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Name of Program <br /> <br /> DIVISION OF YOUTH SERVICES - CBA <br /> PROGRAM AGREEMENT <br /> <br />Psychological Services to Juvenile Court <br /> <br />County's Federal I.D. Number 566000281E <br /> <br />Sponsoring Agency Piedmont Behavioral Healthcare <br /> <br />ContactPerson(name & address) <br /> <br />Leah L. Friday, ACSW <br />Cabarrus Behavioral Healthcare <br /> 457 Lake Concord Road <br /> <br /> Concord, NC Zip 28025 <br /> <br />Phone#(704) 788-1130 Fax#(70~_ 788-6107 <br /> <br />Referral Sources 19th Judicial District <br />Counseling Services <br /> <br />County <br /> <br /> CABARRUS <br /> <br />Program Type <br /> <br />Psychological Services <br /> <br />Funding Period <br />7/1/96 thru <br /> <br />CBA Assigned I.D. # <br />213012 <br /> <br />6/30/97 <br /> <br />New Program <br /> <br />Continuation XX <br /> <br />*Client Capacity 28-32 . Anticipated average length of stay 90-120 <br /> <br /> Estimated number of youth to be served during funding period 80-96 <br /> <br />.(days). <br /> <br />*Actual number of youth admitted last fiscal year: <br /> <br /> 57 <br /> <br />N/A <br /> <br /> Reported using Client Tracking Forms <br /> Reported using Annual Program Review <br />57 # Juvenile Court or law enforcement referred 100 % <br /> <br />Date received in Regional Office <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 please provide this in{ormation for each <br />-- component on a separate sheet. <br /> <br /> DYS (REV. 10-95) <br /> <br /> <br />