dear food provider - feeding westchester

HPNAP 2018-19 – FOOD AND OPERATIONS SUPPORT APPLICATION FEEDING WESTCHESTER

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Dear Food Provider: Feeding Westchester is requesting applications for funding under the New York State Hunger Prevention Nutrition Assistance Program (HPNAP). The application for the HPNAP Food Line of Credit and Operations support/Equipment Grant Application. Please note first time applicants are only eligible for the food lines of credit.

• If your Agency has more than one (1) feeding program, you must complete a separate application for each program.

• IMPORTANT: Your application and required attachments must be emailed to Wendy Armstrong at: [email protected] NO later than June 30, 2018 by 2pm.

• Before emailing your application, save and rename the PDF in the following way: “HPNAP Application FY19 – <enter your agency name>”

All sections must be COMPLETE for application to be considered. An independent HPNAP Advisory Board will determine grant levels for qualified programs. HPNAP Food Grant and Operation Support/Equipment recipients will be notified of allocations in October. If you have any technical questions, you may contact Wendy Armstrong at 914-909-9615. In order to help your program apply for HPNAP funding, TWO (2) workshops are scheduled: New Feeding Westchester agencies and/or anyone who is doing the application for the first time, MUST attend a workshop. Please note that should you not attend a workshop and have questions regarding the application you may experience a delay as call volume is high during this time period. Any questions that arise while filling out the application can be addressed at these workshops. Please see workshop schedule below:

Friday June 15, 2018 (2PM - 3PM) Location: Feeding Westchester 200 Clearbrook Rd. Elmsford, NY 10523 (914) 923-1100

Monday June 18, 2018 (10AM – 11AM) Location: Feeding Westchester 200 Clearbrook Rd. Elmsford, NY 10523 (914) 923-1100

Please Enter through the Agency/Volunteer Entrance Space is limited, so please e-mail [email protected] as soon as possible to reserve a space!

REMEMBER to mark your calendars and email your completed application(s) & required attachments to Wendy Armstrong at: [email protected] NO later than June

30, 2018 by 2pm.

mailto:[email protected]




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1) Is this your first time applying for HPNAP funds?

☐ Yes, this is my first time ☐ No, I have received HPNAP support in the past

2) Agency Name: 3) Agency Reference Number:

4) HPNAP ID Number (if you know):

5) Please indicate the type of Feeding Program your agency operates:

☐ Food Pantry ☐ Soup Kitchen ☐ Emergency Shelter

6) Agency Mailing Address: (Street, City, State, Zip) 7) CONTACT INFO FOR PERSON COMPLETING THIS APPLICATION First Name: Last Name: Title: Phone:

Email Address:


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8) CONTACT INFO FOR AGENCY’S DIRECTOR First Name: Last Name: Title: Phone:

Email Address: 9) How many households does the agency typically serve in a month? 10) How many people does the agency typically serve in a month? (This may be a duplicated number) 11) What are your days & hours for food distribution? 12) Do you offer emergency bags during off hours (Non-Service times)?

Yes No

13) Do you offer home delivery? Yes No

14) How many months per year do you distribute/prepare food? (1 to 12)


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15) How often do you provide food assistance to a household?

As needed without limits Once per month or once every 30 days Weekly Emergency Only Other

16) How does your program record the number of people you serve?

Sign-in Sheet Checklist Assign Numbers Electronic Database Other

17) Please select your food distribution method: (If you are a Soup Kitchen or a Shelter, please select N/A).

Full Client Choice (no pre-bagged items) Partial Client Choice Pre-Packed Bags N/A – we are a Meal Program

18) All prepared Meal programs must carry a current permit from the County or State Department of Health in order to be eligible for HPNAP funding. Do you have a current Westchester County health permit?

Yes No N/A – we are not a Meal Program

19) What geographic region(s) does your agency serve?

Elmsford Katonah Mamaroneck/Larchmont Yonkers Portchester Tarrytown White Plains Peekskill Mount Vernon New Rochelle Ossining Other


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20) What non-food services does your program provide?

Referral Packet(s)/Handouts Access to phone, Internet Job application assistance Referral Bulletin Board/Information Station Clothing Child Health Plus/Family Health Plus WIC DSS/Medicaid/SNAP Benefits None Other onsite services (Please list below, i.e., senior program, library, counselors, smoking cessation programs, job training, cooking classes, health screenings, etc.)

21) Please list staff or volunteers that have a current Servsafe Certificate (Please note: all Westchester County hot meal programs are required to have a certified food handler on-site during food preparation and service).

Staff/Volunteer Name Certification Exp. Date

22) Would your program like to apply for HPNAP Food Line of Credit for 2018-19 grant year? Yes No

23) Requested grant amount for Purchased food (Max $8,000).

Requested grant $ amount for Purchased Food:

24) Are you interested in enrolling in the Green Thumb fresh produce program grant? (Interested agencies will receive separate communications to schedule Green Thumb deliveries. This produce is covered by a separate grant)

Yes No


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HPNAP's Open-to-the-Public definition: Food assistance provided through a food pantry, soup kitchen, or shelter program is considered open to the public if the meal service is inclusive of all populations without regard to gender, race, color, ethnicity, age, nationality, citizenship, marital status, sexual orientation, religious affiliation, income, disability, and health status. To be open to the public, these operations will not exclude any population group described above from receiving food assistance services upon first request or repeat visits for food. This open-to-the-public definition does not affect the ability of organizations to limit services to a particular geographic area, establish frequency of visits, or have a ceiling on the number of individuals the organization is able to feed (based on funding). 25) Does your Emergency Food Program (EFP) meet HPNAP's Open-to-the-Public definition as stated above? Yes No

If "no", please explain:


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26) Committee members are asked to consider the impact and/or uniqueness of your program in its community. Please describe what sets your program apart from others in the community. Share whom your program serves, special considerations made for those who may be at greatest risk and how you enact the mission of your program. (No attachments will be accepted such as newspaper articles, letters or brochures. Please use only the space provided.)


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27) How would the grant funds improve your program's ability to provide food assistance to needy people? Please be specific. List your program's goals to maintain or improve the quality and/or quantity of food assistance during the 2018-19 grant year. (Please do not attach additional sheets). 28) Will you be applying for Operations Support?

Yes No – (If Not you may skip over the following Operations Support sections then sign the last page before submission)


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OPERATIONS SUPPORT BUDGET PROPOSAL SECTION: INSTRUCTIONS: The Total HPNAP Operations Support request is not to exceed $6,000. This amount may be increased to $8,000 if food service equipment is requested as part of the Operations Support grant.

• You may request funding for up to 2 out of the 5 following categories (Staff, Utilities, Space, Food Service/Paper Goods, & Travel.

• Please note that if you apply for more than 2 categories, your application may not be reviewed.

• Capital Equipment has its own category Answer every question that is applicable, incomplete applications will be disqualified.

Category 1: Staff Costs Skip this section if you are not requesting Staff support 29) $ Amount requested: 30) Title of Staff Position: 31) List the specific duties this staff person performs, highlighting those related to food assistance. (Please note only direct service workers may be funded. Administrative workers will not be funded.)


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32) Approximate number of hours per month the staff person would work on food assistance: 33) What is the hourly rate? 34) Number of months worked during the year: (up to 12) 35) Please list the sources and corresponding dollar amounts that contribute to funding this position: 36) If awarded the grant, which form of documentation will your program provide to back up the use of the grant funds expended?

Copies of the payroll register from an outside payroll source Copies of time cards or time sheets showing days and hours worked, and copies of the cancelled paychecks Copies of 1099 or W-2 forms

37) Did your program receive HPNAP Operation Support Staff funding in 2017-2018?

Yes No

If yes, please provide $ amount and for what position:


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Category 2: Utilities Skip this section if you are not requesting Utility support 38) $ Amount requested: 39) Please list the utilities for which you are requesting funding. Explain clearly how this amount was estimated. For example, was it based on expenses in the past, or did you use estimates of how much it costs to operate a freezer or other equipment? (NOTE: Copies of bills are not required for the application, but are required for documentation if you receive a grant for utilities.) 40) Did your program receive HPNAP Operation Support Utilities funding in 2017-18?

Yes No

If yes, please provide $ amount:

41) If only a proportion of a utility bill will be charged to the Operations Support grant, explain what percentage of the bill will be charged, and why. (For example, does the food pantry occupy a percentage of the space to be heated?) 42) If any other funding source(s) currently contribute to funding this expense, please list the sources:


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Category 3: Space Costs Skip this section if you are not requesting Space support 43) $ Amount requested: 44) If only a proportion of your rent will be charged to the Operations Support grant, please give a clear explanation of your reasoning. 45) Did your program receive HPNAP Operation Support Space funding in 2017-2018?

Yes No


46) If any other funding source(s) currently contribute to funding this expense, please list the sources:


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Category 4: Food Service Disposable Products and Other Supplies Skip this section if you are not requesting Food Service Disposable Supply support All Program acceptable items:

• Items such as plastic & paper shopping bags Meal Program acceptable items:

• Plates, cups, bowls, napkins, knives, forks and spoons, plastic wrap, aluminum foil, food containers & cardboard boxes.

• Supplies not necessary to the provision of food, such as office supplies, toilet paper, and cleaning materials are not fundable.

47) $ Amount requested: 48) Detail the $ costs, quantities, & items you are requesting: 49) Did your program receive HPNAP Operation Support funding for disposables in 2017-2018?

Yes No If yes, please provide $ amount:


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Category 5: Transportation Skip this section if you are not requesting Transportation support HPNAP funds will only cover transporting food from the Source to the Emergency Food Provider (EFP) site and not the cost for delivering food from EFP site to pantry recipient. There are two options: Rent/Lease or Mileage Option. Verification of transportation costs will be required if awarded funding, the following documentation must be maintained:

• Records indicating the payment of funds for vehicle rental/lease option • Mileage logs showing dates, destination, and odometer reading of mileage incurred on

vehicles • Records (receipts, invoices, bills of lading, etc.) indications that the transportation costs

charged to the state were required to move food from the source to EFP site NOTE: Receipts dated BEFORE November 1, 2018 will not be accepted. Rental trucks receipts must show payment to be accepted 50) $ Amount requested: 51) Which Option are you requesting funding for?

Rent/Lease Mileage Option

52) Expected miles to be traveled:


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53) Describe how you plan to use the requested funds for transportation. How often does your agency use this transportation? Why is transportation funding needed? 54) How will the requested funds support or improve your program's ability to provide food assistance to needy people? How much food (estimate pounds or cases) will you transport? 55) If any other funding source(s) currently contribute to funding the transportation needed for your program: 56) Did your program receive HPNAP Operation Support funding for Transportation in 2017-18?

Yes No



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Category: Food Service (Capital) Equipment SECTION 6A) Large Equipment – Cold Storage & Stoves Skip this section if you are not requesting Large Capital Equipment support 57) Indicate your agency's Large Capital Equipment request from the approved listing (below). Your agency will be contacted directly to coordinate the purchase of equipment. Please note that typically only one piece of large equipment will be awarded. No bids necessary for the five (5) below items, as they will be purchased from our contracted supplier.

☐ Single Door Refrigerator ☐ Double Door Refrigerator ☐ Single Door Freezer

☐ Double Door Freezer ☐ Stove/Oven 58) Explain why you are requesting this Large Capital Equipment and how it improve your program's ability to provide food assistance to needy people? *You must notify Feeding Westchester if you are unable to take delivery within 30

days of award notification. Equipment will not be stored.


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Category: Food Service (Capital) Equipment SECTION 6B) Other Capital Equipment Skip this section if you are not requesting Other Capital Equipment support Requests for other types of equipment (such as metal shelving, hand truck, metal storage cabinet, table (client choice pantries only), roller conveyor belt (written justification required), etc.), please list them below. Each requested item will only be considered if quotes from three (3) suppliers are provided. You must attach all three (3) quotes to your application. If the requested quotes are not included with your application, your request will not be considered. 59) What “Other” Capital Equipment items are you requesting?

EQUIPMENT ITEM(S) REQUESTED

QUANTITY $ COST/ITEM TOTAL $ COST

60) Total $ Amount requested: 61) Explain why you are requesting this “Other” Capital Equipment and how it improve your program's ability to provide food assistance to needy people?


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Category: Food Service (Capital) Equipment SECTION 6C) Equipment Operation - Use, Installation & Maintenance This section must be filled out if any equipment has been requested. Skip this section if you are not requesting any Capital Equipment support 62) If replacing equipment, explain why the current equipment needs to be replaced. *If HPNAP equipment is being replaced, and you have not already submitted a disposal form, please call Wendy Armstrong at (914) 923-1100 to request a form. No HPNAP equipment may be disposed of without prior permission. 63) Explain how your agency will cover any costs for installing, operating, maintaining, and repairing the requested equipment. If capital improvements become necessary because of the equipment selected, the applicant must explain how these costs will be covered. (HPNAP OS grants will not fund wiring or plumbing work, or building alterations). Additionally it is the awardees responsibility to check that the outlets voltage will accommodate the equipment prior to delivery.


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64) If you have received HPNAP-funded equipment in the past, please list the equipment, brand, and year purchased with previous HPNAP award (i.e. tables, refrigerators, ovens, freezers, and shelves).

HPNAP EQUIPMENT/ITEM(S)

Type of Equipment (HPNAP)

Brand

Year Purchased


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OPERATIONS SUPPORT FUNDING REQUEST CHART 65) Indicate which item is highest priority to your agency and the Total $ Request. ONLY CHOOSE a maximum of two (2) categories and the Capital Equipment line if applicable)

CATEGORY

Total $ Request Priority Level 1st & 2nd & 3rd

Category 1: Staff

Category 2: Utilities

Category 3: Space

Category 4: Food Service Paper Products & Other Supplies

Category 5: Transportation

Food Service (Capital) Equipment

Total Funds Requested:

66) Please fill in the $ amounts of Operational Support received from the grant in the past year.

CATEGORY

Total 2017-18 $ Award

Category 1: Staff

Category 2: Utilities

Category 3: Space

Category 4: Food Service Paper Products & Other Supplies

Category 5: Transportation

Food Service (Capital) Equipment

Please remember to attach and submit three (3) quotes for all applicable “Other” Capital

Equipment requests


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Final Agency Signature & Application Submission Feeding Westchester will arrange for an independent HPNAP Advisory Board to score and determine grant levels for qualified applicants per HPNAP Food Grant and Operation Support/Equipment guidelines. Award recipients will be notified of allocations in October. Remember:

• If your Agency has more than one (1) feeding program, you must complete a separate application for each program.

• IMPORTANT: Your application and required attachments must be emailed to Wendy Armstrong at: [email protected] NO later than June 30, 2018 by 2pm.

• Before emailing your application, save and rename the PDF in the following way: “HPNAP Application FY19 – <enter your agency name>”

67) Final Agency Signature & Submission I confirm all sections of this application have been reviewed for completeness and accuracy. Full Name of contact approving submission (sign if your software allows): Title: Date:


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