The recipient entity's physical address:
           801 Main Street
Franklin, La. 70538

The recipient entity's mailing address (if different):
           P.O. BOX 98
Franklin, La. 70538

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

If the entity is a corporation, list the names of the incorporators:
          JAN DOSSETT, ADRIANE KYLE-WATSON, KELLY ROBISON, KENNETH PERRY,
CHUCK AUTIN, WHYTLEY JONES, SHALARA WELLS

The last four digits of the entity's taxpayer ID number:  6472

What is the dollar amount of the request?  $165,000

What type of request is this?  Capital Outlay 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:
           Cherrise Picard
Executive Director
214 Circle Drive
Franklin, La. 70538

Toccara Reed
Director of Operations
71 MAin Street
Franklin, La. 70538
JAN DOSSETT
Vice-President
413 NEPTUNE STREET
MORGAN CITY, LA 70380

ADRIANE KYLE-WATSON
Treasurer
1002 FLORENCE COURT
MORGAN CITY, LA 70380

KELLY ROBISON
Officer
228 SANDERS STREET
FRANKLIN, LA 70538

KENNETH PERRY
Secretary
1601 IBERIA STREET
FRANKLIN, LA 70538

CHUCK AUTIN
President
306 JACKSON STREET
FRANKLIN, LA 70538

WHYTLEY JONES
Officer
4850 ROUZAN SQUARE AVE. #146
BATON ROUGE, LA 70808

SHALARA WELLS
Officer
8/20 BANK AVE. NEW IBERIA, LA 70560

Provide a summary of the project or program:
           Chez Hope proposes to utilize these funds to cover our organizational insurance policies, as well as the cost of maintenance and repairs for all facilities within our organization.

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. . . . $65,000
          Other Charges. . . . . . . $100,000

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?
          The purpose of this corporation is to provide temporary refuge for persons in various conditions of need or crisis or for any other lawful purpose. A supportive environment will create an atmosphere of want and human understanding. It shall be the duty of this organization to serve all persons regardless of race, color, religion, sex, national origin, handicap, veteran status, or any other merit factor with the same quality of services.

What are the goals and objectives for achieving such purpose?
          Goal
1. Repair and Maintenance of Organizational Facilities.
2. Payment of Organizational Insurance Policies.
Objectives
1. Chez Hope estimates serving 1,500 survivors of Domestic Violence Yearly.
2. Chez Hope estimates serving 300 survivors of Domestic Violence in our emergency shelters.

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:
                
    
     (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:
                

(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:  Cherrise Picard 
                                       address:  P.O. Box 98
                                       phone:  3378284200
                                       fax: 
                                       e-mail:  cpicard@chezhope.org
                                       relationship to entity:  Executive Director