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The 'enter for Emotional and Behavioral Health AIRMH- Camp Manatee Therapeutic Summer Camp — IRC- CSAC <br /> PROGRAM COVER PAGE <br /> Organization Name : The Center for Emotional and Behavioral Health @ IRMH <br /> Executive Director : Dr. Raymond Dean MD E-mail : raymond . dean@irmh . org <br /> Address : 1190 37°i Street Telephone : 772- 563 -4666 ext 1809 <br /> Vero Beach, FL 32960 Fax : 772-770-2025 <br /> Program Director : Mariamma Pyngolil RN E-mail : mariamma. pyngolil@irmh . org <br /> Address : 1190 37thStreet Telephone : 772- 5634666 ext 1838 <br /> Vero Beach FL 32960 Fax : 772-770-2025 <br /> Program Title : Camp Manatee Therapeutic Summer Camp <br /> Priority Need Area Addressed: Therapeutic, intervention and educational program for children <br /> diagnosed with ADHD and other more severe emotional problems in Indian River County <br /> Brief Description of the Program : P1 -640 . 150-85 Therapeutic Camps-Day camp facility that is <br /> appropriately staffed and equipped to provide an opportunity for children who have developmental <br /> disabilities. emotional disturbances and/or health impairments who have other limitations or <br /> problems which require special facilities or projuamming, to enjoy a cooperative living experience in <br /> the out of doors. <br /> SUMMARY REPORT — (Enter Information In The Black Cells Only) <br /> Amount Requested from Funder for 2004 /05 : $ 20 , 000 . 00 <br /> Total Proposed Program Budget for 2004 / 05 : $ 52 , 564 . 25 <br /> Percent of Total Program Budget : 38 . 0 % <br /> Current Program Funding ( 2003 /04 ) : $ 20 , 000 <br /> Dollar increase/ ( decrease ) in request : $ _ <br /> Percent increase / ( decrease ) in request * * : 0 . 0 % . <br /> Unduplicated Number of Children to be served Individually : 35 <br /> Unduplicated Number of Adults to be served Individually : _ <br /> Unduplicated Number to be served via Group settings :mmmmmmm� 2 <br /> Total Program Cost mmm-mmmmWper Client : 1420 . 66 <br /> * * If request increased 5 % or more, briefly explain why : <br /> If these funds are being used to match another source, name the source and the $ amount : <br /> The Organization 's Board of Directors sl approved-this applicatio:?1100 <br /> � (o <br /> Char 1 eS V. Shc �hct t'1 <br /> Name of President/Chair of the Board Signature <br /> Te kr Sus ; <br /> Name of Executive Director/CEO 91 <br /> 3 <br />