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— DocuSign Envelope ID:6D53F1FA-CAAF-413F0-A183-95EF4836E57C <br /> z <br /> Applicant Contact Information <br /> Applicant Organization's Legal Name: Big Brothers Big Sisters of the Trianale, Inc. <br /> Applicant Organization's Physical Address:808 Aviation Parkway, Suite 900, Morrisville, NC <br /> 27560 <br /> Applicant Organization's Mailing Address:808 Aviation Parkway, Suite 900, Morrisville, NC <br /> 27560 <br /> Applicant Organization's Web Address:www.bigstri.org <br /> Executive Director:Erin Callahan <br /> Telephone Number: (919) 850-9772 E-Mail:ecallahanObbbstri.org <br /> Tax ID Number:56-2109717 <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 nvme only) <br /> Proeram Carrboro-HS Chapel Hill- Orange Total <br /> HS County-HS <br /> ComTtiunity ;Slfe=�9se iVJer�#o�i �!P}i< $5,000 $5,000 $10,000 $20,000 <br /> d ,crattons gr-PepriltJr ',xa"`,Ewe}i ` Personnel Personnel Personnel <br /> Totals $5,000 $5,000 $10,000 1 $20,000 <br /> Briefly explain your proposed use of funds: <br /> Funds will be used to cover cost of enrollment, match and support program staff. <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 /> Signature: - <br /> i //S 12-C <br /> Executive irector Date <br /> Signature: <br /> Board Chairperson Date <br />