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DocuSign Envelope ID:7171A1F5-8FF6-4COD-9E6C-2224164C181D <br /> II <br /> (00 FALL 20 16 <br /> ORANGE COUNTY ARTS ARTS IN EDUCATION GRANT <br /> COMMISSION APPLICATION FORM <br /> 1. APPLICANT INFORMATION <br /> Applicant Name /V a r M J ig- Pm en 10 rit SC lao / <br /> Mailing Address 35-6 C.q I e k'/ // $ re t- chir_/ #7/ /C 'Z 7.5/� <br /> J <br /> Daytime Phone 9"7- 9/ ?i7 Email Address lee ens. chi ccs-,lc/2->dt 6. ti S <br /> Web Ste f e Sa C 4 ccse 10 2., 1 C o ks DUNSNumber b 7?$d I/O C <br /> 2. PROJECT DIRECTOR INFORMATION <br /> R-oject Director Name A/d r- kQ eel e. Title 4rf 7 i s l f r <br /> / /Lfd aI v C/ii b Rd, . �.L 7)z) <br /> / <br /> Home Address: ! I/V- g ',c is ) i A ells Ca rr b e re, Arc.. 2.:7 d 1 o <br /> Daytime Phone 7/f'-74-'72-2 0 Px f 2-6 f 0, Evening Phone 57 3 -76 6 - /2-;/ <br /> Email 4 keericeC/ees'a k/2 a ACd WS DUNSNumber, <br /> 3. GRANT REQUEST SUMMARY <br /> Arts Program Gant %quest $ it 24 Total Cwt Match $ LI 0 <br /> Total C rganizational Budget Past Year 0 bo <br /> (Including Pl`SA/CUltural Current Year 77 6 7_- <br /> Enrichment/Art sFrogram) Projected for Next Year °7-1 <br /> Simmary Satement for Proposed Uses of Arts Program Gant: <br /> r <br /> • .1. .amemm.:m51...Iiimi - ' ' - ,--.7airte.,k---) <br /> 1 /t <br /> 4. NARRATIVE <br /> Write a description(no more than three pages~snge spaced)that describesthe following under <br /> separate subheadings: <br /> ❑ Stool profile—a brief overview of population and services <br /> 0 Sc❑aolnaroflprograms—a brief list. <br /> ❑ Proposed usesof grant funds—description,induding 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, ethnidty, <br /> age, and gender. Discuss how arts program will be integrated into the curriculum. <br /> 919 245 2335 I 200 S Cameron Creel, HiilCaorough, NC 27278 I www.artrorange.org <br />