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2. APPLI- a. NUMBER . <br />FEDERAL ASSIS'iriNCE aAPVLIS <br />CATION None <br />1.OFPE ❑ NOTICE OF IN i'ENT <br />IDENTI• b . DATE . <br />5UBhUSSION (OPTIONAL) FIER <br />!Mar* ep• ❑ PREAPPLICATION - 19 91-03 - <br />6 ❑ APPLICATION - <br />ATE <br />a. NUMBER <br />APPLI- <br />CATION <br />b. A PPLICANT <br />IDENTI- <br />c. STATE <br />FIER <br />b. DATE <br />NCI 10 Be <br />ASSIGNED <br />BY STA7 E <br />I _0 _ .00 <br />tr+sr <br />• .: ` eras <br />4. LEGAL APPLICAN'TIRECIPIENT a County <br />A. Applicant Name County GoverIrnent Uxang <br />b. Organization Unit <br />c. StreetJP.O. Box P. 0. Pox 8181 <br />d. City Hillsborough e. County Orange <br />r state : N. C • ZIP Code. 27278 <br />h. Contact Person ware Terri Tyson, R -P Director <br />s 7efp6w. Nn. (919) 968 -6060 <br />7. TITLE OF APPLICANTS PROJECT (Use section IV of this form to provide a summary <br />r description of the project.) <br />orange County-Chapel Hill retired Senior Volunteer <br />Program- The project provides the means by which an <br />individual aged 60 or older may se-*ve the cOaTrulnity as <br />G a volunteer to the best of his/he*- abili.ty- <br />e <br />z9. AREA OF PROJECT IMPACT rNe am t or ir;,.r ,nr.arte: ardra reel PERSON 1 TI ATEEDLNNO. OF <br />C. Orange County, North Carolina 480 <br />12. PROPOSED FUNDING 1 13. CONGRESSIONAL DISTRICT OF: <br />a. FEDERAL <br />S 00 <br />s. APPLICANT <br />Fourth <br />b. A PPLICANT <br />I 3 6 5 9 400 <br />c. STATE <br />- .00 <br />is. PROJECT START <br />DATE r,a, , ch der <br />1991-07-01 <br />d. LOCAL <br />1 13,177 .00 <br />e. OTHER <br />I _0 _ .00 <br />18. DATE DUE. To <br />1FEDERAL AGENCY <br />F Total <br />IS 79 264 '00 <br />19. FEDERAL AGENCY TO RECEIVE REQUEST <br />a. ORGANIZATIONAL UNIT (IF �.PPROPRLATE) <br />Region 1V <br />G ADDRESS <br />101 Marietta Street, N.W. <br />Atlanta, Ga. 30303 <br />b.PROJECT <br />Fourth <br />16. PROJECT <br />DURATION <br />12 tfo.rirs <br />10 17-0 V•-V -L r <br />rew M..A day, <br />19 <br />S. EMPLOYER IDENTIFICATION NUMtA ILLNI <br />56- 6000327 <br />6. a. NUMBER <br />PRO- 2 0 <br />Mists CFVM MULTIPLE ❑ <br />�tetTired <br />sr. Volunteer Prg: <br />8. TYPE OF APPLICANTIRECIPIE`IT <br />A-S1au <br />C swcal Purpme Diwiec <br />B -IrtuaL atom <br />H-Cas r nnT Aecian Agmrwr <br />C�µx+wn <br />1- Higher Edumaional Inatituta.t <br />orR.ruratioa <br />Wndwn Tribe <br />D-Cannty <br />K-0ehar ISPM69 <br />E-, ty <br />F-x" bmA Diacnec <br />inter appropriate letter <br />11- TYPE OF A55I5TANUL <br />A -Baste Grant D- Inaurarm <br />B.. Suppiernenul Grant E- Other <br />C -Lsn E.Ke+ downpAotr leerernl <br />14. TYPE OF APPLICATION <br />A-NL- c- Ra.raimt E- Augmsnutarn <br />B- Rntewai D-- rpnumutiw+ <br />Eneer app Up.w.e 4rr.r� <br />17. TYPE OF CHANGE rFor rir or r ;e, <br />p- .lnee.a. Doli,rs F -oMer rSprirrl <br />B- Oeavaar LWInn <br />C- Immerre Duration <br />D-- oecreaso Dwatwn <br />�- Cynenlauen <br />Enen 000'" 11 Ir_ 1 <br />-mom :raea -, <br />120. {LSTLN, U :';i]t.t(AL <br />GRANT MENT. NO. <br />(IF utio�vNl 1440- 4768/09 <br />21. AEYIAAH6 AIJU>;.1r <br />11 Yes g-No <br />C 22. To trw be%&.q kary dgeard telid data a_ YE5,'rhi.� LV U'FlQk: UY LN"1- :N "1- leldCt sAeYL LI.-.':1- lUP1 /AYYL1b2.11ULI w Y.a MjftljL n r eaaa.nuw. <br />P THE in this preewiinuavaopiiotratt are true TO THE 9 F,C STATEIUTIVE ORDER 12372 PROCESS FOR REVIEW ON: <br />c APPLICANT and c*en't- *-he document. has been dwy DATE ,/ `� <br />.. CERTIFIES authonxed by the geeertung body d the sp- <br />piicam and the opptitant'rtll cmMsky .nth <br />the attacrnd aauraaota if the is <br />t THAT app�ed. b. NO. PROGRAM IS NOT COVERED BY E.O. 12372 0 <br />OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REV[EW ❑ _ <br />? 23. <br />? CERTffYII�1( <br />REPRE. <br />SENTATTVE <br />TYPED NAME AND TITLE <br />Moses Carey, Chair <br />24, APO ar PNICA. re a fh day TI <br />RECEIVED 19 <br />27. ACTION TAKEN 28, <br />i : s. AWARDED <br />uzIJ <br />I i b. RECrED <br />25. FEDERAL APPLICATION <br />FUNDING <br />°wr <br />l? o REruRHFD FOR <br />a FEDERAL <br />AMENDMENT <br />rw ~4 demo <br />W C <br />r I d. RLTURNED FOR <br />b. APPLICAN <br />E.O. 12372 SUMMON <br />c. STATE <br />y x <br />BY APPLICANT To <br />0USTATE <br />e. DFFMU= <br />d LOCAL <br />r. wrrHDRAWN <br />e. OTF1t.R <br />W <br />L Total <br />S <br />i <br />b. <br />i14 CA <br />NO. 126. FEDERAL GRANT <br />Year ,..rrm6 day <br />29. ACTION DATEr 19 <br />.00 31. CONTACT FOR ADDITIONAL <br />.00 - INFORMATION /Mw.r ww relep6a.e n-6en <br />.DO <br />.00 <br />.00 <br />PLI <br />30. +1, <br />VGj19 <br />yaw .nwdt dam. <br />SA R <br />32. <br />rw ~4 demo <br />ENDING <br />DATE 19 <br />M. REMARKS ADDED <br />Yes ❑ <br />No <br />PAGE 1 <br />Pmse+6ed A7r' OMB Cinads MlQS <br />1. <br />