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DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued <br /> Provider'saNki lication <br /> 1. COVER PAGE (Each program requires a separate application.) <br /> a) Applicant Contact Information <br /> Applicant Organization's Legal Name: Orange County Literacy Council, Inc. <br /> Applicant Organization's Physical Address: 200 N Greensboro St, Suite C-2, Carrboro, NC 27510 <br /> Applicant Organization's Mailing Address: 200 N Greensboro St, Suite C-2, Carrboro, NC 27510 <br /> Applicant Organization's Web Address: www.or'angelitoracv.orq <br /> Executive Director: Alice L. Denson <br /> Telephone Number: 919-914-6153 E-Mail: info • Oran•eliterac :or• <br /> DUNS Number: 931145122 <br /> (Dun & Bradstreet, Inc. provides this number at no charge, and it is required for Federal funding recipients.) <br /> b) Pro'ect/Pro•ram Contact Information <br /> Project/Program Name: Adult Literacy <br /> Project/Program Primary Contact and Title: Joy Turner <br /> Telephone Number: 919-914-6153 E-Mail: 'tub rnera arang literacv,orq <br /> c) Funding Request Identification <br /> Total Project/Program Cost: $ Total Amount of Funds Requested: $ <br /> Proposed Use of Funds Requested (2-3 Line Maximum): <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 /> ❑ CDBG Non-Construction (CH) $ ❑ Grant [' Loan <br /> ❑ CDBG Construction (CH) $ ❑ Grant ❑ Loan <br /> ❑ HOME CHDO (OC) $ _ [' Grant ❑ Loan <br /> ❑ HOME Other(OC) $ ❑ Grant ❑ Loan <br /> ® Human Services: ® Carrboro $5,000 ® Chapel Hill $15,000 ® Orange County $15,000 <br /> d) To the best of my knowledge and belief all information and data in this application is <br /> true and current. The document has been duly authorized by the governing board of the <br /> applicant.Awe`Signature: . �� �!' <br /> • er utie Director Date <br /> Signature: . _ .- /- ZG —/G <br /> Bard Chairperson Date <br /> Main Application 1/26/2016 5:06:15 PM Page 3 of 2 1 <br />