WEST VIRGINIA DEVELOPMENT OFFICE

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					      WEST VIRGINIA DEVELOPMENT OFFICE
                 APPLICATION FOR THE
                FLEX-E-GRANT PROGRAM
                        FY 2012

A non-construction leadership and community capacity building program



     ALL APPLICATIONS MUST BE POSTMARKED NO LATER THAN
                       OCTOBER 26, 2012




                     Please return application to:
                  West Virginia Development Office
                          Attn: James Bush
                        State Capitol Complex
                         Building 6, Room 553
                 Charleston, West Virginia 25305-0311




The Flex-E-Grant program is partially funded by the Appalachian Regional
     Commission and the Claude Worthington Benedum Foundation
                           APPALACHIAN REGIONAL COMMISSION
                           FLEX-E-GRANT PROGRAM APPLICATION
                                 STATE OF WEST VIRGINIA

Section I: APPLICANT/PROJECT INFORMATION and SUMMARY

   A. General Information:

Applicant:

Certifying Official:                                    Title:

Contact Person:                                         Title:

Address:

City, State, Zip:

Telephone Number:                                     Fax Number:

E-Mail Address:


List the county(ies) in the project area and their designation (distressed, at-risk, transitional,
competitive):




   B. Project Category and Eligible Activity: Indicate the appropriate project category and
      eligible activity number. (See pages 9-10 of the Technical Assistance Guide.) Place
      the eligible activity number in the space provided. Do not use a checkmark.
      Choose the one project activity that best describes your project.


________        Project Category 1: Individual Capacity Building
________        Project Category 2: Institutional/Organizational Capacity Building
________        Project Category 3: Community Capacity Building



                                                  1
C. Anticipated Outcome(s): Indicate the anticipated outcome of the project. The outcome is
the product that will be created at the end of the project. Check all that apply.

1. New community organization created                                                    _____

2. New partnership created                                                               _____

3. Plan created or revised (strategic plan, marketing plan, sustainability plan, etc.)   _____

4. Community assessment completed                                                        _____

5. Feasibility study completed                                                           _____

6. Organizational assessment completed                                                   _____

7. Financial management training completed (survey required)                             _____

8. Increase in certification of staff members                                            _____

9. Leadership/board development training completed (survey required)                     _____

10. Volunteer recruitment plan completed                                                 _____

11. Other (specify below):                                                               _____




                                                  2
  D. Areas of Emphasis: Check all that apply. (See pages 7-8 of the Technical Assistance
  Guide for full descriptions.)

  _____ 1. Economic Opportunity                 _____ 2. Infrastructure

  _____ 3. Human Resource Development           _____ 4. Local Capacity

  _____ 5. Health Care                          ____   6. Energy Efficiency

  _____ 7. Local Food Systems                   _____ 8. Downtown Improvements

  _____ 9. Creative Communities                 _____ 10. Environmental Assets

  _____ 11. Community Foundations



  Section II: APPLICANT/PROJECT INFORMATION and SUMMARY

Project Name:



Project Goal:




Project Activities:




Project
Outcomes:




                                            3
 Section II: PROJECT FUNDING


                      Source                                Amount           Commitment
                                                                            Letter Enclosed
                                                                              (yes or no)
Flex-E-Grant (indicate the amount requested):
Matching Funds (please list each separately):
1.
2.
3.

TOTAL PROJECT COST (Cannot                              $
exceed $10,000, including local match*):

 Section III: ATTACHMENTS

 A. Project Narrative: The Application Checklist on pages 5-6 of the Application provides detailed
    information regarding the content of the Project Narrative. Please include all required elements
    of the Project Narrative in the order indicated. Maximum length: 5 pages.
 B. Project Budget and Detailed Budget Narrative: Complete the detailed budget form found on
    page 7 of the Application that includes Flex-E-Grant and matching funds. The budget narrative
    must explain in detail expenditures by line item on a separate page.
 C. Project Schedule: A detailed schedule for implementation of the project. Maximum length:
    2 pages.
 D. Letters of Commitment from all sources of matching funds.
 E. Resolution: Submit a resolution from the applicant’s board or governing body that authorizes
    participation in the Flex-E-Grant program. The resolution should also indicate/designate the
    person responsible for signing and acting upon the grant contract, if awarded. A sample
    resolution is provided on page 8 of the Application.
 F. Documentation of Organizational Capacity: Applicant should be able to document successful
    experiences in grant management and project implementation.
 G. Documentation of Non-Profit Status (if applicable): Non-profit applicants must submit a copy
    of their current West Virginia Secretary of State registration as a non-profit corporation. In
    addition, they must also submit proof of their registration with the West Virginia Secretary of
    State as a charitable organization (if applicable) and a copy of their latest IRS Form 990.

 All approved applicants will be required to enter into individual project negotiations prior to contract
 award and project commencement. All grantees will be required to fully participate in a formal
 evaluation process and to attend any mandatory technical assistance workshops or trainings.

 I certify that all statements in this application and the attached documents are true and correct to the
 best of my knowledge. Furthermore, I am authorized by my organization to apply for the
 Flex-E-Grant, and I agree to participate in the evaluation and to attend any mandatory technical
 assistance workshops or trainings.


 __________________________________               _________________________
  Signature of Certifying Official/Applicant               Date
                                                  4
                                   ARC FLEX-E-GRANT PROJECT
                                    APPLICATION CHECKLIST

    Use this checklist as you review and format your application prior to submittal to the WVDO.
    Please be specific and use appropriate page numbers in the spaces provided (do not use
    checkmarks). ALL PROJECTS MUST INCLUDE THE FOLLOWING COMPONENTS:

SECTION I – APPLICANT/PROJECT INFORMATION & SUMMARY (pages 1-3 of the Application)
Page #   A. General Information: Applicant name, address, project purpose, description,
            contact person, etc. The contact person should be an individual that the WVDO can
            contact for additional information or questions about the proposed project.
         B. Project Category and Eligible Activity: Indicate the appropriate project category
            and eligible activity number in the space provided. Details on eligible project
            activities are provided on pages 9-10 of the Technical Assistance Guide.
         C. Anticipated Outcomes: Select the anticipated outcome(s) of the project.
         D. Areas of emphasis: Select the area(s) of emphasis of the project.
SECTION II– PROJECT FUNDING (page 4 of the Application)
         List all sources of funding for the proposed project.
SECTION III – ATTACHMENTS
         A. Project Narrative: Total project narrative cannot exceed 5 pages. Please
            follow the format below and use the bolded section titles in your narrative.
             1) Project Area: Briefly identify and describe the geographic area to be served.
             2) Need for the Project: Provide a brief description of the need for the project.
             3) Goal of the Project: Briefly describe the goal or purpose of the project.
             4) Project Activities: Provide a detailed description of the major project activities.
                Describe how these activities address the need for the project and how they
                further the area(s) of special emphasis you checked on page 3.
             5) Outcomes: Briefly state the expected outcome(s) or product(s) to be derived
                from the project. Describe in quantitative terms how many people will participate
                in the project activities (for example, how many people will be trained, or will
                participate in a planning process, or participate in a community forum). If you
                will be using a survey instrument or other evaluation instrument, include a copy
                with the application. Refer to the anticipated outcome(s) you indicated on page
                2 of the application.
              6) Impact: Describe in detail how your project activities will build the capacity of
                 individuals, organizations, or your community, and how the economic and/or
                 social conditions in your community, county, or region will improve as a result of
                 your project activities.
             7) Sustainability: Briefly describe how the project will sustain your organization or
                initiative, or what plans you have for sustaining your program or initiative.


                                                    5
                                   ARC FLEX-E-GRANT PROJECT
                                    APPLICATION CHECKLIST

SECTION III – ATTACHMENTS (CONT.)
Page #
            B. Project Budget and Detailed Budget Narrative: Complete the detailed
               budget form found on page 7 of the Application that includes Flex-E-Grant
               and matching funds. The detailed budget narrative must explain expenditures
               by line-item. Please provide a detailed budget narrative on a separate
               page.
            C. Project Schedule: Provide a detailed schedule or timeline for implementation
               of the project (maximum 2 pages). NOTE: Projects should be able to
               commence upon award of the Flex-E-Grant and conclude within nine
               months.
            D. Letters of Commitment: Provide letters of commitment from all sources of
               matching funds.
            E. Resolution: It will be necessary to submit a resolution from the applicant’s
               board or governing body that authorizes participation in the Flex-E-Grant
               program.     The resolution should also indicate/designate the person
               responsible for signing and acting upon the grant contract, if awarded. A
               sample resolution can be found on page 8 of the Application. Note that the
               person authorized to apply for Flex-E-Grant funds and enter into
               contractual agreement with the West Virginia Development Office cannot
               be the same person that signs the resolution.
            F. Documentation of Organizational Capacity: Describe and document the
               capacity of the organization to administer Flex-E-Grant funds. Applicants
               should be able to document successful recent experiences in grant
               management and project implementation.
            G. Documentation of Current Non-Profit Status (only applicable to non-profit
               applicants): Non-profit applicants must submit a copy of their current West
               Virginia Secretary of State registration as a non-profit corporation. In addition,
               they must also submit proof of their registration with the West Virginia
               Secretary of State as a charitable organization (if applicable) and a copy of
               their latest IRS Form 990.




                                                    6
Section IV: ATTACHMENT B: PROJECT BUDGET AND DETAILED BUDGET NARRATIVE

Please provide a detailed budget that includes Flex-E-Grant and all matching funds. As a
reminder, Administrative Costs, Indirect Costs, Equipment Purchases, and Construction Costs,
are not permissible.

What is the difference between a direct cost and an indirect cost? A direct cost is any cost
that can be easily identified with a specific project (grant/contract): e.g., Materials & Supplies,
Subcontracts, Consultants. An indirect cost is any cost that cannot be easily identified (or it
would not be cost effective to identify) to a specific project, but identified with two or more final
cost objectives. Indirect costs are not permissible under this program. There are three types of
indirect costs:
   Fringe Benefits: services or benefits provided to employees, e.g., Health Insurance,
   Payroll Taxes, Pension Contribution, Paid Absences, etc.
   Overhead: indirect costs associated with the performance of a project, e.g., Facility
   Costs (rent, heat, electricity, etc.), General Laboratory Supplies, etc.
   G&A: indirect costs associated with the overall management of an organization, e.g.,
   President’s Office, Human Resources Office, Accounting Office, General Office
   Supplies, Office Maintenance, Etc.

                                            Flex-E-Grant             Match               Total
             CATEGORY

     Administration (Salaries, etc.)    Not eligible

     Construction Costs                 Not eligible           Not eligible                  $0.00

     Equipment Purchases                Not eligible           Not eligible                  $0.00

      Indirect Costs                    Not eligible           Not eligible                  $0.00

Direct Program Expenses:
Please list each cost category
individually. Direct costs are line-
items, or explicit project costs.




 TOTAL PROJECT COST (Cannot             $                      $                     $
 exceed $10,000, including local
 match)

         Please provide a detailed narrative for each line-item on a separate page.
                                                 7
                                FY 2012 Flex-E-Grant
                                   Attachment E

                  S A M P L E                R E S O L U T I O N
                      (Must be on letterhead of requesting organization)


The _______________________________ met on _____________________ with a
              (Organization)                     (Date)

quorum present and passed the following resolution.


        Be it resolved that the ________________________________ hereby authorizes
                                        (Organization)

___________________________________ of the ______________________________
(Name of Individual and Title)                          (Organization)

to apply for Flex-E-Grant funds, for leadership and/or capacity building activities, on behalf of

________________________________.
              (Organization)


        Be it also resolved that the ___________________________ hereby authorizes
                                                (Organization)

___________________________________________ of the ______________________
      (Name of Individual and Title)                      (Organization)

to act on its behalf to enter into a contractual agreement with the West Virginia Development
Office to receive and administer grant funds pursuant to provisions of the Flex-E-Grant Program,
if awarded.

        Be it further resolved that the governing body of ___________________ pledges
                                                              (Organization)

$________________ in unencumbered matching funds for the project.
  (Dollar Amount)




Signature:__________________________________

Print Name: ________________________________

Title: ______________________________________

Organization: _______________________________



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