Colorado Division of Criminal Justice s1

JABG- D COLORADO DIVISION OF CRIMINAL JUSTICE JUVENILE ACCOUNTABILITY BLOCK GRANT APPLICATION FOR PROGRAM FUNDS VIA CSPD APPLICANT INFORMATION

APPLICANT AGENCY: Address City, ZIP Project Director E-mail Telephone FAX DUNS NUMBER If you do not have one please check here IMPLEMENTING AGENCY: Contact Email Address City, ZIP Telephone FAX FEDERAL FUNDS REQUESTED: CASH MATCH: TOTAL: TYPE OF AGENCY: FUNCTION OF Law Enforcement Probation Prosecution AGENCY: Courts Social Services Youth Services Public Defense Education Treatment/Mental Health Treatment/Substance Abuse Other Describe:  PROJECT TITLE: PROJECT DURATION: From: October 1, 2010_ To: September 30, 2010 PROJECT DESCRIPTION (Limit to space provided):

PURPOSE AREA #1: PURPOSE AREA #2 (if applicable): PURPOSE AREA #3 (if applicable): PROJECT WILL BE USING RESEARCH OR EVIDENCE-BASED PROGRAMS OR ACTIVITIES: Yes No Provide the name of the Research or Evidence-based program. ______

FY2009 JABG Application Direct Awards

PROJECT SUMMARY

1. PROBLEM IDENTIFICATION (Limit 1 page) Identify the problem or issue to be addressed with relevant existing data. Clearly describe the nature and extent of the problem among the target population.

2. CONTRIBUTING FACTORS (Limit ½ page) Provide an analysis of contributing factors, such as risk and protective factors, identify which contributing factors this project will address and indicate the desired change for each of those factors.

3. INTENDED LONG-TERM OUTCOMES/CHANGES (Limit ½ page) Describe the intended long-term change/outcome desired. Indicate their relation to the proposed project's goals, objectives and contributing factors.

4. PROJECT DESCRIPTION (Limit 1 ½ pages) Describe in detail the project that will be supported with these funds including the services and activities to be provided and how they will not duplicate others offered in the community. If this request is for part of a larger program, the project (and associated costs) must be clearly defined.

5. POPULATION TO BE SERVED (Limit ½ page)

Complete the Table provided to define the proposed target population. Number of Juveniles Targeted to be Served White Black Hispanic Asian/Pacific Native Other/ Total Islander American Unknown Males Females Total Percent of Total to be Served with Limited English Proficiency: %

Provide a description of the target population including age, gender, ethnicity and other characteristics of those the project is intending to serve. Describe how the proposed services are culturally, gender and age appropriate to the proposed target population.

FY2009 JABG Application Direct Awards

6. PROJECT PLAN (Duplicate these Tables as needed- Limit 2 pages per Purpose Area) You must complete this section for each Purpose Area for which you are requesting funding. Provide project/program goals, objectives, services to be provided, outcomes and performance measures using the format provided.

Project Title:

Purpose Area:

GOAL 1: SERVICES TO BE PROVIDED OUTCOME OUTCOME MEASURE & MEASUREMENT TOOLS OBJECTIVE 1.1:

OBJECTIVE 1.2:

OBJECTIVE 2.2:

3 FY2009 JABG Application Direct Awards

OBJECTIVE 3.2:

4 FY2009 JABG Application Direct Awards 7. PROJECT/PROGRAM IMPLEMENTATION OR ENHANCEMENT (Limit 1 page) Provide evidence that the proposed program or program enhancement will result in the intended outcomes including delinquency prevention and maximizing community safety. Cite the evidence or research utilized.

8. APPLICANT AGENCY CAPACITY, COMMUNITY COLLABORATION AND SUPPORT. (Limit ½ page) Show that the applicant agency has the resources and necessary skill set to adequately manage the project. Describe collaboration with other agencies and groups in the community.

PAST PERFORMANCE (For Continuation Applications Only)

1. Summarize the progress made in meeting your previous or current grant goals and objectives and the specific services that have been provided. Describe any changes or improvements made and/or problems encountered in implementing the project. (Limit ½ page)

2. Explain the project's effectiveness and impact on the intended outcomes to date. Include specific data related to changes in contributing factors. (Limit ½ page)

3. LESSONS LEARNED (Limit ½ page) Share any information learned that is not/was not part of the original evaluation design. For instance, unintended results, lessons learned, and challenges overcome. This information is not often part of the formal reporting process, but is very valuable in designing and evaluating future projects. It is also beneficial to share this information with other agencies.

4. PROJECT CHANGES (Limit ½ page) Describe any significant project changes (programmatic or budgetary) in this proposal from previously funded projects.

5 FY2009 JABG Application Direct Awards PROJECT EVALUATION

1. Specifically define the outcomes, impacts, or products you intend to achieve (within the proposed grant period) and how you will measure the degree to which your grant-funded activities are achieving them. Explain how you will document progress toward your objectives. (Limit ½ pages)

2. Will research be conducted as part of this project? (Limit ½ page)  NO  YES If yes, check the type of research proposed:

The planned research/evaluation activities do not involve the collection of information identifiable to private persons.

The planned research/evaluation activities involve the collection of information identifiable to private persons.

If the second box is checked, describe the procedures that will be put in place to ensure administrative and physical security of identifiable data and to preserve anonymity of private persons to whom information relates.

SUSTAINABILITY

1. Describe the plan for reducing reliance on federal funding in the future. Describe the steps you have taken to diversify your funding sources, and/or incorporate this project into local funding sources, e.g. state or local government funding, and/or broad-based community support. (Limit ½ page)

BUDGET

Copy this Budget Table and complete the Table and Narrative for each purpose area as well as the applicant agency's administrative portion of the funds. For continuation applicants: Identify and justify all new budget items and increases in each budget category from previous year funding. ROUND ALL AMOUNTS TO THE NEAREST WHOLE DOLLAR.

Project Title: Purpose Area:

(1) (2) (3) (4) Source Annual Full- Annual Sub-Total % of time TOTAL Fed $ Cash Match time Salary Fringe for This 1. PERSONNEL Benefit Cost Project 6 FY2009 JABG Application Direct Awards + = X % $ + = X % $ + = X % $ + = X % $ TOTAL PERSONNEL COST $ TOTAL Source 2. SUPPLIES AND OPERATING Fed $ Cash Match $ $ $ TOTAL SUPPLIES AND OPERATING COSTS $ TOTAL Source 3. TRAVEL (Designate specifically in-state and out-of-state travel.) Fed $ Cash Match $ $ TOTAL TRAVEL COST $ TOTAL Source 4. EQUIPMENT Fed $ Cash Match $ $ TOTAL EQUIPMENT COST $ 5. CONTRACTED CONSULTANT AND PROFESSIONAL SERVICES TOTAL Source Attach a copy of each contract with a detailed budget. Fed $ Cash Match $ $ TOTAL CONTRACTED COST $ 6. TOTAL OF ALL PROJECT Source COSTS TOTAL Fed $ % of Total Cash Match $ % of Total (1 through 5)

TOTAL COST $

7 FY2009 JABG Application Direct Awards 2. BUDGET NARRATIVE: (Limit 3 pages) Refer to instructions. Follow the same categories and line items as in the Budget Table. Complete a Budget Narrative for each purpose area/project as well as the applicant agency's administrative portion of the funds. For continuation applicants: Identify and justify all new budget items and increases in each budget category from previous year funding.

Project Title: Purpose Area:

8 FY2009 JABG Application Direct Awards 3. TOTAL PROJECT FUNDING:

A. In the box below, provide ALL sources of funding you are CURRENTLY RECEIVING for this project. List the other sources of funding for this project by the type of funds and amount.

List the type and amount of other funding that will be provided to this project.

Fund Type/Describe Amount Federal:

State:

County Government:

Municipal Government:

Private:

Other – specify:

TOTAL PROJECT COSTS

B. What percentage of the total project costs will be supported by the federal funds you are requesting in this proposal? ____%

9 FY2009 JABG Application Direct Awards 4. FINANCIAL MANAGEMENT: Please complete the items below.

Please respond to the following questions about whether your accounting system meets the criteria for managing federal grant funds. (These questions cover areas that will be monitored by DCJ staff during site visits or through other reporting mechanisms. They are not intended to be all inclusive and do not substitute for the agency’s responsibility to meet all federal and state requirements for these grant funds.)

YES NO Does your accounting system separate ALL revenues and expenditures by funding source? YES NO Does your system track revenues and expenditures for each grant award separately through a sub-ledger system? YES NO Does your system allow expenditures to be classified by the broad budget categories listed in the approved budget in your grant, i.e. Personnel, Supplies and Operating, Travel, Equipment and Professional Services? YES NO Do you reconcile sub-ledgers to your general ledger at least monthly? YES NO Do you maintain time sheets, signed by the employee and supervisor for each employee paid by DCJ grant funds? YES NO Do you have written financial policies and procedures in place? YES NO Do you have accounting internal controls in place, such as separation of duties, two signatures on certain checks, reconciliations or other reviews?

If you answered “No” to any of the questions above, please provide an explanation on an inserted page referencing Section V Item #4.

10 FY2009 JABG Application Direct Awards SECTION VIII - CERTIFICATION OF MATCH

This Certification of Appropriation of Match form should be completed by all agencies providing match.

Certification of Appropriation of Match

Colorado Division of Criminal Justice Office of Adult and Juvenile Justice Assistance 700 Kipling Street Denver, Colorado 80215

To Whom It May Concern:

Please be advised that ______has

committed support in the form of form of cash match in the amount of $ to match the

State of Colorado funds for the Juvenile Accountability Block Grant for (Project Title or Agency)

______.

Execution of this document represents a certification that said funds have been earmarked within the appropriation of budget process for use as matching funds for this grant application.

The individual authorized to commit these Sincerely, funds on behalf of the unit of local government or corporation. This individual is either the authorized official or appropriate controller of the matching funds.

Signature/Date

_ Typed Name and Title

11 FY2009 JABG Application Direct Awards X- ATTACHMENTS

Attach the following applicable items behind the Signature page (Page 11 of the Special Provision and Certified Assurances pages) and label with the appropriate title:

A. Organizational Chart – Highlight any positions included in the budget personnel category.

B. Job Descriptions for the positions included in the budget personnel category.

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