DickinsonCounty Endowment Fund
2006 Grant Application
A Proposal for DickinsonCounty Endowment Fund
Grant Dollars for a Middle School Youth Leadership Program
Cover Sheet
Date of application: / 8/24/2006 / Application submitted to: / DickinsonCounty Endowment FundOrganization Information
Name of organization
/Legal name (as listed with IRS)
ISU Extension – DickinsonCountyOrganization Address
/City, State, Zip
/Employer Identification Number (EIN)
1600 15th Street / Spirit Lake, IA 51360 / XXXXXXXXXXPhone
/ Fax / Web site712-336-3488 / 712-336-3498 /
Name of contact person regarding this application
/Phone
/Type of funding sought (circle one):
/Educational
/Civic
/Patriotic
Charitable
/Public
/Religious
Project focus area
(circle all that apply)
/Youth Services
/Family Services
/Housing
Natural Resources
Recreation
/Economic
Development
/Transportation
ConservationIs your organization an IRS 501(c)(3) not-for-profit?
/ x / Yes / NoIf no, is your organization a 170b unit of government?
/ Yes / NoIf no, you must have a fiscal agent. Please list name, address, phone and fiscal agent contact person:
Iowa 4-H Foundation / XXXXXXXXXX
Fiscal agent’s EIN number
What is your fiscal calendar? (Mo/Yr) to (Mo/Yr) /July 2006 to June 2007
Describe your organization’s charitable purpose, program activities, and population served.(4-5 sentences)The mission of IowaStateUniversity Extension (ISUE) is to build partnerships and provide research-based learning opportunities to improve quality of life in Iowa. More specific to the 4-H & Youth Development program area, the mission is to empower youth to reach their full potential working and learning in partnership with caring adults. In Dickinson County, youth seventeen years of age or younger represent approximately 3600 people or 22% of the population.
List any major changes that have taken place in your organization in the last two years.ISUE has been a part of serving youth for over 100 years through the world’s largest youth organization -- 4-H Clubs. Over the past several years more intentional outreach has occurred to provide leadership, teambuilding, and youth adult-partnerships in afterschool programs, school enrichment activities, and numerous special interest initiatives. In DickinsonCounty Extension we have partnered with other community organizations to create and deliver 3 annual retreats to bring nearly 100 high school student council members together each year from throughout the county. The success of this high school leadership initiative has also brought about interest from school districts to implement similar program opportunities at a middle school level.
Briefly describe your organization’s history (year organized) and major accomplishments. What evidence can you provide that you will be able to carry out your project?Iowa has the honor of being the birthplace of the 4-H & Youth Program in 1902. By 1916 DickinsonCountywas providing this opportunity for youth. Today, this programming is not only offered in every county in the state, but has grown nationally and internationally to become the world’s largest youth organization. Ties with IowaStateUniversity ensure that youth program initiatives are founded with research-based methods.In addition, Extension & 4-H Programs in DickinsonCounty have a rich history of partnerships with other community organizations, business entities, and non-profit groups. Projects have had a successful history because of state and local level partnerships. Examples of these partnership successes include: 3 years of Lakes Area Student Council Annual Retreats (LASCAR) and 1 pilot “Ricochet: An ExtremeMiddle School Leadership Adventure” in the Harris-LakeParkSchool District. Both of these leadership initiatives have been supported by local Kiwanis groups, Priority #1, banks, restaurants, and other businesses. Additionally, ISUE has secured approximately $4500 in grants from America’s Promise, Alcohol & Drug Treatment Unit, and the Iowa Department of Public Health to support these two leadership initiatives. The high school LASCAR concept is award-winning, receiving a $1000 National Great Idea Award from America’s Promise and an Iowa Association of Extension Council’s Outstanding Program of the Year Award. We believe our proposed middle school leadership initiative will be equally successful.
Application
Request Summary
Describe the proposed project, including the goals and objectives. Discuss the community need for the project,what populations it will serve, the benefits for the community as a result of the project and the community support for the project.- The project proposal we have is for support for the expansion of the “Ricochet: An Extreme Leadership Adventure” pilot program with middle school students in DickinsonCounty.
- “Ricochet” is designed to help youth discover their leadership abilities and look toward the possibilities they have to impact their communities and county.
- The 15-hour program combines discussions and hands-on challenge-type activities for youth to get a better understanding of leadership in their communities, as well as a community leadership service project selected and implemented by the youth participants.
- The first pilot program was conducted with 12 Harris-Lake Park middle school student council members during the ’05-’06 school year.
- The success of this leadership program was shared with the SpiritLakeMiddle School Principal, Mr. Ratzlaff, and he would support this being offered to the entire middle school student body or approximately 400 students! Realistically, we propose to start with 6th graders and eventually add 7th and 8th graders as the program evolves beyond a pilot phase. Our initial pilot with SpiritLake would be with approximately 100 middle school students.
- Ricochet provides opportunities for adult, youth and community partnerships through volunteerism and financial support. Volunteer adults and high school students assist with program delivery, leadership discussion panels, refreshments and more. Financial support is needed to purchase program supplies, participant t-shirts, training equipment, staff time and travel for training trainers and conducting the program, rental fees for facilities, possible transportation costs, marketing, etc.
- Extension proposes a train-the-trainer format to train community leaders and high school students to help deliver the program with middle school students during the ’06-’07 school year.
- The ultimate outcome of the program is for youth to see themselves as leaders in their communities. We plan to expose them to community leaders and opportunities and encourage them to see opportunities they have which in turn would provide economic development in DickinsonCounty.
Population served
(estimated #): / 100 youth +20 trainers / Grant monies needed:
(Mo/Yr) to (Mo/Yr) / October 2006 to May 2007
Total project cost: / $5600.00 / Total requested from the DCEF / $1350.00
In-kind contributions? / $1430.00
Are matching funds being used? / YES / What percentage of total funds raisedare matched dollars? / 100%
Outline other resources or partners identified to assist with the project; the nature of the in-kind contributions if any, and any other funding secured, applied for and proposed for the project:
- We currently have $1500 in grants from the Iowa Department of Public Health and a partnership with Priority #1 of DickinsonCounty to help implement Ricochet programming in SpiritLake.
- We are asking for $2500 from the DickinsonCounty 4-H Foundation.
- We will be seeking financial and in-kind support from local businesses, organizations, and others based on the amount of funding secured prior to the asking.
- ISUE will provide staff, as well as, in-kind donations with curriculum development, challenge training equipment, printing, marketing, phone calls, some travel expenses, and such.
- As with the Harris-LakePark pilot program, we also plan to seek in-kind donations for facility use and refreshments for the students. If these are not donated, they will add to our budget expenses and asking from community partners.
Indicate desired impact and how you will measure and evaluate the results of the project. Be specific regarding community needs/issues your project will address.
Youth completing the Ricochet Adventurewill be able to:
- identify characteristics of leaders
- identify themselves as a leaders
- share ideas more easily with others
- recognize what causes communication breakdowns
- explain the connection between values and decisions
- use a decision-making model to make a group decision
- use positive techniques for managing the stress associated with leadership
- identify a leadership service project in their community; develop an action plan for the project; and complete theproject in their community
Our future goal is to involve allSpiritLake6th, 7th and 8th grade students in the three Ricochet program phasesto help prepare rural Iowa youth to become leaders in their communities both today and tomorrow. After completing the program youth will be able to accept leadership roles in the community, for instance serving on a local library board, a mayor’s task force, city recreation board or school advisory committee.
What is the timeline for this project?
We plan to pilot the Ricochet program with SpiritLakeMiddle School this fall and conclude with phase I of Ricochet by spring of ’07.
Is this a project that will be sustained? If so, how will you sustain it?
We plan to sustain the program for a number of years. The ISUE Team that created this Ricochet Adventure is developing a Ricochet II and III for middle school students. Pilots of these phases will be on-going during the year. Future plans would be to see this pilot group of 6th graders continue next year with Ricochet II and the following year with Ricochet III. We plan to build the program’s long-term sustainability by offering phase I to all 6th graders, phase II to all 7th graders and phase III to all 8th graders in following years and training more trainers to help with the facilitation. Ultimately, we hope that community leaders see the value in this training and help support it for years to come! Additionally, we will continue to seek out grant funding at all levels.
Attachments
In order to be considered for funding, your application MUST include the following items:
Copy of latest Federal IRS Tax-exempt status letterList of Board of Directors, Director, Staff
Copy of most recent CPA audit, financial statement or tax return (IRS 990 form)
Signed ‘Letter of Intent’ to act as a fiscal agent – only if you are not 501(c)3 or 170b status
Signed Applicant Board Approval Agreement (see below)
Board Approval from Applicant Organization:
We approve submission of this grant request and certify that the purpose of this request is charitable and that monies received from the Dickinson County Endowment Fund will be used solely for the project stated in this application.
Board Chairman / Date~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For DCEFund use only:
Board of Directors Determination: / Approved / Denied / DateThis application has been approved in the amount of $ ______.
Organization Budget
See Attached Organizational Budget
Project Budget
INCOME
Source / AmountSupport
Government grants(IDPH Grant) / $1500.00Foundations / $
Corporations / $
United Way or other federated campaigns / $
Individual contributions / $
Fundraising (Meals -$360 andT-shirts - $960) / $1320.00
Membership income / $
In-kind support(CountyStaff Time - $1430) / $1430.00
Investment income / $
Revenue
Government contracts / $Earned income / $
Other (specify) / $
$
Total Income / $4,250.00
EXPENSES
Item / Amount / %FT/PTSalaries and wages (indicate number of staff and full- or part-time.) / $
1 - Area Youth Field Specialist / $1440.00 / 75% time
$
$
SUBTOTAL / $1440.00
Insurance, benefits and other related taxes / $
Consultants and professional fees / $
Travel / $ 400.00
Equipment / $
Supplies(Folders, Pencils, T-shirts, and name tags, etc…) / $ 1200.00
Printing and copying(Train-the-trainer Binders - $440 and supplies; Registration Materials, Brochures, Posters, and Student Packets $600) / $ 1040.00
Telephone and fax / $
Postage and delivery(2 mailings @.50 x120) / $ 120.00
Rent and utilities(Trainer site & youth site) / $ 540.00
In-kind expenses / $
Depreciation / $
Other (specify)(Leadership Service Project supplies - $500; Refreshments for trainers & youth for 3 sessions x $3/person = $360;) / $ 860.00
$
Total Expense / $5600.00
Difference (Total Income less Total Expense) / $1350.00
Attachments
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