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E <br />STATE AGENCY REQUEST FOR FUNDING FROM INDIAN RIVER COUNTY APR 0 6 2016 <br />FISCAL YEAR 2016/2017 <br />A. Program Cover Page <br />Agency: <br />Guardian ad Litem <br />Telephone: <br />(772) 785-5804 <br />Contact Person:. <br />Vern Melvin <br />Fax: <br />(772) 785-5869 <br />Title: <br />Circuit Director <br />E -Mail: <br />vern.melvin@gal.fl.gov <br />Address: <br />584 NW University Blvd. <br />cc: <br />celia.garcia(cDgal.fl.gov <br />Suite 600 <br />Port St. Lucie, FL 34986 <br />Website Address: <br />www.guardianadIitem.org <br />Program Title: <br />Guardian ad Litem <br />I certify that information contained in this application accurately reflects the activities of this agency and <br />that the expenditures or portions thereof for which County funds are being requested are not reimbursed <br />byany other ource. <br />Vern Melvin, Circuit Director <br />Si ature Print name and title <br />Brief Description of the Program for which funding is requested: <br />The 19th Circuit Guardian ad Litem Program is a partnership of community advocates and professional <br />staff providing a powerful voice on behalf of abused, neglected or abandoned children who are involved in <br />court proceedings in Indian River, Martin, Okeechobee and St. Lucie Counties. <br />Summary Keport <br />ount requested from Indian River County for 2016/2017: <br />otal Proposed Program budget for 2016/2017: <br />Percent of total Program budget: <br />Current Funding (2015/2016) <br />Dollar increase/decrease in request: <br />Percent increase/decrease in request: <br />If request increased 5% or more, briefly explain why: <br />$84,963.35 <br />$369,405.89 <br />23% <br />$91,959.13 IRC Portion <br />$6,995.78 <br />7.607% <br />The Organization's Board of Directors has approved this application on (date): <br />Name of President/Chair of the Board Signature <br />Name of Exec. Director/CEO <br />Signature <br />62 <br />is <br />