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State of North Carolina <br />Division of Social Services <br />Contract Application <br />Page 2 of 7 <br />E. Contract Identification: <br />1. Provider <br />a. Name of Contract Administrator Dr Shirley Carraway <br />Tel. # : (919) 732-8126 <br />b. Name of Program Contact Person: <br />Tel. #: (919) 732-6271 <br />Donna Williams <br />c. Program Name, Location and Mailing Address <br />Orange County Schools <br />Hillsborough NC 27278 <br />d. Additional Service Delivery Sites: <br />e. Status : (X) Public ()Private, non-profit <br />()Private, for Profit ( )Individual <br />f. Provider Contract ID #: <br />2. County Department of Social Services <br />a. Name of Contract Administrator: Nancy Coston <br />Tel. # : (919) 732-8181 <br />b. Name of Services Program Contact Person: Gwen Price or Valerie Collins-Russell <br />Tel. #: (919) 732-8181 <br />c. Address of County Department of Social Services: <br />300 W Tryon St - <br />Hillsborough, NC 27278 <br />