NGO Funding Request


The recipient entity's full legal name:  Cameron Council on the Aging, Inc.

The recipient entity's physical address:
           965 Hwy 384
Lake Charles, La 70607


The recipient entity's mailing address (if different):
           965 Hwy 384
Lake Charles, La. 70607


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:  5944

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:
           Wilson Lejeune - 146 Brents Road, Bell City, La. 70630
Oscar Reyes Sr. - Box 639, Cameron, La. 70631
Annette Norman - 1100 Hwy 384, Lake Charles, La. 70607
Beryl Romero - 103 Brazille Daigle Road, Lake Charles, La. 70607
Rosa Lee Bargeman - 1481 3rd St. Apt. 1457, Lake Charles, La. 70601
Helen Warren - 10104 Gulf Hwy, Lake Charles, La. 70607
Loston McEvers - 1519A Hwy 384, Lake Charles, La. 70607
Lee Allen Benoit - 10388 Gulf Highway, Lake Charles, La. 70607
Ina Jane Gaspard - Box 43, Cameron, La. 70631
Wayne Taylor - 4794 W. Nick Clair, Iowa, la. 70647


Provide a summary of the project or program:
           The proposed project would provide repairs for homes of the elderly including handicapped ramps and installation of other handicapped devices to assist the elderly to remain in the comfort of their own homes. This is essential as Cameron Parish does not have a nursing home facility in the parish. The elderly residents need to remain in their own homes and be safe.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $25,000
          Operating Services. . . . $0
          Other Charges. . . . . . . $25,000

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 purpose is to provide services for elderly residents of Cameron Parish. The agency provides a wide variety of services.

What are the goals and objectives for achieving such purpose?
          The main goal for the program is to help elderly residents remain in the comfort of their own homes and not be institutionalized.

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:
                 none
    
     (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:
                 none

     (c) The percentage of the official's or immediate family member's ownership interest in the recipient entity, if any:
                 na

     (d) The position, if any, held by the official or immediate family member in the recipient entity:
                  na

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: 
               na

(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:
               na

          Provide the name, address, and office of the official to whom the person is related:
                na

          What is the nature of the relationship?  na

(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:
                 na

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


Contact Information
name:  Dinah Landry 
                                       address:  965 Hwy 384
Lake Charles, La. 70607

                                       phone:  337-905-6000
                                       fax:  337-905-6500
                                       e-mail:  dinahlandry@yahoo.com
                                       relationship to entity:  Executive Director