FY2013 APPLICATIONS ARE DUE SEPTEMBER 14, 2012 4 P.M

VALE USE ONLY: App# Award $ V/S or L/E YES NO New Applicant Approved Previously Funded Continuation Applicant Denied All Materials Included Date of Board review ______Project Duration _____ to ______

FY2013 APPLICATIONS ARE DUE SEPTEMBER 14, 2012 4 p.m.

Email one (1) copy of the completed application to [email protected]. Email the document as a Microsoft Word document. Send two (2) original applications with one (1) set of required attachments to: Denver District Attorney’s Office/ Denver VALE Attn: Irene Blatnick 201 W Colfax Ave, 8th Floor Denver, CO 80202 *Faxed applications will not be accepted. SECTION I - APPLICANT INFORMATION

APPLICANT AGENCY Agency Name Project Title Street Address City Zip Phone # Fax # Website

PROJECT DIRECTOR Project Director Position/Title Phone # Fax # E-mail

AMOUNT REQUESTED

TYPE OF AGENCY Nonprofit Status YES NO In Progress Tax ID Number: Government Agency YES NO

2013 ∙ 2nd JD VALE APPLICATION ∙ 1 AGENCY DESCRIPTION (Required for new applicants or current funded programs that have changed) Limit 400 words

CONTINUATION PROJECTS (REQUIRED FOR PROJECTS FUNDED IN FY2012) Provide a brief synopsis of what this project accomplished with the FY2012 Denver VALE grant award. Limit 400 words

2013 ∙ 2nd JD VALE APPLICATION ∙ 2 SECTION II – PROJECT CONCEPT/DESIGN

1) STATEMENT OF NEED Substantiate or quantify the issue your project is designed to address within the 2 nd Judicial District factually or with other supportive data. Limit 900 words.

2013 ∙ 2nd JD VALE APPLICATION ∙ 3 2) PROJECT PLAN In a narrative format, discuss the project that 2nd JD VALE funds will support. Identify the project’s goals and objectives, and the plan to accomplish them including a timeline and milestones. Be specific regarding what services VALE funds will provide within Denver. (Limit 900 words)

2013 ∙ 2nd JD VALE APPLICATION ∙ 4 3) GOALS & OBJECTIVES Identify and describe the project’s goals and objective. The objectives must be measurable and specific. Agency Name:

GOAL 1:

OBJECTIVE 1.1:

Timeline: OBJECTIVE 1.2:

Timeline:

GOAL 2:

OBJECTIVE 2.1:

Timeline:

2013 ∙ 2nd JD VALE APPLICATION ∙ 5 GOAL 3:

OBJECTIVE 3.1:

Timeline:

GOAL 4:

OBJECTIVE 4.1:

Timeline:

2013 ∙ 2nd JD VALE APPLICATION ∙ 6 A) Please describe any challenges for this project that may interfere with successful completion of goals and objectives. Limit 200 words.

B) How will these issues be resolved? Limit 200 words.

4) PERFORMANCE MEASURES A) Process Evaluation – How will the project be evaluated for success? Please describe the evaluation process and the data that will be collected to evaluate and document the accomplishments of the project. Limit 200 words.

B) Outcome/Impact Evaluation - How will the delivery of services improve the life situation of your clients? Limit 200 words.

2013 ∙ 2nd JD VALE APPLICATION ∙ 7 C) Agency Evaluation - How does the agency evaluate the overall success of the services it provides? Limit 200 words.

D) Describe the management structure for this project. Provide the name and position of the specific person responsible for 1) daily operations and 2) expenditure of grant funds. Please explain the role of the project director listed on page 1 if he/she is not responsible for daily operations. Limit 200 words.

E) In compliance with the American Disability Act (ADA) on providing access, will your agency be able to provide accommodations for crime victims or victim service providers who are disabled? YES NO Explain:

5) SERVICE INFORMATION A) Define the specific service area including population and geographic area for this project. (Limit 150 words)

2013 ∙ 2nd JD VALE APPLICATION ∙ 8 B) Is the project located entirely in the 2nd Judicial District? YES NO If not, what percentage of services will be for victims/witnesses in the 2nd JD? What number of people will be served by this project during the contract period? What number of people are currently being served?

C) Describe how the project addresses inclusivity. The definition of inclusivity is: a process in which an agency continuously strives to achieve the ability to work effectively within the cultural context of an individual or community from a diverse culture/ethnic background (e.g. the diversity of staff, volunteers, and/or board representation, etc.). Limit 200 words.

D) Please explain your current outreach efforts to under/unserved populations. What have been the results of these efforts? Limit 200 words.

2013 ∙ 2nd JD VALE APPLICATION ∙ 9 SECTION III - COMMUNITY COLLABORATION

1) VICTIM SERVICES NETWORK A) Describe the agency’s involvement with the Victim Services Network (VSN). Limit 250 words.

2) OTHER AGENCIES AND ORGANIZATIONS A) How will the agency coordinate services with similar or like programs to diminish or eliminate any duplication of services? Limit 250 words.

B) Identify additional agencies, organizations, or other networks/collaborations that will be included in the planning and implementation of this specific project. Limit 200 words.

2013 ∙ 2nd JD VALE APPLICATION ∙ 10 SECTION IV – VICTIMS RIGHTS AMENDMENT

1)VICTIM RIGHTS ACT COMPLIANCE – PROJECT SPECIFIC A) Define how this project will address the guidelines for assuring the rights of victims and witnesses as outlined in the Victim Rights Act (Section 24-4.1-302.5 C.R.S.). List specific services to be provided. Limit 200 words.

B) Define how this project will address law enforcement/victim services needs as outlined in the VALE statute (Section 24-4.2- 105 C.R.S.). Limit 200 words.

2) VRA COMPLIANCE A) Does your agency have a statutory mandate to notify victims under the Victim Rights Amendment (VRA)? YES NO B) How do you presently notify victims of their rights under the VRA?

C) What is the approximate number of clients who receive notifications made by your agency each year? D) What is the approximate total number of notifications made by your agency each year?

3) TRAINING A) Please provide the following information regarding training provided to all paid staff and volunteers about informing victims of their rights under the Colorado Constitution: Date of last training: Training Provided by (trainer/agency): B) What percent of your staff attended the above training? Date of next training: Training Provided by (trainer/agency):

2013 ∙ 2nd JD VALE APPLICATION ∙ 11 4) VICTIM COMPENSATION Are any of the services provided by your agency eligible for Crime Victim Compensation reimbursement? YES NO If so, list services:

Does your agency regularly conduct or receive Crime Victim Compensation training for direct services staff or volunteers? YES NO Date of last training: Training provided by:

5) VICARIOUS TRAUMA Describe the agency’s plan and/or strategies to address vicarious trauma issues within the agency. Limit 200 words.

SECTION V – CONTINUATION APPLICANTS (Required for projects funded in FY2012) 2013 ∙ 2nd JD VALE APPLICATION ∙ 12 1) PROJECT CHANGES Describe any significant project changes (programmatic or budgetary) in this proposal from the project funded in FY2012. If an increased amount is being requested please substantiate or quantify factually the request with supportive documentation. Limit 400 words.

2) EVALUATION OF PAST PROGRESS Summarize the extent to which each of the project’s goals and/or objectives were met, with supporting data included. If a specific objective was not achieved, or only partially achieved, provide an explanation. Limit 400 words.

SECTION VI – FINANCIAL INFORMATION 2013 ∙ 2nd JD VALE APPLICATION ∙ 13 1)TOTAL AMOUNT REQUESTED A) What percentage of your total agency budget is this request for VALE funds? B) Will the amount requested provide full funding for the project? If no, please identify other funding sources and the amounts received within the past two years. Do YES NO not include other VALE funding. Also, please include other pending grants.

1A) OTHER NON –VALE FUNDING SOURCES Source Date of Award Amount to this project Total Award Ex: VOCA 1/1/2012 $10.00 $100.00

TOTAL OTHER FUNDING SOURCES: $0.00

2) VALE FUNDING Are you currently receiving VALE funding from any other Judicial District? YES NO If yes, please identify the Judicial District and the amount requested and awarded

2A) CURRENT VALE FUNDING SOURCES (FY2012) District Date of Request Amount Requested Amount Awarded

TOTAL VALE FUNDING $0.00

3) REQUESTED VALE FUNDING (FY2013) Will you be applying to other VALE Boards for funding? YES NO If yes, please identify the Judicial District and the amount requested.

3A) REQUESTED VALE FUNDING (FY2013) District Date of Request Amount Requested Amount Awarded

TOTAL REQUESTED VALE FUNDING (DO NOT INCLUDE 2ND JD) $0.00

ANTICIPATED CLIENT FEES FROM THIS PROJECT 2013 ∙ 2nd JD VALE APPLICATION ∙ 14 Please explain how the fees are calculated for this project.

IN-KIND/VOLUNTEER SERVICES Describe the volunteer and/or in-kind services that will be provided for this project. Limit 200 words.

FUTURE FUNDING If this project is to continue beyond the initial funding period, describe the sustainability plan for the project for the next 3 years. Limit 200 words.

2013 ∙ 2nd JD VALE APPLICATION ∙ 15 SECTION VI – PROJECT BUDGET

1) BUDGET TABLE (Please see Guidelines for detailed instructions) A) Personnel Total Annual Annual Sub- Total Total Total Total TOTAL/ hours Salary Fringe total Amount amount amount requested %FTE Position Title/ per Benefit requested requested requested from Employee week cost from 2nd from from other funding Name JD VALE VOCA/VAWA other sources VALE Boards $0.00 $0.00

0% 0% 0% 0% 0% $0.00 $0.00

0% 0% 0% 0% 0% TOTAL $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 PERSONNEL COST:

1A) Personnel - Narrative If funds are requested for Personnel, fully explain and justify the need for funding and link each position to specific goals and objectives for this project. Show calculations.

B) Supplies and Operating Project 2nd JD State Other Other TOTAL Amount Funding VALE/VOCA District VALE sources funds funding $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL SUPPLIES/OPERATING COST: $0.00 $0.00 $0.00

2013 ∙ 2nd JD VALE APPLICATION ∙ 16 1B) Supplies and Operating - Narrative If funds are requested for Supplies and Operating, fully explain and justify the need for funding and link each line item to specific goals and objectives for this project. Show calculations.

C) Equipment Project 2nd JD State Other Other TOTAL Amount Funding VALE/VOCA District VALE sources funds funds $0.00 $0.00 $0.00 $0.00 TOTAL EQUIPMENT COST: $0.00 $0.00 $0.00

1C) Equipment - Narrative If funds are requested for Equipment, fully explain and justify the need for funding and link each line item to specific goals and objectives for this project. Show calculations.

D) Travel Project 2nd JD State Other Other TOTAL (Itemize request, e.g. Victim travel Amount Funding VALE/VOCA District VALE sources expenses, Conference, hotels, etc…) funds funds $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL TRAVEL COST: $0.00 $0.00 $0.00

1D)Travel - Narrative If funds are requested for Travel, fully explain and justify the need for funding and link each line item to specific goals and objectives for this project. Show calculations.

2013 ∙ 2nd JD VALE APPLICATION ∙ 17 E) Professional Services/ Project 2nd JD State Other Other TOTAL Consultants Amount Funding VALE/VOCA District VALE sources funds funds $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL PROFESSIONAL SERVICES COST: $0.00 $0.00 $0.00

1E)Professional Services - Narrative If funds are requested for Professional Services, fully explain and justify the need for funding and link each line item to specific goals and objectives for this project. Show calculations including the hourly rate for the contractor.

1F) 2nd JD VALE Grant Request Summary Note: This chart will automatically fill from other tables. Budget Categories 2nd JD VALE Grant Request Personnel $0.00 Supplies and Operating $0.00 Equipment $0.00 Travel $0.00 Professional Services/ Consultants $0.00 Total 2nd JD VALE Funding Requested: $0.00

SECTION I - APPLICANT INFORMATION

2013 ∙ 2nd JD VALE APPLICATION ∙ 18 SIGNATURE PAGE *The applicant assures that the following signatories and all staff and volunteers assigned to this project have read and understood the rights afforded to crime victims pursuant to section 24-1.1-302.5 C.R.S. and the services delineated pursuant to sections 24-4.1-303 C.R.S. and 23-4.1-304 C.R.S.

I hereby certify that the information contained herein is true and correct to the best of my knowledge and belief.

Signature of Project Director Date

Typed Name of Project Director

Signature of Agency Director Date

Typed Name of Agency Director

Signature of Financial Officer Date

Typed Name of Financial Officer

Signature of Authorized Official Date

Typed Name of Authorized Official

Project Director: The person who has direct responsibility for the implementation of the project. This person should combine knowledge and experience in the project area with ability to administer the project and supervise personnel. He/She shares responsibility with the Financial Officer for seeing that all expenditures are within the approved budget. This person will normally devote a major portion of his/her time to the project and is responsible for meeting all reporting requirements. The Project Director must be a person other than the Authorized Official of the Financial Officer.

Agency Director: The executive director of the agency. This may in some agencies be the same person as the project director or authorized official.

Financial Officer: The person who is responsible for all financial matters related to the program and who has responsibility for the accounting, management of funds, and verification of expenditures, audit information and financial reports. The person who actually prepares the financial reports may be under the supervision of the Financial Officer. The Financial Officer must be a person other than the Authorized Official or the Project Director.

Authorized Official: The authorized official is the person who is, by virtue of such person's position, authorized to enter into contracts for the grant recipient. This could include: Mayor or City Manager, Chairperson of the County Commissioners, District Attorney, President of Chairperson of the Board of Directors, Superintendent, or other Chief Executive Officer. 2013 ∙ 2nd JD VALE APPLICATION ∙ 19 APPLICANT CHECKLIST

REQUIRED ATTACHMENTS Agency Budget (waived for governmental agencies) Victim Assistance Program Budget Copy of 501 (c)(3) IRS Tax Ruling (if applicable) Listing of Board of Directors and Key Officers Copy of current Financial Statement and Audit Report (waived for governmental agencies) Management Letter from Auditor (waived for governmental agencies) Random Sampling of Client Satisfaction Surveys Letters of support, cooperation, MOUs and/or written referral procedures Organizational Chart Job description and agency classification for any personnel funding requested Resume of Project Director and Executive Director

Please review the Application Guidelines before submitting this Application.

FY2013 APPLICATIONS ARE DUE SEPTEMBER 14, 2012 4 P.M.

Please email 1 copy of the finished application to [email protected] as a Microsoft Word document. Send 2 original applications with 1 set of attachments to Irene at the address below.

Denver District Attorney’s Office/ Denver VALE Attn: Irene Blatnick 201 W Colfax Ave, 8th Floor Denver, CO 80202 [email protected] 720-913-9201

*Faxed applications will not be accepted.

2013 ∙ 2nd JD VALE APPLICATION ∙ 20