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DocuSign Envelope ID: EB541A3B-1E01-49AB-9E09-7987ECAEC1C4 I 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: Rogers-Eubanks Neighborhood Association (RENA) <br /> Applicant Organization's Physical Address: 101 Edgar Street Chapel Hill, N.C. 27516 <br /> Applicant Organization's Mailing Address: P.O. Box 16903, Chapel Hill, N.C.27516 <br /> Applicant Organization's Web Address: www.rena-center.com <br /> Executive Director: Robert L. Campbell <br /> Telephone Number: 919-933-6210 E-Mail: rplcampbell©gmail.com <br /> DUNS Number: 827097903 <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: Back to School Bash <br /> Project/Program Primary Contact and Title: Robert L. Campbell Executive Director <br /> Telephone Number: 919-918-2822 E-Mail: rogers.road.cc(gmail.com <br /> Project/Program Name: Community Garden <br /> Project/Program Primary Contact and Title: Robert L. Campbell Executive Director <br /> Telephone Number: 919-918-2822 E-Mail: rogers.road.ccgmail.com <br /> Project/Program Name: Summer Enrichment Camp <br /> Project/Program Primary Contact and Title: Robert L. Campbell Executive Director <br /> Telephone Number: 919-918-2822 E-Mail: rogers.road.cc(c�gmail.com <br /> c) Funding Request Identification <br /> Total Project/Program Cost: $11,000.00 Total Amount of Funds Requested: $ 16,000 _ <br /> Proposed Use of Funds Requested (2-3 Line Maximum): Funds for the Back To School bash will <br /> be used on backpacks, school supplies, and event orcastration (clinics, entertainment, and food). <br /> Total Project/Program Cost: $ 3,000 Total Amount of Funds Requested: $ 3,000 <br /> Proposed Use of Funds Requested (2-3 Line Maximum): Funds for the Community Garden will be <br /> used on supplies (garden tools and equpiment, seeds, potting soil) and food and water for <br /> voluenteers. <br /> Main Application1/25/2016P a g e 3 of 32 <br />