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DocuSign Envelope ID: D44FBOEB-DA34-4A73-A73D-3D95E1AE8OA2 <br /> EXHIBIT A <br /> COVER PAGE <br /> Applicant Contact Information <br /> Applicant Organization's Legal Name: The Historical Foundation of Hillsborough &Orange County <br /> Applicant Organization's Physical Address: 201 North Churton St., Hillsborough, NC 27278 <br /> Applicant Organization's Mailing Address: 201 North Churton St., Hillsborough, NC 27278 <br /> Applicant Organization's Web Address: orangenchistory.org <br /> Executive Director: Currently Vacant; contact: Sherry(Sharon C) Appel, Board Chair <br /> Telephone Number: 202-441-3160 E-Mail: sherryappel@gmail.com <br /> Tax ID Number: 560797289 <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 /> Ex. Youth Afterschool Program $10,000 $15,000 $5,000 $30,000 <br /> Operations or Personnel Operations Personnel Operations <br /> Orange County Historical Museum: $10,000 $10,000 <br /> Education through Exhibits <br /> Totals $10,000 $10,000 <br /> Briefly explain your proposed use of funds: <br /> With a new and energized Board of Directors, we will fund expanded and focused <br /> programs for students in county schools; build an additional exhibit; and inventory <br /> the collection to ensure its preservation and protection while using items to enhance <br /> our exhibits. The Board will complete its strategic plan in February and will have <br /> specific goals in mind to enhance the museum and its place in the community. <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: January 14, 2020 <br /> Board Chair Date <br /> DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON DISCRIMINATION CLAUSE <br /> Cover Page ' a g e 6 o f 2 1 <br />