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S p?or! Oar Stdents ?rogr m <br /> <br /> APPLICATION <br /> <br />Title & Authorization Page <br /> <br />County Name: Cabarrus <br /> <br />How lbng has your nonprofit organization been in operation? 8 years <br />Have you ever applied for SOS funding? Yes gl No [21 How many times? <br />Are you currently receiving SOS funding? yes <br />Program Title: 4-H SOS Goldminers <br /> <br />8 <br /> <br />Organization(s) Name/Address: N.C. Cooperative Extension <br /> P.O. Box 387 <br /> <br /> Concord, NC 28026 <br /> <br />Federal Tax ID #: 58-1775850 <br /> <br />Contact Person: Linda F. McGlamer7 <br />Title: Director <br /> <br />Telephone: 704-920-3312 I Fax: 704-792-0539 <br />Address: 715 CabarrusAve., Concord, NC 28026 <br /> <br />I Email: Linda McGlamery~_,ncsu.edu <br /> <br />Did you attend a technical assistance workshop on Jan. 28th or Feb. 4th <br /> <br />'Circle One) YES <br /> Funds Requested'''bq~pr°t~ who ~r= not currently reee~wng SOS funding may r~qu~st up to $75,000 <br /> Total / ,.1 _ ... _ · [ per ye~. ~you ~e cu~ntly recmving SOS ~n~, you may mqu~t ~e ~ndmg <br /> ~ [ } ~ ~ 0 ] ~ount you ~e cu~ently receiving.) <br />Authorization: We/I, ?he undersigned have read and understand the requirements <br />contained in the ~ant and hereby make application for the f~ds. All ~penditures <br />will be in compliance with grant requirements. (All appropriate parties should <br />below / ~, 7// ~ [Date: <br />Title: ~fi;i~, Bo~¢ ~ectors . ~. <br /> <br /> ~ 2~[ Date: <br />Title: <br /> <br />Please attach proof of your organization's 501 (c) 3 status (copy of letter from IRS <br />granting 501 c (3) status) and a completed notarized conflict of interest statement <br />(Form 1012). <br /> <br /> <br />