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DIVISION OF YOUTH SERVICES - CBA <br /> PROGRAM AGREEMENT <br /> <br />Name of Prggram IL~arrie Cr~p <br />Sponsoring Agency tk~arrie Hc~es, Inc. County <br /> <br />Contact Person (name & address) Program Type <br />Keith ~blf-Executive Director <br />P.O. B~x 1026 Funding Period <br />Alb~narlet N.C. 28002 PhoneT~-983-18~6 71}/87 thru <br /> <br /> CBA Assigned I.D. <br />Referral Sources Coat[ Cxxm~elors? M~tal }~alth? 2]3303 <br /> Public Schcols, D~partm~nts of Social Services New program <br /> Continuation X <br /> <br />* Client Capacity 5 . Anticipated average length of stay ]80 <br /> <br /> (days) . Estimated number . of youth, to be served during funding period <br /> <br /> 2 <br /> <br /> Date received in regiona.1 office · <br /> Date received in central office <br /> Date of CBA Approval <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 />