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PART I - FACESHEET <br />APPLICATION FUR FEDERAL ASSISTANCE 1. TYPE OF SUBMISSION: <br />Application ®Non-Gonstrodion <br />2. DATE SUBMITTED TO CDRPORATION 3. DATE RECEIVED BY STATE: STATE APPLICATION IDENTIFIER:84000OOD868 <br />FOR NATIONAL SERVICE (CNS): <br />03/20/2000 4. DATE RECEIVED BY CNS: CNS GRANT NUMBER: <br /> 4405136/19 <br />5. APPLICANT INFORMATION <br /> NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER <br />LEGAL NAME: ORANGE COUNTY GOVERNMENT PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give <br />ORGANIZATIONAL UNIT: COUNTY GOVERNMENT area codes): <br />ADDRESS (give street address, city, county, state and zip code): NAME; KATHERINE L. PORTER <br />ORANGE COUNTY DEPARTMENT ON AGING TELEPHONE NUMBER: (919) 968 - 2054 <br />PO BOX 8181 FAX NUMBER: (919) 968 - 2093 <br />HILLSBOROUGH, ORANGE COUNTY, NC 27278 <br />e. EMPLOYER IDENTIFICATION NUMBER (EIN): 7. TYPE OF APPLICANT: (enter appropriate letter in box) ^ <br />8 <br />5 6- 6 0 0 0 3 2 7 <br />8. TYPE OF APPLICATION: A. State H. Independent School District <br />B. County I. State Controlled Institution of Higher Learning <br />^NEW ^CONTINUATION C. Municipal J. Private University <br />^REVISION D. Township K. Indian Tribe <br /> E. Interstate L. Individual <br />^ ^ <br />If Revision, enter appropriate letter(s) in box(es): F. Intermunlcipal M. Profit Organization <br /> G. Special District N. Private Non-Profit Organization <br />A. Increase Award B. Decrease Award G. Increase Duration O. Other (specify) <br />D. Decrease Duretion Other (specify): 8. 'NAME OF FEDERAL AGENCY: <br /> Corporation for National Service <br />10. CATALOG OF FEDERAL DOMESTIC ASSISTANGE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: <br />002 9 4 0 0 2 <br />94 <br />RSVP <br />: <br />. RETIRED AND SENIOR VOLUNTEER PROGRAM <br />FGP: 94.011 <br />SCP: 94.016 <br />12. AREAS AFFECTED BY PROJECT (Ust Cities, Counties, States, etc.): <br />Hillsborough, Chapel Hill, Carrbaro, Orange County, <br />North Carolina <br />13. PROPOSED PROJECT: START DATE: O7/O1 /2000 END DATE: 06/3O/2003 <br />14. ESTIMATED FUNDING: 15. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE <br />a. FEDERAL g 124,158 ORDER 12372 PROCESS? <br /> a. YES, THIS PREAPPLICATIONlAPPLICATION WAS MADE AVAILABLE <br /> TO THE STATE EXECUTIVE ORDER 12372 PROGES55 FOR <br />b. APPLICANT S 124,908 REVIEW ON: <br />c. STATE S DATE _3121 /2000 <br /> b. N0. ^ PROGRAM IS NOT COVERED BY E.O. 12372 <br />d. LOCAL S ^ OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR <br /> _ . _ ,. ... REVIEW <br />e <br />OTHER 531 <br />39 <br />. $ <br />, <br /> 16. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br />f. TOTAL $ 288,597 ^ YES If "Yes," attach an explanation. ^ NO <br />17. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, TWE DOCUMENT HAS BEEN DULY <br />AUTHORIZED BY THE GOVERNING 90DY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED. <br />a. TYPED NAME OF AUTHORIZED REPRESENTATIVE: b. TITLE: c. TELEPHONE NUMBER; <br />MOSES Carey, Jr. Chair of Orange County Board of Commissioners 919-732-8181 ext 2125 <br />d. SIGNATURE OF AUTHORIZED REPRESENTATIVE: e. DATE SIGNED: <br />Modified Standard Form 424-NSSC (Rev 4/88 and 12/97) <br />PAGE 5 <br />