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DocuSign Envelope ID:85BAA72B-7C62-4B2E-AB73-08822718381 E <br /> Arts in Education Grant - Spring 2016-2017 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 @ephesuspta.org <br /> Web Site <br /> PTA: ephesuspta.org <br /> School: ees.chccs.k12.nc.us <br /> Project Director/Title <br /> Elizabeth Portnoy/Secretary, Ephesus PTA <br /> DUNS Number: 100403450 <br /> 2 Project Director Information <br /> Project Director Home Address <br /> 2453 Sedgefield Dr <br /> Chapel Hill, NC 27514 <br /> Daytime Phone/ Evening Phone —same <br /> (267) 679-8935 <br /> Email Address <br /> elizabeth.portnoy@yahoo.com <br /> 3 Grant Request Summary <br /> Arts Program Grant Request $1000 <br /> Total Cash Match $1000 <br /> Total Organizational Budget (PTSA/Cultural Enrichment Committee/Arts Program) <br /> 2014-2015 $ 8,450 <br /> 2015-2016 $ 5,950 <br /> 2016-2017 $12,850 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 $1000 match from the <br /> PTA budget to pay the artist fees for four Cultural Arts Assembly programs in the 2016-17 school <br /> year. Each program will be presented to half of the student population at the school (Pre-K through <br /> 5th grade): "Aesop Bops" (for grades PreK-2 on October 24, 2016), "Origami Tales" (for grades 3-5 on <br /> November 14, 2016), and "George Washington Carver and Friends" (for PreK-5 in two performances <br /> on February 28, 2017). <br />