Laserfiche WebLink
The Center for Emotional and Behavioral Health-Child/Adolescent Psychiatric Mental Health Clinic-IRC CSAC <br /> SUMMARY REPORT — (Enter Information In The Black Cells Onl <br /> Amount Requested from Funder for 2004 /05 : $ 76 , 000 . 00 <br /> Total Proposed Program Budget for 2004 /05 : $ 252 , 777 . 64 <br /> Percent of Total Program Budget : 30 . 1 % <br /> Current Program Funding ( 2003 /04 ) : $ 76 , 000 <br /> Dollar increase/ ( decrease ) in request : $ _ <br /> Percent increase /( decrease ) in request0 . o <br /> Unduplicated Number of Children to be served Individually : 10 /o <br /> Unduplicated Number of Adults to be served Individually : 100 <br /> Unduplicated Number to be served via Group settings : <br /> Total Program Cost per Client : <br /> 2527 . 78 <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 s� approved this application on ( <br /> ate). to ' V <br /> ChCwlt?5 V 5heshon <br /> Name of President/Chair of the Board Signatur <br /> T(fkFe. rN L . S us ; <br /> Name of Executive Director/CEO i <br /> 4 <br />