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SUMMARY REPORT <br />Amount Requested from Funder for 2018/19: <br />$ <br />Total Proposed Program Budget for 2018/19: <br />$ <br />Percent of Total Program Budget: <br />$ <br />Current Program Funding (2017/18): <br />$ <br />Dollar increase/(decrease) in request: <br />$ <br />Percent increase/(decrease) in request <br />Unduplicated Number of Children to be served Individually: <br />$ <br />Unduplicated Number of Adults to be served Individually: <br />$ <br />Unduplicated Number to be served via Group settings: <br />$ <br />Total Program Cost per Client: <br />$ e <br />Mi <br />**If request increased 5% or more, briefly explain why: <br />If these funds are being used to match another so , rce,,name the source and the $ amount: <br />-v <br />The Organization's Board of Directors has approved this application on: <br />date <br />Name of Preside nt/Chairr Jf e Board Signature <br />or Executive Director/CP& <br />146 <br />