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Ns~C~~Nort~ Subgrban CounselinK Center I <br /> <br />Does your orgmfiz~ion serve low to modm-a~ inoome families or individuals? If you a~w~r no, <br />your orgarfi~tion is not eligible to r~c:eived CDBG fund& <br /> <br />x Yes No <br /> <br />Whatpezeenmgeofp~zsonsserwdarelowJmodmmm~eomeindi~duals?People who are utilizing our <br />sliding fee scale program are all of iowtomoderate income. We also provide counseling <br /> 100 % to persons with insurance who are not eligible <br /> for the sliding fee scale program. <br />What percentage of low/modwra~ income persons served are Ramsey resid~n~? <br /> <br />3-5 % <br /> <br />Will these funds be used for an expansion of an existing program? <br /> <br />x Yes No <br /> <br />Will these funds be used for the creation of a new program? <br /> <br />Yes x No <br /> <br />I <br /> <br />I <br />I <br /> <br />I <br /> <br />pt Jz~&SE PROVIDE THE FOLLOWING INFORMATION WITH YOU~R APPLICATION: <br /> <br />X <br /> <br />X <br /> <br />X <br /> <br />1991 orgarfi?mfon budget Attachment A <br /> <br />Proposed budget forCZ)BG funds CDBG funds are included in our total budget, <br /> do not have a separate CDBG budget, <br />Schedule for e.xpendJture of CDBG funds To be reimbursed quarerly after services <br />are provided and documentation is sent to City of Ramsey <br />Name of indJvSdu~d(s) authorized to receive C2)BG reimbursement checks. <br />Checks to: North Suburban Counseling Center; Terri bielnychenko, Adm. Dir. <br />A copy oftheorganizafion'sardclesofincom>omfion - Sent with last year's applica- <br /> tion. <br /> <br />Appi/¢afions are due to Sytv/a Frolik: Ramsey Municipal Center, 15153 Nowthen Blvd. N.W., <br />R~msey, MN 55303 by 5:00 p.m. on Friday, July 12, 1991. Additional information may be <br />obta/ned from SyMa Frolik~ Zoning Administrator at 427-1410. <br /> <br />! <br />I <br />i <br /> <br />I <br />! <br /> <br /> <br />