APPLICANTS OR APPLICATIONS THAT DO NOT MEET THE ABOVE CRITERIA ARE NOT ELIGIBLE AND WILL NOT BE CONSIDERED FOR FUNDING.

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1 2012 Cherokee Nation Community Work Program Information Sheet The purpose of the Community work program is to provide small amounts of funding to assist communitybased organization, within the Cherokee Tribal Jurisdictional boundaries that are majority operated and Managed by Cherokee Tribal members, to organize around issues and projects that have broad community support. Answer all questions to the best of your ability. Projects should have a self-help focus and must be aimed at improving the community. These are considered investments in that the return or payback to the Cherokee Nation is in the form of stronger Cherokee Communities. The awards are made through a competitive process. Projects shall compete within districts based on criteria contained in the application packet. Groups that are permanently operated and managed by Majority (51%) of organizational board members of Cherokee Nation Citizenship are eligible to apply. Please submit copies of blue tribal membership cards. Projects may consist of a wide range of activities as long as they meet the primary purpose of the program. Examples of previously funded projects include construction of community building, waterlines, recreational facilities, and the development or operation of youth sport programs. The project activities must take place and the organization must be located within the Cherokee Nation Jurisdictional Boundaries. Clear deed to land (minimum of 2 acres) must be in community organization s name or a minimum year property lease with an outside entity at the organizations expense. Projects must be primarily for the benefit of Cherokee Citizens. Proposals who request funds equal to the amount of contributions (primarily community work ) to be provided by the applicant organization will be given preference. Applications must be received in the Community Work Project Office before 2:00 p.m. on January 27, APPLICANTS OR APPLICATIONS THAT DO NOT MEET THE ABOVE CRITERIA ARE NOT ELIGIBLE AND WILL NOT BE CONSIDERED FOR FUNDING.

2 Cherokee Nation Community Work Project Funding Application (Please read all attached instructions before completing this form) 1. Name of Project 2. Dollar amount requested 3. Name and Mailing address of Applicant/ Group/ Organization applying for funds. 4. Applicant/ Group/ Organization applying for funds Tax ID Number: (Required to complete this application. If you need assistance attaining this number please contact our office) 5. address: Fax# 6. County 7. Community (include direction to your project starting from the nearest town eg. from Stilwell go south ): 8. Contact Names: Phone# Phone # Phone # (Please make sure that Contact persons are people with phone numbers that are easily available and can deliver messages if necessary.) They do not necessarily have to be decision makers, i.e. Board Members, but they do need to be people that can get us answers, information, etc.)

3 9. Describe the proposed Project: (attach additional pages if needed.) 10. How will the community be able to match the funding on a dollar for dollar basis (Which should primarily be in the form of community work)? This must be in detail with the specific jobs/ activities to be done, the dollar amount assigned per hour, the basis on the dollar amount proposed, etc. which all must add up to at least the same amount of the Cherokee Nation funds requested. You will put how you propose to use Cherokee Nation funds in a different section. Make sure that the proposed Matching work/ activities are things necessary to complete the project and enhance the cohesiveness of the community, etc. Contracting or payment to TERO approved vendors may be allowed on a case by case basis. The projects with a self help volunteer component will be given preference. You will probably need to attach additional pages to fully answer this item.

4 11. Submit a proposed completion date for this project by specific dates and major things to be accomplished in a 3 phase funding system assuming the project was awarded on January 1, Attach a proposed budget for the project demonstrating how the project will be completed within the funded amounts. Please include (2) material estimates for your proposed budget. TERO vendors should be given preference. 13. How will the proposed project enhance the cohesiveness of the community?

5 14. Do any member(s) of the organization have experience and/or qualifications to carry out the project? If so, please list their names and skills they may have. 15. Show how the community will maintain and operate the project, from the community s own resources after the Cherokee Nation funding has been spent... Please include other Cherokee Nation partnerships, if applicable. 16. What is the annual operating budget for your organization, and what is the source of those funds? 17. How will the proposed project benefit primarily Cherokee Nation Citizens in the Community? What number of Cherokee Tribal Citizens will benefit from the project?

6 19. Provide proof that the organization is permanently controlled, managed and administered by a majority (51%) of Cherokee Nation Citizens which should include the most current documents, such as by-laws, charter, etc. Attach a list of your governing board, including names, home addresses, current phone numbers, and indicate whether they are Citizens of the Cherokee Nation by submitting copies of blue membership cards. We must have some sort of written document that proves the applicant meets the requirements of being Permanently controlled, managed, and administered by a majority of Cherokee Nation Citizens. If this can not be shown or the information is insufficient the application will not be considered for funding. 20. Bookkeeping / accounting methods, i.e. the manner by which you will keep track of money and assure that it is used for intended purposes. Keep in mind, Cherokee Nation has the right to conduct an internal audit of funds awarded for these projects to each organization. 22. Has this organization or any of its members received funding for projects in the past through the Cherokee Nation? Yes No, If yes, has the project been completed and all of the necessary reports submitted. If No, Please explain why the project is not completed and understand that your project may be in jeopardy of further funding. 22. Authorized dated signature of person representing the group or community submitting the Application Signature Date

7 INSTRUCTION FOR COMPLETING THE FUNDING APPLICATION Item 1. Name of Project: Enter the name of the Project on which the requested funds will be spent. 2. Amount Requested From Cherokee Nation: Enter dollar amount being requested from the Cherokee Nation. This should be based off of actual estimates for material and time. 3. Name and address of Group/Applicant/Organization: Enter the name and mailing address of the Group/Applicant/Organization making application for Cherokee Nation Community Work Project funds. 4. Agency Tax ID Number: Enter the Tax Identification Number (TIN) of the Group/Applicant/Organization applying for these funds. Example: Business or corporation number, Federal Tax Identification number. If you need assistance in completing the form contact our office. 5. address and Fax#: Enter Address and Fax number if available. 6. County: Enter name of the county and the Cherokee Nation District where the project is/or will be located. 7. Community: Enter the name of the community served by the proposed project. 8. Contact Names: Enter names and telephone numbers of individuals to contact for information on the project. 9. Describe the proposed project: Fully describe how the requested funds will be used. 10. Matching Preference: Please refer to the question for the detail on how to respond 11. Schedule for Project: List dates of proposed schedule for start-up, operation, and completion of project. Assume funding would be available January 1, Budget: Attach a proposed use of the funds by major categories. Give sufficient information that allows an assessment of whether the costs are reasonable and necessary for completion of the project. 13. Cohesiveness: Explain how the project will make the community stronger by involving more Cherokee Citizens in meeting self determined priorities, more self-sufficient by relying on things other than short term funding, such as community work, grants, etc., and able to survive and prosper even if various programs for individuals no longer exist.

8 14. Experience and Qualifications: Provide information on the prior Experience and/or education of people who will be directly involved in the project that will show that it can be successfully carried out with a minimum of oversight from the Cherokee Nation. Evidence can include prior organization experience and activities as well. 15. Maintenance and Operation: Anything built, purchased or program build or created must be able to be continued, maintained and/or operated from the resources of the community or group and not from Cherokee Nation sources. Show how this is being and will be done. 16. Current operating budget: Provide information, as applicable to show how much money and assets the organization has and can be expected to obtain in the next year. This information will be used to demonstrate both the ability to maintain, operate, and/or continue activities/building/etc. and to show need. 17. Impact on Cherokee Citizens: Explain how the project is primarily designed to include Cherokee Nation Citizens in the design, implementation, management, and benefit from the project. 18. Cherokee Citizen Controlled Organization: See questions for detail as to what to provide. 19. Bookkeeping/Accounting: Explain the bookkeeping/accounting procedures or process that will be used to manage the project fund. 20. Past Funding: Explain if the Organization has received past funding and completed those projects 21. Authorized signature: The application must be signed by a board member or other representative authorized by the community/ group to sign on its behalf. Mail completed application to: Cherokee Nation Community Services Community Works Program P.O. Box 948 Tahlequah, Ok Application must be received in the Community Work Project Office prior to 2:00 p.m. January 27, Any application received after this time will not be considered. NO EXCEPTIONS. For more information contact: (918) or (918)