CFN Template

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2009 CSBG Program Year WV CAA Program Work Plan
Agency Name: Dimension: Agency Program Title: Task Projections Tasks Interventions or Services ROMA GOAL Outcomes Indicators Emergency Services Program Funding Period: WV System Program Name: Action Plan Template: Emergency Services-General CFN Reporting Detail

#
1 Application Ineligible Eligible Assessment Nutrition Education Information Provided TOTAL # Served>>> Client receives food 6 - Low-Income people, especially vulnerable populations, achieve their potential by strengthening family and other supportive services. NPI 6.2 - Emergency Assistance NPI 6.2.A- Food 2 3 4 5 6

PROJECTED # of Households / customers to achieve outcomes 7

This program supports counties in specific service delivery areas. EX: Emergency Services - County A, Emergency Services - County B, Emergency Services - County C EX: Weatherization - County A, Weatherization - County B, Weatherization - County C EX: Head Start - County A, Head Start - County B, Head Start - County C Note: Some agencies prefer to complete Head Start Work Plans by Site vs. County This program supports multiple counties or Service Districts en-mass. IE: Mass Transportation, Information and Referral, Linkages.

Document County Here:

Document Counties/Service Districts Here:

Program Needs Statement

Program Mission Statement

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Business Loans

PY 2009 Program Funding Sources
AGENCY NAME: PROGRAM NAME:

Funding TYPE

Funding Source

TOTAL

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

TOTAL - Program Sources Other
CSBG Form 104 Revised September 2008

$0.00
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