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DIVISION OF YOUTH SERVICES - CBA <br /> PROGRAM AGRE~[EHT <br /> <br />Name of Program Temporary Shelter Care Pro~ect <br /> / <br />Sponsorini Agency Caharrus County / County <br /> / <br /> Department of Social Services / Cabarrus <br /> · / <br />Contact Person (name & address) [ Program Type <br /> ! <br /> }irs. Carolyn Eur~ / Group Home <br /> <br /> Cabarrus County Department of Social Services ! Funding Period <br /> ! <br /> PO Box 6§8, Concord, NC Phone 706-786-7161 ! 7/1/87 thru 6/30/88 <br /> 28026-0668 <br /> / CBA Assigned <br /> / <br />Referral Sources Juvenile Court, Famil~ Court / 213011 <br /> ! <br /> Counselors, Eental Health Center, Schools, / Kev Program <br /> / <br /> Family, Department of Social Services / Continuation X <br /> <br />* Client Capacttx 5 . Anticipated average length of stay 90 <br /> <br />(days). Estimated number of you:h to be served ~uring funding period <br /> <br /> 20 <br /> <br /> Date received in regional office <br /> Date received in central otfice <br /> Date of CBA Approval <br /> <br /> Please submit & copies with original signatures. <br /> <br />tit the funds being requested viii be used for more than one program component <br />please provide this information fo{ each component on a separate sheet. <br /> <br />DYS (Rev. 1/87) <br /> <br /> <br />