2006 Abstinence education (Georgia. Children and Youth Coordinating Council)

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ABSTINENCE EDUCATION

REQUEST FOR PROPOSALS AND
APPLICATION KIT

Children and Youth Coordinating Council 3408 Covington Hwy., 4th Floor Decatur, Georgia 30032-1513
Telephone: (404) 508-6574 www.cycc.state.ga.us
This publication has been prepared under a grant from the United States Department of Health and Human Services. The Children and Youth Coordinating Council hopes this edition will serve the needs of those organizations eligible for funding to provide services for Georgia's children , youth and families.

TABLE OF CONTENTS

PREFACE....................................................................................................... 1

INTRODUCTION....................................................................................................

2

APPLICATION CRITERIA........................................................................................

6

APPLICATION SUBMISSION...................................................................................

8

DEADLINE = March 6, 2006 AT 5:00 PM

APPLICATION REVIEW............................... __ ........................ ... ... ... ... ... ... ... .......... ..

9

NOTIFICATION OF AWARDS..................................................................................

9

MODIFICATION OF FUNDS......................... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... .. ... .. .

9

GENERAL FUNDING POLICIES.............................................................................. 10

CONTINUATION FUNDING POLICIES...................................................................... 12

UNALLOWABLE GRANT EXPENDITURES................................................................. 12

SUBGRANTEE REPORTING REQUIREMENTS.......................................................... 14

FEDERAL ABSTINENCE CRITERIA..................................................................... 16

FUNDING PROVISIONS................................................................................... 16

PROGRAM NARRATIVE....................................................................................... 17

SAMPLE OF SURVEYS...................................................................................... 21

APPLICATION CHECKLIST AND FORMS............................................................... 31

Application Face Sheets Detailed Budget Summary Detailed Budget Narrative Example of Budget Narrative and Summary Evaluation Acknowledgement Form Assurances Certification Audit Information Certification of Equal Employment Program Certification Regarding Lobbying, Debarment & Drug-Free Workplace Non-Supplanting Certification Service Delivery Strategy Act Compliance Certification Accounting System and Financial Capability Informational Questionnaire CYCC Board Members CYCC Technical Assistance Directions to CYCC Office

2006 Abstinence Education RFP and Application Kit

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PREFACE

During the 2006 spring funding cycle, the Children and Youth Coordinating Council will accept grant applications for new abstinence education programs.

Program

Available Funds

Abstinence Education

$794,135

School systems are eligible to apply for up to $200,000 per year for 3 years. Non-profit agencies as well as local units of government are eligible to apply for up to $85,000 per year for 3 years.
All programs are required to provide cash and/or in-kind matching funds equal to 40% of the grant award amount. Third year continuation proposals will be subject to a 25% reduction in funding if original award exceeds $10,000.
Note: Non-profit organizations applying for funds are required to have been in existence for at least 12 months and have 501 {c)(3) status at the time of filing the grant application.

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ABSTINENCE EDUCATION
Request For Proposals

INTRODUCTION
The Children and Youth Coordinating Council (CYCC) wi ll accept applications for the funding of new Abst inence Education programs under the Abstinence Education Block Grant from the United States Department of Health and Human Services (CFDA 93.235) between January and March of 2006. Funding within this area will be devoted exclusively to agencies that seek to prevent teen pregnancies, sexually transmitted diseases, and welfare dependency by providing abstinence until marriage programming. Programs are strongly encouraged to provide youth development activities to promote abstinence from sexual activity. To be eligible for funding, projects cannot vio late any aspect of abstinence education as defined by federal regulation and is required to emphasize abstinence until marriage as the expected standard for ch ildren and teenagers.
If you have any questions in completing this application for grant funds, CYCC staff is available to assist you. A telephone listing and e-mail addresses of grant staff are provided in the back of this book. CYCC will provide a pre-application workshop dedicated to Abstinence funding on January 11, 2006 from 10:00am-3:00pm at the Georgia Public Safety Training Center at 1000 Indian Springs Drive Forsyth, GA. CYCC program and fiscal staff will provide guidance on developing program goals and objectives, evaluation methods, budget parameters, eligible sources of match and computation, as well as other administrative requirements. Agencies seeking CYCC grant funding for the first time are strongly encouraged to attend this workshop. The Council will also offer additional pre-application workshops for juvenile justice fund ing that will include a brief Abstinence section. Please note that these trainings are optional and are provided to clarify the instructions contained in the Request for Proposals and Application Kit. These workshops will be held across the State during January 18-25, 2006. Visit www.cycc.state.ga.us for the dates and locations.
ELIGIBILITY
Eligible applicants include state government, local governments, school systems and non-profit agencies, and religious organizations with 501 (c)(3) status or group exemption. Non-profit agencies refer to page 6 for fu rther instructions.

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FEDERAL ABSTINENCE CRITERIA

Federal legislation defines abstinence education by the following statements.
A Has as its exclusive purpose, teaching the social psychological, and health
gains to be realized by abstaining from sexual activity. B. Teaches abstinence from sexual activity outside marriage as the expected
standard for all school age children. C. Teaches that abstinence from sexual activity is the only certain way to
avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems. D. Teaches that a mutually faithful monogamous relationship in context of marriage is the expected standard of human sexual activity. E. Teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects. F. Teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child's parents, and society. G. Teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances. H. Teaches the importance of attaining self-sufficiency before engaging in sexual activity.
SUGGESTED ACTIVITIES
It is required that all programs focus on abstinence until marriage as well as promote positive community values and encourage healthy lifestyle choices for youth. Programs may be developed specifically for this grant funding or provide an abstinence education component to existing after-school, community-based or school-based youth development projects. Youth development activities include, but are not limited to:
academic tutoring structured recreation community service/outreach mentoring cultural enrichment alcohol, tobacco and other drug prevention character education resistance/life skills relationship building parenting instruction (for teenage parents) parental involvement (for parents or guardians of participants) career counseling summer camp
Go to www.acf.dhhs.gov/programs/fysb/youthinfo for more information about positive youth development.

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OVERALL PROGRAM GOALS
1. Promote the initiation of successful and locally sustainable abstinence until marriage programs
2. Promote parental and guardian involvement
3. Foster the development of local community initiatives that promote healthy lifestyle choices for youth
4. Initiate after-school, school-based and community-based programs utilizing appropriate abstinence until marriage curricula, materials, and resources
5. Prevent teen pregnancy, sexually transmitted diseases, and out-of-wedlock births among youth
6. Prevent welfare dependency

FUNDING PROVISIONS

Teaching or discussing family planning or birth control methods are not appropriate topics for this funding. Birth control methods may be discussed only in relation to failure rates. Programs may not teach or promote religion and are required to be accessible to any interested participant, regardless of religious affiliation. The following statement is from Part 87.2 (c) of the Equal Treatment Regulation:

(c) Organizations that receive direct financial assistance from the Department may not engage in inherently religious activities, such as worship, religious instruction, or proselytization, as part of the programs or services funded with direct financial assistance from the Department. If an organization conducts such activities, the activities must be offered separately, in time or location, from the programs or services funded with direct financial assistance from the Department, and participation must be voluntary for beneficiaries of the programs or services funded with such assistance.

Visit the following websites for additional information.

http ://www.hhs.gov/fbci/final .html http://www.whitehouse.gov/govemment/fbci/guidance/index.html

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BUDGET

Individual state government, local government, and non-profit projects may not exceed $85,000. However, public school systems initiating or expanding an abstinence education curricula or course of study for participants system-wide are eligible for a maximum of $200,000 in grant funding. Each project will be funded for 12 months with a possible 2 years of additional funding. Third-year continuation proposals will be subject to a 25% reduction in funding if original award exceeds $10,000.

All proposals must contain a minimum of 40% non-federal cash matching funds and/or in-kind services as calculated below. All matching items/services/donations must occur during the grant period.

Match Example:
$20,000 Requested Grant Funds X .40 40% Match Requirement
$ 8,000 Required Local Match

TARGET POPULATION
Programs are required to target youth ages 10 - 19. Priority will be given to areas throughout Georgia where there is a high rate of teen pregnancy and/or teen birth rate and organizations submitting proposals to serve Hispanic youth..

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,,

APPL/CATION CRITERIA

II

I. Letters of Support

Applicants are required to provide current and relevant letters of support from public and private agencies as well as community organizations with which the applicant will coordinate program activities. Address all support letters to the Council Director, Pete Colbenson and submit them with the proposal. DO NOT mail support letters separately from the application.

II. Cooperative Agency Applications

Applications submitted in cooperation by two agencies (e.g., county government and a non-profit agency) are required to submit an agreement documenting the lead applicant and describing the paperwork procedures. The "Applicant" is the agency responsible for the overall administrative and financial management of the grant. The "Implementing Agency," if different from the Applicant, is the organization that operates the youth program on behalf of the Applicant.

Ill. Non-Profit Requirements

Non-profit organizations applying for funds are required to have been in existence for at least 12 months and have 501 (c)(3) status at the time of filing the grant application. Submit a copy of the most recent certified financial statement (audit) with the application. Organizations that do not have a certified financial statement are required to submit a financial compilation/summary for the most recent fiscal year. As mandated by O.C.G.A. 50-20-3, include the following six items in the compilation:

1. The financial condition of the non-profit contractor at the end of the previous fiscal year, including revenues and expenditures for that fiscal year;

2. An individual listing of each employee and his/her salary and reimbursable expenses;

3. A listing by category of the sources of income of the non-profit organization;

4. A listing of the source or sources of all public funds received by the non-profit contractor and the program for which the funds were received;

5. A statement (letter) by the president of the organization or person responsible for the financial statements, stating the accounting basis of presentation and describing any respects in which the statements were not presented on a basis consistent with the statements prepared for the preceding fiscal year; and

6. A copy of the non-profit status form 501 (c)(3) issued by the Internal Revenue Service. (DO NOT send a copy of the tax return or a copy of incorporation by the GA Secretary of State).

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IV. Equal Employment Compliance

A State and Local Governments

Certify that an Equal Employment Opportunity Plan (EEOP) exists which is consistent with federal guidelines for minority persons and females. This requirement is mandatory for government entities requesting $25,000 or more in grant funds AND having 50 or more employees. If the government entity is requesting less than $25,000, a certification is not needed. However, if it is requesting $25,000 or more but has less than 50 employees, complete the certification indicating that an EEOP is not required (section 2 of the certification). The EEOP certification is located in the appendix section of this book.

B. Non-Profit Organizations, School Systems and Medical Institutions

Applicants that are non-profit organizations, school systems or medical institutions are not required to develop or submit an Equal Employment Opportunity Plan. However, all recipients of federal funds, regardless of the type of entity, must comply with all applicable non-discrimination laws and regulations as described below:

No person in any state shall, on the ground of race, color, religion, national origin, sex, or disability, be excluded from participation in, be denied the benefits of, be subjected to discrimination under, or denied employment in connection with any program or activity that receives federal financial assistance.

V. Service Delivery Strategy Act Compliance

Effective July 1, 1999, every county (and cities within that county) is required to adopt a Service Delivery Strategy. The strategy is a concise implementation plan among cities and counties to provide local government services and resolve land use conflicts within the county. These strategies are submitted to the Georgia Department of Community Affairs (DCA) for approval, and DCA is charged with monitoring compliance.

As a result of this new law, no state-administered financial assistance can be awarded to a local municipality that is not in compliance with the Act. This requirement applies to all Georgia county governments, city governments, and authorities (e.g., housing, water, and downtown development authorities). Please be aware that some cities will fall into more than one county, and all counties are required to be in compliance for the city to be eligible for funding. To determine whether your municipality is in compliance, you may visit DCA's web site at www.dca.servicedelivery.org. All local municipality applicants must submit a compliance certificate verifying eligibility. The certification is located in the appendix section of this book.

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APPLICATION SUBMISSION

II

Submit the original grant application and two (2) additional copies of the grant application. Attach the original application with a binder clip, however the copies may be stapled. The narrative portion of the application must follow an outline form as described in the "Program Narrative" section on page 17.

Postmark applications with a United States Post Office postmark or other carriers, which provide date verification (Federal Express, etc.) by March 6, 2006 and mail to the following address. METERED POSTMARKS WILL NOT BE ACCEPTED. If desired, proposals may be hand-delivered by 5:00 p.m. on March 6, 2006. [Directions to CYCC office are located in the back of this book.]

Children and Youth Coordinating Council 3408 Covington Hwy, 4th Floor
Decatur, Georgia 30032

(please note new address)
Applicants will not receive verification from CYCC regarding receipt of the application package. Due to the anticipated large volume of applications, we ask that you do not call the office to verify receipt. Applicants wishing to verify receipt are encouraged to use a return receipt service provided by the post office or other such carriers.
An application may be rejected by CYCC for two reasons:

1. LATE SUBMISSION: It is the responsibility of the applicant to ensure that the proposal is received by the specified deadline. NO EXCEPTIONS!

2. INCOMPLETE APPLICATION: Applications will be considered incomplete if any of the following elements are missing.
Original signature of the applying agency's executive officer Grant Application Face Sheet Detailed Budget Summary Budget Narrative Project Narrative The original and two (2) copies of the application documents

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11

APPL/CAT/ON REVIEW

11

Each application received by CYCC will be reviewed to ensure that the proposed project meets the established requirements as well as the goals and objectives of the program contained in the 2006 Request for Proposals and Application Kit. The application will also receive a budgetary review to ensure rational and authorization of costs. CYCC staff may request additional information during the review process. Proposals are reviewed by CYCC staff and accepted based on accuracy, appropriateness, feasibility, and utility, as well as availability of existing local resources, future permanent funding, volunteer support, interagency collaboration and compatibility.

II

NOTIFICATION OF AWARDS

11

Applicants will be notified in writing of the Council's decision by May 30, 2006. Applicants whose projects are denied will also be notified by the above date.

11

MOD/FICA T/ON OF FUNDS

11

Due to the limited amount of funds available, it may be necessary for CYCC to reduce the amount of the grant award from that requested by the applicant. In addition, the Council reserves the right to negotiate budgetary changes with the applicant prior to executing the grant award agreement. The applicant may decline the amended or reduced grant award, and may request a commensurate amendment or reduction in the scope of the project.

If, during the term of the grant award, the funds appropriated are reduced or
eliminated by the Georgia State Legislature or the United States Government, CYCC
may immediately terminate or reduce the grant award by written notice to the grantee. However, no such termination or reduction shall apply to allowable costs already incurred by the subgrantee to the extent that funds are available for payment of such costs.

A request for continuation of funding may not exceed the amount of the previous year's award.

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GENERAL FUNDING POLICIES
11
1. CYCC seeks to fund the initiation of new projects or expand established programs that serve high-risk youth. CYCC will not consider funding established programs with existing operational costs.
2. CYCC reserves the right to designate particular funding priorities during each funding cycle.
3. A high priority rating will be given to applicants that provide intense, long-term, creative youth development activities within the abstinence education program. A low priority rating will be given to applicants that propose a short-term curriculum/cognitive skills only abstinence education program.
4. CYCC requires that each program include the standardized goals and objectives
outlined on page 18. Programs may include additional goals and objectives relevant to the particular program however, do not submit more than 10 goals and objectives combined.
5. CYCC requires that the pre and post test surveys (sample included in RFP) for the middle and high school students be implemented by each program to answer the standard objectives. If you will be implementing the abstinence program in a school system, CYCC requires that the school principle and superintendent sign the Evaluation Acknowledgment form included in this RFP. It may be necessary for you to get approval by the local school board or health curriculum committee before administering the surveys. CYCC will not award an abstinence education grant to an entity that does not comply with the use of these surveys.
6. Gathering and reporting of programmatic data are critical. CYCC requires that evaluation findings be included in applications for continuation (demonstrating progress to date) as well as in the annual program report due at the end of each project year. Evaluation findings illustrate both successful implementation and program impact on participants and/or the community as a whole. Each program will be required to administer the Georgia Abstinence Education pre and post test surveys.
7. If abstinence funding is awarded, the subgrantee will be required to submit a
completion worksheet to CYCC monthly. The form requires participant name or
identification number along with current program status.
8. Funding awarded through this program cannot be utilized in any fashion for family planning purposes. Also, funds may not be used to teach or promote religion.
9. A high priority rating will be given to applicants that promote collaboration among local organizations as well as programs that incorporate parental involvement.
10. A low priority rating will be given to programs where the proposed program falls within the primary responsibilities of other funding agencies.

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11. A high priority rating will be given to programs that serve Hispanic youth. In order to receive this rating you are required to demonstrate a history of serving the Hispanic community.

12. Matching funds and/or in-kind services are required in the amount of 40% of the grant award amount. All successful third-year continuation applications over $10,000 will be subject to a 25% reduction in funding from the first-year award. Note: CYCC funding, in many instances, may not be sufficient to fully implement the program. Therefore, additional local match over 40% should be noted in the application.

13. Programs are funded for one-year periods renewable each year for a total of three years.

14. Funding will not be approved to supplant (replace) obligations that belong to state or local units of government.

15. Grant funds will not be utilized under any circumstances for construction purposes.

16. CYCC will ensure that each congressional district is given equal consideration during the grant review process.

17. Background investigations are required on all project staff and volunteers providing direct services to program participants. It is left to the discretion of the implementing agency to determine the methodology for completing these investigations. Subsequently, it is mandatory that grant applications describe this methodology.

18. CYCC requires all subgrantees to establish and enforce an Internet Security Policy when minor participants and/or staff have access (supervised or unsupervised) to the Internet. This includes any technology provided by CYCC funding and technology utilized by participants during a CYCC funded program component. The Internet Security Policy is intended to restrict access to inappropriate and harmful materials, such as obscene or pornographic content and/or e-mail or chat rooms that may compromise participant personal identification information. CYCC does not recommend or require any specific security or filter programs.

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CONTINUATION FUNDING POLICIES

A continuation proposal is required annually. An initial grant does not guarantee continuous funding. The annual submission allows a project to improve or modify objectives or activities as well as assess the completion of outcome measures. Continuation grants are awarded to programs that,

1. exhibit professional management of grant funds and compliance with administrative requirements,

2. report accomplishments of the prior year, and

3. demonstrate permanent continuation of the program at the conclusion of Council funding.

11

UNALLOWABLE GRANT EXPENDITURES

The following expenditures cannot be purchased with grant funds as stipulated by federal, state, and Council regulations.

Restricted by Federal Regulations

1. Supplantation of grant funds to replace existing funds in order to free up those funds for another use.

2. Consultation fees for the preparation of grant applications.

3. Acquisition of land.

4. Purchase of military-type equipment including weapons.

5. Compensation of full-time federal employees (salary payments, consulting fees, or other payments are prohibited).

6. Contributions for lobbying, printing and publication efforts, telephone and letter writing campaigns to influence federal and state legislation, and legislative liaison activities. Direct testimony regarding program effectiveness is acceptable.

7. The cost of organized fund-raising or salary of individual engaged in fund-raising activity. This does not prohibit fund-raising efforts of non-profit organizations when financed with other sources of income.

8. Corporate formation.

9. Imputed Interest Charges (Late Fees).

10. Incentives purchased to reward individual youth accomplishments are prohibited.

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Restricted by State Regulations

1. The State of Georgia travel regulations stipulate that mileage is reimbursed at $.485 per mile for authorized use of personal vehicle (car) and $.305 per mile for authorized use of personal vehicle (motorcycle).

2. Political contributions and endorsements are prohibited. Political activity including endorsement of any political candidate or party; use of equipment, postage, stationery or personnel on behalf of any candidate or any question of public policy subject to a referendum; and the display of political posters, stickers or other printed material is restricted. Source: O.C.G.A. 50-2-3.

Restricted by Council Policy

1. Construction costs including capital improvements.

2. Building Rental/Lease.

3. Salary increases that augment the award are prohibited unless actual number of hours worked are increased. However, salary increases will be allowed if the agency can shift grant funds among categories without increasing the grant award.

4. Indirect Costs/Administrative Overhead.

5. Honoraria. Payments to participating individuals or guests other than for documented professional services actually rendered are restricted (no speaker fees).

6. Uniform Rental.

7. Computer purchases that are not directly utilized by program participants and unavailable through other sources.

8. Vehicle purchases unless deemed crucial to the success of the program and determined to be unavailable through other sources.

Note: Requested grant expenditures AND the local match are required to be directly related to the grant program, not overall agency use, as well as occur during the proposed project time period.

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11

SUBGRANTEE REPORTING REQUIREMENTS

11

All funded abstinence education programs are required to comply with administrative reporting, grant guidelines, and audit regulations during the project year.

I. Reports

A. Financial (monthly or quarterly)

1. Expenditure Report/Reimbursement Request - submitted monthly or quarterly. Reports are due within 30 days after the end of each chosen cycle. GRANT FUNDS ARE PROVIDED ON A REIMBURSEMENT BASIS ONLY. Reimbursement approval and processing time averages 4-5 weeks once a request is received by CYCC.

2. Subgrantees are required to maintain expenditure documentation such as time and attendance records, equipment purchases, travel logs, supply purchases, inventory records, and consultants' contracts. CYCC may request this documentation at any time.

3. It is mandatory that new subgrantees attend the grant management workshop (to be held June 2006) prior to the release of grant funds. In the event of non-attendance at the workshop, it is the responsibility of the subgrantee to arrange a meeting at the CYCC office to receive assistance.

B. Programmatic

1. Notice of Implementation - submitted within 60 days of award documenting the implementation of the project or justifying the delay in implementation.

2. Mid-Year Progress Report - submitted within 30 days after the end of the sixth (6th) month of the grant period.

3. Final Evaluation Report - due within 30 days after the end of the grant period; the report must be approved by CYCC staff prior to the release of the final reimbursement.
4. Monthly Completion Table- due the 15th of each month.

5. Pre and Post Test Surveys- submitted to CYCC when appropriate. The pretest is to be administered prior to instruction and post tests are administered at the close of the program each year.

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II. Applicable Grant Management Guidelines and Accounting Principles

A. Federal Requirements (to view circulars, visit www.whitehouse.gov/OMB and click on "Circulars")

1. 0MB Circular A-87, Cost Principles for State and Local Governments

2. 0MB Circular A-110, Grants and Agreements with Institutions of Higher Education, Hospitals and Other Non-Profit Organizations

3. 0MB Circular A-122, Cost Principles for Non-Profit Organizations

4. 0MB Circular A-133, Single Audit Act

B. State and Local Requirements

1. State law, or local ordinances

2. State and/or local purchasing laws and regulations

3. CYCC Subgrantee Finance Manual and related program manuals (copies provided to all subgrantees upon receipt of grant award)

Additional details of grant management requirements are available from CYCC staff and will be presented in detail at the grant management workshop held in June of each year.

Ill. Audit Requirements

CYCC requires that the subgrantee provide for an independent audit (or financial compilation) of its financial operations, including compliance with applicable federal and state laws and regulations. Provide CYCC with a copy of such audit reports within 15 days of issuance.

The audit/compilation will be made in accordance with 0MB Circular A-133 (Single Audit Act) as well as be in compliance with all applicable Georgia laws (O.C.G.A. 50-202 through 50-20-8).

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FEDERAL ABSTINENCE CRITERIA

11

11

Federal legislation defines abstinence education by the following statements. Projects may not violate any aspect of the definition.

A Has as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstaining from sexual activity.

B. Teaches abstinence from sexual activity outside of marriage as the expected standard for all school age children.

C. Teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems.

D. Teaches that a mutually faithful monogamous relationship in the context of marriage as the expected standard of human sexual activity.

E. Teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects.

F. Teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child's parents, and society.

G. Teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances.

H. Teaches the importance of attaining self-sufficiency before engaging in sexual activity.

11

FUNDING PROVISIONS

II

Programs may not teach or promote religion.

Family planning or birth control instruction is not appropriate for this funding.

Programs may not provide incentives (trophies/plaques, rewards for individual accomplishments, gift certificates, gas cards, etc.). Items such as motivational tools, training aids, educational materials, and media awareness items may be purchased. These items must be provided to 1! participants or community.

Programs are required to target youth ages 10 - 19.

2006 Abstinence Education RFP and Application Kit
PROGRAM NARRATIVE

Page 17
ij

The following information provides a description of the necessary components to include in the narrative portion of your proposal. Limit the narrative to 10 pages and use the outline format described in this section. The narrative is a detailed statement of the work to be undertaken and answers who, what, when, where, why, and how statements of the project.
I. Problem Statement
A What is the problem the project proposes to solve? Describe the problem and the need it will meet. Provide specific local data such as demographics, poverty rate, teen birth rate, school dropout rate, sexually transmitted disease rates, and juvenile court trends. Describe how the county and local rates compare to the rates for the state. Briefly explain program format and general purpose. If the project targets a particular neighborhood within the county/city, include specific background information. Define the size of the target population to be served. For example, if the program proposes to serve middle school students with severe academic deficiencies, specify the number of such students in the local school system.
B. Why is the project important and how can it impact youth outcomes such as recidivism, school attendance, failure rates, and teen pregnancy? Describe existing gaps in local services for high-risk children and youth and how the proposed project will address these needs. For example, if the proposed project is an after-school tutoring and abstinence education program, discuss the extent to which these types of programs are currently available. Illustrate the need for such programs by describing the current availability of services for this population.
II. Program Goals and Objectives
List the program goals and objectives in a clearly defined and measurable manner. Directly relate issues and risk factors discussed in the problem statement. Whenever possible, compare the goals to available baseline data (e.g., to improve the grades of program participants during the year; or to prevent participants from re-offending after entering the program). Funded programs will be required to submit evaluation data related to each goal and objective included in the application.
CYCC requires performance and outcome measures with a maximum limit of ten goals and objectives combined.

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A. Program Goals

Program goals relate to the implementation and activities of the program. They provide a standard to determine service delivery. Include the estimated number of participants to be served annually and the projected daily capacity of the program. Performance goals may also include specific program activities, number completing the program, and/or quantity of various services. The required goals are as follows.

1. Reduce teen pregnancy.

2. Increase abstinence education among youth ages 10-19.

Develop realistic and fundamental program goals that can be answered by the evaluation component. It is not necessary to include goals for all program activities or components. Address activities that relate to the risk factors identified in the problem statement. Additional program goals may be added to reflect the focus of individual programs.

B. Program Objectives

Program objectives specify the impact that the program expects to have on participants and/or the community as a whole. Program objectives directly relate to program activities and are measurable. For example, a prevention program might focus on reducing delinquency by improving the grades and school attendance of program participants. The required program objectives are as follows.

1. 100% of program participants will remain free of pregnancy or fathering a child while participating in the program.

2. 80% of program participants will be able to define abstinence education by the end of the program year.

3. 60% of program participants will pledge to remain abstinent until marriage.

4. 75% of program participants will be able to implement refusal skills by the close of the program year.

5. 75% of program participants will complete the abstinence education program.

Develop realistic and fundamental program objectives that can be answered by the evaluation component. It is not necessary to include an objective for each program activity or component. Address activities that relate to the risk factors identified in the problem statement such as academic performance, school attendance or behavior, and juvenile court involvement. Additional objectives may be added to reflect the focus of individual programs.

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Ill. Evaluation Plan

The evaluation plan explains what data are to be collected, how data will be analyzed, and who will be responsible for the data collection. For example, an evaluation plan for an abstinence program may gather data pertaining to grades and school attendance on a quarterly basis for program participants and the school system or county as a whole. These data may be analyzed to illustrate increases or decreases of these variables as well as compare them to the averages within the community.

The evaluation plan assesses program progress and determines whether or not goals are attained. Develop a practical plan that considers the type and amount of local data available as well as staff resources. CYCC requires that the evaluation plan address each goal and objective.

IV. Methods and Procedures

Describe in detail the program design/format and the methodology. New programs are required to provide a timetable for program implementation that includes a specific implementation date. Include the following information:

1. a description of the referral process for the program,

2. type and frequency of proposed activities/services,

3. days and hours the project will be operational, including summer components (if applicable), and

4. overall format and organization of the program.

It is essential that the overall organization of the project and the relationship of different program components be clearly described. Link program activities to one another and seek to achieve the overall program goals described in the project narrative. It is also imperative to link program activities to the budget. For example, if there is a student transportation line item in the budget, the narrative must include a description of how student transportation will be implemented. It is mandatory that applicants include a description of their current background investigation policy or plans to perform background investigations for direct service project staff and volunteers if funded.

V. Previous Program Accomplishments

Programs requesting continuation funding are required to provide a description of program activities and accomplishments to date. Include a summary of program activities, the number of youth served to date, and data answering whether or not the goals were met. This information is an essential component of continuation applications. Also include a description of problems encountered with the original design of the program as well as the corrective action taken.

2006 Abstinence Education RFP and Application Kit

Page 20

This section does not apply to first-year applications for the development of completely new programs. However, first-year applications that intend to expand or enhance existing programs are required to provide a summary of the organization's current structure and activities as well as discuss how the proposed project would impact current services.

VI. Additional Funding Sources

CYCC recognizes that grant funds alone, in many instances, will not be adequate to effectively operate a successful program. Provide information on other resources available to fully implement the program. Include any additional matching funds over and above the mandated amount listed within the RFP. The funds described here may not include those previously listed in the Detailed Budget Summary and Budget Narrative portion of the application. The subgrantee will not be required to document these additional resources during the grant cycle.

VII. Continuation Plan Describe the strategy for obtaining permanent financial support for the
program at the conclusion of CYCC funding. Include a description of existing local financial and volunteer support for the project and the plan for involving other local organizations as well as individuals in acquiring permanent funding.

Note. It is imperative that all proposals include the above seven sections in the project narrative. Failure to do so will affect the review of the application.

2006 Abstinence Education RFP and Application Kit

Page 2 1

GEORGIA ABSTINENCE EDUCATION PROGRAM

PRETEST FY06-07

Pleasr create your personal code number below:

Project Number

Gender

Birthdatc

!= femal e 2= nrnl e

M onth Day Year

First 2 letters of
First Name - Last Na me

Please answer the questions on the fol l ow ing pages honestly and as fully as possibl e. Y our answers are confidential. The inform ati on gained from thi s evaluation will be used to prov ide outcome data.

Intended for: Middle School Students
OR Participants 13 years old or YOUNG-ER

I I I_______ 2006 Abstinence Education RFP and Application Kit Section A

Page 22 Se_c_ti_o_n_B_ _ _ _ _____.

What is your age? Age
What grade are you in now? Grade

Have you ever had sex (either oral or vaginal sex)?
1. Yes 2. No 3. I don't know what sex is

Which one category best describes your racial background?
1. White 2. Black/African American 3. American Indian/Native American 4. Asian/Oriental/Pacific Islander 5. Other (please name)
-------
Are you Hispanic or Latino? 1. Yes 2. No
What kind of grades do you usually get in school? (Circle only one response)
1. Mostly A's 2. Mostly A's and B's 3. Mostly B's 4. Mostly B's and C's 5. Mostly C's 6. Mostly C's and D's 7. Mostly D's 8. Mostly D's and F's 9. Mostly F's
How far would you like to go in school? 1. I plan to quit school as soon as I can 2. I plan to finish high school, but not go on after 3. I plan to go to trade or vocational school after high school 4. I plan to go to college after high school 5. I plan to go to college and then take further study at a graduate or professional school
How important is it to you to get a good education?
1. Not important at all 2. Not too important 3. Somewhat important 4. Quite important 5. Very important

Have you ever had oral sex? 1. Yes 2. No
How old were you when you had oral sex for the first time?
1. I have never had oral sex 2. 10 years old or younger 3. 11 years old 4. 12 years old 5. 13 years old
Have you had oral sex in the past 3 months? 1. Yes 2. No 3. I have never had oral sex
How many people have you ever had oral sex with in the past 3 months?
1. I have never had oral sex 2. 1 person 3. 2 people 4. 3 people 5. 4 people 6. 5 people 7. 6 or more people
The last time you had oral sex, was it protected or unprotected?
1. Protected 2. Unprotected 3. I have never had oral sex
Have you ever had vaginal sex? 1. Yes 2. No

2006 Abstinence Education RFP and Application Kit

Page 23

How old were you when you had vaginal sex

The last time you had sex (either oral or

for the first time?

vaginal sex), what one method did you or

1. I have never had vaginal sex

partner use to prevent pregnancy? (Select

2. 10 years old or younger

only one response)

3. 11 years old

1. I have never had sexual intercourse

4. 12yearsold

2. No method was used to prevent

5. 13 years old

pregnancy

3. Birth control pills

Have you had vaginal sex in the past 3

4. Condoms

months?

5. Depo-Provera (injectable birth

1. Yes

control)

2. No

6. Withdrawal

3. I have never had vaginal sex

7. Some other method

8. Not sure

How many people have you ever had vaginal

sex with in the past 3 months? 1. I have never had vaginal sex

Section C

2. 1 person 3. 2 people 4. 3 people 5. 4 people 6. 5 people 7. 6 or more people

Abstinence is voluntarily choosing not to engage in sexual activity (either oral, vaginal, or anal sex).
1. Strongly agree 2. Agree 3. Not sure

The last time you had vaginal sex, was it

protected or unprotected?



4. Disagree 5. Strongly disagree

1. Protected 2. Unprotected 3. I have never had vaginal sex

Abstinence is the only 100% effective protection from the possible physical, emotional, mental, and social consequences

The last time you had sex (either oral or vaginal sex); did you or your partner use a condom?
1. I have never had sex 2. Yes 3. No

of sex before marriage. 1. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

The last time you had sex (either oral or vaginal sex), did you drink alcohol or use drugs before you had sex?
1. I have never had sex 2. Yes 3. No

A person who has had sex can choose abstinence again.
1. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

2006 Abstinence Education RFP and Application Kit

Page 24

Abstinence is healthy.

A person can get sexually transmitted

I. Strongly agree

diseases from sex even if a condom is used.

2. Agree

I. Strongly agree

3. Not sure

2. Agree

4. Disagree

3. Not sure

5. Strongly disagree

4. Disagree

Is there a problem with teens having sex, if a

5. Strongly disagree

girl does not get pregnant?

"Love" and "having sex" mean the same

I. No problem at all

thing.

2. Some problem

1. Strongly agree

3. A big problem

2. Agree

Even if a girl gets pregnant, having sex before marriage can cause a lot of problems for teenagers.
I. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

3. Not sure 4. Disagree 5. Strongly disagree Having sex before marriage is a way to show someone that you like them? I. Strongly agree 2. Agree 3. Not sure 4. Disagree

Would having sex as a teenager make it

5. Strongly disagree

harder for someone to study and stay in school?
I. No, not harder at all 2. Yes, somewhat harder 3. Yes, much harder

Teenagers who have sex before marriage are more popular.
I. Strongly agree 2. Agree 3. Not sure

Would having sex as a teenager make it harder for someone to have a good marriage

4. Disagree 5. Strongly disagree

and a good family life? I. No, not harder at all 2. Yes, somewhat harder 3. Yes, much harder

Having sex with someone before you are married will bring happiness to your life.
I . Strongly agree 2. Agree

Sexual urges can be controlled. I. Strongly agree 2. Agree

3. Not sure 4. Disagree 5. Strongly disagree

3. Not sure 4. Disagree

Section D

5. Strongly disagree

I think it is okay to say "NO" when someone

A person can get sexually transmitted diseases in their mouth from oral sex.
I. Strongly agree 2. Agree 3. Not sure 4. Disagree

wants to touch me. I. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

5. Strongly disagree

2006 Abstinence Education RFP and Application Kit

Page 25

I think people who want to have sex should

If someone did try to get you to have sexual

respect the right of others to say "NO."

intercourse with them during the next year,

1. Strongly agree

what would you do?

2. Agree

I. I definitely would not do it

3. Not sure

2. I probably would not do it

4. Disagree

3. I'm not sure whether I would do it or

5. Strongly disagree

not

4. I probably would do it

How comfortable would you be saying "NO"

5. I definitely would do it

to a sexual come-on?

1. Very comfortable

I plan to save sexual activity for marriage.

2. A little comfortable

1. Strongly agree

3. Very uncomfortable

2. Agree

3. Not sure

4. Disagree

5. Strongly disagree

2006 Abstinence Education RFP and Application Kit

Page 26

GEORGIA ABSTINENCE EDUCATION PROGRAM

PRET EST FY06-07

Please c reate your pe rsonal code numbe r below:

Project Number

Gender

Birtlu.late

!= fe mal e 2=male

Month Day Year

First 2 le tters of First :un e - Last am e

Please answer the questi ons on the fol lowing pages honestl y and as fully as possib le. Your answers are confidenti al. The informati on ga ined rrom this eva luati on will be used to provide outcome data.

Intended for: High School Students
OR Participants 14 years old or OLDER

2006 Abstinence Education RFP and Application Kit

Page 27

Section A
What is your age? Age
----
What grade are you in now? Grade
Which one category best describes your racial background?
1. White 2. Black/African American 3. American Indian/Native American 4. Asian/Oriental/Pacific Islander
5. Other (please name)._ _ _ _ _ __
Are you Hispanic or Latino? 1. Yes 2. No
What kind of grades do you usually get in school? (Circle only one response)
1. Mostly A's 2. Mostly A's and B's 3. Mostly B's 4. Mostly B's and C's 5. Mostly C's 6. Mostly C's and D's 7. Mostly D's 8. Mostly D's and F's 9. Mostly F's
How far would you like to go in school? 1. I plan to quit school as soon as I can 2. I plan to finish high school, but not go on after 3. I plan to go to trade or vocational school after high school 4. I plan to go to college after high school 5. I plan to go to college
How important is it to you to get a good education?
1. Not important at all 2. Not too important 3. Somewhat important 4. Quite important 5. Very important

Section B
Have you ever had either oral, vaginal, or anal sex?
1. Yes 2. No
Have you ever had oral sex? 1. Yes 2. No
How old were you when you had oral sex for the first time?
1. I have never had oral sex 2. 10 years old or younger 3. 11 years old 4. 12 years old 5. 13 years old 6. 14yearsold 7. 15 years old 8. 16 years old 9. 17 years old 10. 18 years old or older
Have you had oral sex in the past 3 months? 1. Yes 2. No 3. I have never had oral sex
How many people have you had oral sex with in the past 3 months?
1. I have never had oral sex 2. I person 3. 2 people 4. 3 people 5. 4 people 6. 5 people 7. 6 or more people
The last time you had oral sex, was it protected or unprotected?
1. Protected 2. Unprotected 3. I have never had oral sex
Have you ever had vaginal sex? 1. Yes 2. No

2006 Abstinence Education RFP and Application Kit

Page 28

How old were you when you had vaginal sex

Have you had anal sex in the past 3

for the first time?

months?

1. I have never had vaginal sex

1. Yes

2. 10 years old or younger

2. No

3. 11 years old

3. I have never had anal sex

4. 12 years old 5. 13 years old 6. 14 years old 7. 15 years old 8. 16 years old 9. 17 years old I0. 18 years old or older

How many people have you had anal sex with in the past 3 months?
1. I have never had anal sex. 2. 1 person 3. 2 people 4. 3 people 5. 4 people

Have you had vaginal sex in the past 3

6. 5 people

months?

7. 6 or more people

1. Yes 2. No 3. I have never had vaginal sex

The last time you had anal sex, was it protected or unprotected?
1. Protected

How many people have you had vaginal sex

2. Unprotected

with in the past 3 months?

3. I have never had anal sex

1. I have never had vaginal sex 2. 1 person 3. 2 people 4. 3 people 5. 4 people 6. 5 people 7. 6 or more people

The last time you had either oral, vaginal, or anal sex; did you or your partner use a condom?
1. I have never had sex 2. Yes 3. No

The last time you had vaginal sex, was it protected or unprotected?
1. Protected 2. Unprotected 3. I have never had vaginal sex
Have you ever had anal sex? 1. Yes 2. No
How old were you when you had anal sex for the first time?
1. I have never had anal sex 2. 10 years old or younger 3. 11 years old 4. 12 years old 5. 13yearsold 6. 14 years old 7. 15 years old 8. 16 years old 9. 17 years old 10. 18 years old or older

The last time you had either oral, vaginal, or anal sex; did you drink alcohol or use drugs before you had sex?
1. I have never had sex 2. Yes 3. No

The last time you had either oral, vaginal, or

anal sex, what one method did you or your

partner use to prevent pregnancy? (Select

only one response)

1. I have never had sex

2. No method was used to prevent

pregnancy

'> .)

.

Birth control pills

4. Condoms

5. Depo-Provera (injectable birth

control)

6. Withdrawal

7. Some other method

8. Not sure

I I 2006 Abstinence Education RFP and Application Kit

Page 29

Section C

Would having sex as a teenager make it

harder for someone to study and stay in

Abstinence is voluntarily choosing not to engage in sexual activity (either oral, vaginal, or anal sex).
I. Strongly agree

school? I. No, not harder at all 2. Yes, somewhat harder 3. Yes, much harder

2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

Would having sex as a teenager make it harder for someone to have a good marriage and a good family life?
I. No, not harder at all

Abstinence is the only 100% effective protection from the possible physical,

2. Yes, somewhat harder 3. Yes, much harder

emotional, mental, and social consequences of sex before marriage.
I. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

Sexual urges can be controlled. I. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

A person who has been sexually active can choose to be abstinent again.
I. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree
Practicing abstinence from sexual activity is healthy.
I. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

A person can get sexually transmitted diseases in their mouth from oral sex.
I. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree
A person can get a sexually transmitted disease from vaginal sex even if their partner uses a condom.
I. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

Is there a problem with teens having sex, if the girl does not get pregnant?
I. No problem at all 2. Some problem 3. A big problem
Even if the girl does not get pregnant, having sex can cause a lot of problems for teenagers.
1.. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

Even ifl am physically mature, that doesn't mean I'm ready to have sex.
I. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

2006 Abstinence Education RFP and Application Kit

Page 30

"Love" and "having sex" mean the same

I think people who want to have sex should

thing.

respect the right of others to say "NO."

1. Strongly agree

1. Strongly agree

2. Agree

2. Agree

3. Not sure

3. Not sure

4. Disagree

4. Disagree

5. Strongly disagree

5. Strongly disagree

Engaging in sex before marriage is a way to show affection to someone.
1. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree
Teenagers who have sex before marriage are more popular.
1. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

How comfortable would you be saying "NO" to a sexual come-on?
1. Very comfortable 2. A little comfortable 3. Very uncomfortable
If someone did try to get you to have sexual intercourse with them during the next year, what would you do?
1. I definitely would not do it 2. I probably would not do it 3. I'm not sure whether I would do it or
not 4. I probably would do it 5. I definitely would do it

Sex before marriage will add happiness to your life.
1. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

Even ifI am in a relationship, that doesn't mean I have to engage in sex.
1. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

Section D
I think it is okay to say "NO" when someone wants to touch me.
1. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

I plan to save sexual activity for marriage. 1. Strongly agree 2. Agree 3. Not sure 4. Disagree 5. Strongly disagree

2006 Abstinence Education RFP and Application Kit

Page 31

APPLICATION FORMS AND CHECKLIST

11

11

Complete the following application forms and include them with the proposal. Use the checklist below to ensure completeness.

Submit an original and two (2) copies of the proposal.

Abstinence Education Applications

_ Application Face Sheets _ Detailed Budget Summary _ Budget Narrative _ Program Narrative (Limit 10 pages)
The following cert(fications are to be completed and signed by the Applicant Agency.
Audit Information Form _ Certification of Equal Employment Program (state & local governments only) _ Certification Regarding Lobbying, Debarment & Drug-Free Workplace _ Non-Supplanting Certification _ Service Delivery Strategy Act Compliance Certification (local governments and authorities
only) _ Evaluation Acknowledgement Form (if administering surveys in a school system,
superintendent and principal must also sign an acknowledgement form) _ Assurances Certification _ Accounting System and Financial Capability Informational Questionnaire _ Certified Financial Statement (send only 1 copy with proposal, non-profit organizations
only) - Support Letters (current and relevant)

ABSTINENCE EDUCATION APPLICATION FACE SHE ET
Chil dren and Youth Coordinati ng Council 3408 Covington Hi ghway, ~ ih Floor Decatu r, Georgia 30032- 15 13 (40~) 508-6574

SECTION I - AP PLI CANT AGENCY (Musi Be Fi.-.c:al A,:enf fo r Grant)
Applirant A:,!l'ncy Name: _ _ _ _ _ _ _ _ _ __ _ __ A. Executin'. Officer Namr:_ _ _ _ _ _ _ _ __ Tillr: _ __ _ _ _ _ _ _ _ _ __ __ __ tailing Atldnss : _ __ _ _ _ _ _ _ _ _ __
C i!): _ _ _ _ _ _ _ Slate:_ Zip:_ _ _ __ Co unty: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ Co ng n s~ional Di~1rk1 :_ _ __ _ _ _ _ _ _ __ Phone: _ _ _ _ _ __ Fax:_ _ __ _ _ __ Em:1il:_ _ _ _ __ _ _ _ _ _ _ _ __ __ ll Fi~cal Cnn1:1c1: _ _ _ _ _ __ _ _ _ _ _ _ __
Tilll: - - -- - - - - - - - - - - - - - -
Mailing Address :_ __ _ _ _ _ _ _ _ _ __
C ity: _ _ _ __ _ _ _ S1:11r: _ Z ip:_ _ _ __ County : _ _ _ __ _ _ _ _ _ _ _ _ __ __ Cong n:s~iu na l Dis1rk1 : _ _ _ _ _ _ _ _ _ _ __ Phonl: _ _ _ _ _ _ _ _Fa x:_ _ __ _ _ __ Em:,il:_ _ _ _ _ _ _ _ __ _ _ __ _ _ __
SECTIO N 2 - IMPLEMENTI NG AGENCY
(/fdijfereut from 11pplirn11f 11xe119) lm pllmlnlin g Aglncy Nam e:_ _ _ _ _ _ _ _ _ _ _ __
EXl'l'llli1r Dirl'ltur :_ __ __ _ _ _ _ _ _ _ _ __ Tille: _ _ _ _ _ _ _ __ _ _ __ _ _ _ __ Ma iling Adtlrcss*:_ _ _ _ _ _ _ _ __ __ _ _
Cit):_ _ _ _ _ _ _ _ State:_ _ Z ip:_ _ __ Count):_ _ __ _ _ _ _ _ _ _ _ _ __ _ _ Congressional Distl'ict: _ _ _ _ _ _ _ _ _ __ Phone: _ _ _ _ __ __ Fax:_ _ _ _ _ __ Email:_ _ _ _ _ __ __ _ _ __ _ _ _ __

SECTI ON 3 - PROJECT DIRECTOR
Na me:_ _ _ _ _ _ __ _ _ _ _ _ _ _ _ __ Title:_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ __ Agl' lll'Y :lllll ' :_ _ _ _ _ _ _ _ _ _ _ _ _ __ Mailing Addre,s*: _ _ _ _ __ _ __ _ _ __
Ci1y:_ _ _ _ _ _ Sta1t: _ _ _ Zip:_ __ _ __ Co11111~: _ _ _ _ __ _ _ _ _ _ _ _ _ _ __ Congres,ional Dh1rk1: _ _ _ _ __ _ _ _ _ __ Pho1ll':_ _ _ _ _ _ _ _ Fax: _ _ _ _ _ _ __ Email: _ _ _ _ _ _ _ _ _ _ __ _ __ _ __
( *OR(,'ANI ZA noN /HAll.!N(,' A!)J)RSS)
SECTION -I TYPE OF APPLICATION (TYPE ONE):
L Jlnitial/ 1'1 Year
0 3"1 Ylar
D o t h(' r If continuation application. plca.~e list all pre, ious grant(s) #:
For f<"dcral n porli11g p urposl~. <lo yo u co nsickr yn ur non-pm lit mg:111i1.atinn a foith-h:1s1d 0 1g,111i1.a1i1111! 0YlS D No
Amount Requested: S _ _ __ _ _ _ __ _ _ _ _ __ Federal Employer ID#: Is th( applicant deli111111cnt on any federa l debt?
Qves

I. lh..: u11dcrs1g11..:d a11lhoii1..:d r..:pr..:~111a111..: 01'1h..: applicanl. ha1..: r..:.1d. 1111dcrsta11d :ind :1gr..:..: I<> al l 1..:b11v..: t:011d111011s sp,x 11"1..:d 111 th..: Childr..:11 :ind Youlh
:mu or C.'oonl111:11111g Co11nl'll's Rcqu..:sl li.ir l'ropos:,ls and 1\pplit:.1lion K11. h,,1i11g r..:ad all ,,11m:h111..:11ts 1h..:r<.:10 do suhmil this appht::111011 on hdiall' lhc
:1pplin1111 Ir a1111rdcd a g r.1111 lo i111pk111.:111 1hc prn1is1on h..:1..:i11. I do l'<.:11il\ 1h111all .opplit:ahk lixk1al and stal..: h111s. ruks am.I rqwl:or mns applil'ahl.:
1h..:1..:10 11111 lx: li>llm1..:d

Applirnnl E.\cnrrile Ollin-r (Sig11a111n ,\;: Dalt)

lmpl(menli ng Agt1H~ EHrn1i1t Ollircr (Signa1t1rl' & Oak)

Tille

Ti rk

(A ll sccl ions of lhc application must be compleled)
SECTION I - APPLICANT AGENCY DATA
Enter name o f appli cant agency. Thi s i s the organi zati on that will admini ster the grant ru nds and wi ll be responsib le for a financial audit.
A Enter requested data for the agency's executi ve ofti cer (Executive Director, Commission Chai r, School Superintendent_ etc.)
B Enter requested d,Ha for the person who wi ll be responsi bl e for tinancial mailers relating lo the
project. such as accou nting and Ii nancial reports on behalf or the appli ca nt agency . Thi s person mu st
be able to answer questions relating to the proposed budget.
SECTION 2 - l i\lPLEMENTI NG AGENCY
Enter requested data for the impl ementing agency, if different from appli ca nt agency. ( Agency may be the same as appli cant agency .)
SECTI ON 3 - PRO.J ECT D I RECTO R
Enter requested data for proj ect director. Thi s w ill be the person responsibl e for implementing and overseeing the proj ect, and who must be able to answer questi ons to the proj ect narrati ve.
SECTION 4
Indi cate whether funding i s requested for a new (initial) proj ect or continuation of a currentl y funded proj ect. If a continuati on proj ect. indi cate previous grant number(s) under whi ch the project was fund ed .
Indi cate whether the appli cant agency is a fai th-based organization.
Enter the amount of grant funds requested. PLEASE USE A W HOLE DOL LAR AMO UNT.
Enter the appli cant' s Federal Employer Iden tifi cati on N umber (EIN) for accounting pu rposes.
I ndi cate whether the A ppli ca nt i s delinquent on any federal debt. If the answer is --yes.. include a detail ed explanation.
T he appli cation must be si gned by the appl ican t's executi ve offi cer. The application shoul d be dated when signed, and the appropriate titl e o f the signer should be in the spa ce provided.
**NOTE: /his 11p11licutio1111111st also he endorsed /~r the exec11/in! (?fjiwr <!fth<' Implementing Agenc,:r. [/' d[[/ere111ji'0/11 the Applirn111.

APPLICATION FACE SHEET

SECTION 5- PROJECT DATA

Antidpated umher of Youth to he Serwd: _ _ __

:\nticipatecl Number of Volunteers: _ _ __

Congressional District(s) to he Sen-cd: _ _ _ _ __

Count)(ies) to ht. Se rn d: _ _ _ _ _ _ __

D Gender Serw d :

Male Onl)

D 0 Female Only

Male and Fema le

Ap11ro:\imale Age Range of Pa,ticipants: Age_ _ __ to age_ _ __

SECTIO 6 - PROJECT TYPE
D Aft er-sdwol Pro::i.ram O Mental t-kalth Prng,,1111

(/H(lr/, all appropriate types)
0 .Jun~nile Dhe rsion/Tnatment Program
O Ahstinencc Edul'ation Program

O Summer Pro:.!ram O .Ju Hnilc Cou,1 lmpnt\ement

SECTION 7 - PROJECT SU IM ARY Project Title: _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ __ S ummary: (Less than 50 words)

SECTION 8 - PROJ ECT ACTI VITI ES (Mark all actfrilies pr<J11itletl through tl,i.\grant. List adtlitio11al ac:tfrities 1111/fo1111d hdm, under "olher'J

D Tutorinl.!fHomcwo rk Assistance O cha rnct(r Education/ Leadership T raining
vocationa l Training
BComrnunit) Sc1-Yice Family Thcra11) Afterrnre/Transitional Sln ires DTranspo11alio n

D Enrichment Act iYities (i.e. arts .~ crnfts. danc<, etc)
~ D Life Skills Training (i.e.. coping skills inst rnctio n, ilnrg ..

Mtntoring

akohol eduration. l'lc.)

D Family Suppo rt/Pare nt Educatio n
D lndiYiclua l/Group Counsdinl.!
D lntensiw Supe rYision/Surn-illancc
O ther:__.,_ __ _ _ _ _ _ _ _ _ _ _ _ _ _ __

-~:/ '' . , INSRUCTIONS FOR COMPLETING.APPLICATION FACE SHEET : -: ..:.: .

J , . . .

-

PART TWO

: .

. _

_ .

(All sections of the applica tion must be completccl) SECTION 5 - PROGRA M DATA
Enter the anti cipated number of youth to be served by thi s grant project. Enter the num ber of anticipated project volunteers F.nter lhe congressiona l district(s) 10 be served by thi s gra nt project. En ter the county(ies) to be served by thi s gra nt project. Select the gender 10 be served by this grant proj ect. Enter 1he age range of project pa,ticipants.

SECT ION 6 - PRO,IECT TYPE
Select the 1ype(s) or prograllls for whi ch you are applyi ng The project lll ay encompass lll ore than one lype li sted.
SECT ION 7 - PRO.J ECT SUMJ\rlARY
Enter the formal titl e of the project, whi ch is brief and descripti ve.
Develop a brie r summary of the project. The summ ary should explain the project ' s opera ti on and how the project will accomplish its objecti ves. The sumlll ary should not exceed 1he space provided. OTE: This summary is used for press releases, etc.
SECT ION 8 - PROJ ECT ACT IVITIES
Select the proposed activities for thi s grant project. Most projects will have mul tiple activities.

DETAILED BUDGET SUMMARY

CYCC Use Only Subgrant Number

Budget Category
A. PERSONAL SERVICES: 1. Salaries

Requested Budget

Grants Funds

Matching Funds

P1{u'c3gnettof

CYCC Approved Budget
D Federal State Matching Funds

>--

-

.._

.

.

2 . Fringe Benefits B. REGULAR OPERATING:

SubT~ _

C. TRAVEL:

Sub-Total

D. EQUIPMENT:

Sub-Total

E. PER DIEM, FEES & CONTRACTS:

Sub -Total

F. TELECOMMUNICATIONS:

Sub-Total

GRAND TOTALS Rev November 2005

Sub-Total

-
I
+
-
100%
--

INSTRUCTIONS FOR COMPLETING DETAILED BUDGET SUMMARY
GENERAL INFORMATION Complete the Detailed Budget Summary for each of the six major categories for which funding is being requested. Designate the appropriate grant and matching funds of the total cost of the item in the appropriate column under "Requested Budget" for each item listed in the category. DO NOT WRITE under the heading of "Approved Budget," as this is for Council use only.
USE ONLY WHOLE DOLLAR FIGURES. Do not complete the space marked "Subgrant Number," this will be assigned by the Council.
CALCULATE THE PERCENT OF BUDGET FOR EACH COST CATEGORY. For example, if you are requesting a total of $75,000 in grant funds and the personal services subtotal is $50,000, the percent of budget for personal services is 67%. Please round to the highest percent, no decimals.
SUBGRANT CHART OF ACCOUNTS The following indicates the appropriate allocation of grant and match expenditures for each budget category. This information has been adapted from the State of Georgia accounting system for ease in reporting grant and matching funds from various state agencies.
PERSONAL SERVICES Regular Salaries Temporary, Hourly Employees Employer Paid Benefits (FICA, Retirement, Health Insurance, Liability Insurance, Etc.)
REGULAR OPERATING Supplies & N\aterials Insurance Postage Dues & Subscriptions Registration Fees Duplication Expenses Snacks Equipment Rental Individual Equipment Purchases with Acquisition Cost of Less Than $1,000
TRAVEL Staff Travel, Lodging, Subsistence Mileage Vehicle Rental Motor Vehicle Expense (gas, maintenance)
EQUIPMENT Individual Equipment Purchases with Acquisition Cost of $1,000 or More
PER DIEM, FEES & CONTRACTS Consultant Fees Contracts Stipends
TELECOM.MUNI CATIONS Long-Distance Calls, Phone Line Installation & Service, Cellular, Pagers, Internet Service
TOTAL REQUESTED BUDGET
List the sum of the category sub-totals for grant funds and local funds (if mandated) with a grand total project cost.
** COMPLETE A BUDGET NARRATIVE AS DESCRIBED ON THE NEXT PAGE**

DETAILED BUDGET NARRATIVE
Complete the Detailed Budget Narrative in addition to the Detailed Budget Summary form. The narrative illustrates how budget figures were computed and how budgeted items relate to the project. Include both requested grant funds and only mandated matching funds. RYplain the "Originating" source(s) of matching funds. (For example, cash matching funds may come through the Georgia Department of Human Resources, but the original source of funds is a federal grant to DHR; and as such, would be ineligible as a non-federal match for a CYCC grant.)
The following examples demonstrate the detail to be included in the budget narrative.
PERSONAL SERVICES. List each staff position involved with program implementation. Include the defined period of time (monthly, annually) for the staff positions and percent of time he/she will dedicate to the project. Indicate the number of hours to be worked, cost per hour and total cost for grant period. If the position is currently on payroll, list current hours and salary with an explanation to request additional grant funding. For continuation projects, explain salary increases. Define and compute the fringe benefits separately from the salary cost.
REGULAR OPERATING. List the primary expenditures (e.g., supplies, educational materials, snacks, etc.) illustrating the basis for computation.
TRAVEL. Document the purpose of the travel and the estimated cost of each trip. Indicate the cost per mile for travel reimbursement (1000 miles x .485 per mile = $485). Expenses for lodging, meals, airfare, and parking are claimed under this category. Registration fees, admission fees, and food related to field trips are to be listed under Regular Operating.
EQUIPMENT. If the budget includes acquisition of equipment, list each item and amount budgeted. Justify the acquisition of equipment. Equipment is defined as an item with an acquisition cost of $1,000 or more.
PER DIEM, FEES & CONTRACTS. List consultants/stipends/contracts by name (if known), rate of pay, time period, total cost, and purpose.
TELECOMMUNICATIONS. Indicate cost and purpose of requested grant funds and/or matching funds for telecommunications, include cellular, pagers, and internet expenses. Please note that requested grant funds are required to be directly related to project cost and may not be an existing cost.
NOTE: Please use only whole dollar amounts for every entry.

Budget Cat egory
A. PERSONAL SERVICES: 1. Salaries
Project Director Abstinence Education Coordinator Youth Coordinator Volunteers

DETA IL ED BUDGET SUMMA RY
*****SAMPLE*****

Requested Budget

CYCC Approved Budget

Grants Funds
12,000. 00 25 ,000. 00 10,500. 00
i

Matching Funds

-

3,600. 00

-

4 ,000. 00

Percant of Bu get
---
-

Federal State

Matching Funds

3,010.00

--- -

2. Fringe Benefits
B. REGULAR OPERATING: Operating Materials Educational Supplies Fie ld Trips Incentives Snacks Cop}'ing Office Space & utilities
C. TRAVEL: Mileage for staff Lodging, Flight, Subsistence, e tc.

Sub-Total

3, 563. 00 51 ,063. 00

3 ,000. 00 6,000. 00 3,500. 00

3,000. 00 1, 125. 00

Sub-Total

16,625. 00

-L

260. 00
I387.00

0 . EQUIPMENT: Projector Computers

Sub-Total

647.00

2 , 1 0 0. 0 0

570.00 1 1, 180.00 2 ,000. 00
420. 00 500. 00 2,000. 00 _ 6, 000. 00 10,920.00
4 ,825.00

70%
-
--

~

23%

1% -

Sub-Total E. PER DIEM, FEES & CONTRACTS: ~ p en d s Consultants/Facilitators

2,100. 00 2, 000. 00

f . TELECOMMUNICATIONS: Telephone Internet
GRAND TOTALS
Rev. Nove mber 2005

SubTotal 2,000.00
r l 50. 00
225.00
I
Sub-Total 675.00
73, 110.00

4 ,825. 00

3%

3 ,000. 00 3 ,000. 00

-~
3%

75.00 30,000. 00

~

>1% 100%

DETAILED BUDGET NARRATIVE
*****SAMPLE*****
PERSONAL SERVICES:
The Project Director's salary is $15,600 of which a portion of the salary will be used for matching funds. This is a part time position. The local family connection will provide the additional funds for the match on this position. $12.50 per hour X 20 hours X 48 weeks=12,000.00 Grant Funds $12.50 per hour X 6 hours X 48 weeks =3,600.00 Matching Funds
Abstinence Education Coordinator salary is $35,000 per year based on average pay scale. We are requesting a portion of the salary for this full time position. The matching portion of the salary will be provided by the Board of Education $25,000 for grant funds or $2,272 monthly= Grant Funds $ 10,000 for matching funds or $909 monthly= Matching Funds
Youth Coordinators (2) will work for nine months at a pay rate of $583 .50 per month for 15 hours per week. We are requesting grant funds for these positions.
Volunteers - Parents, Mentors, and Community Volunteers will assist with the project by volunteering as chaperones, tutors and serving the program in any capacity needed. So far 21 people have committed to helping with the project for an average of 20.5 hours per person as long as the project is operational. This will be matching in-kind. 430 hours X $7 =$3,010
Fringe Benefits - The fringe is 7.5% of the salary for the positions funded under the grant except the volunteers. This covers the FICA & SUIGA.
REGULAR OPERATING:
Operating Materials - Paper, pens, office supplies, decorations for special activities and holidays, paper products, cartridges etc. $455 per month for 1lmonths = $5,000. We are requesting $3,000 in grant funds for this expenditure and local vendors such as Staples and Office Depot have committed to providing the matching funds allocation of $2000 for the year.
Educational Supplies-The supplies cost $6,420. The curriculum, manuals, and teachers guide have a cost of $3,900. We will also purchase life skills workbooks, character education and youth development materials for $2,520.00. We are requesting $6,000 in grant funds and the Board of Education will provide $420 in matching funds.
Field Trips- Three trips planned for the year. Grant funds are requested for $3,500 Tennessee Aquarium - 45@$25=$1,125 Six Flags- Group Discount Rate-45@ $30 =1,350 Sci-Tech-45@ $22. 77=$1,025

Wal-Mart has agreed to provide matching funds for $500 in the form of gift certificates to be presented to the program. Wal-Mart Gift Certificates= 40 @$25 =$1,000 AMC Gift Certificates =35@ $15=$525 Pizza Hut Certificate= 25 @ $10=$250 Footlocker= 10@ $50=$500 Target Gift Certificates= 9@ $25=$225
Snacks -Snacks will be provided for program participants, special events, holidays, award ceremonies, and celebrations. The total cost for snacks will be $5,000. We are requesting $3,000 in grant funds to purchase snacks for the program participants such as fruit juices, crackers, fruits, and other food for special occasions. Local vendors such as KFC, Golden Corral, Domino's Pizza, McDonalds, Olive Garden, and Smith's Supermarket have pledged food contributions to the program that value in excess of $2,000 for matching funds. Letters of Commitment have been attached.
Copying - Copying costs are for memo's to program participants, parents, community leaders and other distribution as deemed necessary. Estimate of monthly cost is $102 per month and we are requesting grant money in the amount of $1, 125
Office Space and utilities - The Board of Education will provide office space and two classrooms for the abstinence program. The annual rental cost of this space on a yearly basis is appraised at well over $15,000. The utilities are estimated at a cost of$1200. This would cost over $16,000 per year out of pocket expense. The matching funds of $6,000 will be provided for this expense.
TRAVEL:
Mileage is requested for staff to attend trainings, workshops, on a needed basis Mileage is computed at 536 miles @ .485 per mile =$260
Lodging, meals, flight fee, shuttle etc. is requested for the abstinence education coordinator to attend a national conference or training which is usually outside of the state such as The National Abstinence Clearinghouse Conference. We are requesting a total of $387. Total grant funds requested for travel are $537.00
EQUIPMENT:
Projector- We are requesting to purchase a Nixon Projector for classroom activities. We are used a state approved vendor and the cost for the projector is $2,100. We are requesting grant funds for this expenditure.
Computer - The School System has agreed to purchase a laptop computer for the abstinence education program valued at $2500. The computer lab will also donate five computers for the tutorial program valued at $2,325. This will be a match of $4,825.

PER DIEM, FEES, & CONTRACTS:
Stipends - Program Participants will receive a stipend at the completion of the program. 40@ $50=$2,000. Grant funds are requested for this expenditure.
Consultants/Facilitators - The County Health Department has agreed to provide nurses on a periodic basis to conduct workshops for the program participants. The estimated value of this training for the workshops is $800.
The local mental health community service board will provide a counselor for program participants and their families that may need help for crisis intervention. This service is valued at $2,000.
Local businesses have agreed to facilitate training workshops for program participants:
Miss Tricia's Beauty Shop- Hair & make-up workshop = $100
Joy's Nail Depot - Manicures =$100 These services will provide matching funds of $200 for the project.
TELECOMMUNICATIONS:
Telephone - Long distance calls - based on monthly cost of $37.50. Grant funds are requested for this expendi ture.
Internet - Cost of $300 annually based on $25.00 per month rate. $225 requested in grant funds for this expenditure. A pledge of $75.00 will be made by a local humanitarian for matching funds.

GEORGIA ABSTINENCE EDUCATION PROGRAM
EVALUATION ACKNOWLGEMENT FORM (To Be Completed By All Applicants)
The Georgia Abstinence Education Program pre and post test surveys were developed to collect statewide demographic and programmatic data that reflect standardized program goals and objectives. The information gathered from these surveys will help to ensure future state abstinence funding as well as assist local programs with securing continued funding.
Each funded program will be responsible for collecting the data. CYCC will be responsible for entering and analyzing the data. In addition, each program will be provided with a copy of the analyzed data (reported in group form) as well as a copy of the overall statewide data after all programs have completed the post test collection. This system will ensure that all programs are reporting the same outcomes in regards to the success of a particular program.
I, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , certify that I understand the purpose (agency executive officer) (school principle, if applicable) (superintendent if applicable)
and use of the pre and post test surveys as well as acknowledge that if I do receive CYCC funding directly or indirectly through a contract, I will be required to implement the surveys.

(Signature) ( Name of Agency)

(Date)

0MB APPRO\.AL NO I 121-0140

ASSURANCES

TI1e Applicant hereby assures and certifies compliance with all Federal statutes, regulations, policies, guidelines and requirements, including

O.MB Crrculars No. A-21, A-110, A-122, A-128, A-87; E.O. 12_372 and Unifom1 Administrative Requirements for Grants and Cooperative

Agreements-2_8 CFR, Part 66, Common Rule, that govern the apphcahon, acceptance and use of Federal funds for this fcderallv-assisted project.

Also the Applicant assures and certifies that:



It possesses !egal authority to apply for the grant; that a resolution,
m{!_tlon or stm1lar action has oeen duly adopted or passed as an
q_fhcml act of the applicant's govemmg bodv. authorizing the hhng of the application. including all understandinos and assurances c_op.tamed ther~in., and directing and authoriz~ng the person 1denhhed as the otl1cml repreSt,:ntatJve of the applicant to act _m coru1~tion .with the application and to provide such add1t1onal mformatlon as may lie required.

2. It \\ill complv with requirements of the provisions of the Unifonn Relocation Assistance and Real Propertv Acquisitions Act of 1970 P.L. 91-646) which provides for fair and equitable treatJnent of persons displaced as a result of Federal and
federally-assisted programs.

3. It will comply _with pr_ovisions of Federal law which limit certain

poht1cal act1V1tles ot ep1ployees of a State or local unit of

goverrum,:nt whose pnnc1pal employment 1s m c01mection with an

m~tlv1ty tmanced m whore or m part by Federal grants. (5 USC

])01,elseq.)





4. It will_ compJy with the mininrnm wage and ma~imum hours provisions ot !he Federal Fmr Labor Standards Act 11 applicable.

5. It will establish safeguards to prohibit employees from usin_g their

pos1hons for a purpose that 1s or give the appearance ot being

motivated by a deslfe for private gain for themselves or others.

particularly those with whom thev have familv. business. or other

ties.







6. It will 0 ive the sponsoring agencv. or the Comptroller General. througfi anv authonzed representative, access to and the right to
examme all records, books, papers, or docmnents related to the
grant.

7. It will comply with all requirements. imposed by the Federal Sponsormg [!gency concemmg spe_c1l r~qulfe1m,nts of Jaw. program reqmrements, and other adinuustratJve requrren1ents.

8. It will insure that the facilities under its O\\Tiership lease or

supervision whi<.::h shall be utilized in the accomp1islunent of the

pro.1ect are not listed m the Envrrorunental protection A 0 ency's

(EPA-list of Violating Facilities and that it will notifv the Federal

l5_rl.afnetcotroargoefnthcey

of the receipt of any c01mnunication from the EPA Office ofFederal Activities indicatino that

a

tac1hty to be used m the project is under consideration forlistino

by the EPA.

"'

9. It wiH comply with the flood insurance purchase requirements of

Section 102(a) of the Flood Disaster Protection Act ot 1973 Public

Law 93-234, 87 Stat. 975, approved December 31. 1976. Section ~ 02(a) reqlfes, on aqd_atter March 2, .1975, the pirrchase of flood

msurance m commrnutles where such msurance 1s available as a

condition. for the reci:ipt of any Feder?l financial assistance for

constrJ1ctloQ or acqrns1tlon purposes tor use in anv area that had

been 1dentJhed bv the Secretarv of the Department ofHousing_and

Urban pevelopnient as. an area havajg special flood hazar~s. -111e

phrase Federal fmancml assistance mcludes anv fom1 ot Joan.

grant, guaranty, msurance pavment, rebate. subsiav. disaster

assistance l9an or grant, or anv other fonn or direct'or indirect

Federal assistance.



10. It w(ll assist the Federal grantor agencv in its compliance with Section 106 of the National Historic Preservation Act of 1966 as amended (16 USC 470), Executive Order I I 593. and the Archeolog1cal and Historical Preservation Act of 1966 ( 16 USC 569a-1 e1 seq.) by (a) consultin~ with the State Historic Preservation _Officer on the conauct of investigations. as
necessarv, to 1denti(v. propel.:!ies listed in or eli~ible tor inclusion m the National Register ot H1stonc Places mat are subject to
adv_erse effects (see 36 CFR Part 80fl8) b~: the activifv, and nohfymg the Federal grantor agencv ot the existence ot miv such
properties, and bv (b) compl~iing with all requirements estabhshefl by the Federal grant9r agency to avoid or mitigate adverse effects upon such properties.

11. It will comp!Y, and assure the compliance of!lBits subgrantees and

contractors, with the applicable provisions ot Title I ot the Onmibus

Cnme Control and Safe Streets Act of 1968. as an1ended. the

Juverule Justice and Delinquency Preventioj1 Act or the Victims of

Cnme_Act, a_s approRnate: 1he J2fOV1s10ns ot the current edition of

the Office ot Justice Pro&rams }'inancia_J and Administrative Guide

for Grants, M7100.1: ana all other applicable Federal Jaws. orders.

crrculars, or regulations.





r8, 12. It will comply with the provisions of 28 CFR applicable to grants and . cooperative agreements, mcludmg Part Administrative Review Procedure: Part 20. Cnmmal Justice Intommtion Svstems Part 22,. Confideritialitv of Identifiable Research and Statisticai Intqn_natJon; Part 23, criminal Intellwcnce Systems Operating Poliqes: Part 30, Intergoverrunental 1<ev1e\v of Department ol Justice Programs and Activities: Part 42. Nondiscrimination/Equal Employment Ooportunity_ Policies arid Procedures: Part 61,
Procedures tor rmplementit1,g the National Envuorunental Policy Act; Part 63, Floodplam Management. and Wetland Protection Pro~edures: and Federal Jaws or regulations applicable to Federal Assistance Programs.

13. It will complv.' and all its contractors will comply with the

nondiscrin1mrition requirements of the Omnibus Cri.Jne Control

and Safe S_treets Act of 1968, as amended. 42 USC 3789(d). or

Victims ot CriJ!1e Act (as appropriate); Title V1 of the Civil

R1 hts.. Act ot I 964, as amended; Section 504 of the

Rebab1htation Act of 1_973, _as an1ended: Subtitle A. Title 11 of

the Amen~ans With D1sab1hties Act (ADA) (1990): Title IX of

the Education Amendments of 1972; the Age_ Discnmination Act

of 1975; Department of Justice Non-Discrtmmahon Regulations.

28 CFR Patt 42. Subparts C, D, E. and G: and De])__artment of

Justice regulations an disability discrimination. 28 CFR Part 35

and Part 31J.





14. In ~e ev_ent a Federal or State court or Federal or State adm1rustratJve agency makes a fmding of discrimination after a du~ proce~s. hearmg an the grounds of race. color religion. nat1op.al on_gm sex, or disability against a recipient or'funds. the rec1p1ent will forward a copy ot the finding to the Off.ice for Civil Rights, Office of Justice Programs.

15. It will provide. an _Equal Employment Qpportunity Prooram if reqmred to mamtam one, where the application is for $500,000 or more.

16. It will complv with the provisions of the Coastal Barrier R~sources Acf (P.L. 97-34_8) dated October 19,1982 (16USC 3)01 et _seq.) which prolub1ts !]le expenditure of most new Federal lunds w1thm the umts ot the Coastal Barner Resources Svstem.

Signature _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
OJP FORM 400013 !Rev 1-0 31 PREVIOUS Eli!TIONS ARE OBSOLETE. ATTACH~IENT TO SF-424

Date- - - - - - - - - - - - - - - - - -

AUDIT INFORMATION
(to be completed by all applicants)
AGENCY'S FISCAL YEAR: Enter Appropriate 12-Month Cycle
(e.g., Jan. 1-Dec. 31; July 1-June 30; Oct. 1-Sept. 30)
DATE OF LAST AUDIT:

DATE OF NEXT AUDIT:

If a grant award is issued to your agency, note the approximate date the

audit/compilation will be submitted to CYCC:

(to be submitted verifying receipt & expenditure of CYCC funding)

Applying Agency Name
Note: Most grants will cover two fiscal periods, and thus, two audits/compilations will need to be submitted to CYCC.

CERTIFICATION OF EQUAL EMPLOYMENT PROGRAM
(appUes to state and local governments)

Q) I, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , certify that
(agency executive officer)

(applying agency)

has formulated an

Equal Employment Opportunity Program in accordance with 28 CFR 42.301,

et seq., subpart E, that it has been signed into effect by the proper agency

authority and disseminated to all employees, and that it is on file in the office of:

(person's name)
(title)
(address) for review or audit by officials of the Children and Youth Coordinating Council or the Office for Civil Rights, U.S. Office of Justice Programs, as required by relevant laws and regulations.

(Signature of Agency Executive Officer)

(Date)

******************************************************* OR *******************************************************

Certification (no EEOP required)

@ I,_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, hereby certify that the
(agency executive officer)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, has less than 50 employees and (applying agency)
is not required to maintain an EEOP, pursuant to 28 CFR 42.301, et seq.

(Signature of Agency Executive Officer)

(Date)

U.S. DEPARTMENT OF JUSTICE OFFICE OF JUSTICE PROGRAMS OFFICE OF THE COMPTROLLER
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT; SUSPENSION AND OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS

Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the instructions for certification included in the regulations before completing this form. Signature of this form provides for compliance with certification requirements under 28 CFR Part 69, "New Restrictions on Lobbying" and 28 CFR Part 67, "Government-wide Debarment and Suspension (Nonprocurement) and Government-wide Requirements for Drug-Free Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of Justice determines to award the covered transaction, grant, or cooperative agreement.

1. Lobbying
As required by Section 1352, Title 31 of the U.S. Code, and implemented at 28 CFR Part 69, for persons entering into a grant or cooperative agreement over $100,000, as defined at 28 CFR Part 69, the applicant certifies that:
(a) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making of any Federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative agreement.
(b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, "Disclosure of Lobbying activities," in accordance with its instructions;
(c) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all subrecepients shall certify and disclose accordingly.
1. Debarment, Suspension, and other Responsibility Matters (Direct Recepient)
As required by Executive Order 12549, Debarment and Suspension, and implemented at 28 CFR Part 67, for prospective participants in primary covered transactions, as defined at 28 CFR Part 67, Section 67.510-
A. The applicant certifies that it and its participants:
(a) Are not presently disbarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three-year period proceeding this application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public

(Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1 )(b) of this certification; and (d) Have not within a three-year period preceding this application had one or more public transactions (Federal, State, or local) terminated for cause or default; and B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application.
3. Drug-Free Workplace (Grantees Other Than Individuals)
As required by the Drug-Free Workplace Act of 1988, and implemented at 28 CFR Part 67, Subpart F, for grantees, as defined at 28 CFR Part 67 Sections 67.615 and 67.620A. The applicant certifies that it will or will continue to provide a drug-free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition;
(b) Establishing an on-going drug-free awareness program to inform employees about-
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse violations occuring in the workplace;
(c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will-

OJP FORM 40616(3/91) REPLACES OJPFORMS 4061/2, 4061/3 AND 4061/4 WHICH ARE OBSOLETE

(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occuring in the workplace no later than five calendar days after such conviction;
(e) Notifying the agency, in writing, within 10 calendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to: Department of Justice, Office of Justice Programs. ATTN: Control Desk, 633 Indiana Avenue, N.W., Washington, D.C. 20531. Notice shall include the identification number(s) of each affected grant;
(f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted-
(1) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended: or
(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;
(g) Making a good faith effort to continue to maintain a drugfree workplace through implementation of paragraphs (a), (b), (c), (d), (e), and (f).
B. The grantee may insert in the space provided below the site(s) for the performance of work done in connection with the specific grant:
Place of Performance (Street address, city, county, state, zip code)

Check0if there are workplaces on file that are not identified
here.
Section 67, 630 of the regulations provides that a grantee that is a State may elect to make one certification in each Federal fiscal year. A copy of which should be included with each application for Department of Justice funding. States and State agencies may elect to use OJP Form 4061/7.
O Check if the State has elected to complete OJPForm
4061/7.
Drug-Free Workplace (Grantees Who Are Individuals)
As required by the Drug-Free Workplace Act of 1988, and implemented at 28 CFR Part 67, Subpart F, for grantees, as defined at 28 CFR Part 67; Sections 67.615 and 67.620A. As a condition of the grant, I certify that I will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant; and
B. If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, I will report the conviction, in writing, within 1O calendar days of the conviction, to: Department of Justice, Office of Justice Programs, ATTN: Control Desk, 810 Seventh Street NW., Washington, DC 20531.

As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications.
1. Grantee Name and Address:

2. Application Number and/or Project Name

3. Grantee IRSNendor Number

4. Typed Name and Title of Authorized Representative

5. Signature

6. Date

u.s. Government Printing Office: 1996 - 405-037/40014

NON-SUPPLANTING CERTIFICATION
(to be completed by all applicants)
Regulations adopted by the U.S. Office of Juvenile Justice and Delinquency Prevention (OJJDP) require certification to the effect that federal funds have not been used to increase state or local funds that would, in the absence of such federal aid, be made available for juvenile justice and delinquency prevention. This certification is required as part of the initial proposal for grant funds to the Children and Youth Coordinating Council.
CERTIFICATION: I certify that OJJDP funds will not be used to supplant state or local funds that would otherwise be available for juvenile justice assistance. I further certify that the project proposed in the grant application meets all the requirements of the Juvenile Justice and Delinquency Prevention Act and its implementing guidelines; that all the information presented is correct; that there has been appropriate coordination with affected agencies; and that the applicant will complywith the provisions of the OJJDP Act, all applicable federal and state laws, and the above-mentioned certification should a grant be awarded.
Signature of Applicant Executive Officer
Typed Name and Title
Date

SERVICE DELIVERY STRATEGY ACT COMPLIANCE CERTIFICATION
(applies to local governments and authorities)

I, _ _ _ _ _ _ _ _ _ _ _ _ _ _, certify that _ _ _ _ _ _ _ _ _ _ _ _County is in

(county commission chair)

(county name)

compliance with the Service Delivery Strategy Act (House Bill 489). I also understand that if my

county is not in compliance, the county and city governments contained therein are not eligible to

receive state-administered financial assistance, grants, loans, or permits.

Signature of Commission Chair Typed Name and Title Date

CHILDREN AND YOUTH COORDINATING COUNCIL

th -'

Floor,

3408

Covington

Highway,

Decatur,

Georgia

30032

ACCOUNTING SYSTEM AND FINANCIAL CAPABILITY INFORMATIONAL QUESTIONNAIRE

SECTION A: PURPOSE

The financial responsibility of subgrantees must be such that the subgrantee can properly discharge the public trust. which accompanies the authority to expend public funds. Adequate accounting systems should meet the following criteria as outlined in the CYCC Subgrantee Finance Manual.

1. Accounting records should provide information needed to adequately identify the receipt of funds under each grant awarded and the expenditure of funds for each grant, for each action program covered by a State's grants and for each subgrant awarded by the State.
2. Entries in accounting records should refer to subsidiary records and/or documentation which support the entry and which can be readily located.
3. The accounting system should provide accurate and current financial reporting information. .J.. The accounting system should be integrated with an adequate system of internal controls to safeguard the funds and assets
covered. check the accuracy and reliability of accounting data. promote operational efficiency. and encourage adherence to prescribed management policies.

SECTION B: ACCOUNTING SYSTEM

1. Has any Government Agency rendered an official written opinion concerning the adequacy of the accounting system for the

D collection. identification and allocation of costs under Federal contracts/grants'7

Yes ONo

a. If yes. provide name and address of Agency perfonning review:

b. Attach a copy of the latest revie,v and any subsequent correspondence. clearance documents. etc. (Note: If review occurred within the past three years. omit questions 2-9 of this Section and Section C.

2. Which of the following best describes the accounting system?

D Manual

3. Does the organization use a double-entry system in accounting for program funds?

.J.. Does the accounting system identify the receipt and expenditures of program funds

Automated D Combination OYes 0No NotSure OYes ONo Not Sure

separately for each contract/grant? 5. Does the accounting system provide for the recording of expenditures for each grant/

OYes 0No Not Sure

contract by the component project and budget cost categories shown in the approved

budget?

6. Are time distribution records maintained for an employee when his/her effort can be

0Yes 0No 0Not Sure

specifically identified to a particular cost objective?

7. Does the accounting/financial system include budgetary controls to preclude incurring obligations in excess of:

a. Total funds available for a grant?

Yes 0No Not Sure

b. Total funds available for a budget cost category (e.g. Personnel, Travel, etc.)?

Yes ONo Not Sure

8. Is the finn generally familiar with the existing regulations and guidelines containing the

Yes QNo ONotSure

cost principles and procedures for the detemlination and allowance of costs in

connection with Federal contracts/grants?

SECTION C: FUND CONTROL
1. Is a separate bank account maintained for grant/contract funds? 2. If Federal grant/contract funds are commingled with organization funds. can the Federal
grant funds and related costs and expenses be readily identified?

0Yes DNo Not Sure
OYes D No Not Sure

SECTION D: APPLICATION CERTIFICATION

I certif\ that the above infonnation is complete and correct to the best of my knowledge.

1. Signature of Applicant Executive Officer

b. Finn Name. Address. and Telephone Number

a. Title:- - - - - - - - - - - - - - - - -

CHILDREN AND YOUTH COORDINATING COUNCIL
ACTIVE COUNCIL MEMBERS

Mr. Andrew Barclay 512 St. Charles Avenue Atlanta, GA 30308
Ms. Bernice Butler 135 Edgewood Avenue, Suite 20 Atlanta, GA 30303

Mr. Donnie Olajmvon 5497 Orchard Court Stone Mountain, GA 30083
Mr. Adam Strain Poppell, IIL CYCC Chair
111 Broad Street Darien, GA 31305

Ms. Catherine Shaw Champion P.O. Box 105 Lookout Mountain, TN 37350

Mr. Dan Provence P.O. Box 572 Bainbridge, GA 31717

Ms. Nighta Davis 794 Ramev Mountain Road Hiawassee, GA 30546

Ms. Kris Rice P.O. Box 9926 Savannah, GA 31412

Dr. Homer Day 616 Golden Road Tifton, GA 31 794

Ms. Kathryn Schrader 2405 Satellite Boulevard, Suite 225 Duluth, GA 30096

Mr. Kenneth M. Dobbs 135 Stovall Road Greenville, GA 30222
Mr. Timothy Echols 503 Raford Wilson Road Commerce, GA 30529
Judge Deborah Edwards Houston County Juvenile Court 202 Carl Vinson Parkway Warner Robins, GA 31088
Ms. Elizabeth M. Hausmann 5040 Johns Creek Court Alpharetta, GA 30022
Mr. Marquis Harris 2056 Vineville Avenue, Apt 3 Macon, GA 31204

Mr. Phillip R. Smith Concord Coalition 127 Peachtree Street, NE, Suite 110 Atlanta, GA 30303
Ms. Barbara Strain P.O. Box 689 Cornelia, GA 30531
Judge Steve Teske Clayton County Juvenile Court Clav1on Countv Courthouse Annex 3 3rd Floor, 121 McDonough Street Jonesboro, GA 30236
Mr. Jack F. Williams 1355 Christmas Lane Northeast Atlanta, GA 30329

Mr. Karl Belle Isle 1420 Creek Overlook Court Marietta, GA 30066

Judge Larry B. Mims 4501 Lee Ann Drive Tifton, GA 31794

Sheriff Jimmie Murkerson Early County Sheriff's Office 402 South Boulevard Blakely, GA 31723

TECHNICAL ASSISTANCE
If you have any questions while preparing the abstinence education grant application, CYCC staff is available for technical assistance. Below are the names, direct telephone numbers and e-mail addresses of staff members who can assist you.

PROGRAMMATIC QUESTIONS?

Danielle E. Ruedt, MPH Abstinence Ed State Coordinator

404-508-6584 DanielleRuedt@cycc. state. ga. uc

Georgina lyamu, MPH Research/Evaluation Coordinator

404-508-5099 Georgina Iyarn u@cycc. state. ga. us

FINANCIAL/ADMINISTRATIVE QUESTIONS?

Quincie McKibben Grants Assistant

404-508-6581 QuincieMckibben@cycc. state. ga. us

DIRECTIONS TO CYCC OFFICE
3408 Covington Highway, 4th Floor Decatur, GA 30032
The following directions are provided should you choose to hand deliver the grant package. We suggest you drive to the front of the building and leave your package in the lobby (a drop-off box will be provided) between 4-5 p.m. Should you wish to park and come to the office, there are limited parking spots for short-term parking only.
The office is located at the corner of Covington Highway and Memorial Drive in the DJJ Headquarters Building. Entrance lobby is located mid-way at the double doors.
From the North {1-75 or 1-85 area): Take 1-285 East (toward Augusta). Go to Exit 41, Memorial Drive/GA 10, and turn right towards Avondale Estates. Go approximately .8 miles to the 5th traffic light. Turn right on Covington Highway/US 278. 3408 Covington Highway is the first drive on the right.
From the South (Atlanta Airport area): Take 1-285 East (toward Augusta). Go to Exit 41, Memorial Drive/GA 10, and turn left towards Avondale Estates. Go approximately .8 miles to the 5th traffic light. Turn right on Covington Highway/US 278. 3408 Covington Highway is the first drive on the right.
From the West: Take 1-20 East to 1-285 North. Go to Exit 41, Memorial Drive/GA 10, turn left towards Avondale Estates. Go approximately .8 miles to the 5th traffic light. Turn right on Covington Highway/US 278. 3408 Covington Highway is the first drive on the right.
Alternate - From 1-20 West: Go East on 1-20 to either the Moreland Avenue or Maynard Terrace exits. Go to Memorial Drive; turn right on Memorial Drive and go approximately 5-6 miles. Turn left on Covington Highway/US 278. 3408 Covington Highway is the first drive on the right.