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Outside Agency Funding Application <br />• July 1, 2010 through June 30, 2011 <br />• <br />• <br />Agency Name: <br />Street Address: <br />Mailing Address: <br />Telephone: <br />Fax: <br />Executive Director: <br />Contact Person: <br />E -Mail: <br />Federal ID Number: <br />Funding Source <br />Current 09/10 Fundin <br />Re nested 10111 Funding <br />Orange County Government <br />Summary: <br />Town of Chapel Hill <br />Summary: <br />Town of Carrboro <br />Summary: <br />Executive Director Board Chair <br />Date <br />Revised May 25, 2010 <br />Date <br />