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DocuSign Envelope ID:51A7A137-A286-4E98-B5F2-A17F8C86549D <br /> COVER PAGE <br /> Applicant Contact Information <br /> Applicant Organization's Legal Name: Chapel Hill Carrboro Meals on Wheels <br /> (DBA Meals on Wheels of Orange County—MOWOCNC, by July 1 of 2020) <br /> Applicant Organization's Physical Address: 1712 Willow Drive,Chapel Hill, NC 27514 <br /> Applicant Organization's Mailing Address: P.O. Box 2102, Chapel Hill, NC 27515 <br /> Applicant Organization's Web Address: www.chcmow.org <br /> Executive Director: Rachel Sobel Bearman <br /> Telephone Number: 919-942-2948 E-Mail: rachel.bearman@chcmow.oM <br /> Tax ID Number: 59-1721954 <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 Hill Orange Total <br /> HS -HS County-HS <br /> In-Home Meal Delivery and Weekday Daily Check-In $18,000 $45,000 $80,800 <br /> Operations Operations Operations <br /> &Personne <br /> Totals N 1000 or 45 00 <br /> Briefly explain your proposed use of funds: <br /> Funding directly supports the delivery of a hot, balanced meal along with a friendly check-in, <br /> Monday-Friday,to older adults, homebound adults, adults with disabilities and those convalescing, <br /> who do not have access to, or the ability to prepare a healthy meal. <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 /> Signatur • t 1 1Q (F01-0 <br /> "T <br /> Executive—etector Date <br /> Signature: �'_�;� � Z,� <br /> Board Chairperson Date <br /> Cover Page <br />