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GRANT APPLICATION Pave 1 of 7 <br />(Type and Complete All Items) <br />• Application for State Assistance Through the <br />i <br />COMMUNITY SF112VICES TRUST FUND <br />DEPARTMENT OF COMMUNITY AFFAIRS <br />DIVISION OF COMMUNITY SERVICES SUBMIT FOUR (4) COPIES <br />2571 EXECUTIVE CENTER CIRCLE, EAST OF THIS APPLICATION <br />TALLAHASSEE, FLORIDA 32301 Due Date: September 1, 19' <br />1. Local Governmental Unit Applying for Grant: <br />1 <br />Name: Indian River County Commission Telephone: (305 ) 569-194 <br />name of town, city or county) <br />Address: Indian River County Courthouse, Vero Beach, F1a.32960 <br />County: Indian River <br />2. Date Submitted: July 23,1977 <br />3. Official with over-all responsibility of grant: (Our Department will <br />contact this person should questions arise in the application process): <br />Nave: Arlene E. Fletcher Tele?hone : ( 305 ) 562-4177 <br />Address: 1316 20th St. P.O. Box 2766, Vero Beach, F1a.32960 <br />Sion ature: `� L2.urJ Administrative Asst. E.O.C. <br />4. <br />Due to new legislative requirements, all services must be certified by <br />the Department of Health and Rehabilitative Services (HRS) District <br />Administrator as not being duplicative. In order to accomplish this <br />reoaiirement, all applicants must contact the District Administrator <br />prior to development of program proposals. Therefore, complete the <br />following: <br />f <br />\ <br />HRS person contacted: Phyllis Roe R, L C n S <br />(District Administrator) " <br />• <br />Telephone: ( 305) 683-6603 Date: 719-7 i l <br />Contacted by: Arlene E. Fletcher Telephone: ( 305 ) 562-4177 <br />5. <br />Following the completion of the Grant application, formal approval of <br />the program proposal must be given by the HRS District Administrator. <br />Applications will not be accepted unless the following stater.,ent is <br />completed by the HRS District Administrator: <br />IQ, the,Di.strict HRS Administrator <br />for District J, hereby certify one of the following statements ofii <br />fact: <br />n-----1. The particular services to be offered in the <br />signature) listed programs are not duplicative of HRS prograr <br />Although similar services may he available from HE <br />we cannot provide these particular services to the <br />- clients without the use of this money. <br />- <br />' 2. HRS has made maximum'use of federal funds for the <br />signature) above listed program areas.— <br />4 <br />3. Funds for this program are available from HRS and <br />signature) the applicant will be eligible for funding during <br />the current grant period. The applicant should cc <br />tact Mr./Ms. for furth <br />information. , <br />AUG0 1977BOOK <br />30 PACE j. <br />49 <br />_ I <br />