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DocuSign Envelope ID: EB294A71-C7D1-4EE4-8287-60A6149320D4 <br /> 1. COVER PAGE <br /> a) Applicant Contact Information <br /> Applicant Organization's Legal Name: Inter-f=aith Council for Social Service <br /> Applicant Organization's Physical Address: 110 W. Main Street, Carrboro, NC 27510 <br /> Applicant Organization's Mailing Address: 110 W. Main Street, Carrboro, NC 27510 <br /> Applicant Organization's Web Address:www.ifcweb.or <br /> Executive Director: Jackie,Jenks <br /> Telephone Number: (919) 929-8360 x14 E-Mail: iienkspifcmailbox.org <br /> Tax ID Number; 591224041 <br /> b) Funding Request <br /> List all FY18-19 Human Services WS) Funding Being Requested — <br /> For All Programs) and the Proposed Use of Funds (2-3 lines or less) <br /> Program Carrboro Chapel Orange Total <br /> _HS Hill -Hs Coup -HS <br /> Homelessness Prevention and Emergency $2,000 $10,000 $5,000 $17,000 <br /> Assistance: Rent and utility assistance;clothing and <br /> transportation vouchers; essential medication <br /> purchase',counsel, information and referrals <br /> Shelters: The only shelters in Orange County. $4,000 $15,000 $45,000 $64,000 <br /> HomeStart for 14 women and 10 families, <br /> Community House for 52 men, and up to 20 <br /> additional people during inclement weather <br /> Permanent Supportive Housing: Housing $10,000 $10,000 <br /> subsidies in market-rate units and case management <br /> for the County's most vulnerable residents <br /> Food security Programs: Food provision in Chapel $9,000 $10,000 $40,000 $59,000 <br /> Hill and Carrboro through the Community Kitchen <br /> (hot meals every day) and the Food Pantry <br /> roceries as often as monthly to neighbors in need <br /> Totals $15,000 $35,000 $100,000 $150,000 <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 /> Signature: JkJUL � - 1123/18 <br /> Executive Director Date <br /> ,Signature: 1123118 <br /> Board Chairperson Date <br /> Agency Information 1/2312018 2:06:13 PM P gc-,, 2 o f 3 7 <br />