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DocuSign Envelope ID:B96D2CB4-5762-4D6D-8B05-3BE103D9D7D8 <br /> 1 "6/ CA Ro <br /> 201718 <br /> C/0 GRASSROOTS ARTS PROGRAM <br /> co\O'c APPLICATION FORM <br /> ORANGE COUNTY ARTS <br /> COMMISSION www.ncarts.org <br /> PART 1 : APPLICATION ORGANIZATION INFORMATION <br /> Organization Name: Carrboro Elementary PTA <br /> Street Address:400 Shelton St. <br /> City: Carrboro I State: NC Zip: 27510 <br /> Phone:919-968-3652 Website:http://c,es.chccs.k12.nc.us <br /> Authorizing Official Name:Jillian La Serna <br /> Authorizing Official Title: Principal <br /> Authorizing Official Phone:919-968-3652 Authorizing Official Email:jlaserna@chccs.k12.nc.us <br /> Applicant Race: N/A 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 complete operating <br /> budgets for the current fiscal year and next fiscal year. Public schools and other large governmental or community agencies should <br /> attach arts program financial information only. Please copy the totals from these attachments in the spaces below: <br /> Last Year Actual:FY15-16 Current Year:FY16-17 Next Year: FY17-18 <br /> Actual Income: $65,258.00 Projected Income: $58,000 Projected Income:$47,600 <br /> Actual Expenses:$63,949.89 Projected Expense: $64,934 Projected Expense: $61,095 <br /> PART 2: PROJECT INFORMATION <br /> PROJECT DIRECTOR INFORMATION (if different from Authorizing Official) <br /> Project Director Name: Lynn Weller <br /> Project Director Title: PTA Cultural Arts Representative <br /> Street Address: 211 Wild Oak Ln. <br /> City: Carrboro State: NC Zip: 27510 <br /> Phone: 919-606-0836 Email: lynnweller@gmaitcom <br /> PROJECT SUMMARY <br /> Title of Grant Program or Project: Carrboro Elementary 2017/2018 Cultural Arts Programming <br /> Grant Amount Requested: $2,500 <br /> Project Start Date(No earlier than July 1, 2017): September 1,2017 <br /> Project End Date(No later than June 30,2018): June 1,2018 <br /> SCHOOLS ONLY: <br /> Are you booking your artists through The Arts Center's Arts in Schools Program? x YES o NO <br /> 5 <br />