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DocuSign Envelope ID:91E71F2D-9A8E-41EB-A333-428A1042BC15 <br /> CAR <br /> 4/ 0 <br /> o 111111- <br /> 1'1 <br /> Coq 2017-18 <br /> co\o• <br /> ORANGE COUNTY ARTS GRASSROOTS ARTS PROGRAM <br /> COMMISSION www.ncarts.org APPLICATION FORM <br /> PART 1 : APPLICATION ORGANIZATION INFORMATION <br /> Organization Name: Hillsborough Elementary PTA <br /> Street Address: 402 N Nash Street <br /> City: Hillsborough State: NC Zip: 27278 <br /> Phone: 919-732-6137 Website: http://vvww.orangecountyfirst.com/he/ <br /> Authorizing Official Name: Ashley Slaughterbeck <br /> Authorizing Official Title: Principal, Hillsborough Elementary <br /> Authorizing Official Email: <br /> Authorizing Official Phone: 919-732-6137, ext 43005 <br /> ashley.slaughterbeck@orange.k12.nc.us <br /> Applicant Race: White 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: $5,194 Projected Income: $5,994 Projected Income: $5,994 <br /> Actual Expenses: $5,194 Projected Expense: $5,994 Projected Expense: $5,994 <br /> PART 2: PROJECT INFORMATION <br /> PROJECT DIRECTOR INFORMATION (if different from Authorizing Official) <br /> Project Director Name: Erika Foster <br /> Project Director Title: PTA Cultural Arts Chair <br /> Street Address: 1111 Terry Road <br /> City: Hillsborough State: NC Zip: 27278 <br /> Phone: 919-724-3545 Email: erikafoster82@gmail.com <br /> PROJECT SUMMARY <br /> Title of Grant Program or Project: Fourth Grade Poetry Residency with Phillip Shabazz <br /> Grant Amount Requested: $900 <br /> Project Start Date (No earlier than July 1, 2017): August 21, 2017 <br /> Project End Date (No later than June 30, 2018): September 1, 2017 <br /> SCHOOLS ONLY: <br /> Are you booking your artists through The Arts Center's Arts in Schools Program? 0 YES X NO <br /> 201/C,10woo1,,Progrnn1Grot11Apik ilin F0i kol <br />