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DocuSign Envelope ID:2F348727-C96D-44CB-A423-F125131FB250C <br /> ORANGE COUNTY <br /> NORTH CAROLINA <br /> FY 2020-21 Outside Agency <br /> Contact Information <br /> Congratulations on being awarded Outside Agency Funding for FY 2020-21! <br /> Please provide the below information regarding your agencies' contacts for fiscal year 21. <br /> Please complete and sign this form electronically and submit to Allen Coleman at <br /> outsideagencies@orangecountync.gov by Friday,August 14, 2020. <br /> Section A: Agency Information: <br /> Agency Legal Name Charles House Association <br /> Agency DBA (If Applicable) <br /> Physical Address 7511 Sunrise Rd <br /> Mailing Address Chapel Hill, NC 27514 <br /> Agency's Telephone Number 919-967-7570 <br /> Agency Website www.charleshouse.org <br /> Section B: Executive Director's Information <br /> Executive Director's Name Paul kl eve r <br /> Executive Director's Telephone Number 919-967-7570 <br /> Executive Director's Email Address paul@charleshouse.org <br /> Will the Executive Director Sign the YES NO <br /> Performance Agreement? 0 0 <br /> If no,please tell us who?-Name: <br /> Email Address <br /> F71 Application Orientation & <br /> What type of Communications should this Training Opportunities <br /> individual receive? II Financial Reporting <br /> Please select check all that apply: 0 Performance Reporting <br /> 0 Performance Agreement Execution <br /> 1 <br />