NGO Funding Request


The recipient entity's full legal name:  West Carroll Council on Aging

The recipient entity's physical address:
           207 East Jefferson Street
Oak Grove, La. 71263


The recipient entity's mailing address (if different):
           P.O. Box 1058
Oak Grove, La 71263


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:  3099

What is the dollar amount of the request?  $50,000

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:
           Brenda Hagan-Executive Director
16288 Hwy. 585
Oak Grove, La. 71263
Gordon N. Smith-Chairman
P.O. Box 238
Oak Grove, La. 71263
Helen Martin
P.O. Box 469
Oak Grove, La. 71263
Karen Sullivan
12296 Hwy 585
Oak Grove, La 71263
David Nagem
P.O. Box 1515
Oak Grove, La. 71263
Karen Vining
5789 Vining Rd.
Pioneer, La. 71266
Johnny Simms
1196 Guice Rd.
Epps, La. 71237
Diane Gunter
P.O. Box 1419
Oak Grove, La 71263
Beth Herring
111 Creech Rd.
Oak Grove, La. 71263
Jessie Craft
P.O. Box 844
Oak Grove, La. 71263
Geraldine Townsend
P.O. Box 124
Oak Grove, La. 71263
Howard Ainsworth
P.O. Box 98
Oak Grove,La. 71263


Provide a summary of the project or program:
           We will use the money to supplement salaries, programs and services for the elderly of West Carroll Parish.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $100,000
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $0
          Operating Services. . . . $40,000
          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 provide services to the elderly of West Carroll Parish which will enhance their day to day living conditions. This will in turn allow them to remain in their homes longer. We also want to provide a safe and happy place for the seniors of our Parish to enjoy a meal and visit with their peers.

What are the goals and objectives for achieving such purpose?
          To improve the quality of life for the seniors of West Carroll Parish.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           One 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:
                 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: 
               N/A

(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:
               N/A

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

          What is the nature of the relationship?  N/A

(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:
                 N/A

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


Contact Information
name:  Brenda Kaye Hagan 
                                       address:  16288 Hwy 585
Oak Grove, La. 71263

                                       phone:  3182827870
                                       fax: 
                                       e-mail:  bkhagan49@aol.com
                                       relationship to entity:  Executive Director