2016-2018 Investment Application

2016-2018

Emergency and Basic Needs Investment Application

Leveraging resources to help people, changelives, and makeyour community investment count throughout the Cedar Valley.

This worksheet is for your reference only. All applications must be
submitted online. The link for online submission will be available at this location on Friday, December 11, 2015.

Program Name:

Organization Requesting Funds:

Address:

Application Contact Name:

(All correspondence regarding this document will be through this person.)

E-Mail: Phone:

CEO or Executive Director:

E-Mail: Phone:

Organization Mission Statement:

CVUW Request: $Total Program Budget: $

$10,000 min. - $75,000 max.Total Agency Budget: $

How does this program define a participant and/or unit (who or what you are measuring)? ______

How many participants and/or units, as defined above, does this program intend to actively engage between July 1, 2016 and June 30, 2017? ______

Brief summary of program (Limit of 50 words): This information will be used for publicity and marketing purposes.

Part 1: Organization and Program Overview

  1. Organization Overview: Provide a brief overview of your organization, including information on each of the bullets below. It is not necessary for organization with long histories to provide extensive detail. Your response in this section is limited to 300 words.
  • History
  • Services and Programs
  • Current Strategic Direction
  1. Emergency or Basic Need Service: Identify the eligible short-term emergency and/or safety net service for which you are applying. (Multiple services can be selected)
  1. Food
  2. Shelter
  3. Rent Assistance
  4. Utility Assistance
  5. Removing other immediate, short-term barriers to safety or work
  1. Statement of Need: Provide a brief description of the community conditions and local data that document the need for the services your program will provide. Discuss increases or decreases 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. (300 word max)
  1. Target Population: Describe the demographic of the target population this program will serve. Is there a targeted geographic area within the community? Explain the criteria individuals and/or families must meet in order to be eligible for this service. (300 word max)
  1. Program Summary: Describe the program’s primary goals. What are the main components and essential tasks, projects or services that directly impact the program goals? Also explain how and when clients are able to access the activities. If applicable, include how many days and hours or units of service are delivered by the program. (500 word max)

Part 2: Service Provision

  1. Background: Tell us how long you have provided the specific program services described. Also include any significant evolution in this area of your work, especially in response to societal, legislative and/or economic changes. (150 word max)
  1. Approach: Provide an explanation for the program’s approach to service delivery. Please explain how research-based strategies, best practices or organization learning support your approach. If the program is not informed by research, best practices or organization learning explain why this is the case. (250 word max)
  1. Continuum of Care/Services: Provide an overview of linkages you provide to other services within your organization, or linkages that you make for clients to other organizations that support the needs of clients accessing basic needs services. Also, if applicable, 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. (300 word max)

Part 3: Program Evaluation

  1. Monitoring Outputs: 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? What tool(s) do you use to collect and analyze these data? What are the outputs that will be reported to United Way for the focus area(s) addressed by the proposed program? **See explanation and requirements of outputs below. (300 word max)
  2. Please provide two years of historical outputs that demonstrate the impact for the focus area(s) selected. An outline or chart is sufficient for this section and is not included in the 300 word max
  1. Quality Improvement: Describe how your organization learns from and incorporates data findings in order to improve planning, strategy, and service delivery. (200 word max)

**Outputs are the direct numerical results of the program activities (i.e. number of clients who receive a service, number of meals served, number of units of service provided, etc.) that show evidence of service delivery. Each output listed should relate to a primary activity listed in the Program Summary section. Outputs are mandatory for each Emergency or Basic Need service selected in Part 1, Number 2.

Part 4: Budget

Using the Budget Worksheet, provide the FY 2016 program budget. Please also include a narrative explaining all projected expenses and revenues. Note any substantial changes that are forecasted for July 1, 2016 – June 30, 2017. Include information about additional sources of revenue for the program, and what effects there will be on the program if these additional sources should not be available. Indicate what your program would do without, or with a lesser amount, of funding than was requested. Please also define any expenses listed in the “Other” line item.

If the program requesting funding is eligible for matching funds, please describe the impact and the mechanism of the matching funds and their impact on the program. For example, if CVUW allocates $10K to Program X, these dollars will be matched by $10K from another source, allowing for 35 additional program participants and increased outputs in the following areas______. If no matching dollars occurs in your program, please specify this. (Matching funds are dollars leveraged by United Way funds, not just additional program dollars from other sources.)

Budget Worksheet

July 1, 2016 - June 30, 2017

Projected Expenses* / Total Budget / CVUW Request / Projected Revenues* / Budgeted / Actual $ Secured in 2015
Personnel / Cedar Valley United Way
Benefits / Government-Local
Rent / Government-State
Utilities / Government-Federal
Office Supplies / Foundations
Program Supplies / Grants
Training / Individual/Corporate Donations
Mileage / Special Events
Equipment / In-Kind
In-Kind / Program Fees paid by participant
Fundraising / other
Scholarships/How Many / Totals
Direct Assistance to participants
Other
Totals:

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