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PROGRAM FUNDING REQUEST <br />The client figures and amounts entered in this section must be consistent with those used. later in the Narrative, <br />Demographics Unduplicated Client Count, and Program Budget Sections of this application. The numbers <br />served should NOT be duplicative of each other and should be a reasonable expectation, given the size and <br />scope of the program. <br />Amount Requested from CSAC for 2021/22 0.00 <br />Total Proposed Program Budget for 2021/22 0.00 <br />Percent of Total Program Budget <br />[W11117 <br />Current Program Funding from CSAC (2020/21) 0.00 <br />Dollar increase/(decrease) in request <br />Percent increase/(decrease) in request <br />Me <br />�� <br />M <br />Unduplicated Number of Children to be served Individually 0 <br />Unduplicated Number of Adults to be served Individually 0 <br />Of the total children and adults served individual, how many <br />are served via group settings 0 <br />Total Program Cost per Client 0.00 <br />Please indicate reason for $ change in request. Check all that apply. <br />r Increased number of clients <br />r Decreased funding from other sources <br />r Addition of staff <br />r Decreased operating expenses <br />r: Decreased services <br />r New Program <br />r Increased operating expenses <br />r Expansion of services <br />1`7 Decreased number of clients <br />r Increased funding from other sources <br />r Decreased staff <br />r Other <br />If request increased by 5% or more over previous year's allocation, provide a detailed <br />explanation as to why. <br />If the funding request is more than 25% of the Program Budget, provide a detailed <br />explanation as to why. <br />How would the program maintain services in absence of CSAC funding? <br />Does the program charge clients any fees for program services? If yes, please explain. <br />If these funds are being used to. match another source, name the source and the $ amo got. <br />CSAC FY22 CORE.APPLICATION - 4 <br />