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COVER PAGE <br /> <br />Applicant Contact Information <br />Applicant Organization’s Legal Name: The Marian Cheek Jackson Center for Saving and Making <br />History <br />Applicant Organization’s Physical Address: 512 W. Rosemary St., Chapel Hill, NC 27516 <br /> Applicant Organization’s Mailing Address: 512 W. Rosemary St., Chapel Hill, NC 27516 <br /> Applicant Organization’s Web Address: www.jacksoncenter.info <br /> Executive Director: George Barrett <br /> Telephone Number: 919-960-1670 E-Mail: george@jacksoncenter.info <br /> Tax ID Number: 46-1988511 <br /> <br />Funding Request <br /> <br />Please list all Fiscal Year 2022 Human Services (HS) funding requested for all programs and the <br />proposed use of funds (please list program name only) <br /> <br />Program Carrboro - <br />HS <br />Chapel Hill - <br />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 />Learning Across Generations: Local Civil <br />Rights & Oral History Education <br /> $9,000 <br />Personnel <br /> $9,000 <br />Personnel <br />$17,500 <br />Personnel <br />$35,500 <br />Keeping Your House a Home: Long term <br />neighbor retention and advocacy <br />(other <br />sources) <br />(other <br />sources) <br />$10,000 $10,00 <br />Totals $9,000 $9,000 $27,500 $45,500 <br /> <br />Exhibit A- Provider’s Outside Agency Application <br />DocuSign Envelope ID: DA5CF954-7FB4-49AB-99CC-0C1ABAA1F102