Form 2 - Home | City of Vancouvervancouver.ca/files/cov/community-services-social-policy... · Web viewNote: If one person participates in your program multiple times, count that

2018 Direct Social Services Grant Application

Form 2

2018 City of Vancouver – Community Services Grants Program Information(Submit 1 copy for every program applied for by your organization)

Organization Name (as indicated in Form 1 question ORO 1.1)

PR 1.0 | ABOUT THE PROGRAM PR 1.1 | Grant Stream Being Applied For (check only one):

Direct Social Services (DSS)

Organizational Capacity Building (OCB)

NOTE: Both DSS and OCB applicants should fill out all questions in this application unless indicated otherwise.

PR 1.2 | Grant Request$

PR 1.3 | Name of the Proposed Program

PR 1.4 | One Sentence Program DescriptionPlease provide a one sentence description of the proposed program and the proposed benefit.

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Note: The above box will expand as you type.

PR 1.5 | Program Alignment with the City of Vancouver’s Healthy City StrategyFrom the list below please identify which of the 13 Healthy City Strategies are most relevant to your program. You may choose up to a maximum of 3 Healthy City Strategies.

NOTE: Refer to Appendix A at for an overview of the Healthy City Strategy and its goals.

A Good Start Active Living and Getting Outside

A Home for Everyone Lifelong Learning

Feeding Ourselves Well Expressing Ourselves

Healthy Human Services Getting Around

Making Ends Meet and Working Well Environments to Thrive In

Being and Feeling Safe and Included Collective Leadership for a Healthy City for All

Cultivating Connections

PR 1.6 | Program Alignment with the City of Vancouver’s Healthy City StrategyProvide a short description of how your program aligns with the 3 Healthy City Strategy goals you identified above. Responses should be 200 words or less.


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PR 2.0 | GENERAL CONTACT INFORMATION NOTE: Please complete the following section ONLY if your program contact information differs from the contact information provided for your organization in Form 1

PR 2.1| General Program Contact InformationStreet address

City

Province Postal Code

Telephone Website

Facebook Twitter

General Email

PR 2.2 | Main Staff Contact for ProgramFirst name

Last name

Title

Telephone

Email

PR 3.0 | CITY OF VANCOUVER SUPPORTPR 3.1| Did you receive a grant for this program last year?

Yes No

PR 3.2 | If you answered yes to question 4.1, what was the amount of the grant?$

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PR 4.0 | PROPOSED PROGRAMPR 4.1 | Briefly describe the program and staff position(s) for which you are requesting a grant. Responses should be 200 words or less


PR 4.2 | How long have you been providing the program for which you are seeking City funding?

Years

PR 5.0 | PARTICIPATION AND IMPACT PR 5.1 | Who are the primary population group(s) for whom this program is intended? (Note: Organization Capacity Building (OCB) applicants indicate primary organizations instead of population groups) Responses should be 100 words or less


PR 5.2 | Number of different individuals per year using the program you are applying for Note: If one person participates in your program multiple times, count that person only once. (OCB applicants indicate number of other non-profits supported annually by the program)

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PR 5.3 | Percentage of the individuals using the program who are living in Vancouver (OCB applicants indicate % of other non-profits supported located in Vancouver) %

PR 5.4 | Client/Participant Population (OCB applicants please do not answer and skip to the next question)Social policy staff is frequently asked to report on the types of programs funded and the population groups with whom they work. The following question will help us estimate the degree to which funded programs work with various population (this information will be used for aggregated statistical purposes only and will not be used to report on any one program).

To the best of your ability, please indicate the approximate percentage of people served by your program who you know would identify in one or more of the following groups.

Note:

We recognize that one person may identify themselves in more than one group so the total % may exceed 100% (e.g. 70% of the people served by your program may be seniors and 60% women and 85% may be low income, etc.)

We recognize that this is not a comprehensive list and that you may not know if people served by your program identify in one of these categories. If you are not able to estimate for a population group(s) simply leave it blank. We are not asking you to survey participants, the percentages below would be your estimate only.

Population GroupApprox. % of

people in your program

Aboriginal peoples – First Nations (Status or Non-Status), Inuit, and Metis %

Children (0 to 12) %

Families %

Immigrants &/or Refugees

In Canada less than 5 years %

In Canada 5 or more years %

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Lesbian, Gay, Bisexual, Queer (LGBQ) %

Trans*, Gender-Variant, Two Spirited (TGV2S) %

People engaged in or exiting sex work %

People living with mental health and /or addictions %

People with low income %

People experiencing homelessness %

People with disabilities %

People whose first language is not English %

Seniors (55+) %

Women %

Youth (13 to 24) %

Other %

PR 5.5 | Gender EquityOn April 5, 2016 Vancouver City Council passed a motion called “Because It’s 2016: Action on Gender Equality”. The motion made a number of commitments including “that Social Policy Grants … ensure that funding and support enables equitable delivery of services for women and girls …”.

Please indicate what steps your program takes to identify barriers to access and ensure equitable delivery of service for women and girls. Responses should be 100 words or less.

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PR 6.0 | ORGANIZING/MOBILIZING VOLUNTEER RESOURCESPR 6.1 | Please list the number of volunteers involved in the program for which you are applying. Volunteers are defined as people who are not remunerated with pay and who work directly with service users, provide administrative support, and/or help with special events. Regular volunteers are involved year-round; casual volunteers are only involved with activities such as special events or one-time programs.

For program(a) Previous year (if applicable) - Number of regular

volunteers

(b) Total annual regular volunteer hours provided (estimate)

(c) Previous year (if applicable) - Number of casual volunteers

(d) Total annual casual volunteer hours provided (estimate)

PR 7.0 | Finance: We require three financial documents:1. Program Budget – excel sheet provided – Form 32. Organization Budget – excel sheet provided – Form 43. Organization Financial Statements

PR 7.1 | Program Budget (Form 3)The template for the Program Budget is attached as an Excel document (Form 3). NOTE: the program budget should be completed according to your organization’s fiscal year.

PR 7.2 | If you received funding for this program last year and are requesting an increase in funding over the rate of inflation (i.e. 2%) provide a rational for the increase, including financial need and the need for additional services. Include details about the additional work that would be supported by the increase, including information about new positions, additional hours and wages. Responses should be 100 words or less.

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Note: The above box will expand as you type

PR 7.3 | Organization Budget (Form 4): This application requires an Operating Budget for the Entire Organization. The template for the Operating Budget for your entire organization is attached as an Excel document (Form 4). NOTE: the organization operating budget should be completed according to your Organization’s fiscal year.

PR 7.4 | Organization Budget (Audited Statements) Attach the organization’s Financial Statements for the most recently-completed fiscal year. Preferably, the statements will have been independently prepared as a Review Engagement or Audit. They must be signed by two board members.

PR 8.0 | Stories of Change This is an opportunity to provide one story of something that has occurred for an individual or group during the past year as a result of your program. These stories offer an opportunity to provide more in depth information and understanding about the changes that occur for the people that you serve as a result of your work.

When you are writing the story, please keep the following guidelines in mind:

Ask for the group or individual’s permission to use this story. Ensure that there is no information included that would identify those

involved. If the story is about an individual, use a pseudonym and be sure that you

have altered or removed any specific information that might lead others to be able to identify that person.

Be sure to include the activities that led to the change(s) and explain the impact of the change(s) on the individual or group.

Provide context: Why is the change that occurred meaningful? Review the story with the individual or group before including it with your

application.

Please place an X in the box here to confirm that the names used in the story are pseudonyms and that all specific identifying information has been altered/removed.

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PR 8.1 | If you have a story that occurred for an individual or group as a result of your program, please include it below.

Stories should be 200 words or less. Please do not provide information that would identify any individual(s).


PR 9.0 | Outcome Measurement Tables

TABLE 1: ONLY FOR PROGRAMS THAT RECEIVED A GRANT LAST YEAR

If you did not receive a grant last year, please skip to Table 2.

Report back on what was actually accomplished in the past 12 months. If this was the FIRST year you received a grant for this program please report on the past 6 months – April to September.

1. Cut and paste directly from last year’s application (a copy of last year’s application was sent to you with this application. Please contact [email protected] if you did not receive it):

o Proposed Activitieso Proposed Outputso Proposed Short Term Outcomeso Proposed Indicators

2. Actual Outputs: report on what was actually accomplished in the last 12 months (September to September).

3. Actual Short Term Outcomes: using the indicators you proposed in your application, report on what was actually achieved in the past 12 months (September to September).

TABLE 2: Activity Plan for the next 12 months (starting September 1)

Table 2 asks you to indicate what you propose to accomplish in the coming 12 months.

If you applied for a grant in this stream last year you may use this as a starting point but be sure to make changes based on what actually happened

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mailto:[email protected]


in the past 12 months and based on what you anticipate will occur in the coming 12 months.

TABLE 3: Monitoring Plan for the next 12 months (starting September 1)

Table 3 asks you to describe how you will monitor your work in the coming 12 months.

If you applied for a grant in this stream last year you may use this as a starting point but be sure to make changes based on what actually happened in the past 12 months and based on what you anticipate will occur in the coming 12 months.

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TABLE 1. Report back on what you actually accomplished IN THE PAST 12 MONTHS (Sept 1 – Sept 1) with your previous year’s grant. See Appendix C in the Information Sheet for assistance with completing the table. NOTE: if you did not receive a grant this past year you do not need to complete Table 1; please proceed to Table 2 on the following page.

Name of Program:

ACTIVITIES(copy directly from

Table 2 in last year’s application)

PROPOSED OUTPUTS

(copy directly from Table 2 in last year’s

application)

ACTUAL OUTPUTSOver the past 12 months (Sept 1)

PROPOSED SHORT TERM OUTCOMES(copy directly from


INDICATORS(copy directly from


ACTUAL SHORT TERM OUTCOMESOver the past 12 months (Sept 1)

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TABLE 2. Outcome Measurement Framework (max 2 pages) for what you propose to accomplish IN THE COMING 12 MONTHS (Sept 1 – Sept 1) with the grant you are requesting. See Appendix C in the Information Sheet for help with completing the table.Name of Program:

ACTIVITIES OUTPUTS SHORT TERM OUTCOMES INTERMEDIATE OUTCOMES

LONG TERM OUTCOME

(insert the Healthy City Goals identified

in question 1.5)

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ACTIVITIES OUTPUTS SHORT TERM OUTCOMES INTERMEDIATE OUTCOMES

LONG TERM OUTCOME

(insert the Healthy City Goals identified

in question 1.5)

TABLE 3. Monitoring Plan (max 2 pages) for what you proposed in your Outcome Measurement Framework in Table 2. See Appendix C in the Information Sheet for help with completing the table.Name of Program:

SHORT- TERM OUTCOMES INDICATORS SOURCE/ METHODS AND FREQUENCY/ WHO WILL DO IT

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SHORT- TERM OUTCOMES INDICATORS SOURCE/ METHODS AND FREQUENCY/ WHO WILL DO IT

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PR 10.0 | Organizational Capacity Building (OCB) QuestionsThis section to be completed only for programs applying for OCB grants

PR 10.1 | How Organizations Are SupportedOCB grants are designed for organizations that develop the capacity of other non-profits by providing one or more of the following (see page 2 of the Information Sheet):

increasing the amount of resources available; OR improving the utilization of resources; OR improving the management and allocation of resources; OR providing linkages and coordination among a number of non-profit social service

agencies operating a hub model service centre.

Describe how your program develops the capacity of other non-profits. Responses should be 100 words or less.

Note: The above box will expand as you type

PR 10.2 | Organizations Supported by the ProgramList the non-profit organizations that have benefited from your organizational capacity building work in the past year. If there are more than 5, please list the 5 with which you have been most actively engaged.

Name of Organization Supports ProvidedPlease limit your response to less than 100 words

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THIS PAGE NEEDS TO BE COMPLETED BY HAND FOR YOUR HARD COPY SUBMISSION

SIGNATURES By signing this application, you are indicating agreement with the following statement and conditions:

We certify that, to the best of our knowledge, the information provided in this civic grant request is accurate and complete and is endorsed by the organization which we represent.

If our organization receives a civic grant, we agree to the conditions set out below and to any other conditions approved by Council. We understand that this application and supporting materials are public documents, and that any member of the public may have access to all or any part of them.

(Signature of two signing officers of the Board of Directors of the organization, NOT staff)

____________________________ ________________________________ ____________________Signature Title Date

Print Name: ________________________

____________________________ ________________________________ ____________________Signature Title Date

Print Name: ________________________

Conditions

1. In the event that the funds are not used for the purpose as described in the application, or if there are misrepresentations in the application, the full amount of the financial assistance will be payable forthwith to the City.

2. If there are any significant changes in the funding of the program or service from that contemplated in the application, the City will be notified of such changes through the Office of the Managing Director of Social Policy forthwith.

3. The Organization will make or continue to make attempts to secure funding from other sources as indicated in its application.

4. The Organization will keep proper books of accounts of all receipts and expenditures relating to the program or service as described in the application.

5. The Organization will make available for inspection by the City or its auditors all records and books of accounts of the Organization upon request from the City.

6. If the program or service proposed in the Organization’s application has not commenced, or is not completed and there remain City funds on hand, or is completed without requiring the full use of the City funds, such City funds will be returned to the City through the Office of the Director of Finance.

7. The program or service may not be represented as a City program, and the Organization does not have the authority to hold itself out as an agency of the City in any way; the only relationship being that the City has approved and granted financial assistance to the Organization.

Please note: Once you submit your application and supporting attachments, they become public documents. Information provided may be used for statistical reporting purposes. Incomplete applications will not be considered. The City reserves the right to apply other evaluation criteria as it deems relevant.

APPLICATION DEADLINE IS 4:30 PM, OCTOBER 13, 2017

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(Be sure to submit the completed application & all required documentation, as outlined on the next page)

ALL required materials (one hard copy and one emailed electronic copy) must be received by the City no later than the deadline time/date.

INSTRUCTIONS AND CHECKLIST FOR APPLICANTSWhen you have completed your application, please submit all of the following documents both by email and one hard copy:

Email the electronic copy of all documents listed below to [email protected]. Board signatures are not required. Give each of the application files a file name that indicates which organization it is coming from.

Mail or deliver one printed copy of all documents listed below, with board signatures where applicable, by 4:30 pm October 13, 2017 to:

Social Policy DivisionCity of Vancouver501 – 111 West Hastings StreetVancouver, BC V6B 1H4

One copy per organization of each of the following (if your organization is applying for multiple grants only submit one of each of the items below):

1) Word version of the Organization Information Form (Form 1) – Only one needed per organization

2) Excel version of Operating Budget for Entire Organization (Form 4)

3) Your most recent audited statements (if you have not already sent them to us). If audited statements are not available, submit your most recent financial statements endorsed by two signing officers of the Board of Directors. The inclusion of these documents is a supplement to your application and not a substitute for completion of the financial information sections of the application form.

4) List of Board of Directors (including names, occupations and/or skills brought to the board and board positions held)

5) Minutes of your most recent Board meeting

6) Minutes of your most recent AGM

7) A copy of your society constitution/bylaws

8) An organization chart showing accountability and communication relationships

9) Certificate of Incorporation

10)Annual Report, if available

11)Completed grants review timetable with your availability for interview

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mailto:[email protected]


One copy of each of the following for every program being applied for:

1) Word version of the Program Information Form (Form 2)

2) Excel version of Program Budget (Form 3)

3) Job descriptions of any positions paid for by the civic grant

Please note that City staff may require additional documentation when reviewing your application

APPENDIX AHealthy City Strategy

In October 2014, Vancouver City Council approved the Healthy City Strategy (HCS). The HSC is a “long term and integrated plan that helps us think, work and act together in new ways to change the conditions that impact the health and well-being of people, place and planet”. It is the City’s plan for social sustainability and consists of 13 goals. The HCS also builds on important research and data that will be shared on the City’s website and can be used by non-profits and the community to gain a better understanding of their neighbourhoods and how Healthy City goals are being advanced. To learn more about the Healthy City Strategy please visit: www.vancouver.ca/people-programs/healthy-city-strategy

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http://www.vancouver.ca/people-programs/healthy-city-strategy


Outline of the 13 Healthy City Goals

1) A Good Start: Vancouver’s children have the best chance of enjoying a healthy childhood

A good start in life is critical for our long term health and well-being. Our physical, social, mental, emotional and spiritual development as children is affected by diverse issues. Your program works in areas like the development of loving and secure attachments, the safety and security of housing and neighbourhoods, and access to nutritious food and quality child care.

2) A Home for Everyone: A range of affordable housing choices is available for all Vancouverites.

Vancouver is a growing and diverse city with significant housing challenges. Providing a range of housing options is critical to the social and economic health of our city. Your program addresses issues including the experience of homelessness, the quality of our housing and housing affordability.

3) Feeding Ourselves Well: Vancouver has a healthy, just, and sustainable food system.Food plays a powerful role in connecting people and in building strong and resilient communities. The City is working toward a just and sustainable food system by addressing a number of gaps in the food system. Your program addresses issues including equal access to healthy, affordable food; opportunities to better support the local food economy; and making more resources available for underserved and vulnerable communities.

4) Healthy Human Services: Vancouverites have equitable access to high-quality social, community, & health services.

Our ability to access human services of various types when we need support impacts our health and well-being. This is particularly true for more vulnerable populations who may face multiple barriers to accessing services. Connecting to services can be a critical first step on the long road to greater mental and physical health and well-being. Your program assists non-profits to operate more effectively and helps vulnerable communities to connect to services.

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5) Making Ends Meet and Working Well: Our residents have adequate income to cover the costs of basic necessities, and have access to a broad range of healthy employment opportunities.

Vancouver is a city with a thriving economy, but it is also a city with high rates of poverty and with many people struggling to make ends meet. This inequity has social and economic costs that affect us all. Your program helps ensure that income is distributed more evenly in our society, and supports healthy work environments and jobs.

6) Being and Feeling Safe and Included: Vancouver is a safe city in which residents feel secure.

A sense that we belong, that we are included and that we are safe in our communities are vital parts of our well-being. Whether threats to our safety are actual or perceived, they can have powerful and lasting impacts on our well-being. Vancouver is a place in which many individuals and groups are excluded from mainstream society. Your program supports a city in which vulnerable communities experience inclusion, belonging and safety.

7) Cultivating Connections: Vancouverites are connected & engaged in the places & spaces that matter to us

Relationships are at the heart of a good life. Our social networks are a critical source of a myriad of supports. A sense of connectedness and engagement in the places and spaces that matter to us is critical for our physical and mental well-being. Your program supports people to feel more connected to social networks, and engaged in civic and community life.

8) Active Living and Getting Outside: Vancouverites are engaged in active living & have incomparable access to nature.

Being physically active throughout our lives whether for recreation, work or transportation is good for our bodies and our minds. Your program provides opportunities to connect active living and getting outside by encouraging outdoor play, active transportation, and access to high quality parks, public spaces, and infrastructure for people throughout their lives.

9) Lifelong Learning: Vancouverites have equitable access to lifelong learning & development opportunities

Learning is important throughout our lives. Gaining new skills and knowledge is important for responding to change, including maintaining employability and preparing for later life. Early learning contributes to school readiness and adult learning increases confidence and self-efficacy. Your program builds the skills and knowledge for people at different stages of their lives to help them achieve their goals and live their lives more fully.

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10) Expressing Ourselves: Vancouver has a diverse and thriving cultural ecology that enriches the lives of all residents and visitors.

Participation in arts and culture is critical to building a vibrant, livable and healthy city. Arts and cultural events range from large scale performances, to street festivals and small-scale community art projects. Each type of activity plays a different but important role in improving our individual and collective well-being. Your program uses art and cultural activities to bring people together often providing an important antidote to social isolation.

11) Getting Around: Vancouverites enjoy safe, active, and accessible ways of getting around the city

Although Vancouver has some of the healthiest citizens in North America, chronic health issues associated with sedentary lifestyles are a major concern. Your program promotes active transportation - walking, wheeling, cycling, boarding or riding public transit - by allowing people to make exercise part of their daily routine.

12) Environments to Thrive: Vancouverites have the right to a healthy environment and equitable access to liveable environments in which they can thrive

Healthy, livable urban environments are characterized by complete, compact and connected communities. There are many interconnected ways in which healthy urban environments lead to better physical and mental health outcomes and abundant opportunities to thrive that can be sustained in the face of local, regional and global challenges. Your program supports key components including a well-planned built environment, a sustainable natural environment, a thriving economic environment and a vibrant social environment.

13) Collaborative Leadership: Collaborative Leadership for A Healthy City For All

Health and well-being are everyone’s business, and working collaboratively to find solutions that benefit everyone is the best way to create a healthy city for all. Moving the dial on complex social issues requires a coordinated approach based on strong and meaningful partnerships. We need to continue to try different things and to do things differently to transform the systems that gave rise to our existing social, economic and environmental challenges. Your program supports integrating and aligning efforts across all partners to address the complex challenges that we face together.

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Documents

Form 2 - Home | City of Vancouvervancouver.ca/files/cov/community-services-social-policy... · Web viewNote: If one person participates in your program multiple times, count that