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Name of Crisis Line / Information and Referral 1 . Is the. aphlir..int (cit+ -count-;) _urr.entl r..c+.ivinq CSTF funds for any activity? No 2. Is the proposed prc+gram/activit.y currently available in the area? Yes 3. Give a brief overview of the proposed activity. refer page 2 A 4. Identify the unmet need that this activity will address. refer page 2 A 5. How will this activity impact on the unmet need in Na. 4 above`.,, refer page 2 A 6. Will this activity attract or include other funding in addition to the required local ;match? Identify source and type if applicable. refer page 2 A 7. who is the specific target population of the proposed activity (elderly, in: igent, handicapped, etc.) All residents of Indian River County 8. How large is the target population (No. 7 above) in the proposed service area for this activity? Present population is 60,000 with an increase of 36,800 in the next 10 years (Quoted by the Chamber of Commerce). 9. How many of the target population will benefit from this activity? 100% 10. What percentage of the target population is affected by this problem (No. 4 above)? We feel that at some time the entire community will benefit from our ser- vice. Having all the information available to us thru the information and referral book, and working closely with all agencies as a Clearing House. 11. Will this activity provide or enhance the access of other exist- ing resources? Yes. As mentioned in #6 and also the increase public awareness through brochures, radio and TV and the billboard that will increase calls and contributions. 12. Define the severity or critical nature of this problem briefly. see #4 - 13. Will this activity provide either: a. quantifiable data related to the un;net n e•:i yes b. a model that can be duplicated elsewhere yes 14. who will do the audit of the activity (CPA, city, county)? William Henson Vero Beach Florida, Indian Piver County