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Cover Page Page 2 of 16 <br /> <br />COVER PAGE <br /> <br />Applicant Contact Information <br /> <br />Applicant Organization’s Legal Name: Refugee Support Center <br /> <br />Applicant Organization’s Physical Address: 401 Highway 54 Bypass, E15, Carrboro, NC 27510 <br /> <br />Applicant Organization’s Mailing Address: PO Box 1025 Carrboro, NC 27510 <br /> <br />Applicant Organization’s Web Address: www.refugeesupportcenter.org <br /> <br />Executive Director: Flicka Bateman <br /> <br />Telephone Number: 919-423-1478 E-Mail: fbatemanrsc@gmail.com <br /> <br />Tax ID Number: 46-3944698 <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 /> <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 />Centralized Location for Services $5,000 <br />Operational <br />$5,000 <br /> <br />Totals $5,000.00 $5,000.00 <br /> <br />Briefly explain your proposed use of funds: <br /> <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 /> <br />Signature: <br /> Board Chairperson Date <br />Funding will assist with rent/utilities for dedicated space to provide direct services to refugees, to <br />store and distribute essential items and goods to refugees, to maximize opportunities for <br />collaboration with partners. <br />other organizations and to serve as training site for volunteers. <br />Exhibit A- Provider’s Outside Agency Application <br />DocuSign Envelope ID: 260EB04B-010B-4888-85D1-932D7BC341C7