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DIVISION 'DF YOUTH SERVICES-C A.. <br /> P.'. )GRAM AGREEMENT <br /> <br />Name of Program Uwharrie Group Home <br /> <br />County's Federal I.D. Number 566000? ~ l E <br />Sponsoring Agency Ilwharrie Homes, 'nc. <br /> <br />Contact Person (name & ac!dress) <br /> <br />(' .mty <br /> <br />Jerry Earnhardt <br />PO Box 1026 <br /> <br />Albemarle, NC <br /> <br />Phone# ~ 983-1808 <br /> <br /> 28002 <br /> <br />Fax #(70~ 983-1808 __ <br /> <br /> CABARRUS <br /> <br />Program Type <br /> <br /> Group Home <br /> <br />Fu?ling Period <br /> <br /> 7 :/98 thru 6/30/99 <br /> <br />CI~..'~ Assigned I.D. <br /> <br />Referral Sources Juvenile Courts, Schools <br /> Department of Social Services <br /> <br />Piedmont Area Men~al Health <br /> <br />213013 <br /> <br />New Program <br /> <br />Continuation X <br /> <br />*Client Capacity 5 . ,'..nticipated average length of stay <br /> <br /> Estimated nu::~ber of you:5 to be served during fm~ding period 4 <br /> <br />i 80 (da~, ,". <br /> <br />*Actual number of ye:Ih admitte st fiscal year: <br /> <br />Reported using Client T' acking Forms <br /> <br />Reported us!ng Annual ~rogram Review <br /> <br /># Juvenile Court or law enforcement referred <br /> <br />0 % <br /> <br />Date received in Regional Office <br /> <br /> PICe:-: submit 4 cqpies w~h original signatures. <br /> <br /> *If the funds being requested will l~c ..:;ed for more t'.:na eno program component please provi:.le this informatio,~ for cach <br /> component on a set:::..[¢ sheet. <br /> <br />DYS (REV. 10-95) <br /> <br /> <br />