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HomeMy WebLinkAboutCOM 0094.000 2010-2012County of Hawaii Nonprofit Organizations Grant Applications for Fiscal Year 2011 -12 February, 2011 Comm. No. q Ref. To: H 5 S PS C Ref. Date FEB 0 8 2011 William P. Kenoi Mayor County of Hawaii Finance Department 25 Aupuni Street, Room 2103 • Hilo, Hawaii 96720 (808) 961 -8234 • Fax (808) 961 -8569 February 7, 2011 Nancy E. Crawford Director Deanna S. Sako Deputy Director r- Cam D 7 . Dominic Yagong Council Chair and Members of the Hawaii County Council Hawaii County Council 25 Aupuni Street Hilo, Hawaii 96720 Re: Nonprofit Grant Applications In compliance with Chapter 2, Article 25 of the Hawaii County Code, I am submitting the applications from eligible nonprofit organizations for your review and appropriation of funds for the FY2011 -12 nonprofit grant program. Also enclosed is a list of these eligible organizations with the name of their program and the amount they are requesting from the County. Should you have any questions, please feel free to call Ted Schrey at 961 -8489. PA'tj C Nancy E. Crawford Director of Finance Enc. Applications for Nonprofit Grant Funds List of Nonprofit Grant Applicants Hawaii County is an Equal Opportunity Provider and Employer Comm. No. 9 4 Ref. To: S Ref. Date FEB n g 2 nii NONPROFIT GRANT APPLICANTS FOR FY2011 -12 Organization Name Program Name REQUESTED 1 Aloha Independe Living Hawai'i I ndepend e nt Living Se $ 1 2 Arc of Hilo Expand Advoc Program 50 ,000.00 3 Arc of Kona Home an Commun Based S ervices - Skills Program 1 4 Alahou Clean & Sober Clean and Sober Housing Pro 20 5 American Cance Society Hawai'i Pacific P atient Services for East & We Hawai'i Cancer P atients 15,0 00.00 6 A merican Red Cross - Hawai'i State Chapter D isaster Response & Prepare for County o Hawai'i 2 7 Arts & Sciences Center HAAS Productions Big Island RC & DC Operations 40,000.00 20,000.00 8 Big Island Resource Conservation and Development Council, In 9 Big Island Substance Abuse Council East H awai'i S Abuse Program 30,000.00 10 Big Island Substance Abuse Coun cil Koku EAP (E As Program) 18,000.00 11 Big Island Substance Abuse Cou We st Hawai'i Substance Abuse Program 30,000.00 12 Boys & Girls Club of the Big Islan :Posit Youth D P rograms: Hamaku Club 30,000.00 13 Boys & Girls Club of the Big Island P ositive Y Develo Programs: Hil Club 40,000.00 14 Boys & Girls Club of the Big Island Positiv Y outh Deve Pr K Clu 30,000.00 15 Boys & Girls Club of the Bi Island Po sitive Yo uth Developm Progra Ocean View C lub T 40,000.00 16 B oys & Girls Club of the Bi Island Positive Y outh Developm Progra Paha C lub 30,000.00 Po sitive Youth Developmen Prog Pa hoa Club 30,000.00 Employ Reh Pro 25,000.00 17 Boys & Girls Club of the Bi Island Center, Inc. 18 {Bra 19 Br idge House, In c. Voc ational S kills Build Pro 30,000.00 20 Child & Family Service Alternati to Vio lence Program 35,000.00 21 Child & Family Service H awaii Co - Domes Abuse Sh elters P 35,000.00 22 Child & Family Service H ilo Tran Housin Program 40,000.00 23 Child & Fa mily Service T herapeu tic Foster Ho Progra 4— 35, 24 Dragons Ey Learnin Cen L iving in the Garden Outre 17,004.00 25 Family S upport Ha Ka'u F amily Cente 60,000.00 26 Friends of Big Island Dr Court A ssistan ce t o Drug C ourt Clients & Pr ogram 10,000.00 Speceds &Enh anceme nt, Center Support, Prevention /Education ial Ne 27 Friends of the Children's Justice Center of East Hawaii & T Pr ograms En hancement and Basic Nee s 5 000.00 1 5,000.00 1 28 } Frien of the Children's Justice Center of West Hawai'i 29 Goodwill Industries of Hawai'i, Inc. Job Connections Prog 30,000.00 30 Goodwill Indu stries of Ha wai'i, Inc. Work Ex perience P 45 000.00 D evelo ment Gr ou Grassroots p Communit p P u u Busine C enter Ku ku P_ p - - - � 55,000.00 - 32 - -- - - GreenWill Co servanc o t h ,Hui Ma - 35 640.00 33 Habitat for Hum anity I Home B Prog Site S 24,000.00 34 Hale A loha O H ilo Habitat fo H umanity, Inc. B uilding Affo rdable H 201 Restore 2011 - -- - - Hawa Advocat Pro 155,855.00 30,046.92 - � 65,000.00 35 — - Hale Aloha O Hilo Habitat fo r Hum anity, In - 36 - H ale Ki a 37 - - - �H amakua Youth Foundation - ---- - _ - Hamakua Yout Ce nter i 20,000.00 38 H awai'i Cen ters for Ind Liv Inde pendent Livin Servic 15,000.00 39 Hawaii Coun Ec onomic Opportu C Food S ervice Tra inin g Progr - 9 9 - 72,964.00 - 40 _ Hawaii Coun Econo O ortu Counc County Opportu Garden E ducation - - 81 79,816.00 41 Hawaii County Economic Op portunity Council Youth Mentoring - Right Track/DOPP 10 9,240.00 42 Hawai'i County Economic Opportunity C ouncil - Yo uth Mentori Languag Arts Multicultural Pr 13,372 24,000.00 43 Haw ai'i FFA Foundation Ko hala Family Natural F Program -- 44 Haw ai'i Island Adult Care I nc. H ilo Adult Day Centers 25,000.00 45 ! Hawai'i Island HIV / AIDS Fou Multi- Disciplinary HIV C Mana Hil 15,000.00 46 Hawai'i Island HIV /AIDS F oundation - - - -- Transmission Preven for H IV + Women i n West Hawai'i 15,000.00 47 Hawai'i Island Workforce & Economic Development Ohana (HIWE Going Home 25,000.00 48 Hawaii Island Workforce & Economic Development Ohana Huiana Student Internship Program 25,000.00 49 (HIWEDO) Hope S ervice s H awaii , I nc. Bey S helte r Tran Hous ing 15,000.00 50 Hope Sery ices Ha wai'i, Inc. Care -A -Va Homel Out reach 20,000.00 51 Ho pe Services Hawaii, Inc. HO res Cen ter 20,000.00 52 Hope Service Hawaii, Inc. Kalok Tran Ho usi ng Program 30,000.00 53 Hope S Ha waii, Inc Kihe Pua Emergency Shelter 15,000.00 5 4 Hop Servi Hawaii, In West H awai'i E merg en cy Ho P 20,000.00 55 Hui Malama Ola NA'Oiwi -t Kokua Hali Health Transportation Program 20,000.00 56 H ui Malama Ola NA'Oiwi Mai Ka M Diabetes Manag Progra 31,328.00 No Ka Wahine: Cancer Program 20,000.00 57 Hui Malama Ola Na 'Oiwi NONPROFIT GRANT APPLICANTS FOR FY2011 -12 Organization Name Program Name REQUESTED 58 Hui Pono Holoholona Sub sidized Low Cost Spay /NeuterCli _ - _ 2 — 59 Island of Hawaii YMCA Impact: Y A 2 011 -2012 40, 60 Island of Hawaii YMC Ka Hale O Na Keiki K alani Honua, Inc Kalauo naoneoPuna Na Alaka' I Hou P rogr a m _ _ - Families -A -Ris A nnual N ature - Cultu - Wellne Ed uca t ional Activit Kalapana Cul Fe - — - Kapio'lani Child Protection Center - West Hawai'I Title IV -B -West HI - 4 f 75 000.00 12 000.00 - 24 000.00 15,000.00 20,000.00 61 62 63 64 Kapi'olani Medical Center for Women &Children C oun s eling & Su pportiv L iving Protect -- _ 65 One Youth Development Y outh Deve m 10,000.00 66 �Keaukaha ala Communiy Resource Center Strategic Planning and Programs for N. Kohala Food Self Sufficienc y 20,000.00 67 Kona Adult Day Center, Inc. Kona Historical Society Adult Day Ca Li ving History Program Operati 2 0 5 68 69 Kona Literacy Council Kailua Learni Cen - 2 70 Ku Aloha Ola Mau Ku'ikahi Mediatio Ce H ui Ho'ola O Na Nahul O Hawaii _ _ - Community M ediati o n Pr - - - 100 000.00 - - 25 000.00 71 72 - - Lyman Museum Edu cation and P ublic P rog r ams 50,000.00 73 Mental Health Kokua Reside Re habi li tatio n Se 15,000.00 74 National Kidney Foundation of Hawaii Chron Ki Diseas Pre Educatio and Inte 48 500.00 75 Neighboohood Place of Kona Nei ghbo r hood P lace - - 15,000.00 - - 76 Neighborhood Pla of Puna Family a nd Co St r _ 25,0 — - 77 O Ka'u Kakou O Ka'u Kakou —- - - 65 000.00 -- 78 - Palekana Kai Oce Sa LL C Ocean Safety Program 30 0 79 Puna Community Medical Center - - Puna Men's Chorus Salvation Army Family Intervention Services Salvation Army Fa In Serv Acu Care Clin Uni Prog -- - - 201 Concert Series Inde Livi Ski Program - W H kP rev e ntion P rogr am s - Honok - - E 144,000.00 - 12,500.00 32,657.00 32,657.00 80 81 82 - — 83 Salvation Ar my Family In Se Special Olympics Hawai'i - East Ha waii Special Olympics Hawaii - West Hawai'i Prev Progr - P aho a 1 Spe ci al Ol Haw E ast Ha wai'i - - -- S pecia l Olym West Hawai'i - Ge F und i ng -- 32,657.00 20,000.00 - 12,000.00 84 85 86 Sure Foundation, Inc. Yeshua Outr Center 70 $7 Volunteer Legal Services Hawai'i _County of Hawai'i P Bono Legal Services 5 5, 00 0.00 $$ West Hawai'i Community H ealth Center _tAdult Emergency D ental Serv 10, 13 000.00 89 West Hawai'i Mediation Center Mediatio Se - 90 YARH - Youth At Risk Hawai'i Jump, Ki ck, A P 15,414.00 91 YWCA of Hawai'i Islan YWCA of Hawaii Island H ealthy Start Plus 75,000.00 - - Sexual Assault Support Services 60,000.00 -- - TOTAL: $ 3,227,650.92 92 _ Aloha Independent Living Hawaii Independent Living Services Aloha Independent Living Hawaii- Atency Name Independent Living Services- Program Name Agency Director: 497 -2350 Contact Person: 497 -2350 Mailing Address: Facility /Site Address: Fax No.: Email Address: Roxanne Bolden Roxanne Bolden P.O. Box 283 Purl City, Hawaii 96782 94-909 Kau'olu Place #211 Waipahu, Hawaii 96797 1- 800 -385 -2454 nubolden @alohailhawaii.org Phone No.: 808- Phone No.: 808- Name of Accountant/CPA (include name of firm if applicable): Newly incorporated, No CPA, only Book keeper Phone No.: Mailing Address: Amount of Request for Cournty Funds: $10,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $0.00 $0.00 $0.00 Agency Mission Statement To provide independent living programs and services to persons with disabilities to assist them in living independently in the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Aloha Independent Living Hawaii - Agency Name Independent Living Services- Program Name Program Description: The concept behind independent living is the empowerment of persons with disabilities to make choices in their lives that will enhance their dignity and self - respect, and provide full integration into the community as equal citizens with all the privileges and responsibilfties available to others. Ignorance and discriminatory practices in society continues to cause a combination of low education, low vocation, low - income and lows social opportunity outcomes. People with disabilities have to overcome their own limitations and inhibitions, as well, as compete in a society that for decades has relegated them to second - class citizens. The Aloha Independent Living Hawaii believes that those who best know the needs of people with disabilities and how to meet those needs are people with disabilities themselves. The practice of °Consumer Control" forms the foundation for staff resources and service delivery. Staff helps consumers with disabilities to address independent living goals. The Aloha Independent Living Hawaii has two broad goals. The first is to addresss the rights and responsibilities of people with disabilities by providing various education, training, and technical assistance services to the system-at-large. We strive to heighten awareness, understanding and compliance so that people with disabilities can have equal access and opportunities. The second goal is to facilitate the accomplishment of individualized goals that consumers establish. Whether the issue is related to housing, benefits, personal care, accessibility, assistive technology, healthcare, transportation, or any other topics of independent living, we want consumers to achieve their goals. Even more than this, we want consumers to learn the process and develop skills for life -tong independent living. Total Budget and Position Count Total Program Budget $250,000 1 Total Prouram Position Count 3 Total Agency Budget 1 $250,000 Total A envy Position Count 1 3 Program Objectives: 1) 1) Provide the consumer training in landlord/tenant rights, how to complete a housing application, how to locate housing and how to maintain their housing situation. This will reduce the risk of being homeless and dependent on others. Timeline: 7/1/11 - 6/30/12 2) 2) Provide the consumer with one- on-one independent living skills to carry out their every day living activities (household and shopping Chores, NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Aloha Independent Living Hawaii - Agency Name Independent Living Services- Program Name Program Description: The concept behind independent living is the empowerment of persons with disabilities to make choices in their lives that will enhance their dignity and self - respect, and provide full integration into the community as equal citizens with all the privileges and responsibilities available to others. Ignorance and discriminatory practices in society continues to cause a combination of low education, low vocation, low�income and lows social opportunity outcomes. People with disabilities have to overcome their own limitations and inhibitions, as well, as compete in a society that for decades has relegated them to second - class citizens. The Aloha Independent Living Hawaii believes that those who best know the needs of people with disabilities and how to meet those needs are people with disabilities themselves. The practice of "Consumer Control" forms the foundation for staff resouirces and service delivery. Staff helps consumers with disabilities to address independent living goals. The Aloha independent Living Hawaii has two broad goals. The first is to address the rights and responsibilities of people with disabilities by providing various education, training, and technical assistance services to the system -at- large. We strive to heighten awareness, understanding and compliance so that people with disabilities can have equal access and opportunities. The second goal is to facilitate the accomplishment of individualized goals that consumers establish. Whether the issue is related to housing, benefits, personal care, accessibility, assistive technology, healthcare, transportation, or any other topics of independent living, we want consumers to achieve their goals. Even more than this, we want consumers to learn the process and develop skills for life -long independent living. Total Budget and Position Count Program Objectives: 1) Provide the consumer training in landlord/tenant rights, how to complete a housing application, how to locate housing and how to maintain their housing situation. This will reduce the risk of being homeless and dependent on others. Timeline: 7/1/11 - 6/30/12 2) Provide the consumer with one -on -one independent living skills to carry out their every day living activities (household and shopping chores, etc.). This will reduce the dependence on others. Timeline: 7/1/11 - 6/30/12 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 3) Provide the consumer with information on their legal rights, how to access information, who to contact, etc. so they may be able to share this knowledge with other consumers. This will empower consumers to self - advocate for their rights. Timeline: 7/1/11— 6/30/12 4) Provide one - on-one training with consumer to acquire problem- solving and decision - making skills. this will empower them to making the right choices. Timeline: 711/11— 6130/12 5) Provide consumer with housing referrals to acquire a place to live. This will increase their independence and decrease dependency on a family and /or friends. Timeline: 7/1/11— 6/30/12 6) Provide consumers wilt attendant referrals to acquire personal care assistance services. This will increase their independence to remain at home versus institutiorranalization. Timeline: 7/1/11— 6/30/12 7) Provide consumer with information on their entitlements and guidelines to apply for these benefits. This will increase self -worth and self- sufficiency in their dais living. Timeline: 6/1/11 - 6/30/12 Program Highlights: (from Fiscal Year 2009 -10) 1) Established a fully functioning board of directors, 51 % of whom are persons with disabilities. 2) Hired two Independent Living (IL) Specialists that assists the Executive Director in direct consumer servies. 3) Collaborated with the following organizations: Kahuku Medical Center to facilitate services for the frail and elderly to maximize existing resources and to prevent premature and/or inappropriate institutionalization. Ho'oikaika Hawaii Peer Mentioring Project for Persons with Traumatic Brain Injury to identify consumers with traumatic brain injury and facilitate appropriate services based on their needs that will assist with their independence. U. S. Army Wounded Warrior Program to assist with soldiers transition needs for living in the community and maintaining their independence. Hawaii Fi -Do Service Dogs in developing a donation program to provide essential dog care items for consumers who own a service, companion or therapy dog. 4) Organized a youth recreational group to provide recreational opportunities for Oahu's North Shore youths while providing independent living skills such as cooperation, responsibility, self - advocacy and interpersonal realations. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Aloha Independent Living Hawaii - Agency Name Independent Living Services - Program Name Performance Measures: �I aNNuuaulu Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Training in landlord/tenant rights, how to complete a housing application, how to locate housing and how to maintain their housing situation. 18 20 25 Training on indepdent living skills. 10 15 25 Traing in legal rights and set# advocacy. 8 15 20 Provide housing referrals to acquire a place to live. 18 20 25 Provide information to consumers on their entitlements. 7 15 20 Provide attendant referrals to acquire personal assistance services. 4 8 10 �I aNNuuaulu Program Expenditures i I Opp 1%.0uic Please explain in detail on sepatalfe sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages 78,573 159,280 158,000 Professional Fees 24 38,000 25,000 Operations 5,386 13,500 13,000 Equipment 1,844 5,000 5,000 Other" 0 0 0 Total 197,011 215,780 201,000 i I Opp 1%.0uic Please explain in detail on sepatalfe sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Aloha Independent Living Hawaii - Agency Name Independent Living Services - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 201041 Budget * FY 2011 -12 Estimate State of Hawaii 128,634 250,000 250,000 Donations 1,000 2,000 2,000 Total a 129,000 252,000 252,000 If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Aloha Independent Living Hawaii (AILH) will continue to apply for the State of Hawaii contract with the Department of Human Services (DHS) Vocational Rehabilitation & Services to the Blind Division to provide statewide independent living services. In addition, AILH will be looking at adding a supportive employment component to our independent living programs and will apply for the contract through DHS VRSBD. Other grant opportunities through the University of Hawaii or other granting agencies will be explored. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Aloha Independent Living Hawaii - Agency Name _ Independent Living Services - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. ff awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. i V( Si nature of Board Presi nt/Chair MWO' of Executive Director ,3t 1 Date 1 31 tt Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTEDI NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 2 Arc of Hilo Expanded Advocacy Program The Arc of Hilo- Agency Name Expanded Advocacy Program- Program Name Agency Director: M. Gleason Phone No.: 935 -8534 Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: D. Perkins 1099 Waianuenue Avenue Hilo, Hawaii 06720 Phone No.: 935 -8534 Aging and Disabilities Resource Center (ADRC) 1055 Kinoole Street, Suite 104, Hilo, Hawaii 96720 (808) 934 -7714 dperkins @hiloarc.org Name of Accountant/CPA (include name of firm if applicable): Ms. Ann Fukuhara, CPA, An Accountancy Phone No.: (808) 961 -5582 Mailing Address: 714 Kanoelehua Ave., Box 6691, Hilo, Hawaii 96720 Amount of Request for County Funds: $50,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $25,000 $20,000 $15,000 Agency Mission Statement: To Improve the quality of life for people with disabilities in Hawaii through educational, vocational and skills training as well as employment and residential opportunities. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 The Arc of Hilo - Agency Name Expanded Advocacy Program- Program Name Program Description: The Expanded Advocacy Program assists people with disabilities and their families to access the essential social services, benefits and resources they need to manage their life with their disabilities. Disabled individuals frequently are not able to access much needed resources due to the inability to fill out an application for services or benefits; being overwhelmed by the program's application process; not knowing the relevant information to provide in order to access services; lacking the expertise to file a formal or informal appeal; the stigma attached to being disabled and not knowing their rights. Consequently, the need for advocacy arises to provide support to these individuals and to promote independent living as an alternative to institutionalization and homelessness through the following services: * Information and Referral; * Advocacy and Counseling; * Outreach; and, * Education. The Program is located at the Aging and Disability Resource Center (ADRC) in Hilo and is an integral component to ADRC's mission of providing a centralized community resource for the aging, disabled, their caregivers, and the community. The Expanded Advocacy Program targets the residents of East Hawaii. However, due to increasing awareness of the Program, the residents and agencies of West Hawaii have contacted this program for help. The Expanded Advocacy Program is designed to assist people with disabilities and their families to access the medical and social services they need in East Hawaii. Many of these services promotes independent living in the community as opposed to institutionalization. Services include: Information and referral; advocacy, counseling, outreach and education. The Program also includes services to the disabled aging population. During the past fiscal year (FY 2009 to 2010), the Program's Advocate was invited to become a Master Trainer with the Stanford University's Chronic Disease Self Management Program. This program provides tools for individuals to manage their chronic diseases such as diabetes, arthritis, hypertension, heart disease, etc. It gives participants the opportunity to learn self- advocacy skills for managing their chronic diseases and empowers them to avoid or delay disability, debilitation, and institutionalization. In addition to empowering participants by postponing or preventing debilitation or disability, this program provides an opportunity for the Arc of Hilo to increase its visibility, outreach and educational efforts in the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Total Budget and Position Count Total Program Bud et $57,023 Total Program Position Count 1 Total Agency Bud et 1 $6.2 Million Total Agency Position Count 174 Program Objectives: Continue program expansion and development by providing the very best services possible at the Office of Aging and Disability Resource Center (ADRC) through on -going evaluation of existing services offered in East Hawaii and by analyzing the areas that are under served and in need for services for people with disabilities in East Hawaii. 1) Continue as a primary resource on disability issues at the ADRC one -stop shop for aging and disability services. 2) Advocate for people with disabilities help them access benefits and services in the community, such as employment training, transportation, housing, wage, medical and insurance benefits; and medical and dental services. The Advocate is able to draw upon a wide range of programs and services available at the Arc of Hilo as well as other resources in our community. 3) Make referrals to the Kokua Program (a United Way funded program) when immediate direct care is needed for people with developmental disabilites. Work with eligible individuals and their families to apply for various government funded programs for long -term supports and services. 4) Expand educational services to individuals and community groups including public and private schools, colleges, service organizations, families, and general public about disability and aging issues. developmental disabilites. 5) Work with eligible individuals and their families to apply for various government funded programs for long -term supports and services. 6) Serve as a community resource for individuals and agencies needing information and referral on any disability related issues such as, benefits (ie. Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), Medicare, Medicaid Waiver Program; landlord /tenant issues, access to durable medical equipment, long -term disability care planning and any other disability issue. Program Highlights: (from Fiscal Year 2009 -10) NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 The Program's Advocate has successfully appealed a client's denial for subsidized housing and prevented the client from becoming homeless; a blind person who uses a wheelchair was able to receive the appropriate incontinent underpads through the advocate's intervention on an insurance plan's denial; another wheelchair user received counseling to plan for independence in preparation of his ailing mother's debilitation; developmentally disabled clients received assistance in the application process for community services; the advocate successfully assisted a disabled client to receive reasonable accommodation under the Americans with Disabilities Act; a disabled client with a seizure disorder received counseling to increase compliance to his treatment and now has his seizures stabilized. Other highlights include: 1) PacRim Conference for People with Disabilities. The advocate received training in Social Security Benefits. This training provided participants the opportunity to learn about the SSDI and SSI benefit incentives for returning to work. 2) Chronic Disease Self- Management Training. The advocate received training to become a Master Trainer to teach consumers and leaders in the community to empower themselves and their community in self - managing their chronic diseases. One of the significant aspects of this training is to increase the individual's wellness, maintain independence for self -care, postpone disability, reduce the number of employee sick days and increase productivity, and ultimately, create a healthier population. 3) Mayor's Committee on People With Disabilities. In June 2010, the Mayor, Billy Kenoi restarted this Committee to address the needs of people with disabilities in Hawaii County. The Advocate serves as the Co -Chair of the Committee. 4) Case Management Coordination Project. The Department of Health's Public Health Nursing Department organizes this project. It is comprised of team members from various agencies in the community that provide support to seniors with significant disabilities. The Advocate participates in the interdisciplinary team meetings to address and provide support to advocacy issues for the clients. 5) Workforce Solutions. The Workforce Development Office's Workforce Solutions committee addresses employer' and employees' needs regarding reasonable accommodation issues for people with disabilities in the workplace. 6) Draft legislative testimony to advocate for people with disabilities in our community. 7) Other activities. The Advocate regularly collaborates with these agencies in coordinating client services or advocating for client. They are: ADRC (Aging and Disability Resource Center), Center for Independent Living, Office of Social Ministry; Hawaii Center for Independent Living; Disability Rights Hawaii, State of Hawaii East Hawaii Developmental Disabilities Council; Department of Developmental Disabilities; Department of Vocational Rehabilitation; Department of Human Services- Benefit Employment & Support Services Division. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 The Arc of Hilo - Agency Name Expanded Advocacy Program - Program Name Performance Measures: it appucable Program Expenditures FY 2009 -10 Actual* FY 2010 -11 Budget* FY 2011 -12 Estimate Information: units of service ** 261 1000 1000 Referrals: number of referrals 62 100 200 Outreach: number of outreach contacts 217 300 300 Advocacy and Counseling: units of service ** 223 2000 1000 Education: number of contacts 21 30 60 Number of clients served 31,149 20 40 ** Each unit of service = 15 minutes it appucable Program Expenditures IT appiicaoie # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages 22,986 46,715 47,100 Professional Fees 47 30 56 Operations 7,332 8,562 11,466 Equipment Other' 784 1,716 2,750 Total 31,149 57,203 61,372 IT appiicaoie # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 THE ARC OF HILO ADVOCACY PROGRAM Salaries and Wages: Disability Services Advocate 35,256.00 Allocated Cost 11,844.00 47,100.00 Operational Expenses Included: Rent and Telephone Notes from Page 3, "Other #" Mileage Reimbursement 300.00 Advertising 1,000.00 Postage 50.00 Promotional Items 500.00 Fee for Health and Job Fairs Booths 100.00 Staff Training (Pacific Rim Conference) 600.00 Staff Training (Other Training) 200.00 Total 2,750.00 The Arc of Hilo - Agency Name Expanded Advocacy Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget * Estimate Total * If nnn1inihl— Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Arc of Hilo has a historical reputation for developing income generating activities to fund its programs. It engages in a variety of income producing activities such as the Adult Day Program, Personal Assistance, Employment Training and Commercial Services. The country's and state's economic crises have also impacted the Arc, and the agency faces many fiscal challenges. However, it continues to explore and pursue other sources such as grant making and fundraising to support this program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 The Arc of Hilo - Agency Name Expanded Advocacy Program - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Sign ure of Board Presidenkhair Si at a of Executive Director / /___ 1 Date l Z / Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 3 Arc of Kona Home and Community Based Services -Life Skills Program C�UwV Arc of Kona Arc of Kona County Grant Application 2011 -2012 HOME AND COMMUNITY BASED SERVICES LIFE SKILLS PROGRAM Agency Director: Gretchen Lawson Phone No.: 808 - 323 -2626 Contact Person: Jeani Navarro Phone No.: 808 - 775 -1090 Mailing Address: PO Box 127 Kealakekua, HI 96750 Facility /Site Address: 81 -1065 Konawaena School Road Kealakekua, HI 96750 Fax No.: 808 - 323 -9444 Email Address: kalopa51(a)-aol.com or jeani@arcofkona.org Name of Accountant/CPA: Ann N. Fukuhara, CPA, MBA An Accountancy Corporation Phone No.: 808 - 961 -5532 Fax: 808 - 934 -8589 Mailing Address: PO Box 6691, Hilo, HI 96720 Amount of Request for County Funds: $15,000.00 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $20,000 $15,000 $10,000 Agency Mission Statement: The Arc of Kona is committed to helping people with disabilities achieve the fullest possible independence and participation in society consistent with their wishes. o: \vp for services \2011- 2012countygrantl l.doc Page 1 Arc of Kona County Grant Application 2011 -2012 Arc of K ona HOME AND COMMUNITY BASED SERVICES LIFE SKILLS PROGRAM Program Description: For over forty years, the Arc of Kona has successfully operated an Adult Day Health (ADH) standard classroom program that currently serves 25 participants and a Personal Assistant/Habilitation program island -wide that serves 70 plus participants on a daily basis in their community setting. These two programs are combined as Home and Community Based Services for individuals with an Intellectual or Developmental Disability. Arc of Kona is committed to serving more participants especially those residing in the most rural areas (Puna /Hamakua /Kohala ) that lack adequate access to community services. All of the participants in the Home and Community Based Services programs have been identified as having a diagnosis of a disability (DD /MR- Developmentally Disabled /Mentally Retarded, now called an Intellectual Disability) by the State of Hawaii and have cognitive limitations that prevent them from living as independently as possible without extensive life skills training and other needed supports. The population is a mix of Native Hawaiian, Asian /Pacific Islander, Filipino and Caucasian youth and adults ranging from 8 to 60 years of age with a core group of young adults in their late teens and mid 20's. All of these individuals are unable to make good judgments due to cognitive delays; therefore needing various supports that insure their safety and help with activities of daily living. The individuals need to be in a caregivers' line of vision at all times and require assistance gaining access to community services and activities that will allow them to begin integration into the communities where they reside. The Developmentally Disabled population has several risk and protective factors that we consider when designing individual life skills training. First, this population is at risk of abuse, both sexual and physical, and need to be taught the skills for saying "NO" and reporting abuse. They are known to be at risk for chronic disease and have 'a high incidence of diabetes and heart problems related to weight and diet. Finally, they are all at risk for homelessness and /or being unprepared to prove they can live independently both with daily living skills and finances. Protective factors we consider include: a) training in social development, b) appropriate sexual behaviors, c) protection from abuse including family members as well as strangers, d) proper nutrition, e) preparing individuals to find their own housing accommodations and live as independently as possible, with or without o: \vp for services \2011- 2012countygrantll.doc Page 2 Arc of Kona County Grant Application 2011 -2012 Arc of Kona HOME AND COMMUNITY BASED SERVICES LIFE SKILLS PROGRAM other agency supports, and f) preparing for work either supported or unsupported at the work site, non - traditional work and entrepreneurial start ups. The "community as a classroom" where participants can practice these skill sets becomes essential to strengthening the protective factors around this vulnerable population. When provided with community access services for their life skills component, our participants not only learn but have the opportunity to share their own many skills and gifts that benefit the larger community. The Arc of Kona's $15,000.00 request will enhance service delivery by providing for life skills training supplies and access to and from home and the classroom, and into community as well as portion of the staffing and payroll taxes attached to the salaries. Total Budget and Position Count Total Program Budget $373,320 Total Program Position Count 6 Total Agency Bud et $3,297,517 Total Agency Position Count 109 Program Objectives: 1) Provide a safe, healthy, and supportive environment for daily living skills in the community setting for 365 days per year from July 1, 2011 to June 30, 2012 for the participants receiving Home and Community Based Services island -wide with focus on the rural underserved areas of the island. Thus, relieving families of the stress of daily care giving and allowing them the opportunity to work if they desire and make a living and /or care for other children. 2) Provide individualized life skills training programs, with measurable goals and objectives that allow each participant to develop at his or her own pace in order to live as independently as possible. 3) Insure access to community events and resources that will be a learning laboratory for independent living and reinforce skills taught throughout the program year, including those for supported employment. 4) Provide needed materials to assess, instruct and support life skills specific training in health and safety areas relating to abuse and appropriate sexual behavior as well as hygiene, money management, household safety issues and nutrition. o: \vp for services \2011- 2012countygrantll.doc Page 3 Are of Kona County Grant Application 2011 -2012 Arc of Kona HOME AND COMMUNITY BASED SERVICES LIFE SKILLS PROGRAM 5) Provide needed supports for interacting appropriately with each other and the public within the community setting throughout the program year that supports the independent living skills /and or work setting required to function on a daily basis. Program Highlights (from Fiscal year 2009 - 2010): The Arc of Kona's programs grew last year increasing our ADH classroom and Personal Assistant/Habilitation with additional participants. This continued growth success has been in part because the Life Skills Program is results driven and families have been pleased and excited with our innovations, especially those in the area of employment preparation. 1) 85 participants received daily lessons on health and safety as they pertain to daily living and toward independent living (including information on hygiene, appropriate sexual behavior, yoga for stretching and balance, fire safety, and classes on nutrition and weight maintenance). Training positively resulted in a reduced number of behavior outbursts and incident reports. 2) 85 participants have been able to access the community (as required by law) for practicum in independent living skills in real life community settings. This resulted positively in 100% of the participants meeting two or more of their individual objectives toward their personal goals, and 85% of participants actually attaining one of their personalized goals. 3) 25 participants were able to participate in yoga classes, walking and stretching training that has resulted in better balance and body awareness and therefore less falling /tripping and more self esteem. 4) 85 participants received training in the nutritional value of foods and were trained to assist in the preparation of healthier meals. The goal this year was to make healthy food choices unsupervised. 5) 30 participants attended a free Kayak/Surf Day and were able to be in the water and participate in a water sport, many for the first time in their life. 6) 30 participants participated in music and art programs offered in the community, four successfully beginning their own non - traditional businesses, and one excelling in video and will begin training professionally with Na Leo. 7) 8 Participants are involved in the Artists Mean Business program and will be launching their own small businesses. o: \vp for services \2011- 2012countygrantll.doc Page 4 Arc of Kona Arc of Kona County Grant Application 2011 -2012 HOME AND COMMUNITY BASED SERVICES LIFE SKILLS PROGRAM Performance Measures: Home and Community Based Services Life Skills Program 1. a. Provide a safe, secure classroom environment with sufficient staff supervision, 5 days a week, 52 weeks a year, for current 25 DD /MR participants. 1. b. Deliver on going life skills training in the classroom and the rural areas as per each individuals' plan which is developed by the Department of Health, the family and the Arc of Kona. 2. Provide access to the community for hands -on life skills training experiences including food and clothing shopping, fire safety, ordering and eating in public, handling money, making appointments, nutrition and exercise, and appropriate behaviors in public (including sexual behavior). 3. Provide on -going Life Skills assessments and data collection for each individual. This includes areas such as recognizing and reporting abuse, health, hygiene, safety, socialization, basic cooking skills, behaviors, consumerism, basic literacy and job skills training. FY 2009 -10 Actual * 260 days of ADH standard classroom activities with a one staff to four participant ratio for 25 participants and 365 days of one on one services for 85 participants. 144 ADH classroom group transports for 25 people into the community and 365+ individual transports to achieve Life Skills plan in the community. 260 days of classroom instruction and 365 days of community instruction for Life Skills and daily living activities with pre and post testing for assessment of base line skills, data collection and quarterly and year end reporting on achieved results. FY 2009 -10 Budget 260 days of ADH standard classroom activities with a one staff to four participant ratio for 25 participants and 365 days of one on one services for 85 144 ADH classroom group transports for 25 people into the community and 365+ individual transports for activities that promote individual life skills goals. 365 days of completed instruction for Life Skills and daily living activities with pre and post testing for assessment of base line skills, data collection and quarterly and year end reporting on achieved results. FY 2011 -2012 Estimate 260 days of ADH standard classroom activities with a one staff to four ratio for 25 -30 participants and 365 days of one on one services for 90 participants. 144 ADH classroom transports proposed and 365+ individual transports proposed to achieve Life Skills plan in the community. 365 days of instruction proposed with assessment, base line, and data collection for results reporting. If applicable: o: \vp for services \2011- 2012countygrantll.doc Page 5 Arc of Kona County Grant Application 2011 -2012 Arc of Kona HOME AND COMMUNITY BASED SERVICES LIFE SKILLS PROGRAM Program Expenditures If applicable "Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages $262,524 $294,765 $309,503 Professional Fees $26,333 $26,664 $26,666 Operations $55,502 $62,662 $64,542 Equipment $2,584 Other" $353,640 $373,320 $358,424 Total $318,026 $357,427 $374,045 If applicable "Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate County of Hawaii $15,000 $15,000 $15,000 Hawaii Island United Way $26,333 $26,664 $26,666 State Medicaid Waiver $309,723 $331,656 $316,758 Client Fees Third Pa $2,584 Total 1 $353,640 $373,320 $358,424 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Each year, the week before Thanksgiving, we hold a bazaar and craft sale that is our signature event. In June of each year, we hold a musical concert in conjunction with Hawaii Performing Arts Festival, with plans to repeat the event again this year. We also have an upcoming Blue Grass benefit concert with Grammy award winning artists Laurie Lewis and Tom Rozum scheduled at the Aloha Theater January 29 of 2011. We have been actively and successfully working with our island wide donors for additional program support. o: \vp for services \2011- 2012countygrantll.doc Page 6 Arc of Kona County Grant Application 2011 -2012 Arc of Kona HOME AND COMMUNITY BASED SERVICES LIFE SKILLS PROGRAM Our goal for the valuable Life Skills Program to be self sustaining is not attainable in the near future. Like all non - profits, the rising costs for services and budget reductions have dramatically affected our families and participant programs. However, we have taken a proactive stance and made internal organizational changes so that our programs can maintain their integrity. With the benefit of a recent grant through the Walmart Foundation, we are able to work with local high schools to transition students with a diagnosis of a disability into off campus work sites and at graduation into competitive employment. This step is one of the proactive measures we are taking to not only help our participants enjoy their community and receive wages for real work, but also not be as dependent on government funds in the future. We are also working with Social Security Benefits Educators to assist families with understanding how benefits work and take the fear out of employment creating a loss of medical and other needed benefits. The Arc of Kona is celebrating its 45th anniversary this year. We have been working diligently to find new and creative ways to raise unrestricted funds to support our numerous programs and actively working with our Board of Directors and the community to offer events all through the year which will also educate the public about the needs of our population and generate a stronger donor list both local and through our website. o: \vp for services \2011- 2012countygrantll.doc Page 7 Arc of Kona County Grant Application 2011 -2012 Arc of Kona HOME AND COMMUNITY BASED SERVICES LIFE SKILLS PROGRAM I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 – 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. /k Av I/ Signature of Board President/Chair �'V-- �8W _3_ § of Executiv6 Director Jai, 2/ d l/ Date Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! o: \vp for services \2011- 2012countygrantll.doc Page 8 E Alahou Clean & Sober Clean and Sober Housing Program Alahou Clean & S ober Clean and Sober Housing Program Agency Director: Sandra K. McCoy Phone No.: (808) 327 -1694 Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Sandra K. McCoy 75 -5708 Alahou Street Kailua -Kona, HI 96740 75 -5708 Alahou Street Kailua -Kona, HI 96740 (808) 327 -1654 Phone No.: (808) 327 -1694 alahoucleanandsober@hawaii.rr.com Name of Accountant/CPA (include name of firm if applicable): Sharon Davis CPA PC Phone No.: 808 - 883 -2748 Mailing Address: P. O. Box 383190, Waikoloa, HI 96738 Amount of Request for County Funds: $20,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $0 $0 $0 Agency Mission Statement: Alahou is the Hawaiian word for "new beginnings." The mission of Alahou Clean & Sober is to provide the opportunity for new beginnings in a clean, safe and supportive living environment for individuals in recovery from addiction to alcohol or drugs who desire to stay clean and sober. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Alahou Clean & Sober Clean and Sober Housing Program Program Description: Life on the street in West Hawaii for an individual battling the dual adversaries of mental illness and addiction is a deadly, no -win game. Eating from garbage bins, at constant physical risk of violence and disease, and having no peer support or role models quickly erodes personal will and self- esteem — and the descent continues. The residents of Alahou Clean & Sober came from that world, and it is to that world they will return if we are unsuccessful in helping them keep their dream of recovery alive. Most of our participants came to Alahou either as homeless or from the court system. For these 50 to 60 people, it's us or the street. Alahou Clean & Sober was formed for the specific purpose of providing up to 60 of these at -risk individuals with a clean, safe and affordable supported- living and recovery program in a peer - enforced drug- and alcohol -free environment. At Alahou, participants proactively care for and monitor each other as they continue to work on their individual recovery programs. The Alahou facility consists of 19 one- and two - bedroom furnished apartments in three separate but adjacent buildings. Apartments are segregated by gender, and bedrooms and living areas are shared. Common areas, including a large covered lanai and coin - operated laundry facility, are shared as well. Residents are responsible for maintaining all common areas, including landscaping, and for maintaining their individual apartments in a clean and habitable manner. Quarters are subject to entry and search without notice by the Executive Director. On -site AA/Substance Abuse support group meetings are conducted several times a week and each resident must attend a minimum of two. Life - skills discussion groups are also conducted several times each week to assist participants in development of effective coping and interpersonal skills. These life- skills meetings are facilitated by professionals from other agencies whose missions include support of our population. Community Meetings are held weekly during which topics of general interest are discussed and issues of concern are raised. The Alahou office is staffed during normal business hours by the Executive and Program Directors and during evening and weekend hours by resident volunteers who monitor the property, provide access to supplies, and respond to emergencies. At the time of occupancy, new residents are required to sign an agreement acknowledging a commitment to abide by Alahou house rules and restrictions, especially with regard to drug or alcohol possession or consumption. They further agree to immediate eviction if they are found to be in possession of drugs or alcohol on Alahou property, or fail to abide by Alahou's house rules regarding behavior. The Executive and Program Directors are the only employees of the corporation. All other administrative and operational functions are handled by volunteers from among program participants. It is this voluntary acceptance of personal responsibility for one's individual success, the success of one's peers, and the success of the Alahou program that marks a significant step along the path to each participant's ongoing recovery. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Alahou Clean & Sober Clean and Sober Housing Program Total Budget and Position Count Total Program Budget $280,000 Total Program Position Count 2 Total Agency Budget $280,000 Total Agency Position Count 2 Program Objectives: 1) Provide accommodations for up to 60 at -risk individuals in need of a clean, safe and affordable supported- living and recovery program conducted in a peer- enforced drug - and alcohol -free environment. Through close coordination with partnering agencies, ensure that occupancy is maintained at or above 85% on a monthly basis. 2) Provide on -site AA/Substance Abuse support group meetings a minimum of four times per week and ensure that each participant attends a minimum of two meetings per week. Transportation is also provided to two off -site AA meetings each week to assist participants in finding sponsors from outside the Alahou community. 3) Provide on -site Relapse Prevention training /discussion group once each week and ensure that each participant attends a minimum of one session per month. 4) Conduct one on -site Community Meeting per week for discussion of topics of general interest and issues of concern. Ensure that each meeting is attended by a minimum of 80% of participants. 5) Form and maintain a Residents' Council made up of volunteer participants which is responsible for overseeing property and apartment maintenance, monitoring property activities and providing access to supplies during non - business hours, and responding to emergencies. The Council is also responsible for monitoring individual participant behaviors, conducting UA and Breathalyzer testing as necessary, recommending consequences for infractions of house rules, and establishment of behavior contracts with incoming participants. The Council will consist of a minimum of four members who will contribute a minimum of 40 hours each per month in performance of Council responsibilities. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Alahou Clean & Sober Clean and Sober Housing Program Program Highlights since 2010 Start -Up: Background In 2006 Sandra McCoy became the Kona Residential Manager for Po'ailani, Inc., a Honolulu - based non - profit human services agency providing housing for individuals having a dual - diagnosis of chemical addiction coupled with mental illness. Until August of 2009, Po'ailani's Kona facility consisted of 19 apartments in a three - building complex located on Alahou Street in Kailua -Kona. The facility was leased from a local entrepreneur and is located on Alahou Street in Kona's "Hamburger Hill" neighborhood. Funded by a combination of rental income and state dollars, Po'ailani provided housing for up to 70 participants and employed 22 program staff. In August 2009, reductions in state funding forced Po'ailani to terminate the lease on two of the three buildings, retaining only seven apartments in the remaining building. In negotiations, the owner agreed to maintain a "clean- and - sober" requirement for tenants of the non - Po'ailani apartments, thereby helping to maintain a stable and less risky environment for program participants. In return for that agreement, Po'ailani agreed to act as Resident Manager for all three buildings at no cost to the owner. Po'ailani continued to operate with only nine program participants. The majority of the residents in the other buildings were previous Po'ailani consumers. These measures proved unsuccessful, however, and Po'ailani ultimately closed its Kona operation in mid -April 2010. All program assets were returned to Oahu for use by Po'ailani's Honolulu residential program. At the time of the program closure, many of the property tenants were long -term Po'ailani program participants and had been clean and sober for two -to -three years. When the closure was announced, a group of the tenants approached Ms. McCoy asking for assistance in starting up a new non - profit agency called Alahou Clean & Sober. Their intent was to continue to maintain the facility as drug and alcohol -free housing where they could continue to work on their individual recoveries. Given their personal experience, not maintaining the environment in that state would result in many of them returning to life on the street and an addictive lifestyle. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Alahou Clean & Sober Clean and Sober Housing Program Highlights 1) On June 16, 2010, Alahou Clean & Sober filed incorporation paperwork with the IRS and was assigned an Employer Identification Number (attached). 2) On July 14, 2010, the Board of Directors of Waikoloa Community Development Corporation agreed to serve as Fiscal Sponsor of Alahou Clean & Sober pending Alahou's receipt of its own 501(c)(3) certification by IRS. 3) On August 4, 2010, Alahou's Articles of Incorporation were certified by the Hawaii Department of Commerce and Consumer Affairs (also attached). 4) On August 16, 2010, Alahou Clean & Sober executed a lease agreement with the property owner and began paying rent and utilities as of September 1, 2010. 5) In September 2010, Alahou Clean & Sober began collecting rental income and established savings and checking accounts with First Hawaiian Bank. 6) In September 2010, Alahou transferred its electric utility account for the property into its own name and funded a $1,900 deposit. Water utility will be transferred in early 2011. 7) In October 2010, Hilton Worldwide donated an eight - passenger van to Alahou Clean & Sober. The van is used to transport participants to medical appointments, AA meetings, court appearances, and occasional group recreational activities. It is also used in shopping for supplies and other general program support. 8) In October 2010, a facility blessing was conducted by Kahu Danny Akaka. 9) On November 11, 2010, Alahou Clean & Sober filed its IRS Form 1023 applying for 501(c)(3) non - profit certification, fully expecting it to be granted by the end of First Quarter 2011. Upon issuance, the exempt status will be retroactive to the date of original incorporation. We are advised by legal counsel that issuance of the exemption is virtually guaranteed. 10) Alahou Clean & Sober has received letters of support (also attached) from numerous partner organizations, including Big Island Drug Court of the Third District, West Hawaii Community Health Center, Hope Services Hawaii, Care Hawaii, Mina Pharmacy, and University of Nations, and from several mental health professionals including Retired State Director of Hale Oluea Clubhouse Hilo, Director of Hale Oluea Clubhouse Kona, and State Mental Health practitioner Barbara Keitner. They all attest to the value of our program to the mental health community and to the Big Island itself. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Alahou Clean R gnhpr Dean and Sober Housing Program Performance Measures: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Average Occupancy per month 85% Weekly On -Site AA/Substance Abuse Meetings 4 Average AA/Substance Abuse Meetings attended per participant per week 2 Monthly On -Site Relapse Prevention Training /Discussion Groups 4 Average Relapse Prevention Sessions attended per participant per month 1 Weekly On -Site Community Meetings 1 Average percentage of participants attending Community Meetings per week 80% Average Number of Hours volunteered by each Residents Council Member per month 40 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Alahou Clean & Sober Clean and Sober Housing Program Program Expenditures applicable Program Expenditures Detail FY 2010 -2011 Budget reflects only ten calendar months of operating expense and only four months of staff salaries. Alahou began operation as of September 1, 2010, and hopes to begin paying salaries to its two staff members as of March 1, 2011. Rental revenues are sufficient to fund all operating expenses with the exception of staff salaries, annualized as follows: Expense FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages 50,000 $25,000 $75,000 Professional Fees 3,600 Vehicle Ins 2,600 Operations 2,400 $171,000 $205,000 Equipment 300 Office Supplies 600 Other' 2,500 Postage /Freight 300 Total 1{ 3,000 $196,000 $280,000 applicable Program Expenditures Detail FY 2010 -2011 Budget reflects only ten calendar months of operating expense and only four months of staff salaries. Alahou began operation as of September 1, 2010, and hopes to begin paying salaries to its two staff members as of March 1, 2011. Rental revenues are sufficient to fund all operating expenses with the exception of staff salaries, annualized as follows: Expense $$$ Rent 120,000 Utilities 50,000 Advertising 400 Vehicle 3,600 Vehicle Ins 2,600 Unit Furnishings 2,400 Insurance 3,600 Lab Supplies 300 Office Supplies 600 Outside Services 2,500 Postage /Freight 300 Repairs & Maint 3,000 Cleaning Supplies 7,500 Phone & Cable 4,000 Travel 500 M isc 3,000 TOTAL 204,300 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Alahou Clean & Sober Clean and Sober Housing Program Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Rental Income $187,500 $225,000 County of Hawaii Non - Profit Grant $0 $20,000 Big Island United Way $20,000 $40,000 Harry and Jeanette Weinberg Foundation $50,000 Total .- _- -- *Il • I- $207,500 $335,000 ii aNpuc;aule NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 Alahou Clean & Sober Clean and Sober Housing Program Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The income stream generated by Alahou's rental revenues appears to be sufficient to cover its facility rental, utilities, insurance and other operating expenses. It is not sufficient, however, to also fund the salaries of our Executive and Program Directors. And, while much of the day -to -day facility oversight is handled by resident volunteers, staff leadership and experience are necessary to ensure adequate community outreach, inter - agency cooperation, and program coordination and integrity. Over the next three years, it is Alahou's intent to build a diversified funding base comprised of a combination of rental revenues, government and private sector grants, and community support. But, given the nature of our program and our participant base, it is unlikely that Alahou Clean & Sober will ever become self- sustaining based only on fees - for - service. While it is difficult to calculate the cost to our community of 50+ previously homeless addictive individuals returning to the streets, we are able to calculate the cost of maintaining a safe and secure environment in which they can continue to pursue their New Beginnings. That is Alahou's budget. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 Alahou Clean & Sober Clean and Sober Housing Program I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Bo rd resident/Chair s" Signature oT7ExVcutive Director r Date I - . o 1 Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 10 ' 4� American Cancer Society Hawaii Pacific Patient Services for East & West Hawaii Cancer Patients American Cancer Society Hawaii Pacific - Agency Name Patient Services for East & West Hawaii Cancer Patients - Program Name Agency Director: Jackie Young, PhD Phone No.: 808- 595 -7500 (Oahu) Contact Person: Cathy Hashimoto Phone No.: 808 - 935 -0025 Mailing Address: Facility /Site Address: Fax No.: Email Address: 120 Pauahi Street, Suite 302 Hilo HI 96720 (same) 808 - 935 -9780 cathy.hashimoto@cancer.org Name of Accountant/CPA (include name of firm if applicable): Phone No.: Mailing Address: Amount of Request for County Funds: $15,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $ 0 $10,000 $10,000 Agency Mission Statement: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Established in Hawaii in 1959, the American Cancer Society Hawaii Pacific, Inc. (ACS), is part of the nationwide community -based voluntary health organization dedicated to eliminating cancer as a major health problem. Sharing in this mission, the East and West Hawaii ACS Hawaii Pacific offices work to save lives by helping people stay well by preventing cancer or detecting it early; helping people get well by being there for them during and after a cancer diagnosis; by finding cures through investment in groundbreaking discovery; and by fighting back by rallying communities worldwide to join the fight against cancer. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 American Cancer Society Hawaii Pacific - Agency Name Patient Services for East & West Hawaii Cancer Patients - Program Name Program Description: As the largest and most comprehensive cancer patient support organization, the American Cancer Society is determined to improve cancer patient quality -of -life by eliminating the gaps in services and information that are inherent in the current health care system. The American Cancer Society's two offices on the Big Island work tirelessly to enhance cancer patients quality -of -life through programs such as: transportation to complete their cancer treatment, informational support to patients and their families to better navigate their cancer journey, messaging about cancer prevention to all Big Island residents, and a venue for the the entire community to fight back against cancer. Total Budget and Position Count Total Pro ram Budget $65,600 Total Pro ram Position Count 0 Total Agency Budget $4,756,144 1 Total Agency Position Count 36 Program Objectives: 1) To support East and West Hawaii residents of the Big Island who are newly diagnosed with cancer, in the completion of their medical treatment; 2) To improve the quality of life for East and West Hawaii residents with a cancer diagnosis; 3) To provide Big Island patients with the most advanced medical information and help with navigating a diagnosis and managing their cancer experience. Program Highlights: (from Fiscal Year 2009 -10) 11 Transportation to Treatment: Cancer patients can't be cured if they aren't able to complete their cancer treatment protocol. Many cancer patients are too frail, too weak, too poor or too emotionally drained to travel on their own. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Transportation to their medical appointments is vital to their recovery and ACS provides financial assistance through taxicab reimbursements, Handi -van vouchers, gasoline debit cards for family members driving them, interisland airfare tickets, and partial transpacific airfare reimbursements when they must fly to the mainland for specialized treatment. In addition, ACS has created its own program, Road to Recovery, where specially trained volunteer drivers, many of whom are themselves cancer survivors, provide car rides to treatment in their own private cars, adding a special measure of empathy and compassion to the journeys. In FY2009/2010, 82 taxicab reimbursements, 140 $50 gasoline debit cards, 402 one -way interisland airline tickets and 3 partial reimbursements for transpacific airfare were distributed to Big Island residents. E Lodging Discount for Patients while on Oahu for Treatment: Big Island cancer patients are provided discounted lodging while staying on Oahu for their cancer surgery or treatment, which helps to alleviate a major financial concern patients face when they cannot receive treatment on their home island. In FY2009/2010, 27 Big Island cancer patients utilized 172 nights of discounted lodging in Oahu partnering hotels. ❑ Reach to Recovery: Visits are provided to newly diagnosed breast cancer patients, who receive kits containing a temporary bra and prosthesis. Reach to Recovery volunteers, each a breast cancer survivor themselves, are certified by ACS in the program. They help patients cope with body image issues, provide an information booklet, and explain options for prostheses and reconstruction. In FY2009/2010, 17 newly diagnosed Big Island breast cancer patients received this service. ❑ Look Good ... Feel Better and Wigs: Classes teach patients how to brighten complexions sallow from disease, create the illusion of eyebrows that have temporarily disappeared, care for nails affected by treatment, and more. For those patients feeling a loss of physical self- esteem, these small classes, shared with other patients, have a therapeutic value far beyond their cosmetic tips. Beautician volunteers are trained and certified to provide their expertise to this program. Wigs, hats, and /or scarves are also provided frre of charge to individuals coping with hair loss. 37 patients participated in Look Good ... Feel Better sessions in FY2009/2010 and 28 wigs were distributed to Big Island patients. ❑ Childhood Cancer programs for keiki with cancer and their families: Having a child with cancer can turn a family upside down. Adding to the heartbreak, there are time - consuming demands on parents, less time for the needs of siblings, and tremendous stress on the affected child. o Camp Anuenue is a weeklong summer camp for children with cancer, ages 7 to 17. This experience provides an opportunity to build friendships with other children who also are fighting cancer. It has helped many keiki find the hope and physical strength to survive. 7 Big Island children attended Camp Anuenue in FY2009/2010; NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 o Ho'oulu Me Ka Ikaika ( "Grow with Strength ") is a retreat for teens and young adults, ages 14 to 21. This retreat empowers young people to face the combined stresses of cancer and the teen years. 2 Big Island teenagers attended the Teen Retreat in FY2009/2010; o Families Can *Sur *Vive is a family conference for children with cancer, their parents and siblings that provides an opportunity for families to discover their individual and family strengths while encouraging trust and communication. 3 Big Island children with cancer, along with 6 parents and 6 siblings attended the Families Can *Sur *Vive Conference in FY2009/2010. E Personal Health Manager: The Personal Health Manager is an organizational portfolio for newly diagnosed patients that contains tailored information, relevant to the type of cancer, which will empower patients to make educated health decisions, and connect them to local resources and services. Additionally, the portfolio helps patients keep track of critical medical information provided by their healthcare team. In FY2009/2010, 92 Big Island cancer patients received their own Personal Health Manager portfolio. El Annual Survivor Celebration: Cancer survivors celebrate life and the victory over crisis. By design, these survivor celebrations are empowering to those who faced their health crisis head on and provide hope and inspiration to those still in treatment. During FY2009/2010, 630 cancer survivors participated in 7 Big Island annual survivor celebrations at Relay for Life events. Client Services: Cancer patients and their families contact the American Cancer Society field offices and Patient Services Center to receive up -to -date cancer information on diagnoses, treatments and prognoses. In FY2009/2010, a grand total of 583 unique Big Island cancer patients were provided at least one type of direct service from ACS, which include any or a multiple of the above. ❑ Trained Cancer Information Specialists: Hawai'i residents are connected to the American Cancer Society's new Patient Services Center based in Austin, Texas. The Patient Services Center keeps Hawai'i time -zone business hours, and provides specialized agents who are trained and familiar with HawaiTs resources and facilities, plus are experts with dealing with the issues of cancer and its emotional, financial, physical and quality -of -life issues. Staff work with patients and families to provide support, navigate healthcare systems, refer to resources and even help patients who need to complete lengthy and often confusing applications. This service is in addition to the American Cancer Society's local field offices. E The Society's National Cancer Information Center's 24 -hour a day 1 -800 telephone line, and www.cancer.org website for cancer information. In FY2009/2010, over 75,000 web visits by Hawai'i residents to the ACS website helped patients and families find out more information about cancer and the programs offered by the American Cancer Society. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 American Cancer Society Hawaii Pacific - Agency Name Patient Services for East & West Hawaii Cancer Patients - Program Name Performance Measures: I applicable Program Expenditures FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual* Budget* Estimate Total East & West Hawaii Cancer 583 626 626 Patients Served 0 0 0 "ACS Days" - Hospital /Community 140 150 160 Health Center Patients Re istered 0 0 0 Cancer Prevention /Early Detection 32,543 35,000 35,000 Information Provided in Face -to- $42,425 $61,560 $65,600 Face Messaging (some people may have received multiple messages Support Group Participants 49 50 50 Interisland Airline Transportation 402 400 425 ... Segments Provided Taxicab One-Way Reimbursements 82 90 100 Gasoline $50 Debit Cards Provided 140 140 165 Look Good ... Feel Better Class 37 40 40 Participants Wigs Provided 28 30 30 Personal Health Manager Kits 92 96 150 Road to Recover Volunteer Drivers 23 28 44 Childhood Cancer Camp 8 g 8 Participants *f I applicable Program Expenditures # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Bud et * Estimate Salaries and Wages 0 0 0 Professional Fees 0 0 0 Operations 0 0 0 Equipment 0 0 0 Other" $42,425 $61,560 $65,600 Total $42,425 $61,560 $65,600 * If or%nli^�Kle # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 American Cancer Society Hawaii Pacific - Agency Name Patient Services for East & West Hawaii Cancer Patients - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Eienonre evenue Source Won To ozaki Fund A. Vierra Fund County of Hawaii Hawaiian Airlines Charity Miles in -kind FY 2009 -10 Actual * $7,000 $11,000 $10,000 $3,450 FY 2010 -11 Bud et * $7,000 $9,000 $10,000 $3,600 FY 2011 -12 Estimate $7,000 $9,000 $15,000 $3,600 Total *VF . ..•..... L.1_ $31,430 $29,600 $34,600 �i aNNiwaulC Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Any shortfall in funding will be made up through the general operating funds from our community fundraising. Until major changes occur in health insurance coverage, physician and facility capacity, and cancer care protocols, we will continue to cobble together a safety net of volunteer programs, donated resources and grant funding to support cancer patients on the Big Island. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 American Cancer Society Hawaii Pacific - Agency Name Patient Services for East & West Hawaii Cancer Patients - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. _Failure to submit a timely, complete and accurate Year -end report will impact the evaluation of your program's or agency's future funding requests 4 Signat Board President/Ch it Sigrfat of Executive ector I ` 1, 7 Z ' t;' i Date 112- Dat UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 American Cancer Society Hawaii Pacific, Inc. Quality of Life Services for Cancer Patients on the Big Island FY2011/2012: July 1, 2011 to June 30, 2012 MASTER Projected Budget Additional Total Budget Direct Patient Services FYI County of Hawaii Request'' Funding Resources Ground Transportation to Treatment (gas cards) for treatment travel on the Big Island and, if medically necessary, on O'ahu $8,250 $3,OOOi $5,250 Taxicab Fare while on O'ahu for cancer surge or treatment - surgery - - -_ $2,500 I $1,500 I -_ $1,000 - Interisland Air Transportation to Treatment - $34,000 $5,000 $29,000 Partial Transpacific Airfare Reimbursement -- _ $1,500; I $0 $1,500 Reach to Recovery j - _ personal visits, support services and supplies for breast cancer patients, and volunteer training - - $500; $0 $500' Road to Recovery - development and volunteer training $500; $500, $0 Look Good ... Feel Better and Wigs classes, wigs, volunteer training - _ - - $5001 $5001, $0 Childhood Cancer Programs (Anuenue, Ikaika, Family) - i $11,OOOi $2,000 $9,000 Newly Enrolled Client Services -- -- including the most up to date information on cancer and local resources; a lending library; and monthly meetings for patients; and educational materials and displays. (Personal Health Managers) $2,0001 $1,150; $850 Ongoing Client Services including supplies for cancer patients, volunteer training, general services - - $500, $0 $500 Survivor Celebration and Fight Back at Relays (7 relays) $4,350 ,- $1,350, $3,000 TOTAL Budgeted for Programs: $65,600! $15,000' $50,600 Note: Based on an estimated 771 cancer patients on Big Island in FY2011, with 626 of them newly diagnosed. loJ American Red Cross - Hawai`i State Chapter Disaster Response & Preparedness for County of Hawaii Agency Name: American Red Cross Hawaii State Chapter Program Name: Disaster Response & Preparedness for County of Hawaii Agency Director: Coralie Chun Matayoshi, Chief Executive Officer Phone No.: 808 - 739 -8101 Contact Person: Youline K. Kalima, County Executive Director Phone No.: 808 - 935 -8305 Mailing Address: American Red Cross Hawaii County 55 Ululani St., Hilo Hawaii 96720 Facility /Site Address: Site One: Hilo 55 Ululani St., Hilo Hawaii 96720 Site Two: Kona 74 -5615 Luhia St., Kailua -Kona, HI. 96714 Fax No.: 808 - 969 -3673 Email address: kalimay @hawaiiredcross.org Name of CPA: CW Associates Phone No.: 808 - 531 -1040 Mailing Address: 700 Bishop Street, Suite 1040 Honolulu, HI 96813 Amount of request for County Funds: 25 000 Prior Year(s) Funding: 2008 -09 2009 -10 2010 -11 $5,000 $20,000 $15,000 Agency Mission Statement: The American Red Cross is a humanitarian organization led by volunteers and guided by its Congressional Charter and the Fundamental Principles of the International Red Cross Movement. Our mission is to prevent and alleviate human suffering by helping people prevent, prepare for, and respond to emergencies, and to provide disaster relief to the people of Hawaii 24 hours a day, 7 days a week, 365 days a year. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011— 2012 Page 1 Although established by Congressional Charter in 1905, the American Red Cross is NOT a government agency and must rely on the generosity of Hawaii's people to provide critical services to the community. All disaster training, services, and financial assistance to victims is free. Therefore, fundraising is critical to ensure that services can continue. History: The Hawaii State Chapter was founded in 1917 and has assisted victims of every major disaster in the islands' history, including the bombing of Pearl Harbor, Hilo tsunami, volcanic eruptions, Big Isle earthquake, Hurricanes Iwa and Iniki, New Years & Manoa floods, Kaloko Dam burst, Sacred Falls landslide, Xerox shooting, air transportation crashes, and hostage situations. The American Red Cross is the only organization mandated by Congress to respond to disasters and provide emergency communication to military families, and the only local nonprofit organization that meets the needs of disaster victims any time of the day, 365 days a year. Because we are an island community and considering the time it takes for assistance from other neighbor islands and the mainland, having the response capacity on island immediately after a disaster is essential. Program Description: The Hawaii County Red Cross Disaster Preparedness and Response Program includes disaster relief assistance to help victims of single family and major disasters overcome the physical and emotional distress of a disaster and meet their immediate emergency needs as they begin to rebuild their lives after a tragedy. This assistance includes food, clothing, shelter, mental health counseling, and financial assistance to help families recover more quickly from a disaster. Our volunteers are ready to respond to disasters 24 hours a day, 7 days a week, 365 days a year. We have 603 active disaster volunteers statewide and leverage the resources of our volunteers to provide this critical service. We also have over a thousand more volunteers statewide who are trained to help in a major disaster. Recruiting, training and mobilizing all of these volunteers is an ongoing job. Because a disaster can strike at any time without notice, advance preparation makes a significant difference in the well -being of a family or the resiliency of a business. As an island community and considering the time it takes for assistance from other neighbor islands and the mainland, having the response capacity on island immediately after a disaster is essential. All disaster training and response are provided free of charge. The Hawaii State Chapter continually trains volunteers to become disaster responders to serve during time of disasters (all disaster training is free). In the last fiscal year, the Red Cross conducted courses for volunteers in different communities statewide to achieve our objective of providing a seamless response when disaster strikes. We train volunteers to be able to conduct disaster assessment in neighborhoods, serve as shelter managers, conduct crisis counseling and emergency first aid and provide financial assistance to those whose homes have been affected by disaster. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 — 2012 Page 2 Our volunteers actively exercise with state agencies in preparation for natural disasters, pandemics and acts of terrorism. Through trained and capable disaster responders, communities will be better prepared prior to, during and after disasters. In light of lessons learned from the recent flooding, Hurricane Katrina and in the past from Hurricane Iniki, it is critical to have trained and capable volunteers ready and prepared to respond if a large disaster struck our islands. In a larger disaster or tragic event, crisis counseling, mass care, disaster welfare information, emergency first aid and other support services as appropriate are also provided to victims. These services are offered to anyone whose loved ones were directly affected by the event. Crisis counseling services may also be extended to the community for secondary victims. Another component of this program is community education, which empowers families and individuals to prepare for and respond to disasters before they strike. This will result in more aware and prepared communities. Red Cross volunteers and staff continually go out into the community to speak to the public about the importance of being prepared before a disaster strikes: get a disaster supplies kit, make a plan for your family and workers, and be informed. Because a disaster can strike at any time without notice, it is essential for communities to be prepared. Advance preparation can make a significant difference in the well -being of a family or the resiliency of a business. With the threat of avian flu, bio- terrorist attacks, and major natural disaster, the American Red Cross is more relevant and necessary than ever before. With global warming and changing weather patterns, it is not "if," but "when" a major disaster in Hawaii will occur. Hawaii is especially vulnerable to hurricanes, tsunami, earthquakes, and other natural disasters. When a disaster strikes, we will have to be able to survive longer on our own due to our isolation. It is critical for the Red Cross to be prepared for and respond to everyday disasters and major disasters. Big Island Disasters the Big Island has had more than its share of disasters over the years, including devastating tsunami, lava flows, flooding, heavy rains, high surf, earthquakes, brush fires, air crashes, explosions and hazardous material incidents. Whatever the incident, the Red Cross has always been there, ready to help those in need. Who We Serve The Hawaii Red Cross provides compassionate aid to people in Hawaii who fall victim to natural and man -made disasters that occur every 3 to 4 days in Hawaii. Disaster victims served by the Hawaii Red Cross are the poorest of the poor. All disaster training and response are provided free of charge, due to the generosity of our donors. According to a U.S. Census Bureau Report, 13.1 % of the Big Island population lives below the poverty level. This "poor and needy" population is particularly vulnerable to disasters and is dependent on Red Cross services when affected by a disaster. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011— 2012 Page 3 Based on family size and income levels, at least 43% of disaster families we served in FY10 on the Big Island were below the poverty level. In FY10, 36% of our Big Island client families made less than $25,000 a year. Of the disaster families, 43% owned their home and only 7% had structure insurance. Since over half of them do not own their homes and have no property insurance, they are truly destitute after a fire destroys everything they own or claims the life of a loved one. The Red Cross is truly a safety net for victims of "every day" disasters who have nowhere else to turn. The Red Cross not only offers food, clothing, and shelter to those who may have lost everything they own, but also volunteer caseworkers provide crisis counseling and emotional support to help these victims get back on their feet. Beyond the "every day" disasters, the Red Cross is preparing for and will respond to major disasters, which may affect the entire population of Hawaii, especially those with special needs like the elderly, frail, handicapped, and poor. When disasters occur, the American Red Cross will be there to support the County of Hawaii by providing families with relief assistance in time of need. The Hawaii State Chapter is requesting $25,000 from the County of Hawaii to help subsidize the financial aid we provide to Big Island disaster victims and emergency responders, train volunteer disaster responders so that local communities on the Big Island are prepared, and to share important preparedness information to people on what to do before a disaster strikes. This amount does not even begin to cover the staff and volunteer training, equipment, and support needed to respond to every day disasters, as well as educate and prepare Big Island residents for the next major disaster that is sure to come. Hawaii County Funding is critical to build resiliency and capacity for the communities of Hawaii County. Total Budget and Position Count Total Program $224,200 Total Program Position Count 1.5 Budget for FY 11 -12 Disaster Services Total Agency Budget $600,000 Total Agency Position Count 4 for FY 11 -12 1. Program Objectives: Overall Goal: To provide 24/7 emergency disaster response and relief to those in need on the Big Island after a disaster (man -made or natural), train volunteer responders and share critical preparedness information to the communities on the Big Island. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011— 2012 Page 4 Objectives: 1. Provide for the immediate emergency needs of Big Island disaster victims (food, clothing, shelter, crisis counseling). All disaster services are free. 2. Increase awareness of disaster preparedness to Big Island residents. Prepare families, businesses, and communities with essential preparedness material and information because a disaster can strike at any time without notice. 3. Train volunteer disaster responders to serve their local communities during times of disaster. We train volunteers to be able to conduct disaster assessment in neighborhoods, run shelters, conduct crisis counseling and emergency first aid, and provide financial assistance to those whose homes have been affected by disaster. Our volunteers actively exercise with federal, state, and county agencies to prepare for natural disasters, pandemics and acts of terrorism. All disaster volunteer training is free. 2. Program Highlights: In the past fiscal year (July 1, 2009 through June 30, 2010), the American Red Cross in Hawaii County provided the following services to Big Island individuals and families: • Responded to 15 disasters on the Big Island enabling 40 individuals to recover from their losses and begin rebuilding their lives. • Opened 1 shelter due to a brushfire, in the event individuals needed to evacuate or were unable to return to their residences. • Retained 157 active disaster volunteers and recruited 25 new volunteers in FY10. • Reached 476 persons with disaster preparedness information through community presentations. • Registered 355 in disaster training courses. Examples of responses are as follows: ■ Ocean View Brushfire: On June 10, 2010, an Ocean View resident left a barbeque unattended and it caused an 80 -acre fire that forced the evacuation of 30 homes affecting 50 residents and burned two unoccupied homes. The RC opened a shelter for evacuees but there was no population. Snacks were provided for the firefighters and volunteers. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 — 2012 Page 5 Pahala Area Fires: After a long period of time without any incidents in this area, three house fires occurred there during March, 2010. The area is remote with few resources and the Disaster Action Team volunteers did an excellent job lining up resources for the clients providing them lodging, food, clothing, bedding, Health Services and Mental Health assistance. Lodging was a particular problem with no hotels in the area and some incidents occurred during Merrie Monarch week when lodging throughout the Big Island is scarce. One incident resulted in a person sustaining burns and he was flown to Honolulu for treatment. His wife accompanied him to Honolulu and Red Cross gave her assistance for lodging, food, and clothing. Kurtistown Fire: Beginning on December 18, 2009, the Big Island experienced one of the worst electrical storms in a long time which caused a 5 -hour loss of power in Paradise Park due to lighting strikes. The Fire Marshall states that it appears lighting struck a home in Kurtistown on December 19. The owner was not home at the time and upon returning, she found her home had been reduced to a pile of ashes. She lost everything and Red Cross assisted her with food, clothing, bedding, and crisis counseling. ■ Hilo Fire: On August 23, 2009, an overnight guest awoke early in the morning to discover the house engulfed in flames. He yelled at the tenant to evacuate and she went out through the bedroom window. The fire caused major damage to the interior making the home not livable. The Red Cross provided emergency assistance for food, clothing, shelter, bedding, and clean up and comfort kits. In the first half of this fiscal year (FYI 1) to date, the Red Cross has already responded to house fires on the Big Island in Kailua -Kona, Kurtistown, Pahoa, and Hilo, along with responding to the ongoing Kalapana lava flow disaster. Our efforts have enabled 8 individuals to recover from their losses and begin rebuilding their lives. We provided 170 community individuals with free disaster response training. Performance Measures: Disaster Response and Preparedness in H awaii rminfv - Dnrfnrm-%ni+e RA- �-...._ NONPROFIT GRANT APPLICATION FISCAL YEAR 2011— 2012 Page 6 FY 2009 -10 Actual FY 2010 -11 Budget FY 2011 -12 Estimate Disaster Responses 15 14 15 Individuals Assisted After Disasters 40 30 50 Mass Shelters O ened /Indvls Sheltered 1/0 1/10 1/15 Numbers Reached through Disaster Presentations in Communities 476 1500 1500 Trained Individuals in Disaster Response 355 350 400 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011— 2012 Page 6 Program Expenditures (Disaster Response and Preparedness): • Monies are budgeted for the entire state for disaster relief assistance as it is unknown where disasters will occur. As disasters occur on the Big Island, expenses will increase accordingly. ** This refers to all administrative, technical and programmatic support provided to the Red Cross in Hawaii County from our Headquarters. Program Funding Source (Disaster Response & Preparedness)- Identify all funding sources (specific to this program only) Revenue Source for Disaster Services Program FY 2009 -2010 Actual FY2010 -2011 Budget FY2011 -2012 Estimate Salaries and Wages 48,747 50,598 52,000 Operations (occupancy, communication, postage) 59,921 58,586 60,000 Equipment 1,032 1,140 1,200 Materials (Supplies) 3,748 6,580 7,000 Travel 6,511 10,860 11,000 Disaster Relief Assistance * 17,253 18,000 18,000 Administrative /Tech Support ** 72,248 73,000 75,000 Total 209,460 218,764 224,200 • Monies are budgeted for the entire state for disaster relief assistance as it is unknown where disasters will occur. As disasters occur on the Big Island, expenses will increase accordingly. ** This refers to all administrative, technical and programmatic support provided to the Red Cross in Hawaii County from our Headquarters. Program Funding Source (Disaster Response & Preparedness)- Identify all funding sources (specific to this program only) Revenue Source for Disaster Services Program FY2009 -2010 Actual FY2010 -2011 Budget FY2011 -2012 Estimate Hawaii County 20,000 20,000 20,000 Hawaii Island United Way 16,500 12,000 10,000 Contributions Direct Mail &Grants * 44,120 33,700 30,000 Fundraising Hats Of 3,836 3,750 3,500 Rent 4,500 4,795 4,500 TOTAL REVENUE 88,956 74,245 68,000 TOTAL EXPENSES 209,460 218,764 224,200 Amount Hawaii Chapter must subsidize for both Hilo and Kona 120,504 144,519 156,200 offices to meet expenses for this p rogram (dis svcs NOTE: 1. HIUW. Total is amount pledged but actual received is dependent on success of their campaign. 2. Contributions and fundraising amounts subsidize both Disaster Services and our Health and Safety Services Program. 3. Grant funding not reflected above NONPROFIT GRANT APPLICATION FISCAL YEAR 2011- 2012 Page 7 Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? We continue to work on increasing Red Cross visibility in the community in order to increase private individual and corporate donations from Big Island residents and businesses. We are looking at possible fundraising opportunities on the Big Island such as special events, along with major donor cultivation. I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. fz � �/ Peter Ho, Chapter Chair Signature of Board President /Chair Coralie Chun Matayoshi, CEO Signature of Executive Director January 21, 2011 Date January 21, 2011 Date NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 — 2012 Page 8 7 Arts & Sciences Center HAAS Productions C 2- Arts & Science Center - Agency Name HAAS Productions - Program Name Agency Director: 2933 Contact Person: 230 -0618 Mailing Address: Facility /Site Address: Fax No.: Gail Clarke Gloria Baraquio P.O. Box 2091 Pahoa, HI 96778 15 -1397 Homestead Rd. Pahoa, HI 96778 808 - 965 -3733 Phone No.: 808 - 2-30-- 06 Ig Email Address: ascpuna @ gmail.com, oneyoga@gmail.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPAs & Management Phone No.: 808 - 242 -5002 Mailing Address: 1885 Main St. Ste. 408, Wailuku, HI 96793 Amount of Request for County Funds: $40,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $0 $20,000.00 $25,000.00 Agency Mission Statement: To provide support services and infrastructure for community -based learning. Phone No.: 808-938-:21.33 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Arts & Science Center - Agency Name HAAS Productions - Program Name Program Description: Launched in August of 2008, HAAS Productions is the digital media program that provides the youth of Puna with real -world opportunities in TV and Film Production. Students in HAAS Productions learn to write, produce, host, direct, and edit videos for personal expression and for public broadcast. The purpose of this program is for individuals to become effective communicators, critical thinkers, community contributors, quality producers, self- directed learners, and responsible users of technology (General Learner Outcomes). HAAS Productions contributes to the development of a local workforce of media artists, in Hawaii and from Hawaii. Directed by TV Producer Gloria Baraquio and instructed by Robert Kraft, Jeannine Baker, and Thea Shapiro on the campus of Hawaii Academy of Arts & Science, the program currently consists of seven students, grades 7 -12. The program is open to all interested youth of Puna. Students meet 1 -2x a week on the HAAS campus or at Keaau Youth Business Center (KYBC) for instruction, creating, planning, filming, and editing. In the past 3 years, HAAS Productions has established community partnerships with HAAS charter school, KYBC, PBS Hawaii, Big Island Film Office, Hawaii Schools Digital Media, Living Local TV, SHOOTZ Studios, Searider Productions, Papa Ola Lokahi, Arnott's Lodge, Na Leo O Hawaii, and Kauhale O Waianae. Students have earned recognition for their production work with local legislators and educators through filming a 70- minute Na Leo TV report and a 75- minute school documentary. While students have interned on local TV /Film sets and entered several video competitions, their most notable accomplishment has been the completion of their documentary on education reform, entitled "Class of 2010 ", which premiered for 400 viewers at the Hilo Palace Theater in August 2010. The film is currently being re- edited for public broadcast on PBS Hawaii and for submission to the Hawaii International Film Festival. This year's efforts are geared towards the production of content for PBS Hawaii's "Hiki No ", the nation's and state's very first student news network (premiering in February 2011). The program is an opportunity for student work, from all Hawaiian islands and schools, to be shared and broadcasted across the state in a weekly news show. Hiki No and programs like HAAS Productions will elevate the literacy of digital media, while bridging communities and generations across Hawaii. With the help of grants and volunteers, HAAS Productions was able to gradually build from zero teachers and equipment to 4 teachers, 6 cameras, 2 tripods, and 3 computers. We continue to solicit funds and options for instructors, a designated media lab, and more technology. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Total Budget and Position Count Total Program Budget $104,000.00 Total Program Position Count 5 Total Agency Budget $244,000.00 Total Agency Position Count 7 Program Objectives: 1) Between September 2010 and June 2011: Complete at least 70 minutes of student - produced video. 2) In March 2011: Air one student package (2 minutes) on Hiki No. 3) In March 2011: Secure waiver forms 4) By June 2011: Enter 4 student films into video competitions. 5) By June 2011: Complete 3 student packages for future Hiki No shows. 6) By June 2011: Sponsor 1 film workshop for the East Hawaii community. 7) By June 2011: Sponsor 1 student film showcase. 8) By August 2011: Secure a Pahoa site for a media lab (either on HAAS campus, Pahoa High, or elsewhere) 9) In August 2011: Register 10 -20 students into the program 10) Throughout the school year (Aug 2011 -Jun 2012): Conduct student meetings /lessons 2 -5x a week. 11) By December 2011: Complete 3 student packages for Hiki No. 12) By December 2011: Present "Class of 2010" documentary at Hawaii International Film Festival and broadcast it on PBS Hawaii 13) Spring 2012: Bring students to STN (Student Television Network) Convention on the mainland. 14) By June 2012: Complete 5 student packages for Hiki No. 15) By June 2012: Enter 4 student films into video competitions. 16) By June 2012: Sponsor 2 film workshops for the East Hawaii community. 17) By June 2012: Sell 400 DVDs of student - produced work. 18) By June 2012: Sponsor 1 student film showcase. Program Highlights: (from Fiscal Year 2009 -10) 1) "Class of 2010 ", a full length documentary on Hawaii education reform, premiered at the Hilo Palace Theater in August 2010, and is considered the greatest accomplishment of HAAS Productions. The film was the culmination of the students' work in school year 2009 -10, which entailed planning, shooting, and editing over 70 hours of footage (about 150 hours of work per person per year). Filming HAAS students, staff, and faculty, Kua O Ka La PCS, Nawahikalaniopu'u PCS, Pahoa High, Puna residents, and local officials /experts, such as Billy Kenoi, Manu Meyer, Emily Naeole, Alapaki Nahelea, Mary Correa, Maunalei Love, Dwight Takamine, and Kathryn Matayoshi, the crew of HAAS Productions not only practiced in- NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 depth film production, but became well- informed about education and social reform in Hawaii. Each of the students from 2009 -10 HAAS Productions felt fulfilled and ready waduate to the next phase of their education. Two 12 graders, an 11 grader, and a 9 th grader moved on to college, one moved to the mainland, while our 8 th grader moved to a different high school. The team of HAAS Productions 2010 -11, this year, consists of a brand new set of students. The full - length documenary is currently being prepared for broadcast on PBS Hawaii and entered into the Hawaii International Film Festival. 2) Over winter break of 2009, PBS Hawaii sponsored a trip for 20 HAAS students and 5 teachers to stay at Kilauea Military Camp for 2 nights, including meals, tours, and bowling. HAAS Productions students were to film their own experience at the volcano, while PBS Hawaii sent a cameraman to document the students enjoying themselves. The trip was an unforgettable and priceless experience for all, connecting with nature, laughing with peers, and capturing all of it on camera. PBS Hawaii created a video piece to air on their station. 3) Students were able to get involved with Census 2010 by creating 3 different 30- second PSAs about the Census. They sat with Census representatives, treated them as clients, learned the facts about the survey, and created videos based on what the representatives wanted to convey. Because of their efforts, Papa Ola Lokahi awarded the students $2000 and aired their PSAs on local television. 4) One student was able to intern as Production Assistant on a multi - million dollar set for the "Predators" film, where she worked with Hollywood actors and professional crew. Two students were able to fly over to Honolulu to intern on the "Living Local" set at KHON2 studio, where they assisted local celebrities and professional crewmembers. 5) HAAS Productions was awarded $20,000 by Hawaii County for their efforts. They also won a small award of $500 from Hawaii Schools Digital Media. 6) Program Director Gloria Baraquio was nominated to the PBS Hawaii Hiki No Steering Committee and to the Big Island Film Committee. She collaborated with Big Island Film Office, HCC, and UHH to plan the first ever East Hawaii Film Conference at UH Hilo, where she also lectured on "Perspectives in Film Education ". Gloria continues to play an active role on the PBS Hawaii Hiki No Steering Committee, where she helps to make decisions on student content, film deadlines, teacher requirements, funding issues, and show format. As of August 2010, Gloria resides on Oahu, where she works in the TV /Film industry as a Producer, Writer, and On- camera Talent for "Living Local" and other productions. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Arts & Science Center - Agency Name HAAS Productions - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Provide activities and opportunities for at -risk youth; mentoring and instruction 8 students, 200 hours 10 students, 150 hours 14 students, 200 hours Final products of student - produced video 100 minutes 70 minutes 100 minutes Videos publicly broadcasted 4 videos, 78 minutes total 3 videos, 6 minutes total 6 videos, 12 minutes total Videos entered into competitions 1 4 4 Film and interact with community members, leaders, and legislators; travel to location shoots 50 hours 20 hours 30 hours Obtain rants /donations $22,500 $26,000 $40,000 Recruit volunteers 4 volunteers, 180 hours total 2 volunteers, 100 hours total 5 volunteers, 100 hours total Training $52; Training $1500 Training $2000 Students intern on professional TV /Film sets 3 internships 2 internships 4 internships Students attend trainings, lectures, workshops, conferences, etc. 2 workshops 2 trainings 3 workshops *If applicable Program Expenditures NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget * Estimate Salaries and Wages 13,100 9000 20,000 Professional Fees 0 0 0 Operations 600 6600 8000 Equipment 4210 4900 5000 Other" Honorarium Travel $3650 Travel $6000 $300; Food /Activities/ Food /Activities/7M Training $52; Training $1500 Training $2000 Travel $2151; Honorarium $200 Honorarium $350 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Wardrobe $438; Props $150 Props $150 Food /Activities $1641 Total 22,442 26,000 41,500 (excluding in- (excluding in- (excluding in- kind) kind) kind If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Arts & Science Center - Agency Name HAAS Productions - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Hawaii County 20,000 25,000 40,000 HAAS - bus, room, assistants 25,000 in -kind 32,000 in -kind 24,000 HSDM 500 1000 1500 Papa Ola Lokahi 2,000 0 0 Volunteers (Industry Professionals) 30,000 in -kind 20,000 in -kind 20,000 in -kind PBS Hawaii 5000 in -kind 2000 in -kind 2000 in -kind Arnott's Lodge 2000 in -kind 0 0 KYBC - facility 3000 in -kind 2000 in -kind 1500 in -kind Student Film Shows 0 1000 1000 ASC -s onsored Workshop Fees 0 800 1000 Fundraisers 360 500 1000 DVD Sales 0 4000 4000 Pahoa Hi h /Kua O Ka La - facility 0 0 8000 Total 87,860 88,300 104,000 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Arts & Science Center continues to seek funding for HAAS Productions through grants, with the hope of being self- sustaining by June 2013. ASC will collaborate with Pahoa High and Kua O Ka La to possibly establish a digital media lab on either campus and combine their students with HAAS students to create videos in Puna. With more partnerships, the program will obtain more supporters and more exposure. HAAS Productions looks forward to having student film showcases where admission fees will be charged. They also plan to offer film workshops for students and the wider community, which will require a registration fee. Another income will be from DVD sales of "Class of 2010" and future compilations of student work. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Arts & Science Center - Agency Name HAAS Productions - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board President/Chairjc.0. S 1 2-o 1 Date ( ( F� /;z0 1 Signature of- Executive UiroGW- 'BoAt - rreas trer J Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 i Big Island Resource Conservation and Development Council, Inc. Big Island RC & DC Operations BIG ISLAND RESOURCE CONSERVATION & DEVELOPMENT COUNCIL, INC.- Agency Name BIG ISLAND RC &DC OPERATIONS - Program Name Agency Director: 6996 Contact Person: David Marquez David Marquez Phone No.: 933- 6996 Mailing Address: 101 Aupuni Street, Ste 229A Hilo, Hawaii 96720 -4261 Phone No.: '933- Facility /Site Address: Same as Mailing Fax No.: Email Address: Name of Accounl Phone No.: Mailing Address: 933 -6995 brcd @hawaii.rr.com ant/CPA (include name of firm if applicable): Alex J. Smith, CPA 808- 737 -7761 1403 Frank Streeet, Honolulu, HI Amount of Request for County Funds: $20,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $NA $15000.00 $10000.00 Agency Mission Statement: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 The mission of the Big Island RC &D Council is to assist the people of the island of Hawaii in achieving sustainable development while caring for and appreciating their natural environment; to insure broadened economic opportunities, enriched communities and better lives. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 BIG ISLAND RESOURCE CONSERVATION & DEVELOPMENT COUNCIL, INC. - Agency Name BIG ISLAND RC &DC OPERATIONS- Program Name Program Description: Big Island RC &DC is requesting funds to assist them in meeting operational expenses. Since its inception in 1975, the council has been aided by their relationship with the National Resources Conservation Service which provided technically and operational assistance. Unforeseen downsizing in NRCS has eliminated the position of the Program Assistant who managed the day to day operations of the council. This has required the hiring of a part time Program Manager by the council. A portion of the operational expenses have also been paid through HADP as indirect expenses. This program will no longer be funded by the federal government. The Big Island RC &D Council, authorized in 1975, covers the entire island of Hawaii. It is incorporated and non - profit within the state of Hawaii and is a tax - exempt, 501 (c)(3) by Internal Revenue Service Determination. The Big Island RC &D Council brought in $500,000 in grant revenues for community projects in 2010. Without interim operational support the council won't be able to continue to provide services to the community. Total Budget and Position Count Total Program Budget $55,000 Total Program Position Count 3 Total Agency Budget NA I Total Agency Position Count 3 Program Objectives: 1) The vision of the Big Island RC &D Council is to conserve, enhance, and promote the economic, cultural, and natural environment of Hawaii. Program Highlights: (from Fiscal Year 2009 -10) 1) HAWAII AGRICULTURAL DEVELOPMENT PROGRAM (HADP) This program supported: Bio -Char Soil Restoration Services, Hawaii Homegrown Food network, Dutch Hawaiian Cheesery, kau Community NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Supported Agricultural Pilot Project, Honoka'a Community Garden, Honeybee Education Project, Production and Marketing of Diverse Nursery Grown Crops. 2) TASTE OF THE HAWAIIAN RANGE A local products gala which showcases localy grown grass fed beef and manu other Big Island products through ans eudcational and gourmet culinary event. 3) SHADE GROWN COFFEE A scientific review of the profitability, yield, pest population density and palnt health associated with different levels of shade on 12 coffee fames in West Hawaii's Kona Coffee belt. 4) KAU COFFEE FESTIVAL An event to for individual growers to showcase their estate grown coffees. 5) HILO INTER- TRIBAL POWWOW A traditional Native American gathering which celebrates Native American culture and its historic connections with Hawaiian culture. 6) HAWAII ISLAND FESTIVAL 30 DAYS OF ALOHA A series of events in celebration of Hawaiian culture which includes the Paniolo Parade and Hoolaulea in Waimea, the Kindy Sproat Falsetto Contest, Ms Aloha Nui Contest, and the Poke Contest. 7) HILO VETERAN'S DAY PARADE 8) Meeting space provided for community groups including the Hilo Bat Watershed Advisory, the Malama Kaipalaoa Working Group, and the PARENTS foster care group. 9) COMMUNITY RESOURCE SITE the council has a computer, printer and "Foundation Center" grant research program available for community use for grant seeking. 10) BIG ISLAND PRO -AM YOUTH SURFING CONTEST A youth oriented surf event that reflects Ancient Hawaiian culture and promotes healthy competition in a drug and alcohol free atmosphere. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 BIG ISLAND RESOURCE CONSERVATION & DEVELOPMENT COUNCIL, INC. - Agency Name BIG ISLAND RC &DC OPERATIONS - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual* FY 2010 -11 Budget * FY 2011 -12 Estimate Hawaii Agricultural Development Program 8 Projects $150,000 7 Projects $115,000 NA Hawaii Island Festival 30 Days of Aloha 3500 Attendees $20,000 Revenue to Community 3500 Attendees $20,000 Revenue to Community 4000 Attendees $25,000 Revenue to Communi Hilo Inter - Tribal Powwow 20,000 Atendees $1,000,000 Revenue to Community 18,000 Attendees $750,000 Revenue to Community 22,000 Attendees $1,000,000 Revenue to Communi USDA RBEG Project Funding 0 2 Projects $86,000 $50,000 Other" 3000 3000 3000 Total 14,040 55,200 54,700 *If applicable Program Expenditures * If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 0 36,000 36,000 Professional Fees 5500 9700 9700 Operations 5290 5500 5500 Equipment 200 1000 500 Other" 3000 3000 3000 Total 14,040 55,200 54,700 * If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 u Please explain in detail on separate sheet Program Expenditures Other Training: Pacific Rim Conference $1500 Legislative Forum $1500 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 BIG ISLAND RESOURCE CONSERVATION & DEVELOPMENT COUNCIL, INC. -Agency Name BIG ISLAND RC &DC ADMINISTRATION - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Sponsor's Dues 2700 2700 2700 Administrative Fees - Projects 19,280 20,000 22,000 County of Hawaii 15,000 10,000 20,000 Other 500 1000 500 NRCS 0 25,000 0 Total 37,480 58,700 45,200 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Due to recent support cuts from NRCS the council is highly motivated to develop a capital campaign and endowment creation. The coucil is also seeking capacity building grants from agencies such as the Hawaii Community Foundation. More community outreach has begun to bring in more projects which will benefit the community and create revenue through adminstrative fees for the council. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 BIG ISLAND RESOURCE CONSERVATION & DEVELOPMENT COUNCIL, INC. - Agency Name BIG ISLAND RC &DC OPERATIONS - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate Year -end report will impact the evaluation of your program's or agency's future funding requests Signature `of B and Signature f Executive Director FOCI Date Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 N Big Island Substance Abuse Council East Hawaii Substance Abuse Program Big Island Substance Abuse Council East Hawaii Substance Abuse Program Agency Director: Dr. Stephen C. Zuniga Phone No.: 969 -9994 Contact Person: Mailing Address: Richard Teanio Phone No.: 935 -4927 135 Puuhonu Way Suite 201, Hilo, HI 96720 Facility /Site Address: 297 Waianuenue Ave, Hilo, HI 96720 Fax No.: Email Address: 969 -7570 LikekeT @bisac.com Name of Accountant/CPA (include name of firm if applicable): John Carbonaro, Carbonaro CPA's & Management Group Phone No.: 808 - 242 -5002 Mailing Address: 1885 Main Street Suite 408, Wailuku, HI 96793 Amount of Request for County Funds: $30,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $20,000 $20,000 $15,000 Agency Mission Statement: The Big Island Substance Abuse Council strives to enhance the quality of care and innovative services in the areas of Substance Abuse Education, Intervention and Treatment. We are dedicated to the healing of mind, body and spirit of individuals, families and others who suffer as a result of alcohol and other substance use, abuse and addiction. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Big Island Substance Abuse Council East Hawaii Substance Abuse Program Program Description: The Big Island Substance Abuse Council's East Hawaii programs provide comprehensive substance abuse treatment services to adults and adolescents through research -based methods and best - practices designed for the area's target population. This population includes adolescents, adults, parents and whole families who are experiencing substance abuse or dependency and require the structure of an institution such as BISAC to begin the process of recovery or intervene with chronic relapse. BISAC recognizes the significant impact of crystal methamphetamine to the addicted individual and our communities, and has designed programs to intervene in the addictive process and build on an individual's or family's strengths to abstain from the use of drugs and alcohol and increase protective factors and relapse prevention skills to maintain their rehabilitation. The East Hawaii BISAC programs provide outpatient treatment and therapeutic living services to adults and offers separate adolescent outpatient services and school based services in twenty -three (23) schools. BISAC gives priority to pregnant women, HIV users, and those with co- occurring disorders. Several of the East Hawaii therapeutic living programs are designed to meet specific needs of the target population and include home -like settings for a variety of specialties including; mothers with children ages birth -6 years, single women, and single men. BISAC has also placed a strong emphasis on providing services to persons abusing or addicted to the drug Crystal Methamphetamine or, "Ice ". The ice epidemic in East Hawaii is truly evident and requires immediate access to treatment services when the opportunity arises. BISAC is requesting funds to subsidize Outpatient and Therapeutic Living Program Treatment services to Adolescents and Adults which will improve the overall quality and accessibility of services for any client who presents themselves at BISAC and requires immediate and intensive care necessary to recover from addiction. Total Budget and Position Count Total Program Budget 1,570,048 Total Program Position Count 29 Total Agency Bud et 4,558,645 Total Agency Position Count 72 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Big Island Substance Abuse Council East Hawaii Substance Abuse Program Program Objectives: 1) Provide immediate access to assessment and treatment services to any individuals who are assessed and diagnosed with any substance related disorders. 2) Increase the availability of extended outpatient and therapeutic living program treatment services to addicted adults and adolescents who may have no other funding availability for treatment services. 3) Decrease the number of days between when an individual requests treatment intervention services and the date that those services are delivered, by funding treatment -on- demand services while alternative reimbursement is identified. 4) Achieve understanding of disease concept of addiction and co- occurring disorders. 5) Reducing recidivism by 30% by not incurring additional arrests 6 months post- treatment. 6) Identify clean and sober social support networks and actively participate to identify and link with support systems in preparation for discharge. 7) Identification of individualized protective factors that will significantly reduce risk factors, and has identified and implemented a minimum of six within the first 90 days of treatment. 8) Complete 80% of identified treatment goals and has developed a transition plan to prepare for discharge. Program Highlights: (from Fiscal Year 2009 -10) • BISAC was able to admit approximately 843 adults into all levels of outpatient substance abuse treatment and Therapeutic Living services in East Hawaii, and 338 adolescents island -wide. Data collected from our 2009 - 2010 Annual Management Report disclosed the following: • 45% Completed Treatment. • 57% were employed, in school, vocational training or volunteering. • 91 % had no new arrests post treatment. • 78% had no new treatment episodes. • 50% were involved in self -help groups post treatment. • 81 % have stable living arrangements post treatment. • 79% did not miss work or school due to drugs /alcohol. • 93% had no Emergency Room admissions post treatment. • 95% had no hospital admissions post treatment. • 85% had no significant psychological distress within 30 days post treatment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Big Island Substance Abuse Council East Hawaii Substance Abuse Program Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Substance Abuse Treatment Units 27,882 30,000 32,000 Professional Fees 22,947 25,242 27,766 Operations 211,452 232,597 255,857 Equipment 26,077 28,658 31,554 Other 45,000 49,500 54,450 Total 1,570,047 1,727,052 1,899,758 Private Insurance 325,980 358,578 394,436 *If applicable Program Expenditures " If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 1,309,571 1,440,528 1,584,581 Professional Fees 22,947 25,242 27,766 Operations 211,452 232,597 255,857 Equipment 26,077 28,658 31,554 Other 45,000 49,500 54,450 Total 1,570,047 1,727,052 1,899,758 " If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate County 20,000 30,000 30,000 State of Hawaii 568,436 625,279 687,807 Federal 448,861 493,747 543,121 HIUW 26,334 28,966 31,863 Private Foundation 45,000 49,500 54,450 Donations/Fundraising 0 0 0 Private Insurance 325,980 358,578 394,436 Client Fees 51,616 56,778 62,456 Training/Other 31,723 34,895 38,385 Total 1,517,950 1,677,743 1,842,518 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Big Island Substance Abuse Council East Hawaii Substance Abuse Program Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Big Island Substance Abuse Council continues efforts to diversify funding sources and expand services where appropriate throughout the State and Island of Hawaii. BISAC has contracted with three new managed care agencies and two new grant providers to diversify our funding stream. A conservative fiscal philosophy coupled with a team of skilled and dedicated staff members has enabled BISAC to expand and retain a positive, prominent presence in the community. BISAC's sound fiscal policies are incorporated into decisions related to program expansion or to enter market niches that would expand the behavioral health continuum. Business decisions include enrolling consumers in a Quest plan when eligible and appropriately utilizing benefits to cover treatment services. Administrative staff is scheduled to participate in meetings with HMSA and other substance abuse treatment providers to evaluate ways on increasing community awareness of insurance benefits and working with physicians to appropriately identify and refer consumers who may need treatment services that would be covered by HMSA insurance. The BISAC Board understands the commitment and priority of this project. The CEO is working to obtain commitments for this project and the Board has anticipated the project costs in the approved budget. The $30,000 requested for East Hawaii under this proposal will go towards the supporting this proposal's requests. BISAC plans include exploring available funding that supports capacity building and sustainability efforts, and reduces our reliance on State and County funds. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Big Island Substance Abuse Council East Hawaii Substance Abuse Program I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Sign ture of Board resident/Chair Patricia Engelhard Signature of Executiv irector Dr. Stephen C. Zuniga Date Z� �deK Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Rol Big Island Substance Abuse Council Kokua EAP (Employee Assistance Program) Big Island Substance Abuse Council Kokua EAP (Employee Assistance Program) Agency Director: Dr. Stephen C. Zuniga Phone No.: 969 -9994 Contact Person: Mailing Address: Dr. Stephen C. Zuniga Phone No.: 969 -9994 135 Puuhonu Way Suite 201 Hilo, HI 96720 Facility /Site Address: 297 Waianuenue Ave, Hilo, Hawaii 96720; 135 Puuhonu Way Ste 201, Hilo, Hawaii 96720 64 -1040 Mamalahoa Hwy Ste 101, Kamuela, HI 96743 Fax No.: Email Address: 969 -7570 drz @bisac.com Name of Accountant/CPA (include name of firm if applicable): John Carbonaro, Carbonaro CPA's & Management Group Phone No.: 808 - 242 -5002 Mailing Address: 1885 Main Street Suite 408, Wailuku, HI 96793 Amount of Request for County Funds: $18,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $00.00 $18,000 $10,000 Agency Mission Statement: The Big Island Substance Abuse Council strives to enhance the quality of care and innovative services in the areas of Substance Abuse Education, Intervention and Treatment. We are dedicated to the healing of mind, body and spirit of individuals, families and others who suffer as a result of alcohol and other substance use, abuse and addiction. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Big Island Substance Abuse Council Kokua EAP (Employee Assistance Program) Program Description: Big Island Substance Abuse Council ( BISAC) d.b.a. Kokua EAP (Employee Assistance Program) provides effective, confidential counseling services to individuals, couples and families in finding life affirming solutions to a variety of problems. Most traditional Employee Assistance Programs offer services to employees; however, Kokua EAP also offers assessment and counseling services to any individuals regardless of race, color, religion, sex or gender, age, national origin, ancestry, marital status, arrest and court record (except as provided by Haw. Rev. Stat. 378 -2.5), disability, sexual orientation, military/veterans status, lactation or other grounds protected under applicable state and federal laws, regulations, and /or executive orders. Our agency -wide behavioral health services have historically provided services to the indigent who do not have the financial means to pay for various consumer related fees or direct service costs. Kokua EAP is not limited to providing services to employees of business, but also offers a leadership training program as well as assessment and counseling services to anyone with mental health needs. Our certified counselors, advanced degree therapists or licensed professionals (whether contracted or employed) offer confidential, short and long -term care, in a safe, professional environment. Individuals seeking counseling services often struggle as they may not have the financial means to cover their share of the costs or may have exhausted eligible benefits. Others clients simply do not have the means to pay for needed services and as a result of this their situations and circumstances deteriorate further and drain limited community resources which can be avoided if the means existed to cover costs related to ongoing counseling care to maintain protective factors which increase the likelihood of a positive outcome to individuals and families. BISAC proposes to utilize awarded County Funds to cover payment for ongoing assessment and counseling services to individuals, couples and families at subsidized or no -cost rates who have no health insurance, restrictive health insurance plans, and /or limited financial resources. Services typically address emotional difficulties, marital and family problems, stress, substance abuse and other issues as well as anger management groups which may be required. The good news is that these problems have solutions when identified early and treated. The services are consistent with our mission and organizational goals and objectives to: 1)To provide a range of coordinated, comprehensive treatment services that addresses the multiple health and human service needs of adult and adolescent substance abusers in our community. 2) To decrease the incidence, severity and debilitating consequences of alcohol and drug abuse among Hawaii Island residents through education, psycho- education and individualized treatment modalities. and 3) To effect significant change in the NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Big Island Substance Abuse Council Kokua EAP (Employee Assistance Program) consumers with substance abuse disorders, resulting in an improved quality of life for both the individual and family, to include successful integration into the community. Additionally, any available operational funds will be used to cover or reduce any operational expenses required to provide services. Such operational expenses typically include salaries, rent, brochure costs, supplies, IT hardware and software support, communication equipment and monthly service costs, audit fees, as well as ongoing staff training and operational costs associated with maintaining organization wide CARF accreditation. Total Budget and Position Count Total Program Budget $20,000 Total Program Position Count 1 Total Agency Bud et 4,558,645 1 Total Agency Position Count 72 Program Objectives: 1) Provide immediate access to assessment and counseling services to any individuals who are assessed as meeting a mental health diagnosis according to the DSM -IV and voluntarily agree to participate in counseling. 2) Increase the availability of outpatient services to individuals who may have limited funding, or no funding availability to cover client fees or counseling services costs. 3) Decrease the number of days between when an individual requests counseling services and the date that those services commence, by funding treatment -on- demand services. 4) Respond to the growing demands for mental health services to East Hawaii residents which have seen services reduced or cut at the State level by the Governor due budget short falls. 5) Reducing the strain on hospital admissions to the emergency room by 30% for a related mental health disorder as a result of engaging the individual in ongoing counseling. 6) Identify appropriate support networks and actively participate to assist the individual with linkage to appropriate support systems. 7) Increase education and training opportunities to interested East Hawaii community professionals or clients on a variety of profesional and consumer related topics offered to the public at a minimal cost. 8) Provide rarely offered or available culturally based, best practices counseling services, as needed or upon request, to a culturally diverse population who prefer alternative healthcare interventions. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Big Island Substance Abuse Council Kokua EAP (Employee Assistance Program) Program Highlights: 1) • Self referral demands for family counseling services decreased over self referrals for individual counseling. 2) • Participated in employee sponsored and community sponsored wellness and health fairs. 3) • Increased demand for culturally based interventions (Ho'opono pono) by employer supervisors and clients of EAP plan. 4) • Self referrals versus employer related referrals equaled the same. 5) • Approximately 60% of the referrals seeking counseling services are women. 6) * Services were expanded to include a Anger Management classes for eligible clients. 7) • Request from another hotel for culturally based interventions (ho'opono pono). Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Treatment Units 179 179 179 Professional Fees 357 Operations $7,667 $5,000 $5,000 Equipment 371 1,000 $1,000 Other Total $23,393 $20,000 $22,000 *If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages $14,998 $14,000 $16,000 Professional Fees 357 Operations $7,667 $5,000 $5,000 Equipment 371 1,000 $1,000 Other Total $23,393 $20,000 $22,000 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Big Island Substance Abuse Council Kokua EAP (Employee Assistance Program) Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Hotel Contract $5,393 $6,000 $4,000 County Grant $18,000 $10,000 $18,000 Total $23,393 $20,000 $22,000 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Big Island Substance Abuse Council d.b.a. Kokua EAP continues its efforts to diversify funding sources and expand services where appropriate throughout the State and Island of Hawaii. Kokua EAP continues its efforts to reach out to employers to educate them regarding the need for contracting such services; especially when times are difficult and stress factors increase for individuals and families which directly impacts an individual's work performance. Kokua EAP is increasing awareness of its training program topics offered to professionals and any interested consumers on a monthly basis on various behavioral health topics. Where feasible, BISAC is pursuing third party reimbursement for mental health services provided by professional or certified staff. A conservative fiscal philosophy coupled with a team of skilled and dedicated staff members has enabled BISAC to expand and retain a positive, prominent presence in the community for the past 47 years. BISAC's sound fiscal policies are incorporated into decisions related to program expansion or to enter market niches that would expand the behavioral health continuum. The $18,000 requested for East Hawaii under this proposal will go towards supporting this proposal's requests; $10,000 to the client assistance fund to subsidize low cost or no -cost counseling services to individuals, couples and families who have no health insurance, restrictive health insurance; and or limited financial resources to cover any and all counseling services. The other $8,000 will be used to cover program operational costs. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Big Island Substance Abuse Council Kokua EAP (Employee Assistance Program) I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Boar President/Chair Patricia Engelhard Signatu a of Execut've D' ector Dr. Stephen C. Zuniga /_ 2 XA V // Date /_Z_ 1 Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 11 Big Island Substance Abuse Council West Hawaii Substance Abuse Program Big Island Substance Abuse Council West Hawaii Substance Abuse Program r%rN*%Py Agency Director: Dr. Stephen C. Zuniga Phone No.: Y99 999 Contact Person: Dana Williams Phone No.: 322 -3100 Mailing Address: 135 Puuhonu Way Suite 201 Hilo, HI 96720 Facility /Site Address: 81 -947 Halekii Street, Kealakekua, HI 96750 Fax No.: 969 -7570 Email Address: Dana.Williams @bisac.com Name of Accountant/CPA (include name of firm if applicable): John Carbonaro, Carbonaro CPA's & Management Group Phone No.: 808 - 242 -5002 Mailing Address: 1885 Main Street Suite 408, Wailuku, HI 96793 Amount of Request for County Funds: $30,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $20,000 $20,000 $10,000 Agency Mission Statement: The Big Island Substance Abuse Council strives to enhance the quality of care and innovative services in the areas of Substance Abuse Education, Intervention and Treatment. We are dedicated to the healing of mind, body and spirit of individuals, families and others who suffer as a result of alcohol and other substance use, abuse and addiction. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Big Island Substance Abuse Council West Hawaii Substance Abuse Program Program Description: The Big Island Substance Abuse Council's West Hawaii programs provide comprehensive substance abuse treatment services to adults and adolescents through research -based methods and best - practices designed for the area's target population. This population includes adolescents, adults, parents and whole families who are experiencing substance abuse or dependency and require the structure of an institution such as BISAC to begin the process of recovery or intervene with chronic relapse. BISAC recognizes the significant impact of crystal methamphetamine to the addicted individual and our communities, and has designed programs to intervene in the addictive process and build on an individual's or family's strengths to abstain from the use of drugs and alcohol and increase protective factors and relapse prevention skills to maintain their rehabilitation. The West Hawaii BISAC programs provide outpatient treatment and therapeutic living services to adults and offers separate adolescent outpatient services and school based services in twenty -three (23) schools. BISAC gives priority to pregnant women, HIV users, and those with co- occurring disorders. BISAC committed funds in 2007 to open a therapeutic living program for males in Kona. BISAC has also placed a strong emphasis on providing services to persons abusing or addicted to the drug Crystal Methamphetamine or, "Ice ". The ice epidemic in West Hawaii is truly evident and requires immediate access to treatment services when the opportunity arises. Currently, the East Hawaii therapeutic living programs are designed to meet specific needs of the target population and include home -like settings for a variety of specialties including; mothers with children ages birth -6 years, single women, and single men. Establishing a therapeutic living program in West Hawaii allows clients to transition to communities where they have chosen to live and work. BISAC has also placed a strong emphasis on providing services to persons abusing or addicted to the drug Crystal Methamphetamine or "Ice ". The ice epidemic in West Hawaii is truly evident and requires immediate access to treatment services when the opportunity arises. BISAC is requesting funds to subsidize Outpatient Treatment and Therapeutic Living Program services to Adolescents and Adults which will improve the overall quality and accessibility of services for any client who presents themselves at BISAC and requires immediate and intensive care necessary to recover from addiction. Total Budget and Position Count Total Program Budget 1 709,333 Total Program Position Count 15 Total Agency Bud et 4,558,645 Total A enc Position Count 72 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Big Island Substance Abuse Council West Hawaii Substance Abuse Program Program Objectives: 1) Provide immediate access to assessment and treatment services to any individuals who are assessed and diagnosed with any substance related disorders. 2) Increase the availability of extended outpatient and therapeutic living program treatment services to addicted adults and adolescents who may have no other funding availability for treatment services. 3) Decrease the number of days between when an individual requests treatment intervention services and the date that those services are delivered, by funding treatment -on- demand services while alternative reimbursement is identified. 4) Achieve understanding of disease concept of addiction and co- occurring disorders. 5) Reducing recidivism by 30% by not incurring additional arrests 6 months post- treatment. 6) Identify clean and sober social support networks and actively participate to identify and link with support systems in preparation for discharge. 7) Identification of individualized protective factors that will significantly reduce risk factors, and has identified and implemented a minimum of six within the first 90 days of treatment. 8) Complete 80% of identified treatment goals and has developed a transition plan to prepare for discharge. Program Highlights: (from Fiscal Year 2009 -10) • BISAC was able to admit approximately 669 adults into all levels of outpatient substance abuse treatment and Therapeutic Living services in West Hawaii, and 338 adolescents island -wide. Data collected from our 2009 - 2010 Annual Management Report disclosed the following: • 45% Completed Treatment. • 57% were employed, in school, vocational training or volunteering. • 91 % had no new arrests post treatment. • 78% had no new treatment episodes. • 50% were involved in self -help groups post treatment. • 81 % have stable living arrangements post treatment. • 79% did not miss work or school due to drugs /alcohol. • 93% had no Emergency Room admissions post treatment. • 95% had no hospital admissions post treatment. • 85% had no significant psychological distress within 30 days post treatment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Big Island Substance Abuse Council West Hawaii Substance Abuse Program Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Substance Abuse Treatment Units 23,559 25,914 28,506 Professional Fees 11,484 12,634 13,897 Operations 232,678 255,976 281,540 Equipment 4,556 5,012 5,512 Other Total 754,145 829,462 912,517 Private Insurance 168,782 185,660 204,226 *If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 505,427 533,970 611,568 Professional Fees 11,484 12,634 13,897 Operations 232,678 255,976 281,540 Equipment 4,556 5,012 5,512 Other Total 754,145 829,462 912,517 * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate County 20,000 10,000 30,000 State of Hawaii 353,097 388,407 427,247 Federal 126,471 139,118 153,030 HIUW Private Foundation Donations/Fundraisin Private Insurance 168,782 185,660 204,226 Client Fees 24,324 26,756 29,432 Training/Other 16,659 18,324 20,157 Total 709,333 768,265 864,092 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Big Island Substance Abuse Council West Hawaii Substance Abuse Program Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Big Island Substance Abuse Council continues efforts to diversify funding sources and expand services where appropriate throughout the State and Island of Hawaii. BISAC has contracted with three new managed care agencies and two new grant providers to diversify our funding stream. A conservative fiscal philosophy coupled with a team of skilled and dedicated staff members has enabled BISAC to expand and retain a positive, prominent presence in the community. BISAC's sound fiscal policies are incorporated into decisions related to program expansion or to enter market niches that would expand the behavioral health continuum. Business decisions include enrolling consumers in a Quest plan when eligible and appropriately utilizing benefits to cover treatment services. Administrative staff is scheduled to participate in meetings with HMSA and other substance abuse treatment providers to evaluate ways on increasing community awareness of insurance benefits and working with physicians to appropriately identify and refer consumers who may need treatment services that would be covered by HMSA insurance. The BISAC Board understands the commitment and priority of this project. The CEO is working to obtain commitments for this project and the Board has anticipated the project costs in the approved budget. The $30,000 requested for West Hawaii under this proposal will go towards the supporting this proposal's requests. BISAC plans include exploring available funding that supports capacity building and sustainability efforts, and reduces our reliance on State and County funds. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Big Island Substance Abuse Council West Hawaii Substance Abuse Program I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board resident/Chair Patricia Engelhard A r.-ry Signature of xecutiv ector Dr. Stephen C. Zuniga 12 / Date Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 12 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club` Agency Director: Zavi Brees- Saunders Phone No.: 961 -5536 (start date: February 1, 2011) Contact Person: Zavi Brees- Saunders Phone No.: 961 -5536 Mailing Address: 100 Kamakahonu Street, Hilo, Hawaii 96720 Facility /Site Address: 43 -1477 Hauola Road, Pa'auilo, Hawaii 96776 Fax No.: 961 -5534 Email Address: zavi @becbi.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: Mailing Address: (808) 968 -1002 P. O. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds: $30,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $40,000 $20,000 $15,000 Agency Mission Statement: To inspire and enable Big Island youth from all backgrounds, especially those from disadvantaged circumstances, to become productive and responsible citizens by offering quality programs in a safe and caring environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 1 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club Program Description: GREAT FUTURES START HERE. When opportunities are available in a community for positive participation, children are less likely to engage in substance use and other problem behaviors. The Boys and Girls Club of the Big Island ( BGCBI) — Hamakua Club, provides those opportunities on a daily basis to the young people of the Hamakua community. Through fun and engaging activities, BGCBI provides a positive atmosphere for youth ages 6 to 18 to explore their interests so that they can reach their full potential and contribute to their communities as productive, responsible citizens. The Hamakua Club offers programs and services during non- school hours aimed at instilling a positive sense of self, increase self- esteem, self- confidence, and teach the skills necessary to make good, sound decisions. The organization was founded as the Boys Club of Hilo in 1952 and has since served over 50,000 youth of East Hawaii. In 2002, they became BGCBI and during the last 7 years, the Board of Directors and Club leadership have demonstrated their commitment by extending their service reach to the youth in Pahoa, Kea'au, Ocean View /Naalehu, Pahala and along the Hamakua coast. BGCBI success is evident on the faces of the youth who attend the Clubs along with the outcome measurement results reported to the following federal, state and private funding agencies: the Office of Juvenile Justice and Prevention, the Boys and Girls Clubs of America, the Hawaii State Department of Human Services /Office of Youth Services, the Hawaii State Department of Health /Alcohol and Drug Abuse Division, Office of Juvenile Prevention Rural Youth Program, Tobacco Trust Settlement administered by the Hawaii Community Foundation, and the Hawaii Island United Way. Reports are available upon request. The Need Honokaa Community: The Honokaa Community, 2003 Hawaii Student Alcohol, Tobacco, and Other nnig Ilse Study administered by the State of Hawaii Department of Health, Alcohol and Drug Abuse Division provides the following family domain data from students in the 12 grade ( http: / /hawaii.gov /health /substance- abuse /prevention- treatment /survey /adsurv. htm • 45 % reported poor family supervision • 32 % reported lack of parental sanctions for Anti - Social Behaviors (ASB's) • 51 % reported parental attitudes favorable toward ATOD use • 39 % reported exposure to family ATOD use • 61 % reported a family (sibling) history of ASB The Honokaa High and Intermediate School Status and Improvement Report for School Year 2009 -2010 ( http: / /doe.k12. hi. us ) provides the following information: • Average Daily Attendance of 89.2 % as compared to the state standard of 95% • Average Daily Absences of 17.8 days as compared to the state standard of 9 days NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 2 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club • 18% of the student body was suspended; 138 students were responsible for 201 suspensions; 14% were for burglary, robbery, or sale of dangerous drugs; 48% were for disorderly conduct and trespassing; 37% were for class cutting, insubordination and smoking. The dropout rate was 8.2% • The School Quality Survey indicated that 43.1% of the student population was involved in their school; 42.2 % showed satisfaction; and 40.3% felt safe while at school. • National Terrallova Assessment indicated 53% of 7 th graders were proficient in Reading; 49% of 7 th graders were proficient in Math. The Hawaii Student ATOD study indicates that 52% of high school students in the Honokaa community experience community disorganization, 50% view laws and norms favorable to drug use, 46% engaged in early initiation of problem behaviors, 28% showed a low perceived risk of ATOD use, 41% interacted with antisocial peers, and 38% felt that their friends reward them for antisocial involvement. A conclusion of the same study indicated that 24% of high school students who participated had a high probability of developing a substance abuse problem or engaging in other problem behaviors. Only 24% of the students who participated in the study had a high number of protective factors indicating that they were less likely to use substances or engage in antisocial behaviors. The Office of Juvenile Prevention SMART System assigns a Community Disadvantage Index of 7 (scale 1 tow to 10 high) to the Honokaa community. All of this powerful data points to the overwhelming need our Hamakua youth and families have for establishing relationships with adults and professionals who care enough to assist them in developing positive personal qualities and support them in their homes, schools, and communities. BGCBI Hamakua Club addresses these needs on a daily basis when they open their doors and encourage all youth who enter to Service Delivery The Hamakua Club was established in May 2008. The Pa'auilo Hongwanji Church Community offered BGCBI their church hall to serve as a permanent Clubhouse. The youth of this community were served by our Mobile Rural Outreach Program prior to the establishment of the Hamakua Club (February 2007). Located adjacent to the Pa'auilo Elementary & Intermediate School enables our members to safely walk to the club without crossing any major streets or roads. The Hongwanji hall is large enough to implement our five core program areas with ease and outdoor areas are used for sports and fitness activities. The Hamakua Club also has a partnership with County Parks and Recreation for use of facility when they are unable to use the hall due to Church functions. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club The Hamakua Club conducts daily after - school programs which include Boys & Girls Club of America's five core programs areas: • Sports, Fitness and Recreation Development develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills. • The Arts: enables youth to develop their creativity and cultural awareness through knowledge and an appreciation of the visual arts, crafts, performing arts and creative writing. • Education and Career Development enables our youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career. • Character & Leadership Development: empowers our youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others' cultural identities. • Health & Life Skills Development: develops our youth's capacity to engage in positive behaviors that nurture their own well- being, set personal goals and live successfully as self- sufficient adults. Every day at the Hamakua Club, youth are greeted by caring, trained youth development staff. These professionals have joined the Boys and Girls Clubs of America "Movement - wide effort to help assure that the members of the Club succeed in school, lead healthy lifestyles, and become the kinds of citizens and leaders their community needs. BGCBI vision is that every young person who walks through the doors of the Club progresses from each grade to the next on time and graduates from high school with a solid plan for the future." By offering a wide variety of programs and activities that focus on academic success, healthy living, and leadership and service, the youth of the Hamakua Club are better prepared for a positive, bright future. BGCBI strives to provide youth development programs that support the fundamental principles and beliefs of the national Boys and Girls Club Movement. Our Core Beliefs A Boys and Girls Club provides: • A safe place to learn and grow • Ongoing relationships with caring, adult professionals • Life - enhancing programs and character development experiences • Hope and opportunity Youth Development Strategy The philosophy underlying BGCBI programming is the Youth Development Strategy. All Boys and Girls Club programs and activities are designed to maximize opportunities for young people to acquire four basic "senses" which help them build self- esteem and grow into responsible and caring citizens. These four senses are: • A sense of competence — Young people feel proud and confident when they acquire new skills and know they can do something and do it well. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club A sense of usefulness — Young people know the satisfaction of doing something of value for others. A sense of belonging — Young people know they are welcome and feel that they fit in and are accepted. A sense of power and influence — Young people know their opinions are heard and valued and that they can influence decisions. The Hamakua Club creates a climate in which these important "senses" are fostered in every participant, member and guest involved in program or just "hanging out ". The following outcomes summarize BGCBI expectations and goals for youth entering the world at age 18: Community and Civic Involvement: Youth have a sense of belonging to their community, family and /or group and are willing to take civic responsibility. They work closely with others to contribute to the greater good. Health and Well- Being: Youth live healthy lifestyles, take part in regular fitness activities, are able to access health care resources and engage in positive behaviors. They use sound judgment about personal safety, nutrition and avoidance of alcohol, drugs and premature sexual activity. Moral Compass: Youth have values enabling them to develop positive relationships with others. These values include honesty, a sense of justice and fairness, respect, caring and spirituality. The Hamakua Club will engage youth in activities that are fun and enjoyable while supporting the development of the capacities described above. Outcome measurement will occur through a variety of surveys BGCBI uses to measure the impact their program is having on the participants. The goal of these measurement tools is to acquire the general well -being of Club members and the degree to which they are acquiring skills, competencies and attitudes in specific areas, while assessing the impact that the Boys and Girls Club has on young people. The membership cost for youth ages 6 through 18 is $10.00 per year. No child Is ever turned away because of the inability to pay. Total Budget and Position Count— FY 2010 -2011 Total Program Budget $113,150 Total Program Position Count 4 Total Agency Budget $1,625,000 Total Agency Position Count 34 (includes $250,000 Hilo renovations NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 5 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club Program Outcome Measures and Objectives: 1) Increase participants' knowledge and awareness of the consequences and harmful effects of tobacco, alcohol, and other drugs on their health and well- being. 2) Increase participants' ability to identify and resist peer and media pressures to engage in risky behaviors. 3) Increase participants' involvement in positive civic and community events. 4) Increase participants' positive attitude toward school /education 5) Decrease risky behavior of youth by increasing participants' positive self esteem through participation in positive youth development programs and activities on a daily basis 2009 -2010 Program Highlights: 1) Total days of operation: 228 Total hours of operation: 1069 School days: 2:00 pm to 6:00 pm School days off - waiver days and intercessions: 8:00 am to 2:00 pm Total youth (6 through 18) registered as members of the Hamakua Program: 83 Total youth members participating in ATOD prevention program curriculums: 36 2) Character and Leadership Development • Community service projects included: recycling initiative, community park clean -ups • Daily character and leadership development through programs and activities: members learn how to contribute to the group, practice teamwork, learn how to be an effective worker, and how to be a member of a group with a common goal. Members are encouraged to assist staff in the kitchen, distributing handouts during programs, contribute their ideas, etc. Staff concentrate on the core values of character development in all they do - Trustworthiness, Respect, Responsibility, Fairness, Caring, Citizenship • Participation in the Boys and Girls Club of the Big Island Youth of the Year program • Participation in the Dr. Martin Luther King, Jr. Day of Service program Education and Career Development • Power Hour Program (homework and academic assistance) • BE GREAT - BE SMART Furlough Friday Program - Pahoa Club operated 17 Furlough Fridays from 7:30 am to 5:30 pm. The mornings were devoted to academics and the afternoons to enrichment. The only charge to parents for this service was an annual $10.00 membership for their child. Health and Life Skills • Too Good For Drugs and Violence ATOD prevention program • Cooking and Nutrition Classes - Triple Play program • Gardening program NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 6 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club • Participation in 2010 National Kick Butts Day with Pa'auilo Elementary and Intermediate School students and after school activities with Club members. 3) Outreach to Pa'auilo Elementary and Intermediate School The Hamakua Club Director works with the agricultural learning program assisting the parent teacher coordinator in the implementation of this unique program. This experience has enabled the director to establish relationships with the local children, their parents, and the school community. This program encourages the students to learn about the historical significance of some of the plants and vegetables in the garden, especially the relationship between ancient Hawaiians and the plants. Students learn how to take care for and manage a nursery, greenhouse, farm life (including animals) and learn how to live a more sustainable life utilizing and reusing all of the gardens resources. The teacher has educated the director about agriculture and care of plants and farm animals, and she has taken this new knowledge and shared it with her Club members, as well as helping students at the school to better understand how to take better care of a living organism. Both the program instructor and the Club Director share the vision of being economical, taking pride in planting things from the ground up, and gaining a sense of satisfaction by passing these values and skills onto our youth. Performance Measures: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual Budget Estimate Youth will participate in The Arts Programs. Examples: ✓ Arts and Crafts 65 75 50 ✓ Dance ✓ Music ✓ Fine Arts Youth will participate in Character and Leadership programs. Examples: 26 30 25 ✓ Keystone Club • Torch Club • Community Service Projects • Club Service Projects Youth will participate in Education and Career Development Programs. Examples: ✓ Power Hour 69 100 50 ✓ Project Learn ✓ Tutoring ✓ Computer Technology Youth will participate in Health and Life Skills Programs. Examples: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club ✓ SMART Moves ✓ Project TNT ✓ Nutrition /Cooking Classes ✓ Triple Pla 92 75 50 Youth will participate in Sports, $56,050 $61,400 $63,250 Fitness and Recreation Programs. $2,500 $2,750 $2,750 Examples: $51,100 $37,000 $38,850 ✓ Team /Individual Sports 86 100 50 • Games Room Activities $111,050 $113,150 $116,850 • Fitness Activities and Programs Parents /families will participate in $23,750 $27,200 $27,200 activities to promote family 4 events 4 events per 4 events per strengthening and unity. year year Program Expenditure Program Funding Sources: Identify all funding sources Revenue Source FY 2009 -10 Actual FY 2010 -11 Budget FY 2011 -12 Estimate Salaries and Wages $56,050 $61,400 $63,250 Professional Fees $2,500 $2,750 $2,750 Operations $51,100 $37,000 $38,850 Equipment $1,400 $12,000 $12,000 Total $111,050 $113,150 $116,850 Program Funding Sources: Identify all funding sources Revenue Source FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual Budget Estimate County of Hawaii — $20,000 $15,000 $30,000 Nonprofit Grant Hawaii Community Foundation: Tobacco $12,500 $12,500 $12,500 Settlement Trust Fund Rural Youth Crime Prevention Program (BGCH /OJP) — $23,750 $27,200 $27,200 FY 11 -12 pending contract extension Hawaii Island United Way — FY 11 -12 pending new $2,200 $4,000 $4,000 contract Boys and Girls Clubs of America - COX Super 0 $16,000 $16,000 Reso urce Grant NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 8 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club Walmart Foundation State 0 $5,000 $5,000 Giving Grant County of Hawaii — SPF SIG pending contract 0 $23,300 $14,000 execution Department of Human Services /Office of Youth $62,500 $15,000 0 Services DHS 10 — OYS 26 Club Fundraising $800 $1,000 $1,000 Total $121,750 $119,000 $109,700 Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? BGCBI Board of Directors and leadership professionals have the following components in place for increased sustainability of programs: a) established annual agency fundraisers; b) an increase in special event fund raising efforts; c) an annual planned giving program in alignment with the Boys and Girls Clubs of America's standards of effective operations — It Just Takes One Campaign to include corporation and individual donors; d) in 2009, BGCBI created a Resource Development Department with a full -time Development Director with increase in grant writing; e) increased marketing initiatives via website design and functionality for resource development purposes; f) Board of Director strategic planning to establish an endowment fund. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 9 Boys & Girls Club of the Big Isl Positive Youth Development Programs: Hamakua Club I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. G Signature of Board President/Chair 4 __4A�� r - U" Signature of Executive Dire or Date j 2 I4 [ I I Date (Signature of Resource Development Director in the absence of Executive Director) UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 10 13 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club a 13 Agency Director: Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Zavi Brees- Saunders Phone No.: 961 -5536 (start date: February 1, 2011) Zavi Brees- Saunders Phone No.: 961 -5536 100 Kamakahonu Street, Hilo, Hawaii 96720 100 Kamakahonu Street, Hilo, Hawaii 96720 961 -5534 zavi @becbi.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: Mailing Address: (808) 968 -1002 P. O. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds: $40,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $40,000 $30,000 $20,000 Agency Mission Statement: To inspire and enable Big Island youth from all backgrounds, especially those from disadvantaged circumstances, to become productive and responsible citizens by offering quality programs in a safe and caring environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 1 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club Program Description: GREAT FUTURES START N. When opportunities are available in a community for positive participation, children are less likely to engage in substance use and other problem behaviors. The Boys and Girls Club of the Big Island (BGCBI) — Hilo Club, provides those opportunities on a daily basis to the young people of the Hilo community. Through fun and engaging activities, BGCBI provides a positive atmosphere for youth ages 6 to 18 to explore their interests so that they can reach their full potential and contribute to their communities as productive, responsible citizens. The Hilo Club offers programs and services during non - school hours aimed at instilling a positive sense of self, increase self- esteem, self- confidence, and teach the skills necessary to make good, sound decisions. The organization was founded as the Boys Club of Hilo in 1952 and has since served over 50,000 youth of East Hawaii. In 2002, they became BGCBI and during the last 7 years, the Board of Directors and Club leadership have demonstrated their commitment by extending their service reach to the youth in Pahoa, Kea'au, Ocean View /Naalehu, Pahala and along the Hamakua coast. BGCBI success is evident on the faces of the youth who attend the Clubs along with the outcome measurement results reported to the following federal, state and private funding agencies: the Office of Juvenile Justice and Prevention, the Boys and Girls Clubs of America, the Hawaii State Department of Human Services /Office of Youth Services, the Hawaii State Department of Health /Alcohol and Drug Abuse Division, Office of Juvenile Prevention Rural Youth Program, Tobacco Trust Settlement administered by the Hawaii Community Foundation, and the Hawaii Island United Way. Reports are available upon request. The Need Hilo Community: Data compiled by the Office of Juvenile Prevention (OJP) SMART system assigns a Community Disadvantage Index of 8 to the Hilo area. (scale 1 low to 10 high) Community, family and child indicators show powerful support of this index. According to the Center on the Family "the Hilo area's unemployment rate is higher than 85% of the communities in the State. This area has the third highest unemployment rate, the third lowest per capita income, and the highest percentage in the State of families who rely on food stamps. More than 33% of children 5 and under are living in poverty. The poverty rate of young children is second in the State. Participation in the Food Stamp and Temporary Assistance to Needy Families programs is more than double the State average. This community has the lowest percentage of families with children that are headed by a married couple. The percent of "idle teen" — those not working or in school — is high. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 2 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club About 40% of the adolescents responding to a Statewide survey of 6 th 8 th , 10 ", and 12 graders reported problems of fighting, graffiti, and crime in their neighborhoods. Positive indicators for the Hilo community include: most teachers, parents, and students report that their schools are safe. About half the youth in the Hilo community survey reported adequate parental supervision and close family ties. The East Hawaii Community Profile document written by Center on the Family, University of Hawaii at Manoa, states that "the problem of alcohol, tobacco and other drug use among the children of East Hawaii is a serious one. The youth of this community start using early, as indicated by the comparatively high rates of sixth graders reporting cigarette, alcohol, marijuana, and crystal methamphetamine use in the 30 days before taking the Hawaii Student ATOD Use Study. East Hawaii has a higher rate, compared to the State, of twelfth graders who claim to drink alcohol on a daily basis and, at all grade levels, youth who have been identified as needing treatment." The 2003 Hawaii Student ATOD Use Study indicates the East Hawaii youth, family, school and community need for substance abuse prevention programs. The following table shows the prevalence of ATOD use 30 days prior to taking the survey for youth of the East Hawaii communities: Substance Use Reported East State by Students Hawaii Smoking cigarettes in the past month • Grade 6 12.3% 2.6% Drinking any alcohol in past month • Grade 8 9.8% 3.9% Drinking alcohol daily in past month • Grade 10 4.0% 2.3% Using marijuana in past month • Grade 12 25.7% 18.4% Using crystal methamphetamine in past month • Grade 6 3.5% 0.2% Using inhalants in past month • Grade 6 5.4% 1.9% As indicated above, youth in East Hawaii are faced with risk factors such as early initiation of problem behaviors w /alcohol and drug use, favorable attitude towards ATOD use, low perceived ATOD use risk and peer approval of ATOD use. Other community, school, and family risk factors include exposure of youth to alcohol and drugs, low school commitment, poor academic performance, lack of family supervision /involvement, lack of parental sanctions for antisocial behaviors, and factors affecting family NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club socioeconomic struggles, such as unemployment and substance abuse. All these risk factors affect youth's ability to make a successful transition to adulthood. All of this powerful data points to the overwhelming need East Hawaii youth and families have for establishing relationships with adults and professionals who care enough to assist them in developing positive personal qualities and support them in their homes, schools, and communities. BGCBI Hilo Club addresses these needs on a daily basis when they open their doors and encourage all youth who enter to A-,.,E) _ Service Delivery The Hilo Club is located in downtown Hilo and sits on a 14 acre property of the Hilo Boarding School. This beautiful site includes 2 baseball fields, a small t- ball /soccer field, and a full size gymnasium. The renovated Clubhouse includes a Club reception area, administrative offices, recreation /game room, art room, teen area, computer lab, patio for leisure and eating, ADA compliant restrooms, ADA compliant entry ways and Hilo Clubhouse fagade that can be used as a gathering /program area. In 2010, the Hilo Club received a grant in the amount of $250,000 from the County of Hawaii 2010 U.S. Department of Housing and Urban Development's Community Development Block Grant. This grant will be used specifically to address the ADA compliance of the baseball field restrooms. The Hilo Club conducts daily after - school, evening, weekend and full -day intercession programs which include Boys & Girls Club of America's five core programs areas: • Sports Fitness and Recreation Development develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills. • The Arts: enables youth to develop their creativity and cultural awareness through knowledge and an appreciation of the visual arts, crafts, performing arts and creative writing. • Education and Career Development enables youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career. • Character & Leadership Development: empowers youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others' cultural identities. • Health & Life Skills Development: develops youth's capacity to engage in positive behaviors that nurture their own well- being, set personal goals and live successfully as self- sufficient adults. Every day at the Hilo Club, youth are greeted by caring, trained youth development staff. These professionals have joined the Boys and Girls Clubs of America "Movement -wide effort to help assure that the members of the Club succeed in school, lead healthy lifestyles, and become the kinds of citizens and leaders their community needs. BGCBI NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club vision is that every young person who walks through the doors of the Club progresses from each grade to the next on time and graduates from high school with a solid plan for the future." By offering a wide variety of programs and activities that focus on academic success, healthy living, and leadership and service, the youth of the Hilo Club are better prepared for a positive, bright future. BGCBI strives to provide youth development programs that support the fundamental principles and beliefs of the national Boys and Girls Club Movement. Core Beliefs A Boys and Girls Club provides: • A safe place to learn and grow • Ongoing relationships with caring, adult professionals • Life - enhancing programs and character development experiences • Hope and opportunity Youth Development Strategy All Boys and Girls Club programs and activities are designed to maximize opportunities for young people to acquire four basic "senses" which help them build self- esteem and grow into responsible and caring citizens. These four senses are: • A sense of competence — Young people feel proud and confident when they acquire new skills and know they can do something and do it well. • A sense of usefulness — Young people know the satisfaction of doing something of value for others. • A sense of belonging — Young people know they are welcome and feel that they fit in and are accepted. • A sense of power and influence — Young people know their opinions are heard and valued and that they can influence decisions. The Hilo Club creates a climate in which these important "senses" are fostered in every participant, member and guest involved in program or just "hanging out ". The following outcomes summarize BGCBI expectations and goals for youth entering the world at age 18: Community and Civic Involvement: Youth have a sense of belonging to their community, family and /or group and are willing to take civic responsibility. They work closely with others to contribute to the greater good. Health and Well- Being: Youth live healthy lifestyles, take part in regular fitness activities, are able to access health care resources and engage in positive behaviors. They use sound judgment about personal safety, nutrition and avoidance of alcohol, drugs and premature sexual activity. Moral Compass: Youth have values enabling them to develop positive relationships with others. These values include honesty, a sense of justice and fairness, respect, caring and spirituality. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 5 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club The Hilo Club will engage youth in activities that are fun and enjoyable while supporting the development of the capacities described above. Outcome measurement will occur through a variety of surveys BGCBI uses to measure the impact their program is having on the participants. The goal of these measurement tools is to acquire the general well- being of Club members and the degree to which they are acquiring skills, competencies and attitudes in specific areas, while assessing the impact that the Boys and Girls Club has on young people. The membership cost for youth ages 6 through 18 is $10.00 per year. No child is ever turned away because of the inability to pay. Total Budget and Position Count — FY 2010 -2011 Total Program Budget $510,200 Total Program Position Count 8 Total Agency Budget $1,625,000 Total Agency Position Count 34 (includes $250,000 Hilo renovations) Program Outcome Measures and Objectives: 1) Increase participants' knowledge and awareness of the consequences and harmful effects of tobacco, alcohol, and other drugs on their health and well- being. 2) Increase participants' ability to identify and resist peer and media pressures to engage in risky behaviors. 3) Increase participants' involvement in positive civic and community events. 4) Increase participants' positive attitude toward school /education. 5) Decrease risky behavior of youth by increasing participation in positive youth development programs and activities on a daily basis. 2009 -2010 Program Highlights: 1) Total days of operation: 238 Total hours of operation: 1,445 ➢ School days: 1:30 pm to 6:00 pm ➢ School days off — waiver days and intercessions: 7:30 am to 5:30 pm Total youth (ages 6 through 18) registered as members: 564 Total youth participating in ATOD prevention program curriculums: 130 2) Character and Leadership Development: ➢ Community /Club service projects ➢ Torch Club — middle school age leadership group ➢ Youth Advisory Group — high school age program planning and service group ➢ Participation in Dr. Martin Luther King, Jr. Day of Service ➢ SMART Leaders — assist staff in ATOD prevention program curriculum implementation with younger members ➢ Participation in the Alu Like Summer Youth Employment Program ➢ Collaboration with Hilo High Key Club and Waiakea High School Junior Achievement Students NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 6 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club ➢ Participation in the Boys and Girls Club of the Big Island Youth of the Year program 3) Health and Life Skills: develops young people's capacity to engage in positive behaviors that nurture their own well- being, set personal goals and live successfully as self- sufficient adults. ➢ SMART Moves and Prevention Program curriculums: Stay SMART, SMART Leaders ➢ Too Good For Drugs and Violence ATOD prevention curriculums ➢ Garden Project: Kaiao Gardens is a collaborative project with the aunties and uncles of the surrounding community. The garden is staffed with volunteers, students from UH Hilo, and a Boys and Girls Club staff member. The children meet three times a week, weather permitting, and community volunteers nurture the garden on Saturdays from 9:00 am to 11:00 am. ➢ Cooking and Nutrition Programs ➢ Participation in 2010 National Kick Butts Day with a lunchtime rally at Hilo High School and after - school program celebration of a tobacco -free lifestyle. Collaboration with University of Hawaii Nursing Baccalaureate Program. 4) Over 600 additional youth are served in the organized athletic program at the Hilo Boys and Girls Club. The baseball fields are used year -round and the Hilo Athletic Director serves as the Commissioner of all leagues played at the Boys and Girls Club. He works closely with all teams and creates an environment that promotes the philosophy of the Positive Coaching Alliance - to teach youth sports organization leaders how to create an organizational culture in which Honoring the Game is the norm. The Hilo Club hosts the following leagues throughout the year: ➢ County Parks & Recreation's T -ball and Coach Pitch Leagues ➢ Pony League — February through July (largest league on the Island) ➢ Winter League — September through December ➢ RBI League — October through December AND May through July Agencies BGCBI continued to maintain relationships with in FY 2009 -2010 included: Tobacco -Free Big Island Coalition, American Lung Association, American Cancer Society, REAL, The Salvation Army Family Intervention Services, Lanikila Learning Center, Alu Like, Department of Defense Summer Youth Employment Program, Pahoa Weed and Seed Project, United States Tennis Association — Hawaii Pacific Section, Bay Clinic, State of Hawaii Department of Education, PATCH, Kick - the -Nic, Prosecuting Attorney's Office, and Hawaii County Department of Parks & Recreation. Performance Measures: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 FY 2009 -10 Actual FY 2010 -11 Budget FY 2011 -12 Estimate Youth will participate in The Arts Programs. Examples: ✓ Arts and Crafts 282 300 150 ✓ Dance ✓ Music NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club ✓ Fine Arts FY 2009 -10 Actual FY 2010 -11 Budget FY 2011 -12 Estimate Youth will participate in Character and $134,000 $169,800 $174,900 Leadership programs. Examples: $6,000 $6,500 $6,500 ✓ Keystone Club 113 150 50 ✓ Torch Club $5,000 $19,800 $17,500 ✓ Community Service Projects 0 $250,000 0 ✓ Club Service Projects $220,000 $510,200 $270,100 Youth will participate in Education and Career Development Programs. Examples: ✓ Power Hour 225 300 100 ✓ Project Learn ✓ Tutoring ✓ Computer Technolo Youth will participate in Health and Life Skills Programs. Examples: • SMART Moves /ATOD 230 300 100 Curriculums • Nutrition /Cooking Classes ✓ Triple Play Youth will participate in Sports, Fitness and Recreation Programs. Examples: ✓ Team /Individual Sports 423 400 400 ✓ Games Room Activities ✓ Fitness Programs and Activities Parents /families will participate in activities to promote family 4 events 4 events per 4 events per strengthening and unity. year year Program Expenditure Program Funding Sources: Identify all funding sources Revenue Source FY 2009 -10 Actual FY 2010 -11 Budget FY 2011 -12 Estimate Salaries and Wages $134,000 $169,800 $174,900 Professional Fees $6,000 $6,500 $6,500 Operations $75,000 $64,100 $71,200 Equipment/Supplies $5,000 $19,800 $17,500 Other renovations 0 $250,000 0 Total $220,000 $510,200 $270,100 Program Funding Sources: Identify all funding sources Revenue Source FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual Budget Estimate County of Hawaii — $30,000 $20,000 $40,000 Nonprofit Grant Hawaii Community $14,167 $12,500 $12,500 Foundation: Tobacco NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 8 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club Settlement Trust Fund County of Hawaii 0 Contingency Funds $15,000 0 ( carryover from 08 -09 Rural Youth Crime Prevention Program (BGCH /OJP) - $23,750 $20,300 $20,300 FY 11 -12 pending contract extension Hawaii Island United Way - FY 11 -12 pending new $2,500 $5,000 $5,000 contract Boys and Girls Clubs of America - COX Super $35,000 $21,700 $21,700 Resource Grant WalMart Foundation State 0 $5,000 $5,000 Giving Grant Boys and Girls Clubs of America/Walmart 0 $6,000 0 Foundation County of Hawaii - SPF SIG pending contract 0 $69,400 $41,640 execution ADAD - FY 11 -12 pending $25,000 $15,000 $15,000 contract extension BGCA/OJP 2010 Mentoring 0 $11,666 $3,889 Department of Human Services /Office of Youth $15,290 $15,290 0 Services DHS 10 - OYS 103) Department of Human Services /Office of Youth Services /BESSD 0 $25,000 $25,000 (DHS 11 - OYS /BESSD 336) - FY 11 -12 pending contract extension Department of Human Services /Office of Youth 0 $25,000 0 Services (DHS 08 - OYS 26) Boys and Girls Clubs of $16,500 0 0 America Family Plus Grant Club Fundraising $25,000 $20,000 $20,000 CDBG Phase 3 0 $250,000 0 (renovations) Total $202,207 $521,856 =$210,029 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 9 Boys & G irls Club of the Big Island Positive Youth Development Programs: Hilo Club Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? BGCBI Board of Directors and leadership professionals have the following components in place for increased sustainability of programs: a) established annual agency fundraisers; b) an increase in special event fund raising efforts; c) an annual planned giving program in alignment with the Boys and Girls Clubs of America's standards of effective operations — It Just Takes One Campaign to include corporation and individual donors; d) in 2009, BGCBI created a Resource Development Department with a full -time Development Director with increase in grant writing; e) increased marketing initiatives via website design and functionality for resource development purposes; f) Board of Director strategic planning to establish an endowment fund. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 10 Bovs & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year-end report will impact the evaluation of your pr o g ram's or agency's future funding requests. �y r Signature of Board President/Chair Signature of Executive Director Date I (2-(� �►1 Date (Signature of Resource Development Director in the absence of Executive Director) UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 11 14 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea'au Club Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea'au Club r Agency Director: Zavi Brees- Saunders Phone No.: 961 -5536 (start date: February 1, 2011) Contact Person: Zavi Brees- Saunders Phone No.: 961 -5536 Mailing Address: 100 Kamakahonu Street, Hilo, Hawaii 96720 Facility /Site Address: Holy Rosary Church Shipman Gym Road, A 25 Keaau, HI 96749 Fax No.: 961 -5534 Email Address: zavi @becbi.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: Mailing Address: (808) 968 -1002 P. O. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds: $30,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $40,000 $20,000 $15,000 Agency Mission Statement: To inspire and enable Big Island youth from all backgrounds, especially those from disadvantaged circumstances, to become productive and responsible citizens by offering quality programs in a safe and caring environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 1 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea'au Club Program Description: GREAT FUTURES START HERE. When opportunities are available in a community for positive participation, children are less likely to engage in substance use and other problem behaviors. The Boys and Girls Club of the Big Island ( BGCBI) — Kea'au Club, provides those opportunities on a daily basis to the young people of the Kea'au community. Through fun and engaging activities, BGCBI provides a positive atmosphere for youth ages 6 to 18 to explore their interests so that they can reach their full potential and contribute to their communities as productive, responsible citizens. The Kea'au Club offers programs and services during non - school hours aimed at instilling a positive sense of self, increase self- esteem, self - confidence, and teach the skills necessary to make good, sound decisions. The organization was founded as the Boys Club of Hilo in 1952 and has since served over 50,000 youth of East Hawaii. In 2002, they became BGCBI and during the last 7 years, the Board of Directors and Club leadership have demonstrated their commitment by extending their service reach to the youth in Pahoa, Kea'au, Ocean View /Naalehu, Pahala and along the Hamakua coast. BGCBI success is evident on the faces of the youth who attend the Clubs along with the outcome measurement results reported to the following federal, state and private funding agencies: the Office of Juvenile Justice and Prevention, the Boys and Girls Clubs of America, the Hawaii State Department of Human Services /Office of Youth Services, the Hawaii State Department of Health /Alcohol and Drug Abuse Division, Office of Juvenile Prevention Rural Youth Program, Tobacco Trust Settlement administered by the Hawaii Community Foundation, and the Hawaii Island United Way. Reports are available upon request. The Need Kea'au Community: Data compiled by the Office of Juvenile Prevention (OJP) SMART system assigns a Community Disadvantage Index of 9 (scale 1 low to 10 high) to the Kea'au area. According to the Center on the Family "this area has a higher percentage of school -aged children than the State average and almost 40% of the children are identified as Native Hawaiian or Native Hawaiian in combination with one or more other races. Data for many of the indicators of child and family well -being in the Kea'au Area are problematic. Unemployment is high and the per capita income is among the lowest in the State. The percentage of families relying on Food Stamps and TANF is about 3 times the State average." The East Hawaii Community Profile document written by Center on the Family, University of Hawaii at Manoa, states that "the problem of alcohol, tobacco and other drug use among the children of East Hawaii is a serious one. The youth of this community start using early, as indicated by the comparatively high rates of sixth graders reporting cigarette, alcohol, marijuana, and crystal methamphetamine use in the NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 2 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea' au Club 30 days before taking the Hawaii Student ATOD Use Study. East Hawaii has a higher rate, compared to the State, of twelfth graders who claim to drink alcohol on a daily basis and, at all grade levels, youth who have been identified as needing treatment." The 2003 Hawaii Student ATOD Use Study indicates the East Hawaii youth, family, school and community need for substance abuse prevention programs. The following table shows the prevalence of ATOD use 30 days prior to taking the survey for youth of the East Hawaii communities: Substance Use Reported East State by Students Hawaii Smoking cigarettes in the past month • Grade 8 15.4% 8.5% Drinking any alcohol in past month • Grade 6 9.8% 3.9% Drinking alcohol daily in past month • Grade 10 4.0% 2.3% Using marijuana in past month • Grade 12 25.7% 18.4% Using crystal methamphetamine in past month • Grade 12 1.7% 0.8% Using inhalants in past month • Grade 6 5.4% 1.9% As indicated above, youth in East Hawaii are faced with risk factors such as early initiation of problem behaviors w /alcohol and drug use, favorable attitude towards ATOD use, low perceived ATOD use risk and peer approval of ATOD use. Community, school, and family risk factors include exposure of youth to alcohol and drugs, low school commitment, poor academic performance, lack of family supervision /involvement, lack of parental sanctions for antisocial behaviors, and factors affecting family socioeconomic struggles, such as unemployment and substance abuse. All these risk factors affect youth's ability to make a successful transition to adulthood. All of this powerful data points to the overwhelming need East Hawaii youth and families have for establishing relationships with adults and professionals who care enough to assist them in developing positive personal qualities and support them in their homes, schools, and communities. BGCBI Kea'au Club addresses these needs on a daily basis when they open their doors and encourage all youth who enter to I fflw`XM� NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea'au Club Service Delivery In the spring of 2010, the Department of Education terminated its agreement with BGCBI and all operations of the Keaau Club ceased due to the inadequacy of the facility the program was located in at the Kea'au Middle School. Today, the Club is temporarily located at the Holy Rosary Church and uses two portable classrooms along with outdoor spaces covered with pop -up tenting. A partnership exists with P &R at Shipman Gymnasium for use of the gymnasium when available. The Church location is within walking distance for middle and high school members and elementary school youth are transported daily via the Club van. BGCBI is continues to search for a permanent home for the Keaau Club. As of this writing nothing has been identified. The Kea'au Club conducts daily after - school, full -day intercession, occasional evening and weekend programs which include Boys & Girls Club of America's five core programs areas: • Sports, Fitness and Recreation Development develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills. • The Arts: enables youth to develop their creativity and cultural awareness through knowledge and an appreciation of the visual arts, crafts, performing arts and creative writing. • Education and Career Development enables our youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career. • Character & Leadership Development: empowers our youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others' cultural identities. • Health & Life Skills Development: develops our youth's capacity to engage in positive behaviors that nurture their own well- being, set personal goals and live successfully as self- sufficient adults. Every day at the Kea'au Club, youth are greeted by caring, trained youth development staff. These professionals have joined the Boys and Girls Clubs of America "Movement - wide effort to help assure that the members of the Club succeed in school, lead healthy lifestyles, and become the kinds of citizens and leaders their community needs. BGCBI vision is that every young person who walks through the doors of the Club progresses from each grade to the next on time and graduates from high school with a solid plan for the future." By offering a wide variety of programs and activities that focus on academic success, healthy living, and leadership and service, the youth of the Kea'au Club are better prepared for a positive, bright future. BGCBI strives to provide youth development programs that support the fundamental principles and beliefs of the national Boys and Girls Club Movement. Core Beliefs A Boys and Girls Club provides: • A safe place to learn and grow NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea'au Club • Ongoing relationships with caring, adult professionals • Life - enhancing programs and character development experiences • Hope and opportunity Youth Development Strategy All Boys and Girls Club programs and activities are designed to maximize opportunities for young people to acquire four basic "senses" which help them build self- esteem and grow into responsible and caring citizens. These four senses are: • A sense of competence — Young people feel proud and confident when they acquire new skills and know they can do something and do it well. • A sense of usefulness — Young people know the satisfaction of doing something of value for others. • A sense of belonging — Young people know they are welcome and feel that they fit in and are accepted. • A sense of power and influence — Young people know their opinions are heard and valued and that they can influence decisions. The Kea'au Club creates a climate in which these important "senses" are fostered in every participant, member and guest involved in program or just "hanging out ". The following outcomes summarize BGCBI expectations and goals for youth entering the world at age 18: Community and Civic Involvement: Youth have a sense of belonging to their community, family and /or group and are willing to take civic responsibility. They work closely with others to contribute to the greater good. Health and Well- Being: Youth live healthy lifestyles, take part in regular fitness activities, are able to access health care resources and engage in positive behaviors. They use sound judgment about personal safety, nutrition and avoidance of alcohol, drugs and premature sexual activity. Moral Compass: Youth have values enabling them to develop positive relationships with others. These values include honesty, a sense of justice and fairness, respect, caring and spirituality. The Kea'au Club will engage youth in activities that are fun and enjoyable while supporting the development of the capacities described above. Outcome measurement will occur through a variety of surveys BGCBI uses to measure the impact their program is having on the participants. The goal of these measurement tools is to acquire the general well -being of Club members and the degree to which they are acquiring skills, competencies and attitudes in specific areas, while assessing the impact that the Boys and Girls Club has on young people. The membership cost for youth ages 6 through 18 is $10.00 per year. No child is ever turned away because of the inability to pay. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 5 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea' au Club Total Budget and Position Count- FY 2010 -2011 Total Program Budget $143,645 Total Program Position Count 4 Total Agency Budget $1,625,000 Total Agency Position Count 34 (includes $250,000 Hilo renovations Program Outcome Measures and Objectives: 1) Increase participants' knowledge and awareness of the consequences and harmful effects of tobacco, alcohol, and other drugs on their health and well- being. 2) Increase participants' ability to identify and resist peer and media pressures to engage in risky behaviors. 3) Increase participants' involvement in positive civic and community events. 4) Increase participants' positive attitude toward school /education. 5) Decrease risky behavior of youth by increasing participants' positive self esteem through participation in positive youth development programs and activities on a daily basis 2009 -2010 Program Highlights: 1) Total days of operation: 231 Total hours of operation: 1,340 School days: 2:00 pm to 6:00 pm School days off - waiver days and intercessions: 7:30 am to 5:30 pm Total youth (ages 6 through 18) registered as members of the Keaau Club: 255 Total youth members participating in Too Good For Drugs & Violence and other ATOD prevention program curriculums: 107 Total other youth participating in ATOD prevention curriculum through outreach: 15 2) Character and Leadership Development: Community /Club service projects ➢ Participation in Dr. Martin Luther King, Jr. Day of Service ➢ Participation in the Alu Like Summer Youth Employment Program ➢ Participation in the Boys and Girls Club of the Big Island Youth of the Year program 3) Education and Career Development ➢ Power Hour (homework assistance and tutoring) - 132 days ➢ BE GREAT - BE SMART Furlough Friday Program - Keaau Club operated 17 Furlough Fridays from 7:30 am to 5:30 pm. The mornings were devoted to academics and the afternoons to enrichment. The only charge to parents for this service was an annual $10.00 membership for their child. ➢ Project Learn implemented daily (high yield learning activities) ➢ Career Exploration and Goals for Graduation with at -risk Keaau High School NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 6 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea'au Club students ➢ Computer Literacy ➢ Book Club at Keaau Public Library 4) Health and Life Skills ➢ Stay SMART and SMART Leaders ATOD prevention curriculums ➢ Too Good For Drugs & Violence — new ATOD curriculum introduced this fiscal year — Keaau staff writes: "The children have learned life skills that will assist them in making positive choices to avoid becoming involved in drugs as well as other inappropriate behaviors including the abuse of the gateway drugs. 1 found that many of the youth in the classes were very knowledgeable about drugs and drug paraphernalia. Many of them have parents or siblings who use drugs, alcohol or tobacco products. They .shared many stories with the class. We talked about positive ways to help these youth as they deal with these very personal issues. We discussed how to deal with their anger or the anger of others directed toward them. This class has been extremely beneficial for our members. " ➢ Kick Butts Day events included participation with Keaau High School rally and Club afterschool event ➢ Triple Play: A Game for the Mind, Body, and Soul: nutrition and daily fitness program Agencies BGCBI continued to maintain relationships with in FY 2009 -2010 included: Tobacco -Free Big Island Coalition, American Lung Association, American Cancer Society, REAL, The Salvation Army Family Intervention Services, Lanikila Learning Center, Alu Like, Department of Defense Summer Youth Employment Program, Pahoa Weed and Seed Project, United States Tennis Association — Hawaii Pacific Section, Bay Clinic, State of Hawaii Department of Education, PATCH, Kick - the -Nic, Prosecuting Attorney's Office, and Hawaii County Department of Parks & Recreation. Performance Measures: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual Budget Estimate Youth will participate in The Arts Programs. Examples: ✓ Arts and Crafts 102 100 75 ✓ Dance ✓ Music ✓ Fine Arts Youth will participate in Character and Leadership programs. Examples: 64 75 50 ✓ Keystone Club ✓ Torch Club ✓ Community Service Projects ✓ Club Service Projects Youth will participate in Education and Career Development Programs. Examples: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea' au Club ✓ Power Hour 137 100 100 • Project Learn $73,680 $79,020 $81,390 • Tutoring $2,500 $2,750 $2,750 ✓ Computer Technolo $51,100 $47,100 $49,455 Youth will participate in Health and $1,400 $14,775 $12,765 Life Skills Programs. Examples: $128,680 $143,645 $146,360 ✓ SMART Moves 122 125 75 • Project TNT • Nutrition /Cooking Classes $8,750 0 0 ✓ Triple Pla Youth will participate in Sports, Fitness and Recreation Programs. $23,750 15,000 $15,000 Examples: ✓ Team /Individual Sports 191 120 100 ✓ Games Room Activities ✓ Fitness Activities and Programs Parents /families will participate in activities to promote family 5 events 4 events per 4 events per strengthening and unity. year year Program Expenditure Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual FY 2010 -11 Budget FY 2011 -12 Estimate Salaries and Wages $73,680 $79,020 $81,390 Professional Fees $2,500 $2,750 $2,750 Operations $51,100 $47,100 $49,455 Equipment/Supplies $1,400 $14,775 $12,765 Total $128,680 $143,645 $146,360 Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual Budget Estimate County of Hawaii — $20,000 $15,000 $30,000 Nonprofit Grant Hawaii Community Foundation: Tobacco $14,167 $12,500 $12,500 Settlement Trust Fund County of Hawaii Contingency Funds $8,750 0 0 ( carryover from 08 -09 Rural Youth Crime Prevention Program $23,750 15,000 $15,000 (BGCH /OJP) - FY 11 -12 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 8 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea' au Club pending contract extension Hawaii Island United Way — FY 11 -12 pending new $2,200 $5,000 $5,000 contract Boys and Girls Clubs of America - COX Super $20,000 $11,000 $11,000 Resource Grant WalMart Foundation State 0 $5,000 $5,000 Giving Grant Boys and Girls Clubs of America/Walmart 0 $6,000 0 Foundation _ County of Hawaii — SPF SIG pending contract 0 $29,300 $17,560 execution ADAD — FY 11 -12 pending $25,000 $15,000 $15,000 contract extension BGCA/OJP 2010 Mentoring 0 $11,666 $3,889 Department of Human Services /Office of Youth Services /BESSD (DHS 11 — OYS /BESSD 0 $15,000 $15,000 336) - FY 11 -12 pending contract extension Club Fundraising $7,600 $8,000 $9,000 Total $121,467 $148,466 $138,949 Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? BGCBI Board of Directors and leadership professionals have the following components in place for increased sustainability of programs: a) established annual agency fundraisers; b) an increase in special event fund raising efforts; c) an annual planned giving program in alignment with the Boys and Girls Clubs of America's standards of effective operations — It Just Takes One Campaign to include corporation and individual donors; d) in 2009, BGCBI created a Resource Development Department with a full -time Development Director with increase in grant writing; e) increased marketing initiatives via website design and functionality for resource development purposes; f) Board of Director strategic planning to establish an endowment fund. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 9 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea'au Club I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board President/Chair M. Cam.,: s b3e:: - Signature of Executive Director Z,2_ Date /)z(. 1 111 Date (Signature of Resource Development Director in the absence of E=xecutive Director) UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 10 15 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club Agency Director: Contact Person: Mailing Address: Zavi Brees- Saunders Phone No.: 961 -5536 (start date: February 1, 2011) Zavi Brees- Saunders Phone No.: 961 -5536 100 Kamakahonu Street, Hilo, Hawaii 96720 Facility /Site Address: 1) County P & R — Kahuku Park/H.O.V.E. 92 -8607 Paradise Circle Mauka, Kahuku, HI 96737 2) County P & R — Na'alehu Community Center 95 -5635 Mamalahoa Highway Na'alehu, HI 96772 Fax No.: Email Address: 961 -5534 zavi @becbi.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: Mailing Address: (808) 968 -1002 P. O. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds: $40,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $40,000 $20,000 $15,000 Agency Mission Statement: To inspire and enable Big Island youth from all backgrounds, especially those from disadvantaged circumstances, to become productive and responsible citizens by offering quality programs in a safe and caring environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 1 & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club Program Description: GREAT FUTURES START HERE. When opportunities are available in a community for positive participation, children are less likely to engage in substance use and other problem behaviors. The Boys and Girls Club of the Big Island ( BGCBI) — Ocean View Club, provides those opportunities on a daily basis to the young people of the Ocean View and Naalehu communities. Through fun and engaging activities, BGCBI provides a positive atmosphere for youth ages 6 to 18 to explore their interests so that they can reach their full potential and contribute to their communities as productive, responsible citizens. The Ocean View Club offers programs and services during non - school hours aimed at instilling a positive sense of self, increase self- esteem, self- confidence, and teach the skills necessary to make good, sound decisions. The organization was founded as the Boys Club of Hilo in 1952 and has since served over 50,000 youth of East Hawaii. In 2002, they became BGCBI and during the last 7 years, the Board of Directors and Club leadership have demonstrated their commitment by extending their service reach to the youth in Pahoa, Kea'au, Ocean View /Naalehu, Pahala and along the Hamakua coast. BGCBI success is evident on the faces of the youth who attend the Clubs along with the outcome measurement results reported to the following federal, state and private funding agencies: the Office of Juvenile Justice and Prevention, the Boys and Girls Clubs of America, the Hawaii State Department of Human Services /Office of Youth Services, the Hawaii State Department of Health /Alcohol and Drug Abuse Division, Office of Juvenile Prevention Rural Youth Program, Tobacco Trust Settlement administered by the Hawaii Community Foundation, and the Hawaii Island United Way. Reports are available upon request. The Need Kau Community: The Kau Community, 2003 Hawaii Student Alcohol, Tobacco, and Other Drug Use Study administered by the State of Hawaii Department of Health, Alcohol and Drug Abuse Division provides the following family domain data from students in the 6 th grade ( http: / /hawaii. .qov /health /substance- abuse /prevention- treatment /survey /adsurv.htm : • 49 % reported poor family supervision • 18 % reported lack of parental sanctions for Anti - Social Behaviors (ASB's) • 18 % reported parental attitudes favorable toward ATOD use • 53 % reported exposure to family ATOD use • 12 % reported a family (sibling) history of ASB The 2009 -2010 School Quality Survey for Naalehu Elementary & Intermediate School indicated that 68.5 % of parents are involved in their child's school. An increase of 19.5% from SY 2008 -2009. ( http: / /doe.kl2.hi.us NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 2 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club The Na'alehu Elementary & Intermediate School Status and Improvement Report for School Year 2009 -2010 ( http: / /doe.kl2.hi.us provides the following information: • Average Daily Attendance of 91.8 % as compared to the state standard of 95 %. An increase of 4.1 % from SY 08 -09. • Average Daily Absences of 13.4 days as compared to the state standard of 9 days. A decrease of 8 days from SY 08 -09. • 84.8 % of the students receive free or reduced -cost lunch 0 The Hawaii Content and Performance Standards show Na'alehu students are 24% below the State average in reading; 24% below the State average in math • The Terrallova scores for 5 th grade students at Na'alehu Intermediate indicate 54% of the students are .below the national norm in reading and 57% of the 6 th grade students are below the national norm in math The Hawaii Student ATOD study indicates that 56% of middle school students in the Ka'u community experience community disorganization, 45% view laws and norms favorable to drug use, 48% engaged in early initiation of problem behaviors, 47% showed a low perceived risk of ATOD use, 53% interacted with antisocial peers, and 48% felt that their friends reward them for antisocial involvement. A conclusion of the same study indicated that 46% of the 6 th grade students who participated had a high probability of developing a substance abuse problem or engaging in other problem behaviors. Only 25% of the students who participated in the study had a high number of protective factors indicating that they were less likely to use substances or engage in antisocial behaviors. Data from Center on the Family of the University of Hawaii ( http: / /uhfamily.hawaii.edu concludes that the people of the Ka'u District face a number of economic, social, and educational hardships. The unemployment rate is the worst in the State. The per capita income is lower than in most other communities Statewide. High proportions of the very young live in poverty, and one -third of the families receive food stamps. The Office of Juvenile Prevention SMART System assigns a Community Disadvantage Index of 9 (scale 1 low to 10 high) to the Ka'u community. All of this powerful data points to the overwhelming need Ka'u youth and families have for establishing relationships with adults and professionals who care enough to assist them in developing positive personal qualities and support them in their homes, schools, and communities. BGCBI Ocean View Club addresses these needs on a daily basis when they open their doors and encourage all youth who enter to iv Service Delivery The Ocean View Club opened its doors to the youth of the Ka'u District in February 2007 while based at the Ocean View Community Center. Transportation for this Club was a daily challenge and in May 2008, BGCBI chose to relocate the operation to Na'alehu Elementary and Intermediate School where we are able to serve both communities with ease. The Club operated out of the school gymnasium and uses all outdoor facilities for NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club sports and fitness activities. Through partnership with Hawaii County Parks & Recreation, the Na'alehu Community Center is now the Club home to conduct game room /social recreation, computer technology, fitness, and health and nutrition programs. In the summer of 2009, the Ocean View Club made a decision to serve two communities in partnership with Hawaii County Parks & Recreation. They wanted to assure that the youth had supervised activities to engage in on a full -time basis. The Ocean View staff spent their mornings in Na'alehu and afternoons in Ocean View at Kahuku Park. In 2010, BGCBI and the County of Hawaii Department of Park & Recreation agreed to locate the Na'alehu operation at the Na'alehu Community Center. The Ocean View Club conducts daily after - school, half -day intercession, and occasional weekend and evening, weekend programs which include Boys & Girls Club of America's five core programs areas: • Sports Fitness and Recreation Development develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills. • The Arts: enables youth to develop their creativity and cultural awareness through knowledge and an appreciation of the visual arts, crafts, performing arts and creative writing. • Education and Career Development enables our youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career. • Character & Leadership Development: empowers our youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others' cultural identities. • Health & Life Skills Development: develops our youth's capacity to engage in positive behaviors that nurture their own well- being, set personal goals and live successfully as self- sufficient adults. Every day at the Ocean View Club, youth are greeted by caring, trained youth development staff. These professionals have joined the Boys and Girls Clubs of America "Movement -wide effort to help assure that the members of the Club succeed in school, lead healthy lifestyles, and become the kinds of citizens and leaders their community needs. BGCBI vision is that every young person who walks through the doors of the Club progresses from each grade to the next on time and graduates from high school with a solid plan for the future." By offering a wide variety of programs and activities that focus on academic success, healthy living, and leadership and service, the youth of the Ocean View Club are better prepared for a positive, bright future. BGCBI strives to provide youth development programs that support the fundamental principles and beliefs of the national Boys and Girls Club Movement. Our Core Beliefs A Boys and Girls Club provides: • A safe place to learn and grow • Ongoing relationships with caring, adult professionals NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club • Life - enhancing programs and character development experiences • Hope and opportunity Youth Development Strategy The philosophy underlying BGCBI programming is the Youth Development Strategy. All Boys and Girls Club programs and activities are designed to maximize opportunities for young people to acquire four basic "senses" which help them build self- esteem and grow into responsible and caring citizens. These four senses are: • A sense of competence — Young people feel proud and confident when they acquire new skills and know they can do something and do it well. A sense of usefulness — Young people know the satisfaction of doing something of value for others. A sense of belonging — Young people know they are welcome and feel that they fit in and are accepted. A sense of power and influence — Young people know their opinions are heard and valued and that they can influence decisions. The Ocean View Club creates a climate in which these important "senses" are fostered in every participant, member and guest involved in program or just "hanging out ". The following outcomes summarize BGCBI expectations and goals for youth entering the world at age 18: Community and Civic Involvement: Youth have a sense of belonging to their community, family and /or group and are willing to take civic responsibility. They work closely with others to contribute to the greater good. Health and Well- Being: Youth live healthy lifestyles, take part in regular fitness activities, are able to access health care resources and engage in positive behaviors. They use sound judgment about personal safety, nutrition and avoidance of alcohol, drugs and premature sexual activity. Moral Compass: Youth have values enabling them to develop positive relationships with others. These values include honesty, a sense of justice and fairness, respect, caring and spirituality. The Ocean View Club will engage youth in activities that are fun and enjoyable while supporting the development of the capacities described above. Outcome measurement will occur through a variety of surveys BGCBI uses to measure the impact their program is having on the participants. The goal of these measurement tools is to acquire the general well -being of Club members and the degree to which they are acquiring skills, competencies and attitudes in specific areas, while assessing the impact that the Boys and Girls Club has on young people. The membership cost for youth ages 6 through 18 is $10.00 per year. No child is ever turned away because of the inability to pay. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 5 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club Total Budget and Position Count— FY 2010 -2011 Total Program Budget $142,050 Total Program Position Count 6 Total Agency Budget $1,625,000 Total Agency Position Count 34 (includes $250,000 Hilo renovations Program Outcome Measures and Objectives: 1) Increase participants' knowledge and awareness of the consequences and harmful effects of tobacco, alcohol, and other drugs on their health and well- being. 2) Increase participants' ability to identify and resist peer and media pressures to engage in risky behaviors. 3) Increase participants' involvement in positive civic and community events. 4) Increase participants' positive attitude toward school /education 5) Decrease risky behavior of youth by increasing participants' positive self esteem through participation in positive youth development programs and activities on a daily basis 2009 -2010 Program Highlights: 1) Total days of operation: 250 Total hours of operation: 1,167 School days: 2:00 pm to 6:00 pm School days off — waiver days: 2:00 pm to 6:00 pm Total youth (6 through 18) registered as members of the Ocean View Club: 221 Total youth members participating in SMART Moves program curriculums: 36 2) Character and Leadership Development: • Club /Community Service Projects • Keystone Club: high school members met on Wednesday evenings from 6 pm to 8 Nisi to Mail piogiaiiis acid activities that will engage them in the Club and the community • Torch Club: middle school members met on Thursday evenings from 6 pm to 7:30 pm to assist with planning activities that provide service to others. • Junior Police Officers: the location at Kahuku Park is large and open. Staff saw the need to institute a program that would assist them in assuring the youth attending were safe and within the parameters of the park. Members, 13 to 15 years old, participated in a safety program and outlining the role they would play to assure that all youth are safe while at the park. • Keiki Club: youth ages 6 to 10 was formed to lay the foundation of serving others in the younger members. • Participation in the BGCBI Youth of the Year program • Participation in Dr. Martin Luther King, Jr. Day of Service NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 6 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club Education and Career Development: • BE GREAT - BE SMART Furlough Friday Program - Ocean View Club operated 17 Furlough Fridays from 7:30 am to 5:30 pm. The mornings were devoted to academics and the afternoons to enrichment. The only charge to parents for this service was an annual $10.00 membership for their child. • Computer Literacy at the P & R Na'alehu Community Center • Power Hour (homework assistance and tutoring): Ocean View staff also included journal writing to improve writing, spelling, grammar, and punctuation • Helping Hand: older members assist younger members with their homework • Computer Literacy at the P & R Na'alehu Community Center • Project Learn high yield learning activities: chess and scrabble being favorites of the youth • College preparation and job readiness activities • Public Speaking skill building activities • Robotics Program 3) Keystone Club Highlight: 2009 Halloween event planned and implemented by Ocean View Teens - The OV Director writes: "The Keystone Club members had a successful family Halloween event that they planned and implemented themselves. They went out in the community and solicited donations for prizes; they created all flyers that they posted throughout Na'alehu and Ocean View. Activities included: a trunk -or -treat with 45 decorated cars and @300 kids and parents enjoyed the haunted hallway, costume contest and dance. The teens were shocked on the number of participants that came and are looking forward to planning next year's event!" Performance Measures: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual Budget Estimate Youth will participate in The Arts Programs. Examples: ✓ Arts and Crafts 110 50 50 ✓ Dance ✓ Music ✓ Fine Arts Youth will participate in Character and Leadership programs. Examples: 50 35 35 ✓ Keystone Club ✓ Torch Club ✓ Community Service Projects ✓ Club Service Projects Youth will participate in Education and Career Development Programs. Examples: ✓ Power Hour 90 75 75 ✓ Project Learn ✓ Tutoring ✓ Computer Technolo NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 Boys & Girls Club of the Big I sland Positive Youth Development Programs: Ocean View Club Youth will participate in Health and Life FY 2009 -10 Actual FY 2010 -11 Budget FY 2011 -12 Estimate Skills Programs. Examples: $66,400 $89,800 $92,500 ✓ SMART Moves 72 75 75 ✓ Project TNT $36,000 $36,700 $38,500 ✓ Nutrition /Cooking Classes $1,400 $12,800 $12,500 ✓ Triple Pla $106,300 $142,050 $146,250 Youth will participate in Sports, Fitness and Recreation Programs. Examples: $5,000 0 0 ✓ Team /Individual Sports 155 100 100 ✓ Games Room Activities ✓ Fitness Activities and Programs $5,000 $20,000 $20,000 Parents /families will participate in activities to promote family 7 events 4 events per 4 events per strengthening and unity. $2,200 year year Program Expenditure Program Funding Sources: Identify all funding sources Revenue Source FY 2009 -10 Actual FY 2010 -11 Budget FY 2011 -12 Estimate Salaries and Wages $66,400 $89,800 $92,500 Professional Fees $2,500 $2,750 $2,750 Operations $36,000 $36,700 $38,500 Equipment/Supplies $1,400 $12,800 $12,500 Total $106,300 $142,050 $146,250 Program Funding Sources: Identify all funding sources Revenue Source FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual Budget Estimate County of Hawaii — $20,000 $15,000 $40,000 Nonprofit Grant Hawaii Community Foundation: Tobacco $7,500 $12,500 $12,500 Settlement Trust Fund County of Hawaii Contingency Funds $5,000 0 0 ( carryover from 08 -09 Rural Youth Crime Prevention Program (BGCH /OJP) — $5,000 $20,000 $20,000 FY 11 -12 pending contract extension Hawaii Island United $2,200 $5,000 $5,000 Way - FY 11 -12 pendin NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 8 Bovs & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club new contract Boys and Girls Clubs of America - COX Super 0 $20,000 $20,000 Resource Grant Walmart Foundation 0 $5,000 $5,000 State Giving Grant County of Hawaii — SPF SIG pending 0 $20,130 $12,080 contract execution Department of Human Services /Office of Youth $62,500 $30,000 0 Services (DHS 10 — OYS 26) 2009 OJP /BGCA $15,750 $5,250 0 Club Fundraising $1,000 $2,000 $2,000 Total $118,950 $134,880 $ 116,580 Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? BGCBI Board of Directors and leadership professionals have the following components in place for increased sustainability of programs: a) established annual agency fundraisers; b) an increase in special event fund raising efforts; c) an annual planned giving program in alignment with the Boys and Girls Clubs of America's standards of effective operations — It Just Takes One Campaign to include corporation and individual donors; d) in 2009, BGCBI created a Resource Development Department with a full -time Development Director with increase in grant writing; e) increased marketing initiatives via website design and functionality for resource development purposes; f) Board of Director strategic planning to establish an endowment fund. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 9 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. A Signature of Board President/Chair r . CQ,5ko r� Signature of Executive Director Date Date (Signature of Resource Development Director in the absence of Executive Director) UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 10 16 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club Agency Director: Contact Person: Mailing Address: Zavi Brees- Saunders Phone No.: 961 -5536 (start date: February 1, 2011) Zavi Brees- Saunders Phone No.: 961 -5536 100 Kamakahonu Street, Hilo, Hawaii 96720 Facility /Site Address: County of Hawaii Department of Parks & Recreation Pahala Community Center 96 -1149 Kamani Street Pahala, HI 96777 Fax No.: Email Address: 961 -5534 zavi @becbi.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: Mailing Address: (808) 968 -1002 P. O. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds: $30,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $40,000 $20,000 $15,000 Agency Mission Statement: To inspire and enable Big Island youth from all backgrounds, especially those from disadvantaged circumstances, to become productive and responsible citizens by offering quality programs in a safe and caring environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 1 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club Program Description: GREAT FUTURES START HERE. When opportunities are available in a community for positive participation, children are less likely to engage in substance use and other problem behaviors. The Boys and Girls Club of the Big Island ( BGCBI) — Pahala Club, provides those opportunities on a daily basis to the young people of the Pahala community. Through fun and engaging activities, BGCBI provides a positive atmosphere for youth ages 6 to 18 to explore their interests so that they can reach their full potential and contribute to their communities as productive, responsible citizens. The Pahala Club offers programs and services during non - school hours aimed at instilling a positive sense of self, increase self- esteem, self- confidence, and teach the skills necessary to make good, sound decisions. The organization was founded as the Boys Club of Hilo in 1952 and has since served over 50,000 youth of East Hawaii. In 2002, they became BGCBI and during the last 7 years, the Board of Directors and Club leadership have demonstrated their commitment by extending their service reach to the youth in Pahoa, Kea'au, Ocean View /Naalehu, Pahala and along the Hamakua coast. BGCBI success is evident on the faces of the youth who attend the Clubs along with the outcome measurement results reported to the following federal, state and private funding agencies: the Office of Juvenile Justice and Prevention, the Boys and Girls Clubs of America, the Hawaii State Department of Human Services /Office of Youth Services, the Hawaii State Department of Health /Alcohol and Drug Abuse Division, Office of Juvenile Prevention Rural Youth Program, Tobacco Trust Settlement administered by the Hawaii Community Foundation, and the Hawaii Island United Way. Reports are available upon request. The Need Ka'u Community: The Ka'u Community, 2003 Hawaii StiMpnt Alcohol, Tobacco, and Other Drug Use Study administered by the State of Hawaii Department of Health, Alcohol and Drug Abuse Division provides the following family domain data from students in the 6 t " grade ( http: / /hawaii.gov /health /substance- abuse /prevention- treatment /survey /adsurv.htm : • 49 % reported poor family supervision • 18 % reported lack of parental sanctions for Anti - Social Behaviors (ASB's) • 18 % reported parental attitudes favorable toward ATOD use • 53 % reported exposure to family ATOD use • 12 % reported a family (sibling) history of ASB The 2009 -2010 School Quality Survey for Ka'u High and Pahala Elementary School indicated that only 66 % of parents are involved in their child's school. ( http: / /doe. kl 2. hi. us NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 2 & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club The Ka'u High and Pahala Elementary School Status and Improvement Report for School Year 2009 -2010 (http: / /doe.kl2.hi.us provides the following information: • Average Daily Attendance of 90.2 % as compared to the state standard of 95% • Average Daily Absences of 15.9 days as compared to the state standard of 9 days i 64.6 % of the students receive free or reduced -cost lunch • The Hawaii Content and Performance Standards show Ka'u High and Pahala Elementary School students are 24% below the State average in reading; 19% below the State average in math • The Terrallova scores for 7 th grade students at Pahala Elementary School indicate 50% of the students are below the national norm in reading and 61% of 7 th grade students are below the national norm in math The Hawaii Student ATOD study indicates that 56% of middle school students in the Ka'u community experience community disorganization, 45% view laws and norms favorable to drug use, 48% engaged in early initiation of problem behaviors, 47% showed a low perceived risk of ATOD use, 53% interacted with antisocial peers, and 48% felt that their friends reward them for antisocial involvement. A conclusion of the same study indicated that 46% of the 6 th grade students who participated had a high probability of developing a substance abuse problem or engaging in other problem behaviors. Only 25% of the students who participated in the study had a high number of protective factors indicating that they were less likely to use substances or engage in antisocial behaviors. Data from Center on the Family of the University of Hawaii ( http: / /uhfamily.hawaii.edu concludes that the people of the Ka'u District face a number of economic, social, and educational hardships. The unemployment rate is the worst in the State. The per capita income is lower than in most other communities Statewide. High proportions of the very young live in poverty, and one -third of the families receive food stamps. The Office of Juvenile Prevention SMART System assigns a Community Disadvantage Index of 9 (scale 1 low to 10 nigh) to the Ka'u community. All of this powerful data points to the overwhelming need Ka'u youth and families have for establishing relationships with adults and professionals who care enough to assist them in developing positive personal qualities and support them in their homes, schools, and communities. BGCBI Pahala Club addresses these needs on a daily basis when they open their doors and encourage all youth who enter to Lim, Service Delivery The Pahala Club conducts daily after - school, half -day intercession, and occasional evening and weekend programs which include Boys & Girls Club of America's five core programs areas: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club • Sports Fitness and Recreation Development develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills. Activities and programs include: game room, indoor /outdoor activities, table tournaments and inter -club leagues. • The Arts: enables youth to develop their creativity and cultural awareness through knowledge and an appreciation of the visual arts, crafts, performing arts and creative writing. • Education and Career Development enables our youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career. • Character & Leadership Development: empowers our youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others' cultural identities. • Health & Life Skills Development: develops our youth's capacity to engage in positive behaviors that nurture their own well- being, set personal goals and live successfully as self- sufficient adults. Every day at the Pahala Club, youth are greeted by caring, trained youth development staff. These professionals have joined the Boys and Girls Clubs of America "Movement - wide effort to help assure that the members of the Club succeed in school, lead healthy lifestyles, and become the kinds of citizens and leaders their community needs. BGCBI vision is that every young person who walks through the doors of the Club progresses from each grade to the next on time and graduates from high school with a solid plan for the future." By offering a wide variety of programs and activities that focus on academic success, healthy living, and leadership and service, the youth of the Pahala Club are better prepared for a positive, bright future. BGCBI strives to provide youth development programs that support the fundamental principles and beliefs of the national Boys and Girls Club Movement. Our Core Beliefs A Boys and Girls Club provides: • A safe place to learn and grow • Ongoing relationships with caring, adult professionals • Life - enhancing programs and character development experiences • Hope and opportunity Youth Development Strategy The philosophy underlying BGCBI programming is the Youth Development Strategy. All Boys and Girls Club programs and activities are designed to maximize opportunities for young people to acquire four basic "senses" which help them build self- esteem and grow into responsible and caring citizens. These four senses are: • A sense of competence — Young people feel proud and confident when they acquire new skills and know they can do something and do it well. • A sense of usefulness — Young people know the satisfaction of doing something of value for others. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club • A sense of belonging — Young people know they are welcome and feel that they fit in and are accepted. • A sense of power and influence — Young people know their opinions are heard and valued and that they can influence decisions. The Pahala Club creates a climate in which these important "senses" are fostered in every participant, member and guest involved in program or just "hanging out ". The following outcomes summarize BGCBI expectations and goals for youth entering the world at age 18: Community and Civic Involvement: Youth have a sense of belonging to their community, family and /or group and are willing to take civic responsibility. They work closely with others to contribute to the greater good. Health and Well- Being: Youth live healthy lifestyles, take part in regular fitness activities, are able to access health care resources and engage in positive behaviors. They use sound judgment about personal safety, nutrition and avoidance of alcohol, drugs and premature sexual activity. Moral Compass: Youth have values enabling them to develop positive relationships with others. These values include honesty, a sense of justice and fairness, respect, caring and spirituality. The Pahala Club will engage youth in activities that are fun and enjoyable while supporting the development of the capacities described above. Outcome measurement will occur through a variety of surveys BGCBI uses to measure the impact their program is having on the participants. The goal of these measurement tools is to acquire the general well -being of Club members and the degree to which they are acquiring skills, competencies and attitudes in specific areas, while assessing the impact that the Boys and Girls Club has on young people. The membership cost for youth ages 6 through 18 is $10.00 per year. No child is ever turned away because of the inability to pay. Total Budget and Position Count— FY 2010 -2011 Total Program Budget $122,420 Total Program Position Count 4 Total Agency Budget $1,625,000 Total Agency Position Count 34 (includes $250,000 Hilo renovations Program Outcome Measures and Objectives: 1) Increase participants' knowledge and awareness of the consequences and harmful effects of tobacco, alcohol, and other drugs on their health and well- being. 2) Increase participants' ability to identify and resist peer and media pressures to engage in risky behaviors. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 5 & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club 3) Increase participants' involvement in positive civic and community events. 4) Increase participants' positive attitude toward school /education 5) Decrease risky behavior of youth by increasing participants' positive self esteem through participation in positive youth development programs and activities on a daily basis 2009 -2010 Program Highlights: 1) Total days of operation: 242 Total hours of operation: 1,069 School days: 2:00 pm to 6:00 pm School days off — waiver days and intercessions: 1:00 pm to 5:00 pm Total youth (ages 6 through 18) registered as members of the Pahala Club: 158 Total youth members participating in Too Good for Drugs and Violence program curriculums: 59 2) Positive Youth Development Activities: • Participation in the 1 St Annual "Get Healthy Ka'u 5k Walk- a -Thon" • Participation in the 2 d Annual Keiki Fishing Tournament at Punalu'u Beach Park. • A strong partnership between the Pahala Boys and Girls Club and the staff of Kau Hospital • Power Hour (homework assistance) is a top priority upon arrival at the Club. On Monday's and Friday's, Club members spend one hour at the Pahala Public Library and work with the librarian on their reading skills. • The partnership with Parks and Recreation in Pahala continues to grow with the sharing of resources that expose our youth to a variety of activities without duplicating services. • Kick Butts Day 2010 was celebrated in March with youth participating in numerous activities that both educated our youth as to the harmful effects of tobacco use and how they can be advocates for a smoke -free lifestyle. • The Pahala Club members continued to participate in Ukulele Lessons with volunteer Keoki Kahumoku. Hula dance is being taught by volunteer Ulu Makuakane who earned the title of 2010 Miss Ka'u Coffee. • Partnership with Na Pua No eau provided Hawaiian cultural activities and field trips on a monthly basis. In November 2009, the Pahala Club and Na Pua No eau hosted a Makahiki in Na'alehu ballpark with Hawaiian sports and games, tug -of -war, ulumaika and spearing banana stalks. Na Pua No eau also educated Pahala members on healthy living, planting their own food, and giving back to their community. Youth were able to experience numerous field trips through the generosity of this group. Some trips included: Imiloa Astrology Center, University of Hawaii at Hilo, local beaches to hold Hawaiian history and cultural classes. • Healthy eating and nutrition is impressed with Pahala Club members through the services of a nutrition specialist who works with youth. • BE GREAT — BE SMART Furlough Friday program operated 17 Furlough Fridays from 7:30 am to 5:30 pm. The mornings were devoted to academics NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 6 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club and the afternoons to enrichment. The only charge to parents for this service was an annual $10.00 membership for their child. Performance Measures: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual Budget Estimate Youth will participate in The Arts Programs. Examples: ✓ Arts and Crafts 95 50 50 ✓ Dance ✓ Music ✓ Fine Arts Youth will participate in Character and Leadership programs. Examples: ✓ Keystone Club 63 25 25 ✓ Torch Club ✓ Community Service Projects ✓ Club Service Projects Youth will participate in Education and Career Development Programs. Examples: 118 75 75 ✓ Power Hour ✓ Project Learn ✓ Tutoring ✓ Computer Technolo Youth will participate in Health and Life Skills Programs. Examples: ✓ SMART Moves 60 50 50 ✓ Project TNT ✓ Nutrition /Cooking Classes ✓ Triple Pla Youth will participate in Sports, Fitness and Recreation Programs. Examples: 100 75 75 ✓ Team /Individual Sports ✓ Games Room Activities ✓ Fitness Activities and Programs Parents /families will participate in activities to promote family 6 events 4 events per 4 events per year strengthening and unity. yea r NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 Boys & Girls Club of the Big Isla Positive Youth Development Programs: Pahala Club Program Expenditure Program Funding Sources: Identify all funding sources Revenue Source FY 2009 -10 Actual FY 2010 -11 Budget FY 2011 -12 Estimate Salaries and Wages $60,602 $70,970 $73,100 Professional Fees $2,500 $2,750 $2,750 Operations $51,100 $36,700 $38,500 Equipment $1,400 $12,000 $12,000 Total $115,602 $122,420 $126,350 Program Funding Sources: Identify all funding sources Revenue Source FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual Budget Estimate County of Hawaii - $20,000 $15,000 $30,000 Nonprofit Grant Hawaii Community Foundation: Tobacco $14,167 $12,500 $12,500 Settlement Trust Fund County of Hawaii Contingency Funds $5,000 0 0 (carryover from 08 -09) Rural Youth Crime Prevention Program (BGCH /OJP) - $23,750 $20,000 $20,000 FY 11 -12 pending contract extension Hawaii Island United Way - FY 11 -12 pending new $2,200 $5,000 $5,000 contract Boys and Girls Clubs of America - COX Super $35,000 $20,000 $20,000 Resource Grant Walmart Foundation State 0 $5,000 $5,000 Giving Grant Boys and Girls Clubs of America/Walmart 0 $6,000 0 Foundation Department of Human Services /Office of Youth 0 $30,000 0 Services (DHS 08 - OYS 26 Club Fundraising $1,000 $2,000 $2,000 Total $101,117 $115,500 $94,500 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 8 Boys & Girls Club of the Big Is land Positive Youth Development Programs: Pahala Club Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? BGCBI Board of Directors and leadership professionals have the following components in place for increased sustainability of programs: a) established annual agency fundraisers; b) an increase in special event fund raising efforts; c) an annual planned giving program in alignment with the Boys and Girls Clubs of America's standards of effective operations — It Just Takes One Campaign to include corporation and individual donors; d) in 2009, BGCBI created a Resource Development Department with a full -time Development Director with increase in grant writing; e) increased marketing initiatives via website design and functionality for resource development purposes; f) Board of Director strategic planning to establish an endowment fund. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 9 & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board President /Chair Signature of Executive Director Date ' Date (Signature of Resource Development Director in the absence of Executive Director) UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 10 17 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club Boys & Girls Club of the Big Island Conov Positive Youth Development Programs: Pahoa Club Agency Director: Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Zavi Brees- Saunders Phone No.: 961 -5536 (start date: February 1, 2011) Zavi Brees- Saunders Phone No.: 961 -5536 100 Kamakahonu Street, Hilo, Hawaii 96720 Pahoa Intermediate & High School 15 -3038 Puna Road, Pahoa, Hawaii 96778 961 -5534 zavi @becbi.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: Mailing Address: (808) 968 -1002 P. O. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds: $30,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $40,000 $20,000 $15,000 Agency Mission Statement: To inspire and enable Big Island youth from all backgrounds, especially those from disadvantaged circumstances, to become productive and responsible citizens by offering quality programs in a safe and caring environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 1 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club Program Description: When opportunities are available in a community for positive participation, children are less likely to engage in substance use and other problem behaviors. The Boys and Girls Club of the Big Island ( BGCBI) — Pahoa Club, provides those opportunities on a daily basis to the young people of the Pahoa community. Through fun and engaging activities, BGCBI provides a positive atmosphere for youth ages 6 to 18 to explore their interests so that they can reach their full potential and contribute to their communities as productive, responsible citizens. The Pahoa Club offers programs and services during non - school hours aimed at instilling a positive sense of self, increase self- esteem, self- confidence, and teach the skills necessary to make good, sound decisions. The organization was founded as the Boys Club of Hilo in 1952 and has since served over 50,000 youth of East Hawaii. In 2002, they became BGCBI and during the last 7 years, the Board of Directors and Club leadership have demonstrated their commitment by extending their service reach to the youth in Pahoa, Kea'au, Ocean View /Naalehu, Pahala and along the Hamakua coast. BGCBI success is evident on the faces of the youth who attend the Clubs along with the outcome measurement results reported to the following federal, state and private funding agencies: the Office of Juvenile Justice and Prevention, the Boys and Girls Clubs of America, the Hawaii State Department of Human Services /Office of Youth Services, the Hawaii State Department of Health /Alcohol and Drug Abuse Division, Office of Juvenile Prevention Rural Youth Program, Tobacco Trust Settlement administered by the Hawaii Community Foundation, and the Hawaii Island United Way. Reports are available upon request. The Need Pahoa Community: Data compiled by the Office of Juvenile Prevention (OJP) SMART system assigns a Community Disadvantage Index of 10 (scale 1 low to 10 high) to the Pahoa area. The above community, family and child indicators show powerful support of this index. According to the Center on the Family "this area has the third highest unemployment rate, the third lowest per capita income, and the highest percentage in the State of families who rely on food stamps. The poverty rate of young children is second in the State. More than 55% of the residents in the Pahoa area receive food stamp assistance. Strengths found in the Pahoa Area include low teacher turnover and the second highest percentage of teachers with advanced degrees in the State. Adolescents report close family and neighborhood ties. The East Hawaii Community Profile document written by Center on the Family, University of Hawaii at Manoa, states that the problem of alcohol, tobacco and other drug use among the children of East Hawaii is a serious one. The youth of this NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 2 & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club community start using early, as indicated by the comparatively high rates of sixth graders reporting cigarette, alcohol, marijuana, and crystal methamphetamine use in the 30 days before taking the Hawaii Student ATOD Use Study. East Hawaii has a higher rate, compared to the State, of twelfth graders who claim to drink alcohol on a daily basis and, at all grade levels, youth who have been identified as needing treatment." The 2003 Hawaii Student ATOD Use Study indicates the East Hawaii youth, family, school and community need for substance abuse prevention programs. The following table shows the prevalence of ATOD use 30 days prior to taking the survey for youth of the East Hawaii communities: Substance Use Reported East State by Students Hawaii Smoking cigarettes in the past month • Grade 10 15.6% 11.3% Drinking any alcohol in past month • Grade 12 55.8% 36.3% Drinking alcohol daily in past month • Grade 6 1.9% 0.4% Using marijuana in past month • Grade 6 8.8% 1.0% Using crystal methamphetamine in past month ® Grade 6 3.5% 0.2% Using inhalants in past month • Grade 6 5.4% 1.9% As indicated above, youth in East Hawaii are faced with risk factors such as early initiation of problem behaviors w /alcohol and drug use, favorable attitude towards ATOD use, low perceived ATOD use risk and peer approval of ATOD use. Community, school, and family risk factors include exposure of youth to alcohol and drugs, low school commitment, poor academic performance, lack of family supervision /involvement, lack of parental sanctions for antisocial behaviors, and factors affecting family socioeconomic struggles, such as unemployment and substance abuse. All these risk factors affect youth's ability to make a successful transition to adulthood. The East Hawaii community profile states that in the realm of individual characteristics and peer influence, East Hawaii teens are high on risk and low on protection. The teens of East Hawaii were the highest in the State on three measures of risk: enjoying doing crazy or dangerous things and will take a dare or do what feels good without thinking about the consequences; an attitude that condones antisocial behaviors; and they see nothing wrong with smoking, drinking, or using illegal drugs. All of this powerful data points to the overwhelming need East Hawaii youth and families have for establishing relationships with adults and professionals who care enough to NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club assist them in developing positive personal qualities and support them in their homes, schools, and communities. BGCBI Pahoa Club addresses these needs on a daily basis when they open their doors and encourage all youth who enter to Service Delive The Pahoa Club has been making a difference in the Puna District since October 2003, initially providing services part -time 2 -3 days a week at the Nanawale Subdivision's Community Center. In August 2004, the program expanded to five days a week and in June 2006 moved to their present location at Pahoa Intermediate and High School, operating Monday through Friday from 2:00 pm to 6:00 pm. On school days off and intercessions, the Club is open full -day providing care to those youth whose parents are employed. The Pahoa Club has formed a strong relationship with the Pahoa DOE School Complex who supports their efforts by providing the BGCBI two large portable classrooms used for implementing BGCA core programs. The Pahoa Club also has use of the school complex fields and outdoor facilities available for sports fitness and athletic activities. The Pahoa Club conducts daily after - school, evening, weekend and full -day intercession programs which include Boys & Girls Club of America's five core programs areas: • Sports, Fitness and Recreation Development develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills. • The Arts: enables youth to develop their creativity and cultural awareness through knowledge and an appreciation of the visual arts, crafts, performing arts and creative writing. • Education and Career Development enables youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career. • Character & Leadership Development: empowers youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others' cultural identities. • Health & Life Skills Development: develops youth's capacity to engage in positive behaviors that nurture their own well- being, set personal goals and live successfully as self- sufficient adults. Every day at the Pahoa Club, youth are greeted by caring, trained youth development staff. These professionals have joined the Boys and Girls Clubs of America "Movement - wide effort to help assure that the members of the Club succeed in school, lead healthy lifestyles, and become the kinds of citizens and leaders their community needs. BGCBI vision is that every young person who walks through the doors of the Club progresses from each grade to the next on time and graduates from high school with a solid plan for the future." By offering a wide variety of programs and activities that focus on academic NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 Boys & Girls Club of the Big Isl Positive Youth Development Programs: Pahoa Club success, healthy living, and leadership and service, the youth of the Pahoa Club are better prepared for a positive, bright future. BGCBI strives to provide youth development programs that support the fundamental principles and beliefs of the national Boys and Girls Club Movement. Our Core Beliefs A Boys and Girls Club provides: • A safe place to learn and grow • Ongoing relationships with caring, adult professionals • Life - enhancing programs and character development experiences • Hope and opportunity Youth Development Strategy The philosophy underlying BGCBI programming is the Youth Development Strategy. All Boys and Girls Club programs and activities are designed to maximize opportunities for young people to acquire four basic "senses" which help them build self- esteem and grow into responsible and caring citizens. These four senses are: • A sense of competence — Young people feel proud and confident when they acquire new skills and know they can do something and do it well. • A sense of usefulness — Young people know the satisfaction of doing something of value for others. • A sense of belonging — Young people know they are welcome and feel that they fit in and are accepted. • A sense of power and influence — Young people know their opinions are heard and valued and that they can influence decisions. The Pahoa Club creates a climate in which these important "senses" are fostered in every participant, member and guest involved in program or just "hanging out ". The following outcomes summarize BGCBI expectations and goals for youth entering the world at age 18: Community and Civic Involvement: Youth have a sense of belonging to their community, family and /or group and are willing to take civic responsibility. They work closely with others to contribute to the greater good. Health and Well- Being: Youth live healthy lifestyles, take part in regular fitness activities, are able to access health care resources and engage in positive behaviors. They use sound judgment about personal safety, nutrition and avoidance of alcohol, drugs and premature sexual activity. Moral Compass: Youth have values enabling them to develop positive relationships with others. These values include honesty, a sense of justice and fairness, respect, caring and spirituality. The Pahoa Club will engage youth in activities that are fun and enjoyable while supporting the development of the capacities described above. Outcome measurement will occur through a variety of surveys BGCBI uses to measure the impact their program NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 5 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club is having on the participants. The goal of these measurement tools is to acquire the general well -being of Club members and the degree to which they are acquiring skills, competencies and attitudes in specific areas, while assessing the impact that the Boys and Girls Club has on young people. The membership cost for youth ages 6 through 18 is $10.00 per year. No child is ever turned away because of the inability to pay. Total Budget and Position Count— FY 2010 -2011 Total Program Budget $143,225 Total Program Position Count 4 Total Agency Budget $1,625,000 Total Agency Position Count 34 (includes $250,000 Hilo renovations Program Outcome Measures and Objectives: 1) Increase participants' knowledge and awareness of the consequences and harmful effects of tobacco, alcohol, and other drugs on their health and well- being. 2) Increase participants' ability to identify and resist peer and media pressures to engage in risky behaviors. 3) Increase participants' involvement in positive civic and community events. 4) Increase participants' positive attitude toward school /education 5) Decrease risky behavior of youth by increasing participants' positive self esteem through participation in positive youth development programs and activities on a daily basis 2009 -2010 Program Highlights: 1) Total days of operation: 245 Total hours of operation: 1,487 School days: 2:00 pm to 6:00 pm School days off — waiver days and intercessions: 7:30 am to 5:30 pm Total youth (ages 6 through 18) registered as members of the Pahoa Club: 215 Total youth members participating in Too Good For Drugs & Violence, Stay SMART AND SMART Leaders ATOD prevention program curriculums: 71 Total other youth participating in ATOD prevention program curriculum through outreach: 55 2) Character and Leadership Development • Pahoa Town Clean -ups • Chartered Torch Club and Keystone Club — participation in beach beautifications, International Coastal Clean -up — Get The Drift & Bag It!, Dr. Martin Luther King, Jr. Day of Service, Red Hand Event at Pahoa High and Intermediate School (PHIS), Kick Butts Day Rally at PHIS, Kick Butts Day activities at Pahoa Club afterschool program, community special events, parades, festivals • SMART Leaders assisted staff in teaching the alcohol, tobacco, and other drug (ATOD) prevention curriculum Too Good For Drugs and Violence NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 6 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club Members became Junior Rangers at Volcano National Park BGCBI Youth of the Year winner — Pahoa Club member, Meghan McGrath, received the highest award any member of a Boys and Girls Club can achieve. In January 2010, Meghan was chosen by our Board of Directors as BGCBI's 2010 Youth of the Year. She competed against other state Club winners in the state competition in March. Meghan was BGCBI 2009 Youth of the Year also and was given the opportunity to be a part of the Hawaii Island United Way's campaign video for 2009! Meghan was officially honored by BGCBI at the BE GREAT Awards Dinner in March 2010. Education and Career Development • Power Hour (homework assistance and tutoring) — 144 days • BE GREAT — BE SMART Furlough Friday Program — Pahoa Club operated 17 Furlough Fridays from 7:30 am to 5:30 pm. The mornings were devoted to academics and the afternoons to enrichment. The only charge to parents for this service was an annual $10.00 membership for their child. • Project Learn implemented daily (high yield learning activities) • Career theme events • Hawaiian culture education • Participation in Alu Like Summer Youth Employment Program • Tobacco education activities included: Kick Butts Day at the State Capitol, Kick Butts Day rally at PHIS with 250 youth in attendance, Kick Butts Day activities at the Pahoa Club with afterschool members, participation in civic education with supporting Bill 216, Freeze Mob activity in partnership with REAL at the Hawaii Island County Fair • Hawaiian culture education activities • Computer Literacy O Family Strengthening Activities: Subjects and topics included: School Supply Giveaway /About Pahoa Club, Career Night, Cultural Sharing and Celebration, Santa is Coming to Pahoa Town, Pahoa Town Christmas Parade, Dr. Martin Luther King, Jr. Day of Service Project, Health and Wellness, Merry Monarch Parade, Health and Safety, Looking Back through Scrapbooking Agencies BGCBI continued to maintain relationships with in FY 2009 -2010 included: Tobacco -Free Big Island Coalition, American Lung Association, American Cancer Society, REAL, The Salvation Army Family Intervention Services, Lanikila Learning Center, Alu Like, Department of Defense Summer Youth Employment Program, Pahoa Weed and Seed Project, United States Tennis Association — Hawaii Pacific Section, Bay Clinic, State of Hawaii Department of Education, PATCH, Kick - the -Nic, Prosecuting Attorney's Office, and Hawaii County Department of Parks & Recreation. Performance Measures: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual Budget Estimate Youth will participate in The Arts Programs. Examples: 110 75 75 ✓ Arts and Crafts ✓ Dance NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 Bovs & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club ✓ Music FY 2009 -10 Actual FY 2010 -11 Budget FY 2011 -12 Estimate ✓ Fine Arts $88,000 $80,600 $83,100 Youth will participate in Character $2,500 $2,750 $2,750 and Leadership programs. $51,100 $45,100 $47,355 Examples: $1,400 $14,775 $12,765 ✓ Keystone Club 54 40 40 ✓ Torch Club $143,000 $143,225 $145,970 ✓ Community Service Projects ✓ Club Service Projects Youth will participate in Education and Career Development Programs. Examples: ✓ Power Hour 129 100 100 ✓ Project Learn ✓ Tutoring ✓ Computer Technolo Youth will participate in Health and Life Skills Programs. Examples: ✓ SMART Moves 126 100 100 ✓ Project TNT ✓ Nutrition /Cooking Classes ✓ Triple Pla Youth will participate in Sports, Fitness and Recreation Programs. Examples: ✓ Team /Individual Sports 150 120 120 ✓ Games Room Activities ✓ Fitness Activities and Programs Parents /families will participate in activities to promote family 10 events 4 events per 4 events per strengthening and unity. year year Program Expenditure NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 8 FY 2009 -10 Actual FY 2010 -11 Budget FY 2011 -12 Estimate Salaries and Wages $88,000 $80,600 $83,100 Professional Fees $2,500 $2,750 $2,750 Operations $51,100 $45,100 $47,355 Equipment/Supplies $1,400 $14,775 $12,765 Other Total $143,000 $143,225 $145,970 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 8 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club Program Funding Sources: Identify all funding sources Revenue Source FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual Budget Estimate County of Hawaii- $20,000 $15,000 $30,000 Nonprofit Grant Hawaii Community Foundation: Tobacco $14,167 $12,500 $12,500 Settlement Trust Fund County of Hawaii Contingency Funds $6,500 0 0 ( carryover from 08 -09) Rural Youth Crime Prevention Program $23,750 $15,000 $15,000 (BGCH /OJP) - FY 11 -12 pending contract extension Hawaii Island United Way - FY 11 -12 pending new $2,200 $5,000 $5,000 contract Boys and Girls Clubs of America - COX Super $35,000 $11,000 $11,000 Resource Grant Walmart Foundation State 0 $5,000 5,000 Giving Grant Boys and Girls Clubs of America/Walmart 0 $6,000 0 Foundation County of Hawaii - SPF SIG pending contract 0 $29,300 $17,560 execution ADAD - FY 11 -12 pending $25,000 $15,000 $15,000 contract extension BGCA/OJP 2010 Mentoring 0 $11,666 $3,900 Department of Human Services /Office of Youth Services /BESSD (DHS 11 - OYS /BESSD 336) - FY 11 -12 pending 0 $15,000 $15,000 contract extension Club Fundraising $10,000 $10,000 $11,000 Total $136,617 $150,466 $140,960 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 9 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? BGCBI Board of Directors and leadership professionals have the following components in place for increased sustainability of programs: a) established annual agency fundraisers; b) an increase in special event fund raising efforts; c) an annual planned giving program in alignment with the Boys and Girls Clubs of America's standards of effective operations — It Just Takes One Campaign to include corporation and individual donors; d) in 2009, BGCBI created a Resource Development Department with a full -time Development Director with increase in grant writing; e) increased marketing initiatives via website design and functionality for resource development purposes; f) Board of Director strategic planning to establish an endowment fund. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 10 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year-end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. ,t ` Signature of Board President /Chair Date r- Signature of Executive Directo ,f1_(. I Date (Signature of Resource Development Director in the absence of Executive Director) NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 11 W e Brantley Center, Inc. Employment Rehabilitation Program Brantley Center, Inc.- Agency Name Employment Rehabilitation- Program Name Agency Director: Steven Pavao Phone No.: '7 15 -1 z yr Contact Person: Steven Pavao Phone No.: I -16--1 2�S Mailing Address: Facility /Site Address: Fax No.: Email Address: P.O. Box 1407 Honoka'a, HI 96727 45 -370 Ohelo Street Honoka'a, HI 96727 775 -0211 bcenter2@hawaiiantel.net Name of Accountant/CPA (include name of firm if applicable): Jennifer Gossert, CPA Phone No.: 969 -3115 Mailing Address: 688 Kinoole Street Suite 201 Hilo, HI 96720 Amount of Request for County Funds: $25,000 Prior Year(s) Funding: 08-09 09-10 10 -11 $10,000 $20,000 $20,000 Agency Mission Statement: To provide quality rehabilitative services to people with disabilities that empower them to participate independently in their community. NONPROFIT GRANT APPLICATION FISCAL VF AR 201142 Page 1 Brantley Center, Inc -Agency Name Employment Rehabilitation- Program Name Program Description: The Employment Rehabilitation Program provides participants with a variety of services that develop and support the accomplishment of goals leading to meaningful employment. These services include; job- readiness classes, competitive employment placement services, and on-the-job follow -up services. Participants receive quality vocational training and at the same time are paid for the work performed. Program staff work closely with the community to provide community -based vocational training, and at the same time provide the public with an additional workforce. Also included in this program are the work transition services for high school students with disabilities. Total Budget and Position Count Total Program Budget 218,477 Total Pro ram Position Count Total Agency Budget 372,099 Total A ency Position Count Program Objectives: 1) Provide vocational evaluations to 35 clients 2) Provide individualized employment planning services to 25 clients 3) Provide work adjustment training to 25 clients 4) Provide occupational skills to 25 clients 5) Provide job- readiness classes to 20 clients 6) Provide competitive job placement and follow -up services to 15 clients 7) Provide work transition services to 15 high school students with disabilities Program Highlights: (from Fiscal Year 2009 -10) 1) 2) 3) 4) 5) 6) 7) Provided vocational evalautions to 12 clients Provided individualized employment planning services to 14 clients Provided work adjustment training to 10 clients Provided vocational training skills to 18 cleints Provided specialized job - readiness classes for 9 cleints Provided job placement services for 8 clients Provided work transition services to 6 high school students NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 0 Page 3 Brantley Center, Inc. - Age Name Emplyment Rehabilitation - Program Name Performance Measures: Number of clients who received employment rehabilitation services. FY 2009 -10 Actual * 21 FY 2010 -11 Budget * 22 FY 2011 -12 Estimate 24 Number of consumers with improved scores on the vocational Evaluation Training Report 8 10 12 Number of consumers with im orved Productivity percentages 12 14 14 Number of consumers who successfully completed the job - readiness class 8 10 10 Number of consumers placed in competitive employment for a minimum of 90 da s 6 10 10 Number of students who received work transition services and were laced in competitive employment 4 12 12 0 Total *If annlinahia 216,941 218,477 232,465 KAtifium,au a Program Expenditures # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 FY 2009 -10 Actual * FY 2010 -11 Bud et * FY 2011 -12 Estimate Salaries and Wages 125,346 126,470 136,788 Professional Fees 15,394 15,415 16,000 Operations Equipment 76,201 76,592 79,677 0 0 0 Other' 0 0 Total *If annlinahia 216,941 218,477 232,465 # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Brantley Center, Inc Agency Name Employment Rehabilitation - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source County of Hawaii State of Hawaii Hawaii Island United My _. 00 . unty of Hawaii -Mass Transit Program Sales & Services Fundraising FY 2009 -10 Actual * 20,000 30,000 20,000 21,000 121,753 4,188 FY 2010 -11 _ . , Budge * 20,000 30,000 20,000 21,000 125,000 2,477 FY 2011 -12 Estimate 25,000 30,000 20,000 21,000 130,000 6,465 11232,41 Total *If �.%r%1i.+. k1- 216,741 uNN11vau1c Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The Brantley Center, Inc. has made a concerted effort to expand its fund development capabilities. In 2010 it initiated it first "Annual Campaign" to raise individual donations for operating capital. The Center is currently working on plans for additional fundraising in 2011. The current financial climate howver makes fundraising challenging. The goal for this program is to become self - sustaining, but the current reality of the economic climate makes that impossible. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Brantley Center, Inc. - Agency Name Employment Rehabilitation - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawal`i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely. complete, and accurate Year -end report will impact the evaluation of Your program's or agency's future funding requests Sig ture �of Signatur(pf Executive Director /- 3 �-- // Date /-31- l 1 Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTEDI NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 19 Bridge House, Inc. Vocational Skills Building Program Bridge House, Inc.- Agency Name 'Vocational Skills Building Program " - Program Name Agency Director: 322 -3305 Mark Schuster Phone No.: 808- Contact Person: 322 -3305 Mailing Address: Facility /Site Address: Fax No.: Mark Schuster P.O. Box 2489 Kailua Kona, HI 96745 78 -6687B Mamalahoa Hwy. Holualoa, HI 96725 808- 322 -0809 Phone No.: 808- Email Address: mark Name of Accountant/CPA (include name of firm if applicable): 'Smart Solutions' % Brenda Smith Phone No.: 808 -960 -5041 Mailing Address: P.O. Box 1164 Captain Cook, HI 96704 Amount of Request for County Funds: $30,0000.00 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $12,000 $15,000 $10,000 Agency Mission Statement: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 The Bridge House mission is to assist adults who are in recovery from drug /alcohol addiction, to develop successful living skills through residential and vocational experiences in our safe, structured and supportive environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Bridge House, Inc. - Agency Name "Vocational Skills Building Program " - Program Name Program Description: The "Vocational Skills Building Program" (VSB) is our specialized in -house program component that provides assessment, referrals and linkage, as well as on -site training that will prepare graduating residents for entry/re -entry into the workforce. This is a mandatory component of the Bridge House experience, for all residents who are unemployed at any time during their stay. Total Budget and Position Count Total Program Bud 78700.00 Total Program Position Count 1.25 Total Agency Bud 307152.75 Total Agency Position Count 1 3 Program Objectives: 1) The VSB generally includes the following components: 1.) Assessment of vocational history, skills, attitude and behavior 2.) On -site training/vocational assignments (this allows staff to observe resident attitude, integrity, punctuality, reliability, etc) 3.) Weekly review of progress towards employment readiness 4.) Referrals/linkages to community and State vocational training or employment resources 4.) Transportation to and from the various training /employment resource centers 5.) In -house assistance with beginning the process of securing employment (e.g. completing job applications, resume preparation, mock interviews, use of office computer and equipment) 6.) Transportation to work -site. 7.) Specialized training in gardening /agriculture. Program Highlights: (from Fiscal Year 2009 -10) 1) 45% of all admits graduated with a 'clinical discharge /program completion', and at 6 months post - discharge 25% were maintaining full - time employment. 2) Of the 50°x6 that we were able to locate at 6 months follow-up, 0% had experienced relapse, were a re- arrest or had been incarcerated. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Bridge House, Inc. - Agency Name • "Vocational Skills Building Program" - Program Name Performance Measures: If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Admits completing the program 45% 65% 65% Graduates employed or attending school/training at discharge 14% 40% 60% At 6 mos post discharge follow-up: 14225.76 14300.00 14400.00 -g raduates remain clean /sober n/a n/a 85% -no new arrests n/a n/a 85% -no incarcerations n/a n/a 85% -g raduates employed n/a n/a 65% If applicable Program Expenditures 11 appncaAie Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 44203.08 40400.00 44100.00 Professional Fees 5175.65 4500.00 4600.00 Operations 14225.76 14300.00 14400.00 Equipment 9429.03 9500.00 9800.00 Other* 5629.89 5500.00 5800.00 Total 1 78663.41 1 742000.00 78700.00 11 appncaAie Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Bridge House, Inc. - Agency Name "Vocational Skills Building Program" - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Hawaii Island United Way 26666.64 23083.32 23083.32 State of Hawaii /ADAD 15146.77 20116.68 13616.68 HI County 15000.00 10000.00 10000.00 Program Fees 10,000.00 19000.00 10000.00 HCF Funds 10000.00 n/a n/a Donations 1850.00 2000.00 2000.00 Total 78663.41 1 742000.00 787000.00 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? We continue to maintain our lychee orchard, and sell the fruit to individuals and our local health food store. In addition, we have planted over 100 keiki coffee trees, with plans to add another 100 trees this year. We are also working with an organic vegetable produce distributor who is assisting us with developing our growing grounds, and who is willing to market our harvest. While sales of produce will help support our program, it is unlikely that we will yet generate enough income to become self - supporting. Thus, we continue to seek out private donations, agricultural oriented grants, and pursue fundraising activities. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Bridge House, Inc. P.O. Box 2489 Kailua -Kona, Hi 96745 Phone: 808 - 322- 3305/Fax: 808 - 322-08 "Program Expenditures" addendum "Other" Includes expenses such as office supplies, drug testing kits, maintenance on agricultural equipment, weedwhacker string, fertilizer, etc. Bridge House, Inc. receives funding from the Deparbnent of Health Akohol & Drug Abuse DMsion, Hawaii Island United Way, Kapiolani Child protection Center, County of Hawa17 and private donations. Bridge House, Inc. - Agency Name "Vocational Skills Building Program" - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that 1 (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, l (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of Your prouram's or agency's future funding requests. Signature of Board President/Chair of Executive Director cnk— 1 7-- 1 1 Date 111�/(( - Oat' I UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 20 Child & Family Service Alternatives to Violence Program Child & Family Service — Agency Name Alternatives to Violence Program — Program Name Agency Director: Howard Garval, President and CEO Phone No. (808) 681 -3500 Contact Person: Heidi Koop, Director of Hawaii Island Programs Phone No.: (808) 935 -8229 Mailing Address: Child & Family Service 91 -1841 Fort Weaver Road Ewa Beach, Hawaii 96706 Facility /Site Address: 1266 Kamehameha Avenue, Suite A Hilo, Hawaii 96720 81 -6587 Mamalahoa Highway, Bldg. C Kealakekua, Hawaii 96750 Fax No.: (808) 961 -2073 (808) 323 -2999 Email Address: hkoop @cfs- hawaii.org Name of Accountant/CPA (include name of firm if applicable): N & K, CPAs, Inc. Phone No.: (808) 524 -2255 Mailing Address: American Savings Bank Tower, 1001 Bishop Street, Suite 1700, Honolulu, Hawaii 96813 -3696 Amount of Request for County Funds: $35,000.00 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $15,000.00 $15,000.00 $20,000.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Child & Family Service — Agency Name Alternatives to Violence Program — Program Name Agency Mission Statement: "Strengthening families and fostering the healthy development of children" Since 1899, Child & Family Service (CFS) has dedicated its efforts to its mission of "Strengthening families and fostering the healthy development of children." CFS has 37 programs statewide that offer an array of effective and culturally relevant services to Hawaii's residents in need. The broad spectrum of services provided by CFS include: domestic violence intervention, case management, residential group homes, alternative education for alienated youth, prevention and treatment of child abuse, and family, school, and community - based counseling related services for children and their families. Infants, children, adolescents, young adults, immigrants, older adults, individuals, and families in need benefit from these services. CFS' programs are responsive, flexible, and focused on positive outcomes. Services are provided in homes, schools and in the community as well as CFS' offices. CFS provides services through 35 sites throughout the State, on the islands of Hawaii, Kauai, Maui, Molokai, and Oahu. CFS' strengths lie not only in its size and ability to share expertise and resources statewide, but also in its ability to adapt services so that they are unique and appropriate to the island and communities it serves. Despite a 40% reduction of funds, CFS successfully continued Domestic Violence services on the island of Hawaii by consolidating operations and optimizing resources. As the community continues to face a multitude of difficult problems during challenging economic times, CFS will demonstrate our commitment to the community of the Big Island by supporting populations that present with increasingly complex problems and situations. CFS continues to be at the forefront of developing the skills, knowledge, and service models to address these needs. Program Description: Funds are requested to support the operation of the Alternatives to Violence (ATV) Program in the County of Hawaii, more specifically two part-time Domestic Violence Specialists. The County of Hawaii funding will support batterers' groups in the county of Hawaii. The ATV Program utilizes an evidence -based curriculum that incorporates a cultural and a value based component. The ATV Program provides an array of Domestic Violence Intervention (DVI) services to men, women and youth. The services to male and female batterers include psycho - educational groups that teach skills of non - violence and accountability for their behavior. The services to victims include legal advocacy to complete and file temporary restraining orders, court advocacy, individualized safety planning, psycho - educational and pattern changing groups, victim support groups and case management. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Child & Family Service — Agency Name Alternatives to Violence Program — Program Name This proposal seeks funding to support Batterer groups. The primary service modality for the ATV Program is group format; research into Best Practices models suggests that groups are the most effective method in working with domestic violence issues. The batterers' groups assist the clients in making changes and can provide a supportive structure that makes it easier for clients to break the denial, blame and minimization and to facilitate offender accountability. Batterers' groups are staffed with both male and female Group Facilitators whenever possible. Research suggests that groups for batterers should be staffed by facilitators of both genders in order to role model appropriate male and female interaction, communication and encourage gender equality. The intention is to serve clients of all cultural backgrounds with a sensitivity that fosters engagement in the process of becoming violence -free. The ATV Program staff monitor batterers on a routine basis (weekly, monthly, and quarterly) for any increase or decrease in their level of risk or identified risk factors. Changes to the client's individual service plan are made incorporating any changes in services that are recommended and then reviewed with the client prior to implementation. All participants are assigned a case manager to monitor their participation and performance during group, maintain contact with probation and other related services, and to provide one to one counseling and referrals as needed. The goal is for clients to understand how violence is used as power in an intimate relationship and causes disrespect and harm that is inconsistent with the values, beliefs and conduct of every culture. This program philosophy and practice also incorporates the understanding of violence against women within a social, economic, and cultural analysis of gender and sexual oppression. Total Budget and Position Count Total Program $615,785 Total Program Position 10 Budget Count Total Hawaii Island $4,252,061 Total Hawaii Island Position 114 Budget Count Total CFS Agency $23,490,481 Total CFS Agency Position 567 Budget I Count Program Objectives: Ensure that 60% of clients who complete batterer intervention services will demonstrate the knowledge, skill and attitudes necessary for maintenance of non - abusive behavior, which includes learning non - violent conflict resolution and non - aggressive communication. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Child & Family Service - Agency Name Alternatives to Violence Program — Program Name 2. Ensure that 100% of clients who complete batterer intervention services will significantly increase their knowledge of the effects of domestic violence on children. Program Highlights: ATV Program clients who have been affected by domestic violence (offenders, victims, child witnesses,) were offered classes that taught them how to overcome the trauma of domestic violence and to be determined to live violence free. The objective is to remind the men and women of the value of respect that can be found in every culture. In Fiscal Year '10, the program provided the following: • 99 men graduated from the offenders program after 28 weeks of required services. • 17 women graduated from the offenders program after 28 weeks of required services. • 461 classes were held for the men's offenders program. • 18 women graduated from the women's support & pattern changing group. • 141 classes were held for the women's offenders program. • 48 classes were held for victims of domestic violence. Performance Measures: *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget* Estimate Number of men graduated from 99 105 120 offenders program Number of women graduated from 17 24 30 offenders program Number of (28 weeks) classes for 461 461 461 men's offender program Number of (28 weeks) classes for 141 144 144 women's offender program *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Child & Family Service - Agency Name Alternatives to Violence Program - Program Name Program Expenditures: * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages $411,329 $413,821 $393,953 Professional Fees $1,719 $2,144 $2,041 Operations $230,061 $199,821 $190,227 Equipment $8,208 $7,500 $7,500 Other" $37,198 $13,517 Total $643,110 $615,786 $586,221 * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate County of Hawaii $30,000 $20,000 $35,000 Judiciary $485,681 $485,499 $485,499 Program Fees $75,784 $58,222 $58,222 HIUW $8,208 $7,500 $7,500 Federal VOCA $37,198 $13,517 Federal VAWA $29,286 Private Foundation $1,000 Total $636,871 1 $615,0241 $586,221 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? CFS is very active in fundraising. Recently, CFS was successful in securing a one -time ARRA grant for the ATV Program to support the victim support groups. However, other funding for this program received a $300,000 decrease in fiscal year 2008 -2009, so fundraising efforts are now focused on replenishing these cuts. CFS will continue to apply for other funding and will continue to review national and local funding options for this program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Child & Family Service — Agency Name Alternatives to Violence Program — Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of �Bo Shelley B. Thompson i � AP of Executive Director Howard S. Garval, President and CEO X7/ // Date Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 21 Child & Family Service Domestic Abuse Shelters Program Child & Family Service — Agency Name Domestic Abuse Shelters Program — Program Name Agency Director: Howard Garval, President and CEO Phone No.: (808) 681 -3500 Contact Person: Heidemarie Koop, Director of Hawaii Island Programs Phone No.: (808) 323 -2664 Mailing Address: Child & Family Service 91 -1841 Fort Weaver Road Ewa Beach, Hawaii 96706 Facility /Site Address: 1266 Kamehameha Avenue, Suite A Hilo, Hawaii 96720 81 -6587 Mamalahoa Highway, Bldg. C Kealakekua, Hawaii 96750 Fax No.: (808) 961 -2073 (808) 323 -2999 Email Address: hkoop @cfs- hawaii.org Name of Accountant/CPA (include name of firm if applicable): N &K CPAs, Inc. Phone No.: (808) 524 -2255 Mailing Address: American Savings Bank Tower, 1001 Bishop Street, Suite 1700, Honolulu, Hawaii 96813 -3696 Amount of Request for County Funds: $35,000.00 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $20,000.00 $15,000.00 $20,000.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Child & Family Service — Agency Name Domestic Abuse Shelters Program — Program Name Agency Mission Statement: "Strengthening families and fostering the healthy development of children" Since 1899, Child & Family Service (CFS) has dedicated its efforts to its mission of "Strengthening families and fostering the healthy development of children." CFS has 37 programs statewide that offer an array of effective and culturally relevant services to Hawaii's residents in need. The broad spectrum of services provided by CFS include: domestic violence intervention, case management, residential group homes, alternative education for alienated youth, prevention and treatment of child abuse, and family, school, and community - based counseling related services for children and their families. Infants, children, adolescents, young adults, immigrants, older adults, individuals, and families in need benefit from these services. CFS' programs are responsive, flexible, and focused on positive outcomes. Services are provided in homes, schools and in the community as well as CFS' offices. CFS provides services through 35 sites throughout the State, on the islands of Hawaii, Kauai, Maui, Molokai, and Oahu. CFS' strengths lie not only in its size and ability to share expertise and resources statewide, but also in its ability to adapt services so that they are unique and appropriate to the island and communities it serves. Despite a 40% reduction of funds, CFS successfully continued Domestic Violence services on the island of Hawaii by consolidating operations, optimizing resources and seeking other funding. As the community continues to face a multitude of difficult problems during challenging economic times, CFS will demonstrate our commitment to the community of the Big Island by supporting populations that present with increasingly complex problems and situations. CFS continues to be at the forefront of developing the skills, knowledge, and service models to address these needs. Program Description: Funds are requested to support the operation of the West Hawaii and East Hawaii Domestic Abuse Shelters (DAS) Program. The County of Hawaii funding will be used to support staffing, more specifically part -time Shelter Workers, for the Shelters to meet the increasing demands for intensive services. In addition, funding will be used for ongoing supply needs, repairs /maintenance, client assistance and provisions. The DAS Program provides emergency shelter to single women /men and women /men with children who are victims of domestic violence (for a maximum of 90 days). These victims flee from the geographic areas of Ka'u all the way to Kohala, from Volcano to Puna, from Puna to Hamakua. Victims from East Hawaii often access the DAS in West Hawaii and vice versa to ensure the highest degree of safety. There are no restrictions to enter the shelter as long as the circumstances of need are identified as a domestic violence issue. The two NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Child & Family Service — Agency Name Domestic Abuse Shelters Program — Program Name shelters that CFS operates are the only shelters on the Big Island to serve the immediate needs of the population seeking safety due to domestic violence. The shelter operates 24 hours a day /365 days a year including holidays. Staff members oversee the safety and needs of the residents. CFS has been providing emergency shelter to the Big Island community for 23 years. The West Hawaii Shelter opened in 1988 followed by the East Hawaii Shelter in 1995. The main goal of the program is to provide a safe environment. Experienced advocates help families identify their needs and develop a plan to meet these needs. In addition, the Shelters offer our residents emergency food, transportation, referrals as needed, case management, individual counseling, advocacy, outreach services, safety planning, assistance with Temporary Restraining Orders, support groups, and personal planning. The Shelter staff works with the mothers /fathers and children to build healthy relationships and to strengthen the women's /men's role as effective parents without using physical and /or verbal violence towards their children. We are committed to raising the consciousness of our society by educating our families on a violence free lifestyle, promoting family coping and stability, and providing a place of refuge. Each Shelter operates a 24 -hour domestic violence hotline which provides crisis intervention, information, and referral services. During the last 18 months, the hotline utilization by victims of domestic violence has increased due to the added economic stressors in the communities of the Big Island. The hotline worker provides a safety assessment, makes recommendations and provides referral and resource information for the callers. It is expected that the hotline will continue to see an increase of calls due to rising violence in the home due to poverty and homelessness. The Shelter in West Hawaii provides three bedrooms with a total of 21 beds for families who enter into the program. In addition to the three bedrooms each room has a full bathroom to accommodate the residents who share the bedroom space. One bedroom is specifically geared towards housing single women and women with disabilities. This room is ADA compliant. The facility also has an ADA ramp for easy access in /out of the Shelter. In addition to the client areas, the shelter also has two offices, a playground and a children's room. These offices are used for intake and exit interviews to provide client confidentiality, case management, and individual counseling. The Shelter also provides our residents with a laundry facility, full kitchen, and a large living and dining room area. On the Shelter site a large Matson container holds furniture items, clothing and household miscellaneous items. These items are donated throughout the year from the West Hawaii community members who support the Shelter. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Child & Family Service — Agency Name Domestic Abuse Shelters Program — Program Name The East Hawaii Hale `Ghana Domestic Abuse Shelter is located in a two -story home on approximately three acres in an agricultural /residential area of East Hawaii and is set off from the roadway. It has three full bathrooms, four bedrooms and has a 20- person capacity. The downstairs of the Shelter facility has a laundry room that is accessed through the covered double car garage entrance. A comfortable -sized living room with an adjoining bathroom is accessible via the laundry room and a short walkway connects into the spacious kitchen area. There is an adjoining dining room and pantry which is also accessible via an entrance off the side of the kitchen that exits into the side yard of the property. The Shelter facility is ADA compliant by having an ADA ramp which leads to the lower floor where an ADA bedroom is located. Total Budget and Position Count Total Program Budget $594,244 Total Program Position Count 16 Total Hawaii Island Budget $4,252,061 Total Hawaii Island Position Count 114 Total Agency Budget $23,490,481 Total Agency Position Count 567 Program Objectives: The CFS Domestic Abuse Shelters' objectives are: 1. Increase client knowledge of community resources by 75 %. 2. Ensure that 90% of clients in shelter will complete a Safety Plan for themselves and their children. 3. Ensure that 60% of single adults and families will move from the shelter to a non - abusive home environment. Program Highlights: During the fiscal year of 2009 -2010, the West Hawaii Domestic Abuse Shelter ( WHDAS) served 186 people; 97 adults and 89 children. The WHDAS provided 5,429 bed days. The WHDAS received 199 hotline calls that involved a crisis due to domestic violence. The WHDAS provided 1,888 requests for information and referral. WHDAS experienced a 75% increase of bed days in fiscal year 2009 -2010 compared to fiscal year 2008 -2009. During the fiscal year of 2009 -2010, East Hawaii Domestic Abuse Shelter (Hale ' Ohana) served 241 people; 144 adults and 97 children. Hale 'Ghana provided 5,243 bed days. Hale 'Ghana received 1,139 hotline calls that involved a crisis due to domestic violence. Hale `Ghana provided 554 requests for information NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Child & Family Service — Agency Name Domestic Abuse Shelters Program — Program Name and referral. Hale `Ohana experienced a 37% of increase of bed days in fiscal year 2009 -2010 compared to fiscal year 2008 -2009. As anticipated, an increase of domestic violence occurred during the last fiscal year due to economic stressful times which historically effects domestic violence between domestic partners. CFS continues to be committed to support the community to ensure that families are protected. Both Domestic Abuse Shelters achieved 100% of their outcomes during the fiscal year of 2009 -2010 except for West Hawaii in the area of adults and families moving into a non - abusive environment. Due to the increasing challenges obtaining affordable housing in West Hawaii under the economic situation, the expected outcome for WHDAS was at 47 %. The staff of WHDAS will continue to support the adults and families to establish a transition to safe housing. Other services include: assisting the residents with personalized safety planning, increasing awareness on the effects of children who witness domestic violence, increasing awareness of community resources, and educating residents on healthy relationships. Performance Measures in West Hawaii: *If applicable ** Estimates are based on historical data. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate" # of Bed Days 5,429 5,500 5,500 # of Hotline Calls 199 200 200 # of Single Women 39 40 40 # of Women w /children 58 60 60 # of Children Served 89 90 90 # of requests for information and referral onl 1,888 2,000 2,000 # of group session 205 200 200 # of individual session hours provided 581 600 600 # of meals provided 12,751 13,148 13,148 # of trips (transportation provided 196 200 200 *If applicable ** Estimates are based on historical data. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Child & Family Service - Agency Name Domestic Abuse Shelters Program - Program Name Performance Measures in East Hawaii: *If applicable ** Estimates are based on historical data. East and West Domestic Abuse Shelter Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate ** # of Bed Days 5,243 5,300 5,300 # of Hotline Calls 1,139 1,200 1,200 # of Single Women 74 80 80 # of Women w /children 70 70 70 # of Children Served 97 100 100 # of requests for information and referral onl 554 600 600 # of group session 203 200 300 # of individual session hours provided 3,485 3,500 3,500 # of meals provided 10,068 12,000 12,000 # of trips (transportation provided 360 1 400 1 400 *If applicable ** Estimates are based on historical data. East and West Domestic Abuse Shelter Program Expenditures * If applicable " Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages. $423,990 $390,148 $398,090 Professional Fees $164 $3,380 $3,400 Operations $256,156 $238,065 $242,686 Equipment $28,000 $28,000 $28,000 Other' $29,568 $27,930 $30,000 Total $680,310 $628,213 $640,776 * If applicable " Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Department of Human Services $497,771 $497,601 $497,601 Program Fees $3,426 $3,380 $3,400 Hawaii Island United Way $18,229 $13,333 $30,000 HPHA Emergency Shelter Grant $28,000 $28,000 $28,000 Prosecutor's VOCA $29,568 $27,930 $30,000 Hawaii County $15,000 $20,000 $35,000 Private Foundation $52,114 $4,000 $5,000 Total 1 $644,108 $594 1 $629,001 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Child & Family Service — Agency Name Domestic Abuse Shelters Program — Program Name Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? CFS strives to achieve sustainability for all its programs. Yet, CFS is also committed to supporting critical services in the community despite their budgetary limitations. Recent funding reductions have had a great impact on the program, which makes fundraising and grant writing even more important. CFS continues actively writing grants for supplemental funding to keep its critical programs operating. CFS relies on other funding sources to fund its Domestic Abuse Shelters, such as Hawaii Island United Way (HIUW), Emergency Shelter Grant (ESG) and Victims of Crime Act from the Prosecutor's Office. In addition, the shelter also charges a modest fee for shelter to those clients with an ability to pay. CFS was able to utilize Community Development Block Grant funding for much needed repairs and improvement projects in West and East Hawaii. It is expected that funding will not be significantly increased for the next Fiscal Year 2011 -2012. CFS will continue to seek other sources of funding to secure the high quality of services in the communities of West Hawaii and East Hawaii. We are asking for additional funding from the County of Hawaii to help offset some of the cutbacks. CFS is committed to providing these services to our communities and will continue to advocate for funding. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Child & Family Service — Agency Name Domestic Abuse Shelters Program — Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signatu of Board Presiden Chair Shelley B. Thompson ignature of Executive Director Howard S. Garval, President and CEO Date T /1i Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 22 Child & Family Service Hilo Transitional Housing Program Child & Family Service — Agency Name Hilo Transitional Housing Program — Program Name Agency Director: Howard Garval, President and CEO Phone No.: (808) 681 -1418 Contact Person: Heidemarie Koop, Director of Hawaii Island Programs Phone No.: (808) 935 -8229 Mailing Address: 91 -1841 Fort Weaver Road Ewa Beach, Hawaii 96706 Facility /Site Address: 1266 Kamehameha, Suite A Hilo, Hawaii 96720 Fax No.: (808) 961 -2073 Email Address: hkoop @cfs- hawaii.org Name of Accountant/CPA (include name of firm if applicable): N &K, CPAs, Inc. Phone No.: (808) 524 -2255 Mailing Address: American Savings Bank Tower, 1001 Bishop Street, Suite 1700, Honolulu, Hawaii 96813 -3696 Amount of Request for County Funds: $40,000.00 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $35,000.00 $15,000.00 $10,000.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Child & Family Service — Agency Name Hilo Transitional Housing Program — Program Name Agency Mission Statement: "Strengthening families and fostering the healthy development of children" Since 1899, CFS (CFS) has dedicated its efforts to its mission of "Strengthening families and fostering the healthy development of children." CFS has 37 programs statewide that offer an array of effective and culturally relevant services to Hawaii's residents in need. The broad spectrum of services provided by CFS include: domestic violence intervention, case management, residential group homes, alternative education for alienated youth, prevention and treatment of child abuse, and family, school, and community - based counseling related services for children and their families. Infants, children, adolescents, young adults, immigrants, older adults, individuals, and families in need benefit from these services. CFS' programs are responsive, flexible, and focused on positive outcomes. Services are provided in homes, schools and in the community as well as CFS' offices. CFS provides services through 35 sites throughout the State, on the islands of Hawaii, Kauai, Maui, Molokai, and Oahu. CFS' strengths lie not only in its size and ability to share expertise and resources statewide, but also in its ability to adapt services so that they are unique and appropriate to the island and communities it serves. Despite a 40% reduction of funds, CFS successfully continued Domestic Violence services on the island of Hawaii by consolidating operations and optimizing resources. As the community continues to face a multitude of difficult problems during challenging economic times, CFS will demonstrate our commitment to the community of the Big Island by supporting populations that present with increasingly complex problems and situations. CFS continues to be at the forefront of developing the skills, knowledge, and service models to address these needs. Program Description: Funds are requested to support the operation of the East Hawaii Transitional Housing Program. The County of Hawaii funding will be used to support the position of a part -time Domestic Violence Specialist operating out of the Hilo office. Victims of Domestic Violence are faced with many challenges when making the courageous decision to finally leave their batterers. As women and men are provided services in our Domestic Abuse programs, it is mostly women who are confronted with financial challenges. When leaving the batterer, the victim embarks upon a path that is as fearful for her and her children as it is to stay with an abusive partner. Many of these women leave with just the clothes that they are wearing, seeking shelter, safety and most of all assurances that they made the right choice. Many lack the skills, tools and resources needed to sustain themselves and their children away from their batterer. In addition, many women NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Child & Family Service — Agency Name Hilo Transitional Housing Program — Program Name are faced with the reality of no financial resources, and inability to access resources due to marital assets retained by the abuser which disqualifies her from eligibility for public assistance or possibly subsidized housing. Many victims turn to the Hilo or Kona Domestic Abuse Shelters initially where they can recover and start planning a new life. The Domestic Abuse Shelters provide safety, basic needs, counseling and support for up to 90 days. Securing a safe home for themselves and their children is one of the serious challenges that the victims are facing in the County of Hawaii due to an expensive rental market and the current economic situation. At the end of the 90 days in a Domestic Abuse Shelter, the victim must make a decision not only for herself but for her children as well. Unfortunately that decision is often to return to the abuser she sought refuge from or to become homeless since resources of financial and housing support are limited. The Hilo Transitional Housing Program is a 24 month program designed to assist victims of domestic violence and their children to rebuild their lives. The program goal is to assist victims and their children in gaining stability and independence while transitioning into a violence -free lifestyle. Victims who qualify for services transition from the Domestic Abuse Shelters located in West and East Hawaii and can be placed in one of six apartments /houses. During their 24 month stay, victims and their families receive intensive support services with the goal to guide the victims and their families towards independence, to move to a regular home in the community, to secure income and to be able to care for the children. By providing weekly home visits, case management, individual family service plans, and information and referrals to community resources, the program allows both the victims and their children the time to heal, and to live safely. The program is in need of a full -time Domestic Violence Specialist to provide case management, counseling, and support to the women. Without the County of Hawaii funding, only a part -time Domestic Violence Specialist can is funded. By only having a part -time Domestic Violence Specialist, positive outcomes for clients are impacted as the time spent with victims to provide support and offer resources is reduced. The Domestic Violence Specialist gives the victims weekly opportunities to learn about and enhance their life skills, including budgeting, money management and job training. In doing so, the Domestic Violence Specialist addresses many of the barriers to establishing income, housing and independence. Total Budget and Position Count Total Program Budget $176,671 Total Program Position Count 1.38 Total Hawaii Island Budget $4,252,061 Total Hawaii Island Position Count 114 Total Agency Budget $23,490,481 Total Agency Position Count 567 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Child & Family Service — Agency Name Hilo Transitional Housing Program — Program Name Program Objectives: 1. To ensure that 70% of the clients will reduce their level of stress as measured quarterly. 2. To increase self- sufficiency for at least 70% of the clients. 3. To support safety by having 90% of the clients maintain a Safety Plan for themselves and their children as measured quarterly. 4. To support permanent living with at least 80% of the clients securing independent housing after 24 months of safe transitional housing. Program Highlights: 1. The program is fulfilling a high need for providing housing for victims of domestic abuse and their families. 2. Twelve families were provided with transitional housing from July 2008 to June 2009. 3. Eleven families were provided with transitional housing from July 2009 to June 2010 (due to extending the time for victims to stay in the program from 12 months to 24 months, we did not serve as many as originally projected). 4. The staff has developed a strong program that focuses on reintegrating victims of domestic abuse into the community and gaining their independence and self- sufficiency. 5. Five families have successfully transitioned into permanent housing between July 2009 and June 2010. 6. Six participants obtained employment enabling three participants to discontinue receipt of welfare benefits. 7. One participant enrolled at the University of Hawaii, seeking a degree in Human Services. 8. Of the 26 participants who have transitioned out of program since its beginning in 2006, 20 participants have made the decision not to re- involve themselves with their abusers and have established a violent free home for themselves and their children. 9. The program established a collaboration with the Forward March job training program, which increases job readiness skills and ability to obtain employment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Child & Family Service — Agency Name Hilo Transitional Housing Program — Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate # of families provided housing 11 12 14 # of service plans developed 11 12 14 # provided case management 11 12 14 # of safety plans developed 11 12 14 # provided aftercare services 6 6 6 # w /secured income 11 12 14 # enrolled in education program 3 1 3 # w /secure employment 6 6 6 # obtained permanent housing 6 6 6 *If applicable Program Expenditures If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages $59,611 $39,701 $60,803 Professional Fees $15,000 $10,000 $40,000 Operations $124,058 $136,970 $139,709 E ui ment 1 $175,5531 $176,671 1 $200,512 Other Total $183,669 $176,671 $200,512 If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate US Department of Justice $150,161 $155,671 $153,012 County of Hawaii $15,000 $10,000 $40,000 Program Fees 1 $10,3921 $11,0001 $7,500 Total 1 $175,5531 $176,671 1 $200,512 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Child & Family Service — Agency Name Hilo Transitional Housing Program — Program Name Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Hilo Transitional Housing Program has been primarily funded by the Department of Justice, Office of Violence Against Women (OVW). Additional funding options have been explored. Additional revenue for the program can include program fees, however clients are not turned away if they cannot pay. CFS has a strong history of fundraising and is committed to growing our private donations and grants. We continue to apply for alternative funding sources for our programs. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Child & Family Service — Agency Name Hilo Transitional Housing Program — Program Name (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signatu of Board President /Chair Shelley B. Thompson ignature of Executive Director Howard S. Garval, President and CEO 1 ,:;2�1 Dat ,�C Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 23 Child & Family Service Therapeutic Foster Home Program Child & Family Service — Agency Name Therapeutic Foster Home Program — Program Name Agency Director: Howard Garval, President and CEO Phone No.: 808 - 681 -3500 Contact Person: Heidemarie Koop Phone No.: 808 - 323 -2664 Mailing Address: Child & Family Service 91 -1841 Fort Weaver Road Ewa Beach, Hawaii 96706 Facility /Site Address: West Hawaii: 81 -6587 Mamalahoa Hwy, Kealakekua 96750 East Hawaii: 1266 Kamehameha Ave, Suite A, Hilo 96720 Fax No.: (808) 323 -2999 West Hawaii (808) 961 -2073 East Hawaii Email Address: hgarval @cfs- hawaii.org hkoop@cfs-hawaii.org Name of Accountant/CPA (include name of firm if applicable): N & K, CPA's, Inc. Phone No.: (808) 524 -2255 Mailing Address: American Savings Bank Tower, 1001 Bishop Street, Suite 1700, Honolulu, Hawaii 96813 -3696 Amount of Request for County Funds: $35,000.00 Prior Year(s) Funding: Therapeutic Foster Home West Hawaii 08 -09 09 -10 10 -11 $20,000.00 $20,000.00 $18,000.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Child & Family Service — Agency Name Therapeutic Foster Home Program — Program Name Agency Mission Statement "Strengthening families and fostering the healthy development of children" Since 1899, Child & Family Service (CFS) has dedicated its efforts to its mission of "Strengthening families and fostering the healthy development of children." CFS has 37 programs statewide that offer an array of effective and culturally relevant services to Hawaii's residents in need. The broad spectrum of services provided by CFS include: domestic violence intervention, case management, residential group homes, alternative education for alienated youth, prevention and treatment of child abuse, and family, school, and community - based counseling related services for children and their families. Infants, children, adolescents, young adults, immigrants, older adults, individuals, and families in need benefit from these services. CFS' programs are responsive, flexible, and focused on positive outcomes. Services are provided in homes, schools and in the community as well as CFS' offices. CFS provides services through 35 sites throughout the State, on the islands of Hawaii, Kauai, Maui, Molokai, and Oahu. CFS' strengths lie not only in its size and ability to share expertise and resources statewide, but also in its ability to adapt services so that they are unique and appropriate to the island and communities it serves. As the community continues to face a multitude of difficult problems during challenging economic times, CFS will demonstrate our commitment to the community of the Big Island by supporting populations that present with increasingly complex problems and situations. CFS continues to be at the forefront of developing the skills, knowledge, and service models to address these needs. Program Description Funds are requested to support the Therapeutic Foster Home (TFH) Program in its work with children who present with severe behavioral challenges such as self- injuries, property damage, physical assaults, truancy, substance abuse and stealing. These children are in high need of professional Support Coordinators and highly trained therapeutic foster parents who are able to give them one -on- one attention. CFS is requesting funding for a half -time Support Coordinator and monies to continue supporting therapeutic activities in the homes and the community. The TFH Program provides foster placement and clinical services for youth who have been identified as needing out -of -home placement. Additional resources are provided to accommodate their emotional, behavioral, and mental health issues. The TFH Program offers a system of support, counseling and skill building to youth as well as training and support to the caregivers and foster parents. The TFH Program provides services countywide on the island of Hawaii. The goal of the program is to teach the child and his /her family how to build NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Child & Family Service — Agency Name Therapeutic Foster Home Program — Program Name trusting relationships that support the child in achieving his or her highest potential. The behavioral health and residential programs at CFS continue to see an increase in the number of youth who are in need of "line of sight" supervision and therapeutic activities throughout the day including weekends. Often, these children are neurologically challenged due to exposure to substances in utero and /or to child abuse and neglect. Most of these children have experienced multiple unsuccessful placements and /or the members of the `ohana are unable to support that child in their homes due to the severity of the behavior and /or other family and work commitments. Many of these children are so desperate that their behaviors place them in acute un.its of hospitals. In recent years, study after study has demonstrated the malevolent effects of substance abuse on women and their children. Deterioration in the physical, mental, and emotional health of the substance - abusing mother and her child has been well documented, with particular emphasis on the potentially devastating effects on the fetus of prenatal maternal drug abuse. In the 1996 Blind Study of Substance Abuse and Need for Treatment Among Women of Childbearing Age in Hawaii women reported using alcohol, tobacco, marijuana, cocaine /crack, and methamphetamine in the greatest numbers. It is well documented that during the 1990s, there was a dramatic increase in the use of methamphetamine ( "ice "). It is anticipated that over time, the number of youth referred for behavioral health services, including therapeutic foster homes, will increase as Hawaii's "ice babies" grow up. During the screening project of a 1,000 pregnant women in 2008 -2009 conducted by the Children's Research Triangle on the Big Island 49.4 % pregnant women reported that they used substances in the month prior to knowledge of pregnancy. The rate of substance use was the highest among Caucasian and Hawaiian women. In addition, it was reported that 42.2% of the women who were drinking in early pregnancy continued drinking after learning of their pregnancy which can put their children at risk for significant neurological impairments. Youth with neurological impairment exhibit combined cognitive, physical and emotional difficulties. They may have learning impairments, behavioral deficits, increased motor activity, and enhanced conditioned avoidance responses. Parents and foster parents become frustrated and cannot cope, resulting in many placements for these youth. Often times, multiple placements reinforce problem behaviors and erode the self- esteem of these youth. It is cost - beneficial to learn more about this population, provide interventions as early as possible, and prevent further problems from developing. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Child & Family Service — Agency Name Therapeutic Foster Home Program — Program Name The current staffing in East and West Hawaii consists of a Director of Hawaii Island Programs and a Program Director who provides programmatic oversight of the Therapeutic Foster Home respectively in Kona and Hilo. A Master's level Mental Health Specialist provides intensive clinical and case management services for the child, the therapeutic foster parents and biological family members. The proposed Support Coordinator will provide daily practical support to the therapeutic foster parents in regards to transportation and appointments. Other duties include the licensing of foster homes and preparing new intakes. CFS has.been developing a program component over the past two years that focuses on the needs of children who have neurological impairments. When these children are placed into our TFH Program, there is a high need for providing one -on -one staffing to allow the child to adjust to his /her new therapeutic foster home. The child is also often adjusting to a new school environment and making connections with other children in the community. CFS staff have received extensive training including Trauma Informed Care that focuses on working with children between the ages 5 and 18 years old with these difficulties. To further support this project, an experienced Support Coordinator is needed to provide intensive services at the beginning of the placement, during crisis situations and transition to a permanent placement. The Support Coordinator would be working under the direct supervision of a clinical licensed Program Director. The Support Coordinator would provide groups to teach life skills that allow the children to learn managing their neurological challenges in a healthy way. Total Budget and Position Count Total Program Budget $423,478 Total Program Position Count 3 Total Hawaii Island Budget $4,252,061 Total Hawaii Island Position Count 114 Total Agency Budget $23,490,481 Total Agency Position Count 567 Program Objectives The intermediate goal of the TFH Program is to provide a safe and stable living environment to youth who experience emotional and /or behavioral problems. This stable environment is needed while the children engage in therapy to address their individualized mental health and behavioral issues. The long -term goal of the program is to provide the support and skill building necessary to empower youth to engage in socially appropriate and manageable behaviors, thereby facilitating the re- unification (if appropriate) of children with their biological families or at the very least to be able to move to a less restrictive environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Child & Family Service — Agency Name Therapeutic Foster Home Program — Program Name Measurable objectives for the TFH Program include: 1. Ninety percent (90 %) of youth show progress in the development of interpersonal relations and life skills, as measured by their participation in extracurricular, community or otherwise pro - social activities as measured quarterly. 2. Ninety percent (90 %) of youth learn how to be a positive and productive member of a family as measured by their ability to follow daily scheduling and complete household duties as measured quarterly. 3. One - hundred percent (100 %) of youth work towards their identified permanency plan goals as measured quarterly. Program Highlights The TFH Program has been very successful in working with youth in our program. Focus has been on developing the program's ability to provide innovative and valuable therapeutic intervention to each youth. CFS continues to be a pioneer in offering services that are trauma informed and that cater to the unique needs of these special children. This approach has helped to prevent referring children to acute services in Honolulu. This evidence -based approach helps to assure that youth are provided supportive services on the Big Island for optimal success. Therapeutic Foster Home — County of Hawaii Performance Measures *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Therapeutic Foster Home Program # of clients served 17 17 20 # of bed days utilized 2,806 3,000 4,000 # of licensed foster homes 12 14 16 # of individual therapy, therapeutic activities and /or skill buildin 425 500 600 # family therapy sessions 184 200 550 # of discharges to a lateral or lower level of care 8 10 12 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Child & Family Service — Agency Name Therapeutic Foster Home Program — Program Name Program Expenditures * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages $105,026 $144,381 $147,289 Professional Fees 1 $20,0001 $18,0001 $35,000 Operations $191,203 $229,732 $234,326 Equipment Other Total $296,229 $374,113 $381,615 * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Department of Health (Child Adolescent Mental Health)" $355,189 $405,478 $255,634 County of Hawaii 1 $20,0001 $18,0001 $35,000 Total 1 $375,1891 $423,4781 $290,634 *If applicable * *DOH funding is projected to decrease, so County of Hawaii funding is even more critical for staffing in the program Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? CFS strives to achieve sustainability for all its programs. Yet, CFS is also committed to providing critical services in the community and pursues new treatment modalities despite their budgetary limitations. CFS is active in writing grants for supplemental funding to keep its critical programs operating. CFS continues to apply to other funders to ensure continuing training by mental health experts to further the project of working with children who are experiencing neurological challenges. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Child & Family Service — Agency Name Therapeutic Foster Home Program — Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board PresidenVChair Shelley B. Thompson ignature of Executive Director Howard S. Garval, President and CEO Date I/ x /// Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 24 Dragons Eye Learning Center Living in the Garden Outreach Dragon's Eye Learning Center LIVING IN THE GARDEN OUTREACH AGENCY DIRECTOR: Geoffrey Kern PHONE NUMBER: (808) 965 -9371 CONTACT PERSON: Debra Welch PHONE NUMBER: (808) 965 -9371 MAILING ADDRESS: Dragon's Eye Learning Center RR2 #3307 Pahoa, HI 96778 SITE ADDRESS: 14 -473 Rail Road Ave. Pahoa, HI 96778 FAX NUMBER: (808) 965 -9371 EMAIL ADDRESS: info @dragonseyecenter.org NAME OF CPA: Nancy Kramer PHONE NUMBER: 965 -2729 MAILING ADDRESS: 15 -2662 Pahoa Village Rd., Pahoa, HI 96778 AMOUNT OF REQUEST FOR COUNTY FUNDS: $ 17.004.00 PRIOR YEAR(S) FUNDING FOR LIVING IN THE GARDEN OUTREACH: 08 -09 09 -10 10 -11 -0- -0- -0- 1. AGENCY MISSION STATEMENT: Dragon's Eye Learning Center was incorporated in 2003 as a 501c(3) nonprofit with the purpose of providing educational experiences of cooperative and sustainable agricultural and economic systems. As part of its youth education initiative, the Center sponsors the Kids of Koa'e 4 -H Club, chartered in 2007. This extracurricular Personal Development program is designed to empower children to take personal responsibility for their learning, allow all ages of children to mix freely with each other, use member -run democratic decision - making and a fair judicial system, and to nurture youth to emerge as capable, contributing members of society. 2. PROGRAM DESCRIPTION: SUMMARY Dragon's Eye Learning Center and the Kids of Koa'e 4 -H Club propose a new outreach program to share sustainable food production technologies with the youth and people of Hawaii. Over the course of ten months, 10 -16 4 -H youth and one adult leader will meet six hours a week to design and build portable display models of aquaponics, a chicken egg laying operation, bio -grub cultivation, top bar hive beekeeping, vermiculture, and silage making. In the Spring, the project team will take these displays on the road to four area schools and three sustainable agriculture festivals, exposing more than one thousand people to Dragon's Eye Learning Center LIVING IN THE GARDEN OUTREACH the systems. The project will be chronicled in a DVD of entertaining and informative segments edited and narrated by DELC's award - winning youth video team, distributed free to schools, and available for viewing on a dedicated webpage. BACKGROUND The goal of "Living in the Garden" is to develop and demonstrate effective, economically - viable methods for Hawaii residents and farmers to locally produce healthy food. Dragon's Eye Farm is home to the program. In 2009, the farm began transitioning from ten years of organic practices to the Korean Natural Farming methods. These methods are being integrated into the farm's commercial scale aquaponic gardens, land based gardens, orchards, pastures, and livestock management (chickens, rabbits, cows, and sheep). With the help of a grant from the County of Hawaii Research and Development, DELC hosted Natural Farming originator Master Cho for a 7 days workshop series in February of 2010 attended by nearly 400. Subsequently. two DELC board members traveled to Korea for a week -long tour of Natural Farming in that country. The farm was recently awarded a grant from the USDA for the construction of a Commercial Scale Natural Farming Chicken Egg Laying Operation. Natural Farming focuses on the cultivation of indigenous microorganisms and shows how to use what is found in the local environment to make food, mineral supplements, and tonics for microbes, plants and farm animals. Natural Farming seeks to empower farmers by lowering the costs of inputs, enabling farmers to produce a nutritious product while contributing to a healthy environment. The farm is regularly toured and is the site of Natural Farming and Aquaponics workshops. For four years, the Kids of Koae 4 -H Club youth have participated in environmental projects such as growing vegetables for their own lunches, raising ginger and turmeric for market, producing organic chicken food, and restoration/invasive species control in two nearby State Reserves. Many of these are chronicled in their 2008 Going Green video series (< http: / /dragonseyecenter .org/home /Go_Green.html >). PROJECT DETAILS Crucial to the success of this project is the 4-H project facilitator who will work for 10 hours a week guiding the youth's efforts and preparing for the next project session. It is important to note that the youth will enjoy unlimited access to functioning on -site backyard and commercial -sized operations. In addition to constructing portable demonstration models, the goal is to give youth the knowledge and the experience they need in order to comfortably converse with and educate the public about each of the systems. Two field trips to other innovative Hawaii -based operations will broaden the team's understanding of the various technologies. Agents and experts from partner organizations, the College of Tropical Agriculture and Human Resources and Cho Global USA, will be periodically consulted to maintain the integrity of the program, and the Hawaii School Garden Network and East Hawaii 4 -H will be invited for on -site preview tours. Five hours per week will be devoted to video archiving of all relevant stages in the project's development, with three older youth forming the videography team. Aspects of the systems that are difficult to share in mobile displays (for instance, honey harvest), will be demonstrated in a DVD of entertaining and informative segments edited and narrated by DELC's award - winning youth video team ( <http: / /dragonseyecenter.org/ home /vidcoaward.html >,< http: // dragonseyecenter .org /home/LifeorIce.html >). Forty copies of the DVD will be donated to partner organizations and Puna schools, and the video segments will be published on the outreach program's webpage. 4 -H member artists will originate a project logo design which will be incorporated with the 4 -14 emblem on t -shirts worn for public appearances. In the Spring, the project team will take these displays on the road to four area schools and three sustainable agriculture festivals, exposing more than one thousand people to the systems. The novelty of most of these technologies will combine with eye- catching display techniques and the presence of live bees, fish and chicks to draw considerable interest among the population. The displays will be housed in attractive portable 2 Dragon's Eye Learning Center LIVING IN THE GARDEN OUTREACH display booths fabricated using local bamboos. Students and staff will be present to discuss each display. Do- it- yourself information will be available in free brochures and a dedicated webpage. For those seriously interested. follow up farm tours and instructive workshops will be scheduled. It is our hope that this program will generate both enthusiasm for and practical steps towards food self - sufficiency for the people of east Hawaii, especially the next generation. What follows are a brief description of each technology, including probable features on display: • Aquaponics. This self - contained Plexiglas unit will combine Australian ebb- and -flow and University of Virgin Islands trough technologies to show how live tilapia and catfish can provide nutrient for lush growing greens and flowers. Transparent containers and fittings will demonstrate automatic siphon. and dissolved oxygen meter will demonstrate oxygenation potential of volcanic cinder bio -lung. • Korean Natural Farming Chicken Egg Laying Operation. Live baby chicks will be housed in a small model of a Korean Natural Farming brooding box. Chicks are fed a specific diet to promote hardiness. Feed will be made at the display. To -scale models of backyard and commercial systems will also be displayed. Egg health will be discussed and egg yolk comparisons demonstrated. • Silage. Akin to a culinary television show, this demonstration will show how to make chicken feed kimchi from start to finish. Ingredients include chopped greens, bio- grubs, indigenous microorganisms, and natural farming inputs. Cuttings for some of the tropical greens will be available for sale. • Bio grubs. The Black Soldier Fly is an advantageous species for fish and chicken feed, due to an ideal fat/protein ratio in the larvae, speed of bio- conversion, ease of harvest, and hygienic characteristics of life- cycle. Clean larvae will be viewed in Plexiglas display and fed live to chickens and/or fish in other displays. A small model of DELC's production unit will be on display, with relevant design considerations labeled. • Vermiculture. Several designs of worm -farms will be shown, along with a variety of feeds appropriate for vermiculture. Integration between worm populations in aquaponic bio -lung and vermiculture operation will be elaborated. • Sustainable beekeeping. The Kids of Koa'e Sustainable Beekeeping project leader and members will design an observation top bar hive. Bee types and activities will be viewable through a window. Samples of bee predators and IPM techniques will be shown. Honey will be for sale. (Other important pollinators, such as the Monarch Butterfly, may be included in this display.) 3. TOTAL BUDGET AND POSITION COUNT Total Program Budget $ 22,254 Total Program Position Count 5 Total Agency Budget $ 24,304 Total Agency Position Count 15 4. PROGRAM OBJECTIVES 1. Design, build, and operate 6 functioning portable sustainable food production systems. 2. Educate 10 -16 4 -H youth in 6 defined 4 -H project categories during 210 hours of instructional time over 35 weeks. 3. Archive, narrate, and produce video documentary of Living in the Garden project. 4. Design, harvest, and build attractive portable bamboo structures to house food system displays. 5. Expose estimated 300 elementary students to 50- minute demonstration of project, including hands -on game activities and short video presentation. Dragon's Eye Learning Center LIVING IN THE GARDEN OUTREACH 6. Prepare and distribute (print and email) brochures and fliers to promote demonstration events. Distribute press release and invite reporters. 7. Build and publish web page to include video, brochure, fliers, donations link, and calendar of follow - up tours and workshops. 8. Expose estimated 750 people to project at Bob Fest, 4 -H Annual Expo, and DELC Living in the Garden Expo. 9. Record and evaluate project (both youth and leaders) in 4-H Record Books and County evaluation procedure. 5. PROGRAM HIGHLIGHTS This is a new program for the 2011 -2012 fiscal year. 6. PERFORMANCE MEASURES Measure 2011 -12 estimated a. average number of 4 -H members involved per week for 35 weeks 13 b. number of functioning portable demonstration systems built 6 c.. number of school students exposed to 50 minute presentation 300 d. number of public engaged for 15 minutes or more at expo booths 750 e. length of DVD in minutes /number of DVDs distributed 45/40 f. One -page evaluative surveys solicited from teachers 12 g. Booth -based surveys solicited from public 250 h. number of 4 -H members including project in record book 6 i. number of hits on project website, Jan -May 2012 300 7. PROGRAM EXPENDITURES 8. PROGRAM FUNDING SOURCES Crucial to the success of Living in the Garden is the continued in -kind support of Aorista (LLC) and Dragon's Eye Farm which collectively provide the 4 -H Club facilities /utilities and the multiple commercial system access free of charge. This donation significantly increases educational opportunity while reducing the 4 FY 2009 -10 FY 2010 -11 FY 2011 -2012 Salaries and Wages Professional Fees $ 11,404.00 Operations Equipment $ 5,600.00 Other (Site Rental Donation 1 $ 5,250.00 Total $ 22,254.00 8. PROGRAM FUNDING SOURCES Crucial to the success of Living in the Garden is the continued in -kind support of Aorista (LLC) and Dragon's Eye Farm which collectively provide the 4 -H Club facilities /utilities and the multiple commercial system access free of charge. This donation significantly increases educational opportunity while reducing the 4 Dragon's Eye Learning Center LIVING IN THE GARDEN OUTREACH need for County funding. Living in the Garden has largely been a volunteer program, and the funding for outreach will increase the breadth and quality of exposure to the public. Expo booths will include fundraising efforts by the 4 -H members, such as DVD sales, beadling bees, re- usable shopping bags, agricultural supplements, plants, and honey. 9. FUTURE PROGRAM SUPPORT This outreach program is the first of a series of methods to share "Living in the Garden" technologies. In the future, instructional DVDs and in -depth Operator's Manuals will be developed and sold to generate revenue. Koa'e neighborhood and Island -wide ecological farming tours will also bring in funding. Monthly free tours will continue to be offered. In -kind donors have vowed to continue their support through free facility use for as long as DELC requires. If this outreach program is as successful as anticipated, then local (such as Hawaii Community Foundation and Hawaii County) and national funds will be sought to extend the reach to Island -wide. Also, Hawaii Tourism Authority funds will be sought for the Living in the Garden Expo in 2013. DELC has also submitted two large national -level grants to the EPA and to Campbell Foundation to develop the mini -farm as a residential ecological farming institute, and will continue to write such large grants in the future. 10. SIGNATURE We have read and understood all of the eligibility requirements; grant conditions; award procedures; and record, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. We hereby certify that information supplied herein including all supporting documents is correct and that we have the authority and ability to fully administer the program pursuant to law. We understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, we understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 or the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future I inding re u sts. co J 11 gignal. of and President Date Signature of Secretary/Treasurer Date 25 Family Support Hawaii Ka'u Family Center Family Support Hawaii Ka`u Family Center Agency Director: Patrick Story Phone No.: (808) 334 -4115 Contact Person: Pam Naumann Phone No.: (808) 334 -4121 Mailing Address: 75 -127 Lunapule Rd., Suite 11 Kailua -Kona, HI 96740 Facility /Site Address: Na`alehu, HI Fax No.: (808) 326 -4063 Email Address: pstory@fsswh.org Name of Accountant/CPA (include name of firm if applicable): Rozanne Connell, Manager Carbonaro CPA & Associates, Inc. Phone No.: Mailing Address: (808) 968 -1002 P.O. Box 4372 Hilo, HI 96720 Amount of Request for County Funds: $ 60,000.00 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $40,000 $40,000 $20,000 Agency Mission Statement: Family Support Hawaii was founded in 1979 as a grassroots organization providing family support in communities throughout West Hawaii. Family Support Hawaii incorporated in 1981 as a private, non - profit organization whose mission is "to Support Families and Communities in Providing Love and Care for our Children." As are all mission statements, this one is carefully chosen. It embodies two key elements: support for families and support for communities. The first guides us in the direct work of supporting families, which we do through our counseling, home visiting, school based and parent education NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 and support programs. The second is to assist communities to develop the capacity to provide a supportive environment for families These are our community development activities, economic development projects, collaboration building and advocacy work for a better quality of life for families her in Hawaii. Program Description: The Ka'u Family Center lives in the heart of rural Na`alehu. It is a welcoming place open daily for families to access emergency food, clothing and household items. Along with meeting the critical needs within the community, the Center provides linkages for health care, mental health needs, career opportunities, and educational and financial assistance. Families within the community are given the opportunity to access computers, fax machines and copiers, all at no charge, enabling them to make connections to improve their individual and family circumstances. The Family Center offers a space for community meetings, support groups and youth programs along with many other programs, activities and services. Community members find the Family Center a comfortable place where they can bring their children to play while they sit and "talk story". This is all made possible by the financial support of the County of Hawaii and through the generous donations of community members and organizations. The Family Center allows other non - profit organizations and community groups to use the facilities, providing office and meeting space. The Malama Prenatal, Early Head Start, and Ka'u Child Development (Early Interventions Services), have staff stationed in the Center. Families are, thus, able to access these services without having to travel long distances. This alleviates some of the transportation and financial concerns many community residents face. The Ka'u Family Center Coordinator, Teresa Alderdyce, is a lifelong resident in the community and has provided services at the center for eighteen years. Teresa has true understanding of and the heart to help those in need. She is involved in many local groups and organizations. She facilitates the Ka'u Community Partnership which meets monthly to address community needs. This meeting affords the opportunities of partnership groups such as QLCC, Tutu and Me, The Boys and Girls Club, Friends of Kahuku Park, Ocean View Community Association, Once Upon a Story, Na`alehu Elementary School, Ka'u Chamber of Commerce, Public Health and other community individuals and service providers, to voice their opinions and celebrate successes. Teresa is also a member of the Ka'u Action Team (KAT) which meets monthly to address substance abuse prevention by providing drug free events and initiatives in the community. The members of KAT represent Adult Mental Health, Lokahi Treatment Center, Ka'u High School, Na`alehu Elementary School, Ocean View Community Association, QLCC and partners with Ka'u Ho`olaulea to provide events in the community. As a project community liaison for the County CDP, she stays well informed on not only the immediate needs within the community, but also the direction in which it is headed. Teresa runs the non - school hour program (funded by the Office of Youth Services) which provides a safe and nurturing environment along with access to opportunities, experiences and services for youth participants and their NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 families. Teresa is a trusted and respected person in the community; one that individuals and families know they can go to in order to receive the help - -be it referrals, linkages or direct services- -they need. One can find many news articles in various community papers throughout the year lifting up the good work done due to the existence of the Ka`u Family Center. Through the partnerships and collaborations nourished by the Family Center Coordinator, here is a small listing of published works: • The Ka`u Community Action Team partnered with Family Support Hawai`i's Ka`u Family Center, QLCC, and Ka`u Parks and Recreation to put on a community Easter Egg Hunt and festivities for families. Over 200 people attended. They received a $750 Healing Our Islands grant to assist in funding this successful event. Drug prevention information and resources were also available for families attending the event. • The annual Keiki Christmas Party was a great success with approximately 300 participants and volunteers enjoying the evening. Dinner was provided along with pictures with Santa, presents for the children and lots of holiday cheer. This event was made possible through a partnership of the Ka`u Family Center, community organizations and volunteers. • In collaboration with members from the Ka`u Community Partnership, the Ka`u Family Center Coordinator facilitated the Annual Ka`u Food Drive in October this past year. The need for food has increased in the community with many ending unemployment benefits and many on fixed incomes. The food drive was a success, with Discovery Harbour Community Association being our biggest supporter. The association collected a large number of non - perishable food items and also presented the Center with a check for $1700.00. There are also many individual stories that have been shared magnifying the importance and need fulfilled by the Ka`u Family Center. Here is a small sampling: • A service provider stationed at the Family Center worked with a young family who lost their mother to suicide in this past year. She was able to help them with food, clothing, Christmas presents for the children, and psychological services by networking through the center. • A single mom found employment as a Certified Nursing Assistant after utilizing the Center's computers for on -line job searching and resume writing /submission. • A local service provider referred a homeless father to the Center where he was able to utilize the computer for a job search and receive linkages for housing assistance. This man is now employed and providing a home for his family. Families in this remote district of Ka`u face many challenges. Accessing child care, health care, employment, housing, substance abuse counseling, financial assistance, educational resources, and transportation are only some of these NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 challenges. In the last few years, with the sharp decline in the nation's economic condition, Ka'u has taken a particularly hard strike. Families more than ever are feeling the financial burdens of simply keeping a roof over their family's heads and food in their children's stomachs. Dealing with this type of stress can lead to substance abuse, crime, and family violence. The Family Center is essential in the community providing the families in need with linkages and referrals and, thus, preventing detrimental issues. However, the Family Center has fallen under its own financial burdens. Receiving only thirty -three percent of the requested funding for the 2010 -2011 fiscal year, has meant cutting back staff and center hours along with supplies. This directly affects the community that relies so heavily on the Center for support. Due to the state of the economy (as of December 2010 The Hawai'i State Department of Labor and Industrial Relations reports the county of Hawai'i at an unemployment rate of 9.7% and Na`alehu School reports that 95% of students attending qualify for free or reduced meals) and the lack of services in the southern regions of Hawaii Island, FSH has chosen to focus on programming the Ka'u District with this request for continuation of the Ka'u Family Center. If the funding requested is awarded in full, the center would be staffed at full time capacity benefitting the community with additional services to include, but not limited to, facilitating classes in parenting education /family planning, computer literacy education with on -site technical support, career development, financial counseling and cultural exploration. We are presently applying for a work capacity grant through the Hawaii Community Foundation that would enable the provision of a teleconference link housed at the Ka'u Family Center. There will be additional teleconference hubs located in Kona, Waimea, and Hilo. This would afford community partners an opportunity to schedule and utilize the equipment. Eventually, this valuable resource would be made available for the community at large. The Center would continue to be a base for other FSH programs, and other service providers and organizations that would also benefit the community. The Ka'u Family Center has proven its worth and established its value to the community by being a consistent point of reference to those who reside there as well as those simply passing through. Our hope for the future is that the Center will be available for the community for as long as the need exists. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Family Support Hawaii Ka`u Family Center Total Budget and Position Count Total Program Budget $ 60,000.00 Total Program Position Count 1 FTE Total Agency Bud et $ 4,526,550.50 1 Total Agency Position Count 87 Program Objectives: 1) Mobilize public and private community resources to help children and families in need. 2) Assist families in achieving economic independence and self- sufficiency. 3) Decrease social isolation in rural communities. 4) Enhance children's development and ability to attain academic and social success. 5) Promote successful transitions throughout a family's major milestones. Program Highlights: (from Fiscal Year 2009 -10) 1) Information and referral services were provided to 136 new and 808 returning individuals during the 2009 -2010 fiscal year. There were a total of 398 requests for assistance with items such as emergency food, clothing, shoes and household items - - -all of which have been provided through donations from community members and groups. 2) Provided technological support for those without access to 477 individuals in Ka`u alone over the year for job search, resume preparation and service coordination and communication. 3) Received in -kind donations including 68 volunteer hours from community members and numerous donations of goods and funds for distribution to families. 4) Provided training and work experience to a high school student through a partnership with Alu Like. This student worked 75 hours as an office assistant which included computer tasks such as updating a community service directory. 5) Other community helping organizations were able to utilize the Ka`u Family Center to provide 255 hours of outside service to the community. These included Hawaii Intake Services, VIP Men's Group, Bay Clinic's Reach Out and Read Literacy Program, Na`alehu Main Street, The Ka`u Partnership and the Ka`u Community Action Team. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 6) The Family Center housed programs designed to support families at many different stages of development, such as Healthy Start Home Visiting, Enhanced Healthy Start, , Early Head Start Programs, Malama Perinatal Program, the Ka`u Child Development Program for infants and toddlers with disabilities and their families and the Non - School Hour Youth Development Program. 7) There were several community -wide family events and activities in which 1693 people participated, including the Annual Easter Egg Hunt, Keiki Christmas Party in which partnerships with local businesses afforded the provision of a family dinner and a gift for each child, and an 'Ohana Health and Fun Day' (substance abuse prevention event). 8) Early Intervention services are now being provided to 10 Ka`u infants and toddlers with disabilities and their families. These services include physical, occupational, speech and developmental therapies. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Family Support Hawaii Ka`u Family Center The Family Center provides assistance with a comprehensive array of family support programs, services and activities. Children's Health • Health and developmental screenings for infants and toddlers • Medical Home Support • Evaluations for developmental delays Adult Health Care • Access to prenatal care • Access to general medical care • Info on diet, nutrition and health Drug Awareness and Counseling • Information • Resource and referral services • Access to mental health services • Support Groups Domestic Issues • Parenting education • Financial counseling, planning and management • Housing Education • After school tutorial programs • Access to GED programs • Reading is FUNdamental early literacy program Children's Issues • Play and Learn groups • Health, medical and nutritional services through Early Head Start and Malama Perinatal programs • Therapeutic services for infants and toddlers with disabilities • Child safety in and out of the home Social Services • Employment opportunities and job seeking support • Information and referral to other government and community resources • Emergency food, clothing and household items • Ka`u Partnership (Advisory Council) NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Family Support Hawaii Ka`u Family Center Performance Measures: Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Education 27 75 75 Em to ment 14 75 75 Financial 5 25 25 Health 4 25 25 Parenting Information 10 75 75 Office Equip/Computer Use 477 150 450 Food 228 350 425 Substance Abuse Support/Info 25 50 75 Program Expenditures * See Below Other Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages $ 26,178.00 $ 11,500.00 $ 35,489.00 Professional Fees $ 313.00 $ 125.00 $ 250.00 Operations $ 215.00 $ 0.00 $ 250.00 Equipment $ 969.00 $ 0.00 $ 1,000.00 Other" $ 131.00 $ 0.00 $ 2,261.00 Total $ 27,675.00 $ 11,625.00 $ 36,989.00 * See Below Other Program Expenditures NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Employee Benefits $ 5,577.00 $ 1,410.00 $ 6,000.00 Payroll Taxes $ 3,244.00 $ 1,395.00 $ 3,000.00 Occupancy $ 6,342.00 $ 5,096.00 $ 6,500.00 Supplies $ 1,459.00 $ 350.00 $ 5,000.00 Travel—Mileage $ 131.00 $ 0.00 $ 2,261.00 Insurance $ 268.00 $ 125.00 $ 250.00 Total $ 17,021.00 $ 8,376.00 $ 23,011.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 Family Support Hawaii Ka`u Family Center Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Hawaii County $ 40,000.00 $ 20,000.00 $ 60,000.00 Private Donations/Fund raising $ 3,700.00 $ 3,000.00 State of Hawaii Total $ 43,700.00 $ 20,000.00 $ 63,000.00 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Ka`u Family Center concept is central to the work of providing supportive services to low- income and immigrant families in rural areas. It is expected that FSH will continue to expand its services to better cover the area of Ocean View Estates - -a Ka`u community in which many FSH program participants currently live. This includes families from the Marshall Islands who are having severe challenges with finances and with health, social service and educational systems. Family support is about investing in the promotion of the positive assets that families want for their children. In the long term, family support is a societal investment in the creation of happy, healthy, productive citizens. This investment has an impact on the families who participate in services, and on society as a whole. Research shows that by investing in positive outcomes for children and families, family support programs also, over the long term can lead to: • fewer teen pregnancies • less juvenile delinquency • improved behavior and performance of children at school • fewer incidents of child abuse and neglect • more families moving from welfare to work • increased self- confidence, knowledge of child development and parenting skills among parents • greater educational attainment among parents Through these positive outcomes, family support allows us as a society to invest in the development of citizens rather than putting money into more prisons, foster homes, and public welfare. This investment has a tremendous effect on overall NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 productivity as a society and on the community and, on a greater scale, of the nation. Collaboration has been a key to the success of the Family Center programs and is recognized as top priority in the continued growth and service of the Centers. Alliance among numerous agencies, student organizations, local governments, school systems, departments of health and social services, civic and religious organizations provides on -site programs, services, and activities. Representation on local Advisory Boards, scholarships and financial assistance, volunteers, and in -kind donations such as educational materials, transportation, and Center space are also contributions that will continue to support the programs. The continued support from the County of Hawaii, along with the powerful support and donations given by community members, is vital to our continuation of the much needed services we provide at the Ka`u Family Center. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 10 Family Support Hawaii Ka`u Family Center I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. --j"t-i _O-C Signatur of Board President /Chair Signature of Executive Director - r Date LD? - i/ Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 11 26 Friends of Big Island Drug Court Assistance to Drug Court Clients & Program Friends of Big Island Drug Court- Agency Name Assistance to Drug Court Clients & Program- Program Name Agency Director: ►0 Phone No.: N/A Contact Person: Carol A. VanCamp, President Phone No.: (808) 982 -9958 or (808) 938 -0828 Mailing Address: Facility /Site Address: Fax No.: Email Address: P.O. Box 6100, Hilo, HI 96720 None- Volunteer Board (808) 982 -9958 (call first) cvancamp3 @hawaii.rr.com Name of AccountantlCPA (include name of firm if applicable): Brian Iwata, CPA, Taketa, Iwata, Hara & Assoc., LLC Phone No.: (808) 935 -5404 Mailing Address: 101 Aupuni St., Suite 139, Hilo, HI 96720 Amount of Request for County Funds: $10,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $10,000 $10,000 $10,000 Agency Mission Statement: The Mission of the Big Island Drug Court is to help address societal problems related to substance abuse in order to minimize their societal and economic costs, and to protect the Big Island community by providing timely and effective treatment for drug offenders with appropriate sanctions and incentives. Simply NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page I stated, the "Friends of Big Island Drug Court" is a 50103 organizations created to provide financial and other support for Drug Court clients and the overall program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Friends of Big Island Drug Court - Agency Name Assistance to Drug Court Clients & Program- Program Name Program Description: The Friends of Big Island Drug Court provides funding and other support for the clients and programs of Big Island Drug Court. This includes rewards and incentives to clients during their drug -free journey (such as gift certificates, movie tickets, etc.), loans or awards for tuition to further their education, and loans or awards for housing, travel or other such needs. The Friends also sponsors graduation supplies for Drug Court clients, and responds to individual requests for support. They also support alumni and support group activities to help ensure long -term success for clients. All programs and activities are conducted by volunteers, as there are no paid employees. The organization is governed by a volunteer board of directors, representing a cross - section of individuals from the community. Total Budget and Position Count Total Program Budget $14,000 Total Program Position Count 0 Total Agency Bud et $14,000 Total Agency Position Count 0 Program Objectives: 1) The Friends is designed to integrate community /private support into governmental efforts directed at the rehabilitation of adult men and women and juveniles, who are charged with or convicted of non - violent felonies and assessed as chemically dependent on alcohol and /or other drugs, by securing financial support for governmental efforts to operate Big Island Drug Court in the Third Circuit. Program Highlights: (from Fiscal Year 2009 -10) 1) Through private donations and fundraising and county non - profit grant assistance, we have been able to provide financial rewards and incentives to motivate Drug Court clients and also to provide awards and loans for tuition, housing, or various other needs of Drug Court clients. The specific goal is to assist in ways that government cannot to help clients successfully complete the Drug Court program and return to society as contributing citizens The cost and benefits to society to rehabilitate these NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 individuals is far less than incarceration, and it also helps to rebuild entire families when a loved one is returned to them as a functional law- abiding citizen.. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Friends of Big Island Drug Court - Agency Name Assistance to Drug Court Clients & Program - Program Name Performance Measures: FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget * Estimate Balance sheet as of 12/31/10 $11,767.26 $14,000 $14,000 *If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 0 0 0 Professional Fees $1,815.10 $1,800.00 $1.800.00 Operations $1,294.28 $12,200.00 $11,800.00 Equipment 0 Other" $6,890.62 $400.00 Total $10,000 $14,000.00 $14,000.00 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 �-r Attachment 2 Summary of FY 2009 -10 Grant Expenditures AGENCY /ORGANIZATION: FRIENDS OF THE BIG ISLAND DRUG COURT PROJECT NAME: FRIENDS OF THE BIG ISLAND DRUG COURT FY 2009 -10 t07ro1ros - 06/30!101 Budget Cate-gory ACTUAL EXPENDITURES 1 Personnel: Salaries $0.00 (For employees supported by County grant funds) 2 Employee Benefits - Health & Dental Insurance; Other Benefits 0.00 (For employees supported by County grant funds) 3 Payroll Taxes - FICA, SUI, Worker's Companesation, TDI 0,00 (For employees. supported by County grant funds) 4 Professional Fees - Legal; Accounting/Bookkeeping; Audit Fees; 0.00 Administrative Fees; Other 5 Supplies - Office; Program: Consumable; Telephone; Postage & 0.00 Freight 6 Occupancy - Rent; Utilities; Repairs & Maintenance (PO Box) 90.00 7 Equipment - Purchase; Rental; Repairs & Maintenance 0.00 8 Insurance - General Liability; Auto; Fire: NDOA Board Insurance 1,815.10 9 Operations - Printing; Publications/Subscriptions; Membership 1,294.28 Dues; Staff Training; Auto Gasoline Purchase 10 Travel - Airfare; per Diem; Auto Rental; Mileage Reimbursement 0.00 11 Other - Tax Screening; Client Assistance; Contract Services; Miscellaneous; Program Expenditures 6,800.62 TOTAL (Items 1 -11) $10,000.00 County of Hawaii - Office of the County Clerk r Human Services Grants - FY 2009 -2010 Friends of Big Island Drug Court - Agency Name Assistance to Drug Court Clients & Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate County of Hawaii Grant $10,000.00 $10,000.00 $10,000.00 Private Donations $0 $4,000.00 $4,000.00 Total $10,000.00 $14,000.00 $14,000.00 *if applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? We will continue to pursue public donations, but recent economic factors make this more challenging. Therefore, we cannot predict when our program will become self- sustaining. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Friends of Big Island Drug Court - Agency Name Assistance to Drug Court Clients & Program - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board President/Chair Npq //a�/// Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTEDI NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 27 Friends of the Children's Justice Center of East Hawaii Special Needs & Enhancement, Center Support, Prevention /Education & Training Programs Friends of the Children's Justice Center of East Hawaii - Agency Name Special Needs and Enhancement, Center Support, Prevention /Education and Training Program- Program Name ( 0 [ U Agency Director. Rachel Pedro, Program Coordinator Phone No.: 808 - 935 -8755 Contact Person: Rachel Pedro, Program Coordinator Phone No.: 808 - 935 -8755 Mailing Address: Facility /Site Address: Fax No.. Email Address: P.O. Box 6908 Hilo, Hawaii 96720 1290 Kinoole Street Hilo, Hawaii 96720 fcjceh@hawaii. rr.com Name of Accountant /CPA (include name of firm if applicable): Jennifer Gossert (Jennifer Gossert, CPA) Phone No.: 808 - 969 -3115 Mailing Address: 688 Kinoole Street, Suite 201, Hilo, Hawaii 96720 Amount of Request for County Funds: $15,000.00 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $15,000.00 $10,000.00 $10,000.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Agency Mission Statement: The agencies mission is to help sexually, physically and emotionally abused children, neglected children, and children who are witnesses to crime, in partnership with the Children's Justice Center of East Hawaii. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Friends of the Children's Justice Center of East Hawaii - Agency Name Special Needs and Enhancement, Center Support, Prevention /Education and Training Program- Program Name Program Description: The Friends of the Children's Justice Center of East Hawaii is a private nonprofit organization founded by concerned community members in 1990 whose primary goal was to protect and enhance the physical and psychological safety of abused or neglected children. The Friends have a unique partnership with the Children's Justice Center (CJC), a State Judiciary Program. The CJC provides a safe, neutral homelike atmosphere where children can be interviewed regarding allegations of abuse, particularly sexual abuse. This Children's Justice Program facilitates and coordinates the system's response to victims of child abuse to reduce their trauma through a multi - disciplinary team approach which involves police, social workers, prosecutors, guardians ad litem, medical professionals, advocates, and others. The Friends support the CJC primarily by helping to provide resources for direct services and programs for child victims and their families which are not available through any other public or private source. The Friends accept requests for funding from state and private agencies working with child abuse victims such as Child Protective Services, Child and Family Services, Hawaii Behavioral Health, Catholic Charities, Parents Inc., and other agencies. The Friends serve children between the ages of 0 -18, who are victims of abuse (sexual, physical, emotional, mental abuse or neglect, or are witnesses to crime) residing in East Hawaii. This includes North Hilo, South Hilo, Hamakua, Puna and parts of Ka'u. We serve children with active or documented cases of abuse and neglect. The Special Needs and Enhancement Program is designed to help child victims develop positive self -worth. The Friends provide resources for needs that are not covered by any other public or private source. Funds are used to provide basic essentials (i.e. clothing, diapers, toiletries), special needs (i.e. air /ground transportation, school supplies, correspondence courses) and enhancement support (i.e. sports, music lessons, and tutoring). The Friends also have a holiday gift program for children not covered by other programs. Center Support: The Friends provide resources to help reduce trauma and ensure the safety and comfort of the children that come to the Children's Justice Center for interviews. The Friends maintain the Center's safe, child - friendly and homelike atmosphere with toys, games and snacks. This is often made possible NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 by community donations. The Friends also help maintain the Center's appearance with repairs and refurbishing when needed. The Prevention and Education Program is designed to educate the community regarding child abuse issues. This program plans events for the public, promoting awareness and prevention of child abuse. The Training Program helps to sponsor the attendance of various professionals (i.e. social workers, police & therapists) at seminars and conferences to learn state -of- the -art interviewing techniques and refine their overall skills. These professionals work with child victims and their families. Training opportunities enhance the quality of services and prevents victims from being re- traumatized by possible difficiencies in the system's response to the allegations of abuse. Total Budget and Position Count Total Program Budget 158,100 Total Program Position Count 1 Total Agency Bud et 178,100 Total Agency Position Count 1 Program Objectives: 1) Provide funds for clothing, toiletries, bed /mattress and other necessities for children in emergency or relative foster placement. 2) Provide funds for tutoring, correspondence courses or summer school to allow a child to graduate or progress to the next grade level. 3) Provide funds for ground or air transportation for children to participate in family vacations /reunions, attend school or team events, or to see medical specialists. 4) Provide funds for children to participate in supervised Spring and Winter Intersession activities, or summer camps. 5) Pay for fees, equipment and supplies needed for extracuricular activities ie: sports, music, art, drama, dancing lessons, etc. 6) Provide funds for holiday or birthday gifts when a child would otherwise not receive a gift. 7) Provide funds (or gift cards) for gas, to families on a limited budget so children may be able to attend treatment programs. 8) Provide funds for diapers, car seats and other baby supplies for infants who are victims of abuse and neglect. 9) Pay for event fees, prom dresses, senior pictures, yearbooks, etc., to give a student a chance to participate in school functions. 10) Assist police, social workers, and other professionals in keeping up to date with the latest investigative techniques, sensitivity training, forensics and knowledge of resources by helping to sponsor their attendance at training workshops and seminars. 11) Provide privacy, comfort and safety for children and family members who come to the Center, by maintaining its warm environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 12) Participate with the East Hawaii Coalition for Child Abuse Prevention in community education activities to increase public awareness. Program Highlights: (from Fiscal Year 2009 -10) 1) Filled 985 Special Needs Requests for abused and neglected children to provide for their emergency or enhancement needs that would otherwise have gone unmet. 2) Continued to partner with Children's Justice Center of East Hawaii to provide requested funds for professionals to attend trainings, including Social Workers, police and other professionals who interface with alleged child victims of abuse. 3) Increased community awareness of Abuse Prevention by participating in educational activities including: ongoing partnership with the East Hawaii Coalitionto Prevent Child Abuse and Neglect, especially for April - Child Abuse Prevention Month; participated in Celebrate Your Family Day at Sangha Hall; participated in the Boy Scouts annual Makahiki Festival; attended community education fairs at UH Hilo's Family Affair event and the Puna Informational Fair at the Pahoa Community Center; and to local churches and organizations. 4) Provided 140, $30 Holiday Gift Cards to Wal Mart, to teens 12 to 17 years old. Coordinated a group of volunteers from the local school Resource Team to assist with wrapping gift cards. 5) Held our signature fundraiser (The Phantom) by distributing 400 invitations and raised approximately $15,000. 6) Sponsored a 7th Annual Prevent Child Abuse Golf Tournament for FCJCEH, at the Mauna Lani North Course. 7) Held a Legislative Open House, February 2010, inviting State Legislators, county mayor, and county council members to visit our agency and meet our Board and volunteers. 8) Submitted one new Grant Requests: Atherton Family Foundation, via Hawaii Community Foundation (awarded pending); and will continue to investigate other grant opportunities. 9) Assisted at Aid Station for runners participating in the 2010 Ironman Triathlon in Kona, as our service to the community. 10) Participated in the 2010 Annual Visitor Industry Charity Walk, a statewide event coordinated by the Hawaii Hotel & Lodging Association. 11) Recruited one new Board Member to our Board of Directors. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Friends of the Children's Justice Center of East Hawaii - Agency Name Special Needs and Enhancement, Center Support, Prevention /Education and Training Program - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Fill Emergency and Enhancement requests through the (SNR Program) Special Needs Requests. 985 1,050 1,200 Professional Fees 12,396 10,000 10,500 Maintain Holiday Gift Program 140 150 150 Equipment Other" Total 1 149,7531 152,6001 158,100 *If applicable Program Expenditures * If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages 31,059 31,800 32,600 Professional Fees 12,396 10,000 10,500 Operations 106,298 110,800.00 115,000 Equipment Other" Total 1 149,7531 152,6001 158,100 * If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Friends of the Children's Justice Center of East Hawaii - Agency Name Special Needs and Enhancement, Center Support, Prevention /Education and Training Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Donations 3,360 3,500 3,500 County of Hawaii Grant 10,000 10,000 15,000 Hawaii Island United Way 2,400 3,000 3,000 Geist Foundations 44,717 46,500 46,500 Teresa Hughes 35,000 40,000 45,000 John Ross Foundation 2,000 5,000 5,000 Charity Walk 3,000 3,000 3,000 Young Brothers 1,000 1,000 1,000 Other Grants 27,785 19,400 15,200 Fundraising net 19,310 20,000 20,000 Admin. fees 636 700 700 Workshop fees 180 200 200 Interest 365 300 Total 149,753 152,600 158,100 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Friends do not collect fees for any of our services. We are continuously researching for additional grant funding, striving to increase donations for our Phantom non -event fundraiser, and expanding participation in our golf tounament fundraiser. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Friends of the Children's Justice Center of East Hawaii - Agency Name Special Needs and Enhancement, Center Support, Prevention /Education and Training Program - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature o Board President/Chair Fl__�_ Si to of xecutive Director ( -z - l( Date bl - X % II Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 as e l Friends of the Children's Justice Center of West Hawaii Enhancement and Basic Needs FRIENDS of the Children's Justice Center of West Hawai'i - Agency Name Enhancement and Basic Needs- Program Name Agency Director: Michelle Ono Phone No.: 808.331.2425 Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Michelle Ono 77 -6403 Nalani Street Kailua -Kona, HI 96740 77 -6403 Nalani Street Kailua -Kona, HI 96740 808.327 -4988 fcjcwh @hawaii.rr.com Phone No.: 808.331.2425 Name of Accountant/CPA (include name of firm if applicable): Steve Fassbender Phone No.: 808.331.2425 Mailing Address: 77 -6403 Nalani Street Kailua -Kona, HI 96740 Amount of Request for County Funds: $15,000.00 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $15,000.00 $15,000.00 $10,000.00 Agency Mission Statement: FCJC -WH mission is to provide assistance to the children of West Hawai'i who have been traumatized by sexual assault, physical abuse and /or neglect, or who have been witnessess to violent crime; to support the Children's Justice Center of West Hawai'i; and to promote the awareness and prevention of child abuse. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-2012 1 FRIENDS of the Children's Justice Center of West Hawaii - Agency Name Enhancement and Basic Needs - Program Name Program Description: The FCJC -WH was established in 1989 as a non profit 501 (c) (3) organization to work in partnership with the Children's Justice Center of West Hawai'i, a part of the State of Hawai'i Judiciary, to provide a safe and warm, child friendly setting where children can be interviewd by specially trained professionals about allegations of sexual abuse,physical abuse, and /or as witnesses to violent crime. The FCJC -WH developed an "Enhancement and Basic Needs" program to provide financial assistance to enhance the opportunites for child and teen victims of abuse to participate and benefit from activites, programs, and services that strive to build self esteem, strengthen self - image and perpetuate self worth, all of which are crucial to the healing process and key in the prevention of future re- victimization. We are also able to assist with emergency assistance and basic needs, such as food and clothing. Our goal is " to help a victim become a child again ". The FCJC -WH requires that a "needs request" form be submitted through a professional working directly with a child /teen such as a social worker, private therapist, guardian ad litem, or school counsler. To be eligle for FCJC -WH assistance, the child /teen must be a victim of a documented case of child abuse and /or neglect or a witness to violent crime. By collaborating with a vast array of professionals, we continue to increase our abilty to effectivly identify and address the needs of child and teen victims of abuse that have not and /or cannot be adequately be met by governmental and /or other private agencies in West Hawaii. The FCJC -WH have utilized funds for child participation in many local programs such as the Donkey Mill Art Center, Horseplay Camp, Aloha Performing Arts Program Theater Workshops, various sports leagues, martial arts programs, afterschool tutoring, music lessons and school intersession programs. Each year we assist West Hawai'i teens who qualify for assistance through our program, to travel to Oahu and participate in the Winner's Camp Foundation's, " Hawai'i Leadership Academy ". This one week camp is designed to enhance self- esteem and strengthen social proficiency and academic performance through lessons on leadership and personal responsibility. In addtition, the FCJC -WH also organizes "Winner's Camp Reunion Activites" to address the need for West Hawai'i graduates to have consistent opportunies to refresh lessons learned as well as strenghten the supportive peer relationships that were created during thier camp experiences. It is our vision that these supportive activites can "help a victim be a child again ", decrease the potential for re- victimization, and ultimately help to break the cycle of child abuse in the West Hawai'i community. The FCJC -WH also collaborate with several local agenices, such as YWCA - Sexual Assualt Support Services, to activley participate in activities that focus on the awareness and prevention of child abuse in our communities. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-2012 2 FRIENDS of the Children's Justice Center of West Hawai'i - Agency Name Enhancement and Basic Needs - Program Name Total Budget and Position Count Total Program Budget 101,300.00 Total Program Position Count 1.0 Total Agency Budget 136,102.50 Total Agency Position Count 1.0 Program Objectives: 1) Assess 800 enhancement and /or basic needs requests benefiting 400 individual children by June 30, 2012; 2) Give 50 FRIEND Bags to children entering the foster care system and /or Domestic Violence Shelters by June 30, 2012; 3) Distribute 150 Holiday Gift Bags to child victims of abuse and neglect in West Hawai'i by December 24, 2011; 4) Assist 12 teens to attend Winners' Camp by June 30, 2012; 5) Organize 5 Winners' Camp Reunion Activities by June 30, 2012; 6) Provide support to and participate in 2 or more prevention and awareness community activities in collaboration with partner agencies; 7) Attend 10 Hui Lau Lima meeting at the Neighborhood Place of Kona, and present 3 informative talks to community agencies /groups by June 30, 2012. Program Highlights: (from Fiscal Year 2009 -10) 1) Accepted and processed 1254 enhancement and needs requests during the 2009 calendar year serving 422 individual children. 2) Distributed 8 FRIEND Boxes during the 2010 calendar year to children entering the foster care system. 3) Supported and participated in several public awareness and child abuse prevention activities such as the YWCA -SASS, "May I Touch You ", sexual assault prevention and safe dating program that traveled to Hawaii Island public high schools. 4) Attended regular Hui Lau Lima Meetings at the Neighborhood Place of Kona and gave several talks to community groups and agencies. 5) Sponsored 18 trips to Winners' Camp in 2010 calendar year. 6) Distributed 140 holiday gift bags to child victims of abuse and neglect in West Hawaii in December 2010. 7) 5 Winners' Camp Reunion activities were organized for West Hawai'i Winners' Camp Graduates. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 FRIENDS of the Children's Justice Center of West Hawai'i - Agency Name Enhancement and Basic Needs - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Children Brought to CJC -WH for Forensic Interviews 98 120 120 Approved Needs Requests 434 800 800 Individual Children Served 220 400 400 FRIEND Boxes for Children Entering Foster Care *2011- Modification to FRIEND Bag - Include children Entering DV Safe Shelters 8 30 50 Holiday Gift Bags 140 150 150 Winners' Camp Attendees 18 15 12 Winners' Camp Reunion Activities 5 5 5 *If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-2012 0 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 0 0 0 Professional Fees 18,352.93 20,505.00 26,400.00 Operations 0 0 0 Equipment 0 0 0 Other 79,853.21 82,750.00 74,900.00 Total 98, 206.14 103, 255.00 101, 300.00 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-2012 0 Other Expenditures - FRIENDS of the Children's Justice Center of West Hawaii ITEM 2009 -2010 2010 -2011 2011 -2012 Actual Budget Budget Athletic $ 5,392.48 $ 5,000.00 $ 5,500.00 Center Support $ 9,563.49 $ 11,375.00 $ 13,650.00 Christmas Bags, Teens $ 1,030.72 $ 1,000.00 $ 1,500.00 Christmas, Other $ 175.00 $ 1,000.00 $ 1,000.00 Clothing $ 4,238.53 $ 3,000.00 $ 4,000.00 Dental $ 1,000.00 $ 1,000.00 $ 1,000.00 Education $ 8,511.58 $ 5,000.00 $ 5,000.00 Enhancement, Basic Needs $ 1,576.90 $ 1,000.00 $ 2,000.00 Enhancement, Miscellaneous $ 4,696.97 $ 4,000.00 $ 4,000.00 Food $ 500.00 $ 500.00 $ 500.00 Food Coupons $ 775.00 $ 1,000.00 $ 1,000.00 FRIEND Boxes $ 755.54 $ 1,000.00 $ 5,500.00 Furniture $ 861.19 $ 500.00 $ 500.00 Gas Coupons $ - $ 100.00 $ 200.00 Graduation $ 159.76 $ 500.00 $ 250.00 Medical $ 480.64 $ 2,000.00 $ 500.00 Music Lessons $ 216.00 $ 500.00 $ 500.00 Performing Arts $ 3,413.29 $ 2,000.00 $ 1,000.00 Prevention /Awareness $ 622.36 $ 500.00 $ 1,000.00 Professional Fee -FCJC $ 8,789.44 $ 13,680.00 $ 17,600.00 School Break Programs $ 2,140.00 $ 5,000.00 $ 3,000.00 School PicturesNearbook $ 467.00 $ 300.00 $ 300.00 School Supplies/fees $ 1,178.96 $ 1,000.00 $ 1,000.00 Summer Cam /Fun $ 3,972.00 $ 5,000.00 $ 5,000.00 Summer School $ 2,102.00 $ 1,000.00 $ 2,000.00 Thera $ 360.00 $ 300.00 $ 300.00 Training & Education $ 617.67 $ 1,000.00 $ 1,000.00 Travel $ 3,710.67 $ 5,000.00 $ 2,500.00 Winners'Camp $ 25,349.49 $ 25,000.00 $ 15,000.00 Winners' Cam reunions $ 5,549.46 $ 5,000.00 $ 5,000.00 TOTALS: $ 98,206.14 $ 103,255.00 $ 101,300.00 FRIENDS of the Children's Justice Center of West Hawai'i - Agency Name Enhancement and Basic Needs - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate County of Hawai'i 15,000.00 10,000.00 15,000.00 Private Foundations 79,300.00 70,000.00 80,501.00 Donations 20,284.55 16,803.00 18,704.00 Total 114,584.55 96,803.00 114,205.00 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The FRIENDS of the Children's Justice Center of West HawaiTs "Enhancement and Basic Needs" program is essentially self sustaining at the present time. We are adjusting our budget to reflect the local economic distress and will explore additional financial grant assistance and fundraising opportunities throughout the year. The Enhancement and Basic Needs Program is the only program of the FCJC -WH and the service we provide is unique and unduplicated in West Hawai'i. Without FCJC -WH assistance, a majority of the children and teens we serve would not receive enhancement opportunities. We strongly believe that County of Hawaii funding continues to be crucial in the success of the Enhancement and Basic Needs Program and meeting the essential need to support children /teens victims of abuse by providing enhancement activities that increase self- esteem and self worth. Any decrease in County of Hawaii grant funding would adversely affect our Enhancement Program and number of children /teen we can provide assistance to, however, every effort would be made to secure funding from other sources to ensure the continuance of our Enhancement and Basic Needs Program. In 2011, the FCJC -WH will implement a more structured volunteer program to maximize the recruitment and retention of dedicated volunteers, who continue to be crucial to our organization. Despite having only one employee, the FCJC -WH is able to "think outside of the box" in terms of potential ideas and projects due to the incredible community support and the immense dedication of our current volunteers. This helps to keep administrative costs down and program support up, which continues to one of our biggest priorities. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-2012 FRIENDS of the Children's Justice Center of West Hawai'i - Agency Name Enhancement and Basic Needs - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. f J 7:2- Date /. Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page G 4.81 Goodwill Industries of Hawaii, Inc. Job Connections Goodwill Industries of Hawaii, Inc. - Agency Name Job Connections - Program Name Agency Director: Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Laura Robertson Phone No.: 808 - 836 -0313 Phyllis Wintter Phone No.: 808 - 934 -8118 500 Kalanianaole Ave, Hilo 96720 200 Kanoelehua Ave, Suite 101, Hilo 96720 808 - 969 -3861 pwintter @higoodwill.org Name of Accountant/CPA (include name of firm if applicable): Catha Combs, Wikoff Combs and Co., LLC Phone No.: 808 - 791 -1420 Mailing Address: 1001 Bishop Street, Suite 2760, Honolulu, HI 96813 Amount of Request for County Funds: $30,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $14,000 $10,000 $7,500 Agency Mission Statement: Our mission statement is: Goodwill Industries of Hawaii, Inc. helps people with employment barriers to reach their full potential and become self - sufficient. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 1 Goodwill Industries of Hawaii, Inc. - Agency Name Job Connections - Program Name Goodwill Industries of Hawaii (Goodwill) has been in business in the State of Hawaii since 1959 providing vocational training and employment services to persons with barriers to employment, including: • Individuals with disabilities; • Youth who have disabilities or are economically disadvantaged; • Disabled veterans; • Asian and Pacific Islander immigrants; • Older individuals and dislocated workers; and • Adults who are economically disadvantaged, including First -to -Work TANF/TAONF /UFUE and Food Stamp recipients. • Ex- offenders transitioning from incarceration into the community With more than 50 years of experience operating vocational training programs as well as teaching life skills, Goodwill has developed an expertise in bringing about success to the people we serve. Goodwill Industries of Hawaii in Hawaii County has been serving our community since 1998. We envision a world where all individuals with disabilities and other barriers will have the opportunity to participate in a full range of life's experiences, including employment. We provide services to empower individuals to be productive and independent, based on their abilities and interests. From July 2009 to June 2010, GIH successfully provided services to 13,318 people statewide, and placed 1,667 people into gainful employment. The Hawaii Island Branch of Goodwill Industries provided services to 3,076 individuals and placed 480 people into employment in 2009 -2010. Over the past five years, Goodwill has provided training and employment services to almost 34,570 people statewide with barriers to employment, and placed 8,557 people into employment. Goodwill's Hawaii Island Branch served 7,278 people and placed into employment 2,235 people over the past five years. These numbers reflect that Goodwill has the necessary skills and experience to perform the proposed services. It is our belief that work is a basic right that will assist people to attain other life goals. Moreover, we believe in each individual's right to self- determination, to make their own decisions regarding life choices as a means of promoting independence and self- sufficiency. Goodwill is a significant contributor to the local economy. As people become self- sufficient, the community is impacted economically. In the recent economic climate, the Job Connections employment and training services are being utilized in record numbers. In 2009 -10, Job Connections received 441 calls inquiring about services. People are seeking ways to be competitive in today's employment market. Often callers are desperate after applying to hundreds of jobs without securing employment. Through training and support, our NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 2 Goodwill Industries of Hawaii, Inc. - Agency Name Job Connections - Program Name participants are finding employment despite high unemployment rates. In previous years, Goodwill has provided a menu of services to train, place and support individuals with barriers into gainful employment and assist them to overcome their barriers to both employment and job retention. Additionally, Goodwill is committed to providing services to help individuals after they have obtained employment to acquire skills and resources to advance, and improve their economic self- sufficiency through training in basic literacy, computer literacy, GED, ESL, and Earned Income Tax Credit filing. Participants are also provided follow -up support after placement into employment. Examples of agencies and partners with whom we coordinate services include the Hawaii Community Correctional Center, Hawaii Paroling Authority, Adult Probation Office, Hawaii Intake Service Center, Workforce Development Division, Department of Human Services, Division of Vocational Rehabilitation, Department of Health, Turning Point for Families, Office for Social Ministry, C.A.R.E. Hawaii, Big Island Substance Abuse Council, Alu Like, Chamber of Commerce, Goodwill Industries International, employers in identified industries with job opportunities corresponding to participants' career goals, and others. In addition to partnerships with other agencies, the Job Connections program has played a major role in the development of the "Going Home Consortium" (formerly the Mayor's Task Force on Employment Solutions) to support inmates and ex- offenders transitioning from incarceration to our community. The Going Home Consortium consists of more than 70 government agencies, private agencies and concerned citizens working together to support ex- offenders re- integrating back into the community in an effort to make our community safe, reunify families, and reduce recidivism by providing services that otherwise did not exist. Employment plays a major part of successful reintegration thereby reducing recidivism. A Goodwill service that is housed in the Goodwill office in Kailua -Kona is the Home Ownership Assistance Program (HOAP). The HOAP program assists Hawaiian Homeland beneficiaries to become employed leading to financial stability. As a result, participants are able to qualify for mortgages to build homes, as well as, avoid foreclosures. Thos Job Connections participants who are eligible for the HOAP program may choose to participate in carpentry apprenticeship training through HOAP to learn new skills and increase their employability. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 Goodwill Industries of Hawaii, Inc. - Agency Name Job Connections - Program Name Program Description: Funding is requested to provide support services to low- income individuals (at or below 150% of the Federal Poverty Guidelines), and particularly to those who have been incarcerated and are being released from Hawaii Community Correctional Center. The funding requested will provide support services to rise to the need of the recent economic crisis as well as to target local ex- offenders for the purpose of creating a safer community and reunifying families by reducing recidivism. The funding requested will provide services for 53 individuals that include the following three components: 1) Intake and Assessment including Individual Program Plan Development 2) Job Readiness Training 3) Job Development and Job Placement Assistance Upon placement into employment near or with their families, the Job Connections program will continue to provide case management and support until the individual achieves employment for one year. Job Connections will provide job development and support services to employers. The Job Connections program has become a leader in providing motivational and inspirational training by using a hands -on approach. First, in the process of assessment, participants learn about themselves by identifying skills acquired, both inside and outside of correctional institutions. As part of assessment, participants are given work skills, soft - skills, interests and personality assessments and corresponding choice of careers. The assessments help give participants language to describe themselves and their skills on a resume and talk about themselves to potential employers. The assessments also assist in career exploration and identifying personal career goals. Participants create their Individual Program Plan that serves as a guide to achieve their desired goals and outcomes. A simple soft - skills assessment assists in identifying areas of weakness such as poor time management and poor money management. Employment Counselors work with clients to improve these skills through formal training and follow -up. Second, in a 20 hour Job Readiness Training course is scheduled within one week to educate and support participants in becoming job ready. In the hands -on class, participants learn how to correctly fill out applications, write their resumes, create cover letters, learn interviewing skills, and learn innovative ways to job search. Graduation is a culmination of all the skills they have learned. They are expected to present themselves properly in appearance, body language, written material, and verbally in mock interviews. Other Goodwill Employment Counselors and /or former graduates (that participants are not familiar with) conduct the mock interviews to simulate elements of a real interview. Third, the participant is assigned an Employment Counselor who helps the participant identify barriers to employment and solutions for removal of the barriers. The participant sets goals for him /herself NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 Goodwill Industries of Hawaii, Inc. - Agency Name Job Connections - Program Name and the Employment Counselor supports them in their achievement. Job Development is an important part of the process of job placement. Counselors contact employers, post job openings on a daily basis, and uncover hidden job markets. Participants are Participants are invited to use the Job Connections office for their job search after graduation. Our counselors will meet with former offenders to assist with job searching. Our clients have access to: computers, internet for job searches, researching companies, and completing applications, daily newspaper, telephone and telephone books, fax machine, and their Employment Counselor's guidance. The result is job placement, self- sufficiency and a stronger local economy. In FY 2009 -2010 the demographics of all participants in the program were: • 47% identified themselves as Hawaiian or part Hawaiian • 76% identified themselves as having a criminal background • 16% identified themselves as having less than a high school education Total Budget and Position Count Total Program Budget $30,000 Total Program Position Count 3 Total Agency Budget $3,000,000 Total Agency Position Count 88 *Total Agency Budget denotes Hawaii Island Branch only Program Objectives: 1) Enroll 53 participants in the Job Connections program. 2) Conduct Intake and Assessment including assessment of skills, soft - skills, personality, career goals, work history and barriers to employment. 3) Develop an Individual Program Plan with each participant that includes creating their goals and the steps needed to achieve them. 4) Conduct Job Readiness Training consisting of 20 hours of hands on classroom training. This may also incorporate topics related to Hawaiian Culture and Values as well as Post Incarceration Syndrome as applicable. 5) Place participants into employment. 6) Conduct job developing activities with employers, pre- screening, job placement and follow up to ensure a smooth transition into employment. The Job Connections program will continue to support the participants and employers for one year from date of placement with a focus on successful job retention and advancement. The emphasis of this program is giving the participants the confidence and tools to maximize their abilities. Our philosophy is to provide an environment for people to believe they can succeed, achieve goals, develop skills and change the barriers they face every day. At Goodwill we believe in the power of work. We create hope, jobs and futures. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 5 Goodwill Industries of Hawaii, Inc. - Agency Name Job Connections - Program Name Program Highlights: 1) In FY 2009 -10, the Job Connections program served 163 participants identified as low income. Of those 163, 99 were new participants and all completed job readiness training and 77 were successful in finding employment, a 77% placement rate. 2) Below are some recent success stories that illustrate the work being done: • A female work furlough inmate had never worked in her life with the exception of her prison job. Her serious substance abuse problem started as a teenager resulted in prison and affected her ability to continue high school. She has overcome her substance abuse, and with our help, is now working on getting her High School Diploma. Her Employment Counselor kept her from quitting her job on several occasions by counseling her when she was frustrated and teaching her how to interact with other employees and her supervisor. As a result, she was still employed at the time of discharge as a success for staying on the job for one year. • One HCCC referral attended Job Readiness Training and began job searching. His barriers included the following: no drivers license or State Identification, no Social Security Card, criminal background and incarcerated for many years, and lack of housing opportunities upon release. He was able to accomplish many of his goals listed as barriers after receiving guidance from his counselor. He got his State Identification and a Social Card. In November, he studied for his license and was able to obtain his driver's license. He got a job as a laborer. He did such great work and earned his employer's trust that he became his employer's personal assistant. He now drives the company work truck and often makes purchases for his employer's company. His boss has recognized his commitment and offered him an apartment to rent. He has saved up enough money to purchase a truck of his own and now has reliable transportation. In addition, he was recently re- united with his 9 -year old son who he has not seen since he was a baby. Our client is working hard on establishing a strong relationship with him, as well as, with his family. 3) Through participation in the Job Connections program ex- offenders experience a positive transition into the community. For Hawaii Community Correctional Center work furlough inmates, the Job Connections staff are the first people the inmates come into contact with when released to attend Job Readiness Training classes. Participants progress from fear of failure to becoming confident men and women in one week's time. The Hawaii Paroling Authority refers parolees who have been unsuccessful in obtaining employment. Our Employment Counselors work closely with parole officers to assist parolees in barrier removal and job placement. As a result, participants gain: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 6 • Empowerment • Initiative • Communication skills • Recognizing triggers for re- offending • Work Ethics • Honesty Performance Measures: Goodwill's Outcome Management System evaluates program services by asking persons served, employers, and referring agencies to complete a follow -up survey used to evaluate the satisfaction and effectiveness of services. Upon program exit, each participant, employer and referring agency will be asked to complete a satisfaction survey. Parties are asked to respond to questions in several areas including the quality of services received, the service outcomes, level of satisfaction regarding the program, and suggestions for changes. Satisfaction surveys are compiled and analyzed on an annual basis. The results are shared with funding sources and Goodwill's Board of Directors. Recommendations for needed changes are analyzed. Plans for improvements are then developed and implemented as a result of this feedback. For the most recent year 2009 -10, 100% of the participants were satisfied with their experience in the Job Connections Program. Participant comments included: • "The Job Connections staff at the Hilo office provided excellent program enrollment, job preparation classes, and a well- equipped resource center. Everything at this program is well above standards. It is a blessing to have such a program that offers the time and effort that these employees have given." • "[Staff] helped me by giving me information. They are reaching out to me to meet me half way. I think it is more just me needing to meet them. I gotta get money, put gas in my car, minutes on my phone. I think the program was good but it was more me needing to get myself straight." • "I like being able to talk to my job counselor and get advice related to workplace difficulties." NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2010 -11 Estimate Job Connections Program $10,000 $7,500 $30,000 Goodwill's Outcome Management System evaluates program services by asking persons served, employers, and referring agencies to complete a follow -up survey used to evaluate the satisfaction and effectiveness of services. Upon program exit, each participant, employer and referring agency will be asked to complete a satisfaction survey. Parties are asked to respond to questions in several areas including the quality of services received, the service outcomes, level of satisfaction regarding the program, and suggestions for changes. Satisfaction surveys are compiled and analyzed on an annual basis. The results are shared with funding sources and Goodwill's Board of Directors. Recommendations for needed changes are analyzed. Plans for improvements are then developed and implemented as a result of this feedback. For the most recent year 2009 -10, 100% of the participants were satisfied with their experience in the Job Connections Program. Participant comments included: • "The Job Connections staff at the Hilo office provided excellent program enrollment, job preparation classes, and a well- equipped resource center. Everything at this program is well above standards. It is a blessing to have such a program that offers the time and effort that these employees have given." • "[Staff] helped me by giving me information. They are reaching out to me to meet me half way. I think it is more just me needing to meet them. I gotta get money, put gas in my car, minutes on my phone. I think the program was good but it was more me needing to get myself straight." • "I like being able to talk to my job counselor and get advice related to workplace difficulties." NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 Program Expenditures * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -08 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages $10,000 $7,500 $30,000 Professional Fees $75,000 $70,000 $70,000 Operations Equipment $85,000 $77,500 $100,000 Other (Payroll Processing Charges)" Total $10,000 $7,500 $30,000 * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate County of Hawaii Non - Profit Grant $10,000 $7,500 $30,000 State of Hawaii $75,000 $70,000 $70,000 Total $85,000 $77,500 $100,000 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The funds requested in this application are for a component of an existing performance based program funded by the State of Hawaii. The money provided by the County allows us to conduct intake and assessments, conduct Job Readiness Training and place participants into employment The remaining State of Hawaii funding will cover the case management and job retention support for the participant and employer until employment for one year is achieved. We will continue to support participants to reach job retention goals of 90 days, 180 days and 360 days on the job. We are working with our funder as well as the Goodwill Industries International to seek opportunities to apply for additional funding. As mentioned earlier, this is the second of two separate applications Goodwill submitted this year. Our top priority is the Work Experience Program. Funding for Job Connections should only be considered if the Work Experience Program is accepted by the County. We do not want to jeopardize the Work Experience Program as the County grant serves as funding of last resort for our trainees who are people with disabilities, who have no other options. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 8 Goodwill Industries of Hawaii, Inc. - Agency Name Job Connections - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Sig ture o Board President/Chair If Z.l�tl Date Signature of Executive Director l 2i i( Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! JAN 2 4 2011 BY: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 9 30 Goodwill Industries of Hawaii, Inc. Work Experience Program Goodwill Industries Of Hawaii, Inc.- Agency Name Work Experience Program- Program Name Agency Director: Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Laura Robertson Phone No.: 808 - 836 -0313 Phone No.: 808 - 961 -0307 500 Kalanianaole Ave, Hilo, HI 96720 500 Kalanianaole Ave, Hilo, HI 96720 Name of Accountant/CPA (include name of firm if applicable): Catha Combs, Wikoff Combs and Co., LLC Phone No.: 808 - 791 -1420 Mailing Address: 1001 Bishop Street, Suite 2760, Honolulu, Hi 96813 Amount of Request for County Funds: $45,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $20,000 $28,000 $25,000 Agency Mission Statement: Our mission statement is: Goodwill Industries of Hawaii, Inc. helps people with employment barriers to reach their full potential and become self - sufficient. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 1 Goodwill Industries Of Hawaii, Inc. - Agency Name Work Experience Program- Program Name Goodwill Industries of Hawaii (GIH) has been in business in the State of Hawaii since 1959 providing vocational training and employment services to persons with barriers to employment, including: • Individuals with disabilities; • Youth who have disabilities or are economically disadvantaged; • Disabled veterans; • Asian and Pacific Islander immigrants; • Older individuals and dislocated workers; and • Adults who are economically disadvantaged, including First to Work, UFUE, TANF/TAONF and Food Stamp recipients. With over 52 years of experience operating vocational training programs as well as teaching life skills, Goodwill has developed an expertise in bringing about success to the people we serve. Goodwill Industries of Hawaii, Hawaii Island Branch has been serving our community since 1998. We envision a world where all individuals with disabilities and other barriers will have the opportunity to participate in a full range of life's experiences, including employment. We provide services to empower individuals to be productive and independent, based on their abilities and interests. From July 2009 to June 2010, GIH successfully provided services to 13,318 people statewide, and placed 1,667 people into gainful employment. The Hawaii Island Branch of Goodwill Industries provided services to 3,076 individuals and placed 480 people into employment in 2009 -2010. Over the past five years, Goodwill has provided training and employment services to almost 34.570 people statewide with barriers to employment, and placed 8,557 people into employment. Goodwill's Hawaii Island Branch served 7,278 people and placed into employment 2,235 people over the past five years. These numbers reflect that Goodwill has the necessary skills and experience to perform the proposed services. It is our belief that work is a basic right that will assist people to attain other life goals. Moreover, we believe in each individual's right to self- determination, to make their own decisions regarding life choices as a means of promoting independence and self - sufficiency. In previous years, GIH has provided a menu of services to train, place and support individuals with barriers into gainful employment and assist them to overcome their barriers to both employment and job retention. Additionally, Goodwill is committed to providing services to help individuals after they have obtained employment to acquire skills and resources to advance, and improve their economic self- sufficiency through training in basic literacy, computer NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 2 Goodwill Industries Of Hawaii, Inc. - Agency Name Work Experience Program- Program Name literacy, GED, ESL, and Earned Income Tax Credit filing. Participants also receive follow -up supports and transitional services once they are employed. GIH will coordinate these services with the appropriate agencies and identified networks of support, to better serve the participant on a long -term basis. Examples of agencies and partners with whom we coordinate services include the Department of Health, Division of Vocational Rehabilitation, Workforce Development Department, Department of Human Services, YWCA, Hawaii Literacy, Department of Education, Legal Aid Society, East Hawaii Coalition for the Homeless, Chamber of Commerce, Goodwill Industries International, employers in identified industries with job opportunities corresponding to participants' career goals, and others. When possible, natural supports will be developed to enhance the individual experience in the workplace. Collaboration between employer, family, friends, and the program staff will be emphasized to increase the probability of success. Program Description: Funding is requested for a Work Experience Program to provide wage subsidy for individuals with disabilities and other barriers to employment. The program format will allow work training opportunities for individuals that do not have work experience or who need additional supports or training to succeed in their employment goals. The training programs available are Janitorial and /or Textile/Wares processing positions. The Work Experience Program will follow guidelines as set forth by the Department of Labor. Goodwill Industries has a subminimum wage certificate that requires the following: • a standard be set for each work station • community wage survey be conducted annually, and • each participant's productivity be measured every six months. Each participant will become familiar with and choose the program that is right for them. When the work experience path has been chosen, the participant will be trained on how to perform the essential job functions needed for the positions(s). The benefits of developing these work skills extend beyond the work environment. Through this program participants learn what it is like to earn a paycheck, while being provided valuable work experience and enhancing skills in a real work setting. We recognize the intrinsic value of work and understand the profound effects that meaningful, tangible employment brings to our trainees' lives. More than bringing financial self - sufficiency, work taps the spirit of the individual, provides equal opportunity, and demands commitment and dedication, values that provide the foundation for the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 Goodwill Industries Of Hawaii, Inc. - Agency Name Work Experience Program- Program Name In 2009 -2010, the Work Experience Program served 19 participants that were enrolled in a Goodwill training program. The format allowed work - training opportunities for individuals to choose a position in our Janitorial program or Textile/Wares Processing program. The Work Experience Program followed guidelines as set forth by the Department of Labor. A standard was set for each workstation, a community wage survey was conducted, and each participant's productivity was measured every six months. Participants developed problem solving skills, motivational skills, an attitude for success, and increased their self - confidence in the workplace. Additional funding is also requested to purchase additional assistive technology devices such as ergonomic and large sight keyboards and mice, joy sticks, touch windows, voice recognition systems, larger monitors, assistive communication software, as well as job readiness and job retention training software. Assistive technology will particularly assist our participants with sight and hearing impairments, Cerebral Palsy or other physical and learning disabilities which limit their use of standard equipment. Additionally, it will enhance our successful Work Experience Program and give all participants additional tools for independence and self- sufficiency in an increasingly competitive job market. In 2009 -2010, Goodwill Industries of Hawaii expanded pre employment and computer based training for persons with more severe physical and learning limitations. Prevocational software, two touch screen dedicated computers, and assistive devices were purchased. Before these acquisitions, 22 participants regularly utilized standard computers. Since then, 8 additional participants have experienced the wonder of technology have learned basic computer skills and been introduced to pre - vocational software. Total Budget and Position Count Total Program Budget $45,000 Total Program Position Count 2 Total Agency Bud et $2,500,000 Total Agency Position Count 88 *Total Agency Budget denotes Hawaii Island Branch only Program Objectives: 1) Enroll 22 participants in the Work Experience Program. 2) Instruct proper work techniques for each workstation to be assigned, by review of the workstation development form during the first week of training. 3) Develop motivational skills and attitudes for success, self- confidence and problem solving skills throughout the training period. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 Goodwill Industries Of Hawaii, Inc. - Agency Name Work Experience Program- Program Name 4) Conduct time measurement study for participant during the first 2 weeks of entry into the program. 5) Review outcomes with the participant upon completion of the time study. 6) Continue to instruct and reinforce correct work procedures. 7) Track work hours, daily or as scheduled to work. 8) Pay each participant semi - monthly, according to hours worked. 9) Conduct time study for each participant every six months. 10) Update wages according to productivity level. 11) Instruct computer skills utilizing assistive technology for persons with physical disabilities (hearing loss, sight impairment, cerebral palsy, etc.) 12) Instruct on computer based programs which focus on creating resumes, completing applications and learning the fundamentals of the job search and job retention. The emphasis of this program is giving the participants the confidence and tools to maximize their abilities. Our philosophy is to provide an environment for people to believe they can succeed, achieve goals, develop skills and change the barriers they face every day. At Goodwill we believe in the power of work. We create hope, jobs and futures. Through our program, clients learn specific vocational skills and work environment behaviors. Individuals choose the work that matches their abilities and interests and earn wages based on productivity. Clients in the custodial services program perform a variety of cleaning duties in restrooms and offices. Clients in the retail program sort, inspect, hang, and price merchandise. Goodwill supervisors provide appropriate guidance during training that emphasizes safety, quality control, production, proper work behavior, and attendance. Program Highlights: 1) Enrolled 21 participants in the Work Experience Program in 2008/2009. 2) In a random audit of program participants we found an average 20% increase in productivity for participants since their entry into the program. 3) Instructed participants in proper work techniques for each workstation. 4) Developed motivational skills and attitudes for success, self- confidence and problem solving skills for each participant. 5) Conducted time measurement study for each participant within 2 weeks from date of entry into program. 6) Reviewed outcome of time study with each participant upon completion of study. 7) Instructed and reinforced correct work procedures with each participant. 8) Tracked work hours, daily or as scheduled to work. 9) Paid participants on a semi - monthly basis, according to hours worked. 10) Conducted time study of each participant every six months. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 5 Goodwill Industries Of Hawaii, Inc. - Agency Name Work Experience Program- Program Name 11) Updated wages according to productivity level. 12) Purchased adaptive equipment for textile processing to accommodate each participant. 13) Assisted one individual to maintain competitive employment. 14) Assisted one individual to continue her goal of self - employment. 15) Placed two individuals in volunteer positions Through participation in the work experience program, six participants have gained valuable job skills and have transitioned to competitive, self or volunteer employment. The Goodwill Aina Keepers, a rotating team of ten participants, paints over graffiti in the community. Another team of six participants work on a gardening project learning sustainability skills. In the work experience program, participants learned how to take direction, follow through on their work and how to work as a team. As they progressed in the program they demonstrated strong work ethic, attention to detail and positive attitude. Two trainees worked in the Goodwill store and regularly volunteers. One gained employment with a local employer. Another trainee continued to maintain her own business, designing, sewing and selling Hawaiian crafts. Her creations are showcased on a website of products and services provided by persons with disabilities on the Big Island. This trainee was able to sell her products as quickly as she designed them and made them. She had a successful booth at the Abled Hawaii Arts festival and at the Maku'u market. All of the participants in the Work Experience Program look forward to receiving a paycheck. Earning a paycheck provides them with opportunities to budget, save and make decisions on where and how to spend their money. The power of work allows participants to gain self- esteem and develop the following qualities that are important for job retention: • Confidence • Initiative • Willingness to learn • Desire to work • Cooperation • Good attendance • Communication skills • Team play • Flexibility • Honesty • Respect for coworkers, workplace, and equipment NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 6 Goodwill Industries Of Hawaii, Inc. - Agency Name Work Experience Program- Program Name Performance Measures: Goodwill's Outcome Management System evaluates program services by asking persons served, employers, and referring agencies to complete a follow -up survey used to evaluate the satisfaction and effectiveness of services. Upon program exit, each participant, employer and referring counselor will be asked to complete a satisfaction survey. Parties are asked to respond to questions in several areas including the quality of services received, the service outcomes, level of satisfaction regarding the program, and suggestions for changes. Satisfaction surveys are compiled and analyzed on an annual basis. The results are shared with funding sources and Goodwill's Board of Directors. Recommendations for needed changes are analyzed. Plans for improvements are then developed and implemented as a result of this feedback. For the most recent year 2009 -10, the Work Experience Program participants that were also enrolled in the Home & Community Based Services Program indicated a participant and advocate satisfaction rate of 100% in the categories of "Very Good" to "Excellent ". Participant's comments included: I like the friends I make and the technology. like to learn a lot on the computer and communicate with others. The staff was always there when I needed help. Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2010 -11 Estimate Work Experience Program $28,000 $25,000 $45,000 Goodwill's Outcome Management System evaluates program services by asking persons served, employers, and referring agencies to complete a follow -up survey used to evaluate the satisfaction and effectiveness of services. Upon program exit, each participant, employer and referring counselor will be asked to complete a satisfaction survey. Parties are asked to respond to questions in several areas including the quality of services received, the service outcomes, level of satisfaction regarding the program, and suggestions for changes. Satisfaction surveys are compiled and analyzed on an annual basis. The results are shared with funding sources and Goodwill's Board of Directors. Recommendations for needed changes are analyzed. Plans for improvements are then developed and implemented as a result of this feedback. For the most recent year 2009 -10, the Work Experience Program participants that were also enrolled in the Home & Community Based Services Program indicated a participant and advocate satisfaction rate of 100% in the categories of "Very Good" to "Excellent ". Participant's comments included: I like the friends I make and the technology. like to learn a lot on the computer and communicate with others. The staff was always there when I needed help. Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 FY 2008 -08 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages $19,864 $20,000 $28,000 Professional Fees Operations Equipment $3,352 $2,000 $14,000 Other (Payroll Processing Charges)' $4,784 $3,000 $3,000 Total 1 $28,000 $25,000 $45,000 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 Goodwill Industries Of Hawaii, Inc. - Agency Name Work Experience Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate County of Hawaii Non - Profit Grant $ 28,000 $25,000 $45,000 Goodwill Industries of Hawaii $1,000 State of Hawaii $232,762 $235,000 $235,000 Total $260,762 $260,000 $281,000 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The Work Experience Training Program is a component of a much larger service provided to persons with disabilities, through the State of Hawaii. The money provided by the County allows trainees to earn money while gaining valuable work experience in a structured learning environment. As they gain the necessary experience they transition out of the program. While this funding pays the direct salary, it does not cover overhead, supervision, and case management. We leverage the County funding to provide a full -range of services for the trainees. Although we do not have alternative funding for the program at this time, we are looking into expanding the program for trainees who possibly qualify for Federal funds and using the County grant for trainees who have no other sources of funding. The County grant serves as funding of last resort for our trainees, who have no other options. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 8 Goodwill Industries Of Hawaii, Inc. - Agency Name Work Experience Program - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. IML-f Sign'' of Boar President/Chair O&C, k Signature of Executive Director i "-t II Date Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! JAN 2 4 2011 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 - 2012'' Page 9 31 Grassroots Community Development Group Kea'au Youth Business Center /Kupukupu Grassroots Community Development Group- Agency Name Kea'au Youth Business Center /Kupukupu - Program Name Agency Director: Trina Nahm -Mijo /Lily Chan - Harris Phone No.: (808) 966 -6354 Contact Person: same Phone No.: same Mailing Address: PO Box 1772, Kea'au, HI 96749 Facility /Site Address: 16 -540 Kea'au -Pahoa Highway, Ste. 6 Kea'au, HI 96749 Fax No.: c/o p. 974 -7757 Email Address: nahmmijo @hawaii.edu Name of Accountant/CPA (include name of firm if applicable): John Carbonaro /Carbonaro CPA & Assocs. Phone No.: (808) 968 -1002 Mailing Address: PO Box 4372, Hilo, HI 96720 Amount of Request for County Funds: $55,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $45,000 $30,000 $20,000 Agency Mission Statement: To strengthen our communities through the cooperative development of programs and services for all of Puna. To provide quality programs for youth. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Grassroots Community Development Group - Agency Name Y Kea'au Youth Business Center /Kupukupu - Program Name Program Description: This free or low -cost program was first started through a HUD Alaskan Native /Native Hawaiian Institutions Asssisting Communities grant in 2007 in response to the ice epidemic and the low social - economic standing of the Puna community. The target population is youth, 12-18 year olds, predominantly from the Puna area. The program is held at Kea'au Youth Business Center located in Kea'au Town Center which has a state-of-the-art multimedia computer lab; the largest fully equipped sound recording studio on the Big Island, and a certified mobile kitchen on wheels. The Middle College day program offers skill building in digital media arts, graphic and publishing arts, music and sound recording, and culinary arts and dual college and high school credit which prepares the student either for college and /or the workforce. Besides the skill building training, participants learn business, teaming and entrepreneurial skills as well as community engagement which gives them tools to survive and thrive in a 21st century global economy and to add to the social and economic capital of their communities. The After - School program is held M -F, 2 -5 p.m. and offers the same curriculum in a modularized format to a broader spectrum of students in the 12- 18 year old target population and takes on real clients as a work training component. Starting in January 2011, the Kupukupu After - School Program for middle school aged students, 12 - 14 years old moved to Kea'au Youth Business Center due to the repossession of the Ola'a Community Center building located on the grounds of the old Kea'au Middle School by the Department of Education. The younger middle school participants are targeted on Tuesdays and Thursdays and the high school students, aged 14 -18 years old are targeted on Mondays, Wednesdays, and Fridays. Total Budget and Position Count Total Program Budget 160,000 Total Program Position Count 5 PT Total Agency Budget 160,000 1 Total A enc Position Count 5 PT Program Objectives: 1) Prevent drug use and other anti - social behaviors in Puna area youth; 2) Provide skill development in digital media arts, music and sound recording, culinary arts, and business; 3) Cultivate the talents and economic viability of area youth; NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 4) Provide Youth Leadership opportunities through community engagement, entrepreneurial training, and product and talent development. 5) Provide pro - social skill development Program Highlights: (from Fiscal Year 2009 -10) 1) Graduated 17 at -risk youth from the Kea'au Middle College (KMC)Program who earned 6 to 12 college credits as well as the High School diploma. Their average GPA increased from 2.1 at start of program to 2.4 at end of program. 60% went on to higher education, mostly at Hawaii Community College. 2) As part of the KMC Program, the students participated in the Earth Day event at the Panaewa Zooa number where they shared educational displays of their year -long environmental projects wotj 400 school aged children and their families. 3) Two students from this fifth KMC cohort received a national award from "The Young Media Makes Big Screen Showcase for their original music video filmed and recorded at KYBC entitled: "Good Vibrations ". 4) Participants of Kupukupu, the After - School Program for middle school students successfully researched, worte and recorded a smoking pre- vention song entitled "Peer Pressure" at the KYBC sound recording studio. The song contained a series of smoking facts to discourage smoking and was playaed at the "Town Meeting on the Future of Puna" held on March 5, 2010 which was attended by about 300 community leaders and members, including our own program participants. 5) Successfully produced, promoted, and screened a feature length film about prescription drug abuse by teens called "Rx ". The film was written, filmed, directed and edited by one of our After - School youth participants, Jesse Tunison. The film used all local actors and was filmed entirely on the Big Island. The film was shown at the Palace Theatre in Hilo and attended by the Mayor, County Council members, state legislators, community leaders and youth. There was a second showing at the LEAD Center in Kona. 6) Another highlight for the year was the increasing collaborations with other schools and organizations who have approached KYBC for our space and services. The Hawaii Academy of Arts and Sciences Public Charter School (HAAS) used our Center every Friday for the AY 2009 -10 to produce a documentary video about public schools called "Class of 2010" which was premiered at the Palace Theatre on August 27, 2010 and a portion of which will be screened on PBS. 7) KYBC also collaborated with Alu Like for the second summer to offer a summer Media Internship through a partnership with Hawaii Independent - -an internet publication on Oahu and 'Apono Hawaii. The 20 interns in this program created a bldg called "Hawaii Youth News" and a music video about Mauna Kea. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Grassroots Community Development Group - Agency Name Kea'au Youth Business Center /Kupukupu - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate 70 Youth develop video /graphic arts skills 80% 85% 90% 60 Youth develop music /sound recording engineering skills 85% 85% 90% 60 Youth develop culinary arts skills 85% 90% 90% 80 Youth develop workforce, business, and /or entrepreneurial trainin 85% 85% 90% Other* 14,878 Total 148,134 157,000 165,000 *If applicable Program Expenditures F If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 57,643 70,000 75,000 Professional Fees 17,667 20,000 20,000 Operations 57,946 62,000 62,000 E ui ment 5,000 8,000 Other* 14,878 Total 148,134 157,000 165,000 F If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Grassroots Community Development Group - Agency Name Kea'au Youth Business Center /Kupukupu - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Bud get* FY 2011 -12 Estimate Hi Tobacco Prevention and Cessation Trust Fund $75,000 $75,000 $75,000 County of Hawaii 50,000 50,000 $55,000 Other Grants 10,333 10,000 12,000 Contributions 4,237 5,000 5.000 - Program income 10,250 14,000 15,000 Fundraising 12,180 8,000 5,000 Total 162,000 162,0001 167,000 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? This program plans to increase revenues through the following activities: 1) Grant writing to foundations, government agencies 2) Entrepreneurial projects, services and products 3) Increased collaborations with other service agencies The goal is to be self- sustaining in three years. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Grassroots Community Development Group - Agency Name Kea'au Youth Business Center /Kupukupu - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. _ I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawai`l, l (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting, of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, an Signature of Boa td Preside Ch it Signature of Executive irector I 1 Dat //a/// _ Dat UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 W Green Will Conservancy Hui Mana'o Green Will Conservancy- Agency Name Hui Mana'o- Program Name Agency Director: Frank Capatch Phone No.: 808 - 965 -5349 Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Fank Capatch P.O. Box 1341 Pahoa, Hi 96778 14 -803 Seaview Pahoa, Hi 96778 808- 965 -5036 frangipon@aol.com Phone No.: 808 - 965 -5349 Name of Accountant/CPA (include name of firm if applicable): Gina Bellassai Phone No.: 982 -5447 Mailing Address: HC 2 Box 9520, Kea'au, Hi, 96749 Amount of Request for County Funds: $35,640 Prior Year(s) Funding: 08-09 9 -10 10 -11 $00.00 $00.00 $00.00 Agency Mission Statement: To empower the People with the skills and practical methods to persevere and sustain; to work toward the sustainability of environment, individuals, families and communities by integrating social work research and practice in small scale, replicable programs. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Green Will Conservancy - Agency Name Hui Mana'o- Program Name Program Description: Hui Man'ao -The Program Description Hui Mana'o, meaning Thinking Together and Sharing Knowledge" is an East Hawaii social services pilot project operated by The Green Will Conservancy, Inc. (GWC), a 501(c)3. Hui Mana'o services 1417 year old youth and their familiesfohanas in the Puna district, which ranks second highest in the state in child poverty. Additionally, rates of high school students that are accepted into colleges in this community are among the lowest in the state. And the community has a high population of Native Hawaiian families, many dealing with the after effects of colonialism and loss of land and culture; including that their children tend to spend more time in the foster care system than non- Hawaiian children. Unfortunately, since the economic downturn, services for these at -risk youth and families have decreased and resources to meet the needs of the area are not only declining, but are more difficult to access because a lack of transportation. According to The State of Social Services in Hawaii 2009 Report, the County of Hawaii in particular now reports the least manageable social services caseload of all the Islands. Hui Mana'o, addresses these concerns by working with the community's youth, 1417 year olds and their familyfohana to build a small -scale human service program and model. The program empowers youth to be successful, self- sustaining and to develop 21st century skills; which according to the National Resource Council, are adaptability, complex communication/social skills, non - routine problem solving skills, self management, self development and systems thinking. Ali of these skills are necessary for youth to be productive and contributing members of the community. Hui Mana'o assists these teens in overcoming obstacles to developing these skills; it also provides pre - vocational and vocational training in their identified interest area. The program begins with a broad target population of at -risk families from this community. At the entry point level, an interagency collaboration screening process takes place where approximately 50-60 teens and their families participate in structured levels of licensed, professional intake and assessment to match family and individual needs with appropriate interventions and/or resources. At intake, GWC and its other human services agency partners provide approximately 50-60 families with comprehensive human services including: family strength identification; GAF (global assessment of functioning) screening; addictions screening; crisis planning; lethality and assault/violence assessments; family dynamic analysis and ego strength assessment. If Hui Mana'o is not a match for the family's needs then they are connected to other agencies and /or licensed professionals who can meet their needs, including Hui Mana'o's collaborative partners such as the Grassroots Community Development Group /Kea'au Youth Business Center and Middle college, Hawaii DOH, SEBD (Support for Emotional and Behavioral) Services and Alu Like. Based on an NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 approximate 5:1 ratio of "families served" to "fully engaged participants" in 2009, the program expects to have at least 10 fully engaged teens from the pool of 50- 60 families in 2010. Hui Mana'o is an after school, weekend and summer day program on 2 acres of land outside of the town of Pahoa. After the initial assessment the teens meet on site with licensed therapists for individual counseling 2 times a week to work on at least 2 treatment goals focusing on their barriers to success. Issues such as drug addiction, problems in school or with family, low self esteem, depression and teen violence are addressed. Participants attend 3 hour pro-social groups twice weekly; on Wednesdays (12:30 -3:30) and Saturdays (12:00 - 3:00). The program is individually designed to meet the needs of the participants and it also includes the involvement of participant's families and /or ohanas, volunteer community members and Kupunas as cultural support systems to teach and mentor the youth. There are four levels to the program design. Initially participants focus on gaining social and pre - employment skills such as following directions, being on time and dressing correctly as well as continuing to explore their interests. Then the participants eventually progress to higher levels, learning personal money management and vocational training at the GWC site in areas of their expressed interests; carpentry; water collection systems; solar and other green technology and sustainable environmental practices such as learning to make soil or reuse materials; small scale landscaping, food gardening and chicken raising; cultural heritage and arts and crafts; and computer and video production. Finally graduates will have opportunities to be mentored into developing their own cottage industries and businesses and /or to be placed in internships. Stipends offer incentives for progress. After the participants leave the program they are monitored for one year on their progress and are offered membership as an alumni member of the Hui Mana'o's Trade Association, which acts in an advisory role for the program, monitors the quality of Hui Manao's participating agency's products and services and seeks to improve networking. Another level of Hui Mana'o is the Annual Youth Leadership Conference Program where 3 regional youth in the summer after their junior year in high school will be chosen from either their respective human service or educational institutions to participate in a unique travel opportunity. Criteria are based on leadership standards established by those institutions considered congruent with the leadership values of GWC. The youth will be matched with an average of six other same age youth from Western New York State and /or international affiliations and will be engaged to attend a 7 to 10 day leadership retreat located on 30 acres of pristine old- growth forest and salmon/ trout breeding streams at a private retreat located in Zoar Valley, New York; which is owned by a GWC Board of Director. The trip also will include historical sight seeing and cultural activities in New York City. The Hui Mana'o program design, with its travel and cultural exposure elements; counselors, teachers and mentor support systems; pro - social skills groups; sustainability practices; technology components and vocational focus, encourages healthy communication and relationships among youth and their community, as well as "Aloha 'Aina" or love of the land. This is likely to empower youth from a variety of cultures to be able to meet challenges of a rapidly changing 21st Century world. Those challenges include environmental concerns and (according to a national survey about 21st century teens) "computers and NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 up -to -date technology; more sources of information and more ways to communicate information; less job security and more downsizing; the growth of the global economy; diversity in the workforce and the declining number of manufacturing jobs". To assist in handling these challenges, the program serves as a consolidated system that streamlines client services and significantly assists in developing the above mentioned 21st century skills, hopefully resulting in their capacity to successfully enjoy their lives within diverse communities and contributing to overall community success of problem solutions. Hui Mana'o is designed to provide families with comprehensive levels of human services to foster these skills. And, based on a recent Puna community needs assessments and 30 years of clinical Social Work practice and research, the program is also testing the hypothesis that an integrated model of teaching vocational and sustainable lifestyle skills, paralleled with counseling to overcome impediments to success, will significantly improve the quality of the lives of these youth and their families. Last year the pilot program served 17 families and 3 fully engaged youth. This year with the help of funding from the County of Hawaii the program will be positioned to serve a pool of 50-60 families and 10 fully engaged youth, ages 14- 17. GWC is requesting $35,640 from the County of Hawaii to Rand the 2nd phases of the open air pavilion construction and the gardening project; the alternative energy and backyard chicken project; curriculum and volunteer manual development; participant stipends; web site developmentfinstruction for participants; video productionrnstruction for participants and the Youth Leadership Conference Program. With the current revenue generation plan, in 2012 the program will be positioned to increase its service base to 100 -120 families and 20 fully engaged youth, as well as be mostly self - sustaining. (See program revenue summary) In conclusion, using an integrated approach, Hui Mana'o meets a number of functions simultaneously; it addresses East Hawaii's transportation shortage since its services are mostly addressed in one location and it teaches participants how to coordinate transportation; deals with individual, family, culture, peer, school and community domains; expands the scope of traditional social work by incorporating sustainable lifestyle practices as a core part of its already well established systems of interventions; serves as a comprehensive demonstration model of human services delivery; positively impacts the self - sufficiency of 50 -60 families in the community and increases the community's sustainability. This integration of demonstration and practice serves GWC's mission to join together social work research and practice via small scale, replicable programs that use ecological methods to sustain individuals, families, communities, and the environment. Total Budget and Position Count NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Program Objectives: 1) M 4) 5) 6) 7) Hui Mana'o's goal is to build a small scale comprehensive and replicatable social service model, which assists at risk youth, 14-17 and their families in overcoming obstacles to developing the skills necessary to be productive and contributing members of the community, with the following objectives for the next year (2011 -2012) being: To provide 50-60 teens and their families with licensed, professional intake and assessment services in order to match family and individual needs with appropriate interventions and/or resources. Increase youth's executive functioning in pre - vocational and vocational areas of their interest. Increase youth's executive functioning in the school environment; Decrease youth's substance abuse and occurances of youth violence; Improve social and relationship functioning among 10 youth, their peers, their families and communities as expressed in individualized identified treatment goals. Increase youth's knowledge and practice of sustainable and green technology, practices and lifestyle. Program Highlights: (from Fiscal Year 2009 -10) 1) Successful operations of board of directors 2) Needs assessment of Puna area youth, 14 -17 3) Design of Hui Mana'o program, for youth 14 -17 4) Acquired 2 acres of leased land 5) Volunteer Curriculum started 6) Recruitment of 17 families and 3 fully engaged participants 7) 1 acre cleared and developed into "Healing Garden" 8) 1/4 acre cleared and temporary structure donated and erected 9) Collaboration began with Grassroots Community Development Group/Kea'au Youth Business Center for vocational cross training, curriculum diversity and providing mental health services to both programs. 10) Alliances formed with Alu Like, Family Court and Teen Court. 11) 1 group of participants had successful experiences and they increased their GAF (Global Assessment of Functioning) scores by an average of 5 %. 12) Connections made with community elders and Kupunas 13) Workshops started in cultural arts and crafts with a Kupuna 14) 15) NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Green Will Conservancy - Agency Name ^ Hui Mana'o - Program Name Performance Measures: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget* Estimate Teens and their families: 17 families 50-60 1. Participate in structured levels of and 3 fully families and licensed, professional intake and engaged 10 fully assessment and then are participants- engaged 2.Are matched with appropriate GAF score participants. interventions and /or resources for increase 2% GAF score higher level of care. average increase 3. Function at higher executive projected for function level. Assessment of families 2- impact measured through before 3 % - and after comparison. GAF = Global Assessment Functionin 10 Youth: 3 10 particip. 1. Function at GAF score with at participants 68 -75 ** least 5% average increase. 68 -75 point point GAF Measured through before and after GAF score score comparison. 2. Decrease in Drug and Alcohol 3particpants 10 particip.* use /are Drug and Alcohol free. 3. Increase functioning level in 3 particpants 10 particip.* school. Regular /successful attendance in school (passing grades of C or better, no fights, suspensions or other violations or revocations). Assessed through before and after program comparison and monthly. 4. Increase positive behaviors with 3 particpants 10 particip.* family. Good participation report (no fights, following basic rules & performing household chores). Assessed through before and after p rogram comparison and monthly. 5. Improve in pre - vocational skills. 3 particpants 10 particip.* (Successful coordination of transportation, participation, attendance, preparedness, safety, and leadership). Assessed through before and after program NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 comparison and monthly. FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate 5. Meet their individualized 3 particpants 10 particip.* identified treatment goal #1, 0.00 including acquiring social skills. $3,000 Assessed Month) $3,200 6. Meet their individualized 3 particpants 10 particip.* identified treatment goal #2. $35,640 Assessed monthly. 7. Acquire new vocational skills and Before we 10 particip . is placed in at least 1 vocational had apprenticeship site or develops a internship simple business plan for a business sites or cottage industry. Assessed established through before and after program comparison and monthly. 8. Engaged in 1 community 3 10 particip. p articipation project artici ants 8. Learn about sustainable lifestyle 3 particpants 10 particip. choices, engage in 1 new habit ( Recycling, etc. for 6 months * *GAF score *Average of of 75 = good 17% functioning increase on level with a 7 point transient validation of and /or slight cognition impairment if likert scale - at all. measured every 6 months. *If applicable Program Expenditures If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 0.00 Professional Fees 0.00 Operations $3,000 Equipment $3,200 Other* $29,440 Total $35,640 If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Hui Mana'o - A Program of the Green Will Conservancy PROGRAM EXPENDITURES - "Other" Itemized Construction of Open Air Pavilion #2 & #3 1,330 :foundation of cut stone in wood frames -------- -- ------------- I ------- ------ — ------- --- ---------------------------------- - - - ---- ------ ------- I -- -------------- - - - - -- --- - -------------- - ------ q 600 : buildings with screen sides (2) ------------------ ....... --------------- -- ----- - ------------ - - -- -- ---------- ----- --------- ------ -------- - -- ---- - ---- -- (est es/benches 0 --- ---------- - --- --- ----- ------ - 1,200 ........ ....... . ---- ---- ----------- ------ 100 labor 10 hrs (a $ 10/hr - - -- --------- ------------ — -------------------------------- ---- ------ -- ------ - - -------- ------- --- - ---- ---- -- --------- - -- --------- 3,230 Alternative Power/Energy Technologies - Stage 2 500 : : earthen (brick) ovens ----- ---- -------- - ------- -- ------------------ --- --- ---- - ---- ------ ----------- - -- -- - - - - -- -- ------------ -- --------- -- - - - - -- --- - --------- '00 ;hay box cookers - -- --- ---- - ) - ----- --------- I ---------- --------------------- - ----- -- -- ------------ ------ — ------- -- -------------- ---- --- - --- -- ------- ------- --- --- --------------- 300 :solar food driers ----------------------- --------- ------------ -------------- ......... ------ ------ - ---------- ........ ....... ...... 270 : 18 hrs @ $15/hr ---------------- - -------------------------- ------- -- ---- ---------------------- - --- --- - ----- ----------- -------- --------- ------------ --- ------------ ------ ------- 1, Curriculum Development 1,800 ;labor 120 hrs (& $15/hr - — -------- — — — --------- Volunteer Manual 240 ;labor 16 hrs @ $15/hr ............ ........ - ------------------------- ----------- ------- ----------------------------- ------ - --------- - -------- -------------------- -------- - - --------- ----------------- ---- 240 Participant/client stipends 3,600 10 participants g $40 on average receiving for 9 months ----------- - participants -- ---- ----- --------------- - --------- --------- ---------- --- ------- - - - ----------------------- - ---------- ---- ----------------- ---------- ----- I ----- ------- -- 3,600 Web Site Development 4.000 ;labor 200 hrs $20/hr - - ------- --------- ---------- -- ---------- ------------------ ------- ------ ---------- - --------------- ------------------ -------- -------- --------------- -------- -------- ----- -------- -- 4,000 Student Exchange Program for 12 days 5,000 : - 3 students and 2 staff, airfare to New York, food and accommodations ------------------ : ------- -------------------- -- --- ------------ ---------------- ----------------- ------ ------ - I --- - ----- ----- --- -------- -------- -- --- -------- ------------ -------- -- ---- 2,000 ;Ground Transportation/Fees (Including day site seeing activity in NYC) -- ------------------------------------------------- ----------- ----------------------- --- --- - ---- ---- --------- ---- 1,500 !Food ----------- -------------- ---------- - ----------------- -- ----- -- -------------------------- -------------------------- ------ - --- ---- --------------- ------------ - --------- ------ ---------- -------- - --- 500 : Guest Speakers ----------- --- - - - - ------ ---- -- ---- --- -- ----------------------------- - - -- - - - - - -- - ---- --- ------- -------- ---- - ------------- - ------------ 9,000 Video Production 3,000 ,Cost of video production ----------- eo ------------- --- --------- ------ - ------- -- - --- - - ---------------------- - --- ------ ------- --------------------------- -------- ------------ 3,000 Natural Farming Backyard Chicken Operation 2,000 12 X 16 chicken house structure -------- -------------------------------- - ----- -- --------- _------------- - ------------------ --------- - ---- ----- ---------- ------------ ------ ------------- - - -------- -- - -- ------- 200 'fowl stock ------------ ------ --- - ----------------------- -------- ---- - ------- -- ----------- I ---- ---- -- ----------- -- ..... .... ---------- - --- - ----- - 1,000 iconsulting/labor 50 hrs (a), $20/hr ----- --------- -- -- ----------- 1 29,440 TOTAL PROGRAM EXPENDITURES - "Other" Itemized I Hui Mana'o - A Program of the Green Will Conservancy For Fi I scatYear 2011-2012 Hawaii Countv Gratit PROGRAM EXPENDITURES - "Operation" Itemized Gardening - Stage 2 Costs Item 1,500 :Fertilizers & Soil Making Materials ------------ ------ -- -------------- -- - ------ ---------- --- ------- ------- -------- - -- -- ----- - ---- -------- ----- 1,000 ant sta rts seeds &p ;seeds ---------------------- ---- ---------- --- - -- --------- ------ --- ----- --- ---- - ---------------- - ----- --- --- ---- ---- ------- 2,500 Natural Farming Backyard Chicken Operation 500 :food for I year -------- --- - ------------ ------------------- ------- - ----- ------- 500 3,000 TOTAL PROGRAM EXPENDITURES - "Operation" Itemized PROGRAM EXPENDITURES - "Equipment" Itemized Alternative Power/Energy Technologies - Stage 2 2,000 :solar panels 1,200 :charge controller /inverter/batteries ------ ------ ---------- - ------- ------------ ,--------- .- - - - - -- -- ---------------- - --------------- ---------- ------- - ------- -------- -------- - -- ------------ -------------------- - 4 - ----- -- -------------------- ----- 3,200 i 3,200 TOTAL PROGRAM EXPENDITURES - "Equipment" Itemized PROGRAM EXPENDITURES - ALL 29,440 ::Other ------------------ ----- -------------- ------------- -- - - ---- -------- ----- -- ------- ------------ ------ ---------- --------- ----------------- ------------------- 3,000 ::Operation ----- -- --------- ------------------- - -------------- • -------- -- --- ------------------ - - -- ----- .... .. ------------ --- - ---- ------------------- - - ----- 3,200 : --- --- -- ------ --------- ------- - - ------------ ------- -------- ------- ------ - ------- -- --- --- -------------- ------- ------ ----------------------- ---- --- ------ ------------------------- 35,640 35,640 TOTAL PROGRAM EXPENDITURES X,C & - 1 - 1 > T ) Green Will Conservancy - Agency Name Hui Mana'o - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate 3rd party billing for clinincal services donated by volunteer licensed mental health clincians $5,016.02 $33,600 Misc. donations $9,604.00 $10,000 GRANT SOLICITATIONS County of Hawaii $35,640 Alexander & Baldwin $15,120 The Atherton Foundation $25,050 Hawaii People's Fund $9,120 The Bill Healy Foundation $18,240 Hawaii Communi Foundation $1,000 Total $26,620 $147,770 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The program plans to increase revenues through: 1.) Increasing its participants and therefore its 3rd party billing; 2.) Additional fund raising through grants solicitations and agency fundraisers; and 3.) Developing a community mental health provider donation program. With the current revenue generation plan, in 2012 the program will be positioned to increase its service base to 100 -120 families and 20 fully engaged youth, as well as be mostly self - sustaining. (See Project Budget- Program Revenue Summary) The program intends on being self sustaining in 2013 as it continues to form alliances and collaborative programming with other agencies, including interagency commercial ventures and participant fundraising. *DETAILED PROJECT BUDGET AND PROGRAM REVENUE SUMMARY ON FOLLOWING PAGES. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 Hui Mana'o - A Program of the Green Will Conservancy Detailed Program Budget PROGRAM EXPENDITURES Land Prep Costs :Item ':Proposed Funding Source 2,000 ::Bulldozing & Dump Trucking - ------- ----------------- ------ -- ---------- ------------ : The Alexander and Baldwin Family Found. -------- ---------------- ---------- ----- -------- I ------------- ---- - --------------- ---------- --------------------------- ------ - ---------- 1,500 Cinders ------------------ ':The Atherton Family Foundation ------ --- - --------- - --------------- ------------- --- ------------- -- ------- - ----------- -------- ----------------------------------- -------- ------------------------------ --------------- 2,000 ;Fencing for 500 ft. (est.) ----------- ------ -------- -- --- - -- - -- . ..... -------------- -- ':The Atherton Family Foundation - - -- --- --------- ----- --- -- - ----- - ---- ---- --------------------- --------- ------------------------- 5,500 ;Total Grant Request for Land �rep Gardening Stage I ' 4,000 Matson Container (est.) The Alexander and Baldwin Family Found. 4,000 ;:Total Grant Request for Gardening - Stage I Gardening - Stage 2 1,500 : : Fertilizers & Soil Making Materials ------ :County of Hawaii - ------------ ----------------- - ------ ------------------- - ------- - - ----------- ------------ - ----------- --------------------- ---------- -- -------- ----- ------ ------- - ------ 1,000 ':seeds & plant starts ----- - ----------------------------- ';County of Hawaii ----------- ----------------- - ------- -- ----------------- ---------------------- -------------- - - -- ------------------- ------------ 2,500 ;Total Grant Request for Gardening - Stage 2 Alternative Power/Energy Technologies - Stage 1 2,000 igenerator - - --------- :The Atherton Family Foundation ----- -------------- ----- -- -- ---- ------- -------------- ----------- -------- ------------- ----------- -1� ------------------ ----------- ---- ----------- 1,000 :solar panels ':The Atherton Family Foundation 895 ':charge control ler/inverterlbatteri es -- -------------------- - -- ----- - :The Atherton Family Foundation ---------- ------------------------- - - - - -- ------------------------------------------------- --------- ---------- ------------------------------------------ 105 ::labor 7 hrs (a $15/hr ------ ------------ --- --------- - -------- -------- -- ------- ------------- ------- The Atherton Family Foundation --- -- -- - ---- ------ ------------- --------- -------- -------- * - - -------- -------- ----- 4,000 Alternative Power/Energy Technologies - Stage 2 500 :earthen (brick) ovens -- ---- ----------- :County of Hawaii - -------------- --------- -------- ----------- - ------------- ---------- ----- ------------ ------------- -- ----- - ---- -- -------------- ------------ -- ------------------ 300 ihay box cookers ------------- - - ----- ----- - ---------- - - ---- ----- --- --- -------- ---------------- County of Hawaii ---- --- ---- - -------- -- ------ I - --------- --- - - ---------- - --------- 300 Solar food driers 4 -------- -- ------ : County of Hawaii -- ----- - - -------------- ------ ----- --- ------ --- --- - - - ----- -- ----- ------- - -- -- --------------- ---------- --- - --- ----- --- -- ----- - --- r 2,000 : :solar panels -- -- -- ----- -- • :unty of Hawaii Co ---- - ------ - - ------- ----- - - - -- ----------- --- --- 1,200 ';charge controller /inverter/batteries i ----------- --1 --------------------- --------------- ----------- --- ----- -- - -------- ':County of Hawaii -- --- - --- -- : ------------- ------ ---- - - --- ------------ --- ---------- --- ------------- - ---------- ........ 270 labor 18 hrs (a), $15/hr ------------- --------------------- - - -- --- ------------------------- ---- -------------- : ;County of Hawaii - - -------- ---- --- - ----------- -- ---------------- ------ ---------------- ------ 4,570 Composting Toilet Instillation 3,200 : Clivus Mulchem Toilet --------------- The Atherton Family Foundation ................. ....... --------- --------------------------- ----- - ---------------- ----------- - - --- --------------- ---------- -------- -------- - - ---------- - gob - itoilet house The Atherton Family Foundation 100 Ial�or 0 hrs hr—g� - - - - - --------------- --- - The Atherton Family Founda 4.200 Natural Farming Backyard Chicken Operation 2,000 : 12 X 16 chicken house structure ---: ---------- - ---------- - -- - -- -- I County of Hawaii ----- ----- ---- - --- ------------ ------ - ----- - ----- ------------ - -- -- ------------------- ----------------------------------- 500 :food for I year �: -- -------------- - -- ----------- -- ------------------------- ------------- :County of Hawaii ---- -------------- - ------------------------------------------------ - --- - ---------- - --- ------------ --- -------------- 200 ;fowl stock --------------- County of Hawaii ' - - --- ------------ --- --- ------------------ --------- --- -------- ------- ------------ ------------------ t-- ---- ----- ------- ----------- -- ------------- -- -- ----- ------ ------------ -- 1.000 !consulting/labor 50 hrs (a $20/hr ------------ -------- - -------- -- ------- -- ---- -- ----------- ---------- - - - : County of Hawaii ---- ----------- ------- --- - - - ------------ 3,700 Water Collection Systems & Mreatment 7,500 foundation and tank — 'The Atherton Family Foundation - ------- — - ------ ------- ------�,-6-0- ----- drinking water purification system (est.) -- ---------- -------- - ::The Atherton Family Foundation -- ------ - - - ----------- - --- — ---------- — 1,000 i water lines ; -- * ---- ---- - ---- --- . . ........ .... - - -------- -- : :The Atherton Family Foundation --------- -------- --- - - ----- ----- ------- I -------------- -- ---------- ...... ------ - - - - - - -- -1 -------- * - ------------------- 966 water ystem ----------- --- ::The Atherton Family Foundation --------- - ----------- -- n - ------ ---------- - ------------ ----------- ----- - filtrations ------------------------- -------- ------------ - - - - -- - 450 : labor 15 hrs $1 0/hr - ------------ ------- - - ---------- -------- ------ ---- -- ------ ----- - -- -- -- --- -- ------------------------ :The Atherton Family Foundation -- --- ---- ---------------------------- ------------------ - - - ----- --- --------- ------- - - ----------------- -- 11,750 Hui Mana'o - Financial Documents Page 1 Hui K4ana'm - A Program of the Green Will Conservancy Detailed Program Budget Construction of Open Air Pavilion #1 650 : foundation of cut stone in wood frames 7he Atherton Family Foundation 300 lbuildings with screen sides (1) 7he Atherton Family Foundation 600 ::tables/benches (2) (est.) The Atherton Family Foundation Construction of Open Air Pavilion #2 & 93 IX )'0 ':foundation of cut stone in wood frames lCounty of Hawaii 600 ibuildings with screen sides (2) ... ;County of Hawaii 1 .200 ':tables/benches (4) (est.) County of Hawaii Board of Directors Training 1,000 : ;training 'The Hawaii Community Foundation Malpractice Insurance icovered by clinicians General Liability/Accident Insurance 3,000 Tom Lodge Insurance 3 rd Party Billings for mental health services Accountant Fees, system design 2,500 : :Gini Bellassai accountant :.3rd Party Billings for_m_ental_health_serv 3,600 800kkeeping 5 hrs/week $15/hr. 3rd Party BillinRs for mental health services Lawyer Fees, system design 1,500 ! : Lawyer '3rd Party Billings for mental health services Student Exchange Program : 3 students and 2 staff, airfare to New York, food and accommodations for 12 days ':County of Hawaii (Including day site seeing activity in NYC) 1,5 :Food Video Production 'County of Hawaii Participant/client stipends 3,600 10 participants on average receiving $40 for 9 months :County of Hawaii Curriculum Development 1,800 :labor 120 hrs (a), $15/hr :County of Hawaii Volunteer Manual 240 : Jabor 16 hrs P. $15/hr County of Hawaii Web Site Development 4.000 labor 200 hrs (@, $20/hr County of Hawaii HuiMana'o - Finamcia|Docunnents Page Hui Mana'o - A Program of the Green Will Conservancy Detailed Program Budget L Staffing - to be funded - Sta e 1 rate/hr hours /week # of weers ;Farm Manager 10 _,- - -------- 10 24 ... - - - -,- - - -- - - - - -- - 2,400 -- - - -- ------------ - 1,920. Farm Helper 8 2-- - - - - - -- : - - - -- -------- ----- - 10 -- -- - - -- - - - - -- -- - - -- 4,320 subtotal staffing - proposed funding - - - source of: -- -- ;The Alexander and Baldwin Family Found. 4,800 ;Program Man.Nol. Coordinator 20 10 24 - - - - -- -- -------- - - - -- - - -- - - - - - -- 4,800 :subtotal staffing - proposed funding source of -- The Alexander and Baldwin Family Found. 9,120 !Total Staffing - to be funded - Stage 1 Staffing - be funded - Stage 2 rate/hr hours /week # of weeks 2,400 ,Farm Manager. 10 - - - - -- - ----- - - - - -- ------ - 10 - 24 - - -;. _ _..- ------ - - - - -- - - 1,920 ;Far H elper - - - ---- 8 -- - - -- - - 1 w 24 -- -- -- - -- : - -- — -- - - - - - 4,320 :subtotal staffing - proposed funding source of: :Hawaii Peoples Fund 4,800 :Program_ Man.Nol. Coordinator 20 1 24 --- - - ------- - - - - -- - - - - -- ----------- - ----- - - - - -- - ----------------- - - 4,800 subtotal staffing - proposed funding - - -- - -- - - - - - -- -- --- - - - - - -- - source of - - - -- -- - - - - -- - -- (Hawaii People's Fund 9,120 :Total Staffing - to be funded - Stage 2 Staffing - to be funded - Sta &e3 r /hr hours /week # of weeks 4,800 ;Farm Manager -- 10 -... - 20 24 - - ----------- - - - - -- - - - -- - - -- ------ - - - - -- ------------ - - - - 3, Farm Helper ---- 8 20 24 - ----- - - - - -- - - - - -- 8 640 ;sub s taffing - proposed funding source of ;The Bill Healy Foundation 9,600 ;Prog Man Coord 20 -- - - - - -- 20 24 ------ - --- - - -- 9,600 subtotal staffing - proposed funding source of: :The Bill Healy Foundation 18,240 ;Total Staffin - to be funded - Sta e3 Staffing - to be covered by 3rd Pa Billies rate/hr hours /week # of weeks 12,480 2 paraprofessional 13 ------ - - - - -- - -- - -- - 10 48 - - - -- - ----- - - - - -- - -- - - ---- - - - - -- - - - - -- --- - - - - -- ------------ - - - - -- - - - - - - - - - - - ------------- - - - - -- - - - -- - - -- - 12,480 'Subtotal staffing - proposed funding source of 3rd Party Billings for mental health services 12,480 :Total Staffing - by the hour; to be funded Staffing - by the hour; in kind contributions rate /hr hours/week # of weeks 13,680 Program Man. Assistant (Intern) 15 19 48 - -- . _ , -- - - -- - -- - - -- - - - - - -- - -- - -- - - - - - - -- 15 ,360 2 pa ti me, licen - clinic a l staff 32 _ - - - -- 5 4 8 - — — - - - -- - - - -- - - - — - 29,040 :Total Staffing - by the hour; in kind contributions Hui Mana'o - Financial Documents Page 3 Hui Mana'o - A Program of the Green Will Conservancy Detailed Program Budget RO - BUDGET WITH FUNDING SOURCES IDENTIFIED anding Sources for the Hui Mana 'o Program %Costs i Costs from Status of - --- ------------------------- --------------- ----------- ------------ .. .... ---- ------ --- ----------- ------- -- - --- ---------- - ----------- 18% 23.080 3rd Partv Billinpas for mental health services Secured I 12% 15,120 The Alexander and Baldwin Family Found. Non-secured 0 ------------ ---- - ----- --- ------------------------------------------------- ------ -- ---- -- ---------- ------ -------- il Foundation 25,050 ;The Atherton Famy --- ---------- ----- --- - - Non-secured -------- ------ ---- ----- ---------------------- - ---- ------------------------- --- ------- ---- ---------------------------- -------- -- -- 9,120 :Hawaii People's Fund --- --- ----- - ----- - -- Non-secured 35,640 County of Hawaii - - ------ - -- Non- secured 1% he Hawaii Community Foundation 1,000 'The : ; Non-secured -- - - ------ ------ -- ----------------- 14% ------ ----------------- --------------- ....... -- --- -- ------------------------ ------- ------ ------- --------- --- -- - - - - -- --- ------- ------ 18,240 ::The Bill Healy Foundation I ----------------- -------- Non-secured ------------- ----------------------------- - -------------------- •--- .. -... - ------ --------- ----------------- ------------------ --- --------- --- ------ --------------- 104.170 ::Total Grant Solicitations --------- Hui Manao - Financial Documents Page 4 Hui Mana'o - A Program of the Green Will Conservancy Detailed Program Budget Hui Mana'o - Financial Documents Page S number of fully wks /yr clients days /wk clients hrs /day clients billing - revenue engaged youth are served are served are served rate/hr generated - - - -- 10 - - - - - -- - - - - - -- 48 - 70 0.5 ;-- - - -- -- - - - -- -- - -- - -:__ _- _- - - - - -- - - - - - -- -------- - -_ - -- - - - - - -- 33,600 - -- -. . - - -- -- - - -- - - -, - -- :(Out of 50 - 60 - -- - - - ----- - - -... - - :families who receive intake, :assessment & intervention/reso Wee matching ;services -- - -- < -- - -- - -- - - - - - -- ---- - - - - - - -- -- - -- - - -- -------------- - ------ - - - - -- -- Revenue from 3rd party billings: i - - - - -- - 33,600 - -- - -- - - - - -- - -- - - -- ------ Budgeted use of income from 3rd party billing: - - - - . _.- -- 23,080 -- -- - - - - -- - - - - Income remaining first year: 10,520 Revenue from 3rd Party Billings, for 2nd Year number of fully wks /yr clients days /wk c lients ; h rs /day clients billi revenue — - - - - -- engaged youth are served are served are served rate /hr generated 20 _ 48 2 0.5 70 - - -. ------ - - - - -- -- -- . ._.. - - -- 67,200 - - -- - - - - -- - - - - - -- - - - - - -- - - - - -- - - - - -- ----- ;(Out of 100 -120 - - - - -- - - - - - - -- ------ - - - - -- -- ;families who :receive intake, .assessment & ! intervention/reso urce matching :services -- -- - -- - ---- - - - - -- - -------------- - - - - -- — - - �-- - Revenue from 3rd party billings: - -- — 67,200 Hui Mana'o - Financial Documents Page S Hui Mana'o - A Program of the Green Will Conservancy . Detailed Program Budget 127,250 ; Total Program Budget, Year 1 Hui Mana'o - Financial Documents Page 6 Green Will Conservancy - Agency Name Hui Mana'o - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. 1(we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. 1 (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, l (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 1 %nature of Presid..0ht/Chair / :3 Date ' 1 Signatur of cutiv Directo' Dat ' UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 33 Habitat for Humanity Home Building Program, Site Supervision Habitat for Humanity — Agency Name Home Building Program — Site Supervision — Program Name Agency Director: Contact Person: Mailing Address: Facility /Site Address: Fax No: Email Address: Patrick F. Hurney Patrick F. Hurney PO Box 4619 Kailua — Kona, Hi 96745 Phone No.: 331 -8010 Phone No.: 331 -8010 73 -5576 Kauhola Street, Space #4 Kailua -Kona, Hi 96740 331 -8020 ed@habitatwesthawaii.org Name of Accountant/CPA (include name of firm if applicable): Alex Smith, CPA Phone No: 877 - 257 -6484 Mailing Address: 1403 Frank Street, Honolulu, Hi 96816 Amount of Request for County Funds: $24,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $25,000 $30,000 $15,000 NONPROFIT GRANT APPICATION FISCAL YEAR 2011 -12 Page 1 Habitat for Humanity West Hawaii — Agency Name Homebuilding Program — Site Supervision — Program Name Agency Mission Statement: Habitat for Humanity West Hawaii is a non - profit, faith -based organization whose mission is to empower families and build community and hope through home ownership opportunities for low- income partner families. Our vision is that all residents of West Hawaii will achieve that through our affordable homebuilding efforts. We serve the entire west side of the Big Island of Hawai'i from Hawi to South Point, where the lack of low- income sustainable housing has been extensively detailed at both the County and State levels. Granted affiliation with Habitat for Humanity International in 2002, this affiliate is a volunteer driven organization with only four (4) full -time staff, including Executive Director, Accountant, Community Relations Director, and the ReStore Manager. The home building projects are undertaken by a committed group of local community volunteers. A dynamic and involved Board of Directors, comprised of 12 members, provides overall leadership to the affiliate. Funding comes from individual, foundation, agency and corporate donations. Habitat for Humanity West Hawai'i stands out from other providers of low income housing in several significant ways. A Habitat mortgage is designed so that no family is paying more than 21 % of their monthly income on their housing, - 30% with utilities, taxes and insurance. Habitat builds homes for families earning between 40 -70% of the median income for the County on a no- interest, no- profit basis and requiring only a 1 % down payment. Families are required to perform a minimum of 500 hours of "sweat equity ". The family support component of the Habitat program provides assistance with budgeting, house repair and maintenance for the duration of the mortgage. The Habitat model allows for the family to have a low monthly mortgage rate (between $350.00 $450.00) and to use the remainder of their income for reliable transportation, quality food, adequate health care, education and recreation. In this way, we seek to break the cycle of poverty for our partner families, helping them to acquire an asset that they can pass on to their children. Habitat for Humanity West Hawaii also operates a `green' social enterprise, the ReStore, which accepts donations of new and used building materials and sells them to the public at deeply discounted prices. Over 300 tons of materials are kept out of the landfill on an annual basis through this type of recycling. Profits pay operating costs and are used to build more local Habitat houses. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Habitat for Humanity West Hawaii— Agency Name Homebuilding Program — Site Supervision — Program Name Program Description: Each year, our affiliate grows and strives to increase its building capacity. In its short history of building homes, HFHWH has earned a `Home Builder" affiliate status — building 3-4 homes a year; the organization is now ramping up to earn "Neighborhood Builder" affiliate status in fiscal 2011/12, where 10 - 20 low - income families will be placed into homes of their own; and also provided with the support services necessary to ensure their successful transition into sustained home ownership. West Hawaii will also be the site of the next Habitat "Blitz Build" in 2012- an accelerated building schedule where up to five homes are built in a 7 - 10 day period. Volunteers come from all over the world to accomplish this amazing task. Habitat for Humanity West Hawaii is seeking $24,000 to hire four (4) site supervisors with professional building skills to supplement the capacity of the Construction Manager hired with funds from the County in fiscal 2010- 11. This will increase our capacity for simultaneous and mulitple builds, and will enable the recruitment and training of build volunteers in preparation for the Blitz Build. Total Budget and Position Count: Total Program Budget $24,000 Total Program Position Count 4 Total Agency Budget $496,000 Total Agency Position Count 6 FT and PT Program Objectives: These part-time site supervisors are critical to meeting the needs of an ever - increasing number of native Hawaiian families whose opportunities for home ownership have always been limited and have decreased due to rapid increases in building costs. The following objectives will be met: • There will be a greater ability to build multiple homes simultaneously • Each build site will have a dedicated staff member who will ensure the smooth flow of operations at the site, thereby eliminating scheduling conflicts and missed deadlines. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Habitat for Humanity West Hawaii- Agency Name Homebuilding Program — Site Supervision — Program Name • The site supervisor will determine the most cost - effective plan and schedule for each individual house, thereby eliminating unnecessary waste. The Construction Manager will be freed up to build economies of scale into the expanding operations • At each build site, the site supervisor will recruit and train a cadre of volunteers to work with trade contractors to complete specific pieces of construction. This will not only provide marketable skills to the volunteers, but also ensure a corps of trained individuals in preparation for the Blitz Build • Habitat for Humanity West Hawaii is committed to building responsibly, or 'green' building, and the site supervisors will ensure the incorporation of the following measures at each site: 1. Minimize the depletion of natural resources 2. Decrease the amount of construction waste going to landfill 3. Control erosion and minimize the impact on natural resources 4. Increase energy efficiency and conserve water in construction 5. Incorporate the use of landscaping strategies to complement the built environment 6. Reduce maintenance costs by using innovative and durable materials 7. Improve indoor air quality by providing proper ventilation 8. Ensure smart site planning and land use 9. Assess the life cycle costs and benefits of sustainable building Program Highlights (from Fiscal Year 2010 -11) • 9 th home completed; construction of 10 home is about to commence • Four families approved by Family Selection Committee • Part-time Development Coordinator hired • First annual signature fundraising event held with positive outcome • Corporate Engagement Strategy approved by BOD • 5 Year Strategic Plan is on track — includes goals for homebuilding; partnerships; financial capacity; recruitment and retention; volunteer management, etc. • Awarded Pualu Award by Chamber of Commerce for environmental awareness o 300 tons of building material saved from landfill NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Habitat for Humanity West Hawaii - Agency Name Homebuilding Program — Site Supervision — Program Name Performance Measures: Objective Activity Measure Responsibility Outcomes Hire Site Place Ad in Multiple homes Supervisors West Hawaii are built Today and Executive simultaneously; Craigs List; Site Director and more families are Supervisors Construction served Review hired Manager, with applications; assistance from Construction is Building efficient and Interview and Committee focused on hire "green" practices Homebuilding costs are reduced through economy of scale Recruit and Volunteer Construction Trained train recruitment Manager and volunteers are volunteers campaign Site Supervisors available for for builds multiple builds Select a cadre and Blitz Build in of 10 -12 particular volunteers in 4 — Corps of 10- Construction 6 communities; 12 trained Manager and Volunteers gain volunteers Site Supervisors marketable skills Assess skills are needed and available in match several Site Supervisors volunteers with West appropriate Hawai`I professionals communities NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Habitat for Humanity West Hawaii - Agency name Homebuilding Program — Site Supervision — Program Name Program Expenditures: ('k'"specific to this program only) Program Funding Sources: Identify all funding sources ( "specific to this program only) Revenue Source FY 2009 -10 Actual FY 2010 -11 Budget FY 2011 -12 Estimate Salaries 0 0 $24,000 Professional fees 0 $12,000 Operations 0 $12,000 $24,000 Equipment Other Total 1$12,000 1$24,000 Program Funding Sources: Identify all funding sources ( "specific to this program only) Revenue Source FY 2009 -10 Actual FY 2010 -11 Budget FY 2011 -12 Estimate County of Hawaii 0 0 $24,000 General Operating_ 0 $12,000 Total 0 $12,000 $24,000 Note: Because Habitat for Humanity West Hawaii has only one "program" — the homebuilding program for low- income families, - the overall Homebuilding Program expenditures and revenues are listed on a `per house basis on the following page. This will indicate the context of the current request for funding from the county. The Family Selection Committee has selected four families and this request reflects the desire of the affiliate to increase its capacity and volunteer resources by building concurrently. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Habitat for Humanity West Hawai`I — Agency Name Homebuilding Program — Site Supervision — Program Name Homebuilding Program -'Per House Expenditures and Revenue Expenses: Per build HPM Package Home 34,000.00 Solar (est.) 5,000.00 Grading/Driveway 17,000.00 Concrete 1,000.00 Plumbing 5,000.00 Electrical 5,000.00 Drywall and Finishing 5,000.00 Environmental Assessment 1,000 Site Supervisor (3000 in beg. And 3000 at 20,000.00 completion) 6,000.00 Administration Fee 7,800.00 Total 86,800.00 Funding Sources Amount Office of Hawaiian Affairs 20,000.00 State Revolving Loan Fund 20,000.00 Federal Home Loan Bank 12,000.00 Softwood Lumber Grant 8,500.00 Habitat Restore 20,000.00 Total 80 500.00 NONPROFIT GRANT APPLICATION FISAL YEAR 2011 -12 Page 7 Habitat for Humanity West Hawaii - Agency Name Homebuilding Program — Site Supervision — Program Name Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Sustainability for the Homebuilding Program is very close: • The popularity of the ReStore has resulted in increased donations and increased revenue each year. • With each new home built, the "Fund for Humanity" continues to grow. This fund is fed by the mortgage payments received from the affiliate's partner families, which then revolve back into home building. The more Habitat homes built, the faster and greater the fund grows. • The Board of Directors has endorsed a five -year Strategic Plan that specifically addresses fiscal solvency. • A part-time Development Coordinator has been hired, and a corporate engagement strategy is underway, in addition to regular grant writing activities. • The affiliate hosted its first signature fundraising event in November, with positive results. This will become annual event. • By 2012, the affiliate hopes to share a new warehouse with another non- profit agency. This will reduce rent and create efficiencies in administrative operations, thereby allowing more funding to go directly into the building of Habitat homes. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 Habitat for Humanity West Hawaii - Agency Name Homebuilding Program- Site Supervision - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your aroo ram's_or agency's future funding requests. Signature I Bo rd Pr ident/Chair 2 -;� I ez Signature of Executive Director Date / 112 17 Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 M Hale Aloha O Hilo Habitat for Humanity, Inc. Building Affordable Housing 2011 Hale Aloha O Hilo Habitat for Humanity- Agency Name Building Affordable Housing 2011 - Program Name Agency Director: Contact Person: Vacant Phone No.: 935 -6677 Phone No.: 640- 2407 Mailing Address: Facility /Site Address: Fax No.: Michele Robles 700 Manono St., Suite 102 Hilo, HI 96720 700 Manono St., Suite 102 Hilo, HI 96720 (808) 935 -6637 Email Address: Michele_Robles @yahoo.com Name of Accountant/CPA (include name of firm if applicable): Alex J. Smith, CPA Phone No.: (808) 257 -6484 Mailing Address: 1403 Frank St., Honolulu, HI 96816 Amount of Request for County Funds: $155,855.00 Prior Year(s) Funding: 08-09 09 -10 10 -11 $0.00 $10,000.00 $0.00 Agency Mission Statement: To eliminate homelessness and poverty housing in East Hawaii. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Hale Aloha O Hilo Habitat for Humanity - Agency Name _ Building Affordable Housing 2011 - Program Name Program Description: Every year Hale Aloha 0 Hilo Habitat for Humanity seeks to build affordable housing in East Hawaii. We serve families earning between 30 -60% of the area median income, reaching families with children, the elderly, and the disabled. Through volunteer labor and tax - deductible donations of money, materials and land; Haibtat builds affordable housing in East Hawaii. Habitat homes are then sold to qualified partner families at no profit and financed with affordable, no interest loans. Their house payments are approximately $450 per month. No down payment is required. Families are selected based on their need for housing, their ability to pay $450 per month, and their willingness to partner with Habitat for Humanity, which requires 500 hours of sweat equity. These construction and financing terms make it possible for at risk families who could never ordinarily become homeowners, to become economically and socially stable, and often at a lower cost than renting. They generally are families that have been paying approximately $800 in rent per month, and now can own a home with a $450 per month mortgage. Additionally, recipient families receive family support services from Habitat for Humanity. First time home owners are trained on home maintenance and the financial responsibilities of owning a home. Families become more sustainable. Studies show that homeownership improves health, has a positive effect on children, builds wealth and strengthens community. This is an excellent investment in a social program, which benefits our community! Hilo Habitat for Humanity will be completing the build of three affordable homes, for three separate families in 2011. We need the support of Hawaii County to help us complete each build for these first time home owners. Total Budget and Position Count Total Program Budget 240,000.00 1 Total Program Position Count 1 Total Agency Bud et 115,585.00 Total A enc Position Count 1 El NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Program Objectives: 1) Complete build of three affordable homes in East Hawaii. 2) Complete first build to be completed by March 2011. 3) Begin second build by March 2011. 4) Complete second build by August of 2011. Applications are currently being reviewed for qualifying family. A family will be chosen by end of February 2011 and building will commence in March 2011. 5) Begin our third build in August 2011. 6) Complete third build by March 2012. Program Highlights: (from Fiscal Year 2009 -10) 1) Celebrated our 20 Year Anniversary 2) Our ReStore celebrated 1 year anniversary in new facility. The Restore diverts waste from Hawaii landfills. 3) In cooperation with the Hilo Bay Rotary Club, earned $10,000 Weinberg Grant. 4) Launched first annual island wide fundraiser with KTA, earnings went to both Hilo and Kona Habitat for Humanity. 5) Obtained Hawaii County Grant of $10,000 6) Launched "Power of One" campaign NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-12 Page 3 Hale Aloha O Hilo Habitat for Humanity - Agency Name Building Affordable Housing 2011 - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Homes Completed 0 3 3 Homes Begun 1 2 3 Families Members Served 15 -20 15 -20 20 -35 Active Volunteers 150 175 200 Contract Staff/Employees PT 0 1 1 Employees FT 1 1 2 Construction Supervisor (PT) 1 1 0 Construction Supervisor (FT) 0 0 1 *If applicable Program Expenditures " It applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages $54,555.33 $54,555.33 $88,950.00 Professional Fees $6,070.00 $9,070.00 $6,835.00 Operations $39,565.57 $51,618.00 $60,000.00 Equipment $0.00 $341.67 $400.00 Other" Total 1 $100,190.90 $115,585.00 $155,785.00 " It applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Hale Aloha O Hilo Habitat for Humanity - Agency Name Building Affordable Housing 2011 - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures: and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future fundinq requests. Sig 12 hair Date Signature of Executive Director _t 3 2 Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL. YEAR 2011 -12 Page 6 35 Hale Aloha O Hilo Habitat for Humanity, Inc. Restore 2011 Hale Aloha O Hilo Habitat for Humanity- Agency Name ReStore 2011 - Program Name Agency Director: Contact Person: Vacant Phone No.: 935 -6677 Phone No.: 640- 2407 Mailing Address: Facility /Site Address: Michele Robes 700 Manono St., Suite 102 Hilo, HI 96720 700 Manono St., Suite 102 Hilo, HI 96720 Fax No.: (808) 935 -6637 Email Address: Michele_Robles @yahoo.com / Name of Accountant/CPA (include name of firm if applicable): Alex J. Smith, CPA Phone No.: (808) 257 -6484 Mailing Address: 1403 Frank St., Honolulu, HI 96816 Amount of Request for County Funds: $30,046.92 Prior Year(s) Funding: 08-09 09 -10 10 -11 $0.00 $10,000.00 $0.00 Agency Mission Statement: To eliminate homelessness and poverty housing in East Hawaii. NONPROFIT GRANT APPLICATNJN FISCAL YEAR 2011 -12 Page 1 Program Objectives: 1) We've obtained a quote from our licensed contractor. 2) Obtain funding that will allow us to build and expansion to the Restore. 3) Build and increase Restore space by 400 square feet. 4) Increase revenue, bringing us closer to the goal of being self sustainability. 5) Divert waste from Hawaii County landfills. 6) We will increase the amount of useable materials from being disposed of in local landfills from approximately 4 tons to 5.5 tons each month or 66 tons per year. This is important, as Hilo's landfills are reaching full capacity. Since the opening of the ReStore in March of 2009, the Restore has diverted over 68 tons of waste from Hawaii landfills. Currently the ReStore diverts approximately 4 tons of useable materials from being disposed of and destroyed. 7) Additionally, Habitat expects an increase in revenue allowing us to pay a majority of Habitat for Humanity in Hilo's administrative and operational cost. The ReStore currently averages $56 per square foot, since opening at it's currently location. At this rate, increasing the store by 400 square feet would mean an additional $22,400 a year. 8) Expected revenue (based on current sales growth rate) without expansion: 2011: $75,785 2012: $83,825 2013: $99,960 9) Expected revenue with expansion: 2011: $101,047 2012: $111,766 2013: $133,280 10) The expansion would also allow us to provide a larger selection of merchandise, and increase our ability to better serve a broader range of clientele and impact the community of East Hawaii in a greater way. Impacting our local landfills and increasing our savings for additional construction to build more housing for families in need. Program Highlights: (from Fiscal Year 2009 -10) 1) Celebrated our 20 Year Anniversary of being in Hilo. 2) Our ReStore celebrated its one year anniversary. 3) In cooperation with Hilo Bay Rotary Club, earned $10,000 Weinberg Grant 4) Launched "Power of One" Campaign 5) Launched first annual wide fundraiser with KTA, earning went to both Habitat for Humanity in Kona and Hilo. 6) Obtained $1,000 grant from WalMart. 7) Obtained $10,000 grant from Hawaii County. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Hale Aloha O Hilo Habitat for Humanity - Agency Name ReStore 2011 - Program Name Performance Measures: If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Homes Completed 0 3 3 Homes Begun 1 2 3 Families Members Served 15 -20 15 -20 20 -35 Community Members Served 1,486 1,662 2,000 Contract Staff/Employees (PT) 0 1 1 Employees FT 1 1 2 Construction Supervisor PT 1 1 0 Construction Supervisor FT) 0 0 1 Average Daily Sales $215.00 $256.00 $300.00 Average Sale $22.00 $25.00 $28.00 Average Monthl Sales $5,012.50 $5,400.00 $8,420.00 If applicable Program Expenditures It applicable * Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY 2009 -10 Actual * FY 2010 -11 Bud et * FY 2011 -12 Estimate Salaries and Wages $54,555.33 $54,555.33 $88,950.00 Professional Fees $6,070.00 $9,070.00 $6,835.00 Operations $39,565.57 $51,618.00 $60,000.00 Equipment $0.00 $341.67 $400.00 Other" Total $100,190.90 $115,585.00 $155,785.00 It applicable * Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Hale Aloha O Hilo Habitat for Humanity - Agency Name Restore 2011 - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Grants $0.00 $15,000.00 $0.00 ReStore $0.00 $10,000.00 $0.00 Fundraising $0.00 $6,00.00 $0.00 Total $0.00 1 $31,000.00 $0.00 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? In 2009, Hilo Habitat for Humanity opened up a ReStore. Selling new, used and gently used building material and home improvement items at 65 -75% below retail. Items are donated from various places. Initially the ReStore was located in a very small location approximately 300 sq. ft.. Side walk sales were held daily, due to lack of space. Over a year ago, we moved to our new ReStore location and celebrated our one year anniversary. The store was opened with the intention of Hilo Habitat for Humanity, becoming self sustainable. Our sales continue to increase each month, as the public becomes more aware of what we have available to sale. The store is doing great! We now have plans to expand the store, to add additional square footage, and allow us to increase revenue. We are working towards our goal of self- sustainablility and we anticipate that we will be self - sustainable in approximately eight to ten years. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Hale Aloha O Hilo Habitat for Humanity - Agency Name Building Affordable Housing 2011 Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 'Z b- I� Date II3o�2olt Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Signature of Executive Director 36 Hale Kipa Hawaii Advocate Program Hale Kipa, Inc.- Agency Name Hawaii Advocate Program- Program Name copy Agency Director: 1829 Contact Person: 589 -1829 x201 Mailing Address: Facility /Site Address: Kona, Hawaii 96740 Fax No.: Ernest Pletan -Cross Jaque Kelley - Uyeoka Phone No.: 615 Piikoi Street Suite 203, Honolulu, Hawaii 96814 East HI: 622 Hinano Street, Hilo, Hawaii 96720 West H1:75 -170 Hualalai Road, Suite 310, Kailua- 808 945 -9007 Email Address: jaq @halekipa.org Name of Accountant/CPA (include name of firm if applicable): Maria Gozzip Phone No.: 589 -1829 x112 Mailing Address: same as above Amount of Request for County Funds: $65,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $60,000 $40,000 $10,000 Agency Mission Statement: Phone No.: 589- NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 To provide opportunities and environments that strengthen and encourage youth, their families and communities to actualize their potential and social responsibility. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Hale Kipa, Inc. - Agency Name Hawaii Advocate Program- Program Name Program Description: Hale Kipa's intensive, wraparound Hawaii Advocate Program (HAP) has been a popular, widely utilized and effective program serving youth and families in both East and West Hawai'i. Hale Kipa still maintains a HAP program that is for youth exiting the Hawaii Youth Correctional Facility and transitioning back to the island of Hawai'i. But, because of the lack of State funding, the HAP program component that served Department of Human Services and Family Court youth has not been re- procured. Hale Kipa is attempting to keep these essential services available and accessible for the youth and their families and is pursuing a range of funding options. Target Population: 6 -17 year old youth who are at high risk of being placed out of their family homes, current foster homes or having further involvement with the juvenile justice system. According to the agency's HAP data and the County of Hawaii's Office of Prosecuting Attorney's Mohala Ka Lehua data, youth in the County of Hawaii (compared to other counties) display the highest rates for: cigarette smoking, alcohol and inhalant use, abuse and neglect, runaway episodes, school suspensions, arrests and teen births. These are the youth that Hale Kipa seeks to identify and assist through its Hawaii Advocate Program. These special Hawaii County monies will allow Hale Kipa to serve about 16 youth referred by DHS or Family Court approximately 7 hours a week for 12 weeks. The agency will serve 4 youth at a time but can admit additional youth if the participants and /or their families require less intensive services or if goals are achieved in less than three months. Additional monies will allow the program to serve more youth and provide additional services. Scope of Work: The HAP model involves "individualized service planning," and services are based on the specific needs of each youth and family. Services are provided using a "strength- based, wraparound" approach that brings together resources and supports for the family, including professionals, community supports, family members and others. Trained Advocates, residing in the involved communities, work closely with each client (averaging 7 hours with 2 -4 visits per week) to empower the family to successfully utilize community resources. Critical to the process is the development of a trusting relationship between the Advocate, youth, and family based on "unconditional care." A team is also formed that is composed of key individuals in the family's life who provide additional support for the family. All youth are admitted to the program in a timely manner. Hale Kipa uses a range of strength -based tools to engage youth and their families. These tools allow the agency to identify and build on the strengths and interests of the NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 youth /families, and the agency completes an individualized assessment that is complemented by an appropriate service plan with youth /family- directed goals. The following identifies activities used to assist youth and their families achieve designated goals. Educational Assistance: Many of the HAP participants have learning, academic and developmental needs. The program places high value on ensuring that the youth's learning and educational needs are met. Much time is devoted to advocating, assessing, supporting, and monitoring their educational needs to create optimum conditions for the youth to be successful; this includes helping youth who bully or are bullied. Other educational - related activities include: • Assisting youth to identify current educational capacities, goals, and learning styles • Advocating for DOE evaluations, attending IEP meetings, and coordinating services • Maintaining school contact to monitor the youth's academic and behavioral performance • Working with parents to provide a positive learning /studying environment • Providing information to youth /family regarding alternative education programs • Introducing youth to post -high school educational and financial aid opportunities • Connecting youth with academic and extra - curricular school opportunities Life Skills Development: If a youth needs to build on a life skill, the following are addressedin individual or psycho - educational groups: • Transportation Health /Hygiene • Time management Communication • Relationships Consumer skills • Leisure time Spiritual well -being • Self- Awareness /Self- Esteem Decision Making /Problem Solving Skills • Relationships /Dating Violence Pregnancy Prevention /Sex Education Employment: Youth need opportunities to explore a myriad of career options and to develop a work ethic, sense of value in contributing to the community, and the skills necessary to succeed and achieve a sense of usefulness and belonging. To assist the youth in these areas, the HAP Advocate may provide the following services: • Helping the youth identify specific job - related interests, capacities, strengths, and weaknesses and creating a career plan • Teaching skills to obtain and maintain employment, including reading want ads, completing job applications, preparing a resume, practicing interviewing skills, and maintaining a proper personal appearance • Monitoring job performance and providing needed feedback Conflict Resolution /Anger Management: Hale Kipa helps participants to find and utilize community resources and can provide limited transportation assistance. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Substance Abuse Education: HAP connects youth and families to resources and facilitates UAs and assessments. Advocates may initially accompany youth to their AA /NA classes to help with the transition. Community Resource Linkages: One of the factors that help youth stay out of trouble and parents feel more comfortable about their youth's whereabouts is youth involvement in a variety of productive activities. Advocates work with each youth to identify interests, coordinate schedules and organize activities that appeal to the youth. HAP staff is very knowledgeable about community resources and ensure the youth and family become linked to positive alternative activities. Crisis Intervention: Staff is accessible on a 7 day - per- week/24 hour - per -day basis. Crisis intervention may range from telephone counseling to in- person, day -or -night family visits. Staff is trained in crisis intervention (CPI) including de- escalation techniques. Appropriate authorities (police, hospitals) are called when safety is threatened. FAMILY SUPPORT Parenting Skills and Support: Families remain an integral component of the HAP program. Services focus on identifying strengths, implementing plans, improving communication, making peace, and building and maintaining relationships. The Program Coordinator and Advocate support parents and help them develop more effective communication and behavioral management skills. Service strategies focus on helping parents meet the needs of their children by providing needed care, discipline, and guidance. Ensuring the health, safety, and welfare of the youth remains of paramount importance. Parents are encouraged to set clear parameters, guidelines, and expectations for the youth and to follow through consistently with appropriate consequences when rules or agreements are broken. If necessary, referrals can be made for more specialized therapy. YOUTH ACCOUNTABILITY Community Service: Advocates assist youth to responsibly complete any mandated community service. HAP believes strongly in the importance of "giving back" to the community and HAP sites have developed a list of community service activities. Restitution: HAP staff assists youth to fulfill any restitution commitments and also stress the importance of demonstrating personal accountability including writing apology letters, paying back businesses, and completing required community service Total Budget and Position Count Total Program Budget 330,567 1 Total Program Position Count 14 Total Agency Budget 10,160,049 Total Agency Position Count 166 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Program Objectives: 1) Incorporating youth development, trauma - informed care and juvenile detention alternative principles in its provision of services, Hale Kipa seeks to assist youth who are at higher risk of becoming involved in unlawful behavior or being placed out of their home due to abuse /neglect or behavioral problems. Agency services help youth to develop enhanced skill and decision - making competence, increase resiliency and coping strategies, decrease vulnerability to victimization and crime, and successfully navigate adolescence. Four of the larger youth goals that HAP track include: 1) prevent out of home placement; 2) prevent further involvement with the juvenile justice system; 3) prevent teen pregnancy; and 4) increase community connections. To reach these performance targets, Hale Kipa, in partnership with school and community agencies, provides activities focused on decreasing risk and increasing protective and resiliency factors. Program Highlights: (from Fiscal Year 2009 -10) 1) Hale Kipa has had an external evaluator evaluate /assess this program yearly since its inception. The evaluator reports that "monthly Report data on impact outcomes shows the program is showing success in preventing youth and family problems in the areas of out -of -home placements, abuse /neglect, arrests, and out -of- wedlock pregnancies, as well as improving youth engagement with education and employment." 2) EAST HAWAI'I 3) Family who was on the verge of being displaced from the domestic violence shelter due to not being able to locate a home for a family of 5 children and a single Mother was able with the support of an advocate to obtain a home. 4) Academic: Client began with not attending school, then attending school daily, then participating daily in class. Clients began to explore and identify interest of enrolling into college. Clients graduated from high school as well as others obtained GED. Clients enrolled into college taking a full load as well as obtaining a 3.2 GPA while in college. 5) Relationships: Families reported growth in the following areas: spend more quality time together, less arguing, more communication. Client and mother have not talked with each other in a long time and with support was able to start the healing process to build a relationship again. Assisted one Mother become clean and sober and is now working to get her children under her own care again. 6) Legal concerns: A few youth were released from probation and DHS jurisdiction due to completing requirements and doing well. They completed community service requirements as well as attended drug abuse treatment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 7) In particular, one client has gone to repeatedly getting suspended and arrested at school to being a role model to others, focused on being a part of the military and being a good community citizen. 8) WEST HAWAII: 9) This past year in Kona a great example of "wrapping" a family occurred. A Waimea family, with the coordination of HAP, Family Guidance Center and a DHS foster parent, helped to stabilize a targeted family. The family had been moving from family to friends, and the children had to change schools frequently. As a result of Hale Kipa services, the family has been able to purchase a car, has moved into a furnished home and, with the recent help of Hale Kipa, the family was able to purchase a refrigerator (special funds at a huge discount). 10) Another youth assisted was a first grader who was being sent home from school a few times a week for aggressive behaior. Within a month, through the help of her Advocate, the mother agreed to go to the doctor to discuss medication options. The boy has not displayed any aggressive behavior at school for over a month. The family continues to receive support to address parental conflict and to better manage the children's behavior. The family has also received housing assistance. 11) Another family in Kona was living for many months in a domestic violence shelter. With the help of their Advocate, the family was able to obtain needed transportation and successfully moved into a home. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Hale Kipa, Inc - Agency Name Hawaii Advocate Program - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Youth will be maintained in their homes 96% 96% 96% Youth will stay arrest -free while in program 95% 95% 95% Youth will not become pregnant while in program 98% 98% 98% Youth will connect to at least 1 new community resource 100% 100% 100% Other 195,150 90,018 32,859 Total 721,570 472,237 193,391 *If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages 345,997 292,905 123,020 Professional Fees 47,817 23,236 9,759 Operations 121,562 61,792 25,953 Equipment 11,044 4,286 1,800 Other 195,150 90,018 32,859 Total 721,570 472,237 193,391 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 Hale Kipa, Inc. —Agency Name Hawaii Advocate Program — Program Name Insert after page 8 Program Expenditures FY 2011— 2012 Estimate (Other Detail) Payroll Tax & Assessments 12 Fringe Benefits 14 Airfare 1 Subsistence per Diem 100 Program Activities 3 Publications & Printing 1 TOTAL 32,859 Insert Page 8A Hale Kipa, Inc. - Agency Name Hawaii Advocate Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate County of Hawaii 40,000 0 65,000 State of Hawaii (Office of Youth Services contracts:HYCF youth (SECURED) 670,978 440,708 66,391 Private Foundations UNSECURED 1,000 1,000 51,000 United Way Funds (UNSECURED) 1,083 0 1,000 Service Program Fees 956 0 0 Other Agency Funds 7,553 30,530 10,000 Total 72,570 472,238 193,391 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? As Hale Kipa has recently been informed of the lack of re- procurement of this program and there has been requests from community workers to continue this service, the agency is being aggressive in its exploration of potential funding sources. There are two other Office of Youth Service Hawaii Advocate Program contracts that Hale Kipa has that focus providing services to youth coming out of the Hawaii Youth Correctional Facility so some infrastructure and personnel costs are being covered by those contracts which lessens the need for other funding sources to cover all costs to operate this program. The agency is applying to private foundations as well as plans to apply for a new OYS RFP that was just released which are very similar services and would focus on youth in the juvenile justice system in attempts to prevent incarceration. It is uncertain at this time how many new funding sources will materialize in the next few months but any services will clearly be appreciated and valuable to the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 - Agency Name - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board"'President/Chair Signature of Executive Director 1' 1('1 ( Date ! / /I /)1 Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 37 Hamakua Youth Foundation Hamakua Youth Center Hamakua Youth Foundation- Agency Name Hamakua Youth Center- Program Name Agency Director: (acting) Joel Cohen and Phyllis Tarail Phone No.: (808) 769 -4490 Contact Person: Liza Franzoni Phone No.: (808)775 -0976 Mailing Address: Facility /Site Address: Fax No.: P.O. Box 381 Honokaa, HI. 96727 45 -3396 Mamane Street Honokaa, HI 96727 (888)658 -5702 Email Address: hamakuayouthcenter@gmail.com Name of Accountant/CPA (include name of firm if applicable): Office Angels/Marysue Joyce Phone No.: (808)896 -1664 Mailing Address: P.O. Box 247 Paauilo, HI. 96776 Amount of Request for County Funds: $20,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $20,000 $15,000 $10,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Hamakua Youth Foundation- Agency Name Hamakua Youth Center - Program Name Agency Mission Statement: The Hamakua Youth Foundation, Inc. (HYF), a community grassroots organization, is dedicated to creating nurturing, stimulating and enjoyable youth - centered, afterschool, occasional weekend and summer programs for children of the Hamakua District. With Hawaiian traditions and values as the host culture, the Hamakua Youth Center engages local youth in leadership training, environmental stewardship, music, visual arts, recreational activities, and exploration of the many cultures represented in our area. By engaging young people -as well as volunteers and staff -in the ongoing design and leadership of the Center's programs, by creating strong partnerships with other community organizations, and by serving as a much needed support system for local families, HYF invests in empowering our youth to achieve their greatest potential in building a sustainable future for themselves and the Hamakua community. Program Description: In late April 2009, after 14 years of service to the Hamakua community, the YWCA Hawaii Island turned over management of the Hamakua Youth Center (HYC) to a group of local community supporters. The grassroots -based Hamakua Youth Foundation, Inc. (HYF) was formed and we received 501(c)(3) status on September 15, 2009. The YWCA acted as the fiscal sponsor during FY 09 -10 and submitted a County of Hawaii Non - Profit Grant application, requesting funds on HYF's behalf. This is the second year of funding requested as our own entity. We are completing a three -year Strategic Planning Process conducted by a cross - section of Board, Staff and Community representatives. Research shows that youth who are left alone and are not engaged in positive social and recreational activities are at a high risk for experimental behavior with drugs, alcohol, sex, vulnerable to feelings of loneliness and isolation, and are prone to injuries and accidents. HYC programming focuses primarily on services for intermediate- and high - school age youth. Our regular afterschool drop -in center hours, that include healthy snacks, tutoring, a computer lab, pool and ping -pong, are 2-6 pm, Monday - Friday. On some evenings and weekends each month, we offer special activities, events, and field trips. HYC provides a safe positive, adult - supervised environment for youth on a daily basis at no cost. Staff identifies areas of need and connects youth with needed social and health services such as counseling, mediation, family planning and family food distribution. Youth know they can find assistance and solutions to the many difficult situations they are facing. The youth have re -named HYC "Our House" and many consider it their second home. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Hamakua Youth Foundation - Agency Name Hamakua Youth Center - Program Name GENDER - SPECIFIC GIRL'S AND BOY'S NIGHTS Facilitated through the practice of Council, these monthly nights are a safe forum for teenage boys and girls to share their feelings and discuss issues of vital importance to them in a confidential, supportive circle. Adults from the community are invited to share their life's experiences. COMMUNITY SERVICE Youth are referred to HYC from both Family Court and Teen Court to fulfill their community service hours. Many youth who visit us due to mandatory community service continue to access HYC as a support center long after their service is over. At HYC, community service youth are engaged on three levels: with our Hawaiian culture program, access to health services, and assistance with clearing up any unfinished business. LIVING HAWAIIAN CULTURE PROGRAM Initiated three years ago, this program focuses on four main areas of learning: Makahiki, Hula, Mahr ai, and Malama Aina. Our multicultural youth are provided with experiential learning opportunities to expand their horizons through the arts and traditions of our host culture. This approach is inclusive of core human values that our youth can build on toward creating shared positive outcomes and inspire the next generation of leaders. SCHOLARSHIP FUND The Big Dave Scholarship Fund began in 2010. Two youth scholarships will be awarded annually to fund higher education goals of our older youth and younger staff. STRATEGIC PLANNING The HYF is committed to long term, sustainability. A Strategic Planning group including Board, Staff, youth and a cross- section of the Honoka'a community will complete our three year plan in March 2011. We do not charge membership, class, or special program fees, although donations are accepted for some special cultural programs. HYF relies heavily on community support including individual contributions of funds, equipment and food. Total Budget and Poettlon Count: Total Program Budget $98,200 Total Program Position Count 5 Total Agency Bud et 150,000 Total Agency Position Count 7 Note 1: For the Agency Budget - {1) FT Fiscal Director, (1) FT Program Director, (1) PT Cultural Specialist, (3) PT Program Assistants, (1) PT Administrative Assistant. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Hamakua Youth Foundation- Agency Name Hamakua Youth Center- Program Name Note 2: The HYF has been awarded $91,799 from a SPF /SiG Underage Drinking Prevention grant to be used in collaboration with local schools and community. The anticipated contract with the County, as of January 31, is not finalized. These funds are for offsite activities and programs and need be spent by 9/29/11. The requested non -profit proposal is for the HYC after - school drop4n program with funding needed for the entire FY' 11 Program Objectives: The primary purpose of the Hamakua Youth Center is to provide youth with a safe environment during non - school hours. Both structured and unstructured activities with adult supervision reduce the risk factors and increase the protective factors influencing the behaviors and outcomes for youth in Hamakua. The objectives are to: 1. Provide youth services during non - school hours as a preventative factor in drug and alcohol use. 2. Perpetuate positive values and place /based learning rooted in our Host culture. 3. Engage youth in projects that foster confidence, self - esteem, and a sense of belonging. Program Highlights: (from Fiscal Year 2009 -10) 1) No new pregnancies among the girls who regularly visit the Center. 2) Significant reduction in acting out. 3) Reduction in risk- taking behavior among our regular youth. 4) Increased use of conflict resolution and successful completion of community service referrals of over 20 youth engaged in cultural values and leadership training. 5) Health, dental, and counseling referrals, court dates, transportation and advocacy for youth's needed services. 6) Connect families in crisis with basic necessities and services. 7) Responded to DOE's Furlough Fridays and the needs of working families by providing a Hawaiian culture -based program at no fee. 8) Gender - specific Girl's and Boy's Night's. 9) Evening Hula classes for youth and adults with performances at community events. 10) Supported working families while perpetuating Hawaiian Culture with the creation of E Ola Mau I Ka Pono Summer Enrichment Program. 11) Began the process of developing a three -year strategic plan. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Hamakua Youth Foundation- Agency Name Hamakua Youth Center - Program Name Performance Measures: *If applicable ** Performance Measures for FY `10 -11 and FY'11 2 12 have changed from FY '09 -10 due to new programs. Program Expenditures FY 2009 -10 Actual ** FY 2010 -11 Partial Estimate* FY 2011 -12 Estimate Average daily attendance by outh 86,462 30 30 Total number of youth served annual) 300 300 Total number of waivers /orientations on file signed by parents of youth participants 28,695 205 250 Agriculture/Mahi'ai/Gardening 100 30 Family Food Distribution 8,702 50 50 Council 123,8601 100 50 Community Service 30 30 Hawaiian Culture Programs 75 150 Multimedia/Music 75 Scholarships 2 2 Community Capacity Buildin 25 10 *If applicable ** Performance Measures for FY `10 -11 and FY'11 2 12 have changed from FY '09 -10 due to new programs. Program Expenditures * If applicable # Please explain in detail on separate sheet 'Please See Attachment "A" NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages 86,462 82,000 95,000 Professional Fees Operations 28,695 40,00 40,000 Equipment Other Program Expenses' 8,702 10,000 15,000 Total 123,8601 132,0001 150,000 * If applicable # Please explain in detail on separate sheet 'Please See Attachment "A" NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Hamakua Youth Foundation - Agency Name Hamakua Youth Center - Program Name Program Funding Sources: Identify all funding sources (specific to this p rogram onl Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate County of Hawaii Non - Profit Grant 15,000 10,000 20,000 Friends of the Hamakua Youth Center 32,694 35,000 40,000 Board of Directors** 15,225 4,700 5,000 H I U W 13,000 13,000 15,000 Cooke Family Foundation 5,000 Change Happens Fund 4,000 4,000 4,000 John Ross Fund 5,000 Rev, Takie Okumura Fund 5,000 Atherton Family Foundation 15,000 10,000 10,000 Walk the Talk Fund 1,000 Gordon Russell Fund 2,000 Hapa Fund 2,500 Hawaii Community Foundation OCB Planning 2,800 Rotary Club 1,275 Other Private Funders 4,200 Other Government Grants — 2 Healing Our Island Grants 4,000 Total $120,694 $79,5001 $98,200 *If applicable ** HYF BOD stepped in to maintain minimal operations Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? HYF's mission is to provide quality no -fee youth programs with the goal of long- term sustainability. As our 3-year Strategic Planning process nears completion, we are committed to increase partnerships with other local organizations as well as expanding recurring donations and funding resources from individuals through outreach at community events and fundraising campaigns via "Friends of the Hamakua Youth Center." Our plan is to keep administrative overhead costs as low as possible by expanding the scope of programming with local financial support, and partnering with other youth services agencies and community volunteers. The ail - volunteer, active Hamakua Youth Foundation Board of Directors works in concert with staff with grant- writing, media, marketing, and community outreach. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Hamakua Youth Foundation- Agency Name Hamakua Youth Center - Program Name (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, l (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Si6fiature 6116ard President/Chair kt 0 , < =�eus Signatilre of Executive Director to UNSIGNED PROPOSALS WILL NOT BE ACCEPTED NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 ATTACHMENT "A" Other Program Expenses: Fr09 -`10 Food and Beverage $2,593.00 Fundraising Expenses $2,460.00 Program Consulting $1,350.00 Program Supplies $1,956.00 Program Travel $315.00 Scholarships $28.00 Total $8,702.00 HYF estimates during the remainder of FY'10 and for the whole of FY'11-'12, Our other program expenses will increase due to expanding programs. i Hawaii Centers for Independent Living Independent Living Services Hawaii Centers for Independent Living- Agency Name Independent Living Services- Program Name Agency Director: Kimo Keawe Phone No.: 522 -5419 Contact Person: Thayer Goya Phone No.: 522 -5409 Mailing Address: 414 Kuwili St, Stuite 102, Honolulu, Hi 96817 Facility /Site Address: 1055 Kino'ole St, Stuite 105, Hilo, Hi 96720 Fax No.: 808 - 522 -5427 Email Address: kimok @pacificil.org & thayerg @pacificil.org Name of Accountant/CPA (include name of firm if applicable): Fred Hattori, Hattori & Co. CPA Inc. Phone No.: 808 - 949 -2656 Mailing Address: 1481 S. King St, Stuite 232, Honolulu, Hi 96814 Amount of Request for County Funds: $15,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $15,000 $15,000 $10,000 Agency Mission Statement: Hawaii Centers for Independent Living, Creating Access, Choice and Independence for People with Disabilities. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Hawaii Centers for Independent Living - Agency Name Independent Living Services- Program Name Program Description: The Hawaii Centers for Independent Living (HCIL) is a non profit organization operated by and for people with disabilities to ensure their rights to live independently and fully integrated in the community of their choice, outside of institutional care settings As a non - profit, county wide resource, HCIL serves people of any age with disability. HCIL was founded on the historical constitutional beliefs of civil rights and the empowerment of people with disabilities to have equal access, opportunities, and choices in life, no matter how severe their disability. To accomplish this, HCIL actively seeks systems change and promotes self - advocacy. The Philosopy That Guides HCIL in Three -Fold: 1. HCIL's objective is to present information on a wide array of options, from full independence to other forms of community -based living, from which individuals with disabilities can make their pwn personal choices. 2. The needs of people with disabilities can be met effectively by comprehensive programs encompassing personal care, housing, transportation, employment, recreation the list is almost endless. This is what drives HCIL's response to consumer request. 3. Those who know best the needs of people with disabilities, and how to meet those needs, are people with disabilities themselves. It is the strong belief in this peer relationships that distinguishes HCIL and its services. Total Budget and Position Count Total Pro ram Budget 1 238,917 Total Program Position Count 5 Total Agency Budget 1 1,267,253 Total Agency Position Count 35 Program Objectives: 1) Provide landlord / tenant rights training, how to complete a housing application, hoe to locate housing and how to maintain their housing situation. This will reduce risk of being homeless and dependent on NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 others. This services will provided to 50 individuals. Timeline: 7/1/11 - 6/30/12. 2) Provide consumers with personal care attendant referrals whom we have screened and interviewed to assist them with their personal care, chores, etc. Provide consumer training on how to interview, hire and fire an attendant. This prevents institutionalization and dependence on family, friends, and neighors. This services will be provided to 41 individuals. Should a person require the service more than one time in the two years period they will be counted as one individual. Timeline: 7/1/11 - 6/30/12 3) Proivde one on one independent living skills to assist consumers in carring out their everyday living activities such as housekeeping, shopping, laundry, cooking, moneymanagement, etc. This will reduce dependence on others this services will be provided to 38 individuals. Timeline: 7/1/11 -6/30/12. 4) Provide consumer with information on their legal rights, how to access consumers to empower self- advocacy. This services will be provided to 50 individuals. Timeline: 7/1/11 - 6/30/12. 5) Provide one on one training on video relay services for the deaf. Serve as the location where consumer can file complaints if they have problems with 711 services. This services will be provided to 15 consumers. Timeline: 7/1/11 - 6/30/12. 6) Provide consumers with housing referrals to acquire a place to live. This will increase their independence and decrease dependency on family and or with friends. 25 people with locate and move into housing. Timeline: 7/1/11 - 6/30/12 7) Provide consumers with job readiness skills. These skills include resume writing, job interviews, locating opportunities, and job requirements. This will provide consumers with skills to acquire employment and become more independent. This services will be provided to 10 consumers. Timeline: 7/1/11 - 6/30/12. 8) Provide consumers with basic computer skills to include email, Microsoft Word, filing documents, and use of the internet. This will create access for the consumers to their community. This services will be provided to 12 consumers. Timeline: 7/1/11 - 6/30/12. 9) Provide consumers with knowledge of their entitlements. This will enable consumers to maximize the amount of benefits that they can receive. This services will be provided to 40 consumers. Timeline: 7/1/11 - 6/30/12. 10) Provide 20 consumers with information and referral services to increase their options of various resources in the community. This will increase their independence. Timeline: 7/1/11 - 6/30/12. Program Highlights: (from Fiscal Year 2009 -10) 1) During this past year, HCIL staff was able to provide housing services to 151 consumers. They taught techniques of how to search out, apply and acquire housing. They also taught skills that will help consumers to NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 identify housing that was in the price range and also had accessible features. The staff provide knowledge to consumers about finding housing options that were subsidized in order to take advantage of housing benefits from the Hawaii Public Housing Authority. 2) The staff was able to assist 76 consumers in finding Personal Assistant services. The staff did screening of applications, security clearance, and reference checks in order to provide the consumers with the best possible candidates for them to hire. 3) The staff provided Independent Living Skills to 26 consumers. Some of those skills were money management, how to manage their PA services, cooking, laundry, and shopping. 4) The staff provide help with finding legal services for 64 consumers. They assisted in explaining the ADA Law and why it is important to have accommodations. They also assisted with consumers with companion animals and rentals and what rights they have under the law. They also assisted consumers in what their rights are for accessible housing. 5) The staff assisted 6 consumers to learn how to use the video phone. This meant that consumers could call and access any government agencies or businesses in their community. This was especially helpful for those who were in process in process of applying for social security. 6) Staff provided information and referral services to all consumers when consumers has issues that didn't relate to services that are provided by HCIL. 7) The staff has also provided computer training to consumers. The staff was able to assist individuals with programs such as Dragon Speak, and basic computer skills for consumers to have access to the community. 8) HCIL also has individuals that work out of their homes. This enables to staff to perform outreach services to those that live in their communities. The geographic area is very large and this gives that consumers better access to staff and they don't have to travel long distance to get to the HCIL office in Hilo. 9) NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Hawaii Centers for Independent Living - Agency Name Independent Living Services - Program Name Performance Measures: If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate 50 landlord / tenant rights training 5111 2952.74 2500 41 personal care attendant referrals 3000 917 2040 38 independent living skills 1444 2769.34 1890 50 empower self-advocacy 3833 4163.18 2490 15 training on video relay services 1000 1375.5 740 25 housing referrals 15000 10000 1240 10 job readiness skills 612 201.74 500 12 basic computer skills 600 40 knowledge of their entitlements 788.62 2000 20 information and referral services 1000 other not listed as current measures 1831.88 If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 9500 5500 9000 Professional Fees 1000 1500 2250 Operations 2750 2000 3250 Equipment 500 500 Other' 1250 1000 0 Total 15000 10000 15000 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Hawaii Centers for Independent Living - Agency Name Independent Living Services - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate State of Hawaii 89675 80584 80584 Federal Funds 184166 135000 135000 Hawaii County 15000 10000 15000 Hawaii Island United Way 20000 13333 13333 Total 308841 238917 243917 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Hawaii Centers for Independent Living was successful in turning in a proposal to become an Employment Network under Social Security Ticket to Work Program. The Employment Network contract was finally approved in September 2010. HCIL became an Employment Network Statewide, covering Oahu and all neighbor islands including Guam. Title VII Part C Federal funds are been spent for increasing outreach services, provide more training for staff and improve our communication and AT equipments systems. We will be applying for additional grants to support specific services areas. Currently we are preparing for a Proposal Application for Independent Living Plan and Purchase of Services for upcoming in April 2011. Our current contract with Vocational Rehabilitation Services expire on June 2011. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 _ Hawaii Centers for Independent Living - Agency Name Independent Living Services - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that l (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. ��439'ehu 4;k k-lal� Sig.rdture of Board Pr ident/Chair Signatu Director �- 24RI- cif/ Date / —a 9 — :)- Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-12 Page 7 'r J Hawaii County Economic Opportunity Council Food Service Training Program HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Food Service Training Program Agency Director: Lester Seto Phone No.: (808) 961 -2681 Ext 203 Contact Person Mailing Address: Facility /Site Address: Fax No.: Email Address: Bettie Wagstaff 47 Rainbow Drive Hilo, Hawaii 96720 47 Rainbow Drive Hilo, Hawaii 96720 (808) 935 -9213 seto Phone No.: (808) 961 -2681 Ext 207 Name of Accountant /CPA (include name of firm if applicable) Carbonaro CPA & Associates Phone No.: (808) 968 -1002 Mailing Address: P.O. Box 4372 Hilo, Hawaii 96720 -------------------------------------------------------------------------- Amount of Request for County Funds: $72,964 Prior Year(s) Funding: 08 -09 None 09 -10 10 -11 None $132,000 Agency Mission Statement: Applicant's mission is the alleviation, elimination and prevention of poverty in the County of Hawaii by: • Mobilizing and channeling private and public resources into antipoverty action; • Stimulating new and effective approaches to the alleviation of poverty; • Strengthening communication, mutual understanding with residents; • Planning the coordination and implementation of antipoverty program; • Educating children and youth to become responsible contributing adults; • Assisting the poor to attain economic self - sufficiency. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 1 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Food Service Training Program Program Description This funding request is to training to seven (7) low- income individuals in the food service field in Kona. The program consists of 160 hours of instructions: 40 in classroom and 120 hours in a full service kitchen. As part of the course the students will complete the Department of Health Food Sanitation Course. The classroom portion of the course will be divided into seven areas: safety procedures; menu planning; portion control; food cost control; cash management; food service program operations; and employment readiness. Students will receive instructions on food handling, food preparation, food storage, proper dress attire, kitchen safety and hazardous material and sanitation. Fundamental requirements to maintain food safety and prevent food borne illness associated with raw and undercooked food; cooking foods to safe temperatures; date labeling, refrigeration and thawing; cooling and heating liquids; serving procedures, cleaning of equipment, food service area and service area; food disposal and personal hygiene will be covered. Students will plan and develop a nutritional five week cycle menu. The final section of the training shall highlight employment and educational opportunities in the food service industry, provide job search strategies and managing personal finances. Upon completion of the training, participants will have developed interviewing skills, a professional resume, and information on social and financial resources in the community. Students will receive a training stipend. Total Budget and Position Count Total Program Budget $ 72,694 Total Program Position Count 7.5* Total Agency Budget $2,301,296 Total Agency Position County 160 *Total Program Position Count is 7.5 full time equivalents (FTE) Program Objectives: 1. Gain basic knowledge of the food service industry 2. Complete and pass the Department of Health Food Sanitation Course 3. Develop resume 4. Develop skills to seek employment at various levels of the food industry NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 2 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Food Service Training Program Program Highlights: (from Fiscal Year 2009 -2010) 15 individuals participated in the first ever class in fiscal year 2009. The course was funded by a grant from the State of Hawaii Department of Human Services. Of the 15 participants, 7 obtained employment in the food service industry and 1 obtained employment in administration. All the participants successfully completed the State of Hawaii Department of Health Food Sanitation Course. Performance Measures: Program Expenditures FY 2009 -2010 FY 2010 -2011 Salaries and Wages Actual Estimate 90% of participants will 100% 90% successfully complete the 27513 27,728 DOH Food Sanitation Class 100% of participants will 100% 100% gain a basic knowledge of 132,000 72,694 the food service field 100% of participants will 100% 100% develop a resume that can be used during employment searches 50% of participants will find 53% 50% employment on completion of the training course Program Expenditures * If applicable # please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 FY 2009 -2010 Actual* FY 2011 -2012 Estimate Salaries and Wages 104,487 44,966 Professional Fees Operations 27513 27,728 Equipment Other# Total 132,000 72,694 * If applicable # please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Food Service Training Program Program Funding Sources: Identify all funding sources (specific to this program only) * If applicable Explain what plans if any, your agency and /or program have to increase revenues to support this program. When do you anticipate your program to become self - sustaining? HCEOC has initiated a fund development program which will consist of multiple fund- raising events. In addition, the food Service Program continues to increase its marketing effort to bring in additional revenue sources. It is hoped that these efforts will bring in funds sufficient to make this program self sustaining. Given the current economic conditions, it is impossible to provide a date when this program will be self - sustaining. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY2010 -11 Actual* FY 2011 -12 Estimate Federal TANF Funds — Department of Human Services 132,000 72,694 Available Federal, State Foundation Grants Agency funds * If applicable Explain what plans if any, your agency and /or program have to increase revenues to support this program. When do you anticipate your program to become self - sustaining? HCEOC has initiated a fund development program which will consist of multiple fund- raising events. In addition, the food Service Program continues to increase its marketing effort to bring in additional revenue sources. It is hoped that these efforts will bring in funds sufficient to make this program self sustaining. Given the current economic conditions, it is impossible to provide a date when this program will be self - sustaining. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Food Service Training Program I(we) have read and understood all of the eligibility requirements, grant conditions; award procedures; and records , reporting and fiscal accountability requirements as mandated in Article 25, Sections 2- 135 -2 -1 -142.2 Hawaii County Code, relating to Appropriations of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statues. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete and accurate year - end report will impact the evaluation of your programs or agency's future funding requests. SignatuIV of hoard President /Chair A Date Z '�_ &'t Signature of Executive Director L1 �7 /Zvl( Date NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 5 HC Hawaii County Economic Opportunity Council Garden Education HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Garden Education Program Agency Director: Lester Seto Phone No.: (808) 961 -2681 Ext 203 Contact Person: Bettie Wagstaff Phone No.: (808) 961 -2681 Ext 207 Mailing Address: Facility /Site Address: Fax No.: Email Address 47 Rainbow Drive Hilo, Hawaii 96720 47 Rainbow Drive Hilo, Hawaii 96720 (808) 935 -9213 seto Name of Accountant /CPA (include name of firm if applicable) Carbonaro CPA & Associates Phone No.: (808) 968 -1002 Mailing Address: P.O. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds:$79,816 Prior Year(s Funding: 08 -09 09 -10 10 -11 N/A N/A $79,816 Agency Mission Statement: Applicant's mission is the alleviation, elimination and prevention of poverty in the County of Hawaii by: • Mobilizing and channeling private and public resources into antipoverty action; • Stimulating new and effective approaches to the alleviation of poverty; • Strengthening communication, mutual understanding with residents; • Planning the coordination and implementation of antipoverty program; • Educating children and youth to become responsible contributing adults; • Assisting the poor to attain economic self - sufficiency. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 1 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL. Garden Education Program Program Description This funding request is to establish an education program and community garden for local residents. The community garden will be located at the HCEOC Sunrise Ridge farm on one acre of land set aside for this purpose. Participants will be provided basis instructions regarding garden techniques, container gardening methods, hydroponic farming, pest control and nutrition. The program will consists of eight hours of classroom instructions followed by instructions on site preparation, tilling, seeding and care of home gardens. Classes on the appropriate vegetable for the soil and climate condition will be discussed. The overall goal is to provide local residents the tools needed to grow many of the foods they eat daily. Priority will be given to low- income a residents as one of the goals is to assist residents in becoming more self sufficiency. As part of this program, participants will receive 4 hours of instruction on nutrition and instructions on cooking the foods they grow. Each session will be conducted over a three month period. Participants will receive instruction from the HCEOC Farm Manager and one assistant. This program will operate year round with one class of participants followed by another. Several classes will be conducted to assist recent immigrants, such as Marshallese and other Pacific Islanders. These classes will be offered separately as it is intended to use local residents as translators as needed. Total Budget and Position Count Total Program Budget $ 89,816 Total Program Position Count 2.5 Total Agency Budget $2, 301,296 Total Position Count 60 *Total Program Position Count is 2.5 full time equivalent positions. Program Objectives: 90% of participants will learn how to grow their own food. 2. 70° o of participants will acquire and use nutrition information and adopt better eating habits. 3. 70% of participants will begin their own home garden Program Ilighlights: There are no program highlights as this will be a new program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 2 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Garden Education Program Performance Measures: Program Expenditures FY 2009 -10 FY 2010 -11 FY2011 -12 Salaries and Wages Actual Budget Estimate 90% of participants will learn how to grow NA NA 90% their own food 0 0 $21,600 70% of participants will acquire and use 0 10 70% nutrition information and adopt better 0 0 $ 0 eating habits 0 0 $89,816 70% of participants will begin their own 70% home gardening Program Expenditures * If applicable # Please explain in detail on separate sheet Note: This is a new program thus there are no prior fiscal year expenses. Program Funding Sources: Identify all funding sources (specific to this program only) FY 2009 -10 Actual FY 2010 -11 Budget FY 2011 -2012 Estimate Salaries and Wages 0 0 $68,216 Professional Fees 0 0 $ 0 Operations 0 0 $21,600 Equipment 0 10 $ 0 Other 0 0 $ 0 Total 0 0 $89,816 * If applicable # Please explain in detail on separate sheet Note: This is a new program thus there are no prior fiscal year expenses. Program Funding Sources: Identify all funding sources (specific to this program only) * If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 FY 2009 -10 FY 2010 -11 FY 2011 -12 State of Hawaii Federal) County of Hawaii Non - Profit Grant Funds $79,816 Agency Funds $10,000 * If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Garden Education Program Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Additional revenue for this program will be sought from foundations, state and federal government grants. As the HCEOC farm becomes profitable, it will provide much if not all of the funds and personnel to sustain this program. I(we) have read and understood all of the eligibility requirements, grant conditions; award procedures; and records , reporting and fiscal accountability requirements as mandated in Article 25, Sections 2- 135 -2 -1 -142.2 Hawaii County Code, relating to Appropriations of Funds to Nonprofit Organizations. I(we) hereby certify that information supplied herein including all supporting documents is correct and that I(we) have the authority and ability to fully administer the program(s) pursuant to law. I(we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statues. If awarded a grant from the County of Hawaii, I(we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your programs or agency's future funding requests. — L�� , �- 1 tv Signatu# of board President /Chair Date 4 t - & , u S 1 h_ o lr Signature of Executive Director Date NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 41 Hawaii County Economic Opportunity Council Youth Mentoring - Right Track /DOPP HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL YOUTH MENTORING -RIGHT TRACK/DOPP Agency Director: Lester Seto Phone No.: (808) 961 -2681 Ext 203 Contact Person: Bettie Wagstaff Phone No.: (808) 961 -2681 Ext 207 Mailing Address Facility /Site Address: Fax No.: Email Address 47 Rainbow Drive Hilo, Hawaii 96720 47 Rainbow Drive Hilo, Hawaii 96720 (808) 935 -9213 seto Name of Accountant /CPA (include name of firm if applicable) Carbonaro CPA & Associates Phone No.: (808) 968 -1002 Mailing Address: P.O. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds: $109,240 Prior Year(s Funding: M ' 09 -10 10 -11 0 $$65,000 Agency Mission Statement: Applicant's mission is the alleviation, elimination and prevention of poverty in the County of Hawaii by: • Mobilizing and channeling private and public resources into antipoverty action; • Stimulating new and effective approaches to the alleviation of poverty; • Strengthening communication, mutual understanding with residents; • Planning the coordination and implementation of antipoverty program; • Educating children and youth to become responsible contributing adults; • Assisting the poor to attain economic self - sufficiency. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 1 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL YOUTH MENTORING —RIGHT TRACK PROGRAWDOPP Program Description: This funding request is to continue the operation of the HCEOC Youth Mentoring -Right Track Program, a drop -out prevention program for youths in grades 9 through 12. The HCEOC Youth Mentoring -Right Track programs goal is to reduce the risk of high school students with chronic absenteeism, failing grades and socio- behavior problems from dropping out of school. Priority is given to economically and culturally disadvantaged students who are mostly from single parent homes and /or homeless. Program Mentors /Facilitators work with school referred students, parents school counselors, teachers, school administrators, as well as family court and other public agencies to establish rapport and open channels of communications between all parties. The program uses the evidence -based program: Positive Action — consisting of educational and cultural activities, afterschool mentoring and tutorial sessions to help students develop positive attitudes toward school, increase self - esteem and explore career options. Sessions are conducted one -one one and in group sessions. Program Mentors meet with the students at least twice each week depending on the student's needs. HCEOC Right Track program's primary objective is improve the graduation rate of low- income high school students, increase their self esteem, and to improve parent -child interaction/communication. A secondary priority is to provide academic assistance to the students enrolled in the program. An individualized plan, based on the results of pre - enrollment assessment tests administered by the DOPP Facilitator, is developed for each student. Parental input is sought prior to the plan being finalized. The program also offers outreach for crisis intervention to students and their families. The program shall serve the following high schools: Pahoa, Waikea, Keaau, and Konawaena Total Budget and Position Count Total Program Budget $109,240 Total Program Position Count 6.5 Total Agency Budget $2,301,296 Total Agency Position Count 60 *Total Program Position Count is 6.5 full time equivalent positions. Program Objectives: 1) Graduate 95% of high school seniors in the program by the end of the school year. 2) Enable 60% of the referred high school students to pass all courses necessary for promotion. 3) Improve 65% of the referred high school student's attendance by 65% or better. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 2 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL YOUTH MENTORING -RIGHT TRACK PROGRAMMOPP 4) Assist 70% of the referred high school students to complete the school year without any suspension exceeding three days. 5) Demonstrate on the pre /post observation form that 80% of the program participants made positive changes in attitude toward self and others. Program Highlights: (from Fiscal Year 2009 -2010) 1. 98% of the senior clients at all the DOPP schools graduated. 2. 78% of all DOPP project students in grades 9 -11 passed all courses necessary for promotion and /or made a 10% improvement in Grade Point Average (GPA) between the beginning and end of their entry into the program. 3. An average of 77% of the entire DOPP clients at all schools had an attendance of 65% or better. 4. 83% of the DOPP clients as a whole finished the school year without any suspensions exceeding three days. This exceeded the stated goal by 13 %. Performance Measures: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 FY FY 2009- FY 2010 -11 2008- 10 (Actual) (Estimate) 09 Graduate 95% of high school seniors in the program by 92% 98% 95% the end of the school year Enable 60% of the referred high school students to pass 67% 78% 60% all courses necessary for promotion Improve 65% of the referred high school students 67% 77% 65% attendance by 65% or better Assist 70% of the referred high school students to 76% 83% 70% complete the school year without any suspensions exceeding three (3) days Demonstrate on the pre /post observation form that 80% 88% 82% 80% of the program's participants made positive changes in attitude toward self and others. Demonstrate on the pre /post observation form that 70% 85% 83% 70% of the program parents developed positive communication with their child, other adults and children of other ethnic groups NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL YOUTH MENTORING -RIGHT TRACK PROGRAM/DOPP Program Expenditures * If applicable # Please explain in detail on separate sheet Note: Total program expenditure For FY 2009 -2010 includes ARRA funds for the period January 1, 2010 to September 30, 2010. Funds for FY 2010 -11 include funds for only 2 schools. No administrative costs were included. FY 2011 -2012 estimates include funds for 4 schools with four Program Facilitators, 1 Community Facilitator(half time), and one Program Manager (half time)as well as a 5% administrative cost. Program Funding Sources: Identify all funding sources (specific to this program only) FY 2009 -10 Actual FY 2010 -11 Budget* FY 2011 -2012 Estimate* Salaries and Wages $200,327 $ 59,463 $97,540 Professional Fees $ 0 $ 0 $ 0 Operations $38,300 $ 5,537 $11,700 Equipment $ 0 $ 0 $ 0 Other $ 0 $ 0 $ 0 Total $238,627.00 $ 65,000 $109,240 * If applicable # Please explain in detail on separate sheet Note: Total program expenditure For FY 2009 -2010 includes ARRA funds for the period January 1, 2010 to September 30, 2010. Funds for FY 2010 -11 include funds for only 2 schools. No administrative costs were included. FY 2011 -2012 estimates include funds for 4 schools with four Program Facilitators, 1 Community Facilitator(half time), and one Program Manager (half time)as well as a 5% administrative cost. Program Funding Sources: Identify all funding sources (specific to this program only) * If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? As a non - profit organization, HCEOC has in the past 36 years competed for and received federal, state and local funding to sustain the Youth MENTORINGs -Right Track Program. A concerted effort is been made to identify funding organizations and fundraising opportunities to enable this program to become self - sustaining. The current economic situation does not allow the agency to predict with any certainty when the program will become self - sustaining. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 FY 2009 -10 FY 2010 -11 FY 2011 -12 State of Hawaii, Department of Education Federal CSBG ARRA funds (ended 9/30/2010) $238,627 County of Hawaii Non - Profit Grant Funds $65,000 $109,240 * If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? As a non - profit organization, HCEOC has in the past 36 years competed for and received federal, state and local funding to sustain the Youth MENTORINGs -Right Track Program. A concerted effort is been made to identify funding organizations and fundraising opportunities to enable this program to become self - sustaining. The current economic situation does not allow the agency to predict with any certainty when the program will become self - sustaining. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL YOUTH MENTORING -RIGHT TRACK PROGRAM/DOPP I(we) have read and understood all of the eligibility requirements, grant conditions; award procedures; and records , reporting and fiscal accountability requirements as mandated in Article 25, Sections 2- 135 -2 -1 -142.2 Hawaii County Code, relating to Appropriations of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statues. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete and accurate year- end report will impact the evaluation of your programs or agency's future funding requests. Signa re of Board P esident /Chair Zt" �� Signature of Executive Director Date 1 12, - 7 f zo11 Date NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 42 Hawaii County Economic Opportunity Council Youth Mentoring Language Arts Multicultural Program HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL YOUTH MENTORING- LANGUAGE ARTS MULTICULTURAL PROGRAM Agency Director: Lester Seto Phone No.: (808) 961 -2681 Ext 203 Contact Person: Mailing Address: Facility /Site Address Fax No.: Bettie Wagstaff 47 Rainbow Drive Hilo, Hawaii 96720 47 Rainbow Drive Hilo, Hawaii 96720 (808) 935 -9213 Phone No.: (808) 961 -2681 Ext 207 Email Address: seto_hceoc o hotmail.com Name of Accountant /CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: (808) 968 -1002 Mailing Address: P.O. Box 4372 Hilo, Hawaii 96720 ------------------------------------------------------------------------------- Amount of Request for County Funds: $ 113, 372 Prior Year(s) Funding: 08 -09 $ 0 09 -10 10 -11 $ 0 $75,000 Agency Mission Statement: Applicant's mission is the alleviation, elimination and prevention of poverty in the County of Hawaii by: • Mobilizing and channeling private and public resources into antipoverty action; • Stimulating new and effective approaches to the alleviation of poverty; • Strengthening communication, mutual understanding with residents; • Planning the coordination and implementation of antipoverty program; • Educating children and youth to become responsible contributing adults; • Assisting the poor to attain economic self - sufficiency. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 1 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNTY Youth MENTORING- Language Arts Multicultural Program Program Description This funding request is to continue the operation of the Language Arts Multicultural Program (LAMP) during fiscal year 2011 -2012. The LAMP is based on a field tested curriculum developed by HCEOC with contributions by James Vasquez, Ph.D and Elaine Kono, Ph.D, Hawaii Department of Education. The curriculum is exclusively designed for school referred underachiever in language arts, writing and speaking, the basics required for extending learning to other area. Since its inception, the curriculum has undergone extensive improvements to assists underachieving students and incorporating multicultural awareness and STEM (science, technology, engineering, math) education initiatives. The HCEOC LAMP program is unique in that it is not only an after school program, but it is also an in -class tutoring programs. Through collaboration with State of Hawaii Department of Education (DOE), the LAMP staff work with the classroom teachers assisting with the day- to- day class material. Students who are experiencing problems with their school work may be helped at the time they are experiencing the difficulty. In some cases, the LAMP staff simply works with the child at his desk; in other cases, the LAMP teacher provides in -depth individualized assistance away from the classroom. Through a mix of recreational, arts, and enrichment activities, the program provides a positive environment for students to develop good interpersonal skills and self confidence. Students are provided age- appropriate learning opportunities designed to improve math, reading, and writing skills. Field trips and excursions expand the student's knowledge of the community. The Program will serve two (2) elementary schools in Hawaii County: Keonopoko Elementary and Naalehu Elementary School. Total Budget and Position Count Total Program Budget $113,372 Total Program Position Count 6.5 Total Agency Budge $2,301,296 Total Agency Position Count 60 * Total Program Position Count is 6.5 full time positions NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 2 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Youth MENTORING — Language Arts Multicultural Program Program Objectives: 1) Gain a minimum of 2 percentile points per year as measured by the Stanford Diagnostic Reading Test, Reading Comprehension subtest for 70% of the program participants. 2) Attain 4.5 in writing or gain one (1) point in writing skills as measured by the SAT Writing Assessment on a seven (7) point scale, one being low, for 80% of the program participants. 3) Attain 80% on the teacher applied LAMP Teacher Attitudinal Observation worksheet or make an increase of 10% between pre and post scores for 80% of program participants. 4) Improve socialization skills by 10% as determined by the pre and post teacher administered Student Socialization Evaluation for 90% of program participants. Program Highlights: (from Fiscal Year 2009 -2010) 1. All students met the SAT Writing Assessment program Objective. 2. 90% of the students met the program objective in speaking and listening. 3. 96% of the students met the socialization objective. Performance Measures: * If applicable Note: Program year was reduced by 4 months. Keonopoko fell to meet reading objective. Three of seven schools: Kapiolani, Keaau and NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual* Budget* Estimate Gain a minimum of 2 percentile points per year as measured 51% 70% 70% by the Stanford Diagnostic Reading Test, Reading Comprehension student for 70 % of the program student. Attain 4.5 in writing or gain one (1) point in writing skills as $5% 80% 80% measured by the SAT Writing Assessment on a seven (7) p oint scale, one being low, for 80% of program students. Achieve 80% on the teacher applied LAMP Teacher's 94% 80% 80% Attitudinal Observation worksheet or make an increase of 10% between pre and post scores for 80% of program students. Improve socialization skills by 10% as determined by the 96% 90% 90% pre and post teacher administered Student Socialization Evaluation for 90% of program students. * If applicable Note: Program year was reduced by 4 months. Keonopoko fell to meet reading objective. Three of seven schools: Kapiolani, Keaau and NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Youth MENTORING — Language Arts Multicultural Program Program Expenditures * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) FY 2009 -10 Actual* FY 2010 -11 Budget* FY 2011 -2012 Estimate Salaries and Wages $341,273 $ 69,832 $ 101,842 Professional Fees $ 0 $ 0 $ 0 Operations $ 42,570 $ 5,168 $ 11,530 Equipment $ 0 $ 0 $ 0 Other# $ 0 $ 0 $ 0 Total $383,843 $ 75,000 $113,372 * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) *If applicable #Note: Program reduced to 2 schools with only teachers, no aide. Administrative costs absorbed by agency. Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? As a non - profit organization, HCEOC has in the past 36 years competed for and received federal, state and local funding to sustain the Youth MENTORING- Language Arts Multicultural Program. A concerted effort is been made to identify funding organizations and fundraising opportunities to enable this program to become self - sustaining. The current economic situation does not allow the agency to predict with any certainty when the program will become self - sustaining. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 FY 2009 -10 Actual FY2010 -11 Budget* FY 2011 -12 Estimate Federal CSBG ARRA Funds Note: Funding ended 09/30/10 $383,843 Agency funds Available Federal, State, Foundation Grants County Funding $75,000 $113,372 *If applicable #Note: Program reduced to 2 schools with only teachers, no aide. Administrative costs absorbed by agency. Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? As a non - profit organization, HCEOC has in the past 36 years competed for and received federal, state and local funding to sustain the Youth MENTORING- Language Arts Multicultural Program. A concerted effort is been made to identify funding organizations and fundraising opportunities to enable this program to become self - sustaining. The current economic situation does not allow the agency to predict with any certainty when the program will become self - sustaining. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Youth MENTORING- Language Arts Multicultural Program I(we) have read and understood all of the eligibility requirements, grant conditions; award procedures; and records , reporting and fiscal accountability requirements as mandated in Article 25, Sections 2- 135 -2 -1 -142.2 Hawaii County Code, relating to Appropriations of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statues. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete and accurate year- end report will impact the evaluation of your programs or agency's future funding requests. Signat of board President /Chair L Signature of Executive Director ( / y -7 Date i 112 2 6 8 Date NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 43 Hawaii FFA Foundation Kohala Family Natural Farming Program Hawaii FFA Foundation Kohala Family Natural Farming Program Project Director: Contact Person: David Fuertes Leanne Okamoto Phone No.: Phone No.: 808 - 938 -5398 Mailing Address: PO Box 6731 Hilo, HI 96720 Facility /Site Address: 54 -3853 Akoni Pule Hwy, Kapa'au Fax No.: Email Address: Leanneokamoto @hotmail.com Name of Accountant/CPA (include name of firm if applicable): Taxes and financial statements to date have been prepared by the Foundation Treasurer and acknowledged by the Interim Executive Director as allowed in By -laws. A CPA is being contracted to prepare current and future tax filings. Phone No.: Mailing Address: Amount of Request for County Funds: $24,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $0.00 $20,000 $49,559 Agency Mission Statement: The FFA motto is "Learning to Do, Doing to Learn, Earning to Live and Living to Serve." And along those lines Hawaii FFA Foundation's mission is to build positive collaborations in agriculture and education that supports an active and sustainable agricultural industry, for the leaders of tomorrow. Four strategic initiatives have been developed to move the organization and community towards realizing this mission: Increase awareness and support for agriculture education and the Future Farmers of America • Strengthen agriculture education • Build agribusiness collaborations for educational and workforce development • Elevate the Future Farmers of America Program. Over the past 4 years Hawaii FFA Foundation has partnered closely with Ka Hana No`eau (KHN), a youth mentorship program in North Kohala, Hawaii. KHN has enjoyed tremendous success in its mentoring programs for Hawaiian youth. The project has met its indicators and the project team has recognized that there is a significant need to expand to increase the program's capacity to reach a larger sector of Hawaii youth. Program Description: The Hawaii FFA Foundation (Foundation) views itself as an agricultural business incubator, who believes that our youth have to know where they are going before they decide if a certain path is the proper path for them to take. With participation from the North Kohala school system, Ka Hana No'eau Mentorship Program and the Hawaii Tourism Authority, students who received formal classroom instruction and exposed to 20 hours each of business planning and Natural Farming courses were able to apply their classroom instruction to a "real life" business scenario. Together, these students, their families (Partners) and the Foundation are working together to create a diversified, taro industry base, capable of consistently supplying Taro and Natural Farming Inputs (fertilizers) as an agricultural self - employed NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 endeavor. The monies received from the Hawaii Tourism Authority helped the Partners create a taro huh bank to grow seed stock to prepare for this projects first planting. Hawaii FFA Foundation Kohala Family Natural Farming Program Program Description (Continued): This grant proposal will help start a Natural Farming Model Garden where Partners will grow Taro using the Korean Natural Farming method created by Master Hankyu Cho. Partners will learn to make Natural Farming Inputs (natural fertilizers) for use and sale. Any Natural Farming workshops will also be open to community members for a small fee that would go towards helping to sustain the project. The Taro corm previously grown by Partners during the huli bank creation phase of the project will be used for the "Kohala Taro Festival" a public event where local and hotel chefs will be invited to showcase their culinary talents using Taro. The event will also serve to dedicate the opening of the model garden and give the Partners an opportunity to demonstrate and market their products. The Foundation has selected 3 acres of fertile land with gravity flowed access to fresh, cold, stream water to be used for this project. An additional 2 acres has been designated to also be suitable should the Partners decide to expand upon this Project's concept. This ahapua a is located approximately 4.5 miles north of Hawi in North Kohala and is part of Ho`ea Agriculture Park. This is also the future site of the Agriculture Resource Center of Ho`ea (ARCH). When complete, this site will include a commercial kitchen, poi factory, meat processing facility, Natural Farming Input processing facility, assembly hall /classroom and the Natural Farming Model Garden "living institue". In Partnership with Ka Hana No'eau we serve an average of 50 youth each year in grades 8 -12. Our youth chosen as Partners for this project come from diverse ethnic backgrounds with strong community roots. 20% of the Project Partners come from single - parent households with 33% of participating families unemployed and 39% of participating families with a part-time income source. 20% of participating families are currently losing their homes due to foreclosure. This Program builds family and community unity, promotes healthy living through Natural Farming and provides Partners with the skill set and opportunity to create their own agribusiness and become self - reliant. If a participating youth partner, after the grant period, decides that farming is not really what he /she would like to do, that decision will be based upon "hands -on" experience and knowledge. Our youth partners will still walk away with sound entrepreneurial management experience to take to his/her next endeavor /opportunity whatever that path may be. Of the 7 seniors that participated last year, 57% are currently attending college, 29% are in the Americorp Program with plans to start college this year, and 14% have entered the workforce. Total Budget and Position Count Total =Pro Budget $50,000 Total Program Position Count 2 Total Agency Budget $700,000 Total Agency Position Count 10 Program Objectives: 1) Prepare land for Natural Farming Model Garden. To be completed by May 31, 2011 2) Create a Natural Farming Model Garden "living institute" to educate people on the importance and practice of Natural Farming, and Agriculture and how they are woven into Hawaiian cultural practices such as kalo production. To be completed by June 30, 2011. 3) Plant and grow taro, banana and sugar cane using Natural Farming methods and Inputs. To be completed by June 30, 2011. 4) Plan and host "Kohala Taro Festival" to dedicate model garden and give Partners opportunity to, demonstrate market and sell their products. Event scheduled for July 16, 2011 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Hawaii FFA Foundation Kohala Family Natural Farming Program Program Objectives (Continued): 5) Make Natural Farming Inputs for Model Garden use and sale. Ongoing, to be completed by September 2011 6) Educate youth on Natural Farming methods and teach them to create sustainable businesses for their own use and to become contributing members of their communities. To be completed by November 30, 2011 7) Participate in family and community resilience building by having the 10 families in this program contribute towards the North Kohala Community Development Plan of becoming 50% food sustainable in 8 years. To be completed by November 31, 2011. Program Highlights: (from Fiscal Year 2009 -10) 1) 2009- partnered with Ka Hana No'eau youth and their families, where they expressed interest in wanting to produce Taro, "students teaching parents with parent/family involvement." 2) 2010 - Hawaii Tourism Authority grant with seed money to start the Kalo movement. Held fundraisers (3) Luaus for project while unifying families. 3) 2010 - Sponsored (2) workshops on Natural Farming that brought Master Cho (founder /creator Cho Global Natural Farming) to Hawaii. Main sponsors: Hawaii FFA Foundation, Kamehameha Schools, Community Based Economic Development, UH CTAHR, Ulupono and Ho'ea Ag Park. 4) 2010 - $50,000 allocated to build the foundation of education of Natural Farming. This money was distributed across the State through Natural Resource Conservation Service (MRCS.) 5) 2010 - $50,000 awarded to Hawaii R & D for Natural Farming on Hawaii Island. $25,000 of which was awarded to the Foundation to create a Natural Farming Model Garden "living institute ". The remaining $25,000 has been budgeted for establishing Natural Farming Certification standards and to hold more workshops taught by Master Cho. Performance Measures: *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget * Estimate Business planning workshops for Partners and $5,000 community (25 ppl) Hawaii Tourism Authority Grant $25,000 3 hands -on luau workshops (200 ppl). 10 families created taro huli bank and produced 8000 taro huli for planting model garden. Natural Farming Model Garden - "living $50,000 institute" for KHN families, community and general public to experience hands -on learning. Produce minimum of 8,000 lbs of taro corm and 64,000 -taro huli for distribution to Partners, sale and project replanting. "Kohala Taro Festival" — dedication of Model Garden and sampling of taro made by local Chefs. Est. attendance by public 250 -300 ppl *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Hawaii FFA Foundation Kohala Family Natural Farming Program Program Expenditures * If applicable Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages Actual * $5,000 $4,500 Professional Fees $5,000 $3,500 Operations $20,000 $42,000 Equipment Other Total $30,000 $50,000 * If applicable Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget * Estimate Hawaii Tourism Authority $25,000 Hawaii R & D Grant $26,000 In -Kind Contributions: Bronson Fuertes — land clearing $12,000 David Fuertes — Tractor /trailer $27,000 Implements $5,000 Trucks 4x4 $35,000 KIC meeting room — 12 mtg. $1,500 David Fuertes — Labor PD - $35,000 Ho'ea ag Park — Land - $3,000 Volunteer Labor — $6,000 Taro Festival — Taro /veggies - $2,500 Equipment - $2,000 Labor - $6,000 Total In -Kind : $135,000 Grant Proposals Under Review: OHA Grant -Input Facility $100,000 USDA Farm Service Agency $2,000 Ka Hana No'eau Business Planning Course $3,000 Total $30,000 $26,000 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? All sales of taro leaf, corm and Natural Farming Inputs as well as any workshop and festival fees (if charged) will go towards supporting and sustaining the Foundation and this program. Agreements have already been initiated with Waipio taro farmer Morgan Toledo to purchase taro corm produced by the program. Within 2 years, the Foundation estimates that this program will generate approximately $30,750 in revenues at which time the program will become self - sustaining with current established in- kind contributions. Within 5 years the Foundation estimates that revenues should reach $195,000 at which time the project will be completely self - sustainable. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Hawaii FFA Foundation Kohala Family Natural Farming Program I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal Year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate Year -end requests. ep rort will impact the evaluation of Your program's or aeency's future funding Signature of Board President/Chair Date Signature of Exe utive Director 1/3 / ? Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 I I Hawaii Island Adult Care, Inc. Hilo Adult Day Centers Hawaii Island Adult Care, Inc.- Agency Name Adult Day Care Centers - Program Name Agency Director: Paula Uusitalo Phone No.: 961 -3747 Contact Person: Mailing Address: Facility /Site Address: Fax No.: Paula Uusitalo 34 Rainbow Drive Hilo, Hawaii 96720 Same as Above 961 -3740 Phone No.: 961 -3747 Email Address: puusitalo @hawaiiislandadultcare.org Name of Accountant/CPA (include name of firm if applicable): Jennifer L. Gossert, CPA Phone No.: 969 -3115 Mailing Address: 688 Kinoole St., Hilo, Hawaii 96720 Amount of Request for County Funds: $25,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $20,000 $20,000 $20,000 Agency Mission Statement: Providing quality care for elders and challenged adults and support for their families. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Hawaii Island Adult Care, Inc. - Agency Name Adult Day Care Centers - Program Name Program Description: Adult Day Care Centers provide a safe, socially active, healthy daytime setting for aging elders and challanged adults who need supervised care and socialization. The Hilo Adult Day Center is open Monday to Friday, 7:00 AM to 5:00 PM and Saturdays from 8:00 AM to 4:00 PM. The Honomu Adult Day Center is currently open Wednesday and Friday from 9:00 AM to 2:00 PM. Total Budget and Position Count Total Program Budget $1,11 54,040:J:o:t ram Position Count 28 Total Agency Budget $1,638,180 Total Agency Position Count 51 Program Objectives: 1) Provide a safe, caring, healthy daytime environment for aging elders and challenged adults; all of whom need assistance with some of their active daily living skills, many are under doctor's orders to attend the day care center. 2) Provide mental stimulation and physical activity through interaction/ socialization with others, hands -on games and activities, singing, arts /crafts, games, bingo, excursions, entertainment and more. These individuals are generally inactive at home, having old -age depression; the day center is geared to give them an experience that promotes happiness, fosters a positive outlook and improves their quality of life. 3) Provide the opportunity for elders to continue living in their own homes, to be with family and to be a part of the community for the rest of their days if possible. 4) Deter pre- mature institutionalization into long term care facilities, allow our elders to live at home in dignity, and also lessen the taxpayer burden which would be paying for the long term care institutionalization. Ninety percent of the patients in long term care facilities in the State of Hawaii are paid for by Medicaid funds. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Hawaii Island Adult Care, Inc. - Agency Name Adult Day Care Centers - Program Name 5) Provide caregivers the opportunity to continue employment, have respite and deter "caregiver burnout ". 6) Provide adult day care to all individuals needing supervised daytime care, regardless of their ability to pay by utilizing Medicaid, federal, state, county and private foundation tuition - assistance funding for poverty level and low income individuals. Program Highlights: (from Fiscal Year 2009 -10) 1) Hawaii Island Adult Care provided day care services to 135 individuals having varied physical and /or mental challenges in FY 2009 -2010. 2) For the fiscal year ending June 30, 2010, 36 new participants were enrolled; 47 were discharged, 59 attended for the full year and 13 clients passed away while attendees of the center and still living at home (this is the real goal for our clients, to move on from this life while still living at home). Of the 135 participants, 70% were over eighty years old, 82% were over seventy years of age. 3) Maintained professional level of client services with Services for Seniors, the Hawaii County Office of Aging, Ohana Health and Evercare Health plans. Continued working with numerous agencies including the Interdisciplinary team (IDT) organized by the state Department of Health to provide elder client specific case management, other agencies included are Department of Human Services Adult Protective Services, Services for Seniors, Kokua Nurses, Care Resources and others. 4) Continued submitting grants and receiving private foundation support for tuition /fee assistance, received adequate support for all clients needing to attend but who could not afford full costs. Continued the monthly Caregiver support group and received a new HMSA Foundation grant to provide caregiver training classes and hands on caregiver care sessions for the community at large. 5) The Board of Directors completed a two year strategic planning process, revised the by -laws and set up additional board policies. 6) Opened its first satellite adult day center in Honomu on July 1, 2010. This rural community program provides a safe, social active healthy daytime setting for frail elders on the Hamakua coast, currently only open two days per week. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Hawaii Island Adult Care, Inc.- Agency Name Adult Day Care Centers - Program Name Performance Measures: *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget * Estimate Average monthly attendance 89 91 93 Total number of individuals 135 140 144 Participants continue to live in their 119 124 129 own homes Families /Caregivers able to 66 71 76 continue employment Families /caregivers receiving 102 107 112 respite Participant continues after 6 months 102 107 112 Participant continues after 1 year 76 81 86 Participant continues after 2 years 47 50 52 Participant continues after 5 22 22 22 ears Average cost of care in a long term $120,000.00 facility for 1 year 1 person Average cost of care at Adult Day 11,880.00 Care Centers for 1 year (1 p erson) Annual medical monies saved on 1 $108,120.00 participant attending day care versus those living in long term care institutions Yearly savings based on discharges $864,960.00 into long term care during this one year period (attended day care at least one year) *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Hawaii Island Adult Care, Inc.- Agency Name Adult Day Care Centers - Program Name Program Expenditures * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 587,251 605,990 595,000 Professional Fees 10,494 9,700 10,000 Operations 422,556 379,090 410,000 Equipment 1,566 800 1,000 Other (Direct Client Assistance 143,340 158,460 173,500 Total 1,165,207 1,154,040 1,189,500 * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009- 10 Actual * FY 2010- 11 Budget * FY 2011 -12 Estimate Tuition /Fees 603,726 703,800 684,500 State 94,905 80,000 105,000 Federal 94,905 80,000 105,000 County of Hawaii 20,000 20,000 25,000 Hawaii Island United Way 16,484 15,960 16,500 May Templeton Hopper Fund 75, 72,500 72,500 Other Grants: Mclnerny /HHA- Charity Walk/ Friends of Hawaii Charities 52,367 60,000 60,000 Donations 10,810 11,100 12,000 USDA Lunch reimbursement 44,356 52,280 58,000 Pin Grant management 4,800 7,200 6,500 Fundraising / Interest / Misc. Sales 25,249 31,200 35,000 SEE Program 65,368 20,000 10,000 Total 1,108, 715 1,154, 040 1,189, 500 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Hawaii Island Adult Care, Inc.- Agency Name Adult Day Care Centers - Program Name Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Adult Day Care Centers program receives more than 50% of its revenue from private tuition and fees, for the remainder, scholarships are needed to provide care to those who need it but cannot afford full costs. With the addition of Honomu Adult Day Center, the need has increased. The adult day center program can only be self- sustaining if the federal and /or state government would recognize the importance of adult day care and being able to live at home, versus long term care institutionalization and the large tax burden that is incurred with institutionalization. What needs to be available is government funding for low income individuals (about 45 -50% of all elders, with the same percentage for our agency participants) who are just above poverty level and thus do not qualify for programs (adult day care and home care) funded by Medicaid (except institutionalization), then HIAC would not be dependent on applying to other sources to assist with tuition costs. Some individuals have purchased long term care insurance, but this only those who could afford to purchase this individual insurance. The Board of Directors and the agency held it's 5 annual golf tournament in July 2010, netting, $22,314 which assists with operating costs, the goal is to hopefully slowly increase this revenue over time. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Hawaii Island Adult Care, Inc.- Agency Name Adult Day Care Centers - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. ?Oure of Board President /Chair S gnature of Executive Director '�31 [ it Date Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Hawaii Island Adult Care, Inc. County of Hawaii Nonprofit Grant Application 2011 - 12 Attachment Explanation Page 5: Program Expenditures Other: Direct Client Assistance: it is the tuition assistance, grant funding, to help cover tuition costs for low income participants who cannot afford full costs. These participants are above poverty level and therefore do not qualify for Medicaid programs which do pay for adult day care among other things. w Hawaii Island HIV /AIDS Foundation Multi - Disciplinary HIV Case Management, Hilo HAWAII ISLAND HIV/AIDS FOUNDATION- Agency Nr--ui MULTI - DISCI PLINARY HIV CASE MANAGEMENT, HIL-0- Program Name Agency Director: Georgie Kennedy 8177 Contact Person: same Phone No.: Mailing Address: 75-240 Nani Kailua Drive, Suite 5 Kailua Kona, HI 96740 Facility/Site Address: 16-204 Melekahiwa Place #1 Kea'au, HI 96749 Fax No.: 331-0762 Email Address: georgie@liihaf.org F91710=39�� Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates for fy ending 6/30/1 Phone No.: 968-1002 Mailing Address: P 0 Box 4372, Hilo, HI 96720 Amount of Request for County Funds: $15,000.00 Prior Year(s) Funding: 08-09 09-10 10-11 $15,000 $15,000 $15,000 Agency Mission Statement: The Hawai'i Island HIV/AIDS Foundation (hereinafter HIHAF) is a non-profit organization dedicated to assisting those affected by HIV/AIDS to maximi;;.:(:: their NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-12 Page 1 quality of life, and to ending the spread of HIV. We also utilize the lessons learned in the HIV epidemic to care and advocate for others in the fight against HIV and related diseases. Our vision is to build a healthier, stronger, and more sustainable community that supports all its members with a focus on HIV issues. HIHAF is an IRS-designated 501 (c)(3) tax-exempt non-profit organization v,fhich provides care and services for people living with HIV/AIDS (PLWHA), and %rare provide HIV prevention and education to the residents of Hawai'i County. Because most of the clients served at the Kea'au office live in the Hilo area, we refer to the Kea'au office as "HIV Foundation - Hilo." Required checklist forms are attached at the end of this proposal. HIHAF has been providing services to people at risk for, infected with, and affected by HIV/AIDS since 1986. Our Foundation has an efficient and effi:otive system to provide a comprehensive continuum of prevention, care, and support services with regard to HIV/AIDS for the entire Big Island. As options for treatment and medical care for HIV-infected individuals continues to dwin61 with the greatest loss of medical professionals on our island, HIHAF's role in h6j our clients manage HIV and AIDS becomes increasingly crucial. As reported by the Hawai'i State Department of Health, Hawai'i County has, the 2nd highest number of AIDS cases in the state. The number of people liviric with HIV/AIDS continues to climb steadily with each passing year of the epidemic, and the modes of transmission are changing. HIV is no longer present primarill, i n high risk populations. In fact, half of the 65,000 new annual infections in V-11a United States take place as a result of heterosexual transmission. Half of 1 11l - Iese new infections are occuring among people aged 15-23. This indicates to Us, that we will continue seeing a rise in clients and their needs will change as the epidemic continues to shape our client population. Presently, HIV Foundation - Hilo provides multi-disciplinary team HIV case management, advocacy, information and referral, food pantry, client financial assistance, and other support services for more than 128 PLWHA (People Living with HIV/AIDS') and affected persons in East Hawai'i monthly. Our case load for the entire island is an average of 260 PLWHA monthly. Over the course of the year of Decerr 2009 through November, 2010, a total of 189 clients have been cared for in Hilo. Care team members support client independence and self-determination b,V providing a range of supportive services. These include knowledge and assistance in accessing a variety of public and private benefit programs, rrlln,dical and nursing services, housing, food, emergency financial assistance, transportation, employment counseling, and other forms of assistance as appropriate to help and support a client's retention and active participation i',n primary medical care. The services received by each client are monitored regularly to determine the effectiveness of the service plan, identify emerging needs, and measure the outcome(s) of service delivery. HIV Foundation - Hilo proposes to continue its provision of high quality multi- disciplinary team HIV case management. As in past years, we continue V�) experience ZERO increases in State of Hawai'i Department of Health funding NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-1.2 Page 2 allocated to HIV/AIDS case management services on all islands with a growing case load. This is reflected in our Program Expenditures and Program Fun Sources tables. Regardless, we will continue, to do our very best, as always, to provide the highest quality of services to all our clients, despite the static funding available to us. Perhaps the greatest challenge that case management has had to face in 11 last three years is the continued island-wide loss of primary and HIV-treating physicians. Many doctors providing treatment to HIV-positive individuals in East and West Hawaii have left private practice and the island. As recently as December 2010 we lost another HIV specialist in Hilo. In addition, the economic downturn has affected our hospitals, other care programs, and the commurlity at large to such an extent that even minimum care can be difficult to find. Spi::ciality care for those with HIV at one point was almost non-existent on the Big Islaind. Thus we have had to cobble together treatment for people with HIV. One solution we have brokered is having the physicians from the AIDS Clinical 'Trials, through John Burns Medical School on Oahu, see patients on a monthly b. :lisis in both East and West Hawaii. This has brought high quality HIV treatment to many of our clients who are currently without a physician. At the present time thely are seeing over 70 HIV+ clients on the Big Island. In addition to specialty care, these clients need a primary care physician lol:':ally. With so few doctors available, those remaining are being overwhelmed by the influx of new patients. Some physicians have limited their practice and are not accepting patients on Medicare or some other types of insurance. Finding a primary physician who understands or is willing to learn the complicated milture of clinically treating HIV, often alongside other health issues, adds to the sco[:i,e and complexities of HIHAF's care team work. Our care team not only educates doctors on resources for the treatment oil HIV, they act as a liaison between clients and their health care providers. They are advocates for comprehensive treatment of the medical and psycho-social r!eeds of our clients in this rural underserved area. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-12 Pave 3 MULTI-DISCIPLI NARY HIV CASE MANAGEMENT, H11L.0- Program Name Program Description: HIV and AIDS still carry a debilitating stigma in our society and clearly here on the Big Island. As a result, many of those who are infected with, affected by, and at-risk for HIV hide their challenges concerning the disease and managing it in their lives. HIHAF is the only place where HiV-positive individuals do not 1­1;:.lve to hide, where they are understood, and where all their needs can at least be addressed, if not fully resolved. A multidisciplinary team composed of two full-time (2.0 FTE) case managers,(a Treatment Advocate, RN; and a Benefits Specialist); one half-time (0.50 F"I"'E) housing specialist and one half- time (0.50 FTE) client services facilitator provide direct care services for PLWHA residing in East Flawai'i. (The housing specialist also serves clients on the west side of the island.) The monthly average active caseload for the East Side office of the Foundation this past year is one hundred and twenty eight (128) clients. Twenty-eight percent (28%) of the HIV Foundation - Hilo's clients are homeless, multiply diagnosed, drug misusers and/or mentally ill. Eighty-six percent (86%) fall unto two or more special population categories as defined by the federal Ryan �/%Ihite CARE Act Title 11. Addressing clients' HIV and AIDS needs often begins and ends in completely different arenas. HIHAF's care team negotiates and juggles relationships ,nJth clients and their families, social service agencies, and state and federal agencies and programs. They reach across Hawaii and into other states to build relationships with other AIDS service organizations to find medical and benefits records, and to establish client histories and needs. They are active in statewide and nationwide care coalitions to enable us to bring the latests and most ul to date information and treatment to our clients. A recent example deals with a client living with AIDS and Hepatitis C. Up 1.,intil this year he was able to work on a part time basis and care for himself with -a complicated medical regime. In June, 2009, he was laid off from his job. 'I,' he result was that he lost his medical insurance, did not have sufficient resour( to pay his rent, and was unable to access medical care and medicine which are critical to maintaining his life. He quite quickly became homelss and was (:k:reply ashamed and afraid. We were finally able to make contact with him and hl ;Iped him to put his life back together. Due to his lack of income and medical insurance we were able to sign him up for a State program which provided him with his medication. He was able to see the physician, at no cost, from the NONPROFII'GRANT APPLICATION FISCAL YEAR 2011-12 Pate 4 Clinical Trials who comes to Hilo once a month. He qualified for a HUD hoi,,rsing program and was able to find affordable housing. As the result of this coml effort his health stabilized, he feels safe, and he began looking for anotherjl: :)b. While he has not been able to find employment in this difficult economic downturn, he is at least willing and able to try. Without our assistance, and the various programs we were able to coordinate for him, he would have most probably died in a very short period of time. Due to the complex nature of treating HIV, HIHAF advocates will continue ID work with as many doctors and care providers in the area as possible. Maintaining strong relationships with professionals and agencies that serve a myriad of social and other needs is only one small part of our advocates' jo h s. Our care teams' holistic care for and dedication to working with all our clierld needs is driven by HIHAF's mission of serving people who are living with HIV to have the fullest most complete life possible. For many people, living with HIV and the financial and logistic difficulties oil' managing their disease is very difficult at best. Their lives are further complicated by fear and stigma. Several of our older female, Hawaiian clk:mts feel that HIHAF is the only safe place for them to let down their barriers, spic�ak of their fear for themselves and their families, and discuss how this disease arld their possible death will affect them. In the safety of our facility, they can stow the depth of their feelings, they can find necessary, life-saving, and diseasc..­ monitoring clinical care and life saving HIV drugs. They also find a should :Ir to lean on and resources for themselves and their families. Over the holidays our entire organization again rallied to make sure that each and every client and family had the resources to have a wonderful meal for (both Thanksgiving and Christmas and that each child had at least one gift for Christmas. We were assisted in this effort by the Toys for Tots program a:; well as the MCC Church in Pahoa and a tiny congregation in Puako. We were extremely fortunate and were able to truly share the intent of these holidays with our less fortunate clients. Holidays are sometimes very difficult for those v, are ill or isolated from their community and family. Our Care team members spent a substantial amount of time calling all clients to ensure they were d( well and determining if there was anything further we could do to assist thorn. Individuals with mental health issues are at a greater risk of acquiring and transmitting HIV. Many of our clients have mental health problems which complicates their ability to care for themselves and take their medications properly. There are very few psycholigists on the Big Island who have experience with people with HIV. We have initiated monthly visits by such a qualified individual to provide therapy to our most affected clients. This psychologist practices and lives in Honolulu so it is necessary for him to cane to the Big Island twice each month to see our clients. The benefit is that our most affected individuals have adequate mental health care and the more stabk,� they become the less chance that they will pass on this disease to others. We <:Ire very proud of this program and have seen the difference it has made in th;:.� lives of our clients with serious mental illness. NONPROFIT GRANT APPLICATION FISCAL YEAR 201112 Pate 5 Another substantial challenge for our care team is to adapt to the new federal prescription drug plan legislation (Medicare D). This program while on the surface is designed to help those in need of medication help, it also greatly complicates accessing necessary medicines through multiple layers of com eligibility criteria, and constant changes to plan structures. In order to enable clients to acquire their medications at the lowest possibIc! cost through this new plan, care team members must understand the client's current income and drug coverage plan, know what drugs the client needs and whk plans cover it. They must have knowledge of the client's other medical neo understand which pharmacies will accept which drug coverage program, and have an understanding of HIV and other pharmaceuticals to compare pricing. This year many of the companies offering Medicare D moved the drugs necessary for the treatment of HIV to the highest, most costly level. The irripact of that change put a significant number of clients into the "donut hole" within 2 months. Our Hawaii Drug Assistance Program for HIV is funded by federal IRyan White Funding. Because of this change, more and more individuals will ml:eve into the HDAP program leaving less of these federal funds for other areas of need. As the number of clients continues to grow, the burden on our care team to provide adequate care also grows. Many of our clients face multiple health issues and need medications to suppress HIV, need other drugs to address:,, side effects of HIV drugs, and need additional drugs to treat opportunistic infec6 related to HIV. Most clients who are taking medications, take from 6 to 10 11rugs daily or multiple times a day. HIHAF's care team members are compassionate and talented. For them, treating someone's HIV encompasses the entire person - not just the disease. For our clients, many who live with fear and stigma, who deal with other medical and social issues, and face declining access to medical services in Hawai'i, HIHAF is the only place to come for support. HIHAF's care team members are often the only people that HIV positive individuals on this island know and trust. They are sensitive professionals who navigate the complications that HIV Lirings to the body and soul. In order to best serve the needs of our clients, a written service plan is dev,- :loped cooperatively by the client and the care team annually. The service plan identifies client needs, defines the specific goals and objectives that address identified needs, and lists the action steps required to accomplish the client's stated goals and objectives. The service plan is developed and implement(-A within two weeks following the intake of a new client and then updated quarterly or more frequently, if necessary, until the client is discharged. In addition to service plan updates, clients are contacted at least once a month to monitor their health status and identify emerging needs. Acute clients in need of more frequent contact can receive telephone calls and/ or office or home visits tl to four times per week. A minimum of one hundred and sixty (160) service pk:ms NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-12 Pate 6 will be developed or revised during the upcoming FY 2011-2012 grant pericid in the East Hawaii office. A similar amount will be completed in the West Ha%%+ aii office. To ensure appropriate access the Foundation's hours of operation are Mom through Friday, 8:00 a.m. to 4:00 p.m. Staff frequently visit clients in their h - Jmes, at the hospital, during their monthly physician's visits and outside of both home and office, if that is what is necessary to help clients engage in their own care. The Client Service Facilitator is responsible solely for the delivery of the folk wing support services: food acquisition for the food pantry, food deliveries, transportation, volunteers, and clerical support. In 2009 the Foundation cn':�ated a new position: Director of Programming. This individual provides prograrri administrative oversight and program supervision for care staff. She also produces quarterly reports for all funders, job counseling, staff training, and Crisis intervention. This individual works directly with the care teams and is SUPE!I'Vised by the Executive Director. Volunteers assist clients with online searches, distribution of food, clerical assistance, and helping clients shop in the food pantry. HIHAF provides invaluable support to HIV-infected individuals to assist there in keeping their loved ones free of HIV. Primary HIV prevention is based upon a culturally appropriate harm reduction methodology. When a new client begins their relationship with HIHAF, we take care to assess their current relational - lips and activities they may participate in that might put others at risk for HIV infection. Care team members either provide such interventions themselvc!s or make referrals to the HIV Foundation - Hilo's prevention department. Care [.earn members also offer anonymous HIV-antibody counseling and testing for family members and significant others. QUANTITATIVE EVALUATION: Quantitative evaluation measures for multi-disciplinary team case manageri services include the collection, tabulation and entry of service data into a computer tracking system provided by the State of Hawaii (E-2). Data routinely tracked include: number of clients, types of service provided, and the nurril5er of services provided by service category as well as the costs for these servic,ns. Planning estimations for service delivery during the FY2011-2012 currently project that a total of twenty-six (26) separate case management services %vill be individually provided to a minimum of 160 clients living with HIV/AIDS. Ser include, but are not limited to: intake, assessment, treatment advocacy, mortality and morbidity tracking, benefits counseling, volunteer referrals, hospital an home visits, medical liaison, crisis intervention, emergency financial assisti:),nce, housing assistance, home care and transportation. Data collection consists of counting the number of written service plans that are developed and/or revised each quarter. Computer reports indicating nurnt'ier and kinds of services delivered by each case manager are generated on a monthly basis. If projections are met or exceeded, service delivery is considered NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-12 Page 7 successful, The service component is also considered successful if ninety percent (90%) of clients have a medical care provider and adhere to their treatment routine resulting in stable health, QUALITATIVE ANALYSIS: A client satisfaction survey is mailed to all clients annually. Completed surveys are returned anonymously. Tallied survey results are distributed to HIHAF` s Board of Directors, staff, clients and state and federal granting organization,.:,. Executive Director and/or board members may, on an unannounced basis, rneel with clients to discuss their satisfaction with services. The Foundation has three client representatives on the Board to bring forward issues specific to client::', needs and desires, CHANGES FOR 2011 The economic downturn continues and has resulted in the loss of employrn of a significant number of clients a decrease of income for many others. Vark')US support programs have closed during the last year which is putting more and more stress on programs, such as ours, to pick up the slack. One of the rnajor programs that support our clients is the State of Hawaii Drug Assistance Pr which initiated a waiting list which extended for approximately 6 months. It has been reinstated, but we have been informed, that it is probable that unless rnore funding is found, this program will again initiate a waiting list later this year. To the best of our ability we are meeting those needs, but not all. Our gral oversight committee is looking carefully at each and every request and foci-ising on those items which make the greatest difference, i.e., requests for media :Il care, medicine, housing and food. This year dental care was not offerred (Jue to a lack of funding. In all cases, every possible funding source for client care is being pursued. HIHAFcontinued with cost cutting activities during the past year in respons,(:]! to the declining economy and in anticipation of funding decreases. Each staff member has taken on more work without the anticipation of additional finaric'ial reward, they have done so cheerfully and with a level of commitment that i�:' astounding. We and our clients are fortunate to have such a talented and committed group of people who have put others above themselves. No n&,✓ employees were hired, no raises given and the Executive Director voluntarily took a 10% decrease in salary. We were able to negotiate a lease renewal for our Hilo office which is well [ the average price in the community. The Kona office lease is presently being renegotiated with the goal of keeping our rental costs as low as possible. Our Board of Directors has also made an even greater commitment to this Foundation. They are giving more of their time and talent to make sure th; 'it we weather this difficult time and grow as an organization at the same time. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-12 Pat 8 Total Budget and Position Count Total P rogram Budget _ 356,40 unt i Total ram Position Co 3.0 - 1:i 'r Total Aaencv Budget 935,679 1 Total Aaencv Position Count F1 4 Program Objectives: 1) Objective One: By July 30, 201 and within twenty-five (25) days following a determination of need, identify and secure appropriate firlancial resources to pay health insurance premiums for no less than ninety percent (90%) of all PLWHA whose access to high quality primary cAre, ancillary health care and specialty medical care would otherwise be in jeopardy. 2) Objective Two: By July 30, 2011 and within twenty-five days followiri(.�i a determination of need, assist no less than ninety percent (90%) of all eligible PLWHA who request or demonstrate a need for substance rriisuse treatment, mental health counseling, HIV-related medication, and fo ) and to obtain such goods and services through appropriate referrals and practical support. 3) Objective Three By July 30, 2011 and within twenty-five days follo\+vJng a determination of need, forestall homelessness by providing financial support and/or housing relocation assistance for no less than ninety percent (90%) of all eligible PLWHA requesting or demonstrating a rleecl for emergency shelter, or either short-term or long-term shelter or housing assistance. 4) In addition,HIV Foundation - Hilo shall provide the types and levels ;:)f case management related supportive services for its consumers, listed below: Benefits assessment/counseling Client family counseling Progressive case notes Crisis intervention Health care assessment/counseling Field /office visits Medical treatment referrals Home visits Housing assessments Intake/assessments Legal document assistance Financial benefits Funeral/estate coordination Generic assistance/counseling Housing assistance Health care benefits Legal advocacy assistance Client monitoring/assessment NONPROFIT GRANT APPLICATION FISCAI, YEAR 2011-12 Pape 9 Nutritional assessment/counseling Risk assessment/counseling Mental health assessment /counseling Service coordination Mental health counseling referrals Transport activities Substance abuse assessment Substance abuse treatment referrals (as available) Total number of service categories: 26 Timeline: Service plans are developed within two weeks of tt`v initial intake session and reviewed quarterly. Service delivery will be on- going during FY 2011 -2012. The services listed above represent baseline service projections. Client- centered Outcome(s): A mimimum of onq : hundred sixty (160) clients and their families will access critical servk: es including medical, financial, social, care givers, legal, nutritional, etc . through the HIV Foundation - Hilo's case management and volunteE:r team. At least ninety percent (90%) of clients will secure a primary i : :, ire physician and remain in medical treatment. Program Highlights: (from Fiscal Year 200910) 1) During FY 2009 -2010, medical case management services included) one hundred ninety eight (193) clients who received medical assessment:, patient education, treatment advice, nutrition, medical liaison, dental liaison. 2) As of December 2010, all clients are receiving the highest gw1lity primary medical care; however, 20% are receiving care through public health clinics, which at times cannot meet all their needs. 3) We have maintained all individuals previously on the housing program and added more as funding became available. We presently have a waiting list of 7. 4) The number of hospital visits during this fiscal year remained ; approximately 1 -2 per month. We presently have 2 clients with end - ::stage cancer. 5) Addition of the Director of Programming has created a smooth, more seamless experience for all clients and better support for staff. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Pate 10 EMS& WN MU LTI-DISCI PLI NARY HIV CASE MANAGEMENT, H11 0- Program Name Performance Measures: *if applicable Program Expenditures FY 2009-10 FY 2010-11 FY 20"11-12 Actual * Budget_* Est ' innate # and types of case management 26 26 JZ 15,000 services provided 2480 3,000 3,000 # of clients receiving case 170 190 170.190 many gement_services 0 0 0 Risk behavior 250 250 2!515 assessment,transmission — -------- -- 371,832 370,480 13!:i6,408 _prevention education HIV counseling & testinq - ---- ------- 25 -- ----- - -- - --- - 25 ----- ------ *if applicable Program Expenditures If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-12 Pate 11 FY 2009-10 FY 2010-11 FY 201'11.12 Actual * Budget_* Estimzt Salaries and Wa 168,426 145 JZ 15,000 Professional Fees 2480 3,000 3,000 O perations 126,926 158,616 1 Equipment 0 0 0 Other" 74,000 63,864 63,864 Total — -------- -- 371,832 370,480 13!:i6,408 If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-12 Pate 11 N HAWAII ISLAND HIV/AIDS FOUNDATION - Agency Neirne MULTI- DISCI PLINARY HIV CASE MANAGEMENT, H11'...0 - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009010 FY 201 FY 20 -1 2 Actual * _P"d f t_� Estirniate Count of Hawaii 15,000 15,000 '115,000 _jDept oj Health -State of H 192,808 192,808 _V]12,808 AIDS Cornm_6nity Care Team 74,000 63,864 __(a3,863 HIUW-18 mo grant 17,000 15,000 unk HUD SPNS housing grant 15,000 15,000 15,000 Private Foundations - estimate 15,000 15,000 unk Donation /Fund 25,000 30,000 35,000 est Total 353,808 346,672 3: *If applicable, Explain what plans, if any, your agency and/or program has to increw.e revenues to support this program. When do you anticipate your program to become self-sustaining? Unfortunately, the HIV/AIDS epidemic shows no sign of ending, and indewl continues to grow. There is often a misrepresentation of facts about the epidemic in the media, indicating a lessening of urgency in dealing with this epidemic. The fact is, there are still a minimum of 65,000 new cases in thC! US each year, and half of these new infections occur through heterosexual transmission and in the age group of 15-23 year-olds. Each newly infected individual presents with a myriad of challenges to be met and overcome. Because the epidemic continues to grow, we do not see a specific point at vivhich our program might become self-sustaining. We continue looking at develo[')ment of various income producing businesses which could help to support the a of our non-profit. We continue seeking colloborators for various aspects of our program, i.e., housing, food, etc. which would help maximize funding for N parties and benefit the community at large. NON PROFIT GRANT APPLICATION FISCAL YEAR 2011-12 Pap-c 12 We have received level or decreasing funding from our main revenue souri:';e, the State of Hawaii Department of Health, for the last 16 years. During this time, the number of people we are caring for has almost tripled. At present rates of infection the number of people seeking services may increase an additional 50% over the next 10 years. The costs for personnel, health insurance, rent, utiJ ties, etc. have risen dramatically over the past few years and no funder seems - k) recognize the kind of stress this creates for the non-profit sector. We are endeavoring to be creative in our approach but the reality is that many organizations may be stretched to the point that they cannot continue. As the only AIDS Service Organization on the Big Island this would be devastatin to those living with HIV/AIDS here. An additional stressor is that our clients live longer now because of the availability of new drug treatments. This is wonderful in that it allows thoSC who are infected to live longer. Simultaneously, it also raises challenges for us ,:!is a Foundation to continue to support their health so that they can live and hop ofully be productive. Few, however, are well enough to work full time and thus their income level puts them into a position of continuing to need our services. We are very grateful that we have this support from the County, and we warit to thank you for this opportunity to apply to you for funding. We will do everyti possible to maximize the use of County funds, if awarded. Note to Program Expenditures: Other: these funds go directly to pay for medicine, medical care, housing, etc. for our clients and are pass through ( No funds are provided for overhead of any kind. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-12 Page 13 IN I Signature of Board President/Chair I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2-135 — 2-142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organization,:,. I (we) hereby certify that information supplied herein including all SUpportin(,j documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand andij comply with the requirement to submit a year-end report to the Count,V Council within 60 _days after June 30 of the fiscal Lear. The report sh,nll include an explanation of the public benefits derived from the awardirig of the grant, a complete accounting of all expenditures supported by Ccou_nty of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete. and accurate vear-end report will impact the evaluation of your pLo_qram`s ;,j3r agency's future funding reguests. Date V 6 ��� Signature n utive 4 Dire or Date NONPROFIT GRANT APPLICATION FISCAL YEAR 2011-12 Paae 14 M Hawaii Island HIV /AIDS Foundation Transmission Prevention for HIV+ Women in West Hawaii HAWAII ISLAND HIV /AIDS FOUNDATION- Agency Name TRANSMISSION PREVENTION FOR HIV+ WOMEN IN WEST HAWAII- Program Name Agency Director: Georgie Kennedy 8177 Contact Person: same Phone No.: Mailing Address: 75 -240 Nani Kailua Drive, Suite 5 Kailua Kona, HI 96740 Facility /Site Address: same Fax No.: 331 -0762 Email Address: georgie @hihaf.org Phone No.: 331- Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates for fy ending 6/30/10 Phone No.: 968 -1002 Mailing Address: P O Box 4372, Hilo, HI 96720 Amount of Request for County Funds: $15,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $15,000 $15,000 $15,000 Agency Mission Statement: The Hawaii Island HIV /AIDS Foundation is a non - profit organization dedicated to assisting those affected by HIV /AIDS to maximize their quality of life, and to NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 ending the spread of HIV. We also utilize the lessons learned in the HIV epidemic to care and advocate for others in the fight against related diseases. Our vision is to build a healthier, stronger, and more sustainable community that supports all its members with a focus on HIV issues. We are an IRS - designated 501(c)(3) tax - exempt non - profit organization that provides care services for People Living With HIV /AIDS (PLWHA), and provides HIV prevention and education to the residents of Hawai'i County. HIHAF has been providing services to people at risk for, infected with, and affected by HIV /AIDS, since 1986. Our Foundation has an efficient and effective system to provide a comprehensive continuum of prevention, care, and support services with regard to HIV /AIDS to the entire Big Island. We refer to the Kona office as "HIV Foundation - Kona ". As reported by the Hawaii State Department of Health, Hawai'i County has the 2 nd highest number of AIDS cases in the state. The number of people with HIV /AIDS climbs steadily upward every year of the epidemic. In the US alone, there are 65,000 new cases of HIV every year. Currently, we know that half of all these new infections occur through heterosexual transmission, putting women at a very high risk of HIV infection. The proportion of cases diagnosed in women has been increasing steadily over time, and we have little reason to believe it will decrease anytime soon. This is a distressing increase in infection among women. The female population in other US and global communities continue to bear the brunt of new HIV infections. Women's rights are often compromised within relationships and, due to gender imbalances within relationships, women continue to be more vulnerable to HIV infection than men. Our Foundation believes in upholding a strong focus on prevention programming, and specifically targeting women and populations vulnerable to HIV infection. Through working with HIV - positive women and addressing their behaviors and empowering them through education and prevention activities, we continue working towards stopping the spread of HIV and AIDS. Without aggressive prevention intervention many more individuals in our community will become infected by the actions of a single individual. We are also actively involved with the most vunerable members of society such as the young women who are being treated at the Big Island Substance Abuse Council. These young women have already been exposed to risky behavior by their drug use. In addition many of them have low self esteem, little or no education, and see themselves as worthless. By working with these young women, getting them tested for HIV and other sexually transmitted diseases, and showing them their worth, we can break the cycle of drug use, casual sex, and destructive behavior. We continue to experience flat funding from the Centers for Disease Control through the State of Hawaii Department of Health allocated to HIV /AIDS prevention services on all islands. This is reflected in our Program Expenditures NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 and Program Funding Sources tables. Notwithstanding these challenges we continue to do our very best to reach as many women as possible and provide them with high quality services. Our committed prevention staff is representative of the women we serve and are a great example to the participants of what they can become if they make the right choices. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 HAWAII ISLAND HIV /AIDS FOUNDATION - Agency Name TRANSMISSION PREVENTION FOR HIV+ WOMEN IN WEST HAWAII- Program Name Program Description: The Hawai'i Island HIV /AIDS Foundation - Kona is proposing to continue funding for the HIV transmission prevention programs for all HIV+ women in West Hawai'i County, including individual and group protocols and counseling and testing of women at risk. This program is designed to STOP HIV at the source, with individuals who can transmit the disease to others. The program also provides early treatment for newly diagnosed HIV positive women, maintenance of stable health and well being for all HIV+ women in West Hawai'i County, long term planning for health maintenance, and transmission prevention interactions. In the past year we have located through outreach, the SISTA Program, and referrals, 5 new HIV+ women in the community, one of them being in her last month of pregnancy when diagnosed. None of them was aware of their status and each presented with significant health and living problems which put them at risk of transmitting the disease to others, Through the concerted efforts of the prevention and care staff of this Foundation, each of these women has received medical care, stabilization of their health and in addition, as needed, mental health, drug treatment, housing assistance, and many other services. At all times during this process, each of the women had on- going counseling on transmission prevention. To date, we have had no reports from them or the community of risky behavior or transmission of HIV by any of these women. Our on -going SISTA Program, "Sisters Informing Sisters about Topics on AIDS" continues to be the cornerstone of reaching at risk women who may already be HIV+ and unaware of their status. This program is directed to low income women at high risk for infection and transmission of HIV. Many of them already suffer from illegal drug use, abusive partners, domestic violence, sexual abuse, poverty, and lack of minimal medical care. This program is an in -depth behavioral change program. Our Women's Outreach Specialist leads this social skills, health promotion, training intervention, aimed at reducing HIV sexual risk behavior among low income minority women who are at highest risk for HIV and other sexually transmitted diseases. The program consists of five once -a -week two -hour sessions, and includes a sixth, "booster" session one month after the women graduate at the fifth session. Most of the women participating are reached through outreach or referred to the program from other local agencies and organizations serving women and families in the community. To date, all the SISTA programs have been extremely well received, with very positive feedback NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 for the program, the facilitator, as well as HIHAF for offering such a comprehensive culturally appropriate program. We include the SISTA Project in this application because it is instrumental in helping us reach women who may already be HIV positive. It allows them to get tested, and if positive, into care services immediately. This program has been developed by the U.S. Centers for Disease Control and Prevention and has been found to be one of the most effective for minority women. We tailor each intervention to be appropriate to the woman we are working with. It is a harm reduction non - judgmental approach that meets women "where they are ", not "where we want them to be" in terms of their behavior. The end result is the empowerment of women by giving them the tools and the ability to direct their lives and health. QUANTITATIVE EVALUATION: Quantitative evaluation measures for this program includes the collection, tabulation and entry of participant data into a computer tracking system provided by the Centers for Disease Control (PEMS). Data routinely tracked include: number of clients, ethnicity, social status, risk categories, type of intervention, number of interventions, outcome information during program and additional follow up 30 and 60 days after completion of program. Planning estimations for interventions and programing for women FY2011 -2012 are as follows: SISTA a minimum of one hundred women (100) will participate in at least five (5) sessions and two (2) follow up sessions.For HIV+ women: a minimum of thirty five (35) women will have assessment sessions, quarterly reviews and quarterly individual prevention sessions. QUALITATIVE ANALYSIS: Data is gathered during outreach and individulized one on one sessions with all participants. For HIV+ women a prevention plan is developed and monitored on a monthly basis to assist the woman at the initial stages of dealing with her new status as HIV +. Later these sessions may be quarterly as she develops the skills necessary to protect herself and her partners. Participants in the SISTA program fill out a pre -test at the beginning of the program. They also fill out knowledge level questionnaires at the end of each session. A final post test is administered to determine level of knowledge, increase or decrease in self awareness of actions, consistency of condom use, level of negotiation skills, etc. A participant satisfaction survey is also administered to determine the efficacy of the presenter, the material, the setting, etc. All of the above data is reported quarterly to the Centers for Disease Control and the Dept. of Health of the State of Hawaii. Additional data is kept on the number of HIV tests administered, as well as Hepatitis C screenings along with the results each month. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 All the above information is also provided to the Board of Directors, staff, and other interested parties to help us improve the quality of our prevention programs. CHANGES FOR 2011: HIHAFcontinued with cost cutting activities during the past year in response to the declining economy and in anticipation of funding and donation decreases. Each staff member has taken on more work without the anticipation of additional financial reward. They have done so cheerfully and with a level of commitment that is astounding. We and our clients are fortunate to have such a talented and committed group of people who have put others before themselves. In addition, we were able to negotiate a lease renewal for our Hilo office which is well below the average price in the community. The Kona office lease is presently being renegotiated. Our Board of Directors has also made an even greater commitment to this Foundation. They are giving more of their time and talent to make sure that we weather this difficult time and grow as an organization at the same time. Total Budget and Position Count Total Program Budget 60,000 Total Program Position Count 1.5 Total Agency Bud et 935,679 Total Agency Position Count 14 Program Objectives: 1) Review each HIV+ woman's transmission prevention service plan in first month of program, and /or initiate new transmission prevention plan for newly infected women. (Estimated 35 women, 1 -2 hours per client.) 2) Refer women to appropriate providers if needed, i.e. mental health providers, substance abuse treatment, etc. within the first month. These providers can deal with some of the behaviors which place these women at risk of transmitting this disease. These professional counseling sessions are paid for by other funding sources. 3) Initiate transmission prevention protocol (estimated 35 clients, 1 hour each) immediately. Reinforce at each meeting until client is stable. Quarterly thereafter or as problems arise. 4) Document progress and adherence to transmission prevention protocol with input from client quarterly (35) 5) Weekly /Monthly /quarterly support for HIV+ women dealing with self - esteem, negotiation, sexual issues, transmission prevention as needed by individual client. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 6) Referral to other women who may be at risk of contracting or transmitting HIV to others by program participants. Referral to result in HIV counseling and testing by prevention outreach staff and screening for participation in the SISTA program if appropriate. 7) Continuation of SISTA program including 5 -2 hour sessions and 1- booster session for a minimum of 100 at risk women in Hawaii County. Program Highlights: (from Fiscal Year 2009 -10) 1) Achieved a review of care prevention service plans for thirty five (35) women during first half of funding year 2009 -2010. 2) Referred women to specialized care for health and /or prevention issues during first half of the funding year. 3) Reviewed and updated health and prevention plans for all participants quarterly. Five new female intakes, one pregnant, had more intensive interventions 4) Initiated in -depth transmission protocols with all participants, and met with each participant on a one -to -one basis quarterly. 5) More than seventy -five (75 %) percent of HIV+ women and participants in the Sista program have reported 100% compliance with prevention protocols by fourth session (i.e., use of condoms or other protection during all sexual encounters.) 6) Twenty -five (25 %) percent of participants have reported compliance 80% of the time to date, with the goal of 100% compliance by the end of the year. 7) Ninety (90 %) percent of participants are documented to have benefited from the program by maintenance of good health, increased self- esteem, and ability to interact with sexual partners in a safe manner, thereby decreasing the possibility of sexual transmission. 8) As of December 2010, zero transmission of HIV by any participants in either program. Stable health reported by all HIV+ participants as a partial result of this program. 9) A total of 65 women of unknown HIV infection status have participated in the SISTA Project training sessions as of December, 2010. 10) On going associations and collaborations with Alternatives to Violence, the Women's Shelter, Big Island Substance Abuse Council, Neighborhood Place, the day shelter, and various other programs that provide services to women in our community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 HAWAII ISLAND HIV /AIDS FOUNDATION - Agency Name TRANSMISSION PREVENTION FOR HIV+ WOMEN IN WEST HAWAII - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate HIV+ individual transmission p revention session assessment 65 60 60 Health Prevention plan review q uarterl y 65 60 60 Quarterly individual transmision p revention sessions 1 hr each 90 85 90 Review and documentation of p rogram quarterl 90 85 90 SISTA program participation 65 70 -100 70 -100 Total 60,0001 60,0001 60,000 *If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 35,000 35,000 35,000 Professional Fees 0 0 0 Operations 25,000 25,000 25,000 Equipment 0 0 0 Other" 0 0 0 Total 60,0001 60,0001 60,000 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 HAWAII ISLAND HIV /AIDS FOUNDATION - Agency Name TRANSMISSION PREVENTION FOR HIV+ WOMEN IN WEST HAWAII - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate County of Hawaii 15,000 15,000 15,000 Dept of Health -CDC 33% women only 1/2 for Kona 16,903 17,750 17,750 HIUW 5,000 5,000 15,000 Foundations 3,000 5,000 7,000 Fundraising 5,000 5,000 5,000 Total 44,903 47,750 59,750 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Unfortunately, the HIV /AIDS epidemic shows no sign of ending, and indeed continues to grow. There is often a misrepresentation of facts about the epidemic in the media, indicating a lessening of urgency in dealing with this currently incurable disease. The fact is, there are still a minimum of 65,000 new cases in the US each year, and half of these new infections occur through heterosexual transmission with the highest rates in the age group of 15 -23 year - olds. Each newly infected individual presents with a myriad of challenges to be met and overcome. Because the epidemic continues to grow, we do not see a specific point at which our program might become self- sustaining. We continue looking at development of various income producing businesses which could help to support the activities of our non - profit. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 We continue seeking colloborators for various aspects of our program, i.e., working with the schools to present programming through existing health education requirements. Our hope would be if we can educate young people early enough, the need for this kind of programming for adults could be diminished. Early prevention has proven to benefit the individual and the community at large. One area that we feel is critically important is working with our youth - especially those 15 -25 years of age. This group has had no consistent programming dealing honestly with sexually transmitted disease prevention. The result is that this group, on the mainland, is experiencing new infection rates that are almost epidemic. We are committed to working with this group, and have done so for the past six years. The first four years this program was small and fully funded with fundraising. During the past two years the County has assisted us thereby allowing us to reach many more of our young people. We need help in advocating to the Centers for Disease Control and the State of Hawaii Department of Health in making our youth a priority. We have received level or decreasing funding from our main revenue source, the Centers for Disease Control through the State of Hawai'i Department of Health, for the last 16 years. During this time, the number of new infections has tripled and changed from predominently homosexuals to hetrosexuals. At present rates of infection the number of people seeking services may increase an additional 50% over the next 10 years. The costs for personnel, health insurance, rent, utilities, etc have risen dramatically over the past few years and creates greater stress on the non - profit sector and the people we serve. We are endeavoring to be creative in our approach but the reality is that many organizations may be stretched to the point that they cannot continue. As the only AIDS Service Organization on the Big Island this would be devastating to the community. It has been conclusively determined that communities without consistent dynamic prevention programs have seen a faster and higher rate of HIV infection than those with programming. We are very grateful for the support provided by the County in the past. We recognize the economic realities being experienced by our own County and are not requesting an increase in funding. We are all prepared to work even harder to stretch our funds to serve as many people as possible. We further wish to thank you for this opportunity to apply to you for funding. We will do everything possible to maximize the use of County funds, if awarded. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 10 HAWAII ISLAND HIV /AIDS FOUNDATION - Agency Name TRANSMISSION PREVENTION FOR HIV+ WOMEN IN WEST HAWAII - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. V Z -7 1 11 Signature of Board Pres' ent/Chair Date I d 7 11r Signature of xecutive irector Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 11 47 Hawaii Island Workforce & Economic Development Ohana (HIWEDO) Going Home Hawaii Island Workforce and Economic Development Ohana (Agency Name) Going Home (Program Name) Agency Director: Sandra Sakaguchi Phone: (808) 959 -6200 Contact Name: Lezlie Padaken Phone: (808) 959 -6200 Mailing Address: 1990 Kinoole Street, Suite 102 Hilo, HI 96720 Fax No.: (808) 959 -6300 Email Address: Name of Accountant/CPA: Phone No.: Mailing Address: hiwedo.director @gmail.com Clyde T. Oshiro, CPA (808) 935 -0885 319 Kinoole Street, Hilo, HI 96720 Amount of Request for County Funds: $25,000 Prior Year(s) Funding: 08.09 09.10 10.11 n/a $15,000 $20,000 Agency Mission Statement: The Hawaii Island Workforce and Economic Development Ohana ( HIWEDO) is a private non -profit established in 2005. The organization's purpose is to facilitate the establishment of a workforce development system for the County of Hawaii that will respond proactively to the divergent employment and training needs of the County by building community collaboration and by expanding financial resources. HIWEDO bridges economic development and workforce development through collaboration with government and private agencies and businesses to develop long term plans, directives and solutions for employment and training to meet the needs of Hawaii County. HIWEDO promotes responsiveness, flexibility, and accessibility in all initiatives. Program Description: The Going Home Consortium is a community -based group of non - profit service providers, government agencies, faith -based groups, businesses, volunteers and formerly incarcerated persons that collaborate to assist Hawaii Island men and women released from correctional institutions with reintegration into community life through employment, training and appropriate supportive services. The significance of Going Home is that without effective supports in the community, offenders are highly likely to commit new crimes. This creates new victims, strains an already overburdened criminal justice system, and hurts family and loved ones. The initiative began in August 2004 under the Hawaii County Mayor's Task Force on Employment Solutions as one of the projects designed to train and prepare the under - utilized segments of the population for employment in the Big Island's workforce. However, with the ex- offender population, employment and training are not stand -alone issues. Rather, a comprehensive approach was needed to address the complex needs and challenges of this population. Through its collaborative structure and working committees, the Going Home Consortium addresses such issues as housing, family reunification, health and wellness and barriers to employment. The Consortium helps develop support networks and builds referral processes to community resources. Since 2008 HIWEDO has provided Going Home with an organizational base of operations, and provides the administrative and fiscal management structure. Going Home has grown from infancy into a broad community effort. The strength of Going Home is the synergy that is created through the cooperative efforts of nearly 40 agencies and organizations, and the partnership with NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Hawai'i Island Workforce and Economic Development Ohana (Agency Name) Going Home (Program Name) government. The Consortium approach provides facilitation, collaboration, community - building, research and support to the organizations involved. Through its strategic planning process, Going Home recognized the need to expand the Consortium and its referral processes to include more organizations specializing in areas of mental health, Hawaiian culture, and family /children services. Additionally, the Consortium is determined to address the necessity of reaching those in need in all parts of the Big Island. For example, in West Hawaii, there is a need to connect with organizations specializing in housing, transportation and substance abuse counseling. Further, the Consortium continues to seek ways to improve the programs and services offered to Big Island offenders. Utilizing its Education and Training Committee, Going Home has created a training model for former offenders that include the delivery of short-term training modules with the emphasis on building skills and /or obtaining credentials that are needed in many occupations. (eg OSHA safety, forklift certification) Total Budget and Position Count Total Program Budget $85,000 Total Pro ram Position Count 1 Total Agency Budget $242,000 1 Total Agency Position Count 4 Program objectives: Going Home (1) Program Operation and Oversight: Provide staff to manage the program on a daily basis, and oversee the development of Objectives 2 -6 below. (2) Coordination of the Going Home Consortium Efforts: Continue the community -based work, support the activities of the committees, promote collaboration, build the employer support network and expand resource development. (3) Expand the Going Home network and improve referral processes to agencies island -wide. (4) Develop a website of community resources. Going Home previously developed and distributed a printed resource directory of agencies that provide support services needed by the ex- offender population. This needs to be updated and developed as an on -line resource. HIWEDO has developed and is currently updating a website for Going Home, which will house the resource directory. (5) Deliver short-term employment skills training classes in both East and West Hawaii. Deliver training modules that include skill sets that are essential in many occupations. (6) Educate Consortium service providers on labor market information and transferable occupational skills, abilities and knowledge. Program Highlights: 1) In partnership with the State Public Safety Department, initiated re -entry programs prior to release. Through Going Home's efforts, the Department of Public Safety received funds to construct an education and training center at the Hale Nani Correctional Facility. HIWEDO was able to secure initial funding for equipment and supplies from the Cooke Foundation and Walmart, as well as through the County non - profit grant process. Classes started at the facility in February 2009. Going Home assisted in the development of the re -entry program curriculum and several Going Home Consortium members deliver the courses. 2) Going Home completed a 5 -year Strategic Plan, with five broad goals: Strengthen and broaden the Going Home Consortium; Establish more effective ties with other organizations and the community; Expand employment and training programs; Establish an island -wide mentoring program; and Establish a data system that can track clients and performance measures that can monitor progress. 3) In October 2010 Going Home received a federal Bureau of Justice Second Chance Act grant to develop an island - wide mentoring program, linking offenders with a trained mentor immediately prior to release. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Hawaii Island Workforce and Economic Development Ohana (Agency Name) Going Home (Program Name) Performance Measures: Prnnram EYnenditures- FY 2009 -2010 FY 2010 -2011 FY 2011 -2012 Salaries and Wages Actual Budget Estimate Increase the number of 35 organizations 40 organizations 44 organizations organizations /agencies involved 20,600 14,600 15,250 with the Going Home Consortium 5,851 0 0 by 10% n/a 0 0 Deliver a half -day gathering in NA NA 40 people will attend, West Hawaii to expand the WH representing 20 network & promote collaboration agencies Develop an on -line resource Build the Going Home Unable to complete in Completion and directory listing organizations that website which will current year due to limited evaluation of the on -line provide services needed by the house the directory budget directory ex- offender population Develop and deliver a series of NA Classes in OSHA Classes delivered in Hilo short-term skills -based training certification and Forklift and Kona, and serving modules for ex- offenders certification delivered in 75 people Hilo and Kona (4 classes) serving 61 eo le Deliver a presentation to NA NA Presentation made at a Consortium service providers on Consortium meeting, labor market information and with 30 people attending transferable occupational skills, abilities and knowledge. Prnnram EYnenditures- Salaries and Wages: Program Coordinators' 1 FTE @ $45,000 per year + Fringe @ .25 = $56,250 Program Coordinator will work full -time with GH Consortium and consultants and work on outreach to implement project. Current funding will support parttime staff until 6/30/2011. Fringe benefits include unemployment insurance, FICA, Medicare, workers compensation, pension, employee benefits (health, dental, retirement, & leave). Professional Fees: 13,500. Consultant/Expert Ted Sakai, retired public safety directory; Instructors for training classes; Website development specialist. Operations: $15,250. Office supplies, classroom materials. Bookkeeper services which includes processing of payments, financial statements, taxes, audit and other processing or fiscal functions needed to implement. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 FY 2009 -10 Actual FY 2010 -11 Budget FY2011 -2012 Estimate Salaries and Wages 94,500 48,600 56,250 Professional Fees 7,200 11,800 13,500 Operations 20,600 14,600 15,250 Equipment 5,851 0 0 Other n/a 0 0 Total $128,151 $75,000 $85,000 Salaries and Wages: Program Coordinators' 1 FTE @ $45,000 per year + Fringe @ .25 = $56,250 Program Coordinator will work full -time with GH Consortium and consultants and work on outreach to implement project. Current funding will support parttime staff until 6/30/2011. Fringe benefits include unemployment insurance, FICA, Medicare, workers compensation, pension, employee benefits (health, dental, retirement, & leave). Professional Fees: 13,500. Consultant/Expert Ted Sakai, retired public safety directory; Instructors for training classes; Website development specialist. Operations: $15,250. Office supplies, classroom materials. Bookkeeper services which includes processing of payments, financial statements, taxes, audit and other processing or fiscal functions needed to implement. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Hawai'i Island Workforce and Economic Development Ohana (Agency Name) Going Home (Program Name) Pro ram Fundinq Sources: Revenue Source FY 2009 -10 Actual FY 2010 -11 Budget FY 2011.2012 Estimate Federal Reed Act funds end 10/31/10 108,151 35,000 n/a County Contract end 12/31/2010 5,000 7,000 n/a County Nonprofit grant 15,000 20,000 25,000 Federal: Second Chance Act administration costs n/a 10,000 15,000 Foundation grants, fund - raisers n/a 3,000 45,000 Total $128,151 $75,000 $85,000 Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Several of the objectives require only one -time or start -up funding, and will be sustained through the volunteer work of the Consortium organizations. HIWEDO will include the administrative and financial management support for sustaining Going Home in its fund development work. Through HIWEDO, Going Home will continue to pursue grant support to expand services and programs. I(we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2.142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I(we) hereby certify that information supplied herein including all supporting documents is correct and that I(we) have the authority and ability to fully administer the program(s) pursuant to law. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Hawai'i Island Workforce and Economic Development Ohana (Agency Name) Going Home (Program Name) I(we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I(we) understand and will comply with the requirement to submit a year -end report to the Legislative Auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete and accurate year-end report will impact the evaluation of your program's or agency's future funding requests. 2. Sig t e of and Presi a hair 6ate Michael Gleason �. X� ignature ottxecutia Director Date Sandra Sakaguchi UNSIGNED PROPOSALS WILL NOT BE ACCEPTED NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 H Hawaii Island Workforce & Economic Development Ohana (HIWEDO) Huiana Student Internship Program Hawaii Island Workforce and Economic Development Ohana (Agency Name) Huiana Student Internship Program(Program Name) Agency Director: Sandra Sakaguchi Phone: (808) 959 -6200 Contact Name: Lezlie Padaken Phone: (808) 959 -6200 Mailing Address: 1990 Kinoole Street, Suite 102 Hilo, HI 96720 Fax No.: (808) 959 -6300 Email Address: Name of Accountant/CPA: Phone No.: Mailing Address: hiwedo.director @gmail.com Clyde T. Oshiro, CPA (808) 935 -0885 319 Kinoole Street, Hilo, HI 96720 Amount of Request for County Funds: $25,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 n/a n/a $20,000 Agency Mission Statement: The Hawaii Island Workforce and Economic Development Ohana ( HIWEDO) is a private non - profit established in 2005. The organization's purpose is to facilitate the establishment of a workforce development system for the County of Hawaii that will respond proactively to the divergent employment and training needs of the County by building community collaboration and by expanding financial resources. HIWEDO bridges economic development and workforce development through collaboration with government and private agencies and businesses to develop long term plans, directives and solutions for employment and training to meet the needs of Hawaii County. HIWEDO promotes responsiveness, flexibility, and accessibility in all initiatives. Program Description: The Huiana Student Internship Program is an island -wide internship program that matches Hawaii Island high school students with business mentors. With the strategy to develop the workplace skills of our island youth and prepare the future workforce, students are placed in 60 -hour internships that are tied to their career pathway interests. The experience supports not only career exploration but also workplace skill development and affords students 0.5 credit toward graduation. Current internship positions are concentrated in the health services, public and human services (education, hospitality, law and social services), and industrial and engineering technology, but cover all DOE career pathways. The program enables students to reflect on and develop their work ethic, fulfills several requirements for the students' Personal Transition Plan (required for graduation) and fosters relevance in education. Internships are available during the school year (from November through April) and during the summer (from July to mid - July). The internships do not interfere with classroom time and it is expected that students will complete their internship hours after school, evenings and /or on weekends as the employer and student schedule allows. Over 90 businesses are in the pool of internship sites, but not all have placements at their sites each term. Roughly 45 -55 are participating each term. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Hawaii Island Workforce and Economic Development Ohana (Agency Name) Huiana Student Internship Program(Program Name) Key features of Huiana include: •A comprehensive application process where schools conduct a pre- screening and selection: -Students and parents must complete application forms. -Student must meet all program requirements, obtain two teacher recommendations and have no disciplinary referrals. -Student prepares a professional resume and cover letter -Students are coached in proper dress for job interviews and the workplace. •A Two -tier interview process -An interview panel conducts the pre - interviews and recommends a business match for the student. -Companies have the option to conduct a second interview with the student. Features of the program from the business perspective include: -Optional wages -Working with and training a potential future employee. -Gaining a better understanding of youth and youth culture. -Taking advantage of advanced technology skills of young people. -teaming /developing new supervisory skills. -Orienting young people to the mentor's profession. Business connect the students' school learning with work -based learning by assigning tasks that are consistent with the Department of Education General Learner Outcomes (GLOs) which are: • Self- directed leamer: the ability to be responsible for one's own learning. • Community Contributor: The understanding that it is essential for human beings to work together. • Complex Thinker: The ability to demonstrate critical thinking and problem solving. • Quality Producer: The ability to recognize and produce quality performance and quality products. • Effective Communicator: The ability to communicate effectively. • Effective & Ethical User of Technology: The ability to use a variety of technologies effectively and ethically. All company employees who work with the student must attend a mentor training session where they learn about the GLOs, how to assign appropriate tasks, program parameters, and techniques for working with youth. Mentors provide supervision and guidance for students at all times. The perceived value of the Huiana Internship Program is founded in the community-based support for student work - based learning. The effective partnership between the education system, the business community, government and the non - profit sector make Huiana greater than the sum of its parts. The DOE, HIWEDO, the business community and government (County offices, and the Dept of Labor's Workforce Development Division) effectively work together to make this program viable and meaningful to the students and their mentors. Total Budget and Position Count Total Pro ram Budget $89,250 Total Program Position Count 1 Total Agency Budget $242,000 Total Agency Position Count 4 Program objectives: Goal 1: Place up to 120, but not less than 90, students in career - related internships. Goal 2: Expand participation in West Hawaii, both of businesses and student interns. Goal 3: Convene a meeting of other youth programs (eg JA, BEP, Boys & Girls Club) for information - sharing and to explore collaboration and resource development. Goal 4: Provide resources to enhance and facilitate program delivery, including (a) educate school coordinators and members of Huiana committees on labor market information and transferable occupational skills, abilities and knowledge; (b) update Huiana website. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Hawaii Island Workforce and Economic Development Ohana (Agency Name) Huiana Student Internship Program(Program Name) Program Highlights: The program serves students primarily in the 11 and 12th grades from all public high schools on Hawaii Island. It has served 190 students from Spring 2009 to Summer 2010. Under funding from the federal Reed Act, funds were available to provide transportation to some youth who would not otherwise have been able to participate. Huiana continues to recruit new businesses to provide career exploration that met students' career interests. New sites for 2010 included expansion for the Health pathway: Pacific Oncology Center, UHH Laboratory for Exercise Sciences, Eye Care Hawaii. For the Public and Human Services pathway, new businesses include a bakery, the Circuit Court in West Hawaii, the County Mayor's Office and Planning Department. In the Business pathway: Suisan (a marketing internship), County Dept of Finance. For the Natural Resources Pathway: Hilo Veterinary Clinic, Aloha Veterinary Center, US Forest Service. For the Arts and Communication Pathway: Focal Pointe, LLC. For the 2011 year, the program added Matson Navigation, two clothing boutiques, a small law office, the State Veterans' Home, and TMT Observatory. Two Ho'ike celebrations were held to culminate the internships. At that time student interns present a display board and deliver a 3- minute talk about their internship experience including what they learned, and how it helped them select or refine their career choice. Huiana completed a strategic plan that focused on core issues of long -term sustainability, institutionalizing the program within the State Dept of Education; ongoing assessment and marketing of the program, and revitalizing the committee structure. Performance Measures: Program evaluation surveys are given to employer /mentors and to student participants. Statistical as well as qualitative information (in the form of comments) are collected, summarized, and analyzed. In addition, the student's work performance is evaluated by the mentor and can be compared with a pre- internship teacher evaluation to provide a pre- and post- indication of student work habits. Program Expenditures: AY 2009.2010 FY 2010 -2011 FY 2011 -2012 Salaries and Wages Actual Budget Estimate #of participating students 96 110 120 Of the above, # from West Hawaii 5 10 15 # of participating employers (ie 42 50 55 those that have interns working at 7,500 6,000 6,000 the site $81,450 $88,500 $89,250 #of new mentors trained 17 23 20 # of mentors matched with 58 65 65 students Program evaluation surveys are given to employer /mentors and to student participants. Statistical as well as qualitative information (in the form of comments) are collected, summarized, and analyzed. In addition, the student's work performance is evaluated by the mentor and can be compared with a pre- internship teacher evaluation to provide a pre- and post- indication of student work habits. Program Expenditures: Salaries and Wages: Program Coordinators 1 FTE @ $45,000 per year + Fringe @ .25 = $56,250 Program Coordinator will work full -time to recruit business mentors. Staff also facilitates Huiana committees.. Current funding will support percentage staff until 6/30/2011. Fringe benefits include unemployment insurance, FICA, Medicare, workers compensation, pension, employee benefits (health, dental, retirement, & leave). NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 FY 2009 -2010 Actual FY 2010 -2011 Budget FY 2011 -2012 Estimate Salaries and Wages 61,650 61,650 56,250 Professional Fees 1,800 6,250 4,000 Operations 10,500 14,600 23,000 Equipment 0 0 0 Other 7,500 6,000 6,000 Total $81,450 $88,500 $89,250 Salaries and Wages: Program Coordinators 1 FTE @ $45,000 per year + Fringe @ .25 = $56,250 Program Coordinator will work full -time to recruit business mentors. Staff also facilitates Huiana committees.. Current funding will support percentage staff until 6/30/2011. Fringe benefits include unemployment insurance, FICA, Medicare, workers compensation, pension, employee benefits (health, dental, retirement, & leave). NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Hawai'i Island Workforce and Economic Development Ohana (Agency Name) Huiana Student Internship Program(Program Name) Professional Fees: JANQ. Website updating Operations: $23,000. Office supplies $125/ per month (project) x 12 = $1,500. Classroom materials, 12 classes @ $50 = $600. Mileage expenses (Hilo to Kona) for Coordinators & Instructors for classes, set up peer network in Kona (20 trips, 200 miles @ .60 per mile = $2,400). Printing costs (mentor manual, project, etc) $2,500. Bookkeeper services: allocation for fiscal services is necessary under current funding restrictions. This includes processing of payments, financial statements, taxes, audit and other processing or fiscal functions needed to implement. Fiscal & operational (services) 900 x 12 months = $10,800. Other. $6,000. Estimate student participation is 120. Incentives in the form of $50 gift certificates are awarded to students. Program Funding Sources: Revenue Source FY 2009 -2010 Actual FY 2010 -2011 Budget FY 2011.2012 Estimate Federal Reed Act funds ended 10/31/10 75,000 35,000 n/a County contract ended 12/31/10 5,450 n/a n/a HEI Charitable Foundation n/a 25,000 20,000 County Nonprofit grant n/a 20,000 25,000 ( requested ) Corporate sponsorships n/a 8,000 9,000 Company support for student stipends 1,000 n/a n/a Young Brothers grant n/a 500 n/a Thirty Meter Telescope grant n/a n/a 10,000 Foundation grants & fundraisers; in kind contributions from DOE to be requested n/a n/a 25,250 Total $81,450 $88,500 $89,250 Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Huiana Student Internship program is not a revenue - generating program and relies on the support of the federal government, state and local appropriations as well as private support to sustain it. The plan to increase support for the program includes soliciting corporations for sponsorships, not only those that have long been partners with the program, but from other companies who have a vested interested in reaching teens and families on the Big Island. HIWEDO will continue to include the administrative and financial management support for sustaining Huiana in its fund development work. Through HIWEDO, Huiana will continue to pursue grant support to expand services and programs. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Hawaii Island Workforce and Economic Development Ohana (Agency Name) Huiana Student Internship Program(Program Name) I(we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2.142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I(we) hereby certify that information supplied herein including all supporting documents is correct and that I(we) have the authority and ability to fully administer the program(s) pursuant to law. I(we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I(we) understand and will comply with the requirement to submit a year -end report to the Legislative Auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Sign ure 9f Board President/Chair Date Michael Gleason Signature op6ecutive Director bate Sandra Sakaguchi UNSIGNED PROPOSALS WILL NOT BE ACCEPTED NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 I � Hope Services Hawaii, Inc. Beyond Shelter Transitional Housing HOPE Services Hawaii, Inc. Beyond Shelter Transitional Housing Agency Director: Brandee Menino Phone No.: 808 - 933 -6013 Contact Person: Katherine Nawahine Phone No.: 808 - 933 -6038 Mailing Address: 1315 Kalanianaole Ave., Hilo, HI 96720 Facility /Site Address: 110 Ululani St., Hilo, HI 96720 Fax No.: (808) 935 -3794 Email Address: bmenino @hopeserviceshawaii.org Name of Accountant/CPA (include name of firm if applicable): Gail Shioshita (808) 933 -6048 1315 Kalanianole Avenue, Hilo, HI 96720 CW Associates Phone No.: (808) 695 -4014 Mailing Address: 700 Bishop St., Suite 1040, Honolulu, HI 96813 -4124 Amount of Request for County Funds: $15,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $15,000 $15,000 $15,000 Agency Mission Statement: On October 1, 2010, the Office for Social Ministry, Care -A -Van Department of the Diocese of Honolulu, became HOPE Services Hawaii, Inc. (HOPE). HOPE manages the same services and programs to those most in need in our community with the same dedicated staff and support from the Diocese of Honolulu. Bishop Larry Silva remains committed to helping the homeless and the incorporation of the Care -A -Van Department into HOPE Services Hawaii, Inc. will allow us to be more visible in our community and be more effective in our delivery of services. HOPE's mission is to bring to life the gospel values of justice, love, compassion and hope through service, empowerment, and advocacy. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 HOPE Services H awaii, Inc. Beyond Shelter Transitional Housing Program Description: The Beyond Shelter Transitional Housing Program was established in 2006. The shelter consists of eight private apartment units, to be occupied by families. There are six (6) — 2 bedroom /2 bath units, one (1) — 1 bedroom / 1 bath unit and one (1) — studio with a bath. Program participants are expected to participate in skill building activities and classes, pay program fees on time, be courteous neighbors, and commit to seeking employment or higher educational opportunities. Our transitional housing program is based on a seamless continuum of care model as advocated by the Department of Housing and Urban Development (HUD). Our target group consists of families with at least one minor child that have been unsheltered or living in an emergency or transitional housing program /shelter. In order to ensure safety for all program participants, we prohibit access to families who have active, unresolved domestic violence or substance use issues. Families are selected based on the following criteria; motivated to continue to make positive life changes, willingness to engage in life skill building activities including credit repair, financial literacy, health education, family enrichment, neighborhood watch; commitment to pay program fees and the willingness to observe House Rules. The Care Coordinator, Case Advocate and Shelter Specialists engage with families weekly to develop individual family service plans that incorporate extensive linkages to agencies throughout our community. The objective is to assist families in accessing educational and vocational training; job placement; transportation support; linkages to substance abuse and mental health treatment; assistance with family reunification; extracurricular and age appropriate enrichment activities for the children; life skills and financial skills training for the whole family; culturally appropriate activities; housing placement assistance; and one year of aftercare after placement in permanent housing. Total Budget and Position Count Total Program Budget 1 115,320.00 Total Pro ram Position Count 1.5 Total Agency Budget 1 4,086,858.00 Total Agency Position Count 62 Program Objectives: 1) 10% of program participants will enroll in a post- secondary higher education institution. 2) 50% of unemployed program participants to enroll in higher /further educational opportunity including college courses, continuing education classes, vocational training or job- readiness /employment programs. 3) 80% of employed participants will maintain employment for at least three months. 4) 80% of participants who transition to permanent housing will remain in housing for at least six months. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 HOPE Services Hawaii, Inc. Beyond Shelter Transitional Housing 5) 90% of program participants will test clean during random drug testing. 6) 75% of school age children residing at Beyond shelter will have participated in at least one extra - curricular activity throughout their program stay. 7) 75% of school age children residing at Beyond Shelter will have received tutoring and homework assistance services. 8) 25% of school age children residing at Beyond Shelter for at least one year will improve their grades (or grading marks) by at least one higher grade /mark Program Highlights: (from Fiscal Year 2009 -10) 1) Greenpower Solutions LLC: Office for Social Ministry, now HOPE, formed a community partnership with Greenpower Solutions LLC, in a common effort to facilitate greater employment opportunities for the homeless in Hawaii County by assisting individuals in the transition from welfare to work and to afford them the prospects to earn "Family Supporting Wages ". The Office for Social Ministry, now HOPE, and Greenpower Solutions LLC has partnered to train and employ the formerly incarcerated and homeless in a promising career with renewable energy. We believe a prosperous economy means a healthier community for all of us. 2) Extracurricular & Enrichment Activities for the Children: HOPE has maintained the partnership with the Parks & Recreation, Boys & Girls Club, and the YWCA to ensure that the children residing at Beyond Shelter are able to access age appropriate community events and participate regularly in extra - curricular activities. This relationship has allowed the children residing at Beyond Shelter the opportunity to participate in safe supervised after school programs, intersession activities, in addition to deposit assistance for YWCA pre - school program. HOPE continues to provide financial assistance for the activity fees, however, we were able to collaborate with Parks and Recreation to reserve a number of spaces for children to expedite the application /payment process in a timelier manner. 3) Youth Posse — Asset Building and Substance Abuse Prevention Program: Through partnerships with Hawaiian Community Assets and Legal Aid Services of Hawaii's Project Laulima program, HOPE Services will be able to implement a comprehensive youth program that focuses on reducing generational poverty. The program will offer individual savings accounts with matching funds for youth who complete Kahua wai wai, a financial literacy program. Staff will coordinate community service activities, entrepreneurial projects, and positive recreational activities with built - in incentives as milestones are achieved. Family Outcome: AB is a woman of amazing resilience. She is an adult survivor of childhood trauma. Lacking skills to cope with compounding life stressors she turned to drugs. Four of her six children were taken into protective foster custody. Faced with the reality that she was recreating her childhood environment, AB entered Big Island Substance Abuse Council's ( BISAC) intensive inpatient family drug treatment program. Prior to BISAC graduation AB, with no permanent housing options, AB applied, and NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 HOPE Services Hawaii, Inc. Beyond Shelter Transitional Housing was accepted for shelter services. During their stay, AB and the boys demonstrated that they wanted a life free of drugs and violence. She attended parenting classes, individual and family counseling. She paid her program fees on time, maintained a clean unit, and kept her two children on a set schedule. She was offered, and accepted, a unit at Beyond Shelter. Once she settled in she worked hard to reunify with her four older children. After six weeks all of her children were reunited with her. AB continued to access services and opportunities offered through Beyond Shelter Program. She enrolled in Employment Readiness Incentive Program, Forward March, Financial Education and Credit Repair, Kahuawaiwai for the children, Neighborhood Watch Program and enrolled in Hawaii Community College (HCC) as a full -time student. AB finished her third semester at HCC, earned a cumulative 3.0 GPA, and remains drug free in a private rental home with her children. Performance Measures: - IT appiicame NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY 2008 -09 FY 2009 -10 FY 2010 -11 2011 -12 Actual Actual Estimate Estimate Number of persons placed in 79 71 75 65 emergency or transitional housin Number of persons placed in 18 24 20 25 p ermanent housin Number of persons participated 37 35 35 40 in community activities Number of persons completed 13 14 10 15 training or education program Number of persons who were 2 3 3 5 placed into drug /alcohol treatment. Number of persons who 8 8 10 12 retained employment for a minimum of six months Number of persons who 7 5 5 5 transitioned off of welfare Number of persons participants 15 19 15 20 retaining permanent housing for at least six months after exiting program - IT appiicame NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 HOPE Services Hawaii, Inc. Beyond Shelter Transitional Housing Program Expenditures II dppiludule # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 Actual * FY 2009 -10 Actual * FY 2010 -11 Budget FY 2011 -12 Estimate Salaries and Wages 16,581.55 25,996.00 21,261.00 15,704.00 Professional Fees 43,035.00 60,400.00 57,380.00 60,000.00 Operations 100,874.29 92,304.00 89,519.00 99,616.00 Equipment 37,129.82 38,400.00 38,400.00 40,320.00 Other" 2,310.27 Total 117,455.84 118,300.00 110,780.00 115,320.00 II dppiludule # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 Actual * FY 2009 -10 Budget * FY 2010 -11 Estimate FY 2011 -12 Estimate Hawaii County 15,000.00 15,000.00 15,000.00 15,000.00 Hawaii State HPHA -DHS Stipend 43,035.00 60,400.00 57,380.00 60,000.00 Hawaii Island United Way 5,425.07 4,500.00 Beyond Shelter Program fees 37,129.82 38,400.00 38,400.00 40,320.00 Carry-over funds from FY07 -08 2,310.27 Hawaii state HPHA grant Receivable 19,537.50 Total 1 122,437.66 1 118,300.00 110,780.00 115,320.00 Trr appucaoie Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? We will continue to search additional federal funding opportunities to help sustain our housing programs. We have also initiated a Volunteer Program to help increase volunteerism opportunities to serve within our programs and maximize our human resources in the community. We are also exploring the possibly in converting these transitional housing units to a permanent supportive housing program through tenant based rental assistance or project based rental assistance funding programs or the acquisition of this property through HOME and or CDBG funding. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 HOPE S ervices Hawaii, I nc. Beyond Shelter Transitional Housing I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board 1 ignature of Executive Director Date 01 - ,01 1 Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 50 Hope Services Hawaii, Inc. Care -A -Van: Homeless Outreach HOPE Services Hawaii, Inc. Care -A -Van: Homeless Outreach Program Agency Director: Brandee Menino Phone No.: 808 - 933 -6013 Contact Person: Carol Weiser Phone No.: 808- 933 -6075 Mailing Address: 1315 Kalanianaole Ave., Hilo, HI 96720 Facility /Site Address: East HI: 1315 Kalanianaole Ave., Hilo, HI 96720 West HI: 74 -5593 Pawai Place, Kailua -Kona 96740 Fax No.: (808) 935 -3794 Email Address: bmenino @hopeserviceshawaii.org Name of Accountant/CPA (include name of firm if applicable): Gail Shioshita (808) 933 -6048 1315 Kalanianole Avenue, Hilo, HI 96720 CW Associates Phone No.: (808) 695 -4014 Mailing Address: 700 Bishop St., Suite 1040, Honolulu, HI 96813 -4124 Amount of Request for County Funds: $20,000.00 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $20,000 $20,000 $20,000 Agency Mission Statement: On October 1, 2010, the Office for Social Ministry, Care -A -Van Department of the Diocese of Honolulu, became HOPE Services Hawaii, Inc. (HOPE). HOPE manages the same services and programs to those most in need in our community with the same dedicated staff and support from the Diocese of Honolulu. Bishop Larry Silva remains committed to helping the homeless and the incorporation of the Care -A -Van Department into HOPE Services Hawaii, Inc. will allow us to be more visible in our community and be more effective in our delivery of services. HOPE's mission is to bring to life the gospel values of justice, love, compassion and hope through service, empowerment, and advocacy. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 HOPE Services Hawaii, Inc. Care -A -Van: Homeless Outreach Program Program Description: For nearly nineteen years, the Office for Social Ministry (OSM) has been the primary homeless service provider on the Big Island. OSM has always strived to help the most vulnerable in our community "reach their full potential, achieve self - sufficiency, and live in a just-and compassionate society ". On October 1, 2010, HOPE Services Hawaii, Inc. (HOPE) was created with the task of continuing the mission of OSM, utilizing the same values and beliefs, but with a focus on ending homelessness. Care -A -Van's mobile homeless outreach program is the only outreach program on Hawaii Island that specifically targets the unsheltered homeless population. Our primary goal is to support the unsheltered homeless and help them to get into healthier and more stable living conditions. With the support of our funders, community associates, and HOPE staff members, the homeless outreach program has been able to serve about 1,500 persons throught Hawaii county. HOPE owns and operates four -wheel drive vehicles, which allows our outreach workers to travel to areas where homeless people congregate. These areas include, but are not limited to, beaches, parks, woods, lava fields, emergency shelters, domestic violence shelters, and in or around downtown Hilo, Puna, Hamakua, and Kailua -Kona. Upon contact with a homeless person, outreach workers strive to establish trust and rapport as a first step towards improving the individual's housing situation and general well- being. Once a trusting relationship is established, case management services commence. Outreach staff will support their homeless consumers through an intake process to assess their housing situation and mental health status. Outreach staff provide services such as helping consumers to obtain legal identification documents, emergency food and hygiene supplies, linkage to medical and dental health care, linkage to mental health care, transportation, and assistance with legal issues. They will also help consumers to obtain educational and employment goals. The purpose of this program is to connect homeless consumers to mainstream community programs and ultimately, to gain housing and self- sufficiency. Aside from our traditional outreach approach, HOPE has established Drop -In sites in Puna and Kailua -Kona. Drop -In sites include an emergency food pantry, clothing bank, emergency household and hygiene supplies, case management services, phone and computer /internet use, mail services, life skills classes, and referrals to community resources. These drop -in sites have been established as another method towards identifying and supporting those who are experiencing homelessness. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 The Friendly Place Drop -in Center, includes breakfast five days a week, an emergency food pantry, clothing bank, provision of emergency household /hygiene supplies, case management services, phone use, mail service, showers, book exchange, laundry facilities, life skills classes, renters' education classes, and referrals and linkages to community service providers. A housing specialist is on staff, and housing applications are available to assist with permanent housing. Further, a representative payee assists participants with their finances. These drop -in sites have been established as another method towards identifying and supporting those who experience homelessness. We partner with community churches where two churches presently are serving lunch twice a week, and on the last two Fridays of each month. Once a week a physician from West Hawaii Community Health Center (WHCHC) sees participants at the Friendly Place Drop -in Center and offers follow up visits at their clinic. The Public Health Nurses administers HEP C immunization shots, and HEP C prevention education materials. Case managers offer outreach & interim case management services for individuals in need of mental health support. Staff provide support to individuals by retrieving a mental health assessment from the Department of Health, Adult Mental Health Division (AMHD) and WHCHC. If indivduals are deemed eligible for services through AMHD, then our staff link these indivduals with a mental health case management provider. If individuals are not found eligible, then our staff will support these individuals with appealing the decision or help them with identifying the best available services for their mental health needs through their insurance carrier. Staff also assist unisured homeless individuals to the State Quest program as an initial step towards receiving health care services. HOPE partners with WHCHC who offers mobile dental services at the Friendly Place Drop In Center twice a week for urgent dental care needs. PReventive care services are offerred as time allows. Total Budget and Position Count Total Program Budget 2,437,452 Total Program Position Count 9 Total Agency Bud et 4,086,858 Total Agency Position Count 62 Program Objectives: 1) 50% of program participants will engage in case management services by implementing real budget planning and seeking out community programs for which they may be eligible. 2) 50% of program participants will enroll in higher educational opportunities, including GED program, college courses, continuing educational classes, vocational training or job- readiness employment programs. 3) 80% of participants who enrolled in shelter programs will remain there until more permanent housing is secured. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 4) 90% of eligible program participants who receive monthly rental subsidies will pay their rent on time for at least six months. 5) 90% of AMHD - eligible participants will enroll in at least one AMHD- contracted program. 6) 80% of program participants will not violate the terms of their lease or be evicted for at least six months. 7) 75% of eligible program participants will take 6 classes of renter's education in our housing program to sustain in healthy relationships with landlords. Program Highlights: (from Fiscal Year 2009 -10) 1) Served 1,619 unduplicated homeless persons in Hawaii County, including 776 unduplicated single persons, 234 unduplicated families with children, and 492 new participants. 2) A total of 335 individuals were placed in permanent housing and 48 persons obtained employment, despite the difficult economic times. 3) Established and maintained relations with community agencies and landlords by regularly attending community meetings and events; member of NARPM (National Association of Residential Property Managers). 4) Mandated trainings for staff include: Domestic Violence and Faith Communities /Stalking, Community Oriented Policing Services: Methamphetamine Conference, Elder Abuse Awareness, Suicide Prevention: Applied Suicide Intervention Skills Training, Fostering Healthy Relationships Through Communication, Workforce Development Training on working while receiving SSI and how it interacts with other social services, Cultural Competency Training, and CPI: Nonviolent Crisis Intervention Training. 5) In September of 2009, OSM (now HOPE) was awarded the contract to provide housing relocation and stabilization services under the Homeless Prevention and Rapid Re- housing Program (HPRP), American Recovery and Reinvestment Act. By October of 2010, all of the direct assistance funds for the entire three year contract had been spent, a total of $353,500. During this time period, HPRP staff completed 464 intakes /assessments and 293 individual case plans. 216 families were served with these funds -67 were rapidly re- housed and 149 were prevented from becoming homeless. 6) In January of 2010, OSM (now HOPE) was awarded the contract to provide SNAP (Supplemental Nutrition Assistance Program) outreach services for Hawaii County by the State Department of Human Services (DHS). Two SNAP Outreach Specialists provide mobile outreach services to individuals who are eligible for SNAP benefits but are not receiving them. They also assist SNAP consumers with the recertification process. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 During this contract period, which ended on September 30, 2010, SNAP Outreach Specialists completed 318 pre- screenings for eligibility, 177 completed applications turned in to DHS, and 108 recertifications. The total amount of benefits generated by the HOPE SNAP Outreach Program for this time period is $719,238.00. This translates into an economic benefit to the community in the amount of $1,323,397.92. HOPE was awarded the new SNAP Outreach contract on October 1, 2010. 7) May 1, 2010 was the start of HOPE's Kukui Shelter Plus Care program's 7 th year of operation. Since that time, we have provided tenant based rental assistance and supportive housing services for 108 severely mentally ill homeless individuals - -28 with families, including minor children. Due to major budget cuts to the state's mental health services, these consumers are not receiving the supportive services that they need in order to remain stabilized in housing. HOPE has one housing specialist in East Hawaii and one in West Hawaii; most of the consumers reside in East Hawaii. During the time period from May 1, 2010 through December 31, 2010, services provided include the following: Counseling /budget planning -223, Landlord contact/counseling -162, Home visits -94, Referrals to other community resources -154, assistance with obtaining employment and /or education -12. 8) On May 1, 2010, OSM /HOPE opened up its New Directions Shelter Plus Care program. This is a 5 year program, providing tenant based rental assistance and supportive services to those who are chronically homeless with a serious mental illness or other disabling condition on the Island of Hawaii. A chronically homeless person is defined as an unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or more OR has had at least four episodes of homelessness in the past three years. The proposed number of persons to be served was four; we transferred eight chronically homeless consumers from the Kukui program due to insufficient funds and housed one individual directly from the streets. Since then, one individual abandoned his apartment due to paranoid delusions and one was terminated due to non - compliance with program rules. One individual successfully transitioned into a subsidized housing program. 9) The TANF Housing Placement program assists families that are homeless or at risk of becoming homeless, and first time section 8 voucher holders to secure and retain permanent housing. In 2010, the TANF program placed 432 individuals, including 267 children, into permanent housing. The TANF Housing Placement program assists with security deposits, utility deposits, and first month's rent. At least 30 of these families have maintained their housing for six months or more. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 HOPE Services Hawaii, Inc. Care -A -Van: Homeless Outreach Program Performance Measures: *If applicable Program Expenditures FY 2009 -10 FY 2010 -11 FY 2011 -12 Salaries and Wages Actual * Budget * Estimate Number of Participants placed in 250 223 250 emergency or transitional housin 1,725,861.78 1,084,436.00 992,113.00 Number of participants placed in 250 335 300 p ermanent housin Number of persons who obtained 55 48 50 employment Number of persons who will enroll 50 48 50 in job readiness/training programs Number of persons provided with 800 1596 1500 food and /or emergency supplies Number of persons referred for 800 779 800 medical or dental care (duplicated) *If applicable Program Expenditures x it applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages 1,008,587.99 1,200,823.00 1,243,644.00 Professional Fees 253,024.61 228,284.00 201,695.00 Operations 1,725,861.78 1,084,436.00 992,113.00 Equipment 3,117.14 3,200.00 Other" Total 2,990,591.52 2,516,743.00 2,437,452.00 x it applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 HOPE Services Hawaii, Inc. Care -A -Van: Homeless Outreach Program Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate State /DHS 712,500 712,500 750,000 HPRP 309,162 235,950 108,533 SNAP 41,498 70,493 70,493 TANF 528,000 528,000 528,000 Hawaii County 20,000 15,000 20,000 Hawaii Count - Pahoa 20,000 20,000 AMHD 66,670 100,000 100,000 AMH -Rep Payee 182,400 192,000 192,000 New Direction 36,960 36,960 Kukui 437,928 465,048 465,048 HIUW 20,000 HCF - SNAP 68,667 70,492 70,492 HCF - HPRP 50,000 50,000 50,000 SHEG 42,750 SHEG Child Care Grant 450,000 Other Grants 61,016 Diocese Support 20,300 25,926 Total 2,990,591 2,516,743 2,437,452 - it appiicabie Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? HOPE will continue to search additional federal funding opportunities to help sustain our outreach programs. We have also expanded our volunteer program to include a full -time Volunter Coordinator to search for and fill positions based on skills and experience. HOPE will also be looking into fund - raising opportunites and developing a donor base for charity funds. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 HOPE Services Hawaii, Inc. Care -A -Van: Homeless Outreach Program I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. �F Signature of Board Pr "dentVIChair Si nature of Executive Director s ir Date Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 51 Hope Services Hawaii, Inc. HOPE resource Center HOPE Services Hawaii, Inc. HOPE Resource Center Agency Director: Brandee Menino Phone No.: 808 - 933 -6013 Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Katherine Nawahine 1315 Kalanianaole Ave. Hilo, Hawaii 96720 116 Kapiolani Street Hilo, Hawaii, 96720 808 - 935 -3794 Phone No.: 808 - 933 -6038 bmenino@hopeserviceshawaii.org Name of Accountant/CPA (include name of firm if applicable): Gail Shioshita (808) 933 -6048 1315 Kalanianole Avenue, Hilo, HI 96720 CW Associates Phone No.: (808) 695 -4014 Mailing Address: 700 Bishop St., Suite 1040, Honolulu, HI 96813 -4124 Amount of Request for County Funds: $20,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $20,000 $15,000 $20,000 Agency Mission Statement: On October 1, 2010, the Office for Social Ministry, Care -A -Van Department of the Diocese of Honolulu, became HOPE Services Hawaii, Inc. (HOPE). HOPE manages the same services and programs to those most in need in our community with the same dedicated staff and support from the Diocese of Honolulu. Bishop Larry Silva remains committed to helping the homeless and the incorporation of the Care -A -Van Department into HOPE Services Hawaii, Inc. will allow us to be more visible in our community and be more effective in our delivery of services. HOPE's mission is to bring to life the gospel values of justice, love, compassion and hope through service, empowerment, and advocacy. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 HOPE Services Hawaii, Inc. HOPE Resource Center Program Description: The mission of the HOPE Resource Center (currently known as Ponahawaiola) is to reduce potential obstacles for men and women formerly incarcerated and /or are experiencing homelessness in Hawaii County. "E Malama Kekahi I Kekahi/Taking Care of Our Own" is an article which was published by the Hawaii Island Correction Advisory Committee in 2003. The purpose of the article is to advocate a "seamless reintegration program" which is the best approach to reducing these obstacles. Since then, the Going Home Consortium created a plan to address re -entry issues. Housing is listed as a priority for persons returning to our community from incarceration. As the Homeless Outreach provider of Hawaii Island, it became apparent that minimal to no discharge planning was happening from jail to our community. When asked why they were homeless, an increasing number said they lacked the housing resources and support upon discharge, have strained their family relationships due to their previous behaviors and thus, not welcomed back home or the ex- offenders supervising authority did not approve their housing situation due to known previous drug related incidents at those identified locations. HOPE staff works collaboratively with public safety and judiciary agencies to recognize offenders at -risk for homelessness and arrange for placement in our transitional housing program prior to their release from incarceration. At the onset of program entry, an initial assessment of the participant's needs is identified. Referrals and linkages to community mainstream programs are made including mental health care, general health care, outpatient substance abuse treatment, application to financial assistance, employment readiness training, and /or enrollment in education programs. Appropriate steps are then made to create an individual support network for each participant. Addition services offered on -site include daily life skills training, re- development and encouragement, gender specific groups, Meth Relapse Prevention groups, linkages to AA support groups, transportation, mentorship, culturally appropriate activities; employment search, housing placement assistance; and one year of aftercare once placement in permanent housing is achieved. The HOPE Resource Center will have a total of fourteen (14) single room occupancy units. HOPE Services Hawaii has recently secured a rental lease a 6,000+ sq ft mutli- use building, with the intention of relocating the transitional program from 483 Kinoole Street to 116 Kapiolani Street by July 1, 2011 and this site was home to Glad Tidings Church. Construction of fourteen (14) 120 square foot single room occupancy units and shared restrooms and showers will begin in April 2011 as soon as the permitting of the construction is complete. Each room with be furnished with a single bed, chest of drawers, apartment sized refrigerator, microwave, a small table and chair. The facility is equipped with a certified kitchen; computer lab with 5 computers for participants use; ADA bathrooms; and a fully functional conference center for community and HOPE program use. Future plans include enhancing the program with physical fitness equipment on site to improve and encourage healthier living, a culinary job training program to build real work skills to market themselves in the employment field, and structured positive recreational activities and fellowship. ° NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 HOPE Services Hawaii, Inc. HOPE Resource Center Total Budget and Position Count Total Program Budget 493,840.00 Total Program Position Count 8 Total Agency Budget 4,086,858.00 Total Agency Position Count 62 Program Objectives: For FY11 -12: 1. Maintain clean and sober housing for 100% of program participants; 2. Decrease violations of conditions of supervised release for 65% of program participants; 3. Increase participation in substance use treatment and mental health services for 70% of program participants; 4. Assist in obtaining employment and education placement for 65% of participants; 5. Assist with increased child support and general family contact for 70% of participants. Program Highlights: (from Fiscal Year 2009 -10) 1) Ponahawaiola Independent Living Readiness (PILR): To date, the most impressive achievement for the Ponahawaiola Community Reintegration Program is its Ponahawaiola Independent Living Readiness (PILR) group. Originally intended to get participants up and ready early, it has evolved into a comprehensive organized membership consisting of all our participants. During its genesis, they formed a board of leaders who are voted into their positions by the general membership. Their Mission is to motivate others to acquire employment, housing, and education while strengthening their spirituality. Their vision is to be gainfully employed, live independently and reinforce their ties to the community and their Values are to stay clean and sober and remain respectfully oriented to their faith, family and freedom. 2) Greenpower Solutions LLC: Office for Social Ministry, now HOPE, formed a community partnership with Greenpower Solutions LLC, in a common effort to facilitate greater employment opportunities for the homeless in Hawaii County by assisting individuals in the transition from welfare to work and to afford them the prospects to earn "Family Supporting Wages ". The Office for Social Ministry, now HOPE, and Greenpower Solutions LLC has partnered to train and employ the formerly incarcerated and homeless in a promising career with renewable energy. We believe a prosperous economy means a healthier community for all of us. 3) The Paxen Group, Inc: Office for Social Ministry, now HOPE, partnered with the Paxen group to offer Forward March Employment classes on site. The Paxen Group is a recognized leader in training and workforce development. Since 1980, Paxen has specialized in developing and delivering training programs that build academic and employability skills for at -risk youths and out -of -work adults. Many of these people are economically and socially disadvantaged. High dropout rates and lack of employment opportunities compound their problems. Forward March provides adult men and women NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 HOPE Services Hawaii, Inc. HOPE Resource Center with the real -world skills they need to be employable. They practice skills such as computer literacy and critical thinking in a real -life setting, allowing them to see how they can use those skills in work and in life. Paxen designed this program to help adults find and keep a job and build career goals. Participants will learn about exploring careers, looking for a job and being an effective employee. Our 10 to 1 student/instructor ratio allows for personal attention and maximizes interaction. Students receive both traditional and computer assisted instruction. We evaluate students regularly and counsel them on how they are applying the skills they learn. 4) Mentorship Program: The OSM Mentorship program was implemented to assist participants in developing personal relationships with established community members. Previous studies have indicated that mentoring reduces recidivism and provides long lasting positive influences in the persons transitioning from incarceration (please see link at bottom for study). The mentorship program provides trained supervised volunteer mentors to mentees transitioning back into the community. Mentoring is based upon trust, the willingness to help others and the ability to be a good listener. The Mentor is asked to make a one year commitment to coach and advise the mentee, and is willing to share his or her life experiences and wisdom with the Mentee. The nature of the Mentor's guidance and support will depend on the Mentee's individual service plan (ISP). The ISP is collaboratively developed between the OSM case managers and the Mentee. It serves as a guidance tool not only for the Mentor but also all involved participants in the case. Performance Measures: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY 2008 -09 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Actual * Estimate Estimate Number of persons placed in 43 50 40 40 transitional housin Number of persons placed in 15 40 15 15 permanent housing Number of persons who obtained 28 29 20 20 employment Number of persons who retained 18 20 20 20 employment for at least three months Number of persons who participated 43 50 40 40 in community activities Number of persons receiving 41 54 40 30 education job training assistance Number of persons accessing health 32 72 30 30 services (nutrition, medical, gerontology, therapeutic massage, aerobic Number of persons accessing mental 21 48 20 20 health services NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 HOPE Services Hawaii, Inc. HOPE Resource Center Program Expenditures It applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 Actual * FY 2009 -10 Budget * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 255,666.50 261,271.00 306,334.00 297,691.00 Professional Fees 414,960.00 436,800.00 414,960.00 414,960.00 Operations 286,581.25 315,409.00 273,266.00 196,149.00 Equipment 1,441.39 5,000.00 Other 5,000.00 5,000.00 5,000.00 7,000.00 Total 542,247.75 576,680.00 579,600.00 493,840.00 It applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 Actual * FY 2009 -10 Actual FY 2010 -11 Actual FY 2011 -12 Estimate County of Hawaii 20,000.00 20,000.00 20,000.00 20,000.00 State of Hawaii DHS 414,960.00 436,800.00 414,960.00 414,960.00 Hawaii Island United Way 15,500.00 40,000.00 40,000.00 20,000.00 Hawaii Hotel Industry Visitor Walk 1,441.39 5,000.00 Kaneta Foundation 5,000.00 5,000.00 5,000.00 7,000.00 Ponahawaiola Program fees 89,959.75 74,880.00 99,640.00 26,880.00 Employment Readiness/Vendor Income 450.00 Carry over FY 07 -08 funds 1,458.23 State of Hawaii HPHA Receivable 56,840.00 Total 605,609.37 576,680.00 579,600.00 493,840.00 `it applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? 1) We will continue to search additional federal funding opportunities to help sustain our housing programs. We have also initiated our Volunteer Program to help increase volunteerism opportunities for our programs and for our community. 2) We have acquired new property with the intent to relocate the program. Rent and utility costs will be considerably reduced. 3) We continue to search for additional funding opportunities to equip the property with a photovoltaic system, further reducing utility costs. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 52 Hope Services Hawaii, Inc. Kaloko Transitional Housing Program HOPE Services Hawaii, Inc. Kaloko Transitional Housing Program Agency Director: Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Brandee Menino Phone No.: 808 - 933 -6013 Paulla DeMello Phone No.: 808 - 933 -6038 1315 Kalanianaole Ave., Hilo, HI 96720 Hinalani Avenue (808) 935 -3794 bmenino @ hopeserviceshawaii.org Name of Accountant/CPA (include name of firm if applicable): Gail Shioshita (808) 933 -6048 1315 Kalanianole Avenue, Hilo, HI 96720 CW Associates Phone No.: (808) 695 -4014 Mailing Address: 700 Bishop St., Suite 1040, Honolulu, HI 96813 -4124 Amount of Request for County Funds: $ 30,000.00 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $0 $0 $0 Agency Mission Statement: On October 1, 2010, the Office for Social Ministry, Care -A -Van Department of the Diocese of Honolulu, became HOPE Services Hawaii, Inc. (HOPE). HOPE manages the same services and programs to those most in need in our community with the same dedicated staff and support from the Diocese of Honolulu. Bishop Larry Silva remains committed to helping the homeless and the incorporation of the Care -A -Van Department into HOPE Services Hawaii, Inc. will allow us to be more visible in our community and be more effective in our delivery of services. HOPE's mission is to bring to life the gospel values of justice, love, compassion and hope through service, empowerment, and advocacy. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 HOPE Services Hawaii, Inc. Kaloko Transitional Housing Program Program Description: The County of Hawaii Office of Housing and Community Development intend to complete Phases I & II of the Kaloko Housing Project by October 2011. The project will be part of a larger development called the Kaloko Housing Program, which will include 96 multi - family units (24 transitional units and 72 affordable units), a warehouse, a self- contained wastewater treatment plant, and a community center. The project is located North of Kaloko Industrial Park, off Hina Lani Street. TMK (3) 7- 3- 009 -055 The initial phases ready for occupancy by November 2011 will add 40 housing units for families and individuals with nowhere to go. Twelve (12) units will be targeted for transitional housing services while the remaining twenty -eight (28) units will be permanent supportive rental housing units. These units will be rented to households whose incomes do not exceed 50% area median income. The Kaloko Housing Program will serve families and individuals experiencing homelessness, including those living in unsheltered situations, transitioning from an emergency shelter, other transitional housing programs, or families at -risk of becoming homeless. Families living in the transitional Housing units will be required to participate in on -site life skills strengthening workshops, weekly resident meetings and meet with their on- site Case Advocate for assistance in making referrals and linkages to community resources that they may be eligible for. Life skills workshops will include budget management, a comprehensive renter's education program, communication, relationships, goal setting, and informational meetings and presentations about community resources. This program is a long awaited resource for the community as there is no other transitional housing program in West Hawaii for families and individuals experiencing homelessness. We intend to partner with existing providers to coordinate additional services on -site at the convenience of the program participants residing at the Kaloko Transitional Housing Program. These services include employment readiness activities to strengthen their soft skills training including resume writing, interviewing, and employment search; health care services; financial literacy, credit counseling, and USDA first time home buyers. We also plan to recruit volunteers to mentor our families in their transition from homelessness to transitional housing to permanent supportive housing. Families may need child care assistance while searching for employment or attending educational opportunities. Appropriate screened Child Care Aides will be recruited to assist with the family's child care needs. HOPE staff have mentioned to Mass Transit Director Tom Brown to coordinate the bus route to stop in front of the program to assist with transportation needs. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 HOPE Services Hawaii, Inc. Kaloko Transitional Housing Program Total Budget and Position Count Total Program Budget 188,100 Total Pro ram Position Count 2 Total Agency Budget 4,086,858 ncy Position Count 62 Program Objectives: For FY11 -12: 1. Provide 50 unduplicated individuals with transitional housing with supportive case management services on -site; 2. Provide 28 families with affordable housing opportunities with supportive case management services on -site; 3. Assist 50% of program participants in obtaining employment (ex. Seasonal, part -time of full- time); 4. Assist 25% of program participants to enroll in training or education programs (examples: job- readiness programs, obtain a GED, higher education); 5. Assist 25% of program participants' access mental health and substance use treatment, supportive services or after -care programs. Program Highlights from FY 09 -10: • New construction coordinated by the County of Hawaii, Office of Housing and Community Development • New Facility in West Hawaii to house families and individuals experiencing homelessness • New affordable and transitional housing units Performance Measures: x If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 FY 2008 -09 FY2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget * Estimate Estimate 1. No. of unduplicated N/A N/A N/A 50 participants served and p rovided transitional housin 2. No. of unduplicated N/A N/A N/A 50 participants exited to p ermanent housin 5. No. of duplicated participants N/A N/A N/A 20 enrolled in training or education program (e.g. GED, job training, etc. 6. No. of unduplicated N/A N/A N/A 20 participants obtained employment x If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 HOPE Services Hawaii, Inc. Kaloko Transitional Housing Program Program Expenditures IT applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 Actual * FY 2009 -10 Actual * FY 2010 -11 Budget FY 2011 -12 Estimate Salaries and Wages 0 0 0 98,000 Professional Fees 0 0 0 0 Operations 0 0 0 40,100 Equipment 0 0 0 50,000 Other" 0 0 0 0 Total 1 0 1 0 0 188,100 IT applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 Actual * FY 2009 -10 Budget * FY 2010 -11 Estimate FY 2011 -12 Estimate DHS Stipend 0 0 0 67,200 Supportive Housing Grant 0 0 0 27,860 Hawaii Community Foundation 0 0 0 20,000 County of Hawaii 0 0 0 30,000 Hawaii Island United Way 0 0 0 10,000 Program Fees 0 0 0 23,040 Fundraising 0 0 0 10,000 Total 0 0 01 188,100 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? We plan to take a four prong approach this year to become self- sustaining. They are: 1. Pursue further fundraising efforts including direct mail; "friend raise;" ask individuals and parishes for donations of time, talent and treasures; coordinating a special event and participating in the West Hawaii Civic Center's Brick Project. 2. Expand our volunteer program by increasing volunteer opportunities. 3. Increase donations of necessary program supplies to decrease operational costs. 4. Seek partnership with West Hawaii Health Center to explore medicaid reimbursement options to provide emergency housing for our common patients (residents of the emergency housing program) experiencing homelessness. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 HOPE Services Ha waii, Inc. Kaloko Transitional Housing Program I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2 -1422, Hawai'i County Code, relating to Appropriation of Funds to nonprofit organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplies herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. C` ' -•�, d Signature of Board 'Oresid4 t/Chair Date % ignature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 53 Hope Services Hawaii, Inc. Mhei Pua Emergency Shelter HOPE Services Hawaii, Inc. Kihei Pua Emergency Shelter Agency Director: ' Brandee Menino Phone No.: 808 - 933 -6013 Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Katherine Nawahine 1315 Kalanianaole Ave. Hilo, Hawaii 96720 115 Kapiolani St. Hilo, Hawaii 808 - 935 -3794 Phone No.: 808 - 933 -6038 bmenino@hopeserviceshawaii.org Name of Accountant/CPA (include name of firm if applicable): Gail Shioshita (808) 933 -6048 1315 Kalanianole Avenue, Hilo, HI 96720 CW Associates Phone No.: (808) 695 -4014 Mailing Address: 700 Bishop St., Suite 1040, Honolulu, HI 96813 -4124 Amount of Request for County Funds: $15,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $20,000 $15,000 $15,000 Agency Mission Statement: On October 1, 2010, the Office for Social Ministry, Care -A -Van Department of the Diocese of Honolulu, became HOPE Services Hawaii, Inc. (HOPE). HOPE manages the same services and programs to those most in need in our community with the same dedicated staff and support from the Diocese of Honolulu. Bishop Larry Silva remains committed to helping the homeless and the incorporation of the Care -A -Van Department into HOPE Services Hawaii, Inc. will allow us to be more visible in our community and be more effective in our delivery of services. HOPE's mission is to bring to life the gospel values of justice, love, compassion and hope through service, empowerment, and advocacy. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 • HOPE Services Hawaii, Inc. Kihei Pua Emergency Shelter Program Description: Kihei Pua Emergency Shelter has been operated by the Office for Social Ministry (OSM), now HOPE Services Hawaii, for four (4) years. It is the only program on the island of Hawaii that is specifically designed to support individuals and families who are either unsheltered, at -risk of becoming homeless, or residing at an emergency or transitional program /shelter. It is a face -paced (6) six -week program with a goal of supporting homeless individuals and families to achieve healthier more stable living conditions. In an effort to achieve this goal, we offer an array of supportive services. Our program provides life skills classes that teach homeless participants how to budget their finances, become responsible, clean, accountable tenants, maintain sobriety and respect others. In addition, we have an on -site care coordinator and case advocate that provide one on one goals setting and counseling, referrals and linkages for case specific services including, mental health services, medical, dental & prescription services, substance abuse treatment programs, temporary employment agencies, educational and vocational training opportunities, elderly care services, public entitlements, social security benefits, and /or HOPE housing placement programs. Our program provides 24 -hour services, 7 days a week, to assess and support the needs of our homeless participants. Total Budget and Position Count Total Program Budget $614,454.00 Total Program Position Count 10 Total Agency Budget $4,086,858.00 1 Total Agency Position Count 62 Program Objectives: 1) Provide 300 program participants with emergency housing and case management. 2) Maintain clean and sober housing for 100% of program participants. 3) Assist 75 program participants in obtaining permanent housing. 4) Assist 20 program participants in obtaining transitional housing. 5) Assist 20 program participants in obtaining employment. 6) Assist 50 program participants in obtaining placement in job training or education programs. 7) Assist 10 program participants in accessing to substance use treatment services. 8) Assist 60 program participants in accessing mental health services. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 HOPE Services Hawaii, Inc. Kihei Pua Emergency Shelter Program Highlights: (from Fiscal Year 2009 -10) 1) Greenpower Solutions LLC: Office for Social Ministry, now HOPE, formed a community partnership with Greenpower Solutions LLC, in a common effort to facilitate greater employment opportunities for the homeless in Hawaii County by assisting individuals in the transition from welfare to work and to afford them the prospects to earn "Family Supporting Wages ". The Office for Social Ministry, now HOPE, and Greenpower Solutions LLC has partnered to train and employ the formerly incarcerated and homeless in a promising career with renewable energy. We believe a prosperous economy means a healthier community for all of us. 2) Employment Readiness and Incentive Program (ERIP): ERIP was implemented after on -going reports reflected that our clients were not able to find an employment training program that targeted the issues directly related to our participants unique array of needs, such as homelessness, lack of child care, lack of transportation, lack of education or prior work history, and criminal backgrounds. ERIP was restructured to meet the needs of all HOPE participants by staggering instructional classroom days and on -site training opportunities in supervised placements at HOPE program sites. Participants are evaluated on their work ethics, attitude and dependability. Participants that have been deemed ready are then they are able to participate in off -site training opportunities. This allows participants to be evaluated in a less structured location. Those that complete this phase are then assisted with job placement. The ERIP director is responsible for building an employment database of community businesses and agencies that have committed to employing our participants as regular employees. Once placed, participants are then provided with monthly follow up services for up to 6 months, to ensure that the transition to regular employment is smooth and to assist both the participant and employer with any issues that may arise. 3) County of Hawaii Parks & Recreation: HOPE has maintained the partnership with the Parks & Recreation to ensure that the children residing at Kihei Pua are able to access community events and participate regularly in extra - curricular activities. This relationship has allowed most of the children residing at Kihei Pua the opportunity to participate in summer fun activities as well. OSM still pays for the activity fees, however, we were able to collaborate with Parks and Recreation to reserve a number of spaces for children from Kihei Pua and expedite the application /payment process in a timelier manner. 4) Family Outcome: AH and JVG are a young couple with one child "AP ". They relocated to Hilo from Kuhio Park Terrace entering OSM's Emergency Shelter Program in October 2008. AH and JVG were both committed to changing their NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 HOPE Services Hawaii, Inc. Kihei Pua Emergency Shelter lifestyle and reducing their dependence on public entitlements. Their family goals were to increase income through employment, enroll "A" in school, obtain an assessment for special education services, address his dental care needs, and engage in family strengthening activities. During their stay at the Emergency Shelter AH obtained a full -time position at Ross. Shortly after, JVG obtained a fulltime position with the Boys and Girls Club. The accomplishment of their employment goals gave AH and JVG the inspiration to reach all the goals set in their individual service plan. Their increased income afforded the young family the opportunity to move into Beyond Shelter. This family continued to be highly motivated after the move. JVG coordinated a series of meetings with Hilo Union Schools' Special Services Coordinator and a childhood psychiatrist to address her child's special education needs. He was referred to Ohana Family Dental for cleaning, fillings and infant pulpotomy. JVG engaged in Consumer Credit Counseling Services to address her poor credit rating and outstanding debt. JVG and AH saved enough money to purchase a dependable car. In November 2009 the family obtained a home in the private rental market. Performance Measures: If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY 2008 -09 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Actual * Estimate Estimate Number of persons placed in 222 281 300 300 emergency shelter (persons served Number of persons exited to permanent 70 82 80 90 housin Number of persons exited to transitional 20 29 20 30 housin Number of persons enrolled in job 6 34 30 50 training or higher education programs Number of persons who obtained 16 21 20 25 employment Number of persons who retained 12 10 10 15 employment for a minimum of three months Number of meals served 1 3,262 5,336 1 5,000 6000 If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 HOPE Serv ices Hawaii, Inc. Kihei Pua Emergency Shelter Program Expenditures it applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 Actual * FY 2009 -10 Budget * FY 2010 -11 Estimate FY 2011 -12 Estimate Salaries and Wages 409,906.60 410,976.00 361,011.00 363,156.00 Professional Fees 421,371.00 525,600.00 493,050.00 520,000.00 Operations 218,747.73 224,486.00 240,240.00 251,298.00 Equipment 10,850.00 11,500.00 11,500.00 15,000.00 Other# 5,623.37 15,512.00 18,851.00 19,000.00 Total 628,654.33 635,462.00 601,251.00 614,454.00 it applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 Actual * FY 2009 -10 Budget * FY 2010 -11 Estimate FY 2011 -12 Estimate County of Hawaii 20,000.00 20,000.00 15,000.00 20,000.00 State of Hawaii DHS - Stipend 421,371.00 525,600.00 493,050.00 520,000.00 Emergency Shelter Grant (Federal) 83,797.00 62,850.00 62,850.00 40,454.00 Hawaii Island United Way 10,850.00 11,500.00 11,500.00 15,000.00 Kihei Pua Program fees 5,623.37 15,512.00 18,851.00 19,000.00 Carry over funds from FY 07 -08 24,389.78 State of Hawaii HPHA Receivable 157,792.50 Total 723,823.65 635,462.00 601,251.00 614,454.00 Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? We will continue to search additional federal funding opportunities to help sustain the shelter programs. We have also initiated our Volunteer Program to help increase volunteerism opportunities for our programs and for our community. Although program fees are an additional source of revenue, we do not have any plans to increase our program participant's program fees this year. Instead, we will continue to assess areas of cost savings, energy efficiency education and maximize our community partnerships. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 HOPE Services Hawaii, Inc. Kihei Pula Emergency Shelter I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 1� Signature of Board Pres - '` �Cj t it Date ��L� d�7rP ���✓ ignature of Chief Executive Officer Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 54 Hope Services Hawaii, Inc. West Hawaii Emergency Housing Program HOPE Servic Hawaii, Inc. West Hawaii Emergency Housing Program Agency Director: Brandee Menino Phone No.: 808 - 933 -6013 Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Paulla DeMello Phone No.: 808 - 933 -6038 1315 Kalanianaole Ave., Hilo, HI 96720 74 -5593 Pawai Place, Kailua -Kona, HI 96745 (808) 935 -3794 bmenino@hopeserviceshawaii.org Name of Accountant/CPA (include name of firm if applicable): Gail Shioshita (808) 933 -6048 1315 Kalanianole Avenue, Hilo, HI 96720 CW Associates Phone No.: (808) 695 -4014 Mailing Address: 700 Bishop St., Suite 1040, Honolulu, HI 96813 -4124 Amount of Request for County Funds: $ 20,000.00 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $0 $10,000 $0 Agency Mission Statement: On October 1, 2010, the Office for Social Ministry, Care -A -Van Department of the Diocese of Honolulu, became HOPE Services Hawaii, Inc. (HOPE). HOPE manages the same services and programs to those most in need in our community with the same dedicated staff and support from the Diocese of Honolulu. Bishop Larry Silva remains committed to helping the homeless and the incorporation of the Care -A -Van Department into HOPE Services Hawaii, Inc. will allow us to be more visible in our community and be more effective in our delivery of services. HOPE's mission is to bring to life the gospel values of justice, love, compassion and hope through service, empowerment, and advocacy. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 HOPE Services Hawaii, Inc. West Hawaii Emergency Housing Program Program Description: The County of Hawaii completed the construction of the West Hawaii Emergency Housing Facility and hosted a blessing and grand opening on October 18, 2010. Soon thereafter, HOPE Services Hawaii gained fiscal and operational responsibilities of the West Hawaii Emergency Housing Facility. This facility was added to the Campus of "The Friendly Place" and expands the efforts of the Drop In Center at 74- 5593 Pawai Place in Kailua -Kona. The County of Hawaii completed the construction of the facility and hosted a blessing and grand opening of this facility on October 18, 2010. This program provides emergency housing for up to 31 individuals at one time. The West Hawaii Emergency Housing Program will be a service- enriched emergency shelter for single individuals experiencing homelessness, with a target stay of no more than 6 months. Due to the high cost of living in West Hawaii and the uncertainty of economic times, program participants will be offered six months to work towards gaining employment, and permanent rental housing. During the duration of the program, life skills workshops and house meetings are facilitated on -site to better prepare participants to live independently. Life skills workshops include budget management, a comprehensive renter's education program, communication, relationships, goal setting, and informational meetings and presentations about community resources. This program is a critical resource for the community as there is no other emergency housing program in West Hawaii for single men and women experiencing homelessness. This is the first of its kind. The emergency shelter is open 365 days a year for 15 hours a day, 7 days a week, opening at 5pm each night and closing at 8am each morning. The emergency shelter is staffed 15 hours a day. The West Hawaii Emergency Housing program is a service- enriched emergency shelter program with its ultimate goal to assist individuals move into permanent housing and work towards becoming self- sufficient. Additional case management services are provided in partnership mental health providers and HOPE's Outreach Specialists at the Drop -In Center. Target Group Single men and women who are experiencing homelessness, include the unsheltered homeless, those living in emergency and transitional housing programs /shelters, and those at -risk of homelessness with a 45 -day eviction notice willing to stay clean and sober and seek outpatient treatment if applicable. Total Budget and Position Count Total Program Bud et 414,168 Total Program Position Count 6 Total Agency Bud et 4,086,858 Total Agency Position Count 62 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 HOPE Services Hawaii, Inc. West Hawaii Emergency Housing Program Program Objectives: For FY11 -12: 1. Provide 50 unduplicated individuals with emergency housing and case management services; 2. Maintain clean and sober housing for 100% of program participants; 3. Assist 50% of program participants in obtaining transitional or permanent housing; 4. Assist 50% of program participants in obtaining employment (ex. Seasonal, part -time of full- time); 5. Assist 25% of program participants to enroll in training or education programs (examples: job- readiness programs, obtain a GED, higher education); 6. Assist 25% of program participants' access mental health and substance use treatment, supportive services or after -care programs. Program Highlights from July 1, 2010 — January 15, 2011: 1. Kona Outdoor Circle: A memorandum of agreement was entered with KOC to plan, design and install a container garden on site as the County's budget for landscaping was eliminated. With the sponsorship of supplies and materials by area businesses and a grant from Hauoli Mau Loa (through Office for Social Ministry) and volunteer labor from current residents and homeless persons and KOC volunteers, under the direction of KOC master designer students, and beautiful garden was developed. 2. Staffing the Emergency Housing Program: Two (2) full -time staff and two (2) part time staff were hired to operate this emergency housing program. Three of four staff are individuals who were either previously homeless and /or were previously incarcerated. 100% of staff have experienced residential living in a homeless program and /or have worked at residential programs previously. HOPE believes in employing individuals making a demonstrated effort in improving their lives and lifestyles. Staff is supervised and mentored by Homeless Programs Manager Paulla DeMello, a certified substance abuse counselor, and Josephine Ibarra, Community Relations Director, a veteran and experienced advocate for the homeless for nearly fifteen (15) years. 3. Furnishing the Facility: The site was furnished with brand new appliances — refrigerator, two ranges & ovens, and 31 units with a single bed, apartment sized refrigerator, microwave, portable table and chair, and portable clothing rack. The facility is equipped with six cameras to help monitor the safety and security of the building. Residents are monitored and mentored in completing their assigned kuleana (responsibility) in cleaning and maintaining the facility. Upon program entry, residents are provided with an XXL Ziploc bag with a towel, washcloth, blanket, bath robe, single sheet set, and covered pillow. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 HOPE Services Hawaii, Inc. West Hawaii Emergency Housing Program Performance Measures: * If applicable Program Expenditures FY 2008- FY2009- FY 2010 -11 FY 2011 -12 Salaries and Wages 09 Actual 10 Budget Estimate Estimate Professional Fees * 1. No. of unduplicated participants N/A 20 30 50 served and provided emergency 10,000 shelter 2. No. of unduplicated participants N/A 2 15 20 exited to transitional or permanent housin 3. No. of unduplicated adults in need N/A 5 10 15 of substance abuse treatment enrolled in a phase of such p rogram 4. No. of unduplicated participants in N/A 7 15 20 need of mental health services accessing such services 5. No. of duplicated participants N/A 7 15 20 enrolled in training or education program (e.g. GED, job training, etc. 6. No. of unduplicated participants N/A 7 15 15 obtained employment * If applicable Program Expenditures If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY 2008 -09 Actual * FY 2009 -10 Actual * FY 2010 -11 Budget FY 2011 -12 Estimate Salaries and Wages 117,705 289,941 Professional Fees Operations 95,147 124,227 Equipment 10,000 Other* Total 222,852 414,168 If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 HOPE Services Hawaii, Inc. West Hawaii Emergency Housing Program Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 Actual * FY 2009 -10 Budget * FY 2010 -11 Estimate FY 2011 -12 Estimate Hawaii Public Housing Authority — DHS Stipend 114,608 250,000 Emergency Shelter Grant 44,792 44,792 Supportive Housing Grant 17,412 24,376 Hawaii Community Foundation 9,000 10,000 County of Hawaii 20,000 Hawaii Island United Way 10,000 10,000 Program Fees 12,040 45,000 Fundraising 5,000 10,000 Total 212,852 414,168 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? We plan to take a four prong approach this year to become self- sustaining. They are: 1. Pursue further fundraising efforts including direct mail; "friend raise;" ask individuals and parishes for donations of time, talent and treasures; coordinating a special event and participating in the West Hawaii Civic Center's Brick Project. 2. Expand our volunteer program by increasing volunteer opportunities. 3. Increase donations of necessary program supplies to decrease operational costs. 3. Seek partnership with West Hawaii Health Center to explore medicare /medicaid reimbursement options to provide emergency housing for our common patients (residents of the emergency housing program) experiencing homelessness. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 HOPE Services Hawaii, Inc. West Hawaii Emergency Housing Program I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2 -1422, Hawai'i County Code, relating to Appropriation of Funds to nonprofit organizations. (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplies herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board Pre pnt/Chair Signature of Executive Director Date ` 11,2 7/�-0 // Date UNSIGNED PROPOSALS WILL NOT BE ACCEEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 55 Hui Malama Ola Na 'Oiwi Kokua Hali Health Transportation Program Hui Malama Ola Na 'Oiwi —Agency Name COPY K6kua Hali Health Transportation Program — Program Name Agency Director: Michelle Hiraishi Phone: 808.969.9220 ext.201 Contact Person: Kelsey Hiraishi Mailing Address: 69A -3 Railroad Ave Hilo, HI 96720 Facility /Site Address: 69A -3 Railroad Ave Hilo, HI 96720 Fax: 808.961.4794 Email Address: Kelsey@ huimalamahawaii.com Name of Accountant /CPA Firm: CW Associates Phone: 808.861.1174 Mailing Address: Topa Financial Center 700 Bishop St, Ste 1040 Honolulu, HI 96813 Phone: 808.969.9220 ext.202 Amount of Request for County Funds: Prior Year(s) Funding: 08 -09 09 -10 $0 $0 Agency Mission Statement: Makou 'o Hui Malama Ola Na 'Oiwi Keia ko makou kuleana: Ho'oulu ola o ka lahui Hawai'i Keia ka mana'o: Malama moku o Keawe Malama na kua'aina Malama kou kino Malama na mea Hawai'i 'Ike makou papalua ikaika ola ka lahui Hawai'i. $ 20,00 10 -11 $20,000 We are the group that takes care of the health of Hawaiian people. Our mission is: To uplift the health of the Hawaiian nation We will: Take care of Hawai'i Island Take care of country and rural areas Take care of your physical, spiritual, and mental body Take care of Hawaiian culture and practices We envision a strong and healthy Hawaiian nation NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Hui Malama Ola Na 'Oiwi —Agency Name Kokua Hali Health Transportation Program — Program Name Program Description: Hui Malama Ola Na 'Oiwi (HMON'(D), the Native Hawaiian Health Care System for Hawai'i Island, is a 501 (c) 3 nonprofit organization designated through the Native Hawaiian Health Care Improvement Act of 1988, Public Law 100 -579. Incorporated in 1991, the agency's basic thrust is to provide access to health services for the island's Native Hawaiian community. Accessibility to health care on Hawai'i Island remains a huge disparity for Native Hawaiian residents. With 40 permanent staff in five locations around the island in Hilo, Pahoa, Ka'u, Kona, and Waimea, HMON'O provides primary care, medical transportation, health care monitoring, education and support to enhance the quality of life of Native Hawaiians and their families. HMON'O is requesting funding from the County of Hawai'i for fiscal year 2011 -2012 to continue "Kokua Hali" health transportation program to provide access to essential health care on the island for the agency's mobility challenged target population. HMON'O currently operates a medical transportation fleet of 10 vehicles island -wide including a four - wheel -drive van equipped with an automatic lift for mobility disadvantaged clients. The specialized vehicle has allowed HMON'O to expand services to wheelchair and limited mobility clients around the island who could not benefit from the agency's current transportation program. With four - wheel -drive capability, HMON'O has provided this specialized service to clients living in more rural areas like Hawaiian Acres, Hawi, Opihika'o, Na'alehu as well as clients living in the Hilo community where many of the roads are unpaved and where access is particularly difficult after heavy rains wash away gravel. Previous years funding allowed HMONO to hire and retain a designated driver who has coordinated deployment schedules with each of our site location staff to provide door -to -door transportation for registered clients to get them to and from physician, diagnostic lab, pharmacy, dialysis, and other health - related appointments. HMON'O prides itself in perpetuating local values of "ho'okipa (hospitality) and ho'omalimali (soothe and flatter) each client as they often are faced with the health stressors that increase their anxiety and reluctance to take the steps to seek medical health care. Our Transportation Specialist will accompany and assist clients from time of pick -up to drop -off to make sure they arrive safely and on time. As a secondary function, this Transportation Specialist would serve as a backup driver between the different HMON'O sites to accommodate spikes in demand for health - related transportation. HMON'O's transportation service operates Monday through Friday by appointment only with scheduling flexibility to accommodate client needs. The Need: The need for the Kokua Hali continued transportation services has not changed much in Hawai'i County as our island continues to be designated a medically underserved community with a shortage of providers in rural areas.' Increasing access to medical services on the island is of particular concern to Hawai'i County because of its large geographic area, low population density, higher poverty rates, limited public transportation, and aging population! U. S. Census Bureau data shows Hawai'i County's resident population at 175,785 in 2008. 3 24 239 or 13.8% were elderly, age 65 or older .4 By 2030 that number is projected to reach nearly 20 %, meaning 2 U.S. Department of Health and Human Services Health Resources and Services Administration, Health Provider Shortage Area, September 30, 2009 Center on the Family Data Center, Comparative Data, Hawai'i County, Census 2000, September 30, 2002 a U.S. Census Bureau: State and County Quick Facts, November 17, 2009 ° U.S. Census Bureau: State and County Quick Facts, November 17, 2009 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Hui Malama Ola Na 'Oiwi — Agency Name Kokua Hali Health Transportation Program — Program Name one out of every five individuals will be age 65 or older. In comparison, in 1970, one out of every 17 individuals was aged 65 or older. Like the state, and the nation as a whole, Hawai'i County is graying, and as residents age, one of the most dramatic changes is an increased demand for medical services compounded by degenerating mobility, presenting a need for specialized transportation.' The aging population served in the FY 2010 -2011 continues to show the use of the Kokua Hali ADA accessible van being utilized on a daily basis. We have encountered situations in the current year where we could not accommodate transports due to van capacity. We have also observed the effect of those clients that are mobility challenged with multiple diagnosed chronic diseases and facing enormous risk factors that leaves them minimal options to get to the doctor. The need is apparent with limited transportation services on the island available for clients. In an average month, HMON'O ADA van currently transports 12 mobility challenged clients with an average of 750 legs or stops for appointments. 80% of HMON'O's mobility challenged clients or 17 clients that has used this service are over the age of 50 years of age since it began in July of 2010. Our elderly population will be faced with additional health care issues as the congressional climate has potential to impact them negatively. HMON'O's five offices around the island continue to received inquiries or requests for health transportation from transportation and mobility disadvantaged clients using wheelchairs or walkers. The agency continues to have active registered clients who will readily benefit from the specialized transportation service, and several live in rural areas requiring four-wheel - drive access. The Response: To address the issue of access to health care on the island for transportation disadvantaged clients, HMON'0's Kokua Hali Health Transportation Program will continue to find every avenue to retain funding for the designated Transportation Specialist to coordinate and provide transportation for clients island -wide who are also mobility disadvantaged. County funding in the current year has proven to be wisely allocated and showing an impact on caring for this target population. HMONO has also seen an increase in enrollment for many of our health education and support groups with a growing population of mobility challenged individuals who now feel comfortable to take advantage of transportation. Especially for residents of more remote areas like Puna, Ka'u, and South Kona, a passenger trip commonly starts with a client being picked up at his home then taken to a physician's visit followed by a diagnostic lab screening and a stop at the pharmacy before returning home. As evidenced in HMON'O transportation logs, a single trip with multiple destinations (transports) like the one described can take up to six hours long. For mobility disadvantaged transports, trip duration is further extended by the additional time required for loading and unloading multiplied by the number of stops a client needs to make. A designated Transportation Specialist for specialized transports has and will ensure continued efficient operation of the Health Transportation Program without negatively impacting HMON'O's capacity to serve clients who are not mobility disadvantaged but need transportation service. With HMON'0's current and anticipated increases in ridership as a result of the agency's (and the broader community's) aging population as well as the agency's expanding health care services around s Health Trends in Hawai'i, A Profile of the Health Care System, Demographics, Elderly Growth Population, Projections s Health Trends in Hawai'i, A Profile of the Health Care System, Demographics, Elderly Growth Population, Projections ' Administration on Aging, 2010, Profile of Older Americans NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Hui Malama Ola Na 'Oiwi — Agency Name Kokua Hall Health Transportation Program — Program Name the island, HMON'O is developing capacity to meet projected demand to ensure clients have professional and reliable transportation to access health care they need. Total Budget and Position Count Total Program Budget $258,310 Total Program Position Count 6 Total Agency Budget $2,808,316 Total Agency Position Count 40 Program Objectives: Hui Malama Ola Na 'Oiwi's Kokua Hali Health Transportation Program will achieve the following objectives in fiscal year 2011 -2012: Objective 1: Increase access to health care on the island for mobility disadvantaged clients. a. Register 25 new wheelchair and limited mobility clients for health transportation service. b. Schedule and provide a minimum of 1050 wheelchair and limited mobility transports. Objective 2: Increase access to health care on the island for transportation disadvantaged clients, including non - drivers and individuals without access to automobiles or adequate transit services. a. Register 90 new clients for health transportation service. b. Schedule and provide a minimum of 8500 transports. Program Highlights: (from Fiscal Year 2010 -11) Hawaii County grant funding for the current fiscal year 2010 -2011 allowed HMON'O to recruit and retain a designated ADA van Transportation Specialist From July 1 to December 31, 2010, Hui Malama Ola Na 'Oiwi (HMON'(D) reported registration of 21 unduplicated mobility challenged clients in the first 2 quarters of the year with clients from Kohala, Kona, Ka'u, Hilo and Puna taking advantage of the transport services with 4500 transport legs during this period. The Kokua Hali Program has also assisted the growing need to transport clients to and from medically related appointments when our normal transportation vans were totally booked. It is anticipated that HMONO will meet the projected income based on the County of Hawaii's funding allocation. A total of 7 clients are wheelchair bound, 5 clients that use a wheelchair for transports but may fluctuate to a walker at times pending their current level of functioning and 11 clients who are challenged with walkers, canes, size and those dealing with physical limitations that require as much support when traveling. The successes and testimonials have included those clients who have taken advantage of this specialty service and actually made improvements in their health that has served as a means to positively increase their mobility capacity. One client began totally dependent on a wheelchair for mobility and demonstrated an increase in positive self concept and as she received the necessary medical care, attended health education classes and has become an active member of our diabetes support group. By having accessibility to these activities she has motivated herself to strengthen her muscles in her legs and hips and the result is? She is currently walking daily. She continues to use this service as needed but has been empowered to set goals with her physician to continue on this trend. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Hui Malama Ola NS'Oiwi — Agency Name Kokua Hali Health Transportation Program — Program Name Another highlight of our transportation program specific to the ADA van is the transport of 4 clients in the past 6 months that were over the weight of 300 lbs. There thankfulness for this vehicle and caring staff resonates within our organization and reminds us of our mission and the reasons "why' we are here in the first place... Malama (Care for) the people of our island communities. In addition to our ADA accessible transportation services, our sites around the island continues to be very busy providing transports for all other community residents needing transports to medically related appointments and needs. Performance Measures: Program Expenditures FY 2009 -10 FY2010 -2011 FY 2011 -12 Salaries and Wages Actual Estimate Estimate Professional Fees 0 (From Feb 0 Operations 51,955 2010) $52,975 Objective 1: Increase access to health care on the 0 0 0 island for mobility disadvantaged clients. 15,390 $14,553 $14,553 a. Register 25 new wheelchair and limited mobility 10 25 25 clients for health transportation service. b. Schedule and provide a minimum of 1050 125 1050 1050 wheelchair and limited mobility transports. Objective 2: Increase access to health care on the island for transportation disadvantaged clients, including non - drivers and individuals without access to automobiles or adequate transit services. a. Register 90 new clients for health transportation 60 90 90 service. b. Schedule and provide a minimum of 8108 6701 8108 8500 transports. Program Expenditures Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual FY2010 -11 Budget FY 2011 -12 Estimate Salaries and Wages $152 $190,782 $190,782 Professional Fees 0 0 0 Operations 51,955 $52,975 $52,975 Equipment 0 0 0 Other —Auto Insurance 15,390 $14,553 $14,553 Total $219,585 $258,310 $258,310 Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual FY2010 -11 Budget FY 2011 -12 Estimate U.S. Department of Health and Human Services $219,585 $238,310 $238,310 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Hui Malama Ola Na `Oiwi — Agency Name Kokua Hali Health Transportation Program — Program Name Health Resources Services Administration (HRSA) Hawai'i County Grant 0 $20,000 $20,000 Total $219,585 $258,310 $258,310 Future Program Support: Hui Malama Ola Na 'Oiwi (HMON'O) is focusing on the following approaches to increase revenues to sustain its Kokua Hali Health Transportation Program: 1. HMON'O has entered into discussion with insurance companies in an effort to collect reimbursements from Medicaid and health insurance providers for non - emergency medical transportation services in order to capture billed revenue to subsidize operating expenses. 2. HMON'O plans to collaborate with West Hawaii Community Health Center and Hamakua Health Center in subsidizing the operational cost that can be enhance their efforts to provide a continuum of care for those patients requiring some form of diabetes management education classes. Resources in qualified staff form both community health centers and HMON'O can only serve to compliment program services to our west Hawaii communities. 3. As one of the five Native Hawaiian Health Care Systems throughout the state, HMON'O continues to be part of a statewide resource development workgroup consisting of representatives from each system. The primary objective of the workgroup is to explore and develop a comprehensive fund development strategy that looks at sustainability via annual donor campaigns, foundation and government grants, endowments, and planned giving. HMON'O is anticipating federal budget cuts and is currently increasing the fundraising efforts as an organization as well as assessing each programs unique impact on our communities and finding the necessary funds specific to continuing and mirroring programs that are working and showing positive health outcomes. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Hui Malama Ola Na 'Oiwi — Agency Name Kokua Hali Health Transportation Program — Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board Chair Signature of Executive Director Date "? 14 - C) 1 Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 56 Hui Malama Ola Na 'Oiwi Mai Ka Malawi Diabetes Management Program Hui Malama Ola Na `Oiwi — Agency Name Mai Ka Mala'ai Diabetes Management Program — Program Name Agency Director: Michelle Hiraishi Phone: 808.969.9220 ext.201 Contact Person: Kelsey Hiraishi Phone: 808.969.9220 ext.201 Mailing Address: Facility /Site Address: Fax: Email Address: 69A -3 Railroad Ave Hilo, HI 96720 69A -3 Railroad Ave Hilo, HI 96720 808.961.4794 kelsev @huimalamahawaii.com Name of Accountant /CPA Firm: CW Associates Phone: 808.861.1174 Mailing Address: Topa Financial Center 700 Bishop St, Ste 1040 Honolulu, HI 96813 Amount of Request for County Funds: $31 Prior Year(s) Funding: 08 -09 09 -10 0 $0 Agency Mission Statement: Makou 'o Hui Malama Ola Na 'Oiwi Keia ko makou kuleana: Ho'oulu ola o ka lahui Hawaii Keia ka mana'o: Malama moku o Keawe Mama na kua'aina Malama kou kino Malama na mea Hawai'i 'Ike makou papalua ikaika ola ka lahui Hawai'i. 10 -11 $0 We are the group that takes care of the health of Hawaiian people. Our mission is: To uplift the health of the Hawaiian nation We will: Take care of Hawai'i Island Take care of country and rural areas Take care of your physical, spiritual, and mental body Take care of Hawaiian culture and practices We envision a strong and healthy Hawaiian nation NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 1 Hui Malama ON Na `Oiwi — A2ency Name Mai Ka Mala'ai Diabetes Management Program — Program Name Program Description Hui Malama Ola Na 'Oiwi (HMON'O), the Native Hawaiian Health Care System for Hawaii Island, is a 501 (c) 3 nonprofit organization designated through the Native Hawaiian Health Care Improvement Act of 1988, Public Law 100 -579. Incorporated in 1991, the agency's basic thrust is to provide access to health services for the island's Native Hawaiian community. Accessibility to health care and available diabetes education opportunities on Hawai'i Island remains a huge disparity for Native Hawaiian residents. With 40 permanent staff in five locations around the island in Hilo, Pahoa, Ka'u, Kona, and Waimea, HMON'O provides primary care, medical transportation, health care monitoring, education and support to enhance the quality of life of Native Hawaiians and their families. HMONO's Diabetes Management Program, Mai Ka Mala'ai (From the Garden) is comprised of 10 weeks of classes, 1 time a week for approximately two and a half hour per class session. This ten week curriculum integrates sustainable fruit and vegetables garden box with the planting expertise as a guide for all participating families with nutrition education in each of the ten week sessions. Diabetes specific education is merged into a host of community health professionals that come to each class and share their profession and the relationship to management of diabetes. Professionals would include a podiatrist for foot care, optometrist for eye care, dentist for dental care, local physicians for kidney health, a mental health specialist for the emotional roller coaster often attributed to the diagnosed diabetics, a pharmacist for the most updated information and education on use of prescriptions to deal with diabetes, a registered dietician /nutritionist for healthy diet practices, advanced nutritional counseling and recipe modification and a motivational speaker to raise spirits and use tools that help each participant as they deal with their diabetes. Each participant completes pre and post screening of blood pressure, pulse oximeter reading, temperature, height and weight, BMI and HbA1c. Blood pressure and weight were completed weekly. Participants will return for a 3, 6 and 12 month follow -up screen. HMON'O is requesting funding from the County of Hawaii for fiscal year 2011 -12 to expand the Mai Ka Mala 'ai Program to residents in West Hawaii. The Need Diabetes is generally more common among the aging population. The proportion of Hawaii residents aged 65 years and older rose from 5% in 1970, to 8% in 1980 to 14% in 1999 (HMSA Foundation, 2001) and in 2008 Hawaii County statistics showed 14.5% of the island population were 65 years and older.` Therefore, the state of Hawaii faces great challenges due to the diabetes burden among its relatively large population of middle -aged and elderly citizens. From 2000 to 2002, on annual average, 8,185 Hawaii residents died at age 18 years or older, caused directly or indirectly by various kinds of diseases, injuries or poisoning, including 191 cases where diabetes was the underlying cause of death and 761 cases where diabetes was the contributory cause of death. In 2005 more than one third of all stroke and coronary heart disease hospitalizations were diabetes related. Hawaiians had the highest mortality rates for diabetes as the underlying cause of death (37), contributory cause of death (134) or the both (171), of all ethnic groups. HMONO has observed an increase in the number of diabetes diagnosed patients who have come in to our primary care clinic to visit our physicians and those diabetic patients who have registered and completed physician diabetes counseling and diabetes management classes. Patient feedback indicates an urgent need for patients to control their diabetes and have on -going opportunity to learn as much about diabetes 1 Department of Health: Hawaii Health Survey (HHS), 2008 Report. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 2 Hui Malama Ola Na `Oiwi —Agency Name Mai Ka Mala'ai Diabetes Management Program — Program Name as they can. In 2009 diabetic patients totaled 384 and physicians reported 316 diabetes related visits. In 2010 the number of newly diagnosed patients increased and the number of clinical encounters for diabetes doubled from 2009. We understand that this is reflective of patients under our Primary Care physicians and have witnessed referrals to our program from private physicians and Bay Clinic in East Hawaii. This growing trend increased the number of people signing up for our classes in East Hawaii where we have reached our capacity and a waiting list has been established. HMONO's request is to expand this program to the West Hawaii areas using county funds for staffing and program supplies. West Hawaii staff of HMONO has expressed the request of those patients served that wants diabetes management classes closer to their communities. The Response To address the need in management of diabetes for the growing diabetic population in Hawaii County, HMONO will organize and implement the Mai Ka Malawi Program for West Hawaii County residents. It is intended that a minimum of 3 group classes in Mai Ka Mala'ai be offered and completed in the fiscal year. Diagnosed diabetics will afford the opportunity to deal with the everyday health issues surrounding their chronic disease by increasing protective factors through established routines such as exercise, nutrition and diet intake, recognition of possible symptoms of diabetics in eye care, foot care and kidney care. We will address mental health issues of participants with possible mind -set and life skill tools to deal with emotions and stressors of disease in themselves, their families and friends. To address the risk factors related to the socio- economic crisis where many of our residents are unemployed, some homeless and little or no means to provide healthy meals, we will assist to implement cost effective garden areas using recycled pallets, maintaining healthy compose and using everyday natural products to create fertilizers as a means of self sustainable food produce for their families. In more detail, the 10 week curriculum consist of 2 sessions on sustainable gardening, 2 classes titled Diabetes 101 where the basic understanding of diabetes and other contributing health factors are shared by a diabetes specialist, 1 session on physical exercise, 1 session on foot care, 1 session on eye care, 1 session on mental health, 1 session on healthy diet practices & nutrition, 1 session on modifying recipes and 1 session on the various pharmaceutical medicines. Based on the dynamics and needs of each group HMONO has been very flexible in retaining local professionals who provide in -kind hours as presenters in the program. Each of our West Hawaii sites can provide transportation on a limited basis for class participants. Total Budget and Position Count TPro ram Bud et $52,901 Total Program Position Count 5 Total A enc Bud et $2,808,316 Total Agency Position Count 40 Program Objectives: Hui Malama Ola Na 'Oiwi's Mai Ka Mala'ai Program will be implemented in West Hawaii and achieve the following objectives in fiscal year 2011 -2012: Objective 1: Increase protective factors of those clients medically diagnosed with diabetes in management of their diabetes 1. Register 50 diabetes diagnosed participants living in the West Hawaii areas into the Mai Ka Mala'ai Program of which 45 will complete the 10 week class. 2. 100% of class participants wanting a garden box or similar will be provided with a box, soil and seedlings. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 Hui Millama Ola Ng `Oiwi — A2encv Name Mai Ka Mala'ai Diabetes Management Program — Program Name 3. 90% of class participants completing the 10 week class will demonstrate improvement in at least two health aspects screened and assessed in the program. 4. 80% of participants completing the class will complete a 3, 6 and 12 month follow -up screening and assessment. Program Highlights: (from Fiscal Year 2010 -11) Hui Malama Ola Na 'Oiwi's Kokua Hali Health Transportation Program funded by the County of Hawaii from July 1, 2010 thru June 30 , 2011 has reported registration of 21 unduplicated mobility challenged clients in the first 2 quarters of the year with clients from Kohala, Kona, Ka'u, Hilo and Puna taking advantage of the transport services with 4500 transport legs during this period. The Kokua Hali Program has also assisted the growing need to transport clients to and from medically related appointments when our normal transportation vans were totally booked. It is anticipated that HMONO will meet the projected income based on the County of Hawaii's funding allocation. Specific to the Mai Ka Mala 'ai Program implemented in East Hawaii in the calendar year 2010, A total of 58 participants completed the 10 week curriculum . Many of these participants had an accompanying family member who attended classes and supported the 'ohana centered value instilled in their respective families. A total of 3 groups or classes were completed with 95% of the clients demonstrating improvement in 2 areas of screening which included monitoring of blood pressure, total cholesterol levels, HBA1c, blood glucose levels, 02 count, weight loss and /or body mass index (BMI), fruit and vegetable intake and increase in daily physical exercise. Personal testimonies from participants has yielded only positive results with one aunty starting the class using a wheelchair and ending the class using a walker with amazing changes in healthy baseline numbers. Currently this aunty is using a walking cane from time to time and has strengthened her leg muscles by walking daily for 30 -60 minutes. Another aunty has helped organize and self perpetuate the newly formed diabetes support group. This group meets every other Wednesday and has outgrown our facility at times with 30 -35 in attendance. This group meets to continue the need for support systems and continued reassurance that alone it is difficult but as a group they are motivated to manage their diabetes. The significance of this highlight is the majority of clients see the support group as a continuum from their Mai Ka Mala 'ai class. Over the years this program has graduated 250 clients with groups 13, 14 and 15 graduating in 2010. A total of 42 garden boxes, 43 planter boxes and 8 round planters were delivered to clients as their own Iohana's "mold" (garden). A total of 13 clients from previous groups had follow -up visits by staff and community professionals who repaired and gave credible guidance to maintain and for some restore their malas. Professor Bill Sakai from the University of Hawaii /Hilo agriculture department honored our program with his presence at classes and on home visits to enhance growth of garden produce, proper fertilizing and dealing with pest and possible deficiencies in the growth process. In summary, it is our belief that we have a Mai Ka Mala'ai program that is very successful in management of diabetes and self empowerment. Expanding this program into West Hawaii is a vital piece in building healthier communities here on the island of Hawaii. Performance Measures NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 FY 2009 -10 Actual FY2010 -11 Estimate FY 2011 -12 Estimate Objective: Increase protective factors of those clients NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 Hui Malama Ola Na `Oiwi — Agency Name Mai Ka Mala'ai Diabetes Management Program — Program Name medically diagnosed with diabetes in management of FY 2009 -10 Actual (East Hawaii) FY2010 -11 Budget (East Hawaii) FY 2011 -12 Estimate (East& West Hawaii) their diabetes $8941 $22,398 $31,740 1. Register 50 diabetes diagnosed participants $1176 $750 0 living in the West Hawaii areas into the Mai Ka N/A N/A 50/45 Mala 'ai Program of which 45 will complete the In supplies this FY $7,900 $12,400 10 week class. 0 $266 $500 2. 100% of class participants wanting a garden $1675 $1,000 $4,341 box or similar will be provided with a box, soil N/A N/A 100% and seedlings. 3. 90% of class participants completing the 10 week class will demonstrate improvement in at N/A N/A 41 least two health aspects screened and assessed in the program. 4. 80% of participants completing the class will complete a 3, 6 and 12 month follow -up N/A N/A 36 screening and assessment. Program Expenditures Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual (East Hawaii) FY2010 -11 Budget (East Hawaii) FY 2011 -12 Estimate (East& West Hawaii) Salaries and Wages $8941 $22,398 $31,740 Professional Fees $1176 $750 0 Office /Program Supplies $9782 $4,481 $3,920 Clinical Supplies In supplies this FY $7,900 $12,400 Gas & Oil 0 $266 $500 Other — Travel /Meetings/ In Kind materials $1675 $1,000 $4,341 Total $21,574 $36,795 $52,901 Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -30 Actual FY2010 -2011 Budget FY 2011 -12 Estimate U.S. Department of Health and Human Services Health Resources Services Administration (HRSA) $21,574 $35,795 $19,332 Hawai'i County Grant 0 0 $31,328 In Kind contributions (UH H Agriculture Department) 0 $1000 1 $2241 Total $21,574 $36,795 1 $52,901 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 5 Hui Malama Ola Na `Oiwi — Agency Name Mai Ka Mala'ai Diabetes Management Program — Program Name Future Program Support Hui Malama Ola Na 'Oiwi (HMON'O) will follow through with the following plan to increase revenues to sustain the Mai Ka Mala'ai Diabetes Management Program: 1. HMON'O is currently in process of getting approval of this program to collect reimbursements from health insurance providers for health education reimbursements that meet the criteria and captures billed revenue to subsidize program expenses. 2. HMON'O plans to shift cost in supplies from funded to recycled materials, business donations, community support and align program with innovative and traditional means to avoid the need for funding. 3. HMON'O plans to collaborate with West Hawaii Community Health Center and Hamakua Health Center in subsidizing the operational cost that can be enhance their efforts to provide a continuum of care for those patients requiring some form of diabetes management education classes. Resources in qualified staff form both community health centers and HMON'O can only serve to compliment program services to our west Hawaii communities. 4. As one of the five Native Hawaiian Health Care Systems throughout the state, HMON'O continues to be part of a statewide resource development workgroup consisting of representatives from each system. The primary objective of the workgroup is to explore and develop a comprehensive fund development strategy that looks at sustainability via annual donor campaigns, foundation and government grants, endowments, and planned giving. HMON'O is anticipating federal budget cuts and is currently increasing the fundraising efforts as an organization as well as assessing each programs unique impact on our communities and finding the necessary funds specific to continuing and mirroring programs that are working and showing positive health outcomes. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 6 Hui Malama ON Na `Oiwi — Agency Name Mai Ka Mala'ai Diabetes Management Program — Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawal'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board Chair �v vl Signature of Executive Director Date - /_�/ Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 57 Hui Malama Ola Na 'Oiwi No Ka Wahine: Cancer Program Agency Director: Contact Person Mailing Address: Facility /Site Address: Fax: Email Address Hui Malama ON NA `Oiwi — Agency Name COPY No Ka Wahine: Cancer Program — Program Name Michelle Hiraishi Phone: 808.969.9220 ext.201 Kelsey Hiraishi 69A -3 Railroad Ave Hilo, HI 96720 69A -3 Railroad Ave Hilo, HI 96720 808.961.4794 kelsey @huimalamahawaii.com Name of Accountant /CPA Firm: CW Associates Phone: 808.861.1174 Mailing Address: Topa Financial Center 700 Bishop St, Ste 1040 Honolulu, HI 96813 Phone: 808.969.9220 ext.202 Amount of Request for County Funds: $20,000 Prior Year(s) Funding: 08 -09 09 -10 0 $0 Agency Mission Statement: Makou 'o Hui Malama Ola Na 'Oiwi Keia ko makou kuleana: Ho'oulu ola o ka lahui Hawaii Keia ka mana'o: Malama moku o Keawe Malama na kua'aina Malama kou kino Malama na mea Hawaii 'Ike makou pipilua ikaika ola ka lahui Hawai'i. 10 -11 $0 We are the group that takes care of the health of Hawaiian people. Our mission is: To uplift the health of the Hawaiian nation We will: Take care of Hawai'i Island Take care of country and rural areas Take care of your physical, spiritual, and mental body Take care of Hawaiian culture and practices We envision a strong and healthy Hawaiian nation NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 1 Hui Malama ON Na `Oiwi — Aeency Name No Ka Wahine: Cancer Program — Program Name Program Description Hui Malama Ola Na 'Oiwi (HMON'O), the Native Hawaiian Health Care System for Hawai'i Island, is a 501 (c) 3 nonprofit organization designated through the Native Hawaiian Health Care Improvement Act of 1988, Public Law 100 -579. Incorporated in 1991, the agency's basic thrust is to provide access to health services for the island's Native Hawaiian community. Accessibility to health care and available diabetes education opportunities on Hawaii Island remains a huge disparity for Native Hawaiian residents. With 40 permanent staff in five locations around the island in Hilo, Pahoa, Ka'u, Kona, and Kohala /Waimea, HMON'O provides primary care, medical transportation, health care monitoring, education and support to enhance the quality of life of Native Hawaiians and their families. Hui Malama Ola Na'Oiwi (HMON'O), the Native Hawaiian Health Care System for Hawaii County, has established the 'No Ka Wahine' Program focused on breast health and cancer prevention education aligned with cancer patient navigation for Native Hawaiian, Pacific Islander, and Filipino men and women and their Iohana. The No Ka Wahine Program services provide breast health and breast cancer education, limited emergency medical assistance for clinical screening and exams, resources for cancer diagnosed women, and follow -up support assistance by HMON'O's trained cancer patient navigators. An established referral process is in place for services in this program. It is our belief that early detection is the key to prevention and management of cancer and all chronic diseases. Cancer Patient Navigators (CPN) have been trained to assist registered patients in most aspects of health education and the stringent processes of screening services, health insurance coverage, transportation and follow -up services for advanced screening and treatment. The No ka Wahine Program implements a knowledge based understanding of diagnosed cancer, tobacco use and dangers of smoking, patient- centered planning for tobacco cessation and provides each participant with 1 to 1 and group opportunity in dealing with the fears and anxiety that comes with cancer prevention and diagnosis. This program integrates both a preventative and intervention based model that is aimed to reduce risk factors contributing to probability of cancer and a much needed support and advocacy by Cancer Program Manager and CPNs for each cancer program participant. This program may not have quantitative statistics but the qualitative impact of those that participate is worth the time, money and effort. HMON'O is requesting funding from the County of Hawai'i for fiscal year 2011 -12 to partially fund the Cancer Program Manager position. The Need Cancer is the first leading cause of death for Hawaiian women, and the second leading cause of death for Hawaiian men. Cancer can be caused by a variety of external, internal, and lifestyle factors. Many types of cancers do not have noticeable symptoms. This is one reason why it is very important to take part in regular cancer screenings. People are at greatest risk for developing cancer if they smoke, drink an average of 2 or more alcoholic drinks daily, do not get daily physical activity, or eat a lot of fast food or high fat foods. Statistically, not only do Native Hawaiians have the highest rates of cancer, they also have the lowest survival rates. The most common cancers among Native Hawaiian women are cancers of the lung, breast, colon and rectum. The most common types of cancer for Hawaiian men are cancers of the lung, colon and rectum, and prostate. Nearly 90% of all lung cancer deaths can be linked to tobacco use, and about 1 in 5 Hawaiians smoke tobacco on a daily basis. Many Native Hawaiians delay screening, diagnosis and NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 2 Hui Malama Ola Na `Oiwi — Aizency Name No Ka Wahine: Cancer Program — Program Name treatment, due to the inaccessibility of healthcare. As a result, morbidity rates due to cancer are disproportionately large for this ethnic group. American Cancer Society notes that much of the suffering and death from cancer could be prevented by more systematic efforts to reduce tobacco use, improve diet and physical activity, and expand the use of established screening tests. Regular use of established screening tests can prevent the development of cancer by finding and removing pre - malignant abnormalities; screening tests can also improve survival by detecting cancer at an early stage when treatment is more effective. The five -year relative survival rate for all cancers for Native Hawaiians is 47 %, compared with 57% for Caucasians and 55% for all races. Native Hawaiians with Cancer rates third in Hawaii in comparison to other ethnicities. It is important to note that many contributing factors can prevent the incidence of Cancer. Tobacco use, maintaining a healthy weight and regular physical activity can prevent many types of cancer. Early detection through screening increases the survival rate. The Department of Health's "The Burden of Cardiovascular Disease 2007" report showed Native Hawaiians with the highest proportion of smokers in the state. The island of Hawaii also reported the highest percentage of smokers in the state. Tobacco use has contributed to cardiovascular disease which in turn has resulted in shortening the lifespan of Native Hawaiians. Combine the fact that smoking has been linked in research directly to increasing the likelihood of heart disease and cancer; it is one of the most deadly risk factors due to its easy availability. Hawaii has seen a decrease in tobacco use in adult (15 %) and youth (13 %) between 1990 and 2008. Hawaii is close to meeting the Healthy People 2010 goal of 12% and is still one of the lowest tobacco use states. The concern HMONO has is the contributing smoking factor of our Native Hawaiian population and the associated risk and direct relationship to the multiple risk factors that haunt our population. One can say that combination of all the risk factors that Native Hawaiians are diagnosed with will only lead to a shorter quality of life. The Response Hui Malama Ola Na 'Oiwi will address the need for tobacco prevention and cessation aligned with cancer patient navigation for those clients diagnosed with cancer. The Tobacco Prevention and Cessation curriculum "Ho'ola Hou" will implemented by our Cancer Program Manager to each of our 5 sites around the island. Each participant will complete a 6 session education class where knowledge based information are discussed, goals are set and monitored and possible strategies are shared to quit smoking, Consultation will be provided by our Cancer Program Manager for each participant and their families. Ho'ola Hou is 1 of the components of the No Ka Wahine Program, the 2 "d being direct services for diagnosed cancer clients. The spectrum in cancer navigation is quite wide as many diagnosed patients are taken by surprise and do not know what to do to help themselves. Our Cancer Program Manager, Leimomi Shearer, completed 'Imi Hale, Native Hawaiian Cancer Network 'Cancer Patient Navigator' certification. As a result of her certification, Leimomi was instrumental in training each of our Health Enhancement Program Outreach staff in patient navigation. Hui Malama Ola Na 'Oiwi currently staffs nine cancer navigators who possess skills in providing technical assistance to cancer program participants. Hui Malama Ola Na 'Oiwi will continue to build relationships with community agencies and entities on Hawai'i Island such as the American Cancer Society and BCCCP health providers. Patient navigation has increased referral of program participants to appropriate community support and assistance for our participating women. In addition, Hui Malama Ola Na 'Oiwi provided Breast Health Care Education at numerous Health Fairs and Women's Wellness events here on Hawai'i Island. 1 Health Trends in Hawaii: A Profile of the HealthCare System NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 3 Hui Malama Ola Na `Oiwi — Agency Name No Ka Wahine: Cancer Program — Program Name Total Budget and Position Count Total Program Budget $58,334 Total Program Position Count 1 Total Agency Budget $2,808,316 Total Agency Position Count 40 Program Objectives: Hui Malama Ola Na 'Oiwi's No Ka Wahine Program will be implemented island -wide and achieve the following objectives in fiscal year 2011 -2012: Increase protective factors of those clients medically diagnosed with cancer in management of their cancer. 1. Register 10 cancer diagnosed participants into the No Ka Wahine Program. 2. The Cancer Program Manager will complete 100 one to one encounters with cancer diagnosed patients. 3. 100% of the emergency medical assistance fund will be allocated and spent in the screening and treatment of cancer diagnosed patients. 4. 80% of cancer diagnosed participants in the No ka Wahine Program will attend the cancer support group at least 4 times throughout the year. Increase protective factors of those enrolled and completing the Ho'ola Hou tobacco prevention and intervention class. 1. Register 30 participants into the Ho'ola Hou class. 2. 25 of the 30 Ho'ola Hou class will complete the 6 week class and participate in a 3 and 6 month follow -up session. 3. 25% of Ho'ola Hou class participants will quit smoking and maintain cessation up to the 6 month follow -up session. Program Highlights: (from Fiscal Year 2010 -11) The No Ka Wahine Program has been very busy this past year as our Cancer Program Manager has been working with 6 more recently diagnosed cancer patients. She has worked as well with a number of small groups and individuals on cancer education. The following chart depicts a breakdown of the categories of encounters performed in 2010. The Ho'ola Hou tobacco prevention and cessation classes have been conducted over the past year with a 20 class participants enrolled, 16 of which completed the 6 cessation sessions and a 3 and 6 month follow up. 4 class participants or 25% of the 16 clients completing the class have quit smoking as of their 6 month follow -up session. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 Number of People Served 97 Breast Cancer Education 6 Breast Cancers Detected 36 Clinical Breast Exams 1 Clinical Trials Education 45 Educational Materials Provided 35 Attendance at Cancer Support Group sessions 2 Referred for Diagnostic Services 2 Referred for Mammogram 2 Treatment Assistance The Ho'ola Hou tobacco prevention and cessation classes have been conducted over the past year with a 20 class participants enrolled, 16 of which completed the 6 cessation sessions and a 3 and 6 month follow up. 4 class participants or 25% of the 16 clients completing the class have quit smoking as of their 6 month follow -up session. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 4 Hui Malama ON Na `Oiwi — Agency Name No Ka Wahine: Cancer Program — Program Name Leimomi Shearer has been honored by the Imi Hale Cancer Institute over the past year for her advocacy for cancer navigation, serving as a state cancer advisory board member and being instrumental in cancer /tobacco health education delivery at numerous community and state health fair events in addition to her direct services to referred clients. Performance Measures Program Expenditures FY 2009 -10 FY2010 -11 FY 2011 -12 Salaries and Wages Actual Estimate Estimate Objective: Increase protective factors of those clients $19,813 $3,800 $1,460 medically diagnosed with cancer in management of $600 0 0 their cancer. $333 $459 $450 1. Register 10 cancer diagnosed participants into 3 12 10 the No Ka Wahine Program. 2. The Cancer Program Manager will complete 100 one to one encounters with cancer 25 100 100 diagnosed patients. 3. 100% of the emergency medical assistance fund will be allocated and spent in the 65% with carry 100% 100% screening and treatment of cancer diagnosed over to next FY patients. 4. 80% of cancer diagnosed participants in the No Ka Wahine Program will attend the cancer N/A 50% 80% support group at least 4 times throughout the year. Objective: Increase protective factors of those enrolled and completing the Ho'ola Hou tobacco prevention and intervention class. 1. Register 30 participants into the Ho'ola Hou 15 20 30 class. 2. 25 of the 30 Ho'ola Hou class will complete the 5 16 25 6 week class and participate in a 3 and 6 month follow -up session. 3. 25% of Ho'ola Hou class participants will quit smoking and maintain cessation up to the 6 3 25% or 4 6 month follow -up session. Program Expenditures NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 5 FY 2009 -10 Actual FY2010 -11 Budget FY 2011 -12 Estimate Salaries and Wages $44 $44,337 $43,174 Office /Program Supplies $19,813 $3,800 $1,460 Staff development $600 0 0 Gas & Oil $333 $459 $450 Other — NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 5 Hui Malama ON Na `Oiwi — A2ency Name No Ka Wahine: Cancer Program — Program Name Travel /Meetings $6,750 $262 $750 Emergency Medical Assistance $11,700 $21,500 $10,500 Administrative Fees $2,500 0 $2,000 Total $86,412 $70,358 $58,334 Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual FY2010 -2011 Budget FY 2011 -12 Estimate U.S. Department of Health and Human Services Health Resources Services Administration (HRSA) $40,238 $45,109 $11,747 Pap Ola Lokahi (Imi Hale) $25,474 $11,249 0 Komen for the Cure Grant $20,770 $14,000 $25,000 Hawai'i County Grant 0 0 $21,587 Total $86,412 $70,358 $58,334 Future Program Support Hui Malama Ola Na 'Oiwi (HMON'O) will follow through with the following plan to increase revenues to sustain the No Ka Wahine Cancer Program: 1. HMON'O is currently in process of getting approval of this program to collect reimbursements from health insurance providers for tobacco cessation health education reimbursements that meet the criteria and captures billed revenue to subsidize program expenses. 2. HMON'O plans to shift cost in supplies from funded to recycled materials, business donations, community support and align program with innovative and traditional means to avoid the need for funding in the area of supplies and equipment for cessation packets. 3. As one of the five Native Hawaiian Health Care Systems throughout the state, HMON'O continues to be part of a statewide resource development workgroup consisting of representatives from each system. The primary objective of the workgroup is to explore and develop a comprehensive fund development strategy that looks at sustainability via annual donor campaigns, foundation and government grants, endowments, and planned giving. HMON'O is anticipating federal budget cuts and is currently increasing the fundraising efforts as an organization as well as assessing each programs unique impact on our communities and finding the necessary funds specific to continuing and mirroring programs that are working and showing positive health outcomes. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 6 Hui Malama ON Na `Oiwi — Agency Name No Ka Wahine: Cancer Program — Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board Chair Signature of Executive Director Date 0 3( / / 1 Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -2012 Page 7 Hui Pono Holoholona Subsidized Low Cost Spay /NeuterClinics Hui Pono Holoholona- Agency Name Subsidized Low Cost Spay /Neuter Clinics- Program Name Agency Director: Frances P. Pueo Phone No.: (808) 968 -8279 Contact Person: Frances P. Pueo Phone No.: (808) 968 -8279 Mailing Address: PO Box 943 Mt. View, Hi 96771 Facility /Site Address: 11 -3434 Hibiscus Street Mt. View, Hi 96771 Fax No.: N/A Email Address: webmistress @hphhawaii.org Name of Accountant/CPA (include name of firm if applicable): Vivian S. Toellner Phone No.: (808) 345 -2753 Mailing Address: PO Box 6894, Hilo, Hi 96720 Amount of Request for County Funds: $20,000.00 Prior Year(s) Funding: 08-09 09 -10 $0 $0 10 -11 $0 Agency Mission Statement: MPH is an all volunteer, non - profit 5010 (3) animal organization, dedicated to providing Low Cost Spay /Neuter for Cats /Dogs in the communities of east Hawaii.. We also Trap, Spay /Neuter, Examine, Vaccinate, Release & Manage (TNRM) feral & abandoned cat/kittens in various locations, including the waste & transfer station in Keaau, to prevent uncontrolled breeding and overpopulation. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Hui Pono Holoholona - Agency Name Subsidized Low Cost Spay /Neuter Clinics - Program Name Program Description: HPH advertises periodic spay /neuter clinic & work directly with the community to provide traps, transportation, and assist individuals with trapping when necessary. We also have daily phone contact and maintain lists of people in need of our assistance. For example, from 2007 until now we spayed /neutered over 1,300 cats. This preventative measure has potentially decreased the cat population in general by 1,422,225. These grant funds we are requesting will be used to maintain & increase our efforts as our operation is outgrowing our donations. Total Budget and Position Count Total Program Budget 20,000.00 Total Program Position Count 12 Total Agency Budget 15,000.00 Total Agency Position Count 5 Program Objectives: 1) Sponsor low cost Spay /Neuter clinics for the public (individuals who meet low income financial criteria). 2) Transport animals biweekly to and from spay /neuter clinic. 3) Transport traps & bait food to and from homes of individuals of low income & elderly. 4) Purchase medical supplies for the Spay /Neuter clinic. 5) Purchase additional traps, pet carriers, kennels & other supplies. 6) Seek homes for adoptable animals. Program Highlights: (from Fiscal Year 2009 -10) 1) HPH is saving lives of innocent animals who would be euthanized or left to suffer in an inhumane environment. In year 2009 & 2010 HPH has spay /neutered over 1,000 cats. We have found homes for many of those animals through our adoptive service program. We have effectively managed a potentially exponential explosion of the cat population at managed colony locations such as the Keaau transfer station and numerous other sites, which would have become an extreme problem at public facilities. HPH publishes a newsletter (Punahele) to keep the public informed of our progress & accomplishments, and maintains a website www.hphhawaii.org NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Hui Pono Holoholona - Agency Name Subsidized Low Cost Spay /Neuter Clinics- Program Name Performance Measures: *if applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Aloha Vet / Dr. Rodrigues 3 1 25 Dr.Brooksby 210 256 300 East Hawaii Veterinary / Dr. Mina 14,025.24 6 25 Dr. Hatt -0- 134 960 Hilo Veterinary Clinic /Dr. Castro 42 11 20 Kilauea Vet Services / Dr. Seeske 27 20 Dr. Kozuma 16 20 Neuter Scooter / Dr. Peavey 245 244 320 *if applicable Program Expenditures x It applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages -0- -0- Professional Fees -0- -0- Operations 14,025.24 35,000.00 Equipment -0- -0- Other" -0- -0- Total 14,025.24 35,000.00 x It applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Hui Pono Holoholona - Agency Name Subsidized Low Cost Spay /Neuter Clinics - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate T -Shirt Sales 402.00 Toys, Bookmarks, etc. 649.00 Yard Sales 1,095.85 Donation Boxes 832.02 Donations b ,Mail 6,598.15 Food Basket Fund 642.78 Walmart Days 353.00 Yard Sale Days 303.37 Recycle ARC 81.31 Mauna Lani 1 3,005.00 Petco Grant 2,500.00 Interest Income 17.92 Give Aloha Program 730.01 Total 17,210.41 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Continuation of donations and fundraising as we have been doing since our inception. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Hui Pono Holoholona - Agency Name Subsidized Low Cost Spay /Neuter Clinics - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Sigrlqture of Board President/Chair � 01 : 1S Signature of Ex cutive Director Date ) �31�11 Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 • Island of Hawaii YMCA Impact: Youth Assets 2011 -2012 Island of Hawaii YMCA- Agen Name IMPACT: Youth Assets 2011 -2012- Program Name Agency Director: Fred Yamashiro Phone No.: 935 -3721 ext 21 Contact Person: Fred Yamashiro Phone No.: 935 -3721 ext 21 Mailing Address: 300 W. Lanikaula Street Hilo, Hawaii 96720 Facility /Site- Address: Hilo Progra -5 2 Ham Place #1106 Kona Program Kailua Kona, Hawaii 96740 Fax No.: 935 -8414 Email Address: Fred.Yamashiro @gmail.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: 968 -1002 Mailing Address: PO Box 4372 Hilo, HI 96720 Amount of Request for County Funds: $40,000 Prior Year(s) Funding: 08 -09 09 -10 ' $10,006 $20,000 $20,000 NONPROFIT GRANT APPLICATION FISCAL YEAR ZOII -I2 Page 1 Agency Mission Statement: MISSION STATEMENT: Aloha Ke Akua — God is Love. "To bring God's Love to children, adults and families of all races and faiths by putting Christian principles into practice through programs that build healthy spirit, mind and body for all ". YMCA CORE VALUES: We teach and demonstrate caring, respect, responsibility and honesty. YMCA THEME: We build strong kids, strong families, strong communities. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Island of Hawaii YMCA - Agency N ame Impact: Youth Assets 2011 -2012- Program Name Program Description: THE YMCA IN TRANSITION (2010): In 2010, the YMCA completed it's transition to a single operation - island wide, based in Hilo with branches in Hilo and Kona. By completing this transition, we have reduced our general operating cost by $200,000. We successfully completed the sale for two properties for $1,400,000. The proceeds from the sales were used to pay all of our short term debt and most of our long term debt. As a result, we are current on our payables to all of our vendors. Our program centers in Hilo and Kona will continue to impact the lives of our young people as its main priority. With our completed transition, we are working more efficiently and effectively as a new Y. FINANCE OFFICE (2010): With the completion of our transition, we completed our 2009 audit and completely reformatted our accounting system. For the past year, the Y has been providing timely, monthly financial reports to it's board of directors. We also completed a detailed and board approved operating budget for 2011. We now have a new full time CEO /CFO on staff overseeing all of our financial operations as well as our daily operations. For the year ending June 30, 2010, (per schedule A) the Y incrurred a loss of $223,000. The County grant of $20,000 and YMCA subsides of $176,000 helped to cover the loss. Under our new Y management, we estimate a loss for the period of July 1, 2011 to June 30, 2012 (see schedule C) to be $109,000. The Y hopes with the contributions of the County of Hawaii ($40,000), United Way ($26,000) and YMCA subsides ($40,000) that it will cover the loss. COLLABORATION: The Y have initiated and have held collabrative meetings with the YWCA, Boy and Girls Club of Hilo, Boys Scouts of America, Queen Liliokalani Children's Center and the University of Hawaii at Hilo. During these tough economic times, we will continue to meet to better serve the community of Hilo and Kona. The YMCA, Boys and Girls Club and YWCA with the Hawaii Island United Way will continue to seek ways to collaborate and meet the needs of children and teens in our community. Through our past surveys, we know that this is an important area that needs to be addressed and dealt with. They YMCA's proposal for 2011 -2012 will continue it's impact as it has in 2010- 2011. Working with children and youth today is a process, one that takes time to help them develop their full poptential. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Many local and national funders have charged youth - serving agencies to develop methods of evaluating their programs that document the positive benefits and impacts of program participation on youth. Young people need what everbody needs. They need support, positive relationships, encouragement, skills and opportunities. However, most young people are not getting what they need in order to succeed in life. Many youth today, are without that positive role model or do not have the strong family relationship as others do. Many are lacking the education and schooling in which they need to continue on into their adult years. As eary as 2000, the Y embraced the Search Institue 40 Developmental Assets approach. This framework of developmental assets is grounded in extensive reseach on child an adolescent development, resiliency, health promotion, disease prevention and public health. Numerous researchers found that assests provide strength for children and youth. The more assets young people have, the more likely they will grow up to be caring and responsible adults. The more they have, the better their chances for contributing to society and finding a meaningrul purpose in life. On the average, young pepole with more assets engage in fewer negative, high risk behaviors, such as drugs and alcohol or having premarital sex, exhibit more positive behaviors, such as succedding in school, assuming leadership roles and valuing diversity and demonstrating resilience in the face of challenges, stresses and difficult situations. Y programs are tools used to develop the fullest potential of every young person. Programs are directed by trained, caring and nurturing adult role models. IMPACT OF RECREATION & SPORTS PROGRAMS: From volleyball to football to afterschool recreational sports programs are some of the most common and popular programs for young people. Much of the research in these types of programs points to the positive nature of physical activity for helath and well -being for youth of all ages. The benefits of different recreation programs vary widely, from getting involved in shared activities, to opportunities for skill development to relationships with other adults as well as peers. Studies have demonstrated that involvement i sports increase self - esteem and success in school. The Island of Hawaii has demonstrated for the past two (2) years results that show participation in Y programs does in fact, impact the lives of young people. However, due to the cost of coding and producing comprehensive executive summary reports, we were unable to participate in surveying our summer participants. These reports would have provided information on how well our participants liked their experiences in our programs. The report would also compare the Island of Hawaii YMCA participant responses with responses from young people in the YMCA's across the country. We regret that we are unable to produce and provide these reports. We hope that with our completed transistion, and with our financial position improving, surveys will be administered and reports prepared in the future. The Y will continue building youth assets. The Y expects to serve over 2,000 children and youth in its variety of youth programs in the 2011 -2012 year. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Parents need child care, afterschool care, preschool, summer and intersession care. Middle school youth, especially teens, need supervised afterschool programs and the Y is preventing students from high risk behaviors during afterschool hours through organized and adult supervised programs. But the need is great and the Y would ike to expend its programs and services to more middle school teens. The Y has implemented a new youth programs in 2010. A gardening and cooking program that will teach youth the skills on how to grow and then even cook the products they are producing. Lessons and skills that they will be able to use and take with them way into adulthood. It will also give them a sense of belonging, ownership and pride in the work that they do and produce. Life skills that they will use in everyday life. With these new youth and child care programs, the Y expects to increase enrollment in these two areas. The Y is very appreciative of the past support of the Hawaii County Non - Profit Grant. With these difficult economic times still ahead of us, we must and will continue to provide the most positive experiences and opportunites for all children and teens. Thank you. Total Budget and Position Count Total Program Budget $630,000. Total Program Position Count 34 Total Aqency Budget $1,000,000 1 Total Agency Position Count 45 Program Objectives: 1) To continue to collaborate with the YWCA, Hawaii Island United Way and the Boys and Girls Club. 2) Continue our new collaboration with Queen Li liokulani Children Center and the Boys Scouts of America. 3) 89% of responding parents in after school programs are satisfied with the program. 4) 92% of responding children in after school programs are satisfied with the program. 5) 89% of responding children in after school agree /strongly agree that they are expected to try harder and do their best. 6) 89% of responding children in summer day camp agree /strongly agree that the Y activities help them to learn how to be a leader. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Program Highlights: (from Fiscal Year 2009 -10) 1) 100% of parent responded that they were satisfied with the Y after school programs in both Hilo and Kona. 2) Served over 700 children in the summer and in tersession (out -of- school) programs in Hilo and Kona. 3) Enrolled over 650 children in the 9 month after school programs in Hilo and Kona. 4) Serviced over 1400 children and youth island wide. 5) Collaborated with (4) youth serving agencies; conducted teen survey. 6) Serviced in our Hilo Program center, children who live as far as Pahoa to Mountain View and Laupahoehoe. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Island of Hawaii YMCA - Agency Name Impact: Youth Assets 2011 -2012 - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget FY 2011 -12 Estimate Total Served 1450 1700 2000 Hilo YMCA Branch 750 1020 1200 Kona YMCA Branch 700 680 800 Equipment Other Total *If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages see Schedule A See Schedule B See Schedule C Professional Fees O erations Equipment Other Total * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 The Island of Hawaii YMCA - Agency Nam Impact: Youth Assets 2011 -2012 - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget * Estimate See See See Schedule A Schedule B Schedule C Total *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Y has taken effective steps to downsize its operation and lower its operating costs. We continue to experience a decrease in contributions. We continue to have more parents being laid off and therefore withdrawing their child from our child care programs due to financial hardship and /or the loss of child care subsidies. Hawaii United Way has also decreased its allocation. We here at the Y are pressed economically and therefore, it will be 3 or more years out before the Y can sustain the programs we are applying funds for. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 The Island of Hawaii YMCA - Agency Na Impact -Youth Assets 2011 -2012 - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year-end report will impact the evaluation of your prog ram's or agency's future funding requests. 7AOn UL_ Signature of Bo rd President/Chair' �o \+�.n'Ccw 0 Signature of Executive Director 1 1 "1 Date 1-3, //,/ Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 Schedule A Island of Hawaii YMCA Profit and Loss Statement for the period July 1, 2009 to June 30, 2010 Income Program Revenue Child Care Programs Income Youth Programs Income Total Program Revenue Cost of Goods Sold Cost of Programs Child Care Programs Cost Youth Programs Cost Total Cost of Programs Gross Profit General and Admin. Expense Advertising Auto Expenses Bank Service Charges Credit Card Fees Dues and Subscription Fair Share Suport Insurance Expense Interest Expense Meeting Expense Miscellaneous Exp. Office Supplies Payroll Process Fees Penalty Expense Postage and Delivery Printing Professional Fees Accounting/Audit Fees Total Professional Fees Rent/Lease Building Space Repairs and Maintenance Computer Software & Equipment Maint. Equipment Building Office Equipment Total Repairs and Maintenance Salaries and Wages Taxes and Licenses General Excise Tax Licenses and Permits Property Taxes State Unemployment Benefits Total Taxes and Licenses Trash Removal Travel & Entertainment Child Care Youth Total 598,898.03 598,898.03 31,280.86 31,280.86 598,898.03 31,280.86 630,178.89 486,436.33 486,436.33 33,946.58 33,946.58 486,436.33 33,946.58 520,382.91 112,461.70 (2,665.72) 109,795.98 928.65 48.50 977.15 1,263.42 66.00 1,329.42 3,596.54 187.85 3,784.39 2,10044 109.71 2,210.15 222.59 11.63 234.22 16,089.09 840.34 16,929.43 33,883.25 1,769.75 35,653.00 9,622.94 502.61 10,125.55 549.56 28.70 578.26 376.20 19.65 395.85 4,427.81 231.27 4,659.08 1,315.42 68.71 1,384.13 2,297.37 119.99 2,417.36 699.70 36.55 736.25 645.96 33.74 679.70 36,352.05 1,898.69 38,250.74 36,352.05 1,898.69 38,250.74 7,782.84 406.50 8,189.34 3,155.20 164.80 3,320.00 726.95 37.97 764.92 4,106.23 214.47 4,320.70 580.03 3030 610.33 8,568.41 447.54 9,015.95 138,198.78 7,218.22 145,417.00 235.35 12.29 247.64 903.00 47.16 950.16 399.24 20.85 420.09 19,717.01 1,029.83 20,746.84 21,254.60 70.13 22,364.73 3,489.48 182.26 3,671.74 1 of 2 Schedule A Island of Hawaii YMCA Profit and Loss Statement for the period July 1, 2009 to June 30, 2010 Air Education/Conference Fees Entertainment Lodging Total Travel & Entertainment Utilities Electricity Gas /Propane Telephone and Internet Water & Sewer Total Utilities Total General and Admin. Expense Total Expense Net Loss Child Care Youth Total 117.47 6.14 123.61 362.00 18.91 380.91 1,340.42 70.01 1,410.43 44.52 2.33 46.85 1,864.41 97.39 1,961.80 11,401.90 595.53 11, 997.43 939.31 49.06 988.37 5,714.75 298.49 6,013.24 2,788.99 145.67 2,934.66 20,844.95 1,088.75 21,933.70 316,374.46 16,524.48 332,898.94 316,374.46 16,524.48 332,898.94 (203,912.76) (19,190.20) (223,102.96) Funding Source County of Hawaii YMCA Subsidy United Way Miscellaneous Income Total Funding Source 10,000.00 10,000.00 20,000.00 167,751.76 9,111.94 176,863.70 24,662.72 - 24,662.72 1,498.28 78.26 1,576.54 203,912.76 19,190.20 223,102.96 2 of 2 Schedule B Island of Hawaii YMCA Estimated Actual For the period July 1, 2010 to June 30, 2011 Ordinary Income /Expense Income Program Revenue Child Care Programs Income Youth Programs Income Total Program Revenue Cost of Programs Child Care Programs Cost Youth Programs Cost Total Cost of Programs Gross Profit Expense General and Admin. Expense Advertising Auto Expenses Bank Service Charges Credit Card Fees Fair Share Suport Insurance Expense Interest Expense Meeting Expense Miscellaneous Exp. Office Supplies Payroll Process Fees Postage and Delivery Printing Professional Fees CFO Contract Fees /Audit Fees CEO Contract Fees Severance Pay Total Professional Fees Rent/Lease Building Space Repairs and Maintenance Computer Software & Equipment Maint. Equipment Building Office Equipment Total Repairs and Maintenance Salaries and Wages Taxes and Licenses General Excise Tax Licenses and Permits Property Taxes State Unemployment Benefits Total Taxes and Licenses Trash Removal Travel & Entertainment Air Estimated Actual as of 6/30/11 Child Care Youth Total 589,328.13 - 589,328.13 - 35,973.50 35,973.50 589,328.13 35,973.50 625,301.63 479,415.11 - 479,415.11 - 37,745.33 37,745.33 479,415.11 37,745.33 517,160.44 109,913.02 (1,771.83) 108,141.19 768.33 98.36 866.69 2,645.32 555.70 3,201.03 3,283.13 403.63 3,686.76 1,855.05 212.18 2,067.24 8,033.81 420.90 8,454.71 24,207.47 2,213.69 26,421.16 10,766.70 2,109.79 12,876.49 3,291.58 590.87 3,882.45 439.62 39.67 479.29 2,364.15 120.98 2,485.13 1,677.17 295.08 1,972.25 757.20 113.08 870.28 756.50 97.78 854.28 35,357.84 2,438.44 37,796.29 21,337.50 4,214.94 25,552.44 5,121.33 1,011.65 6,132.98 61,816.67 7,665.03 69,481.70 7,227.30 961.42 8,188.72 1,657.01 156.80 1,813.81 562.12 88.34 650.46 2,673.31 251.94 2,925.26 690.29 109.83 800.12 5,582.73 606.91 6,189.64 114,097.53 11,749.50 125,847.04 228.08 29.39 257.47 992.79 170.28 1,163.08 522.90 86.43 609.33 11,716.65 569.34 12,285.99 13,460.42 855.45 14,315.87 1,927.90 230.99 2,158.89 114.33 5.56 119.89 1 Of 2 Schedule B Island of Hawaii YMCA Estimated Actual For the period July 1, 2010 to June 30, 2011 Education/Conference Fees Entertainment Lodging Total Travel & Entertainment Utilities Electricity Gas /Propane Telephone and Internet Water & Sewer Total Utilities Total General and Admin. Expense Net Loss Funding source County of Hawaii YMCA Subsidy United Way Miscellaneous Income Estimated Actual as of 6/30/11 Child Care Youth Total 365.19 2,123.91 50.42 20.80 225.25 11.60 385.98 2,349.17 62.02 2,653.84 263.21 2,917.05 12,184.28 801.88 4,763.65 2,538.50 1,568.43 115.25 536.59 336.93 13,752.71 917.13 5,300.24 2,875.43 20,288.32 2,557.20 22,845.51 287,900.76 32,161.43 320,062.19 (177,987.74) (33,933.26) (211,921.00) 10,000.00 10,000.00 20,000.00 154,000.00 11,000.00 165,000.00 11,600.00 11,600.00 23,200.00 2,387.74 1,333.26 3,721.00 177,987.74 33,933.26 211,921.00 2 Of 2 Schedule C Island of Hawaii YMCA Estimate For the period July 1, 2011 to June 30, 2012 Ordinary Income /Expense Income Program Revenue Child Care Programs Income Youth Programs Income Total Program Revenue Cost of Programs Child Care Programs Cost Youth Programs Cost Total Cost of Programs Gross Profit General and Admin. Expense Advertising Auto Expenses Fuel Repairs and Maintenance Total Auto Expenses Bank Service Charges Credit Card Fees Dues and Subscription Fair Share Suport Insurance Expense Interest Expense Meeting Expense Miscellaneous Exp. Office Supplies Postage and Delivery Printing Professional Fees Accounting/Audit Fees CEO /CFO Contract Fees Severance Pay Total Professional Fees Rent /Lease Building Space Repairs and Maintenance Computer Software & Equipment Maint. Equipment Building Office Equipment Total Repairs and Maintenance Child Care Youth Programs Total 614,634.00 614,634.00 44,540.00 44,540.00 614,634.00 44,540.00 659,174.00 433,104.00 433,104.00 43,280.00 43,280.00 433,104.00 43,280.00 476,384.00 181,530.00 1,260.00 182,790.00 819.41 161.86 981.28 3,277.65 647.46 3,925.11 2,458.24 485.59 2,943.83 5,735.89 1,133.05 6,868.94 3,277.65 647.46 3,925.11 1,638.82 323.73 1,962.55 409.71 80.93 490.64 13,930.01 2,751.69 16,681.70 21,304.72 4,208.46 25,513.19 5,786.42 1,143.03 6,929.45 245.82 48.56 294.38 81.94 16.19 98.13 2,867.94 566.52 3,434.47 1,024.27 202.33 1,226.60 819.41 161.86 981.28 9,672.48 1,910.67 11,583.15 42,675.00 8,429.88 51,104.88 10,242.66 2,023.30 12,265.96 62,590.14 12,363.85 74,953.99 8,194.12 1,618.64 9,812.76 1,024.27 202.33 1,226.60 819.41 161.86 981.28 1,638.82 323.73 1,962.55 1,024.271 202.331 1 4,506.77 1 890.25 1 5,397.02 1 of 2 Schedule C Island of Hawaii YMCA Estimate For the period July 1, 2011 to June 30, 2012 Salaries and Wages Taxes and Licenses General Excise Tax Licenses and Permits Property Taxes Total Taxes and Licenses Trash Removal Travel & Entertainment Education /Conference Fees Entertainment Lodging Total Travel & Entertainment Utilities Electricity Gas /Propane Telephone and Internet Water & Sewer Total Utilities Total General and Admin. Expense Net Loss Child Care Youth Programs Total 83,323.19 16,459.38 99,782.57 245.82 48.56 294.38 1,638.82 323.73 1,962.55 819.41 161.86 981.28 2,704.06 534.15 3,238.21 1,843.68 364.19 2,207.87 40.97 8.09 49.06 1,638.82 323.73 1,962.55 122.91 24.28 147.19 1,802.71 356.10 2,158.81 13,110.60 2,589.82 15,700.42 1,024.27 202.33 1,226.60 4,097.06 809.32 4,906.38 2,867.94 566.52 3,434.47 21,099.87 4,168.00 25,267.87 244,006.56 48,200.24 292,206.80 (62,476.56) (46,940.24) (109,416.80) Funding source County Grant YMCA Subsidy United Way Micellaneous Income Total Funding Source 20,000.00 20,000.00 40,000.00 28,000.00 12,000.00 40,000.00 13,200.00 13,200.00 26,400.00 1,276.56 1,740.24 3,016.80 62,476.561 46,940.24 109,416.80 2 of 2 •c Island of Hawaii YMCA Na Alaka'i Hou Program The Island of Hawaii YMCA- Agency Name Na Alaka'i Hou- Program Name Agency Director: Fred Yamashiro Phone No.: 935 -3721 x.21 Contact Person: Fred Yamashiro Phone No.: 935 -3721 x.21 Mailing Address: 300 West Lanikaula Street Hilo, HI 96720 Facility /Site Address: 300 West Lanikaula Street Hilo, HI 96720 Fax No.: 808 - 935 -8414 Email Address: fred.yamashiro @gmail.com / ola.jenkins @gmail.com Name of Accountant/CPA (include name of firm if applicable): Rozanne Connell/ Carbonaro CPA & Associates Phone No.: 808 - 968 -1002 Mailing Address: P.O. Box 4372 Hilo, HI 96720 Amount of Request for County Funds: $75,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $ N/A $ N/A $ N/A Agency Mission Statement: "We build strong kids, strong families and strong communities by enriching the lives of all people in spirit, mind and body." NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 The Island of Hawaii YMCA - Agency Name Na Alaka'i Hou - Program Name Program Description: With new transitions at the Island of Hawaii YMCA, the current leadership has built innovative partnerships within it's island community. Through the value of "helping each other ", the Island of Hawaii YMCA has not only established positive alliances with Boys & Girls Club of Hilo, the Hawaii Island YWCA, the local Boy Scouts and the University of Hawaii at Hilo, but they've also built unique working relationships with community members, a neighborhood church, a motorcycle club and other groups such as the partnering organization supporting this program. In 2005, a concerned group of people living and connected to Hawaii island and concerned with the future of Hawaii and its people sought to establish a grass roots organization that would serve our native community and it's people. Through family clusters and neighborhood support, Kahu O Ka Ula AN (KOKUA) was established with the intention of serving the island community. In partnership with KOKUA, the Island of Hawaii YMCA is building a powerful and effective health and fitness program for the community that will impact and change lives. NA ALAKA'I HOU (The New Leaders) is a program that uses the philosophy and values of our Hawaiian culture with experiential learning and outdoor adventure - based education. The program is designed to increase effective social skills, invest in self - growth and build productive teams. Individually, it is being created to build a person of consciousness to the world and community that he /she is a part of. Collectively, it takes the mentorship of NA ALAKA'I HOU to take the participating organization and it's members forward to achieve breakthrough results that will then filter out not only within their organization, but the community and people that they serve. The need to develop individuals that are grounded in their beliefs, committed to living their values effectively for themselves, and be of service to a positive future for all is more important than ever. The fast pace of technology, expansion of consumerism, growing cynicism, and lack of responsibility has led to a decline in our quality of life and the exploitation of our environment. Never has humanity faced the largest dysfunction and disconnect within the systems we have created. Today, we face the highest crime rate and more social ills than ever before. Our families have lost the ability to lead conscious, healthy lives and as humans we have lost touch with the value of our natural resources. Where once, there were native people who thrived on universal values and respect for their surroundings, today many have forgotten their purpose and role in life's journey and the importance of service leadership. Through reconnecting to Hawaiian culture, values and practices and bridging it with today's most NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 popular leadership ideals, NA ALAKA'I HOU is a program that will inspire and motivate people to seek their true potential and purpose in life while committing to a life of learning and positive action. We have taken the team - building model and adapted it to our island for growing healthy people. Through the use of physically and mentally challenging elements, individuals learn how to better work together as a team with a common goal. Incorporating inherent problem solving skills, learning from each other's examples, and succeeding as part of a team, the individual team members will gain useful tools to better COOPERATE with, TRUST, and RELY ON their classmates, coworkers, families, and neighbors. Using the participants' purpose and goals, NA ALAKA'I HOU designs a program to help meet their intended objectives through personal and written consultation assessments. A challenge course is built and the program consists of a variety of activities, each building upon itself in terms of challenge and capability. The primary course is made up of low ropes and /or high ropes activities, focused on nurturing team building and self esteem skills. Our hope is that participants will not only learn about their own strengths and challenges to make a difference in their lives, but also to learn about the Hawaiian culture through a fun and challenging experience. Many participants experience life changing and breakthrough results. The Challenge Course can be individualized to everyone of all ages. No prior experience or physical ability is necessary. The emotional and physical support from the team will provide each member with the skills needed to attain goals he or she never thought possible. Experiential Education promotes positive behavioral concepts in such a way that participants recognize valuable insights and knowledge about themselves and how to handle problems as an individual and in a group. Through the sequence of events that are arranged by a progression of challenging to most challenging, participants are able to build their self- confidence and realize how important and valuable they are as an individual in helping the team work through course obstacles. Experiential Education and Adventure -Based Education have proven to be successful in cultivating life- applicable skills of cooperation, team -work, trust, communication, and leadership. This educational approach applies non- traditional classroom techniques, and addresses a variety of learning styles by teaching through "hands on" learning. Instead of being taught "how to do it," participants learn by "doing it." After engaging in each activity, the group will be facilitated through a processing discussion to relate the activity to real life scenarios and establish relevant connection to what the participant or group might be facing. This approach is educational, rewarding, and real for the individual, group, and community. NA ALAKA'I HOU uses the challenge course and it's hands on curriculum to promote the following skills: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 • Communication • Physical Ability • Problem- solving • Self Awareness • Self Confidence • Trust • Acceptance • Inner Strength • Cooperation • Leadership With the use of the Hawaiian Culture, its' ancient practices and values, NA ALAKA'I HOU is aligned to connect native Hawaiians and non - natives alike to the important practices of the past by combining the skills of experiential education and ancient Hawaiian value systems in environmental settings. It is through the Hawaiian value system that the NA ALAKA'I HOU program philosophies are built upon. The mainstay of these values includes the following: Lokahi (Unity): The concept of lokahi is probably one of the most important ideas the ancient Hawaiians practiced and embodied. It means unity or connectedness and it also means embracing diversity. Realizing how we all are connected and that every thought or action we have within a community has a direct correlation with the successful outcome or demise of that community. The connectedness is especially important for our youth to embrace for development of self- awareness, self- respect and sense of place. 'Ghana (Family): The importance of a support system that encompasses more than the immediate nuclear family, but includes the concept of hanai or extended family in turn, creating a sense of belonging. Ho'opono (Alignment): Striving to maintain alignment with all living things (person, place or thing) and practicing our skills with integrative awareness between these elements. Using Universal principles of compassion, positive attitude, kindness and integrity while letting go of those elements that does not serve us such as fear, anger, impatience, a traumatic experience and negativity optimizes this dynamic synergy. Kulana (Attitude) /Ha'aha'a (Humility): The learner (participant) and mentor role model (program facilitator) balance an open mind and heart with an aspiration for awakening their true essence. Attitudes of conscious living are based on the Indigenous Hawaiian ways of community connectedness and its unity of consciousness. It is a simplified process handed down through the generations of Hawaiian people and refined as each generation passes. Kuleana (Responsibility): The fostering of each participant to honor and respect the lineage associated with them. Each participant shares a responsibility to themselves, their family, their mentors and their community, to share the truth and authenticity of our soul's efforts to bring about positive outcomes. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Malama (Caring): The idea of caring for yourself, others and your surrounding is a value that is practiced in our mentor relations as well as capitalized through our community work projects, a necessary "giving back" component of the program. Hilina'i (trust) is built by those who offer the support and care to the youth in need. Pono (High character or righteousness): Through our positive relationships we attempt to develop upstanding and morally efficient people who are in balance with their identity and their potential. It is the utilization of traditional Hawaiian values that creates an underlying sense of ease and belonging that not only native Hawaiians relate to, but extends out to people representing other ethnic groups. Our cultural awareness and cultural competency allows us a level of sensitivity to underrepresented groups within our community. Because of the context within a grant- funded program, as well as promising support for long -term stability, surveys will be created for feedback, quality assurance and documentation purposes. Total Budget and Position Count Total Program Budget 150,000 Total Program Position Count 3 -FTE Total Agency Budget 1,000,000 Total Agency Position Count 25- FTE Program Objectives: 1) Train specific members /employees in facilitation skills in the NA ALAKA'I HOU program within the first sixty (60) days. This is a high priority objective. the newness of this program will require not only competent people, but for those who already embody strong leadership and mentorship skills, as well as a lifestyle perspective of the Hawaiian and Big Island culture. 2) Facilitate quarterly (every three months) professional training for program staff by a certified consulting organization with appropriate and professional resources inclusive of NA ALAKA'I HOU program curriculum within the grant year period. 3) Promote community outreach to build client/participant base within the first 90 days. Prior partnerships have already been ongoing and through verbal agreements, there is an eclectic mix of willing organizations and programs wanting to participate in the NA ALAKA'I HOU program. 4) Order /purchase needed supplies, resources, software and materials for the program within the first sixty days. This is a priority objective and NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 probably one of the most costly. Without the necessary equipment needed to build and implement the program, it cannot exist. 5) Build a viable website with technological support within the first quarter that will promote and educate the NA ALAKA'I HOU program as well as serve as a blog -site and feedback center for community and organization participants who have participated and completed our program. Initial website base will be up and running in 90 days. Updates to the website will be ongoing as the program expands. 6) Nurture and educate at least two hundred fifty (250) participants in a completed NA ALAKA'I HOU program session within the one year grant period. This is a feasible number that we may exceed, but due to the newness of this program and the importance of training and equipment quality being optimum, we feel for the grant- funding period that this is a challenge that the YMCA can provide. 7) Survey every program participant for feedback, documentation and quality assurance purposes within one week of completed participation in the program. 8) Create a viable YMCA community event that will also promote the NA ALAKA'I HOU program with participants who have completed it's curriculum /program within the grant year period. 9) Program Highlights: (from Fiscal Year 2009 -10) 1) *not applicable, new program 2) NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 The Island of Hawaii YMCA - Agency Name Na Alaka'i Hou - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Program participants not applicable: new p rogram not applicable: new program 250 Training not applicable: new p rogram not applicable: new program 500 Operations Equipment Other Total *If applicable Program Expenditures If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages not aplicable: new program not applicable: new program * see attached schedule Professional Fees Operations Equipment Other Total If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 The Island of Hawai'i YMCA - Agency Name Na Alaka'i Hou - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate not applicable: new program not applicable: new program see attached schedule Total *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Program support with goal of becoming self- sustaining: 1) Initiate an adventure -based therapy curriculum where participants are immersed in a weekend or one week, life- enriching experience which includes: hiking, camping, backcountry living and wilderness skills (campsite selection, packing a backpack, map and compass orienteering, and basic first aid), expedition behavior, Leave No Trace techniques, kayaking or canoeing, self - awareness, team building and Sense of Place activities. 2) Promote Corporate Trainings: we will individually tailor the needs of large corporate groups through personal consultations who are wishing to build morale, self and team building skills. We will customize each professional NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 training, travel to their corporate site or chosen location and create fun, and challenging initiatives for the business atmosphere. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 10 The Island of Hawai'i YMCA - Agency Name Na Alaka'i Hou - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. SigDature o� f� f B , oar�`resident/Chair Signature of Executive Director 11 31 611 Date i131xil Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 11 Island of Hawaii YMCA Na Alakai Hou Program Budget Program Budget Advertising Auto Expense Bldg & Equip. Repairs and Maintenance Dues and Subscription Equipment Insurance Office Supplies Postage and Delivery Printing and Publication Professional Fees -Audit Fees Professional Fees -Legal Professional Fees - Training Rent Salaries - General and Admin -incl P/R Benefits - allocated Salaries- Direct Program Staff -incl P/R Benefits Utilities - Electricity Utilities- Internet Utilities -Phone (land line and cell) Utilities -Water and Sewer Funding Source County of Hawaii Grant Island of Hawaii YMCA subsidy Total Budget $ 3,000.00 3,000.00 2,500.00 1,200.00 4,000.00 6,000.00 2,400.00 1,200.00 1,400.00 5,000.00 3,000.00 7,000.00 9,600.00 35,000.00 52,500.00 7,200.00 1,200.00 3,000.00 1,800.00 $ 150,000.00 $ 75,000.00 75,000.00 $ 150,000.00 Chi Ka Hale O Na Keiki Families -At -Risk Ka Hale O Na Keiki- Agency Name Families -At -Risk - Program Name Agency Director: Jackie Caputo Phone No.: 775 -9870 Contact Person: Kathy Oshiro Phone No.: 775 -9473 Mailing Address: 45 -3668 Honokaa - Waipio Road Honokaa, H196727 Facility /Site Address: same Fax No.: 808- 775 -9870 Email Address: gso@warmlava.com Name of Accountant/CPA (include name of firm if applicable): Andrade Accounting Service Phone No.: 775 -1319 Mailing Address: 46 -1068 Kinimaka Rd. Honokaa, HI 96727 Amount of Request for County Funds: $12,000 Prior Year(s) Funding: 08-09 09 -10 10 -11 $5,000 $6,000 $10,000 Y A A NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Agency Mission Statement: At Ka Hale O Na Keiki it is our Mission to help children develop a lifelong love of learning through a program that encourages freedom, individualism, and creativity. Our carefully prepared environment provides children with an opportunity to explore their surroundings, challenge their thoughts, and enjoy and love the people and world around them. Through a positive interaction among the children's developmental characteristics, their school, practices, family, and community, children will be ready to have successful learning experiences that will last throughout their lifetime. Above all, our children come first. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Ka Hale O Na Keiki - Agency Name Families -At -Risk- Program Name Program Description: y A safe and loving learning environment for keiki from families who are at poverty level: that is the Families -At -Risk Program. Our Program allows our school to remain open between 2:00 and 5:30 pm daily, year round (including Summers and holidays, providing a safe, stimulating and caring environment for children ages 24 months to 6 years. This frees parents to work at their jobs, and allows the unemployed to seek work and pursue training and educational opportunities, particularly working parents transitioning from welfare assistance. We serve the working poor. These families are likely to be cut off from the mainstream community because of poverty, racism, lack of education, unemployment, and /or the inability to timely access community and human services. They are therefore at risk of being unable to take care of their basic needs and those of their nuclear family. Our school's positive stimulation of children's brains during these critical first years lays the foundation for the child's future ability to learn, develop language, skills, and appropriately interact with others. While under our trained, caring, and gentle care, children at risk learn self- confidence, initiative, self- worth, and independent thinking. As a Nationally Accredited preschool, our teachers are all trained in Early Childhood Education (ECE) and understand child development. They excite our children about learning as well as provide them, and their families, with basic health and nutritional and referrals. We promote positive social behavior and conflict resolution as well as actively engage parents in their children's care and education. In a community where drug abuse is our worst nightmare, we are the anti -drug. Numerous studies have shown that participation of a quality ECE program can actually prevent illegal drug usage in the future, because we teach these at -risk children, at a very early age, how to appropriately handle conflict resolution, help them to attain good self esteem, and help them to appropriately handle stress and disappointment. If we are to break the cycle of drug agues in our community we must begin taking preventative action now and intervene at the preschool -age level. Our community, our island, and our state also benefit, as it is estimated that for every $1 invested in high - quality ECE programs the public will save $7 in costs like remedial education, welfare, and incarceration (Good Beginnings Report, 2010). Children who attend high quality ECE programs are more successful in later life and more productive than their peers who did not attend. Studies are showing that children with access to these quality programs demonstrate higher I.Q.'s, higher High School graduation rated, and are more successful than their peers. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Operating a quality preschool longer than 8 hours a day, and during holidays is very costly as a second qualified teaching staff is required, and such a critical service is simply not economically feasible. As a critical service to the community, Ka Hale O Na Keiki is not just a preschool, a community organization the serves and meets multiple needs for the people of the entire area. With literally no other full -time preschool in our isolated area, parents would have no where to place their child, except perhaps, in front of a neighbor's TV if our Families -At -Risk Program was not available. And, obviously, our Project benefits our parents as well as our children. Our low- income parents, leaving welfare rolls and entering the workforce, become more economically self - sufficient because they have been given access to reliable, quality care for their children. It is imperative, therefore, that we remain open at least 10 % hours a day, for the stability of our entire community. Parents cannot afford to support our Families -At -Risk Program. We agree that private funds are a key to our success, but those funds are very limited. Therefore, we also need additional public support in order to help these young children and their families towards a successful, productive future. We critically the County's continuing financial support until financial stability is realized. We are very grateful to the financial support we have received in the past from our county and truly believe that the County's continuing investment now in the Families -At -Risk Program will save the County nearly ten -fold in future rehabilitation costs. The focus for all of us must be helping our keiki, especially in this time of Recession, for our keiki are OUR future. No time has this belief been more critical than now. Total Budget and Position Count Total Program Budget $69,600 Total Program Position Count 6 Total Agency Bud et $236,400 Total Agency Position Count 6 Program Objectives: 1) Make care and educational services available to at -risk families and their children between the hours of 2:00 pm and 5:30 pm daily 2) Provide high - quality care and educational services to children of at -risk families of the under - serviced Hamakua Coast. 3) Provide monthly scholarship/tuition assistance to at -risk families 4) Maintain a developmentally appropriate learning environment among all students, enduring progress in social, emotional, cognitive, language, and physical development 5) Pursue other funding sources for the Families -at -Risk Program to insure that the Program, and the school, will prevail. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 6) Maintain our National Accreditation status to insure quality. 7) Increase the parenting skills, and the understanding of the developmental and educational needs of children of the at -risk parents we serve 8) Have the Families -At -Risk become financially self- sufficient, no longer a ' financial drain on the Day Program 9) Recognize the need for, and provide referral services for children of at -risk families who may need treatment for known or suspected health, psychological or developmental problems. Program Highlights: (from Fiscal Year 2009 -10) 1) Despite drastic cuts in state funding for tuition assistance to poverty -level families in February 2010, our school remained open, including open for the at -risk families until 5:30 daily, including during monthly holidays, holiday breaks and Summer. 2) In order to continue to balance our budget beginning 3/2010, we took the unprecedented action laying off our school director and then a former director volunteered to perform the duties of a director without pay until a solution can be attained. 3) When over than 25 preschools statewide closed due to the State cuts in February we remained open. 4) Provided a developmentally appropriate, high - quality childcare and educational facility to the working poor of the Hamakua Coast. 5) Provided six jobs in our local community in order to operate the Families - At -Risk Program. 6) Maintained our National Accreditation, insuring that we are providing the best available care and education to our at -risk children, plus allowing us to obtain additional income for the State. 7) Referred one at -risk child, and the family, to special services counseling, to meet their special needs, as identified by our teaching staff. 8) Succeeded in keeping our budget for the Program low, within reason, and affordable to the families we serve while being able to increase our services to them. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Ka Hale O Na Keiki - Agency Name Families -At -Risk - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget FY 2011 -12 Estimate Enrollment 32 31 33 Children enrolled 2:00 -5:30 Families -At -R Progr 32 31 33 Families receiving financial assistance from Ka Hale O Na Keiki for the Families -At -Risk Program 32 31 33 Equipment 1,600 5,800 3,600 Other' Re airs 2,000 3,600 2,434 Total 52,700 64,300 .69,600 *If applicable Program Expenditures * If applicable * Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages 36,400 39,500 44,46 Professional Fees 3,000 2,600 1,493 Operations 9,700 12,800 17,606 Equipment 1,600 5,800 3,600 Other' Re airs 2,000 3,600 2,434 Total 52,700 64,300 .69,600 * If applicable * Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Ka Hale O Na Keiki - Agency Name Families -At -Risk - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Payment from Families -At -Risk Program (family pmt 2,560 3660 4,000 Donations & Fundraisers 7,700 6940 3,400 County of Hawaii Grant 6,000 10,000 12,000 Young Bros. Grant 1,000 1,000 1,000 Friends of Hawaii Charities 2 2,500 2,500 Wilcox Trust 6,500 6,500 6,500 Hard Foundation 2,000 2,000 1,200 Mcinerny Foundation 8,000 12,700 15,000 Liberty Gives Foundation 2,750 10,000 2,500 In -Kind Labor & Materials 9,000 7,500 20,000 Rotary Club 0 1,500 1,500 Day Program payment from families' portion allocated to Families -At -Risk Program 5,190 0 0 Total 52,700 64,300 69,600 * If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Just when we all thought that the State supported the believe of the value of early childhood education for all, regardless of the ability to pay, horrendous cuts in State ECE assistance to poverty -level families were made this past February. We serve these very families who cannot afford quality care and education for their keiki. We were told eleven years ago that our preschool "could not be done ". Yet, here in 2011 we are hear, a Nationally Accredited preschool serving the working poor of the Hamakua Coast. Yes, we were told that our isolated community did not have the economic base to afford an early childhood center, let along a high quality, Nationally Accredited one, and that our area could not provide qualified teaching staff to run such a program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 With the drastic cuts by the State, in order to afford to keep our doors open, we made the unprecedented action of laying off our own School Director. In order to make this all 'work ", a former Director of ours. retired, volunteered to perform as many of the director's duties as possible. Plus, current staff also stepped up to fill in the duty gaps left by our volunteer Director, all with donated time. Our community is really willing to step forward when the need is there. We all see how our families are currently struggling to survive, simply survive, this "economic downturn". Considering the economic status of the Hamakua Coast, the only answer for true financial security for our preschool is State support. With optimism, we see that this new state administration eager to help communities such as ours, on a permanent basis. Until this changeover takes piece, which we believe will happen within the next few years, our families desperately need the County's financial support. Our budget is extremely tight and our receipt of the $12,000 grant from the County is critical for us to continue to serve our community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 Ka Hale O Na Keiki - Agency Name Families -At -Risk - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 - 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, l (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the figcal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely. complete, and accurate ygar -end report will impact the evaluation of your program's o agency's future funding rgguests. ignature of Board President/Chair - ig at at U rig of Executive Di r or Date Date =- UNSIGNED PROPOSALS WILL NOT BE ACCEPTED11 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page l' 62 Kalani Honua, Inc Annual Nature - Culture- Wellness Educational Activities CT111 f Kalani Honua, Inc.- Agency Name Annual Nature - Culture- Wellness Educational Activities - Program Name Agency Director: 965 -0468 X104 Contact Person: 965 -0468 X104 Mailing Address: Facility /Site Address: Fax No.. Email Address: Richard Koob Phone No.: 808- Richard Koob Phone No.: 808- 12 -6860 Kapoho - Kalapana Beach Road Pahoa, HI 96778 12 -6860 Kapoho - Kalapana Beach Road Pahoa, HI 96778 808 - 965 -0527 richkoob@kalani.com Name of Accountant/CPA (include name of firm if applicable): Brian Hawkins, CPA, Judy Aiona, Craig Wilson Phone No.: 808- 965 -0468 X114 Mailing Address: 12 -6860 Kapoho - Kalapana Beach Road, Pahoa, HI 96778 Amount of Request for County Funds: $24,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $NA -.$NA $NA (Not Applicable -- Kalani didn't apply for funds) NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Agency Mission Statement: Literally harmony of heaven and earth, Kalani Honua was named by Kalapana kupuna Kini Pe'a, whose mother was the last instructor at the site's halau before it closed in 1900, .Kalani Honua's educational mission is inspired by this ahupua'a halau and Lono heiau heritage cradled by forest, sky and sea. Hence the mission of non profit Kalani Honua, Inc., aka "Kalani Oceanside Retreat Village," is to continually create and sustain fun, safe educational community services which encourage ALOHA love for life in each person's own deepest way through participation in abundant nature, culture and wellness experiences. Our guidance is The ALOHA Spirit - -the coordination of mind and heart within each person. Aloha brings each person to cherish life and inspires each person to extend good feelings to others. In the contemplation and presence of the life force, Aloha, the following unuhi laula loa (free translation) inspires us: Akahai, a na Hawai'i -- modest are the people of Hawaii; through careful planning and conservation we can live with the resources available to us for generations to come. Lokahi a ku like -- we are unified, we work together in peace and harmony. 'Olu'olu ka mana o -- pleasant are our thoughts, by being positive we create a positive, loving community. Ha'aha'a kou kulana -- we are humble, we need never feel insecure. Ahonui a lanakila -- with patience and perseverance we keep moving forward. NON, GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Kalani Honua, Inc. - Agency Name Annual Nature - Culture - Wellness Educational Activities - Program Name Program Description: Educational services: Kalani Honua serves the people of Hawai'i County by providing, for reasonable fees or free, over 50 Hawaii, nature, culture and wellness educational activities per week -- 3 times the nearest and much appreciated County funded Community Center 15 miles away in Pahoa. These activities, over 80 events, and 100 week -long workshops per year help meet the educational interests 30,000 participants including local residents, 95 volunteers /staff, as well as visitors. Seven staff members are native culture practitioners including Dottie Kealoha Kyser, 100% Hawaiian, Opihikao native, traditional arts and crafts curator. Staff, visitors and local participants reflect the diverse community spectrum that is Puna. Kalani membership is included with program participation -- open to all without regard to race, belief, age, ability, income, cultural affiliation or gender /orientation. Annual reporting: The Kalani Sustainable Community Educational Programs and Farm Report is annually submitted to the IRS, the County Planning Dept., funding organizations, 17,000 members (also a -news subscribers), and posted for 7 million www.kalani.com web views. The Report lists activities involving 31,671 participants and 662 instructors (see www.kalani.com/eco - village /eco- sustainabiity) including free weekly Hawaiian language, hula, meditation classes plus educational treks on 120 acres to identify agriculture, aquaculture, native plant and birds and honor the 'aina's heritage halau and heiau sites. Additional learning opportunities include lauhala weaving, huna, drawing, yoga, qigong, modern /aerial dance, martial arts, athletics, aqua massage, 'ohana and open mic nights, plus excursions -- to Kahuwai on Kamehameha School's Wa awa'a site, Kua O Ka La charter school, La'akea Permaculture Gardens, Hawaii Volcanoes National Park, and other examples of heritage preservation and sustainability. Sustainability, safety training and model; additional community services; economic stimulus: Integral to Kalani's nature - culture - wellness trainings is the experience of Kalani as a model sustainable agrarian community, managed with aloha. Kalani agriculture and state -of- the -art aquaculture systems are as much as 5 times more efficient than standard methods, and produce about 1/3 of the fruits and vegetables consumed, with the remainder coming from and supporting other local organic farmers. 50KW of solar power plus water heating result in 70% sustainable energy, augmented by recycling, zero waste composting, and affordable eco- efficient housing utilizing renewable bamboo and wood construction materials. Kalani annually contributes to overall community safety through CERT (Community Emergency Response Training) and CPR /1 st Aid NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 training. Kalani provides over 18,000 sq.ft. of assembly, in 8 spaces, for local community events, fundraisers, voting and Red Cross emergency services. Kalani Programs about "Appreciating the World's Cultures Through Hawaii's Heritage ", Pahoa area arts activities for youth -at -risk, plus the annual Kalani Performing Arts Festival, and a Hawaiian cultural training program for teachers are among programs that especially benefit youth.- The entire island economy receives a current annual $5 million boost from Kalani program participants, which has amounted to over $100 million since Kalani's 1975 founding). Total Budget and Position Count Total Program Budget $2,800,000 Total Program Position Count 95 Total Agency Bud et $2,800 1 Total Agency Position Count 95 Program Objectives: 1) Provide residents and visitors with 52 weeks of over 50 on -going activities per week, plus over 80 annual events and 100 annual workshops, all focused on educational experiences in agriculture, culture, health and wellness, nature appreciation and eco- sustainability. Kalani's Annual Activities bring locals and tourists to coastal Puna for educational immersion based primarily at Kalani Retreat Village and honoring, including and expanding upon the aloha spirit and visitor enthusiasm generated by Island events (e.g. Merrie Monarch) and the vibrant heritage of Puna. Throughout the year, and particularly during 5 Kalani- hosted Festivals (Puna Music Festival, Kalani Performing Arts Festival, Anuenue Freedom Festival, Eco- Hawaii Festival, and Puna Chefs' and Farmers' Culinary Festival), over 100 local farmers and craftspeople will demonstrate and sell their wares, introducing residents and visitors to products indigenous to Hawai' i. 2) Know & grow: Target and reach 30,000 people hungry to know more about nature and culture and ready to grow in personal and community wellness. The target audience for Kalani's Annual Educational Activities is the diverse population of Hawaii and particularly rural youth, singles and elderly who are sometimes isolated, uninformed, experiencing life /career changes, or otherwise at risk, yet seek a greater understanding and appreciation of Hawaii, nature, culture and wellness. All together over 30,000 people, including 10,000 mainland and foreign visitors plus Hawaii kama aina, and at least 3000 Kalani guests, staff and local resident volunteers, will participate in classes, activities and attend performances, revitalizing their lives and carrying home positive impressions of Puna to the rest of Hawaii and beyond. At least 600 faculty, presenters and performance artists will also benefit. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 3) Strengthen leadership skills in 1000 high - potential participants. This targets the growing demographic of socially responsible residents and travelers, some on a budget, many with expendable income, and all interested in improving their lives through authentic Hawaii nature- culture- wellness experiences. They are creating today's emerging global village through supporting and honoring Hawaii as -a model eco - sustainability destination and host culture. This demographic increasingly contributes to the County's goals for greater ecology and heritage awareness among residents as well as visitors, whose expenditures continue to grow as both residents and travelers look for experiences that provide in -depth cultural immersion. Education leaders and their alaka'i who immerse in Kalani's 100 annual workshops Increase awareness of Hawaii as a world eco - cultural destination through word -of -mouth promotions and partnerships with other of nature - culture - wellness organizations. Attending Kalani's Annual Activities has proven to increase heritage appreciation and Hawaii Island visitorship. Several faculty performers have large local and global networks, such as John Signor, who directs Kalani performing arts and statewide music education programs, Trina Nahm -Mijo, PhD and Jackie Pualani Johnson of UHH, Lynne Minton and Baron Baptiste (leaders of yoga seminars). Kalani's Annual Activities build awareness of the Puna district as an area rich in cultural experiences that inspire thousands of local residents as well as new visitors to this remote eco- conscientious destination. 4) Achieve 3000 Aloha ambassadorships and a $5 million economic stimulus. Kalani's Annual Educational Activities help empower several thousand Hawaii residents to cherish our indigenous and diverse cultures. The Programs also create an educational and economic stimulus to the community that will continue to increase sustainability as eco - conscious participants encourage more responsible residents' malama 'aina as well as more responsible visitation to Hawaii. Kalani's Annual Activities build on a growing niche market of socially responsible nature - culture- wellness enthusiasts and this lifestyle demographic is increasingly contributing to the County's goal of greater resident support and visitor expenditures. It is hoped that the Kalani's Annual Educational Activities will improve the aloha awareness of over 30,000 participants as well as create a corps of 3000 "aloha ambassadors," mostly first time visitors with the desire and networking savvy to inspire thousands of more visitors from their home locations. Respectful of Hawaii heritage and committed to honoring multi- ethnic cultures, both residents and visitors will be increasingly supportive of authentic Hawaii, often volunteering as well as financially supporting the County's economy. Kalani's Annual Educational Activities, budgeted at $2.8 million, are projected to boost the local economy by more than twice that, since for every $1 spent for programs, there is likely to be an additional $1 spent in the local community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Program Highlights: (from Fiscal Year 2009 -10) 1) Kalani Honua serves the people of Hawaii County by providing over 50 Hawaii, nature, culture and wellness educational activities per week (about 3 times the much appreciated Pahoa Community Center) for reasonable fees or free, and over 100 week -long workshops per year in an eff ort to meet the educational interests of local residents (including 86 volunteers) as well as visitors. See the complete 2009 list at www.kalani.com/eco- village /eco- sustainabiity). Here are some highlights: Program highlights from 1/1/2009 to:12/31/2009 [The HNCW code identifies each program/event by its Hawai'i, Nature, Culture, and/or Wellness educational focus. The full report on www.kalani.com also lists dates, locations, plus totals for audiences, participants and faculty, and includes a Farm Report.] : ON -GOING ACTIVITIES (held throughout the year, about once per week): HNC Art Shows & Drawing classes - A Johnson,Tuko, R. Ruiz 64 held HNCW Agriculture classes, treks & gathering plants for crafts 73 held W Wellness Demos- MCerraso,DAlbers,DSanders,SJoy 1357 held NC Native American Ceremonies - Jonathon +.... 5 held NCW Yoga - K Elder, Jared Sam, D Sanders, Peter Lavina ... 848 held NCW Qigong, Mart ialArts,Watsu - SLynn, B Fultz, L Cangemi 255held HNCW Greenhouse ag classes & dances —E Lee, B.Adams 64 held HNC Hawaiian Language & Culture - D KealohaKyser, Wailana 30 held HNC Weaving & Lei Crafts -L Tuia, E Stephany, B Bolton 60 held HNCW Kalani Honua e- newsletters (to 17,000 members), class catalogues, web visits HNCW Meditations, Nature- Cultural Expeditions, - Tim,Omkar 296 held HNCW Hawaiian Hula Performances,Classes,Workshops- 64held HNC Art Exhibits - A Johnson, R Ruiz, B Ellis, RK,... 5 held HNCW 'Ghana Nights &Open Mic staff education - enrichment 64 held HNCW Artist Residencies 11 held HNCW Experience Kalani - nature, culture, wellness weeks 102 held HNCW Community athletic activities & classes328 held WORKSHOPS (each is generally one week in length): HNCW Aikane Cultural Heritage Week 2009 HNCW Aloha International HCW Arlene Lomi Group HNCW At One Yoga HNCW Back To Bliss Yoga NCW Baptiste Yoga HNW Bio /aquatic HW Body Work Intensive HNCW Bollywood Dance Retreat - Hawaii NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 HNCW Caroline's YogaTeacher Training HNCW Chillaxin Hawaii HNCW Couples In Paradise HNCW David Hoffineister HNCW Diane Koerner HNCW Divine Feminine Retreat HNCW Drawing From Source HNCW Dreaming & Awakening HNCW Dreamtime In Paradise HCW Energetic Vinyasa Flow HNCW Feng Shui Seminar HNCW Gena's Yoga Group HNCW Hawaii Electronic Music Festival HNCW Hawaii Men's Yoga HNCW Hawaii Nature Yoga HNCW Hawaii Transformational Intensive HNCW Higher Balance HNCW Hula Heritage Festival HNCW Inner Fire HNCW Inner Vision Yoga HNCW Institute Of Mind Body Soul Medicine HNCW Jamie's Yoga Group HNCW Joti's Dance Retreat HNCW Julie Blew Yoga HNCW Kalani Music HNCW Master Sha Workshop HNCW Melina Meza Creativity HNCW Memorial Men In Renaissance HNCW Men's Tropical Holiday Wk 1 HNCW Men's Tropical Holiday Wk 2 HNCW Michael Ely Personal Transformation HNCW Minton Yoga HNCW New Year's Men's Yoga Retreat HW New Years Raw Food Retreat HNCW Pathways Institute HNCW Pranic Movement Retreat HNCW Prayerformance Tickets HNCW Priya Yoga HNCW Robyn's Yoga Retreat HNCW Sacred Lomi HNCW Shanti Light Bearers Alliance HNCW Singing With Courage HW Source Tantra Couples Retreat HNCW Spring Ashtanga Yoga Retreat HNCW Stewart's Shaman Group HNCW Tamiko's Art Group HNCW Trancedance HNCW Unity Renaissance Church HNCW Visionary Dance NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 HNCW VisionSeeker HNCW Warrior Sage HNCW Wassa Dance HNCW Westminster College HNCW White Eagle Native American Ceremonies HNCW Worldcare Hawaii Retreat HNCW Yoga And Salsa HNCW Yoga Works EVENTS (Generally special once only presentations): Group /Facilitator Name C Rashani concert CW Satya's free belly dancing class C Marnie And Ashee HCW 'Ohana Night Kava Ceremony C Harvey Milk film W OSHO Meditation CW Michael Wertlieb volunteer activity yoga CW Trance Dance W Michael Ely group massage CW Women's Circle HC Hula W/ kumu Ehulani CW Bollywood Dance Retreat W Kristin Shiatsu session W CERT Safety Course community training CW Todd Perkins- Sound Healing C Jon Maestu - dance C Classical Indian Concert - W Jaden Fox - sonic spirit playshop CW Bodywork Training Intensive W Bodywork Training Intensive W The Institute Of Soul Mind CW Liz Christed creative play CW Will Tuttle — author, lecturer CW Hip Hop Dance CW Volunteer Dance W Journey Dance W Stani Crystal Lecture CW Krishna Dass Kirtan Program CW Deeksha meditation CW Nancy Dew yoga renewal CW Baraba Jaba concert CW Craig Kohland's Shamanlc Studies CW Groove Temple concert-dance CW Kirtan event C Rahshani's Evening Of Poetry C Moustapha Bangouri performance C Didjeredoo Workshop CW Conscious Dancer Magazine Dance NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 HNCW Kalani Art Show CW New Years Dance W HIHAF (HIV -AIDS) Fundraiser C Ana - Volunteer — Spanish class CW Mystic Thought W HIV -STD Free Testing HC The Magic Of Puna CW Acro Yoga CW Capoeira NCW Peda animal rights Movie CW Kimberly Dark's Theater of the Opressed W Health lecture, How To Help Yourself HN Naia Rae - photography W Service For Babette Bolton HCW 'Ohana Night- kava ceremony CW African Dance Class W Jacob Miller -Paths to Wellness HCW Michael W's Shabot And Movie W Health lecture; How To Help Yourself HN Gilbert & Stani — geology lecture W Sound Healing C Baraba Jaba concert & dance HNCW Hawaiian Art Show /Exhibit HNCW Magic Of Puna C Gabriela Taylor on Bhutan and Turkey C Tina Malia Concert HC Film Festival Lecture HC Serge King, Huna Healer CW Adrienne Poremba HW HIHAF Fundraiser Dance HCW Gay Pride Fundraiser Dance C Kasi LGBTQ Rehearsal & Performance C Albino Concert, Victoria Bliss HN Henri -Noel — universal geometry W The Works Of Byron Kate CW Visionary Dance CW Heal Your Life /business HW CERT Emergency Response Training Course C Hanna's Dance C Thad Rutkowski — poetry HNCW Silvie, Marine Biologist TOTALS Audiences Participants Faculty 2009 220,046 31,671 662: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 Kalani Honua, Inc. - Agency Name Annual Nature - Culture- Wellness Educational Activities - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate # Participants classes, wksh s 31,671 33,000 35,000 # Audience (presentations) 220,046 230,000 240,000 # Faculty all instructors 662 700 750 # Educational activities per week 48 53 55 Enrollment rosters +evaluation forms 5000+ 5000+ 5000+ Satisfaction rates 98% 100% 100% Suggestions: mahalo & follow-up 100% 100% 100% # Workshops + #Events per year 78W + 119E 88W + 87E 100W +100E Volunteer support hours/ ear 110,000 hrs 120,000 hrs 130,000 hrs Kalani donations to other nonprofits $86,000 $90,000 $95,000 Local economy stimulus $4,500,000 $5,000,000 $5,600,000 $1 for ever $1 paid to Kalani *If applicable Program Expenditures * If applicable "Please explain in detail on separate sheet k. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 10 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages $244,831 $264,000 $275,000 Professional Fees Op erations 2,077,267 2,280,000 2,482,000 Equipment 18,160 20,000 25,000 Other Total $2,340,258 1 $2,564,000 1 $2,782,000 * If applicable "Please explain in detail on separate sheet k. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 10 Kalani Honua, Inc. - Agency Name Annual Nature - Culture- Wellness Educational Activities - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate W.K. Kellog Foundation 20,000 Hawaii Tourism Authority 8,000 17,000 20,000 County of Hawaii this application) 24,000 Program Service Revenue 1,920,743 2,170,000 2,326,000 State Foundation Culture & Arts 10,000 20,000 Hawaii Community Foundation 11,600 20,000 Bank interest income 1,091 1,400 2,000 Member (participant) contributions 316,534 330,000 350,000 Total 2,246,368 2,540,000 2,782,000 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Kalani's Annual Activities will continue serving local residents while also drawing visitors to Puna, including providing economic boosts to typically slow "shoulder seasons." Since participants in the Activities spread the word about Puna's unique nature - culture - wellness attractions, each subsequent year of Activities increasingly directs visitors to Hawaii while inspiring greater commitment to wellness, cultural preservation, nature conservation, and sustainable community living among island residents. Local farmers, businesses and eco endeavors will continue to benefit from students' increased participation in classes, workshops, and events. Increased participation means that Kalani's Annual Activities will continue a 35 year progression to currently being 96% self- sustaining, requiring less than 4% from foundations and government. Compared to County funded Community Centers that provide fewer programs yet require primarily tax -payer support to build and operate, Kalani's Annual Activities require minimal County support yet provide abundant facilities and programs and a $5M economic stimulus to a repidly growing remote area with few government services. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 11 Kalani Honua, inc. - Agency Name Annual Nature - Culture - Wellness Educational Activities - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections -2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board President/Chair Signatur of xecutive Director f +Cc .c L , J K -6 o / ,- 7 Dat 1 � i 4 / Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 12 63 KalauonaoneoPuna Kalapana Cultural Festival KalauonaoneoPuna - Agency Name Kalapana Cultural Festival- Program Name Agency Director: Leroy Dikito Phone No.: 965 -9001 Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Selisa Wright P O Box 1428 Pahoa, HI 96778 12 -7508 Ma'ohe'ohe Place Pahoa, HI 96778 Not applicable kaimubay @gmail.com Phone No.: 965 -9430 Name of AccountantlCPA (include name of firm if applicable): Nancy J. Kramer Phone No.: 965 -2729 Mailing Address: Amount of Request for County Funds: $15,000.00 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $7000 $9000 $15000 Agency Mission Statement: The mission of KalauonaoneoPuna is to perserve the lifestyles that were unique to the 'Ghana of Kalapana. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 KalauonaoneoPuna - Agency Name Kalapana Cultural Festival- Program Name Program Description: The 4 th annual Kalapana Cultural Day is scheduled for Saturday- August 20, 2011. Like its previous festivals, this event will feature a day of interactive cultural demonstrations, food and craft vendors as well as song and dance that pay homage to those who have ancestral connections to the area. This year's theme, "Na Keiki o Kalapana ", will focus on re- building the connections of our children to their'ohana's past, present and future. Total Budget and Position Count Total Program Budget 1 $15,000 Total Program Position Count 1 0 Total Agency Bud et $15,000 1 Total Agency Position Count 1 0 Program Objectives: 1) To create a venue for the 'ohana of Kalapana to impart their knowledge, experiences and talents. 2) To share with malahini (newcomers) the unique lifestyles of the people of Kalapana. 3) To give the kama'aina (residents) of Kalapana a place to gather and reconnect with family and friends. Program Highlights: (from Fiscal Year 2009 -10) 1) The 3` annual Kalapana Cultural Festival "Kanikapila Kalapana Style" was held on Saturday- August 21, 2010. 2) Measureable increase of 34% participation from 2009. 3) Featured interactive display's included coconut frond weaving, haku lei making, canoe building and makahiki games. 4) A double hull canoe was used to advertise the festival on the day of the event as well as guide those unfamiliar to the area towards the Kikala- Keokea community. 5) Entertainment included, among others, Aunty Becky Pau and the Keali'ihoomalu ' ohana, who are well respected families of Kalapana. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 KalauonaoneoPuna - Agency Name Kalapana Cultural Festival - Program Name Performance Measures: FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget* Estimate Festival Attendance 750 800 1000 - it appiicable Program Expenditures x it applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 0 0 0 Professional Fees $712 $800 $1,000 Operations $10,394 $12,600 $14,000 Equipment 0 0 0 Other* $2,310 $2,600 $3,000 Total $13,416 $16,000 $18,000 x it applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 KalauonaoneoPuna - Agency Name I T I i Kalapana Cultural Festival - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate County of Hawaii $9,000 $15,000 $10,000 CPIP $5,000 0 $5,000 KalauonaoneoPuna $660 $1,000 $1,000 Office of Hawaiian Affairs $0 $0 $2,000 Total 1 $14,660 $16,000 $18,000 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Currently, the Kalapana Cultural Festival is a FREE event to share the cultural practices of the Kalapana community with the public. Our goal is to have this festival partially self- sufficient by 2013 and entirely self - sufficient by 2015 through the solicitation of corporate sponsorships, fundraising efforts and /or community donations. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 KalauonaoneoPuna - Agency Name Kalapana Cultural Festival - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a yearend report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate wear -end report will impact the evaluation of your program's or agency's future funding requests. Signature oard President/Chair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTEDI NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 APPENDIX A. Program Expenditures: Other# expenditures, as indicated on the attached Non - profit Grant Application for FY2011, accounts for the Marketing and Advertising expenses incurred for radio, banners, posters and flyers. These expenses are allocated as Other expenses and kept separate from operating expenses as these cost are not mandatory for putting on the event and could be off -set by the solicitation of sponsorships and /or cost negotiations. M Kapi'olani Medical Center for Women & Children Kapio'lani Child Protection Center - West Hawai'i Title IV -B -West HI Counseling & Supportive Living Project Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center -Big Island Title N-13-West HI Counseling & Supportive Living Project and Hale Kako'o of Puna Mental Health Services Agency Director: Contact Person: Steven J. Choy, Ph.D. Phone No.: (808) 535 -7700 Barbara Higa Rogers, Psy.D. Phone No.: (808) 329 -4020 Clinical Manager -KCPC Big Island Mailing Address: Hawaii Pacific Health Research Institute Attn. Allison Lopes 55 Merchant Street — 26 Floor Honolulu, HI 96813 Facility /Site Address: Kailua -Kona Site: 74 -5599 Luhia Street - #E7 Kailua -Kona, HI 96740 Kau Site: 92 -1657B Coconut Drive; Ocean View, HI Puna Site: 16 -2040 Lilikoi Drive; Pahoa, HI Fax No.: (808) 329 -8628 (Kona) 1- 888 - 535 -8820 (Honolulu) Email Address: stevenc(a.kapiolani.orq Name of Accountant/CPA (include name of firm if applicable) (Note: *Accounting services are self provided. E &Y provides external auditing services) Ernst & Young, LLP* Phone No: Mailing Address: Phone No: Mailing Address: (808) 531 -2037 2400 Pauahi Tower 1001 Bishop Street Honolulu, HI 96813 -3429 (808) 531 -2037 2400 Pauahi Tower 1001 Bishop Street Honolulu, HI 96813 -3429 Amount of Request for County funds: $20,000 ($10,000 West HI & $10,000 East HI) Prior Year Funding: 08 -09 09 -10 10 -11 $0.00 $10,000 $5,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center-Big Island Title IV-13-West HI Counseling & Supportive Living Project and Hale Kako'o of Puna Mental Health Services Agency Mission Statement The mission of the Kapi'olani Child Protection Center is to protect children and strengthen families. Program Description The Title IV -B Counseling and Supportive Living Project provides assessment, counseling, service linkage and coordination, educational and supportive services to assist West Hawaii families at risk of child abuse and neglect. The Kailua -Kona Site served the North end of West Hawaii and the Ka'u Site served the South end of West Hawai'i. This program is part of the Kapi'olani Child Protection Center — a Statewide Center whose mission is to protect children and strengthen families. Priority for services is given to families at risk due to substance abuse (85% of referrals). Special priority is given to families who have or are in the process of adopting or otherwise providing a permanent home for children who have been harmed. Services are provided by KCPC -Big Island staff with additional specialized services provided on the Big Island by the Statewide KCPC Staff located on the island of Oahu. The array of services includes, crisis intervention, individual, couple and family counseling, parenting and life skills education, assistance with transitional /supportive living and other adjunct supportive services as needed by family members. Additional specialized services include medical and nursing case reviews and consultations, psychological evaluations, and Multidisciplinary Teams. The IVB program is funded through a Federal Grant and is administered by the State. The shortage of Mental Health services on the Big Island is well documented and it has been very difficult to meet the needs of high risk families especially in the Ka'u and Puna Districts of the Big Island. In order the address the mental health needs of the Big Island, KCPC -Big Island program has begun to focus more attention to the Ka'u area of West Hawai'i and the Puna area of East Hawai'i. KCPC's new Program, Hale Kako'o (House of Support) is partial funded for Psychological Evaluations and Consultations through State Grants but additional private and county funding will be necessary to provide treatment services and to meet the higher needs in this area. All of the substance abuse treatment, supportive living and parenting services will continue to be available for our West Hawaii IVB program with the addition of NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center -Big Island Title IV -B -West HI Counseling & Supportive Living Project and Hale Kako'o of Puna Mental Health Services specialized Parent -Child Interactive Therapy (empirically - supported parenting treatment services) and mentoring services to facilitate the development of healthy families on the Big Island. Because of the high need for mental health services and the major shortage of mental health providers, KCPC will also be providing additional psychological evaluations and psychotherapy treatment services to the Puna area of East Hawaii and will bring Parent -Child Interactive Therapy to the East -Side of the Big Island as well. KCPC is now the PCIT only training facility and the main provider of PCIT services in the State of Hawaii. This form of therapy has been shown to have a dramatic, long- lasting positive effect on families struggling with changing the behaviors and relational styles that led to their neglectful and abusive parenting. KCPC has tried to meet the needs of the Big Island community, but over $100,000 in Federal and State funding for the Big Island was cut in FY 2009 and 2010. With the financial hardship facing our country, and particularly the Big Island County, KCPC services have become more critical in helping strengthen families and prevent child abuse and neglect. Minimally KCPC needs to maintain the current level of services and expand where possible. Without additional County and Hawaii Island United Way funding, many of the most needy Big Island residents may not receive adequate services. Total Budget and Position Count Total Program Budget $251,036 Total Program Position Count 3.50 Total Agency Bud et $3,514,400 Total Agency Position Count 20.20 *Statewide Services Program Objectives 1) Improve child safety by reducing child abuse /neglect risk factors 2) Improve child safety by increasing child protective factors 3) Reduce trauma related to child maltreatment by providing early psychological treatment 4) Prevent future child maltreatment and reduce the associated problems of school drop out, substance abuse, domestic violence, criminal behaviors, homelessness and mental health problems NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 LN Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center -Big Island Title IV -B -West HI Counseling & Supportive Living Project and Hale Kako'o of Puna Mental Health Services Program Highlights (from Fiscal Year 2009 -2010) During FY2010 the following performance measures were obtained: 1) Provided services to 63 families (goal 75), 105 adults (goal 130) and 156 children (goal 150) — West Hawaii 2) Received Permanency Planning Assistance - 3 families — West Hawaii 3) Reduced CA/N risks — 93% of caregivers who completed services — West Hawaii 4) Had no new CPS report within 6 months after case closure — 97% of families who completed services —West Hawaii 5) Had no new CPS report within 1 year after case closure — 97% of families who completed services — West Hawaii 6) 100% of contracted psychological evaluations provided to Hawaii County residents — East and West Hawaii 7) 100% of contracted Multidisciplinary Team Services provided to Hawaii County residents — East and West Hawaii NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 • s, Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center-Big Island Title IV -B -West HI Counseling & Supportive Living Project and Hale Kako'o of Puna Mental Health Services Performance Measures *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual* Budget * Estimate Individuals Completing Service Plan 43% 80% 80% Individuals completing service plan who have established and 93% 95% 95% implemented a child safety plan at closure. Families completing Service Plan who have no new confirmed report of 97% 90% 90% child abuse or neglect at 6 -month follow-u Families completing Service Plan who have no new confirmed report of 97% 95% 90% child abuse or neglect at 1 year follow -up Families participating in the Parent - Child Interaction Therapy will N/A 75% 75% achieve CDI relational skill mastery. Mentor - Mentee Pairs Trained and participated in Recreational/Service N/A 90% 90% activities. *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 t. Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center -Big Island Title IV-13-West HI Counseling & Supportive Living Project and Hale Kako'o of Puna Mental Health Services Program Expenditures * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages $158,703 $147,850 $157,109 Professional Fees 0 0 0 Operations $62,754 $62,453 $69,453 Equipment 0 0 0 Other# 0 0 0 Total $221,457 $210,303 $226,562 * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual* FY 2010 -11 Budget* FY 2011 -12 Estimate Title IV -B Federal Grant $199,000 $194,303 $194,303 Charity Walk $3,000 $3,000 Quest Insurance Payment $10,000 HI County Grant $10,000 $5,000 $20,000 Private Donations or Charity Walk $3,000 Total $212,000 $202,860 227,303 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center-Big Island Title IV -B -West HI Counseling & Supportive Living Project and Hale Kako'o of Puna Mental Health Services Explain what plan, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to be self- sustaining? KCPC -West Hawaii will continue to seek donations and grants to provide the necessary funds to provide these very vital services for West Hawai'i residents. With the reduction in Federal and State funds, the County grant has provided the means to fund some of the necessary operating costs to allow the continuation of IVB funds to the Big Island. Increased efforts for other grants and private donations will assist in decreasing the needs for County funding for the IVB program. KCPC's Hale Kako'o program is a new service providing mental health services to the high need and shortage area of Puna (East Hawai'i). The county funds are needed for operating costs for the startup of this program as the quest insurance reimbursements would be unable to meet all of the costs for the Mental Health Services. If successful in meeting the Puna Residents' needs, KCPC will seek Federal and State Funds in addition to the insurance reimbursements to sustain this program. It is anticipated that Hale Kako'o may be self- sustaining within the next 4 years. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center-Big Island Title IV -B -West HI Counseling & Supportive Living Project and Hale Kako'o of Puna Mental Health Services I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report may impact the evaluation of your program's or agency's future funding requests. Martha B. Smith Chief Operating Officer, KMCWC Steven J. Choy, . KCPC Director '4 ar ara Higa Roger , P y.D. C 'nical Manager -K Big Island / Z01 11 P, Date 1 2( � r Date ( km Da UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 Keaukaha One Youth Development Youth Development Keaukaha One Youth Development- Agency Name Youth Development- Program Name Agency Director: Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Keahi Warfield Keahi Warfield 101 Aupuni Street, Suite 124 Hilo, Hawaii 96720 Bayfront Hilo, Hawaii none w keahi Phone No.: Phone No.: ff S 4&b Name of Accountant /CPA (include name of firm if applicable): Valerie Peralto, Peralto & Co., CPA Phone No.: 961 -3462 Mailing Address: 180 Kinoole Street, Hilo, Hawaii 96720 Amount of Request for County Funds: $10,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $10,000 $10,000 $10,000 Agency Mission Statement: General scope of the activities for Keaukaha One Youth Development is to provide native cultural opportunities for local youth to reconnect them with the historic ocean experience here in Hawaii. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Keaukaha One Youth Development - Agency Name Youth Development - Program Name Program Description: The specific purpose is to continue to reconnect children in the County of Hawaii with Hawaiian cultural heritage relating to ocean activities. Total Budget and Position Count Total Program Budget $10,000 Total Program Position Count 0 Total Agency Bud et $10,000 Total Agency Position Count 0 Program Objectives: 1) The program (1) stresses physical fitness; (2 ) provides instructional use and maintenance of canoes; (3) strives for perfection of swimming skills; (4) provides training in physical fitness at Keaukaha Gym; and (5) provides the use of Hawaiian canoes and volunteer coaching to minor children. The charity strives to coordinate these activities with local schools. Program Highlights: (from Fiscal Year 2009 -10) 1) KOYD contributed valuable points to Keaukaha Canoe Club's first place 'A' Division win in a Moku season in the history of its existence. 2) KOYD continues to sustain ALL age group divisions from Specials - 18 years of age. 3) KOYD continues to support 100+ youth from ages 7 - 18 in teaching them the traditional Hawaiian practices through protocol and use of the Hawaiian canoe. 4) KOYD youth competed in the Haari Boat Festival sponsored by Senator Daniel Inouye and placed 3 rd in the Open Division which contained adult competitors. 5) KOYD managed to qualify 6 crews for the HRCA State Championships, which includes 12 boys, 12 mox, 14 girls, 15 girls, 18 girls, 18 boys. 6) KOYD continues to be the pillar for setting the entire club's standards and focus on remembering why the club exists and hwo the youth are the most valuable asset for the club's future existence. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 7) KOYD provides students with a health, beneficial extra - curricular activity which offets the temptations of getting involved with alcohol and substance abuse, which is a major problem in our communities. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Keaukaha One Youth Development - Agency Name Youth Development - Program Name Performance Measures: FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget * Estimate $10,000 $10,000 $10,000 If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages Professional Fees 1,978 1,000 Operations 2,836 4,500 3,800 Equipment 5,186 5,500 5,200 Other' Total $10,000 $10,000 $10,000 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 KEAUKAHA ONE YOUTH DEVELOPMENT - Agency Name Youth Development - Program Name Program Expenditures Professional Fees CPA for financial statement $1,000.00 Equipment Paddle and canoe repair $ 2,750.00 Paddling Equipment and supplies 1,750.00 Escort Boat Repairs and Maintenance 700.00 Operations Travel Costs 800.00 Uniforms 3,000.00 $10,000.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011- 2012 Page 4a Keaukaha One Youth Development - Agency Name Youth Development - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget * Estimate County of Hawaii $10,000 $10,000 $10,000 Total $10,000 $10,000 $10,000 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The program continues to rely on contributions from the public and private sector in conjunction with fund - raising activities. We strive for community support to spread the word of the accomplishments of the youth, to garner interest from the community at large and benefactors to subsidize our cause of cultural development and physical well being. Our aspiration is to become a self - sustaining program; however, with the terrible economy, particularly in the Keaukaha /Panaewa area of Hilo, this is becoming increasingly difficult. We try our best. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Keaukaha One Youth Development - Agency Name Youth Development - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board P sident /Chair Signat re of Executive irector i l 2 �:Ll/ Date �zL'l Dat UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 lO R Kohala Communiy Resource Center Strategic Planning and Programs for N. Kohala Food Self Sufficiency North Kohala Community Reosurce Center- Agency Name Strategic Planning and Programs for North Kohala Food Self- Sufficiency- Program Name Agency Director: Christine Richardson Phone No.: 889 -5523 Contact Person: Christine Richardson Phone No.: 889 -5523 Mailing Address: P.O. Box 519, Hawi, HI 96719 Facility /Site Address: 55 -3393 Akoni Pule Highway, Hawi, HI 96719 Fax No.: 889 -5527 Email Address: info @northkohala.org Name of Accountant/CPA (include name of firm if applicable): Phone No.: Mailing Address: Amount of Request for County Funds: $20,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $0 $0 $0 Agency Mission Statement: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 The mission of NKCRC is to increase the number of successful community projects by providing local support, bridges to funding and education for projects that benefit the community. North Kohala Community Resource Center was incorporated in the State of Hawaii as a nonprofit on February 13, 2002. NKCRC sponsors and supports individuals or groups who are creating projects that have the potential to enhance and sustain the North Kohala community. From its inception, NKCRC has been unique in its purpose to listen to the ideas and goals that residents of North Kohala have for their community, to act as a link for funding and education to create projects to support those ideas, and to assist in seeing those projects through to successful completion. Most importantly, NKCRC is a nonprofit established and led by diverse individuals who possess an historic and knowledgeable view of the community - with open minds for the future. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 North Kohala Community Reosurce Center - Agency Name Strategic Planning and Programs for North Kohala Food Self- Sufficiency- Program Name Program Description: The North Kohala Community Development Plan (CDP) Strategy 1.4 is to Promote and Support a Community of Diversified Agriculture and the first goal is "The North Kohala community will produce 50% of the food it consumes [by 2018]." The North Kohala community, through the North Kohala Food Forum has started the process of collecting data and convening the community to discuss the goal of the community producing 50% of the food it consumes. Additionally, there are a number of existing initiatives that lead towards agricultural development for increased food security in North Kohala- most notably the Ho'ea Agricultural Park, the North Kohala Eat Locally Grown Campaign and the programs of Ka Hana No'eau. However, there is currently no strategic plan for achieving the ambitious North Kohala community goal of producing 50% of its own food, and there is no mechanism in place to measure progress. This program is for Strategic Planning and Programs which will: - Map existing community initiatives and define the steps towards the 50% food self- sufficiency goal, and simultaneously; - Implement programs which continue to build consumer demand, raise community awareness and support economic development. A strategic plan with clear goals and timelines will help guide the community towards: increased economic development consistent with the community goal of remaining predominantly agricultural, better community health through the promotion of locally produced foods, and food security. Total Budget and Position Count Total Program Budget 20,000 Total Program Position Count 1 Total Agency Bud et 131,000 Total Agency Position Count 1.75 Program Objectives: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Goal #1: Create a replicable model of community food systems through an iterative process of planning and programs. Strategy /Planning 1. Development of a Strategic Plan for achieving 50% food self- sufficiency in North Kohala. Build in a constant feedback loop for planning and programs. Partner with Hawaii Alliance for Community Based Economic Development (HACBED) on framework development. Initiate discussion with University of Hawaii at Manoa- Economic Research Office or other entity to create a framework for monitoring and assessment of awareness, behavioral changes, community health and economic development. Goal #2: Increase access and grow the market for locally grown foods in the North Kohala community. 3. Produce two Community Harvest Hawaii events where people in the community come together to: process and preserve food and distribute the processed food back into the community, 4. Conduct two "Fresh Food for Food Basket" Campaigns which encourage people to dontate their excess produce and fruit to the food basket. 5. Conduct two North Kohala Eat Locally Grown Days which encourage residents through public awareness and coupon incentives to purchase locally grown food from local markets and restaurants. 6. Conduct one local foods event which raises funds for Ka Hana No`eau's 10 x 10 x 10,000 Project, an exponential taro growing project to promote food sustainability. Program Highlights: (from Fiscal Year 2009 -10) 1. North Kohala Food Forum: August 2009, community food survey and convening of over 200 people to discuss barriers and opportunities to food security for North Kohala. 2. Kanu Hawaii Organizer's Boot Camp: In partnership with Kanu Hawaii, we held an Organizers Boot Camp attended by 34 people involved in food self - sufficiency island -wide. 3. Community Outreach: The community outreach campaign employed one -on- one meetings, speaking to groups, social media, traditional media, electronic media and signage. Specifically, as follows: - Presentation at the weekly Kohala Seniors meeting, followed by a local foods luncheon and another short talk two weeks later. - Presentation and local fruit at Kohala Elementary School. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 - Meeting with pastors of North Kohala churches to try to engage the churches. -Table at the Hawi Farmer's Market on two consecutive Saturdays. - Presentation to the Pacific Century Fellows group at the Kohala Intergenerational Center. -Phone calls to North Kohala Take it Off Hawaii group leaders. -Phone calls to various community leaders to engage them and their networks in the campaign. - Presentation at Slow Food Hawaii pot luck. -E- Blasts distributed consistently through the following email networks: Kanu Hawaii (apx.13,000), Sustainable Kohala (apx. 200), Slow Food Hawaii, Take it Off Hawaii (apx. 700), North Kohala Community Resource Center (apx. 20), North Kohala Food Forum (apx. 80), Senator Josh Greene /Independent Physicians Association, Andrea Dean LLC (apx. 1,000) and Hawaii Homegrown Food Network. (apx. 800). -Three large banners posted at the town entrance at the North Kohala Community Resource Center, Takata Store and under the banyan trees at the Hawi Farmer's Market. - Posters at all restaurants and store windows and community bulletin boards in North Kohala, all community bulletin boards and some restaurants and stores in Waimea. Select restaurants in North Kohala also used table top and counter top displays. - Distribution of 400+ sign -up cards and flyers at various locations and events. -The project website- EatLocalHi.org received 2,304 visits since it launched in September, 2010 to present. -North Kohala Eat Locally Grown Facebook Page- 149 page fans. - Andrea Dean business newsletter- distribution to apx.1,000 business contacts statewide. - Twitter @andreadeangreen 500+ followers. - Active posting to KanuHawaii.org and KanuHawaii.org /North Kohala -Wrote and published articles in Hawaii247.com, Kohala Mountain News, North Hawaii News and Hawaii Homegrown Food Network. -Paid advertising in Kohala Mountain News (2,000 distribution), North Hawaii News (5,000 distribution), West Hawaii Today (13,000 distribution) and Big Island Weekly (12,500 distribution). - Calendar listings submitted to Kohala Mountain News, West Hawaii Today and Big Island Weekly. -West Hawaii Today and Hawaii Tribune Herald published a news story. 4. Kanu Hawaii Eat Local Challenge: 124 North Kohala residents registered online for the statewide Kanu eat Local Challenge. The North Kohala Eat locally Grown Campaign was also responsible for signing up numerous people from outside of North Kohala for the statewide Eat Local Challenge. Community partners on the Eat Local Challenge included: Kanu Hawaii, Slow Food Hawaii, Hawaii Organic Farmers Association, Hawaii Homegrown Food Network, Hawaii Farmers Union and Five Mountains Hawaii/Take it Off Hawaii. 5. Eat Locally Grown at Kohala Elementary School, September 24, 2010: The Hoea Agricultural Park and Blue Dragon Farms donated fruit for the 3rd grade students at Kohala Elementary School. Andrea Dean and Susan Cox (Green NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Power Girl) served the fruit in the Discovery Garden and spoke to the students about locally grown foods. 6. North Kohala Eat Locally Grown Day, September 25, 2010: All participating restaurants and stores displayed signage provided by the North Kohala Eat Locally Grown campaign as well as signage they created themselves to feature the North Kohala grown items on menus and in shelves. Participants: Kohala Coffee Mill, Sushi Rock, Kava Kafe, Luke's Place, Zest, Pico's Bistro, Snack Shack, Fig's Mixed Plate, Minnie's and Makapala Store's Hawayann Cafe featured specials using North Kohala produce, fish, and meats. The Hawi Farmers Market and Takata store featured North Kohala Grown produce and products. 7. Food Swap and Drop at the Hawi Farmer's Market, September 25, 2010 8. Introduction to Laau Lapaau (Traditional Hawaiian Medicine), September 25, 2010: Pamela Noeau Day taught a full class of approximately 20 people about identifying, preparing and using locally found and grown plants for medicine. 9. Kohala `Aina Harvest Festival, September 25, 2010: Over 100 people attended this event organized by Uluwehi Farm's Hawaii Youth Agriculture Project. The event was a fundraiser for the Hawaii Youth Agriculture Project and featured live music, all local food, and mini - workshops in banana propagation, natural farming, mycology and mushroom foraging and permaculture design. 10. Growing an Abundant Perennial Food Garden, September 26, 2010: Craig Elevitch, Neil Logan and Sophia Bowart taught full class of approximately 20 people how to establish a low -input garden of perennial food plants that can feed a family healthy, fresh food for years. Community partners were Hawaii Homegrown Food Network and Mohala Lehua Farm. 11. Ingredients (film), September 26, 2010: Sustainable Kohala screened the documentary film Ingredients for approximately 20 people at the Kohala Intergenerational Center. 12. Eat Locally Grown at Kohala Senior Cente, September 27, 2010: Ka Hana No'eau, Hoea Agricultural Park and Andrea Dean cooked and served a locally grown lunch to approximately 50 Kohala Senior Citizens. Food was donated by Ka Hana No'eau, Hoea Agricultural Park, Lokahi Farms, Blue Dragon Farms and Lone Palm Sprout Farm. 13. Waimea Potluck for Eat Local Challenge Participants, September 29, 2010: Approximately 25 people attended a 100% locally grown pot luck at a private home in Waimea. Slow Food Hawaii was a community partner on the Eat Local potlucks in Waimea. 14. Stone Soup Club, September 30, 2010: Chef Greg Menke facilitated about 15 people in the processing and cooking of local foods that people brought to process and share: coconuts, breadfruit, citrus, fish, beef, herbs, fruits, NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 vegetables, and more. The event was hosted in the gourmet kitchen of Deborah and John Winter. 15. Local Talent, Local Food, October 1, 2010: The Kava Kafe featured local, vegan food, local awa and a local talent show ... the highlight of which was a belly dancing act! About 50 -70 people attended throughout the evening. 16. Plant and Seed Exchange Tent at the Kohala Country Fair, October 2, 2010: Hundreds of people came through the seed exchange tent to talk story and take free plants and seeds from 10 local farmers who generously brought plant material to share with the community. 17. Slow Foods Hawaii's All Local Food Potluck, October 3, 2010: About 40 people attended this 100% local food potluck hosted by Slow Food Hawaii at Anna Ranch in Waimea. The above initiatives were executed with a budget of $11,000 as follows: $5,000 County of Hawaii, Department of R & D, $5,000 Kaiser Permanente, $1,000 USDA- Farm Services Agency. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 North Kohala Community Reosurce Center - Agency Name Strategic Planning and Programs for North Kohala Food Self- Sufficiency - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Development of Strategic Plan completion Attendance at Community Harvest 200 people Pounds of Food Collected- Distributed 1000 Ibs Attendance Eat Locally Grown Days 250 people Attendance at 10x10x10k event 75 people Total 20,000 *If applicable Program Expenditures " If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages Professional Fees 10,000 Operations 10,000 Equipment Other* Total 20,000 " If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 North Kohala Community Reosurce_ Center - Agency Name Strategic Planning and Programs for North Kohala Food Self- Sufficiency - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual Budget* Estimate County of Hawaii 20,000 Private Foundation Support (applied 5,000 for) State of Hawaii CBED (applied) 10,000 Total 35,000 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Additional private foundation support is being purused through a number of channels. Community -based strategic planning is not likely to become financially self- sustaining. It is possible that "Eat Local" and "Buy Local' campaign initiatives could become self - supporting through business membership in the future. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 North Kohala Community Reosurce Center - Agency Name Strategic Planning and Programs for North Kohala Food Self- Sufficiency - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board President/Chair C -a - C (2 - 0� Signature of Executive Director Date ,- Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 10 `� Ka Hana No'eau Mentorshidp Program At the Kohala Intergenerational Center P.O. Box 1596 Kapaau, Hawaii 46755 � Phone: (808) 884.5838 `"�+.e,.r" FAX: (808) 884 -5531 Tuesday, January 25, 2011 County of Hawaii Finance Department 25 Aupuni Street, Room 2103 Milo, Hawaii 96720 Re: North Kohala Community Resource Center Application for Strategic Planning and Programs North Kohala Food Self - Sufficiency To Whom It May Concern, I am writing in strong support of the above referenced application. As you know, the issue of food security is a top priority for the County of Hawaii and the community of North Kohala. The North Kohala Community has completed its Community Development Plan (CDP), which has been accepted by the Hawaii County Council. The North Kohala Community Development Plan Strategy 1.4 is to Promote and Support a Community of Diversified Agriculture and the first goal is "The North Kohala community will produce 50% of the food it consumes [by 2018]. " The North Kohala community has started the process of collecting data and convening the community to discuss the goal of the community producing 50% of the food it consumes, and we have many initiatives which support this goal- -but there is currently no strategic plan for achieving this ambitious community goal of producing 50% of our own food. I strongly believe that this project will help our community reach its goal to produce 50% of its own food by mapping our community assets and defining the necessary steps towards this goal. This will help the community draw in the necessary resources and measure our progress. This proposal also includes initiatives, which can be simultaneously employed to planning, gaining the maximum benefit for the community. Andrea Dean, who will be leading this effort in our community is an experienced convener and community organizer who has successfully executed many County funded programs, and I have every faith that she will do an excellent job executing the plan outlined in this proposal. Sincerely, C David Aes Ka Hana No`eau Hocea Agricultural FarL January 26, 2011 County of Hawaii Finance Department 25 Aupuni Street, Room 210' Hawaii 96720 Re: North Kohala Community Resource Center Application for Strategic Planning and Programs for North Kohala Food Self-Sufficiency To Whom It May Concern, I am writing to voice my support of the above referenced application. We see the Ho`ea Agricultural Park as being one of the many efforts in our community that will help move us towards our CDP community goal of producing 50% of our own food. However, we are just one piece of a complex puzzle. Without a comprehensive Strategic Plan to help the community see where we are heading, how will we get there? I believe that this proposal to develop a Strategic Plan, while simultaneously implementing programs which create demand and feed people, will help our community achieve its goals. We envision the North Kohala community becoming a model community for a community- based, culturally appropriate, sustainable food system in Hawaii, and think that Strategic Planning and Programs for North Kohala Food Self - Sufficiency will help us get there. Sincerely, l Marc Kinoshita, Project Manager Ho`ea Agricultural Park P.Q. gox437289, Kamucla, hl 967 808-859 -r 367 67 Kona Adult Day Center, Inc. Adult Day Care KONA ADULT DAY CENTER, INC. - Agency Name ADULT DAY CARE- Program Name Agency Director: Contact Person: ROWENA L. TIQUI ROWENA L. TIQUI Phone No.. Phone No.: Mailing Address: Facility /Site Address: Fax No.: Email Address: P. O BOX 1360 KEALAKEKUA HI 96750 81 -989 HALEKN STREET KEALAKEKUA HI 96750 322 -0614 KADCROWENA @HAWAI I. RR. COM Name of Accountant/CPA (include name of firm if applicable): RONALD G. HAWKES, CPA Phone No.: 939 -7392 Mailing Address: P. O. BOX 2030 KEALAKEKUA HI 96750 Amount of Request for County Funds: $20,000.00 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $20,000.00 $15,000.00 $15,000.00 Agency Mission Statement: "OUR MISSION IS TO PROVIDE SOCIAL AND RECREATIONAL PROGRAMS AND ACTIVITIES THAT ENABLE IMPAIRED ADULTS TO EXPERIENCE FEELINGS OF BELONGING, FRIENDSHIP, ACCEPTANCE, ACCOMPLISHMENT AND INDEPENDENCE IN A CARING AND SECURE SOCIAL ENVIRONMENT." NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 KONA ADULT CENTER, INC - Agency Name ADULT DAY CARE- Program Name Program Description: Adult Day Care is viewed as a promising long -term care option because it provides regular and reliable respite to informal caregivers, while it fosters their continued participation in the workforce. Persons eligible for Kona Adult Day services are those adults 18 years and above, but particularly those 60 years and older, having either a physical or cognitive disability requiring supportive care. These are persons with Alzheimer's disease, dementia or other memory related disorder, those with physical disabilities such as stroke, Parkinson's disease, and multiple sclerosis and those who are socially isolated. Day Care provides a less restrictive setting and a more cost effective program than other types of care, such as home nursing or institutionalization. Total Budget and Position Count Total Program Bud et 311,646.00 Total Program Position Count 6 Total Agency Bud et 1 311,646.00 Total Agency Position Count 6 Program Objectives: 1) For Individuals: a) mentally and physically impaired adults are maintained at their highest level of functioning, thus preventing or delaying further deterioration. b) maximum level of independence is assessed and maintained through the individual program planning. c) client is able to associate with a place and a group corresponding to his/her sense of identity. d) Health monitoring as well as protective ans supportive care for the frail and disabled adults are included in care planning and services. e) caregivers have access to knowledge of elderly services available in the community. f) deter premature or inappropriate institutionalization in a nursing home or hospital. g) socializing, peer interaction and continued relationship with the community is ensured. h) Isolation and prejudice often assiciated with frail and disabled adults is reduced. 2) For Families and Other Caregivers: a) families that desire to keep elderly members in the home are given relief from full -time care of an impaired adult. Family members are enabled to continue productive careers instead of being homebound with an elderly, disabled spouse, parent or other family member. c) families and other caregiver's are assured that elders dependent upon them are being cared for appropriately during the day. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 3) For the Community: a) an integral component of the community service network and of the long term care continuum is made available to the West Hawaii Community. b) the medical community and other resources statewide are provided a liason in the geriatrics, especially Alzheimer's disease and other related disorders. Program Highlights: (from Fiscal Year 2009 -10) 1) Maintained 95% of participants at home for a minimum of six months with adult day services. 2) Maintained or improved socialization /infraction skills of participants by 95 %. 3) Maintained or improved hygiene /self -care of participants by 95 %. 4) Survey satisfaction of caregivers. 5) Had many intergenerational interaction activities with community groups and schools. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 KONA ADULT DAY CENTER, INC. - Agency Name ADULT DAY CARE - Program Name Performance Measures: FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget* Estimate Clients served 42 55 60 If applicable Program Expenditures If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 151,206.68 151,200.00 151,200.00 Professional Fees 4,399.78 4,260.00 4,300.00 Operations 162,844.37 155,986.00 150.000.00 E ui ment Other* Total 318,450.83 311,446.00 305,500.00 If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 KONA ADULT DAY CENTER, INC. - Agency Name ADULT DAY CARE - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate DHS /NHWW 49204.23 43200.00 45000.00 COUNTY OF HAWAII 15000.00 15000.00 20000.00 THERESA HUGHES TRUST 17486.22 18000.00 30000.00 MAY TEMPLETON HOPPER 46000.00 50004.00 50000.00 HAWAII ISLAND UNITED WAY 13939.44 14000.00 15000.00 HCOA- SERVICE FOR SENIORS 1470.00 1680.00 1500.00 OTHER GRANTS 1500.00 1500.00 1500.00 TUITION 89540.00 97350.00 90000.00 PROGRAM FEES 23835.00 24980.00 25000.00 ADULT FOOD PROGRAM 4899.05 4860.00 3500.00 FUNDRAISING 53886.01 28196.00 30000.00 OTHER 11275.00 11276.00 11000.00 INTEREST /DIVIDEND INCOME 1591.25 1600.00 1600.00 UNREALIZED GAIN LOSS 1470.00 0 0 Total 331471.77 311646.00 324100.00 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? It is my goal to enroll 60 clients with an average daily participation of at least 40 and be able to maintain their level of care with no more than 9 employees. I believe at that time we will be self - sustaining. But only if the level of functioning is at level I, which requires minimal supervision. As it is now, instead of the 6 clients to 1 employee as required by the state, it is taking 1 employee to 3 clients because of the level of care required, which is acute care. We have more clients in wheelchairs and using walkers and canes. We have more Alzhiemer's and dementia clients who are low functioning and require a lot of cueing and supervision. In the last 10 years the level of care has increased progressively. I need to have at least 4.5 clients per employee per day to stay in the black. But as you can see the ratio doesn't work, it takes1 employee to take care of 3 clients but I need 4.5 clients to offset the cost of each employee and other expenses. Unfortunately we cannot accept ONLY the clients that require minimal care. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 ., I KONA ADULT DAY CENTER, INC - Agency Name ADULT DAY CARE - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your pro gram's or agency's future funding requests. 1�� C .4cxU 9,.hA am — Signature of Board President/Chair Signature of Executive Dir for Date 11'4:-�:>A � Da e UNSIGNED PROPOSALS WILL NOT BE ACCEPTEDI NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 L• Kona Historical Society Living History Program Operations Kona Historical Society- Agency Name Living History Program Operations- Program Name Agency Director: Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Jill R. Olson Ku'ulani Auld P.O. Box 398 Captain Cook, HI 96704 81 -6551 Mamlahoa Hwy Kealakekua, HI 96750 323 -2398 khs @konahistorical.org Phone No.: 323 -3222 Phone No.: 323 -3222 Name of Accountant/CPA (include name of firm if applicable): Tone Lamkin and Taketa, Iwata, Hara & Assoc, LLC Phone No.: 323 -3222 Mailing Address: P.O. Box 398, Captain Cook, HI 96704 Amount of Request for County Funds: $50,000 Prior Year(s) Funding: 08-09 09 -10 10 -11 $0 $0 $10,000 Agency Mission Statement: Kona Historical Society will preserve the history of Kona to enrich our community and inform our visitors by nurturing an understanding of, and inspiring an appreciation for, Kona's unique island sense of place. We will do this through collecting, preserving, researching, interpreting, and disseminating the history of Kona with an emphasis on the period after 1779. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Kona Historical Society - Agency Name Living History Program Operations- Program Name Program Description: KHS has two unique sites and three programs: 1. Kona Coffee Living History Farm (D. Uchida Farm), a 6 -acre 1920's era coffee farm in Captain Cook, which was homesteaded by Japanese immigrants. The Farm interprets the history of Kona's Coffee Pioneers and their family values, independence, and resourcefulness. 2. H.N. Greenwell Store, an 1890's general store in Kealakekua, founded by H.N. Greenwell, an English immigrant. The Store presents typical 19th century shopping experiences by encouraging visitors to role -play actual multi - cultural customers from the period. It is the oldest commercial building remaining in Kona. We offer living history tours of these sites to school groups, visitors, and local residents. Both sites encourage visitors and local school children to enter the appropriate era with the help of costumed interpreters, historically accurate artifacts, and actual buildings from the period. Both sites are listed on the State and National Registries of Historic Places. 3. Portuguese Stone Oven: in 2005, KHS launched a bread - baking program with an authentic, community sized, traditional oven, which was built adjacent to the H.N. Greenwell Store. Nearly 100 loaves are baked weekly and sold to a steady stream of customers. Visitors and school groups are encouraged to come early to help with the bread - making process, and to sample hot loaves right from the oven. Total Budget and Position Count Total Program Budget 179,622 Total Program Position Count 20 Total Agency Bud et 401,314 Total Agency Position Count 30 Program Objectives: 1) Provide authentic, thoroughly researched, and engaging programs at historic sites. 2) Demonstrate how coffee was grown, picked and processed during the 1920's with the participation of all family members, even the children 3) Convey the history of the 1890's multi - cultural Kona mauka ranching and mercantile community NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 4) Demonstrate how general store customers chose and purchased goods through trade, exchange, credit, or cash, depending on what resources were available to them. 5) Continue the traditions of Portuguese ranching and dairying families with breadbaking in the rustic stone wood -fired oven. 6) Educate visitors to create an understanding of and appreciation for Kona's multi - cultural history. 7) Encourage visitors to participate in hands -on experiences at each site. Program Highlights: (from Fiscal Year 2009 -10) 1) In March 2010 Kona Historical Society was awarded a State Legacy Lands Grant in the amount of $255,000 to purchase 2.1 acres adjacent to the H.N. Greenwell Store site. The property will be used to construct the Kalukalu Ranch Homestead, a typical 1890's Kona ranch. 2) Private Foundations and individuals contributed an additional $335,00 to complete the property purpose and begin construction in 2012. 3) In February 2010 KHS was awarded one of only six worldwide grants from Tourism Cares to provide renovations to the 1920's Kona Coffee Living History Farm structures. 4) In May 2010 the Portuguese oven celebrated five years of producing three types of delicious and authentic bread for the community. 5) An exhibit of historical items and photographs from Kona Historical Society was installed at Kona International airport in the United Airlines arrival area. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Kona Historical Society - Agency Name Living History Program Operations - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Number of Adult Visitors 6209 5800 5700 Number of school children 751 725 750 Operations 75,555 73 81 Equipment 0 0 0 Other" 8,662 10,326 12,387 Total 195,101 189,623 179,622 *If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages 95,525 98,953 82,055 Professional Fees 15,359 6,661 3,750 Operations 75,555 73 81 Equipment 0 0 0 Other" 8,662 10,326 12,387 Total 195,101 189,623 179,622 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Kona Historical Society — Agency Name Living History Program Operations — Program Name Explanation of Program Expenditures on Page 5 Other Expenditures FY 2009 -10 FY 2010 -11 FY 2011 -12 8,662 10,326 12,387 This expense includes FICA taxes. NOTE: Kona Historical Society's fiscal year runs from January through December. Therefore Program Expenditures shown are for: FY 2009 (actual) FY 2010 (preliminary) FY 2011 (budgeted) NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 -A Kona Historical Society - Agency Name Living History Program Operations - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Tours and Admission Fees 59,574 51,088 48,800 Gifts and Publications 21,558 12,319 10,915 Retail Coffee Sales 42,715 35,495 38,000 Mac Nut Crop Sales 2,796 1,548 1,200 Portuguese Bread Sales 25,634 31,014 30,000 State Foundation for Culture & Arts 17,810 18,823 19,800 County of Hawaii Non-profit Grant 5,000 5,000 Young Brothers Tug & Bare Fdn 500 0 500 Coffee Crop Sales 19,199 1,485 0 Total 172,142 137,116 134,415 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? During the last few months of 2010 and during January 2011, we have noticed a slight increase in the number of visitors to our sites. Given State tourism projections, we anticipate that this trend will continue. However, despite increased visitors to our sites, we have not seen a corresponding increase in gifts and retail sales of Kona coffee, which have declined by 24% over the three year period. While the visitors seem to be returning, it's clear that they are not spending as they have prior to Fall 2008. In addition, because of the drought there was little surplus coffee crop to sell wholesale in 2010 and we expect that situation to continue in 2011. KHS has recently updated its website and is in the process of creating a sales page that will make it easier to sell our products on -line, especially coffee. Also, since our bread sales have increased steadily, we plan to add two additional baking days per month. In this way we can capitalize on the trend to purchase locally made products. We continue to take advantage of every free and low cost opportunity to publicize our programs, and have successfullypursued feature articles of activities and programs in local media. A staff member is responsible NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 for making sure our programs and events are listed in publications catering to tourists, as well as in PSA's and local calendars. Our website is up -to -dated regularly by trained staff. In 2008 the Living History Programs overall were self - sustaining, in terms of direct costs. However, in 2009 and 2010, despite cuts in operating hours and operating expenses, revenue generated from program fees and gift and coffee sales did not cover costs. We project this situation to continue at least through the first half of 2012. We hope to see a return of these programs to sustainability by the second half of 2012. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Kona Historical Society - Agency Name Living History Program Operations - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, l (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. ] f 26�I I Date 0 1 1a I t( _ Dat UNSIGNED PROPOSALS WILL NOT BE ACCEPTEDI NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 Y Q&i"W� Signature of Board President/Chair Kona Literacy Council Kailua Learning Center - Agency Name Kailua Learning Center- Program Name Agency Director: Brenda Natina Phone No.: 808 329 -1180 Contact Person: Brenda Natina Phone No.: 808 329 -1180 Mailing Address: Kailua Learning Center 75 -5766 Kuakini Hwy Suite 106A Kailua -Kona, HI 96740 Facility /Site Address: Same Fax No.: 808 329 -1180 Email Address: konalit @msn.com Name of Accountant/CPA (include name of firm if applicable): None Phone No.: Mailing Address: Amount of Request for County Funds: $2,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $2,000 $2,000 $2,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Agency Mission Statement: The Kona Literacy Council's trained volunteer tutors help any adult increase their basic reading, writing, math, and communication skills to enable the learners to become better family members, workers, community members and lifelong learners. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Kona Literacy Council - Agency Name Kailua Learning Center- Program Name Program Description: The Kona Literacy Council's trained volunteer tutors provide free, one -to -one, small group, and computer- assisted literacy services at the Kailua Learning Center to any adult who wants to improve their basic reading, writing, computation skills and computer literacy. Special programs designed to meet the specific needs of the learners are offered, such as: English as a Second Language, preparation for passing the GED or Competency Based High School Diploma, Citizenship preparation, keyboarding and computer literacy. All tutoring is at no cost to the student. All of the approximately 600 students, who have had lessons at the Kailua Learning Center since it opened in September 1992, have made remarkable progress in their basic skills; some have gained their High School Equivalency Diploma, passed the Citizenship exam, and have gotten better jobs. Reading improves the adults' self- esteem, thereby improving their lives and becoming better family members, workers and community members. Total Budget and Position Count Total Program Budget $5,600 Total Program Position Count Total Agency Bud et $5,600 Total Agency Position Count Program Objectives: 1) Continue to provide free one -to -one, small group and computer- assisted literacy services at the Kailua Learning Center to any adult who wants to improve their basic reading, writing, computation and computer literacy skills. 2) Register, schedule, match learner with tutor, and prepare programs for 12 new students for the year. 3) Continue recruiting and training new tutors. 4) Continue networking with community agencies to provide free literacy assistance to their clients, i.e. Department of Human Services, Department of Labor & Industrial Relations, Kona Community School for Adults, various Vocational Rehabilitation Programs, Bridgehouse, Alternatiaves to Violence, court ordered participants, Family Support Services of West Hawaii, Hawaii Community College and the public libraries. 5) Offer pre - employment skills, help in filling out application forms, resume writing and interview skills to enable our learners to get and hold jobs. 6) Improve family literacy services. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 7) Help foreign born learners with their communication skills and assist them in passing their citizenship test. 8) Empower adults to become contributing members of our community by ensuring that everyone increases their literacy skills and becomes lifelong learners. 9) Publish a newsletter three times a year. 10) Hold general membership and public meetings three times a year. 11) Continue writing grants, pursuing fund raising functions, and seeking donations to keep open the doors of the Kailua Learning Center. Program Highlights: (from Fiscal Year 2009 -10) 1) Tutored basic literacy students1) Prepared for high school equivalency class: 4 students. 2) Received High School Equivalency Diploma: 1 student. (includes reading, math & computer literacy): 5 Students. 3) TutoredEnglish as a Second Language students: 7 students. 4) Prepared for high school equivalency class: 4 students. 5) Received High School Equivalency Diploma: 1 student. 6) Left the program and attained employment: 2 students. 7) Retained employment: 4 students. 8) Studying for the citizenship test: 11 students. 9) Entered other educational programs: 0 student. 10) Increased involvement with children's education: 4 students. 11) Met goals: 5 students. 12) Utilized 2 volunteer tutors, 4 auxiliary personnel, plus the Program Director. 13) Tutored approximately 375 hours of actual tutoring. 14) Contributed approximately 400 hours by volunteers in other areas. 15) Trained 0 new tutors. 16) Passed Citizenship Test: 4 students. 17) Provided court ordered community service: 1 male. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Kona Literacy Council - Agency Name Kailua Learning Center - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Tutored Adult Basic Ed. Students 5 9 5 Tutored Pre-Equivalency HS 4 0 5 Tutored ESL Students 7 10 10 Citizenship Students 11 4 5 New Tutors 1 2 2 Newsletters 3 3 3 Board & General Public Meetings 3 3 3 Total Tutoring Hours 375 400 400 Total Non-Tutoring Hours 400 450 400 *If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 0 0 0 Professional Fees 0 0 0 Operations 4,134 4,500 4,300 Equipment 310 400 400 Other" Insurance 500 500 500 Total 4,944 5,400 5,200 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Kona Literacy Council - Agency Name Kailua Learning Center - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate County Grant 2,000 2,000 2,000 Young Brothers 500 1,000 1,000 Ironman 1,000 1,000 1,000 Federal Campaign 613 500 600 Wal -Mart 0 250 250 Donations 500 500 500 Membership Dues 10 50 50 Fundraising 0 100 100 Total 4,623 5,4001 5,500 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The Kona Literacy Council plans to participate in more fundraising and grant proposal writing. Since we do not charge our clients for our literacy services, we will have to continue to rely on the generosity of our community supporters. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 - Agency Name - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signoture of Bbard l�r esident/, hair Sigfi ture of Exe utive Director Date / / / Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Qf , Ku Aloha Ola Mau Hui Ho'ola 0 Na Nahulu 0 Hawaii Ku Aloha Ola Mau- Agency Name Hui Hdola O Na Nahulu O Hawai'i - Program Name Agency Director Contact Person: 9829555 Mailing Address: Facility /Site Address: Fax No.: Email Address: Name of Account; Phone No.: Mailing Address: 96813 Lisa Cook Kelaukila Carter Phone No.: 8085380704 Phone No.: (808) 1130 N. Nimitz Hwy Ste. C -302 Honolulu, Hl 96817 15 -1926 30 /Puakalo Street Hawaiian Paradise Park Kea'au, HI 96749 808 - 982 -9554 Icook @kualoha.org kcarter @kualoha.org ant/CPA (include name of firm if applicable): CW Associates, CPA's 808 - 531 -1040 700 Bishop Street, Suite 1040 Honolulu, Hawaii Amount of Request for County Funds: $100,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $0 $0 $0 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Agency Mission Statement: Agency Mission Ku Aloha Ola Mau (Ku Aloha)" restores meaningful, healthy lives for all Hawaii communities through responsive and responsible action towards present and future needs in the prevention and treatment of addiction. " This name had transitioned the agency from Drug Addiction Services of Hawai' as it moved from diagnoses -based to strength based. The agency wanted its name to be it's vision: 1) demonstrating its value of holistic and comprehensive approaches; 2) one that honors the culture and our connection to the land, sea, sky and eachother; 3) to move towards a stronger sense of spritivality and Aloha. Though difficult to translate into English, Ku Aloha Ola Mau means to give, with compassion, from the deepest part of ourselves, life forever. Program Mission The mission of Ku Aloha's program, Hui Ho'ola O Na Nahulu O Hawaii, (Hui) for which this application is being written, is " to create a healing community, grounded in the spirit and culture of Hawaii that reaches out to all ethnicities suffering from from the disease of addiction." This mission was born out of a community group comprised of Kupuna, policy makers, service providers, the target group and community members who took responsibility and committed themselves to help people and families recover from addiction. The Hui's name means "We are the group that gives life back to the people of Hawai'i." Not knowing the meaning of the name, many years after it was given a group of Haumana (clients are called students in Hawaiian) stated to a group of legislators that "the Hui gave them their lives back ", echoing" Kupuna Napeahi's vision. The name was given by Kupuna Abigail Napeahi, who also gave the program the essence of its aloha and approach: "Every haumana is a precious gift that walks the face of the earth" she would say and then show it. This approach is now the Agency's philosphy and belief, "Every person is special and important." NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 KU — Aloha Ola Mau - Agency Name Hui Hdola O Na Nahulu O Hawai'i - Program Name Program Description: Purpose and Goals This proposal is intended to improve the quality and intensity of effective services for the Native Hawaiian and other Asian Pacific Island populations who are addicted and at high risk for social problems and crime. It shall accomplish this through: 1) increasing the treatment capacity and accessibility for Native Hawaiian and other API populations, 2) enhance the efficacy of services through restoration of family cohesion, traditional values and roles, and promotion of self - sufficiency, health and wellness and community responsibility. Hui Ho'ola O Na Nahulu O Hawaii (Hui) is a program under Ku Aloha Ola Mau. It is specifically geared to rural settings and is a community designed healing center located in Puna. The Hui provides substance abuse treatment that is spiritually and culturally based on the Hawaiian culture, and serves people of all ethnicities on the island of Hawaii. Integrated Approach This will be accomplished through a unique and innovative approach which integrates cultural traditions, values, ceremonies and healing practices into the evidenced based practices of Intensive Outpatient Treatment Cognitive Behavioral Training and Enhancing Motivation for Change. In this approach, cultural modalities do not run parallel or are adjunct services to Western practices, but are blended within the structure, activities, and interventions of the models to provide a seamless, effective and empowering approach. In addition, the Hui provides transportation as many have none and would not access treatment without it. Case management and crisis intervention are also provided. "Ice" and addictive substances create chaos in many lives. However, it is also an opportunity for individuals and their loved ones to be highly motivated to change. Provision of these modalities provides stabilization and connection to other vital community services. The program offers Intensive Outpatient (IOP), Outpatient(OP) and Continuing care modalities. Services include Screening and Assessment, Individual Treatment Planning and Evaluation, Transition and Discharge Planning, overnight retreats. Target population These are comprised of adults aged 18 and over (and their families) who meet State Alcohol and Drug Abuse Division definitions for addiction (DSMIV -TR, American Society of Addiction Medicine (ASAM) Patient Placement Criteria for IOP or OP. The Hui's haumana population is comprised primarily of those addicted to "ice " - crystal methamphetamine, marijuana and alcohol, however NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 those with cocaine and opiate addiction are also accepted. The program provides substance abuse assessment, referral, intensive outpatient, outpatient, continuing care. In addition, it provides services such as acupuncture and lomilomi through licensed consultants. Ho'oponopono, Hawaiian history and values, geneology are provided by community respected kupuna and practitioners trained in these practices. Staff also lead the haumana in ceremonies, traditions and practices. The program has been serving 16 haumana at any given time. However, even when it was serving 40 +, they still had to turn people away due to lack of adequate resources and staffing. This request is to open 15 more slots for those who are indigent and in need of these services. The program is attractive to the target population because of its cultural and spiritual activities, approach and Kupuna services. The Hui is the only outpatient culturally based substance abuse treatment program in Puna. It is located in Kea'au and has to -date treated over 900 individuals and families. It is staffed by Native Hawaiian certified substance abuse counselors (CSAC) and Native Hawaiians who were raised practicing traditional cultural ceremonies, values, chants, and practices which foster resiliency and protective factors as well as healing, recovery and relapse prevention skils and tools. Staffing Program Manager, Sarah Kelaukila Carter - respected community member and 10 years a s Program Manager with Hui Ho'ola Counselors meet State Alcohol and Drug Abuse Division requirements. Randal Kaipo Like, Clinical Supervisor, CSAC Over10 years supervision Rachel Kruse, Traditional Counselor, CSAC and BA Brian Ogawa, BA, working toward CSAC under Kaipo Like Dave Nakaooka, Driver -lives in Puna Counselors provide assessment, treatment planning, individual, group and family counseling through its outpatient, intensive outpatient and continuing care structure. In addition the Hui has assisted Rachel in received her CSAC and is now assisting Brian Ogawa to do the same. He is currently a volunteer. The staff open the doors of college and opportunities also to Haumana through tasks given to haumana which involve going to the local college such as to research their geneaology. The staff and Kupuna work together towards each individual and family, and regard the haumana (clients are called "students" in Hawaiian to remove stigma and provide a role) as special and important to create a sense of wellness and in connecting and giving back to the community. Facilities The agency has land in Kapoho called the Kapoho Educational Cultural Center where many activities take place. There is currently a taro patch, a garden, a large open air pavillion and a handicap accessible restroom. Activities such as men's group, Hawaiian values group, hula, oli, Kihei, etc. are done to teach NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 specific lessons and to awaken positive self- identity, learn Native practicies which are useful in achieving and maintaining recovery, and realizing one's effect and thus responsibility to the land, elements, sea and to eachother. Counseling and assessment are also provided at the office located in Puna. Services The program helps to build self- esteem through validation of one's culture, through role modeling by the staff of appropriate family roles and interaction, learning difficult chants, understanding core values of the culture, the depth of meaning behind learning one's geneaology and respecting others. It also opens the door for higher learning, or job or vocation to play a positive part in the community. Through the Hawaiian culture, the staff lift up other cultures as well so participants from all walks of life and cultures feel the aloha given to them and can identify spiritually with the staff and participants. The Hui provides occasional overnight retreats with and without families. Its activities are what one would see in a healthy community and family. Working together on the land, eating together, men and women having some separate times to process, share and support; creating together, taking classes together, sitting with Kupuna and so forth. The Hui's skilled counselors guide Haumana into processing these activities and find the deeper meaning /lesson(s) and connection in their lives. They move individuals to finding out "who they are" and "where they are going. They understand how some ceremonies, traditions, practices can help them prevent relapse and build strong families of their own. The program accepts people into its "ohana ", teaches them discipline and gratitude and more. The haumana or "students" graduate with new responsibilities as alaka'i or leaders. One by one, family by family, the Hui is transforming the community from the desperation of drug and alcohol addiction to beautiful people and families with a strong sense of self, with tools, skills, knowledge and the determination to create a better legacy for their descendants and for the community. Several of the haumana have become staff of either the Hui or as counselors in other agencies. Evaluation Every six months, outcome data is collected in addition to Consumer Surveys upon discharge, a review of incident reports, trends seen and a review of units of services provided, training needs, etc. These are shared with the Operations Management Team (all supervisors and managers for KAOM sites) for review and to recommend any changes as well as recognizing accomplishments. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Total Budget and Position Count Total Program Budget 199,000 Total Program Position Cou — n — t - 1 3.25 Total Agency Budget 1,924,000 Total Agency Position Count 1 35 Program Objectives: 1) Provide screening to 25 individuals; intake to 20 within the budget year. 2) Provide education and counseling to 15 families to assist them in understanding and implement what was learned in prevention education training by Hui Ho'ola staff and providers within 4 months from admission. 3) Provide counseling and education which is conducive to individuals needs to heal from addictions of alcohol and substance abuse for 15 individuals by the end of the contract year. 4) Provide teachings through Kupuna and staff on self- awareness, kuleana and other Hawaiian values, and mookuauhau to 15 individuals during the course of treatment by the end of the contract year. 5) Provide supplies, transportation, case management, school and vocational counseling to 15 individuals prior to graduation and within the contract year. Program Highlights: (from Fiscal Year 2009 -10) 1) A three day Cultural Immersion Training provided for counselors from two other lead agencies was held at Kilauea Military Camp. Kupuna Pearl Ulu Garmon facilitated and guided a portion of training. Former haumana referrred to as "Alaka'i" shared depth of their experience. Ku Aloha Ola Mau was the lead agency to Kahea this event. 50 adults participated, 4 youths from Kua O Kala were Kako'o of the audio video recording team to capture a day on film. Results showed 96% of participants gained new knowledge and skills that increased their capacity to support youth and /or families and 96% have been able to utilize the new knowledge /skills in their work. 2) The Hui treatment services consistently met or exceeded their projected outcomes. 3) The Hui provided a placement for 4 students attending Hawaii Community College and /or UH -Hilo studying Human Services 4) 2 students attending UOP- University of the Pacific, Stanton,CA, and UH- Manoa return to HI Island to attain study hours through hands -on training at Hui Ho'ola and in doing so, assisting and giving back to their communities as stipulated by the funds awarded these students. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 5) KAOM's program supports and provides support and training annual for 2 youth participants of Alu Like Summer Youth Employment Training Program. 6) Haumana continue to participate in various site visits along with Hui Ho'ola staff in collaboration with agencies to support haumana to attain future endeavors and skills, etc. 7) Celebrating Recovery annual gathering was held in Mo'oheau Park sponsored by Office of Social Ministry (OSM) - Celebrating. 3 Alaka'i of Hui Ho'ola were hired to provide security and "drug free watch ". Hui staff and 7 current haumana provided outreach education awareness of agency services. 8) Community members, alakai, staff, haumana, family members joined a team of dedicated members through the guidance of "Kanu Hawaii ", to malama and kokua Non - profit organizations. Group of 50 adults gathered to participate in re- erecting a water catchment, malama aina in Kapoho to restore weekly cultural services a site for haumana, and communities. Ku Aloha Ola Mau's Kapoho site was selected for Hawaii Island's site. This event was held statewide on this day to " Malama and Kokua sites helping people and each other ". 9) A Certificate of Appreciation from Big Island Drug Court was awarded to Hui Ho'ola O Na Nahulu O Hawai'i in May 2010. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Ku Aloha Ola Mau - Agency Name Hui Ho'ola O Na Nahulu O Hawai'i - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 FY 2010 -11 FY 2011 -12 Salaries and Wages Actual * Budget* Estimate Haumana with no arrests since 96% 70% 70% discharge Haumana with no frequency of 73% 80% 73% drug /alcohol use 30 days prior to follow-u Haumana in stable living 100% 50% 99% arrangements at follow-u Employed, in school or vocational 80% 50% 80% training at follow -up Haumana who did not receive 76% 50% 50% substance abuse treatment since discharge Haumana who did not miss work or 70% 50% 50% school due to drinking /drug use in past 30 days Haumana with no emergency room 98% 75% 75% visits since discharge Haumana who will not be 98% 75% 75% hospitalized for medical problems 6 months post discharge Haumana no needing substance 84% 50% 60% abuse treatment 6 months following discharge. Haumana completing treatment 57% 50% 50% Haumana not experiencing 78% 50% 50% psychological stress at time of follow-u *If applicable Program Expenditures NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 130,859.93 132,925.00 138,242.00 Professional Fees 25,376.06 25,755.00 26,785.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 11 ❑f. P111;au!e Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Operations 85,678.43 92,533.00 96,234.00 Equipment 3095.76 3302.00 3434.00 Other Total 310,698.87 323,127.00 336.051.00 11 ❑f. P111;au!e Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 Ku Aloha Ola Mau - Agency Name Hui Ho'ola O Na Nahulu O Hawaii - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Alcohol and Drug Abuse Division 199,809.50 200,000.00 200,000.00 County of Hawaii 100,00.00 100,00.00 Manage Care Revenue 20,000.00 55,000.00 Other Foundation Rev. 17,131.64 18,000.00 20,000.00 Total 216,941.14 338,000.00 375,000.00 it appiicaoie Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? 1. The program is working toward State Accreditation. Contracts with managed care agencies are awaiting this certification to move forward with paying for their beneficiaries for Intensive Outpatient, Outpatient and Continuing Care. We are anticipating to receive State accreditation this year. 2. At this time managed care only pays for Western approaches. Ku Aloha Ola Mau is on the leadership team of a consortium comprised of Native Hawaiian programs called 'Imi Ke Ola Mau. This group intends to spread awareness of the effectiveness of cultural approaches and need to preserve the culture as well as to support cultural approaches to be accepted by the federal government as evidenced based practices. This will bring the services closer to reimbursement by insurance. In 2008, the Alcohol and Drug Abuse Division issued RFPs which would reimburse cultural services. In December 2010, ADAD asked all programs providing cultural services to share their practices in a Clinical Director's meeting. These are important steps toward change and acceptance of the need for respect and the strengths of the culture in healing from this and other conditions. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 10 3. A three site evaluation was conducted by a Native Hawaiian psychology group, 'I Ola La Hui to begin documenting cultural practices and their effectiveness. Their paper will be published in the future, and the findings were presented at the Native Hawaiian Wellness Research Conference in 2010. From this experience, we estimate sustainability may take up to 10 years. However, it is difficult to estimate. The first step is finding land for a permanent home. Ku Aloha intends to create a strategic plan to attain this needed step. 4. Hui Ho'ola has provided its first cultural training for counselors of Ku Aloha, Hale Kipa and the Coalition for a Drug Free Hawaii. 96% of the participants stated the new knowledge gained from the training increased their capacity to support youth and /or families and that since the training, they have been able to use the new knowledge /skills in their work. We intend to continue these trainings and open them to more and more people in the field. This will increase the income and diversify it as well providing a more solid foundation funding -wise and of skill and knowledge dissemination. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 11 Ku Aloha Ola Mau - Agency Name Hui Ho'ola O Na Nahulu O Hawaii - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate Year -end report will impact the evaluation of your program's or agency's future funding requests. f Signatur of and President /Chair Signature of Executive Director l - ay - a f r Date 9� l' I o l D e UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 12 71 Ku'ikahi Mediation Center Community Mediation Program Ku'ikahi Mediation Center- Agency Name Community Mediation Program- Program Name Agency Director: C. Parkinson Phone No.: 935 -7844 Contact Person: C. Parkinson Phone No.: 935 -7844 Mailing Address: 101 Aupuni St. Ste. 101482 Hilo, HI 96720 Facility /Site Address: Same as above Fax No.: 961 -9727 Email Address: cheryl @kuikahi- mediation.org Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Assoc. Phone No.: 968 -1002 Mailing Address: P.O. Box 4372, Hilo, HI 96720 Amount of Request for County Funds: $25,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $13,000 $18,000 $15,000 Agency Mission Statement: To provide a safe environment, an impartial process, and skilled, professionally trained personnel for the delivery of affordable dispute prevention and resolution services to the East Hawai'i Community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Ku'ikahi Mediation Center - Agency Name Community Mediation Program- Program Name Program Description: Ku'ikahi Mediation Center (KMC) is the only agency providing affordable mediation and facilitation services to our East Hawai'i community, including Kau, Puna and North and South Hilo Districts. In this difficult economy with high unemployment, foreclosures and debt defaults, our services are often the only option for low income people to resolve conflicts and move on with their lives. More than half of our clients have a household income of less than $20,624. For the majority of our clients, hiring lawyers and litigating their problems in court , through trial, is not an option for them. We are able to assist couples in coming to agreements regarding parenting puns, property distribution and communication methods so that they do not further stress the family with the burden of contested litigation. We mediate and facilitate work place disputes so that the workers and small business owners can go on to be productive members of the community instead of being focused on internal disputes. We have also instituted a telephone conference option for collection cases so that the debtors can actually speak directly with a representative of the collection company and work out a reasonable payment plan. The goal of our program is to assist people in resolving their disputes in a peaceful, confidential,workable way and to model the skills that they can use in the future to prevent and resolve conflicts. Under our contract with the Judiciary, we are required to provide mediation services for court referred landlord /tenant and small claims disputes for no charge. We provide these services primarily at the courthouse in Hilo. We have a staff member at the court twice a week to review the docket and confer with the volunteer mediators as to what cases they may be handling. We have at least two volunteer mediators in the courtroom for the landlord /tenant and small claims calendars. Our mediators who perform the court house mediations are provided with special advanced training on handling such cases. We mediate domestic, civil TRO, debt collection and other types of disputes at our office in The Hilo Lagoon Center. The atmosphere at the office is professional, but comfortable, in order to foster a feeling of safety and calmness. All clients are treated with respect and are assured that their dispute is important and their information will remain confidential. Our funding challenges have been great over the last couple of years. Our Judiciary funding is down over 20% and yet our case load is up over 25 %. We are finding that a significant number of the clients who we are allowed to charge, cannot pay any of the mediation fee. Also, our individual contributors have been unable to meet the level of contributions they made in the past. However; despite severe cutbacks in staff pay and hours, we have been able to take on 437 new cases and served 877 clients in this last fiscal year. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 The good news is that even in these grim economic times, our clients are very impressed with our services. More than 85% of our clients were very satisfied or satisfied with our services. Even better, over 95% of our clients would recommend mediation to others. Our volunteer mediators spent over 679 hours in mediation sessions last year and countless other hours assisting in training sessions. We trained 28 new mediators and provided advanced domestic training to 24 of our mediators. We have a pool of over 65 mediators reflecting a diverse and dedicated group of volunteers. Total Budget and Position Count Total Program Budget $130,563 Total Program Position Count 2.5 Total Agency Budget $130,563 Total Agency Position Count 2.5 Program Objectives: 1) Expand public awareness of mediation as an option for conflict resolution with free public workshops in Hilo and Puna. 2) Increase the number of cases that we receive prior to court actions being filed by increasing information available to people who are contemplating filing a court action, such as pamphlets and website links. 3) Improve the quality of our services by increasing staff time for more detailed intake interviews and more assistance for our volunteer mediators. 4) Strengthen and expand the skills of our mediators with 3 advanced trainings in the areas of domestic, debt collection and TRO disputes. 5) Raise our agreement rate to 65% and raise our satisfaction rate to 90 %. 6) Reestablish a peer mediation /anti - bullying program available to the schools in our community. Program Highlights: (from Fiscal Year 2009 -10) 1) KMC served 526 cases during the year -a 25% increase from FY 07 -08, despite significant reductions in funding, 2) We were able to provide staff and mediators for each landlord /tenant and small claims calendar at the court through the year. 3) We increased the number of mediators by 20 and increased the level of training for 24 others. 4) 97% of our clients would definitely or probably recommend mediation to others. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 ku'ikahi Mediation Center - Agency Name Community Mediation Program - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 FY 2010 -11 FY 2011 -12 Salaries and Wages Actual * Budget * Estimate Cases Served Cases resulting in agreements Mediation Trainin s held Active volunteer mediators Volunteer mediator hours Clients served Clients satisfied with service Public Education /Outreach Events 527 57.14% 3 65 678.50 877 87% 5 600 55% 4 -5 75 1000 900 90% 6 575 60% 5 -6 80 1000 950 90% 8 Operations $31,483 $29,838 $29,138 Equipment $4,664 0.00 $500 Other Total $135,467 $121,365 $130,563 *If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 FY 2009 -10 Actual * FY 2010 -11 Bud et * FY 2011 -12 Estimate Salaries and Wages $81,980 $84,002 $92,500 Professional Fees $17,340 $7,525 $8.425 Operations $31,483 $29,838 $29,138 Equipment $4,664 0.00 $500 Other Total $135,467 $121,365 $130,563 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Ku'ikahi Mediation Center - Agency Na Community Mediation Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Contributions $8,299 $8,300 $8,500 Fundraising $12,714 $12,800 $16,000 Fees Hawai'i Justice Foundation $28,959 $5,000 $27,930 $2,000 $27,000 $3,500 County of Hawaii $18,000 $18,000 $20,000 County of Hawaii R & D HIUW Atherton State Judi ;iaa Contract $5,000 $6000 $10,000 $39,359 0 $12,000 $2,500 $42,335 0 $12,000 $3,000 $42,335 Misc. $178 0 0 Total $133,509 $125,865 $131,335 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? KMC plans to do two more fundraisers during the year targeted at a different audience than our annual recognition dinner. We are also working to increase public awareness of our services so that we can attract more clients with an ability to pay the modest fees charges for mediation sessions. The services provided under the judiciary contract are primarily provided at no cost to the clients and we anticipate that the Judiciary will continue to pay a portion of the expense for those services as long as we are under contract to provide them. We have been collaborating with U.H. Hilo in providing our basic training for mediators and that has helped significantly in bringing the training portion of our program to a sustainable level. Providing that the economy improves we anticipate that the program could become self- sustaining within 5 years. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 _ Ku'ikahi Mediation Center - Agen Name Community Mediation Program - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 – 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fisca y ear. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurat y ear-end report will impact the evaluation of your p rogram's or agency's future funding requests. Sign to e of Board President/Chair A gnr f Executive Director ( ' ( — Date / 7 1 Dat UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 72 Lyman Museum Education and Public Programs Lyman Museum- Agency Name Education and Public Programs- Program Name Agency Director: 5021 Contact Person: 5021 Richard Henderson Barbara G. Moir Phone No.: 935- Mailing Address: Facility /Site Address: 276 Haili Street Hilo, HI 96720 276 Haili Street Hilo, HI 96720 Phone No.: 935- Fax No.: 969 -7685 Email Address: bmoir @lymanmuseum.org Name of Accountant/CPA (include name of firm if applicable): Alex Smith, CPA Phone No.: 808 - 737 -7761 Mailing Address: 1403 Frank Street, Honolulu, HI 96816 Amount of Request for County Funds: $50,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $30,000 $20,000 $20,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Agency Mission Statement: To tell the story of Hawai' i, its islands and its people. The Museum exists to: Collect, preserve, and exhibit artifacts, artwork, and memorabilia relating to the culture, art, and historical heritage of Hawaii; Educate and encourage awareness in these areas through visually exciting and interpretive exhibitions, informative tours, special programs, and activities; Serve as a learning resource center for those seeking information, entertainment, and knowledge; Fully extend itself to the public in order to instill community pride and support; Maintain a high standard of excellence and professionalism, seeking to improve, progress, and realize its full potential as a museum. The Lyman Mission House and Museum, founded in 1931, consists of the Lyman family home, first built in 1839, and a modern museum building constructed in 1973. The restored Lyman Mission House is furnished to depict missionary life in Hilo in the period 1840 to 1880. It is a reminder of a devoted band of men and women who dedicated their lives to bringing their Christian faith to the people of these islands and whose presence here exerted a profound influence on the development of these island communities. The adjacent modern Museum houses exhibits and presents programs and activities, including school tours and other group tours, designed to interpret the physical environment and ecology of the islands as well as the rich and varied ethnic heritage of our island people, that there may be a deeper understanding and appreciation of the human and ecological processes ongoing in the fiftieth state, in the heart of the Pacific Basin. The Museum's historical, cultural, contemporary, and environmental exhibits illuminate the following: 1. Hawaiian life prior and subsequent to European discovery 2. The Missionary period of 1840 - -1880 3. The traditional lifestyles of Hawaii's major immigrant groups 4. The natural history of Hawaii, including its volcanos, flora, and fauna 5. Other aspects of ocean and earth science, such as Pacific shells and worldwide minerals NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Lyman Museum - Agency Name Education and Public Programs- Program Name Program Description: Education and Public Programs at the Lyman Museum both reaches out to the community and draws it into the Museum, to "tell the story of Hawaii, its islands and its people" through programs, events, and activities that educate and encourage involvement by the public. Such efforts include focused educational tours; docent training for school and public tours; dissemination of information to teachers about Museum school - related programs, as well as planning assistance; an annual agenda of lectures, demonstrations, performances, workshops, and other presentations for the community; and public programming specifically linked to traveling and special exhibits at the Museum. Total Budget and Position Count Total Program Budget 94,820 Total Program Position Count 2 Total Agency Budget 588,174 Total Agency Position Count 12 Program Objectives: 1) Conduct curriculum- appropriate school tours at the Lyman Museum for student groups of any grade level. 2) Provide teachers on the Island of Hawaii with information about available Lyman Museum educational, school - related programs and how to access them; provide one -to -one assistance to these teachers and schools in planning, organizing, and customizing their Museum experience to best meet the curricular needs of their students. 3) Train docents to lead school and public tours appropriate to different age groups. 4) Publicize and carry out an annual public program for adult members of the community, with semi - monthly lectures, performances, workshops, demonstrations, and other presentations. 5) Develop, publicize, and present special programming for each traveling or special exhibit at the Museum. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Program Highlights: (from Fiscal Year 2009 -10) 1) Serviced more than 1950 students with docent -led school tours (this number would have been higher were it not for Furlough Fridays, reduced instructional days, and the general economic downturn). 2) Trained 3 docents for Lyman Museum school tours. 3) Disseminated Lyman Museum educational program information, and provided one -to -one planning assistance, to 191 school teachers. 4) Presented 8 educational workshops and East Hawaii community tours to 278 members of the public 5) Presented 26 public programs relating to special exhibits and other Hawai'i- relevant topics, to more than 1300 members of the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Lyman Museum - Agency Name Education and Public Programs - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Service students with school tours 1958 2300 2600 Train new docents for school tours 3 5 4 Provide public programs 23 28 28 Service community members with p ublic programs 1431 1550 1550 Disseminate Lyman Museum education information to teachers 191 250 275 Conduct educational workshops for students 0 14 14 Conduct special exhibit - related programs 2 2 2 Disseminate Lyman Museum public program information to community members ( *actual recipient counts will be much higher, w/ info sent electronically & by broadcast as well as print media, to exponentially larger audiences) 500+ *600+ *750+ *If applicable Program Expenditures it appiicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 70,070 70,070 70,070 Professional Fees 2,250 2,750 2,750 Operations 20,000 22,000 22,000 Equipment 0 0 0 Other 0 0 0 Total 92,320 94,820 94,820 it appiicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Lyman Museum - Agency Name Education and Public Programs - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Private donation for public programmin 5,000 5,000 0 Kukulu 'Ola 6,000 0 0 Lyman Museum Operations funds (earned income, donations, endowment allotment 61,070 67,070 44,820 County nonprofit grant funds 20,000 20,000 50,000 Total 92,070 92,070 94,820 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? By offering a regular calendar of public programs scheduled in advance, the Museum anticipates being able to increase paid memberships which allow free admission to such programs. The Museum now charges a nominal program admission fee to nonmembers which is stimulating an increase in paid memberships. Educational services, on the other hand, are never self- sustaining in that they are offered as a public service. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Lyman Museum - Agency Name Education and Public Programs - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board President/Chair Signature of Executive Director Date ' O — It Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 73 Mental Health Kokua Residential Rehabilitation Services Mental Health Kokua Residential Rehabilitation Services Agency Director: Greg Payton Phone No.: 737 -2523 Contact Person: Gary Michell Phone No.: 331 -1468 Mailing Address: 1221 Kapiolani Blvd., Ste 345, Honolulu, HI 96814 Facility /Site Address: 75 -5752 & 75 -5750 Alanoe Pl., Kailua -Kona, HI 96740 140 Wainaku Avenue, Hilo, HI 96720 139 Amau Road, Hilo, HI 96720 Fax No.: 331 -1378 Email Address: gmichell(cD- mhkhawaii.org Name of Accountant/CPA (include name of firm if applicable): Summer B. Such, CPA Phone No.: (808) 737 -2523 ext 1 107 Mailing Address: Mental Health Kokua 1221 Kapiolani Ave, Suite 345 Honolulu, Hawaii 96814 Amount of Request for County funds: $15,000 Prior Year Funding: 08 -09 09 -10 10 -11 $20,000 $18,000 $10,000 Agency Mission Statement: We believe that all citizens should have an opportunity to live and participate in and contribute to their communities. Through specially designed services, Mental Health Kokua helps those in Hawaii who are in mental distress, emotional crisis or recovering from serious mental illness achieve their optimum level of recovery and ability to function in the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Mental Health Kokua Residential Rehabilitation Services Program Description: Funding is requested for our transitional residential services, including PATCH (Psychosocial and Transitional Community Housing) Place and Hale Amau in Hilo, and Hale Alanoe and Kealahou in Kailua -Kona. Mental Health Kokua will offer 28 beds in Hilo and 14 beds in Kailua -Kona, a total of 42 beds from which recovery in the community can occur. Mental Health Kokua staff provide daily on -site supervision and rehabilitation services with the goal to enable clients to move on to more independent housing. While in placement, clients are assisted in acquiring personal and social survival skills necessary for sustained community living. Staff provide training and support in daily living skills and medication management while facilitating social, educational and recreational activities in the community. Clients are also assisted in making connections to community resources including mental health centers, vocational training programs, and community housing agencies, as well as assistance with long -term community placement. These projects provide cost effective, humane, community based alternatives to institutional care and /or homelessness. Transitional bed day costs for FY 2011 are estimated at $94. Comparative bed day costs in a psychiatric hospital are estimated at $800 to $1000 a day. Total Budget and Position Count Total Program Budget 1,035,947 Total Program Position Count 22 Total Agency Bud et 7,815,110 1 Total Agency Position Count 175 Program Objectives: 1) Provide residential and social rehabilitation services to 132 unduplicated persons with serious mental illness. 2) Show completion of identified treatment plan goals upon discharge by at least 80% of clients served. 3) Reduce consumer psychiatric hospitalization by at least 90% 4) Ensure 100% compliance of Commission on Accreditation of Rehabilitation Facilities (CARF) and other monitoring recommendations. 5) Show evidence of satisfaction with services received at least 95% of consumers served 6) Show improvement in daily living skill scores upon discharge in at least 90% of consumers served. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Mental Health Kokua Residential Rehabilitation Services 7) Place at least 90% of consumers, served in more independent living settings following planned discharge. Program Highlights: (from Fiscal Year 2009 -10) 1) Provided transitional residential rehabilitation services in FY 2010 to ninety -four (94) unduplicated clients at PATCH Place and Hale Amau in Hilo and thirty -one (31) unduplicated clients at Hale Alanoe and Kealahou in Kailua -Kona. 2) Discharged 89% of clients to more independent living in the community. All clients showed improvement in daily living skills. 3) Provided a total of 10,572 bed days and 21,144 meals in our transitional residential programs during FY 2010. 4) Implemented NextStep electronic medical record system. Performance Measures: *If applicable Program Expenditures: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget* Estimate Number of unduplicated consumers 125 130 132 served Percentage of consumers served 89% 90% 90% who were discharged to more independent living settings Number of consumers served 7 4 2 requiring hospitalization Percentage of consumer satisfied 96% 96% 98% with services *If applicable Program Expenditures: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Mental Health Kokua Residential Rehabilitation Services * If applicable #Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 1,003,690 1,003,690 1,003,690 Professional Fees 19,954 19,954 19,954 Operations 451,562 443,562 443,562 Equipment 168,526 168,526 168,526 Other#: 116,785 116,785 116,785 Total 1,475,206 1,467,206 1,467,206 * If applicable #Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate County of Hawaii 18,000 10,000 10,000 State of Hawaii - Department of Health 1,128,494 1,128,494 1,128,494 United Way 18,278 18,278 18,278 Program Service Fee 168,526 168,526 168,526 CCS Fees 116,785 116,785 116,785 Donation /other 25,123 25,123 25,123 Other: MHK Support Total 1,475,206 1,467,206 1,467,206 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? During the more than 30 years of providing services to people with mental illness in Hawaii, Mental Health Kokua has been successful in building strong relationships with many foundations and trusts, which have become pivotal in providing funding for new properties and major renovations to existing properties. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Mental Health Kokua Residential Rehabilitation Services Grant funding to help support the general maintenance of our projects in Hilo and Kona has been received from G.N. Wilcox Trust, Bank of Hawaii Charitable Foundation, Hawaiian Tug & Barge /Young Brothers, Ltd., and Visitor Industry Charity Walk. Mental Health Kokua has demonstrated notable ability and success in obtaining funding from private sources such as trusts and foundations and special events and will continue to explore ways to become fully self - sustaining. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Mental Health Kokua Residential Rehabilitation Services I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report may impact the evaluation of your program's or agency's future funding requests. Signature of Board President/Chair Signature Executive irector Date Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 74 National Kidney Foundation of Hawaii Chronic Kidney Disease Prevention, Education and Intervention National Kidney Foundation of Hawaii, Inc. Chronic Kidney Disease Prevention, Education, and Intervention Program Agency Director: Shelly Ogata Phone No.: 238 -3374 Contact Person: Shelly Ogata Phone No.: 895 -0202 (mobile) Mailing Address: 230 Kekuanaoa St. Ste 100 Hilo, HI 96720 Facility /Site Address: same as above Fax No.: 442 -9602 Email Address: shelly @kidneyhi.org Name of Accountant /CPA (include name of firm if applicable): Susan Sowders, CPA Phone No.: 230 -7395 Mailing Address: 92 -551 Uhi St., Kapolei, HI 96707 Amount of Request for County Funds: $48,500 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $0 $0 $0 Agency Mission Statement: The mission of the National Kidney Foundation of Hawaii, a major voluntary health organization, is to prevent kidney and urinary tract diseases, to improve the health and well -being of individuals and families affected by these diseases, and to increase the availability of all organs and tissue for transplantation in Hawaii. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 National Kidney Foundation of Hawaii, Inc. Chronic Kidney Disease Prevention, Education, and Intervention Program Program Description: The Chronic Kidney Disease Prevention, Education and Intervention Program targets both the general population of Hawai'i County and the various high risk groups for chronic kidney disease and kidney failure. Special target groups include people with hypertension, diabetes, obesity, coronary disease, or a family history of CKD [chronic kidney disease]; along with those identified to be at higher risk by ethnicity, including Japanese, Filipinos and Native Hawaiians. The grant funding will enable us to create broad public awareness of CKD and to have direct impact in stopping or delaying the progression of kidney disease for those who are identified by early screening and referred to our education and intervention programs. We will be able to promote our large scale community early disease detection screenings, educational presentations for youths and adults, and intervention trainings to reverse or slow the progression of CKD. Data retrieved from the Westernpacific Renal Network confirms the State of Hawaii continues to lead the nation in Kidney Disease and Kidney Failure, with a rate 30% higher than the rest of the country. In Hawaii, 1 in 7 residents already has CKD or is at high risk for CKD. Because CKD is considered a "silent killer ", most people don't even realize they have it until it's too late and their kidneys have already failed. The average cost of dialysis treatments runs close to $60,000 per patient per year and is subsidized with taxpayer dollars. The cost of our entire Chronic Kidney Disease Prevention, Education and Intervention Program, $40,000, is only 2/3 of this amount, providing valuable and cost effective solutions to the problem of Kidney Disease through programs that provide early disease prevention, education and intervention efforts. The Hawai'i County Grant funds will be used primarily to fund a part-time direct service staff person so we may continue our early detection and prevention screenings and education and intervention services. We also recruit and utilize medical professional and lay volunteers throughout the year allowing us to operate an extremely cost effective and high quality program. NKFH maximizes community resources through collaboration with health agencies and by utilizing donated space for screenings and presentations. All services will be provided free to the public to encourage broad participation. Total Budget and Position Count Total Program Budget $67,200 Total Program Position Count 1 Total Agency Bud et $2.8 mil Total Agency Position Count 11 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Program Objectives: Within a year of receiving funding: 1)Provide a minimum of 3 general CKD screenings with distribution of educational materials and kidney disease home testing kits; 2)Provide at least 1 comprehensive Kidney Early Detection Screening Program (KEDS) full CKD health screening; 3)Provide at least 1 Kidney Interactive Workshop (KIWI) for individuals with early stages of CKD; 4)Provide a minimum of 5 school presentations targeting 100 children before they develop high blood pressure, diabetes, heart disease or obesity, which are precursors to CKD. Program Highlights: (from Fiscal Year 2009 -10) 1)General Screening on 08/15/09 at the Hawaii Diabetes Fair at the Hilo Prince Kuhio Shopping Center; 8 were screened. 2)KEDS on 11/20/09 at the Hilo Medical Center; 135 were screened. 3)KIWI on 01/15/10 to 02/05/10 at the Hilo Medical Center; 17 participants completed the program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 National Kidney Foundation of Hawaii, Inc. Chronic Kidney Disease Prevention, Education, and Intervention Program Performance Measures: *If applicable — Actual & Budget based on smaller number of programs delivered Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate 3 general screenings $100 $200 $600 1 KEDS $3,000 $5,000 $5,000 1 KIWI $2,000 $3,000 $3,000 5 youth education classes N/a N/a $7,500 Other" Total $48,500 *If applicable — Actual & Budget based on smaller number of programs delivered Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages N/a N/a $25,000 Professional Fees N/a N/a $5,000 Operations N/a N/a $16,100 Equipment N/a N/a $2,400 Other" Total $48,500 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 National Kidney Foundation of Hawaii, Inc. Chronic Kidney Disease Prevention, Education, and Intervention Program Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate General funds $5,100 $8,200 $7,200 Other grants N/a N/a N/a In -kind services $10,500 $10,500 $10,500 Total $15,600 $18,700 $17,700 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? We expect to increase revenues to support this program as we build awareness and make an impact in our community. We intend to continue to fundraise and apply for other grants. In addition, our long -term vision would include the opportunity to bill for medical services we provide, which will allow us to become self - sustaining. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 National Kidney Foundation of Hawaii, Inc. Chronic Kidney Disease Prevention, Education, and Intervention Program I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. t c Ck4+ c. _c. J 4)C Signature of Board President/Chair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 JRN :iI - Zull lu ::j National Kidney HI 8085938096 P.001i001 - Agency Name - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end retort will impact the evaluation of your program's or anencv's future fundina reauests. i Signature of Board President/Chair Date 75 Neighboohood Place of Kona Neighborhood Place Neighborhood Place of Kona - Agency Name Neighborhood Place - Program Name COPY Agency Director: Susan Maddox Phone No.: 808 - 331 -8777 Contact Person: Napua Victorino Phone No.: 808 - 331 -8777 Mailing Address: 74 -5565 Luhia St B -1 Kailua Kona, HI 96740 Facility /Site Address: 74 -5565 Luhia St B -1 Kailua Kona, HI 96740 Fax No.: (808)- 331 -8774 Email Address: npkadmin @hawaii.rr.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates, Inc. Phone No.: (808) 968 -1002 Mailing Address: P.O. Box 4372 Hilo, HI 96720 Amount of Request for County Funds: $15,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 10 -11 (est) $556,207 $581,651 $567,296 $460,000 County funds received: FYE 09- 10...$40,000; FYE 10- 11...$15,000; being requested for FY 11- 12...$15,000 Agency Mission Statement: The mission of Neighborhood Place of Kona is to ensure the well being of our children and families by promoting environments of peace and safety. Program Description: The Neighborhood Place of Kona's (NPK) service area stretches from North Kohala to Ka'u and includes the communities of Honokaa, Waimea, Kapa'au, Hawi, North and South Kona, Ocean View, and Naalehu. NPK offers free, voluntary and confidential family - centered services assuring the safety and wellbeing of children and families. NPK is intentionally located to welcome all community members in an empathetic manner and encourages families that are struggling to maintain and sustain themselves in today's uncertain times to use their inherent strengths to improve personal relationships, gain additional parenting skills and develop a family plan based on resiliency. The NPK staff offers compassionate, non - judgmental services, resources, educational programs and case management to individuals and families. The underlying purpose of NPK is to strengthen families so they can avoid situations where they become involved, or re- involved, in the Child Welfare service system. Total Budget and Position Count [ITotal ram Bud et $128,000 Total Pro ram Position Count 1.5 Total Agency Bud et $393,000 1 Total Agency Position Count 5.5 NONPROFIT GRANT APPLICATION - FISCAL YEAR 2011 -12 Page 1 Neighborhood Place of Kona - Agency Name Neighborhood Place - Program Name Program Objectives: 1) Loving Families, Nurturing Homes, Safe Environments Neighborhood Place of Kona is founded on the vision that every child in Hawai'I will grow up in a loving family, nurturing home and a safe environment. There are no fees or referrals required to participate and NK welcomes all individuals and families. The NPK staff use a talk story approach to listen to family concerns and needs first and then work collaboratively to offer parenting skills programs, share information, provide connections to other appropriate community services, provide case management services and follow -up to faciitate successful completion of the agreed upon plan. 2) Provide Direct Family Services Guided by values, and respecting the Hawaiian culture, NPK offers ongoing Ke Ala Kupono parenting classes and ho'oponopono sessions to help strengthen family relationships by increasing families' knowledge of child development, improving parenting and coping skills, and enhancing problem - solving abilities. In cases of extreme need, NPK offers limited basic food and supplies and financial assistance for such things as required assessments, an therapy session, children's activity fees. 3) Increase Awareness of Needs and Service Gaps Collaborating with other agencies and community -based organizations via Hui Laulima and other Island and statewide consortia, NPK is an integral partner in efforts to increase awareness of family needs, gaps in services and the risk factors for child abuse and neglect. 4) Create Environments of Safety and Peace Based on Best Practices NPK integrates cultural values and practices with the current social services best practices to provide high quality, culturally appropriate and relevant services to all who seek support. Program Highlights: 1) NPK offers high quality, compassionate, non - judgmental services to those who ask; there are no fees or referrals required. 2) NPK services area based on working with individuals and families to enhance their inherent strengths, rather than "fixing what's broken ", to improve parenting and coping skills, increase understanding of child develoment stages, learn basic budgeting techniques, and enhance communications and problem - solving ability. 3) NPK Staff are able to assist clients complete applications for housing, childcare and /or financial assistance; locate and schedule substance abuse, anger management and /or domestic violence assessments; and locate counseling services. 4) NPK staff are able to provide informal coaching and family -based ho'oponopono services to ehlp resolve conflicts and strengthen family relationships. 5) Each individual and /or family that requests services is actively engaged by NPK staff in developing and implementing an Individualized Program Plan (IPP) which serves as a guide for receiving the specific support and services needed. NPK staff monitor and record the client's progress with the goal of successful completion within six (6) months. NONPROFIT GRANT APPLICATION - FISCAL YEAR 2011 -12 Page 2 Neighborhood P lace o Kona - Ag ency Na Neighborhood Place -Program Name 6) NPK encourages and engages community members to become aware of the risks of child abuse and neglect, and to take an active role in helping those who are struggling to regain a solid foundation by: a) hosting, and participating in, community activities that increase family interaction, communication and relationships; b) hosting conferences and workshops designed to increase service provider effectiveness; and c) developing relationships with schools that increase awareness of resources and services available in the community to support families prevent child abuse and neglect. Performance Measures: Program Expenditures FY 2008 -09 Actual FY 2009 -10 Actual FY 2010 -11 FYE 2011 -12 Estimated Budget Salaries &Related Note FY 2008 -09 FY 2009 -10 Estimated FY 2011 -12 Professional Fees Actual Actual Actual Estimated Family Strengthening and 141 138 100 75 Prevention Services 2,106 0 0 0 Minimum of New Clients 55 55 75 15,000 Total 166,000 153 1 143,000 50 Families assessed & provided services to 50 104 50 75 prevent child abuse & neglect Families provided information & referral 245 215 240 200 services _ onl y % of prevention families not confirmed for child 95% 98% 95% 95% abuse or neglect while in the program % of families not confirmed for child abuse 90% 93% add 90% 90% or neglect within 6 months of NP case closure Program Expenditures Note 1: Includes salaries, payroll taxes, benefits and contracted fee; salaries frozen for FYE 6110, FYE 6111 and FYE 6112. Note 2: Activities and supplies in direct support of families, including family strengthening community events, limited financial aid for required assessments, initial therapy, job training, child fee -based activities and basic food and hygiene items. NONPROFIT GRANT APPLICATION - FISCAL YEAR 2011 -12 Page 3 FY 2008 -09 Actual FY 2009 -10 Actual FY 2010 -11 Estimated Actual FYE 2011 -12 Estimated Budget Salaries &Related Note 117,758 123,908 87,670 87,670 Professional Fees 4,768 2,460 7,200 7,200 Operations 41,368 21,560 33,130 33,130 Equipment 2,106 0 0 0 Other "Ole 2 0 5,418 1 15,000 15,000 Total 166,000 153 1 143,000 143,000 Note 1: Includes salaries, payroll taxes, benefits and contracted fee; salaries frozen for FYE 6110, FYE 6111 and FYE 6112. Note 2: Activities and supplies in direct support of families, including family strengthening community events, limited financial aid for required assessments, initial therapy, job training, child fee -based activities and basic food and hygiene items. NONPROFIT GRANT APPLICATION - FISCAL YEAR 2011 -12 Page 3 Neighborhood Place of Kona - Agency Name Neighborhood Place - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 Actual FY 2009 -10 Actual FY 2010 -11 Estimated Actual FY 2011 -12 Estimate Blueprint for Change Contract 145,027 166,000 128,000 128,000 County of Hawai' i 0 40,000 15,000 15,000 Fundraising Activities 29,786 10,000 10,000 Other Grants 15,000 7,500 10,000 Annual Giving Campai n 18,847 5,000 5,000 Total 145,027 269,633 165,5 168,000 Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? In 1994 the Hawaii State Senate Concurrent Resolution 89 called for the establishment of a task force to develop a "blueprint for reform of child protective services." Among the task force recommendations was the need to establish family walk -in centers that would provide at -risk families with child abuse prevention services. The Neighborhood Place of Kona, along with Neighborhood Place of Waipahu, was the first to implement the new model, under the non - profit BluePrint for Change organization. The initial funding mechanism was to be State funding based on successful attainment of performance measures demonstrating a clear decrease in children and families in the formal child welfare system. Over the years, various economic downturns and changes in State funding priorities, required Neighborhood Place of Kona to obtain its own 501(c)3 non - profit status and to develops its own funding sources. For more than ten (10) years funding has been sustained through subcontracts from Blueprint for Change from a variety of state and federal funding sources, along with gradually increasing grant requests, an annual golf tournament fundraising event and an annual giving campaign. For the past year, like virtually all other non - profit organizations, Neighborhood Place of Kona has undergone a radical organization restructuring and downsizing as State contracts were cut by 30% to 60% and payments have lagged as much as five (5) months. The result of the restructuring was to allocate the maximum amount of our decreased operating budget to direct family services and support, which meant eliminating two (2) full time administrative position, combining two (2) other positions into a single position, and Board members taking on some administrative tasks. For the next two (2) years, the primary focus of the NPK Board of Directors is to maintain current funding levels, stabilize State Department of Human Services contracts and successfully advocate for timely contract payments. Current contracts will provide personnel expenses, rent, utilities and basic operating costs. NONPROFIT GRANT APPLICATION - FISCAL YEAR 2011 -12 Page 4 Neighborhood Place of Kona - Agency Name Neighborhood Place - Program Name The $15,000 being requested from the County of Hawaii will be critical to our ability to provide the most economically fragile members of our community with basic emergency food needs, limited funds to complete mandated assessments and classes so they can successfully maneuver the social services and judicial systems and emerge as in -tact, resilient families able to provide their children with "a loving family, nurturing home and a safe environment ". In the longer term, while government funding will have an ongoing place in the revenue mix, the percentage of the operating budget will need to decrease substantially. NPK is actively seeking increased grant funding and developing long -term private donors. Board members have made a commitment to significantly increase awareness of Neighborhood Place of Kona within their network of colleagues and contacts to generate additional contributions. I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or atEency's future fundine requests. /V AJ� lje� 1 / 7 ,W1 1 Signatur ar resident/Chair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION - FISCAL YEAR 2011 -12 Page 5 76 Neighborhood Place of Puna Family and Community Strengthening Neighborhood P lace of Puna_ Agency Name Family and Community Strengthening- Program Name Agency Director: Mary Hyslop Phone No.: 965 -5550 Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Mary Hyslop PO Box 2020 Pahoa, HI 96778 15 -3039 Pahoa Village Rd. Pahoa Hawaii 965 -5109 npp2020 @hawaii.rr.corn Phone No.: 965 -5550 Name of Accountant/CPA (include name of firm if applicable): Alex Smith Phone No.: (877) 257 -6484 Mailing Address: 1403 Frank Street Honolulu HI 96816 Amount of Bequest for County f=unds: $25,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $15,000 $10,000 $20,000 Agency Mission Statement: l - 'he goal of the Neighborhood Place of Plana is to prevent child abuse and neglect. The vision: "To Nurture, Strengthen and Celebrate 'Ohana" The mission: "Empowering families and communities in Puna by building strong foundations through healthy relationships that value each person's uniqueness. "E malama pono kakou ". NONPROFIT GRANT APPIACA'rION FISCAL YEAR 2011 -12 0--1. 1 Neighborhood Place of Pun - Ag ency Name Family and Community Strengthening- Program Name Program Description: Home visiting services to families at risk for child abuse and neglect has been documented as an effective approach in the prevention of child abuse and neglect. Outreach workers provide the help that families need in order to raise healthy and safe children and remain out of the Child Protective Service system. The relationships forged between home visitors and parents can break through loneliness and isolation and serve as that first step in linking families to their communities. Strengthening and developing caring communities is also recognized as a way of preventing child maltreatment. Strong positive communities produce healthy families and healthy families raise healthy children. In order to promote and develop caring communities, Neighborhood Place of Puna proposes to bring together the key players in the community, who provide services to families and children and to promote resource sharing among these providers. Neighborhood Place of Puna will also work with community organizations to develop family centered activities so that families will have opportunities to participate and to connect with their communiies. Prevention services to strengthen families are sorely needed because of the high rate of child abuse and neglect in the Puna district. Puna and Wai'anae compete with each other for who will have the highest child abuse indicators. Most often Puna is number one. F'una has the third- highest unemployment rate, the third - lowest per capita income and the highest percentage in the State of families who rely on food stamps (55 %). The poverty rate of young children is second highest in the state with more than 25% of residents receiving assistance from Temporary Assistance to Needy Families. (University of Hawaii, Center on the Family, 2009). Thirty -one percent (31%) of specified and confirmed child abuse and neglect cases in Hawaii County were in the Puna district. (CWS – 2008 statistics). The two most alarming statistics are the high rate of abuse and the rate of removal of Hawaiian children in Puna. While only 28% of Puna's population is Hawaiian, 30.6% of confirmed cases of abuse and neglect are Hawaiian. (DHS -CWS statistics, 2008) In 2009, four horrendous child abase incidents occurred in East Hawaii. As recently as January 2011 another child in East Hawaii was fatally abused. Safety nets for families have been slashed along with monies for prevention. The only other child abuse prevention program in East Hawaii is Healthy Start. While money was recently restored for Healthy Start programs the scope of service is limited to children 0 - 3. Neighborhood Place of Puna provides prevention and family strengthening to any family with children from 0 - 18. NONPROFIT GRANT' APPLICATION FISCAL YEAR 2011 -12 »..— 7 Total Budget and Position Count T T otal Program Budget $ To Program Position Count 2.5 otal Agency Bu dget $079,000 1 Total Agency Position Co unt 7.5 Program Objectives: 1) Help families foster optimal growth in their children by on -going home visits that include education around child development and safe home practices. Forty (40) families will receive intensive home visiting services. Forty (40) families a year will learn parenting skills and child development milestones through culturally competent, weekly home visits. Project outputs include weekly home visits until the family's service plan is completed, assessments for child abuse and neglect, assessments for safe homes, assessments for developmental milestones and individualized service plans that address protective factors and family needs. 2) Provide information, referral and advocacy to Fifty (50) families to help them identify services and teach them how to navigate systems to access what they need including entitlement programs, legal help, counseling, financial assistance, medical care, activities for their children, educational services, housing, etc. 3) Convene direct service providers and other key players involved with child abuse and neglect. Set up regular meetings to generate resource sharing and communication (through emails, newsletters, meeting transcripts, calendar of events, etc. ). Work with service providers to develop public awareness campaigns around abuse and neglect prevention. Twenty -four meetings with providers and other community members. 4) Coordinate, plan and implement community strengthening activities to reduce child abuse and neglect including family fun days, trainings for parents, grandparents and community professionals. Twenty - five units. 1) Program Highlights: (from Fiscal Year 2009 -10) In 2009 -2010 Neighborhood Place of Puna's outreach workers provided home visits to 75 families with over 150 children at risk for child abuse and neglect. Each family was given a resource directory of services and taught how to use the directory. Sixty families received assistance through information, referral and advocacy. NONPROFIT CRANT' APPLICATION FISCAL YEAR.. 2011 -12 Community activities for families included: Ready to Learn School Supply Distribution, Family Fun Days in Kea'au, Pahoa, Kurtistown, Fern Forest, Hawaiian Beaches, Mt. View, Hilo and at Maku'u Farmer's Market - for a total of thirty -four (34) family activities. Highlights include: Ready to Learn School Supply Distribution in two locations ( Maku'u Farmer's Market and St. Theresa's Parish Hall) with the help of over 100 volunteers — put basic school supplies into the hands of 1683 children in a three -hour period. The committee raised over $14,000 to purchase supplies. The Mt. View Family Fun Day — a first time event in the Mt. View area attracting over 600 people. E kukakuka Mai Kakou No Na Karnali'I AHA Conference . Twenty participants from East Hawaii including 5 Neighborhood Place Staff participated in the second state wide AHA conference on Oahu. Neighborhood Place of Puna presented in the first break out session the achievements of East Hawaii including the opening of the second Neighborhood Place in Puna. Day of Mercy On Saturday, June 'I9, Neighborhood Place of Puna partnered with volunteers from Hilo International Christian Church to clean, repair and generally improve two of our family's living situations. Twenty -five volunteers split their labor between two homes. The work began around 8 :00 a.m and ended at 4:00 p.m. The first project was the home of a family of six who were overwhelmed by the filthy and neglected state in which the previous tenants had left their house. This is a "self Built" structure with very limited electricity provided by a small generator. One of the two bathrooms was so neglected that the previous tenant had screwed the door shut instead of cleaning it. Undaunted volunteers unscrewed the door and began to clean, not only the bathrooms but also the entire home. The second home consisted of three young girls and their parents. The Dome has no electricity and no running water. The house, traditional single -wall construction, was missing windows and screens. The family had limited furnishings and prepared food in a covered outdoor kitchen. Volunteers repaired walls, installed screening, made a closet for hanging clothes and built a sleeping platform for the girls. Previously they had been sleeping on the floor. Volunteers not only gave of their time but also sought out donations of materials and furnishings. The church was very enthusiastic. Most members did not realize that this is the way many poor families in Puna live — without electricity and water. They have expressed an explicit interest in doing another long volunteer project in a few months. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Homeless Awareness Community Fair. Over 600 turkey dinners were served in Pahoa. Live entertainment, information booths, free clothing and haircuts. This was the first time this event happened in Puna and was almost as large as Hilo's event. Wrestling and Take Down Clinic -- Olympic coaches came to Pahoa to help youth and their families with the sport of wrestling. Youth, coaches and families came from as far as Kona and Honoka'a to participate in the event. At least 100 wrestlers turned up to learn from Hawaii's best. Blessing and Open House of Neighborhood Place of Puna Uka Advisory Board members have named the Neighborhood facility in upper Puna on N. Kulani Road — Neighborhood Place of Puna Uka. On December 15 about 45 people participated in the blessing of the new facility by Kahu Davis of Kamehameha schools. Kahu was instrumental in the formation of Neighborhood Place of Kona so it was very fitting that he bless NPP's second home. Attendees also brought with them a wrapped Christmas present for NPP's families. Family Christmas Neighborhood Place 01 Puna's Christmas event for children and families. Parents came and selected toys for their children at both locations - 114 children. Parents were also able to select a wrapped "surprise" package for themselves from under the Christmas tree and to help themselves to the food pantry. Tables of "free" things including dishes, clothes, house wares, linens etc.were available for families to take.Christmas at Neighborhood Place of Puna 100% of families were free (64 families) from child abuse and neglect six months from case closure. All families enrolled in home visiting completed their service plans. (100 %) 1) NONPROFIT GRANT APPLICA'T'ION FISCAL YEAR 2011 -12 Neighborhood Place of Puna - Agency Name Family and Community Strengthening - Program Name Performance Measures: *If applicable Program Expenditures FY 2009-10 Actual FY 2010-11 Budget FY 2011-12 Estimate Home visits to 40 families at risk 75 30 40 Child abuse/safety assessments and service plans 50 30 40 Information, referral and advocacy 60 50 50 Convene service providers and key players in child abuse and neglect prevention. N/A 24 24 Co-ordinate family strengthening activities, events and trainings 34 25 25 Families will be safe and will stay out of the Child Protective Service System. 10 0 0 /o NIA 90% *If applicable Program Expenditures If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR. 2011-12 131--- if, FY 2009-10 Actual * FY 2010-11 FY 2011-12 Estimate Salaries and Wages 109,626 __)Budget 123,000 124,000 Professional Fees 5,500 6,000 6,000 Operations 43,884 50,700 60,000 Equipment Total 159,010 179,700 190,000 If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR. 2011-12 131--- if, _ Neigh borhood Place of Pun - Ag ency N ame Family and Community Strengthening - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Bud * FY 2011 -12 Es B lueprint for Ch an g e 98,000 100,000 100, 000 _ R ev. T akie Oku mur a Foun dation _ 10,000 25,000 0 39,700 0 40,0 H awaii Children's Tru F und - County of Hawaii _ 1tl 000 17,000 20,000 25,0 Haw Is land United Wa y 20,000 25, 000 _ 160,000 Tota 179,700 190,000 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Money for prevention programs has become smaller and more difficult to access. Neighborhood Place of Puna has received federal funding to open a second site on N. Kulani but this money is targeted for families already involved in the child protective service system. Our efforts to find additional money for the Ready to Learn School Supply Distribution Project and money for direct financial assistance for families (food, gas and other essentials) is not included nor is it a part of the program in this application. Funds for these two programs (school supplies and financial assistance to families in need) totals in excess of $30,000. Child abuse prevention activities will not become self sustaining. All of our services are free to families and most experts would agree that an ounce of prevention is worth a pound of cure. NONPROFIT GRANT APPLICA'T'ION FISCAL YEAR 2011 -12 D -1.1.7 Neighborhood Place of P — A gency Name Family and Community Strengthening - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal Year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or a gency's future funding requests. Signature of Board President/Chair Signature of E=xecutive Director Date ^� Date i UNSIGNED PROPOSALS WILL NOT BE: ACCE NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 77 O Ka'u Kakou 0 Ka'u Kakou O Ka'u Kakou- Agency Name - Program Name Agency Director: Contact Person: Mailing Address: W. Kawachi Phone No.: 937 -4773 Phone No.: 928 -0027 Facility /Site Address: Fax No.: N. Ebert P. O. Box 365 Pahala, HI. 96777 -0356 Aspen Center Pahala, HI. 96777 808 - 928 -8961 Email Address: ebertn004 @hawaii.rr.com Name of Accountant/CPA (include name of firm if applicable): June Domondon Phone No.: 808- 928 -8961 Mailing Address: P. O. Box 370, Pahala, Hl 96777 -03777 Amount of Request for County Funds: $65000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $ $ $50,000.00 Agency Mission Statement: To Foster Health and Prosperity for all of Ka'u NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 O Ka'u Kakou - Agency Name - Program Name Program Description: Return Ka'u to the Posperous and healthy community it has been in the past. Total Budget and Position Count Total Program Bud et $628501 Total Program Position Count Total Agency Budget Total Agency Position Count Program Objectives: 1) Provide services and activities that assist our Seniors in living out a comfortable and enjoyable lifestyle. 2) Sponsor community activities and events that unite our families and builds the community spirit of Ka'u. 3) Work to keep the land, environment, and historical cultural areas of Ka'u clean and safe. 4) Take an active role in the economic development of Ka'u Program Highlights: (from Fiscal Year 2009 -10) 1) Quarterly highway clean up. 2) Semi - annual cleaning of the Punalu'u Pond. 3) Seniors safety and maintenance programs. 4) Keiki fishing tournament. 5) Cemetery renovation and up keep (locate and preserve Historical Cemeteries). 6) Provide Porta Potties for South Point and Punalu'u Beach ramp area. 7) Community dinner for Seniors and needy of Ka'u. 8) Coqui frog eradication. NONPROFIT GRANT APPLICATION FISCAL YEA -12 Vt 2 i O Kau Kakou - Agency Name - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Pond Clean u $700 $700 $800 Porta Potties $7625 $7665 $7700 Senior Safety Repairs $1500 $1500 $2000 Senior Bingo $2000 $3000 $3500 Keiki Fishing Tournament $3000 $5000 $6000 Scholarship Program (20101 $1000 $4000 $4000 Highway clean u $300 $400 $500 Office Supplies $400 $1000 $1500 Community Dinner $2500 $2700 $2800 Food Drive for Needy of Ka'u $1000 $1000 $1500 Cemetary Renovation $2000 $7000 $7000 Coqui Frog Eradication Donations to other projects or Org. Shave Ice & Popcorn Fundraiser Ka'u Hospital entry way 2010 Hospital Van Summer Fest Health Fair /RunMalk $200 $500 $70000 $25000 $400 $2120 $800 $3000 $25000 $2300 $2200 $900 $25000 *If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 0 0 0 Professional Fees $4500 $5000 $5500 Operations $15725 $47977 $48350 Equipment $25000 $5188 $5650 Other' $72000 $7120 $7700 Total $117225 $65285 $67200 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 0 Kau Kakou —Agency Name Included in the "other" category on page 3 is Money for the; Hospital Van Food Drive for needy of Ka'u Donations to other projects or organizations Scholarship program O Ka'u Kakou - Agency Name - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Ka'u Alumni $3450 $3500 $3800 Ed Olson Foundation $10500 $2000 $2000 Misc. Donations $5000 $5750 $6000 County of Hawaii $15000 $50000 $65000 Recycle Program $4000 $3000 $3000 Roberts Hawaii $40000 Bever) Blew $2100 William Peebles $10000 Total $90050] $64750 $79800 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? It continues to be our mission to get our community to ban together and solve our own problems. We continue to have a depressed economy in the area. We continure to work with many organizations (The Boys and Girls Club, Family Services, Dare Program, various athletic groups. etc.) to accomplish many of the tasks in the community. However, we are the ones to provide the funds for these projects. That is what much of the money from the county has been used for. We hope, with continued funding, to continue working with these groups to make our community a cohesive and working community. We have purchased 2 shave ice machines and a popcorn machine to raise money for O Ka'u Kakou and also to lend to various groups to raise their own funds. The HI 5 can and bottle campaign continues to be a major source of revenue for us. As we continue to research and collaborate partnerships with Federal, State and County programs, it our hope that the County of Hawaii can help us continue with the many projects that are on going for this community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 - Agency Name - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board President/Chair Sig ature of Executive Director 1 -Zq —l( Date Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTEDI NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 i Palekana Kai Ocean Safety, LLC Ocean Safety Program Palekana Kai Ocean Safety, LLC. - Agency Name Ocean Safety Program- Program Name Agency Director: Haden Fragas Phone No.: 9379805 Contact Person: Haden Fragas Phone No.: 9379805 Mailing Address: 980 Railroad Avenue Hilo, Hawaii 96720 Facility /Site Address: 980 Railroad Avenue Hilo, Hawaii 96720 Fax No.: Email Address: Palekanakai @yahoo.com Name of AccountantlCPA (include name of firm if applicable): Phone No.: Mailing Address: Amount of Request for County Funds: $30,000.00 Prior Year(s) Funding: 08-09 09 -10 10 -11 $20,000 $20,000 $15,000 Agency Mission Statement: To educate community youth about ocean water safety while providing opportunities and alternative activities that build these young adults confidence, self- esteem, motivation, and a lifelong respect for the ocean and the skills needed to enjoy the ocean safely. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Palekana Kai Ocean Safety, LLC - Agency Name Ocean Safety Program - Program Name Program Description: Palekana Kai Ocean Safety, LLC. is a non - profit 501 © 3 Organization that provides ocean awareness, ocean safety and ocean rescue training along with lifeguard, First Aid /CPR/AED training free -of- charge for community and at -risk youth between the ages of eleven and eighteen. Additionally the team conducts First Aid /CPR and AED training for staff of various community organizations island -wide. Palekana Kai also provides rescue services at numerous ocean water sports events, such as outrigger canoe regatta, The Business Man Race, Richardson Rough Water Swim, Long Distance Races for the Big Island Racing Association, Paddle Board Races, High School Race and the One Man Canoe Races. Palekana Kai's main objective is to educate and promote public safety and awareness through their water safety programs that include: ocean water safety, First Aid /CPR/AED (automated external defibrillation) and Lifeguard training at various Public Schools and Youth Agencies. The Team's experienced lifeguards conduct ocean safety classes voluntarily at four public schools located in the Hilo and Puna Districts of Hawai'i County. Activities are scheduled throughout the year. Youth between the ages of eleven and fifteen complete basic skills courses and earn certificates of completion that recognize their readiness for the next levels of training. The next levels of training include First Aid /CPR, AED, Ocean Awareness /Safety and Ocean Rescue. After completing the additional training levels youth between the ages of sixteen and eighteen will have the opportunity to complete a basic Lifeguard Training course and earn a Lifeguard Certification Card. This certificate is recognized by the County of Hawai'i as evidence of meeting the primary requirements for an entry level paid Lifeguard 1 position. Total Budget and Position Count Total Program Bud et 30,000.00 Total Program Position Count 7 Total Agency Bud et 30,000.00 Total Agency Position Count 7 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Program Objectives: 1) Obtain equipment needed to expand the current training program and on- site activities enabling our Certified Instructors and staff to continue educating community youth and at -risk youth effectively in the areas of Ocean Awareness /Safety, First Aid /CPR/AED (automated external defibrillation) Oxygen Administration and Bloodborne Pathogens. 2) Conduct informational classes for community youth and at -risk youth in the areas of Ocean Awareness /Safety, First Aid /CPR/AED (automated external defibrillation). It will enable youth to be prepared to respond to an emergency situation should one occur. 3) Conduct informational classes in the areas of Ocean Awareness /Safety, First Aid /CPR/AED (automated external defibrillation) for various agencies, organizations and residents of Hawaii County to enable them to be prepared to respond to an emergency situation. 4) Conduct informational classes in Lifeguarding skills, Oxygen Administration and Bloodborne Pathogens for community youth, at -risk youth, various agencies and organizations. These skills will increase the number of Hawaii County residents to assist in an emergency situation at recreational water sites and our local pools and beaches. It will enhance youth's self- esteem and confidence, opening a large door of opportunities to prepare them for future employment. 5) Decrease the number of injuries and accidents. Decrease the possibility of drowning and death following an emergency situation. 6) Acquire or build a 1,500 square foot facility that will serve as a classroom to conduct informational classes and hands -on activities. Also serve as a storage area for training equipment. Program Highlights: (from Fiscal Year 2009 -10) 1) (10) Water Awareness Classes were conducted - 74 youth participated 2) Youth Mentorship Program conducted once a month - 32 youth participated 3) (8) First Aid /CPR, AED (automated external defibrillation) classes were conducted - 74 youth participated 4) (5) Lifeguard Classes were conducted - 36 youth participated 5) (9) First Aid /CPR, AED (automated external defibrillation) classes were conducted - 82 adults participated 6) (6) First Aid /CPR, AED, Oxygen Administration, Bloodborne Pathogen and Lifeguard Training for the Professional Rescuer Classes were conducted - 35 adults participated 7) (9) Youth who participated in these informational classes were able to use their certificates of completion as experience on their resumes (6) are currently employed NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 8) (7) Youth who participated in First Aid /CPR, AED reported that they were able to utilize their skills by assisting victims who were trouble at our local beaches, parks and resturants. 9) (2) Youth who participated in First Aid /CPR/AED, Oxygen Administration and Lifeguard Training for the Professional Rescuer were able to save the life of a drowning male victim at Coconut Island during an event for Hilo Intermediate School which included over 200 participants 10) Palekana Kai Ocean Safety Rescue Team provided services at 12 Canoe Races, Regattas, Business Man Race, One -Man Race, Paddle Board Race, Rough Water Swim and the Queen Lili'uokalani Long Distance Race - able to serve approximately 3200+ participants over all NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Palekana Kai Ocean Safety, LLC. - Agency Name Ocean Safety Program - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Water Awareness Classes — Youth 74 80 80 Youth Mentorship Program 32 20 25 First Aid /CPR/AED — Youth 74 60 75 Lifeguard Classes — Youth 36 35 40 First Aid /CPR/AED — Adult 82 80 85 Lifeguard Training —Adults 35 30 40 Youth found employment as a result of participating in classes 6 10 10 Youth were able to assist victims in trouble at our local beaches, etc. 7 10 10 Youth who participated in Lifeguard Training were able to save a life 2 5 5 Provide rescue at 12 canoe races, business man, one -man, paddle board, rough water swim and the Queen Lili'uokalani Long Distance Race — participants served 3200 2500 3000 *If applicable Program Expenditures " If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 0 0 0 Professional Fees 0 0 0 Operations 7,894.57 5350.30 15,000.00 Equipment 12,105.43 3182.70 15,000.00 Other* Total 20,000.00 8533.00 30,000.00 " If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Palekana Kai Ocean Safety, LLC - Agency Name Ocean Safety Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate County of Hawai'i 20,000.00 15,000.00 30,000.00 Healing Our Islands - mini grant 2,000.00 Fundraisers 4,000.00 Total 24,000.00 17,000.00 30,000.00 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self-sustaining? Currently fundraising events such as car washes, bake and garage sales, concerts, donations and sponsors continue to cover the basic program expenses such as licensing and registration fees as well as annual First Aid/ CPR and AED certification fees. The County of Hawai'i Non Profit Grants has generously awarded Palekana Kai Ocean Safety, LLC. with a 15,000.00 grant in July of 2010. This Grant was used to purchase training equipment, training -site and office supplies and equipment. Also covered our General Liability Insurance. All of these items are very much needed in order to provide a consistent level of program delivery to teach our youth and those of our Community effectively. Through its community capacity- building program, the County of Hawai'i Department of Research and Development continues to recognize the services that Palekana Kai provides and is providing technical assistance related to non- NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 profit board development, reporting fundraising strategies. The value of this consultation is valued at $2000.00. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 - Agency Name - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 41 (��7- - %7 r� Signature of Board President/Chair F/k �kz_ . Signature of Exe utive Director Dat Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 79 Puna Community Medical Center Acute Care Clinic: Uninsured Program PUNA COMMUNITY MEDICAL CENTER- Agency Name ACUTE CARE CLINIC: UNINSURED PROGRAM- Program Name Agency Director: Rene Siracusa, Board president Phone No.: 808 - 930 -6001 Contact Person: Dan Domizio PA, MPH, Clinical Programs Director Phone No.: 808 - 930 -6001 Mailing Address: 15 -2662 Pahoa Village Rd, Ste 306 /PMB 8741 Pahoa, HI, 96778 Facility /Site Address: 15 -2662 Pahoa Village Rd, Ste 303 Pahoa, HI, 96778 Fax No.: 808 - 930 -6007 Email Address: dand @punahealth.org Name of Accountant/CPA (include name of firm if applicable): Janet Hara; Taketa, Iwata, Hara and Associates, Hilo Phone No.: 808 - 935 -5404 Mailing Address: 101 Aupuni Street, Ste 139, Hilo, HI 96720 Amount of Request for County Funds: $144,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $170,000 $50,000 $59,500 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Agency Mission Statement: "TO PROVIDE READILY ACCESSABLE HEALTH CARE TO THE RESIDENTS OF, AND VISITORS TO, PUNA DISTRICT." PCMC's Board Of Directors and its staff are wholly committed to providing health services for acute medical and surgical problems to the people of our service area, 365 days per year; We are committed to do this in a warm, compassionate and user - friendly manner. All of us are members of the community we serve and have a vested interest in making all our lives more pleasant, even when we, or our loved ones, are sick and hurting. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 PUNA COMMUNITY MEDICAL CENTER - Agency Name ACUTE CARE CLINIC: UNINSURED PROGRAM- Program Name Program Description: The PCMC Ununsured Program fund helps to cover the costs of providing acute health services, and prescriptions to the uninsured and underinsured people of Puna District. Our HSEDC grant of FY 2009 -2010 provides $59,500 of the $149,200 we requested; the remainder of services to the uninsured is being provided as "free" care at a financial loss to PCMC. Because we run out of money to cover care, we also had to stop offering prescription subsidies. Fund raising events and donations are used to offset the expense of the "free" services, but ultimately we lose money once the grant money runs out. If it were not for Hawaii County's support, however, continued service to the uninsured would be much more difficult financially. UNLIKE THE COMMUNITY HEALTH CENTERS IN HAWAII, PCMC DOES NOT ENJOY SUSTAINING GRANTS FROM EITHER THE STATE OR THE FEDERAL GOVERNMENT. We receive our grant money in quarterly payments; we apply the money to cover supplies, medicines, equipment usage, and staff time daily until the account is empty. We use revenues from insurance payers, donations from the community, and other grants as we can apply for to make ends meet. PCMC has promised to serve anyone in this community for acute care problems regardless of their ability to pay. As a NON - PROFIT urgent care facility in East Hawaii, we are unique in this regard. In fact, we receive referrals from the other, for - profit, urgent care clinics when they have uninsured and poor clients show up. We are also unique in that we are opened every day of the year; we saw only 3 clients on Christmas morning, each of whom would have gone to the ER at Hilo Medical Center had we been closed. Was it worth it to be opened for them? We think so, and the clients happily agree. PCMC recently saw its 5, 000 individual client. We have managed 8700+ visits in our first 2 years. Approximately 20% have been uninsured; between 90 and 100 per month; the insurance reimbursements from these visits would have averaged about $90 to $100; this dollar approximation is less than the costs of providing those services. The cost of subsidized prescription medicines and supplies for these uninsured visits is approximately $20 per visit. These figures have been fairly constant through our first 2 years: Uninsured visits: (100 /mo) X 12X$100 = $120,000; Prescription subsidy: (100 /mo) X12 X $20 = $24,000 TOTAL = $144,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Total Budget and Position Count Total Program Budget $144,000 Total Program Position Count 0 Total Agency Bud et $477,000 Total Agency Position Count 8 Program Objectives: 1) - To provide health services and supplemental payments for prescribed medications and supplies (bandages, "Ace wraps ", crutches,etc.) to the uninsured and under - insured clients who utilize the PCMC Urgent Care clinic; 2) - To keep accurate and timely records of all visits, services provided, prescriptions written, and insurance status in our Electronic Health Record system; 3) - To operate the PCMC acute care clinic seven days weekly, including holidays; providing services for common medical problems (infections of skin, respiratory and urinary tract, etc; and common surgical problems (cuts, bruises, sprains, broken bones, foreign bodies, etc.). Services will also include physical exams for school, sports, employment, etc., and immunizations. PCMC will arrange transfer of all clients requiring Emergency Room services at Hilo Medical Center; 4) - To provide services to all uninsured and underinsured clients who request services; approximately 90 -100 clients /month. 5) - To provide vouchers for subsidizing the cost of prescription medication and supplies to clients without insurance; approximately 90- 100 /month; 6) - To provide services to all our clients with the compassion, respect, warmth and friendliness consistent with our promise to the community and our mission. Program Highlights: (from Fiscal Year 2009 -10) 1) - Puna Community Medical Center has met or exceeded all of its stated goals since the initiative began in 2007; 2) - In FY 2009 -2010, we were open 7 days per week including all holidays; half days on Sundays and holidays; WE SAW 474 PEOPLE on those weekends and holidays!; 3) - We were able to manage a broad variety of acute medical and surgical problems, AND to maintain continuity of care by communicating all clinical notes to the the patient's Primary Care Provider the day we saw their patient, or within 24 hours of their visit to PCMC; NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 4) - PCMC played a facilitative roll in helping our uninsured clients find insurance (usually Hawaii's HealthQuest program, or Medicaid) whenever that was feasable, by explaining the process, providing forms,and making referrals to the Quest office, or the Community Health Centers; 5) - PCMC continued to diminish demand on the Hilo Medical Center resources; eliminating a 35 mile drive, reducing ER waiting times, decreasing the number of non - emergent clients crowding the ER schedule, and reducing the number of expensive ambulance runs for non - emergent problems; 6) - Because of the inevitable shortfall in operating expenses, and to continue seeing uninsured patients, fundraising efforts continued throughout FY 2009 -2010, and 2010 -2011; Contributions and fund raising events brought in $13,650 (FY'09 -10), in addition to the HSEDC ($59,500) and Shippers Wharf ($50,000) grants; NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 PUNA COMMUNITY MEDICAL CENTER - Agency Name ACUTE CARE CLINIC: UNINSURED PROGRAM - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Operate Clinic 7 days/week 6 days 7da s 7 days Manage 4000 or more Visits /year 4658 5225 (est) 5225 +10% Cover Care up to 100 uninsured /mo 1018 1000 +(est) 1000 +(est) Prescription Vouchers up to 25 /mo; [vouchers are stopped when quarterly grant funds depleted] 108/$4,000 100 +(est) 100 +(est) Decrease pt load in Hilo ER 7% 7 %+ (est) 7 % +(est) Maintain accurately and timely Electronic Health Records on all pts. 100% 100% 100% *If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages Professional Fees Operations Equipment Other** $101,200 $95,400 (est) # see p/3 Prog Description. $= Increased by 5 -10% (est) Total $101,200 (22% of total expend) $95,400 (20% of total exp; est) Increased by 5- 10% (est) * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 PUNA COMMUNITY MEDICAL CENTER - Agency Name ACUTE CARE CLINIC: UN INSURED FUND - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate HSEDC GRANT $50,000 $59,500 $144,000 PCMC Fund Raising and Donations $13,650 Allocated when available Allocated when available. Third Party Insurance payments $0 $0 $0 HMSA Grant $2,500 Other Grants Toward Uninsured As available Total $66,150 59,500 144,000 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? As with all non - profit health care organizations that have a commitment to serve the uninsured and the poor, supplemental fund raising will always be a necessity in the absence of insurance revenues generated from services rendered. PCMC is on course to have no gap between the total cost of all operations and income from all sources by the end of FY 2010 -2011. Slowly, we will begin building reserves. We have taken the first steps in our effort to achieve a Rural Health Clinic (RHC) federal designation in 2011; there are currently only two RHCs in Hawai'i. They are attached to the hospitals in Pahala and Moloka'i. RHC's are elligible to receive sustaining funds from State and Federal sources, as well as increased reimbursement for Medicare services. With RHC status will come some welcome fiscal assurances that we can continue to provide services to our most needy clients without operating this program in deficit mode. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 The BOD and Staff of PCMC recognize that times are difficult for many people and organizations, including the County of Hawaii itself, we ask that you do what you can to help us provide essential acute care services to the uninsured. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 PUNC COMMUNITY MEDICAL CENTER - Agency Name Acute Care: UNINSURED FUND - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board President/Chair Z;;re o xecutive Director 1 -'*ej -/) Date Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 Puna Men's Chorus 2011 -12 Concert Series Puna Men's Chorus- Agency Name 2011 -12 Concert Series- Program Name Agency Director: Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Amy Yamasaki David Ellis PO Box 1881 Pahoa, Hi 96778 Phone No.: Phone No.: 965 -0505 12 -7124 Kalapana - Kapoho Dr. Pahoa, Hi 96778 808 - 965 -0505 fundraising @punamenschorus.org Name of Accountant/CPA (include name of firm if applicable): Nancy J Kramer CPA Phone No.: 808- 965 -2729 Mailing Address: 15 -2662 Pahoa Village Road #306, Pahoa, Hi 96778 Amount of Request for County Funds: $12,500.00 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $ 0.00 $0.00 $7,000.00 Agency Mission Statement: The Puna Men's Chorus is a diverse 'Ohana which shares the power of music with our community. Grounded in Puna, Hawaii, our voices reach out to inspire, educate and transform ourselves and our world. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 1 Puna Men's Chorus - Agency Name 2011 -12 Concert Series- Program Name Program Description: 2011 -12 Concert Series ara ise Park and the Parker School Theater, Waimea. 1.) Season 1 (July 2011) Puna Men's Chorus "Takes It To The Country' singing your favorite country music. Three concerts in July 2011 - Palace Theater, Hilo, Hawaiian P d; 2.) Season 2 (April - June 2012) All Hawaiian music program performed in multiple locations on the Big Island, in preparation for taking the Hawaiian program to the International GALA Choral Festival in Denver, CO. and sharing Hawaiian music with 200 choruses coming together from throughout the United States and the world. PMC would be the first chorus to ever represent the State of Hawaii at this prestigious choral festival. Total Budget and Position Count Total Program Budget 55,200.00 Total Program Position Count Total Agency Budget 55,200.00 1 Total Agency Position Count Program Objectives: 1) Present to the local community and to a new mainland audience in 2012 - two top notch choral programs, first the country music series in 2011, and second the Hawaiian series in 2012. 2) Educate ourselves and the other performers in choral and movement arts. 3) Seek out and perform outreach opportunities in the community, bringing our music to schools and community organizations and events. 4) Reach out to others in the community to inspire and educate them to join our chorus and other performing arts. 5) Help establish the economic viability of Puna Men's Chorus so that we will become self sustaining. Program Highlights: (from Fiscal Year 2009 -10) 1) "Waiter, There Is A Singer In My Soup" series - dinner theater concert featuring male choral arrangements of popular show tunes. Akebono Theater, Pahoa October 17, 2009. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Ar 2) "Waiter, ... ", Hawaiian Paradise Park October 23, 2009 3) "Waiter,.... ", Wailoa Pavilion, Hilo October 30, 2009 4) "Black and White Night" Hilo - Palace Theater November 6, 2009. 5) "Waiter, There Is a Singer In My Soup- Seaview Performing Arts Center, November 7, 2009. 6) Community Outreach Christmas Caroling - Puna Beach Palisades, December 20, 2009 7) Randolph McCreight's Annual Community Holiday Music Event, Kapoho, December 28, 2009. 8) Hospice of Hilo performance, "Celebration of Life ", Wailoa Pavilion, Hilo May 8, 2010. 9) "ExtrABBAganza" series - featuring ABBA music. Hawaiian Paradise Park, June 25 2010. 10) "ExtrABBAganza" Honoka'a People's Theater, July 3, 2010. 11) "ExtrABBAganza" Palace Theater, Hilo, July 16, 2010. 12) "ExtrABBAganza" Kalani Honua Retreat Center, July 4, 2010. 13) "ExtrABBAganza" excerpts County Fair, Hilo, September 19, 2010. 14) Open Arms MCC outreach, Hawaiian Paradise Park, November 13, 2010. 15) "HoliDAZED!" series - traditional holiday tunes in very non - traditional settings. Palace Theater, Hilo, December 3, 2010. 16) "HoliDAZED!" - Hawaiian Paradise Park, December 4, 2010. 17) "HoliDAZED!" - Kilauea Military Camp Theater, December 10, 2010. 18) "HoliDAZED!" - Kalani Honua Retreat Center, December 20, 2010. 19) Randolph McCreight's Annual Community Holiday Music Event, Kapoho, December 28, 2010. 20) Rotary Club, Hilo, December 21, 2010. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 w Puna Men's Chorus - Agency Name 2011 -12 Concert Series - Program Name Performance Measures: Membership Public Appearance Attendance Volunteers FY 2009 -10 Actual * 24 20 2925 38 FY 2010 -11 Budget* 25 20 3000 50 FY 2011 -12 Estimate 40 25 4000 50 26,700.00 4,000.00 20,000.00 4.500.00 Total * If a f bl 20,664.00 40,650.00 55200.00 -' "NN'waviv Program Expenditures pp ica e # Please explain in detail on separate sheet Salaries and Wa es Professional Fees Operations Equipment Other' FY 2009 -10 Actual * 4 980.00 2,477.00 11,815.00 1,392.00 FY 2010 -11 Budget * 19,650.00 2,500.00 15,000.00 3,500.00 FY 2011 -12 Estimate 26,700.00 4,000.00 20,000.00 4.500.00 Total * If a f bl 20,664.00 40,650.00 55200.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Puna Men's Chorus - Agency Name 2011 -12 Concert Series - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual* FY 2010 -11 Budget* FY 2011 -12 Estimate Dues 1670.00 2000.00 2500.00 Program Ads 3250.00 3500.00 4000.00 Ticket Sales 9713.00 17,500.00 18,000.00 Silent Auction 1425.00 3610.00 4,000.00 Fundraising 978.00 1200.00 1,500.00 Donation 4125.00 7500.00 12,000.00 County Grant 0.00 7000.00 12,500.00 Total 21,161.00 42310.001 54500.00 If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? 1. Hold more concerts throughout the State in 2011 generating increased ticket sale revenue. 2. General mailing for donation solicitation. 3. New web -site seeking donations and ticket sales. 4. Silent Auctions will continue at all performances. 5. Brochure seeks continuing support from the community at large. 6. Sale of CD's and DVD's will begin in 2011 7. Ongoing consultation with a Professional Strategic Planner to create an agency three year plan to insure fiscal soundness. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Puna Men's Chorus - Agency Name 2011 -12 Concert Series - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 99 Signature of BdaPd GL�5�1�rlSl�.'-�� -, �re5idc�•-� Signature of E- ctor ( ZV Date D UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 E191 Salvation Army Family Intervention Services Independent Living Skills Program - West Hawaii The Salvation Army Family Intervention Services Independent Living Skills Program — West Hawaii Agency Director: Pauline Pavao Phone No.: 959 -5855 ext 28 Contact Person: Denise Pacheco Phone No.: 959 -5855 ext. 14 Mailing Address: P.O. Box 5085 Hilo, HI 96720 Facility /Site Address: 1786 Kinoole St. Hilo, HI 96720 Fax No.: 959 -2301 Email Address: Pauline .Pavao @usw.salvationarmy.org Name of Accountant /CPA (include name of firm if applicable): Name: Donna Lum (DHQ Director of Finance) /Cary Ebesugawa, CSE Consulting Phone: (808) 988 - 2136/(808) 981 -2775 Mailing: P.O. Box 620 Honolulu, HI 96809/1542 Maunakai St. Hilo, Hi 96720 Amount of Request for County funds: $32,657 Prior Year(S) Funding: 09 -10 10 -11 11 -12 $15,000 $15,000 $15,000 Agency Mission Statement: To provide youth with skills for a healthy life, and instill purpose, hope, and vision to youth and their families. Our agency's goals are to provide youth with a safe, caring, and nurturing environment. We recognize that all youth are "Youth of Promise," and have the potential to become self- directed, goal oriented and contributing members of our community. Program Description: For children and youth in the foster care system, life's ordinary challenges and opportunities frequently become extraordinary (NCWD, youth.) Between 18,000 and 20,000 youth aged 16 and older transition from the foster care system each year. Not surprisingly, these young adults are particularly vulnerable to drugs, crime, mental health issues, early pregnancy, poverty, homelessness, lack of education, health insurance and employment (Casey Family Services, NCWD, youth.) NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 The Salvation Army - Family Intervention Services — Independent Living Skills Program is designed to help foster youth and emancipated foster youth ages 12 -21 prepare for and manage the transition to productive, self- sufficient adulthood with a base of independent living skills. The goal of the Independent Living Skills Program is to: 1) Provide a comprehensive life skills based curriculum and 2) Provide opportunities for foster youth to pursue higher education, vocational training, and /or employment, 3) Provide linkages and resources to services in the community including: housing, health insurance, and other vital needs. The curriculum emphasizes career, education and job - skills development, utilizing a school -based skills format as a framework for implementing an array of independent living /transition curriculums that can be tailored to fit the respective participants relative to age, level of education and psychosocial developmental levels. The focus of this training is to draw a connection between academic success, jobs skills and positive social skills development in order to attain a higher quality of life in the high need areas of Health, Housing, and Economic Self- Sufficiency. The curriculum is divided by components or themes that highlight sessions connected to self - sufficiency. In following with the school year, each component represents a month. These components include: • Orientation /Personal Development (Sept) • Educational Success & Planning (Oct) • Social and Community Awareness (Nov) • Vocational /Job Skills Training (Dec) • Post -High Options/ Financial Aide (Jan) • Career Preparation & Work -Based Learning Experiences(Feb) • Life Planning & Money Management (Mar) • Self Care & Positive Relationship Building (Apr) • Daily Living & Community Involvement (May) • Evaluation, Youth Recognition (June) Group sessions are held at Konawaena High School on Wednesdays and individual focus sessions on Mondays and Tuesdays. Each foster youth is required to attend one 2 -hour session per week as well as individual sessions. In addition, we stress a youth driven approach when developing their transition plan. Community service projects, Family Strengthening and extra- curricular activities are designed to further expand their knowledge of their community and the abundance of resources available to them. They include: College Fairs, Job Fairs, Housing Fairs, World of Work Tours sponsored by the Hawaii Community College, West Hawaii Community College, University of Hawaii at Hilo, Hawaii National Park Service, National Energy Laboratory Hawaii Authority, Sheraton Keauhou Beach Resort and Spa, Work Force Development Division -West Hawaii and many others. We strongly encourage our participants to engage in civic connectedness and giving back to ones community. The Department of Human Services currently funds our Independent Living Skills Program. Our area of coverage is West Hawaii which includes: Kohala, Waimea, Waikoloa, Kealakehe, Konawaena and the Kau District. This contract supports only a 1.00 FTE Youth Development Specialist IV, which is not enough to cover this vast district. Funding received through the County would help support .50 FTE Youth Development Specialist IV position to increase staff coverage and services to the West Hawaii District. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Total Budget and Position Count Total Program Budget $123,695 Total Program Position Count .5 FTE Total Agency Budget $3,908,562 Total Agency Position Count 70 Program Objectives: The objective of the program is to accomplish the following for 30 foster youth in West Hawaii each year: • Of the 30 foster youth, ages 12 -15 participating in the program, 75% will demonstrate increased independent living skills, as identified in their IL plan. • Of the 30 foster youth, ages 16 plus participating in the program, 75% will successfully complete their Independent Living Skills Program and attain at least a "fair prognosis" of achieving goals of independence upon exiting the program. Of the foster youth, ages 18 plus, participating in the program, 80% will participate in Higher education, Vocational Training, Employment and /or Military • 75% of youth will avoid non - marital childbirth, incarceration and homelessness during program participation. Program Highlights: FY 2009 -10 In our 2009 -2010 fiscal years, The Independent Living Skills Program in West Hawaii provided over 1,442 direct service hours to foster youth and obtained the following performance measures: • 83% of foster youth age 12 -15 demonstrated an increase in Independent Living Skills, as identified in their IL plan • 80 %of foster youth age 16 plus completed their Independent Living Skills Program and attained at least a fair prognosis of achieving goals, as identified in their IL plan • 92% of foster youth 18 plus, participated in Higher Education, Vocational Training Employment and /or Military • 92% avoided non - marital childbirth, incarceration and homelessness during program participation Collaborative partnerships are vital to the success of the Independent Living Skills Program. As such, it is regularly practiced by TSA -FIS in providing a continuum of services and addressing the widest range of our consumers needs. When appropriate, TSA -FIS makes referrals and /or linkages of participants to the following: Inter - Agency, Foster Care Alumni Support Program, Transitional Living Program -HYSN, Independent Living Transition Home -OYS, Street Outreach Program, Emergency Shelter Service, Group Home, Youth Development Program, and Community Based Outreach Services. Community, Alu Like, Catholic Charities, Hawaii Community College- Career Center, Office of continuing education, West Hawaii Community College, Hawaii Foster Youth Coalition, Bay Clinic, Big Island Substance Abuse Clinic, Big Island Work Force Development -West Hawaii, Office of Social Ministry- Care -A -Van. DOE, All High Schools in East and West Hawaii, Alternative Learning Centers, Charter Schools, and Community School for Adults. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Performance Measures: Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Completion of ILSP 30 30 30 Participates in IL Activities 38 30 30 Participates in IL Plan 38 30 30 Follow up and Monitoring 38 30 30 Program Expenditures Program Funding Sources Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY2011 -12 Estimate Salaries and Wages 62,146.69 71,382 87,287 Professional Fees 15,000.00 15,000.00 32,657.00 Operations 26,763.94 34,656 36,408 Equipment Other* 88,910.63 106,038.00 123,695.00 Total 88,910.63 106,038 123,695 Program Funding Sources Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate State of Hawaii 73,910.63 91,038.00 91,038.00 County of Hawaii 15,000.00 15,000.00 32,657.00 Total 88,910.63 106,038.00 123,695.00 Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The Salvation Army - Family Intervention Services, while part of The Salvation Army, is required to seek its own funding for program services. As such, TSA -FIS relies primarily on funding from government at the federal, state and county levels to continue our outreach programs to assist at -risk youth and their families. Such funding is primarily through the purchase of service system, which we are required to submit proposals through a competitive process. Very limited funding is available through grants from trusts and foundations. We continuously explore avenues of funding to continue these programs. However, in view of the nature of our mission in developing healthy lifestyles for youths and their families, we do rely heavily on funding from all levels of government. As such, we do not anticipate being self- sufficient in providing Outreach services to the youth and families residing in Hawaii County. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 The Salvation Army Family Intervention Services Independent Living Skills Program -West Hawaii I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely complete, and accurate year -end report may impact the evaluation of your program's or agency's future funding requests. Si "a �� Z`,,� Da _L A Signature of Executive Director l q �l Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 E* Salvation Army Family Intervention Services Prevention Programs — Honoka'a The Salvation Army Family Intervention Services Prevention Programs - Honokaa Agency Director: Pauline Pavao Phone No.: 959 -5855 x 28 Contact Person: Raymond Dangaran Phone No.: 959 -5855 x 22 Mailing Address: P.O. Box 5085 Hilo, HI 96720 Facility /Site Address: 1786 Kinoole St. Hilo, HI 96720 Fax No.: 959 -2301 Email Address: pauline .pavao @usw.salvationarmy.org Name of Accountant/CPA (include name of firm if applicable): Name: Donna Lum (DHQ Director of Finance) /Cary Ebesugawa, CSE Consulting Phone: (808) 988 -2136/ (808) 981 -2775 Mailing: P.O. Box 620 Honolulu, HI 96809/ 1542 Maunakai St. Hilo, HI 96720 Amount of Request for County funds: $32,657 Prior Year Funding: 08 -09 09 -10 10 -11 $20,000 $15,000 $10,000 Agency Mission Statement: "To provide youth with skills for a healthy life, and instill purpose, hope, and vision to youth and their families." Our agency's goals are to provide youth with a safe, caring, and nurturing environment; and provide opportunities for youth to challenge their life styles through development of appropriate social skills, academic success, and personal resiliency. Program Description: The Salvation Army Family Intervention Services- Prevention Programs provides a safe and nurturing environment along with access to opportunities, experiences, and services to support positive youth development. We utilize a prevention approach to decrease the use and abuse of alcohol, tobacco, and other illicit drugs (ICE, ecstacy, and etc.), involvement in gangs and violence, delinquent behaviors, early sexual behaviors, and to improve academic performance and school attendance. This will be accomplished by implementing Outreach Services (Leadership Development Program and Positive Alternative Activities) to youth ages 9 -18 years old and their families, residing in the Honokaa district. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Leadership Development Program -The L.E.A.D. Team (Learning Experience in Assisting and Directing) provides development of leadership skills and training in areas of personal and social skills, teamwork, decision making, goal setting, and action planning to conduct community service and learning projects. Leadership activities will allow youth to experience leadership, group dynamics and problem solving opportunities such as youth planning committees and youth representative on community collaboration efforts. Positive Alternative Activities consist of: Recreational, PerformingNisual Arts and Humanities, Educational, Cultural, and Youth Leadership Activities. Other prevention activities consist of Community Service and Learning Projects, Drug -free dances, and Excursions. These activities will provide youth with opportunities to develop an understanding of self and one's culture and a sense of identity and belonging, and promote the development of competencies (social well- being, knowledge, and social responsibility. All services will be in conjunction with the Teenage Pregnancy Prevention & Family Strengthening Program in Honokaa, currently funded by the Department of Defense. We propose to implement program services during after - school and occasionally weekend hours. The proposed funding would support and provide for 2 part- time -(.50 FTE) Youth Service Worker at 20 hours a week. These positions will help support an after - school program and provide sufficient supervision and safety for each youth served. Total Budget and Position Count Total Program Budget 129,457 Total Program Position Count 2 -.5FTE Total Agency Budget 3,908,562 Total Agency Position Count 70 Program Objectives: 1) Of the 45 youth targeted to participate in the Prevention Programs, at least 80% will register for Outreach Services (L.E.A.D. Team, Positive Alternative Activities) and maintain participation with the program to completion or for 6 months beyond the registration date. 2) Of the 45 youth participating in the prevention activities throughout the year, at least 80% will participate in Positive Alternative Activities (Community Service and Learning Projects, Recreation, Tutoring, and Community Events), demonstrate an increase in competencies (social well- being, knowledge, and social responsibility) for the first 6 months, and continue that gain for an additional 6 months or completion of the program. Program Highlights: 2009 -10 One of our major accomplishments of the program was the start up of the program with during the new school year and the implementation of the NFocus Database System. At the end of September, we had (32) 7 and 8 t " grade students enrolled in the After - school program. By the end of the school year, we had 45 youth participating in the NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 program activities and services. The Life - skills development component of the program is implemented during Tuesdays and Thursdays, make -up day Mondays, and Wednesdays and Fridays are set for recreational /excursion days. The Life - skills development component of the program was successfully implemented. Youth participates in a 10 session program focused on topics such as: Decision - making, Communication skills, Anger Management, ATOD, Role Models, Occupational skills, Community Involvement, and Making Choices. We successfully implemented a reward structure that kept the youth motivated. We used quality curriculum support, constructing video display /multimedia examples of the days' topic, guest speakers, participated in community services opportunities such as the Peace Parade and the Salvation Army -Food Pantry. We also collaborated with community establishments like Earl's Garage and HI County Parks and Recreation Center in Honokaa. The after school program provided some "out of the classroom" structure in an arena that was of the student's own personal interest. It created an active, healthy environment and was also a springboard for discussions in the curriculum portion. So much of the sports atmosphere parallels life and the development of life skills. The extra effort caused great collaboration with Parks and Recreation, parents, as well as sense of accomplishment. We honored youth with a sports banquet, where awards and parents were actively involved. This focus also led to excursions to other locations where the game was being played in competition. The University of Hawaii at Hilo welcomed us as we visited one of their volleyball matches during their season, and we also had couple experiences with beach volleyball to help broaden their horizons in the sport. The community service portion of the program brought about a participation in a food drive for Thanksgiving. We assisted in the Salvation Army Food Pantry in its preparation for holiday distribution for those in need. All our graduates participated in this or a recycling campaign to get our environment healthy and effective. The Peace Parade in Honokaa was the event where this campaign was communicated. A float was built and then driven in the parade with expressions of the message in literature, song, and signs. This was a collaborative effort with the school and its students. Our monthly themes contained an extensive look at life skills in sports, film production, and music. Having had a recruitment period in January, we then contributed resources and referrals in the areas of tutoring, student reward days, the local youth center, and service to The Salvation Army Corps in the rest of the year. We added and managed new program staff and our cooperation with the school continues as enrollment continues to grow. We made an effective music resources within our own internal FIS staff and utilized school, local resource centers (studios and performance centers), and our own Corps facilities for the after school program. Community Collaborations: Linkages with Other Agencies: At this time the agencies that we have been in contact with is the DOE, Parks and Recreation Department, Police Department, and YWCA. The support that the Honokaa High and Intermediate Schools have given us has been NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 tremendous, they have invited us into their classrooms, given us a place to provide our services and staff support. We continue to create collaborations with other resources such as Hamakua Health Center for resources and information. Performance Measures: Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Participates in L.E.A.D. Team 45 45 45 Participates in Pos. Alter. Activities 45 45 45 Participates in Comm. Srv. Projects 45 45 45 Follow up and Monitoring 45 45 45 Program Expenditures Program Funding Sources Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 65,026.58 67,269 87,195 Professional Fees 0 0 0 Operations 35,893.22 39,531 42,262 Equipment 0 0 0 Other* 0 0 0 Total 100,919.80 106,800 129,457 Program Funding Sources Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Department of Defense (DOD)* 85,919.80 96,800 96,800 County of Hawaii 15,000 10,000 32,657 Total 100,919.80 106,800 129,457 *Teenage Pregnancy Prevention & Family Strengthening Program funded under DOD. Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The Salvation Army - Family Intervention Services, while part of The Salvation Army, is required to seek its own funding for program services. As such, TSA -FIS relies primarily on funding from government at the federal, state and county levels to continue our prevention and intervention programs to assist at -risk youths and their families. Such funding is primarily through the purchase of service system, which we are required to submit proposals through a competitive process. Very limited funding is available through grants from trusts and foundations. We continuously explore avenues of funding to continue these programs. However, in view of the nature of our mission in developing healthy lifestyles for youths and their families, we do rely heavily on funding from all levels of government. As such, we do not anticipate being self- sufficient in providing prevention services to the youth and families residing in Hawaii County. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 The Salvation Army Family Intervention Services Prevention Programs - Honokaa I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report may impact the evaluation of your program's or agency's future funding requests. Signat President/Chair Date rl- 91 re of Executive O vIkk Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Salvation Army Family Intervention Services Prevention Programs - Pahoa The Salvation Army Family Intervention Services Prevention Programs -Pahoa Agency Director: Contact Person: Mailing Address: Pauline Pavao Raymond Dangaran Facility /Site Address Fax No.: Email Address: Phone No.: 959 -5855 x 28 Phone No.: 959 -5855 x 22 P.O. Box 5085 Hilo, HI 96720 1786 Kinoole St. Hilo, HI 96720 959 -2301 pauline .pavao @usw.salvationarmy.org Name of Accountant/CPA (include name of firm if applicable): Name: Donna Lum (DHQ Director of Finance) /Cary Ebesugawa, CSE Consulting Phone: (808) 988 -2136/ (808) 981 -2775 Mailing: P.O. Box 620 Honolulu, HI 96809/1542 Maunakai St. Hilo, HI 96720 Amount of Request for County funds: $32,657 Prior Year Funding: 08 -09 09 -10 10 -11 $20,000 $15,000 $15,000 Agency Mission Statement: "To provide youth with skills for a healthy life, and instill purpose, hope, and vision to youth and their families." Our agency's goals are to provide youth with a safe, caring, and nurturing environment; and provide opportunities for youth to challenge their life styles through development of appropriate social skills, academic success, and personal resiliency. Program Description: The Salvation Army Family Intervention Services- Prevention Programs provides a safe and nurturing environment along with access to opportunities, experiences, and services to support positive youth development. We utilize a prevention approach to decrease the use and abuse of alcohol, tobacco, and other illicit drugs (ICE, ecstacy, and etc.), involvement in gangs and violence, delinquent behaviors, early sexual behaviors, and to improve academic performance and school attendance. This will be accomplished by implementing Community -Based Outreach Services and Positive Alternative Activities to youth ages 9 -18 years old and their families, residing in the Pahoa district. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Outreach services consist of: ➢ Leadership Development Program -The L.E.A.D. Team (Learning Experience in Assisting and Directing) provides development of leadership skills and training in areas of personal and social skills, teamwork, decision making, goal setting, and action planning to conduct community service and learning projects. ➢ TSA -FIS has developed a program called "Project Family" to build relationships between agency, youth, parents, and community. Project Family Activities provide parent support and family strengthening activities to promote family cohesion and positive relationships within diverse family structures. Youth and their families along with agency staff participate in regularly scheduled "Family Days" which are activity -based and fun. ➢ Positive Alternative Activities consist of: Recreational, Educational, Cultural, and Youth Leadership Activities. Other prevention activities consist of Community Service and Learning Projects, Drug -free dances, and Excursions. All services will be part of a compilation of Prevention Programs currently funded by the Office of Youth Services. Program services will be provided at Pahoa School Districts and at the Nanawale Community Center. We propose to implement program services during in- school, after - school, and occasionally weekend hours. The proposed funding would support and provide for 0.25 FTE Youth Development Specialist IV and 2 -Youth Service Workers at 19 hours per week. Supplemental funding from the Office of Youth Services- Positive Youth Development will help support and establish a 1.00 FTE Youth Development Specialist IV to provide outreach services to the Puna Community. The 2 -Youth Service Workers will help support an after school program and provide sufficient supervision and safety for each youth served. Total Budget and Position Count Total Program Budget 103,907 Total Program Position Count 1.95 Total Agency Budget 3,908,562 Total Agency Position Count 70 Program Objectives: 1) Of the 40 youth targeted to participate in the Prevention Program, at least 80% will register for Outreach Services (L. E.A. D. Team, Project Family, Positive Alternative Activities) and maintain participation with the program to completion or for 6 months beyond the registration date. 2) Of the 40 youth participating in the prevention activities throughout the year, at least 80% will participate in Positive Alternative Activities (Community Service and Learning Projects, Recreation, Tutoring, Community Events, and Family Days), demonstrate an increase in competencies (social well- being, knowledge, and social responsibility) for the first 3 months, and continue that gain for an additional 6 months or completion of the program. Program Highlights: FY 2009 -10 We participated with the annual School Supply Distribution in the district of Puna at the Maku'u Farmer's Market. Because of the economy and the growing need for the families in our area, we planned to serve 400 more than last year, planning for 1300 children. The event was filled with fun and families. The event began at 8:30a and we went until the supplies ran out at about 1 lam. We had many volunteers, both young and old. We had a resource center, Picture ID's, Snacks and Juice and of course the much needed free of charge school supplies given a recycled bag that they could use for school too. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 We provided a girls group with 5 females aged 12 -15 at the Pahoa Recreation Center. The curriculum implemented was "Swim with Your Current." This curriculum is for girls who are encouraged to learn more about their feelings, spirit, families and themselves. The girl's gained the ability to go deep within themselves and discover who they really are. Many of them come from dysfunctional families and were able to gain rapport with other members in the group to feel a sense of belonging. The violence prevention program resumed with 15 participants for a 9 week session program. The curriculum included: The Difference between anger and violence, The ABC's (attitude, behavior & consequences), Positive Self -Talk, Time -Outs, Different Communication Styles and which one is the best: Assertive, The Cycle of Violence, Effects of Violence, Role Playing /Goal Setting, and more. Graduation includes a meal, a certificate, a peace making plan and a summary of the participant's growth over the 9 weeks. A summary of the youths' progress, a copy of their certificate and their peace making plan was given to their principal at Pahoa High School. The principal called to extend his thanks of this program and to acknowledge that he's seen a difference with our youth who have completed our program in the past. He's looking forward to seeing the progress of our recent graduates this upcoming school year. We provided a 10 session curriculum and worked with the 20 elementary students from Pahoa Elementary, twice a week. We call them "The Little Leaders." The curriculum topics include: All About Me, Social Skills, Respect, Friendship, Decision Making, The Power of Peer Pressure, Anger Management, Feelings and Communication and Alcohol, Tobacco and Other Drugs. We also coordinated and participated with the Annual Kick Butts Day in the Pahoa Community. We had our substance abuse program, some past youth, a couple teachers, our Community Police: Officer Rances and about 10 teenagers from the ALC, and violence prevention programs who joined in the effort. We began at the school and walked to the Pahoa 7 -11. This year we picked up cigarette butts in the Pahoa town. The youth picked up cigarette butts and cigarette affiliated rubbish. After the butt pick -up, we headed to Kea'au Shipman Park to meet Kea'au and Hilo youth. We had about 50 youth participate in all. We met for fun, trivia, counting of cigarette butts and pizza! We counted 2300 cigarette butts that our youth picked up and the Pahoa site won. It was not necessarily a great accomplishment that we had the most in our community, but it was a definite sign that our kids worked hard cleaning up their community. We collaborated with Neighborhood Place of Puna for their Annual "Celebrate Your Family Day." For the last several years this event has been a family strengthening activity held for the families of all communities to come out and seek resources. April is Child Abuse Prevention Month and every year this event is held in April. Every year more families join us. Our booth consisted of information on our program, Family Photos and packets to go, and a chance to sign up their youth if interested. After the family signed in to our booth, they took a family portrait, and when it was developed they were given a bag with a frame and decorative stickers to complete their framed photo at home. A total of 51 families signed in and took a family portrait! Community Collaborations: Linkages with Other Agencies: Referrals to the prevention programs are currently coordinated through the In- School Services at Pahoa Elementary, Intermediate and High Schools, HAAS (Hawaii Academy of Arts and Sciences), Ku O'Kala, Keonepoko Elementary, and Mountain View Elementary. TSA -FIS has also worked cooperatively in coordinating services for youth and families with the following programs: Big Island Substance Abuse Council; Workforce Investment Youth Employment Services; Hawaii County Community Policing Officers; Bay Clinic; Queen Liliuokalani Children's Center; Neighborhood Place of Puna; Pahoa Parks and NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Recreation; Boys and Girls Club of the Big Island; Alulike Inc; Pahoa Weed and Seed, and Nanawale Community Center. Performance Measures: Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Completion of L.E.A.D. Team 60 60 40 Participates in Pos. Alter. Activities 60 60 40 Participates in Project Family 60 60 40 Follow up and Monitoring 60 60 40 Program Expenditures Program Funding Sources Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 62,800.50 62,747 76,511 Professional Fees 0 0 0 Operations 24,319.31 23,503 27,396 Equipment 0 0 0 Other* 0 0 0 Total 87,119.81 86,250 103,907 Program Funding Sources Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate State of HI -Office of Youth Services* 72,119.81 71,250 71,250 County of Hawaii 15,000.00 15,000 32,657 Total 87,119.81 86,250 103,907 *Positive Youth Development services funded under Office of Youth Services. Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The Salvation Army - Family Intervention Services, while part of The Salvation Army, is required to seek its own funding for program services. As such, TSA -FIS relies primarily on funding from government at the federal, state and county levels to continue our prevention and intervention programs to assist at -risk youths and their families. Such funding is primarily through the purchase of service system, which we are required to submit proposals through a competitive process. Very limited funding is available through grants from trusts and foundations. We continuously explore avenues of funding to continue these programs. However, in view of the nature of our mission in developing healthy lifestyles for youths and their families, we do rely heavily on funding from all levels of government. As such, we do not anticipate being self- sufficient in providing prevention services to the youth and families residing in Hawaii County. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 The Salvation Army Family Intervention Services Prevention Programs -Pahoa I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report may imp the evaluation of vour proaram's or agency's future funding requests. r Sigrr'atuKe of Board President/Chair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 i Special Olympics Hawaii - East Hawaii Special Olympics Hawaii - East Hawaii 08/05/2008 14:49 15308774428 COWDREV PAGE 03115 Special Olympics Hawaii- Agency Name Special Olympics Hawaii - East Hawaii- Program Name Agency Director: 943 -8808 X22 Nancy Bottelo Phone No.: 808- Contact Person: 935 -2459 Mailing Address: Facility /Site Address: Fax No.: Email Address: Denise Cowdrey P.O_ Box 7265 Hilo, H1 96720 230 Kekuanaoa Hilo, HI 96720 982 -6590 D33cowdrey@me.com Phone No.: 808- Name of Accountant/CPA (include name of firm if applicable)^ Akamine, Oyadomar & Kosaki Phone No.: 808 -941 -0500 Mailing Address: 1440 Kapiolani St #900 Honolulu, Hl 96814 Amount of Request for County Funds: 1 $20,000 Prior Year(s) Funding: 08-09 09 -10 10 -11 $12 000 $15,000 $10,000 Agency Mission Statement: NONPROFIT GRANT APPLICATION FISCAL 1r - EAR 2011 -12 Page I Received 01-26 -2011 07:1gam From - 15308774428 To- SPECIAL OLYMPICS HAW Page 003 08/05/2008 14:49 15308774428 COWDREY PAGE 04/15 The mission of Special Olympics is to provide year round sports training and athletio competition in a variety of Olympic-type sports for children and adults with intellectual disabilities, giving them continuing opportunities to develop physical fitness, demonstrate courage, experience joy and participate in the sharing of gifts, skills and friendship with their families, other Special Olympics athletes and the community_ NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Received 01-26-2011 07:19am From-15308774428 To- SPECIAL OLYMPICS HAW Page 004 08!05/2008 14:49 15308774428 COWDRE'Y PAGE 05115 Special Olympics Hawaii - Agency Nam Special Olympics Hawaii - East Hawaii- Program Name Program Description: People who are isolated from life experience by a disability have little chance for the developmental growth and acquisition of important skills that they will need to gain employment, maintain relationships and function within the community. Special Olympics believes that all people, regardless of their disability deserve to lead full, active lives, enriched with social and recreational opportunities that most of us take for granted. Unfortunately, appropriate physical education programs in the public schools and social service programs that realistically address the special needs of this population are virtually non - existent. Special Olympics Hawaii believes that we address a very real issue for all communities throughout the world; which is how to take care of the people within their community that have disabilities: how to employ them. how to take care of their health issues, or just plain how to interact with them_ We help the communities that we are involved in with those issues. Our 6,000 volunteers statewide interact with our athletes and their family members on a weekly basis, our medical volunteers throughout the state have been proficient at interacting with our athletes within their own practices, and an impact study done in 2004 states that 52% of the adult Special Olympics athletes in the United States are employed, over half of those are in competitive employment_ The general disabled population only has 10°x6 employed. This is a significant impact within the communities that we are involved with. Special Olympics East Hawaii continues our Unified Sports Program. We Feel this is a vital program where our special needs individuals interact with their non - handicapped peers on a weekly basis. Unified Sports is a program that combines equal numbers of athletes with intellectual disabilities and special partners without disabilities. All participants are of similar age and athletic ability. This program dramatically increases inclusion of our athletes into the community by helping break down barriers that have historically kept people with and without disabilities apart. Special Olympics East Hawaii now has a softball team, 5 unified bowling teams and 24 unified bocce teams that participant in the Unified Sports Program. They all train and compete together here in East Hawaii and they travel to Maui and Oahu for regional and state competitions. In 2011 we plan to add Unified Track and Field Relay teams and a Unified Soccer team to encourage even more inclusion of our athletes into the community. The benefits for our athletes continue to be: improved physical fitness and motor skills, greater self- confidence, a more postitive self - image, friendships, and increased family support. Special Olympics athletes carry these benefits with them into their daily lives at home, in the classroom, on the job, and In the community_ Families play a significant role in the East Hawaii program. We believe the families who participate with us become stronger as they learn a NON'PROiF'IT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Received 01 -26 -2011 07:19am From-15308774428 To— SPECIAL OLYMPICS HAW Page 005 08'0512008 14:49 15308774428 COWDREY PAGE 06115 greater appreciation for their child's talents. They play significant roles in our organization from an enthusiastic spectator in the stands to coaching their child's team. Our program could not continue without the help from our community volunteers. Our volunteers learn more about the capabilities of people with intellectual disabilities and take that into their own homes. At the Track and Field competition held on April 10, 2010, 85 family members, volunteers and community members participated in "Fans in the Stands ". This program encouraged members of the community to attend the competition and cheer on the athletes. Everyone who participated received a t -shirt which said "Spread the Word to end the Word ". The "R" word. The need for Special Olympics East Hawaii program to continue here on this island is extremely high. Special Olympics provides training for all the volunteers involved in running our program, from the Area Director to our weekend chaperone. These training are essential due to the unique services that we provide. These services are not available anywhere else but with our program. Our program is free of cost to all our athletes, special partners, and coaches. This has been the policy of our organization since its inception, making it a very unique sports program_ Special Olympics Hawaii receive no money from the Kennedy Foundation or the Federal Government. All of the money raised for the East Hawaii program stays here to support our program. Due to the aspect of our program, a volunteer committee under the leadership of our Area Director must raise all the funds needed for this unique program. Those funds will pay for all aspects of the Special Olympics program, which includes, equipment, uniforms, transportation costs, training of the coaching staff, family activities and trainings, and our Athlete Leadership Program (AMPS)_ In the ALPS program athletes are trained to become coaches, public speakers, members of the Board of Directors, officials, and technology experts using PowerPoint_ Special Olympics East Hawaii believes that our athletes are the Voice of our program. In 2011, we will have 3 athletes, 2 family members and 2 coaches representing our program at the Leadership Training. At this conference athletes come together to vote on issues concerning their Special Olympics program, coaches learn leaderhip skills and family bete es that we are working information at program that the people that we are serving. As always, Special Olympics East Hawaii's largest expense for 2011 is transportation. it is an essential part of our program that Special Olympics athletes are provided an opportunity to interact and compete against people of smiliar athletic ability. Unfortunately our area program is too small to be able to provide quality competition, therefore our athletes must travel to other islands to achieve that goal. The state competitions that are held on Oahu 3 times per year provide many activities that our athletes never have a chance to experience. They include; dances, Opening and Closing Ceremonies, entertainment and games, and being exposed to a Healthy Athlete Program. This program provides a free dental screening, vision screening, hearing screening, Fun Fitness (flexibility & strength) screening. nutrition screening and podiatric screening for our athletes. As you know, these services are sometimes not available to individuals with disabilities due to financial difficulty or lack of professionals who NONPROFIT GRANT ,A,pP'LICATION FISCAL YEAR 2011 -12 Page 4 Received 01- 26-2011 07 :lgam From - 15308774428 To- SPECIAL OLYMPICS HAW Page 006 08/05/2008 14:49 15308774428 COWDREY PAGE 07/15 are trained to treat people with disabilities. For some athletes this may be the only time during the year that they are seen by a dentist. Each athlete who participated in the vision screening at the 2010 Summer Games and who required glasses, were given free glasses that were mailed to each athlete. Special Olympics East Hawaii wishes to continue to provide these fantastic opportunities to all the athletes that are currently involved. In order to continue to provide the current services that we do, continue to outreach to new family members and volunteers, continue to train our coaching staff, and to send our Athlete Delegates to Oahu we will need funding from the County of Hawaii. Special Olympics Hawaii -East Hawaii Area is asking for $20,000 from the County of Hawaii to help fund our Special Olympics East Hawaii program activities. Total Budget and Position Count Budget 1 $112 250 Total Program Position Count ludoet 1 $1,664,212 Total A gency Position Count Program Objectives' 1) To provide quality sports training and Olympic type competitions in our area program by June 2012 to 275 athletes & special partners, an increase of 5% from December 2010. 2) To provide sports specific coaches training or recertifications for 5 coaches in various Olympic type sports and various ability levels so that they may provide appropriate training to the athletes within their delegations, an increase of 16% by June 2012. 3) To provide our families, coaches, volunteers and athletes with 3 family activities throughout the year, which will be conducted by our family (Ohana Task Force) committee by June 2012. 4) To provide Leadership Training to 3 athletes, 2 coaches and 2 family members by June 2012 so that they will be able to become ambassadors for Special Olympics East Hawaii within the community. 5) To provide transportation to 160 athletes, coaches & special partners three times a year, so that they may compete at each State Competition with athletes of the same ability level, an increase of 5% by June 2012. 6) To increase business participation in our Mile of Quarters campaign in order to raise more funds to cover our annual budget by June 2012. 7) To continue to have 4 fundraisers a year in which participants will be asked to sell products (such as chill, bento, candy, brownies etc) to help cover the anticipated increases in cost this year and the possibility of reduced donations due to the economic environment we currently have. 8) To increase the number of participants in the Puna district by June 2012, so that we can provide the intellectually disabled rural athletes an opportunity to participate in our sports program, to become more physically fit, to become a healthier person, to be able to socialize with NONPROFIT GRANT APPLICATION FISCAL YEAR 2411 -12 Page 5 15 Received 01-26 -2011 07:19am From- 15308774428 To- SPECIAL OLYMPICS HAW Page 007 08!0512008 14:49 15308774428 COWDREV PAGE 081'15 their peers and be able to compete with other athletes within the same ability level at large state competitions_ 9) To increase the number of partaicipants in the Honokaa - Paauilo area by June 2012, so more intellectually disabled rural athletes may be able to take part in our program, as there are no organized sports programs outside of schools, for them to participate in year round. 10) To providc an opportunity to 460 community volunteers to intoraet with our Special Olympic athletes throughout the year, providing them with the chance to "change the world." Program Highlights: (from Fiscal Year 2009 -10) 1) We conducted 7 area athletic competitions for our athletes and Special Partners. On July 25, 2009 we held the Area Bocce Doubles tournament with 30 athletes, 2 coaches 10 volunteers and 10 family members. Also on July 25, 2009 we held the Area Unified Bocce tournament with 24 athletes, 24 Unified Partners, 2 coaches, 10 volunteers and 10 family members. On August 25 we held the Area golf tournament at Waimea Golf Course with 6 athletes 1 caoch, 2 volunteers and 6 family members in attendance. On October 17, 2009, we conducted our area singles bowling competition with 66 athletes from 5 delegations, with 6 coaches, 37 family members and 73 community volunteers attending this competition, On October 18, 2009, we conducted our area unified (special) partners bowling competition with 10 athletes, 10 unified partners, 2 coaches, 2 delegations, 15 community volunteers and 13 family members in attendance. On November 7, 2009, we hosted the Weinberg Regional Basketball competition at UH Hilo Gynmasium, welcoming 5 teams from the Big Island. Participant and volunteers included 49 athletes, 8 coaches, 4 delegations, 47 community volunteers and 35 family members. On April 10, 2010 we held our area track & field competition at Keaau High School track with 98 athletes participating in the days events. Also in attendance at the areaTrack & Field competition were 8 coaches, 8 delegations, 45 family members and 140 community volunteers. 2) Our Ohana Task Force committee provided our families, coaches, volunteers and athletes with 3 family events. On August 29, 2009 we held our annual "End of Summer Bash" at Wailoa State Park. Attending were 72 athletes, family members, coaches, volunteers & community members enjoying an afternoon of food, games and fellowship. On December 12, 2008, we held our annual Christmas dinner /dance /party at the Church of the Holy Cross. Attending were 85 athletes, family members, volunteers and community members enjoying an evening of good food, great music, the singing of Christmas Carols and a small gift to each athlete who attended. On April 23, 2010 we held our Spring Dance at the Church of the Holy Cross with 88 athletes, family members and community members enjoying the music, food and fellowship, NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Received 01 -26 -2011 07:19am From - 15308774428 To- SPECIAL OLYMPICS HAW Page 008 08105!2008 14:49 15308774428 COWDREV PAGE 09115 3) 4) 5) 7) 8) 9) We provided quality sports training and competitions for 262 athletes and special partners, an increase of 9% over 2009. We provided sports training, competitions and transportation to: 13 soccer athletes, 30 bocce athletes, 24 unified partners, 6 coaches and 3 chaperones during the Aukake Season which ran from June 1 to August 22, 2009. During the Winter season, which ran from August 23 to December 31, 2009, we provided services & transportation to 95 athletes, 10 unified partners, 14 coaches, & 10 chaperones. The last season for this period was the Summer season which ran January 1 to May 30, 2010. During this season, we provided training, competition and transportation to 98 athletes. 6 unified partners. 26 coaches and 14 volunteers. All positions on the area management team, who help to coordinate all activities for Special Olympics East Hawaii's area program were filled and met monthly to discuss and plan operations for the year. The Mile of Quarters fundraising campaign included participation of HELCO Federal Credit Union, Hamakua Coast Community Federal Credit Union, IEG Federal Credit Union and the Big Island Federal Credit Union. This makes 6 local businesses who participate in our annual fundralsing campaign. Athletes, coaches, volunteers and families conducted 4 fundraisers this year selling bentos, chili and brownies to support the area's annual budget needs. A net total of $15,273 was raised through these 4 fundraisers. Athletes, coaches, volunteers and families participated with The Bank of Hawaii in a BBQ steak fundraiser. Bank Of Hawaii made a donation to Special Olympics East Hawaii in the amount of $8,445. We continue to offer 9 sports throughout the year for our athletes which are: track & field, swimming, power lifting, softball, bocce, soccer, golf, basketball & bowling. We continued to provide coaches trainings throughout the year and now require each coach to be a certified coach through our sports training program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Received 01 -26 -2011 07:1gam From-15308774428 To- SPECIAL OLYMPICS HAW Page 009 X8/05/2008 14:49 15308774428 C0I4DREY rrL)ut 1J /1� Special Olympics Hawaii - Agency Name Special Olympics Hawaii - East Hawaii - Program Name Performance Measures: - it appucaDle Program Expenditures " FY 2009 -10 Actual Salaries and Wages 2.140 Professional Fees 0 Operations 87,229 VZ 6542 Total $95.910 FY 2010-11 FY 2011 -1 Budget" Es timate 0 106, 320 104 6,600 5 115.060 $112 * If applicable " Please explain in detail on Sep arei�e sheet NONPROFIT GRANT APPLICATION FISCAL YTAR 2011 -12 Page 8 0 Received 01 -26 -2011 07:19am From - 15308774428 To-SPECIAL OLYMPICS HAW Page 010 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual R ...... Bud et * Estimate Athlete & Special(Unified)Partner ...... 262 260 275 articipants Volunteers from the communi 1 0 440 445 Family Members 115 120 10 Management team members 10 12 1 1 Communi Service Projects 0 3 State competitions attended on 3 3 Oahu Areak ional competitions attended 7 8 7 Delegations(Schools) within the 6 7 6 DOE s stem artici atian 8 9 Total number of delegations 8 participating particip this vear 3 3 Number of %mil events rovided Number of volunteer hours provided 3 10,253 10,850 10,900 by volunteers for training, competitions and fundraisin (Note: these figures are not dollar amounts, but rather in the number of people, events schools or hours - it appucaDle Program Expenditures " FY 2009 -10 Actual Salaries and Wages 2.140 Professional Fees 0 Operations 87,229 VZ 6542 Total $95.910 FY 2010-11 FY 2011 -1 Budget" Es timate 0 106, 320 104 6,600 5 115.060 $112 * If applicable " Please explain in detail on Sep arei�e sheet NONPROFIT GRANT APPLICATION FISCAL YTAR 2011 -12 Page 8 0 Received 01 -26 -2011 07:19am From - 15308774428 To-SPECIAL OLYMPICS HAW Page 010 08/05/2008 14:49 15308774428 COWDREY PAGE 11/15 Special Olympics Hawaii - Agency Na Special Olympics Hawaii - East Hawaii - Program Name Program Funding Sources, Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual '� FY 2010 -11 Bud et * jFY 20 11 -12 timate County of Hawaii Grant Foundations Individual contributions Corporate contributions S ii'-Events HSO Co-op monies Interest Income Merchandise sales Service Clubs 10 9 000 7,720 10,527 27,981 2 ' 800 500 37,853 1 20,000 12 5 000 11,600 4 34,000 2,200 500 37,160 100 5,000 12,500 4,500 35,500 3,700 500 38,450 100 _ Total 107,431 115,560 112,250 "If applicable Explain what plans, if any, your agency and /or program has to incronac revenues to support this program. When do you anticipate your program to become self -sustaining? 2011 -2012 plans to increase revenues to support our programs' 1) We are planning to expand our Mile of Quarters fundraising campaign to more businesses. currently we have 6 businesses participating and we hope to add a few more_ In addition we plan to expand the time frame for this event by 2 more weeks. 2) We are planning to add a 5th fundraiser, The Polar Bear Plunge, by which we plan to generate approximately $4,00046,000 more income. 3) We will be applying for more grants that come available to East Hawaii Non - Profits. Special Olympics East Hawaii is very diverse in how we raise money to support the athletes, families & volunteers. However, as we continue to meet our mission of continuing to outreach to new athletes, familiy members and volunteers within NONPROFIT GRANT APPLICATION FISCAL XE.A,R. 2011 -1.2 Page 9 Received 01 -U -2011 07:19am From-15308774428 To- SPECIAL OLYMPICS HAW Page 011 '08/05/2008 14:49 15308774428 COWDREY PAGE 12I 15 our community, and with increased costs, our budget continues to grow, so even as we get better at raising money, it continues to be difficult to reach our budget without the support of the County of Hawaii. Becoming self sufficient is the ultimate goal of our program, however we do know that if any of our events /grants fail to raise the expected amount of money, our program would change drastically. We would have to cut back on some services that we currently provide and /or we would have to cut back on outreach goals. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -I2 Page 10 Received 01- 26-2011 07:1gam From - 15308774428 To-SPECIAL OLYMPICS HAW Page 012 Special Olympics East Hawaii - Agency Name SOEH General Fund - Program Name (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board Pre ent/Chair 604,CX4 U Si ature xecutive Director /z s A ) Date Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! E:R Special Olympics Hawaii - West Hawaii Special Olympics West Hawaii - General Funding Special Olympics West Hawaii- Agency Name SOWH General Funding- Program Name Agency Director: 8808x22 Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: 130-0 Nancy geteM David Ross Phone No.: 943- Phone No.: 345 -1344 P.O. Box #390358, Keauhou, HI 96739 77 -296 Kalani Way #2 Kailua -Kona, HI 96740 sowhdave @yahoo.com Name of Accountant/CPA (include name of firm if applicable): Akamine, Oyadomari,and Kosaki CPA's, Inc. Phone No.: 808 - 941 -0500 Mailing Address: 440 Kapiolani Blvd.Suite #900,Honolulu, HI 96814 Amount of Request for County Funds: $12,000 Prior Year(s) Funding: 08 -09 09 -10 $12,000 $12,000 Agency Mission Statement: 10 -11 $7,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 The mission of Special Olympics is to provide year -round sports training and athletic competition in a variety of Olympic -type sports for all children and adults with intellectual disabilities, giving them continuing opportunities to develop physical fitness, demonstrate courage, experience joy and participate in a sharing of gifts, skills and friendship with their families, other Special Olympics athletes and the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Special Olympics West Hawaii - Agency Name SOWH General Funding- Program Name Program Description: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Special Olympics believes that people who are isolated from life experience by a disability have little chance for the development growth and acquisition of important skills that they will need to gain employment, maintain relationships and function independently as adults. Special Olympics helps to give individuals with a intellectual disability the necessary skills to achieve that independence. We believe that all people regardless of their disability deserve to lead full, active lives, enriched with social and recreational opportunities that most of us take for granted. Unfortunately, appropriate physical education programs in the public schools and social service programs that realistically address the special needs of this population are virtually non - existent. Special Olympics West Hawaii fulfills that need and provides the necessary skills for people to continue good health throughout their lives within our community. Thanks to the Hawaii County grant, Special Olympics West Hawaii is able to continue to provide many opportunities for the special needs individuals in our community. The benefits that all the athletes receive from their participation in Special Olympics include: improved physical fitness and motor skills, greater self - confidence, a more positive self- image, friendships, and increased family support. Special Olympics athletes carry these benefits with them into their daily lives at home, in the classroom, on the job, and in the community. Families who participate become stronger as they learn a greater appreciation for their childs' talents. We have found that many of our strongest supporters and best volunteers are the family members of our Special Olympics athletes. We provide a "safe haven" for families where they know that their child is not judged and is accepted for who they are and for what they can do. Community volunteers find out what good friends the athletes can be and make long lasting bonds that continue off of the sports field. Everyone learns more about the capabilities of people with intellectual disabilities, and a huge majority of our volunteers continue with the program year after year. These active volunteers are often a source of new volunteers to the program as they share their stories with friends, neighbors and co- workers. Special Olympics West Hawaii Unified Sports Program is a vital program where these special needs individuals interact with their non - handicapped peers on a weekly basis. Unified Sports is a program that combines equal numbers of athletes with intellectual disabilities and special partners without disabilities. All participants are of similar age and athletic ability. This program dramatically increases inclusion of our athletes into the community by helping break down barriers that have historically kept people with and without disabilities apart. Special Olympics West Hawaii will have unified softball, bocce ball and bowling teams in FY 2011 -12, and will expand and have our first unified soccer team. The need for the Special Olympics West Hawaii program to continue here on this island is extremely high. There is no other program in our Area to provide these services to our athletes. Special training is provided for our athletes and the coaching staff throughout the year. The training is essential due to the unique services that we provide. We not only touch the lives of our Special Olympics athletes, but also their families and the hundreds of volunteers from our NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 community. Our founder, Eunice Kennedy Shriver, believes sports training and competition opportunities should be available for all who qualify rather than all who could afford to participate. Therefore, our program is free of cost to all of our athletes, special partners, and coaches. We receive no money from the Kennedy Foundation or the Federal Government. Due to this aspect of our program , a volunteer committee under the leadership of our Area Director must raise all the funds needed for our West Hawaii area program. Those funds will pay for all aspects of the Special Olympics progam. Our largest needs for 2011 -2012 are 1. Develop our new Kau delegation complete with staff, coaches, uniforms, equipment, advertising and promotional materials. 2. Host a neighbor island softball / t -ball tournament. 3. Host a neighbor island Powerlifting Tournament. 4. Host a Soccer and Bocce Ball tournament. As always our largest cost is airfare to get our athletes to their competitions where they compete against their peers from around the state of Hawaii. Hosting three competition days here on the West side of the Island are a lot of work but help us out financially by not having to buy as many flights to off island competitions. It is an essential part of our program that Special Olympics athletes are provided an opportunity to interact and compete against people of smiliar athletic ability. We find as many teams in the commuity as we can to practice and play against, but we still must travel to Oahu three times a year to compete against similar Special Olympics competition at the State Games. The state competitions that are held on Oahu 3 times per year provide many activities that our athletes never have a chance to experience. They include; dances, Opening and Closing Ceremonies, entertainment and games, and free health exams through the Healthy Athlete Program. This Healthy Athlete program provides free dental, vision, hearing, podiatry, flexibility & nutrition screening and education for our athletes. As you know, these services are sometimes not available to individuals with disabilities due to financial difficulty or lack of professionals who are trained to treat people with disabilities. Special Olympics West Hawaii wishes to continue to provide these opportunities to all the athletes that are currently involved and be able to reach out to new special needs individuals througout our communities. In order to do this, we will need funds to maintain our services and to purchase new uniforms and equipment, host local competitions as well as provide transportation for athletes to get to competitions. Special Olympics Hawaii -West Hawaii Area is asking for $12,000.00 from the County of Hawaii to help fund our Special Olympics West Hawaii program activities. Total Budget and Position Count Total Program Bud et $60,000 Total Program Position Count 1 Total Agency Bud et I I Total Agency Position Count 18 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Program Objectives: 1) Expand our new Ka'u delegation to provide services to South Kona and Ka'u Add Unified Soccer to our Summer season to raise the caliber of competition and community involvement. Create an active delegation in the Waimea / Hawi area to provide support to Kohala. Train a new Head of Delegation for Ka'u and Waimea to run an efficient program. Train more coaches and volunteers to continue to provide the highest skilled training to our athletes. Expand out outreach to local school student organizations to educate the youth about our program and the many achievements of people with special needs. Provide athletes with additional opportunities to learn, work opportunities, and move towards self- sufficiency through our partnerships with The Arc of Kona, Full Life Hawaii, and the Kona Paradise Club. Continue to add community service events to give back to the community that is so supportive of us. Expand our management team to have additional input from local community members and businesses. Train a basketball team to represent the State of Hawaii at the National Games. Expand the role that athletes have in planning our social and community service events. Strengthen our financial contacts and expand our local fund raising opportunities. Revitalize our Cop -on -Top fund raiser which has taken in less donations in recent years. Expand our outreach to younger sthletes in the community to enhance the development of our keiki. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Program Highlights: (from Fiscal Year 2009 -10) 1) Our West Hawaii Saints softball team won the gold medal at the State Games for the first time in several years. We partnered with Bank of Hawaii and added a "Steak Plate" fund raiser which raised several thousand dollars for our program. Trained and participated in 7 official Special Olympic sports. Created professional yearbooks for each athlete and volunteer as a thank you and keepsake. Partnered with the P.A.T.H. organization to clear brush on local walking trails. Expanded our relationship witht the West Hawaii Today who featured several stories about SOWH. Expanded the "Fueling Dreams" fund raiser to increase it's revenue and effectiveness. Continued to post pictures and articles spotlighting our athletes and program accomplishments. West Hawaii has contiued our push to make the public aware of our events and that they are open to the public. Expanded our volunteer screening and training practices to keep our program safe and expand the quality of interactions with athletes. Continued to build our relationship with the County of Hawaii division of Parks and Recreation, an essential link to our success. Trained 4 new coaches to raise the quality of instruction our athletes receive. We volunteered at manned two aid stations for the Kona Marathon and the Charity Walk. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Special Olympics West Hawaii - Agency Name SOWH General Funding - Program Name Performance Measures: "If applicable Program Expenditures FY 2009 -10 Actual* FY 2010 -11 Budget* FY 2011 -12 Estimate Number of Athletes in SOWH 38 42 44 Area / Regional Competitions 10 10 10 Competitions held in West Hawaii 4 5 5 Number of Unified Teams 12 12 16 Community Service Project Days 8 9 10 Families Participating in SOWH 28 30 35 State Competitions on Oahu 3 3 3 "If applicable Program Expenditures it applicable 'Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 10000 10500 11000 Professional Fees 2200 2200 2500 Operations 11000 10300 11000 Equipment 900 1100 1500 Other" 250001 27000 34000 Total 57200 1 59100 60000 it applicable 'Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 Special Olympics West Hawaii - Agency Name SOWH General Funding - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate County of Hawaii Non - Profit Grant 15000 7000 12000 Private Donations 5000 7000 6000 .- Cop-on-Top 12000 13000 18000 Corporate Contributions 3500 5000 5000 Underpants Run 3500 5000 4000 Fueling Dreams 3500 4500 4500 Project Compassion 0 2000 0 Visitor Industry charity Walk 10000 10000 10000 SOHI Co-Op Money/ Weinberg 2000 2000 0 Interest, In -Kind, Merchandise, Other 700 600 500 Larry Mitchell Memorial Fund 2000 0 0 Total 572001 561001 60000 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 1) We are planning to increasing our donations for our Cop on Top event in 2011 We are changing venues to our local Wal -Mart store which is the busiest store in town. 2) We will plan to expand our Fueling Dreams event with the Law Enforcement personnel in Kona in partnership with Tesoro. We hope to engage another Tesoro station with the fund raiser. 3) We will work with the Air National Guard to hopefully receive the free airlift from Kona to Oahu for our State Games in December, saving us thousands of dollars. 4) We will continue to make our events more open to the public in order to spread the knowledge of our program and hopefully increase our donation base. However as we continue to meet our mission of continuing to outreach to new athletes, family members and volunteers within our community, our budget continues to grow, so even as we get better at raising money, it continues to be difficult to reach our budget without the support of the County of Hawaii. Becoming self sufficient is the ultimate goal of our program, however we do know that if any of our events /grants fail to raise the expected amount of money, our program would change drastically. We would have to cut back on some services that we currently provide and /or we would have to cut back on our outreach goals. Cutting any services would be tragic since in many areas we are the only services of our kind to the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 10 Special Olympics West Hawaii - Agency Name SOWN General Fund - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board Presi ent/Chair A:30A • 4 Sigture Vecutive I,--)Z6-A) Date / 'cPI.Iff / / Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! Other Estimated Program Expenditures Special Olympics West Hawaii FY 2011 - 2012 Estimated $34,000 Airline Tickets (est. $150 / per) ................................. ............................... $22,500 Ground Transportation of Big Island Competitions .. ............................... $2,500 Train expenses for new coaches and Head of Delegation Training .......... $1,500 Promotional Material (handouts, shirts, awards, ect.) ............................... $ 2,500 Events for Families and Athletes (bbq's, bowling nights, movies ect.) ...... $5,000 Total $ 34,000 i • Sure Foundation, Inc. Yeshua Outreach Center c� �y Sure Foundation, Inc.- Agency Name Yeshua Outreach Center- Program Name Agency Director: Pastor Keith Jackson Phone No.: 966 -6489 Contact Person: Mailing Address: Facility/Site Address: Fax No.: Email Address: Andrea Miday Phone No.: 966 -6489 P.O. Box 1598 Kea'au, HI 96749 16 -1592 Pohaku Circle Kea'au, HI 96749 966 -6712 and rea@surefoundation.ty Name of Accountant/CPA (include name of firm if applicable): Carolee Fernandez, Strategy By Numbers, Inc. Phone No.: 808 -982 -3900 Mailing Address: PO Box 4130 Hilo, HI 96720 Amount of Request for County Funds: $70,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $0 $65,000 $50,000 Agency Mission Statement: Sure Foundation's mission is to build bridges and connect people to Christ. Our vision for the Yeshua Outreach Center is to impact lives, families and our community through Yeshua, which is Hebrew for healing, wholeness and victory. Our mission is to turn lives around through quality Christ - centered mentoring, fitness and support programs. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Sure Foundation, Inc. - Agency Name Yeshua Outreach Center- Program Name Program Description: The Yeshua Outreach Center (YOC) at Sure Foundation in Puna, Hawai'i is designed to provide an alternative outlet for whole families in the community to focus their energy and set personal goals for their future. We hope that by providing a nurturing environment, which focuses on three athletic programs, boxing, weightlifting, and martial arts, we can give families in our community a positive environment in which to develop. In addition to these athletic programs, we offer counseling and community service programs in drug and alcohol abuse, nutrition, and outreach to youth. We hope that in the process of pursuing personal fitness goals, we can offer members of our community some guidance and mentoring that will help prevent them from the distractions of drugs, alcohol and crime. This model for drug and crime prevention has been proven in many cities and communities throughout our country. By combining efforts with local law enforcement and justice department officials, we hope to mainstream our efforts to the broader community. Sure Foundation church has offered their large recreational gymnasium as a site for our center, and all of our volunteer staff are members of either the Hilo or Puna branches of the church. In addition to providing a home for the YOC and helping fund some of its expenses, Sure Foundation has devoted some of its paid employee resources to help coordinate volunteers of the Yeshua programs. Total Budget and Position Count Total Program Budget $221,000 Total Program Position Count 1.8 FTE Total Agency Budget $653,400 Total Agency Position Count 6.5 FTE Program objectives: 1) To formalize the weightlifting program in its own new facility (starting in 2012) and to utilize the new facility to enhance the boxing and Universal Kempo Karate programs by adding new weightlifting equipment (3 and 4 quarters, 2011) 2) To hold regular boxing exhibitions to promote the athletic programs offered by the Yeshua Center (3 -4 events per year, first event of the new fiscal year 2011 -12 scheduled for November 11 to and 12 2011) 3) To enhance membership by 10% though increased enrollment of our boxing, weightlifting, and martial arts programs (ongoing enrollment throughout the year) and to sustain membership by providing higher quality facilities and training to members (starting in 2012 with a new weightlifting facility) 4) To track attendance and monitor effectiveness of intersession and after school programs, by ensuring faithful membership and better recording of enrollment. 5) To involve local private businesses and organizations, such as other Hawaii USA Boxing clubs, Rotary, County government, local Fire and Police Departments, University of Hawai'i Hilo, YMCA, AG Churches, Teen Challenge Hawaii, and HIANG/HIARNG, in our Yeshua programs, to further assist our community families and promote awareness of the Yeshua Center and focus on long -term sustainability NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 Sure Foundation, Inc. - Agency Name Yeshua Outreach Center - Program Name Program Highlights: (from Fiscal Year 2009 -10) Boxing Program • Yeshua Center Boxing program held 4 USA Boxing - sanctioned amateur events during for the fiscal year 2009 -10. These events are highlighted as follows: 1. August 28' and 29 2009, 2 day competition featuring 47 bouts, attended by over 600 people each day 2. December 19 2009, 17 amateur bouts, attended by over 250 people 3. March 13 2010, 19 amateur bouts, attended by 400 -500 people 4. July 23' & 20, 2010, 55 amateur bouts, over 500 people each day • Each of these boxing special events were heavily publicized in local media, and well attended by local and state representatives, such as: Mayor Billy Kenoi and council reps., Emily Naeole- Beason, Jay Yoshimoto, Denise Onishi, and Dominic Yagong. • Currently the boxing program has 45 boxers regularly attending the program, with as many as 102 different boxers having enrolled for some months of 2009 -10. • The Hawaii Tribune -Herald recently featured our July 23 -24 boxing event as a cover story on their sports page (July 20 2010, sports cover page, Kevin Jakahi). Universal Kempo Karate • Universal Kempo Karate (UKK) at YOC had 42 karate students enrolled at the end of the fiscal year 2009 -10, which was an increase of 40% from last year. • During the past year, UKK has had regular testing and rank promotions twice a year for each of the 30 -42 students enrolled. • In addition, UKK members have participated in 2 local sparring competitions in Kamuela, Hawaii, coordinated with other Big Island UKK programs during 2009 -10. Synergy Youth Outreach • Synergy Youth Program holds regular Friday night meetings for youth between 6th and 12 grades with free dinner and sports, break - dancing and other activities run by volunteers from Sure Foundation • The Synergy Youth program has become tremendously popular having up to 130 -150 youth attending their Friday night events (this is an increase of 25% from last year) • We are actively looking for solutions to improve our transportation on Friday nights for youth who wish to attend, but have no ride to and from the events Wei htliftin Program • Weightlifting has had 66 members sign up for at least part of the fiscal year 2009 -10, with a total enrollment of 34, as of June, 2010. This represents an increase of 50% over last year, and exceeds our expectation of 30 enrolled members. • We recognize that the limiting factor to significantly increasing our enrollment in weightlifting is a dedicated facility for weight training and exercise equipment, which will become the focus of our efforts for the fiscal year 2011 -12. • Strengthening our weight training program will have a systemic effect on our other physical activity programs by promoting overall health and fitness. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 Sure Foundation, Inc. - Agency Name Yeshua Outreach Center Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Boxing enrollment (10% increase earl 45 55 55 Karate enrollment (10% increase earl 42 35 52 Weightlifting enrollment (15% increase earl 34 30 45 Friday Night Youth attendance (5% increase earl 140 140 160 Total enrollment in Yeshua 261 260 312 Reduction in school absenteeism of y outh involved in programs NA Reduce by 50% Reduce by 50% Recidivism rates for law offenders who become members NA Reduce by 50% Reduce by 1 50% Attendance rate of members NA >90% >90% *If applicable Program Expenditures * If applicable * Please explain in detail on separate sheet * ** See attached spreadsheet for breakdown of estimated expenses for each program NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages $48,000 $54,000 $55,200 Professional Fees $5,464 $5,700 $7,150 Operations $71,214 $80,125 $81,875 Equipment $65,026 $85,450 $76,775 Other* $2,084 $0 $0 Total $191,788 $225,275 $221,000 * If applicable * Please explain in detail on separate sheet * ** See attached spreadsheet for breakdown of estimated expenses for each program NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Sure Foundation, Inc. - Agency Name Yeshua Outreach Center - Program Name L I-U r O a N O or, O or, v, Cam) v� 1 O p O rV' v O O J O 6. C-1 O G; CA Cn !r - 77 0 ac ° p 1 o ° a -t or, O •- �: r l f'l V, .-r (-1 > (') El (- .Y- ii O O or, p O O v, N 0 0 0 —+ p •-y G: r1 O v 'r: (� (A cfl cn •-: 0 0 0 v, O 0 CA cr7 v7 vs 6 () �!- v O O O O O k r' ✓ ✓ ir, i a w a. :., M v C Z r, a� C J a a 'c �u v G .i (.0 C Gr U d b C Z c 4 c c (/ J i fi r- f' ur .�7 Lr, 0 V, r V) O O t 4r, or, U—) J� O �1 N r'1 a G O O O CU 9J O C) 0 0 u � r w -c a o (U a1 V N :'• 0 v C :•, N v ti CZ � N � Cz G "Li C J C 0 'L r 0 Q G O a NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 o C) O O J W +- NI7 6. U W U C N J' Cn !r - 77 v J� O �1 N r'1 a G O O O CU 9J O C) 0 0 u � r w -c a o (U a1 V N :'• 0 v C :•, N v ti CZ � N � Cz G "Li C J C 0 'L r 0 Q G O a NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 _ Sure Foundation, Inc. - Agency Name - Yeshua Outreach Center - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual* FY 2010 -11 Budget * FY 2011 -12 Estimate County Grant $65,000 $70,000 $70,000 Tuition from membership $ 4,823 $25,100 $20,800 Net Income from special events $ 3,424 $4,000 $7,000 Cash Donations $ 1,737 $3,000 $2,500 Sale of Goods $979 $1,000 $1,000 Admission Fees $5,159 $3,000 $4,500 Youth Boxing Event $215 $0 $0 Registration Fee $100 $0 $0 Sure Foundation will cover all salaries of permanent staff $48,000 $54,000 $55,200 Sure Foundation will donate its recreational facility for Yeshua $5000 /month in -kind $60,000 $60,000 $60,000 Sure Foundation will cover shortfall $2,5381 $5,175 $0 Total t 77T,91,9751 $225,275 $221,000 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? During the fiscal year 2011 -12, YOC will continue to work on a limited budget comprised of a few paid church employees working part of their time runnin YOC, a volunteer work force made up of Sure Foundation church members to run the programs, and a recreational facility donated by Sure Foundation. During this fiscal year, we will focus our efforts on formalizing the weightlifting program in its own facility. Our long- term goal is to support the operating costs of YOC from a combination of revenue sources, including, but not limited to: membership dues from increased enrollment especially in weightlifting, monies derived from special boxing events held at YOC, including sales of goods and entrance and admission fees, as well as business partnerships with local companies interested in sponsoring our efforts. The goal is to make YOC self - sustaining within three years. At that point, we hope to have at least 400 hundred members enrolled in tuition based athletic programs (approximately $120,000 revenue per year), increased revenue from special events sponsored by YOC, multiple businesses donating equipment and supplies for the fitness programs, funds donated through the church allocated for an endowment, and a good track record established with local judges and correctional facilities. By having Sure Foundation lend its support throughout our growth, we hope to gain momentum for this important community program over the next year and quickly develop our own independence. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 Sure Foundation, Inc. - Agency Name Yeshua Outreach Center - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 -- 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 da_ vs after June 30 of the fiscal ygar The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests ignature of Board President/Chair Signature of Exe tive Director Date Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 Rh Volunteer Legal Services Hawaii County of Hawaii Pro Bono Legal Services VOLUNTEER LEGAL SERVICES HAWAII- Agency Name County of Hawaii Pro Bono Legal Services - Program Name Agency Director: 528-7059 Contact Person: L. Dew Kaneshiro L. Dew Kaneshiro Phone No.: (808)- Phone No.: (808)- 528 -7059 Mailing Address: 545 Queen Street, Suite 100 Honolulu, Hawaii 96813 Facility /Site Address: 545 Queen Street, Suite 100 Honolulu, Hawaii 96813 Fax No.: (808) 524 -2147 Email Address: dew @vlsh.org Name of Accountant/CPA (include name of firm if applicable): James Jennings Phone No.: (808) 942 -8813 Ext. 24 Mailing Address: 1600 Kapiolani Blvd. Ste 730, Honolulu, HI 96814 Amount of Request for County Funds: $55,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $ $55,000 $30,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Agency Mission Statement: Volunteer Legal Services Hawai'i (VLSH) was established in 1981 to provide Hawaii's low- income population with free legal assistance through volunteer attorneys. Today, the organization uses the same volunteer service delivery model to serve the indigent, the working poor, the homeless, and other vulnerable groups. While other legal services organizations use staff attorneys to deliver services, VLSH's 12 employees administer a variety of programs that draw on the services of volunteer lawyers and other community and professional volunteers. This method has proven effective at keeping costs low while delivering high quality legal assistance. Collectively, VLSH's pool of attorneys encompass many areas of legal expertise, allowing VLSH to respond to individuals' needs through service options that include advice and counsel clinics, educational workshops, and pro bono referral. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 VOLUNTEER LEGAL SERVICES HAWAII - Agency Name County of Hawaii Pro Bono Legal Services- Program Name Program Description: SCOPE: Volunteer Legal Services Hawai'i serves individuals seeking legal services using a process with four components. Intake Services and the Advice and Counsel Clinic provide assistance and, at the same time, assess whether the individual's matter is appropriate for referral to VLSH's Pro Bono Program and /or VLSH Follow -up Services. (1) Intake Services: An individual who either calls or walks into the office seeking legal assistance speaks with an Intake Specialist. During Intake, the Specialist listens to the individual's explanation of the problem. If VLSH has services to meet the individual's need, the Specialist obtains basic information and determines whether the individual qualifies for VLSH services. Eligible individuals are given a clinic date for advice and counsel with an attorney and, if appropriate, the individual is referred to other resources. (2) Advice and Counsel Clinic: Each clinic participant has a 30 -45 minute face -to- face or virtual meeting with a volunteer attorney. The attorney goes over the case with the client and provides advice regarding legal issues. The matter is then reviewed by VLSH in -house counsel for referral to a volunteer attorney and /or applicable follow up service(s). (3) Pro Bono Referral: If a clinic participant qualifies for a referral to the VLSH Pro Bono Referral Program, a volunteer attorney is recruited to represent the participant. VLSH monitors the status of the matter from placement through closing. VLSH's Pro Bono Referral Program handles a wide range of substantive matters for eligible individuals. For example, representation is available for the following: • Post - divorce decree modification and enforcement • Qualified domestic relations orders • Social security administrative appeals • Federal and state tax controversy • Judicial appeal of unemployment benefits denials • Residential summary possession defense • Collections defense • Chapter 7 bankruptcy • Bench warrant recalls • Converting traffic fines to community service work • Public housing eviction defense NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 • Wills • Powers of attorney • Advanced health care directives • Actions involving temporary restraining orders (4) Follow -up Services: A clinic participant may be referred to other VLSH services such as: • The uncontested divorce workshop • Parenting plan workshop • Chapter 7 bankruptcy program • Drivers license stopper removal program • TRO removal program • Document drafting, and /or follow up advice and counsel sessions The Parenting Plan Mediation Program (PPMP) serves a critical need in income qualified applicants fulfilling a parental role and facing family breakdown. PPMP places participants in a guided paradigm- shifting interactive process that allows them to develop their own practical tools to participate in a child's best interest - centric co- parenting relationship. A particularized draft of a parenting plan is individually developed based upon these principles. A mutually agreed upon parenting plan, based upon the child's best interests, becomes the linchpin to manage conflict in family disputes that would otherwise be mired in judicial and administrative processes. TARGET POPULATION VLSH's mission is to make legal services accessible to the poor, the working poor, the homeless, and other vulnerable populations. The organization serves individuals and families who are at or below 200% of the federal poverty guidelines. The need is great in the County of Hawaii. • The most recent census results for 2009 estimate that 13.3% of Hawai'i's population lives below the poverty line. This translates into 23,625 people living in poverty in the County of Hawaii from a total population of 177,835 ;he The December 2010 report from the Economic Research Organization at University of Hawaii states that Hawa7s economy continues to recover, but in a very uneven fashion. Tourism is leading the recovery but the rest of the economy is stagnant. • The counties are also running at two speeds. Oahu is leading, while Neighbor Island recovery lags. Employment gains have been strongest on Oahu and slowest on the Big Island. Pacific Business News reported on January 2, 2011 that 9.7% of Hawaii County's workforce was unemployed in November of 2010 compared to 6.5% statewide. http: / /bizjournals.com /pacific /news /2011 /01 /07 /hawaiis- counties - see - slight - shifts- in.html NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 • As of January 21, 2011, USA Today reports that there are currently 427 properties in foreclosure in the County of Hawaii. • http: / /usatoday. foreclosure .com /search.html ?st =Hl &tab= f &z = &cno =001 • Those who live in poverty have significant needs for qualified legal advice, counsel and representation. When discretionary income is low or non existent there are few options available when legal assistance is required. These factors are only compounded if the individual or family is homeless or at imminent risk of homelessness. • The Homeless Management Information System (HMIS) database for the Fiscal Year 2006 reported that there were 510 sheltered and 1,936 unsheltered homeless in the County of Hawai'i. A recent report from the University of Hawaii Center on the Family stated that from 2009 until 2010 the rate of homelessness rose in the County of Hawaii by 6 %. The report for the first time took a closer look at homeless children, who make up more than one -third of those in shelters and 10 percent of homeless that are served through outreach services. The report found: ❑ 9 percent of homeless children from 6 to 17 years old were not attending school. ❑ 24 percent of 12th - graders who were homeless and 47 percent of kindergarten -age children were not going to school. ❑ One quarter of children who experienced homelessness had one or more physical, mental, behavioral or developmental problems. The most prevalent was asthma, followed by speech, vision or hearing issues, allergies and learning disabilities. ❑ Children from birth to age 5 made up 56 percent of all minors served through shelter or outreach services. Under this grant, VLSH will bring legal services to these Hawaii County populations that are in crisis -- the indigent, the unemployed, the new poor, and the homeless NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 Total Budget and Position Count Total Program Bud et 81,016.40 Total Program Position Count 8 Total Agency Bud et 657,000 1 Total Agency Position Count 14 Program Objectives: 1) Anticipate receiving 500 intake requests for Legal Services from the County of Hawai'i. 2) Provide 34 legal clinics in the County of Hawaii - 22 in Hilo and 12 in Kona - for face -to -face advice and counsel or brief services from a volunteer attorney. 3) Provide 2 volunteer attorneys per clinic; each can assist up to 6 clients, for a total of 330 clients. 4) Provide phone consultations for those who are unable to meet personally with the attorney or they have a health situation that prevents them from going to the clinic site. 5) Provide pro bono attorneys for 15 clients in litigated cases. 6) Provide 6 uncontested divorce workshops for clients who are not intending to contest their divorce. 7) Provide 670 hours of legal services. 8) Provide up to four Parenting Plan Workshops with a maximum of 9 clients per workshop, depending on demand for service. This workshop is currently facilitated by a VLSH trainer based in Honolulu with the intent to train additional facilitators on the Big Island to ensure continuity in the service. Program Highlights: (from Fiscal Year 2009 -10) 1) The following are the highlights for the County of Hawaii for the fiscal year July 1, 2009 - June 30, 2010. 2) There were 470 intake interviews completed for legal assistance from low - income and vulnerable clients from the County of Hawaii and 325 services provided. 3) Operated 31 Neighborhood Legal Clinics. 4) Opened and provided legal representation in court for 11 clients. 5) Completed legal representation in 12 pro bono cases of which 7 cases are completed, four are ongoing, and one withdrew. 6) Provided advice and counsel services to 325 low- income clients. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 7) Provided uncontested divorce workshops and pro se support to 3 low - income clients. 8) The above services generated 663.67 volunteer hours, worth $151,980.43, provided through the generosity of pro bono volunteer lawyers. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 VOLUNTEER LEGAL SERVICES HAWAII - Agency Name County of Hawai' i Pro Bono Legal Services - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Intake Services 470 - 875 Completed Services - Advice and Counsel 325 449 607 Full Representation 12 22 18 Uncontested Divorces 3 20 9 Neighborhood Legal Clinics 31 34 34 Parenting Plan Program 0 0 8 Bankruptcy Clinics 0 0 4 Volunteer Hours 663.67 707 948 *If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 64,120 64,120 64,846.40 Professional Fees 3,912 3,912 Operations 20,250 20,250 35,570 Equipment 2,250 2,250 1,600.00 Other* Total 90,621 90,621 102,016.40 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 VOLUNTEER LEGAL SERVICES HAWAII - Agency Name County of Hawai' i Pro Bono Legal Services - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate TANF funds 0 15,621 0 Hawaii Justice Foundation 10,000 3,000 6,840 Hawaii State Bar Association 2,000 2,000 2,000 Donations 1,723 15,000 11,050 State Grant -in -Aid 0 0 38,176 Total 13,723 35,621 47,016 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Volunteer Legal Services Hawaii has sustained its volunteer service model for almost 30 years through a variety of revenue streams, including federal, state and county, government funding, foundation grants, and donations from the legal and business community. Using a combination of professional volunteers, paid administrative staff and these varied funding streams, we continually invest in our communities statewide. Additional marketing and advertising commensurate with VLSH's increased focus on and presence in the County of Hawaii will expand the VLSH contacts with those in legal need. VLSH is adding parenting plan workshops and bankruptcy legal services to its County of Hawaii service offerings. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 VOLUNTEER LEGAL SERVICES HAWAII - Agency Name County of Hawaii Pro Bono Legal Services - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board Signature of Executive Director L-,7t Date / �s C( Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 10 • • West Hawaii Community Health Center Adult Emergency Dental Services West Hawaii Community Health Center Adult Emergency Dental Services Agency Director: Richard Taaffe Phone No.: 808 - 326 -3884 Contact Person: Gayle Hunt Phone No.: 808 - 326 -3894 Mailing Address: 75 -5751 Kuakini Hwy., Suite 203 Kailua Kona, HI 96740 Facility /Site Address: 74 -5599 Alapa St (Old Industrial Area) Kailua Kona, HI 96740 Fax No.: 808 - 327 -1939 Email Address: ghuntnwesthawaiichc.org Name of Accountant/CPA (include name of firm if applicable): Nishihama & Kishida, CPAs, INC. Phone No.: 808 -524 -2255 Mailing Address: American Savings Bank Tower 1001 Bishop Street., Suite 1700 Honolulu, HI 96813 -3696 Amount of Request for County Funds: Prior Year(s) Funding: 08 -09 $20,000 09 -10 $ 10,000 $10,000 10 -11 $ 10,000 Agency Mission Statement: The mission of the West Hawaii Community Health Center (WHCHC) is to make quality, comprehensive, and integrated health services accessible to all regardless of income. These services will be culturally sensitive and will promote community well -being through the practice of "malama pono ". Program Description: The Need for Emergency Adult Emergency Dental Services in West Hawaii A report prepared by the Hawaii Primary Care Association in 2005 still holds true in 2011. It stated that, "On the whole, the neighbor islands have greater need and fewer available dentists than Oahu. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 1 Many areas have an acute shortage of dentists willing to serve Medicaid and uninsured patients. Not surprisingly, these same areas have the highest rates of poverty, uninsured and Medicaid participation. For example, 58% of the population of Moloka'i and 55% of the population on the Big Island are either uninsured or covered by Medicaid, compared to 34% on Oahu." For Hawaii adults, the problem of access to care is extreme because of the very limited number of private practice dentists that accept Medicaid, added to the $500 annual cap on adult dental services. The participation of our state's dentists in public insurance plans is so low that according to a 2004 report, Hawaii "ranked almost last — 46th out of 47 states with available data, for the proportion of dentists (30 %) who offer services to publicly - insured individuals." An example of this on the island of Hawaii is that in a 2006 telephone survey of private dentists, only one dentist accepted new Medicaid patients. Dentists state that they do not accept Medicaid primarily because of the low reimbursement rates, leaving adults with severe and immediate dental problems without options for even an extraction to alleviate pain and infection. Given the downturn in the economy, increased layoffs with resulting loss of health coverage, AND the State's elimination of adult dental benefits for Medicaid recipients, the demand for emergency adult dental services is even more acute with adults in need of emergency care having nowhere to turn but to WHCHC's dental van. Although many van patients will be Medicaid - eligible, Medicaid reimbursements alone cannot fully support these emergency services in Kona. WHCHC's Solution —Adult Emergency Dental Services (dental van) WHCHC's dental van is the only solution today for Kona's uninsured and low income adults experiencing dental emergencies. WHCHC has been operating the van two days a week since October 2009 at Kona's Hope Services Hawaii location (formerly called The Friendly Place). Total '11-'12 Bud et and Position Count Projection Total Program Budget $148,744 Total Program Position Count 1.45 FTE full time a uiv Total Agency Budget $6,000,000 Total Agency Position Count 70 FTE full time a uiv Program Objective: Provide quality emergency dental care to approximately 800 adults who are either uninsured or covered by Medicaid. Program Highlights: The van was turned over to WHCHC in July 2009 but due to unforeseen delays, we started seeing patients in October 2009. As of the end of December 2010 (14 months of providing service), a total of 869 adult patients have been provided emergency dental services at the van. The County has been supporting the van since July 1, 2010 (2010 -2011 county fiscal year). Although we had planned to provide services three days a week beginning in early 2010 using a Big Island dentist and letting go of our Oahu based provider in order to save on weekly travel costs, WHCHC has not been able to find a dentist willing to accept a part time position of up to three days a week. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 2 Performance Measures: no County grant funds were used for the dental van project during this grant period ** @ 2 days /wk from grant beginning date of 7/1/2010 to 12/31/2010 (last date of data capture), = 366 adult patients; 750 estimated for total grant year ending 6/30/2011. Program Expenditures: FY 2009 -10 FY 2010 -11 FY 2011 -12 Salaries and Wages Actual* Budget" Estimate Number of uninsured or Medicaid adults seen for 0 750 800 emergency dental services 0 $26,108 $33,030 no County grant funds were used for the dental van project during this grant period ** @ 2 days /wk from grant beginning date of 7/1/2010 to 12/31/2010 (last date of data capture), = 366 adult patients; 750 estimated for total grant year ending 6/30/2011. Program Expenditures: no County grant funds were used for the dental van project during this grant period ** salary is higher than estimate for 2011 -2012 because a visiting mainland dentist was available for a few weeks during the year and an oral health educator was paid for under the van budget * * * see Attachment A for estimate details Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual* FY 2010 -11 Budget ** FY 2011 -12 Estimate * ** Salaries and Wages 0 $125,087 $107,214 Professional Fees 0 $865 $800 Operations 0 $26,108 $33,030 Equipment & Supplies 0 $9,059 $6,500 Other 0 $ 1,200 $1,200 TOTAL 0 $162,319 $148,744 no County grant funds were used for the dental van project during this grant period ** salary is higher than estimate for 2011 -2012 because a visiting mainland dentist was available for a few weeks during the year and an oral health educator was paid for under the van budget * * * see Attachment A for estimate details Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual* FY 2010 -11 Budget FY 2011 -12 Estimate*** Patient Generated (self- pay[uninsured], Medicaid) 0 $101,559 $83,744 George P & Ida Tenney Castle Trust 0 $50,000 $55,000 County of HI 0 $10,000 $10,000 WHCHC Operating Funds $760 ** -- TOTAL 0 $162,319 $148,744 * not applicable for this new program * * any shortfall in funding sources will be absorbed by WHCHC * * * see Attachment A for estimate details Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? In 2011 and beyond, WHCHC will seek funding from a variety of additional sources, both public and private, in order to continue meeting the community's emergency adult dental health needs as the $55,000 from George P & Ida Tenney Castle Trust (a 3 year grant) will end on 12/31/2011. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 3 ATTACHMENT A 1/20/2011 Adult Emergency Dental Services (at the Dental Mobile Van) FY 2011 -12 — Operations Budget Detail EXPENSES: Salaries and Wages Dentist (.40FTE) $ 52,000 Dental Assistant/Van Ops Coordinator ( .50FTE) $ 17,160 Receptionist /Assistant (.50FTE) $ 16,952 Finance related personnel (.05FTE) 1,768 Subtotal: $ 87,880 Fringe @ 22% $ 19,334 TOTAL $107,214 Professional Fees $ 800 (licensing & other associated fees) Operations Utilities $ 3,000 Telephone /Internet /Support ($335/mo) $ 4,020 Van fuel /repair /maintenance $ 2,500 Dental equipment repair /maintenance $ 1,000 Van insurance ($250 /mo) $ 3,000 Interisland air travel (Oahu dentist @ 1 RT /wk for 52 wks @ $150 /wk) $ 7,800 Hotel /car /gas /parking (Oahu dentist approx @ $ 11,410 $219.50/wk) TOTAL $ 32,730 Equipment & Supplies Dental supplies (based on 2010 actual of $7.50 /patient) $ 6,000 Office supplies 500 TOTAL $ 6,500 Other Staff interisland travel (conferences & meetings) $ 1,200 On- island mileage (600 mi x $.50) $ 300 TOTAL $ 1,500 TOTAL $148,744 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 4 West Hawaii Community Health Center Adult Emergency Dental Services I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Elizabe Schick, Board President . Ridhard Taaffd, Eedutiv irector ( / 1 it Date Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Lfk'j West Hawaii Mediation Center Mediation Services West Hawaii Mediation Center Mediation Services Agency Director: Contact Person: Mailing Address: Facility /Site Address: Fax No.: Email Address: Name of Accountant/CPA: Phone No.: Mailing Address: Janie Chandler - Edmondson Phone No.: 885 -5525 Janie Chandler- Edmondson Phone No.: 885 -5525 PO Box 7020, Kamuela, HI 96743 65 -1279 Kawaihae Rd., Ste. 213, Kamuela, HI 96743 887 -0525 ED @WHMediationCenter.org John Carbonaro Carbonaro CPA's 808 - 242 -5002 1885 Main Street, Suite 408, Wailuku, HI 96793 Amount of Request for County Funds: Prior Year(s) Funding: 08 -09 10,000.00 09 -10 10 -11 15,000.00 10,000.00 $13,000.00 Agency Mission Statement: West Hawaii Mediation Center exists to improve the way people deal with conflict by providing mediation, facilitation, conflict resolution education and training services. Program Description: The funds are requested to support West Hawaii Mediation Center (WHMC) which serves the districts of Hamakua, North & South Kohala, North & South Kona, and Ka'u. WHMC provides community -based mediation for both self- referred and courttlegal system referred clients. These services are provided in an accessible and affordable manner to ensure any and all disputes in West Hawaii can be resolved in a safe, fair and appropriate way without the expense (time and money) of litigation. WHMC also provides conflict resolution education and training to adults, and to youth through peer mediation. WHMC utilizes trained community volunteers to deliver this vital service to their fellow community members. Total Budget and Position Count Total Pro ram Budget 107,000.00 Total Program Position Count 1.50 Total Agency Budget 108,100.00 Total Agency Position Count 1.75 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 West Hawaii Mediation Center Mediation Services Program Objectives: 1) Provide information and referral services to individuals who need services instead of, or in addition to, the mediation services offered at WHMC. 2) Recruit, train and retain high quality volunteer community mediators. 3) Provide continuing education opportunities for volunteer mediators as well as specialty trainings, i.e., condominium, special education, civil rights, and domestic mediation. 4) Provide mediation services in an affordable and accessible manner for disputes arising both in and out of the courttlegal system. 5) Offer mediation services for a wide array of dispute issues including neighbor - neighbor, divorce (property division, finances, parenting plans), landlord- tenant, consumer - merchant, real estate, small claims, condominium, civil rights, special education, victim - offender, and community issues. 6) Provide adequate case management services to adequately serve all referred cases. 7) Provide community outreach and education around constructive conflict resolution practices for adults. 8) Educate youth in peaceful conflict resolution skills and provide peer mediation. Program Highlights: 1) Delivered 1760 hours of case intake services. 2) Served 348 cases (72% county courYlegal system referred; 28% self - referred) with 772 clients served. 3) Served an increase of 36 %iln domestic and 14% small debt cases. 4) Utilized volunteer mediators in mediation sessions for a total of 699 hours of mediation (an 8% increase from prior fiscal year.). 5) Reached full agreement in 62% of cases mediated. 6) 207 mediation sessions held. 7) Achieved a 94% service satisfaction rating by respondents (post- mediation satisfaction survey). 8) Achieved a 98% rating by respondents indicating that they would recommend mediation to others in the future. 9) Provided 48% of total services to low income clients (annual income under $20,625). 10) Provided conflict resolution education and peer mediation training to over 500 elementary students in West Hawaii and at community events. (Learning Disabilities Association, Kona Family Fun Day, Waimea Keiki Fest) n...t......�..ne ■Ae�curnc• NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 FY 2009 -10 Actual* FY 2010 -11 Budget* FY 2011 -12 Estimate* Case Mana ement Hours 1760 1760 1760 Mediation Cases Served 348 358 368 Mediation Sessions Conducted 207 215 220 Agreements reached in mediation 62 63% 65% Clients satisfied with service 94% 94% 95% Clients willing to recommend service to 96% 95% 95% others Skills enhancement trainings offered for 8 8 8 volunteers Affordable or free service to low income 48% 50% 52% of clients considered low income Conflict Resolution Education events for 5 6 6 adults and youth. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 West Hawaii Mediation Center Mediation Services Program Expenditures: * If Applicable #Please explain in detail on separate sheet Program Funding Sources: Revenue Source FY 20009 -10 Actual* FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 74,000.00 74,000.00 74,000.00 Professional Fees 500.00 500.00 500.00 Operations 29,500.00 32,000.00 32,000.00 Equipment 300.00 500.00 Other" Total 104,000.00 106,800.00 107,000.00 * If Applicable #Please explain in detail on separate sheet Program Funding Sources: Revenue Source FY 2009 -10 Actual * FY 2010 4 1 Budget * FY 2011 -12 Estimate — County of Hawaii 15,000.00 10,000.00 13,000.00 State of Hawaii 39,138.00 39,100.00 39,100.00 Hawaii Justice Foundation 6,500.00 5,000.00 4,250.00 Hawaii Island United Way 11,850.00 12,000.00 12,000.00 Private Foundations/Partnerships 10,000.00 16,000.00 13,750.00 Donations 6,944.00 6,000.00 6,000.00 Fundraising 6,277.00 10,000.00 10,000.00 Service/Program Fees 1,231.00 8,670.00 1,700.00 8,300.00 1,700.00 8,300.00 Client Private fees Total 105,610.00 108,100.00 108,100.00 If applicable Future Program Support: 1. West Hawaii Mediation Center completed its first Online Auction fundraiser in 2010. WHMC will also provide a guided tour fundraiser. We are planning our next online auction for 2011. In addition to the auction we will continue with our annual Sponsors and Supporters Campaign. This year's Sponsors and Supporters Campaign will be completed in June 2011. 2. West Hawaii Mediation Center continues to receive and seek support from the United Way and other private agencies. 6 new grant proposals have been submitted this fiscal year. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall Include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year- end report will impact the evaluation of your program's or agency's future funding requests. 6 J na4�ure of Board PresidentlChair Date S nature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 411 YARH - Youth At Risk Hawaii Jump, Kick, Aerial Program YARH - Youth At Risk Hawaii - Agency Name Jump, Kick, Aerial- Program Name Agency Director: Contact Person: 4975 Mailing Address: Facility /Site Address: Fax No.: Annlee Post Deann Canuteson Phone No.: 936- POB 1881 Kealakekua, HI 96750 79 -7393 Mamalahoa Highway, #10 Kealakekua, HI 96750 Email Address: whenthen @gmail.com Name of Accountant/CPA (include name of firm if applicable): Our Board of Directors Treasurer, Wally Gallup, Attny is responsible for our bookkeeping at this time. Phone No.: 329 -5014 Mailing Address: 75 -5595 Palani Rd, #307, Kailua -Kona, HI 96740 Amount of Request for County Funds: Prior Year(s) Funding: 08 -09 09 -10 $0 $0 $0 Phone No.: 960 -6464 $15414 10 -11 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Agency Mission Statement: Using physical activity and recreation to facilitate the development of children and youth to significantly influence behavior patterns to prevent or reduce risk. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 YARH - Youth At Risk Hawaii - Agency Name Jump, Kick, Aerial - Program Name Program Description: Mauka Motions' "Jump Kick Aerial" Program provides an opportunity for typically developing English speaking children to be integrated into our afterschool activities and to serve as role models for our children with special needs, or English Language Learners. This program targets Marshallese children as well as children with special needs. The program started as a result of numerous children being at the physical location of Mauka Motion in Kainaliu. The have a church in the same building. These children were basically left afterschool with no formal activities and were not integrating into general children's afterschool activities because they do not speak the language and /or they had special needs. Two volunteers began providing tutoring and organized afterschool activities. What started as a small volunteer program has currently grown to up to 27 children in organized afterschool activities. They have structure, get their homework done (required prior to participating in activities), and using the peer model, are learning English language skills and are becoming integrated into other community activities. Peer model students provide positive peer interactions, demonstrate play skills, and model appropriate language and behavior for children with special and /or language needs while in the classroom setting. A peer model student demonstrates age- appropriate skills in the areas of play, social, behavior, speech, language and motor. A basic principle of human development suggests that any child with a disability who demonstrates a higher level of physical skill development generally has more opportunities to socially interact and learn from their peers through physical activity. The child with adequate physical skills will have a much higher likelihood of being invited to play with their peers resulting in a more active, happier child. Given this principle, motor skill development will always be addressed in our program activities and monitored regularly for progress. Observations will be used to monitor progress. Monday through Friday, there are 2 -4 structured hours planned with adult supervision. Homework tutoring is completed first. In order to participate in activities, school work must be completed. Activities include: participating in basketball practice and games (their team was asked to be in the Parks and Recreation Tournaments in Hilo this year), kenpo karate (provided on -site by our sensei), judo (integrated into a community class), dance (breakdancing with a volunteer dance instructor at KPAC), tumbling (provided at our site by a volunteer) and ocean activities. Each activity is a NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 structured learning class. Performance objectives are set for each different activity. Some are formally documented and some are monitored by observation of skill building. One of the program objectives is to integrate special needs or English Language Learners (Marshallese children) into already existing community childrens activities. This has allowed the children to participate and become accepted by other children. An example of this is their participation in a theater group which performed "Jungle Book" at the Lead Center. Not only the children in the play learned their parts, but other children at home learned the words from the participating children practicing at home. The lead volunteer is in communication with the schools. Communication is essential in order for the volunteers to provide immediate support when a child begins to have difficulties. Everyone is motivated to assure that all children get to participate in the activities. They work together to bring the child back to a successful level. The volunteers are willing to continue to provide the supports voluntarily. However, because of the numbers of children in need, financial support is necessary. We have built the budget to allow for two part time (16 hours per week and 18 hours per week) volunteers. Mauka Motion will provide the physical location for the activities they provide directly. The volunteers will provide physical supervision of the children at community activities as well. Mauka Motion will also pay their mileage at the federal reimbursement level and pay for all supplies, healthy snacks and equipment that is required. Total Budget and Position Count Total Program Budget 0 Total Program Position Count 2 half time Total Agency Budget 0 Total Agency Position Count 2 half time Program Objectives: 1) The overall goal of the program is to provide the language and physical skills necessary for special needs and /or English Language Learner children (ages 5 -14) to fully integrate into the general children's community. 2) Family Satisfaction - a satisfaction survey will be completed at the beginning, at six months and at the end of the year to determine if we met the families expectations and give them the opportunity to tell us what is important to them. 3) All children will express their satisfaction with the program and will provide input into new activities or changes to program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 4) All children will maintain or improve grade /marks level while enrolled in the program. 5) Each child will participate in one activity /event in which they are integrated into a community activity. 6) Non English Speaking children will improve their language skills. 7) Reduce propensity for obesity in all children involved by increasing physical activity. Program Highlights: (from Fiscal Year 2009 -10) 1) What began as a small volunteer support for just a few children, has formed into a viable, accomplished program which supports special needs and Marshallese children to be integrated into our community. 2) As a result of this program last year, their basketball team has been invited to participate in the Parks and Recreation tournament in Hilo. 3) Children participated in the Theater group, and performed Junglebook for their peers and community at the Lead Center. 4) Community collaboration results - other individuals and groups have stepped up to collaborate on activities; asking our children to participate in integrated community children's groups. (i.e., dance, theater, sporting events, etc. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 YARH - Youth At Risk Hawaii - Agency Name Jump, Kick, Aerial - Program Name Performance Measures: *If applicable Program Expenditures FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Parent Satisfaction Survey 85% Child Satisfaction Survey 85% Participate in Integrated Community Events 75% Parenting Information 50 families Challenging Behavior Support 35 families Increased physical fitness 85% Maintain or Improve Grades /Marks 85% *If applicable Program Expenditures * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages 0 Professional Fees 250 Operations 13944 Equipment 3600 Other" 8300 Total 26094 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 YARH - Agency Name Jump, Kick, Aerial - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate County of Hawaii 15,414 Donated scholarships (6 @ 780) 4680 Monthly fees paid by parents (6 @ 780) 4680 Sliding scale fee paid by parents (11 children at estimate of $10 per month per child 1320 Fees are $65 per child per month Total 26094 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? This is a new "formal" program for YARN. YARH has been providing this program informally out of necessity. It has expanded so rapidly and is filling such a need, that we have determined it is time to formalize it into a regular component of our programs. The people for whom the program is provided are welfare recipients and most do not have the resources to pay full price for necessary services. The children would go without these supports and opportunities if we discontinue the service. We are in the process of setting up a scholarship fund in which we are seeking sponsors for children in need. Sponsors would pay a monthly or annual fee to allow one or more children to participate in the program. We are also in the process of evaluating our fee schedule and incorporating a sliding scale fee schedule to allow everyone attending to pay something. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 We will be seeking other foundation support as well as state and federal grant possibilities. Because we are in the beginning phases of making this a formal program within YARH, we cannot anticipate a time frame for sustainabilty. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 YARH - Youth At Risk Hawaii Jump, Kick, Aerial (Afterschool Program) Budget Narrative: Salaries and Wages: 34 hours of supervision time is volunteer. We are not requesting money to cover employees. We are asking for the operational money necessary to keep this program going. Professional Fees: paying a CPA to review our financials at the end of the project ($250). Operation : rent on the building (4800 annually); utilities (4800 annually); intcrnet connection for homework ($744 annually); healthy snacks/water, cups, napkins /wipes, copies /documentation supplies ($3600 annually) (13,944 annually) Equipment — Sporting equipment necessary to participate in organized games (basketballs, ghi, mats, costumes, etc.) Mauka Motion owns sporting equipment now, and will only purchase what is needed). There are instances when a child does not have the correct shoes or protections. if this is preventing them from participating, we sometimes will work with the family to purchase shoes, etc. for an individual, however, the purchased items must be kept at Mauka Motion in a locker. ($3600 annually) Other: Liability Insurance $500 Mileage at .50 per mile — 60 miles per day for 5 days per week for 52 weeks ($7800 annually) YARH - Agency Name Jump, Kick, Aerial - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. —41 Signature of Soard President /Chair 481gnature of Executive Director �s Da e Z Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 91 YWCA of Hawaii Island Healthy Start Plus YWCA of Hawai'i Island- Agency Name Healthy Start Plus- Program Name Agency Director: Jeanine Atebara, Chief Executive Officer Phone No.: (808) 935 -6067 ext. 102 Contact Person: Andrew A. Kahili, Communtiy Relations Events Officer Phone No.: (808) 961 -3877 ext. 127 Mailing Address: 145 Ululani Street Hilo, Hawaii 96720 Facility /Site Address: 1382 Kilauea Avenue Hilo, Hawaii 96720 Fax No.: (808) 961 -9140 Email Address: jatebara @ywcahawaiiisland.org or akahili @ywcahawaiiisland.org Name of Accountant/CPA (include name of firm if applicable): Carbonero and Associates Phone No.: (808) 242 -5002 Mailing Address: 1885 Main Street, Suite 408, Wailuku, Hawaii 96793 Amount of Request for County Funds: $75,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $0 $125,000 $75,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 YWCA of Hawaii Island- Agency Name Healthy Start Plus- Program Name Agency Mission Statement: Our Mission: YWCA Hawai'i Island is dedicated to eliminating racism, empowering women, and promoting peace, justice, freedom and dignity for all. The YWCA Hawai'i Island is dedicated to providing services to meet our Hawai'i Island community needs, drawing together people with diverse experiences and relationships so that we may join together in implementing the YWCA's mission. We work to maintain the National YWCA's goals and objectives, but our primary function is to fulfill our local community's needs. The YWCA Hawai'i Island first organized in Hilo in 1919 when a group of courageous women recognized the need for a women's organization and for programs geared primarily towards women and girls. From a very humble beginning with 14 women housed in a small cottage, the YWCA has expanded from the original residence in both activities and facilities. Throughout our history, the YWCA Hawai'i Island has offered valuable programs and activities for the benefit of women, children and their families. The YWCA Hawai'i Island was established as a 501(c)(3) non - profit organization in 1965 and has been a partner agency of the Hawai'i Island United Way (HIUW) since 1979. It belongs to a national organization consisting of 300 YWCA Associations across the U.S. with 2.6 million members. Employing over 70 full -time and part -time staff, the YWCA offers a variety of services to people of all ages, from newborns to senior citizens in their 90's. throughout the island of Hawai'i. In 2009, the YWCA Hawai'i Island touched the lives of close to 8000 people, almost 5 pecent of the island's population. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 YWCA of Hawai'i Island - Agency Name Healthy Start Plus- Program Name Program Description: The YWCA Hawai'i Island Healthy Start Plus ( "YWCA HSP ") is part of the Hawaii State Department of Health, Hawai'i Healthy Start Program and the State Department of Human Services, Hawai'i Enhanced Healthy Start Program. The YWCA HSP is a voluntary home visiting program that supports families and promotes positive child relationships. Families of infants and children under the age of three (3) years may enter the program. Our home visiting program utilizes a multi - disciplinary team approach and provides culturally appropriate support services within the family's natural environment and primarily focuses on the reduction of parental /environmental stressors, which are directly related to child maltreatment. Children identified as "at risk" are those who may be living at or below poverty levels, lacking basic needs such as food, shelter, clothing, medical and transportation. Children identified as "at risk" may be living in family crisis situations such as domestic violence, mental health issues, possible child abuse or neglect. These children are at increased risk for sub - optimal health, developmental delay and maltreatment. Current research indicates that this problem is a serious threat to the lives of these children and will have a tremendous impact on East Hawaii's community in the future. The YWCA's HSP home visiting program addresses this growing problem by assisting families to learn ways to reduce or eliminate these high -risk factors or stressors within their family environment. The HSP home visiting program addresses the problem by providing culturally appropriate support services to families in their natural home environment. This program is voluntary and available to families who accept the services until their child reaches three years of age. The home visiting program utilizes 8 Home Visitors who are paraprofessionals and works with a team of professionals consisting of a Clinical Manager /Supervisor, Clinical /Intervention Specialist, Child Development Specialist and Registered Professional Nurse. Home visiting services include screenings /assessments for possible delays and referrals for early intervention services. In addition, the program provides child development and parenting information, problem solving skills, and links families with appropriate community resources. The program also identifies families in need of services to address substance abuse, mental health issues and domestic violence. YWCA HSP provides safety net services to HawaiTs most vulnerable families and infants. As part of the State of Hawai'i Blueprint for Change plan, UH economist David McClain conducted a cost benefit study on Healthy Start which showed a 3:1 positive cost benefit ratio. Nationally, prevention and early intervention programs have shown 7:1 cost benefit ratios. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 YWCA of Hawai'i Island - Agency Name Healthy Start Plus- Program Name According to economist James Heckman (NYT op -ed, 7- 29 -08) "Big gaps in potential for educational attainment are present at age 5. Some children are bathed in an atmosphere that promotes human capital and increasingly more or not. By age five, it is depressingly possible to predict who will finish school and college and who will not" This has a real impact on development of human capital and the overall economy. The YWCA Hawai'i Island operates the only home visiting program of its kind in East Hawai'i. In fiscal year 2009 — 2010 the program served 211 families who reside in the Volcano, Mountain View, Kurtis Town, Keaau, Orchidland, Pahoa, Leilani Estates, Opihikao, Kalapana, Pohiki, Kapoho, Naleiwale, Hawaiian Beaches, Hawaiian Paradise Park, Panaewa, South and North Hilo, Honomu, Laupahoehoe, O'okala, Paauilo, Honokaa, and Kukuihaele communities. The funding that we are asking from the County of Hawaii in this proposal, together with other funding sources that we are pursuing, will allow our YWCA Healthy Start Plus Program to provide services to East Hawaii families for fiscal year 2011 -2012 at the same levels that we were able to provide in 2009 -2010 (approximately 211 families). The Healthy Start Program is the only one of its kind in East Hawaii. We feel this program is vital and necessary to reach needy families in rural and remote areas of East Hawaii. We will continue to seek funding for the continuation of this important preventive home visiting program that addresses East Hawaii's children at risk for child abuse and neglect. Total Budget and Position Count Total Prog ram Budget 1,131,712 Total Program Position Count j Total Agency Position Count 18 j 65 j Total Agency Budget 3,525,500 Program Objectives: 1) Identify family's risk factors. 2) Develop a Family Support Plan (FSP) to address identified risk factors. 3) Utilize a cohesive team approach in providing services. The home visiting team members work with the family to develop outcomes, and break those outcomes into meaningful strategies to ensure success. 4) Monitor and review family's progress in completing their objectives /strategies. In order to support the growth in the family, the home visiting team members and NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 YWCA of Hawai'i Island - Agency Name Healthy Start Plus- Program Name the family review the family's progress in completing their objectives /strategies toward the overall achievement of their outcomes. 5) Deliver home visitation services. Home visits are conducted in the family's natural environment by the home visiting team members, in accordance with the FSP, in a seamless, cohesive manner where all disciplines involved communicate with one another regarding their relationship to the family. 6) Ensure care coordination services are provided to families. The care coordinator is responsible to ensure that services delivered by appropriate staff and agencies are coordinated and delivered in timely manner, including assess and monitor families identified with issues of family violence, substance abuse and mental health. 7) Assess and monitor children identified with developmental status and health care needs. 8) Promote positive child health development. 9) Promote positive parent child interaction. 10) Promote a health and safe home environment. Program Highlights: (from Fiscal Year 2009 -10) YWCA Healthy Start Plus Information Summary: 1) 95% of children enrolled in the program had an established medical home. Families were able to identify and secure a primary medical doctor to attend to medical related concerns versus drop -in visits to the emergency room for urgent care. 2) 90% of children who turned 2 years of age during enrollment were fully immunized. This is in compliance with the recommended immunization schedule as per the Centers for Disease Control. 3) 100% of enrolled mothers with a subsequent pregnancy received early prenatal care within the first trimester. 4) 91 % of enrolled families who are eligiable for the Women's Infant Children supplement program were refferred and enrolled in the WIC program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 YWCA of Hawai'i Island - Agency Name Healthy Start Plus- Program Name 5) 98% if children enrolled in the program did not have a confirmed report of Child Abuse and Neglect. 6) 95% of families enrolled in the program received and accepted family planning information presented by program staff. 7) 100% of children screened who are identified with a suspected developmental delay for communication, gross motor, fine motor, problem solving and personal social skills were referred to the State of Hawaii, Early Intervention Services for further review and assessment. Performance Measures: *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget * Estimate Percentage of enrolled children with 100% 100% 98% no confirmed child abuse and /or neglect report Percentage of enrolled children with 90% 88% 88% a completed FSP within 60 days Percentage of enrolled children with 96% 95% 96% an identified medical home Percentage of enrolled children with 100% 100% 100% a suspected developmental delay who were referred to an agency who provides early intervention services _ Percentage of enrolled children fully 80% 77% 82% immunized by age 2 years. Percentage of enrolled families who 95% 95% 95% after 12 months of service received and accepted family plannin *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 YWCA of Hawai'i Island- Agency Name Healthy Start Plus- Program Name Program Expenditures * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate Salaries and Wages $667,903.37 $845,040 $757,119 Professional Fees $ 10,228.12 $12,379 $178,673 Operations $281,051.68 $286,752 $185,920 Equipment $ 2,810.29 $24,999 $10,000 Other" $2,460 0 Total $961,993.46 $1,144,171 $1,131,712 * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate State of Hawaii, Dept of Health $642,579 $670,000 $670,000 State of Hawaii, Dept of Human Services $343,348 $371,712 $371,712 County of Hawaii $125,000 $75,000 $75,000 Office of Hawaiian Affairs $24,999 0 HEI Charitable Foundation $2,460 0 Hawaii Community Foundation 0 $5,000 Akaka Falls Lions Club (Weinberg Foundation) $700.00 0 $10,000 r Donations - Interest $507.00 Miscl. $206.00 Total $1,112,340 $1,144,171 $1,131,712 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 YWCA of Hawai'i Island- Agency Nam Healthy Start Plus- Program Name Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Healthy Start Program has been funded by the State of Hawaii, Department of Health, Maternal Child Health Branch (DOH -MCHB) since 1989 and the Enhanced Healthy Start Program has been funded by the State of Hawaii, Department of Human Services since 2005. In fiscal year 2009 and in 2010 the program was awarded a grant from the County of Hawaii, which has supported the program's ability to continue to provide home visitation services to families who reside in the East Hawaii areas of the Big Island. Given the current economic times and the reduction in funding resources the program must seek out various funding streams in order to maintain the current status of services. In addition to the funding sources listed above, the program will be submitting proposals requesting funding from organizations such as the Hawaii Community Foundation and other Trust and Foundations that support children and youth, and family strengthening. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 YWCA of Hawai'i Island - Agency Name Healthy Start Plus - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Boa T Presi ent /Chair Signature of Executive Director Date 1-31 --1J Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 92 YWCA of Hawaii Island Sexual Assault Support Services YWCA of Hawaii Island- Agency Name Sexual Assault Support Services (SASS)- Program Name Agency Director: Jeanine Atebara, Chief Executive Officer Phone No.: (808) 935 -6067 ext 102 Contact Person: Lorraine Davis, Chief Operating Officer Phone No.: (808) 961 -3877 ext 162 Mailing Address: 145 Ululani Street Hilo, Hawaii 96720 Facility /Site Address: 1382 Kilauea Ave., Hilo, HI 96720 75 -5706 Hanama Place, #202, Kailua Kona, HI 96740 Fax No.: (808) 934 -7179 Email Address: jatebara @ywcahawaiiisland.org or Idavis @ywcahawaiiisland.org Name of Accountant/CPA (include name of firm if applicable): Carbonero and Associates Phone No.: Mailing Address: (808) 968 -1002 P.O. Sox 4372, Hilo, HI 96720 Amount of Request for County Funds: $60,000 Prior Year(s) Funding: 08 -09 09 -10 10 -11 $20,000 $20,000 $15,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 1 Agency Mission Statement: YWCA Hawaii Island is dedicated to eliminating racism, empowering women, and promoting peace, justice, freedom and dignity for all. The YWCA Hawai'i Island, first organized in Hilo in 1919, has offered valuable programs and activities for the benefit of women, children and their families. The YWCA Hawai'i Island was established as a 501(c)(3) non - profit organization in 1965 and has been a partner agency of the Hawai'i Island United Way (HIUW) since 1979. It belongs to a national organization consisting of 300 YWCA Associations across the U.S. with 2.6 million members. Employing over 70 full -time and part-time staff, the YWCA offers a variety of services to people of all ages, from newborns to senior citizens in their 80's. throughout the island of Hawai'i. YWCA Hawai'i Island programs include: • Healthy Start, the only home visitation family support program for all East Hawai'i new mothers and babies who are at risk for abuse; • Teen Court, available island -wide and the only way for teens and `tweens to make up for their first -time offense, give back to the community and wipe their record clean. • Sexual Assault Support Services, the only 24/7 rape crisis center of its kind for all of Hawai'i Island. • An aquatics center that offers the warmest, solar heated salt water and therapeutic pools in East Hawai'i. A preschool that promotes kindergarten readiness by providing care at one of the only nationally accredited preschools on the island. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 2 YWCA of Hawaii Island - Agency Name Sexual Assault Support Services (SASS)- Program Name Program Description: The program's mission is to provide services for the healing and prevention of sexual violence. Sexual violence is a hard topic to talk about and it is on our island. Our victims have been as young as 6 months old and as old as 95 years. Sexual violence is an equal opportunity crime that crosses the boundaries of age, race, religion and gender equally. Sexual violence is pervasive. Sexual violence is crippling to the victim. Victims of sexual violence want to keep their experience a secret. To let you know how pervasive this crime is, imagine yourself seated in a crowded movie theater here on the island. Based on national and local statistics, at least 2 people in every row either has been or will be a victim of sexual violence. If you attend a high school graduation in Hilo, Kona, Honolulu or Phoenix, chances are 1 in 4 girls and 1 in 6 boys will have been a victim of sexual violence already. The impact of sexual violence to a person manifests itself in many different ways and during various times in the victim's life. Studies show that sexual violence left untreated will cost more to the public than the treatment of chronic diseases like diabetes or life- threatening diseases like cancer, with respect to lost wages, mental and emotional issues, and alcohol and substance abuse. In the economic depression that the County of Hawaii has been experiencing, with an increase in financial stress and unemployement, alcohol and substance abuse increases as does sexual and domestic violence. While our funding sources are reducing their assistance to support the services to victims, the demand for the same services has increased. The Sexual Assault Support Services (SASS) works to reduce the incidence of sexual assault and disability to those who have been victimized. Services include the only 24/7 sexual assault crisis line on the island which includes crisis response and stabilization and opportunities to enter into the SASS program for a variety of services. The advocates who answer the crisis line also accompany a victim to the hospital for a forensic exam and, in the case of a minor, will meet the family at the Children's Justice Center to stay with the family during a forensic interview. The SASS program also offers clinical services which includes counseling for the victim and immediate family. The clinician will also accompany the victim and family to court to help prevent retraumatizing the victim and family during court proceedings. The third component of the program is to provide prevention education presentations and activities to our island youth from preschool through college. The prevention educator follows age NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 3 appropriate curriculum surrounding body boundaries, good touch vs. bad touch, healthy relationships and safe dating to island children. The SASS program also provides professional training to adults on how to look for signs of sexual assault, what to do when a child discloses and the effects of sexual assault on a person. All services are provided at no charge to the client or family. The Sexual Assault Support Services program functions as team members with the Hawaii County Sexual Assault Response Team (SART). Both Advocates and therapists work with SART team members in providing quality services to clients. SART team members include police investigators, sex assault nurse examiners (SANE), prosecutors and Child Welfare Services. The YWCA is in our third decade of helping sex assault survivors, who are men, women, girls and boys. Primary funding of the program is through State of Hawaii, Office of the Attorney General through a subcontract with the Kapiolani Women's and Children's Medical Center Sex Abuse Treatment Center. As a result, quality assurance, program and fiscal monitoring of services are maintained at standards. The demand for sexual assault support servcies has increased in recent years. In 2008, our crisis line took 428 calls. In 2009, our crisis line took 907 calls. In 2010, our crisis line took 755 calls. In 2008, our therapists provided counseling to 138 clients. In 2009, our therapists provided counseling to 236 clients. In 2010, our therapists provided counseling to 309 clients. The SASS program experienced budgetary cuts duing the economic downturn beginning in 2008. The budgetary cuts could have resulted in the reduction of services as the demand for services increased. However, because we applied for and received Federal Appropriations and VOCA ARRA funds, the program was able to continue full service and meet the increasing needs of the community. We did not have to turn a single client away. However, both the Federal Appropriations and the VOCA ARRA funds were one -time appropriations and the program is now faced with the possibility of having to reduce our services. The funding requested in this proposal is to provide assistance in continuing to meet the demands of the community rather than reduce the services that are needed to support victims. Total Budget and Position Count Total Program Budget 523,083 Total Program Position Count 13 Total Agency Budget 3,525,500 Total Agency Position Count 65 NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 4 Program Objectives: 1) Continue to operate the 24 -hour, 7 day a week Sexual Assault Crisis Hotline receiving calls island -wide from persons seeking support, information, and referral that may lead to face to face support as described in the next objective. 2) Provide a Sexual Assault Support Services program Advocate to support each sex assault victim undergoing forensic and legal examination in the period July 1, 2010 through June 30, 2011. 3) Deliver professional counseling and /or case management services to at least 100 sex assault survivors. 4) Attend and participate in monthly case tracking and interagency team coordination meetings of the East and West Hawai'i Children's Justice Centers throughout the fiscal year. 5) Provide sexual assault awareness and prevention education to: 1000 school aged students, provide education to at least 35 professionals about sexual assault and the needs of child /adult survivors of sexual assault and methods to detect and report sexual child abuse or abuse of dependant adults. Provide sexual assault awareness and prevention education to: 1000 school aged students, provide education to at least 35 professionals about sexual assault and the needs of child /adult survivors of sexual assault and methods to detect and report sexual child abuse or abuse of dependant adults. Program Highlights: (from Fiscal Year 2009 -10) 1) The most notable outcome of the year was that the program was able to maintain services for victims while sister agencies were having to reduce services. For example, the crisis hotline in Maui was only manned Monday- Friday during regular business hours while we were able to provide 24/7 coverage 365 days of the year. 2) In March 2010, the SASS program added a 0.5FTE therapist to meet the increasing demand for counseling in West Hawaii. In July 2010, due to increasing demand, the program secured funding to increase the position to 0.75FTE and at the time of this proposal submittal, the program could justify an increase from 0.75FTE to full -time. 3) In July 2010, the SASS program added victims counseling services to Naalehu, meeting a need in a communtiy where transportation is an issue. 4) In March, 2010, the SASS program (with support from the Office of the Prosecuting Attorney, Department of Health, and West Hawaii Friends of the Children's Justice Center) presented "Can I Kiss You ? ", a presentation NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 5 by Mike Domritz of Safe Date Project.org. Mr. Domritz spoke at schools in Hilo, Pahoa, Keaau, and Kona about safe dating. Over 2500 students heard his message. Mr. Domritz took a violent message and was able to connect and communicate the seriousness about respecting one another in relationships and coaching over 2500 students about intervening when they see inappropriate relationship behavior happening. 5) In October 2010, the YWCA of Hawaii Island sponsored it's second annual Walk a Mile in Her Shoes event. Walk a Mile in Her Shoes is an international men's march to stop rape, sexual assualt and gender violence. This event brings men together to show their support for and to become a part of the solution to ending sexualized violence. Mayer Billy Kenoi, Police Chief Harry Kubojiri, Fire Chief Daryl Oliveria and Prosecuting Attorney Jay Kimura led the walk with over 200 men participating. 6) In November 2010, the SASS program co- sponsored a training event with the office of the Prosecuting Attorney called Men Can Stop Rape. Men from the community were trained on how to offer assistance in preventing rape. 7) In November 2010, the SASS program sponsored the showing of "Girl with a Dragon Tattoo" (a New York Times bestseller made into a movie) at the Aloha Theater on the West Side of the Island. Over 100 attendees were educated about the effects of violence and rape on a person. 8) Members of the Sexual Assault Support Services staff and YWCA administrators participate in Children's Justice Center Interagency Advisory Committee (IAC), the Hawai'i Coalition Against Sexual Assault (HCASA), The Big Island Coalition Against Physical and Sexual Assault (BICAPSA) and Family Violence Interagency Committee (FVIC), and Sexual Violence Prevention Planning (SVPP) meetings. These committees or coalitions include the involvement by staff from the following agencies: the Hawai'i County Police Department, Hawai'i County Office of the Prosecting Attorney, Child Welfare Services, Department of the Attorney General, Family Court, Probation, Department of Health, Department of Education and statewide service providers_ The efforts foster consistent care throughout the County and State for sex assault services and working together as agencies to provide the best practives of care for victims and their families. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 6 YWCA of Hawaii Island - Agency Name Sexual Assault Support Services - Program Name Performance Measures: NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actual * Budget * Estimate Fully trained personnel are 907 calls 750 800 available to assess and respond to (anticipated) callers on the Sexual Assault Crisis 371 calls Phone Line. Crisis line available 24 were taken hours a day 7 days a week, 365 from 7 -1- days a year.. 2010 to 12- 31 -2010 Crisis counseling, legal systems 192 250 250 advocacy, information and referral (anticipated) are provided to each sex assault 124 victims victim undergoing medical -legal have examination in East and West received Hawai'i. 150 -200 victims will receive service service contacts contacts from 7 -1- 2010 to 12- 31 -2010 Survivors of sexual assault receive 236 250 250 psychotherapy services and (anticipated) intensive clinical case management 140 victims from masters - prepared therapists in have East and West Hawai'i. 100 victims received will receive therapeutic services. service (Victims we counsel range in ages contacts from 4 years of age to elderly. from 7 -1- From October 2010 to December 2010 to 12- 2010, all of our face to face referaa 31 -2010 were under the age of 18, except for one 29 year old adult. School aged students receive 5665 2000 2000 sexual assault prevention and (anticipated) awareness training. 2000 students 836 students will receive training and education. have had (We offer age appropriate training presentation from preschool through college age s from 7 -1- to all communities on the island.) 2010 to 12- 31 -2010 Professionals receive training in 192 200 200 awareness of the needs of adults (anticipated NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 7 and child sexual assault survivors, how to detect and report child . sexual abuse or sexual abuse of dependent adults. 100 adults will receive training. FY 2009 -10 Actual * 102 adults have received training from 7 -1 -2010 to 12 -31 -2010 FY 2011 -12 Estimate Salaries and Wages $ 258,569 383,686 385,000 Professional Fees $ 14,140 9,832 14,000 Operations $ 115,080 128,315 128,000 Equipment 1,250 1,250 Other" Total $ 387,790 523,083 528,250 *If applicable Program Expenditures If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 FY 2009 -10 Actual * FY 2010 -11 Budget* FY 2011 -12 Estimate Salaries and Wages $ 258,569 383,686 385,000 Professional Fees $ 14,140 9,832 14,000 Operations $ 115,080 128,315 128,000 Equipment 1,250 1,250 Other" Total $ 387,790 523,083 528,250 If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 8 YWCA of Hawaii Island - Agency Name Sexual Assault Support Services - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2009 -10 Actual * FY 2010 -11 Budget * FY 2011 -12 Estimate County of Hawaii $20,000.00 $15,000 $60,000 State of Hawaii $289,340.00 $299,860 $289,340 Federal Funds $53,965.00 $186,524 $100,000 Private Foundations United Way Funds Admissions Donations $1,861.00 $1,698 $1,500 Fundraising $9,755.00 $20,000 $20,000 Pay Phone Vending Machines Service/Program Fees Third Party Reimbursements $8,000.00 a. Facilities use $225.00 b. Refunds $2,207.00 Total $385,353.00 $523,082 $470,840 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The agency continues to search for grants and foundations that will support this program. In the past fiscal year, the program was able to obtain funding through Federal Appropriations, VOCA ARRA, VAWA, VOCA and through the Master Contract with Sex Abuse Treatment Center. In addition to grant writing activities, the program has hosted fund - raisers and solicited support through collaboration with partner agencies. The agency and program will continue to search for funding sources, collaborative partnerships while continuing to serve the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 9 YWCA of Hawaii Island - Agency Name Sexual Assault Support Services - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the County Council within 60 days after June 30 of the fiscal year The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board[ Presiden Chair Signature of Executive Director I _3 _1l Date 1 -31 -11 Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2011 -12 Page 10