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State of North Carolina <br />Division of Social Services <br />Contract Application <br />Page 2 of 7 <br />]0 <br />E. Contract Identification: <br />1. Provider <br />a. Name of Contract Administrator Dorothy Pennell <br />Tel. # : (91 91 644-105 1 <br />b. Nazne of Protrram Contact Person: _.Iinuny Modlin <br />Tel. #: <br />c. Program Name, Location and Mailing Address: Employment Security Commission <br />_T3illslzszxo~glr. NC 27278 <br />d. Additional Service Delivery Sites: Skills Development/.IobL,ink Center_ <br />e. Status : (X) Public ()Private, non-profit <br />( )Private, for Profit ( )Individual <br />f. Provider Contract ID #: <br />2. County Department of Social Services <br />a. Name of Contract Administrator: Nancy Coston <br />Tel. # : (919) 245-2800 <br />b. Name of Services Program Contact Person: <br />Tel. #: (919) 245-2800 <br />Gwendolyn Price <br />c. Address of Count~partment of Social Services: <br />NC 27278 <br />