The recipient entity's physical address:
           147 East 20th Street
Reserve, La 70084

The recipient entity's mailing address (if different):
           147 East 20th Street
Reserve, La 70084

Type of Entity (for instance, a nonprofit corporation):  Non-Profit Religious Corp.

If the entity is a corporation, list the names of the incorporators:
          Bethlehem Foundation of Hope, INC

The last four digits of the entity's taxpayer ID number:  2157

What is the dollar amount of the request?  $120,000

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:
           Harold Blood (Treasure)
27 Parlange
Destrehan, La 70047

Forell Bering (Director)
805 Mallard Street
Laplace, La 70068

Provide a summary of the project or program:
           Summer Enrichment Learning Camp for Children

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $60,000
          Professional Services. . . $20,000
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $2,000
          Operating Services. . . . $30,000
          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?
          Summer Learning Program: Furtherance of the empowering families to live well Louisiana promulgated as La

What are the goals and objectives for achieving such purpose?
          Serving impoverished people of Louisiana, to support evidence-based innovative solutions to poverty and to pursue to pursue programs and policies to reduce deprivation and hardship.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           2 months

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:
                 Louisiana Department of Children and Family Services

(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               Providing services, supplies resources, and activities to entities who have certain demographics.


Contact Information
name:  Randall Gaines 
                                       address:  7 Turnberry
Laplace, La 70068
                                       phone:  504-487-9904
                                       fax: 
                                       e-mail:  attyrandal@gmail.com
                                       relationship to entity:  Representative