Community Impact Request for Application

RFA July 1, 2014 – June 30, 2015 1

TABLE OF CONTENTS

COMMUNITY IMPACT...............................................................................................3ORGANIZATION ELIGIBILITY REQUIREMENTS..............................................3-4AGENCIES NOT ELIGIBLE TO APPLY.....................................................................5PROGRAM ELIGIBLITY GUIDLINES.......................................................................5ALLOWABLE COSTS..................................................................................................6UNALLOWABLE COST ..............................................................................................7TIMELINE......................................................................................................................8GENERAL INFORMATION.........................................................................................8PROPOSAL REQUIREMENTS....................................................................................8PROPOSAL CHECKLIST.............................................................................................9COVER SHEET....................................................................................................10 - 14PROGRAM DEMOGRAPHIC SHEET.......................................................................15SECTION I NARRATIVE....................................................................................16 - 17ANTI-TERRORISM COMPLIANCE MEASURES....................................................18NON-DISCRIMINATION POLICY............................................................................19BOARD OF DIRECTORS ..........................................................................................20APPENDIX A...............................................................................................................22FINANCIAL MANAGEMENT SURVEY….......................................Word DocumentSECTION II LOGIC MODEL............................................................Excel SpreadsheetSECTION III BUDGET......................................................................Excel Spreadsheet

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United Way works to advance the common good by focusing on the three building blocks for a good quality of life – education, income and health. We are recruiting people and organizations from all across the community who bring the passion, expertise and resources needed to get things done and we need you to join us. You can give, you can advocate, and you can volunteer. When we work together in common purpose, we Live United.

ORGANIZATIONS ELIGIBLE TO APPLY FOR UWWC COMMUNITY IMPACT GRANT FUNDINGAll applicants must meet the following minimum requirements:

Tax Exempt Status and completion of the IRS Form 990 Organization is recognized as exempt from taxation under Section 501(c)(3) of the Internal

Revenue Code as well as from corresponding provisions of other applicable state, local and foreign laws or regulations.

o Been in existence for a minimum of one (1) year. File the IRS Form 990 in a timely manner (within nine months of last fiscal year end) (unless

organization is exempt by law). A copy of the IRS Form 990 is provided to the organization’s governing body before it is filed.

Legal Requirements Comply with all applicable legal, local, state, and federal operating and reporting requirements

(e.g., nondiscrimination). Conduct anti-terrorism compliance measures. Comply with provisions of Sarbanes-Oxley applicable to nonprofit corporations (whistleblower

protection and implementation of document retention and destruction policies). Registered to conduct charitable solicitations at the state and local level (where applicable).

Governance Have an active, responsible, and voluntary governing body, which ensures effective governance

over the policies and financial resources of the organization and meets at least quarterly. The governing board approves the annual operating budget. The governing board reviews the external annual audit. The governing board reviews its bylaws and other governance documents at least once every three

years. Meeting minutes are maintained. The board approves the process for determining the CEO’s compensation (e.g., type of

comparability data, independent members of the board reviewing and approving CEO compensation).

The board specifically approves the CEO’s compensation.

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Diversity & Inclusion Adhere to a locally developed and adopted statement to ensure volunteers and staff broadly

reflects the diversity of the community it serves.

Code of Ethics Adhere to a locally developed and adopted code of ethics for volunteers and staff, which includes

provisions for ethical management, publicity, fundraising practices, and full and fair disclosure.

Audit Organizations having gross income of $100,000 or more for 3 consecutive years shall annually

submit to an independent audit by a certified public accounting firm or individual CPA.

Organizations having gross income of less than $100,000 shall annually submit to an independent financial review by a certified public accounting firm or individual CPA.

The independent audit or financial review is presented to the full board by the auditor or audit committee chair.

The board, executive committee or audit committee reviews the management letter and takes appropriate actions to minimize any risks identified

Audits must be conducted in accordance with “generally accepted auditing standards” (GAAS) and the financial statements must be prepared in accordance with “generally accepted accounting principles” (GAAP) and must comply with industry applicable regulations and/or guidelines as established by the American Institute for Certified Public Accountants (AICPA) and the Financial Accounting Standards Board (FASB). In general this means (but is not limited to) statements must:

o Be based upon the accrual basis of accounting o Incorporate functional/programmatic detail

Organizations will annually submit to UWWC their audited financial statements and corresponding IRS-990 no later than nine (9) months after the end of each fiscal year.

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ORGANIZATIONS NOT ELIGIBLE TO APPLY FOR COMMUNITY IMPACT GRANT FUNDING As evidenced in their articles of incorporation:

Primarily political in nature. Provide program services limited to the members of a particular religious group. Exist primarily to advocate particular religious beliefs. Organizations whose primary mission/purpose is fundraising.

PROGRAM ELIGIBILITY GUIDELINES Minimum Requirements for a program to be considered for UWWC Community Impact Grant Funding: Program addresses identified indicators in UWWC’s Community Impact Funding Priorities. Program is research or evidence based. Program is provided in Wapello County. Program serves the residents of Wapello County. Program demonstrates effectiveness through measurable outcomes. Organization demonstrates experience, expertise and ability to provide the scope of services and

measurable results. Organization demonstrates sound accounting and fiscal management.

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ALLOWABLE COSTS:

Budget CategoriesA. Personnel Expenses: Include the portion of principal staff time attributed directly to the operation of the community collaborate project. List each staff position. Personnel costs will be paid based on actual time spent on the grant, not budgeted amounts.

B. Personnel Fringe Benefits: Include costs of benefit(s) for staff listed in Personnel Expenses section. You can identify and calculate each benefit or show cost as a percentage of all salaries. You must include FICA, Worker's compensation, and unemployment insurance for all applicable staff. Note: if a fringe benefit amount is over 30%, please list covered items separately and justify the high cost. Holidays, leave, and similar vacation benefits are not included in the fringe.

C. Staff Travel: Describe the purposes for staff travel. Costs allowable are transportation (limit-organizational reimbursement rate or IRS mileage rate), lodging, subsistence, and other related expenses for local and outside the project area travel. Calculations must be included. (Example 1 staff person x 2 nights $200.00 x 6 meals $ 60.00 x 300 miles or $ 165.00 = $425.00)

D. Equipment: Equipment is defined as tangible, non-expendable personal property having a useful life of more than one year and an acquisition cost of $ 1,000.00 or more per unit (including accessories, attachments, and modifications). Include items that do not meet this definition in the Supplies line item. Purchases of equipment are limited to 5% of the total grant amount, i.e., the federal share of all budget line items. If applicable, show the unit cost and number of units you are requesting.E. Supplies: Include the funds for the purchase of consumable supplies and materials. You must individually list any single item costing $ 1,000.00 or more. Example" office supplies (pens, paper, binders, folder, flash drive) x 2 staff x $ 200.00 per year = $ 400.00

F. Contractual & Consultant Services: You may include costs for consultants related to project's operations. Payments to individuals for consultant services under this grant may not exceed $ 400.00 per day (exclusive of any indirect expenses, travel, supplies, etc. Where applicable, indicate the daily rate for consultants.

G. Training: Include the costs associated with training of staff working directly on the project, especially training that specifically enhances staff project implementation and professional skills.

H. Other Program Operating Costs: Allowable costs in this category may include costs specific to the operation of the program for which funds are requested or used as match. Office space rental, internet, utilities, telephone, other costs necessary to operate program. Nothing can be identified as miscellaneous.

Section II: Administrative/Indirect CostsDefinitions: Administrative costs are indirect or centralized expenses of the overall administration of the organization that receives UWWC Funds and do not include particular project costs. These costs may include administrative staff positions that are not listed under Personnel Expenses. UWWC's share of administrative cost is limited to 7% of the overall budget.

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UNALLOWABLE COSTS:AuditsAudit preparation.

Capital Expenditures/ImprovementsCapital expenditures means expenditures for the acquisition cost of capital assets (equipment other than what is allowed under allowable costs, buildings, land), or expenditures to make improvements to capital assets that materially increase their value or useful life.

Capital expenditures for general purpose equipment, buildings, and land are unallowable as direct charges.

Capital expenditures for improvements to land, buildings, or equipment which materially increase their value or useful life are unallowable as direct charges.

DepreciationCosts associated with depreciation expenses are unallowable.

Interest on debtInterest on debt incurred to finance or refinance assets.

OtherThe Unite Way Board of Directors reserves the right to determine other unallowable costs when appropriate.

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Application Timeline

March 21, 2014 UWWC request for application released.

March 26, 2014 General Grant review meeting for all applicants 3:00 pm, United Way of Wapello County.

May 1, 2014 Applications must be post marked May 1, 2014Send to United Way of Wapello County, PO BOX 1778, Ottumwa, IA 52501

If you intend to deliver your completed proposal, they must be delivered to United Way of Wapello County office at 224 E Second Street, Ottumwa IA on or before May 1, 2014 at noon.

Send an electronic copy of the RFA to m.zoromski@wapellocouw.org prior to 11:59 pm on May 1, 2014.

May 21, 2014 Funding Notification to be emailed by May 21, 2014.

General InformationOn March 26, a grant preparation class will be held from 3:00 pm – 5:00 pm. We will review the financial forms, general grant preparation, and deadlines.

Proposal Requirements (submitted proposals not following requirements will not be reviewed) Proposal must address one of the UWWC indicators outlined on page 10 - 14. –The period of

funding for this proposal is July 1, 2014 to June 30, 2015 Proposals must use research based practices. No extensions or late proposals will be considered. All proposals become the property of United Way of Wapello County and will not be returned. Submit one proposal per program. If an agency has multiple programs it may submit one financial audit, one IRS 990, one

Audit, one Anti-Terrorism Compliance, one non-discrimination policy form, one financial management survey, and one board roster.

The proposal must be double-spaced, Times New Roman, 12 pt. font, black. 1 inch margins Section III Program Budget Form, Times New Roman, 12 pt. font, black. Do not submit information or attachments that have not been requested.

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Proposal ChecklistUse this checklist to compile all documentation required for your United Way of Wapello County Community Impact Request for Proposal.

Proposals must be post marked May 1, 2014 or delivered to UWWC office by noon pm on May 1, 2014.

Send to United Way of Wapello County, 224 E Second Street, PO BOX 1778, Ottumwa, IA 52501Document # Hard

CopiesElectronic

CopiesComplete

UWWC

office use only

Proposal Checklist 1 0

Cover Sheet 1 1

Program Demographic Sheet 1 1

Section I Narrative 1 1

Section II Logic Model 1 1

Section III Program Budget 1 1

Board Approved Agency Budget 1 0

Compliance Documentation RequiredFYE 2013 or most recent independent Financial Audit or Financial Review performed by a Certified Public

Accountant(see requirements from page 4)

1 0

FYE 2013 or most recent IRS Form 990 1 0FYE 2013 or most recent Annual Report 1 0

Financial Management Survey 1 0

Anti-Terrorism Compliance Measures Form 1 0

Non-Discrimination Policy Form 1 0

Board of Directors Form 1 0

By signing below, I attest that the information submitted is true and correct and that it has been duly authorized by the Board of Directors and that the Board of Directors.

Executive Director Board Chair

Printed Name Printed Name

Date Date

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COMMUNITY IMPACT FUNDING PROPOSALCover Sheet 4 points

Organization: Program:

Address: Executive Director: Phone: Fax: Email:

Contact Name and Title: Phone: Fax: Email:

Amount requested for FY July 1, 2014 to June 30, 2015$ ____________________

United Way of Wapello County Community Impact Priority Area & Community Impact Indicator: In your chosen Community Impact Priority Area, review the shared outcomes. Select your primary and secondary outcome. Note: for Education, Early learning shared outcomes 1 – 4 are mandatory for all programs.

Education: Raise the Graduation Rate to 87%

Education Shared Outcomes

Early Learning – 1 -4 Mandatory shared outcomes for all early learning programs

1. Children attend early education regularly.

Indicator # and % of children attending 85% of available early education days. (Children attend 85%

of preschool classes within the school year)

2. Parents are engaged in their child’s education and development.

Indicators # of opportunities offered for parent involvement annually (may include in parent teacher

conferences, parent/child activities, parent workshops, parent policy council, on-site parent volunteers or other opportunities.

# and % of parents who participate in at least ___ (target # to be set by individual programs) of activities offered each year.

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3. Children will achieve developmental advancement as outlined in Creative Curriculum and will be ready to benefit from academic, social and emotional activities provided at the next level of education.

Indicators # and % of children who achieve age appropriate cognitive milestones in math, science,

social studies, literacy and creative expression.

# and % of children who display an understanding of literacy through the four modalities for communication: listening, speaking, reading, and writing.

# and % of children who achieve age- appropriate milestones in physical development.( Note: children 2 years and younger in day care use this indicator)

4. Early Education programs participate in recognized quality improvement systems. Indicators

The accreditation status and/or current QRS rating of program.

Third Grade Reading

Participants gain the literacy skills needed to succeed in school.Indicator

# and % of children proficient in 3rd grade reading.

Out of school time programs and youth development programs

Participants have a safe and nurturing environment to go to when out of school.Indicators

# and % of participants who remain enrolled and active in the program for ____(time frame to be determined by individual programs)

# and % of participants attending 85% or more of available activities

Participants gain life skillsIndicators

# and % of youth and/or parents who report participants increased life skills. (Note: programs are strongly encouraged to report indicators measuring attainment of specific skills whenever possible.)

# and % of youth and/or adults reporting improved behavior.

Participants maintain or increase positive academic performance.Indicators

# and % of participants who increase academic knowledge/skills # and % of participants reporting higher aspirations regarding finishing school and beyond

secondary education

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Baseline 60% 4th Grade Reading Proficiency in Wapello County 61% 8th Grade Math Proficiency in Wapello County 55% 8th Grade Reading Proficiency in Wapello County 86% High School Graduation rate for Wapello County 81% High School Graduation rate for Ottumwa Community Schools New Metric needed for Kindergarten Readiness New Metric needed for Post-Secondary Preparation target

Target 80% 4th Grade Reading Proficiency in Wapello County 80% 8th Grade Math Proficiency in Wapello County 80% 8th Grade Reading Proficiency in Wapello County 90% High School Graduation rate for Wapello County 87% High School Graduation rate for Ottumwa Community Schools Target will be developed for Kindergarten Readiness Target will be developed for Post-Secondary Preparation Community Strategies

Income – Increase by 20% the number of households in Wapello County that are financially stability.

Income Shared OutcomesIncome StabilityParticipants make progress toward financial stability goals.

Indicator # and % of clients who apply for or pursue claims for _______ (name of benefit(s)/income

supports to be inserted by individual programs) for which they are eligible.

# and % of participants who address credit problems by obtaining a credit report, repairing credit, reducing short-term debt or establishing/obtaining credit.

# and % of participants who create a budget.

# and % of participants increasing their knowledge and improving skills in financial literacy, money management and consumer safety.

Housing Stability

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Participants achieve housing stability.Indicator

# and % of clients who achieve or maintain stable housing for a minimum of six months

# and % of clients who achieve or maintain stable housing for a minimum of twelve months.

Food SecurityParticipants build knowledge and skills related to cost-effective food choices, food preparation, and safe food storage.

# and % of participants with Increased access to food resources # and % of participants with increased availability of whole foods/basic foods. # and % of participants with increased knowledge and/or skills related to cost-effective

food choices # of individuals and households who participate in skill building efforts is sustained or

increased. # of people/households provided with information and referrals is sustained or increased.

Baseline 48% of households in Wapello County are below 250% of the poverty line or below. 14.3% of Wapello County is food insecure. 26% of children in Wapello County live below the poverty line. Family Supporting wage for

o Single Parent, one child is $ 17.91/houro Single Parent, two children is $24.06/houro Two Parents(one not working), one child $16.77/houro Two Parents(one not working), two children $18.99/hour

Target 28% of households in Wapello County are below 250% of poverty line or below. 10% of Wapello County Food Insecure

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Health - Move Wapello County’s ranking on the County Health Rankings map from the 4th quadrant to the 3rd quadrant. (Minimum county ranking of 75 of 99)

Health Shared Outcomes

Access to healthcare and wellness.Patients/participants have improved access to healthcare.

Indicator # and % of patients with limited English proficiency or are English language learners # and % of patients who are low income # and % of patients who are uninsured or underinsured # of patient visits per year

Patients/participants access and utilize healthcare services, including those for preventive care and mental care.

Indicator # or % of patients accessing healthcare services # or % of patients accessing mental health # or % of youth who have reduced risky behaviors, including alcohol use, drug abuse, and

tobacco use.

Patients/participants and/or families are active partners in their healthcareIndicator

# or % of patients that attend scheduled appointments

Participants are better prepared for wellness.Indicator

# and % of participants who report intent to maintain or increase healthy behavior. # and % of participants who report intent to change risk-related behavior. # and % of participants who change their behavior

Baseline 29% of adults in Wapello County report a BMI of >= 30 68 teenage pregnancy is Wapello County per year – 9th highest in Iowa in number and

10th highest in rate 134.9 per 1000 births 30% - 39% of Wapello County population with Ace score of 2 or more 27% of 11th graders report alcohol use in the last 30 days 21% of 11th graders report tobacco use in the last 30 days 10% of 11th graders report Marijuana use in the last 30 days

Target Cut in half the teenage pregnancy rate to 68 per 1000 20% - 29% of Wapello County population with Ace score of 2 or more 22% of 11th graders report alcohol use in the last 30 days 16% of 11th graders report tobacco use in the last 30 days 5% of 11th graders report Marijuana use in the last 30 days

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Program Demographic Sheet – 1 PointPlease select the demographics served by your program. Select all that apply

Age Groups 0-4 k – 5th grade ages 5 - 10 6th grade – 8th grade ages 11 - 13 9th grade – 12th grade – ages 14 - 17 young adult – ages 18 – 25 adult ages 26 – 30 adult ages 31 - 55 senior ages

Ethnicity/Race White alone Hispanic alone Black or African American alone American Indian and Alaska Native alone Asian alone Native Hawaiian and other Pacific Islander alone Some other race alone Other:_____________________________

Gender Male Female

Household Income: Unemployed Less than $10,890 $10,890 - $22, 350 $22,351 - $37,630 $37,631 - $50,000 Greater than $50,001

Education Level of Clients served: preschool K-5 grade 6-8 grade 9-12 grade GED High School Diploma Tradesman Associates Degree Bachelor’s Degree Master’s Degree PHD

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SECTION I NARRATIVE

Limit Section I narrative to ten (10) pages. Double spaced one inch margins.If sections are left blank a score of 0 will result.

UWWC Community Impact Fund Application Questions;

Organizational Capacity & History (4 pts)Provide a brief history of your work as an organization, including the year your organization was established. In addition, describe how the program connects to the organizational mission and advances the goals of the agency. What expertise does your organization have in addressing the United Way indicators? Describe relevant experience with sharing project goals, program management and collective impact.

Provide specific examples of your organization’s experience and past accomplishments in the proposed areas of activity and your experience operating and overseeing a program comparable with the one proposed. Discuss expertise in building relationships, partnerships and collaborations.

Organizational Structure (10 pts)Identify the key program and fiscal positions responsible for your proposed program, and the percent of time dedicated to the program. Explain relevant experience that staff has for administering a grant and program like United Way of Wapello County Community Impact Grant.

Staff ResponsibilitiesDescribe your capacity to manage a United Way grant and to provide on-site monitoring of financial and other necessary systems. Provide examples of other federal, state or local grants received, including amount and duration. What infrastructure has your organization developed to ensure effective oversight?

Budget AdequacyDescribe how the budgeted amount is adequate and necessary to support the program, including how the funding is linked to program outcomes. Describe your success in raising diverse support for your program. Discuss commitments you have obtained or which you are planning to secure and how they will be used to support this project. Please provide a listing of the source of match for the grant.

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Program Description: (8 Points)Describe primary goal of the program.Provide a brief description of the program. Include basic overview information on the program’s purpose, organization/staffing, activities and services. Describe the targeted population; include specific demographic information on those to be served in the program, including, if available, age, gender, ethnicity, education, socioeconomic status/income/employment, etc.

Quality of Performance: (8 Points)Describe how the program will ensure program quality in order to impact strategies, primary indicators and/or secondary indicators. Include information regarding how the program will address barriers to service. Describe the frequency and duration of services to be provided to clients. Describe the policies and procedures in place to ensure that the program will make progress toward the strategies and indicators. Provide the tools, such as surveys, used to measure program quality.

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ANTI-TERRORISM COMPLIANCE MEASURES

In compliance with the USA PATRIOT ACT and other counterterrorism laws, the United Way of Wapello County requires that each organization certify the following:

“I hereby certify on behalf of:

____________________________________________________________________Organization’s Name

that all United Way funds and donations will be used in compliance with all applicable anti-terrorist financing and asset control laws, statutes and executive orders.”

Print Name: ________________________ Title: _____________________

Signature: _________________________ Date: _____________________

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Non-Discrimination Policy

We hereby certify and have included documentation with this Community Investment request that we are an official 501 (c) (3) under the US Internal Revenue code. We also cerify that our organization fulfills the requirements of the non-discrimination policy as follows below.

___________________________________________________ has adopted a stated policy of non-discrimination in regard to all persons, irrespective of their race, color, creed, religion, national origin, sex, sexual preference, age, disability or veteran’s status, and compliance with all requirements of law and regulations with respect to employment, volunteer participation and the provision of services.

Print Board President/Chairperson name

Signature Board President/Chairperson Date

Print Executive Director name

Signature Executive Director Date

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Board of Directors

Organization Name:

Number of Board meetings per year:

Annual Meeting date:

What is the length of the board member term?

Please list Board members, Officer, Company Affiliation, Current Term and Term Expires in the chart below.

BoardMember

Officer CompanyAffiliation

CurrentTerm

TermExpires

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Appendix A – Glossary of TermsCollaboration – a mutually beneficial and well-defined relationship entered into by two or more organizations to achieve common goals. Collaboration includes a commitment to: mutual relationships and goals; a jointly-developed structure and shared responsibility; mutual authority and accountability for success; and, sharing outcomes, resources and rewards.

Evidence-Based Practices – approaches to prevention or treatment that are based in theory and have undergone scientific evaluation as opposed to approaches that are based on tradition, convention, belief, or anecdotal evidence.

Inputs – the resources a program uses to support its activities and achieves its outcomes, including staff, volunteers, participants, facilities, supplies, resources, funding, etc.

Logic Model – a systematic and visual representation of the relationships among the resources and organization has to operate the program, the activities it plans to do and the changes or results it hopes to achieve. The logic model illustrates the program’s theory of change or the “if …. then” statement: if we do this, then this change will happen.

Outcomes – benefits or changes for individuals or populations during or after participation in program activities reflecting a change in knowledge, attitudes, skills, behavioral changes, or changes in condition or status.

Outputs – direct products of program activities and usually measured in terms of the volume of work accomplished; e.g., number of classes taught, counseling sessions conducted, educational materials distributed, and number of participants receiving the service.

Performance Measures – specific observable, measurable characteristics or changes that represent achievement of a program outcome. Performance measures are what have been observed, measured, assessed, or monitored in clients or systems to learn if the outcome has been achieved.

Priority Outcomes – those outcomes which must be achieved to meet one of the ultimate goals (outcomes). Attaining these will be a strategic focus of United Way’s work for the next 5-10 years. They are:

Education - Raise the Graduation Rate to 87%Income – Increase by 20% the number of households in Wapello County that are financially stable.Health - Move Wapello County’s ranking on the County Health Rankings map from the 4th quadrant to the 3rd quadrant. (Minimum county ranking of 75 of 99)

Request for Proposal (RFP) – a written announcement to agencies or organizations that explains the purpose, outlines the scope of work and solicits proposals for the implementation of the strategies.

Target Population – a defined set of people that a deliberate action is intended to benefit. A target population may be defined by relationship to a particular program or service (e.g., clients of community shelters for homeless families), by geographic locations (e.g., residents of a neighborhood), by demographic characteristics (e.g., Hispanic children), by relationship to an issue of concern (e.g., people who are unemployed, or in other ways.

Unit of Service - the level at which service is delivered. Example: person, day, minutes, hour, pound, etc.

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