Application-Questions-.pdf

Application Report

Enter the project period start and end dates (Cycle 47 Grant Funding - Tribal Health) period begins on March 1, 2025 and ends August 31, 2026).

The federal government requires match funding for grants awarded by SCDD. A 10% match is required for services provided in Poverty Areas and a 25% match is required for Non- Poverty Areas.

The match may include in-kind funding. (Note: your answer to this question will be used to determine your match funding. Please make sure that the match funding in your budget meets the federal requirements for your service area). For more information, you may refer to Exhibit A - California Poverty Levels by County (available in attachments).

Please identify the area in which this project will be implemented:

Please identify the main point of contact for this project.

Applicant Organization: Test

Project Name: Test

Application ID: App-24-234

FundingAnnouncement: Cycle 47 Program Development Grants (PDG) - Tribal Health

Requested Amount:

Section Name: Project Data Sheet Sub Section Name: Applicant's Information

1. Applicant Question: Project Period

Applicant Response:

Sub Section Name: Project Funding

1. Applicant Question: Match Requirement

Applicant Response:

Sub Section Name: Contact

1. Applicant Question: Main Project Contact

Applicant Response:

https://scdd.ca.gov/wp-content/uploads/sites/33/2024/03/Exhibit-A-California-Poverty-Levels-by-County-2021.pdf

Identify the Director (CEO or equivalent) with the legal authority to enter into a contractual agreement on behalf of the Applicant.

Describe your organization's qualifications to design, implement, and successfully complete the proposed project, including the timely production of deliverables. Include experience in working collaboratively with people with I/DD, their families and those governmental and/or community-based entities that provide supports and services.

Please upload your first letter of support.

Please upload your 2nd letter of support.

Please upload your 3rd letter of support.

Is the applicant in good standing with the CA Secretary of State? Please upload confirmation letter(s) or proof of good standing.

2. Applicant Question: Signature Authority

Applicant Response:

Section Name: Project Narrative Sub Section Name: Qualifications

1. Applicant Question: Organization's Qualifications

Applicant Response:

2. Applicant Question: 1st Letter of Support

Applicant Response:

3. Applicant Question: 2nd Letter of Support

Applicant Response:

4. Applicant Question: 3rd Letter of Support

Applicant Response:

5. Applicant Question: Good Standing

Applicant Response:

6. Applicant Question: Defaulted on Grant

Has your agency ever defaulted on a grant, contract, or timely provision of deliverables? If so, please explain.

Please list all grants/awards received from any entity during the last two years that benefit individuals with I/DD and/or their families. Include the name of the project, award date, the funding source, contact person, telephone number, and the full amount of the grant/award.

Please identify those individuals and/or organization(s) that will be collaborating with the Applicant on the proposed project. Provide a brief description of each respective role and responsibilities (including, but not limited to, the production of deliverables). Please upload supporting documentation.

The applicant shall submit collaborators’ letters of support with signature(s) from each intended collaborators, whether entities or individuals.

Should the success of a proposed project involve a formal agreement (e.g. a Memorandum of Understanding [MOU] or a Letter of Commitment), a copy of that agreement signed by all parties having signatory authority must be submitted along with the proposal. Please upload your MOU here, if applicable.

Please explain in detail how this project will address the identified need, as described by the Council

Applicant Response:

7. Applicant Question: Previous Grants/Awards

Applicant Response:

Sub Section Name: Collaboration

1. Applicant Question: Collaborative Partners: Roles and Responsibilities

Applicant Response:

2. Applicant Question: Collaborative Partners: Letters of Support

Applicant Response:

3. Applicant Question: Collaborative Partners: MOU

Applicant Response:

Sub Section Name: Project Rationale

1. Applicant Question: Project Description in the proposed project area descriptions (see instructions for further information):

Please explain how the proposed project aligns with and meets the intent of one or more of the Council’s State Plan goals (for information about goals, see the instructions):

Is this a new or innovative project that can be expanded to other counties, regions or statewide?

If yes, please explain (below) how this project:

1. Will apply innovative and promising practices in its design and implementation;

2. Will build on evidence-based best practice(s); and/or,

3. Can be expanded statewide or to other counties or regions.

Explain the design of the proposed project and how it will be implemented.

Clearly identify the population(s) that will be reached and/or impacted by the proposed project and explain the reason(s) for choosing these specific populations/group(s).

Unserved/underserved communities may be identified by geographic (e.g. urban, rural, frontier, etc.), economic, cultural, ethnic, linguistic, and/or age-related factors, among others.

Select the unserved/underserved population(s)/group(s) served by or expected to benefit from this project and/or its outcomes (Select all that apply):

Applicant Response:

2. Applicant Question: State Plan

Applicant Response:

3. Applicant Question: New/Innovative Project

Applicant Response:

Sub Section Name: Project Implementation

1. Applicant Question: Implementation Plan

Applicant Response:

2. Applicant Question: Target Population

Applicant Response:

3. Applicant Question: Identify Underserved Communities

Applicant Response:

Describe how the proposed project will benefit individuals from unserved/underserved communities and support opportunities for full community inclusion for diverse people with I/DD:

What county/counties will this project serve/reach (Select all that apply)?

Provide a description of specific activities planned during the implementation of the proposed project:

Provide a work plan with intended activities and timeline(s) for the proposed project, including estimated completion dates and delivery of final product(s). Include details below or upload work plan document.

List and provide a description of the products/deliverables to be developed and provided to the Council (e.g. curricula, trainings, manuals, video content, resources, etc.):

Specify the number of people expected to participate in or be served by this project:

4. Applicant Question: Diversity/Disparities

Applicant Response:

5. Applicant Question: Region/Counties

Applicant Response:

6. Applicant Question: Project Activities

Applicant Response:

7. Applicant Question: Work Plan and Timeline

Applicant Response:

8. Applicant Question: Deliverables/Output(s)

Applicant Response:

Sub Section Name: Outcomes

1. Applicant Question: Projected Number of People Reached

The Council reports outcomes to the federal government on an annual basis. Some data is quantitative (e.g. number of laws/regulations/policies/practices created or changed, professionals trained, etc.) and reported through Federal Performance Measures. Quantitative data will still need narrative explanations in the details column. If more space is needed, please use the optional narrative. Please provide the anticipated outcomes for this project, with details/explanation:

(See instructions for further information about federal performance measures.)

Outcomes are the tangible results achieved through the work of the Council and/or its grantees, whether intended or unintended.

Describe the major and/or expected outcomes of the proposed project:

Describe how the successful completion of the proposed project is likely to impact people with I/DD, their families and/or the people/systems serving them?

If this project is likely to continue after the Council's grant cycle has concluded, please provide information (below), including details about continuation funding, project expansion, additional deliverables, etc.

Describe how the proposed project and its outcomes will be evaluated, including details about data collection, analysis, and/or reporting efforts.

2. Applicant Question: Federal Performance Measures

Applicant Response:

3. Applicant Question: Outcomes

Applicant Response:

4. Applicant Question: Impact

Applicant Response:

5. Applicant Question: Project Continuation

Applicant Response:

Sub Section Name: Evaluation Plan

1. Applicant Question: Evaluation Plan

Applicant Response:

Sub Section Name: Required Attachments

Provide an organizational chart for the proposed project only, including sub-Contractors, where applicable.

For each staff person employed by the project, including those identified on the Budget Report, provide a Curricula Vitae/Resume, Duty Statement, and any applicable and current licenses, certifications and/or credentials. If staff has not yet been identified and/or hired, provide position descriptions. No substitutions will be allowed for any of these documents.

Should a proposal require formal approval by the Applicant's 'Governing Board,' proof of such approval must be submitted with this proposal.

Please provide authorizing initials to confirm that the Applicant is financially capable of supporting the project until billing invoices and required bimonthly reporting have been submitted to the Council and reimbursement has been received.

Please enter authorizing initials to confirm that the Budget Report has been completed and match requirement has been verified.

Please read the following statement:

We have read and understand all of the provisions within this RFP and electronic application and agree to be bound by them. Furthermore, we have fully read and reviewed the Terms and

1. Applicant Question: Organizational Chart

Applicant Response:

2. Applicant Question: Personnel Information

Applicant Response:

3. Applicant Question: Governing Board Approval

Applicant Response:

Section Name: Declarations Sub Section Name: Declarations

1. Applicant Question: Financial Assurance

Applicant Response:

2. Applicant Question: Budget Confirmation

Applicant Response:

3. Applicant Question: Final Declaration

Conditions, as stated in the State Contracting Requirements, which is included in the Cycle 47 Grant Guidelines. Finally, by submitting a project proposal, we understand that the proposal document represents an agreement that we will be expected to execute if successfully awarded a Cycle 47 Program Development grant from the California State Council on Developmental Disabilities.

Enter authorizing initials to confirm acknowledgment:

Please enter authorizing initials to confirm that all required components of this application have been completed, including the Budget Report and all required documents have been uploaded into this platform.

Applicant Response:

4. Applicant Question: Final Confirmation