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<br />Program Agreement <br />DEPARTMENT OF JUVENILE JUSTICE AND <br />DELINQUENCY PREVENTION <br /> <br />W?J;Nl~~~~flW~EQJI'J,~tI,~~~f[4lt:;,1 <br /> <br />FUNDING PERIOD <br />I July 1, 2005-June 30,-2006 <br />COUNTY <br />I Cabarrus <br /> <br />SPONSORING AGENCY <br />Please check type: <br /> <br />DPublic <br /> <br />DJJDP PROGRAM FUNDING # (continuation only) <br /> <br />IAREA <br />I Piedmont <br />MULTI-COMPONENTS Dyes D No <br />Genesis...A New Beginning Counseling Services <br />~ Non-Profit Fed.rallD # 86-1137983 <br /> <br />NAME OF PROGRAM <br />PROGRAM COMPONENTS <br /> <br />ALPHA <br /> <br />DJJDP PROGRAM TYPE TOTAL COST OF <br />COMPo 10# NAME OF COMPONENT (enter one choice per component) EACH COMPONENT <br /> Juvenile Sex Offender Counselino Counselino Services $32,500 <br /> TOTAL COST OF COMPONENTS $32,500 <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 I Donna Wise I TITLE I President <br />ADDRESS 117 Cabarrus Avenue West <br />CITY Concord STATE NC ZIP I 28025 <br />PHONE 704-720-7770 EXT. I FAX 704-720-7781 <br />EMAIL dwisetmaenesis-anb.com <br /> <br />CONTACT PERSON (if different from program manager) <br /> <br />NAME Shirley Dennis T TITLE TCounselor <br />ADDRESS T17 Cabarrus Avenue West <br />CITY Concord STATE NC ZIP I 28025 , <br />PHONE 704-720-7770 EXT. I FAX 704-720-7781 <br />EMAIL sdennistmaenesis-anb. com <br /> <br />PROGRAM FISCAL OFFICER (should not be program manager) <br /> <br />NAME ITerry Wise TITLE TVice President <br />ADDRESS 117 Cabarrus Avenue West <br />CITY Concord STATE NC ZII7 I 28025 <br />PHONE 704-720-7770 EXT. I FAX 704-720-7781 <br />EMAIL twisetmaenesis-anb. com . <br /> Submit 5 copies with REVISED 2005 <br /> DJJDP USE ONLY: <br /> oriainal siQnatures Date received in Area Office I <br /> <br />{:" - 4- <br />Page 1 of 10 <br />