Letter Of Intent Form To Continue Funding 2014-2015
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1
2Department of Youth Services Diversion Program
"Letter of Intent Form to Continue Funding 2014-2015"
1
County Name (Payee)
2
Program Name
3
Counties Served by Program
4
Amount Requested - FY14-15
$
-
Estimated Funds Available
5
- as of Sept. 30, 2014
$
-
Net Requested Funds
6
(line 4 - line 5)
$
-
7
FY14 Grant Amount
$
-
Proposed Program Changes
8
(not required)
Affect of Proposed Changes
(Reduced Commitments /
9
Financial Savings, etc.)
10
Submitted by (print or type)
title
contact information
date
Form due by May 12, 2014
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Parent category: Letters