The recipient entity's physical address:
           2007 Roselawn Avenue
Monroe, LA 71201

The recipient entity's mailing address (if different):
           2007 Roselawn Avenue
Monroe, La 71201

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:  3262

What is the dollar amount of the request?  $25,000

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:
           Emily Abraham, board secretary
146 Kervin Road
Rayville, LA 71269

Janice Butler, board member
2310 Marie Place
Monroe, LA 71201

Holly Ramsey, board chairman
1953 Hwy. 546
West Monroe, La 71292

Jason Saucer, board treasurer
623 Winnfield Road
West Monroe, La 71292

Linda Trimble, board secretary
507 Park Avenue
Monroe, LA 71201

Lyndsey Sikes, Executive Director
307 Country Club Rd.
Monroe, LA 71201

Provide a summary of the project or program:
           Life Choices is launching a medical mobile unit in northeast Louisiana to help with access to healthcare for pregnant women. In addition, to provide material assistance to parents through car seats, baby items, diapers and wipes, etc. Due to the poverty level of people in rural areas in northeast Louisiana, and access to transportation, Life Choices' medical mobile unit would reach pregnant women who haven't been able to access care and help prevant maternal/fetal death. Also with the lack of OB/GYN providers in these parishes, Life Choices mobile unit will provide care where no one else is. Life Choices serves Ouachita, Richland, Morehouse, Caldwell, Catahoula, Madison, East and West Carroll and parts of Union parish. The mobile unit is staffed with a driver, nurse practitioner, and client advocate and a mobile ultrasound machine. The unit will also be able to give out material assistance for babies through age 2 like diapers/wipes, car seats, and other baby items.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $8,000
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $12,000
          Operating Services. . . . $5,000
          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?
          Life Choices seeks to offer help to people experiencing an unexpected pregnancy and offer medical services to people in communities wihtout access to providers.

What are the goals and objectives for achieving such purpose?
          Life Choices's goal is to get the mobile medical unit on the road in the next 6 months. We have purchased unit and need to wrap it and update interiors. Our goal is to go to 2 cities a week and offer pregnancy tests and ultrasound and material assistance. The objective of the mobile medical unit is providing access to healthcare where there is 1.) no OB/GYN providers and 2.) clients have problems like transportation. The mobile unit comes straight to their city.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           6 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:
                
    
     (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:  Lyndsey Sikes 
                                       address:  2007 Roselawn Avenue
                                       phone:  3183232200
                                       fax:  3183256698
                                       e-mail:  lyndsey@lifechoicesofmonroe.com
                                       relationship to entity:  executive director