SOI 1275 Attachment 1 - Application and Budget Request Form LOCKED.docx
DOCX document 32 KB Posted
- Solicitation number
- 2138240
- Issued by
- New York
About this file
This document is an Application and Budget Request Form attachment for the New York State Office of Children & Family Services (OCFS) Solicitation of Interest (SOI) 1275 for the New York Statewide Fatherhood Engagement Initiative. The initiative seeks to fund community-based organizations to provide targeted, non-personnel financial support that strengthens relationships between fathers or father figures and their children while improving outcomes for children, youth, and families. Proposed activities should support responsible fatherhood, healthy parenting, positive youth development, family stability, and increased awareness of available community resources, including child care and other family support services. OCFS intends to fund multiple qualified organizations based on established criteria outlined in the SOI announcement. Organizations must meet specified eligibility requirements and submit applications by the deadline noted in the solicitation announcement to be considered responsive.
The form serves as the official application mechanism for interested entities to request funding and present their proposed budgets for participation in the initiative. Applicants are required to demonstrate how their organization satisfies program requirements and how proposed activities align with the initiative's goals of strengthening families and expanding access to services that promote child well-being and long-term success. The funding is structured as non-personnel financial support, meaning organizations cannot use allocated funds for staffing costs but rather for programmatic activities and resources that advance fatherhood engagement and family stability objectives.
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SOI 1275 New York Statewide Fatherhood Engagement Initiative Attachment 1 – Application and Budget Request Form Section 1: Applicant Information
Organization Name:
Organization Street Address:
Project Contact Name:
Project Contact Phone Number (include area code):
Project Contact Email Address:
| Eligibility Criteria |
| Response |
| Are you a Not-for-Profit Organization? |
| |_| Yes or |_| No* |
| Are you prequalified in the New York State Finance System (SFS), if not exempt, at the time of application? |
| |_| Yes or |_| No* |
| Do you have at least one year of experience administering a program that was financially supported by governmental funds? |
| |_| Yes or |_| No* |
| Do you have a fatherhood engagement program serving children and families in New York State that has been existence for at least one year, at the time of application submission? |
| |_| Yes or |_| No* |
* Please note: a “No” response to any eligibility question above may result in your application being disqualified from consideration.
FEIN (9-digit Federal Employer Identification Number):
New York Statewide Financial System (SFS) 10-digit Vendor ID:
Section 2: Service Area
OCFS anticipates awarding a minimum of seven awards; with at least one award being made in each of the OCFS-designated regions below:
· Region 1 (Buffalo): Western NY
· Region 2 (Rochester): Finger Lakes/Southern Tier
· Region 3 (Syracuse): Central NY/North Country
· Region 4 (Albany): Capital District/North Country
· Region 5 (Westchester): Lower Hudson
· Region 6 (New York City): All five boroughs
· Region 7 (Long Island): All Long Island
Indicate the region your application serves:
To see county breakdowns by region, please view the OCFS Regional Map, which is also located here: https://ocfs.ny.gov/directories/assets/docs/DCCSRegionalMap.pdf
Section 3: Project Narrative
Describe how you will increase meaningful engagement between fathers or father figures and their children:
Describe how you will strengthen parenting knowledge, skills, and confidence:
Describe how you will promote healthy child development and positive youth outcomes:
Describe how you will increase awareness of available child care, family support, workforce, or related community resources, as appropriate to the population served:
Describe how you will strengthen collaboration with local partners that support children and families:
Describe how you will demonstrate measurable outcomes that advance the goals of the Fatherhood Engagement Initiative:
Section 4: Budget Request
| Budget Item |
| Cost |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| Total Amount Requested: |
| $ |
The Total Amount Requested must not exceed $10,000. Refer to the Scope of Work section of the solicitation for information regarding what expenses are eligible or ineligible for reimbursement under this program. Please identify quantities and per-unit rates wherever possible in your budget request.
Provide a brief narrative below on how the funds will be utilized. Justification should be clear, specific, and directly linked to the program’s objectives and eligible activities:
Top of Form Section 5: Certification
By signing below, I attest that I have express authority to submit this application and am authorized by law to bind the applicant. I also agree to provide additional information and supporting documentation, if requested by OCFS.
Name
Title
Organization
E-mail Address
Street Address
Phone #
City, State, Zip Fax #
| ____________________________________________________ | _________________ | |
| Signature of Authorized Individual | Date |
Note: This sheet must be completed, signed, and included in your submission.
Section 6: Document Submission
Submit the following documents prior to the Deadline for Submission of Applications, indicated in the solicitation’s Calendar of Events, via email to funding@ocfs.ny.gov:
· Attachment 1 – Application and Budget Request Form (REQUIRED)
Refer to the How to Respond section of the solicitation for additional information regarding requirements and submission instructions.
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