1

FY15 Application

Afterschool Care:

Quality Improvement Grant

Application / Afterschool Care: Quality Improvement Grant
Due Date / Applications must be postmarked by March 28, 2014
Send complete application packet to / Karen Scott
Vermont Afterschool, Inc.
123 Ethan Allen Avenue
Colchester, VT 05446

Application packet requirements / Application Cover (2 pages)
Completed Application
Submit the Original & 5 copies to address above
Copies can be 2-sided (back to back)
OR
Electronic format – PDF or Microsoft Word Document
Application Format / No faxes, extensions,or other electronic formats can be accepted
Sorry, no exceptions can or will be made
Note / Do not attach this sheet to your application – please discard

Afterschool Care: Quality Improvement Grant

Cover Page

(For Office Use Only)

Grant # : ______Stage: Application

Program Area: ______Date Application Received:

Department for Children and Families
Child Development Division / 1

1

1. Name of Organization:

VT Tax ID #: Federal EIN#:

(You must have a VT tax ID #)(This is NOT the same as your VT Tax ID #)

2. Mailing Address: Street or P.O. Box #: City: StateZip County:

Program Location (if different from above):

Daytime Phone Number: E-mail: Organization’s Fiscal Year:

3. Contact Name: Contact Phone #: Contact E-mail:

4. Title of Project:

5. Grant Purpose: (No more than a two sentence explanation of the grant project):

6. Total Amount Requested (maximum amount is $5,000) $

7. Fiscal Agent (if different than organization listed above):

Federal EIN #: VT Tax ID #:

Address of Fiscal Agent: Fiscal Agent’s Fiscal Year:

8. Are you currently licensed through CDD/DCF to provide childcare? Yes No

If yes, date first licensed:

(These funds are prioritized for programs licensed, or planning to become licensed,by CDD/DCF.)

9. Is your agency Private Not-For-Profit, 501c3?: Yes No School?: Yes No

Other Public Organization or Municipality? Yes No

10. AHS OUTCOME AREA: Check the ONE area most related to the purpose of this grant request.
Children Succeed in School Children Live in Safe, Supported Families
11. Total Number of Children Anticipated to be Served with this Grant in Each Age Category:
(Please list numbersin the appropriate box(es):
# Kindergarten (5-6 year olds) # Children in Grades 1-5 # Children in Grades 6-8
12. From the number of children listed in #11(above), list numbersthat fit these descriptions andthat may be served with this grant:
# Children with special needs # Children in Protective Services
# Children currently enrolled in child care financial assistanceAND/OR
# Children who may be eligible for child care financial assistance but not yet enrolled

13. Does your program currently receive a VT Dept.of Education21st Century Learning Center grant?

Yes No

Has this program received a CDD Quality Improvement Grant in the past? When?

14. Indicate your status below in the VT-STARS recognition program and/or achievement of accreditation from a national organization or other national accreditation. Identify the stage you are in.

Check all that apply:

VT-STARS (STep Ahead Recognition System)

Beginning to look into procedures, materials and developing an application timeline

Working on a self-assessment

Have achieved a STARS rating level of: Date achieved:

National Accreditation

Beginning to look into procedures, materials and developing an application timeline

Working on a self-assessment

Have achieved accreditation from another national organization:

Date achieved:

I certify that information contained in this application is true and correct and this program will comply with applicable eligibility criteria for the federal Child Care and Development Fund and the Children, which includes not discriminating or barring participation in this program on the basis of race, religion, sex, color, handicap or national origin. If this program closes, I will contact the Child Development Division regarding the possible redistribution of the materials purchased with this grant and to return any unspent funds.I certify that within one year up to the date of this grant request, all regulatory violations are corrected, no “Parental Notification Letters” have been mailed and the program does not have a pattern of repeated regulatory violations with the CDD.

______

Signature of Person Responsible Title Date

(Executive Director or Designated Official)

SUMMARY PLAN

The application may be downloaded from the Vermont Afterschool, Inc. website ( or applicants may request this document be sent electronically. Answers to all questions and completed attachment charts must be submitted in order for this to be considered a complete application. The Summary Plan MUST NOT EXCEED six (6) single typewrittenpages,one-inch margins, 12 point Times New Roman font, excluding attachments. Pages may be copied back-to-back.

  1. INTRODUCTION: Briefly describe your agency/organization, its structure, and its history of successful grant project management. This establishes the agency/organization’s capability of delivering the outcomes described in the project plan, and identifies responsibility for the use of and accounting for the awarded money. (You will be asked to describe your program and grant request in other sections of the document.)
  1. PROGRAM AND GRANT PURPOSE: Describe how you will improve the quality of your program by clearly answering the following:
  1. Clearly stateyour primarygoal for program quality improvement and how these grant funds will help you achieve them (i.e. VT-STARS, YPQI, other program assessment or accreditation).
  2. List the source, number and exact wording of the standard/s that you have identified to work on to address any gaps in the quality of your services from the assessment you are using.
  1. EVALUATION PLAN:Describe how you will evaluate the implementation and outcomes of your program.
  1. GRANT IMPLEMENTATION: Elaborate on your purpose and how you will use these funds. In the left columnprovide a breakdown of estimatedgrant expenditures. In the rightcolumn, describe the activity and strategies that will assist you in accomplishing your grant purpose/soutlined in Part 2 above.

Amount Requested / Activity and Strategies

Additional Comments:

5. TIMELINE: For the total period of your grant implementation, write a summary for each calendar quarter describing the steps you will take to meet your goals and accomplish your purpose.

July-September
October-December
January-March
April-June

Additional Comments:

6. BUDGET PLAN:

  1. Budget Summary:(Attachment A-1): Use this form to present the details of how your requested funds fit within your total program budget. The 1st column is to inform us ONLY on the amount of CDD funds you are requesting. Column 2 is for any matching funds going into the program other than CDD grant dollars. Your sum total is stated in column 3. You are also asked to identify all sources of additional income, including monies from the CDD Child Care Financial Assistance program.

Note: These grant funds cannot be used for family scholarships, parent transportation, construction or other capital expenses.

B. Grant Budget Narrative: (Attachment A-2): For each category in the A-1 Budget Summary, write a short budget narrative in Column 1 explaining the breakdown ofestimated costs to be paid for with the CDD grant funds. A narrative must include specific costs or price estimates and a summative total within each category.

ATTACHMENT A-1: BUDGET SUMMARY

All applicants MUST use this form to represent the one-year grant period.

The figures in Columns 1 and 2 must add up to the figure/s in Column 3

You are asked to provide specific details in Attachment A-2Budget Narrative

Category / Column 1
Grant Funds Requested from CDD / Column 2*
Other
Financial
Resources / Column 3
Total Program
Costs for Grant Year
Staff Salaries
(In A-2 Budget Narrative, list each position, hours/week, $/hour and total for each position)
Fringe Benefits (specifically related to salaries --
25-30% is average)
Operating Expenses (specific to your grant purpose)
Equipment(can be a maximum of 30% of the grant request total)
Other Program Costs (explain):
Other Program Costs (explain):

TOTAL DOLLARS

*OTHER ANNUAL FINANCIAL SUPPORT FOR THIS PROGRAM

(Figures listed above in Column 2 above, please explain where they are coming from below)

Examples of “Other” include: Other funders, registration fees, fund-raising events,

donations or in-kind contributions, etc.

Income / Amount / Date Received / Pending
Child Care Financial Assistance
Tuition/Fees: what kind; amt per child
Town Allocation
21st Century Community Learning Center Federal Funds
Other Grants/ Revenue Sources (list):
Total Income

ATTACHMENT A-2 GRANT BUDGET NARRATIVE

FOR GRANT FUNDS ONLY

All proposals MUST submit a budget narrative.

Report ONLY on the items you are requesting in Column 1 of Attachment A-1. In each category, list thecoststhat add up to or equal tothe subtotal amounts. Include written explanations where needed.

Staff: List each staff position for this grant, their # of hours on the project; hourly rate, and a subtotal for each position, then a category subtotal. / Itemized Costs and total for this category:
Fringe Benefits: Listall benefit amounts to be paid to specified stafflisted above and subtotal the category. / Itemized Costs and total for this category:
Operating Expenses: List operating expenses related to this grant, specified costs for each and category subtotal. / Itemized Costs and total for this category:
Equipment: List equipment that will be charged to this grant, the cost per item, andcategory subtotal. / Itemized Costs and total for this category:
Other: List any otherrelated activity cost, the amount of each, the documentation for this cost amount, and category subtotal. / Itemized Costs and total for this category:
Total Grant Budget: