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DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 <br /> COVER PAGE <br /> Applicant Contact Information <br /> Applicant Organization's Legal Name:A Helping Hand <br /> Applicant Organization's Physical Address: 1502 West NC HWY 54, Suite 405 Durham, NC 27707 <br /> Applicant Organization's Mailing Address: 1502 West NC HWY 54,Suite 405 Durham, NC 27707 <br /> Applicant Organization's Web Address:www.ahelpinghandnc.org <br /> Executive Director:Jennifer Ashley <br /> Telephone Number: 919-403-5555 E-Mail:Jennifer.ashlev@ahelpinghandnc.org <br /> Tax ID Number: 56-1923835 <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 /> Caregiving Collaborative $6,000 $6,000 $6,000 $18,000 <br /> Personnel Personnel Personnel <br /> Totals <br /> Briefly explain your proposed use of funds: <br /> The Caregiving Collaborative provides access to healthcare through evidence based interventions for <br /> seniors and adults living with disabilities, regardless of their ability to pay.This program provides <br /> consistent and reliable service through it's innovative Caregiving Collaborative, an internship and <br /> volunteer based program, utilizing the local universities to create a meaningful experience for pre- <br /> med students. <br /> To the best of my knowledge and belief all information and data in this application is true and <br /> current. The document s been duly authorized by the governing board of the applicant. <br /> Signature: 1/1/20 <br /> E ec tive Dir for Date <br /> Signature: ��� � r s��` ` � 1/1/20 <br /> Board Chairperson Date <br />