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�. r......... PART 1 OMB APPraVW No. 0948.0043 <br />ArrLt, A f, IIvf,'41 rvrli <br />I DATE SUBWTTED <br />Applicant Identifier <br />FEDERAL ASSISTANCE <br />02 -21 -92 <br />NONE <br />1. TYPE OF SUBw=ON: <br />3. DATE RECEIVED BY STATE <br />state Application Identifier <br />Appfic2bbn Preappadmian <br />❑ Construction ❑ Cansauedon <br />DATE RECEIVED BY FEDERAL AGENCY <br />Federal Identifier <br />❑ Non- Conswcdon ❑ IV77r1•Corlstrucdon <br />S. APPLICANT INFORMATION <br />L:gal Name: <br />Organizational Unit <br />ORANGE 00UM <br />COU[M GOVEMIE r <br />ACdress (give Oty, CDUnty, state, and zip code): <br />Name and telephone number of the person to be contacted on matters <br />Orange County <br />involving this application (give area code): <br />P.O. Box 8181 <br />Kathy Mangum, RSVP Director <br />Hillsborough, NC 27278 <br />(919) 968-0060 <br />6. EMPLOYER IDENTIFICATION NUMBER (EIN) <br />7• TYPE OF APPLICANT: (enter appropriate letter in box) <br />5 6 --- 1 6 1 0 1 0 Ot 3 2 7 <br />A. State H. Independent School District <br />S. County I. State Controlled Institution of Higher Leaming <br />C. Municipal J. Private University <br />D. Township K. Indian Tnbe <br />a. TYPECFAPPLICATION: <br />❑ New Continuation ❑ Revision <br />E. Interstate L Individual <br />F. Intermunicipal M. Profit Organization <br />If Revision, enter appropriate letter(s) in box(es): Q [] <br />G. Special District N. Other (Specify): <br />A. Increase Award B. Decrease Award C. Increase Duration <br />D. Decrease Duration Other (specify): <br />A. NAME OF FED ERAI. AGENCY: <br />ACTION - <br />10. CATALOG OF FEDERAL DOMESTIC <br />I 1 2 <br />11. DESCRIPTIVE TITLE OF APPUCANTS PROJECT: The O.C. Retired <br />ASSISTANCE NUMBER: 7 2 O O <br />islior Volunteer Progr [t provides for individuals EO & <br />77L -: RETIRED SENIOR VOLUNTEM PROGRAM <br />ajer the c:pertu uty to serve the aniTtzaties nar-Lxafi <br />agencies &=-ugh maningful and re arding volunteer <br />plaomt mts. Placrarents are bad on the volunteer's <br />skills, expatim, interests, and the rze6s of the <br />,: AREAS AFFECTED BY PROJECT (Cities, ccunzres. states, etc.;: <br />Hillsborough, Chapel Hill, Carrboro <br />Orange County, North Carolina <br />agencies. Plgencies are rewired to sc-fLit detailed <br />jcb oescripticns of each assigment. <br />! 3. PRCPOSE�I PROJECT: 1 14, CONGRESSIONAL DISTRICTS OF: <br />107H <br />Start Date <br />Ending Date <br />a. Applicant <br />b. Project <br />07 -01 -92 <br />06- 30-93 <br />Fourth <br />Fourth <br />t5. = 37MATED FUNDING: <br />1S IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 17372 PROCESS? <br />a. YES. THIS PREAPPLICATION /APPLICATION WAS MADE AVAILA13LE TO THE <br />a. = ederal <br />S 36,993 .00 <br />STATE <br />O(ECUTIVE ORDER 12372 PROCESS FOR REVIEW ON: <br />b. Applicant <br />$ .00 <br />36,269 <br />DATE <br />c. State <br />S .00 <br />--0— <br />I <br />b. NO. ❑ <br />E3 <br />PROGRAM IS NOT COVERED BY E. O. 12372 <br />OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW <br />d. Local <br />5 13,177 .00 <br />e. Other <br />$ .00 <br />f. Program Income <br />S cc <br />17. 13 THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br />�- <br />❑ Yes If'Yes.' <br />attach an explanation. EX No <br />g. TOTAL. <br />$ .00 <br />86, �l39 <br />19. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPUCATIOK"EAPPLICATION ARE TRUE AND CORRECT. THE DOCUMENT HAS BEEN DULY <br />AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WTTH THE ATTACHED ASSURANCES IF THE ASSISTANCE Is AWARDED <br />a. Typed Name at Authorized Representative <br />' <br />b. Idle <br />C. Tel hone Number <br />9)-732-8181 <br />�.�_w� <br />(9 <br />�.,�r <br />Moses n <br />_ <br />Zt F Orange-.CO, _YYJ� LIP. <br />S Els-t. 2125 <br />e. Date Signed . <br />d. Signature of Authorized Representative <br />Previous Eatiorn Not Usaa. Pwrnwraeo Tor wwr rAPrQWMuvn rage t pro I of 424 (MM. B) rraaraum by OMB Circular A-102 <br />