FY15CICGrantApplication.docx

FY15 Community Innovation Challenge Grant APPLICATION

Application deadline: October 10, 2014

Submission Instructions: This application form and all supporting documents must be submitted via email by October 10, 2014 to: CICgrants@state.ma.us

Please read the Grant Guidelines before completing this application. Applications will not be considered complete unless all requested information is provided. Signoff by participating entities must be included (see form at end of application). Applications received after the deadline will not be considered.

For more information, contact:

Tim Dodd CIC Grant Program Manager Executive Office for Administration and Finance Email: CICgrants@state.ma.us Phone: 617-727-2040 ext. 35405

Project title:

Amount requested:

Identify the lead applicant entity:

If applying for internal efficiency grant: the single local government entity If applying for regionalization grant: a lead municipality chosen from among municipalities participating in initiative; a lead school district among school districts considering forming a regional school district, a lead school district among school districts considering regionalizing services, a regional planning agency or council of governments, or a regional planning agency or council of governments serving as the administrative/fiscal agent on behalf of municipalities.

Lead applicant primary contact:

First Name, Last Name:

Name of Municipality, School, RPA or COG:

Phone Number:

Email Address:

Lead applicant secondary contact:

First Name, Last Name:

Name of Municipality, School, Regional or COG:

Phone Number:

Email Address:

Check type of participating entities:

· Two or more municipalities seeking to collaborate

· Regional school(s)

· School districts considering forming a regional school district or regionalizing services

· Regional planning agency or council of government

· Local government entity and non-profit seeking to collaborate

· Single municipality (for internal efficiency grant proposal) List all participating entities:

Purpose of the grant:

The Executive Office for Administration and Finance is soliciting thoughtful plans and proposals for innovative initiatives. Describe proposed initiative in detail, including exact purpose of the grant funds, objectives, problems trying to address, any efforts or steps already taken to address the problem, any obstacles encountered to date and plans to resolve those challenges, the manner in which economies of scale or efficiencies would be achieved, change in service delivery, what entity would be responsible for service delivery, how participating entities would retain oversight/responsibility of service, and how the population would continue to be served, and how any new service costs will continue to be funded once service is established and grant project completed.

In addition to providing a general description of the proposal here, applicants should also complete the sections below:

Benefits:

Identify cost savings and benefits for each participating entity.

Identify cost savings and how such savings will be achieved, including any removal of redundancies, reductions in personnel or unfilled positions eliminated.

Identify other benefits. Other benefits may include enhanced level of service, improvements to organization or management structure, improved public access to local government services, a more efficient level of service that still meets the population’s needs, improvements in qualifications or efficiency of staff, increased hours of operation, new online availability, or reduction in capital facilities to maintain.

Identify need for funding such that the initiative would not happen or would not achieve the identified benefits without the funds provided by this grant program.

Cost impact:

For each participating entity, identify any new costs that will be incurred and how the costs will be paid for or offset. Describe how new initiative will be made financially viable for the long-term once established.

Measures of success:

Propose approach to evaluating and measuring the success of the initiative, both the success of implementing the proposed project and the success of the initiative or reform going forward once implemented. Include expected measurable improvements in service delivery or efficiency.

Project budget for requested amount:

Provide a detailed and realistic project budget estimate. Include breakdown of amount requested by activity/task and type of cost. If other sources of funds are have been sought for this project, please identify other sources and whether those funds have been applied for (provide copy of application) or secured (provide evidence).

Note if project budget is attached as separate document.

Project timeline:

Projects must be completed before or by December 31, 2014. However, special consideration may be given to extended timelines for extraordinary projects. Note if project timeline is attached as separate document.

Identify innovative aspects of proposal:

...including changes in the way local government does business

Potential applicability to other local governments:

Projects will be evaluated in part on potential for applicability to other local governments and/or potential for expansion. Describe how proposed project meets this requirement of serving as a viable prototype for other local government entities. Describe how this project can be expanded.

Evidence of commitment among applicants/participants:

As evidence of commitment to the proposed project, applicants must submit documentation of signoff from each participating entity: if a city by the mayor or city manager, if a town by the board of selectmen, if a town with a town council by the town manager or administrator, if a school district by the school committee, if a district by the prudential committee.

Complete the form provided on the next page of this application.

LOCAL SUPPORT DOCUMENTATION FORM

Project Title:

Lead applicant primary contact:

First Name, Last Name:

Name of Municipality, School, RPA or COG:

Phone Number:

Email Address:

List all participating entities:

Sign on behalf of the Applicants:

Applicants must submit documentation of demonstrated support for the proposed initiative and grant application from each participating entity through the local support documentation form at the end of the application. Please refer to the chart below to determine who should sign your application.

Signature Entity

Print Name Title

Signature Entity

Print Name Title

Signature Entity

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Signature Entity

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Signature Entity

Print Name Title

Signature Entity

Print Name Title Duplicate this page if space needed for additional signatories FY15 Application Deadline: October 10, 2014 Page 1 of 8