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COVER PAGE <br />Applicant Contact Information <br />Applicant Organization’s Legal Name:Refugee Community Partnership <br />Applicant Organization’s Physical Address:117 W Main St, Carrboro, NC 27510 <br />Applicant Organization’s Mailing Address:PO Box 461,Carrboro, NC 27510 <br />Applicant Organization’s Web Address:www.refugeecommunitypartnership.org <br />Executive Director:Madison Hayes <br />Telephone Number:919-590-5910 E-Mail:development@refugeecommunitypartnership.org <br />Tax ID Number:26-3608741 <br />Funding Request <br />Please list all Fiscal Year 2024 Human Services (HS) funding requested for all programs and the <br />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 />Operation <br />s <br />$15,000 <br />Personne <br />l <br />$5,000 <br />Operations <br />$30,000 <br />Neighborhood Support Circles $10,000 <br />Personnel <br />and <br />Operation <br />s <br />$50,000 <br />Personne <br />l and <br />Operatio <br />ns <br />$10,000 <br />Personnel <br />and <br />Operations <br />$70,000 <br />Totals $10,000 $50,000 $10,000 $70,000 <br />Briefly explain your proposed use of funds: <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 />Signature: <br />Board Chairperson Date <br />Application Signatures: Please submit a wet signature or electronic signature,MS Word <br />cursive fonts are not acceptable. <br />Cover Page Page 7 of 21 <br />Exhibit A <br />Provider’s Outside Agency Application <br />Vice Chair <br />January 12, 2023 <br />January 12, 2023 <br />DocuSign Envelope ID: C7E9E35D-4294-4C57-9D16-FD34B7245AA8