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io <br />State of North Carolina <br />Division of Social Services <br />Contract Application <br />Page 2 of 7 <br />iJ. Contract Identification: <br />1. Provider <br />a. Name of Contract Administrator Don Wilson <br />Tel. # : (91 91 644-105 1 <br />b. Name of Program Contact Person: _Jimmv Modlin <br />Tel. #: <br />c, Program Name, Location and Mailing Address: Timployment Security Commission <br />_Hillsborough. NC 27278 <br />d. Additional Service Delivery Sites: Skills DevelopmenbJobLink Center_ <br />e. Status : (X) Public OPrivate, non-profit <br />( )Private, for Profit ( )Individual <br />f. Provider Contract ID #: <br />2. County Department of Social Services <br />a. Name of Contract Administrator: Nancy Coston <br />Tel. # : (919) 245-2800 <br />b. Name of Services Program Contact Person: Gwendolyn Price <br />Tel. #: (919) 245-2800 <br />c. Address of County Denaztment of Social Services: <br />300 W. Tryon St. <br />Hillsborough, NC 27278 <br />