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DocuSign Envelope ID:8C3AC364-20A8-477A-92A7-8FBD4923E2D0 <br /> I <br /> COVER PAGE <br /> Applicant Contact Information <br /> Applicant Organization's Legal Name_ <br /> Institu R of Art Therapy Inc_(DBA Art Therapy In .l <br /> Applicant Organization's Physical Address: <br /> 200 N. Greensboro St, D-6,S.arrboro, NC, 27510 <br /> Applicant Organization's Mailing Address: <br /> 200 N -Gre,enshoro St, D-6, Carrboro, NC, 27510 <br /> Applicant Organization's Web Address: www ncati org <br /> Executive Director: Hiller R i_�besin <br /> Telephone Number: 610-348-7215113 <br /> i <br /> I : <br /> E-Mail: hrubesin�ncati.ora <br /> ,i <br /> Tax ID Number: 26-14_47-S <br /> Eunding Req!e-st <br /> Please list all Fiscal Year 2021 Human Services (HS)funding requested for alI <br /> programs and the proposed use of funds (please list program name only) <br /> , <br /> Orange j <br /> Program Carrboro HS Chapel Hill HS Total <br /> County HS <br /> Newcomers Art Therapy Program $10,000 $10,000 $20,000 <br /> Arts and Peer Support Group $10,000 $10,000 <br /> i <br /> Totals $10,000 $10,000 $10,000 $30,000 <br /> Briefly explain your pmpo_sed use of funds: <br /> Requested funds will be used to staff the Newcomers Art Therapy Program which provides <br /> art therapy to newly arrived immigrants and refugees in CHCCS schools and local <br /> community centers. The funds will also be used to staff the Arts and Peer Support Group <br /> which provides weekly therapy to adults living with chronic and persistent mental illness in <br /> Orange County. Beyond using funds to pay our clinicians, the funds will be used to <br /> purchase art supplies for the programs, and to conduct and analyze culturally-congruent, <br /> ethical research on the program outcomes. <br /> Cover Page Page 6 of 22 <br /> I <br />