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COVER PAGE <br /> Applicant Contact information <br /> Applicant 0rganization's legal Name:Orange County Department on Aging <br /> Applicantā‘rganization's Physical Address: 2551 Homestead Road, Chapel Hill NC 27516 <br /> Applicantā‘rganization's Mailing Address: 2551 Homestead Road, Chapel Hill NC 27516 <br /> Applicant 0rganization's Web Address:http://www.orangecountync.govfdepartments/aging <br /> Executive Director:Janice Tyler <br /> Telephone Number: 919-245-4255 E-Mail: jtyler@orangecountync.gov <br /> Tax ID Nu m b e r:5 6-6000327 <br /> Funding Request <br /> Please list all Fiscal Year 2020 Human Services(HS)funding requested for all programs and the <br /> proposed use of funds(please listprogram name only) <br /> pmmugm C_arr.6n_ro_- Chapel Qringe Total <br /> HS Hill-Hs Count -HS <br /> Volunteer Connect 55+ Program $1,450 $12,300 $13,750 <br /> Lunch Program $5,000 $15.000 $20,000 <br /> Totals $6,450 $27,300 $33,750 ? <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 /> k <br /> k <br /> axec <br /> Signature: ve Directorr7-t.fi Date <br /> Signature: --- <br /> Board CRairperson Date <br /> 1 <br /> i <br /> l; <br /> Cover Page Page 3 of 14 <br />