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<br />Program information P a g e 13 o f 55 <br />AGENCY INFORMATION <br /> <br />Please provide the following information about your agency: <br /> <br />1. Date of Incorporation (Month/Year): August / 2014 <br /> <br /> <br />2. Agency’s Purpose/Mission (no more than a few sentences): <br /> <br />Club Nova provides opportunities for individuals living with serious mental illness <br />(predominately schizophrenia, bipolar disorder, and major depression) to lead <br />meaningful lives of their choice in the community. Club Nova is an intentional, caring <br />community comprised of members and staff who work together as colleagues to <br />directly address the risks of serious mental illness and improve the health, education, <br />housing, economic stability, and quality of life of each member. Club Nova focuses on <br />members’ strengths and potential rather than their illness. <br /> <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 /> <br />Club Nova has 33 years of experience providing the full range of Clubhouse Model <br />supports and opportunities. We are accredited through a rigorous process assuring <br />fidelity to the Model. This Model operates on proven standards and is replicated in <br />300 communities worldwide. The Model is included in the SAMHSA registry for <br />Evidence-Based Practices and received the Conrad N. Hilton Foundation award for <br />humanitarian work alleviating human suffering. Club Nova is a two-time recipient of <br />the GSK Impact Award for outstanding achievement in improving community health. <br /> <br />We have a long-established record meeting budgets and timetables amidst <br />perpetual changes in the NC mental health system. <br /> <br />4. Living Wage: Does this agency pay permanent employees a minimum living <br />wage? (Yes / No) No <br /> <br />If yes, is this agency an Orange County Living Wage Certified Employer? No <br /> <br />If no, please briefly explain. <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: 11DA72B8-CC83-439E-A25C-F64DE607C614