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DocuSign Envelope ID:312E3C6B-6E22-4E29-9F88-860CF77DF595 <br /> CAR° <br /> "vol <br /> z <br /> 2017-18 <br /> ORANGE COUNTY ARTS covs. GRASSROOTS ARTS PROGRAM <br /> COMMISSION www.ncarts.org APPLICATION FORM <br /> PART 1 : APPLICATION ORGANIZATION INFORMATION <br /> Organization Name: Hillsborough Arts Council <br /> Street Address: 102 North Churton Street <br /> City: Hillsborough State: NC Zip: 27278 <br /> Phone: 919 643-2500 Website: wwwIiUlsboroughrtsccic2g <br /> Authorizing Official Name: Neil Stutzer <br /> Authorizing Official Title: Chair <br /> Authorizing Official Phone: 919 698-1859 Email: nstutzoradsbor.pughartsoNpal.om <br /> Applicant Race: The organization is multi-cultural Organization EIN: <br /> ORGANIZATIONAL FINANCES <br /> Please attach a complete income and expense statement(an audit may be substituted)for your last fiscal year and <br /> complete operating budgets for the current fiscal year and next fiscal year. Public schools and other large governmental or <br /> community agencies should attach arts program financial information only. Please copy the totals from these attachments <br /> in the spaces below: <br /> Last Year Actual: FY15-16 Current Year FY16-17 Next Year FY17-18 <br /> Actual Income: $84,447 Projected Income: $95,830 Projected Income: $106,500 <br /> Actual Expenses: $104,903 Projected Expense: $99,453 Projected Expense: $106,500 <br /> PART 2: PROJECT INFORMATION <br /> PROJECT DIRECTOR INFORMATION (if different from Authorizing Official) <br /> Project Director Name: Same as authorizing official <br /> Project Director Title: <br /> Street Address: <br /> City: State: Zip: <br /> Phone: Email: <br /> PROJECT SUMMARY <br /> Title of Grant Program or Project: Grassroots Organizational Grant <br /> Grant Amount Requested: $6,000 <br /> Project Start Date (No earlier than July 1, 2017): July 1, 2017 <br /> Project End Date (No later than June 30, 2018): June 30, 2018 <br /> SCHOOLS ONLY: <br /> Are you booking your artists through The ArtsCenter's Arts in Schools Program? 0 YES 6 NO <br /> 4)1/ ,(m Pr,yiroiH AH)11, rd[()1L P‘tH( f <br />