The recipient entity's physical address:
           *** Confidential Address ***

The recipient entity's mailing address (if different):
           Boys & Girls Clubs in Louisiana
P.O. Box 51503
Lafayette, LA 70505

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:  1228

What is the dollar amount of the request?  $1,000,000

What type of request is this?  General Appropriation

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:
           President Drake Mills
Boys & Girls Club of North Louisiana 1511 Trenton St
Ruston, LA 71270 drake@ctbonline.com
(318) 254-7422
(318) 243-2525

Vice President Brach Myers
Boys & Girls Clubs of Acadiana 901 Hugh Wallis Rd S
Lafayette, LA 70508 brach.myers@lhcgroup.com
(337) 769-0708

Jonathan Kernion
Boys & Girls Clubs of Southeast Louisiana 6 E 3rd St
Kenner, LA 70062 jkernion@cycleconstruction.com
(504) 467-1444
(504) 874-1723

Eldonta Osborne
Boys & Girls Club of North Louisiana 300 Memorial Dr,
Ruston, LA 71270 eosborne@bgcofnl.org

Ashley Heffernan Kaiser, Esq. akaiser@bgca.org
(443) 949-9312
440 1st St NW
Ste 1020
Washington, DC 20001

Lisa Hurst lhurst@bgca.org
(404) 487-5784
1275 Peachtree St NE
Atlanta, GA 30309

Mary Boyce-Johnson mbjohnson@bgca.org
(239) 250-5949
4303 Fosterdale Ln
Winston Salem, NC 27107

Terri Dorsey tdorsey@bgca.org
(404) 487-5983
1275 Peachtree St NE
Atlanta, GA 30309

Joe Ethier jethier@bgca.org
(404) 487-5632
1275 Peachtree St NE
Atlanta, GA 30309

Provide a summary of the project or program:
           Youth development programming in the core areas of educational enhancement, character and leadership development, healthy lifestyles and more.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $200,000
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $0
          Operating Services. . . . $800,000
          Other Charges. . . . . . . $0

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?
          Not Applicable

What is the entity's public purpose, sought to be achieved through the use of state monies?
          To enable all young people, especially those who need us most, to reach their full potential as productive, caring, responsible citizens

What are the goals and objectives for achieving such purpose?
          To serve additional youth, increase coordination across Clubs in the state for the purpose of providing high quality services to youth.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           1 year

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:
                 No
    
     (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:
                 No

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

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

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:
                

(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               


Contact Information
name:  Ashley Kaiser 
                                       address:  221 Green St
Centreville, MD 21617
                                       phone:  410-266-6380
                                       fax: 
                                       e-mail:  akaiser@bgca.org
                                       relationship to entity:  Board member and Gov't Relations Director