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DocuSign Envelope ID:3F298E85-795E-4517-9AC0-9FEDA409614B <br /> I4k. Eitp <br /> dmIN 0 — <br /> z <br /> 201718 <br /> co <br /> ORANGE COUNTY ARTS GRASSROOTS ARTS PROGRAM <br /> COMMISSION www.ncarts.org APPLICATION FORM <br /> PART 1 : APPLICATION ORGANIZATION INFORMATION <br /> Organization Name: Ephesus Road Elementary School PTA <br /> Street Address: 1495 Ephesus Church Road, Chapel Hill, NC 27517 <br /> City: Chapel Hill State: NC Zip:27517 <br /> Phone:919-929-8715 Website: hftp://ees.chccs.k12.nc.us/ <br /> Authorizing Official Name: Victoria Creamer <br /> Authorizing Official Title: Principal, Ephesus Elementary School <br /> Authorizing Official Phone:919-929-8715 Authorizing Official Email: vcreamer@chccs.k12.nc.us <br /> Applicant Race: n/a Organization EIN: <br /> ORGANIZATIONAL FINANCES <br /> PTA General Budget <br /> Last Year Actual: FY16-16 Current Year: FY16-17 Next Year: FY17-18 <br /> Actual Income: $41,671.76 Projected Income: $34,014.79 Projected Income: $33,000.00 <br /> Actual Expenses: $49,112.30 Projected Expense: $39,989.72 Projected Expense: $34,017.00 <br /> PTA Arts Budget <br /> Last Year Actual: FYI 5-16 Current Year: FY16-17 Next Year: FY17-18 <br /> Actual Income: $1000.00 Projected Income: $2000.00 Projected Income: $1,937.50 <br /> Actual Expenses: $6630.16 Projected Expense: $12,775..00 Projected Expense: $6,650.00 <br /> PART 2: PROJECT INFORMATION <br /> PROJECT DIRECTOR INFORMATION (if different from Authorizing Official) <br /> Project Director Name: Helene Singer <br /> Project Director Title: President, Ephesus PTA, 2017-18 <br /> Street Address: 1495 Ephesus Church Road <br /> City:Chapel Hill State:NC Zip:27517 <br /> Phone:919-929-8715 Email:president@ephesuspta.org <br /> PROJECT SUMMARY <br /> Title of Grant Program or Project: Ephesus Elementary Cultural Affairs Assemblies <br /> Grant Amount Requested: $1937.50 <br /> Project Start Date(No earlier than July 1, 2017):September 2017 <br /> Project End Date(No later than June 30, 2018):June 2018 <br /> SCHOOLS ONLY <br /> Are you booking your artists through The ArtsCenter's Arts in Schools Program'? X YES El NO <br /> ?Di Projhlryl Want AN)11(anon Parke <br />