CHEVRON RICHMOND
2016 Community Engagement Application
Chevron in Richmond is committed to supporting and making social investments in the City of Richmond
and West Contra Costa County. Our goal is to be recognized as an important member of the community by
improving the quality of life for Richmond/West County residents through expanding opportunities for
youth, education and economic development. The primary objectives of our social investments are to:



Youth and Public Safety: Contribute to improving public safety by supporting impactful
intervention programs to vulnerable youth;
STEM Education: Expand access to high-quality education, with a focus on working with the
West Contra Costa Unified School District to address the achievement gaps in science,
technology, engineering and math (STEM) education and to build leadership capacity in these
areas; and
Economic Development: Increase and sustain community economic viability through
comprehensive services that improve family self-sufficiency, develop workforce-ready skills and
help small businesses create jobs.
Chevron believes that the most powerful form of energy is human energy and that energy attains peak
performance through strong involvement and stakeholder engagement. We welcome your organization’s
interest in strategically working with us to contribute to the continued growth of the Richmond area as a
vibrant place to live and work.
INSTRUCTIONS
Please provide the information requested on the following pages
Responses should be emailed directly to:
RichmondCE@chevron.com
Proposals should be typed and not exceed six (6) pages. In addition to the proposal, you are required to
submit the following information*:
 Overall organizational budget
 Project budget
 Copy of IRS 501(c)(3) Not-For-Profit Letter of Determination or a signed MOU from fiscal
agent and a copy of their IRS 501(c)(3) Letter of Determination
 Proof of current “Active” Status (can be requested through the California Franchise Tax
Board at the following link:
https://www.ftb.ca.gov/online/self_serve_entity_status_letter/index.asp?WT.mc_id=Busi
ness_Online_EntityStatusLetter
 Audited financial statements from the previous two years or IRS Form 990 Tax Returns
 Chevron Employee Volunteer Request Form if necessary (Attachment A)
 List of board members
Incomplete proposals or failure to include the necessary documentation may delay the review of a
submission or cause it to be rejected at Chevron’s sole discretion.
General Criteria for Grant Selection
 Target beneficiaries are located in either Richmond, CA, or in West Contra Costa County
 Alignment with Chevron’s funding objectives outlined above
 Quality of proposal
 Clearly outlines problem/issue and addresses the root causes of the identified problem
 Cost-effectiveness of the proposal/budget
 Capacity of the organization to implement the proposal
 Clearly defined, measurable goals/metrics that will speak to the impact/effectiveness of the
program
 Program monitoring and evaluation plan
 Commitment to working with Chevron (if applicable)
 All funding for scholarships will be issued directly to the educational institution hosting the
recipient of the scholarship.
 Applicants must be registered as a nonprofit (charitable) organization with a current 501(c)(3)
tax-exempt status. A copy of an IRS Letter of Determination for the organization must be
included. Note: A “pending” exemption will not suffice.
 Applicants must demonstrate the organization has a status of “Active”
 Applicants must be in operation for at least 1 year before being considered for funding
 Applicants must demonstrate that the programs/services or projects are sustainable beyond the
amount of the Chevron grant
 Applicants must complete and submit the Project Report Form upon completion of the project or
at the end of the grant period, which is one year from date of funding. NOTE: The Project Report
Form must be submitted before being considered for future funding. A copy of the Project Report
Form may be obtained through our website at www.chevronrichmond.com or you may request one
through richmondce@chevron.com.
 PROPOSALS ARE DUE ON THE FOLLOWING DATES IN 2016:
February 22, May 2, August 1 and October 31.
 Please allow three (3) weeks for notification of funding and six (6) weeks for receipt of check if
and once funding has been approved.
Types of Requests Are Generally Excluded From Consideration for Funding*
The types of requests for funding that are generally excluded from consideration include, but are not
limited to: capital campaigns; federal, state or county programs; personal assistance to individuals; faithbased organizations, labor, fraternal, athletic or political organizations; arts and arts education; foundations
and organizations that raise funds for other than non-profit organizations; private schools; travel; bands and
sports organizations.
*Notwithstanding any conflicting statement in this application, any grant or rejection of a grant request is within Chevron’s
sole discretion and in no event shall Chevron be liable to any organization for any request for a contribution or decision to
fund or rejection of any request for funding.
In addition, any and all grants are subject to the availability of funds, and at all times, Chevron reserves the right to fund any
or none of the requests submitted. The fact that Chevron has made this Community Engagement and Support Application
available to the public does not constitute a commitment on the part of Chevron to make an award. Any request for funding is
submitted totally at the risk of the applicant and Chevron shall have no liability to any applicant with respect to any
information provided to Chevron. Under no circumstances whatsoever does this document/application or the preparation of
this document/application by the applicant commit Chevron to pay for the costs incurred in the preparation and submission of
this application or any request for funding. In addition, any final award of any resultant grant cannot be made until funds
have been fully appropriated, allocated, and committed through internal Chevron procedures, and even if Chevron indicates
that it will fulfill the grant request, Chevron may at any time rescind that indication/statement to fund a grant without liability
to the applicant (i.e., the organization requesting the grant) or any third party.
CHEVRON
Application for Community Engagement
Today’s Date:
Name of Organization:
Name of Primary Contact:
Phone Number of Primary Contact:
Address:
Website:
Organization Tax ID # (if applicable):
Have you received Chevron funding before?
Name of Fiscal Agent (if applicable):
Name of Primary Contact:
Phone Number of Fiscal Agent:
Address:
Website:
Fiscal Agent Tax ID #:
Project Title:
Project Implementation Start Date:
Amount of Funding Requested from Chevron:
1.
Title:
Email Address:
Title:
Email Address:
End Date:
Total Project Cost:
The Project Idea:
a.
Please indicate the Area of Impact in which your organization is applying:
 Youth/Public Safety
 STEM Education
 Economic Development
b.
What are the project’s objectives? Why are these objectives worth pursuing?
c.
What problem/issue is your project/organization addressing? How will these objectives
be achieved? (Please address how your work aligns with one or more of our primary
objectives identified above.)
d.
What research or best practice models support your methods?
2.
e.
Who will benefit from the project and how many beneficiaries will be reached? (Please
include specific estimated numbers, target population, special populations, income, age
range, etc.)
f.
What geographic area(s) will be served?
g.
What is the project timetable?
Measuring Results: (You will also need to fill out the projected results on the Target Metrics
sheet below)
a.
What are the intended results (outcomes) of the project and what metrics will be used to
demonstrate results? Please include specific, numerical indicators you will track through
to the project’s completion.
b.
How will you monitor and evaluate the results included above? Your evaluation should
be directly linked to your outcomes and activities. Would your organization agree to an
independent evaluation funded by Chevron if such an evaluation were suggested or
requested?
3.
Sustainability: Is the project sustainable beyond the period of Chevron’s funding? If so, how
will sustainability be achieved?
4.
The Organization: Tell us about your organization. What is its mission? What knowledge or
experience does it have that gives it confidence it can successfully implement the proposed
project?
5.
Budget: [Can be attached separately]
a. Project budget and current sources of funding (please feel free to add additional rows as
needed)
FUNDING SOURCE
AMOUNT OF CONTRIBUTION
1.
2.
3.
4.
5.
b.
Organizational budget and current sources of funding (please feel free to add additional
rows as needed)
FUNDING SOURCE
AMOUNT OF CONTRIBUTION
1.
2.
3.
4.
5.
6.
7.
Public Awareness:
a.
Describe how your organization will inform the community about Chevron’s
involvement in this project. (Note: use of Chevron’s logo will require written prior
approval and strict compliance with Chevron’s legal terms – please indicate that you will
agree to these terms.)
b.
What opportunities, if any, exist for increased Chevron involvement (i.e., are there any
Chevron employee volunteer opportunities)? If a grant is awarded to your organization
and there are employee volunteer opportunities, we will send you a Volunteer Request
Form.
Attachments:
□ Overall organizational budget
□ Project budget
□ Copy of IRS 501(c)(3) Not-For-Profit Letter of Determination or a signed MOU from
fiscal agent and a copy of their IRS 501(c)(3) Letter of Determination
□ Proof of current “Active” Status (can be requested through the California Franchise
Tax Board at the following link:
https://www.ftb.ca.gov/online/self_serve_entity_status_letter/index.asp?WT.mc_
id=Business_Online_EntityStatusLetter
□ Audited financial statements from the previous two years or IRS Form 990 Tax Returns
□ Chevron Employee Volunteer Request Form if necessary (Attachment A)
□ List of board members
Chevron Richmond Social Investment programs: Target Metrics 2015
1.
On what date do you expect the project or program to be completed?
2. Please complete the ‘end of year 1’ target column below for the proposed project or program. If the program is
expected to last longer than one year, please also complete the ‘end of project target’ column. See the ‘definitions’
section for explanations corresponding to the numbered notations.
NOTE: Not all metrics will be applicable to your project. If a metric does not apply, simply mark ‘0’ on the
relevant line.
General Metrics
Proposed
end of
project
target
Actual end
of project
target
Proposed
end of
project
target
Actual end
of project
target
# of direct project beneficiaries in total1

% female
# of indirect project beneficiaries2
Total # of Chevron volunteers on project/program
Total # of Chevron volunteer hours on project/program
# of government institutions or nonprofit organizations with enhanced capacity as a
result of the project (please list)3
# of positive media mentions for the project which mention Chevron
Did the project receive any public awards - if so, how many?
Will this project have a significant public event? If so, how many people will attend the
event(s)?
Amount of cash funds (in US$) leveraged through partnership4
Amount of in-kind contribution leveraged through partnership4
STEM Education Metrics
# of additional resources made available and details of what they were
# students participating in supported project
# of scholarships awarded
# of teachers trained
# of hours of teacher training
# of parents/community members engaged
% of project serving students from low-income families
# of supported students interested in pursuing further STEM education, certification or
career
# of supported students accepted into a post-secondary STEM program
% change in supported student performance in national standard tests in STEM subjects
Career Training Metrics
Proposed
end of
project
target
Actual end
of project
target
Proposed
end of
project
target
Actual end
of project
target
# of individuals starting workforce development/vocational training
# of individuals completing workforce development/vocational training
# of hours of workforce development and vocational training provided
# of teachers or trainers participating in professional development or “train-the-trainer”
programs5
# of trainees getting a job as a result of receiving training
# of trainees earning higher incomes as a result of the program
# of individuals certified or accredited in a skilled trade
Micro and Small Business Support Metrics
# of local businesses supported
# of local business owners and employees who started training
# of local business owners and employees who completed training
$ amount of total loans provided
Total # of loans provided
# of local businesses reporting the ability to generate higher revenues after completing
Chevron-supported project
# of total employees in supported local businesses6
# of additional jobs created as a result of the Chevron funding
# of local businesses completing Chevron-funded supplier development projects that
become vendors for Chevron
Definitions
No.
Metric
Definition
1
# of direct project
beneficiaries
The number of project beneficiaries is the # of people that are directly impacted by
the project. It is the number of people who receive the direct outputs as a result of
Chevron's funding.
2
# of indirect project
beneficiaries
Indirect beneficiaries are those who benefit due to the positive impact on the direct
beneficiaries. (Example: The number of students in the class of the teacher who
was trained as a result of Chevron's funding or the number employed by the SME
receiving a micro-loan.) Only count individuals directly impacted by the direct
beneficiary.
3
# of government
institutions or
nonprofits with
enhanced capacity
Amount of cash
funds (in US$)/ inkind contribution
leveraged through
partnership
Number of external groups that are more effective as a result of training provided
through a project.
4
Leveraged funds are all funds that were contributed as a result of Chevron's
funding to the project. The additional funding must have come as a result
Chevron's investment; it is not simply other donations provided to the partner or
project.
In-kind contributions are any non-cash goods or services provided to the partner
to support the project. Describe each good or service provided and indicate their
value, if known. Estimate if exact value is not known.
5
6
# of teachers or
trainers
participating in
professional
development or
“train-the-trainer”
programs
# of total
employees in
supported local
businesses
Number of trainers participating in workshops or programs that are designed to
make them effective instructors in their skill area. (Example: Welding workshops,
university-level engineering programs, truck driving certification programs,
agricultural training, etc.)
Total number of individuals that are working for the businesses that are
participating and benefiting from this project. (For instance, if the project benefits
2 businesses – 1 with 3 employees and the other with 5 employees – then the
number of employees in the supported business would be 8.)