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GRANT APPLICATION Page 1 of 7 (Type and Complete ALL Items) + Application for State Assistance through the Florida Financial Assistance for Community Services Act of 1974, "Demonstration and Research" Phase. (Community Services Trust Fund) DEPARTMENT OF COMMUNITY AFFAIRS S DIVISION OF COMMUNITY SERVICES This application must: be sub- 71 EXECUTIVE CENTER CIRCLE EAST matted in tripli.cate Taj—coluies. TALLAHASSEE, FLORIDA 32301 Due Date: FEBRUARY' 157 1977' 1. Local Governmental Unit Applying for Grant: Name: Indian River County Commission Telephone (305) 562-4180 Name o town, city or county Address: Indian River County Courthouse, Vero Beach, Fla. 32960 ;,County: Indian fiver 2. Date Submitted: February 11, 1.977 3. Official with over-all responsibility of grant: (Our Department will contact this person should questions arise in the application process): Name: Arlene S. Elmore _ Telephone (305) 562-41.77 Address: 1316 20th St., P. U. Box 2766, Vero Beach, Fla. 32960 Signature: Title Administrative Assistant 4. Due to new legislative requirements, all services must be certified by the Department of Health and Rehabilitative Services (HRS) District Administrator as not being duplicative. In order to accomplish this requirement, all applicants must contact the District Administrator rp for to development of program proposals. Therefore, complete the following: HRS person contacted:` Pyl.lis_Roe __ _ (District Admin Sl trator) Telephone: (305) 683-6603 Date: February 11, 1977 Contacted By: Arlene S. Elmore _ Telephone: ( 305) 562-41.77 5. Following the completion of the grant application, formal approval of the program proposal must be given by the HRS District Administrator. Applications will not )e-accej�tedunless the following statement: is completed by the HRS District.Ainistrator: I, _ _ , the Regional 1l RS Administrator for Rc°gier, District IX hereby certify one of the following statements of. Y Y fact: 1. The particular services to be offered in the (signature— listed programs are not duplicative of 11R5 programs Although similar services may be available from HRS we cannot: provide these particular ser.vicvs to these clients without the, use of this money. 2. HRS has made maximum use of federal funds for the -—Zs�gnature r above listed proyram areas. 3. Funds for this program are available from HRS Jsignatur� and the applicant. will be eligible for funding during the onrrt�nt grant: period. The applicant should contact Mr./Ms. for further inf.ormaLion.4__..