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PROGRAM FUNDING REQUEST <br />Amount Requested from CSAC for 2020/21 <br />0.00 <br />Total Proposed Program Budget for 2020/21 <br />0.00 <br />Percent of Total Program Budget <br />0.00 <br />Current Program Funding from CSAC (2019/20) <br />0.00. <br />Dollar increase/(decrease) in request <br />0.00 <br />Percent increase/(decrease) in request <br />0.00 <br />Unduplicated Number of Children to be served Individually <br />0 <br />Unduplicated Number of Adults to be served Individually <br />0 <br />Unduplicated Number to be served via Group settings <br />0 <br />Total Program Cost per Client <br />0.00 <br />Please indicate reason for $ change in request. Check all that apply. <br />0- Increased number of clients <br />Decreased funding from other sources <br />Addition of staff <br />Orj Decreased operating expenses <br />177, Decreased services <br />C New Program <br />Increased operating expenses <br />Expansion of services <br />r <br />4 Decreased number of clients <br />F7 Increased funding from other sources <br />1 --j Decreased staff <br />I 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 $ amount. <br />-The-Organization's Board of Directors has approved this application on:--- - -�- - - - <br />Electronic Signature of President/Chair of the Board or Executive Director/CPO. (Entering the <br />names of the Executive Director and Board Chair is confirmation that both parties have <br />reviewed this application and approve its submission.) <br />63 <br />CSAC FY21 CORE APPLICATION - 4 <br />