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DocuSign Envelope ID: EOF5DO34-4BD2-4108-A49B-B7DF76BF3EBB <br /> Arts Program Grant - Spring <br /> 2015-16 Application Form <br /> ORANGE COUNTY ARTS Orange County Arts Commission <br /> COMMISSION <br /> Promoting the artistic and cultural development of Orange County, North Carolina <br /> Evaluation Criteria <br /> • Artistic merit of program. <br /> • Populations served—impact for geographic&traditionally under-served populations. <br /> • Feasibility of proposed activity & effectiveness in fulfilling applicant's mission. <br /> • Cooperation between organizations and artists. <br /> + Evidence of feasibility of program, community support, and responsiveness to community needs. <br /> • Emerging organizations are encouraged to apply. <br /> 1 Applicant Information <br /> Applicant Name SECU Family House at UNC Hospitals <br /> Mailing Address 123 Old Mason Farm Rd, Chapel Hill NC 27517 <br /> Daytime Phone 919.932.8000 Fax Number 919.918.3830 <br /> Email Address kirsten @secufamilyhouse.org Web Site www.secufamilyhouse.org <br /> Project Director Allison Worthy Title Volunteer Coordinator <br /> DUNS Number 05-009-4445 <br /> 2 Project Director Information <br /> Project Director Home Address 517 Hooper Lane, Chapel Hill NC 27514 <br /> Daytime Phone 919.932.8000 Evening Phone 919.969.7584 <br /> Email Address allison @secufamilyhouse.org <br /> 3 Grant Request Summary <br /> Arts Program Grant Request $1,500.00 <br /> Total Cash Match $1,500.00 <br /> Total Organizational Budget 2013-2014 $1.066.456 Past Year <br /> 2014-2015 $1.082.840 Current Year <br /> 2015-2016 $1 083,000 (budget not setl Projected for Next Year <br /> Summary Statement for Proposed Uses of Arts Program Grant SECU Family House at UNC <br /> Hospitals asks the OC Arts Commission to continue funding our Music&Arts Program, through <br /> which we pay small stipends to local, talented performers who provide entertainment and respite to <br /> the seriously ill families staying with us during medical treatment. We are happy to share that the <br /> Chapel Hill Service League has granted $1,500 in matching funds to the program as of this May, 2015. <br /> 919/968-2011 —P.O. Box 1177, 131 West Margaret Lane, Hillsborough, NC 27278—www.artsorange.org <br />