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DocuSign Envelope ID:C8F16CD1-FF19-486F-8DD6-57316D1FCD54 <br /> EXHIBIT A - PROVIDERS OUTSIDE AGENCY APPLICATION <br /> m1'7E37E771 <br /> ;,111100ilic, G t jj,j,111 .1 <br /> ApplicY;Int Organization's Legal ? ?al ie: Hillsborough Arts Council <br /> Applicant OrganizY;Ilog's Physical Address: 102 Nollh Churtal Street <br /> pplic nt Org.nization's ?ailing Address: Same <br /> Applicant Organization's Web Address: .hilisboroughartscounciLorg <br /> Executive Director: Neil Stutzer, Chair(We don't have an Executive Director) <br /> Telephone Number: 919 643-2500 y)1'11,11f (J,I, L <br /> Tax ID Nu' lbw:: <br /> ? ) F 1 1180? st <br /> List .11 FYI 71 i S 0 1 e JJj Fu °di 0 01r ei g Re est s <br /> F r f$11 Fir.,12, r.orns.) a th r 110 11 doe of Funs lid's r 1 so) <br /> Prj rrborp çp Oranqp. Total <br /> IlS C <br /> Ex. Youth Afterschool Program $10,000 $15,000 $5,000 $30,000 <br /> Afterschool Program Coordinator salary and materials <br /> for youth activities and projects <br /> Continue to partially support the salary of our sole $12,000 $12,000 <br /> part•time staff position (Program Director)who, in <br /> turn, provides logistical support for 200+volunteers. <br /> Our end goals are to(1) sustain current programs, (2) <br /> expand revenue generating art lessons and retail <br /> opportunities, and (3) use our 30th anniversary to <br /> rebrand HAG and build development efforts. <br /> tals 112,00P $12,001 <br /> y) 11 th. best If y y b lief .11 I to All d 0,1 in thl 11111111H tko is <br /> tr„. all 11 c drr It. To 100 0 0 e. 11„1 e?? y th- go 11 <br /> licant <br /> Si nt r IA <br /> Executive Director Date <br /> Yr./ 7 7LL21 <br /> oard Chirp rson Date <br /> AGE? CY111FORMATIOIII 1/24/2017 948:26 A? 1 ' <br />