Orange County NC Website
Browse       Search
CJPP Application for Continuation of Implementation Funding Page 5 of 5 <br />Does the program anticipate receiving any Project Income? <br />9 No <br />❑ Yes (Attach a completed "Project Income Report" form) Attachment 8 <br />Submit one (1) Original and two (2) copies of Application and Attachments, including <br />budgets. <br />Attachment Check List <br />Attach the following in this order: <br />Attachment Attached? Reason, if Not <br />Attached <br />1. Job Descriptions for all modified CJP Program Positions ❑ Yes same as previous <br />WNo years <br />2. Copies of All MOA's for FY 2011 - 2012 for Service Providers W.1 Yes <br />❑ No <br />3. Copies of All Proposed or Signed and Executed Contracts for FY F6 yes <br />2011 - 2012 for Service Providers <br />❑ No <br />4. Copy of facility license and proof of appropriate certification or <br />❑ Yes <br />110n file —� <br />registration with certifying board. <br />W1 No <br />5. Monthly or Weekly Calendar detailing Services Provided <br />Rf Yes <br />❑ No <br />6. Local CJPP Advisory Board Members and Terms <br />Rf Yes <br />❑ No <br />7. Budget Line Item Justification Form <br />W Yes <br />❑ No <br />8. Budget Summary Form <br />EG Yes <br />❑ No <br />9. Project Income Report (if applicable) <br />❑ Yes <br />I[N/A <br />EGNo <br />10. Information regarding all funding sources beyond CJPP funds ❑ Yes /A —� <br />(Grants, County Funds, etc.) ECi No <br />NOTE: Please number your attachments and submit in the order indicated above. <br />Return to Form. Selection Page <br />http: / /Cjpp.doc.state.nc.usl apps lCJPPFiscaUCJPPFiscalController ?ACTION= SaveForm 2/7/2011 <br />7 <br />