Dziennik Ustaw Nr 63Poz. 587— 3719 —
Część B — wypełnia powiatowe centrum pomocy rodzinie
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Ocena możliwości zwiększenia liczby uczestników w warsztacie terapii zajęciowej
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Część C — wypełnia kierownik powiatowego centrum pomocy rodzinie
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W dniu ........................................... przyjęto/nie przyjęto do dofinansowania koszty wynikające
ze zwiększenia liczby uczestników warsztatu terapii zajęciowej w .............................................
przy .....................................................................................................................................................
w łącznej kwocie: .................................................................................................... zł, w tym na:
adaptację pomieszczeń: ........................................................................................... zł
dodatkowe wyposażenie pomieszczeń: ................................................................... zł
działalność warsztatu na okres ..... m-cy w ......... roku: ........................................... zł
..........................................
/podpis/
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