NGO Funding Request


The recipient entity's full legal name:  Claiborne Voluntary Council on Aging, INC

The recipient entity's physical address:
           608 East 4th Street
Homer, Louisiana 71040


The recipient entity's mailing address (if different):
           P.O. Box 480
Homer, Louisiana 71040


Type of Entity (for instance, a nonprofit corporation):  Non-Profit Corporation

If the entity is a corporation, list the names of the incorporators:
          

The last four digits of the entity's taxpayer ID number:  7834

What is the dollar amount of the request?  $25,000

What type of request is this?  Both

Is this entity in good standing with the Secretary of State?  Yes

Provide the name of each member of the recipient entity's governing board and officers:
           Board of Directors:
Ms. Zelmarie Kennedy-Secretary
Ms. Addie Wafer
Ms. Iris Sanders
Ms. Bobbie Ruple
Ms. Lizzie Williams-Vice-Chairperson
Ms. Faye McKenzie-Treasurer
Ms. Maebell Burns
Ms. Patricia Sanders
Ms. Bobbie Sindle-Chairperson
Ms. Carolyn Adkin
Mr. Adron Hallman


Provide a summary of the project or program:
           To assist with day to day operational cost of the center. Some of our expenses include computer services, monthly telephone expense, insurances, we are in great need of camera's for our building. We have been broken into three times this past year with damage that the council is unable to pay for. We are required and must advertise services and upcoming events for the seniors of Claiborne Parish which can be very expenses and presently we are over budget. Day to day use of supplies i.e. copier paper, cleaning supplies, folders, telephone expenses, vehicle wear and tear, i.e. tires. windshield replacement etc. We have designated amount of dollars in our budget to continue our services in which the council is presently $10,000 in the red trying to assist the seniors in this parish with meals in the home and at the center. We have been assisting those seniors who are discharged from hospitals and rehab centers with meals in the home in which the center is over per our budget. Claiborne Parish is one of the poor parish in Louisiana with very low income seniors. Claiborne parish is very large and spread out in which in turns cost a lot of money for the center to be able to assist those seniors who live in most rural areas. We are having to turn down seniors who desperately needs our help. I as the Director have a responsibility to my community to assist those in need, this is why I am running in a deficient trying to help those elderly with the greatest need, assist them in maintaining independence in their home for as long as possible. With extra funding I could assist more seniors who are homebound in the community with balanced meals, and also those who come to the center to eat five days per week.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $0
          Operating Services. . . . $20
          Other Charges. . . . . . . $5,000

Does your organization have any outstanding audit issues or findings?  No

If 'Yes' is your organization working with the appropriate governmental agencies to resolve those issues or findings?
          

What is the entity's public purpose, sought to be achieved through the use of state monies?
          To assist those seniors of Claiborne Parish a life with dignity, independence, nutrition, transportation to and from doctor appointments, grocery shopping, assist with taking them to pick up their medications at there pharmacy. All of the above can help improve their health physically and mentally.

What are the goals and objectives for achieving such purpose?
          Our mission is to provide a comprehensive and coordinated community based system of services for the elderly to live a life of dignity and independence in their own home.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           6-8 months

If any elected or appointed state official or an immediate family member of such an official is an officer, director, trustee, or employee of the recipient entity who receives compensation or holds any ownership interest therein:
     (a) If an elected or appointed state official, the name and address of the official and the office held by such person:
                
    
     (b) If an immediate family member of an elected or appointed state official, the name and address of such person; the name, address, and office of the official to whom the person is related; and the nature of the relationship:
                

     (c) The percentage of the official's or immediate family member's ownership interest in the recipient entity, if any:
                

     (d) The position, if any, held by the official or immediate family member in the recipient entity:
                 

If the recipient entity has a contract with any elected or appointed state official or an immediate family member of such an official or with the state or any political subdivision of the state:
(a) If the contract is with an elected or appointed state official, provide the name and address of the official and the office held by such person: 
               

(b) If the contract is with an immediate family member of an elected or appointed state official:
          Provide the name and address of such person:
              

          Provide the name, address, and office of the official to whom the person is related:
               

          What is the nature of the relationship? 

(c) If the contract is with the state or a political subdivision of the state, provide the name and address of the state entity or political subdivision of the state:
                 Governor's Office of Elderly Affairs
P.O. Box 61
Baton Rouge, LA. 70821-0061


(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               Title III Contract- For Programs IIIB, IIIC1, IIIC2, IIID, IIIE. Administrative cost, salaries, meals in the home, and the center, supportive services, preventative health, caregiver and respite. Transportation, legal services, homemaker and respite services. PCOA and Senior Center Contract, Supplemental Senior Center.


Contact Information
name:  Denise Blackwell RN 
                                       address:  P. O. Box 480
Homer, LA. 71040

                                       phone:  318-927-6922
                                       fax:  318-927-1070
                                       e-mail:  dblackwell@claibornecouncilonaging.org
                                       relationship to entity:  Executive Director