Download Community Impact Grant Application Part 2 - Volunteer

Insert Agency and Program Name Here
United Way of Pickens County
Mailing Address:
P.O. Box 96
Easley, SC 29641
Physical Address:
201 South Fifth Street
Easley, SC 29640
Page 1 of 12
phone: (864) 850-7094
fax: (864) 306-8675
www.uwpickens.org
2012 Community Impact Grant Application
Application Deadline: Thursday, March 8 at 4:00pm – no exceptions
ORGANIZATION INFORMATION
Organization Name:
Address:
City, State, Zip:
Contact Person:
Phone:
Email:
Title:
Fax:
Website:
Select the most relevant focus area (one area ONLY) that the proposed program addresses:
Education and Youth Development
PROGRAM INFORMATION
Program Name:
Dollar Amount Requested:
Total Program Budget:
Total Organizational Budget:
Financial Stability
Community Basics
$
$
$
PROGRAM COMPLIANCE
The United Way of Pickens County Community Impact grant application is a competitive process.
Applications must be correctly completed to be considered for funding. Please be aware of our
general guidelines as well as instructions from our instruction packet:
1. Please read the Community Impact Priorities and Instruction Packet before filling out
the application.
2. Applications must remain fully intact, including the question or prompt itself. When you type
under a prompt, your answers will self-populate in the application.
3. Use regular Times New Roman or Cambria 12-point font to answer questions or prompts.
Doing this will distinguish your answers from the prompts or questions. Please do not fill out
the application in bold or italicized font.
4. When the application prompts you to insert your program or agency name in the header (these
prompts will be in italics), please delete those words and insert the information regarding your
particular program and agency.
5. On March 8 when the original copy of your proposal is due, submit three (3) 3-hole-punched
copies in individual manila folders to the United Way address above. You may also hand
deliver the applications to the United Way office. Do not staple the applications.
Insert Agency and Program Name Here
Page 2 of 12
6. On April 12 when the final copy of your proposal is due, submit five (5) 3-hole-punched copies
of the grant proposal in individual manila folders to the United Way address above. You may
also hand deliver the applications to the United Way office. Do not staple the applications.
7. Submit one (1) copy of the grant proposal electronically via email to Lisa Watkins, Community
Impact Associate at [email protected] on March 8 (original copy) and again on April 12
(final copy).
8. Include one (1) copy of your data collection tool (survey, assessment, chart, etc.) on March 8
when you submit the original copies of your application.
If you would like manila folders returned to you after these applications have been received, please
do not mark on the outside or staple/tape folders closed. We will keep reusable folders for you to use
in the future.
Insert Agency and Program Name Here
Page 3 of 12
Community Impact Grant Application
Part 1 – Agency and Program Description
Mission Alignment
1. Please insert your board approved agency mission statement and approved agency
objectives here:
2. Program mission and objectives (150 word limit):
3. Explain how this program aligns with your agency’s mission and objectives (100 word
limit):
Target Population
4. Specified target population (50 word limit):
5. Explain how your target population is selected (100 word limit):
Number of Individuals Served
6. Estimated number of individuals or households that will be served in Pickens County
through this program this fiscal year:
7. Projected number of individuals or households that will be served in Pickens County
through this program next fiscal year if this funding request is granted in full:
Alignment with United Way Strategies
8. Under which specific Community Impact goals does your program fall? (Check applicable
strategies/outcomes from the one focus area under which this program is being applied)
Focus Area: Education and Youth Development
Goal 1: Early Childhood Development
Parents and/or expectant parents obtain the essential skills necessary to raising infants
and/or young children
Young children (under 5) have the tools necessary to succeed in a school environment
Goal 2: Academic Achievement and Success
Youth understand the importance of educational achievement and graduation
Youth are academically prepared to achieve and graduate
Youth develop a plan for their life after graduation
Youth reduce risky behaviors
Youth are equipped with necessary life skills
Youth are civically engaged
Focus Area: Financial Stability
Goal 1: Employment Training and Job Connections
Individuals obtain job skills through training and retraining
Individuals have soft-skills training to help secure stable employment
Barriers to job training and education (childcare, transportation, etc.) are decreased
Insert Agency and Program Name Here
Page 4 of 12
Goal 2: Financial Literacy and Stability
Individuals have the skills necessary to be responsible money managers
Individuals have acquired computer literacy skills
Focus Area: Community Basics
Goal: Supporting Services for Families and Individuals in Times of Need
Individuals and families have access to food, meeting their hunger and nutrition needs
Individuals and families have access to shelter and to assistance that helps them meet
their shelter needs
Individuals and families have access to medical, mental health, counseling and addiction
services
Individuals and families have transportation available to help meet basic daily needs
9. Based on your selections above in Question 8, explain how your program works or
functions, including a description of program activities or components, and how it
achieves the Community Impact outcomes that you selected above (500 word limit):
Insert Agency and Program Name Here
Page 5 of 12
Community Impact Grant Application
Part 2 – Financial Information
Program Sustainability
10. What type of funding are you applying for (check any that apply):
Operational funds *
Program upstart
Program sustainment
Program enhancement
* Operational funds will be granted at a maximum of 30% of the total program budget.
11. Briefly discuss how you will sustain this program past this fiscal year (100 word limit).
12. Please list the other sources of funding you have secured for the proposed program in
addition to Community Impact funds.
Program Efficacy
13. Has this program received Community Impact funds before?
Yes
No
If yes, please provide us with the fiscal year(s) and amount(s) you were funded:
Fiscal Year
Amount
$
$
$
$
For each year that you have received Community Impact Funds, please list the
outcomes that were made possible with the support of a United Way of Pickens County
Community Impact grant (150 word limit):
14. For agencies that have not received Community Impact funds before:
a. If your program has been in existence for one year or more, please list the
outcomes made possible as a result of your program (150 word limit):
b. If your program is a new program this year, please list the outcomes you expect to
result from your program (150 word limit):
Insert Agency and Program Name Here
Page 6 of 12
Community Impact Grant Application
Part 2 – Financial Information
REVENUES:
1 UWPC Community Impact grant contribution
2 Other UWPC funds (traditional) contributing to this project
3 Funding designated to Pickens County from other United Ways
4 Contributions from individuals
5 Contributions from foundations or charitable organizations
6 Contributions from corporations
7 Government grants or income
8 Income from fundraising or special events
9 Program fees or other earned income
10 Investment income
11 Other (please explain):
12
*** TOTAL PROGRAM REVENUES – Total of lines 1-11
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
EXPENDITURES:
OPERATIONAL EXPENSES (≤ 30% of total)
Executive and administrative salaries/wages
Executive/administrative fringe/payroll taxes
Consultant and professional fees
Organizational marketing or advertising
Rent and Utilities
Office supplies/printing/postage
Communications (telephone, internet, etc.)
Equipment purchase, rental, maintenance
Other (please list):
Other (please list):
$
Column 1
UWPC Impact
grant
Column 2
Revenues from
all other
sources
Column 3
Total program
expense
-
-
-
$
TOTAL OPERATIONAL – Total of 14-23
PROGRAMMATIC EXPENSES:
Program staff salaries/wages
Program staff fringe/payroll taxes
Program staff training
Program staff travel
Direct assistance to clients
Material or supplies for client
Curriculum purchase or development
Program evaluation or outcome monitoring
Other (please list):
Program
Budget
-
$
-
$
$
*** TOTAL EXPENDITURES
36
$
$
Total of Line 24 and Line 35
*** Total amount in Line 12 should equal total amount in Column 3 of Line 36.
TOTAL PROGRAMMATIC – Total of lines 26-34
$
-
$
$
Insert Agency and Program Name Here
Page 7 of 12
Community Impact Grant Application
Part 2 – Financial Information
Please detail and clarify by explaining the line-item expenditures on your program budget to
present a clear picture of how the Community Impact grant funds will be spent. Please include
dollar amount from the budget table. Line items from column 2 (other revenue sources) do not need
to be included in this section.
Program Implementation
OPERATIONAL EXPENSES
Line 14 - Executive and Administrative Salaries and Wages (percentage of all executive
or administrative salary paid through the Community Impact grant as it pertains to each
employee’s involvement in the specific program):
Line 15 - Executive and Administrative Fringe Benefits/Payroll taxes:
Line 16 - Consultant and Professional fees:
Line 17 - Organizational Marketing or Advertising:
Line 18 - Rent and Utilities:
Line 19 - Office Supplies/Printing/Postage:
Line 20 - Communications:
Line 21 - Equipment Purchase, Rental, Maintenance:
Line 22 - Other (please explain):
Line 23 - Other (please explain):
PROGRAMMATIC EXPENSES (please discuss how these funds will be used as it relates to program
upstart, program sustainment, or program enhancement as chosen):
Line 26 - Program Staff Salaries and Wages:
Insert Agency and Program Name Here
Page 8 of 12
Line 27 - Program Staff Fringe Benefits/Payroll Taxes
Line 28 - Program Staff Training:
Line 29 - Program Staff Travel (cost of program-related travel, including travel to
meetings, conferences and trainings):
Line 30 - Direct Assistance to Clients:
Line 31 - Material or Supplies for Client:
Line 32 - Curriculum Purchase or Development:
Line 33 - Program Evaluation or Outcome Monitoring:
Line 34 - Other (please explain):
15. Will you accept partial funding?
Yes
No
If yes:
If you were to receive 75% of your funding request, explain in detail how you would use
these funds and how your program would be affected (specifically, how would it change
the way your program functions).
If you were to receive 50% of your funding request, explain in detail how you would use
these funds and how your program would be affected (specifically, how would it change
the way your program functions).
If you were to receive 25% of your funding request, explain in detail how you would use
these funds and how your program would be affected (specifically, how would it change
the way your program functions).
16. If you will not accept partial funding, please explain why (include an explanation for any
percentage level listed above at which you will not accept partial funding):
Insert Agency and Program Name Here
Page 9 of 12
Community Impact Grant Application
Part 3 – Outcomes measurement
The United Way of Pickens County is committed to measuring the effectiveness and efficiency of
funded programs through logic models and outcomes measurement. Logic models are a
freestanding explanation of your program. They follow an “if-then” series of thought. A logic
model consists of inputs, activities, outputs, and outcomes.
Inputs are the resources invested in the program through your agency to make it run. They are
the resources that enable you to produce outputs.
Inputs are resources dedicated to or consumed by the program, such as:
• Money
• Equipment and supplies
• Staff and staff time
• Laws and regulations
• Volunteer and volunteer time
• Funder’s Requirements
• Facilities
Activities are the services your program provides to help meet its overarching goals. The results of
your activities are your outcomes, or the effects that you want to see as a product of the program.
Activities are what the program does with the inputs to fulfill its mission, such as:
• Feed and shelter homeless
• Provide job training
• Educate public about signs of child abuse
• Counsel pregnant women
Outputs are the direct products of activities. Outputs can reflect actual counts of people served
and/or quantity of services provided.
Outputs are the direct products of program activities, such as:
• 12 classes taught
• 45 counseling sessions
• 130 educational materials distributed
• 500 hours of service delivered
• 25 participants served
Outcomes are the results associated with your program. They are the benefits the clients or
participants receive during or after the proposed program. Outcomes are the reason why you are
offering a program or service—they are the change you want to make and should be measurable.
Outcomes are the benefits for participants during and after program activities, such as:
• New knowledge
• Modified behavior
• Changed behavior
• Improved condition
• Increased skills
• Altered status
Please provide a clear logic model for your program using the template on the following
page. The logic model should be complete so that it can be understood outside of the
context of the application.
Insert Agency and Program Name Here
Page 10 of 12
[Insert program name here] – Logic Model
Inputs
Activities
Outputs
Outcomes
Resources invested in the organization
that enable the program to function.
Services your PROGRAM provides to
help meet its overarching goals and
create the change you expect to see as a
result of your program.
Direct products of activities. Outputs
show actual counts of people served
and/or quantity of services provided
(use NUMBERS).
Results associated with you program;
specifically, benefits for the clients or
participants during or after the
program. (SEE INSTRUCTIONS!)
Please list your inputs in this column:
Please list your activities in this column:
Please list your outputs in this column:
Please list your outcomes in this column:
*** This form is read vertically—each column is a separate list. It is not necessary to have the same number of items in each list.
Insert Agency and Program Name Here
Page 11 of 12
Community Impact Grant Application
Part 3 – Outcomes Measurement Plan
A clear understanding of a program’s intended outcomes helps to focus the work of the program.
The following outcome measurement plan seeks to capture how and when your program will
collect the stated outcomes.
The outcome measurement plan consists of the following columns: outcome, indicator, data
collection, and timeframe. For the outcome column, simply restate the outcomes from your
logic model. Be sure to list the more immediate outcomes first, followed by intermediate and
long-term outcomes.
The timeframe column refers to when you expect your stated outcome to occur. It should tell the
grant reviewer when you expect to learn or see the results of your program. These results might
occur immediately upon service delivery, after several months, after one year, or after many years.
For example, if a specified outcome is to “improve the reading levels in children ages 8-10” and
you expect the children in your program to show improvements by the end of the school year,
then your timeframe could look like, “At the end of the first school year” or “June 2013”.
An indicator is used to measure the success of an outcome. An indicator is like the “benchmark for
success” for your particular program. Indicators are typically written as a percentage.
For example, if a specified outcome is to “improve the reading levels in children ages 8-10”, then
an indicator of that outcome could look like “75% of all children that finish the program will
improve their reading level by one grade.”
The data collection column refers to how you will collect the data on your outcomes. Common
types of data collection are pre-tests and post-tests, assessments, observation by a trained
professional, open-ended client questions, and focus groups. Be sure to attach these methods of
collection onto the end of the application.
Please fill in the following outcome measurement plan on the following page:
Insert Agency and Program Name Here
Page 12 of 12
[Insert program name here] – Outcome Measurement Plan
Outcomes
(transpose outcomes from
Logic Model)
Timeframe
Indicators
Data Collection Method
Results associated with your program;
benefits for the clients or participants
during this time period.
Specify when you expect this outcome
to occur; at what point do you expect to
see your stated outcomes/results?
What are the measures or indicators of
success for each outcome? (consider
using PERCENTAGES)
Please specify:
 Who collects data
 From whom is data collected
 How is data collected and with what tool
 When data is collected; how frequently
*** This form is read horizontally—each outcome should be measured with a corresponding timeframe, indicator and data collection method.