fy 2017/18 funding application...applications for funding for the services listed above will not be...
TRANSCRIPT
1
FY 2017/18 FUNDING APPLICATION
1
Application for Contingency Funding FY 2017/18 Directions and Information
DO NOT INCLUDE THIS SECTION WITH YOUR APPLICATION! In
Applications for contingency funds may not include requests for the following services:
Services for persons with disabilities - providing transition from youth to adulthood and case management Infant and maternal health and early childhood development - increasing the availability of affordable quality child care through subsidies, prenatal support and care for pregnant women and developing a centralized system to deliver parenting education services. Services to seniors (age 65+) - providing basic services to include: food, homemaker services, personal care services, transportation and case management, providing home modifications to enable seniors to remain as independent as possible Non-school hour services for school age children/youth development/academic enrichment - providing after-school and income-based and geographically distributed summer care with structure, proving academic enrichment/mentoring/tutoring, provide evening and weekend community programs Services for adolescents (age 10-17) - providing opportunities for job training and placement including those that enhance vocational opportunities, providing leadership opportunities, developing mentor/mentee groups Family-based intervention/counseling services/services to prevent-intervene in family violence - providing comprehensive prevention education (to include: financial education, behavior management, life skills, sex education, relationship education, employment), providing accessible community based mental health counseling, providing in-home prevention and intervention services Basic needs services (emergency intervention/assistance and financial stability) – providing food assistance - food banks, providing assistance to prevent homelessness, providing accessibility to emergency/transitional shelters Applications for funding for the services listed above will not be considered.
Application workshop: Thursday, May 25, 2017 at 2:30 p.m. in the training room of the Historic Courthouse, 125 West New York Ave.., Deland, 32720. Please note that workshop attendance is a prerequisite for submittal of a contingency grant application.
June 9, 2017 - Agencies applying for County of Volusia funding must submit their application to 110 West Rich Avenue, Deland, Florida by noon.
Applications may be obtained via email upon request. Contact [email protected]
County of Volusia Phone: (386) 736-5955, ext. 12970 Corry Brown Fax: (386) 943-7011 110 West Rich Avenue Email: [email protected] Deland, FL 32720-4213
2
Overview of Application
1. Workshop attendance It is mandatory that the executive director, or their designated representative, attend the grant workshop and the Children and Families Advisory Board meeting for agency presentations. Workshop attendance is a prerequisite for submittal of a contingency grant application.
2. Check due date and submission location. Exceptions for applications received after the due date and time will be at the discretion of the Volusia County Council. Agencies will be required to provide a written explanation as to why the application could not be submitted on time. Agencies will be advised of the status of the application on the date of agency presentation.
3. Complete all sections of the application. Complete both sections of the application, including the Word documents and Excel files. Applications must be typed, not handwritten. Every question must have a response. Incomplete applications may not be considered for funding.
4. Put the application in the correct order. Please note the order of the application sections listed on page five of these
directions.
5. Add lines to budgets if needed. When completing the budgets for both Section 1 and Section 2, you may add new lines with categories that further describe your agency’s revenues and expenses. E.g., if you receive substantial support from churches, you might add a line for “Donations from local churches.”
6. Complete section 2 for each program. Section 2 Program Information must be completed for each program for which the agency is requesting funding. E.g. if the agency requests funding for three programs, Section 2 must be completed three times, once for each program. The application will then contain: Section 1 (Agency Information) and three Section 2’s (Program Information). Note: If you are applying for funding for the same program operating in separate locations, you may submit one section 2. Separate section 2’s are only required if the programs are truly different in purpose.
7. Do not include these instructions in your copies. The first page of the application should be Section 1’s title page with the required signatures.
8. Do not use binders, report covers, or folders. Simply make copies and place a
staple in the upper left-hand corner.
9. Separate each program. In Section 2, please separate each program by using a sheet of colored paper as the first page of each program.
3
10. Include page numbers. Page numbers have been programmed into the Word
and Excel documents. Each section will start over from one. To distinguish sections, please fill in your agency name and/or program name in the footer so that it will show up on each page. If you have more than one Section 2, change the “A” beside the Section 2 page numbers to “B,” for the second program, “C,” for the third program, and so on. EXAMPLE:
Subsequent pages for the first program would be 2A, 3A, 4A. Subsequent pages for the second program would be 2B, 3B, 4B. Subsequent pages for the third program would be 2C, 3C, and 4C.
11. Complete all forms for total agency budget, total agency salaries, program
budget, and program salaries. If Program Budgets are the same as Total Agency Budget, use the same information and complete forms.
12. Sign the original. Be sure both the Chief Executive Officer and the Chief Volunteer Officer has signed the original.
13. Complete the checklist located on page 2 of section 1.
Section 2
Program:
Basic Needs
Section 2
Program:
Elder Services
Section 2
Program:
Youth
Development
4
Program Description and Outcomes
In Section 2 you are asked to provide outcomes for your programs. Outcomes demonstrate the difference the program makes in the lives of participants. Please number each program outcome and its associated components. Activities
(What
services are
provided?)
Outputs
(What
amount of
service will
be
provided?
Units of
service)
Outcome
Indicators/Measures/Tools
(How will you
determine/measure whether or
not you achieved the
outcome?)
Expected
Outcomes/Goals
(What are the
benefits to program
participants?)
Expectation for
proposed year
(MMYY/MMYY)
What are
you going to
do?
How much
are you
going to
do?
How are you going to measure
the success of what you are
going to do?
What difference
does this program
make?
How many clients
are you proposing
to serve?
Activities are
what a
program
does with its
resources –
the services it
provides to
fulfill its
mission
Examples:
Shelter
Training
Education
Counseling
Mentoring
Outputs are
products of
a program’s
activities
indicated in
numbers,
or units of
service.
Examples:
# of classes
taught
# of
counseling
sessions
# of
educational
materials
distributed
# of hours
of service
delivered
Outcome indicators are the
specific items of information
that track a program’s success
on outcomes. They describe
observable, measurable
characteristics or changes that
represent achievement of an
outcome. Outcome targets are
numerical objectives for a
program’s level of achievement
on its outcomes. List the data
sources from which you will get
the information to support the
goal.
Examples:
Report cards
Participants’ teachers
Pre/post test
Individual program plans
Outcomes are
benefits for
participants during
or after their
involvement with a
program.
Examples:
New knowledge
Increased skills
Changed attitudes
or values
Modified behavior
Improved condition
Example:
% of participants
that earn better
grades following
completion of the
program than in the
grading period
immediately
preceding
enrollment in the
program: 85% will
earn better grades.
Provide the
proposed number
and percent of
participants that
are expected to
achieve the
outcome in the
proposal year.
Example:
Eighty-five of 100
participants, 85%
are expected to
earn better grades
following the
program, than in
the grading period
immediately
preceding the
program.
5
Required Copies
DOCUMENT REQUIRED County of Volusia
Children and Community
Consolidated Funding Application 1 original 12 copies
Audited Financial Statement or
attestation with agency financial statements
(balance sheet and profit and loss) 1
IRS 990 1
*Please note that all copies must be attached within the same packet
and submitted at the same time. (The original application and 12
copies, the audited financial statement or attestation with agency
financial statements, and the IRS 990)
Order of Application
Section 1 Section 1 Word Document including: Title page as coversheet for entire application. Funding Application
Section 1 Excel Budget Documents including: Total Agency Budget
Section 2 Section 2 Word Document including:
Coversheet (This should be on colored paper) Program Summary Program Description and Outcomes Program Demographics Summary Program Classification
Section 2 Excel Document including:
Program Cost Effectiveness/Cost Efficiency Summary
Program Budget
Program Salaries
In-Kind
1
County of Volusia
Application for Contingency Funding FY 2017/18
Agency Name:
Address:
City, State, Zip Code:
Mailing Address:
City, State, Zip Code:
Telephone/Fax:
Email:
Agency’s Fiscal Year:
Federal ID#:
DUNS#:
Executive Director:
Board Volunteer Chair:
We hereby certify that all programs receiving funding from the County of Volusia will
(1) provide services regardless of race, religion, color, sex, or national origin (2) not require attendance at religious services as a condition of assistance (if
agency is affiliated with any religious entity) nor will the program attempt any religious conversion of service recipients
(3) comply with ADA standards as it relates to persons with disabilities We hereby certify there is a written code of conduct that governs performance of the officers, employees, and agents engaged in procurement which states they will avoid any conflict or interest. We hereby certify that all employees of any agency working directly with children have been screened through the Florida Department of Law Enforcement (FDLE) abuse registry and are records of this action are on file at the agency. Our signatures acknowledge that the information contained in this funding application may be shared with other funders. In addition, this certifies that this request is consistent with our organization's mission, Articles of Incorporation and Bylaws, and has been approved by a majority of the agency’s Board of Directors or Advisory Board. __________________________________________________ _____________________ Volunteer Board Chair Date _________________________________________________ _____________________ Agency Executive Director Date NOTE: “Original” application should contain the original signatures on this page. Please mark the original on the cover page
2
Checklist
Attended a grant application workshop.
Completed Section 1 in its entirety, pages 1 to 10.
Completed and attached Section 1’s Agency Budget and Agency Salaries, pages 11 to 12 and In-Kind Summary Page 13.
Completed Section 2 for each program for which agency is requesting funding.
Completed and attached Section 2’s Cost Effectiveness/Cost Efficiency, Program Budget, Program Salaries and In-kind Summary portions for each program.
Both the Agency Executive Director and the Board’s Volunteer Chair have signed the application.
Submitted 1 original application and 12 copies
Submitted one copy of the most recent IRS 990
Submitted one copy of the most recent audit and management letter (if applicable) or attestation with internally generated financial statements for most recent fiscal year to include a balance sheet and profit and loss statement.
3
Section 1
Financial Overview: Explain the steps your agency has taken to reduce overhead costs in the current year (FY 16/17) and how the agency plans to reduce costs in the proposed year (FY 17/18). Include the reasons for the reduction in costs i.e. cuts in funding, increased efficiency, collaboration. In addition, explain how, or if, the reduction of costs affects the amount of service provided. Has the agency given any raises in the last year? If so, explain and include the percentage of the increase by position and program budget.
4
I. Agency funding summary List amounts requested from all funding sources for this application period.
County of Volusia
Funding Type Amount
Requested
Status:
(denied, pending, approved)
Children and Families Advisory Board $
$
$
$
$
Other County of Volusia Sources
CDBG, JAG, ETC. $
County of Flagler
Funding Type Amount
Requested
Status:
(denied, pending, approved)
Source: $
United Way of Volusia Flagler Counties Funding
Funding Type Amount
Requested
Status:
(denied, pending, approved)
Citizens' Review Process $
State of Florida
Funding Type Amount
Requested
Status: (denied,
pending, approved)
Anticipated
Date of
Notification
Department of Children and Families $
Adult Services $
Alcohol Drug Abuse, and Mental Health $
Developmental Disabilities $
Economic Self-Sufficiency $
Family Safety and Preservation $
Department of Health $
Department of Juvenile Justice $
Department of Vocational Rehabilitation $
$
$
$
$
$
Other Include additional efforts to obtain revenues from other grantors and private foundations not listed above*.
Funding Source: Amount Requested: Status:
(denied, pending, approved)
Anticipated Date
of Notification
1.
2.
3.
4.
5.
Add lines for additional grants
5
TOTAL AGENCY BUDGET
AGENCY NAME:
A. B C. Prior Year D. Prior E. Current Year F. Current G. Proposed H. %
Increase
Proposal Year Actuals Proposal Year Year Between
(Copy from 2016/17 application.) (Copy from 2016/17 application.) Projections F. AND G.
(MMYY-MMYY)* (MMYY-MMYY)* (MMYY-MMYY)* (MMYY-
MMYY)*
(MMYY-
MMYY)*
REVENUES:
1 GOVERNMENTAL FUNDING
City-- #DIV/0!
#DIV/0!
Volusia County (CFAB) #VALUE!
Volusia County (ADM match) #DIV/0!
Volusia County (Special Contracts) #DIV/0!
Volusia County (JAG) #DIV/0!
Volusia County (Other) #DIV/0!
#DIV/0!
#DIV/0!
Flagler County #DIV/0!
State (list agency) #DIV/0!
Medicaid #DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Federal (list agency) #DIV/0!
Medicare #DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
-- #DIV/0!
2 GOVERNMENT SUBTOTAL 0 0 0 0 0 #DIV/0!
3 UNITED WAY
United Way of Volusia-Flagler #DIV/0!
Other United Ways #DIV/0!
4 UNITED WAY SUBTOTAL 0 0 0 0 0 #DIV/0!
5 AGENCY GENERATED INCOME
6
Contributions/Fundraising #DIV/0!
Trusts/Bequests #DIV/0!
Foundation Funding #DIV/0!
Membership Dues/Client Fees #DIV/0!
Product/Service Sales #DIV/0!
Investment Income #DIV/0!
Other Income (Itemize)
#DIV/0!
6 AGENCY GENERATED INCOME 0 0 0 0 0 #DIV/0!
TOTAL REVENUE: 0 0 0 0 0 #DIV/0!
EXPENSES:
6 Administration Expenses
7 Program Expenses
8 TOTAL EXPENSES: 0 0 0 0 0 #DIV/0!
9 TOTAL REVENUE: #REF! #REF! #REF! #REF! #REF! #REF!
10 TOTAL EXPENSES: 0 0 0 0 0 #DIV/0!
11 EXCESS/(DEFICIT): #REF! #REF! #REF! #REF! #REF! #REF!
Column C. Provide prior year proposal from 2016/17 application. Column G. Provide your budget for the proposed year.
Column D. Provide prior year actuals, for your fiscal year that is complete. Again, indicate your agency's fiscal year using MM/YY-MM/YY format.
Use your agency's fiscal year, indicated in MM/YY-MM/YY format. Column H. Indicates the % increase (or decrease) from current year to
Column E. Provide the current year proposal from the 2017/18 application. proposed year.
Column F. Provide the projections for the current fiscal
year.
The formula is (Proposed Year - Current Year Projections)
Indicate your agency's fiscal year using MM/YY-MM/YY
format.
Current Year Projections
7
Agency Name:
AGENCY NAME:
A. B. C. D. E. Basis F. Current G. Proposed
Hrs. donated Hourly of Year Year
IN-KIND REVENUE: Description Rate calculation (MMYY-MMYY)* (MMYY-MMYY)*
1 IN-KIND Volunteers
2 IN-KIND Rent
3 IN-KIND
4 IN-KIND
5 IN-KIND
6 IN-KIND
7 TOTAL REVENUE: 0 0
In-Kind is defined as anything given to the agency to support the programs that the agency would
otherwise have to pay for.
Indicate all sources of in-kind. For volunteer in-kind indicate basis of calculation.
For example, if there are 20 hours per week of volunteer time donated,
multiply by hourly rate times 52 weeks. 20 x $10.00=200.00x52=$10,400.00
8
Fundraising Using the table below, please list your organization's current and planned fundraising efforts. This would include, but is
not limited to, special events, sales to the public, and direct mail.
Activity/Event Current Revenue from
this Activity/Event
Proposed Revenue
from this
Activity/Event
Anticipated Date of
Activity/ Event
1.
2.
3.
4.
5.
*Add lines for additional fundraising activities.
Programs for which the agency is requesting funding with this application:
Program Amount Requested
1.
2.
3.
4.
5.
6.
*Add rows as needed until all programs are listed.
Total Amount Requested:
II. Purpose of Agency:
Describe what the agency does, (services provided), how it is done (service delivery). Describe the need
being met. How does the agency differ from other agencies in avoiding duplication of services? What is the
agency’s mission?
9
III. Agency challenges and/or successes (i.e. accreditation):
Explain the challenges experienced in the last year including significant loss of revenue and the impact to the
program(s) for the current year or upcoming year. Also discuss agency successes.
IV. Agency organizational and administrative assessment:
1. Administrative
a) Date of Articles of Incorporation
b) Date of Agency By-Laws
c) Do you have a governing Board of Directors in Volusia/Flagler Counties? Yes No
If no, please describe your system of governance (i.e., chapter of national Organization with local advisory board, local
advisory board has representation on larger regional Board of Directors, program is part of public entity, etc.).
d) Do you have an advisory board composed of clients and community residents? Yes No
e) Are the organization's meeting minutes retained and current? Yes No
f) Is training or orientation provided for new board members? Yes No
g) Are there term limits established for the Board members? Yes No
h) How often did the governing body meet during the last calendar year?
i) What do your bylaws state regarding board participation?
j) Describe the average attendance and level of participation.
k) Do any board members receive any payment from the agency? Yes No
Please explain below.
10
Board Roster: Using the table below, provide the requested information regarding the Board of Directors or
other governing body.
Name
Residence City
and
Zip code
Gender,
Race,
Ethnicity
Board
Position
Business
Affiliation
Date
Appointed
2. Regulatory
a) Florida Corporate Registration Number
b) Florida Department of Agriculture and Consumer Affairs Solicitation of Contribution Number
c) c) Is the Agency current on payment of withholding taxes? Yes No
d) If not, is there an IRS approved payment plan? Yes No
Explain:
e) Does the Agency have the IRS Determination letter identifying classification? Yes No
f) Does the Agency have the federal employer ID statement/letter? Yes No
g) Does the Agency have current fire inspection certificates for all program sites? Yes No
h) Does the Agency have current health inspection certificates if applicable? Yes No
i) Does the Agency have proof of current general liability insurance? Yes No
j) Does the Agency have proof of current worker’s compensation insurance? Yes No
k) Does the Agency have proof of current vehicle insurance, if applicable? Yes No N/A
11
l) Does the Agency have proof of current volunteer insurance, if applicable? Yes No N/A
3. Internal Control/Financial Management a) Does the agency have any past and/or present monitoring or audit findings Yes No
resulting in a suspension or loss of funding? If yes, please explain the
finding(s), the status or resolution if the funding, the funder, and the amount
of funding.
b) Does your organization owe any repayment of funds to any funding sources? Yes No
c) Has your organization declared bankruptcy or had any assets attached by any Yes No
court within the last three years?
d) Does the Agency have written financial policies and procedures? Yes No
e) Does the Agency have established accounting procedures verifying all income Yes No
and expenses?
f) Does the Agency have an independent audit on an annual basis? Yes No
g) If Agency does not have an independent audit, are the agency financials Yes No
reviewed and approved by the Board?
h) Does the Agency have policy/procedure defining personnel authorized to Yes No
purchase materials and services on behalf of the Agency?
i) Does the Agency have policy/procedure for reimbursement of employee Yes No
job-related expenses (e.g. travel)?
j) Does the Agency maintain petty cash funds? Yes No
k) Is the Agency current in all payables? (E.g. rent, taxes, salaries, etc.) Yes No
l) Are property records which describe the location and condition of equipment Yes No
maintained?
m) Are individual payroll records maintained on each employee? Yes No
n) Is there adequate segregation of duties among personnel to preclude Yes No
misappropriation of funds? If not, explain.
o) Are checks issued in pre-numbered sequential order, and all applicable Yes No
check numbers accounted for?
p) When not in use, are checks kept in a secure location? Yes No
4. Monitoring:
Does an independent, national monitoring group such as CARF or NAEYC Yes No
Accredit the agency?
If answered “yes”, please attach copy of certification.
Identify any funder that monitors the agency, indicating date of last monitoring.
(Agency) (Date)
(Agency) (Date)
12
5. Service Delivery: The agency has adopted a target area for service delivery with a defined and Yes No
recognizable boundary.
The target area is:
Note: Please indicate a specific city or cities, or all of Volusia and/or Flagler Counties
6. Fees:
a) Are there guidelines for assessing fees? Yes No
b) Does the bookkeeper and cashier know these guidelines? Yes No
c) Is every effort extended to collect fees? Yes No
d) Does an official of the agency approve uncollectible write offs? Yes No
7. Personnel:
a) Are personnel policies in writing and approved by the Board of Directors? Yes No
b) Are up-to-date job descriptions provided to all employees at the time of Yes No
initial employment?
c) Are job descriptions on file for all positions? Yes No
d) Is the performance of each staff member evaluated at least annually? Yes No
e) Are staff members asked to review and comments on their evaluation? Yes No
f) Is there a mechanism in place for review of contracted services? Yes No
g) Are individual payroll records maintained on each employee? Yes No
8. Client records:
a) Are all client records kept confidential? Yes No
b) Are client records kept in a locked and secured place? Yes No
c) Are there procedures for standardization of client records? Yes No
d) Are client release forms signed before fulfilling requests for client Yes No
records?
13
Section 2
I. Program Information Complete this section, “Program Information,” for each program for which you are requesting funding. Print this cover sheet on colored paper. Agency name:
Program name:
Amount Requested:
Select only one of the following categories that best describe if:
Children are the primary recipients of the service
Adults are the primary recipients of the service
In this section include the following in this order:
Program Information (this Word document)
Program Cost Effectiveness/Cost Efficiency Summary (Excel)
Program Budget (Excel)
Program Salaries (Excel)
In-Kind (Excel)
14
Agency Collaboration
1) List below all agency collaborations for which there are written memorandum of understandings and indicate
the specific provision of services.
2) Describe the need for service:
3) How are you addressing the problem differently than other agencies which provide the same or similar
services?
4) Does the program receive state or federal matching funds? Yes No
5) Does the program use these requested funds to match state or federal funds? Yes No
6) List the funding source, ratio and maximum amounts of all matching funds.
7) Describe the goal of the program:
8) Number of units of service provided:
(Duplicated services) 2017/18 projection
9) Number of clients to be served:
(Unduplicated services) 2017/18 projection
10) Benefit per client:
(Number of clients served, unduplicated, divided by total program cost. Same number as unit cost on Cost
effectiveness/efficiency) 2017/18 projection
11) Are there any significant changes to the program as previously funded, or, any changes to the demographics?
If so, explain.
12) Did you request a grant from this particular funding source for this program last Yes No
year?
13) If yes, and an increase in funding has been requested, please explain the reasons for applying for additional
money.
14) Does this program have a change in the number of staff or staff hours Yes No
dedicated to it?
15) If yes, please explain the reason(s) for the increase or decrease in staff.
16) If you did not previously request a grant for this program, is it a new program Yes No
for your agency?
17) If this is not a new program, how long has it been in existence?
18) Are client fees charged for this program? Yes No
19) If yes, what is the range of fees and how are they determined?
15
20) If fees are not charged, why not?
21) How is client eligibility determined for this program?
22) Describe the waiting list for program services (include the length of the list and how it is managed)
23) Program Location(s) and Schedule:
Location Time Days
*Add additional rows as needed
Program Staff:
Number of paid staff involved in operating program:
Number of Staff Number of Volunteers
List staff positions and schedule for program described.
Staff Schedule
16
II. Program Description and outcomes
Program Name:
Program Goal(s):
Program Description:
Provide a narrative description of this program including target population. What are your efforts to reach the at-risk
population?
17
Program Description and Outcomes
Activities
(What services are
provided?)
Outputs (What
amount of services
will be provided?
(Units of service)
Outcome
Indicators/Measures/Tools
(How will you measure
whether you achieved the
outcome?)
Expected
Outcomes/goals (What
are the benefits to
program participants?)
Expectation Proposed
Year
(MMYY/MMYY)
1.
2.
3.
18
Program Description and outcomes (continued) Activities
(What services are
provided?)
Outputs (What
amount of services
will be provided?
(Units of service)
Outcome
Indicators/Measures/Tools
(How will you measure
whether you achieved the
outcome?)
Expected
Outcomes/goals (What
are the benefits to
program participants?)
Expectation Proposed
Year
(MMYY/MMYY)
4.
5.
6.
19
How do you use outcomes to evaluate your programs and make changes going forward?
III. Program Demographics Summary DO NOT LEAVE BLANK: Please complete the following table summarizing the demographic characteristics of clients
served by this program. If there are no prior year clients put N/A. Do not use percentage, put actual numbers of
clients. Please note that these figures are number of clients served – unduplicated, not number of services provided.
Demographic Characteristics by program A. Prior year
clients (Actual)
mm/yy-mm/yy*
B. Current year
clients
(Projected) mm/yy-mm/yy*
C. Proposed
year clients
(Projected)
mm/yy-mm/yy*
AGE GROUP
0-5
6-10
11-17
18-29
30-54
55-64
Over 65
Undocumented
TOTAL
GENDER
Male
Female
Undocumented
TOTAL
ETHNIC BACKGROUND
Caucasian
African-American
Hispanic
Asian-American
Native American
Other
Undocumented
TOTAL
20
Demographic Characteristics by program A. Prior year
clients (Actual)
mm/yy-mm/yy*
B. Current year
clients
(Projected) mm/yy-mm/yy*
C. Proposed year
clients (Projected)
mm/yy-mm/yy*
LEGAL RESIDENCE
Northwest
Barberville 32105
Cassadaga 32706
DeLand 32720, 32721, 32722, 32723
DeLeon Springs 32130
Glenwood 32722
Lake Helen 32744
Pierson 32180
Seville 32190
Northeast
Daytona Beach 32114, 32115,32116, 32117, 32118, 32119,
32120, 32121, 32122, 32123, 32124, 32125, 32126, 32198
Daytona Beach Shores 32116
Holly Hill 32117, 32125
Ormond Beach 32173, 32174, 32175, 32176
Ponce Inlet/Wilbur-by-the-Sea 32127
Port Orange 32127, 32128, 32129
South Daytona 32121
Southwest
DeBary 32713, 32753
Deltona 32725, 32738, 32738,32739
Enterprise 32725
Orange City 32763, 32774
Osteen 32764
Southeast
21
Edgewater 32132, 32141
New Smryna Beach 32168, 32169, 32170
Oak Hill 32759
Flagler
Bunnell 32110
Flagler Beach 32136,
Marineland 32086
Palm Coast 32135, 32137, 32142, 32164
TOTAL
*Column Description
A. Actual clients served during agency’s last fiscal year. Indicate year in MMYY/MMYY format.
B. Estimated number of clients to be served in agency’s current fiscal year. Indicate year in MMYY/MMYY format. C. Number of clients your agency proposes to serve in the upcoming fiscal year. Indicate year in MMYY/MMYY format.
22
Program Cost Effectiveness/Cost Efficiency Summary
II. Fiscal Revenues A. Prior Year B. Current Year C. Proposed Year
County Funds
Other Government Funding
United Way $0
All Other Income
Total Program Revenues $0 $0 $0
III. Expense A. Prior Year B. Current Year C. Proposed Year
MM/YY-MM/YY MM/YY-MM/YY MM/YY-MM/YY
Administration Salaries $0
Program Salaries $0
All Other Expenses $0
Total Program Expenses $0 $0 $0
IV. Unit Cost A. Prior Year B. Current Year C. Proposed Year
MM/YY-MM/YY MM/YY-MM/YY MM/YY-MM/YY
For Total Customers Served #DIV/0! #DIV/0! #VALUE!
ITEM I - COLUMN C SERVICE DELIVERY - NUMBER OF CLIENTS TO BE
SERVED IN THE PROPOSED YEAR MUST AGREE WITH TOTAL
NUMBER OF CLIENTS TO BE SERVED ON PROGRAM
DEMOGRAPHICS SUMMARY ON PAGES 9A AND 10A
ITEM II - COLUMN C TOTAL PROGRAM REVENUES MUST EQUAL
TOTAL REVENUE ON PAGE 14A LINE 38 COL. G
ITEM III - COLUMN C TOTAL PROGRAM EXPENSES MUST EQUAL
TOTAL EXPENSES ON PAGE 14A LINE 39 COL. G
COLUMN DESCRIPTIONS
Column A. Prior Year - fiscal year completed
Column B. Current Year - current fiscal year
Column C. Proposed Year - upcoming fiscal year
Formula for unit cost for Total Customers Served is # Customers Served/Total Program Expenses
Indicate your agency's fiscal year in MM/YY-MM/YY format.
23
TOTAL PROGRAM BUDGET
AGENCY NAME:
A. B C. Prior
Year
D. Prior E. Current
Year
F.
Current
G.
Proposed
H. %
Increase
I. J. K. L.
Proposal Year
Actuals
Proposal Year Year Between
(Copy from 2016/17 application.) (Copy from
2017/18
application.)
Projections
F. AND G.
(MMYY-
MMYY)*
(MMYY-
MMYY)*
(MMYY-
MMYY)*
(MMYY-
MMYY)*
(MMYY-
MMYY)*
REVENUES:
1 GOVERNMENTAL
FUNDING
City-- #DIV/0!
-- #DIV/0!
Volusia County (CFAB) #VALUE!
Volusia County (ADM
match)
#DIV/0!
Volusia County (Special Contracts) #DIV/0!
Volusia County (JAG) #DIV/0!
Volusia County (Other) #DIV/0!
Flagler County
State (list agency)
Medicaid
Federal (list agency) #DIV/0!
Medicare
24
2 GOVERNMENT
SUBTOTAL
0 0 0 0 0 #DIV/0!
3 UNITED WAY
United Way of Volusia-
Flagler
#VALUE!
Other United Ways #DIV/0!
4 UNITED WAY
SUBTOTAL
0 0 0 0 0 #DIV/0!
5 AGENCY GENERATED INCOME
Contributions #VALUE!
Special Events #DIV/0!
Trusts/Bequests #DIV/0!
Foundations #DIV/0!
Membership Dues #VALUE!
Program Service Fees #DIV/0!
Product/Service Sales #DIV/0!
Investment Income #DIV/0!
Other Income (Itemize) #DIV/0!
6 AGENCY GENERATED
INCOME
0 0 0 0 0 #DIV/0!
7 TOTAL REVENUE: 0 0 0 0 0 #DIV/0!
EXPENSES: REQUESTED AMOUNT
DISTRIBUTION
ADMINISTRATION County United
Way
State Other
1 Salaries #VALUE!
2 Health Insurance #VALUE!
3 Retirement #VALUE!
4 Payroll Taxes #DIV/0!
5 Workers' Compensation #DIV/0!
6 Unemployment Insurance #DIV/0!
7 ADMINISTRATION 0 0 0 0 0 #DIV/0! 0 0 0 0
25
TOTAL
PROGRAM SALARIES #DIV/0!
8 Salaries #VALUE!
9 Health Insurance #VALUE!
10 Retirement #VALUE!
11 Payroll Taxes #DIV/0!
12 Workers' Compensation #DIV/0!
13 Unemployment Insurance #DIV/0!
14 PROGRAM TOTAL 0 0 0 0 0 #DIV/0! 0 0 0 0
15 TOTAL SALARY
EXPENSE
0 0 0 0 0 #DIV/0! 0 0 0 0
OTHER EXPENSES:
16 Conferences, Conventions, Meetings #DIV/0!
17 Consultants #DIV/0!
18 Subcontracted Services #DIV/0!
19 Equipment--lease/rent #DIV/0!
20 Equipment--purchase #VALUE!
21 Food #VALUE!
22 Insurance #DIV/0!
23 Maintenance #DIV/0!
24 Membership dues/Subscriptions #DIV/0!
25 Occupancy--lease/rent #DIV/0!
26 Occupancy--mortgage #DIV/0!
27 Postage and Shipping #DIV/0!
28 Printing and Publications #VALUE!
29 Professional Fees #DIV/0!
30 Specific Assistance to Individuals #DIV/0!
31 Supplies #VALUE!
32 Utilities--telephone,lights, water, gas #DIV/0!
33 Transportation--client #DIV/0!
34 Travel--staff #DIV/0!
35 Other costs (Itemize) #DIV/0!
36 OTHER EXPENSES
SUBTOTAL
0 0 0 0 0 #DIV/0! 0 0 0 0
37 TOTAL EXPENSES: 0 0 0 0 0 #DIV/0! 0 0 0 0
26
38 TOTAL REVENUE: 0 0 0 0 0 #DIV/0! 0 0 0
39 TOTAL EXPENSES: 0 0 0 0 0 #DIV/0! 0 0 0 0
40 EXCESS/(DEFICIT): 0 0 0 0 0 0 #VALUE! 0 0 0
COLUMN
DESCRIPTIONS
Column C. Provide prior year proposal from 2016/17
application.
Column H. Indicates the % increase (or decrease) from current year to
Column D. Provide prior year actuals, for your fiscal year that
is complete.
proposed year.
Use your agency's fiscal year, indicated in MM/YY-MM/YY
format.
The formula is (Proposed Year - Current Year Projections)/Current Year
Projections.
Column E. Provide the current year proposal from the 2016/17
application.
Column I. Amount of line item expense attributed to County
funding
Column F. Provide the projections for the current
fiscal year.
Column J. Amount of line item expense attributed to United Way funding
Indicate your agency's fiscal year using MM/YY-MM/YY format. Column K. Amount of line item expense attributed to State funding
Column G. Provide your budget for the proposed
year.
Column L. Amount of line item expense attributed to other funding
Again, indicate your agency's fiscal year using MM/YY-MM/YY
format.
27
Program Salaries
A. Prior Year Actuals B. Current Year
Projections
C. Proposed Year
Projections
MMYY-MMYY MMYY-MMYY MMYY-MMYY
% of
time
allocated
Salary
Amount
% of
time
allocated
Salary
Amount
% of
time
allocated
Salary
Amount
PROGRAM SALARIES
BY POSITION TITLE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
PROGRAM SALARY SUBTOTAL $0 $0 $0
ADMINISTRATIVE SALARIES
1
2
3
28
4
5
ADMIN SALARY SUBTOTAL $0 $0 $0
TOTAL SALARIES $0 $0 $0
Column A. Provide prior year actuals, for your fiscal year that is complete.
Column B. Provide the projections for the current fiscal year.
Column C. Provide your salary budget for the proposed year.
Indicate your agency's fiscal year using MM/YY-MM/YY format.
29
AGENCY NAME:
PROGRAM NAME:
A. B. C. D. E. Basis F. Current G. Proposed
Hrs. donated Hourly of Year Year
IN-KIND REVENUE: Description Rate calculation (MMYY-MMYY)* (MMYY-MMYY)*
1 IN-KIND Volunteers
2 IN-KIND Rent
3 IN-KIND
4 IN-KIND
5 IN-KIND
6 IN-KIND
7 TOTAL REVENUE: 0 0
In-Kind is defined as anything given to the agency to support the programs that the agency would
otherwise have to pay for.
Indicate all sources of in-kind. For volunteer in-kind indicate basis of calculation.
For example, if there are 20 hours per week of volunteer time donated,
multiply by hourly rate times 52 weeks. 20 x $10.00=200.00x52=$10,400.00