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MAIN APPLICATION <br />1. COVER PAGE (Each program requires a separate application.) <br />a) Applicant Contact Information <br />Applicant Organization's Legal Name: Orange County Disability Awareness Council <br />Applicant Organization's Physical Address: 503 West Franklin St., Chapel Hill, NC 27516 <br />Applicant Organization's Mailing Address: 503 West Franklin St., Chapel Hill, NC 27516 <br />Applicant Organization's Web Address: http: / /triangledac.org/ <br />Executive Director: Timothy Miles <br />Telephone Number: 919.245.4337 E -Mail: ocdac @orangecountync.gov <br />DUNS Number: <br />(Dun & Bradstreet, Inc. provides this number at no charge, and it is required for Federal funding recipients.) <br />b) Protect /Program Contact Information <br />Project /Program Name: Education and Training Resources for People with Disabilities <br />Project /Program Primary Contact and Title: Timothy Miles, Director <br />Telephone Number: 919-245-4337 <br />c) Funding Request Identification <br />E -Mail: ocdac(a)orangecountync.gov <br />Total Project/Program Cost: $30000 Total Amount of Funds Requested: $30000 <br />Proposed Use of Funds Requested (2 -3 Line Maximum): Funding for as- needed basic operating <br />expenses, ADA related workshop employment training, human interest projects, resources, <br />supplies, staff training, computer support, travel and printing. <br />Please check all types, sources, and amounts of funding being requested. You must submit an <br />application package for each funding source. *The Participating Jurisdiction reserves the right to <br />fund projects from any funding source, subject to eligibility and funding constraints. <br />❑ CDBG Non - Construction (CH) $ ❑ Grant ❑ Loan <br />❑ CDBG Construction (CH) $ ❑ Grant ❑ Loan <br />❑ HOME CHDO (OC) $ ❑ Grant ❑ Loan <br />❑ HOME Other (OC) $ ❑ Grant ❑ Loan <br />® Human Services: ® Carrboro $10000 ® Chapel Hill $10000 ® Orange County $10000 <br />d) To the best of my knowledge and belief all information and data in this application is <br />true and current. The document has been duly authorized by the governing board of the <br />applicant. <br />Signature: Timothy L. Miles <br />Executive Director <br />Signature: Lynn M. Sheilds <br />Board Chairperson <br />January 20, 2016 <br />Date <br />January 20, 2016 <br />Date <br />Main Application 2/11/2016 9:12:15 AM Page 3 of 20 <br />