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DocuSign Envelope ID: EBOFBDBE -FD15- 4428- 899B- 19A867F94OCC <br />1. COVER PAGE <br />a) Applicant Contact Information <br />Applicant Organization's Legal Name: Orange Congregations in Mission Inc. <br />Applicant Organizations Physical Address: 300 Millstone Dr. Hillsborough, NC 27278 <br />Applicant Organization's Mailing Address: 300 Millstone Dr. Hillsborough,_ NC <br />Applicant Organization's Web Address: www.ocimnc.org <br />Executive Director: Rev. Sharon S. Freeland <br />Telephone Number.- 919 - 732 -6194 ex. 10 <br />Tax ID Number.-.58-1563438 <br />E -Mail: ocimexecdir(W-embargmail.com <br />lb) 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 - - Carrboro Cheri Or� ang <br />_ - HS Hill - HS Count3 <br />Ex. Youth Afterschool Program $10,000 $15,000 $5,000 <br />ARerschool Program Coordinator salary and materials <br />for youth activities and projects — - _._- <br />Samaritan Relief Ministry <br />Food for pantry, rent and utility assistance for <br />recipients. salary fornrooram manager. <br />Totals <br />$30,000 <br />58,415 1 58,415 <br />- - -- <br />58,415 <br />c) To the best of my knowledge and relief 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: l A - <br />Executive Director Date <br />Signature: J2-j 1113bg <br />Bard Chairperson Date <br />AGENCY INFORMATION 112312018 12:19_•10 PM Page 8 or 25 <br />