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["DEPARTMENT OF CHILD SERVICES"]
["PROPOSAL FOR THE USE OF FEDERAL, STATE, AND COUNTY FUNDS"]
["REGIONAL REQUEST SUMMARY"]
["Agency:",{"$nulls":3},"Funding Period: July 1, 2006 to December 31, 2008"]
["Program Name:"]
["Section IV. (Complete a separate page for each region to be served by this proposal)."]
["A.  Region to be Served:"]
["B.  Program Director:",{"$nulls":4},"Telephone:"]
["C. Mailing Address:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          "]
["(If different from Agency address)"]
["D:  Email Address:"]
["E.  Show breakdown below of proposed service catagories, number of families/clients, and amount requested by county to be served in this region.  Use a separate page for counties in another region."]
[]
["County to be Served","Service","Total Number of Families / Clients (Circle one)",null,"Public Funds Requested","Approved                                                                                                                                                                  (Committee Use only)"]
[]
[{"$nulls":5},"Part I","IL","Part II","Code","County Match"]
{"$rows_empty":15}
["TOTAL ADJUSTED PROGRAM COSTS:                             ",{"$nulls":3},{"v":0,"d":"$0.00"}]
["(CODES FOR COMMITTEE USE ONLY: 1=Family Support; 2=Family Preservation; 3=Time-limited Reunification; 4=Adoption Promotion and Support; 5=Administration/Management; 6=Planning)"]
[]
["Page 9 (   )"]

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