Agency Summary Instructions
Implementing Agency: Enter name of incorporated agency responsible for program.
Program Title: Enter the title of the program.
Program Year: Enter the year the program will operate.
Funding Category: To be completed by the County. Categories include: Youth Development Funding, RHYA Part I, RHYA Part II, Safe Harbor OR Other.
County: Enter County where program applying for funding is located.
Total Program Amount: Enter the total Program Budget.
PERIOD OF ACTUAL PROGRAM OPERATION
Enter the month and year that the program begins (FROM) and the month and year that the program ends (TO).
Enter the type of agency; Federal ID #; Charities Registration #; and agency website (if Applicable). Enter the name, address, city, state, and zip code of the incorporated agency responsible for operation of the program.
CONTACT PERSON FOR AGENCY
Enter name, title, phone number, extension (if applicable) fax number and email of the person who can sign on behalf of the applying agency.
EXECUTIVE DIRECTOR FOR AGENCY
Enter information for the person to contact for this program. The email should be a business or official e-mail address.
RHYA PROGRAMS ONLY:
RHYA I: Provides 60/40 state-local matching funds for coordination of RHY services, as well as short-term (30-60 days) OR (60/120 days) OR residential and non-residential services to runaway and homeless youth under age 21, i.e. Interim Family Programs (Host Home).
RHYA II: Provides 60/40 state-local matching funds for residential and non-residential services to youths ages 16-21 for up to twenty-four months, i.e. Transitional Independent Living Support Programs.