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5 <br /> APPLICATION FOR Part I SF-424 OMB Approvd No.0348.0047 <br /> 4 2.DATE SUBMITTED Applicant Identifier <br /> FEDERAL ASSISTANCE 03-12-97 none <br /> 1.TYPE OF SUBMISSION: 3.DATE nECFJVED BY STATE' Stale Application Identifier <br /> Appllceflon j Preeppllcaflon <br /> ❑Construction ❑ Construction <br /> ❑Non-Construction ❑ Non•Conslrucibn 4.DATE RECEIVED BY FEDERAL AGENCY Federal Identifier <br /> 440S136/17 <br /> S.APPLICANT INFORMATION <br /> Legal Name: Organizational Unit <br /> Orange County County Gayprnmpnt <br /> Address(give cJty,county,stale,and zip code): Name and telephone number of the person to be contacted on matters <br /> Orange County involving this application(give area code): <br /> P. O. Box 8181 <br /> Hillsborough, Orange County, NC 27278 Katherine L. Porter (Kathy) , RSVP Director <br /> D (919) 968-2054 <br /> 6. EMPLOYER IDENTIFICATION NUMBER(EIN) 7. TYPE OF APPLICANT:(enter appropriate letter in box) ®B <br /> A. Slate H. Independent School District <br /> 5 TE — 6 0 0 0 3 2 B. County I. State Controlled Institution of Higher Learning <br /> _ C. Municipal J. Private University <br /> 6. TYPE OF APPLICATION: D. Township K. Indian Tribe <br /> ❑ New K7 Continuation ❑ Revision E. interstate L. Individual <br /> F. Inlermunicipal M. Profit Organization <br /> II Revision,enter appropriate letter(s)in box(es): 0 ❑ G. Special District N. Other(Specify): <br /> A. Increase Award B. Decrease Award C. Increase Duration <br /> D. Decrease Duration Other(specify): 9. NAME OF FEDERAL AGENCY: <br /> Corporation for National Service <br /> National Senior Service Corp <br /> 10. CATALOG OF FEDERAL DOMESTIC 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: <br /> ASSISTANCE NUMBER: 2 0 0 <br /> 11E: Retired & Senior Volunteer Program <br /> 12. AREAS AFFECTED BY PROJECT(Cities,Counties,stafos,otc): <br /> Hillsborough, Chapel Hill, Carrboro, <br /> Orange County, North Carolina, Chatham <br /> 13. PRO S JECT: 14. CONGRESSIONAL DISTRICTS OF: —' <br /> Start Date Ending Date a. Applicant b. Project <br /> 07/01/97 06/30/2000 Fourth Fourth <br /> 15. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? <br /> a. Federal $ .00 a. YES. THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE <br /> 112,530 STATE EXECUTIVE ORDER 12372P nOCESS FOR REVIEW ON: <br /> b. Applicant $ .00 03/12/97 <br /> 1017 945 DATE <br /> c. Slate $ .00 <br /> b. NO. ❑ PROGRAM IS NOT COVERED BY E.O. 12372 <br /> d. Local $ .00 <br /> 39,531 ❑ OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW <br /> e. Other S .00 <br /> I. Program Income $ 00 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br /> Cl Yes If"Yes,"attach an explanation. No <br /> g. TOTAL $ 253,506 D0 <br /> 18, TO THE BEST OF MY KNOWLEDGE ANO BELIEF,ALL DATA IN THIS APPLICAnownEAPPLICATiON ARE TRUE AND CORRECT,THE DOCUMENT HAS BEEN DULY <br /> AUTHORIZED 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 b. title <br /> William L. Crowther (Bill) Chair-.Orange Co. Commissioners <br /> d. Signature of Authorized Representative e. Dale Signed <br /> Prevloan EJIllont Not U,nINe Aulhorlrod Irx Lrx:nl nnprrx/ut6on I'�1�;C � Sla vl.vd I'mm•1?4(nov.A.no�r,.____:r,-•.,.nun r•;,,.,,i.,,n.uq <br /> PAGE l <br />