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					                                  Adult and Family Services Commission
                                  Community Service Block Grant (CSBG)
                                               REQUEST FOR FUNDING
                                                    2012/2013

    Program Overview:

    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:
                        http://www.nevadacountyfundersnetwork.org
(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
                                             (530) 265-1410
    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.lehman@co.nevada.ca.us.

The application is also available online at:   http://www.nevadacountyfundersnetwork.org



    Rev: 1-12-09                                                                                                     2
                                                               COVER SHEET
    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:

    Project Title

    Requested Amount $               (Minimum of $15,000)

    Project Summary – In 100 words or less, please give an overview of your proposed project:


                                                            Priority Objective(s):
   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
                o
_______             3.   TRANSPORTATION

                    4.   CRISIS INTERVENTION/PREVENTION
_______
                    5.   INDEPENDENT LIVNG AND SUPPORT
_______
                    6.   PHYSICAL/MENTAL HEALTH AND WELLNESS
_______
                    7.   EDUCATION
_______
                    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
          collaborating partner.
          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
PROPOSAL NARRATIVE
     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)

          Community Need:
         From the Cover Sheet, list the
          priority objective(s) this project
          will address.
         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?
          Community Impact:
         What will change for low-
          income individuals/families as a
          result of your project?

          Program Description:
         Specific service(s) that will be
          provided
         Specific population to be served
         Geographic area(s) to be served
         Estimated number of people
          that will be served/impacted
      Program Objectives:
     List the objectives that will lead
      to the changes you envision.
     Include the specific activities
      that will be performed to meet
      each objective.
          Program Results:
         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
    served?
    (Refer to ATTACHMENT E)
    Program Integration and            
    Collaboration:
   How will your project integrate
    with existing community
    services?
   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?
    Program Sustainability:            
   Describe how the
    project will be sustained
    through organizational and
    financial commitments over the
    next three years.
   Has this project previously been
    funded?
   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
    lost?




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
Financial Information
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

REQUIRED ATTACHMENTS:


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
     specific need.


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
       (SMART) results.
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
       project.




Rev: 1-12-09                                                                                                    9
                                                        ATTACHMENT A
                                                               (Required)


                                              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 ____________:
                                                                  (month/year)              (month/year)
Ag         Agency Revenue Source                                                                       Amount
          Government grants
          Foundations
          Corporations
          United Way
          Individual contributions
          Fundraising events and products
          Membership income
          Investment Income
          Other (specify):

          Total Revenues

      Annual expenses for the Agency for the time period starting ______________ and ending on ______________:
                                                                   (month/year)                 (month/year)
         Agency Expenses                                                                               Amount
         Salaries and Wages
         Benefits
         Consultants and professional fees
         Travel
         Equipment
         Supplies
         Rent and Utilities
         In-kind expenses
         Other (specify):

          Total
     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

          Total


       Rev: 1-12-09                                                                                                               10
                                            ATTACHMENT B
                                                (Required)

                                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.
                 Benefits
Fringe benefits should be based on
actual known costs or an established
formula.
    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.
                  Travel
Itemized travel expenses of project
personnel by purpose (i.e., staff to
training, home visits, community
outreach, etc).
                Equipment
List non-expendable items that are to
be purchased. Explain how the
equipment is necessary for the success
of the project.
                Supplies
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
project.
            Rent and Utilities
Indicate a percentage of the rent and
utilities for the proposed project.
          Other (specify)

                Total
The total is the sum of the requested
amount.
    Rev: 1-12-09                                                                                       11
                                                    ATTACHMENT C
                                                          (Required)



                                              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 person:

Contact phone and email:

Please describe the services and/or support the collaborating agency/organization will provide to this
proposed project:




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
                ATTACHMENT D
               (501 (C) 3 Status)
                   (Required)




Rev: 1-12-09                        13
                                     ATTACHMENT E


          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

				
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