FY 2012-13
Request for Application
Cover Sheet
Agency and Contact Information
Lead Agency
Contact
Agency Address
Contact Phone Number
Agency Fax Number
Contact Email
Agency Signatures
Agency Director
Printed Name
Agency Director
Signature
Date
President of Board of Directors
Printed Name
President of Board of Directors
Signature
Date
Project Title and Abstract
Project Title
Project Abstract
Please describe your
project in 100 words or
less.
Total Funding
Requested
$
Page 1 of 8
First 5 Napa County
FY 2012-13
Request for Application
Strategies:
This RFA proposal should focus on ONE strategy that your agency will be implementing to achieve one of
First 5 Napa County’s goals.
Please put a check mark next to the ONE strategy your agency is applying for funds for in this
application. If your agency would like to apply for funds for another program, under a second and
different strategy, please complete another application for that request.
Access to Healthcare for Young Children
Strategy:
□
Provide access to affordable health insurance and health care linkages, such as case
management for utilization.
Early Detection, Intervention and Health Education
Strategies:
□
Support prevention, education, outreach, screening, and early assessment and referral. Topics
of emphasis will include: nutrition, obesity, physical activity, oral health and family stability.
□
Provide comprehensive perinatal (prenatal and postpartum) services for families. Description
of possible components: prenatal care and education, home visitation, breastfeeding,
developmental assessments of newborns, parent education (including normal development,
attachment and bonding), postpartum depression screening/referral/support/treatment,
linkages to community support network and peer network.
Infant, Family and Early Childhood Mental Health
Strategies:
□
Support the development of a community multidisciplinary collaborative and services.
Description of possible components: universal screening tool and process, centralized referral
system, multidisciplinary services, further assessment as needed, mental health treatment,
support and education to families, and specialized services.
□
Provide training and education to increase the number of providers trained in strength-based
relational models.
Early Childhood Learning and Education
Strategies:
□
Support professional development and quality improvement of early learning and child care
providers (birth to 5 years) through professional learning communities, trainings, technical
assistance and education.
□
Support parents and children through education on parenting and early literacy. Prepare
children and their families entering kindergarten through transition programs. Support
linkages from early childhood education to kindergarten or provide early childhood education
experiences for those children with no prior experience.
Page 2 of 8
First 5 Napa County
FY 2012-13
Request for Application
Application Checklist
Documents should be assembled in the following order and forms completed and signed. Please
initial to indicate that each of the following has been completed and is contained in the proposal:
Application Checklist
Application Section
Maximum Number of
Pages
Cover Sheet and Abstract
1
Strategies
1
Application Checklist
1
Project Description
4
Agency Description and Capacity
2
Project Evaluation
1
Project Timeline
2
Project Budget and Narrative
5
Attachments (see below)
Completed
(initial)
n/a
Completed
(initial)
Attachments
Tax Identification Number & Verification of Entity Status
Audited Financial Statement
Comprehensive Tobacco Policy
Checklist completed by:
Printed Name
Phone Number
Signature
Date
Page 3 of 8
First 5 Napa County
FY 2012-13
Request for Application
Project Description - 4 pages max (30 points)
a) Describe the proposed project and how each component of the project implements the strategy
you selected to address the goals of the commission by meeting the needs of children 0-5 and/or
their families. Include specific services that will be provided and how these services undertake
the focus area and the strategy. Be specific in the description on the population to be served.
Include the name of the evidence-based, promising or best practice approach, curriculum or
method implemented in the proposed project. Include references when applicable.
b) Describe how the proposed project, by implementing the First 5 strategy, addresses service gaps
and unmet needs in the community.
c) List project staff and outline their roles and responsibilities.
d) If your agency is part of a community collaborative for this project describe your agency’s role
within that collaborative. How does your agency link with other programs in the collaborative to
compliment or enhance work under the Focus Area? If your agency is not part of a collaborative
for this project, but still works with other key partners/agencies in the community, please
describe how this other work in the county compliments or enhances your agencies work under
the Focus Area.
Agency Description and Capacity - 2 pages max (25 points)
a) Describe the agency’s capacity to develop, manage and support the proposed activities.
b) Include an example of a recent accomplishment by the agency in a service area related to the
proposal. If the proposed project was funded by First 5 Napa, or another source in the previous
two years, that should be described here as the accomplishment.
c) Describe how the agency will ensure that the project addresses the diverse cultural, economic,
developmental and/or physical needs of children 0-5 and their families.
Page 4 of 8
First 5 Napa County
FY 2012-13
Request for Application
Project Evaluation - 1 page max (5 points)
The project evaluation section describes how the project’s activities, strategies and outcomes impact the
goal(s), focus areas and strategies of First 5 Napa.1
a) Describe how the proposed project impacts the goal(s) of First 5 Napa.
b) Indicate what changes are expected as a result of the proposed project’s activities and/or
interventions, and how these changes support the goal(s) of First 5 Napa.
c) Describe reasonable indicators and approaches to measuring the expected outcomes.
NOTE: After funding has been awarded, an evaluation plan will be finalized with First 5 Napa’s Staff. The
final evaluation plan will outline the data reporting requirements for First 5 Napa and First 5 California
and will include descriptive and outcome data.
Project Timeline - 2 pages max (5 points)
Please list major project milestones chronologically in the timeline below adding rows as necessary.
Begin the table with the start of the funding cycle, January 1, 2012, and include:
a) Major milestones and action steps that are reasonable and sufficient to complete the project.
b) Projected start and completion dates.
Projected
Start Date
1
Timeline of Project Activities Table
Projected
Completion
Date
Milestone or Action Step
The goals are outlined in the 2011-2016 Community Plan and can be accessed at www.first5napa.org.
Page 5 of 8
First 5 Napa County
FY 2012-13
Request for Application
Project Budget and Narrative - 5 pages max (25 points)
The budget for the project should include expenditures that are reasonable in relation
to the activities proposed. The Budget and Narrative Section is composed of two tables:
Budget Detail Table and Budget Narrative Table. Please take time to review your budget
for accuracy.
Budget Detail Table
Staff Expenses - For the purposes of completing the first part of the Budget Detail Table,
staff expenses are defined as the salary and benefits for personnel who are specifically
assigned to complete the proposed project.
Administrative Expenses - Up to 15% of the total staff budget requested from First 5
Napa can be requested for Administrative Expenses. Allowable expenses include:
project supervision, fiscal services support (auditing, payroll, and accounting services)
and general administrative support (answering phones, sorting mail, making copies). All
expenses must be directly related to administering the proposed project and described
in the budget narrative section that follows.
Operating Expenses - The final section of Budget Detail Table outlines specific
categories for Operating Expenses. Please use the given categories. Items listed in the
“Other” and “Consultant” sections require explanation in the Budget Narrative Table
that follows.
Budget Narrative Table
The Budget Narrative Table is used to understand how the funding requested in the
Budget Detail Table will be used to support the proposed project activities. Items listed
in the “Other” and “Consultant” sections in the Budget Detail Table require explanation
in the Budget Narrative Table.
Page 6 of 8
First 5 Napa County
FY 2012-13
Request for Application
Budget Detail Table
Staff & Administrative Expenses
Jan - June 2012
(6 months)
Full-Time
Equivalent
(% FTE)
Staff Title
Total
Benefits
& Salary
Available
from Other
Sources
Requested
from
First 5 Napa
July 2012 - June 2013
(12 months)
Available
from Other
Sources
Requested
from
First 5 Napa
Jan 2012 June 2013
(18 months)
Total
Requested
from First 5
Staff Expenses
(A)
Total
Administrative Expenses (B)
Total
(up to 15% of Total Project Staff Expenses)
Operating Expenses
Jan - June 2012
(6 months)
Available
from Other
Sources
Expense Category
Requested
from
First 5 Napa
Project Space
Utilities
Office Supplies
Materials
Equipment
Staff Development
Mileage
Consultants
Other Expenses
Operating Expenses
(C)
Total Project Expenses (D) (A+B+C=D)
Total
Total
Page 7 of 8
July 2012 - June 2013
(12 months)
Available
from Other
Sources
Requested
from
First 5 Napa
Jan 2012 June 2013
(18 months)
Total
Requested
from First 5
First 5 Napa County
FY 2012-13
Request for Application
Budget Narrative Table
Staff Expenses
Expense Description
Explanation/Justification/Purpose
Staff
Administrative Expenses
Expense Description
Explanation/Justification/Purpose
Administration
Operating Expenses
Expense Description
Explanation/Justification/Purpose
Project Space
Rent, lease, maintenance of space, insurance for space, or other
project space expenses directly related to the proposed project
Utilities
Phone, electricity, water, garbage, internet service, cell phones or
other utility expenses directly related to the proposed project
Office Supplies
General supplies such as postage, paper, or other office supplies
directly related to the proposed project
Materials
Printing, copying, and other materials directly related to the proposed
project
Equipment
Lease, purchase, maintenance, software, or other equipment expenses
directly related to the proposed project
Staff Development
Required or suggested training, including travel costs if training is out
of area, or other staff development expenses directly related to the
proposed project
Mileage
Local travel expenses directly related to the proposed project.
Consultants
Consultant expenses directly related to the proposed project. Include
hourly rate and estimated number of hours in the Budget Narrative.
Other Expenses
Expenses that support the implementation and operation of the
project but do not fit in any of the categories. Detail items in the
Budget Narrative.
Other Funding Sources
Other Funding Sources for this project
Provide other sources of funding for this project.
Page 8 of 8