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DocuSign Envelope ID:99BDCA4A-2934-455A-8D45-0C865AD016D0 it 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: Biq Brothers Biq Sisters of the Triangle, Inc. <br /> Applicant Organization's Physical Address: 808 Aviation Parkway, Suite 900, Morrisville, NC, 27560 <br /> Applicant Organization's Mailing Address: 808 Aviation Parkway, Suite 900, Morrisville, NC, 27560 <br /> Applicant Organization's Web Address: www.bbbstriangle.orq <br /> Executive Director: Kimberly Breeden <br /> Telephone Number: 919-850-9772 E-Mail: Kbreeden@bbbstri.orq <br /> DUNS Number: 793500641 <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: Community and School-Based Mentorinq <br /> Project/Program Primary Contact and Title: Marian Larson, Grants Coordinator <br /> Telephone Number: 919-850-9772 E-Mail: mlarson@bbbstri.orq <br /> c) Funding Request Identification <br /> Total Project/Program Cost: $245,500 Total Amount of Funds Requested: $15,000 <br /> Proposed Use of Funds Requested (2-3 Line Maximum): These funds are requested to continue to <br /> support our Community and School-Based Mentorinq Program in Chapel Hill, Carrboro, and all of <br /> Orange County for children ages six to 14. <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 $3,000 ® Chapel Hill $6,000 ® Orange County $6,000 <br /> Main Application 5/24/2016 8:51:19 AM .. g 3 of 25 <br />