WEST VIRGINIA DEVELOPMENT OFFICE
APPLICATION FOR THE
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:
Certifying Official: Title:
Contact Person: Title:
City, State, Zip:
Telephone Number: Fax Number:
List the county(ies) in the project area and their designation (distressed, at-risk, transitional,
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
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): _____
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
Section II: PROJECT FUNDING
Source Amount Commitment
(yes or no)
Flex-E-Grant (indicate the amount requested):
Matching Funds (please list each separately):
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:
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
ARC FLEX-E-GRANT PROJECT
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.
ARC FLEX-E-GRANT PROJECT
SECTION III – ATTACHMENTS (CONT.)
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
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
D. Letters of Commitment: Provide letters of commitment from all sources of
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.
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
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
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
Please provide a detailed narrative for each line-item on a separate page.
FY 2012 Flex-E-Grant
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
quorum present and passed the following resolution.
Be it resolved that the ________________________________ hereby authorizes
___________________________________ 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
Be it also resolved that the ___________________________ hereby authorizes
___________________________________________ 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,
Be it further resolved that the governing body of ___________________ pledges
$________________ in unencumbered matching funds for the project.
Print Name: ________________________________