Orange County NC Website
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for Service Providers~J Yes <br />^No <br />4. Copy of facility license and proof of appropriate certification or registration C~Ci yes <br />with certifying board. ^ No <br />5. Monthly or Weeldy Calendar detailing Services Provided ~i Yes <br />^ No <br />6, Local CJPP Advisory Board Members and Terms ~1 Yes <br />^ No <br />7. Budget Line Item Justification Form [~i Yes <br />^ No <br />8, Budget Summary Form ~.1 Yes <br />^ No <br />9, Project Income Report (if applicable) ^ Yes N/A <br />Eti No <br />10, Information regarding all firnding sources beyond C.IPP fluids (Grants, County ~1 yes <br />Funds, etc.) ^ No <br />NGT1/: Please number your attaclunents and submit in the order indicated above, <br />Retrun to Form Selection Page <br />