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APPLICATION FOR FUNDING FOR CONSTRUCTION PROGRAMS <br />Town of Chapel Hill CDBG Program <br />Orange County HOME Program <br />A. Applicant Information <br />Applicant Organization's Legal Name: <br />Primary Contact Person and Title: <br />Applicant Organization's Physical Address: <br />Applicant Organization's Mailing Address: <br />Telephone Number: <br />Email Address: <br />Fax Number: <br />DUNS Number: <br />(Dun & Bradstreet, Inc. provides this number at no charge, and it is required for Federal funding recipients.) <br />B. Project Information <br />Project Name: <br />Total Project Cost: <br />Total Amount of Funds Requested: <br />Please specify the type and amount of funding requested: (Note: If applying for HOME and CDBG funds, <br />please indicate the amount requested from each source.) <br />❑ CDBG: $ and /or ❑ HOME: $ <br />Proposed Use of Funds Requested (provide a concise description of proposed project): <br />To the best of my knowledge and belief all information and data in this application are true and <br />current. The document has been duly authorized by the governing board of the applicant. <br />Signature: <br />Board Chairperson /Department Head Date <br />Page 1 of 9 <br />