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• EXHIBIT A I <br />AGENCY REQUEST FOR FUNDING FROM Indian River COUNTY <br />A. Program Cover Page FISCAL YEAR 2020/2021 <br />Agency: Gifford Progressive Civic League <br />Telephone: (772) 567-1435 <br />Contact Person: Mr. Godfrey Gipson <br />Fax: (772) 569-5563 <br />Title: Director <br />E -Mail: <br />Address: 4855 43rd Avenue <br />Gifford, FL 32967 <br />Website Address: <br />Program Title: <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 />Signature <br />Print name and title <br />Brief description of the Program for which funding is requested• <br />A.voting precinct for local and national elections <br />B.Meals on wheels lunch five (5) days per week <br />-Community organization's meeting weekly and monthly <br />.School related 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 />_Summary Report <br />Amount requested from Indian River County for 2020/2021: <br />$ 12,.185.00 <br />Total Proposed Program budget for 2020/2021: <br />$ 40,785.00 <br />Percent of total Program budget: <br />30% a <br />Current Funding (2019/2020) <br />Dollar increase / (decrease) in request: $ 12,185.00 <br />$ <br />Percent increase / decrease in request: N/A <br />If request increased 5% or more briefly explain _w h_v�: N/A % <br />It:: viganizarion-s Board of Directors has approved this a p'cation n (da ): <br />Joe Idlette, III <br />Name of President/Chair of the Board Sig ature <br />Godfrey E. Gipson i <br />Name of Exec. Director/CEO <br />tgnattu� <br />EXHIBIT A I <br />