NGO Funding Request


The recipient entity's full legal name:  Amelia Green Non-Profit Association for Diabetic Health

The recipient entity's physical address:
           2712 Bocage Lane
Lake Charles, LA 70605


The recipient entity's mailing address (if different):
           2712 Bocage Lane
Lake Charles, LA 70605


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

If the entity is a corporation, list the names of the incorporators:
          Rose Duhon-Sells
Alice Duhon-Ross
Gwendolyn Duhon


The last four digits of the entity's taxpayer ID number:  0259

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

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:
           Gwendolyn Duhon
Executive Director
2048 Willowick St.
Lake Charles, LA 70607

Rose Duhon-Sells
Chief Executive Officer/Founder
2712 Bocage Lane
Lake Charles, LA 70605

Shelby Wilson, Jr.
Asst. Director
2443 Rose St.
Lake Charles, LA 70601

Betty Wilson
Nutritionist/Dietician
2005 Knapp St.
Lake Charles, LA 70601

Elizabeth Heckard
Parish Coordinator
2013 22nd St.
Lake Charles, LA 70601

Edwina Medearis
Registered Nurse
519 Hodges St,
Lake Charles, LA 70601

Elcie Guillory
Board Member
509 N Shattuck St,
Lake Charles, LA 70601

Kelly McWashington
Board Members
1129 Vickery Dr.
DeSoto, TX 75115

Linda Robertson
Accountant
2038 20th St
Lake Charles, LA 70601

Patrick Duhon, Jr.
2901 General Twining St
Lake Charles, LA 70615

Esther Stills
Board Member
2026 23rd St.
Lake Charles, LA 70601


Provide a summary of the project or program:
           This program will provide information on crucial topics to diabetics in the following five parishes: Calcasieu, Evangeline, Jeff Davis, St. Landry and Acadia. The information will be disseminated through bi-monthly training which will provide awareness, knowledge and resources for those living with diabetes. Special emphasis will be focused on reaching rural populations and those individuals lacking access to services within the cities. The executive director will arrange the training sessions and seminars with parish coordinators. The chief executive officer will organize the contacts at the city, state and national levels by bringing in resourceful individuals that may contribute additional funds, current research findings and new and improved methods of managing diabetes. The assistant director will work closely with the parish coordinators at the various parish locations. This individual will work with the nutritionist and bring in additional information on how important exercise is to managing diabetes. The nutritionist/dietician will bring awareness on the importance of healthy eating basics and planning healthy meals. The parish coordinator will be the liaison between the diabetics in the five parish areas. This individual will assist in recruiting diabetics in the target areas, organizing trainings and facilitating resource groups. The accountant will be in charge of the budget and managing receipts and payments for services rendered. A telephone number will be provided where participants may call to acquire information about managing their diabetes. This program is to run for two years. No individuals will be on salaries; individuals will be paid as services are rendered. Dr. Debra Williams, an internist from Beaumont, TX, will conduct the training to all individuals involved in this program.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $10,000
          Professional Services. . . $5,750
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $4,250
          Major Repairs . . . . . . . $0
          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?
          

What is the entity's public purpose, sought to be achieved through the use of state monies?
          The entity's public purpose is to increase awareness of the dangers of unmanaged diabetes and provide information/ resources on managing diabetes.

What are the goals and objectives for achieving such purpose?
          Goals:
1.By providing bi-monthly seminars in rural areas, diabetes management will improve by 75% which will be evident by surveying the diabetic participants.
2. By working within the community and disseminating information, participants will contact friends and family with whom they will share the knowledge and information they have acquired, affecting an addtional 25% in the community.
3.To reduce the numbers of amputations and death in the parishes where the program is established by 45%

Objectives:
1.By providing awareness and information on appropriate diet, simple daily exercise and knowledge of their daily numbers and A1C, the participants will learn how to better manage their diabetes.
2. The diabetic participants will share knowledge acquired at the seminars with family and friends in the community who are diabetic to have a broader impact on diabetes management.
3. The diabetes participants will implement the knowledge they acquire in their daily practices which will reduce the number of amputations and deaths from diabetes by 45%.


What is the proposed length of time estimated by the entity to accomplish the purpose?
           The proposed length of time for program implementation is two years.

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:  Gwendolyn Duhon 
                                       address:  2048 Willowick St.
Lake Charles, LA 70607

                                       phone:  337-513-2177
                                       fax:  4741720
                                       e-mail:  gduhon@mcneese.edu
                                       relationship to entity:  Executive Director