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Please prepare application in quadruplicate. Route all-copies to Community Schools Directoi <br /> (OFFICE USE ONLY: !White Copy To Applicant -/-- Canary Copy - To Principal <br /> (Pink Copy in Community -Schools File -/- Gold Copy - Process File) <br /> Revised 8/82 COMMUNITY SCHOOLS PROGRAM <br /> CHAPEL HILL-CARREORO CITY SCHOOLS <br /> APPLICATION FOR USE OF SCHOOL PLANT AND/OR GROUNDS <br /> (To be prepared in original and 3 copies) <br /> REQUEST FOR USE OF: LINCOLN CENTER —BOARD-MEET NG RQnM <br /> (N= e of Schaal or Plant) (Part of School or Plant) <br /> REQUESTED BY (ORGANIZATION) ORANGE COUNTY BOARD OF-COMMI155TONFRS <br /> MAILING ADDRESS 106 E.! MARGARET LANE, FIiLLSBORaUGN NC TELEPHONE:WORK 967-9251 ext. 510 <br /> DATES HOME— N7A-- <br /> DESIRES: MONDAY OCTOBER 25 <br /> (Use separate Application Dates Day Year Hours <br /> form for each m3nth) <br /> PURPOSE FOR WHICH REQUEsr is MADE REGuLAR BOARD-OF CO, S MFFTT <br /> TYPE OF PROGRAM TO BE GI�EN SEE ABO <br /> I certify that I am authorized to act for the above-named organization and that said'organi- <br /> zation will be responsible for any and all damages done to the plant or equipment while <br /> being used by said organization, and that the charges as stated will be paid. I further <br /> certify that all funds raised above expenses go the the above-named requesting organization. <br /> It is also agreed and understood that no refreshments will be served except in cafeterias. <br /> IN AbDITION, I agree to ill out the MONTHLY USE REPORT FORM provided by the Community Schoo <br /> Office (used to record date related to the after-school use of school facilities and return <br /> it within two days folio ing the last day of use as requested above. <br /> If a religious organizat on, the Minister, <br /> Priest, or Rabbi, must 0 sign: Signature o Applicant/Date <br /> APPROVAL Or. PRINCIPAL <br /> Title of Office <br /> The above dates d­oxTo`t conflict with any schedule or planned school program. <br /> PRINCIPAL'S RECOMMENDATION:I Signature of Principal/Date <br /> I <br /> L <br /> APPROVAL OF COMMUNITY SCH S DIRECTOR <br /> I approve the above application, subject to dates bei g pproved by the rincipal. <br /> (See Schedule of Fees for Cost) <br /> .6 <br /> 4f <br /> Si tore 0? Director/Date <br /> APPLICATIONS AVAILABLE AT ANY SCHOOL PRINCIPAL'S OFFICE OR COMMUNITY SCHOOLS OFFICE. <br />