EMERGENCY FOOD AND SHELTER NATIONAL BOARD PROGRAM [EFSP]
LOCAL RECIPIENT ORGANIZATION FUNDING REQUEST
JAMES CITY COUNTY, VIRGINIA
[Please type all requested information.]
DATE:______EFSP PHASE: 33
AGENCY:______
ADDRESS:______
PHONE: ______FAX: ______
AGENCY CONTACT: ______
E-MAIL ADDRESS: ______
DATE OF LAST FINANCIAL AUDIT: ______
IS THE AGENCY A 501 (C) (3)? ______
TAX ID NUMBER: ______
SERVICE CATEGORIES FOR WHICH THE AGENCY IS REQUESTING EFSP FUNDING
[Check all that apply.]
[] Rent/Mortgage [ ] Utilities [ ] Emergency Food [] Emergency Shelter
Complete and submit the attached worksheets for each category checked above.
I agree to comply with all National and Local Board guidelines.
Signature, Chief Executive Officer: ______
Failure to complete the entire application by the deadline will invalidate the application.
Return completed application with all signatures to or mail to Elizabeth Parman, United Way of Greater Williamsburg, 5400 Discovery Park Blvd., #104, Williamsburg, VA 23188.
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PHASE 33
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APPLICANT AGENCY AND GENERAL INFORMATION
When submitting a request for funding as part of Phase 33 of the Emergency Food and Shelter Program (EFSP), each applicant agency must submit the following:
- An application narrative explaining the (1) agency’s programs and services, (2) the agency purpose and organizational structure, and (3) an operational plan for the program. Please limit your narrative to no more than 2 pages.
- AnEmergency Food and Shelter National Board Program (EFSP) Local Recipient Organization Funding Request: Page 1, and pages 3, 4 and/or 5 as appropriate.
- One (1) copy of the “Required Documentation” as enumerated on Page 6 of the EFSP Local Recipient Organization Funding Request form. If an agency has previously submitted an application for EFSP funds, it is not necessary to submit this supplemental documentation as it is already on file. Agencies applying for the first time must submit supplemental documentation.
PLEASE NOTE THE FOLLOWING:
- Rent/Mortgage/Utilities (RMU) funds may be given to one agency in James City Countydeemed most capable of distributing the funds in an equitable, efficient, and professional manner consistent with the guidelines of the EFSP Board and in the best interests of the clients.
- Emergency Shelter funds will be distributed based upon the number of beds serving James City Countyresidents to applicant agencies based upon a per bed allocation. Or, agencies may also pay the actual per-night charge at any reasonable hotel/motel or non-profit facility acting as a vendor; there is a 30-day limit stay for this OTHER SHELTER
- Agencies will be allowed to apply for all categories of EFSP funding; however, there is no assurance that any category will be funded for any specific agency.
- Applicant agencies may not request specific dollar amounts. They can only apply for available funds and supply requested information to assist in the distribution of those funds.
PHASE 33
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WORKSHEET FOR RENT/MORTGAGE/UTILITIES (RMU) FUNDS
Applicant Agency: ______
One agency will be chosen to administer and distribute RMU/EFSP funds to James City Countyresidents. Agencies wishing to administer and distribute these funds must meet the following criteria as an agency and distribute the funds according to the following recipient priorities and time/budget guidelines.
LOCAL AGENCY REQUIREMENTS(in addition to the standard EFSP requirements):
- Demonstrated administrative capability;
- Ease of accessibility to all areas of James City County;
- Agreement to adhere to recipient priorities;
- Agreement that the development of any criteria more restrictive than those currently required must be approved by the local EFSP Board;
- Agreement to adhere to time/budget guidelines; and,
- Agreement to adhere to EFSP National Board regulations.
Agencies wishing to be considered as the administrator of RMU/EFSP funds, must demonstrate (either below, or in their application narrative) their ability to fulfill all of the above criteria.
PHASE 33
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WORKSHEET FOR EMERGENCY FOOD FUNDS
Applicant Agency: ______
Indicate the applicant agency’s use of calendar or fiscal year in providing service for a 12-month period and provide dates.
Calendar Year ______Fiscal Year _____ Dates ______
Pantry Providers
Use the following formula to determine the agency’s number of meals provided to James City Countyresidents for the past fiscal year. This number will be added to that of other pantry providers, divided by the total, and each agency’s percentage of the total available funds will be determined.
Formula:One bag of food = 9 meals. Multiply the number of bags distributed to James City Countyresidents over a 12-month period x 9 to determine the total number of meals that were provided.
Calculation:# Food bags distributed to James City Countyresidents over 12 months ______x 9 =
Total # of Meals distributed______
On-Site Providers
Use the following formula to determine the agency’s number of meals served to James City Countyresidents during the past fiscal year. This number will be added to the number of meals served by other on-site providers, divided by the total, and each agency’s percentage of the total available funds will be determined.
Formula:Multiply the number of nights of service provided to James City Countyresidents x 3 to determine the total number of meals served, ORfor Feeding Programs, indicate the actual # of meals served to
James City Countyresidents over a 12-month period.
Calculation:# Nights of service to James City Countyresidents over 12 months ______x 3 =
Total # of meals served ______
OR# Actual meals served to James City Countyresidents over 12 months ______
Total number of meals served to James City Countyresidents: ______
Indicate the location of the documentation that verifies these calculations: ______
PHASE 33
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WORKSHEET FOR EMERGENCY SHELTER FUNDS
Applicant Agency: ______
Indicate the applicant agency’s use of calendar or fiscal year in providing service for a 12-month period and provide dates.
Calendar Year ______Fiscal Year ______Dates ______
LINE 1:Total shelter clients last year with James City Countyas origin: ______
LINE 2: Total shelter clients last year other than James City County: ______
LINE 3: TOTAL SHELTER CLIENTS LAST Fiscal Year: ______
LINE 4:Total # of beds in applicant agency shelter[s] as of application date: ______
LINE 5: Percent of clients served last year with origin in James City County: ______
[LINE 2 LINE 4 or James City Countyclients divided by TOTAL shelter clients = percentage]
LINE 6:Number of beds serving James City Countyclients last year: ______
[LINE 4 x LINE 5 or total # of beds times percent of James City Countyclients served]
Agencies receiving Emergency Shelter allocations for MASS SHELTER must accept funds on a per diem basis, and submit appropriate documentation accordingly.
Agencies may also pay the actual per-night charge at any reasonable hotel/motel or non-profit facility acting as a vendor; there is a 30-day limit stay for this OTHER SHELTER.
PHASE 33
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REQUIRED DOCUMENTATION
All new applicants are required to submit one (1) copy of the following materials with their application by 3:00 p.m., Friday, June 17, 2016. If an agency has previously submitted an application for EFSP funding, and there has been no substantive change, it is not necessary to submit this supplemental documentation for Phase 33 as it is already on file.
[ ]Previous year’s financial audit
[ ]Previous year’s IRS Form 990
[ ]IRS determination letter verifying non-profit, 501 (c) (3) status
[ ]Articles of Incorporation (including date of incorporation)
[NOTE: The applicant agency must be incorporated for more than one year, and be able to
demonstrate program, fiscal, and administrative capability for that period of time.]
[ ] List of current Board Members
In keeping with the policies of the Williamsburg Local EFSP Board, failure of an applicant agency to submit ALL information, complete and accurate, as requested, will be cause for the application to be classified as “incomplete,” and therefore not eligible for consideration in the distribution of funds. If, for any reason, any information listed above cannot be provided, the applicant agency must submit written justification stating the reason(s) the information is not available.