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									North Carolina Department of Juvenile Justice and
             Delinquency Prevention




          REQUEST FOR PROPOSALS
         Support Our Students Programs

                 Fiscal Year 2007-2008
             Due Date: Wednesday, October 31, 2007

                         This is a reposting




      Department of Juvenile Justice and Delinquency Prevention
                     George L. Sweat, Secretary
                      1801 Mail Service Center
                    Raleigh, North Carolina 27699
                          www.ncdjjdp.org



                                -1-
Introduction
The following is the Fiscal Year 2007-2008 Support Our Students Request for Proposal
packet for the North Carolina Department of Juvenile Justice and Delinquency
Prevention (herein after referred to as the Department or DJJDP). In addition to the
application you will find instructions, Requirements for Program Operations, and other
support documents that will assist you in completing the application.


The Request for Proposal Process
The Request for Proposals (RFP) is a competitive process in lieu of the normal bidding
(e-procurement) process for other types of state contracts. During the application
process, any 501(c)(3), private not for profit organization within designated counties
may apply for funding. One grant shall be awarded per county. Counties are listed in
the section titled „Eligible Applicants‟.

Support Our Students (SOS) funds provide for the implementation of after school
programs designed to create supportive extra learning opportunities that have a positive
impact on the lives of school-aged children. SOS is a key element in the commitment to
making North Carolina “First in America” in the education and treatment of youth. North
Carolina General Statute § 143B-152 outlines the goals of SOS programs:
      1. Reduce the number of students who are unsupervised after-school, otherwise
      known as “latchkey” children;

      2. Improve the academic performance of students participating in the program;

      3. Meet the physical, intellectual, emotional, and social needs of students
      participating in the program and improve their attitudes and behavior;

      4. Improve coordination of existing resources and enhance collaboration so as
      to provide services to school-aged children effectively and efficiently;

      5. Reduce juvenile crime in local communities served by the program; and

      6. Recruit community volunteers to provide positive adult role models for school-
      aged children and to help supervise after-school activities.


   Now in its thirteenth year of operation, the Department‟s SOS initiative operates in
   all 100 counties in North Carolina. During the 2005-2006 school year, SOS
   programs served approximately 16,000 youth across the state at over two-hundred
   (200) after school program sites.




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Eligible Applicants
A community or neighborhood-based 501(c)(3), private, not-for-profit organization, or a
consortium consisting of one or more local not-for-profit and one or more local school
administrative units may apply for a grant.

A school system is eligible if it applies under its 501(c)(3) Educational Foundation or in
collaboration with a 501(c)3 not-for-profit organization.
Grants will be awarded on a limited, competitive basis. The Department will award
single grants in the following counties:

Cabarrus
Onslow
Pender
Sampson
Surry


Maximum Grant Award Amounts
The maximum grant awards for fiscal year 2007-2008 are outlined by county in
Reference Supplement-I at the end of the RFP.

Funding allocations include State Appropriation and Social Services Block Grant
(SSBG) federal pass through funds. Grant awards are subject to the availability of state
and federal funds to the Department.

A seven (7) month contract will be awarded to selected applicants for the period of
December 1, 2007 to June 30, 2008. Final Contract amounts are subject to adjustment
at the discretion of the Department.


Social Service Block Grant (SSBG)
Funding allocations include State Appropriation and Social Services Block Grant
(SSBG) federal pass through funds. SSBG funds are contracted to DJJDP by the North
Carolina Department of Health and Human Services Division of Social Services (DSS)
and must be used to expand or enhance the SOS program design in accordance with
DSS priorities.

DSS places priority for the use of the SSBG funds within SOS programs on services
designed to address gang violence prevention, teen pregnancy, academic failure and,
reduce juvenile delinquency.




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In Section IV Program Narrative, Subsection A Program Design, applicants must
illustrate how the use of SSBG funds will be incorporated into the overall SOS program
design. Once awards are granted, Grantees will be required to submit a detailed SSBG
program plan for the 2007-2008 fiscal year.


Funding Period
The funding period for the 2007-2008 fiscal year for the SOS grants included in this
posting is December 1, 2007 to June 30, 2008. At the Department‟s option, contracts
can be extended for two (2) one year periods at which time the competitive RFP
process will be required.

The Department may also amend or terminate contracts in the event of noncompliance,
changes in scope of work, or an increase/decrease in the availability of funds to the
Department.



Funding Priorities and Target Population
The proposal should explain in detail how the program or services would specifically
reduce the risk factors present in the lives of the school-age children and families. The
SOS legislation defines „school-aged children‟ as children enrolled in kindergarten
through the ninth grade.
Priority for grant awards will be placed on proposals designed to serve youth in
fourth (4th) through eighth (8th) grade who are at-risk for juvenile delinquency.
Ninth grade students may be served by SOS programs if they are attending junior high
school which serves grades 7, 8 and 9 or if the program incorporates a 9th grade
transition program into the regular program (4th-8th grade) for those youth who have
been served and want/need continued SOS services through the 9 th grade. Proposals
that focus on serving high school students beyond that which is described herein will
not be funded.
Funds provided at the elementary school level could be used to bridge the early school
years and the middle school program. Applicants may choose to focus on programs
which serve children from the same family but attending elementary and middle
schools.


Priority Funding Considerations:
Applications for grants which include the following will receive priority consideration:
   (1) proposals designed to serve youth in fourth (4th) through eighth (8th) grade at risk
       for juvenile delinquency
   (2) proposals designed with research/evidence based practices and strategies
   (3) demonstrated creative use of local resources


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(4) evidence of becoming self-sustaining over time
(5) agency ability to provide adequate and effective services as demonstrated by
    current services provided and/or by the documentation of adequate planning
    and community support in the proposal
(6) proposals designed to serve youth during summer months
(7) Fees for participation in SOS programs or activities should not be required as a
    condition for enrollment or participation. Priority will be given to proposals that do
    not charge fees for participation.




                                         -5-
                               General Instructions
1. A Letter of Intent is required indicating the applicant‟s plan to submit a proposal.
   The Letter of Intent must be received by Monday, October 1, 2007 by 5:00pm.
   See Application Delivery and Shipping Address for address information.
2. Read the entire application packet and these instructions before writing the
   proposal. Follow these instructions carefully. Address each section of the
   application clearly and precisely. Failure to respond to all sections could result in
   disqualification of the proposal.
3. Unless otherwise noted, submit one (1) original application that is clearly marked
   (either by „original‟ stamp or blue ink signature on the Certification in Section II D)
   and four (4) copies of the application with Appendices. Failure to provide one (1)
   original and four (4) copies by Wednesday, October 31, 2007 by 12:00PM may
   result in the proposal not being reviewed for funding.
4. Complete the proposal on pages provided within the grant application packet.
   Appendices may require supplemental information to be included.
5. All proposals must be typed in 12-point font with double-spacing and one-inch
   margins from the right, left, top and bottom of the page. Modifications to font-size or
   margins provided in this application could result in disqualification of the proposal.
6. Do not modify the tables or forms other than to add rows to tables. Do not amend or
   remove the column headings. Modifications or deletions could result in
   disqualification of the proposal.
7. Each copy of the proposal, including the original, shall be fastened with a binder
   clip in the upper left hand corner only and shall not stapled or be contained in any
   form of binder or notebook.
8. Retain the Reference Supplements I, II, and III at the end of the RFP. Do not return
   copies of the Reference Supplements as a part of the proposal.
9. Applications received via facsimile transmission or electronic mail, or those received
   after the due date for submission of grant applications will not be considered. Post
   marks will not be accepted.
10. The response to this application includes (1) the application cover page; (2)
    Sections I-VI of the application and (3) Information required in Appendices A-F with
    Appendix cover pages.
11. The application (Cover Page and Sections I-VI) is limited to a total of twenty-one
   (21) single-sided pages. The Appendices are not included in this page limit.
   The RFP description/instructions and Reference Supplements I, II, and III are not
   to be submitted with the completed application. Any pages in excess of the 21-
   page limit may be discarded and not reviewed.

12. Page Limits for each section are provided in the Grant Application Checklist on
   page 10 of the RFP.



                                           -6-
13. Required Appendices

  Appendix A   Letters of Review/Support
               Applicants are expected to submit a minimum of four (4) letters of
               support and on the original letterhead of the supporting agency. See
               Section IV (E) on Collaboration for additional instructions.
  Appendix B   DJJDP Conflict of Interest Policy Statement
               The Conflict of Interest Policy Statement is a certification that the applicant
               agency has a Board approved conflict of interest policy. The DJJDP
               Conflict of Interest Policy Statement is not a substitute for a Board
               approved policy; it is intended to certify that a Board approved policy exists
               within the applicant organization and discloses conflicts or the appearance
               of potential conflicts within the applicant organization (not just within the
               SOS program operation) to the Department. Directions on page three (3)
               of the Statement requires an attachment with a description of the conflicts
               disclosed on page two (2) of the form.              Failure to provide this
               information may result in the application not being reviewed for
               funding.
  Appendix C   Certification and Sworn Statement of No Overdue Tax Debt
               As defined by G.S. 105-243.1, “Every grantee shall file with the State
               agency or department disbursing funds to the grantee a written statement
               completed by that grantee's board of directors or other governing body
               stating that the grantee does not have any overdue tax debts at the
               federal, State, or local level.” The written statement shall be made
               under oath and shall be filed before the disbursing State agency or
               department may disburse the grant funds. A person who makes a false
               statement in violation of this subsection is guilty of a criminal offense
               punishable as provided by G.S. 143-34(b).”

               Applicants are required to submit the certification and sworn statement on
               original agency letterhead. It must be signed by the Board Chair and a
               second authorizing official. A template is provided in Appendix C. Failure
               to provide this information may result in the application not being
               reviewed for funding.
  Appendix D   Acknowledgement: SOS Requirements for Program Operations
               Provide a signed copy of the acknowledgement form provided. SOS
               Requirements for Program Operations outlines general requirements for
               local SOS programs. SOS Requirements for Program Operations is NOT
               the sole rules document; if awarded funding, grantees will be responsible
               for complying SOS Requirements for Program Operations in addition to
               contract terms and conditions and all applicable state and federal laws.
               Failure to provide this information may result in the application not
               being reviewed for funding.
  Appendix E   Organization & Consortium Capacity
               The following documentation is required to be included in Appendix E.
               Provide one (1) original and five (5) copies of the following:
                   1. Description of Agency – provide a brief description of the agency
                       or organization and organization mission
                   2. Current Agency Budget – describe currently funded programs



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                   (one paragraph each) implemented by applicant including amount
                   of funding, source of funding, and time remaining on the
                   grants/contracts
                3. List of Board of Directors - provide name, title, employer,
                   address, and Board term
                4. Internal Revenue Service (IRS) designation letter – Not-for-profit
                   organizations, including faith-based organizations, must be
                   501(c)(3) certified by the IRS.

             Provide only one (1) original copy of the following with the original
             application:

                 5. Articles of Incorporation – include copy of Articles of
                    Incorporation
                 6. Fiscal Accounting Policies and Procedures - Provide a copy of
                    applicant organization‟s policies and procedures that clearly identify
                    the organization‟s internal accounting environment.
                 7. Separation of Duty- Separation of duty is key to a successful
                    accounting environment. Provide an outline of the individuals who
                    will be responsible for 1) incoming invoices 2) receiving and
                    handling incoming cash 3) payment of invoices 4) recording of
                    financial information into the general ledger. Applicants may
                    include any information that may be useful.
                 8. Agency Conflict of Interest Policy – application must include the
                    Board approved agency/organization conflict of interest policy.
                    Please note that the DJJDP Conflict of Interest Policy Statement
                    required in Appendix B does not constitute as the agency‟s Board
                    approved Conflict of Interest policy.
Appendix F   Budget Summary
             Provide a detailed description and accounting of all major items for
             administration and operation of the SOS program. Budget summary
             includes a Budget Sheet, Budget Narratives (Personnel Itemization,
             Contracted Personnel and Services, and Line Item Budget Narrative), and
             Anticipated Revenue Summary Form. No page limit. See Reference
             Supplement III for Budget Narrative instructions, descriptions, and
             samples.




                                         -8-
Application Delivery and Shipping Address:
The closing date for receipt of applications is Wednesday, October 31, 2007 at
12:00PM. Send applications to:

       Kristin O‟Connor, Community Grants Programs Manager
       Department of Juvenile Justice and Delinquency Prevention
       1805 Mail Service Center
       Raleigh, North Carolina 27699

For hand delivered applications, applications sent overnight, and/or via private courier
(e.g. FedEx), deliver the applications to the Department‟s physical address:

       4112 Pleasant Valley Road, Suite 214
       Raleigh, North Carolina 27612



Requirements for Application Review
Applications may not be reviewed unless the following minimum requirements are met:

      The completed original application and four (4) copies are received by the
       application deadline.
      Signed and notarized copy of DJJDP Conflict of Interest Policy Statement with
       attached description of disclosed conflicts (Appendix B)
      Signed and notarized copy of Certification and Sworn Statement of No Overdue
       Tax Debts (Appendix C)
      Signed copy of the SOS Requirements for Program Operations Acknowledgment
       form (Appendix D)

Applications will not be reviewed unless the following minimum requirement is met:

      Letter of Support from the School-System is included for applications proposing
       services at school-based sites.



Selection Process
An independent grant review committee is selected in accordance with G.S. 143B-
152.5. A substantive review of applications for minimum requirements will be conducted
by the Department on the first business day after the applications are due. The eligible
applications will then be forwarded to the grant review committee who will review, score,
and rank the applications.

The overall quality and core of application and its proposed services are critical factors
the review team uses to inform funding recommendations. The application‟s overall


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quality coupled with past and current performance and the agency‟s capacity to deliver
services are important factors the Department weighs when making the final selection
for the grant awards.

The overall quality the application is, in part, shaped by the degree to which the
following is clearly described:
      The demonstrated need for the after-school program as set forth in the needs
       assessment section of the application narrative.
      The application describes a plan and strategies which give evidence of
       addressing the legislative goals of SOS.
      The proposed services are clearly linked to the known community risk factors
       and needs.
      Services provided are linked to program goals and objectives.
      Where feasible, there is a broad student demographic.
      Families, the neighborhood or community, and, most importantly, students have
       been involved in developing the application and evidence that their involvement
       will continue in a significant way once the program is funded.
      The applicant has made creative and innovative use of volunteers and existing
       community resources.
      The budget is reasonable and reflects the goals, objectives, and strategies
       described in the narrative.
      Objectives are linked to proposal‟s need statement.
      Evidence of sustainability is provided.
      Organizational structure and policies and procedures demonstrate evidence of
       sound internal administrative controls and capacity to deliver services.
    Evidence of support for the program at the community level. Letters of Review
       from the local Juvenile Crime Prevention Council and Letters of Support from
       partnering agencies demonstrate evidence of need within the continuum of
       services, agency capacity to deliver services, strengths in existing services, and
       demonstrated community collaboration.




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Grant Application Checklist

Use this checklist to ensure that all parts of the application are included in the following
order and in accordance with the maximum page limits.

      Section                                                                           Maximum Page Limit
       Application Cover Page.........................................................................    1
       I.     Face Sheet................................................................................. 1
       II.    Program Summary..................................................................... 4
       III.   Needs Assessment....................................................................        2
       IV.    Program Narrative...................................................................... 11
              A. Program Design
              B. Goals, Measurable Objectives & Strategies
              C. Timeline
              D. Staffing and Volunteer Management
              E. Collaboration
              F. Organization & Consortium Capacity
       V.     Quality Assurance/Local Evaluation Plan...................................                  1
       VI.    Sustainability Plan.................................................................1

                                                                            Total Pages:          21

      Appendices                        No Limit: Include all Information including cover pages
       Appendix A:       Letters of Review/Support
       Appendix B:       DJJDP Conflict of Interest Policy Statement
       Appendix C:       Certification and Sworn Statement-No Overdue Tax Debt
       Appendix D:       Acknowledgement Form-SOS Requirements for Program Operations
       Appendix E:       Organization & Consortium Capacity
       Appendix F:       Budget Summary




Components of the Request for Proposal
The following components of the proposal must be submitted in the order indicated and
in accordance with required page limits. Complete the application using the forms and
format provided for all sections.


 Application Cover Page (one page)
 I.         Face Sheet: Sections A-D (limit one page)

 II.        Program Summary (limit four pages)


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This section is a three page summary (that can expand up to four pages) of basic
information about the proposed program which includes a program abstract, program
type, proposed number of participants, and demographic data regarding participants.
Provide a brief description of the program, including the program‟s main purpose, types
of services offered, and expected outcomes. Be as specific as possible.

 III.   Needs Assessment (limit two pages)
Applicants must conduct a needs assessment of existing conditions for school-aged
children in the area to be served by the local SOS program. A needs assessment
entails the gathering of data, both qualitative and quantitative, that demonstrates a
need for the services proposed and that the services address needs of the community,
students, families, and stakeholders. The data provided must be current (no more than
three years old), with sources and dates identified.

This section must clearly detail community risk factors and how the proposed program
will offset the risk factors that place youth at risk for juvenile delinquency.

Applicants must make clear how and to what extent students and families served by the
local SOS program have been involved in the needs assessment.

Suggestions for Applicants: Information to gather and analyze in this section may
come from local/school community based data such as:
          Juvenile delinquency data and crime rates (access local JCPC for data,
            DJJDP website, DJJDP Annual Report, etc.);
          suspension and expulsion data;
          school discipline rates;
          school truancy rates;
          attendance data;
          school drop out rates;
          academic data (EOG data);
          mobility rates;
          poverty data;
          number of „latchkey‟ youth to be served at program site;
          survey/interview data with stakeholders that support program need;
          results of county, school, or local education agency data;
          any other relevant or unique local data that demonstrates the need for the
            program.

 IV.    Program Narrative (limit 11 pages)
Applicants must describe how the proposal addresses the needs described in Section
III which includes proposed goals and anticipated outcomes of the local SOS program.
The program plan must be prepared after consulting with local after-school programs,
schools, community organizations, the local Juvenile Crime Prevention Council (JCPC),
and other appropriate stakeholders which have as their purpose assisting or helping



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school-aged children who are at risk of failing in school or entering the juvenile justice
system.
Families of the students and residents of the neighborhoods and communities to be
served by the SOS program must be involved in the development of the plan.
Furthermore, applicants must provide for the ongoing involvement of these groups in
making decisions concerning the SOS program. Of particular importance is a structure
that truly involves students in decision-making about their after-school program and
environment. A student advisory group or other structure that provides for youth input is
essential.


The Program Narrative section must follow the format provided:
       A. Program Design
      The program design must clearly address each bulleted item in this section:

          Program Design
            Provide a detailed description of the program design. The design should
             describe all components of the program and frequency of delivery of each
             component.

             Describe how the after-school activities will strengthen and support the
              academic and behavioral progress of students participating in the
              program.


             Describe how the students and families of the neighborhood or community
              were involved in developing the program design and include how they
              were selected. (In depth and continuing student involvement is a
              requirement of the program.)

             Describe provisions for snacks.


         Summer Programming
          Describe services to be provided during summer months.

          Risk, Referral and Enrollment
          The SOS program must serve youth who are most at risk for involvement in
          the juvenile justice system. Referral and enrollment to the SOS program
          must be based on known risk factors that place youth at risk for juvenile
          delinquency.




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   List the target criteria to be used for enrollment in the proposed SOS
    program.

   Describe the referral process to be used to enroll youth into the program.
    Include sources of referral to the program. Applicants should include
    letters of support in Appendix A from all referral sources described.

   Describe how the proposed program design will reduce the risk factors
    present in youth served.

   Provide description of active enrollment, completion, or withdrawal from
    the SOS program: Per SOS Requirements for Program Operations, a
    youth may only be considered enrolled and served if s/he is in attendance
    at least once during the program year and excused absences from the
    program cannot qualify as active attendance. Programs may have
    additional definitions to further categorize participation levels

Expansion/Enhancement
 If the applicant organization provides an existing after-school service,
  describe existing services (design, population served, goals, etc.) and
  funding source.

   Provide a detailed description of how the SOS funds will be utilized to
    enhance or expand the current service.


Evidence Based Research
   Describe how the program design is supported by evidence-based
    research. Program designs should be developed based on what research
    indicates as “best” practices for after-school programs and/or youth
    development programs. Include sources of research.

Social Services Block Grant (SSBG)
 Provide a description of how the SSBG funds will be utilized within the
  program design described above. The services proposed with the use of
  allocated SSBG funds must align with DSS priorities and be used to
  enhance the basic SOS program design (DSS priorities are summarized
  on page four (4) of the RFP).

Dosage, Frequency and Location:
 List the days and hours of operation (e.g., Mon-Fri / 2PM-6PM). Be sure
  to adhere to SOS Requirements for Program Operations for standards.



                                - 14 -
      Include a listing of all program locations. Give names of locations,
       physical addresses, site coordinator names, and telephone numbers.
      Describe the length of the program.


   Transportation
      Describe the provision for student transportation services.


B. Goals, Measurable Objectives, and Strategies
Applicants should base the program design on a thorough assessment of the
needs presented in Section III (Needs Assessment), establish a set of
measurable goals and objectives, and strategies to be used to achieve the goals
and objectives.      Applications should clearly demonstrate how the program‟s
activities are linked to the needs and provide specific, measurable, achievable,
realistic, and time-bound (S.M.A.R.T) objectives for measuring achievement of
the goal. Strategies are the actions/ activities that will be implemented in order
to achieve the goals and objectives.

Example of Goals, Measurable Objectives, and Strategies
Goal: Participants of the local SOS program will improve reading skills.
Measurable Objectives:
Sixty percent (60%) of youth scoring below grade level in reading on State
reading tests in 2005-2006 will score at grade level in reading in 2006-2007.
Strategies:
During 2006-2007, the SOS Program will incorporate a literacy-based tutorial
program for youth having below grade level EOG scores in reading during the
2005-2006 program year. The tutorial program will be implemented each day of
the week by contracted certified teachers for the length of the program.

C. Timeline
Timely implementation of the SOS program is a requirement for funding.
Programs should be active within 30 days of the grant award. Programs without
active operation within 30 days must at minimum demonstrate aggressive
program implementation planning activities, collaborative efforts, and staff and
volunteer training plans.

Failure to implement programs within 30 days of the start of the award of funding
may result in contract amendment and/or termination of the contract.




                                   - 15 -
Using the template provided in the application packet, applicants must complete
the timeline for implementation in the areas listed. The completed timeline and
activities should be reflective of the whole program year. Additional activities may
be added.

D. Staffing and Volunteer Management
Applicants must provide detailed descriptions of how the program will be
structured and operated with respect to staffing and qualifications, recruiting,
hiring, and selection, management plans, and training plans. This section must
clearly address each bulleted item:
     Describe the staffing structure (organization structure) for the local SOS
        program. Include an organizational chart with a clear outline as to
        reporting structures and protocols.
     Describe minimum hiring qualifications sought for the Program Director
        and other management staff.
     Describe minimum hiring qualifications sought for direct program services
        staff.
     Describe processes utilized by the organization for staffing the local SOS
        program. Provide a detailed description of the following processes for
        staff and volunteers:
                  i. Recruitment policies/procedures
                 ii. Criminal Background screening policies/procedures. Include
                     additional DMV screening processes employed for
                     transportation staff. Include processes specific to types of
                     screenings utilized and procedures pertaining to candidates
                     with evidence of criminal background histories
                iii. Selection procedures of qualified candidates
                iv. Retention practices
     Describe staff to student ratio
     Describe staff and volunteer training requirements and training plans.



E. Collaboration
Applicants must demonstrate strength in collaboration with partnering agencies.
Applicants should specifically describe how partners will contribute to the
success of the program with services and/or cash or in-kind resources.

Strength of the collaborations is more important than the number of
collaborations. Applicants are encouraged to illustrate collaborative partners
selectively as signed letters of support must be included as a part of the
proposal.



                                    - 16 -
A minimum of four (4) letters are expected to be submitted with the application
as referenced in Appendix A.

   1. Letter of Review: Juvenile Crime Prevention Council (JCPC): It is
      expected that one of the four letters is a Letter of Review from the local
      JCPC. Applicants should plan to present the proposed services and/or
      application to the JCPC for review. The Letter of Review from the JCPC
      may indicate that the applicant requested the JCPC to review the
      application/proposed services and/or the letter may provide additional
      evidence of JCPC assessment that (1) the proposed services meet a
      need within the DJJDP continuum of services, (2) the application
      demonstrates capacity of the agency to provide services and collaborate
      within the community, and/or (3) the JCPC identifies the strengths of the
      application, sites, curriculum, and services. Priority will be placed on
      applications wherein the JCPC Letter of Review includes information to
      support evidence of items 1-3 above. A template is provided in Reference
      Supplement IV. Applicants may submit the template provided or submit a
      formal letter from the JCPC Chairperson.

   2. Three (3) Additional Support Letters: A minimum of three letters from
      any of the following are expected in addition to the JCPC Letter of
      Review. Applicants are advised to provide one letter per category rather
      than letters from duplicate types of agencies. Letters of support from
      each referral source described in the Program Design should be included.
          Schools
          Mental Health
          Court System
          Social Services
          Law Enforcement
          County government
          City Council
          Private partners

   3. REQUIRED FOR SCHOOL-BASED PROGRAMS: Applicants proposing
      to operate one or more SOS program sites in a school or on school
      grounds are required to have a letter of support from the school system
      indicating support for the program.

      In the event of multiple school sites, only one support letter from the
      school system is required if the letter is signed by the Superintendent of
      Schools and addresses support for all school sites. All school sites
      must be listed in the Superintendent‟s letter. If the program is operating
      in more than one school site and the support letter is not obtained from
      the Superintendent, then a letter from each school‟s Principal is required.
      Support letters from the school system will qualify as one of the three


                                  - 17 -
             support letters referenced in #2 above. For applicants proposing school-
             based services, failure to provide a letter of support from the school
             system will result in the proposal not being reviewed for funding.

     The application provides a table for completion. Be sure to list each partner
     described in the proposal. For each partner listed, describe activities/services
     provided by the partnership and a timeframe as to when the activities will be
     conducted or completed.

     The inclusion of four letters is a minimum. Be sure to include a letter of support
     for each partner listed. For example, if the proposal highlights operation at a
     school site, describes three referral sources in the program design, and
     partnership with two agencies to support the services, then a total of seven (7)
     agencies must be listed and letters from each are required to be submitted in
     Appendix A.

     F. Organization & Consortium Capacity
     In addition to the documentation required to be included in Appendix E,
     applicants must include in the program narrative a description of the unique
     qualities and experiences the applicant has for accomplishing the desired
     program outcomes. In this section, applicants are encouraged to demonstrate
     past and current successes in after-school programming implementation and/or
     other youth programming initiatives. Qualitative and quantitative data are both
     encouraged.


V.    Quality Assurance/Local Evaluation Plan (limit one page)
Quality assurance and local evaluation plans are critical for ensuring integrity of
program implementation in relation to its design and continuous program
improvement. The Department contracts with an external evaluator to measure the
effectiveness of SOS programs statewide. In addition to the Department‟s program
evaluation plans, it is the expectation that SOS programs incorporate local quality
assurance/evaluation plans independent of the Department‟s efforts.
In this section, applicants must describe the processes to be utilized for assessing
methods for monitoring progress toward goals and objectives outlined in Section B
(Goals, Measurable Objectives and Strategies) as well as any additional, relevant
progress assessments. The processes should be time-phased and specific to include:
            how progress will be measured (methods, tools, resources, etc.)
            how often progress will be monitored (daily, monthly, quarterly, annually,
             etc)
            strategies for improving identified gap areas (program modifications,
             increased collaboration, staff training, etc.)




                                        - 18 -
 VI.    Sustainability Plan (limit one page)
 Selected applicants are awarded funding for a one-year period with the Department‟s
 option to renew for an additional two (2) years. Applicants are required to describe a
 three (3) year sustainability plan that includes a plan for diversifying funding for the
 local SOS program. In this section, applicants should provide a three-year plan that
 describes:
             how the SOS program will be marketed to students, families, and
              communities to ensure participation in accordance with requirements of
              the grant and continued awareness of the program‟s availability
             the types of support and resources from the applicant organization and all
              partners
             match sources, both cash and in-kind
             a funds diversification plan which includes identification of sources and
              types of local, state, and federal funds, as well as foundations and
              corporate sources


 APPENDIX F: Budget Summary (no page limit; forms included)
 A Budget Sheet, Budget Narratives (Personnel Itemization, Contracted Personnel and
 Services, and Line Item Budget Narrative) and Anticipated Revenue Summary Form
 are required to be prepared within the budget summary section of the proposal. The
 budget summary forms must reflect only those expenditures and revenue sources
 related to the SOS program described throughout the proposal.


 I. Budget Sheet and Budget Narratives:
 Budget Sheet:
 Each county‟s maximum allocation of funding is provided in the Reference
 Supplement –Part I. Applicants should propose a budget based on the total amount
 of funds available which includes the State Appropriation and the SSBG allocation.
 Applicants should propose a budget equal to maximum funds allocated. The total
 funds requested should not exceed nor should be less than the total maximum
 funds allocated for the county. The line item expenditures on the budget summary
 sheet should be inclusive of the SSBG expenses needed to support the services
 described in the Program Design.
General Instructions for completion of Budget Sheet:
      Complete the County, Agency, Federal ID #, and Total Funds Requested
       information.
      In Column B, enter the proposed budget amount for the Administration and
       Program Services expenditure categories (Lines 11-23 and Lines 25-39).



                                         - 19 -
      Calculate the percentage of total budget for each line item and enter the
       percentage in Column C. Adhere to required budget caps summarized above.
      The total proposed budget (Column B, Line 39) must equal the total amount of
       funds requested. The total percentage (Column C, Line 39) must equal 100%.
 Budget Narratives:
 A detailed Budget Narrative for each line item expenditure is also required in Appendix
 F. There are three forms that comprise the Budget Narratives: Personnel Itemization,
 Contracted Personnel and Services, and Line Item Budget Narrative. See Reference
 Supplement-III for Budget Narrative instructions and samples.
 SOS funded programs are subject to the following budget caps:
      Salaries + Fringe Benefits + Contracted Personnel          75%     of   the   Total
       Budget
      Equipment + Materials + Supplies                        13% of the Total Budget


Applicants are advised to budget travel and per diem costs for mandatory events as
referenced in SOS Requirements for Program Operations. At minimum, these
mandatory events include the DJJDP Community Grants Annual Training (3 days), four
(4) DJJDP regional meetings, and one (1) new provider orientation.


II. Anticipated Revenue Summary Form
The Anticipated Revenue Summary Form details projected revenue and match sources
(cash and in-kind) across a three-year period. In Section VI, applicants are required to
provide a three-year sustainability plan which should include a plan for diversification of
funds and sources of match support.

If awarded funds, Grantees will be required to complete a Revenue Summary Form for
actual revenues and match funds twice annually.

General Instructions:
      Complete the County, Agency, Federal ID #, and Total Funds Requested
       information.
      Enter the projected cash and in-kind totals for 2007-2008, 2008-2009, and 2009-
       2010 for each revenue category listed.
      Do not include SOS grant funds.
      Include only those sources dedicated to the SOS program.
      For each „other category‟, specify the source.




                                           - 20 -
    Reference Supplement - I

      County Funding Allocations



Retain reference document for your records




                   - 21 -
                            Reference Supplement I
                            SOS County Allocations
                                  2007-2008

                                                 2007-2008 Contract Amount
      COUNTY                                   (December 1,2007-June 30, 2008)
      Cabarrus                                           $41,496.00
      Onslow                                             $44,016.00
      Pender                                             $44,331.00
      Sampson                                            $45,794.00
      Surry                                              $46,956.00

Note: Appropriations are subject to the availability of state and federal funds to
the Department. Final contract amounts are subject to adjustment at the
discretion of the Department.




                                      - 22 -
      Reference Supplement - II

SOS Requirements for Program Operations

  Retain reference document for your records




                     - 23 -
                     Department of Juvenile Justice and Delinquency Prevention
                                    Community Grants Programs
                                   Support Our Students Program

               ADMINISTRATIVE REQUIREMENTS FOR PROGRAM OPERATIONS
                                   Second Revision


Introduction
This document contains the core administrative requirements needed to administer the Support Our
Students (SOS) grant awarded by the North Carolina Department of Juvenile Justice and Delinquency
Prevention (Department or DJJDP). Grantees must comply with all requirements set forth herein as well
as to the terms and conditions of the executed contract with the Department, SOS Overarching Policy,
and North Carolina General Statutes and North Carolina Administrative Code.

The failure by a Grantee to comply with any provision within all requirements shall constitute, in the sole
discretion of the Department, sufficient cause to revoke the contract pursuant to G.S. 143B-152.3(7).
The Department can suspend payment of SOS funds to any Grantee pending compliance by the Grantee
with these requirements. All provisions within these requirements shall be interpreted in the sole
discretion of the Department.

A primary role of the Community Grants Program Coordinator is to provide technical assistance to
Grantees to help program maintain compliance with state laws and policies. Grantees should contact the
Community Grants Program Coordinator with any questions regarding policies and procedures.

This document supersedes all prior revisions and is effective July 1, 2006. The requirements are subject
to change at the discretion of the Department and/or changes in state or federal laws/policies.

Requirements

 1) Finance and Accounting Requirements
   Each Grantee is responsible for adhering to reporting requirements as outlined in North Carolina
   General Statute 143C-6-21-23 and North Carolina Administrative Code- Chapter 09.

 2) Allowable Uses of State Funds
    In accordance with 09 NCAC 03M.0201, expenditures of State funds by any Grantee shall be in
    accordance with the Cost Principles outlined in the Office of Management and Budget (OMB)
    Circular A-87 and A-122. If the grant funding includes federal sources, the Grantee shall ensure
    adherence to the cost principles established by the Federal Office of Management and Budget.

 3) SOS Budget Caps


                                                  - 24 -
              a) Salaries
                      i. Total salaries, fringe benefits and contracted personnel cannot exceed 75%
                          of the total approved budget.

              b) Physical Plant/Real Property
                     i. Cost and associated financing, equal to or greater than 4% of the total
                         approved budget or related to existing facilities or the construction of
                         replacement facilities require prior Department approval.

                      ii. Grantees shall not incur said costs in a piece meal fashion in order to avoid
                          the 4% limit.

                     iii. Failure to acquire prior approval may result in the disallowance of said cost
                          from SOS disbursement.

                     iv. Any request for approval for rehabilitation or renovation exceeding the 4%
                         cap must have a clear and concise justification related to program needs.

              c) Travel Subsistence
                     i. Providers’ maximum allowable cost for travel subsistence cannot exceed the
                         state per diem rates State per diem rates can be found at the NC Office of
                         State Budget and Management website: http://www.osbm.state.nc.us

              d) Equipment/Materials/Supplies
                     i. See Section (4) (b) below.


4) Property/Equipment Controls
      Property/equipment purchased with SOS funds are the property of the Department.

              a) Property/equipment is defined as anything that has a useful life of more than one
                 year and valued at $350.00 or more.

              b) Grantees’ total cost for the purchase of equipment, materials, and supplies combined
                 shall not exceed thirteen percent (13%) of the total approved budget.

              c) For equipment costing $350 or greater, equipment controls and procedures must
                 include the following:

                        i. Description and location of the equipment, program assigned identification
                           number, manufacturer, serial number, acquisition date and cost.

                        ii. SOS Equipment List (Form D) must be submitted with contract renewal
                            and again on or before August 31st for the fiscal year end June 30th.

                       iii. Equipment shall be assigned a control number in the accounting records
                            and shall be tagged individually with a permanent identification number.




                                               - 25 -
              d) Procedures shall be implemented which ensure that adequate insurance coverage is
                 maintained on all equipment. A review of coverage amounts shall be conducted at
                 the discretion of the Department.


              e) Grantees shall use a competitive bidding process in order to purchase or lease
                 equipment valued $1,000 or more. Grantees must receive at least three written
                 competitive bids prior to purchase and maintain in program files.

                        i. Grantees shall explore cost differentials between leasing and purchasing of
                           said equipment and shall choose the least expensive alternative.

              f) Fixed Asset Disposition
                  Title to equipment costs of $350 or more acquired by the Grantee with SOS funds
                  shall vest in the Grantee, subject to the following conditions:

                        i. The Grantee shall use the equipment only in the project or program for
                           which it was acquired as long as needed.

                        ii. When equipment is no longer needed for the original project or program or
                            if operations are discontinued, the Grantee shall return such equipment
                            to the Department within 30 days.

                       iii. Failure to comply may result in withholding of funds equal to the value of
                            the equipment or legal action as determined by the Department.

                       iv. When acquiring replacement equipment, the Grantee may use equipment
                           purchased through any SOS project or program as trade-in against
                           replacement equipment or may sell said equipment and use the proceeds to
                           offset the costs of replacement equipment. All transactions shall be
                           subject to prior written approval of the Department.

5) Transportation
               a) Grantees shall use a competitive bidding process in order to purchase or lease
                  vehicles valued $1,000 or more. Grantees must receive at least three written
                  competitive bids prior to purchase and maintain in program files.

              b) Youth Transportation
                   i. A daily log detailing the use of vehicles for SOS youth transport shall be
                      maintained by the Grantee and include the following information:
                                    1. Date
                                    2. Origination/Destination
                                    3. Beginning and end mileage
                                    4. Driver name and initials

                    ii. The daily log must be approved at minimum on a monthly basis by the
                        Program or Executive Director.

                   iii. Daily transportation log shall be maintained for any SOS youth transport,
                        regardless of source of funds for vehicle purchase/use.


                                               - 26 -
                   iv. The vehicle need not be purchased with DJJDP funds; any transport of SOS
                       youth is required to be logged.

6) Payroll/Personnel
              a) Grantees shall maintain a documented process of hiring employees and placing
                  volunteers

             b) Grantees shall maintain written personnel policies and written job descriptions

             c) Payroll records shall be maintained for each SOS employee to substantiate the
                staffing cost reported to the SOS program. Records must include:

                      i.   Timesheets or attendance records

                     ii. employee's classification, hours worked, rate of pay and the functional area
                         to which the employee was assigned and actually worked

                     iii. Completed application for employment and resume

                     iv. Information pertaining to the hiring date and rate of pay, including a new
                         hire letter

                      v. Signed, written job descriptions

                     vi. Criminal background check/screening

                    vii. Copy of driver’s license

                    viii. Copies of at least two (2) professional references

                     ix. Performance appraisals

                      x. Acknowledgement of receipt of personnel policies/employee handbook

                     xi. Certificates of completion to authenticate compliance with SOS training
                         requirements

             d)    Individual files for all volunteers must be maintained. At minimum, records should
                  include:

                     i. Time sheets/attendance logs

                    ii. Completed application

                    iii. Criminal background check/screening

                    iv. Copy of driver’s license

                     v. Copies of at least two (2) professional references


                                                - 27 -
                     vi. Signed, written description of volunteer work

               e) If an employee performs duties in more than one cost center, the Grantee shall
                  maintain specific records in order to allocate salary and wage cost to the appropriate
                  cost center.

7) Subcontract/Subgrant Agreements
               a) All Grantees who utilize outside contractors to provide services must obtain a
                  written contract from the subcontractor, which states qualifications, service to be
                  provided, hourly rate and duration of the agreement.

                b) Expenditure of funds for subcontracted/subgranted with a cost greater than $1,000
                   must be submitted for prior approval to the Department.

                c) A written approval shall be prepared by the Department. The expenditure of funds
                   for subcontract/subgrant services shall not be considered approved until which time
                   the Grantee receives written notification of approval from the Department.

                d) Grantee may be required to revert expended funds for services should Grantee fail
                   to obtain prior Department approval for the expenditure for funds for
                   subcontracted/subgranted services.

                e) Grantees shall be responsible for insuring that all subcontractors/subgrantees
                   operate in compliance with all terms and conditions of the executed contract
                   and Federal Certifications, SOS Requirements for Program Operations, N.C.
                   General Statute 143-6.2 and the North Carolina Administrative Code-Chapter
                   09.


8) SOS Reporting Requirements
         A. Financial Reports
              1) Budget Sheet
                    a) Each Grantee shall include appropriate budget information in its application
                        for an SOS grant or contract renewal.

                       b) The budget should reflect the projected annual operating cost for a one year
                          period, and include preparation worksheets.

                       c) Budgets are not deemed to be appropriately filed unless they are properly
                          prepared and contain authorized signatures of preparer, Program Director
                          and a member of Board of Directors.

                       d) All budget sheets must be accompanied with a Budget Narrative (SOS
                          FORM 1010C) that shows calculation of and justification for of all
                          expenditure allocations.

                                i. Budget narratives submitted without calculation and justification of
                                   allocations may be returned to the Grantee for recompletion.



                                                - 28 -
2) Budget Revisions
       a) Grantees’ shall submit a Budget Revision Form (SOS FORM 1010B) to
           request approval of any change to the approved budget sheet submitted with
           contract documents.

        b) Final budget revision requests must be received in the Department by TBD.

        c) Budget revisions submitted with the Final Cost Report will not be approved
           and the Grantee may be required to revert expended funds to the
           Department.

3) Cost Report (SOS Form 1010):
      a) The cost report shall be submitted to the Department twice annually:

                  i. A cost report must be received on or before January 15thfor the
                     period of July 1st to December 31st.

                 ii. A final cost report must be received along with a detailed general
                     ledger on or before August 31st for the period July 1 to June
                     30th.

       b) Costs shall be reported in compliance with generally accepted accounting
          principles.

       c) Cost reports prepared shall be certified for their compliance by the preparer
          of the report, the Grantee’s Program Director and a member of the Board of
          Directors.

       d) In the event the Department determines a cost report does not meet the
          requirement of the SOS program during a detailed review, the Grantee shall
          have 30 days of the said notification to submit a revised cost report or
          additional data.

                  i. The revised report shall be certified for compliance as indicated in
                     (c) above.

       e) If the revised report is not received within 30 days of notification the
          Grantee’s payment for services may be suspended.

       f) In the event that the Grantee discovers that a report submitted is incomplete,
          inaccurate or incorrect, the Grantee shall immediately notify the Department
          that such error(s) exist. This Grantee shall submit a revised report or
          additional data within five business days.

       g) Cost reports must be received with original signatures on or before the
          required due dates. Faxed and emailed copies sent on the due date will
          not be accepted nor constitute compliance with the reporting
          requirement.



                                - 29 -
B. Field Trips
       1) Out of State Field Trips
               a) Prior Department approval is required for out of state field trips involving
                   SOS youth or on behalf of the SOS program. Whenever SOS youth are
                   involved, this approval is required regardless of the source of funds used to
                   expense the trip.

                 b) A formal, written request must be submitted from the Grantee which
                    includes the following information:

                                        i. a description of the trip’s purpose and objectives
                                       ii. timeframe and destination
                                     iii. a description of how the trip aligns with SOS goals
                                           and Grantee’s program plan
                                      iv. mode of travel and accommodation information
                                       v. number of youth participating and selection process of
                                           youth participants
                                      vi. budget and budget narrative
                                     vii. insurance coverage for participants
                                    viii. documentation of parental approval

                 c) It is also recommended that for all field trips, in or our of state, SOS
                    programs have disclaimers in place for parents to sign so that any liability
                    for such trips rests with the organization and not with the Department.

          2) In State Field Trips
                  a) Field trips conducted in-state do not require Department approval, but are
                      subject to routine budget and monitoring reviews. As with out of state
                      trips, the Department will assess overall budget, alignment with goals of
                      the program, availability of the opportunity to youth, and overall
                      appearance of trips as a function of routine program operation reviews.

           3)    As required in N.C.G.S. §143-6.2, proper documentation in the form of
                 invoices and/or receipts for all expenditures must be maintained for all
                 trips, regardless if in or out of state.

           4)    Grantees shall exercise conservatism with expenditures and utilization of
                 state per diem rates for hotels and meals.

           5)    Grantees must maintain documentation of the trip’s program activities
                 and enrichment opportunities in order to demonstrate justification that
                 the trip aligned with the overall SOS program plan and goals.

C. Other Reporting Requirements
         1) Grantees shall adhere to all reporting requirements as outlined in:
             a) Attachment B of Contract: Contract Required Reporting




                                         - 30 -
                    b) SOS Overarching Policy: IP/SS1 Located at www.juvjus.state.nc.us

                    c) North Carolina General Statute 143-6.2

                    d) North Carolina Administrative Code-Chapter 09

                    e) Other as determined by the Department or Office of the State Auditor

               2) All reports must be submitted in original format and with original signatures
                  where indicated. Faxed and emailed copies of reports that require signatures will
                  not be accepted nor constitute compliance with the reporting requirement.


9) Payment Assurances
   The Department shall pay each Grantee that furnishes the services in accordance with the
   approved contract and any amendments there to.

            a) In no case shall the payment for services exceed the amount of the most current
               contract from the SOS program.

                     i. Any payment in excess of executed contract amount shall be refunded to
                        the Department.

            b) The state may withhold payments to Providers under the following circumstances:

                      i. If the state has an expectation that the Provider will not expend the total
                         prospective amount for reasonable and allowable services, the state may, at
                         its discretion, withhold a portion of each payment so as to avoid a large
                         amount due back to the state.

                      ii. Failure to comply with reporting requirements

                     iii. Violation of any terms of the contract.

10)    Disbursements
           a) All state disbursements are subject to cost principles

            b) Funds shall be disbursed in payments over a 12-month period based on the total
               approved contract amount.

            c) A statement of projected unexpended funds shall be filed with the Department by the
               15th of April. This statement shall be prepared jointly by the program director and
               the Chairman of the Board of Directors.

            d) Projected unexpended funds for the remaining three months of the fiscal year not
               requested by the county may be reallocated to the SOS fund for use by other
               participating counties.

            e) Refund checks are requested with the final cost report.



                                             - 31 -
11) Programmatic Administrative Requirements

           a) Each Provider must establish a written program plan designed to meet the needs of
              students in attendance.

           b) Each site must maintain program data to evaluate the overall success of its program
              and to periodically provide information to the SOS program as requested.

           c) All SOS programs must provide at least four days per week of after school
              programming of at least three hours per day or five days of programming of at least
              two and a half hours per day.

           d) A file must be established for each enrollee containing the following information:
                      i. referral documentation (source and reason)
                     ii. enrollment form
                    iii. emergency information
                    iv. emergency contacts
                     v. authorized individuals for student pick-up/drop off
                    vi. medical release forms
                   vii. educational information
                  viii. participant progress/regular updates
                    ix. documentation of family communication and participation
                     x. acknowledgement of program guidelines, code of conduct, and student
                         rights.

           e) Grantees shall have a written outline of the philosophy; objectives and goals it is
              striving to achieve and are available for distribution to interested public.

                      i. The outline should include such topics as: experimental learning,
                         academics, and community service.

           f) The Grantee shall ensure that one individual is responsible for administrative
              direction of the program at all times.

           g) There shall be written policies to protect the rights of students including student
              grievance procedures.

           h) Grantee is required to maintain calendar of activities with supporting daily or weekly
              activity plans to authenticate services delivered.

                      i. Activity plans must include at minimum a title of activity, description of
                         the activity, purpose/objective, reference source, and instructions for
                         activity completion.

           i)   Health and Safety
                     i. Grantees must maintain written policies/procedures regarding the safety and
                        security of youth during all activities.

                    ii. Grantees must maintain current annual fire/health/safety inspections on file
                        for each program site.


                                            - 32 -
                 iii. Grantees must maintain current emergency preparedness plans

                 iv. Emergency procedures must be posted and visible. Grantee is required to
                     maintain documentation of practice drill activities.

                  v. At least one staff member on site at all times must be certified in CPR/First
                     Aid

                 vi. Grantee must maintain daily log authorizing parent/guardian pickup and or
                     drop off for program participants.


       j)    Enrollment Standards

                    i.   Grantees are required to serve a minimum number of youth in accordance
                         with approved grant funding amount.

                                          Minimum Number of Youth Required to Be Served
            Grant Amount
            $40,000 - $50,999                                      30
                                                                   40
            $51,000 - $60,999
                                                                   50
            $61,000 - $75,999
            $76,000 - $90,999                                      65
            $91,000 - $100,999                                     80
            $101,000 - $150,999                                   120
            $151,000 - $200,999                                   150
            $200,000 - $300,999                                   225

                   ii. Failure to meet enrollment standards may result in reduction or suspension
                       of funds or other Department action pursuant to executed contract terms
                       and conditions (Average daily attendance standards are in the process of
                       development).

                  iii. Daily attendance records must be maintained for each month of program
                       operation, including summer programming.

                              a. Records must be maintained at each program site and in
                                 accordance with confidentiality laws.

                              b. Records must authenticate monthly enrollment data reported to
                                 the Department.


12) Collaboration/Marketing
       a) Grantees shall maintain documentation of collaboration with agencies and businesses
           and to sustain growth and promote sustainability.



                                           - 33 -
               i. All partnerships for services should be documented with deliverables
                  outlined (Memoranda of Understanding/Agreements)

       b) SOS marketing materials must contain DJJDP or SOS logo with reference of DJJDP
          as funding source/partial funding source.

13) Communication
      a) Grantees must maintain an operational computer, equipped with email and software
         sufficient to exchange information and complete recordkeeping requirements

       b) Grantees must have e-mail access.

                 i. Email correspondence shall serve as the primary mode of communication
                    between the Department and Grantees.

       c) All changes to program sites, personnel, and contact information, including phone
          number, address, fax number, and email address, must be submitted to the
          Department.

                 i. Grantees must submit a Personnel Change Form to report any changes to
                    staff as reported on Personnel Itemization (SOS Form C) submitted with
                    RFP or contract renewal documents

                                    a) Personnel Change Form may be emailed or sent via
                                       postal service.

                ii. Changes to the approved Program Plan A require prior written approval
                    from the Department

                                    a) Written request for approval shall be made on
                                       Grantee’s letterhead and must indicate the proposed
                                       change, reason, timeline, and impact proposed change.

       d)    Failure to receive information or adhere to reporting requirements due to
       malfunctioning computer equipment is the sole responsibility of the Grantee.

14) Professional Development
       A. Training Requirements

                i. Permanent full-time direct program staff that work all year (approximately
                   8 months)- 8 hours
               ii. Permanent direct program staff that work ½ year (approximately 4 months)-
                   4 hours

               iii. Temporary staff- no requirements at this time

               iv. Volunteers- no requirements at this time

               v. Administrative staff-no requirements at this time


                                        - 34 -
              vi. Training hours must be acquired during the fiscal year, July 1 to June
                  30
      B. Training must be youth development focused and/or have direct impact on service
         provision. Recommended subject areas include CPR/first aid; blood borne pathogen
         containment; de-escalation of conflict; crisis intervention; minority sensitivity; and
         behavior management. Additional recommended training areas shall be provided by
         the Department upon request.

      C. Certificates of completion of required training hours must be maintained in each
         personnel or volunteer file.



15)   Mandatory Functions
      The Department will send a notice of mandatory functions to each Grantee throughout
      the contract period. Grantee attendance is a function of reporting requirements.
      Mandatory functions include but are not limited to:

                 a. New provider orientation
                 b. SOS Regional Meetings
                 c. DJJDP Community Initiatives Annual Training




                                       - 35 -
       Reference Supplement - III


Budget Narrative Information for Completion of
                 Appendix F


  Retain reference document for your records




                     - 36 -
        Reference Supplement for Appendix F: Detailed Budget Narrative

The SOS program budget should be related to the services described in the proposal.
The following forms are required to be completed in Appendix F:

   Personnel Itemization
   Contracted Personnel and Services
   Line Item Budget Narrative

General Instructions
 1. Include only expenses that are directly related to the proposed program and that
    are necessary for program implementation.
 2. Complete all worksheets included in this Appendix.
 3. The Line Item Budget Narrative totals must match the budget proposal line item
    allocations reflected on the Budget Sheet in the Budget Summary section of the
    proposal.
 4. The Personnel Itemization and Contracted Personnel/Services are supplemental
    worksheets to the Line Item Budget Narrative. For these line items, only the total
    amount is required; a description and cost computation are not required as both
    are included in the respective tables.
 5. The Line Item Narrative must include a detailed description and cost computation.
    Failure to provide adequate detail may result in the proposal not being considered
    for funding. An example is provided in this section.

Line Item Descriptions
For each line item, a brief description is provided below. When completing the line item
budget narrative, applicants are required to provide the following:
       1. A detailed description of the costs.
       2. Where multiple costs are included, list each cost separately.
       3. Cost computation and total for each line item.


                         ADMINISTRATION DESCRIPTIONS

Salaries: A description is not required.       Enter the total amount from the table,
Contracted Personnel and Services.

Fringe Benefits: Detail the benefits related to each position listed on the Personnel
Itemization form. As applicable, include the cost and computation of benefits for each
employee in the following areas:
    FICA @ 7.65%
    Health Insurance
    Life Insurance
    Dental Insurance
    Retirement
    Workers Compensation


                                          - 37 -
      Unemployment

Contracted Personnel: A description is not required. Enter the total amount from the
table, Contracted Personnel and Services, for Administration and Program Services.

Cost of Space: Budget all cost related to occupying the administrative site such as
rent, lease agreement, utilities, building repairs and maintenance, alterations, and minor
renovations.

Equipment: Itemize the equipment to be purchased. This should include only
administrative equipment necessary to the operation of the program. Budget such
costs as computers, printers, copiers, equipment rental, equipment maintenance,
software, office furniture. All equipment purchased with SOS funds is vested with the
State of North Carolina and the Department of Juvenile Justice & Delinquency
Prevention. If the grant is awarded, Grantees will be required to submit a itemized
Equipment List twice annually.

Materials and Supplies: Itemize materials and supplies separately by type (office
supplies, copy paper) necessary for the administrative operation of the program.

Telephone: Itemize program-specific costs to implement the program for pro-rata share
or applicable percentage of the total costs of these items. List each item separately.

Travel: Itemize costs associated with anticipated program-related staff travel (staff
training, staff meetings, community meetings, etc.)

Postage Itemize the purpose and cost of postage directly related to the program. List
each item separately.

Other Contracts: Itemize all other administrative related contracts that are not
associated with contracted personnel, contracted services, or contracted transportation.
Contracts to perform audit functions or program evaluation are most commonly
associated with this line item.

Printing and Copying: Itemize all costs associated with printing or copying materials
necessary for administration of the program. This is not to include printing and copying
costs associated with program services.

Other: List and describe any other expense related to the administration of the
program not specifically listed above. Insurance premiums are included in this line item.




                                          - 38 -
                       PROGRAM SERVICES DESCRIPTIONS

Salaries/Fringe/Contracted Personnel:        See descriptions above.       Applicable to
program services personnel.

Staff Development: Itemize costs associated with required or anticipated staff training
or seminars by purpose, and include any associated costs (i.e., mileage, per diem,
meals, hotel, registration fees, etc.) Travel expenditures are limited for reimbursement
in accordance with the Office of State Budget and Management. See
www.osbm.nc.us.org for a schedule of state per diem rates.

Cost of Space: Itemize all costs related to occupying the program site such as rent,
lease agreement, utilities, building repairs and maintenance, alterations, and minor
renovations.

Student Equipment: Itemize the equipment to be purchased for student use. This
should include only program/student equipment necessary to the operation of the
program. All equipment purchased with SOS funds is vested with the State of North
Carolina and the Department of Juvenile Justice & Delinquency Prevention. If the grant
is awarded, Grantees will be required to submit a itemized Equipment List twice
annually.

Student Transportation: Budget student transportation costs, such as vehicle
depreciation or use allowance, vehicle insurance, vehicle lease, vehicle lease, vehicle
maintenance, gas and oil in this category. If the transportation is a contracted service,
itemize the service in the table for Contracted Services and enter costs in the
contracted transportation services line item.

Contracted Transportation Services: Itemized contracted transportation services in
the table, Contracted Services. If there is contracted staff member responsible for the
transportation of students, include the staff member in the Contracted Personnel table.
A description is not required on the Line Item Narrative. On the Line Item Narrative,
enter the total amount from the table, Contracted Services.

Student Materials and Supplies: Itemize program-related materials and supplies
separately by type (consumable workbooks, curriculum) that are expendable or
consumed during the course of the program.

Student Activities: Itemize any activities, including field trips, necessary for program
implementation. For field trips, detail the educational or community-service related
benefits of each field trip and how it relates to the goals of the program. Out of state
field trips require prior review and approval from DJJDP.

Printing and Copying: Itemize all costs associated with printing or copying materials
necessary for the program services operation. This is not to include printing and
copying costs associated with the administrative function of the program.


                                          - 39 -
Other Contracted Services: A description and cost computation are not required in
the Line Item Narrative. Other contracted services should be detailed in the table,
Contract Services. On the Line Item Narrative, enter the total amount from the table,
Contracted Services.

Other: List and describe any other expense related to program services not specifically
listed above.




                                         - 40 -
Sample Line Item Budget Narrative: For Reference Only

Expenditure Categories                        Description                            Cost Computation and Total                   Total
ADMINISTRATION
Salaries                     See Personnel Itemization                                                                        $4,500
Fringe Benefits              Fringe Benefits for Executive Director           [FICA: 7.65% of $4,500= $344.25]                $ 644.25
                                                                              +Workers Compensation @ $50/mo x 12mo x
                                                                              10% = $60.00] + [Health Insurance@ $200
                                                                              per month x 12 mo x 10% = $240]=

Contracted Personnel         Not applicable. No administrative contracted                                                     $ 0.00
                             personnel
Cost of Space                Example: Lease Agreement with Anytown            $500 per month x 10 months = $500.00            $ 500.00
                             Public Schools for administrative office space
Equipment                    Example: (2) Dell Thinkpad Laptop                2 computers x $1,349 ea. = $2,69.00             $2,698.00
                             Computers
Materials & Supplies         Example: Copy Paper                              $30.00 per case x 10 cases = $300.00            $300.00
Telephone                    Example: Roadrunner connection and cost          DSL $40.00 per month x 12 months = $480 +        $840.00
                             of phone line                                    $30.00 per month for phone line x 12 months
                                                                              = $360 Total = $840.00
Travel                       Example: Travel for Executive Director and       $.40 x roundtrip mileage of 200 miles x 1 day   $80.00
                             Board Chairperson to attend DJJDP Annual
                             Training Event
Postage                      Example: Postage for monthly reports and         $.37 x 1 report/mo. X 12 months = $5.00 +       $ 116.00
                             monthly parent letters                           $.37 x 30 letters/mo X 10 months = $111.00
                                                                              Total = $116.00
Other Contracts              Example: Pro-rated share of contracted           Total cost of evaluation $20,000 x 25% for      $ 5,000
                             external evaluator for local program             prorated allocation to SOS program = $5,000
                             evaluation
Printing & Copying           Example: (2) print cartridges for                [$15 per cartridge x 2 = $30.00] + [copying     $ 280.00
                             administrative computer and cost of copying      costs for 1000 brochures @ $.25 per copy =
                             SOS program brochure                             $250]= $280.00
Other                        Example: Insurance for professional liability    Required premiums total of $350.00              $ 350.00
                             and improper sexual contact - $350.00

                                                                                               Total Administrative Costs     $15,308.25

      PROGRAM SERVICES                        Description                            Cost Computation and Total                Total
Salaries                     See Personnel Itemization                        See Personnel Itemization                       $24,000.00



                                                                  - 41 -
Fringe Benefits                      Fringe Benefits for one SOS Site Director         [FICA @ 7.65%=$1836]+ [Health Insurance          $5030.28
                                                                                       per month@ 217.50 x 12 mo= $2610] +
                                                                                       [workers compensation per month @ 48.69 x
                                                                                       12 months= $584.28]= 5030.28
Contracted Personnel                 See Contracted Personnel and Services table       See Contracted Personnel and Services Table      $1,440.00
Staff Development                    Example: 2006-2007 DJJDP Annual                   [$75.00 registration fee x 2 SOS staff =          $ 526.00
                                     Community Initiatives Training Event, ABC         $150.00] + [hotel @ $59 per night x 2 staff x
                                     city, North Carolina                              2 nights = $236.00] +]meals @ $25 per day x
                                                                                       2 staff x 2 days = $100.00] +]100 miles
                                                                                       roundtrip @ $.40/mile] = $40 = $526.00
Cost of Space (site)                 Example: Rent for program site (25 Jones          $600/month x 12 months = $7,200                  $ 7,200.00
                                     Road, Anytown, NC)
Student Equipment                    Example: Purchase of 3 Gateway desktop            3 Gateway computers @ $1,000/each =              $ 3,000.00
                                     computers for technology module for students      $3,000
Student Transportation               Example: Travel to 2 field trips and daily         2 field trips estimated round trip mileage      $ 2,400.00
                                     operating costs to transport youth home in        $0.40/mile x 1000 miles = $17.98] = $400.00
                                     SOS van                                           + [estimated 500 miles/month x 10 months @
                                                                                       $.40 per mile= $2,000] = $2400.00
Contracted Transportation Services   Example: Contracted transportation service        Use of school buses @ 12,000 miles x $.95        $ 11,400
                                     with Anytown School System for daily pick up      per mile
                                     and drop off of student. (This would need to
                                     be reflected in the contracted services table).
Student Materials & Supplies         Example: Purchase of Second Step                  1 curriculum kit x $500.00 per kit x 2 sites =   $ 1,000.00
                                     curriculum for social skills enrichment           $1,000.00
                                     component of program
Student Activities                   Example: (2) field trips during program year.     [Admission @ $10.00/each x 30 youth x 2          $ 600.00
                                     (1) Raleigh Museum of Art and (2) Biltmore        field trips = $600.00] +
                                     Estate in Asheville
Printing & Copying                    Example: Print screen fees for SOS banner        Print screen fee of $100 + $25 for each          $ 150.00
                                     for community outreach efforts                    additional color x 2 colors = $150.00
Other Contracted Services            See Contracted Personnel and Services Table       See Contracted Personnel and Services Table      $ 250.00
Other                                 Not applicable.                                                                                   $ 0.00

                                                                                                     Total Program Services Costs       $ 56,996.28
                                                                                                                 TOTAL BUDGET           $72,304.53
                                                                 (This total should match total budget provided in Budget Summary)




                                                                          - 42 -
Reference Supplement - IV


  JCPC Letter of Review
  Memorandum Template




           - 43 -
                     STATE OF NORTH CAROLINA
     DEPARTMENT OF JUVENILE JUSTICE AND DELINQUENCY PREVENTION
                        1801 MAIL SERVICE CENTER
                   RALEIGH, NORTH CAROLINA 27699-1801
                        TELEPHONE: (919) 733-3388

Michael F. Easley                                                                    George L. Sweat
Governor                                                                                   Secretary

                                               Date
     Memorandum

     TO:        Kristin O’Connor
                1801 Mail Service Center
                Raleigh NC 27601

     FROM:                   , County Juvenile Crime Prevention Council

     SUBECT: JCPC Letter of Review for the                     Program

     The Juvenile Crime Prevention Council (JCPC) supports community resources for
     delinquent and at-risk juveniles. In an effort to indicate the extent to which an applicant
     ensures that the JCPC is aware of the program’s service capacity and quality, the
     following acknowledgements are made: (Check any that apply to this applicant)

                    Acknowledgement that the applicant requested from the JCPC a review of
                    the applicant agency’s proposed services; and one or more of the
                    following:

                    Acknowledgement that the applicant’s proposed program meets a need in
                    the community continuum of services to delinquent and at-risk juveniles as
                    indicated in this county’s annual plan;
                    Acknowledgement that the capacity of the agency to deliver services is
                    adequate as evidenced by current community collaboration and by its
                    demonstrated ability to meet identified needs;

                    Interaction with the JCPC either by regular or periodic attendance or
                    reporting to the JCPC; and




                                               - 44 -
            Comments on the specific strengths of the applicant agency’s sites,
            services, and/or collaborations:            .




JCPC Chairperson Name:
      Mailing Address:


        Phone Number:




                                        - 45 -
 Department of Juvenile Justice and Delinquency Prevention
              Support Our Students Program


                  Grant Application
                  Fiscal Year 2007-2008


          Due October 31, 2007, 12:00PM Eastern




Agency Name:

Program Name:

County:




                            -1-
                                                   SECTION I FACE SHEET
                                                  A. GENERAL INFORMATION
1. Specify County of Application                                              2. Amount of Grant Funds Requested


3A. Current SOS Grantee         Yes       No                                  4. Number of times applied for SOS funding
3B. If yes, number of years as SOS Grantee:

5. Technical Assistance Workshop Attended on December 14th?                   6. Technical Assistance videoconference location
      Yes     No

7. Name and Title of Person Responsible for Preparing the Grant Proposal      8. Name of Organization for Person Preparing Grant Proposal


9. Organization Mailing Address                                               10. Grant Writer‟s Area Code, Telephone Number and Extension


                                                  B. PROGRAM INFORMATION
1. Program Name                                                               2. Program Director‟s Name


3A. Salutation    Mr.     Ms.      Mrs.    Dr.                                4. E-mail Address
3B. Elected?     Yes      No

5. Mailing Address for Program Correspondence                                 6. Program Director‟s Area Code, Telephone Number & Extension


                                                   C. AGENCY INFORMATION
1. Agency Name                                                                2. Street Address

3. County                                                                     4. Mailing Address


5. Zip Code (Mailing)                                                         6. Area Code & Telephone Number of Agency

7. Chief Executive Officer Name                                               8A. Salutation    Mr.    Ms.    Mrs.      Dr.
                                                                              8B. Elected?     Yes     No
9. Area Code, Telephone Number & Extension of Chief Executive Officer         10. Area Code & Fax Number          11. E-mail address

12. Federal Identification Number                                             13. Number of years agency in operation

14. Name of Fiscal Officer                                                    15. Fiscal Officer‟s Area Code, Telephone Number & Extension

16. Name of Chair of Board of Directors                                       17. Board Chair‟s Area Code, Telephone Number & Extension

18. Name of Fiscal Agency, if not Applicant                                   19. Mailing Address for Fiscal Agency, if not Applicant

20. Physical Address for Program Records                                      21. Physical Address for Fiscal Records


                                                          D. CERTIFICATION
     I certify that all information presented throughout the application is true and correct. Furthermore, all applicable statutes,
     terms, conditions, regulations, and procedures for program compliance and fiscal control will be implemented to ensure
     proper accountability of grant funds. I certify that the funds requested in this application will not supplant funds that would
     otherwise be used for the purposes set forth in this proposal. The filing of this application has been authorized by the
     contracting entity and I have been duly authorized to act as the representative of the agency in connection with this
     application. I also agree to follow all terms, conditions, and applicable federal and state statutes.

                         Name of Authorized Official                                               Authorized Official‟s Title


                        Authorized Official‟s Signature                                                        Date




                                                                        -2-
SECTION II: PROGRAM SUMMARY (Limit four pages)

1. Program Abstract
  Provide a brief description of the program, including the program‟s main purpose
     types of services offered, and expected outcomes.


2. Program Proposal Numbers
    Number/Amount
   Total number of youth estimated to be served
   Total number of program/administrative staff (not
   contracted)
   Total number of contracted staff
   Total number of volunteers
   Length of Program Operation (in months)
   Total amount of funds requested
   Cost per participant

3. Estimated Percentage Of Participants Identified By Gender, Race, Ethnicity &
   Grade:
             Gender                 Estimated Percentage                  Total
              Male
                                                                          100%
             Female

               Race                 Estimated Percentage                   Total
             Caucasian
         African-American
          Alaskan Native                                                  100%
         American Indian
               Asian
          Pacific Islander

           Ethnicity                Estimated Percentage                  Total
          Non-Hispanic
            Hispanic                                                      100%
             Haitian
           Jamaican




                                         -3-
               Grade                   Estimated Percentage                   Total
               Grade 4                                                        100%
               Grade 5
               Grade 6
               Grade 7
               Grade 8
      Other (add rows as needed)


4. Does the proposed program charge student fees for participation?
     Yes No
  a. If yes, fee amount? $      How often?

    b. Provide a sliding fee scale if applicable

    c. If yes, provide an explanation for fees charged for participation in a state-funded
    after school program

    d. Describe provisions for providing scholarships for students whose families
       cannot afford the fees


5. CURRENT AFTER SCHOOL SERVICES
   Does the agency/organization currently operate an after-school program?
       Yes      No
    If yes, does the proposed number of youth to be served by SOS programming
    include youth currently receiving after school services?


    Describe how the SOS funds will be used to expand or enhance the current services
    provided.


6. AGENCY BUDGET AND CONTRACT ADMINISTRATION:
    Does the agency/organization receive other state funds?
        Yes       No
    If Yes, list state agencies and amount of funds per agency


    Is this program proposal to be funded in part with these other state funds?
         Yes     No
    If yes, other state funds compose what percentage of total funding?



                                            -4-
    Specify state agency(ies) providing funds to support SOS program proposal


    Does the agency/organization receive private funds?
        Yes       No
    If Yes, list private sources and amount of funds per source


    Is this program proposal to be funded in part with these private funds?
         Yes     No
    If yes, private funds compose what percentage of total funding?

    Specify source providing private funds to support SOS program proposal


   Will the applicant agency be solely responsible for administering all terms and
    conditions of the contract, if awarded, including but not limited to: fiscal
    management, daily program operation, and reporting requirements?
       Yes     No

    If no, clearly describe all relationships, roles, and responsibilities




                                              -5-
Section III: NEEDS ASSESSMENT (Limit two pages)




                                    -6-
SECTION IV: PROGRAM NARRATIVE (limit 11 pages)

A. Program Design


B. Measurable Goals, Objectives and Strategies
There is no requirement for the number of goals, objectives, and strategies provided.
Add additional goals as needed. Delete as necessary.

Goal 1:


Measurable Objectives


Strategies

_____________________________________________________________________
Goal 2:


Measurable Objectives


Strategies

_____________________________________________________________________
Goal 3:


Measurable Objectives


Strategies

_____________________________________________________________________
Goal 4:


Measurable Objectives


Strategies




                                          -7-
 C. Timeline of Implementation

Activity                                                       Month
                           Jul   Aug   Sep    Oct    Nov     Dec   Jan    Feb    Mar     Apr   May   Jun
Program Planning
Recruit Program Staff
Hire Program Staff
Train Program Staff
Marketing and
Community Outreach
Enroll Youth to Program
Provide Services to
Youth
Collect Program-Specific
Data for Evaluation
Participation at JCPC
meetings



 (To add new rows – with the cursor in the last cell, click Table, Insert, Rows Below)


 D. Staffing and Volunteer Management




                                                    -8-
E. Collaboration
Include other agencies that will partner with the applicant, the services partners will
provide to help the program succeed and deliverables the applicant will provide to help
partners succeed. Be specific. Add partners as needed. Letters of support must be
provided in Appendix A.


         Required Partners                       Activities/Deliverables                Timeline
Juvenile Crime Prevention Council

Specify county
Three additional required partners as
described in the RFP Components-
Section IV (E).

Specify each partner. Add rows for
each partner.
School System. Required for School-
Based Programs.

Specify school or school system. Add
rows for each partner.
       Additional Partners                       Activities/Deliverables                Timeline
Add as applicable. Be sure to include
letters of support in Appendix A.

Add rows for each partner.
(To add new rows – with the cursor in the last cell, click Table, Insert, Rows Below)



F. Organization and Consortium Capacity




                                                    -9-
SECTION V: QUALITY ASSURANCE/LOCAL EVALUATION PLAN (limit one page)




                               - 10 -
SECTION VI: SUSTAINABILITY PLAN (limit one page)




                                   - 11 -
                             Appendix A

             Letters of Support/Collaboration
                 Letter of Review: Juvenile Crime Prevention Council
                    Three Letters of Support from Agency Partners
         Letter of Support from School System (for school-based programs)
              Additional Letters for Collaborations (i.e. referral sources)




  Failure of Applicants proposing school-based programs to submit a letter of
support from the School System will result in the application not being reviewing
                                  for funding.




                                       - 12 -
                     Appendix B

DJJDP Conflict of Interest Policy Statement




   Failure to submit documentation may result in the application
                  not being reviewed for funding




                               - 13 -
              NORTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE
                      AND DELINQUENCY PREVENTION

                 CONFLICT OF INTEREST POLICY STATEMENT

Each private, nonprofit entity eligible to receive State funds is required to have a policy that
addresses conflict of interest that may arise when members of its governing body or managing
staff are involved in the disbursement of State funds; and requires the private, nonprofit entity to
file with the agency that disburses State funds a notarized copy of its conflict of interest policy
before any State funds can be disbursed to the entity. The policy shall address situations where
any of these individuals may directly or indirectly benefit. The policy shall include actions to be
taken by the entity or the individual, or both to avoid conflicts of interest and the appearance of
impropriety.
Accordingly, no member or board member of the private, nonprofit entity may receive directly or
indirectly, any funds received from the State of North Carolina, except for duly, authorized staff
compensation and benefits, and reimbursement for expenses actually incurred in connection with
the private, nonprofit entity’s business and in accordance with final approved grant agreements.
WHEREAS, _________________________________(Name of entity) desires to require its
Board of Directors and managing employees to avoid conflicts of interest or the appearance of
impropriety in the disbursement of State funds;

THEREFORE, no member of the Board of Directors or staff members of said private, nonprofit
entity shall participate in the solicitation, negotiation, formation, award, arbitration, modification,
or settlement of any contract or grant funded in whole or in part by State funds or of any dispute
arising under such contract or grant when the director or staff members stands to benefit, either
directly or indirectly, from such grant or contract;
PROVIDED, no member of the Board of Directors or staff members shall be deemed to benefit
directly or indirectly from any contract or grant funded in whole or in part by State funds if
he/she receives only the salary or stipend due to him/her in the normal course of employment
with, or service to, said private, nonprofit entity.

FURTHERMORE, said private, nonprofit entity has written conflict of interest policies and
reporting procedures applicable to board members, staff members and volunteers who have any
interest or any authority regarding the resources of the private, nonprofit entity. These policies
have been communicated to board members, staff members and volunteers and full disclosure
has been provided for any possible appearance of conflict of interest that may exist.




                                                - 14 -
              NORTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE
                      AND DELINQUENCY PREVENTION

                CONFLICT OF INTEREST POLICY STATEMENT

The following serves to identify and document any personal interest staff members, officers,
and members of the Board of Directors may have. This document is also to be used to disclose
any transactions that may result in personal, financial, professional and/or political gain at
the expense of the NC Department of Juvenile Justice and Delinquency Prevention. The
statement requires that all personal relationships that may inappropriately influence (bias)
actions be disclosed. Relationships, be it personal, financial, professional and/or political are
required to be disclosed to this Department. Conflict means a conflict or the appearance of a
conflict between the private interests and official responsibilities of a person in a position of
trust. Persons in a position of trust include staff members or the Board of Directors.

Private, nonprofit entities shall make full disclosure by notice in writing to the full
Governing Board/Council all conflicts of interest, if “yes” is answered to any of the
following: (Check any that apply)

 1. A Board member is related to a staff member.                                     NO
                                                                            YES
 2. A staff member in a supervisory capacity is related to another staff             NO
                                                                            YES
    member whom he/she supervises.
 3. A staff member is related to another staff member.                               NO
                                                                            YES
 4. A board member or staff member has or may have personal,                         NO
                                                                            YES
    financial, professional, and/or political gain at the expense or
    benefit of the private, nonprofit entity.
 5. There is a business entity in which a staff, board, or family member             NO
                                                                            YES
    participates that may be viewed as having direct or indirect
    influence over the private, nonprofit entity’s business.
 6. A staff, board, or family member may be viewed as having direct or               NO
                                                                            YES
    indirect financial gain from personal or business
    investments/interest in real property held by that staff, board, or
    family member.
 7. A staff or board member received honorarium or other                             NO
                                                                            YES
    compensation outside of the scope of employment/operations with
    the private, nonprofit entity that creates or appears to create bias.
 8. A staff or board member secured employment with a competitor or                  NO
                                                                            YES
    other similar private, nonprofit entity.
 9. Ongoing, paid consulting work outside of the staff member’s                      NO
                                                                            YES
    current employment or board member’s with your private,
    nonprofit entity exists.




                                              - 15 -
                    NORTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE
                            AND DELINQUENCY PREVENTION

                       CONFLICT OF INTEREST POLICY STATEMENT

     1. If you have answered, “yes” to any of the aforementioned items you are required to
        provide details for any transaction that exists.
     2. If this statement fails to list a transaction that may exist that is non-financial in nature,
        please attach details.

     Details must include at least the name, and, address, or persons involved, and a description of
                                   the relationship and the transaction.

       Note: Failure to disclose any conflict of interest transaction that exists or is potential
       within your private, nonprofit entity may result in the Department’s cessation of any
                                        further State funds.


County

Agency Name (Legal Applicant)

Federal Tax ID #

Private, nonprofit entity name

Executive Director’s name
Print and Sign

Board Chair’s name
Print and Sign


Sworn to and subscribed before me on the
Day of the date of said certification


____________________________________
      (Notary Public)




Department of Juvenile Justice and Delinquency Prevention
Conflict of Interest Form




                                                            - 16 -
Form DJJDP 13 001
Form Structure Last Revised 2/23/05




                                      Appendix C

                Certification and Sworn Statement of
                        No Overdue Tax Debt

                               Sign, date, notarize and submit
                           Certification and Sworn Statement Form
                                         with application




                 Failure to submit documentation may result in the application
                                not being reviewed for funding


                                             - 17 -
Instructions: Grantee should complete this certification for all state funds received. Entity should enter appropriate
              data in the yellow highlighted areas. The completed and signed form should be provided to the state
              agency funding the grant to be attached to the contract for the grant funds. A copy of this form, along
              with the completed contract, should be kept by the funding agency and available for review by the
              Office of the State Auditor.




                          State Grant Certification – No Overdue Tax Debts

                                             Entity’s Letterhead

                                  [Date of Certification (mmddyyyy)]

                    To:      State Agency Head and Chief Fiscal Officer

Certification:

We certify that the [insert organization’s name]          does not have any overdue tax debts, as
defined by N.C.G.S. 105-243.1, at the federal, State, or local level. We further understand that any
person who makes a false statement in violation of N.C.G.S. 143 C-6.23(b) (N.C.G.S 143-6.2 until
07/01/07) is guilty of a criminal offense punishable as provided by N.C.G.S. 143-34(b).


Sworn Statement:

[Name of Board Chair] and [Name of Second Authorizing Official] being duly sworn, say that we are the
Board Chair and [Title of the Second Authorizing Official], respectively, of [insert name of organization] of
[City] in the State of [Name of State]; and that the foregoing certification is true, accurate and complete to
the best of our knowledge and was made and subscribed by us. We also acknowledge and understand
that any misuse of State funds will be reported to the appropriate authorities for further action.

         ______________________________
         Board Chair
         ______________________________
         [Title of Second Authorizing Official]

Sworn to and subscribed before me on the day of the date of said certification.



_______________________________                                 My Commission Expires: __________
(Notary Signature and Seal)




                                                       - 18 -
                     Appendix D


SOS Requirements for Program Operations


            Sign, date, and return the following
                Acknowledgement Form
                      with application




   Failure to submit documentation may result in the application
                  not being reviewed for funding.




                               - 19 -
        SOS Requirements for Program Operations


                         Acknowledgement Form
          Department of Juvenile Justice and Delinquency Prevention



I have read the SOS Requirements for Program Operations. My signature indicates that I understand that
the SOS Requirements for Program Operations will be included with the executed contract should this
proposal be awarded funds by the Department of Juvenile Justice and Delinquency Prevention.
Furthermore, I also understand that SOS Requirements for Program Operations is not the sole rules
document by which compliance and performance with contract requirements will be measured.




_____________________________________                     ___________________________________
Chief Executive Officer Signature Date                    Program Director Signature     Date




                                                - 20 -
                 Appendix E

Organization and Consortium Capacity

     Submit the following documentation with application


         1.   Description of Agency and Agency Mission Statement
         2.   Current Agency Budget and Description
         3.   List of Board of Directors
         4.   Articles of Incorporation
         5.   Internal Revenue Service (IRS) Designation Letter
         6.   Fiscal Accounting Policies/Procedures
         7.   Separation of Duty
         8.    Board Approved Conflict of Interest Policy
         9.    Insurance Declarations/Certificates of Insurance




                           - 21 -
              Appendix F

          Budget Summary
                    Budget Sheet
      Budget Narrative: Personnel Itemization
Budget Narrative: Contracted Personnel and Services
   Budget Narrative: Line Item Budget Narrative
        Anticipated Revenue Summary Form




                       - 22 -
APPENDIX F: BUDGET SHEET
Complete the Budget Sheet for grant year 2007-2008. A detailed Budget Narrative must be
included in Attachment F.

                                              Budget Sheet
County
Agency Name
Federal Tax ID Number
Grant Year                                             2007-2008
Total Funds Requested                                   $
                         Column A                               Column B            Column C
                Expenditure Categories                        Budget Proposal    % of Total Budget
ADMINISTRATION
11. Salaries                                           $                                             %
12. Fringe Benefits                                    $                                             %
13. Contracted Personnel                               $                                             %
14. Cost of Space                                      $                                             %
15. Equipment                                          $                                             %
16. Materials & Supplies                               $                                             %
17. Telephone                                          $                                             %
18. Travel                                             $                                             %
19. Postage                                            $                                             %
20. Other Contracts                                    $                                             %
21. Printing & Copying                                 $                                             %
22. Other                                              $                                             %
23. TOTAL ADMINISTRATION COSTS                         $                                             %
PROGRAM SERVICES
25. Salaries                                           $                                          %
26. Fringe Benefits                                    $                                          %
27. Contracted Personnel                               $                                          %
28. Staff Development                                  $                                          %
29. Cost of Space (site)                               $                                          %
30. Student Equipment                                  $                                          %
31. Student Transportation                             $                                          %
32. Contracted Transportation Services                 $                                          %
33. Student Materials & Supplies                       $                                          %
34. Student Activities                                 $                                          %
35. Printing & Copying                                 $                                          %
36. Other Contracted Services                          $                                          %
37. Other                                              $                                          %
38. Total Program Services Budget                      $                                          %
39. Total Budget-Administration & Program Services     $                                       100%

Budget Caps:
Lines 11+12+13+25+26+27 (Salaries & Fringe, Contracted Personnel) -75% cap
Lines 15+16+30+33 (Equipment/Materials/Supplies)-13% cap
Lines 14+29 (Rehabilitation/Renovation associate with Cost of Space)_ - 4% cap




                                                     - 23 -
APPENDIX F: BUDGET NARRATIVE: Personnel Itemization

Personnel Itemization
Employee Salaries: List each position by title and name of employee (if available – “TBA” if not already hired). Begin with
Administration salaries followed by Program Services salaries. Show the number of hours each position will work within the
SOS program each week, the number of months per year and the percentage of time to be worked that is directly to this grant
program. Compensation paid for employees engaged in grant activities must be consistent with that paid for similar work within
the applicant organization. To add new rows – with the cursor in the last cell, click Table, Insert, Rows Below.
          Title and Staff Member Name            Number       Number         % of time    Annual         Amount paid with SOS
                                                  hours/     months/year      related      Salary              Grant Funds
                                                  week                        to SOS     including       (Annual Salary + Fringe
                                                (based on                    program       Fringe      divided by % of time related
                                                  40hrs)                                  Benefits           to SOS program)

          Administrative Personnel

Example: Executive Director, Sally Smith            4                12         10%      $45,644.25                     $4,564.42




                                                                      Total Administrative Personnel                             $

        Program Services Personnel

Example: SOS Site Director, Jane Doe               40                12        100%       $25,030                         $25,030




                                                                 Total Program Services Personnel                                $




                                                            - 24 -
APPENDIX F: BUDGET NARRATIVE: Contracted Personnel and Services

   Contracted Personnel and Services: For each contractual staff or service, enter the name, if known, the service           Amount
   to be provided, hourly or daily fee (based on 8-hour day), and estimated time on the project. Provide details re: the    paid with
   contractual revisions including the frequency of service, expected outcomes, deliverable and procurement method.        SOS Grant
                                                                                                                              Funds
   Name of Contracted Personnel                Service Provided             Rate of Pay (Show Computation & Total)
   Example: (2) teachers                       Literacy tutoring      2 tutors x $12/hour x 2 hours/week x 30 weeks =      $1,440
                                                                      $1,440




                                                                                          Subtotal Contracted Personnel $
   Name of Contracted Service                  Service Provided       Rate of Pay (Show Computation & Total)
   Example: ABC Tae-kwon-doe                   Tae-kwon-doe           5 group lessons x $50 per lesson = $250.00           $250.00
                                               lessons




                                                                                           Subtotal Contracted Services $
                                                                             Contracted Staff/Services Category Total:




                                                                   - 25 -
Appendix F: BUDGET NARRATIVE: Line Item Budget Narrative
For each line item expense, provide an itemized description of the expense and include the cost computation to
demonstrate a basis for the total allocated budget amount. Examples of the level of detail required are provided and
are provided to serve only as examples and not necessarily present a true reflection of your program expenses. Do
not delete examples. For salaries, fringe benefits and contracted personnel insert totals only from the Personnel
Itemization Worksheets included with this Appendix. For all other line items, enter information in the unshaded
portion of each column and row. Add rows as need. All line item expenses are subject to state per diem and cost
principles. See www.osbm.state.nc.us.
Expenditure Categories                      Description                   Cost Computation and Total               Total
ADMINISTRATION
Salaries

Fringe Benefits

Contracted Personnel

Cost of Space

Equipment

Materials & Supplies

Telephone

Travel

Postage

Other Contracts

Printing & Copying

Other


                                                                                  Total Administrative Costs   $


                                                          - 26 -
      PROGRAM SERVICES               Description                         Cost Computation and Total             Total
Salaries

Fringe Benefits

Contracted Personnel

Staff Development

Cost of Space (site)

Student Equipment

Student Transportation

Contracted Transportation Services

Student Materials & Supplies

Student Activities

Printing & Copying

Other Contracted Services

Other



                                                                                Total Program Services Costs    $
                                                                                           TOTAL BUDGET         $
                                              (This total should match total budget provided on Budget Sheet)




                                                   - 27 -
Appendix F: Anticipated Revenue Summary Form: Enter the projected revenue
(cash and in-kind) for the three year period. See page twenty (20) of the RFP for
instructions

                            Anticipated Revenue Summary Form
County
Agency Name
Federal Tax ID Number
Grant Year                                      2007-2008
Total Grant Funds Requested                     $
                 Revenue Sources                      2007-2008       2008-2009       2009-2010
Cash Support (do not include SOS grant funds)
Contributions                                   $                 $               $
Local Government                                $                 $               $
Grants                                          $                 $               $
School System                                   $                 $               $
Corporate Sector                                $                 $               $
Church Support                                  $                 $               $
United Way                                      $                 $               $
Program Fundraising                             $                 $               $
Other (Identify)                                $                 $               $
Other (Identify)                                $                 $               $
Other (Identify)                                $                 $               $
TOTAL CASH                                      $                 $               $
In-Kind Support
Space                                           $                 $               $
Transportation                                  $                 $               $
Food and Clothing                               $                 $               $
Labor                                           $                 $               $
Equipment                                       $                 $               $
Materials                                       $                 $               $
Printing Services                               $                 $               $
Personnel Support                               $                 $               $
Other (Identify)                                $                 $               $
Other (Identify)                                $                 $               $
Other (Identify)                                $                 $               $
TOTAL IN-KIND                                   $                 $               $
TOTAL REVENUE                                   $                 $               $




                                                    - 28 -

								
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