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HomeMy WebLinkAbout8.1 FY 17-18 HS Grants Program Funding Recommendations ITEM NO: 8.1 Page 1 of 7 STAFF REPORT HUMAN SERVICES COMMISSION DATE: March 23, 2017 TO: Honorable Chair and Commissioners FROM: Rhonda Franklin, Management Analyst SUBJECT: City of Dublin Fiscal Year 2017-18 Human Services Grants Program Funding Recommendations 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 non-profit organizations applying for grant program funding; discuss the grant applications; review Staff’s recommendation for funding levels, and make funding recommendations for City Council consideration at the April 18, 2017 City Council 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. The estimated Fiscal Year 2017-18 CDBG allocation is $75,602 for direct support of social service programs in the Dublin community, which is the amount received for Fiscal Year 2016-17. This amount is estimated as the final allocations from the Department of Housing and Urban Development (HUD) are currently unknown. General Fund support for Fiscal Year 2017-18 is $140,000 as established by the City Council, and Affordable Housing Fund support is $8,000. In compliance with grant program guidelines, all grants applications must comply with a $3,500 minimum and $25,000 maximum per application request. RECOMMENDATION: Receive Staff recommendation on funding levels, receive organization presentations, deliberate, and make funding recommendations for City Council consideration. DESCRIPTION: The City of Dublin Human Services Grants Program provides financial support to local non-profit organizations serving the Dublin community. The program is supported through three funding sources including the federally funded Community Development Block Grant (CDBG) program and the City’s General Fund and Affordable Housing Fund. Each year the City Council awards funding to organizations Page 2 of 7 that best meet the community’s needs in support of the City’s adopted Mission, Vision and Values (Attachment 1) and needs identified in the Tri-Valley Needs Assessment (Attachment 2). Final consideration of the City Council’s grant funding recommendations is tentatively scheduled for May 2017 as part of the Fiscal Year 2017-18 budget approval. Staff has reviewed the Fiscal Year 2017-18 grant applications to verify that all requests qualify for funding based on the adopted program guidelines. As part of the review, Staff applied the City Council-approved Rating Criteria Worksheet (Attachment 3) to each grant application. Each funding source has variation in application and use requirements and these differences were taken into consideration during the Staff review process. The rating for each application is listed in Attachment 4. The Rating Criteria is only one of several factors used in determining Staff’s funding recommendations. Other factors include consideration of 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, and • whether City funds are used to leverage other funding sources. Based on the Human Services Commission’s work in establishing local and regional priorities, additional consideration was given to applications addressing needs in the areas of: Behavioral Health (mental health and substance abuse), Health Care (including dental), and Senior Services. At the mandatory Grant Application Workshops, grant applicants were informed that the presentation order for this meeting would be based on the date/time their completed application was submitted through ZoomGrants. Attachment 5 provides a chart listing the order in which applications were submitted and will be presented. Human Services Grant Support Fiscal Year 2017-18 marks the 13th year of the City Council’s adopted Human Services Grant funding process. The Fiscal Year 2017-18 funding cap for Human Services Grants Program has been established by the City Council at $140,000 from the General Fund. The General Fund allocation has been supplemented with $8,000 from the Affordable Housing Fund. This approach has provided additional flexibility in funding community organizations providing valued services to Dublin residents. At the October 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, going forward grants would not be awarded to arts or school-based programming or events, but would be focused on the most critical human services needs such as health care, food and nutrition, homelessness, child care, etc. CDBG Program Ba ckground 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 County CDBG Program to allocate funds and to assure that all CDBG-funded activities are in compliance with federal regulations. The City’s CDBG funding allocation for Fiscal Year 2017-18 is estimated at $75,602. This is the amount available for direct support of community programs; however, the City has three (3) additional CDBG funding commitments which are taken off the top of the City’s overall CDBG funding allocation: Page 3 of 7 • The County of Alameda administered City of Dublin’s housing rehabilitation program, estimated at $14,920. • The County of Alameda administered tenant/landlord and fair housing services, and rental rehabilitation program for all Urban County cites, estimated at $210,376 for all six (6) Urban County entities. • Administration fees up to $6,600 are allocated to support the City’s administration of the CDBG program. Alameda County Urban County CDBG Program 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 County Cities,” along with the unincorporated areas of Alameda County. During the current Fiscal Year (FY 2016-17), the City of Dublin received $75,602 for direct support to organizations. This same amount is being estimated for Fiscal Year 2017-18 until the City is provided the approved funding level from Alameda County. Project Type: Public Service Project vs. Capital Project Each year, the County limits each Urban County City to only 12% of the CDBG allocation for service-based organizations and projects. Based on the estimated CDBG allocation, this amount would be $12,373 for public service projects, with the remaining $63,229 for capital projects. The County’s past practice has 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 2017-18, Staff will work with eligible grant applicants and the County to make adjustments as necessary, including implementation of a prorated reduction for all CDBG awards, if necessary. This year the City received two (2) capital project requests and 25 public service project requests. The City typically receives far more service project requests than capital project requests. Existing Facility Project Loan Obligation (Axis Community Health – Health Center) On May 6, 2014 the City Council approved a resolution authorizing the City to enter into a Public Participating Jurisdiction 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 Health Center expansion in Pleasanton. The facility grand opening was held in May 2016. The PPJ allowed the agencies, with city of Pleasanton acting as lead agency, to borrow $1.25 million to support Axis Community Health’s facility construction. As a result of the agreement, the City of Dublin is required to repay its portion of the loan, a total of $265,618, (or approximately $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 4. Outreach Efforts There are many points of contact with organizations as part of the Human Services Grants Program application process. These outreach and education efforts included: • Notices of funding availability and upcoming community workshops to non-profit organizations. • A Request for Proposal was advertised three times in the local newspaper with an open application period from December 1, 2016 to January 8, 2017. • Program announcements and information were posted on the City website with links to the Zoom Grants Application. Page 4 of 7 • Three Mandatory Grant Application Workshops to review the online Zoom Grants Application process and discuss program guidelines for the Fiscal Year. All Fiscal Year 2017-2018 grant applicants attended at least one of the mandatory workshops. Grant Applications Analysis During this year’s application period, the City of Dublin received 27 applications from 22 organizations, a 29% increase in applications from last year. Of the 27 applications received, nine (9) are eligible for CDBG funding. Five (5) organizations submitted applications for two (2) different programs/projects: • Chabot-Las Positas Community College District/Tri Valley One Stop Career Center • Child Care Links • Hope Hospice • Tri-Valley Haven • YMCA of the East Bay Tri-Valley Branch. Attachment 4 summarizes the Fiscal Year 2017-18 funding requests including: the organization’s name and program; the Fiscal Year 2016-17 funding award (if any); the organization’s Fiscal Year 2017-18 funding request; Staff’s 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. The following table shows the number of projects recommended for funding by project type. Project Type Quantity Sum of Recommended Funding Capital/Rehab* 2* $20,502* Services – Medical/Health 1 $10,000 Services – Food 2 $24,100 Services – Homeless 2 $19,000 Services – Financial/Legal 3 $19,000 Services – Disabled/Special Needs 3 $35,000 Services – Other 8 $96,000 Total Projects 21 $223,602 *Includes the Axis Community Heath Facility Loan Obligation Recommendation for Community Development Block Grant (CDBG) Fund Of the 27 applications received, cycle, nine (9) applicants qualified and indicated they were willing to meet the strict federal guidelines for use of CDBG funds. Staff has reviewed past program performance (where applicable) and proposed programs of the service providers to ensure the activities are in compliance with HUD/CDBG guidelines. As a requirement of funding, the City performs a 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. As stated above, an estimated $75,602 in CDBG funds will be allocated to the City for direct funding to organizations. Staff recommends funding seven (7) organizations for Fiscal Year 2017-18 through the CDBG program as follows: Page 5 of 7 CDBG FUND RECOMMENDATIONS FISCAL YEAR 2017-18 Organization Project Requested Amount Recommended Amount Axis Community Health* Facility Project Loan Obligation* $13,502 $13,502 Axis Community Health Enhancing Health Outcomes with Patient Care Messaging $7,000 $7,000 CALICO Center Dublin Child Abuse Intervention $10,000 $10,000 Community Resources for Independent Living (CRIL) Independent Living, Housing & Employment Services for People with Disabilities $10,118 $10,000 Open Heart Kitchen Dublin Meal Programs $25,000 $14,100 Spectrum Community Services Meals on Wheels for Dublin's Homebound Seniors $10,000 $10,000 Tri-Valley Haven Homeless Services Program $25,000 $11,000 Total $100,620 $75,602 *The Axis Community Health Facility Project Loan Obligation agreement was executed in July 2015 and is a 20-year loan repayment commitment, through 2035, with payment remitted annually with CDBG funds. These recommendations are based on City Council discussions, funding decisions approved during the last several grant funding cycles, and the factors identified above. For the past seven years, the City Council has emphasized basic life needs such as food, shelter, and health care, and mental health services in grant funding decisions. The CDBG recommendations are reflective of that approach. Should there be 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, organizations would be required to submit quarterly reports on their progress in reaching the goals and participate in annual site monitoring. Recommendation for General Fund Of the 27 eligible applications received during this year’s application cycle, most applications met Human Services Grant funding criteria. Staff has reviewed past program performance (where applicable) and proposed applicant activities to ensure compliance with program guidelines. As a condition of funding, the City will require 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 Fiscal Year, the summary reports will be provided to the Human Services Commission as an informational item. Staff recommends 13 organizations be funded with the General Fund as follows: Page 6 of 7 GENERAL FUND RECOMMENDATIONS FISCAL YEAR 2017-18 Organization Project Requested Amount Recommended Amount Center for Community Dispute Settlement Tri-Valley Youth Court $3,500 $3,500 Chabot-Las Positas Community College District/Tri Valley One Stop Career Center Dublin Job Initiative $19,385 $15,000 Chabot-Las Positas Community College District/Tri Valley One Stop Career Center Tri-Valley Volunteer Income Tax Assistance (VITA) $7,430 $7,000 Child Care Links Diaper Pantry $13,000 $8,000 CityServe of the Tri-Valley CityServe of the Tri-Valley $15,000 $15,000 Deaf Counseling Advocacy and Referral Agency (DCARA) Deaf Seniors Services $25,000 $10,000 Easter Seals Bay Area Easter Seals Kaleidoscope $15,000 $15,000 Eden I&R, Inc. 2-1-1 Alameda County Communication System $10,000 $10,000 Hope Hospice, Inc. Grief Support Center and Hospice Volunteer Program $18,500 $15,000 Legal Assistance for Seniors Legal Services, HICAP and Community Education for Dublin Seniors $10,000 $8,500 Senior Support Program of the Tri-Valley Case Management $14,280 $13,000 YMCA of the East Bay, Tri-Valley YMCA Affordable Summer Childcare – YMCA Day Camp $25,000 $10,000 YMCA of the East Bay, Tri-Valley YMCA Mental Health Services $25,000 $10,000 Total $201,095 $140,000 R ecommended Affordable Housing Fund Of the 27 applications received, one (1) organization is being recommended for funding through the City’s Affordable Housing Fund: Tri-Valley Haven Domestic Violence Program. 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 funding source in prior years. Using the Affordable Housing Fund for this program provides additional flexibility in awarding funding for applicants furthering the grant program goals. Staff recommends one (1) organization be funded with the Affordable Housing Fund as follows: AFFORDABLE HOUSING FUND RECOMMENDATIONS FISCAL YEAR 2017-18 Organization Project Requested Amount Recommended Amount Tri-Valley Haven Domestic Violence Services Program $25,000 $8,000 Total $25,000 $8,000 Organizations Not Recommended for Funding Of the 27 applications received, seven (7) organizations are not being recommended for funding. The overall funding amount requested exceeded the amount available by almost 90%. As a result, the City is unable to Page 7 of 7 fund all of the application requests. Additional reasons include fund requests being passed through for scholarships, projects not providing direct critical human service needs, and funds requested could be eligibility for other educational and arts related grants. The organizations not being recommended for funding include the following: ORGANIZATIONS NOT RECOMMENDED FOR FUNDING FISCAL YEAR 2017-18 Organization Project Requested Amount Child Care Links Professional Development Training $7,000 Hope Hospice Unified Communications Phone System $20,000 Kidango, Inc. Emerald Vista Parent Workshops $2,000 Sandra J Wing Healing Therapies Foundation Cancer Assistance for Dublin Residents $10,000 Sunflower Hill Sunflower Hill Garden Teachers/Educators $20,120 Team Esteem Student and Parent Education Programs $10,000 Valley Children’s Museum Valley Children’s Museum Children’s Program $25,000 Total $94,120 Summary In total, grant applicants requested $420,835 in funds with only $223,602 grant funds available. The following chart summarizes the total funding requests and Staff recommendations for the Fiscal Year 2017-18 Human Services Grants Program: Funding Sources Funding Request for FY 2017-18 Available Funds & Staff Recommendation FY 2017-18 CDBG Fund $174,898 $75,602*, ** General Fund $245,937 $140,000 Affordable Housing Fund $0*** $8,000 Total $420,835 $223,602 * Estimated amount available for direct funding to community organizations. ** Includes allocation to the Axis Community Health Facility Project Loan Obligation. *** All 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 web link to the Staff Report was sent to all grant applicants. ATTACHMENTS: 1. City of Dublin Mission, Vision and Values 2. Tri-Valley Needs Assessment 14 Areas of Concern 3. Grant Rating Criteria Worksheet 4. Funding Recommendations Summary Table with the Grant Applications attached as Exhibits 5. Grant Applicant Presentation Order Mission, Vision & Values 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. 14 A R E A S O F C O N C E R N as I d e n t i f i e d i n t h e N e e d s A s s e s s m e n t 20 1 1 T r i - V a l l e y N e e d s A s s e s s m e n t Fi n d i n g s b y A r e a o f C o n c e r n * 1 Be h a v i o r a l h e a l t h ( m e n t a l h e a l t h an d s u b s t a n c e a b u s e ) 8 Di s a b i l i t i e s 2 Af f o r d a b l e h o u s i n g 9 Fo o d a n d n u t r i t i o n 3 He a l t h c a r e 10 Se n i o r s e r v i c e s 4 Wo r k f o r c e d e v e l o p m e n t 11 Yo u t h s e r v i c e s 5 Ho m e l e s s n e s s 12 Ch i l d c a r e , e a r l y c h i l d h o o d deve l o p m e n t a n d e d u c a t i o n 6 Tr a n s p o r t a t i o n s e r v i c e s a n d a c c e s s 13 Ch a n g i n g d e m o g r a p h i c s a n d gr ow i n g d i v e r s i t y 7 Do m e s t i c v i o l e n c e a n d c h i l d a b u s e 14 Fi n a n c i a l a s s i s t a n c e *P a g e 3 3 E a s t e r n A l a m e d a C o u n t y H u m a n S e r v i c e s N e e d s As s e s s m e n t 1 Organization: ______________________________ Program: _______________________________ PROPOSAL SCORE 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 DEFINED BY THE 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 organization 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.  Applicant’s activity: (choose a or b) a. benefits a majority of Dublin residents by meeting the City’s Mission, Vision and Values OR b. meets at least one of the U.S. Department of Housing and Urban Development’s Strategic Goals or Policy Priorities.  The organization’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) ______ City of Dublin Universal Grant Rating Sheet TO BE FILLED OUT BY CITY STAFF 2 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 program.  The organization leverages other funding sources to provide 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. FUNDING RECOMMENDATIONS SUMMARY ATTACHMENT 4 1 of 2 ORGANIZATION NAME APPLICATION TITLE FY 2017-18 REQUESTED FUNDING FY 2016-17 APPROVED FUNDING RECOMMENDED FUNDING CDBG FUND AFFORDABLE HOUSING FUND GENERAL FUND RATING POINTS EARNED NUMBER OF NEEDS ADDRESSED Axis Community Health Facility Project Loan Obligation (annual)$13,502 $13,953 $13,502 $13,502 $0 $0 N/A N/A Axis Community Health Enhancing Health Outcomes with Patient Care Messaging $7,000 N/A $7,000 $7,000 $0 $0 14 1 CALICO Center Dublin Child Abuse Intervention $10,000 $8,314 $10,000 $10,000 $0 $0 15 4 Center for Community Dispute Settlement Tri Valley Youth Court $3,500 N/A $3,500 $0 $0 $3,500 15 2 Chabot-Las Positas Community College District/Tri Valley One Stop Career Center Dublin Jobs Initiative 2017-2018 $19,385 $15,000 $15,000 $0 $0 $15,000 15 1 Chabot-Las Positas Community College District/Tri Valley One Stop Career Center Dublin VITA Grant 2017-18 $7,430 $6,000 $7,000 $0 $0 $7,000 14 1 Child Care Links Child Care Links Diaper Pantry $13,000 N/A $8,000 $0 $0 $8,000 12 2 Child Care Links Professional Development Trainings $7,000 N/A - - - -12 1 CityServe of the Tri-Valley CityServe of the Tri-Valley $15,000 $15,000 $15,000 $0 $0 $15,000 14 11 Community Resources for Independent Living Independent Living, Housing & Employment Services for People with Disabilities $10,118 $8,000 $10,000 $10,000 $0 $0 Deaf Counseling Advocacy and Referral Agency (DCARA) Deaf Seniors Services $25,000 N/A $10,000 $0 $0 $10,000 12 2 Easter Seals Bay Area Easter Seals Kaleidoscope $15,000 $15,000 $15,000 $0 $0 $15,000 12 6 Eden I&R, Inc.2-1-1 Alameda County Communication System $10,000 $10,000 $10,000 $0 $0 $10,000 15 14 Hope Hospice, Inc.Grief Support Center and Hospice Volunteer Program $18,500 $15,000 $15,000 $0 $0 $15,000 15 4 Hope Hospice, Inc.Hope Hospice - Unified Communications Phone System $20,000 N/A - - - -13 4 Kidango, Inc.Emerald Vista Parent Workshops $2,000 N/A - - - -11 1 Legal Assistance for Seniors Legal Services, HICAP and Community Education for Dublin Seniors $10,000 N/A $8,500 $0 $0 $8,500 14 3 Open Heart Kitchen OHK-Dublin Meal Programs $25,000 $13,579 $14,100 $14,100 $0 $0 15 5 Sandra J Wing Healing Therapies Foundation Cancer Assistance for Dublin Residents $10,000 $10,000 - - - -14 1 2 of 2 ORGANIZATION NAME APPLICATION TITLE FY 2017-18 REQUESTED FUNDING FY 2016-17 APPROVED FUNDING RECOMMENDED FUNDING CDBG FUND AFFORDABLE HOUSING FUND GENERAL FUND RATING POINTS EARNED NUMBER OF NEEDS ADDRESSED Senior Support Program of the Tri Valley Case Management $14,280 $12,579 $13,000 $0 $0 $13,000 1 Spectrum Community Services Meals on Wheels for Dublin's Homebound Seniors $10,000 $9,179 $10,000 $10,000 $0 $0 15 3 Sunflower Hill Sunflower Hill Garden Teachers / Educators $20,120 N/A - - - -13 2 Teen Esteem Teen Esteem Student and Parent Education Programs $10,000 N/A - - - -12 2 Tri-Valley Haven Domestic Violence Services Program $25,000 $8,000 $8,000 $0 $8,000 $0 15 3 Tri-Valley Haven Homeless Services Program $25,000 $10,000 $11,000 $11,000 $0 $0 15 6 Valley Children's Museum Valley Children's Museum (VCM) Children's Programs $25,000 N/A - - - -13 2 YMCA of the East Bay, Tri-Valley YMCA Affordable Summer Childcare - YMCA Day Camp $25,000 $10,000 $10,000 $0 $0 $10,000 15 2 YMCA of the East Bay, Tri-Valley YMCA Mental Health Services $25,000 $10,000 $10,000 $0 $0 $10,000 15 3 $420,835 $189,602 $223,602 $75,602 $8,000 $140,000TOTAL Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Open Heart Kitchen OHK-Dublin Meal Programs $ 25,000.00 Requested Submitted: 12/20/2016 1:20:06 PM (Pacific) Project Contact Heather Greaux executivedirector@openheartkitchen.org Tel: 925-580-1616 Additional Contacts executivedirector@openheartkitchen Open Heart Kitchen 1141 Catalina Drive #137 Livermore, CA 94550 United States Interim Executive Director/Operations Director Clare Gomes operationsdirector@openheartkitchen.org Telephone(925) 580-1616 Fax Web www.openheartkitchen.org Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Open Heart Kitchen serves prepared, nutritious meals free of charge to the hungry people of Tri-Valley area. We provide a safety net for our neighbors in need during challenging times. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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 1995 as an interfaith effort, Open Heart Kitchen serves more than 300,000 meals annually at 11 servings sites and 25 drop off locations. OHK is the largest meal program of its kind in the Tri-Valley. We have 3 meal programs in Dublin: our Hot Meal Program, our Senior Lunch Program and our Children's Weekend Bag Lunch Program. Our hot meals are made from scratch by our volunteers and served from four locations, Monday through Friday, to anyone in need. Each meal consists of a protein, starch, vegetable, green salad, fruit salad, bread, beverage, and dessert. Our Weekend Bag Lunch program fills the nutritional gap for low income, food in-secure children. Children who receive free school lunches during the Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None week are left without a secure source of nutrition on the weekends. OHK distributes bag lunches to these children and their younger siblings on Friday afternoons. This program continues during the summer months at summer school and low-income housing units. We also provide this program to seniors in a low income senior housing unit and to a local program who provides free services to the Homeless population. Our Senior Meal Program addresses the nutritional gap of low-income seniors. We prepare and serve dinner or lunch for low income seniors 60+ years of age. Monday through Friday. Seniors from the Tri-Valley area are encouraged to join Open Heart Kitchen for a “Senior Friendly” nutritious meal, promoting both social interaction and healthy eating. The Executive Director is responsible for the organization’s achievement of the mission and financial objectives under the direction of the Board of Directors. The Operations Director, with 12 years experience as a non-profit food service provider is responsible for ensuring programs and services are delivered effectively. The Volunteer Coordinator schedules and manages the volunteers. Site Supervisors train and direct volunteers on preparing and delivering our meals. All staff are ServSafe certified. 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. Open Heart Kitchen is seeking funding for our three Dublin meal programs: The Hot Meal Program, the Senior Meal Program, and the Children's Weekend Bag Lunch Program. Dublin Funds will be used for direct meal cost (food/supplies) 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.) 425 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. Staff and community volunteers prepare and serve nutritious meals Monday - Friday. Guests are welcome to eat their meals at our serving locations or meals can be taken "to go". Dublin Hot Meal Program: served Monday's 4-6 pm. Dublin Weekend Bag Lunch Program: bags are prepared weekly and delivered on Fridays to seven Dublin schools and the Groves low-income senior housing unit. We work with the Dublin school district to determine which schools and children will participate in the program. We have extended this program during the summer months. Dublin Senior Meal Program: served at the Dublin Senior Center Monday - Friday. The senior friendly meal includes soup, salad and a freshly prepared entree with vegetables, beverages and dessert. Log sheets are maintained daily at each site to track: number of meals served, meal cost, volunteers’ hours, and the amount of purchased vs. donated food used in each meal service. Quarterly surveys are conducted at each site to track client information. The number of meals and meal cost of each program is calculated and reported to the Board of Directors monthly. Volunteer hours are tracked online on the VO2 system and managed by our Volunteer Coordinator. Each serving site has a Site Supervisor who is Serv-Safe certified in food handling and they train and oversee our volunteers. Site Supervisors report to the Operations Director who is directly responsible for the overall operations of the organization. The Bookkeeper prepares monthly billing for the grants funding. Grant administration is overseen by the Executive Director and reported monthly to the Board of Directors. 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 Dublin grant will be used to purchase food and supplies for the Dublin Meal Programs. Funds are used for direct meal cost. One area of focus for next year for Open Heart Kitchen is to expand our Bag Lunch Program to more schools and to add more food items/adjust the food choices in the bags. Both of these goals require significant additional funding. 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 meeting the outcome(s)? The Tri-Valley Needs Assessment confirmed that hunger is growing in the Tri-Valley. Food insecurity especially impacts children and the growing senior population. Our Senior Program and our Children’s Weekend Bag Lunch Program in Dublin continue to see growth. The Assessment also noted that the homeless and working poor populations are vulnerable. Our Hot Meal Program address hunger concerns in these populations. To track improvements in our provided service, 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 number of meals served in each program every serving day, and logs are maintained by the Executive Director, the Operations Director and the Bookkeeper. The average food cost is tracked monthly by the Executive Director, the Board Treasurer and the Bookkeeper. A report on the number of meals served and the cost of each program, is presented monthly to the Board of Directors. Guest surveys are conducted each quarter to obtain information about the population we serve. We consider our programs successful if the meal count numbers remain constant with community need, and the meal cost is on budget. gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities ✔✔✔✔ Food and Nutrition ✔✔✔✔ Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education ✔✔✔✔ Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above The number of meals served each year continues to grow to meet the demographic changes in the Tri-Valley area. OHK has expanded our programs with the help of our financial donors and hundreds of volunteers, in order to meet this need. We have managed to keep the direct cost of our meals low and on budget. We collaborate with other local social service agencies and non-profit groups, to keep current on the changing hunger needs of our community. Our goal is to adjust our programs to meet any demographic and economic changes in the communities we serve. 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. Open Heart Kitchen is here to help our neighbors in need during challenging times. We serve any hungry person in need who walks in our doors. At Open Heart Kitchen ALL are Welcome. Our Guests come from all walks of life – homeless, veterans, mentally and physically disabled, senior citizens on a fixed income, working poor, the un-employed and under-employed, low-income single-parent families, children and multi-generational families. Anyone who is struggling to make ends meet. . We serve as their safety net. There is no qualifying process, and meals may be eaten at our multiple serving sites or taken as “to go” meals. The Hot Meal Program provides a healthy meal for anyone in our community in need of hunger relief. The Senior Meal Program specifically addresses the nutritional needs of our senior population. The Children’s Weekend Bag Lunch Program addresses our local children’s nutritional needs. Food is a basic human need. People who experience hunger are at risk for serious health problems. Hunger impacts daily life on every level. Nutritional deprivation has lifelong developmental effects, emotionally, physically and mentally. By providing proper nutrition for our neighbors in need, we help lower the overall health cost to the community. OHK Programs offer hundreds of local residents the opportunity to volunteer. Providing volunteer opportunities, benefits the entire community. Volunteering helps a community come together to solve the needs within their own hometown. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? OHK provides culturally appropriate services by offering ethnically diverse menu items. The menus offer a variety of culturally appropriate options and entire multi-cultural themed meals on certain holidays. Our Hot Meal Programs include a protein based entree, with a vegetable side dish, green salad, fruit salad, bread, dessert, and beverages. Although the entree is generally an animal based protein, we also offer a variety of vegetable based dishes at each meal to accommodate our vegetarian guests. For our Senior Meal Program we offer low-salt, low sugar menus that are created by a nutritionist, analyzed for nutritional requirements by a registered dietitian and approved by the Alameda Agency on Aging. We also offer quarterly nutritional education for seniors. Our Bag Lunch Program contains child friendly items, such as low sugar juice, shelf stable milk, baby carrots, fresh fruit, low sugar high fiber muffin, whole grain crackers, and a granola or protein bar. We continue to research new nutritious child friendly lunch items for this program. 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 a variety of methods to outreach in our community 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 meal programs. Our website is linked to the city's human service sites. We share information about our programs in the local news media. We utilize social media (Facebook, Instagram and Twitter) to share about our services. We are registered with the 211 human service referral process. 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 Community Food Bank referral system. We collaborate with local churches, community service groups, and local non-profits in the area to reach those in need. We create and distribute outreach fliers in multiple languages as needed to inform potential guests of OHK's services. We distribute our brochures to schools, community libraries and other Social Service agencies. We are member of Tri-Valley Anti Poverty Collaborative (TVAPC) and Tri-Valley Non Profit Alliance (TVNPA). We attend community meetings, to network and educate the community about our services. 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 Community Food Bank, local food pantries/food providers (Interfaith Sharing, Valley Bible, Tri-Valley Haven Food Pantry, Children's Emergency Food Bank, Fertile GroundWorks, Homeless Refuge), local Churches, schools, businesses, and service organizations to address the issue of hunger. We believe it is important that non-profits all work together as a community to help those in need. When food service providers and other social service agencies work in unity, we are better able to support those in need. Open Heart Kitchen believes through cooperation and collaboration together we will build a stronger community. We refer our guests to other resources such as City Serve, medical care at Axis, community laundry services and showers, Homeless Refuge, clothing providers, the mobile medical unit, We are registered with the 211 human service referral process. We are member of Tri-Valley Anti Poverty Collaborative (TVAPC) and Tri-Valley Non Profit Alliance (TVNPA). We attend community meetings to network and educate the community about our services. We work with Alameda County, the local cities and other social service organizations to meet the community needs. Open Heart Kitchen promotes community involvement by working with the local school districts, court system, and service groups, such as the 4 H clubs, National Charity League, and other youth groups, to promote joint projects that benefit the community. We partner with several organizations who support groups with special needs and schedule multiple volunteer opportunities each week at our sites. 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. We use various outreach efforts in Dublin 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 meal programs. Our website is linked to the city's human service sites. We share information about our programs in the local news media. We utilize social media (Facebook, Instagram and Twitter) to share about our services. We are registered with the 211 human service referral process. We work with Alameda County, the local cities, the local churches and other social service organizations to meet the community needs. We work with the local school districts, court system, and service groups to promote joint projects that benefit the community. We collaborate with City Serve and Children's Emergency Food Bank. We have found the Dublin residents who either volunteer or dine with us at our sites are an invaluable resource for marketing and outreaching in the local community. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The budget is determined each fiscal year using the many years of experience of the OHK Board and management. Each program budget is examined individually and is based on prior years data and the trends witnessed throughout the year. The budget is reasonable for the amount of meals we serve annually. Open Heart Kitchen tracks the cost of meals on a monthly basis. We maximize ways to use donated food and supplies from food drives. We utilize donations from local gardens to help lower the cost of meals. We closely monitor our purchased food costs monthly to make sure we stay on budget. We provide services with minimal staff and capitalize on volunteer hours, allowing us to operate extremely effectively. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If the application does not receive funding, Open Heart Kitchen will research and apply for additional funding opportunities and donations from private and corporate sources in order to keep the programs going. Without the City of Dublin funding, the meal programs may need to be reduced and the number of Dublin residents served may need to be decreased. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ 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. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. ✔✔✔✔ 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 gfedc 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 gfedc 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 gfedc 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 29. Referring to questions 27 and 28 please 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 individuals and families, by providing a nutritious free meal in a safe and dignified environment. By providing funding for OHK's meal programs, you help your neighbors in need while they struggle to make ends meet. Families can focus on staying in their home, instead of worrying where their next meal will come from. Providing this basic human need is sometimes all it takes to keep families together, allowing Dublin to maintain a diverse community, which fosters heritage and cultural development. OHK's programs offer the community the opportunity to bring residents of all ages and cultures together to serve and be served. A melting pot of volunteers come together to build a stronger community that promotes community diversity and understanding. OHK instills honesty, integrity, fairness and dignity with our guests and our community volunteers. We believe and promote effectiveness and efficiency by building partnerships with other service agencies, local businesses, 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 projects 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, social media (Facebook, Instagram and Twitter) newspaper articles, and local TV. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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 recruit multi-lingual volunteers and offer our quarterly surveys in multiple languages as needed. We have utilized the Google Apps that help translate into multiple languages. We have created and distributed outreach flyers printed in multiple languages to inform potential guests of OHK's services. We collaborate with multiple agencies and attend local meetings to increase outreach to the community and educate residents about our services. 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: 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: ✔✔✔✔ Yes. If so, answer questions 31 through 43. gfedc No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement ✔✔✔✔ Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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. ✔✔✔✔ 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. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase homeownership gfedc Promote decent affordable housing ✔✔✔✔ Strengthen communities gfedc Ensure equal opportunity in housing 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: 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?"): 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?"): 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: ✔✔✔✔ Promote participation of grass-roots, faith-based, and other community-based organizations gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability ✔✔✔✔ Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): 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: 425 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". 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" gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 125 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 300 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 20 Disabled 50 Female Headed Households 125 Senior 250 Youth 5 Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 875.00875.00 TOTAL 75 White White + HISPANIC 25 Black/African American Black/African American + HISPANIC 75 Asian Asian + HISPANIC 25 American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC 25 Native Hawaiian/Other Pacific Islander Native Hawaiian/Other 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 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 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). Management strives to find creative ways to find new funding sources. We utilize donated food and supplies to lower the cost of our meal programs. We work with our vendors to find the best pricing on bought products. By leveraging volunteers, we can operate with minimal staff, allowing us to serve clients and meals at a greatly reduced cost. 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-009270 American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC 200 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 425.00425.00 TOTAL ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed Dublin grant funding $ 25,000.00 Corporate Giving $ 35,000.00 Alameda Aging Agency $ 26,000.00 Fundraising $ 27,000.00 Churches $ 7,000.00 Individual Contributions $ 56,000.00 Workplace Giving $ 20,000.00 Other Group donations/grants $ 26,000.00 Total $ 222,000.00 $ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Dublin grant for food and supplies $ 25,000.00 Total $ 25,000.00 $ 0.00 Budget Narrative The budget is determined each fiscal year using the many years of experience of the OHK Board and management. Each program budget is examined individually and is based on prior years data and the trends witnessed throughout the year. The budget is reasonable for the amount of meals we serve annually. Open Heart Kitchen tracks the cost of meals on a monthly basis. We maximize ways to use donated food and supplies from food drives. We utilize donations from local gardens to help lower the cost of meals. We closely monitor our purchased food costs monthly to make sure we stay on budget. We provide services with minimal staff and capitalize on volunteer hours, allowing us to operate extremely effectively. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial List of Board of Directors (or governing body) with contact information ✔✔✔✔ BOD Application ID: 69643 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Current Annual Budget for the Entire Agency ✔✔✔✔ Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ BOD authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ BOD authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Insurance 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 AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE Personnel Policies Grievance Policy REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" SECTION Audit REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. Articles of Incorp REQUIRED FOR CDBG ONLY- CONFLICT OF INTEREST STATEMENT (IF NOT INCLUDED IN BYLAWS) ByLaws REQUIRED FOR CDBG ONLY-ORGANIZATION CHART Org Chart STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ 501c3 501c3-addition 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. Survey-English Survey -Spanish Survey-Chinese 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 Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Easter Seals Bay Area Easter Seals Kaleidoscope $ 15,000.00 Requested Submitted: 12/21/2016 4:46:30 PM (Pacific) Project Contact Abigail Guerdat zlupton@esba.org Tel: 925-448-4949 Additional Contacts none entered Easter Seals Bay Area 391 Taylor Blvd Suite 250 Pleasant Hill, CA 94523 United States Grants Associate Abigail Guerdat abigail.guerdat@esba.org Telephone(925)849-8999 Fax (925)849-8966 Web www.easterseals.com/bayarea Application Questions 1. Please describe your organization category (select one of the following): 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? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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.). 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 Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No ✔✔✔✔ One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding gfedc None 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 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 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 student's 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 almost 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 for each of our groups, youth, teen, and community integration altogether serving 40 participants. Nine (9) of which are Dublin residents, three (3) participants 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 learn 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 (job searching and volunteering), and transportation skills. Many of these skills stay with the participants so they can be active members of the work force. 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 meeting 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 part 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 possible without our help and support. ✔✔✔✔ Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) ✔✔✔✔ Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse ✔✔✔✔ Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services ✔✔✔✔ Child Care, Early Childhood Development and Education ✔✔✔✔ Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above 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 client/customer population served)? The Easter Seals Kaleidoscope 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, and/or 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 greater 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 participants 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 October 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. 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-world 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. 20. 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 support 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 Seals 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. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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 parties for the participants. gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc 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. gfedc 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 gfedc 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 gfedc 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 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, learn, 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. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. 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-005301 gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed Program Service Fee - Revenue $ 32,000.00 $ 9,000.00 Fundraising - Revenue $ 28,000.00 $ 15,000.00 Other income (includes interest income) $ 0.00 $ 0.00 City of Livermore HHSG $ 15,000.00 $ 0.00 City of Pleasanton HHSG $ 15,000.00 $ 0.00 Total $ 90,000.00 $ 24,000.00 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 Printing Publication $ 4,500.00 Supplies Materials $ 25,650.00 Other: Transportation $ 4,500.00 Total $ 476,450.00 $ 0.00 Budget Narrative The above numbers are pulled directly from our operating budget. The HHSG funds are potential funds from the city of Livermore and Pleasanton HHSG funds. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Expense budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial List of Board of Directors (or governing body) with contact information ✔✔✔✔ Board Current Annual Budget for the Entire Agency ✔✔✔✔ Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Insurance 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 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 Application ID: 69943 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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. 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. ✔✔✔✔ 501 c 3 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 the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements ✔✔✔✔ Audit Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Center for Community Dispute Settlement Tri Valley Youth Court $ 3,500.00 Requested Submitted: 1/2/2017 2:08:37 PM (Pacific) Project Contact Tonya Clenney tonyaclenney@communityyouthcourts.com Tel: 925-337-7175 Additional Contacts none entered Center for Community Dispute Settlement 291 McLeod Street Livermore, CA 94550 Executive Director Diane Jeronimo diane.jeronimo@comcast.net Telephone925-373-1035 Fax 925-262-4680 Web http://www.trivalleymediation.com Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). CDS emerged out of a recognized need for non-adversarial conflict resolution for individuals and organizations. CCDS provides in-court and neighborhood mediation, certifies new mediators and works with youth teaching restorative justice principles. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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.). CCDS is a non-profit company founded in 1995 by Diane Jeronimo, a Master Mediator. Diane was approached in 2007 by the Judges at the Gale- Schenone Courthouse in Pleasanton and asked to start a youth court. After some research CCDS decided to open the Tri Valley Youth Court (TVYC). CCDS worked with representatives from Dublin, Pleasanton and Livermore’s Police Departments and School Districts, as well as officers from Alameda County’s Juvenile Probation Department to design the youth courts’ processes. TVYC has been open since January 1998. The Youth Court was so successful, Alameda County asked CCDS to open other courts in the southern Alameda County. Community Youth Courts (CYC) was started in 2011 and consists of the Dublin Unified School District Middle School and High School Youth Councils (new in 2015 and 2016), Eden Township Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None Youth Court, Castro Valley Youth Court, Hayward Youth Court, San Leandro Youth Court, and Tri Valley Youth Court. The youth court is fee-for-service program and we never turn any family away regardless of their ability to pay our program fee. CCDS’ Board of Directors represents the different cities in which CCDS and Community Youth Courts (including the Tri Valley Youth Court) operates. Diane Jeronimo, Tonya Clenney (Executive Director of CYC and Program Director for the Tri Valley court sites) and Karen Halfon (Program Director for the Southern Alameda County court sites) are the only paid staff of CCDS. 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. TVYC’s mission is to empower youth to take an active role in their own rehabilitation by offering them an opportunity to take responsibility for their actions using restorative justice principles. 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.) Based on our previous years averages, we estimate that we will serve 21 unduplicated Dublin residents this year. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. TVYC’s Program Director receives referrals from Dublin Police Services, contacts the referred families and manages their cases throughout their participation; recruits, trains and manages all of the adult (14) and youth (106) volunteers; and inputs and manages program statistical data. The Organization’s Executive Director and the Program Directors meet once every two months to discuss the program. Types of offenses heard at the youth court include: shoplifting, disorderly conduct, vandalism, minor possession of alcohol or a controlled substance. Commitments (which are decided by their peers) are based on restorative justice principles with an emphasis on being accountable and learning from their mistake(s). TVYC refers out to local service organizations for counseling, drug/alcohol rehabilitation, anger management, and driving safety. The Tri Valley Youth Court uses two different court approaches: *The first approach is a “traditional court approach” with an Advocate (lawyer) and a Jury of his/her peers. The process is similar to a “regular” court, with opening statements, questions and closing statements. *The second approach is a “tribunal” approach where volunteer students serve on a panel and meet face-to-face with the participating youth and their family. The youth has three months to complete all of their Commitments. Once the youth has completed the program, the Program Director will send a Notice of Completion to the youth and the referring agency. Then the Program Director will shred the police report and close the case. To date, TVYC has successfully worked with 193 Dublin teens and their families. 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 Dublin Grant funds will be used to pay for 14 families who cannot afford to pay the program fee. The collected program fees are used to pay for all aspects of the program such as office supplies, materials for handouts, data collection, volunteer appreciation, etc. We also use these funds to help families pay for anger management fees when necessary. 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 meeting the outcome(s)? Youth courts use recidivism rates as the measurement of a successful program. Because we are a non-profit and not associated with the police force, we are unable to access juvenile records to keep statistics on recidivism rates. National recidivism rates for teen/youth/peer courts are at 18%. Based on anecdotal data, our recidivism rates are at approximately 4%. ✔✔✔✔ Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above TVYC conducts blind post-program surveys with the participants and their parents. The families are asked about their experience with all aspects of the court, what their satisfaction with the program is, whether they would recommend the program to others and what they like and they would improve on. 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. TVYC anticipates serving low, middle, and high-income youth and their families. Currently, 21% of the participating families from Dublin can only afford to pay a portion of the fee and 37% cannot afford to pay any fee at all. We will be unable to sustain the program if we do not find a way to cover the unpaid fees. With the Dublin grant funds we will be able to continue providing a restorative justice learning experience and help pay some of the anger management fees for the youth who participate in our program. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? The Tri Valley Youth Court adapts its services to the needs of each participating individual and their family. We are very respectful of cultural and religious differences. In addition, the adult and youth volunteers reflect the same demographic as the youth coming through the program. Commitments are tailored to the specific child and their offense and each family’s unique needs are addressed. 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 eligible families are referred to the youth court via the School Resources Officers regardless of their situation. If families are low-income we work out a payment program and a payment amount that will fit their situation. We find volunteer translators for limited English speakers. We find solutions to help people who are disabled participate in the program in a way that is easiest and effective for them; for people with learning disabilities or psychological disorders (tribunals that are less stressful and more personal) or physical disabilities. We are able and happy to address each client’s individual needs. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We work with Dublin Police Services and Dublin Unified School District to identify youth that would benefit from participating in the youth court and peer council. Dublin Polices Services was part of the original group that helped develop the youth court program. We discuss current and past clients, how things are working and what could be working better. The School Resource Officers know the youth they work with in the schools and who would benefit the most from participating in the youth court program. We worked with the Vice Principals of Fallon and Wells Middle Schools and Dublin High School to develop the DUSD Youth Council. The Middle School Youth Council has been active since February 2015 and the Dublin High School Youth Council started in September 2016. We speak monthly to ensure that the program is affecting the change that they are looking for. Many of my Dublin high school volunteers and clients sit on the DUSD Youth Councils. We have contacted Dublin High School civics teachers to ensure that they know of our program’s existence for youth who are looking for volunteer opportunities. Teen volunteers serve as Advocates (lawyers), Court Clerks and Jurors. Teen volunteers see first-hand how they can affect another person’s life immediately and they learn from seeing how another person’s decisions have affected their life. 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. TVYC has volunteer recruitment ads in online volunteer websites. There have been several articles in local papers and the Tri Valley Herald over the years regarding the youth court and restorative justice. TVYC partners with many community organizations. We refer clients to specific organizations such as AXIS Community Health for drug/alcohol rehabilitation and counseling. We meet with AXIS twice a year to discuss the current needs of the clients seen by the youth court and how those needs are met. We also refer to Horizons Family Counseling and Discovery Counseling Center. These organizations know of the Youth Court’s mission and work together with the court to make sure the client’s needs are met. We recommend that families use programs or organizations that available to them via their insurance. We are always looking to find local organizations and programs that will help the youth in our program. Youth participating in our program often volunteer with the Dublin Senior Center, Dublin Heritage Center, Open Heart Kitchen, Tri Valley Animal Rescue, and the East Bay SPCA. The Tri Valley Youth Court has volunteered as a group with the Dublin Public Works Department to clean up trash in the creek area behind Dublin High School, run booths at the Dublin Splatter event and has volunteered at other City of Dublin events. TVYC received the honor of being named Dublin’s 2012 Organization of the Year and we were able to participate in the Dublin St. Patrick’s Day Parade. We enjoy working with the City of Dublin and look forward to continuing. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Participating youth and their families are asked to pay a participation fee of $250. Participation fees pay for all aspects of the program such as office supplies, materials for handouts, data collection, volunteer appreciation, etc. We also use these funds to help families pay for anger management fees when necessary. The requested funds of $3500 would pay 14 full participation fees, or can be spread out to supplement families who can only afford partial payment. If there are funds left, they will be used to help pay for anger management counseling for youth who have been arrested for an assault and/or battery offense (~37% of cases). 20. 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 or receives reduced funding CCDS will continue to look for other funding sources. If the program continues to not receive funding then we will reduce some of the services we are able to offer. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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. TVYC promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities and ensures a safe environment by teaching youth that have been committing crimes how those crimes affect others: the victim, their own family and the community as a whole. With the growing number of juveniles entering the criminal justice system each year and the loss of State funding necessitating the move of cases to already overworked County Probation Officers, young people who have committed misdemeanors or minor offenses receive no consequences. Alternative programs such as TVYC offer the youth an opportunity to learn from their mistakes, give back to the community and remove the arrest from their record. TVYC builds community by bringing youth from the community into a safe, accepting, non-judgmental environment to share their problems. Youth participate in positive peer-to-peer interaction helping each other learn; whether from providing valuable lessons on how their actions affect others to counseling (drug and alcohol, family and/or individual) and anger management. TVYC relates to other communities and entities by collaborating with organizations throughout the Tri Valley to provide services for the youth involved in youth court and by getting Dublin youth involved in volunteer opportunities throughout the entire Tri Valley area. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. ✔✔✔✔ 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 gfedc 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 gfedc 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 gfedc 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 gfedc Yes. If so, answer questions 31 through 43. 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 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). CCDS continues to look for corporate sponsors for Community Youth Courts and we will remain a fee for service 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-110704 ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed Alameda County DRPA Grant $ 15,000.00 $ 15,000.00 First Presbyterian Church of Livermore $ 0.00 $ 657.47 Collected Participation Fees $ 7,250.00 $ 2,982.00 LLNL Home Campaign $ 0.00 $ 120.00 Community Donations $ 500.00 $ 500.00 In Kind Donation: Volunteer Time $ 16,560.00 $ 16,560.00 In Kind Donation: Office Space $ 800.00 $ 800.00 In Kind Donation: Equipment Rental $ 600.00 $ 600.00 Total $ 40,710.00 $ 37,219.47 Funding Uses/Expenses Budget Amount Amount Committed Salary: Program Director .5 FTE $ 14,000.00 $ 14,000.00 Benefits: Workers Comp $ 230.00 $ 230.00 Benefits: Payroll Taxes $ 1,411.00 $ 1,411.00 Marketing/Outreach (web page) $ 368.00 $ 368.00 Supplies $ 800.00 $ 800.00 Telephone $ 700.00 $ 700.00 Volunteer Appreciation $ 2,500.00 $ 2,500.00 Anger Management for Clients $ 1,175.00 $ 1,175.00 Total $ 21,184.00 $ 21,184.00 Budget Narrative The Alameda County DRPA Grant has provided CCDS $15000/year for the Tri Valley Youth Court. First Presbyterian Church of Livermore: First Presbyterian Church of Livermore has donated collected funds to the Tri Valley Youth Court to be used in Peacemaking. We use these funds to pay for anger management classes for our clients. Collected Participation Fees: We have worked with 29 youth and their families this year. Only ten youth and their families have been able to pay the full participation fee. An additional four families were able to make partial payments and 14 families were not able to pay any fee at all. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ CCDS Program Expense Form Financial Information Form for ALL Grant Requests download template ✔✔✔✔ CCDS Financial Information Form List of Board of Directors (or governing body) with contact information ✔✔✔✔ CCDS Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ CCDS Current Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ CCDS Form 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ CCDS Board Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ CCDS Board Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ CCDS Insurance 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 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 STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. ✔✔✔✔ CCDS IRS Letter Application ID: 70321 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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 the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements ✔✔✔✔ CCDS Bank Statement Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Chabot-Las Positas Community College District/Tri Valley One Stop Career Center Dublin VITA Grant 2017-18 $ 7,430.00 Requested Submitted: 1/4/2017 1:29:39 PM (Pacific) Project Contact Sarah Holtzclaw sholtzclaw@clpccd.org Tel: 925-560-9439 Additional Contacts none entered Chabot-Las Positas Community College District/Tri Valley One Stop Career Center 7600 Dublin Blvd Dublin, CA 94568 United States Vice Chancellor for Business Services, designated signer Lorenzo Legaspi llegaspi@clpccd.org Telephone(925) 560-9431 Fax (925) 560-9457 Web trivalleyonestop.org Application Questions 1. Please describe your organization category (select one of the following): 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? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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 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 oversight of the CLPCCD guarantees that we have management, fiscal and governing board oversight of our services and operations. 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 Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. gfedc Private Non-Profit gfedc Public Agency ✔✔✔✔ Other: Self-funded program of educational institution gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None are within the employment scope. One of those services is to offer free tax preparation. The 2017 tax season will be the 5th 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. It is a definite service gap in the Tri-Valley region. The program is highly 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 has continued to expand its free tax preparation services to not only Dublin, but Pleasanton and Livermore, in order to fill gaps where they are needed. 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 VITA program increases access to free tax preparation for the working poor in the region. State and Federal taxes are e-filed by certified volunteers, helping taxpayers avoid predatory refund loans and expensive tax preparation. 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.) 125--As the program builds, we are increasing both the clients served and certified volunteers. For the 2017-18 season, we believe we will service nearly 500 taxpayers, 25% of which will be from Dublin. That is 125 unduplicated residents. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. The Volunteer Income Tax Assistance (VITA) program is free tax preparation services offered by the Tri-Valley One-Stop (TVOS). 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 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 primarily offer the VITA services at our Dublin offices and at in the Pleasanton Public Library. We will also offer drop-off services at the Pleasanton School District Mariachi Program and Las Positas College. 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. TVOS staff acts as the Program Coordinator 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 TVOS or the volunteers. In the past season, we prepared 400 tax returns, with an average household income of just over $17,700. We also were able to help bring nearly a million dollars in federal and state refunds back to the Tri-Valley. Research shows that each of these dollars have a 1.5 multiplying effect on the local economy. 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 17.9% of the program costs. This is an exceptional “deal” for the City as we anticipate that 25% of our clients will be from Dublin. Specifically, grant funds will be used to cover a portion of the staff salaries and benefits associated with this program; supplies such as paper, toner, and office supplies; 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 grant should be looked upon by the City as an investment. Clients tax returns range widely just as the general public. We see some who need to gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) ✔✔✔✔ Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above pay at the time of filing, but most receive a refund. The cost of services was $83 per client. The average refund during the 2015-16 season was about $396. Studies show that tax refunds are spent in the communities, on things such clothing, rent and childcare. That is nearly $50,000 in refunds for Dublin residents. Additionally, studies also show that there is 1.5-2.0% multiplier effect of those refund dollars. In total, the investment of $7,430 could turn into $118,000 for the city. 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 meeting 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 Tri-Valley Volunteer Income 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 returned to clients 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. Though the average household income in Dublin is over $137,000 a year, there are a significant number of families living at or below the living wage – which is $27,830 for a single adult or $60,630 for two adults and two children. In fact, the average household income for our clients during the past tax season was just over $17,700. The VITA program is offered to counter the high cost of paid, and sometimes predatory, tax preparation services. It can cost $350-$500 for simple tax return at the national tax preparation chains. Though national tax preparing franchises advertising free tax preparation, it not truly free. There two- page federal 1040 is free with one w-2. However, any additional w-2’s and all forms there-after, such as the EITC, Child Tax Credit, College Credit worksheets, etc. cost money. Additionally, it costs to file a state return at the same time. The costs can equal 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-Valley One-Stop (TVOS) 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 twice or three times a week. We are one of the only growing programs of the United Way of the Bay Area 7-sounty footprint due to the gap in these services that exists in the region. 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, most the service is face-to-face and side- by-side. We have both Spanish- and Chinese-speaking volunteers, which allows them to communicate directly with the tax payer, without the use of an interpreter. The service is culturally appropriate as it is designed to serve the working poor. We meet the clients in places with easy access and where trust is already established. That includes the TVOS offices, the Pleasanton Library and the Mariachi Program in Pleasanton. 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. 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 VITA are low- to moderate-income working families. The average household income of our clients last season was $24,000. That is below the living wage threshold of a single adult, and yet many have children as well. This population can spend as much or more than their actual refund to have federal and state taxes prepared and e-filed. The intention of the program is to mitigate those costs so they have use of the refund for bills and basic necessities. Our current outreach efforts include community partners who also serve low-income adults. We start marketing during the holidays so we can capture the Christmas food box deliveries. We market through partners such as City Service, the Tri-Valley Anti-Poverty Collaborative, Axis Community Health, the public libraries and the housing authorities. Additional efforts may include cooperative efforts with the school systems, cities, and food banks, thrift shops and churches in the region. For those who look for the services online, we have a section of the TVOS site dedicated to the services and are listed on the United Way of the Bay Area’s site. In the Tri-Valley, many of these families have limited English speakers in their households. Our marketing efforts are all in English and Spanish. Additionally, we strive to have Spanish- and Chinese-speaking volunteers so that families feel comfortable in an already-stressful situation. 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-Valley One-Stop (TVOS) is continually 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. -City Serve – given the reach of City Serve’s coordination, they offer marketing opportunities and the means to educate other providers about the services. -Tri-Valley Anti-Poverty Collaborative – Similar to City Serve, this organizations offers a means of marketing. 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 employees of like- minded organizations can be important conduits of information. Sample organizations that we approach are: -Dublin Adult School and School District -Pleasanton Adult School and School District -Livermore Adult School and School District -Castro Valley Adult 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 Public Information Officer to help develop a public relations strategy to have the services covered in the local media. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. State and federal tax returns are spent directly in the tax payer’s community. Research on the Earned 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 $7,430. •We anticipate the program budget for the 2017-18 fiscal year to be $41,506. •City of Dublin’s $7,430 grant is 17.9% of the total budget •We anticipating serving over 500 clients during the tax season •45% (125) of these, we believe, will be Dublin residents •The average refund in the 2015-16 season was $396 •$396 x 125 taxpayers = $49,500 in refunds to Dublin tax payers •1.5% multiplier effect (conservatively) = $74,250 to the Dublin economy •$350 on average of savings from not paying for taxes to be prepared = $43,750 Total return on the $7,430 grant = $118,000 The average cost per tax return prepared is just over $83. If the City were to pay the full cost for all 125 anticipated Dublin tax returns, the cost be $10,375, far below the requested amount. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? 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 (TVOS) 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. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? gfedc Yes ✔✔✔✔ No 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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 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. We do this through: -Avoiding the high costs of tax preparation. Many of the chain tax preparing companies charge $350-$500 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. -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 nearly $400. We anticipate servicing 125 Dublin residents during the 2017-18 tax season, which is over $49,000 in federal and state dollars directly to Dublin residents, with an additional $43,750 left in the tax payers’ pockets for not having to pay for the tax preparation. 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% multiplier effect on these refunds, which means there could be an economic impact of more than $118,000 on the anticipated refunds processed through the TVOS program for the City of Dublin. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ 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. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc 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 gfedc 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 gfedc 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 gfedc 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 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 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 self-funded service of the Chabot-Las Positas Community College District (CLPCCD) and is a federally-funded entity through the Workforce Investment & Opportunity Act (WIOA). The majority of our funding for our core services is passed through the Alameda County Workforce Development Board (ACWDB) with a match from the 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 17.9% of the total program funding for the 2017-18 season. Our United Way grant has incrementally increased over the past few years, but is in no way enough to support the program fully. Thus we are asking the three main cities within the Tri-Valley to share in the program costs as it directly impacts both the family units and the city as a whole economically. gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. gfedc #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. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. 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 $ 7,430.00 $ 0.00 City of Pleasanton $ 7,430.00 $ 0.00 City of Livermore $ 7,430.00 $ 0.00 United Way of the Bay Area $ 12,000.00 $ 0.00 Chabot-Las Positas Community College Distrcit $ 7,217.00 $ 7,217.00 Total $ 41,507.00 $ 7,217.00 Funding Uses/Expenses Budget Amount Amount Committed Wages $ 15,820.00 $ 7,217.00 Benefits $ 7,119.00 $ 0.00 Supplies $ 325.00 $ 0.00 Rent & Utiliites $ 2,890.00 $ 0.00 Contracted Services (Marketing dev and placement) $ 13,500.00 $ 0.00 Travel Reimbursement $ 250.00 $ 0.00 Volunteer Recognition/Food $ 540.00 $ 0.00 Postage $ 313.00 $ 0.00 Printing/Copying $ 750.00 $ 0.00 Total $ 41,507.00 $ 7,217.00 Budget Narrative The budget for this program is shared between the three cities that benefit economically as well as the College District and the United Way. Aside from the College District, none of the funding for 2017-18 has been secured to date. The largest expense for the program is the staffing and benefits associated with running an exceptional program. Once the program is in place, it's critical to let the audience know about it. Thus. the second largest expense category is contracted services, which includes marketing development and placement in order to get the word out. This program is over and above our regular career services and is thus heavily grant dependent. The College district is committed to the service, however, and will share in the program costs. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Dublin VITA Program Expenses FY17-18 Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Dublin VITA Financial Information FY17-18 List of Board of Directors (or governing body) with contact information ✔✔✔✔ CLPCCD Board of Directors 2016-2017 Current Annual Budget for the Entire Agency ✔✔✔✔ CLPCCD Adoption Budget 2016-17 Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ CLPCCD Tax Exempt Status Letter Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ CLPCCD Authorized Signature and Designated Authority Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ CLPCCD Authorized Signature and Designated Authority Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ CLPCC General Proof of Insurance 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 AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" Application ID: 70664 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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 STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ CLPCCD Tax Exempt Status Letter 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 the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements ✔✔✔✔ CLPCCD Most Recent Audit Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Chabot-Las Positas Community College District/Tri Valley One Stop Career Center Dublin Jobs Initiative 2017-2018 $ 19,385.00 Requested Submitted: 1/4/2017 1:30:56 PM (Pacific) Project Contact Sarah Holtzclaw sholtzclaw@clpccd.org Tel: 925-560-9439 Additional Contacts none entered Chabot-Las Positas Community College District/Tri Valley One Stop Career Center 7600 Dublin Blvd Dublin, CA 94568 United States Vice Chancellor for Business Services, designated signer Lorenzo Legaspi llegaspi@clpccd.org Telephone(925) 560-9431 Fax (925) 560-9457 Web trivalleyonestop.org Application Questions 1. Please describe your organization category (select one of the following): 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? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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 Development Board (ACWDB) 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 self-funded service of the Chabot-Las Positas Community College District (CLPCCD) which offers TVOS management and fiscal oversight. We fall under the Economic Development office of CLPCCD. The Executive Director of this area is Julia Dozier, who has been in her role for over 15 years. The dual oversight of the ACWDB and CLPCCD guarantees that we have both management, fiscal and governing board oversight of our services and operations. Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. gfedc Private Non-Profit gfedc Public Agency gfedc Other: Self-funded program of educational institution gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None 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. During these years, we have worked with economies that are either expanding or contracting, sometimes very drastically. In the current economy, we are helping job seekers find new positions in the competitive environment as well as educating employers on the local labor market and attracting the highest quality workforce. Program Manager, Sarah Holtzclaw, joined TVOS and CLPCDD in January of 2015. Her goals are to continue the high quality of face-to-face services while, at the same time, expand services to community partners, expand online options, assist a wide variety of employers and to grow the Center’s client base in preparation for an eventual down turn in the economy. Under her leadership, TVOS has become an active member of the Tri-Valley community and is one of the most productive Career Centers in the East Bay. 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 Dublin funds will increase our capacity for 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.) We should reach 2500 unduplicated Dublin residents during the 2017-2018 fiscal year. This is less than previous years as job seekers are more difficult to locate in the current economy. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 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. During these years, we have helped thousands of job seekers develop the confidence and skills to secure jobs that can grow into careers. Our services, all of which are free to the public, are offered through our facilities and our staff in Dublin as well as in partner locations throughout the region. We offer self-directed services as well as staff-assisted services. Self-directed clients use our facilities to write resumes, job search, conduct phone or skype interviews, attend some workshops, complete online training, and communicate with potential employers. These job seekers need little or no assistance from our staff. Our staff-assistant clients receive all these same services, but may also attend a number of additional workshops and meet with staff 1-on-1. Our skilled counselors meet with clients and address any barriers the clients may be experiencing in finding gainful employment. Our employment specialist then connects the job ready applicants to open positions in the area. Clients also have an opportunity for additional training through approved training providers or through on-the-job training at an employer. TVOS is non-discriminatory in the people we serve. Our clients come from a wide variety of backgrounds. They include the newly unemployed, long-term unemployed, part-time or underemployed, experienced workers, new immigrants or college students; Veterans, people with disabilities, ex-offenders and CalWorks clients. Part of the requested funds will be put toward the development of a more robust online presence for the One-Stop. We are developing and optimizing a local, electronic job board that can connect local employers to local workers. We would also to take our career services outside the One-Stop’s walls to develop tools that can assist job seekers online. 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 services of the Tri-Valley One Stop are heavily staff-dependent. Though we are working toward offering more information and static services online, clients receive the bulk of our services via workshops and counseling sessions with our staff. Seventy-five percent of our budget is spent on staff salaries. We, are however, working toward offering more information and guides online for those who cannot get to the Center while we are open. We are also preparing our services for the eventual down-turn in the economy when more people are looking for job seeking services. The Dublin Job Initiative has three purposes, all of which will prepare us for the cyclical economy. With the City of Dublin funds, we will increase: 1) our staff’s capacity to train residents by developing new workshops offered at our location and within the community; 2) our staff’s outreach to businesses, offering to assist in their growing needs to find and hire qualified, skilled applicants; 3) our online outreach to those who are under-employed or working two, or more, part-time jobs to make ends meet. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) ✔✔✔✔ Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above objectives will your agency use to track the progress of meeting the outcome(s)? As a federally-funded program through WIOA, we are mandated to track all of the services we offer in our office. Our system uses the back-end of the CalJOBS employment system to track the activities of TVOS clients. We track client progress through our programs and their job placement for one year. In addition, for the Dublin Job Initiative, we will track: 1) The number of services offered to Dublin residents in our offices and throughout the community 2) The number of unduplicated Dublin residents touched 3) The number of Dublin residents using our website 4) The number of Dublin residents attending these workshops at the TVOS offices and within the community 5) The number of new Dublin businesses that are contacted and brought on board 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 Development Board (ACWDB). 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 bi-monthly 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 client/customer population served)? 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 available 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 clients create individual employment plans (IEP) with the help of staff that works tailored to meet their needs and career goals. The IEP is individualized to meet the needs of the client and ensure success in reaching their employment goals. Goals may include learning English, going to an adult school for basic skills, attending training courses, expunging a record or simply networking more. 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 have three Spanish-speaking staff members at TVOS. 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 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 clients but staff of partner agencies so that they can better serve their clients in our absence. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. 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 with which we currently work. 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 developed the Career Center website, work with staff and faculty and hold job fairs on campus. •Department of Rehabilitation – we offer space for their staff and client orientations. We co-enroll clients when appropriate. •Employment Development Department – Veteran services is co-located at TVOS 2x month. •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 & FCI, Dublin - we offer resources and pre-release counseling and workshops for inmates. •Castro Valley Adult School – we co-promote our services to each other clients. •Axis Community Health – we cross-refer clientele. •Tri-Valley ROP & Adult School Cooperative - we work host a Transition Specialist at TVOS and to develop programs that will benefit mutual clients. ROP staff teach computer and Microsoft Office classes at TVOS. •Habitat for Humanity – Habitat teaches financial education classes at TVOS twice a month. •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 outroutreach to other organizations. •Tri-Valley Anti-Poverty Collaborative – we attend TVAPC meetings and sit on committees where appropriate. •Plus many more. 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. Though we have been serving the community since 1998, unfortunately, the Tri-Valley One-Stop Career Center (TVOS) is still a secret to many job seekers and employers alike. In 2015, we hired a new Program Manager who has a marketing and communications background. In addition to running the daily operations of the TVOS, she has made a conscientious effort to expand its marketing and outreach efforts. After creating a consistent, professional look to the collateral and other printed materials, she began a concerted effort of outreach to the region’s community based organizations who also work with people facing barriers. For example, we have new relationships with the Livermore and Pleasanton libraries, based off our successes in Dublin. Additionally, our participation in City Serve and the Tri-Valley Anti-Poverty Collaborative meetings gives us a platform of outreach to organizations serving the community in a different capacity. The Program Manager understands that an official unemployment rate of 2.9% means that the real unemployment rate, which includes discouraged workers, marginally attached and part-time employed workers is closer to 6%. Finding those people is difficult however, as they don’t often seek services in the community for partner referral. To do this, we are working on social media and search engine marketing to bring awareness to our services. We are also working with the wider EastBay Works collaborative to push for more regional marketing. We are also increasing outreach to employers in the region. Though we have had an excellent relationship with employers for over the years, the growth of the region means that more employers are joining the Tri-Valley economy. We are working with the Chambers and Cities to reach them. We have participating in the Tri-Valley Commer-Con and Chamber Business Faire in order to market our services to employers. With the funds from the City, we will be able to increase this outreach. 19. 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 (TVOS) is extraordinary. With two full-time and five part-time staff members, we 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 “survival job” in the interim. Salaries for our clients this past year ranged from $15 an hour to $125,000 a year. The average was $22.34 per hour, or over $46,000 a year. Given this result, our ROI is nearly 25-fold. The City of Dublin’s funding will used to pay for staff to increase outreach efforts and workshop development time. The funding will also be used for strategic marketing/public relations development and placement. In this time of extremely low unemployment, we need to reach part-time and underemployed workers looking to make a move. 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. In this way, we are ready for the eventual day when the economy starts to turn again. We believe that the requested funding will help us to do this. We have structured the program budget to reflect a fair percentage of both personnel and operating costs. It includes ten percent of the projects staffing costs and 28 percent of operating costs. The operating costs budget reflects the true percentage of the people we serve who are Dublin residents. It should also be noted, that we are applying to both the cities of Pleasanton and Livermore for similar funds for this project. The requests made to these other Tri-Valley cities also reflect the percentage of our clients who reside in those cities (25 and 15 percent, respectfully) 20. 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. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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 (TVOS) is also promoting an economically diverse and balance community. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): -answer not presented because of the answer to #30- 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: ✔✔✔✔ 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. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc 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 gfedc 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 gfedc 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 gfedc 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 gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 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 Development Board (ACWDB) 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 Chancellor and Board of Directors. That said, the outreach and marketing efforts 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 120, a reduced funding amount from any of our expected allocations will reduce the effectiveness of our discretionary programs. 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 ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed City of Dublin $ 19,385.00 $ 0.00 City of Pleasanton $ 18,211.00 $ 0.00 City of Livermore $ 14,296.00 $ 0.00 Alameda County Workforce Development Board $ 42,366.00 $ 0.00 Chabot-Las Positas Community College District $ 14,122.00 $ 14,122.00 Other grants $ 15,000.00 $ 0.00 Total $ 123,380.00 $ 14,122.00 Funding Uses/Expenses Budget Amount Amount Committed Wages $ 58,090.00 $ 0.00 Benefits $ 26,140.00 $ 0.00 Supplies $ 425.00 $ 0.00 Printing/Coping $ 1,050.00 $ 0.00 Rent/Utilities $ 8,669.00 $ 0.00 Contracted Services $ 29,006.00 $ 0.00 Total $ 123,380.00 $ 0.00 Budget Narrative The bulk of the costs associated with this program as well as the One-Stop's general career services are staff-related. Rent and marketing services are the other larger costs centers for this project. This project in total amounts to 18.7% of our annual staffing costs (wages plus benefits). As the grant is written, Dublin will be sharing 10% of those staff costs of the project, which is less than 2% of our total annual staffing costs. The operating costs for this project are shared between the three cities, the Alameda County Workforce Development Board (ACWDB) and the Chabot-Las Positas Community College District (CLPCCD). The program is budgets so that the cities portion of the operating costs reflects the percentage of TVOS clients who reside in those cities. Dublin's share of these costs is 28%. Application ID: 69929 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. No funds are actually secured at this project as of yet. The ACWDB and CLPCCD have funded TVOS for over 15 years, so that funding is fairly certain. The other funds are more volatile, though the city of Dublin as been a wonderful funding partner for many years. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Dublin Job Initiative 17-18 Program Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Dublin Job Initiative 17-18 Financial Info List of Board of Directors (or governing body) with contact information ✔✔✔✔ CLPCCD Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ CLPCCD Adoption Budget 2016-17 Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ CLPCCD Tax Exempt Status Letter Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ CLPCCD Authorized Signature and Designated Authority Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ CLPCCD Authorized Signature and Designated Authority Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ CLPCCD General Proof of Insurance 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 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 STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ CLPCCD Tax Exempt Status Letter 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 the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements ✔✔✔✔ CLPCCD Final Audit 2015-16 Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline CALICO Center Dublin Child Abuse Intervention $ 10,000.00 Requested Submitted: 1/5/2017 11:49:51 AM (Pacific) Project Contact Hillery Gladden calicocenter@yahoo.com Tel: 510-895-0702 Additional Contacts none entered CALICO Center 524 Estudillo Ave San Leandro, CA 94577 United States Executive Director Hillery Gladden calicocenter@yahoo.com Telephone(510) 895-0702 Fax (510) 895-0706 Web www.calicocenter.org Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). CALICO achieves healing and justice 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? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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.). CALICO is governed by a 12-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 $760,000 (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 development/communications and finance/administration). The District Attorney’s Office provides significant support by assigning a full-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. Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None Since 1997, CALICO has conducted interviews with over 11,000 children and has successfully facilitated nearly 11,000 multi-disciplinary child-abuse investigations, including over 160 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) have specialized training in trauma-focused interventions for abuse victims. Two CIS are bilingual Latinas who provide services in Spanish as needed. 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? Please explain how your project meets the selected Areas of Concern. 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 appropriately, 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 partners. 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 learn 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 would 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 particular 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 two 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 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 $22,000 in FY17-18. 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- lingual Spanish-speaking families). When interviewers are not conducting interviews, they are performing other related tasks, including client intakes, data entry and quality control, observing and providing feedback to other interviewers, participating in trainings, planning and participating in monthly case review meetings and testifying 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 ✔✔✔✔ Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse ✔✔✔✔ Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above objectives will your agency use to track the progress of meeting the outcome(s)? GOAL 1: Minimize trauma to abused children 1a. At least 75% of children interviewed will feel positive/neutral about their experience 1b. 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 start to finish GOAL 3: Improve the mental health of caregivers. 3a. An FRS will conduct an on-site crisis assessment with at least 75% of families 3b. An FRS will initiate a California Victim Compensation Program (CalVCP) 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 CalVCP application on behalf of the child to provide funds for counseling 4c. At least 50% of caregivers contacted will report their child is enrolled 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 67 interviews with abused Dublin children and 1 interview with an adult with developmental disabilities. Seven (7) of the 67 children also had a developmental disability. Most victims were girls (66%) and most had been sexually abused (81%) and/or physically hurt (16%). Most victims were young: over half were 13 years old or younger (69%). Most identified as white (44%) or Latino (19%). They were primarily referred to CALICO by Dublin Police Services or Children and Family Services. In 2015-16, we conducted 13 forensic interviews of Dublin children. In 2017, 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 all 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 includes 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 forward 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. Two CALICO staff are bilingual/bi-cultural Latinas who accommodate Spanish-speaking families as needed. Over the last five years, approximately 20% 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. 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, 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 referrals 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. Danny McNoughton 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 investigations. In addition, CALICO 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 many 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. 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 return 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. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? CALICO aims to provide services to all children referred to us from Dublin detectives and child welfare workers. In fact, in our 20 year history, CALICO has never turned a child away. Typically, we schedule interviews 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). 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? gfedc Yes ✔✔✔✔ No 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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 involving 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 Dublin 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 yields 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 also matches the city's value of "encouraging public and private partnerships of mutual benefit." 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc 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 gfedc 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 gfedc 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 gfedc 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 ✔✔✔✔ Yes. If so, answer questions 31 through 43. gfedc No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. 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. CALICO makes every effort to provide services in the primary language of the child and his/her caregiver(s). When a child is referred, we ask the 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 informational 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: 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: ✔✔✔✔ Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers ✔✔✔✔ Encourage process streamlining ✔✔✔✔ Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *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: gfedc * 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. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc 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. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase homeownership gfedc Promote decent affordable housing ✔✔✔✔ Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 gfedc Encouraging accessible design features. ✔✔✔✔ Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. 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?"): 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?"): 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Increase the availability of service-enriched housing for persons with special needs. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): 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". 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" 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 gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 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 0 Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 44.0044.00 TOTAL 8 White 6 White + HISPANIC 2 Black/African American 0 Black/African American + HISPANIC 1 Asian 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 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 22.0022.00 TOTAL ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. 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 government, 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, CALICO is working to increase gifts from individual donors (which are important sources of unrestricted funds) yielding funds for FY17-18 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 gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed Request from the City of Dublin $ 10,000.00 Dublin Police Services $ 4,000.00 Alameda County DA's Office (in-kind) $ 3,000.00 $ 3,000.00 First 5 Alameda $ 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 Uses/Expenses Budget Amount Amount Committed Personnel Salary: Staff $ 11,705.00 $ 2,000.00 Personnel Benefits: Staff $ 2,610.00 $ 450.00 Personnel Salary & Benefits: ED (in kind) $ 3,000.00 $ 3,000.00 Supplies $ 277.00 Printing $ 30.00 Postage $ 44.00 Communications $ 100.00 Rent $ 371.00 Audit $ 220.00 Outside Service $ 600.00 Other $ 1,043.00 Total $ 20,000.00 $ 5,450.00 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. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information Form List of Board of Directors (or governing body) with contact information ✔✔✔✔ Board Members Current Annual Budget for the Entire Agency ✔✔✔✔ Agency Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Tax Return Extension 990 Tax Return 2015 Application ID: 70781 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ BOD Designation (Resolution) Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ BOD Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Proof of Insurance 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 AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE Personnel Policies REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" SECTION Most Recent Audit Audit Letter 15-16 REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. Articles of Incorporation Articles of Incorporation (Amended) REQUIRED FOR CDBG ONLY- CONFLICT OF INTEREST STATEMENT (IF NOT INCLUDED IN BYLAWS) Conflict of Interest Policy REQUIRED FOR CDBG ONLY-ORGANIZATION CHART Org. Chart STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ State Determination Letter Federal Determination 501(c)(3) 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. LEP/LAP 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 ✔✔✔✔ Financial Statement Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Tri-Valley Haven Homeless Services Program $ 25,000.00 Requested Submitted: 1/6/2017 9:25:10 AM (Pacific) Project Contact Irina Milinevskaya irina@trivalleyhaven.org Tel: (925) 449-5845 Additional Contacts cynthia@trivalleyhaven.org Tri-Valley Haven 3663 Pacific Avenue Livermore, CA 94550 United States Executive Director Ann King ann@trivalleyhaven.org Telephone(925) 449-5845 x Fax (925) 449-2684 x Web www.trivalleyhaven.org Application Questions 1. Please describe your organization category (select one of the following): 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 applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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 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 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. Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None 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. The Director of Homeless and Family Support Services overseeing Sojourner House has 33 years of experience managing residential programs and the Food Pantry Coordinator has 17 years of experience managing community Food Programs. 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, Case Management, Housing Assistance Placement, Life Skills 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.) 425 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 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. Tri-Valley families are always 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. Our goal is to keep the families together and as much as possible to keep them in Tri-Valley. In addition to weekly meetings with their case manager, counseling is also available, residents also participate in Life Skills classes that cover a variety of topics from budgeting, job readiness, conflict resolution and more. Shelter and eligible community residents have access to the Haven Food Pantry and are encouraged to prepare their own meals. Staff provides support, housing search assistance, guidance and referrals for additional sources of support. Shelter residents may stay at Sojourner House for up to six months. 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 Case Manager's time and part of the Life Skills Instructor's time. 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 meeting the outcome(s)? The success of the Program will be measured through evaluation of clients surveys, statistical results, and the individual goals set by the program participant and her his case manager. Those goals will include: a resident gaining employment, a family transitioning into a permanent living and feeling confident that it will be able to keep it, a family obtaining medical insurance etc. Long-term self-sufficiency achieved by a client would be a success. We recognize that it takes a long time for some of our clients to resolve the issues that led to homelessness, or establish new habits. 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 Shelter 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. Clients will benefit from receiving case management, job and housing search coaching. They will be connected to the housing resources locally and county wide. Our staff will make sure that every possible opportunity is being utilized for the local families to obtain permanent housing. Clients will also benefit from our Food Pantry by receiving free groceries that in many cases they can not afford. Our clients in Dublin, most of them are seniors, will be getting their food from our Mobile Food Pantry, meaning that the transportation issues will be minimized. Last year our Homeless Shelter served 85 unduplicated clients, providing 5427 bednights, and the Food Pantry served 4334 unduplicated clients. 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 in the homeless program. We presently have multiple staff fluent in Spanish, Russian, and French. Multi language fluency is always a consideration when hiring staff and gfedc Behavioral Health (mental health and substance abuse) ✔✔✔✔ Affordable Housing gfedc Health Care (including dental) ✔✔✔✔ Workforce Development ✔✔✔✔ Homelessness ✔✔✔✔ Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse gfedc Disabilities ✔✔✔✔ Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above recruiting volunteers, and wage differentials are given to those fluent in Spanish. All of the Sojourner House (Homeless Shelter) and the Food Pantry intake forms, paperwork and flyers are in English and Spanish, and some are in Chinese. We make sure that we have cooking utensils and dishes that are multi-culturally appropriate such as rice cookers, chopsticks, etc. Our Food Pantry has a capacity to offer ethnic food when needed utilizing store vouchers, and very often we even have it in stock. 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 outreach through many of our programs such as the Food Pantry, 24-hour crisis line etc. We also utilize community resources as much as we can; we participate in community health fairs and outreach events such as Dublin Pride week, we attend monthly meeting with CityServe, where local providers can share their needs, volunteer opportunities etc. Every year our Holiday Warehouse Program for low-income families from the Tri-Valley area brings new participants and spreads the word about our services. 290 Dublin residents signed up for the Program this year. 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. To further address transportation, our sites are near bus routes. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We have developed partnerships with many local businesses and community organizations, that support our programs. Particularly, the Whole Foods Market in Dublin twice a week donates food to our Food Pantry, most recently, Dublin Target joined our large list of generous donors, Eden Housing helps us coordinate our Mobile Food Panrty in Dublin, CityServe provides a great venue for sharing our programs and volunteer opportunities with the other local providers. We truly appreciate those partnerships. In addition to that, 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 CalWORKS 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. 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. This year together with the Cities of Dublin, Livermore, and Pleasanton, Open Heart Kitchen, CityServe, and Interfaith Sharing, Tri-Valley Haven participated in Feed Tri Valley. The mission of Feed Tri Valley is to end hunger by educating and soliciting donations to feed our local community. We also participated in the Dublin Pride week and shared our programs and volunteer needs with the community. We have expanded our services to Dublin residents by bringing our Mobile Food Pantry to Dublin every second Friday of the month providing groceries to 30-50 residents, mostly seniors. In addition we regularly 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 600 students through Health Education classes that we teach in Dublin High School covering topics such as healthy relationships and teen dating violence. This year 290 Dublin residents signed up for holiday foods and gifts 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. 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, CalWORKS, 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. 20. 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 most likely won't be able to keep our Homeless shelter open. Our largest funding source, Alameda County, will be changing its requirements, making it very difficult for Tri-Valley Haven to apply. It is our understanding that funding from the county in FY 2017/18 will support only the sheltering of individuals as opposed to past contracts that combined sheltering with support services provided by case management staff, forcing us to mostly provide beds and food. In addition to that we believe that our clientelle will change dramatically, our local families in need won't be eligible to stay at our shelter and will have to go somewhere else. That said, we feel very strongly that with enough support from the cities of Dublin, Pleasanton, and Livermore we can continue offering our services to the residents of Tri-Valley. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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. gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 N/A 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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. Clients can stay for up to 6 months. During this time residents are provided support with case management, job and house search, reuniting with their children etc. Each participant works with the case manager to design a program that will best meet their needs that are unique to their family. Life skills is a critical program component that helps families to develop a budget, identify credit issues. 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 CalWORKs 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. Another important component of our Homeless Services Program is the Food Pantry. All Shelter residents as well as the community members that are in need have access to our Food Pantry. The Food Pantry is located in Livermore and provides groceries, emergency motel vouchers, gas and phone cards, and referrals to other social services. We also operate a Mobile Food Pantry that delivers food to Dublin, Pleasanton, and Livermore, serving the most vulnerable populations such as seniors, disabled, veterans. Our van goes to Carlo Court and Wexford Appartments in Dublin every second Friday of the month from 12:30 to 1:30. Last year we served 473 Dublin clients through the Food Pantry. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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, 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 “Lionbridge” phone based interpreters. In Dublin, our largest LEP client group is Chinese-speaking. We make sure that our intake forms for the mobile food pantry are available in Chinese. In addition 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 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc 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 gfedc 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 gfedc 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 ✔✔✔✔ Yes. If so, answer questions 31 through 43. gfedc No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. Principle that relates to your project: 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: 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?"): ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers gfedc Encourage process streamlining ✔✔✔✔ Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ 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. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * 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. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc 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. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase homeownership gfedc Promote decent affordable housing ✔✔✔✔ Strengthen communities gfedc Ensure equal opportunity in housing ✔✔✔✔ Promote participation of grass-roots, faith-based, and other community-based organizations gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. ✔✔✔✔ End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc 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. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. gfedc 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?"): 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): 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: 425 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". ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 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" 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 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 actively fundraise and reach out to the corporate and private donors. We have completely re-vamped our mail appeal program to offer more ways to support our programs. We hold donor appreciation events annually. In 2015 we hired a part time Grant Writer to reach out to foundations that support programs similar to ours. In June we held Luna Fest, a short film festival, and the proceeds went directly to support our programs. In 2013 Tri-Valley Haven opened a Thrift Store, 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 15 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 410 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 20 Disabled 85 Female Headed Households 150 Senior 0 Youth 20 Homeless 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 700.00700.00 TOTAL 120 White 40 White + HISPANIC 50 Black/African American 0 Black/African American + HISPANIC 165 Asian 0 Asian + HISPANIC 5 American Indian/Alaskan Native 0 American Indian/Alaskan Native + HISPANIC 5 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 40 Multi Racial + HISPANIC OR other Multi Racial 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 425.00425.00 TOTAL ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed Local Dublin/Livermore/Pleasanton $ 125,000.00 $ 0.00 HCD Linkages $ 42,820.00 $ 0.00 Emergency Food and Shelter Program $ 20,000.00 $ 0.00 Individual Donation/Foundations $ 19,131.00 $ 0.00 Total $ 206,951.00 $ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Case Manager, 23% of Salary and Benefits $ 11,655.00 $ 0.00 Life Skills Instructor, 22% of Salary and Benefits $ 13,345.00 $ 0.00 Other Program Personnel $ 133,951.00 $ 0.00 Supplies $ 8,725.00 $ 0.00 Telephone $ 8,050.00 $ 0.00 Rent and Utilities $ 19,250.00 $ 0.00 Accounting/Audit $ 2,000.00 $ 0.00 Other $ 9,975.00 $ 0.00 Total $ 206,951.00 $ 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: Travel and Mileage, Insurance, Portion of Liability, Property, D&O, and Auto Insurance, Auto Expense. 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 prorated 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 download template ✔✔✔✔ TVH Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ TVH Financial Information Form List of Board of Directors (or governing body) with contact information ✔✔✔✔ TVH List of Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ TVH Current Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ TVH IRS 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ TVH Board of Director's designation of authorized official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ TVH Board of Director's authorization to request funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ TVH - Proof of Insurance 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 AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE TVH Personnel Policies REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" SECTION TVH Audit Requirements TVH Audit REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. TVH Articles of Incorporation TVH Bylaws REQUIRED FOR CDBG ONLY- CONFLICT OF INTEREST STATEMENT (IF NOT INCLUDED IN BYLAWS) Application ID: 70214 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. REQUIRED FOR CDBG ONLY-ORGANIZATION CHART TVH Org Chart STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ TVH State non-profit Letter TVH Federal non-profit Letter 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. TVH LEP Access Policy 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 ✔✔✔✔ TVH Audit Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Tri-Valley Haven Domestic Violence Services Program $ 25,000.00 Requested Submitted: 1/6/2017 9:27:36 AM (Pacific) Project Contact Irina Milinevskaya irina@trivalleyhaven.org Tel: (925) 449-5845 Additional Contacts cynthia@trivalleyhaven.org Tri-Valley Haven 3663 Pacific Avenue Livermore, CA 94550 United States Executive Director Ann King ann@trivalleyhaven.org Telephone(925) 449-5845 x Fax (925) 449-2684 x Web www.trivalleyhaven.org Application Questions 1. Please describe your organization category (select one of the following): 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 applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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 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 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. Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None 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 Program 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? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. Tri-Valley Haven's Domestic Violence Services Program 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 needs, and if it is safe for them to stay at our shelter, and then, if appropriate, an in-person intake is conducted. Each client is assigned to a Case Manager and a Counselor is made available 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 client 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 and part of the Overnight staff's time. These positions are essential for the shelter operations. 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 meeting the outcome(s)? The success of the Program will be measured through evaluation of clients surveys, statistical results, and the individual goals set by the program participant and her/his case manager. Those goals will be set up on a case-by-case basis and may include: reuniting with their children through completing their CPS Plan, finding housing or employment. Some clients will only stay one or two nights, and their goals will be very different such as safely relocating to a different county or a state. Client's progress will be tracked by the case manager during weekly meetings with clients. It will also be monitored at weekly staff meetings during case review. Additionally Case managers consult with staff counselors or the Clinical Supervisor as needed in order to provide the best client 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. 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. Clients will benefit from our program by creating a safety plan for themselves and their children, developing goals and plan of action towards achieving self-sufficiency, and connecting with the resources available in our community. In Fiscal Year 2015/2016 our Domestic Violence Services Program served 258 survivors at the Shelter including 2 Dublin residents ( a mom and a child), and responded to 1321 domestic violence related calls to the crisis line (103 DV/SA related calls from Dublin). 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 clients. We presently have multiple staff fluent in Spanish, Russian, and French. Multi language fluency is always a consideration when hiring staff and recruiting volunteers, and wage differentials are given to those fluent in Spanish. All of the Shiloh (DV Shelter) intake forms, paperwork and flyers are in English and Spanish, and some are in Chinese. We make sure that at the Shelter we have cooking utensils and dishes that are multi-culturally gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness gfedc Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse gfedc Disabilities ✔✔✔✔ Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above appropriate such as rice cookers, chopsticks, etc. Ethnic food is available for our shelter clients at the Food Pantry. We continue educating our staff through participation in the Cultural Competence development projects. The most recent first projects were focused on serving the needs of African-American and Asian/Pacific Islander community. We use a language translation line, provided to us by Alameda County Social Services, to communicate with clients who speak languages other than those spoken by staff. Cultural responsiveness is a standing agenda item at our weekly department staff meeting. We share resources, lessons learned and discuss how to meet current client’s special needs. As an example, we have learned from experience that some Muslim clients require cooking utensils and place settings that have never been used by other families, so we now make sure that we always have these items available. A recent client told us that she was very moved when staff proactively asked her as soon as she entered the shelter if she needed these items, and provided them to her immediately, because she had been feeling apprehensive about how to raise the subject or whether we could accommodate her. 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 outreach through many of our programs such as the Food Pantry, 24-hour crisis line etc. We also utilize community resources as much as we can; we participate in community health fairs and outreach events such as Dublin Pride week, we attend monthly meeting with CityServe, where local providers can share their needs, volunteer opportunities etc. Every year our Holiday Warehouse Program for low-income families from the Tri-Valley area brings new participants and spreads the word about our services. 290 Dublin residents signed up for the Program this year. 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). All of our agency literature is available in Spanish. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We have developed partnerships with many local businesses and community organizations, that support our programs. Particularly, the Whole Foods Market in Dublin twice a week donates food to our Food Pantry, most recently, Dublin Target joined our large list of generous donors, Eden Housing helps us coordinate our Mobile Food Panrty in Dublin, CityServe provides a great venue for sharing our programs and volunteer opportunities with the other local providers. We truly appreciate those partnerships. In addition to that, 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 CalWORKS 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. 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. This year together with the Cities of Dublin, Livermore, and Pleasanton, Open Heart Kitchen, CityServe, and Interfaith Sharing, Tri-Valley Haven participated in Feed Tri Valley. The mission of Feed Tri Valley is to end hunger by educating and soliciting donations to feed our local community. We also participated in the Dublin Pride week and shared our programs and volunteer needs with the community. We have expanded our services to Dublin residents by bringing our Mobile Food Pantry to Dublin every second Friday of the month providing groceries to 30-50 residents, mostly seniors. In addition we regularly 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 600 students through Health Education classes that we teach in Dublin High School covering topics such as healthy relationships and teen dating violence. This year 290 Dublin residents received holiday foods and gifts 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. 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 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, CalWORKS, and Linkages. We refer our clients to AXIS for their health related needs. Trained volunteers provide overnight crisis line coverage as well as (along with TVH staff) around the clock response to sexual assault calls and referrals from local police departments and hospitals. All of this contributes to a very reasonable budget. 20. 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 not be able hire Overnight staff for our Domestic Violence shelter. Having 24-hour coverage for the shelter is extremely important. Overnight staff provides clients with access to household supplies (some clients come to our shelter with literally nothing), helps with conflict resolution when case managers are gone, answers crisis line, helps with data entry, etc. We have not been able to fund this position full time for many years. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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. Tri-Valley Haven's Domestic Violence Services Program includes Shiloh, a 30 bed emergency shelter in a confidential location and a 24-hour Crisis Line. 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. In many cases 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 clients daily to help them with safety planning and respond to their concerns. DV Program offers individual and group counseling for both the survivor and her children. The following groups are available: Parenting, Domestic Violence Support, CalWORKS Job Readiness, Life Skills (such as Personal Finance) etc. The CalWORKS 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. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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, 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 “Lionbridge” phone based interpreters. In Dublin, our largest LEP client group is Chinese-speaking. We make sure that our intake forms for the mobile food pantry are available in Chinese. In addition most flyers, client materials and other communications are created in both English and Spanish. We produce and distribute documents in other ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc 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 gfedc 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 gfedc 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 gfedc 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 ✔✔✔✔ Yes. If so, answer questions 31 through 43. gfedc No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. 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: 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: ✔✔✔✔ Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ 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. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc 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. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase homeownership gfedc Promote decent affordable housing ✔✔✔✔ Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. ✔✔✔✔ End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. gfedc 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?"): 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?"): 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): 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) ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 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". 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" 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 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 actively fundraise and reach out to the corporate and private donors. We have completely re-vamped our mail appeal program to offer more ways to support our programs. We hold donor appreciation events annually. In 2015 we hired a part time Grant Writer to reach out to foundations that support programs similar to ours. In June we held Luna Fest, a short film festival, and the proceeds went directly to support our programs. In 2013 Tri-Valley Haven opened a Thrift Store, 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. 2 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 3 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 1 Disabled 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) 11.0011.00 TOTAL 1 White 2 White + HISPANIC 1 Black/African American 0 Black/African American + HISPANIC 0 Asian 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 1 Multi Racial + HISPANIC OR other Multi Racial 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 5.005.00 TOTAL gfedc #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. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. BL-007058 Budget Funding Sources/Revenues Budget Amount Amount Committed Alameda County Domestic Violence Center Act $ 33,707.00 $ 0.00 Alameda County Family Justice Center $ 10,754.00 $ 0.00 Local Dublin/Livermore/Pleasanton $ 53,813.00 $ 0.00 HCD Linkages $ 40,577.00 $ 0.00 CalOES DV $ 325,374.00 $ 0.00 Emergency Food and Shelter Program $ 5,570.00 $ 0.00 CalWORKS $ 39,301.00 $ 0.00 Foundations $ 24,500.00 $ 0.00 Donations $ 24,018.00 $ 0.00 Total $ 557,614.00 $ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Bilingual Case Manager, 30% of Salary and Benefits $ 14,934.00 $ 0.00 Overnight Staff, 27% of Salary and Benefits $ 10,066.00 $ 0.00 Other Program Personnel $ 444,965.00 $ 0.00 Supplies $ 12,125.00 $ 0.00 Printing/Copying $ 1,890.00 $ 0.00 Telephone $ 13,250.00 $ 0.00 Rent and Utilities $ 42,950.00 $ 0.00 Accounting/Audit $ 7,000.00 $ 0.00 Other $ 10,434.00 $ 0.00 Total $ 557,614.00 $ 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:Travel and Mileage, Portion of Liability, Property, D&O, and Auto Insurance, Auto Expense. 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 download template ✔✔✔✔ TVH Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ TVH Financial Information Form List of Board of Directors (or governing body) with contact information ✔✔✔✔ TVH List of Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ TVH Current Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ TVH IRS 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ TVH Board of Director's designation of authorized official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ TVH Board of Director's authorization to request funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ TVH - Proof of Insurance 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 AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE TVH Personnel Policies Application ID: 70270 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" SECTION TVH Audit Requirements TVH Audit REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. TVH Articles of Incorporation TVH Bylaws REQUIRED FOR CDBG ONLY- CONFLICT OF INTEREST STATEMENT (IF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART TVH Org Chart STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ TVH State non-profit Letter TVH Federal non-profit Letter 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. TVH LEP Access Policy 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 ✔✔✔✔ TVH Audit Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Spectrum Community Services Meals on Wheels for Dublin's Homebound Seniors $ 10,000.00 Requested Submitted: 1/6/2017 12:12:55 PM (Pacific) Project Contact Jillian Schafer JSchafer@spectrumcs.org Tel: (510) 881-0300 ext. 222 Additional Contacts none entered Spectrum Community Services 2621 Barrington Court Hayward, CA 94545 United States Executive Director Lara Calvert lcalvert@spectrumcs.org Telephone(510) 881-0300 x222 Fax (510) 537-3340 Web www.spectrumcs.org Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Spectrum's mission is the improve the health and safety of seniors and low-income residents in Alameda County by enhancing their quality of life and helping them age at home with dignity. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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.). Spectrum’s Meals on Wheel’s Program provides much needed nutritious meals along with an important safety check each day for home-bound seniors age 60 and over in Dublin. These are mostly low-income, disabled, elderly adults who are unable to leave their homes or to provide for their own basic needs. They need home-delivered meals to combat food-insecurity as well as fight isolation. It is the only Meals on Wheels provider in the city of Dublin, a suburban area where homebound seniors face serious issues of food insecurity as they age. Our Meals on Wheels program is overseen by our Senior Nutrition Program Manager, a Registered Dietitian, in conjunction with on-site Meals on Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None Wheels Coordinator in the Tri-Valley. The Meals on Wheels coordinator is the main contact for all of the staff, volunteers, and clients. They conduct in- home assessments, make appropriate referrals for the clients and complete all the routing and meal ordering. All Meals on Wheels volunteers and staff must pass background checks before being trained in subjects such as food safety, protected health information, elder abuse information and mandated reporting. Our training is conducted in one-on-one sessions with Spectrum’s Volunteer and Outreach Coordinator. Many of our dedicated volunteer drivers have been with Spectrum for five plus years. 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 will deliver at least 10,000 nutritious, life-sustaining meals and an important daily safety check to Dublin homebound seniors. 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.) 50 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. Spectrum’s Meals on Wheels Program is a part of our Senior Nutrition Program, one of Spectrum’s two nutrition services exclusively for Alameda County seniors. It is administered by Spectrum’s Senior Nutrition Program Manager, with direction from our Executive Director, and our Spectrum Meals on Wheel staff based in Dublin, Livermore, and Pleasanton. We want to ensure that all Dublin seniors in need of our services are able to be connected with Spectrums Meals on Wheels Program so Spectrum’s Volunteer and Outreach Coordinator attends many outreach events and is involved with the community. We continue to make additional efforts to ensure no senior eligible for the program is missing out on these services. Once a client connects with our program, whether through a referral from the hospital, a phone call from a family member, or as a result of our outreach, the Meals on Wheels Coordinator enrolls the senior in the program as soon as possible. Within two weeks, an in-home assessment is completed, which allows the Coordinator to further assess for other services the Meals on Wheels client may benefit from. The meals are planned by a registered dietitian and strictly adhere to the Older Americans Act-Title IIIC. Spectrum’s volunteer drivers pick up the freshly prepared nutritious meals each morning from our partner, Stanford Care/Valley Care Hospital in Livermore. Our volunteers then deliver the meals to the seniors. These volunteers, in addition to delivering these meals at the same time each day, provide safety checks and a smile with each delivery. Our Meals on Wheels volunteers not only provide nutritious meals but they become a safety net for the seniors they see every day. Often, this special delivery is a reason for our senior clients to get up in the morning, have something to look forward to, and a reminder to take good care of themselves. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). Spectrum’s Meals on Wheels Program is asking for $10,000 to help support a percentage of the cost of the salaries and benefits for two positions: Dublin Meals on Wheels Coordinator and the program’s Volunteer and Outreach Coordinator. The Dublin Meals on Wheels Coordinator is the backbone of the program. They are the main contact for each of our clients, weather they are registering clients for new service, completing assessments or talking to the client about their meal schedule and preferences. The Meals on Wheels Coordinator completes in-home assessments with the clients on a biannual basis. In addition to the regular contact we have with the client, sitting down with the client in their home allows the coordinator to better assess additional resources from which the client may benefit. The Meals on Wheels Coordinator also assists with volunteer scheduling and routing to ensure all of the meals are delivered to the clients in need in a timely manner. The Meals on Wheels Volunteer and Outreach Coordinator recruits, trains, schedules and recognizes volunteers. The meals are delivered each day primarily by volunteers who are dedicated to the program and the clients they serve. The Volunteer and Outreach Coordinator actively participants in the community spreading the word about the Meals on Wheels Program. The involvement in the community is not only to raise awareness to the services that the program offers yet also to recruit volunteers to help support the meals on wheels program. Trained volunteers are an essential piece gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse ✔✔✔✔ Disabilities ✔✔✔✔ Food and Nutrition ✔✔✔✔ Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above of providing the meal and safety-checks for homebound seniors. The request for $10,000 equates to $1 a meal. Supporting Spectrum with a dollar a meal will allow us to continue to provide high quality service and outreach to the community to all Dublin homebound seniors in need. 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 meeting the outcome(s)? We first ask, are all Dublin homebound seniors who want Meals on Wheels being served? Through outreach efforts and collaboration with other non- profits for referrals, we let the community know about this vital service. Having no Dublin senior on a wait-list for service is crucial to the success. The secondary means of measurement we use to evaluate our program and determine success are the number of meals we deliver each fiscal year. We will determine our success in FY 17/18 by reaching or surpassing our contracted goal of 10,000 meals. Our tertiary means of measurement is the number of unduplicated Dublin clients we serve. We will determine our success in FY 17/18 by reaching our surpassing our contracted goal of 50 unduplicated Dublin seniors. We review both of these outcome measures on a monthly basis to ensure we are on track to meet our annual goals. We plan to reach these goals by employing the following objectives: - Continuing to serve all homebound seniors on our current list - Serve 10,000 meals to homebound seniors in Dublin - Continue outreach to serve additional Dublin clients in need. 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 that Spectrum will serve if we receive funds from the City of Dublin is homebound seniors in Dublin. Homebound seniors are the often a hidden, missed population. These individuals are often unable to leave their home, prepare meals for themselves and need assistance with other activities of daily living. The seniors we serve are considered an “at-risk” and vulnerable population by the Center for Disease Control. Their infirm, homebound, and often low-income status, means that Meals on Wheels is often one of the few free services that enables them to remain in their homes as they age. For clients to be eligible for the program they must meet criteria within particular priority level. Over 40% of our recent Dublin clients have been categorized as having an urgent need for the program. An urgent need describes that the client is meeting at least two risk factors. Some risk factors include living alone, recent discharge from the hospital, confined to the bed, no access to meals, or impairments with numerous activities of daily living. These homebound seniors benefit from the Meals on Wheels program by being provided a nutritious meal delivered by a friendly face up to 5 times a week. They are checked on each day their meal is delivered and can count on a trained driver from our program to look out for their best interest. The nutritious meal provided meet 1/3 of the dietary reference intakes for older adults. They also offer therapeutic diets such as renal diets and altered textures such as puree or soft meals. The nutrition benefit and the safety check are excellent benefit to all of the Meals on Wheels clients we serve in Dublin. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? To accommodate the cultural preferences of our Meals on Wheels clients, Stanford Health Care - ValleyCare Hospital, Spectrum’s Meals on Wheels food provider, offers both tortillas and rice as a substitute for bread, as well as a vegetarian menu for those who are vegetarian. There are also 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, Vietnamese, and Mandarin, they 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, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? The Meals on Wheels Program is available and welcoming to all ethnic groups with various income levels. We are fortunate to have members of the Spectrum team who are bilingual. When participating in outreach activities, a member of the team who speaks the primary language of the clientele attending the outreach event will be present to answer any of questions that the prospective new clients have. Our web site is ADA compliant and can be fully translated into all major languages, breaking down barriers to information needed by non-English literate seniors in Dublin. We will continue to expand our outreach to healthcare providers and medical professionals in Dublin and eastern Alameda County, ensuring that they receive materials and referral information in multiple languages. Our Senior Nutrition Program staff works to cultivate connections with faith-based and cultural organizations, businesses, and community venues where seniors and their families gather. We perform outreach regularly to the Chamber of Commerce, the public library, senior housing facilities, churches and business establishments which seniors frequent. With a stronger presence in the community 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 partner organizations: Stanford Health Care-ValleyCare Hospital – Cooks and packs our nutritious meals, while Spectrum provides all the administration and delivery. Senior Support Program of the Tri-Valley –Provides a broad range of social services and care management for Spectrum’s seniors, and makes regular referrals to our Meals on Wheels program. Alameda County Area Agency on Aging – Provides countywide services and a 1-800 number assistance line and is the contractor with Spectrum’s Congregate Meals and Meals On Wheels to seniors. City of Dublin Senior Center - Provides a venue and opportunities for Spectrum to increase awareness of 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 Dublin Meals on Wheels 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 Low-Income Home Energy Assistance Program 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. We have reached out to connect and to distribute our Meals on Wheels information at Alameda County social services, local churches and business establishments that seniors frequent. Spectrum works closely with Senior Support Program of the Tri-Valley who provides a broad range of social services and care management for Spectrum’s seniors, and makes regular referrals to our Meals on Wheels program. 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. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. With a $10,000 grant from the City of Dublin, Spectrum’s Meals On Wheels Program will deliver over 10,000 meals to more than 50 unduplicated homebound Dublin seniors in FY 2017-2018. This funding will ensure that Spectrum will be able to respond directly to requests for Meals On Wheels service, provide high quality service with the Meals On Wheels clients, train and recruit volunteers and outreach in the community. Our proposed budget is based on actual program costs and supporting a percentage of the salaries and benefits of the Dublin Meals on Wheels Coordinator and Volunteer and Outreach Coordinator, two positions that are critical to the success of the Meals on Wheels Program. 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. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? We have seen an increase in need for Meals On Wheels in Dublin over the last few years. Without the funds to cover salaries and benefits, 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, decrease hours of the Meals on Wheels Coordinator and Volunteer and Outreach Coordinator making it difficult to provide the needed high quality service to the clients. 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. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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. Spectrum Community Services Meals on Wheels program promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities to Dublin homebound seniors by providing much needed nutritious meals along with an important safety check. The clients served are mostly low-income, disabled, elderly adults who were unable to leave their homes or provide their own basic needs. They need home-delivered meals to combat food-insecurity as well as fight isolation. The meals are planned by a registered dietitian and strictly adhere to the Older Americans Act – Title IIIC. Our trained volunteers deliver the meals to the seniors while also providing a safety check and a smile with each delivery. According to Meals on Wheels of America, Meals on Wheels not only provides a nutritious meal but volunteers or staff who deliver the senior their meal daily become their safety net. Along with the inevitable impacts of aging come the increased risks of medical emergencies, falls and other accidents. Our volunteers’ safety checks that accompany each meal delivery ensure that, in case of an emergency or problem, appropriate action will be taken and our seniors will not be forgotten. The program does more than simply give food. Meals on Wheels builds community bringing individuals of all ages together to serve the greater good. The volunteers and staff members are responsive to the needs of the clients making appropriate referrals to other outside services when needed. We work with other community providers to ensure the client receives the services that they need. The highest level of customer services is provided as some individuals see the client as their family. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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. Spectrum performs an annual language survey of staff, volunteers, clients, and the community, making note of any gaps and lining up resources and protocols to address needs. The plan informs our staffing, 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 uses 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) Consolidated Plan Guiding Principle that relates to your project: gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. ✔✔✔✔ 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 gfedc 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 gfedc 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 ✔✔✔✔ Yes. If so, answer questions 31 through 43. gfedc No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers gfedc Encourage process streamlining 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: 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?"): 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?"): gfedc Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *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. gfedc 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. ✔✔✔✔ E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase homeownership gfedc Promote decent affordable housing ✔✔✔✔ Strengthen communities gfedc Ensure equal opportunity in housing ✔✔✔✔ Promote participation of grass-roots, faith-based, and other community-based organizations gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): 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: 50 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". ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 42 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 8 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 50 Disabled 0 Female Headed Households 50 Senior 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" 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 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 have undertaken the following actions to reduce our dependency on Dublin’s grant program: -Given the increase in market demand for wages, we are actively recruiting more volunteer drivers in order to decrease the amount of paid drivers -We are actively pursuing and have won several local grants from private foundations to provide overall program support 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 for intake, assessments, and volunteer coordination. 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 0 Youth 0 Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 150.00150.00 TOTAL 33 White 7 White + HISPANIC 4 Black/African American 0 Black/African American + HISPANIC 5 Asian 0 Asian + HISPANIC 1 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 0 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 50.0050.00 TOTAL ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed Area Agency on Aging $ 14,150.00 Meals on Wheels of Alameda County $ 55,000.00 City of Livermore $ 21,000.00 City of Pleasanton $ 12,000.00 Fremont Bank $ 20,000.00 Gillig $ 5,000.00 Program Revenue $ 70,000.00 Volunteers $ 20,000.00 Total $ 217,150.00 $ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries $ 138,806.00 Benefits $ 24,536.00 Supplies $ 1,400.00 Printing/Copying $ 1,200.00 Postage $ 300.00 Telephone $ 1,200.00 Rent and Utilities $ 2,000.00 Accounting/Audit $ 1,140.00 Contracted Services $ 5,000.00 Other $ 31,370.00 Total $ 206,952.00 $ 0.00 Budget Narrative Our total budget for this program is $206,952. We are asking $10,000 from the City of Dublin to fund 4.8% of this project. We will use this funding from the City of Dublin to fund the salaries of two key individuals in providing this life-saving service to Dublin residents: 1. Meals on Wheels Coordinator, who ensures that daily operations run smoothly 2. Volunteer and Outreach Coordinator, who trains, recruits, and appreciates volunteers vital to the success of our program. The request for a dollar a meal is consistent with what is being asked of cities throughout Alameda County to support Meals on Wheels. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information Form List of Board of Directors (or governing body) with contact information ✔✔✔✔ Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Agency Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Tax Return Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Designation of Authorized Official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Authorization to Request Funding Minutes Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Insurance 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 AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE Employee Handbook Affirmation Action REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" SECTION Agency Audit with Highlighted Findings REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. By-laws REQUIRED FOR CDBG ONLY- CONFLICT OF INTEREST STATEMENT (IF NOT INCLUDED IN BYLAWS) Conflict of Interest REQUIRED FOR CDBG ONLY-ORGANIZATION CHART Organizational Chart Application ID: 70746 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ IRS Exempt Letter 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. Language Access Plan 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 Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Kidango, Inc. Emerald Vista Parent Workshops $ 2,000.00 Requested Submitted: 1/6/2017 12:23:20 PM (Pacific) Project Contact Izzy Goodwin egoodwin@kidango.org Tel: 510 897 6959 Additional Contacts none entered Kidango, Inc. 44000 Old Warm Springs Blvd. Fremont, CA 94538 United States Executive Director Scott Moore smoore@kidango.org Telephone(510) 897-6900 Fax (510) 897-6909 Web www.kidango.org Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Kidango continuously works to improve our programs and expand our services to fulfill our mission of inspiring children, empowering families, and building stronger communities. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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.). Kidango has provided services to low-income families and children in the Bay Area since 1979. Starting with just one child development center, we now operate more than 50 centers in 3 Bay Area counties, with the largest concentration of services in Alameda County. Our work is driven by a clear mission: to inspire children for academic success, to empower families to achieve their goals, and to strengthen our highly diverse community in a sustainable manner. Over 90% of families receive free childcare or childcare at a significantly reduced rate, ensuring all children have access to high quality early learning. Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No ✔✔✔✔ One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding gfedc None Kidango offers fully licensed center and home-based programs for children 0-5. Infant, toddler and preschool programs are offered both full-day and part-day depending on the specific location. Across all of our educational services, we emphasize a stimulating, multi-lingual and cross-cultural environment, encouraging children to learn through discovery and play. All programs adhere to California Department of Education standards and requirements. We also participate in the voluntary Quality Rating Improvement System (QRIS). Our staff are hired based on their experience working with young children, their educational background and personal qualities that enable them to be warm, enthusiastic and sensitive Teachers of very young children. Our staff are continually provided with professional development opportunities specific to providing for the unique needs of infant and toddlers. Our staff have received technical assistance and training from the WestEd Program for Infant/Toddler Caregivers, a highly acclaimed, internationally recognized program for promoting excellence and best practices, based on current research, for the care and education of infants and toddlers. Our program has also, in the recent past, been accredited by the National Association for the Education of Young Children, a national, voluntary program and a distinction of excellence. 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 project will provide enrichment activities for low-income families through 2-hour parent workshops focused on math and science, so parents can better assist their children with homework and school 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.) 30 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. Two-hour workshops will be administered on a regular basis, with dates being determined by parent schedules and facilitator availability. The workshops will be focused on helping parents build their comfort level with various topics, specifically math and science. The goal is to increase parents' comfort level in these areas, thus empowering them to serve as a resource for their children learning these concepts for the first time. The facilitator will be a member of the Emerald Vista staff, and childcare will be provided for parents during the workshops to help eliminate barriers to entry. 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 funds will be used to cover the cost of materials and professional services for this program. Materials will include worksheets, workbooks, and other take-home materials for families to keep and reference. The cost of the facilitator will also be covered by funds received from the City of Dublin. 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 meeting the outcome(s)? Attendance will provide the largest challenge, as parent schedules are complex. We will track attendance, and offer workshops at various times to help accommodate as many parent schedules as possible. Additionally, we will survey parents at the beginning and end of each workshop, to determine how the information has impacted them. We expect to see an increase in parents' comfort levels with the material, and improved confidence in fostering an educative environment in their home. 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. Access to high quality early education programs for low-income families has many barriers. By providing workshops for families, Kidango helps ensure parents and caregivers are provided the tools they need to assist their child in learning. Kidango's workshops will encourage an environment for parents to ask questions and build confidence in subjects like math and science, so that they can be a resource for their child and aid in their learning. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above Nearly all of our staff is bi-cultural and bi-lingual (Spanish, Farsi, Hindi and Punjabi). Our staff reflect the community. Staff communicate (in oral and written communication) with children and families in their home language whenever possible. Helping educate parents will improve parent/child interactions in the home, ultimately resulting in a deeper mutual respect for parent and child. 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? Many families that qualify for Kidango aren’t aware of our services. To combat this, we take building a presence in the community very seriously, and reach out to families and meet them wherever they may be. Educating families of all socioeconomic backgrounds about Kidango and our services is paramount to ensuring we are able to fulfill our mission of inspiring children, empowering families, and building stronger communities. Some ways Kidango reaches out to low-income, limited English speakers and/or disabled persons includes: Every Door Direct Mail Flyers with enrollment dates and locations are sent to multiple targeted mail routes throughout the City of Dublin. We partner with the post office, which means no prior registration is required to receive this information. This ensures families who may not know where to look, or that they even had an option for high quality childcare, are provided the tools they need to enroll their child. Flyers are in English and Spanish. Bus Ads Many families who would benefit from Kidango’s services utilize public transportation. Therefore, Kidango contracts with Lamar to target specific bus routes for internal bus advertising. School Flyers In partnership with DUSD, Kidango provides materials to City of Dubin schools for elementary students to take home to their parents. Flyers are in English and Spanish. Social Media Kidango maintains an active Facebook page and Twitter feed, regularly posting information regarding enrollment. Website Kidango’s website is optimized for English and Spanish. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. The only partner relevant for this application is Emerald Vista Apartments, who we partner with to ensure all children have access to high quality early education. 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. Every Door Direct Mail Flyers with enrollment dates and locations are sent to multiple targeted mail routes throughout the City of Dublin. We partner with the post office, which means no prior registration is required to receive this information. This ensures families who may not know where to look, or that they even had an option for high quality childcare, are provided the tools they need to enroll their child. Flyers are in English and Spanish. Bus Ads Many families who would benefit from Kidango’s services utilize public transportation. Therefore, Kidango contracts with Lamar to target specific bus routes for internal bus advertising. School Flyers In partnership with DUSD, Kidango provides materials to City of Dubin schools for elementary students to take home to their parents. Flyers are in English and Spanish. Social Media Kidango maintains an active Facebook page and Twitter feed, regularly posting information regarding enrollment. Website Kidango’s website is optimized for English and Spanish. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Reaching 30 Dublin parents with a budget of $2,000 means that the City of Dublin will be spending $67/person. The impact of these funds will be far- reaching, as entire households will benefit from higher confidence levels among parents to help teach their children. The focus on math and science aligns with the national agenda towards increased education in these specific areas. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? This project is outside of our budget, and therefore would not exist without this funding. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A gfedc Yes ✔✔✔✔ No 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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. Helping provide parents the tools they need to feel confident in helping their child reach their goals builds community and promotes a high quality of life. An education promotes higher income opportunities, lower rates of incarceration, and higher college attendance. One way to ensure children from all socio-economic backgrounds have equal opportunities is to help support education in the home. To ensure children don't stop learning at school, we must provide parents the necessary tools to feel confident support their child, and educate the parents on how to teach. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. ✔✔✔✔ 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 gfedc 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 gfedc 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 gfedc 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 gfedc 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 gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 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). Kidango recently reorganized the Development Department, and hired a new Director of Development and Communications. Over the next 3-5 years, the reorganized department will focus on higher levels of individual, unrestricted funding to help offset the cost of projects, such as this, that outside of the budget scope but still critical for our population. 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-108707 ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed City of Dublin $ 2,000.00 $ 0.00 Total $ 2,000.00 $ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Facilitator Reimbursement (Salary and benefits) $ 900.00 Materials $ 1,100.00 Total $ 2,000.00 $ 0.00 Budget Narrative The facilitator will be a member of the Emerald Vista staff, creating an immediate comfort level between the facilitator and participants. Materials will include worksheets, books, and group discussion materials (flipboards, markers, etc.). The materials will be kept by the families to provide Application ID: 70975 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. an ongoing resource, and the staff member will always be available for any follow-up questions once the workshops are complete. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Form List of Board of Directors (or governing body) with contact information ✔✔✔✔ Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board Designation Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board Designation Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Proof of Insurance 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 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 STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ IRS and FTB Letters 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 the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements ✔✔✔✔ Audited Finacials ending June 30, 2016 Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Deaf Counseling Advocacy and Referral Agency (DCARA) Deaf Seniors Services $ 25,000.00 Requested Submitted: 1/6/2017 1:54:49 PM (Pacific) Project Contact DCARA Grants grants@dcara.org Tel: 510-343-6676 Additional Contacts patty.vanni@dcara.org Deaf Counseling Advocacy and Referral Agency (DCARA) 14895 East 14th Street Suite 200 San Leandro, CA 94578 United States Executive Director Raymond Rodgers raymond.rodgers@dcara.org Telephone(510) 343-6676 Fax (510) 343-2526 Web www.dcara.org Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). DCARA promotes and advocates for the rights of full access to American Sign Language, English, education, employment, and cultural identity of, by, for, and with Deaf, DeafBlind, Hard of Hearing and Late-Deafened people. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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. Deaf Counseling Advocacy and Referral Center (DCARA) has received funding from the City of Fremont for the past 20 years. City of Fremont for Human Services: Fiscal year 16-17 for $15,000, Fiscal year 15-16 for $13,796 and Fiscal year 14-15 for $13,011. DCARA initially received funding from both the Human Service and Senior Services funding sources; both funding awards enabled DCARA to provide social services for the Deaf Community and for the Deaf Senior community. The Deaf Senior Services Program focused on aging related issues which ranged from aging safely, retaining independence, battling isolation and depression, health conservation and prevention, advocacy for access to services including hospitals/medical centers, senior living centers, rehabilitation centers, and assisted living facilities, and technology education. DCARA leveraged funding from the Department of Social Services' Deaf Access Program as to provide Deaf Senior services throughout the Bay Area including the city of Dublin and six other Bay Area cities. In 2010 the city of Fremont altered its approach to applying for city funding. This meant DCARA could only apply from one funding source. DCARA's ability to provide Deaf senior services throughout the Bay Area has since been limited to the city of Fremont with services provided by a City of Fremont funded DCARA Advocate. Effective 2013 DCARA has not received funding from the Senior Services fund Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None from the City of Fremont. 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.). Deaf Counseling Advocacy and Referral Center (DCARA) has provided social services to the Deaf, DeafBlind, DeafDisabled, Hard of Hearing, and LateDeafened (DDBDDHHLD) communities since 1962. DCARA began as a volunteer organization and has since grown into a social services agency with four social services offices and five employment services offices via its partnership with the Employment Development Department. DCARA is the first and oldest Deaf run and operated social services providing critical services for all DDBDDHHLD clients who require services for daily living issues or urgent/emergency needs. DCARA's staff is either Deaf or Hard of Hearing. Two staff members are hearing. DCARA's Board has nine (9) Deaf board members, one hard of hearing board member and one hearing board member. DCARA's of, for, by, and with philosophy drives DCARA's services by leveling the service field for its clients when encountering communication and language barriers from service providers. Further, each DCARA staff offer their own expertise and serve as role models for each client they work with. DCARA has received funding from California's Department of Social Services' Deaf Access Program for 38 years. DCARA's programs include the Deaf Seniors Program, Deaf Services Program, Hard of Hearing/LateDeafened Program, Family Connections Program, and Legal Advocacy Program. Each program provides specialized services for each particular community. DCARA's operational system includes a secured database website in which each Advocate maintains client information and case notes. DCARA's financial director manages DCARA's agency budget including program accounts. DCARA's executive director provides agency oversight as well as creates and maintains collaborative relationships with multiple community based organizations, professional services organizations, service providers, government agencies, and educational institutions. 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. Deaf Seniors Services provide essential and often critical to Deaf Seniors, a community that is significantly underserved and marginalized. This type of services are not readily available by other service providers in American Sign Language. 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.) DCARA aims to serve 25 Deaf, DeafBlind, DeafDisabled, HardofHearing and LateDeafened (DDBDDHHLD) Seniors who are residents of Dublin. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. Deaf Counseling Advocacy and Referral Agency (DCARA) provides direct services to Deaf, DeafBlind, DeafDisabled, Hard of Hearing and LateDeafened (DDBDDHHLD) Seniors and their families via two main service categories: (1) One-on-One service and (2) Community Education. One on One services include a myriad of approaches. The main service is document translation in which the Advocate translates critical documents from service providers such as SSA, DMV, IRS, the courts, wills and trust administration, and medical facilities thus providing language access. Equipment demonstration is a second most requested services as many Seniors are not familiar with new technologies which could connect them with family members and friends thus reducing isolation. Independent living skills (ILS) is provided in conjunction of equipment demonstration which may also include video phone equipment and how to use the hardware. Advocate offers peer counseling to DDBDDHHLD Seniors who struggle with depression, isolation, and/or frustration. Finally, Advocate also provide advocacy alongside with the DDBDDHHLD Seniors who face communication barriers to receiving services from specialized services relating with housing, senior living facilities, senior transportation, or other senior-related services. Community Education for DDBDDHHLD Seniors is another mainstay of DCARA's services. This avenue of information distribution allows for all Seniors to come together receiving essential information while connecting with one another. The dual benefit offers the Seniors the opportunity to maintain key relationships while obtaining vital information. Workshops will fundamental senior related topics. These types of workshops may be available via other service providers but which are not accessible to DDBDDHHLD Seniors. Workshops would be available to hearing service providers on how to work with and provide services to DDBDDHHLD Seniors as well as dispelling negative stereotypes of DDBDDHHLD community. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing ✔✔✔✔ Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness ✔✔✔✔ Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse ✔✔✔✔ Disabilities ✔✔✔✔ Food and Nutrition ✔✔✔✔ Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity ✔✔✔✔ Financial Assistance gfedc None of the above DCARA has a rich mixture of funding sources from the state, local cities, individual donations, foundations, earned income, fundraising events. The City of Dublin funds will help us leverage funding from other public and private sources by emphasizing the support DCARA receives from local cities. We have found this to be advantageous when applying for funding. City of Dublin funding will also help DCARA to leverage funding from foundations and corporations. DCARA hired grant writer to identify funding opportunities and to write and submit proposals to foundations and corporations. It has always been helpful in seeking funding to show support from a variety of sources such as the City of Dublin. DCARA services are an efficient use of the City of Dublin's funding. If DCARA did not exist, and traditional agencies with hearing non-signing staff had to provide services directly to D-HH people, these agencies would have a need to contract sign language interpreters in order to communicate with their D-HH clients. One interpreter is usually sufficient for service duration of one hour or less, but if a service was to go more than one hour, two interpreters would be needed. Traditional agencies would then have to pay $95 per hour or more (plus mileage) for each sign language interpreter in addition to the salary and fringe benefits of their non-signing staff. By funding DCARA, the City of Dublin's funding serves more individuals than would be true for a non-Deaf organization. 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 meeting the outcome(s)? Outcomes for one-on-one services focus on Deaf, DeafBlind, DeafDisabled, Hard of Hearing and LateDeafened (DDBDDHHLD) Seniors would demonstrate increased knowledge, skill, self-advocacy in goal progress report as documented by both the Advocate and DDBDDHHLD Seniors. Specific goals will be identified by both the Advocate and progress kept in detailed notes. Outcomes for Community Education workshops will be documented by providing pre-and post-tests to measure DDBDDHHLD Seniors' knowledge. Handouts will be provided and include random worksheets and pop quizzes. DCARA has found and many educational studies have confirmed, direct interaction with the presenter/s and with peers have positive affect on the individual's learning. Group activities will be utilized to encourage participation; each group will be required to 'report' to the entire group thus sharing multiple perspectives. Presenters will monitor individual participation by taking notes for each registered Senior. Finally, DCARA's Advocate will meet with each DDBDDHHLD senior who attended to offer further one-on- one services. For those who choose one-on-one services, the outcome measures will be applied. 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. Deaf Counseling Advocacy and Referral Agency (DCARA) serves all populations and does not discriminate. DCARA has one requirement in order to be eligible for services. Each individual requesting services must self-identify as Deaf, DeafBlind, DeafDisabled, Hard of Hearing, or LateDeafened (DDBDDHHLD). If a hearing individual requests services they must identify their relationship with a DDBDDHHLD individual; the relationship may be familial, community peer, service provider, or similar. DCARA would be able to expand Deaf Senior Services to DDBDDHHLD Seniors who reside in the city of Dublin as well as surrounding areas. Currently DCARA has limited Deaf Senior Services to the city of Fremont as its Advocate manages an office at the Fremont Resource Center. The expansion of DCARA's Deaf Senior Services would benefit DDBDDHHLD Seniors specifically for residents of Dublin and surrounding areas. Funding would reduce the geographical range of limitations thus allowing DCARA to reach out to more DDBDDHHLD Seniors. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? Deaf Counseling Advocacy and Referral Agency (DCARA) is a strong proponent of communication access and language access. Both forms of access differ significantly from the other. Communication access bridges all parties in their communication mode be it spoken English and spoken Spanish or American Sign Language and spoken English. Language access ensures a meaningful access to information thus an equal opportunity to participate in all activities involving the individual. DCARA's Deaf Seniors Services is specifically tailored to provide services to Deaf, DeafBlind, DeafDisabled, Hard of Hearing and LateDeafened (DDBDDHHLD) individuals in their language-American Sign Language (ASL). No other service organization general service or specialized services are linguisitically accessible to DDBDDHHLD clients. DCARA's staff are culturally appropriate as well as linguisitically appropriate; not only that, DCARA's staff of exceedingly competent in providing services and advocating for their civil rights. DCARA is well versed in the frequent pitfalls of simply hiring an ASL interpreter. DCARA's Advocates are skilled in accommodating DDBDDHHLD clients' comprehension by tailoring the sharing of information constantly. Doing so increases the DDBDDHHLD client's ability to understand and assimilate critical information. ASL interpreters facilitate communications by taking the speech and interpreting into ASL and vice versa. A number of ASL interpreters struggle to ensure effective communications. 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? Deaf Counseling Advocacy and Referral Agency (DCARA) utilizes multiple venues of outreach. DCARA's social media channels include Facebook, Twitter, Instagram, DCARA's website, DCARA's weekly e-News, and DCARA's quarterly newsletter. Each office (both Advocacy offices and Employment offices) maintain a bulletin board announcing all DCARA events, community education workshops, and community events. DCARA also provides an ASL vlog which provides a signed version of the written English announcement. The vlogs are posted on DCARA's website along with captions, written transcript, and image descriptions. Finally, DCARA's staff are available to do document translation in real time ASL, doing the requisite accommodation to optimize the client's comprehension. Each venue as described offers accessibility to all individuals based on their preferred choice of access. Further, each Community Education event provides full communication access and language access by arranging for professional American Sign Language Interpreters, Certified Deaf Interpreters, DeafBlind Interpreters, Support Services Professionals for DeafBlind clients, Oral/Speech Reading Interpreters, real time captioning services, and written English documents. Finally, DCARA is a staunch believer of full communication access and full language access. Anything less would be a violation of Deaf, DeafBlind, DeafDisabled, Hard of Hearing and LateDeafened (DDBDDHHLD) individual rights. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Deaf Counseling Advocacy and Referral Agency (DCARA) has multiple collaborative relationships with multiple agencies and organizations. DCARA works closely with the Bay Area Coalition of Deaf Seniors, National Deaf Seniors, Fremont Oak Gardens, Carlton Plaza (both Fremont and San Leandro facilities), Deaf Community Counseling Services, Family and Children Services, California School for the Deaf, Fremont, and Center for Independent Living Centers. Collaborations with hearing service organizations include Family and Children Services, Center for Independent Living Centers, Carlton Plaza, Paratransit, Kaiser Permanente, Kaiser Senior Advantage, various insurance companies such as Blue Cross, Blue Shield, Affordable Care Act/Covered California, private medical and dental facilities, bank institutions; each of the hearing service organizations provide specialized services but are inaccessible to Deaf, DeafBlind, DeafDisabled, Hard of Hearing and LateDeafened (DDBDDHHLD) Seniors. 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. DCARA advertises its programs, services, and community education workshops and trainings through its "word of hand" (the Deaf equivalent of "word of mouth". Outreach and marketing utilizes DCARA's presence in social media including Facebook, Twitter, Instagram, DCARA's newsletter DeafLink, flyers distributed to multiple service organizations with Deaf services, DCARA's e-news (listserv), informational booths at public events, and on DCARA's website. DCARA's Advocates also provide outreach with each of their clients connecting them with an opportunity to receive additional information and resources that may be relevant to their needs. Marketing on DCARA's website encompasses communication access and language access its use of ASL vlogs (signed version of written blogs), captions, written transcript, and video description. The holistic access offers each individual in the Deaf, DeafBlind, DeafDisabled, Hard of Hearing and LateDeafened (DDBDDHHLD) community to receive the announcement in the most optimal language setting allowing for comprehension. DCARA serves 14 counties as mandated by its contract with California's Department of Social Services Deaf Access Program. Contra Costa County is one of DCARA's service areas and DCARA has worked with residents of Dublin. Residents of Dublin who seek DCARA's services had traveled to DCARA's office in San Leandro; some clients have elected to go to DCARA's Fremont office. For employment services Dublin based clients are referred to Employment Development Department in Concord. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Existing social service organizations rarely have a line item in their budget specifically geared towards access accommodations for Deaf, DeafBlind, DeafDisabled, Hard of Hearing and LateDeafened (DDBDDHHLD) clients. While they may initially accept such clients and provide interpreters for client appointments, as mandated by the Americans with Disabilities Act, these service organizations quickly resent spending social services monies for accommodation requirements and often reduce or even deny services to DDBDDHHLD clients who are unable to receive such services anywhere else. DCARA services are an efficient use of funding. DCARA eliminates the need to deny services by being readily available. DCARA employs staff who are fluent in American Sign Language (ASL) and competent in the provision of a wide range of social services. Further, DCARA's staff have years of experience in working with other service organizations thus encouraging a collaborative relationship between the organizations. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If funds were not awarded for the City of Dublin based Deaf Services Program project, the lives of Deaf, DeafBlind, DeafDisabled, Hard of Hearing and LateDeafened (DDBDDHHLD) people would be adversely impacted, especially those many lives made worse in this current economic crisis where many have lost jobs. Clients (without assistance from staff with appropriate qualifications, fluency in ASL, and sensitivity about D/HH issues) will face great difficulty in getting problems solved in difficult situations or even simple daily living issues. This could lead to exacerbated emergency or crisis situations such as: dealing with an eviction from an apartment unit or how to follow treatment plans prescribed by the doctor; what to do when arrested and there is no interpreter present. Seeking services through mainstream agencies requires the client to work with service provider via an interpreter. Lack of sensitivity to and understanding of cultural backgrounds, language needs as well as the emergent issue often interferes with an efficient provision of services. This translates into markedly higher costs for agencies in hiring sign language interpreters or CART to serve DDBDDHHLD clients. Additionally the sense of urgency would be trumped by the availability of such services resulting in appointments being rescheduled repeatedly until an interpreter is found, resulting in a significant delay in the provision of services. It is near impossible to get interpreters with last minute notice. Agencies have found the costs of interpreters or CART exorbitant and as result have chosen to not accept DDBDDHHLD clients which results increased risk for an escalation of problems. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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. Services providers are not always accessible to Deaf, DeafBlind, DeafDisabled, Hard of Hearing and LateDeafened (DDBDDHHLD) Seniors due to communication and language barriers. Hearing service providers often lack of cultural awareness and sensitivity which contributes to not only a communication barrier but a cultural barrier. DDBDDHHLD clients are often required to return to service organizations to provide time for service provides to arrange for American Sign Language interpreters and then return once ASL interpreters have been confirmed. This delay results in services not being provided in a timely manner and may adversely affect the DDBDDHHLD Senior's need for resolution. Further, this delay is not applicable to hearing Seniors as they are more likely to receive services immediately. DCARA works in tandem with service provides to advocate for full communication and language access to services DDBDDHHLD clients need in order to be self-sufficient and independent in their own homes. DCARA works closely with other city based organizations that provides specialized services such as housing, social security benefits, court- mandated services to name a few. As with city based services these organization lack cultural and communication sensitivity. In some cases city based organizations exhibit more resistance to providing services as city employees struggle to maintain the current caseload. In addition to working in tandem DCARA provides cultural education, Americans with Disabilities Act education, and professional training for city employees as to promote successful service provision for the DDBDDHHLD client. When a DDBDDHHLD Senior has access and receives much needed services they are able to independently decide and implement strategies which leads to successful outcomes. DCARA has worked with DDBDDHHLD clients for more than 50 years and witnessed clients' joy and personal satisfaction when they have realized their own self-sufficiency and independence. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc 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 gfedc 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 gfedc 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 gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 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). Regarding the grants DCARA has received in connection with this proposal, DCARA has received $1.135 million in funding from the California Department of Social Services under Deaf Access Program for the last 38 years to provide case management services, including job development and placement, for Deaf and Hard of Hearing individuals in the 14-county area including the San Francisco/Greater Bay Area region. DCARA provides social services which include communication services, counseling, advocacy, independent living skills training, job development and placement, and community education events on a wide variety of topics, and information and referral to agencies such as Employment Development Department and Department of Rehabilitation. Agency fundraising in the form of direct mail solicitations, events, community donations, and individual board contributions allow us to raise money for operating support that our grants would not otherwise be able to cover. 46. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. Application submitted on 1/5/2017 ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed City of Dublin $ 25,000.00 $ 0.00 California Dept. of Social Services, Office of Deaf Access $ 41,344.00 $ 41,344.00 Total $ 66,344.00 $ 41,344.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries $ 36,590.00 $ 19,303.00 Benefits $ 9,544.00 $ 5,221.00 Supplies $ 790.00 $ 600.00 Printing/Copying $ 720.00 $ 720.00 Postages $ 100.00 $ 100.00 Telephone/Internet $ 1,500.00 $ 1,500.00 Rent and Utilities $ 6,900.00 $ 6,900.00 Accounting/Audit $ 7,700.00 $ 7,000.00 ASL Interpreters/CART $ 2,500.00 Total $ 66,344.00 $ 41,344.00 Budget Narrative The following provides a specific breakdown of all expenses that DCARA would incur upon rewarded fund. Below is a projected budget for the Deaf Seniors Program. Salaries: Advocate (30%), Advocate- Legal (10%), Deputy Director (10%), and Finance Director (5%): City of Dublin City $17,288 and Other Sources $19,303. Total Salaries is $36,590. Benefits: 10.04% based on current cost for FICA & Medicare (7.65%) + Workers comp (1.05%) + Unemployment (1.34%), and Insurance for employees. Premium varies based on employees’ age. These figures are average costs for current staff. City of Dublin City $4,323 and Other Sources: $5,221. Total Benefits: $9,544. Supplies: Office supplies such as paper, forms, copy machine supplies, program supplies, folders, pens for offices. Supplies also includes operating supplies for training, workshops and events. City of Dublin City: $190 and Other Sources: $600 Total Supplies: $790. Printing/Copying: Printing and photocopying for program. Includes envelopes, business cards, general agency and flyers about services offered and upcoming events, etc. and handouts used in training and workshops. Postage: Postage costs for newsletters, flyers, business mailing, etc. Telephone/Internet: Phone lines include fax lines, and DSL & Internet. Rent/Utilities: Office, meeting and workshop space required to provide services. Accounting/Audit: Auditing and preparation of 990 IRS form services by CPA Firm and Payroll Services - by Prime Pay Services Communication access services range from American Sign Language Interpreters, American Sign Language Interpreters, Certified Deaf Interpreters, DeafBlind Interpreters, Real Time Captioning for community events or meetings. We will use both interpreting and real captions services, as well as individual interpreters and CART. Cost of Interpreters ranges from $95 - $150 hour and CART services range from $100- $150. City of Dublin; $2,500. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expenses Budget - DCARA Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information Form List of Board of Directors (or governing body) with contact information ✔✔✔✔ List of Board Directors - DCARA Current Annual Budget for the Entire Agency ✔✔✔✔ DCARA Agency Budget FY 2016-2017 Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ DCARA 990 Tax Return 2015 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Designation of Authorized Official form - DCARA Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board of Director's authorization to request fundin Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Proof of insurance carried 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 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 STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ IRS Letter DCARA State Letter REQUIRED FOR CDBG ONLY- AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must Application ID: 70185 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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 ✔✔✔✔ DCARA Audited Financial for FY 15-16 Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Hope Hospice, Inc Hope Hospice - Unified Communications Phone System $ 20,000.00 Requested Submitted: 1/6/2017 2:30:07 PM (Pacific) Project Contact Natalie Brown natalieb@hopehospice.com Tel: (925) 829-8770 Additional Contacts natalieb@hopehospice.com Hope Hospice, Inc 6377 Clark Avenue Suite 100 Dublin, CA 94568 CEO Bob Boehm bobb@hopehospice.com Telephone(925) 829-8770 Fax (925) 829-0868 Web www.hopehospice.com Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Hope Hospice is a trusted guide, safeguarding dignity, hope and comfort by providing home-delivered, patient-centered care and family support services. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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.). 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 107 paid staff and a cadre of about 135 volunteers. Our Dublin headquarters serves as both the management hub for clinician and volunteer assignments to visit patients in their homes, and the destination for individuals seeking grief support and caregiver education. The CEO reports to the Board and manages a qualified leadership team that provides the professional, medical, financial, and organizational oversight to the programs and activities provided to the community. Our CFO/COO will implement this project to support our clinical team: a Chief Medical Officer specializing in hospice/palliative care, 3 hospice-certified Associate Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: ✔✔✔✔ Capital Project gfedc Public Service Program or Project ✔✔✔✔ Yes gfedc No ✔✔✔✔ One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding gfedc None 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 hospice trained volunteers. This team offers a wealth of experience, expertise, and specialized education to each patient and family. Each hospice team member contributes to an environment that offers patients customized care, comfort, and dignity during their final months and weeks. We offer the only Grief Support program in Tri-Valley designed for children; our professionally lead Grief Support services are free of charge to all area residents who have lost loved ones. Hope Hospice is governed by an 11-member volunteer Board of Directors, contributing a range of expertise from the fields of medicine, finance, business, and law enforcement. Each serves a two-year term and may serve 3 consecutive terms. A 9-member volunteer Advisory Council, comprised of local residents, includes Dublin Mayor David Haubert and other leaders from private and public 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 $20,000 grant to implement a new, HIPAA compliant, unified communications phone system to support remote communications essential to excellent home-delivered patient care. 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 245 Dublin residents will benefit from improved phone communication capabilities during the next fiscal year; an equal or increased number of residents each year over the useful life of the new system (minimum of 10 years) 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. Our CFO/COO, Doug House, will have full oversight of the implementation, administration, and operation of the new phone system. We have a proposal which will suit our unique need to provide HIPAA compliance concerning usage of new technologies such as video conferencing of clinical consultations. The vendor will conduct all facets of installation, training and first year support. Hope Hospice's IT contractor will assume the day-to- day operations of managing the system after year 1, and will support both administrative & management employees at our headquarters in Dublin and clinical field staff visiting patients in their homes, residential or skilled nursing facility. Our field team of 50+ hospice clinicians and 20+ home health clinicians are committed to prompt response to patient needs. Doctors, nurses, social workers, spiritual care counselors, home health aides, and volunteers coordinate care to ensure that hospice patients receive the right care at the right time. The geographically organized interdisciplinary teams meet once per week to review care delivery according to the individualized plan for each patient. Outside of weekly meetings, clinicians are travelling alone en-route to patients and rely on a combination of landline, mobile, and secure communications systems to respond to urgent and critical needs of our hospice patients and their families, and to update medical records promptly. Hope Hospice admits new patients and responds to patients with critical needs or who are actively dying 24 hours a day, 7 days per week and requires a modern, unified communications system that interfaces with mobile devices with HIPAA compliant security and top efficiency. This includes the ability to forward incoming calls automatically to pre-determined mobile numbers, a voicemail-to-email capability, a robust auto-attendant to better manage after-hours calls, and an efficient call routing system for nurses and other clinicians to connect with patients and caregivers. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). A grant from the City of Dublin will combine with other sources of capital funding to purchase a modern phone system which will support the delivery of excellent, responsive, HIPAA compliant patient care. For hospice patients and their families time is a precious commodity; our team of physicians and clinicians strive to deliver the highest quality, compassionate care at the appropriate time along the end of life journey. A phone system supporting unified communications will greatly enhance our ability to provide patient-centered, family-inclusive care - without technological impediment - at the time they need it the most. Our current phone system is more than 10 years old and was developed without solutions for unification with current mobile technologies now widely and routinely used, and with no thought to telemedicine efficiencies on the near horizon. A HIPAA compliant communications interface that brings together video conferencing, instant messaging and email enables doctors and other clinicians to remotely treat patients by easily accessing medical history files via the Internet and providing team support to field clinicians in real time at the patient's bedside; telemedicine is especially applicable for hospice patients because they do not make regular medical office visits. For frail elderly patients and their families, virtual meetings ensure they get the care they need in a timely manner; availability of virtual meetings connecting multiple locations is an important asset to caregivers whose loved ones reside in a separate home, such as skilled nursing facility. A modernized phone system will enhance doctor-to-doctor collaboration - with a few clicks, physicians can consult with a patient's previous doctor, enabling them to quickly make decisions regarding care plans in order to provide the comfort and dignity our hospice patients deserve. A new system will also improve Hope Hospice's collaboration of care with the medical & senior community ✔✔✔✔ Behavioral Health (mental health and substance abuse) gfedc Affordable Housing ✔✔✔✔ Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition ✔✔✔✔ Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above at-large. 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 meeting the outcome(s)? To quantify service delivery we use a comprehensive database to track all contacts, communications and individual/group sessions with patients and caregivers, and with adults and children in our Grief Support program. This tool allows us to track the number of patients and families served and the services utilized or refused, and allows us to constantly review quality. Hope Hospice is committed to maintaining the highest hospice rating possible at www.calqualitycare.org and the Consumer Assessment of Healthcare Providers and Systems survey. Ongoing tracking of such indicators as utilization of care in the final days, pain & symptom control, spiritual care services, social services, grief support services, volunteer services, pharmaceutical and equipment services, and timeliness of after hours triage will allow us to monitor improvements in delivery of care. Additionally, internal assessments will be made of staff satisfaction and reduced stress in relation to telephone communications systems. Improved working relationships within the medical community that result in increased patient referrals will also serve as an outcome measure of success. Most importantly, response from patients and families on the Consumer Assessment of Healthcare Providers and Systems survey will be used to determine outcomes (2016 quarterly ratings average 90%, compared to hospice national average ratings of 84%) Rapidly responding to patient needs is one of our core commitments, however we cannot currently track timeliness of calls answered. The new phone system will allow us to measure call response times in seconds, and make improvements accordingly. Volunteer contributions to patient care are a key factor in the high quality of daily life for our hospice patients and consequently in our agency high quality ratings. Including volunteers in a HIPAA compliant unified communications system will support the continued accessibility of the highest quality of care for our community. 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. Last year 71% of our hospice patients were aged 80+, an at-risk advanced-age demographic that is rapidly expanding as cited in the Eastern Alameda County Needs Assessment. We serve frail seniors and others with advanced illnesses who have received a diagnosis limiting life to 6 months or less, and therefore 100% of hospice patients have met the ADA qualifications as disabled. Many times, their main caregiver is a spouse of equivalent age whose needs are also addressed via the interdisciplinary hospice approach. 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 who are seniors equivalent in age to our hospice patients. Our Grief Support Center also serves adults and children of all ages from the community, many of whom have recently become female head-of-household. We do not discriminate or refuse services to anyone in the community and provide services at no cost to the patient/client. The benefit to low-income community members comes from our commitment to provide services to people who have no resources or coverage. Many families experience a detrimental income/insurance shift when coping with the loss of a family member at the time when they are most in need of care services. Availability and affordability of counseling services, including grief support, for low income families is one of the needs identified in our community. All populations we serve will benefit from efficient, secure, unified communications that a new phone system for Hope Hospice will provide. Improvements in internal communications within our interdisciplinary clinical field teams, interdepartmental communications, and external communications with patients & outside agencies will help us meet our goal to be immediately responsive to patient and family needs. Communications with patients and families will be optimized by using a preferred mode at the most crucial times. 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. Hospice service delivery must be tailored and targeted in ways that are considered appropriate and acceptable practices for multicultural hospice patients and their families. Hope Hospice customizes care for each patient, their family, & their caregivers by offering a comprehensive circle of support & paying attention to all of each individual’s needs – physical, mental, emotional, & spiritual. Our Grief Support Center considers the expression of grief as unique not only within populations, but between individuals. Our hospice staff and volunteers come from a wide variety of cultural backgrounds and professions, and undergo training that includes instruction on acceptance of various cultures and religions. All of the above efforts to reach and serve a multi-cultural community are stymied when the process for coordination of care and patient response relies so heavily on an outdated telephone communications system, which has limited capability for supporting our clinical and care teams who bring care directly to patients' homes. Unified communication modes such as HIPAA compliant video conferencing can bring together a patient and family with their care team from multiple locations; the physician, nurse, social & spiritual workers, home health aides, and volunteers can meet with them in real time to meet their specific needs and concerns. The system will add to Hope Hospice's current success in crossing cultural barriers in order to provide essential care and services. 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. Hospice patients themselves have received a doctor's prognosis limiting life to 6 months or less and are in a disabled condition. All services to hospice patients are delivered in their home, many times at the bedside. As a service agency, we are sensitive and responsive to the needs of all individuals and our services reflect that compassion. Our outreach to these communities, which will be optimized by a unified communications telephone system, includes: • 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 headquarters and Grief Support Center comply with ADA requirements in terms of accessibility of parking, sidewalks, hallways, elevators, restrooms, etc and are accessible to all volunteers, staff, clients or visitors. • We strive to ensure that workshops are held at facilities such as local senior centers, where accessible accommodations are part of the facility's 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. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. A new phone system will improve service integration with the following partners: 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. We have worked with skilled nursing facilities, senior homes, corporations, local churches and community-based organizations. These organizations include Safeway, Stanford Health/ValleyCare, Castlewood County Club, Dublin Senior Center, the University of San Francisco, Heritage Estates, Stoneridge Creek, Reutlinger Jewish Community. Such partnerships integrate access to audiences to help create awareness about end-of-life issues, hospice, and bereavement care. This past year we launched The Five Wishes seminar that promotes the documentation of individuals' desires about end-of-life issues in a user friendly manner. The following in-service trainings conducted by our clinical professionals for local senior residential homes improve the level of care for all seniors in our community: • Pain in the Elderly • Nutrition & Hydration • Learning About Hospice The Family Caregiver Education Series, a volunteer-led program held at our Dublin Headquarters, collaborates with experts from Horizon Elder Care, Tri Valley Personal Home Care, the National Institute on Aging, Senior Support of Tri Valley who share as contributors to educate and support the participants who have taken on the role of caregiver. We work with local schools to educate and provide specialized grief support activities for youth. Our Grief Support Center is the designated provider of critical incident stress management for the Pleasanton Unified School District to provide on-site support services in the event of a critical incident. 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. Hope Hospice staff includes a Community Liaison and a Clinical/Community Liaison who advocate for those in need of hospice and bereavement care. They build relationships within the local medical, civic, and senior community to keep excellent end-of-life care accessible to those in need. 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 area residents announcing events • Sending Hope Hospice’s VOICES Newsletter or Annual Report to Dublin area 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 • Assigned Community Liaisons to serve as Ambassadors for the Dublin and San Ramon Chambers of Commerce • Hosting a joint mixer for the Dublin and San Ramon Chambers of Commerce • Visiting the medical community in Dublin and surrounding areas 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 and other events • Partnering with Pleasanton Rotary Club to present our Family Caregiver Education Series • Partnering with Kiwanis of San Ramon Valley to fund our Transitions Program (provides social services and volunteer support for pre or post hospice patients) • Participated in Make a Difference Day sponsored by Pleasanton Community of Character • Revised our program services brochure • Presented Voices for Hope, a one-hour presentation held at our Dublin headquarters giving inspirational stories and informational facts about the work of Hope Hospice • Participated in Pleasanton Downtown Association's 2016 Pleasanton Street Fair 19. 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 fund approximately 25% of the selected new telephone system. Requests are also being submitted to the cities of Livermore and Pleasanton to fund the balance of the capital cost outlay. Services to Dublin residents in the FY 17/18 are forecast to comprise 15% of our total outreach. Additionally, our headquarters in Dublin serves as the hub from which all patients, caregivers, grief support clients, and volunteers are served; as the point of origin for all community/in-service education and patient advocacy; and as the primary meeting point for all executive, board leadership, and management activities. The project is cost effective as it will foster efficient, HIPAA compliant communications between clinicians, volunteers, and management, which will allow the provision of excellent care to more hospice patients and families in the most responsive time frame possible. It also supports Hope Hospice's position as the preferred provider for our services with all entities with which we integrate care. Additionally, if amortized over a 10 year period the cost per individual served annually (including hospice patients, caregivers, home health patients, volunteers, bereavement clients, and seminar attendees) is estimated to be between $2 - $2.50. This amount covers unlimited communications concerning that individual, either with them, their caregiver, or staff/volunteer communications about their needs, across multiple devices - landline phone, cell phone, soft phone devices (iPads, laptops, etc) - which will be selected according to the most efficient and effective mode. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Hope Hospice is currently relying on 20th century telephone technology to provide excellent patient care in a 21st century environment. Every year that passes in which we do not upgrade our communications platform hinders our ability to collaborate well within the medical & senior care communities, to attract the most qualified care staff, and to deliver the best possible care to our patients and families. In order to make use of efficiencies of video conferencing and other applications, our system needs to be HIPAA compliant; per our Medicare licensing, we cannot make use of insecure live communications such as Facetime to remotely consult about patient care. If we do not secure adequate funding for this project we may be forced to choose a less than optimal new system, which will need replacing earlier than the afore mentioned 10 year amortization period (our preferred system may have a useful life well past this period). This is a disruptive choice as adjusting to any change initially interrupts the flow of procedures, so it would be unacceptably challenging to our care staff. Dublin Police reviewed safety protocols at our headquarters and recommended using our intercom to facilitate emergency evacuation or lockdown; our current phone system is inadequate for the square footage and therefore we will continue to fall short in this aspect of providing a safe work environment for our in-office employees until an updated phone system can be obtained. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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. VoIP TEO Technologies Phone System: Scope of Work Estimate 2 - Pro Servers 110 - UC Extensions 45 - UC Mobile Connector 5 - 9160 IP Phones 1 - 7810 IP Phone 1 - 8030X Expansion Module 59 - 4104 IP Phones 45 - iPhone/Droid Softphones System price includes the following pre-installation configuration: UC appliances extensions and voicemail boxes programming of auto attendants PBX server installation Installation and configuration of all phones Installation of PRI interface testing and verification of operability 2 - A101DEs Warranty, training, and support is included for 1 year from the date of installation 25. 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. Current lease is valid through 2018; we are negotiating to remain in our headquarters in Dublin. We expect to reach agreement without disruption. 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) gfedc Yes ✔✔✔✔ No ✔✔✔✔ Yes gfedc No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 gfedc Not Applicable gfedc Yes ✔✔✔✔ No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc 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. ✔✔✔✔ 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 29. Referring to questions 27 and 28 please 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. A new phone system will improve delivery of the following services which are aligned with the City of Dublin’s Mission, Vision, and Values: Hope Hospice was launched in 1980 by community members who were concerned about elderly people dying lonely & isolated in hospitals, & about their families who required support in order to care for their loved ones in their home. Due to our focus on comfort care and interdisciplinary services, 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. We promote basic safety for each patient - during the admissions process each living facility or home is assessed for fire safety, and patients and caregivers receive education on fall prevention. Our home health services promotes an active & healthy lifestyle to non-hospice patients. Our Grief Support Center supports individuals as they navigate their unique journey through the grief process and prepare to engage in an active and healthy lifestyle and embrace new opportunities ahead. Safe & private support groups help children & adults learn to process a shared grief together. Our annual events such as Night of Remembrance and Hike for Hope bring people of all ages together to remember loved ones in a structured and healthy environment. Dublin values openness and responsiveness to the public and community members. Hope Hospice is lead by a local volunteer board to maintain responsiveness to community concerns. Our programs result from assessing needs and providing the care and assistance not available from other service agencies. We collaborate with private & public organizations to provide end-of-life education, outreach, and grief support services. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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. The initial assessment will determine the patient’s communication ability. For Visually-Impaired Patients: • Hope Hospice personnel will read aloud all documents normally provided to the patient and find out that the person has heard and understands what is read. The Hospice assessment nurse documents this in the medical record. • When requested, Hope Hospice personnel will make any large print patient information applicable to the disease process, i.e., colostomy, diabetic care, heart disease, available for the patient’s use. For Hearing-Impaired Patients: • Hope Hospice personnel interviewing the patient will find out the preferred methods of communication (paper and pencil, lip reading or sign language). The California Relay Service has specially trained personnel available 24 hrs. a day, seven days a week to assist with calls. Call 711 to access the service. • International Hearing Aid Society, 1-800-521-5247 ext. 333 is another resource for deaf/hearing impaired: For Patients Who Require an Interpreter: • The agency makes all reasonable efforts to secure a professional, objective translator for hospice-patient communications, particularly those involving consents and notices. • The Agency makes all reasonable efforts to have written copies of consents and notices available in the language(s) that are commonly spoken in the hospice’s service area. • The hospice may only use family and friends as translators for the patient for non-legal communications if the patient specifically requests this approach. If an interpreter is required: • For Telephone interchange with patient or family-International Effectiveness Center (IEC) 415-788-4149 • For Face to face interpreter or ASL – schedule by calling 925-933-8555 or emailing requests@ie-center.com • For Document translation - iec@ie-center.com Hope Hospice asks new employees to reveal foreign language fluency and has multiple clinicians fluent in several different languages available for translation duty. 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: gfedc 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 gfedc 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 ✔✔✔✔ Yes. If so, answer questions 31 through 43. gfedc No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: 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?"): ✔✔✔✔ Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers ✔✔✔✔ Encourage process streamlining ✔✔✔✔ Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *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. gfedc 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. ✔✔✔✔ 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. gfedc Increase homeownership gfedc Promote decent affordable housing ✔✔✔✔ Strengthen communities gfedc Ensure equal opportunity in housing ✔✔✔✔ Promote participation of grass-roots, faith-based, and other community-based organizations gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. ✔✔✔✔ Increase the availability of service-enriched housing for persons with special needs. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities 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?"): 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): 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: 245 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". gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 80 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 8 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 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" 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 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). Our strategy to maintain long-term sustainability employs both proven and innovative fundraising methods, stewarding financial resources, prudently managing investments, and increasing our service numbers to create a positive economy of scale. As an organization that has been in operation in Tri- Valley since 1980, we have modernized our marketing approach to remain relevant to the current medical industry while sustaining our community- based concern and commitment to care delivery. We have added a division of home health, which is slated to be revenue neutral but will strengthen our position in the community as a health care provider and lay the groundwork to serve more in the community with hospice care. 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 50 Disabled 20 Female Headed Households 30 Senior 8 Youth 0 Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 196.00196.00 TOTAL 164 White 12 White + HISPANIC 2 Black/African American 0 Black/African American + HISPANIC 12 Asian 0 Asian + HISPANIC 0 American Indian/Alaskan Native 0 American Indian/Alaskan Native + HISPANIC 6 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 0 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 196.00196.00 TOTAL gfedc #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. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed City of Dublin $ 20,000.00 $ 0.00 City of Pleasanton $ 28,000.00 City of Livermore $ 28,000.00 Total $ 76,000.00 $ 0.00 Funding Uses/Expenses Budget Amount Amount Committed 2 - 2U Rack Mount Pro Server UCM Software $ 0.00 110 - User Licenses $ 0.00 45 - Mobile Device Connectors $ 0.00 5 - 9160 IP Phone, GigE, Color Touchscreen 1 - 7810 IP Phone, AS SIP, 10 lines 1 - 8030X, 30 Button Exp. Module 59 - 4104 IP Phone, 4 lines 2 - A101DE PRI Card 45 - iPhone/Droid Softphone $ 0.00 TEO Unified Communications System $ 76,000.00 Total $ 76,000.00 $ 0.00 Budget Narrative Funds granted by the City of Dublin will fund approximately 25% of the selected new telephone system. Requests are also being submitted to the cities of Livermore and Pleasanton to fund the balance of the capital cost outlay. Services to Dublin residents in the FY 17/18 are forecast to comprise 15% of our total outreach; additionally, our headquarters in Dublin serves as the hub from which all patients, caregivers, grief support clients, and volunteers are served; the point of origin for all community/in-service education and patient advocacy; and the primary meeting point for all executive, board leadership, and management activities. Thank you for consideration of partnership on this project. The overall FY16/17 budget for Hope Hospice reflects the increasing need for senior care services. The current fiscal year is $8,674,680, a 28% increase over FY15/16 due to an equivalent increase in patient load. The portion of revenue slated to be received via insurance reimbursements for hospice patient care is $8,074,000. The balance is raised through fundraising and investment activities. The budget for FY 17/18 will follow a similar structure and growth pattern, but will also add the home health services division as a billable revenue source - it is forecasted to be a revenue neutral service to the community. Hope Hospice's annual fundraising campaign is comprised of grant seeking, events, and direct response marketing, and unsolicited tribute and legacy gifts. Unrestricted funds committed for the FY 17/18 year from a multi-year pledge event is $42,000. Donations which may be repeated for FY 17/18 include a Wells Fargo grant of $5,000 and a City of Pleasanton grant of $5,000 for each Grief Support Center and Volunteer Program, a Deacon Charitable Fund grant of $3,000 for Volunteer Program. We deeply appreciate the partnership of the City of Dublin in bringing essential Grief Support care and an excellent Volunteer Program to residents of Dublin. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Phone Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Phone System Finanical Info List of Board of Directors (or governing body) with contact information ✔✔✔✔ Board Roster Current Annual Budget for the Entire Agency ✔✔✔✔ FY 16/17 Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 6-30-15 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Authorized Officials Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Authorization to Request Funds Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Proof of Insurance REQUIRED FOR CDBG ONLY-If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) Capital Aquisition Budget REQUIRED FOR CDBG ONLY- PERSONNEL POLICIES INCLUDING AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE Non-Discrimination Policy REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" SECTION Most Recent Audit Application ID: 70726 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. Articles of Incorporation/ByLaws ByLaws REQUIRED FOR CDBG ONLY- CONFLICT OF INTEREST STATEMENT (IF NOT INCLUDED IN BYLAWS) Conflict of Interest Statement REQUIRED FOR CDBG ONLY-ORGANIZATION CHART Organizational Chart STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ IRS Letter 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. LAP 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 Supporting Documents (Not Required) MRC TEO Communications System Quote Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Hope Hospice, Inc Grief Support Center and Hospice Volunteer Program $ 18,500.00 Requested Submitted: 1/6/2017 3:09:24 PM (Pacific) Project Contact Natalie Brown natalieb@hopehospice.com Tel: (925) 829-8770 Additional Contacts natalieb@hopehospice.com Hope Hospice, Inc 6377 Clark Avenue Suite 100 Dublin, CA 94568 CEO Bob Boehm bobb@hopehospice.com Telephone(925) 829-8770 Fax (925) 829-0868 Web www.hopehospice.com Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Hope Hospice is a trusted guide, safeguarding dignity, hope and comfort by providing home-delivered, patient-centered care and family support services. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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.). 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 107 paid staff and a cadre of about 135 volunteers. Our Dublin headquarters serves as both the management hub for clinician and volunteer assignments to visit hospice patients in their homes, and the destination for individuals seeking grief support and caregiver education. The CEO reports to the Board and manages a seasoned & qualified 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, Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None numerous Registered Nurses, Licensed Vocational Nurses, Licensed Clinical Social Workers, Licensed Marriage and Family Therapists, Spiritual Care Counselors, Home Health Aides, a Dietitian, and hospice trained volunteers. This team offers a wealth of experience, expertise, and specialized education to each patient and family. Each team member contributes to an environment that offers patients customized care, comfort, and dignity during their final months and weeks. We offer the only Grief Support program in Tri-Valley designed for children; our professionally lead Grief Support services are free of charge to all area residents who have lost loved ones. Hope Hospice is governed by an 11-member volunteer Board of Directors, contributing a range of expertise from the fields of medicine, finance, business, and law enforcement. Each serves a two-year term and can serve three consecutive terms. A 9-member volunteer Advisory Council is also comprised of local residents, including Dublin Mayor David Haubert and other leaders from private and public 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 $18,500 grant to support the Grief Support Center and Volunteer Program. Funds will be used toward the salaries of the Directors and program staff, who are responding to a 28% increase in hospice admissions in the last calendar year. 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 245 Dublin residents will benefit from the Hope Hospice Grief Support Center and the Volunteer Program during the next fiscal year. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. The Volunteer Program is managed by Jill Biggs-Smith, RN, Hope Hospice’s Director of Volunteers. Mrs. Smith is responsible for recruiting, screening and training candidates, and overseeing their performance to ensure they are high-performing hospice homecare volunteers - the only such trained team in Tri-Valley. Volunteers candidates are processed through an application, interview, background check, health screening, orientation, and a 25- hour online Hospice Education Series. Once initial training is complete, they are prepared to help hospice patients and families as homecare volunteers while maintaining annual mandatory training. Our Volunteer Program has expanded about 13% to 135 volunteers, some serving in multiple roles. About 90 are homecare volunteers; 40 help with fund-raising events. About 20 serve in administrative support roles, and 28 serve in governance or advisory roles. Around 50% are seniors seeking a place to give their time and talents. For FY 15-16 our volunteers gave 5,543 hours of service, and made 1,743 patient or respite visits - a 19% increase in volunteer visits over the previous year due to increasing demand for frail senior services in our area. Lee Ann Morgan, LMFT, is the Director of Grief Support Services. She develops and manages the programs which help people process grief, connect with a caring community, and learn healthy coping skills. She collaborates with the interdisciplinary hospice team; supervises the grief support team who conduct individual grief counseling, facilitate group sessions and initiate community outreach; and teaches classes about the grief process. Grief support groups meet once a week for 8 weeks; a monthly drop-in Pet Loss Grief Support group; Children's Grief Support Groups and Workshops; and 6 special classes (some off-site) such as "Handling The Holidays", and a Service of Remembrance. Grief Support Services are free of charge to families of Hope Hospice patients and all community members in need. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). A grant from the City of Dublin will fund a portion of the program Directors and Staff salaries All hospices are required by law to have a grief support program 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 and staff to deliver the following excellent care: Grief Support for adults improves quality of life by helping people process grief, overcome confusion and fear, connect with a caring community, and learn healthy coping skills. The 13 month program includes a personal consultation, elective participation in on-going grief support groups and activities or one-on-one sessions, and scheduled follow up. Children meet in age-appropriate group sessions encouraging several ways for children to express their feelings: art projects, writing, music, games, and topic discussions. The Grief Support Center also conducts grief-related workshops, memorial events, on-site support for local schools, senior centers, and other organizations. Volunteers support high-quality hospice patient care by providing the scope and depth of services that money can't buy, and not accessible to patients even if they could be purchased. Homecare volunteers provide companionship to patients through listening, reading, music, art, prayer, home repair, meal preparation, gentle touch, and just “being there”. Volunteers provide essential support to family caregivers by offering respite, giving them a chance to run errands or have an afternoon off knowing their charge is under the skilled care of a hospice trained volunteer. 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 photos. ✔✔✔✔ Behavioral Health (mental health and substance abuse) gfedc Affordable Housing ✔✔✔✔ Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition ✔✔✔✔ Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above 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 meeting the outcome(s)? To quantify service delivery we use a comprehensive database to track all contacts, communications and individual/group sessions with patients, adults and children. This tool allows us to track the number of patients and families served and the services utilized or refused, as stated in #11 & 12 above. Quality of Care: Grief Support Center - Everyone experiencing the loss of a family member under Hope 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). 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. 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 overall satisfaction rate of 80% compared the national average of 75.1%. Volunteer Program - Each hospice patient and family are offered volunteer support services upon admission and in subsequent visits by our social workers. The effectiveness of the Volunteer Program is measured by the Consumer Assessment of Healthcare Providers & Systems survey that is completed by the patient's 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 - 90% of those surveyed in the most recent period stated that the volunteer services they were offered and used were the right amount. This exceptionally high rating of our Volunteer Program contributes to Hope Hospice achieving the highest hospice rating possible at www.calqualitycare.org. 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. Last year 71% of our hospice patients were aged 80+, an at-risk advanced-age demographic that is rapidly expanding as cited in the Eastern Alameda County Needs Assessment. We serve 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; the interdisciplinary hospice approach also addresses needs of family caregivers. Free services of the Volunteer Program benefit patients and their families by providing valuable companionship for patients, respite for caregivers, home support (chores, errands), specialized patient physical care (massage, Reiki, cosmetology) 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 who are seniors equivalent in age to our hospice patients. We also serve adults of all ages from the community, many of whom have become female head-of-household. Our children's grief support groups are split between 2 age groups - children ages 6 - 12 and teens ages 13 - 16, and is the only grief program in the Tri-Valley designed for youth. Two Grief Support Providers are now certified as Critical Incident Responders and are trained to provide on-site grief care at schools should a critical incident occur. We do not discriminate or refuse services to anyone in the community and provide services at no cost to the patient/client. The benefit to low-income community members comes from our commitment to provide services to people who have no resources or coverage. Many families experience a detrimental income/insurance shift when coping with the loss of a family member and when they are most in need of care services. 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 Center: 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 is our children’s program which makes effective use of non-verbal methods of expressing grief. Another example is the realization that for some cultures and individuals the process of initiating grief support is intensely private, therefore we offer a choice of individual grief support sessions or group. Volunteer Program: Hospice service delivery must be tailored and targeted in ways that are considered appropriate and acceptable practices for multicultural hospice patients and their families. Hope Hospice customizes care for each patient, their family, & their caregivers by offering a comprehensive circle of support & paying attention to all of each individual’s needs – physical, mental, emotional, & spiritual. 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. The specialized 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. Hospice patients themselves have received a doctor's prognosis limiting life to 6 months or less and are in a disabled condition. All services to hospice patients are delivered in their home, and many times at the bedside. As a service agency, we are sensitive and responsive to the needs of all individuals and our services reflect that compassion. Our outreach to these communities includes: • 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 headquarters and Grief Support Center comply with ADA requirements in terms of accessibility of parking, sidewalks, hallways, elevators, restrooms, etc and are accessible to all volunteers, staff, clients or visitors. • We strive to ensure that workshops are held at facilities such as local senior centers, where accessible accommodations are part of the facility's 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. 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. We have worked with skilled nursing facilities, senior homes, corporations, local churches and community-based organizations. These organizations include Safeway, Stanford Health/ValleyCare, Castlewood County Club, Dublin Senior Center, the University of San Francisco, Heritage Estates, Stoneridge Creek, Reutlinger Jewish Community. Such partnerships integrate access to audiences to help create awareness about end-of-life issues, hospice, and bereavement care. This past year we launched The Five Wishes seminar that promotes the documentation of individuals' desires about end-of-life issues in a user friendly manner. The following in-service trainings conducted by our clinical professionals for local senior residential home staff improve the level of care for all seniors in our community: • Pain in the Elderly • Nutrition & Hydration • Learning About Hospice The Family Caregiver Education Series, a volunteer-led program held at our Dublin Headquarters, collaborates with experts from Horizon Elder Care, Tri Valley Personal Home Care, the National Institute on Aging, Senior Support of Tri Valley who share as contributors to educate and support the participants who have taken on the role of caregiver. We work with local schools to educate and provide specialized grief support activities for youth. Our Grief Support Center is the designated provider of critical incident stress management for the Pleasanton Unified School District to provide on-site support services in the event of a critical incident. 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. Hope Hospice staff includes a Community Liaison and a Clinical/Community Liaison who advocate for those in need of hospice and bereavement care. They build relationships within the local medical, civic, and senior community to keep excellent end-of-life care accessible to those in need. 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 area residents announcing events • Sending Hope Hospice’s VOICES Newsletter or Annual Report to Dublin area 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 • Assigned Community Liaisons to serve as Ambassadors for the Dublin and San Ramon Chambers of Commerce • Hosting a joint mixer for the Dublin and San Ramon Chambers of Commerce • Visiting the medical community in Dublin and surrounding areas 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 and other events • Partnering with Pleasanton Rotary Club to present our Family Caregiver Education Series • Partnering with Kiwanis of San Ramon Valley to fund our Transitions Program (provides social services and volunteer support for pre or post hospice patients) • Participated in Make a Difference Day sponsored by Pleasanton Community of Character • Revised our program services brochure • Presented Voices for Hope, a one-hour presentation held at our Dublin headquarters giving inspirational stories and informational facts about the work of Hope Hospice • Participated in Pleasanton Downtown Association's 2016 Pleasanton Street Fair 19. 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 portion of the salaries for the Directors of Grief Support & Volunteer Services and the program staff to help cover activities targeted and provided to Dublin residents. Dublin hospice patients and caregivers, grief support clients, and volunteers is projected to account for approximately 15% of unique individuals served by Hope Hospice next year. The $18,500 grant request covers 5% of the total budgets for the Grief Support Center and the Volunteer Program. The cash donations received from other Dublin sources - individuals, families, organizations and businesses - for the last 12 months allocable to these programs was about 10% 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, are free to the community, 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 California is $27.59 (2015). Last fiscal year we logged 5543 hours of volunteer time, creating an in-kind value of $152,931. 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 and the philanthropic intentions of local residents, Hope Hospice is able to provide a rich array volunteer services to hospice patients in the Dublin area 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 Support and the Children's Grief Support staff is highly leveraged. 20. 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 community members who are referred from sources other than our hospice program make up 70% of our bereavement clients. Funds to support the Grief Support Center come from partnerships with businesses, service & grant-making organizations, and individuals. 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 from 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 the help they need to manage grief and adjust to their altered life path. 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. Beyond benefitting patients and families, our volunteer program enriches the lives of the volunteers themselves. 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. Local seniors find that Hope Hospice gives them a highly rewarding volunteer experience. If we are not favored with the grant award for this period, we will try to maintain the current volunteer staffing levels, and if we are not successful in acquiring the necessary funds, we may have to reduce the number of volunteers on our staff and limit the patients served by volunteers. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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 skills, and overcome the confusion and fear that grief can cause. To improve 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. We offer specialized groups for children & adults to process a shared grief together. We are clearly aligned with the City of Dublin’s mission to “promote and support a high quality of life...and foster new gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc 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. ✔✔✔✔ 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 gfedc 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 gfedc 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 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 help patients and families live each day to the fullest with dignity, hope, and comfort. 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. For hospice patients and their families, each day is a precious new opportunity - our volunteers are instrumental in making memorable moments possible. The City of Dublin values openness 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 concerns. 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 support services. Our Chief of Quality and Ethics Committee meet regularly to ensure the highest quality of services. We provide services to all in need regardless of the ability to pay. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. 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). Our strategy to maintain long-term sustainability employs both proven and innovative fundraising methods, stewarding financial resources, prudently managing investments, and increasing our service numbers to create a positive economy of scale. As an organization that has been in operation in Tri- Valley since 1980, we have modernized our marketing approach to remain relevant to the current medical industry while sustaining our community- based concern and commitment to care delivery. We have added a division of home health, which is slated to be revenue neutral but will strengthen our position in the community as a health care provider and lay the groundwork to serve more in the community with hospice care. 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 gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed Events $ 150,000.00 $ 42,000.00 Grants $ 60,000.00 Individuals $ 121,059.00 Total $ 331,059.00 $ 42,000.00 Funding Uses/Expenses Budget Amount Amount Committed Grief Support Center - Adult $ 139,944.00 Grief Support Center - Child $ 64,178.00 Volunteer Program $ 126,937.00 Total $ 331,059.00 $ 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 to salaries of the Directors and program staff. The figures shown are for each program for current year; there has been a cost reduction for the Grief Support Center compared to FY 15/16, while a 34% increase in client visits has occurred in the last 12 months (a 40% increase in Dublin clients). This indicates that prior investment to reach more of the community has been effective, and the GSC is delivering more care. The budget reduction in Volunteer Program is due to a transfer of management of our Transitions program to Clinical Directors; however trained volunteers are still required for that program. Volunteer visits are up 19% over the previous year. The overall FY16/17 budget for Hope Hospice reflects the increasing need for senior care services. The current fiscal year is $8,674,680, a 28% increase over last year due to an equivalent increase in patient load. The portion of revenue slated to be received via insurance reimbursements for hospice patient care is $8,074,000. The balance is raised through fundraising and investment activities. The budget for FY 17/18 will follow a similar structure and growth pattern. Hope Hospice's annual fundraising campaign is comprised of grant seeking, events, and direct response marketing, and unsolicited tribute and legacy gifts. Unrestricted funds committed for the FY 17/18 year from a multi-year pledge event is $42,000. Donations which may be repeated for FY 17/18 include a Wells Fargo grant of $5,000 and a City of Pleasanton grant of $5,000 for each Grief Support Center and Volunteer Program, a Deacon Charitable Fund grant of $3,000 for Volunteer Program. We deeply appreciate the partnership of the City of Dublin in bringing essential Grief Support care and an excellent Volunteer Program to residents of Dublin. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Budgeted Expenses Form Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information List of Board of Directors (or governing body) with contact information ✔✔✔✔ Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ HH Organizational Budget FY17 Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 Application ID: 70028 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Authorized Officials Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Request Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Certificate of Insurance 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 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 STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ IRS Determination 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 the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements ✔✔✔✔ Most Recent Audit Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Axis Community Health Enhancing Health Outcomes with Patient Care Messaging $ 7,000.00 Requested Submitted: 1/6/2017 3:56:43 PM (Pacific) Project Contact Valerie Jonas vjonas@axishealth.org Tel: 925.201.6068 Additional Contacts scompton@axishealth.org,contracts@axishealth.org,amcdonald@axishealth.org Axis Community Health 4361 Railroad Avenue Pleasanton, CA 94566 United States CEO Sue Compton scompton@axishealth.org Telephone(925) 201-6068 x Fax (925) 417-1503 x Web axishealth.org Application Questions 1. Please describe your organization category (select one of the following): 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? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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 1972 to serve the children of low-income families, Axis today has a $22 million operating budget and provides high-quality, affordable health care for patients of all ages, cultures and incomes at its three medical clinics. Axis is a Federally Qualified Health Center supported by local, county, state and federal funds, as well as foundation grants, community donations, patient revenues and public insurance such as Medi-Cal and Medicare. In addition to medical services, Axis provides drug and alcohol programs, mental health counseling and a WIC nutrition program. A 501(c)3 organization, Axis’s Board of Directors is comprised of patients and community members. The Axis management team, led by CEO Sue Compton, directs an organization that serves 14,000 Tri-Valley residents annually and employs a staff of 150. Axis has a robust fiscal management capacity. Accounting and internal control systems are in place and fully integrated in the organization’s financial Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project ✔✔✔✔ Yes gfedc No ✔✔✔✔ One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding gfedc None system. A system of checks and balances, including separation of duties, is used to comply with standard accounting practice (GAAP), thus ensuring full accountability for all financial transactions. Monthly financial reports are produced by the CFO and reviewed by management staff, the Board of Directors’ finance committee and the Board itself. Written policies have been developed for all financial and billing operations. Axis’s finance department utilizes MAS 90 accounting software to report, analyze and track financial indicators. This system aligns with the NextGen practice management system. Through the integration of these systems, the agency monitors revenues by source, visit type and numbers. These systems also allow Axis to report and analyze all elements of financial operations. Axis has the capability to maintain files and records and meet all statistical reporting requirements. 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 project will implement a bilingual mobile messaging technology which has proven to be successful at enhancing disease management and increasing preventive care compliance resulting in improved patient health outcomes. 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.) 1475 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. Axis provides primary and preventive medical services for 14,000 area residents of all ages, including 1,475 Dublin residents. More than 30% of patients have a chronic illness, such as diabetes, hypertension or asthma. To improve patients’ health, Axis emphasizes regular care and healthy living, which can prevent acute episodes or health decline. Regular contact with patients is critical to ensuring patients follow prescribed treatment plans. Presently, Axis uses a 10-year-old, auto-calling technology (Teleminder) to call patients with appointment reminders or other health messages. The system has limited programming capability and is not fully compatible with current phone technology, necessitating IT workarounds and a lot of live calling by staff. We seek to replace this outdated system with state-of-the-art mobile technology that includes text messaging and e-mail capabilities which are more effective for reaching patients. The program (CareMessage) will be used to remind patients of upcoming appointments and the need for preventive services (e.g., mammogram, flu shot). The new system also offers health education for targeting patients with specific health issues (e.g., diabetes, smoking cessation, depression). Studies show using mobile technology results in better health outcomes due to improved preventive care and treatment compliance, and reduced health care costs due to reductions in emergency room usage and hospitalizations. The project will be implemented, administered and operated by our Quality Enhancement (QE) team in conjunction with our Clinical Operations and IT staffs. The IT department will install the software and link it to our existing patient management systems and electronic health records (I2I and NextGen). Staff will be trained on system usage. The QE staff will use the system for overall population health management by analyzing patient data and targeting specific populations with preventive care and health education messages. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). This grant request of $7,000 will support acquisition of the CareMessage system and associated staffing costs for implementation. CareMessage is an English/Spanish bilingual messaging system that is specifically designed to improve the health and wellness of underserved patients. The project involves upfront expenditures for software licensing and staff time for system configuration and training. As a result of this investment in mobile technologies, Axis will be able to contact more patients with more types of contacts, e.g., phone, text, or e-mail, and more types of message content. This will also reduce the number of hours staff currently must spend calling patients with reminders for regular services, e.g., appointments, lab tests, preventive care. 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 meeting the outcome(s)? The project will result in several positive outcomes for Axis patients: • Patients will miss fewer medical appointments because they are receiving appointment reminders in a preferred format and preferred language. • Patient compliance with prescribed treatment plans will improve because patients will receive reminders for follow-up care and preventive care. • Patients who have chronic health conditions will receive regular, focused health education programming specific to their health concerns. • Staff time spent making phone calls reminding patients of appointments and other care needs can be redirected to the provision of more direct patient services. Axis will be able to track all CareMessage contacts. Data reports will be produced and reviewed by our Quality Enhancement team to assess reductions in appointment no-show rates, improvements to patient follow-up and preventive care rates, and impacts on subsets of patients with gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing ✔✔✔✔ Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above specific conditions and diseases. Our operations staff will monitor and redirect staff currently assigned to making phone calls to more productive activities involving face-to-face patient service. 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. Axis’s mission is to provide affordable and effective health care for low-income and uninsured Tri-Valley families. We are the sole provider serving this population. This target population experiences significant health disparities particularly in the incidence of chronic diseases such as obesity, diabetes and hypertension. This population is also more likely to have multiple, complex and un/under-treated health problems. 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 Dublin residents are foreign-born, and 29% speak a language other than English at home. These demographics present potential cultural and linguistic barriers to attaining and maintaining good 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 serving 1,012 Dublin residents in 2010 to serving 1,475 in 2015, a 45% increase in just five years (UDS Reports, 2010-2015). This project will benefit low-income and uninsured Dublin residents who receive preventive and primary medical care at Axis. 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. All front-line medical staff and eligibility workers are bilingual in Spanish and English. Axis provides services in a culturally sensitive manner, with staff members representing the cultures and backgrounds of patients. Axis also has care providers fluent in Spanish, Hindi, and Farsi. Employees are trained to recognize and respect differences among patients' values, expectations and experiences. This project will embrace these same policies. Care messages are written at a 6th grade reading level and can be in English or Spanish. 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? 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, school events, low-income housing meetings, faith community events, 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. 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. Axis coordinates with the local community college and the public schools to serve as a site for internship opportunities for students entering the health care field. 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. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The total cost of this project is $44,000 and we are seeking CDBG funding from each of the Tri-Valley cities using a formula that is based upon the city of residence for Axis’s patients. Sixteen percent of Axis’s patients reside in Dublin; 25% reside in Pleasanton and 59% reside in Livermore. As such, 16% of project funds ($7,000) are being requested from The City of Dublin. Project costs include $25,000 for the initial purchase of CareMessage software, with 16% of these funds ($3,977) being requested from Dublin. Implementation and subsequent ongoing utilization of the software will be performed by a Quality Enhancement Coordinator, with 25% of her time being allocated to the project; 16% of project personnel costs ($3,023) is requested from Dublin in support of salary and fringe benefit costs. Dublin’s investment of $7,000 in CDBG funds will support care messaging services for 1,475 Dublin residents over the course of the project year, at a cost per person of $4.75. With this new technology in place, Axis will be able to conduct ongoing and bilingual telephone and text messaging for patients who require reminders for follow-up and preventive care services, health education messages, and reminders to pick up their required ongoing medications at the pharmacy. Implementation of this technology will also free staff, who are currently conducting telephone reminder calls via antiquated technology that requires ongoing staff time and attention, to provide more direct services in the clinic. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Axis is seeking funding for this care messaging project from all three Tri-Valley cities. We will also be seeking support from foundations that fund patient care projects for community health centers. Securing $7,000 in funding from the City of Dublin will greatly improve our ability to seek foundation grants 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 $7,000 we are seeking from the City of Dublin. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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 promotes and supports a high quality of life for low income Dublin residents who face barriers to medical care. The project will serve an estimated 1,475 Dublin residents who obtain primary care medical services at Axis. 95% of these residents have a family income that is less than 200% of the Federal poverty level, and the majority of these residents struggle with ongoing issues related to chronic illnesses, such as heart disease, diabetes and hypertension. Access to ongoing medical management of these conditions results in an enhanced state of health and allows each person to have a higher quality of life – whether through maintaining the ability to be employed or to living independently without the need for hospitalization or skilled nursing services. Axis’s services also promote the maintenance of optimal health for all patients, which includes the prevention of a host of illnesses that impact quality of life. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc 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 gfedc 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 gfedc 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 gfedc 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 ✔✔✔✔ Yes. If so, answer questions 31 through 43. 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. Axis's mission is to provide preventive and primary medical care to all 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 otherwise 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 medical 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: 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: gfedc No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. ✔✔✔✔ Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *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. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase homeownership gfedc Promote decent affordable housing ✔✔✔✔ Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. gfedc 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: 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?"): 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?"): 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): 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: 1475 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". 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" 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 three years after assistance. gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 413 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 1062 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 74 Disabled 236 Female Headed Households 103 Senior 384 Youth 30 Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 2,302.002,302.00 TOTAL 501 White 664 White + HISPANIC 74 Black/African American 0 Black/African American + HISPANIC 177 Asian 0 Asian + HISPANIC 15 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 44 Multi Racial + HISPANIC OR other Multi Racial 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 1,475.001,475.00 TOTAL ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. 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 gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed City of Dublin $ 7,000.00 $ 0.00 City of Pleasanton $ 11,000.00 $ 0.00 City of Livermore $ 26,000.00 $ 0.00 Total $ 44,000.00 $ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Quality Enhancement Coordinator Salary $ 15,500.00 $ 0.00 Quality Enhancement Coordinator Benefits $ 3,500.00 $ 0.00 CareMessage software $ 25,000.00 $ 0.00 Total $ 44,000.00 $ 0.00 Budget Narrative The total cost of this project is $44,000, which includes $25,000 for the initial purchase of CareMessage software which will provide care messaging services for 1,475 Dublin residents over the course of the project year, at a cost per person of $4.75. With this new technology in place, Axis will be able to conduct ongoing and bilingual telephone and text messaging for patients who require reminders for follow-up and preventive care services, health education messages, and reminders to pick up their required ongoing medications at the pharmacy freeing up staff time and attention to provide more direct services to patients in the clinic. The implementation and subsequent ongoing utilization of the software will be performed by a Quality Enhancement Coordinator, with 25% of her time being allocated to the project totaling $19,000 in salary and benefits paid by grant funds, with $3,023 requested from the City of Dublin. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Axis Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Axis Financial Information Form List of Board of Directors (or governing body) with contact information ✔✔✔✔ Axis Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Axis Current Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Axis IRS 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Axis Authorized Official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Axis Board Resolution Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Axis Proof of Insurance 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 AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE Axis Affirmative Action Plan REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS Axis Audited Financials Application ID: 70398 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" SECTION REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. Axis Bylaws Axis Articles of Incorporation REQUIRED FOR CDBG ONLY- CONFLICT OF INTEREST STATEMENT (IF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY-ORGANIZATION CHART Axis Organizational Chart STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ Axis Non-Profit Determination Letter 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. Axis Limited English Proficiency Language Access Plan 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 ✔✔✔✔ Axis Audited Financials Supporting Documents (Not Required) Axis DUNS Verification Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Community Resources for Independent Living Independent Living, Housing & Employment Services for People with Disabilities $ 10,118.00 Requested Submitted: 1/6/2017 3:57:00 PM (Pacific) Project Contact Michael Galvan Programs@crilhayward.org Tel: 510 881 5743 x31 Additional Contacts none entered Community Resources for Independent Living 439 A Street Hayward, CA 94541 United States Executive Director Ron Halog Ron.Halog@crilhayward.org Telephone(510) 881-5743 Fax (510) 881-1593 Web www.crilhayward.org Application Questions 1. Please describe your organization category (select one of the following): 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? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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 37 years, Community Resources for Independent Living (CRIL) has been providing comprehensive life skills training, including housing assistance & 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- Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding ✔✔✔✔ None 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 self-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 larger community. Though we are a small organization, CRIL is fiscally sound and well 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 & 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.) 25 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? Please explain how your project meets the selected Areas of Concern. 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 Independent Living 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 & repair, housing research, applications, interviews, tenant rights & responsibilities. 2. Monthly Job Club & 1:1 Employment Counseling 3. Individualized Travel Training Excursions on WHEELS, BART & AC Transit 4. Monthly Peer Support Groups 5. 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 6. IL Coordinators refer or coordinate meetings with other service providers 7. 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?). CRIL is requesting $10,118 in Dublin Community Grant funding for FY 2017-18, 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 25 low income Dublin seniors and residents with disabilities (a 300% increase in consumers since 2011), 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 commissions. FY 2017-18 continues to see a dramatic increase in the number of Dublin consumers served. Funds will primarily cover 51% of the salary and benefits of the IL Coordinator with a small amount for shared indirect costs associated with necessary program and office operations (e.g., admin, telephone, supplies, insurance, etc.). gfedc Behavioral Health (mental health and substance abuse) ✔✔✔✔ Affordable Housing gfedc Health Care (including dental) ✔✔✔✔ Workforce Development ✔✔✔✔ Homelessness ✔✔✔✔ Transportation Services and Access gfedc Domestic Violence and Child Abuse ✔✔✔✔ Disabilities gfedc Food and Nutrition ✔✔✔✔ Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education ✔✔✔✔ Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above 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 meeting the outcome(s)? CRIL's Housing, Employment & IL Services for people with disabilities will provide 25 Dublin residents with improved access to affordable housing, peer counseling, employment & benefits counseling, travel training, I & R, assistive technology info & AT device loans & advocacy. Housing counseling will include local 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 support, ADA & disability 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 & 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 Corrdinator, 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 IL Coordinator who is an SSA Certified 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. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? 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 & management to develop and maintain strong partnerships & 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 Healthcare. 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. CRIL’s Tri-Valley Coordinator 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 certified 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 parking 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 TheCIL (formerly CIL 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, TheCIL 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 listserv has 850 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. 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 & Pleasanton, funding from the Hindu CCC, and CIL funding for travel training, Dept. of Rehabilitation all contribute to the overall costs of operating CRIL’s Housing, Employment & IL Services program and supporting our full-service branch office in the Tri-Valley. The city of Dublin's portion to support CRIL's Tri-Valley services is 12%. CRIL provides more than one dozen programs & services to residents in the Dublin community, including education, training, employment services, benefits counseling & peer support 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 & advocacy skills training, mobility/travel training, community leadership development, I & R and resource connections. 20. 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 & 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 community with a full-time, full service capacity branch office. Though Dublin funding is only 12% 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 office hours or complete office closure. Without CRIL's local presence in the Tri-Valley, it would be extremely difficult for Dublin residents with disabilities 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. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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 Independent Living philosophy is one of self-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 larger community. Though we are a small organization, CRIL is fiscally sound and well 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 & 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. As a result, the work of CRIL builds community relationships along with networking opportunities in the disability community, as well as, with other communities in Dublin and Alameda County. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc 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. ✔✔✔✔ 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 gfedc 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 gfedc 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 gfedc 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 ✔✔✔✔ Yes. If so, answer questions 31 through 43. 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. !/3 of CRIL's staff are bilingual in English/Spanish, an additional staff member is bilingual in English/Cantonese. We also use the County's language line, 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: 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: gfedc No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers ✔✔✔✔ Encourage process streamlining ✔✔✔✔ Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ 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. gfedc *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, uninsured and under-insured residents with emphasis on activities that: gfedc * 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. gfedc 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. ✔✔✔✔ E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ 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. gfedc Participation of minority-serving institutions in HUD programs. ✔✔✔✔ End chronic homelessness within ten years. ✔✔✔✔ Removal of barriers to affordable housing. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Increase the availability of affordable rental housing for extremely 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). gfedc Assist low and moderate income first-time homebuyers. 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?"): 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?"): 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: ✔✔✔✔ 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc 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): 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: 25 directly; 50 directly 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". 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" 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 ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 10 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 15 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 25 Disabled 5 Female Headed Households 10 Senior 8 Youth 2 Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 75.0075.00 TOTAL 10 White 5 White + HISPANIC 3 Black/African American 0 Black/African American + HISPANIC 5 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 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 0 Multi Racial + HISPANIC OR other Multi Racial n/a Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 25.0025.00 TOTAL ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc 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 an accredited Center for Independent Living by the federal Rehabilitation Services Administration, CRIL’s federal revenues (59%) include ACL funding and CA State Department of Rehabilitation IL funding to provide 7 core IL services within our geographic area. The balance of our revenue is from local social service & CDBG grants, other competitive government grants, private foundations, fee-for-service contracts, fundraising activities and individual donations. Diversified government and private funding allows CRIL to provide additional services that meet the specific needs of our community (e.g., employment assistance, benefits counseling, PAS matching services, mobility/travel training, computer training , disaster preparedness training) and maintain full-service branch offices in the Tri-Cities and Tri-Valley areas. CRIL often partners with other local organizations on grant applications and projects (e.g., TheCIL, AC AAA, ACPHD, Senior Services Coalition, LAS-HICAP, CFILC) to maximize our community reach and service effectiveness. 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 City of Livermore $ 15,142.00 City of Pleasanton $ 18,276.00 Hindu Temple $ 1,000.00 $ 1,000.00 Department of Rehabilitation $ 14,326.00 $ 14,326.00 Center for Independent Living- MTC $ 13,590.00 $ 0.00 Center for Independent Living- GAP CYCLE 5 $ 11,000.00 City of Dublin $ 10,118.00 Total $ 83,452.00 $ 15,326.00 Funding Uses/Expenses Budget Amount Amount Committed ILC- Tri Valley Coordinator $ 35,861.00 $ 7,800.00 ILC- Tri Valley Travel Trainer $ 15,935.00 Program Director $ 2,137.00 Executive Director $ 2,438.00 $ 1,245.00 Finance Director $ 2,082.00 $ 1,063.00 Payroll Taxes and Benefits $ 12,734.00 $ 2,374.00 Supplies- office and program $ 1,044.00 $ 176.00 Printing and Copying $ 678.00 $ 48.00 Postage $ 323.00 $ 57.00 Telephone $ 2,509.00 $ 429.00 Rent and Utilites $ 124.00 $ 22.00 Accounting and Audit $ 594.00 $ 85.00 Contracted Services $ 4,310.00 $ 1,479.00 Other (Books, Dues and Publications) $ 748.00 $ 110.00 Other (Insurance) $ 959.00 $ 138.00 Other (Travel) $ 976.00 $ 300.00 Total $ 83,452.00 $ 15,326.00 Budget Narrative The overall operational budget for CRIL's full service Tri-Valley branch office is $83,452 which covers 1.4 FTE for direct service provision - ILC- Tri Valley Coordinator and ILC- 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 portion of $10,118 would cover 12% of the total project budget and roughly 11% of the salaries and benefits of the service provider. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information Form List of Board of Directors (or governing body) with contact information ✔✔✔✔ Board of Directors Application ID: 70153 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Current Annual Budget for the Entire Agency ✔✔✔✔ 2016-2017 Board approved budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 2014 IRS 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board of Directors Designation of authorized official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board of Directors authorization to request funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ WC Insurance GL Insurance 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 AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE Employee Handbook REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" SECTION Audit 2015 2016 REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. Articles of Incorporation By Laws REQUIRED FOR CDBG ONLY- CONFLICT OF INTEREST STATEMENT (IF NOT INCLUDED IN BYLAWS) Conflict of interest statement REQUIRED FOR CDBG ONLY-ORGANIZATION CHART Org chart STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ State Non-Profit Determination Letter 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. LEP LAP 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 2015 2016 Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Legal Assistance for Seniors Legal Services, HICAP and Community Education for Dublin Seniors $ 10,000.00 Requested Submitted: 1/6/2017 4:44:44 PM (Pacific) Project Contact James Treggiari jtreggiari@lashicap.org Tel: (510) 832-3040 x302 Additional Contacts none entered Legal Assistance for Seniors 333 Hegenberger Road Suite 850 Oakland, CA 94621 United States Executive Director James Treggiari jtreggiari@lashicap.org Telephone(510) 832-3040 x302 Fax (510) 842-1080 Web www.lashicap.org Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The mission of Legal Assistance for Seniors is to ensure the independence and dignity of seniors by protecting their legal rights through education, counseling and advocacy. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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. During FY 2013/14 LAS received funding from Alameda County in the amount of $766,101 to provide legal services (public benefits, elder abuse, guardianship and naturalization, HICAP counseling & health law and elder abuse education; The State Bar of California $80,688 (IOLTA, EAF & EAP to provide legal services (public benefits, elder abuse, guardianship and naturalization); Contra Costa $7,462 Medicare legal; the cities of Fremont ($19,113), Hayward ($18,260), Livermore ($5,000) & Pleasanton ($11,762) for legal, HICAP & CEs; and foundations/corporations $175,500; court appointed fees ($92,037); elder abuse conference sponsorship/registration fees ($39,156) and individual donations ($114,604). During FY 2014/15: Alameda County in the amount of $1,020,381 to provide legal services (public benefits, elder abuse, guardianship and naturalization, HICAP counseling & health law and elder abuse education; The State Bar $33,733 (IOLTA & EAF to provide legal services (public benefits, elder abuse and naturalization); Contra Costa $8,068 Medicare legal; the cities of Alameda ($14,765) Fremont ($13,521), Hayward ($15,000), Livermore ($5,000) & Pleasanton ($12,097); and foundations/corporations $266,000; court appointed fees ($62,926); elder abuse conference Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None sponsorship/registration fees ($71,382) and individual donations ($43,297). During FY 2015/16 LAS: Alameda County in the amount of $918,876 to provide legal services (public benefits, elder abuse, guardianship and naturalization, HICAP counseling & health law and elder abuse education;The State Bar $37,122 (IOLTA & EAF to provide legal services (public benefits, elder abuse and naturalization); Contra Costa $12,000 Medicare legal; the cities of Alameda ($15,696) Fremont ($14,139), Hayward ($20,000), Livermore ($5,500) & Pleasanton ($10,000) and foundations/corporations $163,875; court appointed fees ($204,536); elder abuse conference sponsorship/registration fees ($75,138) and individual donations ($70,226). 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.). LAS has provided advocacy, counseling and education to seniors and service provides for over 40 years. In those 40 years, LAS has built up a strong set of services that are dependable and effective for the seniors we serve. LAS is also involved in many collaborations with community partners that help make our services more effective for our clients. These collaboration are with a variety of entities, including the County, cities and various other nonprofit and for profit agencies. One example is the formal collaboration that LAS has with Family Support Services (FSS) in our guardianship program. LAS attorneys provide the legal work needed and FSS staff provide the social support to ensure that the family is thriving. Because of collaboration like the one with FSS, when a senior comes to LAS, they not only access our services, but those of our amazing partners too. LAS is overseen by a board of directors who come from a broad range of professional backgrounds in areas that are related to the needs of seniors. Many of our board members have been with the agency for quite some time and are greatly aware of the structure and opportunities available to the agency, The management team at LAS is highly experienced and several members of the team have been with the agency for over 20 years. Several of the attorneys providing the legal work, including the managing attorney, have been with the agency for over 10 years and several of our HICAP counselors have been with the agency for over 20 years. Our fiscal staff is highly skilled with a CFO and Development Associate who help LAS maintain a comprehensive fundraising plan that includes a variety of funding sources including foundation grants, contracts with Alameda County, many of the cities in Alameda County and the State Bar of California, events held throughout the year and several focused solicitations to the community for individual giving. 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. Legal Assistance for Seniors will provide advocacy, counseling and education to seniors in Dublin free of charge. Through our legal, community education and HICAP programs, LAS will provide asistance on a broad range of legal and health care issues. 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.) 70 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. After a senior makes contact with LAS, either through an agency referral or by contacting us directly, he or she will meet with an attorney or legal advocate in a designated location. We offer appointments at our Oakland office, easily accessible by public transportation. If a senior is unable to travel due to financial or physical limitations, an attorney will meet with the senior in their home or location convenient for them. We provide counsel and advice or full representation in court if appropriate. LAS also provides Community Education presentations at locations throughout Alameda County. These presentations are aimed at educating seniors, service providers, and other concerned individuals to foster seniors’ independence and prevent the need for future services. Presentation topics include "Knowledge is Key: Know Your Medicare Rights" and "Elder Abuse and Legal Remedies", among many others. LAS’ Community Education Coordinator plans and presents these free sessions, along with legal and HICAP staff as appropriate. Many of LAS’ clients contact us after attending a Community Education presentation for follow-up assistance. If funding request is granted, LAS will seek to provide presentations in the City of Dublin. gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse ✔✔✔✔ Disabilities gfedc Food and Nutrition ✔✔✔✔ Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above LAS provides individual counseling sessions to Medicare recipients through our Health Insurance Counseling and Advocacy Program (HICAP). Sessions are provided by trained and state-registered volunteer counselors at the Dublin Senior Center and can assist Medicare beneficiaries in enrolling in supplemental Medicare plans and savings plans, and can screen denials of coverage for issues that may be appealable to Medicare. These cases are then often referred to LAS’ legal department for direct representation or advice. All services are provided free of charge and are offered in multiple languages, either through in-person interpretation provided by LAS staff or volunteers, or by using “Language 411,” a phone interpretation service. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). Funds from the City of Dublin will be used to provide free legal services, Community Education presentations and Medicare counseling through the HICAP program to Dublin seniors, most of whom will be low or extremely low-income. Although all of LAS’ services are free to clients, LAS must maintain a team of paid staff members. Budget line items include prorated shares of the salaries for staff attorneys and the Community Education Coordinator (listed as an Advocate in the budget narrative) as well as copies for legal cases and presentation handouts, postage, phone, rent at our Oakland office, outreach, and staff travel to and from Dublin for home visits, and presentations. While LAS receives funding from Alameda County for legal services, this funding does not support the entire legal program, and LAS is also required to match these funds. We rely on funding from Dublin, as well as other cities within Alameda County, to help us with this match funding and to help support the cost of service in Dublin. The funding allows attorneys to make home visits. LAS believes this is a critical service for many seniors who, for economic reasons or physical limitations, cannot easily travel from their home. Without someone going to their home or to a meeting place close to their home, many seniors would not be able to access the services they need to stay in their home and thrive in the community. Being able to sit down with an attorney and connect face- to-face often is the difference in the senior's confidence. Often during a home visit, the LAS attorney is also able to identify several other needs of the senior and address these other issues even though it may not have been the initial reason the senior requested assistance. The community education and HICAP services also take place in the community, either in a senior living facility or senior center where it is easiest for seniors to access the services and is the most effective way to ensure positive impacts for seniors. 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 meeting the outcome(s)? LAS has three programs in which services are delivered, legal, community education and HICAP. Direct legal advice and representation will be provided to 10 seniors by LAS attorneys and advocates (working under the supervision of the attorneys and managing attorney) in the areas of elder abuse, health law, legal guardianship, naturalization, public benefits and general legal services. Legal services are provided free of charge to Dublin residents age 60 and over (or age 50 and over for guardianship cases). LAS maintains a directory of local legal and social services agencies to provide referrals if an individual presents themselves with an issue outside the scope of LAS services. In addition to providing direct legal services targeted to reach Dublin seniors, we will also provide a minimum of 3 community education presentations/outreach events for seniors, caregivers and senior service providers, reaching a minimum of 30 Dublin residents. Community Education presentation topics are aimed at educating seniors and their allies to foster seniors' independence and prevent the need for future services. Finally, LAS will also provide free individualized counseling to 30 Medicare recipients living in Dublin through the Health Insurance Counseling and Advocacy Program, which is staffed by highly trained and state-registered volunteer HICAP counselors. The program currently provides counseling at the Dublin Senior Center. In all of our programs, LAS provides evaluation forms to the clients to assess the quality of service provided. The managers review these evaluations to ensure that seniors are being provided with appropriate services and to look for emerging trends in the needs of our clients. LAS maintains a client database which also tracks the number of clients served as well as tracking the demographics of the clients served. This allows LAS to run monthly reports to ensure that we are meeting our contract goals. 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. LAS will serve Dublin residents 60 and older, with the exception of legal guardianship, which will serve clients 50 and older. HICAP counseling services are for clients of any age who are eligible for or receive Medicare. Based on the demographics of the seniors we served in the past, we are estimating that at least 60% will be extremely low-income, 30% will be very low to low-income, and 30% will have a disability. Dublin seniors who would not be able to afford legal services will have their needs met in the areas of elder abuse, guardianship, naturalization, health law and public benefits. In elder abuse cases, seniors may obtain restraining orders against their abusers resulting in an increase in safety and peace of mind. Stabilization will be the outcome of guardianship cases in which the senior is seeking to obtain guardianship of minor(s). Naturalization clients will become US citizens. Health law clients will receive stable health insurance coverage and financial stability and increase in quality of life will be the result of seniors with public benefit cases. From the community education program, Dublin seniors, service providers and other community members will be educated about issues that include Medicare, Medi-Cal, Medicare fraud and abuse, long term care, health care reform, Advance Health Care Directives, public benefits, guardianship of minors, elder abuse prevention, immigration/naturalization and consumer fraud. The goal of the community education program is to prevent and prepare through education presentations. Through HICAP counseling, Medicare beneficiaries receive unbiased advice regarding their health coverage so that they can make informed, confident decisions regarding their coverage and care. If there is a legal issue with their health coverage, the case is referred to the legal team for in depth analysis and potentially representation. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? LAS strives to provide top-quality, culturally sensitive legal services and education to seniors who are traditionally underserved, including low-income seniors, seniors living isolated locations and seniors from culturally and linguistically diverse backgrounds. LAS makes written materials available in various languages. Often this is possible by accessing government documents that explain programs such as Medicare in multiple languages. (In the past, we have provided written materials in Chinese, Farsi, Korean, Spanish, Tagalog, and Vietnamese.) Secondly, we work with other community agencies and cultural centers to provide seniors in those communities with culturally appropriate services. Our bi-lingual staff and volunteers provide interpretation at Community Education presentations, depending on demand. Presentation are frequently done in Spanish, Mandarin and Cantonese. Thirdly, our Health Insurance Counseling and Advocacy Program (HICAP) has volunteers who speak Cantonese, Mandarin, Spanish, Korean, Hindu, and Punjabi. Finally, in both our legal and HICAP programs we use a telephone interpreter service through Alameda County, which provides translators in 17 different languages including American Sign Language. Arrangements are made with the courts in legal cases to ensure a translator is available at the court for the senior. We do not allow language to be a barrier to education, counseling or legal services we are providing. 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? LAS has been providing services throughout Alameda County for over 40 years. Through our various programs, we have built a network of service providers in all parts of Alameda County. These include government agencies, other community based organizations, senior centers, senior housing facilities and for profit senior service providers. As it has long been a priority for the agency to provide of our services where seniors live and where it is convenient for them, LAS is continually working with and collaborating with partners to offer our services in as many locations as possible. Much of our outreach is done through these community partners. The community focus of the agency has led to the legal team to provide home visits, HICAP counseling in almost 40 sites around the County and community education taking place in places in hundreds of locations as varied as community centers to the local diner. LAS also maintains formal contracts with the County of Alameda (Adult Protective Services, DCFS, etc.) as well as cities around the County and is frequently receiving direct referrals from these contracts. LAS maintains a website where contact information is maintained and all staff carry materials about the agency with them while they are in the field providing services. LAS also produces an annual report and has a newsletter that provides updates and information regarding important issues for seniors and senior service providers. LAS specifically reaches out to low-income, limited English speakers and disabled people through having our materials available in community spaces in which people look for assistance including senior centers, senior living facilities and through having our materials available through our community partners. One of the most effective ways we have found to market is through our community education. The presentations often bring up issues for attendees for which they can receive guidance and assistance. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. A large part of the strong foundation for our work has been fostering collaboration and ensuring that we are a good community partner. All three of our main programs take place in the communities in which we serve. LAS maintains a presence at the Dublin Senior Center and has a collaborative working relationship with the Senior Center and its staff, providing Medicare counseling through HICAP. LAS also participates in several community groups including the Kinship Collaborative, the Financial Abuse Specialist Team (FAST) and the Community Project Committee through the Alameda County Bar Association. We are also a founding member of the Senior Services Coalition of Alameda County, which meets regularly to discuss and disseminate information concerning senior service providers. LAS also holds contracts with Alameda County Adult Protective Services and the Department of Children and Family Services, receiving direct referrals for cases involving guardianship, elder abuse, and other legal issues. In collaboration with Family Support Services (FSS), we recently received a large grant to strengthen our work together and support senior kin caregivers caring for minor children. In addition to our formal contacts, LAS maintains informal partnership with many other nonprofit organizations to allow for effective collaboration for the benefit of our clients. When LAS meets with a senior, either individually or as part of a community education event, that senior gains access to all of our community partners. When we identify a senior's needs, LAS attorneys and advocates are trained to not only think of how LAS can help, but how our connections can benefit that senior. In essence, LAS is bringing a network of highly skilled and passionate senior advocates to the senior in Dublin with every interaction. That benefits many seniors regularly as we not only directly serve the senior, we often connect them with a resource to enhance the quality of their life. 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. Through our various programs, we have built a network of service providers in all parts of Alameda County. These include government agencies, other community based organizations, senior centers, senior housing facilities and for profit senior service providers. Much of our outreach is done through these community partners with marketing and work being done at their sites. LAS has maintained a strong presence in the Tri-Valley despite being located in Oakland. In the Tri-Valley, LAS is funded by Pleasanton and Livermore and maintains several HICAP sites for Medicare counseling and community education takes place at senior housing and various other sites. At the Pleasanton Senior Center, LAS runs a legal clinic, once a month, where seniors can sign up to sit down with an attorney for a half hour consultation. Although the senior center is located in Pleasanton, any seniors in the Tri-Valley can sign up for the time slots to meet with the attorney. LAS is always seeking new sites for both counseling and community education to provide additional support to Dublin seniors. LAS maintains a marketing plan, with several regularly updated platforms to keep seniors and service providers working with older adults informed and connected to the agency. We recently launched a new website where contact information is maintained and resources are archived for seniors and providers to learn and empower themselves. When out in the field, all staff carry materials about the agency with them to be able to give seniors information about our programs. LAS also produces an annual report and has a newsletter that provides updates and information regarding important issues for seniors and providers. LAS hosts a Bay Area wide annual outreach event called the Conference on Elder Abuse. Now in it's 12th year, the conference is a chance to gather professionals from a broad range of fields to teach seniors and other service providers as to best practices in elder abuse. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. LAS produces an annual budget based on prior year's actual income and expenses, adjusting for anticipated changes in income and expenses. Our annual budget is approved by our Board of Director's and actuals are compared budgeted goals. In addition, after the close of the each fiscal year, LAS undergoes an annual financial audit by a local CPA firm. One of the items under review for example, is to explain year to year budget variations or fluctuations, if any. Consistently, LAS has not had material weaknesses, deficiencies or misstatements. Alameda County has awarded LAS Title III for over 35 years, the HICAP contract since 1988 and the Title VII contract since 2010; since the early 1990s Alameda County has received dedicated county general funds as well as APS funds in 2000. The services LAS provides to constituents of Alameda County receive benefits at a highly reduced rate than can be provided by the private bar. In addition, LAS has a dedicated base of legal, HICAP counselors and administrative assistants who provide direct legal services, health insurance counseling, community education presentations, as well as intake, phone reception and support pro bono. Due to our client database, LAS tracks number of clients served by jurisdiction as well as demographics (age, ethnicity, income, etc.) that ensures that we can demonstrate to our funders, actual goals met by quantity as well as its impact to our clients. This allows us to also track and predict changes in the needs of the community. In conjunction with the client database, LAS uses a fund accounting software program that allow us to track and isolate income and expenses by funding sources as well as location and program delivery, isolating services and expenses by city and county for example. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? LAS produces an agency budget for the upcoming year based on prior year actual income and expenditures, adjusting as necessary for projected changes to income and operating costs. All of the LAS programs are funded by multiple sources and not receiving this funding would effect the number of clients that LAS could help in Dublin. The services would still be available, but the funding allows LAS to maintain a stronger presence. These funds are critical for LAS to provide the individualized services that many seniors in Dublin need. These funds enhance the personalized services LAS provides to seniors in Dublin in several critical ways. This funding helps LAS ensure that the level of service provided is meeting the needs of the community. The funding allows attorneys to make home visits to Dublin seniors. LAS believes this is a critical service for many seniors who, for economic reasons or physical limitations, cannot easily travel from their home. Without someone going to their home or to a meeting place close to their home, many seniors would not be able to access the services they need to stay in their home and thrive in the community. This funding also allows LAS to do more education at various sites around the city and allows HICAP to send counselors to Dublin to do Medicare counseling. LAS is dedicated to building a financial reserve to provide a cushion and enable the agency to continue providing uninterrupted services in the event of funding loss. LAS has a long history of annual fundraising events, annual appeals as well as a consistent sponsorship to both our annual event and elder abuse conference. Our Executive Director and Development Associate as well as our Board of Directors, are active in our county community establishing new partnerships and funding opportunities. Having diverse funding streams allows LAS to remain flexible if funding streams shift or are removed. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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. LAS believes our work ties strongly into the goal of ensuring a safe community through protecting the safety and independence of seniors. LAS attorneys and advocates will provide direct legal advice and representation to low income Union City seniors in the areas of: (1) elder abuse, including restraining orders and “kick out” orders to remove abusers living in seniors homes, (2) health law, including Medicare, Medi-Cal, and private insurance issues, (3) naturalization, including assisting seniors in applying for fee waivers and disability waivers for the language and testing component of the citizenship interview, (4) public benefits, including Social Security and SSI eligibility, reductions and overpayment issues, and (5) guardianship of minor children for seniors 50 and older who are caring for those children. These services often include a home visit by the attorney to the senior. LAS will also provide outreach at health/senior fairs in Union City though community education for seniors, caregivers and seniors service providers. Dublin seniors, service providers and other community members will be educated about issues that include Medicare, Medi-Cal, Medicare fraud and abuse, long term care, health care reform, Advance Health Care Directives, Public Benefits, Guardianship of minors, elder abuse prevention, immigration/naturalization and consumer fraud. The goal of the community education program is to prevent and prepare through education presentations. Through the Health Insurance Counseling and Advocacy Program (HICAP), Medicare recipients will be provided individualized counseling. HICAP is staffed by highly trained and state-registered volunteer counselors. Seniors will receive unbiased Medicare and related health insurance counseling from highly trained and experienced counselors. Through this counseling, Medicare eligible individuals will have the guidance and confidence to navigate the highly complicated health insurance options available. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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. LAS strives to provide top-quality, culturally sensitive legal services and education to seniors who are traditionally underserved, including low-income seniors, seniors living isolated locations and seniors from culturally and linguistically diverse backgrounds. LAS makes written materials available in various languages. Often this is possible by accessing government documents that explain programs such as Medicare in multiple languages. (In the past, we have provided written materials in Chinese, Farsi, Korean, Spanish, Tagalog, and Vietnamese.) Secondly, we work with other community agencies and cultural centers to provide seniors in those communities with culturally appropriate services. Our bi-lingual staff and volunteers provide interpretation at Community Education presentations, depending on demand. Presentations are frequently done in Spanish, Mandarin and Cantonese. Those staff are also available for one-on-one meetings and home visits for clients who need interpretation services for their meeting. Thirdly, our Health Insurance Counseling and Advocacy Program (HICAP) has volunteers who speak Cantonese, Mandarin, Spanish, Korean, Hindu, gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc 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 gfedc 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 gfedc 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 gfedc 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 ✔✔✔✔ Yes. If so, answer questions 31 through 43. gfedc No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. and Punjabi. Finally, in both our legal and HICAP programs we use a telephone interpreter service through Alameda County, which provides translators in 17 different languages including American Sign Language. Arrangements are made with the courts in legal cases to ensure a translator is available at the court for the senior. We do not allow language to be a barrier to education, counseling or legal service we are providing. 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: 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers ✔✔✔✔ Encourage process streamlining ✔✔✔✔ Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *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. gfedc 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. ✔✔✔✔ E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase homeownership gfedc Promote decent affordable housing ✔✔✔✔ Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. 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?"): 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?"): 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability ✔✔✔✔ Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Persons gfedc Households gfedc 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: 75 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". 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" 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 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). LAS produces an agency budget for the upcoming year based on prior year actual income and expenditures, adjusting as necessary for projected changes to income and operating costs. LAS is dedicated to building a financial reserve to provide a cushion and enable the agency to continue providing uninterrupted services in the event 2 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 13 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/) 3 Disabled 5 Female Headed Households 15 Senior 0 Youth 0 Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 38.0038.00 TOTAL 7 White White + HISPANIC 3 Black/African American Black/African American + HISPANIC 2 Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other 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 3 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 15.0015.00 TOTAL ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. of funding loss. LAS has a long history of annual fundraising events, annual appeals as well as a consistent sponsorship to both our annual event and elder abuse conference. Our Executive Director and Development Associate as well as our Board of Directors, are active in our county community establishing new partnerships and funding opportunities. LAS has a Resource Development Committee that includes board members, staff and key outside individuals that bring their expertise to LAS. This group focuses the fundraising efforts of LAS through planning the fundraising schedule for the coming year and also by working on individual campaigns. 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-110718 Budget Funding Sources/Revenues Budget Amount Amount Committed Alameda County (Title III & VII, HICAP/MIPPA, APS, General Funds, DCFS $ 909,636.00 $ 35,199.00 State of California: Dept of Social Services $ 16,500.00 $ 16,500.00 County of Contra Costa $ 12,000.00 $ 12,000.00 Cities of Alameda, Dublin, Fremont, Hayward, Livermore, Pleasanton, Union City $ 95,450.00 $ 17,169.00 The State Bar of California: IOLTA, EAF, EAP $ 86,510.00 $ 43,255.00 Corporations/Foundations: California Health Advocates, True North Fdn, Van Loben Sels/Rembe Rock Fdn, West Davis & Bergard Fdn, Bernard E & Alba Witkin Charitable Fdn, San Francisco Foundation (Eask Bay Fdn on Aging), Hindu Community & Cultural Center $ 155,500.00 $ 20,000.00 Court Awarded Fees $ 185,000.00 Elder Abuse Conference & training events $ 95,000.00 Fundraising events, individual donations, misc. income $ 122,000.00 Total $ 1,677,596.00 $ 144,123.00 Funding Uses/Expenses Budget Amount Amount Committed Personnel Salaries (see budget narrative) $ 992,016.00 $ 80,594.00 Personnel Fringe Benefits (see budget narrative) $ 297,605.00 $ 21,334.00 Operating Expenses: Equipment Lease/Maintenance, Software/Computer purchases, upgrades $ 8,350.00 $ 50.00 Operating Expenses: Supplies & Minor Equipment $ 7,000.00 $ 1,162.00 Operating Expenses: Printing/Copying $ 15,000.00 $ 11,880.00 Operating Expenses: Postage & Delivery $ 8,000.00 $ 237.00 Operating Expenses: Telephone $ 11,000.00 $ 100.00 Operating Expenses: Rent & Facility expenses $ 173,951.00 $ 20,785.00 Operating Expenses: Accounting/Audit/Payroll/Bank Fees $ 15,700.00 $ 367.00 Operating Expenses: Other Contracted Services $ 26,000.00 $ 425.00 Operating Expenses: Insurance, Membership & Dues, Books $ 32,500.00 $ 782.00 Operating Expenses: Client Costs, Outreach/Conference & Annual Fundraising Costs $ 48,000.00 $ 35.00 Operating Expenses: Staff/VolunteerTraining/Travel, Support & Recognition $ 31,500.00 $ 911.00 Operating Expenses: Equipment (Computers, Software & Upgrades) $ 12,000.00 $ 5,361.00 Operating Expenses: Technology (OnLine access, research) $ 7,296.00 $ 100.00 Total $ 1,685,918.00 $ 144,123.00 Budget Narrative The requested budget funds from the City are as follows: Managing Attorney (2% @ $1,276 per annum); Staff Attorney (3% @ $1,538 per annum); Staff Attorney (3% @ $1,405 per annum); Staff Attorney (4% @ $1,873 per annum); Advocate (1% @ $420 per annum); and Administrative Assistant for client scheduling & intake (2% @ $562 per annum). Fringe Benefits: FICAer @ 7.65%, workers' compensation and SUI @ 1% each, Health/dental/vision/life insurance @ 15% and retirement/benefit plan fees @ 3% for a total of 27.65% ($1,956 per annum) Operating Expenses include Rent & facility costs ($521), Insurance ($70) and Telephone ($30) at .3% of the agency line item expense; Supplies ($40), Postage ($50) and Printing ($90) at .6% of the agency line item expense; Staff/Volunteer Travel @ $.55 per mile ($169) will be underwritten by other funds. In addition during FY 2015/16 LAS recognized $28,111 for in-kind support for attorneys and $42,861 for in-kind support for advocates for a total of $70,972 in-kind legal services support; this support is recognized in our 2015/16 annual audited statement. In addition, 378 hours were donated in support of our Elder Abuse Conference of which, 185 hours were from conference presenters. Finally, 1,195 hours were provided by trained HICAP counselors and community educators. LAS anticipates that these hours, consistent in prior years, will continue during the current fiscal year 2016/17 and also 2017/18. Documents Documents Requested *Required?Attached Documents * Application ID: 69998 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ 201718 Dublin Program Expense Form Financial Information Form for ALL Grant Requests download template ✔✔✔✔ 201718 Dublin Financial Information List of Board of Directors (or governing body) with contact information ✔✔✔✔ List of Board of Directors and Contact Information Current Annual Budget for the Entire Agency ✔✔✔✔ FY 201617 Agency Wide Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ LAS IRS 990 Form Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ LAS Board Resolution Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ LAS Board Resolution Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ LAS Certificate of Auto and General Liability LAS Workers Compensation Certificate of Insurance 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 AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE Legal Assistance for Seniors-Personnel Policies REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" SECTION LAS Audit Requirements LAS FY 1516 Audit Management Letter REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. Articles of Incorporation LAS By Laws REQUIRED FOR CDBG ONLY- CONFLICT OF INTEREST STATEMENT (IF NOT INCLUDED IN BYLAWS) LAS Board of Directors Conflict of Interest REQUIRED FOR CDBG ONLY-ORGANIZATION CHART LAS Organizational Chart STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ IRS Determination Letter State of CA-Determination Letter 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. LAS Language Access Plan 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 ✔✔✔✔ LAS FY 1516 Audited Financial Statements Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Senior Support Program of the Tri Valley Case Management $ 14,280.00 Requested Submitted: 1/7/2017 3:05:22 PM (Pacific) Project Contact Nicole Albrecht nalbrecht@ssptv.org Tel: 925-931-5379 Additional Contacts none entered Senior Support Program of the Tri Valley 5353 Sunol Blvd Pleasanton, CA 94566 United States Administrative Director Nicole Albrecht nalbrecht@ssptv.org Telephone(925) 931-5379 Fax (925) 931-3499 Web ssptv.org Application Questions 1. Please describe your organization category (select one of the following): 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 quality of life. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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 Axis) and Tri-Valley Community Foundation. In 2006, we obtained our own 501c3 and have operated as a private, nonprofit agency since. Currently, we have 23 employees ( 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 Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No ✔✔✔✔ One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding gfedc None 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 Fiscal Committee is a Certified Public Accountant and has experience managing large contracts. Other board members, including a former city commissioner, 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 characters). This text will be used widely during the review and implementation process to describe your project. Case Management ensures all needs in a senior’s life are being met. For each client, case managers develop and execute a plan, which involves implementing, 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 57 unduplicated Dublin clients with this funding. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. 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. Referrals come from a variety of sources, including: Adult Protective Services, police/fire 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 locked cabinets. Each Case Manager has a computer with Microsoft Office and internet access. Case Managers for this project have been employed with Senior Support 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 for?). 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 (Meals on Wheels, PG&E discounts, etc.), referrals of volunteers, etc. Senior Support 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 meeting 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 may be evident in the fact that the senior can remain safely at home with improved quality of life. Success may be gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition ✔✔✔✔ Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above evident when the fire department no longer needs to make repeat visits to lift a senior off the floor. Case Management revolves 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 client 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. 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 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 33 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, Ms. L is a Dublin resident who was initially referred from a Home Health agency, following eye surgery, to work out Medicare and Social Security paperwork issues. Her case manager helped her successfully solve these issues, as well as sign-up for Supplemental Security Income. The case manager learned Ms. L was avoiding essential doctor appointments because making and actually attending an appointment was overwhelming to Ms. L. The case manager makes and takes Ms. L to doctor appointments, as she simply would not go without support. In June, she became ill with a cough. After taking antibiotics without progress, the case manager helped schedule an x-ray, which showed a black mass; a catscan confirmed Ms. L has lung cancer. The doctor gave her 6 months, as the cancer is very aggressive. The case manager found Ms. L a wonderful caregiver, is helping her reconnect with her son out-of-the-area to make end of life plans, and found a volunteer to do her grocery shopping. The case manager coordinated a donated Christmas gift, which brought so much joy; this was her only gift, but she only needed one to have the brightest smile. Ms. L feels the case manager is making an incredibly difficult time manageable and providing not just support, but friendship. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer 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 mental 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. 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? 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 and EMS paramedics. When they find a senior in crisis, they will call us. Our case manager responds by working with the client or the family to provide essential services. This has 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, LinkedIn 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. BUDGET NARRATIVE Describe how this project is 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, PG&E discounts, etc.) Referral of volunteers To serve 25 clients with complete case management services would cost about $12,500. We additionally respond to approximately 500 information and referral calls 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. 20. 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 57 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. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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. Case Management promotes and supports a high quality of life for Dublin seniors. Often, seniors referred to Case Management no longer have any friends, relatives, or social connections in the area; Case Managers often provide the only form of support the senior may have. Through in-home assessments, the Case Manager can ensure seniors are living as safely as possible and address areas of concern. For instance, a Case Manager may be requested to help navigate Medicare paperwork issues; however, a visit to the seniors' home may reveal the electricity is not on and unopened mail is stacked in piles; thus, the Case Manager can help the senior ensure bills are paid timely to keep the lights on, connect the senior to a volunteer to sort mail regularly, and help the senior set-up autopay options for bills. Case Management allows for this type of timely collaboration and communication with strong community partners because we do not simply hand over a phone number to our seniors; Case Managers walk the senior through every step to have the resources they need. Being able to see the seniors' living environment and guide them through the process of connecting to services helps maintain a high quality of life for Dublin seniors. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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. 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 Wellness 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: gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc 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 gfedc 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 gfedc 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 gfedc 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 ✔✔✔✔ Yes. If so, answer questions 31 through 43. gfedc No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers ✔✔✔✔ Encourage process streamlining gfedc Consolidate service delivery gfedc 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: 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: 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?"): 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?"): gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * 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. gfedc 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. gfedc E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase homeownership gfedc Promote decent affordable housing ✔✔✔✔ Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. ✔✔✔✔ Increase the availability of service-enriched housing for persons with special needs. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): 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 list the number of unduplicated Dublin clients your agency anticipates serving in each category. "If none, please enter "0". ✔✔✔✔ Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 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/housing/) Disabled 39 Female Headed Households 57 Senior Youth Homeless 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" 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 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 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 153.00153.00 TOTAL 27 White 4 White + HISPANIC 4 Black/African American Black/African American + HISPANIC 20 Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other 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) 57.0057.00 TOTAL ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed City of Pleasanton (In-Kind space/utilities) $ 88,000.00 $ 88,000.00 Area Agency on Aging(Tri-Valley) $ 37,871.00 $ 0.00 City of Livermore $ 15,712.00 $ 0.00 City of Pleasanton (Case Management) $ 45,000.00 $ 45,000.00 Total $ 186,583.00 $ 133,000.00 Funding Uses/Expenses Budget Amount Amount Committed * ZoomGrants™ is not responsible for the content of uploaded documents. Mary McNamara-Case Manager $ 8,148.00 Jennifer Christensen-Case Manager $ 5,556.00 Executive Director $ 576.00 Total $ 14,280.00 $ 0.00 Budget Narrative Funds will be primarily used for Direct Services. Marlene Petersen is the Executive Director, who has been with the agency 32 years; she works as a case manager as needed. Mary McNamara and Jennifer Nelson are Case Managers with a vast experience in the fields of geriatrics. Please note: The $12,592 amount requested covers direct salary costs. An additional $1,688 is proposed to cover benefits and fringe costs. This brings the total amount requested to: $14,280. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Info List of Board of Directors (or governing body) with contact information ✔✔✔✔ Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Agency Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990_Password 5569 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board Resolution Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Dublin Insurance 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 AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE Personnel Policies REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" SECTION Audit REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. Articles_Bylaws Articles_Constitution Articles_State of CA REQUIRED FOR CDBG ONLY- CONFLICT OF INTEREST STATEMENT (IF NOT INCLUDED IN BYLAWS) Conflict of Interest REQUIRED FOR CDBG ONLY-ORGANIZATION CHART Org Chart STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ 501c3 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. LEP/LAP 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 Supporting Documents (Not Required) Application ID: 69784 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Child Care Links Child Care Links Diaper Pantry $ 13,000.00 Requested Submitted: 1/7/2017 3:48:28 PM (Pacific) Project Contact Laura Page jdavis@childcarelinks.org Tel: (925) 249-3920 Additional Contacts lpage@childcarelinks.org, vdilks@childcarelinks.org Child Care Links 6601 Owens Dr. Ste 100 Pleasanton, CA 94588 United States Interim Executive Director JoAnn Davis jdavis@childcarelinks.org Telephone(925) 417-8733 Fax (925) 730-4942 Web www.childcarelinks.org Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Child Care Links has remained a stable fixture in the Tri-Valley community for over 40 years providing resources that strengthen and support children and their families. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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.). Child Care Links is a nonprofit agency with extensive experience in providing a variety of resources and services to children, families, and community members throughout Alameda County for over 40 years. The agency started with an initial budget of $150,000 that has grown to 21 million, through Federal, State, County, City and private funding. Child Care Links staff is experienced with policies, procedures, and reporting requirements to demonstrate that the amounts provided to the agency are expended in accordance with state and federal law. In-kind services, equipment and personnel will be provided by the Community Services Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No ✔✔✔✔ One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding gfedc None Director and administrative staff. In the 2015-16 fiscal year, Child Care Links provided subsidized child care to 2,144 families, conducted 40 professional development trainings to 350 parents/Child Care Providers, made 831 individualized child care referrals, and distributed 15 free car seats to low-income families. These established relationships will be leveraged to create a network of new program participants that will benefit from this project. In October 2016, Child Care Links conducted a one-week, community-wide Diaper Drive Challenge generating the collection of 55,000 disposable diapers from over 50 participants. In December 2016, the agency soft-launched the Child Care Links Diaper Pantry. To date, over 9,000 diapers have been distributed to 40 families, providing a month supply of diapers and new books for 59 children. As a member of the National Diaper Bank Network, (in partnership with Huggies, the White House and Clinton Foundation) Child Care Links can purchase diapers at a significantly reduced price. 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. Child Care Links will provide free diapers, early literacy materials and car seats to families and partner agencies that serve low-income children in Dublin and the Tri-Valley community. 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.) 40 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. Child Care Links built this project with an infrastructure to support and evaluate participant engagement, track short and long-term goals and objectives, and strengthen community partnerships. The agency has designated staff members for program implementation, measuring impact, fundraising, training, marketing and reporting. A variety of tools are used to research and collect data to evaluate strategies that will better reach and serve the needs of target populations identified as low-income and limited English speaking families. The Child Care Links Diaper Pantry will be open to low-income families every Thursday and the first Saturday of each month. Participants will receive a month supply of diapers and literacy resources. Participant information will be collected to insure participants receive resources on a monthly basis. Appointments are not required. Community organizations can apply to become a Community Partner by referring parents to the Child Care Links Diaper Pantry or by distributing directly to their clients through the Direct Distributor Program. Parents will be required to present an ID and complete a needs assessment questionnaire to measure and track; city of residence, number of children in diapers, quantity and frequency given, diapering activities (talk, read, sing), financial impact, literacy impact, and parent engagement. Free car seats will be distributed by contacting Child Care Links in-house Car Seat Technician to set up an appointment. Parents will be required to bring in their old, damaged or expired car seat in exchange for a new one. Car seats will also be made available to families who don’t have the financial capacity to purchase a developmentally and/or age appropriate car seat. 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 play a critical role in bridging the diaper gap, facilitating early literacy skills, and ensuring the safety and well-being of low income children in Dublin and the Tri-Valley. Specifically these funds will be used to purchase diapers, literacy materials and car seats for families unable to purchase them, and those with outgrown, damaged or recalled car restraints. Car seats will also be made available to families who don’t have the financial capacity to purchase a developmentally and/or age appropriate car seat. 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 meeting the outcome(s)? The success of this project will be measured by the number and frequency that parents are engaging with their children during diaper time, as a result of receiving free educational materials and information about the affects this interaction has on closing the achievement gap between affluent and gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services ✔✔✔✔ Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above low-income families. Outcomes will also measure parent’s ability to go to work or school by having access to an adequate supply of diapers to meet child care program requirements. Measures pertaining to car seats will track the number of car restraints distributed and car seat safety checks administered. Long-term objectives include narrowing the achievement gap between affluent and low-income youth, increasing self-sufficiency so Dublin families can work and contribute to the economy, and increase the well-being and safety of children to reduce the number of improperly used or installed car seats. Progress will be tracked by collecting quantitative and qualitative data through mandatory parent needs-assessment questionnaires, conducting research, survey’s, contests, and communicating with program participants and Community Partners. 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 populations this project will serve is low-income families, limited English speakers and Tri-Valley residents. This population will benefit from the implementation of this project as detailed in questions #12 and #29. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? This project is tailored to the specific needs of the population being served in Dublin and the surrounding communities. Cultural relevance has been woven into the framework of the project using statistical data and research to identify target populations and address their needs. The most common language spoken in Dublin, other than English, is Spanish (37.4%). Child Care Links is actively engaging within the Hispanic community in Dublin. The agency recently conducted several events for Dublin families residing in low-income housing at Wexford Way, Camellia Place and Oak Grove low- income Apartment Complexes. This community was further identified to represent the majority of low-income families residing throughout the Tri-Valley area. Strategies to address the specific needs of this community include, (1) providing dual language English/Spanish books and activity pamphlets alongside free diapers, and (2) actively engaging participants as volunteers to expand program objectives and develop a sustainable model that will support and empower this target population to become contributing members in the economy 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? Child Care Links uses a variety of innovative strategies to consistently collect data, and evaluate objectives on how to best reach low income families, limited English speakers and/or disabled youth. Using this data increases the scope and scale of target marketing efforts through digital, in-print and in-person resources such as, Constant Contact, customized surveys, social media, contests, community events and website analytics. Child Care Links employs staff who speak many of the languages that are spoken by residents in the City of Dublin. They are educated and experienced in providing support and resources to these target populations living in suburban poverty in an affluent community. Child Care links initiates new community relationships through purposeful engagement and outreach initiatives, targeting low-income housing facilities, such as Camellia Place, Wexford Way and Oak Grove Apartments. Other outreach efforts targets health care providers, school district social workers, social service agencies, and collaborating with community organizations who serve low-income and limited English speaking families. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Child Care Links is actively partners with many Tri-Valley agencies such as the Tri-Valley Anti-Poverty Collaborative, Axis Health, WIC, Community Care Licensing, CityServe, CAPE Head Start, Kaiser, Hacienda Helping Hands, the Food Bank, the Dublin, Pleasanton and Livermore School Districts, First 5 Alameda County, California Child Care Initiative Project, County Supervisor Scott Haggerty, Livermore Community Needs Committee, as well as various religious institutions throughout the Tri-Valley. Additional partnerships are currently being developed within the pediatric and maternity industries, below market housing facilities, and the Human Service Departments within each city. Axis Community Health, WIC of Pleasanton, and CityServe of the Tri-Valley have contacted Child Care Links to become community partners in the distribution of diapers to their clients. Axis Community Health has five sites serving more than 14,000 East Alameda County residents, 800 of those children between the ages of 0-3 years old. The majority of their patients live below the poverty line. WIC of Pleasanton serves 500 infants and toddlers a month currently receiving benefits that do not cover the cost of diapers. CityServe of the Tri-Valley serves over 2,000 no income and low- income families a year to bridge gaps in basic living needs. Collaborations such as these are key in meeting the unique and changing needs of Tri- Valley families living in suburban poverty, and building a self-sustaining program that does not require repeat annual funding. Child Care Links will enlist the aid of these partners in order to deliver the most comprehensive services to Dublin families. 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. Child Care Links reaches Dublin residents through ongoing participation in outreach events throughout the Tri-Valley, networking directly with the community that utilizes and/or needs agency services. The agency conducts outreach through; in-print and digital distribution to agency stakeholders, community events (Health & Volunteer Fairs, SeeDubRun, Splatter), flyer distribution to local businesses and schools, online event calendars, churches, mother’s clubs, on-site visits, trainings, and referrals. For larger events Child Care Links’ outreach includes the East Bay Times, Hacienda News, The Patch and Bay Area Parent. The Child Care Links website and social media sites allow parents, educators and Child Care Professionals the ability to download forms, receive current information and view the agency event calendar at their convenience. Child Care Links recently participated in the Dublin Volunteer Fair, SeeDubRun and the Dublin State of the City Address. The agency has a strong collaboration with CityServe and Axis Community Health, working together to meet the specific needs of low-income families living or working in Dublin. Child Care Links actively collaborates with the Dublin Unified School District’s Community Liaison and Student Services to provide outreach and services to families who live in below-market housing facilities. Sites include Camellia Place, Wexford Way and Oak Grove Family Apartments. Additional collaborations with Dublin's School of Imagination, allows children to receive free developmental delay and Autism screenings and onsite referrals to non-profit support agencies. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Funding will cover expenses including staff salary and benefits, the cost associated with program materials, printing, outreach and mileage. Please see the budget and budget narrative for specific line item information. Child Care Links does not anticipate having any unspent grant funds at the end of the fiscal year. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Child Care Links is committed to serving the changing needs of Dublin residents and the Tri-Valley community as a whole, in collaboration with the city of Dublin, regardless of any financial capacity this program application should secure. Restricted funding creates challenges that often impede program growth and impact due to a lack of financial support for operational costs. If Child Care Links receives reduced funding, or no funding, it will limit the scope and reach of the project and it’s impact, prolonging its’ success. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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. gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ 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. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc 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 gfedc 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 gfedc 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 This project fosters new opportunities to bridge the diaper gap for low-income families while providing literacy materials and learning activities they can use to maximize diaper time to read, talk and connect with their child. The project also ensures the safety and well-being of low income children while being transported throughout Dublin and the Tri-Valley. The need for diapers affects 1 in 3 U.S. families. On average, infants require between 8-12 diapers per day, costing $80 to $120 a month, per child. For parents making minimum wage, this means they are spending 15% of their income on diapers. In order for parents to work or attend school, their children must be enrolled in child care programs, which often require a day’s supply of disposable diapers. Medicaid covers over one third of all births in the U.S. each year. Yet despite being critical to the health and hygiene of young children, diapers are excluded as a basic need from state and federal assistance programs. Due to limited resources, parents are forced to make diapers last the entire day by reusing them or substituting them with t-shirts, towels or sheets. The achievement gap between affluent and low-income students has grown substantially over the last few decades. Subsequently, of the children entering kindergarten in Alameda County, 57% are not prepared with the skills they need to succeed, and only 25% of African American and Latino boys and 34% of Latina girls are kindergarten-ready, according to the First 5 of Alameda County’s 2015 School Readiness Assessment Report. Poverty affects the safety and well-being of children who are being transported in damaged, recalled, or expired car seats. Motor vehicle crashes are the leading cause of death for children ages 1-14 years old. Car seats can reduce the risk of death for infants and toddlers by as much as 71 percent when used and installed properly. Currently, 73 % of car seats across the U.S. are used or installed incorrectly. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer to #30- 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY 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 values the collaboration with the City of Dublin to create opportunities that promote economic stability, equality and self-sufficiency to improve the lives of families living and working in Dublin and the Tri-Valley. Actions Child Care Links is taking to become financially self-sufficient include, developing Innovative fundraising strategies and annual Community- Wide Diaper Drives, obtaining unrestricted funds and partnerships with organizations such as Huggies to reduce program expenses 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 ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed -none-$ 0.00 $ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries $ 5,200.00 Benefits $ 1,525.00 Supplies $ 575.00 Printing/Copying $ 109.00 Postage $ 95.00 Telephone $ 68.00 Accounting/Audit $ 326.00 Program Materials $ 4,614.00 Other $ 488.00 $ 0.00 Total $ 13,000.00 $ 0.00 Budget Narrative Other costs include Insurance, Facilities & Maintenance, Payroll Services and other Administrative Costs. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget for ALL Grant Requests Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information for ALL Grant Requests Program Expense Budget for ALL Grant Requests Final List of Board of Directors (or governing body) with contact information ✔✔✔✔ List of Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ IRS 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ BOD designation of authorized official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Authorization to Request Funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Certificate of Insurance Certificates of Insurance Application ID: 70037 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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 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 STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ State Non-Profit Determination Letter Federal Non-Profit Determination Letter 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 the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements ✔✔✔✔ Certified Financial Statement Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Teen Esteem Teen Esteem Student and Parent Education Programs $ 10,000.00 Requested Submitted: 1/7/2017 7:24:16 PM (Pacific) Project Contact Nicku Bruce nickuteenesteem@gmail.com Tel: 9257556791 Additional Contacts none entered Teen Esteem PO BOX 966 Danville, CA 94526 Executive Director Linda Turnbull Linda@teenesteem.com Telephone925-855-9941 Fax Web www.teenesteem.org Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). For more than 20 years,Teen Esteem has been serving the Tri-Valley by educating and empowering students, parents and the community through prevention education on the challenges young people face, emphasizing the importance of respect for self and others. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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. None. 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.). Teen Esteem has more than 20 years of experience in the Tri-Valley delivering our life-changing programs to students and parents/caregivers which include: classroom presentations, assemblies, parent education and community events. Teen Esteem operates with a small, yet experienced leadership and administrative staff and passionate, dedicated group of volunteer speakers. We have reached more than 180,410 students and parents since 1994. Last school year alone we presented our programs to more than 10,000 students and 2,000 adults. We have enjoyed a long-standing relationship with students, parents and educators in the Dublin community. We impacted Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None more than 4,000 students and parents in Dublin in 2016. 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 will give classroom presentations at Dublin High that will empower students to make healthy choices amidst the many pressures they face. We will deliver community presentations that will equip parents to better understand today’s dynamic youth culture. 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.) 600+ students, 600+ parents 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. For this specific project, as we have done in the past, Teen Esteem's Director of Programs will work directly with Dublin High School’s health teachers to schedule and deliver our Teen Esteem classroom presentations to DHS 9th grade students during health class. We place a strong emphasis on coping with academic and performance based pressures, which is a current issue of great importance to the students, parents and Dublin Unified School District. Our presentations also equip and empower students to make wise choices as it relates to: media and social media influences; drug, alcohol and Rx drug abuse; respect for self and others; relationships and personal boundaries; unplanned pregnancy, the emotional impact of intimacy, STIs and rape; sexting and pornography. Once scheduled, our highly trained speakers will come into the classes over the course of multiple days to present the Teen Esteem message during the Health class period. The cornerstone of our message to students is our “Teacup Analogy.” Visit https://vimeo.com/174868811 to watch a clip of this life-changing illustration. Our team will reach out to and partner with Dublin Unified School District/other Dublin community organizations (e.g. Dublin Library) to organize, market and deliver three parent education events, most likely to be held in the evening to allow for max attendance. We will hold one event for grade school parents, one for middle school parents and one for high school parents. We have delivered similar parent education events in other local cities such as Pleasanton, San Ramon, Livermore and Danville. Sample/past presentation topics include, but are not limited to: - 5 Things Every Parent Needs to Know: What kids wish their parents knew, Limiting stress factors, Pressures your kids face, How you can support your child, Warning signs your child needs help - Screens and Teens - Helping Your Kids Find Balance - Managing Academic Pressure - Hands on Help for Today's Digital Family 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 used in the 2017-18 school year to provide: 1) Classroom presentations at Dublin High. These presentations will be given to 9th grade students during their Health Class period. These presentations may impact up to 600 students at this school. We place a strong emphasis on coping with academic and performance based pressures, which is a current issue of great importance to the students, parents and Dublin Unified School District. Our presentations also equip and empower students to make wise choices as it relates to: media and social media influences; drug, alcohol and Rx drug abuse; respect for self and others; relationships and personal boundaries; unplanned pregnancy, the emotional impact of intimacy, STIs and rape; sexting and pornography. The cornerstone of our message to students is our “Teacup Analogy.” Visit https://vimeo.com/174868811 to watch a clip of this life-changing illustration. 2) Three community parent education events. One each for Dublin grade school, middle school and high school parents. In 2016 we reached more than 300 Dublin parents with our programs, however, there are 9,958 students enrolled in the DUSD along with many more who are enrolled in Dublin’s private schools and DUSD home-school or online school programs. We have the opportunity to reach many Dublin parents/caregivers with our life changing information with these grant funds. Our recent parent ed at the Pleasanton Library on Cyberbulling had more ✔✔✔✔ Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above than 200 attendees! Parents who attend our events are also directed to our website where they can receive more helpful resources such as our online parenting video library of ED TALKS. ED TALKS topics are based on the current challenges kids are telling us they are facing, this ensures these parenting videos address the key issues in today’s ever changing youth culture. www.teenesteem.org/educational-videos. Parents may also opt into our email list and receive our monthly parenting newslette 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 meeting the outcome(s)? Teen Esteem’s presentations support the prevention of young people’s engagement in high-risk behaviors. The outcome we strive for is students making healthy decisions that allow them to realize their dreams for the future. Our parent ed events equip parents to better understand today's youth culture and better connect with and support their child(ren). Immediate effectiveness measures we employ to ensure we have met our stated outcome include: 1) Successful planning and delivery of our classroom presentations at DHS and parent education events in the community 2) Administration and review of post-presentation surveys to the students and parents to measure the effectiveness of these vital programs 3) Engagement in open dialogue with the administrative staff at DHS and parents in the community after each presentation to understand the relevance and impact of our programs Statistics from our 2015-16 school year survey supports the effectiveness of our programs. Statistics show that among students to whom we have presented: • 94% of students we presented to whom we presented that took the survey said the Teen Esteem presentation provided them with tools that will make a difference in their life. • 80% agreed the Teen Esteem presentation empowered them to know they can make good decisions that affect their future. • 71% agreed that the Teen Esteem presentation made a difference in the way they think about respecting themselves and others. 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. Teen Esteem serves children in the Tri-Valley from 4th grade through 12th grade in public, private and home school settings as well as the parents/caregivers of those students. These grant funds would specifically serve 9th grade Dublin High School students and parents of students in grade school, middle school and high school throughout the City of Dublin. Teen Esteem’s well-established programs give Dublin help students understand that success in life is highly individualized and take on many forms. We give them tools that will make a difference in their lives and empower them to know they can make good decisions that will allow them to realize their dreams for the future. Our core message to students is that everyone deserves to be treated with respect, no one is disposable; everyone is unique and has value. We educate and empower students to make informed, healthy choices guided by respect for self and others and encourage them to embrace their unique gifts, talents and one-of-a-kind life path. Equally important, parents of these students must be equipped with current information on the ever-changing, digital youth culture in order to better connect with, support and protect their kids. Teen Esteem is here to help and is making a difference in Dublin and beyond! Here are some quotes from Dublin High students following our 2016 Teen Esteem classroom presentations: “It was a well given presentation that was informative and entertaining.” “The presentation reaffirmed that my life has value and meaning.” “I felt really inspired and that I don’t see drinking as a normal, fun part of life anymore.” “One tool I received from the presentation was the power of decision making, and thinking about outcomes and consequences.” 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? Students need to understand the life-changing benefits of making wise decisions and avoiding the lure of risky behaviors. In Dublin a key issue we equip students to successfully face is academic/performance-based pressure. Students, parents and the Dublin Unified School District have identified this as an area where children need additional resources. We have seen a startling increase in the amount of young people in our area who are struggling with depression, anxiety and suicide - often related to academic and performance-based pressures, social media, drug/alcohol and Rx drug abuse. Based on stats from our our own student surveys, over 10% of students to whom Teen Esteem presented said they struggle with suicide “Sometimes” or “Often”. Our presentations are helping students cope with this struggle. “Touching on the topic of suicide helped me so much. I'm so grateful I'm still here to have heard the presentation. It made me want to change my life around. I can't even put into words how much it helped me. I don't want to struggle anymore.” ~ High school student quote following a TE presentation. We are on the front lines of the serious challenges kids face, and our curriculum has an accurate pulse on today’s youth culture. Our relevant, engaging and highly interactive classroom presentations give students practical examples, powerful perspective and helpful tools that will equip them to combat many challenges threatening their well-being including: academic and performance-based pressures, social media and online dangers, bullying, healthy relationship boundaries and avoidance of high-risk behaviors such as drug, alcohol and Rx drug abuse. Our online resources for parents and our live parent education programs help parents better understand the pressures their kids are facing. We equip them with tools they can use to support their children, especially as it relates to academic/performance based pressures, and build healthy parent- child relationships 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? While Teen Esteem serves all children, we recognize that some children we are reaching in Dublin schools are some of the most under-served in the Tri-Valley. According to statistics, approximately 15% of the children in Dublin schools receive free/reduced cost meals, are English learners or are in the foster care system (www.ed-data.gov, 2014-15 school year). Because many of our Teen Esteem programs are delivered in the schools, these students and their parents – many of whom may live at a relative economic and social disadvantage to their peers outside of school – will have the same access to our crucial information as their peers. Teen Esteem’s programs give ALL students the ability to make healthier decisions which will support them as they strive to realize their dreams for the future. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Teen Esteem partners with school districts, schools (public and private), athletic departments as well as individual civic organizations and cities across the Tri-Valley and other local non-profits including the NCAPDA (National Coalition Against Prescription Drug Abuse) and SAPP (Substance Abuse Prevention Partnership). These organization have access to and a pulse on families in our community. Like Teen Esteem, their services seek to equip, educate and empower students, parents and the community on the challenges young people face in today's demanding, dangerous and dynamic youth culture. 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. Teen Esteem aims to promote our own programs as well as support events around the Tri-Valley that encourage healthy kids, supportive parent/child relationships and families. To promote our events we typically partner with the school or organization who is hosting us, leveraging School Loop, emails from the school, Facebook, emails to the Teen Esteem database, traditional event flyers and much more! We employ several marketing vehicles to specifically support the City of Dublin and DUSD. This past school year we used Facebook events/posts and email messaging to our database to promote Dublin events including: “Helping Your Child Excel with Denise Pope” at Dublin High “Keeping You Mentally Fit: How to Manage Stress in High School” at Dublin High School We also promote, host, present material and attend many local events including screenings of “Screenagers” films, Dads on Campus at San Ramon Valley High, our local National Charity League chapters, PTA events, Library events and much more. In 2015-16 we delivered over 31 non-school events in the Tri-Valley community including, but not limited to: 1) Tri-Valley Job Fair parent education presentation on “How To Be Close With Your Kid” 2) Our Executive Director was the keynote speaker of the “She’s All That” Conference in 2016 and our speakers also gave several parent education talks at the event 3) Lunch & Learn presentations at several local corporations including Chevron, Workday and Bishop Ranch. 4) City of Pleasanton Library “What Kids Wish Their Parents Knew” parent ed night 5) Concord Administrators and Law Enforcement educational presentation 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. It costs Teen Esteem approximately $1,100 to give a day of classroom presentations at a high school and $2,200 to give one parent education event. Last school year at DHS we impacted over 400 students across 2.5 days of 9th grade Health Class presentations. In the 2017-18 school year, we expect to reach a growing freshman class at DHS of approximately 600+ DHS 9th grade students which will also require multiple days of classroom presentations. We will also hold 3 community parent education events. The total funding required to deliver these programs to students and parents in Dublin is approximately $10,000. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Grant funds from City of Dublin are critical in allowing us to reach the maximum number of students at DHS and increase the number of parents in the community with access with our vital message and resources. Should this project not receive funding, or receive reduced funding, we will continue to offer our programs as best as we are financially able, focusing on the High School first, then drawing from grant funds and donations from other sources if available to hold Parent Education events in Dublin. As a non-profit organization, our programs rely on the generosity of donations from corporations, private foundations, individual municipalities and one-time and monthly donors. We believe all students need to hear the Teen Esteem message regardless of schools’ budget circumstances and/or ability to pay for our services. As such, we provide our classroom presentations for free and our school assemblies and parent education events for a small fee. All of our classroom speakers are volunteers while our assembly and parent ed speakers receive a small honorarium for their time and expertise. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. n/a 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for gfedc Yes ✔✔✔✔ No construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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. Our project support Dublin’s Mission, Vision and Values including: 1) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. 2) 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 Our student classroom presentations and parent education events equip and empower students to better understand and deal with the many challenges and pressures kids face. Equipping students to make healthy decisions benefits the children for life and in turn, the community on the whole. Our parent education programs nurture the parent(caregiver)/child relationship creating stronger bonds and happier home lives. Our programs help students feel supported so that they can make great choices and realize their dreams for the future. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. ✔✔✔✔ 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 gfedc 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 gfedc 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 gfedc 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 gfedc 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 gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 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 a non-profit organization, our programs rely on the generosity of many different types of donations from corporations, private foundations, individual municipalities and one-time and monthly donors as well as events such as our Annual Fundraising Auction. We employ a grant writer on staff tasked to research new opportunities for Teen Esteem to secure funding as well as write grants for the organization. Teen Esteem works to achieve long-term self-sufficiency and sustainability through thoughtful leadership and staff selection, adaptability to changing population and social dynamics, and strategic business planning with our accomplished board. We work continually to drive down our program costs allowing us to deliver our message to increasing numbers of students and parents in our area. Our 90% growth our programs over the past 5 years has proven our capability to deliver on this goal. 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-110717 ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed City of Dublin Grant $ 10,000.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Total $ 10,000.00 $ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Classroom Presentations at DHS $ 3,300.00 $ 0.00 Parent Ed Event 1 - Grade School Parents/Caregivers $ 2,200.00 $ 0.00 Parent Ed Event 2 - Middle School Parents/Caregivers $ 2,200.00 $ 0.00 Parent Ed Event 3 - High School Parents/Caregivers $ 2,200.00 $ 0.00 Total $ 9,900.00 $ 0.00 Budget Narrative It costs Teen Esteem approximately $1,100 to give a day of classroom presentations at a high school and $2,200 to give one parent education event. Last school year at Dublin High School we impacted over 400 students across 2.5 days of 9th grade Health Class presentations. In the 2017-18 school year, we expect to reach a growing freshman class at DHS of approximately 600+ DHS 9th grade students which will also require multiple days of classroom presentations, we are estimating 3 days. We will also hold 3 community parent education events. The total funding required to deliver these programs to students and parents in Dublin is approximately $10,000. Our total operating budget is approximately $400,000, this will allow us to achieve our goal of reaching 17,000 students and parents in the Tri- Valley in 2016-17 school year. This grant will be used to fund our services, free of charge to the schools and community during the 2017-18 school year (2017-18 budget is still in development). Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget for Project Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information Form List of Board of Directors (or governing body) with contact information ✔✔✔✔ Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ IRS Form Recent Tax Return Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board Director Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board Director Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Insurance 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 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 STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ IRS Form 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. Application ID: 69936 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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 ✔✔✔✔ IRS Form Supporting Documents (Not Required) Dublin Business License Teen Esteem 2016 Newsletter Teen Esteem 2016 Impact Report Teen Esteem In Dublin Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Sandra J Wing Healing Therapies Foundation Cancer Assistance for Dublin Residents $ 10,000.00 Requested Submitted: 1/8/2017 8:04:55 AM (Pacific) Project Contact Carol Halbe carolhalbe@gmail.com Tel: 925.200.5738 Additional Contacts roycook@yahoo.com, swing@healingtherapiesfoundation.org Sandra J Wing Healing Therapies Foundation 440 Boulder Court Ste. 100-C #7 Pleasanton, CA 94566 CEO/President Sandra Wing swing@healingtherapiesfoundation.org Telephone866.862.7270 Fax 877.603.8019 Web www.healingtherapiesfoundation.org Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). SJWHTF provides cancer patients undergoing chemo/radiation treatment with access to acupuncture, acupressure, therapeutic massage, deep breathing meditation and guided/visual imagery when these healing therapies are not affordable or covered by insurance. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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.). Sandra J. Wing Healing Therapies Foundation (SJWHTF) Charity was founded in 2008 when Sandra J. Wing, a dual cancer survivor who benefitted from complementary healing therapies during treatment, sought to provide healing therapies for other cancer patients. The first grants were issued to cancer patients in 2009, and in 2010 SJWHTF received 501(c)(3) status. To date, 942 patients undergoing chemotherapy and/or radiation have received financial support from SJWHTF for complementary therapies to relieve the symptoms associated with cancer and its treatment. SJWHF received a City of Dublin Grant 2016, and is compliant with its reporting procedures and deadlines. SJWHTF annually applies for government and Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None foundation grants, has received $100,000+ in donations this fiscal year from corporations and individuals, and has raised $240,000+ from fundraising. SJWHTF has a proven track record of ethically managing all grants for the direct benefit of the clients and adhering to the donors’ specifications. The Foundation is led by Sandra, a US Army Veteran who has an MBA in Business Management, has worked for 20 years in executive leadership positions and has been the recipient of many Tri-Valley awards for her dedication to helping cancer patients. Sandra is founder and CEO of SJWHTF, and serves as Board Chair/President for the 7 member Board of Directors (see BOD Attachment), which is actively involved in the foundation’s operations (e.g., overseeing client and provider relations, marketing/PR, and fundraising). The Leadership and Advisory Council consists of five members with financial or medical backgrounds. Additionally, 100+ volunteers serve on any of 12 committees, such as: Event Planning, Education, Applications and Care. SJWHTF has one full-time employee, and all administrative costs (including accounting) are paid by individual donations that include annual contributions from Board Members, so that 100% of grant funds go to provide therapy services to cancer patients. 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 of $10,000 to help Dublin residents find relief from the toxic side effects of chemotherapy and radiation during cancer treatment.Sandra J. Wing Foundation creates a bridge to healing therapies for cancer patients in our community. 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.) In 2015-16, SJWHTF issued 220 grants, 16%/35 to Dublin residents. With the expansion and relocation of Axis Community Health, an increasing number of referrals from Dublin is projected;we estimate serving even more cancer patients in 2017 than prior year. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. The Foundation provides funds for complementary therapies, which are not covered by insurance, to cancer patients throughout the Tri-Valley region. We publicize our program with local agencies and receive direct patient referrals from ACS (Am. Cancer Society) and Charlotte Maxwell Complementary Clinic (Bay Area). These partnerships allow us to serve those who meet lower income levels, as defined by the S.F. Foundation. We also receive referrals from medical and radiation oncologists, Stanford/Valley Care, and Epic Care. Patients can find information on our website. Residents of Dublin under physician’s care for cancer, undergoing chemo and/or radiation treatment, who do not have medical insurance that covers the complementary therapies they need, will eligible for funds. Once a referral is received, the patient is contacted and completes a short application describing their medical situation, treatment plan and obtains the physician’s signature. Patients are encouraged to talk with their physician about the therapy they are considering. Applicants may choose from those healing therapies that benefitted the founder, Sandra J. Wing during her cancer journey: acupuncture, acupressure, therapeutic massage, deep breathing meditation and guided/visual imagery. The completed form is submitted via email, mail or fax and will be reviewed by the Review Committee and Board Member. Once approved, payments for services will be made directly to practitioners authorized as service providers to our Foundation’s beneficiaries (all of whom offer our Foundation reduced rates.) Pre and post treatment surveys will be conducted to measure the project’s success. Surveys focus on how patients and those supporting them are affected by complementary therapies during treatment and how we can improve services and continue to can best assist Dublin residents in need. The Foundation will measure effectiveness by the number of cancer patients served. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). Last fiscal year, SJWHTF supported 35 Dublin residents with healing therapy grants and 220 Tri-Valley residents in total. The 2011 Tri-Valley Needs Assessment identifies access to health care and seniors as priorities. SJWHTF is responsive both of these needs. Last year, 70% of Dublin cancer patients who received therapy services had incomes below county annual median for households of three. Of total recipients in the Tri-Valley, 49% had incomes under $55,000, the average age of was 60 years, and 79% were women. 74% were unemployed. We are requesting Human Services Grant funding from Dublin, Livermore and Pleasanton, where 67% of last year's beneficiaries reside. Funding received from the City of Dublin will go directly toward providing therapeutic relief to cancer patients in Dublin. Grant Funding received by SJWHTF does not go to research and development, nor does it pay for any administrative costs; grant funds received are 100% dedicated to provide therapy services for 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 needs of the individual, in general the Foundation makes grants as much as $500 per applicant, in order to provide for enough sessions for maximum benefit. A City of Dublin Grant in the amount of $10,000 would benefit as many as 20 local cancer patients with funds for a series of therapy services. Patients choose the therapy or therapies of their preference and Sandra J. Wing provides payment directly to service providers. Your financial assistance for healing therapies will fill in some of the gaps experienced by Dublin cancer patients, especially those who make up the low- income and under/uninsured in our community 13. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing ✔✔✔✔ Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition ✔✔✔✔ Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above objectives will your agency use to track the progress of meeting the outcome(s)? SJWHTF intends to increase the knowledge about and access to complementary healing therapies for Dublin and Tri-Valley residents with cancer. Healing therapies such as acupuncture, acupressure, guided/visual imagery, deep-breathing meditation, and therapeutic massage can alleviate some of the debilitating side effects experienced during treatment. Knowledge of these therapies and the role SJWHTF plays in supporting cancer patients by financing therapy services is an ongoing objective, and our goal is to continue to reach out to the general population of our community with this message, via press releases, website updates, local newspaper coverage, Foundation newsletters, and email. We measure how successful we are in “getting the word out” through records of attendance and donations at our many fundraising and educational events, and by tracking data on how attendees, donors and clients learn about SJWHTF. With Dublin funds, the Foundation would be able to continue to provide direct financial assistance to eligible Dublin residents undergoing cancer treatment. With population growth and aging indicators, this number is anticipated to be greater than it was in 2016. SJWHTF partners with 35 healing therapy service providers and more than 73% of patient referrals come from medical oncologists, radiation oncologists, cancer treatment centers at hospitals and medical institutions throughout the Bay Area. Strategies for tracking communication to patients include tracking numbers of inquiries and referrals compared to general population and comparing to data from past years. We will analyze past and present referrals and more accessible transportation from Dublin to our service providers. We will measure our overall objective of meeting the needs of individual cancer patients by numbers of applications and beneficiaries and their own testimonies from pre and post healing therapy surveys, posted with permission on the our website. 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. Health issues do not respect age, gender or social status, but coupled with financial hardships, they can be even more devastating. In 2015-16, in the Tri-Valley, many cancer patients who received assistance from SJWHTF had no income (15%) or annual household incomes below $10,000 (4%). Cancer is more than just the disease; it impacts the finances of every household it visits (with the reduction in workload for the patient and/or caregiver.) More than half of the patients who received grants last year (55%) had Stage 3 or 4 cancer diagnoses. Though the data indicates that the majority of beneficiaries include the elderly and residents with low income, the core mission of SJWHTF is to support every Tri-Valley cancer patient, regardless of gender, age, disability, income, ethnicity, or language by providing financial assistance for healing therapies. The youngest recipient was 22 years old and the oldest 86; the requirements are cancer diagnosis and treatment, that healing therapies are not otherwise covered by health insurance, and residence in the Tri-Valley. Healing therapies provide an integrative approach “in addition to, not in place of,” conventional treatments for cancer, and the combination can enable individuals to take a more positive, proactive role in their treatment and recovery. The benefits are movingly expressed in one patient’s own testimony: Jan S. of Dublin, CA writes, “My prognosis is not good. I have been unfortunate to be one of those who has severe neuropathy that has developed from my chemotherapy regimen. This is expected in some patients and I am apparently one of them. In addition, I am allergic to all three medications that are used for treatment of neuropathy symptoms so my only relief is the acupuncture. I am so grateful that this helps with the side effects and that you have helped me receive this treatment. Thank you for all you do. Many thanks for this life-giving gift!” July 2016. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? The largest number of cancer patients served last year by SJWHTF was female (79%) and the average age was 60. Demographic data collected from recipients showed 51% white, 11% Asian, 5% Black and 5% Hispanic, however applicants have the option to decline to state their race or ethnicity. Because healing therapies involve an integrative approach that draws from both Eastern and Western Medicine, and the cancer patients elect the therapies most appropriate for them, the services provided to each recipient are respectful and supportive of patient’s expectations. However, increasingly among all health care practitioners, cultural and linguistic responsiveness to patients is an ongoing challenge in the changing demographic of the Tri-Valley. To begin to address this challenge, SJWHTF partners with 35 healing therapy providers, many who speak multiple languages. Service providers listed on the application form have been qualified by the Sandra J. Wing Healing Therapies Foundation based on patient service. Patients may choose the therapy and provider of their preference from the list of those pre-approved for payment. Allowing recipients to select the most culturally and linguistically appropriate provider as well as the desired type of therapies, helps tailor the services provided to the specific client’s preferences. The Foundation, not the cancer patient, talks directly to the provider to make arrangements for payment, which allows for a respectful relationship between therapist and client, as well as special patient rates to the Foundation. The list of providers is generated from those providers who have been vetted and have successfully provided services to beneficiaries in the past. Currently, all healing therapy service providers are located within the Tri-Valley. This list is updated regularly. 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? Cancer is hard financially, regardless of income level. Referrals for financial assistance come from many sources, with 68% of referrals last year from the medical community. Friends, families and advertising account for 18%. Limited English speakers present challenges, and fortunately many of our volunteers, including those who work directly with grantees, speak multiple languages. Our application is also in Spanish. We coordinate with agencies that serve large numbers of low-income and/or linguistically isolated individuals, and last year 70% of Dublin residents we served had incomes below the County $ 93,600 AMI (Dublin City Council Criteria). Both Stanford/Valley Care, Epic Care and the Charlotte Maxwell Complementary Clinic (CCMC) in Oakland refer cancer patients to us. The CMCC was designed for “care teams,” which resonates with the SJWHTF mission. A care team model was the vision of Charlotte Maxwell, whose work in public health inspired the Charlotte Maxwell Complementary Clinic after she received her own cancer diagnosis in the 1980’s. With her background, Charlotte had seen the value of team care. Facing cancer herself and unable to find a support group that met her needs, Charlotte put together her own health team, consisting of women practitioners who specialized in Chinese herbal medicine, acupuncture, massage, guided imagery, homeopathy and eventually hospice care. Her belief in complementary integrative medicine inspired the CMCClinic, in Oakland, a referral resource for our patients. Last year, 68% of our referrals came from oncologists, chemo and radiation centers and the medical community. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. The SJWHTF collaborates with many local, well-respected medical and cancer organizations in nearby Bay Area communities, including Stanford/Valley Health Care, Kaiser Permanente, Valley Care Medical Oncology Consultants, San Ramon Regional Medical Center, Palo Alto Medical Foundation, Sutter Health and Children’s Hospital. Dr. Rishi Sawhney, Medical Oncologist, Valley Medical Oncology Consultants writes, “As a medical oncologist, being able to give full care to your patient and treat them as a whole is so very important. Complementary therapies help provide that extra coping healing element that standard medical care cannot provide. Healing the spirit and caring for the patient is what I see when my patients come to the Sandra J. Wing Healing Therapies Foundation.” We participate with our medical partners at joint events throughout the year, and many of these partners are annual sponsors who support our fundraising efforts. Kaiser Permanente was our first Grant Sponsor in 2009, and has supported us continuously since then. We have organized several co-sponsored business events with corporate sponsors, and a portion of the proceeds is dedicated to the Foundation. SJWHTF is always seeking ways to enhance knowledge and services through collaboration with medical organizations. SJWHTF has offered community education programs since 2014, and has a dedicated committee to plan and implement several programs on relevant new topics each year. These programs are presented by practicing medical professionals. This year’s topics included How to Handle Side Effects of Chemotherapy, Self-Healing, and Care Giving. We partner with more than 35 service providers, consisting of acupuncturists, massage therapists, mindfulness practitioners and more. As a veteran herself, Sandra enjoys taking her dog to visit patients at the VA Hospital in Livermore. 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. We receive direct patient referrals from the Charlotte Maxwell Complementary Clinic and the Tri-Valley medical community. 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 in the Tri-Valley that provide healing therapies to cancer patients. Most of our referrals come from the medical community or word of mouth. Always responding to opportunities to reach out in the community, CEO and Founder, Sandra J. Wing, has been recognized for her hard work and dedication by The Pleasanton Weekly and its sister publications--Dublin Tri-Valley News, San Ramon Express and Danville Express (with the Tri-Valley Heroes-- Courage Award). Sandra was selected as an Honoree for the HERS Beast Cancer Foundation “People with Purpose” Hope Award and in 2013 she received the “Threads of Hope Award” from Diablo Magazine. In 2016, the Foundation received the Pleasanton Chamber of Commerce’s Excellence in Service Award. As recently as December 2016, after addressing members of the Valley Real Estate Network, Sandra and her work was featured in The Pleasanton Weekly. Our Organization is proud to have been featured on NBC 11, TV30 Tri-Valley Community Focus and Comcast News. We leverage social media via our website, blogs, Instagram and Facebook page and YouTube videos. One of our board members owns and operates a business in Dublin, and since our first grants were issued, 90 of our grant recipients have resided in Dublin. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Our organization ensures that 100% of the City of Dublin Grant monies received will go directly to provide services for cancer patients residing in Dublin. Not only does income typically drop with a cancer diagnosis, but household expenses also typically increase with costs for the many necessities that are not covered by prescriptions (dietary needs, cost of transportation to and from appointments, co-pays, etc.) We do not conduct research or work to find a cure; we make sure grant funds will go directly toward helping the person battling cancer get through a very difficult time. We help all people—young and old, male and female--living with cancers. SJWHTF is a local, primarily volunteer organization with one full-time employee. The total project request for Human Services Grant Funds from Dublin, Livermore and Pleasanton is $ 35,000. The request for $10,000 from Dublin City funds will contribute 29% of the requested total and would allow us to provide healing therapy services up to $500 per grant for as many as 20 Dublin residents (half as many as received services last year). We estimate our total budget for Dublin residents to be more than $34,000 in 2017-18, and consider the HSG contribution to be a reasonable percentage. Depending on the patients’ needs, therapy sessions could provide for a significant portion of their treatment cycle. Additional projected funding sources for the project come from sponsorships, individual donations, and other fund raising events. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If the Sandra J. Wing Healing Therapies Foundation receives reduced or no funding, the amount of assistance immediately available for Tri-Valley cancer patients would diminish. Without adequate funding, we will be forced to deny cancer patients access to some treatments not covered by insurance or further restrict their household income. The Foundation solicits help in many forms: monetary donations, volunteers, patient referrals, supporters to the foundation, healing service providers and other grant funding. Even with these collaborative efforts, we must be prepared to provide assistance for every Dublin resident battling cancer, and we will continue to work tirelessly to honor our commitment to support all Tri-Valley residents in their fight against cancer. Your gift of $10,000 for Dublin residents will help us meet that goal. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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 Dublin’s Mission statement is to “promote and support a high quality of life for its residents.” The SJWHTF has provided a unique service to cancer patients in the Tri-Valley since 2009, granting funds for healing therapies not typically covered by health insurance. Complementary healing therapies for cancer patients support the "quality of life" for residents in perhaps their greatest time of need. Dr. Ricardo DeRosa, Medical Oncologist with Valley Medical Oncology Consultants noted: “Acupressure, massage and meditation enhance positive feelings, and there is scientific evidence that it is helping patients heal. The Foundation is a wonderful opportunity for patients to access supportive care to help them through the difficulties of cancer therapy and the emotional turmoil of diagnosis.” SJWHTF program addresses two of the “2011 Tri-Valley Human Services Needs Assessment” Areas of Concern: “Health Care” and “Senior Services”. Last year, SJWHTF issued more than 18 grants per month for a total of 220 total grants (June 1, 2015 - May 31, 2016). Cancer is a community concern that requires collaboration and communication within Dublin and among Tri-Valley cities. Since the first grants were issued, SJWHTF has partnered with the greater Bay Area medical community and other agencies to reach out to residents with cancer and make supportive health care available and accessible. Our therapy providers have offices throughout the Tri-Valley. As the income data indicates, the Sandra J. Wing Healing Therapies Foundation provides health care support for many low-income and senior cancer patients in our local community. The opening quotation in the “2011 Tri-Valley Human Services Needs Assessment” reads: “Once you are living below the poverty level, you cannot pull yourself out... There is no extra help.” It is that "extra help" that the Foundation offers Dublin residents, and for which we ask your financial support of $10,000. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc 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 gfedc 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 gfedc 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 gfedc 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 gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 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 SJWHTF reaches out to more people in the community, our Foundation has increased awareness of our mission. We leverage a large social network distribution including our website, and send quarterly newsletters to approximately 3,500 people. E-news blasts are sent throughout the year. With increased awareness, sponsorships, donations and contributions have also increased. Special Event Fundraisers such as the Swing for Cancer Therapies Golf Tournament and Ragin’ Cajun continue to generate income while bringing supporters and grant recipients together to acknowledge the work and celebrate the year’s accomplishments. As a result of our efforts, more applications have been received and more grants are being issued each year. In order to make sure funds remain available, we have established an endowment fund made up of gifts and bequests that will be subject to the 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. Sandra J Wing Healing Therapies Foundation is registered with the City of Dublin Business Registration: BL-109882 ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed GRANTS - Foundations $ 40,000.00 CONTRIBUTIONS $ 0.00 Annual Sponsorships $ 120,000.00 Individuals (incl. 100% BOD participation) $ 20,000.00 In Memory of & In Honor of $ 9,000.00 SPECIAL EVENTS Party Palooza $ 15,000.00 Golf Tournament $ 40,000.00 Ragin Cajun $ 210,000.00 Total $ 454,000.00 $ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Grants to Beneficiaries (current year) $ 126,000.00 Grants to Beneficiaries (future years) $ 109,000.00 Party Palooza $ 1,000.00 Golf Tournament $ 10,000.00 Ragin Cajun $ 51,000.00 OPERATIONS Administration/Personnel $ 100,000.00 Contractors $ 37,000.00 Professional Services (Insurance, CPA, legal) $ 5,000.00 Newsletter & Mailers $ 2,300.00 Storage $ 2,400.00 Office Rental $ 1,200.00 Supplies $ 7,000.00 $ 2,000.00 Endowment $ 100.00 Application ID: 69480 Become a fan of ZoomGrants™ on Facebook * ZoomGrants™ is not responsible for the content of uploaded documents. Total $ 454,000.00 $ 0.00 Budget Narrative These budget amounts are based on FYE June 30, 2017. Budget amounts are based on 7 years of Foundation existence. The budget does not include the requested $10,000 from the City of Dublin Human Services Grant, which would go directly to provide more healing therapies to patients in Dublin. Each $1,500 we receive in grants represents three more Dublin cancer patients receiving healing therapies during treatment. With $10,000, we could provide as many as 17 - 20 residents therapy grants of $ 500 each. SJWHTF leverages other funding sources including fundraising events of $ 203,000 after expenses, and individual donations and annual sponsorships of $ 149,000, to support healing therapies. These funds also cover Administrative Costs, Professional Services (CPA, Insurance, Legal, etc.) and Contractors (Quickbooks/Administrative services). Endowment funds provide for sustainability of the program. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget: Cancer Assistance Dublin Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information List of Board of Directors (or governing body) with contact information ✔✔✔✔ BOD and Contact Info Current Annual Budget for the Entire Agency ✔✔✔✔ Annual Budget Entire Agency Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ IRS 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Designation of Authorized Official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Authorization to Request Funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Liability Insurance Workers Comp. 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 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 STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ Non-Profit Determination CA Franchise Tax Board Letter 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 the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements ✔✔✔✔ Agency Audit Supporting Documents (Not Required) 2-1-1 Alameda Co. Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline YMCA of the East Bay, Tri-Valley YMCA Mental Health Services $ 25,000.00 Requested Submitted: 1/8/2017 11:04:00 AM (Pacific) Project Contact Kenny Altenburg kaltenburg@ymcaeastbay.org Tel: 9252634444 Additional Contacts none entered YMCA of the East Bay, Tri-Valley YMCA 5000 Pleasanton Ave Suite 220 Pleasanton, CA 94566 United States VP and Regional Executive Director Kelly O'Lague Dulka kdulka@ymcaeastbay.org Telephone925.263.4444 Fax (925) 263-4445 Web www.trivalleyymca.org Application Questions 1. Please describe your organization category (select one of the following): 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? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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 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 members, 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 Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None 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 implementation 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.) 100 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 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 meeting 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 by the Rosenberg Self Esteem Scale. The Rosenberg Self-Esteem Scale (SES) is a brief and unidimensional ✔✔✔✔ Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity ✔✔✔✔ Financial Assistance gfedc None of the above 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 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. Poor mental health and well-being can be both a determinant & 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 client/customer 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 all 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 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 financial assistance we give to families. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. 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 client referrals. 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, outline 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. We also get many referrals from other leaders of the Tri-Valley Anti-Poverty Collaborative. 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. 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, including 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. 20. 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. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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." gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc 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. gfedc 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 gfedc 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 gfedc 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 gfedc 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 -"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". 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 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). gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. 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. 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 Golf Tournament Fundraiser $ 12,000.00 $ 12,000.00 Board & Staff Contributions $ 12,000.00 $ 12,000.00 City of Pleasanton Grant Funding $ 25,000.00 City of Livermore Grant Funding $ 5,000.00 Total $ 89,000.00 $ 24,000.00 Funding Uses/Expenses Budget Amount Amount Committed Mental Health Therapist Salary $ 65,000.00 Taxes and Benefits $ 16,250.00 $ 16,250.00 Malpractice Insurance $ 1,200.00 $ 1,200.00 Computer and Cell Phones - Therapist & Interns $ 4,500.00 $ 4,500.00 Office Supplies/Record Keeping $ 1,000.00 $ 1,000.00 Therapeutic Supplies & Equipment $ 1,050.00 $ 1,050.00 Total $ 89,000.00 $ 24,000.00 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 download template ✔✔✔✔ Program Expense Budget - MH Services Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information Form - MH Services List of Board of Directors (or governing body) with contact information ✔✔✔✔ Tri-Valley YMCA Board Roster Current Annual Budget for the Entire Agency ✔✔✔✔ Tri-Valley YMCA Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board Designation and Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board Designation and Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ YMCA COI 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 AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" Application ID: 71050 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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 STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ IRS Determination Letter 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 the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements ✔✔✔✔ YMCA Audited Financials Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline YMCA of the East Bay, Tri-Valley YMCA Affordable Summer Childcare - YMCA Day Camp $ 25,000.00 Requested Submitted: 1/8/2017 11:15:03 AM (Pacific) Project Contact Kenny Altenburg kaltenburg@ymcaeastbay.org Tel: 9252634444 Additional Contacts none entered YMCA of the East Bay, Tri-Valley YMCA 5000 Pleasanton Ave Suite 220 Pleasanton, CA 94566 United States VP and Regional Executive Director Kelly O'Lague Dulka kdulka@ymcaeastbay.org Telephone925.263.4444 Fax (925) 263-4445 Web www.trivalleyymca.org Application Questions 1. Please describe your organization category (select one of the following): 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? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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 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 members, 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 Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None 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. 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 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 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.) 120 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, 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 meeting 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 turned 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 project, i.e. seniors, youth, disabled, low-income, etc. gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services ✔✔✔✔ Child Care, Early Childhood Development and Education ✔✔✔✔ Changing Demographics and Growing Diversity ✔✔✔✔ Financial Assistance gfedc None of the above 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% 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 client/customer 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 all 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 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 organizations 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. 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 otherwise. All functions of our camp are already 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. 20. 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. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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! 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc 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. ✔✔✔✔ 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 gfedc 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 gfedc 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 gfedc 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 gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 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 childcare 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 gfedc #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. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed Camp Fees $ 145,500.00 $ 0.00 YMCA Fundraising Events $ 20,000.00 $ 20,000.00 City of Dublin Grant Funding $ 25,000.00 $ 0.00 Additional Grants $ 35,000.00 $ 0.00 Staff Donations $ 5,000.00 $ 5,000.00 Board Donations $ 5,000.00 $ 5,000.00 Total $ 235,500.00 $ 30,000.00 Funding Uses/Expenses Budget Amount Amount Committed Admin Salaries $ 18,000.00 Benefits $ 3,600.00 Program Staff Salaries $ 145,000.00 $ 30,000.00 Program Staff Benefits $ 30,000.00 Outreach/Promotion $ 1,000.00 Supplies/Materials $ 8,500.00 Facility Rental $ 13,000.00 Transportation Costs & Entrance Fees $ 16,400.00 Total $ 235,500.00 $ 30,000.00 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. Programmatic costs cover arts and crafts supplies, STEM learning materials, sports equipment, snacks and camp shirts. We will pay approximately 13,000 in rental costs for ten weeks of camp. Application ID: 71051 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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 download template ✔✔✔✔ Program Expense Budget - Affordable Child Care Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information Form - Affordable Child Care List of Board of Directors (or governing body) with contact information ✔✔✔✔ Tri-Valley YMCA Board Roster Current Annual Budget for the Entire Agency ✔✔✔✔ Tri-Valley YMCA Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board Designation and Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board Designation and Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ YMCA COI 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 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 STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ IRS Determination Letter 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 the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements ✔✔✔✔ YMCA Audited Financials Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Child Care Links Professional Development Trainings $ 7,000.00 Requested Submitted: 1/8/2017 1:21:33 PM (Pacific) Project Contact Laura Page jdavis@childcarelinks.org Tel: (925) 249-3920 Additional Contacts lpage@childcarelinks.org, vdilks@childcarelinks.org Child Care Links 6601 Owens Dr. Ste 100 Pleasanton, CA 94588 United States Interim Executive Director JoAnn Davis jdavis@childcarelinks.org Telephone(925) 417-8733 Fax (925) 730-4942 Web www.childcarelinks.org Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Child Care Links has remained a stable fixture in the Tri-Valley community for over 40 years providing resources that strengthen and support children and their families. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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.). Child Care Links has the capacity to conduct this project through the agency’s extensive experience providing innovative services and trusted resources to families and Child Care Professionals in the Tri-Valley. Child Care Links has direct access to Community Care Licensing, 272 Tri-Valley Licensed Child Care Providers and families served through the agency’s Child Care Referral and Subsidized Child Care Programs. This will increase Child Care Links’ capacity to conduct outreach. Child Care Links provides child care referrals to families seeking child care, subsidized child care to low-income families, car seat safety checks, and Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No ✔✔✔✔ One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding gfedc None professional development trainings to Licensed Child Care Providers, parents, and educators. Training topic examples include, but are not limited to, Supporting Young Bilinguals, Father Engagement, Early Literacy Strategies, Enriching STEM Programs, Effective Communication, Social-Emotional Screening and Development, Creating Safe Environments, Curriculum Development, Best Business Practices, Health and Safety, CPR/First Aid, Nutrition, Positive Discipline, and Inclusion of Children with Special Needs. Child Care Links is a parental choice agency, and allows parents/guardians to select Child Care Providers who will best meet the needs of their child/children and family. Many families enrolled in subsidized child care often choose Licensed Child Care Providers due to reasons such as, convenience, cost, access to trained child care professionals, curriculum, and opportunities to exchange information with staff, peers and other parents. In fiscal year 2015-2016, Child Care Links served 367 duplicated, and 101 Dublin participants through the facilitation of 40 agency wide professional development trainings. The agency provided services to 72 Dublin Child Care Providers and subsidized child care to 82 Dublin children using Licensed Child Care Providers. 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, Licensed Child Care Providers and educators 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? Please explain how your project meets the selected Areas of Concern. 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, online and in-print marketing tools, event calendars, email blasts, social media, surveys 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?). Dublin grant funds will provide free professional development opportunities focused on strengthening the quality of child care to better support the success of children, parents and Child Care Professionals in Dublin and the Tri-Valley area. The Child Care and Development Block Grant Act (CCDBG) of 2014 introduced changes requiring Child Care Providers to have pre-service and ongoing health and safety trainings. The CCDBG Act also introduced a more robust professional development training framework to increase competencies that will promote social, emotional, physical and cognitive development in young children. These funds will provide trainings to meet these enhanced standards. Topics will include: Child Development, Literacy, Supporting Young Bilinguals, Father Engagement, Social, Emotional, Health and Safety, Financial Wellness, and Serving Children with Special Needs (Inclusion). 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 meeting the outcome(s)? • Sign-in Sheets/Tally 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 provide each participant an evaluation at the end of each project activity. This will allow staff to evaluate if activities are effective and addressing the needs of the target audience. gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services gfedc Youth Services ✔✔✔✔ Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above 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. Through the training and technical assistance, Child Care Links will serve Tri-Valley Licensed Child Care Providers. Currently Child Care Links serves 262 Licensed Child Care Providers through the agency’s child care referral program. 72 of the above mentioned Child Care Providers reside in the City of Dublin. This program will allow Licensed Child Care Providers to received free Early Childhood professional development opportunities in order to maintain quality child care programs. Providing professional development and training opportunities for Licensed Child Care Providers will ensure parents have the ability to select a quality child care 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. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer 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 funding? Child Care Links will continue to target those currently enrolled in the agency’s programs. Programs, such as subsidized child care, participants have to be low-income to qualify. Child Care Links staff will work collaboratively with internal staff to outreach to the project’s target audience. Child Care Links will also contact community partners, such as CAPE, Dublin, Pleasanton and Livermore School Districts, Pediatric healthcare facilities, Libraries, Shepard’s Gate, CityServe, 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 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 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, child 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: Child Care Links staff works and collaborates with CAPE HeadStart by providing onsite car seat safety checks, car seat replacements, and literacy activities to CAPE families. Child Care Links also attends 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 Famer’s Market series, St. Patrick’s Day Celebration, SeeDubRun, and Splatter. Child Care Links also outreaches through email distribution, clients 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 Parent’s 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 72 Child 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 800 community members. Child Care Links continuously collaborates with many organizations to provide diverse trainings for Child Care Providers and parents such as School of Imagination, the Department of Education and First 5 Alameda County. In April 2017, Family Resource Navigators, and Child Care Links is collaborating to provide a training series in English and in Spanish, to address the needs of children who have developmental delays, disabilities and social emotional concerns. Attendees will learn comprehensive strategies in identifying behaviors and navigating the system for intervention services. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Funding will cover 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. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Child Care Links is committed to serving the changing needs of Dublin residents and the Tri-Valley community as a whole, in collaboration with the city of Dublin, regardless of any financial capacity this program application should secure. Restricted funding creates challenges that often impede program growth and impact due to a lack of financial support for operational costs. If Child Care Links receives reduced funding, or no funding, it will limit the scope and reach of the project and it’s impact, prolonging its’ success. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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 2015-2016 fiscal year, Child Care Links received 147 child care referral requests from parents/guardians seeking child care in the City of Dublin. gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 gfedc Not Applicable gfedc Yes ✔✔✔✔ No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. ✔✔✔✔ 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 gfedc 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 gfedc 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 gfedc 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 This resulted in 1143 child care referrals of Dublin child care programs. In order to assist Licensed Child 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 the 2015 – 2016 fiscal year, 87% of the child care referrals received were from 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 result, 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. 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.” Child 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 support their day-to-day lives. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. 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). Actions Child Care Links is taking to become financially self-sufficient include; actively looking for new fundraising and grant opportunities on a continual basis, and increasing innovative collaborations with other agencies to reduce program expenses. Working in partnership with other agencies, such as First 5 Alameda County, California Resource and Referral Network, and other cities that support the quality of life for Tri-Valley residents, allows Child Care Links to leverage funds from multiple sources and serve a greater number of Dublin residents. Child Care Links values the collaboration with the City of Dublin to create opportunities that promote; education, diversity, equality, and economic stability to improve the lives of children, families and Child Care Professionals living and working in the Tri-Valley. 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 gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed -none-$ 0.00 $ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries $ 2,800.00 Benefits $ 795.00 Supplies $ 560.00 Printing/Copying $ 0.00 Postage $ 0.00 Telephone $ 45.00 Accounting/Audit $ 0.00 Contracted Services $ 0.00 Events & Workshops $ 2,200.00 Other $ 600.00 Total $ 7,000.00 $ 0.00 Budget Narrative Other costs include Insurance, Facilities & Maintenance, Payroll Services and other Administrative costs. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget for ALL Grant Requests Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information for ALL Grant Requests List of Board of Directors (or governing body) with contact information ✔✔✔✔ List of BOD Current Annual Budget for the Entire Agency ✔✔✔✔ Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ IRS 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ BOD Authorized Official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Authorization to Request Funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Certificates of Insurance REQUIRED FOR CDBG ONLY-If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) Application ID: 71047 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. REQUIRED FOR CDBG ONLY- PERSONNEL POLICIES INCLUDING 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 STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ State Non-Profit Determination Letter Federal Non-Profit Determination Letter 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 the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements ✔✔✔✔ Certified Financial Statement Supporting Documents (Not Required) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Eden I&R, Inc. 2-1-1 Alameda County Communication System $ 10,000.00 Requested Submitted: 1/8/2017 6:11:20 PM (Pacific) Project Contact Alison DeJung bbernstein@edenir.org Tel: 510-537-2710 Additional Contacts none entered Eden I&R, Inc. 570 B Street Hayward, CA 94541 United States Executive Director Alison DeJung adejung@edenir.org Telephone(510) 537-2710 x8 Fax (510) 537-0986 Web www.edenir.org Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The Agency commits itself to serve as a link between individuals and the full range of community resources available to them. We dedicate the Agency’s resources to the empowerment of individuals through dissemination of timely and accurate information. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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.). Eden I&R's governing board meets quarterly and is composed of seven dedicated individuals, with several members having served more than 15 years. Since January 1989, Barbara Bernstein had served as the agency's Executive Director. Upon her retirement, Eden I&R has transitioned Executive Director leadership to Alison DeJung, as of January 3, 2017. 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, human services providers, local government, and Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None people in need throughout the County rely on Eden I&R as a professional and compassionate partner in the delivery of health and human services, housing, and disaster resource referrals. The organization serves as a clearinghouse for accurate community information and is a key component of the disaster response network in Alameda County. Eden I&R created and maintains two databases, a health and human services database and an affordable housing resource database, and provides to the community reliable data on services and housing resources. In addition to 24/7 service to Alameda County callers each day of the year, Eden I&R values its cultural and linguistic diversity throughout the organization and is prepared to serve all Alameda County individuals and families in need of resource referrals. Eden I&R's 2-1-1 Alameda County program offers a number of unique services and benefits, including being the only agency that checks shelter bed availability twice daily. The easy to remember three-digit number is free to all callers and serves callers' unique and individual needs through personalized assessment, resource referrals, follow-up calls, and advocacy for callers needing additional help to connect to resources. Launched in 2007, the 2-1-1 program continues to address all 14 Areas of Concern through community partnerships and program innovation. 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. 2-1-1 is a free, 24/7/365, multilingual phone line that connects indivduals and families (particularly low-income and vulnerable populations) with referrals to city and countywide health, housing, and human services, and disaster 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 450 callers from Dublin, which includes callers who state their city of residency, but who decline to participate in a full intake and needs assessment, as well as callers who agree to complete a full intake and needs assessment. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. With the support 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 public/private sector funding. Since then, Eden I&R has been administering and operating the 2- 1-1 service 24/7/365. 2-1-1 Phone Resource Specialists (PRS) receive rigorous training to help them understand the unique and, often, dire situations faced by callers. PRS assist in prioritizing requests, assessing callers' needs, and remaining sensitive to callers' situations. PRS serve to empower callers to understand and solve their own challenges by working to first understand the caller's situation (e.g., stated and unstated needs, feelings, personal resources, and barriers). The primary objective of the 2-1-1 program is to help callers identify health, housing, and human services resources available to them. 2-1-1 Phone Resource Specialists will present the caller with various approaches to addressing one's needs and explore the caller's own resources (e.g., friends, family, community). Whenever possible, the caller will be provided with at least three referrals to enable him/her to move forward in addressing one's needs. PRS will invite the caller to call again for additional resources as needed. PRS will work with the caller to find the most appropriate options, and when resources have been exhausted, will suggest ways that the caller can advocate for oneself. In addition, the PRS will provide follow-up or advocacy for the caller on cases involving crisis and situations in which the PRS believes that the caller may have difficulty accessing services or clearly communicating one's needs to service providers. To ensure that 2-1-1 callers receive the most up-to-date information and referrals to resources, Eden I&R's Human Services Database and Housing Resource Database are updated daily and records are verified annually per national AIRS Information & Referral standards. 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. Because of the need to continuously staff and operate a 24/7 phone service, staff salaries and benefits represent approximately 85% of the project's costs. 2-1-1 provides referrals to programs identified by the 14 Areas of Concern in the Eastern County 2011 Needs Assessment Report. 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 to be connected to a PRS who will assess the caller's needs and provide access to comprehensive information and referrals, both for needed services as mentioned in the report that exist within the Tri-Valley as well as to services available to them beyond the Tri-Valley to fill current services gaps, i.e., low-cost dental care resources. The remaining funds from the City of Dublin will be used to perform outreach about the 2-1-1 service to Dublin residents, especially low-income and under-served populations. Our goal is to maximize the public's awareness of services information and knowledge on how to access resources. ✔✔✔✔ 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 ✔✔✔✔ Food and Nutrition ✔✔✔✔ Senior Services ✔✔✔✔ Youth Services ✔✔✔✔ Child Care, Early Childhood Development and Education ✔✔✔✔ Changing Demographics and Growing Diversity ✔✔✔✔ Financial Assistance gfedc None of the above Activities will include printing flyers and ordering promotional materials that will be made available to attendees at presentations, resource fairs, and to organizations in Dublin. Agencies and service providers will be invited to request materials at no cost. 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. Public/private funding makes it possible for 2-1-1 to be able to provide health, housing and human services information and referrals on a daily basis, in addition to disaster-related information during and after a disaster. 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 meeting the outcome(s)? 1. Provide a free, major point of entry to health, housing and human services information and referrals for Dublin residents, employees and advocates 24/7/365 and in multiple languages 2. Maintain, update, and verify the more than 2,900 health and human services program entries in the Health and Human Services Database annually to provide the most current services information to Dublin callers 3. Increase the number of housing units in the Housing Database by 450 units countywide 4. Provide in-service training to 2-1-1 PRS on new and existing programs within the community 5. Conduct outreach to Dublin residents by hosting booths/tables at events and offer 2-1-1 outreach materials to organizations and government departments located 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, low-income families, seniors, people living with disabilities, at-risk youth, caregivers and non-English speakers, who are in need of vital resources. 2-1-1 PRS are professionally trained to assess callers' needs, to provide comprehensive and up-to-date information on a wide range of services, and to clearly communicate to callers how to access these resources. The 2-1-1 Call Center is staffed during regular business hours with Bilingual PRS who speak Spanish, Cantonese, Mandarin, Vietnamese, Hindi and Farsi, and who have access to translators in 150 languages via a 24/7 interpretation service. Another segment of the population that benefits from this service are advocates (e.g., case managers, medical personnel, teachers, city officials, administrators, and employers) in Dublin who need help navigating the ever-changing system of human services agencies for their constituents, including clients, patients, students, and employees. The following are recent call examples from Dublin residents: ~ A Dublin resident called for shelters. The caller informed 2-1-1 that he had children but they were not living with him. He further informed 2-1-1 that he had been in a car accident that had left him unable to fully care for himself and his children. He was waiting for his application for disability benefits to be approved. The caller was referred to five subsidized housing listings, to IHSS for in-home support services, and to Second Chance, Inc. for emergency shelter space. ~ A Dublin resident called for information for Community Resources for Independent Living (CRIL) and furniture for her 87-year-old mother. 2-1-1 provided the caller with information on CRIL’s benefits assistance and housing assistance programs, as well as with a referral to the Society of St. Vincent De Paul for its Emergency Assistance and Referral Program for furniture. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? 2-1-1 Alameda County Bilingual PRS speak Spanish, Cantonese, Mandarin, Vietnamese, Hindi and Farsi. Callers have access to 2-1-1 services in over 150 languages via Eden I&R's contractual arrangement with LionBridge to provide interpretation services. Eden I&R has a culturally and linguistically diverse staff: 34% Asian or Pacific Islander, 25% Hispanic or Latino, 20% African American and 3% Native American. In-service trainings provide staff development opportunities that inform staff about cross-cultural issues, including crisis support, homelessness, mental health and health services. In addition, daily over-the-phone and in-person interactions with peers and clients from varying backgrounds reinforce Eden I&R's ability to provide culturally effective and relevant services to diverse populations. For reporting purposes only, part of the call assessment includes asking callers to state their ethnicity, age, income sources, and other demographic information. When requested or identified that a caller would prefer to be connected to services offered in a language other than English, 2-1-1 staff will seek to fulfill this request and search for resources that offer services in the caller's preferred 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 will 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 Dublin residents and employees about 2-1-1 as a critical and free service. These include: speaking to staff from different agencies at cultural, health, senior, and disability resource fairs; posting and making 2-1-1 materials available to Dublin 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 article about 2-1-1 on their website and/or in their newsletter). Staff promote 2-1-1 at fairs and events to serve English speaking and non-English speaking attendees by providing 2-1-1 flyers 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 vital service to Alameda County has been possible because of mutual and longstanding partnerships with approximately 2,900 programs and services, and over 1,100 agencies that make up the service providers listed in Eden I&R's Health and Human Services database. In addition to these relationships, Eden I&R works directly with a number of organizations and is involved in many partnerships, locally, regionally, and state-wide. For example, Eden I&R is one of five Bay Area 2-1-1 programs partnering to develop mutual support systems and data-sharing agreements. The agency is an active member/participant of emergency preparedness and response collaborations with the Alameda County Office of Emergency Services and the Public Health Department, 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 Workforce Development Board, Probation Department, and Housing and Community Development, among many others. As new opportunities arise to collaborate with new or existing partners, Eden I&R seeks to make an introduction and provide staff to attend collaborative meetings throughout Alameda County. 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 media, 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 from the first half of FY 17 include: participation in the 2016 Re-Entry Expo at Santa Rita Jail, Statewide Medical Health Tabletop Exercise, Dublin Senior Center's Community Resource Fair, and distribution of materials to Tri-Valley One Stop Career Center and Tri-Valley YMCA. The Deputy Director currently serves as Treasurer of Alameda County Emergency Managers Association (EMA) and provided updates and outreach about 2-1-1 to attendees at the monthly meetings. In addition, leadership and support staff participated in the 2016 Yellow Command emergency response training, hosted by the Office of Emergency Services in Dublin. 19. 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 missed work for vulnerable Dublin residents seeking needed services; - Provision of access to accurate and appropriate human services 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; - Reduction of city, county and other agency staff being inundated with callers seeking services that 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 English 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 Dublin for less than 1% of the total 2-1-1 costs provides the City of Dublin with a $2 million communication system. 20. 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 public/private 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) making up a percentage 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 the 2-1-1 communication system depends upon the funding commitment of all cities, the County, and private sector funders. Without, the entire funding plan could unravel or the agency could suffer adverse consequences, including a reduction of staff, services, or outreach. No or reduced funding would result in fewer individuals and families receiving critical health, housing and human services information and referrals. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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 services 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 during a disaster response and is a member of various disaster response planning groups such as the Alameda County Emergency Managers' Association and serves during an activation of the Alameda County Emergency Operations Center in the Public Information Officer section. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only 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. ✔✔✔✔ 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 gfedc 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 gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 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 all of Alameda County - including Dublin - means that the service will continue to seek and secure 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 ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed Alameda County Cities $ 365,000.00 $ 0.00 Alameda County Dept. Agencies $ 1,237,101.00 $ 10,000.00 Corporations and Foundations $ 419,865.00 $ 9,000.00 Individual Contributions $ 10,000.00 $ 0.00 Total $ 2,031,966.00 $ 19,000.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries and Wages $ 1,382,721.00 $ 14,150.00 Taxes and Benefits $ 304,024.00 $ 2,000.00 Consulting/Contractual $ 56,652.00 $ 0.00 Mileage $ 10,179.00 $ 100.00 Insurance $ 12,748.00 $ 0.00 Bldg Lease and Maint. $ 83,980.00 $ 2,050.00 Utilities $ 17,813.00 $ 0.00 Telephone $ 29,541.00 $ 350.00 Advocacy and Outreach $ 25,551.00 $ 127.00 Equipment and Supplies $ 68,922.00 $ 100.00 Postage $ 6,743.00 $ 50.00 Printing $ 8,442.00 $ 73.00 Conferences and Training $ 4,673.00 $ 0.00 Dues, Fees and Other Charges $ 19,977.00 $ 0.00 Total $ 2,031,966.00 $ 19,000.00 Budget Narrative The 2-1-1 Alameda County Communication System is Eden I&R's largest program. Given that 2-1-1 is a 24/7/365 program, approximately 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. Commitments for public funding in FY2018 will occur in Spring 2017, while private corporation and foundation funding commitments will occur throughout the fiscal year. Application ID: 71054 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Eden I&R 2-1-1 Program Expense Form Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Eden I&R Financial Information Form List of Board of Directors (or governing body) with contact information ✔✔✔✔ Eden I&R Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Eden I&R Approved FY 17 Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Eden I&R Tax Form 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Designated Official letter Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board authorization letter Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Eden I&R Proof of Liability Insurance 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 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 STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ Eden I&R Federal Tax ID Number Eden I&R State Tax ID Number 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 the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements ✔✔✔✔ Eden I&R FY16 Certified Financial Audit Supporting Documents (Not Required) Eden I&R City of Dublin Business License Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline CityServe of the TriValley CityServe of the Tri-Valley $ 15,000.00 Requested Submitted: 1/8/2017 7:42:16 PM (Pacific) Project Contact Gloria Gregory info@cityservetrivalley.org Tel: 925-452-8276 Additional Contacts info@cityservetrivalley.org, carolyn@cityservetrivalley.org CityServe of the TriValley 11501 Dublin Blvd. Suite 200 Dublin, CA 94568 Executive Director Gloria Gregory gloria@cityservetrivalley.org Telephone925-452-8276 Fax 925-574-2996 Web www.cityservetrivalley.org Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Our mission:to provide solutions to human service needs in the Tri-Valley, especially Dublin, Livermore & Pleasanton;we provide direct assistance & facilitate collaboration between the faith community, non-profits,schools,businesses, government agencies 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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.). CityServe is governed by a diverse seven 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, government and church leadership roles. Our organization's management, programs, and projects are led by Executive Director, Gloria Gregory, who holds a Bachelor's degree in Secondary Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None Education, and is a 32 year Tri-Valley resident with 33 years of professional business experience. Our monthly financial statements and tax returns are prepared by Jill Dykes, owner of Equitable Tax Services in Livermore for over 25 years. She has extensive experience in preparing non-profit financial statements and income tax returns and holds a degree in Business Economics. Jill also provides financial management and budget advice to the Executive Director & Board of Directors. Over the last 4 years we have built a core volunteer administrative/case management team of 7 individuals. These individuals have demonstrated their commitment and ability to staff our office and execute operations. We employ a part-time office administrator for consistent office management. We employ a part-time Spanish interpreter/case manager to serve our sizable Hispanic clientele property. Our office is located in Dublin in the 580 Executive Center office building. Our space allows us to conduct business and admin tasks as well as meet with clients while protecting their privacy. We also have all needed information technology resource, including internet/telephone and a fully functioning website. We employ contract services located in the Tri-Valley to support our technical and website operations at discounted rates in consideration or our non-profit status and the Tri-Valley services we provide. We have a volunteer who manages our social media 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. We seek funding in order to maintain our operations as well as provide funds to continue programs & meet unmet Dublin resident needs, such as payment of motel lodging for Dublin homeless, help with rent, utility bill payments, transfer of donated autos 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 direct help to 200+ Dublin residents & indirect service to another 500+ residents through use of our Tri-Valley Food Resource guide, Thanksgiving Meal & December Outreach guides & resource info in our monthly newsletters & on our website. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. Our work will be structured around 4 on-going primary efforts 1) CityServe's Network for Emergency Shelter, which we believe has established us as a primary resource to which Tri-Valley homeless are referred.We complete a thorough intake form with the referred homeless client/family (most are single mothers with children) & if appropriate provide a minimum of 2-3 nights motel for them as we help them connect with local shelters, resources. We provided over 200 such nights to families in 2016. If additional motel nights are needed, we network with other organizations, primarily CityServe Member Churches to partner in paying for those nights & other legitimate financial needs. 2) CityServe's Network for Community Collaboration; this effort will continue as we plan/facilitate bi-monthly Cityserve Community Meetings. We birthed these meetings 4 years ago to enhance communication/education between non-profits, churches, city agencies, school staff with the goal of increased collaboration & effectiveness. The effectiveness of these meetings is proven. We also facilitate collaboration thru our monthly newsletter & community presence as a hub for resources & information 3) CityServe's Network for Student/School District Support-we will continue to work w/each Tri-Valley School District to be the solution to student unmet needs. Example: the Valley High counselor advised of a student in need of glasses; we met him at Walmart for the exam & purchased the glasses for him. Other needs have been motel nights for school families, help with food, family furniture needs. 4) We will expand CityServe's Network for Homeless Prevention. On a monthly basis we contact below market property mgrs. in the Tri-Valley to learn of available apts.; we advise clients of openings. We will now work with resident mgrs. to help residents in danger of eviction & offer our assistance. Our relationship with these mgrs. is already established.We will offer on-site programs re:parenting & budgeting. 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. $5,000 of the funds will specifically be used to provide financial help to Dublin residents, who have proven legitimate, urgent need to us in situations such as to avoid eviction by paying a reasonable portion of rent direct to a landlord (and, if needed, contacting a community partner to participate in paying any portion larger than we can provide). Other examples of urgent need would be payment of emergency motel lodging costs for Dublin homeless, delinquent utility bills to ensure continuance of service, needed gasoline or bus passes/ BART tickets for transportation to work or necessary appointments, payment of auto registration fees to provide or restore transportation or to accomplish transfer of a vehicle we have secured for a client via donation, payment of a portion or all, if reasonable, of dental or vision costs. $2,000 of the funds will be used toward payment of rent for our Dublin office location. $855 of the funds will be used toward the $4500 annual cost of IT Support. $7145 will be used toward the cost of wages and salaries for the Office Administrator and Executive Director ✔✔✔✔ Behavioral Health (mental health and substance abuse) ✔✔✔✔ Affordable Housing ✔✔✔✔ Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness ✔✔✔✔ Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse ✔✔✔✔ Disabilities ✔✔✔✔ Food and Nutrition ✔✔✔✔ Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity ✔✔✔✔ Financial Assistance gfedc None of the above 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 meeting the outcome(s)? We will continue to track the outcome measures of our efforts through the monthly recap of the Human Services Intake forms we complete detailing each client's data & needs & how we helped meet those needs through direct service & collaboration with other serving organizations. Our Core Team & Board review those recaps monthly to evaluate the effectiveness of our work as well as identify issues we can help address to improve human services work in the Tri-Valley. We will work to be sure we are serving the homeless & other most in need residents in each of the Dublin, Livermore & Pleasanton communities. As we record the results of our efforts in providing an automobile donated through CityServe to a resident in need of transportation or a family moving into below market housing that we have coached through that process, we see another successful outcome measurement. We also measure our monthly productivity by compiling a monthly report of each call to our office regarding volunteer needs & furniture/household item donations available or needed & how we matched the volunteer requests or the donation. Another outcome measure crucial to our success is continued good attendance and participation by representatives of our communities' non-profit, school, government, church and business sectors in our bi-monthly CityServe Community Meetings and clear, effective collaborative results of those meetings. Continued community organization requests to be included in those meetings and requests to be on the agenda will be favorable measures of success. Another measure of our success will be the continued reporting of volunteer hours we have facilitated in our communities through requests for volunteers to our office from local human services non-profits as well as calls to our office from community individuals and groups seeking volunteer opportunities. Year to date as of 11/30/16 we have had 30,620 volunteer hours reported to our office as facilitated through our efforts. 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. As in the past, we will continue to serve primarily low-income individuals and families. Our 2016 Intake forms YTD through November, 2016 document that 85% of those we serve are in the Extremely Low Income group. Another 12% are in the Very Low Income group. We will continue to work directly with the resident services managers at the Dublin below market housing locations to ensure we are serving those communities well. We receive calls/emails from residents services managers at those locations regularly to request help for residents, and we provide help. Our Human Services Intake Form recap YTD through November 2016 also documents that 8% of those we served were disabled, 35% female head of households, 15% seniors, 11% youth, and 31% homeless. We will continue to serve those populations with these funds. We serve the youth in Dublin at Valley High through our partnership with the principal and counselor; we produce a monthly Youth Newsletter, originally created to specifically for Valley High students at the counselor's request to help them be aware of & connect to appropriate community volunteer opportunities. We have provided speakers to Valley High classes with significant messages for the students. We will continue to make the Valley High students as well as other Dublin youth a focus of our work. We also established the Camp Parks New Military Resident family Welcome Program, which includes our assembling and delivering a Welcome Bag to new families moving to the base. 2017 will be the fourth year we have continued this program. The Welcome Bags include a map of Dublin and the Dublin Parks & Rec guide as well as a number of other community-connecting items for the families. As noted above a significant portion of the funds will be used to directly financially assist Dublin residents in need of help with rent to avoid eviction, etc. We will also continue to serve FCI Dublin's specific requests for help eg. with clothing items for inmates being released. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? Our project is culturally appropriate because we do not discriminate in any way toward 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 part-time Spanish-speaking contract employee to enable us to communicate with Hispanic families. We seek to know of resources to help us communicate with other non English speaking clients. We responded quickly to a request from a Wexford Way resident from Afghanistan whose refugee brother and family moved to Dublin in May, 2016. His sister called our office requesting we meet with the family, and we did so immediately with her translating for us. We provided our Tri-Valley Food Resource Guide and the Tri-Valley Affordable Housing Guide to the family and offered to be of help in any other ways needed in the future. 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 facilitated providing beds, dressers, refrigerators, strollers, microwaves, towels, bedding, and more to families with nothing moving into below market housing from a homeless situation. We have contacted Mancini Sleep World and explained needy family situations and requested donated beds, frames and delivery and received those successfully at times and at other times have received a discount so that we paid for the needed bed and frame. Our focus is to fully and sensitively understand each need and use our resources or network of resources to do our best to provide what is 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 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 (such as CRILL). We have a part-time contract employee/case worker who speaks Spanish to enable us to serve that population effectively. As mentioned in an earlier answer, we have worked hard to establish relationships with the below market housing resident services managers at Dublin below market communities. This has resulted in our having the opportunity for outreach to those low-income Dublin residents, including the senior housing communities. We will continue to collaborate with the Dublin Unified School District to participate in their outreach to the below market communities in Dublin; we have done this the last 3 years. Each fall the Dublin School District sponsors an outreach event at Wexford Way and Oak Grove below market family locations; each year we participate and provide much resource material to residents as well as establish relationships with the residents and families so that we have the opportunity to help them when needed. The residents call our office when help is needed. We also responded to the Camilla Place resident manager's invitation in June 2016 to participate in a Resource Fair she organized for her residents on a Saturday morning. As a result of our presence there, we received a request from a resident to help her with her monthly rent in July; her partner had moved out abruptly and she could not pay the rent for she and her 4 children. We received her request on Saturday mooring and met with her the following Tuesday, the date the rent had to be paid, and provided the $400 by check to the property manager she needed to pay the rent. We will continue to respond in this way. If a client is disabled, we go to them if needed rather than require they come to our office. We often meet our clients at their location. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We play a creative, direct role in increasing communication & collaboration between non-profits, school staff, churches, & city agencies..We partner with: Abode Services-homeless program Alameda County Foster Parent Association-foster family support Axis Community Health-serve low income, no income medical & behavioral health needs Children's Emergency Food Bank-food resources for Dublin & Pleasanton residents City of Dublin City of Livermore City of Pleasanton Dublin School Dist.-we collaborate with the district Community Liaison, school principals & counselors to serve students & their families Camp Parks-we serve military families there; we connected them to serving opportunities (like Dublin Pride Volunteer Day). We deliver Welcome Bags to new military families as noted earlier. Easter Seals Kaleidoscope Developmentally Disabled After School Program- for 8 years we have provided consistent volunteers & services Echo Housing-landlord/tenant disputes, homeless related services FCI Dublin-we help w/volunteer needs & reentry needs/mock job interviews La Familia-Counseling, mental health, youth Hope Hospice-end of life counseling & medical services Literary Programs-Dublin, Pleasanton, Livermore libraries Lincoln Child Center & Kinship Services-kinship & foster families Livermore Homeless Refuge-shelter for homeless Livermore School Dist. Open Heart Kitchen-providing food & community for low income residents Partners for Change-teach life skills, ending cycle of poverty Pleasanton School Dist. Senior centers in Dublin, Pleasanton, Livermore -senior services Senior Support Program of the Tri-Valley-senior services Shepherd's Gate & Tri-Valley Haven-programs for limited resource working single mothers & for victims of domestic violence, addiction Tri-Valley Haven-shelter for victims of domestic violence, restraining orders Tri-Valley One Stop Career Center-job search Tri-Valley YMCA-serving families Over 25 Tri-Valley churches 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 & 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. 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-Valley. We consistently participate in Dublin Chamber Expo & Dublin Health Fair. We are members of the Dublin Chamber of Commerce. We actively partner with the principal and counselor and teachers at Dublin's continuation school, Valley High, to meet the needs of the students and their families and have done so for the last 3 years. We participated in the Alameda County "All In" Listening Session Program in December and we chose to facilitate a Listening Group at Wexford Way, a Dublin below market family apartment community, to provide the county with feedback on the residents' perspective of the adequacy of services they feel are available to them. As noted in another answer we participate in any opportunity to present our services to Dublin residents, such as the Camilla Place Resource Fair. 19. 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 operation of our office & operations located in Dublin and basic costs to ensure the sustainability of our work. The Community Care budget is based on actual direct financial expenditures made in 2016 for needs clients could not find met by another organization. Funds invested to meet those needs were carefully evaluated & 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 (motel nights, rent payment to avoid eviction, delinquent utilities, car registration, tires, or restoration of cell phone service). We leverage the Community Care funds buy using them to meet the most urgent need of our client while we network with other sources of help for them. We continue to encourage and provide resource information to clients over a long term period when needed. We are still in contact with one of our first clients, a 58 year old woman living in her inoperable car in the Safeway parking lot on Dublin Blvd. That has been a 6 year relationship. It took 4 1/2 years for her to achieve consistent employment that now supports her apartment rental and living expenses. Thru collaboration we secured a donated car for her, paid motel nights at times, found a room for her to rent in Dublin, connected her to Job Link, the St. Raymond job search support group, which proved very helpful to her, & provided the encouragement she needed to move forward. We are committed to being such a presence in Dublin. Please see the HS (Human Services) Intake/Financial Summary, December 12, 2016, which has been uploaded with this application. It provides graphics on facts of our services in Dublin regarding referrals by month, referral sources, categories served and more. Our budget is a very reasonable investment to achieve this level of service to Dublin & Tri-Valley residents 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? 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 questions 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. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? gfedc Yes ✔✔✔✔ No 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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. Our work directly compliments the City of Dublin's mission to "promote and support a high quality of life which ensures a safe & secure environment that fosters new opportunities". Our programs: CityServe's Network for Emergency Shelter, CityServe's Network for Community Collaboration, CityServe's Network for Student/ School District Support, & CityServe's Homeless Prevention Program are all designed to create a higher quallity of life for Dublin residents. They significantly contribute to an increasingly safe & secure environment that will foster new opportunities for Dublin residents with the least opportunities. CityServe's existence is rooted in a goal of increasing community and improving the quality of life of residents in Dublin. Our collaboration with the school district programs, as already mentioned, promotes events that bring people of all ages together at Wexford Way, Carlow Court and Oak Grove. We publish & deliver our Youth Newsletter to the students at Valley High. Dublin residents continue to be served 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. We established that effort as part of Dublin Pride Week 4 years ago. Our Executive Director has participated in the Dublin Pride Week Committee each year since 2008 to help plan an organize activities for Dublin Pride Volunteer Day & for the week. In 2016 we were pleased our idea to include a Volunteer Fair as part of the event happened. We organized over 10 other non-profits to participate and provide year round volunteer opportunities. We help Dublin residents desiring to serve others find ways to do that continually on our website and via our newsletter. 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 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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 gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. ✔✔✔✔ 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 gfedc 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 gfedc 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 gfedc 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 gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 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 continue to grow our sources of funding. In 2016 donations from individual and business contributions increased significantly. In 2017 we will be using social media to more effectively tell the story of the important role we are playing in the Tri-Valey of giving practical, direct help to the homeless and providing them with the attention and connection to resources needed. This will result in more awareness of the value of our work, and we believe it will enhance the funding we will receive from private and corporate grant sources. We will be making a more concerted and consistent effort to attract funding from those sources in 2017. 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????? ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed City of Dublin Grant $ 15,000.00 City of Pleasanton Grant $ 15,000.00 City of Livermore Grant $ 10,000.00 Member Church Donations $ 36,000.00 $ 32,000.00 Individual, Business Contributions $ 36,500.00 $ 27,400.00 Private & Corporate Grants $ 28,000.00 Total $ 140,500.00 $ 59,400.00 Funding Uses/Expenses Budget Amount Amount Committed Community Care(client assistance) $ 37,850.00 IT & Web Support $ 4,500.00 Spanish Translator/Case Worker-Contract $ 6,000.00 Chamber of Commerce Dues $ 750.00 Equipment expense $ 1,000.00 Insurance (Workers Comp & Liability) $ 2,001.00 Meeting Supplies & Program Materials $ 2,200.00 Mileage reimbursement $ 900.00 Rent $ 12,000.00 Office Supplies & Postage $ 2,750.00 Printing/copying $ 1,000.00 Accounting, auditing services $ 2,000.00 Community Outreach $ 1,200.00 Vally High expenditures $ 500.00 Taxes & Licenses $ 250.00 Office Telephone $ 588.00 Wages & Salaries-Director $ 24,000.00 Wages & Salaries-Office Administrator $ 15,600.00 Wages & Salaries-Asst.Director/Case Mgr $ 18,000.00 Payroll Taxes $ 5,875.00 Total $ 138,964.00 $ 0.00 Budget Narrative The items & amounts entered above represent very limited expenses to accomplish the work we have been doing and will do per this grant application. The Community Care expense of $37850 represents expenditures that will be made to landlords, the Department of Motor Vehicles, P G & E, motels, and other disbursements for the purpose of helping those in urgent human service needs in the Tri-Valley. We are diligent about documenting the legitimacy of a need before disbursing any funds to resolve a need. The other expenses listed are necessary operational costs to support our organization. The budget includes an additional $4,000 for rent above our current cost. We are budgeting that additional amount to allow increasing our office space to accommodate the addition of the Asst. Director/Case Manager position to our staff. If, for some reason, we are unable to secure funding to cover this proposed budget, those two items would be the first to be cut (they will not be implemented until we secure a commitment to fund those items). As noted in the application, we are confident the $28,000 in the proposed budget income will be secured since we will be focused on applying for several private and corporate grants early in 2017 that we have reason to believe will be very favorable to our request for funding. We simply have not made application to those sources yet. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ ProgramExpense Financial Information Form for ALL Grant Requests download template ✔✔✔✔ FinancialInfo List of Board of Directors (or governing body) with contact information ✔✔✔✔ CityServe Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ CityServe Budget 2017 Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Authorized Official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Authorization to Request Funds Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Proof of Insurance Workers Comp Application ID: 69605 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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 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 STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ 501c3 State Non-Profit 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 the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements ✔✔✔✔ Explanation of Certified Financials CityServe Financial 10-16 Supporting Documents (Not Required) City of Dublin Cert of Appreciation Food Pantry Grid Holiday Grid Thanskgvg Grid CityServe Brochure January Newsletter Dublin Stats Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Sunflower Hill Sunflower Hill Garden Teachers / Educators $ 20,120.00 Requested Submitted: 1/8/2017 8:26:50 PM (Pacific) Project Contact Kathy Layman Kathyl@sunflowerhill.org Tel: (925) 963-9675 Additional Contacts lynn@sunflowerhill.org Sunflower Hill P.O. Box 11436 Pleasanton, CA 94588 President, Board of Directors Susan Houghton Susan@sunflowerhill.org Telephone(925) 231-6003 Fax Web www.sunflowerhill.org Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). To improve the lives of developmentally disabled adults via two focus areas: development of two residential communities, and programs with our first being SFH Gardens which provides educational/vocational horticulture training via hands-on classes. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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. Sunflower Hill received grant funding from the following City/County sources during the past three years: - $500,000 from Alameda County Board of Supervisors in 2016, towards development of our Developmentally Disabled residential communities (committed funds but check not yet received) - $5,000 from Alameda County Board of Supervisors in 2016, towards the Sunflower Hill Gardens at Hagemann Ranch in Livermore 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.). Sunflower Hill (SFH) launched the Sunflower Hill Gardens at Hagemann Ranch in April 2015 and has successfully operated the Garden since that time, using it to provide educational and vocational horticultural experience to many special needs individuals from Tri-Valley school classes, an adult day Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project ✔✔✔✔ Yes gfedc No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None program and a special needs internship program. These classes are currently conducted without formal teachers or educators through the use of a small team of dedicated volunteers, which includes 3 Sunflower Hill board members, five special needs interns and classroom assistants plus master gardeners and a part-time paid professional farmer. The hiring of 2 part-time certified educators will enable us to expand our existing horticulture class list with additional schools, classrooms and local programs, as well as to develop a horticulture curriculum for the various educational levels that attend the garden classes. The Teachers / Educators will be responsible for leading the education program with the continued support of our existing volunteer Garden leadership team. The Teachers will also be responsible for adapting classes to ensure the effectiveness of the learning experience for the different levels of the special needs students. Additionally, these teachers are necessary to ensure that classes are held and not cancelled due to lack of volunteer staff availability. 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. Sunflower Hill Gardens was developed to provide educational and horticulture opportunities to special needs individuals. We would like to expand our classes to additional schools and programs, adding improvements with a more formal educational curriculum. 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.) Estimate 80 unduplicated Dublin residents will be served by this program with the addition of the part-time teachers and expanded class groups. Additionally SFH Gardens donates produce to local food banks to help feed low income Tri-Valley residents. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. The SFH Gardens is led by the Gardens Director and the classroom program is led by the Garden Special Needs Programs Director. The SFH Gardens teaching position will be posted on local job boards, with the Garden Leadership team reviewing the resumes and interviewing the qualified candidates prior to making a selection to extend offers. Qualified candidates will need to have basic horticulture knowledge, educational/teaching experience as well as experience working with special needs individuals to enable curriculum adaptations for varying capabilities, comprehension levels, communication methods, and personal interaction challenges. One teacher will focus on transition and adult day programs, and the other teacher will focus on high school and younger ages. In July and August 2017, the teachers will work on curriculum development to be ready for the start of the school year plus work two half days in the Garden to get familiar with the Garden, and to work with the summer school classes and adult day program. In the Fall of 2017, we would expand the number of days in the garden from 3 to 5 and the majority of each Teachers' time will be spent in the garden teaching/leading the classes. These individuals will each be employed approximately 20 hours per week during the school year months with fewer hours per week in summer months based on class needs, and they will report to the Garden Director. The teacher will work directly with the Garden Special needs Program Director, who will provide guidance and direction on the programs and course development. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). SFH Gardens currently has eight different special needs classes and adult day programs that are attending on a regular basis. There are three Dublin classes attending the Garden program (Dublin High School Transition Program plus two Dublin High School Special Day Classes). The hiring of the teachers will enable the expansion to additional special needs classes, transition programs and/or adult day programs in Dublin, and across the greater Tri-Valley area. Also with the funding from the grant, the funded teacher hours will be used to develop a full school-year of curriculum at several key levels to support the needs of the various classes/day programs. These levels target comprehension and ability levels for our special day students and adults. Curriculums developed at multiple levels can be adapted to fit to the developmental needs of the special needs individuals in each class. With the newly developed curriculum, the teachers will teach and lead the classes through the Garden lessons and activities. The teachers would be supported by our current volunteer Garden leadership team, volunteer classroom helpers, interns, certified Master Gardeners and our professional farmer. 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 meeting the outcome(s)? gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) ✔✔✔✔ Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse ✔✔✔✔ Disabilities ✔✔✔✔ Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education ✔✔✔✔ Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above One qualitative measure will be the quality of the lessons themselves within the context of an organized and appropriately adaptive curriculum that can be used across all the levels required for the school or organization groups attending the Gardens classes. These lessons and hands-on activities will be used to reinforce the teaching of the horticulture concepts. In addition, the Garden teachers will work with classroom teachers to integrate garden lessons into classroom lesson plans. A second qualitative outcome measure will be a Garden assessment questionnaire that will be sent to all attending students and teachers. Quantitative measures that we will be tracking are: - Number of special needs horticulture classes/programs conducted in the garden per week and month - Number of unique individuals attending classes in the garden - Number of special needs individuals who successfully complete the curriculum, including all quizzes and tests - Number of hours served in the Garden - Number of individual visits to the Garden These measures can be compared from year to year to track progress and improvements to our program and garden operations. 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 Garden educational / vocational horticulture classes are targeted to special needs individuals from the local schools, local area transition classes (transition programs are for individuals from 18 years old until age 22) and adult day programs in the local area. Additionally the Garden also operates an Internship program for high functioning special needs individuals with the goal to have the Interns eventually running many of the day to day garden operations and participating in assisting with the horticulture classes and activities. The produce harvested at the garden based on the work performed by the classes, volunteers, and Garden leadership team is donated to local food banks and kitchens along with donations to organizations that provide food to low income families and individuals. Last year, the Garden harvested over 9,500 lbs. of food. 70% of our harvest was donated to local food banks, totaling over ~6700 lbs. of produce. These numbers will continue to grow through the expansion of our program and horticulture classes. One of our current classroom teachers from one of the high school transition programs gave us this quote about our program: "Sunflower Hill Garden provides valuable learning experiences for my students through hands-on activities and projects that build greater understanding and appreciation for agriculture, science, and nutrition. The students look forward to Fridays at Sunflower Hill because they connect with the staff members and each task they do. They are proud of the work they do and look forward to discovering each new learning opportunities that are in store for them." 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? SFH Gardens is located on the historic Hagemann Ranch, owned by the City of Livermore owns which requires the SFH Garden to service low income and disadvantaged individuals and families in the community. In the US population, 1 in 68 children are diagnosed with Autism and this number is trending upward. 1 in 5 adults and 1 in 6 children in the US have one or more disabilities. These populations are culturally important to our communities but represent overlooked population groups in terms of services, living opportunities, job choices, etc. It is important for cities to solicit and implement program that can address these populations and their specific needs in the communities. The SFH Gardens program was created to provide vocational and educational horticultural opportunities for special needs individuals, many of which are low income and disadvantaged. The program has objectives in three areas: 1) Development of knowledge and skills leading to vocational opportunities in the horticulture field 2) Development of other capabilities consistent with the objectives of the Special Education Post-Secondary Transition (PST) programs providing opportunity for development in the areas of critical thinking and decision-making, social skills, communication and independence skills 3) Improvements in the quality of life though developing healthy eating, physical exercise, enjoyment of gardening and the outdoors, and accomplishing productive work The hiring of the teachers will help to further enable the execution of the above SFH Garden objectives. 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? SFH Gardens currently has eight different special needs classes and adult day programs that are attending on a regular basis, initially started via contacts with school districts, transition programs and adult day programs in the area. These classes enable outreach to parents, guardians, conservators and teachers across the Tri-Valley area who communicate with others in the special needs community about the garden classes, the food donations to local kitchens and low income families, and the residential communities under development. We plan outreach to the school districts and special needs programs (Dublin, Pleasanton and Livermore) to solicit additional classrooms and programs to participate in our horticulture program. Outreach to the general population in the area occurs through the food pantries where we donate produce, conversations in the garden with volunteers, fliers distributed with classes and SFH garden or community events, fundraisers, family work days, Facebook, Twitter and our monthly newsletter. Family work days occur 4 - 6 times per year where special needs families, friends and local community members come to the garden to volunteer or participate in SFH events (spring planting, pumpkin festival, winter celebration, etc.) which is another source of outreach that identifies new groups for our classes or new low income donation sites for our produce. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Based on agreements with the City of Livermore, Sunflower Hill is required to donate at least 51% of the produce harvested each year to local food banks and kitchens for use in the kitchens and for distribution to local low-income families and individuals. For the past two years, SFH Garden has donate 70% or more of produce harvested. Many community service organizations and special needs families have volunteered work hours in the Garden, working towards their community service goals for their school or community /charity organizations. The following organizations partner with Sunflower Hill Gardens to meet these goals. Providing meals via kitchens and shelters: - Open Heart Kitchen - Tri-Valley Haven - Carmen Avenue Apartments - Shepherd's Gate - Marilyn Avenue School - St. Vincent de Paul @ St. Raymond's Catholic Church Community Service participation and volunteer services: - Livermore Valley Rotary - Rotary Club of Livermore - Pleasanton North Rotary - Pleasanton Downtown Rotary - Pleasanton Boys Team Charity - Pleasanton Girls National Charity League - Local Boy Scout troops - Eagle Scout Projects - Community Church programs and missions Corporate Community Support - Sandia National Laboratories - Salesforce 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 consists of partnering with the following local community partners: Whole Foods (Dublin - in 2015) Savers (Dublin - will be partnering with them in 2017 - date not set yet) Transition and adult programs in Danville, Dublin, Pleasanton and Livermore to participate in horticulture classes New Leaf Community Market (Pleasanton) Inklings Coffee & Tea (Pleasanton) Livermore & Pleasanton Rotaries Food kitchens and pantries in Dublin, Pleasanton and Livermore for donated produce CRIL - Tri-Valley Community Resources for Independent Living Chamber events/mixers, TVNPA (Tri-Valley Nonprofit Alliance) events (we are also a member), Rotary meetings, Pleasanton/Livermore street fairs, Leadership Pleasanton & Livermore classes, Make a Difference Festival SFH Garden Family Days (families with special needs individuals volunteer at the Garden and participate in seasonal events and celebrating key garden activities like spring planting, summer harvesting, etc.) Our marketing consists of the following channels: Facebook - over 1,000 likes with a consistent post reach of 800 to over 2,000 (organically and paid post reach) Monthly Newsletter going out to over 950 contacts with a high open rate SFH Website defining up-to-date information about our Resident development projects, Garden activities and volunteer opportunities, SFH Fundraising events, community events and meetings, grant awards, plus pictures and videos of SHF Gardens volunteers and classes. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The program budget for the teachers is estimated at 35 hours per week spread across 2 part-time teachers so that we can use the hours for development of the curriculums to be taught in the classes at the appropriate levels for the individuals in each classe but also to take advantage of using the hours based on classroom schedules each week and school holidays. In the summer months, the class schedule will be lighter so the hours during those months will be less, built around summer school schedules and sessions. Summer hours will be used initially to create the formal curriculums at various levels, preparing the necessary materials so that the class sessions can be efficiently focused on teaching the concepts and performing the hands-on activities. The rate for the part-time teachers is estimated to be around $35/hr which is reasonable for the skillset we need: teacher certification, basic knowledge of gardening, experience with special needs students and adults and their unique set of abilities, challenges and educational objectives. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If Sunflower Hill does not receive funding from the City of Dublin, the existing horticulture education and vocation program will continue using the existing volunteer team but we will not be able to create the formal multi-level curriculums that enable us to teach at all skills and comprehension levels nor expand the class sessions to reach additional special needs students and adults beyond the current set of classes. If SFH receives reduced funding, we would endeavor to hire one part-time teacher or reduce the hours for the two part-time teachers which would reduce the number of additional classes to be added and/or reduce the curriculum development that could be done for the multiple levels of lessons required for the special needs students. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? gfedc Yes 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) 29. Referring to questions 27 and 28 please 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. Sunflower Hill's mission is to improve the lives of developmentally disabled individuals which involves a diverse population that is often overlooked in terms of their needs, development and their opportunities for work as adults. Our Garden Teaching program addresses this population with the Garden classes and internships which provide new educational and vocational opportunities but also reinforces many of their special education goals for socialization, decision making, independent thinking and communication. The Garden provides a safe and secure environment for this learning to occur, along side classmates, friends and families. This Garden Teaching program supports the Dublin mission to promote a quality of life that fosters new opportunities and sustaining economically balanced and diverse communities. Our Garden provides opportunities for the special needs, diverse population to learn and be physically active in growing and harvesting produce that benefits low income families. The Garden also provides opportunities for reinforcing life skills training that is important for this diverse population to participate in the Dublin community. It also provides them with meaningful work that enhances their self-esteem and build strong work habits. The Garden also supports the Dublin Values of bringing people together - to volunteer and work in the Garden to produce food for kitchens and needy families at the historical Hagemann Ranch site in Livermore. The Garden attracts many community service organizations that collaborate with us and greatly enhance the Garden experience and capabilities through their support with projects (shed, tables for classes, greenhouse, etc.) and donations of materials while enabling them to fulfill their community service goal. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) ✔✔✔✔ 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. ✔✔✔✔ 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 gfedc 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 gfedc 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 gfedc 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 gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 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). Sunflower Hill has had success with our fundraising events during 2016 and have identified additional events that we want to host for the coming year. Additionally we have increased our grant writing this year and identified new corporate, foundation, and private grants that we will be applying for in 2017. As we continue to grow with our Garden mission, we identify new and changing needs for how we can enable our mission to improve the lives of developmentally disabled adults. Currently in the Garden, we also sell our produce (beyond the required percentage of the food donated to kitchens and low income families) to the local community as well which generates income for the Garden operations. Due to constraints in our HUD grant, we are not allowed to increase our percentage available to sell to the local community (thereby increasing our income from direct sales). Lastly we are also working to establish corporate sponsorships for our Garden programs. gfedc 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. ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. 46. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL110708 Budget Funding Sources/Revenues Budget Amount Amount Committed City of Dublin Grant $ 20,120.00 $ 0.00 City of Pleasaton Grant $ 20,230.00 $ 0.00 City of Livermore Grant $ 20,230.00 $ 0.00 Total $ 60,580.00 $ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Part-time Teacher salary/Benefits - 100% $ 31,640.00 $ 0.00 Part-time Teacher salary/benefits - 100% $ 23,940.00 $ 0.00 Curriculum Supplies for classes and lessons $ 5,000.00 $ 0.00 $4000 Total $ 60,580.00 $ 0.00 Budget Narrative The budget includes staff costs to hire 2 part-time teachers (35 hours per week split between 2 teachers at $35/hr rate) to develop curriculum to teach and train on horticultural concepts using the Garden to supplement hands-on activities and observations. This program is also vocational training for some individuals leading to garden internship or part-time work for our developmentally disabled population. Additionally the budget includes a funding line item for curriculum supplies that will be used to teach the class curriculum: - Printer and paper to print class materials and certificate awards - Additional garden tools, gloves, mudboots to support additional and simultaneous classes - Garden equipment to enable students with mobility challenges to participate (i.e. garden seats/kneelers, etc.) - Teaching concept tools - weather stations, soil test kits, butterfly kits, ladybug kits, microscope, etc. The day to day operations of the SFH Garden is funded via fundraising events, grants and public/private donations and provides the environment to enable the educational and vocational training for the special needs school classes, transition programs and adult day programs. We would like to continue to build on our success this past year and expand our reach to more special needs individuals. Having funding to hire part-time teachers that can be devoted to curriculum development and teaching classes allows us to do this and meet our mission goal. The total program budget requested is split between the three city grants since we currently have attendance from schools and programs in each of the three cities plus the food donations provide food and meals to low income families across the Tri-Valley areas. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Sunflower Hill - Program Expense Form Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Sunflower Hill - Financial Information Form List of Board of Directors (or governing body) with contact information ✔✔✔✔ SFH Board of Directors List Current Annual Budget for the Entire Agency ✔✔✔✔ Sunflower Hill Profit & Loss Statement Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Sunflower Hill_990 IRS Tax Form_2017 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board of Directors_Articles of Incorporation_Sunflower Hill Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board of Directors Authorization to Request Funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Workman's Comp and Liability Insurance Workman's Comp and Liability Insurance Information 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 AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS Application ID: 69675 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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 STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ Non-Profit Determination Letter_Sunflower Hill 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 the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements ✔✔✔✔ Sunflower Hill - 990 Tax Form_2015 Supporting Documents (Not Required) Dublin High School Class Visit to the Garden Class Visit to the Garden Sharing at the end of a class visit Sunflower Hill Produce Harvested Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin Parks and Community Services Department 2017-2018 Human Services Grant Program 1/8/2017 deadline Valley Children's Museum Valley Children's Museum (VCM) Children's Programs $ 25,000.00 Requested Submitted: 1/8/2017 11:26:45 PM (Pacific) Project Contact Corinna Calica cdcalica@outlook.com Tel: 707-704-8079 Additional Contacts dawn.benson@comcast.net Valley Children's Museum P. O. Box 2101 Dublin, CA 94568 Executive Director/Administration Marion Thatch mthatch54@gmail.com Telephone510-910-2509 Fax Web www.valleychildrensmuseum.org Application Questions 1. Please describe your organization category (select one of the following): 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Hands-on-learning Children's Museum 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Please indicate below if this application is a request for one-time, "seed," or operational funding. 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.). Valley Children's Museum has a long history of leadership, with a Board of Directors, Advisory Committees and cadre of project volunteers. Since its beginnings, traveling exhibits have been designed, finances managed, studies conducted, fundraising events and outreach undertaken, and website developed, all the while with the goal of building a permanent facility. Collectively, the Board and its Advisory Committees include professional experience in education, accounting and auditing, building and construction, marketing, land management, land development, non-profit management and public service. Finances are audited by the firm Karlsson and Lane. Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. ✔✔✔✔ Private Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None Long-time and new volunteers regularly participate in education and activity development and staffing. Two chapters of the National Charity League provide mother/daughter teams for year-round activity. With a Dublin City grant former Board member Helga Glasson has been engaged as education and activity coordinator. With a committee of educators and volunteers, she has developed a relevant local California Mission Experience field trip, gathered the mailing lists of fourth grade teachers throughout the Tri-Valley, helped create the promotional material and workbook, and oversees supplies, scheduling and staffing the field trips. She also creates and organizes the Farmers Market, Third Saturday and birthday party play session themes and activities. Professional website administrator, Daphne Leonard, with experience managing websites and intranet for large and small businesses, as well as non- profits, is contracted to update the VCM website maintain search engine and social network visibility, and capacity for email communication. Linda Spencer, who has been involved with VCM for ten years first as staff and now as a key volunteer administrator, has 40 years’ experience in non-profit management and fundraising. 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. Hands-on learning activities for youngsters with themes including local history, water, environment, food healthy choices, art, culture and play, as well as fourth grade California Mission studies activities with hands-on components. 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.) 6800 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concern. 11. Explain how this project will be implemented, administered, and operated. Valley Children's Museum has long been a Dublin community activity agency. Valley Children's Museum's children's programs target early childhood through school-age children, ages toddler through 12 years old. Although VCM currently operates in a temporary facility is a 52 ft. x 14 ft. trailer that is outfitted with tables, work stations, and an exhibit on the California Mission era, VCM's children's programs have been the highlight and showcase of VCM's outreach to early childhood education and youth enrichment services. Early childhood development research emphasizes the value of play-based learning through a hands-on approach to stimulate the creative learning capabilities of children – a critical component of long-term learning and success. As VCM implements research-based learning in its program activities offered to young children, brings City of Dublin children to a progressive and innovative way of learning which includes their active involvement. That emphasis, along with the providing a safe learning environment and gathering place for the community, has spurred the growth of the children’s museum phenomenon. Youth enrichment activities will follow a hands-on approach of diverse modalities to curriculum-based learning. The California Mission Experience was originally designed by the Autry History Museum specifically for the state-mandated fourth-grade curriculum and was subsequently updated and vetted by VCM to be utilized by Tri-Valley educators and museum professionals. Ongoing modifications are incorporated as feedback is heard from teachers, such as creating the Mission Experience classroom kit for schools which cannot undertake a field trip. VCM's activities director, manager, and youth volunteers will work in partnership to offer City of Dublin early childhood and youth population cutting- edge resources which may not be readily accessible and available to all Dublin children and youth. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). This grant will provide funds to support operational staffing and materials for Valley Children's Museum's hands-on, play-based and curriculum based education activities at the Museum. Valley Children's Museum's temporary facility is a 52 ft. x 14 ft. trailer that is outfitted with tables, work stations, and an exhibit on the California Mission era. Grant funds will be used to cover portions of the following expenses: 1) provide necessary staffing support to be open each weekend (Saturday and Sunday) of the 2017-2018 year, 2) purchase consumable materials for year-round play-based hands-on activity, 3) contract fee for a part-time Activities Coordinator, 4) contract fee for a part-time website specialist to manage VCM’s web presence and electronic promotion, 5) contract fee for gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services ✔✔✔✔ Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above site manager who opens, closes and maintains the functionality of the museum, printing and postage for promotional mailings. The grant from the City of Dublin is successfully used as a catalyst to encourage other agencies, businesses and service clubs to raise the needed matching funds. Recently, Valley Children's Museum acquired the renowned Imagination Playground modular building blocks to aid with the hands-on and play-based approach to learning. Having the support staffing to utilize the Imagination Playground for City of Dublin residents will be an added feature of attraction for all children, toddler to youth, of diverse abilities. 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 meeting the outcome(s)? Initial goals to be measured will be increasing attendance figures: 100 attendees per evening activity (with the Farmers Market) and 200 attendees per weekend day session (compared to 75 and 100 respectively in 16-17). Related to attendance will be acquisition of additional mailing list names (10 per activity session), volunteers (50 total for the year), contributions (new contributions totaling $3,000) and school fees as specified in the budget ($150 per class for field trips or $100 per class for classroom kits). Post event review will tabulate return attendees and anecdotal stories (indicating successful program). The Mission Experience program will expect to see up to thirty classes registered in 2017-2018. The Education Coordinator will monitor pre- and post- field trip evaluations for teachers to complete and to offer the opportunity for teachers to participate in the Education planning process. 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. In the City of Dublin, 50% of family households have minor children living at home. During activity at the museum’s Emerald Glen site, a random anonymous sample exit survey found the number of children in respondents’ households averaged two, ages from 9 months to 12 years. Hands-on play-based learning is an important component in early childhood development and one that supports traditional structured education programs. When combined with themes that are local priorities, such as history, health and culture, children’s developmental benefits are vastly multiplied. The hands-on interactive activities to be provided at the Museum will benefit children by developing skills in creativity, problem-solving, personal development and cognitive thinking; adults will spend quality time with their children and will interact and learn with them; the community will gain a unique family resource and a gathering place for its residents. Its secondary educational target market (via the California Mission program) is fourth grade school groups from public, private and home school environments. Dublin schools will benefit from the additional of a vetted, nearby field trip that supplements the classroom lessons in the state- mandated California Mission era; teachers will be given an extra, creative tool to enhance their planned activity, students will be more engaged in the learning experience and scores on mandated tests will be improved. In response to teachers’ frustrations over increasing transportation constraints, the Mission Experience classroom kit will provide the same hands-on lessons and workbooks as the field trip, residing in a school for a week for all appropriate classes to share. Valley Children's Museum's primary target audience is children age 10 and under, of all ethnic and socio-economic demographics, and their parents, teachers and caretakers. Participating families and educators have underscored the value to their youngsters. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? The early childhood development profession emphasizes the value of play-based learning to stimulate the creative learning capabilities of children – a critical component of long-term learning and success. That emphasis, along with the providing a safe learning environment and gathering place for the community, has spurred the growth of the children’s museum phenomenon. Valley Children’s Museum bases its activities on professional resources which specialize in early childhood learning and has added to its Board the Director of the Las Positas College Childhood Development Center. Activities and themes are developed with the forethought of future exhibits and programs in the permanent facility to be built at Dublin Crossing. Activities and future plans are validated by adults responding to VCM’s activity “exit survey” expressing they are strongly in favor of a museum in Dublin “because we need one close to home!” They also cite local history, culture, science and art as themes they would like to see in Dublin’s children’s museum and those comments are considered when creating activities. Families, teachers and children are delighted and gratified with the services as an interim step toward a permanent facility at Emerald Glen Park, and are encouraged that plans are in the works to meet the greater need. The California Mission Experience was originally designed by the Autry History Museum specifically for the state-mandated fourth-grade curriculum and was subsequently updated and vetted by VCM to be utilized by Tri-Valley educators and museum professionals. Ongoing modifications are incorporated as feedback is heard from teachers, such as creating the Mission Experience classroom kit for schools which cannot undertake a field trip. Further development of activities will build on those successful activities by engaging new program partners, volunteers and staff with childhood education and museum expertise. 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? Valley Children's Museum is committed to serving the widely diverse family population of Dublin and will promote its programs through a variety of mediums, including social networking sites, electronic and print media, pre-school and elementary school information distribution, youth group associations, large employers and good old fashioned printed flyers distributed through the community. A volunteer specializing in public relations and marketing has been identified and will explore outlets at libraries, government offices, retailers, ethnic- and needs-specific communities, as well. VCM participates in community festivals in Dublin, as well as San Ramon and Pleasanton, offering first-hand activities to the community, and takes advantage of those opportunities to promote planned activities at the Museum. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. City of Dublin: provides site for Museum, partnership with Farmers Market promotion, dissemination of information, as well as a generous community grant and partnership for a permanent facility. VCM has added to this partnership participation in the Splatter event, Movie Nights, Summer Concert series and Heritage Day. National Charity League: two chapters provide regular and reliable volunteer staffing with mother-daughter teams for set up and children’s activities. Dougherty Valley High School: regularly provides volunteers for both on-site activities and off-site materials preparation. Zone 7 and Dublin San Ramon Services District: Water and environment-themed children’s activities, hand-outs, games, and volunteers. BART, Dublin Police, Dublin Fire Department: participation in releveant theme-based activities at the museum. Keypoint Credit Union: Children’s financial literacy program with hands-on activities and incentives, volunteers and materials. Dublin, Livermore, Pleasanton and San Ramon school districts: partnership in developing and implementing and promoting education programs to complement classroom curriculum. Dublin Chamber of Commerce: through membership, promotion, vendor contacts, business donors. Dublin, San Ramon and Pleasanton community festivals: Participation with activity and information booths, reaching a broad cross-section of the populations. Ulferts Center: Providing space and support for community fund- and friend-raising event. Dublin Library: Recent discussions are leading to collaborative programming and outreach. St. Mary’s College: MBA student project conducting needs and strategy analysis. Many more partnership opportunities exist, contingent on increased staff resources to pursue them, including Girl and Boy Scout projects, company “volunteer-for-a-projects” and Dublin Senior 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. Media presence has been utilized with online Dublin Patch (and by extension the entire Patch network) and San Ramon Express, Pleasanton Weekly, Tri Valley Times, San Ramon Chat, City of Dublin, and Facebook. A skilled and experienced web manager utilizes the internet, social networking and website to expand VCM’s breadth of communication. VCM has been added to volunteers’ family-specific blogging sites. VCM maintains a base mailing and e-mail list of over 1,000 addresses for distribution of regular announcements, updates and requests for participation. VCM is a member of the Dublin Chamber and is represented at events of other Tri-Valley Chambers. VCM has recently joined The Tri-Valley Non Profit Alliance. VCM Board members belong to and/or make presentations to several Rotary clubs, Soroptomists, Knights of Columbus and Kiwanis, National Charity League. Active Kid Magazine and Macaroni Kids, both online newsletters targeting families, have adopted VCM in their promotion of local activities for children. VCM has participated with children’s activities at City of Dublin’s community events – Splatter, Heritage Day, Movie Nights, Summer Concerts – as well as at Ulferts Center and the Brookfield Homes community. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Costs for Valley Children’s Museum’s activities at the Museum are minimal. Activities are staffed by volunteers and materials such as yarn, glue, shells, feathers, construction paper etc. are purchased in bulk and with discounts. Printing needs for promotional flyers are budgeted economically, taking advantage of donated and discounted services. Cost of design and reproduction of the teacher workbooks for the California Mission field trip has been donated. Staff support is contracted on a part-time, hourly basis, and paid for hours worked every weekend (Saturday and Sunday) in spring, summer and fall seasons. The Dublin grant share of expenses is very low at approximately $1.50 per child, and Valley Children’s Museum will be responsible for raising three times that much. This grant is successfully used to challenge local corporations and service clubs to contribute both cash and in-kind products and services to the project. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? The effect would be both short- and long-term consequences with fewer Dublin residents and students served now and weakening of the momentum toward goal of the permanent museum. Much has been accomplished by VCM since the 2011 set up of the mobile museum in Emerald Glen Park. Starting with children’s activity in partnership with the Dublin Farmers Market, monthly Saturday activities, birthday parties, the curriculum-based field trip, participation in the Dublin-sponsored activities Splatter, Concert Series, Movie Nights and Heritage Day have been added. In early 2016, VCM relocated the trailer within the heart of Emerald Glen park. The move will be a public relations opportunity for renewed visibility and community partnership, but it will also require an unexpected outlay of funds and human resources. In light of this new task, this grant is more critical to VCM’s programs to meet its mission of education through hands-on activity for children and for the grassroots momentum to continue to build enthusiasm the upcoming campaign for a permanent facility in Dublin Crossing. VCM’s plan for 2017-2018 is to celebrate the move of the museum to its new permanent location in Emerald Glen Park while maintaining programs, increasing attendance at those programs and actively pursuing tasks toward constructing and furnishing the permanent facility. VCM will invest significant energy in design, planning and fundraising for that facility. Without the City of Dublin grant as the cornerstone of support for the essential staffing and supplies, these core activities, which provide the groundswell of public visibility and support, would be jeopardized. The loss of these activities would erode the stability of public and education programs and would negatively impact the matching support as well, an all around lose-lose situation. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 23. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 24. 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 25. 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 26. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? 27. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) 28. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) gfedc Yes ✔✔✔✔ No gfedc Yes ✔✔✔✔ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Not known (please contact staff at 925-833-6645 immediately if you have any questions regarding Davis-Bacon requirements) gfedc 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. ✔✔✔✔ 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 gfedc 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 gfedc 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 29. Referring to questions 27 and 28 please 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 Dublin grant-supported project proposes to utilize VCM’s Museum in Emerald Glen Park to continue consistent weekend operations of the solidly successful hands-on interactive programs for children at two levels: 1) public-access hands-on activities for children ages toddlers - 12 years old, curriculum-based field trips for fourth grade students studying California Missions. Activities will be based on themes of significance to the Dublin community: heritage, diversity, culture, innovation, the environment. Community agencies and corporate partners will collaborate in developing and staffing activities, among them Zone 7 and DSRSD, transportation agencies, school districts, pre-school and elementary school educators. Themes of science, math, archaeology, health, nutrition and fitness will be incorporated into the play-based activities offered at public events. Creative programming, marketing and communications will embrace the variety of cultures in Dublin, bringing together multi-generational families from diverse cultures to experience their children’s excitement at learning through play and to meet each other in the shared goal of providing the best possible learning opportunities for their children. School-based programs will include relevance to Dublin heritage, including Native Americans, pioneer settlers, use of the land, water and environment in the period of California Mission times. Children will develop creative learning and problem-solving skills in an informal learning environment that will enhance their classroom and home school instruction of the state-mandated California. 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 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 -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: -answer not presented because of the answer to #30- 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: -answer not presented because of the answer to #30- 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: -answer not presented because of the answer to #30- 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 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?"): -answer not presented because of the answer to #30- 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: -answer not presented because of the answer to #30- 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): -answer not presented because of the answer to #30- 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: -answer not presented because of the answer to #30- 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 gfedc Yes. If so, answer questions 31 through 43. ✔✔✔✔ No. If no, check box here, and questions 31 through 43 will not be required.. gfedc 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. 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". -answer not presented because of the answer to #30- 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" -answer not presented because of the answer 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 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). Valley Children's Museum actively seeks sponsors, board members, benefactors and grant opportunities for its ongoing operating budget of staffing and museum programs. As the the VCM's Board moves forward to propose opening every weekend of the 2017-2018 year, the VCM Board also proposes City of Dublin to adopt building of its permanent facility on Dublin's Emerald Park. A permanent facility and consistent staffing will incur expenses that will be justifiable by charging admission fees, birthday party hosting, facility rentals, special enrichment programs, and on-site/off-site field trip fees. City of Dublin residents, as well as Tri-Valley community members, desire a safe, secure, and consistently educational and engaging facility of learning for their children. When a permanent facility is in place, residents and locals are willing to invest and sponsor tangible and concrete programs that benefit the Tri-Valley community in a permanent setting. 46. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. 94-3340530 ✔✔✔✔ #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. gfedc #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. gfedc #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. gfedc #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. gfedc #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. gfedc #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget Funding Sources/Revenues Budget Amount Amount Committed California School Mission Program $ 12,000.00 $ 16,950.00 Saturday Hands on Experience $ 7,000.00 $ 11,431.00 Farmer's Market - Apr - Sep $ 6,000.00 $ 11,699.00 Total $ 25,000.00 $ 40,080.00 Funding Uses/Expenses Budget Amount Amount Committed California School Mission Program Site mgr @$15/hr $ 6,453.00 $ 3,000.00 California School Mission Program Booklets - in kind $ 3,000.00 $ 3,000.00 California School mission Program Outreach costs $ 2,000.00 $ 500.00 Sponsorships $ 5,000.00 Farmer's Market - Apr - Sep - Labor @$15/hr - 210 Hrs $ 6,935.00 $ 500.00 Program Mgr - @$25/Hr - Volunteer - 130 hrs $ 0.00 $ 0.00 Program Materials/Exhibit Costs $ 4,750.00 $ 1,500.00 Saturday Hands on Experience Labor @$15/hr - 420 hrs $ 6,300.00 $ 5,000.00 Hands on Saturdays - Materials $ 4,852.00 $ 500.00 Total $ 34,290.00 $ 19,000.00 Budget Narrative The three programs we have defined here are the current programs we are expanding in 2017/2018: The California Mission History program benefits all fourth grade classes in the Tri-Valley and we are looking to expand to other counties in the next two years. This is a program that we developed into a "mobile" program and gains use each year. Now that the museum is back in the Park - we can also offer schools the opportunity to come onsite for classes. This multi-purpose program offers students the opportunity to live a day in the life of a student living in a California Mission in the early 1800s. The expansion of the Super Saturdays to every Saturday will allow the museum to assist with covering costs of labor and materials costs now as sponsors are secured for future funding of programs and special exhibits and programs. Labor, materials and outreach costs will be required to advertise the program for children to visit the museum more often. We also want to include more small exhibits that will be permanent addition to the museum for children to use and potentially send to local libraries as a "VCM outreach" exhibit. Application ID: 69718 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2017 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. The third is the Farmer's Market that runs from April through September each year. Activities range from educational take away to creative design engaging the children's imagination. The museum has drawn in FY13- 5,332; FY14- 4,929 FY15 - 7,792 and as of 12-16-16 -total of 6,374. The school program attendance has ranged from 405 to 600 students. With the museum permanent in the park expanding this program is critical. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ VCM Program Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ VCM Financial Form List of Board of Directors (or governing body) with contact information ✔✔✔✔ Valley Children's Museum Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ VCM Current Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ VCM Tax Return Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ VCM Board Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ VCM Board Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ VCM Liability Certificate 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 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 STATE AND FEDERAL NON-PROFIT 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. ✔✔✔✔ IRS Letter IRS Letter 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 the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements ✔✔✔✔ FY15-16 Tax Returns Supporting Documents (Not Required) ATTACHMENT 5 PRESENTATION ORDER ORGANIZATION APPLICATION TITLE SUBMITTED DATE/TIME 1 Open Heart Kitchen OHK-Dublin Meal Programs 12/20/2016 1:20:06 PM 2 Easter Seals Bay Area Easter Seals Kaleidoscope 12/21/2016 4:46:30 PM 3 Center for Community Dispute Settlement Tri Valley Youth Court 1/2/2017 2:08:37 PM 4 Chabot-Las Positas Community College District/Tri Valley One Stop Career Center Dublin VITA Grant 2017-18 1/4/2017 1:29:39 PM 5 Chabot-Las Positas Community College District/Tri Valley One Stop Career Center Dublin Jobs Initiative 2017-2018 1/4/2017 1:30:56 PM 6 CALICO Center Dublin Child Abuse Intervention 1/5/2017 11:49:51 AM 7 Tri-Valley Haven Homeless Services Program 1/6/2017 9:25:10 AM 8 Tri-Valley Haven Domestic Violence Services Program 1/6/2017 9:27:36 AM 9 Spectrum Community Services Meals on Wheels for Dublin's Homebound Seniors 1/6/2017 12:12:55 PM 10 Kidango, Inc.Emerald Vista Parent Workshops 1/6/2017 12:23:20 PM 11 Deaf Counseling Advocacy and Referral Agency (DCARA) Deaf Seniors Services 1/6/2017 1:54:49 PM 12 Hope Hospice, Inc Hope Hospice - Unified Communications Phone System 1/6/2017 2:30:07 PM 13 Hope Hospice, Inc Grief Support Center and Hospice Volunteer Program 1/6/2017 3:09:24 PM 14 Axis Community Health Enhancing Health Outcomes with Patient Care Messaging 1/6/2017 3:56:43 PM 15 Community Resources for Independent Living Independent Living, Housing & Employment Services for People with Disabilities 1/6/2017 3:57:00 PM 16 Legal Assistance for Seniors Legal Services, HICAP and Community Education for Dublin Seniors 1/6/2017 4:44:44 PM 17 Senior Support Program of the Tri Valley Case Management 1/7/2017 3:05:22 PM 18 Child Care Links Child Care Links Diaper Pantry 1/7/2017 3:48:28 PM 19 Teen Esteem Teen Esteem Student and Parent Education Programs 1/7/2017 7:24:16 PM 20 Sandra J Wing Healing Therapies Foundation Cancer Assistance for Dublin Residents 1/8/2017 8:04:55 AM 21 YMCA of the East Bay, Tri-Valley YMCA Mental Health Services 1/8/2017 11:04:00 AM 22 YMCA of the East Bay, Tri-Valley YMCA Affordable Summer Childcare - YMCA Day Camp 1/8/2017 11:15:03 AM 23 Child Care Links Professional Development Trainings 1/8/2017 1:21:33 PM 24 Eden I&R, Inc.2-1-1 Alameda County Communication System 1/8/2017 6:11:20 PM 25 CityServe of the TriValley CityServe of the Tri-Valley 1/8/2017 7:42:16 PM 26 Sunflower Hill Sunflower Hill Garden Teachers / Educators 1/8/2017 8:26:50 PM 27 Valley Children's Museum Valley Children's Museum (VCM) Children's Programs 1/8/2017 11:26:45 PM CITY OF DUBLIN HUMAN SERVICES GRANTS PROGRAM FISCAL YEAR 2017-18 GRANT APPLICANT PRESENTATION ORDER