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Home My WebLink About2017-064-E Arts - Chapel Hill-Carrboro Public School Foundation - Fall 2016 Arts Grant Agreement WI DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B C l( ORANGE COUNTY ARTS COMMISSION �a a »v (r; 1 1∎iJ r J F 1 a FALL, 2 I6 GRANT AGREEMENT N ;,b; 0 u n THIS AGREEMENT, entered into this 17 day of January, 2017, by and between Orange County ("County"), by and through the Orange County Arts Commission ("Arts Commission") and Chapel Hill-Carrboro Public School Foundation ("Grant Recipient"). WHEREAS, the Arts Commission is a countywide arts agency that ensures the growth of local arts experiences by providing funding and support for diverse high quality programs and projects. WHEREAS, the Arts Commission administers the Spring and Fall Arts Grants Program to provide economic opportunities to Orange County artists and non-profit organizations coordinating arts projects benefiting the citizens of Orange County. WHEREAS, the Spring Arts Grants Program is supported by Arts Commission with funds from the Grassroots Program of the North Carolina Arts Council, an agency of the Department of Cultural Resources and the National Endowment for the Arts. WHEREAS, the Grant Recipient was selected by the Arts Commission to receive the Spring Arts Grant through the procedures duly adopted by the Arts Commission; and WHEREAS, both parties wish to promote and maintain the integrity and clarity of the Grant Recipient's ideas and statements and delineate the Grant Recipient's obligations to the County; NOW, THEREFORE, the County and the Grant Recipient, for the consideration and under the conditions hereinafter set forth, agree as follows: 1. Approved Grant Project. Grant funds are provided under this Agreement for the project ("Project") described in the Grant Recipient's Grant Application, attached hereto and incorporated herein as Exhibit A. 2. Grant Award. Grant funds in an amount not to exceed five hundred dollars ($ 500.00) have been awarded by the Arts Commission to the Grant Recipient for the approved Project. These funds must be matched at least dollar-for-dollar with cash from the Grant Recipient's funds not derived from either Orange County appropriations or the North Carolina Arts Council. 3. Contingency. This grant is contingent on North Carolina Arts Council Grassroots Program funding to the Arts Commission. Final decisions on Grassroots Program funds to the North Carolina Arts Council are subject to approval by the North Carolina General Assembly. 4. Responsibilities of the Grant Recipient 1 Revised January 2017 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B A. Implementation. The Project implementation shall take place between January 1, 2017 and December 31, 2017. The Project shall be implemented in the manner described in Exhibit A. Time is of the essence in the implementation of the Project. B. Modifications to project. Grant Recipient shall present major changes to the original proposal, including but not limited to changes in design, implementation schedule and increase in Project budget by more than 10%, in writing to the Arts Commission for approval. Arts Commission shall approve or disapprove Grant Recipient's request for modifications within seven (7) days of receipt thereof Consent to project modifications shall not be unreasonably withheld. Arts Commission's decisions shall be in writing. In the event the Arts Commission fails to approve or disapprove the requested modifications within the time stated herein, the modifications shall be deemed approved. C. Non—assignment. The grant cannot be assigned or transferred to a different project or artist without prior written approval of the Arts Commission. D. Records. Grant Recipient must maintain records and other evidence pertaining to costs incurred and revenues acquired during the Project implementation. Grant Recipient shall maintain financial records pertaining to the Project for three (3) years from the date of this Agreement, in case of audit. E. Use of Funds. Grant Recipient shall not use the grant funds to repay outstanding taxes or other debts of any nature. The grants shall be utilized solely for the purpose of implementing the Project and Project related expenses. F. Final Report. Grant Recipient shall submit to the Arts Commission a Final Report on January 12, 2018. The Final Report shall be in the format required by the North Carolina Arts Council. Failure to submit the Final Report or late submission of the Final Report, for any reason, shall be grounds for denial and/or cancellation of grant funds for the Project and future grant proposals. 5. Responsibilities of the Arts Commission A. Payment. The Arts Commission shall release the grant funds in the amount of $500.00 to the Grant Recipient. 6. Publicity A. Acknowledgement. Credit must be given to the Orange County Arts Commission and/or the North Carolina Arts Council using the proper logo(s) and credit line in brochures, news releases, programs, and all other printed and online publications. Copies of such printed materials must accompany the evaluation report. Official Orange County Arts Commission and North Carolina Arts Council logos may be downloaded at www.artsorange.org/grantee-resources and may not be altered in any way. When no printed information is used, verbal 2 Revised January 2017 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B credit shall be given. In addition, all print and promotional material must include the following credit line and logo(s) (check all that apply): i. x County Funds Only. Orange County Arts Commission logo required. Credit line: "This program is supported by the Orange County Arts Commission. " ii. North Carolina Arts Council Funding. The Orange County Arts Commission and the North Carolina Arts Council logos are required. Credit line: "This program is supported by the Orange County Arts Commission through the N.C. Arts Council, a division of the Department of Natural and Cultural Resources. " B. The Grant Recipient must enter all events, exhibits and performances open to the public and related to this grant award on the ExploreChapelHillARTS.com website and display Orange County Arts Commission publicity materials (postcards, brochures, etc.) prominently and consistently at their venue or performance space. In addition, the Grant Recipient must add a link to the www.artsorange.org (Orange County Arts Commission logo preferred) to their main webpage. 7. Indemnity. The Grant Recipient agrees to indemnify and hold harmless the County, the Arts Commission and the North Carolina Arts Council and their officers and employees from any and all claims or actual injury, damage or loss to a person, or real or personal property that results from or is in any way connected to the use of the grant funds. 8. Independent Contractor. The Grant Recipient is an independent contractor and not an employee, agent or other representative of the County and/or the Arts Commission. Nothing contained in this Agreement shall be construed to create the relationship of principal and agent, or employer and employee, between Grant Recipient and Arts Commission or Orange County Government. Grant Recipient understands and agrees that he/she is not authorized to incur any expenses or any liability whatsoever on behalf of the County or the Arts Commission and has no authority, expressed or implied, to obligate or make representations on behalf of the County or the Arts Commission. In addition, Grant Recipient agrees to maintain his or her own worker's compensation insurance for himself/herself and his or her employees for the duration of the art work's installation. 9. Termination A. In the event of any of the circumstances set forth below (hereinafter referred to as "default"), the Arts Commission may immediately terminate this Agreement: (i) Any fraudulent representation in any verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. 3 Revised January 2017 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B (ii) Nonperformance, incomplete service or performance, or failure to satisfactorily perform any part of the Project or to comply with any provision of this Agreement, as determined by the Arts Commission in its sole discretion. (iii) Failure to adhere to the terms of applicable county, state or federal laws, regulations, or stated public policy. B. In the event of default by the Grant Recipient, the Arts Commission has the discretion to elect to terminate this Agreement, in whole or in part and/or require the Grant Recipient to repay the grant funds within seven (7) from written notice of default or allow the grant recipient the opportunity to cure the default. This clause shall not be interpreted to limit the County's or the Arts Commission's remedies in law or in equity. 10. Miscellaneous. A. Entire Agreement. This Agreement and the attachments contain the final and entire understanding of the parties with respect to the subject matter of this Agreement. All modifications and amendments to this Agreement shall be in writing. This Agreement shall be binding upon the parties, their heirs, successors and assigns. B. Governing Law. Both parties agree that this Agreement shall be governed by the laws of the State of North Carolina. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all state and federal anti-discrimination laws, policies, rules, and regulations and the Orange County Anti-Discrimination Policy. Any violation of this requirement is a breach of this Agreement and County may immediately terminate this Agreement without further obligation on the part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. By executing this Agreement Provider affirms that Provider is and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. C. Entire Agreement and Signatures. The parties have read this Agreement and agree to be bound by all of its terms, and further agree that it constitutes the complete and exclusive statement of the Agreement between the parties unless and until modified in writing and signed by the parties. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 1 1A and Article 40 of North Carolina General Statute Chapter 66. [SIGNATURE PAGE TO FOLLOW] 4 Revised January 2017 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B IN WITNESS WHEREOF, the Orange County and the Grant Recipient have signed this Grant Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and on behalf of the Grant Recipient DocuSigned by: 0C298F J p i Hill-Carrboro Public School Foundation Date Date For and on behalf of Orange County Government DocuSigned by: bbuAAA,it, tkeum to-rStu1 2/9/2017 a',_ itfiarirnmersley, County Manager Date 5 Revised January 2017 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 1 1, FALL 2016 ORANGE COUNTY ARTS ARTS IN EDUCATION GRANT COMMISSION APPLICATION FORM 1. APPLICANT INFORMATION Applicant Name Nancy Zeman/Chapel Hill-Carrboro Public School Foundation Mailing Address P. O. Box 877, Carrboro, NC 27510 Daytime Phone 919-967-8211 x28376 Email Address nzeman @chccs.kl2.nc.us Web Site www.publicschoolfoundation.org DUNS Number 182048145 2. PROJECT DIRECTOR INFORMATION Project Director Name Nancy Zeman Title Program Services Manager Home Address: 106 Quailview Drive, Chapel Hill, NC 27516 Daytime Phone 919-967-8211 x28376 Evening Phone 919-225-0075 Email nzeman @chccs.k12.nc.us DUNS Number 182048145 3. GRANT REQUEST SUMMARY Arts Program Grant Request $ 500 Total Cash Match $ 500 Total Organizational Budget Past Year $306,880 (Including PTSA/Cultural Current Year $316,700 Enrichment/Arts Program) Projected for Next Year $310,000 Summary Statement for Proposed Uses of Arts Program Grant: The Skoog music project will promote independent involvement in music activities, allowing students with significant disabilities to play music on their own--perhaps for the first time in their lives! 4. NARRATIVE Write a description (no more than three pages,single spaced)that describes the following under separate subheadings: • School profile—a brief overview of population and services. • School's arts programs—a brief list. • Proposed uses of grant funds—description, including location,date,artists involved. Include information concerning whether you have undertaken similar activities in the past. Include approximate number of audience per program;geography of audience;mix of race, ethnicity, age,and gender. Discuss how arts program will be integrated into the curriculum. is 919.245.2335 1 200 S.Cameron Street, Hillsborough,NC 27278 I www.artsorange.org DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 5. APPLICATION CHECKLIST (in this order;do not staple, bind, or put into individual folders) One copy:1 sided,8 1/2"x 11", white paper La Application Form, including signatures gNarrative f, Budget Sheet YJ ❑ Itemized Budget (if necessary) Resumes of key artists and administrators involved in grant funded program(s) Organizational Budget for current AND past two fiscal years NY ❑ Artist contact list, including names, address, phone numbers,and email (if applicable)of all artists involved in grant funded activities Staff roster of all school art& music teachers with position title(s). Board contact list, including names,address, phone numbers, and email (if applicable)of organization's board of directors V Copy of IRS Tax Exemption Letter, if private school NA ❑ Sample programs, press,or other materials from this or similar past programs A(,/k ❑ Sample work by artist (labeled with artists' name,title of work, date of work) produced in the last three years: o Visual artists: CD, DVD,or high resolution photographs (5-10 images). Clearly label each piece with dimensions and media and indicate top of image o Dance or theater artist: CD or DVD, or link to high-quality online video(3-5 minutes) o Music and spoken word: CD, MP3 or link to high-quality online video(3-5 minutes) o Literary arts: Manuscript(10-15 pages)submitted by.pdf or hard copy 6. SIGNATURES Typed or Printed Name—Project Director: Nancy Zeman c/S-: r 11-20-2016 Signature of oject Dir- tor Date E' Typed or Printed Name—Authorizing Official: Lynn Lehmann -:_ 11-20-2016 Si gnat of Authorizing O ff icial Date 919.245.2335 200 S.Cameron Street, Hillsborough, NC 27278 ( www,artsorange.org DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B Arts in Education Application Narrative--Fall 2016 School Profile —a brief overview of population and services McDougle Elementary School's mission is:To support the academic and personal growth of all students through a positive, inclusive and collaborative culture. The school's vision is:Together we learn. Together we grow. Together we celebrate success as we go. Belief Statements of the school are as follows: 1. We believe a positive, supportive, collaborative and differentiated learning community is fundamental to sustaining a culture of learners. 2. We believe embracing mistakes and taking risks empowers all of us, students, teachers and parents, as learners. 3. We believe our success comes from holding students to high expectations and is measured in many ways. 4. We believe all students and staff bring strengths and experiences which are valuable to the entire school community. 5. We believe strong partnerships between home, school and the community will support authentic learning experiences for students and staff. The racial breakdown of McDougle's approximately 500 students is 58 White%, with the non- white portion composed of roughly 6%Asian, 16% Hispanic, 15%African American, and 5% multicultural students. The student population receiving free-or-reduced is approximately 31% at Smith Middle School. School's Art Program-a brief list The arts education program at McDougle Elementary School follows the Arts Education Essential Standards established by the North Carolina Department of Instructional Services. The arts are core subjects for elementary school students and include each of the following arts disciplines: dance, music,theatre arts, and visual arts. Elementary-aged students receive art instruction in their regular classroom as well as once per week in a separate classroom with a certified art instructor.The philosophy of the art program, according to the NC Department of Instructional Services, is as follows: "The arts have been part of life from the very beginning and are an inseparable part of the human journey. They have described, defined, and deepened the human experience.The arts are everywhere in our lives, adding depth and dimension to the environment we live in, and shaping our experience daily. The arts help students perceive and think in new ways. The arts are a powerful economic force as well, from fashion,to the creativity and design that go into every manufactured product,to DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B architecture, to the performance and entertainment arts that have grown into multibillion-dollar industries. Arts education benefits both student and society, because students of the arts disciplines gain powerful tools for many aspects of life." Proposed Uses of Grant Funds —description including location, date, artists involved. Include information concerning whether you have undertaken similar activities in the past. Include approximate number of audience per program; geography of audience; mix of race, ethnicity, age, and gender. Discuss how arts program will be integrated into the curriculum. Grant funds will be used to purchase two Skoogs for use by disabled students in the Exceptional Children's classrooms at McDougle Elementary School. A "Skoog" is a foam cube, compatible with most computers,that acts as a hands-on controller for making music in a way that brings a child's creativity to life (see www.skoogmusic.com). The Skoog music project will promote independent involvement in music activities, allowing students with significant physical differences to play music on their own—perhaps for the first time in their lives! Use of the Skoogs would give students an opportunity to use their motor skills in a practical and naturally motivating setting. The Skoogs will also serve to address the Individualized Education Plan (IEP) goals for each student that relates to active participation;fine and gross motor skills; communication; and independence. This project addresses one of the Chapel Hill-Carrboro City School's (CHCCS) Strategic Plan goals: The culture of schools in CHCCS will be one that encourages innovation, risk-taking, excitement for learning, and personal growth in a trusting partnership with the community. The Skoog music project addresses the above goal by encouraging student excitement for learning through music and use of innovative technology. Teachers expect to see the literary skills of these students with significant disabilities to improve as the use of the Skoogs will promote a sense of fluency and rhythm in reading. In mathematics,the Skoog will assist in attention to patterns and counting to follow a rhythm. The Skoogs will be used most often by the 12 or so students in the Exceptional Education (EC), but will also be available at times to the other 500+ McDougle students. Maggie Pearce, Teacher of Exceptional Children, is a certified special education teacher at McDougle who has extensive experiences with the use of assistive technology with her students. She will collaborate with the other EC classroom teachers,the speech-language therapist,the occupational therapist, and the physical therapist at the school, as well as the school-based music teacher,to facilitate proper training and planning with the Skoogs. The project timetable is as follows: DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B December 2016—Order Skoogs; introduce Skoog technology to all staff and engage in creative brainstorming sessions on its use; introduce Skoog to students and allow for exploration January 2017—Incorporate opportunities to use the Skoog in the EC classrooms,the music classroom, and other settings as opportunities present themselves January-June 2017—Begin data collection on whether students demonstrate active and intentional participation in creating spontaneous and original music June 2017—Complete and return the grant Evaluation Form to Public School Foundation ra jg 1= DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B I // V■ FALL 2016 ARTS IN EDUCATION GRANT ORANGE COUNTY ARTS BUDGET SHEET COMMISSION FINANCIAL INFORMATION Please provide a projected budget for your proposed project utilizing the format below. f' PROJECT EXPENSES Grant Amount + Applicant = Total Expense Requested Cash Match A Personnel Administrative staff Artistic staff Technical/Production staff B Outside Fees and Services Artistic contracts Other contracts: C Space Rental D Travel E Marketing F Remaining Project Expenses G Total Cash Expenses $500 $500 $1000 PROJECT INCOME Cash Income A Admissions B Contracted Services Revenue C Other Revenue(specify) D Private Support Corporate support Foundation support $500 Other private support E Government Support r Federal State/regional(not including this request) Local (not including this request) F Applicant Cash G Grant Amount Requested in this application $500 H Total Cash Income $1000 (must equal Total Cash Expenses,Item G above) 919,245 2335 I 200 S.Cameron Street, Hillsboi°ugh, NC 27278 I www,aitsorange.org is DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B Nancy Word Zeman 106 Quailview Drive Chapel Hill, NC 27516 (h) 919-967-2571, (c) 919-225-0075 EDUCATION: M.S.,Microbiology, B.S. Biology--Virginia Tech PROFESSIONAL EXPERIENCE: Chapel Hill-Carrboro Public School Foundation September 2015-present Project Services Manager • Deal with all things grant-related at PSF including the Foundations granting process,writing grants on behalf of the Foundation, conducting grant-writing workshops, securing partners for grant funding, etc. Benjamin Vineyards, Graham,NC 2001-Present Co-owner and co-manager • Involved with all operations of a family-owned and-operated vineyard Triangle Biotechnology Consulting, Chapel Hill,NC 1991-2006 Consultant • Provided expertise in the fields of food and nonfood biotechnology regulatory issues CPC International Inc. 1981-1991 (various divisions including Corn Products,Enzyme Bio-Systems Ltd.) Development Specialist • Involved with New Product Development and Regulatory Affairs RELEVANT VOLUNTEER AND EDUCATION EXPERIENCE: Chapel Hill-Carrboro Public School Foundation Board 1997-2015 This foundation, associated with the CHCC Schools, creates opportunities for teachers and students in the district • As Co-Chair of the Allocations Committee,have a broad awareness of the programs and needs of the district. Have overseen the disbursement of hundreds of thousands of dollars to the CHCCS district. • Started several new flagship programs, including Teachers First Breakfast and the Race for Education that both continue to be successful fundraisers for the Foundation • Have personally secured hundreds of thousands of dollars in grant money for teachers and district programs • Served previously as Board President, Vice President and Walk for Education Chair School Reading Partners 1998-Present A program that involves reading one-on-one with identified students K through second grade. • Currently Assistant Site Manager at McDougle Elementary and served as a consultant to the District for the 2014-15 school year • Participated at three different elementary schools through the years (McDougle Elementary,Frank Porter Graham Elementary, and Northside Elementary) DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B • My session with a student is included in the instructional video that is used to train new SRP volunteers Coach Write! 2001-2006 A support program that helps students with their writing skills. Typically,the volunteer works with a student in a one-on-one setting on a written piece that he/she is editing. • Helped develop and launch this as a pilot program at Frank Porter Graham Elementary • My session with a student was filmed and is included in the instructional video used to train new Coach Write! volunteers Blue Ribbon Mentor Advocate(BRMA) 2008-2016 The BRMA program pairs mentors with minority students who show promise, generally starting when the student is in fourth grade. • Trained as a BRMA volunteer in 2008 • Paired with an African-American mentee in the Fall of her fifth grade year and continue as a mentee for that student who is now a Senior at Carrboro High School READ2ME:Tailgate Stories 2008-Present An outreach program aimed to keep low income students,the majority of whom are minorities,reading through the summer • With Mary Andrews, initiated this program in one Scroggs neighborhood the first year • This program has now expanded into a district-wide summer program involving all CHCCS district elementary schools at 25 different sites • Successfully written numerous grants annually to fund books for this initiative Family Reading Partners 2010-Present , A program that brings families together around books and encourages reading with at-risk children. We model for parents how to read with their children and have good conversations around quality books. The books are then given to the families to take home for their personal libraries. • Developed with M. Andrews and have conducted numerous sessions at multiple district elementary schools • Program expanded to adolescent parents in all Orange County's high schools • Help select quality literature and write conversation cards for the program • Successfully written multiple grants to obtain funding for the books as well as the meals for this program • This program is now expanding into CHCCS Pre-k programs,the Orange County Literacy Council, Orange County Social Services, and UNC Horizons Program • Received Motheread/Fatheread training in 2012 Guided Reading Bookrooms (GRBs) 1997-2016 Guided Reading Bookrooms in elementary schools are a cost effective way to offer large numbers of sets of books in a range of reading levels and topics to be used for guided reading in all grades/classes within a school • Instrumental in starting three GRBs (McDougle Elementary, Frank Porter Graham Elementary, and Northside Elementary) • Responsible for ordering,processing, and cataloguing new books • Obtained numerous grants for new books that have been added to the schools' collections i' F DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 10 o 0 0 0 0 0 O o 0 0 0 0 0 0 0 O 0 0 0 0 0 0 0 0 0 r1 -0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 N N O O O O O O O O O O O O O O O O O O O O O O O O O CO 0 o °o o ` °o °o o 0° o o °o 0 0 0 0 °O 0 CCD 0 rn N 0 f:. a l0 0 O 10 10 n O IL r r o0 O O 0 r 00 f0 r CO' N CO' r O H m r M rn N CO 0) r M r CO r I£?: a` Li-) 0 0 0 0 0 0 ° O O O 0 0 o 0 o OD o 0 o N o o 0 CO a ' 'o 0 0 0 0 0 0 0 0 0 0 N. r 0 0 0 N 0 0 0 0 0 0 DC CO l'ss 0 V C D 0 CO 0 Co N 0 0 co 0 0)) 0 0 0 0 N 0) V 0) 0 DC 0 0 d `""I N CD O) U CO O N O) CO CD N- 0 N- N (O N 0 CO II) OO co M co •o Lai 0 0 N 0 0 r 0 (0 N 0) CO O N CO CD N r r t- CD L- } r r N r r CO r r 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COi 4J O O O O O 'O O O O O O O O O O O O O O O O O O O O O O 0 o 0 0 0 0 0 0 0 0 o 0 0 0 00 co 0 0 0 0 0 0 0 0 0 0 C) -0 0 0 0 0 0 0 10 N 0 0 N- 0 r N V 0 1O h 0 N 0 1' ..-4 N N h O O CO r r N O N N 0 10 N co- V r r :3' O O M r r r V r N r N CO r r d' 0 n 1' 0) CO CO CO 0 0 0 0 0 0 CO r 0 CO 1' N CD CO N 0 0 LO CO r1 CU CD LO M N r CO CO 0 0 0 0 0 0 )O 0) )O 00 N CO 0 CO CO 0 O CO CO O C L.f) (h M 0 6 0 LD O O @ CO O 6 O r O 1' d' 1' CO O 00 r O CO 0 0 0 N O N co co 0 N V 1' )O 0 00 O) L0 0 7 0D CO 0 N- CO 0 0 0 1' N 0 N O CO N N r 0 0 r c 0 CO CO CO 0 1' N I� n r LO CD 0 LO N- 0) 10 0 W N CO M T (O (D N N dD OJ tD N t N V LOO O n M LD tD (7 N co c0 (O Lc) 0 N 0) N o 00 O O O) 0) 0 n CO N 0 0 O N CO (.,.1 N O O co O I-- 0) N CO O 1' O O IT (D 00)) (D CO M 0 CO LO 0 0 0 LO 0 V 0 O O 0 O (O (V (0 Ln 16 C' O O M O O O O 4 O O r 0 O 6 4 N O 1jf k h N h 0 0 1' O) 0 0) CO (D M O N. 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C G W ii DocuSign Envelope ID:F7163211-DB22-463E-994F-95118O0DB63B h O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O O O O O O O O O O O O O O O O O O O O O O 0 0 o 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 O O O O O O O O O to to (0 d' 0 0 0 0 (1) r O O O O O to CO r CO N 0 CO r N r O O V O d- r - N co- (9 r d LL N N V CO d' d' N (D CO 0 0 0 0 CO 0 0 0 0 CO 0 O O 0) N d' O) 0) O r N 0 0 CO 0 7 0 0 0 0 N _0 CO O d' O 6 6 N d' o o U) O O N d' O O O N O C) O N r tiO r O co O N V CO (0 CO d' 0 0 CO t0 CO to OD O O o 0) 0 DC CO CO CO r ,- CO CO r N 0 CO d- N N V N N r s- tq C) C) O O c- co t0 M • z. o o O O O O O O O O O O O O O O O O O O O O o o O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o• co to co N O O O O to O N O tO to O O (0 co tO (D CO O N N O O O_ 0 N CO tO ,- CO N O W 0 (4) NF (O O CD- 0- C) c- •- CO to O O d 0 CO s- r CO N tO D a 0 d C) 0 0 CO 0 0 0 CO CO 0 d' m O ( 0 V d' 0 0 0 0 0 0 0 0 0 tO t0 0 t0 N C) cV O of to N: v 6 O v to o O O C) CO O tV 01 �',; 0) co O (0 d' CO (O 0 CO 0 CO d' d' O d' d' N CO O to N N tO to 0 to O to N r CO CO d' CO d' N- 4 O sci O O W t0O co d' O ( N N ' Co V I. 04 CO CO 0) 7 C) t0 O d' O N O O O N o O V' r I,- 6 (D m O d' co m N N O co O O O co O O 'Cr o (o ro v v Ci (o Di o r o o d « o d 0 0 - o W W O r N- N C) C d r CO m d M O CO r r r d' CO V CO C N 0 M TO- tO c- 7 O 0 r V Lo V N W op N d' co t CD 0 CO d' 0 0 0 to 0 0 0 0 0) 0 0 W 0 d' _ _ O CO 0 CO 0 0) 0 C) 0 0 0 CO CO 0 N CO (:'.,...'. (V O O 0- 0- 6 (() W O O 0 O O O N O d' r O O C0 W CO (A r r CO CA 0 co at d' co O O co co 0) N co, d 0- r 0 0 r W N •- r •- (0 CO 0 W CO O) c- CO- r N: CC) N CO- N r r c - (^ N. r v v (±) CO • t0 co 6 to to 4 co co O CO 0 r 0 0 to CO CA CO CO CD st N (O d' C) C) CO d' N OD 0 0) 0 (D 0 0 0) co CO to CO (0 6 O M (0 O r O 6 6 O (V C) O tf) CO OJ O d' r �- co CO co C) 0) Cl CO CO 'O d' CO CO 0 CD (0 0) (O d' d' O N N 0) 0 - 0404001040- 04 co co r C V r CO r r CO CO CO N O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (() N n cV O o O (o O r O C1 O d' O O (V C) q) O CO) O oo CO CO 0 0 r r O CO N D) 0 0 O 0) [ CO N- d' O 0) N CO c- V W 0 N- CO N r r C ')O CO) (D (A O Cfl N O O O O 0 0 0 0 0 0 0 O 0 0 0 0 0 0 0 0 C) r O o O O 0 0 0 0 0 0 0 0 CO 0 0 0 0 0 CO 0 CO (V - 6 W O O d' d' W O 6 6 d' N O O 6 6 d' O N O co to CO CA 0 N 0 CO 0) 0 CO (0 O CO _ CO r N CO r r r CO 0 d' N N- 0 to CO N N N r CO- 05. uj c- CO- N- r N N 0 N r 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O 0 o O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O O O 0 0 0 ttj h (V CO O OD (V 0) 4 r 6 6 6 6 6 6 s- 6 6 6 6 6 co 1- CD aN- CO N- ((0 0 O 0 CO 0 t(�') N- CO CO CO - N O O N o N N .-- �- tq V d' N- r N CO 0 N G 2 0 w t 6. C Y ee 0 N [' a `m O 3 c .0 ' c '0 - C N O CN 3 '0 m G O c c N W 0) E r °- 8 O a o o) s w 0.0. ° c0i a �' X X a tQ U c y W W , N C A d W O c W N LL G s G 0 C O O W N O CC O y ❑ c LL O d N V N X C N tl C C N C y O a Y_ y > '6.3 Q d GO C > C X 0. H E. 0 N �' W N c ow O 'O O 7 O 2' i R O W F,: N s. 'y G a Q C O D. 5 I- m O. 0) fx.: W a Ut E '` O 0 O W > m C V W N N }C C O N C d L y O N a G. (o LL a O D 0 p CI 0 0 re, .00 0 C H d 0) 1- li 12- O I-- Z {{ it A r, 4` i „I If O N C O X W R O F DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B Pi 9:08 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 Jul'15-Jun 16 Ordinary Income/Expense Income 30th Anniversary 0.00 Contributions Annual Appeal 27,656.94 Board Contributions 10,530.61 Corporate&Foundation Support 271,289.90 Government Grants 3,500.00 Individual contributions 132,883.30 School Raised Funds 120,304.63 TF Breakfast 96,905.00 Total Contributions 663,070.38 Other Revenue Capital Gains 10,356.68 Dividend Income 29,251.52 Fees 14,106.27 Interest Income 777.75 Net realized gains on investmen -30,712.50 Net unrealized gain on investme 1,549.66 Other income 0.00 Other Revenue-Other 52.22 Total Other Revenue 25,381.60 �> Pass Through Income Blue Ribbon Mentor Advocate Blue Ribbon Mentor 3,000.00 International Trip Fund 0.00 Sponsor a Scholar 0.00 Youth Leadership 0.00 Blue Ribbon Mentor Advocate-Other 0.00 Total Blue Ribbon Mentor Advocate 3,000.00 Chapel-Hill Carrboro City Schoo 246,788.00 Misc Pass Through Income -282,994.13 Rtl Consortium 0.00 Schools Pass Through Income Carrboro High School 0.00 Chapel Hill High School 0.00 Culbreth Middle School 0.00 East Chapel Hill High School East Baseball 1,000.00 East Football 0.00 East Chapel Hill High School-Other 2,290.00 Total East Chapel Hill High School 3,290.00 Estes Hills Elementary School 3,000.00 Frank P.Graham Elementary 0.00 Glenwood Elementary 500.00 Morris Grove Elementary School 1,000.00 Northside Elementary Northside Arts In Action 0.00 Northside Elementary-Other 13,473.86 Total Northside Elementary 13,473.86 Phillips Middle School 750.00 Phoenix Academy 3,750.00 Scroggs Elementary School 0.00 Seawell Elementary 0.00 Smith Middle School 10,442.27 Schools.Pass Through Income-Other 0.00 Total Schools Pass Through Income 36,206.13 Total Pass Through Income 3,000.00 Page 1 f. DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B i 9:08 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 G Jul'15-Jun 16 Programs/Events 5K for Fitness 17,782.76 Inflatables 694.00 Merchandise Sales 981.00 Raffle Tickets 350.00 Total Programs/Events 19,807.76 Total Income 711,259.74 Gross Profit 711,259.74 Expense Contracted Services Expenses Accounting and Audit fees 6,800.00 Bookkeeping 0.00 Legal fees 0.00 Other contracted services 2,750.00 Web/internet support 312.17 Total Contracted Services Expenses 9,862.17 Fundraising 5K for Fitness 11,370.52 Fundraising-other 318.11 Walk For Education 46,327.26 Total Fundraising 58,015.89 Non-operating expenses -178.77 Office Expenses Computer supplies 144.99 Office Supplies 1,603.08 Postage and shipping 1,302.34 Printing and reproduction 1,331.88 Telephone 873.99 Total Office Expenses 5,256.28 Other Operating expenses Advertising and promotions 25.00 Bank Service Charges Investment Fees 2,326.32 Virtual Terminal-trans fees 7.08 Bank Service Charges-Other 4,415.14 Total Bank Service Charges 6,748.54 Board/Meals Expenses 390.80 Depreciation expense 2,914.30 Dining 0.00 Dues,subscriptions and books 1,042.43 Insurance 340.00 Merchant Fees 1,283.06 PO Box&postage Equip Rental 164.00 Travel 300.00 Other Operating expenses-Other 0.00 Total Other Operating expenses 13,208.13 Pass Through Expense 30th Anniversary 0.00 Blue Ribbon Mentor Advocate Blue Ribbon Mentor 1,500.00 Haidt Foundation 0.00 International Trip Fund 0.00 MSAN Student Conference 920.00 Sponsor a Scholar 0.00 Youth Leadership 0.00 Total Blue Ribbon Mentor Advocate 2,420.00 Page 2 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B Gs 9:08 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 Jul'15-Jun 16 Chapel-Hill Carrboro City Schoo 164,491.14 Community Connections Program 0.00 Fund Management Fees 5,727.00 ec Misc Pass Through Expense -234,238.01 NCSA Scholarship 193.00 Rtl Consortium Exp Rtl Reimbursements 23,486.48 Rtl Consortium Exp-Other 7,760.37 Total Rtl Consortium Exp 31,246.85 i- Schools Pass Through Expense Carrboro High School 6,140.79 Chapel Hill High School 0.00 Culbreth Middle School 0.00 East Chapel Hill High School East Baseball 4,012.02 East Football 1,403.33 East Chapel Hill High School-Other 1,700.00 Total East Chapel Hill High School 7,115,35 Ephesus Elementary School 172.00 Estes Hills Elementary School 3,000.00 Frank P.Graham Elementary 0.00 Glenwood Elementary 600.00 Morris Grove Elementary 900.00 Northside Elem Northside Arts In Action 0.00 Northside Elem-Other 16,326.93 Total Northside Elem 16,326.93 Phillips Middle School 750.00 Phoenix Academy 705.68 Scroggs Elementary School 135.00 Seawell Elementary -174.00 Smith Middle School 2,635.27 Schools Pass Through Expense-Other 0.00 Total Schools Pass Through Expense 38,307.02 Pass Through Expense-Other 0.00 Total Pass Through Expense 8,147.00 Payroll-Related Expenses Payroll taxes 10,670.65 Salaries&wages 139,485.70 Vacation/Sick Leave -20,000.00 Total Payroll-Related Expenses 130,156.35 Program Expense Grants Awarded 245,859.93 Other Awards 415.15 Scholarships 22,097.89 School Disbursements 103,820.94 Store Expenses 1,480.00 Teacher programs Other Teacher Programs 27,599.00 Teacher's first expenses Breakfast Expenses 4,648.00 Teacher Store fund 34,108.64 Teachers first-Other 5,098.71 Teacher's first expenses-Other 2,528.65 Total Teacher's first expenses 46,384.00 Page 3 cuSign Envelope ID.91p21±e 2-463E994E9e1800DB63B 9:08 a Chapel Hill-arbor Public School Foundation 11/20/16 Profit & Loss Prey Year Comparison Accrual s s July 2015 through June 2016 Al,a-An# Teacher programs-Other 10268 Total r acher programs 4085 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 9:08 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 Jul'14-Jun 15 Ordinary Income/Expense Income 30th Anniversary 6,355.00 Contributions Annual Appeal 36,733.57 Board Contributions 6,769.29 Corporate&Foundation Support 306,405.55 Government Grants 0.00 Individual contributions 96,378.40 School Raised Funds 128,365.84 TF Breakfast 84,243.00 Total Contributions 658,895.65 Other Revenue Capital Gains 6,977.66 Dividend Income 31,290.46 Fees 12,471.14 Interest Income 338.55 Net realized gains on investmen 61,453.00 Net unrealized gain on investme -96,209.75 Other income 2,024.37 Other Revenue-Other 0.00 Total Other Revenue 18,345.43 Pass Through Income Blue Ribbon Mentor Advocate Blue Ribbon Mentor 58,859.00 International Trip Fund 52,763.08 Sponsor a Scholar 8,329.83 Youth Leadership 2,700.00 Blue Ribbon Mentor Advocate-Other 0.00 Total Blue Ribbon Mentor Advocate 122,651.91 Chapel-Hill Carrboro City Schoo 170,000.00 Misc Pass Through Income -259,821.69 Rtl Consortium 34,344.00 Schools Pass Through Income Carrboro High School 32,492.50 Chapel Hill High School 16,200.00 Culbreth Middle School 6,989.45 East Chapel Hill High School East Baseball 1,250.00 East Football 3,200.00 East Chapel Hill High School-Other 0.00 Total East Chapel Hill High School 4,450.00 Estes Hills Elementary School 0.00 Frank P.Graham Elementary -2,403.42 Glenwood Elementary 425.00 Morris Grove Elementary School 0.00 Northside Elementary Northside Arts In Action 2,403.42 Northside Elementary-Other 49,257.24 Total Northside Elementary 51,660.66 Phillips Middle School 0.00 Phoenix Academy 1,500.00 Scroggs Elementary School -50.00 Seawell Elementary 750.00 Smith Middle School 3,800.00 Schools Pass Through Income-Other -60,336.50 Total Schools Pass Through Income 55,477.69 Total Pass Through Income 122,651.91 Page 5 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 9:08 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 Jul'14-Jun 15 Programs/Events 5K for Fitness 8,390.00 Inflatables 8,386.00 Merchandise Sales 1,550.00 Raffle Tickets 1,009.00 Total Programs/Events 19,335.00 Total Income 825,582.99 Gross Profit 825,582.99 Expense Contracted Services Expenses Accounting and Audit fees 6,500.00 Bookkeeping 5,017.32 Legal fees 2,303.00 Other contracted services 11,440.00 Web/internet support 668.53 Total Contracted Services Expenses 25,928.85 Fundraising 5K for Fitness 9,527.41 Fundraising-other 0.00 Walk For Education 56,064.44 Total Fundraising 65,591.85 Non-operating expenses 0.00 Office Expenses Computer supplies 0.00 Office Supplies 1,709.21 Postage and shipping 1,628.31 Printing and reproduction 2,282.50 Telephone 838.15 Total Office Expenses 6,458.17 Other Operating expenses Advertising and promotions 110.00 Bank Service Charges Investment Fees 2,205.39 Virtual Terminal-trans fees 0.00 Bank Service Charges-Other 413.53 Total Bank Service Charges 2,618.92 Board/Meals Expenses 287.21 Depreciation expense 380.00 Dining 214.60 Dues,subscriptions and books 785.66 Insurance 340.00 Merchant Fees 4,633.93 PO Box&postage Equip Rental 146.00 Travel 1,200.00 Other Operating expenses-Other 0.00 Total Other Operating expenses 10,716.32 Pass Through Expense 30th Anniversary 3,212.22 Blue Ribbon Mentor Advocate Blue Ribbon Mentor 50,500.00 Haidt Foundation 3,309.63 International Trip Fund 55,121.07 MSAN Student Conference 0.00 Sponsor a Scholar 34,322.22 Youth Leadership 2,700.00 Total Blue Ribbon Mentor Advocate 145,952.92 Page 6 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 9:08 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 Jul'14-Jun 15 Chapel-Hill Carrboro City Schoo 120,000.00 Community Connections Program 6,230.17 Fund Management Fees 4,217.00 Misc Pass Through Expense -266,263.82 NCSA Scholarship 3,379.45 Rtl Consortium Exp Rtl Reimbursements 5,420.34 Rtl Consortium Exp-Other 44,158.61 Total Rtl Consortium Exp 49,578.95 Schools Pass Through Expense Carrboro High School 2,004.22 Chapel Hill High School 14,347.53 Culbreth Middle School 7,239.45 East Chapel Hill High School East Baseball 8,762.00 East Football 3,754.92 East Chapel Hill High School-Other 0.00 Total East Chapel Hill High School 12,516.92 Ephesus Elementary School 0.00 Estes Hills Elementary School 0.00 Frank P.Graham Elementary 183.34 Glenwood Elementary 425.00 Morris Grove Elementary 0.00 Northside Elem Northside Arts In Action 82.05 Northside Elem-Other 39,054.08 Total Northside Elem 39,136.13 Phillips Middle School 0.00 Phoenix Academy 500.00 Scroggs Elementary School 0.00 Seawell Elementary 750.00 Smith Middle School 3,500.00 Schools Pass Through Expense-Other -34,527.34 Total Schools Pass Through Expense 46,075.25 Pass Through Expense-Other 41,000.00 Total Pass Through Expense 153,382.14 Payroll-Related Expenses Payroll taxes 7,786.32 Salaries&wages 95,774.24 Vacation/Sick Leave 10,000.00 Total Payroll-Related Expenses 113,560.56 Program Expense Grants Awarded 195,494.37 Other Awards 21.49 Scholarships 0.00 �< School Disbursements 105,267.14 Store Expenses 869.55 Teacher programs Other Teacher Programs 0.00 Teacher's first expenses Breakfast Expenses 4,633.51 Teacher Store fund 29,276.19 Teachers first-Other 2,645.56 Teacher's first expenses-Other 342.24 Total Teacher's first expenses 36,897.50 Page 7 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 9:08 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 Jul'14-Jun 15 Teacher programs-Other 0.00 Total Teacher programs 36,897.50 Total Program Expense 338,550.05 Total Expense 714,187.94 Net Ordinary Income 111,395.05 Net Income 111,395.05 Page 8 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 9:02 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Operations Only-Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 Jul'15-Jun 16 Jul'14-Jun 15 Ordinary Income/Expense Income 30th Anniversary 0.00 6,355.00 Contributions Annual Appeal 27,656.94 36,733.57 Board Contributions 10,530.61 6,769.29 Corporate&Foundation Support 87,486.37 120,645.88 Individual contributions 8,394.42 6,662.15 School Raised Funds 120,304.63 128,265.84 TF Breakfast 19,480.00 16,723.60 Total Contributions 273,852.97 315,800.33 Other Revenue Fees 14,106.27 12,471.14 Interest Income 738.76 326.43 Other income 0.00 2,024.37 Other Revenue-Other 52.22 0.00 Total Other Revenue 14,897.25 14,821.94 Programs/Events 5K for Fitness 17,782.76 8,390.00 Inflatables 694.00 8,386.00 Merchandise Sales 981.00 1,550.00 Raffle Tickets 350.00 1,009.00 Total Programs/Events 19,807.76 19,335.00 Total Income 308,557.98 356,312.27 Gross Profit 308,557.98 356,312.27 Expense Contracted Services Expenses Accounting and Audit fees 6,800.00 6,500.00 Bookkeeping 0.00 5,017.32 Legal fees 0.00 2,303.00 Other contracted services 0.00 11,440.00 Web/internet support 312.17 668.53 Total Contracted Services Expenses 7,112.17 25,928.85 Fundraising 5K for Fitness 11,370.52 9,527.41 Fundraising-other 318.11 0.00 Walk For Education 46,327,26 56,064.44 Total Fundraising 58,015.89 65,591.85 Non-operating expenses 1.61 0.00 Office Expenses Computer supplies 144.99 0.00 Office Supplies 1,603.08 1,712.21 Postage and shipping 1,302.34 1,628.31 Printing and reproduction 520.92 633.02 Telephone 873.99 838.15 Total Office Expenses 4,445.32 4,811.69 Other Operating expenses Advertising and promotions 25.00 110.00 Bank Service Charges Investment Fees 2,326.32 2,205.39 Virtual Terminal-trans fees 7.08 0.00 Bank Service Charges-Other 4,415.14 413.53 Total Bank Service Charges 6,748.54 2,618.92 Page 1 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 9:02 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Operations Only-Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016. Jul'15-Jun 16 Jul'14-Jun 15 Board/Meals Expenses 390.80 287.21 Depreciation expense 2,914.30 380.00 Dining 0.00 214.60 Dues,subscriptions and books 1,042.43 785.66 Insurance 340.00 340.00 Merchant Fees 1,283.06 4,633.93 PO Box&postage Equip Rental 164.00 146.00 Travel 300.00 1,200.00 Other Operating expenses-Other 0.00 0.00 Total Other Operating expenses 13,208.13 10,716.32 Pass Through Expense 30th Anniversary 0.00 3,212.22 Total Pass Through Expense 0.00 3,212.22 Payroll-Related Expenses Payroll taxes 10,670.65 7,786.32 Salaries&wages 139,485.70 95,774.24 Vacation/Sick Leave -20,000.00 10,000.00 Total Payroll-Related Expenses 130,156.35 113,560.56 Program Expense School Disbursements 103,646.94 105,267.14 Total Program Expense 103,646.94 105,267.14 Total Expense 316,586.41 329,088.63 Net Ordinary Income -8,028.43 27,223.64 Net Income -8,028.43 27,223.64 Page 2 cuSign Envelope ID:F71 p21±e w4SEg4Eae1800DB63B . } STAFF ROSTER OF FINE ARTS TEACHERS AT M C D O U G L E ELEMENTARY SCHOOL ( � � ( . r ( TEACHER NAME SUBJECT PHONE EMAIL � ( � ( Erin Rasmussen Art 66160 imsmAS n@c c s.k±n&us ( � � ( [ Nikki Ye| ev rto n Music 66180 . ( nyelverton@chccs.k12.nc.us . { ) ( ( � ( � � ( . \ � \ � ( - ( { � - ( DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 2016-17 CHC PUBLIC SCHOOL FOUNDATION BOARD OF DIRECTORS David Huntoon(5/3) (REVISED AUGUST 2016) May Martin Bryan(1/2) 100 Europa Dr.,Ste.445 (TERM/YEAn) 813 Emory Drive Chapel Hill,NC 27517 Chapel Hill,NC 27517 Office:919968-4911 Home: 919-933-0337 Fax: 919 967-2813 ■ James Barrett(1/1) Cell: 919-656-4346 Email:David @chbcpas.com Board of Education Liaison Email: David is a CPA and partner at 100 Morgan Bluff Lane maymartinbryan @gmail.com Coleman Huntoon&Brown PLLC Chapel Hill,NC 27517 May is active in school and CPAs. 919-593-0592 community organizations. jbarrett@chccs.k12.nc.us James is chair of the Chapel Hill- Christine Cotton(3/1), Jim Kitchen(3/1) Carrboro Board of Education. Communications Chair 109 New Castle Drive 100 Arbor Creek Court Chapel Hill,NC 27517 Laura Baxley(2/2),President Chapel Hill,NC 27516 Home: 919 801-5230 411 Longleaf Dr. Home:919 929-3753 jiinc 11jimkitchen.org Chapel Hill,NC 27517 Cell:919 812-3949 Jim teaches at UNC and is president of Home: 919 967-8396 Email:cmcottonl l(tlyahoo.com Real Property Development. Cell: 919 274-2037 Christine is the founder/director of laura @thebaxleys.org PORCH. Laura is a community and school Matt Marvin(1/2) volunteer. Pat Flores(1/3) 642 Cedarbrook Way 6108 Turkey Farm Rd. Chapel Hill,NC 27516 Lyn Billings(1/3),Vice President Chapel Hill, NC 27514 Email:mmarvin @email.unc.edu 608 Concordia Court 919-490-7194(direct) Matt is Associate Director of Reunion Chapel Hill,NC 27514 919-451-9741 (cell) Giving and Engagement,UNC Kenan- 919-423-6627 Patrick.Q.Flores @morganstanley.com Flagler Business School (919)260-5351 (cell) Pat is Vice President at Morgan Email mm4kkc yahoo.com lbillings018@gmail.com Stanley Wealth Management Lyn is a community and school volunteer. Nik Gandhi(1/2) Suki Newton,Support Committee 101 Arbor Creek Ct. (6/1) Madeline Blobe(2/1),Treasurer Chapel Hill,NC 27516 405 Tramore Drive Chair,Finance Committee Home:919-316-6797 Chapel Hill,NC 27516 200 Manor Ridge Drive Cell:919-707-7040 Home: 919 967-4148 Carrboro,NC 27510 Email:nik gan.dhi @hotmail.com. Cell: 919 247-4148 919-932-4411 Nik is Director of Marketing, Email: SNewton405 @aol.com Email:madyblobe(21gmail.com GRIFOLS USA Suki is an active community Mady is active in schools and volunteer. community organizations. Linda Gilchrist(1/3) 1004 Pinehurst Dr. Laurie Norman(4/1) Vicky Kline(2/2),Secretary Chapel Hill,NC 27517 205 W.Poplar Avenue 3812 Sweeten Creek Road2 Home phone:919-240-7790 Carrboro,NC 27510 Chapel Hill,NC 27514 Cell phone: 847-312-2478 Office:919 843-6979 Home:919-493-7546 lagilchrist(4ahoo.com Home: 919 942-2746 Cell: 919 428-1807 Linda is a community and school Cell: 919 302-4902 vckline @gmail.com volunteer. Laurie Norman@unc.edu Vicky volunteers extensively with the Laurie is Director of Alumni schools. Jeffrey Hart(1/2) Relations,UNC Sch.of Education. 212 Telluride Tr. Lyria Boast(4/3), Chapel Hill,NC 27517 Dan Rockaway(2/2) 403 Westwood Drive Home: 919-932-7274 202 Hogan Woods Circle Chapel Hill,NC 27516 Business: 919-328-8801 Chapel Hill,NC 27516 Home: 919-933-5675 Cell: 919-259-4244 Cell: 919 621-0182 Email:lyria @cribmail.com Email:jhart@rhb.com dan.rockaway @soundsandcolors.net lyriaboast @gmail.com Jeffrey is an attorney with the firm Dan is co-founder and owner of Lyria is a senior consultant at Public Robinson,Bradshaw&Hinson P.A. Sounds and Colors. Impact,research assistant in epidemiology and a school volunteer. 1 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B Dena Thomason(2/1) Ex.Officio Members 6721 Turkey Farm Road (Non-voting) PSF Staff Chapel Hill,NC 27514 Phone: 919 930-5430 Sarita Allen-Medlin(1/2) Lynn Lehmann Email: dthomasonl(i)nc.rr.com 3024 Courtney Creek Blvd. Executive Director Dena is an active school and Durham,NC 27713 8700 Drew Lane community volunteer. Cell: 919-949-5561* Chapel Hill,NC 27516 Home:919-806-8040 Home: 919 968-3925 Ashley Wilson,Past President(4/2) Office:919-969-2482 x 27318 ,� 2.nc.us llehmann @chccs.kl2.nc.us 305 Madera Lane sallen-medlin@.chccs.kl�nc.us Office: 919 968-8819 Chapel Hill 27517 Sarita is the district's elementary PAC Fax: 919 968-7884 Phone: 919 968-3654 teacher. Cell: 919 604-8439 Cell:919 619-3453 ashleyleflerwilson@gmail.com Jim Causby Nancy Zeman Ashley is a school and community 750 S.Merritt Mill Road Program Services Manager volunteer. Chapel Hill,NC 27516 6516 Whitney Rd. Office:919 967-8211 Graham,NC 27253 Ken Witt(4/1) Email:jcausby @chccs.k12.nc.us Chapel Hill,NC 27516 104 Crane Meadow Place Dr.Causby is Interim Superintendent Home:336-525-2401 Chapel Hill,NC 27514 of CHCCS. Cell:919-225-0075 Home: 919 402-0349 Office:919 968-8819 Office: 919 402-4816 Jeff Nash Email:nzeman @chccs.k12.nc.us Cell: 917-597-9855 Lincoln Center Email:kwitt51401 @aol.com Chapel Hill 27516 Office: Ken is Technical Manager of the Office: 919 967-8211 ext.227 Nancy Lees Business,Industry&Government Fax: 919 933-4560 Foundation Asst. team of the American Institute of Email:.jnaslt @ cllccs,aca2.nc US Email: nleesAchccs.kl2.nc.us Certified Public Accountants. Executive Director for Community 107 Cobblestone Drive Relations. Chapel Hill,NC 27516 Allison Worthy(5/3) Office:919 968-8819 517 Hooper Lane Cell: 919 360-4196 Chapel Hill,NC 27514 Home:919 969-7584 Shannon Grabowski Fax: 919 969-7475 mail.com Bookkeeper Email: allisonworthy@gmail.com Office:919 968-8819 Allison is volunteer coordinator, Email:srabowski @chccs.kl2.nc.us SECU Family House at UNC Hospitals. Stephanie Yost(6/3) 7700 Amesbury Drive Chapel Hill,NC 27514 Cell: 919 490-6827 Email:yost(liiemail.unc.edu - Stephanie is a Nurse Consultant with UNC Health Links and School Nurse 2 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B internal revenue Service.x Department $t the Treasury Box 2508 Cincinnati, vri 45201 Date: J U N O 5 2015 Employer Identification Number„ 6614197. Chapel 1111-Carrboro Public; Person to Contact w ID Number: School Foundation Tyrone Thomas- D1000281 724 P.O, Box 877 Contact'Telephone Number: Carrboa), NC 27610 877-M .55W'3"oil-Free Form 990 Required: Yes Dear Sir or Madam: in your letter dated December 15, 2014 you requested classification as a public charity described in section 509(a)(1)and 170(b)(1)(A)(vi) of the Internal Revenue Code. In our letter dated January 1985, we determined that you were exempt under section 501(c)(3) of the Code, We further determined that you weren't a private foundation and you were classified as a public charity described in section 509(s)(3)of the Code. Based on the information you provided,we determined you meet the requirements for Cosification as a public charity described In section 609(a)(1)and 170(b)(►)(A)(vi) of the +..� y Accordingly, we have updated your public charity status In our records as you requested. Since your exempt status wasn't under consideration, you continue to be classified as an - organixation exempt from federal income tax under section 01(c)(0) of the Code. is Grantors and contributors may generally rely on this determination of your foundation status unless the internal Revenue Service publishes notice that you are no longer recognized as tax exempt or classified as a public charity In the Internal Revenue Bulletin. However, if a grantor or contributor takes any action, or falls to take any action, which causes you to lose your exempt status or causes you to be reclassified as a private foundation,that party cannot rely on this determination. Furthermore, a contributor or grantor who knows that the Internal Revenue Service has notified you of . any change in your exempt status or foundation status cannot rely on this determination. For important information about your responsibilities as a tax.exempt organization; go to www.irs.9ovicharities, Enter 4221-PC in the search bar to view Publication 4221-PO, ClYtleefro Guide for 501(c)(3}Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Because this letter could help resolve any questions about your exempt status andior foundation status, you should keep it with your permanent records. • Letter-4425 2015-06-05 15:34 IRS Page 2 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B PaSie 2 It you have ltl Avs rii rti�►. please .� .. _ the ,a�telephone ,, , have any�.f►.G�.+tons, plea a QO611'�9(t the Arson hose I•i'c'es `is'`",'.and number are alowil hi heading t i t'trim l e t t e r. Sincerely, • • &�+" Director, Exempt Organiz tikrm • • • Letter 4425 9c. , , it . WI DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B C l( ORANGE COUNTY ARTS COMMISSION �a a »v (r; 1 1∎iJ r J F 1 a FALL, 2 I6 GRANT AGREEMENT N ;,b; 0 u n THIS AGREEMENT, entered into this 17 day of January, 2017, by and between Orange County ("County"), by and through the Orange County Arts Commission ("Arts Commission") and Chapel Hill-Carrboro Public School Foundation ("Grant Recipient"). WHEREAS, the Arts Commission is a countywide arts agency that ensures the growth of local arts experiences by providing funding and support for diverse high quality programs and projects. WHEREAS, the Arts Commission administers the Spring and Fall Arts Grants Program to provide economic opportunities to Orange County artists and non-profit organizations coordinating arts projects benefiting the citizens of Orange County. WHEREAS, the Spring Arts Grants Program is supported by Arts Commission with funds from the Grassroots Program of the North Carolina Arts Council, an agency of the Department of Cultural Resources and the National Endowment for the Arts. WHEREAS, the Grant Recipient was selected by the Arts Commission to receive the Spring Arts Grant through the procedures duly adopted by the Arts Commission; and WHEREAS, both parties wish to promote and maintain the integrity and clarity of the Grant Recipient's ideas and statements and delineate the Grant Recipient's obligations to the County; NOW, THEREFORE, the County and the Grant Recipient, for the consideration and under the conditions hereinafter set forth, agree as follows: 1. Approved Grant Project. Grant funds are provided under this Agreement for the project ("Project") described in the Grant Recipient's Grant Application, attached hereto and incorporated herein as Exhibit A. 2. Grant Award. Grant funds in an amount not to exceed six hundred dollars ($ 600.00) have been awarded by the Arts Commission to the Grant Recipient for the approved Project. These funds must be matched at least dollar-for-dollar with cash from the Grant Recipient's funds not derived from either Orange County appropriations or the North Carolina Arts Council. 3. Contingency. This grant is contingent on North Carolina Arts Council Grassroots Program funding to the Arts Commission. Final decisions on Grassroots Program funds to the North Carolina Arts Council are subject to approval by the North Carolina General Assembly. 4. Responsibilities of the Grant Recipient 1 Revised January 2017 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B A. Implementation. The Project implementation shall take place between January 1, 2017 and December 31, 2017. The Project shall be implemented in the manner described in Exhibit A. Time is of the essence in the implementation of the Project. B. Modifications to project. Grant Recipient shall present major changes to the original proposal, including but not limited to changes in design, implementation schedule and increase in Project budget by more than 10%, in writing to the Arts Commission for approval. Arts Commission shall approve or disapprove Grant Recipient's request for modifications within seven (7) days of receipt thereof Consent to project modifications shall not be unreasonably withheld. Arts Commission's decisions shall be in writing. In the event the Arts Commission fails to approve or disapprove the requested modifications within the time stated herein, the modifications shall be deemed approved. C. Non—assignment. The grant cannot be assigned or transferred to a different project or artist without prior written approval of the Arts Commission. D. Records. Grant Recipient must maintain records and other evidence pertaining to costs incurred and revenues acquired during the Project implementation. Grant Recipient shall maintain financial records pertaining to the Project for three (3) years from the date of this Agreement, in case of audit. E. Use of Funds. Grant Recipient shall not use the grant funds to repay outstanding taxes or other debts of any nature. The grants shall be utilized solely for the purpose of implementing the Project and Project related expenses. F. Final Report. Grant Recipient shall submit to the Arts Commission a Final Report on January 12, 2018. The Final Report shall be in the format required by the North Carolina Arts Council. Failure to submit the Final Report or late submission of the Final Report, for any reason, shall be grounds for denial and/or cancellation of grant funds for the Project and future grant proposals. 5. Responsibilities of the Arts Commission A. Payment. The Arts Commission shall release the grant funds in the amount of $600.00 to the Grant Recipient. 6. Publicity A. Acknowledgement. Credit must be given to the Orange County Arts Commission and/or the North Carolina Arts Council using the proper logo(s) and credit line in brochures, news releases, programs, and all other printed and online publications. Copies of such printed materials must accompany the evaluation report. Official Orange County Arts Commission and North Carolina Arts Council logos may be downloaded at www.artsorange.org/grantee-resources and may not be altered in any way. When no printed information is used, verbal 2 Revised January 2017 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B credit shall be given. In addition, all print and promotional material must include the following credit line and logo(s) (check all that apply): i. County Funds Only. Orange County Arts Commission logo required. Credit line: "This program is supported by the Orange County Arts Commission. " ii. x North Carolina Arts Council Funding. The Orange County Arts Commission and the North Carolina Arts Council logos are required. Credit line: "This program is supported by the Orange County Arts Commission through the N.C. Arts Council, a division of the Department of Natural and Cultural Resources. " B. The Grant Recipient must enter all events, exhibits and performances open to the public and related to this grant award on the ExploreChapelHillARTS.com website and display Orange County Arts Commission publicity materials (postcards, brochures, etc.) prominently and consistently at their venue or performance space. In addition, the Grant Recipient must add a link to the www.artsorange.org (Orange County Arts Commission logo preferred) to their main webpage. 7. Indemnity. The Grant Recipient agrees to indemnify and hold harmless the County, the Arts Commission and the North Carolina Arts Council and their officers and employees from any and all claims or actual injury, damage or loss to a person, or real or personal property that results from or is in any way connected to the use of the grant funds. 8. Independent Contractor. The Grant Recipient is an independent contractor and not an employee, agent or other representative of the County and/or the Arts Commission. Nothing contained in this Agreement shall be construed to create the relationship of principal and agent, or employer and employee, between Grant Recipient and Arts Commission or Orange County Government. Grant Recipient understands and agrees that he/she is not authorized to incur any expenses or any liability whatsoever on behalf of the County or the Arts Commission and has no authority, expressed or implied, to obligate or make representations on behalf of the County or the Arts Commission. In addition, Grant Recipient agrees to maintain his or her own worker's compensation insurance for himself/herself and his or her employees for the duration of the art work's installation. 9. Termination A. In the event of any of the circumstances set forth below (hereinafter referred to as "default"), the Arts Commission may immediately terminate this Agreement: (i) Any fraudulent representation in any verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. 3 Revised January 2017 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B (ii) Nonperformance, incomplete service or performance, or failure to satisfactorily perform any part of the Project or to comply with any provision of this Agreement, as determined by the Arts Commission in its sole discretion. (iii) Failure to adhere to the terms of applicable county, state or federal laws, regulations, or stated public policy. B. In the event of default by the Grant Recipient, the Arts Commission has the discretion to elect to terminate this Agreement, in whole or in part and/or require the Grant Recipient to repay the grant funds within seven (7) from written notice of default or allow the grant recipient the opportunity to cure the default. This clause shall not be interpreted to limit the County's or the Arts Commission's remedies in law or in equity. 10. Miscellaneous. A. Entire Agreement. This Agreement and the attachments contain the final and entire understanding of the parties with respect to the subject matter of this Agreement. All modifications and amendments to this Agreement shall be in writing. This Agreement shall be binding upon the parties, their heirs, successors and assigns. B. Governing Law. Both parties agree that this Agreement shall be governed by the laws of the State of North Carolina. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all state and federal anti-discrimination laws, policies, rules, and regulations and the Orange County Anti-Discrimination Policy. Any violation of this requirement is a breach of this Agreement and County may immediately terminate this Agreement without further obligation on the part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. By executing this Agreement Provider affirms that Provider is and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. C. Entire Agreement and Signatures. The parties have read this Agreement and agree to be bound by all of its terms, and further agree that it constitutes the complete and exclusive statement of the Agreement between the parties unless and until modified in writing and signed by the parties. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 1 1A and Article 40 of North Carolina General Statute Chapter 66. [SIGNATURE PAGE TO FOLLOW] 4 Revised January 2017 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B IN WITNESS WHEREOF, the Orange County and the Grant Recipient have signed this Grant Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and on behalf of the Grant Recipient DocuSigned by: OC298FK' rt .01-Hill-Carrboro Public School Foundation Date Date For and on behalf of Orange County Government DocuSigned by: �jblitAn,it, lka)mMxstu' 2/9/2017 vii{ umersley, County Manager Date 5 Revised January 2017 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B ORANGE COUNTY-DEPARTMENT USE ONLY Department Party/Vendor Name: Chapel Hill-Carrboro Public School Foundation Party/Vendor Contact Person: Lynn Lehmann Contact Phone: 919-967-8211 Party/Vendor Address:PO Box 877 City Carrboro State: NC Zip: 27510 Department: COUNTYMGR/Arts Commision Amount: 600.00 Purpose: Fall 2016 Arts Grants Budget Code(s): 37601020 683000 Vendor#58283 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑ No Contract Type: (Check one)New ® Renewal ❑ Amendment ® Effective Date 1/17/2017 Approved by Board Yes No Agenda Date: This agreement is approved as to technical form and content: DocuSigned by: Department Director's Signatur fi'iawS Au Date: 0A3E81 B12B364B4... Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insurance standards, specifications, and requirements: /I DocuSigned by: Office of the Risk Management Office aUSX CortAVto Date: 7FDCF9176800498... Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: DocuSigned by: Office of the Chief Financial Office rIA,1641 Art-414..-x- Date:2/8/2017 7D4E5181ACC1409... Legal Services This agreement is approved as to legal form and sufficiency: ocuSigned by: 2/9/2017 Office of the County Attorne 444-14 Date: 4035CB8304CA4A9 to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd @orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: 6 Revised January 2017 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B FALL 2016 ARTS IN EDUCATION GRANT ORANGE COUNTY ARTS COMMISSION APPLICATION FORM 1. APPLICANT INFORMATION Applicant Name Nancy Zeman/Chapel Hill-Carrboro Public School Foundation Mailing Address P. O. Box 877, Carrboro, NC 27510 Daytime Phone 919-967-8211 x28376 Email Address nzeman @chccs.k12.nc.us Web Site www.publicschoolfoundation.org DUNS Number 182048145 2. PROJECT DIRECTOR INFORMATION Project Director Name Nancy Zeman Title Program Services Manager Home Address: 106 Quailview Drive, Chapel Hill, NC 27516 is Daytime Phone 919-967-8211 x28376 Evening Phone 919-225-0075 Email nzeman @chccs.kl2.nc.us DUNS Number 182048145. 3. GRANT REQUEST SUMMARY Arts Program Grant Request $ 600 Total Cash Match $ 600 Total Organizational Budget Past Year $306,880 (Including PTSA/Cultural Current Year $316,700 Enrichment/Arts Program) Projected for Next Year $310,000 Summary Statement for Proposed Uses of Arts Program Grant: A guest poet, Phillip Shabazz, will conduct a Writers Workshop that will culminate in a sharing day of social justice poetry with middle school students of diverse backgrounds during MLK week 2017. 4. NARRATIVE Write a description (no more than three pages,single spaced)that describes the following under separate subheadings: • School profile—a brief overview of population and services. • School's arts programs—a brief list. • Proposed uses of grant funds—description, including location, date, artists involved. Include information concerning whether you have undertaken similar activities in the past. Include approximate number of audience per program;geography of audience; mix of race,ethnicity, age,and gender. Discuss how arts program will be integrated into the curriculum. 919.245.2335 1 200 S.Cameron Street, Hillsborough, NC 27278 I www.artsorange.org DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 5. APPLICATION CHECKLIST (in this order;do not staple, bind, or put into individual folders) One copy:1 sided,81/2"x 11', white paper [i Application Form,including signatures El Narrative 6 Budget Sheet KA 0 Itemized Budget(if necessary) Resumes of key artists and administrators involved in grant funded program(s) 15- Organizational Budget for current AND past two fiscal years pr Artist contact list, including names,address, phone numbers, and email (if applicable) of all artists involved in grant funded activities Ni Staff roster of all school art&music teachers with position title(s). Pa Board contact list, including names,address, phone numbers,and email(if applicable)of organization's board of directors l( Copy of IRS Tax Exemption Letter, if private school (J 0 Sample programs, press, or other materials from this or similar past programs O❑ Sample work by artist(labeled with artists' name,title of work,date of work) produced in the last three years: o Visual artists: CD, DVD,or high resolution photographs(5-10 images). Clearly label each piece with dimensions and media and indicate top of image o Dance or theater artist:CD or DVD,or link to high-quality online video(3-5 minutes) o Music and spoken word:CD, MP3 or link to high-quality online video(3-5 minutes) o Literary arts: Manuscript(10-15 pages)submitted by.pdf or hard copy b. SIGNATURES Typed or Printed Name—Project Director: Nancy Zeman I11-20-2016 Signature of Prt Direct Date Typed or Printed Name—Authorizing Official: Lynn Lehmann 11-20-2016 Signature of Authorizing Official Date ( `'1 y J )0 S or ('.:ry f.I(�l�$bo .i!,3.9€E,.'Ji.. 12%2.; v.,x;✓r .� _?i'�7. :'fe _%(Cy DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B Arts in Education Application Narrative--Fall 2016 School Profile —a brief overview of population and services The Smith Middle School belief statement is, "We believe that all students will grow, learn and achieve when they feel safe, valued and connected." The school website further states, "At Smith, we believe that to support the district vision of instructional excellence, and ensure that all of our students acquire the attributes described in the mission, we must focus on providing a learning environment and school climate that allows students to thrive." Each of the three parts of the belief statement is further described as follows: SAFE: Every student must feel safe at school. Safety includes the aspects of campus safety and security that must be a priority for all school staff. Safety also includes ensuring that the school provides an environment which encourages students to be themselves, to take academic risks,to explore new ideas, and to make and admit their mistakes—an environment in which they feel safe to learn. VALUED: Each student is an individual who brings different experiences, cultures, and perspectives to a school community. It is important that teachers and school leaders create an environment and a community that not only allows space for student differences but also celebrates and values the rich life experiences and perspectives that our students bring with them to school. We must also value the abilities that students bring to our classrooms and engage them in academic work that builds on what they know, helps them grow as learners, and appropriately changes them. CONNECTED: Students must feel connected and invested in their communities. This connection is built in engaging, student-driven classrooms that encourage students to explore and discover new knowledge in partnership with their peers and teachers. This connection is built through encouraging and fostering strong connections between students and adults. Finally, this strong sense of connection is built through the creation and support of a myriad of extracurricular activities that encourages students to collaborate with peers, enables students to display their talents beyond the classroom, and gives students the opportunity to represent themselves,their school, and their community with pride. The racial breakdown of students at Smith Middle School is approximately 50%White, with the non-white portion composed of roughly 24%Asian, 11% Hispanic, 10%African American, and 5% multicultural students. The students receiving free-or-reduced lunch is approximately 21% of Smith Middle School. DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B School's Art Program-a brief list The arts education program at Smith Middle School follows the Arts Education Essential Standards established by the North Carolina Department of Instructional Services. The arts are core subjects for middle school students and include each of the following arts disciplines: dance, music,theatre arts, and visual arts. The philosophy of the program is as follows: The arts have been part of life from the very beginning and are an inseparable part of the human journey. They have described, defined, and deepened the human experience. The arts are everywhere in our lives, adding depth and dimension to the environment we live in, and shaping our experience daily.The arts help students perceive and think in new ways. The arts are a powerful economic force as well, from fashion,to the creativity and design that go into every manufactured product,to architecture, to the performance and entertainment arts that have grown into multibillion-dollar industries. Arts education benefits both student and society, because students of the arts disciplines gain powerful tools for many aspects of life. Proposed Uses of Grant Funds—description including location, date, artists involved. Include information concerning whether you have undertaken similar activities in the past. Include approximate number of audience per program; geography of audience; mix of race, ethnicity, age, and gender. Discuss how arts program will be integrated into the curriculum. Grant funds would be used to bring Phillip Shabazz into Smith Middle School for a "Writers' Workshop" that would lead to a sharing day of social justice poetry during the week of Martin Luther King,Jr.'s birthday. Phillip Shabazz (www.flamesinthefire.com) is a renowned local poet, author, and teaching artist who regularly works with students to get them excited about their writing. His teaching style is engaging,funny, and direct, and he has a special talent that encourages students to be empowered by their own words and expression. The Writers' Workshop focuses on techniques as an approach to enable participants to write more creatively and effectively. The sessions present a unique opportunity for youth and adults to work closely with their peers. During the workshop, students will write lyric and narrative poems and prose as compositions of relationships, and what they mean as they emerge from the interactions of self with others. Mr. Shabazz utilizes the reading-discussion-writing cycle with his workshops and teaches the use of poetic devices such as simile, metaphor, and other traditional literary forms. Each session will involve: • Reading exemplary samples of poems and prose to reference as an integral part of the workshop process • Discussing strategies regarding craft • Working from writing prompts DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B Ih • Writing first drafts • Sharing the drafts to receive constructive feedback • Critiquing each other's work and focus on whether the writer's deep intention is successfully rendered • Revising written work as a way to further the poem's development • Exploring the elements of character, image, scene, situation, tension, connections, structure, imagination, voice, and meaning • Building on what was explored and pay close attention to the wonderful things that make poetry and prose alive • Supporting the development and progress of each writer • Producing new work The Smith Middle School teachers involved in this program are the sixth grade Learning Enrichment and Acceleration program (LEAP)—or the teacher for identified gifted students— and the Advancement Via Individual Determination (AVID)teacher, who provides classroom instruction to students who are traditionally underrepresented. The partnership of LEAP and AVID students is a new approach this school year for the two teachers who are promoting multicultural learning and socialization at the middle school. This project addresses achievement gap and equity goals of the Chapel Hill-Carrboro City School District. Through this collaboration,the AVID and LEAP teachers wish to expose their students to a culture where "academic excellence is cool", while encouraging students to form diverse friendships for socialization, academic, and artistic development. The Writers' Workshop directly addresses the North Carolina English Language Arts Curriculum standards for poetry,writing, presentation skills, and accountable talk. Approximately 90 Smith Middle School students (roughly an equal mix of males and females) will participate in the Writers Workshop with Mr. Shabazz. The majority of the LEAP students are Caucasian while the majority of AVID students are children of color (African American, Latino, Karen, Burmese, and multiracial). All students will be asked to evaluate the project and give feedback at the end of the workshop program. The two sixth grade teachers will further assess the program through ongoing dialogue and observation. DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B // FALL 2016 cev' ARTS IN EDUCATION GRANT ORANGE COUNTY ARTS BUDGET SHEET COMMISSION FINANCIAL INFORMATION Please provide a projected budget for your proposed project utilizing the format below. PROJECT EXPENSES Grant Amount + Applicant = Total Expense Requested Cash Match A Personnel Administrative staff Artistic staff Technical/Production staff B Outside Fees and Services Artistic contracts $600 $600 $1200 Other contracts: C Space Rental D Travel E Marketing F Remaining Project Expenses G Total Cash Expenses PROJECT INCOME Cash Income A Admissions B Contracted Services Revenue C Other Revenue(specify) D Private Support Corporate support Foundation support $600 Other private support E Government Support Federal State/regional(not including this request) Local(not including this request) F Applicant Cash G Grant Amount Requested in this application $600 N Total Cash Income $1200 (must equal Total Cash Expenses,Item G above) 9 i 1 `-:00 s c o ie:on....€-et R-:C.27278 1 viww aisoronoe DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B About Phillip Shabazz As a poet, author, and teaching artist, Phillip Shabazz has built an outstanding, extensive, and respected career. His work, which explores issues of community and culture in America, has been acclaimed by the media, critics, and audiences across North Carolina. His writing expresses diverse points of view, from poems about family and friends challenged by the complexities of life, to narratives that celebrate human possibilities. Educators have called him, "One of the most inspiring individuals in the arts." In an effort to get students excited about creative writing, Shabazz encourages them to be empowered by their own words and expression. Teachers have commented, "His methods succeed in showing students how to use poetry as a tool of learning and communication. His teaching style is engaging, fun, and direct." The North Carolina Arts Council nominated him for the prestigious William C. Friday Fellowship for human relations, praising his contributions to arts education—as a blend of magination, experience, and upbeat sensitivity. As writer and teacher, Mr. Shabazz has created a series of ongoing creative writing workshops for many which he calls "Living Words." Artist Statement Writing is my key to the mind, my door to the heart, my window to the soul. It starts with poetry. i turn words into stories and lyrics without the distraction of television, newsprint, video, junk mail, etc. This always strikes me as magical. Writing fills me with a sense of accomplishment and integrity, and it proves to be a most agreeable vehicle for expressing artistic vision and possibility. i am fascinated by the energy which creative writing gives me, and I've studied it avidly. As a student, I started to read and perform my poems as a creative way to fulfill my passions for artistic expression and for language. Now those passions have transformed me: I love to write. I love to create. I love to express art. I use these outlets as sources for meaningful communication with audiences and students. I write from the inside out. I work as deliberate as I can, consciously employing poetic devices and techniques. My muse is my project manager. Much of my writing revolves around a fascination with real and imagined experiences and the way in which different pieces of information combine to become single coherent poems. The concreteness of writing frees my imagination and it "sees" each poem or story into existence. I am a lifelong reader of literature great and small. I learned how to write through reading. For me, writing by way of reading is what its really all about. I write poems and prose that challenges the reader to think about their inner life, and also their outer surroundings. In each piece, I write to understand what my life means in this world. My body of work is an attempt to share that experience. Teaching Artist Mr. Shabazz became Duke University's third Artist-in-Residence at the Mary Lou Williams Center for Black Culture. While at Duke, Shabazz was a founding member of Spirit-House, a community service organization. During his four-year residency, and with funding from the Siemens, and Mary Duke Biddle Foundation, Shabazz organized both a student art collective, and a twice monthly speaker's series which presented local and nationally known poets and writers. The series also included lectures by well-known educators from area universities and scholars from the National Humanities Center. The residency sought to blend the role of the arts in relation to vital social issues. Shabazz conducts creative writing workshops across his home state of North Carolina, and has taught at over 400 schools, conferences, and community centers. Currently he is a poet-in-the-schools of North Carolina and is affiliated with the NC Arts Council. Prior to this, he was on the artist roster with the Durham Arts Council. He has also been a visiting writer at many colleges and universities including UNC-Chapel Hill, Eton, Winthrop, Warren Wilson, and the Writers' Series at Appalachian State. Shabazz currently lives in Chapel Hill, NC, and continues to reach approximately 12,000 people annually through his work as a poet, teacher, and writer at the grassroots and in the community at- large. DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B Nancy Word Zeman 106 Quailview Drive Chapel Hill, NC 27516 (h) 919-967-2571, (c) 919-225-0075 EDUCATION: M.S.,Microbiology,B.S. Biology--Virginia Tech PROFESSIONAL EXPERIENCE: Chapel Hill-Carrboro Public School Foundation September 2015-present Project Services Manager • Deal with all things grant-related at PSF including the Foundations granting process,writing grants on behalf of the Foundation, conducting grant-writing workshops, securing partners for grant funding, etc. Benjamin Vineyards, Graham,NC 2001-Present Co-owner and co-manager • Involved with all operations of a family-owned and-operated vineyard Triangle Biotechnology Consulting, Chapel Hill,NC 1991-2006 Consultant • Provided expertise in the fields of food and nonfood biotechnology regulatory issues CPC International Inc. 1981-1991 (various divisions including Corn Products,Enzyme Bio-Systems Ltd.) Development Specialist • Involved with New Product Development and Regulatory Affairs Iu RELEVANT VOLUNTEER AND EDUCATION EXPERIENCE: Chapel Hill-Carrboro Public School Foundation Board 1997-2015 E: This foundation, associated with the CHCC Schools, creates opportunities for teachers and students in the district • As Co-Chair of the Allocations Committee,have a broad awareness of the programs and needs of the district. Have overseen the disbursement of hundreds of thousands of dollars to the CHCCS district. • Started several new flagship programs, including Teachers First Breakfast and the Race for Education that both continue to be successful fundraisers for the Foundation • Have personally secured hundreds of thousands of dollars in grant money for teachers and district programs • Served previously as Board President,Vice President and Walk for Education Chair School Reading Partners 1998-Present A program that involves reading one-on-one with identified students K through second grade. • Currently Assistant Site Manager at McDougle Elementary and served as a consultant to the District for the 2014-15 school year • Participated at three different elementary schools through the years (McDougle Elementary, Frank Porter Graham Elementary, and Northside Elementary) DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B • My session with a student is included in the instructional video that is used to train new SRP volunteers Coach Write! 2001-2006 A support program that helps students with their writing skills. Typically,the volunteer works with a student in a one-on-one setting on a written piece that he/she is editing. • Helped develop and launch this as a pilot program at Frank Porter Graham Elementary • My session with a student was filmed and is included in the instructional video used to train new Coach Write! volunteers Blue Ribbon Mentor Advocate(BRMA) 2008-2016 The BRMA program pairs mentors with minority students who show promise, generally starting when the student is in fourth grade. • Trained as a BRMA volunteer in 2008 • Paired with an African-American mentee in the Fall of her fifth grade year and continue as a mentee for that student who is now a Senior at Carrboro High School READ2ME:Tailgate Stories 2008-Present An outreach program aimed to keep low income students,the majority of whom are minorities,reading through the summer • With Mary Andrews, initiated this program in one Scroggs neighborhood the first year • This program has now expanded into a district-wide summer program involving all CHCCS district elementary schools at 25 different sites • Successfully written numerous grants annually to fund books for this initiative Family Reading Partners 2010-Present A program that brings families together around books and encourages reading with at-risk children. We model for parents how to read with their children and have good conversations around quality books. The books are then given to the families to take home for their personal libraries. • Developed with M. Andrews and have conducted numerous sessions at multiple district elementary schools • Program expanded to adolescent parents in all Orange County's high schools • Help select quality literature and write conversation cards for the program • Successfully written multiple grants to obtain funding for the books as well as the meals for this program • This program is now expanding into CHCCS Pre-k programs,the Orange County Literacy Council, Orange County Social Services, and UNC Horizons Program • Received Motheread/Fatheread training in 2012 Guided Reading Bookrooms (GRBs) 1997-2016 Guided Reading Bookrooms in elementary schools are a cost effective way to offer large numbers of sets of books in a range of reading levels and topics to be used for guided reading in all grades/classes within a school • Instrumental in starting three GRBs (McDougle Elementary,Frank Porter Graham Elementary, and Northside Elementary) F; • Responsible for ordering,processing, and cataloguing new books • Obtained numerous grants for new books that have been added to the schools' collections 1 Ii DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B s K -o -o 2 o v -n CD co O e rn a 0 c N is a o m f, 5' m CO Cn O 0) O• V, (D V N , 3 O 00 • 4n C O no W N O i- -4 a o o O 0) O - O W 3 O 0 s 4 n N = i d 3 P- '" . d = m 0 g A v 3 0 cr .fir `G N ' < = N ' w a m O m m O D W * m A N o. g m N m <^ c A g S' T o 5 co co D -i N D C: EEny o, �, o y �, m m m m Q 7c r, Al !; &i c o 4 0 () o 6% c n C1 y ' o a O' F. 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A- N A W CO A o m CO J A A CO O O -co o C N.)0 O) 0 O N 0 CO � N A CO N CO CO A N 1 OC CO 01 CO- V CD O O CD O A V J W O CO O O O O O CO N O (n O O o c 0 O b (n O o O O( O o o O O o 0 o 0 o O O O o O O o O O O co o 0 W 0 0 0 W 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O 0 0 CO N j - CO A 0) CO Cn CO V A CO N (Cl m CZ N .I CO 0) CO CO W o m O N O (n -co V -. W OJ O CO 0) J O A -co A in A -co O CO y C N 0 CO 0 m 01 --. A CO CO A W A CO 0 cn 0 0) 0) 01 W CO 0 V O A O 0 W O J 0 O > A CO W V O 0) O 0 0 01 O O V O O A O CO O o O O o O O O O o O o O O O o o O O o o O O o O O O C O O O O O o O O O O O O O O O O O O O O O O O O O O O O N N -< - N N 0- N) 0 J J N n V co W A O N N n O J CO m ✓ N � W O W N A _V -CO m 0 O P 43 N N W -CO J J J -+ D N o N L N W N A 0 0 CO 0 W _. Cr, V N A CO W N A CO 0 A N N) V O CO c O A N co co O 6 O N O O N V CO 0) O 0 CO O W W O W W o CD CO m o O o o O N W CO O 0 CO V V o o O O J CO O 'co N J CO 'co N co O O O O o co co O J N CD CO O O W O 01 m N CO m A W N N N N .( J- A O) J V cn CO N W m 0 N j N co 0 J V CO N co o m - co N) O --� W A CU J -co -s J A V - W W W -A• 01 0 W L - Cn A 0 Cn CZ CO V 01 0 0 A W A N 0 (Cl CO 0 IV 0 0 N W e Ni W O CO V 0 c0 N O O O N J N .A• CD O CO A co co 0 O A J N J co 0 IJ -, A W o o Cn O) CO V A N A V N o cO W O o CO 0 o A co Co J co A A O (n cn Of N O A co (D cn O O (Cl O O N CA cn W J 0 Ni N N -< J W CA J W cn co V 0 A 0) CO N A 0) N N 0) W A J N m N CO CO 0 A O N W A 0 0 CO N CO CO A C J CO CO W W W O ( N CO ( CO CO J N 0 NA) CO O 0 N n v N O( C" A CO N A CO O CO J N 0 A W O 01 0 CO 0 0 CO N 01 CO N O O O O cD 0 • O in o o O in W 6 *co m O) in W V o o A o N) N (O J o W O O N - CO N) 0 0 0 N CO J 0 CO CD 0 0 O 0 N CO N 0 01 W CO CO W CC- A -< N N m NT , W CA CZ W J A N N no W CO 0) CO W -s n 0 O W co W O O J Oc O CO J N A 0 N N W O in J W 0) J N J O F, C Ni N N 0 N A O CA CA W V m CO O A CO (n 0 W 0 (n A A Ot CA CA W J CO CO co O - O o O A A A O J 0 O O O cO O O CO N CO (n CO W (( 0 'CO W 0 o W in in co N C U in CO (n 0 0 0 0 0 0 W Co -' N) CO (n Co - W (n O O N CO 0 N A CO 0 J W 0 o 0 0 0 O W W (n CO A J 0 A CO(n- -i N (p ON 5. 0 W o O A CO n O▪ co A 0) CO J A O N -. -s CO n 0 v n O J 1-, :I, O n O _n n O J O O N (n Ln f O O O O O O O O O W W co O O O O O O O O O O O O O O O P P P P P O O O O O O O P P P P P P O O O o O O O o F-` 0 0 0 0 0 0 0 0 o O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 6 cr., O O O O O O O O co O O O O O O O O O O O O O O O O O O ▪ J (A co• > 0 W CO (0 _1 W o J CO CCOO W CO N ` O O O 01 CCOO 0 c00 -CO A tt0 -CO CO CO 0 CO CO CO W CO 0 V OD CO N 0 Z f0i Ni O N N P P P P P W O CO (O V O V J N A O O O O O co O O (D I- 0 CD , o O O -, o O O v O O O J V o O O o 0 0 'a 0 0 0 A co J O O O J O O O CO O O O co W O O O O O O O O O O (i CO N W O - CO > N O) -s O- 03 V Ol o 0 co > co -a --� _0 co V (n CT CO W Q. (n N CO 0 CO > CO -co co J O 0 O O O O O J O O J 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 F-` 0 Ni 0 0 0 0 0 0 0 0 0 0 0 o O o 0 0 0 o O o 0 0 0 0 0 ro J N O 0 to 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 tn. m { C r. DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B a w m x .. ' m 0 N N r. I: I,'. lc 1 i E 4. Y I'' tt I's 0 O 'O " 0 0 0 O 0 0 7 I'' y E. F- 2 m t .a O 0 T ;•N O c O O Q d 54 O. O N c O O to:: d fO m N %.o to V W -i 7 V 0 0 W D 3 2 N, cC N 3 y N 3 x -I -O m N N 2 N O 0 N O O. N CO O e*,. 5, m ,z O (9 N N .�. 7.' d O N N 6 m x G O N Z �+ CD O O x G Et (kD N .On 3 i _II N 0 N = (O R N R. N Q d 7 N 0 N fD N N x �j 'O N O CO T Cp m N O 0 0.N ry O g 7 N - N C N C 0. 0 0 N '� x x V N a .Oi. N 'O N L CD O 0 8 3 0 e, 2 d Nm N 0 N N 0O i O 0 RC C O N O tt . N y 7 co 3 O d N 0. 2 0 F. N 0 CO N J V ir A A o N N 0 N O O N J N O V 0) O CO 0 CO CO 0) 'co N N W J W l,.. CO N 0 W N 0 O) CT 0 N 0 J CO N CO 0 W N OC (Cl O O 0 O 0 O O O O O O O O 0 O O O O O O O O VY to- OCT N.) IQ CT W OF CD > N N N -� O > J A O J J CO N rt J CT CO 01 -+ 0) CO CO CO CO 0 0) CO CO CO 01 0) O. N O A O) )O 0 0 CO. A N CO O) CO A A 01 0 CO co N Co O m O O O O O O O O O 0 0 0 O O O O *co O J co O O O co O O O O O O O O O O O O O O O O N W O CO 0 CO CO OF ((CC r -CO J CD CO A CO N CO Co - A J CO �. CO CO -1 0 0 CO -+ N CO CT J J O O 0) 0 co O CO O CO CO N 0 O A 0 W O V m m O N 0 N J N 0) O O 0 0 0 0 0 0 0 0 0 0 0 O O 0 0 0 0 O O O O O O O O O O co O O O 0 0 0 0 0 0 0 0 0 0 O N ON) CWT '03 A N co rn co co A -CO V N N O N CO O co N N O A A 0) CO 0 0) CO CO CO A O_ _ CO O) N CO CO 0 0) W J A O W O (n O W N O O) CO O J co co W O at D) O) OF N CO CO O O O) O CO O CO N A W 'CO CO A O) P0 CO N W CO 0 01 0 0 J 0 W 0 CD CO A CT CO Cr co 00 W A A J J (O W _ _ N W N 0) J J 0C -1. (D O W 0 N CO -. J -1. N CD J O 0) J J A O N W CO 0 0 0 CO A CO W CO 0) CD CO J J CO CO CO CO CO O J A 0 N O) (T O O) 0 O D) 0 J J O) CT N N N 0 O) CD O O O W O W O N W N 0 A O CO - o O Co o O O o Cn o o O A W o 0 > CO 0 A [[I N C• WT CO N A Co J A A A _ f W 0 -CO O N CO CO W -CO N -co A J J V 0) CO CO A 0 A CO J A J CO CO N J. J 0 CO CO W J 0 A CO O (n 0 O 0 J CO CO 0) co A A CA 0) 0 A L, O 0 O 0 0 O m 0 Co O) CO in A CO CO O A ■J J A 0 CO N 0 0 O N 0 A O r CO A CO at ON A A co li _ CCOO _O N) 0) A (0T m (0 0 W (0n A ✓ A -CO A 0) W J N ' CT 0 CT 0 CT CO N N 0 CO O) N A A -i O A A W _ 0 W CCO 0 N --1 A 0) 0 CO W N N O N CO 0 0 m CT A 0 W A V (T P. V O W CO N <T o Co in 0 0 O 0 O) W O CO O A : o 0 O CO A O CO CO 0 0 O 0 0 0 CO CT AA A 0 A OC N CNn 0 CO > CT O) m 00) A T. N O 0 O N co .-. CO W N O O O O N N O CO 0 CT CO CO 0 0 CT (T 0 CO 0 01 0 0 0 0 CT CT CO (n O O O O O O O O O O 0 O O O O O O O O O O O O 0 0 0 0 0 0 0 0 0 0 0 0 0 O O O O O 0 0 o 0 O co O O O O O O O 0 O O O O O co O O O O O O co co 0 fT N WW A N N A -CO 0 N �I CO CO .-� J W CO CO -co O CO O O O W CO N CO CO 0 O AO CO CO A N 0 CO 0 J CO V N 0 W O N 0 0 0 A N 0 0 CT 0 0 A 01 D) O) O A 0 W co O W O O O O CO 0 0 0 0 CO 0 N CO CO W A N ' CD m N -" -1 A 0 A O O J y J W O N co J CO CT o O O O 0 J CO Y O O O o A o Cn CT O O O O O 0 O O O I" O O O O O O O O O O O O O 0 O O O O O O O O O 0 0 0 0 0 0 0 0 0 0 0 0 O O O O 0 0 0 r O O O O O O O O O O O O O O O O O O O O O DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 9:08 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 Jul'15-Jun 16 Ordinary Income/Expense Income 30th Anniversary 0.00 Contributions Annual Appeal 27,656.94 Board Contributions 10,530.61 Corporate&Foundation Support 271,289.90 Government Grants 3,500.00 Individual contributions 132,883.30 School Raised Funds 120,304.63 TF Breakfast 96,905.00 Total Contributions 663,070.38 Other Revenue Capital Gains 10,356.68 Dividend Income 29,251.52 Fees 14,106.27 Interest Income 777.75 Net realized gains on investmen -30,712.50 Net unrealized gain on investme 1,549.66 Other income 0.00 Other Revenue-Other 52.22 Total Other Revenue 25,381.60 Pass Through Income Blue Ribbon Mentor Advocate Blue Ribbon Mentor 3,000.00 International Trip Fund 0.00 Sponsor a Scholar 0.00 Youth Leadership 0.00 Blue Ribbon Mentor Advocate-Other 0.00 Total Blue Ribbon Mentor Advocate 3,000.00 Chapel-Hill Carrboro City Schoo 246,788.00 Misc Pass Through Income -282,994.13 Rtl Consortium 0.00 Schools Pass Through Income Carrboro High School 0.00 Chapel Hill High School 0.00 Culbreth Middle School 0.00 East Chapel Hill High School East Baseball 1,000.00 East Football 0.00 East Chapel Hill High School-Other 2,290.00 Total East Chapel Hill High School 3,290.00 Estes Hills Elementary School 3,000.00. Frank P.Graham Elementary 0.00 Glenwood Elementary 500.00 Morris Grove Elementary School 1,000.00 Northside Elementary Northside Arts In Action 0.00 Northside Elementary-Other 13,473.86 Total Northside Elementary 13,473.86 r Phillips Middle School 750.00 Phoenix Academy 3,750.00 Scroggs Elementary School 0.00 Seawell Elementary 0.00 Smith Middle School 10,442.27 Schools Pass Through Income-Other 0.00 Total Schools Pass Through Income 36,206.13 Total Pass Through Income 3,000.00 Page 1 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 9:08 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 Jul'15-Jun 16 Programs/Events 5K for Fitness 17,782.76 Inflatables 694.00 Merchandise Sales 981.00 Raffle Tickets 350.00 Total Programs/Events 19,807.76 Total Income 711,259.74 Gross Profit 711,259.74 Expense Contracted Services Expenses Accounting and Audit fees 6,800.00 Bookkeeping 0.00 Legal fees 0.00 Other contracted services 2,750.00 Web/internet support 312.17 Total Contracted Services Expenses 9,862.17 Fundraising 5K for Fitness 11,370.52 Fundraising-other 318.11 Walk For Education 46,327.26 Total Fundraising 58,015,89 Non-operating expenses -178.77 Office Expenses Computer supplies 144.99 Office Supplies 1,603.08 Postage and shipping 1,302.34 Printing and reproduction 1,331.88 Telephone 873.99 Total Office Expenses 5,256.28 Other Operating expenses Advertising and promotions 25.00 Bank Service Charges Investment Fees 2,326.32 Virtual Terminal-trans fees 7.08 Bank Service Charges-Other 4,415.14 Total Bank Service Charges 6,748.54 Board/Meals Expenses 390.80 Depreciation expense 2,914.30 Dining 0.00 Dues,subscriptions and books 1,042,43 li Insurance 340.00 Merchant Fees 1,283.06 PO Box&postage Equip Rental 164.00 Travel 300.00 Other Operating expenses-Other 0.00 Total Other Operating expenses 13,208.13 Pass Through Expense 30th Anniversary 0.00 Blue Ribbon Mentor Advocate Blue Ribbon Mentor 1,500.00 Haidt Foundation 0.00 International Trip Fund 0.00 MSAN Student Conference 920.00 Sponsor a Scholar 0.00 Youth Leadership 0.00 Total Blue Ribbon Mentor Advocate 2,420.00 Page 2 F DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 9:08 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 Jul 15-Jun 16 Chapel-Hill Carrboro City Schoo 164,491.14 Community Connections Program 0.00 Fund Management Fees 5,727.00 Misc Pass Through Expense -234,238.01 NCSA Scholarship 193.00 Rtl Consortium Exp Rtl Reimbursements 23,486.48 Rtl Consortium Exp-Other 7,760.37 Total Rtl Consortium Exp 31,246.85 Schools Pass Through Expense Carrboro High School 6,140.79 Chapel Hill High School 0.00 Culbreth Middle School 0.00 East Chapel Hill High School East Baseball 4,012.02 East Football 1,403.33 East Chapel Hill High School-Other 1,700.00 Total East Chapel Hill High School 7,115.35 Ephesus Elementary School 172.00 Estes Hills Elementary School 3,000.00 Frank P.Graham Elementary 0.00 Glenwood Elementary 600.00 Morris Grove Elementary 900.00 Northside Elem Northside Arts In Action 0.00 Northside Elem-Other 16,326.93 Total Northside Elem 16,326.93 Phillips Middle School 750.00 Phoenix Academy 705.68 Scroggs Elementary School 135.00 Seawell Elementary -174.00 Smith Middle School 2,635.27 Schools Pass Through Expense-Other 0.00 307.02 Total Schools Pass Through Expense 38,307.02 Pass Through Expense-Other 0.00 Total Pass Through Expense 8,147.00 Payroll-Related Expenses Payroll taxes 10,670.65 Salaries&wages 139,485.70 Vacation/Sick Leave -20,000.00 Total Payroll-Related Expenses 130,156.35 Program Expense Grants Awarded 245,859.93 Other Awards 415.15 Scholarships 22,097.89 School Disbursements 103,820.94 Store Expenses 1,480.00 Teacher programs Other Teacher Programs 27,599.00 Teacher's first expenses Breakfast Expenses 4,648.00 Teacher Store fund 34,108.64 Teachers first-Other 5,098.71 Teacher's first expenses-Other 2,528.65 Total Teacher's first expenses 46,384.00 Page 3 . . ( cuSign Envelope ID.91p21±e 2-463E994F-9511800DB63B . ( 9:a Chapel Hill-ar or Public School Foundation . ( 11/2e6 Profit & Loss Prey Year Comparison Accrual s . July 2015 through June 2016 ( Jul 5.Js# Teacher programs-Other ,gA . ( Total t acher programs 74,085.68 Total Program Expe_e 67,39.59 Total Ex#_e 92,226 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 9:08 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 Jul'14-Jun 15 Ordinary Income/Expense Income 30th Anniversary 6,355.00 Contributions Annual Appeal 36,733.57 Board Contributions 6,769.29 Corporate&Foundation Support 306,405.55 Government Grants 0.00 Individual contributions 96,378.40 School Raised Funds 128,365.84 TF Breakfast 84,243.00 Total Contributions 658,895.65 Other Revenue Capital Gains 6,977.66 Dividend Income 31,290.46 Fees 12,471.14 Interest Income 338.55 Net realized gains on investmen 61,453.00 Net unrealized gain on investme -96,209.75 Other income 2,024.37 Other Revenue-Other 0.00 Total Other Revenue 18,345.43 Pass Through Income Blue Ribbon Mentor Advocate Blue Ribbon Mentor 58,859.00 International Trip Fund 52,763.08 Sponsor a Scholar 8,329.83 Youth Leadership 2,700.00 Blue Ribbon Mentor Advocate-Other 0.00 Total Blue Ribbon Mentor Advocate 122,651.91 Chapel-Hill Carrboro City Schoo 170,000.00 Misc Pass Through Income -259,821.69 Rtl Consortium 34,344.00 Schools Pass Through Income Carrboro High School 32,492.50 Chapel Hill High School 16,200.00 Culbreth Middle School 6,989.45 East Chapel Hill High School East Baseball 1,250.00 East Football 3,200.00 East Chapel Hill High School-Other 0.00 Total East Chapel Hill High School 4,450.00 Estes Hills Elementary School 0.00 Frank P.Graham Elementary -2,403.42 Glenwood Elementary 425.00 Morris Grove Elementary School 0.00 Northside Elementary Northside Arts In Action 2,403.42 Northside Elementary-Other 49,257.24 Total Northside Elementary 51,660.66 Phillips Middle School 0.00 Phoenix Academy 1,500.00 Scroggs Elementary School -50.00 Seawell Elementary 750.00 Smith Middle School 3,800.00 Schools Pass Through Income-Other -60,336.50 Total Schools Pass Through Income 55,477.69 Total Pass Through Income 122,651.91 Page 5 1- r DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 9:08 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 ii Jul 14-Jun 15 Programs/Events 5K for Fitness 8,390.00 Inflatables 8,386.00 Merchandise Sales 1,550.00 Raffle Tickets 1,009.00 Total Programs/Events 19,335.00 I' Total Income 825,582.99 Gross Profit 825,582.99 Expense Contracted Services Expenses Accounting and Audit fees 6,500.00 Bookkeeping 5,017.32 Legal fees 2,303.00 Other contracted services 11,440.00 Web/internet support 668.53 Total Contracted Services Expenses 25,928.85 Fundraising 5K for Fitness 9,527.41 Fundraising-other 0.00 Walk For Education 56,064.44 Total Fundraising 65,591.85 Non-operating expenses 0.00 Office Expenses Computer supplies 0.00 Office Supplies 1,709.21 Postage and shipping 1,628.31 Printing and reproduction 2,282.50 Telephone 838.15 Total Office Expenses 6,458.17 Other Operating expenses Advertising and promotions 110.00 Bank Service Charges Investment Fees 2,205.39 Virtual Terminal-trans fees 0.00 Bank Service Charges-Other 413.53 Total Bank Service Charges 2,618.92 Board/Meals Expenses 287.21 Depreciation expense 380.00 Dining 214.60 Dues,subscriptions and books 785.66 Insurance 340.00 Merchant Fees 4,633.93 PO Box&postage Equip Rental 146.00 Travel 1,200.00 Other Operating expenses-Other 0.00 Total Other Operating expenses 10,716.32 Pass Through Expense 30th Anniversary 3,212.22 Blue Ribbon Mentor Advocate Blue Ribbon Mentor 50,500.00 Haidt Foundation 3,309.63 International Trip Fund 55,121.07 MSAN Student Conference 0.00 Sponsor a Scholar 34,322.22 Youth Leadership 2,700.00 Total Blue Ribbon Mentor Advocate 145,952.92 Page 6 r; DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 9:08 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 Jul'14-Jun 15 Chapel-Hill Carrboro City Schoo 120,000.00 Community Connections Program 6,230.17 Fund Management Fees 4,217.00 Misc Pass Through Expense -266,263.82 NCSA Scholarship 3,379.45 Rtl Consortium Exp Rtl Reimbursements 5,420.34 Rtl Consortium Exp-Other 44,158.61 Total Rtl Consortium Exp 49,578.95 Schools Pass Through Expense Carrboro High School 2,004.22 Chapel Hill High School 14,347.53 Culbreth Middle School 7,239.45 East Chapel Hill High School East Baseball 8,762.00 East Football 3,754.92 East Chapel Hill High School-Other 0.00 Total East Chapel Hill High School 12,516.92 Ephesus Elementary School 0.00 Estes Hills Elementary School 0.00 Frank P.Graham Elementary 183.34 Glenwood Elementary 425.00 Morris Grove Elementary 0,00 Northside Elem Northside Arts In Action 82.05 Northside Elem-Other 39,054.08 Total Northside Elem 39,136.13 Phillips Middle School 0.00 Phoenix Academy 500.00 Scroggs Elementary School 0.00 Seawell Elementary 750.00 Smith Middle School 3,500.00 Schools Pass Through Expense-Other -34,527.34 . Total Schools Pass Through Expense 46,075.25 Pass Through Expense-Other 41,000.00 Total Pass Through Expense 153,382.14 Payroll-Related Expenses Payroll taxes 7,786.32 F' Salaries&wages 95,774.24 Vacation/Sick Leave 10,000.00 E. Total Payroll-Related Expenses 113,560.56 Program Expense Grants Awarded 195,494.37 �r Other Awards 21.49 -- Scholarships 0.00 School Disbursements 105,267.14 Store Expenses 869.55 Teacher programs Other Teacher Programs 0.00 Teacher's first expenses Breakfast Expenses 4,633.51 Teacher Store fund 29,276.19 Teachers first-Other 2,645.56 Teacher's first expenses-Other 342.24 Total Teacher's first expenses 36,897.50 Page 7 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 9:08 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 Jul'14-Jun 15 is Teacher programs-Other 0.00 Total Teacher programs 36,897.50 Total Program Expense 338,550.05 Total Expense 714,187.94 Net Ordinary Income 111,395.05 Net Income 111,395.05 Page 8 F': DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 9:02 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Operations Only-Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016 Jul'15-Jun 16 Jul'14-Jun 15 _ Ordinary Income/Expense Income 30th Anniversary 0.00 6,355.00 Contributions Annual Appeal 27,656.94 36,733.57 Board Contributions 10,530.61 6,769.29 Corporate&Foundation Support 87,486.37 120,645.88 Individual contributions 8,394.42 6,662.15 School Raised Funds 120,304.63 128,265.84 TF Breakfast 19,480.00 16,723.60 Total Contributions 273,852.97 315,800.33 Other Revenue Fees 14,106.27 12,471.14 Interest Income 738.76 326.43 Other income 0.00 2,024.37 Other Revenue-Other 52.22 0.00 Total Other Revenue 14,897.25 14,821.94 Programs/Events 5K for Fitness 17,782.76 8,390.00 Inflatables 694.00 8,386.00 Merchandise Sales 981.00 1,550.00 Raffle Tickets 350.00 1,009.00 r Total Programs/Events 19,807.76 19,335.00 Total Income 308,557.98 356,312.27 Gross Profit 308,557.98 356,312.27 Expense Contracted Services Expenses Accounting and Audit fees 6,800.00 6,500.00 Bookkeeping 0.00 5,017.32 Legal fees 0.00 2,303.00 Other contracted services 0.00 11,440.00 Web/internet support 312.17 668.53 Total Contracted Services Expenses 7,112.17 25,928.85 Fundraising 5K for Fitness 11,370.52 9,527.41 Fundraising-other 318.11 0.00 Walk For Education 46,327.26 56,064.44 Total Fundraising 58,015.89 65,591.85 Non-operating expenses 1.61 0.00 Office Expenses Computer supplies 144.99 0.00 Office Supplies 1,603.08 1,712.21 Postage and shipping 1,302.34 1,628.31 Printing and reproduction 520.92 633.02 - Telephone 873.99 838.15 Total Office Expenses 4,445.32 4,811.69 Other Operating expenses Advertising and promotions 25.00 110.00 Bank Service Charges Investment Fees 2,326.32 2,205.39 Virtual Terminal-trans fees 7.08 0.00 Bank Service Charges-Other 4,415.14 413.53 Total Bank Service Charges 6,748.54 2,618.92 Page 1 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B 9:02 AM Chapel Hill-Carrboro Public School Foundation 11/20/16 Operations Only-Profit & Loss Prey Year Comparison Accrual Basis July 2015 through June 2016. Jul'15-Jun 16 Jul'14-Jun 15 Board/Meals Expenses 390.80 287.21 Depreciation expense 2,914.30 380.00 Dining 0.00 214.60 Dues,subscriptions and books 1,042.43 785.66 Insurance 340.00 340.00 Merchant Fees 1,283.06 4,633.93 PO Box&postage Equip Rental 164.00 146.00 Travel 300.00 1,200.00 Other Operating expenses-Other 0.00 0.00 Total Other Operating expenses 13,208.13 10,716.32 Pass Through Expense 30th Anniversary 0.00 3,212.22 Total Pass Through Expense 0.00 3,212.22 Payroll-Related Expenses Payroll taxes 10,670.65 7,786.32 Salaries&wages 139,485.70 95,774.24 Vacation/Sick Leave -20,000.00 10,000.00 Total Payroll-Related Expenses 130,156.35 113,560.56 Program Expense School Disbursements 103,646.94 105,267.14 Total Program Expense 103,646.94 105,267.14 Total Expense 316,586.41 329,088.63 Net Ordinary Income -8,028.43 27,223.64 Net Income -8,028.43 27,223.64 Page 2 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B STAFF ROSTER OF FINE ARTS TEACHERS AT SMITH MIDDLE SCHOOL SUBJECT TEACHER NAME PHONE EMAIL Art Chris Harkey ext. 21413 charkey @chccs.k12.nc.us Art Missy Valentine ext. 21529 mvalentine @chccs.k12.nc.us Band/Orchestra Jeremey Bellion ext. 21435 jbellion @chccs.k12.nc.us Chorus & Band Seamus Kenney ext. 21615 skenney @chccs.k12.nc.us Theater Danka Kulikowski ext. 21614 dkulikowski @chccs.k12.nc.us is is r DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B r 2016-17 CHC PUBLIC SCHOOL FOUNDATION BOARD OF DIRECTORS David Huntoon(5/3) (REVISED AUGUST 2016) May Martin Bryan(1/2) 100 Europa Dr.,Ste.445 (TERM/YEAR) 813 Emory Drive Chapel Hill,NC 27517 Chapel Hill,NC 27517 Office:919 968-4911 Home: 919-933-0337 Fax:919 967-2813 James Barrett(1/1) Cell: 919-656-4346 Email:David @chbcpas.com ■ Board of Education Liaison Email: David is a CPA and partner at 100 Morgan Bluff Lane maymartinbryan @gmail.com Coleman Huntoon&Brown PLLC Chapel Hill,NC 27517 May is active in school and CPAs. 919-593-0592 community organizations. jbarrettAchccs.k 12.nc.us James is chair of the Chapel Hill- Christine Cotton(3/1), Jim Kitchen(3/1) 1 Carrboro Board of Education. Communications Chair 109 New Castle Drive 100 Arbor Creek Court Chapel Hill,NC 27517 Laura Baxley(2/2),President Chapel Hill,NC 27516 Home: 919 801-5230 411 Longleaf Dr. Home: 919 929-3753 jim(a,jimkitchen.org Chapel Hill,NC 27517 Cell: 919 812-3949 Jim teaches at UNC and is president of Home:919 967-8396 Email: cmcottonll@yahoo.com Real Property Development. Cell:919 274-2037 Christine is the founder/director of lauracl thebaxleys.org PORCH. Laura is a community and school Matt Marvin(1/2) volunteer. Pat Flores(1/3) 642 Cedarbrook Way 6108 Turkey Farm Rd. Chapel Hill,NC 27516 Lyn Billings(1/3),Vice President Chapel Hill, NC 27514 Email:mmarvin @email.unc.edu 608 Concordia Court 919-490-7194(direct) Matt is Associate Director of Reunion Chapel Hill,NC 27514 919-451-9741 (cell) Giving and Engagement,UNC Kenan- 919-423-6627 Patrick.Q.Flores imorganstanley.com Flagler Business School (919)260-5351 (cell) Pat is Vice President at Morgan Email mm4kk @yahoo.com lbi1lings018 @gmail.corn Stanley Wealth Management Lyn is a community and school volunteer. Nik Gandhi(1/2) Suki Newton,Support Committee 101 Arbor Creek Ct. (6/1) Madeline Blobe(2/1),Treasurer Chapel Hill,NC 27516 405 Tramore Drive Chair,Finance Committee Home: 919-316-6797 Chapel Hill,NC 27516 200 Manor Ridge Drive Cell: 919-707-7040 Home: 919 967-4148 Carrboro,NC 27510 Email:nik_gandhi @hotmail.com Cell:919 247-4148 919-932-4411 Nik is Director of Marketing, Email: SNewton405 @aol.com Email:madyblobe @gmail.com GRIFOLS USA Suki is an active community Mady is active in schools and volunteer. community organizations. Linda Gilchrist(1/3) 1004 Pinehurst Dr. Laurie Norman(4/1) Vicky Kline(2/2),Secretary Chapel Hill,NC 27517 205 W.Poplar Avenue 3812 Sweeten Creek Road2 Home phone:919-240-7790 Carrboro,NC 27510 Chapel Hill,NC 27514 Cell phone: 847-312-2478 Office:919 843-6979 Home:919-493-7546 lagilchrist @yahoo.com Home: 919 942-2746 Cell: 919 428-1807 Linda is a community and school Cell: 919 302-4902 - vckline @gmail.com volunteer. Laurie Norman@unc.edu Vicky volunteers extensively with the Laurie is Director of Alumni schools. Jeffrey Hart(1/2) Relations,UNC Sch.of Education. 212 Telluride Tr. Lyria Boast(4/3), Chapel Hill,NC 27517 Dan Rockaway(2/2) 403 Westwood Drive Home: 919-932-7274 202 Hogan Woods Circle Chapel Hill,NC 27516 Business:919-328-8801 Chapel Hill,NC 27516 Home: 919-933-5675 Cell:919-259-4244 Cell:919 621-0182 Email: lyria @cribmail.com Email:jhart@rhb.com dan.rockawayliisoundsandcolors.net lyriaboastagmail.com Jeffrey is an attorney with the firm Dan is co-founder and owner of Lyria is a senior consultant at Public Robinson,Bradshaw&Hinson P.A. Sounds and Colors. Impact,research assistant in epidemiology and a school volunteer. 1 f=, DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B Dena Thomason(2/1) Ex.Officio Members 6721 Turkey Farm Road (Non-voting) PSF Staff Chapel Hill,NC 27514 Phone:919 930-5430 Sarita Allen-Medlin(1/2) Lynn Lehmann Email: dthornason l nc.rr.com 3024 Courtney Creek Blvd. Executive Director Dena is an active school and Durham,NC 27713 8700 Drew Lane community volunteer. Cell:919-949-5561* Chapel Hill,NC 27516 Home:919-806-8040 Home: 919 968-3925 Ashley Wilson,Past President(4/2) Office: 919-969-2482 x 27318 Email:llehmann @chccs.kl2.nc.us 305 Madera Lane sallen-medlin @checs.kl2.nc.us Office:919 968-8819 Chapel Hill 27517 Sarita is the district's elementary PAC Fax: 919 968-7884 Phone: 919 968-3654 teacher. Cell: 919 604-8439 Cell: 919 619-3453 ashleyleflerwilson @gmail.com Jim Causby Nancy Zeman Ashley is a school and community 750 S.Merritt Mill Road Program Services Manager volunteer. Chapel Hill,NC 27516 6516 Whitney Rd. Office:919 967-8211 Graham,NC 27253 Ken Witt(4/1) Email:jcausby @chccs.k12.nc.us Chapel Hill,NC 27516 �. 104 Crane Meadow Place Dr.Causby is Interim Superintendent Home:336-525-2401 Chapel Hill,NC 27514 of CHCCS. Cell: 919-225-0075 Home: 919 402-0349 Office:919 968-8819 Office:919 402-4816 Jeff Nash Email:nzeman(cichccs.k12.nc.us Cell: 917-597-9855 Lincoln Center Email:kwitt51401 a,aol.com Chapel Hill 27516 Office: Ken is Technical Manager of the Office: 919 967-8211 ext.227 Nancy Lees Business,Industry&Government Fax: 919 933-4560 Foundation Asst. team of the American Institute of Email:"jaxdsll(a,,chics.k.l2.nc.G�4 Email: nlees @chccs.k12.nc.us Certified Public Accountants. Executive Director for Community 107 Cobblestone Drive Relations. Chapel Hill,NC 27516 Allison Worthy(5/3) Office:919 968-8819 517 Hooper Lane Cell: 919 3 60-41 96 Chapel Hill,NC 27514 Home:919 969-7584 Shannon Grabowski Fax: 919 969-7475 Bookkeeper Email: allisonworthy(igmail.com Office: 919 968-8819 Allison is volunteer coordinator, Email:srabowski@chccs.kl2.nc.us SECU Family House at UNC Hospitals. Stephanie Yost(6/3) 7700 Amesbury Drive Chapel Hill,NC 27514 Cell: 919 490-6827 Email:yostAemail.unc.edu -- Stephanie is a Nurse Consultant with UNC Health Links and School Nurse 2 Ei DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B internal l Revenue Service Treasury of Nt�Lh P.O. Box 2508 Cincinnati, OH 45201 Date: II N 0 5 2015 Employer identification Number, 56-1421977- - ._ . .. Chapel Heil-Carrboro Public porson to Contact w 1D Number; School Foundation Tyrone Thomas- ID1000281724 P.O. Box 877 Contact Telephone Number: Carrboro, NC 27810 877-829.6500 Toll-Free Form 990 Required: Yes Dear Sir or Madam; In your letter dated December 15, 2014 you requested classification as a public charity described In section 509(01)and 17O(b)(1)(A)(vi) of the Internal Revenue Code. in our letter dated January 1985, we determined that you were exempt under section 501(c)(3) of the Code, We further determined that you weren't a private foundation and you were classified as a public oharity described in section 509(a)(3)of the Code, Based on the information you provided,we determined you meet the requirements for classification as a public charity described in section 509(a)(1)and 170(b)(1)(A)(vi)of the Code. Accordingly, we have updated your public charity status In our records as you requested. Since your exempt status wasn't under consideration, you continue to be classified as an organization exempt from federal income tax under section 501(c)(8) of the Code. Grantors and contributors may generally rely on this determination of your foundation status unless the Internal Revenue Service publishes notice that you are no longer recognized as tax exempt or classified as a public charity in the internal Revenue Bulletin. However, if a grantor or contributor takes any action, or fails to take any action, which causes you to lose your exempt status or causes you to be reclassified as a private foundation, that party cannot rely on this determination. Furthermore, a contributor or grantor who knows that the Internal Revenue Service has notified you of any change in your exempt status or foundation status cannot rely on this determination. For important information about your responsibilities as a takexeript organization, go to www.irs.covfoharities, enter"4221-PC" In the search bar to view Publication P ub li cat(Qn 422i«! C Compliance wuid for +1 40(3)Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. because this letter could help resolve any questions about your exempt status and/or foundation status,you should keep It with your permanent eent records Letter 4425 2015-06-05 15:34 (RS Paae 2 DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B ry YOU t have an .4t resiio ns, please oOfh c t the person 1,A,I ic„)yA name and telephone number iii€bei ai t° tai-*vv t hi iii; neaatncj of trim ii?UUer. Sincerely, u.s t.. �'ftflcerei , Director, Exempt Orgy•;tzattor • • Letter 4426 "F.:lc: ni..ric: 1:1-rt:, �`