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2021-595-E-OC Rape Crisis Center-Outside Agency
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2021-595-E-OC Rape Crisis Center-Outside Agency
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Last modified
10/22/2021 3:33:43 PM
Creation date
10/22/2021 3:33:23 PM
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Contract
Date
10/21/2021
Contract Starting Date
10/21/2021
Contract Ending Date
10/22/2021
Contract Document Type
Agreement
Amount
$62,000.00
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<br />Program information P a g e 18 of 31 <br /> Unknown 11 <br />Total 60 <br /> <br />Of the above, how many Hispanic/Latino 10 <br />Of the above, how many non‐Hispanic/Latino 50 <br />Total 60 <br />Age <br />0‐5 years 0 <br />6‐18 years 5 <br />19‐50 years 45 <br />51+ years 5 <br />Unknown <br />Total 60 <br />Geographic Location <br />Town of Chapel Hill 15 <br />Town of Carrboro 10 <br />Orange County ( Outside of Chapel <br />Hill/Carrboro) <br />25 <br />Outside of Orange County 10 <br />Unknown <br />Total 60 <br />Income <br />Low‐income (80% of the Area Median Income and <br />Below) Please see income table in the attachments <br />60 <br />Total 60 <br /> <br /> <br /> <br /> <br />8. Cost Per Individual <br /> <br />This cost per individual must reflect the total program budget divided by the total number of program <br />individuals in this application. <br /> <br /> Actual 2019‐20 Projected 2020‐21 Projected 2021‐22 <br />Total Cost of Program 25000 <br />Total # of Individuals 60 <br />Cost Per Individual 416 <br /> <br />9. Performance Indicators <br />For Chapel Hill and Carrboro applicants: <br />Please complete the following chart with information about the Strategic Objective, Intermediate Result, and <br />the Agency Performance Indicator for each program for which you are applying for funding. Please see the <br />Results Framework in the Attachments section as a reference. <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: BEA4B8BB-13B7-4322-9698-A424692E9FD4
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