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0 6 <br /> ORANGE COUNTY <br /> NON-DEPARTMENTAL APPLICATION FOR CONTRIBUTION <br /> FISCAL YEAR 1987-88 <br /> INSTRUCTIONS: PLEASE SUBMIT AN ORIGINAL AND ONE COPY ACCOMPANIED BY SUPPORTING <br /> DOCUMENTS TO DONNA WAGNER, BUDGET/MANAGEMENT ANALYST, ORANGE <br /> COUNTY FINANCE OFFICE, 106 EAST MARGARET LANE, HILLSBOROUGH, <br /> NORTH CAROLINA 27278, NO LATER THAN APRIL 6, 1987. <br /> 1. Name of Agency: <br /> 2. Mailing Address: <br /> 3. Name and Title of Person Completing Form: <br /> 4. Telephone Number: <br /> 5. Governing Board (Titles and Members) : <br /> 6. List total number of persons receiving or requesting assistance in each category: <br /> • <br /> 1986-87 1986-87 1987-88 1987-88 <br /> Indirect Direct Indirect Direct <br /> Contact Contact Contact Contact <br /> (Phone) * (Face-to-Face)* (Phone) Face-to-Face) <br /> Number of Persons Requesting Services <br /> Orange County (Unincorporated) <br /> Carrboro <br /> . :..Chapel _Hill <br /> r <br /> Hillsborough <br /> Number of Persons Served <br /> Orange County (Unicorporated) <br /> Carrboro <br /> Chapel Hill <br /> 1 <br /> Hillsborough <br /> • <br /> *Expected on June 30, 1987 <br /> -1- <br />