OSCEOLA COUNTY COMMUNITY SERVICE AGENCY GRANT PROGRAM NONPROFIT ORGANIZATION APPLICATION FOR FUNDING COUNTY FISCAL YEAR 2018 (OCTOBER 1, 2017 SEPTEMBER 30, 2018) The Community Service Agency (CSA) Grant Program was initiated by the Board of County Commissioners (BOCC) in 2011 to address human service needs in Osceola County. The CSA Grant program collaborates with community organizations in assisting residents with specific needs in the County. To apply for FY 2018 funding, the following application must be completed and received by March 31, 2017. OSCEOLA COUNTY BOARD OF COUNTY COMMISSIONERS C/O HUMAN SERVICES DEPARTMENT Community Service Agency Grant Program County Fiscal Year 2018 Page 1 of 16
Application Submission Instructions Please review the application thoroughly before you begin. Organize your information carefully for each section based on the section heading. Follow the instructions and page allowances per section. Reviewers may disregard pages that exceed the stated limitations. Components: A. Please prepare one (1) original application, labeled ORIGINAL on the cover page and place in a 1inch soft-sided binder. B. Prepare an additional Seven (7) copies of the application. Please fasten each copy with a staple or binder clip. C. Prepare one (1) thumb drive that includes a PDF file of the complete application including all attachments. Presentation: 1. The original application must be presented in a soft sided, one inch (1 ) three-ring binder. 2. The application must include a table of contents and labeled tabs identifying each section. 3. No hand-written applications will be accepted. 4. Pages must be typed using a twelve (12) point font, single spaced paragraphs, with no less than one-half inch (1/2 ) margins, top, bottom and sides. 5. Please follow the page limit instructions for each section. 6. A check list has been provided listing all of the components of the grant application. The original application (including attachments) prepared according to the above instructions, ten copies of the complete fully executed application, and a thumb drive containing a PDF file of the complete fully executed application must be received no later than 5:00 PM, March 31, 2017 to be considered for funding. Submit to: Osceola County CSA Grant Program Human Services Department 330 North Beaumont Avenue Kissimmee, FL 34741 Page 2 of 16
SECTION I. APPLICATION CHECKLIST When submitting the application, be certain that it is complete and includes all necessary attachments and signatures. Section I Application Checklist (Section Value) Section II Administrative Information Section III Program Description (20 Points) Section IV Uniqueness of Service Organization (10 Points) Section V Contribution to Citizens (20 Points) Section VI Number of Participants, Sustainability (20 Points) Section VII Strategic Plan: Objectives & Performance (10 Points) Section VIII Budget Information (A through F) (20 Points) Section IX Section X Statement of Assurances Accounting System Certification NOTE: Applications approved for county funding will become an attachment to a contract between Osceola County Board of County Commissioners and the Applicant. Page 3 of 16
SECTION II. ADMINISTRATIVE INFORMATION Complete the contact information indicated. 1. AGENCY NAME: Name: Address: Telephone: Email: Tax Exempt No: 2. CONTRACT/PROJECT DIRECTOR: Name: Address: Telephone: Email: 3. CHIEF FINANCIAL OFFICER: Name: Address: Telephone: Email: 4. OTHER: Name: Address: Telephone: Email: Page 4 of 16
SECTION III. PROGRAM DESCRIPTION: 20 Points In a concise narrative, briefly describe the mission of the applicant agency. Describe the specific need for the program services identified for funding. Be certain to provide current data that fully defines the nature and extent of the targeted issues to justify the need for funding. Describe how the requested funding will be applied. A maximum of three (3) typed pages is allowed for Section III., Program Description. Page 5 of 16
SECTION IV. UNIQUENESS OF SERVICE ORGANIZATION 10 Points Explain how the program services identified for funding are unique among Osceola County nonprofits agencies that may provide similar services. Provide requested attachments. A maximum of two (2) typed pages is allowed plus requested attachments for Section IV., Uniqueness of Service Organization 1. Provide an Agency Organizational Chart. 2. Provide resumes for staff members involved in the PROGRAM described for funding. 3. Provide a list of names for the Board of Directors, including position held on the board, years served, term expiration date. 4. Provide a schedule of the annual board meeting dates and the number of board members in attendance at each meeting. 5. Calculate the percentage of the board members in attendance at the board meetings during the calendar year ending December 31: Board Member Name Position Years served Term expiration date Other Page 6 of 16
SECTION V. CONTRIBUTION TO CITIZENS 20 Points Quantify the activities of the program identified for funding and how those activities affect the lives and welfare of citizens. Use this section to detail the value that is brought to the community through the County s financial support. Be certain to illustrate clearly the cost benefit that is returned from the County s investment in your program as it applies to citizens lives and welfare. This could include leveraging of resources, value of donated time by volunteers and community partners or other valuations. The potential costs for other programs if the funding were not provided should also be included. A maximum of two (2) typed pages is allowed for Section V., Contribution to Citizens. Page 7 of 16
SECTION VI. NUMBER OF PARTICIPANTS, SUSTAINABILITY 20 Points Annually, how many Citizens participate in and benefit from your services? How many Citizens, specific to the program identified for funding, will benefit directly from the funds requested? Describe the plan for program sustainability. A maximum of two (2) typed pages is allowed for Section VI., Number of Participants, and Sustainability. Page 8 of 16
SECTION VII. STRATEGIC PLAN, OBJECTIVES & PERFORMANCE: 10 Points Describe how the identified program meets one or more elements of the Osceola County Strategic Plan included as part of the NOFA. In narrative form, identify at least three (3) specific objectives of the Program and how attainment of the objectives will be measured. Each objective must include: (1) Need (objective to be satisfied) (2) Proposed activity that satisfies the Need (3) Outcome from accomplishment of the objective A maximum of two (2) typed pages is allowed for Section VII., Strategic Plan Objectives & Performance. Page 9 of 16
SECTION VIII. BUDGET INFORMATION A through F: 20 Points (A) SUMMARY Please complete the summary information below. The Total Program Budget Amount must include all requests for funding from other sources. Itemization of non-county funds is requested under the CSA GRANT PROGRAM REVENUE section. Disclose the amount of CSA grant funding awarded for FY2012/13. Disclose the amount of CSA grant funding awarded for FY2013/14. Disclose the amount of CSA grant funding awarded for FY2014/15. $ $ $ Disclose the amount of CSA grant funding awarded for FY2015/16. Disclose the amount of CSA grant funding awarded for FY2016/17. $ $ The funding request for the grant program must be a minimum of one percent (1%) of the total grant program budget. REQUESTED CSA GRANT FUNDING - FY2018 (OCTOBER 1, 2017 SEPTEMBER 30, 2018) $ TOTAL PROGRAM BUDGET FY2017 $ TOTAL PROJECTED PROGRAM BUDGET - FY2018 $ Projected Increase/Decrease in Total Program Budget comparison FY2017 with projected FY2018 $ Page 10 of 16
SECTION VIII. BUDGET INFORMATION (B) CSA GRANT PROGRAM BUDGET EXPENSES The expenses on this page should reflect only the specific program for which CSA Grant funding is requested. If the program is not active at this time, fill out only the proposed column. (Report only a calculated portion of the Agency Budget that pertains to the specific Program for which funding is requested.) PROGRAM BUDGET EXPENSES PROGRAM PERSONNEL EXPENDITURES: PROGRAM OCCUPANCY EXPENDITURES: Professional Staff Salaries Support Staff Salaries Employee Benefits Payroll Taxes/Other TOTAL PERSONNEL EXPENSES: Building Lease/Rent Maintenance Utilities Insurance TOTAL OCCUPANCY EXPENSES: PROGRAM OPERATING/PROGRAMMATIC EXPENDITURES: Office Supplies Office Expense/Computer Communication Printing Direct Services Professional Fees/Outside Consultants Staff Travel Staff Development/Training Volunteer Expenses Awards Advertising Subscriptions/Publications Fundraising Expenses Support to Parent Organization Dues Licenses, Taxes, Insurance Equipment Lease/Maintenance Vehicle Maintenance Depreciation Expense Interest Expense Annual and Special Meetings Miscellaneous Expenses Current 2016/2017 Proposed 2017/2018 Page 11 of 16
Other TOTAL OPERATING/PROGRAMMATIC EXPENSES: SECTION VIII. BUDGET INFORMATION (C) PROJECT BUDGET NARRATIVE In narrative form, detail how the requested County funds will be expended per line item as reported under the CSA GRANT PROGRAM BUDGET. A maximum of two (2) typed pages is allowed for Section VIII., Project Budget Narrative. Page 12 of 16
SECTION VII. GRANT PROGRAM BUDGET INFORMATION (D) CSA GRANT PROGRAM REVENUE The revenue on this page should reflect only the specific program for which CSA Grant funding is requested. If the program is not active at this time, fill out only the Proposed 2017/18 and Secured 2017/18 columns. (Report only a calculated portion of the Applicant Agency income that pertains to the specific Program for which funding is requested.) Funding Source Category* Current 2016/2017 Federal Sources Proposed 2017/2018 Secured 2017/2018 State Sources Osceola County CSA Grant Request Other County funding Applicant Agency Client Service Fees Fund Raisers Thrift Shop General Sales Investment Income Memberships Individual Contributions Other: Business Contributions Foundations/Trust Other Total Program Revenue Page 13 of 16
Total CSA Grant Program Expenses (from Section B.) SECTION VIII. BUDGET INFORMATION (E) FORM 990 Attach a copy of the Agency's form 990 Department of the Treasury Internal Revenue Service Return of Organization Exempt Form Income Tax: Part I Summary page with Signature only. (F.) ORGANIZATIONAL FINANCIAL AUDIT Attach a copy of the applicant s most recent organizational Financial Audit: Comments and Findings sections only. Page 14 of 16
SECTION IX. STATEMENT OF ASSURANCES As a condition of receipt of County funds, the applicant must comply with the requirements of courts, local, state and federal laws, rules, regulations, and guidelines. As a part of the application and as a part of acceptance and use of County funds, the applicant agrees that: 1. It possesses legal authority to apply for the assistance, that the application has been approved by the applicant's governing body, including all assurances contained herein. 2. It will utilize County funds to provide a range of services and activities having measurable and potentially major impact on the community's mental and physical welfare needs. 3. It possesses the sound fiscal controls and fund accounting procedures necessary to assure the proper disbursal of an accounting for County funds. 4. It will permit and cooperate with county, state, and federal investigations designed to evaluate compliance with the law. 5. It will give the Osceola County Board of County Commissioners, or its authorized representative complete access to examine all records, books, papers, or documents related to the assistance. 6. It will, in accordance with Florida Statutes, comply with nondiscrimination provisions. 7. It will, in accordance with Florida Statute 119.07, comply with the provisions of public examination of records in regards to said funds. 8. It will attest, the application and its various sections, including budget data, are true and correct. Information contained in this application accurately reflects the activities of this agency and that the expenditures or portions thereof for which the County funds are being requested are not reimbursed by any other source. 9. Upon being awarded assistance, the applicant agrees to furnish a certificate of insurance listing the Osceola County Board of County Commissioners as certificate holder. 10. An organizational chart of the Board of Directors and Administrators, including names and offices or position held will be submitted as part of the application. 11. The application will become part of a contract between the Board and the Applicant. AGENCY AUTHORIZED OFFICIAL: Name, Title Signature Date Page 15 of 16
SECTION X. ACCOUNTING SYSTEM CERTIFICATION A. STATEMENT OF FINANCIAL OFFICER I am the Chief Financial Officer of (name of organization) and, in this capacity, I will be responsible for providing financial services adequate to insure that establishment and maintenance of an accounting system for this organization, which is a non-profit agency charged with carrying out a program(s) under County funding. The accounting system will have internal controls adequate to safeguard the assets of such agency, and the accuracy and reliability of accounting data, promote operating efficiency, and encourage compliance with prescribed management policies of the agency. (Name of Organization) (Name of Chief Financial Officer) (Signature of Chief Financial Officer) (Date) (Telephone Number) Page 16 of 16