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Attachment 1 FY 2017/18 Grant Applications: Art, Cultural, and Educational ATTACHMENT 1 P ART DOCENTS Town of Los Gatos FY 2017/18 Community Grant Program Application Summary Project: Project/Program: Art Education Services to Los Gatos Union School District Program Manager: Stefanie Johnston Agency: Name of Agency: Art Docents of Los Gatos Site Address: 17000 Roberts Road Los Gatos, CA 95032 Name of Executive Director: Michelle Abene, President Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Who benefits: all students in the Los Gatos Union School District (4 elementary schools: Blossom Hill, Daves Avenue, Lexington, Van Meter; 1 middle school: Fisher Middle School), grades K-8. Direct Services: To fulfill the need outlined in the "Memorandum of Understanding" between the Art Docents of Los Gatos and the Los Gatos Union School District, the Art Docents agree to provide: • A comprehensive and sequential visual arts program aligned with the California Public School Art Standards; • Docent -led, hands-on art technique lessons; • Arrangements and payment for the professional guest artist to visit each school in the district; • Production of the Annual District -wide Student Art Show in which the entire Los Gatos community is invited to attend; • Training and continuing education for volunteer docents who provide services How, when, where, services are delivered: Trained docents take the program directly into all K-5 classrooms, and by request into grades 6,7 and 8 classrooms in the LGUSD during school hours throughout the school year. The program consists of : • Print presentations: a mix of digital slides and poster -sized hand-held, mounted prints • Hands-on workshop lessons that use traditional art materials: • The Annual Student Art Show, held once a year over the span of a week, usually in May in the Fisher School multi -purpose room. Each classroom arranges for a tour during school hours, led by Art Docents. • Sponsor professional guest artists who set-up demonstrations in one location at each school are visited by classes. Students may also view the demonstration during recess and lunch. Why should services be provided: When we educate children in the arts, we provide them with another way to communicate their ideas and comprehend their world. Art links us to other cultures, other times in history, other neighborhoods. A complete art education teaches students to see clearly, to think creatively, and to give form to the future. Exposure to the art enhances their ability to become flexible, innovative and creative individuals. By providing this services, the Art Docents of Los Gatos are fulfilling the commitment of the Los Gatos Union School District to the visual arts. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2016/17 (adopted) FY 2017/18 (requested) Clients: FY 2016/17 (actual) FY 2017/18 (proposed) Town annual funding amount $4000 $4000 Unduplicated annual Los Gatos clients 3268 3268 Total annual program budget $67570 $67570 Total unduplicated annual clients 3268 3268 Town $ as % of annual total 5.9 5.9 Los Gatos clients as % of annual total 100 100 2 TOWN OF LOS GATOS + FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I. PROGRAM/PROJECT INFORMATION 0 Fee Schedule, Membership, or other fees II. AGENCY INFORMATION 0 Current Board of Directors 0 Articles of Incorporation 0 Bylaws 0 Organizational Chart 0 Brochures, Flyers, Promotional Materials Ill. FISCAL INFORMATION 0 Audit or Financial Statement plus Letter of Auditability 0 Organizational Budget 0 Internal Revenue Service Ruling Letter (Section 501 c.3) 0 California Revenue Code (Section 23701 d) 3 TOWN OF LOS GATOS FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION 1. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Art Docents of Los Gatos, Inc. Address of organization 17000 Roberts Road Los Gatos, CA 95032 Organization contact (Name, title, telephone number, email address) Stefanie Johnston Program Coordinator 408-335-2366 artdocents@me.com Program name Art Education Services Site address of program All 5 Schools in Los Gatos Union School District: Fisher Middle School, Louise Van Meter Elementary, Blossom Hill Elementary, Daves Avenue Elementary, Lexington Elementary Program manager (Name, title, telephone number, email address) Michelle Abene, President 408-656-1399 wow123@me.com Annual grant amount requested FY 2017/18 $4000.00 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. The Art Docents of Los Gatos was formed in 1973 to fill a void left by the decrease in school spending for the Arts. For the past 43 years the Art Docents program has provided a comprehensive and sequential visual- arts program, unduplicated in the scope or quality by any other school or town program, to over 3000 Los Gatos students in the Los Gatos Union School District. The Art Docents work in collaboration with one district art teacher who travels between the four elementary schools. The goal of our cultural/educational program is to meet the Guiding Principles of the Visual Art Standards outlined by the State of California: to introduce art as a tool for creative expression; to develop familiarity with diverse cultures and appreciate one's common heritage: to appreciate and experience the creation of art. The program helps fulfill the arts and cultural needs of our community as outlined in the Town's arts/cultural plan. The program also is continually being evaluated to ensure that it meets the California Visual Art Standards adopted by the school district. 4 c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client.A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2017/18 Number of Services Provided Annually FY 2017/18 Number of Unduplicated Los Gatos Residents served Annually 1. Sequential art Appreciation lessons presented a minimum of five times a year to each student in grades K-5. Lessons vary from 20-75 minutes. Spanish and French language students at Fisher receive one 90-minute lesson per year. 440 2200 2. Hands-on art technique workshops for grades K- 5 consisting of sculpture, still life, collage, abstract composition, face/figure drawing, and photography. Scientific Illustrations is taught at Fisher Middle School to all 7th graders. 131 2440 3. One professional guest artist visit per school per year 5 3268 4. Annual Student Art Show displays work in a gallery setting fro one week. Approximately 2300 students participate each year. Evening reception and afternoon hours provide viewing hours for the public. 1 week-long show 3268 5. Community adult program services for docents (continuing education): art tours, lectures, and docent trainings. 6 art tours 6 art lectures 12 trainings 92 Average number of direct services received by each unduplicated client: _9_ Average number of direct services received by each unduplicated Los Gatos client: _9 5 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2017, through June 30, 2018, An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2017/18 Number of Services Provided Annually 1. Informational and referral 80-100 calls and contacts 2. The Palette newsletter connects docents to monthly activities and provides information about Art Docents for parents. 9 per year 3. Website. www.artdocents.com Ongoing; and updated monthly 4. Multi -media art resource loan program to teachers and docents 500 approximately F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Age Under 18 years old 3268 19 — 50 years old 93 51 years old and over 5 Disability Status Disabled Not Disabled Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Income 50% of median and below 51 % - 100% of median Above 100% of Median Sex Female Male Total Total Los Gatos clients 3366 6 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. II. AGENCY INFORMATION A. General Information Legal Name of Organization Art Docents of Los Gatos, Inc. Address of Organization 17000 Roberts Road Los Gatos, CA 95032 Name of Executive Director Michelle Abene, President 2015-20 ] 7 Date of Incorporation March 1980 Insurance/Tax Information Federal Employer Tax Number ID# 94-2697299 State Employer Tax Number C0978543 Worker's Compensation Carrier/ Policy Number State Fund: 907058215 Liability Insurance Carrier Travelers Insurance Co. Amount of Liability Coverage 2,000,000 Property Damage (combined with liability) 300,000 Combined Single Limit 1,000,000 Policy Period 2/20/17-2/20/18 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2017/18. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Program Coordinator 1 $24.00 30 100% Volunteers Active 68 $0 3 100% Sustaining 25 $0 .5 100% C. Agency Experience --Describe the experience of your Agency in providing program services. • The Art Docents of Los Gatos have successfully provided art education and enrichment services to the LUSCD since 1973. • To become a docent, one has to complete a nin-week training session. Also, throughout the school year refresher classes are offered to all docents who wish to hone specific skills relative to our programs. • A curriculum committee, which includes members with education degrees and art experience, ensures the lessons are aligned with the California State Standards for Visual Arts and Common Core. They also refine and tweak the lessons on the advice of teachers if issues arise. • A continuing education committee ensures the volunteer docents receive updated training to stay abreast of current lessons by networking with the greater local community to provide art -related studio tours, museum visits, and classes. D. Staff Experience —Describe the experience of key staff assigned to the program. The Art Docent Program Coordinator provides continuity in the area of support for the volunteer docents and contact with the teachers in the district. The organization is advised by a Board of Directors who meet four times a year and provide guidance in a number of areas. An Executive Board (consisting of a President, VP Programs, VP of Membership, VP of Fundraising, Treasurer, Secretary and Parliamentarian meets once a month and oversees the committees formed to deal with the daily services offered to the students and fundraising, budgetary, and docent issues that arise. The Program Coordinator works directly with the following committees: Training, Art Show, Curriculum, Guest Artist, Fundraising, Hospitality, Publicity, Newsletter, Continuing Education, Website, School Representatives. E. Staffing Plan —Describe any anticipated staffing changes to occur during FY 2017/18. None. 8 III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summa Budget Data FY 2017/18 FY 2016/17 Los Gatos grant funding Requested: $4000 Received: $4000 Total Program budget $ $ Los Gatos grant as percentage of total Program budget % 5.9 % 5.9 Total Organization budget $ 67570 $ 67570 Cost per year per unduplicated Los Gatos client $ 21 $ 21 Revenue Summa Revenue Source FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Los Gatos grant $ $4000 $ $ $4000 $ Other municipal funding (please specify: City of Monte Sereno) $ 1000 $ $ 1000 $ County funding (please specify:) $ $ $ $ State funding (please specify:) $ $ $ $ Federal funding (please specify:) $ $ $ $ Other jurisdiction funding (please specify: LGUSD,LGEF, H&S Clubs ) $ 47500 $ $ 47500 $ Fees for services: membership dues $ 3250 $ $ 3250 $ Donations: Business Community and Membership Fundraisers $ 5400 $ $ 5400 $ Reserve contingency fund $ 60000 $ $ 60000 $ All other sources (please specify: Service Clubs and Bank interest) $ 2090 $ $ 2090 $ Total $ 123240 $ $ 123240 $ 9 Expenditure Summa Expense Category FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Personnel $ 36600 $ $ 36600 $ Facility $ 5000 $ $ 5000 $ Overhead $ 5670 $ $ 5670 $ Materials/Supplies $ 1700 $ $ 1700 $ Professional Services: $ 4300 $ $ 4300 $ Fundraising $ $ $ $ Capital Projects $ $ $ $ Other (please specify: Program Expenses) $ 14300 $ $ 14300 $ Total $ 67570 $ $ 67570 $ BUDGET NOTES: 1. Art Docents of Los Gatos has only one prozram: therefore Organizational and Program budgets are the same. 2. Membership fundraiser held every other year. 3. New Budget for fiscal year 2017-18 will be adopted in May: estimated to be similar to current year. B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. No. C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. No. D. Budget Alternatives —What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. School expenses will not be affected. Cuts will be made in other areas and/or reserve funds tapped. 10 E. Funding Sources —Describe your organization's efforts in pursuing other funding sources. 1. Apply for yearly grants from Silicon Valley Creates and Monte Sereno 2. Board solicitation of donations from local business community and service clubs 3. Membership Fundraisers held in 2016-17: Holiday Lights, Nicks Next Door Luncheon, Mulch Madness,TBA F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. N/A G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. N/A CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: 31\,2017 1\(\. -eeros of LO5(;61}-os Organization Name Cep Executive Director N1 � l✓1�� I� e b'efrt 1,1-ey •e14 (Print Name) 11 This Page Intentionally Left Blank LG COMMUNITY CONCERTS Town of Los Gatos FY 2017/18 Community Grant Program Application Summary Project: Los Gatos Community Concerts Kevin Hayashi, President Agency: Los Gatos Community Concert Association P.O. Box 1116 Los Gatos, CA 95031 Kevin Hayashi, President Project Description: The Los Gatos Conununity Concert Association is a 501(c)(3) non-profit organization. Our mission is "To provide the community access to live performing arts concerts at an affordable cost." We have provided an annual concert series for the past 69 years consisting of four top quality musical performances presented for the local community at a very affordable cost. In addition, as an outreach program, we also try to arrange for free encore performances by some of our artists, at a local venue for a community group such as students or non -mobile elderly. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. IProgram Funding: Town annual funding amount Total annual program budget FY 2016/17 (adopted) $ 3,800 $ 20,950 Town $ as % of annual total 18% FY 2017/18 Clients: (requested) $ 5,000 Unduplicated annual Los Gatos clients $ 24,700 Total unduplicated annual clients 20% Los Gatos clients as % of annual total FY 2016/17 (actual) 295 est. FY 2017/18 (proposed) 300 475 est. 480 62% 63% TOWN OF LOS GATOS ti• FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Los Gatos Community Concert Association Address of organization 16250 Shannon Road, Los Gatos, CA 95032 (address of LGCCA president) Organization contact (Name, title, telephone number, email address) Kevin Hayashi, President, 408-204-0674 kevin_hayashi@yahoo.com Program name Los Gatos Community Concerts Site address of program Los Gatos High School Theatre 20 High School Court, Los Gatos, CA Program manager (Name, title, telephone number, email address) See Organization contact above Annual grant amount requested FY 2017/18 $5,000 B. Community Need Statement While the Silicon Valley in general has a wealth of cultural arts entertainment available, it usually comes at a cost: high ticket price and inconvenient venue location/transportation. The elderly population and the residents in general of the Los Gatos community deserve to have quality live musical performances offered locally at a reasonable price. C. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2017/18 Number of Services Provided Annually FY 2017/18 Number of Unduplicated Los Gatos Residents served Annually 1. Musical Concert Performances 4 300 Average number of direct services received by each unduplicated client: 4 Average number of direct services received by each unduplicated Los Gatos client: 4 3 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2017, through June 30, 2018. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service 1. N/A FY 2017/18 Number of Services Provided Annually 2. F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services, Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Age Under 18 years old 20 19 — 50 years old 60 51 years old and over 220 Disability Status Disabled Not Disabled 35 265 G. Client Participation Requirements Ticket Prices: Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Income 50% of median and below 51 % - 100% of median unknown Above 100% of Median Female unknown Male Total Los Gatos clients Series Subscription of 4 Concerts - $60 Adult/ $55 Senior/ $10 Student/ $130 Family Individual Concert - $25 Adult/ $20 Senior/ $5 Student 4 H. AGENCY INFORMATION A. General Information Legal Name of Organization Los Gatos Community Concert Association Address of Organization 16250 Shannon Road, Los Gatos, CA 95032 (address of LGCCA president) Name of Executive Director Kevin Hayashi Date of Incorporation June 27, 1957 Insurance,Tax Information Federal Employer Tax Number 94-6122399 State Employer Tax Number Entity ID: 0340387 Worker's Compensation Carrier/ Policy Number N/A Liability insurance Carrier Non Profit's Insurance Alliance Amount of Liability Coverage $2,000,000 Property Damage (combined with liability) $1,500,000 Combined Single Limit $1,000,000 Policy Period 3/26/16 — 3/26/17 B. Stating Profile Please complete the chart below for your organization as it will be staffed during FY 2017/18. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Eiript gs.. Volunteers President 1 N/A 4 100% Vice President of Artists and Subscriptions 1 N/A 4 100% Vice President of Publicity 1 N/A 3 100% Treasurer N/A 2 100% Secretary 1 N/A 2 100% Board Members 13 N/A 1 100% 5 C. Agency Experience —Describe the experience of your Agency in providing program services. The Los Gatos Community Concert Association has been producing an annual 4 concert series for 69 years continuously since 1947. D. Staff Experience —Describe the experience of key staff assigned to the program. President — 9 years; VP of Artists/Subscriptions-20 years; VP of Publicity — 9 years; Treasurer — 2 year; Secretary — 7 years; 12 years on Board. 24 years on Board. 14 years on Board. 3 years on Board. 11 years on Board. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2017/18. None 6 III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summa Budget Data FY 2017/18 FY 2016/17 Los Gatos grant funding Requested: $5,000 Received: $3,800 Total Program budget $ 24,700 $ 20,950 Los Gatos grant as percentage of total Program budget 20% 18% Total Organization budget $ 1,500 $ 1,500 Cost per year per unduplicated Los Gatos client $ 87 $ 76 Revenue Surma Revenue Source FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Los Gatos grant $ 5,000 $ 5,000 $ 3,800 $ 3,800 Other municipal funding (please specify:) $ 1,000 Monte Sereno $ 1,000 Monte Sereno County funding (please specify:) $ $ $ $ State funding (please specify:) $ $ $ $ Federal funding (please specify:) $ $ $ $ Other jurisdiction funding (please specify:) $ $ $ $ Fees for services $ 13,000 $ 13,000 $ 11,490 $ 11,490 Donations $ 4,300 $ 4,000 $ 3,770 $ 3,450 Reserve contingency fund $ 12,000 $ $ 12,000 $ All other sources (please specify:) $ 2,700 Program ads $ 200 IBM Matching grant $ 2,700 Program ads $ 2,210 Program ads $ 225 IBM Matching grant $ 2,210 Program ads Total $ 38,200 $ 24,700 $ 34,495 $ 20,950 7 Revenue Source FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Expenditure Summa Expense Category FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Personnel $ $ $ $ Facility $ $ $ $ Overhead $ 700 $ 400 $ 700 $ 400 Materials/Supplies $ 2,000 $ 1,500 $ 1,945 $ 1,400 Professional Services $ 22,800 $ 22,800 $ 19,150 $ 19,150 Fundraising $ $ $ $ Capital Projects $ $ $ $ Other (please specify:) $ 700 insurance $ $ 700 Insurance $ Total $ 26,200 $ 24,700 $ 22,495 $ 20,950 B. Organization Contracts —Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? NO. If so, please describe. C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? NO. If so, please describe. D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? We are continually investigating new funding sources and applying for arts grants. We do have a reserve contingency fund which we use if required. Describe how a reduction will affect the achievement of stated goals. Our goals will be completed in any event, while our contingency fund may be diminished. E. Funding Sources —Describe your organization's efforts in pursuing other funding sources. We actively pursue funding through grants from arts organizations, service clubs, corporations, and government entities, as well as through corporate sponsors, program advertisements, and in -kind donations. F. Supplies Disclosure —If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. N/A G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. N/A 8 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: .4r.,4v, ,20I7 J Organization Name 1/ Execu a Direc, -4:Le (f 6 j (Print Name) 9 LG MORNING ROTARY Town of Los Gatos FY 2017/18 Community Grant Program Application Summary Project: Project/Program: 2017 Plein Air Fine Art Festival and Wine Tasting Program Manager: Ginger Taylor McDonald & Bill Parkin Agency: Name of Agency: Los Gatos Morning Rotary Club Charitable Foundation Site Address: PO Box 282, Los Gatos, CA 95031 Name of Executive Director: Trevor Schwartz President Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. LGMR CF is a nonprofit 501(C)3 organization chartered in 2003. Our Mission is to provide funding for the educational support of youth involved in the arts, music and science. LGMR members commit hundreds of volunteer hours and professional experience to sustain this mission. Since 2009, we have produced an annual Plein Air Exhibit in the Town of Los Gatos. In 2016, over 1000 residents and visitors came to the Town Plaza to view and purchase paintings of the Town and the surrounding areas created by 34 nationally acclaimed Plein Air artists. Net Proceeds of the event were donated to the NUMU HS Art Competition, the LG Art Docents for K-5 in class art training, the LGMR Lighting for Literacy program which provides STEM education to many of our local schools, the Montalvo Art Education Program student leadership training and scholarships plus many other local humanitarian programs. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: Town annual funding amount FY 2016/17 (adopted) N/A FY 2017/18 (requested) $1,500 Clients: Unduplicated annual Los Gatos clients FY 2016/17 (actual) FY 2017/18 (proposed) Total annual program budget N/A $123,000 Total unduplicated annual clients 1000+ 1000+ Town $ as % of annual total N/A 1.2% Los Gatos clients as % of annual total We do not have data TOWN OF LOS GATOS @ FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION 1. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Los Gatos Morning Rotary Charitable Foundation Address of organization PO Box 282 Los Gatos, CA 95031 Organization contact (Name, title, telephone number, email address) Trevor Schwartz, President 408-569-8003 trevorschwartz@gmail.com Program name 2017 Plein Air Fine Art Festival and Wine Tasting Site address of program LGMR PO Box 282 Los Gatos, CA 95031 Program manager (Name, title, telephone number, email address) Ginger Taylor McDonald, CoChair, 408-656-7184, gingergtmmkt@gmail.com Bill Parkin, CoChair 408-358-3876, parkinw@verizon.net Annual grant amount requested FY 2017/18 $1,500 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. Historically, the Town of LG has been known as a promoter and center of the arts. LGMR has partnered with the town since 2003 to offer various cultural events to the citizens of the Town. Since 2009, the LGMR Plein Air Festival has given residents and local artists access to world -class Plein Air artists and their work. Net Funds raised from the event are donated directly to local organizations that are equally dedicated to the advancement of the art, music and science for youth, namely, NUMU, Museum of Los Gatos the Art Docents of LG, Montalvo's Art Education Program, and Lighting for Literacy. We also donate funds for college scholarships, high school leadership training programs, the Boy Scouts, the Sea Scouts and the LG High School Boosters. c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct 3 service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2017/18 Number of Services Provided Annually FY 2017/18 Number of Unduplicated Los Gatos Residents served Annually 1. Not applicable 2. 3. 4. 5. Average number of direct services received by each unduplicated client: Average number of direct services received by each unduplicated Los Gatos client: D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July I, 2017, through June 30, 2018. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2017/18 Number of Services Provided Annually 1.2017 Los Gatos Plein Air Fine Art Festival I 2. 3. 4. F. Demographic Information: Not Applicable 4 Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents' FY 2017/18 Age Under 18 years old 19 — 50 years old 51 years old and over Disability Status Disabled Not Disabled Demographic Data Annual Number of Unduplicated Los Gatos residents' FY 2017/18 Income 50% of median and below 51 % - 100% of median Above 100% of Median Sex Female Male Total Total Los Gatos clients G. Client Participation Requirements Not applicable Attach appropriate fee schedules, membership requirements, or other fee listings. II. AGENCY INFORMATION A. General Information Legal Name of Organization Los Gatos Morning Rotary Charitable Foundation Address of Organization PO Box 282, Los Gatos, CA 95031 Name of Executive Director Trevor Schwartz Date of Incorporation Articles of Incorporation were filed in 2009. lnsurance/Tax Information Federal Employer Tax Number Not Applicable State Employer Tax Number Not applicable Worker's Compensation Carrier/ Policy Number Not applicable Liability Insurance Carrier All Active US Rotary Clubs & Districts: Lockton Companies, 500 West Monroe, St. 3400, Chicago, 111, 60661 (312) 669-6900 Amount of Liability Coverage $2,000,000 5 Property Damage (combined with liability) $2,000,000 Combined Single Limit $2,000,000 Policy Period July 2016/2017: renewed each year. B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2017/18. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Approximate Flours Percent of Time Classification Hourly Rate Worked per to Program Week Employees None Volunteers Committee Members 10 Not applicable 10 100% Event Staff 60 Not applicable 12 100% C. Agency Experience --Describe the experience of your Agency in providing program services. LGMR club has organized two or more fundraising events per year since it was in 2003 LGMR has annually produced a Plein Air Fine Art festival since 2009 LGMR's current major fundraisers are Plein Air ($70K production costs) and Claws for a Cause ($75K production costs) D. Staff Experience --Describe the experience of key staff assigned to the program. Operations staff (fundraising, marketing, volunteers) bring years of professional experience to the LGMR programs, and in related business or nonprofit organizations. Artistic staff has years of experience with the Plein Air Fine Art Festival and related business or non- profit organizations. The event Artists chair is also a key director (volunteer) of the Los Gatos Gallery 24 partnership. E. Staffing Plan —Describe any anticipated staffing changes to occur during FY 2017/18. Core staff and event volunteers have worked Plein Air for several years. Newer LGMR members are expected to contribute and are trained to perform specific tasks. 6 111.. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summa Budget Data FY 2017/18 FY 2016/17 Los Gatos grant funding Requested: $1,500 Received: None Requested Total Program budget $123,110 $116,030 Los Gatos grant as percentage of total Program budget % 1.2% Total Organization budget $226,115 $208,020 Cost per year per unduplicated Los Gatos client $N/A $N/A Revenue Summa Revenue Source FY 2017/18 Organizational Budget FY 2017/18 Program . Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Los Gatos grant $1,500 $1,500 none requested 0 Other municipal funding (please specify) $0 $0 $0 $0 County funding (please specify:) $0 $0 $0 $0 State funding (please specify:) $0 $0 $0 $0 Federal funding (please specify:) $0 $0 $0 $0 Other jurisdiction funding (please specify:) $0 $0 $0 $0 Fees for services $0 $0 $0 $0 Donations $5580 $0 $13,160 $0 Reserve contingency fund $69,050 $0 $ $0 All other sources: Fundraisers (please specify:) $226,115 $123,110 $208,020 $116,030 Total $233,195 $124,610 $221,180 $116,030 Expenditure Summary 7 Expense Category FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Personnel $0 $0 $0 S0 Facility $15,050 $1,920 $13,530 $0 Overhead $7,500 $0 $7,270 $0 Materials/Supplies $52,530 $5,700 $51,025 $5,660 Professional $1,930 $0 $2,110 $0 Fundraising $11,700 $7,200 $8,570 $5,590 Capital Projects. $6,000 $6,000 $0 $0 Other Artist's Commissions (please specify:) Grants $36,000 $54,400 $36,000 $28,470 $35,830 $58,190 $35,830 $40,730 Total $185,210 $85,290 S58,190 $87,810 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. NO C. Organization Investigations--ls your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. NO D. Budget Alternatives —What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. We will be required to reduce promotional expenses and exhibit expenses. Town of LG funds will provide the means to expand awareness and attract greater interest to attend and support the art, music and science education for youth. E. Funding Sources —Describe your organization's efforts in pursuing other funding sources. Volunteers help to reach out to local, businesses and organizations as sponsors of the event. Sponsors help to offset production event costs, and ultimately increase funds to event beneficiaries. We are trying to increase attendance at our Exhibit and VIP Reception. We are seeking grants from other sources. The Town of Monte Sereno has committed. Bay Area News is considering F. Supplies Disclosure —If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. NONE G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. NONE 8 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: L ) , 2017 Los Gatos Morning Rotary Charitable Foundation Organization Name Executive Director Trevor Schwartz, Pres. LGMR CF (Print Name) 9 NUMU CATALOGUING a or Los G ros Town of Los Gatos FEB - 7 2017 FY 2017/18 Community Grant Program Application Summary CLERK DEN a ran Project: Project/Program: NUMU Cataloguing and Digitization Project (NUMU CDP) Program Manager: Stefanie Midlock Agency: Name of Agency: Los Gatos Museum Association (New Museum Los Gatos) Site Address: 106 E. Main Street, Los Gatos, CA 95030 Name of Executive Director: Lisa Coscino Project Description: Provide brief description of agency, agency goals; and agency services. Describe your program briefly, including who benefits from your program. New Museum Los Gatos (NUMU), formerly the Los Gatos Museum Association founded in 1965, is a public non-profit art and history museum located in the Civic Center Plaza in downtown Los Gatos. NUMU requests a grant to support the cataloguing and digitizing of its permanent collection. NUMU is the steward of an estimated 3,000 pieces of art and artifacts that tell the story of the Town of Los Gatos. This rich collection is held in trust for the public, and benefits the residents of Los Gatos by providing them a link to the past from which to frame the present and plan for the future. This is the first phase in a multi -year project with the goal of cataloguing and digitizing the entire collection. We estimate that this funding support will complete the first ten percent of the project. The artifacts in NUMU's collection were originally stored in the Forbes Mill Museum and the Los Gatos Art Museum. Since moving them to NUMU's new site in the Civic Center, the artifacts have been inventoried, housed, and secured in a new climate -controlled secured storage room. The next step in caring for NUMU's permanent collection is to create an accurate, detailed, publicly accessible online database. Funding from this grant will allow NUMU to hire a dedicated staff person to work solely on making the collection accessible online through proper cataloguing and digital imaging. NUMU's mission is to "engage community at the intersection of art, history and education through innovative, locally connected and globally relevant exhibits programs and experiences." The online database would aide the Museum to create meaningful experiences with its permanent collection by allowing anyone in Los Gatos, and around the world, to view and contribute to the understanding and contextualization of objects. NUMU strives to not just preserve Los Gatos history but also share it. Appropriately cataloguing the important artifacts of Los Gatos means that they will be correctly documented and tracked. In the short term, that means that the artifacts can be used in exhibits, educational programs, and can be available to researchers. In the long term, it means future generations of Los Gatos residents will have tangible pieces of their history. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2016/17 (adopted) FY 2017/18 (requested) Clients: FY 2016/17 (actual) FY 2017/18 (proposed) Town annual funding amount n/a $7,000 Unduplicated annual Los Gatos clients n/a Total annual program budget n/a $ 7,890.58 Total unduplicated annual clients n/a Town $ as % of annual total n/a 89% Los Gatos clients as % of annual total n/a TOWN OF LOS GATOS ❖ FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I. PROGRAM/PROJECT INFORMATION Li Fee Schedule, Membership, or other fees II. AGENCY INFORMATION D Current Board of Directors Articles of Incorporation D Bylaws ❑ Organizational Chart ❑ Brochures, Flyers, Promotional Materials 1I1. FISCAL INFORMATION 2 Town of Los Gatos FY 2017/18 Community Grant Program Application Summary RECEIVED rowN OF LOS GATOS FEB ` 7 2017 CEDE? vir Project: Project/Program: NUMU Cataloguing and Digitization Project (NUMU CDP) Program Manager: Stefanie Midlock Agency: Name of Agency: Los Gatos Museum Association (New Museum Los Gatos) Site Address: 106 E. Main Street, Los Gatos, CA 95030 Name of Executive Director: Lisa Coscino Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. New Museum Los Gatos (NUMU), formerly the Los Gatos Museum Association founded in 1965, is a public non-profit art and history museum located in the Civic Center Plaza in downtown Los Gatos. NUMU requests a gram to support the cataloguing and digitizing of its permanent collection. NUMU is the steward of an estimated 3,000 pieces of art and artifacts that tell the story of the Town of Los Gatos. This rich collection is held in trust for the public, and benefits the residents of Los Gatos by providing them a link to the past from which to frame the present and plan for the future. This is the first phase in a multi -year project with the goal of cataloguing and digitizing the entire collection. We estimate that this funding support will complete the first ten percent of the project. The artifacts in NUMU's collection were originally stored in the Forbes Mill Museum and the Los Gatos Art Museum. Since moving them to NUMU's new site in the Civic Center, the artifacts have been inventoried, housed, and secured in a new climate -controlled secured storage room. The next step in caring for NUMU's permanent collection is to create an accurate, detailed, publicly accessible online database. Funding from this grant will allow NUMU to hire a dedicated staff person to work solely on making the collection accessible online through proper cataloguing and digital imaging. NUMU's mission is to "engage community at the intersection of art, history and education through innovative, locally connected and globally relevant exhibits programs and experiences." The online database would aide the Museum to create meaningful experiences with its permanent collection by allowing anyone in Los Gatos, and around the world, to view and contribute to the understanding and contextualization of objects. NUMU strives to not just preserve Los Gatos history but also share it. Appropriately cataloguing the important artifacts of Los Gatos means that they will be correctly documented and tracked. In the short tenn, that means that the artifacts can be used in exhibits, educational programs, and can be available to researchers. In the long term, it means future generations of Los Gatos residents will have tangible pieces of their history. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 20.16/17 (adopted) FY 2017/18 (requested) Clients: FY 2016/17 (actual) FY 2017/18 (proposed) Town annual funding amount n/a $7,000 Unduplicated annual Los Gatos clients n/a Total annual program budget n/a $ 7,890.58 Total unduplicated annual clients n/a Town $ as % of annual total n/a 89% Los Gatos clients as % of annual total n/a ' TOWN OF LOS GATOS + FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST' Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I. PROGRAM/PROJECT INFORMATION 0 Fee Schedule, Membership, or other fees II. AGENCY INFORMATION 0 Current Board of Directors 0 Articles of Incorporation U Bylaws ❑ Organizational Chart [1 Brochures, Flyers, Promotional Materials 111, FISCAL INFORMATION 2 n Audit or Financial Statement plus Letter of A uditability Li Organizational Budget E internal Revenue Service Ruling Letter (Section 501 c.3) 0 California Revenue Code (Section 23701 d) TOWN OF LOS GATOS •r FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION 1. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization ( Los Gatos Museum Association Address of organization 106 E Main Street Los Gatos, CA 95030 Organization contact (Name, title, telephone number, email address) Kimberly Snyder, Operations & Membership Manager Phone: 408-354-2646 E-mail: ksnyder@numulosgatos.org Program name NUMU Cataloguing and Digitization Project (NUMU CDP) Site address of program 106 E Main Street Los Gatos; CA 95030 Program manager (Name, title, telephone number, email address) Stefanie Midlock, Exhibition Registrar Phone: 408-354-2646 Email: smidlock@numulosgatos.org Annual grant amount requested FY 2017/18 1 $7,000 3 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. For over 50 years, the Los Gatos Museum Association has collected items related to the town's history and art. In the digital age, it is the time to make that collection meaningful and accessible to the Los Gatos community through proper cataloguing and digitization. The ability to access the museum's collections online gives the community a new avenue for learning and increases opportunities for the public to interact with their art and history in an educational and inspiring manner. Digitization is a way to reach the Los Gatos community when they are not physically able to come to the museum. Local school children can get information to enrich their understanding of California history by looking online at objects used in their hometown. Digitized art can inspire artists facing mobility or transportation challenges. Digitizing NUMU's collection allows Los Gatos residents to be in touch with art and history on their terms and when it's convenient for them. Additionally, a deeper understanding of the collection will allow NUMU's curators and researchers to properly interpret the vibrant and fascinating story of Los Gatos through its artifacts and art. c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2017/18 Number of Services Provided Annually FY 2017/18 Number of Unduplicated Los Gatos Residents served Annually Collections assistant to inventory, catalogue and preserve items in the collection. 2. l n/a 3. 4. 5. Average number of direct services received by each unduplicated client: no data Average number of direct services received by each unduplicated Los Gatos client: no data 4 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2017, through June 30, 2018. An indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. FY 2017/18 Number of Services Provided Annually 1. Access to NUMU's collection online via eHive online database to anyone with an internet connection. No data 2. 3. 4. Description of Service F. Demographic information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. 'Please see below. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Under 18 years old 19 — 50 years old 51 years old and over Disabled Not Disabled Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 income 50% of median and below 51 % - 100% of median Above 100% of Median Female Male Total. Total Los Gatos clients 1 * Specific demographic data has not been calculated because we believe that this project provides a direct service to the entire Los Gatos community. Because the outcome of the project will be available online without restrictions, the data produced by this project will be readily accessible to everyone. G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. n/a II. AGENCY INFORMATION A. General Information Legal Name of Organization Address of Organization Name of Executive Director Date of Incorporation Insurance/Tax Information Los Gatos Museum Association 106 E. Main Street, Los Gatos, CA 95030 Lisa Coscino Federal Employer Tax Number State Employer Tax Number Worker's Compensation Carrier/ Policy Number Liability Insurance Carrier Amount of Liability Coverage Property Damage (combined with liability) Combined Single Limit Policy Period 1965 94-1619601 3649433-4 EIG207701401 AP Intego/ Employers I million per occurrence 2 million aggregate of annual claims 1 million January 12, 2017 — January 12, 2018 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2017/18. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification E ;tp o e$ Executive Director Art Curator Operations & Membership Manager 1 Approximate Hourly Rate $25 Salary Hours Worked per Week 40 + 15 Percent of Time to Program 40 2% 5% 3% 6 Education Coordinator Creative Director 1 Salary Salary 32 40 1% 4% History Curator Community Outreach Coordinator Exhibition Registrar Collections Assistant 1 I l 1 $25 $14 40 14 l 0% 2% Salary $13 40 16 35% 100% C. Agency Experience --Describe the experience of your Agency in providing program services. Since 1965, the Los Gatos Museum Association has collected and housed hundreds of objects that represent and reflect the town's rich history and art. The New Museum Los Gatos is committed to continuing this tradition while preserving and sharing the history and art that makes Los Gatos so vibrant. Our staff in collections, art and history are professionally trained and educated in advanced degree programs related to collections management and work to make NUMU a vital part of the ongoing preservation and interpretation of the history and art of Los Gatos. The new facility allows us to properly store and secure the collections in a climate -controlled room. There are also security and fire safety measures in place that were not available prior to our move. NUMU has already begun to utilize an online database system called ei-live, which allows residents of Los Gatos, and the larger world, to view NUMU's collection. With funding from this grant, we can increase the amount of records that are currently online, strengthening the communities' connection to and ability to access the collection. D. Staff Experience --Describe the experience of key staff assigned to the program. Stefanie Midlock, M.A. is the Exhibition Registrar and will serve as the project manager. Stefanie earned her master's degree in Museum Studies from San Francisco State University and specializes in collections management and registration. She has worked in the museum field for eight years caring for museum collections, and has worked on similar projects in various Bay Area institutions, including the creation of 1000 new catalogue entries at her last position of Assistant Collections Manager for the Los Altos History Museum. She works to the standards and best practices of the American Alliance of Museums to ensure that the best care is being given to objects in NUMU's collection. Marianne McGrath, M.A. in Art History is the Art Curator at New Museum Los Gatos. She has worked at the museum for 10 years and is well versed in the art collection and local artists. She strives to collect art that showcases Los Gatos artists. Amy Long, M.A. in Public History, is the History Curator at New Museum Los Gatos. Her training includes collections management, and training in the care, preservation, and inventory, housing and moving of hundreds of objects for the California State Parks Collections in Sacramento. Amy is dedicated to preserving and sharing the history of Los Gatos through rotating exhibits at New Museum Los Gatos. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2017/18. Collections Assistant: The success of this grant application will mean the addition of a new, temporary position. In conjunction with the NUMU Cataloguing and Digitization Project, the Collections Assistant will be responsible for creating accurate and detailed digital catalogue records, creating paper records, organizing and reconciling existing paper records, photographing and numbering collections objects, verifying and tracking the locations of collections objects, and both unpacking and repacking boxes of collection objects safely. 8 III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively. please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summary Budget Data I FY 2017/18 FY 2016/17 Los Gatos grant funding Requested: 7,000.00 Received: n/a Total Program budget $ 7,890.58 n/a Los Gatos grant as percentage of total Program budget 89% n/a Total Organization budget $ 670,000 n/a Cost per year per unduplicated i Los Gatos client n/a n/a Revenue Summary SEE P&L Revenue Source FT 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Los Gatos grant $ 7.000 $ 7,000 $7,000 n/a Other municipal funding (please specify: ) n/a n/a n!a n/a County funding (please specify:) n/a n/a n/a n/a State funding (please specify:) n/a n/a n/a n/a Federal funding (please specify:) n/a n/a n/a n/a Other jurisdiction funding (please specify:) n/a n/a n/a n/a Fees for services $ 177,600.00 $ 890.58 $149,991.29 n/a Donations (unrestricted + restricted) $ 171,000 n/a $125,308.41 n/a Reserve contingency fund n/a n/a n/a n/a All other sources Grants + Foundations $83,000 n/a $ 37,000 $ 3,000 j Membership dues $77,000 n/a $49,272 n/a Totals 535,100.00 7,890.58 361,721.70 $3,000 9 . • ---,-- - - Expense Category FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Personnel $ 449,515 $ 6,240.00 $356,875.45 $ 3,700 Facility $35,212 $ 699.56 $ 30,405.06 $ 699.56 Overhead $33,500 $ 845.42 $ 49,749.65 $ 0 Materials/Supplies $ 57,500 $ 105.60 $ 41,075 $ 655.14 Professional Services $ 88,000 $ 0 $ 119,739.62 $ 0 Fundraising $ 18,300 $ 0 $ $ Capital Projects $ 0 $ 0 $ 55,000 $ 55,000 Other (please specify:) Scholarships $7,500 $ 0 $ 2,500 $ 0 Total $ 695,227.00 $7,890.58 $ 622,686.75 $ 4,355.14 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? if so. please describe. No. C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. No. D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. NUMU is working to identify other funders for this project. if funding is not secured, NUMU will continue with the project as staff and time allow. The project will most likely be stalled for periods of time due to the demands of other museum duties on current staff members. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. NUMU continuously seeks private donations, restricted gifts, and foundation and corporate funding for its projects. The Executive Director and Development Team are in communication with potential donors through personal meetings, cultivation events and general NUMU activities. Development consultant expertise is sought from time to time. Granting opportunities are activity researched by the collections and curatorial staff, and applications are continually submitted. 10 F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe: 1. Digital Camera: Nikon Coolpix S7000 16 MP Digital Camera with 20x Optical IS Zoom. $226.95 (amazon.com) to photograph the artifacts in the collection. 2. Scanner: Epson Perfection V600 Color Photo Image Film Negative and Document Scanner: $202.46 (amazon.com) to digitize the two-dimensional artifacts (such as archives, photographs, slides, negatives) in the collection. 3. Adobe Creative Suite "Photography" for Photoshop CC: $119.88 for a year, to edit the photographs and scans and produce high quality images for the online database. G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. No. CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: February 7, 2017 Los Gatos Museum Association Organization Name Executive Director Lisa Coscino This Page Intentionally Left Blank NUMU MUSEUM EXPLORER Town of Los Gatos FY 2017/18 Community Grant Program Application Summary Project: Project/Program: Museum Explorer Program Program Manager: Madeleine Crow RECEIVED TOWN OF LOS GATOS FEB - 7 2017 CLERK DEPARTMENT Agency: Name of Agency: Los Gatos Museum Association (New Museum Los Gatos) Site Address: l06 E. Main Street, Los Gatos, CA 95030 Name of Executive Director: Lisa Coscino Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. The Mission of New Museum Los Gatos (NUMU): Engaging community at the intersection of art, history and education through innovative, locally connected and globally relevant exhibits, programs and experiences. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. IProgram Funding: Town annual funding amount Total annual program budget FY 2016/17 (adopted) $7,000 $30,725.21 Town $ as % of annual 23% total FY 2017/18 Clients: FY 2016/17 I FY 2017/18 (requested) (actual) (proposed) $7,000 Unduplicated 729 1,400 annual Los Gatos clients 30,800 Total 1,468 600 unduplicated annual clients 23% Los Gatos 49.7% 43% clients as % of annual total TOWN OF LOS GATOS + FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. 1. PROGRAM/PROJECT INFORMATION Q Fee Schedule, Membership, or other fees II. AGENCY INFORMATION Q Current Board of Directors Q Articles of incorporation Q Bylaws Q Organizational Chart Q Brochures, Flyers, Promotional Materials III. FISCAL INFORMATION 0 Audit or Financial Statement plus Letter of Auditability 0 Organizational Budget Q Internal Revenue Service Ruling Letter (Section 501 c.3) D California Revenue Code (Section 23701 d) TOWN OF LOS GATOS + FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION 2 I• PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Address of organization Los Gatos Museum Association Organization contact (Name; title, telephone number, email address) Program name Site address of program Program manager (Name, title, telephone number, email address) 106 E. Main Street Los Gatos, CA 95030 Kimberly Snyder. Operations & Membership Manager Phone: 408.354.2646 E-mail: ksnyder@numulosgatos.orp Art & History Museum Explorer Program 106 E. Main Street Los Gatos, CA 95030 Madeleine Crow, Education & Programs Manager Phone: 408.354.2646 Email: mcrow�a,numulosgatos.org Annual grant amount requested FY 2017/18 $7,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. As the cultural backbone of Los Gatos and its surrounding communities, the Los Gatos Museum Association has been serving the Los Gatos community for over fifty years. New Museum Los Gatos (NUMU) curates and presents art and history exhibitions, supporting programs and hands- on art making programs in its extensive exhibition space and dedicated Studio, offering fresh perspectives on Bay Area history, art, and the innovation of our times. NUMU's education programs also provide learning opportunities for adults, youth and children. This Community Grant proposal focuses on NUMU's children programs. NUMU's current education program serving elementary age school students is the Museum Explorer Program. The Museum Explorer Program includes school tours for elementary school students in kindergarten through fifth grade. At present, Explorer is offered for one week in February and one week in April, with optional additional dates throughout the school year, October through April. The Museum Explorer Program is designed to introduce students to art and history themes in an age appropriate manner within the context of a museum setting. Children from Los Gatos schools participate in large numbers; as do children from the 3 surrounding Santa Clara County communities. The Program provides many children with their first exposure to a museum. Smithsonian research has shown that museum enrichment experiences have a significant positive impact on child development. While art and history learning opportunities can be found in our local schools, galleries, and studios, a museum provides a unique venue for such exploration. Museums educate, lend inspiration, and offer exposure to a range of cultural perspectives with unparalleled resources including historical artifacts and original artworks. As our Museum develops in its new location, we wish to continue to expand and deepen our educational offerings to the children of our community. The Museum requests Community Grant funding to continue offering the Museum Explorer program year-round. In addition, we would like to offer a transportation stipend to offset transportation expenses, thus enabling more young students' participation, particularly those in area Title 1 schools. The Museum Explorer program speaks to the nature of the Los Gatos community, providing important cultural and learning opportunities to its residents of all ages. For better-resourced schools in Los Gatos and the surrounding communities the Explorer program is a curriculum supplement. We are working directly with the Los Gatos School district and its elementary school teachers to create lessons complementing classroom curriculum. NUMU meets grade specific curriculum standards, and each program is designed specifically for each visiting class and the their current curriculum. For schools with fewer resources, Explorer is a vital part of classroom planning and often provides a first-time museum experience for many students. For Los Gatos students who come from families with fewer resources, the Museum's educational programming provides essential educational and cultural opportunities. c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2017/18 Number of Services Provided Annually FY 2017/18 Number of Unduplicated Los Gatos Residents served Annually 1. E-newsletters to all elementary teachers 9 e-newsletters are sent out to each teacher. 260 teachers within the Los Gatos Schools (Private & Public Schools) 2. Direct Mailings 3 mailings (500 brochures, 50 posters are taken and sent to local schools) 26 Los Gatos Vice Principals /Principals 3. Program Tours for Art and History 50 Tours 30 Tours 25-72 students per tour 1,400 children 4 300 parents Average number of direct services received by each unduplicated client: 9 Average number of direct services received by each unduplicated Los Gatos client: 9 D. Indirect Services i List, describe, and quantify each indirect service to be provided annually from July 1, 2017, through June 30, 2018. An Indirect Service is a service for which there is no identifiable client: for example, information and referral that is given over the phone. Description of Service FY 2017/18 Number of Services Provided Annually 1. Emails and phone conversations 250 2. Wcbsite announcements and applications 100% available to clients 3. Marketing — Outreach to local businesses, outreach through LGUSD newsletters and elementary Home and School Clubs 400 F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Age Under 18 years old Annual Number of Unduplicated Los Gatos residents FY 2017/18 1,000 19 50 years old 51 years old and over Disability Status Disabled Not Disabled 475 No data No data Demographic Data Annual Number I of Unduplicated Los Gatos residents FY 2017/18 income 50% of median and below No Data 51% - 100% of median Above 100% of Median Female Male Total Total Los Gatos clients No Data No Data 2,000 5 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. II. AGENCY INFORMATION A. General Information Legal Name of Organization Los Gatos Museum Association Address of Organization 106 E. Main Street, Los Gatos, CA 95030 Name of Executive Director Lisa Coscino Date of Incorporation 1965 Insurance/Tax Information Federal Employer Tax Number 94-1619601 State Employer Tax Number 3649433-4 Worker's Compensation Carrier/ Policy Number EIG207701401 Liability Insurance Carrier AP lntego/ Employers Amount of Liability Coverage 1 million per occurrence Property Damage (combined with liability) 2 Million aggregate of annual claims Combined Single Limit 1 Million Policy Period January 12, 2017 — January 12, 2018 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2017/18. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Executive Director 1 Salary 40 + 3% Art Curator 1 $25 30 2% Operations & Membership Manager 1 Salary 40 1 % 6 Creative Director History Curator Coirununity Outreach Coordinator Contracted story teller Bookkeeper Education Coordinator 1 Salary 40 1.5% 40 4% 14 8% N/A 10 1 1 � 1 $200 per session 32 45% Salary /salary • ]� /100 1% $35 per hour C. Agency Experience --Describe the experience of your Agency in providing program services. The Los Gatos Museum Association has delivered cultural and historical educational programs as part of its core mission since its founding in 1965. These programs have focused on providing children and youth with outstanding learning experiences. The current Explorer program has been in place for nine years. All NUMU education programs use a combination of trained staff, experienced volunteers, and professional consultants to deliver exceptional learning experiences for student participants. Planning for Explorer begins a year in advance in order to allow time to develop program content, communicate with the classroom teachers, and obtain external funding. It is a measure of the excellence of these programs that the NUMU has been successful in obtaining the needed financial support for both. Credentialed consultants are interviewed and carefully selected to ensure excellent delivery, creative and imaginative curriculum planning. D. Staff Experience --Describe the experience of key staff assigned to the program. Madeleine Crow is our Education & Programs Manager. She holds a joint honors degree in Art History and French from the University of St. Andrews in Scotland, and has six years experience teaching and working with children. She is currently completing a dual MA/MBA program at John F. Kennedy University in Museum Studies with a focus in Education. She currently designs, coordinates, and schedules the Explorer program and is part of the Explorer teaching team. She has been with the Museum since 2014. Education Consultant Jerry Falek is part of the Explorer teaching team. Mr. Falek is well known throughout the region as an outstanding practitioner of teaching through the imaginative use of story, music, puppets and theater in schools, universities, and community centers. He has an M. Ed in special education and his work has taken him to such diverse places as Soledad Prison and rural Alaska. He provides a wide range of programs for audiences of all ages, from medieval tales of King Arthur, to the writing of Beatrix Potter, to programs of Jewish culture. Mr. Falek is a frequent guest presenter at the Children's Discovery Museum of San Jose. He is on the artist roster for Young Audiences of Northern California and the Alaska State Council of the Arts, and is a regional instructor for the California Arts Project. An important focus of his work has been the social and emotional needs of at -risk children. Art Curator, Marianne McGrath, M.A. has more than 18 years experience in developing and delivering art education programming in a variety of contexts. From 2008-2011 she served as the Museum's Education Curator, managing and originating many of the core features of the Explorer Program. Under her leadership, the Explorer Program grew to include many teachers both in Los Gatos and the surrounding communities that incorporated the program into their curriculum planning. Ms. McGrath has also served in other positions in the museum and has been NUMU's Art Curator since 2013. Julie Harper, M.A. is NUMU's Creative Director. Ms. Harper has worked to produce exhibits in galleries and museums and is an experienced graphic designer and social media coordinator. She will create the collateral materials for Museum Explorer. Kimberly Snyder, Operations and Membership Manager, holds B.A. degrees in both History of Art and Visual Culture and Business Management Economics with an emphasis on accounting. Ms. Snyder handles the invoicing for Museum Explorer as well as all general operations for the Museum. She has been with the Museum since the beginning of 2014. Leslie Sanchez is the Community Outreach Coordinator. She holds an Associate's degree in Biology and a minor in Interior Design. Ms. Sanchez works with Ms. Crow to connect directly with Los Gatos schools and organizations, informing parents and teachers of our program opportunities, and marketing the program to a wider audience. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2017/18. No staffing changes are anticipated. s • F. 11I. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Sunnna?y Budget Data FY 2017/18 FY 2016/17 Los Gatos grant funding Total Program budget Los Gatos grant as percentage of total Program budget Requested: $7,000 $30,886 22.6% Received: $7,000 $29,536.48 23.7% Total Organization budget $670,000 $524,000 Cost per year per unduplicated Los Gatos client $30.89 $8.94 Revenue Summary Revenue Source FY 2017/18 FY 2017/18 Organizational Program Budget Budget FY 2016/17 Organizational Budget Los Gatos grant 1 Other municipal funding (please specify: ) $ 7,000 1 $ 7,000 $ I$ $7,000 $ FY 2016/17 Program Budget $ 7,000 County funding (please specify:) $ 1$ $ $ State funding (please specify;) $ I$ $ $ Federal funding (please specify:) $ 1$ $ $ Other jurisdiction funding (please specify:) $ �$ $ Fees for services Donations (unrestricted + restricted) Reserve contingency fund $ 177,600.00 1 $ 8,500 $ 17J,000 $9,000 $149,991.29 $125,308.41 $ I$ $ 7,000 $ 10,536.48 All other sources Grants + Foundations $83,000 1 $6,386 $ 37,000 $ 5,000 Membership dues $77,000 1 $ $49,272 $ Totals 1535,100.00 1 S30,886 361,721.70 $29,536.48 9 Exlpendiiure Summary Expense Category FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Personnel $ 449,515 $ 11,000 $356,875.45 $ 11,000 Facility $35,212 $ $ 30,405.06 $ Overhead $33,500 $ 3706.32 $ 49,749.65 $ 3,544.32 Materials/Supplies $ 57,500 $ 3,600 $ 41,075 $ 3,600 Professional Services $ 88,000 $ 10,000 $ 119,739.62 $ 10,000 Fundraising $ 18,300 $ 500 $ $ 200 Capital Projects $ 0 $ $ 55,000 $ Other (please specify:) Scholarships $7,500 $ $ 2,500 $ Transportation Stipends $ 2,000 $ 2,000 $ 500 $ 500 Total $ 695,227.00 $ 30,886 $ 622,686.75 $29,536.48 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? if so, please describe. No C. Organization Investigations--ls your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. No D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. There will be no impact on the achievement of the basic two weeks of the Explorer Program. I3owever, NUMU will continue to seek private and foundation funding to increase the offered dates and to offer scholarships to area Title I Schools. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. NUMU continues to seek private donations, restricted gifts, and foundation and corporate funding for its programs. The Executive Director and Development Team are in close communication with potential donors through personal meetings, cultivation events and general museum activities. Development consultant expertise is sought from time to time. Granting l0 opportunities are activity researched and applications arc continually submitted. F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $ ] 00 or more are to be purchased with Community Grant funds, please describe. No G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. No CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. if this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the hest of my knowledge. Date: February 7 , 2017 New Museum Los Gatos Organization Name Executive Director Lisa Coscino (Print Name) ATTACHMENT 1 SAMPLE PARTICIPATION AGREEMENT Over the course of the contract period, a grantee may be required submit Participation Agreements similar to this sample. Do not submit this Sample Participation Agreement with your completed application. , a nonprofit corporation, provides certain services to individuals and families in Santa Clara County. Partial funding (subsidy) for these services is provided under contract by the Town of Los Gatos to this Agency. This information is reviewed for quality control and/or auditing purposes only. Therefore it is held in confidence by the Agency, the Town, and the Federal representatives and not considered "Public Information." The purpose of this Participation Agreement is as follows: 1. To have the client acknowledge the request and receipt of needed services and provide the client with an opportunity to evaluate such services. 2. To have the client authorize the release of demographic information to the Agency/the Town. 3. To assure the client that information about them is held in confidence and not considered public information and that only statistical information about all clients served is reported. 4. To have the client hold harmless and release from liability the Agency, the Town, and their respective employees, officers, and agents in the event of any suit, claim, loss, damage, or obligation arising out of/or attributed to any of the Agency's programs. Please complete the following: Name: Age: Address: Phone: Sex (check one): 0 Male 0 Female Disability Status (check one): 0 Disabled 0 Not Disabled Female Head of Household (check one): 0 Yes 0 No Income Level (check one): ❑ 30% of median and below ❑ 31 % - 50% of median ❑ 51 % - 80% of median ❑ 81 % - 100% of median ❑ Above 100% of median 1 understand that this agreement is an affidavit and certify that the information provided above is true and complete. 12 Signature Date 13 This Page Intentionally Left Blank FY 2017/18 Grant Applications: Human Services COUNSELING AND SUPPORT SERVICES FOR YOUTH (CASSY) Town of Los Gatos FY 2017/18 Community Grant Program Application Summary Project: Project/Program: School Based Mental Health Services at Program Manager: Kelly Sumner RECEIVED TOWN OF LOS GATOS JAN 31 2017 CLERK )iDEPARMENT Los Gatos High School Agency: Name of Agency: Counseling and Support Services for Youth (CASSY Site Address: LGHS 20 High School Court Los Gatos, CA 95030 Name of Executive Director: Christy Hayes Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Now entering our eighth year in partnership with Los Gatos High School, CASSY is well positioned to deepen the impact of our programs on student's social/emotional health, which has far reaching implications for students' academic success. We have developed a strong partnership with the district, with the school, and with the community at large. As a result, we are the sole provider of school -based mental health services at LGHS and are now an established presence in our schools, which has led to an increase in self selection among students for services. CASSY will address the gap in youth mental health services in Los Gatos by partnering with Los Gatos High School to provide competent, accessible therapists on the school campus at no cost to students and families. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2016/17 (adopted) FY 2017/18 (requested) Clients: FY 2016/17 (actual) FY 2017/18 (proposed) Town annual funding amount $15,000 $20,000 Unduplicated annual Los Gatos clients 500 500 Total annual program budget $361,113 $371,946 Total unduplicated annual clients 7,500 7,500 Town $ as % of annual total 4% 5% Los Gatos clients as % of annual total 7% 7% 1 TOWN OF LOS GATOS ❖ FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Counseling and Support Services for Youth (CASSY) Address of organization 544 Valley Way Milpitas, CA 95035 Organization contact (Name, title, telephone number, email address) Christy Hayes — Executive Director 408-493-5289, Christy@cassybayarea.org Program name School Based Mental Health Services at Los Gatos School Site address of program LGHS 20 High School Court Los Gatos, CA 95030 Program manager (Name, title, telephone number, email address) Kelly Sumner — Program Manager 408-493-5289, Kelly@cassybayarea.org Annual grant amount requested FY 2017/18 $20,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. According to the California Healthy Kids Survey, nearly 1 in 5 high school students in Santa Clara County has seriously considered suicide in the last year. A recent CDC report also found that 20% of young people —nearly 60,000 students in Santa Clara county alone —experience other mental health issues, such as depression, anxiety, eating disorders, academic stress, post -traumatic stress due to trauma or violence, and low self-esteem. Sadly, only one-third of children who are actually diagnosed with a mental health issue will even receive treatment. For adolescents living in poverty, the statistics are much worse: 90 percent diagnosed with a mental health issue report not receiving counseling or other services. Regardless of socioeconomic class, the cost of private care, complicated insurance battles, transportation issues, and stigma often act as 3 barriers to a child receiving proper care. Left untreated, mental health issues have a profound impact on a student's academic achievement and career readiness. Research clearly shows that students with unmet mental health needs are more likely to have lower grades and test scores while also experiencing higher rates of suspension, expulsion, and truancy; not surprisingly, they are also more likely to dropout of school altogether. Simply put, when a child is depressed or processing trauma, they have a difficult time focusing on school. Meanwhile, teachers and parents are often at a loss as to how to get a child back on track, or how to handle the classroom disruption or noncompliance that can accompany mental health issues. Too often, the result is a child who become increasingly isolated, who abuses substances, or, in the most tragic cases, commits suicide the second leading cause of death for youth in Santa Clara County. However, there is hope. Studies also show that students are far more likely to seek counseling when it is at their school, especially if it is free. Research also shows that when struggling youth do receive proper support, academic success is likely to follow. They build important emotional regulation and coping strategies that help them stay focused in class and help them develop positive peer, teacher and familial relationships, among other benefits. Providing high -quality school -based mental health support benefits the entire school, resulting in increased attendance and a more positive school climate —one in which students feel safe and supported. Clearly, if we are to ensure that all students thrive academically, we must ensure they have high -quality social -emotional support on school campuses. c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2017/18 Number of Services Provided Annually FY 2017/18 Number of Unduplicated Los Gatos Residents served Annually 1. Psychotherapy sessions (individual, family, group and crisis) 2500 570 2. Classroom presentations 18 500 3. Peer Mediation Training 30 15 4. Staff trainings and consultations 300 65 5. Community Education Presentations 10 150 Average number of direct services received by each unduplicated client: 6 Average number of direct services received by each unduplicated Los Gatos client: 6 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2017, through June 30, 2018. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. 4 Description of Service FY 2017/18 Number of Services Provided Annually 1. N/A 2. 3. 4. F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Age Under 18 years old 350 19 — 50 years old 150 51 years old and over Disability Status Disabled Not Disabled Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Income 50% of median and below 51%- 100%of median Above 100% of Median Sex Female 210 Male 140 Total Total Los Gatos clients 500 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. CASSY services are provided free to all participants. 5 II. AGENCY INFORMATION A. General Information Legal Name of Organization Counseling and Support Services for Youth Address of Organization 544 Valley Way Milpitas, CA 95035 Name of Executive Director Christy Hayes Date of Incorporation 5/8/2009 Insurance/Tax information Federal Employer Tax Number 26-46551] 6 State Employer Tax Number 298-2814-2 Worker's Compensation Carrier/ Policy Number Hartford Insurance Company/policy il 76 WEG LN1696 Liability Insurance Carrier CPH & Associates Amount of Liability Coverage $1 million each occurrence/$5 million aggregate Property Damage (combined with liability) $15,000 Combined Single Limit $1 million Policy Period Annual renewal each September B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2017/18. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Executive Director 1 $52 40 5% Program Manager 1 $35 40 15% Site Coordinator 1 $30 40 100% Therapists 2 $28 40 100% Volunteers 6 C. Agency Experience --Describe the experience of your Agency in providing program services. Seven years ago, CASSY was founded by two experienced school therapists to meet the glaring need for high -quality mental health support in Silicon Valley schools. From a single Ravenswood City School District summer school program in 2009, CASSY has grown into a non-profit organization that partners with 43 Santa Clara and San Mateo county public schools to provide comprehensive mental health services to all enrolled students at no charge. Our mission is to de -stigmatize mental health services and make supporting students' social and emotional well-being the norm in our schools. CASSY places competent, compassionate therapists directly on school campuses, eliminating the transportation, financial, and insurance barriers that so often prevent young people from getting the help they need. We support students through individual, group, and family counseling, while also offering crisis support and intervention, staff and parent consultations, and classroom lessons on bully prevention, depression, and suicide awareness. Annually, we provide direct services to over 5,000 students. Indirectly, 33,000 students benefit from their peers, teachers, and parents developing tools to foster positive relationships, responsible decision -making, and social skills. D. Staff Experience --Describe the experience of key staff assigned to the program. Executive Director, Christy Hayes, is a credentialed early childhood teacher and brings to CASSY more than a decade in diverse nonprofit management and leadership roles in addition to deep experience with and understanding of every level of child development and student support. Program Director, Kelly Sumner, is an established clinician with over 15 years of experience, including the past six years as a clinical supervisor. Before joining CASSY, Kelly was the clinical supervisor for Adolescent Counseling Services in Palo Alto and supervised a team of MFT Trainees and Interns at Palo Alto High School. She was a clinical supervisor at Family and Children Services of Silicon Valley for the Independent Living Program Wellness Services, which served transition -aged foster youth. Site Coordinator, Erica Smith, is a Licensed Marriage and Family Therapist. She began her work at Living Arts Counseling Center and then expanded her training at Rape Trauma Services when she had the opportunity to work in a variety of therapeutic settings in the bay area. During this time she began to work exclusively with the adolescent population. She recently completed her doctorate in Depth Psychology with an emphasis in Psychotherapy at Pacifica Graduate Institute. Therapists employed by CASSY hold a graduate degree in a mental health related field and have a minimum of two years working with school based services for youth. All CASSY therapeutic staff are registered with the Board of Behavior Sciences, which includes a LiveScan background check. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2017/18. We do not anticipate any changes to our current staffing structure at this time. III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summar Budget Data FY 2017/18 FY 2016/17 Los Gatos grant funding Requested: $20,000 Received: $15,000 Total Program budget $371,946 $361,113 Los Gatos grant as percentage of total Program budget 5% 4% Total Organization budget $3,076,316 $2,999,932 Cost per year per unduplicated Los Gatos client $160 $150 Revenue Summar Revenue Source FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Los Gatos grant $20,000 $20,000 $15,000 $15,000 Other municipal funding (please specify: ) $ $ $ $ County funding (please specify:) $ $ $ $ State funding (please specify:) $ $ $ $ Federal funding (please specify:) $ $ $ $ Other jurisdiction funding (please specify:) $ $ $ $ Fees for services $2,464,199 $240,519 $2,363,300 $233,514 Donations $592,117 $111,427 $584,500 $112,599 Reserve contingency fund $ $ $ $ All other sources (please specify:) in -kind, etc $ $ $37,132 $ Total $3,076,316 $371,946 $2,999,932 $361,113 8 Expenditure Summary Expense Category FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Personnel $2,907,354 $332,525 $2,822,674 $322,840 Facility $ $ $ $ Overhead $160,961 $38,648 $166,969 $37,523 Materials/Supplies $8,001 $773 $10,288 $750 Professional Services $ $ $ $ Fundraising $ $ $ $ Capital Projects $ $ $ $ Other (please specify:) $ $ $ $ Total $3,076,316 $371,946 $2,999,932 $361,113 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. No C. Organization Investigations--ls your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. No D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. CASSY is committed to providing comprehensive mental health services at or above current levels in Los Gatos and will seek additional funds through other grants or individual donors as necessary to sustain the program. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. CASSY works in collaboration with several local organizations in Los Gatos to ensure community awareness and expand our financial support. We attend meetings with: CASA, Los Gatos Lions Club, Los Gatos Rotary, Los Gatos History Club, LGHS Home and School Club, The New Millennium Foundation, The Parenting Continuum, and Drug Free Community Committee Meeting. We solicit individual donor support through the Los Gatos Wildcat Days each fall as students return to school. 9 F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. We do not plan to use the grant funds to purchase supplies. G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. We do not plan to use the grant funds for travel expenses. CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: \ , 2017 Counseling and Support Services for Youth (CASSY) Organization Name Christy Hayes (Print Name) Jo This Page Intentionally Left Blank LIVE OAK ADULT DAY SERVICES Town of Los Gatos FY 2017/18 Community Grant Program Application Summary Project: Project/Program: Adult Day Care - Los Gatos Program Manager: Colleen Hudgen, Executive Director Agency: Name of Agency: LIVE OAK ADULT DAY SERVICES Site Address: 111 Church Street, Los Gatos, CA 95030 Name of Executive Director: Colleen Hudgen Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Direct Services Service Days of adult day care (recreation and social activities) provided to Los Gatos frail seniors. FY 2017/2018 (proposed) Days of respite provided to Los Gatos caregivers corresponding to program days. 1000 1000 FY 2015/16 (actual) FY 2015/16 — 744 FY 2015/16 (as of 12/31/2016) 744 FY 2015/16-744 FY 2015/16 (as of 12/31/2016) 744 Noon meals provided to Los Gatos frail seniors. Breakfasts provided to Los Gatos frail seniors. 1000 1000 FY 2015/16 — 744 FY 2015/16 (as of 12/31/2016) 744 FY 2015/16 — 744 FY 2015/16 (as of 12/31/2016) 744 Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: Town annual funding amount Total annual program budget Town $ as % of annual FY 2016/17 (adopted) FY 2017/18 (requested) Clients: 13,000 $13,094 Unduplicated annual Los Gatos clients FY 2016/17 (actual) 20 FY 2017/18 (proposed) 20 (1st half 2016-17) 179,192 211,399 Total unduplicated annual clients 64 64 (1st half 2016-17) 7.3% 6.1% Los Gatos 31% 31% clients as % of annual total ° total 64 64 TOWN OF LOS GATOS ❖ FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I. PROGRAMIPROJECT INFORMATION ✓ Fee Schedule, Membership, or other fees H. AGENCY INFORMATION ✓ Current Board of Directors ✓ Articles of Incorporation ✓ Bylaws ✓ Organizational Chart ✓ Brochures, Flyers, Promotional Materials M. FISCAL INFORMATION ✓ Audit or Financial Statement plus Letter of Auditability ✓ Organizational Budget ✓ Internal Revenue Service Ruling Letter (Section 501 c.3) ✓ California Revenue Code (Section 23701 d) 2 TOWN OF LOS GATOS ❖ FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization LIVE OAK ADULT DAY SERVICES Address of organization 1147 Minnesota Avenue San Jose, CA 95125 Organization contact (Name, title, telephone number, email address) Colleen Hudgen, Executive Director Telephone (408) 971-9363 liveoakdaycare@att.net Program name Adult Day Care -Los Gatos Site address of program 111 Church Street Los Gatos, 95030 Program manager (Name, title, telephone number, email address) Colleen Hudgen Executive Director (408) 971-9363 liveoakdaycare@att.net Kelly Mitchell, Program Director, Los Gatos site (408) 354-4782 Igliveoak@hotmaii.com Annual grant amount requested FY 2017/18 $13,094 3 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. Santa Clara County is home to over 200,000 seniors aged 60 and over, about 16% of the total county population, expected to double in the next 10 years (2010 U.S. Census). The county's senior population has grown faster in the last 20 years than state and national rates. (COASV, Exec. Summary, June 2012 and SCC, Seniors' Agenda: Phase II, Oct.2012). As the population ages over time the increase in the need for care and services is a priority issue for our community. One out of eight people in this country is 65 and older. By 2030, 20% of the population will be senior citizens. Disabled seniors with chronic mobility and self -care limitations, living on low -fixed incomes, are at the highest risk of social isolation, depression, neglect, abuse, and premature / long-term institutionalization. Also "at -risk" are family members who provide over 70% of care for their elderly loved ones. County needs assessments on health and quality of life consistently report inadequate services for the elderly, as well as the strain on family members caring for an older dependent relative. A recent study found family caregivers are more likely to experience negative health effects like anxiety, depression and chronic disease. Even worse, those who experienced mental or emotional stress while caring for a disabled spouse were 63% more likely to die within four years than noncaregivers who were also tracked. ('Who Will Care for the Caregivers?", New York Times, January 19, 2017). Persons most likely to need support and long-term services, i.e., those aged 85 and over, will increase at a dramatic rate. By 2030, more than one in four (25%) of county residents will be a senior (COASV and SCC CAP). Day care for frail seniors and respite for their caregivers have been designated by all the aforementioned community health studies as priority needs. With the steady and ongoing increase in the aging population, and the frequency of older adults subject to disorders impeding self-sufficiency and quality of life, the needs of seniors will continue to demand greater attention, while respite care for informal caregivers will be an accompanying key senior issue. LIVE OAK's senior clients are frail, at -risk, dependent and disabled by age -related disorders which deny them the ability for self -care, mobility, and healthy functioning. The dearth of appropriate and affordable services, isolation, loneliness and depression, malnutrition and neglect or abuse challenge their health, dignity, comfort and overall quality of life. Day care for frail seniors and respite for their caregivers have been designated by all of the aforementioned community health studies as priority needs. Through advocacy on behalf of seniors and promotion of adult day care as a positive and economical mode of care for the frail elderly population, LIVE OAK provides a viable and consistent contribution to meeting the critical need for senior -related services in Santa Clara County. With the steady and ongoing increase in the aging population, and the frequency of older adults subject to disorders impeding self-sufficiency and quality of life, the needs of seniors will continue to demand greater attention, while respite care for informal caregivers will be an accompanying key senior issue. By promoting adult day care as a positive and economical mode of care for the frail elderly population, LIVE OAK provides a viable and consistent contribution to meeting the critical need for senior -related services in Santa Clara County. Our request for funds is geared to providing essential human services for special needs, very low and low income populations and households (disabled and dependent seniors). The frail, at -risk seniors who will attend LIVE 4 OAK are not able to attend mainstream senior center programs. They need a safe and supportive environment offering hands-on assistance with activities of daily living including eating, ambulating, toileting, etc. They are also at great risk of isolation, falls, over/under medicating and/or premature hospitalization/institutionalization. c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2017/18 Number of Services Provided Annually FY 2017/1.8 Number of Unduplicated Los Gatos Residents served Annually 1. Days of adult day care (recreation and social activities) provided to Los Gatos frail seniors. 1000 20 2. Days of respite provided to Los Gatos caregivers corresponding to program days. 1000 20 3. Noon meals provided to Los Gatos frail seniors. 1000 20 4. Breakfasts provided to Los Gatos frail seniors. 1000 20 Average number of direct services received by each unduplicated client: 238 Average number of direct services received by each unduplicated Los Gatos client: 200 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2017, through June 30, 2018. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2017/18 Number of Services Provided Annually 1. Referrals/Outreach. 120 2. Staff consultations, counseling, assessments, Caregiver 75 5 Support Workshops. 3. In-service programs. 4 F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Age Under 18 years old 19 — 50 years old 1 51 years old and over 19 Disability Status Disabled 20 Not Disabled Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Income 50% of median and below 20 51 % - 100% of median Above 100% of Median Sex Female 13 Male 7 Total Total Los Gatos clients 20 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. II. AGENCY INFORMATION A. General Information Legal Name of Organization LIVE OAK ADULT DAY SERVICES Address of Organization 1147 Minnesota Avenue San Jose, CA 95125 Name of Executive Director Colleen Hudgen Date of Incorporation April 26, 1985 Insurance/Tax Information Federal Employer Tax Number 77-0069106 6 State Employer Tax Number 324-0529 2 Worker's Compensation Carrier/ Policy Number Arthur J. Gallagher & Co. Ins. Brokers of CA, Inc. / 9061931-14, Policy Period 7/01/14- 7/01 /15 Liability Insurance Carrier San Jose Insurance Agency, Inc. 201401332NPO Amount of Liability Coverage $2,000,000 Property Damage (combined with liability) Included Combined Single Limit $1,000,000 Policy Period 8/12/16-8/12/17 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2017/18. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Executive Director 1 49.37 40 25 Chief Operations Officer 1 36.24 40 25 Development Associate 1 30.00 20 25 Program Dir., Willow Glen 1 27.67 35 0 Program Dir., Gilroy 1 30.21 32 0 Program Dir., Los Gatos 1 25.39 28 100 Program Dir., Cupertino 1 26.79 35 0 Program Specialists (4 sites) 1 10.80-13.81 32 3 @ 100 Volunteers Program volunteers* 155 N/A Variable 25 Board of Directors 8 N/A Variable 100 Advisory Council 12 N/A Variable 25 *Over 300 volunteer hours are donated to the agency every month. C. Agency Experience —Describe the experience of your Agency in providing program services. Describe the experience of your Agency in providing program services. LIVE OAK has been the primary adult day care provider for the general disabled senior population in Santa Clara County for 33 years. Since its inception in 1983 as a small part-time program in Los Gatos, services have been expanded to four full-time adult day care centers serving hundreds of frail seniors and their families with life -sustaining adult day care and caregiver respite services. D. Staff Experience --(Describe the experience of key staff assigned to the program. Describe the experience of key staff assigned to the [program. Exec Director: 36 years' nonprofit experience in development/administration of health, human services and senior programs, including 14 years managing the Senior Outreach Case Management program at OUTREACH and six in Florida as Executive Director of a 24- hour facility for mentally/physically/developmentally challenged adults. Asst. to Exec. Director: 22 years in nonprofit industry. Development Associate: grant writing and 20 years fundraising experience. Program Directors: M.A. in gerontology or related fields. Asst. Program Directors: degreed/trained in gerontology. Program Specialists are trained and experienced in elder care. IE. Staffing Nan —Describe any anticipated staffing changes to occur during [TY 2017/18. Each of the four LIVE OAK adult day care centers is staffed with a Program Director, Assistant Program Director and 3-4 Program Specialists who provide direct client care in serving frail senior participants. No staff changes are anticipated during FY 2017-18. 8 III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Data FY 2017/18 FY 2016/17 Los Gatos grant funding Requested: $13,094 Received: 13,000 Total Program budget $147,630 $147,536 Los Gatos grant as percentage of total Program budget % 8.9 % 8.9 Total Organization budget $1,276,723 $1,276,629 Cost per year per unduplicated Los Gatos client $ 654.70 ($13,094 / 20 clients) $ 650.00 ($13,000 / 20 clients) Revenue Source FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 201.6/17 Program Budget Los Gatos grant $1.3,094 $13,094 $13,000 $13,000 Other municipal funding (please specify: ) $ $ $ $ City of San Jose-CDBG $21,388 $21,388 City of Campbell $12,142 $12,142 City of Gilroy $10,000 $10,000 City of Santa Clara $4,400 $4,400 City of Cupertino $15,098 $15,098 City of Sunnyvale $5,000 $5,000 $ State funding (please specify:) Meals reimb. $44,771 $11,192 $44,771 $11,192 Federal funding (please specify:) Sourcewise $100,000 $ $100,000 $ Other jurisdiction funding (please specify:) $ County funding (please specify): SSA -General Funds $65,050 15,000 $65,050 CDBG $20,000 $10,000 $20,000 $10,000 Fees for services $640924 $102,011 $640,924 $102,011 9 Revenue Source FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Donations $72,781 $1,333 $72,781 $1,333 Reserve contingency fund $ $ $ $ All other sources (please specify:) $ $ $ $ Foundations & Corporations $243,821 $10,000 $243,821 $10,000 United Way Silicon Valley $2,977 $ $2,977 $ Interest Income $429 $ $429 $ Net Investment Income $4,848 $ $4,848 $ Total $1,276,723 $147,630 $1,276.629 $147,536 Expenditure Summ Expense Category FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Personnel $814,297 $127,098 $814,297 $127,098 Facility $100,757 $15,167 $100,757 $15,167 Overhead $0 $0 $0 $0 Materials/Supplies $127,363 $2,905 $127,363 $2,905 Professional Services $52,123 $6,973 $52,123 $6,973 Fundraising $ $ $ $ Capital Projects $0 $0 $0 $0 Other (please specify) Misc: Taxes, Equip., Training, Travel, Ins. $29,385 $1,348 $29,291 $1,348 Accounting/Audit $58,889 $58,889 Building Repairs $10,753 $213 $10,753 $213 Purchased Services $44,510 $5,295 $44,510 $5,295 Depreciation $38,646 $418 $38,646 $418 Total $1,276,723 $159,417 $1,276,629 $159,417 B. Organization Contracts -Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. N/A C. Organization Investigations -Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. N/A 10 D. Budget Alternatives —What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. LIVE OAK maintains a diverse funding base including government agencies, private foundations, businesses and clubs, individual donors, Board pledges, client fees and special fundraising events. In the event of reduced, or loss of, funding, our efforts would include seeking increased gifts from existing funders, researching new donors, encouraging increased support from our client families, etc. CDBG funding from Los Gatos and other communities is integral to our ability to provide day care for the growing numbers of frail seniors. We maintain a 5:1 client -staff ratio to ensure safety and quality care for our frail clients. Any reduction in funds would directly impact the number of clients we are able to serve. E. Funding Sources —Describe your organization's efforts in pursuing other funding sources. Maintaining a diversified, stable funding base is an ongoing agency priority to ensure financial stability and uninterrupted operation in case of a loss or reduction in funding from a particular source. Fundraising efforts are ongoing and include renewing proposals with known donors, researching new sources, keeping abreast of developments in the nonprofit arena, participating in speaking presentations and community and business fundraising events. The agency's Board includes a Fund Development Chairperson. Board recruitment requires willingness to make personal gifts to the agency and participate in fundraising efforts. F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. N/A G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. N/A. CDBG funds are used only to cover salaries of program personnel. 11 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, 1 certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: /a /3 Live Oak Adult Day Services Organization Name Executive Director Colleen Hudcien (Print Name) ,2017 12 LIVE OAK SENIOR NUTRITION Town of Los Gatos FY 2017/18 Community Grant Program Application Summary Project: Project/Program: Live Oak Senior Nutrition Center Program Manager: Mary Alden Goulart Agency: Name of Agency: Live Oak Senior Nutrition Center Site Address: 111 Church St., Los Gatos, CA 95030 Name of Executive Director: Mary Alden Goulart Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Direct Services: Service FY 2017/18 (proposed) FY 2016/17 (actual) Meals Served 14000 13900* Transportation 3000 2709 Homebound Assistance 300 218 Phone Assistance and Referrals 600 709 Outreach Paratransit 2700 2600 Health & Safety Screening 200 116 Avg. Weekly Socialization (hrs) 3500 4425 ea l count includes Live Oak, Villa Vasona and Live Oak Adult Day Center Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2016/17 (adopted) FY 2017/18 (requested) Clients: FY 2016/17 (actual) FY 2017/18 (proposed) Town annual funding amount $28,500 $30,000 Unduplicated annual Los Gatos clients 200 200 Total annual program budget $181,094 $177,977 Total unduplicated annual clients 300 300 Town $ as % of annual total $16% $17% Los Gatos clients as % of annual total 67% 67% TOWN OF LOS GATOS • FY 2017/18 AFPLICATLON FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT ffiNFORMATION A. Contact Information Legal name of organization Live Oak Senior Nutrition and Service Center Address of organization 111 Church St. Los Gatos, CA 95030 Organization contact (Name, title, telephone number, email address) Mary Alden Goulart Executive Director (408) 354-0707 Mary.Goulart@LGUMC.Org Program name Same as above Site address of program Same as above Program manager (Name, title, telephone number, email address) Same as above Annual grant amount requested FY 2017/18 $30,000.00 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. According to the latest data available from the County of Santa Clara's Senior Nutrition Program collected during the FY2015/16 Nutrition Risk Screening, nearly 70% of Los Gatos clients who attend the Live Oak Senior Nutrition program eat alone most of the time and do not have enough money to buy food needed. The survey also shows that more than half (54%) are unable to shop or cook for themselves and many (46%) eat fewer than 2 meals per day. For most off our clients, enjoying a hot meal with their friends at Live Oak is the only social time they get all week. AAA reports that "strong social connections are fundamental to physical and mental well- being". Perspectives on Psychological Science notes the health effects of prolonged isolation are equivalent to smoking 15 cigarettes a day and increases the risk of death by anywhere from 26% to 45%. According to "The Journals of Gerontology" published by the Oxford .Iournals, "social isolation is associated with worsening health and poses a particularly severe risk for older adults". These risks include increased mortality, morbidity, depression and cognitive decline (IEng, Rimm, Fitznnanrice & Kawachi, 2002), and increased) number of fails. US News reports sunpport these facts and add "mental abilities 3 can suffer as a person's world shrinks...and cognitive decline and dementia are more likely with isolation". An increase in older adult suicides and elder abuse have also been associated with social isolation in seniors. AARP stated in 2014, more than 10 million adults aged 60 and older in the US were at risk of hunger, lacking access to enough nutritious food to lead to a healthy, active lifestyle, leading to a higher prevalence of chronic conditions, medication non -adherence and hospital readmissions. AARP also reports that Second Harvest Heartland has seen a 1000 % increase in referrals for "food insecure older adults". Santa Clara County Second Harvest Food Bank estimates that 47% of seniors in Santa Clara County do not receive adequate nutrition. Clearly the issues of hunger and social isolation are both on the rise, bringing the existence of "social malnutrition" and physical malnutrition into focus as two of the leading causes of health decline in American oiler adults. c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2017/18 Number of Services Provided Annually FY 2017/18 Number of Unduplicated Los Gatos Residents served Annually 1. Meals Served 13,900* 200 (of 300) 2. Transportation (Paratransit included) 2,709 48 3. Socialization (hours per week) 4,425 198 4. Phone Assistance 700 90 5. Homebound Assistance 220 115 *Meal count includes Live Oak, Villa Vasona and Live Oak Adult Day Center Average number of direct services received by each unduplicated client: 300_ Average number of direct services received by each unduplicated Los Gatos client: _200 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2017, through June 30, 2018. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. 4 Description of Service FY 2017/18 Number off Services Provided Annually 1. Information and Referrals 600 2. Health & Safety Info/Training 200 F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Age. Under 18 years old 19 — 59 years old *County requires participants to be age 60 and older 60 — 64 years old 25 65 years old and over 175 Disability Status Disabled 16 Not Disabled 184 Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Income 50% of median and below 189 51 % - 100% of median 9 Above 100% of Median 1 Sex Female 102 Male 98 Total Total Los Gatos clients 200 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. No fees are charged. A $3.00 contribution is requested but no one is turned away if unable to pay. Clients must be 60 years of age or older. 5 II. AGENCY INFORMATION A. General Information Legal Name of Organization Live Oak Senior Nutrition and Service Center Address of Organization 111 Church Street Los Gatos, CA 95030 Name of Executive Director Mary Alden Goulart Date of Incorporation May 1974 Insurance/Tax Information Federal Employer Tax Number 94-1399283 State Employer Tax Number 347-821-3 Worker's Compensation Carrier/ Policy Number State Compensation Insurance Fund Policy 149075149-14 Liability Insurance Carrier Great American Insurance Group — MAC 0594766 Amount of Liability Coverage 2,000,000.00 (aggregate) Property Damage (combined with liability) 1,000,000.00 Combined Single Limit 1,000,000.00 Policy Period 10/08/17 to 10/08/18 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2017/18. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Mary Alden Goulart-Director n/a $26.50 30 100 Michelle Shimada- Office Ast. n/a $17.23 9 100 Michelle Shimada-Bookkeeper n/a $21.29 3 100 Sandra Amaro — Kitchen Mng. n/a $13.18 22.5 100 Volunteers Board of Directors 8 0 n/a 100 Community Volunteers 31 0 n/a 100 6 C. Agency Experience --Describe the experience of your Agency in providing program services. Live Oak Senior Nutrition and Service Center (LOSNSC) has been, since May 1974, has been dedicated to providing hot nutritious lunches to seniors (over sixty) in the Los Gatos Community. At this point, LOSNSC is the ONLY week -day hot lunch program in town. LOSNSC provides a place for seniors to gather, make friends, socialize, get health and emergency preparedness info, and get information about the services that are available to them. With funding from Santa Clara County and the town of Los Gatos augmented by support from Los Gatos United Methodist Church, grants, community support, and a cadre of loyal volunteers, LOSNSC has been able to full the need for seniors to maintain a healthy and independent life for over forty years. LOSNSC has consistently high ratings in the annual assessment from the County Department of Social Services. The Board of Directors has steered the agency through economic downturns and has kept operating costs to a minimum while continually seeking adequate sources of income. D. Staff Experience —Describe the experience of key staff assigned to the program. Mary Alden Goulart — Ex. Director: 21+ yrs. experience in Senior Care industry, management of retirement living, assisted living, adult day care, senior center and some Hospice work. 11 yrs. experience in an acute care pediatric hospital with emphasis on improving patient and family centered care, working alongside top hospital management. She is a Life coach and transition consultant, specializing in aging, elder care, End -of -life and Grief coaching. Goulart has a Certificate in Food Safety from Santa Clara County and is certified through Santa Clara County as a Community Emergency Rescue Team (CERT) membcr. E. Staffing Plan —Describe any anticipated staffing changes to occur during FY 2017/18. Where are no staffing changes anticipated M. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summa Budget Data FY 2017/18 FY 2016/17 Los Gatos grant funding Requested:$30,000 Received: Total Program budget $177,977 $181,094 Los Gatos grant as percentage of total Program budget %17 %16 Total Organization budget $177,977 $181,094 Cost per year per unduplicated Los Gatos client $593 $604 Revenue Summa Revenue Source FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Los Gatos grant $30,000 $30,000 $28,500 $28,500 Other municipal funding (please specify:) $ $0 $0 $0 County funding (Note a) (please specify: Santa Clara County) $133,521 $133,521 $-1-28.332 $128,332 $115,000 $115,000 $110,000 $110,000 State funding (please specify:) $0 $0 $0 $0 Federal funding (please specify:) $0 $0 $0 $0 Other jurisdiction funding (please specify:) $0 $0 $0 $0 Fees for services [Note b $0 $0 $0 $0 Donations Board members, mail campaign, individuals, churches $10,000 $10,000 $12,000 $12,000 Reserve contingency fund [Note c] $10,977 $10,977 $18,594 $18,594 All other sources (please specify: fund raisers, project grants, Live Oak Adult Day Services reimbursement) $12,000 $12,000 $11,800 $11,800 Total $177,977 $177,977 $181,094 $181,094 8 a. FY16-17 based on executed contract amendment Number 6 to Santa Clara County contract of $128,332 adjusted to reflect expected county payments against contract. The contract value is the maximum available, provided we serve the full number of contracted meals. Due to individual vagaries of weather, sickness, etc. some of our clients miss their "reservations" they had made for meals, and we typically serve less than the contracted number. The county payment through the fiscal year is based solely on the number of meals actually served, despite fixed line -item costs enumerated in the contract. FY17-18 country funding based on a preliminary Santa Clara County -provided preliminary framework budget, which won't be finalized or negotiated until about June 15, 2017. The expected FY17-18 income from the county reflects the preliminary MAXIMUM county contract value of $133,521 adjusted to $115,000 to reflect potential fewer meals served than contracted. In the last completed fiscal year, Fiscal 15/16 ended on June 30 2016, the county actually paid us only $106,177.07 of the MAXIMUM contract value of $130,065.16. b. Re: fees for service. We collect on behalf of Santa Clara. County a voluntary contribution from the participants for meal costs; all such contributions are remitted directly and completely to the county — our program retains none of the contributions for its local budgetary purposes. c. We have an endowment fund we have invested at Charles Schwab. When the budget doesn't otherwise close, we sparingly use interest/dividends and principal from the fund to supplement other sources of funding. This line item of the Revenue Budget is calculated as the amount needed to close the gap between our Expenditure budget and our other sources of revenue. diture Summa Expense Category FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Personnel $74,145 $74,145 $68,638 $68,638 Facility $6,000 $6,000 $6,000 $6,000 Overhead [Note d] $16,815 $16,815 $28,337 $28,337 Materials/Supplies $0 $0 $0 $0 Professional Services $0 $0 $0 $0 Fundraising $375 $375 375$ 375$ Capital Projects $0 $0 $0 $0 Other (please specify: Catered food; non food [napkins, cups, paper supplies, etc.], program costs [senior celebrations, entertainment, etc.]) $80,642 $80,642 $77,744 $77,744 Total $177,977 $177,977 $181,094 $181,094 d. We changed accounting method for our bookkeeper for this grant FY 2017/18. Prior, we had included the bookkeeper's salary under overhead. In order to better track all our personnel costs, we are now (FY17/18) accounting the bookkeeper's salary under Personnel. 9 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. No C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. No D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. Funding for essential senior nutrition programs like ours is difficult to find. A reduction in Town funding would devastate our program and possibly force us to discontinue providing vital nutrition, social nourishment, information and referral services, as well as safety net efforts that keep many of our seniors safe from scams, homelessness and isolation. Our current and future older adult Los Gatos residents who rely on our services do not have local alternative to our program. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. Our Board's fundraising efforts result in about 17% of our annual budget including fundraising events at Los Gatos United Methodist Church, Los Gatos Service and Community Clubs and both corporate and individual donors. Interest from our endowment (now about $210,000) provides about 5% of our annual budget. In order to keep the continuity of our program stable, we have occasionally been forced to dip into the principal of our endowment to cover short fall in other income sources. This includes short falls in County and Town funding. F. Supplies Disclosure —If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. None G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. None 10 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, 1 certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: February 7th, 2017 Live Oak Senior Nutrition and Service Center Organization Name Executive Director Mary Alden Goulart (Print Name) 11 LGS RECREATION: Town of Los Gatos FY 2017/18 Community Grant Program Application Summary Project: Project/Program: LGS Recreation's 55 Plus Program and Senior Services Program Manager: Janet Sumpter Agency: Name of Agency: Los Gatos -Saratoga Community Education and Recreation (LGS Recreation) Site Address: 208 E. Main Street, Los Gatos, CA 95030 Name of Executive Director: Ms. Nancy Rollett Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Los Gatos -Saratoga Department of Community Education and Recreation is a school district, education based public recreation agency. LGS Recreation was formed in 1956 as part of a Joint Powers agreement between the three School Districts: the Los Gatos Union School District, the Saratoga Union School District and the Los Gatos -Saratoga Joint Union High School District. The School Districts formed LGS Recreation to ensure the effective and efficient provision of community education and recreation services to the communities of Los Gatos, Saratoga and Monte Sereno. Our mission is to help build a healthy community by providing a wide range of education, recreation and enrichment programs to the citizens of the community. We receive no tax dollars. We are supported solely by user fees. We carry out our mission in partnership with the member School Districts and by establishing individual and organizational partnerships throughout the community. The LGS Recreation's 55 Plus Program is responsible for managing Senior Services for the Town of Los Gatos. We provide on -going social and educational opportunities to over 450 senior members as well as information and referral services to over 75 Seniors in the community requiring support services. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal ear. Program Funding: FY 2016/17 (adopted) FY 2017/18 (requested) Clients: FY 2016/17 (actual) FY 2017/18 (proposed) Town annual funding amount N/A Requested: $12,500. Unduplicated annual Los Gatos clients 60 60 Total annual program budget $ 236,444 $ 213,583 Total unduplicated annual clients 75 75 Town $ as % of annual total N/A 5.9% Los Gatos clients as % of annual total 80% 80% TOWN OF LOS GATOS • FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Los Gatos -Saratoga Department of Community Education and Recreation Address of organization 123 E. Main St. Los Gatos, CA 95030 Organization contact (Name, title, telephone number, email address) Nancy Rollett (408) 207-4900 NRollett@lgsrecreation.org Program name LGS Recreation's 55 Plus Program Site address of program LG Adult Recreation Center 208 E. Main St. Los Gatos, CA 95030 Program manager (Name, title, telephone number, email address) Janet Sumpter, Supervisor 408-335-9982 janet(a,1gsrecreation.org Annual grant amount requested FY 2017/18 $12,500 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. Grief Support Groups (2) and Transitions Support Group (1): There are a number of seniors that greatly benefit from professional facilitators leading small groups involving grief support and transitions support. Small, intimate groups offer a chance to connect with others and be socially and emotionally supported during a vulnerable, sometimes lonely and frightening time. At this time we have an on -going, and very popular, monthly widows group called `Single Again...But Not By Choice'. We would like this successful, cohesive group of 10-12 participants to continue. We seek to launch a new grief support group for men and women who have recently lost a partner. We also currently offer a bi- monthly `Transitions' support group that we would like to continue. This group is important to help people navigate changes in their personal situation. Our professional facilitators, with backgrounds in social work and gerontology, assist seniors with their personal journey of assisting loved ones, feelings of being overwhelmed, and moving successfully to the next passage in their life and more. The above programs requesting the grant support are in alignment with the Town of Los Gatos' Age Friendly Initiative. 3 c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2017/18 Number of Services Provided Annually FY 2017/18 Number of Unduplicated Los Gatos Residents served Annually 1. Transitions Support Group 24 meetings z 25 2. Grief Support Groups 24 meetings 35 3. 4. 5. Average number of direct services received by each unduplicated client: 2 as described above Average number of direct services received by each unduplicated Los Gatos client: 2 as described above D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2017, through June 30, 2018. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2017/18 Number of Services Provided Annually 1. Monthly Flyer coordination & distribution 12/monthly 2. Newsletter submissions- edit/copy and distribute 12/monthly 3. Phone calls and reaching out to members and recruiting/inviting new members 12/monthly 4. Office/volunteer support to the seniors that drop -in daily 250 days- 4 hours daily 1,000 hours 5. Supervisor to oversee, supervise and coordinate Services 12/monthly 6. Marketing- brochure/Web Quarterly 4 F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Age Under 18 years old 19 — 50 years old 51 years old and over 60 Disability Status Disabled 10 Not Disabled 50 Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Income 50% of median and below 20 51%- 100%of median 20 Above 100% of Median 20 Sex Female 40 Male 20 Total Total Los Gatos clients 60 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. Membership H. AGENCY INFORMATION A. General Information Legal Name of Organization Los Gatos -Saratoga Department of Community Education and Recreation Address of Organization 123 E. Main St., Los Gatos, CA 95030 Name of Executive Director Ms. Nancy Rollett Date of Incorporation 1956 Insurance/Tax Information Federal Employer Tax Number 77-0415139 State Employer Tax Number 698-1541 3 Worker's Compensation Carrier/ Policy Number PROTECTION INSURANCE PROGRAM FOR SCHOOLS / PIPS0012113 Liability Insurance Carrier ALLIANCE OF SCHOOLS FOR COOPERATIVE INSURANCE PROGRAMS / 155-2016 Amount of Liability Coverage $5,000,000 per Occurrence Property Damage (combined with liability) $100,000,000 Combined Single Limit $5,000,000 per Occurrence 5 Policy Period Julyl, 2016- July 1, 2017 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2017/18. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Nu mbe r in cIas sitic atlo n Approximate Hourly Rate Hours Worke d per Week Percent of Time to Program Employees Lynnette Vega — Independent Contractor and facilitator for the group Single Again, But Not By Choice. She will be the facilitator for the newly proposed Grief Support group for Men and Women. Lynnette offers other senior programs with LGS Recreation 1 $67 hr (rate includes follow up meetings and communications beyond the scheduled group times.) ($4,824 yr.) 6 hours monthly direct support 20% Janet Sumpter- Organize & coordinate the services listed for grant support 40 hr week position 1 $62 per hour ($1,488 yr) 2 hours monthly 5% Lori Krueger- Senior Office Clerk- drop -in office hours for daily senior support & referral -office hours office hours annually 500 hrs. 1 $44 per hour ($3,168 yr) 6 hours monthly 10% Volunteers Janeen Pratt, Transitions Support Group facilitator, currently provides her services pro bono but will be unable to continue in that capacity in 2017/18. 1 $67 hr. (rate includes follow up meetings and communications beyond the scheduled group time.) Requesting Pay for 2017 forward to continue. ($4,824) 6 monthly 100% C. Agency Experience --Describe the experience of your Agency in providing program services. LGS Recreation has extensive experience providing programs to the Los Gatos community. In the area of Senior Services, for the past five years LGS Recreation staff has provided Information and Referral for the Town of Los Gatos. Also for the Town of Los Gatos, The LG Recreation's 55 Plus Program schedules, promotes and manages multiple large and small social events, educational meetings and coordinates small group meetings in social and emotional support type programs. D. Staff Experience —Describe the experience of key staff assigned to the program. TRANSITIONS SUPPORT GROUP: Janeen Pratt, MA, Geriatric Care Manager, currently facilitates our `Transitions' Support Group pro bono. Janeen has been a Care Manager for Interim Healthcare and a past Care Manager for Pathways. SINGLE AGAIN, BUT NOT BY CHOICE and GRIEF SUPPORT: Lynnette Vega, Adult Education credentialed teacher in Gerontology. Lynnette teaches gerontology classes at Foothill Community College and currently successfully facilitates many of our small educational and social groups including Reader's Workshop, Women's Artist Connection, Dinner Club. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2017/18. Janeen Pratt, Transitions Support Group, facilitator currently provides her services pro bono but will be unable to continue in that capacity in 2017/18. With this grant she would become an independent contractor with LGS Recreation and this would enable her to continue program services. 6 III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summa Budget Data FY 2017/18 FY 2016/17 Los Gatos grant funding Requested: $12,500. Received: nil Total Program budget $213,583 $ 236,444 Los Gatos grant as percentage of total Program budget 5.2% 0 % Total Organization budget $8,962,842 $ 8,719,245 Cost per year per unduplicated Los Gatos client $ $ Revenue Summar Revenue Source FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Los Gatos grant $ $ $ $ Other municipal funding (please specify: ) $ $ $ $ County funding (please specify:) $ $ $ $ State funding (please specify:) $ $ $ $ Federal funding (please specify:) $ $ $ $ Other jurisdiction funding (please specify:) $ $ $ $ Fees for services $ 8,820,827 $ 68,400 $ 8,730,206 $ 71,800 Donations $ $ $ $ Reserve contingency fund $ $ $ $ All other sources (please specify:) $ $ $ $ Total $ 8,820,827 $ 68,400 $ 8,730,206 $ 71,800 Expenditure Summary 7 Expense Category FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Personnel $ 5,250,765 $ 136,876 $ 4,936,644 $ 154,554 Facility $ 776,776 $ 0 $ 678,200 $ 1,800 Overhead $ $ $ $ Materials/Supplies $ 515,249 $ 11,600 $ 548,767 $ 13,540 Professional Services $ 1,941,475 $ 63,600 $ 2,100,514 $ 65,400 Fundraising $ $ $ $ Capital Projects $ $ $ $ Other subscription fees/meals entertainment $ 478,577 $ 1,507 $ 455,120 $ 1,150 Total $ 8,962,842 $ 213,583 $ 8,719,245 $ 236,444 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. N/A C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. N/A D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. We must discontinue the program without the ability to charge for the program and compensate the Instructors. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. 100% self supporting charging for services provided F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. Hand-outs, workshops, meeting refreshments, paper/pens, printing or copying in house G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. N/A 8 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non-discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: February 7 2017 Los Gatos -Saratoga Department of Community Education and Recreation Organization Name Exe utive Di ector Nancy Rollett (Print Name) 9 LGS RECREATON (CLUBHOUSE SCHOLARSHIP FUND) Town of Los Gatos FY 2017/18 Community Grant Program Application Summary Project: Project/Program: LGS Recreation Clubhouse Scholarship Fund Program Manager: Manuel Enriquez Agency: Naive of Agency: Los Gatos -Saratoga Department of Community Education and Recreation Site Address: 123 E. Main Street, Los Gatos, CA 95030 Name of Executive Director Nancy Rollett Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Since its inception in 1956, Los Gatos -Saratoga Community Education and Recreation (LGS Recreation) has been dedicated to providing high -quality community education and recreational services to the residents of Los Gatos, Saratoga, Monte Sereno and Mountain communities. A joint powers agency under the authority of three local school districts, Los Gatos Union School District, Saratoga Union School District and Los Gatos -Saratoga Union High School District, LGS Recreation administers hundreds of fee -based programs annually for its more than 9,000 youth, adults and 55 plus participants. For the last thirty-five years LGS Recreation has offered Clubhouse. Clubhouse provides young people with a safe, healthy and nurturing before and after school environment and is conveniently located on school grounds for families. The program is an expansion of the traditional school day offering a range of engaging activities that incorporate academics, youth development and recreation. As outlined on the following pages, we are requesting grant funds to cover the scholarships we're anticipating awarding families attending a Los Gatos Clubhouse location. In return, this would allow us to accommodate additional scholarships request at our other Clubhouses based in Saratoga and San Jose. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2016/17 (adopted) FY 2017/18 (requested) Clients: FY 2016/17 (actual) FY 2017/18 (proposed) Town annual funding amount $0 $20,000 Unduplicated annual Los Gatos clients 618 637 Total annual program budget $612,972 $724,710 Total unduplicated annual clients 1562 1609 Town $ as % of annual total $0 2.8% Los Gatos clients as % of annual total 40% 40% TOWN OF LOS GATOS mgo FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I. PROGRAMIPROJECT INFORMATION Fee Schedule, Membership, or other fees II. AGENCY INFORMATION Current Board of Directors Articles of Incorporation Bylaws Organizational Chart Brochures, Flyers, Promotional Materials III. FISCAL INFORMATION Audit or Financial Statement plus Letter of Auditability Organizational Budget Internal Revenue Service Ruling Letter (Section 501 c.3) California Revenue Code (Section 23701 d) 2 TOWN OF LOS GATOS ❖ FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Los Gatos -Saratoga Department of Community Education and Recreation Address of organization 123 E. Main Street Los Gatos, CA 95030 Organization contact (Name, title, telephone number, email address) Nancy Rollett Executive Director (408) 354-8700 nroIlett.(a),1gsrecreation.org Program name LGS Recreation Clubhouse Scholarship Fund Site address of program 123 E. Main Street Los Gatos, CA 95030 Program manager (Name, title, telephone number, email address) Manuel Enriquez School Services Director (408) 354-8700 menriquezAlgsrecreation.org Annual grant'amount requested FY 2017/18 $20,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. Clubhouse has 18 students currently on a scholarship, eight of those attending one of the four locations in the Town of Los Gatos. LGS Recreation is a self-sustaining agency with rising operating cost. Our discount percentage awarded for scholarships has been reduced from 30% off to now 20% off for this fiscal year. Historically LGS Recreation has not promoted its scholarship opportunities but rather awarded a discount on the program's monthly tuition as requested by families demonstrating a need. Our program is unique in that it is the only on -site after school care option for families but also designed to align with stakeholder input from on -going surveys and student led decisions. Clubhouse tuition cost are set to go up again in the fall, but we know access to affordable after school programs boost students' academic performance, reduce risky behaviors, promote physical health, and provide a safe, structured environment for the children of working parents. 3 c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2017/18 Number of Services Provided Annually FY 2017/18 Number of Unduplicated Los Gatos Residents served Annually I. Child care -Blossom Hill Clubhouse 1 2 2. Child care-Daves Ave Clubhouse 1 2 3. Child care -Lexington Clubhouse 1 2 4. Child care -Van Meter Clubhouse 1 2 5. Average number of direct services received by each unduplicated client: _I Average number of direct services received by each unduplicated Los Gatos client: 1 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2017, through June 30, 2018. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2017/18 Number of Services Provided Annually 1. Front office representative (fielding scholarship inquires) On -going 2. School Service Director (composing application) 1 3. Scholarship Committee Mtg. (review incoming request/notify families) On -going 4. 4 F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Age Under 18 years old 637 19 — 50 years old 0 51 years old and over 0 Disability Status Disabled 0 Not Disabled 637 *We don't survey participants for proof of income Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. II. AGENCY INFORMATION A. General Information Legal Name of Organization Los Gatos -Saratoga Department of Community Education and Recreation Address of Organization 123 E. Main Street Los Gatos, CA 95030 Name of Executive Director Nancy Rollett Date of Incorporation 1956 lnsurance/Tax Information Federal Employer Tax Number 77-0415139 State Employer Tax Number 698-1541 3 Worker's Compensation Carrier/ Policy Number Protection Insurance Program for Schools/PIPS0012113 Liability Insurance Carrier Alliance of Schools for Cooperative Insurance Programs/155-2016 Amount of Liability Coverage $5,000,000 per occurrence Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Income 50% of median and below We currently do not survey families for this data. Scholarships are awarded based of HUD guidelines 51% - 100% of median Above 100% of Median Sex Female 269 Male 368 Total Total Los Gatos clients 5 Property Damage (combined with liability) $100,000,000 Combined Single Limit $5,000, 000 per occurrence Policy Period July 1, 2016 — July 1, 2017 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2017/18. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Clubhouse Supervisor 1 $39.71 40+ 80% Clubhouse Director 4 $23.79 40+ 80% Senior & Recreation Leaders 21 $14.05 25-30 100% Volunteers C. Agency Experience --Describe the experience of your Agency in providing program services. For more than 60 years LGS Recreation has been a vital resource for this community. Providing a wide - range of educational and recreation experiences for residents, a gathering space for families and social groups but also a contributor to the health of children, youth, adults, and seniors. Our Clubhouse program continues to be one of the agency's hallmark programs, serving more than 1,800 students this school year alone. And even with thirty-five years of operating experience, the program continually assesses its progress with all stakeholders, which we believe has solidified its reputation for being a safe, enriching and fun before and after -school place for youth. D. Staff Experience --Describe the experience of key staff assigned to the program. Each day our staff continue to make a difference in the lives of our children and families. They are committed leaders working to make our students feel connected, supported, confident and empowered. To ensure this level of service and that we maintain a safe and healthy Clubhouse environment for all, staff are trained monthly in areas like active supervision, child abuse and neglect, mandated reporting, emergency preparedness, CPR & first aid, bullying prevention, etc. E. Staffing Plan —Describe any anticipated staffing changes to occur during FY 2017/18. At this time we don't anticipate any staffing changes to our Clubhouse program. Although, if a member of our current team does decide to move on in their professional career, we have a Human Resources department that is robust in recruitment and will react thoughtfully and timely to fill any staffing shortages. 6 III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budder Summary "Expenses " Budget Data FY 2017/18 FY 2016/17 Los Gatos grant funding Requested: $20,000 Received: Total Program budget $ 724,710 $612,972 Los Gatos grant as percentage of total Program budget 2.75% 0% Total Organization budget $8,820,827 $8,719,245 Cost per year per unduplicated Los Gatos client $ $ Revenue Summa Revenue Source FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Los Gatos grant $ $ $ $ Other municipal funding (please specify: ) $ $ $ $ County funding (please specify:) $ $ $ $ State funding (please specify:) $ $ $ $ Federal funding (please specify:) $ $ $ $ Other jurisdiction funding (please specify:) $ $ $ $ Fees for services $8,820,827 $1,346,925 $8,730,206 $1,295,000 Donations $ $ $ $ Reserve contingency fund $ $ $ $ All other sources (please specify:) $ $ $ $ Total $8,820,827 $1,346,925 $8,730,206 $1,295,000 Expenditure Summai Expense Category FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Personnel $5,250,765 $597,339 $ $ Facility $776,776 $57,001 $ $ Overhead $ $137,250 $ $ Materials/Supplies $515,249 $54,210 $ $ Professional Services $1,941,475 $6,700 $ $ Fundraising $0 $ $ $ Capital Projects $ $ $ $ Other (Subscription & fees/meals & entertainment) $478,577 $9,460 $455,120 $7,600 Total $8,962,842 $724,710 $8,719,245 $612,972 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. No C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. No D. Budget Alternatives —What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. If funding is not provided or provided at a reduced rate, we will need to consider: • Higher increase to tuition fees • Consider reducing scholarship fund E. Funding Sources —Describe your organization's efforts in pursuing other funding sources. Our long-term goal is to attract donors to fund our scholarship opportunities in 2018. F. Supplies Disclosure —If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. N/A Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. N/A G. 8 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: v �( _ i/i , 2017 LA29 11,'2Zr( Organization Name ecutive D rector (Print Name 9 ATTACHMENT 1 SAMPLE PARTICIPATION AGREEMENT Over the course of the contract period, a grantee may be required submit Participation Agreements similar to this sample. Do not submit this Sample Participation Agreement with your completed application. , a nonprofit corporation, provides certain services to individuals and families in Santa Clara County. Partial funding (subsidy) for these services is provided under contract by the Town of Los Gatos to this Agency. This information is reviewed for quality control and/or auditing purposes only. Therefore it is held in confidence by the Agency, the Town, and the Federal representatives and not considered "Public Information." The purpose of this Participation Agreement is as follows: 1. To have the client acknowledge the request and receipt of needed services and provide the client with an opportunity to evaluate such services. 2. To have the client authorize the release of demographic information to the Agency/the Town. 3. To assure the client that information about them is held in confidence and not considered public information and that only statistical information about all clients served is reported. 4. To have the client hold harmless and release from liability the Agency, the Town, and their respective employees, officers, and agents in the event of any suit, claim, loss, damage, or obligation arising out of/or attributed to any of the Agency's programs. Please complete the following: Name: Age: Address: Phone: Sex (check one): 0 Male 0 Female Disability Status (check one): 0 Disabled 0 Not Disabled Female Head of Household (check one): 0 Yes 0 No Income Level (check one): ❑ 30% of median and below ❑ 31 % - 50% of median ❑ 51 % - 80% of median ❑ 81% - 100% of median ❑ Above 100% of median I understand that this agreement is an affidavit and certify that the information provided above is true and complete. Signature Date 10 NEXT DOOR SOLUTIONS Town of Los Gatos FY 2017/18 Community Grant Program Application Summary Project: Project/Program: Shelter & Support Services for Victims of Domestic Violence Program Manager: Colsaria Henderson, Director of Programs Agency: Name of Agency: Next Door Solutions to Domestic 'Violence Site Address: 234 E. Gish Road, Suite 200; San Jose, CA 95112 Name of Executive Director: Susan McInnis, Acting Executive Director Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Since 1971 Next Door Solutions to Domestic Violence (NDS), an autonomous, 501c3 nonprofit based in San Jose, has served hundreds of thousands of women and children impacted by domestic violence (DV), creating pathways for survivors to move from crisis to safety, stability and self-sufficiency. Our mission is "to end domestic violence in the moment and for all time." NDS uses strategies of Woman -Defined intervention and advocacy programs focusing on increasing self-determination and safety for DV victims, and prevention programming focused on social mobilization at the individual and community level. As the only agency is the county that is solely focused on addressing domestic violence, NDS leverages its experience and expertise by implementing comprehensive, compassionate, Woman -Defined services to financially, ethnically, and linguistically diverse families through bilingual services specifically addressing the unique needs of DV survivors through four core programs: • Crisis Services: Emergency Shelter and Hotline — safe haven, food, case management, counseling, other supportive services. The Shelter and Hotline are open 365 days a year, 24 hours each day. • Support Groups: 11 county wide, including one in Los Gatos; Kids Club — positive play for youth while parent is attending groups at the Community Office and HomeSafe residential sites • Community & Systems Advocacy: Walk -In Crisis Counseling, legal advocacy, assistance with restraining orders, and access and referrals to other supportive services • Self -Sufficiency: Provides long-term Intensive Case Management based on the Eight Domains of Self -Sufficiency framework: Income, Housing, Food, Education, Employment, Healthcare, Wellness, and Domestic Violence (safety); and workshops and a support group; services are provided at the Community Office and HomeSafe residential sites Proposed Program Services: NDS proposes to serve 52 Los Gatos residents, including children, who are victims of domestic violence with one or more services from NDS core programs: Crisis Services (Shelter/Hotline), Support Groups, and Community & Systems Advocacy. All services are free of charge. Of the proposed services, only one is located in Los Gatos - a Support Group at St. Mary's Church on Bean Avenue. All other services are provided at the 24/7 Emergency Shelter located in Santa Clara County (confidential location for client safety), and at the Community Office on Gish Road in San Jose (Support Groups and Community & Systems Advocacy), and an additional Support Group in Mountain View; NDS also provides a Support Group at Elwood Women's Correctional Facility (a high percentage of incarcerated women are victims of abuse). Any Los Gatos resident can participate in any of the proposed services (any location), and we will report on proposed services provided to all residents of Los Gatos. • 24/7 Emergency Shelter and Hotline - NDS opened the Emergency Shelter for victims of domestic violence in 1971, one of the first in the state and nation, and has provided continuous services for 46 years. The Shelter operates 24 hours a day, 365 days a year housing 19 people at any one time. Victims have been displaced or have fled their home due to abuse. Clients receive: • Safe haven from potentially life -threatening abuse (physical and psychological) in a home -like environment; • Food, personal hygiene products, clothing, and same -day assistance in obtaining necessary medications; • Culturally and linguistically specific Risk Assessment and Safety Plan; • Counseling — dealing with crisis, trauma, and feelings of isolation, depression and anxiety • Holistic case management and advocacy focused on housing and immediate and short-term goals; • Assistance with housing searches and identifying resources to assist in obtaining housing; • Financial literacy screening, links to emergency cash aid and food stamps, and rental subsidies for eligible clients via outside sources; • Links to NDS legal advocacy (including restraining orders), Support Groups, Self -Sufficiency workshops and case management, and referrals to outside resources. The (Shelter) Children's Advocate provides: • Transition Plan with mother — helps the child adjust to leaving home, shelter stay, and other changes • Assistance enrolling children in school or maintaining current enrollment, including free transportation when necessary • Education/homework assistance • Child -centered, age and development appropriate recreational activities (group/individual) while mothers are in other on -site sessions/services The Shelter is similar to a multi -family style home, with two family rooms, a bedroom and ADA compliant bathroom on the first floor, a dorm room with bunk beds, bedrooms for families, two (additional) full bathrooms, and a large common kitchen and dining area where clients can prepare and share meals (if desired). The Shelter location is confidential, maintains a safety gate, and several active security cameras, and has a lift for wheelchair use. • Community & Systems Advocacy (C&SA): Survivors receive Walk -In Crisis Counseling, Risk Assessment, Safety Plan, legal advocacy, restraining order assistance, referrals to outside services and resources, and assurance and comfort. Advocates coordinate services that address risk, safety, hunger, homelessness, and health, helping clients rebuild their lives, and coordinate emergency services and referrals to other NDS and community services to address identified needs. Advocates are sensitive to the client's cultural and linguistic needs and, when necessary, make referrals to community agencies that help specific ethnic groups and referrals to doctors and counselors who understand their language and culture. Services are offered on a walk-in basis and clients receive a one-to-one counseling session. Advocates are highly trained in addressing barriers to safety, stability and self-sufficiency. Length of session is based on needs of the client; additional appointments are arranged after the initial intake. Survivors develop their self -efficacy to address short-term challenges to safety and stability. Legal advocacy provided by the Advocate assists survivors with restraining orders, referrals to attorneys, 2 mediation, and follow-up services — helping survivors to address legal issues that impact their safety and housing status. Advocates teach clients how to navigate family, criminal, and immigration law and the legal system according to the provisions of the Violence Against Women Act (VAWA). NDS also works in partnership with Pro Bono Project, Bay Area Legal Aid, Santa Clara University Law, and Asian Law Alliance which provides no fee legal counsel for people of low-income. For ending abuse, many survivors rate filing a RO as one of the most effective tools, second only to leaving the abuser. • Support Groups: NDS offers a weekly Support Group at St. Mary's Church on Bean Avenue in Los Gatos on Monday evenings. In addition, Los Gatos residents may attend other Support Groups offered at NDS' Community Office and in Mountain View at the Palo Alto Medical Foundation facility. In total, NDS offers 11 Groups, three of which are offered in Spanish. Support Groups, led by highly trained NDS facilitators, are important in our work with victims of domestic violence (DV) as they provide a Larger circle of support as each participant makes connections with the others facing similar problems. They help each other cope better and feel less isolated; isolation is a prevalent control tactic used by an abuser. Participants in group sessions find discussing their problems with those who can offer genuine empathy gives them a sense of belonging and encouragement. Group members provide support and direction for others struggling with the same issues they have faced in the past. NDS collects client data through a Client Intake Form, capturing DOB/age, gender, sexual orientation, primary language, race and ethnicity (self -identify), and sources of income. Forms are in English and Spanish. Data is entered into a database designed for domestic violence services, WS Osnium. The intake form is also used to collect information on the NDS programs/services the client engages in or is referred to, and information specific to their situations in regards to domestic violence. Biweekly, NDS' Database Coordinator compiles and enters the information into WS Osnium. This data is used for internal and external report generation. Additional client and program information is acquired through surveys and exit interviews for information on overall experiences, service usefulness to client, delivery of services, and suggestion for improvement or additional services/programs. NDS' service model is based on the Woman -Defined Advocacy model that builds a partnership between the Advocate and client, who ultimately defines the advocacy and help she needs. Program staff are bilingual (English -Spanish), culturally competent, trained/certified DV Peer Counselors (California Evidence Code: Section 1037-1037.8) with additional training in Woman -Defined Advocacy, Risk Assessment, Safety Plan development, Trauma Informed Care, Client -Centered Intensive Case Management, Motivational Interviewing; and advocacy skills in housing, financial, employment, health/ wellness, and educational goal setting, intervention planning, and resource identification and referrals. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2016/17 (adopted) FY 2017/18 (requested) Clients: FY 2016/17 (actual) FY 2017/18 (proposed) Town annual funding amount 15,000 15,000 Unduplicated annual Los Gatos clients 28 28 Total annual program budget 2,508,009 3,051,153 Total unduplicated annual clients 2,570 2,595 Town S as % of annual total .51 % 50% Los Gatos clients as % of annual total 1.I % 1.1% 3 TOWN OF LOS GATOS v FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Next Door Solutions to Domestic Violence Address of organization 234 E. Gish Road, Suite 200 San Jose, CA 95112 Organization contact (Name, title, telephone number, email address) Susan Mclnnis, Director of Finance & Operations; (408) 501-7564; smcinnis@nextdoor.org Program name Shelter & Support Services for Victims of Domestic Violence Site address of program • Shelter — undisclosed location in Santa Clara County (confidentiality and safety) • NDS' Community Office (above address) • St. Mary's Church; 219 Bean Ave.; Los Gatos 95030 • Palo Alto Medical Foundation; 701 E. El Camino Real; Mountain View 94040 • Elmwood Women's Correctional Facility; Milpitas Program manager (Name, title, telephone number, email address) Colsaria Henderson, Director of Programs (408) 501-7557; chendersonAnextdoor.org Annual grant amount requested FY 2017/18 $15,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. Per research complied by the National Coalition Against Domestic Violence': • 1 in 3 women have been physically abused by an intimate partner • 1 in 5 women have been severely physically abused by an intimate partner • Nearly 1 in 5 teenage girls who have been in a relationship said a boyfriend threatened violence or self -harm if presented with a breakup Domestic violence (DV) is prevalent in every community and affects all people regardless of age, socioeconomic status, sexual orientation, gender, race, culture, religion, or nationality. DV victims 4 comprise an isolated and extremely underserved, almost invisible, population. Physical violence is often accompanied by emotionally abusive and controlling behavior as part of a much larger, systematic pattern of dominance and control. Domestic violence can result in physical injury, psychological trauma, and even death. The devastating consequences of domestic violence can cross generations and last a lifetime. Domestic violence is a primary cause of women"s homelessness, and SCC's 2015 Point -In -Time Homeless Census and Survey revealed that 47% of homeless families with children respondents had experienced DV; 19% of families and 17% of individual respondents stated that DV was the primary cause of their homelessness; 4% reported currently experiencing DV/IVP abuse; and 27% reported DV experience across a lifetime. Per the Census Quickfacts data, in 2015 the Town of Los Gatos had an estimated population of 30,765, of which 52. l % were female (16,028); 19.7% of the population was foreign born and 5.6% of the population were at or below the Federal poverty level. Using the DV ratios stated in the first paragraph of this section, it is possible that anywhere from 3,200 to 5,300 female Los Gatos residents could or have experienced, in their lifetime, abuse by and intimate partner or been threatened with violence. During the period of 2006 — 2015, the Los Gatos Police Department received, on annual average, 67 domestic violence related calls, with approximately five involving a weapon.' The unfortunate fact is that many incidents of domestic violence go unreported — for many reasons — and are also listed as another crime, such as assault or homicide, and are not classified as domestic abuse. Los Gatos client snapshot: 90% are of low-income or less; 50% White/Caucasian, 25% Hispanic; 25% divided between Asian, Native American/Alaska Native, Bi-racial, and Other; 7% need language assistance; 14% are immigrants/refugees/asylum seekers; and 4% are homeless. c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2017/18 Number of Services Provided Annually FY 2017/18 Number of Unduplicated Los Gatos Residents served Annually 1.Shelter — all services 20 2 2. Support Groups 240 36 3. Community & Systems Advocacy 50 14 4. N/A 0 0 Average number of direct services received by each unduplicated client: 5.32 Average number of direct services received by each unduplicated Los Gatos client: 2.80 5 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2017, through June 30, 2018. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2017/18 Number of Services Provided Annually 1. Crisis Counseling via 24/7 Hotline 30 2. Brochure Disbursement 250 3. Community Outreach 10 F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Age Under 18 years old 1 19 — 50 years old 37 51 years old and over 14 Disability Status Disabled Not Disabled 52 Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Income 50% of median and below 42 51 % - 100% of median 7 Above 100% of Median 3 Sex Female 51 Male 1 Total Total Los Gatos clients 52 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. The only requirement to receive NDS services is to be a victim of domestic violence. No one is ever charged a fee for NDS services. 6 II. AGENCY INFORMATION A. General Information Legal Name of Organization Next Door Solutions to Domestic Violence Address of Organization 234 E. Gish Road, Suite 200 San Jose, CA 95112 Name of Executive Director Susan McInnis, Acting Executive Director Date of Incorporation 12/24/1974 Insurance/Tax Information Federal Employer Tax Number 94-2420708 State Employer Tax Number 0728377 Worker's Compensation Carrier/ Policy Number Guide One Insurance / 001438255 Liability Insurance Carrier Nonprofits Insurance Alliance of California Amount of Liability Coverage 2,000,000 Property Damage (combined with liability) 2,000,000 Combined Single Limit 1,000,000 Policy Period 07/01 / 16 — 07/01/17 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2017/18. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Management 6 $23 - $53 40 60% - 90% Emergency Shelter 7.98 $16 - $22 Varies 100% Community & Systems Advocacy 4.28 $17 - $19 Varies 100% Self Sufficiency 6.625 $18 -$19 Varies 0% Support Group 2.35 $16 - $22 Varies 100% Administration & Fundraising 5.8 $21 - $36 Varies 25% - 50% Volunteers Volunteers 18 X Varies Unknown 7 C. Agency Experience --Describe the experience of your Agency in providing program services. In 1971, a group of women concerned about the unmet need for services addressing domestic violence (DV) in Santa Clara County (SCC) created a grassroots movement and together created a hotline and refuge/shelter (a garage used as a safe haven) for domestic violence survivors and their children. The refuge, the Shelter Next Door, was the second domestic violence shelter program in California and was the first domestic violence shelter in the nation to offer bilingual English -Spanish services. In December 1974 they incorporated as the non-profit Women's Alliance (WOMA), and in 1989, WOMA changed its name to Next Door Solutions to Domestic Violence (NDS). In 2003 NDS merged with Women and Their Children's Housing (WATCH) as both shared a long commitment to ending domestic violence. This partnership leveraged their accumulative assets and connected NDS to the HomeSafe housing communities in San Jose and Santa Clara, an innovative housing project that offers women and child victims of domestic violence affordable, shared, permanent housing units. Forty-six years later the 24/7 Hotline number remains unchanged since 1971,.the Shelter is now a large family home that houses 19 people at any one time, and NDS has expanded services to address the unmet, unique needs of DV survivors. And like other great Silicon Valley organizations that started in a garage, NDS has continued to evolve to continually address the needs of those it serves, to help survivors rebuild their lives by partnering with them to identify options and working together to determine risks and pathways from crisis to self- sufficiency, and identify innovative prevention strategies focused on changing norms within our community. NDS' service model is based on the Woman -Defined Advocacy model that builds a partnership between the Advocate and client. Program staff are bilingual (primarily English -Spanish), culturally competent, trained/certified DV Peer Counselors (California Evidence Code: Section 1037-1037.8); NDS is a certified DV Peer Counselor trainer and not only provides training for its own staff, but also trains many others who work with DV clients here in SCC and other parts of the Bay Area. All clients receive Risk Assessments and Safety Plan - Culturally and linguistically specific lethality Risk Assessments help clients understand life -generated risks and batterer-generated risks, and the level of risk of the offender re -offending and a victim's risk of further assault. Using a series of questions to determine the client's particular needs, the Advocate helps the client decide on the most beneficial services and assist them in accessing those services. The information is used to develop a realistic Safety Plan - for home, familial residences, places of employment, and with any children, and contain simple but critical steps the survivor can take to increase their, and any children's, safety while they deal with the violence they face in their personal life. Safety Plans are updated and changed according to the client's situation. NDS regularly conducts community outreach and DV educational activities at numerous locations throughout the county to increase awareness and reach more battered women — and expands its reach through collaborations and implementation of innovative approaches to create new and expanded access to DV services, i.e., Stanford School of Medicine - health/wellness workshops; Mayview Community Health Center — integrated systems of care. NDS is one of the County's Emergency Assistance Network providers and a participating member in the 1,000 Out of Poverty committee (Step Up Silicon Valley: goal to cut poverty in SCC). NDS provides Rapid Rehousing intensive case management services to victims of domestic violence as a collaborative partner with four additional agencies funded by ESG funds via the City of San Jose. NDS also works in collaboration with the Health Trust in providing transitional housing services to victims of domestic violence who also have AIDS/HIV. And NDS recently was chosen as one of four agencies in California to implement a Housing First pilot program for victims of domestic violence in Santa Clara County. In FY 15-16, more than 2,700 women and children experiencing domestic violence received comprehensive services, providing safe haven, stability, and self-sufficiency; NDS also responded to more than 15,000 Hotline calls providing crisis counseling and advocacy services. Next Door Solutions continues to be a leading DV agency in creating solutions to what the Center for Disease Control and Prevention (CDC) has labeled as "a serious, preventable public health problem that affects millions of Americans" and in fulfilling its mission to end domestic violence in the moment... and for all time. D. Staff Experience --Describe the experience of key staff assigned to the program. NDS is governed by a 12 member volunteer board of directors. The agency is currently under the direction of an Acting Executive Director, Susan McInnis, after the retirement of Kathleen Krenek in August 2016 after serving the agency and the community for 15 years. • Susan McInnis, Acting Executive Director; Director of Finance and Operations: BS Finance and Accounting and Master's Program coursework in International Relations; joined NDS in 2013; more than 21 years of experience in overseeing all areas of financial and operations management. Under the direction of the Executive Director (under recruitment) and currently the Board Chair, Susan is responsible for financial and administrative management of the agency, grant compliance, and internal controls. Susan supervises the Database and Office Coordinator, and two contractors (IT and accounting). As Acting Executive Director she maintains overall management of the organization and works with the Director of Programs and the Director of Development in providing general leadership and oversight of program development, alignment with the strategic plan, personnel, fundraising, finance, and grants. • Colsaria Henderson, Director of Programs: Masters of Social Work, emphasis Administration and Planning, joined NDS in 2014; five years directorial level experience in managing DV programs and 10 years of experience providing case management, treatment plan development, and counseling. Reports to Executive Director (under recruitment); responsible for planning, directing, evaluating, providing Leadership to all program areas; advocates on behalf of victims of DV in relevant community -wide policy discussions. • Patricia Nanez, Manager of Crisis Services, joined NDS in 2002 as the Shelter's Grave Yard/Overnight Case Manager, and has continued to grow with the organization becoming the Shelter Coordinator in 2006 and then Manager of Crisis Services in 2007. Additional experience includes four years in office management and services, and college course work in health care administration, management and supervision, business communications and skills, and computer Information Technology. As Manager: oversees and manages the day-to-day operation of the Shelter and Hotline including program personnel and program management; develops, maintains, and monitors trauma informed program services, activities, events, and development; represents the program to the community and serves on program and advocacy related committees; reports to the Director of Programs. • Rachel Arias, Manager of Community and Systems Advocacy: BA Psychology, joined NDS in 2014. Experience: five years DV advocacy providing legal advocacy, crisis intervention, support group curriculum development and facilitation, client intake and direct services, and volunteer management. As Manager: oversees crisis counseling, risk assessment, safety planning, legal advocacy that includes assistance with restraining orders, court preparation; responsible for staff program training manages eight program staff and a consulting attorney (contractor); reports to the Director of Programs. • Aparna Dhoraje, Support Group Coordinator, MA Counseling Psychology; joined NDS in 2000 as the Shelter Coordinator, leaving in 2002. She rejoined the agency in 2008 as the Support Group Coordinator. Additional experience includes four additional years working with and providing services to 9 domestic violence populatons, and two years providing counseling services to youth. Aparna is fluent in South Asian languages. As Coordinator: provides program supervision and oversight and staff in delivery of appropriate group services; maintians current groups and develops and initiates new groups to address client needs, including new locations; reports to the Director of Programs. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2017/18. Next Door Solutions/ executive director retired in August 2017 and the board appointed Susan Mclnnis, Director of Finance and Operations as the Acting Executive Director. The board has engaged a professional recruiter who will assist in identifying qualified candidates for the Executive Director. NDS anticipates that the position should be filled before the end of the current fiscal year. There are no staffing changes anticipated at the director or management level, or any reorganization of the staffing plan or program offerings anticipated now or in the next fiscal year. All program components are under the oversight of the Director of Programs, who supervises the Manager of Crisis Services, Manager of Community & Systems Advocacy, and Support Group Coordinator. The Director reports to the Executive Director (Acting). Program Managers supervise staff within each program focus and these staff report to their program manager. The Support Group Coordinator supervises Support Group Facilitators. III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summa Budget Data FY 2017/18 FY 2016/17 Los Gatos grant funding Requested: $1.5,000 Received: $15,000 Total Program budget $1,461,700 $1,297,365 Los Gatos grant as percentage of total Program budget .93% 1.15% Total Organization budget $2,943,143 $2,508,009 Cost per year per unduplicated Los Gatos client $237.21 per support service/client; $117.71 per Shelter bednight $199.70 per support service/client; $113.49 per Shelter bednight Revenue Summai Revenue Source FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Los Gatos grans $ 15,000 $ 15,000 $ 15,000 $ 15,000 Other municipal funding $ 128,092 $ 36,244 $ 97,316 $ 4,884 10 Revenue Source FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget (City of San Jose; City of Milpitas; city of Santa Clara) County funding (SCC Social Services Administration, Adult Protection Services, Urban CDBG) $ 450,568 $ 369,128 $ 464,763 $ 395,163 State funding (CA Office of Emergency Services) $ 844,428 $ 513,244 $ 547,296 $ 321,525 Federal funding (FEMA) $ 25,000 $ 25,000 $ 169,509 $ 169,509 Other jurisdiction funding (Marriage & Probation fees) $ 102,000 $ 102,000 $ 102,000 $ 102,000 Fees for services $0 $0 $0 $0 Donations $ 1,275,221 $ 401,084 $ 1,001,727 $ 289,284 Reserve contingency fund $0 $0 $0 $0 All other sources (Interest, In -Kind and Other Income) $ 127,216 $0 $ 110,417 $0 Total $ 2,967,525 $ 1,461,700 $ 2,508,028 $ 1,297,365 Expenditure Summar Expense Category FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Personnel $1,963,533 $ 893,058 $ 1,802,371 $ 917,110 Facility $ 222,431 $ 132,320 $ 214,644 $ 127,958 Overhead (communications, insurance, equipment) $ 80,216 $ 44,626 $ 80,682 $ 41,184 Materials/Supplies (Program & $ 264,971 $ 53,353 $ 95,401 $ 42,295 Office expense) Professional Services $ 235,955 $ 204,725 $ 159,526 $ 127,491 Fundraising $ 11,140 $ 0 $ 2,500 $0 Capital Projects $ 0 $ 0 $ 0 $0 Other: Travel $ 24,885 $ 20,810 $ 5,395 $ 300 In -Kind $ 126,426 $ 95,022 $ 109,522 $ 25,000 Depreciation $ 22,148 $ 16,979 $ 22,148 $ 15,220 Misc. $ 15,820 $ 807 $ 15,820 $ 807 Total $ 2,967,525 $ 1,461,700 $ 2,508,009 $ 1,297,365 11 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. NDS has never had funds withdrawn or a contract terminated. C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. NDS is not currently on probation or under investigation by any agency. D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. Funding from the Town of Los Gatos Community Grant is essential to providing the level of service which will generate the greatest outcomes for its residents receiving services. Primarily, with any shortfall from the Town of Los Gatos, NDS would have to use available unrestricted funds used to cover necessary operational and administrative expenses to keep program services up to an acceptable level. Barring that, our recourse would be to reduce the number of program staff or not fill open positions and to reduce services, i.e., limit the number of crisis counseling sessions per clients. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. NDS has a resource development team composed of a full-time Director of Development, a Grants Manager, a Development and Communications Officer, and a part-time Development Database Specialist that is responsible for the creation and execution of an annual resource development plan. Acknowledging the importance of community support to offset economic challenges, NDS continues to put a priority on building relationships with private and corporate foundations and individual donors and raising awareness of the widespread impact that domestic violence (DV) has on the community. As DV is a primary cause of women's homelessness, increasing awareness and investments is on -going. And as DV does not recognize economic status, level of education, place of residence, or race/ethnicities, we reach out to all municipalities to contribute to the support of their constituents impacted by DV, as well as state and federal funding. Other sources of revenue that are projected to fund services for Los Gatos residents include the County's Social Services Administration, Adult Protection Services, Urban CDBG; California Office of Emergency Services (CalOES); FEMA, Office on Violence Against Women, (Department of Justice), HUD; grants from other municipalities; California Marriage License & Probation Fees; Foundations, Individual Donors; and Interest, In -kind and Other Income. F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. NDS will not be purchasing any non -expendable supplies with a unit cost of $100 or more. G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. All travel expense in (full) budget is for local travel relating to program services; mileage is reimbursed at 12 current Federal Reimbursement Rate and parking reimbursed at cost. Staff tum in mileage reimbursement forms monthly or when they have accumulated $10 in costs. ' http://www.ncadv.org/learn/statistics "http://oag.ca.gov/crime/cjsc/stats/dometic-violence Los Gatos Years 2006-2015 13 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: February 5, 2017 Next Door Solutions to Domestic Violence Organization Name xecutive Director (Acting) Susan McInnis (Print. Name) 14 PARENTS HELPING PARENTS Town of Los Gatos FY 2017/16 Community Grant Program Application Summary Project: Project/Program: Family Support Services Program Manager: Trudy Grable, Community and Family Services Director Agency: Name of Agency: Parents Helping Parents, Inc. Site Address: 1400 Parkmoor Ave Suite 100, San Jose CA 95126 Name of Executive Director: Maria Daane Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. PHP's Family Support program addresses the special needs of children with disabilities and special health care needs and their families through parent education, support, information, consultation, and training. By working directly with the children and strengthening their families, children with disabilities and other special needs will reach their full potential and bring value to the Los Gatos community. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program bending: FY 2016/17 (adopted) FY 2017/18 (requested) Clients: FY 2016/17 (actual) FY 2017/18 (proposed) Town annual funding $0 $2,000 Unduplicated annual Los Gatos clients 128 140 amount Total annual program $1,512,979 $1,512,979 (pending board approval) Total unduplicated annual clients 7178 7590 budget Town $ as % of annual total 0% <1% Los Gatos clients as % of annual 1.8% 1.8% total TOWN OF LOS GATOS •o• FY 2017/1.8 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I. PROGRAMIPROJECT INFORMATION C " Fee Schedule, Membership, or other fees N i ll% II. AGENCY INFORMATION ❑ Current Board of Directors ❑ Articles of Incorporation ❑ Bylaws O Organizational Chart ❑ Brochures, Flyers, Promotional Materials III. FISCAL INFORMATION O Audit or Financial Statement plus Letter of Auditability O Organizational Budget O Internal Revenue Service Ruling Letter (Section 501 c.3) ❑ California Revenue Code (Section 23701 d) TOWN OF LOS GATOS ❖ FY 2017/18 2 TOWN OF LOS GATOS !*C FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Parents Helping Parents, Inc. Address of organization 1400 Parkmoor Ave Suite 100 San Jose CA 95126 Organization contact (Name, title, telephone number, email address) Maria Daane, Executive Director 408-727-5775 x 153 mariad@php.com Program name Family Support Site address of program 1400 Parkmoor Ave Suite I00 San Jose CA 95126 Program manager (Name, title, telephone number, email address) Trudy Grable Community and Family Services Director 408-727-5775 x 102 trudy@php.com Annual grant amount requested FY 2017/18 $2,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. PHP helps children of all ages with any disability (whether physical, mental, emotional or learning), as well as their families and the professionals (educators, speech and occupational therapists, etc.) who work with them. Most of our clients live, work or go to school in Santa Clara County. PHP's Family Support program addresses the exceptional needs of children with disabilities and special health care needs and their families, while helping to build a better, more just world for 3 these children. There were 552 children enrolled in special education in the Town of Los Gatos in school year 2015-2016 and PHP helped 91 of them. This year we expect to serve 128 children and their families. Parents Helping Parents is ready to provide support to all of these people with disabilities and their families. PHP is a great starting point for families when children are newly diagnosed, but the help doesn't stop there. At PHP, clients never "age -out" of services. PHP provides services throughout each child's lifetime, as infants, children, youth and adults. PHP's client service statistics are consistent with the population of the Bay Area census reports. The demographics of the Los Gatos families served by PHP are 14% Asian & Pacific Islander, 73% Caucasian, and 13% all other races. The disabilities associated with the Los Gatos families served are: autism 28% speech impaired 4% learning disability 16% orthopedic 3% attention deficit disorder 10% multiple disabilities 2% intellectual disability 3% other disability 34% c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2017118 Number of Services Provided Annually FY 2017/18 Number of Unduplicated Los Gatos Residents served Annually 1. Family Support 28,462 140 2. 3. 4. 5. Average number of direct services received by each unduplicated client: 3.75 Average number of direct services received by each unduplicated Los Gatos client: 3.75 4 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2017, through June 30, 2018. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2017/18 • Number of Services Provided Annually I. 2. 3. 4_ F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Age Under 18 years old 119 19 — 50 years old 21 51 years old and over 0 Disability St is Disabled 140 Not Disabled 0 Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Income 50% of median and below * 51% - 100% of median ** Above 100% of Median ** Sex Female 49 Male 91 Total Total Los Gatos clients * * PHP's client statistics are tracked using an in-house customized database in which each client or professional contact, service provided, resource needed, training attended, and other relevant information is recorded. Verification of individual client income is not recorded since all services 5 are for individuals with disabilities, a HUD -eligible population. G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. Parents Helping Parents offers most services free of charge. Trainings and workshops that request fees have scholarships available. Memberships are voluntary and scholarships are available to families with need. No family is turned away for financial reasons. II. AGENCY INFORMATION A. General Information Legal Name of Organization Parents helping Parents, Inc. Address of Organization 1400 Parkmoor Ave Suite 100 San Jose CA 95126 Name of Executive Director Maria Daane Date of Incorporation 1979 Insurance/Tax Information Federal Employer Tax Number 94-2814246 Staff Employer Tax Number C0978446 Worker's Compensation Carrier/ Policy Number State Comp Ins Fund/9045338-2017 Liability Insurance Carrier Nonprofit Ins Alliance -CA Amount of Liability Coverage $1,000,000 Property Damage (combined with liability) $3,000,000 Combined Single Limit $1,000,000 Policy Period 3/2/16-3/2/17 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2017/18. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Resource Specialists 23 $17 average 17 100 CFS Director (program rngr) 1 $41 30 100 Edu Svcs Director 1 $41 32 100 6 Volunteers C. Agency Experience —Describe the experience of your Agency in providing program services. Parents Helping Parents (PHP) is a nonprofit, parent -directed family resource center serving Los Gatos and the surrounding area. PHP was founded in 1976 by two parents of children with disabilities. They saw a need for families like themselves to network to share the challenges, knowledge gained and successes involved in raising their children with special needs. PHP has grown into a multi -service resource center for families of children of all ages with any disability or chronic or life -threatening illness such as epilepsy or cancer. Last year PHP delivered over 26,000 direct services for children with special needs with a budget of $1.9 million, a staff of 33 employees, and 175+ volunteers. PHP's mission is to help children and adults with special needs receive the support and services they need to reach their full potential by providing information, training and resources to build strong families and improve systems of care. PHP's goals for all of our services are: • To improve the quality of life for children with any disability, chronic, or life -threatening illness and their families through access to appropriate services, interventions and resources. • Through parent education opportunities, to provide children having any special need with parents that have skills to navigate the unfamiliar territory of raising a child with special needs. To increase self-sufficiency in parents of children with any special need by providing complete information about educational rights to ensure that their child's educational needs are being met. • To promote parent/professional collaboration to improve direct services, identify informal supports, and create caring communities for children that are reflective of their culture, priorities, and needs. At PHP, services are family -centered, i.e. focused on the family as the unit of support not just the child. PHP's family support services include: • Emotional support and guidance from staff and volunteer peer -mentors • Practical support such as information on specific health conditions, community resources, securing supports, and funding • Parent education and trainings on navigating the educational, Iegal, social service and medical systems of care • Condition and culturally -specific parent/professional support and information groups • A one -of -a -kind assistive technology preview and demonstration center with services for infants through adults at -risk -of or with disabilities ' Children's workshops O A comprehensive special needs resource lending library There are several family resource centers in Santa Clara County providing quality services. PHP's is the only one whose focus is on disabilities, special health care needs, behavioral, and learning disability issues and whose services are delivered by trained staff who are also parents of children with disabilities. PHP is recognized as unique in the field and viewed as experts by other agencies for providing support, information, and direction to families of children with disabilities and special needs by parents of children with disabilities and special needs. D. Staff Experience --Describe the experience of key staff assigned to the program. PHP's uniqueness lies in a staff of parents experienced with having a child with special needs; and that staff also has the necessary education and qualifications to perform the positions they hold. The Program Manager is a parent of an adult with special needs and has been closely involved with the organization since 1986. She has held executive positions within the agency since 1991. Prior to coming to PHP, she had a 15-year history in the health care field and held a Teaching Credential in a related field. She has a Certificate in Early Childhood Intervention from Santa Clara University. E. Staffing Plan —Describe any anticipated staffing changes to occur during FY 2017/18. Each Resource Specialist has more than five years of experience providing support, training and education to children with disabilities and their families. Most of the staff have bachelor's degrees or advanced training in related fields and are also parents or relatives of individuals with special needs or are themselves an individual with a disability. Staff are able to provide services in English, Spanish, Vietnamese, French, Arabic, Italian and American Sign Language. 8 F. III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summa Budget Data FY 2017/18 FY 2016/17 Los Gatos grant funding Requested: $2,000 Received: $0 Total Program budget $1,512,979 (2017/18 budget not approved yet by board) $1,512,979 Los Gatos grant as percentage of total Program budget <1% 0 Total Organization budget $1,907,746 (2017/18 budget not yet approved by board) $1,907,746 Cost per year per unduplicated Los Gatos client $265.77 per year ($14.28 from Los Gatos funding) $265.77 per year Revenue Summa Revenue Source FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Los Gatos grant $2,000 $2,000 $0 $0 Other municipal funding: City of Mt View $5,000 $5,000 $5,000 $5,000 County funding: SCC SSA, SCC Mental Health $170,411 $170,411 $170,411 $170,411 State funding: DDS Early Start, CDE Family Empowerment Center, Early Start Plus $380,418 $380,418 $380,418 $380,418 Federal funding: US Dept of Education $518,129 $518,129 $518,129 $518,129 Other jurisdiction funding: First 5 Santa Clara County $76,364 $76,364 $76,364 $76,364 Fees for services $161,374 $ $161,374 $ Donations $485,050 $360,657 $487,050 $362,657 Reserve contingency fund $0 $0 $0 $0 All other sources: Special Events $109,000 $0 $109,000 Total $1,907,746 S1,512,979 51,907,746 51,512,979 9 • L!-weftut tut c uunrnrur y Expense Category FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Personnel $1,250,224 $929,787 $1,250,224 $929,787 Facility $120,000 $100,000 $120,000 $100,000 Overhead $392,634 $410,343 $392,634 $410,343 Materials/Supplies $28,199 $21,699 $28,199 $21,699 Professional Services $55,650 $35,150 $55,650 $35,150 Fundraising $33,600 $0 $33,600 $0 Capital Projects $0 $0 $0 $0 Other: Insurance & Depreciation $20,000 $16,000 $20,000 $16,000 Total $1,900,307 $1,512,979 $1,900,307 $1,512,979 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. PHP has never had any funds withdrawn or contracts terminated for cause or performance, or questionable costs on any financial statements or audit. C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. PHP is not on probation or under investigation. D. Budget Alternatives —What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe bow a reduction will affect the achievement of stated goals. PHP will seek other sources of funding for services to Town of Los Gatos residents if not funded. PHP is requesting a small grant so we hope there would be no reduction over that granted in FY2015/16 and prior years. The Town of Los Gatos grant shows the local support for services to individuals with disabilities and helps make the case for other funding support. E. Funding Sources —Describe your organization's efforts in pursuing other funding sources. At PHP, we continually explore a variety of methods to generate income to support our 10 programs. Our strategy includes seeking funding through government, corporation, foundation and individual donor support, as well as through memberships and program fees where possible. F. Supplies Disclosure -If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. No supplies will be purchased. The grant would support a small portion of one staff's salary. G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. No travel expense will be funded by this grant. CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: February 2, 2017 Parents Helping Parents, Inc. Organization Name Executive Director Maria Daane (Print Name) 11 This Page Intentionally Left Blank UNITED WAY BAY AREA Town of Los Gatos FY 2017/18 Community Grant Program Application Summary Project: Project/Program: 211 Program Manager: Kelly Batson Agency: Name of Agency: UWBA Site Address: 550 Kearny Street, Suite 1000, SF, CA 94102 Name of Executive Director: Anne Wilson Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. United Way Bay Area's (UWBA) mission is to be the catalyst that enables people to strengthen their communities by investing in one another. Founded in 1922, UWBA has historically served as a funderof hundreds of nonprofits through its donor company workplace campaigns. In the last decade, it has transformed into an incubator of innovative programs to improve educational opportunities, access to basic needs, and financial stability for disadvantaged communities. Today, UWBA also utilizes its expertise in convening to leverage the power of high -performing, data -driven partners and agencies, with the goal of reducing poverty in the Bay Area. UWBA's initiatives serve over a quarter -million Bay Area residents annually, in eight of the Bay Area's nine counties — Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, and Solano. 211 is a free phone number and online database that connects Santa Clara County residents quickly and effectively to existing health and human service programs, joblessness support, and disaster response information in their communities. It is available 24 hours a day, 7 days a week and in 170 different languages. Nationally, 211 covers 90 percent of the US population. Currently, over 92 percent of the California's population has access to 211. 211 information and referral providers connect people of all income levels and language and cultural backgrounds to resources tailored to their needs and circumstances, taking into account accessibility, eligibility requirements, and other factors through live assistance from certified information and referral specialists or online. In 2016, 23,820 Santa Clara County residents relied on 211 for help finding needed community services such as rent and mortgage assistance, food and shelter, healthcare, job training, transportation, childcare, and senior care. 211 services have also been important gateways for enrolling low- and moderate -income families in health insurance programs, including Healthy Families and the county -based Children's Health Initiative. Additionally, 211 plays a critical role in providing information and support in times of disaster, such as evacuation, shelter, food, medical and recovery information, and providing public officials with feedback from callers about changing conditions. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2016/17 (adopted) FY 2017/18 (requested) Clients: FY 2016/17 (actual) FY 2017/18 (proposed) Town annual funding amount $2,500 $5,000 Unduplicated annual Los Gatos clients n/a n/a Total annual program budget $1,211,881 $1,786,694 Total unduplicated annual clients n/a n/a Town $ as % of annual total .002% .003% Los Gatos clients as % of annual total n/a n/a 2 TOWN OF LOS GATOS + FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization United Way of the Bay Area Address of organization 550 Kearny Street, Suite 1000, SF, CA 94108 Organization contact (Name, title, telephone number, email address) Kelly Batson, VP Program Operations, (415) 808-4315, kbatson@uwba.org Program name 211 Site address of program 550 Kearny Street, Suite 1000, San Francisco, CA 94108 and 1400 Parkmoor Ave. San Jose, CA, 95126 Program manager (Name, title, telephone number, email address) Kelly Batson, VP Program Operations, (415) 808-4315, kbatson@uwba.org Annual grant amount requested FY 2017/18 $5,000 8. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. Los Gatos has 30,391 residents (2013 US Census estimate). At any point, regardless of income, any resident may have a health and human service need. 211 is a county -wide health and human service information and referral service. The largest benefit is the easy to remember 3-digit, single call telephone number that can connect people with important community services and volunteer opportunities with vetted information that includes program eligibility requirements, etc. as opposed to individuals calling each agency on their own. Many professional service personnel and employers utilize the service and refer their clients or staff to 211 to access information on additional, beneficial resources. It differs from 4-1-1 in that the caller does not have to know the name of the agency they want to contact or even where they can go for help; 211 call specialists are trained according to national standards to identify the type of service and the best location for the caller. All 211 call center specialists are Alliance of Information and Referral Services (AIRS) certified and trained to ask 4 pertinent questions in order to make the best possible referral, and are also trained in domestic violence, suicide, veteran's issues, and mandated reporter protocols. The caller can also receive multiple referrals for multiple services with one call. 211 provides this support to Santa Clara County's 1.8 million people; this includes the Town of Los Gatos' 30,391. Additionally, 211 is regulated by the California Public Utilities Commission (CPUC) to play a role in disseminating public information in a disaster; we are part of Santa Clara County's Emergency Operations Plan, and will be activated to the Emergency Operations Center in the event of a local disaster. 211 serves the entire Town of Los Gatos - 24 hours a day. All Los Gatos residents have: e Free access from cell phones, pay phones, home phones, and all other land lines • Free access to the 211 SCC website (www.211bayarea.org) O Free TTY access to 211 SCC by calling 866-390-6845. C. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2017/18 Number of Services Provided Annually FY 2017/18 Number of Unduplicated Los Gatos Residents served Annually n/a n/a n/a n/a n/a n/a n/a n/a n/a Average number of direct services received by each unduplicated client: n/a, Average number of direct services received by each unduplicated Los Gatos client: _n/a__ D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2017, through June 30, 2018. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2017/18 Number of Services Provided Annually All Los Gatos residents have free 211 phone access 30,391* 5 All Los Gatos residents have free 211 website access if they have internet service at www.211bayarea.org 30,391* All Los Gatos residents have free TTY access to 211 by calling 866-390-6845 As needed *211 is available to all Los Gatos residents. This number reflects the 2013 population estimate from the US Census Bureau. F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Age Under 18 years old Not collected 19 — 50 years old Not collected 51 years old and over Not collected Disability Status Disabled Not collected Not Disabled Not collected Demographic Data 2016 Santa Clara County Residents (Los Gatos residents will represent 1%-2% of numbers below) Income 50% of median and below Not collected 51% - 100% of median Not collected Above 100% of Median Not collected Sex Female 15,184 Male 9,055 Total Total Los Gatos clients 30,391 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. There are no service fees, membership requirements, or fees for listing services. At any point, regardless of income, any resident can call 211 at any time. All calls are confidential. II. AGENCY INFORMATION A. General Information Legal Name of Organization United Way Bay Area 6 Address of Organization 550 Kearny Street, Suite 1000, SF, CA 94108 Name of Executive Director Anne Wilson Date of Incorporation 1922 Insurance/Tax Information Federal Employer Tax Number 94-1312348 State Employer Tax Number 910-0381 Worker's Compensation Carrier/ Policy Number Cypress Insurance Company/ UNWC701503 Liability Insurance Carrier Massachusetts Bay Insurance Co. Amount of Liability Coverage $2,000,000 Property Damage (combined with liability) N/A Combined Single Limit $3,000,000 Policy Period 7/1/2016 — 7/1/2017 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2017/18. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees VP, Program Operations 1 $58 37.5 20% Database Analyst 1 $28 37.5 100% Outreach and Partnership Specialist 1 $28 37.5 100% Volunteers None at this time C. Agency Experience --Describe the experience of your Agency in providing program services. Established in 1922, United Way Bay Area's (UWBA) mission is to be the catalyst that enables people to strengthen our communities by investing in one another. In response to recent findings that one in four Bay Area residents are living in poverty, UWBA is committed to breaking the cycle of poverty. As a leader in the Bay Area nonprofit sector, UWBA is on the front lines operating 7 systems -changing programs that provide real solutions to help move people out of poverty. Each year, these innovative programs—SparkPoint, Earn It! Keep It! Save It!, 211, MatchBridge, and the Emergency Food & Shelter Program — help more than 250,000 Bay Area residents. We connect them to food and shelter, put people back to work, bring tax dollars back to our community, help youth succeed in school and in the workplace, and move people toward financial stability. In order to execute on these programs, UWBA partners with hundreds of nonprofits, churches, local and national businesses, school districts, county and city governments, and other social services organizations. Types of partnerships include grantee relationships, thought partners, fellow service providers, and more. To achieve our goal to eliminate poverty, UWBA is recruiting multi -sector partners to join the cutting poverty movement by utilizing a collective impact framework, which requires a highly coordinated system of shared metrics, alignment of resources, and a community roadmap to address large-scale problems. D. Staff Experience --Describe the experience of key staff assigned to the program. Kelly Batson is the Vice President of Program Operations. She began working with United Way Bay Area in 2006, when she joined the Earn It! Keep It! Save It! team. She was the program director for that program for 4 years and began to oversee the 211 program in summer 2015. She has extensive program management, budgeting, fundraising, and supervising experience. In her current role, she provides program oversight and strategic direction and is responsible for fundraising and partner development. Jay Hernandez is our Database Analyst. She has been with United Way Silicon Valley (now merged with United Way Bay Area) for almost 20 years. She spent her first 10 years with United Way in the accounting department, learning to appreciate systems and data. When 211 Santa Clara County launched, she was intimately involved in the CPUC application and supported the team with resource and database management. In her current role, she manages the resources for our 6 counties, ensuring we are building a robust database. She is also responsible for reporting and data analysis. Eruke Ohwofasa, our Outreach and Partnership Specialist, has been with United Way for almost 3 years. She spends most of her time out in the community with agency partners and potential users of 211. In her current role, she is staying on top of developments in our county and making sure we add new programs or agencies to our database among other partnership cultivation activities. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2017/18. We have plans to hire a 211 Program Manager by the end of Quarter 1. This Program Manager will be responsible for partnership development in Santa Clara County in addition to database alignment and fundraising. 8 III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summary Budget Data FY 2017/18 FY 2016/17 Los Gatos grant funding Requested: $5,000 Received: $2,500 Total Program budget $1,786,694 $1,221,881 Los Gatos grant as percentage of total Program budget .003% .002% Total Organization budget $22,962,451 (projected)* $18,622,493 Cost per year per unduplicated Los Gatos client $ N/A $ N/A Revenue Summary Revenue Source FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Los Gatos grant $5,000 $5,000 $2,500 $2,500 Other municipal funding (6 cities — including DCYF SF) $930,750 $80,000 $925,637 $88,625 County funding (please specify: Santa Clara) $150,000 $150,000 $150,000 $150,000 State funding (please specify: none) $240,000 $ $240,000 $0 Federal funding (please specify: IRS) $400,000 $ $380,000 $0 Other jurisdiction funding (please specify: none) $0 $ $0 $0 Fees for services $978,450 $0 $931,857 $0 Donations (Kaiser, Grove, Haas, etc.) $5,000,000 $200,000 •$4,000,000 $220,000 Reserve contingency fund $0 $0 $0 $0 All other sources (please specify: campaign, individual, bequests, and endowment) $15,258,251 $1,351,694 $11,992,499 $760,756 Total $22,962,451 $1,786,694 $18,622,493 $1,221,881 9 Expenditure Summary Expense Category FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Personnel $9,609,267 $382,329 $7,308,468 $254,886 Facility $1,630,108 $103,853 $1,556,830 $69,235 Overhead $1,899,203 $172,512 $1,103,748 $143,760 Materials/Supplies $26,366 $12,000 $20,305 $10,000 Professional Services (call center & database software subscription) $2,236,296 $1,063,500 $2,036,296 $709,000 Fundraising $0 $0 $0 $0 Capital Projects $0 $0 $0 $0 Other (please specify:) website, advertising $7,561,211 $52,500 $6,596,846 $35,000 Total $22,962,451* $1,786,694 $18,622,493 $1,221,881 *This is an estimate as the FY2017/18 budget has yet to be approved. B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. N/A C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. N/A D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. We will have to seek corporate and other private funding or subsidize with general funds — our goals will remain the same. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. 10 We apply for multiple city grants, county grants, and several private foundation grants. In addition, we look for corporate gifts and special project contracts with local government agencies. F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. N/A G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. N/A CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: UWBA ri;312Luin`/ 3 ,2017 Organization Name Executive Director Anne Wilson (Print Name) 11 WEST VALLEY COMMUNITY SERVICES Town of Los Gatos FY 2017/18 Community Grant Program Application Summary Project: Project/Program: Community Access to Resources and Education (CARE) Program Manager: Sujatha Venkatraman Agency: Name of Agency: West Valley Community Services Site Address: 10104 Vista Drive Cupertino CA 95014 Name of Executive Director: Josh Selo Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Community Access to Resources and Education (CARE) provides support to low income seniors, high -risk families with children, at -risk youth and the disabled in Los Gatos through case management and supportive services. The main objectives of CARE are to encourage more stable and sustainable solutions to help clients facing hunger and homelessness, and make critical human services easily available and accessible to clients through a one stop full service concept. CARE incorporates both case management and wrap around services to help low income, at -risk and vulnerable households manage a food or housing crisis. CARE will provide stabilization to help Los Gatos residents maintain housing stability, prevent eviction, and rapidly re -house homeless households. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2016/17 (adopted) FY 2017/18 requested Clients: FY 2016/17 (actual) FY 2017/18 (proposed Town annual funding amount 15,000 30,000 Undup annual LG clients 30 Househo ld 50 Househol d Total annual program budget 150,000 200,000 Total undup annual clients 500 Househo Id 500 Househol d Town $ as % of annual total 13% 15% LG clients as % of annual total 6% 10% TOWN OF LOS GATOS FY 2017/E43 APPLICATION, FOR COMflJTrT FY GRANT FEJNDING GRANT APPLICATION ll0 FROGRAM/P'RCJECT INFORMATION A. Contact Information Legal name of organization West Valley Community Services Address of organization 10104 Vista Drive Cupertino CA 95014 Organization contact (Name, title, telephone number, email address) Josh Selo Executive Director 408-956-6113 joshs@wvcommunitysenices.org Program name Community Access to Resources and Education Site address of program 10104 Vista Drive Cupertino CA 95014 Program manager (Name, title, telephone number, email address) Sujatha Venkatraman Associate Director Stability Support Services sujathav@wvcommunityservices.org Annual grant amount requested FY 2017/18 $30,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. While the west valley region of Santa Clara County is often perceived as affluent, approximately 21,350 individuals (11.17%) live in poverty in Los Gatos, Saratoga, Cupertino, West San Jose, and Monte Sereno according to the U.S. Census. In Los Gatos alone, more than 4,000 men, women and children are living in poverty. Rent increased in Silicon Valley by 8% between 2014 and 2016, straining household budgets and pushing families closer and closer to a financial and/or housing crisis. At West Valley Community Services, requests for basic human needs such as food, shelter, emergency financial aid, and housing assistance have increased year over year. Furthermore, 80% of clients who seek services from West Valley Community Services are in some form of financial crisis due to personal loans, high interest payday loans, credit card debt, past due medical bills, or car repair bills. The high cost of living in Santa Clara County, 3 combined with the challenges created by growing personal debt, is creating enormous challenges in our community and undermining the ability for our clients to meet their basic needs. The community faces other challenges such as: Lack of transportation for individuals without a car, who rely on public transportation, or who are no longer able to drive. • Lack of in -home care and supportive services for low income seniors unable to afford part or full-time caregivers. • Lack of affordable housing, which places significant stress on household budgets, impacts individuals and seniors living on a fixed income, and undermines the diversity of our communities. CARE incorporates both case management and wrap around services to help at -risk and vulnerable families manage crisis and stabilize in order to move towards self-sufficiency. The target population of CARE includes seniors, families with children, at -risk youth and disabled adults on extremely low income or fixed income. CARE also works with individuals and families who are homeless or are at -risk of losing housing. The focus of CARE is to ensure that the most vulnerable citizens in Santa Clara county are able to have their basic hunger and housing needs met; to protect them from abuse; and to provide access to healthcare and public benefits. Central to this focus is the case manager, who serves as the client's advocate, coordinates supportive services, and serves as the conduit for accessing other community benefits and programs. This helps clients navigate a complex system, and helps them to overcome their sense of isolation and become valued citizens in their community. CARE programs specific activities include the following: °Case Management: Case management is a key component of CARE that focuses on self-sufficiency with more stable and sustainable solutions. CARE case managers work with clients to assess family needs by using an assessment tool that measures their vulnerability score across varying domains, including housing, food security, and employment. Based on this assessment, the case manager works with the client to develop a Self -Sufficiency plan with goals to address critical family needs and move the individual from crisis to stability. •Benefit Clinics: A one stop service which helps make the application for public assistance benefit programs accessible for all. This service screens clients to see which benefits they are qualified to receive such as food stamps, free/reduced fee lunches, Medicare and Medicaid. Financial Coaching: West Valley Community Services provides financial literacy programs that teach clients basic and essential budgeting and savings skills. Group workshops and individual financial coaching are provided in conjunction with case management. In Los Gatos, the CARE program will serve the most vulnerable population with a main focus on 4 senior citizens and the chronically homeless. Under the senior services component of CARE, case managers will provide intensive case management to seniors including bi-weekly check -ins, and coordination of services through our partners, including Live Oak Adult Day Services' Senior Nutrition program, Sourcewise, the Health Trust and other local senior programs to ensure that seniors are connected to available resources in their community. West Valley Community Services is proposing to co -locate at the Live Oak site so that the case manager will be connected to the high risk and low income seniors. West Valley Community Services will develop a partnership with Live Oak Senior Nutrition program to provide case management at all sites in Los Gatos including Villa Vasona. The CARE program will continue to provide outreach at the Los Gatos Adult Recreation Services and has developed partnerships with Health Trust's SPA program and the Caring about Resident Elders program in Los Gatos, who will be providing direct referrals to CARE. CARE will also be available to Los Gatos residents from our Mobile Food Pantry unit, located weekly in Los Gatos. C. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2017/18 Number of Services Provided Annually FY 2017/18 Number of Unduplicated Los Gatos Residents served Annually 1. Intensive Case Management 100 50 Average number of direct services received by each unduplicated client: 2 Average number of direct services received by each unduplicated Los Gatos client: _50 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2017, through June 30, 2018. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2017/18 Number of Services Provided Annually 1. Supportive Services such as employment classes, financial coaching, and nutrition classes 4 2. Special Programs such as school clothing and backpacks, holiday programs, and summer camps 6 5 I♦e Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Age Under 18 years old 0 19 — 50 years old 25 51 years old and over 25 Disability Status Disabled 5 Not Disabled 45 Demographic Data , Annual Number of Unduplicated Los Gatos residents FY 2017/18 Income 50% of median and below 5 51% - 100% of median 0 Above 100% of Median 0 Sex Female 25 Male 25 Total Total Los Gatos clients 50 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. West Valley Community Services provides programs and services free of charge. Households applying for services will be asked to provide the following documents: c Proof of Los Gatos residency by PG&E bill or other utility bill. e Proof of income (entire household) and meet HUD income guidelines. e Provide ID for all adults in household and birth certificate for all children. e Proof of emergency for any financial assistance. Also, must provide proof that with the requested assistance, client is able to pay the following month's expenses. e Proof of rental agreement. 6 �Io AGENCY INFORMATION Ao General Information Legal Name of Organization West Valley Community Services of Santa Clara County, Inc. (West Valley Community Services) Address of Organization 10104 Vista Drive Cupertino, CA 95014 Name of Executive Director Josh Selo Date of Incorporation July 1976 Insurance/Tax Information Federal Employer Tax Number 94-2211685 State Employer Tax Number C0773975 Worker's Compensation Carrier/ Policy Number ProSight Specialty Insurance WV20140007927 Liability Insurance Carrier 2,000,000 Amount of Liability Coverage Commercial General Liability General annual aggregate: $2,000,000 Property Damage (combined with liability) $3,000,000 Combined Single Limit $1,000,000 Policy Period 6/1/2016-6/30/2017 Worker's Compensation Policy Period 12/31 /2016-12/31 /2017 BeStaffing Profile West Valley Community Services is requesting staffing cost with this funding. We are requesting funding for 30% of staff time for the Case Manager to help administer and coordinate the CARE program to Los Gatos residence. West Valley Community Services will leverage the Program Manager of Client Services time to provide oversight to the intensive case management services. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Case Manager 1 $22 14 36% Volunteers N/A 7 C. Agency Experience —Describe the experience of your Agency in providing program services. West Valley Community Services, Inc. is a private non-profit, community based agency that has been providing direct assistance and referral services in the West Valley communities of Los Gatos, Saratoga, Cupertino, Monte Sereno, West San Jose, and the unincorporated mountain regions. For 40 years, we have been providing a continuum of basic needs, housing assistance and family support services including: information and referrals, food, homeless services, affordable housing, financial assistance and case management. Founded in 1973 by three public health nurses, the Cupertino Roundup became incorporated as Cupertino Community Services in 1976. In 2008, we changed our name to West Valley Community Services to better reflect the community we serve. West Valley Community Services provides the most vital and basic human services to the Los Gatos community's neediest individuals and families. West Valley Community Services has implemented integral program improvements that transitioned the agency from a basic needs provider to the West Valley's premier comprehensive social services organization. In addition to distributing basic needs services, West Valley Community Services focuses on providing intensive case management to each client and ensuring access to a continuum of services to provide a strong foundation for those who have been threatened with hunger and homelessness. Last year, West Valley Community Services assisted 2,230 individuals facing a hunger or housing crisis in our community. We provided groceries, household items, diapers and personal care items to 1,223 individuals, and distributed more than 672,380 pounds of food through our pantry. In addition, we helped clients avoid homelessness by providing $167,869 in emergency fmancial assistance for rent, utilities, and apartment deposits. D. Staff Experience --Describe the experience of key staff assigned to the program. West Valley Community Services' staff has significant educational and professional expertise in working with low-income families and the homeless community. Strategic program direction will be led by Sujatha Venkatraman, Director of Stability Support Services, who holds a MSW and has over 10 years' experience in community development. Program management and clinical supervision will provided by Grace Davis who holds a BSW and is currently in the process of obtaining her MSW. Josh Selo, the Executive Director, has an MBA in Finance and more than 16 years of nonprofit management experience. He works closely with West Valley Community Services staffto ensure appropriate financial and programmatic transparency to support the organization's core mission. The West Valley Community Services staff and volunteer core are bi-lingual and multicultural. The agency intake form is available in English, Chinese, and Spanish, Vietnamese, and Russian. Throughout West Valley Community Services' 44-year history of providing basic need and case management services to assist clients to retain housing to prevent homelessness and displacement, there have been program and organizational procedures in place for quality 8 assurance. In the past five years since West Valley Community Services has moved towards an intensive case management model, institutional policies and procedures for quality service delivery has been implemented. Some of these policies include weekly group case consultation and review, weekly individual staff supervision, file/documentation review, clinical training, and program training. Case management staff is required to participate and comply with the quality assurance standards set by West Valley Community Services and fenders. In addition, West Valley Community Services staff that provides direct client services hold either a Bachelor or Master's degree in a social sciences field. All program management staff hold a degree in Social Work. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2017/18. N/A F III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Altematively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Bud et Summa ~ Budget Data FY 2017/18 FY 2016/17 Los Gatos grant funding Requested: $30,000 Received : $15,000 Total Program budget $200,000 $150,000 Los Gatos grant as percentage of total Program budget 15% 10% Total Organization budget $2,723,600 $ 2,644,272 Cost per year per unduplicated Los Gatos client $600 $ 500 Revenue Summary 9 Revenue Source FY 2017/18 Organization al Budget FY 2017/18 Program Budget FY 2016/17 Organizationa 1 Budget FY 2016/17 Program Budget Los Gatos grant $45,000 $30,000 $30,000 $ 15,000 Other municipal funding (please specify: ) $347,490 $ $347,490 0 County funding (please specify:) $547,126 $ $531,187 $ State funding (please specify:) $0 $ $0 $ Federal funding (please specify:) $604,902 $ $604,902 $ Other jurisdiction funding (please specify:) $0 $ $0 $ Fees for services $381,491 $ $381,491 $ Donations $261,700 $ $241,700 $ Reserve contingency fund $0 $ $0 $ All other sources (please specify:) Foundation $563,061 $ $507,502 $135,000 Total $2,750,770 $ $2,644,272 $ 150,000 Expenditure Summa Expense Category FY 2017/18 Organizationa 1 Budget FY 2017/18 Program Budget FY 2016/17 Organization al Budget FY 2016/17 Program Budget Personnel 1,200,666 $150,00 1,180,666 $ 100,000 Facility 396,079 $ 384,543 Overhead + Supplies 121,821 $ 118,273 $ Professional Services 87,825 $ 78,825 Fundraising 241,134 $ 199,203 Capital Projects $ 10 Other: Pass thru Emergency $703,245 $75,000 682,762 50,000 Assistance Total $ 2,750,770 $ 200,000 $ 2,644,272 $ 150,000 E. Organization Contracts —Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. N/A C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. N/A D. Budget Alternatives —What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. West Valley Community Services is the agency assigned to provide basic need services to Los Gatos residents as part of the county -wide Emergency Assistance Network. If not funded at the requested level, West Valley Community Services will be required to deny services to qualified individuals residing in the Town of Los Gatos. This would be a first in West Valley Community Services' history of services to the west valley region of the county. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. West Valley Community Services is committed to its mission to providing services to all qualified residents of our county's west valley communities. To ensure this, West Valley Community Services employs a multilayered approach to fundraising, including events, major gift solicitations, planned giving, grant writing, corporate gifts, and direct mail appeals. F. Supplies Disclosure —If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. N/A G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. Community Grant funds will not be used for staff travel expense. 11 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non-discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: February 6th . 2017 West Valley Community Services Organization Name Executive Director Josh Selo (Print Name) 12 This Page Intentionally Left Blank YWCA SILICON VALLEY Town of Los Gatos FY 2017/18 Community Grant Program Application Summary RECEIVED TOWN OF LOS GATOS FEB _ 7201? CLERK DEFAR'IVERr Project: Project/Program: Domestic Violence Support Services for Los Gatos Residents Program Manager: Arnie McClane, Director of Support Services Agency: Name of Agency: YWCA Silicon Valley Site Address: 375 S. Third Street, San Jose, CA 95112 Name of Executive Director: Tanis Crosby Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. YWCA Silicon Valley is on a mission to empower by working to end racism and violence, to achieve solutions for survivors of violence facing homelessness, and to inspire by closing the education and prosperity gap. For over 110 years, YWCA has identified the unique needs of Santa Clara County women, delivering innovative programs to meet those needs. Impacting over 18,000 individuals last year at 25 community locations, YWCA empowers women, children and families, while eliminating racism, hatred and prejudice. YWCA will provide the Town of Los Gatos with essential domestic violence services including: a 24- hour toll -free hotline (English/Spanish), emergency shelter, basic needs (i.e. food, clothing, toiletries, etc.), crisis counseling, legal advocacy, individual and/or group therapy, children's play therapy, children's art therapy, preventative education, safety planning, domestic violence education, information and community referrals. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2016/17 (adopted) FY 2017/18 (requested) Clients: FY 2016/17 (actual) FY 2017/18 (proposed) Town annual funding amount $6,000 $6,000 Unduplicated annual Los Gatos clients 5 (to date) 15 Total annual program budget $1,457,090 $1,457,090 Total unduplicated annual clients 342 (to date) 1000 Town $ as % of annual total 0.4% 0.4% Los Gatos clients as % of annual total 0.01 0.015 TOWN OF LOS GATOS y FY 2017/18 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization YWCA of Silicon Valley Address of organization 375 S. Third Street, San Jose, CA 95112 Organization contact (Name, title, telephone number, email address) Adriana Caldera, MPA Chief Program Officer 408-295-4011 x 373 acaldera@ywca-sv.org Program name Domestic Violence Support Services for Los Gatos Residents Site address of program Main Office: 375 S. Third Street, San Jose, CA. 95112 Satellite Office: 298 S. Sunnyvale Ave., Ste. 105, Sunnyvale, CA. 94086 Emergency Shelter: Confidential Location in the County of Santa Clara Program manager (Name, title, telephone number, email address) Amie McClane Director of Support Services 408-295-4011 amcclane@ywca-sv.org Annual grant amount requested FY 2017/18 $6,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. According to the Centers for Disease Control, it is estimated that nationally 1 in 4 women and 1 in 7 men will experience domestic violence in their lifetimes. Domestic violence is one of the leading causes of homelessness for women and children in the United States, and in Santa Clara County. The U.S. Department of Justice reports that one in four homeless women are homeless because of violence committed against her. Here at home, according to the 2015 Santa Clara County Point -in -Time Count Report, nearly half of respondents of families with children reported having experienced domestic violence (47%). Sadly, each year in Santa Clara County, over 2100 requests for emergency shelter and 3 housing assistance for domestic violence victims often go unmet. Domestic violence affects individuals in a variety of ways: physically, emotionally, mentally and financially. Domestic violence can greatly impact an individual's everyday life. Victims' work and school performance can suffer, and victims can develop detrimental health behaviors such as alcohol dependency, substance abuse, and eating disorders. Domestic violence is also directly linked to mental health issues such as the development of mood, personality, or behavioral disorders. This can include depression, post -traumatic stress disorder, manic-depressive disorder and dependence personality disorder. Domestic violence is a lethal criminal justice and public health issue that poses serious problems for Town of Los Gatos residents —including its children. A national survey of American families reported 50 percent of the men who frequently abused their intimate partners also frequently abused their children. According to the National Coalition Against Domestic Violence, "Witnessing violence between one's parents or caretakers is the strongest risk factor of transmitting violent behavior from one generation to the next." c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2017/18 Number of Services Provided Annually FY 2017/18 Number of Unduplicated Los Gatos Residents served Annually 1. Crisis Calls: Full access to confidential intervention, counseling and support through our 24-hour toll -free bilingual (English/Spanish) crisis line. 25 (calls received) 20 per fiscal year 2. Counseling: Provide counseling services to victims of domestic violence and also provide children's services. 25 counseling sessions 10 unduplicated clients 3. Legal Advocacy Services: Victim Advocacy, court accompaniment, legal information and referrals with filling restraining orders, immigration, divorce proceedings and child custody proceedings. 10 (legal advocacy services) 5 per fiscal year Average number of direct services received by each unduplicated client: 6 Average number of direct services received by each unduplicated Los Gatos client: 3 4 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July I, 2017, through June 30, 2018. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2017/18 Number of Services Provided Annually 1. YWCA Silicon Valley, Domestic Violence Department staff and volunteers will appear, participate, educate, and distribute information and materials to local businesses, organizations and health fairs. YWCA Silicon Valley, Domestic Violence Department staff and volunteers will appear, participate, educate and distribute information and materials to local businesses, organizations and health fairs. 8 per fiscal year F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Age Under 18 years old 1 19 — 50 years old 12 51 years old and over 2 Disability Status Disabled 2 Not Disabled 13 Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2017/18 Income 50% of median and below 12 51% - 100% of median 3 Above 100% of Median Sex Female 13 Male 2 Total Total Los Gatos clients 15 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. 5 IL AGENCY INFORMATION A. General Information Legal Name of Organization YWCA Silicon Valley Address of Organization 375 S. Third Street, San Jose, CA 95112 Name of Executive Director Tanis Crosby Date of Incorporation 1914 Insurance/Tax Information Federal Employer Tax Number 94-1186196 State Employer Tax Number 91008946 Worker's Compensation Carrier/ Policy Number Cypress Insurance Company YWWC700672 Liability Insurance Carrier Riverport Insurance Company #RIC0014680 Amount of Liability Coverage $1,000,000 Each Occurrence / $ 3,000,000 Annual Aggregate Property Damage (combined with liability) Riverport Insurance Company #RIC0014680 Combined Single Limit $1,000,000 Each Occurrence Policy Period 7-1-16 — 7-1-17 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2017/18. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Legal Services Specialist 1 $24.00 40 11.8% Volunteers 6 C. Agency Experience —Describe the experience of your Agency in providing program services. The YWCA serves a diverse constituency, comprised of 65 percent racial/ethnic minorities, 80 percent children, and a majority of clients who qualify as low- to moderate -income. In FY 2015-2016, a total of 1070 unduplicated clients received domestic violence services from the YWCA. Overall, the agency's interconnected programs serve over 18,000 people annually through the following service areas: *TechGYRLS® provides underserved girls, third grade through high school, with a safe, girls -only environment for exploring the world of science, technology, engineering, art, and math (STEAM). *Sexual Assault services include: a 24-hour crisis line and crisis counseling; legal and medical advocacy and accompaniment services; and education and prevention programs; and professional trainings. *Domestic Violence services include: confidential emergency shelter and wrap -around services, such as the Santa Clara County's only toll -free 24-hour bilingual (English/Spanish) crisis line, case management, legal advocacy, safety planning, transitional housing, and domestic violence outreach/education. *Child Care services include quality and affordable childcare through licensed facilities for children, from six weeks to 12 years of age. *Counseling services include trauma -informed, empowerment -based individual and group therapy for survivors of domestic violence and sexual assault, and counseling to students in the San Jose Unified School District. D. Staff Experience —Describe the experience of key staff assigned to the program. YWCA's Support Services Department (domestic violence, sexual assault, and human trafficking programs) draws on the collective talent of 42 staff members and over 275 volunteers. Domestic Violence service delivery is managed by a highly -qualified team comprised of the following key staff: Arnie McClane, Director. of Support Services Licensed Marriage & Family Therapist; M.A in Counseling Psychology; BS in Family and Consumer Sciences (Specialization in Family Studies); 40-hour training in Domestic Violence; 40-hour training in Sexual Assault; Certified in Danger Assessment; Strong Field Leadership Development Program Cohort III. Eight years' experience working in the domestic violence field; emergency shelter/program management. Denise Henderson, Director of Clinical Services Licensed Marriage & Family Therapist; MA in Counseling Psychology; State Certified 40-hour training in Domestic Violence and Sexual Assault; 11 years of experience as Director of Clinical Services. Sandra Hernandez, Sheller Manager BS in Health Education. State Certified 65-hour training in Domestic Violence and Sexual Assault; CPR/First Aid Certified; Mental Health First Aid USA certified; Family Development Credential. Six years of experience working in domestic violence emergency shelter program/management. Bilingual English/Spanish. Lindsey Mansfield, Crisis Support Manager BA Sociology; State Certified 65-hour training in Domestic Violence and Sexual Assault; nine years' experience in providing crisis call center direct services; five years' experience in case management. Phoenix Podell, Legal Services Specialist BA in Sociology; State Certified 65-hour training in Domestic Violence and Sexual Assault; 14 years' experience in providing direct services to survivors of domestic violence, with focus on legal advocacy. E. Staffing Plan —Describe any anticipated staffing changes to occur during FY 2017/18. There are no anticipated staffing changes to occur during the 2017-2018 fiscal year. All key staffing positions are filled and fully operational. H. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summary Budget Data FY 2017/18 FY 2016/17 Los Gatos grant funding Requested: $6,000 Received: $6,000 Total Program budget $1,457,090 $1,457,090 Los Gatos grant as percentage of total Program budget 0.4% 0.4% Total Organization budget $7,680,361 $7,680,361 Cost per year per unduplicated Los Gatos client $1,324 $400 8 Revenue Summar Revenue Source FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Los Gatos grant $6,000 $6,000 $6,000 $6,000 Other municipal funding (please specify: ) Mountain View $31,080 $31,080 $31,080 $31,080 County funding (please specify:) SSA; PREA $278,779 $230,797 $278,779 $230,797 State funding (please specify:) CaIOES; RPE; Marriage License Fees $980,079 $662,802 $980,079 $662,802 Federal funding (please specify:) CDGB; ESG; OVW; HUD CoC $2,507,643 $71,121 $2,507,643 $71,121 Other jurisdiction funding (please specify:) Evergreen; SJSU $249,000 $ $249,000 $ Fees for services $1,318,439 $ $1,318,439 $ Donations (individual, events, corp, found) $1,256,000 $44,650 $1,256,000 $44,650 Reserve contingency fund $ $ $ $ All other sources (please specify:) In -kind; penis restricted $1,053,341 $410,640 $1,053,341 $410,640 Total $7,680,361 $1,457,090 $7,680,361 $1,457,090 Expenditure Summa Expense Category FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget Personnel & Benefits $4,240,638 $827,964 $4,240,638 $827,964 Facility $281,467 $64,631 $281,467 $64,631 Overhead $ $ $ $ Materials/Supplies $118,303 $65,378 $118,303 $65,378 Professional Services $608,669 $57,677 $608,669 $57,677 Fundraising $928,027 $ $928,027 $ Capital Projects $ $ $ $ Other (please specify:) insurance, telephone, local transportation, $1,503,259 $441,440 $1,503,259 $441,440 9 Expense Category FY 2017/18 Organizational Budget FY 2017/18 Program Budget FY 2016/17 Organizational Budget FY 2016/17 Program Budget printing, training/conf., taxes and licenses, postage, client assistance, dues/subs., depreciation, misc. Total $7,680,361 $I,457,090 $7,680,361 $1,457,090 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. NO C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. NO D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. In the event that less than full funding is available, the YWCA Silicon Valley will continue to search for diversified avenues of funding. In the event that no funding is available, we will have to consider that services may have to be reduced per our stated goals. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. The YWCA Silicon Valley has an over one -hundred -year record of fiscal stability, and maintains diverse revenue streams through public grants/contracts, consistent earned income, and contributions from private (individual, corporate, and foundation) donors, which support its nearly six -million -dollar annual budget. The YWCA's programs are designed with sustainability in mind and the agency strives to build diverse portfolios of funders to ensure collaboration and leveraging opportunities. The YWCA is committed to stretching every dollar to its fullest potential to best serve the community and those who invest in the organization. Specific fundraising goals and revenue targets are outlined annually in agency's Fund Development Plan. The YWCA remains committed to sustaining existing and cultivating new sources of funding to continue providing critical, live -saving services for victims of domestic violence. F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. N/A G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. N/A 10 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, 1 certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: February 6, 2017 YWCA Silicon Valley Organization Name Executive Director Tanis Crosb (Print Name) 11 YWCA SILICON VALLEY PSYCHOTHERAPY FEE SCHEDULE INDIVIDUAL AND GROUP The YWCA Domestic Violence Department maintains the following sliding fee scale to ensure that women at all income levels are able to participate in psychotherapy. Gross Annual Income Number of People Supported by Income, (Including Self) Y 2 3 4 or More Ind. Group Ind. Group Ind. Group Ind. Group Cal Works (Per Sup.) $5 $5 $5 $5 $5 $5 $5 $5 Unemployed or Income limited to government subsidy $10 $10 $10 $10 $10 $10 $10 $10 Less than $20,000 $10 $10 $10 $10 $10 $10 $10 $10 $21,000 to $30,000 $20 $20 $20 $20 $15 $15 $15 $15 $31,000 to $40,000 $35 $30 $35 $30 $30 $25 $25 $20 $41,000 to $50,000 $55 $40 $55 $40 $50 $35 $45 $30 Over $50,000 $75 $55 $75 $55 $65 $45 $55 $35 This Page Intentionally Left Blank