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DocuSign Envelope ID: 1056F994-88AA-4336-8102-E1F3178D3BE7 <br /> COVER PAGE <br /> Applicant Contact Information <br /> Applicant Organization's Legal Name:Orange Congregations in Mission <br /> Applicant Organizations Physical Address:300 Millstone Dr. Hillsborough, NC 27278 <br /> Applicant Organization's Mailing Address:300 Miilstpne Dr. Hillsborough, NC 27278 <br /> Applicant Organization's Web Address:âť‘cimnc.org <br /> Executive Director: Rev.Sharon S. Freeland <br /> Telephone Number:519-732-6194 E-Mail:âť‘cimexecdirPernbargmaii.com <br /> Tax ID Number <br /> Funding Request <br /> Please list all Fiscal Year 2020 Human Services( IS)funding requested for all programs and the <br /> proposed use of funds(please list program name only) <br /> Program Carrboro- Chapel Drange Total <br /> HS 1iiH-HS Chun -HS <br /> Ex, YouthAftemchaalProgram $10,000 $15,000 $5,R00 $30,000 <br /> Samaritan Relief Ministry,food and financial assistance 58,415 <br /> Meals on Wheels food 34,000 <br /> Totals 92,415 <br /> To the best of my knowledge and belief all information and data in this application is true and <br /> current. The document has been duly authorized by the governing board of the applicant. <br /> Signature: r It 2-Z <br /> Executive Director Date <br /> Signature: <br /> Board Chairperson Date <br />