Laserfiche WebLink
<br />Program Agreement <br />DEPARTMENT OF JUVENILE JUSTICE AND <br />DELINQUENCY PREVENTION <br /> <br />~~!;'QjU~fll~1 <br /> <br />FUNDING PERIOD <br />1 July 1, 2005-June 30, 2006 <br />COUNTY <br />I CABARRUS <br /> <br />SPONSORING AGENCY <br />Please check type: <br /> <br />o Public <br /> <br />DJJDP PROGRAM FUNDING IIlaontinuatlon only) <br />I 313012 <br />AREA <br />I PIEDMONT <br />MULTI-COMPONENTS ~ Ves 0 No <br />DAYMARK Recovery Services Inc. <br />~ Non-Profit Federal 10 # 02-0707661 <br /> <br />NAME OF PROGRAM <br />PROGRAM COMPONENTS <br /> <br />I Psychological & Substance Abuse Evaluation Services <br /> <br />DJJDP PROGRAM TYPE TOTAL COST OF <br />COMP.I[)jI NAME OF COMPONENT (enter one choice per component) EACH COMPONENT <br />313012 PsVchological Evaluation Services Psvcholooical Services $39,202 <br />313023 Substance Abuse Evaluation Services PSycholooical Services. $38,594 <br /> TOTAL COST OF COMPONENTS $77,796 <br /> <br />Does this program have a Slandardlzed Program evaluation Protocol (SPEP) rating? <br /> <br />Compo 101 Component Prevention <br />Compo 101 Component Prevention <br />Compo 1[)jI Component Prevention <br /> <br />PROGRAM MANAGER name & address (same person on signature page) <br /> <br />o No OVes <br /> <br />Court Supervision <br />Court Supervision <br />Court Supervision <br /> <br />NAME IJoan Simpson, Psy.D. I TITLE IClinical Site Director <br />ADDRESS 11305 South Cannon Blvd <br />CITY Kannapolis ISTATE I NC I ZIP I 28083 <br />PHONE 704-939-1100 I EXT. I I FAX I 704-9391120 <br />EMAlL isimoson@davmarkrecoverv.ora <br /> <br />CO TACTP RSO .fdjfli <br /> <br />fr <br /> <br />) <br /> <br />N E N(I erent om program manager <br />NAME IJayme Earnhardt I TITLE ILicensed Psychological Associate <br />ADDRESS 11305 South Cannon Blvd <br />CITY Kannapolis JSTATE 1 NC 1 ZIP I 28083 <br />PHONE 704-939-1100 I EXT. 1 I FAX I 704-939-1120 <br />EMAIL ivodicet'6>.davmarkrecoverv. ora . <br /> <br />PROGRAM FISCAL OFFICER (should not be prOllram manager) <br />NAME !Jill Gosnell I TITLE I Practice Manager <br />ADDRESS 11305 South Cannon Blvd <br />CITY Kannapolis ISTATE 1 NC I ZIP 1 28083 <br />PHONE 704-939-1100 I EXT. I I FAX I 704-939-1120 <br />EMAIL iaosnell{cl)davmarkrecoverv.ora <br /> Submit 5 copies with REVISED 2006 <br /> DJJDP USE ONLY: <br /> oriainal sianatures Date received in Area Office I <br /> <br />I=-- 4- <br />