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DocuSign Envelope ID:883AB84D-78B1-4D41-BOEF-BE6A942205E0 <br /> Artist Project Grant— Fall <br /> 2015-16 Application Form <br /> Orange County Arts Commission <br /> 1 Artist Information <br /> Applicant Name: Susie Wilde <br /> Mailing Address:7400 Talbryn Way, Chapel Hill, NC 27516 <br /> Daytime Phone: 919-932-3300 <br /> Email Address:susiewilde @bellsouth.net <br /> Web Site: www.ignitingwriting.com <br /> DUNS Number: Wilde, Susan Hays, 833269637 <br /> 2 Grant Request Summary <br /> Arts Program Grant Request: $1,000 <br /> Total Cash Match: $1,000 <br /> Summary Statement for Proposed Use of Arts Program Grant: partial funding for a <br /> children's book writing residency at Rogers Road Community Center <br /> t� �e W►tcke- [I f '1-1 ( (5 <br /> Artist Signature Date Typed or Printed Artist Name <br />