Provide information about the composition of your entire staff: Number of Full-Time Part-Time Contract: Gender: Male Female Race/Ethnicity: Black/African American American Indian Asian Hispanic/Latinx Other Provide information about volunteers serving the DV or SA program that is the subject of this application: Number of active volunteers: Estimated financial value of volunteer support to your program: Explain method used to calculate estimated value of volunteer support: Provide information about the composition of your Board of Directors: Number of people currently serving on the Board: Gender: Male Female Age: < 35 35-50 51-65 > 65 Race/Ethnicity: American American Indian Asian Hispanic/Latinx Other 1) List current written memorandums of understanding or agreement (MOUs or MOAs) that your organization has in place, such as those with hospitals or neighboring DV or SA programs. 2) List and describe how your organization coordinates and collaborates with community partners, task forces, committees, councils, response teams, and/or other entities to carry out the DV or SA program. 3) Describe your organization’s process for making interagency referrals. The comment box below has a 1000-character limit including spacing and punctuation. PERSONNEL List all NCCFW/YI funded positions. For each position listed, indicate the entire salary/wage amount (not just the amount funded by NCCFW/YI, but the entire annual salary/wage amount) and the percentage of the entire salary/wage to be funded by each type of NCCFW/YI fund during fiscal year 2017-2018. If a position performs both DV and SA services and will be a proposed line item on both your DV and SA budgets, then that position should be listed in this section both on your DV grant application and also on your SA grant
Provide information about the composition of your entire staff: Number of Full-Time Part-Time Contract: Gender: Male Female Race/Ethnicity: Black/African American American Indian Asian Hispanic/Latinx Other Provide information about volunteers serving the DV or SA program that is the subject of this application: Number of active volunteers: Estimated financial value of volunteer support to your program: Explain method used to calculate estimated value of volunteer support: Provide information about the composition of your Board of Directors: Number of people currently serving on the Board: Gender: Male Female Age: < 35 35-50 51-65 > 65 Race/Ethnicity: American American Indian Asian Hispanic/Latinx Other 1) List current written memorandums of understanding or agreement (MOUs or MOAs) that your organization has in place, such as those with hospitals or neighboring DV or SA programs. 2) List and describe how your organization coordinates and collaborates with community partners, task forces, committees, councils, response teams, and/or other entities to carry out the DV or SA program. 3) Describe your organization’s process for making interagency referrals. The comment box below has a 1000-character limit including spacing and punctuation. PERSONNEL List all NCCFW/YI funded positions. For each position listed, indicate the entire salary/wage amount (not just the amount funded by NCCFW/YI, but the entire annual salary/wage amount) and the percentage of the entire salary/wage to be funded by each type of NCCFW/YI fund during fiscal year 2017-2018. If a position performs both DV and SA services and will be a proposed line item on both your DV and SA budgets, then that position should be listed in this section both on your DV grant application and also on your SA grant
NCCFWYI%202017-2018%20Grant%20Application%20for%20NEW%20Applicants%20as%20of%20March%202%202017.docx