Montgomery County - Application
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Page 1 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application The Montgomery County Executive's Community Collaboration Grants may be included in the County Executive’s annual recommended budget to support non profit organizations delivering services consistent with the County Executive’s Mission Statement. The Montgomery County Executive's Community Collaboration Grants do not include the following: l Health and Human Services Community Service Grants l Housing and Community Affairs Community Development Block Grant l County Council Grants Please note that applications for the Executive’s Community Collaboration Grants are subject to the Maryland Public Information Act (MPIA) (found at Md. Code Ann., State Gov’t., §10611 through 628 (MPIA)) and the County must comply with the disclosure requirements of the MPIA when a request for documents is received. Prior to starting the online application, it is recommended that you first download and review a blank Montgomery County Executive's Community Collaboration Grant Application Form ( | ). You are encouraged to write your responses into the form fields provided in the PDF or Word file, then copy and paste your prepared responses to the relevant online application form fields. The online grant application form does not accept or save partially completed forms. In addition, each page must also be completed before you can move to the next page. And, it is also recommended that you print each page as completed. A Frequently Asked Questions document is provided for your reference. In addition, a completed sample file is also provided to assist you (please see link below). Completed Sample Grant Application Form Please select the "Next Page" button to complete the online Montgomery County Executive's Community Collaboration Grant application to request a grant. Print This Page General Information and Instructions Page 2 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application A red asterisk (*) indicates a required form field. Print this Page 1. Organization's Legal Name: 2. Federal Tax ID: 3. Street Address (i.e. 123 Anywhere Rd): 4. Additional Address Information (i.e. Suite #, Floor, etc...): 5. City: 6. State Abbreviation (i.e. MD, VA, DC, ...): 7. Zip Code (xxxxx or xxxxxxxxx): 8. Phone Number 1 (xxxxxxxxxx): 9. Phone Number 2 (xxxxxxxxxx): 10. Fax Number (xxxxxxxxxx): 11. Executive Director's or CEO's Salutation : 12. Executive Director / CEO First Name: 13. Executive Director / CEO Last Name: Applicant / Organization Contact Information * * * * * * * * * * Mr. n m l k j Ms. n m l k j Mrs. n m l k j Dr. n m l k j Other (please specify) n m l k j A City Chamber of Commerce 00-0000000 100 Maryland Ave Suite 100 Rockville MD 21784 555-555-5555 443-555-5555 555-555-5551 John Doe Page 3 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application 14. Will the Executive Director / CEO be the primary contact for this grant application? * Yes n m l k j No n m l k j Page 4 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application A red asterisk (*) indicates a required form field. Print this Page 1. Contact's First Name: 2. Contact's Last Name: 3. Contact Person's Salutation, if the contact person is not the Organization's Executive Director or CEO: 4. Select the Contact Person's Preferred Title: 5. Contact's Email Address: 6. Organization's Web Site Address: Applicant / Organization Contact Information Continued * * * * * * Mr. n m l k j Ms. n m l k j Mrs. n m l k j Dr. n m l k j Other (please specify) n m l k j Chairman of the Board n m l k j Chief Executive Officer (CEO) n m l k j Director n m l k j Executive Director n m l k j Founder n m l k j President n m l k j President and CEO n m l k j Vice President n m l k j Other (please specify) n m l k j Jane Doe jane.doe@citycommerce.org www.citycommercesample.org Page 5 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application A red asterisk (*) indicates a required form field. Print this Page 1. Type of Funding Request: 2. Type of Activity to be funded (check all that apply for this project): Select Funding Type(s), Activity Type(s), County Priority(s) * * Operating Funds n m l k j Capital Funds (i.e. bricks/mortar, facility grants, renovation, etc...) n m l k j New Americans (Immigrant Services) g f e d c Economic Development g f e d c State Bond Bill Match g f e d c Arts and Humanities g f e d c Health Care g f e d c Behavioral Health g f e d c Services to Seniors g f e d c People with Disabilities g f e d c Services to Children, Families (includes early childhood programs) g f e d c SafetyNet Services (food, shelter, and emergency housing) g f e d c Positive Youth Development Services (includes outofschool time programs; such as tutoring, mentoring, academic enrichment, recreation, and gang prevention programs) g f e d c Support to Volunteerism/Community Services g f e d c Other (please specify) g f e d c 5 5 6 6 Community Development Page 6 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application 3. Provide and help advance the County Executive's Priority Areas (check all that apply for this project): * A Responsive and Accountable Government g f e d c Affordable Housing in an Inclusive Community g f e d c An Effective and Efficient Transportation Network g f e d c Children Prepared to Live and Learn g f e d c Healthy and Sustainable Communities g f e d c Safe Streets and Neighborhoods g f e d c A Strong and Vibrant Economy g f e d c Vital Living for All Our Residents g f e d c Page 7 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application A red asterisk (*) indicates a required form field. Print this Page 1. Briefly describe the mission of your agency and the programs and services of your agency which support this mission. How have your organization's efforts made a difference in the community? (< 200 words) 2. Briefly state the purpose of the specific request. (< 125 characters) 3. Briefly describe your project and how it specifically helps advance the County Executive's Priority Areas. (< 250 words) 4. How will the program / activity described collaborate or coordinate with other nonprofit organizations in the community? (< 250 words) 5. What is the total program/activity cost? Please enter numeric values only (i.e. 10000) and round to the nearest ten in the form field provided below. No dollar signs are allowed in the numeric field. Additional Questions * 5 5 6 6 * * 5 5 6 6 * 5 5 6 6 * The City of Commerce is dedicated to supporting an economic environment where businesses, non-profit institutions, and residents can thrive and work together to promote economic growth and prosperity for the community. The organization helps business entities and residents on a daily basis with job training services, network opportunities, and funding. In addition, the organization also assists with building community to business partnerships to enable them to better serve the community groups. Establish a web site to enable community organizations and businesses to deliver business and job training services The City of Commerce would like to establish a web site to enable community organizations and businesses to deliver business and job training services to the Latino community. The web site will serve as a platform to enable non-profit community organizations and businesses to register and network effectively through Social Networking technology. The web site will also host free training resources including webinars, relevant training courses, and training materials, guides, etc... In addition, the web site will provide news and events related to business networking and job training services. 50000 Page 8 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application 6. What portion of the total program cost will be funded or raised from Federal, State, and or private sources? (< 250 words) 7. How does the nonprofit agency plan on sustaining the activity in the future? (< 250 words) 8. State the efforts made to recruit volunteers and/or to leverage the community resources? (< 250 words) 9. Please provide outcome measures or results to date for this project, if applicable, and the outcomes you expect to accomplish should this grant be awarded. (< 250 words) * 5 5 6 6 * 5 5 6 6 * 5 5 6 6 * 5 5 6 6 It is estimated that the total cost of the program will $50,000.00. The total portion funded by Federal, State, or private resources is 50% or $25,000. Therefore, we are requesting $25,000 from the County. The City of Commerce organization is planning to sustain this activity by utilizing volunteers to help maintain the site and free technology resources. Since we are hosting the content on a free Social Media web site, we do not need to fund software, hardware, or data archiving maintenance costs on a annual basis. So, we can keep costs down in future years. We have a Latino business committee which is comprised of business leaders and community representatives who will help us to recruit volunteers. Also some of the funding requested will go to the obtaining the marketing materials necessary to recruit volunteers. To date, the organization has supported the development and advancement of over 150 Latino owned businesses in the community. The organization has promoted the advancement of businesses by providing training seminars, workshops, and access to other related-resources. In 2012, the organization trained over 1,200 people and referred over 500 people to businesses searching for trained staff. As a result, 300 (60%) of the people trained and referred by the organization obtained a job. Page 9 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application 10. Has the program/activity received County funding within the past three years? If so, please list the source of the funding. Sources may include Health and Human Services Community Service Grants, Housing and Community Affairs Community Development Block Grant, County Council Grants, County Executive Community Collaboration Grants, funds in the Cost Sharing CIP Project, or added to the base of a County Department's Budget. (< 250 words) * 5 5 6 6 The program has not received funding from the County in the past. Page 10 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application A red asterisk (*) indicates a required form field. Print this Page For fields requiring budget funding numbers (i.e. Donations, Federal Grant Grants, State Grant Funds, etc...))... l please enter numeric values only l decimals are permitted l no dollar signs ($) or commas are allowed in the numeric fields l IF NOT APPLICABLE, ENTER THE NUMBER 0 Please enter the total dollar amount of the Organization's Matching Funds for this Project by applicable source: 1. Donations ($): 2. Federal Grant Funds ($): 3. InKind Funds ($): 4. State Grant Funds ($): 5. Volunteers ($): 6. Other ($): Funding Sources * * * * * * 5000 5000 0 5000 10000 0 Page 11 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application All items should total the amount requested in this grant application. The following budget information pertains only to the project for which you are requesting funds. This should not be your organization's total operating budget. Please separately identify each staff position for which you are requesting funding along with a per hour cost for each. Also, please identify major categories of any operating expenses for which you are requesting funding (i.e. rent, utilities, insurance, printing, supplies, etc...). Operating and Capital items should be listed by number, type, and unit cost. If applicable, renovation plans should be submitted via email attachment to exec.grants@montgomerycountymd.gov. Also, please identify any nonCounty funding sources specifically received for the project. A red asterisk (*) indicates a required form field. Print this Page For Requested Grant Fund form fields ($)... l please enter numeric values only l decimals are permitted l no dollar signs ($) or commas are allowed in the numeric fields l if requested funds are 0, then enter 0. 1. Budget Item 1 Brief Description: 2. Budget Item 1 Requested Grant Funds ($): 3. Budget Item 2 Brief Description (If not applicable, enter "N/A"): 4. Budget Item 2 Requested Grant Funds ($) (If not applicable, enter 0): 5. Budget Item 3 Brief Description (If not applicable, enter "N/A"): 6. Budget Item 3 Requested Grant Funds ($) (If not applicable, enter 0): 7. Budget Item 4 Brief Description (If not applicable, enter "N/A"): 8. Budget Item 4 Requested Grant Funds ($) (If not applicable, enter 0): 9. Budget Item 5 Brief Description (If not applicable, enter "N/A"): Project Budget * * * * * * * * * Web Site Design and Development 10000 Marketing Materials and Content 5000 Support Staff (Training / Technical Support) 10000 N/A 0 N/A Page 12 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application 10. Budget Item 5 Requested Grant Funds ($) (If not applicable, enter 0): 11. Would you like to add more budget items or categories? * * Yes n m l k j No n m l k j 0 Page 13 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application A red asterisk (*) indicates a required form field. Print this Page For Requested Grant Fund form fields ($)... l please enter numeric values only l decimals are permitted l no dollar signs ($) or commas are allowed in the numeric fields l if requested funds are 0, then enter 0. 1. Budget Item 6 Brief Description: 2. Budget Item 6 Requested Grant Funds ($): 3. Budget Item 7 Brief Description (If not applicable, enter "N/A"): 4. Budget Item 7 Requested Grant Funds ($) (If not applicable, enter 0): 5. Budget Item 8 Brief Description (If not applicable, enter "N/A"): 6. Budget Item 8 Requested Grant Funds ($) (If not applicable, enter 0): 7. Budget Item 9 Brief Description (If not applicable, enter "N/A"): 8. Budget Item 9 Requested Grant Funds ($) (If not applicable, enter 0): 9. Budget Item 10 Brief Description (If not applicable, enter "N/A"): 10. Budget Item 10 Requested Grant Funds ($) (If not applicable, enter 0): 11. Would you like to add more budget items or categories? Additional Project Budget Items * * * * * * * * * * * Yes n m l k j No n m l k j N/A 0 N/A 0 N/A 0 N/A 0 N/A 0 Page 14 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application A red asterisk (*) indicates a required form field. Print this Page For Requested Grant Fund form fields ($)... l please enter numeric values only l decimals are permitted l no dollar signs ($) or commas are allowed in the numeric fields l if requested funds are 0, then enter 0. 1. Budget Item 11 Brief Description: 2. Budget Item 11 Requested Grant Funds ($): 3. Budget Item 12 Brief Description (If not applicable, enter "N/A"): 4. Budget Item 12 Requested Grant Funds ($) (If not applicable, enter 0): 5. Budget Item 13 Brief Description (If not applicable, enter "N/A"): 6. Budget Item 13 Requested Grant Funds ($) (If not applicable, enter 0): 7. Budget Item 14 Brief Description (If not applicable, enter 0): 8. Budget Item 14 Requested Grant Funds ($) (If not applicable, enter 0): 9. Budget Item 15 Brief Description (If not applicable, enter "N/A"): 10. Budget Item 15 Requested Grant Funds ($) (If not applicable, enter 0): Additional Project Budget Items * * * * * * * * * * N/A 0 N/A 0 N/A 0 N/A 0 N/A 0 Page 15 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Please sum up all of your Budget Items to determine the Total Dollar Amount Requested. Remember the total dollar amount requested will be applied to the application submitted for a project (one request per application / project). A red asterisk (*) indicates a required form field. Print this Page For the Total Dollar Amount Requested field: l please enter numeric values only l decimals are permitted l no dollar signs ($) or commas are allowed in the numeric fields 1. Total Dollar Amount Requested (one request per application / project): Total Dollar Amount Requested * 25000 Page 16 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application A red asterisk (*) indicates a required form field. Print this Page 1. As the contact person for this application, I am aware that I have the responsibility of notifying the Montgomery County Office of Management and Budget immediately, via email at exec.grants@montgomerycountymd.gov or in writing to Montgomery County Office of Management and Budget, 14th Floor, 101 Monroe Street, Rockville, MD 20850, if there are any changes that need to be made to the grant application or if the Organization ceases operations or becomes a subsidiary of another organization. 2. I hereby certify that information submitted in the grant application is a true and correct statement of facts. I, as a designated legal representative or contact of the Organization, further certify that this Organization shall abide by and be subject to all applicable Federal, State and Local laws and regulations pertaining to any subsequent grant that may be issued. Agreement * * Yes, I understand. g f e d c Yes n m l k j Page 17 Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application Montgomery County Executive's Community Collaboration Grant Application To review your application, please select the Previous Page button and go back to review and/or print each individual page. When you are ready to submit the application, please select the Submit Application button. If you have any questions regarding the application itself or your application's status, please do not hesitate to email your question to exec.grants@montgomerycountymd.gov. Print this Page Review and Submit Application