Sample "Proposal for Vdf Grant - $4,999.99 or Less" - Arizona

Proposal for Vdf Grant - $4,999.99 or Less is a legal document that was released by the Arizona Department of Veterans Services - a government authority operating within Arizona.

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***FOR EXAMPLE PURPOSES ONLY***
Attachment One – Certification and Authorization
Grantee hereby certifies, by signature in the Authorization section below: In accordance with A.R.S. § 35-393 et seq.,
the Grantee does not have scrutinized business operations in Iran; and in accordance with A.R.S. § 35-391 et seq., the
Grantee does not have scrutinized business operations in Sudan.
Grantee’s Chief Executive Officer authorizes this VDF Proposal?
Yes
No
An officer of Grantee’s governing body (such as a board member) must sign this VDF Grant Proposal.
The undersigned, an authorized officer of the Grantee organization, does hereby certify that the information set
forth in this VDF grant proposal is true and correct; that the federal tax exemption determination is valid and the
present operation of the grantee organization and its current sources of support are not inconsistent with the
Grantee organization’s continuing tax exempt classification. Furthermore, monies provided under this VDF grant
will be used only for the proposed purpose. Misuse of monies or failure to provide the required reporting
documentation is, including but not limited to, cause for denial of any future grant request or proposal to ADVS.
John R. Doe
Director
Name (Print)
Title or Position
Both PDF Certified Electronic Signature and Scanned Wet signatures are accepted
07/01/2021
Signature
Date
Acceptance of Proposal and VDF Grant Award
(For ADVS Use Only)
1. By this notice, you, the applicant, are notified of the Department’s decision to either grant or decline, in whole or in
part, the funding as proposed by your written VDF proposal in response to ADVS Request for VDF Grant Proposal
$4,999.99 or Less as received, accepted, reviewed and considered by the Department.
The Department in whole accepts your proposal and grants money in the amount of $
for the Veterans’ services specified in the VDF-RFGP.
OR
The Department in part accepts your proposal and grants money in the amount of $
for the Veterans’ services specified in the VDF-RFGP limited to the following Veterans’ services:
2. If your proposal is accepted as described above, you are now bound to perform as Grantee based upon the VDF
Grant as granted above.
You are hereby cautioned not to commence any work or provide any material or service under this VDF Grant until you
receive a VDF Grant release document, or written notice to proceed, if applicable from the VDF Program Manager.
Awarded this
day of
, 2021
ADVS Director
CY21 VDF Grant Proposal $4,999.99 or Less
rev. 07/21
Page 10 of 13
© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
***FOR EXAMPLE PURPOSES ONLY***
Attachment One – Certification and Authorization
Grantee hereby certifies, by signature in the Authorization section below: In accordance with A.R.S. § 35-393 et seq.,
the Grantee does not have scrutinized business operations in Iran; and in accordance with A.R.S. § 35-391 et seq., the
Grantee does not have scrutinized business operations in Sudan.
Grantee’s Chief Executive Officer authorizes this VDF Proposal?
Yes
No
An officer of Grantee’s governing body (such as a board member) must sign this VDF Grant Proposal.
The undersigned, an authorized officer of the Grantee organization, does hereby certify that the information set
forth in this VDF grant proposal is true and correct; that the federal tax exemption determination is valid and the
present operation of the grantee organization and its current sources of support are not inconsistent with the
Grantee organization’s continuing tax exempt classification. Furthermore, monies provided under this VDF grant
will be used only for the proposed purpose. Misuse of monies or failure to provide the required reporting
documentation is, including but not limited to, cause for denial of any future grant request or proposal to ADVS.
John R. Doe
Director
Name (Print)
Title or Position
Both PDF Certified Electronic Signature and Scanned Wet signatures are accepted
07/01/2021
Signature
Date
Acceptance of Proposal and VDF Grant Award
(For ADVS Use Only)
1. By this notice, you, the applicant, are notified of the Department’s decision to either grant or decline, in whole or in
part, the funding as proposed by your written VDF proposal in response to ADVS Request for VDF Grant Proposal
$4,999.99 or Less as received, accepted, reviewed and considered by the Department.
The Department in whole accepts your proposal and grants money in the amount of $
for the Veterans’ services specified in the VDF-RFGP.
OR
The Department in part accepts your proposal and grants money in the amount of $
for the Veterans’ services specified in the VDF-RFGP limited to the following Veterans’ services:
2. If your proposal is accepted as described above, you are now bound to perform as Grantee based upon the VDF
Grant as granted above.
You are hereby cautioned not to commence any work or provide any material or service under this VDF Grant until you
receive a VDF Grant release document, or written notice to proceed, if applicable from the VDF Program Manager.
Awarded this
day of
, 2021
ADVS Director
CY21 VDF Grant Proposal $4,999.99 or Less
rev. 07/21
Page 10 of 13
© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
***FOR EXAMPLE PURPOSES ONLY***
Attachment Two – VDF Grantee’s Organization Information
Submit organization’s information as indicated below:
Attach and wholly incorporate additional sheets as necessary to respond to this Attachment Two.
Identify any such attachment as “Attachment to Attachment Two.”
Identify, by its number below, each requirement responded to in the attachments.
1.
Representative or Agent
Applicant is the Proposed Grantee that proposes to perform and complete the described event, program, or project and
Statement of Work for ADVS as Grantor.
OR
Applicant is the representative or agent for the Proposed Grantee that proposes to perform and complete the described
event, program, or project and Statement of Work for ADVS as Grantor.
If Applicant is a representative or agent of the Proposed Grantee, attach a true and full copy of the power of attorney or
other written instrument or instruments by which the Applicant is duly appointed as representative or agent for the
Proposed Grantee and which expressly states the authority and powers of the appointment.
2.
Veterans Service Organization (VSO) Charter
National ABC Non Profit
Yes
No
Grantee is a VSO?
If yes, chartered by:
(Chartering state or national VSO)
Grantee’s Form of Organization
3.
ABC NON PROFIT
Grantee’s Business Name:
Include: VSO post or chapter number and/or, if any, other organization designation, e.g.: Sole Proprietor / Co. / Inc. / LTD / LLC / Partnership, etc.
Please include the mailing address if it differs from the physical address
3839 N. 3rd St.
Street Address:
AZ
85012
Phoenix
City:
State:
ZIP:
(602) 555-5555
(602) 555-5556
Phone:
Fax:
abcnonprofit.org
inbox@abcnonprofit.org
Email:
Website:
Arizona
01/01/2000
State of Incorporation/Organization:
Date Incorporated/Organized:
Yes
No
Grantee is in good standing with its state of incorporation or organization?
Grantee’s Operations
4.
Director
All correspondence pertaining to
John R. Doe
Chief Staff Officer:
Title:
the
application will be sent to this
John Smith
Treasurer
Contact Person:
Title:
person and email address
602-555-5554
jsmith@abcnonprofit.org
Contact Person’s Email:
Phone:
07/01
06/30
2021
Grantee’s fiscal
From Mo/Day
To Mo/Day
year:
Total Operating Budget:
Past Year
Current Year
0
25
125
150
0
Grantee’s Staff:
Paid FT
Paid PT
Volunteers
Other
Total Employees
The name associated with the EIN
Yes
No
Grantee’s EIN*: must match the grantee's business name.
Federal Tax Exempt Status?
*Federal Employer Tax Identification Number
If no, explain why not on attachment.
Has Grantee’s governing board approved a policy, which states that the organization does not discriminate as to age, race,
religion, disability, sexual orientation, sex or national origin?
01/01/2000
Yes
No
If Yes, when? _
CY21 VDF Grant Proposal $4,999.99 or Less
rev. 07/21
Page 11 of 13
© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
***FOR EXAMPLE PURPOSES ONLY***
Attachment Three – Statement of Service – Event/Program/Project
Complete the SOS below. Provide specific responses.
Attach and wholly incorporate additional sheets as necessary to respond to this Part Three.
Identify any such attachment as “Attachment to Part Three.”
Identify, by its number below, each requirement responded to in the attachments.
1.
Veteran Service Event/Program/Project Proposed
4,999.99
Total VDF Grant amount proposed by Grantee for the Event/Program/Project:
$
10,000.00
Total Budget for the Event/Program/Project:
$
Veteran Relief Program
Event/Program/Project Title:
The Veteran Relief Program provides housing support, food relief, and emergency
Description:
financial assistance to Arizona Veteran clients. The program includes Arizona Veterans of all
The description of your project/program/event should be clear, concise and reflected in
ranks and services.
your budget worksheet.
The service area for this program is primarly in the West Valley of the greater
Location:
Phoenix metro area.
06/30/2022
07/01/2021
To
Event/Program/Project Dates:
From
06/01/2021
Date(s) Funds are Required:
2.
Target Arizona Veteran Population
Arizona Veterans in need of financial assistance primarily in the West Valley
Target veteran population:
Pursuant to A.R.S. 41-608, the VDF may only be used
for Veterans in this state and may not be used for
project/program/event benefiting Active Duty Service Members
This program addresses immediate financial
Benefits to target veteran population from Event/Program/Project:
needs primarily brought on due to deaths, divorces, car, troubles, medical, temporary lodging, transportation
and issues with or lack of employment with the goal of crisis prevention for Veterans and their families.
Benefits to the target population should include expected outcomes
Grantee’s Plan for Event/Program/Project
3.
as applicable.
07/01/2021
Date Grantee began or will begin preparation for event/program/project:
We partner with other
How Grantee will involve target veteran population in planning of event/program/project:
agencies who recommend and conduct initial interviews/vetting of applicants. These
include NWVA; Veteran's Success Center; Be Connected; Luke Chaplains.
Agencies and those listed
How Grantee will involve the target veteran population in event/program/project:
above, screen, interview, and vet potential needy veterans and their families and refer those clients to us.
Our Chapter Board then reviews applications and personally interviews each client.
The interview is conducted by 3 to 5 ABC Non Profit
What Grantee will do at and during event/program/project:
Members who are also Veterans, in person when possible and virtually if necessary. The interview results and supporting mater ials are
then sent to our Board of Directors for final approval.
CY21 VDF Grant Proposal $4,999.99 or Less
rev. 07/21
Page 12 of 13
© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
***FOR EXAMPLE PURPOSES ONLY***
Attachment Three – Statement of Service – Event/Program/Project, Continued
This program is entirely run by volunteers who are
Who else will perform and complete event/program/project:
Veterans and members of our ABC Non Profit. Funds for this program come from member donations and grant funds.
Payments are made to agencies of the client directly (landlords, utilities, etc.) as much as possible.
How Grantee will advertise event/program/project to target veteran population:
We will use our regular contact with support agencies, word of mouth, put out press releases, advertise on our website,
and include the program details in our newsletter and emails to members.
Immediately
Date(s) when Grantee will advertise event/program/project:
4.
Results
All grant awards require deliverables submitted to ADVS, this section should show what and how you plant to report.
We take
Describe how Grantee will show how the veteran population benefited from event/program/project proposed:
photos of our clients who have received assistance and provide a description of how the award was used
These descriptions are consolidated and published after obtaining release permission from the client.
The written final report will provide a detailed
How Grantee will compare and show actual expenditure to proposed budget:
list of expenditures by description of the applicant's needs and how the needs are being met by this award.
In addition to the expenditure report, we will submit any applicable receipts as proof of purchase or payment.
5.
Mission and Qualification
The mission of our organization includes,
Briefly describe Grantee’s service and support mission to veterans:
"to undertake charitable, social and similar events." We accomplish this through various events including
helping those in need with the Veteran Relief Program and through scholarships that are funded separately.
This program was created
Briefly explain how grantee is qualified to perform and complete proposed event/ program/ project:
three years ago and has grown each year. We have safeguards in place by way of screening and avoiding direct payments to Vete rans.
The need for assistance has increased over the last three years, particularly in this past year with the impacts of COVID-19.
6.
Event/Program/Project Funding Considerations
16,249.00
Total dollar amount Grantee needs for performance and completion of event/program/project:
$
11,250.00
Total dollar amount Grantee will request from other funders for event/program/project:
$
Please list other event/program/project funding sources here and dollar amount:
NAME
AMOUNT REQUESTED
Veteran and Military Family Foundation
10,000.00
$
1,250.00
Donations from ABC Non Profit members
$
$
CY21 VDF Grant Proposal $4,999.99 or Less
rev. 07/21
Page 13 of 13
© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
FOR EXAMPLE PURPOSES ONLY
Please note, the VDF does not
Arizona Department of Veterans' Services
cover personnell costs
Budget Worksheet - Template
VDF Grant Year 2021-2022 (FY22)
Line Revenue
FY Organization Budget
VDF Grant Request
1
Grants
14,999
4,999
2
Contracts
N/A
N/A
3
Corporate contributions
N/A
N/A
4
Membership
1,250
N/A
5
Individuals
N/A
N/A
6
Fees for services
N/A
N/A
7
Fundraisers, events, sales
N/A
N/A
8
Endowment
N/A
N/A
9
Interest income
N/A
N/A
10
Miscellaneous
N/A
N/A
11
Total
$16,249
$4,999
12
In-kind
$0
N/A
13
Total Revenue
$16,249
$4,999
Line Expenses (Examples)
FY Organization Budget
VDF Grant Request
14
Staff salaries and wages
0
0
Please
If any contract services are required, grantee
List each position and cost
list all planned
must submit qoutes/estimates for those services
expedentitures
15
Contract Services
0
0
in the
List actual contract requirement and cost
applicable line
16
Occupancy and utilities
0
0
item row
Please provide a spenddown
List lease cost
of how you plan to apply the
List utilities such as electric, etc.
VDF grant monies to your
17
Equipment
0
0
project/program/event
List types and cost
budget
18
Supplies and materials
0
0
Rental Assistance
9,899
3,549
Food Assistance
2,000
250
Electric Bill Assistance
1,750
500
Gas Bill Assistance
1,000
100
Water Bill Assistance
700
100
Fees Accrued from Late Payment of Bills
200
200
Job Related Training
200
100
Telephone Bill Assistance
500
200
19
Printing and copying
0
0
20
Telecommunications
0
0
21
Travel and meetings
0
0
List location and cost of travel
22
Marketing and advertising
0
0
23
Staff and volunteer training
0
0
24
Other
0
0
25
Administrative
0
0
(Grant request can't exceed 12.5%)
26
Total
$16,249
$4,999
28
Revenue over Expenses
$0
$0