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10 <br />State ofNorth Carolina <br />Division of Social Services <br />Contract Application <br />Page 2 of 7 <br />E. Contract Identification: <br />1. Provider <br />a. Name of Contract Administrator Dr. Shirley Carraway <br />Tel. # : (919) 732-8126 <br />b. Name of Program Contact Person: Donna Williams <br />Tel. #: (9191732-6271 <br />c. Program Name, Location acid Mailing Address: Orange County Schools <br />x(1(1 F. T<ing_$t <br />Hillsborough. NC 27378 <br />d, Additional Service Delivery Sites: <br />e. Status : (X) Public OPrivate, non-profit <br />( )Private, for Profit ( )Individual <br />f: Provider Contract ID #: <br />2. Count~partment of Social Services <br />a. Nazne of Contract Administrator: Nancy Coston <br />Tel. # : (919) 732-8181 <br />b. Nance of Services Program Contact Person: Gwen Price <br />Tel. #: (919) 7.32-8181 <br />c. Address of Count~partment of Social Services: <br />P.O. B x 1~ <br />300 W..Tryon St. <br />Hillsborough, NC 27278 <br />