HARVARD KENNEDY SCHOOL SOCIAL IMPACT BOND TECHNICAL ASSISTANCE LAB
Single Jurisdiction 2014 Technical Assistance Application
Please complete this application and save it as a .doc or a .pdf file before emailing it to us at:
hks-siblab@hks.harvard.edu
Applications should not exceed five pages. To receive full consideration, applicants should
complete and submit an application form by December 19, 2014. We will accept additional
applications on a rolling basis through February 13, 2015, but cannot guarantee they will
receive full consideration.
If you have any questions regarding this application, please visit hks-siblab.org for further
information or contact us by emailing hks-siblab@hks.harvard.edu
I.
Applicant Details
Application contact
[This should be the person who will serve as the primary contact during the application
process.]
Name and job title:
Division:
Email:
Telephone:
Address:
State/ City:
ZIP code:
Jurisdiction
[The governmental authority overseeing the project: e.g. State of Iowa, City of Chicago.]
Lead agency
[The unit through which the project will be administered: e.g. Budget Office, Governor’s
Policy Unit, Department of Health and Human Services.]
Other agencies also involved in this application
[Please provide a list of any other government agencies or units within your jurisdiction that
have a stake in the success of this pay for success (PFS) project and with whom you are
working.]
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HARVARD KENNEDY SCHOOL SOCIAL IMPACT BOND TECHNICAL ASSISTANCE LAB
Single Jurisdiction 2014 Technical Assistance Application
Project lead
[This should be the member of staff who will be responsible for day-to-day management of
the project and will supervise the government innovation fellow.]
Name and job title:
Division:
Email:
Telephone:
Address:
State/ City:
ZIP code:
Why is your jurisdiction interested in the PFS social impact bond model?
[Please provide a brief summary of your motivation for considering this model.]
II.
Policy Area
Although an important part of the technical assistance will involve helping governments
decide which policy areas are the best fit for this model, it is useful to have some sense at
this point of your current thinking about where you would apply the model. Priority will be
given to projects that apply the model to new policy areas or that apply it to existing policy
areas in an innovative way (see the Proposal Request for additional information).
What problem is your jurisdiction trying to solve? What policy areas in your jurisdiction
would most benefit from this model?
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HARVARD KENNEDY SCHOOL SOCIAL IMPACT BOND TECHNICAL ASSISTANCE LAB
Single Jurisdiction 2014 Technical Assistance Application
Please indicate the 2014 Social Innovation Fund (SIF) Focus Area(s) with which your
specified policy area(s) aligns.
 Youth Development
 Economic Opportunity
 Healthy Futures
III.
Current Level of Readiness
Please note that prior experience and expertise are not prerequisites for selection. These
questions are simply intended to determine your current capacity and level of need.
For each policy area identified, please describe your jurisdiction’s readiness to implement
a PFS project in this area. This description may include a possible target population, a
description of innovative service providers in your jurisdiction, existing evidence on the
efficacy of possible interventions, or a target geographic area.
What level of support for testing the PFS social impact bond model is there among senior
government officials in your jurisdiction?
What steps has your jurisdiction already taken toward implementing a PFS project? (For
example, drafting or issuing an RFI, writing or passing enabling legislation, etc.)
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HARVARD KENNEDY SCHOOL SOCIAL IMPACT BOND TECHNICAL ASSISTANCE LAB
Single Jurisdiction 2014 Technical Assistance Application
Please indicate which of the following letters of support for a PFS project you have
included with your application:
 Letter of support from Governor/Mayor’s Office or equivalent
 Letter of support from your jurisdiction’s central budget office or equivalent
 Letter of support from the agency that may lead implementation efforts (e.g.,
Department of Health and Human Services).
IV.
Building Future Success
If the intervention is successful, what is the potential for expanding it within your
jurisdiction and/or replicating it in other jurisdictions?
V.
Other
Memorandum of understanding: To be considered eligible for the selection process,
governments will need to be willing to enter into an MOU with Harvard University over the
terms of the pro bono technical assistance.
Knowledge sharing: If selected, Government Partners should, to the extent legally
permissible, be willing to make key final documents from the PFS development process
publically available, including feasibility studies, contracts and evaluation plans.
The SIB Lab is located within the Taubman Center for State and Local Government at the Harvard Kennedy School.
This assistance is made possible by generous grants from the Social Innovation Fund and the Pritzker Children’s
Initiative.
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