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~~ 2) \:/ <br />PART I - FACESFIEET <br />APPLICATION FOR FEDERAL, ASSISTANCE ' rYPEOFSUHMISS1oN: <br />lication ®Nw-Construcdoo <br />A <br /> pp <br />2. DATE SUBMIT-1'ID TO CORPORATION FOR 3 a.. DATE RECENED BY STATE: 3 b STATE APPLICATION IDENTfFTER: <br />NATIONAL SERVICE (CNS): <br />04-07-2006 <br />^B APPLICATION IDR 4. a DATE RECEIVED BY CNS: 4 b. CNS GRANT NUMBER: <br />o6SROtaaaa 03SRSNC132 <br />5. APPLICANT INFORMATION <br /> NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER <br />LEGAL NAME: ORANGE COUNTY GOVERNMENT PERSON 70 BE CONTACTED ON MAT-IERS RNOL.VWG T}IIS APPC.ICATION (give <br />ORGANIZATIONAL UNIT: ORANGE COUNTY DEPARTMENT ON AGING area rodes): <br />ADDRESS (give slreu address. city. county. smte and zip code): NAME: KATHERINE L. PORTER <br />Orange County Government Department on Aging rE[TtrxoNE NUMBER: (919) 968 - 2054 <br />P. O. Box 8181 FAX NUMBER: (919) 968 - 2093 <br />Hillsborough, NC 27278 <br />NCIiS <br />RCn~CO <br />ORANGF <br />KPORTF <br /> . <br />. <br />. <br />tN . NN.rr.Mnn.nnnnns• <br />6 EMPLOYER IDENTIFICATION N[1MBER (EJNp 7 TYPE OF APPC ICANT': (enter npproprinrc letter in Los) ^ <br />B <br />5 6 - 6 0 0 0 3 2 7 LOCAL-0OVERNMENT-COUNTY <br />B. TYPE OF APPLLCATION (Check appropriate boz): A Smte H Independent School Distrin <br />B County I Stain Controlled [ntGWtian of Higher Lcanting <br />^NEW ®CON"JHJUATION C. Municipal T. Private University <br />^REV[SION D. T'ownsNp K. Indian Tribe <br />id <br />l <br />i <br />^ ^ v <br />ua <br />E. Inlersmm L. Ind <br />F Intarmunicipal M Profit Orgnnizalien <br />IfRevisian. enter appropriam letter(s)in box(es): G Special District N. Private Neo-Profit Organizndon <br />A Inemase Award B Decmase Awanl C. Inemase Duration O. Odter (specify) <br />DDecmaze Dumlion EOdter (spec): 9 NAME OF FL•DERAL AGENCY: <br /> Corporation for National & Community Service <br />]0. CATAL.GCi OF FEDERAL DOMESTIC ASSISTANCE NUMBER: I1 DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: <br />RSVP: 9a 002 RETIRED & SENIOR VOLUNTEER PROGRAM <br />FGP: 94.011 <br />scP: 9a ole 9 4 0 0 2 <br />Senior Demonstration: 94.015 <br />12. AREAS AFFECTED BY PROJECT (Lill Cities, CnuNies, Smtes. etc J: <br />TOWNS OF: HILLSBOROUGH, CHAPEL-FALL, AND CARRHORO <br />ORANGE COUNTY, NORTH CAROLINA <br />13. PROPOSED PROTECT: START DAIS: 07/01/2006 END DALE: 06/30/2009 <br />I4. ESTIMATID FUNDING: I5. IS APPLICATION SUHTECT TO REVIEW BY STATE EXECUTIVE <br />a. FFDERAL~ S 180,7$:3 ORDER 12372 PROCESS? <br /> a YES THIS PREAPPLICATION/APPLICATION WAS MADE AVAHABLE <br />FOR <br /> TO THE STA TE EXECUTIVEORDER 12372 PROCESS <br />b. APPLICANT S 212,571 REVIEW ON: <br /> <br /> DAIE <br />n STATE y <br />b.. NO ^ PROGRAM IS NO'I COVERED BY EO. I?372 <br />d LOCAL. g 41,O.j1 ^ OR PROGRAM HAS NOI BEEN SELECTED DY STATE FOR <br /> REVIEW <br /> 5 <br />e GTTIFR <br /> I6. IS THE APPLICANT DELWOUEN7 ON ANY FEDERAL-DEBTT <br />f TOTAL y 434,:3$5 ^ YES If"Yes;'ntmch an explanadon. ®NO <br />TO 1T~ BEST OF MY KNOWLEDGE AND DELIEF. ACL DATA IN TI115 APPLICATIONA'REAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN DULY <br />17 <br />. <br />AUTHORED HY THC GOVERNING BODY OF THE APPLICANT AND THE APPL (CANT WILL COMPL Y WITH THE ATTACHED ASSURANCPS ff THE ASSISTANCE IS AW ARDED. <br />n TYP®NAME OF AUTHORIZED REPRESENTATIVE: b TITLE: c TELEPHONE NUMBER: <br />Barry Jacobs Chair, Orange County Board of Commissioners 919-245-2:300 <br />d SIGNATURE OF AUTHORIZED REPRESENTATIVE: e. DATE SIGNED: <br /> 0416.2006 <br />Modified Standard Form 424NSSC (Rev 4/01) <br />