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---o·· -- -·-- . ·-· . . - ... - -- ? Appro1·a/ , xpirt1 Du,mbtr JI, I 966 (1, 2). Off ICE Of . ECOMOMIC OPPO ~T UNITY (FO:t VISTA VISTA PROJECT PROPOSAL om,1 us. ONLY) (3-1 CJ 41 SPONSOR INfO!tMATIO~ S~CTION I ~3 2. N O . AND STRE ET la . NAME Of SPONSO~ OR OTH:R PA~TICIPATING AGENCY . • · Comm unity Re 1 at ions Comm1ss 1or 3. CITY ~ TOWN 36-43 ~- COUNTY 5. STATE O 52-56 7. CODE ,. CONG~i:S57, SIONAL DIST. 5a 8. 4th & 5th 30303 Fulton Atlanta 12-35 6S Mitchell St., S. W. Room 1203 City Hall I Gsponsor Other parcici2 pacing agency 6 . ZIP Card No. 42 Ti:LEPHONE (Arta codt and ,rumbtr) l 404 !522-4L163 433,434 1Ext. THIS SECTION TO BE COMPLETED ONLY BY PARTICIPATING OR COOPERATING AGc:NCIES A. NAM! · OF SPONSOR WITH WH:CH THE AGENCY IS PA rn Cl?ATING OR COOP1:RATION l 0 (Chtet) Co-sponsor jointly and equally responsible for conduct of :,reject rnd supervision and support of volunteers 2 0 Will provide general !~p~rvisibn of the project Cord No. 4-3j12-36 11. NUM3ER ANO ST~EET (If dijftrml fro;,, 10. O FFICIAL REPRESENTING THE SPONSOR OR ~ARTICl?A TING @._ 9. RELATIONSHIP TO SPONSOR AND E:CTENT OF PARTICIPATION 3 0 Will undertak e conduct of proje=t and su~rvis i~ n 1!"!~ sup pore of vo l un · teers on default of primary sponsor 1) /t,111 AG.ENCY a, Name: b. Title: ,,, zi, cooe 13. STATE 12. CITY, TOWN, OR COUNTY u. TELEF'Ho,-..,: ( Arta cod, a,r,I ,rumb,r) ..

I i' E 16. TY/>f o, l'roP05AL (Chtd) l of previously approved . project 3 0 17. TYPE 01' f>:IOJECT (Ch«.i.) O Rural communiry c!evelopment 0 lnJum-on reservation 3 0 Indians-off reservation ,4 0 Migrants , 0 Job corps-conservat ion 6 0 Ru ral-Appalachian 7 0 Other rural poor ... - Q:9 Initial proposal O Amendment or extension l '

Other/Sptrif,J ~ l 30 0 TNst Ter/y 2 31 e) 1:/rban community ~ •!· 18 . NO. 0, VOlUN TEERS O!JESTE0 2 0 Mentally ill O Job Corps -urhan 34 0 Justice n O Mencally r<"urdeJ 36 0 Ocher urban P<JOr 32 H 19. SPONSm O RGANIZATION L NON-COYT. NON NON-PROFIT O RG . (Ch,rlt) COMPLETc ITEMS C ANO 0 . A. PUBLIC ACENCY (Ch tc.l ) 0 0 30 ,4 0 5 1 Ciry 2 Cour.ry 0 0 Tribal Council 6 Othe r (Sp,cify) 7 0 0 Q C. TAX STAT!JS O Tax exempc-d.He of IRS Nling _ _ _ __ lnco rponted I U nincocporaceJ 0 }0 2 Sme Fed=I " Non Tax Exempt Non Ta, Exempt -fil S ruling applied for 0 . 0A TE O ~- · 45-47 GANIZATION 9ECAN l... I O PERA TIONS ( .\lo,,th,- Yurr ) ••• ' Jan. [1967 20 . P~INCIPAL PROGRAM OF SPONSOR

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O Commun ity de,elopmenc 9 0 Coopera;i ves 4:l-49 PHSENT ACTIVITIES TO COM!AT P~O3LEMS OF ~OVERTY . . 2 0 Job train ing 10 0 Citizenship Improve community relati ons ; insure J O Sdf help programs OTHER PROGR.\~f SUPPORT op portunit y for all to develop fullest 4 0 Education 11 0 NYC potential; proraote mutual respect, , 0 Healch programs 12 0 Job Corps · 0 Man~..,er. tolerance, etc. 6 0 Mental health U Jev : and min ing I . !Rl:fl Y 0ESC~13E THE PU~ro A. l 7 0 8 D Recreac,on Conrauni ty Relati ons I4 Child care AN D FUNCTION OF THE SPONSO~ ANO ITS PAST ANO E9 Ocher ( Spn·iJi) ACCEPTANCE OF COND ITIONS This proposal ..,-ich all forms. ex!-. ib ics and accachments herern. is submi,ced for consideration as a VISTA projecc . It is unJerscooJ and a$reeJ by the undersign ed JuchorizeJ repre,cncJcivc of the sponsor. chJt a project developed as a ~esulc oi chis proposal is subitct co che condir,ons ~et forch in ,r.e \'!STA r.unual. " Guidelines for Sponsors ... I. TYPED N.A.~E A!'olC TmE OF SPONSOR VISTA ;orm 4:20 2. SIGNATURE l. DATE DEC 65 P11. I of 6 I t • �