Social and Community Investment Fund 2016 Funding Application Form

Instructions: Refer to each section of this application, and compete the relevant sections:

Section 1. Agency Information Completed by all applicants

Section 2. Financial Information Completed by all applicants

Section 3. Service Targets, Evaluation and Reporting Completed by all applicants

Section 4. Checklist and Signature Completed by all applicants

Name of Agency:

Name of Project or Program:

A signed, original application form, including one copy of the required attachments, must be

received no later than

Friday Oct 9, 2015 at 4:30 pm

County of Simcoe Administration Centre Social and Community Services Division

1110 Hwy 26 West Midhurst, ON L0L 1X0

Attention: Trevor McAlmont

Program Supervisor

Tel: (705) 722-3132 ext. 1460 trevor.mcalmont@simcoe.ca

Social and Community Investment Fund

2016 Funding Application Form

Due: Oct 9, 2015 by 4:30 pm

The County of Simcoe provides a Social and Community Investment Fund (SCIF) to help local organizations develop community-based initiatives that address poverty. SCIF is intended to provide opportunities for low-income families through community programs. The goals of the SCIF program are: (1) to support external programs that address services for low income families, particularly those in receipt of social assistance, and (2) to address pressures identified in the social service sector.

It is recognized that a continuum of supports is an ideal approach for a combination of crisis intervention and preventative measures when addressing poverty. The amount of funding available may change from year to year. A community-based allocations committee is used to help review and make project funding recommendations for County Council consideration.

Section 2. Project Information

1a. Contact information:

Organization Name:

Street Address: P.O. Box:

City/Town: Prov. P Code:

Telephone: ( ) Fax: ( )

Website:

Senior Administrator/Executive Director Name:

Title: Telephone: ( )

Email Address: Cell: ( )

Fax: ( )

Project Coordinator Name

Title: Telephone: ( )

Email Address: Cell: ( )

Fax: ( )

1b. Please indicate which of the following geographic areas the project/program will serve:

County-wide Alliston and area

Barrie and area Bradford/Innisfil and area

Collingwood/Wasaga Beach and area Orillia and area

Midland/Penetanguishene and area

1c. What is the total amount of funding requested for this project?

$ TOTAL

Section 2. Project Information

2a. In 250 words or less, please provide a brief description of the project. Describe the program target population and demographics as well as any best practices that will be implemented. Explain how it addresses service gaps and needs.

Section 2. Project Information

2b. In 250 words or less, please describe how this proposal contributes to short and long term poverty reduction solutions in your local community, including solutions that are directed at ending poverty at the systemic level? Describe the ability and readiness to implement and evaluate best practice program strategies.

Section 2. Project Information

2c. What is the primary function/role/mandate of the sponsoring agency for this project? Describe the capacity to administer the major program goals and expected outcomes.

2d. In 250 words or less, explain how this project will demonstrate collaborative service delivery approaches with community partners.

Section 2. Project Information

2e. In 250 words or less, identify and describe the short and long term outcomes this project/program expects to achieve. Explain how program participants will be better off after engaging in this program.

On the following page, include a total budget for operating this project. By funder, list both revenues received or anticipating along with expenses that include a detailed breakdown of staffing positions and FTE’s. Include all related costs such as training, rental and supplies.

SCIF funding supports salary positions and eligible project program costs such as supplies, transportation and up to 10% project administrative costs such as administrative salary. Capital costs are not eligible for SCIF consideration. Please include your agency’s annual operating budget and latest audited financial statement.

Section 3. Financial Information: SCIF BUDGET WORKSHEET

For the Period Beginning: January 1, 2016 and ending: December 31, 2016

County of Simcoe Other Funding Supporting this Project

Total SCIF Request:

SCIF Other County Funding Private Fundraising (United Way, Trillium, etc) Federal Government Funding County of Simcoe Member Municipalities' Funding Provincial Ministry Funding Local Health Integration Network (LHIN) Others: TOTAL $

_.00

EXPENSES Total Revenue

# FTE Position Title

Staff Benefits Rent Phone Utilities Insurance Audit

Supplies & Others

Equipment

Volunteer Training

Staff Training

Travel

As part of the allocations for funding, service targets and quarterly reports must be maintained by your agency. Complete the following estimated service targets (Outputs). These service targets will be used to measure overall project outcomes and will be reflected as part of the service agreement with the County of Simcoe. In addition, identify how your project intends to track outcomes for your target population

(Outcomes).

OUTPUTS How much will you do?(Estimate Service Targets)

# of Children served

# of Adults served

# of Community Partnerships

How will you track program performance?

Examples:

Waitlists Dropout rate Client satisfaction

Program costs

Increased attendance or access

Staff-client relationships or staff morale

OUTCOMES

How will you track if anyone is better off? What will the Impact be?

Examples:

Healthy lifestyle changes

Child Resiliency Parent Employment Parent-child relationships Increased Wellness Reduced Poverty Access to resources Client narratives/stories

References & Resources

www.raguide.org

www.resultsaccountability.com www.resultsleadership.org

Section 4. Service Targets, Evaluation and Reporting

Please confirm one copy of each of the following documents is enclosed with your application:

Attachment 1 – Proof of Eligibility

Attach a complete copy of documents that will confirm the eligibility of the organization such as letters patent, notification of registration of charitable status or special act of incorporation.

Attachment 2 – Proof of Insurance

Attach certificate of insurance in the amount of not less than five million dollars ($5,000,000.00) per occurrence.

Attachment 3 – Financial Records

Include your agency’s annual operating budget and latest audited financial statement

Attachment 4 – Criminal Reference Check Policy

Attach documentation highlighting your Criminal Reference Check Policy and Procedure.

Attachment 5 – List of your Board of Directors

This list must include names, board positions, telephone numbers, and e-mail addresses.

Attachment 6 – Outreach Materials and Evaluation Reports

Attach additional documents such as brochures, pamphlets and evaluation work undertaken.

Declaration

I confirm that the information contained in this application and the accompanying documents is true, accurate and complete. I acknowledge that if this application is approved, I will be required to enter into a formal, legally binding agreement with the County of Simcoe that will outline the terms and conditions of the grant.

Name and Signature of the Executive Director and Chair/President of Board of Directors:

Name Title

Signature Date

Name Title

Signature Date