GA J860 2006 SI A;) ;;,o~ 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 Page I 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. 2006 Abstinence Education RFP and Application Kit Page 2 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. 2006 Abstinence Education RFP and Application Kit Page 3 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. 2006 Abstinence Education RFP and Application Kit Page 4 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 2006 Abstinence Education RFP and Application Kit Page 5 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.. 2006 Abstinence Education RFP and Application Kit Page 6 ,, 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). 2006 Abstinence Education RFP and Application Kit Page 7 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. 2006 Abstinence Education RFP and Application Kit Page 8 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 2006 Abstinence Education RFP and Application Kit Page 9 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. 2006 Abstinence Education RFP and Application Kit Page IO 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. 2006 Abstinence Education RFP and Application Kit Page 11 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. 2006 Abstinence Education RFP and Application Kit Page 12 11 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. 2006 Abstinence Education RFP and Application Kit Page 13 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. 2006 Abstinence Education RFP and Application Kit Page 14 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. 2006 Abstinence Education RFP and Application Kit Page 15 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). 2006 Abstinence Education RFP and Application Kit Page 16 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. 2006 Abstinence Education RFP and Application Kit Page 18 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. 2006 Abstinence Education RFP and Application Kit Page 19 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~. 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 -- - .._ . . 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