Appendices

Appendix A: Guidelines for Budget Forms

Appendix B: Developing Measurable Goals and Objectives

Appendix C: Cultural Competency Criteria

Appendix D: Partner Signature Form (for Collaborative Proposal Only

Appendix A: Guidelines for Budget Forms A-I Detailed Budget The following budget information must be completed for each service strategy being proposed.

Budget Summary: Provide the amount of funding requested in one or more program areas from the County to support the program. Indicate the total amount of revenue from other sources of funding which will also support the project. Detail regarding revenue sources will be given on the third page of the budget.

Part a: Salaries and Wages

Instructions: Provide the position title for each position for which funding is sought. Indicate the number of months each position will be staffed during the fiscal year. Indicate the total FTE allocation, salary costs, and fringe costs for each position associated with the service strategy.

Fringe costs are costs for employee health insurance, retirement, unemployment, social security, and other payroll expenses. Indicate how fringe costs are computed - actual or a percentage of salaries. Include actual percentage used to calculate fringe costs.

Be sure to provide the salary and fringe cost for each position.

Part b: Materials and Supplies

Instructions: List each line-item expenditure by cost per unit.

Example:

Travel: 1,000 miles @ $0.31 per mile = $310

(For each line item specify the total budgeted amount.)

This section should reflect the formula used by proposers to compute the amount budgeted for each line item reflected on the proposed budget. Some expenses lend themselves to a unit cost, and some don't; e.g. anticipated miles to be driven or hours of consultation to be purchased, rate of reimbursement per mile/hour, printing costs times "x" number of brochures, etc. Unit costs, as in the case of routine office supplies, may simply be the estimated cost per month times the number of months of proposed program operation. The intent is to be able to understand and evaluate how proposers have constructed their budgets.

Part c: Capital Outlay Instructions: Capital Outlay is any non-consumable item with a purchase price greater than $100 and a life expectancy of more than one year. Specify items included in this category.

Examples:

3 desks @ $175 each = $525 1 Dell Computer @ $2,000 each = $2,000 (For each line item specify the total amount budgeted for the service strategy.)

Part d: Indirect Cost Instructions: List each indirect cost by type and amount. Be specific. Also list indirect cost percentage used. (For each line item specify the total amount budgeted for the service strategy.)

Indirect costs are expenditures charged against all programs an agency operates.

For example, if your program is a branch office of a larger agency and some of the costs of that agency are charged to your program, they are indirect costs.

Indirect costs should not be duplicated under any other line item.

Part e: Total Projected Expenditures

Sum totals from Parts a. through d. and record where indicated.

Part f: Detailed Revenue Instructions: List by name other revenue sources for this application including grants from other funding sources, in-kind contributions, and project fees. Also specify the total projected revenue by source.

A-11. Budget Detail Form

Agency Name:

RFP Number:

JCP Funds Requested:

Other Revenue:

Total Budget:

Part a: Salaries / Wages (For additional positions, add additional pages)

Number of Months

% FTE Total Cost

Total Fringe @ ___ %:

Total Personnnel Cost:

Part b: Materials and Services

Total

Contract Services

Training & Development

IT Services

Program Supplies

Direct Services to Youth & Families

Telephone & Internet

Rent & Utilities

Event Expense

Position Title

Categorical Item

Total

Evaluation

Equipment

Office Supplies

Printing & Copying

Repair & Maintenance

Meeting Expense

Parking & Mileage

Subtotal Amount:

Part c: Capital Outlay

Total

Total Capital Outlay Costs:

Part d: Indirect Cost (Detailed Charges)

Total

Total Indirect Costs:

Categorical Item (continued)

Item Description

Description of Services

Part e: Total Projected Expenditures (a + b + c + d) Cost per Unit of Service: $

Please define Unit of Service and Explain Formula:

Percentage of Total Budget which is Indirect Cost: %

Part f: Detailed Revenue

Amount

Total Projected Revenue:

Projected Revenue Sources

Identify by name other sources for this service, providing detailed for Other Revenue given in the Budget Summary. (Include in-kind contributions and projected fees)

Appendix B: Developing Measurable Goals and Objectives B-I Measurable Goals and Objectives

a. Juvenile Crime Prevention Goals and Objectives

Programs applying for funding under this RFP must incorporate State and County goals with respect to the Juvenile Crime Prevention Plan for BE 2025- 2027. The JCP plan has the primary goal of preventing criminal referrals in youth and reducing Juvenile recidivism. Best practice research indicates that targeted interventions that address the five risk factors (antisocial behavior, poor family functioning, school failure, substance abuse, negative peer association) have the highest likelihood of preventing juvenile crime, thereby accomplishing the above goals.

Proposers’ overall goals and objectives should relate to the above risk factors and reflect overall Juvenile Crime Prevention goals. Proposers’ measures must reflect plans and capacity to utilize the Oregon Juvenile Crime Prevention Risk Screen, Interim Review and Access Database. A sample work-plan is included at the end of Appendix E-I.

b. Definitions and Guidelines for Work Plans

Proposers must submit a clear and comprehensive work plan that indicates how their particular strategy/activity will support the County’s overall goals related to preventing juvenile delinquency. Work plans will need to indicate planned outputs/process measures, objectives and how those objectives will be measured. Following are definitions relevant to the work plan, a sample work plan (see E II), and a blank work plan form (see E III).

A. Strategy/Activity refers to specific action(s) the proposers plans to engage in towards the accomplishment of delinquency prevention.

Examples might be: Provide positive, skill-building after school activities for county youth at risk for delinquency, or provide intensive case management services in a school setting to county youth at risk for delinquency.

Outputs/Process Measures refer to those items that quantify numbers to be served and methods to be employed in applying the strategy towards the goal of delinquency prevention.

Examples are: Enroll 20 youth in Program X by March 1, 2016, successfully engage 80% of enrolled youths’ parent/guardian in case planning activities, or link 85% of youth identified by the OJCP Risk Screen to have academic risk factors with academic tutoring.

Outcomes/Outcome Objectives refer to incremental goals that contribute to the overall goal of delinquency prevention.

Examples might be: Improve school commitment, increase substance abuse resistance skills, or increase positive peer associations.

Measures refer to how the proposers plans to measure the objectives identified in the work plan. Measures should indicate who will be collecting the data and how.

Examples might be: As measured by improved performance in the school domain on the OJCP Interim Review, or as measured by client satisfaction survey administered at school year end, or per program observation.

B-II Work Plan Sample Overall Goal Prevent Juvenile Delinquency Strategy/Activity Outputs/Process

Measures Outcome/Outcome

Objectives Measures

Provide positive, skill-building after school activities for county youth at risk for deliquency

Improve positive youth identity

-End of year youth self-survey -Staff observation Self-esteem inventory

15 of 20 youth will attend program activities 80% of the year

Improve school commitment

-OJCP Interim Review performance in the school domain -Parent Report -School attendance records

Complete a service plan with 80% of program youth

Improve peer interactions

-Staff observation -OJCP Interim Review performance in the peer domain

80% of enrolled youth will complete service plan components

Increase positive after-school involvement

-End of year self-survey -Staff observation -Parent report

15 of 20 youths’ parent/guardian will in attendance 80% of scheduled parent nights

Improve family communication styles

-Staff observation -Parent report -End of year youth self-survey

Enroll 20 youth in Program by September 30,2026

B-II Work Plan Overall Goal Prevent Juvenile Delinquency Strategy/Activity Outputs/Process

Measures Outcome/Outcome

Objectives Measures

Appendix C-1: Cultural Competency Criteria

Culture - means an entire set of values, behaviors, attitudes, social interactions, and communication patterns that distinguishes a group of people.

Cultural Competency - means development of behaviors, attitudes, and policies that enable providers to deliver services in ways that meet the needs of a variety of subgroups.

Cultural Competency Criteria - a guideline which assists organizations to achieve tangible goals in their commitment to diversity.

A. Environment: means the community the program operates in.

A.1. The program has identified resource people from various segments of the community.

A.2. The program makes, at least, quarterly direct person-to-person contact with these resource persons.

A.3. Resource persons are asked to participate in the evaluation(s) identified in component F.

A.4. The program has accurate demographic data about various cultural communities it proposes to serve.

B. Management Control: means the governing and administration system for the program.

B.1. The board will be comprised of people from various ethnic and cultural backgrounds.

B.2. The program has written policies or plans which call for the program to become culturally competent. These written policies or plans must be approved by the Board of Directors.

C. Inputs: means the money, technology, human resources, etc., coming into the program.

C.1. The program employs ethnically and culturally diverse staff and/or volunteers in positions that have direct contact with clients.

C.2. The program serves clients commensurate with the ethnic and cultural demographics of the community.

Appendix C-2 D. Change Technology: means the activities and interactions which occur to create positive change or add value.

D.1. Each staff member and volunteer receives at least four hours of cultural competency training annually.

D.2. The program has a resource library containing up-to-date articles, books, tapes, etc., related to cultural issues.

D.3. The program provides opportunities which help clients understand and appreciate cultural differences.

E. Facility and Grounds: means the actual site(s) where program activities and services occur.

E.1. Reasonable accommodation to ensure access to services is made by removing architectural and structural barriers.

E.2. Posted information is written in a variety of appropriate languages.

E.3. The atmosphere in the program acknowledges and welcomes people from diverse cultural backgrounds through art work, posters, books, etc.

F. Outputs: means the actual service or product which is delivered, hopefully, with positive change or value added. It also means any resources leaving the program, i.e., staff turnover, etc.

F.1. Clients from all cultural backgrounds successfully complete the program in similar ratios.

F.2. All clients receive similar services, however, the services are appropriate and relevant to the client's cultural background.

F.3. Personnel records reflect nondiscriminatory practices in the hiring, promotion, and retention of staff.

G. Feedback: means the information relating to program goals and objectives.

G.1. The program assesses its "cultural competence" policy and plans with input from staff, volunteers, resource people, and clients.

G.2. All programs funded by Washington County will submit an outline of their "cultural competency" plan detailing the goals, objectives, and post-assessment for each item of the criteria.

Appendix D: Partner Signature Form

Organization Include Name, Address, Phone

Leverage/Match Volunteers, On-site services, etc.

SIGNATURE