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DocuSign Envelope ID:A2DC2EF9-6C9A-438D-A97D-84CEA493644C <br /> EXHIBIT A <br /> COVER PAGE <br /> Applicant Contact Information <br /> Applicant Organization's Legal Name: Chapel Hill/ Carrboro Children's Museum <br /> Applicant Organization's Physical Address: 201 S. Estes Drive, Suite A-9 Chapel Hill, <br /> NC 27514 <br /> Applicant Organization's Mailing Address: As above <br /> Applicant Organization's Web Address: www.kidzuchildrensmuseum.ora <br /> Executive Director: Lisa Van Delman <br /> Telephone Number: 919 933 1455 E-Mail: vandeman(a�kidzuchildrensmuseum.ora <br /> Tax ID Number: 20-2058235 <br /> Funding Request <br /> Please list all Fiscal Year 2021 Human Services (HS) funding requested for all <br /> rograms and the proposed use of funds please list pro ram name only) <br /> Program Carrboro - Chapel Oranae Total <br /> HS Hill - HS Coun -HS <br /> Ex. Youth Afterschool Program $10,000 $15,000 $5,000 $30,000 <br /> Operations or Personnel Operations Personnel Operations <br /> Adaptive Playdates $5,000 <br /> Operations <br /> STEM based Open Access $22,395 <br /> programs during out of school time <br /> Operations <br /> Totals $5,000 $22,395 $27,395 <br /> Cover Page P a g e 6 o f 2 5 <br />