Partnership for Child Health

910 North Jefferson Street

Jacksonville, Florida 32209

Phone: (904) 798-4166

Email:

RESPONSIBILITIES OF A FISCALLY SPONSORED PROGRAM

A program under sponsorship must carry out programmatic activities that contribute or relate to the mission of the Partnership for Child Health to work with the community toadvocate for and develop and implement services and systems of care to improve the health and wellbeing of all children and youth inNortheast Florida—especially those with special health care needs. The sponsored program is responsible for:

  • understanding and conducting ethical business practices consistent with IRS regulations, all applicable laws, funder restrictions, and Partnership for Child Health policies and procedures;
  • managing day-to-day operations, financial management and fundraising to sustain the work;
  • developing systems that are compatible and mutually-supportive;
  • assuring accuracy of financial reports provided by the Partnership for Child Health;
  • full disclosure of project activities and issues critical to risk management; and
  • communicating openly and directly and transferring information in a timely and complete manner.

Fiscal Sponsorship Application

DATE09/01/17YEAR PROGRAM STARTED 2016

NAME OF PROGRAM Social AllianceFor Equality (SAFE) Resource Center

CONTACT PERSON/TITLE Katryne Lukens Bull, MPH

ADDRESS UF College of Medicine - Jacksonville

580 W. 8th St., Tower II, Room 6015, Mailstop T-60

CITYJacksonvilleSTATE FLZIP 32209

WORK PHONE 904-244-9630CELL PHONE 904-994-6864

FAX 904-244-9234EMAIL

WEBSITE ADDRESS None yet.

PROGRAM PROFILE

1)Total program budget: Current year $1200.00Last year (actual expenses) $ 0

2)Who are your current funders for this program? Include amount of funding from each source.

Current Funding Source
(Use separate sheet if necessary) / Amount Received / Date funds received
Generosity / 600 / Ongoing
In Person / 100 / 04/01/17
Click here to enter text. / Click here to enter text. / Click here to enter text.

3)Do all of your current funders allow use of and compensation paid to a fiscal sponsor?

☒YES ☐NO ☐NOT SURE

4)List other sources of funding from which you plan to seek support.

Possible Funding Source
(Use separate sheet if necessary) / Due date to submit
proposal to funder / Date proposal
was submitted / Date funds expected
Corporate Sponsors / TBD / TBD / TBD
Grants / TBD / TBD / TBD
Fundraising Events / TBD / TBD / TBD

5)What is the projected duration of the project/program: From (date)09/01/17 to (date)09/01/19

6)Number of paid employees to be hired by the fiscal sponsor: Full-time:0Part-time:0

7)Does your program have an Employer Identification Number (EIN)? ☐YES ☒NO

If yes, what is your organization’s EIN:Click here to enter text.

8)Do you plan to seek 501(c)(3) status from the IRS?

☐*Application is in progress ☒YES ☐NO ☐NOT SURE☐N/A

*What is the date submitted and status of your application to the IRS? Click here to enter text.

PROGRAM ACTIVITY

9)What is the mission of the program? How does this mission align with the mission of Partnership for Child Health to work with the community toadvocate for and develop and implement services and systems of care to improve the health and wellbeing of all children and youth inNortheast Florida—especially those with special health care needs?

The Social Alliance For Equality is a group of LGBTQIA+ persons, and their allies, who support the equal rights of all individuals regardless of national origin, faith, melanin levels/skin color, gender/expression, sexuality, ability, or class via an LGBT+ health, resource, and education center.

10)Describe the organizational structure of the program.

A 3 to 5 member Board of Directors will oversee the daily activities, fundraising, and sponsorships of the SAFE Resource Center as well as the utilization of volunteers as needed.

11)What is the program’s plan for the next 12 – 24 months? Be specific with goals, fund raising activities and timeline.

Goal 1: To acquire and move into a physical space for the SAFE resource center.

Goal 2: Set up the SAFE resource center to serve the LGBTQ+ community of Jacksonville.

Objectives: meet the needs not currently met by other organizations, link people to those organizations, and provide a safe space where people can meet. We hope to model ourselves after the resource center in Gainesville and hopefully work toward being like the Orlando Center

Goal 3: Partner with community groups to raise funds to support the SAFE resource center

Goal 4: Seek 501c3 status and register with the State of Florida sunbiz/Dept of Ag and Consumer

12)Describe community involvement. How does your program reach out to the public? With what groups or individuals will you collaborate?

Our goal is to provide resources on health, education, and community awareness to the LGBTQ+ community of Jacksonville. We plan to partner with corporate entities and community organizations to meet this goal. We will work closely with JASMYN, PFLAG and the UNF LGBT Resource Center (the three funded entities in Jacksonville) to avoid duplication and coordinate to meet needs.

We plan to develop a website and resource directory, along with linking to other sites which have on-line resources. We also plan to do outreach through health fairs (partnering with mobile services and others), through the school system, and through social media. Currently, we have a Facebook page with 839 members. It is currently a closed group and only available through word of mouth and administrator approval.

13)Which fiscal sponsorship services will help your program:

☒ Fiscal management services (Process donations and disburse the funds to your organization.)

☐ Human Resources / payroll and benefits administration

☐ Other Click here to enter text.

ATTACHMENTS CHECKLIST – REQUIRED

Please include the following ATTACHMENTS with the application form

☒ Organizational budget

☒ List of board of directors, advisory board or steering committee members and their affiliations

☒ List of staff and/or volunteers (full-time and part-time) with description of responsibilities

☒ References - Please list contact information for two people or groups familiar with your program that we may contact (please state relationship to your program and include phone numbers and e-mail address)

The following ATTACHMENTS are OPTIONAL:

1.Press clippings

2.Newsletters or other publications

3.Letters of support (maximum of 2)

4.Organizational financial statement from most recent completed fiscal year

OTHER INFORMATION ABOUT YOUR PROGRAM - OPTIONAL:

VISION/PURPOSE

The purpose is to have a safe space for LGBTQIA+ community members to promote, educate, and develop programs centering on sexual orientation, gender identity and gender expression in Jacksonville, Florida.

We provide resources intended to:

  • Raise awareness regarding lesbian, gay, bisexual, and transgender (and any sexual orientation/gender expression) issues.
  • Affirm lesbian, gay, bisexual, and transgender (and any sexual orientation/gender expression) identities and lives by fostering a safe, inclusive, multicultural environment for Jacksonville’s LGBTQ+ community.
  • Build linkages with other LGBTQ+ organizations and allied programs through outreach and community development efforts.
  • Become a clearing house for resources to support the health and well-being of the LGBTQ+ community.

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