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DocuSign Envelope ID:05AC53B6-D6A8-4C58-AE61-C86lC28D8998 <br /> r,xiuDIL,ft <br /> COVER PAGE <br /> Applicant Contact Information <br /> Applicant Organization's Legal Name: Hillsborough Arts Council <br /> Applicant Organization's Physical Address: 102 North Churton Street,Hillsborough—N.C.2 178 <br /> Applicant Organization's Mailing Address: 102 North Churton Street, Hillsborough, NC 2727R <br /> Applicant Organization's Web Address:www.hillsboroughartscouncil.org <br /> Executive Director:Torey Mishoe <br /> Telephone Number:919-643-2500 E-Mail:director@hillsboroughartscouncil.org <br /> Tax ID Number:56-2163979 <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 Oran a Total <br /> HS Hill-HS CounttV-HS <br /> Ex. Youth Afterschool Program $10,000 $15,000 $5,000 $30,000 <br /> Operations or Personnel Operations Personnel Operations <br /> Organizational Development for Community Outreach $20,000 $20,000 <br /> and Sustainability I Personnel <br /> Totals <br /> Briefly explain your proposed use of funds: <br /> Funds will be used to support the cost of the Executive Director for the Hillsborough Arts Council <br /> (HAC).This role supports all arts programs and events,and is critical in creating outreach and <br /> educational opportunities for 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: <br /> Executive Director Date <br /> Signature: , /�3/Zd Zct <br /> oar airpe s n Date <br /> Cover Page P a g t, 6 o f 2 1 <br />