Non-Profit Service Agency

Nonprofit Service Organization Cobb County Nonprofit Grant Funding FY 2017 and FY 2018 Application

Please complete all sections. APPLICATION MUST Submit original and all copies to: BE TYPED (not handwritten or hand printed). Cobb County Finance – Budget Division INCLUDE ORIGINAL PLUS THREE (3) CLIPPED 100 Cherokee Street, Suite 430 (4th Floor) COPIES OF THE APPLICATION. Marietta, GA 30090 ATTN: Catherine Brown

Submission Deadline: Thursday, March 31, 2016 1:00 p.m.

Part I: APPLICANT INFORMATION

1. Name of Organization:

Name Telephone Fax Website

Address City State Zip Code

2. Cobb County address (if different from above):

Address City State Zip Code

3. Primary contact person for this grant application:

Name Title Telephone Fax E-mail

4. Financial contact for this grant application, if different than above:

5. Senior Officer (Board Chair, etc.)

6. Applicant’s fiscal year begins ______and ends ______

7. Applicant’s EIN #: ______DUNS #: ______

8. Is your organization currently registered with the Secretary of State? ___ Yes ___ No

Cobb County Nonprofit Grant Application FY 17-18 Page 1 9. Priority Area(s) for which Cobb County funds are being requested (Check all that apply)

NOTE: Cobb County will not fund projects outside of these categories.

(A.) Total request Basic Needs (includes housing/shelter, food, clothing and health) $______%______(organization’s Cobb County total operating budget)

___ Organization’s General and Administrative Activities (Operating) ___ Maintain Existing Services ___ Improvement to Existing Services ___ New Services ___ Project Support ___ Other (Specify) ______

(B.) Total request Education/Employment $______%______(organization’s Cobb County total operating budget)

(C.) Total request Public Safety/Legal System/Crime Prevention $______%______(organization’s Cobb County total operating budget)

(D.) Total organization’s Cobb County operating budget $______.

Part II: ORGANIZATION INFORMATION

10. What is the mission of your organization? When was it founded? Describe its history and experience in providing services to Cobb residents. (300 words maximum)

11. Strategic Plan (1 page maximum) a. Does your organization have a Board approved strategic plan? Yes No b. How often is the organization’s strategic plan reviewed? ______c. Describe how the strategic plan is used by your staff: ______

d. Describe how this request fits with your strategic plan: ______

Cobb County Nonprofit Grant Application FY 17-18 Page 2 12. Board of Directors: a. How many Board members do you have? ______b. How often does the full Board of Directors meet? ______c. How often do your Board Officers meet? ______d. Are Board members compensated? ____ Yes ____ No if “yes,” please describe. e. Title of Officer with fiscal oversight responsibility for the organization. ______

13. List any conditions or recommendations included in either of the last two audited financial reports or reviews or correspondence from the organization’s auditor.

__ Not Applicable

If applicable, describe how the organization has addressed conditions and/or recommendations. If more space is needed, please add pages:

14. Complete the table below: A) Place a check mark next to funding resources received in the last (2) years. (Check all that apply) B) Calculate the percentage of the last completed FY budget for each funding source. (overall organization)

Funding Category Check All That Apply % of Last Completed FY Budget (Organization) FY 2014 FY 2015 FY 2015 Local State Federal Foundations Corporations Individuals Other

15. Did the organization receive grant funding through the Cobb County Nonprofit Grant process during the last grant cycle? ______Yes ______No

Cobb County Nonprofit Grant Application FY 17-18 Page 3 Part III: PROGRAM INFORMATION Check and complete one set of Part III questions for each Priority Area for which the organization is applying. (Attach additional pages as needed.)

___ Basic Needs (includes housing/shelter, food, clothing and health) ___ Education/Employment ___ Public Safety/Legal System/Crime Prevention

I. Describe the need(s) or problem(s) in the community to be addressed with the request for Cobb County funding. (1,000 words maximum) A. Describe your target population (include age, income, special needs, geographical service area and any other special characteristics). B. Indicate needs to be addressed with Cobb County funds. C. Provide statistical data on need in Cobb County. D. Identify other organizations that are working to meet the same need in Cobb County. E. Identify remaining service gaps in Cobb County.

II. Describe in detail the project/program/service to be carried out with the funding being requested from Cobb County. (1,000 words maximum) A. Include a description of how this effort will address the needs identified in this application. B. State exactly how Cobb County funds will be used.

III. Describe how your organization is uniquely qualified to provide the service. A. Include qualifications B. Programs of the organization C. Past program results D. Number of years your organization has provided the programs/services for which funding is requested

16. Indicate the accessibility of your programs and services to your target population. Please address: a. Location b. Transportation E. Handicapped accessibility

Cobb County Nonprofit Grant Application FY 17-18 Page 4 17. Program Outcome Model: What are the OUTCOMES you plan to achieve? (Outcomes are measurable changes in a person’s behavior or condition.) Outcomes are not merely the number served or the results of customer service surveys. Answer the Program Outcome Model questions below to describe the expected outcomes and logic behind achieving them. You MUST include at least one of the mandatory outcomes, but no more than a total of 4, associated with each priority area for which you are applying (See Instruction Guide for required outcomes and indicators). (ADD TEXT BOXES UNDER EACH SECTION)

a. Inputs: What resources are needed to make the program work? b. Activities: What does the program do with those resources? c. Outputs: What are the direct products of program activities? d. Outcomes: What change has occurred as a result of these activities? MUST include at least one of the mandatory outcomes associated with the priority area for which you are applying.

18. Outcome Measurement Framework: How are you going to measure the outcomes for this project? Use the Outcome Measurement Framework questions below and give specific examples. For each mandatory outcome, you MUST include at least one of the mandatory indicators (See Instruction Guide for required outcomes and indicators).

For each outcome stated in question #21, please answer the following questions: a. Outcome: Please restate the outcomes listed above. b. Indicator(s): What evidence will you have that the outcome has been attained? c. Measurement Instruments: Where are you going to get your data? How will you collect it? What instruments will you use? Any evaluation tools included in your answer should be available for review at the site visit. d. Target: What is your goal for each outcome? i. Provide the goal (s) in raw numbers ii. Provide the goal (s) in percentages

Cobb County Nonprofit Grant Application FY 17-18 Page 5 Part IV: FINANCIAL INFORMATION Program Budget ONLY

Check and complete a budget for each Priority Area for which the organization is applying.

___ Basic Needs (includes housing/shelter, food, clothing and health) ___ Education/Employment ___ Public Safety/Legal System/Crime Prevention

(Round to Nearest Dollar) SECTION I: Program Revenue FY16 FY17 October- October- September September Cobb County Nonprofit Grant Requested Funds Other Revenue Sources (excluding the Cobb County Nonprofit Grant) Program In-Kind Donations Total Program Revenue SECTION II: Program Expenditures (Cobb County Funds Only) General/Operating (non-salaries): Day-to-day operating costs of an existing program or organization. Examples: rent, maintenance, power bills, office supplies, etc. Fundraising (non-salaries): Costs of fundraising activities, marketing and to expand audience base; costs associated with an organized effort by a nonprofit to secure funds on an annual basis and campaign to raise funds for a variety of long- term purposes, such as building construction or acquisition, endowments, land acquisition, etc. Program Implementation (non-salaries): Cost of developing and/or implementing specific projects or programs, including workshops. Other Program Implementation Costs:

Cobb County Nonprofit Grant Application FY 17-18 Page 6 Program Salary: Cost of salary and benefits for full-time, part-time and contractual labor. Administrative Salary: Cost of salary and benefits for full-time, part-time and contractual labor. Fundraising Salary: Cost of salary and benefits for full-time, part-time and contractual labor. Supplies: Equipment: Costs of equipment or furnishings Travel: Professional Development/Training: Other (Specify):

Total Cobb County Requested Grant Fund Expenditures

Cobb County Nonprofit Grant Application FY 17-18 Page 7 Part V: ATTACHMENTS

19. All attachments should be in 8-1/2” x 11” format and unbound, to permit copying and filing. Original plus three (3) copies of the application must be attached. Only one set of attachments needs to be submitted. Please attach the following:

a) List of the Board of Directors and Officers b) Most recent Board minutes c) Copy of your IRS verification of nonprofit, tax-exempt status d) Copy of most recent registration receipt with Secretary of State e) Copy of your most recent audited financial statements or review, including a balance sheet showing assets and liabilities f) Copy of your organization’s current operating budget g) Copy of your current organizational by-laws h) Copy of your articles of incorporation i) Original, Signed Certificate of Attendance – RFP Training

Authorized Signature

I certify that, to the best of my knowledge, the information provided in this application and any attachments is accurate, complete and endorsed by the organization that I represent. I certify that if funds are received for service operations as a result of this application, the service will be operated for the benefit of Cobb County residents.

______Signature of Authorized Agent Date

______Name (Printed) Title (Printed)

______Board Chair Signature Date

______Name (Printed)

Cobb County Nonprofit Grant Application FY 17-18 Page 8