Created 3/7/14
AL SENAVITIS
MISSION IMPACT FUND
(ASMIF)
“SAMPLE” GRANT APPLICATION
1C
1C
SPECIAL OLYMPICS PENNSYLVANIA
ASMIF COVER SHEET
Local Program: ___Area X__(X , Y and Z Counties) ______
Mailing Address: _____PO Box 999 Xville PA _17000______
Project Name: _____Expansion of Competition Opportunities (Athletics)______
Contact Person Name: ______Kristie Smith______
Contact Person Phone Number: ___XXX XXX-XXXX______
Contact Person Email Address: ______
Amount requested: $__3000______Total budget for the project: $__$4000______
To the best of my knowledge, the information contained in this ASMIF Grant application is accurate. Our Local Program will agree to carry out this project, as described in this application and consistent with the Terms of the Grant, if a grant is awarded.
□ By checking this box, the Local Program Manager acknowledges and accepts the above statement.
Kristie Smith______12/28/13______
Printed Name Date
XXX XXX-XXXX_____
E-Mail Phone #
□ By checking this box the RFD acknowledges review of the application and recommends approval.
______Jim Binz______12/29/13
Print Name (Field Director) Date
(XXX)XXX-XXXX
E-Mail Phone #
The RFD does not recommend approval for the following reasons:
______
Special Olympics Pennsylvania
ASMIF Program Narrative
(Maximum two (2) pages)
1. What is the project?
Area X has provided sports competition to Special Olympics athletes in X, Y and Z counties since 2005. We currently provide competition in basketball, soccer and bowling. There is a growing interest in athletics competition and we would like to expand the local program’s offerings to include athletics.
2. What is the specific goal of the project?
The goal of the project is to offer training and competition in athletics to as many as 20 athletes over the course of the five month project period. We have polled our athletes and believe that we have the interest to support the creation of an athletics team that will be able to compete with other Special Olympics athletics programs.
3. How will the project be measured and what threshold is established for success?
The project will be measured by: a) the level of participation we are able to establish as athletes are given the opportunity to compete via the athletics program; b) our ability to secure sufficient volunteers to conduct all of the training sessions we have planned; and c) our capacity to offer the athletics team competition at both the regional and state levels. We will strive for the regular participation of twenty Special Olympics athletes throughout the course of the project period. We expect to recruit four volunteers to coach the athletes as they train two days per week over a twelve week period and expect to take our athletics team to sectional and state competitions.
4. Why is this project needed and why are ASMIF dollars needed to implement it?
Due to financial constraints, we are currently unable to offer an athletics program to our athletes but have secured the support of two local businesses to provide some needed support for the program over the next three years. Lowe’s and Home Depot have each committed $500/year to support the Athletics Program over the first three years of the program. Unfortunately, this level of support does not match the costs of the desired level of participation so we are asking for support from the ASMIF Fund in the initial year to allow more of our athletes to get involved at the outset of the program.
5. Who will implement the program?
The Area X Management Team will be responsible for implementing the Program under the specific leadership of Kristie Smith, our local program manager. We have developed an implementation plan that accounts for the key tasks with timetables for completion of those tasks and a launch date of March 1, 2014.
6. Where will it take place?
We have secured a commitment from our local community college to give access to the track and field area two days per week over the twelve week period of time in which we plan to offer training for our athletes.
7. Will there be support from other sources? List with amounts and sources of support and include in-kind donations?
As reflected above, Lowe’s and Home Depot have each pledged $500 per year over three years. Area X Community College has committed to the free use of its track and field area for practice sessions two nights per week over the course of the projected training period.
8. Is there potential for future project growth? If yes, how?
Yes – as the program matures, we expect that more athletes may be interested in participation. Additional athletes can participate without the need for additional practice space but there would be additional costs for uniforms, registration fees, etc.
1. How will the project continue after the grant has ended? Please provide your plan for continued support.
The commitments from Lowe’s and Home Depot will last for at least two additional years. The commitment from Area X Community College for the practice area is not limited to one year so we expect to be able to continue to train there. Once the program is established, we will assess the specific ongoing and potential additional costs associated with the continuation of the program based on the first year experience. We have already identified several businesses in Area X that have expressed tentative interest in providing support for the Area X Program. We will use the experience of the first year of the Athletics Program to show these businesses the level of interest in participation and solicit their support for the continuation of the program.
SPECIAL OLYMPICS PENNSYLVANIA
ASMIF PROJECT BUDGET SHEET
BUDGET ITEMIZATION
Budget Item / ARequest
For ASMIF $ / B
Other Sources*
$ / C
Total
Project
$ / D
Status
(Pending/
Committed/
Unsecured))
Sports Equipment
Equipment – Rent/Lease
Transportation Services / $800 / $800 / Pending
Hotel/Housing Expense / $800 / $800 / Pending
Registration Expense / $600 / $1,000 / $1,600 / Partially Committed
Facilities
Uniforms / $800 / $800 / Pending
Supplies
Contracted Services
Other (Explain)
Total / $ 3,000 / $ 1,000 / $ 4,000
*Other Sources: Other financial resources dedicated to this project (i.e. Local program $, other grant funds, in-kind $, etc.)
*Verify: The combination of the amounts for each budget item in Columns A and B above equal the amount of Column C.
*Verify: The amounts of each budget item in each column sum to the total amount at the bottom of each column.
BUDGET NARRATIVE
Please provide the basis for all of the above ASMIF request costs. Use additional sheets as necessary.
Note: All costs reflected in the budget narrative should be based on estimates derived from actual quotes obtained from projected suppliers. Please identify projected supplier in budget narrative and the date of the quote.
For example:
Uniforms – 20 uniforms x $50.00 each (1/1/14 - quote via XYZ Company) = $1000.00
Hotel/Housing – Hotel rooms at $80.00 per room per day x 5 athletes (1 per room) x 2 days = $800.00 (1/1/14 – quote via Holiday Inn)
Transportation Services – two vans for 20 athletes @ $200/van/competition x two competitions (sectionals and) states = $800 (Quote – 1/12/14 – STA Transportation)
Housing/Hotel Expense – 10 rooms for 20 athletes @ $80/room/night x one night’s lodging = $800 (Quote – Comfort Inn and Suites – 1/12/14)
Registration fees – for twenty athletes @ $40/athlete/competition x two competitions = $1,600 (Quote Per SOPA costs as of 1/1/14)
Uniforms – competition jerseys and pullovers for 20 athletes @ $40/athlete = $800 (Quote –1/15/14 - Trau + Loevner Embroidery)
Total Project Expense = $800 + $800 + $1,600 + $800 = $4,000
SPECIAL OLYMPICS PENNSYLVANIA
ASMIF TERMS OF THE GRANT
Please Read Carefully
All ASMIF Grant Funds awarded under the terms of this contract are for the sole purposes identified in the attached grant application. Please complete the information listed below and sign, date and return with your completed grant application packet.
By signing below you are acknowledging the receipt and agreement of the terms listed and will be responsible for completing any tasks identified in those terms.
Local Program Project Name: Expansion of Competition Opportunities (Athletics)
Amount of Grant Request: $3,000
Grant Begins/Ends: March 1, 2014
Purpose of the Grant: To provide an opportunity for Area X Special Olympics athletes to compete in the newly developed Athletics Program.
______
Expenditure of Grant Funds: This grant is for use as stated above and corresponds to the submitted project budget. The project is subject to change only with written authorization from the ASMIF Committee. The entire grant must be used by the Local Program and any remaining funds must be returned to SOPA as outlined under Return of Grant Funds.
Return of Grant Funds: Any unused funds must be returned to the Finance Department of Special Olympics Pennsylvania at the time the closing report is submitted. Local Programs should use the ASMIF standard letter, a sample of which is included as part of the closing report form, to submit a check made payable to Special Olympics Pennsylvania for the return of unused grant funds. If you have any questions, please contact the Finance Department at 1-800-235-9058.
Closing Report to SOPA.: The Local Program will submit a closing report to the Regional Field Director for deposit in the SOPA Drop Box created for ASMIF submissions. The closing report must be submitted to Regional Field Director no more than thirty (30) days after the conclusion of the project. The closing report must include: (a) the attached Closing Report Form and (b) copies of receipts for all expenditures.
Conflict of Interest: Funds awarded to local Programs through this program are solely for the benefit of our athletes. Questions concerning any real or potential conflict of interest should be directed to the Regional Field Director.
Sharing Information: Special Olympics Pennsylvania reserves the right to share the activities funded through the ASMIF Program with other Special Olympics local programs.
□ By checking this box the Local Program Manager acknowledges and accepts the terms and conditions of this grant as specified in this section of the application.
Kristie Smith______12/28/13
Print Name of Local Program Manager Date
cc: Project Contact Person
Local Program Files
Regional Field Director
6D