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2 <br />TITLE PAGE: Citizen Corps Council Grant Application <br />Application Deadline: INCOMPLETE APPLICATIONS For Internal Use <br />Postmarked by midnight on WII.L NOT BE CONSIDERED <br />Frida Ma 30, 2003 FOR Fi7NDING <br />Please type or print in black ink <br />ORGANIZATION TYPE <br />501 (c) (3), municipal or county County <br />government <br />LEGAL APPLICANT INFORMATION <br />Organization Name: Orange County Citizen Corps Council <br />Contact Person: Nick Waters <br />Employer ID Number: 56-6000327 <br />Address: P.O. Box 8181 <br />City Hillsborough State NC Zip 27278 <br />Phone 919-968-2050 Fax 919-968-4066 <br />E-mail nwaters(a~co.orange.nc.us <br />Budget <br />Contractual Services: <br />Travel: <br />Equipment: <br />Supplies/Other Operating Expenses <br />Total Grant Funds Requested <br />$720.00 <br />$0 <br />$0 <br />$1780.00 <br />$2500.00 <br />PROPOSED PROGRAM YEAR <br />Beginning Date July 1, 2003 Ending Date December 31, 2003 <br />Certification (required) <br />Name: Nick Waters Signature <br />(print) <br />Title Emergency Management Director Phone 919-968-2050 Date <br />PLEASE ATTACH 501(C)(3) or 501(C)(6) DOCUMENTATION TO THI5 SHEET. <br />