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Name of Pro.am <br /> <br /> DIVISION OF YOUTH SERVICES - CBA <br /> <br />PROGRAM AGREEMENT <br />Psychological Services to Juvenile Court <br /> <br />Sponsoring Agency Piedmont Area Mental Health, <br /> <br /> Mental Retardation & Substance Abuse Authority <br /> <br />ContactPerson(name & ad,ess) <br /> <br /> Esther M. Winters, Ph.D. <br /> Cabarrus Mental Health Center <br /> 457 Lake Concord Road <br /> <br /> Concord, NC Zip. 28025 <br /> <br />Phone# (704) 788-1130 Fax#(709 788-6107 <br /> <br />Referral Sources 19th Judicial District Counseling <br />Services <br /> <br />County <br /> <br /> Cabarrus <br /> <br />Program Type <br /> <br /> Psychological Services <br /> <br />Funding Period <br /> <br /> 7/1/95 thru <br /> <br />CBA Assigned I.D. # <br /> 213012 <br /> <br />6/30/96 <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 />38 Reported using Client Tracking Forms (lst 3 quarters) <br />n/a .Reported using Annual Program Review <br /> <br />38 # Juvenile Court or law enforcement referred 100 % (Is t 3 quarters) <br /> <br />Date received in Regional Office <br /> <br />Please submit 4 copies with original signatures. <br /> <br />*If the ~unds being requested will be used for more than one program component please provide this information for each <br />comp'onent on a separate sheet. <br /> <br />DYS (Rev. 1-95) <br /> <br /> <br />