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Cover Page P a g e 6 o f 23 <br /> <br />COVER PAGE <br /> <br />Applicant Contact Information <br /> <br />Applicant Organization’s Legal Name: Table Ministries, Inc. <br /> <br />Applicant Organization’s Physical Address: 209 E. Main Street, Carrboro, NC 27510 <br /> <br />Applicant Organization’s Mailing Address: same as above <br /> <br />Applicant Organization’s Web Address: www.tablenc.org <br /> <br />Executive Director: Ashton C. Tippins <br /> <br />Telephone Number: (919)636-4860 E-Mail: actippins@tablenc.org <br /> <br />Tax ID Number: <br /> <br />Funding Request <br /> <br />Please list all Fiscal Year 2022 Human Services (HS) funding requested for all programs and the proposed <br />use of funds (please list program name only) <br />Program Carrboro - <br />HS <br />Chapel <br />Hill - HS <br />Orange <br />County-HS <br />Total <br />Ex. Youth Afterschool Program <br />Operations or Personnel <br />$10,000 <br />Operations <br />$15,000 <br />Personnel <br />$5,000 <br />Operations <br />$30,000 <br />Food to Front Door: Food, supplies, program staff, <br />operations, & space <br />15000 15000 15000 45000 <br /> <br />Totals 15000 15000 15000 45000 <br /> <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: 6AACAE3D-76C8-46BA-8DCC-C71ED367AD95