2021-636-E-Health-El Futuro-Outside Agency & MOE

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Cover Page Page 2 of 11 COVER PAGE Applicant Contact Information Applicant Organization’s Legal Name: El Futuro, Inc. Applicant Organization’s Physical Address: 2020 Chapel Hill Road, Suite 23, Durham, NC 27707 Applicant Organization’s Mailing Address: 2020 Chapel Hill Road, Suite 23, Durham, NC 27707 Applicant Organization’s Web Address: www.elfuturo-nc.org Executive Director: Luke Smith, MD Telephone Number: 919-688-7101 E-Mail: lsmith@elfuturo-nc.org Tax ID Number: Funding Request Please list all Fiscal Year 2022 Human Services (HS) funding requested for all programs and the proposed use of funds (please list program name only) Program Carrboro - HS Chapel Hill - HS Orange County-HS Orange Co Health Dept Total Avanza: Mental Health Access and Engagement for Latino Immigrant Youth and Families $8,500 Personnel $12,500 Personnel $35,000 Personnel $22,200 Personnel $78,200 Personnel Totals $8,500 $12,500 $35,000 $22,200 $78,200 Briefly explain your proposed use of funds: To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Signature: January 13, 2021 Executive Director Date Signature: January 13, 2021 Board Chairperson Date Provide direct mental health treatment services for Orange County Latino families through our Durham clinic and school-based services (via telehealth as long as COVID persists); provide prevention and education through workshops and seminars for Latino parents in partnership with schools and other agencies. EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATIONDocuSign Envelope ID: 632D5DCD-C75A-47B6-A24A-296BD1CD5165