2014 Community Impact
Request for Proposal Guidelines
General Programming
General Programming is an area that addresses community concerns not included in the Community Impact Focus Areas.
Specific funding areas include the following:
1. Healthy Communities, Safe Communities, or Safety Net Services
The following RFP table represents the focus areas, required target populations, outcomes, strategies, indicators, and
program requirements.
Target Populations: Programs must serve the target population stated and be able to track all outcome measures specific
to that group. Programs that serve additional target populations within the same program must be able to demonstrate that
United Way funds were used only for the requested target populations.
Strategies: Programs must employ the strategies required for each program model. Program activities and methods
needed to achieve each strategy may be determined by the program requesting funding. However, activities and methods
must demonstrate how they contribute to achieving each listed strategy.
Indicators: Programs must employ all listed indicators. Additional indicators currently used in programs may be included,
but must demonstrate how they contribute towards the outcome.
Program Requirements: Each applicant must be able to demonstrate that all program requirements will be satisfied by
attaching documentation listed previously. Program requirements represent best-practices that successful programs
incorporate into operations on a regular basis. These requirements demonstrate an ongoing effort to maintain and improve
program quality and service.
Due Dates:
Letter of Intent: February 1, 2014
Request for Proposal Applications: March 3, 2014
United Way of Medina County EDUCATION IMPACT FUNDING
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1. RFP: General Programming
Expected Program Outcome: Provision of services to un-served, or underserved populations, which will result in healthy communities, safe
communities, or provide a safety net for those in crisis.
Target Population
Un-served or Underserved
populations not addressed
through Community Impact
Strategies
1. Create healthy
communities through
program services to target
populations
Indicators
1. Demonstrated health/lifestyle
improvements of clients served.
-or2. Create safe communities
through program services
to target populations
2. Demonstrated improved safety for clients
served.
-or-
3. Provide safety net services
to target populations
Program Requirements for
all applicants
1. Evaluation System and/or
Evidence Based Evaluation
Tool (should be capable of
tracking all required
indicators and also track
unduplicated number of
services provided)
2. Qualified and Trained Staff
Members
3. Established in-take and
assessment process.
3. Demonstrated system to deliver safety
net services to target populations
COMMUNITY IMPACT FUNDING-General Programming
2014 Three-Year Funding Request for Proposal
All applications are due on March 3, 2014 by 5:00 p.m. and must be emailed to mburk@unitedwaymedina.org
Incomplete or late applications will not be considered for funding.
SECTION 1: AGENCY & PROGRAM INFORMATION
Organization: Click here to enter text.
Executive Director: Click here to enter text.
Mailing address: Click here to enter text.
City: Click here to enter text.
State: OH
Zip: Click here to enter text.
Program Name: Click here to enter text.
Address of Program Site (if different from above): Click here to enter text.
City: Click here to enter text.
State: OH
Zip: Click here to enter text.
Program Primary Contact: Click here to enter text.
Program Primary Title: Click here to enter text.
Primary Contact Phone:Click here to enter text.
Primary Contact Email: Click here to enter text.
SECTION 2: PROPOSED PROGRAM & CAPACITY
Please select the RFP for which you are requesting funding.
If applying for more than one RFP, a separate application must be completed for each program.
See attached RFP logic models for expected outcomes, strategies, indicators and program requirements.
X
RFP
Healthy Communities
Safe Communities,
Safety Net Services
As an authorized representative of my organization, I certify that the statements contained herein are true, complete and
accurate to the best of my knowledge.
Name:
Title :
Signature
Name:
Printed
Date
Instructions: Please complete the following narrative questions, 1-12, by answering directly into this document.
Responses should be limited to a maximum of five pages for narrative questions 1-12.
I. PROGRAM NARRATIVE
Organization Description
1. Mission statement
2. Brief description of current programs
3. Are any programs currently funded by United Way of Medina County? If so, for how long?
Program Description-In detail, answer #4-#7 and describe how the proposed program fits within the RFP and aligns
with required strategies and indicators.
4. How does the program support the selected RFP?
5. How long has the program been operating? If this is a new program, why is it being developed at this time?
6. Describe the program activities and how they contribute to achieving the required strategies?
7. Share an example that demonstrates the organization’s ability to deliver a quality program. (Implementation of best
practices, evaluations, or any acknowledgements of your work)
Target Population
8. Describe the organization’s current relationship with the population(s) it intends to serve.
9. Explain how you will engage the population(s) you are proposing to serve.
10. Does the program serve additional target populations, and if so, will it be possible to report on the specified target
population only?
Community Involvement and Collaboration
11. Identify your staff’s current involvement with local committees and/or task forces that work to address Household
Sustainability strategies. List these activities and identify key staff involved.
12. Describe current or planned collaborations* with local agencies, civic organizations, schools or businesses to
improve the program for which you are requesting funding. (Please note that the definition for “collaboration” refers to the
means through which individuals or organizations work together in a concerted effort toward mutually desired ends. Examples could
include shared client referral networks, coordination of client services, volunteer support, or opportunities to engage in shared
programming or decision making.)
13. Provide references of at least one collaborative partner, and no more than three, for this program. If there are no
collaborative partners at this time, please list three organizations that you feel would benefit your program
through a future collaboration.
Full Name
Organization/Business
United Way of Medina County GENERAL IMPACT FUNDING
Phone
E-mail
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II. PROGRAM EVALUATION
14. Using the table below, provide estimates of the quantity of services/activities the program will provide. These
items should include the activities and outputs the program produces.
ACTIVITY MEASURES
Annual Estimate
15. Using the table below, provide estimates for program strategies, as they relate to your program services.
Program strategies must include those listed in the RFP for which you are applying.
Additional strategies may be listed but must demonstrate effectiveness towards desired outcome.
Strategies are the methods/best-practices/interventions the program provides to the target population.
STRATEGY MEASURES
United Way of Medina County GENERAL IMPACT FUNDING
Annual Estimate
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16. Using the table below, provide estimates of program indicators as they relate to your program services.
Program indicators must include those listed in the RFP for which you are applying.
Additional indicators can be included but must demonstrate effectiveness towards desired outcome.
Indicators demonstrate how the target population has improved or changed during the course of the program.
INDICATOR MEASURES
Annual Estimate
Number (#)
Percent (%)
Program Requirements
17. Please submit the requested documentation that pertains to the program requirements listed in the RFP for which
you are applying.
Requirements that have “ALL” listed in the left-hand column must be submitted by ALL applicants.
RFP #
ALL
Requirement
Evaluation System and/or Evidence Based
Evaluation Tool (should be capable of
tracking all required indicators)
Documentation
Submit a copy or synopsis of the evaluation system or
evidence based evaluation tool used in the program
ALL
Qualified and Trained Staff Members
ALL
Established in-take and assessment process.
Submit a copy of staff members and credentials/training
certificates
Submit a copy of the in-take form/needs assessment.
United Way of Medina County GENERAL IMPACT FUNDING
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III. BUDGET/FINANCIAL INFORMATION
18. Program Budget-Revenue & Support
Description
Actual FY 2010
Actual/Projected FY
2011
Proposed FY 2012
Contributions and
Dues
Foundations and
Trusts
Special Events
Federated Fund
Raising Orgs.
Other United Ways
Contracts/Grants
from Govt. Orgs.
Membership Dues
Program Service Fees
Investment Income
Other Revenue
Prior Period
Balances/Interfund
Transfers
UWMC Revenue
Allocations and
Designations
TOTAL
United Way of Medina County GENERAL IMPACT FUNDING
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Program Expenses
Description
Actual FY 2010
Actual/Projected FY
2011
Proposed FY 2012
Salaries
Employee Benefits
Payroll Taxes
Professional Fees
and Contracted
Services
Occupancy
Specific Assistance
to Individuals
Membership Dues
Special Event
Expenses
*All Other Expenses
TOTAL
United Way of Medina County GENERAL IMPACT FUNDING
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