PLEASE NOTE: THIS IS NOT THE OFFICAL APPLICATION. IT IS A WORKSHEET FOR YOUR ORGANIZATION TO USE TO PRE-PREPARE YOUR ANSWERS BEFORE ENTERING THEM INTO THE ONLINE SYSTEM. IT IS RECOMMENDED THAT YOU KEEP A COPY OF THIS DOCUMENT FOR YOUR RECORDS.
UnitedWayofVolusia-FlaglerCounties,Inc
FundingApplicationforFiscalYear2015-2016
*Required
1. AgencyName*
2. DBA
AgencyDBA
3. HQAddress*
HeadquartersStreetAddress
4. HQCity*
HeadquartersCity
5. HQState*
HeadquartersState-2-letterAbbreviation
6. HQZip*
HeadquartersZipCode
7. LocalAddress *
LocalStreetAddress
8. LocalCity*
LocalAddressCity
9. LocalState*
LocalState-2-letterabbrevation
10. LocalZip*
LocalAddressZipCode
11. ContactName*
12. ContactEmail*
13. ContactPhone*
14. FYBegin*
BeginningDateofFiscalYear
Example:12/15
15. FYEndff
EndingDateofFiscalYear
Example:12 / 15
16. FederalIDNumber*
17. EDName*
ExecutiveDirector
18. EDAddress*
ExecutiveDirectorStreetAddress
18. EDCity*
ExecutiveDirector’sCity
19. EDStateff
ExecutiveDirectorState-2-letter
Abbreviation
20. EDZip*
ExecutiveDirectorZipCode
21. EDPhone*
ExecutiveDirectorPhoneNumber
22. BoardChair*
BoardVolunteerChairName
23. ChairAddress*
24. ChairCity*
25. ChairState*
26. ChairZip*
27. ChairPhone*
I.AGENCYINFORMATION/OVERVIEW
28. AgencyDescription*
GeneralDescriptionofAgency(50wordsmaximum)
29. Mission*
AgencyMissionStatement
30. Vision*
AgencyVisionStatement
31. History*
BriefHistory(dateestablished,etc.)
32. Services*
ServicesProvidedbyAgency
33. Delivery*
HowAreServicesProvided?
34. Target*
GeographicAreaofService
Checkallthatapply.
___ FlaglerCounty
___ VolusiaCounty
___ BothFlaglerandVolusiaCounties
___ Flagler,Volusia,OtherCounties
II.PURPOSEOFAGENCY
35. NeedsMet*
Describethecommunity need(s)beingmetbyyouragencyservices
Checkallthatapply.
___ Education ___ Income
___ Health
___ Basic needs(food,shelter,clothing,financialassistance)
36. NeedsExplanation*
ExplainNeedsBeingMet
37. Changes/Challenges*
Checkanysignificantchangesand/orchallengesthatoccurredinthelastyear.
Markonlyoneoval.
___ Changeofchiefexecutives (financeofficer,director,etc.)
___ Significant lossoffederalfunding
___ Significant lossofstatefunding
___ Eliminationofsignificant programoractivity
___ Findingslistedinannualagencyaudit
___ Nosignificantchangesorchallenges
38. ChangesExplanation*
Pleaseexplainsignificant changesnotedabovewithprogram,funding,findings,corrective measures.Ifnone,pleasetypeN/A.
39. Successes*
Pleasediscuss agencysuccesses.
Ill.BoardofDirectors
40. BoardLocal*
DoyouhaveagoverningBoardofDirectorswithlocalrepresentation?
Markonlyoneoval.
___ Yes
___ No
41. Governance
Ifyouanswered"no"above,pleasedescribeyoursystemofgovernance(i.e.,chapterof nationalOrganizationwithlocaladvisoryboard, localadvisoryboardhasrepresentationon largerregionalBoardofDirectors,programispartofpublicentity,etc.
42. MeetingFrequency11
Howoftendidthegoverningbodymeetduringthelastcalendaryear?
Markonlyoneoval.
___ Monthly
___ Bi-Monthly
___ Quarterly
___ LessthanQuarterly
43. FrequencyDetails
Ifmeetinglessthanquarterly, pleaseexplain.
44. Attendance*
Describetheaveragemeetingattendance.
Markonlyoneoval.
___ Onlyminimumnumberofattendeestoachieveaquorum
___ Atleast25%oftheappointedboard
___ Atleast50%oftheappointedboard
___ Atleast75%oftheappointedboard
IV.AGENCYFUNDINGSUMMARY
45. MatchingFunds11
Doesyouragencyreceivematchingfunds?
Markonlyoneoval.
___ Yes
___ No
7/51
46. Ifyes,whatisthematchratio?
Identify the match ratio for any grant that is leveraged. For example, the return is $4 per $1 raised locally. The match ratio is 1:4.
Fundraising
Indicatewhatpercentagethefollowingeffortscompriseyourtotalfundraisingefforts.
47. SpecialEvents*
Markonlyoneoval.
___ 0%
___ 1-25%
___ 26-50%
___ 51-75%
___ morethan75%
48. Raffles*
Markonlyoneoval.
___ 0%
___1-25%
___ 26-50%
___ 51-75%
___ morethan75%
49. DirectSolicitation*
Markonlyoneoval.
___ 0%
___ 1-25%
___ 26-50%
___ 51-75%
___ morethan75%
50. Grants*
Markonlyoneoval.
___ 0%
___ 1-25%
___ 26-50%
___ 51-75%
___ morethan75%
51. Other*
Markonlyoneoval.
___ 0%
___ 1-25%
___ 26-50%
___ 51-75%
___morethan75%
52. Agency-generatedrevenues*
Checkallthatapply.
___ PerClientFee
___ FeeforService
___ Memorials
___ Saleofmaterialorproduct
___ Other.
V.AGENCYFINANCIALOVERVIEW
53. AgencyFinancialNarrative*
AGENCYFINANCIALNARRATIVE:Thenarrativeshouldhelpthereaderunderstandhow yourbudgetalignswithprogramservices.Includeinformationabout:In-kindrevenues receivedandthevalueofsuchin-kinditems.Agency-generatedrevenues(feeforservices slidingscale,perclientfee,specialevents,memorial).UnitedWaycontributions,whether one,two,ormulti-county.Budgetaryshortfalls.Anyreservesastheyrelatetoorganizational shortfalls andviability.Identify anysignificantfinancialchangesexperiencedbytheagency andreflectedinthebudgetfinancialdatabetweenPriorYearActualandCurrentYear Projection,ANDbetweenCurrentYearProjectionandProposedYear.
In-KindRevenues
Checkallthatapplyregardingin-kindrevenuesthatarereceivedand thevalueofsuchin-kind itemsannually.
54.LegalServices•
Markonlyoneoval.
___ 0
___ $1-$2,500
___$2,501-$5,000
___ $5,001-$15,000
___ Greaterthan$15,000
55. Advertising/Marketing Services*
Markonlyoneoval.
___ 0
___ $1-$2,500
___ $2,501-$5,000
___ $5,001-$15,000
___ Greaterthan$15,000
56. FinancialServices*
Markonlyoneoval.
___ 0
___ $1-$2,500
___ $2,501-$5,000
___ $5,001-$15,000
___ Greaterthan$15,000
57. OfficeRealEstate•
Markonlyoneoval.
___ 0
___ $1-$2,500
___ $2,501-$5,000
___ $5,001-$15,000
___ Greaterthan$15,000
58. Volunteers*
Markonlyoneoval.
___ 0
___ $1-$2,500
___ $2,501-$5,000
___ $5,001-$15,000
___ Greaterthan$15,000
59. Other*
Markonlyoneoval.
___ 0
___ $1-$2,500
___ $2,501-$5,000
___ $5,001-$15,000
___ Greaterthan$15,000
60. OtherUWContributions*
IsyouragencyreceivinganycontributionsfromotherUnitedWays?
Markonlyoneoval.
___ Yes
___ No
61. OtherUWDetails
Ifyes,pleaseexplain
62. BudgetaryShortfalls*
Discussanybudgetaryshortfalls:
Markonlyoneoval.
___ Minimal-lessthan6%ofoperating/programbudget,noprogramimpact
___ Minor-lessthan10%ofoperating/programbudget,minimalprogramimpact
___ Moderate-greaterthan10%ofoperating/programbudget,moderatetosignificant
programimpact
___ Significant-greaterthan15%ofoperating/program,unabletooperateprogramat
prioryearlevelsandprogramindangerofelimination
63. ShortfallExplanation*
Explaintheaboveshortfalls.Ifnone,pleasetypeN/A.
64. ReservesUsed*
Discussanyreservesastheyrelatetoorganizationshortfallsandviability
___ Nouseofreserves
___ Useofreservesfornon-recurringexpenses
___ Useofreservesforreoccurringexpenses(i.e.,operationalandsalaryneeds)
___ Reservesusedregularlytofundprogramoperatingcostsandsalaries-notableto
provideprogrammingwithoutthisfundingsource
65. ReservesExplanation*
Explaintheaboveuseofreserves.Ifnone,pleasetypeNIA.
66. FinancialChanges*
Identify anysignificant(10%or$2,500,whicheverisgreater)financialchangesexperienced bytheagencyandreflectedinthebudgetfinancialdatabetweenPriorYearActualand CurrentYearProjectionANDCurrentYearProjectionandProposedYear
___ Salaries
___ Utilities
___ ProfessionalServices
___ Insurances(notemployeebenefits)
___ SpecificProgramExpenses
___ None
___ Other:
67. FinancialChangesExplanation*
Explaintheabovefinancialchanges.Ifnone,pleasetypeN/A.
68. AllocationPanel*
Listrecommendations/commentsmadebylastyear'sallocationpanelasstatedintheaward letter.
69. RecommendationsChanges*
Listchangesmadeandresultsduetotherecommendations/commentsfromtheallocation panel.
2014-2015AGENCYSELF-EVALUATION
RelationshipwithUnitedWay
70. AgencyAgreement*
TheboardunderstandsandapprovestheUnitedWayAgencyAgreement
Markonlyoneoval.
___ Yes
___ No
71. Fundraising Policies*
TheagencyisknowledgeableofandfollowsUnitedWayfundraisingpolicies
Markonlyoneoval.
___ Yes
___ No
72. InternalFundraisingCampaign*
TheagencyconductsaninternalUnitedWayfundraisingcampaignamongitsemployees
Markonlyoneoval.
___ Yes
___ No
73. PaceSetterAgency
Ifagencyconductedinternalfundraising,wasagencyaPaceSetter,finishingtheCampaign priortotheUnitedWayCampaignKick-Off?
Markonlyoneoval.
___ Yes
___ No
74. SpeakersProvided*
DidtheagencyprovidespeakersforUnitedWayCampaignpresentations?
Markonlyoneoval.
___ Yes
___ No
75. CouncilofAgencyExecutiveMeetings*
TheagencydirectorattendsCouncilofAgencyExecutivesmeetings.
Markonlyoneoval.
___ Yes
___ No
76. AgencyRepresentation*
TheagencyisrepresentedatUnitedWayeventsandfundraisers(i.e.,CampaignKick-Off, RaceParking,PositivePicketing,etc.)
Markonlyoneoval.
___ Yes
___ No
77. UnitedWayLogo*
TheUnitedWaylogoisdisplayedontheagency'sbuilding,website,brochures,publications, andothermarketingmaterials.
Markonlyoneoval.
___ Yes
___ No
78. OutcomeMeasurementTraining*
Staffrepresentative(s)fromtheagencyattendedanOutcomeMeasurementTraining
Markonlyoneoval.
___ Yes
___ No
79. GrantWorkshop*
Staffrepresentative(s)fromtheagencyattendedtheGrandWorkshopfortheFunding
Application
Markonlyoneoval.
___ Yes
___ No
80. SelfEvaluationComments
PleaseshareanycommentsyouhaveregardingyourrelationshipwithUnitedWaywith regardtotheselfevaluationquestionslistedabove.
PROGRAMS
81. ProgramTotal*
TotalAmountRequestedforProgramsinthis
Application
82. P1*
ProgramOneName
83. P1Amount*
AmountRequested
84. P2
ProgramTwoName
85. P2Amount
AmountRequested
86. P3
ProgramThreeName
87. P3Amount
AmountRequested
88. P4
ProgramFourName
89. P4Amount
AmountRequested
90. P5
ProgramFiveName
91. P5Amount
AmountRequested
92. P6
ProgramSixName
93. P6Amount
AmountRequested
SECTION2:PROGRAMINFORMATION
94. P1Name• ProgramName
95. P1ServiceArea*
PleaseselectONEServiceAreathatBESTdescribestheimpactfocusofthisprogram. ServiceareaswillbeusedtoreportbacktoUnitedWaydonors.
Markonlyoneoval.
Education
___ Income
___ Health
___ BasicNeeds
96. P1Description*
Provideashortdescriptionofthisprogram(50wordsmaximum)
97. P1Needs*
Whataretheneedsinourcommunityforthisprogram'sservices?
98. P1Addressing*
Howareyouaddressingtheneedforservices?
99. P1Impact*
Whatisthelongtermimpacttotheclientsandtothecommunity?
100. P1Matching*
Doestheprogramreceivematchingfunds?
Markonlyoneoval.
___ Yes
___ No
101. P1Matching Source
Ifmatchingfundsarereceived,indicatethefundingsource.
102. P1Match Ratio
Identify thematchratioforanygrantthatisleveraged.Identifythecaponanyleveraged grant.Forexample,thereturnis$4 per$1raisedlocally.Theleverageof1:4isuptoacap
of $50,000(i.e.$50,000bringsinamaximumof$200,000).
103. P1Grant*
Wasagrantrequestedlastyear?
Markonlyoneoval.
___ Yes
___ No
104. P1IncreaseRequest*
Wasafundingincreaserequested?
Markonlyoneoval.
___ Yes
___ No
105. P1 ClientFees*
Werethereclientfees? Markonlyoneoval.
___ Yes
___ No
106. P1 ClientsServed*
Numberofclientsserved(Unduplicated
Services)(2014-2015Projection)
107. P1 Cost/Client*
Cost/client(in$)(#ofclientsserved, unduplicated,dividedbytotalprogramcost) (2014-2015Projection)
108. P1Locations*
ListseparatelocationsforProgram
109. P1Days*
DaysofOperation
110. P1Hours*
HoursofOperation
111. P1Staff*
Numberofstaff
112. P1Volunteers*
Numberofvolunteers
I. PROGRAMOVERVIEW
113. Prog1Changes*
Hasthisprogramhadamajorchangeinthefacilities,staff,orservicesinthepast12 months?
Markonlyoneoval.
___ Yes
___ No
114. Prog1ChangeComments
Ifyes,pleaseexplainthechangeandimpactontheprogram.
115. Prog1NewProgram
Ifyoudidnotpreviouslyrequestagrantforthisprogram,isita newprogramforyour agency?
Markonlyoneoval.
___ Yes
___ No
116. Prog1Age
Ifthisisnota newprogram,howlonghasit beeninexistence?
117. Prog1Collaboration*
Giveexamplesofcollaborativeeffortsregardingthisprogram.DONOTINCLUDE RELATIONSHIPSFORCLIENTREFERRALSONLY.
118. Prog1Fees*
Areclientfeeschargedforthisprogram?
Markonlyoneoval.
___ Yes
___ No
119. Prog1FeeRange
Ifyes,whatistherangeoffees,andhowarethesefeesdetermined?
120. Prog1FeeWaiver
Iffeesarenotcharged,whynot?
121. Prog1ClientEligibility*
Howisclienteligibilitydeterminedforthisprogram?
122. Prog1WaitList*
Describethewaitinglistforprogramservices (includethelengthofthelistandhowitis managed).
II.PROGRAMDEMOGRAPHICS SUMMARY
Pleasecompletethefollowingquestionssummarizingthedemographiccharacteristicsofclients servedbythisprogram. IftherearenoprioryearclientschooseN/A. Donotusepercentage; putactualnumbersofclients. PLEASE NOTETHATTHESEFIGURESARENUMBERSOF CLIENTSSERVED-UNDUPLICATED,NOTNUMBEROFSERVICESPROVIDED.
AGEGROUP-0-5
123. P10-5PriorYr•
Prioryearclientsaged0-5(actual)07/13-
06/14
124. P10-5 CurrentYr*
Currentyearclientsaged 0-5(projected)
07/14-06/15
125. P10-5ProposedYr
Proposedyearclientsaged0-5(projected)
07/15-06/16
AGEGROUP6-10
126. P16-10PriorYr•
Prioryearclientsaged6-10(actual)07/13-
06/14
127. P16-10CurrentYr*
Currentyearclientsaged6-10(projected)
07/14-06/15
128. P16-10ProposedYr*
Proposedyearclientsaged6-10(projected)
07/15-06/16
AGEGROUP11-17
129. P111-17PriorYr*
Prioryearclientsaged11-17(actual)07/13
-06/14
130. P111-17CurrentYr*
Currentyearclientsaged11-17(projected)
07/14-06/15
131. P111-17ProposedYr
Proposedyearclientsaged11-17(projected)
07/15-06/16
AGEGROUP18-29
132. P118-29PriorYR*
Prioryearclientsaged18-29(actual)07/13-
06/14
133. P118-29CurrentYr*
Currentyearclientsaged18-29(projected)
07/14-06/15
134. P118-29ProposedYr*
Proposedyearclientsaged18-29(projected)
07/15-06/16
AGEGROUP30-54
135. P130-54PriorYr*
Prioryearclientsaged30-54(actual)07/13-
06/14
136. P130-54CurrentYr*
Currentyearclientsaged 30-54(projected)
07/14-06/15
Proposedyearclientsaged30-54(projected)
07/15-06/16
AGEGROUP55-64
138. P155-64PriorYr*
Prioryearclientsaged55-64(actual)07/13-
06/14
139. P155-64CurrentYr*
Currentyearclientsaged 55-64(projected)
07/14-06/15
140. P155-64ProposedYr*
Proposedyearclientsaged55-64(projected)
07/15-06/16
AGEGROUP65+
141. P165+PriorYr*
Prioryearclientsaged65andover(actual)
07/13-06/14
142. P165+CurrentYr*
Currentyearclientsaged65andover
(projected)07/14-06/15
143. P165+ProposedYr*
Proposedyearclientsaged65andover
(projected)07/15-06/16
AGEGROUPUNDOCUMENTED
Prioryearclientsageundocumented(actual)
07/13-06/14
145.P1UndocumentedCurrentYr
Currentyearclientsageundocumented
(projected)07/14-06/15
146.P1UndocumentedProposedYr
Proposedyearclientsageundocumented
(projected)07/15-06/16
GENDER GROUP-Male
147.P1MalePriorYr*
PrioryearclientsMale(actual)07/13-06/14
148.P1MaleCurrentYr*
CurrentyearclientsMale(projected)07/13-
06/15
149.P1MaleProposedYr
ProposedyearclientsMale(projected)07/15-
06/16
GENDER GROUP-Female
150.P1FemalePriorYr*
PrioryearclientsFemale(actual)07/13-06/14
151.P1FemaleCurrentYr*
CurrentyearclientsFemale(projected)07/14-
06/15
152.P1FemaleProposedYr
ProposedyearclientsFemale(projected)
07/15-06/16
GENDERGROUP-Undocumented
153.P1UndocumentedPriorYr
PrioryearclientsUndocumented(actual)
07/13-06/14
154.P1UndocumentedCurrentYr* CurrentyearclientsUndocumented (projected)07/14-06/15
155.P1UndocumentedProposedYr
ProposedyearclientsUndocumented
(projected)07/15-06/16
ETHNICBACKGROUND-Caucasian
156.P1CaucasianPriorYr*
PrioryearclientsCaucasian(actual)07/13-
06/14
157.P1CaucasianCurrentYr*
CurrentyearclientsCaucasian(projected)
07/14-06/15
158.P1CaucasianProposedYr*
ProposedyearclientsCaucasian(projected)
07/15-06/16
ETHNICBACKGROUND-African-American
159.P1African-AmericanPriorYr*
PrioryearclientsAfrican-American(actual)
07/13-06/14
160.P1African-AmericanCurrentYr*
CurrentyearclientsAfrican-American
(projected)07/14-06/15
161.P1African-AmericanProposedYr* ProposedyearclientsAfrican-American (projected)07/15-06/16
ETHNICBACKGROUND-Hispanic
162.P1HispanicPriorYr*
PrioryearclientsHispanic(actual)07/13-
06/14
163.P1HispanicCurrentYr*
CurrentyearclientsHispanic(projected)
07/14-06/15
164.P1HispanicProposedYr*
ProposedyearclientsHispanic(projected)
07/15-06/16
ETHNICBACKGROUND-Asian-American
165.P1Asian-AmericanPriorYr
PrioryearclientsAsian-American(actual)
07/13-06/14
166.P1Asian-AmericanCurrentYr*
CurrentyearclientsAsian-American
(projected)07/14-06/15
167.P1Asian-AmericanProposedYr* Proposedyearclients Asian-American (projected)07/15-06/16
ETHNICBACKGROUND·NativeAmerican
168.P1NativeAmericanPriorYr
PrioryearclientsNativeAmerican(actual)
07/13-06/14
169.P1NativeAmericanCurrentYr* CurrentyearclientsNativeAmerican (projected)07/14-06/15
170.P1NativeAmericanProposedYr* ProposedyearclientsNativeAmerican (projected)07/15-06/16
ETHNICBACKGROUND· Other
171.P1OtherPriorYr
PrioryearclientsOther(actual)07/13-06/14
172.P1OtherCurrentYr
CurrentyearclientsOther(projected)07/14-
06/15
173.P1OtherProposed Yr*
ProposedyearclientsOther(projected)07/15-
06/16
ETHNICBACKGROUND·Undocumented
174.P1UndocumentedPriorYr*
PrioryearclientsUndocumented(actual)
07/13-06/14
175.P1UndocumentedCurrentYr
CurrentyearclientsUndocumented
(projected)07/14-06/15
176.P1UndocumentedProposedYr* ProposedyearclientsUndocumented (projected)07/15-06/16
LEGALRESIDENCEDEMOGRAPHICS
FLAGLER
177.P1BunnellPriorYr
PrioryearBunnell32110clients(actual)
07/13-06/14
178.P1BunnellCurrentYr
CurrentyearBunnellclients(projected)07/14-
06/15
179.P1BunnellProposedYr
ProposedyearBunnellclients(projected)
07/15-06/16
180.P1FlaglerBeachPriorYr
PrioryearFlagler32136clients(actual)07/13-
06/14
181.P1FlaglerBeachCurrentYr
CurrentyearFlaglerclients(projected)07/14-
06/15
182.P1FlaglerBeachProposedYr
ProposedyearFlaglerclients(projected)
07/15-06/16
183.P1MarinelandPriorYr
PrioryearMarineland32086clients(actual)
07/13-06/14
184.P1MarinelandCurrentYr
CurrentyearMarinelandclients(projected)
07/14-06/15
185.P1MarinelandProposedYr
ProposedyearMarinelandclients(projected)
07/15-06/16
186.P1Palm CoastPriorYr
PrioryearPalmCoast32135,32137,32142,
32164clients(actual)07/13-06/14
187.P1Palm CoastCurrentYr
CurrentyearPalmCoastclients(projected)
07/14-06/15
188.P1Palm CoastProposedYr
ProposedyearPalmCoastclients (projected)
07/15-06/16
NORTHEAST
189.P1DaytonaBeachPriorYr
PrioryearDaytonaBeachclients(actual)
07/13-06/14
190.P1DaytonaBeachCurrentYr
CurrentyearDaytonaBeachclients
(projected)07/14-06/15
191.P1DaytonaBeachProposedYr
ProposedyearDaytonaBeachclients
(projected)07/15-06/16
192.P1DaytonaBeachShoresPriorYr
PrioryearDaytonaBeachShoresclients
(actual)07/13-06/14
193.P1DaytonaBeachShoresCurrentYr
CurrentyearDaytonaBeachShoresclients
(projected)07/14-06/15
194.P1DaytonaBeachShoresProposedYr
ProposedyearDaytonaBeachShoresclients
(projected)07/15-06/16
195.P1HollyHillPriorYr
PrioryearHollyHillclients(actual)07/13-
06/14
196.P1HollyHillCurrentYr
CurrentyearHollyHillclients(projected)
07/14-06/15
197.P1HollyHillProposedYr
ProposedyearHollyHillclients(projected)
07/15-06/16
198.P1Ormond BeachPriorYr
PrioryearOnnondBeachclients(actual)
07/13-06/14
199. P1OrmondBeachCurrentYr CurrentyearOnnondBeachclients (projected)07/14-06/15
200. P1OrmondBeachProposedYr
ProposedyearOnnondBeachclients
(projected)07/15-06/16
201. P1PI/WilburPriorYr
PrioryearPonceInlet/Wilbur-by-the-Sea clients(actual)07/13-06/14
202. P1PI/WilburCurrentYr
CurrentyearPonceInlet/Wilbur-by-the-Sea clients(projected)07/14-06/15
203. P1PI/WilburProposedYr
ProposedyearPonceInlet/Wilbur-by-the-Sea clients(projected)07/15-06/16
204. P1PortOrangePriorYr
PrioryearPortOrangeclients(actual)07/13-
06/14
205. P1PortOrangeCurrentYr
CurrentyearPortOrangeclients(projected)
07/14-06/15
206. P1PortOrangeProposedYr
ProposedyearPortOrangeclients(projected)
07/15-06/16
207. P1SouthDaytonaPriorYr
PrioryearSouthDaytonaclients(actual)
07/13-06/14
208. P1SouthDaytonaCurrentYr
CurrentyearSouthDaytonaclients(projected)
07/14-06/15
209. P1SouthDaytonaProposedYr
ProposedyearSouthDaytonaclients
(projected)07/15-06/16
NORTHWEST
210. P1BarbervillePriorYr
PrioryearBarbervilleclients(actual)07/13-
06/14
211. P1BarbervilleCurrentYr
CurrentyearBarbervilleclients(projected)
07/14-06/15
212. P1BarbervilleProposedYr
ProposedyearBarbervilleclients(projected)
07/15-06/16
213. P1CassadagaPriorYr
PrioryearCassadagaclients(actual)07/13-
06/14
214. P1CassadagaCurrentYr
CurrentyearCassadagaclients(projected)
07/14-06/15
215. P1CassadagaProposedYr
ProposedyearCassadagaclients(projected)
07/15-06/16
216. P1DelandPriorYr
PrioryearDelandclients(actual)07/13-06/14
217. P1DelandCurrentYr
CurrentyearDelandclients(projected)07/14-
06/15
218. P1DelandProposedYr
ProposedyearDelandclients(projected)
07/15-06/16
219. P1DeleonSpringsPriorYr
PrioryearDeleonSpringsclients(actual)
07/13-06/14
220. P1DeleonSpringsCurrentYr CurrentyearDeleonSpringsclients (projected)07/14-06/15
221. P1DeleonSpringsProposedYr
ProposedyearGlenwoodclients(projected)
07/15-06/16
222. P1GlenwwodPriorYr
PrioryearGlenwoodclients(actual)07/13-
06/14
223. P1GlenwoodCurrentYr
CurrentyearGlenwoodclients(projected)
07/14-06/15
224. P1GlenwoodProposedYr
ProposedyearGlenwoodclients(projected)
07/15-06/16
225. P1LakeHelenPriorYr
PrioryearLakeHelenclients(actual)07/13-
06/14
226. P1LakeHelenCurrentYr
CurrentyearLakeHelenclients(projected)
07/14-06/15
227. P1LakeHelenProposedYr
ProposedyearLakeHelenclients(projected)
07/15-06/16
228. P1PiersonPriorYr
PrioryearPiersonclients(actual)07/13-06/14
229. P1PiersonCurrentYr
CurrentyearPiersonclients(projected)07/14-
06/15
230. P1PiersonProposedYr
ProposedyearPiersonclients(projected)
07/15-06/16
231. P1SevillePriorYr
PrioryearSevilleclients(actual)07/13-06/14
232. P1SevilleCurrentYr
CurrentyearSevilleclients(projected)07/14-
06/15
233. P1SevilleProposedYr
ProposedyearSevilleclients(projected)
07/15-06/16
SOUTHEAST
234. P1EdgewaterPriorYr
PrioryearEdgewaterclients(actual)07/13-
06/14
235. P1EdgewaterCurrentYr
CurrentyearEdgewaterclients(projected)
07/14-06/15
236. P1EdgewaterProposedYr
ProposedyearEdgewaterclients(projected)
07/15-06/16
237. P1NewSmyrnaBeachPriorYr
PrioryearNewSmyrnaBeachclients(actual)
07/13-06/14
238. P1NewSmyrnaBeachCurrentYr CurrentyearNewSmymaBeachclients (projected)07/14-06/15
239. P1NewSmyrnaBeachProposedYr
ProposedyearNewSmymaBeachclients
(projected)07/15-06/16
240. P1OakHillPriorYr
PrioryearOakHillclients(actual)07/13-06/14
241. P1OakHillCurrentYr
CurrentyearOakHillclients(projected)07/14-
06/15
242. P1OakHillProposedYr
ProposedyearOakHillclients(projected)
07/15-06/16
SOUTHWEST
243. P1DebaryPriorYr
PrioryearDebaryclients(actual)07/13-06/14
244. P1DebaryCurrentYr
CurrentyearDebaryclients(projected)07/14-
06/15
245. P1DebaryProposedYr
ProposedyearDebaryclients(projected)
07/15-06/16
246. P1DeltonaPriorYr
PrioryearDeltonaclients(actual)07/13-06/14
247. P1DeltonaCurrentYr
CurrentyearDeltonaclients(projected)07/14-
06/15
248. P1DeltonaProposedYr
ProposedyearDeltonaclients(projected)
07/15-06/16
249. P1EnterprisePriorYr
PrioryearEnterpriseclients(actual)07/13-
06/14
250. P1EnterpriseCurrentYr
CurrentyearEnterpriseclients(projected)
07/14-06/15
251. P1EnterpriseProposedYr
ProposedyearEnterpriseclients(projected)
07/15-06/16
252. P1OrangeCityPriorYr
PrioryearOrangeCityclients(actual)07/13-
06/14
253. P1OrangeCityCurrentYr
CurrentyearOrangeCityclients(projected)
07/14-06/15
254. P1OrangeCityProposedYr
ProposedyearOrangeCityclients(projected)
07/15-06/16
255. P1OsteenPriorYr
PrioryearOsteenclients(actual)07/13-06/14
256. P1OsteenCurrentYr
CurrentyearOsteenclients(projected)07/14-
06/15
257. P1OsteenProposed Yr
ProposedyearOsteenclients(projected)
07/15-06/16
Ill.PROGRAMOUTCOMES
258. INPUTS*
WhatRESOURCESare dedicatedtothisprogram?
259. ACTIVITIES "'
WhatSERVICESareprovided?
260. OUTPUTS*
WhatAMOUNTSOFSERVICEareprovided?
261. OUTCOME1*
BENEFITtoprogramparticipants
262. Out1Indicators*
HowwillyoumeasurewhetheryouachievedOUTCOME1?
263. Out1DataSource*
WhereandhowwillyougetyourinformationforOUTCOME1?
264. Out1PrevYr*
Actualpreviousyear07/13-06/14forOUTCOME1
265. Out1CurrentYr*
Currentyearprojected07/14-06/15forOUTCOME1
266. Out1PropYr*
Proposedyearprojected07/15-06/16forOUTCOME1
267. OUTCOME2*
BENEFITtoprogramparticipants
268. Out2Indicators*
HowwillyoumeasurewhetheryouachievedOUTCOME2?
269. Out2DataSource*
WhereandhowwillyougetyourinformationforOUTCOME2?
270. Out2PrevYr*
Actualpreviousyear07/13-06/14forOUTCOME2
271. Out2CurrentYr*
Currentyearprojected07/14-06/15forOUTCOME2
272. Out2PropYr*
Proposedyearprojected07/15-06/16forOUTCOME2
273. OUTCOME3
BENEFITtoprogramparticipants
274. Out3Indicators
HowwillyoumeasurewhetheryouachievedOUTCOME3?
275. Out3DataSource
WhereandhowwillyougetyourinformationforOUTCOME3?
276. Out3PrevYr
Actualpreviousyear07/13-06/14forOUTCOME3
277. Out3CurrentYr
Currentyearprojected07/14-06/15forOUTCOME3
278. Out3PropYr
Proposedyearprojected07/15-06/16forOUTCOME3
279. OUTCOME4
BENEFITtoprogramparticipants
280. Out41ndicators
HowwillyoumeasurewhetheryouachievedOUTCOME4?
281. Out4DataSource
WhereandhowwillyougetyourinformationforOUTCOME4?
282. Out4PrevYr
Actualpreviousyear07/13-06/14forOUTCOME4
283. Out4CurrentYr
Currentyearprojected07/14-06/15forOUTCOME4
284. Out4PropYr
Proposedyearprojected07/15-06/16forOUTCOME4
285. OUTCOME5
BENEFITtoprogramparticipants
286. Out5 Indicators
HowwillyoumeasurewhetheryouachievedOUTCOME5?
287. Out5DataSource
WhereandhowwillyougetyourinformationforOUTCOME5?
288. Out5PrevYr
Actualpreviousyear07/13-06/14forOUTCOME5
289. Out5CurrentYr
Currentyearprojected07/14-06/15forOUTCOME5
290. Out5PropYr
Proposedyearprojected07/15-06/16forOUTCOME5
291. Measurements*
Howhaveyouusedoutcomemeasurementsinthepast12monthstoevaluateyour programsandwhatchangesdidyouimplementgoingforwardasaresult(givespecific examples)?
IV.IN-KINDREVENUES
Describeyourin-kindrevenues(i.e.,volunteers,rent,equipment,advertising,etc.).In-kindis definedasanythinggiventotheagencytosupporttheprogramthattheagencywouldotherwise havetopayfor.
292. In-Kind1*
In-kindrevenue1
293. IK1Desc*
Descriptionofin-kindrevenue1
294. IK1Hours
Hoursdonatedforin-kindrevenue1
295. IK1Rate
Hour1yrateforin-kindrevenue1
296. IK1CurrentYr*
Currentyear(07/14-06/15)
297. IK1ProposedYr*
Proposedyear(07/15-06/16)
298. In-Kind2
In-kindrevenue2
299. IK2Desc
Descriptionofin-kindrevenue2
300. IK2Hours
Hoursdonatedforin-kindrevenue2
301. IK2Rate
Hour1yrateforin-kindrevenue2
302. IK2CurrentYr
Currentyear(07/14-06/15)
303. IK2ProposedYr
Proposedyear(07/15-06/16)
304. In-Kind3
In-kindrevenue3
305. IK3Desc
Descriptionofin-kindrevenue3
306. IK3Hours
Hoursdonatedforin-kindrevenue3
307. IK3Rate
Hourlyrateforin-kindrevenue3
308. IK3CurrentYr
Currentyear(07/14-06/15)
309. IK3ProposedYr
Proposedyear(07/15-06/16)
310. In-Kind4
In-kindrevenue4
311. IK4Desc
Descriptionofin-kindrevenue4
312. IK4Hours
Hoursdonatedforin-kindrevenue4
313. IK4Rate
Hourlyrateforin-kindrevenue4
314. IK4CurrentYr
Currentyear(07/14-06/15)
315. IK4ProposedYr
Proposedyear(07/15-06/16)
316. In-Kind5
In-kindrevenue5
317. IK5Desc
Descriptionofin-kindrevenue5
318. IK5Hours
Hoursdonatedforin-kindrevenue5
319. IK5Rate
Hourlyrateforin-kindrevenue5
320. IK5CurrentYr
Currentyear(07/14-06/15)
321. IK5ProposedYr
Proposedyear(07/15-06/16)
322. TotRevCurrentYr*
TotalIn-KindRevenueCurrentYear07/14-
06/15
323. TotRevPropYr*
TotalIn-KindRevenueProposedYear07/15-
06/16
324. MorePrograms*
Doyouhaveanotherprogramtodescribe?
Markonlyoneoval.
___ Yes
___ No
YOU WILL NEED TO FILL OUT THE PROGRAMS SECTION FOR EACH PROGRAM