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• 1 • I <br />EXHIBIT A <br />AGENCY REQUEST FOR FUNDING FROM Indian River COUNTY <br />FISCAL YEAR 2020/2021 <br />A. Program Cover Page <br />Agency: <br />211 Palm Beach/Treasure Coast, Inc. <br />Contact Person: <br />Alix Allison <br />Title: <br />Compliance Manager <br />Address: <br />P.O. Box 3588 <br />Lantana, FL 33465-3588 <br />Website Address: <br />www.211 treasurecoast.org <br />Program Title: <br />211 HelpLine <br />Telephone: 561-383-2170 <br />Fax: 561-547-8639 <br />E -Mail: Alix.allison@211 pbtc.org <br />I certify that information contained in this application accurately reflects the activities of this agency and that <br />the expenditures or portions thereof for which County funds are being requested are not reimbursed by any <br />other source. <br />Sharon.C'Herrou Sharon L'Herrou. President/CEO <br />Signature Print name and title <br />dneT aescnotion ct the Nronram Tor wnicn Tunaina is reauested: <br />211 HelpLine is the crisis hotline and community helpline serving individuals and families in Indian River <br />County who are struggling with life's challenges and need someone to talk to, someone who cares, and <br />someone who can connect them with the services they so desperately need. 211 HelpLine operates <br />24 hours per day/365 days per year, providing technology-based services consisting of information, <br />assessment, referral, advocacy, and follow-up, along with crisis intervention, suicide prevention, and <br />emergency counseling. Highly trained Resource Center Specialists are non -judgmental, exhibit active <br />listening skills, and utilize a comprehensive Health and Human Services Database to make appropriate <br />referrals based on callers' requests and inquiries. 211 Helpline is also the regional responder for the <br />National Suicide Prevention Lifeline, meaning that anyone in the Treasure Coast that dials the 1 -800- <br />273 -TALK number, reaches our trained staff who are able to de-escalate suicidal callers. Our staff save <br />lives, every single day! <br />summary rceport <br />Amount requested from Indian River County for 2020/2021: $10,855 <br />Total Proposed Program budget for 2020/2021: $ 557,709 <br />Percent of total Program budget: 1.95% <br />Current Funding (2020/2021) $ 10,642 <br />Dollar increase / (decrease) in request: $ 213 <br />Percent increase / decrease in request: 2% <br />F request increased 5% or more, briefly explain why: <br />N/A <br />We are requesting a modest 2% increase. <br />The Organization's Board of Directors has approved this application on (date): May 18, 2020 <br />-Inhn Deese <br />Name of President/Chair of the Board <br />Sharon L'Herrou <br />Name of Exec. Director/CEO <br />! 7&4 ZZaara <br />Signature <br />Stirarrm t'4(Prrma <br />Signature <br />EXHIBIT A <br />