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-- Sponsoring Agency <br /> of Social Services <br /> <br />Name of Program <br /> <br />County's Federal I.D. Number 566000281E <br /> <br /> Cabarms County Department <br /> <br /> DIVISION OF YOUTH SERVICES <br /> <br /> PROGRAM AGREEMENT <br />Temporary Shelter Care <br /> <br /> Contact Person (name and address) <br /> <br />- Deedee Wright, SWS III <br /> <br /> P.O. Box 668 <br /> <br />Concord, NC Zip 28026-0668 <br /> <br />Phone# (704) 792-0401 Fax~ (704) 788-8420 <br />Referral Sources District Court Judge, Juvenile <br /> <br />Court Counselors, Parent/Caretakers, School <br /> <br />Personnel, DSS <br /> <br />_*Client Capacity 5 <br /> <br /> Estimated number of youth to be served during funding period <br /> <br />County <br /> <br />CABARRUS <br /> <br />Program Type <br /> <br />Temporary Foster Care <br /> <br />Funding Period <br /> <br />7/1/98 thru <br /> <br />CBA Assigned I.D.# <br />213011 <br /> <br /> New Program <br /> Continuation X <br /> <br />· Anticipated average length of stay <br /> <br /> 28 <br /> <br />6/30/99 <br /> <br />90 <br /> <br />(days).' <br /> <br />*Actual number of youth admitted last fiscal year: <br /> <br />26 Reported using Client Tracking forms <br /> <br />N/A Reported using Annual Program Review <br /> <br />28 # Juvenile Court or law enforcement referred <br /> <br />72 % <br /> <br />Date received in Regional Office <br /> <br />Please submit 4 copies with original signatures. <br /> <br />*I/the funds being requested will be used for more than one program component please provide this information for component on a <br />separate sheet. <br /> <br />DYS (REV. 10-95) <br /> <br /> <br />