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DocuSign Envelope ID: 324CD765-DCA3-42C5-B339-89CADOBBF40E <br /> I /if Cā– 04,Ro, <br /> N-4.104, Q <br /> *101, 201718 <br /> eco <br /> ARTS GRASSROOTS ARTS PROGRAM <br /> ORANCE (Amin' <br /> COMMISSION www.ncarts.org APPLICATION FORM <br /> PART 1 : APPLICATION ORGANIZATION INFORMATION <br /> Organization Name:Phillips Middle School PTSA <br /> n.ā€ž <br /> Street Address:608 N. Estes Or, <br /> City:Chapel Hill j Stale:NC Zip:27514 <br /> Phone:919-9292188 Alebsitewww.chccs.k12,nc.usiphillins <br /> Authorizing Official Name:Jen Clark <br /> Authonzing Official Title:President <br /> Authorizing Official Phene919-929-2188 Authorng 01h6 Emelt gotshle4mail.com <br /> Applicant Race:rile 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 y,ā€žr Actual:FYI 548 Ountent Year IrY1647 Next Year FY17-10 <br /> Actual Income: $35,537 e.51 Projected Income: $30,000 Projected Income,$38,535.00 <br /> Actual Expenses:$34,908.57 Projected Expense: $38,500 Projected Expense, $30535.00 <br /> PART 2: PROJECT INFORMATION <br /> PROJECT DIRECTOR INFORMATION (if different from Authorng,Offic <br /> Project Director,1 ,,orneCristirie Smith <br /> Project Director Title.Cultural Encrich merit Co-Chair <br /> Street Address:712 Emory Drive <br /> City:Chanal Hilt tate NC Zip:27517 <br /> Phone,919-285-4786 Emaitsmithgrr11969@gmaitcom <br /> PROJECT SUMMARY <br /> Title of Grant Program or Project:Phillips Middie School P'TSA <br /> Grant Amount Requested:$1,700.00 <br /> Project Start I je(No earlier than July 1, 2017):August 28, 2017 <br /> Project End Date (No later than June 30ā€ž2018):June 8, 2018 <br /> SCHOOLS ONLY: <br /> Are you hooking your artists through The AdsCenters Arts in Schools Program? fill YES EI NO <br /> ,q1u h,,F,11,h /i 11101 $ (1))11, thih 1 ' <br />