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EXHIBIT A <br />INDIAN RIVER COUNTY NONPROFIT / QUASI AGENCY REQUEST FOR FUNDING <br />A. Program Cover Page <br />Agency: Gifford Progressive Civic League Telephone <br />Contact Person: Mr. Godfrey E. Gipson Fax: <br />Title: Director E -Mail: <br />Address: 4855 43rd Ave. Vero Beach, FL <br />32967 <br />Website Address: <br />Program Title: Gifford Progressive Civic League <br />(772) 567-1435 <br />(772) 569-5563 <br />bpearce()gyac.net <br />I Agree - By checking the "I Agree" box and entering your name below, you certify that information contained <br />in this application accurately reflects the activities of this agency and that the expenditures or portions thereof <br />for <br />which County funds are being requested are not reimbursed by any other source. <br />Name: Godfrey E. Gipson Title: Director <br />t3net description of the Proaram for which tunaina is reauestea <br />A. Voting precinct for local and national elections <br />B. Meals on wheel lunch five (5) days per week <br />C. Community organization's meeting weekly and monthly <br />D. 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 Keport <br />Amount requested from Indian River County for 2021/2022: $12,185.00 <br />Total Proposed Program budget for 2021/2022: $40,785.00 <br />Percent of total Program budget: 29.88% <br />Current Funding (2020/2021) $12,185.00 <br />Dollar increase / (decrease) in request: $0.00 <br />Percent increase / decrease in request: 0% <br />request increased 5% or more, briefly explain why: <br />The Organization's Board of Directors has approved this application on (date): 03/29/2021 <br />Name of President/Chair of the Board: Joe Idlette, III <br />Name of Exec. Director/CEO: Godfrey E. Gipson <br />EXHIBIT A <br />