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CJPP Application for Continuation of Implementation Funding <br />[B] Check all services that apply <br />[1] GCt Substance Abuse Treatment <br />[2] ❑ Educational Services <br />[3] ❑ Job Development Services <br />[4] Ri Cognitive Behavioral Intervention <br />[5]! Domestic Violence Services <br />[6] Life Skills <br />[7] ❑ Sex Offender <br />[8] ❑ Others <br />11 . Service Provider Information <br />Page 4 of 5 <br />[A] List the NON - CONTRACTED (i.e., services at NO COST to CJPP) Service Providers to the <br />program. Attachment. 2 <br />Attach a Copy of Memorandums of Agreement (MOA's) in attachment section for FY 2011- <br />2012. MOA's should be maintained in Program files on site. <br />I[The Division of Community Corrections and TASC I <br />[B] List the CONTRACTED (i.e., services at COST to CJPP) Service Providers to the program. <br />Attachment ) <br />Attach a Copy of Proposed or Signed Contracts in attachment section for FY 2011 - 2012. <br />Contracts should be maintained in Program files on site. <br />Genesis ... A New Beginning, Inc. <br />Please Note: Attachments are required for contracts and MOA's for FY 2011 - 2012 <br />12. Project Income <br />Does the program anticipate receiving any Project Income? <br />Eli No <br />❑ Yes (Attach a completed "Project Income Report" form) Attachment S <br />Attachment number 2 <br />http: / /cjpp.doc.state.nc.usl apps/ CJPPFisca]ICJPPFifeAlController ?ACTION= SaveForm P204MO11, <br />On Site <br />Off Site <br />Assessment <br />9 <br />❑ <br />Etl ROPT <br />Fj <br />❑ <br />F► IOPT <br />❑ <br />F1 Support Services <br />El <br />R6 After Care <br />El <br />�I Drug Screens <br />Eti <br />❑ <br />1 Other <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />�1 <br />❑ <br />F <br />❑ <br />❑ <br />❑ <br />0 <br />El <br />Page 4 of 5 <br />[A] List the NON - CONTRACTED (i.e., services at NO COST to CJPP) Service Providers to the <br />program. Attachment. 2 <br />Attach a Copy of Memorandums of Agreement (MOA's) in attachment section for FY 2011- <br />2012. MOA's should be maintained in Program files on site. <br />I[The Division of Community Corrections and TASC I <br />[B] List the CONTRACTED (i.e., services at COST to CJPP) Service Providers to the program. <br />Attachment ) <br />Attach a Copy of Proposed or Signed Contracts in attachment section for FY 2011 - 2012. <br />Contracts should be maintained in Program files on site. <br />Genesis ... A New Beginning, Inc. <br />Please Note: Attachments are required for contracts and MOA's for FY 2011 - 2012 <br />12. Project Income <br />Does the program anticipate receiving any Project Income? <br />Eli No <br />❑ Yes (Attach a completed "Project Income Report" form) Attachment S <br />Attachment number 2 <br />http: / /cjpp.doc.state.nc.usl apps/ CJPPFisca]ICJPPFifeAlController ?ACTION= SaveForm P204MO11, <br />