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8.2 FY 2016-2017 HS Grants Program Funding Recommendations
��fi.�t�DU� !�i `itY' ��1 'l� 'r �'1l� STAFF REPORT ��iro��'v`' HUMAN SERVICES COMMISSION DATE: January 28, 201G TQ: Honorable Chaix and Commissioners FROM: Micki Cronin, Assistant Director of Parks and Community ,,�(�� �,��--�' Services $�J�E�: City of Dublin Fiscal Year 2016-2017 Human Services Grants Program Funding Recommendations By: Rhonda Franklin, ManagementAnaly.rt EXECUTIVE SUMMARY: On annual basis, the Human Services Commission reviews Human Services Grants Program applications for the upcoming Fiscal Year. The Commission will receive presentations from community organizations applying for grant program funding; discuss the grant applications; review StafPs recommendation for funding levels, and make funding recommendarions for City Council consideration at the February 16, 2016 meeting. FINANCIAL IMPACT: The Human Services Grants Program is supported by several funding sources including the Community Development Block Grant (CDBG) Fund, the General Fund and the Affordable Housing Fund as appropriate. The preliminary Fiscal Year 2016-2017 CDBG allocarion is $93,658. A portion of this funding, appro�cirnately $72,709, is available for direct support of social service programs in the community. Final allocarions from the Department of Housing and Urban Development (HUD) will not be known until at least March 2016. The Fiscal Year 2016-2017 Human Services Support Grant funding cap is $130,000 (General Fund) as established by the City Council. In compliance with grant program guidelines, all grants applications must comply with a $3,500 minimum and$25,000 maximum per application (project) request. RECOMMENDATION: Receive organization presentations, review StafPs recommendation on funding levels and make funding recommendations for City Council consideration. DESCRIPTION: The City of Dublin Human Services Grants Program provides financial support to local nonprofit organizations serving the Dublin community. The program is supported through several funding sources including the federal Community Development Block Grant (CDBG) program and the City's General Fund and Affordable Housing Fund (as appropriate). Each year the City Council awards funding to organizarions ITEM NO: 8.2 that best meet the community's needs in support of the City's adopted Mission, Vision and Values (Attachment 3) and needs identified in the Tri-Valley Needs Assessment (Attachment 4). Prior to the Fiscal Year 2014-2015 funding cycle, a City Council Grants Program Subcommittee provided policy and grant funding recommendations to the full City Council for consideration. For Fiscal Year 2014- 2015, the grant process was modified to include a review of grant applications by the newly formed Human Services Commission. The Human Services Commission assumed the role of reviewing funding applications, ' receiving presentations from each grant applicant and making recommendations to the City Council. The iCity Council will consider the Human Services Commission's funding recommendarions at the meeting on �' February 16, 2016 for inclusion in the Fiscal Year 2016-2017 budget. Final consideration of the City Council's grant funding recommendations is tentatively scheduled for May 2016 as part of the biennial budget hearing. Staff has reviewed the Fiscal Year 2016-2017 grant applications to verify that all xequests qualify for funding ' based on the adopted program guidelines. As part of the review, Staff applied the Ciry Council-approved Rating Criteria (Attachment 5) to each grant application. Each funding source does have some variation in , application and use requirements; these differences were taken into consideration during the Staff xeview process. The rating for each application can be found in Attachment 2. The Rating Criteria is only one of several factors used in determining StafPs funding recommendations. Other factors include consideration such elements as: the number of Dublin residents served and cost per participant;past performance for existing Dublin programs;whether the project addresses one or more of the 14 Key Areas of Concern identified in the 2011 Tri-Valley Needs Assessment Report (Attachment 4); and whether Ciry funds are used to leverage other funding sources. Throughout the gxant process, applicants are regularly advised that the success or implementation of their program or project should not be solely dependent on receipt of grant funding from the City of Dublin. Organizations are strongly encouraged to leverage any City grant award with other revenue sources. Based on the Human Services Cominission's work in establishing local and regional priorities this past year, additional consideration was given to applications addxessing needs in the areas of: Behavioral Health (mental health and substance abuse), Health Care (including dental), and Senior Services. Similar to past yeaYS, grant applicants were informed that the presentation order for this meeting would be based on the date/titne their completed application was submitted through ZoomGrants. Attachment 1 pxovides a chart lisring the order in which applications were submitted and will be presented. CDBGProgram Background.• Community Development Block Grant funds are provided by the U.S. Department of Housing and Urban Development (HUD). The City of Dublin works with Alameda County's Urban CDBG Program to allocate funds and with HUD to assure that all CDBG-funded activities are in compliance with federal regulations. The City of Dublin has participated in Alameda County's Urban-County CDBG Program since 1982. The City of Dublin, along with the cities of Albany, Emeryville, Newark, and Piedmont (cities with a population of less than 50,000 residents), are called the "Urban Counry Cities," along with the unincorporated areas of r'1lameda County. During the current Fiscal Year (FY 2015-2016), the City of Dublin received $93,658 in CDBG funding. For FY 2016-2017 Dublin's portion of funding is expected at the same amount; however, only $72,709 of this amount is available fox direct support to organizations. Every year, the County dedicates a percentage of each Urban County City's total CDBG funding allocarion to the Counry of Alameda's Housing Rehabilitation Pxogram. This Program is available to income qualified households within each of the respective Urban County Cities as well as the unincorporated County for needed home maintenance and repairs. In addition, the County may limit each Urban County City to only 12% of the CDBG allocation for service-based organizations and projects. The County's past practice has 2of7 been to review all applications received from each Urban County City to determine if the overall request for service-based projects exceeds the 12% limit. For the past few years, the County has requested that the City make adjustments to the service-based project allocation as the County was projected to exceed the 12% limit. If adjustments are needed for Fiscal Year 2016-2017, Staff will work with eligible gxant applicants and the County to make adjustments as necessary, including implementation of a prorated reduction for all CDBG awards,if necessary. On May 6, 2014, the Ciry Council approved a resolurion authorizing the Ciry to enter into a Public Parriciparing Jutisdiction Agreement (PPJ) with the Cities of Pleasanton, Livermore, and the County of Alameda for repayment of a HUD loan to support Axis Community Health's Clinic Expansion). The City oE Dublin has been supporring predevelopment acriviries for this project over the past several years through the CDBG program. The PP] allows the agencies,with City of Pleasanton acting as lead agency, to borrow $1.25 nvllion to support A�s Community Health's facility construction. As a xesult of the agreement, the City of Dublin is xequired to repay its portion of the loan, a total of $265,618, (or $13,374.18 each year) through CDBG funds. The funding allocation for repayment of the loan is identified as part of the Staff recommendations in Attachment 2. CDBG funds are categorized as federal funds with strict use,reporting and monitoring requirements to insure compliance with federal regulations. Many organizations are not able to meet these requirements and are therefore not eligible to receive CDBG funds. To comply with the County's CDBG program timelines and to assist with timely reporting to F-�UD, the Corrunission's CDBG funding recommendations must be considered at the City Council meeting on February 16,2016. Human Servtces Support GrantProgram Background.• Fiscal Year 2016-2017 marks the 12`" yeax of the City Council's adopted Human Services Grant funding process. This foxmalized grant process was the result of the Ciry Council's desire to standardize an application and reporting process for organizations requesting and receiving financial support from the City's General Fund and other City funding sources. The funding cap for Human Services Grants Program has been established by the City Council at $130,000 from the General Fund. As appropriate, the General Fund allocarion has been supplemented by the Affordable Housing Fund. This approach has provided addirional flescibility in funding community organizations pxoviding valued services to Dublin residents. At the Octobex 20, 2015 City Council Meeting, the City Council discussed the funding priorities for the upcoming grants cycle. The discussion resulted in City Council direction that the Grants Program emphasize funding programs specifically directed towards human service needs. As such the City Council decided that, for Fiscal Year 2016-2017 and beyond, grants would not be awarded to arts or school-based programining or events, but would be focused on the most critical human services needs such as health care, food and nutrition,homelessness,child care, etc. Outreacb Efforts �s in past years, there were many points of contact with organizations as part of the Human Services Grants Program application process. These outreach and education efforts included: • In October 2015, a letter was sent to all past grant applicants to notify of a change of Department administration and of City Council's direction that the program would focus heavily on critical human service needs. • In October 2015, notices of funding availability and upcoming community workshops were mailed to organizations. 3 of 7 • In October and November 2015, a Request for Proposal was advertised three times in the local newspaper for Grants, with an open application period set between November 12 and December 11, 2015. • Program announcements and information were posted on the City website with links to the Zoom Grants Application. • On November 12 in the morning and November 18, 2015 in the evening, City Staff held Mandatory Grant Application Workshops with interested community organizations to review the online Zoom Gxants Applicarion process and discuss program guidelines for the year. All Fiscal Year 2016-2017 grant applicants attended at least one of the mandatory meetings. • In January 2016,Human Services Grants Program information was distributed to the Human Services ' Commissioners to familiarize them with the grant applications and online grant application program. Analpsis During this year's application cycle, the City of Dublin received 21 applications from 18 organizations. Of the 21 eligible applications received, seven (7) met the CDBG criteria and the remaining were considered for other grant program criteria. Three (3) organizations submitted applications for two (2) different programs/projects: Chabot-Las Positas Community College District/Tri Valley One Stop Career Center,Tri- Valley Haven, and YMCA of the East Bay Tri-Valley Branch. When more than one application is submitted, organizations are re9uired to rank their funding requests based on the organization's priority. Upon Staff review, all applications were deemed complete and all organizarions met the minimum applicarion requirements. Staff reviewed all applications and rated them according to the following City Council approved criteria: • Organization and Management—Evaluates the agency's ability to run and manage its operations; � Needs and Benefits—Assesses if the request meets the targeted population and meets at least one goal and/or policy established by the City's Mission,Vision and Values or HUD guidelines; � Funding and Budget—Evaluates the agency's ability to leverage funds,reviews fees and current audits. Attachment 2 summarizes the Fiscal Year 2016-2017 funding requests including: the orgaruzation's name and ' program; the Fiscal Year 2015-2016 funding award (if any); the organizarion's Fiscal Year 2016-2017 funding request; StafPs funding recommendation (including funding source); the rating score for each application; and the number of "Needs" the service or project meets as outlined in the Tri-Valley Needs Assessment. The Staff recommendations are based on the rating criteria and the additional factors outlined earlier in the report. Finally, the program criteria provide that organization funding requests and awards must be between $3,500 and $25,000. CommunityDevelopmentBlock Grant(CDBG)Funds ' Of the 21 eligible applicarions received during this year's application cycle, seven (7) applicants qualified and indicated they were willing to meet the strict Eederal guidelines for use of CDBG funds. Staff has reviewed past program performance and proposed activities of the service providers to ensure the activiries are in compliance with HUD/CDBG guidelines. As a requirement of funding, the City performs an annual site-monitoring visit to each agency. This site-monitoring visit includes a review of organization and ' client files to ensure compliance with HUD guidelines. There were no findings issued during the prior monitoring period for any of the organizations funded through the CDBG program. 4of7 In the table below, of the anticipated $93,658 allocated to the City, $72,709 is expected to be available for funding organizations through the Human Services Grants Program. Staff recommends funding six (6) organizations for Fiscal Year 2016-2017 through the CDBG program as follows; the one remaining organization is recommended for funding through other sources (Community Resources for Independent Living): CDBG FUND RECOMMENDATIONS FISCAL YEAR 2016-2017 Organization Pro'ect Recommended � Funding Axis Community Health* Facility Project Loan Obligation* $13,374 CALICO Center Dublin Chiid Abuse Intervention $7,500 Open Heart Kitchen Dublin Meal Programs $13,000 Senior Support Program of the Tri Valley Case Management $12,000 Spectrum Community Services Meals on Wheels for Dublin's Homebound Seniors $$,835 Tri-Valley Haven Domestic Violence Services Program $8,000 Tri-Valley Haven Homeless Services Program $10,000 Total $72,709 *The A�s Community Health Facility Project Loan Obligation agreement was executed in July 2015 and is a 20-year loan repayment conunitment. These recommendadons are based on City Council discussions, funding decisions approved during the last several grant funding cycles, and the factors identified above. For the past six years, the City Council has emphasized basic life needs such as food, shelter, medical services, and educarion in grant funding decisions. The CDBG recommendations are reflective of that approach. In addition to the CDBG funding recommendation of $72,709 in the table above, the City has three (3) additional CDBG funding commitments which total the $93,658 in funding for the year: • The County of Alameda administers the City of Dublin's rehabilitarion program. In Fiscal Year 2016- 2017, $14,349 is preliminarily allocated to that program; • Administration fees in the amount of $6,600 are allocated to support administration of the CDBG program. � An additional percentage is also used to fund Counry of Alameda administered tenant/landlord and fair housing services for the City. � iAfter funding the program's mandatory functions listed above, $72,709 remains for direct allocarion to qualifying applicants. Should there be further decreases in the CDBG allocation, Staff will apply the percentage of the decrease evenly across all the organizations (with allowance for rounding and compliance with grant guidelines). If adjustments are necessary to comply with the 12% service-based project cap, Staff will work with the organizations and the County to bring grant allocations into compliance. The organizations, as recommended, meet the CDBG program's national objectives of benefiting income qualified persons, homeless persons or persons with disabilities; and all qualify as eligible uses of CDBG funds. If approved, the City would enter into mandatory contracts with the County and with the funded organizations. As required by CDBG guidelines, organizarions would be required to submit quarterly reports on their progress in reaching the goals and parricipate in annual site monitoring. 5 of 7 General Fund Of the 21 eligible applications received during this year's application cycle, most applications met Human Services Grant funding criteria. Staff has reviewed past program performance and proposed applicant activities to ensure compliance with program guidelines. As a condition of funding, the City will require a semi-annual and an annual summary report from each agency receiving funding. These reports detail how many residents were assisted; how the funds were used; if the program goals as outlined in the grant application were met; and the overall impact of the funding. Once submitted at the end of the calendar year and Fiscal Year, the summary reports are provided to the Human Services Commission as an informational item. Axis Community Health submitted an application to request funds for pre-construction costs for development of a dental care facility. This type of project request is not eligible for CDBG funding as a service or capital project. As a result, Staff is recommending that the Commission consider funding this project using the $30,000 the City Council set aside for the Cominission to fund a one-rime special project. Staff recommends that the following 14 organizations be funded with General Funds as follows: GENERAL FUND RECOMMENDATIONS FISCAL YEAR 2016-2017 Organization Project Amount Capital Project for Dental Axis Community Health Services $0 Chabot-Las Positas Community College District/Tri Valley One Stop Career Center Dublin Job Initiative $15,000 Chabot-Las Positas Community College District/Tri Tri-Valley Volunteer Income Tax Valley One Stop Career Center Assistance $6,000 Child Care Links Early Childhood Education $15,000 CityServe of the Tri-Valley CityServe of the Tri-Valley $15,000 Dublin High School Parent Faculty Student Dublin High Safe and Sober Grad Organization Night&Senior Scholarships $0 Dublin Partnerships in Education Community Grant $0 Easter Seals Bay Area Easter Seals Kaleidoscope $15,000 2-1-1 Alameda County Eden I&R, Inc. Communication System $10,000 Homebuyer Financial Literacy Habitat for Humanity East Bay/Silicon Valley, Inc. Counseling Program $9,000 Grief Support Center and Hospice Hope Hospice, Inc Volunteer Program $15,000 Healing Therapies for Cancer Sandra J. Wing Healing Therapies Foundation Patients $10,000 YMCA of the East Bay,Tri-Valley YMCA Mental Health Services $10,000 YMCA Day Camp-Affordable YMCA of the East Bay,Tri-Valley YMCA Summer Child Care $10,000 Total $130,000 6of7 Affordable Housing Fund Of the 21 applications received, one (1) organization is being recommended for funding through the City's Affordable Housing Fund: Community Resources for Independent Living. Housing services are allowable expenses per the City's Zoning Ordinance, Section 8.68.080A as long as income verification is collected. These programs have been supported through this City Eunding source in prior years. Using the Affordable : Housing Fund for these programs provides additional flexibility in awarding funding for applicants furthering the grant program goals. Staff recommends funding the organization as follows: AFFORDABLE HOUSING FUND RECOMMENDATIONS FISCAL YEAR 2016-2017 Recommended Organization Project Funding Community Resources for Independent Independent living Services and Living Housing $8,000 Total $8,000 ' In total, $282,503 was requested through the Human Services Grants Program. The following chart summarizes the total funding requests and Staff recommendations for the Fiscal Year 2016-2017 Human Services Grants Program: , Funding Request for Staff Recommendation Funding Sources FY 2016-2017 FY 2016-2017 CDBG Fund * $106,892 $72,709** General Fund $175,611 $130,000 Affordable Housing Fund $0*** $8,000 Total Human Services Grants $282,503 $210,709 *These amounts do not include$20,949 committed for two CDBG programs (Rehabilitation Program and ' Administrative costs). **Includes allocation to the Axis Community Health Facility Project Loan Obligation. ***Non-CDBG requests included in General Fund requests. NOTICING REQUIREMENTS/PUBLIC OUTREACH: Noticing requirements and public outreach are identified in the Outreach Efforts above. A copy of the Staff Report was sent to all grant applicants. ATTACH M ENTS: 1. Grant Applicant Presentarion Order ; 2. Funding Request Summary Table with the grant applications attached as Exhibits 3. City of Dublin Mission,Vision and Values 4. Tri-Valley Needs Assessment 14 Areas of Concern 5. Grant Rating Criteria V�'orksheet 7 of 7 ATTACHMENT 1 City of Dublin Human Services Grants Program Fiscal Year 2016-2017 Grant Applicant Presentation Order # Organization Program 1 Open Heart Kitchen Dublin Meal Programs 2 Easter Seals Bay Area Easter Seals Kaleidoscope 3 Eden I&R, Inc. 2-1-1 Alameda County Communication System 4 Tri-Valley Haven Homeless Services Program 5 Dublin Partnerships in Education Community Grant 6 Chabot-Las Positas Community College District/Tri Valley One Stop Career Center Dublin Job Initiative 7 Dublin High School Parent Faculty Student Organization Dublin High Safe and Sober Grad Night&Senior Scholarships $ Chabot-Las Positas Community College District/Tri Valley One Stop Career Center Tri-Valley Volunteer Income Tax Assistance 9 Tri-Valley Haven Domestic Violence Services Program 10 Sandra J. Wing Healing Therapies Foundation Healing Therapies for Cancer Patients 11 Axis Community Health Capital Project for Dental Services 12 CALICO Center Dublin Child Abuse Intervention 13 Hope Hospice, Inc Grief Support Center and Hospice Volunteer Program 14 Senior Support Program of the Tri Valley Case Management 15 Community Resources for Independent Living Independent Living Services and Housing 16 Child Care Links Early Childhood Education 17 Habitat for Humanity East Bay/Silicon Valley, Inc. Homebuyer Financial Literacy Counseling Program 18 Spectrum Community Services Meals on Wheels for Dublin's Homebound Seniors 19 YMCA of the East Bay,Tri-Valley YMCA Mental Health Services 20 CityServe of the Tri-Valley CityServe of the Tri-Valley 21 YMCA of the East Bay,Tri-Valley YMCA YMCA Day Camp-Affordable Summer Child Care ATTACHMENT 2 � � • � � • �• • � � �: . . ,� Axis Community HeaPth ' CapitaE Project for Dertta) $25,d00'� �q' � Services Axis Community Health Facility Project Loan $13,374.18 $13,374.18 _ Z REQUIRED Obli ation REQUIRED CALICa�enter : Dublin Child Abuse $l0,fJ00 $7,30Q $7,735 15 4 �nterventiar� ' Chabot-Las Positas Dublin Job Initiative $15,611 $9,600 $15,000 14 1 Community College District/Tri Valley One Stop CareerCenter �habot-Las Positas Tri-Valfey Volunteer $6,000 N/A $6,000 15 1 Community CoNege lncome Tax Assistance District/Tri Va61ey One Stop CareerCenter Child Care Links Early Childhood $15,000 $8,000 $15,000 15 1 Education CityServe of the Tri-Va�ley CityServe of the Tri- $15,000 $10,000 $15,000 15 8 Valle Community Resources for Independent Living $8,586 $5,000 $8,000 15 6 Independent Living Services and Housing Dublin High�hoa1 Parent publin N�gh Safe and ' $4,000 $3,500 I $0 11 1 Faculty Student Organization Sober Grad Night& 5eniar Scholarships Dublin Partnerships in Community Grant $10,000 $12,000 $0 13 4 Education Easter Seals B�y Area EasterS�aEs Kaleidoscope $15,OE)U $5,040 $15,000 12' 3 Eden I&R,Inc. 2-1-1 Alameda County $10,000 $10,000 $10,000 15 14 Communication 5 stem Habitat for Humanity East Hom2buyer Fipanetaf $10,000 'First Time $9,000 13 1' Bay/Silicon Vafley,Inc. Literacy Counseling Applicant Program Hope Hospice,Inc Grief Support Center and $15,000 $11,400 $15,000 15 3 Hospice Volunteer (FY 14/15) Pro ram O en Heart Kitchen Dublin Meai Pro rams $15,000 $12,600 $13,000 15 4 Sandra J.Wing Healing Healing Therapies for $10,000 $5,831 $10,000 14 1 Therapies Foundation Cancer Patients (FY 14/15) Senior$upport Program of Case Mdnagement $14,556 $11,646 $1?,000 15 < 1 the Tri Valley Spectrum Community Meals on Wheels for $15,750 $8,350 $8,600 14 3 Services Dublin's Homebound Seniors Tri-Vatley Mav�n '; bo�nesti�Violence $8,On0 $8,000 $8,OQ0 �,5" 3 Senric�s Pro ram Tri-Valley Haven Homeless Services $10,000 $10,000 $10,000 15 3 Pro ram YMCA of the East Say,Tri- ' Ment�l Health`5ervices $?5,000 `$9,900 $10,000 22 3 Yatley YMCA YMCA of the East Bay,Tri- YMCA Day Camp- $25,000 N/A $10,000 13 2 Valley YMCA Affordable Summer Child Care TOTAL $282,503 $72,709.18 $8,000 $130,000 *Recommended to be funded by the Human Servlces Commission one-time special project fund. EXHIBITS TO ATTACHMENT 2 � II I II Email This Preview Save as PDF Print Close Window A�♦ � � 1 Powered bv ZoomGrar�tsT'�' City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program : 12/11/2015 deadline Axis Community Health Capital Project for Dental Services $25,000 Requested ( Axis Community Health Submitted: 12/11/2015 9:50:50 AM(Pacifc) I 4361 Railroad Avenue � Telephone(925)201-6068 x � ! Pleasanton,CA 94566 Fax (925)417-1503 x Project Contact ; United States Web axishealth.org Valerie Jonas ; vionas�a axisheaith.orq ! CEO Tel:925.201.6068 i Sue Compton scqmpton^axishealth.orq ' Additional Contacts I apimentel@axishealth.org,scompton@axishealth.org i Application Questions ISome answers will not be presented because they are not part of the selected group of questions based on the answer to#30. � 7.Please describe your organization category(select one of the following): � Private Non-Profit r Public Agency r Other: 2. Please describe your agency's mission(no more than 3 sentences or 250 characters►. Axis provides quality,affordable,accessible and compassionate health care services that promote the well-being of all members of the community. 3.For what type of Dublin Grant is your agency applying? IJ Capital Project � Public Service Program or Project 4. Is this a"new"service,program,project or activity7"New"is identified as not yet started,implemented or in operation. (� Yes r No 5. Please indicate below if this application is a request for one-time funding and/or"seed"funding. � One-time funding � Seed funding r One-time and Seed funding � Operational funding r None 6. If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received within the last three years Qurisdiction,year,amount,purpose,etc.�.Enter"N/A"if you HAVE received Dublin Funds. N/A 7.Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.). Axis,a non-profit Federally Qualified Health Center(FQHC),provides medical,behavioral health,and WIC nutrition services to more than 14,000 Tri- Valley residents.We are the sole provider of care for low-income and uninsured residents enrolled in Medi-Cal or the county health program (HealthPac). Options for dental services for low-income residents are extremely limited,leaving most with no local access to care.Patients needing urgent dental care must travel to Alameda County's Highland Hospital in Oakland,where waiting lists stretch out for months.The lack of dental services means low- income patients do not receive essential preventive care,resulting in unnecessary dental and health complications. In response,Axis is working with the cities of Dublin,Livermore and Pleasanton and Alameda County Health Services to develop dental services in the Tri-Valley.As an FQHC,our organization would qualify as a Denti-Cal provider and be abie to receive reimbursement for dentai services at a rate that supports a financialiy feasible model.Our objective is to develop a locally-based dental service to serve low-income children and adults. Axis's infrastructure meets federal regulatory requirements for provision of services.We've maintained contracts with the State,the County and the cities of Pleasanton,Livermore and Dublin for more than two decades.We have fulfiiled contractual requirements and passed a�i audits without findings.Financial records are maintained to standard accounting procedures and annual audits are conducted by an independent CPA firm. In the past 8 years,we have completed 6 facility projects;5 involved federal funds including HRSA/CIP and CDBG federal funds through locai jurisdictions,under the purview HUD.We have expertise in project development,federal procurement requirements,the public bid process,and reporting requirements. Each project has been on time,on budget,and in full compliance with federal requirements. 8. Provide a brief summary of the project for which your agency fs seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementation process to describe your project. ' To meet the need for affordable dental care for low-income or uninsured residents,Axis is developing a facility that will house this service.Funds are sought for pre-construction costs for project activities during FY 2016/17. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) 7,000 upon project completion 10.Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? r Behavioral Health(mental health and substance abuse) � Affordable Housing ; � Health Care(including dental) � Workforce Development � Homelessness � Transportation Services and Access � Domestic Violence and Child Abuse � Disabilities r Food and Nutrition � Senior Services (� Youth Services (� Child Care,Early Childhood Development and Education � Changing Demographics and Growing Diversity r Financial Assistance r None of the above 11. Explain how this project will be implemented,administered,and operated. This project is being implemented at the direction of the CEO and the Axis Community Heaith Board of Directors.A capital project oversight committee, comprised of inembers of the board of directors,CEO,CFO,and Chief Development Officer,will oversee project administration and operations.The committee will report to Axis's board of directors.The committee's role wilt be to develop the project scope,timelines and budget;secure qualified services,including architectural,legal and financial consultants,and general contractor;and to oversee project activities.Additionally,the CEO and Chief Development Officer will work collaboratively with the Tri-Valley Dental Project Stakehoider Group to ensure that input from key stakeholders is integrated into project plans. 12. Describe in detail the role of Dublin grant funds in this proJect(e.g.,what specifically will the grant funds be used for?). Funding from Dublin for this capital project will address the gap in dental services for low-income and uninsured residents.Specifically,Dublin grant funds,in combination with CDBG funds from the cities of Pleasanton and Livermore,will be used for phase one of pre-development during which Axis will conduct a demographic assessment of the population to be served;develop a business plan that takes into account projected revenues and operational expenses;develop a capital project budget for the facility;determine the project site;and engage an architect to initiate pre-design and programming of space. Development of dental services has been a priority for Axis for many years.The majority of dentists in the Tri-Valley do not accept Denti-Cal--only four dentists do.Our patients must go to Highland Hospital in Oakland(or other out-of-area providers)for dental services,where the wait time is 6-8 months.Based on our patient population and other community data,we estimate 20-30,000 people in the Tri Valley need access to dental services. In the 2011 Eastern Alameda County Human Services Needs Assessment conducted by the Cities of Dublin,Livermore and Pleasanton,a key finding in the health care area indicated that"dental care for low-income residents,particularly the elderly,is very scarce."The report quoted one Medi-Cal recipient as follows:"People do not understand the gravity of not having dental needs met.The only thing Med-Cal provides right now is extraction." In 2014 staff from the Cities of Dublin,Livermore and Pleasanton and Axis Community Health,began to meet to discuss addressing this serious need. In 2015 a Key Stakeholders group began to meet to clarify the need,identify barriers,and identify resources.The Key Stakeholders agreed on working toward Axis providing dental services for the Tri-Valley and to assist us in effectively designing a clinic and services that best meet the needs of area residents. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome(s)? Healthy People 2020,the standards of health care for the U.S.,states:"A growing body of evidence has linked oral health,particularly periodontal (gum)disease,to several chronic diseases,including diabetes,heart disease,and stroke.In pregnant women,poor oral health has also been associated with premature births and low birth weight.These conditions may be prevented in part with regular visits to the dentist."Healthy People 2020 sets the Leadin Health Indicator tar et at 49%of ersons a ed 2 or older who visited the dentist in the ast ear.This indicator was at 44.5% in 2007,and went down to 41.8%in 2011.Data indicate that socio-economic factors,such as education and income,drive this percentage down. In eastern Alameda County,the resources currently do not exist for achieving this goal.This project seeks to address this issue.Success will be measured by achieving the following objectives: •Completion of demographic assessment of the population to be served.This information is essential to determining the scope of the project,e.g., number of chairs and providers needed. •Development of a business plan that projects revenues and operational expenses.This pro forma budget will analyze anticipated reimbursements from payer sources and staffing costs.It will guide development of services that are achievable and sustainable. •Development of a capital project budget for facility development.Based on costs for the physical site and construction,this budget will determine the amount of capital needed for project construction and completion. •Engagement of an architectural firm to initiate pre-design and programming of space.Architectural and engineering analyses are essential to site selection.Initial pre-design and programming of the space into functional areas(e.g.,x-ray,reception,dental chair)are important factors in site ' maximization. , - 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled,low-income,etc. There is a growing number of low-income and uninsured Tri-Valley residents who do not have access to dental services.Axis's new dental program will serve Dublin families living below 200%FPL.This project serves Dublin's most impoverished residents;many are the working poor who are struggling to maintain life's basic needs for their families.Dublin is experiencing substantial population growth and a growing poverty rate.The population jumped more than 53%over the past decade(Census 2010)and the number of Dublin residents in need of general assistance has doubled since 2003(2011 Needs Assessment).The past decade has seen growing diversity,with an increase of nearly 400%in the Asian population(3,101 to 12,321).Twenty-one percent of Dubiin residents are foreign-born,and 29%speak a language other than Engiish at home.These demographics present potential cultural and linguistic barriers to attaining and maintaining good health,including dental health. Axis continues to see a tremendous rise in the number of Dublin residents in need of our services.In fact,we have gone from providing medical services for 1,012 Dublin residents in 2010 to serving 1,371 in 2014,a 35%increase in just four years(UDS Reports,2011-2014).This project will benefit low-income and uninsured Dublin residents by providing access to dental services. 15. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the client/customer population served)? Axis's mission is to provide quality,affordable,accessible and compassionate health care services that promote the well-being of all members of our community.To meet this goal,Axis provides linguistically and culturally appropriate services and dental services will embrace these policies as well. Front-line dental staff will be bilingual in Spanish and English.Translation services for other languages will be available as needed.Our employees are trained to recognize and respect differences among patients'values,expectations and experiences.Staff members represent the cultures and backgrounds of our patients,with care providers fluent in many languages. 76.Explain how your agency witl outreach to low-income,limited English speakers,andlor disabled persons. How will each of these groups access the project for which your agency is requesting funding? Axis is the sole agency providing health care services for low-income and uninsured Dublin residents.Half of our patients are limited English speakers.Axis promotes its services,in English and Spanish,through community events,organizations and media outlets.Our Enrollment Specialists and Community Relations Coordinator focus on reaching low-income,limited English speakers and other challenged populations,including those with disabilities,to assist them in overcoming common barriers to accessing care,such as language,cultural differences,or a lack of knowledge of how to enroll in public insurance.Other multi-lingual referral mechanisms include the patient services specialists who field calls from the public and the TeleMinder automated appointment-reminder service. In addition,Axis receives referrals from Alameda County's 211 agency,whose staff has the capacity to speak to callers in more than 150 languages.All Axis services are designed to accommodate individuals with disabilities and to comply with the Americans with Disabilities Act. 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Axis coordinates services on a number of levels.For patient care,we have cooperative agreements with partners regarding specific needs,such as ValleyCare Medical Center for obstetrics services and Highland Hospital for specialty medical services.Additionally,Axis is part of the Alameda Health Consortium and works with the other community health centers to assess community needs,identify new opportunities for collaboration,coordinate patient advocacy,delineate effective continuums of care and prevent duplication of services. Among our safety-net services partners are Tri-Valley Haven,which provides a food bank and shelter services for homeless families and victims of domestic violence;Hope Hospice,the area's hospice and grief counseling service;Open Heart Kitchen,which offers a hot-meal program;and CAPE/Head Start,which provides early intervention and educational services for low-income children. For this project,Axis has been working actively with all three Tri-Valley cities through the Dental Services Key Stakeholder Group.Additional partners inGude Alameda County Health Services,CAPE,Senior Support Program of the Tri-Valley,and Southern Alameda County Dental Society. 18. Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. Axis's Community Outreach Coordinator and Enrollment Specialists perform regular outreach at health fairs,community forums and faith-based events and work closely with Head Start,school-based services,parent-education programs and other human services providers to identify prospective clients.Axis also alerts underserved populations to its services through its own client-friendly website;through 211.org,a free information and referral service;and through ACHealthcare.org,a website that enables Alameda County residents to locate the nearest health care provider,with special emphasis on programs that can assist non-English speakers.Because one-third of clients rely on public transportation,Axis sites are located near bus lines.Our enrollment specialists have been providing services at the Dublin library on a regular basis and attending Dublin's Wells Middle School annual services fair for parents in the fall.With the start of the Affordable Care Act in 2013,Axis has increased its outreach and marketing throughout the Tri-Valley.In Dublin,Axis has presented at Dublin library,at Covered California information nights,at low-income housing meetings,and many other places.We are actively setting up more informational opportunities in Dublin to reach people newly eligible for Medi-Cal and coverage through the health exchange,particularly since our demographic studies indicate that Dublin has a large number of newly eligible families. 19. Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. This project meets a number of the City of Dublin's Mission,Vision,Values and Strategies. I The project aligns with the Mission or Vision statement to"promote and support a high quality of life which ensures a safe and secur9 environment that fosters new opportunities."This project provides capacity to meet the needs of the increasing number of low-income and uninsured Dublin residents in need of dental services.Access to dental care directly impacts the quality of life of these families.Among Dublin's Values is an emphasis on"encouraging collaboration and communication with other communities on issues of mutual concern."This project is collaborative amongst the cities of the 7ri-Valley which seek to provide dental care capacity for the Tri-Valley's neediest residents. 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The provision of dental services is directly related to maintaining good health and to preventing the onset of other diseases.The critical lack of dental services for low-income and uninsured residents in the Tri-Valley is an ongoing cause of concern amongst local government,county health agencies, and area safety-net providers. This project is targeted to reduce healthcare costs by providing ongoing preventive dental services.It will also offer treatment for people with critical dental care needs that may prevent them from obtaining and sustaining jobs.Furthermore,provision of care will hugely reduce the amount of suffering borne by those who must travel out of area and wait long months for treatment. Axis anticipates being able to develop and deliver this service at a reasonable and sustainable cost.The pre-development capital project costs for this Phase I project are in-line with the overall ratios of the project scope. 21.If this application does not receive funding,or receives reduced funding,what will be the effect on the project? Axis is seeking funding for pre-construction of this capital project from all three Tri-Valley cities.Securing$25,000 in funding from the City of Dublin will greatly improve our ability to seek further public funding as it demonstrates the continued collaborative effort within the Tri-Valley to meet the health care needs of low-income residents.Without this grant funding,we will be less well-positioned in our efforts,and will also need to find other sources for the$25,000 we are seeking from the City of Dublin. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? r Yes r' No 23.If you answered yes to the preceding question please explain.Enter"N/A"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures)? � Yes � No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25. If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"N/A"if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms,plans for future relocation or expansion,etc.).Enter"N/A"if not applicable. N/A 27.If your ageney is requesting Capital funding,wlll this proJect require implementatfon of Davis-Bacon/Falr Labor Standards Act requirementsT r Not Applicable r Yes � No � Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin's Mission 8 Vision Statements: (you may choose more than one) � Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. � Balance history with progress,to sustain an enlightened,economically balanced and diverse community. r Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. r Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) r Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development r Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety r Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendly deveiopment, transit-oriented devetopment,green buitding and environmental responsiveness;promotes high quality design and architecturai standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City � Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication � Relating to Other Communities and Entities:by encouraging coliaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutal benefit 30.'*QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.**Are you are interested in applying for CDBG funds7 r Yes.If so,answer questions 31 through 43. r No.If no,check box here,and questions 31 through 43 will not be required.. � Don't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDBG ONLY-Explain your Limited English Proficiency/Language Access Plan(LEP/LAP).How does your agency outreach to limited Engilsh speaking residents to encourage access to services&housing?What access accommodations are used?Provide detail Please enter"N/A"if you are not interested in qualifying for CDBG funding. Axis's mission is to provide preventive and primary medicai care to ail members of the community,regardless of income,language,ethnicity or any other factor.Axis's services are designed to reach out to underserved and uninsured populations,including low-income racial and ethnic minority populations who othervvise lack access to health care.Our ability to effectively engage this population is evidenced by the increasing number of Dublin residents we serve.As the sole provider of inedical services for the region's low-income and uninsured population,Axis serves a patient population that is ethnically and linguistically diverse.Because half of our medical patients are Spanish-speaking,all front-line staff(call center,case managers,enrollment staff,receptionists and medical assistants)are required to be bilingual in English and Spanish.Axis's medical staff speaks a variety of languages,including Spanish,Hindi,Farsi,Mandarin,and Urdu and also has expert multicultural health care skills and specific knowledge relevant to serving low-income,culturally diverse communities.This expertise successfully transcends cultural and other barriers,creating a bridge to health care and a medical home for Dublin's underserved residents. 32.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Guiding Principle that relates to your project: (� Be culturally accessible,appropriate and inclusive (� Encourage community engagement and involvement � Promote energy and resource efficiency � Encourage networking and information sharing across service providers � Encourage process streamlining r Consolidate service delivery � Not Applicable.I am not interested in qualifying for CDBG funding. 33.CDBG ONLY•Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Goals that relates to your project: r A)Support and develop a continuum of housing resources that will increase access to low-income,seniors,disabled and homeless persons with emphasis on activities that: I— 'Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. (� *Preserve and increase affordable rentai housing opportunities for low and moderate income households. r *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. � 'Promote fair housing and reduce housing discrimination. � B)Improve community health and access to basic and specialty care including dental and optometry care,behavioral and mental health care services especially for low-income,u�insured and under-insured residents with emphasis on activities that: � •Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. � "Increase outreach and access for underserved populations including limited English speaking persons,youth,disabled,seniors and homeless persons. � C)Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. r D)Support and expand programs and opportunities that keep seniors engaged and involved in their community. r E)Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. � F)Not Appiicable.I am not interested in qualifying for CDBG funding. 34.CDBG ONLY-Identify AT LEAST ONE U.S.Department of HUD Strategic Goal that relates to your project: � Increase homeownership � Promote decent affordable housing r Strengthen communities � Ensure equal opportunity in housing I� Promote participation of grass-roots,faith-based,and other community-based organizations � Not Appiicable.I am not interested in qualifying for CDBG funding. . en . . epa men o o icy r ori y a re a es o your pro�ec : � Provide increased homeownership and rental opportunities for low and moderate-income persons,persons with disabilities,the elderly, minorities,and families with limited English proficiency. � Improving the quality of life for our Nation's communities � Encouraging accessible design features. r Participation of minority-serving institutions in HUD programs. � End chronic homelessness within ten years. ' � Removal of barriers to affordable housing. i � Not Applicable.I am not interested in qualifying for CDBG funding. 36.CDBG ONLY-Identify AT LEAST ONE Consolidated Plan objective that relates to your project: III' � Increase the availability of affordable rental housing for eutremely low income(30%),very low income(50%)and low income(80%) � households. � Preserve existing affordable rental housing and ownership for households at or below 80%of Area Median Income(AMI). r Assist low and moderate income first-time homebuyers. � Reduce housing discrimination. �' Maintain,improve and expand(as needed)the capacity of housing,shelter and services for homeless individuals and families including integrated healthcare,employment services and other supportive services. (� Maintain and expand activities designed to prevent those currently housed from becoming homeless. � Build on inter-jurisdictional cooperation to achieve housing and homeless needs. r Increase the availability of service-enriched housing for persons with special needs. � Not Applicable. I am not interested in qualifying for CDBG funding. 37.CDBG ONLY-Select ONE Objective that relates to your project(TIP:When selecting an objective ask yourself,"What is the purpose of the activity?What is the larger community need that I am seeking to address?"): r Creating a Suitable Living Environment � Providing Decent Affordable Housing (� Creating Economic Opportunities r Not Applicable.I am not interested in qualifying for CDBG funding. 38.CDBG ONIY-Select ONE Outcome that relates to your project(TIP:When selecting an outcome ask yourself,"What type of change or result am 1 seeking?"�: � Availability/Accessibility � Affordability r Sustainability � Not Applicable. I am not interested in qualifying for CDBG funding. 39.CDBG ONLY-Select ONE Specific Indicator that relates to your project: � Public facility or infrastructure:This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality,then this indicator will report the number of household units that no longer have access to a substandard service. � Public Service:This indicator shows the number of persons that have been assisted with new or improved access to a service.If the activity was used to meet a quality standard or to measurably improve quality,then this indicator will report the number of persons that no longer have access to a substandard service. r Ta�geted�evitalization:This indiCator shows a range of outcomes such as jobs created and retained,businesses assisted,low-and moderate- income persons and households served,slum/blight demolition,number of acres of brownfields remediated,etc.in a targeted area. (— Commercial facade treatments or business building rehabilitation:This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. � Brownfields remediated:This indicator shows the number of acres of brownfields that were remediated. � Rental units constructed:This indicator shows the number of affordable rental units created,as well as the number of years of affordability, number of units occupied by the elderly,and those units designated for chronically homeless persons and persons with HIV/AIDS. � Rental units rehabilitated:This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability,units for chronically homeless persons,elderly persons,and persons with HIV/AIDS. I� Homeownership units constructed or acquired with rehabilitation:This indicator shows the total number of homeownership units constructed, acquired,and/or acquired with rehabilitation per activity.This inGudes total number of affordable units,number of years of affordability,Energy Star qualified units,section 504 accessible units,and number of households previously living in subsidized housing.In addition,data will be collected on the number of units occupied by the elderly,number of units designated for persons with HIV/AIDS,and number of units for the chronically homeless. 1— Owner occupied units rehabilitated:This indicator shows the total number of owner occupied units rehabilitated,including the number of these units occupied by the elderly,number of units designated for persons with HIV/AIDS,and number of units for the chronically homeless. I� Direct financial assistance to homebuyers:This indicator shows the number of homebuyers receiving direct financial assistance,housing counseling,and down payment assistance/closing costs. r Tenant Based Rental Assistance(TBRA):This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance(less than 12 months)and the number of homeless and chronicaily homeless households assisted. I— Homeless shelters:This indicator shows the number of homeless persons given overnight shelter. � Emergency housing:This indicator shows the number of beds created in an overnight shelter or other emergency housing. J� Homeless prevention:This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. r Jobs created:Of the total number of jobs created,this indicator shows the number of jobs that have employee-sponsored health care,the types ofjobs created(using Economic Development Administration(EDA)classifications)and the number of persons unemployed before taking the job. r Jobs retained:Of the total number of jobs retained,this indicator shows the number of jobs retained,the number of jobs with employer- sponsored health care benefits,and the types of jobs retained(using EDA classifications) r Business assistance:This indicator shows the total number of businesses assisted.Specifically,it shows the number of new businesses, existing businesses,and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. � Businesses providing goods or services:This indicator shows whether an assisted business provides goods or services to meet the needs of , the service area,neighborhood,or community,as determined by the grantee. r Not Applicable. I am not interested in qualifying for CDBG funding. 40.CDBG ONLY-Please choose a common indicator that your agency wiil use to track clients(select only ONE): r Persons � Households � Not Applicable.I am not interested in qualifying for CDBG funding. 41.CDBG ONLY-For the category you selected above,provide the total number of unduplicated Dublin clients(EITHER Persons OR Households)your agency anticipates serving through this project: 7000 42.CDBG ONLY-Based on the common indicator you selected above,please list the number of unduplicated Dublin clients your agency anticipates serving in each category."If none,please enter"0". _ _� 1960j Low Income(50%-80%AMI;please refer to the Income Limits chart at www.dublin.ca.gov/housing/) � ���� �� 5040�Extremely Low Income(<30%AMI;please refer to the Income Limits chart at www.dublin.ca.gov/housing� � �� �0 Disabled ,_..__._� _ 1120€Female Headed Households �� � � 490=Senior � � 1820'Youth 140 Homeless 'Not Applicable.I am not interested in qualifying for CDBG funding.(Type N/A) ;";;�:i<<�.���'TOTAL 43.CDBG ONLY•List the number of clients your agency anticipates serving in racelethnicity categories.The sum entered below must match the total clients entered in#42 above.Per HUD"Hispanic"is an ethnicity,not a race."If none,please enter"0" 2380 White 3150}White+HISPANIC 350'Black/African American _.__ �__ -°°0�Black/African American+HISPANIC � 840�Asian ���� _ � _0�Asian+HISPANIC , � ��70f American Indian/Alaskan Native � ����� -�-�0�American Indian/Alaskan NaUve+HISPANIC ��� �� 0?Native Hawaiian/Other Pacific Islander __.. .,,__.,. 0 Native Hawaiian/Other Pacific Islander+HISPANIC 0'i American Indian/Alaskan Native and White 0'American Indian!Alaskan Native and White+HISPANIC 0�Asian and 1Nhite 0 Asian and White+HISPANIC 0' Black/African American and White 0 Black/African American and White+HISPANIC 0'American Indian/Alaskan Native and Black/African American 0!American Indian/Alaskan Native and Black/African American+HISPANIC 210:Multi Racial+HISPANIC OR other Multi Racial _ „ _ ��Not Appiicable.I am not interested in qualifying for CDBG funding.(Type N/A) � � 7,Ot34.Ci�:TOTAL 44.If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY �' #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. I� #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. r #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. � #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. � #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. � #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. r If you have more than 6 applications per organization,agency,district or entity,check here. 45. Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program�. Axis continually seeks funding from private foundations and donations from individuals to cover operational costs that are not covered by reimbursements from public health insurance,such as Medi-Cal,Medicare and HealthPac. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-010832 Budget Funding Sources/Revenues Budget Amount Amount Committed City of Livermroe $125,000.00 $0.00 _ . City of Pleasanton $100,000.00 $0:00 City of Dublin $25,000.00 $0.00 Total $250,000.00 $0.00 Funding Uses/Expenses Budget Amount Amount Committed Design $25,000.00 $0.00 Aquisition $140,000.00 $0.00 Other Soft Costs $85,000.00 $0.00 Total $250,000.00 $0.00 Budget Narrative ' During Phase I of pre-construction for this capital project the costs are as follows: $25,000 Architectural for site assessment during site selection and pre-design for programmatic use of space $140,000 Acquisition provides initial funds(down payment)for acquiring$1-2 million site $20,000 Demographic Assessment to determine utilization and required space $20,000 Business Plan Analysis to determine revenues and costs for operations $20,000 Contractor Pre-Construction Services $20,000 Due Diligence and other items required for site acquisition(ALTA,Phase 1 Environmental,etc.) $5,000 Legal fees Documents Documents Requested* Required? Attached Documents` Program Expense Budget for All.Grant Requests � Proaram Expense Bud�et downioad tempiate Financial Information Form for ALl Grant Requests (� Financiai Informatior,Farm download temqiate List of Board of Directors(or governing body)with contact r Board of Directors list information Current Annual Budget for the Entire Agency r Apencv�udqet Copy of most recently submitted IRS 990 form or Tax Retum � Tax retum (include complete form) Board of Oirector's(or goveming body's)designation of I� Desic�nation af authorizinq official ' authorized official Board of Director's(or goveming body's)authorization to r Board Resoiutian for Dublin Grant request funding(may be same document as one above) Proof of insurance carried,including bonding,liability and/or r Insurance certificate workers'compensation REQUIRED FOR CDBG ONLY-If requesting Capital Funding, I� please upload your Capital expenditure budget(your own format is acceptable) REQUIRED FOR CDBG ONLY-PERSONNEL POLICIES INCLUDING IW AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS r AND COPY OF LAST AUDIT HIGHLIGHTING"FINDINGS" SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION � AND BYLAWS. REQUIRED FOR CDBG ONLY-CONFUCT OF INTEREST r STATEMENT QF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART � STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. � No�i-arafit determination letter All organizations MUST have approved non-profit status from the State of California and Federal Tax identification Number at time of application.Non-compliant applicants will be disqualified. REQUIRED FOR CQBG ONLY-AGENCY'S LIMITED ENGUSH (— PROFICIENCY LANGUAGE ACCESS PLAN(LEP/LAPj.Must include outreach to limited English speaking residents to encourage accessto serviees&housing.lnctude what access accommodations are used. - REQUIRED FOR CDBG-LEVERAGING REPORT-this is due wifh � the 2nd quaRer report no late�than January 45th Certified Audit and/or Certified Financial Statements (� Axis Audited Financials 06-15 *ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:47547 ��� Become a tan of ZacmC>r�nts"'on Facebook �� Problemsp Contacl us at F)ueslions�a�Znon,Grants.cuin �2002-2016 GrantAnalyst.com.All rights resened. -. "ZoomGrants"and the ZoomGrants logo are tredemarks of GrentAnalyst.com,ILC. _,,_�o!�[i:-;.;s.: II i ,II Email This Preview Save as PDF Print Close Window A�♦ Power�d bv Zoom�rar�fsT"' City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadline CALICO Center Dublin Child Abuse Intervention $ 10,000 Requested � CAUCO Center Submitted: 12/11/2015 10:13:45 AM(Pacific) ( 524 Estudillo Ave �� � Telephone(510)895-0702 �� � San Leandro,CA 94577 Fax (510)895-0706 Project Contact United States Web www.calicocenter.org Holly Fleming calicocenter;ayahoo.com Interim Executive Director Tel:510-895-0702 Erin Harper calicacenter,�a vahoo.com Additional Contacts none entered Application Questions ISome answers will not be presented because they are not part of the selected group of questions based on the answer to#30. � 1. Please describe your organization category(select one of the following�: � Private Non-Profit ' � Public Agency r Other: 2. Please describe your agency's mission(no more than 3 sentences or 250 characters�. CALICO achieves justice and healing for abused children.Its mission is to provide a supportive environment to interview children and facilitate a collaborative response to child abuse in which the needs of children take precedence. 3. For what type of Dublin Grant is your agency applying? r Capital Project � Public Service Program or Project 4. Is this a"new"service,program,project or activity?"New"is identified as not yet started,implemented or in operation. � Yes r No 5. Please indicate below if this application is a request for one-time funding and/or"seed"funding. � One-time funding r Seed funding r One-time and Seed funding � Operational funding � None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other CitylCounty funding received within the last three years(jurisdiction,year,amount,purpose,etc.).Enter"N/A"if you HAVE received Dublin Funds. N/A 7. Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skilis and experience,etc.�. CALICO is govemed by a 14-member Board of Directors that oversees finances,operations and fundraising and a 30-member advisory committee (comprised of representatives from each partner agency agency)which creates and monitors program activities.With an annual operating budget of over$750,000(for county-level services)CALICO supports two interviewing sites,seven full-time staff and three part-time staff(including staff for interviewing,family support services,training,team coordination,fund developmenUcommunications and finance/administration).The District Attorney's Office provides significant support by assigning a fuil-time Executive Director(ED),who reports to the CALICO Board of Directors,and a District Attorney Liaison to observe interviews and ensure the integrity of investigations. Since 1997,CALICO has conducted interviews with over 10,000 children and has successfuily facilitated nearly 10,000 multi-disciplinary child-abuse investigations,including over 150 involving Dublin victims.CALICO's dedicated team of five Child Interview Specialists(CIS)possesses over 60 years of experience at CALICO and have each conducted hundreds(and in some cases thousands)of forensic interviews.CALICO's two Family Resource Specialists(FRS)are masters-levei mental-health clinicians with specialized training in trauma-focused interventions for abuse victims.Two CIS and one FRS are bilingual Latinas who provide services in Spanish as needed. CALICO is currently transitioning to a new ED.She is anticipated to begin in mid-January.An Interim ED will oversee CALICO until the new ED begins. : The Interim ED has been empioyed with CALICO for six years,first as a CIS and currently as the Multi-Disciplinary Team and State Coordinator.She is well prepared to oversee the project,ensuring it is compieted on time,within budget and achieves the proposed goals.She will also oversee data collection and ensure that reports are submitted as required 8. Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementation process to describe your project. CALICO proposes to conduct 16 forensic interviews with 12-16 Dublin children who have been sexually or physically abused,provide support services to 10 caregivers of the Dublin victims and facilitate a multi-disciplinary response to the allegations. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) 22 10.Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? � Behavioral Health(mental health and substance abuse) � Affordable Housing r Health Care(including dental) r Workforce Development � Homelessness r Transportation Services and Access � Domestic Violence and Child Abuse r Disabilities r Food and Nutrition I� Senior Services � Youth Services � Child Care,Early Childhood Development and Education (� Changing Demographics and Growing Diversity (� Financial Assistance r None of the above ' 11. Explain how this project will be implemented,administered,and operated. CALICO proposes to conduct 16 forensic interviews with 12-16 children from Dublin and provide support services to 10 caregivers.Children will be referred to CALICO primarily by Dublin Police Services(DPS)with some referrals from Alameda County Children and Family Services(CFS). Forensic interviews are the cornerstone of a child-abuse investigation.A child's statement may be the only evidence to determine if a crime occurred or if the child is safe at home.For many children,their CALICO interview is the first time they fully describe what happened and,if handled appropnately,an essential first step toward healing.At CALICO,children are welcomed into a comfortable setting.The interviewing rooms are painted in warm colors and the family waiting areas are equipped with art supplies,toys,videos and books,in multiple languages.Skilled interviewers meet individually with each child,asking non-leading,developmentally appropriate questions to elicit the child's account of the abuse.The interview is recorded,and the investigating team(a DPS detective,CFS worker and prosecutor)observes from another room,providing supplemental questions through an earpiece.Each child leaves with a stuffed animal,book and blanket donated by community paRners. CALICO believes that to support an abused child,we must ensure s/he has the full and appropriate support of his/her caregiver.While children are interviewed,a Family Resource Specialist(FRS)meets with the caregiver,conducting a crisis assessment to leam more about the child,the traumatic experience,and the living environment.The FRS follows up with the family at least twice by phone to provide further support,and additional drop-in workshops are offered monthly in English and Spanish.Through these services,CALICO is in a unique position to intervene at a pivotal moment,which may be the only opportunity to put that child on a path to healthy adulthood. 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?). , City of Dublin Community Grant funding wouid help offset the cost of our Child Interview Specialist(CIS)team.CALICO's services are crisis-oriented, meaning that an interview may be scheduled with little notice to accommodate the urgent needs of a paRicular case.In most situations,fewer than 24 hours elapse from the time we get the initial referral from the Dublin detective or child welfare worker to seeing the child at our center. In some cases, that time may shrink to under one hour.For that reason,we have a minimum of iwo CIS scheduled to work during normal business hours(we maintain a minimum staff of two because CALICO works simultaneously out of two locations,San Leandro and Oakland).In addition,all CIS are available by pager evenings,nights and weekends for situations that require immediate attention.Please note that our family support staff are also available,but funding for those positions will be covered by other sources. The estimated cost to ensure that CALICO staff are available,when needed,to respond to the referrals of Dublin children and families is approximately $20,000 in FY16-17.Of that,the most significant expenses are staff salaries and benefits.City of Dublin funds would specifically offset a portion of staff salaries and benefits of the CIS team,which includes five part-time interviewers(including two bilingual Latinas who serve bilingual and mono- linguai Spanish-speaking families).When interviewers are not conducting interviews,they are performing other related tasks,including client intakes, data ent and uali control observin and rovidin feedback to other interviewers artici atin in trainin s lannin and artici atin in monthl ' case review meetings and testiTying in court,all necessary for the successful completion of our forensic interviewing services. ' 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome�s)? GOAL 1:Minimize trauma to abused children 1 a.At least 75%of chiidren interviewed will feel positive/neutral about their experience 1 b.At least 75%of caregivers will indicate a favorable response to their child's treatment GOAL 2:Improve coordination of child-abuse case investigations among multiple agencies 2a.A multi-disciplinary team(comprised of a prosecutor,Dublin detective,and/or child welfare worker)will observe at least 75%of interviews 2b.At least 70%of children eligible for a forensic medical exam will receive one 2c.Monthly case Review meetings will be held at least 10 times per year to review select cases in depth from staR to finish GOAL 3:Improve the mental health of caregivers. 3a.An FRS will conduct an on-site crisis assessment with at least 75°/a of families 3b.An FRS will initiate a California Victim Compensation Program(CaIVCP)application(or ensure one was already completed)on behalf of at least 50%of caregivers(to access funds for mental health services for the caregiver) 3c.An FRS will contact at least 75%of caregivers by phone after they leave CALICO 3d. By a second follow-up call,at least 35%of caregivers will be enrolled in counseling Goal 4:Improve the mental health of victims 4a.An FRS will provide at least 75%of caregivers with psycho-education on the effects of trauma on children 4b.An FRS will assist at least 75%of families with a CaIVCP application on behalf of the child to provide funds for counseling 4c.At least 50°/a of caregivers contacted will report their child is enroiled in counseling CALICO tracks data for each child,family and case,including victim and offender demographics;data about the nature of the abuse,interview and multi-disciplinary team response;and extensive family support data,including caregiver demographics,services provided on site,referrals provided, outcome of follow-up calls and participation in counseling services. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled,low-income,etc. ' The target population for this grant is Dublin children,ages 2-17,as well as adults with developmental disabilities who are victims of sexual abuse, ' physical abuse or neglect,exploited as prostitutes and/or are exposed to violence in their homes and communities. Over the past 5 years,CALICO has conducted 54 interviews with abused Dublin children and 1 interview with an adult with developmental disabilities. Most victims were girls(61%)and most had been sexually abused(78%)and/or physically hurt(16%).Most victims were young:over half were ', twelve years old or younger(63°/a).Most identified as white(43%)or Latino(25%).They were primarily referred to CALICO by Dublin Police Services ' or Children and Family Services. In 2014,we conducted 15 forensic interviews of Dublin children,more than any year prior.In 2015,we are well on our way to serving a similar group and number of children.Children benefit from CALICO services because the services are child-focused,friendly and facilitated by staff who are specially trained to talk to children of ali ages and developmental levels.In that way,child who come to CALICO are not caused further trauma by participating in a child-abuse investigation. This project also targets the caregivers of those children,which typically inGudes a mother,step-mother,foster mother or other related caretaker. Caregivers of victims experience a range of emotions(sadness,anger,confusion,and shame)and are typically unaware of how their reactions affect their child's long-term healing.CALICO services benefit caregivers by engaging a team of professionals to support them through every step in the process,including attending to their medical,mental health and legal needs;providing crisis intervention,as needed;and explaining the investigative process and what to expect moving forvvard in terms of their case,their child's response to trauma,and their own response. ' 15. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the client/customer population served)? CALICO is sensitive to the unique cultural and linguistic needs of each family served.At intake,we collect information about the race/ethnicity of the child,the child's primary language,and the caregiver's primary language.Three CALICO staff are bilingual/bicultural Latinas who accommodate Spanish-speaking families as needed.Over the last 5ve years,one-fourth of the forensic interviews we conducted with Dublin victims were with children who identified as Latino;for several Dublin families,services were provided in Spanish.If families speak a language other than English or Spanish(which is uncommon with regard to Dublin families),we work with the referring agency to arrange for a court-certified interpreter and may use the services of the county's language line,called Lionbridge.In addition,key documents are translated into Spanish,and we can download select materials in other languages. CALICO is also sensitive to providing high-quality,appropriate services for victims who are deaf.In 2014,CALICO conducted 2 interviews with the help of an American Sign Language(ASL)Interpreter.We also trained our staff and partners about the deaf community,ASL and best practices for ' assisting victims and families in that community.For example,in August 2014 CALICO arranged for a sign language interpreter to attend our Program Advisory Committee meeting to educate our partners about ASL,ways to communicate with both the child and the parent(s),the different types of interpreters and the qualifications of each kind of interpreter. 16.Explain how your agency will outreach to low-income,limited English speakers,and/or disabled persons.How will each of these groups access the project for which your agency is requesting funding? For this project,CALICO will accept referrais primarily from DPS officers and child welfare workers.Families cannot directly refer a child to CALICO, but we will help them make an official report if they contact us instead of the police or child-abuse hotline.Given the nature of our work,CALICO has little control over which children get brought to the center.Yet through training and community outreach,we are able to help patrol officers,detectives, child welfare workers,and youth-serving professionals understand their respective roles in reporting and investigating child abuse.By doing so,we hope to increase the number of victims identified and improve the appropriateness of each agency's response.In addition,we provide information about which children are more at risk(including individuals with disabilities,limited English speakers and other populations of children that are more easily isolated and have limited access to services)and how professionals can be more sensitive and aware in their interactions with these groups. For adult victims,CALICO receives referrals from Adult Protective Services(APS).In October 2015,CALICO provided a training to APS caseworkers about referring victimized adults with special needs to CALICO;appropriate ways to illicit information from this vulnerable population;and best practices for an effective multi-disciplinary team response. ' 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service ' integration. CALICO facilitates a unique collaborative partnership among 29 agencies that includes the following:Dublin Police Services(and eighteen other law enforcement agencies),six county agencies that respond to Dublin children(Behavioral Health Care Services,County Counsel,District Attorney's Office,Probation,Social Services,and the Family Justice Center),two local hospitals(Children's and Highland)that provide forensic medical exams for Dublin victims,and the state child-care licensing organization.CALICO signs an annual operating agreement with Chief Houghtelling and other county leaders,Sgt.Rafael Alvarez is the DPS representative on CALICO's Program Advisory Committee,(which meets monthly to guide policy and programming),and DPS detectives participate in monthly case-review meetings. Collaboration,for CALICO,extends well beyond facilitating joint child-abuse investigations between Dublin Police Services and the child-welfare system.CALICO has strategically crafted joint staffing positions to further advance its mission and better aid children.For example,CALICO is one of few non-profits that co-locates with a government partner—a prosecutor is assigned full-time to CALICO who observes interviews and advises on ' irnestigations.In addition,CAUCO has built a unique collaborative partnership with Children's Hospital of Oakland.While the recency of the abuse determines whether a child is first interviewed at CALICO or treated at the hospital,to a family in crisis they make little distinction.Through two shared staff positions,CALICO and Children's Hospital provide parallel services to families that are mutually reinforced regardless of which agency the family first visits. 18. Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. CALICO has strong working relationships with other community-based organizations based in the Tri-Valley area that provide legal,medical and therapeutic services to Dublin children and families that come through CALICO.CALICO's Family Resource Specialists routinely refer families to the following agencies:Tri-Valley Haven(families are referred for restraining orders for domestic violence,legal custody issues,sexual assault and , domestic violence counseling services,and for basic needs such as food,shelter and clothing);Axis Clinic(for counseling services);and individual mental-health clinicians who are approved to accept California Victim Compensation Program reimbursement. As noted previously,CALICO does not do direct marketing to families;all referrals must come via law enforcement officers or child welfare workers. However,we host quarterly trainings for new investigators so that all detectives and child welfare workers(as well as other professionals such as ' district attorneys,victim advocates and medical personnel)are aware of CALICO services,the Alameda County protocol for how we work together across agencies,and the process for referring families.Approximately 100 professionals attend those annually. , CALICO also offers a child sexual abuse prevention workshop geared toward parents of children in grades K-3 about situations that put children at risk of sexual abuse and about behaviors of adults and older youth that may suggest that the individual intends to sexually offend against a child. ' Trainings are scheduled throughout the county upon request,and we have reached hundreds of parents through these outreach efforts. 19. Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. CALICO's services closely match the City of Dublin's mission,vision,values and strategies.It terms of the City's mission/vision,CALICO"supports a high quality of life and ensures a safe and secure environment."When a situation invoiving suspected abuse of a Dublin child is referred to CALICO, we are able to quickly mobilize a multi-agency team to ensure the threat of violence is removed,the child is no longer in imminent danger,and the child and family can begin the process of healing.With information gleaned at CALICO,our partners in Dubiin Police Services and the Alameda County District Attorney's Office can hold offenders accountable thus removing the risk to other Dublin children to whom the abuser might otherwise have access.Finally,by connecting abused children with therapeutic support,we help a child onto a path of healthy adulthood. In terms of the City's values,through our close partnership with Dublin Police Services,we"ensure a safe community by providing high quality police service."Dublin detectives come to CALICO because our services works—it yieids the best information to determine if a crime has been committed and if a child is safe at home—and because CALICO provides services they cannot get elsewhere or replicate on their own.Each of CALICO's five highly skilled Child Interview Specialists interviews over 100 children annually.For most investigators,it would take 5-10 years of on-the-job experience to acquire that level of expertise.By making its services invaluable to its partners,CALICO improves the quality of police service available to the Dublin community,and creates life-changing outcomes for an abused child. In addition,CALICO's deep commitment to collaboration aiso matches the city's value of"encouraging public and private partnerships of mutual benefit." 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. ' CALICO services are designed to be cost-effective as they eliminate duplication while raising quality.Prior to CALICO,Dublin detectives and child welfare workers would conduct independent,overlapping investigations,which raised the overall costs.In addition,high-quality investigations require ' professionals who are adequately trained.Given the dozens of patrol officers,detectives and child welfare workers who could be assigned to investigate a child-abuse allegations in Dublin,there are considerable costs to ensure each professional understands the dynamics of child abuse, how to interact and develop rapport with children(particularly children in crisis),and how to minimize bias in how questions are posed to a child.With CALICO,that expertise rests in a skilled staff team who has participated in hundreds(in some cases,thousands)of child-abuse investigations. A national cost-benefit analysis found that investigations in counties that followed the child advocacy center(CAC)model implemented at CALICO proved to be 36%less expensive than the traditional model.The benefits didn't end with cost.In comparison to counties that did not use a CAC model, the CAC counties show significantly more evidence of coordinated investigations;authorize more forensic medical examinations(which can provide important evidence for the investigation and provide the child with a heightened sense of well-being to learn that their body is in good health);provide referrals three times as often for mental health services;and result in increased parent and caregiver satisfaction with the investigation. ' If CALICO did not exist,child abuse allegations would still need to be investigated and that responsibility would fully retum to law enforcement officers and child welfare workers.In that case,the City of Dublin would incur considerably more costs by taking on those tasks themselves and would get less value for that investment than they do by engaging CALICO services. ', 21.If this application does not receive funding,or receives reduced funding,what will be the effect on the project7 aims o provi e services o a c i ren re erre o us rom u in e ec rves an c i we are wor ers. ypica y,we sc e u e in erviews within 24 hours of a referral and accommodate a quicker response when needed(CALICO currently offers 24-hour service by pager).We have never refused services to a child due to insufficient funds,and we aim to ensure we have the infrastructure and resources to continue to interview 100%of children referred.Funds from the City of Dublin would contribute significantly to making that possible.Without these funds,we will need to look elsewhere to fill the gap,possibly to private foundations(which are often highly competitive and restrictive in terms of how funds can be expended)or appeals to individual donors.If we were unable to secure funds,we would need to reduce expenditures,starting with"non-essential" expenditures(e.g.,trainings,equipment upgrades,annual increases,etc.).We would then consider scaling back personnel so that each staff member would be required to take on a larger caseload.Given the emotionally difficult nature of our work,there are concerns such an option could result in significant secondary trauma and burnout.Finally,if left with no other options,we would be forced to reduce services to a child or family(meaning we may have to triage cases and not offer services for every referral). 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 1� Yes � No 23.If you answered yes to the preceding question please explain.Enter"N/A"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures)1 r Yes r No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25.If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"N/A"if not applicable. N/A 26.If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms,plans for future relocation or expansion,etc.).Enter"N/A"if not applicable. N/A 27. If your agency is requesting Capital funding,will this project require implementation of Davis-BaconlFair Labor Standards Act requirements? � Not Applicable � Yes � No � Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identity AT LEAST ONE of the City of Dublin's Mission&Vision Statements:�you may choose more than one) r Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new oppoRunities. � Balance history with progress,to sustain an enlightened,economically balanced and diverse community. � Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. (� Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) r Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development � Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety � Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architecturai standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City r Goveming:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication � Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutal benefit 30.**QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.•*Are you are interested in applying for CDBG funds? � Yes. If so,answer questions 31 through 43. (Y No.If no,check box here,and questions 31 through 43 will not be required.. r pon't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDBG ONLY-Explain your Limited English Proficiency/Language Access Plan(LEP/LAP�.How does your agency outreach to limited English speaking residents to encourage access to services&housing?What access accommodations are used?Provide detail Please enter"N/A"if you are not interested in qualifying for CDBG funding. ma es every e o o provi e services in e pnmary anguage o e c i an is er caregiver s . en a c i is re erre ,we as e referring party what the primary language is of the child(ren)being interviewed and of his/her caregiver(s).If the child or family's primary language is Spanish(or if the family is bilingual in English and Spanish),then we assign a bilingual(English/Spanish)Child Interview Specialist and Family Resource , Specialist to provide services.If the child's primary language is a language other than English or Spanish(including sign language),then the referring party(the detective or child welfare worker)arranges to have a court-certified interpreter participate in the interview.If the caregiver(s)'primary , language is a language other than English or Spanish,then CALICO arranges for interpreting services or uses the county's language line. : CALICO's Family Resource Specialists are also sensitive to refer families for community-based services that are language-appropriate.We have strong relationships with many service providers that offer services in languages other than English and have informationai brochures in languages other than Spanish and English. 32.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Guiding Principle that relates to your proJect: �" Be culturally accessible,appropriate and inclusive � Encourage community engagement and involvement 1— Promote energy and resource e�ciency � Encourage networking and information sharing across service providers � Encourage process streamlining � Consolidate service delivery � Not Applicable.i am not interested in qualifying for CDBG funding. 33.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Goals that relates to your project: r A)Support and develop a continuum of housing resources that will increase access to low-income,seniors,disabled and homeless persons with emphasis on activities that: � 'Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent ` housing. r � � 'Preserve and increase affordable rental housing opportunities for low and moderate income households. � � *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. � (� *Promote fair housing and reduce housing discrimination. I � B)improve community health and access to basic and specialty care including dental and optometry care,behavioral and mental health care services especially for low-income,uninsured and under-insured residents with emphasis on activities that: I� 'Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. (� 'Increase outreach and access for underserved populations including limited English speaking persons,youth,disabled,seniors and homeless persons. , � C)Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. r D)Support and expand programs and opportunities that keep seniors engaged and involved in their community. r E)Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. r F)Not Applicable.I am not interested in qualifying for CDBG funding. 34.CDBG ONLY-Identify AT LEAST ONE U.S.Department of HUD Strategic Goal that relates to your project: r Increase homeownership , � Promote decent affordable housing � Strengthen communities r Ensure equal opportunity in housing � Promote participation of grass-roots,faith-based,and other community-based organizations r Not Applicabie. I am not interested in qualiTying for CDBG funding. 35.CDBG ONLY-Identify AT LEAST ONE U.S.Department of HUD Policy Priority that relates to your project: � Provide increased homeownership and rental opportunities for low and moderate-income persons,persons with disabilities,the elderly, minorities,and families with limited English proficiency. � Improving the quality of Iife for our Nation's communities r Encouraging accessible design features. r Participation of minority-serving institutions in HUD programs. I� End chronic homelessness within ten years. � Removai of barriers to affordable housing. 1� Not Applicable. I am not interested in qualifying for CDBG funding. 36.CDBG ONLY•Identify AT IEAST ONE Consolidated Plan objective that relates to your project: . (� Increase the availability of affordable rental housing for extremely low income(30%),very low income(50%)and low income(80%) households. J— Preserve existing affordable rental housing and ownership for households at or below 80%of Area Median Income(AMI). � Assist low and moderate income first-time homebuyers. Reduce housing discrimination. ' � Maintain,improve and expand(as needed)the capacity of housing,shelter and services for homeless individuals and families including integrated healthcare,employment services and other supportive services. (� Maintain and expand activities designed to prevent those currently housed from becoming homeless. r Build on inter-jurisdictional cooperation to achieve housing and homeless needs. � Increase the availability of service-enriched housing for persons with special needs. r Not Applicable.I am not interested in qualifying for CDBG funding. 37.CDBG ONLY-Select ONE Objective that relates to your project(TIP:When selecting an objective ask yourself,"What is the purpose of the activity?What is the larger community need that I am seeking to address?"): � Creating a Suitable l.iving Environment � Providing Decent Affordable Housing � Creating Economic Opportunities � Not Applicable. I am not interested in qualifying for CDBG funding. 38.CDBG ONLY-Select ONE Outcome that relates to your project(TIP:When selecting an outcome ask yourself,"What type of change or result am I seeking?"�: � Availability/Accessibility � Affordability � Sustainability � Not Applicable.I am not interested in qualifying for CDBG funding. 39.CDBG ONLY-Select ONE Specific Indicator that relates to your project: � Public facility or infrastructure:This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure.If the activity was used to meet a quality standard or to measurably improve quality,then this indicator will report the number of household units that no longer have access to a substandard service. � Public Service:This indicator shows the number of persons that have been assisted with new or improved access to a service.If the activity was used to meet a quality standard or to measurably improve quality,then this indicator will report the number of persons that no longer have access to a substandard service. � Targeted revitalization:This indicator shows a range of outcomes such as jobs created and retained,businesses assisted,low-and moderate- income persons and househoids served,slum/blight demolition,number of acres of brownfields remediated,etc.in a targeted area. � Commercial facade treatments or business building rehabilitation:This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. � Brownfields remediated:This indicator shows the number of acres of brownfields that were remediated. ' � Rental units constructed:This indicator shows the number of affordable rental units created,as well as the number of years of affordability, number of units occupied by the elderly,and those units designated for chronically homeless persons and persons with HIV/AIDS. � Rental units rehabilitated:This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability,units for chronically homeless persons,elderly persons,and persons with HIV/AIDS. r Homeownership units constructed or acquired with rehabilitation:This indicator shows the total number of homeownership units constructed, acquired,and/or acquired with rehabilitation per activity.This includes total number of affordable units,number of years of affordability,Energy ' Star qualified units,section 504 accessible units,and number of households previously living in subsidized housing.In addition,data will be collected on the number of units occupied by the elderly,number of units designated for persons with HIVIAIDS,and number of units for the chronically homeless. r Owner occupied units rehabilitated:This indicator shows the total number of owner occupied units rehabilitated,inGuding the number of these units occupied by the elderly,number of units designated for persons with HIV/AIDS,and number of units for the chronically homeless. I— Direct financial assistance to homebuyers:This indicator shows the number of homebuyers receiving direct financial assistance,housing . counseling,and down payment assistance/closing costs. r Tenant Based Rental Assistance(TBRA):This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance(less than 12 months)and the number of homeless and chronically homeless households assisted. r Homeless shelters:This indicator shows the number of homeless persons given overnight shelter. � Emergency housing:This indicator shows the number of beds created in an ovemight shelter or other emergency housing. � Homeless prevention:This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. r Jobs created:Of the total number of jobs created,this indicator shows the number of jobs that have employee-sponsored health care,the types ofjobs created(using Economic Development Administration(EDA)classifications)and the number of persons unemployed before taking ' the job. � Jobs retained:Of the total number of jobs retained,this indicator shows the number ofjobs retained,the number of jobs with employer- sponsored health care benefits,and the types of jobs retained(using EDA classifications) 1— Business assistance:This indicator shows the total number of businesses assisted.Specifically,it shows the number of new businesses, existing businesses,and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. r Businesses providing goods or services:This indicator shows whether an assisted business provides goods or services to meet the needs of the service area,neighborhood,or community,as determined by the grantee. r Not Applicable. I am not interested in qualifying for CDBG funding. 40.CDBG ONLY-Please choose a common indicator that our a enc will use to track clients select onl ONE : r Persons r Households r Not Applicable.I am not interested in qualifying for CDBG funding. 41.CDBG ONLY-For the category you selected above,provide the total number of unduplicated Dublin clients(EITHER Persons OR Households)your agency anticipates serving through this project: 22 42.CDBG ONLY-Based on the common indicator you selected above, please list the number of unduplicated Dublin clients your agency anticipates serving in each category."If none,please enter"0". _ 16 Low Income(50%-80%AMI;please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 6'Extremely Low Income(<30%AMI;please refer to the income Limits chart at www.dublin.ca.gov/housing/) 1'Disabled 9' Female Headed Households - ._.__ � 0�Senior �:;� .--- 12�Youth , _ _T 0'Homeless , � _ � ��Not Applicable.I am not interested in qualifying for CDBG funding.(Type N/A) � � - ����44.00�TOTAL 43.CDBG ONLY-List the number of clients your agency anticipates serving in race/ethnicity categories.The sum entered below must match the total clients entered in#42 above.Per HUD"Hispanic"is an ethnicity,not a race."If none,please enter"0" ���� �� �8'�White � ( 6!White+HISPANIC k 2 Black/African American : __ . _ � 0' Black/African American+HISPANIC i 1'Asian i _ __ _ :, 0:Asian+HISPANIC 0'American Indian/Alaskan Native '; 0-American Indian/Alaskan Native+HISPANIC 0 Native Hawaiian/Other Pacific Islander � � �� 0:Native Hawaiian/Other Pacific Islander+HISPANIC � 0 American indian/Alaskan Native and White �0�'American Indian/Alaskan Native and White+HISPANIC �� � 0:Asian and White � � � � 0:Asian and White+HISPANIC �� � � 0�Black/African American and White � ..�_ ����; 0�Black/African American and White+HISPANIC � 0�.American Indian/Alaskan Native and Black/African American — -- ---� 0�American Indian/Alaskan Native and Black/African American+HISPANIC � � 5:Multi Racial+HISPANIC OR other Multi Racial � -_- - ....,, N/Ai Not Applicable.I am not interested in qualifying for CDBG funding.(Type N/A) --.,_ _.� ;?2.00;TOTAL 44.If your agency is submitting more than one application or the same agency has different programs within it,please RANK the ' priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY � #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. (� #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. r #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. 1� #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. 1- #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. � #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. I- If you have more than 6 applications per organization,agency,district or entity,check here. 45. Please describe actions your organization is taking to become financially self-sufficient(i.e,what steps are you taking to reduce dependency on the City's grant program). CALICO pieces together many small grants and donations(from govemment,private foundations,corporations,civic groups and individuals)to meet its operating expenses each year.Our board and staff continually look for ways to leverage new funds.Recently,the Fund Development Committee of the board of directors has created a corporate subcommittee that will focus on finding new opportunities for sponsorship from corporations and businesses looking to support nonprofits.Additionally,the Communications&Development Coordinator works to increase gifts from individual donors (which are important sources of unrestricted funds).She is leading several community fundraising strategies that will yield funds for FY16-17 that can be used to support Dublin families if other sources of funding are not secured.These strategies include participating in the Oakland Running Festival, hosting CALICO's annual One Child at a Time benefit in the early fall and conducting a direct-mail campaign. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-109881 Budget ___.____.._. ___.�_�_._ _._..��_____�-. ..�_. _�____ _.�__�.__ -- � Funding SourceslRevenues Budget Amount Amount Committed Request Trom City of Dublin $10,000.00 Dublin Police Services $4,000.00 Alameda County District Attomey Office(in-kind) $3,000.00 $3,000.00 First 5 Alameda County . $1,000.00 $1,000.00 Alameda County Social Services Agency _ $1,400.00 $1,400.00 Community Fundraising . $600.00 Total $20,000.00 $5,400.00 Funding USeslExpenses Budget Amount Amount Committed : Personnel Salary:Staff $11,705.00 $1,962.00 Personnel Benefits:Staff $2,610.00 $438.00 Personnel Salary&Benefits:ED(in-kind) $3,000.00 $3,000.00 Supplies $277.00 $0.00 Printing $30.00 $44.00 Postage $100.00 Communications RenUUtilities $371.00 ' Audit $220.00 Contracted Services $600.00 Other $1,043.00 $0.00 Total $20,000.00 S 5,400.00 Budget Narrative The request of$10,000 from the City of Dublin will support nearly one hour per week at the average pay of approximately$33 per hour of five members of the Child Interview Specialist team to ensure there is full-time coverage to support Dublin children.Average pay is used to calculate the request because,due to the crisis-oriented nature of our work,CALICO does not know ahead of time which Child Interview Specialist will conduct each interview. Child Interview Specialist,$33 x 50 hours+22.3%benefits=$2,000 x 5 CALICO's current benefit rate of 22.3%for employees includes payroll tax,workers comp,FICA,health,vision,dental,and 403b matching. The$1,055 in other costs include funds for miscellaneous expenses,(e.g.,insurance,licenses,fees,parking,mileage)and training for CALICO staff,Dublin detectives and other professionals serving Dublin families. The funding secured to date for this project is$5,400 in in-kind support from the District Attorney's office that covers a portion of the salary and benefits of the Executive Director related to this project.Also,CALICO is expecting year 3 funding of a three-year contract from Alameda County Social Services Agency,but a contract for FY 16-17 is not yet executed.CALICO has also secured funding from Alameda County First 5.The remaining funds are expected to be received from Dublin Police Services(a request was made in December 2015)and community fundraising(including fundraising events such as the One Child at a Benefit and the CALICO charity team in the Oakland Running Festival). CALICO provides forensic interviews,family support services,multi-disciplinary team coordination,professional trainings and prevention trainings to all of Alameda County.Services to Dublin children and family account for approximately 22%of CALICO's work countywide. Documents Documents Requested' Required? Attached Documents' Program Expense Budget for ALL Grant Requests � CALICO Proaram Expense Form downioad temqlate - Financial tnformation Form for ALL Grant Requests J CALICO Fiiianciai information Form downioad tempiate List of Board of Directors(or governing body)with contact � �ist of Bnard of Directars information CuRent Annual Budget for the Entire Agency � CALICO Ooeratirq E3udaet Copy of most recently submitted IRS 990 form or Tax Return � CALfCQ 990 (include complete form) Board of Director's(or governing body's)designation of � Board of Directors's Fundinc�Resolutior� authorized officiai Board of Director's(or governing body's)authorization to 1�' BQD Authorization request funding(may be same document as one above) Proof of insurance carried,including bonding,liability and/or l� insurance Gertificate workers'compensation REQUIRED FOR CDBG ONLY-If requesting Capital Funding, r please upload your Capital expenditure budget(your own format is acceptable) REQUIRED FOR CDBG ONLY'-PERSONNEL POUGES INCLUDING � Fersonnel Policies AFFIRMATIVE RCTION PLAN AND GRIEIVANCE PROCEQURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS � CALICO Audit AND COPY OF LAST AUDfT HIGHLIGHTING"FINDINGS" SECTION REQUIRED FOR CDBG ONI.Y-ARTICLES OF INCORPORATION � ��w� AND BYLAWS. Articles af Incarporation-driainai Articies of incorporation-Amended REQUIRED FOR CDBG ONLY-CANFUCT OF INTEREST r Conflict of interest Folicv STATEMENT QF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART � CALICO OrQanizatio�Chart STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. � Federai Determinatio;�Lett�r All organizations MUST have approved non-profit status from State Determination Letter the State of California and Federal Tax Identification Number at time of application.Non-compliant applicants wili be disqualified REQUIRED FOR CDBG ONLY-AGENCY'S LIMITED ENGUSH I— �EPJLAP PROFICIENCY LANGUAGE ACCESS PLAN(LEP/LAP).Must include outreach to limited English speaking residents to encourage access to services&housing.Include what access accommodations are used. REQUIRED FOR CDBG-LEVERAGING REPORT-this is due with r the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements � CALICO Audit 'ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:46491 � Become a tan of`LucmGcuu.s`^'on Facebook . Problems?Contact us at G}ues`bons;3r2oum�;ants.c�m . 0 2002-20 7 6 GrantAnalyst.com.All rights reserved. "ZoomGrants"and the ZoomGrants logo are tredemarks of GrentAnalyst.com,LLC. �... �cccu*�E�nwser � I�i��� � � Email 7his Preview Save as PDF Print Ciose Window A�♦ � Porvered bv ZcomGrantsT�' City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadline Chabot-L.as Positas Community College District/Tri Valley One Stop Career Center Dublin Job Initiative $15,611 Requested Chabot-Las Positas Community College DistricUTri Valley One Stop � --------�----- ------�-- Submitted: 12/8/2015 3:45:52 PM(Pacific) Career Center Telephone(925)560-9431 � Fax (925)560-9457 Project Contact 7600 Dublin Blvd Web trivalleyonestop.org Sarah Holtrclaw Dublin,CA 94568 sholtzclawCa�dpccd.orq United States Tel:925-560-9439 Chancellor Additional Contacts Jannett Jackson none entered iiackson[�a clpccd.ora 1 -._..._ -----......_ � Application Questions _ __.__... _ _.__ _.._ .. . __..___ _______ _._ ---_______.------- -----__._.---�_._.___ � Some answers will not be presented because they are not part of the selected group of questions based on the answer to#30. � ' 1. Please describe your organization category(select one of the following�: � Private Non-Profit r Public Agency � Other. 2. Please describe your agency's mission(no more than 3 sentences or 250 characters). The mission of the Tri-Valley One-Stop Career Center(TVOS)is to provide high-quality,integrated,seamless,accessible and professional employment services for employers and job seekers. 3.For what type of Dublin Grant is your agency applying? 1� Capital Project � Public Service Program or Project 4. Is this a"new"serv(ce,program,project or activlty?"New"Is Identlfied as not yet started,implemented or In operation. � Yes I� No 5.Please indicate below if this application is a request for one-time funding and/or"seed"funding. r One-time funding � Seed funding r One-time and Seed funding � Operational funding � None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received within the last three years(jurisdiction,year,amount,purpose,etc.).Enter"N/A"if you HAVE received Dublin Funds. N/A 7. Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.�. The Tri-Valley One-Stop Career Center(TVOS)is a contractor of the Alameda County Workforce Investment Board(ACWIB)to service as a "Specialized One-Stop".Our systems and operations are structured by the federal Workforce Investment and Opportunity Act(WIOA)which stipulates the essential career services we must provide.We are a service of the Chabot-Las Positas Community College District(CLPCCD)which offers management and fiscal oversight.We fall under the Economic Development office of the District.The Executive Director of this area is Julia Dozier,who has been in her role for 15 years.The dual oversight of the ACWIB and CLPCCD guarantees that we have both management,fiscal and goveming board oversight of our services and operations. TVOS has been in business of providing quality career services to the Tri-Valley region since 1998.The staff and management are dedicate to provide each client and employer with the best possible service.We have employees who have been doing this work for over 15 years and others who bring in new ideas as they have joined the staff in the last year.Program Manager,Sarah Holtzclaw,joined TVOS and CLPCDD in January of 2015. Her goals are to continue the high quality of services while,at the same time,expand services to community partners,service a wide variety of employers and to grow the Center's client base. 8.Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementation process to describe your project. The funds wiil increase our outreach and services to Dublin residents,providing a comprehensive range of no-cost employment and training services for employers and job seekers. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) Our increased services and outreach in 2016-17,we should reach 3100 unduplicated Dublin residents 10.Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? � Behavioral Health(mental health and substance abuse) ' r Affordable Housing � Health Care(including dental) � Workforce Development r Homelessness (� Transportation Services and Access r pomestic Violence and Child Abuse 1� Disabilities � Food and Nutrition (� Senior Services � Youth Services � Child Care,Early Childhood Development and Education r Changing Demographics and Growing Diversity � Financial Assistance r None of the above 11. Explain how this project will be implemented,administered,and operated. The Tri-Valley One-Stop Career Center(TVOS)has been successfully offering career services for 15 years.Our services are offered through our facilities and staff.Clients use our facilities to write resumes,job search,conduct interviews,attend workshops,compiete online training,and communicate with potential employers.Our counselors meetwith clients 1-on1 and address any barriers the client may be experiencing in finding gainful employment.Our employment specialist then connects the job ready applicants to open positions in the area. The Dublin Job initiative will be a part of a larger Outreach Initiative that is intended to help TVOS reach more peopie in the community.With one main office in Dublin,our scheduled workshops are not always going to be available when clients need them.Our staff is busy offering career services in our current offices.However,we have partners throughout the Tri-Valley whose clients would benefit from our services but can't get to our offices when iYs open or at the time that a workshop is offered.Additionally,there are thousands of Tri-Valley residents who are under-employed but cou�d use our services during hours our office is not open. With the help of the City of Dublin,we will fund a new staff inember to offer our workshops and services outside of our physical offices.The full Outreach Initiative will fund one new staff member fully and partially fund two other existing staff inembers partially to assist. It will also fund the development and placement of inessages and marketing in order to attract new clients who may need or want career services but don't know we are available. The existing Program Manager will develop the marketing strategy and messages.An existing Career Counselor will train and assist the new Outreach Specialist.That new staff member will be responsible for taking our services out into the community, meeting with community groups and monitoring the program results. 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?). The Tri-Valley and Bay Area economy has cyclical characteristics.Though it is a job seekers market at the time of this writing with an unemployment rate under 3%. However,this official rate does not account for the long-term unemployed or the under-employed who took a lower paying job or two simply to make ends meet.The economy of the Tri-Valley is strong at the time of this writing.It may not be by the fiscal year 16-17. The Dublin Job Initiative has three purposes,all of which will prepare us for the cyclical economy.With the City of Dublin funds,we wiil increase: 1)our capacity to train residents by developing new workshops offered at our location and within the community; 2)our outreach to businesses,offering to assist in their growing needs to find and hire qualified,skilled applicants; 3)our outreach to those who are under-employed or working two,or more,part-time jobs to make ends meet. 73. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome�s)? As a federall -funded ro ram throu h WIOA we are mandated to track all of the services we offer in our office.Our s stem uses the CalJobs employment system to track the activities of TVOS clients. For the Dublin Job Initiative,we will track: 1)The number of new workshops developed 2)The number of Dubiin residents attending these workshops at the TVOS offices and within the community 3)The number of new Dublin businesses that are contacted and brought on board 4)The number of Dublin residents touched through specific outreach efforts 5)The number of services offered to Dublin residents 6)The number of unduplicated Dublin residents touched 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled,low-income,etc. Our office is open to the public,without regard to income,ability or experience.We do limit our clientele to adults 18 years of age and over per our contract with the Alameda County Workforce Investment Board(ACWIB).However,we won't turn anyone away.We have a MOU with the California Department of Rehabilitation(DOR)to cooperatively serve people with disabilities.We are one of the only Job Centers in the region with a workshop specifically for the older worker.Additionally,the California Employment Development Department(EDD)is onsite weekly to help veterans of all ages in their job search. The federal Workforce Investment and Opportunity Act(WIOA)law requires that a certain percentage of our clients have economic barriers such as a basic-skills deficiency or low-income.To serve this population,we have outreach referrals from Axis Community Health,city libraries,CalWorks and other community organizations serving low-income adults.We also have outreach to the incarceration facilities in Dublin to work with offenders prior to their release back into the community. 15. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the clienUcustomer population served)7 Services in our offices are done on an individual or small group environment.We pride ourselves on the diversity of both the people we serve and the breadth of the jobs availabie at any given time.Clients can access services at three levels:self-guided where they simply use our offices and ' equipment;small groups where clients access small group workshops to help in their search;or one-on-one case management where staff spends time with them individually to work on resumes,interview skills and job search strategies.Our more-intensive Gients create individual employment plans with the help of staff that works tailored to meet their needs and career goals.We target high growth,high wage industries to help our clients succeed over time in their career development. Our Outreach Specialist will primarily focus on the 1-to-many model of workshops.If more intensive services are needed,we will determine the best course of action and how our career counselors can work with that individual to meet their needs. 16.Explain how your agency will outreach to low-income,limited English speakers,andlor disabled persons.How will each of these groups access the project for which your agency is requesting funding4 We have three Spanish-speaking staff members at NOS.We have translated our materials into Spanish and have outreach to Spanish-speaking populations in the region.For those who speak other languages,we have a third-party translation service available to us. As a federal-funded site,we are an"Equal Opportunity Employer/Program."We have auxiliary aids and services available upon request to individuals with disabilities including software installed on computers to aid visually and auditory impaired individuals,TTY and magnifying equipment.We also work with the Department of Rehabilitation to co-enroll and help clients with disabilities. Our current outreach efforts include community partners who also serve low-income adults,such as Axis Community Health and the public libraries and the housing authority.We have opened opportunities to not only teach Gients but staff of paRner agencies so that they can better serve their clients in our absence. This particular funding request is actually to increase this Outreach and to be available to these populations where they are.We understand that not everyone can frequent our offices during the work day.We would like to offer workshops and services outside normal working hours,and within the community more frequently.Our Outreach Initiative,of which the Dublin Job Initiative is a part of,will allow us to do that. 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. The Tri-Valley One-Stop Career Center(TVOS)is continually seeking partnership with other community organizations across the Tri-Valley and beyond. Lack of employment is often a reason for the need of other services.The old saying that"a good job is the best doctor"is not too far off.The following are organizations that we work with currently.Over the coming year,this list is sure to expand as there are many organizations doing great work and helping people find employment. •Los Positas Community College—educating students for the workforce.We help with the Career Center on campus. •DepaRment of Rehabilitation(DOR)—we offer space for their staff and client orientations.We co-enroll clients when appropriate. •Employment Development Department(EDD)—Veteran services is co-located at TVOS 1x week. •Social Service Agencies(SSA)—we serve CalWorks clients,offer space and applications for public benefit enrollments •Dublin Public Library—We offer our workshops and career counseling onsite 3x a month •Santa Rita Jail—we offer resources and pre-release counseling and workshops for inmates •FCI,Dublin-we offer resources and pre-release counseiing and workshops for inmates •Castro Valley Adult School—we co-promote our services to each other clients,co-develop workshops and send ciients to their campus for training when appropriate •Axis Community Health—we cross-refer clientele •Tri-Valley Educational Cooperative—we bring employers to the table for high school students to learn career paths and skills deveiopment •St.Raymond's Church Job Club—we cooperate in handling individual cases when appropriate and cross-refer clientele •City Serve of the Tri-Valley—we attend meetings to learn of other resources in the region and to outreach to other organizations.. �AARP—we collaborate with marketing and training for our similar free tax preparation services 18.Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. This particular funding request is actually to increase this Outreach and to be available to these populations where they are.A portion of the Initiative is to develop a stronger marketing strategy and to place the messages where they will be high visible and effect. In 2015,we hired a new Program Manager who has a marketing and communications background.In addition to running the daily operations of the Tri- Valley One-Stop Career Center(TVOS),she has made a conscientious effort to expand its marketing and outreach efforts.She updated and redesigned the NOS marketing materials to be consistent and thorough.We have developed materials for partners to display and distribute.We have are reaching new community-based organizations that we've not met before and revitalizing those relationships we've let lapse.For example we have new relationships with the Livermore and Pleasanton libraries,based off our successes in Dublin.Our participation in City Serve meetings gives us a platform of outreach to organizations serving the community in a different capacity.We are revitalizing our social media presence to not only include Linkedln but also Facebook and Yelp.We are also in the process of redesigning our website to be more interactive and of greater service to our clients and employers.In fact,the City funds will be used to increase our marketing and outreach efforts for the purpose of expanding our client base. We are also increasing outreach to employers in the region.Though we have an excellent relationship with employers for over the years,the growth of the region means that more employers are joining the Tri-Valley economy.Our membership to the Dublin Chamber of Commerce gives us access to the smaller employers.With the funds from the City,we will be able to increase this outreach as well via chamber mailings,potential advertisements and local job fairs. 19. Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. The Dublin Job Initiative is intended to reach and serve more job seekers and employers within the City of Dublin.Our work is one of economic development that directly corresponds with the City's high quality of life mission and vision.By helping Dublin residents secure employment,we are increasing disposable income that will be spent in the region.We are also helping employers to grow by finding qualified employees for their businesses.Both sides of this coin help the region grow,and bring security to the City.Given that our services are open to the public,we believe that the Tri-Valley One-Stop Career Center(NOS)is also promoting an economically diverse and balance community. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The return on investment for the Tri-Valley One-Stop Career Center(NOS)is extraordinary.With one full-time and six part-time staff members,we are able to touch and serve thousands of people in the Tri-Valley area to one degree or another.For those who come into our offices and receive services,the cost of that service is,on average,$1,900 per person.We strive to place our clients in jobs that are$20/hour or high unless they need what we call a"survivai job"in the interim.For clients who find employment at$50,000 a year,our ROI is more than 25-fold. The City of Dublin's funding will used to pay for outreach efforts and workshop development time,which is more staff time,but also strategic marketing/public relations development and placement.The more people who know about our services,the more we can help.The more businesses that know about us,the more jobs we can fill inside the City.This includes taking part in community events,offering our workshops and services to community paRners and developing a marketing plan that will reach new clients and businesses. We believe that the requested funding will allow us to do this.It should also be noted,that we are applying to both the cities of Pleasanton and Livermore for similar funds that will be combined to make a greater impact. : 21.if this application does not receive funding,or receives reduced funding,what will be the effect on the project? Our operational budget is very tight.Since our services are individual and staff-dependent,the vast majority of existing budget is used for staff salaries.Marketing,outreach and new workshop development efforts unfortunately are a luxury that can only happen with dedicated funding. Unfortunately,those are also the best means to expand our services to benefit more people and reach more businesses.Should we not receive the City funding,or received a reduced amount,our outreach efforts will be reduced to meet that new reality. 22.Does your agency anticipate having any unspent grants funds at the end of the fiscal year? r Yes � No 23.If you answered yes to the preceding question please explain.Enter"N/A"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures)? (� Yes � No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25. If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"NIA"if not applicable. N/A 26.If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms,plans for future relocation or expansion,etc.�.Enter"N/A"if not applicable. N/A 27. If your agency is requesting Capital funding,will this project require implementation of Davis-BacoNFair Labor Standards Act requirements? � Not A licable � Yes � No � Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) P 28.PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin's Mission&Vision Statements: (you may choose more than one) � Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. � Balance history with progress,to sustain an enlightened,economically balanced and diverse community. � Encourages innovation of City life,including programs to strengthen our economic vitality,suppoRs environments stewardship and sustainability through the preservation of our natural surroundings. � Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) (� Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development r Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety 1� Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City � Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and e�ciency and strives to build an informed community through communication � Reiating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concern,and encouraging public and private paRnerships of mutal benefit 30.*'QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.**Are you are interested i�applying for CDBG fundsT � Yes.If so,answer questions 31 through 43. � No.If no,check box here,and questions 31 through 43 will not be required.. � Don't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDBG ONLY-Expiain your Limited Engiish ProfiiciencyiLanguage Access Plan(LEPtLAP).How does your agency outreach ta iimited Engiish speakrng residents tp encourage access ta sxrvices$�housing?V1+hat access accommodations are used? Provide detail ..ar;s�verr,cf,�reser�t�d b�r„vuse oftne sns�verfo�130- 32.CDBG QN�Y-identify AT LEAST ONE U.S.Department of Housing and Urban qevelopment iHUD)Consalidated Pian Guiding Principle that relates to yaur project: -ansiv�r nat presenCed becat�se o;Che ansvver to#30- 3S.CDBG ONLY-identify AT LEAS7 ONE U.S.Department of Housing and Urban Development rHUD}Consolideted Plan Goais that relates to your project: -ar�s�ver not preserateci Ger.ause af r(ae ans4ver!o#3�- 34.COSG ONLY-ldentify AT LEAS7 ONE U.S.Department of HUD Strategic Goal that relates to your project: -7n,s!a�er r?of preser�"rad because oi rhe ans4��er to#30- 35.CDBG ONLY-identify AT LEA5T ONE U.S. Department nf HU6 Palicy Priority that relatas to your praject: -�ns��ver ra�t,aresent�;w because oithe�ns���er to#�30- 36.COBG ONLY-Identify AT L5AS7 ONE Consalidafed Pian objective that relates to your project: -a?�:;!terr?t7tprps�nre;;rec;r,{as�o`:ne rtn�:i�;e;�v#;?0- 37.CQBG ONLY-Seiect ONE Objecfive that relates to your project{TIP:When selecting an abjective ask yoc�rseif,"What is the purpose of tho activity7 What is 2he larger community �7eed that i am seeking ta address?"): � �tn.ys,;r� ,t�r� �r ;�'t�c..� >�:t�,; t F s,"s:,� „ifi�3G. 38.CDBG ONLY•5elect tJN6 Outcoine that ralafss to your project{TIP:When seiecting an outcome ask yaarseli,"What type of � change or rasuit am i s�eking?"}: � _�,;S,t-errCt,�lc;�se±ateG UeGauSe of`"r,e ars�^re� io ti:?!i- 39.CDSG ONLY-Seteet ONE Specific Indicator that relates to your project: -ar3siver n,c,�reser;i�d�3ec<3use of the�nst-+�er to�30- d0.CDSG ON�Y-Piease choose a common indicator thac your agency will use to track cfients{seleci anly ONE). -r���s�n e~not�resented heeause of the�r�s�-vet�to#3�- 41.CDBG QNIY-For the category you selected above,provide tfie totai number of undupiicated Dublin ciients(EITHER Persons OR Households)yo�r agency anticipates serving through this project: -anskver nai presented because of!he ans�-verTo#30- 42.CDBG ONLY-Based on the common indicator you selected abnve, pEease Iisi the number of uriduplicated Dubiin ciients your agency anticipaYes serving in eaci�cafec�ary."1�nc�ne, please enY�r"p". � <it'.�iG: .?.�l r't i. ...�.� E� l✓ti6 ,�,,.,�: t 'c��t):.�`'1... 43.CDBG ON�Y-Ust the n�rmber of clients your agency anticipates servirog in racetsthnieity categories,The sum entered below musi match the tatal ciients entered in#A2 ahove. Far HUD"Hispanic"is an ethnicity,not a race."If none; piease e�eter"0"' ansv�-er ro!p%eseri�ci b�ce�use o`:i;e ans4ver rn�3J 44.If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY � #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. r #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. r #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. � #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. � #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. � #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. � If you have more than 6 applications per organization,agency,district or entity,check here. 45.Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). The Tri-Valley One-Stop(TVOS)is a federally funded entity through the Workforce Investment&Opportunity Act(WIOA).The majority of our funding is passed through the Alameda County Workforce Investment Board with a match from the Chabot-Las Positas Community College District(CLPCCD). The City of Dublin grant funding is a small portion of our budget,but one that is valued highly by both TVOS staff and the CLPCCD Chanceilor and Board of Directors. That said,the Outreach Initiative of which this grant will partially fund,is outside our WIOA funding scope.Our base services are not dependent on the City's grant program,but this specific initiative is relying on the funding.As said in question 21,a reduced funding amount from any of our expected allocations will reduce the effectiveness of this Outreach Initiative. ' 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-010043 Budget _ _ _ _� __ Funding Sources/Revenues Budget Amount Amount Committed City of Dublin $15,611.00 $0.00 City of Livermore $7,500.00 $0.00 City of Pleasanton $7,500.00 $0.00 : Alameda County Woricforce Investment Board ' $78,664.00 $0.00 Chabot-Las Positas Community College Distrcit $26,221.00 $0.00 United Way of the Bay Area $1,556.00 $0.00 Total $137,052.00 $0.00 , Fundiny Uses/Expenses Budget Amount Amount Committed Salaries $73,472.00 $0.00 Benefits $46,280.00 $0.00 Supplies $375.00 $0.00 Printing/Copying $1,050.00 $0.00 Postage $3,375.00 $0.00 Contract Services $12,500.00 $0.00 Total $137,052.00 $0.00 ' Budget Narrative The program will hire one Outreach Specialist who is responsible for the on-going community relations,workshops outside the One-Stop office within the community,and all marketing that is done.Printing and postage includes mailings to three chambers of commerce memberships. Contracted services includes strategy,design and placement of effective marketing elements.These may include,among other things,social media ads,web ads,radio and the like. Base funding is not committed because the Alameda County Workforce Investment Board(ACWIB)contract will be renewed for the 2016-17 Fiscal year through an RFP.Chabot-las Positas Community College District match funding is dependent upon the ACWIB funding.We have ' received ACWIB funding for 15 years,so there is no reason to believe that we will not in the 2016-17 fiscal year. Documents Documents Requested* Required? Attached Documents* Program Expense Budget for ALL Grant Requests � Dublin Job initiative Proqram Exoenses FY15-17 dawnioad tempiate Financial Information Form for ALL Grant Requests � Dubiin Job fnitiative Financial Information download template List of Board of Directors(or governing body)with contact (� GLPCCd Board of Directors 2015-2016 information _ Current Annual Budget for the Entire Agency I� CLPCCD Adootion Budaet 2015-2016 Copy of most recently submitted IRS 990 form or Tax Return � E1N letter.no 99d or tax retums to submit (indude complete form) : Board of Direetor's(or governing body's)designation of � CLPCCP Signature Autharization autho�ized official Board of Director's(or governing body's)authorization to � Fundinp Reauest Authorization request funding(may be same document as one above) Proof of insurance carried,including bonding,liability andlor � Proaf of Insurance workers'compensation REQUiRED FOR CDBG ONLY-If requesting Capital Funding, � please upload your Gapital expenditure budget(your own format is acceptable) REQUIRED FOR CDBG ONLY-PERSONNEL POLICIES INCLUDING r AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS � AND COPY OF LAST AUDIT HIGHLIGHTING"FINDINGS" SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION � AND BYLAWS. REQUIRED FOR CDBG ONLY-CONFLICT OF INTEREST � STATEMENT(IF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART r STATE AND FEDERAL NON-PROFIT DETERMINATION LETfER. r IRS Tax Exempt Letter.CLPCCD All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time ofiapplication.Non-compliant applicants will be disqualified. REQUIRED FOR CDBG ONLY-AGENCY'S LIMITED ENGLISH r PROFICIENCY LANGUAGE RCCESS PLAN(lEPlLAP).Must include outreach to limited English speaking residents to e�courage access to services&housing.Include what access accommodations are used. REQUIRED FOR CDBG LEVERAGWG REPORT-this is due with � the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements � CLPCCD Mast Recent Audit `ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:47959 Become a far oiZr.�umi;rants"'on Facebook � Problems?Contact us at��az�tionvi.+�LUOrnGs2nis cam 02002-2016 GrantAnalystcom.All rights reserved. � "ZoomGrants"and the ZoomGrants logo are trademarks of GrantAnalyst.com,LLC. _�_;.�`.�[3 c�sF, � � � Emaii This Preview Save as PDF Print Clase Window Ai♦ `�'o�vered bv loomGrantsT�" ' City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadline Chabot-Las Positas Community College District/Tri Valley One Stop Career Center Tri-Valley Volunteer Income Tax Assistance $6,000 Requested ( Chabot-Las Positas Community College DistricUTri Valley One Stop Submitted: 12/10/2015 4:40:19 PM(Paciflc) Career Center Telephone(925)560-9431 � -- Fax (925)560-9457 Project Contact 7600 Dublin Blvd Web trivalleyonestop.org Sarah Holtzclaw Dublin,CA 94568 shoftzclaw(rr�clpccd.orq United States Tel:925-560-9439 ! ' � Chancellor ' Additional Contacts ( Jannett Jackson none entered ! llackso�clpccd.org Application Questions i _ _._ _._ _�._ ��._----- .__ _—____-_ --_.__ �____ _------- -- � ; � Some answers will not be presented because they are not part of the selected group of questions based on the answer to#30. ( i 1. Please describe your organization category(select one of the following�: � Private Non-Profit (— Public Agency � Other: 2. Please describe your agency's mission(no more than 3 sentences or 250 characters�. The mission of the Tri-Valley One-Stop Career Center(TVOS)is to provide high-quality,integrated,seamless,accessible and professional employment services for employers and job seekers. 3.For what type of Dublin Grant is your agency applying? r Capital Project � Public Service Program or Project 4. Is this a"new"service,program,project or activity?"New"is identified as not yet started,implemented or in operation. � Yes � No 5. Please indicate below if this application is a request for one-time funding and/or"seed"funding. � One-time funding � Seed funding � One-time and Seed funding IV Operational funding � None 6. If your agency has NEVER received grant funding from the City of Dublin,please describe any other CitylCounty funding received within the last three years(jurisdiction,year,amount,purpose,etc.�.Enter"N/A"if you HAVE received Dublin Funds. N/A 7. Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.). In addition to providing quality career services to our community,we believe that we can serve our clients and the community in other capacities that are within the employment scope.One of those services is to offer free tax preparation.The 2016 tax season will be the fourth season that we offer this service.Each year,it has grown in the number of volunteers and the clients we have served.Though AARP has offered similar services for years,there is not enough capacity to help everyone who needs it.To help,the United Way of the Bay Area has offered small amounts of seed money. The program is highiy regulated by the Internal Revenue Service.The program and volunteers must adhere to specific training and certifications,as well as operational standards and procedures.Taxes are completed by certified volunteers on a nationally-used software platform.The program is audited on-site by both the United Way and the IRS at least once during the season. Site Coordinator,Alexandra Gallegos has been facilitating the program since its inception in 2013.Program Manager,Sarah Holtzclaw,joined TVOS and CLPCDD in January of 2015.She has a background of developing and expanding a free tax preparation program in Oregon.Under her guidance, TVOS will continue to expand its free tax preparation services to not only Dublin,but Pleasanton and Livermore,in order to fill gaps where they are needed. The Tri-Valley One-Stop Career Center(TVOS)is a service of the Chabot-Las Positas Community College District(CLPCCD)which offers management ' and fiscal oversight.We fall under the Economic Development office of the District.The Executive Director of this area is Julia Dozier,who has been in her role for 15 years.The dual oversight of the ACWIB and CLPCCD guarantees that we have both management,fiscal and governing board oversight of our services and operations. 8. Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementation process to describe your project. This program increases free tax preparation availability in the region.State and Federal taxes are e-filed by certified volunteers.The service helps taxpayers avoid predatory refund loans and expensive tax preparation,keeping money in their pockets. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) As the program builds,we are increasing both the clients served and certified volunteers.By the 2016-17 season,we believe we will service nearly 400 taxpayers,45%of which will be from Dublin.That is 180 unduplicated Dublin residents. 10.Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your proJect identify with? � Behavioral Health(mental health and substance abuse) {� Affordable Housing � Health Care(including dental) (� Workforce Development � Homelessness � Transportation Services and Access � Domestic Violence and Child Abuse � Disabilities r Food and Nutrition ' � Senior Services � Youth Services (— Child Care,Early Childhood Development and Education � Changing Demographics and Growing Diversity r Financial Assistance � None of the above 11. Explain how this project will be implemented,administered,and operated. The Free Tax Preparation services offered by the Tri-Valley One-Stop(TVOS)is a 9-month endeavor.We are part of two networks:the Earn It,Keep It,Save It(EKS)network for the United Way of the East Bay;and the national Volunteer Income Tax Assistance(VITA)network operated by the federal IRS.Each of these networks have guidelines and operational standards to which we must adhere. The actual taxes are prepared by certified volunteers from the end of January through April 15.However,the planning,training,volunteer recruitment and marketing starts in September each year.The end-of-season follow-up with both the United Way and the IRS goes well into May. We will offer the VITA senrices at our Dublin offices,in the Pleasanton Public Library and at Las Positas College in Livermore.We operate these sites as gap-fills for the over-whelmed AARP sites which offer similar services.As our services grow,the days and hours of operation will grow to meet the demand. NOS staff act as the Program Coordinators for this program.This person oversees the implementation and operation of all tax services,working in conjunction with Site Coordinators who manage the volunteers and processes at the time of the service.All volunteers are certified in basic tax law and in the approved program software through the IRS.Clients can make 45-appointments at any of locations.The taxes are filed electronically when ' possible and no paperwork is held by NOS or the volunteers. ' 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?). Though the tax preparation services are free to the tax payers,it does have operational expenses.As the budget is laid out,the City of Dublin grant funds will cover 17.8%of the program costs.This is an exceptional"deal"for the City as we anticipate that 45%of our clients will be from Dublin. Specifically,grant funds will be used to cover staff a portion of the staff salaries and benefits associated with this program;supplies such as paper, toner,office supplies,and the purchase of a portable,wireless printer;marketing costs such as printing and postage;a small portion of the rent and utilities for the office space;and miscellaneous costs such as travel for staff;and volunteer recognition such as end of season thank you gifts and food. This rant should be looked u on b the Cit as an investment.Clients tax returns ran e widel 'ust as the eneral ublic.We see some who need to pay at the time of filing,but most receive a refund.The cost of services was$84 per client.The average refund during the 2014-15 season was about$400.With California now offering a state EITC,the refunds should be higher in the coming years.Studies show that tax refunds are spent in the communities,on things such clothing,rent and childcare.Additionally,studies also show that there is 1.5-2.0%multiplier effect of those refund dollars. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome�s)? The Volunteer Income Tax Assistance(VITA)program is tracked meticulously by the IRS and United Way.As the end of the season,we should receive aggregated data on all of the clients we served. For the Dublin Free Tax Preparation program,we will track: 1)Total number of clients served 2)Percentage increase of client served 3)Total number of Dublin residents served 4)Total state and federal dollars returned to clients 5)Total state and federal dollars returned to Dublin clients 6)Total EITC retumed to Gients served 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled, low-income,etc. The Volunteer Income Tax Assistance(VITA)federal free tax preparation program is a service for working families of low or moderate incomes of $60,000 or less.Given the cost of living in the Tri-Valley,we fudge this limit some,but do focus on the low to moderate income households. The VITA program is offered to counter the high cost of paid,and sometimes predatory,tax preparation services.It can cost$250-$400 for simple tax return at the national tax preparation chains.This equals the average refund,which means the tax payer does not benefit from their refund at all.Add to that the high interest rates of a refund anticipation loan,and the low-income tax payer can actually be in debt from filing their taxes.VITA and the Tri-Vailey One-Stop are intending to mitigate those costs and helping hard working families keep and save as much of their money as possible. We coordinate our services with AARP,more senior-focused services so that there is not an overlap of times and days.This assures that there is a free tax service offered in each of the three main Tri-Valley cities rivice or three times a week. 15. How is this project culturally appropriate�i.e.,describe how it is specifically tailored to the client/customer population served)? The Volunteer Income Tax Assistance(VITA)program is intended to help working families file their taxes for free.It is a service that offers one-on- one tax preparation with a certified volunteer.The volunteer completes the client's state and federal tax returns while that tax payer sits beside them. In some cases,the tax payer will have delivered their paperwork for filing and return to sign it.However,the majority of the service is face-to-face and side-by-side. Additionally,the Tri-Valley One-Stop(TVOS)is a Certified Acceptance Agency through the IRS,which allows us to streamline the process of obtaining an Individual Tax Identification Number(ITIN),for tax payers without a Social Security number.Our Site Coordinator is also bi-lingual in Spanish,which allows her to communicate directly with the tax payer. 16.Explain how your agency will outreach to low-income,limited English speakers,and/or disabled persons.How will each of these groups access the project for which your agency is requesting funding? The intended clients of the Volunteer Income Tax Assistance(VITA)are low-to moderate-income working families.In the Tri-Valley,many of these families have limited English speakers in their households.Our marketing effoRs are all in English and Spanish.Additionally,we strive to have at least one Spanish-speaking volunteer at each tax session. Our current outreach efforts include community partners who also serve low-income adults,such as Axis Community Health and the public libraries and the housing authority.Additional efforts may include cooperative efforts with the school systems,cities,and food banks,thrift shops and churches in the region.We are continually looking for new ways to effectively and efficiently market these services. Additionally,the Tri-Valley One-Stop(TVOS)is a Certified Acceptance Agency through the IRS,which allows us to streamline the process of obtaining an Individual Tax Identification Number(ITIN),for tax payers without a Social Security number.This is important for foreign-born tax payers who are paying taxes for the first time.They must apply for the ITIN at the time of the tax preparation and send the taxes with their applications.An ITIN number can be used for paying taxes only,which is one step in the process of becoming a citizen of this country. 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. The Tri-Vailey One-Stop(TVOS)is continualiy seeking partnership with other community organizations across the Tri-Valley and beyond.There are five main partners in this program,each of which contribute to its success.We are continually seeking out new partners who can help and add to the program success.Currently,our partners include: •Las Positas Community College—students are often low-income.We will offer drop off services where students can drop their paperwork one week and pick it up the next. •Pleasanton Library—Unlike Dublin and Livermore,the Pleasanton Library did not have tax preparation services until we approached them for the 2015-16 tax season. •AARP—we collaborate with marketing and training for our similar free tax preparation services.Our services are scheduled so they do not overlap but complement the AARP services in each city •United Way of the Bay Area—the United Way is both a funder and a partner:They provide training for our site coordinators,marketing materials and support •Internal Revenue Service—the IRS provides the software,training materials and technical support.IRS employees also volunteer as tax preparers during the season. 18. Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. Marketing and outreach is a critical component to growing this program and serving more Tri-Valley residents.We are developing posters and fliers to hand out to organizations who serve low-income residents,in particular.Word of mouth is a strong asset.Former clients,as well case employees of like-minded organizations can be important conduits of information.Sample organizations that we will approach are: •Dublin Adult School and School District •Pleasanton Adult School and School District •Livermore Adult School and School District •Castro Valley AduR School •Axis Community Health •City Serve of the Tri-Valley—as a conduit to regional churches and Open Heart Kitchen •Tri-Valley Haven,Shephard's Gate •Goodwill,Savers and other thrift stores in the region •YMCA of the Tri-Valley •Cities of Dublin,Pleasanton and Livermore •Libraries of Dublin,Pleasanton and Livermore •Chambers of Commerce of Dublin,Pleasanton and Livermore—employers passing information to employees We will also employ the services of the Chabot-Las Positas Community College District Pubiic Information Officer to help develop a public relations strategy to have the services covered in the local media. 79. Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. The Volunteer Income Tax Assistance(VITA)program is one that can be directly linked to economic vitality and to a safe and secure public environment.Free tax assistance programs through the federal government are intended to help seniors and low-income tax payers.AARP is focused on the seniors through their services.The Tri-Valley One-Stop(TVOS)is focused low-to moderate income tax payers through the VITA program. Security of our Dublin residents is in the form of cost avoidance through the free tax preparation,which leaves more money in their pockets.The through: •Avoiding the high costs of tax preparation.Many of the chain tax preparing companies charge$250-$400 for a very simple return.By offering these services for free,tax payers avoid these costs. •Avoiding predatory refund anticipation loans(RAL).RALs are loans a tax payer takes out with their anticipated refund as collateral.Since a RAL is only a 10-14 day loan,the interest rate can be as much as 500%.By using VITA services,the taxpayer avoids the hard sell of RALs and avoid those costs. Additionally,we are offering the security of tax preparation and adherence to federal laws for our clients.Taxes scare many people.We take that fear out of their hands by preparing and filing their state and federal taxes for them. The program contributes to the economic vitality of Dublin through the refunds received by the tax payers.The average refund for our clients during the 2014-15 season was$400.We anticipate servicing 180 Dublin residents during the 2016-17 tax season,which is$72,000 in federal dollars directly to Dublin residents.Research shows that these tax refunds are spent immediately in the community on basic needs and delinquent accounts. Research also shows that there is a 1.5-2.0°/a multiplier effect on these refunds,which means there could be an economic impact of$108,000 on the anticipated refunds processed through the NOS program for the City of Dublin. 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The Volunteer Income Tax Assistance(VITA)program is one that can be directly linked to economic vitality and to a safe and secure public environment.State and federal tax returns are spent directly in the tax payer's community.Research on the Eamed Income Tax Credit(EITC),in particular,shows that there is 1)a multiplier effect on the refund in the community of 1.5-2.0%;and 2)the EITC is an actually encouragement to employment by single mothers in particular.Here's is the City of Dublin's return on their investment of$6,000. •We anticipate the program budget for the 2016-17 fiscal year to be$33,722. •City of Dublin's$6,000 grant is 17.8%of the total budget •We anticipating serving over 400 clients during the tax season •45%(180)of these,we believe,will be Dublin residents •The average refund in the 2014-15 season was$400,though this should rise with the new California EITC •$400 x 180 taxpayers=$72,000 in refunds to Dublin tax payers •1.5%muttiplier effect=$108,000 to the Dublin economy •$250 on average of savings from not paying for taxes to be prepared=$45,000 Total return to family budgets and the City of Dublin economy on the$6,000 grant=$153,000 21. If this application does not receive funding,or receives reduced funding,what will be the effect on the project7 Volunteer Income Tax Assistance(VITA)programs across the country are primarily grant funded.In fact,the US Congress appropriates funding each year to promote and support the service in all 50 states.The United Way of the bay Area and its network is a large recipient of this federal grant funding.The Tri-Valley One-Stop(NOS)is a recipient of some of this funding through the United Way.We anticipate that as our program grows,the United Way funding will also grow.The Chabot-Las Positas Community College District has funding this service primarily in the initial years.However, as it grows,the outside funding will need to grow as well.Like others across the country,the program is dependent on contributions and grants and will,unfortunately,only be able to continue as the funding continues. . oes your agency an icipa e aving any unspen gran s un s a e en o e �sca year � Yes � No 23. If you answered yes to the preceding question please explain.Enter"N/A"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures)? r Yes � No.If no,enter N/A for questions 25 8�26,and check Not applicable for question 27 25.If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"NIA"if not applicable. ' N/A 26.If your agency is requesting Capitai funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms,plans for future relocation or expansion,etc.�.Enter"N/A"if not applicable. N/A ' 27.If your agency is requesting Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? � Not Applicable I� Yes (� No � Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES IdentiTy AT LEAST ONE of the City of Dublin's Mission 8 Vision Statements: (you may choose more than one) I� Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. ' 1� Balance history with progress,to sustain an enlightened,economically balanced and diverse community. � Encourages innovation of City life,inGuding programs to strengthen our economic vitality,suppoRs environments stewardship and sustainability through the preservation of our natural surroundings. � Promotes active and healthy lifestyle through the creation of first-Gass recreational oppoRunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) (— Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development ' (� Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety � Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendly development, transit-oriented development,green buiiding and environmental responsiveness;promotes high quality design and architectural standards in private development and in all public facilities and develops transpoRation systems that facilitate ease of movement throughout the City r Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication I� Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues ot mutuai concem,and encouraging public and private partnerships of mutal benefit 30.*'QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.'*Are you are interested in applying for CDBG funds? � Yes.If so,answer questions 31 through 43. 1� No.If no,check box here,and questions 31 through 43 will not be required.. r pon't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. � 31,CpSG{7N�.Y-Explain your Gimited Engiish Prrrficiencyil�ang�iage Access Plan(�.EPI�A�')=How does yaiir agency outreach to fimitod Er�glish speaking residents to encne�rage access to services&housing?What access accommodations are used? Provide detail , � -ansvver nc�"r preser�'ed aec2if3se U;tY�e 2nsvv�r'tt��3G- 32.CDBG ONLY-identify AT LEAST ONE U.S.Department of Housing and Urban Development{HUD)Consnlidated Plan Guiding Principie that relates to your project: -ar�s«er not presented Gecause of fhe ansa^.�er to#30- 33.CDBG ONLY-identify A7 LEAST ONE U.S.Department of Housing and Urban QevelopmeM{HUD}Gonsolidated Pian Goais that reiates to your project: -ansv✓er i�c�t presenCed becai+se of the answer Co#30- 34.CDBG ONLY-Identify AT LEAST ONE U.S.Department aP HUD Strategic Gaal that relates to your project: ansvver not presented because of tt�e a;�sv✓er to#30- 35.CDBG ON�Y•identify A7 LEASY ONE U.S, Deparimerft of HUD Policy Priarity that reiates to your project: -�ar;st:ver r,�i pre:er,>�;c,t;e;:ause c>f i+�e ar;s�er.,;�:3!;. 36.CDBG t}N�Y-identi(y AT LEAST ONE Consolidated PEan abjective that relates ta your proj2ct: -a;?st,,;er nc7t�>rc;�senrec°i�ecause of trE ar?st^.-er'to#,?ti_ 37.CDBG ONLY-Select ONE Objective that relates to your project(71P:When selectittg an objective ask yourself,'"What is the purpose of the activify?What is the Iarger community need thaY I am seeking to address?"): - ai�svver i3ot p��sented hacai�se o`ihe ar�swer To#30- 38.CD6G ONLY-Seisct ONE Outcame that relates to your project{TIP:When sefecting an outcome ask yaurself,"What type of change or resuiY am t seeking?"): -ar;stiver nnt pres�r�ted because of!he ans�ver!o#K?0-. 39.CDBG ONIY-Select 4NE Specific Indicator that reiates to your praject: -�nsiver not prasenie�l�er,ause ot t!��>ar�s�ver fo#30- 40.C6BG QN�Y-Please choose a common indicator that your agency will use to track ciients(select anly ONE): -answcr na!pres�tat�d A��cause af rne�r�s������to#3�- d1.CDBG ONLY-For the category yqu seler.ted above,provide the totai number af undupiicated Dublin clients{EiTHER Persnns C1R HousehQidsl your agei�cy anticipates serving through this projeet: � —'s'tS�:t�f� C)';?'F, t `'r''Ait , ,:.{;<; r.,F�c.. �,,.f, :O'1r.3C).. �� 42.GD6G QNI.Y-Bas�ci an fhe cominon iadicatar you s�lected above, please Iist the nirmber oP undupifcated Dubiin cfients yaur � : agency anticipates serving in each categary, "If nane, piease enter"0". i ���sn- <<�te e a'�v�f,,�..��o.:�._.a .>.t� .:tc:.:-;�- � 43.CQBG ONL�-list the number of ciients your agency anticipates serving in race(ethnicity categories.The sum entered below ; must match the totai ciients entered in#42 abav�.Per HUD"Hispanic"is an ethnicity,not a race.'"If none,please enter"'0" -ar;s�ver nr�t��resanteG necause oi,he anss.�et�to#3�- �� i 44.If your agency is submitting more than one application or the same agency has different programs within it,please RANK the � priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY i � #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. r #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. I— #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. � #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. � #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. � #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. � If you have more than 6 applications per organization,agency,district or entity,check here. 45. Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). The Tri-Valley One-Stop(TVOS)is a federaily-funded entity through the Workforce Investment&Opportunity Act(WIOA).The majority of our funding : is passed through the Alameda County Workforce Investment Board(ACWIB)with a match from the Chabot-Las Positas Community Coilege District (CLPCCD).Though TVOS is a grant-dependent service provider,we are not dependent on the City's grant program for our general career services. The requested funding from the City for the Volunteer Income Tax Assistance(VITA)program is 17.8%of the total program funding for the 2016-17 season.We are working with the United Way to increase our direct funding through their IRS grant.As our program grows,we believe the United Way funding will match that growth,and thus help reduce the need for City funding. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL 010043 Budget Funding SourCes/Revenues Budget Amount Amount Committed City of Dulbin $6,000.00 $0.00 City of Pleasanton $8,000.00 $0.00 City of Livermore $6,000.00 $0.00 United Way _ $8,500.00 $0.00 Various Foundations/Corporations $7,222.00 $0.00 Total $33,722.00 $0.00 Funding UseslExpenses Budget Amount Amount Committed Salaries $16,529.00 $0.00 k Benefits $9,612.00 S 0.00 Supplies $750.00 $0.00 Printing/Copying $684.00 $0.00 Postage $115.00 $0.00 Telephone $50.00 $0.00 Rent&Utiliites $3,582.00 $0.00 Travel Reimbursement $500.00 $0.00 Volunteer RecognitionlFood $1,900.00 $0.00 Total $33,722.00 3 0.00 Budget Narrative The Volunteer Income Tax Assistance(VITA)program is evaluated on a year-by-year basis to understand the continued need and available funding.While we are preparing for the 2015-16 tax season right now,this funding request is looking forward to the 2016-2017 tax season. Thus,no funding has yet to be secured for the 2016-17 season.We are proud that our home city of Dublin is the first such ask. The program expenses are heavily weighted to staff salarieslbenefits and volunteer recognition.These are two items without which this program will not operate.All other items are needed for operations and marketing of the services. Documents Documents Requested* Required? Attached Documents' Program Expense Budget for ALL Grant Requests � Proqram Expenses Fonm downioad iemplate Financial Information Form for ALL Grant Requests � Financiai infonnatian Form downloati template List of Board of Directors(or governing body)with contact r GLPCCD Board of Trustees 2015 2016 information __ Current Annual Budget for the Entire Agency � C�PCCD Adoption Budqet 2015-2016 Copy of most recently submitted IRS 990 form or Tax Return � IRS Tax Exempt Letter GLPCCD no 990 or tax return (include compiete form) _ Board of Director's(or goveming body's)designation of � CLPCCP Sicanature Authorization authorized official Board of Director's(or goveming body's)authorization to � Authorization to Repuest F4ndinq request funding(may be same document as one above) Proof of insurance carried,including bonding,liability and/or � ProQf of Insurance C�PCCD workers'compensation REQUIRED FOR COBG ONLY-If requesting Capital Funding, � please upload your Capital expenditure budget(your own format is acceptable) REQUIRED FOR CDBG ONLY-PERSONNEL POUCIES INCLUDING I� AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS I� AND COPY OF LAST AUDIT HIGHUGHTING"FINDINGS° SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION r AND BYLAWS. REQUIRED FOR CDBG ONLY-CONFLICT OF INTEREST r STATEMENT(IF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONIY-ORGANIZATfON CHART � STATE AND FEDERAL NON-PROFIT DETERMINATION IETTER. r IRS Tax Exempt Letter CLPCCD All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application.Non-compliant applicants will be disqualified. REQUIRED FOR CDBG ONLY-AGENCY'S LIMITED ENGLISH � PROFiGIENCY LANGUAGE ACCESS PLAN(LEPlLAP).Must include outreach to limited English speaking residents to encourage access to services&housing.Include what access accommodations are used. REQUIRED FOR CDBG-LEVERAGING REPORT-this is due with � the 2nd quarter report no later than January 15th Certified Audit andlor Certified Financial Statements � CLPCCD Mast Recent Audit oom ran s is no responsi e or e con en o up oa e ocumen s. Application ID:48366 Become a fan of Ziiom,rants'"on Facebook � Problems7 Contact us at wues6ens��ZoemGrarts.com �2002-2016 GranlAnalyst.cam.All righls reserved. "ZoomGrants"and the ZoomGrants logo are trademarks of GrantAnalysLCOm,LLC. ; Lr,GOUt�Brewser � 'III � Email This Preview Save as PDF Print Close Window A�♦ Povverad bv ZoomGrantsT'� City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadline Child Care Links Early Childhood Education $15,000 Requested i Child Care Links � � Y ��� � --____.��..._..�.._ .___�__.,�,_.�.__.. _.�.___..�. Submitted: 12/11/2015 2:17:34 PM(Pacific) i 6601 Owens Dr. Telephone(925)417-8733 ( Ste 100 Fax (925)730-4942 Project Contact Pleasanton,CA 94588 Web www.childcarelinks.org Donnamane Fuller ! United States ct:�arnosonn,hi�dcarei�nks_c�c ! Tel:(925)417-8733 �, Executive Director ; Carol Thompson Additional Contacts ' ct�orr7osan^achiidca�elinKS.orq i none entered I ; �J Application Questions _ ��_________�_____ � � Some answers will not be presented because they are not part of the selected group of questions based on the answer to#30. ( 1.Please describe your organization category(select one of the following): � Private Non-Profit r Public Agency � Other. 2. Please describe your agency's mission(no more than 3 sentences or 250 characters). Providing Resources that Strenthen and Support Children and their Families. 3.For what type of Dublin Grant is your agency applying? � Capital Project (� Public Service Program or Project 4. Is this a"new"service,program,project or activity?"New"is identified as not yet started,implemented or in operation. 1— Yes r No 5.Please indicate below if this application is a request for one-time funding and/or"seed"funding. r One-time funding � Seed funding � One-time and Seed funding � Operational funding � None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other CitylCounty funding received within the last three years�urisdiction,year,amount,purpose,etc.).Enter"NIA"if you HAVE received Dublin Funds. N/A 7.Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skilis and experience,etc.). Since its inception in 1976,Child Care Links has remained a trusted resource to families and Child Care Professionals in the Tri-Valley.The agency's dedication to its Mission Statement of providing support and resources to the Tri-Valley community is consistently seen in its growing and innovative efforts to provide services to the community. ' Child Care Links provides child care referrals to families seeking child care,subsidized child care to low-income families,car seat safety checks,and professional development to Licensed Child Care Providers.Training topics include,but are not limited to,CPR/First Aid,Health and Safety,Nutrition, Business Practices,Car Seat Safety,Positive Discipline,Inclusion of Children with Special Needs,and Building Developmentally Appropriate Curriculums. Child Care Links is a parental choice agency,and aliows parents/guardians to select Child Care Providers who will best meet the needs of their childlchildren and family.Many families enroiled in subsidized child care often choose Licensed Child Care Providers due to reasons such as, convenience,cost,access to trained child care professionais,curriculum and opportunities to exchange information with staff and other parents. In fiscal year 2014-2015,Child Care Links provided subsidized child care to 81 Dublin children using Licensed Child Care Providers. Child Care Links has the capacity to conduct this project through the agency's extensive experience providing car seat safety checks to the Tri-Valley community and providing professional development opportunities to Licensed Child Care Providers.Chiid Care Links also has direct access to Licensed Child Care Providers and the families served through the agency's Child Care Referral and Subsidized Child Care Programs.This will increase Chi�d Care Links'capacity to conduct outreach. 8. Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementation process to describe your project. To provide increased support and services to parents/caregivers and Licensed Child Care Providers to better the lives of the children they care for in the City of Dublin. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) 100 10.Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? 1— Behavioral Health(mental health and substance abuse) � Affordable Housing � Health Care(including dental) I� Workforce Development � Homelessness ' 1— Transportation Services and Access r pomestic Violence and Child Abuse � Disabilities � Food and Nutrition � Senior Services � Youth Services I� Chiid Care,Early Childhood Development and Education r Changing Demographics and Growing Diversity � Financial Assistance � None of the above : 11. Explain how this project will be implemented,administered,and operated. Child Care Links staff will coordinate and manage all project related support and services.Staff will actively recruit Licensed Child Care Providers and parents/caregivers through current agency programs,community events,mailings,online event calendars,email blasts,social media,and Tri-Valley community partners. Registration and sign-in sheets will be administered and collected at all project related activities and events.This information will allow staff to measure the attendance and city residence of each attendee.Evaluations will also be conducted to ensure the project activities are of quality standards and that program staff are addressing the direct needs of the target audience. Staff will ensure activity content is appropriate for the target audience and that the curriculum/activities are adapted and/or translated as needed for cultural appropriateness. 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?). One of the roles of the Dublin grant will be to provide professional development opportunities to Licensed Child Care Providers.Topics will include, Child Development,Literacy,Health and Safety,and Serving Children with Special Needs(Inclusion).The above mentioned training opportunities will allow Licensed Child Care Providers to have access to free,ongoing professional development opportunities that will allow them to better serve and provide child care to the children in their programs. The Dublin funding will also provide funding to purchase car seats(child restraints)for families with outgrown,damaged,or recalled car seats.The car seats will also be made available to families who do not have the financial capacity to purchase a developmentally and/or age appropriate car seat.During the 2014-2015 fiscal year,Child Care Links received multiple referrals from such community paRners as,Shepard's Gate,and Tri-Valley Haven,whose clients were in need of car seats,however,unable to purchase them on their own.The number of car seats that will be purchased will be based off of the need of the community. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome�s)? •Sign-in SheetslTally Forms:Child Care Links will track attendees as well as city residence through administering registration,sign-in sheets and tally forms.This will allow staff to measure the unduplicated quantity of attendees and in which city they reside. •Evaluations:Child Care Links will rovide each artici ant an evaluation at the end of each activi .This will aliow staff to evaluate if activities are effective and addressing the needs of the target audience. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabied,low-income,etc. Through the training and technical assistance,Child Care Links will serve Licensed Child Care Providers.This program will allow Licensed Child Care Providers to received free Early Childhood professional development opportunities in order to maintain quality child care environments. Providing professional development and training opportunities for Licensed Child Care Providers will ensure parents have the ability to select a quality program that best meets their family's needs.Knowing their child is in a safe environment and are being cared for by trained and qualified Child Care Professionals will allow parents/guardians to maintain stable and continuous employment.If parents/guardians do not have adequate child care,they are unable to work. As demonstrated through previous Dublin funding years,Car Seat Safety Program is an important and successful service Child Care Links offers the Tri-Valley community.In 2014-2015 funding year,43%of all of the agency's car seat instatlations/checks were of Dublin residents.According to a study conducted by SafeKids.org,73%of car seats are not installed or used correctly.With proper installation and use,child safety seats can reduce fatal injury by 71%for infants and by 54%for toddlers,age 1-4 years old(SafeKids.org).Child Care Links will continue to target and educate the Tri- Valley community and provide Car Seat Safety Checks. To continue to increase the safety of children,when being transported in vehicles,Dublin funds will allow Child Care Links to target low income parents/guardians who are in need of a car seat,or have been found to own an outgrown,damaged,or recalled car seat. 15. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the clienUcustomer population served�? Child Care Links staff maintains awareness of culturally appropriate practices through on-going engagement in the community and building and maintaining relationships with community members.Outreach events,home visits,and technical assistance appointments are examples of activities that keep Child Care Links staff aware of the diverse and cultural needs of those who live and work in the city of Dublin.Staff will work directly with hired trainers/facilitators to ensure training material and content are culturally appropriate and translated as needed. 16.Explain how your agency will outreach to low-income,limited English speakers,and/or disabled persons.How will each of these groups access the project for which your agency is requesting funding7 Child Care Links will continue to target those currently enrolled in the agency's programs.Programs such as,subsidized child care,and Cal Fresh, participants have to be low-income to qualify.Child Care Links staff will work collaboratively with internal staff to outreach to the projecYs target audience.Child Care Links will also contact community partners,such as CAPE,Kidango,Shepard's Gate and Tri-Valley Haven to promote project activities and services to their clients.Having been a stable fixture in the community for almost 40 years,Child Care Links has made many established relationships with community agencies such as the above mentioned. To meet the needs of limited English speakers,Child Care Links has staff that are fluent in English,Spanish,Mandarin,Taiwanese,Cantonese, Vietnamese,and Russian.Translation services will also be made available for those interested in attending trainings in English. Child Care Links also employs a full time Inclusion Coordinator.This staff member provides effective strategies and tools to assist Licensed Child Care Providers providing child care to children with special needs.Project staff will collaborate with the agency's Inclusion Coordinator to determine needed Inclusion workshops and trainings for Licensed Child Care Providers serving children with special needs. Outreach will continue,but not be limited to,contacting local Mother's Groups,Nanny Agencies,and attending local community events and meetings. 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Valley Family Child Care Association:Child Care Links staff attends,participates and distributes agency program and service information directly to Family Child Care Providers.The VFCCA also refers the families they serve through their child care programs to Child Care Links programs,such as , the subsidized child care,chiid care referrals,and the Car Seat Safety Program. Directors of the Valley:This group is comprised of Child Care Center Directors of the Tri-Valley.Child Care Links staff attends,participates and distributes agency program and service information directly to Center Child Care Directors.The DOV group also refers the families they serve through their child care programs to Child Care Links programs,such subsidized child care,child care referrals,and the Car Seat Safety Program. School of Imagination:Child Care Links Inclusion Coordinator works directly with School of Imagination Co-Founder and Executive Director.Together they provide Inclusion services to Tri-Valley families.Many times,due to School of Imagination's high Wait List,parents are often referred to Child Care Links for Inclusion services and assistance with finding child care. CAPE HeadStart:In previous years,Child Care Links staff worked and collaborated with CAPE HeadStart by providing onsite car seat safety checks, car seat replacements,and literacy activities to CAPE families.Child Care Links also has attended CAPE's parent meetings to provide agency program and service information. California Resource and Referral Network:Annually,Child Care Links receives a list of every Child Care Center and Family Child Care program in the Tri-Valley.In addition,monthly,Child Care Links receives an update of Child Care Programs,which have closed,opened or are pending child care license approval.This allows Child Care Links to maintain an updated database of Child Care Programs in the Tri-Valley.It also increases the agency's outreach capacity. 18. Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. To maintain visibility in the Tri-Valley community,Child Care Links is consistently participating and providing outreach services to many different outlets in the Dublin Community.Each year,Child Care Links participates in Dublin events such as,the Famers Market series,St. Patrick's Day Celebration and Splatter.Child Care Links aiso outreaches through emaii distribution,ciients currently being served through agency programs,flyer distribution to local businesses,online event calendars,onsite trainings and child care referrals. In the past,Child Care Links has funded promotions and advertisements through Bay Area Parent,Pleasanton,Dublin and Livermore Patch,and ParenYs Press. Through the agency's partnership with the California Resource and Referral Network,Child Care Links receives monthly and annual contact information for every Tri-Valley Child Care Program.This allows Child Care Links to directly contact and outreach to the 129 Chiid Care Programs currently in the City of Dublin. Social Media is another venue used to market and outreach to Dublin residents.Child Care Links maintains a current and up-to-date website,providing information regarding upcoming events and workshops.The agency also manages a Facebook page that has over 350 followers and distributes a bi- monthly email Newsletter,which is sent out to over 700 community members. Child Care Links also continuously collaborates with Dublin program,School of Imagination.In August 2015,School of Imagination Co-Founder and �! Executive Director,and Child Care Links Inclusion Coordinator,collaborated and provided an extensive training series to Tri-Valley Licensed Child Care Providers on Inclusion.Attendees participated in a 4 part training series to learn comprehensive and cutting-edge Inclusion and intervention services. The training series included necessary strategies,tools,and tips to best address serving children with special needs in the classroom. 19. Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. In the 2014-2015 fiscal year,Child Care Links received 125 child care referral requests from parents/guardians seeking child care in the City of Dubiin. This resulted in 884 child care referrals of Dublin child care programs.In order to assist Licensed Chiid Care Providers in maintaining safe and quality programs,Child Care Links will provide free professional development opportunities.Topics will include,child development,literacy,health and safety, and serving children with special needs(Inclusion). Dublin funding will also assist Child Care Links with keeping families working.In 2014,70%of the child care referrals received were ftom parents seeking child care due to employment.When children are being cared for in quality child care programs,parents/guardians can maintain their employment.As a resuit,families are working and maintaining stable employment and have the ability to financially contribute to Dublin's economy.If parents/guardians do not have adequate child care,they are unable to work. The Dublin funding will also allow Child Care Links to continue to provide new car seats(child restraints)for families with outgrown,damaged,or recalled car seats.The car seats will also be made available to Dublin families who do not have the financial capacity to purchase a developmentally and/or age appropriate car seat. Child Care Links strongly supports the city of Dublin's mission to,"support a high quality of life which ensures a safe and secure environment that fosters new opportunities."Chiid Care Links supports the creation and maintenance of quality child care environments and child safety.As a result, the Dublin community receives valuable skills,and relevant resources to strengthen and suppoR their day-to-day lives. , 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Funding will cover operating expenses including staff salary,and benefits,the cost associated with training and program materials,printing,outreach and mileage.Please see the budget and budget narrative for specific line item information.Child Care Links does not anticipate have any unspent grant funds at the end of the fiscal year. 21.If this application does not receive funding,or receives reduced funding,what will be the effect on the project? Child Care Links funding is specific to the program it is mandated and/or awarded to operate.If this application is not funded,the agency has no discretionary revenue to provide the services.The City of Dublin's consideration of this request is greatly appreciated. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? (— Yes I�° No 23.If you answered yes to the preceding question please explain.Enter"N/A"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures)T r Yes � No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25.If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"N/A"if not applicable. N/A 26.If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms, plans for future relocation or expansion,etc.).Enter"NIA"if not applicable. N/A 27. If your agency is requesting Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirementsT I� Not Applicable (� Yes � No Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin's Mission 8 Vision Statements: (you may choose more than one) � Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. r Balance history with progress,to sustain an enlightened,economically balanced and diverse community. r Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. � Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) � Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities , and fostering heritage and cultural development � Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety J! Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectura�standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City r Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication � Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concem,and encouraging public and private partnerships of mutal benefit 30.*'QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.**Are you are interested in applying for CDBG fundsl I- Yes.If so,answer questions 31 through 43. � No.If no,check box here,and questions 31 through 43 will not be required.. � Don't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDBG ONLY-Expiain yaur Limited English ProficiencylLanguage Access Pian(LEP/LAP}. How does your agency oukreach to limited English speaking residents to encourage access to services 8�housing?What access accommadations are used? Provide detaii -ans�-��er not preser�ted because of the ans��rer to#30- 32.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Mousing and Urban Development{NUD)Carrsolidated Pian Guiding Principle that relates to yaur project: � -arrs�-ver raoC x�resent�;d becaz.rse of the ar,stve.r ro#�3�1- 33.CDBG ONLY-identify AT LEAS7 ONE U.S.Deparfinent of Housing and Urksan Develapment SHUD)Cansolidatsd Pian Goais thai relates ta your project: � -�(1Sbt-E??",'i'v Ci!gSC;'7;'F.'t'i i7P.,C%7LSE;:)�i�t@ tx'?,S'<':�3t!O 1;.1'�i... .. � 34.CDBG ONLY-lde��tify AT�EAST ONE U.S.Depariment of HUD SCrategic Goai Chat relakes to your projecC: -t'z':'+ "�� itr�)t{ ��?-Y,'ti i N. �..,,°.'� f?!a/;S t f.�..:''.3?i.. . 35.CDBG C}NI.Y-identify AT t_EABT C}NE U.5. Departm�n#ot HUD Policy Priority th�#relates to your project: . -.�?t?SL1•f:';)t>'#?rGSG;�t�.l J�E'C�3iiS�Ol tytE:GY;S4".�E't�^,n,$::j(}- �. 36.CDBG ONLY-Identify AT LEAST QNE Consaiidated Pian abjective that relates to your project: �� -�a,35+,ver ne?pres�;+�ted b�cause af fhe�r,su��r to#.30- 37.CDBG QNLY-Select ONE Ubjective that relates Ya your project(TIP:When selecting an objective ask yo�rself,"What is the purpose of the activity?YVhat is the larger community need that i am seeking ta address?"): -ansvver t�oi presen,ed becatise of tt?e atist-ver to#3l?- 38.CDBG ONLY-Seiect ONE Outcome that relates to your project(TIP:When selecting an outcome ask yourseli,"VVhat type of change or result am I seeking?"�: ansaver r,nt preser�ied becaiise oi fJ�e ans4»er to#30- 39.CDBG t?NLY-Seisct ONE Specific Indicatnr that refates ta your praject: -anstver naf presented�ec�3use of f?�e arsia-er to#3L'- 40.CDBG OhllY-Piease choose a common indicatar that ynur agency wil!use ta track clients(ssiect only ONE�: -�r:s:+�er r;r,!�?r;;sx;�r,t�C uecaiase af the�rs�re+*o�°�?�- 41.CDBG pN�Y-fiar the category yoic selscted ahave,pravide the total number of undupiicated Dubiin clients f EiTNER Persans OR � Nr�useholds)your ageticy anticipates serving Chrough this projcact: .aras4:F;r r.�ai,r,rc, � ?fe,r�e.,.,�+sr; ,` „r a^s4 cr;n#3�:.. � 42.CDBG ONLY-Sased on tMe com�non indicatar you sei2cted a6ovQ, pi�ase list the namber ot undupiicated Dubfin ciients your agency anticipates serving in each cat�qorq."if nane; piease enter„p" -ansi-��er no �resenten ecai�se o ne ans4A�sr to 43.CDBG ONLY-List the number of ciients your agency anticipates serving in racelethnicity categories.The sum entered beiow must match the total clients entered in#42 above. Per HUD"Hispanic"'rs an ethnicity,not a race."if none, please enter°0'" -arts�ver not presented becausa ef the ansvver to#30- 44.If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY r #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. (� #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. r #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. � #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. r #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. (� #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. I— If you have more than 6 applications per organization,agency,district or entity,check here. 45. Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). , Child Care Links looks for fundraising and grant opportunities on a continuous basis.Working in collaboration with other agencies,such as First 5 Alameda County and California Resource and Referral Network,allows Child Care Links to leverage funds from multiple sources and serve a greater number of residents. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-109890 ' Budget ---- Funding SourceslRevenues _ Budget Amount Amount Committed -none- $0.00 $0.00 Funding USeslExpenses Budget Amount Amount Committed Salaries $5,455.00 Benefits $1,925.00 Supplies $980.00 Printing/Copying $95.00 Postage $128:00 Telephone $45.00 Rent and Utiiities $0.00 Accounting/Audit $496.00 Contracted Services $950.00 Events&Workshops $3,450.00 Insurance,Facilitities,Maintenance,Payroll Services and other Administrative costs $1,476.00 $0.00 Total S 15,000.00 $0.00 Budget Narrative PERSONNEL: Staff Salary:$5455 has been budgeted toward,and represents,9°/a staff's annual salary. FRINGE BENEFITS: Fringe Benefits:$1925 has been budgeted toward benefits including FICA,SU�,Worker's Compensation,Life Insurance,Cash Fringe Benefit, Behavioral Heaith,SEP-IRA,Acupuncture/Chiropractor and Long Term Care NON-PERSONNELPROGRAM SUPPORT: Supplies-Program:$980 has been budgeted towards program materials and supplies. Printing/Copying:$95 has been budgeted towards printing and copying costs for outreach efforts marketing and training materials. Postage:$128 has been budgeted towards postage.This will cover the mailing costs of program outreach and advertisement. Telephone:$45 has been budgeted towards telephone use costs.This will allow staff to provide technical assistance to community and correspondence with training facilitators. Rent and Utilities:Nothing has been budgeted ccoun mg u i: as een u ge e owar agency au i s. Events&Workshops:$3450 has been budgeted towards events and workshops.This funding will cover facilitator costs and training materials. Insurance,Travel,Payroll Audit&Administrative:$1476 has been budgeted toward general operating expenses. Documents Documents Requested* Required? Attached Documents* Program Expense Budget for ALL Grant Requests � Propram Exc�ense dawnioad tempiata Financial Information Form for ALL Grant Requests � Financial information for aii Grant Reauests do�xnload temqiatE List of Board of Directors(or governing body)with contact � List of BOD information Current Annual Budget for the Entire Agency (�' Annuai Budqet Copy of most recently submitted IRS 990 form or Tax Retum � IRS 990 (inGude complete form) _ Board of Director's(or goveming body's)designation of � SOD Authorized Officiai authorized official Board of Director's(or governing body's)authorization to � Authorization ta Reouest Fundinq request funding(may be same documentas one above) Proof of insurance carried,including bonding,liability and/or � Proof o#Insurance workers'compensation REQUIRED FOR CDBG ONLY-If requesting Capital Funding, r please upload your Capital expenditure budgef(your own format is acceptabie) REQUIRED FOR CDBG ONLY-PERSONNEL POLICIES INCLUDING r AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS � AND COPY OF LAST AUDIT HIGHLIGHTING"FINDINGS" SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION I� AND BYLAWS. REQUIRED FOR CDBG ONLY-CONFLICT OF INTEREST r STATEMENT(IF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART r STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. I� Federai All organizations MUST have approved non-profit status from State the State of California and Federal Tax Identification Number at –"— time of application.Non-compliant applicants will be disqualified. REQUIRED FOR CDBG ONLY-AGENCY'S UMITED ENGLISH r PROFICIENCY LANGUAGE ACCESS PLAN(LEP/LAP).Must include outreach to limited English speaking residents to encourage access to services&housing.Include what access accommodations are used. REQUIRED FOR CDBG-LEVERAGING REPORT-this is due with � the 2nd quarte�reportno laterthan January 15th Certified Audit and/or Certified Financial Statements r Financials *ZoomGrantsT"'is not responsible for the content of uploaded documents. Application�D:47786 Become a fan uf ZuumGrants'°on Facebook Problems7 Contaet us at uu=stlnns;r,`�Z.e�mGrants.cem �2002-2016 GrantAnalysLcom.All rights reserved. "2oomGrants"and the ZoomGrants logo are trademarks of GrantAnalyslcom,LL0. . :.00cut�Brc�,vsc-�, � �I II��,�IIII�II � Emaii This Preview Save as PDF Print Ciose Window A�♦ � Po�vered bv ZoomGranfsT"" City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadline CityServe of the TriValley CityServe of the Tri-Valley $15,000 Requested CityServe of the TriValley Submitted: 12/11/2015 4:13:06 PM(Pacific) 11501 Dublin Blvd. Telephone925-452-8276 Suite 200 Fax 925-574-2996 Project Contact Dublin,CA 94568 Web www.cityservetrivalley.org ' Gloria Gregory info;cz�citvservetrivallev.orq Executive Director Tel:925-452-8276 Gloria Gregory aloria(c"�citvservetrivallev.orq Additional Contacts carolyn@ cityse rvetrivalley.org,m ary'ory@citywervetriva Iley.o rg Application Questions ISome answers will not be presented because they are not part of the selected group of questions based on the answer to#30. ( 1. Please describe your organization category(select one of the following): ` 1� Private Non-Profit � Public Agency � Other: 2. Please describe your agency's mission(no more than 3 sentences or 250 characters). We exist to serve people in the Tri-Valley by sending volunteers from local churches&the general community to non-profits in our Tri-Valley& coordinating resources between the faith-based community,non-profits,schools,businesses,8�government agencies. 3.For what type of Dublin Grant is your agency applying? � Capital Project r Public Service Program or Project 4. Is this a"new"service,program, project or activity?"New"is identified as not yet started,implemented or in operation. � Yes � No 5. Please indicate below if this application is a request for one-time funding andlor"seed"funding. � One-time funding � Seed funding r One-time and Seed funding � Operational funding r None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other CitylCounty funding received within the last three years(jurisdiction,year,amount,purpose,etc.).Enter"NIA"if you HAVE received Dublin Funds. N/A 7.Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.�. CityServe is governed by a diverse eight member board of directors that meets monthly.Board members are qualified to make decisions on the organization,strategy and operations of this non-profit.They include a diverse group of individuals currently employed in business,church leadership, and military and government empioyment. Programs and projects are led by Executive Director,Gloria Gregory,a 31 year Tri-Valiey resident with 33 years of professional business experience. Gloria holds a Bachelor's degree in Secondary Education).Our monthly financial statements and tax returns are prepared by Jill Dykes,tax preparation business owner over 25 years(Equitable Tax Services in Livermore).She has extensive experience in preparing non-profit financial statements and income tax returns and holds a degree in Business Economics. Over the last 3 years we have buiit a core volunteer administrative team of four individuals who have demonstrated their commitment and ability to staff our o�ce and manage operations.A fifth core team member recently joined us who now serves as our Spanish-speaking member.In October 2015 we hired our first employee,a part-time office administrator,in order to establish stronger office management. We occupy administrative space in the form of an o�ce,with access to a board room,located in The Executive Center in Dublin.Our space ailows us to conduct business and admin tasks as well as meet with clients while protecting their privacy.We also have everything required in the form of information technology including interneUtelephone and a fully functioning website. 8. Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementation process to describe your project. We seek funding in order to maintain our operations as well as provide funds to continue programs 8 meet unmet Dublin resident needs,which have been historically proven such as assistance with auto registration fees,help with rent,utility bill payments 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) We estimate we will serve nearly 2,000 unduplicated residents in Dublin(1,176 were served in 2015). 10.Which of the 14 Areas of Concern identified in the Eastern County 2017 Needs Assessment Report does your project identify with? � Behavioral Health(mental health and substance abuse) � Affordable Housing r Health Care(including dental) r Workforce Development � Homelessness r Transportation Services and Access � Domestic Violence and Child Abuse r Disabilities 1� Food and Nutrition � Senior Services � Youth Services � Child Care,Early Childhood Development and Education ` I� Changing Demographics and Growing Diversity (� Financiai Assistance � None of the above 11. Explain how this project will be implemented,administered,and operated. The project has been impiemented and will be administered and operated as demonstrated over the past 2 years of Dublin grant cycles.The Board of Directors will continue to oversee the organization's vision and the pertormance and fiscal accountability of the Executive Director.The Executive Director will oversee the performance and accountability of the O�ce Administrator and Core Team voiunceers as weu as au tne operations ot tne organiZation.The Executive Director will be responsible for prudent and effective management of all funds.The Office Administrator will be responsible for training and overseeing all office volunteers and for maintenance of appropriate records and office procedures and poliCies.The Core Team volunteers will be responsible for assisting the Executive Director in decisions and actions to creatively meet the unmet individual and family needs referred to us by the city personnel,school district personnel,non-profit personnel,churches,and residents of Dublin and the Tri-Valley and continue to provide unique programs in Dublin and the Tri-Valley.The Executive Director and designated Core Team volulnteers will be responsible for the quality and effectiveness of the website and use of social media to increase awareness of the services we provide as well as awareness of community needs and volunteer opportunities,and increase community collaboration in meeting unmet needs.The Executive Director will continue to plan and implement agendas for the bi-monthly CityServe Community Meetings,which have an established value in increasing communication, education and awareness of the many resources to meet human services needs in the Tri-Valley.The Executive Director&core team members will continue participation in various human services focused community meetings.The Executive Director is on the steering committe of the Tri-Valley Poverty Awareness Coalition.Such presence and participation enhances our effectiveness. 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?). Dublin grant funds are critical in providing a reasonable share of the investment necessary to support our operations and services.Funds will specifically be used for: 1/3 the budgeted Community Needs expense($5800),1/3 the annual rent($3,000),1!3 the annual insurance cost($600),1/3 the phone expense($200),1/3 the annual budget for office supplies($550),100%of the budget for programs(ail listed programs take place in Dublin)-$3750,$300 of the dues and subscriptions budget,1/3 the printing/copying expense($800).Total=$15,000 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome�s�? The outcome measures crucial to the success of the project will include another year of increased investment of volunteer hours in Tri-Valley human services focused non-profits facilitated through CityServe of the Tri-Valley.That number has grown each year since our organization's inception.YTD through Nov.30,2015 that number exceeded 32,000 hours.During 2015 we were contacted by Bank of the West,Keller Williams Realty,Kaiser Member Services Cit of Pleasanton Cit of Dubiin AT&T Valle Children's Museum Senior Su oR Pro ram of the Tri-Valle Lincoln Kinshi Child Care,Pulte Homes,PG&E&more organizations to help them locate group volunteer oppoRunities in the T�-Valley or to provide volunteers for non-profit needs.The monthly CityServe newsletter we publish and our website serve our communities with efficient and effective means of matching volunteers with human service volunteer needs.It will also be crucial that we continue to document the direct services we provide to individuals and families,who have been referred to us by employees of Tri-Valley entities such as the Dublin,Pleasanton,Livermore school districts,Dublin, Pleasanton,Livermore city employees,Echo Housing,Shepherd's Gate,Congressman Eric Swalwell's office,Dublin Mayor David HaubeR,Dublin Senior Center,Wexford Way and Carlow Court Resident Services Managers,Axis Community Health,Dublin Chamber of Commerce and more.We record each referral and the resources we connect them with or the action we take to directly help them on our Human Services Intake Form.YTD through 12/10/15 we have completed 92 of these forms(37 Dublin residents,35 Livermore residents,and 20 Pleasanton residents),several of which represent months of working with individuals/families to help them improve their life situations.We also keep a phone log of each call coming into our office and prepare a monthly recap of the need represented by the call and location of the caller. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled, low-income,etc. We serve all segments of the needy in the Tri-Vailey.Our 2015 Intake forms document that we serve a significant number of seniors(we collaborate with the Senior Support Program of the Tri-Valley,the Dublin Senior Center and below market senior housing resident services managers to serve the senior population in Dublin).We serve the at-risk youth of Dublin directly and consistently through our bi-weekly Valley High Breakfast on Friday mornings.We serve all youth through monthly production and distribution of our CityServe Youth Newsletter,which highlights volunteer opportunities in the Tri-Valley that paRicularly fit youth skills and available time.We solicit volunteers for tutoring programs at Dublin's schools and at after school ' programs at Wexford Way.We serve the disabled in Dublin by responding to calis for direct service help(2015 Intake forms document our quick visits to a mother and disabled daughter facing forced relocation from a Dublin apartment due to increased rent;our visits and coaching on ways to communicate with the landlord resulted in that family being allowed to remain in the apartment.We also quickly responded to an IHSS worker's call to " our office to request help for a disabled resident at the Groves senior housing in Dublin.We collaborated with St.Vincent de Paul in Dublin to counsel him in his financial management,pay a portion of his rent and help with his auto registration cost.We continually serve the low-income by responding to various one-time needs for help with utility bills,cell phone costs,job search resources,gas cost for getting to work,and more.We collaborate with the Dublin School District in their outreach program to the below market housing families in Dublin at Wexford Way and Oak Groves.In October 2015 Tri-Valley Haven allowed us to register residents in those locations on-site for the Tri-Valley Haven Holiday distributions for November and December special distributions in Livermore. 15. How is this project culturatly appropriate(i.e.,describe how it is specifically tailored to the clienUcustomer population served)? Our project is culturally appropriate because we do not discriminate in any way in the individuals/famiilies we serve.We strive to listen closely and understand the perspective of each client and their culture.Our attention and services are open to all ethnic,racial and religious groups.We have recently focused on finding a Spanish-speaking volunteer to enable us to communicate with Hispanic families.We pursued this goal and now have a very qualified Spanish-speaking volunteer available to contact any client Hispanic client we have who needs communication in Spanish.We seek to know of resources to help us communicate with other non English speaking clients.We are working to locate a Farsi speaking volunteer available to help us communicate with a significant population at Wexford Way. In addition to serving ethnic diversity without discrimination,we address the culture of poverty and work hard to match specific needs with solutions that include financial resources as well as logistic resources by connecting people with tangible goods.We have provided the means for anything ' from strollers to oil changes to rooms for temporary housing. 16.Explain how your agency will outreach to low-income,limited English speakers,and/or disabled persons.How will each of these groups access the project for which your agency is requesting funding? One of our primary goals continues to be to collaborate with non-profit agencies that have programs already in place to reach out to low-income, limited or non-English speakers(such as La Familia)and the disabled.We do have volunteers going to Open HeaR Kitchen,reading to Spanish- speaking pre-kindergartners,consistently serving at Easter Seals Kaleidosocope Developmentally Disabled After School Program,and serving the ethnicly diverse population at the Dublin Senior Center.As mentioned in answer to question#15,in October we secured a committed Spanish- speaking volunteer and already have a significant record of more effective and frequent service to Hispanic residents in the Tri-Valley. 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. CityServe actively partners with the DublinlTri-Valley organizations listed to provide more direct services to clients,more volunteers,and more community awareness of the services these non-profits provide.We play a creative,direct role in increasing communication and collaboration between non-profits,school personnel,churches,and city agencies through our bi-monthly CityServe Community Meetings and the listing of Tri-Valley resources on our website and in our newsletters.We partner with: Agape Villages Foster Family Agency-serves foster families ' Axis Community Health-serves low income,no income medical and behavioral health needs Children's Emergency Food Bank-provides food resources for Dublin and Pleasanton residents ' CASA(Court Appointed Special Advocate)-serves at-risk youth in the Tri-Valley area and beyond Camp Parks-we serve military families there and have connected them to serving opportunities(like Dublin Pride Volunteer Day to connect them to our community.We created the Camp Parks Welcome Bag program and Camp Parks Dublin decal program to recognize and affirm the value of the military families at Camp Parks ' Easter Seals Kaleidoscope Developmentally Disabled After School Program-we provide consistent volunteers and services to this disabled youth focused non-profit. Fertile Groundworks-community gardening and food education Hope Hospice-end of life counseling and medical services Literary Programs-Dublin,Pleasanton&Livermore libraries Lincoln Child Center&Kinship Services Livermore Homeless Refuge-shelter for the homeless Open Heart Kitchen-providing food&community for low income residents Senior centers in Dublin,Pleasanton,Livermore-senior services ' Senior SuppoR Program of the Tri-Valley-senior services Shepherd's Gate&Tri-Valley Haven-programs for limited resource working single mothers,programs for victims of domestic violence&addiction Tri-Valley YMCA-serving families Valley Pregnancy Center 18.Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. CityServe's website,www.cityservetrivalley.org lists pertinent information about who we are,resources regarding volunteer needs at human services focused non-profits in Dublin&the Tri-Valley,a listing of over 30 of those non-profits&how to contact them.Our monthly newsletters (general&youth newsletters)are posted on the website.Our monthly newsletters are electronically sent to a database of over 300 Tri-Valley leaders 8�residents.We organize&facilitate bi-monthly CityServe Community Meetings to maintain a community awareness of our services.We are listed as a resource by Eden I&R&provided as a resource through their 211 program.We are listed in the Human Service Pocket Guide produced&distributed by the cities of Dublin,Pleasanton,&Livermore.Our Executive Director volunteers monthly at the Open HeaR Kitchen serving site in Dublin in order to engage with clients there&offer appropriate assistance as discovered.We collaborate with the Dublin School District in outreach programs to below market housing communities in Dublin.In those programs we provide material on resources those residents may need,i.e.the Hot Meal and Food Pantry Listing we created to compile in one document all the hot meal locations and times and food pantry locations and hours and contact numbers throughout the Tr-Valiey. In October at the programs at Wexford Way,Carlow Court and Oak Groves we distributed donated,laundered clothing to youth,adults,seniors.We also had solicited and received permission from Tri-Vailey Haven to register residents in Dublin for their Holiday Distribution Program and did so at Wexford Way,Oak Groves,Carlow Court,8 Valley High as a location to serve families in the general Dublin community. December 2014 we initiated a distribution of clothing,personai care items,food,toys,&household goods to Dublin residents in collaboration with the ' Tri-Valley YMCA.Participation in Dublin Chamber Expo&Dublin Health Fair 19. Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. The City of Dubiin's Value,"Our Values in Building Community-Promote locations and events that bring people of all ages together"is one we clearly support and work to establish. CityServe's existence is rooted in a goal of increasing community and improving the quality of life of residents in Dublin.Our coilaboration with the school district programs,as already mentioned,promotes events that bring people of all ages together at Wexford Way,Carlow Court and Oak Groves.We have created a Dublin program in which primarily senior residents come together and model serving and care for at-risk youth through the Valley High Breakfast program at Dublin's continuation school.We publish and deliver our Youth Newsletter to the students at Valley High and at the : breakfasts talk to them about Dublin community opportunities to serve Dubiin residents at the Dublin Open Heart Kitchen Monday afternoon serving site or through the CityServe initiated food drive that benefits Dublin's food bank(the Children's Emergency Food Bank)as part of Dublin Pride Volunteer Day. Our focus truly is to serve segments of the Dublin population who are experiencing human service needs which may prevent them from the security needed to enjoy the community implied in all ages coming together at Dublin locations and events. 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. This budget is cost effective because it represents minimal expenditures for continuing use of our office location in Dublin and basic costs to ensure the sustainability or our work.The Community Needs budget is based on actual direct financial expenditures made in 2015 for needs clients could not find met by another organization.Funds invested to meet those needs were carefully evaluated and the limited funds were used to gain the maximum benefit to help clients(many times single parents with children involved or senior citizens)to survive a homeless or critical item need(repair of a car or restoration of cell phone service so needed resources could be accessed or communication from an employer could be restored).Based on 2015 facts,this budget will take homeless Dublin youth out of a situation in which he was sleeping in an apartment stairwell in east Dublin,it will allow restoration of utilities to a single mother and her 5 children who had living in west Dublin without power for 5 months,it will help provide a 70 year old senior resident new to Carlow Court who had lost all her belongings because she could not pay a storage unit bill-it will provide her with bath towels ' and a blanket and an initial,basic food supply,and donarted fumiture and household goods. 21. If this application does not receive funding,or receives reduced funding,what will be the effect on the project7 If we do not receive funding,our ability to continue to provide the many services,and especially the critical direct services,we provide to Dublin residents will be seriously jeopardized.There would not be funds to help Dublin individuals and families in the ways we have provided examples of in the answer to question#20 above. If we receive reduced funding,there will be an effect that the extent of services we hope to provide to Dublin residents and the increase in the level and amount of services and creativity we can bring to longer term solutions for Dublin's human service issues will be diminished to the degree our funding is reduced. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? � Yes � No 23.If you answered yes to the preceding question please explain.Enter"N/A"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures)T ' (� Yes I� No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25. If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"NIA"if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms,plans for future relocation or expansion,etc.).Enter"N/A"if not applicable. N/A 27.If your agency is requesting Capital funding,will this project require implementation of Davis-BaconlFair Labor Standards Act requirements? � Not Applicable r Yes I— No (+ Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES IdentiTy AT LEAST ONE of the Ciry of Dublin's Mission 8 Vision Statements:(you may choose more than one) � Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. r Balance history with progress,to sustain an enlightened,economically balanced and diverse community. r Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. � Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) � Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development � Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety � Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City � Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication r Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutal benefit 30.**QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.**Are you are interested in applying for CDBG funds? � Yes. If so,answer questions 31 through 43. � No.If no,check box here,and questions 31 through 43 will not be required.. 1— Don't know.If you are unsure,please cail the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDBG t3NLY-Explain yaur Limited Engiish ProficiencyiLanguage Access Ptan(LEPIL.AP}.How does your agency outreach to Iimited English speaking residents to encourage access to services&hausing?What access accommodatians are used? Pravide detai! -answer nvt presenfe�'k�ae�us��of�he�nst.,,ar±r�#3�J 32,CdBG ONLY-ldentify AT LEAST ONE U.S.Depaitment of Housing and Urban�evelopment(HUD)Consotidated Plan Guiding Principie that relates to your praject: -��s.+rer not p�cser�Petl t�ecr7use et fhe a;?s4�er lo#3C1- : 33.CDBG QNLY-identify AT I.EAST ONE U.S.Department of Housing and Urban Development(HUD)Gansolidated Pian Goais that relates to your project: -ar,swer nof�resented because af the ansia-er!o#30- 34.CDBG ONLY-Identify AT LEAST ONE U.S.Department af HUD Strategic Goai that relates to your praject: -ar�s�.✓er r�of presenfad because of th,e ansiver to#3Q- 35.CDBG ONLY-Identify AT t,EAST iJNE U.S.Department of HUD Policy Priority that reiates to your project: -arastver r�of praserfed because of�he ansiver to#3D- 36,CDBG ONLY-Identify AT LEAST ONE Cansolidated Pian ob�ective that�elates Yo your project. -ans�-ver noP preseniecl because of the arasi-�r�r tn#30-. 37.CDBG ONLY-Select ONE Objective that relates to your prajact(TiP:When selecting an objectiue ask yourself,"What is the purpoae oE the activiey?What is khe larger community nead Yhat i am seQking ta address?"}: ..�f?S'.',°i"^O!,C.'`E'SE't7:`�'i ufiCciilSF'O.`.`.tp a.;S'-�;G'r;i;i�"',..?;� . 38,CD�G{}N�.Y-Se{ect ONE CJUtcome that relates tc�yo�r project(TIP:When selecting an outcc�me ask yaurseif,"INhat Cype af change nr resuit a�n !seeking'?"}: � ...� .�;r-:�Y��U�j1i�a`r i,.UY%f?i,aU„f;�;f;' t;tt..,� �i .:�?n.. �. 39.CDBG ONLY•Sei�ct ONE Specilic ind3cator fhat relat�s fo your proj�ct: � -ar7sv��ernot u?"°serte�hecause af?:he ans��r�%to#3J- . ease c aose a common in icator ai your agency wi use o rac c ients se ect on y -ansvver rtot presan?ed because of the arts4a�er'to#3t?-- � 41.CDBG ONLY-For fhe category you selected above,provide the totai number of undupiicated Dublin ciients{EiTHER Fersons QR Hausehalds)your agency anticipates serving through this project: � ��ns;ver�nc,t presente<1�eca�.se nf if�e�nsu�er`e#3t3- A2.CDBG ONLY-8ased on the common indicato�yau selected above, piease Iist the number ot undupiicated Qubiin clients yo�r agency anticipates servir�g in each category."if none, piease enter"0". -ar;s�:ti���;�of pre;e,,�e;c,'bec,e;;se of:r e'%�r�ct^:-c-?rn#3r�- ' 43.CDBG QNLY•4ist the n�rmb�r ai clicnts your ac�ei�cy anYicipates serving irr racefethnicity categories.ThQ sum enter¢d belaw � must�na#ch the total clier5ts antered in#42 ahove. Per MUQ"Hispanic"'is an ethnicity,nat a race."if none,please enter"Q" � c3�S�y �CT t'rf. G �'�9 tJr �..>�i:7 t G.:i;St (, .,�rr,.,:�-- 44.If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY � #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. r #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. � #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. � #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. � #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. r #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. � If you have more than 6 applications per organization,agency,district or entity,check here. 45. Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). As our budget shows,and as our 2015 YTD profit and loss shows,we have grown in our ability to attract support funds through business/corporation and individual donations.We have also been preparing strategies to submit grant applications to businesses like Welis Fargo Bank.We have identified a grant writing resource who has provided us with a list of bay area grant sources likely to fund our work.In 2015 we grew our Board of Directors membership to include a member with experience in a non-profit fundraising position,and we held two small fundraising event (our first),that were successful.We will continue to develop fundraising strategies.We also host a well-attended annual Prayer Breakfast which allows networking by local business leaders,churches and military personnel,and is a vehicle for financiai pledges. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. Our business license customer number is 00043509. Budget �� __.__.. .�.____._.___.. _ __ Funding Sources/Revenues Budget Amount Amount Committed Church contributions $20,000.00 $20,000.00 Ciry of Dublin Grant $15,000.00 $0.00 City of Livermore Grant __ $15,000.00 $0.00 Ciry of Pleasanton Grent $15,000.00 $0.00 Corporate grants/donations __ $20,000.00 $5,000.00 ' Individual donations $14,400.00 $12,000.00 Total _ $99�400.00 $37,000.00 Funding UseslExpenses Budget Amount Amount Committed Personnel expenses-contract salaries(F�cecutive Director$33,500,Officer Administrator$18,000) $51,500.00 $34,000.00 Rent $9,000.00 Phone $600.00 Insurance $1,800.00 Office supplies $1,650.00 Contracted services(tech,website support,grant writing) $9,000.00 $3,000.00 Dues(Chambers of Commerce) $900.00 $0.00 Board expense $250.00 $2,400.00 Printing©ing $900.00 Accounting/Audit Postage $200.00 Community Needs:bus/BART tickets$550,utilities$1300,gas$400,medical$900,gift cards$200, $�7,450.00 phones/phone service$750,shelter$12,000,Tires,auto registration,etc.$650 ', Programs(Valley High Breakfasts$1500,Camp Parks Welcome Bags$160Q Camp Parks Breakfasts(2x) $3,750:00 $250 _ oa , • � • Budget Narrative ! This budget provides for the establishment of salaried contract positions of Executive Director and O�ce Administrator,which are necessary ' for the sustainabiiity of the organization.The budget also provides for minor expansion of office space to accommodate our need for expanded square footage needed.Other expenses are based on actual 2015 ytd expenses through October 31,2015.Our coverage of unmet individual and family financial needs(emergency shelter(motel costs),help with rent,utility,cell phone,auto registration,etc.expenses)provides only a portion of those needs;we collaborate with churches and other paRners who also directly cover such financial needs.We believe this overall budget is very reasonable for the service we provide to our communiities. Documents Documents Requested* Required? Attached Documents" Program Expense Budget for AlL Grant Requests r ProgramExpense dawnload template _ Financial Information Form for ALL Grant Requests � Financialinfo download template _ _ List of Board of Directors(or goveming body)with contact � Board of Directors information ' Current Annual Budget for the Entire Agency r 2015 budpet Copy of most recentty submitted IRS 990 form or Tax Retum r 990 Tax fonn (inGude compiete form) Board of Director's(or goveming body's)designation of � Deswnated Offciai authorized official Board of Directo�'s(or govemingbody's)authorization to � Authorization Request Funds request funding(may be same document as one above) Proof of insurance carried,inGuding bonding,liability andlor (�' Proof of Ins workers'compensation REQUIRED FOR CDBG ONLY-If requesting Capital Funding, r please upload your Capital expenditure budget(your own , format is acceptable) REQUIRED FOR CDBG ONLY-PERSONNEL POLICIES INCLUDING I� AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS � AND COPY OF LAST AUDIT HIGHLIGHTING"FINDINGS" SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION � AND BYLAWS. REQUIRED FOR CDBG ONLY-CONFLICT OF INTEREST r STATEMENT(IF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART � STATE AND FEDERAL NON-PROFIT QETERMINA710N LETTER. I� tea EiN , All organizations MUST have approved no�-profitstatus from State nan-profit desiqnation the State of Gaiifornia and Federal Tax Identification Number at time of applicaUon.Non-compliant applicants will be disqualified. REQUIRED fOR GDBG ONLY-AGENCY'S LIMITED ENGLISH C ' PROFICIENCY LANGUAGEACCESS PLAN(LEP/LAP).Must include outreach to limited English speaking residents to encourage access to services&housing.Include what access accommodations are used. REQUIRED FOR CDBG-LEVERAGING REPORT-this is due with � the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements I^� Financiaiinfo 'ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:48444 � Become a fan or 2r,er�,Granis''�on Fecebook � Problems7 Contact us at��estio-�>;a"�Zocm;rai+.is.com . �2002-2016 GrantAnalyst.com.All�ights reserved. '� "ZoomGranls"and the ZoomGrants logo are trademarks of GrantAnalyst.com,LLC. ��L`s I 6row'er { � Email This Preview Save as PDF Print Ciose Window A�♦ p ��� r o.vered bv LoamGr�,ntsT��" City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program ' 12/11/2015 deadline Community Resources for Independent Living Independent Living Services and Housing a 8,586 Requested j Community Resources for ' Independent Living —� Submitted: 12/11/2015 12:48:03 PM(Pacific) ��� Telephone(510)881-5743 439 A Street Fax (510)881-1593 Project Contact Hayward,CA 94541 Web www.crilhayward.org Michael Galvan United States Proqrams(c�crilhavward.orq � Tel:510 881 5743 x31 Executive Director Ron Halog Additional Contacts Ror�HalaqC�a crilhavward.orq Michael.Galvan@crilhayward.org Application Questions ( Some answers will not be presented because they are not part of the selected group of questions based on the answer to#30�� 1. Please describe your organization category(select one of the following): � Private Non-Profit r Public Agency (y Other: 2. Please describe your agency's mission(no more than 3 sentences or 250 characters). CRIL is a peer-based disability resource agency that provides advocacy,services and resources for people with disabilities to improve lives and make communities fully accessible. 3.For what type of Dublin Grant is your agency applying? I— Capital Project � Public Service Program or Project 4. Is this a"new"service,program,project or activityT"New"is identified as not yet started,implemented or in operation. r Yes � No 5.Please indicate below if this application is a request for one-time funding and/or"seed"funding. � One-time funding � Seed funding � One-time and Seed funding r Operational funding r None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received ' within the last three years(jurisdiction,year,amount,purpose,etc.).Enter"N/A"if you HAVE received Dublin Funds. N/A 7.Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.). For 36 years,Community Resources for Independent Living(CRIL)has been providing comprehensive life skills training,including housing assistance 8�job readiness to southern&eastern Alameda County residents with all types of disabilities.The majority of CRIL's service providers are peers- individuals who have a disability-who are uniquely qualified to offer peer support and empowering guidance to lower income residents who face physical and societal barriers to employment,self-sufficiency,self-determination and access to goods&services.Since opening a full-service Tri- Valley branch office in 2001,CRIL has also been readily accessible to Dublin residents with disabilities and seniors with functional limitations. ; The Independent Living philosophy is one of seif-directedness and self-determination.With support,encouragement,self-advocacy skills and equal access to resources,people with significant disabilities can achieve their goals and prosper as active members of their community.CRIL's board of directors and management are also community members with disabilities who are role models,for both our consumers and the iarger community. Though we are a small organization,CRIL is fiscally sound and weil managed organizationally.We serve a larger number of consumers,offer more diverse wrap-around services and effect more social&policy systems change through our community advocacy than many larger independent living centers in CA.CRIL's staff 8 management are highly trained and educated in the fields of social service,education,psychology,sociology,counseling, community organizing&theology.All services providers are cross trained by their peers , 8. Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters�.This text will be used widely during the review and implementation process to describe your project. Provide Housing Assistance, Employment Counseling,Advocacy Training,Travel Training, Leadership Development and Independent Living Support Services for under-served,low income Dublin residents with disabilities and seniors with functional limitations. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) 20 directly;50 indirectly. 10.Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? r Behavioral Health(mental health and substance abuse) � Affordable Housing � Health Care(including dental) � Workforce Development � Homelessness r Transportation Services and Access � Domestic Violence and Child Abuse � Disabilities r Food and Nutrition I� Senior Services r Youth Services r Child Care,Early Childhood Development and Education � Changing Demographics and Growing Diversity � Financial Assistance 1� None of the above 11. Explain how this project will be implemented,administered,and operated. CRIL's Tri-Valley staff are quite familiar with the resources and services available in Dublin and the surrounding cities.With our Tri-Valley office located in the Livermore Multi-Service Center,we have developed strong relationships with service providers at ECHO,Abode,the Livermore Housing Authority,Dublin's Housing Services Department and other local agencies that provide housing&social services.CRIL's Tri-Valley Employment& Benefits Coordinator is a bilingual woman with a disability,and provides disability peer support and role modeling to both English and Spanish speaking residents of Dublin.This year,CRIL will actively recruit Dublin youth(16-24)to establish a Disability Action Network for Youth(DANY),a disability rights advocacy group. CRIL is a subcontractor with the Chronicle Season of Sharing program and has access to funding to assist qualifying low-income residents with one- time delinquent mortgage or rent payments,security deposits,faccess modifications or other costs associated with retaining housing or moving into a new home. CRIL's Housing,Employment&IL Services will be administered through the following comprehensive service methods: 1.Monthly Housing Workshops-topics include individual housing needs,eligibility for Section 8&other subsidized programs,credit reports 8 repair, housing research,appiications,interviews,tenant rights&responsibilities. 2.Monthly Job Club&1:1 Employment Counseling 3.Monthly Travel Training Workshops 4.Individualized Travei Training Excursions on WHEELS,BART&AC Transit 5.Monthly Peer Support Groups 6.Individual Independent Living Plan development&coordination-CRIL's 2 IL Coordinators meet individually with each consumer to develop a plan with specific steps&timelines for meeting goals 7.IL Coordinators refer or coordinate meetings with other service providers 8.IL Coordinators check in with each consumer every 30-60 days to see how they're doing with meeting goal 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?). Dublin Grant funds will be used to help support the costs of operating a full-service branch office in the Tri-Valley,thereby being accessible to low- income Dublin residents with disabilities. CRII is requesting$8,586 in Dublin Community Grant funding for FY 2016-17,which will allow us to increase Independent Living(IL),Housing services,Youth Services,Mobility and Travel Training,as well as,Job Readiness support in the Tri-Valley area.CRIL projects to serve 20 low income Dublin seniors and residents with disabilities,as well as provide I&R to 50 other residents.CRIL will actively recruit youth to form a Disability Action Network for Youth(group advocacy)and to offer a Community Leadership Academy:Leaders Without Leaders which develops leadership skills and encourages participants to join community and government committees and comissions. FY2015-16 continues to see a dramatic increase in the number of Dublin consumers served.Funds will primarily cover XXXX%of the salary and benefits of the two IL Coordinators with a small amount for shared indirect costs associated with necessary program and o�ce operations(e.g., telephone,supplies,insurance,etc.). 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome(s)? CRIL's Housing,Employment 8 IL Services for people with disabilities will provide 20 Dublin residents with improved access to affordable housing, peer counseling,employment 8�benefits counseling,travel training,I&R,assistive technology info&AT device loans 8 advocacy.Housing counseling will include iocal resource info,application assistance,budgeting&credit counseling,landlord mediation and/or applications to the Chronicle Season of Sharing and Dept.of Rehabilitation's housing transition fund.CRIL will also provide indirect information&referral,technical&assistive technology suppoR,ADA&disabiiity law education and community advocacy to 50 additional Dublin residents&businesses to increase their knowledge& independence.With Livermore&Pleasanton youth,a youth advocacy group(DANY)will be formed. CRIL utilizes a national online database management system called CILSuite,which is specifically designed to track data and services for independent living centers.Data can be entered securely from any computer with internet access and CRIL management is able to monitor the timeliness and completeness of every consumer's service record.The structure of the online Intake form and data logs allows for uniformity and consistency in all consumer service records.CILSuite allows CRIL staff and management to regularly track and monitor each consumer's status with completing steps to achieve their personalized goals,as well as progress toward achieving the defined program outcomes:retention or placement in affordable, , accessible housing�an increase in personal independence&self-sufficiency. Consumers complete an annual Satisfaction Survey which allows us to evaluate the type&quality of services provided.Consumers provide management&the board of directors with feedback on the impact that our services 8�supports have had on their level of independence. 14.Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled,low-income,etc. This program will serve low and very low income Dublin residents of all ages who have a disability or disabling condition,including youth and seniors. Dublin residents will benefit by being able to retain or obtain affordable,accessible and safe housing through their work with CRIL's IL Corrdinators, which in turn decreases the City's homeless population and minimizes the possbility of unneccessary institutionalization of this at-risk population. Those seeking employment will have guidance and assistance from CRIL's Employment&Benefits Coordinator who is an SSA CeRified Work Incentives Counselor(CWIC),specially trained on counseling consumers on the integration of work incentives and other tools to achieve self- sufficiency through employment.CRIL's providers will also assist consumers with navigating the job readiness resources available through the American Job Centers,and prepare consumers for their job hunt through the CRIL Job Club which addresses creating cover letters,resume writing, interviewing skills,dressing for success and more. Other Dublin residents with disabilities will obtain needed information,support,counseling and training which will help them maintain or gain greater independence and well being,thereby decreasing the likelihood of emergency intervention or institutional care.A Dublin resident who benefited from CRIL services is Willie.With three CRIL staff collaborating with Season of Sharing to process his application for help quickly,Willie was approved with $1,341 for rental deposit,and moved into the apartment in Dublin within 1-1/2 weeks.Had CRIL not acted in an efficient,and quick manner I believe Willie could have lost his section S voucher,and become homeless. 15. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the clienUcustomer population served�7 CRIL's IL services are directed specifically toward low-income Dublin residents with disabilities&older seniors who are typically underserved and extremely vulnerable.Since the majority of CRIL's staff are also people with disabilities who live in Alameda County,we are in a uniquely credible& powerful position to provide peer counseling,personal support,an array of local resources and peer role modeling with this population. Having a full service branch office at the Livermore Multi-Service Center also allows CRIL staff 8 management to develop and maintain strong partnerships 8 collaborations with other Dublin area social service agencies.For example,we have presented workshops on personal assistance services,assistive technology,disaster preparedness&healthy living at the Dublin Senior Center and to residents who live at local HUD apartment complexes.We have also partnered with the Livermore Hindu CCC annually since 2012 to sponsor a Mega Health Fair for low-income Tri-Valley residents.With grant funding,CRIL has provided 175 low income residents with free flu vaccines through Sutter At-Home Heaithcare.CRIL also participates in the Tri-Valley Affordable Housing Committee as we collaborate with others to address the severe housing crisis in Dublin and the East Bay. one of CRIL's Tri-Valley Coordinators is also bilingual&bicultural in Spanish/English and is therefore able to provide culturally appropriate,direct outreach&services to the 14.5%Hispanic population of Dublin.Not only are individual services provided in Spanish for these consumers,but many of our classes,workshops and trainings are also separately conducted in Spanish or with simultaneous translations provided.We also have a contract with Hands On and a list of ceRified independent ASL interpreters that we utilize for County residents who are deaf. 16.Explain how your agency will outreach to low-income,limited English speakers,and/or disabled persons.How will each of these groups access the project for which your agency is requesting funding? CRIL has 3 offices strategically located in southern and eastern Alameda County to provide optimum access to everyone who can benefit from CRIL's services.All three offices(Hayward,Livermore,and Fremont)are on,or close to,bus routes and other forms of public transit.Facilities are also completely accessible to people with mobility and sensory disabilities and include automatic doors,accessible paricing and restrooms,TTY phones, and materials in other languages and alternate formats.All 3 offices are open Monday through Friday with drop-in hours on Tuesdays&Thursdays. Services are also provided via phone,in the community,or at the person's home for those who cannot readily travel to one of the offices. More than 1/3 of CRIL's staff are bilingual in Spanish/English,with one Tri-Valley provider being a Latina with a disability.Another CRIL service : provider is Chinese and speaks Cantonese.All CRIL informational materials are available in large print,Braille,on CD and in Spanish and Chinese.CRIL utilizes the County's Language Line for other language translations. 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. CRIL's Tri-Valley branch is located in the Livermore Multi-Resource Center,allowing CRIL to work closely with several other service agencies co- located at the Center.CRIL staff often bring a consumer over to work with a colleague at Department of Social Services,Department of Rehabilitation, ECHO Housing or EBI in order to address the person's comprehensive needs,especially in relation to housing assistance.We have closely collaborated with the Livermore Housing Authority,Abode,ECHO and Season of Sharing(SOS)a number of times in order to improve the probability of reaching the desired outcome of a housing placement Various Tri-Valley workshops are often co-facilitated with staff from Alliance Health,Senior Services Coalition,the Public Authority of Alameda County,the Alameda County Public Health Department,Social Security and the Alameda County Food Bank.Some are held at the Livermore Multiservice Center and others at Tri-Valley area senior centers,libraries or housing complexes.Other social service agencies with which CRIL staff routinely coordinates services include Eden Housing,BACS,BOSS,FESCO,HACA,Tri-Valley Senior Support Services,CIWP,the Center for Independent Living(CIL),Spectrum,Season of Sharing and the Tri-Valley Haven. CRIL partners with CIL in Berkeley and the Alameda County Area Agency on Aging(AAA)in the county's Aging&Disability Resource Connection or ADRC.This core team of CRIL,CIL and AAA is working with over 20 other agencies that serve seniors and persons with disabilities to improve the access to and coordination of Long Term Services and Supports for these populations to maintain their health,independence and activity within the community. 18.Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. CRIL participates in or co-sponsors over 50 outreach events annually with several located in the Tri-Valley cities and in Dublin specifically.Many of these outreaches are targeted toward youth,seniors,families,people with disabilities or communities with health concerns and Spanish-speaking groups.CRIL has participated in the Dublin Senior Health Fair,the Tri-Valley youth transition fair,as well as the Hindu Temple Health Fair and several community and senior fairs in Livermore and Pleasanton.Our staff often attend community meetings and events in the Tri-Valley,including visiting residents and resident managers at Dublin housing complexes,such as The Groves and Emerald Vista. We also advertise in the Alameda County print and online telephone directories,with Eden 211,local newspapers,Spanish language channel 14, Chinese World News,Alameda County Senior Directory,Livermore Hindu Center,Livermore Chamber news,Hayward Chamber news,Fremont FRC news,at local senior centers,libraries and city halls,and on CRIL's own website and Facebook page,as well as in our monthly e-newsletters and periodic event mailings.Our website is fully W3C accessibly-compliant(www.crilhayward.org),has a large print access feature,and has a Google button for immediate,basic translation into other languages.CRIL's iistserv has 740 consumers who regularly(twice a month)receive emails from : CRIL concerning the disability community. CRIL Staff,Board,Disability Action Network and Disability Action Network for Youth members also serve on number of boards,commissions and advisory councils throughout Alameda County.Therefore,we are involved in a variety of social and economic justice activities with other local : agencies,and are well known in the community. 19.Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. CRIL's Independent Living, Housing 8 Employment Program promotes and supports a high quality of life and ensures a safe,diverse and economicaily balanced community within Dublin by providing suppoR services and direct intervention to help low income people with disabiiities who are at risk of losing their housing maintain it,and those who need to secure affordable housing obtain it. In addition,since Dublin values a strong,open and responsive government that addresses the needs of all residents and businesses,CRIL's Housing, Employment and IL Program suppoRs meeting the City's goal of investing in a community service that reaches out to its most vulnerable and growing population of older seniors with disabling conditions as weil as very low income residents of all ages with disabilities. 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Since the majority of CRIL's consumers are extremely low income,it is vital&significant that CRIL does not charge consumers for any program costs &does not limit the amount of services they can receive. The cities of Livermore 8�Pleasanton,funding from the Hindu CCC,ACTC and Cal Tran funding for travel training,Dept.of ED and funds under contract with CIL,all contribute to the overall costs of operating CRIL's Housing,Employment&IL Services program and supporting our full-5ervice branch office in the Tri-Valley.The city of Dublin's poRion to support CRIL's Tri-Valley services is 9.37%. CRIL provides more than one dozen programs&services to residents in the Dublin community,including education,training,employment services, benefits counseling&peer suppoR groups.We also provide ADA materials to businesses&non-disabled Dublin residents,which improve the accessibility&inclusiveness of the Dublin community.Housing placement services are extremely time intensive and often,especially for very low income residents who can only afford subsidized housing units,take a longer period of time to achieve.Typically hours&hours of direct service time and networking are involved in helping people with disabilities locate an affordable and accessible long-term home--even when they already have a rare Housing Choice voucher. This project is very cost effective for the City because with a limited investment that leverages other funding,CRIL is able to maintain a level of knowledgeable,caring,and culturally proficient service providers to assist the City with reducing homelessness&meeting the housing needs of its most vulnerable residents,assist others in obtaining employment&moving out of poverty,and to improve the lives of many other low income residents with disabilities through peer support groups,IL 8 advocacy skilis training,mobilityltravel training,community leadership development,I&R and resource connections. 27.If this application does not receive funding,or receives reduced funding,what will be the effect on the project? Funds contributed by the City of Dublin help leverage funds from the other two cities in the Tri-Valley area,as well as private foundation 8�other government support.The diversity of Tri-Valley funding specifically allows CRIL to maintain a local presence in the Tri-Valley area,serving the entire communi y wi a -ime, u service capaa y ranc o ice. Though Dublin funding is only 9.37%of the total program budget,CRIL strongly relies on the City's support to maintain our presence in the Tri-Valley. Without Dublin funding,CRIL would not be able to continue operating a full service branch office in the Tri-Valley area.CRIL has sustained significant cuts to its operating budget since the great recession of 2008 and the slow economic recovery.Some of these cuts have resulted in decreased staffing and loss of individual services availability.Further reductions would result in diminished o�ce hours or complete office closure.Without CRIL's local presence in the Tri-Valley,it would be extremely difficult for Dublin residents with disabilties to receive personalized,in-depth services.For those who are in jeopardy of losing their housing,Dublin would see an increase in homelessness and institutionalization among its most vulnerable residents -a significantly threatening reality in this current environment of high rents and low vacancies. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? � Yes � No 23.If you answered yes to the preceding question please explain.Enter"N/A"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures)? r Yes r No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25.If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"NIA"if not applicable. N/A 26.If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms,plans for future relocation or expansion,etc.).Enter"N/A"if not applicable. N/A 27. If your agency is requesting Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements7 � Not Applicable 1" Yes (� No r Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identity AT LEAST ONE of the City of Dublin's Mission&Vision Statements:(you may choose more than one) � Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. � Balance history with progress,to sustain an enlightened,economically balanced and diverse community. � Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. � Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) r Building Community:by promoting IoCations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development � Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety � Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendiy development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City � Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication � Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutal benefit 30.*'('�UESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.**Are you are interested in applying for CDBG funds? � Yes.If so,answer questions 31 through 43. r No.If no,check box here,and questions 31 through 43 will not be required.. � Don't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDBG ONLY-Explain your Limited English ProficiencylLanguage Access PIan�LEP/LAP).How does your agency outreach to limited English speaking residents to encourage access to services 8 housing?What access accommodations are used?Provide detail P/ease enter"N/A"if you are not interested in qualifying for CDBG funding. . o s s a are i ingua m ng is panis ,an a i iona s a mem er is i ingua in ng is an onese. e a so use e oun s anguage ine, as well as,having resources for ASL interpreters.CRIL's materials are avaliable in alternative format:Large print,Braille,CD. 32.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Guiding Principle that relates to your project: , � Be culturally accessible,appropriate and inclusive r Encourage community engagement and involvement 1� Promote energy and resource efficiency � Encourage networking and information sharing across service providers � Encourage process streamlining 1�1 Consolidate service delivery � Not Applicable.I am not interested in qualifying for CDBG funding. 33.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Goals that relates to your project: � A)Support and develop a continuum of housing resources that will increase access to low-income,seniors,disabled and homeless persons with emphasis on activities that: (� `Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. � `Preserve and increase affordable rental housing opportunities for low and moderate income households. � *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. r *Promote fair housing and reduce housing discrimination. (�' B)Improve community health and access to basic and specialty care including dental and optometry care,behavioral and mental health care ' services especially for low-income,uninsured and under-insured residents with emphasis on activities that: (� *Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. �' 'Increase outreach and access for underserved populations including limited English speaking persons,youth,disabled,seniors and homeless persons. � C)increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 1° D)Support and expand programs and opportunities that keep seniors engaged and involved in their community. �' E)Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. r F)Not Applicable. I am not interested in qualifying for CDBG funding. 34.CDBG ONLY-Identify AT LEAST ONE U.S.Department of HUD Strategic Goal that relates to your project: ' I� Increase homeownership � Promote decent affordable housing � Strengthen communities , � Ensure equal opportunity in housing ' � Promote participation of grass-roots,faith-based,and other community-based organizations r Not Applicable.i am not interested in qualifying for CDBG funding. 35.CDBG ONLY•Identify AT LEAST ONE U.S.Department of HUD Policy Priority that relates to your project: - r Provlde InCrBased homeownefship and rental opportunities for low and moderate-income persons,persons with disabilities,the elderly, minorities,and families with limited English proficiency. (�° Improving the quality of life for our Nation's communities (� Encouraging accessible design features. � Participation of minority-serving institutions in HUD programs. r End chronic homelessness within ten years. � Removal of barriers to affordable housing. (— Not Applicable. I am not interested in qualifying for CDBG funding. 36.CDBG ONLY-Identify AT LEAST ONE Consolidated Plan objective that relates to your project: r Increase the availability of affordable rental housing for extremely low income(30%),very low income(50%)and low income(80%) households. r Preserve existing affordable rentai housing and ownership for households at or below 80%of Area Median Income(AMI). ' (� Assist low and moderate income first-time homebuyers. (— Reduce housing discrimination. � Maintain,improve and expand(as needed)the capacity of housing,shelter and services for homeless individuals and families including integrated healthcare,employment services and other supportive services. � Maintain and expand activities designed to prevent those currently housed from becoming homeless. r Build on i�ter-jurisdictional cooperation to achieve housing and homeless needs. � Increase the availability of service-enriched housing for persons with special needs. Not Applicable.I am not interested in qualifying for CDBG funding. 37.CDBG ONLY-Select ONE Objective that relates to your project(TIP:When selecting an objective ask yourself,"What is the purpose of the activity?What is the larger community need that I am seeking to address?"): r Creating a Suitable Living Environment f Providing Decent Affordable Housing 1� Creating Economic Opportunities � Not Applicable.I am not interested in qualifying for CDBG funding. 38.CDBG ONLY•Select ONE Outcome that relates to your project(TIP:When selecting an outcome ask yourself,"What type of change or result am I seeking?"): � Availability/Accessibility � Affordability r Sustainability � Not Applicable.I am not interested in qualifying for CDBG funding. 39.CDBG ONLY-Select ONE Specific Indicator that relates to your project: ' r Public facility or infrastructure:This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure.If the activity was used to meet a quality standard or to measurably improve quality,then this indicator will report the number of household units that no longer have access to a substandard service. �' Public Service:This indicator shows the number of persons that have been assisted with new or improved access to a service.If the activity was used to meet a quality standard or to measurably improve quality,then this indicator will report the number of persons that no longer have access to a substandard service. (^ Targeted revitalization:This indicator shows a range of outcomes such as jobs created and retained,businesses assisted,low-and moderate- income persons and households served,slum/blight demolition,number of acres of brownfields remediated,etc.in a targeted area. � Commercial facade treatments or business building rehabilitation:This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. � Brownfields remediated:This indicator shows the number of acres of brownfields that were remediated. r Rental units constructed:This indicator shows the number of affordable rental units created,as weli as the number of years of affordability, number of units occupied by the eiderly,and those units designated for chronically homeless persons and persons with HIV/AIDS. � Rental units rehabilitated:This indicator shows the number of affordable rental units rehabilitated as weil as the number of years of affordability,units for chronically homeless persons,elderly persons,and persons with HIV/AIDS. (� Homeownership units constructed or acquired with rehabilitation:This indicator shows the total number of homeownership units constructed, acquired,and/or acquired with rehabilitation per activity.This includes total number of affordable units,number of years of affordability,Energy Star qualified units,section 504 accessible units,and number of households previously living in subsidized housing.In addition,data will be collected on the number of units occupied by the elderly,number of units designated for persons with HIV/AIDS,and number of units for the chronically homeless. r Owner occupied units rehabilitated:This indicator shows the total number of owner occupied units rehabilitated,including the number of these units occupied by the elderly,number of units designated for persons with HIV/AIDS,and number of units for the chronically homeless. 1� Direct financial assistance to homebuyers:This indicator shows the number of homebuyers receiving direct financial assistance,housing counseling,and down payment assistance/closing costs. � Tenant Based Rental Assistance(TBRA):This indicator shows the total number of households receiving TBRA as well as the number with shoR-term rental assistance(less than 12 months)and the number of homeless and chronically homeless households assisted. r Homeless shelters:This indicator shows the number of homeless persons given ovemight shelter. r Emergency housing:This indicator shows the number of beds created in an overnight shelter or other emergency housing. � Homeles5 prevention:This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. � Jobs created:Of the total number of jobs created,this indicator shows the number of jobs that have employee-sponsored health care,the types of jobs created(using Economic Development Administration(EDA)classifications)and the number of persons unemployed before taking the job. r Jobs retained:Of the total number of jobs retained,this indicator shows the number of jobs retained,the number of jobs with employer- sponsored health care benefits,and the types of jobs retained(using EDA classifications) � Business assistance:This indicator shows the total number of businesses assisted.Specifically,it shows the number of new businesses, ! existing businesses,and the DUNS number of each business so that HUD can track the number of new businesses that remain operationai for three years after assistance. � Businesses providing goods or services:This indicator shows whether an assisted business provides goods or services to meet the needs of the service area,neighborhood,or community,as determined by the grantee. (� Not Applicable. I am not interested in qualifying for CDBG funding. 40.CDBG ONLY-Please choose a common indicator that your agency will use to track clients(select only ONE): � Persons � Households � Not Applicabl�. I am not interested in qualifying for CDBG funding. 41.CDBG ONLY-For the category you selected above,provide the total number of unduplicated Dublin clients(EITHER Persons OR Households)your agency anticipates serving through this project: irec y; m irec y. 42.CDBG ONLY-Based on the common indicator you selected above,please list the number of unduplicated Dublin clients your agency anticipates serving in each category."If none,please enter"0". 5 Low income(50%-80%AMI;please refer to the Income Limits chart at www.dublin.ca.gov/housing/) , 15 Extremely Low Income(<30%AMI;piease refer to the Income Limits chart at www.dublin.ca.gov/housingn 20 Disabled 5 Female Headed Households � � 10��`Senior __ ______ ... , 5,Youth - -- 2:Homeless � N/Ai Not Appiicable.I am not interested in qualifying for CDBG funding.(Type N/A) __., �� ���62.d0'TOTAL 43.CDBG ONLY-List the number of clients your agency anticipates serving in race/ethnicity categories.The sum entered below must match the total clients entered in#42 above.Per HUD"Hispanic"is an ethnicity,not a race."If none,please enter"0" � .__. . _, __ 8,White � �_����� 5`'White+HISPANIC � � � 2;Black/African American 0 Black/African American+HISPANIC _ 3 Asian 0'Asian+HISPANIC 0 American Indian/Alaskan Native 0 American Indian/Alaskan Native+HISPANIC 2' Native Hawaiian/Other Pacific Islander 0 Native Hawaiian/Other Pacific Islander+HISPANIC � e_ __ , _. 0 American Indian/Alaskan Native and White 0'American Indian/Alaskan Native and White+HISPANIC � �� 0�Asian and White ' 0'Asian and White+HISPANIC ' 0;Black/African American and White � � � 0;BlacklAfrican American and White+HISPANIC � 0�American IndianlAlaskan Native and BlacklAfrican American ,___ _ _. ,_ __._ _ �-- E 0�American Indian/Alaskan Native and Black/African American+HISPANI ti_ .___ ______��.., , �__� _� _0;Multi Racial+HISPANIC OR other Multi Racial i����������������0�Not Applicable.I am not interested in qualifying for CDBG funding.(Type N/A) � �____�0.��`TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY (� #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. r #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. (W #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. � #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. � #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. r #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. r If you have more than 6 applications per organization,agency,district or entity,check here. 45. Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). CRIL's Strategic Plan for 2014-2017 and CRIL's Board of Directors have placed a new emphasis on fundraising and fund development outside of grants.In 2013-2015,CRIL had successful fundraising events. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-009274 Budget Funding Sources/Revenues Budget Amount Amount Committed Center for Independent Living-GAP Cycle 5 $19,984.00 $19,984.00 City of Pleasanton-Health and Human Services $14,963.00 City of Livermore-Health and Human Services $11,449.00 City of Dubiin-Community Services Grant $8,586.00 Department of Rehabilitation $35,581.00 $35,581.00 Hindu Temple $1,000.00 Total $91,563.00 $55,565.00 Funding Uses/Expenses Budget Amount Amount Committed ILC-Tri Valley Travel Trainer $32,492.00 $19,984.00 ILC-Employment and Benefits _ $23,252,00 $23,253.00 Program�irector $0.00 Executive Director $1,495.00 $624.00 Finance Director $1,154.00 $482.00 Benefits-Payroll Taxes,Health&Dental Insurance $21,862.00 $7,441.00 Supplies•office and program $1,020.00 $393.00 Printing and Copying $644.00 $95.00 Postage $307.00 $128.00 Telephone $2,125.00 $886.00 Rent and Utilities $205.00 $60.00 Accounting and Audit $591.00 $247.00 Contracted Services $4,339.00 $1,393.00 Insurance $967.00 $403.00 Outreach $125.00 $59.00 Travel $700.00 $0.00 Dues Books and Publications $285.00 $118.00 Total $91,563.00 $55,565.00 Budget Narrative The overall operational budget for CRIL's full service Tri-Valley branch office is$91,563 which covers 1.0 FTE for direct service provision- Independent Living Travel Training Coordinator.A small percentage is allocated to the Executive Director and Finance Director. Additional program expenses include essential,non-personnel,direct costs such as supplies,printing,telephone,occupancy,insurance and outside contractors(computers and server)that are allocated to this project based on a federally approved Cost Allocation Plan. The City of Dublin's poRion of$8,586 would cover 9%of the total project budget and roughly 54%of the salaries and benefits of the service provider. Documents � Documents Requested' Required? Attached Documents* Program Expense Budget for ALL Grant Requests � Prooram Expense Budaet downioad tempiate Financial information Form for ALL Grant Requests 1� Financial information Form downlaad template List of Board of Directors(or governing body)with contact r Board of Directors information Current Annual Budget for the Entire Agency I� Current Annual Budqet Copy of most recently submitted IRS 990 form or Tax Retum � 990 Tax forms 2013 2014 (inGude complete form) Board of Director's(or goveming body's)designation of (�' Boa�d of Directors authorized official Board of Director's(or goveming body's)authorization to � Board af Directors request funding(may be same document as one above) Proof of insurance carried,including bonding,liability and/or � WC insurance workers'compensation GL Insurance REQUIRED FOR CDBG ONLY-If requesting Capital Funding, r please upload your Capital expenditure budget(your own orma is accep a e REQUIRED FOR CDBG ONLY-PERSONNEL POLICIES INCLUDING I� AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS � AND COPY OF LAST AUDIT HIGHLIGHTING"FINDINGS" SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION � AND BYLAWS. REQUIRED FOR CDBG ONLY-CONFLICT OF INTEREST � STATEMENT(IF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART r STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. � State Non-Profit Determination Letter All organizations MUST have approved non-profit status from the State of California and FederaFTax Identification Number at time of application.Non-compliant applicants will be disqualified. REQUIRED FOR GDBG ONLY-AGENCY'S LIMITED ENC�LISH C� PROFICIENCY LANGUAGE AGCESS PLAN(LEP/LAP).Must inGude outreach to limited English speaking residents to encourage access to services&housing.Include what access accammodations are used. REQUIRED FOR CDBG LEVERAGING REPORT-this is due with � • the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements r 2413-2014 audit *ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:47975 Become a fari oYZCr.mGrants"�'on Facebook � Problems?Contact ue at Qoe�tions�c�7r,oroG*ants cam � �2002-2016 GrenlAnalystcom.All rights reserved. . "ZoomGrants"and the ZoomGrents logo are trademarks of GrantAnalyst.com,LLC. � L�`-Ly:�Bfawscr . � I � Emaii This Preview Save as PDF Print Glose Window A�♦ � � Po�vered bv ZcomGrarats��"' , City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadline Dublin High School Parent Faculty Student Organization Dublin High Safe and Sober Grad Night & Senior Scholarships $4,000 Requested Dublin High School Parent Faculty � �,�__.____._.___. � Student Organization ------ � Submitted: 12/10/2015 2:00:31 PM(Pacific) —��`"— Telephone(925)833-3300 8151 Village Parkway Fax (925)833-3344 Project Contact Dublin,CA 94568 Web http://www.dublinusd.org/Domain/132 Catheryn Grier United States team4rierC7a vahoo.com Tel:925-364-0338 PFSO President Catheryn Grier Additional Contacts teamqriera{�vahaa.com 2oldblues@sbcglobal.net Application Questions _�._._ �._ __.. _----��.--—_._.....------_. _.__.._. ___ __.__.__.__.__... .__---..---__.—__.___—�_. ----____..__..___s ISome answers will not be presented because they are not part of the selected group of questions based on the answer to#30. 1. Please describe your organization category(select one of the following): r Private Non-Profit (� Public Agency ' � Other. 2.Please describe your agency's mission(no more than 3 sentences or 250 characters). To support Dublin High students,staff,and adminstrators fill campus needs via fundraising efforts,and recruit and employ volunteer effoRs on behalf of Dublin High School. 3.For what type of Dublin Grant is your agency applying? r Capital Project ' r Public Service Program or Project 4.Is this a"new"servlce,program,project or activity?"New"is Identified as not yet started,implemented or in operation. � Yes (k' No 5.Please indicate below if this application is a request for one-time funding andlor"seed"funding. r One-time funding 1J Seed funding � One-time and Seed funding r Operational funding ' � None ' 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received within the last three years(jurisdiction,year,amount,purpose,etc.).Enter"N/A"if you HAVE received Dublin Funds. N/A 7.Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.). The Dublin High PFSO is a Iong-established campus support group,dating back to the early days at Dublin High,with a history of participation by parents,staff,and students.Parents have been serving as the leads in the organization since its inception.Each of our graduating classes from freshman to seniors are supported by"Parent Reps,"who coordinate events and fundraising efforts for the classes through the duration of their school careers. We have a large executive board made up of officers,as well as our Parent Reps.We have liaisons within the administration,including the vice principal and student activities director who help to guide and coordinate our efforts throughout the school year.Many of the parents who are serving on the high school PFSO board are very experienced parent volunteers who have worked in similar capacities at the elementary school and middle school levels,as well as throughout the community.The group has a long history of strong fiscal management. The Grad Night event has been a successful Dublin High endeavor since 1991,and is planned in concert with the School Resource Officers from the Dublin Police Department.Valley High students are also invited to attend. Other activities that have become impoRant to the senior classes include a Senior Banquet,Senior Picnic,and Senior Ball.While the Parent Reps do everything possible to fundraiser to help offset the cost of these events,much of the burden must fall on the students through ticket sales.The PFSO has found over the last few years that,with the growth of the high school's enrollment,a greater number of students can ill afford to pay for these events(with total ticket prices growing to well over$350 per person).it is our goal to provide as many scholarships as possible so that all students would have an opportunity to make the most of their graduating year and ceiebrate in a safe environment. 8. Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters).This text wili be used widely during the review and implementation process to describe your project. While the funds would help support our effort to hold a Safe and Sober Grad Night celebration for the graduating seniors,more importantly,we could provide up to 40 scholarships for seniors who would be financially unable to participate in class events. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) 525 for the graduation class(possibly attending the event),with up to 40 full or partial scholarships for those unable to pay. 10.Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? � Behavioral Health(mental health and substance abuse) � Affordable Housing r Health Care(including dental) � Workforce Development I— Homelessness I� TranspoRation Services and Access � Domestic Violence and Child Abuse (� Disabilities r Food and Nutrition � Senior Services r Youth Services r Child Care,Early Childhood Development and Education r Changing Demographics and Growing Diversity ' � Financial Assistance � None of the above 11. Explain how this project will be implemented,administered,and operated. The Grad Night event,which has taken place every year since 1991,is planned and executed by the parents who represent the graduating class.It is administered by those same parents,with support from the PFSO and many parent volunteers of the graduating students.The class keeps its own accounting under the umbrella of the PFSO treasury.Months are spent planning activities,fundraising to support the costs,and purchasing supplies. On the night of the event,large groups of parent volunteers are brought in over several shifts to supervise the facility and the students,and security is provided.Students are admitted and are unable to leave until the event ends.The event is a positive way to keep the students safe when they might OthefWi52 h8ve 8n oppOrtunity to make poor Choices in an effort to celebrate their graduation. Several months prior to the major senior year events,Dublin High administrators will reach out to the Parent Reps to let us know of students they know to be from less-fortunate homes.Funds are requested ftom the Class'PFSO account to help pay for scholarships so that those students can also enjoy their class'activities.Those students remain anonymous. For most of the nearly 25 years of Grad Night celebrations,the event has been held off-campus,in a local gym/sports complex,where the students are able to paRicipate in a wide-range of activities.Last year's graduating class,as well as the upcoming Class of 2016,decided to take a trip to Disneyland instead of renting the nearby facility.The Class of 2017 parents prefer to go back to the more traditional method of celebration-renting a local facility.UnfoRunately,with the 2016-2017 school year calendar not yet confirmed,we are unable at this time to make firm plans for our Grad Night celebration.However,this does not diminish the fact that whatever safe and sober event we are able to plan will require some funding,as well as some help in providing much-needed scholarshi 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?). We project that the majority of any funds provided by the grant fund committee would be used to provide scholarships to those students who may otherwise be able to participate due to financial hardship.It is a costly enough endeavor to provide the facility,activities,and refreshments for close to 500 students,while trying to keep the event at a reasonable cost for students so that as many as possible can participate.To also try and provide scholarships from what money we have in the bank would make that nearly impossible. 73. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or ' objectives will your agency use to track the progress of ineeting the outcome(s►? At the Grad Night event,Dublin High and Valley High graduates celebrate as a class-perhaps for the last time-in an appropriate way with supervision and care.Most importantly,students return home safely at the end of the night to their loved ones,and the community is safer and more secure as a result.More than just a"party,"Grad Night is a yearly commitment by parents,the school,and the community to conduct a great,"once in a lifetime"celebration that is alcohol-and dru -free.A sense of communit is develo ed as eve one works to kee the raduates entertained and safe on potentially the most dangerous night of their lives. ' Because of the importance in providing this safe event for the graduating seniors,it is imperative that we include as many graduates as possible.It is not out of the question that all of the grant money awarded would be given as scholarships to students who could not attend due to lack of funds. ' 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled,low-income,etc. This event serves the outgoing senior class of Dublin High School and Valley High School,providing a place where,in the hours following their high school graduation ceremony,they can celebrate their accomplishments as a class.Most importantly,they can celebrate in a safe,supervised,and controlled environment,greatly diminishing the likelihood that these students would turn to other less-appropriate forms of celebration,such as drinking or other illegal activities. Additionally,we anticipate that most of the funds awarded would be used to help the low-income students in our community by awarding them "scholarships"to use toward Grad Night and other Senior year events.The Parent Reps do their best to keep costs low so that each and every graduating senior has an opportunity to participate in the celebrations,regardless of income level. 15.How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the clienUcustomer population served)? The event is geared toward teens with activities designed to keep them active and engaged.Past activities include swimming,carnival games,rock : Gimbing,video game arcades,inflatable activities(slides,human foosball,obstacle courses),and games of basketball.More importantly,it provides a sense of togetherness and community. 16.Explain how your agency will outreach to low-income,limited English speakers,and/or disabled persons.How will each of these groups access the project for which your agency is requesting funding? All Dublin High and Valley High graduating seniors are invited to attend the Grad Night party,and while there is an admission fee to attend for students (ensuring their attendance due to their own investment in the event),we work closely with the school's administrators to provide financial assistance to those students who are unabie to afford the ticket price.The administration at both high schools are able to identify those students,and they remain anonymous.It is truly our goal to use this grant money to serve as many students as possible with admission to not only Grad Night,but to other important events at the end of Senior year(Senior Ball,Senior Banquet,and Senior Picnic).The cost to attend all of those events can tum out to be over$350 per student.(Ticket prices for Grad Night alone can cost upwards of$100 per student,taking into consideration other fundraising dollars.) , 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integretion. We have partnered in the past with other local high schools,including the parent booster groups at Foothill High School and Amador Valley High School in Pleasanton to share expenses and themes for decorations.We also support one another in set-up and clean-up activities after the event is over.We also partner with Dublin Police Services,specifically our School Resource Officers,to ensure a secure environment,and to provide backup to the parent supervisors. 18.Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. Outreach is not entirely applicable,as the event is solely geared for Dublin High and Valley High seniors;however,we do indeed engage in substantial : outreach to the parent volunteers in our community to assist in supervision and implementation of the event.We also reach out,through school administration,to those families who are in need and cannot afford to pay for the events themselves.It is important that ALL students are given the opportunity to celebrate their graduation through a safe and sober activity,in a controlled environment. 19. Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. The Grad Night event absolutely fits in with several of the City's Values,including a High Quality of Life and a Safe and Secure Environment. We,as parents,are working hard through this event to keep our teenagers/young adults safe and secure during this milestone celebration.By extension,this event also contributes to the overall safety of our community and teaches our children that we value responsibility. It also fits with the Value of Community Building,not only as a promotion of the time the students will spend together,but with our C011abor8tive effortS with Pleasanton schools.It is part of the unique and dynamic community opportunities offered to the youth of Dublin. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Through the PFSO,the parent class representatives have been raising money for this event for the four years the participating students are in school. Funds are raised both through PFSO general fundraisers,such as Fireworks sales and a Raise Your Class dinner/dance,but also through class- specific fundraising efforts to help boost the individual class accounts.This project is as cost-effective as it can be given its large scale,but we are as efficient as possible in pairing with other schools to share costs and resources and also in recycling some of the decorations and supplies that have been used at Dublin High for other activities(such as Homecoming)for many years. Our ultimate goal is to allow as many students from the graduating classes of both Dublin High and Valley High to paRicipate in this important event. While we do everything possible to keep the costs down,we know that whatever the price,some students will not be able to participate.That is why the need for money for scholarships is so crucial. 21. If this appiication does not receive funding,or receives reduced funding,what will be the effect on the project? If the application goes unfunded,we know that a large number of students will be unable to participate in any senior year activities due to the lack of impoRant scholarship money.The Senior Class representatives will also have to scramble to add additional fundraisers to make up the shortfall.An increase in ticket prices for any/all of the senior year events will mean that even more students will have to miss activities due to financial hardship.It is both a significant financial strain,as well as a time strain,for those who are working on behalf of the students. 22.Does your agency anticipate having any unspent grants funds at the end of the fiscal year? (� Yes � No , 23.If you answered yes to the preceding question please explain.Enter"N/A"if not applicable. , N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures�? � Yes ' � No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25.If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.Iater in the"Documents"tab.]Enter"N/A"if not applicable. ' N/A 26.If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms,plans for future relocation or expansion,etc.�.Enter"N/A"if not applicable. N/A 27.If your agency is requesting Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? r Not Applicable ' � Yes � No � Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin's Mission&Vision Statements:(you may choose more than one) (�" Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. (� Balance history with progress,to sustain an enlightened,economically balanced and diverse community. ' r Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. � Promotes active and healthy iifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) � Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development � Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety � Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City r Goveming:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication (— Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutal benefit 30."'*QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.`•Are you are interested in applying for CDBG funds? I� Yes.If so,answer questions 31 through 43. � No.If no,check box here,and questions 31 through 43 will not be required.. � Don't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDBG ONLY-Explain your�imited English Praficiency/language Access Plan(�EPI�AP).How does your agency outreach to limited English speaki�g residents ta encourage access ta services&housing?What access accammadations are used? Provide detail -anstvcr rac�f pre.ser7ted bec�3us�of ii�re ans��er�fo#30- 32.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Nousing and Urban C}evelapment(HUD)Consolidated Pian Guiding Principle that reiates to yaur praject: ' -ans�rer na#,prese;ited k�ec�tase of the at�st�v�;r Ya'#3t)- 33.GDBG ONLY-identify AT IEAST ONE U.S.Department of Housing and Urban Development(NUD)Consalidated Pian Gpals that relates ta your project: � -ans�,ver r�ot pieser�ted aec�use of the ans��er to#3G- ' 34.CDBG ONLY-Identify AT LEA57 ONE U.S.Department of NUD Strategic Goal tfi�at re3ates to your project: ��� -artswer nof�rese+�red because of fh�ans�rer�o#30- 35.CDBG ONLY-ldentify AT LEAST ONE U.S.Department of HUD Policy Priority that relates to yaur project: -ar�a��ver r�ot presenied because of the ar�sin er tn#30- . - enti y anso i ate an o )ec ive t a re ates o your pro�ec : -ar�s�:ver r?c'presented recause oF Lhe�:3savc�r to#3t)- 37.CdBG ONLY-5elect ONE Objective that reiates to your project{TIP:When selecting an objective ask yourself,"What is Lhe purpose of the activity?Nfhat is the iarger community need tha#i am seeking 4a address?"j: -ans4��e��ncC pr�ese��t�d bea<�rus�ot the ans�ver io�3�J- 38.CDBG ONLY-Select ONE Outcom�that reiates ta your project(TIP:When selecting an outcame ask yourself,"VYhat tppe of change ar result am I seeking?"): -ans:-ver r�ot r>resented because af the arzs4ver to#30- � 39.CDBG ONLY-Select ONE Specific(ndicator tha#relates to your project: -ans�ier raat presented beeause of the rv�siv�r�to#30- 40.CDBG ONLY-Please choose a common indicator that your agency wiil use ta track clients{seleet anly OFiE): -ansaver noY presented becai�se of the ans�ver+o#3�1- 41.GDBG ON�Y-For ihe category you se(ected above,provide the total number of unduplicated pubiin ciients{E{THER Parsans OR Hausehaldsj your agency anticipates serving through this project: -vnswer r;ot presentetl becat4se of ftte ar,svv�r to#30- 42.CDBG ONLY-Based on the common indicator you seiected above,please Iist the number of unduplicated Dublin ciients your agency anticipates serving in each cakegory."If none,piease enter"4". -ans�a�er n�!r�r�se,nted�ecausP of i�he�r�s�:�er to#.�?�- � A3.CDBG ONLY-L ist the number of alicnCs your agency anticipates servir�g in racelethniciky categories,The sam entered beiow �ni�st ma�ch the tota(clienis entered in#��d2 above. P�r NUD"Nispanic"is an ethnicity,ne�t a racQ."if none, �Iease enter"�" � � ,.�;er r>:=, `,<:,, r r>`, c a:s��� ,r+;s0- 44.If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY �✓ #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. � #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. r #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. (� #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. � #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. (� #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. r If you have more than 6 applications per organization,agency,district or entity,check here. 45.Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce : dependency on the City's grant program). The PFSO works diligently to fundraise creatively with our families and we will continue to seek out new opportunities to offset the costs. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-105768 Budget -___ _ _. __.___. __._ Funding SourceslRevenues Budget Amount Amount Committed Fireworks/Dinner Dance Income $14,000.00 $14,000.00 Miscellaneous Fundraisers $8,000.00 $8,000.00 Student Ticket Purchase(400 @$85.00) $34,000.00 $34,000.00 Total $56,000.00 S 56,000.00 Funding USes/Expenses Budget Amount Amount Committed Facility Rental $28,000.00 $0.00 Activities Rental $28,000.00 $0.00 Decorations $1,500.00 $0.00 Food $1,500.00 $0.00 Supplies $500.00 $0.00 Rental Equipment(truck) $300.00 $0.00 Insurance $175.00 $175.00 $100.00 $0.00 Stipends $60,075.00 $175.00 Total Bud et Narrative The Grad Night event alone costs approximately$60,000 to execute from start to finish.Other activities-Senior Banquet and Senior Picnic-are also paid for mostly by the Class of 2017,using fundraising dollars(in addition to nominal ticket prices).Classes spend four years fundraising to get to the these events through a variety of ineans.(For example,class parents have been volunteering at the St.Patrick's Day Festival and Splatter event since 2013 to eam income for these events.) The cost of renting the Club Sport Facility in Pleasanton,one of the few venues in the area large enough to hold the event,is approximately $28,000 given the increase in student population at Dublin High and the increase in the rental cost.Rental of arcade games,carnival games, inflatables,and DJ services and equipment has been similar in costs appearing in the budget above. Decorations are re-purposed as much as as feasible,but requires the purchase of items such as building materials.Supplies include food and drink for upwards of 500 students,as well as prizes for games and other activities.Student tickets,which we aim to keep at a reasonable level,offset some of the costs of the event,but are not enough.If ticket prices are too high,we will not be able to serve the greatest number of students possible,as many will be priced out of the event.It is our desire to keep ALL graduating senior"safe and sober"on this all-important night.We also can't ask all of the other students to provide aid for the 20-40 students who will not be able to afford a ticket at all. Documents Documents Requested* Required? Attached Documents* ' Program Expense Budget for ALL Grant Requests � Dublin Hiah PFSO Proc�ram Exoense Budaet downioad temoiate Financial Information Form for ALL Grant Requests r Financial Infonnation Fonn downioad temniate List of Board of Directors(or goveming body)with contact � Dubiin Hiqh 5chaoi PFSQ�ecutive Baard information Current Annual Budget for the Entire Agency � 2015-16 Dublin Ni h PFSQ Bud et Copy of most recently submitted IRS 990 form or Tax Retum � Dubi±n Hiph PFSQ Tax Return-IRS 990 Form (include complete form) Board of Director's(or governing body's)designation of (' �oard of Directar's Desiqnation of Ruthorized Officiai authorized official Board of Director's(or governing body's)authorization to � Board of Director's Authorization to Reauesi Fund+nq request funding(may be same document as one above) Proof of insurance carried,inGuding bonding,liability and/or � Proof of Insurance workers'compensation ' REQUIREO FOR CDBG ONLY-If requesting CapRal Funding, � please upload your Capital expenditure budget(your own format is acceptable) _ REQUIRED FOR CDBG ONLY-PERSONNEL POLICIES INCLUDING � AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS r AND COPY OF LAST AUDIT HIGHLIGHTING"FINDINGS" SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION r AND BYLAWS. REQUIRED FOR CDBG ONLY-CONFLICT OF INTEREST r STATEMENT(IF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART � ' STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. �~' Non-Profii Determsnation!etter All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application.Non-compliant applicants will be disqualified. REQUIRED FOR CDBG ONLY-AGENCY'S LIMITED ENGUSH � PROFICIENCY LANGUAGE ACCESS PLAN(LEP/LAP).Must include outreach to limited English speaking residents to encourage access to services&housing.Include what access accommodations are used. _ • REQUIRED FOR CDBG-LEVERAGING REPORT-this is due with � the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements r DubFn Hioh PFSO Tax Return-IRS 990 Form *ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:48312 �� Become a fan of Ze:n?Gran*.s"'on Facebook ���. Problems9 Conlact us at Qcestiors;d.-Lo�mGrants.ca!n ra na ys.com. ng reserv . � � "ZoomGrarrts"and the ZoomGrants logo are Vademarks of GraMAnalyst.com,LLC. Lnqout�Brca.vser � � ��' Emaii This Preview Save as PQF Print Ciose Window A�♦ I 'I, �� Povvered bv ZoomGranTsTh' : City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadiine Dublin Partnerships in Education Community Grant $10,000 Requested I Dublin Partnerships in Education � M+N_.. � ���^ }» - � _,.,_____�w___ Submitted: 12/7/2015 5:35:52 PM(Pacific) � P.O. Box 2307 Telephone(925)828-2551x8024 6800 Penn Drive Fax (925)803-9746 Project Contact Dublin,CA 94568 Web www.dpie.org Susan Campbell United States SUS2ll(G:dpi�.Otp � Tel:(925)828-2551x5435 � Executive Director �; Susan Campbell Additional Contacts j S�,san�dple orq donna@dpie.org i � � Application Questions ISome answers will not be presented because they are not part of the selected group of questions based on the answer to#30. ` 1.Please describe your organization category(select one of the following): � Private Non-Profit r Public Agency � Other. 2. Please describe your agency's mission(no more than 3 sentences or 250 characters). Dublin PaRerships in Education is a non-profit foundation dedicated to fostering mutally beneficial business,community and educational partnerships in order to maximize resources and enrigh the learning experiences for all students in the DUSD. 3.For what type of Dublin Grent is your agency applying? 1^ Capital Project I�° Public Service Program or Project 4. Is this a"new"service, program,project or activity?"New"is identified as not yet started,implemented or in operation. � Yes I� No 5.Please indicate below if this application is a request for one-time funding and/or"seed"funding. l� One-time funding � Seed funding � One-time and Seed funding � Operational funding r None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received within the last three years(jurisdiction,year,amount,purpose,etc.).Enter"N/A"if you HAVE received Dublin Funds. N/A 7.Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.). These funds will provide the necessary means to facilitate the GearUp-Workforce Boot Camp and Challenge Day programs for young adults in Dublin. DPIE's staff and governing board are comprised of civic leaders and business people whose combined resources and experience provide the necessary skill and knowledge to bring the business community and community leaders together to assist us in a mutably beneficial manner to support and enhance the lives of these undeserved young adults.Challenge Day is led by a group of professional who specialize in mental health and anti bullying in young adults.GearUP is lead by leaders in the business community and by professionals in career and workforce building. 8. Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementation process to describe your project. DUBLIN PARTNERS IN EDUCATION will support two programs for low-income and under-served students,GearUp-a Workforce Bootcamp and Challenge Day. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) 9100 students and their families 10.Which of the 74 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? r Behavioral Health(mental health and substance abuse) � Affordable Housing (f Heaith Care(including dental) �' Workforce Development ! r Homelessness ' � Transportation Services and Access � Domestic Violence and Child Abuse I� Disabilities � Food and Nutrition � Senior Services r Youth Services : � Child Care,Early Childhood Development and Education � Changing Demographics and Growing Oiversity � Financiai Assistance � None of the above 11. Explain how this project will be implemented,administered,and operated. ' This is a Grant request to provide DPiE with support for our Challenge Day at both Valley High and Dublin High locations and support for GearUP— Workforce Boot Camp for young adults in Dublin. DPIE's GearUp—Workforce Boot Camp is a program specifically targeting the undeserved young adults in Dublin.It is a Career and Life Development Boot Camp for Young adults located at Valley High. During the first three months of the program,participants develop career exploration and professional skilis.These undeserved young adults then apply those skills during the second three months on an internship at one of GearUp's corporate partners,and are suppoRed by staff advisers, professional mentors,with a powerful network of community-based people. We want to empower participants to reach their potential by developing confidence,career skills and real-world experience. ' This is the opportunity to create strong members of our society.To get them on the right track.Many of these young adults have no mentors in their life and by joining the business community they are given a leg up to success and prevent them from becoming a burden to society. Challenge Days are powerful,high-energy programs in which youth and adult participants are guided through a series of experiential learning processes.The overall goals of the program are to increase personal power and self esteem,to shift dangerous peer pressure to positive peer support and to eliminate the acceptability of teasing,violence and all forms of oppression.Challenge Day is designed to unite the members of the community and to empower them.Challenge day also successfully addresses the issues of violence,teasing,social oppression,racism,harassment, conflict management,suicide,peer pressure,alcohol and drugs.The program welcomes parents/guardian,teachers,administrators,police officers, elected o�cials,community members and any other interested adults. ' 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?). Th8 FUI1dS WIII b@ USBd t0 faCilitate bOth the GearUp-Workforce Boot Camp and the Challenge Day at both Valley and Dublin locations. We need funding for the GearUp-Workforce BootCamp program to help off-set the cost of materials,facilitation and sCholarships for the y0ung 2dults who compiete the workforce program. The Challenge Day Program costs$3400 per day per location.We will be holding Challenge Day at both Valley and Dublin locations. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome�s)? The measurable outcomes for the GearUp program will be the success rate for the participants in obtaining job placement after completing the requirements of the GearUP-Workforce Boot camp program.Our goal is a 100%success rate.The participants will be accomplished at Career Development,Constructing a Career and Academic Portfolio,Navigating online Employment Sites,Employment Skills and Mock Interviews, Communication Skills,Balancing life,Work and Family,Personal Financial Management,Time Management and Self Care,It-Making Technology Work for You-Introduction to Coding and Computer Skill in the Workplace,Ethical Practices in the Workplace and Conflict Resolution,Networking Basics for Personal and Career Growth,Las Positas College Tour.We will host panel discussions with various trades:Construction,IT,Health Care,and Utilities (PG&E). A Challenge Day is a 6 1/2 hour experiential program.These results are reflected on Challenge Day's pre and post surveys to participating students: 95%of students would recommend the Challenge Day program to friends or family 91%of students feel the skills taught will be helpful to them in their personal life 90%of students report being more aware of the effects of bullying,accepting and suppoRing of other students,understanding of other people's experiences,aware that their actions affect others,and likely to help others. 80°/a of students report being more connected to other students and adults,likely to speak up when seeing someone bullied.More accepting of themselves and hopeful about their future.More likely to work to improve relationships. 81%of students made a commitment for change. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled,low-income,etc. Dublin Unified School District includes students in all socioeconomic levels.With the wide diversity of language and homelands found in Dublin,all of our programs are designed to reach a variety of students.We work directly with the facilitators to make certain our programs are supportive and reflective of their needs. The GearUP Workforce Bootcamp works with predominately low income and undeserved young adult with the Dublin Unified School District.Most of our participants will be from Valley High.Many of them do not have mentors or opportunities to propel them into a successful life.They will benefit by learning how to become self-sufficient and will learn the steps to create a success career.For a young adult in this low socioeconomic group the best opportunity for them is a chance to learn how to sustain themselves.They will gain the self confidence to promote themselves is a positive way with a self esteem that comes from knowledge and a strong mentorship. 15. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the clienUcustomer population served)4 Cha�lenge Day and GearUp-Workforce Boot Camp are designed to work with all students,and therefore,all of the many cultures that exist in Dublin. We are seeking procurement of funding to bring Challenge Day to Valley High School,a highiy impactive program where students and staff learn to cultivate a culture of inclusion and acceptance,as well as learn to communicate through the celebration of every type of diversity. GearUP-Workforce Boot Camp is tailored to the undeserved and low socioeconomic young adult population in Dubiin. 16.Explain how your agency will outreach to low-income,limited English speakers,and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? We work with each and every student involved in our programs despite any language,income or physical challenges.Both our GearUP and Challenge Day reach out to young adults and are open to all that apply.Young adults who experience a sense of safety and connection at school establish health better adult and peer relationships,feel respected,and are empowered to help create a positive school climate. A positive school environment Increases academic achievement,results in healthier choices and behaviors among students,and allows them to grow . into contributing adults in society. Students who experience chronic emotional stress and social alienation have impaired learning and memory and the early onset of common diseases Students who do not feel safe in school are at risk for learning and memory problems;are more likely to avoid school or drop out;exhibit higher anxiety and depression;or attempt suicide during childhood and later in life.Conversely,students who experience a sense of safety and connection are better able to establish healthy adult and peer relationships,feel respected within the school and community,and are more likely to experience academic achievement,make healthier choices,and grow into contributing adults in society.Administrators,teachers,and staff members also benefit from positive school climates.Challenge Day's experiential workshop helps students overcome cultural,social,and economic differences and build a powerful,connected community.They address prejudice,bullying,violence,harassment,isolation,and intolerance,and build emotional safety and social connections among youth 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Our organization partners with the Dublin Unified School District,each Parent Faculty Club and the Dublin High Parent Faculty and Student organization. While maintaining our separate organizations,our goal is to support the needs of each of these groups,as well as the Dublin Chamber of Commerce and various other businesses in our community and the surrounding area.Specifically,we work with the Administration office of City government on preparing opportunities for the City to share with students with the Inside Dublin program,which educates students on the various local government career opportunities and pathways.The Fire Department and Police Services departments are both valuable partners with DPIE and provide ongoing educational programs for our students and the community.We also partner with other non-profit organizations such as School of Imagination,who have loaned us their bus for field trips for DUSD students.We have supported several businesses through promotions on our website,newsletter, local press and Facebook page.These partnerships will not only benefit DPIE's business sector stakeholders,but our city and residents,as a whole. We support Innovation Tri-Valley's DreamMakers and RiskTakers and celebrated our Dublin Students and their accomplishments. 18.Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. DPIE markets our programs through our website(www.dpie.org),Monthly e-newsletters that goes out to an every expanding email database,as well as our Facebook page.Through collaboration as Ambassadors with the Dublin Chamber of Commerce and our business partnerships,we also stay connected to the business community.We attend the Ribbon Cuttings to welcome new businesses to the City of Dublin.We are currently founding Members of the Tri-Valley Non Profit Alliance.The Alliance is a large group of non-profits in the Tri-Valley who share ideas and common goals.We are collaborating on a Regional level with the Wente Foundation for the Arts Education.This collaboration includes the School Superintendents of Livermore,Pleasanton,Dublin and San Ramon along with the Executive Directors of their Education Foundations and the Superintendent of the DPIE Enrichment Academy.DPIE paRicipates and sponsors a Community Day at Camp Parks strengthening our relationships with the Military families in Dublin. For the past 6 years,we have partnered with the Dublin Rotary to supply every third grader in the School District with beautifully illustrated,hardcopy dictionaries.We also partner with Dublin Rotary and the Wells Middle School Band for the City's Non-Profit Fireworks Sales program during the lottery and sales,and split proceeds evenly regardless of who is selected in the lottery.For the past two years,DPIE has partnered with the Dublin High School Culinary Program to operate our Summer Enrichment Academy"nutrition cart,"which provides nutritious snacks for our students.This mutually beneficial partnership provides valuable business experience and fundraising opportunities to the DHS Culinary Program,as they keep 100%of the proceeds from their sales.We also partnered with the Dublin High Culinary Program by engaging them for our desserts at our Celebrity Waiter Dinner. We also partnered with PFCs to market our afterschool and STEM Academy. 19.Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. DPIE has a similar Mission and Vision to that of the City of Dublin.Our commitment is to foster new opportunities for students,businesses,and families within our community.We develop opportunities for our business community and school community to get to know each other,and partner on mutually beneficial projects and programs.By working with our young adults in a positive manner we are building a better community,A better community adds value to businesses and to the overall well-being of our citizens. DPIE's Values are shared by building community and providing programming and promoting events that bring everyone together. We focus on collaborating with other organizations to meet the needs of our student and family populations,as well as our local businesses.We collaborate with Career Track,Chevron and PG&E just to name a few corporations that have helped build our GearUp—Workforce Boot Camp.We build community and promote culture through our various programs. DPIE employs similar strategies in working within our community.Our economic development plan includes strengthening the ties between our business community and our families.With our frequent Facebook postings,monthly communications at various meetings/events,and monthly newsletters,we work hard to provide connectivity throughout our city. 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The District has grown to over 9200 students.With this growth comes an increased need to support the programs that DPIE has provided to make this community a place to live and thrive.Our support for undeserved students(GearUp)and Challenge Day makes us a strong partner.Our undeserved young adults need our assistance now more than ever.Our GearUp-Workforce Boot Camp has a cost of$9000 ensuring that this undeserved,low socioeconomic population does not fall through the cracks and end up costing society more funding in the long run. Challenge Day will assist with the prevention of bullying and other mental health issues.The cost to DPIE is$3400 for each location.The$6800 price for the program to help prevent a young adult from entering the judicial system is a small price tag. 27. If this application does not receive funding,or receives reduced funding,what will be the effect on the project? Without funding,the ultimate loss will be to the important programming that supports non-violent behavior,strong citizenship and career development and suppoR DPIE supplies to the young adults in Dublin.Challenge Day at the high schools and our GearUp Workforce Bootcamp are opportunity for us to serve these young adults who would otherwise not be engaged.They have a higher risk of falling through the cracks and becoming a burden on our society. 22.Does your agency anticipate having any unspent grants funds at the end of the fiscal year7 � Yes � No 23.If you answered yes to the preceding question please explain.Enter"N/A"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures�? r Yes � No.If no,enter N/A for questions 25 8 26,and check Not applicable for question 27 25. If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"N/A"if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms,plans for future relocation or expansion,etc.�.Enter"NIA"if not applicable. N/A 27.If your agency is requesting Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? � Not Applicable (� Yes � No r Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin's Mission&Vision Statements:(you may choose more than one) � Promotes and suppoRs a high quality of life which ensures a safe and secure environment that fosters new opportunities. � Balance history with progress,to sustain an enlightened,economically balanced and diverse community. r Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. r Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) r Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development r Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety � Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quaiity design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City � Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises airness in consi era ion o issues an prow es a ig eve o cus omer serwce;responsiveness rom i y s a o ci izens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication � Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutal benefit 30."'4UESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.**Are you are interested in applying for CDBG funds? � Yes.If so,answer questions 31 through 43. � No.If no,check box here,and questions 31 through 43 will not be required.. , r pon't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31,CQBG bNIY-Explain your limited Engiish Proficiencyllanguage Access Pian(LEP/LAP).How daes your agency outreach to limited E�glish speaking residents to encourage access to services 8�housing?Wt�at access accommodations are used? Provide detail _ar:s=v��t ro.prt�ser?t�d uct;at:�e a`ti;n arsa4er to#30 32.CDBG QN4Y-Identify AT LEAST ONE U.S.Department of Housing and Urban Development{H�iD}Consoiidated Pia�Guiding Prineiple that relates C�yoGir praject: -a�isvl-�r t?a2 E1r�S�r��.�t i.F:. a�se v`�;�e rfnst-er r<�#?3tJ� 33.CDBG ONLY•Identify AT LERST C?NE U.S, Department of Nousing and Urban Development{HUD}Consolidated Ptan Goais that , reiates to yo�r project: � -8t"tSVVE?!"r7Qi�rrF=3f'RtA�h<;C;:�(1SC C`rt,G<3ttSS%E".O 1#:.��� 34.CDBG ON�Y-iderrYify AT LEAST ONE U.S.C�epartment of HUD Strategic Goaf that relates to your project: -3!?S.�L'�1�^JZ/3!fi�8?)�.`E:C",bC3CatiSE,0'tflE:�TSV��r@"!O#:3.ni- , 35.CDBG ONLY-Identify A7 LEAST ONE U.S. Department of HUD Policy Priority that reiates to your praject: -an,s�ver not/�;esanted because of ihe ar,s4-ve�io#30- 36.CDBG ONIY-Identify AT LEAST ONE Consnlidated Plan objective that retates to your prnject: -ar�s4ver not presel�ted because af the ansaver to#k?0- 37.CDBG QNL.Y-Seiect ONE Objective that relates to your project{TiP:When selecting an objective ask yourseif,°What is the purpose of the activity?What is the Iarger community need that I am seeking ta address?"}: -7r�swer nni presenfed because of the ans�var Yo#3Q- 38.CDBG ONLY-Select ONE Outcame that relates to your project{TIP:When selecting an outcome ask yourself,"What type af change or result am i seeking?"j: � -anstver�not preser�ted ber��trse o!if�e ans�✓er fo�30- 39.CDBG ONLY-Select ONE Specific indicator that reiates to your project: �' ::!'S4'1°7-"�Ot X:rP,S87?�8d�'3C'citlSF'(i`;•liP?RS'c'<'G','f0'r�`3v... 4Q.CDBG ON�Y-I�fease choose a common indicator thaC your ag�ncy wili t�se to track clienYs(seiect anly ONE}: ..,9/"iS� c' ."l:`i..(E,SE� 'Fiil z','..1U::£: .� .1/;;�fr. .t":'t}i:,.`ij.. 4�.CDBG ONLY-For the categ�ry yau selacted above,provide the total nurnber of undupiicated Dubiin clients(EITHER Persons dR Hausuhoidsl your agency anticipates serving thrnugh this project: -ar�sv��r raot�resented bec,a�.se af t:h��r�si��e>?t�#3� 42.CDBG ONLY-Based on the common indicator you selected above; please list the number of undupiicated Du61in clients your agency anticipates serving in each category."if none, please enter"0°. � -�ns��r�r�nvt pr�-�ser?t�d t,�er,�t�se ofttae�r;svv�r tc�#30- 43.CDSG ONIY•List the number af ciients yo�r agency anticipates serving in racefethnicity categories.7he sum ent�red below must match the tatai clients entered in#42 above, Per HUd"Hispanic"is an ethnicity;not a race."if nane,please enter"0" � -ar�si�der raot gresenteG bec�use of the r�r�svvei to#30- 44.If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY � #1-This program/project has the highest priority for funding within the organization,agency,district or entity. � #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. r #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. � #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. � #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. � #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. 1— If you have more than 6 applications per organization,agency,district or entity,check here. 45.Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). We ask other funders for money,but it is difficult to promote programs that others feel the City or School District should be assisting with. We have received some money for Challenge Day from Kaiser and Palo Alto Medicai in the past,but it does not cover the entire cost. We received$1000 for GearUp-Workforce BootCamp from Chevron,but that will not cover the entire cost.Dublin Partners in Education has funded several programs that the City has not been able to fund.The City is growing at a very fast rate and DPIE will reach out to the education arm of our City to assist in every way we are able.The City Grant has allowed us to use fundraising dollars to meet the needs of our growing community. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-010048 Budget Funding SourceslRevenues Budget Amount Amount Committed GearUP-Workforce BootCamp $13,000.00 $0.00 Challenge Day $6,800.00 $0.00 Total $19,800.00 $0.00 Funding Uses/Expenses Budget Amount Amount Committed GearUP-Workforce BootCamp Scholarships $9,000.00 $0.00 GearUP-Workforce BootCamp-Facilitator $4,000.00 $0.00 GearUP-Workforce BootCamp-materials $400.00 $0.00 Challenge Day Valley High $3,400.00 $0.00 Challenge Day Dublin High $3,400.00 $0.00 Total $20,200.00 $0.00 Budget Narrative Without the additional funding from the City of Dublin we will not be able to proceed with these two valuable programs to assist the undeserved � young adults in Dublin.The GearUp-Workforce Boot Camp is vital to the future of these students.This is their opportunity to move forvvard in their lives and become productive without being a burden on the social and economic programs later on in life. A strong sense of self-esteem and empathy for others will be a life-long lesson that most are not learning in their homes. This is an opportunity to present positive role models in social behavior,career possibilities and motivation to become well adjusted adults.DPIE works in conjunction with facilitators,the community and students to make these successful.. Documents _..______.__ Documents Requested* Required? Attached Documents' Program Expense Budget for ALL Grant Requests � ��.._.�9?t dawnioad temoiate Financial information Form for ALL Grant Requests � Financiais downioad tempiate List of Board of Directors(or governing body)with contact � Board of L�irectors information Current Annual Budget for the Entire Agency � Annuai Budaet Copy of most recently submitted IRS 990 fortn or Tax Retum r Farm 990 (include complete form) Board of Director's(or governing body's)designation of (�" PresidenYs Authorization authorized official Board of Director's(or goveming body's}authorization to r PresidenYs Authorizatian request funding{may be same document as one above) Proof of insurance carried,including bonding,liability and/or � Cert of insurance workers'compensation REQUIRED FOR CDBG ONLY-1f requesting Capitai Funding, � please upload your Capital expenditure budget(your own format is acceptabie) REQUIRED FOR CDBG ONLY-PERSONNEL POLICIES INCLUDING r ' AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS r AND COPY OF LAST AUDIT HIGHLIGHTING"FINDINGS" ' SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION r ' AND BYLAWS. REQUIRED FOR CDBG ONLY-CONFLICT OF INTEREST STATEMENT(IF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART � STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. � Franchise Tax eaard Exemption All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application.Non-compliant applicants will be disqualified. REQUIRED FOR CDBG ONLY-AGENCY'S LIMITED ENGIISH � PROFICIENCY LANGUAGE ACCESS PLAN(LEP/LAP).Must include outreach to limited English speaking residents to encourage access to services&housing.Include what access accommodations are used. REQUIRED FOR CDBG-LEVERAGING REPORT-this is due with (— the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements r Financials *ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:47697 Become a fan oil.00�rC;ran!s"'on Facebook Problems?Contact us at i�cestions��-ZaumGrants.cem - �2002-2016 GrantAnalystcom.All rights reserved. � "ZoomGrants"and the ZoomGrants logo are trademarks of GrentAnalyst.com,LLC. l._;x;^ut�6tewsar � � � �� � Emaii This Preview 5ave as PDF Print Close Window Ai♦ � � Po�vered bv ZoomGrantsT��' City of Dublin Parks and Community Services Department � 2016-2017 Community Grants Program 12/11/2015 deadline Easter Seals Bay Area Easter Seals Kaleidoscope ' $15,000 Requested ' Easter Seals Bay Area , _-- -----..�____ .�._� ___ Submitted: 11/25/2015 3:47:43 PM(Paciflc) �� 391 Taylor Blvd� Telephone(925)849-8999 ! Suite 250 Fax (925)849-8966 Project Contact i Pleasant Hill,CA 94523 Web www.easterseals.com/bayarea ' Zach Lupton i United States ziupton(c�esba.orq ; ` Tel:925-828-8857 i President,C.E.O. Susan Armiger Additional Contacts sarmiper,nesba.orq none entered Application Questions - ISome answers will not be presented because they are not part of the selected group of questions based on the answer to#30. I 1. Please describe your organization category(select one of the following): � Private Non-Profit I— Public Agency (� Other: 2. Please describe your agency's mission(no more than 3 sentences or 250 characters). Easter Seals is leading the way to ensure individuals and families affected by disabilities can live,learn,work and play to their full potential. 3.For what type of Dublin Grant is your agency applying? r Capital Project �' Public Service Program or Project 4.Is this a"new"service,program,project or activity?"New"is identified as not yet started,implemented or in operation. r Yes r No 5.Please indicate below if this application is a request for one-time funding andlor"seed"funding. �" One-time funding � Seed funding � One-time and Seed funding � Operetional funding ' r None ' 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received within the last three years Qurisdiction,year,amount,purpose,etc.).Enter"N/A"if you HAVE received Dublin Funds. N/A 7.Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.). Easter Seals Kaleidoscope is a subsidiary of Easter Seals Bay Area.Kaleidoscope has(1)Director of Program Development,(1)Site Supervisor,(3) Lead Teachers,and(6)assistant teachers.Those that work directly with children have past experience in this field.All the Lead Teachers hold a Bachelor's Degree and support staff are currently working towards that goal or an Associate's Degree.Many of our staff have been working in this field the majority of their adult lives,some have had experiences dealing with family members and others have found a passion for working with this population. 8. Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementation process to describe your project. The Kaleidoscope program focuses on developing interpersonal communication,social,and independent living skills through participation in community based,athletic,pre-vocational,and recreational activities. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project:(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) 7 10.Which of the 14 Areas of Concern identified in the Eastern County 2071 Needs Assessment Report does your project identify with? � Behavioral Health(mental health and substance abuse) � Affordable Housing � Health Care(including dental) 1v Workforce Development I� Homelessness � Transportation Services and Access r pomestic Violence and Child Abuse r Disabilities � Food and Nutrition 1— Senior Services (� Youth Services � Chiid Care,Early Childhood Development and Education � Changing Demographics and Growing Diversity � Financial Assistance r None of the above 11. Explain how this project will be implemented,administered,and operated. Kaleidoscope meets the educational needs of school-aged children through the development and implementation of supervised activities that supports academic learning and positive development by:working directly with teachers to identify key support issues whether behavioral or academic, working with participants and their families to monitor progress towards each studenYs Individualized Education Plan,and incorporating community- based activities so that they will feel comfortable and confident in typical environments. We are creating an environment that is all inclusive for every student that attends our program.We have succeeded in creating a greater sense of : independence in our participants,helping them learn life skills that will be necessary beyond the influences of Kaleidoscope.We have also created an environment where our participants with disabilities have learned to trust and rely on one another,deep friendships have been built between participants,and we have seen an increased awareness in community involvement.More and more,our participants have come to own a part of Kaleidoscope,have become more involved in planning and implementing activities,and have gained a valuable sense of accomplishment working with their fellow friends. Kaleidoscope's underlining hope is to provide as many opportunities that we can to foster an environment where youth and adults with disabilities succeed and support each other,build a social network that is trusting within their circle of friends,and to feel more comfortable within the community at large,and because of this,we are creating and implementing new services and activities aimost every day. 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?). The City of Dublin's Grant funds will help to support the salary of our three(3)Lead Teachers.Lead Teachers are responsible for creating curriculum fOf eBCh Of ouf gf0ups,youth,teen,and Community integration altogether serving 40 participants.Nine(9)of which are Dublin residents,three(3) paRicipants in each of the groups.Lead Teachers help to improve the experiences of all our students enrolled at Kaleidoscope. Supporting these staff costs is even more critical as the Kaleidoscope program continues to grow as the strongest behavioral program in Alameda County.As a result of continually high success rate of our program,the Regional Center of the East Bay is referring high numbers of individuals who require Intensive Behavioral and Social Skills(IBSS)training at a 1:1 teacher/participant ratio.While individuals requiring 1:1 ratio are the most resource intensive students we serve,the growth and development outcomes for these individuals are the most impressive.Almost all of these students who exit the program require only a 1:3 or 1:5 teacher/participant ratio.This means that youth are now able to be contributing members of their families and communities. As the participants get older,they leam life skills(cooking,cleaning,ordering,etc..),self-care skills(hygiene,oral care,etc...),leisure skills (recreational trips to the movies,bowling,lunch with friends,etc...),and pre-vocational skills Qob searching and volunteering),and transportation skills.Many of these skills stay with the participants so they can be active members of the work force. 73. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome�s)? The Lead Teacher at Easter Seals Kaleidoscope will work closely with parents,teachers,behaviorists and case managers to ensure that goals listed on the Individuals Educational Plan(IEP)are met.Through repetition and practice many of our participants are able to meet these goals and exceed them.Often times,parents/guardians/caregivers may have other goals not on the IEP such as making friends,riding a bike,throwing a baseball which they share with the Lead Teachers,which then becomes a paR of the monthly calendar that the Lead Teachers create. Many of our parents/guardians/caregivers have expressed just how much Easter Seals Kaleidoscope has meant to their family and their son/daughter and that it may not have been possibie without our help and support. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled,low-income,etc. For more than 25 years,Kaleidoscope has been teaching vital independent living skills to youth and adults with developmental disabilities. The Kaleidoscope program is a home-away-from-home for its participants,offering a nurturing,structured environment that prepares them for independence through age-appropriate activities and positive peer interaction.Kaleidoscope currently provides more than 30,000 hours of service to children and adults with disabilities annually. In addition to affordable after-school care,Easter Seals Kaleidoscope gives caregivers a much-needed break from the 24-hour demands of caring for an individual with special-needs.Kaleidoscope gives parents time to tend to other obligations,to spend with their children,or to simply rest.The Easter Seals Kaleidoscope program enables caregivers to recharge emotionally and physically so that they are able to care for their child with a disability. 15. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the clienticustomer population served)? The Easter Seals Kaieidoscope program serves individuals with disabilities ranging from the ages of 5 to 22.Kaleidoscope has three groups.The Youth Group serving ages 5 to 12,the Teen Group serving ages 13 to 17,and the Community Integration Group serves ages 18 to 22. Within each group they focus on stated IEP goals while working on age-appropriate tasks,social skills,life skills,while maintain an appropriate level of : peer interactions.Each group focuses on getting their participants to the next level,example:youth group focuses on getting the participants to joining the teen group at an appropriate social level,the teen group focuses on getting the participants to the community integration group and the community integration group focuses on prepping the participants to move into a group home,a day program,gaining employment,and being productive members of their communities. 16.Explain how your agency will outreach to low-income,limited English speakers,andlor disabled persons.How will each of these groups access the project for which your agency is requesting funding? Easter Seals Kaleidoscope works directly with the disabled population.Easter Seals Kaleidoscope is a vendor of the Regional Center of the East Bay. Kaleidoscope receives referrals that are low-income,limited English speaking,as well as the disabled population. Easter Seals Kaleidoscope serves low income families,limited English speaking families,single parents,and not only the disabled individuals but also disabled head of house hold families. 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greate�service integration. Easter Seals Kaleidoscope has not partnered with other outside organizations.Easter Seals Kaleidoscope has utilized outside services such as County Connection and Wheels Bus for transportation services,the paRicipants collected canned goods and donated to Valley Christian Church,and participated in Special Olympics.Easter Seals Kaleidoscope will also utilize volunteers from City Serve throughout the year. 18.Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. Easter Seals Kaleidoscope has worked with the Regional Center of the East Bay,Dublin,Livermore,Pleasanton,San Ramon,and Castro Valley School Districts along with other local day programs to set up a network of resources for referrals,advocating,and services.Parents,volunteers,staff and friends of the program have been strong advocates for our program. In Odober of 2014,Easter Seals Kaleidoscope held our annual Art&Sound Festival.During this time the Dublin Chamber of Commerce,the Dublin Patch,and many local businesses were contacted to help promote the event.Many companies placed our poster in their storefront window and others passed the save the date cards to their employees.Without their support,our event would not have been as great as it was. 19. Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. Being that Easter Seals Kaleidoscope is a site based program,we often rely on volunteers to help with events,special projeCts,and sporting events. By using volunteers from the city of Dublin,City Serve,parents/friends,and surrounding communities we have created a unique way for the community as a whole to gain knowledge and understanding of the population we serve. Within the past year we have had over 150 volunteers assist with maintaining the garden on,assist with coaching during the Special Olympics regional tournaments,provide support during the Art&Sound Festival held at the Kaleidoscope center.Volunteers have also deep cleaned our buildings and vehicles,replenished the tan-bark on the playground,collected donations for our events,and assisted with the many paRies for the participants. Kaleidoscope has also participated in many resource meetings to establish a network of caregivers,housing solutions,employment opportunities,legal ' guidance,and special day programming. Easter Seals is Leading the way to ensure individuals and families affected by disabilities can live,Iearn,work,and play to their full potential.Within our mission we promote and support a high quality of life which ensures a safe and secure environment that fosters new opportunities for our families that we serve through direct programming and day to day operations with our participants. Many of the parents of the participants we serve have praised our program with comments such as,"My son would have never learned to ride a bike if it wasn't for your program"or"Our daughter would never have friends if we didn't send her to Kaleidoscope".With direct impact such as these, Easter Seals Kaleidoscope meets all of the criteria of the City of Dublin's Mission,Vision,Values,and Strategies. 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The Easter Seals Kaleidoscope After-School program's design allows us to offer cost-effective,comprehensive transitional services for youth and young adults with disabilities without sacrificing quality of services.By offering the program as a programmatic component of the Easter Seal Bay Area,we are able to share expenses and resources based on a pro-rated share between programs.A portion of the program occurs in the community so participants have the opportunity to apply the functional skills they obtain in a real-worid setting. Because transportation is often costly,Easter Seals continues to partner with County Connection and Working with Wheels,a local non-profit that works with our Community Integration participants to offer bus and public transportation training.Research clearly shows that youth and young adults with disabilities who do not receive the transitional programming and interventions they need to foster a successful adulthood,will likely rely on public benefits(SSDI)for the duration of their life.This is extremely costly and does not allow individuals with disabilities to become full-fledged members of their communities. Necessary and standard operating expenses for the project include:rent,utilities,and phone lines;supplies include:materials to be distributed to partnering community-based organizations on persons with disabilities and inclusionary practices,and training materials that are used for providing direct services to participants;and activity fees represent costs like eating in the community and admittance to community recreation programs.Direct service salaries for the Lead Teachers represent the entire cost of the project. There are no capital or equipment costs for this program. 21. If this application does not receive funding,or receives reduced funding,what will be the effect on the project? ' If the City of Dublin is unable to provide funding,we will seek contributions from other organizations to cover program costs that are not funded through earned revenue.However,the suppoR from the City of Dublin would go far in helping us provide the level of quality programming our families need,and would also demonstrate local community support enabling us to leverage additional funds through a community-based challenge grant. Easter Seais is also committed to fund raise for additional financial support,and as an example,the Kaleidoscope After-School program host an annual Art&Sound Festival with a silent auction.Not only is this a fundraiser,but it also raises awareness within the communities we serve. Easter Seals is very thankful about leveraging City Grant funding from the City of Dublin to raise additional awareness and support,and to cultivate life-long champions of the Kaleidoscope program. We would not be as successful as we are without the help of the Dublin community. 22.Does your agency anticipate having any unspent grants funds at the end of the fiscal year? � Yes (✓ No 23. If you answered yes to the preceding question please explain.Enter"NIA"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures)? � Yes r No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25.If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"N/A"if not applicable. N/A 26.If your agenGy is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms,plans for future relocation or expansion,etc.).Enter"NIA"if not applicable. N/A 27.If your agency is requesting Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? r Not Applicable � Yes � No r Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin's Mission&Vision Statements:(you may choose more than one) � Promotes and suppoRs a high quality of life which ensures a safe and secure environment that fosters new opportunities. � Balance history with progress,to sustain an enlightened,economically balanced and diverse community. � Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. (�Y Promotes active and healthy lifestyle through the creation of first-ciass recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) � Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety � Guiding Development:to assure that development contributes positively to the City's fiscai health;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City r Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises faimess in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and e�ciency and strives to build an informed community through communication � Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutal benefit 30."*QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.*•Are you are interested in applying for CDBG funds? !— Yes.If so,answer questions 31 through 43. 1�° No.If no,check box here,and questions 31 through 43 will not be required.. � Don't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDBG QNLY-Expiain yaur Limited Engiish Proticiency/�anguage Access PIan�LEPfLAP). How does your agency outreach to limited English speaking residents to encourage access ta services&housi�g?What access accommodations are used? Prnvide detaii ar;s�,���sr�;ot ri?cst;r;!e tf tJc;c�us�o-rrae G�t�Svdf-rYO#,3�+. 32.CDBG ONLY-ident+fy AT LEAST ONE U.S.Department of Hausing and Urban Developmen#(HUd}Consolidated Pian Guiding Principle that relates to your prnject: -ar,si,ver no"t presei�ted(�ecause of tl�e ansuF�er to#30- 33.CDBG{3N�Y-Identify AT LEA5T dNE U.S.Department oF Housing and Urban Development(HUD)Gonsoiidated Pian Goals that relates to yaur pro}ect: -ans�ver�7ot presented because af the a+�s�ver to#3D- 34.CDBG ONLY-Identifiy AT�EAST ONE U.S.Departmant of NUQ Strategic Goal that relates to your project: -ar�swer r�ot�aresen'ed bc-cacrse of the a+�sia�er to#30- 35.CdBG ONLY-Identify AT LEAST ONE U.S. Department of NUD Palicy Priority that relates to your project: � ansti-ver rro*�>t�esent�ed P�ECa�rse of the a��sti^✓e�r�r�#30- � 36.CDBG ONLY-identify AT LEA5T ONE Consoiidated Plan ohjective that relates to your prc�ject: � -t.r3s,v�r,,vt,�resrr.'���tt tac; ���.�se v.�r:e ar�st�r:~i��#3t�- � 37,Gp6C;pNl'Y-Select ONE Qbjective#hat relates to your project{71P:When selecting an objective ask yourseif;"What is the purpos�of the activiYy?What is#he larger community need thak k am seeking to address?"): <i.r � r ,- r_ #�z�._ � -9�.,.1 t it j3.E�„f, .�,..,c,�,. .i �.e°�� ,.. .,...>4 , .. ... : 38.CDBG t}NlY-Select ONE Outcome ihat relates ta yaur prnject{TIP:When selecting an autcame ask yourself,"What type of change or resuit am f see#ing?"}: ai�rsv���r i;ot p,�se;;•'et1 bf;c�c�se of the a;zsl^.�er!o#3C� � 39.CqBG ONLY-5elect ONE Specific Indicator that relates to your project: � ...8t 1 SVJt3r�t 30�(J?-@aL:t?fB��JPCc�.tt.`;t?o(P�I B c�!1 SvJBY 1U#30- 44.CDBG ONLY-Piease choase a common indicator th8t your agency will use t4 tr�Ck ClientS f S�ieGt Oniy QNE): � -arrswer raaT present�d beca��se of tne anss��e%to#�30- � 4L CDBG pN�Y-Fpr the categary yau selected abave,provide the total number of undupi�cated Dubiin Gients{EITHER Persons OR Hausehoids)your agency anticipates serving through this project: ' -anstaer not presented becat�se of the ansvver?o#30- d2.CDBG ONLY-Based an the cornmon indicator you selected above;piease list the number oF unduplicated Dub�in clients your agency anticipates serving in each category."If nane, please enter"0". -ar�s��ver nat present�d�e;;aase of th�aa�s�a�er"o#30- 43.CDBG ON�Y-List the nu�nber of clients yaur agency anticipates serving in race/ethnicity categories.The sum entered below must match the totai cli�nts entered in#42 above.Per NU4"Hispanic"is an ethnic'rty;not a race.'"If nane;please enter"0" -3RS;bE"';':O[�:If,'SE;t3t�t"��;E;CFit1:�f,'C>i`f�"1B a(13-ePwI i0�.�:1-. 44.If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY � #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. r #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. � #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. (— #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. � #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. � If you have more than 6 applications per organization,agency,district or entity,check here. 45. Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). Easter Seals Kaleidoscope is a non-profit organization that continually loses money year after year.The Kaleidoscope program host an annual Festival fundraiser and Easter Seals Bay Area host multiple fundraisers throughout the year to support the program. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-00301 Budget Funding Sources/Revenues Budget Amount Amount Committed Program Service Fee-Revenue $32,000.00 $90,000.00 Fundraising-Revenue $28,000.00 $15,000.00 Other income(inGudes interest income) $0.00 $0.00 City of Livermore HHSG $5,000.00 $5,000.00 Ciry of Pleasanton HHSG $10,000.00 $10,000.00 Total $75,000.00 $120,000.00 Funding Uses/ExPenses Budget Amount Amount Committed Program Staff Salaries _ $350,400.00 Program Staff Benefits $85,700.00 Professional Fees $1,700.00 Equipment Rental/Maintenance $4,000.00 PrintingiPublication $4,500.00 SupplieslMaterials $25,635.00 Other.Transportation $4,500.00 Total $476,435.00 $0.00 Budget Narrative The above are direct numbers pulled from operating cost budgets.The$15000.00 is for potential City of Livermore and Pleasanton Housing and Human Services Grants. Documents Documents Requested' Required? Attached Documents* Program Expense Budget for ALL Grant Requests r F�pense budQe# download temalafe _ Financial Information Form for ALL Grant Requests � Financia! downiaad template _ List of Board of Directors(or governing body)with contact � 8oard list information Current Annual Budget for the Entire Agency � Budqet Copy of most recently submitted IRS 990 form or Tax Return r IRS 990 (include complete form) Board of Director's(or governing body's)designation of r Authorization authorized official Board of Director's(or goveming body's)authorization to r Board of directors list request funding(may be same document as one above) Proof of insurance carried,inGuding bonding,liability and/or (�° Insurance workers'compensation REQUIRED FOR CDBG ONLY-If requesting Capital Funding, � please upload your Capital expenditure budget(your own format is acceptable) REQUIRED FOR CDBG ONLY-PERSONNEL POLICIES INCLUDING r AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS r AND COPY OF LAST AUDIT HIGHLIGHTING"FINDINGS" SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION AND BYLAWS. REQUIRED FOR CDBG ONLY-CONFLICT OF INTEREST � STATEMENT(IF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART r STATE AND FEDERAL NON-PROFIT DETERMINATION LETfER. r Non-Profit�etermination Letter All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application.Non-compliant applicants wiil be disqualified. REQUIRED FOR CDBG ONLY-AGENCY'S LIMITED ENGLISH I� PROFICIENCY LANGUAGE ACCESS PLAN(LEPILAP).Must include outreach to limited English speaking residents to encourege access to services&housing.Include what access accommodations are used. REQUIRED FOR CDBG-LEVERAGING REPORT-this is due with � the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements � Audit 'ZoomGrantsT""is not responsible for the content of uploaded documents. App�ication ID:47790 � Become a fan of ZoomGrants*"on Facebook � Prohlems7 ConNact us et�uestions aZoomGrants.com . �2002-2016 GrantAneryst.com.All rights reserved. � "ZoomGrents"and the ZoomGrants logo are trademarks of GrantAnalyst.com,LLC. � Loaout�8rowser � . Emaii This Preview Save as PDF Print Clase Windaw Ai♦ � Poiarered bv ZoomGranfsT"' City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadiine Eden 18R,Inc. 2-1-1 Alameda County Communication System ; $10,000 Requested � Eden I&R,Inc. ����� � ____._ __.__. __ _ Submitted: 12/7/2015 1:42:44 PM(Pacific) � 570 B Street Telephone(510)537-2710 x8 I Hayward,CA 94541 Fax (510)537-0986 Project Contact United States Web www.edenir.org Barbara Bemstein bbernstein@edenir.org Executive Director Tel:510-537-2710 x8 Barbara Bernstein bbernsteinC�u edenir.orq Additional Contacts none entered Application Questions ____ ..� �__._��____.___ ____� ISome answers will not be presented because they are not part of the selected group of questions based on the answer to#30. � 1. Please describe your organization category(select one of the following): � Private Non-Profit � Public Agency I� Other. 2. Please describe your agency's mission(no more than 3 sentences or 250 characters►. This agency commits itself to serve as a link between individuals and the full range of community resources availabte to them.We dedicate the agency's resources to the empowerment of individuals with timely and accurate information about resources. 3.For what type of Dublin Grant is your agency applyingT r Capital Project r Public Service Program or Project 4.Is this a"new"service,program,proJect or activity?"New"is identified as not yet started,implemented or in operation. � Yes I� No 5.Please indicate below if this application is a request for one-time funding and/or"seed"funding. � One-time funding � Seed funding r One-time and Seed funding r Operational funding � None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received within the last three years Qurisdiction,year,amount,purpose,etc.).Enter"NIA"if you HAVE received Dublin Funds. N/A 7. Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.). Eden I&R's governing board meets quaRerly and is composed of seven dedicated individuals,with several members having served more than 15 years.The agency's staff has been led by Executive Director Barbara Bernstein since January 1989.More than one-third of staff members have been with Eden I&R for ten or more years,testifying to the stability of the agency. As the only countywide comprehensive Information and Referral(I&R)provider in Alameda County,Eden I&R is relied upon by human service providers,local government and people in need throughout the County as a professional and compassionate partner in the delivery of human services; the clearinghouse for accurate community information;a key component of the disaster response network in Alameda County;a reliable source for data on service needs and deiivery systems;and a culturally and linguistically diverse organization prepared to serve Alameda County's individuals and families. Eden I&R's 2-1-1 program offers a number of unique services and benefits,including being the only agency that checks shelter bed availability twice daily. 8. Provide a brfef summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementation process to describe your project. 2-1-1 is a free,24/7/365,multilinguai phone line that connects indivduals and families(particularly low-income,at-risk people)with referrals to city and countywide heaith,housing and human service resources. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) Our goal is to assist 500 callers.It is not possible to discern whether all cailers are unduplicated because callers often share their city of residency but � may not provide addtional demographic information. 10.Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with7 (� Behavioral Health(mental health and substance abuse) r Affordable Housing r Health Care(including dental) 1� Workforce Development (�' Homelessness r Transportation Services and Access r pomestic Violence and Child Abuse �' Disabilities � Food and Nutrition (�' Senior Services � Youth Services � Child Care,Early Childhood Development and Education � Changing Demographics and Growing Diversity � Financial Assistance I� None of the above 11. Explain how this project will be implemented,administered,and operated. With the suppoR of numerous organizations and community leaders,Eden I&R was designated by the California PUC to be the 2-1-1 provider for Alameda County and launched the service in 2007 with publiGprivate sector funding.Since then,Eden I&R has been admi�istering and operating the 2- 1-1 service 24/7/365. 2-1-1 Phone Line Resource Specialists(PLRS)are rigorously trained to understand the unique and often dire situations faced by callers,and are able to assist in prioritizing requests,build an action plan,and be sensitive to the needs of callers.PLRS do not attempt to solve cailers'problems,but empower callers to understand and solve their own probiems by working to fully understand the cailer's situation(e.g.,origins to the needs,the feelings callers have about their circumstances,the personal resources callers may bring to bear on the issue,and the barriers they face).The primary objective of the 2-1-1 phone line is to help caliers identity the health,housing and/or human service resources that can meet their needs. Whenever possible,PLRS provide follow-up on cases involving endangerment and situations in which the PLRS believes that the caller may have difficult accessing services or clearly communicating their particular circumstances.PLRS present the caller with various approaches to addressing the problem and explore the caller's own resources(e.g.,friends,family,faith-based community).In addition,the caller will be provided with at least three referrals to enable him/her to choose the most appropriate resources.PLRS pursue the problem until both the caller and PLRS are assured that all appropriate options have been exhausted and will suggest ways the caller can advocate for him-or herself. To ensure that 2-1-1 cailers receive the most up-to-date information and referrals to resources, Eden I&R's Human Services Database is updated daily with every program record updated at minimum once a year. : 12.Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?). Dublin grant funds will be used to assist Dublin residents,employees and advocates in accessing health,housing and human services information and referrals 24/7/365.Due to the need for continuous staffing to operate a 24/7 phone service,staff salaries and benefits represent 85%of the projecYs costs.2-1-1 provides referrals to programs identified by the 14 Areas of Concern in the 2011 Eastern County Needs Assessment.The report also identifies a shortage of affordable housing,mental health services,child care and workforce development programs in the Tri-Valley.Dublin residents can call 2-1-1 any hour of the day or night and be connected to a PLRS who will assess the caller's needs and provide access to comprehensive information and referrals to the needed services mentioned in the report and more. The remaining funds from the City of Dublin will be used to perform outreach to the Dublin community,especiaily low-income and under-served populations,about the availability of the service.Our goal is to eliminate or reduce the perceived lack of information on how to access resources. Activities will include printing flyers and other promotional materials that will be made available at various organizations and departments in Dublin. 2-1-1 is supported by a variety of partnerships and contracts with new and existing programs.Government,foundations,corporations and individuals provide a leveraged funding partnership.PubliGprivate funding makes it possible for 2-1-1 to be able to provide health,housing and human service information and referrals on a daily basis plus additional services like disaster-related information and eligibility for public assistance programs. 13. Piease list and brief►y describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome(s)? 1.Provide a free,major point of entry to health,housing and human service information and referrals for Dublin residents,employees and advocates 24/7/365 in multiple languages; 2.Maintain and update the more than 2,900 health and human services program entries in the Health and Human Services Database at least once annually in order to provide the most current information to Dublin callers, 3.Increase the number of housing units in the Housing Database by 450 units countywide; 4.Provide weekly in-service training to 2-1-1 PLRS on new and existing programs in the community;and 5.Conduct outreach in Dublin by hosting booths/tables at relevant events as they arise and replenish 2-1-1 outreach materials,as needed,for organizations and government departments in Dublin. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled, low-income,etc. Although available to all Dublin residents,2-1-1 is especially critical for vulnerable populations such as the homeless,very low-income families,frail elders,people living with disabilities,at-risk youth,caregivers and non-English speakers who are in need of vital resources.2-1-1 PLRS are professionally trained to assess callers'needs and provide comprehensive and up-to-date information on a wide range of services.The 2-1-1 Call Center is staffed during regular business hours with Bilingual PLRS who currently speak Spanish,Cantonese,Mandarin,Vietnamese,Hindi and Farsi, and over 150 languages are translated via a 24/7 interpretation service. Another segment of the population that benefits from this service are advocates(e.g.,case managers,medicai personnel,teachers,city officials and administrators,and employers)in Dublin who need help navigating the every-changing system of human service agencies for their clients,patients, students,constituents and employees. The following are recent examples of calls from Dublin residents: -A Dublin resident called in search of housing that she could afford.She was referred to Shepherd's Gate for transitional housing;to Leahy Square Apartments in Livermore;and to an apartment on Foothill Blvd.in San Leandro. -A Dublin mother called seeking assistance with rent and deposit for her son who has a disability and has SSI.She was referred to Season of Sharing. -A Dublin woman with a disability called and shared that she was unable to use public transit due to her blindness.She was referred to the Lions Center for the Blind in Oakland for its travel training program. -A single mother with a mental disability and two small children called from Dublin for financial assistance.She was referred to REACH,HEAP and Season of Sharing for her utility bill;the Washoe Tribe of Nevada and California for Native American TANF information;and Child Care Links for subsidized child care. 15. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the clienUcustomer population served)? 2-1-1 Bilingual Resource Specialists currently speak Spanish,Cantonese,Mandarin,Vietnamese,Hindi and Farsi.Callers can access 2-1-1 services in over 150 languages via Eden I&R's contractual arrangement with LionBridge to provide instantaneous interpretation services.Eden IS�R has a culturally and linguistically diverse staff:34%Asian or Pacific Islander,25°/a Hispanic or Latino,20%African American and 3%Native American. In-service trainings are provided that focus on cross-cultural issues.In addition,the daily interactions with peers and clients from different backgrounds,along with weekly staff training on area resources,reinforce Eden I&R's ability to provide culturally effective and relevant services to diverse target populations. For reporting purposes only,Eden I&R's 2-1-1 PLRS ask clients their ethnicity,but the comprehensive assessment of needs and the types of information and referrals provided to each caller are the same.The only difference is a non-native English speaker(or someone who is more comfortable communicating in their first language)or a non-English speaking caller might request that programs they are referred to have staff that speak their language.(Eden I&R's comprehensive database indicates each agency's language capabilities.) 16.Explain how your agency will outreach to low-income,limited English speakers,and/or disabled persons.How wfll each of these groups access the project for which your agency is requesting funding? Different outreach methods have been pursued and will continue to be pursued to inform all Dublin residents and employees about his critical and free service.These inGude:speaking to staff from different agencies at resource,cultural,health,senior and disability fairs;posting and making 2-1-1 materials available at local agencies;submitting press releases to local publications;placing 2-1-1 materials with other agency giveaways(e.g., holiday food baskets and give-away bags);and seeking assistance from other agencies and departments to help inform the public about 2-1-1 (e.g., posting a logo or aRicle about 2-1-1 on their website and/or in their newsletter). All outreach activities are focused on agencies and events that serve vulnerable populations.To accommodate limited English speakers,2-1-1 flyers and are distributed with English on one side and Spanish,Chinese,Vietnamese or Tagalog on the other side. 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Eden I&R's 40 years of successful operations have relied upon the mutual and longstanding partnerships with approximately 2,900 programs and services,and over 1,200 agencies to maintain Eden I&R's information databases.In addition to these relationships,Eden I&R works directly with a number of organizations and is involved in many partnerships.For example,Eden 18R is one of five Bay Area 2-1-1 centers partnering to develop mutual support systems and data-sharing agreements;is an active member/participant of emergency preparedness and planning groups with Alameda County Office of Emergency Services and the Public Health DepaRment,among others.Eden I&R staff participates in the County's Reentry Collaborative,EveryOne Home,and was a member of the East County Needs Assessment Steering Committee. Eden I&R maintains a number of collaborations with public and private agencies to provide comprehensive services to those in need.These collaborations include the East Bay Community Law Center,Workforce Investment Board,Probation Department,and Housing and Community Development,among many others. 18.Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. Eden I&R provides thousands of pieces of 2-1-1 outreach and marketing materials each year in several languages to a wide variety of inedia, community organizations,social service agencies,faith-bases organizations,schools,business/corporate entities and government departments and agencies.These materials include informational flyers,business cards,magnets,posters and promotional items. Examples of targeted outreach include:participation in Santa Rita jail re-entry events and the City of Dublin's St.Patrick's Day Fair;hosting a booth or table at the Dubiin Senior Center's community events;and distribution of materials at Dublin City Hall offices,transportation centers(e.g.,BART)and with many faith-based organizations. 19. Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. 2-1-1 Alameda County is a free,three-digit telephone number,available in multiple languages,that enables callers to have confidential and easy access 24/7/365 to health,housing and human service information.2-1-1 is a single point of entry to services that complements and supplements Dublin city services. Eden I&R's delivery of 2-1-1 services is consistent with the City of Dublin's mission that"promotes and supports a high quality of life which ensures a safe environment that fosters new opportunities"as it provides residents easy and affordable access to information and referrals to a wide range of critical health,housing and human services that improve quality of life.Such services promote economic vitality and well-being.In terms of public safety,Eden I&R is the countywide communications agency for disasters and is a member of various disaster planning groups such as the Alameda County Emergency Managers'Association and the Alameda County Emergency Operations Center Team. 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The cost effectiveness of 2-1-1 lies in its ability to serve as a single,central access point for a full range of information related to personal and economic self-sufficiency,including critical human services and housing.This single point of contact for local services is cost effective in many ways, including: -Reduction of wasted effort,expense and time off work for vulnerable Dublin residents seeking needed services; -Provision of access to accurate and appropriate human service information that is free,simple to use and readily available; -Elimination of the need for other agencies/departments to dedicate staff time or additional resources to compile and continually update databases of area services; -Freeing of city,county and other agency staff from being inundated with callers seeking services other agencies/departments handle,allowing staff members to concentrate on their core assignments; -Provision of culturally and linguistically appropriate services to residents who have limited or non-English proficiency; -Reduction of frustration for residents trying to navigate the complex and every-changing social services system to find the right resources;and -Contribution from the City of Dubiin for less than 1%of the total 2-1-1 costs provides the City of Dublin with a$2 million communication system. 21.If this application does not receive funding,or receives reduced funding,what will be the effect on the project? 2-1-1 Alameda County relies on a leveraged publiGprivate partnership among the county,the cities and the private sector.The public sector funding consists of a fair and equitable funding plan with each entity(all cities combined is considered one entity)allocated approximately 30%of the total funding costs.The City of Dublin's contribution of$10,000 is based on its population size of approximately 2%of the county's population.The operation of this communication system depends on the commitment of the cities,the county and the private sector to fulfill their share or the entire funding plan could unravel.No or reduced funding would result in fewer individuals and families receiving critical health,housing and human services information and referrals. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? � Yes � No 23.If you answered yes to the preceding question please explain.Enter"NIA"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures�? r Yes � No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25.If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"NIA"if not applicable. N/A 26.If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms, plans for future relocation or expansion,etc.).Enter"N/A"if not applicable. N/A 27.If your agency is requesting Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? r Not Applicable r Yes � No Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin's Mission 8 Vision Statements: (you may choose more than one) � Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new oppoRunities. � Balance history with progress,to sustain an enlightened,economically balanced and diverse community. � Encourages innovation of City life,including programs to strengthen our economic vitality,suppoRs environments stewardship and sustainability through the preservation of our natural surroundings. 1� Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) 1� Building Community:by promoting locations and events that brings people of ail ages together;providing more venues for family-based activities and fostering heritage and cultural development � Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety � Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City r Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication r Relating to Other Communities and Entities:by encouraging coliaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutal benefit 30.**QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.**Are you are interested in applying for CDBG funds? � Yes.If so,answer questions 31 through 43. r No.If no,check box here,and questions 31 through 43 will not be required.. � Don't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CqBG ONLY-Expiain your Limited Engiish ProficiencyiLanguage Access Plan(LEPl�AP}. How does yaur agency outreach to timited Eng4ish speaking residents Eq encaurage access to services& hpusing?What access accommodations are used? Provide detaii ..��S6i-t, .{l�X?:£i !.,1:)£ r!:fi:i. , inc�: p 1'.,"ilj.. �. 32.CDB�ONLY-ldentify AT LEAST OFtE U.S. Department of Noe»ing and Urban Devef�pment(HUD)Cansolidated Plan Guiding Principie that r�lat�s tc�y+aur project: -arrswer notv?es�.n,Pec9 beoG=�.+sca o``rP�e ans�^rer to#30. 33.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Nousing arsd Urban Development SNUD)Cansoiidated Plan Goais that reiates ta your project: � ar;s��er�noi nrese�rted becaase oi tl�e ar,s�vt�er to#K30- 34.CDBG ONLY-ideMify AT LEAST QNE U.S.Department pf HaD Strategic Goal that relates to your project: -ans�ve��r�ot p�ese+�ted because af!?�e ansa+�er to#3�- 35.CDBG ONLY-Identify AT�EAST ONE U.S.Department of HUD Policy Priority tha#reiates to yaur praject: -ar�s�er not pres�r�ted because af fhe ansi-ver ta t�30- 3fi.CDBG ONL.Y•ldentify AT LER5T ONE Consolidated Pian objeckive that relates to your praject: -anSiNer nof presented because oPthe anse�e�ta#30- 37.CDSG ON�Y-Select ONE Objective that relates to your praject(TIP:When seleeting an objective ask yoursel#,"What is the purpose of the activity?Wha#is the larger cammunity need that I am seeking to address?"�: -ansvver noi presented because of tt?c ai�siv�:r tc�#30- 38.CDBG{3NLY-Select ONE Outco�ne that relates ta yp�r praject{TIP:When selecting an nutcome ask yourself,°What type af change or res�rit am i se�king?"j: -unst-ver'ra't�!�s�nferl ber,r-,u�.e t>`ti'�e ans4ver ro?#;.rJ 39.CDBG ONLY-Seleet C?tdE Specifie lndicatar that relates to yaur prnject: �7t15'.,F.�"riCf C�7£�S-�:��d/JO� �uvC:�f.����RS� G t�t�F."�iJ- . 40.CDBG C}NLY- Piease chaose a cnmman indicatar that your agency wilf use to track clients(select oniy ONEa: ..zri5��i r .,!(�?a �{ ir:a,f,r�F.-��1�^!�° �£�!';S .E, ,,. ��_3(J�- 41,CDBG t�NLY� Far ths category you seiected above,provicle the total number nf undupiicated publin ciients{EiTNER Persans L1R Househoids)yaur agenny anticipates serving throGfgh tMis praject: .snswr r n�rt r�� ,c;��ed rr�a�;se:,f ti�e a rs� �,ta ir;;0- 42.GDBG{7NLY-Based on the common indicatar you selected above,please list the number of undupiicated Qubiin ciients your agency anticipates serving in each category."if none, please enter"0". ans�err?o,preser?ie F�ecat}se n ttae�r;s��er.ca r- 43.CDBG�NIY-�ist the numher of ciien#s your ager,cy anticipates serving in racelethnicity categories.The sum entered belaw must match the tata!clients entered in#42 abave. Per HUD"Nispanic"is an ethnicity,not a race."if none, ptease enter"0" ..8175':Y..�`/I?<)t U'�.!-'.SE;p?�°,"?B;;F�t.;.F'i;`rt7F'V317SbVE';IO�;j�... 44.If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY r #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. � #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. � #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. � #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. r #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. 1— #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. (— If you have more than 6 applications per organization,agency,district or entity,check here. 45. Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). The unique programmatic nature of 2-1-1-serving ail of Alameda County-inciuding Dubiin-means that the service will continue to seek and utilize funding from the County's cities as well as County departments.This public funding,in turn,allows Eden I&R to seek leveraged funding from foundations,corporations and individuals. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-109873 Budget Funding Sources/Revenues v � � �v„� �m gudget Amount Amount Committed Alameda County Cities $365,000.00 $100,000.00 Alameda County Departments/Agencies $1,226,236.00 $0.00 Corporations and Foundations $409,000.00 $20,334.00 Individuals $10,000.00 $0:00 $0.00 $0.00 Total $2,010,236.00 a 120,334.00 Funding UseslExpenses Budget Amount Amount Committed Salaries and Wages $1,387,856.00 $120,334.00 Taxes and Benefits $306,279.00 $0.00 Consulting/Contractual $48,850.00 $0.00 Mileage _ $9,769.00 $0.00 Insurance $10,347.00 $0.00 Bldg Lease and Maint. $81,766.00 $0.00 Utillties _ $18,140.00 $0.00 Telephone $31.002.00 $0.00 Advocacy and Outreach $15,000.00 $0.00 Equipment and Supplies $52,733.00 $0.00 , Postage $7,154.00 $0.00 Printing $10,278.00 $0.00 Conferences and Training $13,000.00 $0.00 Dues,Fees and Other Charges $18,064.00 $0.00 $0.00 Total 5 2,010,238.00 $120,334.00 Budget Narrative The 2-1-1 Alameda County Communication System is Eden I&R's largest program.Because 2-1-1 is a 24/7/365 program,85%of the budget is for salaries,taxes and benefits.This funding enables 2-1-1 to remain available at all times for Dublin and County residents,employees and their advocates.In addition to the committed funding for FY2017,Eden I&R has pending requests totaling more than$500,000 for FY2017.The totai amount for committed and pending funding is over$600,000.Commitments for public funding in FY2017 will occur in Spring 2016,while private corporate and foundation donors will make commitments throughout the fiscal year. Documents Docume�ts Requested* Required? Attached Documents" Program Expense Budget for ALL Grant Requests � Eden I&R Praaram Exoense Form FY16-17 ownoa empae Financial Information Form for ALL Grant Requests I� Eden I&R Financiai Information Fo;m FY16-17 download tempiate List of Board of Directors(or goveming body)with contact I� Eden 18�R Soard of Directors : information Current Annual Budget for the Entire Agency � Eden 18�R FY16 Budaet ' Copy of most recentiy submitted IRS 990 form or Tax Retum r Eden i&R Fnrm 990 (inciude compiete form) Board of Director's(or governing body's)designation of � Edenl&R Board�etter authorized official Board of Director's(or governing body's)authorization to r EdEn I&R Board Authorization�etter request funding(may be same document as one above) Proof of insurance carried,including bonding,liability and/or r Eden I&R Insurance workers'compensation REQUIRED FC)R CDBG ONLY-ff requesting Capital Funding, r please upload your Capital expenditure budget(your own format is acceptable) REQUIRED FOR GdBG ONLY-PERSONNEL POLICIESiNCLUDING � AFFIRMATNE AC710N PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS � AND COPY OF LAST AUDIT HIGHLIGHTING"FINDINGS" SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION . r AND BYLAWS. REQUIRED FOR CDBG ONLY-CONFLICT OF INTEREST I STATEMENT(IF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART r STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. � Ede3�I&R StatellRS Exemption Letters All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application.Non-compliant applicants will be disqualified. REQUIRED FOR CDBG ONLY-AGENCY'S LIMITED ENGLISH � PROFICIENCY LANGUAGE ACCESS PLAN(LEP/LAP).Must include outreach to limited English speaking residents to encourage access to services&housing.Include what access accommodations are used. REQUIRED FOR CDBG-LEVERAGING REPORT-this is due with r the 2nd quarter report no later than January 15th Certified Audit and/or Certified Finaneial Statements � Eden I&R Audited Financiai Statement 'ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:48013 Become a fan of LoomGrants"'on Facebook � Problems?Contact us at�uestio�ns�a�LoamGrants.cmn 02002-2016 GrantP,nalyst.com.All rights reserved � ZoomGrants"and the ZoomGrants logo are trademarks of GrentAnalystcom,LLC. . �C_�_out�6iowse� �. ��� Emaii This Preview Save as PDF Print Ciose Window Ai♦ Powered t�v ZoomGr�ntsT"' City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadline Habitat for Humanity East Bay/Silicon Valley,Inc. Homebuyer Financial Literacy Counseling Program � $10,000 Requested Habitat for Humanity East Bay/Silicon Valley,Inc. — ------- �� Submitted: 12/11/2015 2:22:45 PM(Pacific) � Telephone510-251-6304 2619 Broadway Fax 510-251-6309 Project Contact Oakland,CA 94612 Web www.habitatebsv.org Lesley Casto LCastoC+�habitatebsv.orq Chief Executive Officer Tel:510-803-3381 Janice Jensen JJensenC�habitatebsv.orq Additional Contacts none entered , I ----�.�—.____--__------------- ---I Application Questions _..._.....__ ._.----_. _ ...... ........ ..__ ......_... _...... ._._...__....._ ...._ __._. ..-----._.. _._._.____.�________ � Some answers will not be presented because they are not part of the selected group of questions based on the answer to#30. � 1. Please describe your organization category(select one of the following�: � Private Non-Profit � Public Agency r Other: 2. Please describe your agency's mission(no more than 3 sentences or 250 characters�. Habitat for Humanity East Bay/Silicon Valley,Inc.(Habitat)empowers families through successful homeownership and financial counseling,builds affordable and sustainable housing solutions,and revitalizes neighborhoods. 3.For what type of Dublin Grant is your agency applying? r Capital Project � Public Service Program or Project 4.IS thls d"new"service,program,project or activity4"New"Is Identifled as not yet started,implemented or in operation. 1! Yes � No 5.Please indicate below if this application is a request for one-time funding and/or"seed"funding. (- One-time funding � Seed funding � One-time and Seed funding � Operational funding � None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received within the last three years�urisdiction,year,amount,purpose,etc.).Enter"N/A"if you HAVE received Dublin Funds. We have not received funding from Dublin.We have active City and County partners supporting both new a new affordable housing development as well as a manufactured home repair program.We have not previously received funding from a city or county for our counseling program.We have received the following funding including: In 2013,Habitat received$500,000 in CDBG funding from the City of Fremont for site acquisition costs for an upcoming development in Fremont,$1.5 million in HOME funds from Contra Costa County for construction costs for 12 new affordable homes,and$29,563 in CDBG funding from the City of Hayward for site acquisition costs for an upcoming project in Hayward.In 2014,Habitat received$600,000 from the Housing Authority at the City of Hayward for our upcoming development.In 2015,Habitat was awarded$17,368.76 in public service funding for the Manufactured Home Repair Program. 7. Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skilis and experience,etc.). Habitat is a HUD-certified counseling agency that has been providing financial education workshops and has help held 652 individual financial counseling appointments through the Homebuyer Financial Literacy Counseling Program(HFLC Program)since 2012. Habitat has the experience and capacity to implement the HFLC Program on time and within resources by utilizing an experienced staff who are committed to the HFLC Program.Our Oakland-based financial counselor heads the HFLC Program.She has over eight years'experience as a housing counselor and education specialist.She developed the HFLC Program work plan,develops and conducts training programs for internai staff,and will provide financial education workshops and one-on-one financial counseling.Our Milpitas-based financial counselor has over seven years'experience as a homeowner selection specialist and financial counselor.She will provide financial education workshops and one-on-one financial counseling.We have staff members and volunteers than can provide transiation services for Spanish and Chinese speakers. 8. Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters�.This text will be used widely during the review and implementation process to describe your project. The HFLC Program combines free financial education workshops and financial coaching designed to enable lower income households with resources and training to prepare them for long-term financial stability and future homeownership. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) Habitat will serve an estimated 50 lower income Dublin residents through one-on-one counseling sessions and workshops offered by the HFLC Program. 10.Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? � Behavioral Health(mental health and substance abuse) � Affordable Housing � Health Care(including dental) IM Workforce Development � Homelessness (— Transportation Services and Access � Domestic Violence and Child Abuse f Disabilities r Food and Nutrition 1� Senior Services 1� Youth Services r Child Care,Early Childhood Development and Education I� Changing Demographics and Growing Diversity � Financial Assistance r None of the above 71. Explain how this project will be implemented,administered,and operated. The HFLC Program is unique in combining free financial education workshops and financial coaching designed to enable low-income clients to improve their financial situation in practical ways so that they are ready to purchase a home either through HabitaYs homeownership program or on the market. Financial workshops will include(1)understanding the homebuying process,(2)managing income and expenses/setting goals and priorities,(3) savings strategies,(4)credit repoRs and credit scores/credit repair/building credit,(5)keeping debt under control,and(6)identity theft and predatory lending.These classes will allow residents of Dublin who are at or below 80%area median income to become familiar with the process and responsibilities of owning a home.HabitaYs HFLC program expanded over the years to include a dual track education workshop series in recognition of the differing levels of support required for individuals.The workshops provide a classroom setting for individuals that are in similar financial situation and have similar goals.HabitaYs financial coaching offers one-on-one counseling from an experienced financial counselor who individualizes the sessions depending on the needs of the client. 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?�. Habitat is requesting$10,000 to fund financial education workshops for the Dublin community along with individual housing counseling sessions.The funding will be used to support the development and dissemination of marketing materials specifically geared to reach residents in the City of Dublin, enhance staff training and cover the cost of educational program materials.Marketing for the program will be announced through HabitaYs website and flyers distributed through community organizations and community outreach events. With additional funding from Dublin,Habitat will be able to expand this program to serve approximately 50 Dublin residents through workshops on homeownership and money management as well as individual housing counseling sessions.Through the HFLC Program,Habitat will provide individual counseling assistance by setting goals and working toward overcoming the obstacles preventing clients from becoming homeowners. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to treck the progress of ineeting the outcome(s�? Habitat expects program clients to increase financial literacy,develop working budgets,improve credit scores to levels acceptable to the mortgage finance community,save money for settlement costs,reduce debt to meet national lending debt standards,and qualify to apply for a conventional mortgage or for a loan through HabitaYs homeownership program.HabitaYs program provides a long-term and sustainable solution to an increasing need for comprehensive financial education and counseling services in the housing realm and beyond. Habitat assesses the effectiveness of outreach and marketing by tracking the number of new clients who enroll in the HFLC Program and uses financial literacy surveys to collect feedback from HabitaYs participants within the financial literacy programs.Habitat has begun to track new clients through the use of Counselor Max software that allow us to track clients who become homeowners after they complete our financiai workshops and/or financial counselin . Outcome data collected from this program has been critical in program development by assessing the information gaps and topics that need additional time or are more effectively taught one-on-one.HabitaYs HFLC program expanded over the years to include a dual track education workshop series in recognition of the differing levels of support required for individuals.The workshops provide a classroom setting for individuals that are striving for similar goals,while the individual counseling is personalized for specific needs of each client.Workshop feedback will continue to be collected and assessed in order for Habitat to educate and empower clients. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled,low-income,etc. All participants in this program must be under 80%Area Median Income and residents of Dublin.This will be confirmed through an income evaluation conducted by our financial counselor.Clients are typically hard-working people from the support sector that are vital to the health of the community. Many of HabitaYs clients have limited English,which often leads to misinformation and lack of access.Through HabitaYs programs,more families will have the best opportunity possible to attain the financial well-being by improving credit worthiness and overall debt,as well as empower more families with the information needed for successful homeownership. 75. How is this project culturally appropriate(i.e.,describe how it is specifically taflored to the clienUcustomer population served)? Habitat has a long history working closely with households from a variety of different cultures and backgrounds.Through translation services, experienced staff members,and individualized one-on-one financial coaching,the HFLC Program creates an inclusive learning environment for all households. 16.Explain how your agency wili outreach to low-income,limited English speakers,and/or disabled persons.How will each of these groups access the project for which your agency is requesting fundingl All of HabitaYs flyers are always offered in English,Spanish,and Chinese as weli as a page that describes our translation service that is detailed in 6 different languages.Habitat has Spanish speaking staff members working in its homeowner relations department that are able to assist with ali inquiries,as we�l as assist during homeownership orientations.With the help of voiunteer translators and nonprofit organizations that offer translation assistance,we are able to provide additional language services to non-Engiish speaking participants.Working with this under-served community will increase the percentage of Dublin's population that are able to achieve housing stability. 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Habitat works with a large number of faith organizations,non-profits,and veteran organizations to help spread the word about our program and the semi-monthly workshops that we host.Faith organizations continue to be a great partners for our organizations.We currently work with the following : churches in Dublin including:John Knox Presbyterian Church,Resurrection Lutheran Church,St.Philip Lutheran Church and St.Raymond Catholic Church.These churches have all been a great source of volunteers,have financially sponsored many projects throughout our history,and have assisted in the outreach of our services to their congregations.Through these partnerships,we will be able to engage even more Dublin residents in our program. 18.Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. Habitat has done extensive outreach in the Tri-Valley,specifically in Livermore and Pleasanton,and is looking forward to working more closely with organizations in Dublin.Homeownership Orientations,which are held approximately 10 times per year,often bring in hundreds of potential applicants to HabitaYs programs.Habitat has held a number of orientations in the City of Livermore including:three at the Veterans Memorial Building in Livermore, two at the Civic Center Library,and an orientation at the Fellowship Hall in Livermore.Habitat has been active with veteran organizations throughout the Tri-Valley including presenting at the Livermore Job and Resource Fair at Las Positas College and at the Palo Alto Veteran Affairs Resource Fair. Habitat has flyered and been in contact with almost 300 veteran organizations throughout our service area with the following in the cities in Livermore and Pleasanton.Habitat has and continues to flyer in Livermore at libraries and with other non-profits,as well as work with the City of Livermore in order to reach under-served populations. 19. Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mlssion,Vision,and Values. HabitaYs HFLC Program's guiding principle and the City of Dublin's mission align as both are built on creating and sustaining opportunities that improve quality of life of residents of Dublin.Safe and secure environments are often a result of a stable living environment which guides all of the work that Habitat does.The HFLC Program is a long-term strategy to improve and secure the quality of life by empowering communities with fiscal stability and homeownership.Supporting the HFLC Program will also further Dublin's vision of an economicaily balanced community through promoting resources and training for low income communities.Through HabitaYs program,Dublin residents will be engaged and educated leading to an inclusive and economically balanced community. 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Habitat's HFLC is a cost effective program with ongoing support from both corporations as well as foundations.With funding from the City of Dublin, the HFLC will have a total budget in FY17 of$194,014.33,with revenue from ongoing support from corporations and foundations,as well as Habitat supporters.With a$10,000 grant from the City of Dublin,Habitat will have the resources to expand our services into the City.The majority of the funding,$8,050 in uses,will go towards the staff resources needed for successful counseling and outreach for 50 Dublin residents.The reminder of the funding,$1,950 will contribute to the supplies,rent of space,mileage,and communication materials needed in order to conduct successful marketing,outreach and financial counseling specifically for the City of Dublin. 21.If this application does not receive funding,or receives reduced funding,what will be the effect on the project? With reduced or a lack of funding from Dublin,the HFLC program will continue to serve individuals throughout our territory,but with the lack of resources we will lack the capacity to outreach and market to Dublin residents and serve residents in their local community. 22.Does your agency anticipate having any unspent grants funds at the end of the fiscal year? r Yes I^A No 23.If you answered yes to the preceding question please explain.Enter"N/A"if not applicable. 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures)? � Yes � No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25. If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"N/A"if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms,plans for future relocation or expansion,etc.).Enter"N/A"if not applicable. N/A 27. If your agency is requesting Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? r Not Applicable r Yes � No � Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin's Mission 8 Vision Statements: (you may choose more than one) � Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. r Balance history with progress,to sustain an enlightened,economically balanced and diverse community. � Encourages innovation of City life,including programs to strengthen our economic vitality,suppo�ts environments stewardship and sustainability through the preservation of our natural surroundings. � Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,faciiities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) � Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development � Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety � Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in private development and in all pubiic facilities and develops transportation systems that facilitate ease of movement throughout the City � Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication � Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutal benefit 30.*"QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.'*Are you are interested in applying for CDBG funds? r Yes.If so,answer questions 31 through 43. � No.If no,check box here,and questions 31 through 43 will not be required.. r pon't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDBG ONLY-Explain your Limited English Proficiency/Language Access Plan(LEPILAP).How does your agency outreach to limited English speaking residents to encourage access to services&housing?What access accommodations are used?Provide detail : Please enter"N/A"if you are not interested in qualifying for CDBG funding. Habitat has a variety of sources to serve non-English speaking population,inGuding using in-person and telephone translation services.Financial education workshops and one-on-one financial counseling are offered in English and Spanish.In addition,we have several volunteers who provide Mandarin and Cantonese translation.For all other languages,we use a ianguage interpretation service. 32.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Guiding Principle that relates to your project: � Be culturally accessible,appropriate and inclusive � Encourage community engagement and involvement r Promote energy and resource efficiency � Encourage networking and information sharing across service providers � Encourage process streamlining � Consolidate service delivery (� Not Applicable. I am not interested in qualifying for CDBG funding. 33.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Goals that re a es o your pro�ec : r A)Support and develop a continuum of housing resources that will increase access to low-income,seniors,disabled and homeless persons with emphasis on activities that: � 'Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. � •Preserve and increase affordable rental housing opportunities for low and moderate income households. � *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. r 'Promote fair housing and reduce housing discrimination. � B)Improve community health and access to basic and specialty care including dental and optometry care,behavioral and mental health care services especially for low-income,uninsured and under-insured residents with emphasis on activities that: r •Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. � 'Increase outreach and access for underserved populations including limited English speaking persons,youth,disabled,seniors and homeless persons. r C)Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. r D)Support and expand programs and opportunities that keep seniors engaged and involved in their community. r E)Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. }4 F)Not Applicable.I am not interested in qualifying for CDBG funding. 34.CDBG ONLY-Identity AT LEAST ONE U.S.Department of HUD Strategic Goal that relates to your project: � Increase homeownership � Promote decent affordable housing � Strengthen communities (� Ensure equal oppoRunity in housing � Promote participation of grass-roots,faith-based,and other community-based organizations 1� Not Applicable. I am not interested in qualifying for CDBG funding. 35.CDBG ONLY-Identify AT LEAST ONE U.S.Department of HUD Policy Priority that relates to your project: � Provide increased homeownership and rental opportunities for low and moderate-income persons,persons with disabilities,the elderly, minorities,and families with limited English proficiency. r Improving the quality of life for our Nation's communities � Encouraging accessible design features. r Participation of minority-serving institutions in HUD programs. � End chronic homelessness within ten years. � Removal of barriers to affordable housing. r Not Applicable.I am not interested in qualifying for CDBG funding. 36.CDBG ONLY-Identify AT LEAST ONE Consolidated Plan objective that relates to your project: (+ Increase the availability of affordable rental housing for extremely low income(30°/a),very low income(50%)and low income(SO%) households. r Preserve existing affordable rental housing and ownership for households at or below 80%of Area Median Income(AMI). � Assist low and moderete income first-time homebuyers. (� Reduce housing discrimination. J� Maintain,improve and expand(as needed)the capacity of housing,shelter and services for homeless individuals and families including integrated healthcare,employment services and other supportive services. (� Maintain and expand activities designed to prevent those currently housed from becoming homeless. (� Build on inter-jurisdictional cooperation to achieve housing and homeless needs. � Increase the availability of service-enriched housing for persons with special needs. � Not Applicable. I am not interested in qualifying for CDBG funding. 37.CDBG ONLY-Select ONE Objective that relates to your project(TIP:When selecting an objective ask yourself,"What is the purpose of the activityl What is the larger community need that I am seeking to address?"): � Creating a Suitable Living Environment r Providing Decent Affordable Housing r Creating Economic Opportunities � Not Applicabie.I am not interested in qualifying for CDBG funding. 38.CDBG ONLY-Select ONE Outcome that relates to your project(TIP:When selecting an outcome ask yourself,"What type of change or result am I seeking?"): r Availability/Accessibility r Affordability � Sustainability Not Applicable.I am not interested in qualifying for CDBG funding. 39.CDBG ONLY-Se�ect ONE Specific Indicator that relates to your project: � Public facility or infrastructhrnewhor limprovedsaccess to the facility oe infrast uctureVefthe activity was usedltofinelet a quality standard�i�'��ties that provide individuals w measurably improve quality,then this�e�rr°ber'lof pe�rsotns tha have been ass sted with new o�imp oved access tooa servicenf the activtY r Public Service:This indicator shows t was used to meet a quality standard or to measurably improve quality,then this indicator will report the number of persons that no longer have access to a substandard service. � Targeted revitalization:This olds served�slum/blight demoi tion,e umber of acres of beownfieldsaemed ated etce naa ta geted area.d moderate- income persons and househ (- Commercial facade treatments or business building rehabilitation:This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. (— Brownfields remediated:This indicator shows the number of acres of brownfields that were remediated. 1� Rental units constructed:This indicator a d those units des gnated for chronacally homeless pe sons a d persons wi h HIV/AIDS�rdability, number of units occupied by the elderly, r Rental units rehabilitated�T clall n homteless persons,e derly perso sa alnd persone w'th HbV/A DS as well as the number of years of affordability,units for chr Y � Homeownership units constructed bi ta on eWactivity.This include1s tot�al numbe�of affordable un tse number of years o1f affordabilityr Energy acquired,and/or acquired with reha p Star qualified units,section 504 accessied b nthe elde lym umbehof un tsldes gnated forl per�sons w th HIV/AIDSlnand numdbter ofdun ts forbhe collected on the number of units occupi y chronically homeless. (� Owner occupied units rehabilitat be hof un ts des'gna edtfor peasons w th HIV/AIDS and'number of untslfor the chronically ho ebess f these units occupied by the elderly,nu (� Direct financiai assistance to homebuyers:This indicator shows the number of homebuyers receiving direct financial assistance,housmg counseling,and down payment assistance/closing costs. (� Tenant Based Rental Assistanc s(t aR12 molnths)antd the number of h meless and chron callyrhoml elless of useholdsfassisted umber with short-term rental assistance(le � Homeless shelters:This indicator shows the number of homeless persons given overnight shelter. r Emergency housing:This indicator shows thee number�of hou eholds th t recei eldhemeegency finanrcial ass stance to Iprevent homelessness (� Homeless prevention:This indicator shows th and emergency legal assistance to prevent homelessness. (— Jobs created:Of the total numb nomic DevelopmentlAdmin st ation(EDA)classf cations)andtthev u ber�of persons unemployed before taking type s o f j o b s c r e a t e d(u s i n g E c o the job. r J o b s r e t a ined:Of the total numb and the types of obsl reta e d(u s n g E D A classbficationS)retained,the number of jobs with employer- sponsored health care benefits, r Business assistance:Thi he DUNS number of each bus ness so that HUD can track the nu'mberyoftnew bus ness sbhat rema n ope ational for existing businesses,and t three years after assistance. (� Businesses providing goods or services:This indicator shows whether an assisted business provides goods or services to meet the needs o the service area,neighborhood,or community,as determined by the grantee. � Not Applicable.I am not interested in qualifying for CDBG funding. 40.CDBG ONLY•Piease choose a common indicator that your agency will use to track clients(select only ONE): � Persons 1� Households � Not Applicable.I am not interested in qualifying for CDBG funding. 41.CDBG ONLY•For the category you selected above,provide the total number of unduplicated Dublin clients(EITHER Persons OR Households)your agency anticipates serving through this project: HabitaYs HFLC Program will serve 50 low-income Dublin residents during the fiscal year 2017 starting in July 2016. 42.CDBG ONLY•Based on the common indicator you seiease enter'0 p�ease list the number of unduplicated Dublin clients your ��. agency anticipates serving in e a ch cate gor y.'If none,p _a ___.��_. 18!Low Income(50%-80%AMI;please refer to the Income�imits chart at www.dublin.ca.gov/housi n g `� 8',Extremely Low Income(<30%AMI;please refer to the Income Limits chart at www.dublin.ca.gov/housing� � ����� � ��2;Disabled �� �� 13'�Female Headed Households � �� � il>�Senior ;_ . _ ___� �, � � ��� 0';Youth 0'Homeless e N/A) � � � � �Not Applicable.I am not interested in quatifying for CDBG funding.(Typ � '_�`:)'TOTAL � 43.CDBG ONLY-List the number of clients your agency anticipates serving in racelethnicity categories.The sum entered below must match the total clients entered in#42 above. Per HUD"Hispanic"is an ethnicity,not a race."If none,please enter"0" 2o White White+HISPANIC 15 Biack/African American ��� � � Black/African American+HISPANIC � . 9 Asian � � Asian+HISPANIC � ����L American Indian/Alaskan Native -_ ���� �,American Indian/Alaskan Native+HISPANIC � _. __.___ _.._.._,, 1'Native Hawaiian/Other Pacific Islander � Native HawaiiaNOther Pacific Islander+HISPANIC American Indian/Alaskan Native and White `American Indian/Alaskan Native and White+HISPANIC Asian and White 'Asian and White+HISPANIC Black/African American and White Black/African American and White+HISPANIC American Indian/Alaskan Native and BlacklAfrican American 'American IndianlAlaskan Native and Black/African American+HISPANIC � 2`Multi Racial+HISPANIC OR other Multi Racial ! Not Applicable.I am not interested in qualifying for CDBG funding.(Type N/A) q3.C�Q TOTAL 44.If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY r #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. � #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. r #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. r #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. � #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. � #6-This program/project has the 6th highest priority for funding within the organization,agency,distrid or entity. r If you have more than 6 applications per organization,agency,district or entity,check here. 45. Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce : dependency on the City's grant program). HabitaYs funding comes from diverse sources of revenue including individuals,foundations,corporations,local businesses,the faith and civic communities,youth groups,special events,government sources,and mortgage income from our partner families.These efforts to diversify funding has catalyzed organizational fiscal health allowing Habitat to generally break even or to generate a slight cash surplus on a yearly basis.At the end of Fiscal Year 2015 assets totaled more than$35 million and net assets totaled more than$24 million.Revenue will exceed$18 million for Fiscal Year 2015.Habitat maintains a revolving line of credit of$2.75 million to support quarterly fluctuations in cash flow;approximately$163,000 is outstanding on the line as of June 30,2015. Habitat's HFLC Program received more grant funding last year than ever before,and we have already received funding for this fiscal year. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-109852 Budget Funding SourceslRevenues Budget Amount Amount Committed City of Dublin $10,000.00 $0.00 Habitat Contribution $54,014.34 $54,014.34 Charles Schwab Foundation $15,000.00 $15,000.00 Citi Foundation $20,000.00 $20,000.00 CharleaSchwab Bank $50,000.00 $50,000.00 an o menca , • • p� $5,000.00 $5,000.00 Mechanics Bank $5,000.00 $5,000.00 Walter and Elise Haas Foundation $20,000.00 $0.00 Total $194,014.34 $149,014.34 Funding Uses/Expenses Budget Amount Amount Committed Salaries and Benefits $175,839.34 $130,839.34 Supplies $1,400.00 $1,400.00 Pnnting/Copying $4,975.00 $4,975.00 Rent and Utilities $2,000.00 $2,000.00 Mileage _ $5,700.00 $5,700.00 Staff Training Specific to Program Deiivery $4,100.00 $4,100.00 Total $194,014.34 $149,014.34 Budget Narrative HabitaYs HFLC is a cost effective program with ongoing support from both corporations as well as foundations.With funding from the City of Dublin,the HFLC will have a total budget in fiscal year 17 of$194,014.33,with revenue from ongoing support from corporations and foundations,as well as Habitat supporters.With a$10,000 grant from the City of Dublin,Habitat will have the resources to expand our services into the City.The majority of the funding,$8,050 in uses,will go towards the staff resources needed for successful counseling and outreach for 50 Dublin residents.The reminder of the funding,$1,950 will contribute to the supplies,rent of space,mileage,and communication materials needed in order to conduct successful marketing,outreach and financial counseling specificaily for the City of Dublin.While this program's budget looks like a smaller program compared to the HabitaYs total budget being over$24,145,972;this program is an integral part of the work that Habitat does in providing affordable housing solutions to low-income households throughout our territory. Documents Documents Requested* Required? Attached Documents' Program Expense Budget for ALL Grant Requests r Proqram Expense Budqet dawnload tempiate Financial Information Form for ALL Grant Requests � Financiai Information Form dawnload temqlate List of Board of Directors(or governing body)with contact r List of Board Directors information Current Annual Budget for the Entire Agency � Gurrent Annual Aaencv Budaet Copy of most recently submitted IRS 990 form or Tax Retum r Farm 99Q FY14 Pubiic Disclosure Capv (include complete form) _ __ Board of Director's(or governing body's)designation of � Board desianation of Authoritv authorized official Board of Director's(or goveming body's)authorization to � Board Resolution request funding(may be same document as one above) Proof of insurance carried,including bonding,liability and/or � Proof of Insurance workers'compensation REQUIRED FOR CDBG ONLY-If requesting Capital Fundi�g, r please upload your Capital expenditure budget(your own format is acceptable) , REQUIRED FOR CDBG ONLY-PERSONNEL POLICIES INCLUDING r Personnei Policies irciudinq Affirmative Action Plan AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS � Agancy Audit Reauirment from Bviaws No Findinas to report AND COPY OF LAST AUDIT HIGHLIGHTING"FINDINGS" SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION � Articies of incorparation AND BYLAWS. _ REQUIRED FOR CDBG ONLY-CONFLICT OF IMEREST r Conflict of interest Paiicv STATEMENT(IF NOT INCLUDED 1N BYLAV�) REQUIREDfOR CDBG ONLY-ORGANIZATION CHART � Oraanization Chert STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. � NornPro6t Determination Letter All organizations MUST have approved non-profit status from the State of'Galifornia and'Federal Tax Identification Number at time of applicaUon.Non-compliant applicants will be disqualified. REQUIRED FOR CDBG ONLY-AGENCY"S LIMITED ENGLISH (� Aqencv's Limited EnQiish Proficiencv�an4uaae Access Plan PROFICIENCY LANGUAGE ACCESS PLAN(LEP/LAP).Must m u e ou reac o imi e ng is spea mg resi en s o encourage access to services&housing. Include what access accommodations are used. REQUIRED FOR CDBG LEVERAGING REPORT-this is due with r the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements r Audited Financiai Statement 'ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:48488 Become a fan of ZoomGrents`"on Facebook . ProblemsT Conlaet us at�uestions-^2ZoomGrants co;n � �2002-2016 GrenV+nalysl.com.All rights reserved. �. "ZoomGrants"and the ZoomGrants logo are trademarks of GrentAnalyst.com,LLC. t u cut�Browser � Emaii This Preview Save as PDF Print Close Window A�♦ , � F'pw6'r�Gl bV ZOOmG(e7t?tSrn, City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadline Hope Hospice,Inc Grief Support Center and Hospice Volunteer Program $15,000 Requested Hope Hospice,Inc Submitted: 12/11/2015 10:41:49 AM(Pacific) � 6377 Clark Avenue Telephone(925)829-8770 i Suite 100 Fax (925)829-0868 ' Project Contact , Dublin,CA 94568 Web www.hopehospice.com Natalie Brown douqh!c�hopehospice c,orr� ; CEO Tel:(925)829-8770 i Bob Boehm b:;bb^"oaet�osp?ce.cam Additional Contacts natalieb@hopehospice.com I � � Application Questions ' � Some answers will not be presented because they are not part of the selected group of questions based on the answer to#30. I 1. Please describe your organization category(select one of the following): � Private Non-Profit r Public Agency � Other: 2. Please describe your agency's mission(no more than 3 sentences or 250 characters). Hope Hospice is a trusted and nuRuring guide,helping patients and families find comfort and dignity.Every end-of-life experience will be patient- centered,based on individual choice and lightened by hope,comfort and dignity. 3.For what type of Dublin Grant is your agency applying? r Capital Project � Public Service Program or Project ' 4. IS thls a"new"Servlce,program,project or activity?"New"ts ide�tified as not yet started,implemented or in operation. � Yes I� No 5. Please indicate below if this application is a request for one-time funding and/or"seed"funding. � One-time funding 1� Seed funding r One-time and Seed funding r Operational funding (� None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received withtn the last three years(jurisdiction,year,amount,purpose,etc.).Enter"NIA"if you HAVE received Dublin Funds. N/A 7.Please provide information to justify your agency's capacit�to conduct this project(type of management or governing body,fiscal staff resources,skilts and experience,etc.�. Hope Hospice,Inc.is a 501(c)(3)nonprofit organization and a proven leader in hospice care in the Tri-Valley.Since 1980,families and physicians have turned to us for quality,compassionate care at the end of life.Today,we are an organization of 60 paid staff and a cadre of about 115-125 active volunteers.Our Dublin headquaRers serves as the management hub for care staff and volunteer visits to hospice patients in their homes,and the destination for individuals seeking grief suppoR.Hope Hospice is dedicated to helping our patients,their families,and grief support clients live each day to the fullest with dignity,hope,and courage. The Chief Executive Officer reports to the Board and manages a seasoned&qua�ified leadership team that provides the professional,medical, financial,and organizational oversight to the programs and activities provided to the community.Our clinical team includes a Chief Medical Officer specializing in hospice/palliative care,3 hospice-certified Associate Medical Directors,numerous Registered Nurses,Licensed Vocational Nurses, Licensed Clinical Social Workers,Licensed Marriage and Family Therapists,Spiritual Care Counselors,Home Health Aides,a Dietitian,and trained volunteers offer a wealth of experience,expertise,and specialized education.Each team member creates an environment that offers patients customized care,comfort,and dignity during their final weeks,and the time and tools needed to cope with the grief process for those who have lost loved ones. Hope Hospice is governed by a 10-member volunteer Board of Directors,all of whom are local residents,contributing a range of expertise from the fields of inedicine,finance,business,and law enforcement.Each serves a two-year term and can serve three consecutive terms.A 10 member volunteer Advisory Council is comprised also of local residents,including Dublin Mayor David Haubert and other leaders from private and non-profit organizations. 8. Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementation process to describe your project. We are seeking a$15,000 grant to support the Grief Support Center and Volunteer Program.Funds will be used to support the salaries of the Director of Grief Support Services,the Children's Grief Support Provider,and the Director of Volunteers 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once rega�dless of number of services received in a year.) In FY15 Dublin residents served included 88 grief support clients,29 hospice patients and their caregivers(58 total),35 volunteers,and 3 in Caregiver Ed.We estimate 190 Dublin residents to be served in FY16/17. 10.Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? � Behavioral Health(mental health and substance abuse) � Affordable Housing � Health Care(including dental) � Workforce Development � Homelessness (� Transportation Services and Access � Domestic Violence and Child Abuse � Disabilities r Food and Nutrition r Senior Services r Youth Services , � Child Care,Early Childhood Development and Education � Changing Demographics and Growing Diversity � Financial Assistance ' r None of the above 11.Explain how this project will be implemented,administered,and operated. The Volunteer Program is managed by Jiil Biggs,RN,Hope Hospice's Director of Volunteers.Ms.Biggs is responsible for recruiting,screening and training candidates,and overseeing their performance to ensure they are high-performing hospice/palliative care volunteers. - All of our volunteers are required to complete an application,interview,background check,health screening,orientation,annual mandatory training and ; participate in an innovative 25-hour Hospice Education Series called Teaching Transitions.Once their training is complete,volunteers are prepared to help the patients and families. In any given year,our Volunteer Program consists of approximately 115-125 volunteers,some in multiple roles.About 90 provide services to patients,caregivers,and family members-including grief support-while 30 donate time to fund-raising events each year.Another 15 volunteers provide administrative support to the Volunteer and Development departments and 28 serve in governance or advisory roles.For FY 14- 15 our volunteers gave 5,850 hours of service,and made 1,460 patient client visits to 147 individuals/families-including 465 hours provided in our Grief Support Center. Lee Ann Morgan,LMFT,is the Director of Grief Support Services.She develops and manages the Grief Support Center's programs,collaborates with the interdisciplinary team,supervises the grief counselors,and teaches classes about the grief process.We train post-graduate interns who conduct individual grief counseling,facilitate group sessions and provide support for community outreach.In 2014/15 we offered support groups that meet once a week for 8 weeks;a drop-in Pet Loss support group;Children's Grief Workshops;and,6 special classes(4 off-site)such as"Handling The Holidays",and a Service of Remembrance.Grief Support Services are offered free of charge to families/friends of a Hope Hospice patient as well as to all other members of the community. 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used forl). A grant from the City of Dublin will be used specifically to pay a poRion of the salaries of the Grief Support Center Director,Children's Grief Support Provider,and the Volunteer Program Director.All hospice organizations are required by law to have a grief support and a volunteer program but these services are not billable or reimbursable through insurance or other subsidies.Both programs require many hours of planning,preparation, participation and follow-up by the Directors to deliver the following excellent care: The Grief Support program for adults consists of 13 months of grief support,which includes a personal consultation,elective participation in on-going grief support groups and activities or one-on-one sessions,and scheduled follow up.The children come together in age-appropriate,time-limited group sessions encoura in several wa s for children to ex ress their feelin s:art ro'ects writin music ames and to ic discussions.The Grief Support Center conducts community outreach in the form of grief-related workshops,memorial events,on-site support for local schools,senior centers,and other organizations as needed Our volunteers provide the scope and depth of services that money can't buy,and many of which would not be affordable to our patients if they could be purchased.Patient care volunteers provide companionship to patients through listening,reading,music,aR,prayer,home repair,meal preparation, gentle touch,and just"being there".Volunteers also provide essential support to patients and their families by offering respite care,which allows the patienYs primary caregiver a chance to run errands or have an afternoon off.Trained or certified volunteers deliver Art Therapy,Massage Therapy, Cosmetology services,Pet Therapy,and Reiki to our hospice patients.Volunteers also provide support at the time of death and during bereavement, and produce treasured mementos such as Life Review video and Hands of Love photography. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome(s)? Every area resident experiencing the loss of a family member under hospice care will be offered individual assessments and/or individual grief support sessions,four adult group sessions focusing on significant loss and tragic loss,two closed group sessions for children(ages 6-12 and 13-18). These same grief support services are offered free of charge to community members whose loved ones were not on patient care at Hope Hospice. Drop-in Pet Loss support group is offered twice per month,and 4-6 community workshops on a specific grief-related topic are slated to be held. To quantify service delivery we use a comprehensive database to track all contacts,communications and individual/group sessions with adults and children.This tool allows us to track the number of patients served and the services utilized or refused,as stated in#9 above. Strategies for assessing the success of our Grief Support Services vary because grief is a process and is unique to each individual.However,one tool used to measure our success against national benchmarks is The National Hospice and Palliative Care Organization(NHPCO)Family Evaluation of Bereavement Services Survey(January-June 2015).The summary report reveals Hope Hospice has an overail satisfaction rate of 90.6%compared the national average of 75.8%. The effectiveness of the Volunteer Program is measured by an evaluation survey that is completed by the patienPs caregiver and family members to measure the quality and usefulness of the services they received,as well as that of the volunteer(s)providing them-86.1%of those surveyed stated that the volunteer services they were offered and used were the right amount. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled,low-income,etc. Annually,about 86%of our hospice patients are ages 70 and above.These are frail seniors with advanced illnesses who have received a diagnosis limiting life to 6 months or less.Many times,their main caregiver is a spouse of equivalent age.Free services provided through the Volunteer Program benefit patients,and the families of those in hospice care,as we provide respite for caregivers,home support(chores,errands),specialized physical care(massage,Reiki)and music,arts or pet therapy,and other volunteer services as described in#12 above. Grief Support Services benefit those that wish to have support after the death of a loved one.Many grief support clients are widows or widowers equivalent in age to our hospice patients.Since our grief support services are available to everyone in the community we also serve adults of all ages. Our children's grief support groups are split between 2 age groups-children ages 6-12 and teens ages 13-16.A grief support specialist is available to work with schools and community organizations to educate care-giving adults about the unique impact of grief on the young. We do not discriminate or refuse services to anyone in the community and provide services at no cost to the patienUclient.The benefit to low-income community members comes from our commitment to provide services to people who have no resources or coverage.While well below the national or state rate,Dublin has a 4.1%poverty level and a 4°/a unemployment rate.Availability and affordability of counseling services,including grief support, for low income families is one of the needs identified in our community. 15. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the client/customer population served)� All volunteers and staff are trained in the emotional,social and spiritual issues of the dying and bereaved,cultural sensitivity,family dynamics,and communication skills,personal and professional boundaries and self-care. Grief Support Program:The expression of grief is unique not only within populations,but between individuals.The nature of the loss itself also influences the complexity and depth of the grief response.Our professionally-trained grief support providers skillfully apply their experience and training in dealing with highly individualized grief situations.Those same skills resulted in thoughtfully designed programs and grief support sessions that help individuals work through their personal grief process.An example of our staffs specialized training is that received from the nationally- acclaimed Doughy Center.Based on the successful model created by the Doughy Center,our Children,Teen,and Family Specialist revamped our children's program to make more effective use of non-verbal methods of expressing grief.Another aspect of grief support that our staff has addressed is the realization that for some cultures and individuals the process of initiating grief support is intensely private. Volunteer Program:Hospice service delivery must be tailored and targeted in ways that are considered appropriate and acceptable practices for multi- cultural hospice patients and their families.Our hospice volunteers come from a wide variety of cultural backgrounds and professions.This diversity of life experience increases the likelihood that we are able to provide volunteers that will be compatible with the broad spectrum of individual needs presented by the population at large.Teaching Transitions(volunteer hospice training)includes instruction on acceptance of various cultures and religions. 16.Explain how your agency will outreach to low-income,limited English speakers,and/or disabled persons.How will each of these groups access the project for which your agency is requesting funding? Hope Hospice is committed to serving families of diverse background,culture,language,learning style,and disabled conditions.Our outreach to these communities inGudes: •A diversified clinical team with multiple language and cultural capacity. •We utilize a language translation service,including ASL,which is available 24 hours a day. •Our corporate offices comply with ADA requirements in terms of accessibility of parking,sidewalks,hallways,elevators,restrooms,etc.As a service agency,we are sensitive and responsive to the needs of all individuals and our services reflect that compassion.We strive to ensure that workshops are held at facilities such as local senior centers,where similar accommodations are part of the excellent service. •Volunteer home care visits,as well as all hospice services,are provided direct to the hospice patient in their place of residence,and many times at the bedside.Hospital beds are provided in the home to facilitate maximum patient and worker safety. •Spiritual care is provided according to the religious or spiritual preference of the patient and family members. •Low-income people benefit from our services which are offered free of charge.Availability of counseling services at no charge,including grief support,for low income families was one of the needs identified for our community. 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Hope Hospice collaborates with many partners in the area.We provide educational classes and bereavement activities for both adults and youth.We have working relationships with several city municipalities,corporations and community-based organizations.Examples include: We have worked with skilled nursing facilities,senior homes,corporations,local churches and community-based organizations to provide an educational program that starts the conversation about end-of-life issues and hospice care.These organizations include Safeway,ValleyCare Medical Center,Castlewood County Club,Dublin Senior Center and the University of San Francisco,Coalition for Compassionate Care,providing access to audiences to help create awareness about end-of-life issues,hospice and bereavement care. Our current educational program is the Family Caregiver Education Series,a volunteer enterprise program operated under the Director of Volunteers and held at our Dublin Headquarters.Experts from Horizon Elder Care,Tri Valley Personal Home Care,the National Institute on Aging,Senior Support of Tri Valley share as contributors to educate and support the participants who have taken on the role of caregiver. We work with local schools through the Dubiin Unified School District to educate and provide specialized grief support activities for youth.The staff at the Grief Support Center are trained in the effects of grief on children and teens and work with the counseling staff of the local elementary,middle, and high schools to educate teachers about the special needs of children experiencing grief. We partner with ARF to provide pet therapy to children grieving the loss of a loved one,and with Valley Humane Society to provide Canine Comfort volunteer visits to hospice patients. 18.Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. Current marketing and outreach activities include: •Advertising regularly in senior magazines and newspapers,promoting hospice and grief support services •Sending direct mail and email to Dublin residents announcing events •Sending Hope Hospice's VOICES Newsletter to Dublin residents 3 times per year •Announcing Grief Support Center programs in local media,in schools,churches,fire departments,police departments,senior centers. •Hosting the annual Service of Remembrance at our headquarters in Dublin •Participating in the Senior Info Fair presented by the Dublin Senior Center and serving as a member of the planning committee •Visiting the medical community in Dublin to educate healthcare providers and staff on hospice care and the availability of grief support for Dublin patients. •Hosted a table at the Dublin Chamber of Commerce Business Expo •Partnering with Pleasanton Rotary Club to launch our Family Caregiver Education Series •Partnering with Kiwanis of San Ramon Valley to launch our Transitions Program(provides social services and volunteer support for pre or post hospice patients) •Speaking about volunteer oppoRunities at the Dublin Library •Revised our program services brochure •Developed Voices for Hope,a one-hour presentation held bi-monthly at our Dublin headquarters giving inspirational stories and informational faCts about the work of Hope Hospice •Participated in the full schedule of Pleasanton Downtown Association's 2015 Pleasanton Street Parties •Held our 35th Anniversary Celebration at the Shannon Community Center in Dublin;honored the staff and volunteer contributions that have made Hope Hospice a premier community-based service agency;the event was covered by local press and social media. 19. Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. The primary mission of the Grief Support Center is to help grieving people of all ages connect in safe and caring support groups,learn healthy coping skilis,and overcome the confusion and fear that grief can cause.In order to develop an improved quality of life,we support each individual as they navigate their unique journey through the grief process and prepare to engage in new opportunities ahead.Our overall mission is clearly aligned with the City of Dublin's mission to"promote and support a high quality of life...and foster new opportunities". The primary mission of the Hope Hospice Volunteer Program is to provide supplementary,professional and non-professional duties which aid the delivery of safe and optimal hospice patient care.Our volunteers further our primary goal—helping patients and families live each day to the fullest with dignity,hope,and courage.Many hospice families state that the quality of their daily lives is improved for the patient,the caregiver,and other family members immediately upon starting hospice service.For hospice patients and their families,each day is a precious new opportunity-our volunteers are instrumental in making special and memorable moments possible. The City of Dublin values openness with and responsiveness to the public and community members.Hope Hospice was founded 35 years ago by a group of local concerned citizens to offer hospice and grief support services.Still today,we are lead by a local volunteer board to maintain responsiveness to community concems.Our programs are the result of assessing needs and providing the care and assistance not available from other service agencies.To meet mutual needs we work with private and public organizations to provide end-of-life education and outreach,and grief suppo sernces. ur ie o ua i an ics ommi ee mee regu ar y o ensure e ig es qua i y o services. e provi e sernces o a in nee regardless of the ability to pay. ' 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. ' Funds granted by the City of Dublin will be allocated to pay a small poRion of the salaries for the Director of the Grief Support Center,the Children's Grief Support Provider,and the Director of Volunteers to cover activities targeted and provided to Dublin residents.Dublin hospice patients and their caregivers,grief support clients,and volunteers account for approximately 10%of unique individuals served by Hope Hospice in FY 14/15.The ', $15,000 grant request covers 3°/a of the total budgets for the Grief Support Center and the Volunteer Program.The value of donations received from ' other Dublin sources-individuals,families,organizations and businesses,both in-kind and cash donations-for the last 12 months was almost 6%of ' the combined budgets for Grief Support and Volunteer Program.A grant from the City of Dublin will effectively match the Dublin community donations at a.5 to 1 rate and help meet the budget for Dublin services rendered.Both of these programs rely on community donations for support and are not billable services even though they are required by Medicare. The Independent Sector estimates that the value of an hour of volunteer time in Califomia is$26.87(2014).Last fiscal year we logged 5,850 hours of ' volunteer time,creating an in-kind value of$157,189.The actual cost of staffing to provide our wide range of volunteer services would far exceed this value.By leveraging the leadership skills of our Director of Volunteers,Hope Hospice is able to provide a rich array volunteer services to hospice patients in Dublin and surrounding areas which would otherwise not be possible.Likewise,by maximizing the variety and availability of the services offered in the Grief Support Center by relying on a combination of staff,interns,and community partners to meet the needs of grieving individuals,the investment in the Director of Grief SuppoR and the Children's Grief Support staff is highly leveraged. 21. If this application does not receive funding,or receives reduced funding,what will be the effect on the project? Grief Support Services for family members of hospice patients are a required service for Medicare certification of our hospice program,but hours logged are not billable.Services we provide to the community members who are referzed to Hope Hospice outside of our hospice program make up 70%of our bereavement clients.Funds to support the Grief Support Center come from partnerships with businesses,service organizations,and community members.To provide our vital grief support services to those who are facing the loss of loved ones,we have consistently pursued all available avenues of support,such as grants from other organizations,private donations,and proceeds ftom fund-raising events.If the program is not fully funded we may have to consider charging fees for community clients,however that is undesirable because it discourages grieving individuals from seeking help. Volunteers are considered an essential element to the work of our hospice team and are also mandated by Medicare,however,none of the costs of administering and implementing the Volunteer Program are funded.Volunteers report a sense of personal satisfaction as they make significant contributions to both the community and patients receiving hospice care.Many volunteers state that being involved in hospice work allows them to better prioritize important aspects of their own lives.If we are not favored with the grant award for this period,we will try to maintain the current service levels,and if we are not successful in acquiring the necessary funds,we may have to reduce the number of people served by volunteers. 22.Does your agency anticipate having any unspent grants funds at the end of the fiscal year? , r Yes � No 23.If you answered yes to the preceding question please explain.Enter"N/A"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures)? r Yes �' No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25. If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"N/A"if not applicable. N/A 26.If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the ', property,lease terms,plans for future relocation or expansion,etc.).Enter"NIA"if not applicable. N/A 27. If your agency is requesti�g Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? � Not Applicable � Yes � No � Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin's Mission 8 Vision Statements:(you may choose more than one) r Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. � Balance history with progress,to sustain an enlightened,economically balanced and diverse community. r Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. � Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) �' Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development �' Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety � Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in ' private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the Ciry r Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication (� Relating to Other Communities and Entities:by encouraging coilaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutal benefit 30."*QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG�FUNDING ONLY.**Are you are interested in applying for CDBG funds? 1— Yes. If so,answer questions 31 through 43. � No.if no,check box here,and questions 31 through 43 will not be required.. � Don't know. If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDSG Oh(LY-Expiain yow�r Limited Engiish ProficiencyfLanguage Access PIan�LEPtLAP}.Now daes your agency outreach to limifed Engiisti speaking residents to encourage access to services&housing?What access accommodations are used? Pravide detail _8ns'.s�,r rto%p!e�er;!ea t,�eCatise o':`.�e t:;,7s4-rer ta#30- 32.CDBG ONLY-Idantify AT LEAST ONE U.S.Department of Nousing and Urban 4evelopment(HUD)Consolidated Plan Guiding Principie that ralates to your project: -ansvver nct pres�?7re�J Gecause o;tlae aras�?�er?cr#�30- �� 33.CDBG ONLY-identify AT LEAS7 ONE U.S.Department of Housing and Urban Development{NUDE Consalidated Plan Gaals that relates to yaur project: -ai�s�ver rlot presenfed because of the ai�saverTo#30- 34.CDBG ONLY-Identify AT LEAST ONE U.S.Department of HUD Strategic Goa!that reiates to your proyeet: -ar+s.•ver i�at��ressnted becat�se of frre ansi�ver to#3d 35.CDBG pNLY-identify A7 LEAST ONE U.S.Department of HUQ Paiicy Prioriky that relates ta your project: -:�nsvver,7ot presented beca�rse or fhe a��sv.�er;o#30- 36,CDBG ONIY�identify AT LEAST ONE Consolidated Pian objective that relates to your project: -ans����r rrat,aresentecl hecaarsc of fhe answer tc#�30- � 37.CDOG dN�Y-Select ONE Objective that retates to yaur project(TIP:When selecting an objective ask yourself;"What is the pur�ose of the activity?What is the larger communi#y need that I am seeking ta address?"}: ...8t*5',:-6'.'r'�C''��r�5�"�t;f£:G`ti�CBUSC'^f`+?�inSt^:-E;.•0#,?D- . 3�.CDSG ONIY-Seiect C7NE Outcome that reiates to yaur project(71P:When selecting an autca�ne ask yourself,"What type of change ar result am I seeking?"): � a:a>>,ver�i�ui�;�e��r�fed be�� s�;af t F,.�r?�avF�tc#3Q� 39.CD�G ONl.Y-Select ONE Specific lndicator ihat relates to your project: -:3ns�„'t;r/;�t presen±Ac7 h,er.ause c`t,'te answnr!q it�!1- . 4Q GD�G ONIY-Please choose a comman indicator that your agency wiii use ta track clien#s(select oniy ONE}: -t:775�Vef i�Gt/7'BSGPff,'d h@CBUS�Cf fr;E:�1154'v"t:r C:.��.��- � 41.CD�G ONLY-Forthe category you selected above,pravide the tota)number of undupiicated Dubiin clients(EiTHER Persnns OR Households}your agency anticipates serving through this project: -aristver not�rraset�ted b�ca�+se of?he answer�fo#30- � 42.CDBG ONLY-Based on the common indicatar you selected above,please tist th�number of undupiicated Dubiin ciients your agency anticipates serving in each category."If none, please enter"0". -answe�r�oP presented becac+se of the a��su�ferTn#34- 43.GDBG ONLY-List the number of ciients your agency anticipates serving in racetethnicity categories.The sum entered below must match the total clients entered in#42 abave.Per HUQ"Hispanic"is an ethnicity;not a race."if none,piease enter'"0" �riswer rro!prese��Ced becaase vf?lae answ.er to#30- � 44.If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY (� #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. � #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. s #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. (� #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. (— #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. r #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. � If you have more than 6 applications per organization,agency,district or entity,check here. 45. Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). We will achieve long-term sustainability by employing both proven and innovative fundraising approaches,stewarding financial resources,prudently managing investments,and increasing our service numbers to create a positive economy of scale. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-005299 , Budget Funding SourceslRevenues Budget Amount Amount Committed Events $204,275.00 $0.00 Grants $65,000.00 $0.00 Individuals $193,992.00 $0.00 Total $463,267.00 $0.00 Funding UseslExpenses Budget Amount Amount Committed ' Grief Support Center-Adult $223,724.00 Grief Support Center-Child __ $71,023.00 Volunteer Program $168,520.00 Total $463,267.00 $0.00 Budget Narrative The funds requested from the City of Dublin,paired with funds raised annually from Dublin residents and organizations,are in proportion to the services we deliver to Dublin residents and will be applied directly to salaries as follows:for the Director of Grief Support-$7,500 and Director of Volunteer Program-$5,000 and the Child Grief Support staff-$2,500.The budget figures shown are the totals for each program for the current year,no substantial changes are expected at this time for FY 16/17.Hope Hospice conducts an annual fundraising campaign comprised of grant seeking,events,and direct response marketing.In addition,we receive unsolicited tribute and legacy gifts.We are currently conducting our FY 15/16 campaign and as yet do not have any funds committed for the FY 16/17 budget.An example of funds committed for our current year which may be repeated for the FY 16/17 budget include a Wells Fargo grant and a City of Pleasanton grant both of$5,000 for Grief Support Services,an Ebay grant of$10,000 and a Joseph and Vera Long Foundation grant of$15,000 both for the Volunteer program. We have three events planned for the FY 16/17 budget-a Voices for Hope breakfast on September 21,2016,a Hope 100 Golf Marathon October 10,2016,and The Hike for Hope 2017 in May.The overall budget for Hope Hospice for the current fiscal year is$6,774,515 of which ' $5,885,237 is budgeted to be received via insurance reimbursements for hospice patient care rendered.The balance is slated to be raised through fundraising and investment activities.We deeply appreciate the partnership of the City of Dublin in bringing essential Grief SuppoR care and offering an excellent Volunteer Program to residents of Dublin. Documents �,. ' Documents Requested* Required? Attached Documents' Program Expense Budget for ALL Grant Requests 1� Proaram Expense Budaef download temelate _ Financial Information Form for ALL Grant Requests � Financial information download temalate List of Board of Directors(or governing body)with contact � Board of Directors Roster information ' Current Annual Budget for the Entire Agency � Aqencv Budqet FY 15/16 Copy of most recently submitted IRS 990 form or Tax Retum � �90 (include complete form) ggp pa�g Board of Director's(or goveming body's)designation of � Authorized 5taff authorized official Board of Directo�'s(or goveming body's)authorization to r Boartl Authorization request funding(may be same document as one above) Proof of insurance carried,including bonding,liability and/or I°� Proof of Insurance workers'compensation REQUIRED FOR CDBG ONLY-If requesting Capital Funding, please upload your Capital expenditure budget(your own format is acceptable) REQUIRED FOR CDBG ONLY-PERSONNEI POLICIES INCLUDING I� AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS r AND COPY OF LAST AUDIT HIGHUGHTING"FINDINGS" SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION C4 AND BYLAWS. REQUIRED FOR CDBG ONLY-CONFLICT OF INTEREST � STATEMENT(IF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART I� STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. � 501 c3 All organizations MUST have approved non-profit status from the State of California and Federal Tax identification Number at time of application.Non-compliant applicants wilt be disqualified. REQUIRED FOR CDBG ONLY-AGENCY'S LIMITED ENGLISH I� PROFICIENCY LANGUAGE ACCESS PLAN(LEP/LAP).Must inGude outreach to limited English speaking residents to encourage access to services&housing.Include what access accommodations are used. REQUIRED FOR CDBG-LEVERAGING REPORT-this is due with � the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements � Audit 'ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:48162 Became a fan o(ZoomGran!s"`on Facebook � Problems7 Contad us at�ues6ans�^aZoomG!ants.com �2002-2016 GrantAnalyst.com.All rights reserved. . "ZoomGrents"and the ZoomGrants logo are trademerks of GrantAnalyst.com,LLC. ; Loacu �6rowser � � � Email This Preview Save as PDF Print Ciose Window AL♦ Potvered bv ZoomGrarltsT�" City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadline ' Open Heart Kitchen Dublin Meal Pograms � $15,000 Requested i Open Heart Kitchen � ._.___ __. _—_. _ __m. ____._ _._,___._�._______.__�m__ __.__ Submitted: 11/20/2015 11:30:41 AM(Pacific) i 1141 Catalina Drive#137 Telephone(925)580-1616 � Livermore,CA 94550 Fax (925)292-4532 Project Contact i United States Web www.openheartkitchen.org Linda McKeever ; executivedirector�openheartkitchen.orq � Executive Director Tei:925 580 1616 i Linda McKeever executivedirectar,cni.o�enheartkitchen.orq Additional Contacts none entered Application Questions , Some answers witl not be presented because they are not part of the selected group of questions based on the answer to#30. � 1.Please describe your organization category(select one of the following): � Private Non-Profit r Public Agency � Other: 2. Please describe your agency's mission(no more than 3 sentences or 250 characters). Open HeaR Kitchen's mission is to provide nutritious meals,to those in need in the Tri-Valley.Together with the communities'generosity and support we can provide a safety net against hunger for our neighbors in need. 3.For what type of Dublin Grant is your agency applyfng? � Capital Project r Public Service Program or Project 4.Is this a"new"service, program, project or activity?"New"is identified as not yet started,implemented or in operation. r Yes � No 5.Please indicate below if this application is a request for one-time funding and/or"seed"funding. � One-time funding � Seed funding (� One-time and Seed funding � Operationai funding r None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received within the last three years(jurisdiction,year,amount,purpose,etc.).Enter"NIA"if you HAVE received Dublin Funds. N/A 7.Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.). OHK has been providing meals for people in need since 1995.We have three Dublin Meal Programs:The Hot Meal Program:Children's Box Lunch Program and the Senior Meai program.Hot meals are made from scratch and served to anyone in need on Mondays in Dublin.The senior meal program provides senior friendly meals to low income Dublin seniors Monday through Friday at the Dublin Senior Center.The weekend box lunch program provides Dublin school children healthy nutrition choices on the weekend.Children who receive free schooi lunches during the week are left without on the weekends to fill this nutritional gap.OHK distributes bags with two healthy lunches per child on Friday afternoons to 6 Dublin schools and the Groves.Management:Executive Director is responsible for organization's consistent achievement of the mission and flnancial objectives under the direction of the Board of Directors.The ED shapes and upholds the strategic vision by developing strategies to move the organization forward,setting goals,creating and implementing action plans,evaluating and processing results.Linda McKeever has 20 years'experience working on non-profit Boards and she holds a�on-profit management certification from Cal State East Bay.The Director of Operations reports directly to the ED and is responsibie for ensuring programs and services are delivered effectively to OHK clients at all sites,including quality assurance and regulatory compliance.Clare Gomes has over 10 years of Food service management and has a degree in nutrition.Shawnda Boost is our Volunteer Coordinator: she schedules and manages the volunteers.She has 15 years management experience and has been.Site Supervisors:train and direct volunteers on preparing and delivering our meal programs,all our site supervisors are serv-safe certified.Community volunteers are the largest part of our staff. Board of Directors iist attached. 8. Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementation process to describe your project. We are seeking funding for the three Dublin meal programs.The hot meal program,the senior meal program,and the children's weekend box lunch program.Dublin Funds will be used for direct meal cost of the Dublin programs. : 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) 350 to 400 clients 10.Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? I� Behavioral Health(mental health and substance abuse) I� Affordable Housing (� Health Care(including dental) � Workforce Development r Homelessness I— Transportation Services and Access � Domestic Violence and Child Abuse r Disabilities � Food and Nutrition � Senior Services � Youth Services (� Child Care,Early Childhood Development and Education ; � Changing Demographics and Growing Diversity . � Financial Assistance � None of the above 11. Explain how this project will be implemented,administered,and operated. Staff and community volunteers,prepared and served nutritious meals daily,our Dublin Hot Meal program is served on Monday at 6533 Sierra Lane. Guests are welcome to eat their meals at our serving locations or meals can be taken to go. Box Lunch Program:each week we prepare and delivered weekend lunches to six Dublin title one school and the Groves.We work with the Dublin school district,local school principals and teachers to determine the schools and children to participate in the program.Lunches are delivered and distributed to participating schools each Friday afternoon.Children of low income families and their siblings are encouraged to participate in the free program.We have extended this program to continue service to children in need during the summer. The senior meal program is served at the Dublin senior center Monday through Friday.The senior friendiy meal includes soup,salad and a freshly prepared entree with vegetabies and desert. Each serving day we use daily log sheets to track:the number of ineals served,meal cost,volunteers'hours,the amount of purchased and donated food used in eaCh meal service.Monthly surveys are taken at each site to track client information.The number of ineals and meal cost of each program is calculated and reported to the Board of Directors monthly.Volunteer hours are tracked online on the V02 system and managed by our volunteer Coordinator.Each serving site has a Site Supervisor who is serv-safe certified in food handling,they train and direct our volunteers.Site Supervisors report to the Operations Director who is directly responsible for the overall food operations of the organization. Grant administration:The Operations Director collects confidential client information on monthly surveys approved by the City.The Bookkeeper; prepares monthly billing on the CDBG Grants.Grant administration is overseen by the Executive Director and reported to the Board of Directors monthly. 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?). Dublin Funds will be used to purchase food and supplies for the programs. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome(s�? As stated in the Tri-Valley needs assignment hunger is growing in the Tri-Valley.It especially impacts the senior population and our children.The senior program and the children's weekend lunch program is our fastest growing programs in Dublin.To track improvements in this area,Open Heart Kitchen evaluates the success of our meal programs by applying two key criteria,meal count and cost per meal.We track the number of people served in each program.The number of ineals served by program is tallied every serving day and accurate logs are maintained by the Executive Director,the Operations Director and the Bookkeeper.The average food cost is tracked monthly by the Executive Director,Board Treasurer and Bookkeeper.A full repoR on the number of ineals served and the cost is presented to the Board of Directors monthly.Guest surveys are conducted and logged each quarter to have accurate records of the population we serve.Volunteers encourage guests to provide feedback on the surveys.We consider our programs successful if the meal count numbers remain constant with community need and the meal cost is on budget.The number of meals served each year continues to grow to meet the demographic change in the Tri-Valley area.OHK has increased the programs with the help of our financial donors and hundreds of voluni�rs.We have managed to keep the direct cost of our meals low and on budget.We work closely with local social service a encies and other non- rofit rou s to kee current data on the chan in hun er needs of our communities.Our oal is to ad�ust our programs to meet any demographic and economic change in the communities we serve.The number of seniors participating in the program continues to grow.With the cooperation of the public libraries,the summer children meal program is also growing. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this proJect,i.e.seniors,youth,disabled,low-income,etc. The funds for this project will serve guest from all walks of life;low income to extremely low-income residents,the homeless,seniors,single parent families,children,veterans,disabled,unemployed and underemployed all are welcome.With your help we provide a safety net against hunger.Food is a basic human need,and proper nutrition to those in need is a challenge for many.The hot meal program addresses anyone in need of hunger relief. The senior meal program specifically addresses the nutritional needs of our senior population.The Children's weekend lunch program addresses our children's nutritional needs.People who experience hunger are at risk for serious health problems.Hunger can be life-threatening by increasing the risk for stroke,prolonging recovery from illness,extending hospital stays,limiting the effects of prescription drugs,decreasing resistance to infection, and even increasing the occurrence of depression and isolation.By providing proper nutrition for our neighbors in need,we help lower the overall health cost to the community. We also feel,providing volunteer opportunities,benefits the Dublin volunteers as well as the entire community.Volunteering helps a community come together to solve the needs within the community.Volunteering is good for your health at any age,but iYs especially beneficial in older adults,and youth.In seniors volunteering has been shown to lessen symptoms of chronic pain and heart disease.In youth volunteering help prevention of depression,isolation and anti-social behavior.OHK Programs offers hundreds of residents'volunteer oppoRunities and its many positive benefits for themselves,their families and the community. 15. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the clienUcustomer population served)? OHK provides culturally appropriate services by offering ethnically diverse menu items.On many occasions,OHK offers entire multi-cultural meals. Our condiment tables at the hot meals serving sites always have salsa and tabasco sauce for those who wish to flavor their food with these items. For our senior citizens,we offer low-salt,low sugar menus.In addition we offer nutritional education for seniors and parents.The hot meals include a protein,vegetable,green salad,fruit salad,bread,dessert,and beverages.The protein is generally a meat;but we also offer a sufficient variety of vegetable dishes at each meal to accommodate our vegetarian guests.Several of our site managers speak Spanish,and many of our volunteers speak fluent Spanish and a variety of languages and are readily available to converse with our non-English-speaking guests and students.Our box lunches contain child friendly items,such as containers of juice,milk,a fruit snack,a package of baby carrots,a fresh orange and or apple,low sugar high fiber muffin,cheese and crackers,and a granola or protein bar.We are always looking for new nutritious child friendly lunch items for this program.The surveys are offered in English,Spanish,Chinese,and Tagalong.We ask for client feedback on the type of food they would like to have us add to our menus.We adjust the menus to accommodate client requests 16.Explain how your agency will outreach to low-income,limited English speakers,and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? We use various outreach efforts to try to inform the hungry people in the Tri-Valley about the OHK Meals programs:Our web site, www.openheartkitchen.org,has a complete description of all our services.Information about our programs is also listed in local news media such as The Pleasanton Weekly,The Independent,Tri-Valley Newspapers,The Valley Times,Channel 26,Channel 30,Comcast Public Service Announcements and KKIQ.We are part of the United Way's 211 human service referral process and our website is linked to the city's human service sites.Our serving site locations are included in the Tri-Valley's Emergency Disaster Relieve Referral program and the San Francisco's Disaster relief programs,we are part of the Alameda County Food Banks referral system,the Tri-Valley Hunger coalition and we work closely with local churches, community service groups,and non-profits in the local area to reach those in need.Our Outreach Committee creates and distributes outreach flyers printed in English,Spanish and other languages to inform potential guests of OHK's services.These are posted in strategic locations;e.g.,bus stations and laundromats,schools,community libraries and Social Service agencies.Ultimately,we believe that testimony from our appreciative guests and the students receiving box lunches is the best source of new participants.We would like to work closer with the City for creative ideas for outreach. 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Open Heart Kitchen works closely with the Alameda Agency On Aging,Alameda County Food Bank,Local Food pantries,local Churches,businesses, service origination's and civic groups to address the issue of hunger.Open HeaR Kitchen is a member of the Tri-Valley Hunger Coalition,a group consisting of organizations dedicated to the issue of hunger.We work with Alameda County,the local cities and other social service organizations such as the United Ways 211 Human Service Network to meet the community needs.Our serving sites are included in the Tri-Valley Emergency Disaster Relieve Referral Program,and the Pleasanton-Livermore Disaster Council. Open Heart Kitchen is part of the Cities Volunteer 2 system to promote community involvement.We work with the Local school districts,court system, ° and service groups such as the 4 H clubs,the national charity league,and other youth groups to promote joint projects that benefit the community. Open Heart Kitchen believes it is important that as a non-profit we all work together as a community to help those in need.Open HeaR Kitchen works with other local nonprofits that serve seniors,the youth and the homeless.We encourage the homeless and other non-insured clients to receive medical care by providing bag lunches to the mobile health units in Livermore.We also work with other non-profits by providing access to our washer and dryer,allowing the homeless the ability to do their laundry.We work with local business,churches and civic groups on community gardens allowing fresh produce to be given to people in need.Open Heart Kitchen believes through cooperation and collaboration together we will build a stronger community. 18.Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizaUons in the City of Dublin or Tri-Valley. We use various outreach efforts;our web-site,www.openheartkitchen.org,Information about our programs is featured in local news media such as The Pleasanton Weekly,The Independent,Tri-Valley Newspapers,Channel 30,Comcast Public Service Announcements and KKIQ.We are part of the United Way's 211 human service referral process and our website is linked to the city's human service sites.Our serving site locations are included in the Tri Valley's Emergency Disaster Relieve Referral program and SF Foundation Disaster program.We are part of the Alameda County Food Banks referral system,Tri-Valley Hunger coalition.We work closely with local churches,community service groups,and non-profits in the local area to reach those in need.Our Outreach Committee creates and distributes outreach flyers printed in English,Spanish and other languages to inform potential guests of OHK's services.These are posted in strategic locations;e.g.,bus stations and laundromats,schools,community libraries and Social Service agencies.Ultimately,we believe that testimony from our appreciative guests and the students receiving box lunches is the best source of new participants.We work with other non-profits by providing access to our washer and dryer,allowing the homeless the ability to do their laundry.We work with the church community to provide showers for the homeless.We work with local business,churches and civic groups on community gardens allowing fresh produce to be given to people in need.OHK believes through cooperation and collaboration together we will build a stronger community.We work with the local school districts,court system,and service groups such as the 4 H clubs,the national charity league,and other youth groups to promote joint projects that benefit the community.OHK is currently working with Cities and other non-profits to have uniform data collection forms to capture the changing needs and the populations served in our communities. 19.Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. Open Heart Kitchen promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities for low income individual and families to enjoy a nutritious free meal in a safe and dignified environment.By providing funding for OHK programs you help our neighbors in need while they struggle to make ends meet.Sometimes this small amount of help is all it takes to keep families in their homes,allowing Dublin to maintain a diverse community which fosters heritage and cultural development.OHK programs offer the community the opportunity to bring : residents of all ages together to serve and or be served.Volunteers of all ages come together to build a stronger community that promotes community diversity and understanding.OHK exercises honesty,integrity,fairness and dignity with our guest and our community volunteers.We believe and promote effectiveness and efficiency by building coalitions with other service agencies,local business,community groups and churches for the greater good of the community.We provide connectivity with Dublin residents and the local business through volunteer activities,food drives, community gardening programs and fund-raisers'we participate in local events to promote an enlightened,economic balanced and diverse community. We promote collaborative activities through our web-site,Facebook,newspaper articles,local TV,and social media outlets.We also feel,providing volunteer opportunities,benefits the Dublin volunteer as well as the entire community.In today's busy society,it can be hard to think about finding time to volunteer.However,the benefits of volunteering are enormous,both to you,your family and the community. 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The budget is reasonable for the amount of ineals we serve and is based on 16 years of experience.Open Heart Kitchen tracks the cost of ineals on a monthly basis.We continually find new creative ways to use donated food and supplies from food drives,and local gardens to help lower the cost of ineals.By leveraging our purchased food with donated food and providing our services with minimal staff and maximum volunteerism,Open Heart Kitchen operates extremely effectively.The large number of volunteers we use on a weekly base encourages community involvement and demonstrates community awareness of residents in need. 21. If this application does not receive funding,or receives reduced funding,what will be the effect on the projectT If the application does not receive funding Open HeaR kitchen would look for additional donations from private and corporate sources to try to keep the programs going.Without city funding the programs may need to decrease the number of Dublin residents served. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? r Yes � No 23.If you answered yes to the preceding question please explain.Enter"NIA"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures�T r Yes r No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25. If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"N/A"if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms, plans for future relocation or expansion,etc.).Enter"N/A"if not applicable. N/A 27.If your agency is requesting Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? �' Not Applicable r Yes � No � Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin's Mission 8 Vision Statements:(you may choose more than one) r Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. � Balance history with progress,to sustain an enlightened,economically balanced and diverse community. � Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. r Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) i� Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development r Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety � Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City r Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication � Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutal benefit 30.**QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.*'Are you are interested in applying for CDBG funds? r Yes.If so,answer questions 31 through 43. � No.If no,check box here,and questions 31 through 43 will not be required.. � Don't know.If you are unsure,piease call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDBG ONLY-Explain your Limited English Proficiency/language Access Plan(LEP/LAP).How does your agency outreach to limited English speaking residents to encourage access to services 8 housing?What access accommodations are used? Provide detail Please enter"N/A"if you are not interested in qualifying for CDBG funding. We print our program information and surveys in several languages.Many of our volunteers speak several languages. 32.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Guiding Principle that relates to your project: � Be culturally accessible,appropriate and inclusive r Encourage community engagement and involvement � Promote energy and resource efficiency � Encourage networking and information sharing across service providers � Encourage process streamlining r Consolidate service delivery � Not Applicable.i am not interested in qualifying for CDBG funding, 33.CDBG ONLY•Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Goals that relates to your project: � A)Support and develop a continuum of housing resources that will increase access to low-income,seniors,disabled and homeless persons with emphasis on activities that: r 'Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. � 'Preserve and increase affordable rental housing opportunities for low and moderate income households. (� *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. r 'Promote fair housing and reduce housing discrimination. � B)Improve community health and access to basic and specialty care including dental and optometry care,behavioral and mental health care services especially for low-income,uninsured and under-insured residents with emphasis on activities that: I� *Support the maintenance and expansion of services and programs aimed at weliness and preventative care services. � "Increase outreach and access for underserved populations including limited English speaking persons,youth,disabled,seniors and homeless persons. �' C)Increase and maintain affordable and accessible weliness and development opportunities for youth that are age appropriate. � D)Support and expand programs and opportunities that keep seniors engaged and involved in their community. 1� E)Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. � F)Not Applicable.I am not interested in qualifying for CDBG funding. 34.CDBG ONLY-Identify AT LEAST ONE U.S.Department of HUD Strategic Goal that relates to your project: r Increase homeownership � Promote decent affordable housing 1� Strengthen communities � Ensure equal opportuniry in housing . � Promote participation of grass-roots,faith-based,and other community-based organizations : � Not Applicable.I am not interested in qualifying for CDBG funding. 35.CDBG ONLY-Identify AT LEAST ONE U.S.Department of HUD Poifcy Priority that relates to your project: (— Provide increased homeownership and rental opportunities for low and moderate-income persons,persons with disabilities,the elderly, minorities,and families with Iimited English proficiency. � Improving the quality of life for our Nation's communities (� Encouraging accessible design features. � Participation of minority-serving institutions in HUD programs. � End chronic homelessness within ten years. � Removal of barriers to affordable housing. � Not Applicable.I am not interested in qualifying for CDBG funding. 36.CDBG ONLY-Identify AT LEAST ONE Consolidated Plan objective that relates to your project: � Increase the availability of affordable rental housing for extremely low income(30%),very low income(50%)and low income(80%) households. r Preserve existing affordable rental housing and ownership for households at or below 80%of Area Median Income(AMI). r Assist low and moderate income first-time homebuyers. r Reduce housing discrimination. � Maintain,improve and expand(as needed)the capacity of housing,shelter and services for homeless individuals and families including integrated healthcare,employment services and other supportive services. � Maintain and expand activities designed to prevent those currently housed from becoming homeless. (� Build on inter-jurisdictional cooperation to achieve housing and homeless needs. � Increase the availability of service-enriched housing for persons with special needs. � Not Applicable. I am not interested in qualifying for CDBG funding. 37.CDBG ONLY-Select ONE Objective that relates to your project(TIP:When selecting an objective ask yourself,"What is the purpose of the activity?What is the larger community need that I am seeking to address?"): � Creating a Suitable Living Environment r Providing Decent Affordable Housing � Creating Economic Opportunities r Not Appiicable.I am not interested in qualifying for CDBG funding. 38.CDBG ONLY•Select ONE Outcome that relates to your project(TIP:When selecting an outcome ask yourself,"What type of change or result am I seeking?"�: � Availability/Accessibility � Affordability � Sustainability � Not Applicable.I am not interested in qualifying for CDBG funding. 39.CDBG ONLY-Select ONE Specific Indicator that relates to your project: (� Public facility or infrastructure:This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure.If the activity was used to meet a quality standard or to measurably improve quality,then this indicator will report the number of household units that no longer have access to a substandard service. r Public Service:This indicator shows the number of persons that have been assisted with new or improved access to a service.If the activity was used to meet a quality standard or to measurably improve quality,then this indicator will report the number of persons that no longer have access to a substandard service. � Targeted revitalization:This indicator shows a range of outcomes such as jobs created and retained,businesses assisted,low-and moderate- income persons and households served,slum/blight demolition,number of acres of brownfields remediated,etc.in a targeted area. (— Commercial facade treatments or business building rehabilitation:This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. r Brownfields remediated:This indicator shows the number of acres of brownfields that were remediated. � Rental units constructed:This indicator shows the number of affordable rental units created,as well as the number of years of affordability, number of units occupied by the elderly,and those units designated for chronically homeless persons and persons with HIVlAIDS. r Rental units rehabilitated:This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability,units for chronically homeless persons,elderly persons,and persons with HIV/AIDS. � Homeownership units constructed or acquired with rehabilitation:This indicator shows the total number of homeownership units constructed, acquired,and/or acquired with rehabilitation per activity.This inGudes total number of affordable units,number of years of affordability,Energy Star qualified units,section 504 accessible units,and number of households previously living in subsidized housing.In addition,data will be collected on the number of u�its occupied by the elderly,number of units designated for persons with HIV/AIDS,and number of units for the chronically homeless. r Owner occupied units rehabilitated:This indicator shows the total number of owner occupied units rehabilitated,including the number of these units occupied by the elderly,number of units designated for persons with HIV/AIDS,and number of units for the chronically homeless. � Direct financial assistance to homebuyers:This indicator shows the number of homebuyers receiving direct financial assistance,housing counseling,and down payment assistance/closing costs. � Tenant Based Rental Assistance(TBRA):This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance(less than 12 months)and the number of homeless and chronically homeless households assisted. r Homeless shelters:This indicator shows the number of homeless persons given overnight shelter. ' � Emergency housing:This indicator shows the number of beds created in an overnight shelter or other emergency housing. � Homeless prevention:This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. � Jobs created:Of the total number of jobs created,this indicator shows the number of jobs that have employee-sponsored health care,the types of jobs created(using Economic Development Administration(EDA)classifications)and the number of persons unemployed before taking the job. � Jobs retained:Of the total number of jobs retained,this indicator shows the number of jobs retained,the number of jobs with employer- sponsore ea care ene i s,an e ypes o �o s re ame using c assi ica ions � Business assistance:This indicator shows the total number of businesses assisted.Specifically,it shows the number of new businesses, existing businesses,and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. � Businesses providing goods or services:This indicator shows whether an assisted business provides goods or services to meet the needs of the service area,neighborhood,or community,as determined by the grantee. � Not Applicable.i am not interested in qualifying for CDBG funding. 40.CDBG ONLY-Please choose a common indicator that your agency will use to track clients(select only ONE�: � Persons (v Households � Not Applicable. I am not interested in qualifying for CDBG funding. 41.CDBG ONLY-For the category you selected above,provide the total number of unduplicated Dublin clients(EITHER Persons OR Households)your agency anticipates serving through this project: 350 to 400 clients 42.CDBG ONLY•Based on the common indicator you selected above,please list the number of unduplicated Dublin clients your agency anticipates serving in each category."If none,please enter"0". 200'Low Income(50%-80%AMI;please refer to the Income Limits chart at www.dublin.ca.govlhousing/) 180'Extremely Low Income(<30%AMI;please refer to the Income Limits chart at www.dublin.ca.gov/housingn 25 Disabled ___ __ : 50�Female Headed Households _ _ __._., 100=;Senior � 200i�Youth � � 20 Homeless ._ .._.... ._ �.�, i Not Appiicable.I am not interested in qualifying for CDBG funding.(Type N/A) __ . . � 7 7 5.0 t�t TOTAL 43.CDBG ONLY-List the number of ciients your agency anticipates serving in race/ethnicity categories.The sum entered below must match the total clients entered in#42 above.Per HUD"Hispanic"is an ethnicity,not a race."If none,please enter"0" --- 75'i White 50!White+HISPANIC 20' Black/African American 'Black/African American+HISPANIC ___ 751i Asian Asian+HISPANIC American Indian/Alaskan Native � I American IndiaNAlaskan Native+HISPANIC � 10 Native Hawaiian/Other Pacific Islander Native HawaiiaNOther Pacific Islander+HISPANIC �-- _ _, �American Indian/Alaskan Native and White � � ;American Indian/Alaskan Native and White+HISPANIC � � 20i Asian and White � '���—�����Asian and White+HISPANIC �� � 10'Black/African American and White � �� Black/African American and White+HISPANIC � 10:American Indian/Alaskan Native and Black/African American __ I American IndiaNAlaskan Native and Black/African American+HISPANIC 80' Mutti Racial+HISPANIC OR other Multi Racial Not Applicable.I am not interested in qualifying for CDBG funding.(Type N/A) �.zv0�'TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY r #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. r #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. � #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. � #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. r #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. r #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. � If you have more than 6 applications per organization,agency,district or entity,check here. 45.Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). : We continually find creative ways to find new funding sources.We use donated food and supplies to lower the cost of ineals.By leveraging volunteers and with minimal staff we can serve more clients and meals at a greatly reduced cost.We are asking the City of Dublin to share in less than 8%of the total cost of the Dublin programs. 46.All organizations must provide valid City of Dublin Business Registration number at time of applicatlon.Please provide the organization's registration number here. BL-00927 Budget Funding Sources/Revenues Budget Amount Amount Committed Dublin CDBG funding $15,000.00 Foundation Funding $30,000.00 $4,000.00 Appeal tetter $60A00.00 Alameda Aging Agency $23,000.00 Church Donations $8,000.00 Individual Contributions $40,000.00 Holiday Giving drive _ $5,000.00 $2,000.00 events $5,000:00 generaf funds $12,503.00 Total $198,503.00 S 6,000.00 Funding UseslExpenses Budget Amount Amount Committed Dubiin funding for Food and supplies $15,000.00 . Total $15,000.00 b 0.00 Budget Narrative The budget is reasonable for the amount of ineais serve and is based on 20 years of experience.Open HeaR Kitchen tracks the cost of ineals on a monthly base.We continually find new creative ways to use donated food and supplies from food drives to help lower the cost of ineals. We only have a few paid staff member at each site.By leveraging our purchased food with donated food and providing our services with minimal staff and maximum volunteerism,Open Heart Kitchen operates extremely effectively.The large number of volunteers we use on a : weekly basis demonstrates community involvement and community awareness of our neighbors in need,two of OHK's Key Values. Documents _� __ _.� __... ________ ._ _.____.� - Documents Requested` Required? Attached Documents` Program Expense Budget for ALL Grant Requests (f Proaram expenses dawnioad template Financial information Form for ALL Grant Requests � financiai information form downioad tempiate financiai information form List ofBoard of Di�ectors(or governing body)with contact � Board of Directars information _ Current Annual Budget for the Entire Agency � budq,et ali proarams Copy of most recently submitted IRS 990 form or Tax Return � 990 part 1 (include complete form) 99p part 2 Board of Director's(or goveming body's)designation of � Board Committes/orq chart authorized official Board of Director's(or goveming body's)authorization to � Board of Director's{or qoverninq bodv's)authorization to : request funding(may be same document as one above) reauest fundinq tmav be same document as one above Proof of insurance carried,including bonding,liability and/or r dubiin insurance workers'compensation Insurance Insurance cert 2 REQUIRED FOR CDBG ONLY-If requesting Capitai Funding, � please upload your Capital expenditure budget(your own format is acceptabie) ' REQUIRED FOR CDBG ONLY-PERSONNEL POUCIES INCLUDING r Grievance aoiicv AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE persanei poiicies - REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS I— audit letter AND COPY OF LAST AUDIT HIGHLIGHTING"FINDINGS" audit inforr7�ation SECTIOIV audit resr�onse REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION � F�rticies Of Incorporation AND BYLAWS. REQUIRED FOR CDBG ONLY-CONFLICT OF INTEREST r Conflict of Inferest Policv STATEMEM'(IF NOT INCIUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART I� Orq Chart STATE AND FEDER,4L NON-PROFIT DETERMINATION LETTER. r 501 c letter All organizations MUST have approved non-profit status from the State of Califomia and Federal Tax Identification Number at time of appliqtion.Non-compliant applicants will be disquatified. ' REQUIRED FOR CDBG ONLY-AGENCY'S LIMITED ENGLISH � survevs in multi lanauaaes PROFICIENCY LANGUAGE ACCESS PLAN(LEP/LAP).Must ' indude outreach to limited English speaking residents to encourage access to services&housing.Include what access accommodations are used. ': REQUIRED FOR CDBG LEVERAGING REPORT-this is due with � audit information the 2nd quaRer report no later than January 15th Certified Audit and/or Certified Financial Statements � audit information finanriai Audit CommitteebYlaws Bvlaws *ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:47630 . Become a tan cii ZocmGrant�"'on Paceboak � Problemsl Contact us at Cluestions•;v)ZeomGraets.com �. �2002-2016 GrantAnalystcom.All rights reserved. � "ZoomGrants"and the ZoomGrants logo are tredemarks of GrantAnalysLCOm,LLC. �� i_a_„eut�Br:,e+ser � 0 �. Email This Preview Save as PDF Print Ciose Window A�♦ Po��vered bv Z�oomGrantsT�' City of Dublin Parks and Community Services Department ' 2016-2017 Community Grants P�ogram 12/11/2015 deadline Sandra J.Wing Healing Therapies Foundation Healing Therapies for Cancer Patients b 10,000 Requested Sandra J.Wing Healing Therapies Foundation --~----------- � �°°°�� � Submitted: 12/10l2015 5:41:08 PM(Pacific) — Telephone866-862-7270 440 Boulder Ct. Fax 877-603-8019 Project Contact Suite 100C#7 Web www.healingtherapiesfoundation.org Roy Cook Pleasanton,CA 94566 rovcook�vahoo.com Tel:925.895.5656 CEO/President Sandra Wing Additional Contacts swinq(a�healinqtherapiesfoundatioi�.orq debra@syacpa.com Application Questions ( Some answers will not be presented because they are not part of the selected group of questions based on the answer to#30. � 1. Please describe your organization category(select one of the following): � Private Non-Profit � Public Agency � Other: 2. Please describe your agency's mission(no more than 3 sentences or 250 characters). The mission of the Sandra J.Wing Healing Therapies Foundation is to provide cancer patients,during their treatment period,with financial assistance for complementary healing services. 3. For what type of Dublin Grant is your agency applying? r Capital Project r Public Service Program or Project 4.Is this a"new"service,program,project or activityT"New"is identified as not yet started,implemented or in operation. � Yes � No 5.Please indicate below if this application is a request for one-time funding and/or"seed"funding. � One-time funding I— Seed funding r One-time and Seed funding � Operational funding � None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received within the last three years(jurisdiction,year,amount,purpose,etc.).Enter"NIA"if you HAVE received Dublin Funds. N!A 7. Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.). The foundation was founded in August,2008 and has since provided grants for over 740 cancer patients.With the exception of our CEO,we are an all-volunteer organization overseen by a board of directors of 10 individuals,an advisory committee of 5 individuals and over 100 volunteers.Our board of directors'experience is diverse,including business,finance,city government and healthcare.Our advisory committee includes medical and finance professionals.We have been fortunate enough to receive and execute a community grant from Dublin in 2014 and community grants from Pleasanton in 2014 and 2015. 8. Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters�.This text will be used widely during the review and implementation process to describe your project. Grant funds go directly to pay for complementary treatments for cancer patients in the Tri-Valley area.Our foundation provides funds directly to service providers providing these therapies.Funds provide immediate relief to local cancer patients. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.�UNDUPLICATED:client is counted only once regardless of number of services received in a year.) 20 10.Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? � Behavioral Health(mental health and substance abuse) I� Affordable Housing � Health Care(including dental) r Workforce Development � Homelessness � Transportation Services and Access � Domestic Violence and Child Abuse � Disabilities 1� Food and Nutrition r Senior Services � Youth Services � Child Care,Early Childhood Development and Education r Changing Demographics and Growing Diversity 1� Financial Assistance � None of the above 11. Explain how this project will be implemented,administered,and operated. Grant funds will be set aside for residents of Dublin according to existing application and approval processes.The process by which a patient applies for a grant is simple.The patient is asked to complete a short form(available online or by mail)describing his or her medical situation and treatment plan;obtain the physician's signature;and submit the form via mail,e-mail,or fax.The Foundation's application review committee,chaired by a board member,reviews the applications.Once approved,payments for services are made directly to service providers. 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?). 100%of Dublin Grant funds will go directly to cancer patients to fund healing therapies that provide relief from the side effects of chemotherapy. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome(s)? The program's success is measured by client surveys conducted before and after patients receive the healing therapies.Surveys focus on how patients and those supporting them are affected by the complementary therapies during their treatment.Post-treatment surveys focus on how treatment helped improve their health and well-being and how the program can continue to assist those most in need.The Foundation also measures success by the number of cancer patients served by Foundation support. The program's progress and results are communicated via multiple media,including,but not limited to,press releases,Foundation website updates, : Foundation newsletters,and e-mail communication.Communications are targeted to the general population of the Tri-Valley region of the San Francisco Bay Area 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the lmplementation of this project,i.e.seniors,youth,disabled,low-income,etc. To quaiify for grant funds: The cancer patient must be a resident in one of these California Tri-Valley cities:Pleasanton,Livermore,Dublin,San Ramon or Danville. The patient must be under physician's care. The patient must be undergoing chemotherapy and/or radiation treatment. The application form must be completed,signed and sent back to the Foundation. The applicanYs insurance does not provide coverage for the five therapies listed above. Healing therapies work alongside traditional approaches such as chemo and radiation.Healing therapies alleviate the side effects which are experienced before and after surgery and during treatment.These therapies often help cancer patients move forward and continue their treatment program. ' 15. How is this project culturally appropriate�i.e.,describe how it is specifically tailored to the cllenUcustomer population served)? To date,90 Dublin residents with a diverse ethnic,economic and religious background have benefited from grants.A$10,000 grant will allow this number to grow.Although grants are awarded to anyone going through cancer treatment,38%of past recipients have been diagnosed with breast cancer with over half of all recipients at stage 3 or 4.The average age is 57 with a range of 4 to 88.81%are women,with 74%of all beneficiaries unemployed. 76.Explain how your agency will outreach to low-income,limited English speakers,andlor disabled persons.How will each of these groups access the project for which your agency is requesting funding? . The Foundation rovides funds to residents of the Tri-Valle re ion of the San Francisco Ba Area who do not have insurance to cover the complementary therapies they desire,and in most cases do not have the financial resources to pay for the treatment on their own.Without our help, these patients would not receive this important treatment.The Foundation encourages applications from all racial and ethnic backgrounds.We publicize our program with local agencies that serve large numbers of low income individuals and minorities.We partner and receive direct patient referrals from the Cha�lotte Maxwell Complementary Clinic and Axis Community Health.These partnerships allow the Foundation to serve patients that meet lower income levels as defined by the San Francisco Foundation. We have multilinguai volunteers available to assist any applicant. 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We partner and receive direct patient referrals from the Charlotte Maxweil Complementary Clinic and Axis Community Health.These partnerships allow the Foundation to serve patients that meet lower income levels as defined by the San Francisco Foundation.We have over 35 service providers that provide healing therapies to cancer patients.Most of our referrals come from the medical community or word of mouth. 78.Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. Our organization is proud to have been featured on NBC 11,N30 Tri-Valley Community Focus and Comcast News.Many articles have been published in the Tri-Valley Herald,Valley Times,Independent and Pleasanton Weekly newspapers.We have a regularly published newsletter.We leverage social media via our website,blogs,Instagram,FaceBook page and YouTube videos.As stated earlier,90 of our grant recipients have resided in Dublin.One of our board members owns and operates a business in Dublin. 19.Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. By providing treatments that allow those suffering from cancer to lead a more fulfilling life,our grants support a high quality of life.Service provides benefit economically.Our annual golf tournament,Ragin'Cajun and Party Palooza events bring members of all ages from the community together.Our services require beneficiaries reside in Dublin,San Ramon,Pleasanton,Danville or Livermore.As such communications are targeted to these residents. 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. 100%of grant funds go directly to pay for complementary treatments for cancer patients in the Tri-Valley area.The Sandra J.Wing Healing Therapies Foundation provides funds directly to service providers providing these therapies. Funds provide immediate relief to local cancer patients.For example,$100 will provide two therapeutic massage sessions and$300 will provide up to six acupuncture sessions.Although each grant is made based on the individual needs of each applicant,in general,the Foundation makes grants of $500 per applicant to cover enough sessions of the healing therapy for maximum benefit.A grant of$10,000 will benefit at least 20 local cancer patients. The Foundation does not used funds from grants to pay for administrative expenses,which are covered by individual donations and monies raised at a variety of fundraisers. 21. If this application does not receive funding,or receives reduced funding,what will be the effect on the project? Since grant funds are directly related to the amount of cancer patients we are able to support.Each$1,000 in a reduced grant amount represents two less people served. 22.Does your agency anticipate having any unspent grants funds at the end of the fiscal year7 r Yes r No 23.If you answered yes to the preceding question please explain.Enter"N/A"if not applicable. N/A ' 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures)T � Yes � No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25. If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"NIA"if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms, plans for future relocation or expansion,etc.).Enter"NIA"if not applicable. N/A 27. If your agency is requesting Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? � Not Applicable r Yes � No r Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin's Mission&Vision Statements: (you may choose more than one) � Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. � Balance history with progress,to sustain an enlightened,economically balanced and diverse community. � Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. I— Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) � Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development r Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety (� Guiding Development:to assure that development contributes positively to the City's fiscal heaith;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City (� Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication (�' Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutai benefit 30.*"QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.*'Are you are interested in applying for CDBG funds? r Yes.If so,answer questions 31 through 43. � No.If no,check box here,and questions 31 through 43 will not be required.. � Don't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDBG ONLY-Expiain your Limited Engiish Proficiency/�anguage Access Plan{�EPILAP).How daes your ageney outreach to timited Engiish speaking residents ta encourage access ta services&housing?What access accnmmodatio�s are used? Provide detaii -ar�swer r?�t p��es�n'twd Ylecause 3f f.",e ar�svver'o#30- � 32.CRBG ONLY•Identify AT LEA5T ONE U,S. Department of Housing and Urban QevetopmenY{WUD}Gansolidated Pian Guiding Principle that relates tq your prajec#: r,Sy=f' C3(r'rG r E i t:F _,r.O`t.G<4�'iSi°YL �C,iF.,�?- . 33.CDBG t3NLY-idenYify AT LEAST OFi�U.S.DeparY�isnT oP Housing and Urban D�veiopme�t2{HUDj Consolidat�d Pian Goais Chat relates to your pr+�ject; .�r,S.�1'G'/1�G:',",�t"E.' .'GG tif,-, 7 ':;F?Jf n@ 'ri$l;i E�f. .r>$t.J'11- 34.CDBG ONLY•fdentify AT LEAST QNE U.S.Department of HUD 5trategic Goal that relates to your project: at?st-it;r ro!pr6se»terl UecauSe ot'he atts�?-er'o#3(?- 35.CDBG ONLY-identify A7�EAST ONE U.S.Dapartment of HUD Policy Priority that relates to your project: -ar�swer r�o?gresen,fad b�cause af the r�r�s�ver Pa#30- 36.CDBG ONLY-Identify AT LEAST ONE Cnnsolidated Pian objective that rsiates ta your project: -ans.a�er nof presented because of the ansa�er to#3D- . 37.CRBG ONLY-Select ONE Objective that reiates to your project(TIP:When selecting an objective ask yourseif,"What is the purpose of the activity?What is the larger community need that 1 am seeking to address?"�: -ansvvei nof preser?Ted because ot!he ans�ver ta#30- 38.CDBG ONLY-Select ONE Outcome that relates to your project{TIP:When seiecting an outcome ask yourseif,"What type ofi change or resuit am 1 seeking?"}: ar?st-�rer no!;�:eser�ted b�:Cause cf':ne rans�.,:er`o#?tI 39.CDBG ON�Y•Se€ect ONE Spec+fic Indicatar that r�lates ta your project: � at+s�:a-er r�t taresen`�a'r�;=.,u,;se of t%,�e�rtsv.s, `c#30- 40.CbBG ONLY-F'lease ehaosca a commQn indicator that your agency witl use to track ciients(select only ONE): � �rt�sivcr rx�f F�r�s�,7..�l oE.��� se�f '� _s�-�,�. ��P3t�- 41.CDBG 4FdLY- Fi�r ihe category you seiected above,provide the total number of u�dupiicated Dubfin ciients{EITHER Persans C1R Househalds}your agency anticipaCes s�rving through this praject: -e3!r54'i-@t�Y)<J?�C3r:'rS°%ri�?j�.7f'C�tlS@ O`;•I;E�;;S4'vE;'O#.�:::J- 42.CDBG ONLY-Based on khe common indicator you selected above,ptease list the number af unduplicated Dubiin clients your agency anticipates serving in each category."if none, piease enter"0". -answernof presente:�b�;eai�se�i,+�he ansEV�r:o#3�- � . - ist e num er o c ients your agency anticipa es serving m race e nici y categpries. e sum en ere e ow must match the totai clients entered in#42 above. Per HUD"Hispanic"is an ethnicity,not a race."{f none, pisase enter"0" -anst-vc-t'not gresEr�ied t�ecat�s�ot tfae ans�ver ro#?C)- 44.If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY � #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. I— #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. � #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. � #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. � #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. � #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. I— If you have more than 6 applications per organization,agency,district or entity,check here. 45.Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). The Foundation raises funds from a wide range of sources.During our last fiscal year,we received donations from companies and individuals donors totaling slightly over$100,OOO;additionally through fundraising efforts we raised a net in excess of$240,000.Each board member contributes personally significant donations of at least$1,200 annually.We have 100%board participation.We also receive corporate matching funds and have started participation in eScrip.We receive in-kind assistance and gifts-in-kind(such as food,entertainment,and auction items)for our fundraising : events.We have recently applied for grants from several foundations and governmental sources.The Foundation has also established an endowment fund made up of gifts and bequests that will be subject to a requirement that the principal be maintained intact and invested to maintain,for perpetuity, a reliable source of income. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-109882 Budget ��Funding Sources/Revenues Budget Amount Amount Committed Grants-Corporations $15,000.00 Grants-Foundations $25,000.00 Annual Sponsors $25,000.00 Contributions-individuals $20,000.00 Contributions-In memory of&in honor of $9,000.00 Special Events-Party Palooza,Golf Tournament,Ragin Cajun $230,000.00 Other-Interest and net investment gain $4,000.00 Expired Grants $20,000.00 Contributions-Corporations&Foundations $8,000.00 Total $356,000.00 $0.00 Funding Uses/Expenses Budget Amount Amount Committed Grantsto Beneficiaries $105,000.00 Marketing $5A00.00 Speciai Events,Aarty Palooza $1,000.00 Special Events-Gaif Toumament $6,000.00 Special Events-Ragin Ca}un $45,000.00 Operations-Bookkeeping and Admin $16,000.00 Rent $1,200.00 Insurance $1,900.00 Newsletter-printing and postage $7,000.00 Storage $1,800.00 Supplies,postage,communication,prof.fees $8,100.00 CEOlPresident Salary+taxes $111,000.00 Office/Admin Support $20,000.00 Endowment $27,000.00 Total $356,000.00 $0.00 Budget Narrative The budget amounts are based upon FYE June 30,2016.Budget amounts are based upon 7 years of foundation existence.Budget does include requested$10,000 from Dublin Community Grant Program. Documents Documents Requested' Required? Attached Documents* , Program Expense Budget for ALL Grant Requests (� Proaram Expense Budpet download temt�late ; Financial Information Form for ALL Grant Requests r Financiai lnformatio+7 Farm dovmload tempia#e List of Board of Directors(or governing body)with contact 1J Board Contact List information , Current Annual Budget for the Entire Agency � Bud et Copy of most recently submitted IRS 990 form or Tax Return C' Tax Retum (inciude complete form) ' Board of Director's(or governing body's)designation of � Desianation of Authorized Officiai authorized official _ ' Board of Di�ector's(or goveming body's)authorization to � Authorization to Repuest Funds request funding(may be same document as one above) Proof of insurance carried,including bonding,Iiability and/or r Proof of insurance workers'compensation REQUIRED FOR CDBG ONLY-If requesting Capital Funding, � please upload your Capital expenditure budget(your own format is aceeptable) REQUIRED FOR CDBG 4NLY-PERSdNNEL POUCIES INCLUDING r AFFIRMATIVE ACT�ON PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS � AND COPY OF LAST AUDIT HIGHLIGHTING"FINDINGS" SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION (- AND BYLAWS. REQUIRED FOR CDBG ONLY-CONFLICT OF INTEREST � STATEMENT QF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART (� ' STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. (� IRS Letter All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application.Non-compliant applicants will be disqualified. ' REQUIRED FOR CDBG ONLY-AGENCY'S LIMITED ENGLISH I4 PROFICIENCY LANGUAGE ACCESS PLAN(LEP/LAP).Must include outreach to limited English speaking residents to encourage access to services&housing.Include what access accommodations are used. REQUIRED FOR CDBG LEVERAGING REPORT-this is due with r the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements � Aqencv Audit 'ZoomGrantsT""is not responsible for the content of uploaded documents. ' Appiication ID:48097 � Become a ian of Zoomurants"'on Facebook �� Problems?Contad us at�uesFOns•^a2ccmGrants com 02002-2078 GrantAnalyst.com.All rights reserved. �' "ZoomGrants"and the ZoomGrants logo are trademarks of GrantAnalyst.com,LLC. �. :.c.._y_„ut�Isra.vse, � � Email This Preview Save as PDF Print Ciose Window A�♦ F'vv�t�r�q bv ZoomGr�ntsT"" City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadline Senior Support Program of the Tri Valley Case Management a 14,556 Requested Senior Support Program of the Tri Valley Submitted: 12/11/2015 11:01:04 AM(Pacific) � Telephone(925)931-5378 5353 Sunol Blvd Fax (925)931-3499 Project Contact Pleasanton,CA 94566 Web ssptv.org Marlene Petersen United States micpeter5en2Q02LraYahoo cam Tel:925-931-5378 Executive Director Mariene Petersen Additional Contacts maetersen assptv.orq nalbrecht@ssptv.org Application Questions � Some answers�will not be presented because they are not part of the selected group of questions based on the answer to#30. i 1. Please describe your organization category(select one of the following): r Private Non-Profit � Public Agency � Other. 2. Please describe your agency's mission(no more than 3 sentences or 250 characters). Senior Support Program of the Tri-Valley's mission is to provide seniors in-home services to foster independence,promote safety and well-being, preserve dignity and improve qualiry of life. 3.For what type of Dublin Grant is your agency applying? r Capital Project � Public Service Program or Project 4.Is this a"new"service,program,proJect or activity?"New"is ide�tified as not yet started,implemented or in operation. � Yes � No 5.Please indicate below if this appiication is a request for one-time funding and/or"seed"funding. � One-time funding 1� Seed funding r One-time and Seed funding � Operational funding � None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received within the last three years(jurisdiction,year,amount,purpose,etc.►.Enter"N/A"if you HAVE received Dublin Funds. N/A 7. Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.). Senior Support is a one-stop resource shop for seniors.Since 1981,we have successfully managed the responsibilities and regulations of various private,foundation,city,and county grants. Senior Support was formerly under the umbrella agencies of Valley Community Health Center(now Auis)and Tri-Valley Community Foundation.In 2006,we obtained our own 501 c3 and have operated as a private,nonprofit agency since.Currently,we have 23 employees(20 part-time),giving us collectively over 165 years of employment with Senior Support.The years of education and experience from reliable staff,compliance with contract parameters,accurate record keeping,timely reports and billing,strong Board of Directors and Executive Director,and open lines of communication between service providers and funders are vital ingredients qualifying Senior Support for this project. We have an active,"hands on"Board of Directors.Our Board President formerly worked in the geriatric field.The head of our Fiscai Committee is a Certified Public Accountant and has experience managing large contracts.Other board members,including 2 former city commissioners,are professionals from government,agriculture,medical and business sectors. Senior Support contracts with Bay Valley Accounting Professionals for accounting and payroll services.Bay Valley manages large accounts in addition to ours and has experience using nonprofit bookkeeping practices.Our Board of Director's Finance Committee meets monthly with the Executive Director and Bay Valley to review all fiscal activities and proposed expenditures.The Finance Committee reports monthly to the Board of Directors.The system of checks and balances we adhere to protect awarded funds. We have an annual audit prepared by Hernan Puentes and Associates. In this audit,our internal controls and protocols are scrutinized in accordance with auditing standards generally accepted in the U.S.in addition to Government Auditing Standards. 8. Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 charecters).This text will be used widely during the review and implementation process to describe your project. Case Management ensures afl needs in a senior's life are being met.For each ciient,case managers develop and execute a plan,which involves impiementing,coordinating,monitoring,and evaluating cost-effective resources to improve quality of life. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) ; We anticipate serving 65 unduplicated Dublin clients with this funding. ' 10.Which of the 14 Areas of Concern identified in the Eastern County 2071 Needs Assessment Report does your project identify ' with? � Behavioral Health(mental health and substance abuse) r Affordable Housing (� Health Care(including dental) � Workforce Development � Homelessness � Transportation Services and Access r pomestic Violence and Child Abuse r Disabilities I! Food and Nutrition (� Senior Services r Youth Services � Child Care,Early Childhood Development and Education , � Changing Demographics and Growing Diversity (� Financial Assistance (— None of the above 71. Explain how this project will be implemented,administered,and operated. Case Management is a crucial service,as we connect seniors to the resources and assistance they need to thrive.Thus,referrals come from a variety of sources,including:Adult Protective Services,police�re departments,medical discharge planners,senior center/housing facility staff,and concerned citizens.A referral can be as simple as a phone call to a case manager,available 5 days a week. Case managers typically meet with seniors in their home to gain a better understanding of their environment and eliminate potential barriers surrounding transportation.If a client should need/desire to come to our offices,we are located in a handicap-accessible office near a major bus ' route.Wheels/Dial-A-Ride can drop-off riders at our front door.Case Managers make every effort to accommodate seniors'needs and are also available to meet at the Dublin Senior Center and Dublin Library,upon request. TOgether,the senior and Case Manager create a comprehensive,practical plan identifying available resources for the senior's many needs.Every ; case is monitored on an on-going basis through phone calls/home visits.All activity is documented;client files are considered confidential and kept in lacked cabinets.Each Case Manager has a computer with Microsoft Office and intemet access. Case Managers for this project have been employed with Senior SuppoR collectively for over 20 years.They have a variety of backgrounds,both educationally and professionally in health and social services.The Executive Director supervises the Case Management team and facilitates weekly Case Management meetings.Trained volunteers are used for clerical duties and phone monitoring of clients.Billing and payroll services are provided by Bay Valley Accounting Professionals,while annual auditing is done through Hernan and Associates.The majority of office supplies and printing/copying are provided through private donations. 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for7). The City of Dublin grant funds will be mainly used for direct senior services.The primary costs associated with this program come from Case Manager salaries and travel expenses associated with driving to a senior's home,taking a senior to their medical appointments,and/or driving a senior to other needed services.These funds will allow case managers to conduct:initial intakes,home visits(assessments of seniors'needs),creation of care plans and implementation of services,monitoring on a regular basis,resource referrals(Meais on Wheels,PGS�E discounts,etc.),referrals of volunteers,etc.Senior SuppoR is fortunate to have the opportunity to operate in the Pleasanton Senior Center rent and utility free,which reduces overhead expenses and allows us to provide more direct services.Expenses for copying,office supplies,accounting,insurance and auditing are minimal,as they are spread among all Senior Support contracts and largely paid through private donations. Case Management is provided on a one-on-one basis and is personalized;therefore,the exact time and cost for each client varies significantly. Senior Support is diligent in utilizing Case Managers'time as efficiently and effectively as possible. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome(s)? Outcomes in Case Management are measured by the improvement in the quality of life and safety for the seniors who received our services.Success is different for each senior.This improvement may be evident in a cleaner living environment;better nutrition and mobility;and access to mental and medical health services.Success ma be evident in the fact that the senior can remain safel at home with im roved ualit of life.Success ma be evident when the fire department no longer needs to make repeat visits to lift a senior off the floor.Case Management revoives around taking many small steps,leading to a better life.Our primary desired outcome is for seniors to have the information,support and resources enabling them to maintain independence,improve physical and mental health,and remain at home with dignity intact. During the initial assessment,the Case Manager assists the senior in setting goals and putting services in place.The care plan for each ciient is thoroughly documented and filed.Through telephone monitoring and repeat home visits,the case manager tracks and documents progress and modifies the care plan as needed.A strong indicator of progress is improvement in scores for activities of daily living(ADLs)and indirect activities of daily living(IADLs),which are documented. From over 25 years of delivering Case Management,we know when basic physical,social and emotional needs are met,even in small increments, lives are improved.Case Management is key in linking seniors to services that provide meals,transportation,home care,safety devices,social activities,medical care,access to government benefits,and a multitude of other resources. 74. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled,low-income,etc. All program recipients are age 60+living in Dublin.Priority is given to seniors who are living in the greatest economic need,functionally impaired,or minority.Senior Support is the only nonprofit agency providing free Case Management,specifically tailored to older adults,for Dublin residents.We have been serving Dublin's seniors for over 32 years.Case Management benefits seniors by enabling them to remain living independently and safely in their own community,with familiar surroundings,and an improved quality of life.For instance,we first met Ms.B when the Dublin Senior Center suggested calling Senior Support for help applying for CalFresh(food stamps).A Case Manager met with Ms.B,completed paperwork for CalFresh, and identified other needs.As Ms.B has sole guardianship over an energetic,fun-loving 5-year-old,she often lacks the time and energy to manage her own chronic health conditions.Her Case Manager referred her to Senior Support's In-Home Exercise,Nutrition,and Medication Safety Programs. She now has the knowledge and tools to comply with her doctor's recommended diet and medication regimen.The Case Manager also provided resources to receive assistance paying PG&E bills and a free Saturday program specifically for children of older adult guardians,which provides Ms. B a much needed break.Ms.B couldn't believe all these services were free and feels more confident about managing her health while raising a 5- year-old.She loves having more energy and truly appreciates having her Case Manager to better navigate challenges in her life. 15. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the clienUcustomer population served)? Regardless of ethnicity,nationality,sex,religion or any other differences,seniors have one thing in common,which is the challenges associated with , aging;this is a culture in itself.Senior Support staff members have over a decade of experience in the field of aging.We hold weekly staff meetings where cases can be discussed and problem-solved.In-services are given to staff and volunteers in the fields of inental and physical health, finance/benefits,safety and adaptive devices and other geriatric specialists.Case Managers also attend classes throughout the county presented by Area Agency on Aging and the American Society on Aging;they also receive in-service education from groups,such as the Livermore Shiva Vishnu Temple and Afghan Elderly Association. Senior Support works with many community groups and faith-based groups that volunteer to help seniors in need.Some of these groups are available to help us further understand the customs and needs of seniors who have limited English,are non-English speaking or are from other countries. Senior Support has staff and volunteers with language capabilities in English,Spanish,Mandarin,Cantonese,Japanese,Italian,Farsi and American Sign.We have learned that the Tri-Valley,especially Dublin,has a growing number of residents speaking Mandarin and Cantonese.We have numerous programs,especially our health education programs,available in English and Mandarin/Cantonese.By expanding our services to accommodate this group,we are learning the importance of including the non-English speaking Tri-Valley population;we enjoy learning new ways to best accommodate this population. 76.Explain how your agency will outreach to low-income,limited English speakers,and/or disabled persons.How will each of these groups access the project for which your agency is requesting fundingl Senior Support staff continuously participates in outreach events to the senior population and to the community at large.Besides one-on-one outreaches,we try to do a minimum of one community outreach monthly.Our case manager will be present as needed at the Dublin Senior Center for ' case management services.Some of our outreach efforts are held at senior apartment complexes and mobile home parks.These sites enable us to reach seniors who are homebound and unable to get out on their own.We also conduct presentations to groups in the community,such as employee groups,clubs,churches,service groups and caregiver workshops.We have multilingual staff,volunteers and interns who can perform outreach in areas as needed.Senior Support is also able to provide information to Dublin's limited-English speakers through our handouts and brochures that are available in English,Spanish and Chinese.Senior Support staff members are very sensitive to and aware of different cultural needs.We work well ' with seniors'families and friends to make sure proper services are in place.We are sensitive to the multicultural needs in our Community,and our staff participates in training to address the diversity of clients we serve. The majority of seniors served through our program are visited in their homes,where a complete assessment is made of their needs.If they should need to come to the offices,we are conveniently located at the Pleasanton Senior Center in an area that was originally designed for an adult day care program.It is wheelchair accessible and has three handicapped restrooms.It is also on a major bus route with a stop on the street in front of the building.Wheels Dial-A-Ride drops off at our front door. Senior Support also has a volunteer transportation program available to Case Management clients who need transportation in order to access services and resources put into place by the Case Manager. 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We are proud to work collaboratively with many organizations and agencies throughout the Tri-Valley and Alameda County.We have established referral procedures between agencies that eliminate delays and confusion.Lines of communication have been established to ensure information and referrals flow between agencies.We have a strong collaboration with Spectrum Community services.A client who needs meals brought to them can have the meals started with one simple phone call.We have partnerships with many faith-based and other organizations that have joined with us to provide home clean-up and support.In our goal to reach the shut-ins in crisis,we developed a strong partnership with the Dublin police department. When they find a senior in crisis,this department will call us.Our case manager responds by working with the client or the family to provide essential services.Thishas helped to eliminate repeat 911 calls. We have worked closely with the Dublin Senior Center for many years.Their staff often refers clients they are concerned about.Our nurses provide Health Screenings at the Senior Center and use of the Senior Center is often a part of our case manager's care plans.In addition to the above collaborations,we have developed strong relationships with local hospital staff,including Valley Care and Kaiser social workers and discharge planners.Other agencies we work with are HICAP,LAS,Legends,Adult Protective Services,Public Health,CRIL,Open Heart Kitchen,Tri-Valley Haven,Wiesner Foundation,Salvation Army,Social Security,IHSS,and the local transportation agencies.We work with AXIS Community Health to provide and receive referrals. In the past year,we have also developed a strong partnership with City Serve,who has provided us with much assistance for our seniors;they provide an extra set of hands to our case managers.A simple phone call from these agencies is all that is needed for our support efforts to begin. 18. Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. Senior Support provides outreach to Dublin residents through media,community fairs,local events,and presentations to local organizations,clubs and groups.We appreciate annually participating in Dublin's Senior Info Fair,which is very popular.We have had newspaper articles in the Independent, Pleasanton Weekly and the Valley Times.We have a website,Facebook page,Linkedln profile and various social media coverage.Once a year,the staff works closely with the City of Dublin and the Dublin Police Department,assisting seniors with cleaning their homes,gardening and minor home maintenance.We work with the Dublin Police Department and city for holiday giving events,St.Raymond's Church for Thanksgiving meal deliveries, and City Serve to address community needs.We also collaborate with Tri-Valley Rotary Organization,providing them with referrals of seniors who need home clean-ups or minor home repair.Several Dublin residents were included in this project.We also work with local community colleges, providing opportunities for student internships and data for research.The interns provide exercise coaching,record keeping,assistance with classes, accounting help,and health screenings.We partner with and are a recipient of Hacienda Park Helping Hands.Senior Support case management is not a standalone program.It is one part of our services encompassing In-Home Counseling,Family Caregiver Support,Friendly Visiting,Home Care Worker Registry,same day door-through-door Senior Transportation Program,Exercise&Nutrition Programs,Partners in Safety,Health Services,alcohol and other drug prevention,and Information and Referral Service.All of these services are available to Dublin senior citizens.With the diversity of programs and staff backgrounds,there is constant collaboration within our organization as we work to meet the needs of older adults effectively and efficiently, ultimately improving their quality of life. 19. Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. Senior Support will provide case management services for 57 Dublin senior citizens(consisting of 21 full and 36 one-time case management services).This project meets the City of Dublin's mission/vision to"promote and support a high quality of life which ensures a safe and secure environment that fosters new opportunities."For the city of Dublin,Senior Support's case management program is the only free service that walks seniors through the process of getting connected to essential services.Case management brings resources;services and referrals to achieve maximum health;mobility management;safe environment modification tools;and socialization opportunities to older adults.So often,seniors referred to case management are struggling to meet basic needs(i.e.food,shelter,transportation,medical care)and not aware of resources to meet these needs.Educating seniors on local opportunities available is essential.Ultimately,each senior we serve will realize their full potential and choose to paRicipate in activities that will give them confidence and encourage them to continue to be involved and viable in the Dublin community. 20. BUDGET NARRATIVE Describe how this project ig cost effective and how the budget is reasonable for the anticipated result. Each new client costs approximately$500.00 per year;the services provided to the seniors include but are not limited to: Initial intake Home visit(assessment of senior's needs) Care plan and implementation of services ' Monitoring on a regular basis Resource referral(Meals on Wheels,PGS�E discounts,etc.) Referral of volunteers To serve 25 clients with complete case management services would cost$12,500.We additionally respond to approximately 500 information and referral calis per year and serves at least 40 one-time service clients,requiring a case manager to gather information and offer limited coordination of services.These costs,compared to an average of$90,000 per year per client for institutionalization,that often becomes the taxpayers'responsibility, are very cost effective.Senior Support strives to keep costs at a minimum.We are grateful for the many volunteers who assist with office support and telephone reassurance. 21.If this application does not receive funding,or receives reduced funding,what will be the effect on the project? The demand for services already exceeds our capacity level to provide them,making it necessary to prioritize services to those most at risk. We will continue to provide very limited Case Management to Dublin seniors as allowed through our Area Agency on Aging funding.If full funding is not received,we will have to reevaluate the number of seniors that will be served.However,if no funding is received we would only be able to serve approximately 15 seniors with the funds we receive through our Case Management Program funded by the Area Agency on Aging.These are not counted in the 65 we propose to serve through this grant Having each city in the Tri-Valley provide funding is essential to maintain the level of service we have been privileged to provide for the past 33 plus years.If funding is not received,seniors who have needs that can quickly be solved,allowing them to return to an active life,will fall through the cracks,resulting in future failure to thrive and being at risk to live independently. Senior Support continuously looks for more funding to provide all necessary services.We look to foundations,fundraisers,donations,businesses and the county to provide these monies.We continually look for volunteers from the community to expand our services. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? � Yes r No 23.If you answered yes to the preceding question please explain.Enter"NIA"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures)� r Yes � No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25.If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"N/A"if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms,pla�s for future relocation or expansion,etc.�.Enter"N/A"if not applicable. N/A 27. If your agency is requesting Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? � Not Applicable r Yes r No r Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin's Mission&Vision Statements:(you may choose more than one) � Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. r Balance history with progress,to sustain an enlightened,economically balanced and diverse community. (� Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. � Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) r Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development � Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety � Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City (� Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication � Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutal benefit 30.*'llUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.*'Are you are interested in applying for CDBG funds? � Yes.If so,answer questions 31 through 43. � No.If no,check box here,and questions 31 through 43 will not be required.. � Don't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 37.CDBG ONLY-Explain your Limited English Proficiency/Language Access Plan(LEP/LAP).How does your agency outreach to limited English speaking residents to encourage access to services 8�housing?What access accommodations are used?Provide detail Please enter"N/A"if you are not interested in qualifying for CDBG funding. Senior Support has in-service education for staff and volunteers from various cultural,ethnic and under-served populations through organizations such as the Afghan Elderly Association,Livermore Shiva Vishnu Temple,and The National Hispanic Council on Aging E Learning cultural competence courses.Senior Support staff is diverse in its cultures,races,ethnic backgrounds,nationalities and geographic origins. We work with community,ethnic,cultural,and faith based groups through outreach and volunteer recruitment.Our outreaches to these groups always produce both individual volunteers and those wanting group projects.Although these individuals and groups will help any senior,they are a valuable resource we can access when our staff needs help in further understanding the customs and needs of seniors who are limited or non- English speaking or come from other countries. Senior Support provides education and materials to a diverse population.Our staff and volunteers have language capabilities in English,Spanish, Mandarin,Cantonese,Japanese,Italian,Farsi and American Sign.We provide nutrition education and counseling as well as our Finding Weliness program(consisting of alcohol/medication education classes)in Mandarin and Cantonese.Educational materials are developed by program managers, educators and the executive director.These materials are translated into Spanish and Chinese.Bilingual volunteers are available to accompany staff when English is not the primary language. 32.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Guiding Principle that relates to your project: r Be culturally accessible,appropriate and inclusive r Encourage community engagement and involvement � Promote energy and resource e�ciency � Encourage networking and information sharing across service providers � Encourage process streamlining r Consolidate service delivery � Not Applicable. I am not interested in qualifying for CDBG funding. 33.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Goals that relates to your project: A)Support and develop a continuum of housing resources that will increase access to low-income,seniors,disabled and homeless persons with emphasis on activities that: � *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. (� `Preserve and increase affordable rental housing opportunities for low and moderate income households. r *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. � 'Promote fair housing and reduce housing discrimination. r B)Improve community health and access to basic and specialty care including dental and optometry care,behavioral and mental health care services especially for low-income,uninsured and under-insured residents with emphasis on activities that: I+ *Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. r *Increase outreach and access for underserved populations including limited English speaking persons,youth,disabled,seniors and homeless persons. � C)Increase and maintain affordable and accessible weliness and development opportunities for youth that are age appropriate. � D)Support and expand programs and opportunities that keep seniors engaged and involved in their community. r E)Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. . � F)Not Applicable.I am not interested in qualifying for CDBG funding. 34.CDBG ONLY-Identify AT LEAST ONE U.S.Department of HUD Strategic Goal that relates to your project: (— Increase homeownership I� Promote decent affordable housing � Strengthen communities � Ensure equal opportunity in housing I— Promote participation of grass-roots,faith-based,and other community-based organizations I� Not Applicable.I am not interested in qualifying for CDBG funding. 35.CDBG ONLY•Identify AT LEAST ONE U.S.Department of HUD Policy Priority that relates to your project: r Provide increased homeownership and rental opportunities for low and moderate-income persons,persons with disabilities,the elderly, minorities,and families with limited English proficiency. � Improving the quality of life for our Nation's communities , (� Encouraging accessible design features. � Participation of minority-serving institutions in HUD programs. � End chronic homelessness within ten years. � Removal of barriers to affordable housing. , r Not Applicable.I am not interested in qualifying for CDBG funding. 36.CDBG ONLY-Identify AT LEAST ONE Consolidated Plan objective that relates to your project: � Increase the availability of affordable rental housing for extremely low income(30%),very low income(50%)and low income(80%) households. r' Preserve existing affordable rental housing and ownership for households at or below 80%of Area Median Income(AMI). � Assist low and moderate income first-time homebuyers. � Reduce housing discrimination. � Maintain,improve and expand(as needed)the capacity of housing,shelter and services for homeless individuals and families inCluding integrated healthcare,employment services and other supportive services. r Maintain and expand activities designed to prevent those currently housed from becoming homeless. � Build on inter-jurisdictional cooperation to achieve housing and homeless needs. r Increase the availability of service-enriched housing for persons with special needs. I� Not Applicable.I am not interested in qualiiying for CDBG funding. 37.CDBG ONLY-Select ONE ObJective that relates to your project(TIP:When selecting an objective ask yourself,"What is the purpose of the activity?What is the larger community need that I am seeking to address?"�: (� Creating a Suitable Living Environment � Providing Decent Affordable Housing � Creating Economic Opportunities � Not Applicable. I am not interested in qualiTying for CDBG funding. 38.CDBG ONLY•Select ONE Outcome that relates to your project(TIP:When selecting an outcome ask yourself,"What type of change or result am I seeking?"): � Availability/Accessibility f Affordability r Sustainability ' r Not Applicable.I am not interested in qualifying for CDBG funding. 39.CDBG ONLY•Select ONE Specific Indicator that relates to your project: � Public facility or infrastructure:This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure.If the activity was used to meet a quality standard or to measurably improve quality,then this indicator will report the number of household units that no longer have access to a substandard service. � Public Service:This indicator shows the number of persons that have been assisted with new or improved access to a service.If the activity was used to meet a quality standard or to measurably improve quality,then this indicator will report the number of persons that no longer have access to a substandard service. r Targeted revitalization:This indicator shows a range of outcomes such as jobs created and retained,businesses assisted,low-and moderate- income persons and households served,slum/blight demolition,number of acres of brownfields remediated,etc.in a targeted area. r Commercial facade treatments or business building rehabilitation:This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. ' � Brownfields remediated:This indicator shows the number of acres of brownfields that were remediated. � Rental units constructed:This indicator shows the number of affordable rental units created,as well as the number of years of affordability, number of units occupied by the elderly,and those�nits designated for chronically homeless persons and persons with HIV/AIDS. r Rental units rehabilitated:This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability,units for chronically homeless persons,elderly persons,and persons with HIV/AIDS. r Homeownership units constructed or acquired with rehabilitation:This indicator shows the total number of homeownership units constructed, acquired,and/or acquired with rehabilitation per activity.This includes total number of affordable units,number of years of affordability,Energy Star qualified units,section 504 accessible units,and number of households previously living in subsidized housing.In addition,data will be collected on the number of units occupied by the elderly,number of units designated for persons with HIV/AIDS,and number of units for the chronically homeless. � Owner occupied units rehabilitated:This indicator shows the total number of owner occupied units rehabilitated,including the number of these units occupied by the elderly,number of units designated for persons with HIV/AIDS,and number of units for the chronically homeless. 1� Direct financial assistance to homebuyers:This indicator shows the number of homebuyers receiving direct financial assistance,housing counseling,and down payment assistance/closing costs. � Tenant Based Rental Assistance(TBRA):This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance(less than 12 months)and the number of homeless and chronically homeless households assisted. r Homeless shelters:This indicator shows the number of homeless persons given overnight shelter. � Emergency housing:This indicator shows the number of beds created in an overnight shelter or other emergency housing. � Homeless prevention:This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. � Jobs created:Of the total number of jobs created,this indicator shows the number of jobs that have employee-sponsored health care,the types of jobs created(using Economic Development Administration(EDA)classifications)and the number of persons unemployed before taking the job. r Jobs retained:Of the total number of jobs retained,this indicator shows the number of jobs retained,the number of jobs with employer- sponsored health care benefits,and the types of jobs retained(using EDA classifications) r Business assistance:This indicator shows the total number of businesses assisted.Specifically,it shows the number of new businesses, existing businesses,and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. � Businesses providing goods or services:This indicator shows whether an assisted business provides goods or services to meet the needs of the service area,neighborhood,or community,as determined by the grantee. r Not Applicable.I am not interested in qualifying for CDBG funding. 40.CDBG ONLY-Please choose a common indicator that your agency will use to track clients(select only ONE): � Persons r Households r Not Applicable.I am not interested in qualifying for CDBG funding. 41.CDBG ONLY-For the category you selected above,provide the total number of unduplicated Dublin clients(EITHER Persons OR Households)your agency anticipates serving through this project: 57 42.CDBG ONLY-Based on the common indicator you selected above,please Iist the number of unduplicated Dublin clients your agency anticipates serving in each category."If none,please enter"0". 10 Low Income(50%-80%AMI;please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 47 Extremely Low Income(<30%AMI;please refer to the Income Limits chart at www.dublin.ca.gov/housingn !Disabled 39'Female Headed Households _ _ _ � � 57�Senior _ _____.. 'Youth � (� 'Homeless `�:��� �� �� �Not Applicable.I am not interested in qualifying for CDBG funding.(Type N/A) .__...1.53 OQ i TOTAL ' 43.CDBG ONLY-List the number of clients your agency anticipates serving in race/ethnicity categories.The sum entered below must match the total clients entered in#42 above.Per HUD"Hispanic"is an ethnicity,not a race."If none,please enter"0" _ _ 27 White ' 4 White+HISPANIC 4 Black/Africa�American Black/African American+HISPANIC �� 20�Asian __ _ - - ;Asian+HISPANIC American IndiaNAlaskan Native _. �American IndiaNAlaskan Native+HISPANIC � ;Native Hawaiian/Other Pacific Islander _�.�_.�--_._..�.___._ _, __.,.. _,_ _.. Native HawaiiaNOther Pacific Islander+HISPANIC � ��American Indian/Alaskan Native and White ' � ;American Indian/Alaskan Native and White+HISPANIC : �Asian and White ! 'Asian and White+HISPANIC - Black/African American and White ' Black/African American and White+HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American+HISPANIC 2 Multi Racial+HISPANIC OR other Multi Racial Not Applicable.I am not interested in qualifying for CDBG funding.(Type N/A) � �� Sf.GG1TOTAL 44.If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY r #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. � #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. � #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. r #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. � #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. � #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. � If you have more than 6 applications per organization,agency,district or entity,check here. 45. Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). Senior Support constantly looks for more funding to provide necessary services.We look to foundations,fundraisers,donations,businesses and city governments to provide these monies.We also continuously look for volunteers to expand our services. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-007038 Budget Funding Sources/Revenues Budget Amount Amount Committed Ciry of Pleasanton(in-Kind space/utilities) $88,000.00 $88,000.00 Area Agency on Aging(Tri-Valley) $32,623.00 $32,623.00 City of Livermore $15,712.00 $0.00 ' City of Pleasanton(Case Management) $41,000.00 $41,000.00 Total $177,335.00 $161,623.00 Funding Uses/Expenses Budget Amount Amount Committed ' Marlene Petersenll% $1,040.00 Luz Saldana/10% $4,056.00 Lucy Morgan/l4% $2,496.00 ' ana o o , . Nicole AlbrechUl% $780.00 Amy Iwamoto/2% $572.00 Total $12,142.00 $0.00 Budget Narrative Funds will be primarily used for Direct Services. Marlene Petersen is the Director has been with the agency 31 years;she works as a case manager as needed. Luz Saldana is our lead Case Manager and bilingual. Lucy Morgan is a Case Manager/Registered Nurse. Dana Volk is a Case ManageNMarriage and Family Therapist. Nicole Albrecht is an Administrative Director who ensures all reports are in compliance and submitted.Nicole writes Senior SupporPs grants ' and conducts all outreaches. ' Amy Iwamoto is a bookkeeper who maintains our budget and all invoices. Please note:$12,142 covers direct salary costs.An additional$2,064 covers frings(benefits)and an additional$350 is proposed to cover travel expenses.This brings the total amount requested to:$14,556. : Documents Documents Requested' Required? Attached Documents* ' Program Expense Budget for ALL Grant Requests � Pro�ram Expensas downiaad tempiate Financiai Information Form for ALL Grant Requests � Financial Infonnation downioad tempiate List of Board of Directors(or governing body)with contact � Board of Directors Part 1 information Board of Directors Part 2 Current Annual Budget for the Entire Agency r Aqencv Budqet Copy of most recently submitted IRS 990 form or Tax Retum � 990 Passward 5569 (include compfete form) Board of Director's(or governing body's)designation of � Board Desiqnation authonzed official ' Board of Director's(or governing botly's)authorization to � Board Authorization request funding(may be same document as one above) Proof of insurance carried,inGuding bonding,liability and/or r Evidence of insurance workers'compensation , REQUIRED FOR CDBG ONLY-If requesting Capital Funding, � please upload your Capitai expenditure budget(your own format is acceptable) REQUIRED FOR CDBG ONLY-PERSONNEL POLICIES INCLUDING � Personnel Policies AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS Ir Audit AND COPY OF LAST AU01T HIGHLIGHTING"FINDINGS° SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION � Articles Bviaws AND BYLAWS. Articies Caistitutian Articies State of CA ' REQUIRED FOR CDBG ONLY-CONFLICT OF IMEREST (� Gonflict of interest ' STATEMENT QF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART � Qra Chart STATE AND FEDERAL NON-PROFIT DETERMINATION LEfTER. r 501 c3 All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application.Non-compliant applicants will be disqualified. REQUIftED FOR CDBG ONLY-AGENCY'S LIMITED ENGLISH � LEP/LAP PROFIGIENCY LANGUAGE ACCESS PLAN(LEP/LAP).Must inGude outreach to limited English speaking residents to encourage access to senrices 8�housing.Include what access accommodations are used. REQUIRED FOR CDBG-LEVERAGING REPORT-this is due with r ' the 2nd uarter re ort nolater than Janua 15th 1 i f Certified Audit and/or Certified Financial Statements � Audit � 'ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:48263 Become e fan of�ncm6rants""on Facebook Problems?Contact us et Qeestions(a?ZoamGrants.com . �2002-2016 GrentAnalystcom.All rights reserved. � "ZoomGrants"end the ZoomGrants logo are trademarks of GrantAnalyst.com,LLC. . �Cii:lut�Browser �. i i i I � i i Y � I 1I t I t Email This Preview Save as POF Print Glose Window A�♦ ,�� Po�vered bv ZoomGrantsT'�' City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadline Spectrum Community Services Meals on Wheels for Dublin's Homebound Seniors $15,750 Requested Spectrum Community Services .^4m�^p�M Submitted: 12/11/2015 2:39:02 PM(Pacific) 2621 Barrington Court Telephone(510)881-0300 x222 Hayward,CA 94545 Fax (510)537-3340 Project Contact United States Web www.spectrumcs.org Samantha Finkelstein sfinke�stein(a�s�ec+_rumcs.orq Executive Director � Tel:(510)881-0300 ext.222 i Lara Calvert � icalvert{c�s�ectrumcs.orq Additional Contacts � phemdon@spectrumcs.org i Application Questions - - _._—._._...----_..------._____..._.__�________.._..__....____..-- _..._.___ —�_..�__���.. � Some answers will not be presented because they are not part of the selected group of questions based on the answer to#30. � 1. Please describe your organization category(select one of the following�: � Private Non-Profit r Public Agency � Other: 2. Please describe your agency's mission(no more than 3 sentences or 250 characters). We are a non-profit agency with a mission to support low-income,disadvantaged families,individuals,and elderly residents of Alameda County in their efforts to improve self-sufficiency and the overall quality of their lives. i 3.For what type of Dublin Grant is your agency applying? I� Capital Project (J Public Service Program or Project 4.Is this a"new"service,program,project or activity9"New"is identified as not yet started,implemented or in operation. ; I� Yes ; f% No 5. Please indicate below if this application is a request for one-time funding and/or"seed"funding. I� One-time funding li Seed funding (- One-time and Seed funding � Operational funding r None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received within the last three years(jurisdiction,year,amount,purpose,etc.).Enter"N/A"if you HAVE received Dublin Funds. N/A 7.Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.). Every year,Spectrum works with over 11,000 individuals and families in Alameda County,and our multiple programs have developed in response to real needs in the community.Spectrum's programs include Home Weatherization and Energy Assistance,Fall Prevention Program,and our Senior Nutrition Program. Spectrum employs 55 paid staff and manages an operating budget of approximately$4.7 million.Our ability to manage our financial resources effectively and to respond to the changing needs of the community is reflected in our history of growth and service.A 501(c)(3)non-profit,Spectrum is governed by a Board of Directors drawn from the jurisdictions we serve,ensuring that organizational policy reflects the diversity,character and needs of the communities we serve. Since 1978 Spectrum has prepared and delivered over 3.9 million meals to elderly residents throughout Alameda County.Today,our Senior Nutrition Program provides over 450 congregate meals and over 125 home-delivered meals per day-over 100,000 each year.Spectrum maintains rigorous oversight of financial resources in order to meet federal,state and county reporting requirements.Our infrastructure(facilities,equipment,and staf� is stable,and with it the capacity to successfully manage and operate the Meais On Wheels program in the Tri-Valley,serving Dublin,Livermore, Pleasanton,and Sunol. Spectrum's Senior Nutrition Program is monitored by the County Area Agency on Aging,whose annual monitoring visits provide important feedback to project management as staff continue their quest for excellence,continuing to provide service while being cheertul,and committed to their routes. Spectrum consistently provides high quality,nutritious food to Dublin seniors who are most in need on a daily basis. 8. Provide a brief summary of the proJect for which your agency is seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementation process to describe your project. Meals on Wheels delivers meals to Dublin homebound seniors.We expect to serve at least 10,500 meals,without which nutrition status and quality of life will suffer.We are requesting funding for mileage and personnel to continue this lifesaving service. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) 45 10.Which of the 74 Areas of Concern identified in the Eastern County 20/1 Needs Assessment Report does your project identify with? I— Behavioral Health(mental health and substance abuse) (� Affordabie Housing (— Health Care(including dental) � Workforce Development r Homelessness � Transportation Services and Access I— Domestic Violence and Child Abuse � Disabilities (J Food and Nutrition � Senior Services r Youth Services � Child Care,Early Childhood Development and Education r Changing Demographics and Growing Diversity r Financial Assistance � None of the above 11. Explain how this project will be implemented,administered,and operated. Spectrum's Meais on Wheels program seeks to maintain or improve the wellbeing of frail,homebound Dublin elders by providing them with nutritious meais for specified dietary restrictions,as well as regular safety checks. Under the direction of our Senior Nutrition Program Manager,beginning on July 1,2016,Spectrum will deliver at least 10,500 meals to frail homebound seniors residing in Dublin for 365 serving days through June 30,2017. The Meals on Wheels Coordinator personally visits Dublin seniors to assess needs and determine eligibility.If eligible,the coordinator then modifies the delivery route and schedules delivery days as needed.Five days a week(excepting thirteen holidays)the Meals on Wheels driver will pick up individually packaged meals prepared at Stanford Healthcare—ValleyCare hospital and deliver them to elderly clients. Records of daily routes,delivery, mileage,food safety measures,client feedback,and more are maintained daily and collected for qualiry assurance and reporting by program staff. Due to the homebound status of our clients,the home-delivery driver is often the only person who sees the senior that day.Thus,our team of drivers is a vitally important component of a clienYs safety net.Drivers are trained to observe physical and environmental changes that might indicate need for other support services or assistance,and report those changes to the Meals on Wheels Coordinator,who will connect the senior with appropriate services provided by our cooperative partners including Alameda County 2-1-1 and the Senior Support Program of the Tri-Valley. Spectrum has worked hard to maintain a high standard for our senior nutrition program.We are monitored annually by the Alameda County Area Agency on Aging in areas of:food sanitation,safety,preparation,performance,and client satisfaction.The outcomes of the monitor visit are submitted to the Program Manager,Executive Director,and Board 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for7). Dublin Community Grant funds will make it possible for Spectrum to serve the increasing number of Dublin's elderly homebound residents who need home-delivered meals.Grant funds will ensure that Spectrum's Meals on Wheels program will respond to new requests and will not be forced to start a waiting list.Specifically,grant funds will help to cover 1)the mileage for one route,estimated to be 6,000 miles a year at a reimbursement rate of $0.575 per mile 2)a portion of the part-time salary and benefits of the Meals On Wheels Coordinator,who is responsible for overseeing all paid and volunteer drivers,scheduling,home assessments,and community outreach and 3)a portion of the salary of our newest position,Meals on Wheels Volunteer Coordinator,who will be responsible for outreach to both volunteers and potential clients. The dedicated Dublin route that will be supported by Dublin CDBG funds allows us to reach Dublin residents no matter where they live,ensuring that the Meals On Wheels service is accessible to seniors in Dublin who need it.Spectrum's Meals on Wheels program serves adjacent Tri-Valley cities of Pleasanton and Livermore,and,depending on the location of clients in need,our Meals On Wheels routes in those cities often include parts of Dublin. The resulting comprehensive coverage enables us to consistently provide a key component of the preventative health care and supportive services that frail Dublin seniors need to continue livin in their own homes. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome(s�? In the last fiscal year,we aimed to serve 4,500 meals.In reality,we served 9,974,seeing major growth(222%of goal)due to significant need in this area.In the coming grant year,we anticipate serving at least 10,500 freshly prepared,nutritious meals and wellness checks.Spectrum's Meals on Wheels Coordinator will also connect clients to community-based senior support services as needed.Together,these benefits will have a direct and lasting positive effect on the health and well-being of our homebound frail senior clients. We maintain daily logs of ineals delivered and clients served,and spreadsheet the data for monthly reports to our government funding sources.The Senior Nutrition Program Manager also reviews this data personally on a regular basis throughout each quarter. In order to achieve our primary goals,quality assurance and client satisfaction are critically important.Weekly,ongoing reviews of operations and meals served ensure that management and administration identify and correct any potential production or delivery problems before they become significant. The Senior Nutrition Program Manager and Administrative Assistant to Senior Nutrition welcome telephone calls from senior clients and families,and field several calls weekly.They contact the Meals on Wheels Coordinators each week for updates,and connect with drivers several times a week.All suggestions are reviewed by the Program Manager,and appropriate action is taken when needed.We also distribute client surveys once a year, giving seniors an opportunity to comment and give feedback about meals,service,and quality. Spectrum is monitored annually by the County Area Agency on Aging in areas of:food sanitation,quality,safety,preparation,performance,and client satisfaction.The outcomes of the monitoring visit are submitted to the Program Manager and Executive Director.Spectrum consistently earns high marks,and we expect this same high level of excellence this year. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled,low-income,etc. 100°/a of Meals on Wheels clients in Dublin are functionally impaired,unable to perform such essential activities as dressing,bathing,cooking, shopping,household chores,etc.More than half(70%)are age 75 or older. Spectrum exceeds the CDBG nationai objectives of"at least 70%of the program's participants must have low or moderate income":30%of homebound Dublin seniors served by Spectrum are extremely low-income;70%are very low—low income(based on HUD guidelines). The seniors served by Spectrum's Meals on Wheels program is a special needs group that is isolated because of homebound status and tends to be poorer,older and frailer than most of Dublin's senior.Spectrum's Meals on Wheels program serves a population slightly more diverse than the senior : population of Dublin.Over the last year,our client population has become even more diverse,and we anticipate that the population served in the grant year will be 70%white,10%Hispanic,5%Asian,10%African American. Dublin's homebound seniors who qualiiy for and utilize the Meals on Wheels program will benefit from regular safety checks,consistent interaction with Meals on Wheels drivers and volunteers,while benefiting from the preventative measures of the nutritious meals served by the program.The subsidized meals help ensure that those struggling to make ends meet do not need to sacrifice good nutrition.For those recuperating from a hospital stay,the assistance and regular meals help them recover sooner and return to an active life in the community,preventing re-hospitalization.For those who are indefinitely homebound,the Meals on Wheels program provides consistent wholesome meals,and regular interaction with a friendly delivery driver,ensuring these vulnerable members of our community to not go unseen.These benefits combine to improve quality of life and help frail seniors continue living in their homes. 15. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the clienUcustomer population served)? To accommodate the cultural preferences of our Meals on Wheels clients,Stanford Health Care-ValleyCare Hospital,Spectrum's Meals on Wheels meal provider,offers both toRillas and rice as a substitute for bread,as well as a vegetarian menu for those who are vegetarian.Stanford,as our meal contractor,provides special meals for traditional and ethnic holidays. Spectrum maintains a diverse workforce that reflects the communities we serve.Our staff includes workers who are bilingual in English,Spanish, Fijian,Hindi,Cantonese,and Mandarin,and who assist the Meals on Wheels Coordinator and Delivery Driver to communicate with the seniors we serve. 16.Explain how your agency will outreach to low-income,limited English speakers,andlor disabled persons.How will each of these g�oupS aCCess the project for which your agency is requesting fu�ding4 The provider community is an essential part of our outreach,as health care and social services providers are often the ones who are most aware of a senior's needs and are the ones who make referrals for the seniors in their care.We will continue to expand our outreach to providers,ensuring that they receive materials and referral information that is relevant to the languages spoken by their clients.Our Senior Nutrition Program staff works together to cultivate connections with faith-based and cultural organizations in the community,and with businesses and community venues where seniors and their families gather.We outreach regularly to the Chamber of Commerce,the public library,senior housing facilities,churches and business establishments which seniors frequent. We have been extending our outreach in Dublin,making contacts with local newspapers and on-line community newsletters,as well as seeking cable and radio public service announcement spots.We will continue these activities in the coming grant year. With a stronger presence in the community,this grant year,we will continue recruiting volunteers from the community to help us serve more seniors in need.These recruitment efforts will be in multiple languages. 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Spectrum works closely with the following paRner organizations Stanford Healthcare-ValleyCare Hospital—Provides the meal and packing of the home-delivered meals,Spectrum provides all the administration and delivery.Valley Care Hospital's discharge planners work closely with Spectrum's Meals on Wheels Coordinator to ensure that meal delivery is in place for seniors leaving the hospitaL Senior Support Program of the Tri-Valley—Provides a broad range of social services and care management for Spectrum's participants,and makes referrals regularly to the Meals on Wheels program. Alameda County Area Agency on Aging—Provides countywide services and an 800 assistance line and is the contractor with Spectrum's i Congregate meals and Meals On Wheels to seniors. City of Dublin Senior Center-Provides a venue and opportunities for Spectrum to increase awareness of senior nutrition and the Meals on Wheels program. Alameda County 2-1-1 (Eden I&R)-Provides a wide access to community services in Alameda County. Spectrum's coordinated service network enables the Meals Coordinator to effectively provide access to needed supportive services such as the Senior Support Program of the Tri-Valley.In addition,seniors are often referred to Spectrum's own Low-Income Home Energy Assistance Program (LIHEAP)and Weatherization services. 18. Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. Spectrum's community outreach program has built awareness of the Meals on Wheels program among seniors,their families,and the Dublin community. Meals on Wheels program staff have worked closely with Dublin's Senior Center for many years,where our staff make announcements and educationai presentations several times a year regarding senior nutrition and the Meals on Wheels program.We have regularly reached out to connect and to distribute our Meals on Wheels brochures at local physicians and social services,the Chamber of Commerce,the public library,senior housing facilities,churches and business establishments that seniors frequent. Each delivery driver has a magnetic sign on his or her car,which helps to identify our staff and volunteers and promotes our program on the delivery routes.The magnets include our program name and phone number. 19.Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. Meals On Wheels programs that deliver meals to frail homebound seniors living in the community promote and support quality of life and ensure a safe and secure environment for those seniors.But more than that,a community that sustains a Meals On Wheels program is a community committed to protecting its most vulnerable members.Dublin is demonstrating responsiveness to the needs of the community in remaining committed to ensuring the safety and well-being of homebound seniors.Meals on Wheels helps achieve this by providing both nutritious meals,consistent human interaction,and regular safety checks for the people who utilize the service. Responsiveness to community needs is of primary importance to Spectrum as well,and this program supports Dublin's value to encourage collaboration and communication with other communities on issues of mutual concerns,as our services span across the Tri-Valley area. Additionally,we distribute client surveys,giving seniors an oppoAunity to comment and give feedback about meals,service,and quality.The survey is available in English,Spanish and Chinese.The Senior Nutrition Program Manager welcomes and invites communication from senior clients and family, ' referral sources and partner agencies.All suggestions are reviewed in a quality improvement process,and if needed,appropriate action is taken. 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. With a$15,750 grant from the City of Dublin,Spectrum's Meals On Wheels Program will deliver over 10,500 meals to more than 45 homebound Dublin seniors in FY 2016-2017.This funding will ensure that Spectrum will be able to respond directly to requests for Meals On Wheels service without starting a waiting list.Our proposed budget is based on actual program costs and we are not asking Dublin to cover the cost of the meals, administrative overhead or other indirect costs.While gas prices fluctuate,our reimbursement rate for the Meals On Wheels Driver's mileage remains steady and predictable. Government and private funding sources cover only a portion of the operating expenses.Given the constraints that Alameda County's Area Agency on Aging Title III-C and USDA funding imposes on the operations of the Senior Meals Program,Spectrum has become adept at leveraging these funds to maximum efficiency.We feel this cost-effectiveness is evident in the attached budget. Title III asks for client donations.We request a voluntary$3.75 donation,and the cost of one meal is about$9.42.Given the limited resources available to many of our Dublin Clients,they are often unable to provide the suggested donation.This makes it extremely difficult to continue providing the services that these members of our community so clearly need. In the 2014-15 fiscal year,with the generous grant of$7,902 from the City of Dublin,we were able to serve 9,974 meals,with Dublin's contribution covering$0.79 per meal.This year,we are asking the City of Dublin to cover$1.50 per meal. 21.If this application does not receive funding,or receives reduced funding,what will be the effect on the project? Over the last few years,the number of ineals served to elderly homebound Dublin residents through Spectrum's Meals On Wheels program has grown dramatically,as we met 222%of our contracted goal last Fiscal Year.Without the funds to cover salaries and mileage,it would be extremely difficult to serve the low-income,homebound Dublin seniors who need Meals On Wheels.Without adequate funding,Spectrum may be forced to cap services and maintain a waiting list for new applicants for Meals On Wheels.We ask the grant committee to consider the impact that the loss of this life- sustaining service will have on seniors who find themselves homebound,unable to prepare meals or shop for food.Without accessible Meals On Wheels service,homebound seniors recuperating from an illness may be at risk of re-hospitalization,and frail elders with chronic conditions and/or mobility limitations may not be able to receive the nutrition they require.If this service is lacking,it also puts Dublin's homebound seniors at risk for decreased quality of life and increases safety risk.The proposed funding will enable Spectrum's Meals On Wheels program to be responsive to the needs of vulnerable seniors in the Dublin community. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? r Yes I� No 23.If you answered yes to the preceding question please explain.Enter"NIA"if not applicable. 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures)? � Yes r No.If no,enter N/A for questions 25 8 26,and check Not applicable for question 27 25. If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"N/A"if not applicable. N/A 26.If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms,plans for future relocation or expansion,etc.).Enter"NIA"if not applicable. N/A 27.If your agency is requesting Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? r Not Applicable (� Yes ' r No � Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin's Mission&Vision Statements:(you may choose more than one) � Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. � Balance history with progress,to sustain an enlightened,economically balanced and diverse community. � Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability ', through the preservation of our naturai surroundings. � Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) � Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development � Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety � Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendty development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City (�°' Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; ' exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication � Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutal benefit 30.**QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BIOCK GRANT (CDBG)FUNDING ONLY.'*Are you are interested in applying for CDBG funds� � Yes. If so,answer questions 31 through 43. � No.If no,check box here,and questions 31 through 43 will not be required.. (� Don't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDBG ONLY-Explain your Limited English Proficiency/Language Access Plan(LEP/LAP).How does your agency outreach to limited English speakfng residents to encourage access to services 8 housing?What access accommodations are used�Provide detail Please enter"N/A"if you are not interested in qualifying for CDBG funding. Spectrum performs an annual language survey of staff,volunteers,clients,and community,making note of any gaps and lining up resources and protocols to address needs.The Plan informs our sta�ng,outreach activities,consumer materials,web site,communications and operations.In between the annual language survey,we periodically update our Internal Language Directory that allows staff to quickly access non-English proficient speakers on staff(we update this document whenever there is a staff change).Should a staffer with language expertise be on vacation or out sick, Spectrum's management staff use the Language Directory so that,should the need arise,a fluent speaker from another department can assist.Our goal is that all clients and prospective clients and their families have access to Spectrum services in the language in which they are proficient,that they are treated with respect and that their questions are answered in a timely fashion. 32.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consoiidated Plan Guiding Principle that relates to your project: � Be culturally accessible,appropriate and inclusive r Encourage community engagement and invotvement � Promote energy and resource efficiency r Encourage networking and information sharing across service providers r Encourage process streamlining Consolidate service delivery � Not Applicable.I am not interested in qualitying for CDBG funding. 33.CDBG ONLY-Identify AT IEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Goals that relates to your project: r A)Support and develop a continuum of housing resources that will increase access to low-income,seniors,disabled and homeless persons with emphasis on activities that: r *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. � *Preserve and increase affordable rental housing opportunities for low and moderate income households. r *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. � *Promote fair housing and reduce housing discrimination. r B)Improve community health and access to basic and specialty care including dental and optometry care,behavioral and mental health care services especially for low-income,uninsured and under-insured residents with emphasis on activities that: � "Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. 1� "Increase outreach and access for underserved populations including limited English speaking persons,youth,disabled,seniors and homeless persons. r C)Increase and maintain affordable and accessible weilness and development opportunities for youth that are age appropriate. (� D)Support and expand programs and oppoRunities that keep seniors engaged and involved in their community. I�' E)Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. � F)Not Applicable. I am not interested in qualifying for CDBG funding. 34.CDBG ONLY-Identify AT LEAST ONE U.S.Department of HUD Strategic Goal that relates to your project: � r Increase homeownership i ; � Promote decent affordable housing � � Strengthen communities � Ensure equal opportunity in housing ' � Promote participation of grass-roots,faith-based,and other community-based organizations � Not Applicable.I am not interested in qualifying for CDBG funding. 35.CDBG ONLY-Identify AT LEAST ONE U.S.Department of HUD Policy Priority that relates to your project: � Provide increased homeownership and rental opportunities for low and moderate-income persons,persons with disabilities,the elderly, minorities,and families with limited English proficiency. r Improving the quality of life for our Nation's communities r Encouraging accessible design features. r Participation of minority-serving institutions in HUD programs. � End chronic homelessness within ten years. (— Removal of barriers to affordable housing. (� Not Applicable.I am not interested in qualifying for CDBG funding. 36.CDBG ONLY-Identify AT LEAST ONE Consolidated Plan objective that relates to your projeCt: r Increase the availability of affordable rental housing for extremely low income(30%),very low income(50%)and low income(80%) households. ' I— Preserve existing affordable rental housing and ownership for households at or below 80%of Area Median Income(AMI). 1� Assist low and moderate income first-time homebuyers. (— Reduce housing discrimination. r Maintain,improve and expand(as needed)the capacity of housing,shelter and services for homeless individuals and families including integrated healthcare,employment services and other supportive services. r Maintain and expand activities designed to prevent those curzently housed from becoming homeless. � Build on inter-jurisdictional cooperation to achieve housing and homeless needs. � Increase the availability of service-enriched housing for persons with special needs. � Not Applicabie.I am not interested in qualifying for CDBG funding. 37.CDBG ONLY-Select ONE Objective that relates to your project(TIP:When selecting an objective ask yourself,"What is the purpose of the activity?What is the larger community need that I am seeking to address?"): � Creating a Suitable Living Environment r Providing Decent Affordable Housing � Creating Economic Opportunities � Not Applicable.I am not interested in qualifying for CDBG funding. ' 38.CDBG ONLY-Select ONE Outcome that relates to your project(TIP:When selecting an outcome ask yourself,"What type of chan e or resuit am 1 seekin 7" : ' r Availability/Accessibility �� � Affordability � Sustainability � Not Applicable. I am not interested in qualifying for CDBG funding. 39.CDBG ONLY-Select ONE Specific Indicator that relates to your project: � Public facility or infrastructure:This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure.If the activity was used to meet a quality standard or to measurably improve quality,then this indicator will report the number of household units that no longer have access to a substandard service. r Public Service:This indicator shows the number of persons that have been assisted with new or improved access to a service.If the activity was used to meet a quality standard or to measurably improve quality,then this indicator will report the number of persons that no longer have ' access to a substandard service. r Targeted revitalization:This indicator shows a range of outcomes such as jobs created and retained,businesses assisted,low-and moderate- . income persons and households served,slum/blight demolition,number of acres of brownfields remediated,etc.in a targeted area. 1� Commercial facade treatments or business building rehabilitation:This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. 1� Brownfields remediated:This indicator shows the number of acres of brownfields that were remediated. � Rental units constructed:This indicator shows the number of affordable rental units created,as well as the number of years of affordability, ' number of units occupied by the elderly,and those units designated for chronically homeless persons and persons with HIV/AIDS. � Rental units rehabilitated:This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability,units for chronically homeless persons,elderly persons,and persons with HIV/AIDS. � Homeownership units constructed or acquired with rehabilitation:This indicator shows the total number of homeownership units constructed, acquired,and/or acquired with rehabilitation per activity.This includes total number of affordable units,number of years of affordability,Energy Star qualified units,section 504 accessible units,and number of households previously living in subsidized housing.In addition,data will be collected on the number of units occupied by the elderly,number of units designated for persons with HIV/AIDS,and number of units for the chronically homeless. � Owner occupied units rehabilitated:This indicator shows the total number of owner occupied units rehabilitated,including the number of these units occupied by the elderly,number of units designated for persons with HIV/AIDS,and number of units for the chronically homeless. '' r Direct financial assistance to homebuyers:This indicator shows the number of homebuyers receiving direct financial assistance,housing counseling,and down payment assistance/closing costs. r Tenant Based Rental Assistance(TBRA):This indicator shows the total number of households receiving TBRA as well as the number with ' short-term rental assistance(less than 12 months)and the number of homeless and chronically homeless households assisted. � Homeless shelters:This indicator shows the number of homeless persons given overnight shelter. � Emergency housing:This indicator shows the number of beds created in an ovemight shelter or other emergency housing. ' � Homeless prevention:This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. r Jobs created:Of the total number of jobs created,this indicator shows the number of jobs that have employee-sponsored health care,the types of jobs created(using Economic Development Administration(EDA)classifications)and the number of persons unemployed before taking the job. � Jobs retained:Of the total number of jobs retained,this indicator shows the number of jobs retained,the number of jobs with employer- sponsored health care benefits,and the types of jobs retained(using EDA classifications) � Business assistance:This indicator shows the total number of businesses assisted.Specifically,it shows the number of new businesses, existing businesses,and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. � Businesses providing goods or services:This indicator shows whether an assisted business provides goods or services to meet the needs of the service area,neighborhood,or community,as determined by the grantee. I— Not Applicable. I am not interested in qualitying for CDBG funding. 40.CDBG ONLY•Please choose a common indicator that your agency will use to track clients(select only ONE): (' Persons � Households r Not Applicable.I am not interested in qualifying for CDBG funding. 41.CDBG ONLY-For the category you selected above,provide the total number of undupiicated Dublin clients(EITHER Persons OR Households)your agency anticipates serving through this project: 45 ' 42.CDBG ONLY-Based on the common indicator you selected above,please list the number of unduplicated Dublin clients your agency anticipates serving in each category."If none,please enter"0". 13':Low Income(50%-80%AMI;please refer to the Income Limits chart at www.dublin.ca.gov/housing/) ��� �� 32�=Extremely Low Income(<30%AMI;please refer to the Income Limits chart at www.dublin.ca.gov/housing� � 45�Disabied 51 Female Headed Households 45:Senior Oi Youth _ . 0:Homeless ;Not Applicable.I am not interested in qualiTying for CDBG funding.(Type N/A) __ __ _... _......_...� i40.Q0�TOTAL 43.CDBG ONLY-List the number of clients your agency anticipates serving in race/ethnicity categories.The sum entered below must match the total clients entered in#42 above.Per HUD"Hispanic"is an ethnicity,not a race."If none,please enter"0" �� �� ���33�White � � � 3`.White+HISPANIC _, , � 5`��;Black/AfricanAmerican � _ . _ 0;BlacklAfrican American+HISPANIC _ __ _ 4I Asian 0 Asian+HISPANIC 0'American Indian/Alaskan Native OI American Indian/Alaskan Native+HISPANIC 0 Native Hawaiian/Other Pacific Islander 0 Native HawaiianlOther Paciflc Islander+HISPANIC 0 i American Indian/Alaskan Native and White 0'American Indian/Alaskan Native and White+HISPANIC __ 0'Asian and White 0!Asian and White+HISPANIC I �� � Ot BlacklAfrican American and White � 0;Biack/African American and White+HISPANIC � �� �� 0�American Indian/Alaskan Native and Black/African American ,�_-__�.��.__._a�. � Oi American Indian/Alaskan Native and Black/African American+HISPANIC ����� � 0�Muiti Racial+HiSPANIC OR other Multi Racial � , �� ��s Not Applicable.I am not interested in qualifying for CDBG funding.(Type N/A) � �a�Ot�;TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY � #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. � #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. (� #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. � #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. � #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. � #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. � If you have more than 6 applications per organization,agency,district or entity,check here. 45. Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). In this partnership with the City of Dublin,we are doing what is within our power to fund the Meals on Wheels program.Given the increase in wages, we are attempting to utilize more volunteers rather than paid staff.We will,however,always require some paid staff to oversee central service. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-006992 Budget �,_ .�_� Funding SourceslRevenues eudget Amount Amount Committed Area Agency on Aging $14,000.00 $0.00 Alameda County Meals on Wheels $56,000.00 $0.00 City of Livermore $15,000.00 $0:00 City of Pleasanton $10,000.00 $0.00 Total $95,000.00 $0,00 Funding Uses/Expenses Budget Amount Amount Committed Salaries $114,830.00 $0:00 Benefits $30,377.00 $0.00 ' Supplies $2,761.00 $0.00 Printing/Copying $150.00 $0.00 Postage _ $383.00 $0.00 Telephone _ g 839.00 $0.00 Rent and Utilities $6,755.00 $0.00 Accounting/Audit _ $612.00 $0.00 Contracted Services $2,250.00 $0:00 Mileage $31,103.00 $0.00 Total $190,060.00 $0.00 Budget Narrative Our total budget for this program is$190,060.00.We are asking for$15,750 from the City of Dublin to fund 8%of this project.We will use this funding from the City of Dublin to partially fund the salaries of 3 key individuals in providing this life-saving service to Dublin residents:1)Our Meals on Wheels Coordinator,who ensures that daily operations run smoothly 2)Our Accounting Clerk,who ensures donations are handled properly,and 3)We will be adding a Volunteer/Outreach Coordinator to our team,who will be key in allowi�g us to find and utilize more volunteers in our program,ensuring home deliveries reach our seniors,and helping us have stronger presence in the community,so that seniors who may benefit from our program know about us.See attached documents for additional details.The remainder of these funds will be used to cover the cost of mileage required to deliver nutritious meals to our frail,homebound senior clients. Documents Documents Requested* Required? Attached Documents"` Program Expense Budget for ALL Grant Requests � Proaram Expense Budqet download template Financial Information Form for ALl Grant Requests � Financiai information Form dawnload tempiate List of Board of Directors(or goveming body)with contact � List of Board of Directors with contact information _ _ Current Annual Budget for the Entire Agency � FY 15-16 Final Budaet for Entire Aqencv Copy of most recenUy submitted IRS 990 form or Tax Retum � iRS 99q (include complete form) Board of Director's(or governing body's)designation of � Authorized Official authorized official Board of Director's(or goveming body's)authorization to r Auti7orized Officiai request funding(may be same document as one above) Proof of insurance carried,including bonding,liability and/or (� Proof of Insurance workers'compensation REQUIRED FOR CDBG ONLY-If requesting Capital Funding, r please upload your Capital expenditure budget(your own format is acceptable) REQUIRED FOR CDBG ONLY-PERSONNEL POUCIES INCIUDiNG � Emplovee Handboak AFFIRMATNE ACTION PLAN AND GRIEIVANCE PROCEDURE Affirmative Action REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS r Aaencv Audit AND COPY OF IAST AUDIT HIGHUGHTING"FINDINGS' SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION I- 6v�aws AND BYLAWS. Articles oP incorporation REQUIRED FOR CDBG ONLY-CONFUCT OF INTEREST � Emqiovee Handbook tSee p 11 for Conflict of Interestl STATEMENT(IF NOT INCIUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART r Or anization Chart STATE AND FEDERA�NON-PROFIT DETERMINATION LETTER. r Determina6on tIRS Exemptl Letter All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application.Non-compliant applicants will be disqualified. RE4UIRED FOR CDBG ONLY-AGENCY'S LIMITED ENGUSH r Lanc�uaqe Access Pian PROFICIENCY LANGUAGE ACCESS PLAN(LEP/LAP).Must inGude outreach to limited English speaking residents to encourage access o services ousing. n u e w a access accommodations are used. REQUIRED FOR CDBCr LEVERAGING REPORT-this is due with � the 2nd quarter report no later than January 15th Certified Audit and/or CeRified Financial Statements � Financial Statements 'ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:48220 Become a fan r,�!7_c��mGiants"'on Facebook � Problems7 Contact us at�uestons�tT,7,c�m,rant>.com 02002-2016 GrantAnalystcom.All rights reserved. � � "ZoomGrants"and the ZoomGrants logo are trademarks of GrantAnalyst.com,LLC. Lo_gou;�6,ewse; IIIIII Email This Preview Save as PDF Print Ciose Window Ai♦ 4 Powered bv Zaom�ranfsT�' City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadline Tri-Valley Haven Domestic Violence Services Program $8,000 Requested ' Tri-Valley Haven I ._____.__ _...___________.�a._. ____.______� .� _ __ i � Submitted: 12/10/2015 5:04:09 PM(Pacific) ; 3663 Pacific Avenue Telephone(925)449-5845 x i Livermore,CA 94550 Fax (925)449-2684 x Project Contact � United States Web www.trivalleyhaven.org Irina Milinevskaya � Irii�a(atrivali�yhaven.cr� ! Executive Director TeC(925)449-5845 � Ann King � ' annCc�tnvalieyhaven.orq Additional Contacts i cynthia�trivalleyhaven.org � Application Questions ISome answers will not be presented because they are not part of the selected group of questions based on the answer to#30. I 1.Please describe your organization category(select one of the following): � � Private Non-Profit � Public Agency r Other: 2. Please describe your agency's mission(no more than 3 sentences or 250 characters). Tri-Valley Haven creates homes safe from abuse,contributes to a more peaceful society.One person,one family,one community at a time.Together we build a world without violence. 3.For what type of Dublin Grant is your agency applying7 r Capital Project r Public Service Program or Project 4. Is this a"new"service,program,project or activity?"New"is identified as not yet started,implemented or in operation. r Yes � No 5.Please indicate below if this application is a request for one-time funding and/or"seed"funding. � One-time funding � Seed funding (— One-time and Seed funding ' 1� Operational funding ' � None ' 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received within the last three years�urisdiction,year,amount,purpose,etc.�.Enter"N/A"if you HAVE recelved Dublin Funds. N/A 7.Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.►. Founded in 1977,Tri-Valley Haven is the premier provider of shelter and support services for victims of domestic violence,sexual assault, homelessness and hunger.What began as a crisis hotline run out of a founding Board Member's garage,the Haven has grown to be the most comprehensive safety net program in the Tri-Valley.Today our programs include:Shiloh,our 30 bed domestic violence safe house,24/7 crisis hotline ' for domestic violence and sexual assault,Rape Crisis Center,Violence Prevention Education, Legal Clinic,Individual and Group Counseling,Sojourner House 16 Bed Family Shelter, Food Pantry,Parenting Program,and a Thrift Store.Notably,both our shelters are the only shelters locally that allow teen boys to stay with their families and our family shelter is the only local shelter to admit two parent families as well as single fathers with their children. Through innovation and dedication,the Haven has developed the resources to confront domestic violence,homelessness and hunger. Tri-Valley Haven's major governing body is the Board of Directors.Each Board Member's term is two years.Our Management team consists of the Executive Director and five managers.Tri-Valley Haven has its own Finance and Compliance Department.All of our Direct Service staff such as Case Managers,Life Skills Instructors etc.are required to have a Bachelors Degree or equivalent life experience. Direct Service staff all complete 65-hour State approved training. 8.Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementation process to describe your project. Tri-Valley Haven's Domestic Violence Services Project will provide assistance with DV related issues through Crisis Line and Domestic Violence Shelter. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) 75 10.Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? r Behavioral Health(mental health and substance abuse) � Affordable Housing � Health Care(including dentai) I— Workforce Development �' Homeiessness I� Transportation Services and Access � Domestic Violence and Child Abuse � Disabilities �' Food and Nutrition r Senior Services � Youth Services � Child Care,Early Childhood Development and Education r Changing Demographics and Growing Diversity r Financial Assistance � None of the above 11. Explain how this project will be implemented,administered,and operated. Tri-Valley Haven's Domestic Violence Services Project is an existing project.Our 24-hour Crisis Line is the main point of entry for women seeking shelter.Clients are also referred to us via our website,law enforcement,hospitals,211,shelter networks,etc.Each client is screened via telephone to assess their safety and their needs,and then,if appropriate,an in-person intake is conducted. Each client is assigned to a Case Manager and a Counselor is made availabie to her should she wish to participate in counseling. Following groups are available for adult clients: DV Support Group, Job Readiness Group,Parenting Group,etc.Goals are set for each client individually depending on the very specific needs of each ciient during the first meeting with the Case Manager.Tracking of the progress toward the goals will be performed on a weekly basis.The maximum length of stay at the Shelter is 105 days. 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?). The funds requested from Dublin will be used to pay part of the Bilingual Case Manager's time.This position is essential for the shelter operations since a very large group of our clients is Spanish speaking and many are monolingual. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives wlll your agency use to track the progress of ineeting the outcome(s►? The outcomes will be unique for each client,and defined on a case-by-case basis according to goals set between the case manager and Gient.Some goals are very simple,such as getting a California l.D.,and some as labor-intensive as finding housing or employment.Some clients may stay at the Shelter for as little as two nights if all they need is a safe location as they prepare to relocate to another city or state.Others may take the entire 105 days to find affordable housing,paRicipate in job training and get a job.Some may be focused on reuniting with their children through completing their CPS Plan.Whatever their goal may be,our clients have the opportunity to receive counseling,Life Skills classes,individually tailored case management and referrals to a range of community based services to help them increase safety and security. Tracking the progress toward clients'goals is performed by each individual's case manager during weekly meetings with clients.Progress is also monitored at weekly staff meetings during case review.Additionally Haven's case managers and counselors meet together once each month with the Clinical Supervisor to share ideas and suggestions.We cannot express enough the importance of having a Bilingual Case Manager to fully communicate with our Spanish speaking clients. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled,low-income,etc. We serve women survivors of Domestic Violence and their children.Male survivors are served with all available services at our Community Building. Motel Vouchers are available for them through the ESTA(Emergency Shelter and Transportation Assistance)program.Our ultimate goal is that upon completion of our program a client at a very minimum will have a safety plan for herself and children,and also will develop goals and a plan of action towards achieving self-sufficiency.Clients will be equipped with information on how to establish healthy relationships and increase self-esteem and gain awareness of resources in the community.In Fiscal Year 2014l2015 our pomestic Violence Services Program served 263 survivors at the Shelter includin 6 Dublin residents and res onded to 1333 domestic violence related calls to the crisis line 95 DV/SA related calis from Dublin.This year so far 2 domestic violence survivors from Dublin have been served at our DV Shelter and 43 callers used the Crisis Line. 15. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the client/customer population served�? We have multi-cultural staff members and volunteers who utilize their cultural backgrounds to enhance the services we provide to our ciients.We have recently hired a Cantonese speaking Case Manager to serve our Cantonese speaking clients. We presently have staff fluent in Spanish,Russian,Hindi,Urdu,Punjabi,Cantonese and French.Multi language fluency is always a consideration when hiring,and wage differentials are given to those fluent in Spanish.Our intake forms,paperwork and flyers are in English and Spanish.We make sure that at the Shelter we have cooking utensiis and dishes that are multi-culturally appropriate such as rice cookers,chopsticks,etc. In the last few years Tri-Valley Haven participated in the Cultural Competence development projects.The first project was focused on serving the needs of African-American community and the second one on serving the needs of Asian/Pacific Islander community. I In our hiring process we ask potential empioyees to taik about their commitment to and experience in developing culturai competency. 16. Explain how your agency will outreach to low-income,limited English speakers,and/or disabled persons.How will each of these groups access the project for which your agency is requesting funding? We conduct regular Outreach effoRs through many of the programs Tri-Valley Haven offers as well as through other community resources.These internal programs inGude our Food Pantry,24-hour crisis line etc.Tri-Valley Haven's Holiday Warehouse Program for low-income families from the Tri- Valley area brings new participants every year.350 Dublin residents signed up for the Program this year.Tri-Valley Haven participates in community health fairs and outreach events such as St.Patrick's Festival(when available)etc. TVH staff maintains a good working relationship with CRIL,a local service provider for persons with disabilities and also is aware of key services ° such transportation for persons with disabilities and how to access them.Telephone screenings and in-person intake processes include questions about needed accommodations(such as a bottom bunk,private room or special dietary needs). 17.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We have Operational Agreements with over 60 organizations including Police Departments from Livermore,Dublin and Pleasanton,District Attorney's Offices,local school Districts,other domestic violence and homeless shelters,hospitals,and social service agencies.The Haven's Community linkages go beyond the Tri-Valley area via collaborative with agencies throughout the Alameda County,including the Alameda County Family Violence Council, the CaIWORKS Domestic Violence Advisory Board,and the Alameda County Everyone Home.The Haven,together with the other five agencies participates in the Alameda County Housing-Jobs Linkages Program to help clients obtain long-term housing,and achieve self-sufficiency.In addition to that,we have wonderful relationships with many local businesses,that support our programs.Particularly,the new Whole Foods Market in Dublin twice a week donates food to our Food Pantry,Dublin Safeway every year participates in the"Stuff the Bus"event which supports our Holiday Program.We truly appreciate those partnerships. 78.Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific coliaboration with other service organizations in the City of Dublin or Tri-Valley. There are many ways we outreach to Dublin residents.We conduct presentations to the Dublin Police Services on Domestic Violence,Sexual Assault and Homelessness issues and the programs that Tri-Valley Haven offers.Our Community Education Program reaches over 500 students through Health Education classes that we teach in Dublin High School covering topics such as antibullying and teen dating violence.This year 350 Dublin residents will be served through the Holiday Warehouse Program in Livermore.This Program is helping low and very low income families in the Tri- Valley area to prepare Thanksgiving dinner and shop for holiday presents for their loved ones. 19. Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. The core of Tri-Valley Haven's Domestic Violence Services Program is Shiloh,a 30 bed emergency shelter in a confidential location.Shiloh provides a safe haven and comprehensive services to survivors of family violence.Participants can stay at the shelter for a maximum of 105 days.Shiloh accepts single women and women with children.Our 24-hour Crisis Line is the main point of entry for women seeking shelter.Potential residents are also referred via our website,the National Hotline,law enforcement,hospitals,211,community referrals and outreach events.Callers requesting shelter undergo a screening process where staff evaluates the safety and appropriateness of the program.We recognize that this is a critical time for a woman fleeing violence and this is when she is most likely to return to her abuser.In response to this,staff checks in with Gients daily to help them with safety planning and respond to their concerns.DV Program offers counseling for both the survivor and her children.The following groups are available:Parenting,Domestic Violence Support,CaIWORKS Job Readiness,Life Skills(such as Personal Finance)etc.The CaIWORKS Specialist provides advocacy and information regarding public benefits program and employment preparation and job search assistance.Shiloh also participates in Linkages,a subsidized housing program with case management.The Domestic Violence Services Program promotes family and community safety, through collaboration with law enforcement and public sources available.We believe that Dublin residents as well as residents of any other Tri-Valley area city will benefit from it. 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Domestic Violence Services Program utilizes in-house and donated services as much as possible to meet clients'needs and hoid down costs. Residents are able to obtain food from the TVH Food Pantry,they are given clothing vouchers and referrals to our Thrift Store,they receive assistance applying for government services such as CAL Fresh,CaIWORKS,and Linkages.We refer our clients to AXIS for their health related needs.We try to minimize expenses for outside services whenever possible.Trained volunteers provide overnight crisis line coverage as well as (along with TVH staf�around the clock response to sexual assault calis and referrals from Iocai police departments and hospitals.Aii of this contributes to a very reasonable budget. 21. If this application does not receive funding,or receives reduced funding,what will be the effect on the project? Receiving less grant funding would negatively impact direct services provided to our clients by our bilingual case manager,since these funds are requested for that position.We would have to rely on Telelnterpretors(translating service)which is less personal and less private.For our clients in crisis,in-person intervention and counseling is the more engaging and effective support response.Our bilingual case manager provides these essential in-person services. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? � Yes � No 23.If you answered yes to the preceding question please explain.Enter"N/A"if not applicable. NJA 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,fumiture,fixtures�� � Yes I�' No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25.If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"N/A"if not applicable. N/A 26.If your age�cy is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms, plans for future relocation or expansion,etc.�.Enter"N/A"if not applicable. N/A 27. If your agency is requesting Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? � Not Applicable � Yes � No r Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dubltn's Mission&Vision Statements:(you may choose more than one) r' Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. � Balance history with progress,to sustain an enlightened,economically balanced and diverse community. (� Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. � Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) (— Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development � Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety 1� Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City � Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication I� Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concem,and encouraging public and private partnerships of mutal benefit 30.'*QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNIN DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.*•Are you are interested in applying for CDBG funds? � Yes.If so,answer questions 31 through 43. ' r No.If no,check box here,and questions 31 through 43 will not be required.. r pon't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDBG ONLY-Explain your Limited English Proficiency/Language Access Plan(LEP/LAP).How does your agency outreach to limited English speaking residents to encourage access to services&housing?What access accommodations are usedT Provide detail : Please enter"N/A"if you are not interested in qualifying for CDBG funding. We at TVH are committed to continuously improving our services to limited English speaking clients.We have staff conversant in Spanish,Russian, Urdu,Hindi,Punjabi,Cantonese and French.With the population becoming very diverse,bilingual and bicultural staff are in strong demand throughout Alameda County,and they are difficult to obtain and retain.We seek out bilingual/bicultural staff,and provide a wage differential for those that speak Spanish.We have a Video Relay Service for clients conversant in ASL.This two way Internet based video link gives hearing impaired clients access to Sorenson's ASL interpreters.If staff is not available to converse directly with an LEP client,we utilize"Telelnterpretors"phone based interpreters. Our largest LEP client group is Spanish-speaking.Most flyers,client materials and other communications are created in both English and Spanish.We produce and distribute documents in other languages when available. 32.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Guiding Principle that relates to your project: (� Be culturaliy accessibie,appropriate and inclusive I� Encourage community engagement and involvement Promote energy and resource efficiency � Encourage networking and information sharing across service providers r Encourage process streamlining , � Consolidate service delivery r Not Applicable.1 am not interested in qualifying for CDBG funding. 33.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Goals that relates to your project: : (i° A)Support and develop a continuum of housing resources that will increase access to low-income,seniors,disabled and homeless persons with emphasis on activities that: �' 'Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. � "Preserve and increase affordable rental housing opportunities for low and moderate income households. � *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. � *Promote fair housing and reduce housing discrimination. r B)Improve community health and access to basic and specialty care including dental and optometry care,behavioral and mental health care services especially for low-income,uninsured and under-insured residents with emphasis on activities that: I— *Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. � *Increase outreach and access for underserved populations including limited English speaking persons,youth,disabled,seniors and homeless persons. r C)Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. � D)Support and expand programs and opportunities that keep seniors engaged and involved in their community. r E)Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. r F)Not Applicabie.i am not interested in qualifying for CDBG funding. 34.CDBG ONLY-Identify AT LEAST ONE U.S.Department of HUD Strategic Goal that relates to your project: r Increase homeownership � Promote decent affordable housing � Strengthen communities r Ensure equal opportunity in housing 1� Promote participation of grass-roots,faith-based,and other community-based organizations I� Not App�icable.I am not interested in qualifying for CDBG funding. 35.CDBG ONLY-Identify AT LEAST ONE U.S.Department of HUD Policy Priority that relates to your project: (� Provide increased homeownership and rental opportunities for low and moderate-income persons,persons with disabilities,the elderly, minorities,and families with limited English proficiency. � Improving the quality of life for our Nation's communities (— Encouraging accessible design features. r Participation of minority-serving institutions in HUD programs. � End chronic homelessness within ten years. � Removal of barriers to affordable housing. � Not Applicable.I am not interested in qualifying for CDBG funding. 36.CDBG ONLY-Identify AT LEAST ONE Consolidated Plan obJective that relates to your project: r Increase the availability of affordable rental housing for extremely low income(30%),very low income(50%)and low income(80%) households. r Preserve existing affordable rental housing and ownership for households at or below 80%of Area Median Income(AMI). r Assist low and moderate income first-time homebuyers. � Reduce housing discrimination. 1� Maintain,improve and expand(as needed)the capacity of housing,shelter and services for homeless individuals and families including integrated healthcare,employment services and other supportive services. r Maintain and expand activities designed to prevent those currentty housed from becoming homeless. � Build on inter-jurisdictional cooperation to achieve housing and homeless needs. � Increase the availability of service-enriched housing for persons with special needs. � Not Applicable. I am not interested in qualifying for CDBG funding. 37.CDBG ONLY-Select ONE Objective that relates to your project(TIP:When selecting an objective ask yourself,"What is the purpose of the activity?What is the larger community need that I am seeking to address?"): � Creating a Suitable Living Environment � Providing Decent Affordable Housing I� Creating Economic Opportunities Not Applicable.I am not interested in qualifying for CDBG funding. 38.CDBG ONLY-Select ONE Outcome that relates to your project(TIP:When selecting an outcome ask yourself,"What type of �' change or result am I seeking?"�: I � Availability/Accessibility � Affordability r Sustainability � Not Applicable. I am not interested in qualifying for CDBG funding. 39.CDBG ONLY-Select ONE Specific Indicator that relates to your project: � Public facility or infrastructure:This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure.If the activity was used to meet a quality standard or to measurably improve quality,then this indicator will report the number of household units that no longer have access to a substandard service. � Public Service:This indicator shows the number of persons that have been assisted with new or improved access to a service.If the activity was used to meet a quality standard or to measurably improve quality,then this indicator wiil report the number of persons that no longer have access to a substandard service. r Targeted revitalization:This indicator shows a range of outcomes such as jobs created and retained,businesses assisted,low-and moderate- income persons and households served,slum/blight demolition,number of acres of brownfields remediated,etc.in a targeted area. r Commercial facade treatments or business building rehabilitation:This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. � Brownfields remediated:This indicator shows the number of acres of brownfields that were remediated. � Rental units constructed:This indicator shows the number of affordable rental units created,as well as the number of years of affordability, number of units occupied by the elderly,and those units designated for chronically homeless persons and persons with HIV/AIDS. �' Rental units rehabilitated:This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability,units for chronically homeless persons,elderly persons,and persons with HIV/AIDS. r Homeownership units constructed or acquired with rehabilitation:This indicator shows the total number of homeownership units constructed, acquired,and/or acquired with rehabilitation per activity.This includes total number of affordable units,number of years of affordability,Energy Star qualified units,section 504 accessible units,and number of households previously living in subsidized housing.In addition,data will be collected on the number of units occupied by the elderly,number of units designated for persons with HIV/AIDS,and number of units for the chronically homeless. r Owner occupied units rehabilitated:This indicator shows the total number of owner occupied units rehabilitated,including the number of these units occupied by the elderly,number of units designated for persons with HIV/AIDS,and number of units for the chronically homeless. r Direct financial assistance to homebuyers:This indicator shows the number of homebuyers receiving direct financial assistance,housing counseling,and down payment assistance/closing costs. r Tenant Based Rental Assistance(TBRA):This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance(less than 12 months)and the number of homeless and chronically homeless households assisted. r Homeless shelters:This indicator shows the number of homeless persons given overnight shelter. � Emergency housing:This indicator shows the number of beds created in an overnight shelter or other emergency housing. I— Homeless prevention:This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. � Jobs created:Of the total number of jobs created,this indicator shows the number of jobs that have employee-sponsored health care,the types of jobs created(using Economic Development Administration(EDA)classifications)and the number of persons unemployed before taking the job. � Jobs retained:Of the total number of jobs retained,this indicator shows the number of jobs retained,the number of jobs with employer- sponsored health care benefits,and the types of jobs retained(using EDA classifications) � Business assistance:This indicator shows the total number of businesses assisted.Specifically,it shows the number of new businesses, existing businesses,and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. r Businesses providing goods or services:This indicator shows whether an assisted business provides goods or services to meet the needs of the service area,neighborhood,or community,as determined by the grantee. r Not Applicabie.I am not interested in qualifying for CDBG funding. 40.CDBG ONLY-Please choose a common indicator that your agency will use to track clients(select only ONE): � Persons � Households � Not Applicabie. I am not interested in qualifying for CDBG funding. 41.CDBG ONLY-For the category you selected above,provide the total number of unduplicated Dublin clients(EITHER Persons OR Households)your agency anticipates serving through this project: 75(CDBG statistics are collected for shelter clients only-crisis calls are entirely confidential and callers are not required to disclose identifying data) 42.CDBG ONLY-Based on the common indicator you selected above, please list the number of unduplicated Dublin clients your agency anticipates serving in each category."If none, please enter"0". 0 Low Income(50%-80%AMI;please refer to the Income Limits chaR at www.dublin.ca.gov/housing/) 5 Extremely Low Income(<30%AMI;please refer to the Income Limits chart at www.dublin.ca.gov/housing/) _. 1 Disabled � rvwW��m 5'Female Headed Households ���� ����0;Senior ��� 0'Youth � 0�'Homeless � ' 0'Not Applicable.I am not interested in qualifying for CDBG funding. (Type N/A) �� t 1.t7C TOTAL � 43.CDBG ONLY-List the number of clients your agency anticipates serving in race/ethnicity categories.The sum entered below must match the total clients entered in#42 above. Per HUD"Hispanic"is an ethnicity,not a race."If none,please enter"0" �__ 1 White _ 2 White+HISPANIC 1 Black/African American _.__ 0!Black/African American+HISPANIC 0;Asian � 0;Asian+HISPANIC 0'American Indian/Alaskan Native O;American lndian/Alaskan Native+HISPANIC —_ .� _.,,.,_,, 0`Native Hawaiian/Other Pacific Islander 0:Native Hawaiian/Other Pacific Islander+HISPANIC ������� ��� 0;American Indian/Alaskan Native and White --���� �� ��������� 0 F American Indian/Alaskan Native and White+HISPANIC �� 0':Asian and White � 0�Asian and White+HISPANIC �� � 0'Black/African American and White � 0 Black/African American and White+HISPANIC 0'American Indian/Alaskan Native and Black/African American 01 American Indian/Alaskan Native and Black/African American+HISPAMC 1 Multi Racial+NISPANIC OR other Multi Racial 0 Not Applicable. I am not interested in qualifying for CDBG funding.(Type N/A) _. ��.G�7�i TOTA� 44. If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY � #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. � #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. � #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. r #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. r #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. r #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. � If you have more than 6 applications per organization,agency,district or entity,check here. 45. Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program�. Domestic Violence Services Program budget is intentionally diversified,so losing one potential source would not force us to close the project completely.We actively fundraise and reach out to the corporate and private donors.In 2013 Tri-Valley Haven opened a Thrift Store,formerly operated by Buenas Vidas,expecting to over time generate enough revenue to support programs facing the loss of funding. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. : BL-007058 Budget ' �.-- --_.._.______ ___.__�_... ------- Funding SourceslRevenues eudget Amount Amount Committed Alameda County Domestic Violence Center Act $32,544.00 $0.00 oca u in easan on rvermore HCD Linkages $38,334.00 $0.00 CaIOES DV $326,410.00 $0.00 EFSP $8,000.00 $0.00 CaIWORKS $40,146.00 $0.00 Foundations $23,759.00 $0.00 Individual Donations $1,449.00 $0.00 Total $503,642.00 $0.00 Funding Uses/Expenses Budget Amount Amount Committed Bilingual Case Manager, 16%of Salary and Benefits $8,000.00 $0.00 Other Program Personnel $407,764.00 $0.00 Operating Expenses: Supplies $15,383.00 $0.00 Printing/Copying $2,818.00 $0.00 Telephone $13,962.00 $0.00 Rent and Utilities $29,242.00 $0.00 Other $26,473.00 $0.00 Total S 503,642.00 $0.00 Budget Narrative Revenue:The composition of revenue is our best estimate based on the previous years of operation. Expenses:Personnel Costs include salaries and benefits.Sick leave,vacation,and holidays are not included in the benefits calculation for staff that will be paid with the Dublin grant funds.Other Operating Costs include:Maintenance,Travel and Mileage,Insurance,Property Tax,Auto Expense,and Accounting/Audit Expenses. Domestic Violence Services Budget is part of the overall agency budget that includes other programs and departments such as Homeless and Family Support Services,Sexual Assault Services,Finance etc.thus only a portion of Liability Insurance,Auto Insurance,Audit etc.being charged to this Program. Documents Documents Requested* Required? Attached Documents* Program Expense Budget for ALL Grant Requests � TVM Praqram Expense Budnet download#emplate Financial Information Form for ALL Grant Requests r TVH Financial Information downioad tampiate List of Board of Directors(or governing body)with contact � TVH�ist of Board of Directors � information Current Annual Budget for the Entire Agency � TVH Gurrent Annuai Budpet. Copy of most recentty submitted IRS 990 form or Tax Retum � TVN IRS 990 (include complete form) Board of Director's(or goveming body's)designation of � TVH BOD desipnation of authorized officiai authorized official Board of Director's(or goveming body's)authorization to r TVN BOD authorization ta request fundina request funding(may be same document as one above) Proof of insurance carried,including bonding,Iiability and/or r TVH Praof of Insurance woricers'compensation REQUIRED FOR CDBG ONLY-If requesting Capital Funding, � please upload your Capital expenditure budget(your own format is acceptable) REQUIRED FOR CDBG ONLY-PERSONNEL POLICIES INCLUDING r ?VH Personnel Pciicies AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUOIT REQUIREMENTS � TVH Audit Requirements AND COPY OF LAST AUDIT HIGHLIGHTING"FINDINGS" 1"VH Coov of last Audit SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION r TVH Articies of incorpqratinn AND BYLAWS. TVH Bvlaws REQUIRED FOR CDBG ONLY-CONFLICT OF INTEREST Iy STATEMEM(IF NOT INCIUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART � TVH Orqanizational Chart STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. � TVH Federal non-orofit letter All organizations MUST have approved non-profitstatus from TVN State Non-profit determination letter the State of Califomia and Federal Tax Identification Number at time of application.Non-compliant applicants will be disqualified. REQUIRED FOR CDBG ONLY-AGENCY'S LIMITED ENGLISH � TVH t imited Enqiish Proficiencv Lanpuaae access Palic�+ PROFICIENCY LANGUAGE ACCESS PLAN(LEP/LAP).Must inGude outreach to limited English speaking residents to encourage access to services 8 housing.Include what access accommodations are used. REQUIRED FOR CDBG LEVERAGING REPORT-this is due with � the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements r' TVH Certified Audit 'ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:48152 Became a fan of ZoomGranis'"on Facebook - Problems7 Contact us at�uestians!�ZaumGrants.cam . �2002-2016 Grant4naystcom.All rights reserved. .. "ZoomGrents"and the ZoomGrants logo are trademarks of GrantAnalystcom,LLC. � �opcui�Hrowser i j � I II I� Y�i II � Email This Preview Save as PDF Print Close Window Ai♦ i � ' � i Po�vered bv ZcomGrantsT°' � City of Dublin iParks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadline ; Tri-Valley Haven � Homeless Services Program $10,000 Requested I Tri-Valley Haven � Submitted: 12/7/2015 4:13:52 PM(Pacific) 3663 Pacific Avenue Telephone(925)449-5845 x Livermore,CA 94550 Fax (925)449-2684 x Project Contact United States Web www.trivalleyhaven.org Irina Milinevskaya iri��a trivallevhaven.org Executive Director Tel:(925)449-5845 Ann King annCa�trivallevhaven.orp Additional Contacts Cynthia@triva lleyhaven.org Application Questions __.�---...___._._.�—�____—_._.__.._.___.__._ __._—_____.-------------------__..__.�._.-------_-- ( Some answers will not be presented because they are not part of the selected group of questions based on the answer to#30. I 1. Please describe your organization category(select one of the following): � Private Non-Profit r Pubiic Agency � Other. 2. Please describe your agency's mission(no more than 3 sentences or 250 characters�. Tri-Valley Haven creates homes safe from abuse,contributes to a more peaceful society.One person,one family,one community at a time.Together we build a world without violence. 3.For what type of Dublin Grant is your agency applyingT r Capital Project r Public Service Program or Project 4.Is this a"new"serviee,program, proJect or activity7"New"Is identified as not yet started,implemented or in operation. � Yes � No 5. Please indicate below if this application is a request for one-time funding andlor"seed"funding. � One-time funding (� Seed funding r One-time and Seed funding r Operational funding � None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received within the last three years(jurisdiction,year,amount,purpose,etc.).Enter"N/A"if you HAVE received Dublin Funds. N/A 7. Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.). Founded in 1977,Tri-Valley Haven is the premier provider of shelter and support services for victims of domestic violence,sexual assault, homelessness and hunger.What began as a crisis hotline run out of a founding Board Members garage,the Haven has grown to be the most comprehensive safety net program in the Tri-Valley.Today our programs include:Shiloh,our 30 bed domestic violence safe house,24/7 crisis hotline for domestic violence and sexual assault,Rape Crisis Center,Violence Prevention Education,Legal Clinic,Individual and Group Therapy,Sojourner House 16 Bed Family Shelter,Food Pantry,Parenting Program and a Thrift Store. Notably,both our shelters are the only shelters locally that allow teen boys to stay with their families and our family shelter is the only local shelter to admit two parent families as well as single fathers with their children. Through innovation and dedication,the Haven has developed the resources to confront domestic violence,homelessness and hunger. j Tri-Valley Haven's major governing body is the Board of Directors.Each Board Member's term is two years.Our Management team consists of the : Executive Director and five managers.Tri-Valley Haven has its own Finance and Compliance Department.All of our Direct Service staff such as Case '� Managers,Life Skills Instructors etc.are required to have a Bachelors Degree or equivalent life experience.Direct Service staff all complete 65-hour I State approved training. 8.Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementation process to describe your project. Tri-Valley Haven's Homeless Services Program will provide assistance with issues related to Homelessness through the Shelter, Life Skilis classes including job readiness and job search,and the Food Pantry. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) 270 70.Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your proJect identify with? r Behavioral Health(mental health and substance abuse) � Affordable Housing � Health Care(including dentai) � Workforce Development � Homelessness � Transportation Services and Access r pomestic Violence and Child Abuse r Disabilities � Food and Nutrition (— Senior Services � Youth Services � Child Care,Early Childhood Development and Education r Changing Demographics and Growing Diversity � Financial Assistance r None of the above 11. Explain how this project will be implemented,administered,and operated. Tri-Valley Haven's Homeless Shelter and the Food Pantry opened in 2002.Clients are referred to us via our website,shelter network,211,Food Pantry,Thrift Store etc.and Tri-Valley families are given first priority.When a resident is admitted into the shelter program s/he is assigned a case manager who works in partnership with the resident to identify challenges and develop a plan to end the cycle of homelessness.in addition to weekly meetings with their case manager,counseling is also availabie,residents also participate in Life Skills ciasses that cover a variety of topics from budgeting,job readiness,conflict resolution and more.Residents have access to the Haven Food Pantry and are encouraged to prepare their own meals as well as participate in keeping the shelter clean.Staff provides support,guidance and referrals for additional sources of support.Shelter residents may stay at Sojourner House for up to six months. 72. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?�. The funds requested from Dublin will be used to pay part of the Case Manager's time and part of the Life Skills Instructor's time. 13. Please Ilst and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome(s)? A family or an individual becoming self-sufficient and transitions successfully out of homelessness into mainstream living will be our ultimate measure of success.Other important outcomes include:connecting clients with appropriate service/housing,a client obtaining sobriety for the first time in years,a resident gaining employment,a family getting medical insurance.We truly believe that great success of the program can be maintained over time is almost never achieved in 30 days. Tools that we use to track clients'progress include database,R-Client,client files,direct service logs,open-ended feedback questionnaire,continuous evaluation by a case manager,and a clinical assessment eta 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled,low-income,etc. Our Homeless Sheiter and Food Pantry clients are almost exclusively extremely low through low income single parents with their children,two parent families,single women,disabled individuals and seniors. Our ultimate goal is that upon completion of our program a family or an individual will successfully transition out of homelessness into a stable housing. At a very minimum our clients will be aware(in many cases will be waiting for an approval)of the programs and services that are available for them and wiil help them to reach their goals. Last year Sojourner House served 81 unduplicated clients,providing 5560 bednights,and the Food Pantry served 4455 unduplicated Gients. 75. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the clienUcustomer population served)? We have multi-cultural staff members and volunteers who utilize their cultural backgrounds to enhance the services in the homeless program.We have recently hired a Cantonese speaking Case Manager since noticed that a lot of our clients are Cantonese/Mandarin speaking. We presently have staff fluent in Spanish,Russian,Hindi,Urdu,Punjabi,Cantonese and French.Multi language fluency is always a consideration when hiring,and wage differentials are given to those fluent in Spanish.All of the Sojourner House(Homeless Shetter)and the Food Pantry intake forms a ervvork and fl ers are in En lish and S anish.We make sure that we have cookin utensils and dishes that are multi-culturall a ro riate such as rice cookers,chopsticks,etc.Our Food Pantry has a capacity to offer ethnic food when needed. 16.Explain how your agency will outreach to low-income,limited English speakers,and/or disabled persons.How will each of these groups access the project for which your agency is requesting funding7 We conduct regular Outreach efforts through many of the programs Tri-Valley Haven offers as well as through other community resources.These internal programs inGude our Food Pantry,24-hour crisis line etc.Tri-Valley Haven's Holiday Warehouse Program for low-income families from the Tri- Valley area brings new participants every year.350 Dublin residents signed up for the Program this year.Tri-Valley Haven participates in community health fairs and outreach events such as St.Patrick's Festival(when available)etc. TVH staff maintains a good working relationship with CRIL,a local service provider for persons with disabilities and also is aware of key services such transportation for persons with disabilities and how to access them.Telephone screenings and in-person intake processes include questions about needed accommodations(such as a bottom bunk,private room or special dietary needs).Sojourner House was remodeled before it was opened in 2002 to include a ramp and a handicap accessible bathroom.Our Pantry has a portable ramp when appropriate,though clients seldom come in beyond the counter. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We have Operational Agreements with over 60 organizations including Police DepaRments from Livermore,Dublin and Pleasanton,District Attorney's Offices,local school Districts,other domestic violence and homeless shelters,hospitals,and social service agencies.The Haven's Community linkages go beyond the Tri-Valley area via collaborative with agencies throughout the Alameda County,including the Alameda County Family Violence Council, the CaIWORKS Domestic Violence Advisory Board,and the Alameda County Everyone Home.The Haven,together with the other five agencies participates in the Alameda County Housing-Jobs linkages Program to help clients obtain long-term housing,and achieve self-sufficiency.In addition to that,we have wondertul relationships with many local businesses,that support our programs.Particularly,the new Whole Foods Market in Dublin twice a week donates food to our Food Pantry,Dublin Safeway every year participates in the"Stuff the Bus"event which supports our Holiday Program.We truly appreciate those partnerships. 18. Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. There are many ways we outreach to Dublin residents.We conduct presentations to the Dublin Police Services on Domestic Violence,Sexual Assault and Homelessness issues and the programs that Tri-Vailey Haven offers.Our Community Education Program reaches over 500 students through Health Education classes that we teach in Dublin High School covering topics such as antibullying and teen dating violence.This year 350 Dublin residents will be served through the Holiday Warehouse Program in Livermore.This Program is helping low and very low income families in the Tri- Valley area to prepare Thanksgiving dinner and shop for holiday presents for their loved ones. 19. Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. Sojourner House is a sixteen bed facility that houses homeless couples with children,single parents with children and single women.Families stay in bedrooms and are encouraged to maintain a family-like atmosphere similar to what will be encountered upon exit from the shelter.Clients can stay for up to 6 months,during which time residents are provided support to stabilize and to develop the skills and knowledge to help break the cycle of homelessness.Each participant works with their case manager to design a program that will best meet their needs that are unique to their family.Life skilis is a critical program component that helps families to develop a budget,identify credit issues,assist in housing search,and provide job coaching. We advocate for clients to help them access mainstream services and help motivate participants to be active agents of change in their lives,and the lives of their families.All residents are also referred to a counselor.Tri-Valley Haven's CaIWORKs Specialist provides services to domestic violence survivors at the homeless shelter.Sojourner House residents participate in Linkages,a subsidized transitional housing program with case management for clients who are working toward self-sufficiency.Clients in Linkages may remain in that program for up to 12 months.All Shelter residents utilize our Food Pantry for food.The Food Pantry is located in Livermore and provides essential nourishment for low income residents of Tri- Valley Area.The Pantry also provides emergency motel vouchers,gas and phone cards,and referrals to other social services.Last year we served 286 Dublin Gients through the Food Pantry.This number includes 67 seniors and 25 disabled Dublin residents. 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Homeless Services Program utilizes in-house and donated services as much as possible to meet clients'needs and hold down costs. Residents are able to obtain food from the TVH Food Pantry,they are given clothing vouchers and referrals to our Thrift Store,they receive assistance applying for ' government services such as CAL Fresh,CaIWORKS,and Linkages.We refer our clients to AXIS for their health related needs.We try to minimize expenses for outside services whenever possible.Use of volunteers and donated goods is also a major factor in helping hold the costs down. 21. If this application does not receive funding,or receives reduced funding,what will be the effect on the project? Without this funding,the hours of both,the Life Skills Instructor and the Case Manager may have to be reduced,which will result in fewer services offered to our clients. 22.Does your agency anticipate having any unspent grants funds at the end of the fiscal year7 1— Yes � No 23.If you answered yes to the preceding question please explain.Enter"N/A"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for ' construction,equipment,furniture,fixtures)? r Yes � No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25.If our a enc is re uestin Ca ital fundin describe the detailed sco e of work for the ro'ect. ou will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"N/A"if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms,plans for future relocation or expansion,etc.).Enter"N/A"if not applicable. N/A 27.If your agency is requesting Capital funding,will this project require implementation of Davis-BaconlFair Labor Standards Act requirements? 1� Not Applicable � Yes � No � Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identity AT LEAST ONE of the City of Dublin's Mission&Vision Statements:(you may choose more than one) � Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. � Balance history with progress,to sustain an enlightened,economically balanced and diverse community. I- Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. � Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) r Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development � Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety � Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendiy development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the Ciry I� Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication � Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutal benefit 30.**QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.*'Are you are interested in applying for CDBG funds7 � Yes.If so,answer questions 31 through 43. r No.If no,check box here,and questions 31 through 43 will not be required.. I� Don't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDBG ONLY-Explain your Limited English Proficiency/Language Access Plan(LEP/LAP).How does your agency outreach to limited English speaking residents to encourage access to services&housing?What access accommodations are used?Provide detail Please enter"N/A"if you are not interested in qualifying for CDBG funding. We at TVH are committed to continuously improving our services to limited English speaking clients.We have staff conversant in Spanish,Russian, Urdu,Hindi,Punjabi,Cantonese and French.With the population becoming very diverse,bilingual and bicultural staff are in strong demand throughout Alameda County,and they are difficult to obtain and retain.We seek out bilingual/bicultural staff,and provide a wage differential for those that speak Spanish.We have a Video Relay Service for clients conversant in ASL.This two way Internet based video link gives hearing impaired clients access to Sorenson's ASL interpreters.If staff is not available to converse directly with an LEP client,we utilize"Telelnterpretors"phone based interpreters. Our largest LEP client group is Spanish-speaking.Most flyers,Gient materials and other communications are created in both English and Spanish.We produce and distribute documents in other languages when available. 32.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Guiding Principle that relates to your proJect: � Be culturally accessible,appropriate and inclusive r Enwurage community engagement and involvement (— Promote energy and resource efficiency � Encourage networking and information sharing across service providers 1� Encourage process streamlining r Consolidate service delivery � Not Applicable.I am not interested in qualifying for CDBG funding. 33.CDBG ONLY-Identify AT LEAST ONE U.S.Department of Housing and Urban Development(HUD)Consolidated Plan Goals that relates to your project: � A)Support and develop a continuum of housing resources that will increase access to low-income,seniors,disabled and homeless persons with emphasis on activities that: r *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. i, � 'Preserve and increase affordable rental housing opportunities for low and moderate income households. r *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. i � *Promote fair housing and reduce housing discrimination. � � B)Improve community health and access to basic and specialty care including dental and optometry care,behavioral and mental health care services especially for low-income,uninsured and under-insured residents with emphasis on activities that: i � 'Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. � 'Increase outreach and access for underserved populations including limited English speaking persons,youth,disabled,seniors and homeless persons. I � C)Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. i, r D)Support and expand programs and opportunities that keep seniors engaged and involved in their community. � E)Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved . populations. � F)Not Applicable.I am not interested in qualitying for CDBG funding. I� iI 34.CDBG ONLY-Identify AT LEAST ONE U.S.Department of HUD Strategic Goal that relates to your project: r Increase homeownership � Promote decent affordable housing � Strengthen communities � Ensure equal opportunity in housing � Promote participation of grass-roots,faith-based,and other community-based organizations I— Not Applicable.I am not interested in qualifying for CDBG funding. 35.CDBG ONLY-Identify AT LEAST ONE U.S.Department of HUD Policy Priority that relates to your project: � Provide increased homeownership and rental opportunities for low and moderate-income persons,persons with disabilities,the elderly, minorities,and families with limited English proficiency. � Improving the quality of life for our Nation's communities � Encouraging accessible design features. I � Participation of minority-serving institutions in HUD programs. � End chronic homelessness within ten years. 'I (� Removal of barriers to affordable housing. I r Not Applicable.I am not interested in qualifying for CDBG funding. 36.CDBG ONLY-Identify AT LEAST ONE Consolidated Plan objective that relates to your project: � Increase the availability of affordable rental housing for extremely low income(30%),very low income(50%)and low income(SO%) households. � Preserve existing affordable rental housing and ownership for households at or below 80%of Area Median Income(AMI). � Assist low and moderate income first-time homebuyers. � Reduce housing discrimination. � Maintain,improve and expand(as needed)the capacity of housing,shelter and services for homeless individuals and families including integrated healthcare,employment services and other supportive services. r Maintain and expand activities designed to prevent those currently housed from becoming homeless. r Build on inter-jurisdictional cooperation to achieve housing and homeless needs. r Increase the availability of service-enriched housing for persons with special needs. r Not Applicable. I am not interested in qualifying for CDBG funding. 37.CDBG ONLY-Select ONE Objective that relates to your project(TIP:When selecting an objective ask yourself,"What is the purpose of the activity7 What is the larger community need that I am seeking to address?"): (d Creating a Suitable Living Environment � Providing Decent Affordable Housing I, r Creating Economic Opportunities � (— Not Applicable. I am not interested in qualifying for CDBG funding. 38.CDBG ONLY•Select ONE Outcome that relates to your project(TIP:When selecting an outcome ask yourseif,"What type of change or result am I seeking�"): '; � Availability/Accessibility r Affordability � � Sustainability � Not Applicable.I am not interested in qualifying for CDBG funding. 39.CDBG ONLY-Select ONE Specific Indicator that relates to your project: i r Public facility or infrastructure:This indicator shows the number of persons that have been assisted by public facility or infrastructure activities � a prow e m ivi ua s wi new or improve access o e aci i y or in ras ruc ure. e ac iw was use o mee a qua i y s an ar or o measurably improve quality,then this indicator will report the number of household units that no longer have access to a substandard service. � Public Service:This indicator shows the number of persons that have been assisted with new or improved access to a service.If the activiry was used to meet a quality standard or to measurabiy improve quality,then this indicator will report the number of persons that no longer have access to a substandard service. r Targeted revitalization:This indicator shows a range of outcomes such as jobs created and retained,businesses assisted,low-and moderate- income persons and households served,slum/blight demolition,number of acres of brownfields remediated,etc.in a targeted area. (� Commercial facade treatments or business building rehabilitation:This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. � Brownfields remediated:This indicator shows the number of acres of brownfields that were remediated. ' � Rental units constructed:This indicator shows the number of affordable rental units created,as well as the number of years of affordability, number of units occupied by the elderly,and those units designated for chronically homeless persons and persons with HIV/AIDS. � Rental units rehabilitated:This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability,units for chronically homeless persons,elderly persons,and persons with HIV/AIDS. � Homeownership units constructed or acquired with rehabilitation:This indicator shows the total number of homeownership units constructed, acquired,andlor acquired with rehabilitation per activity.This includes total number of affordable units,number of years of affordability,Energy Star qualified units,section 504 accessible units,and number of households previously living in subsidized housing.In addition,data will be collected on the number of units occupied by the elderly,number of units designated for persons with HIV/AIDS,and number of units for the chronically homeless. r Owner occupied units rehabilitated:This indicator shows the total number of owner occupied units rehabilitated,including the number of these units occupied by the elderly,number of units designated for persons with HIV/AIDS,and number of units for the chronically homeless. � Direct financial assistance to homebuyers:This indicator shows the number of homebuyers receiving direct financial assistance,housing counseling,and down payment assistance/closing costs. r Tenant Based Rental Assistance(TBRA):This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance(less than 12 months)and the number of homeless and chronically homeless households assisted. r Homeless shelters:This indicator shows the number of homeless persons given overnight shelter. r Emergency housing:This indicator shows the number of beds created in an overnight shelter or other emergency housing. (— Homeless prevention:This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. � Jobs created:Of the total number of jobs created,this indicator shows the number of jobs that have employee-sponsored health care,the : types of jobs created(using Economic Development Administration(EDA)classifications)and the number of persons unemployed before taking the job. � Jobs retained:Of the total number of jobs retained,this indicator shows the number of jobs retained,the number of jobs with employer- sponsored health care benefits,and the types of jobs retained(using EDA classifications) I� Business assistance:This indicator shows the total number of businesses assisted.Specifically,it shows the number of new businesses, existing businesses,and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. � Businesses providing goods or services:This indicator shows whether an assisted business provides goods or services to meet the needs of the service area,neighborhood,or community,as determined by the grantee. r Not Applicable.I am not interested in qualifying for CDBG funding. 40.CDBG ONLY-Please choose a common indicator that your agency will use to track clients(select only ONE): � Persons � Households � Not Applicable.I am not interested in qualifying for CDBG funding. 41.CDBG ONLY-For the category you selected above,provide the total number of unduplicated Dublin clients(EITHER Persons OR Households)your agency anticipates serving through this project: 270 42.CDBG ONLY-Based on the common indicator you selected above,please list the number of unduplicated Dublin clients your agency anticipates serving in each category."If none,please enter"0". 20'Low Income(50%-SO%AMI;please refer to the Income Limits chart at www.dublin.ca.gov/housing!) 250 Extremely Low Income(<30%AMI;please refer to the income Limits chart at www.dublin.ca.gov/housingn 20'Disabled 501 Female Headed Households 65'Senior 0 Youth 2'Homeless . � � �� 0����Not Applicable.I am not interested in qualitying for CDBG funding.(Type N/A) � 4Q�7.�f7;TOTAL � 43.CDBG ONLY-List the number of clients your agency anticipates serving in race/ethnicity categories.The sum entered below must match the total clients entered in#42 above.Per HUD"Hispanic"is an ethnicity,not a race."If none,please enter"0" _ e__. . 50'White � 50 White+HISPANIC 40 Black/African American 0.Black/African American+HISPANIC 105 Asian 0 Asian+HISPANIC 2'American Indian/Alaskan Native ' 0'American IndiaNAlaskan Native+HISPANIC _ � 0��Native Hawaiian/Other Pacific Islander ' � � � 0;Native Hawaiian/Other Pacific Islander+HISPANIC ��� ��������� OE American Indian/Alaskan Native and White � �� �01 American Indian/Alaskan Native and White+HISPANIC � �� 0;Asian and White � � � _ _ __ 0�Asian and White+HISPANIC , __.. . � ._, � 0;Black/African American and White i 0 Black/African American and White+HISPANIC �I 0'American Indian/Alaskan Native and Black/African American 0 American Indian/Alaskan Native and Black/African American+HISPANIC 23 Multi Racial+HISPANIC OR other Multi Racial 0 Not Applicable.I am not interested in qualitying for CDBG funding. (Type N/A) 'i: v���TOTAL � 44.If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY r #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. r #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. r #3-This programlproject has the 3rd highest priority for funding within the organization,agency,district or entity. � #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. r #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. r #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. � If you have more than 6 applications per organization,agency,district or entity,check here. 45. Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). Homeless Services Program budget is intentionally diversified,so losing one potential source would not force us to close the project completely.We actively fundraise and reach out to the corporate and private donors.In 2013 Tri-Valley Haven opened a Thrift Store,formerly operated by Buenas Vidas,expecting to over time generate enough revenue to support programs facing the loss of funding. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-007058 Budget Funding Sources/Revenues Budget Amount Amount Committed Alameda County $144,432.00 $0.00 local Dublin/Livermore/Pleasanton $43,207.00 $0.00 HCD Linkages $42,820.00 $0.00 EFSP $20,000.00 $0.00 Individuai Donations $55,524.00 $0.00 Foundations $4,000.00 $0.00 Total $309,983.00 $0.00 Funding Uses/Expenses Budget Amount Amount Committed Case Manager,9%of Salary and Benefits $4,695.00 $0.00 Life Skills Instructor,9%of Safary and Benefits $5,305.00 $0.00 Other Program Personnel $210,303.00 $0.00 pera ing xpenses: Supplies $5,511.00 $0.00 Printing/Copying $1,586.00 $0.00 Telephone $10,421.00 $0:00 Rent and Utilities $13,610.00 $0.00 Accounting/Audit $13,478.00 $0.00 Other $45,074.00 $0.00 Total $309,983.00 $0.00 Budget Narrative Revenue:The composition of revenue is our best estimate based on the previous years of operation. Expenses:Personnel Costs include salaries and benefits.Sick leave,vacation,and holidays are not included in the benefits calculation for staff that will be paid with the Dublin grant funds.Other Operating Costs include:Maintenance,Travel and Mileage,Insurance,Property Tax,Auto Expense,Administrative Expenses and Support. Homeless Services Budget is part of the overall agency budget that includes other programs and departments such as Domestic Violence Services,Sexual Assault Services,Finance etc.thus only a portion of Liability Insurance,Auto Insurance,Audit etc.being charged to this Program. Documents Documents Requested* Required? Attached Documents* Program Expense Budget for ALL Grant Requests I� TVH Propram Exoense Budqet download template Financial Information Form for ALL Grant Requests (' TVN Financiai information downioad terr,plate List of Board of Directors(or governing body)with contact I� TVH list of Board of Qirectors information Current Annual Budget for the Entire Agency r TVH Gurrent Annual Budqat Copy of most recently submitted IRS 990 form or Tax Return � TVN IRS 990 (include complete form) Board of Director's(or governing body's)designation of � TVN BOD desianation of authorized official authorized officiai Board of diredor's(or goveming body's)authorization to � TVH BOD authorizatiorrto repuest fundinq request funding(may be same document as one above) Proof of insurance carried,inGuding bonding,IiabiHty and/or � TVH Proof of Insurance workers'campensation REQUIRED FOR CDBG ONLY-If requesting Capital Funding, r please upload your Capital expenditurebudget(your own format is acceptable) REQUIRED FOR CDBG ONLY-PERSONNEL POLICIES INCLUDING � TVH Personnei Policies AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS I� T`�H Audit Requirements AND COPY OF LAST AUDIT HIGHLIGHTING"FINDINGS' TVH Ca�v af last Audit SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION � TVH Articies of incorporation AND BYLAWS. TVN Bvlaws REQUIRED FOR CDBG ONLY-CONFLICT OF INTEREST � STATEMENT(IF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART r TVH Orqanizational Chert STATE AND FEDERAL NON-PROFIT DETERMINATION IETTER. r TVH State Non-profit determination letter All organizations MUST have approved non-profit status from TVH Federal non-orofit letter the State of California and Federal Tax Identification Number at time of application.Non-compliant applicants will be disqualified. REQUIRED FOR CDBG ONLY-AGENCY'S LIMITED ENGLISH r TVH L.imited Enqlish Proficiencv Lanauaqe access Policv PROFICIENCY LANGUAGE AGCESS PLAN(LEP/LAP).Must include outreach to limited English speaking residents to encourage access to services&housing.InGude what access accommodations are used. REQUIRED FOR CDBG LEVERAGING REPORT-this is due with I� the 2nd quarter report no laterthan January 15th Certified Audit andlor Certified Financial Statements � TVH Certified Audit *ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:47631 Become a fan o?7oomGrants"'on Facebaok � Problems7 Contact us at�uestions;cDZoomGrarts.coni � �2002-2016 GrentAnelystcom.All rights reserved. - "ZoomGrants"and the ZoomGrants logo ere trademarks of GrantAnelysLcom,LLC. � lo_a_ou±�Brewser i I � � i ij , III Email This Preview Save as PDF Print Close Window A�♦ , f OWG(Bd bV ZOOtYI�'(e�/7f3T�"� ; City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadline YMCA of the East Bay,Tri-Valley YMCA Mental Health Services $25,000 Requested YMCA of the East Bay,Tri-Valley YMCA - — Submitted: 12/11/2015 4:01:38 PM(Pacific) Telephone925.263.4444 6693 Sierra Lane Fax (925)263-4445 Project Contact Suite F Web www.trivaileyymca.org Kenny Altenburg : Dublin,CA 94568 kaltenburq�a ymcaeastba�orp United States Tel:9252634444 ; VP and Regional Executive Director Additional Contacts ; Kelly O'Lague Dulka none entered ! kdulka;a^;ymcaeastbay oro Application Questions ISome answers will not be presented because they are not part of the selected group of questions based on the answer to#30. ( 7.Please describe your organization category(select one of the following): � Private Non-Profit ' � Public Agency � Other: 2. Please describe your agency's mission(no more than 3 sentences or 250 characters). At the Y,strengthening the community is our cause.With a focus on youth development,healthy living and social responsibility,we work to ensure that everyone,regardless of age,income or background,has the opportunity to leam,grow and thrive. 3.For what type of Dublin Grant is your agency applying? 1— Capital Project (� Public Service Program or Project i 4.Is this a"new"service,program,project or activity?"New"is identified as not yet started, implemented or in operation. r Yes r No 5. Please indicate below if this application is a request for one-time funding and/or"seed"funding. r One-time funding 1� Seed funding I� One-time and Seed funding � Operational funding r None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received within the last three years�urisdiction,year,amount,purpose,etc.).Enter"N/A"if you HAVE received Dublin Funds. N/A 7. Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.). The Tri-Valley YMCA is a branch of YMCA of the East Bay.The Y has been a presence in the East Bay since 1879 and the Tri-Valley branch has been offering high quality programs for children and their families since 1965.The Tri-Valley YMCA has an active and engaged Board of Managers made up of inembers,community leaders and business leaders who oversee the branch operations. An Executive Director and a Branch Operations Director head up the management team,and a staff of 40 provide the day to day services the Y provides.The executive director holds two master's degrees and has 30+years of experience working with children and families.The Branch Operations Director has a business degree and has worked for the past seven years in community engagement for children and families.Our Childcare Program Director has nearly 20 years of experience in licensed childcare.Our mental health staff includes a licensed clinical social worker, a licensed marriage and family therapist,and-WITH GRANT FUNDING,will soon include Mental Health interns. ' 8. Provide a brief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementatfon process to describe your proJect. We are seeking funding to expand our ability to provide behavioral health care services for children and families in Dublin.We specifically focus our services on low-income families who have kids with special needs. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) 36 10.Which of the 74 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? � Behavioral Health(mental health and substance abuse) r Affordable Housing r Heaith Care(including dental) ' � Workforce Development r Homelessness � Transportation Services and Access � Domestic Violence and Child Abuse � Disabilities (W Food and Nutrition (— Senior Services I� Youth Services � Child Care,Early Childhood Development and Education � Changing Demographics and Growing Diversity � Financial Assistance � None of the above 11. Explain how this project will be implemented,administered,and operated. Grant funding will be used to expand our clinical staffing so that we can increase the services we provide to low-income children with special needs. While we were aware that there was a shortage of behavioral health care services for children in the Tri-Valley,we underestimated the extent.Our mental health staff reached full caseload capacity within six months of starting the program.It is critical that we add more staff to address the needs of the most vulnerable children and families in Dublin.We now have two licensed therapists on staff,and we are seeking funding to support these ' positions.This would be a GREAT INVESTMENT,as we would have the ability to staff between 2-4 interns under them. Parents turn to the Y every day for help in navigating through the challenges of family life.They know and trust us to help them.The Y is uniquely positioned to help families secure the resources and services they need when faced with the challenges unique to raising kids with special needs because we already offer case management services,information and referral services,parent education and support,respite services and a wide array of youth development programs that help kids become more confident and connected. Families experience a real shortage of behavioral health care services in the eastern region of Alameda County.In response to this unmet community need,as identified through a variety of community needs assessment avenues,the Y has worked to expand our behavioral health care services.With our recently established Mental Health Services Department,we have been able to serve children whose families need support,education and encouragement to parent effectively.In the first year,our staff has been overwhelmed with requests for services and is at capacity.Dublin families seeking or referred for free or low cost mental health services will be assigned to a staff therapist for assessment and treatment planning. 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?). By securing grant funding from the City of Dublin,we will be able to expand the number of low-income Dublin residents we serve.Currently,families with limited resources have trouble accessing behavioral health care services.First,there is a critical shortage of services.Second,the services that are available are often very complicated and challenging to secure.At the Y,we have very little red tape.If a family needs services,we provide them. We honor the dignity of the families we serve and work with them to secure resources.We do not require extensive proof of income status or health care coverage.We simply get engaged with families,help them figure out what they need to help their children thrive and we partner with other organizations and agencies to maximize access to the resources families need. Since we are already providing these services with the therapists that we have on staff,we will be able to quickly expand them with this grant funding.Conversely,not receiving grant funding would limit our ability to quickly expand this department,hindering our ability to reach more Dublin residents with these services. We believe that an increase in behavioral health care services to children and families in Dublin will have impactful,long lasting benefits. ' 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome(s�? We will measure the success of our behavioral health care program in three significant ways.Utilizing standard evidence-based measures as outlined by SAMHSA,children will demonstrate: 1.Decreased symptomatology,improved functionality at school,and improved stability/functionality at home 2.Increased self-esteem as measured b the Rosenber Self Esteem Scale.The Rosenber Self-Esteem Scale SES is a brief and unidimensional measure of global self-esteem.The Rosenberg Self-Esteem Scale has demonstrated good reliability and validity across a large number of different sample groups.The SES has been validated for use with both male and female adolescents. 3.Increased internal and external assets.These increases will be tracked using the Search Institute's Survey of Student Resources and Assets.The Survey gives information on young people's assets,thriving indicators,and risk behaviors. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project,i.e.seniors,youth,disabled,low-income,etc. The population we serve in our Dublin facility is comprised primarily of low income families from Dublin.Approximately 40%of participants are from low,moderately low and extremely low income single-parent households.The percentage of children from low income families in our summer camps and sports programs in Dublin is much higher than in any other Y programs.Approximately 25%of the kids we serve come from single family households with income below the poverty line.Another 18%come from families with combined household income of less than$40,000 per year.To serve these families,the Y does extensive fundraising all year to be able to offer financial assistance to cover the cost of programming.In addition,a high percentage of the kids we serve have special needs.These range from adjustment disorders,ADHD to Aspergers Syndrome and other forms of Autism,to emotional and behavioral challenges. , There is increasing evidence that early intervention,prevention and the promotion of better mental health and well-being across the whole population is vital for a healthy society.Therefore promoting mental health and well-being can have multiple benefits:improved health outcomes,life expectancy, productivity and educational and economic outcomes as well reductions in violence and crime. I j Poor mental health and well-being can be both a determinant 8 an outcome of poverty,disadvantage and social inequalities,therefore interventions should focus on:building resilience at the levels of the individual,family,community&environment can help promote well-being during times of adversity;developing personal resilience to help prevent suicide,in combination with effective community suicide prevention measures;increasing individual,family&community resilience by actions to reduce inequalities,prevent violence,reduce homelessness,improve housing conditions&debt management and promote employment. 15. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the clienUcustomer population served)? The Tri-Valley YMCA is open to all.We believe that diversity is important as it provides our community with unique and inspirational perspectives.We hire staff that reflects the diverse community we serve.We have staff of alt ages,races and socio-economic backgrounds.We want every child to feel welcome at the Y and have strong,caring adults with whom they can identify. 16. Explain how your agency will outreach to low-income, limited English speakers,and/or disabled persons.How will each of these groups access the project for which your agency is requesting funding? For all of our programming,the Y is here for the community-we want to provide opportunities for all.We try to reach undeserved families in a variety of ways.We have relationships with many referral and assistance programs induding Child Care Links and 4Cs of Alameda County.We also post ' information through the local libraries and school districts. We believe that our programs and services must be accessible to all.All of our facilities meet ADA requirements and are easily accessibly by public transportation.In addition,the YMCA will not turn anyone away due to inability to pay.We are continually fundraising to increase the amount of financial assistance we give to families. 77.Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integratfon. The Tri-Valley YMCA partners with the Dublin,Livermore and Pleasanton Unified School Districts to ensure that the services we provide are aligned with the district goals and objectives for their students.The faculty and staff of these districts provide support for our programs,staff and families in addition to making ciient referrais.The staff at these school districts knows some of these families even better than we do,and thus can give us some insight on what the best approach may be to reach out to them. In addition to working with the above-mentioned partners,the Tri-Valley YMCA has partnerships with local churches,nonprofits and many local businesses and donors that provide financial support for the YMCA.Without the support of these partners,we would not be able to offer the mental health services at the capacity that we are currently offering them at. 18. Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outiine specific collaboration with other service organizations in the City of Dublin or Tri-Valley. As previously mentioned,we have great relationships with Dublin Unified School District,local nonprofits,churches,businesses,etc.These partners are well-aware of the work that the Y takes on,and are constantly referring people to our mental health services.When we get new clients referred to us,we gauge what their needs are,what their ability(or inability)to pay is,and then proceed with treatment from there. In all honesty,marketing has not been the issue that we've faced as our caseload was at capacity within the first 6 months of offering Mental Health services.Our goal now is to continue to spread the word about what services we provide,while finding the capacity to meet more of the need that exists. 19. Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. When people think of"healthy lifestyles",they often think of physical health-eating well,exercising,maintaining a healthy weight,not smoking,etc.In fact,"healthy lifestyles"should really be focusing on the entire person.Because of this approach,we believe this project falls in line with the following Mission and Vision of the City of Dublin: -"Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities." -"Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs." In terms of the City's value on"Governing",we believe that this project would open our community's eyes to the desperate need for these services in our community.The City has a chance to show the importance of this focus on mental health,and that they are committed to responding to this need. These are the kinds of actions that will foster an informed and involved community...they will show how committed we are to"openness and ' responsiveness to the public and community". 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. This grant request is for a portion of the salary and benefits for a licensed clinician who will provide behavioral health care services to low-income families,especially those with children that have special needs.Prevention,early identification,and intervention of behavioral health strategies are integral components of a holistic health and human service delivery system serving individuals across the lifespan.Early,adverse experiences of children and youth have serious impacts on social,emotional,physical,mental,and behavioral health development and on their later health and quality of life as adults.Other factors,inGuding access,provider shortages,training and development,technological infrastructure,and resource - sustainability also affect the provision of preventive behavioral health care for individuals,families,and communities. At the Y,our focus on youth development,healthy living and social responsibility intersect in the provision of behavioral health care services.We know that caring for a child's mental health will have lasting positive benefits and failing to do so not only puts the child at risk later in life,but puts the community at risk as well.It is essential that the lack of behavioral health care services be addressed in the Tri-Valley and the Y can do so at a very reasonable cost. The salary range is competitive for similar positions in the nonprofit realm,and while the cost per resident seems high,the relative benefits will be major. 21. If this application does not receive funding,or receives reduced funding,what will be the effect on the project? If this application does not receive funding we will continue to seek funding from other potential partners,though this will be a tough road for us as Clinical Mental Health programs are very expensive per resident served. We will not be able to serve as many Dublin residents if we are not funded by this grant. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? � Yes ' � No 23.If you answered yes to the preceding question please explain.Enter"N/A"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,ffxtures�? r Yes r No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25.If your agency is requesting Capital funding,describe the detailed scope of work for the project. [You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"N/A"if not applicable. N/A 26.If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms,plans for future relocation or expansion,etc.).Enter"N/A"if not applicable. N/A 27. If your agency is requesting Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirementsT r Not Applicable I— Yes � No � Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin's Mission 8.Vision Statements:(you may choose more than one) (d Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. (� Balance history with progress,to sustain an enlightened,economically balanced and diverse community. � Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. � Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) r Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development � Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety r Guiding Development:to assure that development contributes positively to the City's flscal health;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in private development and in atl public facilities and develops transportation systems that facilitate ease of movement throughout the City �' Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication � Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutaf benefit 30.**QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.*'Are you are interested in applying for CDBG funds7 � Yes.If so,answer questions 31 through 43. r No.If no,check box here,and questions 31 through 43 will not be required.. r pon't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. : 31.CDBG ONLY-Explai�your Limited English Proficiencyl�anguage Access Plan(I.EPlLAP). How does your agency outreach ta limited English speaking residents to encourage access to services 8�housing?What access accommodations are used? Provide detail -ans!.ver not presef�Ced because of the ansv�er fo#3l� 32.CpBG ON�Y-ldentify AT�EAST ONE U.S.Department af Nousing end Urban Development(NUD)Cpnsotidated Plan Guiding � Principle that relates to your proj�ct: . ._�f)S.V�!'rJ��JI'�S+vY7j:.aC�f)FSc7U68 0;ir�,''eir)[iv1�F;7('{3#,3�-- � 33.CDBG ONLY-Identify AT lEABT ONE U.S.Department af Housing and Urban Development(HUD)Consolidated Ptan Goals that � reiates to your�iroject: � �3t3S."r-t� ,�..,f/1r£ ,F�l.f(.;�JE.��;1Sf;;G� ;f :.�!�Si. �'�.i,i#.3�- 34.CdBG ONLY-{cientify AT l.EAS7�NE U.S. �epartmer7t af HUD Strategic Gaal that rela#es to you�projecC: -.3^Siiy�t�p��i/}/Y,':it?i?i6'U Ci@,�stiSE.,:i.'`%l?F,?:�^::1%:F_-',a`�TM�z;�i_ �. 35.CBBG ONLY-fdentify AT�EAST ONE U.S.Department of HUD Pnlicy Priarity that relates ta your project: � r,ns�ve��not nresen"red ber�,use r�f tt�e�ns�ti-er?o#3� 36.GDBG ONLY-identify AT LEAST ONE Consofidated Plan objective that reiates ta your project: -ans�uer not preser�ted b�,xaatrs�of?1��;;�ns4�r�r�io#k30- 37.CDBG ONLY-Select ONE Objective that relates to your praject{TIP:When selecting an abjective ask yo�rself,"What is the purpose of the activity?What is the Iarger community need that 1 am seeking to address?"}: -ansr�c�r raoi presented kecause of the ans�ver to#30- 38.COBG ONLY-Seiect ONE Outcame that relaies to your project{TIP:When selecting an outcome ask yourseif,"What type af change or result am I seeking?"): -ansvb�er no#preser?fed�ecause of fhe ansvrer ta#30- 38.CDBG ONLY-Select ONE Specific Indicator that relates to yaur project: -�rJStuer noi preser�fed because of?he 2ns4^�er to#30- 4p.CdBG tSNL.Y-Please choose a common indicator that your agency wiif use to track clients(seiect only t}NE}: -an,s4t�er'ne?pr�selziec;b�:cause r�f ihe anss<,�er to�30- 41.COBG ONLY-For the category you selected above,provide the tntal numbar of undupiicated D�blin clients(EITHEt2 Persons CiR � Househalds)yaur ac�er7cy anticipates serving through this praject: -�1?SbYE'f;1G�r;'f;S@Y'��EC7,`iE't;ia(r.>Ei Of i�)E£��ti�t^'t;"iC#:?(.1- . 42,COBG ONLY-Based an the common indicator you selected above; piease list the number of undupiicated Duh�in clients yaur agency anticipates s�rving �n each category. "if nane, please enter"0". s.��,�.�ot,�>r� r `t;��,i�e ��se;� �� ,�u,:�, _ �.:3r� � 43.CDSG ONLY- �ist the number of clienis your agency anticipates serving in race?efhnicify categories.The sum entered below � mGisY match the fotal cliQnts enfarQd in#42 abov�. Per HUD "Nispanic"is an�thnicity,not a race."If none, piease enter"4" ..ctliS.Y�'It0!�?t'�-SY.^!�G'bcCBu.S�Gf;�!?E>'e'r'?SVVP„"10�'.;G.. 44.If your agency is submitting more than one application or the same agency has different programs within it,please RANK the priority of this application,with number 7 being the highest priority for funding.There should only be one#1 PER AGENCY � #1 -This programlproject has the highest priority for funding within the organization,agency,district or entity. � #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. � #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. � #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. r #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. r #6-This programlproject has the 6th highest priority for funding within the organization,agency,district or entity. � If you have more than 6 applications per organization,agency,district or entity,check here. 45. Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). e ri- a ey is comp e e y se -su icien inancia y or e programs a are a rea yrunning. a eing sai , ere are emerging nee s in the community every year,and we are relying on the City's grant program(as well as all of the other funding streams out there)to help us address these needs. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-106916 Budget Funding SourCes/Revenues _ Budget Amount Amount Committed City of Dublin Grant Funding $25,000.00 Co-payments _ _ $10,000.00 $0.00 Golf Tournament Fundraiser $12,000.00 $12,000.00 Board and Staff Contributions $12,000.00 $6,000.00 City of Pleasanton Grant Funding $25,000.00 City of Livermore Grant Funding $5,000.00 Total $89,000.00 $18,000.00 Funding Uses/Expenses Budget Amount Amount Committed Mental Health Therapist Salary $65,000.00 $0.00 Taxes and Benefits $16,250.00 $16,250.00 Malpractice insurance $1,200.00 $0.00 Computer and Cell Phones-Therapist and Intems $4,500.00 $0.00 Office Supplies/Record Keeping $1,000.00 $700.00 Therapeutic Supplies&EquipmeM $1,050.00 $1,050.00 Total $89,000.00 $18,000.00 Budget Narrative The costs associated with hiring one clinician(licensed clinical social worker or licensed marriage and family therapist)would largely fall into four categories:salary,taxes and benefits,malpractice insurance and the costs associated with maintaining communications(computer,cell phone,office supplies,etc.). Currently,the salary range for a licensed clinician is$60,000 to$80,000.We would seek to hire someone at the lower range to maximize the Y's resources and the grant funders'resources. Our overall branch budget is approximately$2.1 million and our behavioral health care services program currently accounts for about 5%. Documents Documents Requested* Required? Attached Documents' Program Expense Budget for ALL Grant Requests �' Propram Expense Form downioad tempiate Financial Information Form for ALL Grant Requests � Financiai information Form download temalate List of Board of Directors(or governing body)with contact r YMCA Soard Roster information Current Annual Budget for the Entire Agency � Tri-ValieY YMCA Budqet Copy of most recently submitted IRS 990 form or Tax Return � YMCA 990 (include complete form) Board of Director's(or governing body's)designation of � Board Desi nq ation authorized official Board of Director's(or goveming body's)authorization to � Board Authorization request funding(may be same document as one above) Praof of insurance camed,inGuding bonding,liability and/or � Proof of Insurance workers'compensation REQUIREDFOR CDBG ONLY-1f requesting Capitai Funding, � please upload your Capital'expenditure budget(your own format is acceptable) REQUIRED FOR CDBG ONLY-PERSONNEL POLICIES INCLUDING C� AFFIRMATIVE ACTION PLAN AND GRIENANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS � AND COPY OF LAST AUDIT HIGHLIGHTING"FINDINGS" SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION I� AND BYLAWS. REQUIRED FOR CDBG ONLY-CONFUCT OF INTEREST C� STATEMENT(IF NOT WCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART (— STATE AND FEDERAL NON-PROFIT DETERMINATtON LETTER. � IRS Letter Ali organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of applfcation:Non-compliant applicants will be disqualified. REQUIRED FOR CDBG ONLY-AGENCY'S LIMITED ENGIJSH r PROFtCIENCY LANGUAGE ACCESS PLAN(LEP/LAP).Must inGude outreach to limited English speaking residents to encourage access to services 8�housing.Include what access accommodations are used. REQUIRED FOR CDBG-LEVERAGING REPORT-this is due with � the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements � Audited Financials `ZoomGrantsT"is not responsible for the confent of uploaded documents. Application ID:48495 Become a tan ol ZccmGran[s"'on Pacebook � Problems?Contaet us at�uestiens(uZooroG•anG.com �2002-2016 GrantAnalyst.com.All rights reserved. .. "ZoomGrants'end the ZoomGrants logo are trademarks ot GrentAnalyst.com,LLC. � Lcocut�5rpwser .i.. �`J�II�� �� I � Emaii This Preview Save as PDF Print Close Window Ai♦ � , Povvered bv Zoom�rantsT"' City of Dublin Parks and Community Services Department 2016-2017 Community Grants Program 12/11/2015 deadline YMCA of the East Bay,Tri-Valley YMCA YMCA Day Camp - Affordable Summer Child Care $25,000 Requested YMCA of the East Bay,Tri-Valley I YMCA �.__._, ____�__ --- Submitted: 12/11/2015 4:29:55 PM(Pacific) I ��--���im�""� ^-""v""mm� Telephone925.263.4444 ! 6693 Sierra Lane Fax (925)263-4445 Project Contact ; Suite F Web www.trivalleyymca.org Kenny Altenburg �I Dublin,CA 94568 kaitenburq{7a.vmcae�st�av_org � United States Tel:9252634444 ; I, VP and Regional Executive Director Additional Contacts ! Kelly O'Lague Dulka none entered � kdulka;^c,ymcaeastbav.crq Application Questions ��_ � Some answers will not be presented because they are not part of the selected group of questions based on the answer to#30. ' 1.Please describe your organization category(select one of the following): r Private Non-Profit r Public Agency � Other: 2. Please describe your agency's mission(no more than 3 sentences or 250 characters). At the Y,strengthening the community is our cause.With a focus on youth development,healthy living and social responsibility,we work to ensure that everyone,regardless of age,income or background,has the opportunity to learn,grow and thrive. 3.For what type of Dublin Grant is your agency applying? r Capital Project � Public Service Program or Project 4. Is this a"new"service,program,project or activity7"New"is identified as not yet started,implemented or in operation. . 1� Yes I� No 5. Please indicate below if this application is a request for one-time funding and/or"seed"funding. (� One-time funding � Seed funding � One-time and Seed funding � Operational funding � None 6.If your agency has NEVER received grant funding from the City of Dublin,please describe any other City/County funding received within the last three years Qurisdiction,year,amount,purpose,etc.).Enter"N/A"if you HAVE received Dublin Funds. N/A 7.Please provide information to justify your agency's capacity to conduct this project(type of management or governing body,fiscal staff resources,skills and experience,etc.�. The Tri-Valley YMCA is a branch of YMCA of the East Bay.The Y has been a presence in the East Bay since 1879 and the Tri-Valley branch has been offering high quality programs for children and their families since 1965.The Tri-Valley YMCA has an active and engaged Board of Managers made up of inembers,community leaders and business leaders who oversee the branch operations. An Executive Director and a Branch Operations Director head up the management team,and a staff of 40 provide the day to day services the Y provides.The executive director holds two master's degrees and has 30+years of experience working with children and families.The Branch Operations Director has a business degree and has worked for the past seven years in community engagement for chiidren and families.Our Childcare Program Director has nearly 20 years of experience in licensed childcare. We are the leading childcare provider in the nation,and utilize the best practices of the YMCA of the USA to develop top-quality childcare and day camp programs. 8. Provide a b�ief summary of the project for which your agency is seeking funding(no more than three sentences or 250 characters).This text will be used widely during the review and implementation process to describe your project. We are seeking funding to provide low-income families with affordable access to childcare in the summer months.Affordable childcare is especially tough to come by in the summer,as families need full day care and some school-year providers are closed. 9.Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.(UNDUPLICATED:client is counted only once regardless of number of services received in a year.) 100 10.Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? (� Behavioral Health(mental health and substance abuse) (— Affordable Housing (— Health Care(including dental) (� Workforce Development 14 Homelessness r Transportation Services and Access (— Domestic Violence and Child Abuse � Disabilities � Food and Nutrition I"� Senior Services � Youth Services r Child Care,Early Childhood Development and Education � Changing Demographics and Growing Diversity � Financial Assistance r None of the above 11. Explain how this project will be impiemented,administered,and operated. Y-Camp provides children with a community of caring adults,who nurture experiential education that results in self-respect and appreciation for human value.Over the years we have seen a dramatic increase in the number of low-income families that want to attend the Y summer day camp program(Y-Camp).We are very committed to doing whatever it takes to serve this population,but it requires us to keep raising more and more money. We are seeking grant funding to ensure that those low-income families have access to affordable summer care,and that their children have the same summer experience as any other child in our community. All of our outcomes--self-identity,self-worth,self-esteem,leadership,and self-respect--build personal competencies.These personal competencies are reflected in the four"C's"of the Y-Camp community:compassion,contribution,commitment,and character! For years,Y-Campers'parents have reported that when their children return home from camp they are more caring,understand the importance of giving,are more equipped to stand up for what they know is right,and are willing to be more responsible.These are the qualities that will help build a successful nation and a civil society. EaCh summer the Y offers 10 weeks of summer day camp for children entering kindergarten through high school.The program includes recreational and educational activities that allow children to learn,grow and thrive in the summer months.Our staff work diligently to provide a positive, encouraging environment so that every child can reach his full potential. 12. Describe in detail the role of Dublin grant funds in this project(e.g.,what specifically will the grant funds be used for?). These grant funds will be utilized to provide fee subsidies to the low-income families in Dublin that CRITICALLY need affordable childcare.The Y fundraises throughout the entire year to provide these families with financial assistance,but we cannot meet the need that currently exists in our community.We will rely heavily on other funders(include the City of Dublin hopefully)to ensure that these children have a safe and enriching environment during the summer months. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project.What strategies or objectives will your agency use to track the progress of ineeting the outcome�s)? 1.20%more low-income families than in previous year's camp enrollment 2.20%increase in amount of financial assistance we provide to families for Summer Day Camp 3.ZERO Dublin families tumed away from camp due to their inability to pay We will track these numbers through our registration forms,financial assistance applications,and overall branch budget.We already track these numbers every year,but these goals are very aggressive,with the hope that we receive full funding. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this ro'ect i.e.seniors outh disabled low-income etc. The population we serve in Y-Camp is as diverse as the community in which we live.Approximately 50%of the campers at our Pleasanton camp are from Pleasanton,30%are from Dublin,10°/a are from Livermore and 10%are from outlying cities.The percentage of children from low income families is much higher than in any other Y programs.Approximately 25%of the kids we serve come from single family,low income households.Another 18% come from families with combined household income of less than$40,000 per year.To serve these families,the Y does extensive fundraising all year to be able to offer financial assistance to cover the cost of day camp. In addition,a high percentage of the kids we serve have special needs.These range from ADHD to Aspergers Syndrome and other forms of Autism, to emotional and behavioral challenges.Some of our campers have developmental delays and other cognitive challenges.Others have physical limitations.We work to make sure that we can provide services for these kids who might otherwise be left without summer care. 15. How is this project culturally appropriate(i.e.,describe how it is specifically tailored to the clienUcustomer population served)? The Tri-Valley YMCA is open to all.We beiieve that diversity is important as it provides our community with unique and inspirational perspectives.We hire staff that reflects the diverse community we serve.We have staff of all ages,races and socio-economic backgrounds.We want every chiid to feel welcome at the Y and have strong,caring adults with whom they can identify. 16.Explain how your agency will outreach to low-income,limited English speakers,and/or disabled persons.How will each of these groups access the project for which your agency is requesting funding? For all of our programming,the Y is here for the community-we want to provide opportunities for all.We try to reach undeserved families in a variety of ways.We have relationships with many referral and assistance programs including Child Care Links and 4C's of Alameda County.We also post information through the local libraries and school districts. We believe that our programs and services must be accessible to all.All of our facilities meet ADA requirements and are easily accessibly by public transportation.In addition,the YMCA will not turn anyone away due to inability to pay.We are continually fundraising to increase the amount of scholarships we give to families. . 17.Identify the organizatfons that your agency partners with and describe their relevant capabilities that result in greater service integration. We have been running this summer camp for many years now,and are continually improving the exceptional camp program that we implement.Our main partnerships will be in the marketing front,as we will want to ensure that the low-income families in Dublin are aware of the financial assistance that we have to offer.Please see#18 below. 18. Describe the marketing and outreach your organization has done,particularly to Dublin residents.In addition,outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. Our outreach efforts will include utilizing DUSD,Emerald Vista,local churches and nonprofits,the libraries,and more. We don't want any parent in Dublin to have to leave their children home along this summer,due to their family's inability to pay. 19.Referring to questions 28,29 and 30,describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin's Mission,Vision,and Values. Providing low-income children with the childcare they deserve includes providing them with the summer experiences that many of their peers get to enjoy.This project will help give these families the"high quality of life"and"active and healthy lifestyles"that the City of Dublin is so committed to. Additionally,our summer day camps are an incredible environment to"Bring the Community Together".Since our attendees are so incredibly diverse, cultural barriers are broken down at a very young age.This is one of the characteristics of our camp that we take the most pride in! 20.BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. We are able through fundraising and participant fees to provide a high quality day camp program.That being said,there is an increased need in our community for childcare,particularly during the summer months when parents need full-day care.Many parents have to end up leaving their children home alone at an earlier age than they would othervvise. All functions of our camp are aiready up and running,and we have the capacity to add more children if we can afford to do so.Since we are already raising a significant amount of money to provide these services,this additional funding will allow us to reach 100 more Dublin residents this upcoming summer. 21.If this application does not receive funding,or receives reduced funding,what will be the effect on the project? If this application does not receive funding we will continue to seek funding from other potential partners...HOWEVER,we will certainly not be able to serve as many low-income Dublin residents,as we still need to ensure that we are not running our camp at a major deficit. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? � Yes r No ' 23.If you answered yes to the preceding question please explain.Enter"NIA"if not applicable. N/A 24.CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project(e.g.one time expenses for construction,equipment,furniture,fixtures)? � Yes � No.If no,enter N/A for questions 25&26,and check Not applicable for question 27 25.If your agency is requesting Capital funding,describe the detailed scope of work for the project.[You will also be asked to attach a budget,photos,designs,site plans,specs,etc.later in the"Documents"tab.]Enter"NIA"if not applicable. n/a ' 26. If your agency is requesting Capital funding please describe any land tenure issues(e.g.does your agency own or lease the property,lease terms,plans for future relocation or expansion,etc.).Enter"N/A"if not applicable. n/a 27.if your agency is requesting Capital funding,will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? � Not Applicable r Yes � No (� Not known(please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28.PERFORMANCE MEASURES IdentiTy AT LEAST ONE of the City of Dublin's Mission&Vision Statements:(you may choose more than one) (� Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. r Balance history with progress,to sustain an enlightened,economically balanced and diverse community. (W Encourages innovation of City life,including programs to strengthen our economic vitality,supports environments stewardship and sustainability through the preservation of our natural surroundings. (� Promotes active and healthy lifestyle through the creation of first-class recreational opportunities,facilities and programs. 29.Identify AT LEAST ONE of the City of Dublin's Values:(you may choose more than one) r Building Community:by promoting locations and events that brings people of all ages together;providing more venues for family-based activities and fostering heritage and cultural development � Ensuring a Safe Community:by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety r Guiding Development:to assure that development contributes positively to the City's fiscal health;supports pedestrian-friendly development, transit-oriented development,green building and environmental responsiveness;promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City r Governing:that commits to openness and responsiveness to the public and community;operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service;responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication � Relating to Other Communities and Entities:by encouraging collaboration and communication with other communities on issues of mutual concern,and encouraging public and private partnerships of mutal benefit 30.**QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDING ONLY.*•Are you are interested in applying for CDBG funds7 � Yes.If so,answer questions 31 through 43. �' No.If no,check box here,and questions 31 through 43 will not be required.. � Don't know.If you are unsure,please call the City at(925)833-6645 and speak to a staff person that can answer your questions. 31.CDBG t7NLY-Explain your Lirnited Ezigiish Proficiencytl.anguage Access Plan(LEPILAPj.How daes your agency outreach to iimited Engiish speaking residents ta encourage access ta services&housing?What access accommodations are used?Prov'sde detail � ans�ver�noi{are:se;�ted b�cet:se r�t t!ae ans�ve!rc�k�3{,'.. 32.CdBG aNLY-identify AT�EAST ONE U.S.Departmeni of Housing and Urban Development(HUD}Consolidateci Pian Guiding Princip4e that r�lates to yaur praject: � ar��sw���r�ot�3resc;r�tC�;r.l beca�ise of tt;e ar��GV�r fo�#3C?_ 33.GDBG flNIY-Identify AT LEAST ONE U.S.Departmenk of Nousing and Urban Deveiopment(HUD)Consolidated Platt Goals that relates to your project: -ans4��er not presented because af fhe ar,sbver to#3�- 34.GDBG ONLY-identify AT LEAST ONE U.S.Department of HUD 5trategic Goal that relates to your projact: -af;st-ver not presented because of tl�e ansaver to�i30- 35.CDBG ONLY-Identify AT LEAST QNE ll.S.Qepartment of HUD Policy Priarity that relates to your project: -ar;si-�rer noi presenfsd because af tr�e ans4+.�er'o�30- 36.CDBG QN�Y-identify AT IEAST ONE Consolidated Pian abjective that relates to yaur project: -anst-��er no!preser�ted Gecause of fhe ans4ver!o#30- 37,CDBG ONLY-Select ONE Objective that relates to your prajecY(TIP:When seiecting an objective ask yourseif,"What is the purpose of the activity?What is the larger cqmmureity need that 1 atn seeking to address?"j: -_-3ns:ver r?ra`r;!'es��r;+ec9 r;e<;ause o1 it?e ar,s!.a�tt>s�:?�i 38.GDBG QNLY•Select�NE 9utcome that r�lates to your prnject{TIP:YVhen selecting an outcome ask yourself;"What type of change or result am i seeking?"): -ans�.t�er r,ot prese��ter�t�ecause o: �e ans4ver,o �- 39.CDSG ON�Y-Selsct QNE Specific Indicator that ralates to your project: -ans��ver not p+esented'vecau�e of fhe ans�yer to#30- 40.CDSG ONLY•Please choose a cammon indicator that your agency wiii use to track ciients{select only ONE}: -ans.arer not presented because of t»e ans4ve?to#34- . 41.CDBG t7NLY-Far the category you selected above,provide the totai numtaer o�undupiicated dublin ciients(Ei7NER Persons OR Households}your agency anticipates serving through this project: ' -ans�der�aaT or�senTed hecazts�of fhe answer to#.3Q- �� 42.CDBG ONLY-Based on tha common indicator you selected abave, please list the number af undupiicated Dubiin clients yaur agency anticipates serving in each category."if rinne, please enter"0". . _��r�t,,.,;n,r;o?tir£�:s-P7i;E,t7(;ec%:tr�E',o`'17e r>%;svV£*/�%o#:3.�'i... � 43.CDBG ONLY� List the number of clients your at�ency anticipates serving in racelethnicity categories.The sum entered bekow must match th�total ciients entered in#42 above. Per NUD"Mispanic"is an ethnicity,nat a race."if nane, piease enter"0" . -dnsbYEr 2'r�,r e r t'Ct�i( �..'SF,t)' t �e..:>b°�r :�a 3t;sl)- . 44.If your agency is submitting more than one application or the same agency has differe�t programs within it,please RANK the priority of this application,with number 1 being the highest priority for funding.There should only be one#1 PER AGENCY (� #1 -This program/project has the highest priority for funding within the organization,agency,district or entity. � #2-This program/project has the 2nd highest priority for funding within the organization,agency,district or entity. � #3-This program/project has the 3rd highest priority for funding within the organization,agency,district or entity. (— #4-This program/project has the 4th highest priority for funding within the organization,agency,district or entity. � #5-This program/project has the 5th highest priority for funding within the organization,agency,district or entity. I— #6-This program/project has the 6th highest priority for funding within the organization,agency,district or entity. � If you have more than 6 applications per organization,agency,district or entity,check here. 45.Please describe actions your organization is taking to become financially self-sufficient(i.e.what steps are you taking to reduce dependency on the City's grant program). The Tri-Valley YMCA is completely self-sufficient financially for the programs that are already running.That being said,there are emerging needs in the community every year,and we are relying on the City's grant program(as well as all of the other funding streams out there)to help us address these needs-including the INCREASED need for affordable chi�dcare in Dublin. 46.All organizations must provide valid City of Dublin Business Registration number at time of application.Please provide the organization's registration number here. BL-106916 Budget � �._ --_____��...__...____�_________�_._�.._._._._____._....__.._--- Funding Sources/Revenues Budget Amount Amount Committed Camp Fees $145,500.00 $0.00 YMCA Fundraising Events $20,000.00 $10,000.00 City of Dublin Grant Funding $25,000.00 $0.00 Additfonal Grants $35,000.00 $0.00 Staff Donations $5,000.00 $2,000.00 Board Donations $5,000.00 $3,OOQ:00 Total $235,500.00 $14,000.00 Fundin�UseslExpenses Budget Amount Amount Committed Admin Salaries`(see instructions) $18,000.00 Benefits'(see instructions) $3,600.00 Prograin Staff Salaries $145,000.00 $14,000.00 Program Staff Benefits $30,000.00 ' Outreach/Promotion $1,000.00 Supplies/Materiai _ $8,500.00 Facility Rental $13,000.00 Transportation Costs and Entrance Fees $16,400.00 Total $235,500.00 $14,000.00 Budget Narrative The primary cost involved in running day camps is staffing.We have approximately 20 part time staff one full time camp director and a senior program director who oversee our camping programs. rogramma ic cos s cover a s an cra s supp ies, eaming ma ena s,spo s eqwpmen,snac s an camp s i s. e wi pay approximately 13,000 in rental costs for ten weeks of camp. In the past,we were able to collect more camp fees,but now more and more families need financial assistance,even though our camp is the more affordable option in the Tri-Valley. '*`Please Note-Since the primary cost of camp is the staffing,we are only able to add more low-income families to our camp if we add additional staff.This is why we are applying the City of Dublin grant to this line item. Documents Documents Requested* Required? Attached Documents* Program Expense Budget for ALL Grant Requests I^� Propram Expense Form downlaad tempiate Financial Information Form for ALL Grant Requests r Financial Informatian Form dowMoad temolate List of Board of Directors(or goveming body)with contact r YMCA E3aard Roster information CurrentAnnual Budgetforthe Entire Agency (' Tn-Vailev YMCA Budttet Copy of most recently submitted IRS 990 form or Tax Return � YMCA 990 (include complete form) Board of Director's(or governing body's)designation of r Soard Desianation authorized official Board of Director's(or goveming body's)authorization to � Baard Authorization request funding(may be same document as one above) Proof of insurance carried,including bonding,liability and/or � Proaf of Insurance workers'compensation R�QUIRED FQR CDBG ONIY-If requesting Capital Funding, r please upload'your Capital expenditute budget(your own format is aeceptable) REQUIRED FOR CDBG ONLY-PERSONNEL POLICIES INCLUDING � AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY-AGENCY AUDIT REQUIREMENTS r AND COPY OF LAST AUDIT HIGHUGHTING"FINDWGS" SECTION REQUIRED FOR CDBG ONLY-ARTICLES OF INCORPORATION � AND BYLAWS. REQUIRED FOR CDBG ONLY-CONFLICT OF INTEREST � STATEMENT(IF NOT INCLUDED IN BYLAWS) REQUIREO FOR CDBG ONLY-ORGANIZATION CHART r STATE AND FEDERAL NON-PROFIT DETERMINATION IETTER. �' ;RS Letter All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application.Non-compliant applicants will be disqualified. REQUIRED FOR CDBG ONLY-AGENCY'S LIMITED ENGLISH r PROFICIENCY IANGUAGE ACCESS PLAN(LEP/LAP).Must include outreach to limited English speaking residents to encourage access to senrices&housing.Include what access accommodations are used. REQUIRED FOR CDBG-LEVERAGING REPORT-this is due with r the 2nd quarter report no later than January 15th Certified Audit andlor Ce�tified financial Statements � Audited Financials •ZoomGrantsT""is not responsible for the content of uploaded documents. Application ID:48496 � Become a fan of Zaan��(>ran!s"'on Facebook � Problems7 Contact us at Quostion��la?Gu�inGrarts.cnm �� �2002-2018 GrantAnalyst.com.All rights reserved. �. � "ZoomGrents"and the ZoomGrants logo are trademarks of GrenlAnalyslcom,LLC. .. � i�EA�;v.s . ATTACHMENT 3 �� . . t��B��� Mission, Vision & Values ��� r������ Ensuring the Prosperity & Well-Being of Our Community The City Council adopted Dublin's Mission, Vision, and Values statements as part of the City's 10-Year Strategic Plan. These statements are intended to serve as guidance for the City Council and commissions in their deliberations on various proposals presented to them, and to ensure that our developing community remains happy, healthy, and well-balanced. These statements were updated and modified in 2013. Our Mission The City of Dublin promotes and supports a high quality of life, ensures a safe and secure environment, and fosters new opportunities. Our Vision Dublin is a vibrant city committed to its citizens, natural resources, and cultural heritage. As Dublin grows, it will balance history with progress,to sustain an enlightened, economically balanced and diverse community. Dublin is unified in its belief that an engaged and educated community encourages innovation in all aspects of City life, including programs to strengthen our economic vitality, and support environmental stewardship and sustainability through the preservation of our natural surroundings. Dublin is dedicated to promoting an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities, and programs. Our Values . Our Values in Building Community o Promote locations and events that bring people of all ages together. o Provide more venues for family-based activities. o Foster heritage and cultural development. • Our Values in Ensuring a Safe Community o Provide high quality police and fire services to insure the safety of the citizens living in the community. o Provide education and training to residents and businesses that would promote public safety. . Our Values in Guiding Development o Assure that development contributes positively to the City's fiscal health. o Support pedestrian-friendly development,transit-oriented development, green building, and environmental responsiveness. o Promote high quality design and architectural standards in private development and in all public facilities. o Develop transportation systems that facilitate ease of movement throughout the City. � E-� z w � x U Q F � -� d � � � � _ �� Q +-+ �� � � cII cn � � V U r. j � � � � _ � � i — � N � � � ����� � � � U � � C'�� O � aA � , � ?� }+ � v CO +.+ � L' 'v? � � u c� � v � � . � •� � �� ' �� a � � :� �3 ,r,.► � N N � Q � t�A � ' � � ._ � � , � O 'aio � ��„' �r � � � p � � � � ' � tk � � �+. �w O y� � , w � � p � � � Ca 'a U taA ti � � : Y ' - � - � , .. �i � ` � '� , cn � � 41 3 � V � ,�.� fa (B � .+n � � "� � ; t � ,_., � � � 'M. +-+ t� V, � � C � � 't3 � �p � N � .> � � -� � � � � .� O N c"� }+ c� cn � � � '� � � u � � � p O � � � � � +� `� ; •r fa +�-+ � � N � fa � � L*. t� � V L N � :� ,�°�, � -� s o � ° `� a �- �` � a L � � � _ � �, � � O � � � � � 00 s�3 Q Z � I--- G'� :E ATTACHMENT 5 ,�� City of Dublin C'�lJB�IN Universal Grant Rating Sheet c ��.r F t��rv�� Tti BE FlLLED OUT BY CITY STAFF Organization: Program: PROPOSALSCORE Maximum of 15 points RECOMMEND FUNDING Yes ❑ No ❑ FUNDING SOURCE CDBG❑ Comm. Grant❑ Incl. Fund❑ Total Requested Total Recommended IF RECOMMENDING CDBG FUNDING, NOTE THAT CDBG FUNDS MAY ONLY BE USED FOR THE FOLLOWING ACTIVITIES AS DEFWED BYTHE U.S.DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (CHECK ONE). CAPITAL PROJECTS ❑ PUBLIC SERVICE ❑ HOUSING ❑ ECONOMIC DEVELOPMENT ❑ THE WORD°PROGRAM"IS USED BELOW ON THIS FORM TO INCLUDE SERVICES,ACTIVITIES OR IMPROVEMENTS. 1. Organization/Management • The organizarion previously received funding from Dublin,and has fully complied with the City's management procedures,including invoice and report deadlines. • The organization, as presented in the application,is able to achieve the stated goals and outcomes. • The organization and their staff are qualified and have the capacity to provide for the program. (i.e.non-profit status, resumes for staff, a Board of Directors,information on clients served). • The organization has completed all required aspects of the application process. • The proposed program has a successful proven track record (not a new program). (Maximum of 5) 2. Needs/Benefit • The beneficiaries are an appropriate target group (lower income residents,handicapped,elderly,youth, etc.) • The organization provides an activity to Dublin residents that other organizations do not provide. � t�ppli«nt's ac.t��it�y�: (choose a or b) � a. t�enc.fits �z mzjc�rir�- oflh�blin rc�iden�� tav inceciil�; the C;it� � Mi�Sion V�Sion and ValueS C1R b. mf.f.ts a.t:le�rst one of rhe l���.5.I�e��artineut:�f[Iousi�i��znd t rl��an llevc.lo�ntcnt>>riate�t�C;oals or Polir.e I'rioritie�. • The organizarion's program meets one of the 14 Areas of Concern as identified in the 2011 Eastern Alameda County Needs Assessment Report • The organization collaborates with other agencies to enhance services. (Maximum of 5) 1 3. Funding/ Budget � • The amount of funding requested compared to the number of Dublin residents served is reasonable. • Fiscal responsibility-evaluation of the most current audit does not reveal one or more*material weaknesses* (or equivalent) that could jeopardize other funding. • Program and administrative budget covers the cost to provide for the pxogram. • The organization leverages other funding sources to pxovide activities/services/improvements. • The organization charges a fee and/or produces other income that may be used to support this program (review submitted fee schedule if applicable). (Maximum of 5) *Standardized accounting audit statements . 1. A"Control Deficiency",which is the lowest of the three deficiencies,exists when the design or operation of a control does not allow management or employees,in the normal course of performing their assigned functions, to prevent or detect misstatements on a timely basis. 2. A "Significant Deficiency" is a control deficiency or a combination of control deficiencies, that adversely effects the organization's ability to initiate,authorize,record,process or report financial data in accordance with the Generally Accepted Accounting Principles,and that the likelihood of a misstatement of the organization's financial statement that is more than inconsequential which will not be prevented or detected by the organization's established internal controls. 3. A"Material Weakness", is a significant deficiency or a combination of significant deficiencies,that results in more than a remote likelihood that a material misstatement of the financial statements which will not be prevented or detected by the organization's established internal controls. ❖ Rating Criteria is subject to change from time to time to reflect the current industry or to address the type of applications received.❖ 2