Adult and Family Services Commission
Community Service Block Grant (CSBG)
REQUEST FOR FUNDING
The Adult and Family Services Commission (AFSC) announces the Request for Funding (RFF) for the Community
Services Block Grant (CSBG) funding to allow local non-profit agencies an opportunity to provide creative, innovative and
collaborative services for residents of Nevada County. This funding is separate from the County’s Community Initiative
Funding. Funding must be targeted to very low-income residents (see ATTACHMENT E 2010/2011 Poverty Guidelines for
CSBG) verifiable and must meet the priority objectives outlined in the Community Action Plan (CAP) listed below and can
be found at the Nevada County Funders Network website. Priority will be given to collaborative projects. Agencies are
encouraged to submit an application for services that will enhance the quality of life of local, very low-income residents
and provide assistance that promotes self-sufficiency. Funding requests are for the calendar years of 2012 and 2013.
Awards can range from $15,000 to $84,855 per funding year. CSBG funds are awarded for two consecutive years, and
are contingent on Federal, State and local funding remaining the same and Board of Supervisor’s approval of, and
funding for, these contracts.
Competitive Program Funding Criteria:
Awards will be made for funding proposals that meet at least one of the following objectives. Funding proposals
not meeting Priority Objective(s) will not be reviewed.
1. FOOD AND NUTRITION 2. HOUSING AND SHELTER
3. TRANSPORTATION 4. CRISIS INTERVENTION/PREVENTION
5. INDEPENDENT LIVING & SUPPORT 6. PHYSICAL/MENTAL HEALTH & WELLNESS
7. EDUCATION 8. HOMELESS SERVICES
Downloadable copy of the proposal application available July 22, 2011 at:
(or) call the Nevada County Department of Social Services for a digital copy at (530) 265-1410.
APPLICATION DUE SEPTEMBER 2, 2011 BY 5:00 P.M. TO:
COUNTY OF NEVADA
Department of Social Services
Nevada County Adult & Family Services Commission
ATTENTION: ALISON LEHMAN, DIRECTOR
950 Maidu Avenue
Nevada City, CA 95959
Rev: 1-12-09 1
COMMUNITY SERVICES BLOCK GRANT FUNDING
PROPOSAL APPLICATION INSTRUCTIONS:
The proposal application consists of the following:
A two page Cover Sheet
A Proposal Narrative that has two sections: The Organization and The Proposed Project.
This Proposal Narrative cannot be more than five (5) pages total.
Attachments –Submit A, B, C and D required attachments.
Documents or materials not specifically requested will NOT be reviewed.
Use 12pt font or larger
Incomplete applications will result in proposals not being considered for funding. All required attachments must be
submitted as part of the application.
Funding is subject to the Nevada County Adult & Family Services Commission recommendations and Nevada County
Board of Supervisors’ approval.
CSBG funding awards are awarded for two consecutive years and are contingent on Federal, State and local funding
remaining the same and the Board of Supervisor’s approval of, and funding for, these contracts.
Applications must be received by SEPTEMBER 2, 2011 AT 5:00 P.M. to:
Nevada City Truckee
COUNTY OF NEVADA COUNTY OF NEVADA
Department of Social Services Department of Social Services
Nevada County Adult & Family Services Commission Nevada County Adult & Family Services Commission
Attention: Alison Lehman, Director Attention: Alison Lehman, Director
950 Maidu Avenue 10075 Levon Avenue, Suite 207
Nevada City, CA 95959 Truckee, CA 96161
Applications received after the due date and time will NOT be accepted.
Mail or deliver one (1) original and eleven (11) printed copies of your Proposal Application. The application must be
received by 5 P.M. on 9/2/11. The original copy must include the signature of the Authorized Representative for
the agency submitting the application.
Faxed or emailed applications will not be accepted.
Postmarked applications dated before the due date, but received after the due date will not be accepted.
For information or questions, contact Alison Lehman, Nevada County Department of Social Services
(530) 265-1410 or email: Alison.email@example.com.
The application is also available online at: http://www.nevadacountyfundersnetwork.org
Rev: 1-12-09 2
I. Applicant Information:
Submitting Organization Phone Number
Physical Address City State Zip
Mailing Address City State Zip
Contact Person Phone Fax
Job Title E-mail address
Authorized Agency Representative, if different from Contact Person:
II. Project Information:
Requested Amount $ (Minimum of $15,000)
Project Summary – In 100 words or less, please give an overview of your proposed project:
Awards will be considered for funding proposals that meet at least one of the following objectives. Funding Proposals not
meeting Priority Objective(s) will not be reviewed.
Check which objective(s) your funding proposal is addressing.
_______ 1. FOOD & NUTRITION
_______ 2. HOUSING AND SHELTER
_______ 3. TRANSPORTATION
4. CRISIS INTERVENTION/PREVENTION
5. INDEPENDENT LIVNG AND SUPPORT
6. PHYSICAL/MENTAL HEALTH AND WELLNESS
8. HOMELESS SERVICES
The proposed project is:
A new service or program for your agency
An expansion of an existing service to a new geographic area or target group
A one-time-only event
An existing service or program with no new changes
Due to loss of previous funding source(s)
Due to an unforeseen catastrophic occurrence
Other, please explain
Rev: 1-12-09 3
Listed below are the required attachments to the project application. Proposals will not be considered if the
following attachments are not included with the application:
Attachment A - Itemized Agency and Proposed Project Budget
Attachment B - Proposed Project Budget Narrative
Attachment C - If applicable, the standardized Letter of Commitment from Collaborative Partners
shall be included with the application. A separate Letter of Commitment is needed from each
Attachment D - Attach your 501 (C) (3) status verification and/or related documentation (current IRS tax-
exempt status classification letter.)
Attachment E- 2010-2011 CSBG Poverty Guidelines, is to be used to determine the targeted
population (very low-income) for the use of CSBG funding.
If awarded, your agency will be required to enter into a County Funding Agreement and must comply with all
of the following requirements:
Insurance Documents (proof of):
o Up-to-date Commercial General Liability, minimum of one million dollars coverage
(certification and additional insured endorsement with matching policy numbers)
o Up-to-date Auto Commercial, minimum of one million dollars coverage (certification
and endorsement with matching policy numbers)
o Workers’ Compensation certification (indicate if not applicable)
o Errors and Omissions Insurance or Professional Liability insurance certification,
minimum of one million dollars coverage
One of the following Financial Statements:
o Professionally prepared audit, if available
o Self-prepared /contracted audit, if available
o Most current Profit and Loss statement
o Most current Balance Sheet
o Copy of most recently submitted tax return
Rev: 1-12-09 4
This Proposal Narrative has two sections: 1) The Organization and 2) The Proposed Project. Please read the instructions on the
left hand side of the chart and type your responses in the corresponding box to the right. The boxes will expand as you type. Please
remember that the total Proposal Narrative cannot exceed five (5) typed pages.
I. The Organization (Please use 12-point font or larger)
State your organization’s mission
Describe your organization’s short
and long term financial solvency
II. The Proposed Project (Please use 12-point font or larger)
From the Cover Sheet, list the
priority objective(s) this project
What is the community’s unmet
need in this area? Please
support with data.
What would be the impact to
the community if this project
did not receive funding?
What will change for low-
income individuals/families as a
result of your project?
Specific service(s) that will be
Specific population to be served
Geographic area(s) to be served
Estimated number of people
that will be served/impacted
List the objectives that will lead
to the changes you envision.
Include the specific activities
that will be performed to meet
How will you show success in
meeting these objectives?
Rev: 1-12-09 5
What will be measured?
How will it be measured? List
any formalized programs or
tools you will use, if any.
How will you verify the low-
income status of each individual
(Refer to ATTACHMENT E)
Program Integration and
How will your project integrate
with existing community
Describe how your agency plans
to collaborate with other
agencies to provide the
proposed service. A
standardized letter of
commitment (ATTACHMENT C)
must be included for each key
partner if the proposed project
is a collaborative effort.
Why is your agency or
partnership best suited to
provide these services?
Describe how the
project will be sustained
through organizational and
financial commitments over the
next three years.
Has this project previously been
If so, how was it funded?
Was it sustained?
If no, why not?
Has your organization lost
funding due to cuts over the
last fiscal year?
If so, what type of funding was
Rev: 1-12-09 6
Checklist – Before you deliver your proposed project application, did you remember to:
Complete the two page Cover Sheet
Have your Authorized Representative sign the Cover Sheet
Make sure your Proposal Narrative does not exceed five (5) typed pages
Complete and submit required attachments A, B, C and D
Mail or deliver one (1) original and eleven (11) printed copies of your Proposal Application. The application must
be received by 5 P.M. on 9/2/11.
Signature of Authorized Representative:
I hereby certify that information in this application is true and correct and reflects our agency’s intended use of funds.
Name and Title:
Signature: _____________________________________________ Date: __________________
Rev: 1-12-09 7
As part of the proposal application, the following attachments must be attached.
APPLICATIONS THAT DO NOT INCLUDE REQUIRED AGENCY AND PROGRAM BUDGETS
WILL NOT BE ACCEPTED
Attachment A- Complete and submit Agency and Project Budget.
Attachment B- Complete and submit Proposed Project Budget Narrative.
Attachment C- If applicable, submit Letter(s) of Commitment from Collaborating
Organizations(s). A separate Letter of Commitment is needed from
each collaborating Partner Agency. Letters of Support are not the same
as Letters of Collaboration. Letters of Support are used to show how
other agencies are in support of what you are proposing to do. Letters
of Commitment from Collaborating Organizations are used when other
agencies actually contribute to the proposed project. This contribution
can be financial and/or service related.
Attachment D- Attach your 501 (C) (3) status verification and/or related documentation
(current IRS tax-exempt status classification letter).
Rev: 1-12-09 8
Community Services Block Grant Application
Application Evaluation Criteria
100 Total Possible Points
A. Community Need (15 points)
Points are awarded to applications that demonstrate a specific need for the program/project.
B. Community Impact (15 points)
Points are awarded to applications that demonstrate the extent to which the activity will address this
C. Program Description (10 points)
Points are awarded to applications that demonstrate a well-conceived program.
D. Program Objectives (10 points)
Points are awarded to applications that demonstrate the steps that lead to the change.
E. Program Results (10 points)
Points are awarded to applications that include specific, measurable, attainable, realistic and timely
F. Program Integration and Collaboration (20 points)
Points are awarded to applications that delineate how their program will fit into the current service
array and to those applications that involve more than one agency.
G. Program Sustainability (10 points)
Points are awarded to applications that demonstrate realistic sustainability plans for their program.
H. Budget and Budget Narrative (Attachments A & B) (10 points)
Points are awarded to applications that have clear and realistic budgets that support the proposed
Rev: 1-12-09 9
Agency and Project Budget
Directions: The Agency and Project Budget should not exceed one page and should follow the following format. Please
indicate the dates covered by your annual Agency Budget since different fiscal calendars use different time frames (i.e., some
st st st
fiscal calendars start January 1 , some start July 1 and others start October 1 ).
Annual revenue to the Agency for the time period starting ____________ and ending on ____________:
Ag Agency Revenue Source Amount
Fundraising events and products
Annual expenses for the Agency for the time period starting ______________ and ending on ______________:
Agency Expenses Amount
Salaries and Wages
Consultants and professional fees
Rent and Utilities
Please provide a budget for the proposed project and amount of matching funds from the agency.
Amount Requested As applicable, show amount to be Total Budget
Project Expenses from CSBG Awards funded from other sources. List the from all sources
amount and source.
Salaries and Wages $ from
Benefits $ from
Consultants and professional fees $ from
Travel $ from
Equipment $ from
Supplies $ from
Rent and Utilities $ from
In-kind expenses $ from
Other (specify): $ from
Rev: 1-12-09 10
Proposed Project Budget Narrative
Directions: The Budget Narrative should not exceed one page and should follow the following format.
Salaries and Wages
List each position by title and name of
employee, if available. Show annual
salary rate and the percentage of time
to be devoted to the project.
Fringe benefits should be based on
actual known costs or an established
Consultants and Professional Fees
For each consultant enter the name, if
known, service to be provided, hourly
or daily fee (8-hour day), and
estimated time on the project.
Itemized travel expenses of project
personnel by purpose (i.e., staff to
training, home visits, community
List non-expendable items that are to
be purchased. Explain how the
equipment is necessary for the success
of the project.
List items by type (office supplies,
postage, training material, copying
paper, and other expendable items)
and show the basis for computation.
Generally, supplies include any
materials that are expendable or
consumed during the course of the
Rent and Utilities
Indicate a percentage of the rent and
utilities for the proposed project.
The total is the sum of the requested
Rev: 1-12-09 11
Community Services Block Grant
Letter of Commitment from Collaborative Partners
Proposed Project Title: ______________________________________________________________
Name of agency submitting this proposal: _______________________________________________
Collaborating Agency Information
Name of collaborating agency/organization:
Contact phone and email:
Please describe the services and/or support the collaborating agency/organization will provide to this
Please describe any funding the collaborating agency/organization will provide to this proposed project:
Please describe the benefits the proposed project will bring to the community:
Signature of the Collaborating Agency’s Authorized Representative:
I hereby certify, as a collaborating agency, that information in this Letter of Commitment is true and correct.
Print Name and Title: ______________________________________________________________
Signature: ______________________________________ Date: ___________________________
Rev: 1-12-09 12
(501 (C) 3 Status)
Rev: 1-12-09 13
2010-2011 CSBG POVERTY GUIDELINES
Size of Family Unit or Number in Household Monthly Income Annual Income
1 $907.50 $10,890
2 $1,225.83 $14,710
3 $1,544.16 $18,530
4 $1,862.50 $22,350
5 $2,180.83 $26,170
6 $2,499.16 $29,990
7 $2,817.50 $33,810
8 $3,135.83 $37,630
For Family units with more than 8 members, add $3,820 for each additional
member. (The same increment applies to smaller family sizes, as can be seen in
the figures above)
Rev: 1-12-09 14