TOTAL * Number of worked per year. Fulltime for a full year is 2,080 hours. Section 12 Fringe Benefits: – Type of Benefit Cost Explanation Workers Compensation FICA State Unemployment Health/Dental Insurance Other (vehicle, housing, life, etc.) TOTAL Section 13 Program General Information, Update, Service Goals, and Objectives. – Please attach a document that separately answers the following questions (reference each question by number). 1. Please LIST the program’s mission, goals, and objectives. 2. Describe the program and/or general operations for which you request this money. 3. Break-down the monies as to which area they will be used is $ amount. 4. Please describe how this program evaluates and measures effectiveness. 5. Describe how and how many (in hours) volunteers this program uses. 6. Describe your program’s efforts re: cooperation and collaboration with agencies. 7. Describe your program’s target population. 8. Please LIST any major changes in service since your last review. Were changes due to funding cuts, reduction in program, increased efficiencies? 9. Please LIST the number of new positions next year. 10. Please LIST the number of positions eliminated next year. 11. LIST and describe any major purchases the program plans for next year. 12. LIST past year fund raising events and detail amounts received (gross/net), are these events to be held again this year. 13. Does this program use a sliding fee scale (describe)? 14. Please LIST the unit of service in of dollar cost per hour per individual served, and describe a unit of service for this program. Is the unit of service a full hour? 15. How many units can the program provide? 16. How many perspective recipients are on your waiting list? 17. How long will it be (in days) before your program can serve the first person on the waiting list? Section 14 Program Beneficiary Statistics – Prior Current Projected 1. Total count of clients
TOTAL * Number of worked per year. Fulltime for a full year is 2,080 hours. Section 12 – Fringe Benefits: Type of Benefit Cost Explanation Workers Compensation FICA State Unemployment Health/Dental Insurance Other (vehicle, housing, life, etc.) TOTAL Section 13 – Program General Information, Update, Service Goals, and Objectives. Please attach a document that separately answers the following questions (reference each question by number). 1. Please LIST the program’s mission, goals, and objectives. 2. Describe the program and/or general operations for which you request this money. 3. Break-down the monies as to which area they will be used is $ amount. 4. Please describe how this program evaluates and measures effectiveness. 5. Describe how and how many (in hours) volunteers this program uses. 6. Describe your program’s efforts re: cooperation and collaboration with agencies. 7. Describe your program’s target population. 8. Please LIST any major changes in service since your last review. Were changes due to funding cuts, reduction in program, increased efficiencies? 9. Please LIST the number of new positions next year. 10. Please LIST the number of positions eliminated next year. 11. LIST and describe any major purchases the program plans for next year. 12. LIST past year fund raising events and detail amounts received (gross/net), are these events to be held again this year. 13. Does this program use a sliding fee scale (describe)? 14. Please LIST the unit of service in of dollar cost per hour per individual served, and describe a unit of service for this program. Is the unit of service a full hour? 15. How many units can the program provide? 16. How many perspective recipients are on your waiting list? 17. How long will it be (in days) before your program can serve the first person on the waiting list? Section 14 – Program Beneficiary Statistics Prior Current Projected 1. Total count of clients
Ouside%20Agencies%20Application.docx