<p> 2017 Emergency Feeding Program Food Grant Application</p><p>Grant Eligibility Requirements for Program:</p><p>1) Must be a food pantry, hot meal, or shelter program 2) Must have been approved by Second Harvest on or before April 1, 2016 3) Cannot currently on “hold” or on “probation” 4) Have an Active Status with Second Harvest 5) Have a current non-profit 501(c)(3) status with the Internal Revenue Service, or have required tax-exempt status (some churches) 6) Be in Good Standing with Second Harvest during the past year by: a. Ensuring compliance with the current policies in place by Second Harvest, detailed in the Second Harvest Agency Relations Manual and set forth in the Partner Charity Letter of Agreement including: i. Submitting payments within 30 days of the statement date; ii. Submitting statistical reports no later than the 15th of the month for the previous month; b. Ensuring compliance with the current regulations in place by the Ohio Department of Job and Family Services (ODJFS), detailed in the ODJFS Food Programs Manual and set forth in the USDA, OFPACP Letter of Agreement including: i. Serving clients at least once per month, each month of the year; ii. Prominently displaying the “And Justice for All” poster and the TEFAP Applicant and Recipient Rights Document; iii. Prominently displaying the current ODJFS Income Eligibility Guidelines provided by Second Harvest (pantry programs); iv. Honoring client eligibility criteria as established by the ODJFS (pantry programs); v. Utilizing the current ODJFS Household Income Eligibility Guidelines and Eligibility To Take Food Home forms provided by Second Harvest or current forms in PantryTrak (pantry programs). Instructions & Notes:</p><p> If you operate more than one program, each program must apply separately</p><p> Include your Program number, DUNS number & EIN number on the application</p><p> A program which does not submit an application will not be considered for food grant funding in 2017</p><p> Answer ALL questions. Mark not applicable if the question does not apply to your organization or program</p><p> You may attach additional sheets if more space is needed to answer a question. </p><p> Late or incomplete applications will not be considered.</p><p>Grant Application P a g e | 1  Include a copy of your program budget with the Application.</p><p> Return completed applications by 12:00 am on MONDAY, MARCH 27, 2017.</p><p>General Information:</p><p>Agency Name: Second Harvest Office Use Only Statistics Current  Yes  No Agency Director/Senior Pastor:</p><p>Agency Mailing Address: Account Current  Yes  No EIN Number DUNS Number Monitor Current  Yes  No </p><p>Phone Email Trainings Current  Yes  No </p><p>Program Name: Program Number: Program Coordinator: E-mail: Site Address: Phone: Program Type: Hot Meal __ Program Days & Hours of Operation: Pantry __ Shelter __ </p><p>What is the total number of households and individuals served last month? HH: IND:</p><p>What is the average number of households and individuals served last year? HH: IND:</p><p>By what percent has the total number of households and individuals you serve increased from January 2016 to December 2016? </p><p>Explain if you recently have served less households and/or people. (percentage decreased)</p><p>Does your program have a specific service area? (County, City, School District, etc.)  Yes  No If yes, state your service area:</p><p>What documentation do you require clients provide to receive food assistance? </p><p>Grant Application P a g e | 2 Do you require a fee or donation to receive food assistance?  Yes  No If yes, explain:</p><p>How often are clients allowed to receive help from your program?</p><p>Estimated percentage of food your program received from Second Harvest last year for this program:</p><p>Estimated percentage of food needed to run your program which you get from other sources: (food drives, wholesale or retail stores, food donations, etc.)</p><p>Do you currently offer other services at your site? (In addition to the program for which you are making application.)  Yes  No Do you offer any of the following services? Utility Assistance  Rent/Mortgage Assistance  Clothing  OBB  Furniture/Household Items  Hot Meal  Shelter  Pantry/Mobile Pantry  Kids Cafe  BackPack  Farmers Market  CSFP  Other  If you checked “Other”, please explain:</p><p>Do you collaborate with other Agencies in your area?  Yes  No Explain how and why or why not:</p><p>Grant Application P a g e | 3 Financial Information:</p><p>Is your program having financial difficulties?  Yes  No If yes, explain:</p><p>Have you had to eliminate services, cut back on days/times services are offered or decrease amount of food being given to clients over the last year due to budget constraints?  Yes  No If yes, please explain:</p><p>Has your Agency or Program(s) gained or lost a significant source of funding in the past year?  Yes  No If yes, please explain how much and the effect on your program:</p><p>Do you have more than one funding source? (fundraisers, donations, grants, food drives, etc.)  Yes  No Please list types below:</p><p>What will additional food grants funds allow you to do? Serve more people? Serve more often?</p><p>What other resources do you need to help serve additional families?</p><p>Additional information you would like us to know about your Agency or Program(s) such as challenges, future plans, etc.:</p><p>Dollar amount of grant funding you are requesting for your program from April 15, 2017 through March 31, 2018. </p><p>Grant Application P a g e | 4 Note: Attach your Program budget to the Application on a separate sheet.</p><p>As an authorized representative of the program, I understand the Grant Eligibility Requirements listed on Page 1 of this application to receive the 2017 Emergency Feeding Program Food Grant and I agree to meet these conditions. I further understand that failure to comply with any of the above requirements will disqualify our program from receiving grants in the future.</p><p>Name of Authorized Representative: (PLEASE PRINT)</p><p>Signature of Authorized Representative Date</p><p>Submitting the Application:</p><p>Applications must be received before 12:00 AM on Monday, March 27, 2017</p><p>Mail Application To: Second Harvest Food Bank of North Central Ohio Attn: Cathy Sheetz Program & Member Services 5510 Baumhart Rd. Lorain, OH 44053-1982</p><p>Email Application To: [email protected]</p><p>Contact the Agency Relations staff if you have questions regarding the Application:</p><p>Grant Application P a g e | 5 Bev Lizanich, Director of Program & Member Services, via email: [email protected]; or by phone: 440.960.2265 , ext. 309</p><p>Cathy Sheetz, Program & Education Assistant, via email: [email protected] ; or by phone: 440.960.2265, ext. 313</p><p>Grant Application P a g e | 6</p>