Submit completed applications to:County of Tulare – Tulare County Youth Commission

2800 W. Burrel Ave.Visalia, CA 93291

Attn: Samantha Ferrero

Deadline – 12 p.m. FridayMarch 23, 2018

*MUST BE TYPED*

Step Up Youth Activities Grant ApplicationAgency name:

Program name (if different):

Agency mailing address: __________ ______

City: State: Zip Code:

Agency physical address (if different): ______

City: State: Zip Code:

Phone: Fax: E-Mail:

Contact name & title:

Amount requested in this application: $5,000 $10,000o Would you be able to make your program work with a grant in an amount less than you are

currently requesting? __________________________________________________________

Supervisorial District in which your project or services take place: _________________Your project must take place in only one district and should not cross district lines. Please verify your district at: https://electedl.tularecounty.ca.gov/electiondatalookup/

General Agency Information

1. Describe your organization and the constituents you serve, including your mission statement, and your prior experience with the Step Up Youth Activities program, or similar youth programs. (500 word limit).

2. Have you been funded by the Step Up Youth Activities program in the past?

3. Describe the current fundraising activities of the agency.

4. Describe any agency financial/budgetary problems or debt within the last 5 years (including annual budget deficits).

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5. List the key Agency staff directly providing services with the program or activity for which funding is being requested. If it is a start up program with no staff, please list the positions. (Indicate those who are to be paid from County funds.)

Staff Name Position Paid from County FundsYes No

6. What is your organization’s total annual budget?

7. What is the budget for the division or department that will be implementing the program? (If you are asmaller organization and this does not apply, please write “N/A.”)

Program Information

8. Describe the specific intended use of the Step Up Youth Activities Grant requested by the agency. How many youth will be directly impacted? (200 word limit)

9. Describe the strategies that will be used to recruit at-risk youth to participate in the program. (200 word limit)

10. Describe the strategies that will be used to recruit adults to work with the youth in this program. (200 word limit)

11. The Step Up Youth Activities Grant Program is designed to assist at-risk and/or underserved youth and redirect them from potentially harmful behaviors into positive behaviors, associations and social networks, How will the proposed program help these youth?

12. Within the district in which you are applying how is the particular geographic area underserved? Provide supporting evidence (Ex: high unemployment, no youth centers, no after school programs).

13. Describe the role of partnerships and/or collaborations with other organizations in carrying out the proposed project (please provide partner’s/collaborator’s contact information). What other funding or resources does the proposal leverage?

14. Summarize the projected outcomes of the program or activity for which funding is being sought and how these will be measured by the agency. In reviewing grant proposals and allocating grant funds, preference will be given to grants that identify measurable outcomes. (see table below and add pages as necessary)

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Measurable Outcomes

Projected Outcomes: What will involved youth gain from participating in this program?

What tools will you use to measure the outcomes?

15. Briefly describe how your project will be operational (with youth involved) by July 1, 2018. Complete the Action Plan, which is available on www.stepuptc.com.

16. Briefly describe the program’s sustainability plan for continuing the requested program beyond the one year of grant funding. (50 word limit)

17. Be sure to complete the Budget Form, which is available on www.stepuptc.com.

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This form must be submitted with your application.U

CERTIFICATION

This certifies that the information contained in this application is true and accurate and that this application has been authorized by the applicant agency. Further, this acknowledges that the County of Tulare is not responsible for any error or omissions herein.

Date: Signature:

Agency: Title:

Board of Directors’ Authorization to Request Funds:

A resolution of the Board of Directors must be submitted by the agency authorizing this funding request. A copy of the resolution should be signed by one member of the governing body and may include authorization of a representative of the agency to negotiate for and contractually bind the agency.

Agencies must submit the original application signed by an authorized agent and an additional six (5) copies of the signed original (6 total). Agencies must send the electronic version of their application to Youth Commission Staff at sferrero@co.tulare.ca.us. Please use the following checklist to ensure all required attachments are submitted.

One copy of the agency’s most recent fiscal year-end financial statement signed by an officer of the board;

One copy of the agency’s IRS 501(c)(3) determination letter;o If the 501(C)(3) letter is more than three (3) years old, a copy of the printout from the

IRS website showing that the organization is still a valid charitable organization must be submitted. See: http://www.irs.gov/Charities-&-Non-Profits/Exempt-Organizations-Select-Check

One copy of the resolution of the Board of Directors authorizing the grant application o Should an organization be unable to obtain a resolution from their Board of Directors

by the application deadline, the Youth Commission will accept a form signed by two designated Board members and/or their designees authorizing the submittal of the application.

List all contact information for those advisors responsible for the grant and those responsible for reporting during the grant cycle.

Mail or deliver the completed application with attachments before 12:00 pm on Friday, March 23, 2018 to:

County of Tulare – Tulare County Youth Commission2800 W. Burrel Ave.

Visalia, CA 93291Attn: Samantha Ferrero

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