EMERGENCY FOOD AND SHELTER NATIONAL BOARD PROGRAM
APPLICATION FOR PHASE 32 FEMA FUNDING – TELLER COUNTY
The local FEMA Board has elected to move to an electronic submission. Your Electronic application must be
received by 5:00pm on June 30, 2014. You must drop off a CD-ROM (our Email system is not able to accept
large files) at:
Pikes Peak United Way
Attention Anastasia Storer
518 North Nevada Avenue
Colorado Springs, CO 80903
Your application must be submitted as a single Adobe Acrobat (.pdf) file – do not send multiple documents. If
you need help with this because you’re unable to do this yourself, you may elect to submit your application
in multiple files by June 15th and I will create a single .pdf for you. If you elect to do this, the files must be
delivered via a CD-ROM to Anastasia at Pikes Peak United Way – Emailed files will not be accepted. She will
then create your .pdf for you.
Late applications will not be accepted.
Important Dates
May 19, 2014 at 9:00am: Application Q&A. This meeting will be at Pikes Peak United Way. If you have
questions about the application, this is a good time to get answers. Be sure to review the application prior to the
session. You must RSVP to Anastasia by May 15th if you are going to attend.
June 30, 2014: Application deadline. The application must be received by 5:00pm. Late applications will not
be accepted.
July 9, 2014 8:00am – 12:00pm: Agency Presentations and Q&A with the Board. This meeting will be at Pikes
Peak United Way. Your agency may come and make a short presentation to the Board, after which the Board
members will be allowed to ask any questions they may have about your agency and/or the program/s for which
you are requesting funding. You must Email Anastasia by July 1st and let her know if your agency wishes
to make a presentation. The presentation itself must be no more than 5-7 minutes in length – no PowerPoint,
please, though you’re welcome to provide the Board with handouts if you wish. Please arrive at least 15
minutes before your scheduled presentation time. Note: This is an optional, not mandatory, presentation.
Agencies receive 1st payment: We anticipate this occurring in the September – October 2014 timeframe.
Interim LRO Report/2nd Payment Request Form Due: We anticipate this occurring in the January – February
2015 timeframe.
Agencies receive 2nd payment: We anticipate this occurring in the March – April timeframe.
Final Reports Due. Reports must be completed via the EFSP website and then mailed/delivered to Anastasia
with all required documentation at Pikes Peak United Way. We anticipate this happening in the July-August
2015 timeframe.
If you have questions, please contact: Anastasia Storer at 955-0734 or claire@ppunitedway.org
In the case of when FEMA funds will be received and
when the FEMA reports will be due,
we are unable to provide definitive dates at this time,
as they will change based on when the funding cycle begins
and the money is awarded through the National Board.
EMERGENCY FOOD AND SHELTER NATIONAL BOARD PROGRAM
APPLICATION FOR PHASE 32 FEMA FUNDING – TELLER COUNTY
SECTION A – BASIC INFORMATION
Organization:
Contact Person Responsible for Application:
Address:
Telephone:
Fax:
E-mail:
What are your organization’s office hours and days per week?
Executive Director:
Executive Director Cellphone Number:
Executive Signature:
Mission Statement:
The FEMA Board reserves the right to ask your organization follow-up questions prior to awarding
funding. Questions must be answered in writing within 48 hours.
State your funding request in each category and the total amount requested. The Board
encourages agencies to focus requests on no more than two categories.
Category
Served Meals
Mass Shelter
Rent/Mortgage Assistance
Other Food
Utility Assistance
Total
Amount Requested
EMERGENCY FOOD AND SHELTER NATIONAL BOARD PROGRAM
APPLICATION FOR PHASE 32 FEMA FUNDING – TELLER COUNTY
SECTION B – AGENCY/PROGRAM INFORMATION
Please answer all questions. In answering Section B, your narrative must not exceed four pages.
Section A, Section C and your financial statements do not count as part of the four pages.
1. How long has your organization been in existence in Teller County?
2. Provide a brief description of your agency and the services it provides in Teller County.
3. Describe the program you would like funded by the Local FEMA Board and exactly what the funds
will be used for.
4. How do you demonstrate your program’s effective outcomes? If you’ve received FEMA funding in
the past, please demonstrate the outcomes you’ve achieved with the funds.
5. What is the target population of the program?
6. What makes this program unique from other similar programs offered by other agencies?
7. What impact will these funds make in the community? How many people will be served by this
program?
8. Describe your agency’s procedures for collaborating with other agencies to avoid duplication of
services between clients. If your agency is currently collaborating with other agencies, please
describe the collaboration.
9. Describe how your agency maximizes funds to serve the greatest number of people.
10. FEMA funding amounts have fluctuated a great deal over the past couple of years. Please
discuss how your agency will continue to provide the services of this program should the amount
of FEMA funding received by your agency decrease in 2015.
11. Provide your most recent Profit and Loss statement with full year-to-date information, as well as a
copy of your current Budget. Label this as Attachment 1.
12. Provide your most recent audited financials and IRS 990. Your agency must be able to provide an
audit/IRS 990 that is no more than two years old (2012) to be eligible for FEMA funds. Label this
as Attachment 2.
13. Provide a program budget table that identifies all known funding sources for this program, as well
as projected funding sources and program expenses. Label this as Attachment 3.
EMERGENCY FOOD AND SHELTER NATIONAL BOARD PROGRAM
APPLICATION FOR PHASE 32 FEMA FUNDING – TELLER COUNTY
SECTION C - LOCAL RECIPIENT ORGANIZATION CERTIFICATION FORM
As a recipient of Emergency Food and Shelter National Board Program funds made available for
Phase 32 and as the duly authorized representative of
,
Name of Agency
I certify that my public or private organization:
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Has the capability to provide emergency food and/or shelter services;
Will use funds to supplement and extend existing resources and not to substitute or
reimburse ongoing programs and services;
Is nonprofit or an agency of government;
Has an accounting system or fiscal agent approved by the Local Board and will pay all
vendors by LRO check;
Will conduct an independent annual audit if receiving $25,000 or more in EFSP funds;
Understands that cash payments (including petty cash) are not eligible under EFSP;
Has a Federal Employer Identification Number (FEIN);
Practices non-discrimination (LROs with a religious affiliation will not refuse service to an
applicant based on religion, nor engage in religious proselytizing or religious counseling
with Federal funds);
Has a voluntary board if private not-for-profit;
Will comply with the Current Phase’s Responsibilities & Requirements Manual, particularly
the Eligible and Ineligible Costs section, and will inform appropriate staff or volunteers of
EFSP requirements;
Will provide all required reports to the Local Board in a timely manner; (e.g., 2 nd
Payment/Interim and Final Reports);
Will expend monies only on eligible costs and keep complete documentation (copies of
canceled LRO checks — front and back, invoices, receipts, etc.) on all expenditures for a
minimum of three years after end of program;
Will spend all funds and close-out the program by my jurisdiction’s selected end-ofprogram date and return any unused funds to the National Board ($5.00 or more; make
checks payable to United Way of America/Emergency Food and Shelter National Board
Program);
Will provide complete documentation of expenses to the Local Board, if requested, no later
than one month following my jurisdiction’s selected end-of-program date;
Will comply with the Office of Management and Budget Circular A-133 if expending
$300,000 or more in Federal funds;
Will comply with lobbying prohibition certification and disclosure of lobbying activities if
receiving more than $100,000 in EFSP funds, if applicable; and,
Has no known EFSP compliance exceptions in this or any other jurisdiction.
Signature:
Print Name:
Title:
Date:
LRO ID #:
FEIN#: