The recipient entity's physical address:
           1405 W. Pinhook Road, Suite 108, Lafayette, LA 70503

The recipient entity's mailing address (if different):
           1405 W. Pinhook Road, Suite 108, Lafayette, LA 70503

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?  $2,000,000

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 Clubs of North Louisiana
1511 Trenton St., Ruston LA 71270

Vice President – Brach Myers
Boys & Girls Clubs of Acadiana
901 Hugh Wallis Rd S, Lafayette, LA 70508

Angel Nelson
Boys & Girls Clubs of Metro Louisiana
8281 Goodwood Blvd, Suite A, Baton Rouge, LA 70806-7742

Eldonta Osborne
Boys & Girls Club of North Louisiana
300 Memorial Dr, Ruston, LA 71270

Laura Ferrell
9243 Gulf Beach Hwy
Cameron, LA 70631

Ashley Heffernan Kaiser, Esq.
440 1st St NW, Ste 1020, Washington, DC 20001

Lisa Hurst
1275 Peachtree St NE Atlanta, GA 30309

Stacy Blackmon
1275 Peachtree St NE Atlanta, GA 30309

Joe Ethier
1275 Peachtree St NE Atlanta, GA 30309

Provide a summary of the project or program:
           Boys & Girls Clubs provide quality out of school time programming at more than 25 sites in Louisiana. These funds would support Club programming to serve more youth in the areas of healthy lifestyles, academic success, workforce readiness, and character and leadership. Clubs use proven programming prepared by outside entities or the National Boys & Girls Clubs organization.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $2,000,000
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $0
          Operating Services. . . . $0
          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?
          

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?
          Boys & Girls Clubs would reach more youth with higher quality programming.

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:
                 n/a
    
     (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:
                 n/a

     (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:
                

(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 Heffernan Kaiser 
                                       address:  1275 Peachtree St NE, Atlanta, GA 30309
                                       phone:  4102666380
                                       fax: 
                                       e-mail:  akaiser@bgca.org
                                       relationship to entity:  Board Member