Laserfiche WebLink
'CJPP Application for Continuation of Implementation Funding Page 5 of 6 <br /> <br />[5] [] Domestic Violence Services [] [] <br />[6] ~' Life Skills ~' [] <br />[7] [] Others [] [] <br /> <br />13. Service Provider Information <br />[A] List the NON-CONTRACTED (i.e., services at NO COST to CJ'PP) Service Providers to the <br />program. Attachment 2 <br /> <br /> Attach a Copy of Memorandums of Agreement (MOA's) in attachment section for FY 2004 - <br />2005. MOA's should be maintained in Program files on site. <br /> <br />[B] List the CONTRACTED (i.e., services at COST to CJPP) Service Providers to the program. <br />Attachment 3 <br /> <br /> Attach a Copy of Proposed or Signed Contracts in attachment section for FY 2004 - 2005. <br />Contracts should be maintained in Program files on site. <br /> <br /> lIndividual Intake - Contracted rate $50.00 per intake. <br /> [Individual Therapy Sessions - Contracted rate $20.00 per hour. <br /> IGroup Therapy - Contracted rate $20.00 per hour. <br /> <br />Please Note: Attachments are required for contracts and MOA's for FY 2004 - 2005. <br /> <br />14. Project Income <br /> <br />Does the program anticipate receiving any Project Income? ~ No <br /> <br /> [] Yes (Attach a completed "Project Income Report" form) Attachment 8 <br /> <br />Submit one (1) Original and two (2) copies of Application and Attachments, including <br /> budgets. <br /> <br />Attachment Check List <br /> <br />Attach the following in this order: <br />Attachment <br /> <br />1. Job Descriptions for all modified CJP <br />Program Positions <br /> <br />2. Copies of All MOA's for FY 2004 - 2005 for <br />Service Providers <br /> <br />3. Copies of All Proposed or Signed and <br />Executed Contracts for FY 2004 - 2005 for <br /> <br />Attached? Reason, if Not Attached <br /> <br />[] Yes <br />~No <br /> <br />~'Yes <br />[] No <br />~'Yes <br />[] No <br /> <br />I[ AI1 services are contracted through <br />[CARE, there are no CJPP program <br />Ipositions. . <br /> <br />hl-tn'//einn rlr~- ~t~t~ hr. ~m/~nn~/~ rDDl:;';er.a l/F'lDD!~';er,~It'",-,..~-~l I.~O ^ t-,"m'r'~xr_c. .... ~ __ <br /> <br /> <br />