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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 Rape Crisis Center <br />Applicant Organization's Physical Address: 1506 E. Franklin Street, Ste 302, Chapel Hill, NC 27514 <br />Applicant Organization's Mailing Address: P.O. Box 4722, Chapel Hill, NC 27515 <br />Applicant Organization's Web Address: ocrcc.org <br />Executive Director: Alyson Culin <br />Telephone Number: 919 - 968 -4647 E -Mail: alyson(c)-ocrcc.org <br />DUNS Number: 835160862 <br />b) Project/Program Contact Information <br />(i) Project/Program Name: Client Services <br />(ii) Project/Program Name: Community Education <br />Project/Program Primary Contact and Title <br />c) Funding Request Identification <br />(i) Total Project/Program Cost: $349,572.50 <br />(ii) Total Project/Program Cost: $349,572.50 <br />Total Amount of Funds Requested: $74,000 <br />n Culin. Interim Executive Director <br />Proposed Use of Funds Requested (2 -3 Line Maximum): <br />Provide 24 -hour crisis intervention services for survivors of sexual violence. Provide community <br />education, training, and advocacy on sexual assault prevention and response, including programs <br />in Chapel Hill - Carrboro City Schools, Orange County Schools, and independent schools. <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 $12,000 ® Chapel Hill $27,000 ® Orange County $35,000 <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: Z25/1 <br />f� <br />Exec Date <br />Signature: � <br />B94l tKAp'ers"on Date <br />