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AGENCY REQUEST FOR FUNDING FROM Indian River COUNTY <br />FISCAL YEAR 2018/2019 <br />A. Program Cover Page <br />Agency: Gifford Progressive Civic League <br />Contact Person: Godfrey E. Gipson <br />Title: Director <br />Address: 4855 43rd Avenue <br />Vero Beach, FL 32967 <br />Website Address: <br />Program Title: <br />Telephone: (772) 567-1435 <br />Fax: (772) 569-5563 <br />E -Mail: <br />I certify that information contained in this application accurately reflects the activities ofl <br />that the expenditures or portions thereof for which County funds are being requested are <br />by any other source. <br />Signature <br />Godfrey E. Gipson, Director <br />Print name and title <br />tiriet description of the Proaram for which tundrna is reauested: <br />A. Voting precinct for local and national elections <br />B. Meals on wheel lunch five (5) days per week <br />C. Community Organizations meetings weekly and monthly <br />D. School relative activities <br />E. Town Hall meetings <br />F. Health Care check-ups <br />G. Church held functions <br />H. Gifford Youth Orchestra weekly practices <br />I. Alzheimer and Parkinson Association IRC, Inc. on Monday and Thursday's <br />aummdry mupua <br />Amount requested from Indian River County for 2018/2019 <br />Total Proposed Program budget for 2018/2019.- <br />Percent <br />018/2019:Percent of total Program budget: <br />Current Funding (2017/2018) <br />Dollar increase / (decrease) in request: <br />Percent increase / decrease in request: <br />it request increasea o ro or more. onernv exoiarn wnv: <br />$ 12,185.00 <br />$ 12,185.00 <br />3 agency a <br />The Organization's Board of Directors has approved this appf M>ation on (date)- <br />Joe Idlette, III \ <br />Name of President/Chair of the Board Signature <br />Godfrey E. Gipson <br />Name of Exec. Director/CEO 24 1 nat e <br />