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DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued <br /> ProvidersaibkratNlication <br /> 1. COVER PAGE (Each program requires a separate application.) <br /> a) Applicant Contact Information <br /> Applicant Organization's Legal Name: Inter-Faith Council for Social Service <br /> Applicant Organization's Physical Address: 110 West Main Street, Carrboro, NC 27510 <br /> Applicant Organization's Mailing Address: 110 West Main Street, Carrboro, NC 27510 <br /> Applicant Organization's Web Address: www.ifcweb.org <br /> Executive Director: Michael Reinke <br /> Telephone Number: 919.929.6380 E-Mail: mreinkeifcmailbox.org <br /> DUNS Number: 171570906 <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: Residential Services - Community House and Home Start; Community <br /> Services - Food Programs, Support Circles <br /> Project/Program Primary Contact and Title: Stephani Kilpatrick, Residential Services Director and <br /> Kristin Lavergne, Community Services Director <br /> Telephone Number: Stephani Kilpatrick 919.967.1086 Kristin Lavergne 919.929.6380 <br /> E-Mail: Stephani Kilpatrick: skilpatrickifcmailbox.orq: Kristin Lavergne: klavergneifcmailbox.org <br /> c) Funding Request Identification <br /> Total Project/Program Cost: $1,338,838 Total Amount of Funds Requested: $89,000 <br /> Proposed Use of Funds Requested (2-3 Line Maximum): To renew funding of IFC food and shelter <br /> programs serving Orange County's citizens in need, to fund a 15 hour per week Case Manager for <br /> HomeStart residential program, and to help fund half of the salary costs of a half-time staff person to <br /> coordinate the Orange County Partnership to End Homelessness Support Circles Program. <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 /> X CDBG Non-Construction (CH) $ X Grant 0 Loan <br /> CDBG Construction (CH) 0 Grant Loan <br /> 111 HOME CHDO (OC) 0 Grant E Loan <br /> fl HOME Other (OC) El Grant —I Loan <br /> X Human Services: X Carrboro $14,000 X Chapel Hill $25,000 X Orange County $50,000 <br /> Main Application 1/25/2016 12:58:53 PM Page 3 of 33 <br />