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1 II. APPLICANT INFORMATION 1. Organization: Wetide Community YMCA 2. Contact Peron: Elaine Hardy Title: Y Achiever Program Director 3. Organization' Addre: 3700 Old Laning Road Laning, MI Phone Number: Fax Number: WEB: 6. Propoal Title: Y Achiever Program Amount Requeted: $ 4, Federal Tax Identification Number: Preference of receiving Ingham County communication regarding community agency fund: Pleae Check One - O U.S. Potal Service X X Addre: cottgoldtein@ymcaoflaning.org 10. Pleae indicate the name and title of peron who are authorized to execute agreement on behalf of your organization: Name: Anthony Fragale Name: Scott Goldtein Title: Preident & CEO, YMCA of Laning Title: Executive Director 11. Nonprofit Organization: Pleae Check One - 501(c)(2) X 501(c)(3) 501(c)(4) 502(c)(3) OOther (pecify) 12. Buine organization (profit): N/A 13. Unit of government including chool (pecify): N/A 14. Not incorporated (pecify legal and/or profeional tatu of the requeting individual): N/A 15. How long ha the applicant' organization been in buine? Since year 16. What i the number of full-time equivalent poition currently employed? How many volunteer are currently involved?

2 18. a. How doe your propoal involve coordination or collaboration with County ervice, other local government, or other agencie? The Y Achiever Program ha trong collaborative relationhip and partnerhip with area buinee, chool ditrict and agencie throughout Ingham County. Some of thee relationhip include the Laning School Ditrict. Michigan State Univerity. Laning Community College. Detroit Chai. MSU Federal Credit Union, and the Michigan Legilative Caucu. Michigan Department of Tranportation and the Federal Highway Adminitration. Thee organization provide adult career mentor, reource for ervice, referral and on occaion financial upport. b. What other program imilar to your program are operating in the County? Michigan State Univerity' King. Park. & Chavez Program provide aitance in gaining admiion to MSU for firt generation college candidate. There are currently no other youth development program in the greater Laning area where a tudent can remain engaged from middle chool through high chool that provide expoure to over 70 college and univeritie, ha corporate mentoring, college readine, college tour, and develop for youth lifetime marketable kill. 19. I thi your firt requet for fund from Ingham County? O ye X no 20. a. Have you ought fund for thi propoal or concept from any other entity? Pleae identify who and the repone. X ye Q no The program i upported by buinee and individual a a part of our Annual Campaign. The annual upport uually average about $ Other program upport i through corporate ponorhip and more recently partnerhip with tate agencie uch a MDOT. b. Doe the propoal anticipate utilizing fund from other ource? X ye Q no c. To what extent i the other funding aured? The program funding determine the impact of the program. Currently, we operate the program well below the budgeted amount needed. The current funding allow u to erve between 75 & 100 teen. To date, we have commitment to upport 60% of the program budget. 316

3 III. DETAILED SCOPE OF WORK The Scope of Work hould be one page or le and contain: 1. A tatement regarding the general nature of the ervice and population with which your agency concern itelf. 2. A tatement explaining how the propoal will addre the County' long-term objective of Meeting Baic Need. (See the attached Reolution # Reolution Approving Criteria for Ranking 2014 Application for Community Agency Funding. Priority conideration will be given to applicant that meet the objective of Meeting Baic Need; however, if there are fund available, econdary conideration will be given to agencie erving vulnerable population. 3. A tatement detailing the pecific ervice which will be provided by Ingham County' appropriation. A tatement of the pecific target group for thee area. 4. A tatement decribing the eligibility criteria for thee ervice. (See the attached Reolution # Reolution Approving Criteria for Ranking 2014 Application for Community Agency Funding and mut erve reident of Ingham County to be eligible.) 5. A tatement decribing the time for the performance of thee ervice. 317

4 IV. DETAILED SCOPE OF WORK Since 1877, the YMCA of Metropolitan Laning' primary purpoe ha been the principle center for program that; intill a trong ene of poitive value, develop character and leaderhip kill, enhance and promote healthy lifetyle and trengthen family life. Our Miion i to enhance the live of men, women, boy and girl regardle of race, creed, age, economic circumtance, and phyical or mental abilitie. The Y provide quality program, activitie and facilitie which develop and maintain Chritian value and idea. The Y Achiever Program addree Ingham County' long term objective of "Meeting Baic Need" in the following way. The Y Achiever Program erve tudent in familie who have been adverely affected by the current economic climate. While the program doe not provide direct crii care, the Y Achiever Program doe meet the county' objective in providing baic neceitie by helping tudent develop marketable kill. The corporate mentoring component of the program afford tudent the opportunity to meet with area profeional to gain a greater undertanding of the current and emerging job market and the kill needed to uccefully compete for employment. In direct relation to helping to obtain the baic neceity of food, the Y Achiever Program doe provide it participant with lunch during it bi-weekly meeting and provide referral for participant' familie to local agencie who need direct ervice or crii care. On ome occaion the Y doe provide help for familie to meet baic need through direct upport. The Y Achiever Program alo addree Ingham County' long term objective of "Fotering Appropriate Youth Development". Our program deliver quality aet baed programming that provide: poitive interaction with caring adult role model, upport and incentive for youth to tay in chool, expoure to college, academic program and curriculum, expoure to career and working profeional who help young people develop academic and career goal, and leaderhip kill. The Y Achiever Program alo provide tudent with referral to academic upport program, aitance with college admiion and tructured activitie in afe and upportive environment. Goal for the program include: improving grade & attendance, expoure to college & univeritie and interaction with adult caring adult role model. The Y Achiever Program i a twelve month program that operate during the academic chool year. Student and mentor meet twice monthly on Saturday in eion of mall career cluter. Thee cluter reflect the youth' career interet and are facilitated by an adult who i elected baed on their level of accomplihment in hi/her profeion. At the end of the program, employer, youth and community upporter all come together for a Salute/Recognition event for the adult mentor, youth and program ponor. The Y Achiever Program target lat chance, low income youth who reide within Ingham County. Thee youth may have little or no expoure to poitive adult role model and very little preparation for higher education. They are actively recruited from local middle and high chool with pecial attention given to thoe who are "at rik" of educational or ocial failure. However, any tudent actively enrolled in grade 7-12 i encouraged to participate. In the 2012/2013 program year, we erved youth from nine area high chool and three middle chool. The appropriation by Ingham County will upport deerving tudent to attend the National College Tour. Annually, The Y Achiever Program conduct a tour of hitoric college and univeritie acro the United State which expoe tudent to college program and curriculum. Along with the highly popular college tour program, the Y Achiever Program maintain a 100% high chool graduation rate of it ongoing program participant. 318

5 V. PROJECT BUDGET The Propoed Line Item Budget hould be tructured to addre four major area: Peronnel Service, Profeional and Contractual Service, Operating Expene, and Direct Service to Ingham County Reident. Pleae be advied that for 2013 emphai will be placed on proviion of direct ervice to county reident and ue of Community Agency fund for peronnel related expenditure i trongly dicouraged. COUNTY REQUESTED AMOUNT OTHER SOURCES 1 Peronnel Service a. Salarie & Wage $10,000 2 Profeional and Contractual Profeional Fee (Speaker) $3,000 3 Operating Expene a. Supplie b. Telephone c. Potage & Shipping d. Occupancy e. Equipment $5,000 $975 $1,300 SI,000 $5,000 f. Print & Publication g. Hitoric College Tour h. Staff Conference & Training i. Special Event - Salute Banquet j. Adminitrative Support $4,500 $4,000 $28,500 $3,000 $6,000 $2,725 4 Direct Service to Ingham County Reident a. Food b. Utilitie $6,000 c. Shelter/Houing TOTAL $4,500 $76,

6 7/23/2013 Functional Operating Statement All Branche - Operation Only 2013 Budget- Branch Summary 2013 Budget Contribution $ 6, Memberhip Due 5,353, Program Service Fee 3,300, Sale 16, Invetment Income 14, Micellaneou Revenue 39, TOTAL PUBLIC SUPPORT & REVENUE 8,731, Salarie And Wage 4,252, Employee Benefit 628, Payroll Taxe 470, Purchaed Service 230, Supplie 364, Telephone 94, Potage And Freight 20, Occupancy 1,432, Bond Interet Expene 40, Equipment Cot 253, Printing, Promotion, Etc. 71, Travel And Employee Expene 99, Conference/Meeting/Training 10, Memberhip Due 93, Financing Cot 2, Other Inurance Premium 118, Micellaneou 21, Intra YMCA Expene Tranfer Metro Service Allocated Fixed Aet Purchae - OPERATING EXPENSES 8,202, Debt Retirement Board Authorized Tranfer OTHER BUDGETED EXPENSES 200, , , TOTAL EXPENSES 8,731, NET RECEIPTS OR (DEFICIT) S 320

7 FOR YOUTH DEVELOPMENT FOR HEALTHY LIVING FOR SOCIAL RESPONSIBILITY BOARD OF DIRECTORS Chairperon: Catherine A. Jacob, Lawyer, Loomi Law Firm 1t Vice Chair: Chuck Cercone, Aociate Dean of Faculty, Cooley Law School 2nd Vice Chair: Kelli Ellworth-Etchinon, VP of Community & Buine Development, LAFCU Treaurer: Janene Mclntyre, Attorney, Foter Swift Collin & Smith PC Secretary: Dana Rapier, Aitant Vice Preident: Quality Aurance and Training, Jackon National Life Dave Brower, retired, CFO & Controller, Michigan State Univerity Doug Cooper, Chae Bank Linda Frederickon, Marketing, Sale & Communication Manager, Michigan Virtual Univerity Heather Kim, Sale Manager, Greater Laning Convention and Viitor Bureau Mark Krauhaar, CEO, Bell Title Company Chuck Levy, Preident, Shinberg Agency Tobi Moore, Director of Marketing and Communication, CA2E Dorothy E. Maxwell, Preident/CEO, Max Weingar Group Jim Nyquit, Shareholder/Director, Maner, Coterian & Elli, P.C. Peter Pratt, Vice Preident for Health Policy, Public Sector Conultant Jame Schmelter, Team Director, PNC Wealth Management Denie Schroeder, Director, Aleru Retirement Solution Scott Stewart, Firtmerit Bank Larry Wilhite, Vice Preident-Legal & Rik Management Service, Sparrow Hopital Dave Zimmerman, Firt Vice Preident- Invetment, Merrill Lynch 321

8 Internal Revenue Service Department of the Treaury P. O. Box 2508 Date: May 19, 2005 Cincinnati, OH Peron to Contact: YOUNG MENS CHRISTIAN ASSOCIATION Sheila Schrom OF LANSING Ml Cutomer Service Repreentative 119 N WASHINGTON SQ Toll Free Telephone Number LANSING Ml :30 a.m. to 5:30 p.m. ET Fax Number: Federal Identification Number: Dear Sir or Madam: Thi i in repone to your requet of May 19, 2005, regarding your organization' taxexempt tatu. In Augut 1942 we iued a determination letter that recognized your organization a exempt from federal income tax. Our record indicate that your organization i currently exempt under ection 501(c)(3) of the internal Revenue Code. Our record indicate that your organization i alo claified a a public chanty under ection 509(a)(2) of the Internal Revenue Code. Our record indicate that contribution to your organization are deductible under ection 170 of the Code, and that you are qualified to receive tax deductible bequet, devie, tranfer or gift under ection 2055, 2106 or 2522 of the Internal Revenue Code, If you have any quetion, pleae call u at the telephone number hown in the heading of thi letter. Sincerely, Janna K. Skufca, Director, TE/GE Cutomer Account Service 322

9 i CERTIFICATE OF LIABILITY INSURANCE YMCAOFM-01 DUKA DATE JMM.'DD.'YYYY) 4/26/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder i an ADDITIONAL INSURED, the policy(ie) mut be endored. If SUBROGATION IS WAIVED, ubject to the term and condition of the policy, certain policie may require an endorement. A tatement on thi certificate doe not confer right to the certificate holder in iieu of uch endorement). PRODUCER Shinberg Inurance Agency 1400 Abbot Rd, Suite 440 Eat Laning, Ml (517) n m ct Karla Dudaik ^SI addre: kdudaik@hinbergagency.com ^Sy_RER(S) AFFORDING COVERAGE FAX A/C. No) Y M C A Of Metropolitan Laning 119 N Wahington Square Laning, MI inurer b :Auto Owner Inurance Co_ inurer c :Granite State Inurance Co. inurer d:accident Fund Inurance Co of America inurer e traveler COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUBR I POLICY EFF POLICY EXP LTR ' TYPE OF INSURANCE INSR WVD POLICY NUMBER I (MM/DD/YYYYJ WM/DDfYYYY) GENERAL LIABILITY A X COMMERCIAL GENERAL L B I CLAIMS-MADE ' X ABILITY OCCUR GEN1 AGGREGATE LIMIT APPLIES PER X POLICY ject ' LOC AUTOMOBILE LIABILITY X ANY AUTO I ALL OWNED I AUTOS HIRED AUTOS X JL : SCHEDULED ; : AUTOS NON-OWNED AUTOS 01LX /1/2013 i /1/2013 5/1/2014 5/1/2014 EACH OCCURRENCE DAMAGE TO RENTED PREMISES [Ea occurrence.! MED EXP (A-iy one pe-on) PERSONAL S ADV INJURY GENERAL AGGREGATE PRODUCTS COMP.'OP AGG COMBINED SINGLE LIMIT (Ea accident1; BODILY INJURY (Per peron) BODILY INJURY {Per accident) PROPERTY DAMAGE [PER ACCIDENT) LIMITS S 1,000, ,000 " 5,000 i",bob~dob S 2,000,000 1,000,000 1,000,000 1,000,000 S 1,000,000 X UMBRELLA LIAB j X OCCUR EACH OCCURRENCE 15,000,000 C EXCESS LIAB CLAIMS-MADE 01UD /1/2013 5/1/2014 AGGREGATE 15,000,000 DED X RETENTIONS 10,000 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER.'EX OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If ve decribe under DESCRIPTION OF OPERATIONS below CLTIVE : j i N/A WCV /1/ /1/2013 v WC STATU- A TORY LIMITS L EACH ACCIDENT EL DISEASE - EA EMP -OYEE E.L DISEASE - POLICY OTH ER JMIT 500,000 S 500, ,000 E Director & Officer E EPL! : /1/2012 8/1/2012 3/1/2013 8/1/2013 Limit Retention $3,000,000 $10,000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES [Attach ACORD 101, Additional Remark Schedule, if more pace i required) CERTIFICATE HOLDER CANCELLATION Y Achiever 3700 Old Laning Road Laning, Ml SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2010/05) ACORD CORPORATION. All right reerved. The ACORD name and logo are regitered mark of ACORD 323

CERTIFICATE OF LIABILITY INSURANCE

ACORD CERTIFICATE OF LIABILITY INSURANCE Date (MM/DD/YR) Today s Date THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES