Council of Family and Child Caring Agencies

Small Agency Consulting Program Application

Submission Date: Agency Name: Agency Address: Contact Person: Contact Person email: Telephone: Website: Executive Director:

Section 1: Program (see instructions)

Summarize agency programs including:

Mission

Services

Identify current ACS program contracts – i.e. foster care, preventive services, community partnership initiatives, other (specify):

1 All information included in this application will be treated as confidential by COFCCA. Identify contracts with other New York City agencies that relate to your interest in responding to the ACS RFP (i.e. Homeless Services, DYCD, Health and Mental Hygiene, others):

Demonstrated commitment to:

Community(s) you intend to serve. Describe agency relationship and connection to groups or programs within a specific community district(s) (name district(s))

2 All information included in this application will be treated as confidential by COFCCA. Describe how your agency deals with issues of cultural competence:

Section 2 Total Agency Budget (Current fiscal year) and previous fiscal year expenditures (attach details)

Fiscal Year 2007 Expenditures Fiscal Year 2008 Budget

Attach current agency budget approved by board of directors and most recent income statement and balance sheet from the most recent audited financials (Note: organizations not requiring audited financial statements - attach IRS form 990 Parts I – IV)

Section 3: Expenditures and Staffing

Expenditures Fiscal Year 2007 Fiscal Year 2008 Foster Care Preventive Services Community Services  Child Care  Senior Services  Community development  Other  Other  Other Total

Staffing(number of Fiscal Year 2007 Fiscal Year 2008 positions) Program Management and General Other Total

3 All information included in this application will be treated as confidential by COFCCA. Section 4: Agency Response to RFP

Services agency is considering included in response to RFP

Community District(s) Foster care – indicate types of foster care programs

Preventive Services – indicate types of preventive service programs

Community Coalitions

Fiscal Conduit

Section 5: Agency organization and staff assigned to respond to RFP

Describe how your agency will assign staff to work on the RFP

Primary staff member responsible for preparing RFP:

4 All information included in this application will be treated as confidential by COFCCA. Role of the Consultant:

Reporting relationship (who will direct consultant’s activities?)

 Areas of involvement – a consultant may be of assistance in one of three broad categories. Please describe how you intend to use a consultant’s services and whether your intended use falls within the categories outlined below. Estimate the amount of time you believe you will require from the consultant.

 Proposal writer – taking the work prepared by others and converting to the text required to respond to the RFP.

 Facilitator – reporting to a single person within the agency – but given assignment to work with agency staff in developing the agency’s position and response to the RFP. The consultant may also be responsible for writing the RFP.

 Community Development Liaison – would be responsible to work with developing liaison between agency and community – or work with a community based group to facilitate its response to the RFP. Depending on the type of agency this consultant might also be responsible for all or some of the responsibilities above.

Please return as soon as possible via email, fax, or mail: Email: [email protected] Fax: 212-929-0870 Mail: COFCCA, 254 W. 31st Street, 5th Floor, NYC NY 10001

5 All information included in this application will be treated as confidential by COFCCA.