_}r•. !��"i3jlj'�1 i } Y�il�lt i� !' 4;i "f �c�y ?fa �i !y' i`J t }.,:t ..� .,'�,., IRjJlliuf�r x€'ll <br /> E>E pryirllll jJEii;';!i�!`,lyiu <br /> I€+til€i!i',+;;� i'.€.,it?! '"::! <br /> �$I:' y' I°�J''t !"€G' i nt;1;Ir IJEI!i?i!'1'€l71i j l?' ! I€' . '+ Ptl t{�,,€"{n.!x, !u!:', ,»,!pm I I , ,!r. ;tt'I a!'. .'?ut lar•'= t,�;,�;t�,,y _, <br /> ii€'I .-�� l ' l�?�J ' 'i�'+,'}rt ;!�f}", tf�s�i !, , i !y�ill 7.:,6: �;'>�'711.,VSr' •_-IIEIYIA L�,;!i <br /> i:,1� � ,l'A ,. 1 1� ! l }dl l al c Sl'1€!i SII}i i a JI yGy €' t �!,I, P I.€ t tlii 7;J!!Ii. i it r€bt!,,r i,t€r :•�i?i �tt€E I!;�y <br /> t!IJt!�€�� �El JI. €� li !i ! } }��J ill!}I i t t€ r } �'� ��� s �t j l I.'•� '.I ���,j�{.,•1}����y�,,, �' <br /> ,!•,� 1 ,` pt,; 411€�� t' �• }�I��{{ ����i 1 Iill��� �t(r-jj,i�'. `!S€€.±I.!'�,'1( ,k;',laH".,}t-'; i,,:.<,•� <br /> - u AIR <br /> !'Sil'1 }'I fllEn'}i'fh <br /> €!€ I� }I, .'i I � � }JI>�ty' •1, �!! r ! �ur` l I' i ' �� i I )'I'}i x lEl'li'J I'. t ' ,r�v.€J,,y�� I!.,,,y IrE: <br /> • . �f'�;- {li' lJ s€l €; ! i ' }tl yil� t� ,�I 1111 r.I� <br /> M <br /> €! Ili,I f,'GI'rr€' t €€•', €' <br /> � u 1.lI{l"•€ ?{}i{!fJl�i ?SII � �� I�' 18} 11 �!� :! �I J l �, �� <br /> � •�1 i1' � � t � �Iltn)N 'L r� ;4,i rty,i'I{.l 1J�€ y,I !�lif I€ l€I ii t(Ellli I, I to n I{!f�'�r , tiyUi `I#f!��I€hiitl!E; <br /> €�ll)i�Jj`(�I��� ! } i i 1` ilk i I}I yl }y�I ,,� !s I} '� g y i 'I �') :t! i lr'!:,l}•r i�., ,i}J'i!ti'tl�! <br /> I jy- � '}Ifl! € !€!I`.II i } II ' I t t I ( € 7. ..t! nn !t x, ,t 'x,rt 11 a url�•tl r r u ,'! ! xr tJ I ! I'•+; !',�i iri€, <br /> i!{j, rIj,` I! '},i its II .!', 1 ! � ( !!I �� €€ It� } l i ��i ` �•' l' Ei <br /> '• . 'hil`1 ±. ,€4 � J u;u.r . !'lJy;t Jllyyylll��li i(I!y€i 11.ill �i!��Il!!I'l} li I� IE �}��€ !li l <br /> Rrogram'.ihfor mat ion ___..., .a g-e 1 4___o.f_ .6 <br />