New Citizen Program

Request for Investment 2016

City of Seattle | New Citizen Program RFI Guidelines and Application / 1

Attachment 1

2016 New Citizen Program Request for Investment

Application Checklist

Thischecklistis intendedtohelpyoucompleteyourapplicationpacketpriortosubmission.Pleasedonotsubmitthisform withyourapplication.

 Completedandsignedthe2-pageApplicationCoverSheet(Attachment2)*

 Completedthe Narrativeresponse

  • Mustnotexceed15pages(8½x11),singlespaced,double-sided,size12 font,with1 inchmargins.
  • Pagecountdoesnotincludetherequired forms(Attachments2,3 and4)andsupportingdocuments.

 CompletedtheProposedProgramBudget(Attachment3)*

 CompletedtheProposedPersonnelDetailBudget(Attachment4)*

 Attachedthefollowingsupportingdocuments*

 A listofallkeypersonnelandjobdescriptionsofstaffwhowillhavea significantrolein programcoordinationandservicedelivery.

 A copyofyouragency’smostrecentfinancialauditorForm990ortaxreturn,perSectionIV.

 Acopyofyouragency’sfinancialstatementfromthelastfiscalyear,certifiedbyyouragency’sCFOorfinancialmanager or Executive Director.

 A currentcertificateofnonprofitstatus.

 Ifyouragencyhasanapprovedindirectrate,attacha copyofproofthattherateisapprovedby anappropriatefederalagencyoranotherentity.

 RosterofyourcurrentBoardofDirectors.

 Proof of BIA recognition and accreditation. If you are not yet BIA-accredited and are pursuing accreditation, includea letter with the following details: date application was submitted, status of application and prospect of obtaining successful accreditation by May 1, 2016.

 If youareproposingtoprovideanynewservicesforyouragency,attacha start-uptimelineforeach service,beginningJanuary1,2016.

 If youareproposinga significantcollaborationwithanotheragency,attacha signed MOU/MOAfromthatagency’sDirectororotherauthorizedrepresentative.

*Thesedocumentsdonotcountagainstthe15pagelimitfortheproposalnarrativesection.

AllapplicationsareduetotheSeattle Office of Immigrant and Refugee Affairsby 12:00p.m.onMonday, April 11, 2016.Applicationpacketsreceivedafterthisdeadlinewillnotbeconsidered.SeeSectionI forsubmissioninstructions.

City of Seattle | New Citizen Program RFI Guidelines and Application / 1

Attachment 2

New Citizen Program

Request for Investment 2016

Application Cover Sheet

1. ApplicantAgency:
2. Agency Address:
3. AgencyExecutive Director:
4. AgencyPrimaryContact:
First and Last Name: Title:
Email:
Phone#:
5. Federal TaxIDorEIN:
6. DUNS Number:
7. ProgramName:
8. FundingAmountRequested (7/1/16 – 6/30/17):
9. PartnerAgency(if you have a significant collaboration in place):
ContactName: Title:
Address:
Email: PhoneNumber:
AuthorizedSignatureof Applicant/LeadAgency
To the bestofmyknowledge andbelief, all informationin thisapplicationistrue andcorrect.The document hasbeen duly authorized by thegoverningbody of theapplicantwho will complywith all contractual obligationsif the applicantis awardedfunding.
Name and Title of Authorized Representative: ______
Signature of Authorized Representative: ______Date: ______
City of Seattle | New Citizen Program RFI Guidelines and Application / 1

New Citizen Program

Request for Investment 2016

Proposed Program Budget

July 1, 2016 – June 30, 2017

ApplicantAgency Name:
AmountbyFund Source
Item / Requested
OIRA Funding / Other1 / Other1 / Other1 / TOTAL
PERSONNELSERVICES
Salaries(Full-Part-Time)
FringeBenefits
SUBTOTAL – PERSONNEL SERVICES
OPERATING EXPENSES
Rent
Equipment
Office Supplies
Telephone
Postage
Utilities
Repairs& Maintenance
Insurance
Other Operating
SUBTOTAL - OPERATING
OTHERSERVICESCHARGES
Expert& ConsultantServices
OtherProfessionalServices3
Training& Travel
Advertising
Printing& Duplicating
OtherMiscellaneousExpenses4
AdministrativeCosts/IndirectCosts5
SUBTOTAL –OTHERSERVICES CHARGES
TOTALEXPENDITURES
1Identifyspecificfundingsourcesincludedunderthe “Other”column(s)above: “Other”column(s)above:
$
$
$
$
Total / $
2Other Operating–Itemizebelow:
$
$
$
$
Total / $
3OtherProfessionalServices–Itemizebelow:
$
$
$
$
Total / $
4OtherMiscellaneousExpenses–Itemizebelow:
$
$
$
$
Total / $
5AdministrativeCosts/IndirectCosts–Itemizebelow
$
$
$
$
Total / $

5AdministrativeCosts/IndirectCosts: OIRAplacesafifteen percent (15%)capon reimbursement for agencyindirectcosts,basedonthetotal contractbudget. Restrictions related tofederal approvedratesandgrantsourcesstill apply.

Doestheagencyhaveafederallyapproved rate? Yes No

If yes,providethe rate:

Classification ofExpendituresGuidelines

PERSONNELSERVICES– Personnel involved in the provision of services for this contract.

SalariesWages–Expensesforsalaries andwagesprovidedforfull-time and part-timeemployees.

FringeBenefits –Includes FICA, Pensions & Retirement, Health Care, Industrial Insurance, Dental, Unemployment

OPERATING EXPENSES – Related to the provision of services for this contract.

Rent–Rental of office buildings,

Equipment – Small equipment such as computers, printers, cell-phones and other small equipment under $5,000.

OfficeSupplies–Supplies,materials, software, and other supplies.

Telephone–Includesinstallation,longdistance,andlocaltelephoneservicecosts.

Postage–Includesallmeterpostage,stamps,postalpermits,etc.

Utilities–Includes gas, electricity, water, garbage, sewer etc.

RepairsMaintenance–Includesallservicesrequiredin themaintenanceof officeequipment,andbuildings.

Insurance–Includesallinsurancepremiumsexceptwhatis applicableto PersonnelServices.

Other Operating

OTHER SERVICES & CHARGES – Other items related to the provision of services for this contract.

ExpertConsultantServices–Auditingservices,accountingservices,speciallegalservicesandother individualandone-timeservices.

OtherProfessionalServices–Including janitorial, security and other professional services.

TrainingTravel – Training and travel expenses for contract-funded personnel and volunteers, includingregistration fees, transportation, mileage, mealsand lodgingexpenses.

Advertising–Includescostof advertising,publicationof publicnotices,andothersuchitems.

PrintingDuplicating–Includesprinting,copying,brochures,outreachmaterials.

OtherMiscellaneousExpenses–Includesotherexpensesnotcoveredsuch as dues, memberships, subscriptions and other items.

AdministrativeCosts–Collectionofadministrative/indirectcostsincurredbytheagency’soperationof thiscontract.Theexactrate,mechanicsofcollectionand specificapprovaltousethisexpenditureobjectwillbe givenonacontract-by-contract basistocertainagencies.

City of Seattle | New Citizen Program RFI Guidelines and Application / 1

Attachment 4

New Citizen Program

Request for Investment 2016

Proposed PersonnelDetailBudget

July 1, 2016 - June30,2017

ApplicantAgency Name:
Agency’sFull-Time Equivalent (FTE) = / AmountbyFund Source(s)
PositionTitle / Staff Name / FTE / #of
Hours
Employed / Hourly
Rate / Requested
OIRA Funding / OtherFund
Source / OtherFund
Source / OtherFund
Source / Total
Program
Subtotal–SalariesWages
Personnel Benefits:
FICA
Pensions/Retirement
IndustrialInsurance
Health/Dental
UnemploymentCompensation
Subtotal–PersonnelBenefits:
TOTALPERSONNEL COSTS(SALARIESBENEFITS):
City of Seattle | New Citizen Program RFI Guidelines and Application / 1