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B K 00026 PG <br />Providerr'uthorzed"Signature <br />Date: ?� <br />TJAAA Addendum Form July 2014 — June 2015 <br />Silver Sneakers- We plan to implement the Silver Sneakers <br />program as soon as the contract is approved and signed by <br />our County Manager. <br />Please insert, or attach, a <br />Arthritis Foundation Tai Chi- Training $550 <br />budget for the expenditure of <br />Arthritis Foundation Tai Chi Instructor Fees $1200 <br />the funds, by Program to be <br />Powerful Tools for Caregivers Instructor Fees $800 <br />provided. <br />Powerful Tools for Caregivers Supplies $200 <br />Silver Sneakers and Senior Games Program Materials $158 <br />Please complete Certification <br />of Required Minimum Local <br />Match form below. <br />Who will be impacted by <br />Senior adults /Diner's Club participants, Caregivers. <br />these efforts? (target <br />audience <br />How will you do outreach <br />Flyers, radio, local newspaper, web -site and social media sites. <br />for this evidence based <br />Distribute flyers at Senior Apartment Complexes and announce <br />program(s)? (Please <br />at any speaking engagements. Include in monthly newsletter. <br />complete required Form <br />733 below <br />Please list any <br />partnerships, additional <br />funds or resources that <br />you anticipate using to <br />supplement or sustain your <br />efforts. <br />Please review <br />Administrative Letter # <br />DAAS -13 -15 at the link <br />referenced to the right. If <br />applicable, indicate any <br />httD://www.ncdhhs.00v/aaina/admltrs/2013/DAAS-1 3-15 pdf <br />entity with which you <br />intend to subcontract and <br />explain how you will <br />monitor that subcontractor. <br />Please submit copies of <br />your subcontract(s) with <br />this Addendum. <br />Providerr'uthorzed"Signature <br />Date: ?� <br />TJAAA Addendum Form July 2014 — June 2015 <br />