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The Center for Emotional and Behavioral Health — Child/Adolescent Psychiatric Mental Health Clinic — IRC - CSAC <br /> SUMMARY REPORT — (Enter Information In The Black Cells 4� - <br /> Amount Requested from Funder for 2005 / 2005 000 . 00 <br /> Total Proposed Program Budget for 2005 / 2006 $ 283 , 007 . 55 <br /> Percent of Total Program Budget : 26 . 9 % <br /> Current Program Funding ( 2004 / 05 ) : $ 76 , 000 <br /> Dollar increase /( decrease ) in request : $ - <br /> Percent increase / ( decrease ) in request * * : 0 . 0 % <br /> Unduplicated Number of Children to be served Individually : 100 <br /> Unduplicated Number of Adults to be served Individually : <br /> Unduplicated Number to be served via Group settings : - <br /> Total Program Cost per Client : 2830 . 08 <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 pprovXthis application n <br /> Name of President/Chair of the Board Signa re <br /> �.7"e-�� e.�.r 1— • S � s i <br /> Name of Executi e Director/CEO e <br /> 4 <br />