SAFETHRIVE Budget App.xls

XLS spreadsheet 1 MB Posted Feb 26, 2018

Attached to: Madison’s Northside: A Safe and Thriving Community Youth Employment and Leadership Development
Solicitation number: 8718-2018-LN
Issued by: Wisconsin

About this file

Written by GovTribe AI · Nov 19, 2025

This is a budget application template for the City of Madison's Community Development Division for the 2018-19 Madison Northside: Safe and Thriving Community Funds program. The application solicits proposals from qualified entities to provide one or more of four primary program types: youth employment services targeting youth involved with the juvenile justice system, youth leadership development through Peace Projects or Non-Violence Clubs, expansion of pro-social activities and youth development programs with cross-generational engagement, and formation of a Northside Youth Employer Coalition to coordinate resources and training among businesses employing youth. Applicant organizations must provide proposed program names, contact information, and funding requests across multiple program categories. The application requests budget information for both 2018 and 2019 fiscal years and requires applicants to identify their legal status as 501(c)(3) organizations or secure a fiscal agent with such status.

The budget template tracks funding sources including Dane County Human Services, Dane County CDBG, Madison-Safe/Thrive allocations, Other Madison funds, United Way allocations and designations, other government sources, fundraising donations, and other revenue streams. Budget categories encompass personnel, operating expenses, and space costs. The application requires applicants to address program accessibility, outreach strategies, staffing positions with hourly wages, demographic data for participants served, poverty and racial equity considerations, and compliance with the Madison Living Wage Ordinance requiring all contracted staff to receive Madison Living Wage. Applicants must also document their current service participant demographics and identify underserved populations, explaining disparities and plans to address inequities.

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8718-0-2018 Madisons Northside - A Safe and Thriving Community.pdf	PDF	Feb 26, 2018

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CoverPage

APPLICATION FOR 2018-19 MADISON NORTHSIDE: SAFE AND THRIVING COMMUNITY FUNDS
1. AGENCY CONTACT INFORMATION
Legal Name of Organization
Mailing Address
Telephone
FAX
Director
Email Address
Additional Contact
Email Address
	Federal EIN:
	DUNS #:
	SAM Registration:
Is this group a 501 (C)(3)?
If no, applicant will need to secure a fiscal agent with 501 (C)(3) status
Name of Fiscal Agent
Fiscal Agent Contact Person
Fiscal Agent Email
A Fiscal Agent Form must be signed by the Fiscal Agent and submitted with this application.
2. PROPOSED PROGRAMS			2018-19 Request	Proposed Program Type
Program Name		Letter
Enter program name here		A	$0	A. Northside Youth Summer Employment Services
Contact:			Phone:		Email:
Enter program name here		B	$0	B. Youth Leadership Peace Project
Contact:			Phone:		Email:
Enter program name here		C	$0	C. Youth Program Expansion
Contact:			Phone:		Email:
Enter program name here		D	$0	D. Northside Youth Employer Coalition
Contact:			Phone:		Email:
		E	$0	Select a Program Type from the Drop-Down
Contact:			Phone:		Email:
Program F		F	$0	Select a Priority Statement from the Drop-Down
Contact:			Phone:		Email:
Program G		G	$0	Select a Priority Statement from the Drop-Down
Contact:			Phone:		Email:
Collaborative		H	$0	Select a Priority Statement from the Drop-Down
Contact:			Phone:		Email:
		TOTAL REQUEST	$0
3. SIGNATURE
Enter name:
		By entering your initials in the box		you are electronically signing your name and certifying that all information
				in this application is true and accurate.
DATE

&L&"Arial,Bold"&8&UCOMMUNITY DEVELOPMENT DIVISION&C&"Arial,Bold"&10COVER PAGE&R&"Arial,Bold"&8&UCITY OF MADISON &L&"Arial,Bold"&8COVER PAGE - &P&C&"Arial,Bold"&8 2018-19 APPLICATION FOR MADISON'S NORTHSIDE: A SAFE AND THRIVING COMMUNITY&R&"Arial,Bold"&8MARCH 29, 2018

Youth Employment

ORGANIZATION:	0					2018-19 REQD AMOUNT:
PROGRAM/LETTER:	A	Enter program name here				0
PRIORITY STATEMENT:	A. Northside Youth Summer Employment Services
PROGRAM BUDGET
2018 PROPOSED BUDGET		ACCOUNT CATEGORY
	SOURCE				SPECIAL
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS
DANE CO HUMAN SVCS	0	0	0	0	0
DANE CO CDBG	0	0	0	0	0
MADISON-SAFE/THRIVE	0	0	0	0	0
OTHER MADISON	0	0	0	0	0
UNITED WAY ALLOC	0	0	0	0	0
UNITED WAY DESIG	0	0	0	0	0
OTHER GOVT*	0	0	0	0	0
FUNDRAISING DONATIONS	0	0	0	0	0
OTHER*	0	0	0	0	0
TOTAL REVENUE	0	0	0	0	0
2019 PROPOSED BUDGET
	SOURCE				SPECIAL
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS
DANE CO HUMAN SVCS	0	0	0	0	0
DANE CO CDBG	0	0	0	0	0
MADISON-OJJDP	0	0	0	0	0
OTHER MADISON	0	0	0	0	0
UNITED WAY ALLOC	0	0	0	0	0
UNITED WAY DESIG	0	0	0	0	0
OTHER GOVT	0	0	0	0	0
FUNDRAISING DONATIONS	0	0	0	0	0
OTHER	0	0	0	0	0
TOTAL REVENUE	0	0	0	0	0
*OTHER GOVT & OTHER 2018
Source	Amount	Terms
	0
	0
	0
	0
	0
TOTAL	0
Youth wage information and any addional information about revenue and expenses for this program.

&L&"Arial,Bold"&8&UCOMMUNITY DEVELOPMENT DIVISION&R&"Arial,Bold"&8&UCITY OF MADISON &L&"Arial,Bold"&8YOUTH EMPLOYMENT&C&"Arial,Bold"&8 2018-19 APPLICATION FOR MADISON'S NORTHSIDE: A SAFE AND THRIVING COMMUNITY&R&"Arial,Bold"&8MARCH 29, 2018

Youth Leadership

ORGANIZATION:	0					2018-19 REQD AMOUNT:
PROGRAM/LETTER:	B	Enter program name here				0
PRIORITY STATEMENT:	B. Youth Leadership Peace Project
PROGRAM BUDGET
2018 PROPOSED BUDGET		ACCOUNT CATEGORY
	SOURCE				SPECIAL
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS
DANE CO HUMAN SVCS	0	0	0	0	0
DANE CO CDBG	0	0	0	0	0
MADISON-SAFE/THRIVE	0	0	0	0	0
OTHER MADISON	0	0	0	0	0
UNITED WAY ALLOC	0	0	0	0	0
UNITED WAY DESIG	0	0	0	0	0
OTHER GOVT*	0	0	0	0	0
FUNDRAISING DONATIONS	0	0	0	0	0
OTHER*	0	0	0	0	0
TOTAL REVENUE	0	0	0	0	0
2019 PROPOSED BUDGET
	SOURCE				SPECIAL
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS
DANE CO HUMAN SVCS	0	0	0	0	0
DANE CO CDBG	0	0	0	0	0
MADISON-OJJDP	0	0	0	0	0
OTHER MADISON	0	0	0	0	0
UNITED WAY ALLOC	0	0	0	0	0
UNITED WAY DESIG	0	0	0	0	0
OTHER GOVT	0	0	0	0	0
FUNDRAISING DONATIONS	0	0	0	0	0
OTHER	0	0	0	0	0
TOTAL REVENUE	0	0	0	0	0
*OTHER GOVT & OTHER 2018
Source	Amount	Terms
	0
	0
	0
	0
	0
TOTAL	0
Addional information about revenue and expenses for this program.

&L&"Arial,Bold"&8&UCOMMUNITY DEVELOPMENT DIVISION&R&"Arial,Bold"&8&UCITY OF MADISON &L&"Arial,Bold"&8YOUTH LEADERSHIP&C&"Arial,Bold"&8 2018-19 APPLICATION FOR MADISON'S NORTHSIDE: A SAFE AND THRIVING COMMUNITY&R&"Arial,Bold"&8MARCH 29, 2018

Expanded Programming

ORGANIZATION:	0					2018-19 REQD AMOUNT:
PROGRAM/LETTER:	C	Enter program name here				0
PRIORITY STATEMENT:	C. Youth Program Expansion
PROGRAM BUDGET
2018 PROPOSED BUDGET		ACCOUNT CATEGORY
	SOURCE				SPECIAL
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS
DANE CO HUMAN SVCS	0	0	0	0	0
DANE CO CDBG	0	0	0	0	0
MADISON-SAFE/THRIVE	0	0	0	0	0
OTHER MADISON	0	0	0	0	0
UNITED WAY ALLOC	0	0	0	0	0
UNITED WAY DESIG	0	0	0	0	0
OTHER GOVT*	0	0	0	0	0
FUNDRAISING DONATIONS	0	0	0	0	0
OTHER*	0	0	0	0	0
TOTAL REVENUE	0	0	0	0	0
2019 PROPOSED BUDGET
	SOURCE				SPECIAL
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS
DANE CO HUMAN SVCS	0	0	0	0	0
DANE CO CDBG	0	0	0	0	0
MADISON-OJJDP	0	0	0	0	0
OTHER MADISON	0	0	0	0	0
UNITED WAY ALLOC	0	0	0	0	0
UNITED WAY DESIG	0	0	0	0	0
OTHER GOVT	0	0	0	0	0
FUNDRAISING DONATIONS	0	0	0	0	0
OTHER	0	0	0	0	0
TOTAL REVENUE	0	0	0	0	0
*OTHER GOVT & OTHER 2018
Source	Amount	Terms
	0
	0
	0
	0
	0
TOTAL	0
Addional information about revenue and expenses for this program.

&L&"Arial,Bold"&8&UCOMMUNITY DEVELOPMENT DIVISION&R&"Arial,Bold"&8&UCITY OF MADISON &L&"Arial,Bold"&8EXPANDED PROGRAMMING&C&"Arial,Bold"&8 2018-19 APPLICATION FOR MADISON'S NORTHSIDE: A SAFE AND THRIVING COMMUNITY&R&"Arial,Bold"&8MARCH 29, 2018

Youth Employer Coalition

ORGANIZATION:	0					2018-19 REQD AMOUNT:
PROGRAM/LETTER:	D	Enter program name here				0
PRIORITY STATEMENT:	D. Northside Youth Employer Coalition
PROGRAM BUDGET
2018 PROPOSED BUDGET		ACCOUNT CATEGORY
	SOURCE				SPECIAL
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS
DANE CO HUMAN SVCS	0	0	0	0	0
DANE CO CDBG	0	0	0	0	0
MADISON-SAFE/THRIVE	0	0	0	0	0
OTHER MADISON	0	0	0	0	0
UNITED WAY ALLOC	0	0	0	0	0
UNITED WAY DESIG	0	0	0	0	0
OTHER GOVT*	0	0	0	0	0
FUNDRAISING DONATIONS	0	0	0	0	0
OTHER*	0	0	0	0	0
TOTAL REVENUE	0	0	0	0	0
2019 PROPOSED BUDGET
	SOURCE				SPECIAL
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS
DANE CO HUMAN SVCS	0	0	0	0	0
DANE CO CDBG	0	0	0	0	0
MADISON-OJJDP	0	0	0	0	0
OTHER MADISON	0	0	0	0	0
UNITED WAY ALLOC	0	0	0	0	0
UNITED WAY DESIG	0	0	0	0	0
OTHER GOVT	0	0	0	0	0
FUNDRAISING DONATIONS	0	0	0	0	0
OTHER	0	0	0	0	0
TOTAL REVENUE	0	0	0	0	0
*OTHER GOVT & OTHER 2018
Source	Amount	Terms
	0
	0
	0
	0
	0
TOTAL	0
Addional information about revenue and expenses for this program.

&L&"Arial,Bold"&8&UCOMMUNITY DEVELOPMENT DIVISION&R&"Arial,Bold"&8&UCITY OF MADISON &L&"Arial,Bold"&8YOUTH EMPLOYER COALITION&C&"Arial,Bold"&8 2018-19 APPLICATION FOR MADISON'S NORTHSIDE: A SAFE AND THRIVING COMMUNITY&R&"Arial,Bold"&8MARCH 29, 2018

Summer Nights

ORGANIZATION:	0					REQUESTED AMOUNT:
PROGRAM/LETTER:	E	0				0
PRIORITY STATEMENT:	Select a Program Type from the Drop-Down
PROGRAM BUDGET
2018 PROPOSED BUDGET		ACCOUNT CATEGORY
	SOURCE				SPECIAL
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS
DANE CO HUMAN SVCS	0	0	0	0	0
DANE CO CDBG	0	0	0	0	0
MADISON-CDD	0	0	0	0	0
UNITED WAY ALLOC	0	0	0	0	0
UNITED WAY DESIG	0	0	0	0	0
OTHER GOVT	0	0	0	0	0
FUNDRAISING DONATIONS	0	0	0	0	0
MADISON OJJDP	0	0	0	0	0
OTHER	0	0	0	0	0
TOTAL REVENUE	0	0	0	0	0
2019 PROPOSED BUDGET
	SOURCE				SPECIAL
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS
DANE CO HUMAN SVCS	0	0	0	0	0
DANE CO CDBG	0	0	0	0	0
MADISON-CDD	0	0	0	0	0
UNITED WAY ALLOC	0	0	0	0	0
UNITED WAY DESIG	0	0	0	0	0
OTHER GOVT*	0	0	0	0	0
FUNDRAISING DONATIONS	0	0	0	0	0
MADISON OJJDP	0	0	0	0	0
OTHER**	0	0	0	0	0
TOTAL REVENUE	0	0	0	0	0
*OTHER GOVT 2018
Source	Amount	Terms
	0
	0
	0
	0
	0
TOTAL	0
**OTHER 2019
Source	Amount	Terms
	0
	0
	0
	0
	0
TOTAL	0

&L&"Arial,Bold"&8&UCOMMUNITY DEVELOPMENT DIVISION&C&"Arial,Bold"&10PROGRAM DESCRIPTION&R&"Arial,Bold"&8&UCITY OF MADISON &L&"Arial,Bold"&8PROGRAM A - &P&C&"Arial,Bold"&8CDD 2018 APPLICATION FOR ADULT AND YOUTH EMPLOYMENT&R&"Arial,Bold"&8AUGUST 7, 2017

PgmF

ORGANIZATION:	0		REQUESTED AMOUNT:	ORGANIZATION:	0		ORGANIZATION:	0		ORGANIZATION:	0			ORGANIZATION:	0							ORGANIZATION:	0		ORGANIZATION:	0
PROGRAM/LETTER:	F	Program F	0	PROGRAM/LETTER:	F	Program F	PROGRAM/LETTER:	F	Program F	PROGRAM/LETTER:	F	Program F		PROGRAM/LETTER:	F	Program F						PROGRAM/LETTER:	F	Program F	PROGRAM/LETTER:	F	Program F
PRIORITY STATEMENT:	Select a Priority Statement from the Drop-Down
				3. ACCESSIBILITY: Describe how aspects of your program ( e.g. hours of availability, response time, location, staffing,			7. OUTREACH: Describe how you use, or will use, marketing and outreach strategies with your intended service population?			11. PROGRAM STAFFING 2016: Identify all positions that are involved as staff to this program.				15. What is your best estimate for the percentage of your program population that is low income?								17. The City is interested in addressing issues of poverty and racial equity for residents of Madison. Examine the completed chart in			PROGRAM BUDGET
				and outreach and engagement efforts) ensure that a diverse client base will find your program accessible,			How will these efforts improve your services?			Madison Living Wage Ordinance requires that all staff performing work in a contracted service receive Madison Living Wage.												question 16 on Madison demographics. Please comment on your programs current service participants and identify your			20. 2015 BUDGET		ACCOUNT CATEGORY
1. SERVICE DESCRIPTION - Describe the proposed service(s). Include key aspects of program design: structure of				culturally responsive, welcoming and effective in achieving increased well being and safety.						Staff Title	FTE	Duties	Hourly Wage*	16. DEMOGRAPHICS: Complete the following chart for unduplicated participants served by this program in 2014. Indicate the number								underserved population(s). Explain how you understand any disparities and plans you have to address these issues.				SOURCE				SPECIAL
programming, staffing, expected frequency of client contact, duration of client contact, focus of curriculums as applicable, etc.											0			and percentage for the following characteristics. For new programs, estimate projected participant numbers and descriptors.											REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS
											0								MADISON						DANE CO HUMAN SVCS	0	0	0	0	0
											0			DESCRIPTOR	PART #	PART %	STAFF #	STAFF %	GEN %	POV %	R/POV**				DANE CO CDBG	0	0	0	0	0
											0			RACE											MADISON-CDD	0	0	0	0	0
											0			WHITE/CAUCASIAN	0	0%	0	0%	80%	67%	16%				UNITED WAY ALLOC	0	0	0	0	0
											0			BLACK/AFRICAN AMERICAN	0	0%	0	0%	7%	15%	39%				UNITED WAY DESIG	0	0	0	0	0
											0			ASIAN	0	0%	0	0%	8%	11%	28%				OTHER GOVT	0	0	0	0	0
											0			AMERICAN INDIAN/ALASKAN NATIVE	0	0%	0	0%	<1%	<1%	32%				FUNDRAISING DONATIONS	0	0	0	0	0
											0			NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER	0	0%	0	0%	0%	0%	0%				USER FEES	0	0	0	0	0
							8.COLLABORATION: Describe your agency's experience and success in collaborating with other organizations to deliver				0			MULTI-RACIAL	0	0%	0	0%	3%	4%	26%				OTHER	0	0	0	0	0
							services to the target population for this program. To what extent are you using collaborative approaches in this program design?				0			BALANCE/OTHER	0	0%	0	0%	1%	2%	28%				TOTAL REVENUE	0	0	0	0	0
										TOTAL	0		*(LIVING WAGE FOR 2016 IS $12.83)	TOTAL RACE	0	0%	0	0%
														ETHNICITY											21. 2016 PROPOSED BUDGET
										PURPOSE				HISPANIC OR LATINO	0	0%	0	0%	7%	9%	26%	18. Does the staffing of the program reflect the racial and cultural diversity of the residents served? If not, plans do you have				SOURCE				SPECIAL
										In allocating resources to address service needs, we are committed to supporting organizations that are welcoming,				NOT HISPANIC OR LATINO	0	0%	0	0%	93%	81%	74%	to address this?			REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS
										inclusive and culturally responsive environments for all of Madison's residents. Accordingly, we will be gathering				TOTAL ETHNICITY	0	0%	0	0%							DANE CO HUMAN SVCS	0	0	0	0	0
										information about your service populations, your staffing and your governing boards that will help us gain greater insight				AGE							*REPORTED MADISON RACE AND ETHNICITY PERCENTAGES ARE				DANE CO CDBG	0	0	0	0	0
										into our capacities as a community to engage and serve an increasingly diverse population.				<2	0	0%					BASED ON 2009-2013 AMERICAN COMMUNITY SURVEY FIGURES.				MADISON-CDD	0	0	0	0	0
				4. POPULATION SERVED: Describe in terms of age, income level, limited English proficiency, literacy, cognitive or										2 - 5	0	0%					AS SUCH, PERCENTAGES REPORTED ARE ESTIMATES.				UNITED WAY ALLOC	0	0	0	0	0
				physical disabilities or challenges.						12. How is your client demographic information (gender, age, race, ethnicity, and disabilities) collected?				6 - 12	0	0%					See Instructions for explanations of these categories.				UNITED WAY DESIG	0	0	0	0	0
														13 - 17	0	0%									OTHER GOVT*	0	0	0	0	0
2. IMPACT: Describe how the proposed program will contribute to the Community Goals and the Community Indicators of Success							9. How are volunteers utilized in this program? (select one)							18 - 29	0	0%					**R/POV=Percent of racial group living below the poverty line.				FUNDRAISING DONATIONS	0	0	0	0	0
identified in the 2016 Plan for Community Development Division Provision of Adult Senior or Crisis Support Services (refer to instructions).								Number of volunteers utilized in 2014?						30 - 59	0	0%									USER FEES	0	0	0	0	0
								Number of volunteer hours utilized in this program in 2014?						60 - 74	0	0%									OTHER**	0	0	0	0	0
										13. Do you collect household income levels for participants?				75 & UP	0	0%									TOTAL REVENUE	0	0	0	0	0
										If yes, how do collect this information?				TOTAL AGE	0	0%
							10. EXPERIENCE: Describe how the experience and qualifications of your program staff							PERSONS WITH DISABILITIES	0	0%									*OTHER GOVT 2016
				5. PROPOSED SERVICE NUMBERS: Include number of unduplicated clients to be served, number of service hours			will contribute to the success of the proposed program?							RESIDENCY											Source	Amount	Terms
				to be provided, number of workshops/classes, etc.)										CITY OF MADISON	0	0%										0
														DANE COUNTY (NOT IN CITY)	0	0%						19. How does this program serve non-English speakers?				0
										14. What measure do you use to describe client income levels?				OUTSIDE DANE COUNTY	0	0%										0
												Qualification for free and reduced lunch		TOTAL RESIDENCY	0	0%										0
												Dane County median Income		TOTAL	0	0%										0
												Federal Poverty		MALE	0	0%									TOTAL	0
												Food Share qualification		FEMALE	0	0%									**OTHER 2016
												Other:		UNKNOWN/OTHER	0	0%									Source	Amount	Terms
				6. LOCATION: Location of service and intended service area (include specific boundaries of service area, if applicable).																						0
																										0
																										0
																										0
																										0
																									TOTAL	0

&L&"Arial,Bold"&8&UCOMMUNITY DEVELOPMENT DIVISION&C&"Arial,Bold"&10PROGRAM DESCRIPTION&R&"Arial,Bold"&8&UCITY OF MADISON &L&"Arial,Bold"&8PROGRAM A - &P&C&"Arial,Bold"&8CDD 2016 APPLICATION FOR CRISIS/SENIORS&R&"Arial,Bold"&8JUNE 19, 2015

PgmG

ORGANIZATION:	0		REQUESTED AMOUNT:	ORGANIZATION:	0		ORGANIZATION:	0		ORGANIZATION:	0			ORGANIZATION:	0							ORGANIZATION:	0		ORGANIZATION:	0
PROGRAM/LETTER:	G	Program G	0	PROGRAM/LETTER:	G	Program G	PROGRAM/LETTER:	G	Program G	PROGRAM/LETTER:	G	Program G		PROGRAM/LETTER:	G	Program G						PROGRAM/LETTER:	G	Program G	PROGRAM/LETTER:	G	Program G
PRIORITY STATEMENT:	Select a Priority Statement from the Drop-Down
				3. ACCESSIBILITY: Describe how aspects of your program ( e.g. hours of availability, response time, location, staffing,			7. OUTREACH: Describe how you use, or will use, marketing and outreach strategies with your intended service population?			11. PROGRAM STAFFING 2016: Identify all positions that are involved as staff to this program.				15. What is your best estimate for the percentage of your program population that is low income?								17. The City is interested in addressing issues of poverty and racial equity for residents of Madison. Examine the completed chart in			PROGRAM BUDGET
				and outreach and engagement efforts) ensure that a diverse client base will find your program accessible,			How will these efforts improve your services?			Madison Living Wage Ordinance requires that all staff performing work in a contracted service receive Madison Living Wage.												question 16 on Madison demographics. Please comment on your programs current service participants and identify your			20. 2015 BUDGET		ACCOUNT CATEGORY
1. SERVICE DESCRIPTION - Describe the proposed service(s). Include key aspects of program design: structure of				culturally responsive, welcoming and effective in achieving increased well being and safety.						Staff Title	FTE	Duties	Hourly Wage*	16. DEMOGRAPHICS: Complete the following chart for unduplicated participants served by this program in 2014. Indicate the number								underserved population(s). Explain how you understand any disparities and plans you have to address these issues.				SOURCE				SPECIAL
programming, staffing, expected frequency of client contact, duration of client contact, focus of curriculums as applicable, etc.											0			and percentage for the following characteristics. For new programs, estimate projected participant numbers and descriptors.											REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS
											0								MADISON						DANE CO HUMAN SVCS	0	0	0	0	0
											0			DESCRIPTOR	PART #	PART %	STAFF #	STAFF %	GEN %	POV %	R/POV**				DANE CO CDBG	0	0	0	0	0
											0			RACE											MADISON-CDD	0	0	0	0	0
											0			WHITE/CAUCASIAN	0	0%	0	0%	80%	67%	16%				UNITED WAY ALLOC	0	0	0	0	0
											0			BLACK/AFRICAN AMERICAN	0	0%	0	0%	7%	15%	39%				UNITED WAY DESIG	0	0	0	0	0
											0			ASIAN	0	0%	0	0%	8%	11%	28%				OTHER GOVT	0	0	0	0	0
											0			AMERICAN INDIAN/ALASKAN NATIVE	0	0%	0	0%	<1%	<1%	32%				FUNDRAISING DONATIONS	0	0	0	0	0
											0			NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER	0	0%	0	0%	0%	0%	0%				USER FEES	0	0	0	0	0
							8.COLLABORATION: Describe your agency's experience and success in collaborating with other organizations to deliver				0			MULTI-RACIAL	0	0%	0	0%	3%	4%	26%				OTHER	0	0	0	0	0
							services to the target population for this program. To what extent are you using collaborative approaches in this program design?				0			BALANCE/OTHER	0	0%	0	0%	1%	2%	28%				TOTAL REVENUE	0	0	0	0	0
										TOTAL	0		*(LIVING WAGE FOR 2016 IS $12.83)	TOTAL RACE	0	0%	0	0%
														ETHNICITY											21. 2016 PROPOSED BUDGET
										PURPOSE				HISPANIC OR LATINO	0	0%	0	0%	7%	9%	26%	18. Does the staffing of the program reflect the racial and cultural diversity of the residents served? If not, plans do you have				SOURCE				SPECIAL
										In allocating resources to address service needs, we are committed to supporting organizations that are welcoming,				NOT HISPANIC OR LATINO	0	0%	0	0%	93%	81%	74%	to address this?			REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS
										inclusive and culturally responsive environments for all of Madison's residents. Accordingly, we will be gathering				TOTAL ETHNICITY	0	0%	0	0%							DANE CO HUMAN SVCS	0	0	0	0	0
										information about your service populations, your staffing and your governing boards that will help us gain greater insight				AGE							*REPORTED MADISON RACE AND ETHNICITY PERCENTAGES ARE				DANE CO CDBG	0	0	0	0	0
										into our capacities as a community to engage and serve an increasingly diverse population.				<2	0	0%					BASED ON 2009-2013 AMERICAN COMMUNITY SURVEY FIGURES.				MADISON-CDD	0	0	0	0	0
				4. POPULATION SERVED: Describe in terms of age, income level, limited English proficiency, literacy, cognitive or										2 - 5	0	0%					AS SUCH, PERCENTAGES REPORTED ARE ESTIMATES.				UNITED WAY ALLOC	0	0	0	0	0
				physical disabilities or challenges.						12. How is your client demographic information (gender, age, race, ethnicity, and disabilities) collected?				6 - 12	0	0%					See Instructions for explanations of these categories.				UNITED WAY DESIG	0	0	0	0	0
														13 - 17	0	0%									OTHER GOVT*	0	0	0	0	0
2. IMPACT: Describe how the proposed program will contribute to the Community Goals and the Community Indicators of Success							9. How are volunteers utilized in this program? (select one)							18 - 29	0	0%					**R/POV=Percent of racial group living below the poverty line.				FUNDRAISING DONATIONS	0	0	0	0	0
identified in the 2016 Plan for Community Development Division Provision of Adult Senior or Crisis Support Services (refer to instructions).								Number of volunteers utilized in 2014?						30 - 59	0	0%									USER FEES	0	0	0	0	0
								Number of volunteer hours utilized in this program in 2014?						60 - 74	0	0%									OTHER**	0	0	0	0	0
										13. Do you collect household income levels for participants?				75 & UP	0	0%									TOTAL REVENUE	0	0	0	0	0
										If yes, how do collect this information?				TOTAL AGE	0	0%
							10. EXPERIENCE: Describe how the experience and qualifications of your program staff							PERSONS WITH DISABILITIES	0	0%									*OTHER GOVT 2016
				5. PROPOSED SERVICE NUMBERS: Include number of unduplicated clients to be served, number of service hours			will contribute to the success of the proposed program?							RESIDENCY											Source	Amount	Terms
				to be provided, number of workshops/classes, etc.)										CITY OF MADISON	0	0%										0
														DANE COUNTY (NOT IN CITY)	0	0%						19. How does this program serve non-English speakers?				0
										14. What measure do you use to describe client income levels?				OUTSIDE DANE COUNTY	0	0%										0
												Qualification for free and reduced lunch		TOTAL RESIDENCY	0	0%										0
												Dane County median Income		TOTAL	0	0%										0
												Federal Poverty		MALE	0	0%									TOTAL	0
												Food Share qualification		FEMALE	0	0%									**OTHER 2016
												Other:		UNKNOWN/OTHER	0	0%									Source	Amount	Terms
				6. LOCATION: Location of service and intended service area (include specific boundaries of service area, if applicable).																						0
																										0
																										0
																										0
																										0
																									TOTAL	0

&L&"Arial,Bold"&8&UCOMMUNITY DEVELOPMENT DIVISION&C&"Arial,Bold"&10PROGRAM DESCRIPTION&R&"Arial,Bold"&8&UCITY OF MADISON &L&"Arial,Bold"&8PROGRAM A - &P&C&"Arial,Bold"&8CDD 2016 APPLICATION FOR CRISIS/SENIORS&R&"Arial,Bold"&8JUNE 19, 2015

PgmH

ORGANIZATION:	0					ORGANIZATION:	0		ORGANIZATION:	0		ORGANIZATION:	0		ORGANIZATION:	0				ORGANIZATION:	0					ORGANIZATION:	0
PROGRAM/LETTER:	H	Collaborative				PROGRAM/LETTER:	H	Collaborative	PROGRAM/LETTER:	H	Collaborative	PROGRAM/LETTER:	H	Collaborative	PROGRAM/LETTER:	H	Collaborative			PROGRAM/LETTER:	H	Collaborative				PROGRAM/LETTER:	H	Collaborative
						PRIORITY STATEMENT:	Select a Priority Statement from the Drop-Down
PROGRAM BUDGET									7. POPULATION SERVED: Please describe in terms of age, income level, LEP, literacy, cognitive or physical disabilities			13. BARRIERS TO SERVICE: Are there populations that are experiencing barriers to the service you are proposing,i.e, cultural			17. PARTICIPANT INCOME LEVELS:					22. DEMOGRAPHICS						23. PROGRAM OUTCOMES
1. 2013 BUDGET		ACCOUNT CATEGORY							or challenges.			differences, language barriers and/or physical or mental impairments or disabilities? Describe the ability of proposed program			Indicate the number of households of each income level and size that this program would serve in 2014.					Complete the following chart for unduplicated participants served by this program in 2012. Indicate the number and percentage										Number of unduplicated individual participants served during 2012.	0
	SOURCE				SPECIAL	DESCRIPTION OF SERVICES						to respond to the needs of diverse populations.			Income Level			Number of Households		for the following characteristics. For new programs, please estimate projected participant numbers and descriptors.										Total to be served in 2014.
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS	3. NEED FOR PROGRAM: Please identify local community need or gap in service that the proposed program will address.									Over 80% of county median income			0
DANE CO HUMAN SVCS	0	0	0	0	0										Between 50% to 80% of county median income			0		PARTICIPANT			PARTICIPANT			Complete the following for each program outcome. No more than two outcomes per program will be reviewed.
DANE CO CDBG	0	0	0	0	0										Between 30% to 50% of county median income			0		DESCRIPTOR	#	%	DESCRIPTOR	#	%
MADISON-CDD	0	0	0	0	0										Less than 30% of county median income			0		TOTAL	0	0%	AGE			Refer to the instructions for detailed descriptions of what should be included in the table below.
UNITED WAY ALLOC	0	0	0	0	0										Total households to be served			0		MALE	0	0%	<2	0	0%
UNITED WAY DESIG	0	0	0	0	0															FEMALE	0	0%	2 - 5	0	0%	Outcome Objective # 1:
OTHER GOVT	0	0	0	0	0				8. LOCATION: Location of service and intended service area (include census tract where service is tract specific).						18. HOW IS THIS INFORMATION CURRENTLY COLLECTED?					UNKNOWN/OTHER	0	0%	6 - 12	0	0%
FUNDRAISING DONATIONS	0	0	0	0	0																		13 - 17	0	0%	Performance Indicator(s):
USER FEES	0	0	0	0	0																		18 - 29	0	0%
OTHER	0	0	0	0	0																		30 - 59	0	0%
TOTAL REVENUE	0	0	0	0	0																		60 - 74	0	0%	Proposed for 2014:		Total to be considered in	0		Targeted % to meet perf. measures	0%
						4. SERVICE DESCRIPTION - Describe the service(s) provided including your expectations of the impact of your activities.			9. OUTREACH PLAN: Describe your outreach and marketing strategies to engage your intended service population.														75 & UP	0	0%			perf. measurement			Targeted # to meet perf. measure	0
2. 2014 PROPOSED BUDGET															19. USER FEE STRUCTURE					Note: Race and ethnic categories are stated			TOTAL AGE	0	0%
	SOURCE				SPECIAL															as defined in HUD standards			RACE			Explain the measurement
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS							14. EXPERIENCE: Please describe how your agency, and program staff experience, qualifications, and past											WHITE/CAUCASIAN	0	0%	tools or methods:
DANE CO HUMAN SVCS	0	0	0	0	0							performance will contribute to the success of the proposed program?											BLACK/AFRICAN AMERICAN	0	0%
DANE CO CDBG	0	0	0	0	0																		ASIAN	0	0%
MADISON-CDD	0	0	0	0	0										20. AGENCY COST ALLOCATION PLAN: What method does your agency use to determine indirect cost allocations								AMERICAN INDIAN/ALASKAN NATIVE	0	0%
UNITED WAY ALLOC	0	0	0	0	0										among programs?								NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER	0	0%
UNITED WAY DESIG	0	0	0	0	0																		MULTI-RACIAL:	0	0%	Outcome Objective # 2:
OTHER GOVT*	0	0	0	0	0																		Black/AA & White/Caucasian	0	0%
FUNDRAISING DONATIONS	0	0	0	0	0																		Asian & White/Caucasian	0	0%	Performance Indicator(s):
USER FEES	0	0	0	0	0				10. COORDINATION: Describe how you coordinate your service delivery with other community groups or agencies.														Am Indian/Alaskan Native & White/Caucasian	0	0%
OTHER**	0	0	0	0	0																		Am Indian/Alaskan Native & Black/AA	0	0%
TOTAL REVENUE	0	0	0	0	0																		BALANCE/OTHER	0	0%	Proposed for 2014:		Total to be considered in			Targeted % to meet perf. measures	0%
																							TOTAL RACE	0	0%			perf. measurement			Targeted # to meet perf. measure	0
*OTHER GOVT 2014						5. PROPOSED PROGRAM CONTRACT GOALS: Include clearly defined service goals and process objectives: number of									21. PROGRAM ACTIVITIES: Describe activities/benchmarks by timeline to illustrate how your program will be implemented.								ETHNICITY
Source	Amount	Terms				unduplicated clients to be served, number of service hours to be provided etc.													Est. Month				HISPANIC OR LATINO	0	0%	Explain the measurement
	0														Activity Benchmark				of Completion				NOT HISPANIC OR LATINO	0	0%	tools or methods:
	0																						TOTAL ETHNICITY	0	0%
	0											15. LICENSING OR ACCREDITATION: Report program licensing, accreditation or certification standards currently applied.											PERSONS WITH DISABILITIES	0	0%
	0																						RESIDENCY
	0																						CITY OF MADISON	0	0%
TOTAL	0								11. VOLUNTEERS: How are volunteers utilized in this program?														DANE COUNTY (NOT IN CITY)	0	0%
**OTHER 2014																							OUTSIDE DANE COUNTY	0	0%
Source	Amount	Terms				6. SERVICE HOURS: Frequency, duration of service and hours and days of service availability.						16. STAFF: Please indicate FTE’s dedicated to this program, and required qualifications for these staff positions.											TOTAL RESIDENCY	0	0%
	0											All positions in city-funded programs must meet City Living Wage requirements.
	0											Staff Title	FTE	Qualifications
	0
	0								12. Number of volunteers utilized in 2012?
	0								Number of volunteer hours utilized in this program in 2012?
TOTAL	0

&L&"Arial,Bold"&8&UCOMMUNITY DEVELOPMENT DIVISION&C&"Arial,Bold"&10PROGRAM DESCRIPTION&R&"Arial,Bold"&8&UCITY OF MADISON &L&"Arial,Bold"&8PROGRAM H - &P&R&"Arial,Bold"&8JUNE 4, 2013

PgmI

ORGANIZATION:	0					ORGANIZATION:	0		ORGANIZATION:	0		ORGANIZATION:	0		ORGANIZATION:	0				ORGANIZATION:	0					ORGANIZATION:	0
PROGRAM/LETTER:	0	0				PROGRAM/LETTER:	0	0	PROGRAM/LETTER:	0	0	PROGRAM/LETTER:	0	0	PROGRAM/LETTER:	0	0			PROGRAM/LETTER:	0	0				PROGRAM/LETTER:	0	0
						PRIORITY STATEMENT:	0
PROGRAM BUDGET									7. POPULATION SERVED: Please describe in terms of age, income level, LEP, literacy, cognitive or physical disabilities			13. BARRIERS TO SERVICE: Are there populations that are experiencing barriers to the service you are proposing,i.e, cultural			17. PARTICIPANT INCOME LEVELS:					22. DEMOGRAPHICS						23. PROGRAM OUTCOMES
1. 2013 BUDGET		ACCOUNT CATEGORY							or challenges.			differences, language barriers and/or physical or mental impairments or disabilities? Describe the ability of proposed program			Indicate the number of households of each income level and size that this program would serve in 2014.					Complete the following chart for unduplicated participants served by this program in 2012. Indicate the number and percentage										Number of unduplicated individual participants served during 2012.	0
	SOURCE				SPECIAL	DESCRIPTION OF SERVICES						to respond to the needs of diverse populations.			Income Level			Number of Households		for the following characteristics. For new programs, please estimate projected participant numbers and descriptors.										Total to be served in 2014.
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS	3. NEED FOR PROGRAM: Please identify local community need or gap in service that the proposed program will address.									Over 80% of county median income			0
DANE CO HUMAN SVCS	0	0	0	0	0										Between 50% to 80% of county median income			0		PARTICIPANT			PARTICIPANT			Complete the following for each program outcome. No more than two outcomes per program will be reviewed.
DANE CO CDBG	0	0	0	0	0										Between 30% to 50% of county median income			0		DESCRIPTOR	#	%	DESCRIPTOR	#	%
MADISON-CDD	0	0	0	0	0										Less than 30% of county median income			0		TOTAL	0	0%	AGE			Refer to the instructions for detailed descriptions of what should be included in the table below.
UNITED WAY ALLOC	0	0	0	0	0										Total households to be served			0		MALE	0	0%	<2	0	0%
UNITED WAY DESIG	0	0	0	0	0															FEMALE	0	0%	2 - 5	0	0%	Outcome Objective # 1:
OTHER GOVT	0	0	0	0	0				8. LOCATION: Location of service and intended service area (include census tract where service is tract specific).						18. HOW IS THIS INFORMATION CURRENTLY COLLECTED?					UNKNOWN/OTHER	0	0%	6 - 12	0	0%
FUNDRAISING DONATIONS	0	0	0	0	0																		13 - 17	0	0%	Performance Indicator(s):
USER FEES	0	0	0	0	0																		18 - 29	0	0%
OTHER	0	0	0	0	0																		30 - 59	0	0%
TOTAL REVENUE	0	0	0	0	0																		60 - 74	0	0%	Proposed for 2014:		Total to be considered in	0		Targeted % to meet perf. measures	0%
						4. SERVICE DESCRIPTION - Describe the service(s) provided including your expectations of the impact of your activities.			9. OUTREACH PLAN: Describe your outreach and marketing strategies to engage your intended service population.														75 & UP	0	0%			perf. measurement			Targeted # to meet perf. measure	0
2. 2014 PROPOSED BUDGET															19. USER FEE STRUCTURE					Note: Race and ethnic categories are stated			TOTAL AGE	0	0%
	SOURCE				SPECIAL															as defined in HUD standards			RACE			Explain the measurement
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS							14. EXPERIENCE: Please describe how your agency, and program staff experience, qualifications, and past											WHITE/CAUCASIAN	0	0%	tools or methods:
DANE CO HUMAN SVCS	0	0	0	0	0							performance will contribute to the success of the proposed program?											BLACK/AFRICAN AMERICAN	0	0%
DANE CO CDBG	0	0	0	0	0																		ASIAN	0	0%
MADISON-CDD	0	0	0	0	0										20. AGENCY COST ALLOCATION PLAN: What method does your agency use to determine indirect cost allocations								AMERICAN INDIAN/ALASKAN NATIVE	0	0%
UNITED WAY ALLOC	0	0	0	0	0										among programs?								NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER	0	0%
UNITED WAY DESIG	0	0	0	0	0																		MULTI-RACIAL:	0	0%	Outcome Objective # 2:
OTHER GOVT*	0	0	0	0	0																		Black/AA & White/Caucasian	0	0%
FUNDRAISING DONATIONS	0	0	0	0	0																		Asian & White/Caucasian	0	0%	Performance Indicator(s):
USER FEES	0	0	0	0	0				10. COORDINATION: Describe how you coordinate your service delivery with other community groups or agencies.														Am Indian/Alaskan Native & White/Caucasian	0	0%
OTHER**	0	0	0	0	0																		Am Indian/Alaskan Native & Black/AA	0	0%
TOTAL REVENUE	0	0	0	0	0																		BALANCE/OTHER	0	0%	Proposed for 2014:		Total to be considered in			Targeted % to meet perf. measures	0%
																							TOTAL RACE	0	0%			perf. measurement			Targeted # to meet perf. measure	0
*OTHER GOVT 2014						5. PROPOSED PROGRAM CONTRACT GOALS: Include clearly defined service goals and process objectives: number of									21. PROGRAM ACTIVITIES: Describe activities/benchmarks by timeline to illustrate how your program will be implemented.								ETHNICITY
Source	Amount	Terms				unduplicated clients to be served, number of service hours to be provided etc.													Est. Month				HISPANIC OR LATINO	0	0%	Explain the measurement
	0														Activity Benchmark				of Completion				NOT HISPANIC OR LATINO	0	0%	tools or methods:
	0																						TOTAL ETHNICITY	0	0%
	0											15. LICENSING OR ACCREDITATION: Report program licensing, accreditation or certification standards currently applied.											PERSONS WITH DISABILITIES	0	0%
	0																						RESIDENCY
	0																						CITY OF MADISON	0	0%
TOTAL	0								11. VOLUNTEERS: How are volunteers utilized in this program?														DANE COUNTY (NOT IN CITY)	0	0%
**OTHER 2014																							OUTSIDE DANE COUNTY	0	0%
Source	Amount	Terms				6. SERVICE HOURS: Frequency, duration of service and hours and days of service availability.						16. STAFF: Please indicate FTE’s dedicated to this program, and required qualifications for these staff positions.											TOTAL RESIDENCY	0	0%
	0											All positions in city-funded programs must meet City Living Wage requirements.
	0											Staff Title	FTE	Qualifications
	0
	0								12. Number of volunteers utilized in 2012?
	0								Number of volunteer hours utilized in this program in 2012?
TOTAL	0

&L&"Arial,Bold"&8&UCOMMUNITY DEVELOPMENT DIVISION&C&"Arial,Bold"&10PROGRAM DESCRIPTION&R&"Arial,Bold"&8&UCITY OF MADISON &L&"Arial,Bold"&8PROGRAM I - &P&R&"Arial,Bold"&8JUNE 4, 2013

PgmK

ORGANIZATION:	0					ORGANIZATION:	0		ORGANIZATION:	0		ORGANIZATION:	0		ORGANIZATION:	0				ORGANIZATION:	0					ORGANIZATION:	0
PROGRAM/LETTER:	A	Enter program name here				PROGRAM/LETTER:	A	Enter program name here	PROGRAM/LETTER:	A	Enter program name here	PROGRAM/LETTER:	A	Enter program name here	PROGRAM/LETTER:	A	Enter program name here			PROGRAM/LETTER:	A	Enter program name here				PROGRAM/LETTER:	A	Enter program name here
						PRIORITY STATEMENT:	A. Northside Youth Summer Employment Services
PROGRAM BUDGET									7. POPULATION SERVED: Please describe in terms of age, income level, LEP, literacy, cognitive or physical disabilities			13. BARRIERS TO SERVICE: Are there populations that are experiencing barriers to the service you are proposing,i.e, cultural			17. PARTICIPANT INCOME LEVELS:					22. DEMOGRAPHICS						23. PROGRAM OUTCOMES
1. 2013 BUDGET		ACCOUNT CATEGORY							or challenges.			differences, language barriers and/or physical or mental impairments or disabilities? Describe the ability of proposed program			Indicate the number of households of each income level and size that this program would serve in 2014.					Complete the following chart for unduplicated participants served by this program in 2012. Indicate the number and percentage										Number of unduplicated individual participants served during 2012.	0
	SOURCE				SPECIAL	DESCRIPTION OF SERVICES						to respond to the needs of diverse populations.			Income Level			Number of Households		for the following characteristics. For new programs, please estimate projected participant numbers and descriptors.										Total to be served in 2014.
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS	3. NEED FOR PROGRAM: Please identify local community need or gap in service that the proposed program will address.									Over 80% of county median income			0
DANE CO HUMAN SVCS	0	0	0	0	0										Between 50% to 80% of county median income			0		PARTICIPANT			PARTICIPANT			Complete the following for each program outcome. No more than two outcomes per program will be reviewed.
DANE CO CDBG	0	0	0	0	0										Between 30% to 50% of county median income			0		DESCRIPTOR	#	%	DESCRIPTOR	#	%	If applying to OCS, please refer to your research and/or posted resource documents if appropriate.
MADISON-CDD	0	0	0	0	0										Less than 30% of county median income			0		TOTAL	0	0%	AGE			Refer to the instructions for detailed descriptions of what should be included in the table below.
UNITED WAY ALLOC	0	0	0	0	0										Total households to be served			0		MALE	0	0%	<2	0	0%
UNITED WAY DESIG	0	0	0	0	0															FEMALE	0	0%	2 - 5	0	0%	Outcome Objective # 1:
OTHER GOVT	0	0	0	0	0				8. LOCATION: Location of service and intended service area (include census tract where service is tract specific).						18. HOW IS THIS INFORMATION CURRENTLY COLLECTED?					UNKNOWN/OTHER	0	0%	6 - 12	0	0%
FUNDRAISING DONATIONS	0	0	0	0	0																		13 - 17	0	0%	Performance Indicator(s):
USER FEES	0	0	0	0	0																		18 - 29	0	0%
OTHER	0	0	0	0	0																		30 - 59	0	0%
TOTAL REVENUE	0	0	0	0	0																		60 - 74	0	0%	Proposed for 2014:		Total to be considered in	0		Targeted % to meet perf. measures	0%
						4. SERVICE DESCRIPTION - Describe the service(s) provided including your expectations of the impact of your activities.			9. OUTREACH PLAN: Describe your outreach and marketing strategies to engage your intended service population.														75 & UP	0	0%			perf. measurement			Targeted # to meet perf. measure	0
2. 2014 PROPOSED BUDGET															19. USER FEE STRUCTURE					Note: Race and ethnic categories are stated			TOTAL AGE	0	0%
	SOURCE				SPECIAL															as defined in HUD standards			RACE			Explain the measurement
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS							14. EXPERIENCE: Please describe how your agency, and program staff experience, qualifications, and past											WHITE/CAUCASIAN	0	0%	tools or methods:
DANE CO HUMAN SVCS	0	0	0	0	0							performance will contribute to the success of the proposed program?											BLACK/AFRICAN AMERICAN	0	0%
DANE CO CDBG	0	0	0	0	0																		ASIAN	0	0%
MADISON-CDD	0	0	0	0	0										20. AGENCY COST ALLOCATION PLAN: What method does your agency use to determine indirect cost allocations								AMERICAN INDIAN/ALASKAN NATIVE	0	0%
UNITED WAY ALLOC	0	0	0	0	0										among programs?								NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER	0	0%
UNITED WAY DESIG	0	0	0	0	0																		MULTI-RACIAL:	0	0%	Outcome Objective # 2:
OTHER GOVT*	0	0	0	0	0																		Black/AA & White/Caucasian	0	0%
FUNDRAISING DONATIONS	0	0	0	0	0																		Asian & White/Caucasian	0	0%	Performance Indicator(s):
USER FEES	0	0	0	0	0				10. COORDINATION: Describe how you coordinate your service delivery with other community groups or agencies.														Am Indian/Alaskan Native & White/Caucasian	0	0%
OTHER**	0	0	0	0	0																		Am Indian/Alaskan Native & Black/AA	0	0%
TOTAL REVENUE	0	0	0	0	0																		BALANCE/OTHER	0	0%	Proposed for 2014:		Total to be considered in			Targeted % to meet perf. measures	0%
																							TOTAL RACE	0	0%			perf. measurement			Targeted # to meet perf. measure	0
*OTHER GOVT 2014						5. PROPOSED PROGRAM CONTRACT GOALS: Include clearly defined service goals and process objectives: number of									21. PROGRAM ACTIVITIES: Describe activities/benchmarks by timeline to illustrate how your program will be implemented.								ETHNICITY
Source	Amount	Terms				unduplicated clients to be served, number of service hours to be provided etc.													Est. Month				HISPANIC OR LATINO	0	0%	Explain the measurement
	0														Activity Benchmark				of Completion				NOT HISPANIC OR LATINO	0	0%	tools or methods:
	0																						TOTAL ETHNICITY	0	0%
	0											15. LICENSING OR ACCREDITATION: Report program licensing, accreditation or certification standards currently applied.											PERSONS WITH DISABILITIES	0	0%
	0																						RESIDENCY
	0																						CITY OF MADISON	0	0%
TOTAL	0								11. VOLUNTEERS: How are volunteers utilized in this program?														DANE COUNTY (NOT IN CITY)	0	0%
**OTHER 2014																							OUTSIDE DANE COUNTY	0	0%
Source	Amount	Terms				6. SERVICE HOURS: Frequency, duration of service and hours and days of service availability.						16. STAFF: Please indicate FTE’s dedicated to this program, and required qualifications for these staff positions.											TOTAL RESIDENCY	0	0%
	0											All positions in city-funded programs must meet City Living Wage requirements.
	0											Staff Title	FTE	Qualifications
	0
	0								12. Number of volunteers utilized in 2012?
	0								Number of volunteer hours utilized in this program in 2012?
TOTAL	0

&L&"Arial,Bold"&8&UCOMMUNITY DEVELOPMENT DIVISION&C&"Arial,Bold"&10PROGRAM DESCRIPTION&R&"Arial,Bold"&8&UCITY OF MADISON &L&"Arial,Bold"&8PROGRAM K - &P&R&"Arial,Bold"&8JUNE 4, 2013

PgmL

ORGANIZATION:	0					ORGANIZATION:	0		ORGANIZATION:	0		ORGANIZATION:	0		ORGANIZATION:	0			ORGANIZATION:	0					ORGANIZATION:	0
PROGRAM/LETTER:	A	Enter program name here				PROGRAM/LETTER:	A	Enter program name here	PROGRAM/LETTER:	A	Enter program name here	PROGRAM/LETTER:	A	Enter program name here	PROGRAM/LETTER:	A	Enter program name here		PROGRAM/LETTER:	A	Enter program name here				PROGRAM/LETTER:	A	Enter program name here
						PRIORITY STATEMENT:	A. Northside Youth Summer Employment Services
PROGRAM BUDGET									7. POPULATION SERVED: Please describe in terms of age, income level, LEP, literacy, cognitive or physical disabilities			13. BARRIERS TO SERVICE: Are there populations that are experiencing barriers to the service you are proposing,i.e, cultural			17. PARTICIPANT INCOME LEVELS:				22. DEMOGRAPHICS						23. PROGRAM OUTCOMES
1. 2013 BUDGET		ACCOUNT CATEGORY							or challenges.			differences, language barriers and/or physical or mental impairments or disabilities? Describe the ability of proposed program			Indicate the number of households of each income level and size that this program would serve in 2014.				Complete the following chart for unduplicated participants served by this program in 2012. Indicate the number and percentage										Number of unduplicated individual participants served during 2012.	0
	SOURCE				SPECIAL	DESCRIPTION OF SERVICES						to respond to the needs of diverse populations.			Income Level			Number of Households	for the following characteristics. For new programs, please estimate projected participant numbers and descriptors.										Total to be served in 2014.
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS	3. NEED FOR PROGRAM: Please identify local community need or gap in service that the proposed program will address.									Over 80% of county median income			0
DANE CO HUMAN SVCS	0	0	0	0	0										Between 50% to 80% of county median income			0	PARTICIPANT			PARTICIPANT			Complete the following for each program outcome. No more than two outcomes per program will be reviewed.
DANE CO CDBG	0	0	0	0	0										Between 30% to 50% of county median income			0	DESCRIPTOR	#	%	DESCRIPTOR	#	%	If applying to OCS, please refer to your research and/or posted resource documents if appropriate.
MADISON-CDD	0	0	0	0	0										Less than 30% of county median income			0	TOTAL	0	0%	AGE			Refer to the instructions for detailed descriptions of what should be included in the table below.
UNITED WAY ALLOC	0	0	0	0	0										Total households to be served			0	MALE	0	0%	<2	0	0%
UNITED WAY DESIG	0	0	0	0	0														FEMALE	0	0%	2 - 5	0	0%	Outcome Objective # 1:
OTHER GOVT	0	0	0	0	0				8. LOCATION: Location of service and intended service area (include census tract where service is tract specific).						18. HOW IS THIS INFORMATION CURRENTLY COLLECTED?				UNKNOWN/OTHER	0	0%	6 - 12	0	0%
FUNDRAISING DONATIONS	0	0	0	0	0																	13 - 17	0	0%	Performance Indicator(s):
USER FEES	0	0	0	0	0																	18 - 29	0	0%
OTHER	0	0	0	0	0																	30 - 59	0	0%
TOTAL REVENUE	0	0	0	0	0																	60 - 74	0	0%	Proposed for 2014:		Total to be considered in	0		Targeted % to meet perf. measures	0%
						4. SERVICE DESCRIPTION - Describe the service(s) provided including your expectations of the impact of your activities.			9. OUTREACH PLAN: Describe your outreach and marketing strategies to engage your intended service population.													75 & UP	0	0%			perf. measurement			Targeted # to meet perf. measure	0
2. 2014 PROPOSED BUDGET															19. USER FEE STRUCTURE				Note: Race and ethnic categories are stated			TOTAL AGE	0	0%
	SOURCE				SPECIAL														as defined in HUD standards			RACE			Explain the measurement
REVENUE SOURCE	TOTAL	PERSONNEL	OPERATING	SPACE	COSTS							14. EXPERIENCE: Please describe how your agency, and program staff experience, qualifications, and past										WHITE/CAUCASIAN	0	0%	tools or methods:
DANE CO HUMAN SVCS	0	0	0	0	0							performance will contribute to the success of the proposed program?										BLACK/AFRICAN AMERICAN	0	0%
DANE CO CDBG	0	0	0	0	0																	ASIAN	0	0%
MADISON-CDD	0	0	0	0	0										20. AGENCY COST ALLOCATION PLAN: What method does your agency use to determine indirect cost allocations							AMERICAN INDIAN/ALASKAN NATIVE	0	0%
UNITED WAY ALLOC	0	0	0	0	0										among programs?							NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER	0	0%
UNITED WAY DESIG	0	0	0	0	0																	MULTI-RACIAL:	0	0%	Outcome Objective # 2:
OTHER GOVT*	0	0	0	0	0																	Black/AA & White/Caucasian	0	0%
FUNDRAISING DONATIONS	0	0	0	0	0																	Asian & White/Caucasian	0	0%	Performance Indicator(s):

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File details come from the government source that posted it. Updated Nov 19, 2025.