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DIVISION OF YOUTH SERVICES - CBA <br />PROGRAM AGREEMENT <br /> <br />Name of Program Temporary Shelter Care Project <br /> <br />Spormoring Agency Cabarrus County <br /> <br /> Department of Social Services <br /> <br />Contact Person (name & address) <br /> <br /> Mrs. Carolyn Eury <br /> <br /> Cabarrus County Department df Social Services <br /> <br /> P.O. Box 668, Concord, NC Zip. 28026-0668 <br /> <br />Phone# ~04) 786-7141 Fax #(7_0_Z0 788-8420 <br /> <br />Referral Sources Juvenile Court ~ Family Court <br /> <br />Counselors, Mental Health Center, Schools~ <br /> <br />Department of Social Services, Family~ Law E~f. <br /> <br />*Client Capacity 5 . Anticipated average length of stay <br /> <br /> Estimated number of youth to be served during funding period 20 <br /> <br />County <br /> <br /> Cabarrus <br /> <br />Program Type <br /> <br />Temporary Shelter Care <br /> <br />Funding Period <br /> <br /> ?/1/9s mm 6/30/96 <br /> <br />CBA Assigned I.D. # <br /> <br /> 213011 <br /> <br />New Program <br />Continuation X <br /> <br />90 (day~. <br /> <br />*Actual number of youth admitted last fiscal year: <br /> <br />24 .Reported using Client Tracking Forms <br /> <br />0 .Reported using Annual Program Review <br /> <br />14 # Juvenile Court or law enforcement referred <br /> <br />58 <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. !-95) <br /> <br /> <br />