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01-22-2015 HSC Agenda Packet
Page 1 of 2 CITY OF DUBLIN HUMAN SERVICES COMMISSION MEETING AGENDA THURSDAY, January 22, 2015, 6:00 PM DUBLIN CIVIC CENTER, 100 CIVIC PLAZA, CITY COUNCIL CHAMBERS 1. CALL TO ORDER 2. PLEDGE OF ALLEGIANCE 3. ORAL COMMUNICATIONS 3.1 Public Comments At this time, the public is permitted to address the Human Services Commission on non-agendized items. The Commission must, however, comply with all State Laws in regard to items not appearing on the posted agenda. The Commission may respond to statements made or questions asked, or may request Staff to report back at a future meeting concerning the matter. Any member of the public may contact the Office of the Community Development Department related to the proper procedure to place an item on a future Human Services Commission agenda. The exceptions under which the Human Services Commission MAY discuss and/or take action on items not appearing on the agenda are contained in G.C. 54954.2(b)(1)(2)(3). 3.2 Administration of Oath of Office by Deputy City Clerk Gloria McCafferty to newly appointed Human Services Commissioners Melissa Sladden and Melissa Strah 3.3 Election of Officers for Chairperson and Vice-Chairperson 4. MINUTES OF PREVIOUS MEETINGS –October 23, 2014 STAFF RECOMMENDATION: Approve Minutes. 5. WRITTEN COMMUNICATIONS – None 6. PUBLIC HEARING – None 7. UNFINISHED BUSINESS – None 8. NEW BUSINESS 8.1 City of Dublin Fiscal Year 2015-2016 Community Grants Program Funding Recommendations The Human Services Commission will: (1) receive presentations from community organizations applying for grant program funding; (2) discuss the grant applications; and (3) make funding recommendations for the City Council’s consideration at the February 17, 2015 meeting. STAFF RECOMMENDATION: Receive Report and Organization Presentations and Make Funding Recommendations for City Council Consideration. Page 2 of 2 9. OTHER BUSINESS Brief INFORMATION ONLY reports from the Human Services Commission and / or Staff related to meetings attended at City Expense (AB 1234). 10. ADJOURNMENT – Next Meeting Thursday, April 23, 2015 This AGENDA is posted in accordance with Government Code Section 54954.2(a) If requested, pursuance to Government Code Section 54953.2, this agenda shall be made available in appropriate alternative formats to persons with a disability, as required by Section 202 of the Americans with Disabilities Act of 1990 (42 U.S.C. Section 12132), and the federal rules and regulations adopted in implementation thereof. To make a request for disability-related modification or accommodation, please contact the Office of the Community Development Department at (925) 833-6610 at least 72 hours in advance of the meeting. A complete packet of information containing Staff Reports (Agenda Statements) and attachments related to each item is available for public review at least 72 hours prior to a Human Services Commission Meeting or, in the event that it is delivered to the Commission less than 72 hours prior to a Humans Services Commission Meeting, as soon as it is so delivered. The packet is available in the Community Development Department at the Civic Center. HUMAN SERVICES COMMISSION Mission The City of Dublin Human Services Commission is dedicated to outreach, education, and collaboration to address the community’s human service needs as represented in the adopted needs assessment. Vision The Human Services Commission seeks solutions to the needs identified in the adopted needs assessment. The Commission will make recommendations to the Council on priorities for efforts that are consistent with the City Council’s adopted mission, vision and values. The Commission evaluates, encourages and advocates for the provision of human services in the community by making recommendations for organizational grant funding, educating residents on human services needs and promoting available services, supporting citizen awareness, engagement and volunteerism in addressing human service needs, and by collaborating with neighboring cities on regional human services solutions. DRAFT HSC Meeting Minutes, October 23, 2014 Page 1 of 6 HUMAN SERVICES COMMISSION REGULAR MEETING DRAFT Minutes CITY OF DUBLIN October 23, 2014 The October 23, 2014 Human Services Commission (HSC) was called to order at 7:01:13 PM at the Dublin Civic Center, Dublin, California, by Chair Lockhart. ROLL CALL Commissioners (Cm.) Present: Lockhart, McCormick, Muetterties Commissioners Absent: Vice Chair (VC) Brown, Wakamoto-Lee PLEDGE OF ALLEGIANCE Chair Lockhart led the Pledge of Allegiance. ORAL COMMUNICATIONS 3.1 Public Comments Ralph Johnson, Director of Homeless and Family Support Services, with Tri-Valley Haven (Haven) provided an update of the Haven’s food pantry. The hours of operation are Monday- Wednesday 1:00-5:00 PM and Thursday 1:00-7:00 PM. The Haven is servicing an average of 40-60 households each day. The families receive donated food, including an emergency food box. Mr. Johnson also spoke of the Haven’s participation in Cal-Fresh, an Alameda County program. The Haven has a part-time new staff member that works at the Haven’s food pantry helping people enroll in the Cal-Fresh program. This new staff member is looking for Dublin locations to assist people in Cal-Fresh enrollment. He asked the HSC for suggestions on potential locations in Dublin where outreach would make sense. Cm. McCormick asked if the Haven is looking for office space in these outreach locations. Mr. Johnson clarified that office space is not necessary, just a table and chair would be needed. He mentioned that the post office or supermarket might be suitable. Chair Lockhart suggested the community room at Emerald Vista because it would provide a location and audience, seniors and families, who may be in need of the Cal-Fresh program. She also recommended reaching out to Gloria Gregory with CityServe who is working with Valley High School on identifying and responding to community needs. MINUTES OF PREVIOUS MEETINGS 4. July 24, 2014 On a motion by Cm. McCormick and seconded by Cm. Muetterties, on a vote of 3-0-2, the HSC approved the minutes of the July 24, 2014 meeting. Vc. Brown and Cm. Wakamoto-Lee were absent from the meeting. WRITTEN COMMUNICATIONS – None DRAFT HSC Meeting Minutes, October 23, 2014 Page 2 of 6 PUBLIC HEARING – None UNFINISHED BUSINESS – None NEW BUSINESS 8.1 Alameda County social services provided to Dublin residents Josh Thurman, Deputy Chief of Staff from Alameda County Supervisor Haggerty’s Office, presented information on the social services provided to Dublin residents by Alameda County agencies. Chair Lockhart asked where La Clinica de la Raza is located. Mr. Thurman responded that the clinic is in Oakland, California. Chair Lockhart asked if any hospitals in the Tri-Valley participate in publicly funded dental care programs. Mr. Thurman responded no. Chair Lockhart asked if there are mental health services available at Valley High School. Mr. Thurman responded yes. Additionally, early intervention services are provided at Fallon Middle School where Coordination of Services Team meetings are held weekly. During the 2013 school year there were 220 mental health sessions between staff and students. Chair Lockhart noted the pressure students are under from family to achieve a high level of performance in school. Mr. Thurman agreed that mental health services in schools and dental services have been identified as major needs in the Tri-Valley. Chair Lockhart asked if the money funded for In-Home Supportive Services (IHSS) is for caretakers in the home. Mr. Thurman responded yes. Amy Cunningham, Assistant to the City Manager, explained that the congregate meal program was previously provided by Spectrum Community Services (Spectrum) and as of July 2014, Open Heart Kitchen is providing all senior congregate meal programs in the Tri-Valley. Mr. Thurman stated that Spectrum has provided a wonderful service. For this funding cycle, Alameda County was looking for a Tri-Valley based provider and Open Heart Kitchen filled the need. He next stated that there are only two Dublin dentists in the Tri-Valley that take Denti-Cal patients. DRAFT HSC Meeting Minutes, October 23, 2014 Page 3 of 6 Ms. Cunningham stated that the Tri-Valley Cities met with Sue Compton at Axis Community Health to discuss dental care services and potential funding through Alameda County to attract private dentists. The level of Denti-Cal subsidies prove to be an obstacle in enticing dentists to participate in the program. Mr. Thurman stated that specialty medical services are not provided in the Tri-Valley. He mentioned there are discussions with Alameda Health Systems to co-locate the top three referred services to Axis. He explained that the volume of people requiring specialized services dictates the services offered in an area. At this point, the volume in the Tri-Valley has not substantiated the need for providing these services locally. Chair Lockhart stated that if the service is available in the Tri-Valley, she believes the volume will increase. She explained that the Tri-Valley HSC Commissions are jointly focused on mental health and dental health as top priorities. In the past the Tri-Valley cities may have focused on health services within their own city, but now the focus is providing a facility within the Tri-Valley that can provide these services. She next mentioned a dental vehicle program that the City of Pleasanton was trying to get up-and-running. Ms. Cunningham explained that the dental vehicle program has been studied and currently is not moving forward. Mr. Thurman explained that while a dental vehicle does provide screening, a medical home is still needed to provide the dental services. Chair Lockhart responded that if there was a medical home at Axis then appointments could be set up at a facility. Ms. Cunningham explained that a mobile dental van only accommodates one person at a time, so logistically and financially it would be difficult to fund. She mentioned that conversations with Axis are in process to provide a space for dental services. There is an opportunity to share administrative and other overhead expenses by co-locating dental services with medical services. Additionally, the Cities will be in contact with Southern Alameda County Dental Association’s president to obtain the perspective of dental professionals regarding the challenges of providing these services. Chair Lockhart stated that if kids are insured and there is a sufficient volume, the dental van might be a viable option. Mr. Thurman indicated that the State has reinstated dental services for adults. In addition to the University of the Pacific Dental Clinic, a satellite school located in Union City, accepts Denti-Cal. He then mentioned that operational funding for a mobile dental is costly. Funding the driver alone costs nearly $50,000 due to special licensing. From a County perspective it is not effective to fund an exam without a medical home to conduct needed treatment. DRAFT HSC Meeting Minutes, October 23, 2014 Page 4 of 6 Chair Lockhart asked Mr. Thurman for an update on a potential youth center in the Tri-Valley. Mr. Thurman explained that a youth center was explored in Livermore, but the volume of reimbursement would not cover the cost. He then mentioned that the center in San Lorenzo cost $20 million to build and $8-$10 million a year to operate. Chair Lockhart asked how San Lorenzo is able to afford operating the facility. Mr. Thurman stated that San Lorenzo received redevelopment funds. Cm. McCormick asked for a copy of the Mr. Thurman’s presentation. Ms. Cunningham responded that a copy of Mr. Thurman’s presentation will be forwarded to the HSC. She then asked Mr. Thurman if substance abuse programs in the Tri-Valley are provided only by Axis. Mr. Thurman confirmed that all the substance abuse programs in the Tri-Valley are provided by Axis. Ms. Cunningham asked the HSC if they would like to defer the conversation about the presentation until all the HSC members are present. Chair Lockhart suggested providing the presentation data to the Commissioners who were absent and then discussing it as a group. Cm. McCormick stated that the presentation was helpful in identifying funding needs and will be useful when recommending funds for the Community Grant Program. Chair Lockhart stated that she felt tonight’s presentation confirmed that funding should include programs that support mental and dental health. Marlene Petersen, Director of Senior Support Services (Senior Support) stated that they are serving over 300 seniors in the Dublin area. In addition to case management they provide mental health and transportation programs. She mentioned that in the past a dental van was used for exams and would visit senior centers. The seniors would then need to be transported to San Leandro for the dental work. That particular dentist billed Denti-Cal. She emphasized that without proper dental care, stomach problems are a real issue for seniors. Chair Lockhart asked if seniors need chiropractic services because she knows several chiropractors who are willing to provide this service to seniors. Ms. Petersen stated that Senior Support offers in-home fitness programs and that no seniors have requested chiropractic services. She stated that seniors may not ask for this service because they are not familiar with what it entails. DRAFT HSC Meeting Minutes, October 23, 2014 Page 5 of 6 8.2 Fiscal Year 2013-2014 Community Grant Program: Grant Recipient Year-End Reports Ms. Cunningham presented the Fiscal Year 2013-2014 Community Grant Program year-end summary reports submitted by grant recipients. Cm. Muetterties asked if the Community Grant funding amount will be the same dollar amount as last year. Ms. Cunningham stated that Community Development Block Grant funding, provided through Alameda County, may be reduced as a result of federal budget reductions. Chair Lockhart asked when the City Council will start the strategic planning process. Ms. Cunningham stated that the start date has not been identified. She stated that the HSC will be notified when it commences. Cm. McCormick asked if the art program applicants are eligible to apply for Community Grant Program funding. Ms. Cunningham stated that the arts program applicants remain eligible to apply for Community Grant Program funding. She then related how the Heritage and Cultural Arts Commission provided recommendations about funding the arts programs to City Staff. Staff is evaluating the data to present to the City Council in the coming months. This action was a result of the HSC’s recommendation to the City Council last year that alternative options for arts programs be studied. OTHER BUSINESS 9. Brief INFORMATION ONLY reports from the Human Services Commission and / or Staff related to meetings attended at City Expense (AB 1234). Next HSC meeting, Thursday, January 22, 2015, 6:00 PM HSC application period will open in mid-November Axis Community Health ground breaking took place, October 16, 2014 Tri-Valley Poverty Awareness Luncheon, October 30, 2014, 11:30 AM - 1:30 PM Chair Lockhart stated that she was invited to a meeting to be held by CityServe at Valley High School on October 27, 2014, to discuss local holiday needs. She then stated that she is attending as a citizen, not representing the Commission. She next stated that Eden Housing at Emerald Vista is interested in providing an after school educational program for high school students because of low performance levels. Teachers from Valley High School will participate, but funding is needed. Ms. Cunningham stated that Open Heart Kitchen is interested in expanding in Dublin beyond the current services they provide. DRAFT HSC Meeting Minutes, October 23, 2014 Page 6 of 6 ADJOURNMENT Being no further business, the meeting adjourned at 8:34:01 PM. Respectfully Submitted, _________________________________ Anastasia Nelson, Recording Secretary APPROVED: ____________________________ Chairperson, Chair Lockhart COPIES TO: All Grant Applicants 1 of 8 ITEM NO: 8.1 AGENDA STATEMENT HUMAN SERVICES COMMISSION DATE: January 22, 2015 TO: Human Services Commission SUBJECT: City of Dublin Fiscal Year 2015-2016 Community Grants Program Funding Recommendations Prepared by Amy Cunningham, Assistant to the City Manager EXECUTIVE SUMMARY: The Human Services Commission will: (1) receive presentations from community organizations applying for grant program funding; (2) discuss the grant applications; and (3) make funding recommendations for the City Council’s consideration at the February 17, 2015 meeting. FINANCIAL STATEMENT: The Community Grants Program is supported by several funding sources including the Community Development Block Grant (CDBG) Fund, the General Fund and the Affordable Housing Fund as appropriate. The preliminary Fiscal Year 2015-2016 CDBG allocation is $90,189. A portion of this funding, approximately $69,812, is available for direct support of social service programs in the community (“service-based”). Final allocations from the Department of Housing and Urban Development (HUD) will not be known until at least March 2015. The Fiscal Year 2014-2015 Community Support Grant funding cap is $120,000 (General Fund) as established by the City Council. In compliance with grant program guidelines, all grants applications must comply with a $3,500 minimum and $25,000 maximum per application (project) request. RECOMMENDATION: Receive Report and Organization Presentations and Make Funding Recommendations for City Council Consideration. DESCRIPTION: The City of Dublin Community Grants Program provides financial support to local not-for-profit organizations serving the Dublin community. The program is supported through several funding sources including the federal Community Development Block Grant (CDBG) program and the City’s General Fund and Affordable Housing Fund (as appropriate). Each year the City Council awards funding to organizations that best meet the community’s needs in support of the City’s adopted Mission, Vision and Values (Attachment 3) and needs identified in the Tri-Valley Needs Assessment (Attachment 4). Prior to the Fiscal Year 2014-2015 funding cycle, a City Council Grants Program Subcommittee provided policy and grant funding recommendations to the full City Council for consideration. For Fiscal Year 2014-2015, the grant process was modified to include a review of grant applications by the newly formed Human Services Commission. The Human Services Commission has assumed the role of reviewing funding applications, receiving presentations from each grant applicant and making recommendations to the City Council. The City Council will consider the Human Services Commission’s funding recommendations at the meeting on February 17, 2015 for inclusion in the budget. Final COPIES TO: All Grant Applicants 2 of 8 ITEM NO: 8.1 consideration of the City Council’s grant funding recommendations is tentatively scheduled for May 2015 as part of the biennial budget hearing. Staff has reviewed the Fiscal Year 2015-2016 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 (Attachment 5 for reference) to each grant application. Each funding source does have some variation in application and use requirements; these differences were taken into consideration during the staff review process. The rating for each application can be found on Attachment 2. The Rating Criteria is only one of several factors used in determining Staff’s funding recommendations. The Rating Criteria takes into consideration such elements as: the number of Dublin residents served and cost per participant; past performance for existing Dublin programs; whether the project addresses one or more of the 14 Key Areas of Concern identified in the 2011 Tri-Valley Needs Assessment Report (Attachment 4 for reference); and whether City funds are used to leverage other funding sources. Throughout the grant process, applicants are regularly advised that the success or implementation of their program or project should not be solely dependent on receipt of grant funding from the City of Dublin. Organizations are strongly encouraged to leverage any City grant award with other revenue sources. Based on the Human Services Commission’s work in establishing local and regional priorities this past year, 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. Similar to past years, 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 1 provides a chart listing the order in which applications were submitted and will be presented. CDBG Program Background: Community Development Block Grant funds are provided by the U.S. Department of Housing and Urban Development (HUD). The City of Dublin works with Alameda County’s Urban CDBG Program to allocate funds and with HUD to assure that all CDBG-funded activities are in compliance with federal regulations. The City of Dublin has participated in Alameda County’s Urban-County CDBG Program since 1982. The City of Dublin, along with the cities of Albany, Emeryville, Newark, and Piedmont (cities with a population of less than 50,000 residents), are called the “Urban County Cities”, along with the unincorporated areas of Alameda County. During the current Fiscal Year (FY 2014-2015), the City of Dublin received $92,020 in CDBG funding. For FY 2015-2016 Dublin’s portion of funding is expected to total $90,189 (a 2% reduction); however, only $69,812 of this amount is available for direct support to organizations. Every year the County dedicates a percentage of each Urban County City’s total CDBG funding allocation to the County of Alameda’s Housing Rehabilitation Program. This Program is available to income qualified households within each of the respective Urban County Cities as well as the unincorporated County for needed home maintenance and repairs. In addition, the County may limit each Urban County City to only 15% of the CDBG allocation for service-based organizations and 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 15% limit. For the past two years, the County has requested that the City make adjustments to the service-based project allocation as the County was projected to exceed the 15% limit. During these funding cycles, Axis Community Health worked with City Staff and the County to make adjustments to their designated funding sources. Their cooperation has resulted in County-wide compliance with the 15% cap without reductions to any Dublin grant allocations. If adjustments are needed for Fiscal Year 2015-2016, 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. COPIES TO: All Grant Applicants 3 of 8 ITEM NO: 8.1 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 Clinic Expansion (Item 8.2, Resolution #51-14). The City of Dublin has been supporting predevelopment activities for this project over the past several years through the CDBG program. The PPJ allows 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 $221,676, each year through CDBG funds. The funding allocation for repayment of the loan is identified as part of the staff recommendations in Attachment 2. CDBG funds are categorized as federal funds with strict use, reporting and monitoring requirements to insure compliance with federal regulations. Many organizations are not able to meet these requirements and are therefore not eligible to receive CDBG funds. To comply with the County’s CDBG program timelines and to assist with timely reporting to HUD, the Commission’s CDBG funding recommendations must be considered at the City Council meeting on February 17, 2015. Community Support Grant Program Background: Fiscal Year 2015-2016 marks the eleventh year of the City Council’s adopted Community Grant funding process. This formalized grant process was the result of the City Council’s desire to standardize an application and reporting process for organizations requesting and receiving financial support from the City’s General Fund and other City funding sources. The funding cap for Community Support grants has been established by the City Council at $120,000 from the General Fund. As appropriate, the General Fund allocation has been supplemented by the Affordable Housing Fund. This approach had provided additional flexibility in funding community organizations providing valued services to Dublin residents. As a result of last year’s grant process, the Human Services Commission recommended to the City Council that research be completed to determine another venue and funding source for arts related programs. The City Council agreed with the recommendation and directed Parks and Community Services staff to undertake the project. The research is nearing completion and is expected to be presented to the City Council in the coming months. Outreach Efforts As in past years, there were many points of contact with organizations as part of the Community Grants Program application process. These outreach and education efforts included: • In early October 2014, notices of funding availability and upcoming community workshops were mailed to organizations. • In early November 2014, a Request for Proposal was advertised 3 times in the local newspaper for Grants, with an open application period set between November 13 and December 11, 2014. • Program announcements and information were posted on the City website with links to the Zoom Grants Application. • On November 12 and November 20, 2014, City Staff held Mandatory Grant Application Workshops with interested community organizations to review the online Zoom Grants Application process and discuss program guidelines for the year. All Fiscal Year 2015-2016 grant applicants attended at least one of the mandatory meetings. COPIES TO: All Grant Applicants 4 of 8 ITEM NO: 8.1 • In January 2015, Community Grants Program information was distributed to the Human Services Commissioners to familiarize them with the grant applications and online grant application program. ANALYSIS During this year’s application cycle, the City of Dublin received 30 applications from 27 organizations or groups. Of the 30 eligible applications received, 8 met the CDBG criteria and the remaining 22 met other grant program criteria. Three organizations submitted applications for two different programs/projects: Dublin High School Parent Faculty Student Organization, Tri-Valley Haven, and YMCA of the East Bay Tri-Valley Branch. When more than one application is submitted, organizations are required to rank their funding requests based on the organization’s priority. Upon Staff review, all applications were deemed complete and all organizations met the minimum application requirements. Staff reviewed all applications and rated them according to the following City Council approved criteria: • Organization and Management – Evaluates the agency’s ability to run and manage its operations; • Needs and Benefits – Assesses if the request meets the targeted population and meets at least one goal and/or policy established by the City’s Mission, Vision and Values or HUD guidelines; • Funding and Budget – Evaluates the agency’s ability to leverage funds, reviews fees and current audits. Attachment 2 summarizes the Fiscal Year 2015-2016 funding requests including: the organization’s name and program; the Fiscal Year 2014-2015 funding award (if any); the organization’s Fiscal Year 2015-2016 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. CDBG Funds Of the 30 eligible applications received during this year’s application cycle, 8 applicants qualified and indicated they were willing to meet the strict federal guidelines for use of CDBG funds. Staff has reviewed past program performance and proposed activities of the service providers to ensure the activities are in compliance with HUD/CDBG guidelines. As a requirement of funding, the City performs an annual site-monitoring visit to each agency. This site-monitoring visit includes a review of organization and client files to ensure compliance with HUD guidelines. There were no findings issued during the prior monitoring period for any of the organizations funded through the CDBG program. In the table below, of the anticipated $90,189 allocated to the City, $69,812 is expected to be available for funding organizations through the Community Grants Program. Staff recommends funding 5 organizations for Fiscal Year 2015- 2016 through the CDBG program as follows, the 3 remaining organizations are recommended for funding through other sources (Community Resources for Independent Living, Tri-Valley Haven Domestic Violence Program, and Tri-Valley Haven Homeless Services: CDBG Fund Recommendations Fiscal Year 2015-2016 Axis Community Health – Improving Patient Care with Facilitated Medication Review $9,000 Calico Center – Dublin Child Abuse Intervention $7,000 Open Heart Kitchen - Dublin Meal Programs $12,000 Senior Support Program of the Tri-Valley - Case Management $10,000 COPIES TO: All Grant Applicants 5 of 8 ITEM NO: 8.1 Spectrum Community Services - Meals on Wheels $8,250 REQUIRED - Axis Community Health – Facility Project Loan Obligation $23,562 Total $69,812 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 five years, the City Council has emphasized basic life needs such as food, shelter, medical services, and education in grant funding decisions. The CDBG recommendations are reflective of that approach. In addition to the CDBG funding recommendation of $69,812 in the table above, the City has 2 additional CDBG funding commitments which total the $90,189 in funding for the year: • The County of Alameda administers the City of Dublin’s rehabilitation program. In Fiscal Year 2015-2016, $13,777 is preliminarily allocated to that program; • Administration fees in the amount of $6,600 are allocated to support administration of the CDBG program. After funding the program’s mandatory functions listed above, $69,812 remains for direct allocation to qualifying applicants. Should there be further decreases in the CDBG allocation, Staff will program 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 15% 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. Community Support Grants General Fund Of the 30 eligible applications received during this year’s application cycle, all applications met Community Grant funding criteria. Staff has reviewed past program performance and proposed applicant activities to ensure compliance with program guidelines. As a condition of funding, the City requires 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 year, the summary reports are provided to the Human Services Commission as an informational item. Of the applications submitted for Community Grant funding, Staff recommends that 24 organizations be funded as follows: General Fund Recommendations Fiscal Year 2015-2016 CARD – Collaborating Agencies Responding to Disasters – Helping Dublin Prepare to Prosper! $0 Center for Community Dispute Settlement – Tri-Valley Youth Court $3,500 Chabot-Las Positas Community College District - Tri-Valley $10,000 COPIES TO: All Grant Applicants 6 of 8 ITEM NO: 8.1 One Stop Career Center Child Care Links - Early Childhood Education $10,000 Children’s Emergency Food Bank – New Building $7,500 CityServe of the Tri-Valley – Operational Grant $5,000 Dublin High School – Dublin High Freshman Mentor Program $0 Dublin High School PFSO - Sober Grad Night $4,000 Dublin High School PFSO – Every 15 Minutes Program $7,000 Dublin Partnerships in Education – Operational $10,000 Eden I&R, Inc.- 2-1-1 Alameda County Communications System $10,000 Easter Seals Bay Area – Kaleidoscope Program $3,500 Hope Hospice, Inc.- Grief Support Center and Volunteer Program $10,000 Kidango, Inc.- Emerald Vista Enrichment Program $4,000 Livermore Valley Performing Arts Center – Arts in the Schools with Cheza Nami Foundation $0 Pacific Chamber Symphony - “Music is Fun” Educational assemblies for elementary schools $0 Partners Fore Golf, Inc. – The First Tee Tri-Valley Expansion into Dublin $3,500 School of Imagination – Happy Talkers Screening and Training Project $5,000 Tri-Valley Haven - Domestic Violence Services Program * $5,000 Tri-Valley Haven – Homeless Services Program $9,000 Valley Children’s Museum – Mobile Museum Children’s Activities 15-16 $5,000 ValleyCare Health System – CPR in Schools $0 YMCA of the East Bay Tri-Valley Branch – Behavioral Health Care Services for Kids with Special Needs $8,000 YMCA of the East Bay Tri-Valley Branch – Tri-Valley YMCA Mentoring Program $0 Total $120,000 * See Affordable Housing Fund for additional recommendation Note that Children’s Emergency Food Bank’s application indicates that once completed, they may consider donating the proposed new structure to John Knox Presbyterian Church. The California State Constitution prohibits governmental support for religious purposes. The City Attorney’s Office has opined that if City funds are used for the project and Children’s Emergency Food Bank later donates the structure to the church, it could be interpreted as a violation of the Constitution. If funding is ultimately approved for the Children’s Emergency Food Bank, Staff will work with the organization and the City Attorney’s Office to create a funding agreement that ensures City funds are allocated and used as required by the California State Constitution. Affordable Housing Fund Two organizations are recommended for funding through the City’s Affordable Housing Fund: (1) Community Resources for Independent Living; and (2) Tri-Valley Haven Domestic Violence Services. 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 these programs COPIES TO: All Grant Applicants 7 of 8 ITEM NO: 8.1 provides additional flexibility in awarding funding for applicants furthering the grant program goals. Staff recommends funding the organizations as follows: Affordable Housing Fund Recommendations Fiscal Year 2015-2016 CRIL-Independent Living, Housing & Employment Services for People with Disabilities $4,500 Tri-Valley Haven - Domestic Violence Services Program * $3,000 Total $7,500 * See General Fund for additional recommendation In total, $380,028 was requested through the Community Grants Program. The following chart summarizes the total funding requests and Staff Recommendations for the Fiscal Year 2015-2016 Community Grants Program: Total Grant Funding Recommendation Funding Request for FY 2015-2016 Staff Recommendation FY 2015-2016 CDBG Fund * $52,646 $69,812 ** General Fund $322,382 $120,000 Affordable Housing Fund $5,000 *** $7,500 Total Community Grants $380,028 $197,312 * These amounts do not include $20,377 committed for two CDBG programs (Rehabilitation Program and Administrative costs). ** Includes allocation to the Axis Community Health Facility Project Loan Obligation. *** Tri-Valley Haven Domestic Violence Services funding request included in General Fund. NOTICING REQUIREMENTS / PUBLIC OUTREACH: 1. Identified in “Outreach Efforts” above. 2. Copy of Staff Report to All Grant Applicants. ATTACHMENTS: 1. Grant Applicant Presentation Order 2. Funding Request Summary Table Exhibits: Grant Applications (Hard copy of applications available for public review, electronic copies for Commission members) A. Axis Community Health – Improving Patient Care with Facilitated Medication Review B. CALICO Center – Dublin Child Abuse Intervention C. CARD – Collaborating Agencies Responding to Disasters – Helping Dublin Prepare to Prosper! D. Center for Community Dispute Settlement – Tri-Valley Youth Court E. Chabot-Las Positas Community College District – Tri-Valley One Stop Career Center F. Child Care Links – Early Child Education G. Children’s Emergency Food Bank – New Building H. CityServe of the Tri-Valley – CityServe of the Tri-Valley I. Community Resources for Independent Living – Independent Living, Housing & Employment Services for People with Disabilities J. Dublin High School – Dublin High Freshman Mentor Program COPIES TO: All Grant Applicants 8 of 8 ITEM NO: 8.1 K. Dublin High School Parent Faculty Student Organization – Dublin High Safe & Sober Grad Night L. Dublin High School – Every 15 Minutes Program M. Dublin Partnerships In Education – DPIE City of Dublin Community Grant N. Easter Seals Bay Area – Easter Seals Kaleidoscope Youth Grant (Zach Lupton) O. Eden Information & Referral – 2-1-1 Alameda County Communications System P. Hope Hospice, Inc. – Grief Support Center and Volunteer Programs Q. Kidango, Inc. – Emerald Vista Enrichment Program R. Livermore Valley Performing Arts Center – Arts in the Schools with Cheza Nami Foundation S. Open Heart Kitchen – Dublin Meal Program T. Pacific Chamber Symphony – “Music is Fun!” Educational assemblies for elementary schools U. School of Imagination – Happy Talkers Screening and Training Project V. Senior Support Program of the Tri-Valley – Case Management W. Spectrum Community Services – Meals on Wheels for Dublin’s Homebound Seniors X. Tri-Valley Haven – Domestic Violence Services Program Y. Tri-Valley Haven – Homeless Services Program Z. Valley Children’s Museum – Mobile Museum Children’s Activities 15-16 AA. ValleyCare Health System – CPR in Schools BB. YMCA of the East Bay, Tri-Valley Branch – Behavioral Health Care Services for Kids with Special Needs CC. YMCA of the East Bay, Tri-Valley Branch – Tri-Valley YMCA Mentoring Program 3. City of Dublin Mission, Vision and Values 4. 14 Needs Identified in 2011 Tri-Valley Needs Assessment 5. Grant Rating Criteria Worksheet ATTACHMENT 1 City of Dublin Community Grants Program Fiscal Year 2015-2016 – Grant Applicant Presentation Order Organization Program 1 Easter Seals Bay Area Kaleidoscope Program (Zach Lupton) 2 Dublin High School PFSO Every 15 Minutes Program 3 Tri-Valley Haven Tri-Valley Haven’s Homeless Services Program 4 Open Heart Kitchen Dublin Meal Programs 5 Valley Children’s Museum Mobile Museum Children’s Activities 15-16 6 Chabot-Las Positas Community College District / Tri-Valley One Stop Career Center Project Dublin 7 Tri-Valley Haven Tri-Valley Haven’s Domestic Violence Services Program 8 Axis Community Health Improving Patient Care with Facilitated Medication Review 9 Children’s Emergency Food Bank New Building 10 Community Resources for Independent Living (CRIL) Independent Living, Housing & Employment Services for People with Disabilities 11 Child Care Links Early Childhood Education 12 Kidango Inc. Emerald Vista Enrichment Program 13 CALICO Center Dublin Child Abuse Intervention 14 Eden I&R Inc. 2-1-1 Alameda County Communications System 15 Dublin Partnerships in Education DPIE City of Dublin Community Grant 16 Hope Hospice Inc. Grief Support Center and Volunteer Programs 17 CityServe of the Tri-Valley CityServe of the Tri-Valley 18 CARD – Collaborating Agencies Responding to Disasters Helping Dublin Prepare to Prosper! 19 Senior Support Program of the Tri-Valley Case Management 20 Partners for Golf Inc. dba The First Tee of the Tri-Valley The First Tee Tri-Valley Expansion into Dublin 21 Dublin High School Parent Faculty Student Organization Dublin High Safe and Sober Grad Night 22 Livermore Valley Performing Arts Center Arts in the Schools with Cheza Nami Foundation 23 ValleyCare Health Systems CPR in Schools 24 Dublin High School Dublin High Freshman Mentor Program 25 Spectrum Community Services Meals on Wheels for Dublin’s Homebound Seniors 26 Pacific Chamber Symphony “Music is Fun!” Educational Assemblies for Elementary Schools 27 Center for Community Dispute Settlement Tri-Valley Youth Court 28 YMCA of the East Bay, Tri-Valley Branch Tri-Valley YMCA Mentoring Program 29 YMCA of the East Bay, Tri-Valley Branch Behavioral Health Care Services for Kids with Special Needs 30 School of Imagination Happy Talkers Screening and Training Project Organizations Eligible for CDBG Funds Prior Year Funding FY 2014-2015 Funding Request FY 2015-2016 Staff Recommendation FY 2015-2016 Rating Points Earned # of Needs Addressed * Axis Community Health - Patient Care **$10,000 $9,000 14 2 CALICO Center - Child Abuse Intervention $6,500 $7,500 $7,000 15 4 Open Heart Kitchen - Dublin Meal Programs $10,000 $15,000 $12,000 15 4 Senior Support Program of the Tri-Valley - Case Management $9,500 $11,646 $10,000 14 1 Spectrum Community Services - Meals on Wheels for Homebound Seniors $7,902 $8,500 $8,250 15 3 Axis Community Health - Facility Project Loan Obligation $23,500 -$23,562 -2 Total Available $69,812 $52,646 $69,812 Organizations Eligible for Affordable Housing Fund Prior Year Funding FY 2014-2015 Funding Request FY 2015-2016 Staff Recommendation FY 2015-2016 Rating Points Earned # of Needs Addressed * Community Resources for Independent Living - Independent Living, Housing & Employment Services $3,500 $5,000 $4,500 15 6 Tri-Valley Haven - Domestic Violence Services ***(see below)(see below)$3,000 15 3 Total Available: N/A $5,000 $7,500 Organizations Eligible for General Fund Prior Year Funding FY 2014-2015 Funding Request FY 2015-2016 Staff Recommendation FY 2015-2016 Rating Points Earned # of Needs Addressed * CARD - Helping Dublin Prepare to Prosper!n/a $25,000 $0 11 14 Center for Community Dispute Settlement - Tri- Valley Youth Court n/a $3,500 $3,500 12 2 Chabot-Las Positas Community College - Tri- Valley One Stop Career Center $10,000 $12,000 $10,000 15 1 Child Care Links - Early Childhood Education $10,000 $25,000 $10,000 15 1 Children's Emergency Food Bank - New Building n/a $20,000 $7,500 13 1 CityServe of the Tri-Valley - CityServe $12,360 $12,510 $5,000 13 8 Dublin High School - Dublin High Freshman Mentor Program n/a $25,000 $0 10 3 Dublin High PFSO - Dublin High Safe and Sober Grad Night $4,000 $4,000 $4,000 14 1 Dublin High School - Every 15 Minutes Program n/a $8,000 $7,000 14 2 Dublin Partnerships in Education - DPIE Community Grant $10,000 $20,000 $10,000 15 9 Eden I&R, Inc. - 2-1-1 Alameda County Communications System $10,000 $10,000 $10,000 15 14 Easter Seals Bay Area - Kaleidoscope $4,000 $15,000 $3,500 12 3 Hope Hospice, Inc. - Grief Support Center & Volunteer Programs $11,400 $15,000 $10,000 14 3 Kidango - Emerald Vista Enrichment $10,000 $8,000 $4,000 11 1 Livermore Valley Performing Arts Center - Arts in the Schools with Cheza Nami Foundation n/a $13,872 $0 10 2 Pacific Chamber Symphony - Music is Fun! Assemblies $0 $11,500 $0 10 2 Partners for Golf - First Tee Tri-Valley Expansion into Dublin n/a $7,000 $3,500 13 1 School of Imagination - Happy Talkers Screening and Training Project $6,625 $25,000 $5,000 13 5 Tri-Valley Haven - Domestic Violence Services ***$8,000 $8,000 $5,000 15 3 Tri-Valley Haven - Homeless Services $10,000 $10,000 $9,000 15 3 Valley Children's Museum - Mobile Museum Children's Activities $6,625 $6,000 $5,000 15 2 ValleyCare Health System - CPR in Schools n/a $5,000 $0 10 1 YMCA of the East Bay - Behavioral Health Care Services for Kids w Special Needs n/a $18,000 $8,000 12 3 YMCA of the East Bay - Mentoring Program n/a $15,000 $0 11 2 Total Available $120,000 $322,382 $120,000 * Needs as outlined in the Tri-Valley Needs Assessment (Attachment #4) ** Allocation moved to Axis Capital Project to comply with HUD public services funding cap *** Tri-Valley Haven Domestic Violence Program - General Fund + Affordable Housing Fund ATTACHMENT 2 Fiscal Year 2015-2016 City of Dublin Community Grants Program 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Axis provides quality, affordable, accessible and compassionate health care services that promote the well-being of all members of the community. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Axis Community Health Improving Patient Care with Facilitated Medication Review Axis Community Health 4361 Railroad Avenue Pleasanton, CA 94566 United States Tel: (925) 201-6068 x Fax: (925) 417-1503 x Web: axishealth.org EIN: 94-2232394 DUNS: 052146990 Project Contact Alicia Pimentel vjonas@axishealth.org Tel: 925.201.6035 Additional Contacts vjonas@axishealth.org,scompton@axishealth.org CEO Sue Compton scompton@axishealth.org USD$ 10,000 Requested Submitted: 12/9/2014 1:59:13 PM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35647 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 $12 million operating budget and provides high-quality, affordable health care for patients of all ages, cultures and incomes at its two 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 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. Taking medication is an important element of patients achieving and maintaining wellness. This project will support a dedicated registered nurse for reviewing and facilitating patient medication refills to help ensure timely and appropriate 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.) 480 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. Medication prescription evaluation and refills are part of the ongoing services at Axis and are handled by our medical providers and support staff. This project aims to enhance patient service and improve treatment compliance by adding the focused services of a registered nurse to manage and facilitate the process. When doctors prescribe medications, this information is entered into patients' charts. At refill time, the RN will review the need for the medication and work with the patient and physician to ensure that all care needs are being met. For many patients with ongoing medication needs, such as insulin or blood pressure medicine, the RN will review and authorize renewals or schedule patients for check ups prior to reauthorization as appropriate. In addition to providing enhanced patient education, the refill nurse also relieves the administrative burden on our physicians, thus giving the providers more time to see patients. The addition of this position will allow us to add 1 – 2 more appointment slots to each of our doctor’s daily schedules. With a current waiting list of nearly thirty days for new patients, an increase in capacity is especially important to our ability to meet the health care needs of the Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35647 Tri-Valley’s low income population. 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 $10,000 will support a .14 FTE Registered Nurse to evaluate and facilitate prescription refill requests for 480 Dublin residents according to established Axis prescription protocols. The RN will complete prior authorizations for medications in accordance with insurance formularies, which ensures that patients with ongoing medication needs do not experience any disruption in treatment. Additionally, the RN will ensure that patients understand the role of their medications in their treatment plan and will provide health education about the condition for which the patient is being treated. The RN will document all services in patient charts, and ensure ongoing communication with the patients' provider and care team. These steps will contribute significantly to the health of Dublin residents receiving care at Axis. 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)? This project will result in several positive outcomes for patients: Patient service will be improved by reducing the wait time for receiving approvals for medication renewals. Patient care will be improved by ensuring that patients have all needed medications with no disruption; additionally patient care will improve as any needed check ups prior to medication renewal will be scheduled without delay. Patients will benefit from more health education provided by the RN about how their medications impact their condition and the importance of medication compliance. With an RN reviewing and performing medication checks, more provider time will be available for medical visits which will meet the growing need for more medical visits that we are experiencing as our patient population increases. Axis tracks all medication renewals in our robust electronic health records system. Data reports will be produced and reviewed by our Quality Enhancement team, under the direction of the Medical Director. The team meets monthly to address patient service, patient care and quality measures. 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 1,362 in 2013, a 35% increase in just four years (UDS Reports, 2011- 2014). 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. 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 preventive and primary medical services for low-income and uninsured Dublin residents. Half of Axis’s medical patients are limited English speakers. Axis promotes enrollment services, in English and Spanish, through community events, organizations and media outlets. Our four Enrollment Specialists and Community Relations Coordinator focus on reaching low-income, limited English speakers and other challenged populations, including those with disabilities, to assist them in overcoming common barriers to accessing care, such as language, cultural differences, or a lack of knowledge of how to enroll in public insurance. Other multi-lingual referral mechanisms include the patient services specialists who field calls from the public and the TeleMinder automated appointment-reminder service. In addition, Axis receives referrals from Alameda County’s 211 agency, whose staff has the capacity to speak to callers in more than 150 languages. All Axis services are designed to accommodate individuals with disabilities and to comply with the Americans with Disabilities Act. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Axis coordinates services on a number of levels. For patient care, we have cooperative agreements with partners regarding specific needs, such as ValleyCare Medical Center for obstetrics services and Highland Hospital for specialty medical services. Additionally, Axis is part of the Alameda Health Consortium and works with the other community health centers to assess community needs, identify new opportunities for collaboration, coordinate patient advocacy, delineate effective Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35647 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. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. This project meets a number of the City of Dublin’s Mission, Vision and Values. The project aligns with the Mission or Vision statement that “promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities.” This project provides more resources to meet the needs of the increasing numbers of Dublin residents using our services. Effective medication management directly impacts their care. This project aligns with Dublin’s Value that emphasizes “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.” Through this project, Dublin residents in our care will be educated about proper use of their medications and safe disposal of unused medications, which is an important safety issue for the Dublin community and for emergency services providers. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. This project is cost effective and reasonable because it will provide low-income Dublin residents ongoing assistance with their medication management which can reduce the need for and the costs associated with further medical interventions. For example, timely, appropriate refills of medications for asthma, diabetes or hypertension can prevent acute episodes requiring hospitalization. Of the approximately 960 Dublin adults receiving care at Axis, we expect 50%, or 480, will be served by the Prescription Refill Nurse at a cost of $20.83 per interaction. This money is well-spent by ensuring that patients understand the proper use of their medications, the importance of staying on medications to control chronic conditions, and to provide patients with immediate information regarding any questions on side effects, need for check ups or lab work, or other matters. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Axis is seeking funding for this patient care enhancement 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 $10,000 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 $10,000 we are seeking from the City of Dublin. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35647 be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. 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 Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35647 medical staff speaks a variety of languages, including Spanish, Hindi, Farsi, Mandarin, and Urdu and also has expert multicultural health care skills and specific knowledge relevant to serving low-income, culturally diverse communities. This expertise successfully transcends cultural and other barriers, creating a bridge to health care and a medical home for Dublin's underserved residents. 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35647 Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35647 Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: 480 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". 14 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) 466 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) 24 Disabled 77 Female Headed Households 19 Senior 0 Youth Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35647 10 Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 610.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" 164 White 188 White + HISPANIC 21 Black/African American 0 Black/African American + HISPANIC 87 Asian 0 Asian + HISPANIC 4 American Indian/Alaskan Native 0 American Indian/Alaskan Native + HISPANIC 7 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 9 Multi Racial + HISPANIC OR other Multi Racial 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 480.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). 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. Budget Funding Sources/Revenues Budget Amount Amount Committed City of Livermore USD$ 30,000.00 USD$ 0.00 City of Pleasanton USD$ 20,000.00 USD$ 0.00 Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35647 City of Dublin USD$ 10,000.00 USD$ 0.00 Other Grants USD$ 13,632.00 USD$ 0.00 Total USD$ 73,632.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Prescription Refill Nurse Salary USD$ 62,400.00 USD$ 0.00 Prescription Refill Nurse Benefits USD$ 11,232.00 USD$ 0.00 Total USD$ 73,632.00 USD$ 0.00 Budget Narrative The Prescription Refill Nurse (RN) will evaluate prescription refill requests according to established protocols, ensuring the timely and appropriate use of medications. This effort will ensure that low-income residents receiving treatment at Axis have better health outcomes. This grant request will support a .14 RN to manage medication refills for XXX Dublin residents. The request is based on an hourly rate of $30 X 291 hours salary plus benefits of 18%. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Axis Program Expense Budget Financial Information Form for ALL Grants 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 Agency 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 Board Authorized Official 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 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 Equal Opportunity for Employment REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" SECTION Axis Audit June 30 2014 REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. Axis Articles of Incorporation Axis By-Laws REQUIRED FOR CDBG ONLY- CONFLICT OF INTEREST STATEMENT (IF NOT INCLUDED IN BYLAWS) Standards of Conduct REQUIRED FOR CDBG ONLY-ORGANIZATION CHART Axis Organization Chart STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER 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 LEP/LAP Plan Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35647 REQUIRED FOR CDBG- LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35647 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35647 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). CALICO achieves justice and healing for abused children. Its mission is to provide a supportive environment to interview children and facilitate a collaborative response to child abuse in which the needs of children take precedence. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline CALICO Center Dublin Child Abuse Intervention CALICO Center 524 Estudillo Ave San Leandro, CA 94577 United States Tel: (510) 895-0702 Fax: (510) 895-0706 Web: www.calicocenter.org EIN: 94-3256781 DUNS: 019379754 Project Contact Victoria Gwiasda calicocenter@yahoo.com Tel: 510-895-0702 Additional Contacts none entered Executive Director Victoria Gwiasda calicocenter@yahoo.com USD$ 7,500 Requested Submitted: 12/10/2014 4:51:49 PM (Pacific) Application Questions Page 1 of 13Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36084 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), which creates and monitors programmatic activities. With an annual operating budget of over $800,000 (for countywide services), CALICO supports two interviewing sites, six full-time staff, and four 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 who reports to the CALICO Board of Directors and a District Attorney Liaison to observe interviews and ensure the integrity of investigations. Since 1997, CALICO has successfully facilitated nearly 10,000 multi-disciplinary child-abuse investigations, including over 150 involving Dublin victims. CALICO’s dedicated team of five Child Interview Specialists (CIS) possess over 50 years of experience at CALICO and have each conducted hundreds (and some cases thousands) of forensic interviews. CALICO's two Family Resource Specialists (FRS) are masters-level mental-health clinicians with specialized training in trauma-focused interventions for abuse victims. Two CIS and both FRS are bilingual Latinas who provide services in Spanish as needed. The CALICO Executive Director (ED) has nearly 20 years of senior management experience in public and not-for-profit violence prevention organizations, the last nine at CALICO. With the assistance of a Bookkeeper, the ED successfully manages complex public and private grants and a diverse financial portfolio. She will oversee this project, ensuring it is completed on time, within budget, and achieves the proposed goals. She will also oversee data collection and will submit reports as required. 8. Provide a brief summary of the project for which your agency is seeking funding (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. CALICO proposes to conduct 15 forensic interviews with 12-15 Dublin children who have been sexually or physically abused, provide support services to 10 caregivers of the Dublin victims, and facilitate a multi-disciplinary response to the allegations. 9. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED: client is counted only once regardless of number of services received in a year.) 22 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing 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 None of the above 11. Explain how this project will be implemented, administered, and operated. CALICO proposes to conduct 15 forensic interviews with 12-15 abused Dublin children and provide support services to 10 caregivers (which represents a 20% increase from FY14-15). Children will be referred primarily by Dublin Police Services (DPS) with some referrals from Alameda Co. 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 Page 2 of 13Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36084 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, child welfare 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, nights and weekends for situations that require immediate attention. Please note that our family support staff are also available, but funding for those positions will be covered by other sources. The estimated cost to ensure that CALICO staff are available, when needed, to respond to the increased number of referrals of Dublin children and families is approximately $16,500 in FY15-16. 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 objectives will your agency use to track the progress of meeting the outcome(s)? GOAL 1: Minimize trauma to abused children Obj. 1a. At least 75% of children interviewed will feel positive/neutral about their experience Obj. 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 Obj. 2a. A multi-disciplinary team (comprised of a prosecutor, Dublin detective, and/or child welfare worker) will observe at least 75% of interviews Obj. 2b. At least 70% of children eligible for a forensic medical exam will receive one Obj. 2c. At least 10% of Dublin cases will be reviewed in-depth at case review meetings GOAL 3: Promote support to and the mental health of the victim Obj. 3a. An FRS will provide psychoeducation to at least 75% of caregivers regarding the impact of trauma on children and appropriate parental response Obj. 3b. An FRS will initiate a California Victim Compensation Program (CalVCP) application on behalf of at least 75% of the victims to access funds for counseling Obj. 3c. At least 50% of caregivers will report in follow-up that their child is enrolled in counseling GOAL #4: Enhance support to and mental health of caregivers Obj. 4a. An FRS will conduct an on-site crisis assessment with at least 75% of families Obj. 4b. An FRS will initiate a CalVCP application on behalf of at least 50% of caregivers Obj. 4c. An FRS will contact at least 75% of caregivers by phone post-interview CALICO uses a robust database to track 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; the disposition of the criminal and social service cases; notes on cases discussed at Case Review; and extensive family support data, including caregiver demographics, the types of services provided on-site, status and outcome of follow-up calls, types of referrals provided, participation in counseling and assessment of 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 toddlers, children and adolescents (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 exposed to violence in their homes and communities. In the last five years, CALICO conducted 54 forensic interviews of Dublin childrenand 3 interviews with adults with developmental disabilities. Most of the victims were girls (65%), and most had been sexually abused (84%) and/or physically Page 3 of 13Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36084 hurt (18%). The victims were quite young, with over half (56%) age twelve and younger. Most identified as white (42%) or Latino (35%). They were primarily referred to CALICO by Dublin Police Services or child protective services. In 2014, we conducted more interviews of Dublin children than in any year prior (and continuing an upward trend from 2013). We anticipate serving a similar group and number of children in FY15-16. Children benefit from CALICO services because the services are child-focused, child-friendly and facilitated by staff who are specially trained to talk to children of all ages and developmental levels. In that way, children at 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; provide 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. Four CALICO staff are bilingual/bicultural Latinas who accommodate Spanish-speaking families as needed. Over the last five years, over one-third 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 will arrange for a court-certified interpreter and may use the services of the county’s language line. 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 with developmental disabilities (DD). CALICO recently devoted considerable attention to improving our county’s response to victims with developmental disabilities. In 2013, we created permanent changes to our multi-disciplinary team policies and practices. For example, through periodic trainings, CALICO increased the knowledge of its partner agencies regarding types of DD, the heightened risk of victimization of people with DD, and ways to facilitate their ability to give statements regarding their victimization. Related key lessons and themes are now embedded in CALICO’s core training curricula. In addition, we created buy-in across county agencies that cases involving victims or witnesses with DD need to be handled in a specialized, sensitive and diligent manner. Finally, we revised agency documents, including our intake form and the Alameda County Child Abuse Protocol, to incorporate Adult Protective Services into all services and add a section regarding forensic interviews of people with DD. 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. We have recently modified our procedures with regard to serving victims with developmental disabilities. We gather information upfront about the nature of the disability, and take into consideration situations that might impede a victim’s ability to participate in an interview. For example, when possible, we schedule interviews at times of the day that will maintain routines as to avoid creating undue anxiety for victims with autism. We also take into consideration any medication and its impact on levels of alertness throughout the day. Finally, we solicit information about the victim’s preferred method for communication (e.g., use of aids, electronics, etc.) to ensure the interviewing team is appropriately prepared. 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 thirty 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 McCarthy and other county leaders, Sgt. Rafael Alvarez is the DPS representative on CALICO’s Program Advisory Committee, (which meets monthly to guide policy and programming), and DPS detectives participate in monthly case-review meetings. Collaboration, for CALICO, extends well beyond facilitating joint child-abuse investigations between Dublin Police Services and the child-welfare system. CALICO has strategically crafted joint staffing positions to further advance its mission and better aid children. For example, CALICO is one of few non-profits that co-locates with a government partner – a prosecutor is assigned full-time to CALICO who observes interviews and advises on investigations. In addition, CALICO has built a Page 4 of 13Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36084 unique collaborative partnership with Children’s Hospital of Oakland. While the recency of the abuse determines whether a child is first interviewed at CALICO or treated at the hospital, to a family in crisis they make little distinction. Through two shared staff positions, CALICO and Children’s Hospital provide parallel services to families that are mutually reinforced regardless of which agency the family first visits. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. CALICO has strong working relationships with other community-based organizations based in the Tri-Valley area that provide legal, medical and therapeutic services to Dublin children and families that come through CALICO. CALICO’s Family Resource Specialists routinely refer families to the following agencies: Tri-Valley Haven (families are referred for restraining orders for domestic violence, legal custody issues, sexual assault and domestic violence counseling services, and for basic needs such as food, shelter and clothing); Axis Clinic (for counseling services); and individual mental-health clinicians who are approved to accept California Victim Compensation Program reimbursement. As noted previously, CALICO does not do direct marketing to families, as all referrals must come via law enforcement or child welfare workers. However, we do 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. Approx. 100 professionals attend 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. Finally, CALICO recently welcomed a new board member from Ross Stores in Dublin. Leslie Oestreicher, the Director of Corporate Social Responsibility & Sustainability, joined the board for a three-year term starting in April. She is helping CALICO in its outreach strategies to corporations, including Ross 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. CALICO’s services closely match the City of Dublin’s mission, vision values and strategies. It terms of the City’s mission/vision, CALICO “supports a high quality of life and ensures a safe and secure environment.” When a situation 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." 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. CALICO services are designed to be cost-effective as they eliminate duplication while raising quality. Prior to CALICO, Dublin detectives and child welfare workers would conduct independent, overlapping investigations, which raised the overall costs. In addition, high-quality investigations require professionals who are adequately trained. Given the dozens of patrol officers, detectives and child welfare workers who could be assigned to investigate a child-abuse allegation 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 and child welfare workers. In that case, the City of Dublin would incur considerably more costs by taking on Page 5 of 13Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36084 those tasks themselves and would get less value for that investment than they do by engaging CALICO services. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? CALICO aims to provide services to all children referred to us from Dublin detectives and child welfare workers. 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). 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Page 6 of 13Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36084 Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. 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 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 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: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *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: Page 7 of 13Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36084 * 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. F) Not Applicable. I am not interested in qualifying for CDBG funding. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Page 8 of 13Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36084 Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Page 9 of 13Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36084 Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: 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". 15 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) 7 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) 1 Disabled 7 Female Headed Households 1 Senior 11 Youth 0 Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 42.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" 6 White 6 White + HISPANIC 3 Black/African American 1 Black/African American + HISPANIC 2 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 Page 10 of 13Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36084 4 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 22.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). 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. Budget Funding Sources/Revenues Budget Amount Amount Committed Request from City of Dublin USD$ 7,500.00 Dublin Police Services USD$ 4,000.00 Alameda County District Attorney Office (in-kind) USD$ 2,600.00 USD$ 2,600.00 First 5 Alameda County USD$ 1,000.00 Alameda County Social Services Agency USD$ 1,400.00 Total USD$ 16,500.00 USD$ 2,600.00 Funding Uses/Expenses Budget Amount Amount Committed Personnel: Salary USD$ 10,475.00 USD$ 1,850.00 Personnel: Benefits USD$ 2,800.00 USD$ 750.00 Supplies USD$ 190.00 Printing USD$ 60.00 Postage USD$ 60.00 Communications USD$ 100.00 Rent/Utilities USD$ 750.00 Audit USD$ 100.00 Contracted Services USD$ 500.00 Other Expenses USD$ 1,465.00 Total USD$ 16,500.00 USD$ 2,600.00 Budget Narrative The request of $7,500 from the City of Dublin will support nearly one hour per week of four members of the Child Interview Specialist team, as follows, to ensure there is full-time coverage to support Dublin children: Child Interview Specialist (1), $39.00 per hour x 45 hours +23.7% benefits = $2,170 Child Interview Specialist (2), $25.75 per hour x 44 hours +23.7% benefits = $1,400 Child Interview Specialist (3), $38.29 per hour x 45 hours +23.7% benefits = $2,130 Child Interview Specialist (4), $33.11 per hour x 44 hours +23.7% benefits = $1,800 CALICO's current benefit rate of 23.7% includes payroll tax, workers comp, FICA, health, vision, dental, and 403b matching. The $1,465 in other costs include funds for miscellaneous expenses, (e.g., insurance, licenses, fees, parking, mileage) Page 11 of 13Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36084 and training for CALICO staff, Dublin detectives and other professionals serving Dublin families. The funding secured to date for this project is $2,600 in in-kind support from the District Attorney's office that covers a portion of the salary and benefits of the Executive Director related to this project. Also, CALICO is expecting year 3 funding of a three-year contract from Alameda County Social Services Agency, but a contract for FY15-16 is not yet executed. The remaining funds are expected to be received from Dublin Police Services (a request will be made by January 2015) and request for funding to Alameda County First 5. CALICO currently receives First 5 funding, but is in year 2 of a two- year contract so will need to re-apply competitively for a grant beginning FY15-16. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Program Expense Form Financial Information Form for ALL Grants 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 CALICO Operating Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) IRS Form 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) Funding Request Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation Insurance 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 Employee Policies REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" SECTION Agency Audit REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. Articles of Incorporation Bylaws REQUIRED FOR CDBG ONLY- CONFLICT OF INTEREST STATEMENT (IF NOT INCLUDED IN BYLAWS) Conflict of Interest Policy REQUIRED FOR CDBG ONLY-ORGANIZATION CHART Organization Chart STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER State Determination Letter Federal 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Page 12 of 13Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36084 Application ID: 36084 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 13 of 13Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36084 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). CARD works to transform emergency preparedness and disaster response into a fear-free, empowering, and immediately beneficial pursuit for all. We help nonprofits, faith agencies, and other stakeholders to create a connected and resilient community. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline CARD - Collaborating Agencies Responding to Disasters Helping Dublin Prepare To Prosper! CARD - Collaborating Agencies Responding to Disasters 1736 Franklin Street Suite 450 Oakland, CA 94612 Tel: 510.451.3140 Fax: Web: www.CARDcanhelp.org EIN: DUNS: Project Contact Lars Eric Holm larseric@cardcanhelp.org Tel: 510.451.3140 Additional Contacts AMJ@CARDcanhelp.org, Fola@CARDcanhelp.org Executive Director Ana-Marie Jones AMJ@CARDcanhelp.org USD$ 25,000 Requested Submitted: 12/11/2014 11:28:41 AM (Pacific) Application Questions Page 1 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35685 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.). CARD has been providing emergency preparedness, disaster response, and business continuity services to the service sector for 25 years, and we are the agency designated by the Alameda County Office of Emergency Services and Homeland Security for providing these services across the Alameda County Operational Area. CARD is also the designated agency chosen by several foundations and other government partners (including the Alameda County Public Health Department) to support the full engagement of vulnerable communities and the nonprofits and faith agencies that support them in a range of emergency services related endeavors. Over the last several years CARD has been recognized for our ability to provide these services. Recognition has been in the form of several awards, including: CARD: - Three Cable Television Telly Awards - FEMA Award “Project Impact” - CESA (California Emergency Services Association) Gold Award - Resolution from the Alameda County Board of Supervisors Ana-Marie Jones, our executive director: - Hall of Fame, International Women in Homeland Security and Emergency Management - Named “Major Player”, Emergency Management Magazine - Women Who Dare Award, from Girls Inc. Our capacity to deliver our customized services — consistently, professionally, and to the high satisfaction of our audiences — is well documented by many hundreds of evaluations, as well as by multiple letters of support, and many online recommendations and endorsements. We are happy to provide letters of reference, testimonials, and local references for our work. 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. CARD will engage a variety of community stakeholders in emergency preparedness, disaster response, and business continuity. We will engage Dublin audiences using our fear-free empowerment model, culturally appropriate tools, trainings, and curricula. 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.) At least 15%-20% of Dublin residents depend on the services of community agencies, and this project targets those service providers. We hope to directly engage over 200 representatives from Dublin agencies. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above Page 2 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35685 11. Explain how this project will be implemented, administered, and operated. Working with City of Dublin staff and designated partners, CARD will plan and deliver a variety of community engagements, trainings, and on-line offerings (Webinars, Twitter chats, conference calls, posted videos, etc). CARD will work with nonprofit organizations, faith agencies, and local government partners to provide appropriate, accessible, and consistent preparedness support to vulnerable communities. Trained and experienced CARD staff will deliver the content, as well as custom-tailor tools to be used by any Dublin agency, business, or service group. CARD staff will also handle administrative tasks and logistics, including tracking evaluations, attendance lists, scheduling, and maintaining finances and the budget. We will conduct outreach and support using e-mail, social media, in-person, telephone, etc. Major initiatives include providing trainings and presentations, distributing tools, and providing support to agencies and county departments via consultations, facilitations, debriefs, social media support, exercises, etc. Expected Outcomes: - CARD support available to City of Dublin staff. - A minimum of eight community engagements delivered (trainings, consultations, facilitations, webinars, conference calls, Twitter chats, and presentations). - Tools and support provided. - Evaluations administered. - Documentation of improved knowledge, skills, comfort level, participation, etc. - Minimum of 200 representatives from Dublin service agencies engaged. 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 from the City of Dublin will primarily be used for: salaries for staff to conduct the outreach, training, and followup to the community partners, and of course, we have expenses related to transit costs, reproduction of tools, incidentals, tool development, and printing, etc. To make this project successful for the community service providers located in and around the City of Dublin, CARD staff will be engaged in the following activities: - Outreach to nonprofits, faith agencies, and service providers. - Tailoring tools and curricula for City of Dublin audiences. - Delivering classes, presentations, and public events related to emergency preparedness, disaster response, and community continuity planning. - Working with designated City of Dublin staff to ensure all resources are leveraged to their greatest potential. These funds, generously granted by the City of Dublin, will be used to meaningfully engage your key local stakeholder groups in an empowering approach to agency, community, and individual preparedness. These dollars will fund CARD to plan and execute the delivery of this project. 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)? As a result of this grant: City of Dublin nonprofits, faith agencies, and service providers will have been provided multiple opportunities to engage in a variety of preparedness related activities. CARD will have created and custom-tailored a variety of tools, resources, and products for use by the businesses and agencies of the City of Dublin. City of Dublin participants will have engaged in emergency preparedness and safety-related events in person, by email, mail, phone, or via online portals. CARD will have worked with the designated City of Dublin staff to ensure resources provided by the City are appropriately included in the engagements. City of Dublin's designated representative will have been given access to the various evaluations, polls, and related feedback from the participants. We will track the progress of the outcomes via on-line evaluations and polls, written evaluations and polls, and conversations with trainees. We will follow up and regularly be available to City of Dublin staff, to ensure fulfillment. 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 ultimate beneficiaries of CARD’s work includes the members of our community who are: frail elderly, infants and children, people with disabilities, homeless people, limited English proficiency (LEP) residents, medically fragile individuals, low-income families, clients of the criminal justice system, religious communities, and others in culturally isolated and marginalized communities. These are the people whose unique and ever-changing preparedness needs are hardest to address through traditional government means, and these are the people who suffer more adverse impact from disasters and the social service disruptions disasters cause. The individuals we will target for direct engagement in our offerings include the staff, volunteers, and leadership of nonprofits, faith agencies, and service groups inside the City of Dublin and Page 3 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35685 neighboring jurisdictions. While it is impossible for any jurisdiction to reach, protect, and serve all people in any vulnerable population group, using CARD’s “Prepare to Prosper” model, tools, and approach, the City of Dublin can help build the capacity of the city’s diverse service providers to be stronger, more resilient businesses, and proactive partners in addressing the emergency preparedness and disaster response needs of the vulnerable communities they serve. All of CARD’s public offerings made possible with this funding will, of course, be open to City of Dublin staff, especially those with responsibilities for providing direct service to vulnerable and at-risk residents. Designated representatives from the City of Dublin are also welcomed to invite other community partners and vendors, based on available seating in these public offerings. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? CARD’s mission and entire framework rests on the principles of making all aspects of emergency preparedness and disaster response culturally appropriate and accessible for the most vulnerable communities. Specifically, we have created tools for the lowest income communities and rewritten and reframed response conversations to respect the missions, mindsets, and muscles of our partners and the communities they serve. To reach diverse and often underserved members of our public, CARD targets and partners with the nonprofits, faith agencies, and service providers who together form the safety net for people in need. Rather than random acts of preparedness or trying to engage disconnected individuals, CARD’s focus is on serving the needs of agencies whose missions, commitments, and resources allow them to sustainably and successfully engage with these communities. Many of our stakeholders in public health related agencies whole-heartedly embrace our “Prepare for Health” framework. Collaborators with religious agencies are often drawn to our ability to incorporate some of the most deeply cherished aspects of their faith as part of their preparedness and planning contributions. At CARD, we believe that freed from politics and bureaucratic constraints, empowered preparedness can help us transform our communities, our health, and our economy. 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 vast majority of CARD’s outreach to vulnerable communities is done in close partnership with local community agencies. We most often choose trusted partners with established relationships with the target audience. CARD staff also use any resources that can be made available by the City of Dublin, and we will use the Eden I&R database to supplement any needed research. We have two Spanish-speaking trainers on staff, and we can work with our community resources to fill other language needs if requested. We will conduct outreach for this project first and foremost in partnership with the nonprofit, faith, and service agencies currently serving the needs of Dublin residents. We will work with these providers to help them embrace emergency preparedness and planning efforts. CARD’s planning and organizing support can take the form of creating flyers, posters, handouts, blog posts, and other tools to support direct outreach, as well as arranging conference calls and planning meetings. CARD staff will also work with available City of Dublin staff to ensure that this project is leveraging currently available City resources, including but not limited to: Parks and Recreation assets, public buildings, social services programs, City publications, local media assets, etc. CARD uses social media platforms (Facebook, LinkedIn, Twitter, YouTube, etc.) to reach potential audiences, as well as our own internal database of agencies. Your community agencies will be given many choices as to how they would like to engage in this preparedness and safety initiative. Whether it’s open public events, or smaller private trainings, or perhaps direct consultation over the phone, or a “staff only” webinar, we have multiple ways to make this work for the agencies serving the people of Dublin. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. CARD partners with hundreds of agencies across the region, and many government stakeholders. Each of these partners come with different missions, muscles, and mindsets that allow them to reach, serve, and empower vulnerable communities. Rather than trying to engage disconnected individuals, CARD’s focus is on serving the needs of agencies whose missions, commitments, and resources allow them to sustainably and successfully engage with vulnerable people. We work in partnership with several entities whose membership includes people with commitments to serve the people of Dublin. This includes our partners in Alameda County Social Services, the Alameda County Community Food Bank, Eden Information & Referral, Alameda County Public Health Department, CRIL- Community Resources for Independent Living, VOAD - Voluntary Organizations Active in Disasters, Alameda County EMA (Emergency Managers Association), CESA (California Emergency Services Association), and more. Traditionally, nonprofits have been pushed and prodded to embrace conventional approaches to readiness, with little success. With this project the capabilities of these different partners is incorporated into the approach. A simple example is a childcare agency: the staff cannot and should not attempt to prepare their agency and protect the children using the same information as an agency serving homeless adults. Rather, it is more effective to leverage the childcare agency's access to parents, their existing protocols and regulations, and incorporate key concepts into their existing specialized trainings. Generic messaging for preparedness and response, delivered by messengers without relevant capabilities, wastes resources and causes people to ignore the preparedness message. This approach allows for all partners to better integrate preparedness concepts and helpful habits into their everyday programs and services. Page 4 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35685 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. CARD conducts outreach in many ways, with the following methods being the most common: - Phone calls - Emails - Sharing in public venues - Fliers/posters - Social media For the reasons described earlier, we do not conduct random outreach to Dublin residents, rather our outreach is targeted to service providers, whose clients and consumers are dependent on these agencies for critical support on a day-to-day basis. In the last year CARD has participated in over 25 events in Dublin. Some of these events include: - City of Dublin faith community breakfast - Bay Area Community Health Resilience Forum - Alameda County VOAD Meeting - Hurricane Sandy Lessons Learned Workshop - Golden Guardian exercise planning meetings - EMA meetings Due to cutbacks in County funding we will not be able to respond to the needs and requests of City of Dublin agencies without this support. Further, rather than simply responding to the requests from Dublin's community agencies, this funding will allow us to proactively offer support to nonprofits, faith agencies, and other support services that, for whatever reason, have not been proactive in engaging in community preparedness activities. If the City of Dublin specifically requests our support to conduct outreach directly to Dublin residents, we would, of course, be happy to provide assistance. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. CARD's offerings are framed and tailored specifically to fill the gap that local government and traditional disaster resources cannot. By funding this project, the City is actively demonstrating a commitment to strengthening the safety net and helping all communities to have access to the culturally appropriate emergency preparedness and safety support they need. With CARD's open door policy and active facilitation style, all agencies participating in these offerings learn how to best leverage each other's strengths, solve shared problems, and create stronger, more authentic, and rewarding partnerships. With this empowered platform for action, we promote and support the higher quality of life Dubliners seek, and it more readily fosters new opportunities and partnerships. CARD's work in this domain comes from the perspective of balancing history with being progressive, and looking at this conversation from the perspective of creating equity, balance, and opportunity for all Dublin residents. In this CARD - City of Dublin partnership, preparedness will be presented as a positive, life-affirming, sustainable, and culturally appropriate benefit for any audience. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. This project is highly cost effective, as CARD has long specialized in making preparedness effective, sustainable, and accessible for our lowest income communities — this requires that our services and offerings be cost appropriate. Normally, hiring a consultant to create custom-tailored tools and presentations for specialized audiences is an expensive undertaking. However, by engaging CARD you are literally leveraging the knowledge base and experience that has been built through years of research, and working directly with these communities since the start of the nonprofit preparedness movement. You are further leveraging funding from many sources, including funding from local supporters, and from other states and jurisdictions. Beyond being “reasonable”, many of CARD’s costs are considerably lower than what you would pay if you tried to provide these services through for-profit consultants, in part because we receive many nonprofit discounts for several of the services and supplies we use. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? This project of bringing empowered preparedness to the service providers of Dublin simply will not happen without funding from the City of Dublin. Due to budget cuts at the County level, we cannot offer the same level of service we have offered in the past. CARD cannot offer our trainings, especially with the highly successful open-door policy (meaning that local business, government partners, and interested stakeholders can freely join in) unless we receive support from the City of Dublin. Recent acts of civil unrest, both in the streets of neighboring cities, as well as on BART, continues to cause an increase in demand for our services. Further, the recent storm has raised concern for many disabled and older residents about who will come to their aid in a disaster or crisis situation. Without funding for this project, we will need to refer many of the requests we get for service back to the City. Sadly, we do know that many of the agencies requesting our services are doing so specifically because we are able to give them what local jurisdictions cannot, so this would translate to agencies not getting the support they need. Page 5 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35685 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. Page 6 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35685 No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Page 7 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35685 Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Page 8 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35685 Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Page 9 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35685 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). Traditionally, we have NOT been dependent on this grant program. Our work in Dublin has long been funded by other Page 10 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35685 partners. We will look to build partnerships with local Dublin businesses through this grant to secure ongoing support. Budget Funding Sources/Revenues Budget Amount Amount Committed -none-USD$ 0.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Personnel Expenses: Salaries USD$ 18,275.00 Personnel Expenses: Benefits USD$ 3,225.00 Operating Expenses: Supplies USD$ 500.00 Operating Expenses: Printing/Copying USD$ 1,500.00 Operating Expenses: Other (Mileage and Incidentals) USD$ 1,500.00 Total USD$ 25,000.00 USD$ 0.00 Budget Narrative This project is highly cost effective, as CARD has long specialized in making preparedness effective, sustainable, and accessible for our lowest income communities — this requires that our services and offerings be cost appropriate. Normally, hiring a consultant to create custom-tailored tools and presentations for specialized audiences is an expensive undertaking. However, by engaging CARD you are literally leveraging the knowledge base and experience that has been built through years of research, and working directly with these communities since the start of the nonprofit preparedness movement. You are further leveraging funding from many sources, including funding from our supporters, and from other states and jurisdictions. Beyond being “reasonable”, many of CARD’s costs are considerably lower than what you would pay if you tried to provide these services through for-profit consultants, because we receive many nonprofit discounts for several of the services and supplies we use. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Program Expense Budget for ALL Grants Financial Information Form for ALL Grants download template Financial Information Form for ALL Grants List of Board of Directors (or governing body) with contact information List of Board of Directors Current Annual Budget for the Entire Agency CARD's 2014-2015 Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) 2012-2013 990 Board of Director's (or governing body's) designation of authorized official Board of Director's Board of Director's Board of Director's (or governing body's) authorization to request funding (may be same document as one above) Board of Director's Proof of insurance carried, including bonding, liability and/or workers' compensation Liability and Worker's comp 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 Page 11 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35685 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 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35685 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 12 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35685 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). CCDS 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? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. CCDS receives $90K/year from Alameda County's DRPA grant. $15K/year is allocated to the youth courts. Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Center for Community Dispute Settlement Tri Valley Youth Court Center for Community Dispute Settlement 291 McLeod Street Livermore, CA 94550 Tel: 925-373-1035 Fax: 925-262-4680 Web: http://www.trivalleymediation.com EIN: 94-3207385 DUNS: Project Contact Tonya Clenney tonyaclenney@communityyouthcourts.com Tel: 925-337-7175 Additional Contacts none entered Executive Director Diane Jeronimo diane.jeronimo@comcast.net USD$ 3,500 Requested Submitted: 12/11/2014 3:59:48 PM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36198 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 DUSD Peer Council, Eden Township Youth Court, Castro Valley Youth Court, Hayward Youth Court, San Leandro Youth Court, 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.) We have served an average of 21 Dublin students per year since 2008. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. 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 (25) and youth (129) 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 Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36198 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 four or five 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 153 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 7%. 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. In addition, we are in the process of developing a confidentiality form that will allow us to access the participating youth’s criminal record until they are 18 for statistical purposes only. 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 and middle-income youth and their families. Currently, 37% of the participating families from Dublin can only afford to pay a portion of the fee and 26% 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 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 individual and their family that participates in the youth court. 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 crime 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 needs. 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 most 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 now meet once a year to 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 to develop the DUSD Peer Council. The Peer Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36198 Council has been active since February of this year. We speak monthly to ensure that the program is affecting the change that they are looking for. Many of our Dublin high school volunteers and clients sit on the DUSD Peer Council. 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 two booths at the Dublin Splatter event for the last two years 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. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. CCDS is requesting funding for the Tri Valley Youth Court (TVYC). This program serves Dublin residents by providing at-risk youth who have committed a misdemeanor or lessor crime an opportunity to give back to the victim(s) of their crime and learn from their experience. 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. 20. 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 (~30% of cases). 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If this application does not receive funding 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. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36198 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36198 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. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36198 Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36198 Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36198 Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). CCDS is currently looking for corporate sponsors for Community Youth Courts and we will remain a fee-for-service program. Budget Funding Sources/Revenues Budget Amount Amount Committed Alameda County DRPA Grant USD$ 15,000.00 USD$ 15,000.00 Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36198 First Presbyterian Church of Livermore USD$ 0.00 USD$ 827.63 Collected Participation Fees USD$ 7,650.00 USD$ 3,670.00 LLNL Home Campaign USD$ 0.00 USD$ 135.00 Community Donations USD$ 500.00 USD$ 500.00 In Kind Donation: Volunteer Time USD$ 24,138.00 USD$ 24,138.00 In Kind Donation: Office Space USD$ 800.00 USD$ 800.00 In Kind Donation: Equipment Rental USD$ 600.00 USD$ 600.00 USD$ 0.00 USD$ 0.00 Total USD$ 48,688.00 USD$ 45,670.63 Funding Uses/Expenses Budget Amount Amount Committed Salary: Program Director .5 FTE USD$ 14,000.00 USD$ 14,000.00 Benefits: Workers Comp USD$ 230.00 USD$ 230.00 Benefits: Payroll Taxes USD$ 1,411.00 USD$ 1,411.00 Professional Development USD$ 1,000.00 USD$ 1,000.00 Marketing/Outreach (web page) USD$ 368.00 USD$ 368.00 Supplies USD$ 800.00 USD$ 790.00 Telephone USD$ 700.00 USD$ 722.00 Volunteer Appreciation USD$ 5,000.00 USD$ 4,833.00 Anger Management for Clients USD$ 827.63 USD$ 1,080.00 USD$ 0.00 USD$ 0.00 Total USD$ 24,336.63 USD$ 24,434.00 Budget Narrative Funding Sources/Revenues The Alameda County DRPA Grant has provided CCDS $15000/year for the Tri Valley Youth Court. We are coming up on grant renewal time and we have been told that the amount of Alameda County DRPA funds has been reduced. 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 31 youth and their families this year. Only 12 youth and their families have been able to pay the full participation fee. An additional nine families were able to make partial payments and ten families were not able to pay any fee at all. Lawrence Livermore National Laboratory (LLNL) Home Campaign: We have been very lucky to be included on the LLNL Home Campaign this year. LLNL offers employees an opportunity to give a percentage of their paycheck to a charity of their choice. Community Donations: This includes money donated from members of the community. In Kind Donations: OrgMetrics donates office space and office equipment to CCDS and Community Youth Courts. Funding Uses/Expenses The Program Director is paid $14,000/year for a half time position Marketing/Outreach: Community Youth Courts maintains a webpage with information about each youth court. Supplies: This includes paper, printer ink, folders, pens, postage, etc. Telephone: phone and fax lines. Volunteer Appreciation: Gift cards for youth volunteers and one Volunteer Appreciation event for adult volunteers. Anger Management: TVYC pays the anger management fees for clients who cannot afford to pay. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Program Expenses for FY 2015-16 CCDS Financial Information Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36198 Financial Information Form for ALL Grants download template List of Board of Directors (or governing body) with contact information CCDS Board of Directors Current Annual Budget for the Entire Agency CCDS 2014 Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) CCDS Form 990 2013 Board of Director's (or governing body's) designation of authorized official CCDS BOD Letter of Designation and Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) CCDS BOD Letter of Designation and Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation CCDS 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 CCDS 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 36198 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36198 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). To provide resources and services in support of employers and all job, training, and education seekers. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (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 Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Chabot-Las Positas Community College District/Tri Valley One Stop Career Center Project Dublin Chabot-Las Positas Community College District/Tri Valley One Stop Career Center 7600 Dublin Blvd Dublin, CA 94568 United States Tel: (925) 560-9431 Fax: (925) 591-9100 Web: Trivalleyonestop.org EIN: 94-167063 DUNS: 94-167063 Project Contact Rafael Valle rvalle@clpccd.org Tel: 925-560-9439 Additional Contacts none entered Chancellor Jannett Jackson jjackson@clpccd.org USD$ 12,000 Requested Submitted: 12/9/2014 10:02:46 AM (Pacific) Application Questions Page 1 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36099 governing body, fiscal staff resources, skills and experience, etc.). The Las Positas College/Tri-Valley One Stop management consists of Las Positas College leadership in the form of Vice President of Student Services Diana Rodriguez who oversees all program activities. Additionally, Rafael Valle functions as Director of the Career Center and reports directly to Mrs. Rodriguez. All laws and regulations are stipulated via federal law through the Alameda County Workforce Investment Board staff and Board of Directors. Fiscal staff resources are dictated annually and are dependent on the federal funding allocation administered by the Alameda County Workforce Investment Board. Vice President Diana Rodriguez has significant years of experiences in planning and negotiations. Furthermore, Rafael Valle has over 5 years of working experience in One Stop operations and holds an advanced degree in counseling. 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 workforce development activities to Dublin citizens categorically classified as job seekers, laid off workers/displaced workers, youth, new entrants to the workforce, veterans, persons with disabilities, ex-offenders and services for employers. 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.) Center expects approximately 3,600 unduplicated Dublin residents to be served by this project. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. Project Dublin will be implemented by skilled career center counselors meeting with Dublin citizens and addressing any barriers the client may be experiencing in finding gainful employment. Administration and operation goals will strictly be monitored by Las Positas College and the Alameda County Workforce Investment Board. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). Requested funds would be used to provide workforce development activities to Dublin citizens categorically classified as job seekers, laid off worker/displaced workers, youth, new entrants to the workforce, veterans, persons with disabilities, ex- offenders and services for employers. This program is an extension of services offered at the Chabot-Las Positas College/Tri-Valley One-Stop Career Center acting in compliance with the Federal Workforce Investment Act of 1998. Examples of services are as follow: Core, intensive training and outreach programs to youth and ex-offenders. Also, in the upcoming year 2015 we are already scheduled to offer resume and tips letter writing workshops at the Dublin library. Page 2 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36099 Core services consist of labor market information, initial assessment of skill levels, job search and placement assistance. Development of Individual Employment Plan, vocational counseling, development of professional resume (s), personalized and video-taped mock interview sessions and feedback, job development and job referrals. Financial assistance addressing mental health concerns, testing services (i.e. typing tests, software assessment skills test, etc.) financial assistance to purchase appropriate textbooks or job-specific equipment/licenses (i.e. tools sets, nursing uniforms, construction steel toe boots, hazmat endorsements, etc.), reimbursement of certain parking fees, reimbursement of certain transportation fees; vocational training programs; job retention services; and on-the-job training (OJT) services. Intensive services are available to eligible unemployed individuals who have completed at least one core service, but have not been able to obtain employment, or employed individuals needing additional services to obtain or keep employment that will lead to personal self-sufficiency. 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 center will track Dublin citizens via our East Bay Works Online previously known as Virtual One Stop System (VOS). Specific services are recorded such as career counseling, resume writing, interviewing workshops. Furthermore, precise trainings are also carefully tracked and accounted for when Dublin citizens need and desire to upgrade their marketable skills. 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 targeted populations to be served are Job seekers laid off workers/displaced workers, youth, new entrants to the workforce, veterans, and persons with disabilities and employers. How are they benefiting from these services: By providing resources and services in support of employers and all job, training, and education seekers, Dublin residents become more marketable in the job market leading to permanent employment. All of our services are free of charge, ALWAYS! 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? The Las Positas College/Tri Valley One Stop Career Center are dedicated to working with all individuals from varied socio- economic statuses and cultural backgrounds. Furthermore, we work in conjunction with the State Unemployment Development Department in order to gain a clearer understanding of the greater east bay area and the citizens which we serve. An EDD representative in on site one day a week to assist veterans who are in need of unemployment assistance. And lastly, we have a psychologist onsite who provides stress counseling to reduce depression and barriers and to maximize job seeker’s potential. 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 primary language other than English most encountered at the center is Spanish. Thus, we have outreach materials in the Spanish language. Furthermore, we have two full time employees and one part time employee that are fluent in Spanish. In regards to disable persons, one of our partners is the State Department of Rehabilitation which is on site three days a week to assist individuals with disabilities. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. The Tri-Valley One Stop Career Center is in partnership with the Employment Development Department and provides mutual assistance to job seekers. Workability Department at LPC works with students with disabilities; they provide a more personal service by assigning an employee to their students when in need of seeking employment. We also partner with them to ensure a full integration of services is provided. We are certainly attempting to pursue economic development initiatives that attract new businesses initiatives as well as supporting and reinforcing the existing businesses. Partners meetings involves the Economic Department of the City of Dublin, City of Pleasanton, City of Livermore, and other vital partners to collaborate in projects such as job fairs, Alameda County Sheriff’s Office annual re-entry expo, Federal Correctional Institution – Mock job fair, Honor a hero/Hire a veteran event, and other potential events soon to be coordinated. 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. The Las Positas College / Tri Valley One-Stop coordinates with the Dublin Library ongoing basis to conduct various employment related workshops as necessary. We also provide services to the Dublin Federal Correctional Institution and The Santa Rita Jail. Page 3 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36099 Lastly, anytime we are notified by the Alameda County Workforce Investment Board that a mass layoff will take place in Dublin, We work closely with the employer in order to provide rapid response services to those workers who will be losing their jobs. These services include assistance with unemployment insurance, resume writing, interviewing, job leads and in some instances re-training. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. By allowing and/or increasing the chance of Dublin residents obtaining sustainable employment, the Tri-Valley One Stop Career Center is promoting and supporting a high quality of life ensuring safe and secure environment that fosters new opportunities. We are also providing development and positively contributing to the City’s fiscal health. And lastly, economic development is taking place by attracting and working with new employers and also by continued working and strengthening existing businesses. Overall, the project will assist Dublin residents, youth, adults, and seniors, to become economically self-sufficient and to empower them with the skills, tools and resources to remain competitive in a rapidly changing global economy. The Dublin community will ultimately be able to reap the benefits of an educated and competitive workforce. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Last year's 2014-2015 $10,000 contribution was utilized to offset a total of $84,526 in re-training programs of 24 Dublin residents. The previous year 2013-2014 $10,000 contribution was utilized to offset a total of $ 79,981 in re-training programs of 21 Dublin residents. In 2012-2013 $14,000.00 contribution was utilized to offset a total of $67,349.00 in re-training programs for 18 Dublin residents. Being that we anticipate another difficult economic year of possible lay off Dublin workers, the proposed $12,000.00 would be directly applied to those Dublin citizens most in need of re-training. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? The Tri-Valley One-Stop Career Center’s budget was cut by 16.3% in 2014-2015 from $393,633 to $329,199, 45% in 2011-2012, and it was later reviewed by the Workforce Investment Board and re-adjusted budget by 13.8% from $393,633 to $457,000, in 2012-2013 budget was cut by 2%, and cut again 12% for the current 2013-2014 budget whereby some Dublin individuals may be unable to get into retraining programs. The decreased in our budget will ultimately affect Dublin residents and re-training possibilities will strictly be driven by our own budget. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Page 4 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36099 Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: Page 5 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36099 A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. 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. F) Not Applicable. I am not interested in qualifying for CDBG funding. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Page 6 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36099 Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Page 7 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36099 Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Page 8 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36099 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). Tri-Valley One Stop Career Center is actively seeking for funding from private and other public sources. Another alternative is to possibly start charging employers for job fairs, employment services, etc. Budget Funding Sources/Revenues Budget Amount Amount Committed Workforce Investment Act USD$ 329,199.00 USD$ 329,199.00 Total USD$ 329,199.00 USD$ 329,199.00 Funding Uses/Expenses Budget Amount Amount Committed Staff Salaries USD$ 287,547.00 USD$ 287,547.00 Staff Fringe Benefits USD$ 17,252.00 USD$ 17,252.00 Staff Travel USD$ 2,500.00 USD$ 2,500.00 Staff Training/Conferences USD$ 3,500.00 USD$ 3,500.00 Facilities Operations USD$ 3,400.00 USD$ 3,400.00 Office Operations USD$ 4,000.00 USD$ 4,000.00 Suportive Services USD$ 1,000.00 USD$ 1,000.00 MSG grant services USD$ 10,000.00 USD$ 10,000.00 Total USD$ 329,199.00 USD$ 329,199.00 Budget Narrative We are closely/strictly monitored by the Workforce investment Board regarding our expenses. The above is a representation of how our expenses are allocated based on current funding levels pertaining to 2014- 2015 fiscal year. Documents Page 9 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36099 Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Program Expense Budget 2014-15 Financial Information Form for ALL Grants download template Financial Information List of Board of Directors (or governing body) with contact information Board of Directors Board of Directors Current Annual Budget for the Entire Agency Annual Budget for entire agency Copy of most recently submitted IRS 990 form or Tax Return (include complete form) IRS990 form Board of Director's (or governing body's) designation of authorized official BOD designation authorized official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) BOD requesting funding 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 Nonprofit 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 36099 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 10 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36099 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Providing resources that strengthen and support children and their families 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (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 Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Child Care Links Early Childhood Education Child Care Links 6601 Owens Dr. Ste 100 Pleasanton, CA 94588 United States Tel: (925) 417-8733 Fax: (925) 730-4942 Web: www.childcarelinks.org EIN: 94-2379571 DUNS: Project Contact Carol Thompson cthompson@childcarelinks.org Tel: (925) 417-8733 Additional Contacts dfuller@childcarelinks.org Executive Director Carol Thompson cthompson@childcarelinks.org USD$ 25,000 Requested Submitted: 12/10/2014 3:45:35 PM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35848 governing body, fiscal staff resources, skills and experience, etc.). For over 38 years, Child Care Links has remained a stable fixture in the Tri-Valley community. The agency’s dedication to its mission statement of providing support and resources to the Tri-Valley community is consistently seen in its growing and innovative efforts to provide services to the community. Child Care Links serves a diverse population and has built a strong foundation to serve children and families in the community. This project will assist with further diversification of agency services. Child Care Links offers referrals to families seeking child care in the Tri-Valley, referrals to local agencies providing human services like housing, food, counselling and clothing, subsidized child care to income eligible families and parent and provider education training and technical assistance opportunities. These topics include, but are not limited to, CPR/First Aid, Health and Safety, Nutrition, Business Practices, Car Seat Safety, Positive Discipline, Communication, Inclusion of Children with Special Needs, and Building Developmentally Appropriate Curriculums. Child Care Links provides extensive professional development opportunities to existing child care providers, as well as support and technical assistance to aspiring and new providers. Additionally, Child Care Links offers tools for providers to implement in their programs once completion of the training has occurred. Through referrals parents are given the resources to find quality child care, allowing them to maintain steady employment. Child Care Links is dedicated to providing efficient resources and support services for the community. Through involvement in local community events, committees and collaborations, the agency is able to report on child care issues, and outreach to underserved populations to inform them of available services. 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 training and resources that strengthen and improve the quality of life for children, parents and child care providers living and working 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.) 200 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. Child Care Links staff will coordinate and manage all ECE workshops, trainings, car seat checks and support to parents and providers of the Dublin community. Staff will be actively involved in the community and collect data on those who reside or work in the City of Dublin and receive services. This will allow Child Care Links to meet local needs, provide the most innovative, current information and maintain communication with the city on local and state child care issues. Residential data will also be collected through technical assistance tally forms, and quarterly reports. In conjunction, Resource and Referral staff will also generate an annual child care supply and demand report, and an annual rate survey. This will allow the agency and the City of Dublin to collect up-to-date information on services provided and the needs and gaps in the community. Outreach will be administered through mailings, email blasts, distribution of flyers to the community, online event Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35848 calendars, social media and agency website. Registration and sign-in sheets will be administered at all workshops and events and will measure the attendance and city of residence information of those that attend. Staff will also ensure training content is appropriate for the target audience and that the curriculum is adapted and/or translated as needed for cultural appropriateness. Child Care Links will also ensure trainings maintain quality standards by offering feedback and technical assistance to trainers hired to facilitate workshops and trainings. 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 funding will be used to: Provide trainings and technical assistance to Family Child Care Providers, Center based staff, licensed-exempt providers, potential providers and parents of the Tri-Valley community focusing primarily on those who work and live in Dublin. A variety of topics will be included such as child development, curriculum development, business practices, health and safety and serving children with special needs. Provide enhanced technical assistance for at least 8 child care programs that attend trainings funded by this grant. Family home and center based staff will receive technical assistance and mentoring in applying information and techniques learned in trainings offered at Child Care Links. Short and long term technical assistance/mentoring will be available. Child Care Links’ staff will work in collaboration with child care programs to determine the length of time, topics to be covered and desired end result of each request for technical assistance/mentoring. Purchase as least 6 car seats (child restraints) for families with outgrown, damaged or recalled car seats to increase the safety of children when transported in vehicles. According to the National Highway Traffic Safety Administration (NHTSA), in California, 1,220 children’s lives were saved in 2012 by the use of child restraints and seat belts. Replacement will be on a first-come, first served basis with priority given to low-income families, Dublin residents and then to families in the Tri-Valley area. Provide at least 3 presentations to parents who work and live in the City of Dublin on parenting and child developments topics such as choosing quality child care, car seat safety and emergency preparedness. These presentations will be marketed to businesses in the City of Dublin, the public library, parent groups and local agencies offering direct services to parents. Produce an annual rate survey for the City of Dublin, and document any changes in child care supply and demand; this will aid the city in planning for the community’s child care needs. 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)? Child Care Links’ primary strategy to track the progress of meeting grant outcome(s) will be to use sign-in sheets. This will allow Child Care Links staff to track the number of participants who live and/or work in the City of Dublin. After each training participants are asked to complete an evaluation. These evaluations will help ensure the quality of trainings offered, inform staff of parent and provider interest in future training topics and/or identify child care programs in need of enhanced technical assistance. 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. Child Care Links will serve families and child care providers in the Tri-Valley, focusing on those who work and live in the City of Dublin, through technical assistance, referrals to licensed child care facilities, subsidized child care programs, trainings, the agency website and networking at outreach events. Many low income families are served by Child Care Links due to their need to find quality child care, a concern or question about a child development, children with special needs, a need for car seat installation or an interest in upcoming workshops or training events. Through enhanced technical assistance providers will experience personal and program growth while applying information learned to their child care program. Staff will assist providers in understanding what they have learned, mastering techniques they have been exposed to, enhancing the quality of their program and meeting the unique needs of children in their care. Child Care Links will offer parent trainings and workshops in familiar and convenient settings, such as the local library, child care programs, parent groups and human services agencies. The above mentioned are places in the community where parents already conduct business, receive support services and have relationships with staff and residents in their community, so it proves to be an effective way to provide services to Tri-Valley parents. Between July and December 5, 2014, 36% of the parents/grandparents participating in car seat checks were Dublin residents. Providing a free car seat to replace seats that a child has outgrown, is damaged or has been recalled will improve the safety and well-being of children and families residing in Dublin and the Tri-Valley area. Between July and December 5, 2014, 36% of the adults participating in car seat checks were Dublin residents. The annual rate survey, documenting any changes in child care supply and demand; will aid the city in planning for the community’s child care needs. 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 engagement in the community and relationships with parents and child care providers. Outreach events, home visits and technical assistance appointments are examples of activities that keep Child Care Links’ staff up-to-date of the diverse and cultural needs of those who live and work in the City of Dublin. Staff works with trainers to ensure that training content is respectful and appropriate for the parents and child care providers who attend training. Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35848 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? Local human services agencies and Child Care Links collaborate to refer low-income families, limited English speakers and/or disabled persons to each other to ensure that families are informed of support services available in the Tri-Valley area. These collaborations and staff participation in local outreach events increase the number of families who learn about, and access, Child Care Links services. Child Care Links employs staff who speak Spanish, Mandarin, Taiwanese, Cantonese, Vietnamese and Russian. Translation services are also available for those interested in attending trainings in English. Child Care Links employs a full time Inclusion Specialist who works closely with families and providers serving children with special needs. The Inclusion Specialist provides a variety of services to parents and providers including on-site observation, behavior management techniques, tips for working with children of all ages and stages, arranging an inclusive child care environment and communicating concerns between and child care providers. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Child Care Links works in collaboration with many agencies in the community to increase visibility, outreach and work with agencies that have similar missions and objectives. Creating and maintaining relationships allows Child Care Links to leverage funds from multiple sources in order to serve a greater number of residents. The Valley Family Child Care Association holds their monthly meetings on site at Child Care Links, allowing staff to stay updated with family child care providers as well as keep providers informed on community and state issues. Child Care Links is also present at the Directors of the Valley meetings, allowing similar relationships to be formed with center based staff. Many Tri-Valley agencies now refer families to Child Care Links for car seat installation including Valley Memorial, Valley Care Hospital, Pleasanton PD, Kaiser and AAA. Child Care Links partners each year with School of Imagination by volunteering at the “Happy Talkers Community Event”, where free developmental delay and autism early intervention screenings are available for families. Child Care Links frequently collaborates with CAPE Headstart in Dublin by offering car seat checks and literacy activities to the Frederiksen site. Child Care Links’ staff attends CAPE parent meetings to provide information about child care referral and subsidized child care opportunities. Child Care Links also works closely with the California Child Care Resource and Referral Network, First 5 of Alameda County, Community Care Licensing, Cities of Dublin and Pleasanton, and the Tri-Valley School Districts. 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 participates in outreach events throughout the Tri-Valley community networking directly with the community that utilizes and/or needs agency services. The agency outreaches through email distribution, subsidy clients, community events (Preschool Fair, Happy Talkers Outreach Fair, Dublin Farmer’s Market and Splatter), flyer distribution to local businesses and schools, online event calendars, mother’s clubs, on-site visits, trainings, and referrals. For larger events (Preschool Fair and Happy Talkers Outreach Fair) Child Care Links’ outreach includes the Bay Area Parent and Parent’s Press. The Child Care Links website and social media sites allow parents and providers the ability to download forms, receive current information and view the agency event calendar at their convenience. Child Care Links collaborates with Dublin's School of Imagination, allowing children to receive free developmental delay and Autism screenings and onsite referrals to non-profit support agencies. Parents also have the opportunity to attend free seminars to increase their own knowledge of their child’s needs. In one day, a parent receives opportunities for answers to questions and assessments regarding their child that may normally take months. Parents are also linked to pediatricians, speech and language pathologists, occupational therapists, and behavioral specialists. Hearing screenings are also available. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. 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” for children and their families though quality child care programs, car seat checks, effective communication and understanding of child development that allows for every child to have their unique needs met. Child Care Links’ services keep families working. Free child care referrals and guidance in choosing quality child care helps parents find the quality care they need. When children are being cared for in quality child care programs parents can maintain and focus on their employment. The free quality training programs, resources and technical assistance that Child Care Links provides increases the supply of quality child care in the City of Dublin. As a result, families are working, able to maintain stable employment and have the ability to financially contribute to Dublin’s economy. Child Care Links continuously supports an engaged and educated community of child care providers and families through free training, technical assistance and outreach activities. Child Care Links promotes events that bring people of all ages together through participating in local community events, like Splatter, the Happy Talkers Outreach Fair and Dublin Farmer’s Markets. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35848 anticipated result. Funding will cover operating expenses including staff salary and benefits, the cost associated with trainings and site visits, 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. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Child Care Links’ funding is specific to the program it is mandated and/or awarded to operate. If this application is not funded, the agency has no discretionary revenue to provide the services herein. The City of Dublin’s consideration of this request is greatly appreciated. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35848 responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35848 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 Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35848 Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35848 (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35848 #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). Child Care Links constantly looks for fundraising and grant opportunities. Working in collaboration with other agencies, like First 5 Alameda County, allows Child Care Links to leverage funds from multiple sources and serve a greater number of residents. Budget Funding Sources/Revenues Budget Amount Amount Committed N/A USD$ 0.00 USD$ 0.00 Total USD$ 0.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries USD$ 9,762.00 USD$ 0.00 Benefits USD$ 3,428.00 USD$ 0.00 Supplies USD$ 3,148.00 USD$ 0.00 Printing/Copying USD$ 150.00 USD$ 0.00 Postage USD$ 298.00 USD$ 0.00 Telephone USD$ 104.00 USD$ 0.00 Rent and Utilities USD$ 0.00 USD$ 0.00 Accounting Audit USD$ 525.00 USD$ 0.00 Events and Workshops USD$ 5,600.00 USD$ 0.00 Insurance, Travel, Payroll, Admin. USD$ 1,985.00 USD$ 0.00 Total USD$ 25,000.00 USD$ 0.00 Budget Narrative PERSONNEL: Staff Salary: 9,762 has been budgeted toward, and represents, 9% staff's annual salary. FRINGE BENEFITS: Fringe Benefits: 3,428 has been budgeted toward benefits including FICA, SUI, Worker's Compensation, Life Insurance, Cash Fringe Benefit, Behavioral Health, SEP-IRA, Acupuncture/Chiropractor and Long Term Care NON-PERSONNEL PROGRAM SUPPORT: Supplies-Program: 3,148 has been budgeted towards program materials and supplies. Printing/Copying: 150 has been budgeted towards printing and copying costs for outreach efforts marketing and training materials. Postage: 298 has been budgeted towards postage. This will cover the mailing costs of program outreach and advertisement. Telephone: 104 has been budgeted towards telephone use costs. This will allow staff to provide technical assistance to community and correspondence with training facilitators. Rent and Utilities: Nothing has been budgeted Accounting Audit: 525 has been budgeted toward agency audits. Events & Workshops: 5,600 has been budgeted towards events and workshops. This funding will cover facilitator costs and training materials. Insurance, Travel, Payroll Audit & Administrative: 1,985 has been budgeted toward general operating expenses. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Program Expense Budget Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35848 Financial Information Form for ALL Grants 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 Tax Return Board of Director's (or governing body's) designation of authorized official Board of Dir. designation of authorized official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) Request for Funding 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 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 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35848 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35848 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The Children's Emergency Food Bank is a local non-profit organization serving Pleasanton, Dublin, San Ramon and Danville, California since 1969. The Food Bank provides food for families in emergency situations rather than ongoing support. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. We have never received funding from the City of Dublin or any other city, county, state or federal organization. We rely Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Children's Emergency Food Bank New Building Children's Emergency Food Bank 7421 Amarillo Road Dublin, CA 94568 United States Tel: 925-828-5363 Fax: Web: childrensemergencyfoodbank.org EIN: 51-0159391 DUNS: Project Contact Rick Snowden rick.snowden@att.net Tel: 602-625-9928 Additional Contacts none entered President Rick Snowden rick.snowden@att.net USD$ 20,000 Requested Submitted: 12/10/2014 11:01:07 AM (Pacific) Application Questions Page 1 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35936 greatly on donations from individuals in the community and are part of the Raley's Food for Families Program, receiving continued support from them. We are not supported by the Alameda or Contra Costa County Food Banks. Cash donations are always welcome and are used in conjunction with food donations to support our program. 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.). " Children's Emergency Food Bank" is the operational name of the organization. The Federal Internal Revenue Service and the State of California recognize the organization as tax exempt under section 501(c)3 of the internal Revenue Code. The Federal Employer Identification number is 51-0159391 and was issued in September 1975. The California Corporation Name was originally "The Children' Emergency Council" the name was changed to "Children's Emergency Food Bank in 2009. The Corporate Number remains C0735535 and is registered with the California Secretary of State as of May 1, 1975. The Children's Emergency Food Bank is affiliated with John Knox Presbyterian Church(USA) of Dublin, California as a mission outreach program. The Food Bank operates independently of the church and maintains its own assets which consist primarily of donated food items and donated cash. The inventory of food is stored and distributed from a building on the property of the church. The building is approximately 20' x 20' and resembles a Tuff Shed. The Food bank has no employees, all personnel are volunteers. The Board of Directors of the Food Bank consists of the President, Treasurer and Secretary and no fewer than two or more than four Directors. The Board meets quarterly and in special session as required. There are over twenty volunteers supporting the Food Bank on a regular basis and there is a wealth of talent available from the congregation of the church. 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 current building is over forty years old and resembles a 20' x 20' Tuff Shed. The roof leaks, the floor is deteriorating, the electrical system is in disrepair and the shelving needs to be replaced. The plan is to replace it with a new Tuff Shed. 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 2013 183 Dublin residents were clients which was 56% of our total clients. Through November 2014 179 Dublin residents were clients which was 61% of our total clients. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. The Food Bank will contract with Tuff Shed to purchase a 20' x 20' building. Tuff Shed will manage the technical parts of the project such as obtaining the necessary permits and hiring the professionals required for some parts of the project. Tuff Shed will coordinate the portions of the work that can be performed by volunteers such as; installing insulation, installing dry, wall, building shelves, etc. Volunteers from John Knox and the local community will do as much of the work as is reasonable and within code. Page 2 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35936 Because the existing building will need to be demolished and removed prior to the new construction it will be necessary for us to close for some period of time. We will try to make this as short a time as possible and may be able to continue limited service to our clients during construction from temporary quarters. 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 Food Bank has some funds available for this project. Every dollar that we receive from this grant will be used in conjunction with ours to replace the building, install electricity, phone service and equip the new building so that it can continue to serve the community as it has since 1969. 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)? There is only one critical measure to the success of this project, cash. The Food Bank has some cash available but not enough. Currently, we have about $10,000 that we could use. The project will probably consume $30,000 so the arithmetic is simple. If we are fortunate to receive sufficient funds from the grant we will replace the building in the second half of 2015. If we don't we will continue to serve our clients from the existing location until we are able to raise the additional funds required. 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. Replacing the building will allow us to continue serving the population we have served since 1969 form a safer more efficient facility. We serve those in need of food. Our clients include; seniors, youth , disabled, low income, single parents, military, and even the homeless, Although, we refer those clients to organizations that are more capable of serving their needs. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? There is no cultural impact. The client base has been served from this location since 1969. The new building will be in the same location and look almost identical to the existing building. The difference is that it will protect our inventory of food better and provide our volunteers a safer and more efficient work environment from which to serve their clients. 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 already serve the client groups mentioned above and have for over forty five years. This project is about improving the facility and continuing the service we have provided for quite some time. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Children's Emergency Food Bank has been in operation in Dublin since 1969, Some of our partners are; Raley's Food for Families, Dublin/San Ramon Women's Club, John Knox Women's Association, Whole Foods Market San Ramon, Peet's Coffee, Calpine Corporation, Open heart Kitchen, Wells Middle School, Valley Christian Church, City Serve, Grocery Outlet, Dublin, Dublin Rotary and the Dublin Unified School District. Again, we want to improve our facility to be able to continue to serve the Tri-Valley. 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. Again, we have been serving the area since 1969. The organizations listed in #17 attest to that fact. We do continue to talk with potential new supporters and try to attend meetings sponsored by the City of Dublin, City Serve and other faith based organizations. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. We are trying to replace a dilapidated building with a new one to better serve our clients and provide a safer environment for our volunteers. We are trying to provide food and nutrition to those who need help. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The cost of the new Tuff Shed is subject to some negotiation. We will try to get as much positive press for them as we can. However, it will be what it will be. We need the new building and the grant will shorten the process. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? The new facility will be delayed until we can raise enough funds to move ahead without help from the City of Dublin. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A Page 3 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35936 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. The project is to replace the current building which is approximately 20' x 20' with a new 20' x 20' Tuff Shed. This was explained in question #11. I will submit a picture of the current building and floor plan sketches when asked later in the application. 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. The building is located on the campus of John Knox Presbyterian Church in Dublin, California. The current building is owned by the Church. The Food Bank pays the Church a token rental fee of $50.00 per month. The Food Bank will use current funds and any grant funds to buy and install the new Tuff Shed. When the project is totally complete we will probably donate the building to the Church and resume the token rental fee. That will allow the Food Bank to remain as a rider to the Churches insurance policy. 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Page 4 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35936 Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. Page 5 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35936 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Page 6 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35936 Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Page 7 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35936 Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). We have been financially independent and serving those in need of food in Dublin since 1969. Our building is over forty years old and needs to be replaced. Any funds received from this grant will be used in conjunction with our own to replace the building Page 8 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35936 Budget Funding Sources/Revenues Budget Amount Amount Committed N/A USD$ 0.00 USD$ 0.00 Total USD$ 0.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed N/A USD$ 0.00 USD$ 0.00 Total USD$ 0.00 USD$ 0.00 Budget Narrative There is no line item budget. The Food Bank currently has $10,000 earmarked for this project. We know that the cost for the building, slab, electricity, insulation, dry wall and shelving will be near $30,000. We will use our money, grant funds and other donations to complete the project in the required timeframe. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Expense Budget Financial Information Form for ALL Grants download template Financial Information Financial Information 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 990 Board of Director's (or governing body's) designation of authorized official Authorized Individual Board of Director's (or governing body's) authorization to request funding (may be same document as one above) Auth. to Request Funding 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 Fed. 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 State Non-Profit Info. Page 9 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35936 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 Existing Building * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35936 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 10 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35936 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). CityServe exists to serve people by sending volunteers of the local church to the non-profits serving in our Tri-Valley and by coordinating resources between the faith-based community, non-profits, schools, businesses, and government agencies. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline CityServe of the TriValley CityServe of the TriValley CityServe of the TriValley 11501 Dublin Blvd. Suite 200 Dublin, CA 94568 Tel: 925-452-8276 Fax: 925-574-2996 Web: www.cityservetrivalley.org EIN: 37-1735822 DUNS: 078694167 Project Contact Gloria Gregory info@cityservetrivalley.org Tel: 925-452-8276 Additional Contacts gloria@cityservetrivalley.org Executive Director Gloria Gregory gloria@cityservetrivalley.org USD$ 12,510 Requested Submitted: 12/11/2014 10:39:57 AM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35804 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.). We have formed a coalition of 18 Tri-Valley member churches (7 are located in Dublin) who have contributed over 25,000 ytd volunteer hours (an average of 244 volunteers per mo.) supporting 30+ non-profit agencies plus many individual families of the Tri-Valley. As we continue to grow, the greater the positive impact on our communities will be. CityServe is governed by a Board that meets monthly. Programs and projects are led by Executive Director, Gloria Gregory, a 30 year resident of the Tri-Valley with 30 years of professional business experience. Fiscal staff accountant, Jill Dykes has 25 years of accounting experience and handles monthly financial statement production and non-profit tax preparation. CityServe continues to grow its now 18 member coalition base by seeking other Dublin partners. 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. CityServe exists to coordinate resources between the faith-based community, non-profits, businesses, schools and government agencies to meet human services needs in Dublin and the Tri-Valley. The value of the collaboration we facilitate is proven. 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.) CityServe estimates that it will serve more than 502 UNDUPLICATED Dublin residents, the majority of whom are low-income or those seeking to serve in Non-profit agencies that reach out to the low income, in the upcoming 2015-2016 year. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. The project has already been implemented, and funding is sought to strengthen the infrastructure of our organization. Key positions are those of the Executive Director and Office/Volunteer Coordinator, and these must become paid positions to ensure sustainability. Our staff has been 100% volunteer to date, and the City of Dublin's continued funding will provide funds for immediate local human services needs, programs at Valley High School and operating expenses such as liability insurance and website/tech support while we grow the sources of funding from an increased number of member churches and from other grants and corporate/individual donations. The Board oversees vision and fiscal and staff accountability. The Executive Director will continue to establish and maintain relationships with local non-profit leaders, city human services staff, Tri-Valley school district child welfare & counseling staff, member church leaders. The Executive Director will continue to plan and facilitate bi-monthly CityServe Community Meetings focused on collaboration & education among local resources and monthly Member Church Liaison meetings to discuss and evaluate success in the effectiveness of the faith community fulfilling a meaningful and effective role in partnering with other community resources to meet local human service needs. The Office/Volunteer Coordinator will be a newly established position and will oversee office operations and interaction with all volunteers. Our website, www.cityservetrivalley.org, is evolving to be the most comprehensive source for resources and human services volunteer opportunities in the TriValley. The monthly CityServe Newsletter is e-mailed to over 100 non-profit, government, school, church and business leaders and is designed to provide news on the most urgent human service non- profit volunteer needs as well as weekly community resources to meet needs (like the Joblink employment search support group). Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35804 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 grant funds will be used as follows: Providing a hot breakfast at Valley High School (Dublin's continuation school), which includes proven opportunity for students and faculty to communicate and foster closer relationships (150/month= $1350 per year), providing funds for use in meeting immediate human service needs in Dublin, e.g. temporary shelter in motel for homeless, gasoline for job search, crib mattress for baby, bus tickets for east Dublin high school student, delinquent utility bill to avoid discontinuance of service ($250/month = $3,000/year), 1/3 the necessary annual liability insurance premium necessary ($500), 1/3 annual cost of website/technology support ($3,000), Dublin Chamber of Commerce annual dues ($210), 1/3 annual budgeted rent ($3,000), 1/3 cost of printing and copying our monthly newsletters ($800) and 1/3 cost of accounting and auditing services ($650). Total = $12,510 funding needed to supplement CityServe Member Church donations and private donations as we work to secure additional sources of funding through other Tri-Valley city grant programs, private and corporate grant programs and individual donations. 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)? It is crucial that we document, on a monthly basis, the number of volunteer hours that are attributable to our existence at the local human services non-profits we partner with as well as in collaboration with the Dublin School District Community Liaison and school counselors and city/county agencies. It is crucial that we maintain and can provide records of successes in providing needed assistance to individuals and families referred to us by non-profits, city/county agencies, and schools. That needed assistance will include items like use of CityServe funds and/or networking our Member Churches along with other community resources to provide temporary shelter for those homeless or living in a car, payment of delinquent utility bills or rent, auto repairs, provision of necessary household items like bedding, cooking utensils, gas/bus tickets for travel to work, bring children to school. These units of service allow us to track volunteer project hours by non-profits, city/county agencies, schools, and families/individuals. Other tools planned to track the progress of this project include monthly analysis of the number of calls into the office from phone logs re: numbers and types of requests in these categories: 1) for volunteers from non-profits, schools, city/county agencies 2) for volunteer opportunities for individuals/families, corporate groups, 3) for individual/family human service needs. We will complete Intake Forms to detail requested human service needs assistance and a detailed recording of how we responded to help meet the need, tracking CityServe's customer centered 1 person at a time connection with Dublin's LMI, (Low Moderate Income) residents. We will maintain records of the bi-monthly CityServe Community Meetings, providing details on what local human service non-profit efforts were presented and what collaborative resolutions to needs were identified, as well as what new concerns regarding human services needs were discussed. 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. CityServe has a proven leadership role in facilitating collaboration & action among non-profits, churches, school staff and city/county agencies in reaching & serving those in need of health care, experiencing homelessness, searching for a job, seeking escape from domestic violence, struggling with disabilities, in need of food and nutrition, seniors, youth and foster children, local active duty military personnel, locally incarcerated and their families, as well as addressing literacy and other needs in Dublin & the Tri-Valley. For 6 years we have partnered with the Easter Seals Kaleidoscope Developmentally Disabled After School Program. We have routinely provided volunteers to serve at their events, routinely deep cleaned facilities & painted them inside & out, created a garden to teach planting & nutrition, provided music performances & participation. We have directly focused on and will continue to focus on serving families in need in Dublin schools through the Thanksgiving Meal Distribution and December Adopt A Family Program. We have given special attention to encouraging at risk students at Dublin's Valley High School, serving a hot breakfast for students & faculty every other Friday and creating a CityServe Youth newsletter to help youth find volunteer opportunities & learn the value of "giving back". We have also served families at Wexford Way, providing backpacks & school supplies for children returning to school and providing written information to residents in October regarding the Tri-Valley Haven required registration for their Thanksgiving & Holiday Food & Gift Distribution Program. We have and will continue to consistently be a resource to broadcast the volunteer needs at the Dublin Senior Center and effectively provide volunteers to fill that need. We have (using CityServe funds and collaborating with CityServe Member Churches) provided temporary shelter to homeless referred to us by the City of Dublin, Dublin Police Dept. All will continue. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? In providing information and services (temporary shelter, transportation, information on local resources, etc.) it is always our goal to listen to and observe each client/customer in order to tailor our service to that person's particular need, experience, and cultural heritage. CityServe addresses a large variety of needs that affect the local residents of Dublin. Our mission is to be an important community resource to creatively complement other resources in serving those with human services needs in Dublin and the Tri-Valley. Our attention and services are open to all ethnic, racial and religious groups. 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 CityServe's primary goals is to collaborate with the non-profit agencies that have programs already in place to reach out to low-income, limited English speakers and the disabled. We do have volunteers going to OpenHeart Kitchen, reading to Spanish speaking pre-kindergartners, serving at Easter Seals Kaleidoscope, and serving seniors at the Dublin Senior Center. CityServe enhances the existing agencies so that their programs are able to serve more people but we do plan to focus on recruiting more Spanish speaking volunteers in the coming year. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35804 CityServe partners with the listed Dublin /TriValley organizations to provide more funding, more volunteers, and more community awareness. As most are competing for the same pool of funds and volunteers CityServe steps in to bring a personal touch that results in greater service. Our expanding member base allows for greater service. At each CityServe liaison meeting, the agencies’ representatives get to hear what other agencies are doing and learn best practices from one another. Liaisons take back needs to their members informing them of specific serving opportunities while fostering and encouraging volunteer support of community human services needs. Agape Village Foster Family Agency-Youth Axis Community Health-Primary and preventative medical care for low income Blue Star Moms-Military Childrens Emergency Food Bank CASA -Voice for youth, dependents of juvenile court system Camp Parks-Outreach Dublin Senior Center Easter Seals Bay Area Kaleidoscope-Youth, age 5-22 with autism and developmental disabilities EveryOne Counts! -2015 homeless count Fertile Groundworks-Community education, food Gideons International -Provides Bibles to hotels, schools, hospitals, jails Hope Hospice Literacy Programs-Pleasanton, Livermore libraries Lincoln Child Center- Kinship services Livermore Homeless Refuge -Homeless refuge(Nov-April) Livermore Pregnancy Resource Center New Day for Children -Program and facility for girls ages 10-18 caught in sexual exploitation Open Arms Transitional Care -Transition program for jail/prison inmates back to community/family Open Heart Kitchen Pleasanton Senior Center Safe Families for Children -Temporary safe haven for children of parents in crisis Santa Rita Jail Ministry San Ramon Senior Center Sr. Support of TriValley Sentinels of Freedom-Veterans Shepherd's Gate Teen Esteem-Equips teens/parents TriValley Haven TriValley YMCA Valley Care Health Systems Valley Pregnancy Center Young Life - role models for youth The Well - food pantry 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, membership listings, serving opportunities, resources, and the newsletters for 2014. We electronically send monthly newsletters to representatives of non- profits, schools, City of Dublin, Dublin Chamber of Commerce, Dublin businesses and others in the Tri-Valley (Livermore, Pleasanton, San Ramon) that we serve. A volunteer coordinator is linked with each non-profit and is tasked with making sure that CityServe knows what is going on in the agency, ie, needs, events, changes. The Executive Director has also spoken about CityServe at several churches in Dublin, Pleasanton and Livermore, met with representatives of Dublin USD, Pleasanton USD and Livermore USD and area business leaders and put out displays with our newsletter at community and church events. We have connected with the Camp Parks chaplain and have been involved in several projects including a Vacation Bible School, pancake breakfast, Christmas dinner and welcome baskets there. We also sponsored the 2nd Annual TriValley Prayer Breakfast in Dublin last month attended by over 240 local residents, business professionals, and community leaders and hosted by Dublin Mayor Sbranti, where our Executive Director spoke about CityServe's mission and work. A video was shown of testimonials by the Directors of the Senior Support Program of the Tri-Valley (Marlene Petersen), the Tri- Valley YMCA (Kelly Dulka), Liz Buckley, counselor at Dublin's Valley High, Janet Cameron, Livermore School District Child Welfare & Attendance Specialist and a Livermore resident whose family had directly received help from several community resources as coordinated by CityServe regarding the community value of CityServe. We were recently requested to make our newsletters available in the Dublin library for patrons asking about volunteer opportunities. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. CityServe is all about building community and improving the quality of life in Dublin. We desire to see a united citizenry who is concerned about our neighbors’ well-being, a community where people come together to serve one another. Studies have shown that people who are connected with other people and who are engaged in volunteerism are not only happier but physically and mentally healthier. (See Corporation for National and Community Service, Office of Research and Policy Development. The Health Benefits of Volunteering: A Review of Recent Research, Washington, DC 2007.) CityServe is a community bridge that connects volunteers from churches, businesses, and the Dublin community at large to help the non- profits serve those who are struggling with problems that often keep them from living a productive life. CityServe creatively contributes leadership, ideas and actions to improve the human service conditions in Dublin. What better way to bring about a more safe and secure environment that fosters new opportunities. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35804 anticipated result. This budget is cost effective and reasonable because it provides the most basic needs for an organization to operate effectively. It includes a $30,000 salary for the Executive Director, whose job responsibilities would command a salary over $100,000 in private industry. It includes a $20,000 salary for an Office/Volunteer Coordinator, which is well under what a comparable private industry postion would require. The budget we present for all items is clearly reasonable and includes our cultivation of private grants and donations to secure the majority of funds. Our anticipated outcome is that CityServe will continue to support and contribute to the City of Dublin’s vision of commitment to their citizens and cultural heritage as well as creating an enlightened and diverse community. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If we do not receive our funding request from the City of Dublin, our ability to continue to provide the services we do for the City of Dublin, our local non-profits, the programs at Valley High, and the immediate assistance we provide the homeless and near homeless will be in jeopardy. Our ability to expand our outreach into the community will also be limited. This funding will be an important factor in ensuring the sustainability of this organization. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35804 Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35804 E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. F) Not Applicable. I am not interested in qualifying for CDBG funding. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35804 Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35804 Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35804 #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). Actions include increasing membership, heightened Board philanthrophy by identifying and cultivating other private donor sources (annual, major and ultimate gifts), along with increased grant writing. Budget Funding Sources/Revenues Budget Amount Amount Committed Member Church donations USD$ 15,000.00 USD$ 15,000.00 City of Dublin USD$ 12,510.00 City of Pleasanton USD$ 12,510.00 City of Livermore USD$ 12,510.00 Corporate donations/grants USD$ 42,950.00 Total USD$ 95,480.00 USD$ 15,000.00 Funding Uses/Expenses Budget Amount Amount Committed Community Outreach USD$ 14,550.00 Insurance USD$ 1,500.00 Rent USD$ 9,000.00 Audit USD$ 2,000.00 Printing, Supplies USD$ 3,450.00 USD$ 3,450.00 Total USD$ 30,500.00 USD$ 3,450.00 Budget Narrative Our staff has been 100% volunteer to date. but in order to continue and expand our programs, we need to dedicate funds to make paid positions for the Executive Director and Office/Volunteer Coordinator. We will be seeking corporate donations and using most of the financial commitments from our member churches to provide this. Funding from the City of Dublin will allow us to provide funds for immediate local human services needs, programs at Valley High School and operating expenses such as liability insurance and website/tech support. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template ProgramExp Financial Information Form for ALL Grants download template FinancialInfo List of Board of Directors (or governing body) with contact information board of directors Current Annual Budget for the Entire Agency P&L Copy of most recently submitted IRS 990 form or Tax Return (include complete form) IRS form 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) FundAuthRequest Insurance Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35804 Proof of insurance carried, including bonding, liability and/or workers' compensation declaration Directors Ins 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 EIN Ca Franchise Doc 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35804 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35804 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). 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? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Community Resources for Independent Living Independent Living, Housing & Employment Services for People with Disabilities Community Resources for Independent Living 439 A Street Hayward, CA 94541 United States Tel: (510) 881-5743 Fax: (510) 881-1593 Web: www.crilhayward.org EIN: 94-2598873 DUNS: 037321957 Project Contact Sheri Burns Programs@crilhayward.org Tel: 510 881 5743 x5930 Additional Contacts Michael.Galvan@crilhayward.org Executive Director Sheri Burns Sheri.Burns@crilhayward.org USD$ 5,000 Requested Submitted: 12/10/2014 11:45:09 AM (Pacific) Application Questions Page 1 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35388 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 35 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. In 2013, we added mobility training to help address the challenging public transportation systems for people with disabilities who live in the Tri-Valley. The majority of CRIL's service providers are peers - individuals who have a disability - who are uniquely qualified to offer peer support and empowering guidance to lower income residents who face physical and societal barriers to employment , self-sufficiency, self-determination and access to goods & services. Since opening a full-service Tri- Valley branch office in 2001, CRIL has also been readily accessible to Dublin residents with disabilities and seniors with functional limitations. The Independent Living philosophy is one of self-directedness and self-determination. Given support, encouragement, self- advocacy skills and equal access to resources, people with significant disabilities can achive 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, community organizing, occupational therapy & theology. All services providers are cross trained by their peers in all aspects of independent living and are therefore "IL Generalists" with a wealth of knowledge and compassionate understanding. 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 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.) 12 directly; 40 indirectly. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. CRIL's Tri-Valley staff are extremely familiar with the resources and services available in Dublin and the surrounding cities. With CRIL's 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 and social services. CRIL's Tri-Valley Employment & Benefits Coordinator is also a bilingual woman with a disability, and is able to provide disability peer support and role modeling to both English and Spanish speaking residents of Dublin. Page 2 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35388 CRIL is a long-standing subcontractor and advisory committee member with the Chronicle Season of Sharing program and has access to funding that can assist qualifying low-income residents with one-time delinquent mortgage or rent payments, security deposits, access 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 covered include individual housing needs, eligibility for Section 8 and other subsidized programs, credit checks & repair, housing research, applications, interviews, tenant rights and responsibilities and more. 2. Monthly Job Club & 1:1 Employment Counseling 3. Monthly Travel Training Workshops 4. Individualized Travel Training Excursions on WHEELS, BART & ACT 5. Monthly Peer Support Groups to address various IL topics 6. Individual Independent Living Plan development & coordination - CRIL's 2 IL Coordinators meet individually with each consumer to help them develop a plan that includes specific steps & timelines for meeting their goals 7. IL Coordinators refer or coordinate meetings with other outside service providers 8. IL Coordinators check in with each consumer every 30 - 60 days to see how they're doing with meeting their goals 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). Dublin Grant funds will be used to help support the costs of operating a full-service branch office in the Tri-Valley, thereby being accessible to low-income Dublin residents with disabilities. CRIL is requesting $5,000 in Dublin Community Grant funding for FY 2015-16, which will allow us to increase Independent Living (IL), Housing services, Mobility and Travel Training, as well as, Job Readiness support in the Tri-Valley area. CRIL projects to serve 12 low income Dublin seniors and residents with disabilities, as well as provide I & R to 40 other residents. FY2014-14 has seen a dramatic increase in the number of Dublin consumers served. Funds will primarily cover 4.71% of the salary and benefits of the two IL Coordinators with a small amount for shared indirect costs associated with necessary program and office operations (e.g., telephone, supplies, insurance, etc.). The overall Dublin portion of the Tri-Valley services budget is 4.68%. Due to significant reductions in government and foundation funding over the past few years - funding that previously supported the majority of CRIL's Tri-Valley budget for branch office services - Dublin Grant funds are necessary to support maintaining CRIL's local presence in the Tri-Valley. 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 12 Dublin residents with improved access to affordable housing, peer counseling, employment & benefits counseling, travel & mobility 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 40 additional Dublin residents & businesses to assist them with increasing their knowledge & independence. CRIL utilizes a national online database management system called CILSuite, which is specifically designed to track data and services for independent living centers such as CRIL. 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. In addition, 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 are also asked to 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. Our annual survey return rate has been 12% with a 99% good or higher satisfaction rate. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. This program will serve low and very low income Dublin residents of all ages who have a disability or disabling condition, including youth and seniors. Dublin residents will benefit by being able to retain or obtain affordable, accessible and safe housing through their work with CRIL's IL Corrdinators, which in turn decreases the City's homeless population and minimizes the possbility of unneccessary institutionalization of this at-risk population. Two Dublin residents who have benefited from CRIL's services this year are a retired mom and her son who has Cerebral Palsy. They have used Dial-A-Ride but have found that it requires lots of pre- planning and takes a good deal of time. The two worked with CRIL's travel trainer and not only learned how to use the fixed bus routes but also BART. The two are now able to visit family in Livermore more often, have ventured into San Francisco, and are planning more trips with their increased independence. Those seeking employment will have guidance and assistance from CRIL's Employment & Benefits 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 Page 3 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35388 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, therby 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 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. One of CRIL’s Tri-Valley Coordinators is also bilingual & bicultural in Spanish/English and is therefore able to provide culturally appropriate, direct outreach & services to the 14.5% Hispanic population of Dublin. Not only are individual services provided in Spanish for these consumers, but many of our classes, workshops and trainings are also separately conducted in Spanish or with simultaneous translations provided. Consumers who speak other languages are served via contracted translators through the County’s Language Line Services. 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 throughout 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 woman 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. 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 seniors, families, people with disabilties or with health concerns and Spanish-speaking groups. We also advertise in print and online telephone directories, through Eden 211, local newpapers, Spanish language TV-14, Chinese World News, Alameda County Senior Directory, Livermore Hindu Center, the Chambers of Commerce in Livermore, Hayward and San Leandro, Fremont FRC news, local senior centers and city halls, and CRIL's own website, Facebook page and e-newsletters. Our website is fully W3C accessibility-compliant (www.crilhayward.org), has a large print access feature, and has a Google translate button for immediate, basic translation into other languages. 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, TVHOC or ECHO Housing 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 Servcies 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. Page 4 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35388 In 2014, CRIL partnered with CIL in Berkeley and the Alameda County Area Agency on Aging (AAA) to establish an Aging & Disability Resource Connection or ADRC in Alameda County. This core team of CRIL, CIL and AAA is working with over 20 other agencies that serve seniors and persons with disabilities to improve the access to and coordination of Long Term Services and Supports for these populations to maintain their health, independence and activity within the community. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. CRIL participates in or co-sponsors over 50 outreach events annually with several located in the Tri-Valley cities and in Dublin specifically. Many of these outreaches are targeted toward seniors, families, people with disabilties or communities with health concerns and Spanish-speaking groups. In the past, CRIL has participated in the Dublin City St. Patrick's Fair and the Dublin Senior Health Fair, the 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 newpapers, 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. 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. CRIL's Executive Director served as a disability advisory member of the 2004 and the 2011 Tri-Valley Needs Assessment steering committee. In 2012, CRIL's ED served on the steering committees to establish a disaster-support FAST training program and a VOAD in Alameda County, and worked with Alameda County Public Health Department on developing a Risk-based Pilot Project to provide emergency assistance to the County's most frail seniors and residents with disabilities. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. CRIL's Independent Living, Housing & Employment Program promotes and supports a high quality of life and ensures a safe, diverse and economically balanced community within the City by providing support services and direct intervention to help low income people with disabilities who are at risk of losing their housing maintain it, and those who need to secure affordable housing obtain it. In addition, since the City values a strong, open and responsive government that addresses the needs of all residents and businesses, CRIL's Housing, Employment and IL Program supports meeting the City's goal of investing in a community service that reaches out to its most vulnerable and growing population of older seniors with disabling conditions as well as very low income residents of all ages with disabilities. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Since the majority of CRIL's consumers are extremely low income, it is vital & significant that CRIL does not charge consumers for any program costs & does not limit the amount of services they can receive. The cities of Livermore & Pleasanton, funding from the Hindu CCC, ACTC and Cal Tran funding for travel training, Dept. of ED and SSA WIPA funds under contract with CIL, 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 4.68%. 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 only can afford Section 8 voucher 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 HUD 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. 21. 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 4.68% of the total program budget, CRIL strongly relies on the City's support to maintain our Page 5 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35388 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 during the last five years of the great recession and 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 disabilties to receive personalized, in- depth services. For those who are in jeopardy of losing their housing, Dublin would see an increase in homelessness and institutionalization among its most vulnerable residents - a significantly threatening reality in this current environment of high rents and low vacancies. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; Page 6 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35388 responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. CRIL is a “cross-disability” and inclusive service and advocacy organization which means we work with people who have any kind of significant disability and are part of our community. It is CRIL’s policy to provide culturally and linguistically appropriate communication and resources to all members of our southern and eastern Alameda County service area. For this reason, it is CRIL’s policy to hire the most qualified individual for each position with a preference given to persons who have a disability and/or who are bi- or multi-lingual. More than 1/3 of CRIL’s staff speak and write Spanish and one Coordinator speaks/writes Chinese. Several volunteers are also bilingual in an Asian language or in Spanish. For those consumers who speak a language other than Spanish or Chinese, we utilize the County’s Language Line. All CRIL documents are translated into Spanish and Chinese as well. For outside paperwork that is not available in another language, we will translate it for the consumer, either verbally or in writing. For deaf consumers, we contract with a certified ASL interpreter or use a VRS relay app on our iPad. Please see CRIL's LEP/LAP Policy and Plan for more information. 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. Page 7 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35388 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Page 8 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35388 Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. Page 9 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35388 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: 12 directly; 40 indirectly. 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". 4 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) 8 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) 12 Disabled 3 Female Headed Households 6 Senior 1 Youth 1 Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 35.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" 6 White 3 White + HISPANIC 1 Black/African American 0 Black/African American + HISPANIC 2 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 0 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 12.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY Page 10 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35388 #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). CRIL's Strategic Plan for 2014-2017 and CRIL's Board of Directors have placed a new emphasis on fundraising and fund development outside of grants. In 2013 and 2014, CRIL had successful fundraising events. Budget Funding Sources/Revenues Budget Amount Amount Committed Center for Independent Living-GAP Cycle 5 USD$ 44,129.00 Center for Independent Living- WIPA USD$ 20,000.00 City of Pleasanton- Health and Human Services USD$ 14,500.00 Kaiser Permanente Mt. Diablo Valley Fund USD$ 9,991.00 City of Livermore USD$ 7,500.00 Bank of the West USD$ 4,702.00 Hindu Temple USD$ 1,000.00 City of Dublin USD$ 5,000.00 Total USD$ 106,822.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed ILC-Tri Valley Travel Trainer USD$ 34,566.00 ILC- Employment and Benefits USD$ 24,477.00 Program Director USD$ 4,110.00 Executive Director USD$ 1,860.00 Finance Director USD$ 1,162.00 Benefits-PayrollTaxes, Health and Dental Insurance USD$ 26,682.00 Supplies- office and program USD$ 1,567.00 Printing and Copying USD$ 756.00 Postage USD$ 819.00 Telephone USD$ 2,396.00 Rent and Utilites USD$ 314.00 Accounting and Audit USD$ 679.00 Contracted Services USD$ 5,010.00 Insurance USD$ 1,113.00 Outreach USD$ 132.00 Travel USD$ 704.00 Other* USD$ 475.00 Total USD$ 106,822.00 USD$ 0.00 Budget Narrative he overall operational budget for CRIL's full service Tri-Valley branch office is $106,822.00 which covers 1.75 FTE for direct service provision - an Independent Living Employment & Benefits Coordinator and an Independent Living Travel Training Coordinator. A small percentage of supervision time is allocated to the IL, Housing & Employment program's direct supervision by the Program Director and oversight by the Executive 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 $5,000 would cover 4.68% of the total project budget and roughly 4.71% of the salaries and benefits of the two service providers. Page 11 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35388 Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Program Expense Budget Financial Information Form for ALL Grants 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) 2012 2013 IRS 990 Form or Tax return 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 Personnel Policies Grievance Procedure Non Discrimination Policy REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" SECTION 2013-2014 audit REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. Articles of Incorporation Agency Bylaws 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 Federal Non-profit 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35388 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 12 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35388 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The Freshman Mentor Program gives freshmen a supportive environment to ease adjustment to high school. Each student's personal, social and academic growth is enriched by the leadership of upper class students offering help and modeling excellence. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Dublin High School Dublin High Freshman Mentor Program Dublin High School 8151 Village Parkway Dublin, CA 94568 Tel: (925) 833- 3300, X 7003 Fax: (925) 833- 3322 Web: www.dublinusd.org EIN: DUNS: Project Contact Maureen Byrne vereenbrad@dublin.org Tel: (925) 570-5360 Additional Contacts macdonaldkathleen@dublinusd.org,angeldiazjennifer@dublinusd.org,byrnemaureen@dublinusd.org Superintendent Stephen Hanke hankesteve@dublinusd.org USD$ 25,000 Requested Submitted: 12/11/2014 2:54:21 PM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36137 funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. Dublin High School's programs have received funding from the City of Dublin. The FMP program is new to the 2014-2015 school year and has not received any city support. 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 program is modeled after a similar program implemented at a high performing high school in the midwest. Our team has visited the program and has consulted with their coordinator. Certificated staff member, Jennifer Angel-Diaz coordinates the program. Mrs. Angel-Diaz was given one release period for the 2014-2015 school year for the coordination. Daily agendas are developed by Mrs. Angel-Diaz as she and fellow coordinators, Ms. Lenni Velez and Ms. Sara Hollison work with the student mentors to develop their capacity to do so. 23 staff members are paid to participate in advisory. The role of the adviser is to help the student mentors run the program. The advisers meet together to collaborate on how best to coach the students. We have 90 student mentors. These mentors went through an application process and have been receiving regular training throughout the year. As this is a new program, we are using multiple measures to assess efficacy. These measures include student and staff surveys as well as information on student attendance, grades and participation in school events. We have worked with the district office on budgetary needs. Current indicators speak to a need to provide more initial and ongoing training to both our mentors and advisers. Ongoing supports in terms or supplies and incentives would be beneficial. 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. Freshmen meet in small group classes for the first 20 minutes of the lunch period. Staff and upper class students provide mentorship with specific daily curriculum. Through this process, freshmen are guided to greater participation and success. 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.) 680. We have freshman class of 580 students with 90 upperclassmen mentors. With growing enrollment, we anticipate the number to grow next year. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. All Dublin High School freshmen take part in the Freshman Mentor Program. Students are grouped according to their placement with counselors to enable the full complement of services during the school year. As part of their course assignments, 9th graders are assigned to a small group, which is overseen by a DHS faculty member. Within each classroom, 3-4 trained upper class mentors work with students daily to deliver pre-planned curriculum designed to help 9th Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36137 graders learn the strategies for high school success. In addition to student mentors, classes are frequently visited by counselors to acquaint students with the details of moving through high school and planning for college. The program is organized and managed by teacher coordinator, Jennifer Angel-Diaz. She develops daily lesson plans for the program, communicating often with the faculty and student mentors. Assistant principal Maureen Byrne oversees the program. The additional 20 minute lunch period, instituted in the 2014-2015 school year, allows time to conduct instruction and build community within the freshman class. Ongoing training of student mentors is conducted by Ms. Angel-Diaz and Ms. Lenni Velez during monthly 'Lunch and Learn' sessions, as well as late summer meetings. Student mentors are carefully selected using a rubric that includes, grades, behavior, and teacher recommendations. 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 would be used for ongoing training and support of our mentors. These are 90+ upperclassmen who need to be trained in the areas of facilitation, public speaking, peer mediation, tutoring and leadership. These students are expected to relate well to the freshmen and provide a supportive, positive, and welcoming experience to Dublin High School. This is intended to be a safe space for students and an avenue for incoming students to be initiated into Dublin High's culture of integrity in action and academic success. The funds for the grant would pay for three days of training for the mentors. These trainings will be conducted by professional motivational speakers skilled in training leaders. As the mentors volunteer their time we want to provide meaningful trainings that include materials. The funds will be used for the classroom supplies to assist in projects throughout the year, the FMP shirt designed to set the mentors apart as a group. As part of the initial days with the freshmen, the mentors will review Dublin High School's Code of Conduct. This will be presented in our yearly agenda, a manual also designed to aid students with organization. These agendas will be bought with the grant funds to give every freshman a tool to help them be successful. Gifting this to the freshman will ensure that every student has an equitable opportunity to start out organized. As the Freshman Mentor Program is a component to a larger structural change at Dublin High, grant funds will also be used to buy staff a copy of the book Mindset. We will be having school wide discussions next year rooted in the book's underlying philosophy we can develop the love of learning and resilience that will lead to great accomplishments. 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: 1. More successful freshman students, academically and socially. Early high school connections and engagement. 2. Greater leadership development for upper class students, including speaking skills, monitoring and engaging younger peers and building relationships within the student body and across classes. 3. Long term high school growth beyond 9th grade, resulting in fewer high school dropouts, greater motivation to be involved in extra curricular activities, reduced social and emotional problems during teen years and more satisfaction as a learner through the development of a growth mindset. Strategies to track outcomes: 1. Student and teacher surveys conducted through the school year to track satisfaction and highlight issues to address. 2. Ongoing accounting of D's and F's at all grading periods: Progress Reports, Quarters, and Semesters. 3. Monitoring of student behavior--Referrals, Suspensions, and Expulsions. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. The funds would all go directly to the high school students of Dublin. The program serves in two capacities, each with the potential of significant impact. The first is the impact on the 9th graders. As DHS has grown, we have seen 9th graders entering with very diverse skills sets. Some have been raised in Dublin, have older siblings and have the capacity to "do" high school successfully. Others do not. This program levels the field for all, providing consistent training on skills needed to be successful at Dublin High School. Last year we graduated 410 seniors and this fall welcomed close to 600 freshman. Our projections is that those numbers will continue to go. The FMP program is a deliberate mindful way to continue the sense of community that the students at Dublin High School have long enjoyed. Students learn the procedures and systems, but they also have a chance to be acculturated into the Dublin High community. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? Classes are conducted by engaging the freshmen in all ways to encourage them to find their personal comfort zones in the high school. Through the use of older student mentors, 9th graders see models to emulate and to question about every activity from joining clubs and attending dances to selecting coursework for upcoming years. The relationships built between the juniors and seniors and the incoming 9th graders are invaluable to the overall climate created in the school. The feeling of unity and common understanding of traditions, creates a positive campus milieu that is open and growth oriented. The atmosphere of warmth and equality has set DHS apart from other schools, but as the enrollment grows, it is critical to maintain that environment. As we recruit the older students we have been mindful to find students from all our groups. We have athletes and band members from all backgrounds, their commonality in that they are proud to be Gaels and want to give back. 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 9th grade students are included and main streamed in this program. Since this is a program to build and share community Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36137 with all students, it allows for a positive, non-graded, engaging environment in which incoming students find friendship and acceptance. Students are assigned randomly based on their counselor so the same class will have students of all backgrounds and abilities. Because the program is facilitated by upper class peers, freshmen can find models to emulate as they move through high school. At the same time, the mentors can be students who have not previously had the opportunity to show leadership. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. It is a Dublin Unified School District goal to increase vertical collaboration and mentorship K-12. The Freshman Mentor Program is one step in the direction of preparing our students for their journey through high school and beyond. Through continuing and increasing communication with our middle and elementary schools, we find ways to better serve our students. Our discoveries will lead to better identifying student needs at younger ages as well. 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. Re-framing and enhancing the academic and social climate at Dublin High School is necessitated by ongoing academic concerns, fast growing enrollment issues and increasing diversity. With that in mind, the Dublin Unified School District held several community-wide meetings last Spring to obtain parent and student input about a schedule change to allow for the Freshman Mentor Program. Responding to the needs, the Dublin Unified School Board agreed to expand the school day at the high school to accommodate the Freshman Mentor Program. Through letters home, school meetings, and school board interaction, the community has been informed throughout the process. This outreach will continue as re-framing efforts develop. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. The Freshman Mentor Program meets the City of Dublin's goals through ultimately enriching the lives of every high school student, thereby creating a better educated, engaged resident. From the Mission: the program offers a high quality of life to young people, fostering new opportunities to succeed during key years of development. From the Vision: the program helps build the desired 'engaged and educated community' through participation and understanding that community matters. From the Values: Build communication that enables learning and development of our youth. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. For a relatively small cost to the city, the Freshman Mentor Program provides a first step to reaching out to young people to maximize achievement in high school. By supporting the costs of boosting enthusiasm with money for mentors and teachers to nurture community, the program can flourish and reach its goals. The purchase of books for teacher advisors and mentors lends an academic element to enable teaching of a growth mindset to our students. Students can come to understand that success is largely a result of hard work and discipline and that talent is created through consistent effort. We have seen schools in the Tri-Valley lose either a sense of community or decrease in academic rigor. The Freshman Mentor Program is designed to ameliorate both those concerns. By fostering a sense of purpose as a successful student and a valued member of the Dublin High community, we feel our students will graduate prepared for anything. This program is also unique and will be something that will set our community apart. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Without the support, our program will be less able to flourish as it should. This program offers so much to so many and provides one chance to really enrich the learning lives of every 9th grader at Dublin High School. Please help us achieve our goals. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36137 be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian- friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36137 Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36137 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, 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 Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36137 occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: n/a 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36137 White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial n/a Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). We received initial monies from the DUSD school board this year. Their ongoing support will be in terms of personnel costs for the coordinator and the advisers. As the school population grows we will continue to seek out grants to enhance the program. Budget Funding Sources/Revenues Budget Amount Amount Committed Total USD$ 0.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Training Days for mentors USD$ 10,500.00 Agendas for all freshmen USD$ 6,000.00 Supplies for each FMP group USD$ 6,000.00 Shirts for mentors USD$ 1,500.00 Mindset for staff USD$ 1,000.00 Total Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36137 USD$ 25,000.00 USD$ 0.00 Budget Narrative Although we have financial support from the Dublin Unified School District, the budget for training and supplies is very limited. With further support we feel we can offer a higher level of service to our community. The benefit will be more capable and confident student mentors who in turn will be able to guide our freshmen. This is a pivotal step in helping our high school reach higher success for a broader range of students. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Program Expense Budget Financial Information Form for ALL Grants download template Financial Infor form for all grants List of Board of Directors (or governing body) with contact information Board Of Trustees with Contact Info Current Annual Budget for the Entire Agency Adopted Budget for 2014-2015 Copy of most recently submitted IRS 990 form or Tax Return (include complete form) Tax Status as School District Board of Director's (or governing body's) designation of authorized official Board Members 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 Trustees authorization for funding Proof of insurance carried, including bonding, liability and/or workers' compensation Proof on 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 School District 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 36137 Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36137 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36137 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Supporting the students and faculty at Dublin High School. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Dublin High School PFSO Every 15 Minutes Program Dublin High School PFSO 8151 Village PKWY Dublin, CA 94568 United States Tel: 925-833-3300 Fax: Web: dublinhighpfso.com EIN: DUNS: Project Contact Jean Josey DHSE15@gmail.com Tel: 925-819-1250 Additional Contacts jijosey@gmail.com; btdyer@comcast.net President Christine Bennett chris@workvantage.com USD$ 8,000 Requested Submitted: 12/4/2014 5:20:10 PM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35212 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 Every 15 Minutes project is staged every 4 years as a collaboration between Dublin High School and Valley High School to serve the needs of all 9th-12th graders in our city. We have a proven track record of successfully presenting this program. We have an extensive volunteer network, committee chairpersons in place, and very detailed notes from the prior two stagings of the event on which to draw. The chairpersons from the last event (held in the spring of 2012) not only turned over binders filled with every detail of a very successful program, complete with contact names and information, minute-to-minute timelines, and detailed expense reports, but they have indicated that they remain available to consult with this year's chairpersons to ensure that the program is a success. 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. "Every 15 Minutes" is a dramatic enactment of a fatal car accident and it's aftermath, designed to instill in teen drivers the consequences of driving under the influence. It also covers distracted driving and offers tools for making better choices. 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.) "Every 15 Minutes" will be presented to approximately 2500 9th-12th grade students (2380 from Dublin high School; 120 from Valley High School) and up to 100 other community members. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. A committee of volunteers, led by two co-chairs, will coordinate all aspects of this very intensive 2-day program. On Day 1, before students come to school, two wrecked cars are brought to the campus and staged as if they had been in a collision. Bleachers are rented and brought in to provide seating in a semi-circle around the cars. Student actors are made-up to look as if they have been in an accident. One student is designated as a drunk driver; two are designated as DOA; 5 others are designated as injured. These students are placed in the vehicles shortly before the main student body is released from class to sit on the bleachers. The enactment consists of 911 tapes being played, police and fire responding to the scene, the drunk driver being "arrested" and taken to jail, injured students being taken away by ambulance, and the DOA being taken out in the coroners van. The student body is informed that the students have died. Video is taken at the hospital, the morgue, parent notifications, the jail, etc. The second day, there is an assembly (formattted to look like a funeral, complete with coffin), where the video is played for the student body. Guest speakers are brought in to describe the impact that drunk/distracted driving has had on their lives. Grief counselors are made available to the students during these two days. In addition, there is an intensive retreat for the students who are "actors" in the cars, as well as students who are pulled out of class on Day 1 as "walking dead" to serve as a reminder to the general student body that drunk/distracted driving can effect any of them. The committee is responsible for coordinating with the Dublin PD, Fire Department, CHP, hospitals, jail officials, bleacher rental company, videographer, florist, etc. to ensure that all pieces are in place. This is a proven program, developed by they California Highway Patrol, with supporting materials to ensure success. Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35212 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 is a very expensive project. The City Grant funds may be used for: -Bleacher rentals (our largest expense, with a student body this size). -Professional Videographer Services, the second most expensive, and one of the most important pieces of this project. Every stage of the program is videotaped: the staged "party" where the students get "drunk" before driving, the accident scene, the hospital scene, the parental death notifications, the "drunk" student's booking and arraignment, etc. The entire video is professionally edited and then shown to the entire student body. -Audio/Visual equipment to provide the sounds and effects for the crash scene, as well as the sound and projection system for the "funeral" assembly. -Hotel fees for the retreat for student participants (approximately 25 students and their chaperones). -Luncheon for volunteers, students, and their parents -Mock-tombstone supplies for the "walking dead" and those students designated as "DOA" in the accident. -Supplies for the retreat. -Printing costs. The most likely use for the Dublin grant funds will be for printing costs and the Videographer. Those two pieces together are budgeted to cost the approximate amount we are requesting 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)? 1. Reduce traffic accidents caused by teen drivers under the influence. If even one accident is prevented, this program will be a success. 2. Reduce the number of teens texting while driving, thus leading to fewer accidents by distracted teen drivers. If even one accident is prevented, this program will be a success. 3. Raise awareness of drunk/distracted driving among teens, and empower them to make better choices and to speak up when they see their peers about to make a poor choice. If even one student feels emboldened to take an impaired student's keys or ask a friend to put away the phone while driving, the program will have been a success. It is hard for us to give specific strategies that we can use to measure the success of the program, but we know programs such as these work. We do know historically that students continue to discuss and implement the strategies they learn for years after the program. According to the CHP's website, "The [Every 15 Minutes] program’s name was derived from the fact that in the early 1990’s, every fifteen minutes someone in the United States died in an alcohol-related traffic collision. However, with the implementation of new laws, grass roots programs like Mother’s Against Drunk Drivers (MADD), Students Against Destructive Decisions SADD, Friday Night Live (FNL) and programs such as [Every 15 Minutes], the death rate is now every thirty minutes, a figure which continues to be unacceptable." 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 benefit every single high school student in Dublin, as Dublin High School coordinates with Valley High School on this program. Because this program is so expensive, we only run Every 15 Minutes every 4 years, thereby ensuring that each student sees it one time in their high school career. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? The entire program has been designed by the CHP to be most impactful to teens. The actors are teens (from the local school population), and the audience can relate to the situation they find themselves in. Because we use local teens, local PD, local fire department, take the "injured" students to the local hospital, etc., we are making the enactment as realistic as possible. Further, the speakers that come to the assembly on the second day are local, as opposed to those from the national speaking circuit, and they are very good at connecting with the students. We have found in the past that this program is extremely impactful to our local teens, and find that they still talk about their experiences with it many years later. This population (high school students) are within a year or so one way or another of getting their driver's licenses, and therefore the information that is presented is extremely timely. Teens may think they are invincible, but when they see a video of a coroner informing the mother of one of their classmates that the classmate died in a drunk driving accident, they don't soon forget it. Likewise, they get to see a video of the "drunk driver" being booked into Santa Rita Jail and having an initial appearance before a judge. These things leave a lasting impression on even the most cynical of teens. 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 high school students particpate in this program. The students that are designated as the "walking dead" are chosen by the administration to come from all demographic groups at the high school, thereby ensuring that as many students as possible know someone who has been removed from class and designated as "deceased." Further, all students, regardless of income level, language spoken at home, or disability level, come to the accident scene. Even those students who are English Language Learners, while they may not undersand all the words that are said on the 911 recording over the loud speaker, understand what they are seeing when the police department and the ambulances take their classmates away from the crash scene. Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35212 This program truly reaches all students at both of our high schools. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We partner with: Dublin PD - to provide officers to assist with the crash enactment and to "arrest" our DUI suspect Dublin Fire Department - to assist with the crash enactment and to use the "jaws of life" to extract students from the car and transport students from the crash scene to the ambulance CHP - to provide the medivac helicopter to evacuate the most seriously wounded student local hospitals - to receive the wounded students and allow us to film their "treatment" and the notification of their parents Alameda Sheriff's Department and Santa Rita Jail - to "book" our DUI suspect Alameda County Courthouse - to "arraign" our DUI suspect 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. The public is welcomed to attend this event. While we do try to keep the details, and the date, a secret from the kids as much as possible to preserve the impact of the program, we do put out a press release prior to the event inviting the public to come to the crash enactment and the subsequent assembly. We find (regretablly in the global context, fortunately for this event) that most students don't read the paper, and so putting out a press release doesn't tend to lessen the impact or the surprise for our students too much. Because the program is run during the school day and students are excused from classes, we have a built-in strategy for ensuring participation. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. The Every 15 Minutes program is a two-day program for high school students and challenges them to think about drinking, driving, personal safety, the responsibility of making mature decisions and the impact their decisions have on family, friends, and many others. It focuses not only on driving under the influence, but also distracted driving. Additionally, teens are taught not only to make their own good choices, but are empowered to intervene when they see their peers about to make a dangerous choice. The City of Dublin's Mission, Vision, and Values document says the city of Dublin will, "Provide education and training to residents and businesses that would promote public safety." Not only does this program affect the safety and security of our teens, but it affects the safety and security of every citizen in Dublin. When a teenager drives impaired, he not only endangers himself, but those around him as well. When a young driver texts and drives, she puts the entire community at risk, not just herself. This program reinforces these ideals and makes the whole city of Dublin safer. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. This is an expensive program. It requires the coordination of multiple municipal agencies, vendors, and volunteers. For this reason, we only run the program every 4 years, thereby ensuring that each high school student in Dublin has the opportunity to benefit from the program, but not become numb to it. By directly serving 2500+ residents, and indirectly serving the entire City of Dublin, the value of the program is immeasurable. We anticipate that the total cost of the program will be approximately $29,000. In 2008, it was $22,000; in 2012 it was $25,000. With the population growth at our high schools, and inflation, we believe the cost will be closer to $29,000 for 2016. However, because the program is only run every four years, and has the potential to save untold thousands of dollars in emergnency reponse fees, medical fees, and lives, we believe that the benefits far outweigh the costs. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If the City of Dublin is unable to fund this project, or is unable to fund the entire requested $8000, we will still proceed with the project. We are requesting approximately $20,000 from the CHP to provide the bulk of our funding, and we will be attempting to make up the difference with outside donations. If the City of Dublin is unable to help, or doesn't fully fund our request, we will hold fundraisers, look to corporate sponsors, do everything in our power to ensure that this program goes forward. There are a limited number of corporate sponsors in Dublin, and many already donate heavily to the schools, but we will do our best to secure the funding outside of the grant process. Unfortunately, if the city is not able to fufilll our request, while the program will still go forward, it will likely have to be scaled back, thereby blunting the impact for our students. For example, one of the most powerful aspects of the program is the retreat for the "walking dead" and the crash participants. If we don't receive city funding, we will have to find another way to quarantine those students (who have no contact with the outside world, because of course they are "dead," from the time of the crash enactment until the assembly on the second day). Other cost cutting measures would have to be explored, but since much of the services for this program are already donated, we would be hard pressed to cut enough corners to make up the difference. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35212 No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35212 Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35212 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35212 Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35212 Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). We constantly hold fundraisers (dining outs, product sales), an annual gala/auction, and donation drives. Budget Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35212 Funding Sources/Revenues Budget Amount Amount Committed CHP Grant - Dublin High School USD$ 9,999.99 CHP Grant - Valley High School USD$ 9,999.99 Donations from Local Businesses and Individuals USD$ 1,200.00 City of Dublin City Grant USD$ 8,000.00 Total USD$ 29,199.98 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Videographer (throughout project) USD$ 5,200.00 Bleacher Rentals (crash day) USD$ 15,000.00 Audio/Video Services (Crash Day and assembly) USD$ 2,500.00 DVD copies USD$ 60.00 Hotel for Student Retreat USD$ 1,200.00 Printing USD$ 3,000.00 Supplies USD$ 500.00 Postage USD$ 80.00 Flowers (for funeral assembly) USD$ 120.00 Chair Rental (for funeral assembly) USD$ 540.00 Food USD$ 600.00 Make-up (for crash victims, walking dead) USD$ 75.00 Towing Fees USD$ 320.00 Total USD$ 29,195.00 USD$ 0.00 Budget Narrative The Every 15 Minutes program, while administered by the Dublin High School PFSO, is completely dependent on outside funding sources. Because it is only run every 4 years, it is not part of either the DHS or Valley High School PFSO budgets. To that end, we rely on outside fundraising to run the program. The CHP has grants specifically for this program that we anticipate receiving for both Dublin High and Valley that will make up the bulk of the funding. The remaining funding will come from the City of Dublin Grant, hopefully, with supplemental money coming from individual donations from local service organizations, corporations, and citizens. Vidoegrapher - this is the key to the entire program. Every piece is professionally taped and edited, from the staged party where the students get "drunk" and get behind the wheel, to the hospital emergency room, to the parental death notifications, to the jail, and everything in between. It is all edited into a final video that is shown at the "funeral" assembly. Bleachers - The largest expense, but critical for putting 2500 students up close and personal to the crash site. A/V Services - Sound systems and effects during the simulated crash and during the "funeral" assembly. DVD Copies - Of the finished video. Hotel Retreat - For the 25 student participants and their chaperones. Printing - Programs, shirts, tombstones, obituaries, press releases, etc. Supplies - For the retreat and 2 luncheons. Flowers - To enhance the "funeral" assembly. Postage - For invitations, contracts, thank you notes, and such. Chair rental - for adults and staff at the "Funeral" assembly. The students sit in the bleachers inside the school gym. Food - For the two lunches - one for the student participants on day 1, one for a wide variety of participants on day 2. Make-up - to make the students look sufficiently injured or dead. Towing fees - to get the wrecked cars on and off campus. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template E15Min - Program Expense Budget for All Grants Financial Information Form for ALL Grants download template E15Min - Financial Information Form for ALL Grants List of Board of Directors (or governing body) with contact information E15Min - DHS PFSO Executive Board Current Annual Budget for the Entire Agency E15Min - Dublin High PFSO Current Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) E15Min - DHS PFSO Tax Return Board of Director's (or governing body's) designation of authorized official E15Min - School Authorization Letter E15Min - Authorization Letter from PFSO Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35212 Board of Director's (or governing body's) authorization to request funding (may be same document as one above) E15Min - Authorization Letter from School E15Min - Authorization Letter from PFSO Proof of insurance carried, including bonding, liability and/or workers' compensation E15Min - Proof of Insurance (PFSO Is Covered under Dublin School District - DUSD) 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 E15Min - State Non-Profit Determination Letter E15Min - 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35212 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35212 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). To support Dublin High students, staff, and administrators, fill campus needs via fundraising efforts and recruit and employ volunteer efforts on behalf of Dublin High School. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Dublin High School Parent Faculty Student Organization Dublin High Safe and Sober Grad Night Dublin High School Parent Faculty Student Organization 8151 Village Parkway Dublin , CA 94568 United States Tel: (925) 833-3300 Fax: (925) 833-3344 Web: http://www.dublinusd.org/Domain/132 EIN: 94-1742440 DUNS: 94-1742440 Project Contact Catheryn Grier teamgrier@yahoo.com Tel: 925-364-0338 Additional Contacts none entered PFSO President Christine Bennett chris@workvantage.com USD$ 4,000 Requested Submitted: 12/11/2014 1:24:01 PM (Pacific) Application Questions Page 1 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36098 7. Please provide information to justify your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). The Dublin High PFSO is a long-established campus support group, dating back to the early days of Dublin High, with a history of participation by parents, staff, and students. Parents have been serving as the leads in the organization since its inception. Each of our graduating classes from freshman to seniors are represented by "Parent Reps" who coordinate events for the classes through the duration of their school careers and have a large staple of volunteers that they draw from throughout. We have a large executive board made up of officers as well as our Parent Reps as well as liaisons within the administration, including the vice principal and student activities directors who help to guide and coordinate our efforts throughout the school year. Many of the parents who are serving on the high school PFSO board are very experienced parent volunteers who have worked in similar capacities at the elementary and middle school levels. The group has a long history of strong fiscal management. The Grad Night event has a long history at Dublin High, having run each year since 1991 and is planned and prepared in concert with School Resource Officers from the Dublin Police Department. 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 requested funding will support our annual effort to hold a Safe and Sober Grad Night celebration for the senior class following their high school graduation ceremony. 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.) 400 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. The Grad Night event, which has happened every year since 1991, is planned and executed by the parents who represent the graduating class. It is administered by those same parents, with support from the PFSO and parent volunteers of the graduating students. The class keeps its own accounting under the umbrella of the PFSO treasury. Months are spent planning activities, fundraising to support the costs, preparing decorations, and purchasing supplies. On the night of the event, large groups of parent volunteers are brought in over several shifts to supervise the facility and the students and security is provided. Students are admitted and not allowed to leave the event until it ends. 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 play a key role in financing the event. It is a costly endeavor to provide the facility, activities, and refreshments for nearly 400 students, particularly as the size of our student body continues to grow at Dublin High. Dublin Grant Funds provide an important supplement to funds that have been raised by the PFSO on behalf of the class for four years. Dublin Grant funds will be used for facility rental, decorations and supplies, and allow us to keep the cost to students Page 2 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36098 as affordable 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)? At the Grad Night event, Dublin High graduates celebrate as a class -- perhaps for the last time -- in an appropriate way with supervision and care. Most importantly, students return home safely at the end of the night to their families and the community is safer and more secure as a result. More than "just a party," Grad Night is a commitment by parents, school, and the community to conduct a great, "once in a lifetime" celebration that is alcohol and drug free. A sense of community is developed as everyone works to keep the graduates entertained and safe on potentially the most dangerous night of their lives. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. This event serves the outgoing senior class of Dublin High School, providing a place where, in the hours following their high school graduation ceremony, they can celebrate their accomplishments as a class. Most importantly, they can celebrate in a safe, supervised, and controlled environment, greatly diminishing the likelihood that these students would turn to other less- appropriate forms of celebration, such as drinking or other illegal activities. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? The event is geared toward teens with activities such as swimming, carnival games, video game arcades, "Sumo" wrestling, and dodge ball and basketball games -- all designed to keep students active and engaged. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? All Dublin High seniors are invited to attend the Grad Night party and while there is an admission fee to attend for students -- thus, ensuring their investment in attending the event, rather than blowing it off because they know it's free -- we work closely with the school's administration to provide financial accommodations who are unable to afford the ticket price. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We have partnered in the past with other local high schools, including the parent booster groups at Foothill High School and Amador Valley High School in Pleasanton to share expenses and theming for decorations. We also support one another with clean-up efforts after the event is over. We also partner with Dublin Police Services, specifically our School Resource Officers, to assure a secure environment and also provide backup to the parent supervisors in the event of something unforeseen. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. Outreach is not entirely applicable here given that the event is solely geared for Dublin High seniors; however, we do indeed engage in substantial outreach to the parent volunteers in our community to assist in supervision and implementation of the event planning. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. The Grad Night event absolutely fits in with several of the City's Values including a High Quality of Life and a Safe and Secure Environment. We, as parents, are working hard through this event to keep our teenagers safe and secure during this milestone celebration. By extension, this event also contributes to the overall safety of our community and teaches our children that we value responsibility. It also fits with the Value of Community Building, not only as s promotion of the time the students will spend together, but with our collaborative efforts with Pleasanton schools. And it is part of the unique and dynamic community opportunities offered to the youth of Dublin. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Through the PFSO, the parent class representative have been raising money for this event for the four years the participating students are in school. Funds are raised both through PFSO general fundraisers such Fireworks Sales and a Raise Your Class dinner/dance, but also through class-specific fundraising efforts to help boost the individual class accounts. This project is cost-effective as it can be given its large scale, but we are as efficient as possible in pairing with other schools to share costs and resources and also in recycling some of the decorations and other supplies that we have used at Dublin High for other activities such as homecoming and prom/dances. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If the application goes unfunded, the Senior Parent representatives for the Class of 2016 will be scrambling to add fundraisers to make up the shortfall, all the while spending time preparing for such senior year activities as Senior Banquet, awards night, prom, and Senior Picnic. It is both a significant financial strain and a time strain for those who are working on behalf of the students. Page 3 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36098 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. Page 4 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36098 No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Page 5 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36098 Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Page 6 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36098 Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Page 7 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36098 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). The PFSO works diligently to fundraise creatively with our families and we will continue to seek out new opportunities to Page 8 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36098 offset costs. Budget Funding Sources/Revenues Budget Amount Amount Committed Fireworks/Dinner Dance Income USD$ 12,000.00 USD$ 12,000.00 Direct class donations USD$ 2,500.00 USD$ 2,500.00 Student ticket purchase USD$ 18,000.00 USD$ 18,000.00 Total USD$ 32,500.00 USD$ 32,500.00 Funding Uses/Expenses Budget Amount Amount Committed Facility Rental USD$ 17,000.00 USD$ 17,000.00 Activities Rentals USD$ 17,500.00 USD$ 17,500.00 Decorations USD$ 3,000.00 USD$ 3,000.00 Food USD$ 3,000.00 USD$ 3,000.00 Supplies USD$ 250.00 USD$ 250.00 Rental equipment USD$ 500.00 USD$ 500.00 Insurance USD$ 1,000.00 USD$ 1,000.00 Stipends USD$ 100.00 USD$ 100.00 Total USD$ 42,350.00 USD$ 42,350.00 Budget Narrative The event costs approximately $45,000 to execute from start to finish. Classes spend four years fundraising to get to this event -- as well as Senior Banquet and Senior Picnic -- through a variety of means. The cost of renting the Club Sport Facility in Pleasanton, one of the few venues in the area large enough to hold the event, has run approximately $15,000 a year for the past few years. Rental of arcade games, carnival games, inflatables, and DJ equipment for music has been similar in cost. Decorations are recreated and re-generated as much as feasible, but requires the purchase of items such as building materials. Supplies include food and drinks for 400 students, as well as prizes for games and other necessary items. Student tickets, which we aim to keep at a reasonable level, offset some of the costs of the event, but clearly not enough. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Grad Night Budget Financial Information Form for ALL Grants download template Senior Class Budget Activity List of Board of Directors (or governing body) with contact information PFSO Executive Board Current Annual Budget for the Entire Agency 2014-2015 Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) 2013 PFSO IRS 990 Form Board of Director's (or governing body's) designation of authorized official Designation of authorized grant writer Board of Director's (or governing body's) authorization to request funding (may be same document as one above) PFSO Authorization to Request Funding 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 Page 9 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36098 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 DHS PFSO Federal Non-Profit Letter DHS PFSO State 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. REQUIRED FOR CDBG- LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 36098 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 10 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36098 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Dublin Partnerships in Education is a non-profit foundation dedicated to fostering mutually beneficial business, community and educational partnerships in order to maximize resources and enrich the learning experiences for all students in the DUSD 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Dublin Partnerships in Education DPIE City of Dublin Community Grant Dublin Partnerships in Education P.O. Box 2307 6800 Penn Drive Dublin, CA 94568 United States Tel: (925) 828-2551x8024 Fax: (925) 803-9746 Web: www.dpie.org EIN: 94-3207780 DUNS: Project Contact Susan Campbell susan@dpie.org Tel: (925) 828-2551x5435 Additional Contacts jlemmo@ft.newyorklife.com Executive Director Susan Campbell Susan@dpie.org USD$ 20,000 Requested Submitted: 12/11/2014 8:04:11 AM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35841 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.). This is an Operational Grant request to provide DPIE with support for staffing for four part-time employees. We provide programming that assists students, parents and businesses throughout our community. The request for operational support includes payroll, insurance and office equipment. This grant will also support our Four Pillars of Service for funding a variety of programs: 1. Career Exploration; 2. Arts-both visual and performing; 3. Resources for Educators; and 4. Educational Support. DPIE's staff and governing board are comprised of civic leaders and business people whose combined resources and experience provide the necessary skills and knowledge necessary to bring the business and school communities together in a mutually beneficial manner to support and enhance our students' learning experience in a fiscally sound manner. 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 is a request for an Operational Grant to help DPIE continue the work described in our Four Pillars of Service (also known as CARE Grants): 1. Career Exploration; 2. Arts –both visual and Performing Art;3. Resources for Educators; and 4. Educational S 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.) 9200 Students and their families 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. DPIE's daily operations are currently administered by three regular part-time employees: an Executive Director, an Enrichment Academy Superintendent, and an Administrative Assistant. With the growth of our Enrichment Academy, we are seeking to add an additional part-time person to assist in facilitation of this successful program. Project-based contract employees are hired, as needed, to assist in the implementation of various programming in order to keep administration costs at a minimum. Limited-term, part-time employees are also hired as needed for our Summer Enrichment Academy. DPIE also has a Board of Directors who engage in monthly Board meetings at the DPIE office, as well as participate throughout the year in various committee meetings. DPIE committees, which are comprised of Board and Staff members, include: Governance, Finance/Budget, Programs, Fundraising/Events, Membership, and PR/Marketing. Board members are local business people and civic/community leaders who live throughout our City. We operate from a set of goals designed for each school year. At the end of each year, the Governance Committee evaluates the success of each program and makes recommendations to the Board and staff for the following year. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). These operational grant funds will be used to keep our office open each day from 9:00 a.m. to 1:00 pm, Monday through Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35841 Friday, year-around. The grant helps maintain four (4) regular, part-time employees who fundraise, create and administer programs for students throughout the school district, create partnerships between the business and educational community, and represent the education foundation with the business community in Dublin and the Tri-Valley region. It is also used to help keep our office equipment and supplies in working order. Our Enrichment Academy is growing at a rate of an additional 100 students per year. Our needs increase incrementally with each class. We are focusing on growing our classes and it now takes two people dedicated to working strictly with the Enrichment Academy year round to make it successful. This puts a natural burden on the rest of DPIE and its programming. Maintaining our office hours and staffing remains our greatest challenge. 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)? Our program is designed to assist students in four major areas of their education: 1. Career Exploration for Students - Signature program is Career Exploration which includes Career Days at Middle and High Schools with an emphasis on STEM careers, as well as Health and Trade Classes at Valley High. We offer Career Exploration every Friday at Wells Middle School during their Career Wheel Classes. In addition, we are piloting a new Program at Valley High School: GearUP – a Workforce Bootcamp - designed to work with underserved students to prepare them for a career they may not have considered. This is a voluntary student program held after school on Tuesdays and Thursday from January thru March with a set curriculum consisting of “Time Management, Coping/Life Skills, Electronic Resumes and Interviewing Skills” as a few examples. We are also offering Expert Panels from local businesses in various fields to give these students a sampling of careers that they may have not considered in the past. In April the students will apply for internships with local volunteer companies. At the culmination of the GearUP Program we hope that they will have gained the skills and confidence to make good decisions regarding their futures. 2. Arts Education: Signature Program - Afterschool Art Program at the Middle Schools, Guest Artist classroom visits, Art Supply Donations, and Common-Core Arts Integration Certification for Two Teachers at Each Elementary School. Our Arts Program will include a Poster Contest with the Theme: Be Loyal to Your Soil – Compost at Dublin High School. We are also formulating performing arts after school program: Fiddle Club -with the pilot program at Kolb Elementary. 3. Resources for Educators: Signature Program - New Teacher Welcome Grants, as well as local business in-kind donations and subject expert speakers for classrooms. We were able to Grant a portion of the costs for Special Education Recumbent Bikes at Dublin High School last year and this year. 4. Educational Support: Signature Program - STEM-based, WASC-accredited Summer Enrichment Academy, which provides for-credit enrichment and advanced math and science classes for high school students, as well as enrichment classes for middle school students. DPIE offers scholarships to the Academy for qualifying low income students. Our strategies for tracking program success are evaluation of money spent, surveys and progress counted through the administration of the programs by DPIE's Governance Committee. This year, we are focusing on developing a more formal tool for measurement, especially as it relates to our Enrichment Academy as required by WASC (Western Association of Schools & Colleges). 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. Dublin Unified School District includes students in all socio-economic levels. With the wide diversity of language and homelands found in Dublin, all of our programs are designed to reach a variety of students. We make certain that our programming and granting process directly impact each and every school in the DUSD at every level. We work directly with the schools to make certain our programs are supportive and reflective of their needs. For example, art at a middle school level was limited this year and, in response, DPIE budgeted funds to implement after school art programs at both Wells and Fallon Middle Schools to fill that need. Although a small fee is charged, scholarships are available to low income students so they don't miss any opportunities due to lack of funds. Additionally, DPIE provides bi-lingual guest speakers for the classrooms when needed. The GearUP Workforce Boot Camp targets Valley High School students that are on the low socio- economic scale. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? Our programs are designed to work with all students, and therefore, all of the many cultures that exist in Dublin. We have provided international guest chefs to the Dublin High culinary program to demonstrate the preparation of culturally diverse cuisine, while educating the students about the culture of that particular country being represented. We also procure funding to bring Challenge Day to Valley High School, a highly impactive program where students and staff learn to cultivate a culture of inclusion and acceptance, as well as learn to communicate through the celebration of every type of diversity. 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 of these groups exist within the school community, and our job is to work with each and every student involved in our programs despite any language, income or physical challenges. This year, the DPIE board implemented an ongoing scholarship program for our Enrichment Academy Classes and Afterschool Art Program. Recently we provided the ESL classes an opportunity to participate in a lecture on recycling. Students who are enrolled in the School District's free or reduced lunch program are eligible to receive 25%, 50% or 100% scholarships depending on their situation. Our scholarship program also provides for special requests, such as assistance with the Close-Up program, at the end of the fiscal year, if monies are still available in the fund. Also this year, in our efforts to reach out to the disabled student body, we were able to procure gap funding to purchase the second specialized bicycle Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35841 and extra equipment for severely disabled students at Dublin High. This specialized 3-wheel bike is designed to carry severely disabled students, giving them their first bicycle experience. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Our organization partners with the Dublin Unified School District, each Parent Faculty Club and the Dublin High Parent Faculty and Student organization. Most recently, the DPIE Board took action that would allow staff to partner with the middle school PFCs for their assistance in marketing our afterschool art classes in order to fill them to capacity. As a result of this partnership, DPIE donated to them all proceeds from the class registration fees. While maintaining our separate organizations, our goal is to support the needs of each of these groups, as well as the Dublin Chamber of Commerce and various other businesses in our community and the surrounding area. Specifically, we work with the Administration office of City government on preparing opportunities for the City to share with students with the Inside Dublin program, which educates students on the various local government career opportunities and pathways. The Fire Department and Police Services departments are both valuable partners with DPIE and provide ongoing educational programs for our students and the community. We also partner with other non-profit organizations such as School of Imagination, who have loaned us their bus for field trips for DUSD students. This year, DPIE promoted the holiday Tri-Valley Community Outreach Thanksgiving Dinner campaign through our Facebook page. We have supported several businesses through promotions on our website, newsletter, local press and Facebook page. These partnerships will not only benefit DPIE's business sector stakeholders, but our city and residents, as a whole. We support Innovation Tri-Valley’s Dream Makers and Risk Takers and celebrated our Dublin Students and their accomplishments. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. DPIE markets our programs through our website (www.dpie.org), Monthly e-newsletters that goes out to an every expanding email database, as well as our Facebook page. Through collaboration as Ambassadors with the Dublin Chamber of Commerce and our business partnerships, we also stay connected to the business community. We attend the Ribbon Cuttings to welcome new businesses to the City of Dublin. We are currently founding Members of the Tri-Valley Non Profit Alliance. The Alliance is a large group of non- profits in the Tri-Valley who share ideas and common goals. We are collaborating on a Regional level with the Wente Foundation for the Arts Education. This collaboration includes the School Superintendents of Livermore, Pleasanton, Dublin and San Ramon along with the Executive Directors of their Education Foundations and the Superintendent of the DPIE Enrichment Academy. DPPIE participates and sponsors a Community Day at Camp Parks strengthening our relationships with the Military families in Dublin. For the past 6 years, we have partnered with the Dublin Rotary to supply every third grader in the School District with beautifully illustrated, hardcopy dictionaries. We also partner with Dublin Rotary and the Wells Middle School Band for the City's Non-Profit Fireworks Sales program during the lottery and sales, and split proceeds evenly regardless of who is selected in the lottery. For the past two years, DPIE has partnered with the Dublin High School Culinary Program to operate our Summer Enrichment Academy "nutrition cart," which provides nutritious snacks for our students. This mutually beneficial partnership provides valuable business experience and fundraising opportunities to the DHS Culinary Program, as they keep 100% of the proceeds from their sales. We also partnered with the Dublin High Culinary Program by engaging them for our desserts at our Celebrity Waiter Dinner. We also partnered with PFC's to market our afterschool art program. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. DPIE has a similar Mission and Vision to that of the City of Dublin. Our commitment is to foster new opportunities for students, businesses, and families within our community. We develop opportunities for our business community and school community to get to know each other, and partner on mutually beneficial projects and programs. As it relates to environmental sustainability, this year, we implemented an innovative "green" art program at Wells Middle School where DPIE's after school art students beautified their campus, by decorating large planters and then working with the "Go Green" Club to place, plant and maintain the greenery throughout the year. We promote environmental stewardship, by collaborating this year with StopWaste to educate the community on the values of recycling through presentations during ESL classes, a Poster Contest at Dublin High (Be Loyal to Your Soil –Compost) and an interactive recycling table at our Walk 4 Education in May. DPIE's Values are shared by building community and providing programming and promoting events that bring everyone together. This year we will collaborate with the local business community and the PFC’s on a family focused WALK 4 EDUCATION at Dublin High. We focus on collaborating with other organizations to meet the needs of our student and family populations, as well as our local businesses. We build community and promote culture through our various art programs. This year, our art program included new middle school art classes, common core arts integration training for elementary school teachers, and monetary "seed" grant for a new Fiddle Club at Kolb Elementary. DPIE employs similar strategies in working within our community. Our economic development plan includes strengthening the ties between our business community and our families. With our frequent Facebook postings, monthly communications at various meetings/events, and monthly newsletters, we work hard to provide connectivity throughout our city. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35841 Our operations will include four regular part-time employees, several part-time, limited-term employees (enrichment academy teachers and staff), project-specific, limited-term independent contract employees (speaker/career and art programs), and a volunteer non-profit board of directors of up to 12 community residents and/or business people. The make-up of our staffing is designed to keep overhead down by maintaining a very small "critical need" staff, and then targeting limited term employees as needed for specific programming. The operational funding we are requesting will help us keep our office open from 9am - 1pm daily during the school year, and 8am - 1pm during summer academy hours. It will also provide development and support of all fundraising and programming for the students and families of Dublin Unified School District. It is far easier to apply and receive grants for programming rather than operational support. We must also fund equipment replacement and supplies for operation. This support allows us to use fundraising dollars to meet the needs of the community. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Without funding, the ultimate loss will be to the important programming and support DPIE supplies to the schools. Without operational support, hours will be cut from an already slim schedule and will lead to a loss in availability of workers to fund raise and develop programs such as our Middle School Afterschool Arts Program, Challenge Day at Valley High, Educational Support for the various Academy Pathways we are involved in at the high school level, teacher classroom support, the performing arts Fiddle Club and our GearUp Workforce Bootcamp. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35841 Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *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. Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35841 * 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. F) Not Applicable. I am not interested in qualifying for CDBG funding. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35841 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35841 Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not 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: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35841 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). N/A Budget Funding Sources/Revenues Budget Amount Amount Committed Enrichment Academy USD$ 65,000.00 Interest Income USD$ 100.00 Events - net USD$ 56,340.00 Grants USD$ 12,500.00 Donations and memberships USD$ 13,300.00 Total USD$ 147,240.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Teacher Grants USD$ 8,000.00 USD$ 7,500.00 Fireworks Donations USD$ 1,000.00 Sponsorships USD$ 3,300.00 Website Exspenses USD$ 6,000.00 Career Exploration USD$ 3,000.00 USD$ 3,000.00 Rent and Facilities Expense USD$ 12,000.00 Office Supplies and Misc. USD$ 1,000.00 Postage USD$ 300.00 Bank/Merchant Fees USD$ 2,000.00 Office equipment USD$ 500.00 Outside Acounting Services USD$ 4,200.00 Corporate Filing fees USD$ 100.00 Insurance USD$ 3,500.00 Executive Director Expenses USD$ 600.00 Marketing and promotion USD$ 2,000.00 Professional Development USD$ 1,200.00 Payroll and related expenses USD$ 72,540.00 Total USD$ 121,240.00 USD$ 10,500.00 Budget Narrative At the end of the school year, the Dublin Partners in Education Board of Directors will designate net profit dollars to programs of the Dublin School District based on conversatons with the District staff. Greatest needs are given the highest priorities. The District has grown to over 9200 students. With this growth comes an increased need to support the programs that DPIE has provided to make this community a place to live and thrive. Our support for underserved students(GearUp) and Special Needs makes us a strong partner. With the growth in the Schools our teachers need our assistance more than ever. Documents Documents Requested *Required?Attached Documents * Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35841 Program Expense Budget for ALL Grants download template Program Expense Budget for all Grants Financial Information Form for ALL Grants download template Financial Information Form List of Board of Directors (or governing body) with contact information DPIE Board and Staff Roser Current Annual Budget for the Entire Agency DPIE Annual Budget for City Grant Copy of most recently submitted IRS 990 form or Tax Return (include complete form) DPIE 2012 form 990 City Grant Board of Director's (or governing body's) designation of authorized official Board Authorization for City Grant Board of Director's (or governing body's) authorization to request funding (may be same document as one above) Board President Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation Philadelphia Insurance Declarations Pages Hartford Insurance Declarations Pages 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 DPIE Proof of Non-Status 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35841 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35841 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). 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? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Easter Seals Bay Area Zach Lupton Easter Seals Bay Area 391 Taylor Blvd Suite 250 Pleasant Hill, CA 94523 United States Tel: (925)849-8999 Fax: (925)849-8966 Web: www.easterseals.com/bayarea EIN: 94-3120231 DUNS: 072321854 Project Contact Zach Lupton zlupton@esba.org Tel: 925-828-8857 Additional Contacts none entered President, C.E.O. Susan Armiger sarmiger@esba.org USD$ 15,000 Requested Submitted: 11/19/2014 10:35:54 AM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35090 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) Program Manager, (1) Site Supervisor, (1) Administrative Coordinator, (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 Bachelors Degree and support staff are currently working towards that goal or an Associates 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 this field. 8. Provide a brief summary of the project for which your agency is seeking funding (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. The Kaleidoscope program focuses on developing interpersonal communication, social, and independent living skills through participation in community based, athletic, pre-vocational, and recreational activities. 9. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED: client is counted only once regardless of number of services received in a year.) 9 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. 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?). Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35090 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. 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 Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35090 goods and donated to Valley Christian Church, and participated in Special Olympics. Easter Seals Kaleidoscope also utilizes the Cities of Livermore and Pleasanton grant funding. 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. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. Being that Easter Seals Kaleidoscope is a site based program, we often rely on volunteers to help with events, special projects, and sporting events. By using volunteers from the city of Dublin, City Serve, parents/friends, and surrounding communities we have created a unique way for the community as a whole to gain knowledge and understanding of the population we serve. Within the past year we have had over 150 volunteers assist with maintaining the garden on, assist with coaching during the Special Olympics regional tournaments, provide support during the Art & Sound Festival held at the Kaleidoscope center. Volunteers have also deep cleaned our buildings and vehicles, replenished the tan-bark on the playground, collected donations for our events, and assisted with the many parties for the participants. Kaleidoscope has also participated in many resource meetings to establish a network of caregivers, housing solutions, employment opportunities, legal guidance, and special day programming. Easter Seals is Leading the way to ensure individuals and families affected by disabilities can live, 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", "My daughter would never have friends if we didn't send her to Kaleidoscope". With direct impact such as these, Easter Seals Kaleidoscope meets all of the criteria of the City of Dublin's Mission, Vision, Values, and Strategies. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The Easter Seals Kaleidoscope After-School program's design allows us to offer cost-effective, comprehensive transitional services for youth and young adults with disabilities without sacrificing quality of services. By offering the program as a programmatic component of the Easter Seal Bay Area, we are able to share expenses and resources based on a pro-rated share between programs. A portion of the program occurs in the community so participants have the opportunity to apply the functional skills they obtain in a real-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. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If the City of Dublin is unable to provide funding, we will seek contributions from other organizations to cover program costs that are not funded through earned revenue. However, the 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 Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35090 awareness within the communities we serve. Easter Seals is very thankful about leveraging City Grant funding from the City of Dublin to raise additional awareness and support, and to cultivate life-long champions of the Kaleidoscope program. We would not be as successful as we are without the help of the Dublin community. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35090 Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. Often times case managers from Regional Center of the East Bay will be available to translate if need be. Currently Easter Seals Kaleidoscopes Administrative Coordinator is fluent in Spanish, one Assistant Teacher is fluent in Portuguese, and one Assistant Teacher is fluent in American Sign Language. Easter Seals Kaleidoscope is not applying for CDBG funding. 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35090 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35090 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35090 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: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35090 #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). Easter Seals Kaleidoscope is currently looking into other funding sources, such as private pay, health insurance coverage, etc... Budget Funding Sources/Revenues Budget Amount Amount Committed Program Service Fees - Revenue USD$ 322,256.00 USD$ 89,743.00 Fundraising - Revenue USD$ 28,000.00 USD$ 15,000.00 Other Income (Includes interest income) City of Livermore HHSG USD$ 5,000.00 USD$ 5,000.00 Pleasanton Community Grant USD$ 9,000.00 USD$ 9,000.00 Total USD$ 364,256.00 USD$ 118,743.00 Funding Uses/Expenses Budget Amount Amount Committed Program Staff Salaries USD$ 350,421.00 Program Staff Benefits USD$ 85,708.00 Professional Fees USD$ 1,700.00 Equipment Rental/Maintenance USD$ 4,000.00 Printing/Publication USD$ 4,500.00 Supplies/Materials USD$ 25,635.00 Other: Transportation USD$ 4,500.00 Total USD$ 476,464.00 USD$ 0.00 Budget Narrative The above are direct numbers pulled from operating cost budgets. The 14000.00 was from the City of Pleasanton and Livermore Grants which have been invoiced. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Program Expense Budget Financial Information Form for ALL Grants download template Dublin Financial Form List of Board of Directors (or governing body) with contact information Board of Directors list Current Annual Budget for the Entire Agency 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 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) Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35090 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 501c 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35090 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35090 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Eden I&R believes that all individuals are entitled to fully utilize all community resources for which they are eligible and that optimum utilization of these resources can substantially enhance the quality of life in the community. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Eden I&R, Inc. 2-1-1 Alameda County Communications System Eden I&R, Inc. 570 B Street Hayward, CA 94541 United States Tel: (510) 537-2710 x8 Fax: (510) 537-0986 Web: www.edenir.org EIN: 94-2339050 DUNS: 134391861 Project Contact Barbara Bernstein bbernstein@edenir.org Tel: 510-537-2710 x8 Additional Contacts adejung@edenir.org, hyuen@edenir.org, jvilleneuve@edenir.org Executive Director Barbara Bernstein bbernstein@edenir.org USD$ 10,000 Requested Submitted: 12/10/2014 5:04:53 PM (Pacific) Application Questions Page 1 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35189 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 comprised of seven dedicated individuals, with several members having served between 10-20 years. The agency’s staff has been led by Executive Director Barbara Bernstein since January, 1989. Eleven of the 36 staff members have been with Eden I&R for ten or more years, testifying to the stability of the agency. As the only countywide comprehensive Information and Referral (I&R) provider in Alameda County, Eden I&R is relied upon by human service providers, local government, and people in need throughout the County as: a professional and compassionate partner in the delivery of human services; the clearinghouse for accurate community information; a key component of the disaster response network in Alameda County; a reliable source for data on service needs and delivery systems; and a culturally and linguistically diverse organization prepared to serve Alameda County’s individuals and families. 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 Alameda County is a free, 24/7, multilingual phone line that connects individuals and families (particularly low-income, at-risk people) with referrals to city and countywide health, housing & human service resources. 9. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED: client is counted only once regardless of number of services received in a year.) Our goal is to assist 600 callers. It is not possible to discern whether all callers are unduplicated because callers often are rushed and only share their city of residency but may not provide additional demographic information. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. 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 Line Resource Specialists (PLRS) are rigorously trained to understand the unique and often dire situations faced by callers, and are able to assist in prioritizing requests, build an action plan, and be sensitive to the needs of callers. PLRS do not attempt to solve callers' problems, but empower callers to understand and solve their own problems by working to fully understand the caller's situation (e.g. origins of the needs, the feelings callers have about their circumstances, the personal resources callers may bring to bear on the issue, and the barriers they face). The primary objective of the 2-1-1 phone line is to help callers identify the health, housing and/or other human service resources that can meet their needs. Whenever possible, PLRS provide follow-up on cases involving endangerment and situations in which the PLRS believes that the caller may have difficulty accessing services or clearly communicating their particular circumstances. PLRS present the caller with various approaches to addressing the problem and explore the caller's own resources (e.g., friends, family, Page 2 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35189 faith-based community). Where possible and desirable, the caller will be provided with at least three referrals to enable him/her to choose the most appropriate resources. PLRS pursue the problem until both the caller and PLRS are assured that all appropriate options have been exhausted, and will suggest ways the caller can advocate for him or herself. To ensure that 2-1-1 callers receive the most up-to-date information and referrals to resources, Eden I&R's Human Services Database is updated daily with every program record updated, at minimum, once a year. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). Dublin grant funds will be used to assist Dublin residents, employees, and advocates in accessing health, housing and human services information and referrals, 24 hours a day, 7 days a week. Due to the need for continuous staffing to operate a 24/7 phone service, staff salaries and benefits represent 85% of the project's costs. 2-1-1 provides referrals to programs identified by the 14 Areas of Concern identified in the 2011 Tri-Valley Needs Assessment. The report also identifies a shortage of affordable housing, mental health services, child care and workforce development programs in the Tri-Valley. Dublin residents can call 2-1-1 any hour of the day or night and get connected to a Phone Line Resource Specialists who will assess the caller's needs and provide access to comprehensive and holistic information and referrals to those needed services mentioned in the report and more. The remaining funds from the City of Dublin will be used to perform outreach to the Dublin community, especially low-income and under-served populations, about the availability of the service. Our goal is to eliminate or reduce the perceived lack of information on how to access resources. Activities will include printing flyers and other promotional materials that will be made available at various organizations and departments in Dublin. 2-1-1 is supported by a variety of partnerships and contracts with new and existing programs (e.g., Earned Income Tax Credit, Workforce Investment Board, etc.). Government, foundations, and corporate financial assistance provide a leveraged funding partnership. Public/private funding makes it possible for 2-1-1 to be able to provide health, housing, and human service information and referrals on a daily basis plus additional services like disaster-related information, and eligibility for public assistance programs. 13. 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 major point of entry to health, housing & human service information and referrals for Dublin residents/employees 24/7, in multiple languages; 2. Maintain and update the over 2,800 health & human services program entries in the Services Database at least once annually in order to provide the most current information to Dublin callers; 3. Increase the number of affordable rental housing units in the Housing Database by 450 units County-wide; 4. Provide weekly in-service trainings to 2-1-1 PLRS on new and existing programs in the community; 5. Conduct outreach in Dublin by hosting booths/tables at relevant events as they arise and replenish 2-1-1 outreach materials, as needed, for organizations and government departments in Dublin. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. Although available to all Dublin residents, 2-1-1 is especially critical for vulnerable populations such as single parents, very low-income families, frail elders, people with disabilities, at-risk youth, caregivers, and non-English speakers who are in need of vital resources. 2-1-1 PLRS are professionally trained to assess callers' needs and provide comprehensive and up-to-date information on a wide-range of services. The 2-1-1 Call Center is staffed during regular business hours with Bilingual PLRS who speak Spanish, Cantonese, Mandarin, Vietnamese, Hindi and Farsi, and over 150 languages are translated via a 24/7 interpretation service. Another segment of the population that benefits from this service are advocates (e.g., case managers, medical personnel, teachers, city officials and administrators, and employers) in Dublin who need help navigating the ever-changing system of human service agencies for their clients, patients, students, constituents, and employees. The following are recent examples of calls from Dublin residents: 1.A single mother with physical disability and three small children called 2-1-1 from Dublin for help paying her rent and a utility bill. The caller was referred to Season of Sharing, CRIL, and ECHO Housing for rent assistance, REACH and HEAP for utility assistance, and Tri-City Volunteers for a Thanksgiving basket. 2.A single mother of three children living in Dublin, who was a victim of domestic violence, called 2-1-1 for housing assistance. The caller informed 2-1-1 that she was being evicted, but she had a job working through the CalWorks Program. The caller was living on only $800/month. 2-1-1 referred the caller to Alpha Omega Foundation, Matilda Cleveland House, and Banyan House for transitional housing, the 24 Hour Mobile Response Team for Domestic violence related assistance, and Bay Area Legal Aid for legal assistance. The caller was encouraged to utilize 2-1-1 anytime for emergency shelter information. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? 2-1-1 Bilingual Resource Specialists speak Spanish, Cantonese, Mandarin, and Vietnamese, Hindi and Farsi. Callers can access 2-1-1 services in over 150 languages via Eden I&R's contractual arrangement with LionBridge to provide instantaneous translation services. Eden I&R has a culturally and linguistically diverse staff: 34% Asian or Pacific Islander, 25% Hispanic or Latino, 20% African American, and 1% Native American. In-service trainings are provided that often focus on cross-cultural issues. In addition, the daily interactions with peers and clients from different backgrounds, along with weekly staff training on area resources, reinforce Eden I&R's ability to provide Page 3 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35189 culturally effective and relevant services to diverse target populations. For reporting purposes only, Eden I&R's 2-1-1 PLRS ask clients their ethnicity, but the comprehensive assessment of needs and the types of information and referrals provided to each caller are the same. The only difference is a non-native English speaking (or someone who is more comfortable communicating in their native tongue) or a non-English speaking caller might request that programs they are referred to have staff that speaks their language (Eden I&R's comprehensive database indicates each agency's language capabilities). 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How 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 all Dublin residents and employees about this vital and free service. These include: speaking to staff from different agencies at resource/cultural/health/senior/disability fairs; posting and making 2-1-1 materials available at local agencies; submitting press releases to local publications; placing 2-1-1 materials with other agency giveaways (e.g., holiday food baskets and goodie bags); and seeking assistance from other agencies and departments to help inform the public about 2-1-1 (e.g., posting a logo/article about 2-1-1 on their website and/or newsletter). All outreach activities are focused on agencies and events that serve vulnerable populations. To accommodate limited English speakers, 2-1-1 flyers are distributed with English on one side, and Spanish, Chinese, Vietnamese, or Tagalog on the other side. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Eden I&R's 38 years of successful operations have relied upon the mutual and longstanding partnerships with approximately 2,900 property owners/managers and 1,100 agencies to maintain Eden I&R's information databases. In addition to these relationships, Eden I&R works directly with numerous organizations and is involved in many partnerships. For example, Eden I&R is one of five Bay Area 2-1-1 centers partnering to develop mutual support systems and data sharing agreements; is an active member/participant of emergency preparedness and planning groups with Alameda County Office of Emergency Services and the Public Health Department, among others; Eden I&R staff participates in the Tri-Valley Housing Scholarship monthly meetings, participates in the County's Reentry Collaborative, and was a member of the East County's Needs Assessment Steering Committee. Eden I&R is an active partner in several agency service delivery collaborations, including partnerships that enhance the 2-1-1 service and provide greater service integration. Examples include: -Earned Income Tax Credit program to explain tax credit eligibility and to refer low-income callers to Volunteer Income Tax Assistance sites for free tax preparation assistance. -CalFresh to prescreen callers for eligibility to receive food assistance to help meet their nutritional needs. -Alameda County Workforce Investment Board to assist the unemployed in their housing and human service needs. 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, social service, faith-based, schools, business/corporate, and government organizations. as well as to low-income housing complexes in Dublin. These materials include informational flyers, business cards, magnets, posters, promotional items, press releases/articles, and PSA's. In response to a request from the Community Services staff of Dublin, Pleasanton, and Livermore, Eden I&R staff increased its outreach during 2014 in the Tri-Valley by distributing material, making presentations, and attending resource fairs. Examples of this targeted outreach included: -Resource Fairs at Santa Rita Jail, Senior Center Information Fair, Tri-Valley Special Education Information Fair, Dublin St. Patrick's Day Fair -Presentations at senior and low-income Housing Complexes: Carmen Avenue Apartments, Oak Grove, Carlow Court, and Wexford Way -Presentations to staff at Open Heart Kitchen, A Hand 'n Hand, Tri-Valley One Stop, Tri-Valley Haven, Axis Community Health, Valley Continuation School, Dublin School District. -Distribution of materials at Dublin City Hall offices, Dublin BART Station, Dublin Farmers Market, many faith-based organizations. In addition, Eden I&R is working with the volunteers and staff at CityServe who are assisting the agency as "ambassadors" by helping distribute information about 2-1-1 throughout the Tri-Valley. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. 2-1-1 Alameda County is an accessible three-digit telephone number, available in multiple languages, that enables callers to have free, confidential and easy 24/7 access to health, housing and human service information. 2-1-1 is a single point of entry to services that compliments and supplements Dublin city services. Page 4 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35189 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 referral 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 lead communications agency in Alameda County's Collaborating Agencies Responding to Disaster and is a member of various disaster planning groups such as the Alameda County Emergency Managers' Association and the Alameda County Emergency Operations Center Team. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The cost effectiveness of 2-1-1 lies in its ability to serve as a single, central access point for a full range of information related to personal and economic self-sufficiency, including crucial human services and affordable housing. This single-point access for local services is cost effective in many ways: -It reduces wasted effort, expense and time off work for vulnerable Dublin residents seeking needed services. -It makes access to accurate and appropriate human service information free, simple to use, and readily available. -It eliminates the need for other agencies/departments to dedicate staff time or additional resources to compile and continually update a database of area services. -It frees city, county, and other agency staff from being inundated with callers seeking services other agencies/departments handle. This allows staff members to concentrate on their core assignments. -It provides culturally and linguistically appropriate services to residents who have limited or non-English proficiency. -It reduces the frustration for residents trying to navigate the complex and ever-changing social system to find the right resource. -By contributing less than 1% of the total 2-1-1 cost, the City of Dublin receives a $1.4 million public communication system. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? 2-1-1 Alameda County relies on a leveraged 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 is considered one entity) allocated approximately 30% of total funding costs. Among the cities' portion, the City of Dublin's contribution of $10,000 is based on its population size of approximately 2% of the county's population. The operation of this communication system depends on the commitment of the cities, the county, and the private sector to fulfill their share or the entire funding plan could unravel. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Page 5 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35189 Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. Page 6 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35189 *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. Page 7 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35189 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Page 8 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35189 Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Page 9 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35189 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). We hope to gain additional funding in new business this year. Budget Funding Sources/Revenues Budget Amount Amount Committed Government USD$ 1,277,386.00 Foundations/Corporations USD$ 445,200.00 USD$ 55,000.00 Individual Contributions USD$ 5,250.00 Total USD$ 1,727,836.00 USD$ 55,000.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries USD$ 1,182,379.00 Taxes & Benefits USD$ 277,335.00 Supplies USD$ 17,148.00 Printing & Copying USD$ 17,815.00 Postage USD$ 4,814.00 Telephone USD$ 35,121.00 Rent & Utilities USD$ 93,766.00 Accounting/Audit USD$ 19,114.00 Contracted Services USD$ 42,502.00 Other Operating Expenses USD$ 37,842.00 Total USD$ 1,727,836.00 USD$ 0.00 Budget Narrative Salaries & Benefits: This pays for staff salaries and benefits so that the phone line could be staffed with Phone Line Resources Specialist 24 hours a day; the housing and the services databases will be continually enhanced maintained and updated; and administrative personnel could make sure that the operations goals and outcomes are met. Supplies: Covers office and general supplies. Printing/Copying: This covers the cost of printing presentations and outreach materials to various property owners/managers and organizations I order to maintain up-to-date databases about available housing and other Page 10 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35189 agency services and to ensure that information about availability and new/changed services and programs were shared. The distribution of outreach materials to government departments other nonprofits agencies and the public is necessary to educate individuals about the availability of the 2-1-1 phone system. Telephone: Telephone cost includes general office phones for local, long distance, cellular, fax, SSL web hosting, email and other general communication costs. Rent & Utilities: Cost includes building lease water , gas, waste, janitorial, insurance and small building repairs. Accounting/Audit: cost involves third party payroll processing, year end reporting, auditing and business tax filings. Contracted Services: Services are for business system and software updates to the phone and computer services. Training, Staff Development dues & Subscriptions: This covers the recruitment and training of staff and other related expenses necessary to ensure up to date skills for our staff. Other cost are membership fees, subscription cost with the Chamber of Commerce and other professional alliances and non-profits like the Alliance for Information and Referral System (AIRS) the California Alliance for Information and Referral Services (CAIRS) and the California Association of Nonprofits (CAN) Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Eden I&R Program Expense Financial Information Form for ALL Grants download template Eden I&R Financial Information List of Board of Directors (or governing body) with contact information Eden I&R Board Contact Info Current Annual Budget for the Entire Agency Eden I&R Current Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) Eden I&R recent form 990 return Board of Director's (or governing body's) designation of authorized official Eden I&R Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) Eden I&R Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation Eden I&R 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 Eden I&R State & Federal Nonprofit status REQUIRED FOR CDBG ONLY- AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to Page 11 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35189 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35189 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 12 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35189 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Hope Hospice is a trusted and nurturing guide, helping patients and families find comfort and dignity. We ease your physical pains; we soothe your emotional sorrows. With life coming full circle, we are there for your journey. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Hope Hospice, Inc. Grief Support Center and Volunteer Programs Hope Hospice, Inc. 6377 Clark Avenue Suite 100 Dublin, CA 94568 United States Tel: (925) 829-8770 Fax: (925) 829-0868 Web: www.hopehospice.com EIN: 94-2576059 DUNS: N/A Project Contact Victoria Emmons billb@hopehospice.com Tel: 925-829-8770 Additional Contacts none entered Chief Executive Officer Victoria Emmons victoriae@hopehospice.com USD$ 15,000 Requested Submitted: 12/11/2014 8:42:50 AM (Pacific) Application Questions Page 1 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36075 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 in Dublin and surrounding communities have turned to us for quality, compassionate care at the end of life. Today, we are an organization of 65 paid staff and a cadre of about 120-130 active volunteers. We customize care for each patient, their families, and their caregivers. Our clinical team includes a Chief Medical Officer who specializing in hospice/palliative care and bioethics, two hospice- certified Associate Medical Directors, numerous Registered Nurses, Licensed Vocational Nurses, Licensed Clinical Social Workers, Licensed Marriage and Family Therapists, Spiritual Care Counselors and a Dietitian and trained volunteers offer a wealth of experience, expertise, and specialized education. Each team member creates an environment that offers the patient customized care, comfort, and dignity during their final days. Hope Hospice is governed by a 15-member volunteer Board of Directors, all of whom are local residents. Each serves a two- year term and can serve three consecutive terms. A 13 member volunteer Advisory Council includes Dublin Mayor David Haubert. The Chief Executive Officer reports to the Board and manages a seasoned leadership team that provides the professional, medical, financial, and organizational oversight to the programs and activities provided to the community. 8. Provide a brief summary of the project for which your agency is seeking funding (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. We are seeking a $15,000 grant to support the Grief Support Center and Volunteer Program. Funds will be used to support the salaries of the Director of Grief Support Services, Director of Volunteers, and a member of the Children's Grief Support Team. 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? 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 None of the above 11. Explain how this project will be implemented, administered, and operated. The Volunteer Program is managed by Jill Biggs, RN, Hope Hospice’s Director of Volunteers. Ms. Biggs is responsible for recruiting, screening and training candidates, and overseeing their performance to ensure they are high-performing hospice/palliative care volunteers. All of our volunteers are required to complete an application, interview, background check, health screening, orientation, annual mandatory training and participate in a semi-annual 25-hour Hospice Education Series consisting of 16 core competencies. Once their training is complete, volunteers are prepared to help the patients and families. In any given year, our Volunteer Program consists of approximately 120-130 volunteers. About 90 individuals provide services to patients, caregivers, and family members - including grief support - while 30 donate their time to fund-raising events each year. Another 15 volunteers provide administrative support to the Volunteer and Development departments and 28 serve in governance or advisory roles. For FY 13-14, our volunteers gave 5,624 hours of service, and made 1,053 patient client visits Page 2 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36075 to 160 individuals/families - including 661 hours provided by volunteers in our Grief Support Center. Lee Ann Morgan, LMFT, is the Director of Grief Support Services. She develops and manages the Grief Support Center’s programs, collaborates with the interdisciplinary team, supervises the grief counselors, and teaches classes about the grief process. We have cultivated and trained post-graduate interns who conduct individual grief counseling, facilitate group sessions and provide support for community outreach. The 2014 calendar offered support groups that meet once a week for 8 weeks; a drop-in Pet Loss support group; Children's Grief Workshops; and, a special class on "Handling The Holidays". Grief Support Services are offered free of charge to families/friends of a Hope Hospice patient and, for a nominal $10 fee, to other members of the community. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). A grant from the City of Dublin will be used specifically to pay a portion of the salaries of the Grief Support Center and Volunteer Program Directors and a member of the Children's Grief Support Team. The services offered through the Grief Support Center require many hours of planning, preparation, participation and follow up, regardless of the number of clients who benefit from the scheduled activity. The services include one-on-one grief support sessions, unique group sessions designed specifically for adults and children, community-based seminars and workshops on grief-related topics, and a library of resource material. All hospice organizations are required by law to have a volunteer program but these services are not billable or reimbursable through insurance or other subsidized health care programs. Our volunteers provide the scope and depth of services that money can't buy, and many of which would not be affordable to our patients if they could be purchased. Volunteers give freely of themselves to help others and to build community. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? Dublin residents will receive: 50 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 twice per month, and four community workshops on a specific grief-related topic. One of our strategies to assess progress is to use a comprehensive database to track all contacts, communications and individual/group sessions with adults and children. This tool allows us to track the number of patients served and the services utilized or refused. Strategies for tracking 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 2014). The summary report reveals Hope Hospice has an overall satisfaction rate of 73.05% compared the national average of 68.9%. The effectiveness of the Volunteer Program is measured by an evaluation 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. Fifty-nine percent of those surveyed stated that the volunteer services they were offered and used were the right amount. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. Hope Hospice provides hospice care and services to all adults of all ages and our grief support services are available to everyone in the community. We do not discriminate or refuse services to anyone in the community and seek to provide services at the lowest cost to the patient/client. Grief Support Services benefit those that wish to have support after the death of a loved one. Free services provided through the Volunteer Program benefit patients and families of those in hospice as we can provide free respite for caregivers, home support (chores, errands), specialized physical care (massage, Reiki) and music, arts or pet therapy. The benefit to low-income community members comes from our commitment to provide services to people who have no resources or coverage. While well below the national or state rate, Dublin has a 4.1% poverty level and a 4% unemployment rate. We strive to provide all services at the lowest possible cost. Availability and affordability of counseling services, including grief support, for low income families is one of the needs identified in our community. The specialized services provided through the Volunteer Program are all free of charge and the Grief Support Services are free to those with a loved one utilizing our hospice services. Other community members are charged a nominal fee, waived if they cannot afford it. Our program for children and teens addresses these needs through comprehensive grief support services and the availability of a grief support specialist who works directly with schools and community organizations to educate care-giving adults about the unique impact of grief on the young. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? Grief Support Program: The expression of grief is unique not only within populations, but between individuals. The nature of the loss itself also influences the complexity and depth of the grief response. Our professionally-trained grief support providers skillfully apply their experience and training in dealing with highly individualized grief situations. Those same skills resulted in thoughtfully designed programs and grief support sessions that help individuals work through their personal grief Page 3 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36075 process. An example of our staff's specialized training is that received from the nationally-acclaimed Doughy Center. Based on the successful model created by the Doughy Center, our Children, Teen, and Family Specialist revamped our children’s program to make more effective use of non-verbal methods of expressing grief. Another aspect of grief support that our staff has addressed is the realization that for some cultures and individuals, the process of initiating grief support is intensely private. Volunteer Program: When providers do not have a common cultural background with patients, the ability to support, nurture, and promote maximum independence can be threatened. Hospice service delivery must be tailored and targeted in ways that are considered appropriate and acceptable practices for multi-cultural hospice patients and their families. Our hospice volunteers come from a wide variety of cultural backgrounds and professions. This diversity of life experience increases the likelihood that we are able to provide volunteers that will be compatible with the broad spectrum of individual needs presented by the population at large. 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. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? Hope Hospice is committed to serving families of diverse background, culture, language, learning style, and disabled conditions. Our outreach to these communities includes: • A diversified clinical team with multiple language and cultural capacity. Our strategic plan includes a community outreach project specifically focused on cultural groups identified in local demographic data. The plan includes collaboration with local ethnic-specific community groups to reach underserved individuals and families. • Our corporate offices comply with ADA requirements in terms of accessibility of parking, sidewalks, hallways, elevators, restrooms, etc. As a service agency, we are sensitive and responsive to the needs of all individuals and our services reflect that compassion. We strive to ensure that workshops are held at facilities such as local senior centers, where similar accommodations are part of the excellent service. • Spiritual care is provided according to the religious or spiritual preference of the patient and family members. • Low-income people benefit from our services as we strive to offer them free or at low cost, as appropriate. Availability and affordability of counseling services, including grief support, for low income families was one of the needs identified for our community. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Hope Hospice collaborates with many partners in the area. We provide educational classes and bereavement activities for both adults and youth. We have working relationships with several city municipalities, corporations and community-based organizations. Examples include: We work with skilled nursing facilities, senior homes, corporations, local churches and community-based organizations to provide an educational program designed to begin the conversation about end-of-life issues and hospice care. Organizations we currently work with include Safeway, ValleyCare Medical Center, Castlewood County Club, Dublin Senior Center and the University of San Francisco. We work with local schools through the Dublin Unified School District to educate and provide specialized grief support activities for youth. The staff at the Grief Support Center are trained in the effects of grief on children and teens and work with the counseling staff of the local elementary, middle, and high schools to educate teachers about the special needs of children experiencing grief. We partner with Valley Humane Society to provide pet therapy for those grieving the loss of a loved one. One of the major barriers to seniors gaining access to low-cost services and support is lack of transportation. In many cases, the person cannot drive or is unable to use public transportation. Relationships with local community-based organizations allow us to expand the accessibility of our services to seniors. We conduct our annual Service of Remembrance at the Dublin Library. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. Current marketing and outreach activities include: • Advertising regularly in senior magazines and newspapers, promoting hospice and grief support services • Sending direct mail and email to Dublin residents announcing events • Sending Hope Hospice’s VOICES Newsletter to Dublin residents 3 to 4 times per year • Announcing Grief Support Center programs in local media • Hosting the annual Service of Remembrance at the Dublin Library Community Room • Partnering with the Dublin Library to create a bibliography of grief support information • Participating in the Senior Info Fair presented by the Dublin Senior Center and serving as a member of the planning committee • Visiting the medical community in Dublin to educate healthcare providers and staff on hospice care and the availability of grief support for Dublin patients. Page 4 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36075 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. Whether engaged in care with our hospice patients or offering grief support to those coping with loss, Hope Hospice’s mission is to be “a trusted and nurturing guide, helping patients and families find comfort and dignity.” The primary mission of the Grief Support Center is to help people cope with grief, connect with a caring community, and learn healthy coping skills. An important goal of grief support is to help the individual overcome the confusion and fear that grief can cause and develop healthy coping skills that can result in an improved quality of life. To succeed in our mission, we enlist the help of interns and community volunteers in providing grief support, education and outreach. Our overall mission is clearly aligned with the City of Dublin’s mission to “promote and support a high quality of life . . . and foster new opportunities”. The primary mission of the Hope Hospice Volunteer Program is to provide supplementary, professional and non-professional support duties which will be beneficial to the delivery of optimal hospice patient care. Our volunteers selflessly give of their time and talent to further our primary goal – helping patients and families find comfort and dignity. The City of Dublin values openness with and responsiveness to the public and community members. Hope Hospice is a community-based agency that has offered grief support services to local communities for more than 34 years. Our programs are the result of assessing needs and then providing the care and assistance not available from other service agencies. As an example, in recent years, we have encountered an increasing need for grief counseling to be available for Dublin residents. Understanding that the need is particularly acute for seniors and children, our services are available to individuals of all ages. We provide these services regardless of the ability to pay. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Funds granted by the City of Dublin will be allocated to pay a small portion of the salaries for the Director of the Grief Support Center, a member of the Children’s Grief Support Team, and the Director of Volunteers. Our proposal seeks funding for only a small portion of their salaries to cover activities targeted and provided to Dublin residents. The Independent Sector estimates that the value of an hour of volunteer time in California is $26.34 (2013). Last fiscal year we logged 5,624 hours of volunteer time, creating an in-kind value of $148,136. Our request is highly leveraged by other donations, and represents great value for the City of Dublin. Furthermore, please note last fiscal year Dublin residents constituted 14% of our hospice patients, 11% of our grief support clients, and 8% of our volunteers. In other words, our $15,000 request represents a cost of $68.81 on a "Cost per Dublin Resident" basis. [Note: $15,000 divided by 221 Dublin residents "served" last fiscal year (38 hospice patients; 82 grief support clients; 77 caregivers; and 21 volunteers) = $68.81.] 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Funds to support the Grief Support Center are partially reimbursable by insurance; but the remainder comes from partnerships with local businesses, service organizations, and community members. To provide our vital grief support services to those who are facing the loss of loved ones, we have consistently pursued all available avenues of support, such as grants from other organizations, private donations, and proceeds from fund-raising events. Volunteers are considered an essential element to the work of our hospice team and are mandated by Medicare , however, none of the costs of administering and implementing the Volunteer Program are funded. Volunteers report a sense of personal satisfaction as they make significant contributions to both the community and patients receiving hospice care. Many volunteers state that being involved in hospice work allows them to better prioritize important aspects of their own lives. If we are not favored with the grant award for this period, we will try to maintain the current service levels, and if we are not successful in acquiring the necessary funds, we may have to reduce the number of people served in 2015. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. Page 5 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36075 N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Page 6 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36075 Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. 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. F) Not Applicable. I am not interested in qualifying for CDBG funding. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. Page 7 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36075 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, 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 Page 8 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36075 occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: NA 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White Page 9 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36075 White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). We will achieve long-term financial sustainability by employing both proven and innovative fundraising approaches, stewarding financial resources, prudently managing investments and increasing our service area to create a positive economy of scale. Budget Funding Sources/Revenues Budget Amount Amount Committed Program Fees USD$ 12,000.00 USD$ 12,000.00 Alameda County - Volunteer Program USD$ 10,000.00 USD$ 0.00 Individual Donations USD$ 225,000.00 USD$ 0.00 City of Dublin USD$ 15,000.00 USD$ 0.00 City of Livermore USD$ 5,000.00 USD$ 0.00 City of Pleasanton USD$ 5,000.00 USD$ 0.00 Total USD$ 272,000.00 USD$ 12,000.00 Funding Uses/Expenses Budget Amount Amount Committed Page 10 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36075 7% of Director of Grief Support Services salary USD$ 5,000.00 USD$ 0.00 8 % of Grief Support Team wages USD$ 5,000.00 USD$ 0.00 7 % of Volunteer Director salary USD$ 5,000.00 USD$ 0.00 Total USD$ 15,000.00 USD$ 0.00 Budget Narrative Funds granted by the City of Dublin will be allocated to pay a small portion of the salaries for the Director of the Grief Support Center, a member of the Children’s Grief Support Team, and the Director of Volunteers. Our proposal seeks funding for only a small portion of their salaries to cover activities targeted and provided to Dublin residents. Most program revenue projected for 2015 has not been committed at this time but we predict will see the same funding as last year and will cover all expenses. The Independent Sector estimates that the value of an hour of volunteer time in California is $26.34 (2013). Last fiscal year we logged 5,624 hours of volunteer time, creating an in-kind value of $148,136. Our request is highly leveraged by other donations, and represents great value for the City of Dublin. Furthermore, please note last fiscal year Dublin residents constituted 14% of our hospice patients, 11% of our grief support clients, and 8% of our volunteers. In other words, our $15,000 request represents a cost of $68.81 on a "Cost per Dublin Resident" basis. [Note: $15,000 divided by 221 Dublin residents "served" last fiscal year (38 hospice patients; 82 grief support clients; 77 caregivers; and 21 volunteers) = $68.81.] Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Expenses Financial Information Form for ALL Grants download template HH Rev and exp List of Board of Directors (or governing body) with contact information HH 2014 BOD Current Annual Budget for the Entire Agency Current 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 oard of Director's designation of authorized official by-laws Board of Director's (or governing body's) authorization to request funding (may be same document as one above) Board auth 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 STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER Page 11 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36075 STATE AND 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 36075 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 12 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36075 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Kidango's mission is to inspire children for academic success, to empower families to achieve their goals, and to strengthen our highly diverse community in a sustainable manner. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Kidango, Inc. Emerald Vista Enrichment Program Kidango, Inc. 44000 Old Warm Springs Blvd. Fremont, CA 94538 United States Tel: (510) 897-6900 Fax: (510) 897-6909 Web: www.kidango.org EIN: 94-2581686 DUNS: 051288132 Project Contact Pepijn van Houwelingen grants@kidango.org Tel: 510 897 6934 Additional Contacts pvanhouwelingen@kidango.org Executive Director Paul Miller pmiller@kidango.org USD$ 8,000 Requested Submitted: 12/10/2014 3:45:47 PM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35812 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.). With over 50 child development centers across the Bay Area, and over 35 years of experience in providing early childhood services, Kidango benefits from a strong history and organizational infrastructure to support activities at every level of the agency. Under the leadership of Executive Director Paul Miller Kidango has grown from one center to having many locations throughout the region. Our main office is located in Fremont. Central coordination of our educational programs is ensured by our Managers of Education. Other services provided from our main office include finance and human resources, ensuring adequate ‘backbone’ capacity to successfully execute diverse programs for the communities we serve. Each of our child development centers is overseen by a Regional Director, who manages several sites, and a Center Director, who focuses on a single site. This grant application pertains to our Emerald Vista center in Dublin, which is overseen by Regional Director Brian Chaquette. Working closely with Emerald Vista Center Director Camille Hernandez, Brian will be responsible for the successful implementation and evaluation of our proposed Emerald Vista Enrichment Program (see also question 11 below). Kidango is an experienced provider of Kindergarten-readiness services, with a strong focus on play-based learning in a developmentally appropriate setting that not only honors but also celebrates cultural and linguistic diversity. We have also successfully undertaken diverse enrichment activities for children at our various centers; it is our experience that these activities provide extremely valuable opportunities for children’s self-actualization outside the standard curriculum and make a considerable contribution to children’s overall Kindergarten-readiness. 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 Emerald Vista Enrichment Program will provide a range of enrichment workshops for low-income preschoolers. This will support Kindergarten-readiness and provide exciting avenues for academic, creative and physical development. 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.) Approximately 80 preschool children will be served by this project. A majority of these will be extremely or very low income (30-50% of median income). 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. As indicated under question 7, Regional Director Brian Chaquette will be responsible for the implementation, administration and operation of the Emerald Vista Enrichment Program. Specifically, Brian will contact appropriate workshop providers from the Dublin or Tri-Valley community with expertise in one or more of the areas described under question 12. He will then collaborate with workshop providers to purchase appropriate materials. Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35812 For each of the enrichment workshops to be held the next step will then be implantation, i.e.: holding the workshop at our Emerald Vista child development center. Brian and Center Director Camille Hernandez will collaborate with providers and the center’s teachers to facilitate a successful workshop for children at the center. After each workshop as well as at the end of the Program, Brian will ensure that adequate evaluation is undertaken (see also question 13). Finally, throughout the process he will maintain all (financial) documents for compliance and reporting purposes. Kidango’s Grants Manager, Dr. Pepijn van Houwelingen, will collaborate with Brian to answer any potential queries and to ensure full compliance as required by the City of Dublin. 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 overarching aim of the Emerald Vista Enrichment Program is to provide (extremely/very) low income preschoolers with enrichment opportunities that would typically be unavailable to them. To this purpose we will hold a series of 4-hour workshops for the children at our Emerald Vista center in Dublin (2 classrooms with 80 children in total), each of which will be provided by an individual or organization from the Dublin/Tri-Valley community with relevant expertise. By allowing children to explore a range of new and exciting avenues for learning, including creative self-expression and STEM topics, a valuable contribution will be made to their academic, physical and creative development, thereby strengthening their overall Kindergarten-readiness. This will ultimately contribute to children’s mental and physical well-being as well as their long-term success. Specifically, Dublin grant funding will be utilized to remunerate workshop providers and to purchase needed materials. It is important to note that grant funding will not merely be a one-off ‘donation’; the intention is that teachers will be able to incorporate enrichment activities into their curriculum and use purchased materials for several years. Therefore, it is best to think of this application as an opportunity to invest in a substantially diverse and stimulating curriculum for low-income Dublin preschoolers. With the requested amount ($8000), we will be able to hold a total of 8 workshops at $1000 each. The following topics will be covered: - Language and literacy - STEM - Social-Emotional Development - Music and Movement - Outdoor Activities/Sports - Arts and Crafts - Food and Nutrition - Health and Safety 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)? Evaluation for this program will encompass formative as well as summative efforts. As to the former, indicators of success will be, for each individual workshop, whether the workshop was held in an engaging and developmentally appropriate manner. This will be determined on the basis of qualitative observations by teachers as well as Regional Director Brian Chaquette. On the basis of these observations adjustments will be made if necessary to ensure continual improvement of the program. Given the nature of enrichment workshops and their sometimes intangible or long-term effects (e.g. stimulating a child to learn how to play an instrument, or fostering an interest in science), quantitative summative evaluation is not easily undertaken for this program (with the exception of quantitative Kindergarten-readiness measures already utilized, specifically the Desired Results Developmental Profiles, though it must be noted that demonstrating independent effects in this regard is notoriously difficult). However, we fully recognize the importance of measuring and demonstrating impact. To this purpose, at the end of the program teachers will collect qualitative information from participating children to assess which parts of the program they enjoyed and to what extent it has motivated them to continue to explore the topics that were covered. In this vein, we will consider the program a success if more than 80% of the children interviewed indicate that they learned something new from the program and that it has inspired them to further explore one or more of the topics covered (e.g. by reading more, playing music, playing more sports, etc.). Lastly, Kidango is more than willing to collaborate with the City of Dublin on gathering additional data pertaining to impacts, as required or suggested by the City. 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 program will serve preschool children (3-5 years old). 40% of the children currently enrolled at Emerald Vista are Hispanic, while 25% are Asian, together constituting the largest single groups. Furthermore, over 50% of the children served by our Emerald Vista center are extremely low income (?30% of local median income). An additional 30% are very low income (?50% of median income). The remaining 20 percent are low or moderate income (80%? ?120% of median income). Given the socio-economic background of the children that receive our preschool services, generally speaking they enjoy few Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35812 opportunities to explore extra-curricular activities such as sports and arts. The Emerald Vista Enrichment Program will therefore allow children to learn about new and exciting topics/activities. This will contribute to Kindergarten-readiness as well as to the children’s overall development, allowing them to discover avenues for learning, development and self- expression that they would otherwise not have enjoyed. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? Kidango is well aware of the cultural diversity of the communities served by our programs. All our direct service staff are culturally and linguistically reflective of this diversity and as an organization we have been successful in working with children and families from a very wide range of social, cultural and linguistic backgrounds. While our existing experience in this field will provide for the overarching setting in which the project will be undertaken, we will ensure that workshop providers are knowledgeable in their field of expertise as well as suited to work with culturally/linguistically diverse preschool children. Regional Director Brian Chaquette will take all necessary measures to ensure that this important aspect of the program is fully taken into account, as we recognize its significance in terms of the accessibility and resultantly the success of the 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? Given that the proposed program will serve children already enrolled at our Emerald Vista center, additional outreach will not be necessary. In general terms, however, Kidango works primarily with low-income families and has significant experience and adequate resources for serving this population. In addition, we work extensively with English learners and ensure accessibility through the cultural/linguistic appropriateness of our curriculum as well as through full immersion of English learners and children with developmental delays or physical handicaps. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. For over 35 years, Kidango has collaborated with diverse Bay Area organizations. Our child development centers are established through collaborations with school districts and municipalities to coordinate and enhance services to children and their families. When families struggle to meet basic needs, their children’s educational accomplishments often suffer as a result. If this occurs, we respond to our families’ needs through individualized family social services and parent involvement plans. We provide direct services such as translation, developmental and mental health assessments, and intervention. Through long- standing relationships with community service providers, we facilitate access to emergency housing, food, medical care, special education, transportation, job training, and financial supports. Kidango partners with 4Cs of Alameda County, a resource and referral agency, to assist in outreach to and enrolling low-income families. We collaborate with Community Access for Preschool Education (CAPE) for families to access health screenings and other services for children enrolled at Kidango centers in Dublin and in other communities. Through Alameda County, Kidango is an Early and Periodic Screening, Diagnosis and Treatment (EPSDT) contractor, providing mental health services to children enrolled at Kidango and CAPE infant and preschool programs. Families’ housing, food and medical care needs are met by our referrals to local providers including Eden Housing, Axis Community Health Clinic, Bayside Pediatrics, Open Heart Kitchen, Shepherds Gate and The Tri Valley Haven Shelter. These partnerships help us support the goals and strengths of each family in our programs. 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. Kidango maintains an in-house marketing and advertising team that conducts enrollment campaigns for the Emerald Vista center in Dublin and our other centers. Kidango also has an enrollment and administrative team that supports enrollment to our centers by conducting outreach to low-income and limited English speaking families who have applied for services either directly through Kidango or through Alameda County’s Centralized Eligibility List (CEL). Our bilingual/bicultural (English/Spanish) enrollment specialists contact interested families and work closely with them both on the enrollment paperwork and in understanding the income and family requirements for their eligibility. Kidango also identifies and seeks out low-income Dublin children and families through our affiliation with 4Cs of Alameda. Through 4Cs of Alameda County’s Resource & Referral Network, we reach Dublin families in need of subsidized early childhood education. Our marketing and advertising team plans extensive print, online, radio & television, and social media campaigns all year long. These campaigns emphasize academics, kindergarten readiness, and the availability of programs to suit any income level. We also reach families in local newspapers, yellow pages, media outlets, radio stations, and other channels. Flyers with information about our Dublin center are also distributed at local elementary schools, colleges, job placement centers, and businesses. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. The objectives of Kidango’s Emerald Vista Enrichment Program are closely in sync with the City of Dublin’s mission to promote high quality of life for its citizens. By offering low-income children the opportunity to explore a range of extra- curricular activities, the program will allow children to learn about diverse activities and foster new interests that they would otherwise not have been able to discover. Clearly, this contributes to their overall quality of life, in addition to underpinning their readiness for Kindergarten. Moreover, given the incorporation of various healthy and active workshops into the program, children will be encouraged to maintain an active and healthy lifestyle through a first-class program. In terms of the City of Dublin’s values, the proposed program contributes to community building by engaging with diverse Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35812 workshop providers from the local community. This will allow children to enhance their understanding of diverse topics and it will enable teachers to incorporate new topics into their curriculum. In addition, workshop providers are likely to find working with our children, whose families typically face many economic and other challenges, a rewarding experience that contributes to deepened community ties and mutual understanding. Lastly, the cultural component of the program will contribute to the City of Dublin’s aim to foster heritage and culture. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Dublin Community Grant funds will positively impact approximately 80 children in the first year. In addition there will be positive impacts throughout the following years as materials and curriculum ideas will continue to be used by teachers. Given that we are requesting $8000, the investment would be $100 per child in the first year. For a total of 8 enrichment workshops with significant anticipated effects from which low-income children will substantially benefit, we are convinced this is a reasonable amount. To be more specific, per activity we have budgeted $400 for remuneration of workshop providers (4 hours of activity for 2 classrooms at $50 per hour). This is below typical market rates, which is accomplished as a result of our collaboration with providers from the local community. Per classroom there will then be a material cost of $300. The specifics of this will differ per activity and will be determined in collaboration with workshop providers, but we are confident that the investment is reasonable in light of the anticipated lasting impacts and repeated use of materials purchased (e.g. music instruments, arts materials). 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If this application is unsuccessful, or partially successful, Kidango will consider offering a smaller range of enrichment workshops. This will be decided in light of the amount of funding offered. Even though children will benefit optimally from the program as a whole, an advantage of the program’s design into specific components is that it allows for flexibility to deal with funding contingencies. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35812 Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35812 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. F) Not Applicable. I am not interested in qualifying for CDBG funding. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35812 Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35812 Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35812 American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). Kidango is commited to expanding its programs and increasing unrestricted funding through grants and contracts for services. Budget Funding Sources/Revenues Budget Amount Amount Committed City of Dublin USD$ 8,000.00 USD$ 0.00 Total USD$ 8,000.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Materials USD$ 4,800.00 USD$ 0.00 Provider reimbursements USD$ 3,200.00 USD$ 0.00 Total USD$ 8,000.00 USD$ 0.00 Budget Narrative Please refer to the budget narrative. With regards to the program's fit within Kidango's budget, it is worth emphasizing that for extracurricular activities we are wholly dependent on grants, as most of our sources of revenue are restricted. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Program Budget Financial Information Form for ALL Grants download template Financial Info List of Board of Directors (or governing body) with contact information Board List Current Annual Budget for the Entire Agency Kidango budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) Kidango 990 Board of Director's (or governing body's) designation of authorized official Designation Board of Director's (or governing body's) authorization to request funding (may be same document as one above) Designation Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35812 Proof of insurance carried, including bonding, liability and/or workers' compensation 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 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. REQUIRED FOR CDBG- LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35812 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35812 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). LVPAC's mission is to offer a broad range of arts experiences and opportunities to engage our diverse community. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. Pleasanton FY 2014/15 $7,500 Community Grant Program - Civic Arts for Arts in the Schools program with Cheza Nami Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Livermore Valley Performing Arts Center Arts In The Schools with Cheza Nami Foundation Livermore Valley Performing Arts Center 2400 First Street Livermore, CA 94550 Tel: (925) 373 - 6100 Fax: (925) 373 - 6097 Web: http://www.mylvpac.com EIN: 68-0419182 DUNS: Project Contact Arthur Barinque abarinque@livermoreperformingarts.org Tel: (925) 301 - 0731 Additional Contacts info@chezanami.org, dbridges@livermoreperformingarts.org, nmueller@livermoreperformingarts.org Executive Director Scott Kenison skenison@livermoreperformingarts.org USD$ 13,872 Requested Submitted: 12/11/2014 1:58:16 PM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35793 Pleasanton FY 2014/15 $3,850 Community Grant Program – Youth for Arts in the Schools program with Cheza Nami Alameda County Arts Commission 2014 ARTSFUND $1,500 Livermore FY 2012 $1,000 Tourism Grant for ArtWalk event 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.). LVPAC believes our mission to offer a broad range of opportunities & experiences to engage our diverse community includes providing school districts across the region with access to free in-school performances featuring different cultures within our community. Our partner Cheza Nami teaches African culture through interactive dance, play & movement. LVPAC has recently hired Scott Kenison as Executive Director in December & Chris Carter as Development Director in November. With new leadership in these two critical roles, we are undergoing a strategic planning process to enhance all of our educational programming. In concept, we plan to incorporate an out-of-school component to provide teacher trainings, field trips & diversity-focused performances using Tri-Valley cultural arts organizations such as Cheza Nami. Additional funding sources include support from LVPAC’s Education Fund & LVPAC’s development team will seek other grants, corporate sponsorships and individual donations for this project. Scott Kenison, LVPAC Executive Director, is an expert in management and operations for community-centered theaters & performing arts centers, most recently as the Chief Operating Officer for The Atlas Performing Arts Center in Washington, D.C. Nancy Mueller, LVPAC Education Outreach Coordinator & Marketing Director, has over 25 years of marketing, operations & customer service experience from a variety of Tri-Valley businesses. Linda Ryan, LVPAC Bothwell Arts Center Manager, is a professional artist & has worked with award-winning youth programs such as Pathways to Picasso and ABC Music Pathways. Catherine Ndungu-Case, President/CEO, was born in Kenya to a traditional African home. Ms. Ndungu-Case founded the non-profit organization Cheza Nami Foundation, whose goal is to introduce children and adults of all ethnic backgrounds to African culture through interactive music and dance. As project director, Ms. Ndungu-Case will implement the project and conduct the assemblies. 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. LVPAC requests $13,872 for a one-year Arts in the Schools program to produce 12 in-school cultural performing arts assemblies featuring African music and dance by Cheza Nami Foundation at Dublin Unified School District elementary schools. 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.) 4,700 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. The goals of this project are to increase multicultural awareness and understanding among Dublin elementary school Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35793 students about the cultural and performing arts and the uniqueness of African culture. LVPAC and Cheza Nami will partner to produce (12) twelve in-school cultural performing arts assemblies at K-5th grade elementary schools within the Dublin Unified School District for the 2015-2016 school year. LVPAC will handle project operations and administration; providing marketing and fund development support, project follow- up and grant funding reports with City of Dublin and Dublin Unified. Cheza Nami will provide African Cultural Arts and Learning (CAL) and education through two 45-minute assemblies at each Dublin elementary school. Assemblies cover greetings, dress, drumming and dance, games, history, cultural activities, and schooling. Students and teachers will experience African culture first-hand through active participation. Cheza Nami will implement the project by handling school calendaring, pre-assembly communication with school sites, producing assembly presentation and conducting post-assembly evaluations. We have contacted Superintendent Hanke to outline outreach and marketing efforts to the Dublin elementary school principals and faculty and staff. We have been successful in bringing the Cheza Nami in-school assemblies to six Pleasanton elementary schools and will be seeking funding from the City of Pleasanton to reach three other Pleasanton elementary schools and three Pleasanton middle schools. In addition, we are applying to City of Livermore to bring the in-school assemblies into Livermore Title 1 elementary and middle schools. 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 toward direct project expenses related to each school assembly. The Arts in the Schools program will utilize study guides and teacher training materials from the “Travels With Music” curriculum. License fees and teacher materials are listed under other operating expenses. Under contracted services, the cost of program coordination and teaching artists is accounted for. The contracted services for Cheza Nami teaching artists is negotiated at a rate of $275 per day. While the market rate for master artist is a minimum of $300 per day, we have negotiated a lower rate because of the relationship we have with them and Cheza Nami. In addition, our contract artists volunteer their time for rehearsals. The authentic African drums and musical instruments for each school assembly are also incorporated into our direct project expenses. 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)? Outcome(s): Schools receive a unique educational enrichment experience in cultural performing arts. Outcome(s): Participants will emerge with the following skills and benefits: * Enhanced knowledge of African culture. * Enhanced knowledge of social, global and historical studies. * A heightened desire to engage in the arts and learn about other cultures. * Better overall health and wellness/well-being through movement. * Develop global awareness, appreciation and global citizenship. * Enhanced music ability. Prior to an assembly, representatives from Cheza Nami Foundation collaborate with teachers to ensure assembly content coincides with student curriculum. Pre-assembly handouts are offered to educators so that students may learn about African culture in the classroom. The interactive nature of each assembly engages students in an unique way which enhances their cognition and retention skills. After each assembly, a survey is given to see what the students have learned from the assembly. Answers are gathered and assessed to evaluate students learning. 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. K-5 students in the Dublin Unified School District will benefit from the Arts in the Schools program by receiving educational enrichment in cultural performing arts, especially underprivileged children and students with special needs with limited access to multicultural programs. Students will gain increased knowledge in conjunction with teacher curriculum and state academic standards in the areas of social studies, history and performing arts. Through Cheza Nami Foundation's implementation of the Arts In the Schools Program, students will emerge with the following skills and benefits: * Enhanced knowledge of African culture. * Enhanced knowledge of social, global and historical studies. * A heightened desire to engage in the arts and learn about other cultures. * Better overall health and wellness/well-being through movement and creative expression. * Develop global awareness, appreciation and global citizenship. * Enhanced music ability, coordination and balance. Exposure to cultural performing arts programs allows for increased interest in the arts which have neurological benefits that lead to improved performance and cognitive skills. We know from research funded by the National Endowment for the Arts that children and teenagers who participate in arts education programs show improved student academic performance and civic participation. Involvement in the arts allows youth to be healthy contributors to society by enhancing and developing their strength, resiliency, creative thinking skills and self-image. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? The Arts in the Schools project promotes cultural diversity and global citizenship. The assemblies will provide a hands-on experience of African culture, exposing elementary school students to a culture other than their own. Cheza Nami’s artists introduce children to African songs, language, music, drumming and choreographed rhythmic movement. Most of the tools Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35793 and instruments used are African; however students will gain an interest in other world cultures and an appreciation of music and dance. As one of the most diverse cities in the Bay Area, Dublin's focus on community unification would benefit from highlighting African culture with our program. Based on the 2014 Nielsen Demographic Snapshot Report, 9.25 % of Dublin residents are Black or African American descent while 48% are white and 38% are Asian. The 2010 Census Population report states that 9.6% of Dublin residents are African American (4,347 African-American/46,036 Total 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? LVPAC and Cheza Nami will outreach to the principals of each elementary school and the Dublin Unified Superintendent’s office. Teachers are introduced to a wide range of activities that can help music become a part of the classroom environment and can also be integrated into the curriculum for social studies, history and performing arts. Students from low-income families, limited English speakers and/or disabled persons are an integral part of the school population and will benefit from the school assembly presentation as well. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Cheza Nami Foundation: "Cheza Nami" is Swahili for "Come play with me". Cheza Nami Foundation is a California based 501 (c) 3 non-profit organization, with headquarters in Pleasanton California. The Cheza Nami Foundation believes in a play based approach to education. Cheza Nami teaches African culture through dance, play and movement. As a cultural community-based partner, Cheza Nami provides the on-the-ground knowledge of our community and in-depth experience of African 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. The majority of our marketing effort is focused on the Tri-Valley region, including digital marketing, radio, newspaper, direct mail, television and more. Our media sponsor partners are KKIQ radio and Bay Area News Group. We work closely with Visit Tri-Valley, and many nonprofits in the region. Our collaborations regarding Education Outreach include: -Science on Saturdays which brings middle and high school students to the Bankhead Theater for science-based lectures presented by Lawrence Livermore National Laboratory during the month of February. -Year-round Field Trip Opportunities for K-5 students provided by California Theater Center productions that focus on fairy tales and classic literature such as Adrocles and the Lion, Puss In Boots, and The Emperor's New Clothes; and by LVPAC Resident Company Valley Dance Theatre that provides student performances of The Nutcracker during the holidays In addition, LVPAC houses nine resident companies: Cantabella Children's Chorus, Del Valle Fine Arts, Livermore-Amador Symphony, Livermore Valley Opera, Pacific Chamber Symphony, the Rae Dorough Speakers Series, Sycamore Strings Academy, Tri-Valley Repertory Theatre, Valley Concert Chorale, and Valley Dance Theatre. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. Our project meets the City of Dublin’s Mission and Vision by showcasing our community’s rich cultural arts and introducing youth to another culture other than their own. LVPAC’s Art in the Schools program maintains a balance of cultural history with progress by enlightening and engaging students with knowledge of the world’s diversity. The interactive nature of Cheza Nami Foundation’s first-class assemblies promote active and healthy lifestyles through African cultural music and movement. In harmony with the City of Dublin’s values, the Art in the Schools program builds community by producing in-school assemblies that brings people of all ages together to foster cultural development and an appreciation of other people. By collaboration and communication with other organizations within the community who express mutual concern, LVPAC is able to tackle the issue of Arts Education, while encouraging public and private partnerships that are mutually beneficial for participating organizations and the community. Cheza Nami’s assembly presentation teaches the values of respect, community and togetherness. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The collaboration of LVPAC and the Cheza Nami Foundation places the Arts in the Schools project in the best position to reach over 4,700 students within the Dublin Unified School District. By leveraging resources across organizations, both organizations are able to capitalize on the other’s capacity and strengths, thus minimizing cost while effectively pushing the project forward. LVPAC’s expertise highlights cost consciousness and effectiveness with school outreach programs. Marketing and administration costs have been reduced by using LVPAC’s staff and in-house print production. Cheza Nami Foundation has developed a network of master artists that allows for artistic contributions at a reduced rate. Cheza Nami Foundation volunteer staff hours also allow for a minimization of production costs. The Arts in the Schools project with Cheza Nami is a model for LVPAC’s future education outreach programs and collaborative partnerships with local culturally-based organizations that reflect the diversity of the Tri-Valley region. We hope to widen the scope of the Arts in the School project to highlight other world cultures and art forms, pending further development of LVPAC’s strategic plan. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? The ultimate goal of Arts in the Schools is to reach about 4,700 students within the Dublin Unified School District through 12 cultural performing arts assemblies at a cost of $14,502 total. If funding were not made available to fulfill 12 assemblies, the next goal would be 2,250 students through 6 assemblies at a cost of $7,251. The minimum goal is to reach 1,000 students. This would entail 2.5 assemblies at $3,625. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35793 Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35793 Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35793 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35793 Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35793 Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). LVPAC is undergoing a comprehensive strategic plan and will seek corporate sponsorship and individual major gifts to diversify our funding sources for our educational outreach efforts. Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35793 Budget Funding Sources/Revenues Budget Amount Amount Committed LVPAC Education Fund USD$ 630.00 USD$ 630.00 Total USD$ 630.00 USD$ 630.00 Funding Uses/Expenses Budget Amount Amount Committed Materials: Drums/Musical Instruments USD$ 600.00 Personnel: 6 teaching artists USD$ 9,900.00 Travels with Music single site license USD$ 582.00 Travels with Music single site teacher resource USD$ 90.00 Program Oversight/Coordination USD$ 1,500.00 Marketing/Administration/Printing USD$ 150.00 USD$ 150.00 Insurance USD$ 900.00 LVPAC Education Coordinator USD$ 480.00 USD$ 480.00 Travel USD$ 300.00 Total USD$ 14,502.00 USD$ 630.00 Budget Narrative Personnel costs cover master teaching artists at negotiated at $275 per day. Program oversight covers program administration support from Cheza Nami's Executive Director. Materials covers equipment for drums and musical instruments. Marketing/Administration/Printing and LVPAC Education Coordinator's time will be covered by LVPAC. Insurance will cover general liability insurance cost. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Program Expense Budget for ALL Grants - LVPAC Financial Information Form for ALL Grants download template Financial Information for ALL Grants - LVPAC List of Board of Directors (or governing body) with contact information LVPAC Board of Directors Roster Current Annual Budget for the Entire Agency 2015 LVPAC Summary Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) 2013 990 LVPAC Public Disclosure Tax Return Board of Director's (or governing body's) designation of authorized official LVPAC Designation of Authorized Official and Authorization to Request Funding Board of Director's (or governing body's) authorization to request funding (may be same document as one above) LVPAC Designation of Authorized Official and Authorization to Request Funding Proof of insurance carried, including bonding, liability and/or workers' compensation LVPAC Copy 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) Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35793 REQUIRED FOR CDBG ONLY-ORGANIZATION CHART STATE AND FEDERAL NON-PROFIT DETERMINATION 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35793 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35793 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Open Heart Kitchen’s mission is to provide nutritious meals, to those in need in the Tri-Valley. Together with the communities’ generosity and support we can provide that safety net against hunger for our neighbors in need. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Open Heart Kitchen Dublin Meal Pograms Open Heart Kitchen 1141 Catalina Drive #137 Livermore, CA 94550 United States Tel: (925) 580-1616 Fax: (925) 292-4532 Web: www.openheartkitchen.org EIN: 94-3396038 DUNS: 097698521 Project Contact Linda McKeever executivedirector@openheartkitchen.org Tel: 925 580 1616 Additional Contacts none entered Executive Director Linda McKeever executivedirector@openheartkitchen.org USD$ 15,000 Requested Submitted: 12/8/2014 7:37:56 AM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35636 7. Please provide information to justify your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). OHK has been providing meals for hungry people in need since 1995. Dublin Programs: The Hot Meal Program: Children’s Box Lunch Program and the Senior Meal program. Hot meals are made from scratch and served to anyone in need on Mondays in Dublin. In 2014 OHK started providing the senior meal program for low income Dublin senior Monday through Friday at the Dublin Senior Center. The Weekend Lunch program provides Dublin school children healthy nutrition choices on the weekend. Children who receive free school lunches during the week are left without on the weekends to fill this nutritional gap. OHK distributes bags with two healthy lunches per child on Friday afternoons to 6 Dublin schools. The Executive Director of OHK is responsible for organization’s consistent achievement of its mission, financial objectives under the direction of the Board of Directors. The ED shapes and upholds the strategic vision of OHK by developing strategies to move the organization forward, setting goals, creating and implementing action plans, evaluating and processing results. Linda McKeever has 20 years’ experience working on non-profit Boards and she holds a non-profit management certification from Cal State East Bay. The Director of Operations reports directly to the ED and is responsible for ensuring programs and services are delivered effectively to OHK clients at all sites, including quality assurance and regulatory compliance. Clare Gomes has over 10 years of Food service management and has a degree in nutrition.Shawnda Boost is our Volunteer Coordinato:she schedules and manages the volunteers. She has 15 years management experience. Site Supervisors: train and direct volunteers on preparing and delivering our meal programs and all our servsafe certified. Community volunteers are the largest part of our staff. Board of Directors list attached. 8. Provide a brief summary of the project for which your agency is seeking funding (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. We are seeking funding for the three Dublin meal programs. The hot meal program, the senior meal program, and the children's weekend box lunch program. Dublin Funds will be used for direct meal cost. 9. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED: client is counted only once regardless of number of services received in a year.) 350 to 400 clients 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? 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 None of the above 11. Explain how this project will be implemented, administered, and operated. With minimal staff and community volunteers, nutritious meals are prepared and served fresh daily. OHK's Hot Meal program serves on Monday in Dublin. Guests are welcome to eat their meals at our serving locations or meals can be taken to go. Our Box Lunch program is prepared each week and delivered to the Dublin title one schools, the Groves and Low income residents of Camellia Place. We work with the Dublin school district, the local school principals and teachers to determine which schools and which children want to participate in the program. Lunches are delivered and distributed to participating schools each Friday afternoon. Children of low income families and their siblings are encouraged to participate in the program. The senior meal program is served at the Dublin senior center Monday through Friday. The meal includes soup, salad and a freshly prepared entree with vegetables and desert. At Each serving day we use daily log sheets to track: the number of meals served, volunteers and their hours and the Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35636 amount of purchased and donated food used in each meal service. Monthly surveys are taken at each site to track client information such as income per household. The 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 OHK's Volunteer Coordinator. Each serving site has a Site Supervisor to train and direct volunteers. Site Supervisors report to the Operations Director who is directly responsible for the food operations of the organization. Grant administration: The Operations Director collects confidential client information on monthly surveys approved by the City. The Bookkeeper; prepares monthly billing on the CDBG Grants. Grant administration is overseen by the Executive Director and reported to the Board of Directors monthly. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). Dublin Funds will be used to purchase food and supplies for the programs. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? As stated in the Tri-Valley needs assignment hunger is growing in the Tri- Valley. It especially is impacting the senior population and our children. To track improvements in this area. Open Heart Kitchen evaluates the success of our meal programs by applying two key criteria, meal count and cost per meal. The number of meals served is tallied every serving day and accurate logs are maintained by the Executive Director, the Operations Director and the Bookkeeper. The average food cost is tracked monthly by the Executive Director, Board Treasurer and Bookkeeper. A full report on the number of meals served and the cost is presented to the Board of Directors monthly. Guest surveys are conducted and logged each quarter to have accurate records of the population we serve. Volunteers encourage guests to provide feedback on the surveys. We consider our programs successful if the meal count numbers remain constant with community need and the meal cost is on budget. The number of meals served each year continues to grow to meet the demographic change in the Tri-Valley area. Open Heart Kitchen has increased the number of serving days and locations, with the help of our financial donors and hundreds of volunteers. Open Heart Kitchen has managed to keep the direct cost of our meals low and on budget. We work closely with local social service agencies and other non-profit groups to keep current data on the changing hunger needs of our communities. Our goal is to adjust our programs to meet any demographic and economic change in the communities we serve. This year to meet the growing needs, Open Heart Kitchen has added a new senior meal program in Dublin and increased our box lunch program to serve lunches during the summer. The number of seniors participating in the program continues to grow weekly. With the cooperation of the public libraries, the summer children meal program is also growing. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. The funds for this project will serve guest from all walks of life; the homeless, seniors, single parent families, children, veterans, unemployed and underemployed low income to extremely low-income Dublin residents. OHK is their safety net against hunger. Food is a basic human need, and proper nutrition to those in need is a challenge for many. The hot meal program addresses anyone in need of hunger relief. The senior meal program specifically addresses the nutritional needs of our senior population. (this year Open Heartt Kitchen has taken on the Dublin senior centers hot meal program)the The Children’s weekend lunch program addresses our children’s nutritional needs. People who experience hunger are at risk for serious health problems. Hunger can be life-threatening by increasing the risk for stroke, prolonging recovery from illness, extending hospital stays, limiting the effects of prescription drugs, decreasing resistance to infection, and even increasing the occurrence of depression and isolation. By providing proper nutrition for our neighbors in need, OHK helps lowers the overall health cost to the community. We also feel, providing volunteer opportunities, benefits the Dublin volunteers as well as the entire community. Volunteering helps a community come together to solve the needs within the community. Volunteering is good for your health at any age, but it's especially beneficial in older adults, and youth. In seniors volunteering has been shown to lessen symptoms of chronic pain and heart disease. In youth volunteering help prevention of depression, isolation and anti-social behavior. OHK Programs offers hundreds of residents’ volunteer opportunities and its many positive benefits for themselves, their families and the community. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? OHK provides culturally appropriate services by offering ethnically diverse menu items. On many occasions, OHK offers entire multi-cultural meals. Our condiment tables at the hot meals serving sites always have salsa and tabasco sauce for those who wish to flavor their food with these items. For our senior citizens, we offer low-salt, low sugar menus. In addition we offer nutritional education for seniors and parents. The hot meals include a protein, vegetable, green salad, fruit salad, bread, dessert, and beverages. The protein is generally a meat; but we also offer a sufficient variety of vegetable dishes at each meal to accommodate our vegetarian guests. Several of our site managers speak Spanish, and many of our volunteers speak fluent Spanish and a variety of languages and are readily available to converse with our non-English-speaking guests and students. Our box lunches contain child friendly items, such as containers of juice, milk, a fruit snack , a package of baby carrots, a fresh orange and or apple, low sugar high fiber muffin, cheese and crackers, and a granola or protein bar. We are always looking for new nutritious child friendly lunch items for this program. The surveys are offered in English, Spanish, Chinese, and Tagalong. We ask for client feedback on the type of food they would like to have us add to our menus. We adjust the menus to accommodate client requests. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? We use various outreach efforts to try to inform the hungry people in the Tri- Valley about the OHK Meals programs: Our web Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35636 site, www.openheartkitchen.org, has a complete description of all our services. Information about our programs is also listed in local news media such as The Pleasanton Weekly, The Independent, Tri -Valley Newspapers, The Valley Times, Channel 26, Channel 30, Comcast Public Service Announcements and KKIQ. We are part of the United Way's 211 human service referral process and our website is linked to the city's human service sites. Our serving site locations are included in the Tri Valley's Emergency Disaster Relieve Referral program and the San Francisco's Disaster relief programs, we are part of the Alameda County Food Banks referral system, the Tri- Valley Hunger coalition and we work closely with local churches, community service groups, and non- profits in the local area to reach those in need. Our Outreach Committee creates and distributes outreach flyers printed in English, Spanish and other languages to inform potential guests of OHK's services. These are posted in strategic locations; e.g., bus stations and laundromats, schools, community libraries and Social Service agencies. Ultimately, we believe that testimony from our appreciative guests and the students receiving box lunches is the best source of new participants. We would like to work closer with the City for creative ideas for outreach. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Open Heart Kitchen works closely with the Alameda Agency On Aging, Alameda County Food Bank, Local Food pantries, local Churches, businesses, service originations and civic groups to address the issue of hunger. Open Heart Kitchen is a member of the Tri- Valley Hunger Coalition, a group consisting of organizations dedicated to the issue of hunger. We work with Alameda County, the local cities and other social service organizations such as the United Way's 211 Human Service Network to meet the community needs. Our serving sites are included in the Tri- Valley Emergency Disaster Relieve Referral Program, and the Pleasanton-Livermore Disaster Council. Open Heart Kitchen is part of the Cities Volunteer 2 system to promote community involvement. We work with the Local school districts, court system, and service groups such as the 4 H clubs, the national charity league, and other youth groups to promote joint projects that benefit the community. Open Heart Kitchen believes it is important that as a non-profit we all work together as a community to help those in need. Open Heart Kitchen works with other local nonprofits that serve seniors, the youth and the homeless. We encourage the homeless and other non-insured clients to receive medical care by providing bag lunches to the mobile health units in Livermore. We also work with other non-profits by providing access to our washer and dryer, allowing the homeless the ability to do their laundry. We work with local business, churches and civic groups on community gardens allowing fresh produce to be given to people in need. Open Heart Kitchen believes through cooperation and collaboration together we will build a stronger community. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. We use various outreach efforts; our web-site, www.openheartkitchen.org, Information about our programs is featured in local news media such as The Pleasanton Weekly, The Independent, Tri-Valley Newspapers, Channel 30, Comcast Public Service Announcements and KKIQ. We are part of the United Way's 211 human service referral process and our website is linked to the city's human service sites. Our serving site locations are included in the Tri Valley's Emergency Disaster Relieve Referral program and SF Foundation Disaster program. We are part of the Alameda County Food Banks referral system, Tri- Valley Hunger coalition. We work closely with local churches, community service groups, and non- profits in the local area to reach those in need. Our Outreach Committee creates and distributes outreach flyers printed in English, Spanish and other languages to inform potential guests of OHK's services. These are posted in strategic locations; e.g., bus stations and laundromats, schools, community libraries and Social Service agencies. Ultimately, we believe that testimony from our appreciative guests and the students receiving box lunches is the best source of new participants. We work with other non- profits by providing access to our washer and dryer, allowing the homeless the ability to do their laundry. We work with the church community to provide showers for the homeless. We work with local business, churches and civic groups on community gardens allowing fresh produce to be given to people in need. OHK believes through cooperation and collaboration together we will build a stronger community. We work with the local school districts, court system, and service groups such as the 4 H clubs, the national charity league, and other youth groups to promote joint projects that benefit the community. OHK is currently working with Cities and other non-profits to have uniform data collection forms to capture the changing needs and the populations served in our communities. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. Open Heart Kitchen promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities for low income individual and families to enjoy a nutritious free meal in a safe and dignified environment. By providing funding for OHK programs you help our neighbors in need while they struggle to make ends meet. Sometimes this small amount of help is all it takes to keep families in their homes, allowing Dublin to maintain a diverse community which fosters heritage and cultural development. OHK programs offer the community the opportunity to bring residents of all ages together to serve and or be served. Volunteers of all ages come together to build a stronger community that promotes community diversity and understanding. OHK exercises honesty, integrity, fairness and dignity with our guest and our community volunteers. We believe and promote effectiveness and efficiency by building coalitions with other service agencies, local business, community groups and churches for the greater good of the community. We provide connectivity with Dublin residents and the local business through volunteer activities, food drives, community gardening programs and fund-raisers’, We participate in local events to promote an enlightened, economic balanced and diverse community. We promote collaborative activities through our web-site, Facebook, newspaper articles, local TV, and social media outlets. We also feel, providing volunteer opportunities, benefits the Dublin volunteer as well as the entire community. In today's busy society, it can be hard to think about finding time to volunteer. However, the benefits of volunteering are enormous, both to you, your family and the community. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The budget is reasonable for the amount of meals we serve and is based on 16 years of experience. Open Heart Kitchen Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35636 tracks the cost of meals on a monthly basis. We continually find new creative ways to use donated food and supplies from food drives, and local gardens to help lower the cost of meals. By leveraging our purchased food with donated food and providing our services with minimal staff and maximum volunteerism, Open Heart Kitchen operates extremely effectively. The large number of volunteers we use on a weekly base encourages community involvement and demonstrates community awareness of residents in need. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If the application does not receive funding Open Heart kitchen would look for donations from private and corporate sources to try to keep the programs going. Without city funding the programs may need to decrease the number of Dublin residents served. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35636 Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. We print our program information and surveys in several languages. 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35636 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35636 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35636 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: 350 to 400 clients 42. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients your agency anticipates serving in each category. "If none, please enter "0". 200 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) 150 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) 50 Disabled 75 Female Headed Households 100 Senior 100 Youth Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 675.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" 75 White 65 White + HISPANIC 15 Black/African American Black/African American + HISPANIC 75 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 25 Asian and White Asian and White + HISPANIC 10 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 85 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 350.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35636 #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). We continually find creative ways to find new funding sources. We use donated food and supplies to lower the cost of meals. By leveraging volunteers and with minimal staff we can serve more meal at a greatly reduced cost. Budget Funding Sources/Revenues Budget Amount Amount Committed Dublin CDBG USD$ 15,000.00 USD$ 0.00 Foundation Funding USD$ 20,000.00 USD$ 2,000.00 Appeal Letter USD$ 50,000.00 USD$ 3,000.00 Alameda Aging Agency USD$ 20,000.00 Church Donations USD$ 8,000.00 Individual Contributions USD$ 43,000.00 other events USD$ 20,000.00 Total USD$ 176,000.00 USD$ 5,000.00 Funding Uses/Expenses Budget Amount Amount Committed Food and supplies USD$ 15,000.00 Total USD$ 15,000.00 USD$ 0.00 Budget Narrative The budget is reasonable for the amount of meals serve and is based on 17 years of experience. Open Heart Kitchen tracks the cost of meals on a monthly base. We continually find new creative ways to use donated food and supplies from food drives to help lower the cost of meals. We only have a few paid staff member at each site. By leveraging our purchased food with donated food and providing our services with minimal staff and maximum volunteerism, Open Heart Kitchen operates extremely effectively. The large number of volunteers we use on a weekly basis demonstrates community involvement and community awareness of our neighbors in need, two of OHK's Key Values. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Dublin budget Financial Information Form for ALL Grants download template Dublin Finincial List of Board of Directors (or governing body) with contact information Board of Directors Current Annual Budget for the Entire Agency budget all programs Copy of most recently submitted IRS 990 form or Tax Return (include complete form) taxes part1 Board of Director's (or governing body's) designation of authorized official Board Committes Board of Director's (or governing body's) authorization to request funding (may be same document as one above) letter of auth to request funds Proof of insurance carried, including bonding, liability and/or workers' compensation Insurance cert 1 City f Dublin insurance cert2 REQUIRED FOR CDBG ONLY-If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35636 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 Finding letter P & L audit 2014 REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. Articles Of Incorporation 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 update STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER 501 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. outreach outreach 2 REQUIRED FOR CDBG- LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35636 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35636 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The Pacific Chamber Symphony is a mid-sized orchestra serving the local communities where our core supporters live and work and where our performances, educational programs, and civic participation cultivate a greater sense of community. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Pacific Chamber Symphony "Music is Fun!" Educational assemblies for elementary schools Pacific Chamber Symphony PO Box 3134 164 Main Street, Suite C, Pleasanton CA 94566 Livermore, CA 94550 United States Tel: (800) 630-7836 Fax: (925) 631-0236 Web: www.PacificChamberSymphony.org EIN: 94-3105631 DUNS: Project Contact Lawrence Kohl LawrenceKohl@hotmail.com Tel: 925-324-2775 Additional Contacts rjkoopman@comcast.net, m_brent@yahoo.com Music Director/ CEO Lawrence Kohl LawrenceKohl@hotmail.com USD$ 11,500 Requested Submitted: 12/11/2014 3:33:46 PM (Pacific) Application Questions Page 1 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36182 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.). Pacific Chamber Symphony (PCS) has presented this program in more than seven school districts over twenty years to more than 200,000 children. The musicians are among the finest professionals, and they have performed at thousands of these programs. Furthermore, the music is specifically arranged by professional composers for each performance. The music director has also been a music educator for more than thirty years. The PCS staff and board have substantial experience in management and program coordination with the schools. 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. Our flute, clarinet, trumpet, violin and cello quintet performs two back-to-back assemblies for each public elementary school, featuring the music of different countries and cultures to introduce and teach music fundamentals. 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.) 3,600 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. The assembly performances will take place from January through May, 2016. The sequence of activities will begin in September, 2015, when PCS will contact the musicians and the schools to coordinate and develop a schedule. The music director will determine the curriculum and theme with the district. Music will be composed and/or arranged for the ensemble and the teacher packets will be developed accordingly. These activities happen with constant communication with the schools. PCS will deliver the educational packets about two weeks before the assemblies to assist the teacher with their preparation. The musicians will meet to rehearse and develop presentations. The assemblies are meant to be interactive: students will be asked to identify, understand, and participate in the process. Following the assemblies, the director follows up at each school and collects the completed teacher response forms. Teachers are encouraged to email the director with specific questions. Children often send letters and/or drawings to PCS. These optional efforts deepen their musical experience. The director reviews the teacher responses, which provide input for continuous program 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?). The funds will be used to pay for: 1. The musicians' and the music director's salaries 2. Educational materials, music arrangements, and 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)? Pacific Chamber Symphony evaluates the success of our in-school performances from the compiled results of teachers' feedback forms and students' drawings and letters. The students are remarkably articulate about their experience. Page 2 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36182 Subsequently, PCS, in discussion with the elementary schools, aims to gain greater understanding of the children's specific needs and preferences. The resulting feedback of these discussions is processed by the PCS director and the participating musicians, who influence the nature of future programs. 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 following benefits are offered to all public elementary school children who attend the assemblies. 1. Music helps children by -engaging them completely and stimulating the integration of left and right brain processes. -facilitating sensory learning and offering opportunities to link learning styles -honoring individuality and expression -establishing a space for reflection in their lives, in their school, and in the community. 2. Our program helps the music programs by implementing best practices: Most theorists agree that music is best learned through recurring sensory experiences that provide both variety and repetition. One of these experiences categorizes elements in music. This "ear training" teaches students to identify musical concepts as they listen. We also encourage students to develop their own musical opinions and preferences as a first step to establishing a relationship to music. 3. The curriculum is designed with respect to the teleological considerations outlined above. Each year the curriculum focuses on a specific musical concept with corresponding musical ensemble selections. As children learn about the basic concepts of music (rhythm, melody, acoustics, timbre, harmony, form, style, etc.), they develop awareness, understanding and appreciation of its many forms. The curriculum also offers an opportunity for students to create artwork or write a letter describing the concert and what they learned. This is a proven method for reinforcing the meaning and joy of the musical experience. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? Music is a universal language. It crossing cultural divides. What PCS strives to do is to reach every child by specifically performing music of different countries, cultures and time periods to connect with the diversity of cultural heritage in our schools. This plan reinforces the concept of the child's own culture as well as belonging to the diverse community in which he or she lives. 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? As the program reaches all elementary school children, all can access the program. For large blocks of non-English speaking students, we will engage translators. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We work closely with the Dublin School District and the individual elementary schools. Each school appoints an assembly coordinator with whom we work on scheduling delivery of educational packets and assembly setup. The school coordinator keeps the teachers and staff informed of the assembly schedule to ensure proper preparation and smooth running on the assembly day. 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. Parents are informed of our assemblies, and teachers have the option to give their students good listening award certificates to take home. We also offer substantial family discounts to our main season concerts. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. The enjoyment and understanding of how music is put together and the introduction to classical music by the Bay Area's finest professional informs the children that they too can enjoy and participate in musical activity that nurture "promotes and supports a high quality of life." Our program "balances the history" of music with current trends and introduces music from diverse cultures, performed on an orchestral instrument and open to be enjoyed by all levels of the socioeconomic scale. Children who study music learn how to think cortically and act positively, making for an "enlightened, economically balanced and diverse community." Our program strives to persuade children that music is a meaningful part of an "active and healthy lifestyle." We promote "community cultural opportunities" by encouraging children to participate in their school music programs. Those programs have increased enrollments due to our inspiring assemblies. When children study and learn about music, they take it home where it becomes part of "family-based activities" and "cultural development." We encourage families to attend our main season concerts by offering family discounts. Music "builds community." By supporting the Pacific Chamber Symphony's "Music is Fun!" the City demonstrates that it "is committed to openness and responsiveness to the public and community," because our program is wanted by the schools and community; cares that the residents of the community enjoy, appreciate and understand, in a thoughtful and meaningful way, the best of what life has to offer; is "fair" to all its residents with the highest level of customer service - by giving them great art performed and taught by the best professionals. Page 3 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36182 Music is communication, it is a team and audience endeavor where every person gives their best for the benefit of the performance. Music helps "build an informed community." 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The investment of $11,500 to reach all public school children (about 3,600) is just over a mere $3.00 per child. Taking children to San Francisco (of whom only a fraction could go) would be far more costly for the travel, performance costs, and time spent away from school (time away would also impact other school activities). Our program is highly cost effective. Further our program is not just a performance, it is a structured learning experience focused on teaching the elements of music fundamentals. No other program achieves these ends at this minimal cost per child. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? The project will not take place. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Page 4 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36182 Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. Page 5 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36182 E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. F) Not Applicable. I am not interested in qualifying for CDBG funding. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Page 6 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36182 Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. Page 7 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36182 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY Page 8 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36182 #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). We are seeking grants from foundations. Budget Funding Sources/Revenues Budget Amount Amount Committed City of Dublin USD$ 11,500.00 USD$ 0.00 Hacienda Child Development Fund USD$ 1,000.00 USD$ 0.00 Total USD$ 12,500.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Artistic Personnel USD$ 9,500.00 Music Director CEO USD$ 2,000.00 Materials and Operations USD$ 1,000.00 Total USD$ 12,500.00 USD$ 0.00 Budget Narrative Most of the expenses are artistic: professional services of the musicians (at $125 per musician per assembly with rehearsal time included) composing/arranging the music. A part of the music director/CEO's salary (8%) is directed towards the program to cover the time and costs of coordination grant writing and for the development of the educational packet for the teachers. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template ProgramBudget Financial Information Form for ALL Grants download template FinancialInfo List of Board of Directors (or governing body) with contact information ListOfBoard Current Annual Budget for the Entire Agency BudgetEntireAgency 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 AuthorizedPerson Board of Director's (or governing body's) authorization to request funding (may be same document as one above) AuthRqFunding Proof of insurance carried, including bonding, liability and/or workers' compensation insurance certificate REQUIRED FOR CDBG ONLY-If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) Page 9 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36182 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 501c3 designation 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 36182 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 10 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36182 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). To impact the lives of young people by providing educational programs that build character, instill life-enhancing values and promote healthy choices through the game of golf. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. City of Pleasanton Community Grant (2011/12) $4580- cover a portion of the coaching and access expenses of 50 Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Partners Fore Golf Inc. dba The First Tee of the Tri-Valley The First Tee Tri-Valley Expansion into Dublin Partners Fore Golf Inc. dba The First Tee of the Tri-Valley 2843 Hopyard Rd. Ste. 143 Pleasanton, CA 94588 United States Tel: (925) 462-7201 Fax: (925) 461-1013 Web: thefirstteetrivalley.org EIN: 20-2189915 DUNS: Project Contact Andrew Zeller thefirstteetvdan@yahoo.com Tel: 925-519-3369 Additional Contacts thefirstteetrivalley@gmail.com,azeller@thefirstteetrivalley.org Executive Director Andrew Zeller azeller@thetrivalleyfirsttee.org USD$ 7,000 Requested Submitted: 12/11/2014 12:31:46 PM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36140 scholarship kids attending our Life Skills Experience classes and 50 scholarship kids attending summer camp. City of Pleasanton Community Grant (2013/14) $2400- to increase our reach into the under-served portion of Pleasanton by covering a portion of the cost of scholarships for our programs. 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 First Tee of the Tri-Valley has been serving families in our area since 2005. In the last ten years we have developed into a very strong First Tee chapter. In 2014 alone, 12,000 elementary school students participated in our 3-5 week P.E. unit, 687 children benefited from our Life Skills Experience Classes, 284 attended our seasonal camps, 212 girls participated in our Girls Golf programs, and 104 more advanced golfers played in our tournaments. We also provided programming through our outreach campaign to another 675 kids. Our Board of Directors is made up of 28 professional men and women dedicated to our mission. We have three full-time staff (executive director, program director, and office manager), one part-time staff (National School Program), eight trained coaches and over 25 trained volunteers, all focused on providing programming to our current students while reaching out to more families and growing the program. Our main source of funding is from the five fundraisers we hold every year. These events have provided the finances to grow and manage the programs we have in Pleasanton. 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 better serve the children of Dublin, The First Tee of the Tri-Valley plans to expand its character building programming using the facilities at Dublin Ranch Golf Course. 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 will offer 8 classes in 2015; 2 in Spring, 3 in Summer, 3 in Fall. Each class will accomodate 10 participants for a total of 80 students. Assuming 15 children register for 2 sessions, there will be 65 unduplicated Dublin residents served. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. The First Tee of the Tri-Valley will provide all of the coaches, volunteers, equipment, marketing material and administrative support for the classes. Dublin Ranch will provide time on their putting green and golf course as well as a place to store the equipment and display program flyers. We will start in the Spring of 2015 with two classes. They will run on two different days of the week from the week of 4/6 to Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36140 the week of 5/25. One of the classes will be a beginner level and the other will be intermediate. Our coaches will arrive early to set up their stations and stay after class to clean up, answer parents' questions, and make sure all children are picked up. We will offer three classes in the Summer and Fall. The levels will be determined after we see what kind of interest we had in the Spring. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). Our vision when we became The First Tee of the Tri-Valley was to provide programming to the families in our area, focusing on Pleasanton, Dublin, and Livermore. We implemented the National School Program into Dougherty Elementary and Kolb Elementary. We also established a relationship with Dublin Easter Seals, facilitating after-school golf lessons for the Kaleidoscope group every Thursday afternoon. However, only 9% of our total participants live in Dublin. We believe if we can expand programming into Dublin we can positively impact the lives of more Dublin children. The grant funds in this project would be used to cover the portion of the cost of holding Life Skills Experience Classes at Dublin Ranch Golf Course that are not covered by participant fees. The one-time start up costs are for equipment. The operating costs include access fees from the golf course and coaching fees. 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 offer 2 classes (one beginner and one more advanced) in the Spring of 2015. We will offer 3 classes in both the Summer and Fall. We will be successful in our reach if we can fill the three Fall classes (30 students) with children from Dublin. We also have a goal of reaching out to those families that could normally not offer golf lessons to their children and provide scholarships. We will be successful meeting our goal if at least 30% of our kids are on scholarship. Our mission is to use the game of golf to teach our 9 Core Values (Honesty, Judgment, Sportsmanship, Respect, Confidence, Integrity, Responsibility, Courtesy, and Perseverance). We send out a survey to the parents after every session asking if they have seen a difference in their children in their children's behavior. We will be successful impacting the lives of young people if the majority of those taking the survey respond that they have seen a positive difference in their children in at least one of these areas. 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. Youth between the ages of 7-17 will benefit from our programming. Through our relationships with the elementary schools in Dublin, we will specifically focus on engaging those children that might not otherwise be able to participate in after-school sports because of family finances. We will also be looking to serve those children that could most benefit from our 9 Core Values curriculum. All children are welcome to join our classes. We have children with physical and behavioral issues that have benefited from our safe fun environment. During personal interviews, 78% of The First Tee participants described their ability to transfer life skills through specific examples and stories. Life skills including decision-making, self management and goal setting were consistently transferred to situations involving school, family, jobs, college, career and out-of-school activities. For example, many students found they were better able to stay positive when frustrated with homework, to set specific goals for earning better grades, and to look for solutions to problems with friends. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? Our organization does not exist to produce competitive or future professional golfers. Rather, we are committed to producing mature young adults who embody the Core Values and are prepared to face the challenges of adolescence and adulthood. Children in our area best learn positive character traits by seeing them exhibited by people they admire and by having a safe environment in which to practice these traits. Character development principles such as conflict resolution and goal setting can not be instilled as effectively in a classroom lecture or discussion. Youth who learn these important life skills while doing a fun recreational activity are much more likely to retain the information and improve their daily lives. No other sport involves such a high etiquette standard as golf. The inherent culture of golf (calling penalties on yourself, respecting the other players and facility, persevering through mistakes, deciding on strategy) provides the perfect backdrop for life lessons. 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 programming offered by The First Tee of the Tri-Valley is open to any individual between the ages of 7 and 17 regardless of their income level, first language, and capabilities. The chapter works hard to identify and include individuals and groups of "low-income" and "at-risk" youth who will benefit most from the core values and character development the curriculum provides. The chapter plans to continue its relationship with the school system and individual physical education teachers. Teachers and administrators who interact with these children and teens on a daily basis have a greater understanding of their needs and how our programming can help benefit the families. Often specific teachers will help the chapter identify groups of Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36140 students that participate in after school programs. We will give the teachers the freedom to offer to these students free The First Tee programming at our facilities. A second goal would be to identify additional groups outside of the school system that would be great partners and who could help us reach low-income families. Hopefully these partnerships would be with youth-serving non-profit organizations interested in adding golf activities/character building to their current program offerings. All programming for the chapter carries a "Pay What You Can Policy" that allows any individual to gain full or partial financial scholarship with no questions asked. The Dublin families will simply contact our office, explain what they need, and register for a class. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. As a youth development organization, the chapter partners with countless organizations including but not limited to local businesses, schools and school districts, golf courses, food and beverage services, and other not-for-profit organizations. As an example, we partner with Dublin Easter Seals to provide a fun and positive weekly after-school recreational experience for the people in the program. We bring the golf and character development expertise to this partnership while Easter Seals provides the skills for most effectively teaching and mentoring the participates. Together this creates an outlet for these students to have an enjoyable social and athletic experience in a safe and controlled environment tailored directly to their needs. We use this same model of partnering with other agencies and jointly benefit from our individual strengths as we serve 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. We first introduced our National School Program into the PE classes at Dougherty Elementary and Kolb Elementary in the Spring of 2012, coaching approximately 500 children at each school. We also financially support the middle school teams at Wells Middle School and Fallon Middle School as well as both the boys and girls golf teams at Dublin High School. A very strong and longstanding relationship has been established between The First Tee of the Tri-Valley and Dublin Easter Seals. Over the years our instructors have also participated in Family Days at Camp Parks, explaining our programs and offering scholarships to participating military families. Additionally, we have run annual programs with the School of Imagination serving children with autism. We currently offer classes and facility use for the Northern California Special Olympics Team. Other service organizations we have collaborated with include: Axis Community Health, Horizons Family Counseling, American Heart Association, Matters of Community, ChildCare Link, Boy Scouts of America, Girl Scouts of America, the Terrance Kelly Foundation, the Taylor Family Foundation, Livermore Area Police Activities League, Tri-Valley REACH, Agape Villages, Shepard's Gate, Las Positas College- College Bound Scholars, Tri-Valley YMCA Y-Princess, Hayward Leadership Public School and the City of Newark Recreation Program. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. The First Tee Dublin Expansion Project supports Dublin's Mission, Vision and Values. With respect to Dublin's Mission Statement, the Life Skills Experience classes foster a safe and secure environment physically and emotionally. Our coaches and volunteers have all gone through background checks and training. The 9 Core Values of honesty, judgment, sportsmanship, respect, confidence, integrity, responsibility, courtesy, and perseverance are not only taught in the class, but are the standards of our organization. In this safe and secure environment, the children are exposed, for many the first time, to golf. For some, this new opportunity will become a life-long hobby. Dublin's vision celebrates economic diversity in its citizenry. Scholarships allow for all children, regardless of their economic situation, to participate in an after-school activity together. We are dedicated to promoting an active and healthy lifestyle through our first-class recreational programs. We also support this vision with The First Tee Nine Healthy Habits curriculum, created through a collaboration among The First Tee, ANNIKA Foundation and Florida Hospital for Children. This curriculum promotes healthy, active lifestyles for young people through nine health and wellness topics. The topics cover three areas: Physical Health (Diet, Exercise and Sleep, Physical Safety), Emotional Health (Vision, Mind, Family), and Social Health (Friends, School, and Community). Our programs also promotes the value of building community. We promote golf as an activity that brings people of all ages together. In fact, many times it is the grandparents that register the kids for the program, hoping to have another activity to enjoy with their grandchildren. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. As we all know, golf is an expensive sport. It is cost prohibitive for a large percentage of the population in the East Bay. We decrease the cost by using volunteers, negotiating lower access fees with golf courses, and fundraising. This project lowers the price point and thereby opens the doors of this sport and the life lessons it provides to many kids. Because of our pay-what-you-can policy, families that can afford the program will pay the registration fee. The grant funds will go where they are most needed. It will not be covering the fees for families that can pay themselves. Once we have an established program in Dublin, we believe we will be able to successfully reach out to local individuals and Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36140 businesses for continued financial support. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? We will need to re-think the timing of bringing programming to Dublin, delaying it until we are able to generate the funds through a corporate gift or a Dublin fundraiser. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication 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 Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36140 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36140 Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36140 Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36140 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36140 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). One of our goals for 2015 is to increase our corporate donors. We are currently working on setting up corporate golf leagues at Dublin Ranch Golf Course to help us build relationships with Dublin businesses. Budget Funding Sources/Revenues Budget Amount Amount Committed Programming fees (30% on scholarship) USD$ 8,120.00 Total USD$ 8,120.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Access (assuming $8 fees per participant per class) USD$ 5,120.00 Coaches USD$ 5,760.00 on-line registration fees USD$ 240.00 10 sets of clubs & First Tee books USD$ 1,500.00 SNAG Equipment USD$ 2,500.00 USD$ 0.00 Total USD$ 15,120.00 USD$ 0.00 Budget Narrative The standard registration fee for our 8 week Life Skills Experience Sessions is $145, however we have a pay-what-you- can policy. Approximately 25% of our kids are on full scholarship. Access fees would be paid to Dublin Ranch for use of their putting green and golf course. $8 per day for 8 days is a cost of $64 per participant per session. We pay our coaches for two hours each class- 1.5 hours for the class and .5 hours to set up and tear down. In the Spring we will have 2 pros at $50/hour. In the Summer and Fall we will have 2 pros at $50/hour and 1 trained The First Tee coach at $30/hour. We take all registrations through our on-line registration system and are charged $3 per transaction. Currently the chapter runs programming primarily in Pleasanton at the Pleasanton Golf Center. The chapter works extremely hard to generate funds to cover all expenses associated with administration and programming (direct costs). Because this is a new project in a new area, the chapter needs to raise additional funds outside of its current business model. The above budget is only the direct costs of this project, completely separate from the chapter's current operating budget. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Project Expenses Financial Information Form for ALL Grants download template financial budget List of Board of Directors (or governing body) with contact information Board of Directors Current Annual Budget for the Entire Agency 2014 budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) 990(pages1-4) 990(pages 5-8) 990(pages 9-12) Board of Director's (or governing body's) designation of authorized official BOD letter Board of Director's (or governing body's) authorization to request funding (may be same document as one above) BOD letter Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36140 Proof of insurance carried, including bonding, liability and/or workers' compensation 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 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 36140 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36140 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). School of Imagination brings out the extraordinary in every child by providing groundbreaking, collaborative, and individualized educational, therapeutic, and family support services through the highest quality inclusion program that supports ALL children 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline School of Imagination Happy Talkers Screening and Training Project School of Imagination 9801 Dublin Boulevard Dublin, CA 94568 Tel: 925 829 9555 Fax: 925 829 9555 Web: www.soi4kids.org EIN: 20-8683005 DUNS: 025495543 Project Contact Charlene Sigman charlene@soi4kids.org Tel: 9258299555 x 705 Additional Contacts mitch@soi4kids.org,erin@soi4kids.org Executive Director Charlene Sigman charlene@soi4kids.org USD$ 25,000 Requested Submitted: 12/11/2014 4:54:28 PM (Pacific) Application Questions Page 1 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35859 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.). This project provides screening of children for behavioral health and developmental needs, in Dublin preschools and childcare centers. Screenings are followed by a comprehensive training program, giving parents and educators the tools they need to be successful together in their child’s journey. School of Imagination is a registered 501c3 in operation since 2001 and has the capacity to execute this groundbreaking project, in partnership with Dublin for the following reasons. HISTORY OF SUCCESS. Since 2001, School of Imagination has a history of developing and implementing programs which impact families in the community. With the All-American City of Dublin’s flagship school at full capacity, the strategic priority has become creating sustainable solutions for other schools in the community. LEADERSHIP. Led by Executive Director and Co-Founder, Charlene Sigman- a widely respected pioneer in early childhood education. Her academic credentials include graduate degrees in education and speech language pathology. She is dual licensed by the State of California as both a speech pathologist and preschool site director. Additionally, Charlene leads the only center-based, Early Start Denver Model (ESDM) program in North America. ESDM was heralded by Time Magazine as a Top 10 Medical Breakthroughs of 2012 for the treatment of autism. QUALIFICATIONS. With more than a decade of experience developing and implementing screenings for behavioral health, developmental delays and autism, the Happy Talkers’ screening project has assisted hundreds of Dublin children, free of charge. MANAGEMENT SCOPE- School of Imagination has a team of approximately 50, including managers of medical services, clinical care, educational services and administrative support. FISCAL RESOURCES- The organization has great financial health and stability. School of Imagination carries no debt, and is sustained by a variety of therapy and educational services, providing a diversified revenue stream. 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. Implementing behavioral/developmental screenings, serving at-risk children in Dublin. Training educators and parents to provide cutting-edge care; including the Time Magazine Top 10 Medical Breakthrough for the treatment of autism/behavioral disorders. 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.) The number of Dublin Residents to be served is estimated is based upon the capacity of each program (# of children and their families) as well as Educators receiving the specialized training. Children: 234, Educators: 26, Parents: 52=312 in 1st year. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. The project features a sequential series of phases. The goal is for each school, agency and childcare center to become a leader in early identification, and a model inclusion program. Additionally, each parent will have access the best possible care for their child. Page 2 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35859 Phase 1- Orientation: Introducing parents and educators (Teacher, Coach, Childcare provider, etc) to the Happy Talkers Screening and Training Project. Phase 2- Assessment: The child’s parents and educators are administered the user-friendly, HIPPA compliant assessment tool. Phase 3- Review: Happy Talkers clinicians review each assessment. Recommendations may include attending the upcoming multidisciplinary screening. Phase 4- Screening. During the Multidisciplinary screening event, families will meet with a clinical team, which includes a pediatrician, psychologist, speech and occupational therapist, giving deeper insight and explanation into their child behavior and development. At the same event, the family is assisted with the appropriate next step, which may include facilitating care through the Regional Center, Axis Community Health, Child Care Links, or their own insurance. Supporting those families continues throughout these next phases. Phase 5- Provider Training: Over the next six weeks at the providers’ environment, Happy Talkers trains the specific strategies and inclusion principles needed for their population. Phase 6- Parent Training: An opportunity for parents to access additional tools and support to manage their child’s behavior, speech, language and motor development, as well as navigating the available agencies and resources. Phase 7- Re-Assessment: As a follow-up, parents and teachers are administered the HIPPA compliant assessment tool again, every 3 months to 6 months. This is all well within our experience and expertise. A decade of research and development is behind our proprietary Happy Talkers Online Assessment Tool and multi-disciplinary screening process. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). Children with behavioral and developmental disabilities are typically referred to School of Imagination; however our facility has been at capacity for more than two years. We have been acquiring the expertise and tools to empower our community stakeholders, so more families can access the care their child needs. In 2014, Alameda County funding has enabled us to become the only center-based provider of the autism breakthrough, Early Start Denver Model, in North America. Safeway has funded refreshments for families during the screenings, and SurveyGizmo has donated their advanced software platform and support. We now need funding from Dublin to bring this service to the Dublin community. Specifically, funds will allow us to implement a sustainable community screening for behavioral and developmental delays. These screenings will help families access the care they need, as quickly as possible. In addition, funding would increase the capacity the recreation department, community preschool teachers and childcare providers, to create an inclusive experience for all children. Phase 1, Orienting the parents, Dublin funding would support the staffing and material resources necessary to introduce the educators and parents to the project. This includes instructor time and preparation. Phase 2. Assessing the children, (online) Dublin funding is minimal as the significant software expense has been donated. Dublin funding would support the minimal administrative and user assistance necessary. Phase 3, Reviewing the assessments, Dublin funding would support a specialist to review the assessments and facilitate the appropriate recommendations with the parents and educators. Phase 4, Screening, Dublin funding of the core multidisciplinary team would be heavily leveraged by the volunteer participation of our local. Phase 5 and 6, Dublin would fund a six weeks intensive training for educators. This training will provide the specific strategies 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)? The outcomes of the project include the following over a 12 month period: (1) screen a minimum of 300 children for behavioral/developmental delays and provide family guidance and support. (2) train more than 100 professionals and educators with cutting-edge tools to provide inclusion and early intervention. Since the project is data driven using advanced surveying software, we are able to analyze the outcomes of our intervention and inclusion strategies, measure efficacy and develop recommendations for that facilitate sustainability. This comparative data can function to measure development as it relates to the norms for the age group, and the different peer groups being measured. Throughout our program, we would expect objective and subjective reporting for at-risk children to improve. By administering the same assessment to the parents’ consistently, we are able to accurately measure each child’s progress. Combined with the educator’s assessment, we are able to capture a comprehensive, 360 degree view of the child. This also facilitates for improved communication with all members of the child’s care team. Throughout the project, we will maintain a partnership with the child’s family. While the analytical results are a useful indicator to measure the success of the project, it is the feedback of the family which has the most relevance. The goal of which is to ensure each family can access the education and care their child needs. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the Page 3 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35859 implementation of this project, i.e. seniors, youth, disabled, low-income, etc. Our project will serve Dublin families with children younger than eight years of age, as well as their educators (school, agency and childcare center). Our screenings and assessments are sensitive identifying the signs of behavioral and developmental disorders including: Autism Spectrum Disorder, Pervasive Developmental Disorders, Asperger's, PDD-NOS, Attention Deficit, Developmental Speech or Language Disorder, Auditory Disorders, Apraxia. More importantly, it allows parents to access care, no matter a diagnosis. Families with a child suffering from a behavioral or developmental disorder will benefit on many levels. They will get answers, fast, at no cost. They will gain access to care and assistance navigating resources. Perhaps most significantly, in the case when early intervention is instituted because of the screening, the benefit is a lifelong impact for the child, and their family. Dublin schools, agencies and childcare centers benefit by increasing their capacity to support all children. Through this program, the tools are in place to both identify delays early, access care, communicate progress, and create an inclusive environment which brings out each child’s true potential. Dublin truly maintains it’s All-American City status, on the cutting-edge of education and pediatric services, setting the bar for creating inclusive environment for children, and instilling tolerance and acceptance community-wide. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? Our experience providing screenings and trainings throughout Fremont, San Jose, Oakland and Pleasanton, has made our organization acutely aware of how to best adapt our Phases for the population served. Once we have a firm understanding of the educators’ challenges and needs, we develop a timeline together for the Phase and discuss the process. Through that process, we identify necessary language formats of the screening tool and resource material. These are accommodated through partnerships with agencies such as Child Care Links/First 5. To address any cultural sensitivities and potential communication issues, we have developed a volunteer Family Buddy program which matches volunteers of the same language, to translate and escort the family through every step of the screening. . 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? Families with children with disabilities, especially limited English speakers, face extraordinary challenging accessing care for their child. It’s for this reason we partner with schools and agencies in the community which serve these children and offer our services, at their location. By delivering our programs in partnerships with their trusted resource, we can work together to ensure our service in a format that truly addresses their needs. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Our Project is a true partnership, engaging compatible agencies involved in, and serving early childhood education. In the Tri-Valley, Pediatricians and clinicians from Sutter, Palo Alto Medical Foundation, Kaiser and Valley Care donate their time to participate in our multi-disciplinary screenings. The Department of Developmental Services agency, Regional Center East Bay, is an consistent presence at our screenings, providing onsite guidance and access to care for qualifying families. Uninsured families have the support of Axis Community Health, which assists them in obtaining medical assistance. Child Care Links, 4 C's of Alameda County parnter to provide support and additional resources. Parents Helping Parents is a trusted resource, providing a connection to others who have walked the same journey. Becton Healthcare Resources donates its services to assist families access their existing health benefits. Alameda County/Help Me Grow features an evolving database of available resources for 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. In years past, we've reached families in need TV, radio and newspaper, hyper-local media like the Patch and Weekly. With the overwhelming demand as of late, we find our relationships, grassroots campaigning and social media are more than effective enough. Page 4 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35859 We receive consistent support from the following service organizations: Dublin Lions Club/Rotary Dublin-San Ramon Women's Club Dublin-Pleasanton Soroptomists While we enjoy volunteer and funding support from these service organizations, we can also count on their assistance when it comes to reaching Dublin residents with screening and training opportunities. Alameda County Supervisor Haggarty and District Attorney O'Malley have also been wonderful champions over the years. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. This project will implement behavioral/developmental screenings, improving access to care for at-risk children in Dublin. Additionally, the project trains educators and parents to provide cutting-edge care; including the Time Magazine Top 10 Medical Breakthrough for the treatment of autism/behavioral disorders. Dublin residents are served greatly by this project as it: "Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities." The mission of the screening and training project is to improve the quality of life for children with behavioral/developmental disabilities. We are creating safe and secure environments and equipping the community with the tools to include and serve all children. "Balance history with progress, to sustain an enlightened, economically balanced and diverse community." A diverse community means that children with disabilities are included, not segregated. Through this, many wonderful things happen. The progress of children with disabilities soars; the cost of their care plummets and typical peers become enlightened, empathetic and compassionate. "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 mutual benefit" Each year, we partner with programs throughout the Tri-Valley, reaching children in need outside of Dublin, and leveraging the relationship in our neighboring communities. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. We have put together a financially efficient program by teaching Educators and Parents to utilize the online screening tool for the initial screening, using a very small Team to implement multidisciplinary screenings, training programs and classroom observation and follow-up for children that have developmental challenges. By providing a multidisciplinary screening, parents get a direct roadmap to the services that their child needs from a Team of Specialists looking at all areas of development instead of paying for multiple assessments to get the answers they need. The Educator Training Program gives teachers information regarding all types of developmental challenges and offers specific strategies as to how they can best support each child. Generally, unless a child is already receiving some type of therapy and the therapist comes into the classroom and trains them, the educator does not get this type of information or strategies. Educators can take a class at a Community College but they are offered only occasionally and cost between $200-$300 per student. Parent Training programs are also difficult to access and, unless their child is receiving services, parents do not have access to the training. Overall, this program is very unique and very cost effective for families and schools. The cost of Clinical Assessments by trained providers can range from $400-$1200 per child depending upon the type of assessment and the costs of therapy range from $120-$140 per 1 hour session. This program streamlines the assessment process, offers resources and training that are generally inaccessible and continued support that is not generally offered to Early Educators or Parents unless a child is receiving therapy services. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If this application does not receive funding, we will have to focus our efforts building the capacity of programs in our neighboring cities. While the parent's will find a way to get their children to another city for an inclusion program to help their child, we need more options in our hometown, the All-American City of Dublin. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes Page 5 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35859 No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A Page 6 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35859 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. Page 7 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35859 End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Page 8 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35859 Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) TOTAL Page 9 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35859 0.00 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" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). Our program is currently self-sufficient at our Dublin campus. The City's support allows us to serve others in the community, and is leveraged by our corporate, foundation and agency partners, who are invested in sustaining the Screenings and Trainings Budget Funding Sources/Revenues Budget Amount Amount Committed Alameda County- Early Start Denver Model Certification USD$ 50,000.00 USD$ 50,000.00 City of Pleasanton USD$ 5,000.00 USD$ 5,000.00 Chevron Corporation USD$ 5,000.00 USD$ 5,000.00 Dublin Lions Club USD$ 1,000.00 USD$ 1,000.00 Page 10 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35859 Safeway Corporation USD$ 2,000.00 USD$ 2,000.00 Insperity USD$ 5,000.00 USD$ 5,000.00 SurveyGizmo Software USD$ 4,800.00 USD$ 4,800.00 Microsoft USD$ 7,000.00 USD$ 7,000.00 Total USD$ 79,800.00 USD$ 79,800.00 Funding Uses/Expenses Budget Amount Amount Committed UC Davis Mind Institute- ESDM Training USD$ 50,000.00 USD$ 50,000.00 Pleasanton- CAPE Preschool Screenings and Trainings USD$ 5,000.00 USD$ 5,000.00 Background Checks Volunteers- Insperity USD$ 2,000.00 USD$ 2,000.00 Copies, Printing, Shirts, Food for families, Supplies and Equipment USD$ 11,000.00 USD$ 11,000.00 HIPPA Compliant Screening Software/Platform USD$ 4,800.00 USD$ 4,800.00 Volunteer meals, facility cost, security USD$ 7,000.00 USD$ 7,000.00 Total USD$ 79,800.00 USD$ 79,800.00 Budget Narrative School of Imagination flagship program is staffed by a Team of Clinicians and Educators that serve the needs of the children within the program who are children with Special Needs as well as typically developing. We provide an Inclusion Preschool program for 120 children and various therapy programs for approximately 220 children each week. Nearly 80% of the program budget goes towards payroll costs for our Educators and Therapists as each of the programs we provide are offered in a 1:1 model or a low student to teacher ratio model in classrooms. Standard range of pay for Therapists is between $60,000-$90,000 per year with Teachers and Teaching Assistants ranging from $30,000-$40,000 annually. We are very light on administrative costs and are self-sustaining for the programs we run (we don’t rely upon grants/funding to sustain). Donations that we receive are assigned to our scholarship program for children who cannot afford our services and new programs that we develop. The Happy Talkers Screening and Training Program is an additional program that would allow us to spread our methodology to local preschools to support the children that come to them with developmental challenges. By providing an online screening tool, multidisciplinary screening services, direct referral for resources and educator and parent training we would be able to achieve our goal of helping more children, families and Early Childhood Educators. The costs associated with the program are to provide the Clinicians to implement the screening and training program. The hourly rate for clinicians is $120. With the proposed program we can use our clinicians in various ways to provide the review of the online screening results, provide the multidisciplinary screening and referral services and most importantly train the educators and parents. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Program Expense Budget Financial Information Form for ALL Grants download template Financial Information Form List of Board of Directors (or governing body) with contact information List of Board Members Current Annual Budget for the Entire Agency Current Annual Budget for the Entire Agency Copy of most recently submitted IRS 990 form or Tax Return (include complete form) 990 2013 State Tax Return 2013 Federal Tax Return (download) Board of Director's (or governing body's) designation of authorized official Board Authorization 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 Workers Compensation General Insurance REQUIRED FOR CDBG ONLY-If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) Page 11 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35859 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 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35859 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 12 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35859 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Senior Support Program of the Tri-Valley's mission is to provide in-home services to seniors fostering independence, promoting safety and well being, preserving dignity and improving quality of life. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Senior Support Program of the Tri Valley Case Management Senior Support Program of the Tri Valley 5353 Sunol Blvd Pleasanton, CA 94566 United States Tel: (925) 931-5378 Fax: (925) 931-5391 Web: ssptv.org EIN: 20-3225569 DUNS: 19-4024761 Project Contact Marlene Petersen mjcpetersen2002@yahoo.com Tel: 925-931-5378 Additional Contacts nalbrecht@ssptv.org Executive Director Marlene Petersen mpetersen@ssptv.org USD$ 11,646 Requested Submitted: 12/11/2014 11:49:17 AM (Pacific) Application Questions Page 1 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35737 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 (SSPTV) has managed contracts for over 3 years. As a 510c3, we have held and managed Private, Foundation, City and County grants and contracts since 1981. We successfully managed the responsibilities and regulations of these various grants. We currently have 20 employees (19 part-time) giving us collectively over 160 years of employment with SSPTV. The years of education and experience from reliable staff members, compliance with contract parameters, accurate record keeping, timely reports and billing, a strong Board of Directors and Executive Director, and open lines of communication between the service providers and funders are vital ingredients in contract management qualifying SSPTV for this project. SSPTV contracts with Bay Valley Accounting Professionals for accounting and payroll services. SSPTV’s Board of Director’s Finance Committee meets monthly with our Executive Director and its accounting firm to review all fiscal activities and proposed expenditures. The fiscal committee reports monthly to the Board of Directors. The system of checks and balances we adhere to protect the funds awarded to SSPTV. SSPTV has an active, “hands on” board of Directors. Our Board President formerly worked in the geriatric field. The head of our Fiscal Committee is a CPA and has experience managing large contracts. Other board members, including 2 former Livermore Commissioners, are professionals from government, agriculture, medical and business sectors. The accounting firm we contract with, Bay Area Accounting Professionals, manages large accounts in addition to ours and has experience working in nonprofit bookkeeping practices. SSPTV has an annual audit prepared by Hernan Puentes and Associates. Within this audit, our internal controls and protocols are reviewed and approved in accordance with auditing standards generally accepted in the United States in addition to the standards applicable to financial audits contained in 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. The Case Management Team develops individual plans, implements, coordinates, monitors and evaluates the options and services required to meet seniors’ health and human service needs, promoting quality and cost effective interventions and 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.) 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? 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 None of the above 11. Explain how this project will be implemented, administered, and operated. Senior Support (SSPTV) has been providing services to Tri-Valley seniors since 1981, 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 then. Referrals for Case Management come from a variety of sources, including private citizens, police/fire departments and Page 2 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35737 medical discharge planners. This is one of the most important services a senior can receive, as we provide them with a comprehensive and practical plan identifying available resources for their many needs. Every case is monitored on an on- going basis. The Case Managers for this project have been employed with SSPTV collectively for over 18 years. They have a variety of backgrounds, both educationally and practically in health and social services. They are directly supervised by the Executive Director. Weekly Case Management meetings are facilitated by the Executive Director. Trained volunteers are used for clerical duties and phone monitoring of clients. Billing and payroll services are provided by Bay Area Accounting Professionals. Annual auditing is done through Hernan and Associates. The majority of office supplies and printing/copying are provided through private donations. The process for handling clients has worked successfully in the past. All activity is documented. All client files are considered confidential and are maintained and kept in locked cabinets. Each Case Manager has a computer with Microsoft Office and internet access. Case Management services are provided in the senior's home. If a client should need/desire to come to our offices, we are located in a handicapped accessible office located 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 available to meet with them at the Dublin Senior Center and Dublin Library upon request. 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), 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 Program 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 of the seniors who have received our services. This improvement may be evident in a cleaner living environment, improved nutrition, mobility, and access to mental and medical health services. It may be evident in the fact that the senior has been able to remain at home safely with improved quality of life. It may be 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 that will enable them to maintain their independence, improve their physical and mental health, and remain in their homes with a better quality of life, safety and well-being 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 their progress and modifies the care plan as needed. A good indicator is the improvement in the scores of their activities of daily living and indirect activities of daily living. (ADL's and IADL's) Telephone and daily activity logs are kept by all SSPTV employees to evaluate the effectiveness of program and efficient use of time. All of the components of Senior Support Program of the Tri-Valley are designed to enhance and improve the lives of our senior citizens. Case Management links seniors to services that provide meals, transportation, home care, safety devices, social activities, medical care, access to government benefits, when appropriate and a multitude of other resources. When basic physical, social and emotional needs are met, even in small increments, lives are improved. 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 those living in the greatest economic need, functionally impaired or minority. SSPTV is the only nonprofit agency providing free Case Management to Dublin residents, specifically tailored to senior citizens. We have been serving Dublin's seniors for over 32 years. The benefits of Case Management are the seniors' ability to remain living independently and safely in their own community with familiar surroundings and with an improved quality of life. For instance, we first met Ms. M when her mother, a senior, received case management services. Ms. M was the sole care provider and utilized case managers to complete Medicare paperwork. When Ms. M's mother passed, she became depressed and anxious about her living situation; she could no longer live in her mom's home. A case manager was able to help Ms. M find low-income housing in Dublin, get hired working a part-time job, and provide numerous referrals/resources, such as a scholarship Ms. M received to ride Wheels. With ongoing case management, Ms. M has become independent again. In order to better navigate the ups and downs in her life, Ms. M was also referred to SSPTV's counseling program. Ms. M feels secure again in her life, enjoys attending luncheons at SSPTV and has even started volunteering. We have the unique opportunity to refer clients, like Ms. M, requiring mental health services to the Licensed Marriage and Family Therapist on the Senior Support Staff. Having this essential program is just one of the many senior services we provide on an on-going basis. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? Page 3 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35737 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 Program of the Tri-Valley 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. SSPTV 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 the 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. SSPTV is also able to provide information to Dublin's limited-English speakers through our handouts and brochures that are available in English, Spanish and Chinese. Senior Support staff members are very sensitive to and aware of different cultural needs. We work well with seniors' families and friends to make sure proper services are in place. We are sensitive to the multicultural needs in our community, and our staff participates in training to address the diversity of clients we serve. The majority of seniors served through our program are visited in their homes, where a complete assessment is made of their needs. If they should need to come to the offices, we are conveniently located at the Pleasanton Senior Center in an area that was originally designed for an adult day care program. It is wheelchair accessible and has three handicapped restrooms. It is also on a major bus route with a stop on the street in front of the building. Wheels Dial-A-Ride drops off at our front door. Senior Support also has a volunteer transportation program available to Case Management clients who need transportation in order to access services and resources put into place by the Case Manager. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We are proud to work collaboratively with many organizations and agencies throughout the Tri-Valley and Alameda County. We have established referral procedures between agencies that eliminate delays and confusion. Lines of communication have been established to ensure information and referrals flow between agencies. We have a strong collaboration with Spectrum Community services. A client who needs meals brought to them can have the meals started with one simple phone call. We have partnerships with many faith-based and other organizations that have joined with us to provide home clean-up and support. In our goal to reach the shut-ins in crisis, we developed a strong partnership with the Dublin police department. When they find a senior in crisis, this department will call us. Our case manager responds by working with the client or the family to provide essential services. 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 Screening 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. SSPTV 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 and organized. We have had newspaper articles in the Independent, Pleasanton Weekly and the Valley Times. We have a SSPTV website and our executive director is on Facebook and the professional network “LinkedIn.” 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. SSPTV also works with local community colleges, providing opportunities for student internships and data for research. The interns provide exercise coaching, record keeping, Page 4 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35737 assistance with classes, accounting help, and health screenings. We partner with and are a recipient of Hacienda Park Helping Hands. SSPTV case management is not a standalone program. It is one part of SSPTV's services encompassing In- Home Counseling, Family Caregiver Support, Friendly Visiting, Home Care Worker Registry, same day door-through-door Senior Transportation Program, Exercise & Nutrition Programs, Partners in Safety, Health Services, alcohol and other drug prevention, and Information and Referral Service. All of these services are available to Dublin senior citizens. With the diversity of programs and staff backgrounds, there is constant collaboration within our organization as we work to meet the needs of older adults effectively and efficiently, ultimately improving their quality of life. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. SSPTV will provide case management services for 57 Dublin senior citizens (consisting of 21 full and 36 one-time case management services). This project meets the City of Dublin’s mission/vision to “promote and support a high quality of life which ensures a safe and secure environment that fosters new opportunities." Case management brings resources, services and referrals that help the senior achieve maximum health, mobility, safe environment, and socialization. Educating seniors on the local opportunities available is essential. Ultimately, each senior we serve will realize their full potential and choose to participate in activities that will give them confidence and encourage them to continue to be involved and viable in the Dublin community. 20. BUDGET NARRATIVE Describe how this project 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 21 clients with complete case management services would cost $10,500. The agency also responds to approximately 500 information and referral calls per year and serves at least 36 one-time service clients, requiring a case manager to gather information and offer limited coordination of services. These costs, compared to an average of $90,000 per year per client for institutionalization, that often becomes the taxpayers’ responsibility, are very cost effective. Senior Support strives to keep costs at a minimum. We are grateful for the many volunteers who assist with office support and telephone reassurance. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? The demand for services already exceeds our capacity level to provide them, making it necessary to prioritize services to those most at risk. We will continue to provide very limited Case Management to Dublin seniors as allowed through our Area Agency on Aging funding. If full funding is not received, we will have to reevaluate the number of seniors that will be served. However, if no funding is received we would only be able to serve approximately 15 seniors with the funds we receive through our Case Management Program funded by the Area Agency on Aging. These are not counted in the 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 31 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 be 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 county to provide these monies. We continually look for volunteers from the community to expand our services. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A Page 5 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35737 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. SSPTV 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. SSPTV 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 Page 6 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35737 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 where 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: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Page 7 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35737 Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Page 8 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35737 Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: 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". 10 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) 47 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled 39 Female Headed Households 57 Senior Youth Page 9 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35737 Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 153.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" 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) 57.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). SSPTV 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. Budget Funding Sources/Revenues Budget Amount Amount Committed City of Pleasanton (In-Kind space/utilities) USD$ 66,000.00 USD$ 66,000.00 Area Agency on Aging(Tri Valley) USD$ 31,466.00 USD$ 31,466.00 Page 10 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35737 City of Livermore USD$ 10,500.00 USD$ 10,500.00 City of Pleasanton (Case Management) USD$ 31,674.00 USD$ 31,674.00 Total USD$ 139,640.00 USD$ 139,640.00 Funding Uses/Expenses Budget Amount Amount Committed Marlene Petersen/.01% USD$ 1,173.00 Luz Saldana/16% USD$ 7,106.00 Lucy Morgan .0666% USD$ 3,367.00 Total USD$ 11,646.00 USD$ 0.00 Budget Narrative All funds will be used for Direct Services Luz Saldana is case Manager and bilingual . Lucy Morgan is a case Manager/nurse Marlene Petersen is The Director has been with the agency 30years, also works as case manager as needed Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template financial expense budget Financial Information Form for ALL Grants download template Financial Information for all Grants List of Board of Directors (or governing body) with contact information Board of Directors Current Annual Budget for the Entire Agency annual 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 Designation 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 Endorsement (Page 06) 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 agency audit REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. Articles Part 01 Articles Part 02 Articles Part 03 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 501C3 Limited English Page 11 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35737 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35737 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 12 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35737 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). We are a non-profit agency with a mission to support low-income, disadvantaged families, individuals, and elderly residents of Alameda County in their efforts to improve self-sufficiency and the overall quality of their lives. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Spectrum Community Services Meals on Wheels for Dublin's Homebound Seniors Spectrum Community Services 2621 Barrington Court Hayward, CA 94545 United States Tel: (510) 881-0300 x222 Fax: (510) 537-3340 Web: www.spectrumcs.org EIN: 94-1748275 DUNS: Project Contact Samantha Finkelstein sfinkelstein@spectrumcs.org Tel: (510) 881-0300 ext. 222 Additional Contacts lcalvert@spectrumcs.org Executive Director Lara Calvert lcalvert@spectrumcs.org USD$ 8,500 Requested Submitted: 12/11/2014 3:16:05 PM (Pacific) Application Questions Page 1 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36107 7. Please provide information to justify your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). Every year, Spectrum works with over 11,000 individuals and families in Alameda County, and our multiple programs have developed in response to real needs in the community. Spectrum’s programs include Home Weatherization and Energy Assistance, Fall Prevention Program, and our Senior Nutrition Program. Spectrum employs 55 paid staff and manages an operating budget of approximately $4.7 million. Our ability to manage our financial resources effectively and to respond to the changing needs of the community is reflected in our history of growth and service. A 501(c)(3) non-profit, Spectrum is governed by a Board of Directors drawn from the jurisdictions we serve, ensuring that organizational policy reflects the diversity, character and needs of the communities we serve. Since 1978 Spectrum has prepared and delivered over 3.9 million meals to elderly residents throughout Alameda County. Today, our Senior Nutrition Program provides over 450 congregate meals and over 125 home-delivered meals per day - over 100,000 each year. Spectrum maintains rigorous oversight of financial resources in order to meet federal, state and county reporting requirements. Our infrastructure (facilities, equipment, and staff) is stable, and with it the capacity to successfully manage and operate the Meals On Wheels program in the Tri-Valley, serving Dublin, Livermore, Pleasanton, and Sunol. Spectrum’s Senior Nutrition Program is monitored by the County Area Agency on Aging, whose annual monitoring visits provide important feedback to project management as staff continue their quest for excellence, continuing to provide service while being cheerful, and committed to their routes. Spectrum consistently provides high quality, nutritious food to Dublin seniors who are most in need on a daily basis. 8. Provide a brief summary of the project for which your agency is seeking funding (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. Meals on Wheels provides a vital service of 4,500+ meals to over 45 homebound seniors in Dublin, without which nutritional status and quality of life may suffer. Spectrum is requesting funding to cover mileage, personnel costs in order to continue providi 9. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED: client is counted only once regardless of number of services received in a year.) 45 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. Spectrum’s Meals On Wheels program seeks to maintain or improve the wellbeing of frail, homebound Dublin elders by providing them with nutritious meals for specified dietary restrictions, as well as regular safety checks. Under the direction of our Senior Nutrition Program Manager, Spectrum will begin on July 1, 2015 and will deliver at least 4,500 meals to frail homebound seniors residing in Dublin for 365 serving days through June 30, 2016. The Meals on Wheels Coordinator personally visits Dublin seniors to assess needs and determine eligibility. If eligible, the Page 2 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36107 coordinator then modifies the delivery route and schedules delivery days as needed. Five days a week (excepting thirteen holidays) the Meals On Wheels driver will pick up individually packaged meals prepared at Valley Care Hospital and deliver them to elderly clients. Records of daily routes, delivery, mileage, food safety measures, client feedback, etc. are maintained daily and collected for quality assurance and reporting by program staff. The home-delivery driver is often the only person who sees the senior that day, and is thus an important component of the client’s safety net. Drivers are trained to observe physical and environmental changes that might indicate need for other support services or assistance, and report those changes to the MEALS ON WHEELS Coordinator, who will connect the senior with appropriate services provided by our cooperative partners including Alameda County 2-1-1 and the Senior Support Program of the Tri-Valley. Spectrum has worked hard to maintain a high standard for our senior nutrition program. We are monitored annually by the Alameda County Area Agency on Aging in areas of: food sanitation, safety, preparation, performance, and client satisfaction. The outcomes of the monitor visit are submitted to the Program Manager, Executive Director, and Board. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). Dublin Community Grant funds will make it possible for Spectrum to serve the increasing number of Dublin's elderly homebound residents who need home-delivered meals. Grant funds will ensure that Spectrum's Meals On Wheels program will respond to new requests and will not be forced to start a waiting list. Specifically, grant funds will help to cover 1) the mileage for one route, estimated to be 6,000 miles a year at a reimbursement rate of $0.56 per mile, 2) a portion of the part- time salary and benefits of the Meals On Wheels Delivery Driver who covers that route, two hours each weekday, and 3) a portion of the part-time salary and benefits of the Meals On Wheels Coordinator. The dedicated Dublin route that will be supported by Dublin CDBG funds allows us to reach Dublin residents no matter where they live, ensuring that the Meals On Wheels service is accessible to seniors in Dublin who need it. Spectrum’s Meals On Wheels program serves adjacent Tri-Valley cities of Pleasanton and Livermore, and, depending on the location of clients in need, our Meals On Wheels routes in those cities often include parts of Dublin. The resulting comprehensive coverage enables us to consistently provide a key component of the preventative health care and supportive services that frail Dublin seniors need to continue living in their own homes. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? In the grant year, over 45 frail, homebound Dublin seniors will receive over 4,500 freshly prepared, nutritious meals and safety checks. In addition, Spectrum’s Meals On Wheels Coordinator will connect clients to community-based senior support services as needed. Together, these benefits will have a direct and lasting positive effect on the health and well-being of our homebound frail senior clients. We maintain daily logs of meals delivered and clients served, and spreadsheet the data for monthly reports to our government funding sources. In order to achieve our primary goals, quality assurance and client satisfaction are critically important. Quality measurement and evaluation are ongoing activities. Weekly reviews of operations and meals served ensure that management and administration identify and correct any potential production or delivery problems before they become significant. The Senior Nutrition Program Manager and Program Assistant welcome telephone calls from senior clients and families, and field several calls weekly. They contact the Meals On Wheels Coordinators each week for updates, and connect with drivers several times a week. All suggestions are reviewed by the Program Manager, Samantha Finkelstein, RD, and if needed, appropriate action is taken. We also distribute client surveys once a year, giving seniors an opportunity to comment and give feedback about meals, service, and quality. Spectrum is monitored annually by the Alameda County Area Agency on Aging in areas of: food sanitation, quality, safety, preparation, performance, and client satisfaction. The outcomes of the monitor visit are submitted to the Program Manager and Executive Director. Spectrum consistently earns high marks for high standards in food quality, delivery system and program operations. We expect to achieve this same high level of excellence during the grant year. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. Virtually 100% of Meals On Wheels clients in Dublin are functionally impaired, unable to perform such essential activities as dressing, bathing, cooking, shopping, household chores, etc. More than half (70%) are age 75 or older. Spectrum exceeds the CDBG national objectives of “at least 70% of the program’s participants must have low or moderate income”: 30% of homebound Dublin seniors served by Spectrum are extremely low-income; 70% are very low – low income (based on HUD guidelines). The seniors served by Spectrum’s Meals On Wheels program is a special needs group that is isolated because of homebound status and tends to be poorer, older and frailer than most of Dublin’s senior. Spectrum’s Meals On Wheels program serves a population slightly more diverse than the senior population of Dublin. Over the last year, our client population has become even more diverse, and we anticipate that the population served in the grant year will be 70% white, Page 3 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36107 10% Hispanic, 5% Asian, 10% African American. Thus, Dublin’s homebound seniors who qualify for and utilize the Meals on Wheels program will benefit from regular safety checks, consistent interaction with MEALS ON WHEELS drivers and volunteers, while benefiting from the preventative measures of the nutritious meals served by the program. The subsidized meals help ensure that those struggling to make ends meet do not need to sacrifice good nutrition. For those recuperating from a hospital stay, the assistance and regular meals help them recover sooner and return to an active life in the community. These benefits combine to improve quality of life and help frail seniors continue living in their homes. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? To accommodate the cultural preferences of our Meals On Wheels clients, the Valley Care Hospital, Spectrum’s Meals On Wheels meal provider, offers both tortillas and rice as a substitute for bread, as well as a vegetarian menu for those who are vegetarian. Valley Care, as our meal contractor, provides special meals for traditional and ethnic holidays. Spectrum maintains a diverse workforce that reflects the communities we serve. Our staff includes workers who are bilingual in English, Spanish, Fijian, Hindi, Cantonese, and Mandarin, and who assist the Meals On Wheels Coordinator and Delivery Driver to communicate with the seniors we serve. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? The provider community is an essential part of our outreach, as health care and social services providers are often the ones who are most aware of a senior’s needs and are the ones who make referrals for the seniors in their care. We will continue to expand our outreach to providers, ensuring that they receive materials and referral information that is relevant to the languages spoken by their clients. Our Senior Nutrition Program staff works together to cultivate connections with faith-based and cultural organizations in the community, and with businesses and community venues where seniors and their families gather. Our congregate dining sites are excellent referral sources for the Meals On Wheels program, and the Dublin Senior Center, provides an important connection with the community. We outreach regularly to the Chamber of Commerce, the public library, senior housing facilities, churches and business establishments that seniors frequent. We have been extending our outreach in Dublin. Our Meals On Wheels Coordinator is making contacts with local newspapers and on-line community newsletters, as well as seeking cable and radio public service announcement spots. We will continue these activities in the 2015/16 grant year. With a stronger presence in the community, in the 2015/16 grant year, we will begin 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: Valley Care Health System – Provides the meal and packing of the home-delivered meals, Spectrum provides all the administration and delivery. Valley Care Hospital’s discharge planners work closely with Spectrum’s Meals On Wheels Coordinator to ensure that meal delivery is in place for seniors leaving hospital. Kaiser Permanente Medical Facility in Livermore - A referral source for the Meals On Wheels program. Senior Support Program of the Tri-Valley – Provides a broad range of social services and care management for Spectrum’s participants, and makes referrals regularly to the Meals On Wheels program. Alameda County Area Agency on Aging – Provides countywide services and an 800 assistance line and is the contractor with Spectrum’s Congregate meals and Meals On Wheels to seniors. City of Dublin Senior Center - Provides a venue and opportunities for Spectrum to increase awareness of senior nutrition and the Meals On Wheels program. Alameda County 2-1-1 - Provides a wide access to community services in Alameda County. Spectrum’s coordinated service network enables the Meals Coordinator to effectively provide access to needed supportive services such as the Senior Support Program of the Tri-Valley. In addition, seniors are often referred to Spectrum’s own Low-Income Home Energy Assistance Program (LIHEAP) and Weatherization services. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. Spectrum’s community outreach program has built awareness of the Meals On Wheels program among seniors, their families, and the Dublin community. Meals On Wheels program staff have worked closely with Dublin's Senior Center for many years, where our staff make announcements and educational presentations several times a year regarding senior nutrition and the Meals On Wheels program. We have regularly reached out to connect and to distribute our Meals On Page 4 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36107 Wheels brochures at local physicians and social services, the Chamber of Commerce, the public library, senior housing facilities, churches and business establishments that seniors frequent. Each delivery driver has a magnetic sign on his or her car, which helps to identify our staff and volunteers and promotes our program on the delivery routes. The magnets include our program name and phone number. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. Meals On Wheels programs that deliver meals to frail homebound seniors living in the community promote and support quality of life and ensure a safe and secure environment for those seniors. But more than that, a community that sustains a Meals On Wheels program is a community committed to protecting its most vulnerable members. Dublin is demonstrating responsiveness to the needs of the community in remaining committed to ensuring the safety and well-being of homebound seniors. Meals on Wheels helps achieve this by providing both nutritious meals, consistent human interaction, and regular safety checks for the people who utilize the service. Responsiveness to community needs is of primary importance to Spectrum as well, and this program supports Dublin’s value to encourage collaboration and communication with other communities on issues of mutual concerns, as our services span across the Tri-Valley area. Additionally, we distribute client surveys, giving seniors an opportunity to comment and give feedback about meals, service, and quality. The survey is available in English, Spanish and Chinese. The Senior Nutrition Program Manager welcomes and invites communication from senior clients and family, referral sources and partner agencies. All suggestions are reviewed in a quality improvement process, and if needed, appropriate action is taken. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. With a $8,500 grant from the City of Dublin, Spectrum’s Meals On Wheels Program will deliver over 4,500 meals to more than 45 homebound Dublin seniors in FY 2015-2016. This funding will ensure that Spectrum will be able to respond directly to requests for Meals On Wheels service without starting a waiting list. Our proposed budget is based on actual program costs and we are not asking Dublin to cover the cost of the meals, administrative overhead or other indirect costs. While gas prices fluctuate, our reimbursement rate for the Meals On Wheels Driver’s mileage remains steady and predictable. Spectrum has been dealing with 25% increases in minimum wage over the last 18 months, since the last increase to $9.00 per hour, effective July 1, 2014. We are now preparing to accommodate the upcoming wage increase to $10 per hour, which will come into effect on January 1, 2016. Our staff costs remain very low, in part due to the stability of Spectrum’s dedicated workforce and an exceptional safety record. Government and private funding sources cover only a portion of the operating expenses. Given the constraints that Alameda County’s Area Agency on Aging Title III-C and USDA funding imposes on the operations of the Senior Meals Program, Spectrum has become adept at leveraging these funds to maximum efficiency. We feel this cost-effectiveness is evident in the attached budget. Title III asks for client donations. We request a voluntary $3.75 donation, and the cost of one meal is about $9.42. Given the limited resources available to many of our Dublin clients, they are often unable to provide the suggested donation. This makes it extremely difficult to continue providing the services that these members of our community so clearly need. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Over the last few years, the number of elderly homebound Dublin residents accessing Spectrum's Meals On Wheels program has grown, from 35 seniors in Fiscal Year 2010-11 to 57 thus far for Fiscal Year 2014-15. Without the funds to cover salaries and mileage, it would be extremely difficult to serve the low-income, homebound Dublin seniors who need Meals On Wheels. Without adequate funding, Spectrum may be forced to cap services and maintain a waiting list for new applicants for Meals On Wheels. We ask the grant committee to consider the impact that the loss of this life-sustaining service will have on seniors who find themselves homebound, unable to prepare meals or shop for food. Without accessible Meals On Wheels service, homebound seniors recuperating from an illness may be at risk of re-hospitalization, and frail elders with chronic conditions and/or mobility limitations may not be able to receive the nutrition they require. If this service is lacking, it also puts Dublin’s homebound seniors at risk for decreased quality of life and increases safety risk. The proposed funding will enable Spectrum’s Meals On Wheels program to be responsive to the needs of vulnerable seniors in the Dublin community. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes Page 5 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36107 No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. Spectrum performs an annual language survey of staff, volunteers, clients, and community, making note of any gaps and Page 6 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36107 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 use the Language Directory so that, should the need arise, a fluent speaker from another department can assist. Our goal is that all clients and prospective clients and their families have access to Spectrum services in the language in which they are proficient, that they are treated with respect and that their questions are answered in a timely fashion. 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Page 7 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36107 Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Page 8 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36107 Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: 45 42. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients your agency anticipates serving in each category. "If none, please enter "0". 40 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) 17 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) 1 Disabled N/A Female Headed Households 55 Senior Page 9 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36107 0 Youth 0 Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 113.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" 34 White 6 White + HISPANIC 6 Black/African American 0 Black/African American + HISPANIC 3 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 4 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 53.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). In this partnership with the City of Dublin, we are doing what is within our power to fund the Meals on Wheels program. Given the increase in wages, we are attempting to utilize more volunteers rather than paid staff. We will, however, always require some Budget Page 10 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36107 Funding Sources/Revenues Budget Amount Amount Committed USD$ 0.00 USD$ 0.00 Total USD$ 0.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries USD$ 4,407.00 Benefits USD$ 918.00 Mileage USD$ 3,175.00 USD$ 0.00 Total USD$ 8,500.00 USD$ 0.00 Budget Narrative The Meals on Wheels Home Delivery Coordinator is key to our program by registering seniors and ensuring meals are delivered every day. The additional Meals on Wheels Home Delivery Driver will enable us to expand the number of Dublin seniors we serve. Mileage is needed to reimburse both paid and volunteer drivers. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Program Expense Budget Financial Information Form for ALL Grants 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 Current 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 Authorization 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 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 Employee Handbook REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS" SECTION June 2014 Financial Statement REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. Articles of Incorporation Bylaws REQUIRED FOR CDBG ONLY- CONFLICT OF INTEREST STATEMENT (IF NOT INCLUDED IN BYLAWS) Conflict of Interest Stmt REQUIRED FOR CDBG ONLY-ORGANIZATION CHART Organization Chart STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER Determination Letter REQUIRED FOR CDBG ONLY- AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to Language Access Plan Page 11 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36107 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 36107 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 12 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36107 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). 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? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Tri-Valley Haven Tri-Valley Haven's Domestic Violence Services Program Tri-Valley Haven 3663 Pacific Avenue Livermore, CA 94550 United States Tel: (925) 449-5845 x Fax: (925) 449-2684 x Web: www.trivalleyhaven.org EIN: 94-2462357 DUNS: 834704538 Project Contact Irina Milinevskaya irina@trivalleyhaven.org Tel: (925) 449-5845 Additional Contacts none entered Executive Director Ann King ann@trivalleyhaven.org USD$ 8,000 Requested Submitted: 12/9/2014 1:23:37 PM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35904 7. Please provide information to justify your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). Founded in 1977, Tri-Valley Haven is the premier provider of shelter and support services for victims of domestic violence, sexual assault, homelessness and hunger. What began as a crisis hotline run out of a founding Board Member’s garage, the Haven has grown to be the most comprehensive safety net program in the Tri-Valley. Today our programs include: Shiloh, our 30 bed domestic violence safe house, 24/7 crisis hotline for domestic violence and sexual assault, Rape Crisis Center, Violence Prevention Education, Legal Clinic, Individual and Group Counseling, Sojourner House 16 Bed Family Shelter, Food Pantry, Parenting Program and most recently a Thrift Store. Notably, both our shelters are the only shelters locally that allow teen boys to stay with their families and our family shelter is the only local shelter to admit two parent families as well as single fathers with their children. Through innovation and dedication, the Haven has developed the resources to confront domestic violence, homelessness and hunger. Tri-Valley Haven's major governing body is the Board of Directors. Each Board Member's term is two years. Our Management team consists of the Executive Director and five managers. Tri-Valley Haven has its own Finance and Compliance Department. All of our Direct Service staff such as Case Managers, Life Skills Instructors etc. are required to have a Bachelors Degree or equivalent life experience. Direct Service staff all complete 65-hour State approved training. 8. Provide a brief summary of the project for which your agency is seeking funding (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. Tri-Valley Haven's Domestic Violence Services Project will provide assistance with DV related issues through Crisis Line and Domestic Violence Shelter. 9. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED: client is counted only once regardless of number of services received in a year.) 65 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. Tri-Valley Haven's Domestic Violence Services Project is an existing project. Our 24-hour Crisis Line is the main point of entry for women seeking shelter. Clients are also referred to us via our website, law enforcement, hospitals, 211, shelter networks, etc. Each client is screened via telephone to assess their safety and their needs, and then, if appropriate, an in- person intake is conducted. Each client is assigned to a Case Manager and a Counselor is made available to her should she wish to participate in counseling. Each adult client participates in groups such as 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?). Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35904 The funds requested from Dublin will be used to pay part of the Bilingual Case Manager's time. This position is essential for the shelter operations since a very large group of our clients is Spanish speaking and many are monolingual. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? Expected outcomes are mainly defined on a case-by-case basis according to goals set between the case manager and client. Case management is client centered and safety focused. Some goals are as simple as developing a safety plan or getting a California I.D. and some as labor-intensive as finding housing or employment. Some clients may stay at the Shelter for as little as two weeks if all they need is a safe and stable environment as they prepare to relocate to another city or state. Others may take the entire 105 days to find affordable housing, participate in job training or gain employment. Some may be focused on reuniting with their children through completing their CPS Plan. Whatever their goal may be, our clients receive domestic violence counseling, Life Skills classes, individually tailored case management and referrals to a range of community based services to help them increase safety and security. Tracking the progress toward clients' goals is performed by each individual's case manager during weekly meetings with clients. Progress is also monitored at weekly staff meetings during case review. Additionally Haven's case managers and counselors meet together once each month with the Clinical Supervisor to share ideas and suggestions. We cannot express enough the importance of having a Bilingual Case Manager to fully communicate with our Spanish speaking clients. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. Our target populations are women survivors of Domestic Violence and their children. We serve male survivors with all available services at the Community Building. Motel Vouchers are available for them through the ESTA (Emergency Shelter and Transportation Assistance) program. Our ultimate goal is that upon completion of our program a client at a very minimum will have a safety plan for herself and children, and also will develop goals and a plan of action towards achieving self-sufficiency. Clients will be equipped with information on how to establish healthy relationships and increase self-esteem and gain awareness of resources in the community. Last year our Domestic Violence Services Program served 267 survivors at the Shelter including 1 Dublin resident, and responded to 1470 domestic violence related calls to the crisis line (90 DV related calls from Dublin). This year so far 4 domestic violence survivors from Dublin have been served at our DV Shelter and 35 callers used the Crisis Line. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? TVH is very proud to have multi-cultural staff members and volunteers who utilize their cultural backgrounds to enhance the services we provide. Both staff and volunteers actively participate in the Diversity trainings. We presently have staff fluent in Spanish, Russian and French. Multi language fluency is always a consideration when hiring, and wage differentials are given to those fluent in Spanish since a lot of our clients are Spanish-speaking. All of our intake forms and flyers are in English and Spanish. In the last four years Tri-Valley Haven participated in the Cultural Competence development projects. The first project was focused on serving the needs of African-American community and the second one on serving the needs of Asian/Pacific Islander community. In our hiring process we ask potential employees to talk about their commitment to and experience in developing cultural competency. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? We conduct regular Outreach efforts through many of the programs Tri-Valley Haven offers as well as through other community resources. These internal programs include our Food Pantry, 24-hour crisis line etc. Tri-Valley Haven's Holiday Warehouse Program for low-income families from Tri-Valley area brings new participants every year. In fact, 268 Dublin residents signed up for the Program this year. Tri-Valley Haven participates in community health fairs and outreach events such as St. Patrick's Festival (when available) etc. TVH staff maintains a good working relationship with CRIL, a local service provider for persons with disabilities and also is aware of key services such transportation for persons with disabilities and how to access them. Entrances to all Tri-Valley sites are clearly marked. Telephone screenings and in-person intake processes include questions about needed accommodations (such as a bottom bunk, private room or special dietary needs). 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We have Operational Agreements with over 60 organizations including Police Departments from Livermore, Dublin and Pleasanton, District Attorney's Offices, schools, 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. The most recent one is with the help and support of the City staff we are setting up a Cal-Fresh enrollment at the Dublin Library, Dublin Senior Center and possibly at the Affordable Housing Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35904 Sites. Additionally we have always been using the St. Patrick's Festival as an opportunity to introduce our services and the work that we do to as many Dublin residents as we can when available. We conduct presentations to the Dublin Police Department on the Domestic Violence, Sexual Assault and Homelessness issues and the programs that Tri-Valley Haven offers. This year we also conducted a presentation for the Dublin school district on antibulliyng. Our Community Education program reaches over 500 Dublin High school students. We also run a "BeStrong" Girl's Club at Dublin High that will be presenting an awareness event on teen dating violence in February. And last, but not the least, this year 268 Dublin residents will be served through the Holiday Warehouse Program in Livermore. This Program is helping low and very low income families in the Tri-Valley area to prepare Thanksgiving dinner and shop for holiday presents for their loved ones. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. The core of Tri-Valley Haven's Domestic Violence Services Program is Shiloh, a 30 bed emergency shelter in a confidential location. Shiloh provides a safe haven and comprehensive services to survivors of family violence. This 30-bed program enables participants to stay for a maximum of 105 days. Shiloh accepts single women and women with children. Our 24-hour Crisis Line is the main point of entry for women seeking shelter. Potential residents are also referred via our website, the National Hotline, law enforcement, hospitals, 211, community referrals and outreach events. Callers requesting shelter undergo a screening process where staff evaluates the safety and appropriateness of the program. We recognize that this is a critical time for a woman fleeing violence and this is when she is most likely to return to her abuser. In response to this, staff checks in with clients daily to help them with safety planning and respond to their concerns. DV Program offers weekly counseling for both the survivor and her children. The following groups are available each week: Parenting, Domestic Violence Support, CalWORKS Job Readiness, Life Skills (such as Personal Finance) etc. 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. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Tri-Valley Haven's Domestic Violence Services Program cross-utilizes other TVH 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 help applying for government services such as Food Stamps, etc. Health Services are provided through the Valley Care Mobile Health Unit that we have an MOU with. By utilizing in-house services whenever possible, expenses for outside services are minimized. Use of volunteers is also a major factor in helping hold the costs down. 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. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Since this grant would support our Bilingual Case Manager, a reduction in the hours of this position would result in monolingual clients having reduced access to direct services in their own language, and would require other staff to depend more upon the TeleInterpreters language line for routine client interactions. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35904 Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. The TVH Cultural Competence Plan has instituted a multi-pronged approach to improving services to clients with Limited English Proficiency (LEP). We have staff conversant in Spanish, Russian and French. 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 “TeleInterpretors” phone based interpreters. Our largest LEP client group is Spanish-speaking. Most flyers, client materials and other communications are created in both English and Spanish. We produce and distribute documents in other languages when available. 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35904 Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35904 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, 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 Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35904 occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: 65 (CDBG required statistics will be collected for Shelter residents only. Due to the nature of the Crisis Line, stats such as income level, race etc. are impossible to collect). 42. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients your agency anticipates serving in each category. "If none, please enter "0". 0 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) 4 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) 0 Disabled 4 Female Headed Households 0 Senior 0 Youth 0 Homeless n/a Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 8.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" 1 White Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35904 1 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 n/a Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 4.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). Domestic Violence Services Program budget is intentionally diversified, so losing one potential source would not force us to close the project completely. We actively fundrase and reach out to the corporate and private donors. Budget Funding Sources/Revenues Budget Amount Amount Committed Alameda County Domestic Violence Center Act USD$ 27,795.00 USD$ 0.00 Local Dublin/Pleasanton/Livermore USD$ 31,000.00 USD$ 0.00 HCD Linkages USD$ 39,559.00 USD$ 0.00 CalWORKS USD$ 38,515.00 USD$ 0.00 CalOES DV USD$ 298,152.00 USD$ 0.00 EFSP USD$ 30,000.00 USD$ 0.00 Foundations USD$ 10,000.00 USD$ 0.00 Total USD$ 475,021.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35904 Bilindual Case Manager, 18% of salary and benefits USD$ 8,000.00 USD$ 0.00 Other Program Personnel USD$ 334,808.00 USD$ 0.00 Operating Expenses Supplies USD$ 10,222.00 USD$ 0.00 Printing/Copying USD$ 2,548.00 USD$ 0.00 Telephone USD$ 14,378.00 USD$ 0.00 Rent and Utilities USD$ 21,710.00 USD$ 0.00 Accounting/Audit USD$ 12,231.00 USD$ 0.00 Other USD$ 71,124.00 USD$ 0.00 Total USD$ 475,021.00 USD$ 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. Other Operating Costs include: Maintenance and repair costs, portion of liability, property and auto insurance, travel costs, and administrative costs. 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. There was a notable increase in the Maintenance Expenses compared to last year. Our facilities are old and require a lot of attention in order to keep them running smoothly. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template TVH Program Expense Budget Financial Information Form for ALL Grants 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 Directors 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 Directors 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 Copy of the last 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 Organizational Chart TVH State non-profit determination letter Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35904 STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER TVH 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. TVH LEP policy REQUIRED FOR CDBG- LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35904 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35904 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). 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? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. n/a Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Tri-Valley Haven Tri-Valley Haven's Homeless Services Program Tri-Valley Haven 3663 Pacific Avenue Livermore, CA 94550 United States Tel: (925) 449-5845 x Fax: (925) 449-2684 x Web: www.trivalleyhaven.org EIN: 94-2462357 DUNS: 834704538 Project Contact Irina Milinevskaya irina@trivalleyhaven.org Tel: (925) 449-5845 Additional Contacts none entered Executive Director Ann King ann@trivalleyhaven.org USD$ 10,000 Requested Submitted: 12/5/2014 3:22:11 PM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35682 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 most recently a Thrift Store. Notably, both our shelters are the only shelters locally that allow teen boys to stay with their families and our family shelter is the only local shelter to admit two parent families as well as single fathers with their children. Through innovation and dedication, the Haven has developed the resources to confront domestic violence, homelessness and hunger. Tri-Valley Haven's major governing body is the Board of Directors. Each Board Member's term is two years. Our Management team consists of the Executive Director and five managers. Tri-Valley Haven has its own Finance and Compliance Department. All of our Direct Service staff such as Case Managers, Life Skills Instructors etc. are required to have a Bachelors Degree or equivalent life experience. Direct Service staff all complete 65-hour State approved training. 8. Provide a brief summary of the project for which your agency is seeking funding (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. Tri-Valley Haven's Homeless Services Program will provide assistance with issues related to Homelessness through the Shelter, job readiness/job search Life Skills education and the Food Pantry. 9. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED: client is counted only once regardless of number of services received in a year.) 270 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. Tri-Valley Haven's Homeless Services Program is an existing project. Clients are referred to us via our website, shelter network, 211, Food Pantry, Thrift Store etc. and Tri-Valley families are given first priority. When a resident is admitted into the shelter program s/he is assigned a case manager who works in partnership with the resident to identify challenges and develop a plan to end the cycle of homelessness. In addition to weekly meetings with their case manager, weekly counseling is also available, residents also participate in nightly Life Skills classes that cover a variety of topics from budgeting, job readiness, conflict resolution and more. Residents have access to the Haven Food Pantry and are encouraged to prepare their own meals as well as participate in keeping the shelter clean. Staff provides support, guidance and referrals for additional sources of support. Shelter residents may stay at Sojourner House for up to six months. 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 Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35682 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 most important outcome for us is that a family or an individual become self-sufficient and transitions successfully out of homelessness into mainstream living. Another very important outcome is connecting clients with appropriate service/housing. Other outcomes can include: a client obtaining 30 days clean and sober for the first time in years, a resident gaining employment, a family getting medical insurance. We truly believe that great success of the program can be maintained over time is almost never achieved in 30 days. Tools that we use to track clients' progress include database, R-Client, client files, direct service logs, open-ended feedback questionnaire, continuous evaluation by a case manager, and a clinical assessment etc. 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. Our ultimate goal is that upon completion of our program a family or an individual will successfully transition out of homelessness into a permanent housing. At a very minimum our clients will be aware (in many cases will be waiting for an approval) of the programs and services that are available for them and will help them to reach their goals. Last year Sojourner House served 96 unduplicated clients and the Food Pantry served 5,353 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. Both staff and volunteers actively participate in the Diversity trainings. We presently have staff fluent in Spanish, Russian and French. Multi language fluency is always a consideration when hiring, and wage differentials are given to those fluent in Spanish. All of the Sojourner House (Homeless Shelter) and the Food Pantry intake forms, paperwork and flyers are in English and 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? We conduct regular Outreach efforts through many of the programs Tri-Valley Haven offers as well as through other community resources. These internal programs include our Food Pantry, 24-hour crisis line etc. Tri-Valley Haven's Holiday Warehouse Program for low-income families from Tri-Valley area brings new participants every year. In fact, 268 Dublin residents signed up for the Program this year. Tri-Valley Haven participates in community health fairs and outreach events such as St. Patrick's Festival (when available) etc. TVH staff maintains a good working relationship with CRIL, a local service provider for persons with disabilities and also is aware of key services such transportation for persons with disabilities and how to access them. Entrances to all Tri-Valley sites are clearly marked. Telephone screenings and in-person intake processes include questions about needed accommodations (such as a bottom bunk, private room or special dietary needs). Sojourner House was remodeled before it was opened in 2002 to include a ramp and a handicap accessible bathroom. Our Pantry has a portable ramp when appropriate, though clients seldom come in beyond the counter. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We have Operational Agreements with over 60 organizations including Police Departments from Livermore, Dublin and Pleasanton, District Attorney's Offices, schools, 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. The most recent one is with the help and support of the City staff we are setting up a Cal-Fresh enrollment at the Dublin Library, Dublin Senior Center and possibly at the Affordable Housing Sites. Additionally we have always been using the St. Patrick's Festival as an opportunity to introduce our services and the work that we do to as many Dublin residents as we can when available. We conduct presentations to the Dublin Police Department on the Domestic Violence, Sexual Assault and Homelessness issues and the programs that Tri-Valley Haven offers. This year we also conducted a presentation for the Dublin school district on antibulliyng. Our Community Education program reaches over 500 Dublin High school students. We also run a "BeStrong" Girl's Club at Dublin High that will be presenting an awareness event on teen dating violence in February. And last, but not the least, this year 268 Dublin residents will be served through the Holiday Warehouse Program in Livermore. This Program is helping low and very low income families in the Tri-Valley area to prepare Thanksgiving dinner and shop for holiday presents for their loved ones. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. Sojourner House is a sixteen bed facility that houses homeless couples with children, single parents with children and single Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35682 women. Families stay in bedrooms and are encouraged to maintain a family-like atmosphere similar to what will be encountered upon exit from the shelter. Clients can stay for up to 6 months, during which time residents are provided support to stabilize and to develop the skills and knowledge to help break the cycle of homelessness. Case management is based on the empowerment model. Each participant works with their 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, assist in housing search, provide job coaching. We advocate for clients to help them access mainstream services and help motivate participants to be active agents of change in their lives, and the lives of their families. All residents are also referred to a counselor. Tri-Valley Haven’s 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 24 months. All Shelter residents utilize our Food Pantry for food. The Food Pantry is located in Livermore and provides essential nourishment for low income residents of Tri-Valley Area. The Pantry also provides emergency motel vouchers, gas and phone cards, and referrals to other social services. Last year we served 323 Dublin clients through the Food Pantry. 282 of these were extremely low income, 28 were disabled head of households, 54 were female headed households, and 74 were seniors. Also 56 social service referrals were provided to Dublin clients. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Homeless Services Program cross-utilizes other TVH 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 etc. Health Services are provided through the Valley Care Mobile Health Unit that we have an MOU with. By utilizing in-house services whenever possible, expenses for outside services are minimized. Use of volunteers is also a major factor in helping hold the costs down. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Without this funding Tri-Valley Haven would need to reduce the hours of both our Life Skills Instructor and our Case Manager. This reduction in hours would result in fewer services offered to our shelter residents and less support available to them as they struggle to break the cycle of homelessness. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35682 Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. The TVH Cultural Competence Plan has instituted a multi-pronged approach to improving services to clients with Limited English Proficiency (LEP). We have staff conversant in Spanish, Russian and French. 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 “TeleInterpretors” phone based interpreters. Our largest LEP client group is Spanish-speaking. Most flyers, client materials and other communications are created in both English and Spanish. We produce and distribute documents in other languages when available. 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35682 *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. 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. F) Not Applicable. I am not interested in qualifying for CDBG funding. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35682 Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35682 Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: 270 42. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients your agency anticipates serving in each category. "If none, please enter "0". 15 Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) 255 Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) 48 Disabled 116 Female Headed Households 64 Senior 0 Youth 15 Homeless 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 513.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" 62 White 54 White + HISPANIC 23 Black/African American 0 Black/African American + HISPANIC 94 Asian 0 Asian + HISPANIC 2 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 Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35682 0 American Indian/ Alaskan Native and White + HISPANIC 0 Asian and White 0 Asian and White + HISPANIC 1 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 34 Multi Racial + HISPANIC OR other Multi Racial 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 270.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). Homeless Services Program budget is intentionally diversified, so losing one potential source would not force us to close the project completely. We actively fundrase and reach out to the corporate and private donors. Budget Funding Sources/Revenues Budget Amount Amount Committed Alameda County USD$ 140,000.00 USD$ 0.00 Local Dublin/Livermore/Pleasanton USD$ 40,000.00 USD$ 0.00 HCD Linkages USD$ 41,595.00 USD$ 0.00 Emergency Food and Shelter Program USD$ 14,500.00 USD$ 0.00 Emergency Shelter Grant USD$ 200,000.00 USD$ 0.00 Donations USD$ 6,168.00 USD$ 0.00 In-kind revenue USD$ 5,000.00 USD$ 0.00 Total USD$ 447,263.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Case Manager, 10% of salary and benefits USD$ 4,692.00 USD$ 0.00 Life Skills Instructor, 9% of salary and benefits USD$ 5,308.00 USD$ 0.00 Other Program Personnel USD$ 314,481.00 USD$ 0.00 Operating Expenses: Supplies USD$ 7,200.00 USD$ 0.00 Printing/Copying USD$ 0.00 USD$ 0.00 Telephone USD$ 8,250.00 USD$ 0.00 Rent and Utilities USD$ 14,850.00 USD$ 0.00 Accounting/Audit USD$ 1,750.00 USD$ 0.00 Other Costs USD$ 90,732.00 USD$ 0.00 Total USD$ 447,263.00 USD$ 0.00 Budget Narrative Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35682 Revenue: The composition of revenue is our best estimate based on the previous years of operation. Expenses: Personnel Costs include salaries and benefits. Other Operating Costs include: Maintenance and repair costs, portion of liability, property and auto insurance, travel costs, and administrative costs. Homeless Services Budget is part of the overall agency budget that includes other programs and departments such as Domestic Violence Services, Sexual Assault Services, Finance etc. thus only a portion of Liability Insurance, Auto Insurance, Audit etc. being charged to this Program. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template TVH Program Expense Budget Financial Information Form for ALL Grants 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 Directors 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 Directors 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 Copy of the last 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 Organizational Chart STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER TVH State non-profit determination letter TVH 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. TVH LEP ACCESS PLAN REQUIRED FOR CDBG- LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35682 Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35682 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35682 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). To spark the adventure of lifelong learning in children and their grown-ups through hands-on play and interactive exhibits. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (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 Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline Valley Children's Museum Mobile Museum Children's Activities 15-16 Valley Children's Museum P.O. Box 2102 Dublin, CA 94568 United States Tel: (000) 000-0000 Fax: (000) 000-0000 Web: www.valleychildrensmuseum.org EIN: 94-3340530 DUNS: Project Contact Linda Spencer mslindaspencer@aol.com Tel: 925 828 2892 Additional Contacts N.A n/a n/a n/a info@valleychildrensmuseum.org USD$ 6,000 Requested Submitted: 12/8/2014 7:53:00 PM (Pacific) Application Questions Page 1 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35485 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. 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.) 4055 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. 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. Page 2 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35485 VCM will offer children's hands-on learning activities weekly April – September and each third Saturday. VCM's Activities Manager (Helga Glasson) will develop and produce age-appropriate activities to be offered year-round at the 4-hour Saturday and weekly Farmers Market sessions. These public sessions are staffed by a Site Manager who oversees set-up and facility operation, by a VCM representative and by volunteers from throughout the community to assist the children. The California Mission studies field trip for fourth grade classrooms will be offered to supplement teachers’ state-mandated lessons on the California Mission era. A new portable kit featuring the hands-on components of the field trip will be offered for classes that are not able to travel to the museum. It will be delivered to the school, left for a week for use by all the fourth- grade classes at that school, and will be guided by the classroom teacher. Helga will develop mailing lists for all elementary schools and home school associations in the Tri-Valley, create both e-mail and postcard announcements, monitor scheduling and staffing via the VCM website, develop pre- and post-event evaluation forms, provide for the necessary supplies, staff and train volunteers for classroom visits. Field trips are available T-Th November – March, and by special arrangement. Expanded weekend activities based on the California Mission field trip will be developed for those who want a more in-depth experience after their school field trip. Activities will emphasize dance, music, crafts and food. VCM’s website manager will promote both play-based activities and education programs via hard copy and email announcements, social network outlets, media releases and website updates. Linda Spencer will oversee volunteers to support activities. 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 staffing and materials for Valley Children's Museum's play-based and education activities at the Museum. Grant funds will be used to cover portions of the following expenses: 1) purchase consumable materials for year-round play- based hands-on activity, 2) contract fee for a part-time Activities Coordinator, 3) contract fee for a part-time website specialist to manage VCM’s web presence and electronic promotion, 4) contract fee for 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. 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 per evening activity (with the Farmers Market) and 125 per weekend day session (compared to 75 and 100 respectively in 14-15). 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 sixteen classes registered in 2015-16. 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 Page 3 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35485 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 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 activity 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. Page 4 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35485 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. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. This Dublin grant-supported project proposes to utilize VCM’s Museum in Emerald Glen Park to continue the solidly successful hands-on interactive programs for children at two levels: 1) public-access activities for children age 10 and younger and 2) 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 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. 20. 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. 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. Page 5 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35485 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. 21. 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 2015, VCM is faced with the challenge of relocating the trailer within the 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 2015-16 is to celebrate the move of the museum to its new location in Emerald Glen Park while maintaining programs, increasing attendance at those programs and actively pursuing tasks toward the permanent facility. With the onset of planning of the Dublin Crossing Park site and the children’s museum within it, VCM will invest significant energy in design, planning and fundraising for that facility. Without the 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. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Page 6 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35485 Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. Page 7 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35485 *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: * 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. F) Not Applicable. I am not interested in qualifying for CDBG funding. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. Page 8 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35485 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Page 9 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35485 Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Page 10 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35485 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). The City of Dublin is a vital partner in these programs provided for the residents of Dublin, and VCM diversifies and seeks to increase supplemental support through activity fees, corporate and institutional grants. Budget Funding Sources/Revenues Budget Amount Amount Committed School fees (Note 1) USD$ 5,900.00 USD$ 0.00 Government grants USD$ 8,000.00 USD$ 0.00 Corporate grants (Note2) USD$ 8,000.00 USD$ 0.00 Organization grants USD$ 2,000.00 USD$ 0.00 Individual gifts USD$ 2,735.00 USD$ 0.00 Total USD$ 26,635.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Contractors (Note 3) USD$ 14,660.00 USD$ 0.00 Supplies USD$ 10,110.00 USD$ 0.00 Printing USD$ 1,750.00 USD$ 0.00 Postage USD$ 115.00 USD$ 0.00 Total USD$ 26,635.00 USD$ 0.00 Budget Narrative NOTES (1) Field trips @ $150 per class; Classroom kits @ $100 per school (2) Including in-kind (3) Contractors: Education and Activity Director $12,000 Site Manager $2,160 Web Manager $500 The budget for these activities represents approximately 80% of the organization's operating budget, which maintains minimal overhead expenses, directing the vast majority of its budget to direct programs. Documents Page 11 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35485 Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Program Expense Budget Financial Information Form for ALL Grants download template Financial Information List of Board of Directors (or governing body) with contact information Board List Current Annual Budget for the Entire Agency Agency Budget 2014-15 Copy of most recently submitted IRS 990 form or Tax Return (include complete form) 990 Form Board of Director's (or governing body's) designation of authorized official Designated Official Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) Board Authorization to Submit Proof of insurance carried, including bonding, liability and/or workers' compensation Insurance Document 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 IRS Non Profit Letter CA Tax 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 35485 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 12 of 12Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35485 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The mission of ValleyCare Health System is to assume the leadership role for the health of the communities of the Tri-Valley. 3. For what type of Dublin Grant is your agency applying? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. Measure A Funds- 2013- $15,727- ER and Pediatric Equipment 7. Please provide information to justify your agency's capacity to conduct this project (type of management or Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline ValleyCare Health System CPR in Schools ValleyCare Health System 1111 E Stanley Blvd Livermore, CA 94550 United States Tel: (925) 373-4560 Fax: (925) 373-4117 Web: www.valleycare.com EIN: 94-2941652 DUNS: Project Contact Breanne Powers bpowers@valleycare.com Tel: (925) 373-4560 Additional Contacts none entered Chief Executive Officer Scott Gregerson sgreggers@valleycare.com USD$ 5,000 Requested Submitted: 12/11/2014 2:44:48 PM (Pacific) Application Questions Page 1 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35176 governing body, fiscal staff resources, skills and experience, etc.). ValleyCare, as an official American Heart Association Training Site, will develop and support student training by utilizing their existing AHA instructors. ValleyCare will continue to support this program by donating instructor time to support training of selected student volunteers to become AHA CPR instructors and mentor them as they outreach back to their high school and community. 8. Provide a brief summary of the project for which your agency is seeking funding (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. Dublin High School students will be the leaders to bring the “CPR in Schools” program to their high school and community while being mentored and supported by ValleyCare AHA Training Center staff. 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.) CPR training to the 2,000+ Dublin High School students has the potential to grow and expand within each of the student’s homes. The possibilities are endless to reach into sports, teams, scouts, clubs, and groups. 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. Our initial target group is existing and upcoming ValleyCare High School Junior Volunteers. These energetic, young community leaders commit to serving ValleyCare’s patients and our community on a weekly basis. It is our goal to offer these students a CPR class for themselves, as well as the option for more leadership opportunities by becoming a CPR instructor. . As a second step, the goal of this program is to reach beyond ValleyCare to the Dublin community. This vision includes Junior Volunteer instructors providing CPR training to Dublin High School students. In addition, the American Heart Association now offers a program “CPR in Schools”. The program has compact and portable training kits that include everything needed to learn CPR, AED skills, and choking relief in the classroom setting. The kit was developed so educators, nurses, and even students could train groups of 10 students at once. ValleyCare staff will work with the Dublin High School to help identify avenues of approach to offer the CPR training to the high school students. Focus will be on Leadership classes, health classes, team building sessions, scouts, clubs and groups. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for?). Currently, community CPR provider courses cost approximately $100.00 to obtain and this instructor class would be offered to the Junior Volunteers and key Dublin High students at no cost. The initial purchase of training supplies including mannequins, student workbooks, instructor manuals, course materials, and AED simulators is necessary. In order to purchase the “CPR in Schools” training kits that would be needed to train at Dublin High School we are requesting a grant of $5,000-$7,500. 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)? Page 2 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35176 There are approximately 100 ValleyCare Junior volunteers who will be offered the instructor training. The progress of our outreach to the student volunteers will be our ability to give back to the students and provide CPR training to them; provide and support some of them as they become instructors; and the number of peers and teachers at their high schools that receive CPR training. Ultimately, our progress would be measured if even one student enabled another person to live another day by knowing what to do. The AHA motto of “Life is Why” is guiding our desire to provide CPR outreach to the high school and 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. As noted by the American Heart Association (AHA), cardiac arrest is a leading cause of death in the United States. CPR provided by nonmedical personnel outside of the hospital can double or even triple a victim’s survival rate. Interestingly, schools across the country are adding thousands of lifesavers to communities by training their students and faculty to community CPR. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? The outreach to offer CPR by community teenagers is universally applied across all cultures. 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? By reaching out to students at the high school, they in turn, can take these skills into their homes and community. Some high schools have offered the students the ability to check out a mannequin set to take home and teach to their own family members. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. ValleyCare maintains the high standards required by the American Heart Association to be a training program for its physicians and nurses. 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. ValleyCare Health System has an Urgent Care located in Dublin as well as Occutpational Health. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. More than 14 states currently require CPR training for high school seniors to meet graduation requirements. It is expected that even more states will join this movement. Currently, California does not require CPR training for graduation. A program such as this will put our community in the lead of such standards. This aligns well with the City of Dublin’s Value of Ensuring a Safe Community by providing education and training to residents and businesses that would promote public safety. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. 1-AHA Training Center staff time to train, mentor and outreach will be covered by ValleyCare.. 2-Grant to purchase training materials and kits 3-Students seeking leadership and volunteer opportunities can become CPR instructors. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? The first phase will be to offer CPR training to the ValleyCare Junior Volunteers. The training will be offered several times during the spring semester and during orientation of new volunteers going forward. It is anticipated that the current 70 high school student volunteers and approximately 30 new student volunteers will be trained by end of summer 2015. The ability to outreach to the Dublin community would be as restricted as the ability to purchase the durable medical equipment. The “CPR in Schools” training kits are a necessary part of the initiative to offer this outreach and training to the students. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 Page 3 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35176 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Page 4 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35176 Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Page 5 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35176 Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Page 6 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35176 Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum Page 7 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35176 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" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). ValleyCare Health System has worked on reducing costs to help become more self-sufficient. We will not begin this specific program if we do not receive grant funding as this is not in our budget currently. Budget Funding Sources/Revenues Budget Amount Amount Committed No charge to students USD$ 0.00 USD$ 0.00 Total USD$ 0.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Supplies USD$ 8,154.00 USD$ 8,154.00 Total Page 8 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35176 USD$ 8,154.00 USD$ 8,154.00 Budget Narrative 1-AHA Training Center staff time to train, mentor and outreach will be covered by ValleyCare.. 2-Grant to purchase training materials and kits 3-Students seeking leadership and volunteer opportunities can become CPR instructors. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Program Expense Budget Financial Information Form for ALL Grants download template Financial Statement 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 BOD designation of authorized official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) BOD designation of authorized official Proof of insurance carried, including bonding, liability and/or workers' compensation Insurance Insurance 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 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Page 9 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35176 Application ID: 35176 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 10 of 10Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=35176 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). 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? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline YMCA of the East Bay, Tri-Valley Branch Behavioral Health Care Services for Kids with Special Needs YMCA of the East Bay, Tri-Valley Branch 6693 Sierra Lane Suite F Dublin, CA 94568 United States Tel: (925) 263-4444 Fax: (925) 263-4445 Web: www.trivalleyymca.org EIN: 94-1156317 DUNS: Project Contact Kenny Altenburg kaltenburg@ymcaeastbay.org Tel: 9252634444 Additional Contacts none entered Executive Director Kelly O'Lague Dulka kdulka@ymcaeastbay.org USD$ 18,000 Requested Submitted: 12/11/2014 4:51:36 PM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36171 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 Operations Director has a business degree and has worked for the past five years in community engagement for children and families. Our Childcare Program Director has nearly 20 years of experience in licensed childcare. And our mental health staff includes a licensed clinical social worker, a marriage and family therapist and a social work intern. 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.) 36 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. 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 are seeking funds to add one additional full-time licensed therapist. This would allow us to increase the number of interns by two, thus increasing our clinical staff by a total of three. 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 Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36171 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. 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. 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 measure of global self-esteem. The Rosenberg Self-Esteem Scale has demonstrated good reliability and validity across a large number of different sample groups. The SES has been validated for use with both male and female adolescents. 3. Increased internal and external assets. These increases will be tracked using the Search Institute's Survey of Student Resources and Assets. The Survey gives information on young people’s assets, thriving indicators, and risk behaviors. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. The population we serve in our Dublin facility is comprised primarily of low income families from Dublin. Approximately 40% of participants are from low, moderately low and extremely low income single-parent households. families. 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. 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 Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36171 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. 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. They also provide marketing opportunities. In addition to working with the above-mentioned partners, the Tri-Valley YMCA has partnerships with CityServe of the Tri- Valley, local churches, nonprofits and many local businesses and donors that provide financial support for the YMCA. In addition, we have received nearly a million dollars in tangible resources (household goods, furnishings, clothing, etc.) in the past year that have been distributed out to families in need. 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 are working hard to develop partnerships with organizations, corporations and individual donors who see the value in serving children from low income households. We seek to mobilize resources for the families we serve. We have a strong board committed to raising the funds needed to expand services to meet community need. Our list of partners and sponsors has increased significantly but we continue to invite new individuals and businesses into the mission of the Y to ensure that our efforts are sustainable. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. Providing a positive, safe and healthy place for children to learn, grow and thrive is consistent with the goal of promoting and supporting a high quality of life which ensures a safe and secure environment that fosters new opportunities. Project is consistent with the goal of 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. 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. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. This grant request is for a portion of the salary and benefits for a licensed clinician who will provide behavioral health care services to low-income children with 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 child seems high, the relative benefits will be major. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If this application does not receive funding we will continue to seek funding from other potential partners, though this will be a tough road for us as Clinical Mental Health programs are very expensive per resident served. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36171 No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36171 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36171 End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36171 Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) TOTAL Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36171 0.00 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" White White + HISPANIC Black/African American Black/African American + HISPANIC 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). The Tri-Valley 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 to help us address these needs. Budget Funding Sources/Revenues Budget Amount Amount Committed City of Dublin Grant Funding USD$ 18,000.00 Co-payments USD$ 9,000.00 Golf Tournament Fundraiser USD$ 9,000.00 USD$ 9,000.00 Board and Staff Contributions USD$ 18,000.00 USD$ 18,000.00 Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36171 City of Pleasanton Grant Funding USD$ 18,000.00 City of Livermore Grant Funding USD$ 9,000.00 Total USD$ 81,000.00 USD$ 27,000.00 Funding Uses/Expenses Budget Amount Amount Committed Mental Health Therapist USD$ 62,000.00 USD$ 8,000.00 Taxes and Benefits USD$ 15,500.00 USD$ 15,500.00 Malpractice Insurance USD$ 1,200.00 USD$ 1,200.00 Computer and Cell Phone USD$ 1,500.00 USD$ 1,500.00 Office supplies / recordkeeping USD$ 800.00 USD$ 800.00 Total USD$ 81,000.00 USD$ 27,000.00 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 Grants download template Program Expense Budget - Behavioral Health Financial Information Form for ALL Grants download template Financial Information Form for Behavioral Health 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 Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) YMCA of the East Bay 990 Board of Director's (or governing body's) designation of authorized official Tri-Valley YMCA Board Designation Form Board of Director's (or governing body's) authorization to request funding (may be same document as one above) Tri-Valley YMCA Board Authorization Form Proof of insurance carried, including bonding, liability and/or workers' compensation Tri-Valley YMCA 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 IRS Letter Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36171 STATE AND 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 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 36171 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36171 1. Please describe your organization category (select one of the following): Private Non-Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). 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? Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes No 5. Please indicate below if this application is a request for one-time funding and/or "seed" funding. One-time funding Seed funding One-time and Seed funding Operational funding None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Funds. N/A Powered by ZoomGrants™ City of Dublin Community Development Department 2015-2016 Community Grants Program 12/11/2014 deadline YMCA of the East Bay, Tri-Valley Branch Tri-Valley YMCA Mentoring Program YMCA of the East Bay, Tri-Valley Branch 6693 Sierra Lane Suite F Dublin, CA 94568 United States Tel: (925) 263-4444 Fax: (925) 263-4445 Web: www.trivalleyymca.org EIN: 94-1156317 DUNS: Project Contact Kenny Altenburg kaltenburg@ymcaeastbay.org Tel: 9252634444 Additional Contacts none entered Executive Director Kelly O'Lague Dulka kdulka@ymcaeastbay.org USD$ 15,000 Requested Submitted: 12/11/2014 4:42:38 PM (Pacific) Application Questions Page 1 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36176 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 Operations Director has a business degree and has worked for the past five years in community engagement for children and families. Our Childcare Program Director has nearly 20 years of experience in licensed childcare. And our mental health staff includes a licensed clinical social worker, a marriage and family therapist and a social work intern. 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 Tri-Valley YMCA is striving to offer a mentoring program for at-risk K-12 students. Through partnerships with local school districts, youth service organizations, & businesses, the Y will identify & pair at-risk youth with caring, responsible adults. 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.) 15 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, and operated. The purpose of the project is to offer a mentoring program for at-risk K-12 students. Through partnerships with local school districts & other youth service organizations, the Tri-Valley YMCA will identify and pair at-risk youth with caring, responsible adults who, while serving as mentors, will provide academic & social support and positive life coaching. On the surface a demographic overview of the Tri-Valley area would indicate that many families in our area are affluent & that the community is “resource rich.” While that is true for a large percentage of families, those living at or below the poverty line are largely invisible, with limited access to services & resources. The Tri-Valley YMCA is committed to working with children and families that wouldn’t otherwise have access to services. We engage in extensive fundraising to make sure that no one is turned away from essential services & programs because of an inability to pay. The goal of our mentoring program is to match caring, responsible adult volunteers from the community with students who have been identified as at-risk. The risks are many: poor academic performance, poor social skills, family discord or dysfunction, likelihood to engage in risky behaviors related to alcohol and drug use or premature sexual activity. These students have been identified by parents, teachers or counselors as good candidates for a mentoring relationship. Our goal is to bring together approximately 45 mentors & mentees each year, with at least 15 in Dublin. The commitment Page 2 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36176 from both mentors and mentees will be for at least one year. They will be asked to meet weekly to share very basic day to day activities. From help with homework, to washing the car, to going out for ice cream or to a baseball game, the mentor agrees to spend time with the mentee engaged in activities that facilitate relationship building. It is the very relationship that allows the mentee to grow in confidence and aim toward a higher level of success. 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 is for a portion of the salary and benefits for a mentor coordinator, who is needed to recruit the mentors, partner with the school districts and other organizations on identifying the mentees, facilitating the meetings between the mentors and mentees, and gathering the data on the impact of this program. 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 mentoring program in three significant ways: 1. Changes in self-esteem are evaluated using the Rosenberg Self Esteem Scale. The Rosenberg Self-Esteem Scale (SES) is a brief and unidimensional measure of global self-esteem. The Rosenberg Self-Esteem Scale has demonstrated good reliability and validity across a large number of different sample groups. The SES has been validated for use with both male and female adolescents. 2. Academic performance is assessed using semi-annual comparison data from attendance records, report cards and teacher assessments. 3. Improved social skill acquisition will be tracked using the Search Institute's Survey of Student Resources and Assets. The Survey gives information on young people’s assets, thriving indicators, and risk behaviors. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. The population we serve in our Dublin facility is comprised primarily of low income families from Dublin. Approximately 40% of camp participants are from low, moderately low and extremely low income single-parent households. families. The percentage of children from low income families in our 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 ADHD to Aspergers Syndrome and other forms of Autism, to emotional and behavioral challenges. This program would be focused on serving the most at-risk and under-served students in Dublin Unified School District, as identified by the district itself. 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, and will ensure that we have this same focus during our recruitment of mentors. We have staff of all ages, races and socio-economic backgrounds, and will do the same for our mentor pool. 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, but will rely heavily on the school district to guides us to the right families. We also post information throughout public spaces, such as the local libraries. 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. 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. In fact, these school districts are the ones who have brought this critical need to our attention. The faculty and staff of these districts provide support for our programs, staff and families in addition to making referrals. The Y is also partnering with City Serve of the Tri-Valley, and a variety of other youth-focused nonprofit organizations to bring this program to life. In addition to working with the above-mentioned partners, the Tri-Valley YMCA has partnerships with many local businesses Page 3 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36176 and donors that provide financial support for the YMCA. Several of these business have already committed to working with us on finding mentors to pair up with the youth in this program. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley. For this particular program, we would rely heavily on DUSD to identify and nominate students for this program. In addition to this, we also have a partnership with the Emerald Vista staff at Eden Housing for them to do the same. By working with these two organizations, and other youth-serving nonprofits in the area, we could ensure that we are providing this program to the Dublin youth that need it the most. Additionally, our relationships throughout the Tri-Valley expand to PUSD and LJUSD, City Serve, PTownLife, and a variety of other organizations, so that we can ensure the same focus and intention is happening in Pleasanton and Livermore. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, and Values. This project clearly promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. There is no comparable program offered in the Tri-Valley, and the impact that this project would have on our at-risk youth would help ensure this secure environment, while providing new opportunities for our community members to step up as mentors. Project is consistent with the goal of 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. Pairing up adult mentors with at-risk youth is a GREAT way to strengthen each of these families (both the mentors and mentees) by opening them up to new experiences and relationships. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. The project does this by focusing on at-risk youth, at an age where they still have an opportunity to improve the trajectory of their lives. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. This grant request is for a portion of the salary and benefits for a mentor coordinator, who is needed to recruit the mentors, partner with the school districts and other organizations on identifying the mentees, facilitating the meetings between the mentors and mentees, and gathering the data on the impact of this program. The salary is competitive for similar positions in the nonprofit realm, and the cost of ~$1,000 per mentee is VASTLY below the primary alternative for these youth, which is to send them to counseling. This would cost ~$6,000-$8,000 per year per child... not to mention the severe lack of these resources in this community. While the cost per resident for this program is relatively high compared to other programs requesting funding, the impact it will have on each youth are INCREDIBLY high and again, the cost is still very low compared to alternative programs that would TRULY address this need. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If this application does not receive funding we will continue to seek funding from other potential partners, though this will be a tough road for us as Mentoring programs are very expensive per resident served. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? Yes No 23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable. N/A Page 4 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36176 27. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes No Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. ** QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, answer questions 31 through 43. No. If no, check box here, and check the not applicable box at the end of each question. Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Page 5 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36176 Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. 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. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Page 6 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36176 Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter-jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"): Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Page 7 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36176 Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: N/A 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". Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits) Disabled Female Headed Households Senior Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC Page 8 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36176 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 Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the highest priority for funding within the organization, agency, district or entity. #2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity. #5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). The Tri-Valley 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 to help us address these needs. Budget Funding Sources/Revenues Budget Amount Amount Committed City of Dublin Grant Funding USD$ 15,000.00 City of Pleasanton Grant Funding USD$ 15,000.00 Golf Tournament Fundraiser USD$ 7,500.00 USD$ 7,500.00 Board and Staff Donations USD$ 7,500.00 USD$ 7,500.00 City of Livermore Grant Funding USD$ 15,000.00 Total USD$ 60,000.00 USD$ 15,000.00 Funding Uses/Expenses Budget Amount Amount Committed Mentor Coordinator USD$ 45,000.00 USD$ 0.00 Taxes and Benefits USD$ 11,125.00 USD$ 11,125.00 Computer and Cell Phone USD$ 1,500.00 USD$ 1,500.00 Office Supplies and Record Keeping USD$ 375.00 USD$ 375.00 Mentor Training USD$ 2,000.00 USD$ 2,000.00 Total Page 9 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36176 USD$ 60,000.00 USD$ 15,000.00 Budget Narrative The costs associated with hiring one Mentor Coordinator would largely fall into three categories: salary, taxes and benefits, and the costs associated with maintaining communications (computer, cell phone, office supplies, etc.). In addition to this, we need to build a budget for the training meetings, supplies, etc. for our mentors. Currently, the salary range for a coordinator with this experience level would be in the mid $40,000-$55,000. 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 this program would account for about 3%. Documents Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grants download template Expense Budget for Mentoring Program Financial Information Form for ALL Grants download template Financial Information Form for Mentoring Program 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 Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) YMCA of the East Bay 990 Board of Director's (or governing body's) designation of authorized official Tri-Valley YMCA Board Designation Form Board of Director's (or governing body's) authorization to request funding (may be same document as one above) Tri-Valley YMCA Board Authorization Form Proof of insurance carried, including bonding, liability and/or workers' compensation Tri-Valley YMCA 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 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 Page 10 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36176 * ZoomGrants™ is not responsible for the content of uploaded documents. Application ID: 36176 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2007-2014 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout Page 11 of 11Print/Preview 12/30/2014https://www.zoomgrants.com/printprop.asp?rfpid=638&propid=36176 City of Dublin Ten Year Strategic Plan Adopted Fiscal Year 2013-2014 Update MISSION The City of Dublin promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. 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. VALUES Our Values in Building Community • Promote locations and events that bring people of all ages together. • Provide more venues for family-based activities. • Foster heritage and cultural development. Our Values in Ensuring a Safe Community • Provide high quality police and fire services to insure the safety of the citizens living in the community. • Provide education and training to residents and businesses that would promote public safety. Our Values in Guiding Development • Assure that development contributes positively to the City’s fiscal health. • Support pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness. • Promote high quality design and architectural standards in private development and in all public facilities. • Develop transportation systems that facilitate ease of movement throughout the City. Our Values in Governing • Commit to openness and responsiveness to the public and community. • Operate at all times with honesty and integrity. • Exercise fairness in consideration of issues. • Provide a high level of customer service and responsiveness from City staff to citizens. • Embrace technology to improve effectiveness and efficiency. • Strive to build an informed community through communication. Our Values in Relating to Other Communities and Entities • Encourage collaboration and communication with other communities on issues of mutual concern. • Encourage public and private partnerships of mutual benefit. 14 AREAS OF CONCERNas Identified in the Needs Assessment2011 Tri-Valley Needs AssessmentFindings by Area of Concern *1Behavioral health (mental health and substance abuse)8Disabilities2Affordable housing9Food and nutrition3Health care10Senior services4Workforce development11Youth services5Homelessness12Child care, early childhood development and education6Transportation services and access13Changing demographics and growing diversity7Domestic violence and child abuse14Financial assistance*Page 33 Eastern Alameda County Human Services Needs Assessment 1 K:\GRANTS\Funding Year 2015-2016\Criteria Rating Sheet FY 15-16.doc 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 K:\GRANTS\Funding Year 2015-2016\Criteria Rating Sheet FY 15-16.doc 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.