Agency Name:
Program Name:
CHECKLIST AND ASSEMBLY INSTRUCTIONS FOR
EASTSIDE PROMISE NEIGHBORHOOD
SUMMER 2013 PURCHASE OF SERVICE
OST FY13S: OUT OF SCHOOL TIME
This Checklist must accompany your submission.
This page is not included in your total page limitation.
Submit by 3:00 p.m., Friday, April 5, 2013 to:
Eastside Promise Neighborhood Office
601 Lamar, Building #6
(on the grounds of the Ella Austin Community Center)
Applicants are to organize and submit 1 original and 15 complete paper copies of their application. Applicants are also
required to submit 1 electronic version of the application on a CD or flash drive. Applicants may not use any substitute
forms or recreate these forms separately. All forms can be found at www.eastsidepromise.org.
Bind application with one staple, upper left-hand corner – do not use any other forms of binding. Observe page limits.
Do not change the margins fonts or formatting of the document except as noted in the application.
If any section of form is incomplete, the proposal is automatically disqualified.
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Required Attachments
_____ This Completed Checklist (this page does not count toward 8 page limit)
_____ 1 Original and 15 three-hole punch copies of completed application
_____ 1 Electronic Version on CD or flash drive
_____ Job Descriptions for each position which funding is requested
_____ Memorandum of Understanding and/or letters of Support for Collaborative Programs
_____ For collaborative programs, a flow chart describing the collaboration
_____ Letter of support and endorsement from agency or EPN Principal for plan outlined
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Section I. – Organizational Information Section (1 page limit)
Section II. – Program Design (6 pages maximum)
SECTION II-1 Proposed Program Narrative Summary (2 page limit)
SECTION II-2 Required Program Elements (1 page limit)
SECTION II-3 Outcomes, Indicators Of Success & Reporting (1 page limit)
SECTION II-4 Required Results Expected (1 page limit)
SECTION II- 5 Outreach Plan (1/2 page limit)
SECTION II- 6 Capacity to work in this arena/area of expertise (1/2 page limit)
Section III. – Program Budget, Narrative & Matching Funds
1. Program Budget Workbook
2. Program Budget Narrative
3. Match Section complete (“Other Costs”)
Section IV. – Daily Schedule for Proposed Program (1 page limit)
This section for
Eastside Promise
Neighborhood use
only