2013 2014 CRP Funding Proposal

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					                         ORANGE COUNTY/CITY OF ORLANDO
                          CITIZENS’ REVIEW PANEL (CRP)
                           2013-2014 FUNDING PROPOSAL
                          I. COVER SHEET & AUTHORIZATION PAGE

Legal Name of Agency:

DBA:

Mailing Address:

CEO/President:                                                     Email:

Telephone:                                                         Fax:

Contact Person:                                                    Title:

Telephone:                                                         Email:

Agency Fiscal Year: (mm– mm)

Funding Panel:

Request for Proposal:
RFP Agencies Only

AUTHORIZATION:
 Our signatures certify that to the best of our knowledge the information contained in this proposal is
 accurate, complete and consistent with our organization’s Mission, Articles of Incorporation and By-
 Laws and that we have the legal authority to sign below. Florida has a very broad public records law.
 As a result, upon request, unless otherwise exempt, any written communication created or received
 by Orange County and/or the City of Orlando officials and employees will be made available to the
 public and media. Furthermore, under Florida law, email addresses are public records.



Chief Volunteer Officer (type or print)                  Chief Professional Officer (type or print)



Chief Volunteer Officer (sign in blue ink)               Chief Professional Officer (sign in blue ink)


Date                                                     Date



                                                     1
Agency:

                                                    II. INDEX
                                                      SECTION                        PAGE #
              I.   Cover Sheet & Authorization Page
             II.   Index
             III   Supporting Documents Checklist
             IV.   Summary Of Funding Request
             V.    Agency Overview
             VI.   Board Governance And Structure
            VII.   Panel Recommendations
           VIII.   Employee Structure And Compensation
             IX.   Agency Revenue Comparison
             X.    Agency Expenditure Comparison
             XI.   Agency Budget Explanation
            XII.   Program Overview – ________________________________
           XIII.   Program Specific Information
           XIV.    Program Demographics
            XV.    Program Geographic Data
           XVI.    Program Outcomes
          XVII.    Program Revenue Comparison
          XVIII.   Program Expenditure Comparison
           XIX.    Program Expenditure Detail
            XX.    Program Budget Explanation: Orange County/City Of Orlando – CRP




                                                        2
Agency:

                                       III. SUPPORTING DOCUMENTS CHECKLIST
INSTRUCTIONS: Attach items for your agency in the order listed below to the original and each copy of the proposal.
Place an “X” in all boxes indicating included or not included.
                                                                                                                                                       Not
                                                                                                                                     Included
                                                                                                                                                     Included

       1. 501 (C)(3) Determination Letter from the IRS
       2. Current By-Laws
       3. Audited Financial Statement with Management Letter* (Most Recent)
       4. Agency Audited Management Letter for Audit Submitted or Letter from the
          Auditor stating no Management Letter was issued.
       5. Agency’s Response to the Audited Management Letter (if applicable)
       6. IRS Form 990 (Most Recent)
       7. Any correspondence received from the Internal Revenue Service since
          January 1, 2011
       8. Organization Chart
       9. Annual Report
       10. Discrimination/EEO Policy
       11. Insurance Certificate and Endorsements**
       12. Licenses and Certificates
       13. Strategic Plan/ Planning Document
       14. Americans With Disabilities Act (ADA) Policy
       15. Letters of Partnerships & Collaborations or Memorandums of Understanding
           (MOU) from agency partners listed in the Agency Overview Section of the
           funding proposal.
Please answer the questions below and provide a detailed explanation where necessary.
     1. Provide an explanation for any requested documents not attached.




     2. Is your agency (local chapter) involved in any pending litigation?        YES _____ NO _____
        (If yes, please explain) (Please use additional sheets of paper if needed)




* Agencies must comply with OMB Circular A-133 Audits of Institutions of Higher Learning.
** Insurance carriers furnishing coverage must be authorized to do business in the State of Florida, and must possess a minimum, current rating of A- Class VIII in
the most recent edition of “Best Key Rating Guide”. Insurance Certificates must have all applicable endorsements required by funder.

                                                                                 3
Agency:

                                IV. SUMMARY OF FUNDING REQUEST
                                             RENEWAL AGENCIES
                      ORANGE COUNTY PROGRAM ALLOCATION SUMMARY
For any agency currently receiving funding, please list past, current, and proposed funding amounts in Orange
County’s fiscal year (October – September). Note: Table is an embedded spreadsheet with formulas, double click to
activate, and then enter information. Calculations are automated. When completed, click outside the spreadsheet to
deactivate. See instructions for more information about embedded spreadsheets.
                                                Past         Current                   Proposed
        Program Name                                                      % change                 % change
                                           (FYE 2012)       (FYE 2013)              (FYE 2014)
                                                                              0%                         0%
                                                                              0%                         0%
                                                                              0%                         0%
                                                                              0%                         0%
                                                                              0%                         0%
                                  Total:                0            0        0%                 0       0%

                     CITY OF ORLANDO PROGRAM ALLOCATION SUMMARY
For any agency currently receiving funding, please list past, current, and proposed funding amounts in the City of
Orlando’s fiscal year (October – September). Note: Table is an embedded spreadsheet with formulas, double click to
activate, and then enter information. Calculations are automated. When completed, click outside the spreadsheet to
deactivate.
                                                Past         Current                   Proposed
        Program Name                                                     % change                 % change
                                           (FYE 2012)       (FYE 2013)              (FYE 2014)
                                                                              0%                         0%
                                                                              0%                         0%
                                                                              0%                         0%
                                                                              0%                         0%
                                                                              0%                         0%
                                  Total:                0            0        0%                 0       0%

                               REQUEST FOR PROPOSAL (RFP) AGENCIES
          ORANGE COUNTY REQUEST FOR PROPOSAL (RFP) ALLOCATION SUMMARY
                            (FOR RFP AGENCIES ONLY)
For any agency applying for funding through the Orange County RFP Process please list if applicable, current and
proposed funding amounts in Orange County’s fiscal year (October – September). Note: Table is an embedded
spreadsheet with formulas, double click to activate, and then enter information. Calculations are automated. When
completed, click outside the spreadsheet to deactivate.
                                                Past        Current                  Proposed
        Program Name                                                     % change                  % change
                                           (FYE 2012)       (FYE 2013)              (FYE 2014)
                                                                              0%                        0%
                                                                              0%                        0%
                                                                              0%                        0%
                                                                              0%                        0%
                                                                              0%                        0%
                                  Total:                0            0        0%              0         0%


                                                            4
Agency:

                                      V. AGENCY OVERVIEW

    1. Agency’s History and Mission Statement: Provide a brief agency history and mission
       statement that includes agency’s goals and objectives. (Not to exceed 1 page)




    2. Major Agency Activities and Accomplishments During the Past Year: Provide information
       on major activities such as special events and agency/program achievements. (Not to exceed ½
       page)




    3. Major Changes During the Past Year: Provide information regarding any major changes that
       your agency has experienced during the past year (e.g., Board or Staff Changes, Mergers,
       Location, Policy). (Not to exceed ½ page)




    4. Agency Partnerships and/or Collaborations: List any organizations with which your agency
       has partnerships and/or collaborations. Attach letters of partnership and/or memorandum of
       agreements (MOU) on partner’s letterhead, from each partner at the end of the funding proposal
       in the order as listed on the Support Documentation Checklist. (Not to exceed ½ page)




                                                    5
Agency:

                                  VI. BOARD GOVERNANCE AND STRUCTURE
Please answer the following questions for your last completed fiscal year (12 months) according to your
agency’s bylaws.
    1. Board Structure:
          a) How many current Board Members does your agency have?
               b) How many available Board slots does your agency have?
               c) How many Board meetings were held during the past year?
               d) What is the percentage of Board attendance for the past year?
               e) How many hours has the Board contributed to the agency during the past year?
                  (Include all subcommittee meetings, Board activities, etc.)

    2. Board Governance Structure:
         a) According to your agency’s by-laws, describe the attendance guidelines and requirements for
            Board and committee meetings.


               b) List your Board’s subcommittees, including the responsibilities of each committee and how
                  many times per year each committee meets.


               c) How does your agency ensure the diversity (ethnicity, gender, expertise) of the Board?


               d) Discuss any changes/resignation of Board members during the last year that were not related to
                  term expiration.


    3. Board’s Role & Responsibilities: Please describe the Board’s role in supervising the fiscal
       matters of the agency.



    4. Advisory Committee:
       a) Does your agency have an Advisory Committee? If yes, please answer questions b-f.                Yes     No
       b) Describe the role of the Advisory Committee.



          c)   How many current Advisory Committee Members does your agency have?
          d)   How many available Advisory Committee slots does your agency have?
          e)   How many Advisory Committee meetings were held during the past year?
          f)   What is the percentage of Advisory Committee attendance during the past year?
          g)   How many hours has the Advisory Committee contributed to the agency during the past
               year? (Include all activities, fundraisers, etc.)

                                                          6
Agency:

                                                BOARD INFORMATION FORM

                                                      EXECUTIVE COMMITTEE
                     Board     Business Affiliation                          Phone &      Areas of              Race/      # of Continuous   Current Term
          Name                                        Mailing Address                                 Gender
                    Position        & Title                                   Email       Expertise            Ethnicity   Years on Board     Expiration




                                                       MEMBERS AT-LARGE
                                                      Business Affiliation             Areas of                 Race/      # of Continuous   Current Term
             Name              Board Position                                                         Gender
                                                           & Title                     Expertise               Ethnicity   Years on Board     Expiration




                                                                        7
Agency:

          VII. PANEL RECOMMENDATIONS (FOR RENEWAL AGENCIES ONLY)
Included in your 2012 – 2013 Orange County/City of Orlando – CRP Award Letters were panel
recommendations made by the Citizens’ Review Panel (CRP) Board members. List all recommendations
and/or concerns, and then provide an explanation of what steps have been taken to address each of them.




                                                    8
Agency:

                           VIII. EMPLOYEE STRUCTURE AND COMPENSATION
Using the chart below, provide a breakdown of employee compensation for all current agency employees.
Salary information should NOT reflect benefits, taxes, or other employee related expenditures. Note:
Table is an embedded spreadsheet with formulas, double click to activate, and then enter information. Calculations
are automated. When completed, click outside the spreadsheet to deactivate.


Definition of Employee Groups: (Please provide definitions if your agency defines the categories
differently.)

      Upper Management – CEO, President, Executive Director, Vice President, Director
      Middle Management – Senior Manager, Manager, Other
      Support Staff – Administrative Assistant, Clerical
      Direct Service – Counselors, Childcare Providers, any staff working directly with clients/customers
      Other Employee group not listed above (please define): ______________________________________



                                             # of   # FTE #PTE          # of            Total     % of Total
                 Employee Group            Postions (filled) (filled) Vacancies        Salaries    Salaries
          Upper Management                                                         $          -       0%
          Middle Management                                                        $          -       0%
          Support Staff                                                            $          -       0%
          Direct Service                                                           $          -       0%

          Other (please define position)                                           $          -       0%

                      Totals               0        0         0      0             $          -       0%


      1. Does your agency currently have leased employees? If yes, please provide information about
         your leased employees. Include the name of the leasing company, positions, and total salaries of
         the group employees (Do not exceed ½ page).




                                                          9
Agency:




          AGENCY BUDGET
          REVIEW SECTION




                10
Agency:




             Page Left Blank Intentionally
                        Insert
          Agency Revenue Comparison Budget
               Spreadsheet – Section IX
                         Here




                         11
Agency:




               Page Left Blank Intentionally
                          Insert
          Agency Expenditure Comparison Budget
                 Spreadsheet – Section X
                           Here




                           12
Agency:
Program:


                                   XI. AGENCY BUDGET EXPLANATION
Using the submitted Agency budget spreadsheets (Sections IX and X) as a reference, please answer the
questions below. Budgets should only reflect the organization’s operating budget. Below-the-line resources
such as in-kind goods and/or services should not be included in the budget. Note: Table is an embedded
spreadsheet with formulas, double click to activate, and then enter information. Calculations are automated.
When completed, click outside the spreadsheet to deactivate.

    1. Total Agency Budget: In agency’s fiscal year, complete the table below.

                                                              Past                     Current              Proposed
           Insert Agency fiscal year (mm/yy)                (mm/yy)                    (mm/yy)              (mm/yy)
                       Total Agency Budget $                                -    $                 -    $              -

 Administrative & Fundraising Costs                $                        -    $                 -    $              -

 Percentage of Administrative &
                                                                      #DIV/0!                 #DIV/0!             #DIV/0!
 Fundraising Costs to Agency’s Budget*
    *Percentage of administrative and fundraising costs as reported in most recent IRS Form 990.

    2. Percentage of Administrative and Fundraising Costs More Than 25%: If the percentage of
       administrative and fundraising costs is more than 25% of your agency’s budget for the Current and/or
       Proposed fiscal years, provide a breakdown of all included expenses and your plan to lower costs in
       the future for each year. (Do not exceed ½ page)




    3. Agency Fundraising Activities: List and describe fundraising efforts for Past (FYE ‘12),
       Current (FYE ‘13) and Proposed (FYE ‘14) fiscal years. Include actual costs compared to the net
       funds raised for each activity. (Not to exceed 1 page)




                                                              17
Agency:
Program:

    4. Agency Reserves: Answer the following questions about your agency’s funding reserve.

              a. Does your agency currently have a funding reserve?


              b. If yes, what is the balance of your agency’s funding reserve?


              c. How does your agency fund the funding reserve?


              d. Provide your agency’s guidelines for utilizing funds in the funding reserve.


              e. If your agency does not have a funding reserve, what is your agency’s contingency plan
                 in the event there is a shortfall in operational funding?



    5. Percentage of Funding: What percentage of the agency’s total revenue is currently funded by:
       Note: Table is an embedded spreadsheet with formulas, double click to activate, and then enter
       information. Pie chart is automated. When completed, click outside the spreadsheet to deactivate.

                                                                      City of Orange
                                                                       Other
          Orange County                        0%                    Orlando County
                                                                         0%
                                                                        0%      0%
          City of Orlando                      0%
          Other                                0%
          Total (should equal 100%)            0%


    6. Professional Fees/Outside Consultants: Provide a breakdown of all costs included in the line item,
       Professional Fees/Outside Consultants, reflected on the Agency Expenditure Comparison
       spreadsheet.




                                                        18
Agency:
Program:

    7. Budget Variances: Using the submitted Agency budget spreadsheets (Sections IX and X) as a
       reference, please explain any significant variances in the agency’s budget (losses and/or gains) which
       equal 15% and greater or at least $5,000 for each line item.
           a) Historical Budgeted (FYE 2012) vs. Historical Actual (FYE 2012)

           b) Historical Actual (FYE 2012) vs. Current (FYE 2013)

           c) Current (FYE 2013) vs. Proposed (FYE 2014)


    8. Explanation of Surplus/Deficits: What is your agency’s procedure for handling a
       surplus or deficit for your agency’s total budget? (Do not exceed ½ page)




    9. Using the submitted Agency budget spreadsheets (Sections IX and X) as a reference,
       please provide an explanation for any surpluses or deficits for your agency’s total budget:

           a) Historical Actual (FYE 2012)

           b) Current (FYE 2013)

           c) Proposed (FYE 2014)


    10. Other Major Funders: Using the submitted Agency budget spreadsheets (Sections IX
        and X) as a reference, list all funding sources and funding amounts for budget line -
        Other Major Funder. DO NOT include any funding obtained through the CRP Process.

           a) Historical Actual (FYE 2012)

           b) Current (FYE 2013)

           c) Proposed (FYE 2014)

    11. Other Government Funding: Using the submitted Agency budget spreadsheets
        (Sections IX and X) as a reference, list all funding sources and funding amounts for
        budget line - Other Government. DO NOT include any funding obtained through the
        CRP Process.

           a) Historical Actual (FYE 2012)

           b) Current (FYE 2013)

           c) Proposed (FYE 2014)

                                                      19
Agency:
Program:

    12. Miscellaneous Expenses: If you reported or proposed miscellaneous expenditures which equal 15%
        or more of the agency’s budget or at least $5,000 on the Agency Expenditure Comparison (Section
        X), list and explain specific expenses including dollar amounts.

           a) Historical Actual (FYE 2012)

           b) Current (FYE 2013)

            c) Proposed (FYE 2014)
    13. In-Kind Donations: Please provide the amount and description of all in-kind donations
        reflected on the Agency Revenue Comparison spreadsheet (Section IX).
           a) Historical Actual (FYE 2012)

           b) Current (FYE 2013)

           c) Proposed (FYE 2014)

    14. Leveraging: Provide a breakdown of all matching dollars received for all agency revenue.
    Funder & Amount of        Match Source        Amount of Match    Total Amount of Terms & Time Period
         Funding                                    per Dollar       Matched Dollars      of Match




                                                    20
Agency:
Program:




           INDIVIDUAL PROGRAM
           INFORMATION SECTION
               Complete for each program.



            NAME OF PROGRAM:




                           21
Agency:
Program:


                                    XII. PROGRAM OVERVIEW

1. Brief Program Description: Please provide a brief description of the program. (Not to exceed 50
   words)




2. Program Detailed Description and Design: Please provide a detailed description of the program
   including the main purpose of the program; types of services provided; agency’s history and
   experience providing these services; the need for the program; geographic area to be served;
   partnership with other agencies to provide the program; participant goals and objectives; targeted
   groups to be served; staffing plan. Please include any data you are using to support the requested
   need exists in Orange County/City of Orlando. (e.g., agency data, survey information, needs
   assessment data, other secondary data sources, etc.) (Not to exceed 2 pages)




3. Success Story: Please provide a short program success story from the program’s last fiscal year. (Not to
   exceed 1 page)




                                                     22
Agency:
Program:


                              XIII. PROGRAM SPECIFIC INFORMATION

    1. Cost Efficiency/Return on Investment: Describe the program’s cost efficiency and return on
       investment to the community. Include cost of services and measurable benefits to the community.
       (Not to exceed 1 page)




    2. Community Support: Describe the current community support for the program. List type of support
       and how it is provided. (Not to exceed ½ page)




    3. Outreach Plan: Describe the outreach plan for the program and strategies used to engage target
       population. Include how participants are identified, engaged, and retained. (Not to exceed ½ page)




     4. Waiting List: Does this program have a waiting list?                               Yes            No
         If yes, please provide:
               a. The number of clients on the list
               b. The average time on waiting list
               c. The date of oldest referral
               d. How often the list is revisited, include how you prioritize the list? (Explain below)




              If no, how do you address overflow? (Explain below)




                                                         23
Agency:
Program:

    5. Program Changes: If this program has previously received funding, list any significant changes to
       the program during the past year. Include demographics, staffing, locations, hours, etc. (Do not
       exceed ½ page)




    6. Volunteer Usage: Answer the following questions regarding your program’s use of volunteers.

           a. How are volunteers utilized to support this program? Explain your program’s strategy
              for recruitment, orientation, and training of volunteers.




           b. List all background checks and screenings necessary for each volunteer position in your
              program. Site the governing agency that has oversight for each screening listed. Include
              whether you are currently in compliance with each background check or screening
              requirement listed.




                                                    24
 Agency:
 Program:


                                        XIV. PROGRAM DEMOGRAPHICS
 Complete this section for each funder if your program has received funding from Orange County and/or City
 of Orlando – CRP for fiscal year October 1, 2011 through September 30, 2012.
                                   Orange County Demographic Information
      1. Provide the following information about all unduplicated clients served by this program from October
         1, 2011 to September 30, 2012. Only include information for clients funded by Orange County.

                    Total Number of Unduplicated Clients Served:

                          NA – My agency was not funded during this timeframe.

AGE                                       RACE/ETHINICITY                              HOUSEHOLD INCOME
              MALE         FEMALE                             MALE          FEMALE     Less than $25,000
0-4                                       Black                                        $25,000 - $50,000
5-9                                       White                                        $50,001 - $100,000
10-14                                     Hispanic/Latino                              $100,000+
15-19                                     Asian/Pacific                                Unknown
                                          Islander
20-34                                     Native American                              TOTAL
35-54                                     Mixed/Biracial
55-64                                     Other
65+                                       Unknown
Unknown                                   TOTAL
TOTAL

      HOUSEHOLD TYPE                          EMPLOYMENT STATUS                                 RESIDENCE
                With         Without                            MALE        FEMALE                     MALE   FEMALE
               Children      Children
Married/
                                          Employed                                   Orange County
Couple
Single
                                          Unemployed                                 Other
Female
Single                                    Retired                                    Unknown
Male
Extended/
                                          *N/A
Multi-                                                                               TOTAL
Family
Other                                     Unknown

Unknown                                       TOTAL
                                          *not expected to work, i.e., children
 TOTAL
      2. If you are unable to provide any of the above information, please explain.


                                                                25
 Agency:
 Program:

                                   City of Orlando Demographic Information
        1. Provide the following information about the unduplicated clients served by this program from
           October 1, 2011 to September 30, 2012. Only include information for unduplicated clients that
           resided within city limits.
                     Total Number of Unduplicated Clients Served:

                          NA – My agency was not funded during this timeframe.

               AGE                                   RACE/ETHINICITY                                HOUSEHOLD INCOME
               MALE         FEMALE                                      MALE       FEMALE     Less than $25,000
0-4                                       Black                                               $25,000 - $50,000
5-9                                       White                                                $50,001 - $100,000
10-14                                     Hispanic/Latino                                     $100,000+
15-19                                     Asian/Pacific Islander                              Unknown
20-34                                     Native American                                     TOTAL
35-54                                     Mixed/Biracial
55-64                                     Other
65+                                       Unknown
Unknown                                             TOTAL
 TOTAL

      HOUSEHOLD TYPE                           EMPLOYMENT STATUS                                        RESIDENCE
                With        Without
                                                                   MALE           FEMALE                          MALE   FEMALE
               Children     Children
Married/
                                          Employed                                          City of Orlando
Couple
Single
                                          Unemployed                                        Other
Female
Single                                    Retired                                           Unknown
Male
Extended/
                                          *N/A
Multi-                                                                                      TOTAL
Family
Other                                     Unknown
Unknown                                        TOTAL
                                          *not expected to work, i.e., children
 TOTAL


        2. If you are unable to provide any of the above information, please explain.




                                                                   26
Agency:
Program:


                               XV. PROGRAM GEOGRAPHIC DATA

Please indicate areas where clients lived during the period of October 1, 2011 to September 30, 2012.

 NA – My agency was not funded during this timeframe.

                                                  CITIES
 Apopka                   Bay Lake                 Belle Isle           Eatonville            Edgewood

 Lake Buena Vista         Maitland                 Oakland              Ocoee                 Orlando

 Windermere               Winter Garden            Winter Park          Unincorporated Orange County

                                                ZIP CODES
 32703        32704   32709        32710      32712          32751    32768          32777     32789         32790

 32792        32793   32794        32798      32801          32802    32803          32804     32805         32806

 32807        32808   32809        32810      32811          32812    32813          32814     32816         32817

 32818        32819   32820        32821      32822          32824    32825          32826     32827         32828

 32829        32830   32831        32832      32833          32834    32835          32836     32837         32839

 32853        32854   32855        32856      32857          32858    32859          32860     32861         32862

 32867        32868   32869        32872      32877          32878    32885          32886     32887         32890

 32891        32893   32896        32897      32898          32899    34734          34740     34760         34761

 34777        34778   34786        34787


                                           NEIGHBORHOODS
 Alafaya               Aloma                  Azalea Park             Bithlo                 Carver Shores

 College Park          Downtown               Fairvilla               Hiawassee              Holden/Parramore

 Lockhart              Margaret Square        Mercy Drive             Orlo Vista             Pine Castle

 Pine Hills            Sand Lake              South Creek             Taft                   Union Park

 Washington Shores




                                                        27
Agency:
Program:


                                     XVI. PROGRAM OUTCOMES
FOR NEW AGENCIES ONLY
    Proposed Outcomes: Provide at least two (2) proposed program outcomes and your plan for measuring
    the success of your program. Include measurable outcomes, activities, indicators, tools and frequency of
    data collection (e.g., sign in sheets collected daily) that will be used to evaluate program success. (Do not
    exceed 1 page)




                                                       28
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Program:

                                                             PROGRAM LOGIC MODEL
Complete this section if your organization is currently receiving funding for fiscal year 2012-2013 from Orange County and/or City of Orlando – CRP.
1.    Measuring Program Success: Complete the Program Logic Model to reflect how you will measure program success. Include funder
approved Outcomes, activities, indicators, tools used to evaluate program success, and frequency of data collection.
          RESOURCES                       ACTIVITIES                       OUTPUTS                  OUTCOMES                         GOALS
     SERVICE PROVIDERS:


      PROGRAM SETTING:



     COMMUNITY FACTORS:


      COLLABORATIONS:



  SERVICE TECHNOLOGIES:



      FUNDING SOURCES:



        PARTICIPANTS:




2.         How frequently is data collected? (e.g., sign in sheets collected daily).




                                                                                                                                                       29
Agency:
Program:

                                          OUTCOMES REPORT
Complete this section if your organization received funding for fiscal year 2011-2012 from Orange County
and/or City of Orlando – CRP. This information should be based on data collected from October 1, 2011 to
September 30, 2012 for each funder.
                                               Orange County
     Number of Unduplicated Clients Funded
     by Orange County:

     Outcome 1:

     Number of Unduplicated Clients
     Measured for this Outcome:
     Program Goals/ Target Baseline for this
     Outcome:

     What were the Outcome results?

     Was Outcome Achieved?                                             Yes                    No
       If no, provide explanation and plans
        for program adjustments.

     Outcome 2:

     Number of Unduplicated Clients Measured
     for this Outcome:
     Program Goals/ Target Baseline for this
     Outcome:

     What were the Outcome results?

     Was Outcome Achieved?                                             Yes                    No
      If no, provide explanation and plans
       for program adjustments.

      Outcome 3:

     Number of Unduplicated Clients
     Measured for this Outcome:
     Program Goals/ Target Baseline for this
     Outcome:

     What were the Outcome results?

     Was Outcome Achieved?                                             Yes                    No
      If no, provide explanation and plans
       for program adjustments.
                                                                                                       30
Agency:
Program:

                                               City of Orlando
     Number of Unduplicated Clients That
     Lived Within City Limits:

     Outcome 1:

     Number of Unduplicated Clients
     Measured for this Outcome:
     Program Goals/ Target Baseline for this
     Outcome:

     What were the Outcome results?

     Was Outcome Achieved?                                       Yes   No
      If no, provide explanation and plans
       for program adjustments.


     Outcome 2:

     Number of Unduplicated Clients Measured
     for this Outcome:
     Program Goals/ Target Baseline for this
     Outcome:

     What were the Outcome results?

     Was Outcome Achieved?                                       Yes   No
       If no, provide explanation and plans
        for program adjustments.

      Outcome 3:

     Number of Unduplicated Clients
     Measured for this Outcome:
     Program Goals/ Target Baseline for this
     Outcome:

     What were the Outcome results?

     Was Outcome Achieved?                                       Yes   No
       If no, provide explanation and plans
        for program adjustments.



                                                                            31
Agency:
Program:




            INDIVIDUAL PROGRAM
           BUDGET REVIEW SECTION




                                   32
Agency:
Program:




                Page Left Blank Intentionally
                           Insert
            Program Revenue Comparison Budget
                    Spreadsheet – XVII
                            Here
           Note: Be Sure To Insert Page Numbers on Each Spreadsheet




                                                                      33
Agency:
Program:




                 Page Left Blank Intentionally
                            Insert
               Program Expenditure Comparison
                  Budget Spreadsheet – XVIII
                             Here
           Note: Be Sure To Insert Page Numbers on Each Spreadsheet




                                                                      34
Agency:
Program:




                   Page Left Blank Intentionally
                              Insert
                   Program Expenditure Detail
                    Budget Spreadsheet – XIX
                               Here
           Note: Be Sure To Insert Page Numbers on Each Spreadsheet




                                                                      35
Agency:
Program:


                                  XX. PROGRAM BUDGET EXPLANATION
Using the submitted Program budget (Sections XVII - XIX) as a reference, please answer the questions below.
Below-the-line resources such as in-kind goods and/or services should not be included in the budget.

    1. Funding Justification: Provide information to justify the requested level of program funding, to
       include but not be limited to, the reason this problem should be addressed with funds from each
       of the funder.

                  Orange County


                  City of Orlando


    2. Percentage of Current Program Funding: What percentage of the program’s total budget is funded
       by: Note: Table is an embedded spreadsheet with formulas, double click to activate, and then enter
           information. Pie chart is automated. When completed, click outside the spreadsheet to deactivate.


                                                                           Other
                                                                         Orange
          Orange County                            0%                     City of
                                                                             0%
                                                                         County
                                                                         Orlando
                                                                           50%
          City of Orlando                          0%                     50%
          Other                                    0%
          Total (should equal 100%)                0%

    3. Explanation of Funding: Using the Program Expenditure Detail spreadsheet (Sections XIX) as a
       reference, please provide a breakdown for each year, what funding from Orange County and /or City
       of Orlando – CRP specifically funds.
                                            Current Funding                          Proposed Funding
                                              (FYE 2013)                                (FYE 2014)

              Orange County

              City of Orlando




                                                                                                               36
Agency:
Program:

    4. Units of Service: Provide your program’s definition of a unit of service (e.g., shelter nights, hours,
       etc.) and the cost per unit ($ per unit). Then in the space provided, calculate the total cost of a
       program year based on the defined unit of service. ($ - unit cost X # of units in a program year = total
       cost per program year) Be specific to each funder.
                               Description of Unit of       Cost per Unit of         Total Cost per Program
                                      Service                   Service                       Year
                                  (e.g., Shelter Night)     (e.g., $10 per night)   (e.g., $10 X 50 nights = $500)

           Orange County

           City of Orlando



    5. Funding Priorities: Prioritize the proposed funding by listing specific items including the funding
       amounts (e.g. $2,500 cost of living increase, $8,000 will provide a half-time caseworker thus
       reducing case load by 10%).
                     Orange County – CRP                       City of Orlando – CRP




    6. Professional Fees/Outside Consultants: Provide a breakdown of all costs included in the line item,
       Professional Fees/Outside Consultants, reflected on the Program Expenditure Comparison and
       Program Expenditure Detail spreadsheets (Sections XVIII and XIX).

               Program Expenditure Comparison                Program Expenditure Detail




                                                                                                                37
Agency:
Program:

    7. Budget Variances: Please explain any significant variances in the program’s budget (losses and/or
       gains) which equal 15% and greater or at least $5,000 for each line item.
              a) Historical Budgeted (FYE 2012) vs. Historical Actual (FYE 2012)

              b) Historical Actual (FYE 2012) vs. Current (FYE 2013)

              c) Current (FYE 2013) vs. Proposed (FYE 2014)


    8. Miscellaneous Expenses: If you reported or proposed miscellaneous expenditures which equal 15%
       or more of the agency’s budget or at least $5,000 on the Program Expenditure Comparison, list and
       explain specific expenses including dollar amounts.

              a) Historical Actual (FYE 2012)

              b) Current (FYE 2013)

              c) Proposed (FYE 2014)


    9. Other Funders: Is the program requesting funding from other sources? If yes, please provide the
       names of each additional funder, how much is being requested, and an explanation of how funds will
       be used.




    10. In-Kind Donations: Please provide the amount and description of all in-kind donations
           reflected on the Program Revenue Comparison spreadsheet.
              a) Historical Actual (FYE 2012)

              b) Current (FYE 2013)

              c) Proposed (FYE 2014)




                                                                                                           38

				
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