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ORGANIZATION: GIFFORD YOUTH ACTIVITY CENTER, INC. <br /> PROGRAM: YOUTH AND FAMILY GUIDANCE PROGRAM <br /> FUNDER:, CHILDREN' S SERVICES ADVISORY COMMITTEE <br /> PROGRAM COVER PAGE <br /> Organization Name : Gifford Youth Activity Center Inc (GYAC) <br /> Executive Director: Angelia Perry E-mail : ayerry (c�gyac . cc <br /> Address : 4875 43 `d Avenue Telephone : (772 ) 794 = 1005 <br /> Vero Beach FL 32967 Fax : (772 ) 569=5563 <br /> Program Director: Dr. Joe Hannam E-mail : ihannam (c)gyac . cc <br /> Address : 4875 43 `d Avenue Telephone : (772 ) 794 = 1005 ex. 41 <br /> Vera Beach, FL 32967 Fax : (772 ) 569-5563 <br /> Program Title : Youth and Family Guidance Program <br /> Priority Need Area Addressed: Mental Health <br /> Brief Description of the Program : The Youth and Family Guidance Program will provide on site <br /> counseling services to at-risk students and their families for the <br /> purpose of addressing emotional <br /> behavioral, and academic problems that may impede the academic success of the students we serve <br /> Taxonomy Definition — General Mental Health Information/Education RR 5150 2500 <br /> SUMMARY REPORT — Enter Information In The Black Cells Only) <br /> FAmountuested from Funder for 2009 / 10 : $ 25 , 00000 <br /> sed Program B udget fo r 2009 / 10 : $ 50 , 778 . 00 <br /> otal Program B udget: 49 . 2 % <br /> ram Funding ( 2009 / 10 ) : <br /> D ollar incre ase/ ( de cre ase ) in req uest : $ 25 , 00 0 <br /> Percent increase /( decrease ) in request * " : 9D IV / 0 ! <br /> n up licated N umb er o f Ch ildren to b a serve n ivi ua y : 200 <br /> Unduplicated N umber of Adults to be served Individually : 3 0 <br /> Unduplicated N umber to be served via Group settings : _ <br /> Total Program Cost per Client : <br /> 220 . 77 <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 has approved this application on (date). April 14. 2009 <br /> Alan S . Polackwich, Sr. � P� ._,_.,$ �Q� , �► <br /> Name of President/Chair of the Board Signa ure <br /> Angelia Perry <br /> Name of Executive Director/CPO Signatur <br /> 2 <br />