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DocuSign Envelope ID: E2E21521-71A5-4711-A40C-EC691AF3B3A7 <br /> 11/ <br /> .11".\ FALL 2016 <br /> ARTS IN EDUCATION GRANT <br /> ORANGE COUNTY ARTS <br /> COMMISSION APPLICATION FORM <br /> 1. APPLICANT INFORMATION <br /> Applicant Name Mc NAj k L k'YL' 1 TGxj School PTA- <br /> Mailing Address 8 9D Dl1 Fade-flu/1k goad , Chafe) " al, IVC. 17516 <br /> Daytime Phone gig- wog- 2435 Email Address Py11 4owell @c,VieGS.k/Z.nC.us <br /> Web Site kite '// YYie U$bUNS Number 83o( '72 ell.; <br /> 2. PROJECT DIRECTOR INFORMATION - <br /> Project Director Name 510bhai, Col5an Title PTA Ci4-}-wu.14 +s Cvord,ha-}o r <br /> Home Address: 303 Mo((v ,iel5s i d e, Dom Caf born, NC.. 2 5/o <br /> Daytime Phone 91 q - 259- 37-5 2 Evening Phone 7/q " 269.3752 <br /> Email 5I0bhanCO(3ciaIv /'Con) DUNS Number g ?92.94$ <br /> 3. GRANT REQUEST SUMMARY <br /> Arts Program Grant Request $ 310. DD Total Cash Match $ 3qo. ©D <br /> Total Organizational Budget Past Year $6,4 ho. O-D <br /> (Including PTSA/Cultural Current Year 4 4 (s.45.OD <br /> Enrichment/Arts Program) Projected for Next Year 4 5.i <br /> 5 00. O'0 <br /> Summary Statement for Proposed Uses of Arts Program Grant: TO) per4 ri iayices <br /> by fie, 1J vf-% Caro l,vltt- Y ou,tic► T Ch sews ble. , l <br /> Ala o►n servo) Pmmses Febrt• Qrj 15 2..o/ <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 1 200 S.Cameron Street,Hillsborough, NC 27278 I wwwc7rtsorcinge.org <br />