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AGENCY REQUEST FOR FUNDING FROM Indian River COUNTY <br />FISCAL YEAR 2020/2021 <br />• A. Program Cover Page <br />Agency: <br />New Horizons of the Treasure Coast, Inc. <br />Contact Person: <br />George Shopland <br />Title: <br />President/CEO <br />Address: <br />4500 West Midway Road <br />Fort Pierce, FL 34981 <br />Website Address: <br />www,nhtclnc.org <br />Program Title: <br />Mental Health and Substance Abuse Services <br />• <br />Telephone: 772-672-8350 `f <br />Fax: 772-468-5806 <br />E -Mail: gshopland@nhtcinc.org <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 othe source. <br />George Shopland, President/CEO <br />Si nature Print name and title <br />Brief description of the Program for which funding is rectuested: <br />The -purpose of this application Is to secure match funding necessary to leverage funding from the Department of Children and <br />Families through their contract with Southeast Florida Behavioral Health Network (SEFBHN). The funds requested will be used to <br />provide services to Indian River County residents ranging from emergency stabilizatlon provided 2417 to intensive community based <br />programs for children and adults. (A Program Description of all services, locations and service time is attached.) The attached report <br />"Units of Service Report with State Rate" shows the specific services provided and number of residents accessing these services for <br />the period 7/1/2018 to 06/3012019. The match grant funding provided by IRBOCC for FYI 8/19 leveraged over $4,809,411 In total <br />services. <br />if <br />Amount requested from Indian River County for 2020/2021: $319,884 <br />Total Proposed Program budget for 2020/2021: $ 24,871,136 <br />Percent of total Program budget: 1.3 oda <br />Current Funding (2019/2020) $319,884 <br />Dollar increase/ (decrease) in request: $ O <br />Percent increase / decrease in request: 0.0 <br />If request increased 5% or more, briefly explain whv: <br />March 25, 2020 <br />i ne urganization's tdoara of uirectors has approved thll�_appii ion on (date <br />Patricia Austin \ :� <br />Name of President/Chair of the Board <br />George Shopland <br />• Name of Exec. Director/CEO <br />3 <br />Signature <br />SignaSigna uree <br />