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APPENDIX L1 APPENDI 2009 and 2010 ORGANIZATION / PROGRAM REVENUE PLEASE PROVIDE THE AMOUNTS AND SOURCES OF ALL FUNDING (REVENUE) ALLOCATED TO VICTIM SERVICES, BASED ON PROGRAM'S PREVIOUS, AND CURRENT, FISCAL YEAR BUDGETS. 2009 - 2010 2010 - 2011 CURRENT FISCAL SOURCE PROJECTED FISCAL YEAR REVENUE YEAR BUDGET AMOUNT AMOUNT FEDERAL FUNDS (excluding VOCA & STOP VAWA) VOCA FUND STOP VAWA FUND STATE FUNDS LOCAL GOVT. FUNDS OTHER SOURCES A fiscal year (FY) is the 12-month period that coincides with an organization's budget and financial cycle. A fiscal year may match a calendar year, but it usually differs. For example, the Federal fiscal year is from October 1 through September 30; the State of Oregon fiscal year is from July 1 through June 30. The information provided in the Current Fiscal Year section should represent the agency's current budget. The information in the Projected Fiscal Year section should be a budget forecast of the funds the agency expects to collect during the agency's next (2010-2011) fiscal year. APPENDIX L1 APPENDIX L4 2010 VOCA BASIC GRANT SERVICES ORGANIZATION NAME: 1 IMPLEMENTING AGENCY SUB-TYPE Rape Crisis Faith Based Organization Shelter Other 2 GROUPS SERVED: Previously Underserved (select one) Victim of Violent Crimes Against the Disabled Victim of Violent Crimes Against the Elderly Other 3 IDENTIFY THE VICTIMS TO BE SERVED THROUGH THIS VOCA FUNDED PROJECT (Check the boxes that apply) A CHILD PHYSICAL ABUSE G ADULTS MOLESTED AS CHILDREN B CHILD SEXUAL ABUSE H SURVIVORS OF HOMICIDE C DUI/DWI CRASHES I ROBBERY D DOMESTIC VIOLENCE J ASSAULT E ADULT SEXUAL ASSAULT K OTHER VIOLENT CRIME F ELDER ABUSE L OTHER 4 CHECK THE SERVICES TO BE PROVIDED BY THIS VOCA FUNDED PROJECT (Please refer to the VOCA Grant Management Handbook for service delivery definitions) A CRISIS COUNSELING H CRIMINAL JUSTICE B FOLLOW-UP CONTACT I EMERGENCY FINANCIAL ASSISTANCE C THERAPY J EMERGENCY LEGAL ADVOCACY D GROUP TREATMENT K ASSISTANCE IN FILING COMPENSATION E CRISIS HOTLINE L PERSONAL ADVOCACY F SHELTER/SAFE HOUSE M INFORMATION AND REFERRAL INFORMATION AND REFERRAL (In- G Person) N OTHER (Specify) 5 STAFF AND VOLUNTEER INFORMATION A. TOTAL FTE SUPPORTED WITH THESE FUNDS: ________________ B. NUMBER OF VOLUNTEERS ASSOCIATED WITH THE PROJECT: _________ APPENDIX L5 2010 BASIC GRANT BUDGET & COMPUTATION PAGE XYZ Shelter Oct. 1, 2010 - Sept. 30, 2011 ORGANIZATION NAME PROJECT PERIOD GRANT MATCH MATCH TOTAL Computation FUNDS FUNDS TYPE PROJECT Personnel #1) Position Title/FTE .25 FTE Children's Advocate Salary $2,785/mo x 12 mo x .25 FTE or $33,420/yr x .25 FTE 8,355.00 2,939.06 11,294.06 Benefits Benefits @ 28% of the VOCA funded salary ($8355 x .28 = $2088.75) 2,339.40 2,339.40 #2) Position Title .50 FTE DV/SA Advocate Salary 20 hrs/wk x 52 wks = 1040 hrs/yr x $16.07/hr for 6 mos & $16.87/hr for 6 mos. 17,128.80 17,128.80 Benefits Benefits @ 28% of the VOCA funded salary ($17,128.80 x .28 = $4,282.20) 4,796.06 4,796.06 Match Source Volunteers - (500 hrs/yr x $14/hr) 7,000.00 IK 7,000.00 Total Personnel 32,619.26 9,939.06 42,558.32 Services and Supplies 1) Contractual Services* Child Therapist ($35/hr x 2 hrs/wk x 52 wks) 3,640.00 3,640.00 2) Travel Advocate mileage (162 mi/mo x 12 mo x $.485/mi); 225 miles round trip x $.485/mi. 1,051.97 250.00 C 1,301.97 3) Training Volunteer training: $10/person x 10 = $100. Director's Day: Hotel: 2 nights @ $70; meals: 2 days @ $39/day 318.00 318.00 4) Office Supplies 1,950.00 250.00 C 2,200.00 5) Postage 1,600 stamps @ $.42/each 672.00 672.00 6) Printing & Copying 1,000 brochures @ approx. $1.25 each, 100 copies/mos x $.05/copy 1,310.00 1,310.00 7) Telephone $40/monthly service fee x 12 months, 1 cell phone @ $45/mos x 12 mos 1,020.00 1,020.00 8) Equipment Rental $50/monthly copier rental fee x 12 months 600.00 600.00 Match Source General or Unrestricted Fund Total Services and Supplies 10,561.97 500.00 11,061.97 Other Services $3,000 per month for the Agency x 12 mos = $36,000/year/10 total FTE within the agency and prorated 1) Rent for .75 FTE VOCA funded positions as noted above. 2,700.00 1,500.00 C 4,200.00 2) Emergency Services $25/client x 75 clients 1,875.00 1,875.00 3) Audit Costs 4) Capital Outlay 5) Other (Describe) Match Source General or Unrestricted Fund Total Other Services 4,575.00 1,500.00 6,075.00 TOTAL EXPENDITURES 47,756.23 11,939.06 59,695.29 *If a grant is funded that includes contractual services, the agency must provide a copy of the signed contract. IMPORTANT: The dollar amounts and timelines listed above must be consistent with those on the coversheet. 2010 BASIC GRANT BUDGET & COMPUTATION PAGE APPENDIX L5 ORGANIZATION NAME PROJECT PERIOD GRANT MATCH MATCH TOTAL FUNDS FUNDS TYPE PROJECT Computation Personnel #1) Position Title/FTE Salary Benefits #2) Position Title Salary Benefits Match Source: Total Personnel 0.00 0.00 0.00 Services and Supplies 1) Contractual Services* 2) Travel 3) Training 4) Office Supplies 5) Postage 6) Printing & Copying 7) Telephone 8) Equipment Rental Match Source: Total Services and Supplies 0.00 0.00 0.00 Other Services 1) Rent 2) Emergency Services 3) Audit Costs 4) Capital Outlay 5) Other (Describe) Match Source: Total Other Services 0.00 0.00 0.00 TOTAL EXPENDITURES 0.00 0.00 0.00 *If a grant is funded that includes contractual services, the agency must provide a copy of the signed contract. IMPORTANT: The dollar amounts and timelines listed above must be consistent with those on the coversheet. APPENDIX L6 2010 Budget Narrative/Justification BUDGET ITEM NARRATIVE/JUSTIFICATION OF BUDGET ITEM Personnel: Salary Children's Advocate will provide direct services to survivors and their family. See the attached job #1) Position Title description for more details. DV/SA Advocate will be hired and funded at a .50 FTE by [VOCA/VAWA or ODSVS] funds. This position will be responsible for the initial contact with victims as well as ongoing support and advocacy, #2) Position Title as needed. The Advocate will receive a cost of living adjustment (COLA) the 6th month of this grant. The calculations on the budget page reflect this adjustment. #3) Position Title All benefits are calculated at 28% of base salary. The rate covers FICA, health care, social security, Personnel: Benefits workmans compensation, short term disability. Services and Supplies Child Therapist will provide one-on-one counseling with survivors as well as work with non offending 1) Contractual Services* family members. See contract for specifics. 1. Local mileage for Advocate to travel to meet with clients and attend client meetings with other service 2) Travel providers. 2. Estimated mileage for the Children's Advocate to attend SATF Advocate training. 1. Provide a 40-hour volunteer training for agency new volunteers. 3) Training 2. Attend SATF Advocate training. 1. General office supplies: paper, pens, printer cartridges, computer software for the new computer. 2. Personal Computer: 1 desktop computer necessary to replace 10 year old computer. This will be 4) Office Supplies used solely for victim services. 5) Postage Necessary for mailing office and client documents. 1. Routine office copying and client documents. 6) Printing & Copying 2. Printing of agency brochures. 7) Telephone Agency landline telephone service and one cell phone 24/7 crisisline A photocopier will be leased for 12 months and the cost is pro-rated across funding streams. See item 6 8) Equipment Rental above for purpose. Other Services 1) Rent Covers pro-rated share of office space. 2) Emergency Services Client emergency services to cover client basic needs 3) Audit Costs 4) Capital Outlay 5) Other (Describe) *If a grant is funded that includes contractual services, the agency must provide a copy of the signed contract. ADDITIONAL MATCH INFORMATION (For VOCA only) JUSTIFICATION OPTIONAL: If there is additional information to include about the VOCA match, please add here. APPENDIX L6 2010 Budget Narrative/Justification BUDGET ITEM NARRATIVE/JUSTIFICATION OF BUDGET ITEM Personnel: Salary #1) Position Title #2) Position Title #3) Position Title Personnel: Benefits Services and Supplies 1) Contractual Services* 2) Travel 3) Training 4) Office Supplies 5) Postage 6) Printing & Copying 7) Telephone 8) Equipment Rental Other Services 1) Rent 2) Emergency Services 3) Audit Costs 4) Capital Outlay 5) Other (Describe) *If a grant is funded that includes contractual services, the agency must provide a copy of the signed contract. ADDITIONAL MATCH INFORMATION (For VOCA only) JUSTIFICATION OPTIONAL: If there is additional information to include about the VOCA match, please add here.