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a <br />State of North Carolina <br />Division of Social Services <br />Contract Application <br />E. Contract Identification: <br />1. Provider <br />Page 2 of 6 <br />a. Name of Contract Administrator Gloria Williams <br />Tel. P: 9 19 ) 929-U494 <br />b. Name of Pro ram Contact Person <br />Tel. it: - <br />Faye Hall <br />C. Program Name, Location and Mailing Address: <br />Joint Orange Chatham Community Action Agency <br />105 West Chatham St., P. 0. Box 27 <br />Pittsboro, NC 28312 <br />d. Additional Service Delivery Sites: <br />410 Caldwell St., Chapel Hill, NC 27514 <br />Margaret Lane, Hillsborough, NC 27278 <br />e. Status: (x) Public ( ) Private, non - profit <br />( ) Private, for profit ( ) Individual <br />f. Provider Contract ID #: 56- 0861200 <br />2. County De artment of Social Sen ices <br />a. Name of Contract Administrator: Martha Pryor -Cook <br />Tel. #: 91 -6 LX L- 281 2 <br />b. game of Services Program Contact Person: Qwendolyn D. Price <br />Tel. #: ,2T -712-8181 Ext . 2847 <br />C. Address of County Department of Social Services: <br />DSS -1292 (4/87) <br />Family Services <br />00 Jest Trvon Street <br />T 7278 <br />I <br />