NGO Funding Request


The recipient entity's full legal name:  Tensas Council on Aging, INc.

The recipient entity's physical address:
           118 Plank Road
St. Joseph, LA. 71366


The recipient entity's mailing address (if different):
           P. O. Box 726
St. Joseph, LA. 71366


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

If the entity is a corporation, list the names of the incorporators:
          Gary Warlick
Jacqueline Schauf
Louise Taylor
Pamela King
Wilma Matthews
Donna Rushing
Mary Garrett
Barbara Blackmon
Betty Roberts
Pearl Conner


The last four digits of the entity's taxpayer ID number:  6636

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

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:
           Executive Director - Clarissa C. Newman, P. O. Box 726, St. Joseph, LA. 71366
Gary Warlick - President - P. O. Box 226, St. Joseph, LA. 71366
Louise Taylor - Secretary/Treasurer-P. O. Box 403, St. Joseph, LA. 71366
Donna Rushing - Vice-President - 6232 Hwy. 65, St. Joseph, LA. 71366
Jacqueline Schauf - P. O. Box 46, St. Joseph, LA. 71366
Barbara Blackmon, P. O. Box 88, St Joseph, LA. 71366
Mary Garrett - P. O. Box 251, St. Joseph, LA. 71366
Betty Roberts - P. O. Box 764, St. Joseph, LA. 71366
Wilma Matthews - P. O. Box 362, St. Joseph, LA. 71366
Thelma Bradford, P. O. Box 127, St. Joseph LA. 71366
Pearl Conner - P. O. Box 7583, St. Joseph, LA. 71366
Pamela King - P. O. Box 846, St. Joseph, LA. 71366


Provide a summary of the project or program:
           To provide funds to help repair a newly acquired building that was donated for our new senior center. We will need a new roof and many repairs to the building. These funds will help with this.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $20,000
          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 make necessary repairs to the building including roof, floors, walls, and other items. This building was donated to the Tensas Council on Aging, Inc. to be used as its senior center.

What are the goals and objectives for achieving such purpose?
          To make the building more inhabitable by making necessary repairs to the roof, walls, floors, and other items. We are currently renting a building, but needs these funds to make repairs.

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

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:  Clarissa C. Newman 
                                       address:  P. O. Box 726
St. Joseph, LA. 71366

                                       phone:  318-766-3770
                                       fax:  318-766-3774
                                       e-mail:  tenscoa@yahoo.com
                                       relationship to entity:  Executive Director