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DocuSign Envelope ID: FBE59735-B91D-4458-ABBA-952977038A66 <br /> Arts in Education Grant — Fall 201516 Application Form <br /> Orange County Arts Commission <br /> Promoting the artistic and cultural development of Orange County, North Carolina <br /> 1 Applicant Information <br /> Applicant Name/Mailing Address <br /> Ephesus Elementary School PTA <br /> Ephesus Elementary School <br /> 1495 Ephesus Church Road <br /> Chapel Hill, NC 27517 <br /> Daytime Phone/ Fax Number <br /> School phone: (919)929-8715 <br /> School fax; (919) 969-2366 <br /> Email Address <br /> president(cD-ephesuspta.orq <br /> Web Site <br /> PTA: ephesuspta.org <br /> School: ees.chccs.k12.nc.us <br /> Project Director/Title <br /> Kristen Stewart/ President, Ephesus PTA `� 11/Lc/-) <br /> DUNS Number 7 <br /> 2 Project Director Information <br /> Project Director Home Address <br /> 404 Holly Lane <br /> Chapel Hill, NC 27517 <br /> Daytime Phone/ Evening Phone —same <br /> (919) 619-4808 <br /> Email Address <br /> president(aD-ephesuspta.orq <br /> 3 Grant Request Summary <br /> Arts Program Grant Request <br /> $1000 <br /> Total Cash Match <br /> $1700 <br /> Total Organizational Budget (PTSA/Cultural Enrichment Committee/Arts Program) <br /> 2014-2015 $ 8,450 <br /> 2015-2016 $ 5,950 <br /> 2016-2017 $10,000 anticipated <br /> Summary Statement for Proposed Uses of Arts in Education Grant <br /> The Ephesus Elementary School PTA is requesting a $1000 to be matched by $1700 from the PTA <br /> budget to pay the artist fees for two Cultural Arts Assembly programs. The programs will be <br /> presented to all students at the school (Pre-K through 5th grade): "Didgeridoo Down Under" (to be <br /> performed on January 6, 2015) and "Meet Dr. King" (on February 26, 2015). <br />