West Virginia Development Office s1

WEST VIRGINIA DEVELOPMENT OFFICE APPLICATION FOR THE FLEX-E-GRANT PROGRAM YEAR 17

A non-construction leadership and community capacity building program

ALL APPLICATIONS MUST BE POSTMARKED NO LATER THAN JANUARY 12, 2018

Please return application to: West Virginia Development Office Attn: James Bush State Capitol Complex Building 3, Suite 700 Charleston, West Virginia 25305-0311

The Flex-E-Grant program is funded by the Appalachian Regional Commission and the Claude Worthington Benedum Foundation APPALACHIAN REGIONAL COMMISSION FLEX-E-GRANT PROGRAM APPLICATION STATE OF WEST VIRGINIA

Section I: APPLICANT/PROJECT INFORMATION and SUMMARY

A. General Information:

Applicant Organization:

Certifying Official: Title:

Contact Person: Title:

Organization Address:

City, State, Zip:

Contact Telephone Number:

Contact E-Mail Address:

Applicant Organization EIN Number: ______

Applicant Organization DUNS Number: ______

List the county(ies) in the project area and their designation (distressed, at-risk, transitional, competitive):

B. Project Category and Eligible Activity: Indicate the appropriate project category and eligible activity number. (See pages 9-10 of the Technical Assistance Guide.) Place the eligible activity number in the space provided. Do not use a checkmark. Choose the one project activity that best describes your project.

2 ______Project Category 1: Individual Capacity Building ______Project Category 2: Institutional/Organizational Capacity Building ______Project Category 3: Community Capacity Building

C. Anticipated Outcome(s): Indicate the anticipated outcome of the project. The outcome is the product that will be created at the end of the project. Check all that apply.

1. New community organization created _____

2. New partnership created _____

3. Plan created or revised (strategic plan, marketing plan, sustainability plan, etc.) _____

4. Community assessment completed _____

5. Feasibility study completed _____

6. Organizational assessment completed _____

7. Financial management training completed (survey required) _____

8. Increase in certification of staff members _____

9. Leadership/board development training completed (survey required) _____

10. Volunteer recruitment plan completed _____

11. Other (specify below): _____

3 D. Areas of Emphasis: Check all that apply. (See pages 7-8 of the Technical Assistance Guide for full descriptions.)

_____ 1. Economic Opportunity _____ 2. Infrastructure

_____ 3. Human Resource Development _____ 4. Local Capacity

_____ 5. Health Care ____ 6. Energy Efficiency

_____ 7. Local Food Systems _____ 8. Downtown Improvements

_____ 9. Creative Communities _____ 10. Environmental Assets

_____ 11. Community Foundations

Section II: APPLICANT/PROJECT INFORMATION and SUMMARY

Project Name:

Project Goal:

Project Activities:

Project Outcomes:

Section II: PROJECT FUNDING

4 Source Amount Commitment Letter Enclosed (yes or no) Flex-E-Grant (indicate the amount requested): Matching Funds (please list each separately): 1. 2. 3.

TOTAL PROJECT COST: $

Section III: ATTACHMENTS

A. Project Narrative: The Application Checklist on pages 5-6 of the Application provides detailed information regarding the content of the Project Narrative. Please include all required elements of the Project Narrative in the order indicated. Maximum length: 5 pages. B. Project Budget and Detailed Budget Narrative: Complete the detailed budget form found on page 7 of the Application that includes Flex-E-Grant and matching funds. The budget narrative must explain in detail expenditures by line item on a separate page. C. Project Schedule: A detailed schedule for implementation of the project. Maximum length: 2 pages. D. Letters of Commitment from all sources of matching funds. E. Resolution: Submit a resolution from the applicant’s board or governing body that authorizes participation in the Flex-E-Grant program. The resolution should also indicate/designate the person responsible for signing and acting upon the grant contract, if awarded. A sample resolution is provided on page 8 of the Application. F. Documentation of Organizational Capacity: Applicant should be able to document successful experiences in grant management and project implementation. G. Documentation of Non-Profit Status (if applicable): Non-profit applicants must submit a copy of their current West Virginia Secretary of State registration as a non-profit corporation. In addition, they must also submit proof of their registration with the West Virginia Secretary of State as a charitable organization (if applicable) and a copy of their latest IRS Form 990.

All approved applicants will be required to enter into individual project negotiations prior to contract award and project commencement. All grantees will be required to fully participate in a formal evaluation process and to attend any mandatory technical assistance workshops or trainings.

I certify that all statements in this application and the attached documents are true and correct to the best of my knowledge. Furthermore, I am authorized by my organization to apply for the Flex-E-Grant, and I agree to participate in the evaluation and to attend any mandatory technical assistance workshops or trainings.

______Signature of Certifying Official/Applicant Date

5 ARC FLEX-E-GRANT PROJECT APPLICATION CHECKLIST

Use this checklist as you review and format your application prior to submittal to the WVDO. Please be specific and use appropriate page numbers in the spaces provided (do not use checkmarks). ALL PROJECTS MUST INCLUDE THE FOLLOWING COMPONENTS:

SECTION I – APPLICANT/PROJECT INFORMATION & SUMMARY (pages 1-3 of the Application) Page # A. General Information: Applicant name, address, project purpose, description, contact person, etc. The contact person should be an individual that the WVDO can contact for additional information or questions about the proposed project. B. Project Category and Eligible Activity: Indicate the appropriate project category and eligible activity number in the space provided. Details on eligible project activities are provided on pages 9-10 of the Technical Assistance Guide. C. Anticipated Outcomes: Select the anticipated outcome(s) of the project. D. Areas of emphasis: Select the area(s) of emphasis of the project. SECTION II– PROJECT FUNDING (page 4 of the Application) SECTION III – ATTACHMENTS A. Project Narrative: Total project narrative cannot exceed 5 pages. Please follow the format below and use the bolded section titles in your narrative. 1) Project Area: Briefly state what community, county, or counties your project will serve. (One or two sentences.) 2) Need for the Project: Provide a description of the need for the project. (One or two paragraphs.) 3) Goal of the Project: Briefly describe the goal or purpose of the project. (One or two sentences.) 4) Project Activities: Describe in detail the training, planning, or civic engagement activities that your project will conduct. How will the activities lead to achieving the goal? Also describe what other organizations/agencies you will partner with. (No more than three pages.) 5) Outcome(s): Briefly state the expected outcome(s) or product(s) to be derived from the project and that will benefit the project area. Describe in quantitative terms what you will have at the end of the project that you did not have at the beginning of the project. If you will be using a survey instrument or other evaluation instrument, include a copy with the application. (Several sentences.) 6) Impact: Describe how the outcome (the deliverable or product) identified above will improve your project area identified above. How will the outcome promote economic or community development? (One or two paragraphs). 7) Sustainability: How will you continue to promote economic or community development in your community or region after the conclusion of your project? What will you need to continue to promote economic or community development? Have you identified any alternative sources of funding? (One or two paragraphs.)

6 ARC FLEX-E-GRANT PROJECT APPLICATION CHECKLIST

SECTION III – ATTACHMENTS (CONT.) Page # B. Project Budget and Detailed Budget Narrative: Complete the detailed budget form found on page 7 of the Application that includes Flex-E-Grant and matching funds. The detailed budget narrative must explain expenditures by line-item. Please provide a detailed budget narrative on a separate page. C. Project Schedule: Provide a detailed list of milestones for implementation of the project (maximum 1 page). NOTE: Projects should be able to commence upon award of the Flex-E-Grant and conclude within ten months. D. Letters of Commitment/Support: Provide letters of commitment from all sources of matching funds. Provide letters of support from project partners. E. Resolution: It will be necessary to submit a resolution from the applicant’s board or governing body that authorizes participation in the Flex-E-Grant program. The resolution should also indicate/designate the person responsible for signing and acting upon the grant contract, if awarded. A sample resolution can be found on page 8 of the Application. NOTE: You must have two different signatures from officials of the applicant organization. F. Documentation of Organizational Capacity: Describe and document the capacity of the organization to administer Flex-E-Grant funds. Applicants should be able to document successful recent experiences in grant management and project implementation. G. Documentation of Current Non-Profit Status (only applicable to non-profit applicants): Non-profit applicants must submit a copy of their current West Virginia Secretary of State registration as a non-profit corporation. In addition, they must also submit proof of their registration with the West Virginia Secretary of State as a charitable organization (if applicable), a copy of their latest IRS Form 990, and a copy of their 501c3 IRS determination letter.

7 Section III: ATTACHMENT B: PROJECT BUDGET AND DETAILED BUDGET NARRATIVE

Please provide a detailed budget that includes Flex-E-Grant and all matching funds. As a reminder, Indirect Costs, Equipment Purchases, and Construction Costs, are not permissible. Administrative costs can only be used as match.

What is the difference between a direct cost and an indirect cost? A direct cost is any cost that can be easily identified with a specific project (grant/contract): e.g., Materials & Supplies, Consultants. An indirect cost is any cost that cannot be easily identified (or it would not be cost effective to identify) to a specific project, but identified with two or more final cost objectives. Indirect costs are not permissible under this program. There are three types of indirect costs: Fringe Benefits: services or benefits provided to employees, e.g., Health Insurance, Payroll Taxes, Pension Contribution, Paid Absences, etc. Overhead: indirect costs associated with the performance of a project, e.g., Facility Costs (rent, heat, electricity, etc.). G&A: indirect costs associated with the overall management of an organization, e.g., President’s Office, Human Resources Office, Accounting Office, General Office Supplies, Office Maintenance, Etc.

Flex-E-Grant Match Total CATEGORY

Administration (Salaries, etc.) Not eligible

TOTAL PROJECT COST $ $ $

Please provide a detailed narrative for each line-item on a separate page.

YEAR 17 Flex-E-Grant Attachment E

8 S A M P L E R E S O L U T I O N

(Must be on letterhead of requesting organization)

The ______met on ______with a (Organization) (Date)

quorum present and passed the following resolution.

Be it resolved that the ______hereby authorizes (Organization)

______of the ______(Name of Individual and Title) (Organization)

to apply for Flex-E-Grant funds, for leadership and/or capacity building activities, on behalf of

______. (Organization)

Be it also resolved that the ______hereby authorizes the (Organization)

certifying official ______(Name of Individual and Title)

of the ______(Organization)

to act on its behalf to enter into a contractual agreement with the West Virginia Development Office to receive and administer grant funds pursuant to provisions of the Flex-E-Grant Program, if awarded.

Be it further resolved that the governing body of ______pledges (Organization)

$______in unencumbered matching funds for the project. (Dollar Amount)

Signature:______

Print Name: ______

Title: ______

Organization: ______