Orange County NC Website
Browse       Search
DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 <br /> - s s l s n{ „ s t s i t l ' ( i� � I , ',�� �,g <br /> t �86 .I:I r i� i1� 1 1, ,8i�I �111�11•',01� 1 1,Rl�l 111"Wi11-1 il�r-}�lill?!l hu[�}s�tiflti iibtil' <br /> Applicant�onta-t Inform':ation <br /> A0plicant Organization's Legal Larne:Exchange Club's Family Center in Alamance County <br /> DEX:Exchange Club's Family Center of the Central Piedmont <br /> Applicant Organization's Physical Address. 200 N. Main Street Graham NC 27253 <br /> /?ppiicant Organization's Mailing Address:200 N. Main Street Graham, NC 27253 <br /> Applicant Organization's Web Address:www.facebook.com/familycenterinAlamanceOrange <br /> Executive Director:Sarah E.G, Black, M.A, MFT <br /> Telephone'Num6er:336-227-5601 E-Mail:sarahblack(a)-exchangefcp.org <br /> Tax lO Number: 56-2227006 <br /> ..Funding Request <br /> please!ist 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 /> I Prvgrarn Carrboro- Chapel Orange Total <br /> - HS Hill-HS County-HS <br /> ;�° ?I; e,';I t " t; °tli I tt 1 ! $10,000 $15,000 $5,000 $30,000 <br /> ss <br /> <,� p t7 erations Persanne! Operations <br /> Parent Aide Program $1,500 $22,336 $22,336 $46,172 <br /> O erations, Supplies, & Personnel Personnel All All 3 <br /> Children's Parents Parenting Classes $0 $1,844 $1,000 $2,844 <br /> Travel, Supplies, & Personnel <br /> Totals $1,500 $24,180 1 $23,336 $49,016 <br /> Briefiv explain yourproposed use of funds: <br /> The funds for the Parent Aide program will be used for salary and benefits of <br /> program; staff, mileage, supplies/ client emergency funds, rent/utilities/operations. <br /> The funds for the Children's Parents classes will be used for salary and benefits of <br /> facilitator, mileage, and program/office supplies. <br /> To the best of my knowledge and belief all information and data in this application is true and <br /> current. The ocumen has bee dul a thor' �ed by the governing board of the applicant. <br /> Signature: J 10 jZoZO <br /> Executive Director, Date <br /> Sign ature: <br /> Board Chairperson Date <br /> Cover Page P a g e 2 o f 10 <br />