2018 SUMMER CAMP SERVICE PROVIDER APPLICATION FOR FUNDING

Transcription

1 2018 SUMMER CAMP SERVICE PROVIDER APPLICATION FOR FUNDING

2 Applications will not be accepted or considered for funding if the application is incomplete or does not include the required information listed below. Application Checklist One Original application with two authorized signatures. Ten typed copies of the Summer Camp Funding Application for 2018 submitted on or before January 22, 2018 by 4:00 p.m. to Jill Marcum at 110 West Rich Avenue, Deland, FL Proof of Liability Insurance with the County of Volusia listed as additional insured must be provided prior to entering into an agreement with Community Assistance Current (within the last 12 months) fire inspection report for each camp location. If report notes deficiencies, proof of correction must be provided prior to entering into an agreement with Community Assistance Current IRS W-9 form Page 1 of 8

3 Agency Name: Legal Name (if different than above) Address: Telephone : Fax: Executive Director: Contact Person: Contact Person s Telephone: Contact Person s Background Check: All employees of this agency working directly with children have undergone a level 2 background screening through the Florida Department of Law Enforcement (FDLE) for child abuse involvement. A level 2 background screen includes a fingerprint check of state and federal criminal history information conducted through FDLE and the Federal Bureau of Investigation. Records of this action are on file with the agency. A list of summer camp staff will be provided by start of camp. This agency is in good standing with the County of Volusia and local governments and has not had a contract(s) for service terminated for cause. Yes Yes No No Certification: I certify that the statements herein are true and correct, and are the established policies of my agency, to the best of my knowledge and belief. Agency Executive Director Date Agency Board President Date Page 2 of 8

4 1. Describe the mission of your agency: 2. List all camp locations by address: Camp Address 3. Provide dates of summer camp and time of operation: 2018 Summer Camp Program is funded June 4, 2018 July 23, Any dates outside of the official scholarship program schedule will not be eligible for funding. Dates of operation Time of operation 4. Provide beginning and end date, time, and location for camp registration: These dates and locations will be given to approved families. The registration end date will be used as the voucher expiration date, after the voucher expires the scholarship award is voided and the scholarship will be offered to another eligible child. Registration end date must be prior to start of camp. Date registration begins Date registration ends Time Location Page 3 of 8

5 5. How many scholarship eligible children will you accept? (Must agree to retain at least 20 children per site to be considered for funding) Agency must be selected by a minimum of 20 eligible scholarship children by the last application submittal date, April 17, 2018 to remain an approved provider. Summer Camp Site Total children to be served Number of scholarship children to be served 6. A. List primary point of contact and secondary point of contact for your agency. If contact changes provider must notify the County as soon as possible. Two different addresses must be provided below, agencies should have the ability to respond to messages within two business days. Name Title Best contact number B. Vouchers and fund requests are required to be mailed or hand delivered. Weekly attendance sheets should be submitted electronically. If you are unable to meet this requirement please explain below how you plan to submit the weekly attendance sheets. Page 4 of 8

6 7. Provide tentative daily schedule of planned activities: Time Activity (Example) 8:00-9:00 - Arrival time/arts and crafts 9:00-10:00 - Outside play (weather permitting) 10:00-11:00 - Reading activities 11:00-12:00 - Free play 12:00-12:30- Lunch 8. Provide list of staffing positions (add additional pages if needed): Position Number of staff 9. What types of training do you provide for your staff? Do you require your staff to have any specific certifications? Please describe. 10. Provide the child to staff ratio: Page 5 of 8

7 11. Provide the weekly rate and registration fee. If your agency offers discounted rates for members and/or city residents, please include the amount. Amounts submitted in this application will be published as part of the provider list attached to the family scholarship application. Any discounted rates must be clearly defined. County staff must be able to easily identify a child s appropriate rate. Weekly rate Registration fee Discount (if any) Explanation of Discount: 12. Please describe how your agency will supply the additional funds needed to operate for the full 8 weeks of summer camp. (Provider is reimbursed for expenses 2 times during the 8 week period with the remaining amount owed paid after the end of camp. The agency will need to have enough funds on hand to run the program.) Page 6 of 8

8 13. A. Does your agency provide food? Yes No B. Please check the meals you provide: Breakfast Snack Lunch N/A C. If your agency provides food, what source do you use? 14. A. Does your agency offer field trips? Yes No B. If so, what type of trips do you offer? Is there an additional charge for field trips? 15. What type of transportation do you use for field trips? 16. Provide a brief summary of the agency s summer camp history. Include how long the agency has provided summer camp, average number of children served, what age group was served and the location where summer camp was provided (if other than current site). Page 7 of 8

9 17. Provide a brief explanation of any accidents occurring at your site/sites during the last summer cycle. Include how the problem was resolved. Page 8 of 8