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STATE HISTORIC PRESERVATION OFFICE <br />OFFICE OF ARCHIVES AND HISTORY <br />NORTH CAROLINA DEPARTMENT OF CULTURAL RESOURCES <br />Addendum to Grant Application <br />EQUAL OPPORTUNITY STATEMENT <br />THE NORTH CAROLINA HISTORIC PRESERVATION PROGRAM RECEIVES FEDERAL <br />FINANCIAL ASSISTANCE FOR IDENTIFICATION AND PRESERVATION OF HISTORIC <br />PROPERTIES. UNDER TITLE VI OF THE CIVIL RIGHTS ACT OF 1964 AND SECTION 504 OF <br />THE REHABILITATION ACT OF 1973, THE UNITED STATES DEPARTMENT OF THE <br />INTERIOR PROHIBITS DISCRIMINATION ON THE BASIS OF RACE, COLOR, CREED, <br />NATIONAL ORIGIN, SEX, RELIGION, AGE, OR HANDICAP IN ITS FEDERALLY-ASSISTED <br />PROGRAMS. IF YOU BELIEVE YOU HAVE BEEN DISCRIMINATED AGAINST IN ANY <br />PROGRAM, ACTIVITY, OR FACILITY, AS DESCRIBED ABOVE, OR IF YOU DESIRE <br />FURTHER INFORMATION, PLEASE WRITE TO: OFFICE OF EQUAL OPPORTUNITY, <br />UNITED STATES DEPARTMENT OF THE INTERIOR, WASHINGTON, DC 20240. <br />CLG OR OTHER APPLICANT: <br />Signature <br />!printed Name Title <br />Orange County, North Carolina, CLG <br />Name of local government, non-profit organization, or educational institution <br />Date of Signing: <br />Project: Hollow Rock Access Area/New Hope Preserve <br />CLG, IF THE APPLICANT IS A LOCAL GOVERNMENT, NON-PROFIT <br />ORGANIZATION OR EDUCATIONAL INSTITUTION APPLYING THROUGH A CLG: <br />Signature <br />Printed Name Title <br />Name of CLG or CLG Commission <br />Date of Signing: <br />Note: Acknowledgement of the Equal Opportunity Statement above shall accompany each application for <br />federal funding. Receipt of this signed and dated statement will fulfill this requirement. The applicant must <br />• ., . . I •. P'l - - -- --'' - _____T 'L i? --- --- -,----i 1 * __'* __? * __ ss1_.*_ _ 4A__.... <br />Page 3 of 3