SOI 1276 Attachment 1 - Application Form LOCKED.docx
DOCX document 35 KB Posted
- Solicitation number
- 2138350
- Issued by
- Bronx County, Nissequogue Village, New York
About this file
This is an application form attachment for a Solicitation of Interest (SOI 1276) issued by the New York State Office of Children & Family Services (OCFS) for participation in Dolly Parton's Imagination Library (DPIL) in New York City. The program provides financial assistance to eligible organizations to participate as new Local Program Partners or expand existing participation in the five boroughs of New York City (Brooklyn, Bronx, Manhattan, Queens, and Staten Island). Eligible applicants include New York State 501(c)(3) libraries, public library systems, not-for-profit organizations located within the five boroughs, and NYC school districts. The application form requires organizations to provide organizational information, including the organization's name, director, project contact information, Federal Employer Identification Number (FEIN), and New York State Vendor ID or a completed NYS Substitute W-9. The program aims to mail one high-quality, age-appropriate book per month to registered children from birth through their fifth birthday at no cost to families. Applicants must complete and submit the application form, the NYS Grants for DPIL Participation Certification and Acknowledgement, and a Memorandum of Agreement (MOA) with Dollywood Foundation prior to the specified deadline via email to funding@ocfs.ny.gov. If awarded but lacking a MOA, organizations must obtain one within 60 days and provide proof to OCFS before receiving funds.
The application requires applicants to define their coverage area by city, town, village, county, zip code, or school district and calculate the total grant amount based on the population under five years old to be served, percentage of the population below poverty level, and a fixed cost of $1.30 per child per month for up to 12 months. Individual grants are capped at a maximum of $50,000 and a minimum of $2,000. OCFS has approximately $395,000 available to fund multiple qualified organizations through this solicitation. The grant funds cover up to 50 percent of Local Program Partners' monthly costs, with partners responsible for the remaining 50 percent of the approximately $2.60 per child per month cost for wholesale books and mailing. Applicants must use 2024 American Community Survey (5-Year Estimates Subject Tables) data to determine population and poverty statistics for their proposed coverage areas.
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SOI 1276 Dolly Parton’s Imagination Library in New York City Attachment 1 – Application Form Section 1: Organizational Information
Name of Organization:
Name of Organization's Director:
Name of Project Contact:
Project Contact Phone Number (include area code):
Project Contact Email Address:
| Organization Type | Comment by Chmielewski, Theodore (OCFS): Must ensure this matches the SOI. |
| Yes | |
| No |
| New York State (NYS) 501(c)(3) library, public library system, or not-for-profit organization located within the five boroughs (Brooklyn, Bronx, Manhattan, Queens and Staten Island) of NYC |
| |_| |
| |_| |
| NYC school district |
| |_| |
| |_| |
Please note: For entities serving areas located outside the five boroughs of New York City, see SOI 1266 Dolly Parton’s Imagination Library (Round 1.2) on the OCFS Website.
FEIN (9-Digit Federal Employer Identification Number):
Does your organization have New York State Vendor ID?
· |_| Yes (enter 10-digit SFS Vendor ID Number):
· |_| No
If your organization does not have a Vendor ID#, then you must also include the NYS Substitute W-9 with your application.
Does your organization have a Memorandum of Agreement (MOA) with the Dollywood Foundation to be a local program partner for Dolly Parton's Imagination Library (DPIL)?
· |_| Yes (provide a copy of your MOA with your application)
· |_| No
If your organization does not have an MOA with DPIL: if awarded, you must obtain an MOA with DPIL within 60 days and provide proof to OCFS before you receive any funds.
Top of Form Section 2: Community Need
Instructions for completing this section:
Coverage Area: List each city/town/village, county, zip code, or school district in your coverage area. This should match the areas currently enrolled in with DPIL plus any area being added as part of this grant project proposal. Choose the largest option that encompasses your coverage area. For example, if your coverage area consists of an entire county, list the county rather than the towns or zip codes within the county.
Population Under 5 To Be Served (A): Using the 2024 American Community Survey (5-Year Estimates Subject Tables), as a guide, enter the population proposed to be served under 5 for each segment of your coverage area. www.wwe.com
% Below Poverty Level (B): Using the same 2024 American Community Survey (5-Year Estimates Subject Tables), enter the % below poverty level for each segment of your coverage area. (Use the % for "Population for whom poverty status is determined" not the % for "under 5 years")
Cost Per Child (C): Local Program Partners will enroll children within their selected coverage area and pay, on average, $2.60 per child/per month towards wholesale book and mailing costs, the grant can be used to fund up to 50% of these monthly costs that the Local Program Partners incur. Therefore, this solicitation provides $1.30 per child per month.
# Months (D): Contracts awarded in response to this solicitation are anticipated to be for up to one (1) year. The anticipated budget will span a period of 12 months.
You will need one row for each city/town/village, county, zip code, or school district in your coverage area. If your coverage area encompasses an entire town or county, only use the name of the town or county and not the individual zip codes.
Complete this table for all coverage areas:
| Coverage Area |
| (A) |
Population Under 5 To Be Served (B) % Below Poverty (C) Cost Per Child (D) # Months Total Cost A x C x D
| % |
| 1.30 |
| 12 |
| $ |
| % |
| 1.30 |
| 12 |
| $ |
| % |
| 1.30 |
| 12 |
| $ |
| % |
| 1.30 |
| 12 |
| $ |
| % |
| 1.30 |
| 12 |
| $ |
| % |
| 1.30 |
| 12 |
| $ |
| % |
| 1.30 |
| 12 |
| $ |
| % |
| 1.30 |
| 12 |
| $ |
| Total Amount Requested: |
| $ |
Total Cost: This is calculated by multiplying (A) Population Under 5 To Be Served, (C) Cost Per Child, and (D) # Months in each row. A x C x D = Total Cost for each Coverage Area. Adding together the Total Costs in each row will provide the Total Amount Requested by this application. The total requested amount must be between $2,000 and $50,000.
Top of Form Section 3: Certification and Document Submission
Certification and Acknowledgment to be signed and kept on file by the applicant’s Chief Administrative Officer.
After completing Step 1 of the application process, submit the following documents prior to the deadline via email to funding@ocfs.ny.gov to complete Step 2:
· Attachment 1 – Application Form
· Attachment 2 – NYS Grants for DPIL Participation Certification and Acknowledgement
· Your organization’s Memorandum of Agreement with Dollywood for participation as a Local Program Partner in Dolly Parton’s Imagination Library (if available)
Refer to the How to Respond section of the solicitation for detailed instructions.
File details come from the government source that posted it. Updated .