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DocuSign Envelope ID:71 71A1 F5-8FF6-4COD-9E6C-2224164C181 D <br /> /Pi <br /> FALL 2016 <br /> ORANGE COUNTY ARTS ARTS IN EDUCATION GRANT <br /> COMMISSION APPLICATION FORM <br /> is <br /> Fs <br /> 1. APPLICANT INFORMATION <br /> Applicant Name No II MCI'de 0e/4'1e/11/4 'ry C tt d 1 <br /> Mailing Address 35 0 C4104416/ „Meet/1 e fie '2 7s/ 7 <br /> I, <br /> Daytime Phone / / ' >) Email Address q KCet,e(0 GhcCS'. hi, AC, IA S <br /> Web Site /7 $ (A((c, /</2 Pi( U S DUNS Number 07 ypyog6 <br /> 2. PROJECT DIRECTOR INFORMATION <br /> Project Director Name 4ICJ' !Veer' Title /" � /An 61 <br /> Home Address: J did 7Y r �)es A( 114 I y o g,' C)y b D2-„? <br /> 0 <br /> s° -)2Zd p <br /> ekrrtEe„ , /VC 2-7 ” <br /> Daytime Phone / '� <br /> Y �. 1(l of, l Evening Phone � 20 <br /> TO <br /> � � g � r�� 7�� f 3 / <br /> Email a k ee �Cis• �` , <br /> l: � I �,Z tfr DUNS Number N/It <br /> 3. GRANT REQUEST SUMMARY <br /> Arts Program Grant Request $ / 11- Total Cash Match $ C I "- <br /> r <br /> Total Organizational Budget Past Year 2, 0 6 0 i. <br /> (Including PTSA/Cultural Current Year 2.. 6 3 2- <br /> Enrichment/Arts Program) Projected for Next Year Z/ o <br /> Summary Statement for Proposed Uses of Arts Program Grant: <br /> lac 1 . <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.artsor ancie,cra <br />