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1/12/24, 10:17 AM HSOA-24-16 <br />https://chapelhillnc.workflow.opengov.com/#/explore/records/63230/296812 11/13 <br />Community Impact Award <br />Please describe the impact the proposed programs will have on the target population. Please include specific <br />quantitative and qualitative data in your response. <br />What methods/tools will your organization use to evaluate the proposed program’s effectiveness? Please <br />include specific examples, such as a logic model. <br />Please briefly describe how your proposed programs aligns with evidence-based approaches to addressing <br />human service need(s). <br />Please describe one to three key partnerships/collaborations that add the most value to the success of the <br />proposed programs. <br />If you are not awarded a Community Impact Award, what would your agency’s funding request be? <br />Applicant Statement <br />Disclosure of Conflicts of Interest <br />Are any board members or agency employees, <br />including their immediate relatives and business <br />associates, current beneficiaries of the proposed <br />program for which funds are being requested? <br />No <br />Are any board members or agency employees, <br />including their immediate relatives and business <br />associates, members of or related to members of <br />the governing bodies of Chapel Hill, Carrboro, or <br />Orange County? <br />Yes <br />Docusign Envelope ID: F5E5F5C2-1D2F-4220-AB83-15724033E4F0