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Program Agreement <br />DEPARTMENT OF JUVENILE JUSTICE AND <br />DELINQUENCY PREVENTION <br />SECTION I <br />U <br />FUNDING PERIOD DJJDP PROGRAM FUNDING # (continuation only) <br />Jul 1, 2006-June 30, 2007 <br />COUNTY AREA <br />Oran e Central <br />MULTI-COMPONENTS ^ Yes ^ No <br />SPONSORING AGENCY Mental Health Association in Orange County <br />Please check type: ^ Pubiic Q Non-Front Federal ID # 56-1165029 <br />NAME OF PROGRAM Family Advocacy Network <br />PROGRAM COMPONENTS <br />DJJDP <br />COMP. ID# <br />NAME OF COMPONENT PROGRAM TYPE <br />(enter one choice per component) TOTAL COST OF <br />EACH COMPONENT <br /> Famil Advocac Parent/Famil Skill Buildin $59,261 <br /> <br /> <br /> <br /> <br />TOTAL COST OF COMPONENTS $59,261 <br />Does this program have a Standardized Program Evaluation Protocol (SPEP) rating? <br />Comp.ID# Component Prevention <br />Comp.ID# Component Prevention <br />Comp.ID# Component Prevention <br />oonr_onnn nnentert=R nan,a R aririraSS IS9me nersOn on slanature oaae) <br />No ^ Yes <br />Court Supervision <br />Court Supervision <br />Court Supervision <br />NAME Mark Sullivan, MSW TITLE Executive Director <br />ADDRESS 302 W. Weaver St. <br />CITY Carrboro STATE NC ZIP 27510 <br />PHONE 919-942-8083 EXT. FAX <br />EMAIL msullivan(cilmhaoc.com <br />CnNTACT PFRRnN /if different from nroaram manager) <br />NAME Cindy Wilkins, BSW TITLE Family Advocate <br />ADDRESS 302 W. Weaver St. <br />CITY Carrboro STATE NC ZIP 27510 <br />PHONE 919-942-8083 EXT. FAX <br />EMAIL cindyw(a~mhaoc.com <br />PROGRAM FISCAL OFFICER (should not be program manager) <br />NAME Matt Pohlman TITLE Treasurer <br />ADDRESS 302 W. Weaver St. <br />CITY Carrboro STATE NC ZIP 27510 <br />PHONE 919-942-8083 EXT. FAX <br />EMAIL shelbynmatt(a>hotmail.com <br /> Submit 5 copies with <br />original signatures REVISED 2005 DJJDP USE ONLY: <br />Date received in Area Office <br />Page 1 of 10 <br />