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<br />I <br />I <br />, u_ <br />I <br />I <br />I <br />I <br /> <br />STATE OF HINNESOTA <br />GOVERNOR'S COHMISSION ON CRIHE <br />PREVENTION AND CONTROL <br /> <br />1. PROJECT TITLE <br /> <br />NORTHHEST SUBURBAN YOUTH SERVICE BUREAU <br /> <br />2. PROGRAM UNDER HHICH APPLICATION IS MADE <br /> <br />APPLICATION FOR ACTION GRANT <br /> <br />PAGE 1 <br /> <br />DO NOT WRITE IN THIS SPACE <br /> <br />Appl. Number <br /> <br />Date Received <br /> <br />Number: 2 Title: Direct Service to Youth at Point of <br />Entry into the Criminal Justice System <br /> <br />.------.------- <br /> <br /> <br />:~~:~~~N:~::~_ J~. DURA::ON <br /> <br />6. IMPLEMENTING AGENCY <br /> <br />1---- <br /> <br />months <br /> <br />North~"est Suburban Youth Service Bureau <br />___ Board of Directors <br />8. CONTACT PERSON/PROJECT DIRECTOR <br /> <br />Name <br />Title <br />Street <br />City <br />State/Zip <br />Phone <br /> <br />Dennis Rau/Barbara Hhitmore <br />Student Services Coordinators <br />2425 Long Lake Rd./70l H. Co. <br />New Brighton/Roseville <br />55112/55113 <br />786-5200/484-8559 <br /> <br />Rd.B <br /> <br />10. FINANCIAL OFFICER <br /> <br />I <br />I <br />, <br />I, <br />I-- <br />I <br /> <br />Name <br />Title <br />Street <br />City <br />State/Zip <br />Phone <br /> <br />Don Sholund <br />Finance Director <br />2701 Lexington Avenue N. <br />Roseville <br />Minnesota 55113 <br />484-3371 <br /> <br />12. Have you received support for this proj- <br />ect from the Governor's Crime Commissioll <br />in the past? ( ) Yes (x) No <br /> <br />If yes, please indicate grant number(s) <br />assigned to previous grant(s) awarded for <br />this proj ect: <br /> <br />Year 1 2 3 4 <br /> <br />5. SPONSORING UNIT OF GOVERNMENT <br /> <br />CITY OF ROSEVILLE <br /> <br />RAHSEY <br /> <br />7. COUNTY OF SPONSORING UNIT <br /> <br />9. AUTHORIZED OFFICIAL <br /> <br />Name <br />Title <br />Street <br />City <br />State/Zip <br />Phone <br /> <br />James Andre <br />City of Rosevil1e 11anager <br />2701 Lexington Avenue N. <br />Roseville <br />Minnesota 55113 <br />484-3371 <br /> <br />11. EQUAL EMPLOYMENT OPPORTUNITY COORDINATOR <br />Dave Pokorney, Administrative Ass't. <br />of City of Roseville <br /> <br />Name <br />Title <br />Street <br />City <br />State/Zip <br />Phone <br /> <br />2701 Lexington Avenue N. <br />Roseville <br />Hinneso ta 55113 <br />48!~-3371 <br /> <br />13. Does the sponsoring unit of government <br />maintain a written Equal Employment Oppor- <br />tunity Program? () Yes (x) No <br /> <br />In Process <br />Has this program been certified by the <br />state Department of Human Rights? <br />( ) Yes (x) No <br />Date of Certifi~ation: <br /> <br />14. All appropriate A-95 Clearinghouses were notified <br />of the intent to submit this application as of (date): <br /> <br />15. Application is made for a grant under the Omnibus Crime Control and Safe Streets Ace of <br />1968 (PL 90-351) as amended (PL 93-83) in the amount and for the purposes stated hereinQ <br />Funds awarded pursuant to this application will not be used to supplant or replace funds <br />or other resources that would otherwise have been made available for law enforcement <br />and ~riminal justice purposes. <br /> <br />~ ./' . <br />~?~-:-. ~~ <br />?SIGNATURE OF AUTHORIZED OFFICIAL <br /> <br />GCCP&C Form 3 (Rev. q-75) <br /> <br />Ir/z ~-/? s- <br />DATE SIGNED <br />