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U 7 6 • EMERGENCY SHELTER GRANTS PROGRAM <br /> APPLICATION SUMMARY FORM <br /> 1. APPLICANT <br /> a. Name of local government: County of Orange <br /> b. Address: F.O. Box 8181, Hillsborough, N.C. 27278 <br /> c. County: Orange <br /> d. Local Government Contact Person: Tara L. Fikes <br /> Address: p.O. Box 8181, Hillsborough, N.C. 27278 <br /> Telephone: (919) 732-8181 <br /> 2. SHELTER (SUBRECIPIENT) <br /> a. Name of shelter: InterFaith Council for Social Services, Inc. <br /> b. Address: 207 Wilson St- <br /> Chapel Hill, N.C. 27514 <br /> c. Subrecipient Contact Person: Chris Moran, Community Services Consultant <br /> Telephone: (919) 929-6380 <br /> 3. ADMINISTERING AGENCY N/A <br /> a. Name of administratering agency: <br /> b. Contact person and phone number: <br /> 4. GRANT REQUEST <br /> Operations funds requested $5,000 <br /> 5. If the local government certifications are to be submitted at a later date than <br /> the application due date, please indicate that date: N/A <br /> 6. CERTIFICATION <br /> To the best of my knowledge and belief, data in this application is true and <br /> correct. The document has been duly authorized by the governing body of the <br /> applicant and the applicant will comply with the attached certifications if the <br /> assistance is approved. <br /> a. Typed Name and Title of Chief Elected Official of local government <br /> applicant: <br /> Shirley E. Marshall, Chair <br /> Orange County Board of Commissioners <br /> b. Signature c. Date <br /> ESGP #101 (Revised 3/88) _ <br />