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CJPP Application for Continuation of Implementation Funding <br />[4] E~J Cognitive Behavioral Intervention C/j <br />[5] ^ Domestic Violence Services ^ <br />[6] ^ Life Skills ^ <br />[7] ^ Sex Offender ^ <br />[8] ^ Others ^ <br />Page 4 of 5 <br />11. Service Provider Information <br />[A] List the NON-CONTRACTED (i.e., services at NO COST to CJPP) Service Providers to the program. <br />Attaclunent 2 <br />Attach a Copy of Memorandums of Agreement (MOA's) in attachment section for FY 2009 - 2010. MOA's <br />should be maintained in Program files on site. <br />The Division of Community Corrections and TASC which are pending based on the selection of the new <br />treatment provider. <br />[B] List the CONTRACTED (i.e., services at COST to CJPP) Service Providers to the program. Attachment 3 <br />Attach a Copy of Proposed or Signed Contracts in attachment section for FY 2009 - ZO10. Contracts should <br />be maintained in Program files on site. <br />The program is out for through March 31, 2009 and the new provider should be selected in May 2009. <br />Please Note: Attachments are required for contracts and MOA`s for FY 2009 - 2010. <br />12. Project Income <br />Does the program anticipate receiving any Project Income? <br />~ No <br />^ Yes (Attach a completed "Project Income Report" form) Attachment 8 <br />Submit one (1) Original and two (2) copies of Application and Attachments, including 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 />Positions <br />2. Copies of All MOA's for FY 2009 - 2010 for <br />Service Providers <br />3. Copies of All Proposed or Signed and Executed <br />Contracts for FY 2009 - ZO10 for Service Providers <br />4. Copy of facility license and proof of appropriate <br />certification or registration with certifying board. <br />^ Yes <br />~I No All services will be contracted through the <br />provider. There are no CJP program positions. <br /> <br />^ Yes <br />ErJ No Contract is currently out for bid through March <br />31, 2009. <br /> <br />^ Yes <br />~I No Contract is currently out for bid through March <br />31, 2009. <br /> <br />^ Yes <br />Contract is currently out for bid tluough March <br />Attachment number 1 <br />http://cjpp.doc.state.nc.us/apps/CJPPFiscal/CJPPFiscalController?ACTION=SaveFornz 3/10/2009 <br />