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Name of Program <br /> <br />Sponsoring Agency <br /> <br />DIVISION OF YOUTH SERVICES - CBA <br />PROGRAM AGREEMENT <br /> <br />Uwharrie Group Home <br /> <br />Uwharrie Homes, Inc. <br /> <br />ConmctPerson(name & address) <br /> Jerry Earnhardt <br /> <br />PO Box 1026 <br /> <br />Albemarle, NC <br /> <br />Zip 28002 <br /> <br />Ph0ne#P04) 983-1808 Fax#(706) 983-?073 <br /> <br />Re~nmlS0~ces Juvenile Court, Schools <br /> Department of Social Services. <br /> Piedmont Area Mental Health <br /> <br />County <br /> <br /> C~barrus <br /> <br /> Program Type <br /> <br /> Group Home <br /> Fund~g'Period <br /> <br />7/I/95 thru6/30/96 <br /> <br /> CBA AssignedI.D.# <br /> <br /> 213013 <br /> <br />New Program <br />Continuation X <br /> <br />*Client Capacity 4 . Anticipated average length of stay 180 <br /> <br />Estimated number ofyouth to be served during funding period ~4 <br /> <br /> ~Counting only Cabarrus County Youth <br /> <br /> *Actual nmnber of youth admired last fiscal year: <br /> <br />3 Reported using Client Traqking Forms <br /> <br />0 Reported using Annual Program Review <br /> <br />2 # Juvenile Com~ or law enforcement referred <br /> <br />(days). <br /> <br />67 % <br /> <br />Date received in Regional Office <br /> <br /> Please submit 4 copies wilh original signatures. <br /> <br />*If the funds being requested will be used for more than one program component please provide this <br />information for each component on a separate sheet. · <br /> <br />DYS (Rev. 1-95) <br /> <br /> <br />