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• <br />STATE HISTORIC PRESERVATION OFFICE <br />OFFICE OF ARCHIVES AND HISTORY <br />NORTH .CAROLINA DEPARTMENT OF CULTURAL RESOURCES <br />Addendum to Grant Application <br />EQUAL OPPORTUNITY STATEMENT <br />THE NORTH CAROLINA HISTORIC PRESERVATION PROGRAM RECEIVES FEDERAL <br />FINANCIAL ASSISTANCE FOR IDENTIFICATION AND PRESERVATION OF HISTORIC <br />PROPERTIES. UNDER TITLE VI OF THE CIVII. RIGHTS ACT OF 1964 AND SECTION 504 OF <br />THE REHABILITATION ACT OF 1973, THE UNITED STATES DEPARTMENT OF THE <br />INTERIOR PROHIBITS DISCRIlVIINATION ON THE BASIS OF RACE, COLOR, CREED, <br />NATIONAL ORIGIN, SEX, RELIGION, AGE, OR HANDICAP IN ITS FEDERALLY-ASSISTED <br />PROGRAMS. IF YOU BELIEVE YOU HAVE BEEN DISCRIMINATED AGAINST IN ANY <br />PROGRAM, ACTIVITY, OR FACILITY, AS DESCRIBED ABOVE, OR IF YOU DESIRE <br />FURTHER INFORMATION, PLEASE WRITE TO: OFFICE OF EQUAL OPPORTUNITY, <br />UNITED STATES DEPARTMENT OF THE INTERIOR, WASHINGTON, DC 20240. <br />CLG OR OTHER APPLICANT: <br />Signature <br />• <br />Printed Name Title <br />Orange Count ,North Carolina, CLG <br />Name of local government, non-profit organization, or educational institution <br />Date of Signing: <br />Project: Hollow Rock Access Area/New Hope Preserve <br />5 <br />CLG, IF THE APPLICANT IS A LOCAL GOVERNMENT, NON-PROFIT <br />ORGANIZATION, OR EDUCATIONAL INSTITUTION APPLYING THROUGH A CLG: <br />Signature <br />Printed Name Title <br />Name of CLG or CLG Commission <br />Date of Signing: <br />• <br />Note: Acknowledgement of the Equal Opportunity Statement above shall accompany each application for <br />federal funding. Receipt of this signed and dated statement will fulfill this requirement. The applicant must <br />sign the statement; and, if the applicant is a non-profit organization or educational institution applying throe <br />Page 3 of 3 <br />