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DIVISION OF YOUTH SERVICES - CBA <br /> <br />PROGRAM AGREEMENT <br />N~meofProgramPsychological Services to Juvenile Court <br /> <br />County's Federal I.D. Number 56600028 IF, <br /> <br />Sponsoring AgencyPiedraont BehavioraI Healthcare <br /> <br />ContactPe~on(name & ad&ess) <br />Vincent L. Pastore, Ph.D. <br />457 Lake Concord Rd <br /> <br />Concord, N,C, Zi[28025 <br />Phone#~04)788-1130 Fax#q04) 7886104 <br /> <br /> Re~rralSources{9th Judicial District: Juvegile <br /> Court: Counselinm Services <br /> <br /> County <br /> <br /> CABARRU$ <br />Program Type <br />Psychological Servfces <br />Funding Period <br /> <br />7/1/98 thru6/30/99 <br /> <br /> CBA Assigned I.D. # <br /> 213012 <br /> <br />New Program <br /> <br />Continuation xx <br /> <br />*Client Capacity_ 28-32 . Anticipated average length of stay 90-120 <br /> <br /> Estimated number of youth to be served during funding period 80-96 <br /> <br />(days). <br /> <br />*Actual number of youth admitted last fiscal year: <br /> <br />26 Reported using Client Tracking FormsAs of 3/1/98 <br />N/A Reported using Annual Program Review <br /> <br />23 tt Juvenile Court or law enforcement referred 88 % <br /> <br />Date received in Regional Office <br /> <br /> Please submit 4 copies with original signatures. <br /> <br /> * If the funds being requested will be used for more than one program component please provide this information for each <br /> component on a separate sheet. <br /> <br />DYS (REV. 10-95) <br /> <br /> <br />