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DocuSign Envelope ID:2B362E51-9A19-4059-AA75-CO8A33D65AFD <br /> .x�e4bif <br /> COVER PAGE <br /> Applicant Contact Information <br /> Applicant Organization's Legal Name:The Arc of the Triangle,, Inc. <br /> Applicant Organization's Physical Address: 1709 Legion Road, Suite 100, Chapel Hill, NC <br /> 27517 <br /> Applicant Organization's Mailing Address: 1709 Legion Road, Suite 100, Chapel Hill, NC <br /> 27517 <br /> Applicant Organization's Web Address:www.arctriangle.org <br /> Executive Director:Jennifer Pfaltzqraff <br /> Telephone Number:919-942-5119 x117 E-Mail:jpfaltzgraff(d.arctrlangle.orq <br /> Tax ID Number:56-1214133 <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 /> Ex.Youth Ajierschool Program $10,000 $15,000 $5,000 $30,000 <br /> OperahoPs orT4rsonnf2l Operations Personnel Operations <br /> Community Programs $7,500 $15,000 $7,500 $30,000 <br /> Operations Personnel Operations <br /> Totals $7,500 $15,000 $7,500 $30,000 <br /> Briefly explain your proposed use of funds: <br /> The proposed use of funds will go towards the expense of operating and running our <br /> Community Programs located in Orange County. <br /> To the best of my knowledge and belief all information and data in this application is true and <br /> current. The document h s been duly authorized by the governing board of the applicant. <br /> Signature: <br /> E ive Director Date <br /> Signature: 90�4 1/�_ 1oeo <br /> Board Chairperson Date <br /> Cover Page P a 0 0 6 0 1 :_f Y <br />