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7 <br /> APPLICATION SUMMARY <br /> Applicant Contact Information <br /> Applicant Organization's Legal Name: <br /> Applicant Organization's Physical Address: <br /> Applicant Organization's Mailing Address: <br /> Applicant Organization's Web Address: <br /> Executive Director: <br /> Telephone Number: E-Mail: <br /> Tax ID Number: <br /> Funding Request <br /> Please list all Fiscal Year 2024 Human Services (HS)funding requested for all programs and the proposed <br /> use of funds(please list program name only) <br /> Program Carrboro- Chapel Orange Total <br /> HS Hill-HS County-HS <br /> Ex. Youth Afterschool Program $10,000 $15,000 $5,000 $30,000 <br /> Operations or Personnel Operations Personnel Operations <br /> Totals <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 /> Cover Page P a g 5 of 21 <br />