United Way of Broward County - Request for Applications

United Way of Broward County - Request for Applications

Request for Applications

For Fiscal Year 2016-17 Services

COMMUNITY IMPACT AREA:

EDUCATION

Available January 14, 2016

Closes February 26, 2016

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United Way of Broward County - Request for Applications

UNITED WAY OF BROWARD COUNTY

REQUEST FOR APPLICATION: EDUCATION

Part I: APPLICANT AGENCY INFORMATION

1. General Agency Information

Applicant Agency Legal Name:
Main Administrative Address:
City & State: / Zip Code:
Telephone Number:
Website:
CEO/Executive Director:
Office Phone Number: / E-mail Address:
Federal Identification Number:
Applicant Agency Fiscal Year: Beginning (mm/dd): Ending (mm/dd):

1. Certification of Accuracy and Compliance

I do hereby certify that all facts, figures, and representations made in the application are true and correct. Furthermore, all applicable statutes, terms, conditions, regulations and procedures for program compliance and fiscal control will be implemented to ensure proper accountability. I certify that the funds requested in this application will not supplant funds that would otherwise be used for the purposes set forth in this program and are a true estimate of the amount needed to operate the proposed program. The filing of this applicationhas been authorized by the contracting entity and I have been duly authorized to act as the representative of the agency in connection with this application. I also agree to follow all Terms, Conditions, and applicable federal and state statutes.

______

Print Authorized Official’s NameAuthorized Official’s Title

______

Authorized Official’s SignatureDate

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United Way of Broward County - Request for Applications

1. Organization Background

1. Provide a concise description of the Applicant Agency, including its history, years of operation, general mission statement and primary services provided. (Up to 10 points)

1. How does the Applicant Agency support United Way of Broward County? (Up to 10 points)

☐ Workplace fundraising campaign

☐ Facility tours

☐ Speakers bureau members

☐ Event Support

☐ Other (Please describe) ______

1. Has the Applicant Agency been a defendant in any litigation or regulatory action in the last three (3) years? If yes, provide a brief explanation of each instance. (Up to 5 points)

1. Is the Applicant Agency accredited? If yes, please include the name of the accrediting body, the level of accreditation, and the time period, if applicable. (Up to 5 points)

Part II PROGRAM INFORMATION

1. Program Information:

Program Name:
Funding Category: / ☐Young Children
☐Elementary Students
☐Mentoring Adolescents
☐Special Needs
Funding Request: / $
Is this program currently funded by UWBC? / Yes ☐ / No ☐

1. Application/Program Contact Information:

Name:
Title:
Phone Number:
E-mail Address:

1. Program Location(s):

(please attach additional addresses if needed)

Name of Location (School/Organization):
Address:
City & State: / Zip Code:
Name of Location (School/Organization):
Address:
City & State: / Zip Code:
Name of Location (School/Organization):
Address:
City & State: / Zip Code:

1. Executive Summary:

1. Please summarize the proposed program in 250 words or less, including in your summary the general population to be served, the number of clients expected to be served, and the types of services to be delivered. (Up to 5 points)

1. Needs Statement

1. Provide a narrative detailing the community need that will be addressed through the proposed program. The statement should include city, school, and/or neighborhood statistics regarding the identified issue, as well as a description of the existing educational resources and gaps. (Up to 15 points)

1. Target Population

1. Describe the population anticipated to be served and how services provided to the anticipated population address the needs statement. Please include the age range, racial/ethnic, socioeconomic characteristics, income level, and/or special conditions. (Up to 15 points)

1. Describe the Applicant Agency’s experience in serving this target population. (Up to 15 points)

1. Describe the capacity of the Applicant Agency to undertake the proposed program (capacity includes facilities, personnel, qualifications, supplies, etc.). Include your knowledge of, and experience, with Broward’s Family Strengthening resources and demonstrate the ability to make referrals for families of students whose family functioning may be an impediment to school success.(Up to 15 points)

1. Specify the number of unduplicated clients that the program expects to serve on an annual basis in the program for which funds are being requested. (Up to 10 points)

1. Describe the training provided to the program staff that will ensure cultural awareness and sensitivity in providing services to a diverse population. (Up to 10 points)

1. Proposed Program Services

1. Describe how the proposed services/program meets UWBC’s scope for the Education area. (Up to 10 points)

1. Identify the selection criteria for individuals/families to participate in the program. (Up to 10 points)

1. Describe the strategies that will be utilized to engage and retain clients and their families, if applicable. (Up to 10 points)

1. Describe the time of day and days of the week that services are provided, and state the rationale as to why the days and times of operation were selected. Describe how your services will be provided during the School Year and what strategies/activities you will provide to prevent “summer slide.” (Up to 10 points)

1. Identify the anticipated length and frequency that services will be provided to clients. (Up to 10 points)

1. Describe your understanding of positive social/emotional child development and how your proposed program will promote resiliency factors that contribute to student success. (Up to 10 points)

1. Briefly describe your knowledge of ALICE and the United Way’s Centers for Working Families initiative and demonstrate your ability to refer families with economic/income instability for services through the supportive network. (Up to 10 points)

1. Will UWBC funding of this program leverage either state, federal or private sources of funding? If yes, please specify the amount anticipated to be leveraged through funding this proposal (must be included in the budget summary). (Up to 5 points)

1. Has this program been monitored by UWBC or any other funder within the past 12 months? If yes, please list date and agency that monitored this program. Copies must be provided upon request.

Funder / Date of Monitoring

ORGANIZATIONAL ATTACHMENTS

Attachment AAudited Financial Statement(s): Must be included with Application as Organizational Attachment “A”. Applicant Agencies are required to submit their audited financial statements for the most recently completed fiscal year or the previous fiscal year if the most recent one ended within 180 days of the due date of this Application. Smaller agencies (those agencies with annual revenues less than $300,000) must submit unaudited compiled financial statements prepared by a CPA.

Attachment BApplicant Agency Verification: Complete and attach the two (2) page form provided as Organizational Attachment “B” to the Application. Requires original signature duly verifying the authority of the signatory to act on behalf of the Applicant Agency for this Application and certifies that all representations made in the Application are true and correct.

Attachment CCertificate of Corporation: Must be submitted as Organizational Attachment “C”. The Applicant Agency is required to attach a printout of the Public Inquiry page from Corporations Online, ( dated within twelve (12) months of the due date of this RFA, stating that Applicant Agency is active. In the alternative the Applicant Agency may submit a copy of its Certificate of Corporation from the Secretary of State, State of Florida certified and dated by the Secretary of State within twelve (12) months of the due date of this RFA. This Certificate must state on its face that the Applicant Agency is active. Please note that a copy of the Articles of Incorporation, acknowledgement of Annual Reports, or any similar document does not meet the requirements of this section.

Attachment DCurrent Drug Free Work Place Certification: Complete and attach the two (2) page form provided as Organizational Attachment “D”. This certifies that the Applicant Agency will provide a drug-free workplace. Notarized original signature required.

Attachment E IRS determination of 501 (c) (3) nonprofit status, if applicable. Include as Organizational Attachment “E”.

Attachment FClient Non-Discrimination Policy: A sample policy is provided.

Include the Applicant Agency’s current policy as Organizational Attachment “F”. The Applicant Agency

will not engage in or commit any discriminatory practice in violation of the Broward

County Human Rights Act. Original signature required.

Attachment G Current Equal Employment Opportunity Policy: A sample policy is provided. Include the Applicant Agency’s current policy as Organizational Attachment “G”.

Attachment H Current Americans with Disabilities Act Policy: A sample policy is provided. Include the Applicant Agency’s current policy as Organizational Attachment “H”.

Attachment IInclude a direct line Organizational Chart showing where this program would function within the Applicant Agency if the requested funds are awarded. The Organizational Chart should be attached to this Application as Organizational Attachment “I”.

Attachment JNot-for-Profit organizations must include a list of the Applicant Agency’sBoard of Directors, and/or Advisory Board, including their addresses and offices held within the Board as Organizational Attachment “J”.

Attachment KThe second page of the Organizational Profile for Providers, which has been submitted to 211-Broward First Call for Help, must be attached to this Application as OrganizationalAttachment “K”. Directions for obtaining the appropriate form can be accessed by calling the Information Manager at 211-Broward First Call for Help at (954) 390-0493 or by emailing at

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Organizational Attachment “A”

AUDITED FINANCIAL STATEMENTS

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United Way of Broward County - Request for Applications

Organizational Attachment “B”

AGENCY VERIFICATION

NAME OF Applicant Agency:______

I hereby certify that:

1.I am duly authorized to sign this Application.

2.I have participated in and/or read the information provided in this Application and agree to the terms and conditions in the Application.

3.Quotations and all other responses in this Application are, to the best of my knowledge, accurate and true.

4.I recognize that failure to be truthful in this Application may result in the canceling of a contract award.

5.I understand that United Way of Broward County will award the contract that is most advantageous to Broward County, taking all other factors into consideration.

6.I certify that all persons, companies or parties interested in the Application, made it without collusion with any other person, persons, company or parties submitting an Application and that it is in all respects made in good faith.

7.I certify that NO litigation is threatened or pending which could impair this Applicant Agency’s ability to fulfill the provisions of this Application.

8.I certify that NO adverse action is pending or threatening by any regulatory, licensing, or oversight Applicant Agency which could impair the Applicant Agency’s ability to fulfill the provisions of this Application.

9.All Applicant Agency decisions regarding recruitment, hiring, promotions, releases, and conditions of employment will be made without regard to consideration of race, creed, religion, gender, country of national origin, age, physical or mental handicap, marital status or any other factor which cannot lawfullybe used as a basis for an employment decision.

10.The budget included in this Application is a reasonable estimate of the anticipated revenues and expenditures for the activities proposed.

Organizational Attachment “B”, Agency Verification, page 2

11.Any of the following documents are available upon request by the United Way of Broward County and will be produced by the Applicant Agency within five (5) work days and may not need to be submitted with this Application:

a.Agency By-laws

b.Personnel Policies and Procedures

c.Job Descriptions

d.Licenses to Operate Agency/Program

If any of these statements cannot be made, please explain on a separate 8 ½ x 11 sheet of paper and attach to this form.

OFFICIAL AUTHORIZED TO SIGN AND BIND Applicant Agency TO APPLICATION: / WITNESS SIGNATURES:
Signature / Signature
Name (Print or Type) / Name (Print or Type)
Title (Print or Type) / Date
Date
Signature
Name (Print or Type)
Date
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United Way of Broward County - Request for Applications

OrganizationalAttachment “C”

CERTIFICATE OF CORPORATION

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United Way of Broward County - Request for Applications

Organizational Attachment “D”

DRUG FREE WORKPLACE CERTIFICATION

The undersigned Applicant Agency hereby certifies that it will provide a drug-free workplace program by:

(1)Publishing a statement notifying its employees that unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace, and specifying the actions that will be taken against employees for violations of such prohibition;

(2)Establish a continuing drug-free awareness program to inform its employees about:

(I)The danger of drug abuse in the workplace;

(ii)The policy of maintaining a drug-free workplace;

(iii)Any available drug counseling, rehabilitation, and employee assistance programs; and

(iv)The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;

(3)Giving all employees engaged in performance of a contract a copy of a statement required by subparagraph (1);

(4)Notifying all employees, in writing, of the statement required by subparagraph (1), that as a condition of employment on a covered contract, the employee shall;

(I)Abide by the terms of the statement; and

(ii)Notify the employer in writing of the employee’s conviction under criminal drug statute for a violation occurring in the workplace no later than 5 calendar days after such conviction;

(5)Notifying United Way of Broward County in writing within 10 calendar days after receiving under subdivision (4) (ii) above, from an employee or otherwise receiving actual notice of such conviction. The notice shall include the position title of the employee;

(6)Within 30 calendar days after receiving notice under subparagraph (4) of a conviction, taking one of the following actions with respect to an employee who is convicted of a drug abuse violation occurring in the workplace:

(I)Taking appropriate personnel action against such employee, up to and including termination;

(ii)Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purpose by federal, state, or local health, law enforcement, or other appropriate agency; and

Organizational Attachment “D”, Drug Free Workplace Certification, page 2

(7)Making a good faith effort to maintain a drug-free workplace program through implementation of subparagraphs (1) through (6).

______

(Applicant Agency Signature)

______

(Print Applicant Agency Name)

STATE OF

COUNTY OF

The foregoing instrument was acknowledged before me this day of ,

20 , by ______

(name of individual signing)

as of

(title) (name of Applicant Agency/entity)

known to me to be the person described herein, or who produced as identification, and who did/did not take an oath.

NOTARY PUBLIC

My commission expires:

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United Way of Broward County - Request for Applications

OrganizationalAttachment “E”

IRS Form 501(c)(3)

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United Way of Broward County - Request for Applications

Organizational Attachment “F”

CLIENT NON-DISCRIMINATION POLICY

In accordance with Title VII of the Civil Rights Act of 1964, the Americans with Disabilities Act of 1990, and the Broward County Human Rights Act (Broward County Code, Chapter 16½), the Applicant Agency’s decisions regarding the delivery of services under any Agreement with Broward County will be made without regard to, or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully used as a basis for service delivery.

The Applicant Agency will not engage in or commit any discriminatory practice in violation of the Broward County Human Rights Act (Broward County Code, Chapter 16½) in performing any services under any Agreement with United Way of Broward County.

Applicant Agency: ______

Executive Director: ______

(Signature)(Date)

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United Way of Broward County - Request for Applications

Organizational Attachment “G”

EQUAL EMPLOYMENT OPPORTUNITY POLICY

POLICY:

The progress of our organization requires that we utilize all available staff to the fullest, regardless of race, color, religion, age, gender, sexual orientation, disability, political affiliation or belief, national origin, veteran status or marital status. Unlawful discrimination must be eliminated and individuals with demonstrated talent recognized and encouraged through fair and equitable personnel practices. It is the policy ofthis Agency to grant equal employment opportunities to all qualifies persons without regard to the factors listed above.

This Agency’s policy of nondiscrimination includes, but is not limited to, employment advertising, recruiting, employment, placement, promotion, transfer, and selection for training, rates of pay, and layoff or termination. All employees are informed of the emphasis on nondiscrimination.

This Agency will comply with all provisions of applicable federal, state, and local equal opportunity laws, orders, rules, and regulations and will cooperate with all agencies established under such laws in guaranteeing compliance.

PROCEDURES:

1.All applications for employment will be printed with the term “Equal Opportunity Employer”.

2.All advertisements for recruiting purposes will contain the statement “An Equal Opportunity Employer” at the bottom of the ad.

Agency: ______

Executive Director: ______

(Signature)(Date)

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United Way of Broward County - Request for Applications

Organizational Attachment “H”

AMERICANS WITH DISABILITIES ACT POLICY

This Agency and its employees support through policy, procedure, and action the right of disabled persons, prospective staff and persons served, to equal access to services and employment.

APPLICANTS:

This Agency shall make efforts in good faith to arrange “reasonable accommodations” for qualified applicants, providing these accommodations do not create “undue hardship” for the agency.

The process of “reasonable accommodations” will include the following steps: 1) Consultation with the individual by the supervisor or operations director; 2) Identifying barriers in question; 3) Identifying possible accommodations (including assistance from outside authorities or agencies); 4) Assessing reasonableness of accommodations with the final decision from the Executive Director or designee; and 5) Implementing the accommodation or determining that the accommodation would be an “undue hardship”.

Should the accommodation create an “undue hardship” for the Agency, the prospective employee will be offered the opportunity to implement the accommodation on their own.