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Cover Page P a g e 6 o f 28 <br />COVER PAGE <br />Applicant Contact Information <br />Applicant Organization’s Legal Name: Table Ministries, Inc. <br />Applicant Organization’s Physical Address: 209 E. Main St. Carrboro, NC 27510 <br />Applicant Organization’s Mailing Address: 209 E. Main St. Carrboro, NC 27510 <br />Applicant Organization’s Web Address: www.tablenc.org <br />Executive Director: Ashton C. Tippins <br />Telephone Number: 919-636-4860 E-Mail: info@tablenc.org <br />Tax ID Number: <br />Funding Request <br />Please list all Fiscal Year 2023 Human Services (HS) funding requested for all <br />programs and the proposed 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 />TABLE@Home – food, supplies, <br />program staff, operations, and space <br />$16,000 $18,000 $16,000 $50,000 <br />Totals $16,000 $18,000 $16,000 $50,000 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: 5334673A-3749-4438-A4C5-1C05EECD11F3