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DIVISION OF YOUTH SERVICES - CBA <br /> PROGRAM AGREEMENT <br /> <br /> Hame of Program Tempprary Shelter Care Project <br /> / <br /> Sponsoring Agency Cabarrus County / County <br /> ! <br /> -. pepartment of Social Services / Cabarrus <br /> ! <br /> Contact Person (name & address) / Program Type <br /> / <br /> Mrs. Carolyn Bury / Group Home__ <br /> / <br /> Cabarrus County Department of Social Services ! Funding Period <br /> ! <br /> P. O. Box 668 Phone.. 704-786-7141~_ / 7/1!90 thru 6/30/91 <br /> Concord, N. C. 28026-0668 / <br /> / CBA Assigned I.D. # <br /> ! <br /> Refecral Sources Juvenile' ~onrt, Family Court / 213011 <br /> ! <br /> Counselors, Mental Health Center, Schools, / New Program <br /> / <br /> Department of Social Services, Family / Continuation X <br /> <br /> * Client CapaeitM 5 __ Anticipated average length of stay 90 <br /> (days). Estimated number of youth to be served during funding period <br /> <br /> 20 <br /> <br /> Date received in regional office <br /> Pate received in central office <br /> Date of CBA Approval <br /> <br /> Please submit 4 cppies w~th orisf.al signatures. <br /> <br />*if tile [unds being requested will be used for more than Due program component <br />please provide this information for each component on a separate sheet. <br /> <br />DYS (Rev. 1/87) <br /> <br /> <br />