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2023-467-E-Health Dept-Planned Parenthood South Atlantic-Outside Agency
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2023-467-E-Health Dept-Planned Parenthood South Atlantic-Outside Agency
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Last modified
8/30/2023 2:15:01 PM
Creation date
8/30/2023 2:14:49 PM
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Template:
Contract
Date
8/28/2023
Contract Starting Date
8/28/2023
Contract Ending Date
8/28/2023
Contract Document Type
Contract
Amount
$20,000.00
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Geographic Location <br />Town of Chapel Hill 220 240 190 190 <br />Town of Carrboro 70 20 60 60 <br />Orange County (Outside of Chapel <br />Hill/Carrboro)90 44 75 75 <br />Outside of Orange County <br />Total 380 304 325 325 <br />Income <br />Low-income (80% of the Area <br />Median Income and Below) <br />Please see income table in the <br />attachments **** <br />Total <br />* PPSAT does not collect income information. However, 86% of Orange County patients are <br />uninsured or use Medicaid. <br />12. Cost Per Individual <br />This cost per individual must reflect the total program budget divided by the total <br />number of program individuals in this application. <br />Actual <br />2021-2022 <br />Projected <br />2022-2023 <br />Projected <br />2023-2024 <br />Total Cost of Program $22,750 $27,000 $27,000 <br />Total # of Individuals 304 325 325 <br />Cost Per Individual $74.84 $83.08 $83.08 <br />13. Performance Indicators <br />For Chapel Hill and Carrboro applicants: <br />Please complete the following chart with information about the Strategic Objective, <br />Intermediate Result, and the Agency Performance Indicator for each program for which you <br />are applying for funding.Please select one strategic objective per program.If you would <br />like to provide additional information on how your program aligns with additional strategic <br />objectives, please include that information in Question 10 – Program Description. See the <br />Results Framework in the Attachments section as a reference. <br />Program Name: Sexual Health Education and Outreach <br />Strategic <br />Objective <br />(please choose <br />one from the <br />Results <br />Framework) <br />□ Children improve their educational outcomes <br />□ Residents Increase their livelihood security <br />☑Residents improve their health outcomes <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATIONDocuSign Envelope ID: 33DAB98C-9F47-479D-8E75-67FFA543C9FB
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