5-Attachment A - Application Form - Advancing Economic Empowerment for Survivors of Human Trafficking.docx

APPLICATION FORM

ADVANCING ECONOMIC EMPOWERMENT FOR SURVIVORS OF HUMAN TRAFFICKING

Content

Request For Proposals (RFP) – Advancing Economic Empowerment for Survivors of Human Trafficking This form is intended for Proposers who are applying to serve as contractors for the Advancing Economic Empowerment for Survivors of Human Trafficking should review the Request For Proposals (RFP) to understand the required scope and services sought and for information on all required documents and submission. There are no minimum or maximum numbers of characters for any of the questions included in this form.

Organization Information

Application Contact

Secondary Contact

Section 1 – Experience: Application Attachments Required Documents – Checklist

Attachments as part of proposal-Checklist

F. OPS-FRM-640 -Team Make-Up and Local Workforce Form ☐

Exhibits

3. Federal IRS Form 990 or 990-N (E-postcard-Required upon award) ☐

4. Sample Contract (Required upon award)

5. Scoring Summary (Template for your reference)

6. Activities Report (Template for your reference)

Section 2 – Approach: History, Experience and Staffing Attach an agency-level organizational chart for your entire agency (if large or administering in multiple sites and locations) and a more detailed chart for program-level administration. For some agencies, a single chart may be sufficient. The organizational chart(s) document(s) should only list titles/functions and need not include individual staff names.

· History and purpose of organization, including number of years in service

· Agency’s experience and success in providing related services

· Responsible staff for with appropriate credentials to perform the program services outlined in the specifications

· Highlight your agency’s availability to designate a point of contact (POC) who will be responsible for all activities and communication, including attendance at all planning meetings during contract period.

· Outline how the organization or staff are uniquely qualified to provide the services.

· Plan to fill any positions that need to be filled to administer programming

· Describe the organization experience operating Advancing Economic Empowerment for Survivors of Human Trafficking

· Describe the organization prior success with City of Dallas contracts

· Describe the organization methods for data collection Click or tap here to enter text.

Section 3 – Approach: Case History List in the table below the number of outcomes for FY 2022, 2023, and 2024 years.

Section 4 – Approach: Outreach and Intake Provide the following information. Organizations should propose approaches that are consistent with the principle of universal representation:

· How your agency will meet the targeted population utilizing effective outreach efforts.

· Please describe how your program will incorporate community referrals.

· The plan for developing selection criteria for receiving representation.

· Describe how the organization will conduct intakes.

· Please describe how your program will collaborate and engage with key community stakeholders to educate the community about the program.

Click or tap here to enter text.

Section 5 – Approach: Representation Please specify the following:

· How you plan to serve eligible Dallas residents? Describe your organization’s approach to provide.

Click or tap here to enter text.

Section 6 – Approach: Program Work Plan and Activities Timeline Please describe your program implementation timeline and the intended start date for providing eligible services. Please indicate if you have already hired staff to work in this project. Indicate if you have already started providing Advancing Economic Empowerment for Survivors of Human Trafficking. If you have not hired staff, please indicate your expected timeline to staff up and start accepting applications when funding becomes available.

Click or tap here to enter text.

Section 7 – Approach: Program Evaluation Organization may choose to attach evaluation tools, intake forms and other documents in support of this section, including intake or client eligibility forms. The organization should outline their eligibility criteria and should ensure that clients served meet these criteria.

Provide the following information:

· How would the organization define a successful program?

· How many residents do you anticipate representing with the total funding provided? Please note that the awardee will collaborate with the City of Dallas to confirm the caseload number upon commencement of the contract

· Describe any prior experience in program data management, including data collection and reporting of vulnerable populations

Click or tap here to enter text.

Section 8 – Program Budget, Cost, and Timeframe Please provide the following information:

· Fill out and attach program budget (Attachment E Program Budget Worksheet)

· Narratives should describe each line item in the budget. Response should list every staff person included and briefly describe their duties, clearly describe what is being covered by subcontract funds. Additionally, outline any in-kind resources or funds that will also be applied to the project as leveraged resources Click or tap here to enter text.

Section 9 Required Acknowledgements The City will work with each Provider on the following action items. Please check each to affirm. This process will be completed on the third Tuesday of each month for the previous month:

Monthly reports send to city staff assigned (Due the 3rd Tuesday of the month)

Monthly invoice and reimbursement requests (Due the 3rd Tuesday of the month)

Evaluation Criteria

Evaluation Criteria Weighting

Each category will be evaluated based on the measures below:

1. Experience (Sections 1, 2, & 3) – 40 points The proposal shall indicate the applicant’s experience working directly with:

· All applicable required documentation were provided

· Prior experience demonstrated providing Advancing Economic Empowerment for Survivors of Human Trafficking services and experience working with the population intended to be served and to have clear and appropriate processes in place to document and verify client eligibility

· Demonstrated prior experience in program development and management, including a track record sufficient to undertake and support the program services outlined and reporting of vulnerable populations

· Demonstrated past performance success with City contracts or prior contracts/grants for related project services

· Demonstrated to have the responsible staff (or ready to hire) and leadership for administrating program with appropriate credentials to perform the program services outlined in the specifications and the ability to initiate services promptly after contract award and viability of the proposed representation plan

2. Approach (Sections 4, 5, 6, & 7) – 30 points Applicants shall present an overall description and understanding of the project and the general approach taken in responding to this RFP. The following criteria include:

· Provided description of the organization’s approach/work plan and clear outline deliverables that align with the scope of services outlined. The organization described how the program will meet the targeted population identified in the RFP utilizing equitable, inclusive, and effective outreach efforts. The organization articulates how the program targets individuals living in communities of concentrated poverty. The organization defines a successful program.

· Described how the program will incorporate community referrals and clearly stated outputs and outcomes (logic model) to determine the impact of the program and number of cases intended to serve. Described how the program will collaborate and engage with key community stakeholders to educate the community about the program

· The description of workplan includes an evaluation plan to measure the success of clients and services

3. Program Budget (Section 8) – 30 points Applicants should use Attachment E Program Budget Worksheet page of the application form. The budget should outline the budget plan that supports the program services, identify the budget item, briefly describe the item, and identify the corresponding amount for the item. The budget should reflect a 1-year contract term.

Applicants are also encouraged to outline identifying any in-kind resources or funds that will also be applied to the project as leveraged resources. There is no minimum amount of leveraged funding required for this opportunity.