HomeMy WebLinkAbout2017-448-E Arts - Northside Elementary PTA - 2017-18 Arts Grant Agreement DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
1111 11 /
coo, 11111,
August 15, 2017
Andrew Riggs, PTA Treasurer
Northside Elementary School PTA
350 Caldwell St.
Chapel Hill, NC 27516
GRANT AWARD LETTER
Fiscal Year 201 8
Grant Category Grassroots Arts Program
Funding Source NC Arts Council Grassroots Arts Program
Award $1 ,030.00
Start Date July 1 , 2017
End Date June 30, 2018
OCAC Report Due Friday, July 6, 2018
Project Title Cultural Arts Programs
Staff Contact Katie Murray, Director
919/245-2335
kmurray@orangecountyncgov
Stipulations 1 . Grantee must properly credit the Orange County Arts
Commission and/or North Carolina Arts Council (according
to Funding Source, provided above), using the proper logo
AND credit line on all publicity materials. View proper credit
line language and download logos on the OCAC website at
https://artsorange.org/grants/grantee-resources
2. Grantee must spend $1 ,030 on the hiring of multicultural
artists as described in application.
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB C
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ORANGE COUNTY ARTS COMMISSION
��� yr 2C��iL7 L GRANT AGREEMENT
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THIS AGREEMENT, entered into this 17 day of August, 2017, by and between Orange County
("County"), by and through the Orange County Arts Commission ("Arts Commission") and
Northside Elementary School PTA ("Grant Recipient").
WHEREAS, the Arts Commission is a countywide arts agency that ensures the growth of
local arts experiences by providing funding and support for diverse high quality programs and
projects.
WHEREAS, the Arts Commission administers the annual Grants Program to provide
economic opportunities to Orange County artists and non-profit organizations coordinating arts
projects benefiting the citizens of Orange County.
WHEREAS, the annual Arts Grants Program is supported by Arts Commission with
funds from the Grassroots Arts Program of the North Carolina Arts Council, a division of the
Department of Natural and Cultural Resources, a state agency.
WHEREAS, the Grant Recipient was selected by the Arts Commission to receive the
annual Arts Grant through the procedures duly adopted by the Arts Commission; and
WHEREAS, both parties wish to promote and maintain the integrity and clarity of the
Grant Recipient's ideas and statements and delineate the Grant Recipient's obligations to the
County;
NOW, THEREFORE, the County and the Grant Recipient, for the consideration and
under the conditions hereinafter set forth, agree as follows:
1. Approved Grant Project. Grant funds are provided under this Agreement for the project
("Project") described in the Grant Recipient's Grant Application, attached hereto and
incorporated herein as Exhibit A.
2. Grant Award. Grant funds in an amount not to exceed one thousand tinny ($ 1,030)
have been awarded by the Arts Commission to the Grant Recipient for the approved
Project. The Recipient shall be required to match funds 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, as outlined in the attached Exhibit A.
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
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A. Implementation. The Project implementation shall take place between July 1,
2017 and June 30, 2018. 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 described in the attached Exhibit A.
F. Final Report. Grant Recipient shall submit to the Arts Commission a Final Report
on July 6, 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
$1,0303 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
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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 required for audio projects: "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 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.
(ii) Nonperformance, incomplete service or performance, or failure to
satisfactorily perform any part of the Project or to comply with any
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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 Non-Discrimination Policy and
Orange County Living Wage Policy (each policy is incorporated herein by
reference and may be viewed at
http://www.orangecountync.gov/departments/purchasing_division/contracts.php).
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
11A and Article 40 of North Carolina General Statute Chapter 66.
[SIGNATURE PAGE TO FOLLOW]
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DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
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
L4e Signed by:
e,1 p n5 8/23/2017
RE"" S',Treasurer Date
For and on behalf of Orange County Government
LDocuSigned by:
f,otA lLi, kum144U(SLUI 9/5/2017
riteeffictinnersley, County Manager Date
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DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Northside Elementary PTA Party/Vendor Contact Person: Andrew Riggs Contact Phone:
646-498-3357 Party/Vendor Address: 350 Caldwell St. City Chapel Hill State: NC Zip: 27516 Department:
COUNTYMGR/Arts Commission Amount: 1030.00 Purpose: 2017-18 Arts Grants Budget Code(s): 37601020-
683000 Vendor# 62286 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type:
(Check one)New ® Renewal❑ Amendment ❑ Effective Date 8/17/2017 Approved by Board Yes No
Agenda Date:
This agreement is approved as to technical fo Viand content:
Department Director's Signatur le"'S "' Date: 8/23/2017
0A3E61 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:
DocuSigned""by:
''1L
Q�ASA. Cbrik,e o 8/25/2017
Office of the Risk Management Officer 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 Officer ('b 0. -I_ Date: 8/25/2017
7D4E5181ACC1409...
Legal Services
This agreement is approved as to legal form and sufficiency:
DocuSigned by:
Office of the County Attorney (.Aril- 1S(b Date: 9/5/2017
079A4D525C0F4FB...
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd(a)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:
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DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
odow,„,,v dowe
;46
2017-18 GRANT APPLICATION COVERSHEET
Applicant: Northside Elementary PTA
Date Received: 5128!:117.0 Date Notified Complete,: 5/26/17
Project Title:
Cultural Arts Programs (TAG) Date: Sept 17 - April 18
Use of F A1St ic Contracts
NCAC Funding Priority: 0 ft @ 2nd 3rd
NCAC Multicultural Requirem 1250 ent? IE Yes Amount $ M No
Total number served: 491 students
CHCCS Chapel' Hill
Community served:
Demogrphics:42% FRL
CHECKLIST
• Completed application form with E B dget: FY17-18
signatures @ Board List
• Narrative El Tax exemption letter
IM Project Budget worksheet @ Sample publicity
IN Resumes of key artists/instructors E Work samples,
Financials: FY15-16 0 Letters of support Inot requo red)
• Financials: FY16-17
AMOUNT REQUESTED: $1250 AMOUNT GRANTED:
FINAL SCORE:
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
'14t°1■01161F
Plitt
201718
ARTS GRASSROOTS ARTS PROGrAM
ORANGE COUNTY
commlsslott www„nca rts.org APPLICATION FORM
„
PART I APPLICATION OR,OANIZ,A,TIO,N INFORMATION c
Organization Name: ille° :01 prit
JJLt
Street AdriressL,3_5iiiiliiiii,LLIcliiiiivizaj
,111.
City:
, State,: Ltii3O' ,
Phone: e :x.c1 Ntifebsite: c 411 e.
Authorizing Official Name:
Authorizing Official Tale:
.Authorizing Official Phone: t g, „, 2,5 ,Authorizing Official Email: eiriiilt:/krililirieiikiii'vrt,idetihtili
Applicant Race: Organization EIN: -
0 GANIZATIONAL FINANCES
Please attach a complete ncome and expense statement(an audit may be substituted)for your last fiscal year and
complete operating budgets for the current fiscal year and next fiscal y par. Public schools and other large governmental or
community agencies should attach arts program tiniarir;101 information only. Please,copy the totals from these attachments
in the spaces blow:
LtYrAwil: FY"16.16 Current Yer FYI r-17 Next Yer: FY1718
Actual Income: $ 0 „ 0 6 Projected Income: $ ,57 9 63 s," I Projected income: $ 0,
Actual Expenses: $ o g° Projected Expense: $ „ Projected Expense,:
PART 2 PROJECT INFORMATION
PROJECT DIRECTOR 1NF0RNIATION if different from Aiothoriziril
Project Director Nsrni Ii _10,
Project Director :': ;1: Is r,,E,,w -41
Street,Address:
City - t
Phone: - V c'''L Email: d C0,41
PROJECT SUVINIARY
„ ;
Title of(want Program of Project Aid - 1_4,117 " —
(742 FiLeki ' Litfic
Grant Amount Requested: qe" 2.5
In
Project Start Date (No earlier than Jul y 1, 2017):
Project End Date (No later than jape 30,
SCHOOLS ONLY:
Are you booking your artists through The ArtsDenters Arts Schools Program? 1134./;;;S 0 NO
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
PROJECT 11 'ARRATIVE
Please attach a narrative providing the information rebut sted below for the project you propose. Please be as concise
and specific as possible:
1. Please gve a brief description of your organization, including mission, board and.staff composition, current arts
programs and servites and number and kinds of people served. Public schools and other large governmental or
community agencies should provide a description of thqiir arts program only rather than the entire organization. (250
words or less)
2. Offer a brief summary of the proposed project,
3. Stale your project's goals.
4. Offer a description of intended participants/audience, including estimated numbers and raclei and cultural
composition. For school applications please include the demographic breakdown of the student body, as well as the
prcentage of students on the Free and Rzrduced Lunch Program,
5. Describe the location where project will take place.
6. Explain all project activities.
7, Describe alt artists to be involved in the project, how and why they were chosen„ and the rate of payment for their
services If you have not yet selectiA the artists; describe the kinds of artists you intend to involve and how you will
select them (Schools, please indicate if you are working with The ArtsContens Arts in School program to secure your
artists), Please include the ethnicity of artists or instructors hired for the project.
B. Describe how the project will be publicized and promoted to reach intended participants.
9. Describe how you will evaluate the project.
PROJECT BUDGET
Please provide a projected budget for your proposed project utilizing the format below. You may attach an additional
detailed budget if necessary, but the tables below must be filled out Please see the attached Glossary of Budget Terms
for more information,
PROJECT EXPENSEEl Exph notion Grant Rees si 4nrnwif Match/rig Funds Tam'Expense
Adininistratilre Staff: $
A. Personnel Artistk Staff;
Tectinoalirtotlitoif on Veit $
, Er Outside Fees and MUM CohtreCtS. $ e- $ ii„.3„„_„,„t5- $ 2 5 1210°
! Services Other contracts:
C. Space Rental s
$
D. Travel ' $
E. Marketing
F. Remaining Project
Expenses
G. Total Cash Expenses $ ' n) $ 2. $ Z.
CO4ItSt1040010; 77-1-7TO.444,406k, - 60,14;;:okno4;;;;;T7
A. Admissions
B. Contracted Services
Revenue
C. Other Revenue
Corporate Support
U. Private Support Foutulation Support
Other private support
Federat
E. Government Support Staie/Regio net
Loaf(not including this reques):
F. Applicant Cash $
G. Grant Amount Requested .1
15
thip mpPeetion)
H. Total Cash Income (must
equal Total Cash Expenses, ' $ z) 50
Item above
A Ii 9 PIC
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
PART 3: AppLicATIoN cHEcKLIST
APPLICATION CHECKLIST
Please compile in this order. Do not staple, bind, or put into individual folders or staev;s. Provide one copy,
one sided, 8.5 x 11 white paper. A digital copy of the application is not necessary,
O Application Form, including signatures
CI Narrative
O D;tailed Budget(if necessary)
O Resumes of key artists and administrators involved in grant funded program(s)
O Income and Expense statement for FY15-16
O Budget or year-to-date statement for FY16-17
O Budget for FY17-18
O Current Board of Directors list
O Copy of IRS Tax Exemption Letter, if applicable
O Sample programs, press, or other materials from this or similar past programs
O Work samples by artists), labeled with artists' name, title of work, date of work, produced tri the last thiree years
0 Visual artists. CD, DVD„ or high resolution photographs(8 images per artist MAX), clearly labeed l with
dimensions and media and indicate top of image
o Dance or theater atiist, CD or EDVD, or link to high-quailly online video (3-5 minutes)
it Music and spoken word: CD „ IMP or link to high-quality online video(3-5 minutes)
• Literary arts, Manuscript(10-15 pages) submitted as .pdf file or hard copy
PART 4: cERTIFICATION
We understand that are to respond to any of the above items may adversely affect the consideration of this application.
We certify that we ale committed to the completion of the o
prop, sed project in compli;nce with legal requirements and
granting procedures. We certify that the information contained in this application, including attachments and supporting
materials,is true and correct to the It;st of our knowledge.
PriOJECT DIRECTOR (if appitc
Printed or typed name,
IJ
Signature:
r Ar
Date: di- 2 z
AUTHORIZING OFFICIAL(required)
Printed or typed name: -A
- '
signature:
(
Date:
„ „
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
Northside Elementary School
OCAC Grassroots Arts Prograt,H, Applicati, n 2017
School Profile
hi 2013 Northside Elementary School (NES) opened in the Chapel Hill Carrboro City
Schools (CHCCS) district in Orange County. This school was intentionally built in the
historic Northside neighborhood, centrally located in downtown Chapel Hill on the same
site where three African-American schools existed from 1924-1966, Northside Elementary
currently enrolls i$'91 students, drawing on residents from neighborhoods throughout the
town of Chapel Hill and Carrboro, .Northsides student population represents 6 races and
ethnicities: approximately 13% are Asian, 23%are Black/African.American, 1„5% are
Hispanic, less than 1% are American Indian/Alaskan Native, 5%are Mixed Race and 44%
are White. NES has 52,5% boys and 47$% girls and 93A %, of students are ages 6-11.
Northside offers classes in Pre-K through 5th Grade including a class for Special Needs and
programs in English as a Second Language, Exceptional Children and Gifted Education. NES
has approximately 16% Limited English Proficiency(LEP) students and 17.1% of students
have special needs. As an indicator of socioeconomic status, Northside Elementary School
has one of the highest free and red.uced priced lunch in the district at 42%,, The leaders of
Northside feel it is very important to create relevant multi-cultural art programs for
Northside studei Is who otherwise would not have the resources to participate m similar
activities at home,.
School's Art
We celebrate cultural diversity at Northside and find that students Can learn effectively'
about others through musk,art and perforrnaoce. With the help of the OCAC,the Cultural
Arts Committee worked with the Carrboro Arts Center this year to bring a diverse range of
performances to our school: The NC Youth Tap Ensemble exploring the history of tap,
David Gonzalez on cultivating relationships and communities and Bright Star Children's
Theater exploring leaders and topics in African American history. in addition, we have
several school programs that support the arts_ iNavigate is an afteiscihool program which
focuses on performance; the club organized and performed the play"Twisted Fairy Tales'
this year. Another afterschool program.is Navigators on the Move which focuses on music
and rhythm and community outreach, When relevant and applicable,a grade level may
participate in a field trip that focuses on the arts. Every Fall Northside hosts an Art and
Music Showcase Night whcrc students display their visual art and participate in musical
performances. in addition, teachers and staffoften come'together to dance and sing& ring
school assemblies, Our Physical Education Coach organizes as Spring Dance Flight where'
each class learns a different dance from a different time period and culture. NES also hosts
an International Navigator Night in the spring where Northside.families often demonstrate
their native culture through music and dance. STEAM day and Maker's .Faire are annual
programs where students participate in interactive, hands on activities to explore art,as it
relates to other topics. Al] of these programs are important to Northside and require
hind ng or assistance from the PTA.
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
Northside Elementary School
OCAC Grassroots Arts Program Applicatlin 2017
Geography of Audience
All °lithe Cultural Art performances will be a requirement for grades K-5 at ,NES and will
take place in the school auditorium, Northside Elementary currently enrolls 491 students
representing 6 races and ethnicities ,approximately 13% are Asian, 23% are Bia,ck/African
American, 15% are Hispanic, less than 1%are American Indian/Alaskan Native, 5% are
Mixed Race and 44% are White, NES has 52,5% boys and 47,5%girls and 93.4 %of
students are ages 641, NES has approximately 16% Limited English Proficiency (LEP)
students and 17,1% of,students have special needs, As an iniicator of socioeconomic
status, Northside Elementary School has one of the highest free and reduced priced lunch
in the district.at 42%. The PTA of Northside feels it is very important to bring relevant art
and performance programs to Northside students who otherwise would not he able to
afford to go see these programs at'UNC or the Carrboro Arts Center.
Proposed Use of Grant Irr.jAkflas,
The grant funds will enable the PTA and the Cultural Enrichment Committee to offer three
cultural art performances to all of the students at Nortnside, All of these programs are very
important to Northside Elementary as we continue to understa .d the African American
heritage of this school's neighborhood community, build compassionate relationships!
within a diverse student body and find inspiration in the Arts as a mode of creative
expression and common language that students from different backgrounds can engage in
together., Prom these performances, we hope that. NES students can gain a greater
understanding of the performing arts from a multicultural perspective and in turn be
inspired and encouraged to pursue their own artistic dreams and goals.
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
rilarthSide MetV ry School
°CAC Grassroots Arts Program Application 2017
Provosed Programs
Soul Street Dance Corhparty
Dates: September 25-29, 2017
Grades; K-5
Description : 'No Bones About it," - These impressive dancers exhibit how the human body
accomplishes seemingly super-human leaps and bounds through a network of bones,
joints, muscles and the brain. Demonstrating with props and high-energy dance segments,
the dancers reveal how signals from the brain tell muscles to stretch or contract.allowing
our bodies to move the way we want them to,
Wehsite: www.soulstreetdance,com
Multicultural Folk:tales Form Anansi Zeus with Donna Washington,
Dates:January 8-12, 2018
Grades: K-H
Description r Donna Washington presents a wide range of tales from many different
cultures that can be mixed and matched to make a set appropriate for your school's needs.
Donna provides a fast paced, interactive program that will excite the students
about reading, biological sciences, the art of performance,and cultural
differences and similarities. Her tales will enhance the study of:ancient Greece, the
African American experience in America, West African folklore, China and the
Appalachian Mountains,
Website: www,donna wash ington,com.
Gahm pha
Dates:April 9-13, 2018
Grades K-12
Description: Combining stunning acrobatics,striking visual effects, physical comedy and
inventive choreography, Galumpha brings to life a world of imagination, beauty, muscle
and merriment,The three performers create images ranging from the ridiculous to the
sublime, drawn together into a seamless whole, consistently bringing audiences to
their feet. Galumpha is a triumphant mix of art and entertainment,offering world-class
choreography that is exciting for audiences of all ages!
Websitc: www,galumpha.com
All performances contracted through:
The C.arrboro A rtsCente r
300-6 East Main Street
Carrhoro, NC 27510
919,929.2787
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
Ni rthside Elementary School
OCAC Grassroots Arts Progra Application 20 lo 7
PIAroitural Arts Cann B0liget.
2017-2018 Proposed Programs
$ 900 Soul Street Dance Company
$ 700 ulticultural Folkfaies from Anarisl to Zeus, Donna Washington
$ 900 Galumpha
$ 2,500 Total cost and Proposed Budget
$ 1,250 Matching PTA funds
$ 1,250 Grant Request
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
Northside Elementary PTA
Profit& Loss Budget vs, Act('.1
July 2015 through June 2010
I 11.11=1.1111111111•1111111111111111111111111111•11111111MMIN
Wools Eluegria 1101/Of %
, I■nnie 1 r 41•Mill II. " I
locums
Duns sod CorientInot
Fuss Freer Furniraiser 4,10200 421.1000 202,00 10481%
Misaohnoous Donahoris 161 18 76000 -5511,51 24 10%
Norf ti skto PTA Does 2,1271Y 10500,QC 627,00 I4 I. %
PTA Thrift Shop Allocation 2043.13 000 3,503 13 100.0%
Total Dims and Contribotiona 10,053,32 6,450,50 4,20332 165,17%
FUrldral.sing intorno
Sox,'Tops,fur Edlue411ort 1,607,10 7,105,00 507,40 146„13%
Fon6YourPTA,(Arnacon) 772.27 509.00 272.27 154.45%
Road-aithon 14,213.50 15,000 00 -711847 54:75%
Restaurant Fe,milly Nights 475.00 00060 125,30 73 12%
Scrip Program '792,00 060 702,90 L00,6%
Total FunduriMng Income t7,83.7.10 17,260,00 661,10 103E4%
Interest and Retails
Tax Rotunda 1.444t;',03 456,00 637403 192.6%
...... .. . ,- , 4
Pohl Interest and Refunds 1,403 760 Oil 60303 102,Elli
Resdrieti„d,ir name
Pall Granary'Gift Cards 1813 00 1,0213,1010 Old 01)
Total Resiirieted Income 1,1313 CO 1,11011.,113 61 di(111 101.0%
School Eventsigervieas Income
Bingo,14 i ht 63'3 00 600,00 55„00 100.33%
194)4k F4fr 5526,05 0600.00 020.25 110,45%
fill Festival 090110 650„00 140.00 117.1116'
$rent Ferns 7,910 00 6,400.00 1,540,00 121,0E%
Walk far Education Booth 135,50 1106 135.00 100.0%
Yearbook,
5,1(74,03 2,500„00 614.00 12401.1%
Total School Event orSorices income, 19,470.83 16,350.00 3,120.63 11909%
Total triennia 51 on 111) 41,750 On 9299E6 12227% '
....4.01101... . wwwww ...■,......■...
51,040,06 41,760 05 0,290,08 12207%
Expense
Duns and Contribution Expenses
Nallonal PTA DUOS V DO 225,0 -2,25,00 6,0%
NC PTA Duo* 90019 175,110 66600 477.73%
PTA Council Dues 50,00 50.0a 0.00 180,0t1ii
Tatar Duos and Contribution Exponsos 400,00 450,00 136,00 106.09%
FIN,G,ronory Pilft Cord PAL rChittaria 1,553 00 1,0011,00 562.00 150,3%
Filnirsic nit Expenses
Box Tops for Education 000 200,00 200.00 0,0%
Road-a-1h= 63002 1,500.00 -608 58 59.54%
Total Fundraising Extdenatis 893.02 1.7510.00 -806,90 52,50%
Grounds
Garden 475,71 750 00 -27429 03 42,%,
,re,Clittis C.00 2,000.013 .200.00 010%
Ployaroand 253,95 500,05, -245,01 50 0%
Total Grrounirs 729.70 2,25060 22.15%
inotrottiOnal tit eterlil"sMq ulp
Cultural Eon Omer t 2,125 kr! 2,000,0€ 45.010 loala%
Paper 10.64 1,0001313 4191.33, 13137%
Totar Inshrucil on ai idaterialsiE1u1p 2Z03/37 3,060.013 -82633 73 ri%
Pogo 1 of 2
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
Northaide Elementary PTA,
Profit & Loss Budget vs. Actual
July 2015 through June 2016
Actua Is SAW $Or %
ne■■m. ,111. 11 011MINEMIMMINI110 110111=1=1=11111111111111111
PTA Aerrithi%kabob
Bad Chocks 0,00 60.08 -50.00 0;0%
Bask{ten 214.00 60.00, "I 14.30 1.4904%
Hospitality 425,59 1,530;5117 -524.01 42.6%
Onsurance 215.00 .225.00 -16.00 93,etaN
Freskinst Dis cretianary 445,40 1,0=12(3 -6E4.5:: 44,51%
Treasurer.Dlscretionary 304.35 350000 44.15 112.50%
Total PTA Admisistratloo -I,70043 24555,08 -1374.5! 03.0400
School Eventslervices Expenses, .
5th Grade Graduation Ceremony 93.43 50100 406130 10,65%
Bingo Plight 573,50 5505,00 7320 114.75%
6/00K'B4�k 302748 0,000..00 027.40 110.40%
Fail Festival 1076;13 755.00 -7 ,90 515.15%
Saint Roos 5,93455 4,398,53 1,500,02 135.55%
TeacherUStalf Appreciation 1,;'.63 59. 2,001,00 -0,39,41 08.1E1%
Walk for Se us eon Booth 462„2S 0.08 462,25 15004
Yearbook 1,641.53 2,500150 -1357130 79.7%
. .....,.... ....
'total,School EventtaS cruises Expense 8 'I 7,575,07 101,6111,53 955,14 105.7556
Staff Support;
An 'Tea cher 430,25 1,000,011 -569 14, 43 VA
Forniiy.SpeMolist 05343 1,500231) ,,a4e,,eo 56;55%
Literacy Coach(bookreein boas) 100,95 250,00 -5985 75401%
Music Teacher 0.,00 1800433 -"1,000 80 0,056
PE leacher 1111,50 1,500„IX5 -3112.14 74.52%
PrSmItial
041,50 50030 -158,04 05.39%
Professional D u4volon in writ 7990)31 3,000.30 .773..19 74033%
Soneol Neese 479.62 500.33 21)3)0 05.02%,
Staff liValkie TalkieS 1,473.50 1,550,30 -7580 5587%,
Tea,c110(Allocations 5,02135 1,900,00 -4,0/1..,32
Tamale!1,shirts 736„,511 (400 OX) 13,344 12270%
vico PrInoral 200„CO 501.33 -300.80 40.0%
...................................................................., 4101■1.1.111.10 1.1.110.11 1.1001.6■11.1.010111■11MONI MININIIMI■MIMIMIIII
'Total Staff Support 131074.32 21,000,)30 41„T236 '15.984,„
Student Su.?!.ort
5th 00rJde1idEIIe$choal Visit 243,91 :MAO 450,39 K2%
Field Trips 945.30 3,(J00.30) -205500 51,5%
thisviaale 305,130 3110.20 0.00 1001.0%
Nu winators on.thO Maw? 350.01) 730003 5100 15110%
Odyssey of lb u Mind 13503 15100 0.80 100.8%
Total Student Support, 1,923,61 4,(535„00 22;111..00 47.:67,4
Transition
Carry coder Funds „I 0,05 30 —-12443„53 2,3,309„139 40)4190%%
. . —.........----,
"Total Transillion 1345830 -12,843.53 Z3,309.89 ,ill 4S%
,, ....... ...... ..gg.g....,....g. ma■..
Toial 830e$5 Si 045138 41.0133.1)0) 9,289 c8 122,27%
x■•■••■• iiiiiiiimiiiiiimmiiiiiiiii*iiiiiii7 10..iii.116.10.11,11X01.1.0 v
Net linsorno 0.2001 0.00 0,00 OA%
..,
pap 2 of 2
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497,SC1EB ....,,,, Elementary PTA
0510(17 ,
Accrual Brads Profit & Loss Budget vs., Actual
July 2616 threu1 June,2017
I
All 16-Jun 17 4 tie,,..., $Osier 3uii,,,,,e1
MmettaggitMkeffillaREM 11211101111MVEN Pot= S‘ ,WWWINBE AI
Ordinary income/Ex parr
looms]1:.
' es,srui Coatiebolloris
Fuss Free Fund r6 o.or 6,120,00 5,000100 1,I20„99 1 22„,42%
Cik's■
it income 10,137,00 1%187,00 0,00 100,0%
Miscellaneous Donation$ 2400,75 205,00 2,213333 1,175,0%
Northaide PTA,Duca 2,030,00, 2,100,00 -7060 96.01%
T-,i.cher Ap muclithan Donations 390,00
Teacher Fundral a 4-ic-F■-.1t1'Trip 4,861.00 5,000,00 -130.00 97.22%
TOM Duna and Contributions 25,997 74 22,492 00 3,505.74 115.59%
Fundraising Income
Amazon Grocery.(Kr..t e OW onesirt 446.29, -.1.(1.00 -253,71 55_79%
Box Tops for E,riricaln 1„421.40, 1,200.00, 221.40 1114,45%
Ry ad-a-thou 12,927.99 16,000.00 -3,17261 80,19%
ROSIMAIII I Family Nights 300.00, 800.00 -50060 37 5%
Sodp Pro tarn 160,04 1,200.00 -1,039,00 13.41%
Whole Fames Scrip 1128,00 0.00 1,128.00 100.0%
.11641WWW1Y11011.11KNOW UNOMMIIMOMIVINNONEM
Total Ril ild raising income 10,201,02 20,001100 -2,719,22 81.41%
Interest and Fkfunno
Tax.m.,-'Lind 1 1,730,01 2,000.00 -209,99 89,8%
annanaMAIWAXMAP amMa.M........... ASYMPSSO. t
TO'MI Intere,... .,,hd RefUnds 1.730,01 2.000,00, -269.99 808%
Bashi 4,1' Income
FIN Groom Gift Cards 1,556.00 1,000,1,.., 45,00 97.19%
inantailnalaRSMOMMA Nallananananna ROXIMMINIMMAMANNWIN.N.N K.
Total Reside.iisi become 1.655,00 1,000.00 -45,00 97.19%
School EventaiSantoca Income
Bank Fair 8,353.58 (I000, $ 358.58 105.89%
Fail Festival 722.10 0.06 722,10 100 0%
Spot Roma 2,472,00 8,800,09 -4,329,00 36,30%
Yearbook 3,520,52 3,500,00 20.52 100,79%
AtEnNat
Total School EvernhiSOMICen11.00Me "13,074.20 15,300,00 -3,228,80 80.21%
Total Blooms 50,65s 57 52,892.00 -3,752,43 93,99%
Gross Profit 58,628.57 62,392,00 -3,758.43 93.,98%
Expesi.i,,,4,
Sues and Contribution Expenses
NC PTA Duco, 812.00 040.00 .28.00 06(17%
PTA Council 130e s 50.00 50,00 0„00 100,0%
lgintataalait■ Itliaaaankanalan IltalanlEablatanannanlaawasw gaganaganaaarnaa
Talail Mad and Contribution Exponii,s 862.00 8.1f.00 9085%
FN Gromay Gift CI rd PuroliD4os 1,455,00 1,600.00 -145.00 90,94%
Fundraising Expenses
Sox Tier a her Education 0,00 150,00 050,00 00%
Ras1o4tion 1,434,77 1,200.00 234,77 119,56%
I lanaaanagfatiNaa MOM..
Total Fundraising Expenses 1,434.77 1,250,00 84.77 106.28%
Grounds
Suntan 900,00 900.00 0,.90 100,0%
P4.1 a 1 of 3
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18Rp ...j,,, w,El-,
,.ntary PTA
06/10/17
Accrual Basis Profit & Loss Ir. udget vs. Actual
July 2al 6 through June 2017
Jul 16-Jun 17 Budget $Over1rottlunt %ot t ticluot
Gorthati-Grant Exponent 4,03697 4,037,00 -0,03 100.0%
Grounds
1000i30 1,a00 00 0.00 1000%
Pin t round 21,05 500,00 41/8.95 4 21%
Total Grounds 5,958.02 (i4700 -4/6,913 92 55%
to Mid tonal Mot,-riat-'Ault)
Cultural EarichnsaM 2818,00 2,018,00 0,00 100.0%
Paper 207,63 300.00 -2.37 N,2 t%
Teaching Items 7,548,70 7,451,00 91,70 101,31%
Total Instruction i I MaterialsiE4 Op 10,454.33 10,3513.00 95,33 100,92%
PTA Anal titration
Bad Cheeks 12 00 25 00 .12.00 480%
think , ,is 54,04 100.00 -45.06 54.04%
CoMing-nay Fonds 903.5:3 1,500.00 -535.47 54.24%
tilespliality 230.11 500.00 -205,80 5 .02%
insurance 215.00 230.00 -15.00 93.48%
Tot PTA Administiretton, 1534,60 2,355.00 -620.32' 56.111%
School Events/Services Expellees
5th Or g le Gradootioit Ceremony 0.00 500.00 -500„00 0,0%
Otago Night 0,00 500.00 -600,00 0 0%
Book Fair 6,415,65 0,000.00 415,05 100.93%
Fail' ...F6-tillai 307.40 0.00 307.40 1000%
Other Set tool Events Peprme,os 261.04 500.00 ,-235.96 52,21%
Spirit Items 2708,45 4,500.00 .1,731.55 01,52%
Toacl,-)111Stolt Appended on 751 50 500 00 251-50 1503%
Walk for Education Booth 0.00 135,00 -135,00 0.0%
Yearbook
0.00 2,500.00 -2,500.00 00%
, .
Total School EventaitSetv NOS Expenses 10,504.04 15,235.00 -4,730100 58 05%
Staff Support
Art Teacher 754,57 1,000,00 445,43 75.46%
Family$peciadiat 430.00 1,500,00 1,051130 29.27%
Music Teacher 0,00 1 u000,00 -1,000..00 0(1%
PE. Teacher 940,60 S000 00 -51.20 94.88%
Principal 464.33 500,00 -35.07 92.37%
Proree t,one]Dtvelopm AM 2000.00 2,000 00 0.00 100.0%
so 001 Nurse 340,09 300,00, 46.00 115 5.0%
Teacher Allocations 4,620,02 9,000,110 -5,279„93 40.67%
Teacher I-rhirts 554,17 556.00 -1.88 DO.67%
Vice Pithelpel 427.10 500,00 -2.30 99 54%
ISKONATEAPARWRIMESMANRIMMUI PIIMANWMFAXWAYANMAWO 411101Netli 11108,01MONISIMAIMIIMPAI
Total'Staff Support 10,625.28 18,265,01) -7,630.72
S1 admit Support
5th Grade Middle School Visit 114180 311000 -180.25 30.93%
Fled Tripe 5,948.00 8,000.00 -2,057,00 14.20%
School Certilvel-Nseig atm Club 3011.00 300 00 0.00 100 0%
Schoot DartmerNevtg Mar Club 300.00 300,00 1100 100,0%
Plus,2 ula
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB a' Ele,,,entary PTA
05/10117
,.,
Accrual z,s41s l'1.'milt & Loss Budget vs. Actwi
July 2016 through June 2017
Al ;
Jut"15-JIM 17 Budget $avow Mutat %of Nurtual i'
T 1 LE Donal km for NES, 5„500.00 5,500.00
Total Student Support 12153,80 14,400,00 -2,,,PA0.20 04,4%
Total Expense 54,991.92 70„002,00 -15901T00 77„57% ,
Net Ordinary Income 3,,616,65 -8,,500,00 12,11065 -.42..9%
hicame 3,0113,65, .4,50100 '120 45,A5
.
P4!..el 3 et 3
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
Northside Elerrientary PTA
DRAFT BUDGET
Ju'y 2011 through June 2018
I 17 -Jun 13
PT Carryover 10,000.00
Ordirlory cornniExpense
Income
Duos and Contributions
Fuss Free Iletl rid raiser 6,15,0,00
Grant Income 1.25000 iligrant
miscellanea=Don ntiom 2,500 00
rtide PTA Dues 2000, .00
Teacher Appreciation Donations 400.00
Tat Does and Contributions 12,300
Fundraising income
AninrorihNbov es/Grocery(Kroger) 500 00
Bog Tops for Education 1,400 00
Read-othon 1 3,000,00
Res toura n1 Farrel y Nights 1,000 DO
Whole Foods Gift Cards 1,200,00
Total runurai 9 log Income 17,1 00.00
hie and Rafords
Tax Refunds 1.500,00
Total Interest and Refunds 1.500,00
Resin G ted Income
FIN Grocery Gilt Cards 1,600,00
Total Restricted Income M00.00
Soo E ntsMerviees Income
ook Fah 0(100.00
Spirit items 1 000.00
Yearbook 31,500,00
Total School EventsiSery lees Income 10,500,00
Total lneorne 43,000,00
Gross Profit 43 000 00
Ea Revise
DUOS mid Contra)lotion Expen sos
NC PTA Does i320,00
It Council Does 50 On
Total Du es and Co n tribu ti on Expenses 370,m
FIN Dreeery a C rd Purcilases 1500.00
Fundraising!Expenses
Box Tolf s for Education 100 00
100(1.0(1
■OrattIMMAIWWWWWWWWWWWW*Otti
Total Fundraising Expenses 1,100,00
Grounds
Garden Student'Mu Wee rs 1,000,00
Gordan 500,00
Total Grounds 1,500,00
nstructorifi PillatenallsJEquip
Page 1 of 3
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
Northside Elementary PTA,
DAFT
July 2017 through June 2018
Jul'17-Jun it
rCulintal Erinchment 2,50000 pant
Paper and Office Supplies SW 00
Sensory Boom Project S00.00
Technolog y
Totall lnsteurtional latatatriets/Ennio 6,6 u„00
PTA Administration
Bad Checks 28.00
Gank fees
12 .00
Cord ingericy IF ands I 500 00
Hospitality 500 00
Insurance 230,00
Total PTA Administration 2300.00
SC11001 Evontosorvi■oes ExpontiOS
Gredu G radiation Ceremony 300,0D
PTA Events 800.00
:ook Fair 0.000.00
STEAM Day,Fiald DayiSchool Events 350.00
Spirit limns 1,000 00
Teacher/Staff Appreciation 900,00
Yearbook 2,500.00
Total School EvnW Vt,650,00
Staff Support
Ant Teacher 1,000,00
Fantily Specialist I,000,00
Music Teacher 1 000,00
PE Teacitor 1,00008
Principal 300.00
PreoloreI Dcopmen l 3,000.00
School Nurse 500.00
Teacher Allocations 9,500,00
Teacher t-shirts 300,00
Vice Principal 500,50
MM.
Total Staff Suppod 1 l,30n 00
Student Support
Sth Grade Middle School Visit 300.00
irtiliday 1Books 500.00
Field Trips 3,000,00
All Pro Gads 500,00
School Carnival-Navigator Club 300.00
School Dance-Navigator Club 300.00
Total Student Support 4,900,00
Transition
Carry Over Funds 8,000.00
Real Ton Won 8,000,00
Intel Ea 08iise 59,000 00
Page 2 of 3
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
Northeide Elementary.. PTA
DRAFT "
July 2017 through June 2018
J 4"17-Jura 1
Ordinary income 0.00
Not income W "
Page 3,of
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
Nort.).side Elementary School
OCAC Crassrolols Arts Protram Applicatiq.,:,„o 2017
Staff Roster of MusiclArc Teachers and PTA Boarctcootcts
Tudeni:
Kathryn Cole - Librarian Media Specialist
Donald Parker- Music Teacher
Alder Keene - Art Teacher
FTA,t3,4pra(incgriiirtg201720113),
President Kiirtherlee Preis Ildnaprejs@gmall.com
Vice Presidents: Alston Morgan la morgan83@gma iLcom
Julia Masterson ç hi
Secretary: Leah Waldrop 1waldrop@chces.k12.ncats
ftea,surer: Andrew Riggs awriggs385ftmaitcom
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
sib CaroIH Jayne President
3501 Glenwood Meow',Raleigh, NC;.27612
01911707-0534,(010)255-0417(NC)
Fax,: (919)787-0569, www,acEtn,e.eg
everychild.otir voice, ortiee(Onejoia,org
May 6, 2013
President:
ll.lorthside Elementary School PTA
350 Caldwell Street
Chapel Hill,NC 27516
EIN:
Dear PTA President:
We arc pleased to inform you that your PIA is included in the P9A. 1, ortli Carolina Congress of Parents and'Teachers,
Inc group income ta,x exompt ion., North Carolina IrIA's Group Exemption Number(GEN) is 8535. Contributioos to your
organization may be treated as charitable contributions when donors calculate their federal income taxes. In addition,your
organization is exempt from federal ineo,:lc taxes on its receipts.
The internal Revenue Service states that organizations exempt from income taxes under Section 501(0(3)of the Internal
Revenue code need not complete Form 990 &annual gross receipts arc not normally in excess of$50,000*. "Gross
receipts" is defined as -me total income received from all sources during the annual accounting period, without
subtracting any costs or expenseS". An organization with gross receipts that are normally $50,000 or less may file Form
e-Postcard) instead of filing,Form 990 or form 990,1Z.
Gross receipts are considered to be $50,000 or less if the organization is
Up to a,year old arid has received $75,000 or less during its first year either in donations or pledges;
(b) Between I and 3 ycats old and averaged $60,000 or less in gross receipts during each of its first 2 tax years; or
3 years old or more and averaged $50,000 or less in gross receipts ror the immediately preceding 3 tax years
(including the year for which the return would he filed).
If yon orc riot required TO Mc Form i 990, but receive the IRS fornt„you must check the box showing"income less than
$50,000", sign and date the form,and return it to the IRS. Il'you are required to tile Form 990,you monist complete and
attach Schedules A and B. Schedules A and B (Form 990) arc integral parts of Fenn 990 for Section 50 t(c)(3)
organizations required to file this form. 'Therefore,any organization that does not submit completed Schedules A and B
with its Form 990 does nor!satisfy its filing requirements. Form 990 or the 990-N e.pasteard most be filed by the 15th
day of tire Midi month after t e end *I'your ruhnual accounting period. lithe return is filed laic, a penalty ot'S20 a day
may be charged. The penalty is not to exceed the lcssrof$I0,000 or 5 percent of the orgarniation's gross receipts for the
year, Also, a penalty may he charged if the return is filed incorrectly or incompletely„
Local units failing to nay membership dues annually are deleted from our rosier and are not eligible,for inclusion in the
group income tax exemption, The Internal Revenue Service is notified when a VIA dissolves its affiliation with State and
National PTA.
As with all official documentation,please file this tenet with your PTA's permanent records in a safe. location.
Sincerely,
Jayne Tipton
----- President
*As of 2010 tax,year, for returns filed in 2011. For the 2009 tax year and earlier,the anTlind gross income had to be not
more than $25,000.
DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB
112,Q Ilqariintm g..,,(119,o Trermory
Internal Revenope:cc%Ice
P .O. Box 35045 In reply refrr to 075252634i
Jacksonville FL 32202-0000 Feb . 10 , 2012 LTR 4167C EU
0011000 00
00021620
BODE : TE
PTA NORTH CAROLINA CONGRESS OF
PARENTS AND TEACHERS
PARENT ORGANIZATION
d'A 3501 GLENWOOD AVE
RALEIGH NC 27612-4934
7997
Employer identification Number :
Group Exemption, Number : 8535
Person to Contact : Irene McHugh
Toll Free Telephone Number: 1-877-829-55D0
Dear T.xpayert
This is in response to your Feb . 01 , 2012 , request for information
about your tax-exempt status .
Our records indicate that you were issued a determination lettr in
May 1905 , and that you are currently exempt under section
501 (c ) (03) of the Int, roal Revenue Code ,
0.sed on the information supplied, we recognized the subordinates
named on the list you submitted as exempt from Fed :ral income tax
under section 501 ( c) (03) of the Code.
Donors may deduct contributions to you as provided in section 170 of
the Code . Bequests , legacies , devises , transfers , or gifts to you or
for your use are diductible for Federal estate and gift tax purposes
if they meet the applicable provisions of sections 2055 , 2106 and
2522 of the Code .
If you hzve any questions , Please call us at the telephone numbr
shown in the heading of this 1 .,...tter .
Sincer4ly Yours ,
4 ,111r ,
I
Wanda E . Carey
Service Center TaxoaYer Advocate
(