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//-i~_ a 7 <br />~~ <br />section 11.0 <br />GRANT APPLICATION FORM <br />General Information <br />Legal Name of Applicant Organization: Orange- County <br />Name and Title of Authorized Signer for Applicant Organization: Laura Blackmon, County Zsanager <br />Mailing Address: p O Boa 8181 <br />City: Hillsborough State: HC County Orange Zip: 27278 <br />Street Address: 200 S. Cameron Street <br />City: Hillsborough State: BCCounty Orange - Zip: 27278 <br />Phone: 919-245-2300 Fax: 919-644-3004 <br />e-Mail: lblaclomoa@co .orange . nc . ns <br />Federal Tax ID Number. 56-6000327 <br />Total Amount of Fending Being Requested under this Application: $ 3.949.45 <br />*Name of PEG Channel for which Funding is Being Sought: 1 <br />Total Amount of Funding Being Requested for this Channel: $ 3 , 949.45 <br />• Type of Programming Offered by this Channel (P,E and/or G): G <br />Street Address: 2501 Homestead Road <br />City: Chapel Hill State:NC County Orange Zip: 27514 <br />Phone: <br />Fax: <br />If this is a shared" channel, please list the other local governments which share operations <br />or programming with this channel: Not shared <br />Name and Title of Manager or Project Contact at PEG Channel: Gwen Harvey <br />Street Address: <br />City: <br />Hillsborough State• NC County Orange Zip: 27278 <br />Phone: 919-245-2307 <br />Fax: 919-644-3004 a-Mail: <br />gharvey@co.oraage.nc.ns <br />*If requestir:g fug:ding for n:ultiple clian~:els, please attach additional pages to this <br />Application Form mid list complete information for all cl:annels for which funding is being <br />sought under this Application. <br />200 South Cameron Street <br /> <br />