PNP - Formstack

2022 Non-Profit Grant Funding Application

To be eligible for funding, the applicant agency must:

Submit a completed 2022 City and County of Broomfield Health and Human Services (HHS) Grant Application including all required attachments.
Be a Non-Profit Organization (i.e. certified by the Internal Revenue Service as exempt under Internal Revenue Code Section 501(c)(3) or 509(a), and provide legal documentation of its 501(c)(3) or 509(a) tax exempt status).
Sufficiently demonstrate that services will be provided to Broomfield residents and fill a health or human service need/gap within Broomfield.

Funding Tiers:

Tier 1: Up to $15K
- For promoting the greater diversity of service providers ensuring sustainability for all residents
- Any non-profit serving health or human service needs or Broomfield residents
- Simpler application (Please see questions below.)
- Maximum amount for new agency
- Semiannual Grant Reports
- Optional participation in regular non-profit consortium meetings (same as Tier 3 below)
Tier 2: Over $15K up to $75K
- Ongoing funding for necessary service deliver that complements and supports health or human services needs
- Have received grant previously
- More information requested in application (Please see questions below.)
- Semiannual Grant Reports
- Regular non-profit consortium meetings (same as Tier 3 below) if housing or mental health category
Tier 3: Over $75K
- Collaborate with service providers in an effort to drive key results for the community
- More information requested in application (Please see questions below.)
- Quarterly Grant Reports or via performance evaluation meetings
- Mandatory regular non-profit consortium meetings during 2022 to discuss goals, performance metrics, outputs and outcomes, collaboration and impact on community priorities including housing/mental health. (Results-Based Accountability, Four Disciplines of Execution)

Funding Restrictions:

Funds must be used for Broomfield residents.
Funds may not be used for capital expenditures or for functions that are not critical to the mission of the grant project/program/service.
Funds may not be used for religious programming/activities, for proselytizing activities, or for the purchase, development or distribution of materials or information that promote a particular religion or faith.
Funds may not be used for endowment purposes.
Funds may not be re-granted to an agency other than the original requestor.
Funds may not be used to pay down debt.
Agencies may not attempt to influence legislation as a substantial part of their activities and may not participate in any campaign activity for or against political candidates.
No more than 15% of the request may be used for indirect costs.

Submission Methods:

All applications must be submitted using the online application. Please contact Mandy Walke at awalke@broomfield.org or 720.887.2279 if you need technical assistance.
(Optional) Agencies may submit a 5-minute video presentation related to their agency, application, and proposal via email to awalke@broomfield.org.
If you need the application translated into Spanish, Vietnamese, Hmong, or Mandarin/Chinese (Simplified), please contact Mandy Walke at awalke@broomfield.org or 720.887.2279 by Friday, September 17, 2021.

Grant Timeline:

Application posted on website: Friday, September 3, 2021.
Grant application information/technical assistance meeting (attendance is strongly encouraged): Monday, September 13, 2021, from 9 to 10:30 a.m. via Zoom. Connection information will be sent in the confirmation email after submission of your application as well as available on the website at: www.broomfield.org/PNPGrant.
Grant Applications due on or before Friday, October 15, 2021, no later than 5 p.m. Late applications will not be accepted.
Funds awarded in early 2022.
Funds must be expended by December 31, 2022.
Mid-year* (semi-annual) funding report due by July 31, 2022. Year-end (final) funding report due by January 31, 2023. *Agencies receiving over $75,000 of grant funding will be required to do quarterly instead of semi-annual reports.

Contract and Reports:

Agencies awarded grants must enter into a binding contract with the City and County of Broomfield (sample available here: https://www.broomfield.org/PNPGrant) and must meet the audit/external review requirements of the City and County of Broomfield. Agencies must use funds in accordance with their grant proposal. Any modifications to fund usage after funds have been awarded must be submitted via a written proposal and must be approved by HHS Management. Funding in one year does not guarantee funding in future years. The agency must retain records of accounting and services for 3 years. The agency must submit grant reports as specified by Broomfield.

Discrimination Policy:

The City and County of Broomfield Department of Human Services does not exclude, deny benefits to, or otherwise discriminate against any person on the grounds of race, religion, color, creed, political belief, national origin, gender, age, presence of disability, gender identity, sexual orientation, or any other classification that is protected by applicable law admission to, participation in, or receipt of the services and benefits of any of its programs and activities or in employment therein, carried out by the Broomfield Human Services Department. This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Age Discrimination Act of 1975, and Regulations of the US Department of Health and Human Services issued pursuant to the Acts, Title 45 Code of Federal Regulations Part 80, 84 and 91. To file a complaint, contact Venita Dye at 720.887.2250, or vdye@broomfield.org.

Proposal Instructions

(Please answer all components of each prompt/question. Failure to answer all components may result in point deductions.)

Section 1: Proposal to Address Community Needs and Priorities – 60 points

Proposals must be in alignment with City and County Community Needs, Community Health Improvement Plan, and/or HHS Priorities:

City Council’s 2021 priorities related to Health and Human Services.
Health and Human Services Strategic Priorities:
- For Our Community:
  - Whole Family Success: Utilizing a multi generational approach, create a thriving community that promotes whole family success, employment and economic resiliency, and healthy childhood development.
  - Physical and Behavioral Health: Create healthy families and community through increased access to care and support for physical, emotional, and behavioral health.
- For Our Partnerships:
  - Collaboration and Integration: Work together as a department and a community to efficiently use resources by collaborating on shared goals. Leverage technology systems and personal partnerships to support whole family care and success.
The most recent Community Health Needs Assessment for Broomfield resulted in the development of the Behavioral Health Improvement Plan (BHIP) that prioritizes two complex and evolving health issues: mental health and substance abuse misuse. The three goals of BHIP are:
- Change the narrative: Build understanding of mental health as a positive state of well-being that the community builds and maintains together.
- Reduce barriers to service for mental health and substance misuse.
- Increase community connectedness and decrease social isolation and exclusion.

The grant application and reporting format will include the basic principles of the Results-Oriented Management and Accountability (ROMA) Logic Model with additional components and includes five broad categories: Identified Problem/Need/Situation, Services/Activities, Projected Outcomes, Outcome Indicators, and Data Source & Collection/Reporting.

Identified Problem/Need/Situation: Succinctly describe the purpose of the proposed grant project/program and the specific service need gap that you are seeking to fill. It must be in alignment with the Community Needs of the City and County of Broomfield and align with Broomfield HHS’ mission and strategic priorities. Services must be targeted to serve Broomfield residents. Indicate how you identified the problem/need/situation (e.g. what research was conducted via community indicator or survey, etc.). When possible, include Broomfield-specific data.
Services/Activities: List the services/activities that your agency will provide. Indicate if these services are proposed, new, or existing, and how and where Broomfield residents access services. Include the frequency and timeline of services, eligibility criteria, and target demographics. Are services direct (e.g. food provided to client) or indirect (e.g. operational costs of staff that will serve clients)?
Collaboration: Explain active partnerships, collaboration, and engagement with other community partners to leverage efforts and collectively impact and make progress on Community Needs. Clarify how your agency mitigates duplication or redundancy in the system. If there are other organizations in the community addressing this need, describe what differentiates your agency’s services from others.
Outputs: Describe the quantifiable deliverables/services rendered. (e.g. X number of residents received Y number of treatment sessions.) Indicate how many unduplicated Broomfield residents are projected to receive services through Broomfield funds and in total. (e.g. Your agency anticipates providing food to 350 unduplicated Broomfield residents; Broomfield funds will be used to support food provision for 150 of those 350 residents.)
Projected Outcomes: Describe the qualitative data on the progress made toward mitigating the Community Need. (e.g. As a result of our services, X% of clients reported a reduction in symptoms and improvements in mental health and self-sufficiency after __ months of services.) You can include the impact on residents if your services were not available. Not all services will have correlated outcomes. Some outcomes may be direct, while others may be indirect. Please explain via evidence-based practice/principles and research how outcomes can be determined. Please cite your evidence-based practice/principle.
- If your agency is requesting over $10,000, please give detailed projected outcomes including short-term (0-12 months), middle-term (1-3 years), and long-term (over 3 years) outcomes and community impact of your proposed services. Not all terms may apply.
Outcome Indicators: How will you measure and report progress toward achieving the projected outcomes listed? What tools, processes do you use to collect data and measure success? (e.g. evaluation and measurement tools)
Reporting: Are there other forms of reporting that your agency already completes that support your grant proposal? If so, please include those items as an addendum to your application.
How do you ensure Broomfield residents are being targeted?

Section 2: Narrative – 25 points

Applicants will be given an additional one page narrative to provide additional information. Please include:

History of working with Broomfield residents, including current percentage of your agency’s clientele that are Broomfield residents;
History of working with Broomfield HHS;
Description of governing body and level of engagement; and,
Description of Stakeholders and how input is gathered from Stakeholders to improve and enhance services.
Does your agency provide Public Health Services?
Have the Regional Accountable Entity (RAE) impacted the provision of services and agency funding? If so, how?
Has the Affordable Care Act (ACA) impacted the provision of services and agency funding? If so, how?
Has the COVID-19 pandemic impacted the provision of services and agency funding? If so, how?
(If applicable) What are the current trends in your agency’s field that may impact services or funding?

Section 3: Budget/Financial Stability - 15 points

Budget/Financial Stability will be assessed by completion of the Spending Plan Form.

Section 4: Required Miscellaneous Documents – No points allotted, but necessary documents for committee to review

And lastly, applicants will be required to provide electronic copies via email or website address for the following:

Current annual operating budget (only for agencies requesting general operating support);
List of current Board of Directors;
Most recent fiscal year-end audit or independent financial review, financial statements;
Most recent annual report;
Strategic plan; and,
Copy of most recent IRS Letter of Determination indicating 501(c)(3) or 509(a) tax-exempt status from within past 5 years.
Letters of support - optional. (Letters of support are strongly encouraged to assist the committee in determining who are the stakeholders that support the Applicant’s request for funding to support their services.)

I have read and meet all the funding restrictions. *

Proceed to Application

Funding Tiers

Tier 1: Up to $15K

For promoting the greater diversity of service providers ensuring sustainability for all residents
Any non-profit serving health or human service needs of Broomfield residents
Simpler application (Please see questions below.)
Maximum amount for new agency
Semiannual Grant Reports
Optional participation in regular non-profit consortium meetings (same as Tier 3 below)

Tier 2: Over $15K up to $75K

Ongoing funding for necessary service delivery that complements and supports health or human service needs
Have received grant previously
More information requested in application (Please see questions below.)
Semiannual Grant Reports
Regular non-profit consortium meetings (same as Tier 3 below) if housing or mental health category

Tier 3: Over $75K

Collaborate with service providers in an effort to drive key results for the community
More information requested in application (Please see questions below.)
Quarterly Grant Reports or via performance evaluation meetings
Mandatory regular non-profit consortium meetings during 2022 to discuss goals, performance metrics, outputs and outcomes, collaboration, and impact on community priorities including housing/mental health. (Results-Based Accountability, Four Disciplines of Execution)

Please choose the Funding Tier you are submitting for:*

Tier 1: Up to $15K Tier 2: Over $15K up to $75K Tier 3: Over $75K

Summary of Applicant Information

Please note applicants who start the application and would like to use the Save and Resume feature will need to save all uploads to the last step before they submit the application. The application is not able to save the uploads during the Save and Resume phase.

Organization Name*

Organization's Mission Statement*

Website*

Executive Director*

First Name

Last Name

Grant / Program Administrator*

First Name

Last Name

Email*

Preferred email address to send grant correspondence

Summary of Funding Request*

Proposed services and number of residents

Amount Requested* $

Type of Request*

General operating support for the agency General operating support for a specific program /service Direct good / services for Broomfield residents (e.g. rental assistance or food for a food bank) One-time event Seed funds/start-up costs for a specific program / project / service

Other:

Select all that apply

By signing below, I certify that the information contained in this application is true and correct to the best of my knowledge.

Signature of Executive Director or Designee*

[clear]

Use your mouse or finger to draw your signature above

Section One: Proposal to Address Community Needs and Priorities - 60 Points

1. Please describe the identified Problem / Need / Situation your agency is addressing and how it aligns with the Community Needs and Priorities. Succinctly describe the purpose of the proposed grant project/program and the specific service need gap that you are seeking to fill. It must be in alignment with the Community Needs of the City and County of Broomfield and align with Broomfield HHS’ mission and strategic priorities. Services must be targeted to serve Broomfield residents. Indicate how you identified the problem/need/situation (e.g. what research was conducted via community indicator or survey, etc.). When possible, include Broomfield-specific data.*

2. Please describe your agency's proposed Services / Activities in response to the Community Needs and Priorities. List the services/activities that your agency will provide. Indicate if these services are proposed, new, or existing, and how and where Broomfield residents access services. Include the frequency and timeline of services, eligibility criteria, and target demographics. Are services direct (e.g. food provided to client) or indirect (e.g. operational costs of staff that will serve clients)?*

3. Please describe how your agency partners with the other entities to leverage your impact and reduce duplication of services to address Community Needs. Explain active partnerships, collaboration, and engagement with other community partners to leverage efforts and collectively impact and make progress on Community Needs. Clarify how your agency mitigates duplication or redundancy in the system. If there are other organizations in the community addressing this need, describe what differentiates your agency’s services from others. *

4. Please describe the Projected Outputs of your agency's proposed services. Describe the quantifiable deliverables/services rendered. Indicate how many unduplicated Broomfield residents are projected to receive services through Broomfield funds and in total.*

5. Please describe the Projected Outcomes of your agency's proposed services. Describe the qualitative data on the progress made toward mitigating the Community Need.You can include the impact on residents if your services were not available. Not all services will have correlated outcomes. Some outcomes may be direct, while others may be indirect. Please explain via evidence-based practice/principles and research how outcomes can be determined. Please cite your evidence-based practice/principle. If your agency is requesting over $10,000, please give detailed outcomes including short-term (0-12 months), middle-term (1-3 years), and long-term (over 3 years) outcomes and community impact of your proposed services. Not all terms may apply.*

6. How will you measure and report progress toward achieving your Projected Outputs and Outcomes (Outcome Indicators)? What tools, processes do you use to collect data and measure success? (e.g. evaluation and measurement tools) *

7. Does your agency already complete forms of reporting that support your grant proposal?*

Yes No

7a. Please upload the relevant documents. Please combine all reports into one document to upload. Note: applicants who start the application and would like to use the Save and Resume feature will need to save all uploads to the last step before they submit the application. The application is not able to save the uploads during the Save and Resume phase.

No File Chosen

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7b. List and describe any uploaded documents

8. How do ensure funding is used to serve Broomfield residents?*

Section Two: Narrative - 25 Points

1. History of working with Broomfield residents, including current percentage of your agency's clientele that are Broomfield residents: *

2. History of working with Broomfield HHS: *

3. Description of Board of Directors and level of engagement: *

4. Description of Stakeholders and how their input is gathered from to improve and enhance services: *

5. Does your agency provide health services?*

Yes No

6. Have your services been impacted by the Regional Accountable Entity (RAE)?*

Yes No

How has RAE impacted the provision of services and agency funding?

7. Have your services been impacted by the Affordable Care Act (ACA)?*

Yes No

How has ACA impacted the provision of services and agency funding?

8. Have your services been impacted by the COVID-19 pandemic?*

Yes No

How has the COVID-19 pandemic impacted the provision of services and agency funding?

9. What are the current trends in your agency's field that may impact services or funding?*

Section Three: Spending / Plan / Budget - 15 Points

The amounts entered in Section Three should only be for the agency's specific service/activity towards which they will use Broomfield grant funds.

Expenditures related to proposed services

Overhead / Indirect Costs

Salaries & Benefits for Non-Programmatic Staff: *

Broomfield Grant Funding Amount* $

Total Program Budget * $

Supplies:*

Broomfield Grant Funding Amount * $

Total Program Budget * $

Contractuals: *

Broomfield Grant Funding Amount* $

Total Program Budget* $

Administrative Costs:*

may not exceed 15% of request

Broomfield Grant Funding Amount* $

Total Program Budget * $

Program / Direct Costs

Salaries & Benefits for Programmatic Staff: *

Broomfield Grant Funding Amount * $

Total Program Budget* $

Direct client benefits / program expenses tied directly to Broomfield residents served:*

Broomfield Grant Funding Amount* $

Total Program Costs* $

Revenue (Other fund sources for program / project)

Donations: *

Individuals / Corporations / Foundations, etc.

Donations* $

Other Government Contributions:*

Text area for brief description: e.g. Medicaid funding, or other State / Federal / local funding fees charged by organization, co-pay fees etc.

Other Government Contributions* $

In-Kind Contributions:*

donated good, professional services, volunteer time

In-Kind Contributions* $

Total Other Funds Dedicated to Project: *

Total Other Funds Dedicated to Project* $

Does your agency charge fees or require client contributions?*

Yes No

Fees for Services / Participant Contributions

Amount of Fees for Services / Participant Contributions $

Upload fee schedule

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Earned Income / Other Revenue:*

Amount of Earned Income / Other Revenue * $

Please use the space below to provide supplemental information on spending plan / budget.

1. Cost per Broomfield resident including projected total unduplicated number of residents to be served by your organization as well as the number of residents to be served just with the requested Broomfield funds. If that cost exceeds $250 per resident, explain why.*

2. Sustainability Plan: If funds were not available, is there a plan to sustain services?*

3. Describe the accounting method to track funds and residents served.*

Section 4: Miscellaneous Documents

Current annual operating budget for agencies requesting general operating support*

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List of current Board Members*

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Most recent fiscal year-end audit or independent financial review, financial statements*

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Most recent annual report*

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Strategic Plan*

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Copy of most recent IRS Letter of Determination indicating 501(c) or 509(a) tax-exempt status from within past 5 years.*

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Letters of support - optional

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File uploads may not work on some mobile devices.

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