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<br />Program Agreement <br />DEPARTMENT OF JUVENILE JUSTICE AND <br />DELINQUENCY PREVENTION <br /> <br />IJ;ir~i~~~~~1'1r:7~!1 <br />%_,<'f..;.d\iiZ.;;"., ;.' ~\l'_< . ~ ,\c'f;-"<>~"^_,,,,,_, ~_ <br /> <br />FUNDING PERIOD <br />I July 1, 2006 - June 30, 2007 <br />COUNTY <br />I Cabarrus <br /> <br />SPONSORING AGENCY <br />Please check type: <br /> <br />D Public <br /> <br />OJJOP PROGRAM FUNDING # (continuation only) <br />I 313012 I <br />AREA <br />I Piedmont I <br />MUL TI-COMPONENTS [2] Yes DNa <br />DA YMARK Recovery Services, Inc. <br />[2] Non-Profit FederallD # 02-0707661 <br /> <br />NAME OF PROGRAM <br />PROGRAM COMPONENTS <br /> <br />I Psychological & Substance Abuse Services <br /> <br />OJJOP PROGRAM TYPE TOTAL COST OF <br />COMPo 10# NAME OF COMPONENT (enter one choice per component) EACH COMPONENT <br />313012 PsVcholoQical Evaluation Services Psvcholooical Services $38,545 <br />313023 Substance Abuse Evaluation Services Substance Abuse Services $38,156 <br /> TOTAL COST OF COMPONENTS $76.701 <br /> <br />Does this program have a Standardized Program Evaluation Protocol (SPEP) rating? <br /> <br />Compo 10# Component Prevention <br />Compo 10# Component Prevention <br />Compo 10# Component Prevention <br /> <br />PROGRAM MANAGER name & address (same person on signature page) <br /> <br />D No DYes <br /> <br />Court Supervision <br />Court Supervision <br />Court Supervision <br /> <br />NAME IJanice S. Sanders TITLE IMental Health Team Leader <br />ADDRESS 11305 S. Cannon Blvd. <br />CITY Kannapolis STATE NC ZIP 1 28083 <br />PHONE 704 939-1100 EXT. 1128 IFAX 704939-1173 <br />EMAIL isanders(ci)davmarkrecoverv.oro <br /> <br />CONTACT PERSON (if different from program manager) <br /> <br />NAME 1 TITLE I <br />ADDRESS 1 <br />CITY STATE ZIP 1 <br />PHONE EXT. 1 FAX <br />EMAIL <br /> <br />PROGRAM FISCAL OFFICER (should not be program manager) <br /> <br />NAME IJill Gosnell I TITLE I Practice Manager <br />ADDRESS 11305 S. Cannon Blvd. <br />CITY Kannapolis STATE NC ZIP 1 28083 <br />PHONE 704 939-1100 EXT. 1185 IFAX 704 939-1173 <br />EMAIL ioosnell(ci)davmarkrecoverv .oro <br /> Submit 5 copies with ; REVISED 2006 <br /> I DJJDP USE ONLY: <br /> oriainal sianatures Date received in Area Office I <br /> <br />t="- t 5 <br />Page 1 of 10 <br />