United Way of Tulare County by IborATu


									            2013 Application for Funding
                           Applications are due by 3:00 p.m.
                            Friday, October 12, 2012
                                  (NO EXCEPTIONS)

    ORGANIZATION understands that it is mandatory that board members who are
  knowledgeable of ORGANIZATION programs and finances are present if a site visit is
 requested by United Way. It is further understood that if a board member is not present,
   the site visit will be terminated and ORGANIZATION will be ineligible for funding.

                            REQUIRED ATTACHMENTS:
       ONE (1) Copy of your 2011 audit report (with Management Letter,
        if any).
       ONE (1) Copy of your 2011 IRS Form 990 and CPA or Accountant
        Review if your organization’s budget is $50,000.00 or less.
       SIX (5) Copies of:
                            The completed application
                            Standards of Excellence
                            List of board members with term beginning and ending dates.
                            Annual Report
                            Annual Operating Budget (most recently approved)
                            Strategic Plan or Summary of Strategic Goals (most recently

    Call Ernie Hernandez at (559) 685-1766, if you have any questions.

                       UNITED WAY OF TULARE COUNTY
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                     GRANT APPLICATION FOR YEAR 2013


Business Address:

Mailing Address:

Contact Person:


Phone:                                                Fax:

Email:                                                Website:

Person preparing this Application:

1. Brief history of your organization. What public value was your organization created
   to achieve?

2. Provide your organization’s mission statement and brief overview of the specific
   programs / services provided to whom.

3. Which United Way Impact Area and targeted outcome(s) does your grant request
   target? Please see Impact Areas and Targeted Outcomes on page 4 of this

4. What program or services are you proposing to provide with the support of UWTC
   funding? Please complete the attached logic model to indicate the proposed
   program objectives, strategies, outcomes, and success measurements.

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5. How will this proposal advance the mission and strategic objectives of your

6. How do the proposed programs and services align with the United Way Impact
   Areas, Targeted Outcomes, and Operating Principles?

7. How do you collaborate with other community stakeholders to maximize your impact
   and resources available for clients?

8. Amount requested (not to exceed $35,000.00):

9. What percent of the organization’s total operating budget does your grant request

10. Program/Project name, if applicable:

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       UWTC’s Board of Directors is committed to funding organizations that:

                Have written plans in place which include measurable objectives, timelines, and clearly
                 defined measures of program quality and success (evaluation).
                Have aligned or are working toward aligning with Standards of Excellence.
                Are committed to improving conditions, resolving problems, and promoting self-
                 reliance rather than dependency.
                Are committed to the use of collaboration as a strategy for effectively maximizing

                                              Impact Areas
                   Successful Youth                                       Strong Families

   Increase youth participation in leadership             Increase financial capability and economic
    development programs;                                   security for families;
   Increase literacy, numeracy, and school-               Increase parenting skills;
    readiness;                                             Reduce incidents of domestic violence; and
   Increase academic achievement (e.g. high school        Increase access to emergency assistance and
    graduation rates, improved test scores); and            other community based safety net services.
   Increase enrollment in higher education
    opportunities (e.g. college and vocation schools)
   Reduce incidents of child abuse and neglect.

                 Healthy Communities

   Maximize independence for elders and disabled;
   Reduce incidents of elder abuse and fraud;
   Reduce alcohol and drug addiction; and
   Increase access to nutrition and/or mental health

       Contact Ernie Hernandez at (559) 685-1766 or ernie@unitedwaytc.org with any questions.

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                                                                        PART – I
                                                                     LOGIC MODEL

A. Previous year’s goals or priorities. What                                       C. The outcomes or results and the benefits
                                                     B. What was done and how.
you set out to do.                                                                 to participants.

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                                                                          PART - II
                                                                 SAMPLE LOGIC MODEL

A Workplan – outlines the work to be done and what impact the work will have on your clients. It is the changes that the program intends to set in motion through
its activities and how it will measure the impact. Below is an explanation of what is needed followed by a blank form for you to complete.

                                                                                                                 D. HOW ARE RESULTS
 A. PROGRAM                  B. HOW? STRATEGIES/ SPECIFIC               C. TARGETED
                                                                                                                 MEASURED (DATA
 OBJECTIVES                  ACTIVITIES                                 OUTCOMES/RESULTS
                                                                                                                 COLLECTION TOOLS)
 To do what? For             Strategies are planned actions to          Outcomes are the benefits to             Results are measured by
 whom? By when?              achieve objectives.                        participants during or after their       change made as a result of
                             Activities are what a program does –       involvement with a program.              involvement with a program.
                             the services it provides – to achieve      Outcomes may relate to                   What data measurement tool is
                             objectives.                                knowledge, skills, attitudes,            used?
                                                                        values, behaviors, conditions, or
 Example:                    Example:                                   status.
 1. To improve school        1. Conduct pre-assessment survey           Results are the desired outcome          Example:
 attendance and              to determine each child’s                  from an action.                          1. Cumulative files are
 academic performance        attendance and academic                                                             maintained and regularly
 of 2,000 children in        performance by key indicators.             Example:                                 updated for each program
 grades 3-6.                                                            1. 70% of children who remain in         participant.
                             2. Regularly scheduled meetings            the program for the academic year
                             with teachers and parents to report        perform at or above grade level in       2. Information is collected from
                             progress.                                  reading and math.                        the child, parents, site
                                                                                                                 personnel, and teachers.
                             3. Children are provided one-on-           2. 90% of the children who remain
                             one/ group tutoring/homework               ___ improve attendance by 80%.
                             assistance by trained program

                             4. Children participate in supervised

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                                                                      LOGIC MODEL
Organization: _____________________________________________

Please indicate with a check () the primary impact area with which your organization aligns. Check one only.
IMPACT AREAS:             ___ Successful Youth
                          ___ Strong Families
                          ___ Healthy Communities

                                                                                                                 HOW ARE RESULTS
        PROGRAM                                  HOW?                                 TARGETED
                                                                                                                 MEASURED (DATA
                                                                                                                COLLECTION TOOLS)

Include additional pages as needed

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                                             PART - III
                                  BUDGET AND BUDGET NARRATIVE


                                                                   Amount Requested from
                            Budget Categories                             UWTC
       A. Personnel: (list each position)

                                            Sub-Total Personnel

       Benefits (Health Insurance, Retirement, Payroll)
                              Sub-Total Personnel and Benefits

       Administrative Expense:
       Example: Office Supplies & Materials
       Example: Telephone & Communication

                               Sub-Total Administrative Expense

       Program Expense:
       Example: Program Materials & Supplies
       Example: Travel

                                     Sub –Total Program Expense

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Budget Narrative: Line Item Explanations

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                                               PART - IV
                                     BEST PRACTICES INVENTORY
                                      AREAS FOR IMPROVEMENT

Please list indicators that are not in place, or that need improvement, in each of the twelve sections.

      CATEGORY                      Explain what needs to be done                     By         By Whom
1. Mission & Vision

2. Administration

3. Human Resources

4. Diversity

5. Governance

6. Planning

7. Financial Practices

8. Internal Controls

9. Public Reporting and

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10. Legal

11. Facilities

12. Technology

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                                             Standards of Excellence

    The organization has a clearly stated mission, and a clear, compelling vision approved by the board, in pursuit of
    improving the lives of the people it serves.

             Yes       No    Indicators:

  A. E                     The organization has a written mission statement.

  B. E                     The mission statement is approved by the board.

  C. R                     The mission and vision statements are affirmed annually by the board.

The organization delivers high-quality operational support of its business, supporting human resources
administration, finance, and information technology.

             Yes       No    Indicators:
  A.   E                   The organization carries adequate liability insurance that protects the organization’s assets.

                             Date policy last reviewed: _____________                   By whom: ____________

  B.   E                   Liability insurance includes dishonesty/fidelity bond.

  C.   E                   The organization carries Directors and Officers insurance.

  D.   E                   Federal and state payroll report filings are current.

  E.   E                   Quarterly and annual payroll report filings are current.

  F.   E                   The organization has security safeguards in place to protect the privacy of files and records.

  G. R                     The organization has a comprehensive written business continuity plan to ensure appropriate
                             and timely internal actions following major crisis, disasters or loss of key staff.

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The organization has a written policy that includes affirmatively equal opportunity to all qualified employees and applicants for
employment without regard to any individual’s, sex, race, color, ancestry, citizenship status, religious creed, national origin,
sexual orientation, physical disability (including HIV and AIDS), mental disability, medical condition (cancer), age, gender,
marital status, registered domestic partner status, status as a special disabled or Vietnam-era Veteran or the need for family
care leave.

               Yes       No       Indicators:
  A. E                          The organization has an up-to-date HR policies and procedures manual.

                                  Date Adopted: _____________ Date last reviewed: _____________
                                  By whom: _________________

  B. E                          The organization has a written policy requiring background checks for all potential employees.

  C. E                          The organization has a policy requiring background checks and fingerprinting of all potential
                                  employees and volunteers working with children and youth.

  D. E                          A policy manual is provided to all employees and a signed acknowledgment of receipt is kept in
                                  each employee file.

  E. E                          The organization maintains current job descriptions for all staff.

  F. E                          The organization has current and legally compliant employee records for all staff (i.e. W-4 and I-9

  G. R                          The organization provides employees on-going opportunities for professional development
                                  through activities such as: attending workshops, specialized training, coaching, etc.

The organization adheres to a policy that ensures volunteers and staff reflects the diversity of the community it serves.

              Yes       No        Indicators:
  A. R                          The organization has a written diversity statement/policy.
                                  Date approved:______________

A board of directors that is effective in setting direction for the organization, ensuring necessary resources and providing
oversight of programs, finances, legal compliance, and values.

               Yes       No         Indicators:
  A.     E                        Orientation for new board members includes personal, legal, and ethical responsibilities in the
                                    governance of this organization.

  B.     E                        The board meets at least quarterly.

  C.     E                        The board includes at least two members with strong financial and accounting experience
                                    (understanding of balance sheets, profit and loss statement, etc…).

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 D.    E                    The board approves the organization’s operating budget.


 E.    E                    Board packets are distributed at least 3 days in advance of meetings and include at least an
                              agenda, minutes, and financial statements.

 F.    E                    The board reviews and approves the annual audit and IRS Form 990.

 G.    R                    The organization regularly reviews and updates its policies and procedures.

 H.    E                    Board members periodically rotate off the board.

 I.    R                    The organization has a written process for board recruitment and training.

 J.    E                    Board members are provided a written job description that clearly outlines general and legal

 K.    E                    Board members annually verify in writing that they have reviewed the organization’s Code of
                              Ethics and Conflict of Interest Policy.

 L.    E                    Board members make annual financial contributions to the organization and/or actively
                              participate in organization’s fundraising activities.

The organization establishes short and long-term goals and identifies strategies to accomplish them.

             Yes       No     Indicators:
  A.   E                    A written strategic plan is in place creating the future of the organization.

  B.   E                    The plan includes measurable objectives, strategies, timelines, and accountabilities.

  C.   R                    Reports are prepared during the year measuring progress toward objectives, explanations for
                              variances, and changes in course as a result of lessons learned.

In order to maintain the public’s trust, the organization has written policies and procedures in place to ensure strong financial
management, compliance with legal and regulatory requirements, and internal controls over all of the organization’s resources
that help further its mission.

              Yes       No    Indicators:

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 A.   E                 The organization has written accounting / financial policies and procedures that are followed.

                          Date last reviewed: _________________             By whom: _____________

 B.   E                 The organization has an active Finance Committee that meets at least quarterly.

 C.   E                 The organization has written board approved, sound and prudent investment policies and
                          financial practices.

                       Date last reviewed: _________ By whom: ________________

 D.   E                 The organization maintains an independent Audit Committee.
                          (if gross revenues = $2 million or more)

 E.   E                 Financial statements are prepared on a timely basis and reviewed with the board at least

 F.   R                 Finance reports are made to the board by a member of the Finance Committee.

 G.   E                 Financial statements include a balance sheet, profit and loss statement of income and expenses,
                          and budgeted income and expenses, as well as year-to-date totals as compared with budget.

 H.   E                 Variances in budget to actual are explained in writing to the Finance Committee and the board by
                          the C.E.O/C.F.O.
 I.   E                 Staff, board members, and volunteers who handle cash or investments are bonded to safeguard
                          those assets.
 J.   E                 The organization has a written policy identifying authorized check signers and the number of
                          signatures required on checks in excess of specified dollar amounts.
 K. E                   All expenses of the organization are approved by a designated person before payment is made.

 L.                     The board of directors, or an appropriate committee, solicits bids, interviews auditors, and hires
                          an auditor to audit the organization’s books.

 M. E                   An annual audit is conducted, for organizations with annual budgets of $50,000.00 or more, by
                          an independent Certified Public Accountant whose examination complies with generally accepted
                          auditing standards and Generally Accepted Accounting Principles (GAAP).

 N. E                   An annual review is conducted, for organizations with annual budgets of $50,000.00 or less, by
                          an independent Certified Public Accountant whose examination complies with generally accepted
                          review standards and Generally Accepted Accounting Principles (GAAP).

 O. E                   The board monitors compliance with findings described in the management letter, if one is

 P. E                   The audit or review and the IRS Form 990 are presented to the full board by the independent
                          Certified Public Accountant for adoption.

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  Q. E                      Government contracts, purchase of service agreements, and grant agreements are in writing and
                              are reviewed by a staff member and a board officer / committee of the organization to monitor
                              compliance with all stated conditions.

  R. R                      The organization has established, or is actively trying to develop, a reserve of funds to cover at
                              least three months of operating expenses.

  S. R                      The organization prepares and distributes (printed copies or electronic format posted on
                              organization’s website) to donors, community, and other stakeholders, an Annual Report which
                              includes program accomplishments and audited financial statements.

The organization properly ensures the accuracy of financial statements, safeguards assets and
maintains an appropriate separation of duties for all financial transactions and functions by maintaining
effective internal controls.

             Yes       No    Indicators:

  A. E                     The organization maintains a set of written internal controls, including the handling of cash and
                             deposits, approval over spending, and disbursements, petty cash, spending authority/limits,
                             ordering of supplies, authorized check signatures, and other financial transactions.

  B. R                     Internal controls, policies and procedures are reviewed at least every three years by the
                             finance/audit committee of the organization.

                             Date last reviewed: ____________          By whom: ________________

The organization is open and candid about its activities and operations. It provides public access to
documents appropriate to ensure transparency in governance, finances, and ethical matters.

              Yes      No    Indicators:
  A.   E                   The organization adheres to a written code of ethics for volunteers and staff which include
                             provisions for ethical management, publicity, fundraising practices, and full and fair disclosure.

                             Date board approved: ___________          Date last reviewed: ___________
                             By whom: __________________

  B.   E                   The organization has a written Conflict of Interest Policy which is adhered to by staff, board, and
                             other volunteers.

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  C.     E                  The organization promotes a culture of ethical behavior at all levels and encourages employees
                              and volunteers to communicate any known or suspected wrongdoing to the appropriate person.

  D.     E                  The organization provides public access to documents about its activities and operations such
                              as the IRS Form 990, audited financial statements, and annual report.

The organization complies with all applicable legal, local, state, and federal operating and reporting requirements.

                Yes      No   Indicators:
   A. E                     The organization promotes itself as an equal opportunity employer.

   B. E                     The organization has access to legal counsel.

   C. E                       The IRS Form 990 is filed in a timely manner (within nine months of fiscal year end).

10. STANDARD: LEGAL cont’d

   D. E                     The organization has and adheres to a written policy to protect whistle-blowers from retaliation.

   E. E                     The organization has and adheres to a written policy to prevent individuals from tampering with
                              or destroying records so as to impede an official proceeding.

   F. E                     The organization periodically, reviews bylaws for compliance.
                              Date last reviewed: ___________                   By whom: ____________

The organization provides a safe, welcoming physical environment that is accessible, practical, recognizable, and expressive
of the organization’s mission.

               Yes       No   Indicators:
  A. E                      Facilities are adequate for staff and program needs and meet local, state, and federal safety
                              standards as applicable.

  B. E                      Office equipment is adequate for current needs of the organization.

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     C. E                    The organization provides a safe work environment through the creation and
                               implementation of a building security plan, procedures and protocols, and a physical structure
                               that is up to code, including compliance with the Americans with Disabilities Act (ADA),
                               Occupational Safety and Health Administration (OSHA) regulations and other applicable laws
                               and regulations.

     D. E                    The organization maintains a healthy and productive workplace by providing job- appropriate
                               workspace and equipment designed to enhance productivity.

The organization provides a reliable IT environment that includes infrastructure, training, maintenance and support;
leverages leading –edge applications and architecture to support open access, integrated solutions and a high degree
of security.

               Yes       No     Indicators:

     A   R                    The organization has a written technology plan guiding what IT systems to have in place.

     B   R                    The organization has adopted privacy and use policies that guide staff and volunteers on
     .                          appropriate use of equipment, Internet, and Social Media.

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