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DocuSign Envelope ID: 5D512265-377E-4DF8-BOA6-19210828B197 <br /> 11I/ 0 <br /> GI rii-'t - 2011748 <br /> GRANGE COUGTY ANTS <br /> cu <br /> GRASSROOTS ARTS PROGRAM' <br /> ettraINIISSION WW W.nearts,org APPLICATION FORM' <br /> PART 1: APPLICATION ORGANIZATION INFORMATION <br /> Organization Name: Pathways Elernentanj (Orange County Schools) <br /> Street Address:431 Strouds Creek Road <br /> City: Hillsborough State: NC zip. 2727B <br /> ---- <br /> Phone: 019-732-9136 'IAlebsite: http://www.orangecountyfirst.com/pe <br /> Authorizing Official Name: Patricia Harris <br /> Authorizing Official Title: Orange County Schools Director of College and Career Readiness, CTE„ 'Guidance <br /> Authorizing Official Email: <br /> Authorizing Official Phone: 919-732-8126 IIL <br /> patriciaharrisecirange.k12.nc.OS <br /> „ <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 AptuaJffy:15-1,8_ 1 Current yeer:7FY176-17, _ Next Year <br /> ., <br /> Actual Income: $825 <br /> $8 Projected income. $2000 <br /> Projected Income: $ 2,350 <br /> Actual Expenses: 25 Projected Expense: $2,000 <br /> Projected Expense: $2,350 <br /> PART 2: PROJECT INFORMATION <br /> PROJECT DIRECTOR INFORMATION Of different from Authorizing Official), <br /> Project Director Name: Wayne Wilson <br /> Project Director Title. Music Teacher, Pathways Elementary <br /> Street Address: 431 Stroods Creek Road <br /> Crty: Hillsborough 1 State: NC I Zip: 27278 <br /> Phone: 919-732-9136, ext 46801 [ Email: waynewilson@orange,k12 nc LIS <br /> PROJECT SUMMARY <br /> Title of Grant Program or Project: Orange County Schools' All County Chorus, <br /> Grant Amount Requested: $1,000 <br /> Project Start Date(No earlier than July 1, 2017) December 1, 2017 <br /> Project End Date(No later than June 30, 2018): March 15„ 2018 (clinic/performance) <br /> SCHOOLS ONLY: <br /> Are you booking your artists through The ArtsCenter's Arts in Schools Program? IA YES X NO <br />