EMERGENCY AND BASIC NEEDS APPLICATION

Transcription

1 STRATEGIC INVESTMENT GRANTS: Emergency and Basic Needs Application EMERGENCY AND BASIC NEEDS APPLICATION This worksheet is for your reference only. All applications must be submitted online. A link to the online application will be distributed by to Information Session attendees on October 12, Paper or submissions will not be considered. The final page of this packet contains a checklist of all required application components.

2 Legal Name of Organization: SUMMARY SHEET FORM (2 points) (For reference only. Please complete and submit online.) DBA (if applicable): Mailing Address, City, State, and Zip: Phone: Fax: EIN: Website: Name of CEO or Executive Director: Phone: Application Contact & Title (if not the CEO or Executive Director): Phone: Organization Information Mission Statement: Year Founded: Tax Exemption Status: 501(c)(3) Using a fiscal sponsor Name of fiscal sponsor: Other than 501(c)(3), describe: 1 M I L E H I G H U N I T E D W A Y E M E R G E N C Y A N D B A S I C N E E D S A P P L I C A T I O N

3 Number of Employees: Full-time: Part-time: Grant Request Information Type of Grant Requested (select one): Amount of Request: $ General Operating Support Program Support For requests other than general operating support, provide the name of the program/project: For requests for other than general operating support, describe what the grant will be used for: For requests for other than general operating support, state how long your organization has run the program/provided the service(s) described in this proposal. Financial Information Organization s Current Budget for Fiscal Year Ending: mm/dd/yy Income: $ Expenses: $ AND, if other than a general operating request, Program or Project budget: $ Dates: from: mm/dd/yy to: mm/dd/yy Income: $ Expenses: $ Has your organization ever received Mile High United Way funding? (Other than donor designated funds) Yes No If yes, please explain 2 M I L E H I G H U N I T E D W A Y E M E R G E N C Y A N D B A S I C N E E D S A P P L I C A T I O N

4 ORGANIZATIONAL OVERVIEW Overview and History: Provide a brief overview of your organization, including its history services and programs hallmark accomplishments and/or awards received current strategic direction It is not necessary for organizations with long histories to provide extensive detail. Your response in this section is limited to 500 words. (2 points) Inclusiveness and Nondiscrimination: Describe how your organization ensures inclusiveness in its staff, board, volunteers, and program offerings. Your response in this section is limited to 250 words. You will be asked to upload your formal, board-approved inclusiveness/nondiscrimination policy in the last section of this proposal. (2 points) NARRATIVE There are two sections in the narrative. This section is your opportunity to present a thorough description of the work for which funding is being requested. In short, we are asking you to identify a community need, tell us how your work addresses that need, state why you use the approach and strategies you do, and show how you measure results and use that information to improve your work and bring about community change. We ask that you write in such a way that a reader who does not know about your work will be able to visualize and understand it. 1. Program Plan (42 points total) Short-Term Emergency & Safety Net Service(s) Provided: Choose from dropdown menus. Identify the eligible short-term emergency and safety net service(s) for which you are submitting this proposal. Target Population: Based on the service(s) selected, whom do you serve? Be specific in reference to demographics of the people you serve. How do you recruit participants and what criteria must individuals and/or families meet in order to be eligible for your services? Your response in this section is limited to 300 words. (5 points) Area Served: Please complete the table below to provide information about the population(s) you serve. Please complete for each program delivery site. (5 points) Street address where services are delivered Number served Proportion of participants at or below 250 percent of Federal Poverty Level (FPL)* *If unavailable, please provide the best FPL data you have to demonstrate the economic need of the population served at this location. 3 M I L E H I G H U N I T E D W A Y E M E R G E N C Y A N D B A S I C N E E D S A P P L I C A T I O N

5 Statement of Need: Briefly describe the existing demand for program services in the geographical area served by the program. Discuss decreases/increases in services provided and/or number of clients served. How is your program effective and efficient in meeting the community need? Describe steps taken to ensure you are addressing an unmet need and are not duplicating existing services or explain why duplication is necessary. Your response in this section is limited to 300 words. (5 points) Primary Program Activities: Primary program activities refer to essential tasks, projects, or services that directly impact program goals. Please describe each primary activity and explain how clients access the activities. If applicable, include how many days and hours or units of service are delivered by the program. Your response in this section is limited to 500 words. (15 points) Approach to Service Delivery: Provide an explanation for the program s approach to service delivery. Please explain how research-based strategies, best practices or organizational learning support your approach. If the program is not informed by research, best practices or organizational learning, explain why this is the case. Your response in this section is limited to 250 words. (10 points) Service Provision: Tell us how long you have provided the specific services described. Please include any significant evolution in this area of your work. Your response in this section is limited to 150 words. (2 points) 2. Continuum of Care/Other Services: Provide an overview of other services provided by your organization or the linkages that you make for clients to other organizations that support the needs of clients accessing basic needs services. Specifically, please detail how your program addresses root causes of client needs (after/while they access basic needs services) to ensure they have opportunities that help them move closer to self-sufficiency. Your response in this section is limited to 300 words. (10 points) 3. Evaluation (20 points total) Monitoring and Evaluation Approach: Describe your organization s ability to report on the short-term emergency and safety net services described in this application. What data do you collect and how? At what points in time? What tool(s) do you use to collect and analyze these data? Your response in this section is limited to 300 words. (10 points) Quality Improvement: Describe how your organization learns from and incorporates performance measurement findings in order to improve planning, strategy, and service delivery. Each proposal must include at least one notable illustration/example of organizational capacity to learn from its evaluation results to improve service delivery. Your response in this section is limited to 300 words. (10 points) 4 M I L E H I G H U N I T E D W A Y E M E R G E N C Y A N D B A S I C N E E D S A P P L I C A T I O N

6 REQUIRED ATTACHMENTS (20 points) Provide a header on each attachment that includes name of organization, and title of document. Please upload as a PDF. Financial Attachments Note: Provide explanations for items that may raise questions in any of the attached financial documents. You may write explanations on the documents or include comments on an additional page. 1. Budget(s) Organization s operating budget for the current fiscal year, including revenues and expenses. If available, also include the budget for the upcoming fiscal year. If the request is for a program, also include the program budget. 2. Current (Year-to-Date) Financial Statements Include a Statement of Financial Position (Balance Sheet) and Statement of Activities (Income and Expense Statement) through the most recently completed operating month available (must be within the past three months). Provide the Statement of Activities in a budget-to-actual format if the organization uses that format. 3. Audit & Year-End Financial Statements Submit an annual independent audit for the most recent fiscal year completed by an independent Certified Public Accountant. If the organization operating budget is under $250,000, a completed annual independent review and certified year-end financials approved by Board Chair and Executive Director may be substituted. 4. Sources of Income Table Complete the table below for the organization as a whole, based on the most recently completed fiscal year. Categories may be modified. Percentage Funding Source % Government grants (federal, state, county, local) % Government contracts % Foundations % Business % Events (include event sponsorships) % Individual contributions % Fees/earned income % In-kind contributions (optional) % Other % TOTAL (must equal 100%) 5. Proof of IRS Federal Tax-Exempt Status Must be dated within the past five years. 6. Secretary of State Certificate of Good Standing Must be dated within the past 90 days. 7. Most Recently Completed IRS Form M I L E H I G H U N I T E D W A Y E M E R G E N C Y A N D B A S I C N E E D S A P P L I C A T I O N

7 8. Explanation of Items in Financial Attachments (if applicable) Other Attachments 1. Board of Directors List Include the following items for each board member: Position(s) on the board (officer and committee positions) Occupation and name of employer and/or affiliation(s) Length of term and end-date 2. Inclusiveness/Nondiscrimination Policy 3. Names and Qualifications of Key Staff 4. Expectations The expectations document outlines Mile High United Way partner expectations for the funding cycle. The Chief Executive s signature on this document acknowledges that the organization agrees to the terms and that the proposal is submitted in good faith. 6 M I L E H I G H U N I T E D W A Y E M E R G E N C Y A N D B A S I C N E E D S A P P L I C A T I O N

8 CHECKLIST The Emergency and Basic Needs grant application consists of the following components. This checklist will help ensure a complete proposal. Please complete and submit each section online. Summary Sheet Organizational Overview Narrative 1. Program Plan 2. Collaborative and Cooperative Relationships 3. Evaluation Required Attachments Financial Attachments 1. Budget(s) 2. Current (year-to-date) financial statements 3. Most recent audit/financial review and year-end financial statements 4. Sources of income table 5. Proof of IRS federal tax-exempt status, dated within the past five years 6. Secretary of State Certificate of Good Standing 7. Most recently completed IRS Form Explanation of items in financial attachments, if applicable Other Attachments 1. Board of Directors list 2. Inclusiveness/nondiscrimination policy 3. Names and qualifications of key staff 4. Expectations Thank you for your time and effort in completing this application. 7 M I L E H I G H U N I T E D W A Y E M E R G E N C Y A N D B A S I C N E E D S A P P L I C A T I O N