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DocuSign Envelope ID: 112713E4-A11E-4CO3-B5A6-92020A894CD7 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 1. COVER PAGE (Each program requires a separate application.) <br /> a) Applicant Contact Information <br /> Applicant Organization's Legal Name: OE Enterprises, Inc. <br /> Applicant Organization's Physical Address: 348 Elizabeth Brady Road Hillsborough, NC 27278 <br /> Applicant Organization's Mailing Address: 348 Elizabeth Brady Road Hillsborough, NC 27278 <br /> Applicant Organization's Web Address: www.oeenterprises.orp <br /> Executive Director: Margaret Samuels <br /> Telephone Number: 919-732-8124 E-Mail: samuelsm @oeenterprises.org <br /> DUNS Number: 189444938 <br /> (Dun & Bradstreet, Inc. provides this number at no charge, and it is required for Federal funding recipients.) <br /> b) Project/Program Contact Information <br /> Project/Program Name: Transitions to Employment <br /> Project/Program Primary Contact and Title: Tracey Craven, Director of Community Employment <br /> Telephone Number: 919-732-8124 E-Mail: cravent @oeenterprises.org <br /> c) Funding Request Identification <br /> Total Project/Program Cost: $1.295.000 Total Amount of Funds Requested: $66.100 <br /> Proposed Use of Funds Requested (2-3 Line Maximum): OE Enterprises seeks funding for <br /> provision of vocational placement, training, and community integration supports for students and <br /> adults who have disabilities. <br /> Please check all types, sources, and amounts of funding being requested. You must submit an <br /> application package for each funding source. *The Participating Jurisdiction reserves the right to <br /> fund projects from any funding source, subject to eligibility and funding constraints. <br /> ® Human Services: ®Carrboro $5,000 ®Chapel Hill $10,000 Orange County$51,100 <br /> d) To the best of my knowledge and belief all information and data in this application is <br /> true and current. The doc, ent has been duly authorized by the governing board of the <br /> applicant. <br /> / -i • IA/ 1/25/16 <br /> Signature: <br /> Executive Director Date <br /> Signature: ^e. <br /> 1/25/16 <br /> Board Chairperson Date <br /> Main Application 2/1/2016 11:26:11 AM I:' c 3 of 1 <br />