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0 GRANT APPLICATION Page 1 of 7 (Typq and Complete ALL Items) Application for State Assistance through the Florida Financial Assistance for Community Services Act of 1974, "Demonstration and Research" Phase. ' (Community Services Trust Fund) DEPARTMENT OF COMMUNITY AFFAIRS DIVISION OF COMMUNITY SERVICES This application must be sub - 2571 EXECUTIVE CENTER CIRCLE EAST matted in triplicate 3 copies. TALLAHASSEE, FLORIDA 32301 Due Date: FEBRUARY 15, 1977' 1. Local Governmental Unit Applying for Grant: Name: Indian River County..Comtrission Telephone (305) 562-4186 Name of town, city or county Andress: Indian River County Courthouse, Vero Beach, Fla. 32960 ;,County: Indian fiver 2. Date Submitted: February 11, 1977 3. Official with over-all responsibility of grant: (Our Department will contact this person should questions arise in the application process): Name: Arlene S. Elmore Telephone (305) 562-4177 Address: 1316 20th St., P. 0. Box 2766, Vero Beach, Fla. 32960 Signature: Title Administrative Assistant 4. Due to new legislative requirements, all servi:.-s must be certified by the Department of Health and Rehabilitative Services (HRS) District Administrator as not being duplicative. In order to accomplish this requirement, all applicants must contact the District Administrator prior to development of program proposals. Therefore, complete the following: HRS person contacted: Ph 11•is Roe ..- (District Administrator) Telephone: (305) 683-6603 Contacted By: Arlene S. Elmore Date: February 11, 1977 Telephone: (305) 562-4177 5. Following the completion of the grant application, formal approval of the program proposal must be given by the HRS District.Administrator. Applications will not be accepted unless the following statement: is -- completed by the HRS Dirstrictr- .Administrai:or: I, the Regional HRS Administrator for ,R,egienDistrict IXC hereby certify one of the following statements of fact: 1. The particular services to be offered in the (signature) listed programs are not duplicative of HRS programs Although similar services may be available from IiRS we cannot; provide these particular services to these clients without the use of this money. 2.- HRS has made maximum use of federal funds for the sagIT, ture above listed program areas. 3. Funds for this Program are available from IIRS sJ7(j —na t t —ir 37Y and the applicant will be eligible for funding during Lhe current grant period. rhe applicant should contact- Mr./Ms. for furthor information. FEB 91977 i6ok 28 432