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DocuSign Envelope ID: E9DE81F9-0070-4074-8F70-93DABC24ACE1 L 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: The Women's Center, Inc. dba Compass Center <br /> for Women and Families <br /> Applicant Organization's Physical Address: 210 Henderson St., Chapel Hill NC 27514 <br /> Applicant Organization's Mailing Address: Post Office Box 1057; Chapel Hill, NC 27514 <br /> Applicant Organization's Web Address: compassctrorg <br /> Executive Director: Cordelia Heaney <br /> Telephone Number: (919) 968-4610 E-Mail: directoracompassctr.org <br /> DUNS Number: 931214985 <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: <br /> 1) Domestic Violence Crisis Services <br /> 2) Self Sufficiency Programs: Legal Information, Financial Education & Career <br /> Preparedness <br /> 3) Community Education & Civic Engagement <br /> Project/Program Primary Contact and Title: Ardith Burkes, Associate Director <br /> Telephone Number: (919) 968-4610 E-Mail: programsdirectoracompassctrorq <br /> c) Funding Request Identification <br /> Total Project/Program Cost: $600,385.33 Total Amount of Funds Requested: $102,200.00 <br /> Proposed Use of Funds Requested (2-3 Line Maximum): To provide domestic violence crisis <br /> services, financial education and career preparedness services, legal information services, <br /> connections to community resources, youth and adult training and education on the prevention of <br /> interpersonal violence and civic engagement related to women's and gender issues. <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) $ P Grant E Loan <br /> Lii CDBG Construction (CH) H Grant I- Loan <br /> Li HOME CHDO Grant P Loan <br /> HOME Other I- Grant 0 Loan <br /> Human Services: IZ] Carrboro $8,400 El Chapel Hill $29,300 Orange County $64,500 <br /> Main Application 1/24/2016 2:59:42 PM Page 3 of 5 8 <br />