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DocuSign Envelope ID:B3D8E8FB-78D9-4B50-80E2-1077055FA40B <br /> COVER PAGE <br /> Applicant Contact information <br /> Applicant Organization's Legal Name: Volunteers for Youth, Inc. <br /> Applicant Organization's Physical Address: 205 Lloyd Street, Suite 103, Carrboro,_NC 27510 <br /> Applicant Organization's Mailing Address: 205 Lloyd Street Suite 103 Carrboro NC 27510 <br /> Applicant Organization's Web Address: www.volunteersforyouth.org <br /> Executive Director: Susan Worley <br /> Telephone Number: 919-967-4511 E-Mail: susan@volunteersforyouth.org <br /> Tax ID Number: 58-1457945 <br /> Funding Request <br /> Please list all Fiscal Year 2021 Human Services(HS)funding requested for all programs and the proposed <br /> use of funds(please list program name only) <br /> Program Carrboro- Chapel Orange Total <br /> HS Hill-HS County-HS <br /> Mentoring, community service, &teen court $3,250 $12,000 $11,000 $26,250 <br /> programs <br /> Totals $3,250 $12,000 $11,000 $26,250 <br /> Briefly explain your proposed use of funds: <br /> Portion of program coordinators' salaries, youth activities, and general operating expenses <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: 1-/0 ?(9 <br /> Executive Director LI Date <br /> Signature: L4t 10 202V, <br /> Board C ' erson Date <br /> Cover Page P a g e 6 a f 2 1 <br />