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CJPP Application for Continuation of Implementation Funding <br />Page 5 of 5 <br />Submit one (1) Original and two (2) copies of Application and Attachments, including <br />budgets. <br />Attachment Check List <br />Attach the following in this order <br />Attachment <br />Attached? Reason, if Not Attached <br />1. Job Descriptions for all modified CJP Program <br />© Yes <br />11 <br />Positions <br />F6 No <br />2. Copies of All MOA's for FY 2011 - 2012 for Service <br />9Yes <br />The Division of Community <br />Providers <br />❑ No <br />Corrections and TASC <br />3. Copies of All Proposed or Signed and Executed <br />WI Yes <br />Genesis...A New Beginning, <br />Contracts for FY 2011 - 2012 for Service Providers <br />a No <br />Inc. <br />4. Copy of facility license and proof of appropriate <br />wI Yes <br />certification or registration with certifying board. <br />D No <br />5. Monthly or Weekly Calendar detailing Services <br />91 Yes <br />Provided <br />0 No <br />6. Local CJPP Advisory Board Members and Terms <br />w Yes <br />Il No <br />7. Budget Line Item Justification Form <br />WYes <br />G No <br />8. Budget Summary Form Yes <br />No <br />9. Project Income Report (if applicable) Yes 11 <br />Fi No <br />10. Information regarding all funding sources beyond ❑ Yes 11N/A <br />CJPP funds (Grants, County Funds, etc.) W1 No <br />NOTE: Please number your attachments and submit in the order indicated above. <br />Return to Form Selection Page <br />Attachment number 2 <br />http: //( jpp.doc.state.nc.us/ apps/ CJPPFiscal /CJPPFFsdalController ?ACTION= SaveForm Paik- W'2011 <br />