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DocuSign Envelope ID: 16527E62-848E-428A-BF83-02D57E8435C9 <br /> I1 <br /> FALL 2016 <br /> ARTS IN EDUCATION GRANT <br /> ORANGE COUNTY ARTS <br /> COMMISSION APPLICATION FORM <br /> 1. APPLICANT INFORMATION <br /> Applicant Name 12 1('I I2c M idak-Sct o I Ks <br /> Mailing Address 2O& Acs or, atapa T it, N ' <br /> Daytime Phone 11 v` . -t2'61 • it 65 Email Address CS.Imo( i((I ca cl j fra - c-eseev" <br /> Web site, c A C .k12•UlC 115 t41 (f (p 3 (72(1?5 (1dfi <br /> C � � �SDUNS Number 241- <br /> 2. PROJECT DIRECTOR INFORMATION ba�- L� p �' otat <br /> Project Director Name 06-6/7 " t7`` Title WI& X 01' w d f <br /> Home Address: t 2■ e -U�5 Dv. 0"-a(P ? l ` (I,t J c. �5(a— <br /> Daytime Phone q( I- a-Le 5 'CMG' Evening Phone t V? q (? • �L <br /> Email S I K0'100140 0_660A-- DUNS Number 11/0"-- <br /> 3. GRANT REQUEST SUMMARY <br /> Arts Program Grant Request $ I I D 00- 0t' Total Cash Match $ 1 0 5O,Ob <br /> Total Organizational Budget Past Year 1d5, ()° <br /> (Including PTSA/Cultural Current Year `Z t S 3 0. o 0 <br /> Enrichment/Arts Program) Projected for Next Year 4 2 60, 00 <br /> Summary Statement for Proposed Uses of Arts Program Grant: P1i I lip M t ri(e. s c I IAA <br /> E i l l use. 41,Le,5Irete '02 fupt- L c i.0,04. L ?S i—CCS (Foy- -rub po mm `o <br /> ° Uv j 0 1 0 r Ukotory e icecui 2/ ) )1 J- v017",To2i) rA,s, <br /> (6030) fr 4, ►. g 4f ') 1.6,k;t1 9 fq- k f3 cast 12sb) Ot6 <br /> 4. NARRATIVE <br /> Write a description (no more than three pages,single spaced)that describes the following under <br /> separate subheadings: <br /> • School profile—a brief overview of population and services. <br /> • School's arts programs—a brief list. <br /> • Proposed uses of grant funds—description, including location, date, artists involved. Include <br /> information concerning whether you have undertaken similar activities in the past. Include <br /> approximate number of audience per program;geography of audience; mix of race, ethnicity, <br /> age, and gender. Discuss how arts program will be integrated into the curriculum. <br /> 919.245.2335 ( 200 S.Cameron Street,Hillsborough, NC 27278 ( www.artsorange.org <br /> 1 <br />