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Page 2 of 27 <br /> <br />Attachments <br />(A description of these items is <br />available on page 13: “Description <br />of Required Attachments.” Please <br />contact us if it will not be <br />possible to provide any of these <br />required attachments at the time <br />of application: <br />bbouma@orangecountync.gov) <br /> <br /> <br /> <br />☐ Applicant Organization’s Annual Budget and Proposed Project Budget (Use <br />template provided) <br />☐ Applicable Financial Records to prove eligibility: IRS Federal Form 990 or <br />Applicant Organization’s Tax Returns from 2019 <br />☐ Applicable Financial Records to prove eligibility of collaborator/partner (if <br />they are receiving project funds): IRS Federal Form 990 or Tax Returns from <br />2019 <br />☐ List of members of organization’s Governing Board (if Board exists) <br />☐ Solid Waste Program Fee (SWPF) Verification (for commercial property <br />owners and renters) <br />☐ Certificate of Insurance <br /> <br /> <br />COVER PAGE <br /> <br />Applicant Organization’s Contact Information <br />Organization’s Legal Name: North Carolina Sustainable Energy Association (NCSEA) <br />Physical Address: 4800 Six Forks Rd., Suite 300 Raleigh, NC 27609 <br />Mailing Address: (same as above) <br />Web Address: www.energync.org <br />Telephone Number: (919) 832-7601 <br />E-Mail: info@energync.org <br />Tax ID Number: 58-1342588 <br /> <br /> <br />Funding Request Summary <br /> <br />Please list all Fiscal Year 21-22 Community Climate Action Grant funding requested for the project you are proposing <br />and the proposed use of funds (please list project name only). Applicants will be asked to provide more details on their <br />proposed project budget in the Budget Worksheets attachment. <br /> <br /> <br />Project: Neighborhood Energy Resiliency Project (NERP) <br />Project Management/Reporting $20,000 <br />Workshop $5,000 <br />Community Organizing $8,000 <br />Events (educational contractor <br />shadowing and meetings) <br />$3,000 <br />DocuSign Envelope ID: 05316BF7-95C7-4D54-82D9-7EBD5926DA4D