S Grant - NC Community Transportation Program CTP Administrative & Capital Grant Application 2008-2009

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FY2009 COMMUNITY TRANSPORTATION PROGRAM GRANT APPLICATION NORTH CAROLINA DEPARTMENT OF TRANSPORTATION FEDERAL SECTION 5311 & STATE FUNDING SYSTEM DESIGN VERAL INFORMATION APPLICANT'S LEGAL NAME: Orange County ~ MAILING ADDRESS: PHYSICAL ADDRESS: TAXPAYER IDENTIFICATION NUMBER: CONTACT PERSON PHONE NUMBER: EMAIL ADDRESS: TYPE OF APPLICANT TYPE OF TRANSIT SYSTEM TYPE OF SERVICE - (check "all" that apply) Q Demand Response ~ Subscription ~ Deviated Fixed Route SERVICE OPTIONS - (check "all" that apply) General Public (] Human Service PURCHASE SERVICE -List agencies that purchase service from the transit system. Note: List agency ONCE envy 1 Name: Department of Social Services ~ Check if agency purchased service last year List Programs Served: 1) Medicaid clients 2) Work First clients 3) Low income clients 4) 5) Agency 2 Name: Department on Aging ~ Check if agency purchased service last year List Programs Served: 1) Senior Center clients 2) Special senior event clients 3) 4) 5) ency 3 Vame: O C Health Department D Check if agency purchased service last year List Programs Served: 1) Low income clients 2) 3) 4) 5) ;ncy 5 Jame: ^ Check if agency purchased service last year List Programs Served: 1) 4) 5) P.O. Box 8181 PO Box or Stmet Address Hillsborou h, N.C. 27278 City, State Zip 600 Hi hwa 86 North Sheet Addmss Hillsborou h, N.C. 27278 City, State Mr. Jer Passmore 919-245-2008 Area Code & Phone lUumber ' assmore co.oran e.nc.us Public County Government Single-County ~ Fixed Route ^ Other: (specify below) ^ Brokerage (Contractual service not a referral) ^ Other: (describe below) Agency 4 Name: Triangle Counsel of Governements ~ Check if agency purchased service last year List Programs Served: 1) Nutrition clients 2) 3) 4) 5) Agency 6 Name: ^ Check if agency purchased service last year List Programs Served: 1) 2) 3) 4) 5) CTP2009 Page 1 of 5