CITY OF HOLLYWOOD GENERAL FUND AGENCY GRANT PROGRAM APPLICATION REQUEST FOR FUNDING FISCAL YEAR 2018 The City of Hollywood City Commission will consider applications for General Fund Agency Grants to agencies that provide services to residents of Hollywood for fiscal year 2018. Applications shall be submitted for a one-year grant cycle dependent on the following criteria: 1) Availability of funds from the City s General Fund 2) Applicant is a non-profit organization 3) Performance of agency against quantifiable and measurable criteria, which the agency must specify 4) The City s receipt and approval of all insurance certificates required by the City s Risk Manager. Application Requirements Applicant programs/projects must align with at least one of the eight (8) Focus Areas: 1) Art and music 2) Education concentrated in the areas of math and science 3) Health, wellness and nutrition 4) Shelter and housing 5) Respite care and services 6) Diversity and cultural outreach 7) Training and career planning/development 8) Veteran services Applications including all required attachments (see section XI below) must be submitted by the deadline of February 23, 2017 at 3:00 p.m. to: City of Hollywood, Budget Administration Division Attention: Hilde Johnson 2600 Hollywood Boulevard #415 Hollywood, FL 33020 City of Hollywood General Fund Agency Grant Application 2018 1
Submissions must consist of: One (1) typed or clearly printed completed, original, signed and dated application form along with all attachments. Fifteen (15) double-sided photocopies of the package (application and attachments) with each package separated by a colored sheet of paper, or a binder clip. Please do not staple or use any other form of clip, band or binding. A PDF copy of the entire application package (including attachments). A Microsoft WORD copy of the completed application (without attachments). The PDF copy of the application and attachments, and the Microsoft WORD copy of the application should be submitted via email to hjohnson@hollywoodfl.org. All agencies receiving funding will be required to enter into a contractual agreement with the City which will specify performance and periodic financial and program reporting requirements. The City of Hollywood reserves the right to determine whether submitted proposals are eligible, timely and complete, whether funding requests are appropriate, and whether other considerations relating to the funding application and funding requirements have been met. All decisions of the City Commission are final and binding. Additional specific requests for follow-up information may be required by the City of Hollywood from the submitting agency when the information sought is deemed necessary and in the City s best interest. City of Hollywood General Fund Agency Grant Application 2018 2
APPLICATION COVER SHEET Agency: Address: City: State: Zip: Telephone: ( ) Fax No.: ( ) Federal Tax ID (EIN): Program Title: Primary Focus Area: Name of CEO or Board President: CEO or Board President Email: Name & Title of Grant Contact: Grant Contact Cell Phone: ( ) Grant Contact Email: Application must be signed by the applicant s CEO or Board President. By signing this application, the authorized representative certifies that the organization for which funding is sought has full knowledge of the grant request and is able to utilize the funds sought for their stated purpose. Print Name: Title: Signature of CEO or Board President: Date: City of Hollywood General Fund Agency Grant Application 2018 3
INFORMATION ON THE PROPOSED FY2018 PROGRAM/PROJECT: I. BRIEF STATEMENT OF THE AGENCY S PURPOSE AND MISSION: (350 word maximum) II. PROGRAM/PROJECT DESCRIPTION: a. Beginning program date b. Ending program date c. Days and Hours of Operation d. If your service agency function is to provide financial subsidies enabling your clientele to enroll in other programs, please check this box. e. Please provide a one paragraph description of your program that will be used as the summary description of your program for the review board. Please remain under the 350 word maximum. Include specific program activities including timeline and specific program strategy. (350 word maximum) City of Hollywood General Fund Agency Grant Application 2018 4
III. PROGRAM/PROJECT NEEDS AND OBJECTIVES: Include why the program/project is essential for the City of Hollywood. What needs will the program/project address? (350 word maximum) III. ANTICIPATED BENEFITS AND OUTCOMES: a. Describe the anticipated benefits of this program / project to Hollywood residents (200 word maximum). b. Describe the anticipated outcomes as the result of this program / project (200 word maximum). c. Total non-duplicated number of all clients, recipients or participants expected to be directly served by the proposed program / project in fiscal year 2018. d. Number of non-duplicated number of Hollywood residents expected to be directly served by the proposed program / project in fiscal year 2018. Please Note: For item IIId, please provide an accurate estimate of the number of unique residents of Hollywood you expect to serve throughout fiscal year 2018 (October 1, 2017 through September 30, 2018). Grant funding, if awarded, may be significantly less than the amount of funding requested in this application, yet, the number of Hollywood residents to serve is expected to remain the same as entered above. City of Hollywood General Fund Agency Grant Application 2018 5
V. STAFF QUALIFICATIONS: List the names and qualifications of staff involved in this program/project on the chart provided. Name Qualification(s)/Degree(s) Year(s) of Experience VI. PREVIOUS BENEFITS AND OUTCOMES: If the program/project was operating in 2016, please provide a year-end report with that year s accomplishments, the total number of clients, recipients or participants directly served by the program/project in 2016 and the number of Hollywood residents directly served by the program/project in 2016. If the program/project is currently operating in 2017, please provide a status update. (350 word maximum) City of Hollywood General Fund Agency Grant Application 2018 6
VII. COMMUNITY COLLABORATIONS AND PARTNERS: Describe the roles of collaborating agencies, programs and individuals if applicable. Attach letters of support from collaborators. (350 word maximum) City of Hollywood General Fund Agency Grant Application 2018 7
VIII. BUDGET (please use chart provided): What is the annual program/project cost? Provide the amount of funds requested and secured for the program/project. Secured funds may be from other grant sources or the applicant s budget. Because the intended purpose of this grant is to provide supplemental funding for program related activities, please do not request funding for non-program related expenses, such as administrative costs, insurance, advertising, etc. If more space is needed, please attach your budget in the same format. Budget Item Total Cost $ Requested $ Other Secured Funding Sources Total $ TOTALS = What is the estimated cost per Hollywood participant? Estimate of total agency revenues and expenditures. Fiscal Year Revenue Expenditures FY2018 $ $ City of Hollywood General Fund Agency Grant Application 2018 8
IX. OTHER FUNDING SOURCES DETAIL: List grants received from ALL sources including the City of Hollywood or its agencies during the preceding five (5) fiscal years. Examples of City funding sources would include the Agency Grant Program, the Community Redevelopment Agency, CDBG funding, Police Department grants, etc. Funding Source Amount Received FY 13 Amount Received FY 14 Amount Received FY 15 Amount Received FY 16 Amount Received FY 17 X. PROGRAM/PROJECT EVALUATION: How will you measure the success of the proposed program/project? (350 words maximum) City of Hollywood General Fund Agency Grant Application 2018 9
XI. ATTACHMENTS: Attachment A: Attach the most recent audited financial statement, preferably FY16. If agency does not have a certified audit, submit a compilation of financial statements, including income statement and balance sheet for the most recent year. Attachment B: Attach the most recent completed IRS Form 990. Attachment C: Attach the most recent letter from the Internal Revenue Service (or other evidence) determining the tax-exempt status under section 501 (C) (3), 501(C) (4), or 501(C) (6) of the Internal Revenue Code. Attachment D: Attach letters of community support for the proposed program/project. Attachment E: Attach a current Certificate of Insurance for Commercial General Liability Insurance naming the City as an Additional Insured with not less than the following limits: Products-Comp/Op Aggregate $1,000,000 Personal and Advertising Injury $1,000,000 Each Occurrence $1,000,000 General Aggregate $1,000,000 City of Hollywood General Fund Agency Grant Application 2018 10