Health and Social Services Block Grant Application

Health and Social Services Block Grant Application

FY2013-2014

Proposal Guidelines, Criteria & Application

Every other year, the City and Borough of Juneau’s Social Services Advisory Board (SSAB) provides small grants for community-based nonprofit health and social service agencies. The SSAB is now accepting applications for the fiscal year 2013-2014 funding cycle.

For an application please download electronic forms at These forms are designed to be filled out electronically using Word or Adobe PDF. If you do not have access to Word or Adobe, or wish to fill out the forms by hand, please contact Lisa Flores at 586-0305 for an application with more space available for handwriting.

Please note the following dates:

• Monday, January 23rd, 2012 at 5:15 p.m. – An open meeting, to discuss the grant application process:to be held, at the Downtown Library Large Conference room (292 Marine Way, Juneau, AK99801).

• Friday, February 3rd, 2012 – Submission date for any questions you may have after the meeting: all questions must be submitted in writing to Lisa Flores at: 155 S. Seward Street, Controller’s Office, Juneau, AK, 99801 or via email at .

• Friday, February 17, 2012by 4:30 p.m. (local time) – Application deadline: The original application, plus eight copies, must be received via mail at: 155 S. Seward Street,Juneau, AK, 99801. ATTN: Lisa Flores, Controllers Office or hand deliveredto 105 Municipal Way, Room 201.

• Monday, March 19, 2012at 5:15 p.m. – Recommendation decisions made: The SSAB will meet on in the Downtown Library Large Conference room, to determine its grant award recommendations to the Assembly.

Targeted Projects

The SSAB has determined it appropriate to match its focus with community issues, or categories, identified in the United Way’s Compass II Assessment report (2005) and its Community Indicators report (2011). The McDowell Group conducted these assessments by focusing on community based research regarding social issues that were of particular concern to both residents and social service providers in Juneau. The SSAB will also use the Juneau Economic Development Council’s Juneau Economic Indicators report (2011) to further support the data and information presented in the United Way Compass II and Indicators report. These documents will provide the framework for the funding decision-making process.

The goal in utilizing research-based data and information is to help the SSAB, and the broader provider community, more effectively target community issues and to more efficiently utilize public funds through the grant process. For more information about the United Way Compass II report, United Way Indicators, and the JEDC Juneau Economic Indicators, follow the links provided below:

United Way Indicators Report:

JEDC Juneau Economic Indicators:

Funded projects will focus on one or more of the issues below, which are not listed in any order of importance. Applicants can apply for funding for a program that focuses upon one or more of the categories. Within these three primary categories are indicator themes which come from the previously mentioned United Way and JEDC reports.

Health

1. Access to Health Care(affordable healthcare, insurance coverage)
2. Suicide prevention
3. Substance Abuse treatment/prevention
4. Infants and Toddlers
5. Seniors
6. People with Disabilities

Education

1. Readiness to Learn (literacy fundamentals)
2. Early Elementary Performance (reading, writing)
3. Success in High School (dropout/graduation rate, disproportionally)
4. CommunityBuilding in Schools (student volunteers, parent engagement)

Income Stability

1. Access to Employment (access to childcare, quality of care)
2. Shelter and Housing (supported/transitional housing, emergency shelter, cost of living)
3. Poverty
4. Young adult stability (teen pregnancy)
5. Family stability (adult/mentor support and availability, domestic violence)

The SSAB does not anticipate any currently-funded agencies becoming ineligible for future funding due to this change in our grant process. It is our hope that by utilizing community based research and analysis to drive funding priorities, we will expand funding opportunities to agencies that were not eligible in past grant cycles, and provide greater visibility to the issues and needs of the community.

Criteria for Successful Projects

Provides social service(s) addressing significant issue/need, as identified in United Way Compass II, Community Indicators/JEDC Juneau Indicators

Implement an approach with potential for substantive impact, as demonstrated by use of a best or promising practices model

Demonstratedability to evaluate program through use of performance measures, plan to execute strategy for capturing/reporting data and information about program outcomes

Application clearly describes the human/social service needs being addressed by the program and includes supporting/substantiating local data and information to demonstrate why program is needed

Application clearly describes program’s past successes, demonstrating competencies and plan for sustainability

Includes a well-designed program budget

(Line-item format, accurate income and expense projections)

Application clearly describes how the requested funds will be used to support the goals and objectives of the program

Provides evidence of strong leadership and community engagement (fosters civic engagement, opportunities for volunteerism, public education and outreach)

Collaborates with other agencies/community partners in serving targeted population(s) (Public education/outreach, wrap-around services, team approach to treatment/provision of services, referral)

Provides community-based diversity and cross-cultural awareness/competency training

Grant Checklist

(Submit only the materials requested and in the order itemized below)

ORGANIZATIONAL INFORMATION

1)Cover sheet (included below) with original signature of agency authorizing official

2)IRS 501(c)3 status documentation

3)List of current board members

4)Resolution or other documentation demonstrating that the organization’s board of directors is aware of and supports this application

5)Strategic plan for organization with date approved by the board of directors (if available)

6)Organization’s current year operating budget using form provided (Organization Budget)

7)Financial statement of most recently completed fiscal year (audited if available)

PROJECT INFORMATION

8)Itemize project budget for FY13-14 using the budget template provided (Program Budget FY13-14)

9)Project timeline

10)Names and phone numbers of three references familiar with the organization and this project

11)If your project received a grant in FY11-12 grant period, please include a copy of your last annual report (both financial and narrative portions)

Please complete the application on the following pages and attach to the items requested above.

Health and Social Services Block Grant Application

FY2013-2014

Cover Sheet

Contact Information

Application contact: / Title:
Phone: / Email address:

Project Information

Project title:
Project budget: / Amount requested:
Grant request level: Tier I (up to $25,000) Tier II ($25,001 - $50,000)

Organization Information

Legal name of organization:
Address of organization:
Fax number: / Web address:
Date of incorporation: / Federal tax ID #:
Proof of organization status IRS 501(c)3: Yes No
Mission statement:
Head of organization: / Title:
Phone: / Email address:
Financial Summary / Last complete fiscal year (actual) / Current Fiscal Year (budget)
Operating Revenue
Operating Expenses

______

Authorizing signature of Organization Head or Board ChairDate:

Printed Name:

Title:

I. ORGANIZATION/AGENCY INFORMATION:
Organization/Agency Name
a)Organization/Agency’sHistory:
b)Services Provided in Juneau:
II. PROJECT - Identify and/or Describe:
c)Project Leader and Team:
d)Number of beneficiaries:
e)Number of volunteers involved in the project, if any, and their role:
f)Need for this project:
g)Current status of the project:
h)Timeline for completion:
i)Project goal(s) for your target population(s):
j)Actual or expected results from outcome-based evaluation, and how the proposed project will be assessed:
III. BUDGET- Describe:
k)Total Cost of Project:
l)How much has been raised to date and from whom, with specific amounts:
m)How much will be contributed by the applicant:
n)How much is requested in this proposal:
o)How will the organization anticipate raising the balance:
p) Pending applications or projected sources of funds for the project:
IV. SUSTAINABILITY:
q)Resources currently available or projected to sustain the project in the future?(Explain)
Program/Project Narrative (1000 words or less, attach a separate page if needed)
Be sure to: 1) address how your program fits into funding categories, 2) the program’s approach to serving the target population, and 3) how the program utilizes a best or promising practice model.
Describe ability to evaluate program through use of performance measures, and how you will implement a strategy for capturing and reporting data and information about program outcomes.
Describe the client population served by the program, the client needs that will be met by the program, and the data and information that has been used to support a need for this program.
Describe the program’s past successes and a plan for sustainability.
What are the goals and objectives of the program, and how will you achieve the desired results?Please use the format below as an example of how the Board would like the goals and objectives presented. This information will be used on how performance is rated in the future. Attach an additional sheet if necessary.
Goal #1: ______
Obj. A: ______
Obj. B: ______
Describe the leadership in your organization and efforts to promote community engagement, opportunities for volunteerism, and public education and outreach.
Describe collaboration with other agencies/community partners in serving the target population, such as public education/outreach efforts or events, wrap-around services, team approach to provision of services, agency referral.
Describe any community-based diversity and/or cultural competency and/or cross-cultural awareness training provided to staff/clients
Are you the only agency/program providing a specific service to Juneau? Please describe.
If you received grant funds in 2011-2012, please describe how you achieved the goals and objectives of your program funded by SSAB.

Program Budget FY 13-14

Name of Organization:
Program Title:
Program Budget
CBJ Grant / Other / In / Project
Request Budget / + / Income / + / Kind / = / Total
A. Personnel Services(List positions involved with project)
Subtotal / $ / $ / $ / $
Fringe Benefits
Total Personnel Services / $ / $ / $ / $
B. Travel(Description of travel and/or training)
Total Travel / $ / $ / $ / $
C. Facility(Itemize)
Total Facility / $ / $ / $ / $
D. Supplies/Materials(Itemize in general categories)
Total Supplies / $ / $ / $ / $
E. Equipment(Itemize rentals, leasepurchase agreements, etc)
Total Equipment / $ / $ / $ / $
F. Other Operating(Itemize)
Total Other Operating / $ / $ / $ / $
Total Project Budget / $ / $ / $ / $

If you want the Excel version of this Budget form, please contact Lisa Flores @ 586-0305 or e-mail to request it.

Organization Budget

Name of Organization:
Program Title:
Organization Budget
CBJ Grant / Other / In / Project
Request Budget / + / Income / + / Kind / = / Total
A. Personnel Services(List positions involved with project)
Subtotal / $ / $ / $ / $
Fringe Benefits
Total Personnel Services / $ / $ / $ / $
B. Travel(Description of travel and/or training)
Total Travel / $ / $ / $ / $
C. Facility(Itemize)
Total Facility / $ / $ / $ / $
D. Supplies/Materials(Itemize in general categories)
Total Supplies / $ / $ / $ / $
E. Equipment(Itemize rentals, leasepurchase agreements, etc)
Total Equipment / $ / $ / $ / $
F. Other Operating(Itemize)
Total Other Operating / $ / $ / $ / $
Total Project Budget / $ / $ / $ / $

If you want the Excel version of this Budget form, please contact Lisa Flores @ 586-0305 or e-mail to request it.

Health and Social Services Block Grant

FY2011-2012

Scoring Form

(To be filled out by SSAB board members)

Agency/Project ______Scored by______

Provides social service(s) addressing significant issue/need____ Yes ____ No

(If No, application does not meet minimum requirements)

Criteria / Points Available / Points Awarded
1 / Implement an approach with potential for substantive impact, as demonstrated by use of a best or promising practices model / 10
2 / Application clearly describesability to evaluate program through use of performance measures and strategy for capturing/reporting data and information about program outcomes / 10
3 / Application clearly describes the human/social service needs being addressed by the program and includes supporting/substantiating local data and information to demonstrate why program is needed / 10
4 / Application clearly describes program’s past successes, demonstrating competencies and plan for sustainability / 10
5 / Includes a well-designed program budget
(Line-item format, accurate income and expense projections) / 10
6 / Application clearly describes how the requested funds will be used to support the goals and objectives of the program / 10
7 / Provides evidence of strong leadership and community engagement (fosters civic engagement, opportunities for volunteerism, public education and outreach) / 10
8 / Collaborates with other agencies/community partners in serving targeted population(s) (Public education/outreach, wrap-around services, team approach to treatment/provision of services, referral) / 10
9 / Provides community-based diversity and cross-cultural awareness/competency training / 10
10 / Bonus Points
Achieved program goals and objectives = 5 pts
Agency is only provider in community offering specific service = 5 pts / 10
TOTAL / 100

CBJ SSAB Block Grant, 2013-2014Page 1