NGO Funding Request


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

The recipient entity's physical address:
           965hwy 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:
          Dinah Landry

The last four digits of the entity's taxpayer ID number:  8002

What is the dollar amount of the request?  $30,000

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:
           Executive Director. Dinah Landry 191 LeBoeuf road. bell City. La. 70630
Board Chairman. Annette Norman.
Vice Chairman. Lee Allen Benoit


Provide a summary of the project or program:
           Funding will be utilized to purchase a mini van to transport senior citizens to doctor appointments and other health care treatment

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $30,000
          Major Repairs . . . . . . . $0
          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?
          No

What is the entity's public purpose, sought to be achieved through the use of state monies?
          The purpose of the agency is to provide services for the elderly of Cameron Parish.

What are the goals and objectives for achieving such purpose?
          The overall goal is to provide services including nutrition, homemaker and transportation as well as health, and other in home services.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           1 year and continuing.

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:
                 O

     (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: 
               None

(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:
               None

          Provide the name, address, and office of the official to whom the person is related:
                None

          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:
                 None

(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               None


Contact Information
name:  Dinah Landry 
                                       address:  965 Hwy 384. Lake Charles. La. 70607
                                       phone:  337 532 3030
                                       fax:  337 905 6500
                                       e-mail:  Dinahlandry@yahoo.com
                                       relationship to entity:  Director