Attachment B-Grant Application Response Form.docx
DOCX document 83 KB Posted
- Attached to
- 27EHSSSYIGRANTHTKA: Grant Application for the SSYI Human Trafficking Intervention Program
- Solicitation number
- BD-27-1039-EHS01-EHS01-132905
- Issued by
- Massachusetts
About this file
This is a grant application response form issued by the Commonwealth of Massachusetts Executive Office of Health and Human Services (EOHHS) for the Safe and Successful Youth Initiative Human Trafficking Intervention Program (Grant Application Number: 27EHSSSYIGRANTHTKA). The solicitation seeks qualified entities to implement comprehensive services addressing human trafficking intervention for youth, including individual and community services such as survivor mentoring, case management, and systems coordination. Respondents may also propose statewide training and technical assistance activities. The grant application requires respondents to submit organizational information detailing their background, structure, and capacity; programmatic responses demonstrating their ability to deliver the specified services; and completed budget forms for each state fiscal year covered under the grant term, which spans from January 1, 2027, through June 30, 2029 (covering portions of FY2027, FY2028, and FY2029). No specific response deadline or award date is identified in this response form document.
Respondents must demonstrate sound financial condition with unqualified audit opinions and submit comprehensive revenue documentation for fiscal years 2026 through 2028, including all public and private funding sources. Organizations must certify compliance with Commonwealth terms and conditions, establish policies aligned with the Massachusetts Legislative Task Force on the Prevention of Child Sexual Abuse recommendations, and disclose any potential conflicts of interest. Respondents may propose subgrantees but remain fully responsible for subgrantee performance. New grantees must complete W-9 forms and authorize electronic funds transfer. The application requires narratives addressing cultural responsiveness, service delivery protocols, data collection and measurable outcomes, and staffing including individuals with lived experience of human trafficking. Organizations with annual revenues of $10 million or more may limit financial documentation to funding sources directly supporting the proposed program or relevant department.
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
ATTACHMENT B
RESPONSE FORM
GRANT APPLICATION
FOR
SAFE AND SUCCESSFUL YOUTH INITIATIVE
HUMAN TRAFFICKING INTERVENTION PROGRAM
GRANT APPLICATION NUMBER:
27EHSSSYIGRANTHTKA
SUBMITTED BY (Organization Name):
RESPONDENT ORGANIZATION
(Text boxes will expand up to the maximum allowable character limit.)
Organization Legal Name: [ ]
Trade name(s) and any other name(s) under which the organization does, or has done, business: [ ]
Principal Address:
City: [ ] State: [ ] Zip Code: [ ]
Telephone: ( ) - FAX: ( ) - URL: [ ]
FEIN: [ ]
MMARS Vendor Customer (VC) Code (if known): [ ]
Type of legal entity (e.g., corporation, limited partnership, nonprofit corporation, etc.): [ ]
CONTACT PERSON
Include the following information for the individual who should be contacted to discuss any aspect of the Respondent’s completed Response Form:
| Name |
| [ ] |
| Title |
| [ ] |
| Street Address |
| [ ] |
| City, State Zip Code |
| [ ] |
| Phone Number |
| [ ] |
| [ ] |
BUSINESS RESPONSE
Each Respondent must complete this section, provide any additional information requested and upload the required documents to COMMBUYS, as specified.
When completing this section, note that an “X” in the box of each item indicates an affirmative response to the item. If one or more of the boxes are not checked, please upload to COMMBUYS as part of the Response a separate document titled “Business Response—Additional Information” containing an explanation and organized by Business Response item below.
RESPONDENT QUALIFICATIONS AND AGREEMENT READINESS
The Respondent certifies that:
☐ The Respondent meets the Respondent qualifications provided in Section 1.6 of the Grant Application and is qualified to provide the services in accordance with the requirements listed in Attachment A and will remain qualified for the duration of the Grant Agreement.
☐ The Respondent agrees to establish and implement policies, procedures, practices, and a code of conduct consistent with the recommendations of the Massachusetts Legislative Task Force on the Prevention of Child Sexual Abuse (see Sections 1 and 2.5 of Attachment A). The Safe Kids Thrive website (https://safekidsthrive.org/elements-of-prevention/) of the Children’s Trust of Massachusetts operationalizes the Task Force’s recommendations. The Respondent shall apply and customize this information to Participants of all ages and to the Respondent’s specific Program.
☐ The Respondent accepts the terms of this Grant Application and of the Model Grant Agreement provided in Attachment A, without substantive change, including but not limited to the following, which are part of the final Grant Agreement:
☐ Commonwealth Terms and Conditions ☐ Standard Contract Form ☐ Standard Contract Form Instructions, Contractor Certifications, and Commonwealth Terms and Conditions ☐ The Response will remain in effect until a Grant Agreement resulting from this Grant Application is executed.
Attachment B: Response Form EOHHS—Safe and Successful Youth Initiative Human Trafficking Intervention Program Grant Application Page 2
SUBAWARDS
Identify proposed Subgrantees (if any):
| Subgrantee 1. Name: |
| [ ] |
| Address: |
| [ ] |
| City, State Zip Code: |
| [ ] |
| Telephone: |
| [ ] |
| Contact Person and Title: |
| [ ] |
| Subgrantee 2. Name: |
| [ ] |
| Address: |
| [ ] |
| City, State Zip Code: |
| [ ] |
| Telephone: |
| [ ] |
| Contact Person and Title: |
| [ ] |
| Subgrantee 3. Name: |
| [ ] |
| Address: |
| [ ] |
| City, State Zip Code: |
| [ ] |
| Telephone: |
| [ ] |
| Contact Person and Title: |
| [ ] |
Attach additional pages, if needed.
Acknowledge that all Subgrants and other financial and programmatic agreements or arrangements will be in writing and will contain terms consistent with all terms and conditions of the Grant Application and Grant Agreement.
☐ Place an “X” in the box to acknowledge. or ☐ Not applicable/No subawards.
Acknowledge that the Respondent shall not be relieved of any legal obligations under any Grant Agreement resulting from the Grant Application as a result of any Subgrant and that it shall be fully responsible for the Subgrantees’ performance.
☐ Place an “X” in the box to acknowledge. or ☐ Not applicable/No subawards.
FINANCIAL CONDITION
The Respondent must demonstrate to the satisfaction of EOHHS that it is in sound financial condition and that any significant financial problems are being addressed with appropriate corrective measures. EOHHS may disqualify a Respondent if the Respondent fails to submit the documents required by this section, or if the documents indicate to EOHHS, in its reasonable discretion, that the Respondent’s financial condition is unsatisfactory.
1. Indicate the current total organizational budget for FY2027.
By placing an “X” in the boxes below, the Respondent certifies that the following statements are true and accurate and that the organization is in compliance with the described financial conditions. If any of the following conditions are not met, please submit a letter of disclosure as an Attachment in COMMBUYS. The Respondent certifies that the Respondent:
☐ Is in sound financial condition and has sufficient financial reserves to perform the requirements of the Grant Agreement and has received an unqualified audit opinion for the latest audit of its financial statements.
Specify the date of the last audit [ ]; OR ☐ Is in sound financial condition and will have sufficient financial reserves to perform the requirements of the Grant Agreement prior to the execution of the Grant Agreement, if selected, and will have received an unqualified audit opinion for the latest audit of its financial statements, prior to execution of the Grant Agreement.
The Respondent also certifies:
| ☐ | In the last ten years, the Respondent has not undergone any bankruptcy or insolvency proceeding, whether voluntary or involuntary, nor undergone the appointment of a receiver, trustee, or assignee for the benefit of creditors. |
| ☐ | It is not the subject of any current litigation or findings of non-compliance under federal or state law. |
| ☐ | It has not been the subject of any past litigation or findings of non-compliance under federal or state law. |
| ☐ | No corrective actions or sanctions have been imposed on the Respondent. |
| ☐ | In the last three years, it has not had any vendors or subcontractors cancel contracts with the Respondent or implement performance-based sanctions. |
| ☐ | It is not aware of any circumstance materially and adversely affecting the Respondent’s financial condition that is not reported in the foregoing financial statements and that, to the best of its knowledge, the Respondent is not delinquent in the payment of any federal or state tax. |
REVENUES
1. Attach an Excel spreadsheet that includes a comprehensive list of all revenues, including but not limited to public and private funding sources and investment income for fiscal year 2026 (July 1, 2025–June 30, 2026), fiscal year 2027 (July 1, 2026–June 30, 2027), and fiscal year 2028 (July 1, 2027–June 30, 2028). Organizations with a total annual revenue below $10 million should provide this information for the organization as a whole. Organizations with a total annual revenue of $10 million or more may limit this list to funding sources that directly support the proposed Program or the department within which it sits.
The Respondent shall include any contractual relationships with the Commonwealth of Massachusetts, with federal and local government agencies, and with all other entities, including but not limited to foundations, individual donors, and anticipated fundraisers.
For each funding source include:
The funding name/description The funding term The total funding amount The name of the funding entity For FY2027 and FY2028, the status of the funding (e.g., committed or pending) (no page maximum)
☐ Revenue listing attached.
Describe any current efforts to secure additional funding, partnerships, or contracts to support programming in FY2027 and FY2028. This includes any efforts that are planned or currently underway. (maximum 1 page)
☐ Funding narrative attached.
CONFLICT OF INTEREST
Neither the Respondent nor any Subgrantees shall have any interest that will conflict with the performance of services required under any Grant Agreement resulting from the Grant Application, or that may be otherwise anti-competitive, as determined by EOHHS, for the duration of the Grant Agreement. If EOHHS determines that a Respondent possesses a conflicting interest, EOHHS reserves the right to propose measures or to consider measures proposed by the Respondent that would eliminate or mitigate such conflicting interest to EOHHS’s satisfaction.
To demonstrate freedom from conflicting interests, the Respondent certifies that:
☐ No interest will conflict with the performance of services required under the Grant Application and Grant Agreement. (See Section 5.13 of Attachment A.)
Place an “X” in the box to acknowledge.
☐ The Respondent will submit any additional information requested by EOHHS that may be relevant to the Respondent’s or any Subgrantee’s financial, legal, contractual, or other business or personal interests as they relate to the Grant Application and Grant Agreement. Place an “X” in the box to acknowledge.
The Respondent shall disclose any other information that may be relevant to its financial, legal, contractual, or any other business interests as it relates to the Grant Application and the Grant Agreement. If additional detail is needed to demonstrate freedom from conflicting interest, submit documentation in accordance with the submission instructions at the beginning of this Business Response section.
REQUIRED FORMS AND CERTIFICATIONS
The Respondent shall submit the Commonwealth-required forms below. All of the Commonwealth-required forms may be downloaded from the “File Attachments” section of this solicitation on the COMMBUYS website:
☐ W-9 Form (Massachusetts Substitute W-9 Format - Request for Taxpayer Identification Number and Certification) (New Grantees only) ☐ Contractor Authorized Signatory Listing The following documents are included among the required forms posted on COMMBUYS for review purposes only. The selected Respondents will complete these documents as part of the Grant Agreement execution process. For the latter two documents, Respondents shall certify acceptance of the terms and conditions in these documents in Section A above. EOHHS is prohibited from amending these documents or agreeing to any change in the language. Any Respondent’s suggestion or requirement altering these documents will be disregarded.
1. Authorization for Electronic Funds Transfer Form (New Grantees only)
1. Standard Contract Form (including Standard Contract Form Instructions, Contractor Certifications, and Commonwealth Terms and Conditions)
1. Commonwealth Terms and Conditions
PROGRAMMATIC RESPONSE
Provide responses as directed below. Responses cannot exceed the specified character limit for each response box or page limit for each attachment, if specified.
Responses must demonstrate the Respondent’s ability to assume all programmatic requirements in Section 2 of Attachment A, Model Grant Agreement (“Attachment A”). If a Respondent is unable to provide the information required in a specific submission requirement, expressly identify which information is not being submitted, and why. Submit the most comparable information available and explain, in accordance with this section, how the Respondent will have the capability to perform all Grant Agreement responsibilities.
1. ORGANIZATIONAL INFORMATION
1. Describe the organization’s background, structure, and capacity to carry out the proposed activities under this Grant Agreement. Include the following in the response:
1. The organization’s formation date, mission, and primary goals.
Current service areas and geographic reach.
Experience collaborating with EOHHS and other state agencies, including, for example, the Department of Children and Families, the Department of Youth Services, and Massachusetts District Attorneys’ offices.
Experience providing the types of services or collaborating with the types of service providers contemplated in Attachment A, Section 2.2.A, including but not limited to behavioral health service providers, community-based organizations, law enforcement agencies, residential facilities, and schools.
Experience working with individuals who have experienced Human Trafficking, including but not limited to experience providing mentoring and case management to those individuals.
Experience employing individuals with lived experience of Human Trafficking, including experience providing supports to said individuals in the workplace (e.g., clinical supervision, training, and leadership opportunities).
Experience meaningfully integrating the lived experience of individuals who have experienced Human Trafficking into program design and organizational operations (e.g., advisory boards and boards of directors).
If the Respondent is applying to provide Statewide Training and Technical Assistance, include information about the following in the response:
Experience delivering trainings to diverse stakeholders and the organization’s relevant areas of expertise.
Experience providing technical assistance, including case consultations to organizations and entities working with individuals who have experienced or may be at risk of Human Trafficking.
Experience acting as a Project Manager.
Describe the organization’s practices and philosophy for delivering services. Include the following in your response:
1. How the organization provides culturally responsive services that reflect individuals’ beliefs, cultures, values, gender identity and expression, sexual orientation, race, ethnicity, socioeconomic status, disability, language, national origin, and other identities and attributes.
How the organization’s current policies, procedures, and practices align or will align with the Massachusetts Legislative Task Force on the Prevention of Child Sexual Abuse recommendations as reflected in the Safe Kids Thrive website’s 8 Elements of Prevention (see Sections 1 and 2.5 of Attachment A).
(maximum 14,000 characters, including spaces)
Enter narrative here.
PROPOSED PROGRAM
1. Provide a description of the services the organization proposes to offer, pursuant to Section 2.2.A Individual and Community Services, in Attachment A. Include the following in the response:
1. How the organization will implement Individual and Community Services, including Survivor Mentoring, Case Management, and systems coordination and collaboration.
How the organization will ensure access to clinical consultation through internal staff or consultants, as needed, to support staff providing Survivor Mentoring or Case Management; how the organization will determine when clinical consultation is needed and any alternative methods of providing support to staff.
The proposed service flows and protocols, including how Participants will access services; the coordination between Survivor Mentoring, Case Management, and other related services and/or service referrals; and what the Participant experience will look like from initial engagement through ongoing service delivery.
The proposed location(s) where services will be delivered and how the Program setting supports service delivery.
An overview of data and measurable outcomes proposed to evaluate program quality and inform continuous improvement.
If the organization is proposing any supplemental services, please provide a description of the proposed services and their implementation. Please also describe how the proposed services will expand or strengthen the delivery and impact of Individual and Community Services.
Identify anticipated challenges in providing Individual and Community Services; describe how the organization will address said challenges.
(maximum 10,000 characters, including spaces)
Enter narrative here.
2. If the Respondent is proposing to provide Statewide Training and Technical Assistance (see Section 2.2.B Statewide Training and Technical Assistance, in Attachment A), include a narrative with the following in the response:
1. A summary of training and technical assistance activities the organization proposes to offer, pursuant to Section 2.2.B Statewide Training and Technical Assistance, in Attachment A.
A description of how the lived experience of individuals who have experienced Human Trafficking will be integrated into the design and implementation of training and technical assistance.
The organization’s proposed approach to coordinating with EOHHS and other relevant stakeholders to support the implementation of high-quality technical assistance opportunities. This portion of the response should address the role of the Project Manager and other relevant staff members, the development of training and SSYI HT materials, and the organization’s approach to ensuring high-quality, timely deliverables.
Identify anticipated challenges in providing Statewide Training and Technical Assistance and describe how the organization will address said challenges.
(maximum 10,000 characters, including spaces) Enter narrative here.
COST RESPONSE
1. COST RESPONSE
Each Respondent must attach a completed Program budget as the Cost Response in the form and format posted on COMMBUYS as Attachment C, consistent with Section 4 of Attachment A. Each Respondent must:
1. Follow the instructions provided in the Instructions sheet in Attachment C.
1. Complete narrative cells for each line of the Respondent’s proposed budget.
Complete a budget form for each state fiscal year of the Grant Agreement term, i.e., separate forms for Q3 through Q4 of FY2027 (January 1, 2027–June 30, 2027), FY2028 (July 1, 2027–June 30, 2028), and FY2029 (July 1, 2028–June 30, 2029).
1. Submit the budget form as an Excel file using the file naming convention: Attachment_C_SSYI_HT_Budget_Form_OrganizationName.
☐ Attachment C Budget Form attached.
File details come from the government source that posted it. Updated .