THE CHICAGO COMMUNITY TRUST

UNITY CHALLENGE 2010

Application

Please complete the application by filling in the fields provided and answering questions listed. While there is no word limitation, we encourage short and concise narratives. Applications must be submitted electronically by August 13, 2010 at 5 p.m.

Please e-mail this grant application and additional documents to ubject line “Unity Fund Application”. Be sure to include “Unity Challenge” and the applicant name on each document. Only ONE application per agency will be permitted. Please direct any questions to .

This information will be held in strictest confidence.

  1. ORGANIZATION INFORMATION

Name of Agency:

Address:

EIN Number:

Head of Organization:Title:

Email:

Contact Person:Title:

Email:Phone:

Fiscal agent (required for non-501c3 organizations):

Brief Organizational Description

Mission:

History:

Summary of Current Programs:

Key program for which funding support is being sought under this RFP:

______Aging______Domestic Violence

______Developmental Disabilities______Mental Health

______Child Care/Youth______Homeless Services

Organizational Budget

Fiscal year end date: / FY’09 / FY’10 / FY’11
Revenue
Expenses
Surplus / (Deficit)
Net Assets
Notes (explain if there is a budget deficit or surplus):
  1. CATEGORY FOR THIS FUNDING APPLICATION

Please review carefully the eligible categories for this RFP, select the one for which you seek funding support and provide complete answers to all the questions listed under the specific category. Keep the narrative short and succinct.

This application is for: (check one)

Program-level Projects:

______1) Meet increased programmatic need

______2) Program conclusion or transition

Agency-level Projects:

______3) Agency streamlining, restructuring or shutdown

Category 1 – Meet increased programmatic need

  1. Describe the problem your proposal seeks to address. Document the size of your current caseload and the expansion above the current caseload you seek to undertake. Discuss reasons for the expanded caseload. Discuss why this service expansion would meet a critical need in your community. Document the level of funding cuts experienced by your agency for the program.
  1. Describe your plan for service expansion. This includes timeline, description of critical tasks and staffing plan. Describe your agency’s capacity to expand your program.
  1. Describe the proposed service outcomes of the program expansion and program evaluation plans.
  1. Describe how Unity Challenge funding will complement existing funding streams.
  1. Describe any plans or possibilities for continuing the expanded program upon conclusion of Trust Unity Challenge funding.

Category 2 – Program conclusion or transition

  1. Describe the program that is anticipated to close and the reason it is closing.
  1. Describe the service needs of clients in the closing program and needs to be addressed necessitated by the closing of the program.
  1. Describe the proposed program closeout and related activities to be funded under this RFP. This includes timeline, critical tasks, system for tracking client referrals to other services, and staffing transitions.
  1. Describe client outcomes that will be achieved through an orderly closing of the program.

Category 3 – Agency streamlining, restructuring or shutdown

  1. Describe rationale for your selection of partnering agency(ies) to work on joint program solving.
  1. Describe the financial challenges your agency and any partner agencies face due to the economic crisis or funding shortfalls.
  1. Describe your proposed action. This should include description of the coalition, merger, efficiency, planning process, or shutdown proposed. It should include a timeline, key tasks, key personnel, and items to be purchased with funds generated by this proposal.
  1. Describe how your proposed activities will lead to outcomes such as: service to greater numbers of clients, preserving service to existing clients, more efficient client service, or cost-savings to the participating agency(s).
  1. Describe how your action will contribute to long-term sustainability of services to at-risk populations in your community.
  1. Provide descriptions of any consulting personnel needed to implement the project and/or their resume or qualifications.
  1. Provide goals and objectives reflective of the anticipated outcomes of the project. These should reflect services to clients, financial savings and agency structure.
  1. PROPOSED PROJECT BUDGET

If you seek support for program expansion (category 1), please fill out the budget information for both FY’10 and FY’11. If you seek support for category 2 or 3 of this RFP, fill out only information for FY’11.

Revenue / FY’10 / FY’11
Support request from The Chicago Community Trust
Other sources (please list the source(s) and whether it is pending or secured)
-
-
-
-
Total revenue
Expenses
1. Personnel Expenses
- Salaries
- Fringe Benefits
2. Non-Personnel Expenses
- Contract Services/Professional Fees
- Office Space
- Equipment/Supplies
- Staff/Board Development
- Indirect Costs
- Other
Total expenses
  1. BUDGET NARRATIVE

Provide budget narrative to explain justification for line-item expenses and budget request. If the “Other” line item is more than 10% of the total budget, please list what’s included under “Other” and provide justification.

Geographic Area Served:

(Please check up to 10 descriptions of the geographic areas that the programs at your agency supported by Unity Funds will serve)

____Rogers Park____West Ridge____Uptown

____Lincoln Square____NorthCenter____Lakeview

____Lincoln Park____Near North Side____EdisonPark

____NorwoodPark____JeffersonPark____Forest Glen

____North Park____AlbanyPark____PortagePark

____Irving Park____Dunning____Montclare

____Belmont Cragin____Hermosa____Avondale

____Logan Square____HumboldtPark____WestTown

____Austin____WestGarfieldPark____EastGarfieldPark

____Near West Side____North Lawndale____South Lawndale

____Lower West Side____Loop____Near South Side

____Armour Square____Douglas____Oakland

____FullerPark____Grand Boulevard____Kenwood

____WashingtonPark____Hyde Park____Woodlawn

____SouthShore____Chatham____AvalonPark

____South Chicago____Burnside____CalumetHeights

____Roseland____Pullman____South Deering

____East Side____West Pullman____Riverdale

____Hegewisch____Garfield Ridge____ArcherHeights

____BrightonPark____McKinleyPark____Bridgeport

____New City____West Elsdon____GagePark

____Clearing____West Lawn____Chicago Lawn

____West Englewood____Englewood____Greater Grand Crossing

____Ashburn____Auburn Gresham____Beverly

____WashingtonHeights____MountGreenwood____Morgan Park

____O’Hare____Edgewater____Citywide

____City of Chicago - South____City of Chicago – Southwest

____City of Chicago – West____City of Chicago – Northwest

____City of Chicago – North____Suburban Cook – South

____Suburban Cook – Southwest____Suburban Cook – West

____Suburban Cook – Northwest____Suburban Cook – North

____Cook County_____Metropolitan Area

BOARD AND STAFF DEMOGRAPHIC INFORMATION

Please outline the composition of your organization’s board and staff.

Board Members / Senior Staff / All Staff
Female
Male
TOTAL
African-American
Asian
Caucasian
Latino
Native American/ Alaskan Native
Other
TOTAL (must equal the same as Total for gender)
Persons with disabilities

Total full-time and part-time must equal total of All Staff

Staff
Full-Time
Part-Time
Volunteer
Contract
Estimated Participant Profile (in percentages)
Female
Male
African-American
Asian
Caucasian
Latino
Native American/ Alaskan Native
Other
Persons with disabilities

***ADDITIONAL DOCUMENTS REQUIRED***

  • 501c3 tax determination letter. If a fiscal agent is used, submit 501c3 tax determination letter of the fiscal agent.
  • Board list including affiliations
  • Most recent audit and current final financial statement
  • Budget details for the current operating fiscal year
  • Bios of key project staff

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