Orange County NC Website
Browse       Search
DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />1. COVER PAGE <br />a) Applicant Contact I Fdom-liakion <br />Applicant Organization's Legal Name- The Hrstoric2I Foundation of Hillsborough <br />Orange County <br />Applicant Oroaniz tion's PhysiQall Address: 201 Ncra,� Churtr)n St., Hillsborough. NC <br />27278 <br />Applicant Organizafion's Mailing Address 201 Hodh Churton St., Hillsbcr-ourgl7, NC <br />27278 <br />ApPii w t Organization's Web Address- €Lr.a iaLnohrstory.or_q <br />Executive Director: Stephanre F'ryp <br />Telephone Numbs (919) 732 -2201 E -Mail: direclor@ci.--angenchi�tor-y.org <br />Tax lb Number: 6M797289 <br />b) Funding Request <br />List all FY'18 -19 Human Servires tHS1 Funding Being Requested — <br />Fw All Pro rams and the Proposed Use of Funds (2 -3 limes or lass) <br />Pro-11ram <br />Ey- Youth Afterschool Progr'arn <br />Aftersc'hool Program Coordinator w1aryr and materials <br />iqr outih activities ,and prcijer <br />Oran untyr F- rstwgal Museum-- Education through <br />Exhibits; OutTeaeh EduG- ion: PresarwatiQn aM <br />R i;h (in udes research) <br />T�tal� <br />arrt,�r <br />Ms Hill H <br />$10,000 1 , <br />PQH�__ Total <br />Coup -HS <br />V5,001) $30,000 <br />16 ,388 <br />To the best of my knowledge and belief all information a rr.d data in this application is <br />true an,d current `fhe doh has been-duly authorized by the goveming board of the <br />applicant.' � . <br />Signature, <br />AG Eft CY I NFOR �10 1 1;: r A l Page :8 o f 40 <br />