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Home My WebLink AboutCOG SPCS Grant Application Final FY 2021-22 Updated 5.3.2021FY2021-22 CITY OF GEORGETOWN STRATEGIC PARTNERSHIPS FOR COMMUNITY SERVICES GRANT APPLICATION City of Georgetown Checklist of Attachments and Signature Page Email the completed Application with required attachments to shirley.rinn@georgetown.org , mail to City of Georgetown, Attn: Strategic Partnerships for Community Services, P.O. Box 409, Georgetown, Texas 78627, or hand deliver to City Hall, 808 Martin Luther King, Jr. St., Georgetown, Texas 78626. The deadline to submit the completed Application is NO LATER THAN JUNE 12, 2021, by 5:00 PM. Late submissions will be declined without consideration. Signature Authorization and Certification of Information I certify, to the best of my knowledge, that all information included in this proposal is correct. The tax exempt status of this organization is still in effect. If a grant is awarded to this organization, then the proceeds of that grant will not be distributed or used to benefit any organization or individual supporting or engaged in unlawful activities. In compliance with the USA Patriot Act and other counterterrorism laws, I certify that all funds received from City of Georgetown will be used in compliance with all applicable anti-terrorist financing and asset control laws, statutes, and executive orders. __________________________________________________________ ___ _______________________ Signature & Title of Authorized Representative (e.g. Executive Director) Date __ ________________________________________________________ Printed Name and Title REQUIRED ATTACHMENT CHECKLIST Budget Information. Include: Program/Project Budget, including all funding sources and expenditures (Excel template provided); Actual Program/Project Budget for prior fiscal year (if applicable); Proposed Organizational Budget for current fiscal year; Organization budget for prior fiscal year. Previous fiscal year financials in PDF format (if e-mailed). Include: balance sheet; income statement; year-to-date financials (balance sheet and income statement). Logic Model Key Staff list. Include titles, short bio, and length of time employed. Please speak specifically to the staff member(s) who will be directing the program and explain why her/his oversight positions the program for success. Copy of the organization’s current 501(c) (3) IRS Letter of Determination indicating tax-exempt status. (If applicable a copy of your fiscal sponsor’s IRS Letter of Determination). Current Board member list. Specify the percentage of the Board members who make a financial contribution to your organization. Include the following information for each board member: Position and number of years served Professional affiliations (name of organization of employment and title) City and zip code of residence Citations and additional information (if applicable). This attachment may be used to cite any statistics/research, to define key terms and/or acronyms, and may include critical detail about your organization or program(s) not already in the grant (no marketing material, please). If applicable: Collaborative work with Georgetown Independent School District staff and/or students. (Attach District’s Letter of Approval). Most recent IRS Form 990, Form 990-EZ or Form 990-N Most recent independent financial audit including Auditors notes and Management Letter. (Both the 990 and audit documents should be the same fiscal year). If no audit is available, please attach a document that explains why to comply with Question 5a. *Do not include additional attachments other than the documents requested above. Please read the following statement and check the box certifying that this application is complete according to The City of Georgetown’s requirements. I have reviewed the City of Georgetown’s Strategic Partnerships for Community Services Grant Funding Policies and Guidelines to determine if this grant request meets their criteria for funding. FY2021-22 CITY OF GEORGETOWN STRATEGIC PARTNERSHIPS FOR COMMUNITY SERVICES GRANT APPLICATION Instructions: Complete City of Georgetown’s Strategic Partnerships for Community Services Grant Application Word template. Email the completed Application with required attachments to shirley.rinn@georgetown.org , mail to City of Georgetown, Attn: Strategic Partnerships for Community Services, P.O. Box 409, Georgetown, Texas 78627, or hand deliver to City Hall, 808 Martin Luther King, Jr. St., Georgetown, Texas 78626. The deadline to submit the completed Application is NO LATER THAN JUNE 12, 2021 by 5:00 PM. Late submissions will be declined without consideration. PART I. COVER PAGE Organization Name Date IRS Approved 501(c)(3) Status Organization’s legal name: (as shown on 501(c)(3) IRS Letter) Federal Tax ID # Mailing Address City and zip code Phone Number Website Address Program/Project Name Amount Requested Executive Director: (or top executive) (Please include prefix and title) Phone # Email Address: Main contact(s) for this proposal: (Please include prefix and title) Phone # Email Address: Board President: Phone # Email Address: Program or Project Information Program/Project Name Amount Requested Type of Request: Program or Project Support (check one) Program or Project Aligns with City’s Key Priority Area (check one or more) New program or project Existing program or project Expansion of an existing program or project New Collaboration Public Safety Transportation Housing Parks & Recreation Veteran Services Safety Net Program/Project Summary: 100 words or less summarize main objectives and anticipated results (one paragraph) # Current population served by organization (unduplicated individuals and geographic area(s) – cities, counties, etc.) (Unduplicated individuals and geographic areas(s) –cities, counties, etc.) # Target population served through this proposed program request in Georgetown (unduplicated individuals and geographic area(s) – cities, counties, etc.) PROGRAM/PROJECT STAFFING: Enter the total number of proposed staff to accomplish the program/project activities. # Full-time staff: # Part-time staff: # Volunteers: Organization’s fiscal year end date: through (i.e. 07/01/2021 through 06/30/2022) Organization’s annual budget: $ Total program/project budget: $ Type of Funding Request: (check all that apply) General Operating Support Other (explain) How did your organization hear about the City of Georgetown’s Strategic Partnerships for Community Services Grant Program? 1. About Your Organization / 1a. Organization Mission Character Limit: 500 1b. Organization Vision Character Limit: 1000 1c. Date of Incorporation Character Limit: 10 1d. Describe your organization's scope of work Character Limit: 2500 1e. Describe your organization's target population Character Limit: 1000 1f. How many unique individuals did your organization serve during the prior fiscal year? Character Limit: 100 1g. What geographic area does your organization serve? Character Limit: 500 1h. What is the purpose of this funding request? Provide enough detail about the program or project so that someone who is not familiar with it can understand what you hope to do, why it is needed and how it will impact your targeted population. Does the program or project address an emerging need or a critical community issue? If so, describe the need and explain how the program or project seeks to address the need. Describe the location of services, and length of services. Character Limit: 2500 1i. Who will your program or project serve? Please describe the program or project’s target population, including age, gender, and socioeconomic group it intends to impact. What geographic area will be served? How many Georgetown individuals will be served by the program/project? Character Limit: 500 1j. How does your program or project intend to achieve the above? How will you know if you are successful? Specifically what and or who will you measure or assess to achieve your program goals and objectives? Character Limit: 500 1k. What Organizations will collaborate with you on the program or project? Please list any partners or collaborators and describe the specific role of each. (i.e., agencies, businesses, schools, government entities and others). How does working with these partners/collaborators affect the success of this project/program? Character Limit: 1000 1l. How does the program or project intend to expend the grant? How will The City of Georgetown’s money be spent (description of amounts, e.g. Salary & Benefits $15,000; horses)? Provide a brief list of major budget items. Briefly, why do you propose these particular expenditures? Character Limit: 1000 2. Commitment to Georgetown / 2a. Is your organization's main office located in Georgetown? Choices Yes No If no, where is your organization's main office located? Do you maintain a satellite office in Georgetown? What is the address of the Georgetown-based satellite office? Character Limit: 1000 2b. What year did your organization start serving Georgetown? Character Limit: 10 2c. Describe your organization's work in Georgetown Character Limit: 1500 2d. How many unique Georgetown residents did your organization serve during the prior fiscal year? Out of the total number of unique individuals your organization served during the prior fiscal year (see Question 1f), how many Georgetown citizens did your organization serve? Character Limit: 10 2e. Please select the Georgetown (City limits, ETJ and immediate surrounding area) zip codes your organization serves Choices 78626 78628 78633 78673 78674 76537 76527 3. Funding Request / 3a. Please describe how SPCS grant funds will be used, if awarded. Character Limit: 1000 3b. Alignment with City of Georgetown’s Strategic Partnerships for Community Services Grant Funding Policies and Guidelines, and Target Population Describe how your organization and this funding request aligns with the City of Georgetown’s Key Priority Areas (Cover Page Part I) and your organization’s Target Population. Specifically identify the target population with which you will be working. Character Limit: 3000 4. Prior Relationship with City of Georgetown / 4a. Has your organization ever received a City of Georgetown grant, sponsorship, or other financial or in-kind support? Choices Yes No If yes, please list years, amounts, and type of funding (grant, sponsorship, other financial support) your organization has received from City of Georgetown. Character Limit: 1000 4b. Do you currently receive a rent or other in-kind subsidy from the City of Georgetown? Choices Yes No If yes, include the location/address of the property and the current monthly rent per your lease agreement and/or the total and type of in-kind support received from the City of Georgetown. Character Limit: 250 5. Financial Overview / 5a. Most Recent Audit. If your organization is applying for more than $25,000, include all formal communication received from the audit firm in relation to the audited financial statement. If your organization is applying for less than $25,000 and if your organization has not commissioned a financial audit, the city will accept a CPA prepared financial statement review. If you are applying for less than $15,000 and if your organization has not commissioned a financial audit or does not have a CPA prepared financial statement review, the City will accept a compilation of the organization’s financials, which is when a CPA takes financial data provided by your organization and puts them in a financial statement format that complies with generally accepted accounting principles, with no further review. Organizational Strategy & Capacity / Remember to answer Questions 6a-6e at the organizational level, not the program level. Be sure to cite all statistics and research in a separate document. 6a. What is your organization striving to accomplish? Clearly and concisely state your organization's ultimate goal for intended impact. Identify the groups or communities you aim to assist, the needs your work is addressing, and your expected outcomes. Examine how your goals for the next three to five years (or an alternate time frame specified in your answer) fit within your overall plan to contribute to lasting, meaningful change. When finished ask yourself, "If someone unfamiliar with our work were to read this, would they have a clear definition of what long-term success means for my organization?" Character Limit: 2000 6b. What are strategies for making this happen? Describe your organization's strategies for accomplishing the long-term goals you cited in 6a. Specify the broad approaches you employ and why your organization believes these methods will benefit your target population or advance your issue. State near-term activities that serve as important building blocks for future success, explaining how these elements strengthen your organization's strategic approach. Character Limit: 2000 6c. What are your organization's capabilities for doing this? Detail the resources, capacities, and connections that support your progress toward long-term goals cited in 6a. While describing your organization's core assets, identify both internal resources (including, but not limited to, staff, budget, and expertise) and external strengths (including partnerships, collaborations, networks, and influence) that have contributed to, or will contribute in the future to, the accomplishment of these goals. Character Limit: 2000 6d. How will your organization know if you are making progress? Explain how your organization assesses progress toward your intended impact cited in 6a. Identify milestones that signal progress and success. Describe your assessment and improvement process: the methods you use as you monitor key indicators and how your organization uses that information to refine your efforts. Character Limit: 2000 6e. What have and haven't you accomplished so far? Demonstrate recent progress toward your long-term goals cited in 6a. by describing how your near-term objectives are propelling your organization toward your ultimate intended impact. Go beyond the outputs of your work to make clear how these outcomes are contributing to fulfilling long-term goals. In describing both outcomes achieved and those not yet realized, include what your organization has learned about what does and doesn't work, what risks and obstacles exist, and what adjustments to goals, strategies, or objectives have been made along the way. Character Limit: 2000 6f. Key Staff List Include titles, short bio, and length of time employed. Please speak specifically to the staff member(s) who will be directing the proposed work and explain why her/his oversight positions the work or success. the way. Character Limit: 1000 6g. Board List List individual board member’s name, place of business, home address, and years with the organization. Specify the percentage of board members that make a financial contribution to your organization. 6h. 501(C)3 IRS Determination Letter Proposed Program Details / 7a. Description of Proposed Program If proposed Program is the same as and incorporates overall Organizational mission, strategy and goal, please make that notation and refer to responses in Section 6. If the Program request is different, please be specific about how you intend to utilize the requested grant funds for your proposed program. (i.e. if you need office supplies, training for volunteers, horses, etc., be specific). Describe the program for which you are requesting funding and the issue it seeks to address. Detail the strategies, resources, capacities, and connections that support your progress toward the program's identified goals. Provide evidence to support the strategies you employ within the program that reinforce your organization's long-term goals, and whether such strategies have been proven by research. Character Limit: 2000 7b. How does this program or project contribute to your organization’s overall mission? What is the specific unmet need(s) you are seeking to address? What activities will your program implement to address this need? Is this a new, or an expansion of an ongoing program? If this is an existing program, provide service statistics and how it was previously funded. Describe your target population and how many individuals will be impacted during the grant period. What percentage of individuals served will be Georgetown residents? Character Limit: 2000 7c. Proposed Impact What does your program or project hope to accomplish? (Outputs and/or Outcomes) Describe your program or project’s overall goals and objectives. Where will the activities take place? How will this program or project transform your organization and how will it transform the lives of the target population? Character Limit: 2000 7d. Do you have data that supports your proposal with existing research or agency experience. If yes, please provide statistics about the local area if possible. Describe to what extent to which your program/organization is based on evidence-based, best, or best practice. Is the program based on another program/project that has been shown to be effective in other settings? Character Limit: 2000 7e. Please provide the names of other agencies that provide similar, overlapping, or duplicate services as your organization. Please describe those services, particularly as to how those services are similar to, overlap, or duplicate the program or project you plan to accomplish with this grant request. Character Limit: 1000 7f. Provide program service costs in the table below and describe how you arrived at your service cost. (Enter the mathematical calculations in the table below that resulted in the individual/unit service cost). Program Service Costs (Note: Table below will expand should you need to include additional comments/clarifications.) Proposed Total Number of Unduplicated Individuals Served Total Program Costs Cost Per Unduplicated Individual 7g. Does this program provide opportunities for matching or incentive funds within your organization or from other grantees? Character Limit: 500 7h. What staff, board, or volunteer training and professional development needs are required to implement this program or project, if any? Please be specific. If not, how does the organization provide the initial, annual and on-going training to your Board members, program staff and volunteers? (e.g., trainings on cultural competency, effective use of social media, or fundraising techniques). Character Limit: 1000 7i. Identify collaborating partners for the program or project and describe their role and expertise. Due to space limitations, describe the interactions that are most important to the program in terms of helping it achieve its goals. (Limited to bullet points). 7j. What is the timeline for implementing this grant? Please include the program or project’s major events, activities and where and when they will take place. (Limit to bullet points and chronological order). 7k. If your proposed program or project is ongoing, please explain how you will continue to deliver benefits to the target population after the grant period has ended. What is your Board’s role in ensuring the continuation of the program? If the project is not ongoing, please explain how you will responsibly bring the project to an end. Character Limit: 1000 7l. How do you determine the Georgetown community's need for this program? Character Limit: 2000 7m. Provide Budget for Proposed Program Provide the budget for your proposed program using the Excel template provided. 7n. Provide Actual Program Budget for Prior Fiscal Year 7o. Does this program provide opportunities for matching or incentive funds within your organization or from other grantees? Character Limit: 500 Goals / Grant Period: The grant period for all City of Georgetown’s Annual Grants is October 1, 2021 – September 30, 2022. 8a. Number of Georgetown Residents to be Served by this Grant. Character Limit: 6 8b. Goals & Logic Model Define the primary goal you hope to achieve through this funding for your program. The goal should be attainable within a 12-month period, and must relate to goals/outcomes articulated in the Program request section of this proposal. To complete the table below you must first complete the required City of Georgetown’s Program/Project Logic Model Template (Please see www.georgetown.org to review additional information on the Program Logic Model, and Glossary in preparation for how to complete the Logic Model Attachment.) Enter the information from your completed Program Logic Model into the Target Population, Outcomes and Performance Measures table below. Please add additional pages if necessary GOAL: (Note: Table below will expand should you need to include additional information) Target Population (Describe individuals who will benefit from the program and how many will be served during the 12 month grant period) Number served during the grant period: Outcomes/Results (Written as change statements) Performance Measures (What and how will you measure and quantify the programs results?) GOAL: Target Population (Describe individuals who will benefit from the program and how many will be served during the 12 month grant period) Number served during the grant period: Outcomes/Results (Written as change statements) Performance Measures (What and how will you measure and quantify the programs results?) GOAL: Target Population (Describe individuals who will benefit from the program and how many will be served during the 12 month grant period) Number served during the grant period: Outcomes/Results (Written as change statements) Performance Measures (What and how will you measure and quantify the programs results?) 8c. How will the evaluation results be used to inform/strengthen future programming and organizational operations? Character Limit: 2000 Organizational Financials / 9a. Fiscal Year Start Date Please enter the start date of your current fiscal year Character Limit: 10 9b. Fiscal Year End Date Please enter the end date of your current fiscal year. Character Limit: 10 9c. What are your organization's cash reserves, i.e., days cash on hand? Character Limit: 20 9d. How many months could the organization operate at your continued budget level? Character Limit: 10 9e. Balance Sheet for Prior Fiscal Year 9f. Income Statement for Prior Fiscal Year 9g. Actual vs. Budget Income Statement for the Prior Fiscal Year 9h. Current Year-to-Date Financials to include Balance Sheet and Income Statement. 9i What percentage of your budget is for Administration and what percentage is used to provide Services for your target population? Administration is defined as general and administrative expenses (G&A). 9j. Year-to-Date Cash Flow Statement. What are your cash reserves? How many months could you operate at your continued budget level? If your organization generates a Cash Flow statement, please provide, If not, leave blank. 9k. Organization Budget for Proposed Fiscal Year, Related to the Grant Period 9l. Sources of Organizational Support-Previous and Current Fiscal Year (The purpose of this section is to provide an overview of your organization’s revenue streams for the previous fiscal year end and current year-to-date). Instructions: List all funding sources for both years. For the current FY enter the dollar amount of funding to date. Indicate whether the funds are pending (P), or in-hand (I). Examples: $5,000 (P), $10,000 (I) Previous Fiscal Year End Dates: _________ to _________ Current Fiscal Year End Dates:________to ___________ External Sources Name(s) of Funders(s) Amount Previous Fiscal Year Name(s) Funder(s) Amount Current Fiscal Year Foundation Grants Individual Contributions N/A – no need to disclose the name of individual donors N/A- no need to disclose the name of individual donors Corporate Foundations Government Grants Fundraising Events (net) Other Specify Describe: Internal Sources Program Service Revenue Membership Income Investment Income Other Specify Describe TOTAL REVENUES TOTAL REVENUES Please list all funding sources receiving this program request. Enter the name of the funder, amount and date the funds were requested and the current funding status of the request. Funding status examples: Funded, Pending, or Committed. Please add extra sheets if necessary. Funding Sources Receiving this Program or Project Request Name of Funder Amount requested Date Requested Funding Status 9k. Most Recent Organization Audit See Q5a for financial reporting parameters. Citations, Acknowledgement & Assurance / 10a. Citations and Additional Information (optional) This attachment may be used to cite any statistics/research, to define key terms and/or acronyms, and may include critical details about your organization or program(s) not already included within this application that will strengthen your case for funding (no marketing material, please). File Size Limit: 2 MB 10b. Acknowledging the City of Georgetown Type your name and date in the space below to assure that if funded, the organization will acknowledge the City of Georgetown on all related marketing materials, your website, social media, and in any other communications in which this program is promoted. Character Limit: 50 10c. Assurance Type your name and date in the space provided to assure that by submitting this application, you 1) confirm that the information herein is true and correct, 2) confirm that if funded, funds will be spent according to the budget listed in this application, and 3) confirm that the organization will submit interim and final reports as required. Character Limit: 50 THANK YOU for your time and effort in completing these forms!