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f _ EXHIBIT A j <br />AGENCY REQUEST FOR FUNDING FROM Indian River COUNTY <br />FISCAL YEAR 2019/2020 <br />A. Program Cover Page <br />Agency: Gifford Progressive Civic League Telephone <br />Contact Person: Godfrey E. Gipson Fax: <br />Title: Director E -Mail: <br />Address: 4855 43rd Avenue <br />Vero Beach, FL 32967 <br />Website Address: <br />Program Title: <br />(772) 567-1435 <br />(772) 569-5563 <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 />by any other source. <br />A�i� <br />I I�T OC! JCrey 640 <br />So <br />- <br />!&� N,' <br />Signature Print na and titles <br />i <br />Brief de cri tion of the Program for which funding is requested: <br />A. <br />Voting precinct for local and national elections <br />B. <br />Meals on wheel lunch five (5) days per week <br />C. <br />Community organization's meeting weekly and monthly`; <br />_ <br />D. <br />School relative activities <br />E. <br />Town hall meetings <br />F. <br />Health care check-ups <br />APR 1 1 2019 <br />G. <br />H. <br />Church held functions <br />Gifford Youth Orchestra weekly practices <br />n <br />�tiA_ <br />OUuuuQl V IRCP UI L <br />Amount requested from Indian River County for 2019/2020: $12,185.00 <br />Total Proposed Program budget for 2019/2020: $12,185.00 <br />Percent of total Program budget: % <br />Current Funding (2018/2019) $ <br />Dollar increase/ (decrease) in request: $ <br />Percent increase / decrease in request: % <br />If request increased 5% or more, briefly explain why: <br />EXHIBIT A <br />