JCDPC Application for Funding

JCDPC Application for Funding

2020 Funding Cycle
Project Title:
Type of Program: Mark the one (1) domain under which your program/project best fits. (Defined by the nature of the program itself, not the agency doing the program)

Prevention/Education Treatment/Recovery Justice/Law Enforcement
Project Purpose:
Applicant Agency:
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Contact Person:

First Name Last Name
Phone:

Area Code Phone Number
Email Address:
example@example.com
Amount requested from JCDPC:
$
Total Program Budget:
$
Estimated number of people to be served or impacted:
Has this agency been funded previously?

Yes No
If so, for how long?
IMPLEMENTING AGENCY AGREEMENT

A. I, the undersigned, affirm that I am aware of and support the aforementioned proposal for funding of the program from the Local Drug-Free Communities Fund.

B. I am aware that our organization may be required to give a 5-10 minute presentation regarding our grant proposal during a Grant Review Committee meeting.

C. If recommended for funding by JCDPC, I understand that:

1. the legal agency will be required to enter into a contractual agreement with JCDPC;
2. I or another representative from my organization must attend 6 JCDPC meetings or events within the same calendar year of receiving the grant;
3. our organization will be responsible for presenting a 5 to 10 minute oral program report and semi-annual written reports;
4. I will provide statistics and objective updates for the Comprehensive Community Plan;
5. all literature and/or press releases regarding this program will acknowledge JCDPC as a partner.

My failure to do any of the above-mentioned items could affect my future funding from JCDPC.
Signature

Clear
Date:

Month Day Year
Date
Title:
Agency:
1. Please provide a program description including core features of program and cooperative efforts within the community.
2. Please describe the target population, including the expected number of Jay County residents directly or indirectly served or impacted by the grant.
3. Please explain how your program will address one of the Problem Statements and at least one objective stated on page 2. Your program must target at least one objective to be eligible for funding. If your program addresses more than one objective, please explain each separately
4. Please explain in this section how your program will provide outcome measurements (objective, indicator, time frame, data source, etc.)

Questions to answer when completing this portion of the application:

Objective: (which objective you are addressing from page 2 of the grant)

Indicator: (what you are going to measure)

Time Frame: (time frame you are going to measure)

Data Source: (who/what will collect information for you)

Data Collection Method: (how you are going to get information)

Estimated # of Participants: (anticipated number to serve)
Objective:
Indicator:
Time Frame:
Data Source:
Data Collection Method:
Estimated # of Participants:
Objective:
Indicator:
Time Frame:
Data Source:
Data Collection Method:
Estimated # of Participants:
Objective:
Indicator:
Time Frame:
Data Source:
Data Collection Method:
Estimated # of Participants:

Program Budget
5. Please provide a Detailed Project Expense that represents how the grant money requested from JCDPC would be spent. Please use the Detailed Project Expense and Income Budget form on the following pages.
FORM 1: DETAILED PROJECT EXPENSE BUDGET
Project Title:

EXPLANATION

AMOUNT REQUESTED FROM JCDPC

AMOUNT REQUESTED FROM FOUNDATIONS AND CORPORATIONS ETC.

VALUE OF IN-KIND MATCHING RESOURCES

Salary - Program Providers

Taxes/Benefits

Equipment & Technology

Travel/Mileage

Postage

Printing

Training

Supplies

Contracts

Other

Administrative Overhead *

TOTAL EXPENSES

*Keep within 5% to 8% rage of project budget.

FORM 2: DETAILED PROJECT INCOME
Project Title:
First Year of JCDPC Funding for this project was:

INCOME SOURCE

This Year

Last Year

JCDPC/Drug Free Indiana Fund

Foundations

Government: Federal

Government: State

Government: Local

School Corporations

Corporations

Program-Generated

Individual Contributions/Memberships

Other

TOTAL PROJECT INCOME

As JCDPC is not a permanent funder, identify present and/or potential future funding sources for continuation of project beyond period covered by funds requested through the Drug-Free Communities Fund.

SOURCE

AMOUNT

Should be Empty:

JCDPC Application for Funding

Program Budget