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FOR OFFICE USE ONLY <br /> ACK <br /> PROP-NO. <br /> GRAN7,ID NO. <br /> Please check grant TRIANGLE COMMUNITY FOUNDATION <br /> program for which <br /> you wish to be <br /> considered: Spring 1997 Grant Application <br /> Hurricane Fran ❑ All applicants will be notified by June 15, 1997. <br /> Basic Human X Please read the attached "Information on Grants" before filling out this <br /> Needs form. <br /> General Grants ❑ <br /> Total Given in Spring 1996 Grant Cycle: $165,308.64 to 24 agencies of 111 agencies requesting funds <br /> 1. Name of Organization: Orange County Department on Aging Eldercare Program <br /> 2. Contact Name and Title: Christina M. Jacob, Eldercare Specialist <br /> 3. Phone Number: 919/968-2085 Fax Number: 919/968-2093 <br /> 4. Mailing Address: Chapel Hill Senior Center. <br /> 400 S. Elliott Rd Chapel Hill, NC 27514 <br /> 5. Street Address: NA <br /> (if different) <br /> 6. E-Mail Address: NA <br /> (Is this a home or work address?) <br /> 7. How long has this organization been in existence? Began as a Council on Aging in 1976 and <br /> became a county department in 1980. <br /> 8. Tax Status (check one): <br /> Tax-exempt charitable organization (501(c)(3)] _xi Governmental tax-exempt unit <br /> Other nonprofit (specify status) Unincorporated association <br /> Affiliated with tax-exempt organization Other (specify) <br /> Please attach a copy of your organization's IRS tax status determination letter (not applicable to government <br /> agencies or religious congregations). A tax exempt identification number is npt sufficient. <br /> 8. In the space below, please provide a one-paragraph summary of your three-page narrative in 100 <br /> words or less (please do not attach on a separate page or exceed space provided). <br /> Most older adults in Orange County prefer to live independently as long as possible. Assistance with <br /> in-home related tasks, such as help with errands and companionship, generally delays <br /> dependence. However, in Orange County, there are few options for older adults who need this <br /> kind of assistance and can not afford it. Public programs generally restrict assistance to the very <br /> poor or those with personal care needs. The help that is available is minimal and costly to the <br /> public. A cost-effective approach is needed. The proposed program would establish and <br /> coordinate a corps of volunteers to provide such assistance. <br /> 9. Total cost of project: $ $4,800 (please list entire amount, not just amount requested) <br /> 10.Amount requested from the Triangle Community Foundation: $ _ _$4,800 <br /> Trian,Ee Community Foundation Page ! of 3 Grant Application <br />