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<br />Page 2 of 22 <br /> <br />Attachments <br />(A description of these items is <br />available on page 13: <br />“Description of Required <br />Attachments.” Please contact <br />us if it will not be possible to <br />provide any of these required <br />attachments at the time of <br />application: <br />sustainability@orangecountync <br />.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 2023 <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 2023 <br />☒ List of members of organization’s Governing Board (if Board exists) <br />☒ Certificate of Insurance <br /> <br /> <br />COVER PAGE <br /> <br />Applicant Organization’s Contact Information <br />Organization’s Legal Name: Habitat for Humanity, Orange County, N.C., Inc. <br />Physical Address: 88 Vilcom Center Drive, Suite L110, Chapel Hill, NC 27514 <br />Mailing Address: 88 Vilcom Center Drive, Suite L110, Chapel Hill, NC 27514 <br />Web Address: www.orangehabitat.org <br />Telephone Number: (919) 932-7077 <br />E-Mail: ajacoby@orangehabitat.org <br />Tax ID Number: 58-1603427 <br /> <br />Funding Request Summary <br /> <br />Please list all proposed projects (please list project name only) for which you are requesting Community Climate Action <br />Grant funding for Fiscal Year 2024-25. Make sure to include a brief description of the proposed use of funds. Applicants <br />will be asked to provide more details on their proposed project budget in the B udget Worksheets attachment. <br /> <br />Project Equipment Operations Personnel Total <br />Example: Youth Climate Leadership Project $10,000 $15,000 $5,000 $30,000 <br />Rooftop Solar for Affordable Habitat Homes $100,000 <br /> <br />Docusign Envelope ID: AA482F5E-25D4-439A-862A-65CC63DF3A74