Orange County NC Website
Browse       Search
DocuSign Envelope ID: C47D73DC -CC50- 4723 - 8253- AE01785E7FAA <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />1. COVER PAGE <br />a) Applicant Contact Information <br />Applicant Organization's Legal Name: The ArtsCenter <br />Applicant Organization's Physical Address: 300 -G East Main Street, Carrboro, NC 27510 <br />Applicant Organization's Mailing Address: 300 -G East Main Street, Carrboro, NC 27510 <br />Applicant Organization's Web Address: www.artscenterlive.org <br />Executive Director: Daniel Y. Mayer <br />Telephone Number: 919 - 929 -2787 x 217 <br />Tax ID Number: 51- 0198497 <br />E -Mail: dmayer(Dartscenterlive.org <br />b) Funding Request <br />List all FY18 -19 Human Services (HS) Funding Being Requested — <br />For All Programs) and the Proposed Use of Funds (2 -3 lines or less) <br />Program <br />Carrboro <br />Chapel <br />Hill - HS <br />Orange <br />County-HS <br />Total <br />- HS <br />Ex. Youth Afterschool Program <br />Afterschool Program Coordinator salary and materials <br />for youth activities and projects <br />$10,000 <br />$15,000 <br />$5,000 <br />$30,000 <br />General Support for Arts Programs <br />$20,000 <br />$20,000 <br />$40,000 <br />ArtsCenter Youth Education Department <br />$15,000 <br />$15,000 <br />Totals <br />$45,000 <br />c) 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 />Signatur : <br />x ecuti a Ire or <br />Signature: <br />��a. ��...�.. <br />Board Chairperson <br />/,_:� 11 & <br />Date <br />Date <br />l 12,3 12.4 / T <br />AGENCY INFORMATION 1/23/2018 1:53:53 PM Page 7 of 22 <br />