The recipient entity's physical address:
           1051 Chennault Park Dr.
Monroe, LA 71203

The recipient entity's mailing address (if different):
           1051 Chennault Park Dr.
Monroe, LA 71203

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:  9978

What is the dollar amount of the request?  $80,000

What type of request is this?  Both

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, Ross Slacks, 311 King Oaks Dr. Monroe, LA 71202
President Joyce Powell, 171 Horseshoe Lake Road, Monroe LA 71203

Provide a summary of the project or program:
           The proposed project is an emergency need for replacing damaged roof of the NELA Delta Africa American Heritage Museum. The requested funds will help in this endeavor.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $10,000
          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?
          The purpose is to repair the roof at the NELA Delta African American Heritage Museum.

What are the goals and objectives for achieving such purpose?
          The goal is to keep the museum functioning and operational and without funds we would not be able to stay open to the public.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           90 days

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:  Ross Slacks 
                                       address:  311 King Oaks Dr., Monroe, LA 71202
                                       phone:  318-235-7090
                                       fax: 
                                       e-mail:  rossslacks@aol.com
                                       relationship to entity:  Executive Director