2007-08 4-H AFTERSCHOOL MINI-GRANTS

Creating After-School Slots for Youth

Proposal Cover Sheet

Information for Agreement between National 4-H Council and:

______

NOTE: Include the name of the 4-H Extension entity managing the funds (Fiscal Agency)

Date:

County:

State:

University:

Principal Investigator:

NOTE: This person will be responsible for ensuring evaluation participation and documentation, submission of any and all reports, and any information due to or requested by National 4-H Council.

Name:

Title: Extension Educator, 4-H Youth Development

Address:

City, State, Zip:Email:Telephone:

Fax:

State Extension 4H/Youth Development Program Leader or Administrator (as appropriate):

Name: Wendy Brock

Title: Program Leader, 4-H Youth Development

Address: Moiles House, 180 Main St

City, State, Zip: Durham, NH 03824

Email:

Telephone: 603-862-2187

Fax: 603-862-2157

Fiscal Agency Contact:

NOTE: This agency representative will be responsible for the submission of any and all financial reports or information due to or requested by National 4-H Council.

Name:(Who the 4-H Office will send the money to in your organization)

Title:

Address:

City, State, Zip:

Email:

Telephone:

Fax:

Make Check Payable to (4-H Extension entity name):Cheshire UNH Cooperative Extension NOTE: Checks will be mailed to the 4-H Extension entity managing the funds.

GRANT APPLICATION: 2007-08 JCPenney Afterschool Fund Mini-Grants

The JCPenney Afterschool Fund project is a competitive process. The goal is to select programs that will collectively create/sustain 2000 after-school slots. The following criteria will be used to select the winning grant proposals. A total of 50 points may be awarded, as follows:

Executive Summary (5 points) –Describe the key points of your project. This should communicate what your project is all about in 150 words or less.

Project Description(25 points)–The project description should include:

  • Problem statement (8 points)- Identify the problem to be impacted by this proposal. Explain how it was identified and why it is the issue of highest need in your state/community.
  • Action plan(15 points) - Outline the proposed plan of action. Provide a timeline for project completion.
  • Capacity and Project Results(2 points) – Describe your capacity to meet the project goal of the 2007-08 JCPenney Afterschool Fund Grant and expected project results. Include a statement in this section that indicates you will adhere to the data collection and reporting protocol as defined by National 4-H Council in the grant RFP.

Demographics(10 points) – Complete the following chart, providing estimates of the population(s) to be served by this grant.

Sex (by #) / Residence (by %) / Race (by #)
Female / Farm / 0% / African American
Male / Towns under 10,000 and rural non-farm / 0% / Asian
Age (by #) / Town and cities 10,000-50,000 and their suburbs / 0% / Caucasian
5 / Suburbs of cities over 50,000 / 0% / Native American
6-12 / Central cities/urban areas of over 50,000 / 0% / Other
13-17 / Total Participants
18+ / Percent Hispanic

Budget(10 points) – Funds can only be used to create new after-school slots for youth or to maintain slots for youth who are on the verge of losing their after-school slot due to financial hardship of the family or loss of after-school program subsidies.

Please use the following procedure for requesting funds:

Cost per slot ÷ 2 x number of slots to be created = Grant Request

Here is an Example:

If the total cost per student is $1,000 for the school year, the mini-grant can only cover 50% of the per student (“slot”) cost or $500. (IF the cost per student exceeds $1,000, applicants are encouraged to request an average of $500 per student from the JCPASF.

If you need to create 10 slotsthe formula would look like this:

$1,000 ÷ 2 = $500 x 10 slots = $5,000 requested.

REMEMBER A 100% CASH MATCH IS REQUIRED. In this example, a $5,000 match would be required making your total cost column below: Grant + Match = $10,000. Even if the cost per student exceeds $1,000, applicants are encouraged to only request an average of $500 per student from the JCPAS Funds.

Please include the following table in your proposal:

Total number
of slots to be created/sustained / Amount of grant funds requested / Amount of match* (must meet or exceed grant funds requested) / Total Cost for Slots created/sustained
*Source of Matching Funds: Please list all sources and amount from each source. The total should equal the Amount of match listed in the table above.
  • SCORING: 50 point scale

Maximum Points Possible / Category
5 points / Executive Summary
25 points / Project Description
10 points / Demographics
10 points / Budget

2007-08 JCPASF Mini-Grants Application 1 1