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DocuSign Envelope ID:8C3F60DE-6E3D-42CA-B364-FB7D449BBC74 <br /> EXHIBIT A <br /> COVER PAGE <br /> Applicant Contact Information <br /> Applicant Organization's Legal Name:Alliance for Historic Hillsborough <br /> Applicant Organization's Physical Address: 150 E. King St., Hillsborough, NC 27278 <br /> Applicant Organization's Mailing Address: 150 E. King St, Hillsborough, NC 27278 <br /> Applicant Organization's Web Address:www.historicHillsborough.org <br /> Executive Director: Sarah Parris <br /> Telephone Number:919.732.7741 E-Mail:sarah@historichilisboroughl.org <br /> Tax ID Number: 56-1818934 <br /> Funding Request: $9,200 <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 /> Visitor Services,Burwell School Historic Site 9,200 9,200 <br /> Totals 9,200 9,200 <br /> Briefly explain your proposed use of funds: <br /> Funds will support visitor services at the Burwell School Historic Site, administered through the <br /> Alliance for Historic Hillsborough. Funding will support the provision of tours, programs and services <br /> to 4000+schoolchildren and adults from all areas of the county and the state at the 200-year-old <br /> historic house museum,the only such site in Orange County that is open to the public free of charge <br /> year-round. <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: �� ��wc o / Z JV 1-2-0 <br /> Executive Director Date <br /> Signature: ( 1 )4 /2,0 <br /> and Chairperson Date <br /> Cover Page P a g e 6 o f 2 3 <br />