OPTION ONE

THE NAVIGATOR OPTION APPLICATION

Application Instructions
Please read before completing your response.
THE INSTRUCTIONS ARE FOUND IN PART III –
THE FULL SERVICE OPTION SUBMITTAL INSTRUCTIONS
MAKE SURE TO SUBMIT THE REQUISITE NUMBER OF COPIES AS DIRECTED
Please review the specifications before responding.
Mark the applicable boxes with your response, or respond directly below the question, the boxes will expand to accommodate your responses.
Attach any requested Exhibits to the final submission.

OPTION ONE

THE NAVIGATOR OPTION APPLICATION

Notice of Fund Availability

To Serve

Out-of-school youth

  1. Organization Name:
/
  1. Program Name:

  1. Organization Address:

  1. Telephone Number:
/
  1. Fax Number:

  1. Program Services Location(s)

  1. CEO/Executive Officer:
Email address: /
  1. CEO Phone Number:
CEO Fax Number:
  1. Chief Financial Officer (CFO):
Email address: /
  1. CFO Phone Number:
Fiscal Agent Information if different
(corporate name, address, phone number, email )
  1. Program Contact Person and Title:
/
  1. Phone Number:

  1. Program Contact e-mail address:
/
  1. Contact Fax Number:

  1. Annual Cost of Navigator Salary and Fringes
Salary: $______
Fringe Benefits: $______
Overhead associated with the Navigator Position:
$______(Leave this blank if being provided as in-kind)
______
17Has your organization ever been debarred from receiving federal funds?
Yes  No / 16. In Kind or non WIOA Contributions such as overhead or indirect costs associated with the Navigator position
$______

Navigator Application

18. Type of Entity: _____Corporation _____Private for-Profit _____Private Not-for-Profit
_____Sole Proprietorship _____ Partnership _____ Government
_____ Other Public Agency (Specify) ______
If organization is an out of state corporation, please provide the state of incorporation
______
  1. Licensed to do business in the Commonwealth of Pennsylvania?
Yes No N/A
  1. Years in Business _____
Years in Lehigh Valley _____ /
  1. Federal ID Number:

  1. DUNS Number If Applicable:
/ If you do not have a DUNS number you can
apply for free just use the link below:
This takes 30 days.
  1. Total Number (between 25 – 30) of Youth in the Cohort Caseload to be Assigned to the Navigator

  1. Proposed Performance Objectives
# of Youth: / # of youth to be placed in post-secondary education by
6/30/18:______
# of youth who will receive their high school diploma or GED by
6/30/18:______
# of youth not going on to post-secondary school to be placed in
unsubsidized employment or military by 6/30/18:______
# of youth placed in jobs who are in a job 12 months after
placement?______
# of estimated to complete the program by 6/30/18:______
Expected median wage for youth placed into unsubsidized employment upon by 6/30/2018:______
  1. In no more than ½ page, tell us about your organization, general service mission, and primary services provided to youth. Include a copy of your organizational chart and indicate where the proposed program reports within your agency. Clearly note the position responsible for the direct supervision of the navigator position.
  1. Please describe your experience in working with out-of-school youth with barriers and the successes you have achieved. Limit your response to no more than ½ page.

WIOA Barriers include:

  • School dropout
  • Basic skills deficient or English as a Second Language and economically disadvantaged
  • Homeless
  • Attachment to foster care
  • Pregnant or parenting
  • Disability
  • Needs assistance to enter or complete education or enter employment and economically disadvantaged
  1. How do you currently identify and recruit youth for your existing programs? How will you determine youth who require individualized navigator services? How will you assure a full cohort of youth for the navigator (12 – 15 youth per caseload)?
  1. Please describe the program you are currently operating and services being provided for youth who meet the description of “out of school” under WIOA? Please include narrative explaining how you keep the youth engaged in your program activities.
  1. In creating your program design did you research other successful models, replicate a successful program design, or include elements proven to be successful in working with youth? Please describe in no more than 125 words or ¼ of a page.
  1. Name and describe the specific core services and program components offered by your program and the services you will add as a result of access to WIOA funded activities. Include the number of unduplicated participants who will receive each service. Add lines as necessary.

List the Services Offered Youth in Your Program /  / WIOA Services that Youth Will Receive – Check all applicable services /  / # of Youth Who Will Receive the Service
Assessment / WIOA Eligibility
Service Strategy / Career Plan
Counseling / Counseling
Post-Secondary Occupational Skills Training
GED
Work Experience
Internship / OJT
Tutoring / Remediation
Support Services (List) / Transportation Assistance
Clothing Voucher
Financial Literacy
Employability Skills
Entrepreneurial Training
Leadership Development Training
Adult Mentoring
Follow-Up
  1. What are the characteristics of youth served by your program?

Youth Characteristics / 
High school dropout 18 or over
High school dropout under 18
Currently enrolled in GED classes
High School Graduate not enrolled in post-secondary school
Ex Offender (Extra Points in Evaluating the Proposal)
Homeless
Pregnant or parenting
Attachment to Foster Care System
Runaway
Disabled (Extra Points in Evaluating the Proposal)
Basic skills deficient and economically disadvantaged
Needs WIOA services to complete their education or obtain employment and economically disadvantaged
  1. Describe how your program is staffed and how the addition of a Navigator will assist in improving outcomes for the youth to be served?
  1. LVWDB will reimburse the cost of navigator salary and fringes, as well as related indirect costs or overhead, if the latter are not provided as an in kind service. Does your organization have the fiscal capability to invoice LVWDB on a regular/ monthly basis and to wait 30 days for payment of your invoice?
  1. If your application is funded you will need to supply the following documents. Please indicate if you will be able to provide the documents:

Documents / 
3rd Party Insurance Certificate Indemnifying LVWDB
W-9
Current Board Information (List of members where applicable)
Non Discrimination Federal Form
Federal Lobbying Certificate
Incorporation Certificate (where applicable)
501(c) 3 status from IRS (where applicable)
Drug Free Workplace Federal Form
Copy of recent audit or financial statement as applicable

Evaluation Criteria

Available Points / Points Awarded
1 / Applicant has experience and an existing program serving out-of-school youth
Applicant is serving ex-offender youth (add 2.5 points)
Applicant is serving youth with disabilities (add 2.5 points) / 15 (+ up to
5 pts. for serving
ex-offender and disabled)
See Questions: 25, 26, 27, 28 and 31
Available Points / Points Awarded
2 / The youth can benefit from being offered WIOA services / 7.5
See Questions: 29, 30 and 32
Available Points / Points Awarded
3 / The staff costs for the Navigator are reasonable
See Question: 15 and 15a / 7.5
See Question: 15 and 15a
Available Points / Points Awarded
4 / The performance objectives proposed will assist LVWDB in meeting state performance measures / 20
See Questions: 23, 24, and 32
Available Points / Points Awarded
5 / Applicant is leveraging funds / 5
See Question: 16 and 16a
Available Points / Points Awarded
6 / Applicant has already recruited out-of-school youth
and/or and is serving youth likely to be eligible for
WIOA services / 10
See Questions: 27, 30, and 31
Available Points / Points Awarded
7 / Applicant can wait to be reimbursed / 5
See Question: 33
Available Points / Points Awarded
8 / The Navigator will add to Applicant’s program / 10
See Question: 32
Available Points / Points Awarded
9 / The program design includes evidenced-based, researched successful elements or strategies / 10
See Question: 29
Available Points / Points Awarded
10 / Applicant will provide required documents / 5
See Question: 34

EXPERIENCE REFERENCE FORM

The below named organization/individual has responded to a Request for Proposals (RFP) for the delivery of Youth ProgramServices to Lehigh Workforce Development Board (LVWDB) youth participants aged 17 - 24.

Proposer/Proposer Organization
Proposer/Representative or Contact
Signing Below for the Organization
Title of Authorizing Signatory
The undersigned individual certifies that they are authorized to represent the above named organization and authorizes ______
to provide the requested information, complete this form and submit the form to LVWDB at the fax number provided above.
Signature
Date

For Completion By Organization Providing the Reference

Name of Person Completing this Form
Title
Signature
Contact information
Email/Telephone

Please check all services provided by the Proposer Organization for your entity:

Employability skills training to youth
Matching youth to a mentor
Tutoring
Leadership Development Training / Financial Literacy / Entrepreneurial Training
Counseling
Assessment
Guidance

During what period of time was this work performed? Check all which apply.

2016
2015
2014
2013
Other please specify

Service Levels

# of individuals receiving services

Please rate the following specific factors relative to this agency’s effectiveness, on a scale of 1 to 5, with 5 being the highest/best.

Quality of Services
1234 5
Proposer Met All Performance Objectives
1234 5
Communication with Youth
1234 5

Please rate the following specific factors relative to this agency’s effectiveness, on a scale of 1 to 5, with 5 being the highest/best (continued):

Day-to-day responsiveness
1234 5
Hiring and retaining competent staff (If N/A please so indicate)
1234 5
Motivating youth
1234 5
Management of files and paperwork
1234 5
Establishing and maintaining effective working relationships with community partners
1234 5
Administrative and financial management
1234 5
Providing excellent service
1234 5
How would you rate your overall experiences with this proposer?
1234 5

Please respond to the following:

To the best of your knowledge: / Yes / No
Has proposer failed to complete any contract?
Has any contract between Proposer and your organization been terminated due to alleged poor performance or default?
Would you say this proposer (and their key staff) conducted themselves with a high degree of integrity?
Would you contract with the proposer again?

Provide any general comments you feel you would like to add:

LVWDB thanks you for taking the time to complete this reference form.

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