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The Center for Emotional and Behavioral Health®IRMH — Parenting Education Group — IRC- CSAC <br /> SUMMARY REPORT nter Information In The Black Cells Onl <br /> Amount Requested from Funder for 2004 /05 : $ 5 , 600 . 00 <br /> Total Proposed Program Budget for 2004 /05 : $ 9 , 127 . 96 <br /> It <br /> Percent of Total Program Budget : 61 . 3 %0 <br /> Current Program Funding (2003 /04 ) : . $ <br /> Dollar increase/ (decrease) in request : $ 5 , 600 <br /> Percent increase/( decrease) in request * * • # DIV /O ! <br /> UndupLcated . Number of Children to be served Individually : _ <br /> .�} Unduphcated: Number `of Adults to be served Individually : 42 <br /> Unduplic d um efto be served via Group settings : 8 <br /> T.. otaLProgram Cost� per_ Client : 182 . 56 <br /> I€reques increased 5% or more, briefly explain why: <br /> a = <br /> fir <br /> If these funds are being used to match another source, name the source and the $ amount: <br /> The Organization #s Board ofDireetors approvaatthis application o dot • J o) (o • (7 <br /> yr fK <br /> //�� � ,� �� t Y <br /> l okG.V _. <br /> a ys , y d f T � � <br /> Name of Ffesideat/Chait"of the Board <br /> SiSt <br /> t TL <br /> Signature t 3 d • d _ 1 <br /> vc'� y <br /> Name of Executive Du eetoi/CEO ' <br /> s X <br /> tr <br /> r. y <br /> t { <br /> JYSLv. <br /> T 1 <br /> 51 <br /> Pf <br /> 9 vy y . <br /> i <br /> Xy"3'sya <br /> 1 y <br /> • ; <br /> • <br /> r It <br /> m <br /> n <br /> ty�'k'^ <br /> .p4 ' .a.: � e•. n . . . it 15 = 1 k <br /> y r � <br /> . - . . <br />