Community Grants
Micro Grants Application 2009
Section 3 - MICRO GRANTS APPLICATION FORMS
RELEASE DATE: JANUARY 21. 2009
Applications Accepted By: March 10, 2009 (For grants to begin July 1, 2009) August 11, 2009
The Commission cannot give grants for items that have already been purchased or for services that have already been provided.
Please read Section 1: “ Micro Grant Instructions & Guidelines, and Attachments” before you fill out these forms. All the forms that follow are available as Word files. They can be downloaded from the Commission website at www.tccfc.org or requested as an email attachment from Sheila Kruse at sheilakruse@sbcglobal.net or Janet Cook at JCook@co.tuolumne.ca.us
Please add your organization’s name as a header for the following section.
Applicant’s Name: __________________________________
Micro Grant Proposal Cover Sheet 2009
Name of Applicant: Address: Contact Person: e-mail: Descriptive Title of Project: Phone: Fax:
Total Amount of Request: Must not exceed $1,000 Project Start Date:
Must be at least one month after the date that the Commission acts on funding proposals.
Total Project Cash Budget:
Project Completion Date:
Please list below all additional community agencies and organizations who will attest, if contacted, that they are contributing resources and/or that they are a critical part of the service strategy that you are requesting funds for:
I authorize submission of this application:
Name of authorized agency official
Name of agency/organization
Title of authorized agency official
Authorized Signature
Date
Micro Grant Application Forms, January 2009
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Tuolumne County Children and Families Commission
Request for Micro Grant Funds Detail Sheet This narrative section should not exceed 3 pages (8” x 11.5”). Applicants are encouraged to be brief, but to answer each question. If you are using a word processor, please use a font size of at least 12 points. For your convenience, this form is provided as a fill-in form in Microsoft Word – just type your answers in the boxes after the questions. 1. Request: What will you use the requested funds for? What are your planned activities? When will the project start and when will it be completed?
2.
Need for Project: Why is this project needed in Tuolumne County?
Micro Grant Application Forms, January 2009
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Tuolumne County Children and Families Commission
3.
Number Served: As a result of either direct service, or of activities to strengthen
organizations, how many unduplicated young children from birth to their 6th birthday, caregivers, and/or pregnant women will benefit during the grant period? If applicable, how many service providers will benefit? Indicate whether the benefit will be direct or indirect. If this is not applicable, or difficult to estimate, please write a brief statement explaining why. (Direct means that the grant funds will be used to provide children and parents directly with a service; indirect means that, as a result of resources for training or capacity building, children and parents will be served more effectively during the grant period.)
Answer: Direct Indirect Children 0-5 Parents/Caregivers of children birth -6th birthday Pregnant Women Service Providers Total
4. Link to Strategic Plan Outcomes: In the tables following, please check at least one outcome that you feel your project will address for pregnant women and/or children from birth to their 6th birthday.
FIRST 5 STRATEGIC PLAN OUTCOMES
Outcome #1. FIRST 5 funds will be invested to fill identified service gaps and/or to expand
the coordination or capacity of existing services which promote improved family functioning in the areas of: a. Self-sufficiency and basic needs provision; b. Improvement of skills and knowledge about parenting, child development, and/or home environments supportive of cognitive development; c. Family Literacy; d. Improvement in behavioral health status for young children and their families; e. Reduction of trauma and crisis; f. Persistence in drug and alcohol recovery treatment.
Outcome #2. FIRST 5 funds will be invested to fill identified service gaps and/or to expand the
coordination or capacity of existing services which promote improved child development through: a. Access to licensed (and legally licensed exempt) and accredited child care facilities to meet parent’s identified needs (such as quality, location, time availability and age-specific needs). b. Building the capacity of child care providers/early childhood educators to provide healthy and safe environments and high quality care; c. Access to screening and intervention for developmental delays, behavioral issues, and other special needs. d. Capacity to identify and serve children with special needs (including behavioral issues) in childcare and early childhood education settings.
Micro Grant Application Forms, January 2009
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Tuolumne County Children and Families Commission
Outcome #3. FIRST 5 funds will be invested to fill identified service gaps and/or to expand the
coordination or capacity of existing services which promote improved health through: a. Access to preventative health care and primary health care through reduction of barriers or by strengthening systems of care; b. Access to preventative dental care and to dental services through reduction of barriers or by strengthening systems of care; c. Reduction in exposure to environmental (or prenatal) tobacco smoke; d. Improved nutrition and physical activity.
Outcome #4. FIRST 5 funds will be invested to expand the coordination or capacity of organizations
to improve systems of care. These enhancements will lead to: a. Service integration; b. Access to services, especially in underserved areas, and to populations with identified barriers to access and/or indicators of poor family health and functioning. c. Cultural competence in service provision.
If you think that your project description in Question #1 does not show a clear link to these outcomes, and would like to explain further, do so here:
5. Other Resources: Will you use other resources to support the project? If your project will benefit children above the age of 5, you must provide additional resources to fund the project.
Micro Grant Application Forms, January 2009
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Tuolumne County Children and Families Commission
BUDGET FORM MICRO GRANT
(Add or subtract extra lines as needed; available as an Excel file on the website)
List the items that you need for the portion of your project that serves the First 5 target audience (a)
List the amount of funds you are requesting from First 5 for each item. (b) $ $ $ $ $
If there is other cash available for the item, list that here
Total Cash Cost of Each Item
(c) $ $ $ $ $ $
(add columns b and c) $ $ $ $ $ $
TOTAL COSTS FOR PROJECT:
$
If there will be non-cash contributions, such as volunteer labor or donated materials, list them here:
Micro Grant Application Forms, January 2009
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Tuolumne County Children and Families Commission
FIRST 5 ONGOING FUNDING FORM
Have you ever received funding from FIRST 5 Tuolumne County for this project (or a closely related project)? If so, you must fill out this form. Name of previously funded project: Dates of Funding: Amount of Commission Funding: Total Cost of Project:
Please explain why you must return to the Commission to request ongoing funds. Answer here (use space as necessary): Please describe what plans you have to look for other sources of funding in the future. Answer here (use space as necessary):
_____________________________________________________________________ Commission staff attach review of previous grant (Benchmarks met, outcomes measured, grant management issues)
Micro Grant Application Forms, January 2009
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Tuolumne County Children and Families Commission
HISTORY OF OTHER FUNDING SOURCES
Has your organization received any funding other than FIRST 5 funding in the last year to support the services that you describe in this application (or very similar services?) Will you be receiving any funding other than FIRST 5 funding during the grant period? If so, you must fill out this form. If not, skip this form. If you only received FIRST 5 funding, do not fill out this form. State law prohibits Commission funds from funding existing levels of service or programs. To ensure compliance with this provision, please provide the following information: 1. Have you or any other entity provided the services or programs for which you are seeking funding in the county in the last year? Please explain. Answer: 2. If you have provided the services or programs in the past year, please describe (1) the source of funding for those services or programs, including the time period you received such funding, the amount of the funding, and the identity of the grantor, and (2) the start and end dates for those programs. Answer:
3. Are you eligible to receive any funds during the grant period for any aspect of the services or programs for which you seek funding? If so, please describe those funds, including the amount of the funds, period of payment, and whether those funds are earmarked for specific purposes. Answer:
4. If you are seeking funding for a program or level of service that you currently provide but that will no longer be funded during the grant period, please provide documentary evidence that such funds will no longer be available during the grant period. Answer: List the documents you are attaching, here.
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