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(Part 2) <br />PART I - FACESHEET <br />APPLICATION FOR FEDERAL ASSISTANCE <br />1. TYPE OF SUBMISSION: <br />Application ® Non - Construction <br />2. DATE SUBMITTED TO CORPORATION FOR <br />3. a. DATE RECEIVED BY STATE: <br />3.b. STATE APPLICATION IDENTIFIER: <br />NATIONAL SERVICE (CNS): <br />04-07 -2006 <br />2B APPLICATION IDt# <br />4. a. DATE RECEIVED BY CNS: <br />41. CNS GRANT NUMBER: <br />06SR064484 <br />03SRSNC132 <br />5. APPLICANT INFORMATION <br />LEGAL NAME: ORANGE COUNTY GOVERNMENT <br />NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER <br />PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give <br />ORGANIZATIONAL UNIT: ORANGE COUNTY DEPARTMENT ON AGING <br />area codes): <br />NAME: KATHERINE L. PORTER <br />ADDRESS (give street address, city, county, state and zip code): <br />Orange County Government Department on Aging <br />TELEPHONE NUMBER: (919) 968 - 2054 <br />P. O. Box 8181 <br />FAx NUMBER: (919) 968 - 2093 <br />Hillsborough, NC 27278 <br />P-MA H. Ann F.• KPOR TER OCO.OR ANCTRNC -TT <br />6. EMPLOYER IDENTIFICATION NUMBER (EIN): <br />7. TYPE OF APPLICANT: (enter appropriate letter in box) ❑ <br /> <br />B <br />LOCAL GOVERNMENT - COUNTY <br />A. State H' Independent School District <br />8. TYPE OF APPLICATION (Check appropriate box): <br />❑NEW ®CONTINUATION <br />B. County 1. State Controlled Institution of Higher Learning <br />G Municipal J. Private University <br />❑REVISION <br />D. Township Ir Indian Tribe <br />Ii Interstate L Individual <br />If Revision, enter appropriate letters) in box(es): ❑ ❑ <br />F. Intenmmicipal M. Profit Organization <br />G. Special District N. Private Non -Profit Organization <br />A. Increase Award B. Decrease Award C. Increase Duration <br />O. Other (specify) <br />D. Decrease Duration E. Other (specify): <br />9. NAME OF FEDERAL AGENCY: <br />Corporation for National & Community Service <br />10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: <br />11. DESCRIPTIVE TITLE OF APPL.ICANT's PROJECT: <br />RSVP 94.002 <br />FGP: 94.011 <br />RETIRED & SENIOR VOLUNTEER PROGRAM <br />SCP 94.016 <br />Senior Demonstration: 94.015 <br />12. AREAS AFFECTED BY PROJECT (List Cities, Counties, States, etc.): <br />TOWNS OF. HILLSBOROUGH, CHAPEL BILL, AND CARRBORO <br />ORANGE COUNTY, NORTH CAROLINA <br />13. PROPOSED PROJECT: START DATE: 07/01/2006 <br />END DATE: 0660/2009 <br />14. ESTIMATED FUNDING: <br />15. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE <br />ORDER 12372 PROCESS? <br />a. FEDERAL, <br />$ 180,753 <br />a YES. THIS PREAPPLICATION /APPLICATION WAS MADE AVAILABLE <br />TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR <br />b. APPLICANT <br />$ 212,571 <br />REVIEW ON: <br />DATE <br />c. STATE <br />$ <br />b. NO. ❑ PROGRAM IS NOT COVERED BY E.O. 12372 <br />❑ OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR <br />REVIEW <br />d. LOCAL <br />$ 41,031 <br />e. OTHER <br />$ <br />16. IS THE APPLICANT DELINOUENT ON ANY FEDERAL DEBT? <br />❑ YES If "Yes," attach an explanation. ® NO <br />f. TOTAL <br />S 434,355 <br />17. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICAnON ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN DULY <br />AUTHORMED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED. <br />a. TYPED NAME OF AUTHORIZED REPRESENTATIVE: <br />h TITLE: <br />c. TELEPHONE NUM13ER: <br />Barry Jacobs <br />Chair, Orange County Board of Commissioners <br />919 - 245 -2300 <br />d SIGNATURE OF AUTHORLZID REPRESENTATIVE: <br />e. DATE SIGNED: <br />0418 -2006 <br />Modified Standard Form 424 -NSSC (Rev 4101) <br />