The recipient entity's physical address:
           4255 East Brookstown Dr
Baton Rouge, LA 70805

The recipient entity's mailing address (if different):
           4255 East Brookstown Dr
Baton Rouge, LA 70805

Type of Entity (for instance, a nonprofit corporation):  Limited Liability Company

If the entity is a corporation, list the names of the incorporators:
          Elliott Temple

The last four digits of the entity's taxpayer ID number:  2374

What is the dollar amount of the request?  $500,000

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:
           Elliott Temple - CEO - 11655 Highland Rd Baton Rouge, La 70810
Soundra Johnson - Board member - 13719 Bayswater Dr Baton Rouge, La 70810
Collis Temple - Board Member - 22784 Ligon Rd Zachary La 70791
Ayoi Temple - Board Member - 11655 Highland Rd Baton Rouge, La 70810

Provide a summary of the project or program:
           Mental Health/Community Engagement

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $200,000
          Professional Services. . . $150,000
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $75,000
          Operating Services. . . . $75,000
          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?
          Community Outreach Services works on engaging in the community by providing Mental health services and working with members of the community and helping them with community development.

What are the goals and objectives for achieving such purpose?
          Community Outreach Services provides counseling services substance abuse services, work with members on and help with providing community resources.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           12 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?  tax paying citizen

(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:
                 N/A

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


Contact Information
name:  Elliott Temple 
                                       address:  11655 Highland Rd
Baton Rouge, La 70810
                                       phone:  2259391324
                                       fax:  2254445209
                                       e-mail:  2133cosbr@gmail.com
                                       relationship to entity:  CEO