Orange COUNTY CITIZENS Review Panel (CRP)

ORANGE COUNTY CITIZENS’ REVIEW PANEL (CRP) FUNDING PROPOSAL FY: 2016-2017 I. COVER SHEET & AUTHORIZATION PAGE

Legal Name of Agency:

Registered Fictitious Name: Registered on Florida Department of State Division of Corporations (www.sunbiz.org)

Mailing Address:

Chief Professional Officer: Title:

Telephone/Fax: Email:

Proposal Contact Person: Title:

Telephone: Email:

Agency Fiscal Year: (mm– mm) Website:

Funding Panel:

Request for Proposal: RFP Agencies Only Authorization Our signatures certify that to the best of our knowledge the information contained in this proposal is accurate, complete and consistent with our organization’s Mission, Articles of Incorporation and Bylaws and that we have the legal authority to sign below.

Chief Volunteer Officer (type or print) Chief Professional Officer (type or print)

Chief Volunteer Officer (sign in blue ink) Chief Professional Officer (sign in blue ink)

Date Date Florida has a very broad public records law. As a result, upon request, unless otherwise exempt, any written communication created or received by Orange County officials and employees will be made available to the public and media. Furthermore, under Florida law, email addresses are public records.

1 INDEX SECTION PAGE # Cover Sheet & Authorization Page Index Supporting Documents Checklist Summary of Funding Request Agency Overview Board Governance And Structure Employee Structure And Compensation Agency Revenue Comparison Agency Expenditure Comparison Agency Budget Explanation Program/RFP Overview – Program/RFP 1 – Program/RFP Specific Information Program Demographics Program Geographic Data RFP - Proposed Outcomes Program Logic Model Program Outcomes Report Program/RFP Revenue Comparison Program/RFP Expenditure Comparison Program/RFP Expenditure Detail Program/RFP Budget Explanation: Orange County– CRP Program/RFP Overview – Program/RFP 2 – Program/RFP Specific Information Program Demographics Program Geographic Data RFP - Proposed Outcomes Program Logic Model Program Outcomes Report Program/RFP Revenue Comparison Program/RFP Expenditure Comparison Program/RFP Expenditure Detail Program/RFP Budget Explanation: Orange County– CRP Program/RFP Overview – Program/RFP 3 – Program/RFP Specific Information Program Demographics Program Geographic Data RFP - Proposed Outcomes Program Logic Model Program Outcomes Report Program/RFP Revenue Comparison Program/RFP Expenditure Comparison Program/RFP Expenditure Detail Program/RFP Budget Explanation: Orange County– CRP SUPPORTING DOCUMENTS CHECKLIST Instructions: In the order listed below, attach the following items to the original and each copy of the proposal. Place an X in all boxes indicating included or not included. Place NA for items not applicable.

2 Not Included Included 1. 501(C)(3) Determination Letter from the IRS 2. Fictitious Name Registration or Renewal from the Florida Department of State Division of Corporations (www.sunbiz.org) 3. Current Bylaws

4. Audited Financial Statement with Management Letter* (most recent) 5. Agency Audited Management Letter for Audit Submitted or Letter from the Auditor stating no Management Letter was issued. 6. Agency’s Response to the Audited Management Letter (if applicable) 7. IRS Form 990 (most recent) 8. Any correspondence received from the Internal Revenue Service since January 1, 2014 9. Annual Report (produced by organization) 10. Discrimination/EEO Policy 11. Insurance Certificate and Endorsements**

12. Strategic Plan/Planning Document and Updates 13. Americans With Disabilities Act (ADA) Policy 14. Letters of Partnerships & Collaborations or Memorandums of Understanding (MOU) from agency partners listed in the Agency Overview Section of the funding proposal. Please answer the questions below and provide a detailed explanation where necessary. 1. Provide an explanation for any requested documents not attached.

2. Is your agency (local chapter) involved in any pending litigation? Yes No (If yes, please explain) (Please use additional sheets of paper if needed)

* Agencies must comply with OMB Circular A-133 Audits of Institutions of Higher Learning. ** Insurance carriers furnishing coverage must be authorized to do business in the State of Florida, and must possess a minimum, current rating of A- Class VIII in the most recent edition of “Best Key Rating Guide”. Insurance Certificates must have all applicable endorsements required by funder.

SUMMARY OF FUNDING REQUEST RENEWAL AGENCIES ORANGE COUNTY PROGRAM ALLOCATION SUMMARY

3 For any agency currently receiving funding, please list past, current, and proposed funding amounts in Orange County’s fiscal year (October – September). Note: Table is an embedded spreadsheet with formulas, double click to activate, and then enter information. Calculations are automated. When completed, click outside the spreadsheet to deactivate. See instructions for more information about embedded spreadsheets.

Program Name Past Current % change Proposed % change (FYE 2015) (FYE 2016) (FYE 2017) 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% Total: 0 0 0% 0 0%

REQUEST FOR PROPOSAL (RFP) AGENCIES ORANGE COUNTY REQUEST FOR PROPOSAL (RFP) ALLOCATION SUMMARY For any agency applying for funding through the Orange County RFP Process please list if applicable, current and proposed funding amounts in Orange County’s fiscal year (October – September). Note: Table is an embedded spreadsheet with formulas, double click to activate, and then enter information. Calculations are automated. When completed, click outside the spreadsheet to deactivate. Past Current Proposed Program Name % change % change (FYE 2015) (FYE 2016) (FYE 2017) 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% Total: 0 0 0% 0 0%

AGENCY OVERVIEW 1. Agency’s History and Mission Statement: Provide a brief agency history and mission statement that includes agency’s goals and objectives. (Not to exceed 1 page)

2. Agency Affiliation: Is your agency a part of a larger organization? If yes, please explain your affiliation. Include information regarding operational oversight, dues, etc.

4 3. Major Agency Activities and Accomplishments during the Past Year: Provide information on major activities such as special events and agency/program achievements. (Not to exceed ½ page)

4. Major Changes during the Past Year: Provide information regarding any major changes that your agency has experienced during the past year (e.g., Board, Staff, Mergers, Location, and Policy). (Not to exceed ½ page)

5. Agency Partnerships and/or Collaborations: List any organizations with which your agency has partnerships and/or collaborations. Place an asterisk (*) next to the partners pertaining to this funding proposal. Attach letters of partnership on partner’s letterhead and/or memorandum of understanding (MOU) from each partner associated with this proposal as listed on the Support Documents Checklist.

BOARD GOVERNANCE AND STRUCTURE Please answer the following questions for your last completed fiscal year (12 months) according to your agency’s bylaws. 1. Board Structure: a) How many available Board slots does your agency have? b) How many currently seated Board Members does your agency have? c) How many Board meetings were held during the past year? d) What is the percentage of Board attendance for the past year? 2. Board Governance Structure: a) Describe the attendance guidelines and requirements for Board and committee meetings.

5 b) List your Board’s subcommittees, including the responsibilities of each committee and how many times each committee meets per year.

c) Describe your diversity goals for the agency’s Board?

d) Discuss any changes/resignation of Board members during the last year that were not related to term expiration.

3. Board’s Role & Responsibilities: Please describe the Board’s role in supervising fiscal matters of the agency.

4. Advisory Board: Ye N a) Does your agency have an Advisory Board? If yes, please answer questions b-f. s o b) Describe the role of the Advisory Board.

c) How many current Advisory Board Members does your agency have? d) How many available Advisory Board slots does your agency have? e) How many Advisory Board meetings were held during the past year? f) What is the percentage of Advisory Board attendance during the past year?

6 BOARD INFORMATION FORM 1. Provide a breakdown of the membership of your organization’s current Board of Directors.

EXECUTIVE COMMITTEE

# of Business Affiliation Phone & Areas of Continuous Current Term Name Board Position Mailing Address Gender & Title Email Expertise Years on Expiration Board

MEMBERS AT-LARGE # of Business Affiliation Areas of Continuous Current Term Name Gender & Title Expertise Years on Expiration Board

2. Describe efforts made to recruit new board members. Please include anticipated start date of upcoming board term and expertise.

7 EMPLOYEE STRUCTURE AND COMPENSATION Using the chart below, provide a breakdown of employee compensation for all current agency employees. Salary information should NOT reflect benefits, taxes, or other employee related expenditures. Note: Table is an embedded spreadsheet with formulas, double click to activate, and then enter information. Calculations are automated. When completed, click outside the spreadsheet to deactivate. Definition of Employee Groups: (Please provide definitions if your agency defines the categories differently.)

 Upper Management – CEO, President, Executive Director, Vice President, Director  Middle Management – Senior Manager, Manager, Other  Support Staff – Administrative Assistant, Clerical  Direct Service – Counselors, Childcare Providers, any staff working directly with clients/customers  Other Employee group not listed above (please define): ______

# of # FTE #PTE # of % of Total Employee Group Total Salaries Postions (filled) (filled) Vacancies Salaries

Upper Management $ - 0% Middle Management $ - 0% Support Staff $ - 0% Direct Service $ - 0% Other $ - 0% (please define position) Totals 0 0 0 0 $ - 0%

1. Does your agency currently have leased employees? If yes, please provide information about your leased employees. Include the name of the leasing company, positions, and total salaries of the group employees (Do not exceed ½ page).

8 AGENCY BUDGET REVIEW

9 Page Left Blank Intentionally Insert Agency Revenue Comparison Budget Spreadsheet Here

10 Page Left Blank Intentionally Insert Agency Expenditure Comparison Budget Spreadsheet Here

11 AGENCY BUDGET EXPLANATION Using the submitted Agency budget spreadsheets as a reference, please answer the questions below. Budgets should only reflect the organization’s operating budget. Below-the-line resources such as in-kind goods and/or services should not be included in the budget. Note: Table is an embedded spreadsheet with formulas, double click to activate, and then enter information. Calculations are automated. When completed, click outside the spreadsheet to deactivate. 1. Total Agency Budget: In agency’s fiscal year, complete the table below.

Past Current Proposed

Total Agency Budget $ - $ - $ -

Administrative Costs $ - $ - $ -

Percentage of Administrative Costs to #DIV/0! #DIV/0! #DIV/0! Agency’s Budget* Percentage of administrative costs as reported in most recent IRS Form 990*. 2. Percentage of Administrative Costs more than 25%: If the percentage of administrative costs is more than 25% of your agency’s budget for the Current and/or Proposed fiscal years, provide a breakdown of all included expenses and your plan to lower costs in the future for each year. (Do not exceed ½ page)

3. Agency Fundraising Activities: List and describe fundraising efforts for Past, Current and Proposed fiscal years. Include actual costs compared to the net funds raised for each activity. (Not to exceed 1 page)

12 4. Agency Reserves: Answer the following questions about your agency’s funding reserve. a) Does your agency currently have a funding reserve? If Yes, answer b-d. If No, proceed to e. b) What is the balance of your agency’s funding reserve? c) How is the agency’s reserve funded?

d) Provide your agency’s guidelines for utilizing funds in the funding reserve.

e) If your agency does not have a funding reserve, what is your agency’s contingency plan in the event there is a shortfall in operational funding?

5. Professional Fees/Outside Consultants: Provide a breakdown of all costs included in the line item, Professional Fees/Outside Consultants, reflected on the Agency Expenditure Comparison budget spreadsheet.

6. Budget Variances: Using the submitted Agency Expenditure Comparison budget spreadsheet as a reference, please explain variances of 20% or greater in the agency’s Historical Budgeted and Historical Actual (FYE 2014).

7. Explanation of Surplus/Deficits: What is your agency’s procedure for handling a surplus or deficit for your agency’s total budget? (Do not exceed ½ page)

8. Leveraging: Provide a breakdown of all matching dollars received for all agency revenue.

Funder & Amount of Match Source Amount of Total Amount Terms & Time Funding Match per Dollar of Matched Period of Match Dollars

13 INDIVIDUAL PROGRAM/RFP INFORMATION

Complete for each program/RFP.

Name of Program/RFP 1:

14 PROGRAM/RFP OVERVIEW

1. Brief Program/RFP Description: Please provide a brief description of the program/RFP. (Not to exceed 50 words)

2. Program/RFP Detailed Description and Design: Please provide a detailed description of the program or proposed RFP, including the main purpose, types of services provided, agency’s history and experience providing these services, the need for the services, geographic area to be served, partnership with other agencies to provide the services, participant goals and objectives, targeted groups to be served, staffing plan, and community support. Please include any data you are using to support that the requested need exists in Orange County. (e.g., agency data, survey information, needs assessment data, other secondary data sources, etc.) (Not to exceed 2 pages)

3. Success Story: Please provide a short success story from last fiscal year. (Not to exceed 1 page)

15 PROGRAM/RFP SPECIFIC INFORMATION

1. Outreach Plan: Describe the outreach plan for the program/RFP and strategies used to engage target population. Include how participants are identified, engaged, and retained. (Not to exceed ½ page)

2. Waiting List: Does this program have a waiting list? Yes No If yes, please provide: a) The number of clients on the list b) The average time on waiting list c) The date of oldest referral d) How often the list is revisited, include how you prioritize the list? (Explain below)

. If no, how do you address overflow? (Explain below)

3. Program Changes: If your agency has previously received funding for this program/RFP, list any significant changes to the program during the past year. Include demographics, staffing, locations, hours, etc. (Do not exceed ½ page)

4. Volunteer Usage: Answer the following questions regarding the use of volunteers. a) How volunteers are or will be utilized to support this program/RFP? Explain your strategy for recruitment, orientation, and training of volunteers.

b) List all background checks and screenings necessary for each volunteer position. Include whether you are currently in compliance with each background check or screening requirement listed.

16 PROGRAM DEMOGRAPHICS Demographic Information 1. Provide the following information about all unduplicated clients served by this program from October 1, 2014 to September 30, 2015. Only include information for clients funded by Orange County. Total Number of Unduplicated Clients Served: NA – My agency was not funded during this timeframe.

AGE RACE/ETHNICITY HOUSEHOLD INCOME MALE FEMALE MALE FEMALE Less than $25,000 0-4 Black $25,000 - $50,000 5-9 White $50,001 - $100,000

10-14 Hispanic/Latino $100,000+ Asian/Pacific 15-19 Unknown Islander 20-34 Native American TOTAL 35-54 Mixed/Biracial 55-64 Other 65+ Unknown Unknown TOTAL TOTAL

HOUSEHOLD TYPE EMPLOYMENT STATUS RESIDENCE With Without MALE FEMALE MALE FEMALE Children Children Married/ Orange Employed Couple County Single Female Unemployed Other

Single Male Retired Unknown Extended/ *N/A TOTAL Multi-Family Other Unknown Unknown TOTAL *not expected to work, i.e., children TOTAL

2. If you are unable to provide any of the above information, please explain.

17 PROGRAM GEOGRAPHIC DATA Please indicate areas where clients lived during the period of October 1, 2014 to September 30, 2015. NA – My agency was not funded during this timeframe.

CITIES Apopka Bay Lake Belle Isle Eatonville Edgewood

Lake Buena Vista Maitland Oakland Ocoee Orlando

Windermere Winter Garden Winter Park Unincorporated Orange County

ZIP CODES 32703 32704 32709 32710 32712 32751 32768 32777 32789 32790

32792 32793 32794 32798 32801 32802 32803 32804 32805 32806

32807 32808 32809 32810 32811 32812 32813 32814 32816 32817

32818 32819 32820 32821 32822 32824 32825 32826 32827 32828

32829 32830 32831 32832 32833 32834 32835 32836 32837 32839

32853 32854 32855 32856 32857 32858 32859 32860 32861 32862

32867 32868 32869 32872 32877 32878 32885 32886 32887 32890

32891 32893 32896 32897 32898 32899 34734 34740 34760 34761

34777 34778 34786 34787

NEIGHBORHOODS Alafaya Aloma Azalea Park Bithlo Carver Shores

College Park Downtown Fairvilla Hiawassee Holden/Parramore

Lockhart Margaret Square Mercy Drive Orlo Vista Pine Castle

Pine Hills Sand Lake South Creek Taft Union Park

Washington Shores

18 RFP PROPOSED OUTCOMES (New Agencies Only) Provide at least two (2) proposed outcomes and plan for measuring success for this RFP.

Outcome 1:

a) Proposed Indicator:

b) Proposed Measurement Tool: c) Proposed Frequency of Data Collection:

Outcome 2:

a) Proposed Indicator:

b) Proposed Measurement Tool: c) Proposed Frequency of Data Collection:

19 PROGRAM LOGIC MODEL Complete this section if your organization is currently receiving funding for fiscal year 2014-2015 from Orange– CRP. 1. Measuring Program Success: Complete the Program Logic Model to reflect how you will measure program success. Include funder approved Outcomes, activities, indicators, tools used to evaluate program success, and frequency of data collection. Resources Activities Outputs Outcomes Goals Service Providers:

Program Setting:

Community Factors:

Collaborations:

Service Technologies:

Funding Sources:

Participants:

2. How frequently is data collected? (e.g., sign-in sheets collected daily).

20 PROGRAM OUTCOMES REPORT Complete this section if your organization received funding for fiscal year 2014-2015 from Orange County – CRP. This information should be based on data collected from October 1, 2014 to September 30, 2015.

Outcome 1:

Total number of clients counted Total number of clients meeting this towards this outcome: outcome: Percentage of outcome achieved: (# of clients meeting this outcome ÷ # of clients counted towards this outcome) Was Outcome Achieved? Yes No If no, provide an explanation and plan for program adjustments.

Outcome 2:

Total number of clients counted Total number of clients meeting this towards this outcome: outcome: Percentage of outcome achieved: (# of clients meeting this outcome ÷ # of clients counted towards this outcome)

Was Outcome Achieved?

If no, provide an explanation and plan Yes No for program adjustments.

Outcome 3:

21 INDIVIDUAL PROGRAM/RFP BUDGET REVIEW

22 Page Left Blank Intentionally Insert Program/RFP Revenue Comparison Budget Spreadsheet Here

Note: Be Sure To Insert Page Numbers on Each Spreadsheet

23 Page Left Blank Intentionally Insert Program/RFP Expenditure Comparison Budget Spreadsheet Here

24 Page Left Blank Intentionally Insert Program/RFP Expenditure Detail Budget Spreadsheet Here

25 PROGRAM/RFP BUDGET EXPLANATION Using the submitted Program/RFP budget as a reference, please answer the following questions. Below-the- line resources such as in-kind goods and/or services should not be included in the budget.

1. Explanation of Funding: Using the Program/RFP Expenditure Detail budget spreadsheet as a reference, please provide, for each year, a breakdown of what funding from Orange County – CRP will specifically fund. Funding for FYE 2016 Funding for FYE 2017

2. Units of Service: Provide the unit of service (e.g., shelter nights, hours, etc.) and the cost per unit ($ per unit). Then, in the space provided, calculate the total cost of a service year based on the defined unit of service. (# of units in a service year x $ - unit cost = total cost per service year) Be specific to each funder. Note: Proposed unit cost is not guaranteed. If the agency is recommended for funding, the final unit cost will be negotiated and must be approved by each funded before contract execution. Description of Unit of Cost per Unit of Total Cost per Service Service X Service Year (e.g., 45 units, Shelter Night – (e.g., $10 per night) = (e.g., $10 X 50 nights = $500) Use of a bed with 1 meal and hot shower)

3. Professional Fees/Outside Consultants: Provide a breakdown of all costs included in the line item, Professional Fees/Outside Consultants, reflected on the Program/RFP Expenditure Comparison budget spreadsheets.

4. Budget Variances: Using the submitted Program/RFP Expenditure budget spreadsheet as a reference, please explain variances of 20% or greater in the agency’s Historical Budgeted and Historical Actual.

PROGRAM/RFP OVERVIEW

27 4. Brief Program/RFP Description: Please provide a brief description of the program/RFP. (Not to exceed 50 words)

PROGRAM/RFP SPECIFIC INFORMATION

28 5. Outreach Plan: Describe the outreach plan for the program/RFP and strategies used to engage target population. Include how participants are identified, engaged, and retained. (Not to exceed ½ page)

6. Waiting List: Does this program have a waiting list? Yes No If yes, please provide: e) The number of clients on the list f) The average time on waiting list g) The date of oldest referral h) How often the list is revisited, include how you prioritize the list? (Explain below)

8. Volunteer Usage: Answer the following questions regarding the use of volunteers. c) How volunteers are or will be utilized to support this program/RFP? Explain your strategy for recruitment, orientation, and training of volunteers.

d) List all background checks and screenings necessary for each volunteer position. Include whether you are currently in compliance with each background check or screening requirement listed.

PROGRAM DEMOGRAPHICS

29 Demographic Information 3. Provide the following information about all unduplicated clients served by this program from October 1, 2014 to September 30, 2015. Only include information for clients funded by Orange County. Total Number of Unduplicated Clients Served: NA – My agency was not funded during this timeframe.

PROGRAM GEOGRAPHIC DATA

30 Please indicate areas where clients lived during the period of October 1, 2014 to September 30, 2015. NA – My agency was not funded during this timeframe.

ZIP CODES 32703 32704 32709 32710 32712 32751 32768 32777 32789 32790

32792 32793 32794 32798 32801 32802 32803 32804 32805 32806

32807 32808 32809 32810 32811 32812 32813 32814 32816 32817

32818 32819 32820 32821 32822 32824 32825 32826 32827 32828

32829 32830 32831 32832 32833 32834 32835 32836 32837 32839

32853 32854 32855 32856 32857 32858 32859 32860 32861 32862

32867 32868 32869 32872 32877 32878 32885 32886 32887 32890

32891 32893 32896 32897 32898 32899 34734 34740 34760 34761

34777 34778 34786 34787

Washington Shores

RFP PROPOSED OUTCOMES (New Agencies Only) 31 Provide at least two (2) proposed outcomes and plan for measuring success for this RFP.

Outcome 1:

d) Proposed Indicator:

e) Proposed Measurement Tool: f) Proposed Frequency of Data Collection:

Outcome 2:

d) Proposed Indicator:

e) Proposed Measurement Tool: f) Proposed Frequency of Data Collection:

Program Setting:

Community Factors:

Collaborations:

Funding Sources:

Participants:

Outcome 1:

Outcome 2:

Outcome 3:

PROGRAM/RFP OVERVIEW

40 7. Brief Program/RFP Description: Please provide a brief description of the program/RFP. (Not to exceed 50 words)

PROGRAM/RFP SPECIFIC INFORMATION

41 9. Outreach Plan: Describe the outreach plan for the program/RFP and strategies used to engage target population. Include how participants are identified, engaged, and retained. (Not to exceed ½ page)

10. Waiting List: Does this program have a waiting list? Yes No If yes, please provide: i) The number of clients on the list j) The average time on waiting list k) The date of oldest referral l) How often the list is revisited, include how you prioritize the list? (Explain below)

12. Volunteer Usage: Answer the following questions regarding the use of volunteers. e) How volunteers are or will be utilized to support this program/RFP? Explain your strategy for recruitment, orientation, and training of volunteers.

f) List all background checks and screenings necessary for each volunteer position. Include whether you are currently in compliance with each background check or screening requirement listed.

PROGRAM DEMOGRAPHICS

42 Demographic Information 5. Provide the following information about all unduplicated clients served by this program from October 1, 2014 to September 30, 2015. Only include information for clients funded by Orange County. Total Number of Unduplicated Clients Served: NA – My agency was not funded during this timeframe.

PROGRAM GEOGRAPHIC DATA

43 Please indicate areas where clients lived during the period of October 1, 2014 to September 30, 2015. NA – My agency was not funded during this timeframe.

ZIP CODES 32703 32704 32709 32710 32712 32751 32768 32777 32789 32790

32792 32793 32794 32798 32801 32802 32803 32804 32805 32806

32807 32808 32809 32810 32811 32812 32813 32814 32816 32817

32818 32819 32820 32821 32822 32824 32825 32826 32827 32828

32829 32830 32831 32832 32833 32834 32835 32836 32837 32839

32853 32854 32855 32856 32857 32858 32859 32860 32861 32862

32867 32868 32869 32872 32877 32878 32885 32886 32887 32890

32891 32893 32896 32897 32898 32899 34734 34740 34760 34761

34777 34778 34786 34787

Washington Shores

RFP PROPOSED OUTCOMES (New Agencies Only) 44 Provide at least two (2) proposed outcomes and plan for measuring success for this RFP.

Outcome 1:

g) Proposed Indicator:

h) Proposed Measurement Tool: i) Proposed Frequency of Data Collection:

Outcome 2:

g) Proposed Indicator:

h) Proposed Measurement Tool: i) Proposed Frequency of Data Collection:

Program Setting:

Community Factors:

Collaborations:

Funding Sources:

Participants:

Outcome 1:

Outcome 2:

Outcome 3: