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TAJF Application for Funding 11 12 Part I by PUHLP0J7

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									                             GRANT APPLICATION

                              2011-2012 Grant Year
                            (September 1, 2011 – August 31, 2012)

             Interest On Lawyers Trust Accounts (IOLTA)
                   Basic Civil Legal Services (BCLS)
              Crime Victim Civil Legal Services (CVCLS)
Submit the completed application (which includes budget and any necessary attachments) by
delivering a signed, hard copy original to TAJF addressed as follows:
                                 Attention: Jonathan W. Vickery
                              Texas Access to Justice Foundation
                                   1601 Rio Grande, Suite 351
                                      Austin, Texas 78701
        Phone: (512) 320-0099 ext. 110| (800) 252-3401 ext. 110| Fax: (512) 469-0112

And BY e-mailing an electronic copy to reports@teajf.org. Return completed forms in their
original electronic format: please do not convert into a PDF if you do not have to. If you are
unable to submit the application by e-mail or experience difficulty doing so, contact Jonathan
Vickery at (800) 252-3401, ext. 110 or by e-mail at jvickery@teajf.org. If you have an
attachment that cannot be transmitted in electronic form, note that you are submitting hard copy
only. Applications cannot be sent via fax.

                               SUBMISSION DEADLINE
ALL APPLICATIONS MUST BE RECEIVED AT TAJF OFFICE BY NO LATER THAN
Monday, MARCH 28, 2011 AT 5:00 P.M. Applications and Assurances not signed will be
viewed as an application incomplete and not submitted timely.

Instructions:
         Your proposal and budget should reflect that there are approximately 14% less in
          IOLTA funds and 46% less in BCLS funds from the previous grant year.

         Please have page 2 of this application signed by the executive director and board
          chair along with page 9 (attached assurances) and page 10 (BCLS certification) [if
          BCLS applicant] and complete the Board roster and submit with application. Please
          review the attachment checklist on page two. Scan as separate pages documents
          that have to be signed and send them in as separate attachments.

         Complete fully all tabs in the excel spreadsheet file, “Part II Financial Information for
          Funding 11-12.xls” included with this application. Scroll to view all tabs.

There is no guarantee that any proposed application and budget will be funded at any level.
   A.        Applicant Information

Organization Name:

Address:

City:                                                               State:                        Zip:

Web Site Address: http://www.

Executive Director:

Phone:                                                       Fax:

Executive Director’s E-mail Address:

Chair of Governing Board:

Board Chair’s Address:
Date Incorporated:
day/month/year                                               Federal Tax Identification Number:


   B. Funds Requested for 2011-2012-* The “Low Income” category indicates that an application will be
             considered for funding in one of the three service areas in Texas. The “Discretionary” category is for those projects that
             serve low income Texans statewide.

                                                                                                      Discretionary- (State
        Only Request Category of Funds                    Low Income Population                              Wide)
        received in 2010-2011                               Grant Application                          Grant Application
             IOLTA Funds Requested:                      $                                        $
             BCLS Funds Requested:                       $                                        $
             CVCLS Funds Requested                       $                                        $

   C.        Attachments Checklist

            □          TAJF Assurance Form 1

            □          BCLS Certification Form 2 (if applicable)

            □          Roster of Current Board of Directors/Trustees Form 3

                       Certificate of professional liability and malpractice coverage or copy of cover page
            □          from your organization’s professional liability and malpractice coverage


   D. Signatures
    Executive Director Signature

    Chair of Board Signature:


   TAJF Grant Application, 2011-2012                                                                                              Page 2
E.       Recent Changes and Accomplishments in 2010
1. Changes in Organization

Please highlight any material changes in your organization in 2010 and include any material changes in
your legal services program in 2010 and so far in 2011.




2. Snapshot of Accomplishments in your Legal Services Program for 2010

Summarize your organizations most significant achievement(s) in 2010. Include

        Numbers of people who benefited;
        Policies or procedures changed to benefit the low-income community;
        Improvements in the administration of justice for the poor;




3. Discuss, elaborate or highlight some of your outcomes (reported in your 2010 SAR)- Provide
in Bullet Points

             Extended Representation Outcomes




             Brief Representation Benefits (Including Advice & Counsel)




             Dollar Benefits Achieved for Clients




TAJF Grant Application, 2011-2012                                                                 Page 3
F.      Description of Proposed TAJF Funded Legal Services
1. Target Populations by TAJF Funding Source

Check the appropriate category for each funding source as to what population will be served by the
funding source in the table below.


      IOLTA –BCLS- CVCLS
                           a.    General low income population; no specific client groups targeted.

                           b.    One low income client group
                                 If item “b” is checked, you must check below the specific group targeted by your
                                 services.

                                          (1)            Elderly

                                          (2)            Children/youth

                                          (3)            Victims of Crime (including domestic violence)

                                          (4)            Persons with disabilities

                                          (5)            Inmates

                                          (6)            Immigrants (including refugees)

                                          (7)            Migrant workers

                                          (8)            Homeless persons

                                          (9)            Persons with AIDS or terminal illness

                                          (10)           Veterans

                                          (11)        One distinct population other than above-specify

                                 Other -
                           c.    specify:



2.    Legal Problems Addressed

Check the appropriate category per funding source in the table below (a, b, or c).

       IOLTA - BCLS - CVCLS
                            a.      Full range of legal problems.

                            b.      Particular problems. If this category is checked, check all below that apply:

                                    (1)         Family Law (including stopping domestic violence)

                                    (2)         Public benefits

                                    (3)         Housing / homelessness issues

                                    (4)         Immigration

                                    (5)         Employment

                                    (6)         Disability

                                    (7)         Health

                                    (8)         Consumer

                                    (9)         Other problems - specify:




TAJF Grant Application, 2011-2012                                                                                   Page 4
3. Geographic Service Area

Describe below the geographic area (and list all counties) that would be served by each of the requested
TAJF funds.


a. IOLTA




b. BCLS




c.   CVCLS




4. Specific Uses for the Requested Funds

Describe the specific purposes for which the funds will be used regarding personnel. For example,. “The
requested funds will cover salaries and support costs for 1.5 full time equivalent lawyers to represent
clients in housing matters.” This should reconcile with your proposed budget


IOLTA


BCLS


CVCLS



5. Overview of Legal Services Activities to be Provided by TAJF Funds

In the space below, please briefly elaborate the client legal problems to be addressed with TAJF funding.
PLEASE BE CONCISE. What would be helpful is a one or two-sentence summary of the project or legal
services to be provided by each requested fund. For example, “IOLTA funds are sought to fund a project
to serve the homeless with legal aid in obtaining public benefits in El Paso” or “CVCLS funds are sought
to fund a legal aid project serving victims of domestic violence with protection and divorce in the
panhandle”.

.

IOLTA




TAJF Grant Application, 2011-2012                                                                 Page 5
BCLS




CVCLS




6. Anticipated Outcomes and Results of TAJF FUNDS -

Please list the specific, anticipated outcomes in quantitative terms.
          Level of Service Provided:                    Estimated number of individuals to
                                                        be provided TAJF funded legal
                                                        services:

          Brief Advice and/or counsel

          Assistance in Completing Forms or
          Applications or other limited service

          Representation in Court and/or
          Administrative Proceedings

          Representation in Appeals or Other
          Complex Matters

          Other Legal
          Assistance Specify Below:

          Assisted Pro Se / Self Represented
          Activities

          Estimated Total


          Pro Bono:


          Est. # of New Volunteer Attorneys
          Recruited


          Est. # of Clients Cases to be referred to
          Volunteer Attorneys




TAJF Grant Application, 2011-2012                                                            Page 6
7. Outreach to Target Recipients of Proposed Services

How will potential clients be made aware of the availability of proposed services, particularly those
hard-to-reach populations you anticipate serving?
.




8. Resource Development

    Please briefly describe your resource development efforts for 2011.




9. Pro Bono Private Bar Involvement

Please describe how your organization enlists the pro bono support of the private bar including any
planned recruitment efforts in 2011.




10. Collaboration with Private Bar and Other Community Organizations

Please give one example of how you plan on cooperating and collaborating in your service area in 2011
for each of the following:

    (a) other organizations providing civil legal services to the indigent in your service area:


    (b) the local organized bar(s):


    (c) social and human service organizations;


    (d) governmental agencies, and


    (e) [For CVCLS applicants] other organizations that specifically provide victim related services .




TAJF Grant Application, 2011-2012                                                                       Page 7
                                       FORM 1
                               GRANT ASSURANCES
       Assurances Given by Applicant as Conditions for Receipt of any TAJF Grant

Applicant assures that:

1. Applicant certifies that it is currently a 501 (c) (3) non profit corporation and will restrict the
   use of TAJF funds to law related activities or purposes that are charitable or educational
   within the meaning of Section 501(c)(3) of the Internal Revenue Code of 1954, and will not
   use TAJF grant funds for any prohibited purposes.

2. It will restrict the use of TAJF funds to permissible activities and legal services to permissible
   eligible clients in accordance with the specific TAJF fund requirements (See below
   attachment). Applicant understands that fees by the organization may not be charged to a
   TAJF funded client in whole or in part, including fees such as appointment or consultation
   fees. This does not include fees to be paid to a third party by the client such as filing fees
   and court fees and costs. Applicant also understands and agrees that TAJF clients must be
   income eligible according to TAJF funded guidelines (see 2011-2012 eligibility guidelines
   attached). Applicant acknowledges that they have reviewed the attached restrictions and
   income guidelines for TAJF funds and will be strictly complied with.

3. It will not discriminate on the basis of race, creed, religion, marital status, color, national
   origin, sex, age or disability, or as otherwise prohibited by the laws of the United States and
   the State of Texas, against (1) any person applying for employment or employed by the
   applicant with respect to any personnel action proposed or taken concerning the applicant or
   employee and (2) any person seeking services, participation in, or the benefits or proceeds
   of, the program or projects supported in whole or part by TAJF funds.

4. Except for matters involving limited advice and brief services (e.g. clinics, hotlines, and
   similar services), applicants shall execute a written retainer agreement, or letter of
   engagement with each client who receives legal services from the grantee. For cases that
   are referred by applicants to pro bono private attorneys, applicants shall make available to
   the accepting attorney a standard form retainer agreement which may be modified based on
   agreement between the pro bono attorney and client.

5. Applicant acknowledges that it is responsible for compliance with TAJF grant requirements
   including rules of the court and specific grant manual provisions that can be accessed at
   www.teajf.org. It will, upon request, cooperate with all data collection and evaluation
   activities undertaken by TAJF and give any authorized representative of TAJF access to any
   copies of all financial records, books, papers, or documents, provided that TAJF shall not
   have access to any reports, records, or information subject to the attorney-client privilege. It
   will provide, upon request, periodic written reports detailing the use of TAJF funds in light of
   the proposed use described in the grant application.

6. It understands and agrees that the TAJF may, in its sole discretion, grant funds in greater or
   lesser amounts and/or for greater or lesser periods of time than requested in this



TAJF Grant Application, 2011-2012                                                              Page 8
    application. It further understands that there are no assurances that TAJF will fund the
    proposal submitted.

7. It understands and agrees that the application, once received by TAJF, becomes the
   property of TAJF.


8. It will promptly notify TAJF of any organizational or programmatic changes should it occur
    such that information contained in its grant application and budget is no longer correct, or
    that would render the organization ineligible for a TAJF grant.

9. TexasLawHelp Participation Certification – Applicants understand that they must be listed in
   the TexasLawHelp directory of legal services. See www.TexasLawHelp.org. If grantee is
   listed in the TexasLawHelp directory, grantee assures that its listing on TexasLawHelp is
   accurate and up-to-date as of the date of this application. Applicant further agrees to
   provide a link to Texaslawhelp on their own organization web site that will be displayed
   prominently . Applicant further agrees that if funded for the 2011-2012 grant year, the
   applicant will collaborate and contribute to a substantive law folder on Texaslawhelp and
   consult and cooperate with Texas Legal Services Center as to what content, materials are
   needed that the applicant can provide, create or update. Applicant agrees to continue to
   collaborate and contribute in a reasonable and good faith manner to the web site during the
   2011-2012 grant year.


I have read these assurances and understand that if this application is approved for
funding, the grant will be subject to these assurances. I certify that the applicant will
comply with these assurances if the application is approved.

Executive/Program Director:                        Board Chairperson:


Signature: ________________________                Signature:

Date: ____________________________                 Date:




TAJF Grant Application, 2011-2012                                                         Page 9
                                           FORM 2

                 BCLS ANNUAL CERTIFICATION [ For BCLS Applicants Only]



By signing a 2011-2012 BCLS Grant Agreement if offered, I hereby certify that the organization
named below will act in accordance with the Grant Agreement; Chapter 51, Government Code,
Subchapter J (“the Act”); and the Rules and Procedures Governing the Administration of the
Basic Civil Legal Services Program, Including the Distribution of and Sanctions with respect to
the Funds (“the Rules”). I further certify that, in compliance with Rule 9.4 (i), that no BCLS
Funds will be used for any activities prohibited by the Act or the Rules.




Name of Executive Director




Signature                                          Date




Name of Organization




TAJF Grant Application, 2011-2012                                                       Page 10
                                      FORM 3- 2011-2012 GY

      Board of Directors Roster of________________________[type in name of program]


Board Member Name                                                     Term        Service
                                                                    Expiration    (Years)
                                                                      Date




  TAJF Grant Application, 2011-2012                                              Page 11
                     2011-2012 IOLTA/BCLS Financial Eligibility Guidelines
                                     (125 % of Poverty)

         Household Size                   Annual Income       Monthly            Weekly
                                    1               $13,538             $1,128            $260
                                    2                18,213              1,518             350
                                    3                22,888              1,907             440
                                    4                27,563              2,297             530
                                    5                32,238              2,686             620
                                    6                36,913              3,076             710
                                    7                41,588              3,466             798
                                    8                46,263              3,855             890
For each additional person in the household, add:
                                      $4,675                   $390                        $89


                          2010-2011 CVCLS Financial Eligibility Guidelines
                                      (187½ % of Poverty)

         Household Size                   Annual Income       Monthly            Weekly
                                    1               $20,307             $1,692            $391
                                    2                27,319              2,277              525
                                    3                34,331              2,861              660
                                    4                41,344              3,445              795
                                    5                48,356              4,030              930
                                    6                55,369              4,614            1,065
                                    7                62,381              5,198            1,200
                                    8                69,394              5,783            1,335
For each additional person in the household, add:
                                      $7,013                   $584                       $135




          TAJF Grant Application, 2011-2012                                           Page 12
                               TAJF FUNDS RESTRICTIONS
IOLTA funds may not be used:

       To directly fund class action lawsuits;

       To directly fund lawsuits against governmental entities, except by individuals to secure
        entitlement to benefits such as, but not limited to, social security, aid to families with
        dependent children, food stamps, special education for the handicapped, Medicare,
        Medicaid, subsidized or public housing, or other economic, shelter or medical benefits
        provided directly to indigent individuals;

       To support lobbying for a candidate or issue and

       May not be used in matters that might reasonably be expected to result in a fee from
        public funds or from an opposing party unless appropriate attempts have been made to
        obtain representation from an attorney in private practice (SEE BELOW ATTORNEY
        FEE CASES).

BCLS funds may not be used:

       To directly or indirectly support a class action lawsuit;

       To directly or indirectly support a lawsuit against a governmental entity (except by
        groups or individuals to gain benefits authorized by statute or regulation -SEE BELOW
        SUITS AGAINST GOVERNMENT), political party or candidate;

       To directly or indirectly support lobbying for or against a candidate or issue;

       To directly or indirectly support abortion litigation;

       To directly represent an individual who is confined to jail or prison;

       To directly provide legal services to an individual who is not legally in this country unless
        necessary to protect the physical safety of the individual and

       May not be used for any case or matter that, if undertaken on behalf of an indigent
        individual by an attorney in private practice, might reasonably be expected to result in
        payment of a fee for legal services from an award to an individual client from public
        funds or from an opposing party, unless appropriate attempts have been made to obtain
        representation from an attorney in private practice (SEE BELOW ATTORNEY FEE
        CASES).




TAJF Grant Application, 2011-2012                                                            Page 13
CVCLS funds may not be used:

       To support class actions;

       To directly or indirectly support a lawsuit against a governmental entity (except by
        groups or individuals to gain benefits authorized by statute or regulation - SEE BELOW
        SUITS AGAINST GOVERNMENT), political party or candidate;

       To directly or indirectly support lobbying for or against a candidate or issue and

       May not be used for any case or matter that, if undertaken on behalf of an indigent
        individual by an attorney in private practice, might reasonably be expected to result in
        payment of a fee for legal services from an award to an individual client from public
        funds or from an opposing party, unless appropriate attempts have been made to obtain
        representation from an attorney in private practice (SEE BELOW ATTORNEY FEE
        CASES).

SUITS AGAINST GOVERNMENT - Funds may be used to support a lawsuit brought by an
individual, solely on behalf of the individual or the individual’s dependent or ward, to compel a
governmental entity to provide benefits that the individual or the individual’s dependent or ward
is expressly eligible to receive, by statute or regulation, including social security benefits, aid to
families with dependent children, financial assistance under Chapter 31, Human Resources
Code, food stamps, special education for persons with disabilities, Medicare, Medicaid,
subsidized or public housing, and other economic, shelter or medical benefits provided by a
government directly to an indigent individual, but not to support a claim for actual or punitive
damages.


ATTORNEY FEE CASES - The prohibition of handling cases involving attorney fee awards
shall not be applicable in any case where the organization determines in good faith that the
indigent person seeking legal assistance has made reasonable efforts to obtain the services of
an attorney in private practice for the particular matter (including contacting attorneys in private
practice in the county of residence of the indigent person who normally accept cases of a similar
nature), and has been unable to obtain such services because the potential fee is inadequate, is
likely to be uncollectible, would substantially consume any recovery by the client, or because of
any other reason which the organization, acting in good faith, believes prevents the client from
obtaining the services of a private attorney.

A BCLS grantee awarded attorney’s fees shall send the attorney’s fees to the Comptroller if any
attorney representing any party involved in the case was paid in that case directly from funds
from a BCLS grant. The Comptroller shall deposit the fees to the credit of the Account for use in
the Basic Civil Legal Services Program.




TAJF Grant Application, 2011-2012                                                             Page 14

								
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