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DIVISION OF YOUTH SERVICES - CBA <br /> PROGRAM AGREEMENT <br /> <br />Name of Program Rome-Based Services <br /> <br />Sponsoring Agency Cabarrus County Department of <br /> <br /> Social Services <br /> <br />Contact Person (name & address) <br /> <br />Yvette Wilder, MSW, Treatment Supervisor <br /> <br />P.O. Box 668, Concord, North Carolina <br /> <br /> 28026-0668 Phone 786-7141 <br /> <br />Referral Sources District Court 3udges <br /> <br />Juvenile Court Counselors, Parents/Caretaker, <br /> <br />School Personnel, Department of Social Services <br /> <br />County <br /> <br />Cabarrus <br /> <br />Program Type <br /> <br />Non-Residential <br /> <br />Funding Period <br /> <br />7/1/94 thru 6/30/95 <br /> <br />CBA Assigned I.D. # <br /> <br />213005 <br /> <br />New Program <br /> <br />Continuation X <br /> <br />*Client Capacity 10 Anticipated average length of stay 120 <br /> <br />(days). Estimated number of y~uth to be served during funding period 30 <br /> <br />21 <br /> <br />NA <br /> <br />21 <br /> <br /> Date received in regional office <br /> Date received in central office <br /> Date of CBA Approval <br /> <br />Reported using Client Tracking Forms <br /> <br />Reported using Annual Program Review <br /> <br /># Juvenile Court or Law Enforcement referred <br /> <br />100% <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 <br />please provide this information for each component on a separate sheet. <br /> <br /> <br />