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9 <br /> AGENCY INFORMATION <br /> Please provide the following information about your agency: <br /> 1. Date of Incorporation (Month/Year): <br /> 2. Agency's Purpose/Mission (no more than a few sentences): <br /> 3. Please provide a brief description of your organization's past achievements in carrying out similar <br /> projects and evidence of successful record of meeting proposed budgets and timetables (no more than <br /> 100 words). <br /> 4. Living Wage: Does this agency pay permanent employees a minimum living wage? (Yes/No) <br /> If yes, is this agency an Orange County Living Wage Certified Employer? <br /> If no, please briefly explain. <br /> Schedule of Positions: #of FTE—Full-Time Paid Positions: #of FTE—Part-Time Paid Positions: <br /> Race& Equity <br /> Consistent with our commitment to equity and inclusion,the Towns of Chapel Hill and Carrboro and <br /> Orange County Government are taking steps together to center racial equity in the Human Services <br /> Funding Program. We are requesting basic information about your organization's racial equity work. <br /> 5. How has your organization incorporated racial equity goals into your organizational goals? <br /> 6. Please describe how you have involved the intended beneficiaries of the proposed project in the <br /> planning and design process (in 100 words or less). <br /> 7. Please fill in your agency demographics in the table below: <br /> Agency Demographics <br /> Staff Board <br /> Sex <br /> Male <br /> Female <br /> Non binary/Genderqueer <br /> Other/prefer not to answer/unknown <br /> Total 0 0 <br /> Race and Ethnicity <br /> Program information Pa . - o f 21 <br />