2021-247-E-Human Rights-The Marian Cheek Jackson Center outside agency agreement

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DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F COVER PAGE Applicant Contact Information Applicant Organization's Legal Name:The Marian Cheek Jackson Center for Saving and Making History Applicant Organization's Physical Address:512 W. Rosemary St, Chapel Hill, NC 27516 Applicant Organization's Mailing Address:Same as above. Applicant Organization's Web Address:www.)acksoncenter.info Executive Director: Hudson Vaughan Telephone Number: 919-960-1670 E-Mail: Hudson@Jacksoncenter.info Tax ID Number:46-1988511 Funding Request Please list all Fiscal Year 2021 Human Services(HS)funding requested for all programs and the proposed use of funds(please list program name only) Program Carrboro- Chapel Orange Total HS Hill-HS County-HS Ex. Youth Afterschool Program $10,000 $15,000 $5,000 $30,000 O eralions or Personnel Operations Personnel Operations Learning Across Generations:Local Civil Rights&Oral $9,000 $9,000 $17,500 $35,500 History Education Personnel Personnel Personnel Keeping Your House a Home:Long-term neighbor (other (other $10,000 $10,000 retention and advocacy sources) sources) Personnel Totals $9,000 $9,000 $27,500 $45,500 Briefly explain your proposed use of funds: Funding will provide critical capacity for our teacher teams to reach over 3,000 k-12 students with critical civil rights history education, and for our Community Advocacy Specialist to connect over 125 low-income community elders with critical home repairs, retention tools, and land-loss prevention programs. To the best of my knowledge and belief all information and data in this application is true and current. The document Pas been duly authorized by the governing board of the applicant. r Signature: ,. Executive Dir t Date Signature: � � Boa46alrpersod Date Cover Page P a g e 6 o f 2 1