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HomeMy WebLinkAboutCOM 0486.000 2002-2004 ~tv or W .!r~ William Takaba Harry Klm Director Mnyor ; r : Nancy E. Crawford •ri Deputy Director h Ol ~M~~ County of Hawaii Finance Department o 25 Aupuni Street, Room 118 • Hilo, Hawaii 9fi720 s (808) 961-8234 • Fax (808) 961-8248 _ C~ ~ n'• February 3, 2004 ca .v z. ; ~ ~1~, _ Honorable James Arakaki, Chairperson and p~, ; c~ C Members of the County Council z%~ cn Hawaii County Council 25 Aupuni Street Hilo, Hawaii 96720 RE: NONPROFIT ORGANIZATIONS In compliance with Chapter 2, Article 25 of the Hawaii County Code, I am submitting the qualifying applications from nonprofit organizations for your review and appropriation of funds for FY2004-05. Also enclosed is a list of the 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. 1 William Tak a Director of Finance Enc. Applications for Nonprofit Grant Funds List of Nonprofit Grant Applicants (Or. file in the Clerk's Office) Comm. No. Ref. To: S E Ref. Uate NONPROFIT GRANT APPLICANTS FOR FY2004-05 ORGANIZATION NAME PROGRAM NAME REQUESTED American Red Cross -Hawaii State Chapter Caregiving $ 7,000.00 The Arc of Hilo Person Centered Adult Supports 30,000.00 Bay Clinic, Inc. Violence Intervention Project 26,000.00 Big Island Substance Abuse Council BISAC East Hawaii Substance Abuse Council 40,000.00 Big Island Substance Abuse Council BISAC West Hawai i Substance Abuse Program 40,000.00 Boys & Girls Club of the Big Island SMART Moves 50,000.00 Brantley Center, Inc. Transportation Program 25,000.00 Bridge House, Inc. Vocational Skill Building Program 18,000.00 Center for Independent Living -East & West Hawaii Independent Living Services 20,000.00 Diabetes Network of Hawaii County Developing A Healthier Lifestyle Series 10,000.00 East Hawai i Coalition for the Homeless Kihei Pua Emergency Shelter 39,000.00 East Hawai i Coalition for the Homeless Kihei Pua Transitional Housing Program 3,500.00 Family Support Services of West Hawaii Family Centers 65,000.00 Special Needs, Enhancement, Center Support, Friends of the Children's Justice Center of East Hawaii Prevention/Education and Training Programs 15,000.00 Friends of the Children's Justice Center of West Hawaii Enhancement and Basic Need Program 15,000.00 Goodwill Industries of Hawaii, Inc. Work Experience Program 20,000.00 Hamakua Health Center Transportation 10,000.00 Hawai i County Economic Opportunity Council Transportation 145,000.00 Hawai i Island Adult Care, Inc. Hilo Adult Day Center 25,000.00 Hawai i Island HIV/AIDS Foundation Multi-Disciplinary HIV Case Management, Hilo 10,000.00 Transmission Prevention for HIV+ Women in West Hawaii Hawai i Island HIV/AIDS Foundation County 15,000.00 Helping Hands Hawaii Hilo Assertive Community Treatment (ACT) 200,000.00 The Island of Hawaii YMCA Ku'ikahi Mediation Center 10,000.00 The Island of Hawaii YMCA Youth Services 60,000.00 Ka Hale O Na Keiki, Inc. Families-At-Risk Project 6,000.00 Kapiolani Child Protection Center-Wes[ Hawaii Kapiolani Medical Center for Women & Children Title IV-B-West Hawai i Counseling & Supportive Living Project 20,000.00 Kona Adult Day Center, Inc. Adult Day 15,000.00 Kona ARC/Kona Krafts Captain Cook Domiciliary Home 17,000.00 Kona Literacy Council Kailua Learning Center 1,500.00 Mental Health Kokua Residential Rehabilitation Services 20,000.00 North Kohala Community Resource Center Kohala Community Athletic Association 5,000.00 Office for Social Ministry Care-A-Van 29,000.00 Office for Social Ministry Hawaii Island Food Bank 32,500.00 Office for Social Ministry Mobile Care Health Project 25,000.00 The Salvation Army - Family Intervention Services Ho'okala Adolescent Diversion Program -West Hawaii 29,000.00 The Salvation Army -Family Intervention Services Youth Service Center -Puna 35,000.00 Special Olympics Hawaii -East Hawaii Special Olympics Hawaii -East Hawaii 12,000.00 Special Olympics Hawaii -Wes[ Hawaii Special Olympics Hawaii -West Hawai i General Funding 10,000.00 Turning Point for Families, Inc. Alternatives to Violence -North Hawai i Waimea Groups 10,000.00 Turning Point for Families, Inc. Rural Outreach Project 5,000.00 Turning Point for Families, Inc. West Hawai i Domestic Abuse Shelter 22,000.00 West Hawaii Mediation Center Mediation Services 10,000.00 YWCA of Hawaii Island Ekahi Program (Hamakua Youth Center) 6,000.00 YWCA of Hawaii Island Sexual Assault Victim Empowerment 50,000.00 TOTAL $ 1,258,500.00 County ofHawai`i Nonprofit Organizations Grant Applications for Fiscal Year 2004-05 OJNtY OF ~~w ~dJ,,~, ;t . _ - Nwa.•' l~tf OF~NF'~ February, 2004 American Red Cross Hawaii State Chapter - AgerlCy Name caregiving -Program Name Agency Director: Coralie Chun Matayoshi, Chief Executive Officer Phone No.: 808-739-8101 Contact Person: Youline Kalima, County Executive Director Phone No.: 808-935-8305 Mailing Address: 55 Ululani Street, Hilo, HI 96720 Facility/Site Address: Site One (Above) Site Two (Kona): 74-5615 Luhia Street, #A1-B, Kailua-Kona, HI 96740-1680 Site Three (Training Center): 116 Keawe Street, Hilo, HI 96720 Fax No.: 808-969-3673 Email Address: ykalima@hawaii.rr.com Amount of Request for County funds: $7000.00 Prior Year Funding: 01-02 02-03 03-04 $5000.00 $5000.00 $5000.00 NONPROFTT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Agency Mission Statement: The mission of the American Red Cross is as follows: "The American Red Cross, a humanitarian organization led by volunteers and guided by its Congressional Charter and the Fundamental Principles of the International Red Cross Movement, will provide relief to victims of disasters and help people prevent, prepare for and respond to emergencies." Program Description: The American Red Cross Caregiving Program helps youth and adults develop the skills and knowledge to care for themselves and others. The two courses offered in the Caregiving Program under Community Education include Babysitting and Nurse Assistant Training. Certified instructors train students in specific skills needed to perform in their job as a Babysitter or Nurse Assistant. Through practice and demonstration, the students successfullly master the skills and behaviors necessary for certification as a Babysitter or Nurse Assistant. The Babysitting Course prepares youth ages 11 and up to interview for a babysitting job, choose safe and age-appropriate toys and games, perform first aid, learn diapering and feeding techniques, handle bedtime issues, and other tips for a rewarding and safe babysitting experience. The Nurse Assistant Training Course has user friendly materials designed to help the student develop patient care and other job-related skills. The course reviews medical terminology, basic human anatomy, communication skills, basic math skills and provides information on patients with special needs such as Alzheimer's disease. The course also provides hands on experience in an actual health care setting and works with the students to manage their own career path as a Nursing Assistant. Total Budget and Position Count Total Program Bud et 203257.00 Total Pro ram Position Count 4 Total Agency Budget 381846.00 Total A ency Position Count 9 NONPROFTT GRANT APPLICATION FISCAL YEAR 2004-OS Pale 2 American Red Cross Hawaii State Chapter - Agency Name caregiving -Program Name Program Objectives: Overall Goal: To provide youth and adults with the skills and knowledge to care for themselves and others in both the home and health care setting. 1) Increase the number of caregiving courses offered throughout the County by 5°~ over the year 2) Increase the number of persons trained in Babysitting in Hawaii County by 5% over the year 3) Increase the number of persons trained as Nursing Assistants by 10% over the year 4) Increase awareness of training by providing program materials to Hawaii County Schools, Hospitals and Long Term Care facilities 5) Partner with two other community groups in Hawaii County to increase program awareness Program Highlights: Immediate Outcomes of Training: Increased knowledge on how to identify potential hazards in the location where the person provides care. Increased knowledge and skills in how to prevent unintentional injury of people under the participant's care. Increased participant's willingness and comfort to act using the learned skills during an emergency situation. Increased number of certified caregivers in the community and reduction of unemployment rate. Longer Term Outcomes of Training: Reduction in accidents of children under the care of a youth babysitter Reduction in accidents of patients or other persons that require special care Increase in quality of caregiving for both tong-term and short-term care in community settings NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Budget * Estimate Nurse Assistant Trainin Courses 6 6 8 Nurse Assistant Trainin Enrollees 48 48 80 Bab sittin Courses 0 0 1 Bab sittin Enrolles 0 0 10 Program Outreach to Schools, 0 0 4 schools Hospitals and Long Term Care (2 each in Facilities Kona and Hilo) 4 other facilities (2 each in Kona and Hilo Community Partners 0 1 4 partners established (2 each in Kona and Hilo *If applicable NONPROFTI' GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 American Red Cross Hawaii State Chapter - Agency Name caregiving -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 69409.00 78816.00 78816.00 Professional Fees 1000.00 1000.00 10001.00 O erations 119465.00 118441.00 118441.00 E ui ment 5072.00 5000.00 7000.00 Other* Total 194946.00 203257.00 203257.00 *P/ease explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Hawaii Count 5000.00 5000.00 7000.00 Hawaii Island United Wa 11500.00 11500.00 11500.00 Pro ram Fees 143785.00 110676.00 110676.00 Pro ram Materials Resale 6632.00 8285.00 8285.00 Total 166917.00 135461.00 135461.00 *If applicable NONPROFTT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 American Red Cross Hawaii State Chapter - Agency Name Caregiving 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 ayear-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 resort may impact the evaluation of your program's or agency's future funding requests ~22 O_I Signature of Board President/Chair Date ~~aa~e ~ Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 6 The arc of Hilo -Agency Name Person centered Adult supports -Program Name Agency Director: Mike Gleason Phone No.: 935-8535-11 Contact Person: Ronald Penn Phone No.: 935-8535 ext 19 Mailing Address: 1099 Waianuenue Ave. Hilo Hawaii 96720 Facility/Site Address: Same Fax No.: 961-0148 Email Address: mgleason@hiloarc.org Amount of Request for County funds: $30000.00 Prior Year Funding: 01-02 02-03 03-04 $28000.00 $29000.00 $29000.00 Agency Mission Statement: The mission of The Arc of Hilo is to improve the quality of life for people with developmental and other disabilities on Hawaii through educational, vocational and skill training as well as employment and residential opportunities. Program Description: The Person Centered Adult Supports Program is designed to assist adults with developmental disabilities/mental retardation to transition from person-centered facility-based supports to person-centered community-based supports and to provide these community-based supports based on individual choice. Some of these supports are: Relationship building, Circle building, Learning to be a consummer, Personal supports and needs, Getting around, Communicating and expressing self, Job Support/coaching, Volunteer opportunity support, and Community activities. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Total Budget and Position Count Total Pro ram Bud et 195860.00 Total Pro ram Position Count 3 Total A enc Bud et 3043780.00 Total A enc Position Count 62 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 Tne arc of Hilo -Agency Name Person centered adult supports -Program Name Program Objectives: 1) Transition 17 clients from facility-based supports to community-based supports through relationship building, circle buidling, teaching consumer skills, providing personal supports to meet individual needs, teaching communication skills, and providing job coaching/support. 2) Assist clients to obtain independent living situations in the community if they desire. 3) Assist clients who are eligible for Medicaid Waiver services to transition to those programs. Program Highlights: 1) The program has assisted 5 clients to develop small businesses of their own. 2) The program provided job coaching to 15 clients employed in the community. 3) The program assisted 3 clients transition to Medicaid Waiver programs. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-OS Actual * Bud et * Estimate Job Coachin 14 14 15 Circle Buildin 16 17 17 Relationshi Buildin 3 3 5 Communication Skills 14 14 16 Communit Activities 2 4 5 Gettin Around 3 4 5 Learnin to be a Consumer 5 6 7 Volunteer O ortunities Su ort 2 2 4 Personal Su orts and Needs 14 15 16 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Tne arc of Hilo -Agency Name Person centered adult supports -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 47020.00 113589.00 93660.00 Professional Fees 7992.00 858.00 1000.00 O erations 40894.00 99193.00 98000.00 E ui ment 148.00 1100.00 3200.00 Other* Total 96054.00 214740.00 195860.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Count of Hawaii Funds 29000.00 29000.00 30000.00 State of Hawaii Funds 163860.00 163860.00 Private Donations 5000.00 A enc Trainin Pro rams OtherlnternalA enc Funds 62054.00 21880.00 2000.00 Total 96054.00 214740.00 195860.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Nonprofit Grant Application The Arc of Hilo Person Centered Adult Supports Program Fiscal Year 2004-05 ATTACHMENT TO: The Arc of Hilo "Program Expenditures Table" and the "Program Revenue Sources Table" on page 4 FY 2002-03 Actual column refers to "Residential Services/Dom Home Program" FY 2003-04 Budget and the FY 2004-05 Estimate columns refer to the "Person-Centered Adult Support Program" The Arc of Hilo -Agency Name Person Centered Adult Supports - 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 ayear-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 vour program's or aoencv's future fundino requests Si ture of Board Presid t/Chair Date `Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Bay Clinic, Inc -Agency Name Violence Intervention Project - f fOgram Name Agency Director: Stephanie Launiu Phone No.: 934-3206 Contact Person: Mary Furlong Phone No.: 966-9217 Mailing Address: PO Box 1141 Kurtistown, HI 96760 Facility/Site Address: 311 Kalanianaole, Hilo, HI 96720 Fax No.: 961-4795 Email Address: thebayclinic@HHIN.com Amount of Request for County funds: $26000.00 Prior Year Funding: 01-02 02-03 03-04 $19000.00 $20000.00 $20000.00 Agency Mission Statement: Bay Clinic, Inc. is community directed and committed to improving the health and well-being of all people. Program Description: The Violence Intervention Project (VIP) of Bay Clinic, Inc. provides direct services in Kau and Puna by offering weekly psycho~ducational groups to men who batter. VIP tracks compliance and provides collateral support to the Judiciary, Adult Probation, and CPS. VIP is active in community awareness, education, and coordinating victim advocacy services in Kau and Puna. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Total Budget and Position Count Total Pro ram Bud et 35700.00 Total Pro ram Position Count 3 Total A enc Bud et 6880198.00 Total A enc Position Count 92 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 Bay Clinic, Inc. -Agency Name Violence Intervention Project - PrOgfam Name Program Objectives: 1) Make Domestic Violence services available in rural Kau and Puna districts by offering psycho-educational groups to men who batter. 2) Increase community safety by holding perpetrators accountable, tracking compliance, and providing collateral support to the Judiciary, Adult Probation, and CPS. 3) Provide referrals to support services for victims and families. 4) Collaborate with Pahoa Neighborhood Place to increase Domestic Violence services and awareness. 5) Improve the ways Kau and Puna families and communities address and resolve family abuse concerns by being active participants in the Domestic Violence Interagency Team. 6) Reduce isolation from services and increase accessibility by offering direct services in the community. Program Highlights: 1) Provided 48 groups for men who batter in Kau 2) Provided 48 groups for men who batter in Puna 3) Attended court to offer adjudicated men information and options. 4) Tracked data and maintained records for collateral agencies. 5) Participated in Healthy Intentions Project's "Domestic Harmony" events to promote a positive community goal. 6) Participated in the statewide Rural Community Response Program to flag high risk cases to be team managed by all involved agencies. 7) Presented educational displays at community events and health fairs. 8) Joined the Hawaii Island Anti-Bullying Coalition. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Pahoa week) men's rou 48 48 48 Kau week) men't rou 48 48 48 Intakes Pahoa 37 31 35 Intakes Kau 15 13 15 Avera e # in Pahoa 18 16 18 Avera e # in Kau 10 11 11 Court a earances 35 20 20 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Outreach meetin s 12 12 12 Present education, community 5 6 6 events 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Bay Clinic, Inc -Agency Name Violence Intervention Project - Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 0.00 0.00 0.00 Professional Fees 17040.00 17040.00 28000.00 O erations 2960.00 2960.00 2960.00 E ui ment 0.00 0.00 0.00 Other* 3900.00 3900.00 3900.00 Total 23900.00 23900.00 35700.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et' Estimate Hawaii Coun 20000.00 20000.00 26000.00 Fees 3900.00 3900.00 4000.00 In Kind 3500.00 3500.00 3500.00 Unfunded 2200.00 Total 27400.00 27400.00 35700 *lf applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Bay Clinic, Inc -Agency Name Violence Intervention Project - 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 ayear-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 vear-end resort may impact the evaluation of vour program's or agency's future funding reouests. Signature of Board President/Chair Date l Signature of Executive Director Dat UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 6 Big Island Substance Abuse Council _ BISAC East Hawaii Substance Abi.,se Council Agency Director: Gloria J. Egle Phone No.: 969-9994 Contact Person: Wesley Margheim Phone No.: 935-4927 Mailing Address: 234 Waianuenue Avenue Hilo, HI 96720 Facility/Site Address: 297 Waianuenue Avenue Hilo, HI 96720 Fax No.: 969-7570 Email Address: ceo@bisac.com Amount of Request for County funds: $40,000 Prior Year Funding: 01-02 02-03 03-04 $27,000 $27,000 $27,000 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 spirits of individuals, families and others who suffer as a result of alcohol and other substance use, abuse and addiction. 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 is primarily families to include, adolescents, 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. BISAC recognizes the significant impact of crystal methamphetamine on this population 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 cast Hawaii BISAC NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 1 programs provide outpatient treatment and therapeutic living services to adults and outpatient services (in both outpatient setting and in eight (8} school based programs island wide) to adolescents, giving special emphasis 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 0-5, fathers with children ages 5-12, women who are transitioning out of the Department of Corrections, 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 the Outpatient Treatment services to the Adolescents and Adults who present themselves at BISAC and require the immediate and intensive care necessary to recover from this terrible addiction. Total Budget and Position Count Total Pro ram Bud et 2,284,430 Total Pro ram Position Count 60 1 Total A enc Bud et 3,446,912 Total A enc Position Count 84 Program Objectives: 1) Provide immediate access to assessment and treatment services to individuals who have identified themselves as Crystal Methamphetamine abusers or dependent. 2) Increase the availability of extended outpatient treatment sessions to methamphetamine addicted adults and adolescents who 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 full understanding of disease concept of addiction as demonstrated by ability to verbalize personal symptoms within the first 30 days of treatment. 5) Identify potential for continued drug/alcohol and relapse risk with development of specific coping skills to reduce that risk within the first 30 days of treatment. 6) Demonstrate the severity of personal substance abuse issues through the completion of a written autobiography within the first 30 days of treatment. 7) Identify need for clean and sober social support network and begin developing support system as demonstrated by participation in a minimum of three 12 step meetings per week within the first 60 days of treatment. 8) Identify need for family support and family involvement in recovery process by engaging in a minimum of three (3) family therapy sessions within the first sixty (60) days of treatment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 9) Identification of individualized protective factors that will significantly reduce risk factors, and has implemented a minimum of six within the first 90 days of treatment. 10) Complete majority of previously identified treatment goals and has developed a transition plan to prepare for discharge within the first 90 days of treatment. Program Highlights: 1) Was able to admit 1,042 adults and adolescents into all levels of outpatient substance abuse treatment and Therapeutic Living services. 2) Achieved 61 % of completed treatment program objectives. 3) Reduced Criminal behavior by 85% as evidenced by no new arrests at 6 (6) months post treatment. 4) Achieved 62% of long-term abstinence from all drugs and/or alcohol use at six (6) months post discharge from treatment 5) 84% of the clients discharged from the Therapeutic Living Programs reported maintaining clean and sober housing at six (6) months post discharge from treatment. 6) Have 65% of clients employed, enrolled in school/vocational training or volunteering at the time of discharge and at six (6) months post discharge. 7) Reduced the client's use of medical services by 95% as demonstrated by no emergency room visits or hospital admissions during the first six (6) months post discharge. Performance Measures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Substance Abuse Treatment da s 23,836 24,443 24,582 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Big Island Substance Abuse Council BISAC East Hawaii Substance Abuse Council Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 1,379,853 1,595,869 1,608,869 Professional Fees 18,343 13,711 13,711 O erations 663,692 632,325 632,325 E ui ment 33,230 15,525 15,525 Other* Van 27,000 27,000 27,000 Total 2,122,118 2,284,430 2,297,43.0 'Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Count 27,000 27,000 40,000 State of Hawaii 947,649 867,974 867,974 Federal 803,068 972,133 972,133 HIUW 10,625 15,000 15,000 Assessments 2,200 Donations/Fundraisin 4,050 5,000 5,000 Private Insurance 284,932 284,460 284,460 Client Fees 114,420 87,026 87,026 Hina Mauka 19,234 15,000 15,000 Trainin /De osit Forfeit 13,452 10,837 10,837 Total 2,226,630 2,284,430 2,297,430 `If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Bi Island Substance Abuse Council BISAC East Hawaii Substance Abuse Council 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 ayear-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 ignature of Boar resident/Chair Date Patricia Engelhard ~ Signature of EStecutive Director Date Gloria J. Egle-Garbutt UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 The Big Island Substance Abuse Council BISAC West Hawaii Substance Abuse Program Agency Director: Gloria J. Egle Phone No.: 969-9994 Contact Person: Wesley Margheim PhonR No.: 935-4927 Mailing Address: 234 Waianuenue Ave Hilo, HI 96720 Facility/Site Address: 81-947 Halekii Street Keakakekua, HI 96750 Fax No.: 969-7570 Email Address: ceo@bisac.com Amount of Request for County funds: $40,000 Prior Year Funding: 01-02 02-03 03-04 $27,000 $27,000 $27,000 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 spirits of individuals, families and others who suffer as a result of alcohol and other substance use, abuse and addiction. 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 is primarily youth and young adults who are experiencing substance abuse or dependency and require the structure of an institution such as BISAC to begin the process of recovery. BISAC recognizes the significant impact of crystal methamphetamine on this population and has designed programs to intervene in the addictive process and build on an individual'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 outpatient services (in both outpatient setting and in NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 eight (8) school based programs island wide) to adolescents, giving special emphasis to pregnant women, HIV users, and those with co-occurring disorders. 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 the Outpatient Treatment services to the Adolescents and Adults who present themselves at one of BISAC's 2 outpatient sites (Waimea and Kealakekua) and require the immediate and intensive care necessary to recover from this terrible addiction. Total Budget and Position Count Total Pro ram Bud et 1,164,775 Total Pro ram Position Count 24 Total A enc Bud et 3,446,912 Total A enc Position Count 84 Program Objectives: 1) Provide immediate access to assessment and treatment services to individuals who have identified themselves as Crystal Methamphetamine abusers or dependent. 2) Increase the availability of extended outpatient treatment sessions to methamphetamine addicted adults and adolescents who 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 full understanding of disease concept of addiction as demonstrated by ability to verbalize personal symptoms within the first 30 days of treatment. 5) Identify potential for continued drug/alcohol and relapse risk with development of specific coping skills to reduce that risk within the first 30 days of treatment. 6) Demonstrate the severity of personal substance abuse issues through the completion of a written autobiography within the first 30 days of treatment. 7) Identify need for clean and sober social support network and begin developing support system as demonstrated by participation in a minimum of three 12 step meetings per week within the first 60 days of treatment. 8) Identify need for family support and family involvement in recovery process by engaging in a minimum of three (3) family therapy sessions within the first sixty (60) days of treatment. 9) Identification of individualized protective factors that will significantly reduce risk factors, and has implemented a minimum of six within the first 90 days of treatment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 10) Complete majority of previously identified treatment goals and has developed a transition plan to prepare for discharge within the first 90 days of treatment. Program Highlights: 1) Was able to admit 366 adults and adolescents into all levels of outpatient substance abuse treatment and Therapeutic Living services. 2) Achieved 54% of completed treatment program objectives. 3) Reduced Criminal behavior by 87% as evidenced by no new arrests at 6 (6) months post treatment. 4) Achieved 60% of long-term abstinence from all drugs and/or alcohol use at six (6) months post discharge from treatment 5) 76% of the clients discharged from the Therapeutic Living Programs reported maintaining clean and sober housing at six (6) months post discharge from treatment. 6) Have 55% of clients employed, enrolled in school/vocational training or volunteering at the time of discharge and at six (6) months post discharge. 7) Reduced the client's use of medical services by 97% as demonstrated by no emergency room visits or hospital admissions during the first six (6) months post discharge. Performance Measures FY 2001-02 FY 2002-03 FY 2003-04 Actual * Bud et * _ Estimate Substance Abuse Treatment Da s 11,811 13,941 14,024 *If applicable NONPROFIT GRANT APPLICATION FISCAL REAR 2004-OS Page 3 Big Island Substance Abuse Council BISAC West Hawaii Substance Abuse Treatment Program Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 562,566 788,382 801,382 Professional Fees 10,980 11,469 11,469 O erations 278,165 322,399 322,399 E ui ment 17,435 15,525 15,525 Other* Vans 0 27000 27000 Total 869,146 1,164,775 1,177,775 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Count 27,000 27,000 40,000 State of Hawaii 474,723 744,733 744,733 Federal 162,950 271,974 271,974 HIUW 10,625 10,000 10,000 Assessments 1,080 0 0 Donations/Fundraisin 5,000 5,000 5,000 Private Insurance 103,514 104,068 104,068 Client Fees 34,177 2,000 2,000 Hina Mauka 14,808 0 0 Total 833,877 1,164, 775 1,177,775 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Big Island Substance Abuse Council BISAC West Hawaii Substance Abuse Council 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 ayear-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. ignature of Board resident/Chair Date Patricia Engelhard ~ ~ ~ , , !'Signature of E~tecutiv~ Director Date Gloria J. Egle-Garbutt UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Boys & Girls Club of the Big Island - Ag@I1Cy Na171@ SMART Moves - f~POgt'al'1'1 X18111@ Agency Director: Steven G. Pavao Phone No.: 961-5536 Contact Person: Steven G. Pavao Phone No.: 961-5536 Mailing Address: 100 Kamakahonu Street FacilitylSite Address: 100 Kamakahonu Street Fax No.: 961-5189 Email Address: Steven@becbi.com Amount of Request for County funds: $50000.00 Prior Year Funding: 01-02 02-03 03-04 $30000.00 $36000.00 $38000.00 Agency Mission Statement: 'To inspire and enable all youth, especially youth from disadvantaged circumstances, to realize their full potential as productive, caring and responsible citizens." Program Description: SMART Moves: Helping the Young People of the Big Island Develop Skills to Resist Tobacco, Alcohol, Other Drugs, and Premature Sexual Activity NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 1 The Need Tobacco, alcohol and other drug use are a particularly insidious problem because it rarely remains isolated. It is widely recognized as a major contributing factor in other youth problems including school failure, truancy, runaways, suicide, pregnancy, school dropout, family problems, auto accidents, unemployment and crime. Tobacco is today widely recognized as the ultimate "gateway" drug. Research indicates that the majority of illicit drug users began their substance abuse with tobacco, often at a very young age. Today the United States has the highest rate of illicit drug use of any industrialized nation. Across the country every community, regardless of location and income level, has been touched by drug use. Consider the following statistics: Police chiefs were 10 times more likely to believe that violent crime can be curtailed more effectively by reducing drug abuse than by reducing the number of guns on the streets. They also believe by a margin of two to one that reducing drug and alcohol abuse is a more effective strategy for combating violent crime than longer prison sentences for criminals. • Drug use among young teenagers is climbing rapidly: marijuana smoking among eighth graders has more than doubled since 1991. • In 1995, one in five 13-year-olds reported using inhalants, an increase of 30 percent since 1991. Inhalants kill as many as 1,000 people each year, most of them still in their teens. Nearly 11 percent of the 22 million U. S. teenagers are using drugs - mostly marijuana, but also cocaine, LSO and other hallucinogens. • Every year 3 million teens -approximately one in four sexually experienced teens -acquire an STD. • 13 percent of all U.S. births are to teens. • Each day in America nearly one thousand Amerigns die from tobacco related diseases. Each day in America three thousand teens smoke their first cigarette. Statistics for our community are just as alarming: § Hawaii County has the highest rates of crystal methampetamine use in the state § Hawaii County has the highest rates of youth at risk due to indicators such as the highest rates of unemployment, highest rates of high school dropouts, highest rates of juvenile delinquency, highest rates of child abuse and out-of- home placement. Too many children today grow up with few, if any, positive role models and little, if any, encouragement to resist tobacco, alcohol, other drugs and sexual activity. The norm and expectation for these young people, whether perceived or real, is that it is almost a "rite of passage" to smoke tobacco, drink alcohol, use other drugs and engage in sex. Not only is this the perception of young people NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 themselves but often the perception of the adults in their lives whose passive resignation encourages rather than discourages these behaviors. While young people are taught skills to prepare them to face educational challenges, at critical stages of psychological, emotional and intellectual development they are often not taught the skills needed to make the transition from childhood to adulthood and to resist tobacco, alcohol, other drugs and premature sexual activity. Our children are growing up in very stressful times, and we need to do more to help them. Responding to the Need Until recently, most prevention programs failed, in large part because they were based on faulty assumptions about why young people begin using tobacco, alcohol, and drugs in the first place. Early prevention efforts relied on scare tactics and moral exhortations, expressing prohibitionist views that linked drugs to dangerous criminal influences. Few of these programs were systematically evaluated, but those that were failed to show reduced drug use among participants. Responding to the urgent need for an effective prevention program, Boys & Girls Clubs of America developed and field-tested a comprehensive program to help young people develop skills to resist tobacco, alcohol, other drug use and premature sexual activity. The results were outstanding. Called SMART Moves, the program is based on two rigorously tested curricula: Life Skills Training (Gilbert Botvin, Ph.D., Cornell University) and Project SMART (William Hansen, Ph.D., University of Southern California). SMART Moves is now used successfully in communities across the nation. The program is based on a resistance training/social skills model. Using small group activities, it teaches young people to recognize and resist media influences and peer pressures to engage in tobacco, alcohol, other drug use and early sexual involvement. SMART Moves recognizes that in addition to resistance training and the development of social skills, selfoesteem is a very important factor in regulating basic human drives and attitudes. When children are made to feel that they matter, that they have a unique contribution to make, and when they are helped to understand their feelings, they are less likely to endanger their own health or that of others by indulging in behaviors that put them at risk. SMART Moves also recognizes that in order for youth to learn and apply prevention principles, prevention programs must include parents and members of the community. SMART Moves uses a team approach to implement the program. The prevention team consists of Club staff, community representatives, parents and older teens. NONPROFTT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 The SMART Moves curriculum is comprised of the following components: Be SMART: An inoservice training that provides staff and volunteers with an overview of the program, and suggests ways to incorporate the prevention message into ongoing Club programs. SMART Kids Make SMART Moves: A skills development program for boys and girls ages 6 to 9. The program focus is on selfoawareness, decision-making and interpersonal skills, while communicating age appropriate information about tobacco, alcohol and other drugs. Start SMART: A resistance skills program for youth ages 9 to 12 that focuses on ways to identify and resist peer, social and media pressures to use tobacco, alcohol, other drugs or become sexually involved. It includes ageoappropriate discussions of puberty and friendships. Stay SMART: A social skills program for adolescents ages 13 to 15 that teaches resistance skills, stress reduction techniques, communication skills, assertiveness training and life planning. It provides accurate information about tobacco use, alcohol use, other drug use and adolescent sexuality. SMART Parents: A program for parents that emphasizes communication skills and factual information about tobacco use, drug use, alcohol use, and adolescent sexuality. Act SMART: An age-appropriate program developed with the American Red Cross, to educate youngsters about HIV/AIDS. This curriculum emphasizes sexual abstinence and the avoidance of drugs as the most effective ways to prevent HIV/AIDS transmission and infection. Through these program components, 600 youth wilt be involved in small group prevention activities; more than 2400 will be involved in Club/communityowide prevention activities; 100 parents will be trained; and 85 volunteers will help in community service projects. Achievements SMART Moves is: Recognized as one of 10 exemplary primary prevention programs by the U. S. Office of Substance Abuse Prevention, the National Association of State Alcohol and Drug Abuse Directors, and the National Prevention Network. Lauded as a premier national prevention program by the White House Conference for a DrugOFree America as well as the Children's Defense Fund. Cited for its parent-training component by the Office of the Inspector General of the U.S. Department of Human Services Administration. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 4 • Noted for its effectiveness in a study conducted by the Center for Health Policy Research of The Pennsylvania State University. • Singled out for praise in The Making of a Drug Free America: Programs That Work by Mathea Falco (former Assistant U.S. Secretary of State for Narcotics Affairs). SMART Moves is unique among prevention programs in that: SMART Moves is the sole national prevention program currently addressing the problems of tobacco, alcohol, other drug use and teen pregnancy in one comprehensive curriculum. • SMART Moves employs a team consisting of staff, parents, community representatives and older Club members to impart the knowledge and teach the skills needed by young people to avoid tobacco, alcohol, other drugs and premature sexual involvement. SMART Moves actively involves parents in the prevention effort. SMART Moves is incorporated into all Club activities and programs. SMART Moves uses teen leaders who act as role models to younger people. Total Budget and Position Count Total Program Bud et 50000.00 Total Pro ram Position Count 1 Total A enc Bud et 892,000.00 Total A ency Position Count 14 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 _ Boys s~ cirfs club of the Big Island -Agency Name sMART Moves -Program Name Program Objectives: 1) The objective of the SMART Moves program is to prevent the onset of tobacco, alcohol and other drug use, and sexual involvement by young people. This is accomplished by: 2) Increasing participants' knowledge about tobacco, alcohol and other drugs and sexuality. 3) ~ Increasing communication among staff members, parents, guardians and Club members regarding tobacco, alcohol, other drugs and adolescent sexual involvement. 4) ~ Helping preoteens identify and resist peer and media pressures to use tobacco, alcohol and other drugs, and understand the physical and social changes taking place in their lives. 5) Helping teens develop and improve skills around making decisions, resisting social and peer pressures, and coping with the stress of growing up 1) The objective of the SMART Moves program is to prevent the onset of tobacco, alcohol and other drug use, and sexual involvement by young people. This is accomplished by: 6) 2) ~ Increasing participants' knowledge about tobacco, alcohol and other drugs and sexuality. 7) 3) Increasing communication among staff members, parents, guardians and Club members regarding tobacco, alcohol, other drugs and adolescent sexual involvement. 8) 4) ~ Helping preoteens identify and resist peer and media pressures to use tobacco, alcohol and other drugs, and understand the physical and social changes taking place in their lives. 9) ~5) Helping teens develop and improve skills around making decisions, resisting social and peer pressures, and coping with the stress of growing up.. Program Highlights: 1) During the current fiscal year (2003-2004) we have completed SMART Moves with 385 youth as of December 31, 2003. We completed our Quick SMART, drug, alcohol and tobacco prevention program with all participants in our RBI Baseball Program. We opened sites at Keaau Middle School and Nanawale Community Center in an effort to expand our services and reach more youth with our SMART Moves program. Our Puna sites have served over 100 youth as of December 31, 2003. We have conducted SMART girls to over 180 teen and pre-teen girls in East Hawaii this fiscal year. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 6 Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Budget * Estimate Youth Com leted SMART Moves 462 500 600 Youth Com leted Quick SMART 126 150 200 Youth Com leted SMART Girls 66 85 100 Youth Com leted Street SMART 32 100 100 Youth Com leted Start SMART 186 200 300 Youth Com leted Sta SMART 83 100 150 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 7 Boys & Girls club of the Big Island -Agency Name sMART Moves -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 26554.00 29566.00 34872.00 Professional Fees 2488.00 3200.00 5200.00 O erations 6305.00 4034.00 7628.00 E ui ment 653.00 1200.00 2300.00 Other' Total 36000.00 38000.00 50000.00 'Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate State Office of Youth Services 12500.00 150000.00 150000.00 Office of Juvenile Justice & 25000.00 115000.00 150000.00 Delin uenc Prevention Tobacco Settlement Trust Fund 0.00 60000.00 60000.00 Hawaii Island United Wa 15000.00 20000.00 20000.00 Hawaii Count 36000.00 38000.00 50000.00 McCabe Foundation 50000.00 0.00 50000.00 Pro ram Fees 40000.00 50000.00 60000.00 Athletic Fees 0.00 20000.00 30000.00 Concession Income 5000.00 15000.00 20000.00 Fundraisin 20000.00 40000.00 50000.00 Annual Cam ai n 0.00 100000.00 100000.00 Donations 15000.00 20000.00 20000.00 Trusts & Foundations 12500.00 85000.00 100000.00 Federal Lunch Pro ram 18000.00 26000.00 32000.00 Total 249000.00 739000.00 892000.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 8 Boys & Girls Club of the Big Island - /fig@I1Cy N8t11@ SMART Moves - PrOgCal71 N8111@ 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 inGuding 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 ayear-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 vear-end report may impact the evaluation of your program's or agency's future funding requests. V ~ ~ l./K/ ~1 $ Arf.~ 2er~ Signature of Board President/Chair Date Signature Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 9 Brantley Center, Inc. -Agency Name Transportation Program -Program Name Agency Director: Cami Post Phone No.: 775-7245 Contact Person: Cami Post Phone No.: 775-7245 Mailing Address: P.O. Box 1407, Honokaa, Hawaii 96727 Facility/Site Address: 45-366 Ohelo Street, Honokaa, Hawaii 96727 Fax No.: 775-0211 Email Address: bcenter2@gte.net Amount of Request for County funds: $25,000 Prior Year Funding: 01-02 02-03 03-04 $21,000 $21,000 $21,000 Agency Mission Statement: To provide quality services in addressing community needs for vocational and independent living skills training programs for people with mental, emotional, and/or physical disabilities. Program Description: Brantley Center, Inc. provides transportation services to people with disabilities who reside in the districts of Hamakua and North and South Kohala. Transportation services include: transporting to and from Brantley Center, transportation to several work sites in the districts we serve, transportation within the community to provide training in accessing community resources, and transportation to medical and dental appointments. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Brantley Center, lnc. -Agency Name transportation Program -Program Name Total Budget and Position Count Total Pro ram Bud et 63,000 Total Program Position Count .5 Total Agency Budget 382,184 Total Agency Position Count 8 Program Objectives: 1) Transport up to 25 consumers to and from Brantley Center, Inc. as needed. 2) Transport 24 consumers each day to various work sites within the districts of Hamakua and North and South Kohala. 3) Transport 40 consumers to Hilo and Kona for monthly excursions to provide training in community awareness and encourage participation in community activities/events. 4) Transport 24 consumers to various agencies in the community to provide training in accessing community resources. 5) Transport 15 consumers to medical and/or dental appointments. 6) Provide monthly ground maintenance services to 25 private homes and businesses. 7) Provide monthly ground maintenance services to 45 Hawaii County reservoir sites, pump station sites, and cemeteries. Program Highlights: 1) Transported 22 consumers to and from Brantley Center as needed. 2) Transported 21 consumers to various work sites daily. 3) Transported 32 consumers to Hilo and Kona for monthly excursions. 4) Transported 21 consumers to community agencies/businesses for training in accessing community resources. 5) Transported 9 consumers to medical and dental appointments. 6) Provided monthly ground maintenance services to 19 private homes and businesses. 7) Provided monthly ground maintenance services to 44 Hawaii County reservoir sites, pump station sites, and cemeteries. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 Brantley Center, Inc. -Agency Name Transportation Program - F~Ogram Name Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Budget * Estimate Number of unduplicated consumers 36 45 45 served Number of consumers who 14 20 20 increased scores on the Vocational Evaluation Re ort Number of consumers successfully 4 4 5 laced in com etitive em to ment Number of consumers who 18 20 20 increased their levels of functioning in inde endent livin skills Number of consumers who 30 40 40 participated in community activities/events Number of consumers who 10 14 15 maintained their independent living arran ements within the communi Monthly ground maintenance 19 22 25 services provided to private homes and businesses Monthly grounds maintenance 44 44 45 services provided to the County of Hawaii's reservoir sites, pump station sites, and cemeteries located in Laupahcehoe and the districts of Hamakua, and South Kohala *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Brantley Center, lnc. -Agency Name Transportation Program -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Budget * Estimate Salaries and Wa es 7,000 7,000 9,500 Professional Fees 1,000 1,000 1,000 O erations 13,000 13,000 14,500 E ui ment 38,000 Other* Total 21,000 21,000 63,000 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate County of Hawaii 21,000 21,000 25,000 Federal -DOT 30,400 Fundraisin 7,600 Total 21,000 21,000 63,000 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Brantley Center, lnc. -Agency Name 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, 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 ayear-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 vear-end report may impact the evaluation of vour program's or agency's future fundincl requests / ~ d J Signantur of Board President/Chair Date Signature of Executive Director Dat UNSIGNED PROPOSALS WILL NOT BE ACCEPTED NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 BRIDGE HOUSE, INC -Agency Name VOCATIONAL SKILL BUILDING PROGRAM - PfOgfam Name Agency Director: Cheryl Taupu Phone No.: 322-3305 Contact Person: Cheryl Taupu Phone No.: 322-3305 Mailing Address: P.O. Box 2489, Kailua-Kona. HI 96745 Facility/Site Address: 78-6687 A Mamalahoa Hwy. Holualoa, HI 96725 Fax No.: 322-0809 Email Address: cheryl_bridgeh@earthlink.net Amount of Request for County funds: $18000.00 Prior Year Funding: 01-02 02-03 03-04 $16000.00 $17000.00 $17000.00 Agency Mission Statement: The mission of Bridge House is to assist adults in early recovery from addictions develop successful living skills though residential and vocational experiences in a safe and supportive environment. Program Description: Between 95 and 98% of all individuals admitted into Bridge House are unemployable and most have not worked for more than one or two months for the year prior to entering Bridge House. Bridge House believes that recovery from addiction is only possible if the "whole" person is taken care of and that an important part of recovery from substance abuse is taking responsibility for ones self and being contributing members of the community. This includes obtaining and maintaining appropriate employment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Bridge House, Inc, is requesting funds for the Vocational Skills Building Program which was started in 1996 and was developed to help residents of Bridge House learn basic job readiness skills such as getting to work on time, performing assigned tasks and behaviors needed to maintain employment. The program has since evoled into a more comprehensive program providing job skills evaualtion, job coaching, encouraging participation in continuing education, and matching residents to jobs that better fit the individual's skills, knowledge and talents. All resident admitted into Bridge House participate in an Initial Vocational/Employment Evaluation which gives staff a basic idea of the resident's employment history, if any, knowledge, talents, skills and interests. Using the results of this evaluation in conjunction with personal observations of staff and twice monthly clinical reviews, program staff helps residents identify skills, attitudes and behaviors needed to attaining appropriate employment and formulates an individual plan to help coach the individual resident in employment skills, appropriate attitudes and behaviours, inter-personal skills, appropriate dress, language and other items needed for obtaining and maintaining appropriate employment. At approximately 90 days of participation in the program staff and residents complete aPre-employment Evaluation which assess willingness to participate, punctuality, ability to meet goals and other items as needed to assess employment readiness. Between 100 to 120 days of residency, individual residents, with staff assistance start job searches for appropriate employment. Staff transports residents to and from all potential employers and helps residents complete applications. Staff assist residents in preparing forjob interviews and transports to and from their job site when they obtain employment. Another important part to the program is networking and forming informal partnerships with employers in the community to help train and employ residents. Staff identifies and forms working relationships with employers in the community to train and employ residents. Total Budget and Position Count Total Pro ram Bud et $40,714 Total Pro ram Position Count 2 Total A enc Bud et $353,394 Total A enc Position Count 6 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 BRIDGE HOUSE, INC. -Agency Name VOCATIONAL SKILLS BUILDING PROGRAM - PPOgfam Name Program Objectives: 1) All residents receiving a clinical discharge who have the ability to be employed will be gainfully employed prior to discharge from Bridge House. This objective can be obtained by: a. Vocational skills evaluations b. Employment counseling/coaching c. Job training d. Skills building, and e. Transportation services All residents participate in initial and ongoing vocational skills evaluations. Using the evaluations as well as staff observations and twice monthly clinical evaluations, staff helps residents identify skills, attitudes and behaviors needed to attain appropriate employment. Employment counseling, job training and skills building are provided by staff and other employment related services in the community. Taking the results of the initial evaluation staff gives residents written job assignments to complete on a daily basis. Staff coaches the individual residents to help residents gain skills needed to perform given tasks as would be expected in a "real world" job and confidence in their ability to obtain and maintain appropriate employment. The majority of the residents admitted into Bridge House do not have reliable transportation or have permanently lost their license to operate a motor vehicle. Even though there is a bus system, the bus schedule is not compatible with the Bridge House schedule and/or does not travel to enough areas at the right time for residents to adequately do job searches or to use as transportation to and from work. Staff provides transportation services to ensure that residents are given sufficient opportunities to find employment and have reliable transportation to and from employment. This also demonstrates to the residents the importance of being on time to work. 2) Residents will be employed in jobs that best match their abilities This objective can be obtained by: a. Ongoing performance evaluations b. Ongoing monitoring c. Self-identifying employment preferences, and d. Ongoing job counseling/coaching e. Follow-up NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 These ongoing activities help residents find employment that best matches their skills and abilities. Being employed in a job that one is suited for and is happy doing, is one of the key components for maintaining a job long-term. Staff conducts follow-up interviews of all former residents at 3, 6 and 12 months post discharge. The primary reason for follow-ups is to monitor the efficacy of all of the programs of Bridge House, Inc. If during the follow-up staff finds that former residents need further assistance, staff can offer appropriate help. Former residents report at follow-up that participating in the Vocational Skills Building Program gave them a sense of pride and elevated their self-esteem which in turn empowered them to make the changes needed to stay clean and sober and to maintain employment. 3) Staff will network and build cooperative relationships with a minimum of 10 community resources to training and/or employing residents. This objective can be obtained by: a. Contacting possible employers/partners b. Obtaining information relating to job requirements from partners c. Work with residents on the skills needed to fulfill job requirements, and d. Ongoing networking with identified partners These activities ensure that residents obtain appropriate employment prior to discharge and build ongoing community support of Bridge House which benefits the residents and community in general. Program Highlights: 1) In fiscal year 2002103 Bridge House served an average of 15 residents per month. 35 residents received a clinical discharge. 24 were working full- time at the time of discharge, 4 were working part-time, 3 were in job training/school, and 4 were permanently disabled and unable to work. 2) Program staff built relationships with 10 employers/community partners who provided either training or employment for the majority of those discharged from Bridge House. 3) 21 of the 28 residents were still employed at 3 and 6 months follow-up. (Data for 12 month follow-up is not available at this time.) 4) From July 1, 2003 to December 30, 2003, Bridge House served an average of 20 residents per month. This is an increase of 5 residents per month more than last fiscal year. (96% reported crystal methamphetamine as their drug of choice. 95% had not worked more than 30 days in the 3 months previous to entering Bridge House. 98% were involved in the criminal justice system.) 5) Since July 1, 2003 Bridge House discharged 35 residents. 20 received clinical discharges and were working at the time of discharge. Of the 20 receiving a clinical discharge only two (2) were working at the time they were admitted into Bridge House. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 6) Of the 20 receiving clinical discharges, 12 were still working as of December 30, 2003 and 1 was on Worker Comp for a back injury. Bridge House was unable to contact 7 former residents for follow-up data. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Workin time of dischar a 28 30 35 Workin 3 months follow-u 75% 80% 80% Workin 6 months follow-u 75% 80% 80% Staff will build relationshi s w/ 10 communi artners 100% 100% 100% "'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 BRIDGE HOUSE, INC. -Agency Name VOCATIONAL SKILLS BUILDING PROGRAM - Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es $41,387 $43,053 $41,845 Professional Fees $5,598 $5,700 $5,808 O erations $27,815 $27,053 $34,233 E ui ment 0 0 0 Other* 0 0 0 Total $74,800 $75,806 $81,886 *P/ease explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate State of Hawaii/ADAD $39,234 $39,234 $39,234 HUD 10,994 12,000 0 HIUW 13,000 13,000 13,000 Pro ram Fees 11,572 11,572 11,572 Coun of Hawaii 0 0 18,000 Total $74,800 $75,806 $81,806 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 6 BRIDGE HOUSE, INC -Agency Name VOCATIONAL SKILL 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 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 ayear-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 proaram's or aaencv's future funding requests. Signature of Board President/Chair Date - Signature o x utive Dire Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 7 CIL- East & west Hawaii -Agency Name Independent Living Services - Program Name Agency Director: Patricia Lockwood Phone No.: 935-3777 Contact Person: Laura Tobosa Phone No.: 935-3777 Mailing Address: 400 Hualani Street, Suite 16D, Hilo, HI 96720 Facility/Site Address: Same As Above Fax No.: 961-6737 Email Address: cileh@interpac.net Amount of Request for County funds: $20,000 Prior Year Funding: 01-02 02-03 03-04 $15,000 $15,000 $15,000 Agency Mission Statement: We believe in ensuring the rights of people with disabilities to live independently and fully integrated in the community, outside of institutional care setting. 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 low 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 citizenship. Since CIL-EH and CIL-WH believes that those who best know the NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 cIL -East & west Hawaii -Agency Name Independent Living Services - PfOgl'am Name 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. Total Budget and Position Count Total Pro ram Bud et 338,683 Total Pro ram Position Count 9 Total A enc Bud et 2,000,084 Total A enc Position Count 35 Program Objectives: 1) Provide landlord/tenant rights training, 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: 7/1/04 - 6/30/05 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 in how to interview, hire and fire an attendant. This prevents institutionalization and dependence on family, friends and neighbors. Timeline: 7/1/04 - 6/30/05 3) Provide one-on-one independent living skills to carry out their every day living activities such as housekeeping, shopping, laundry, cooking, etc. This will reduce dependence on others. Timeline: 7/1/04 - 6/30/05 4) Provide consumer with information on their legal rights, how to access information, who to contact, etc. This knowledge can be shared with other consumers to empower self-advocacy. Timeline: 7/1/04 - 6/30/05 5) Provide one-on-one training with consumers to acquire problem-solving and decision-making skills. This will provide the decision to make the right choices. Timeline: 7/1/04 - 6/30/05 6) Provide consumers with housing referrals to acquire a place to live. This will increase their independence and decrease dependency on family and/or friends. Timeline: 7/1/04 - 6/30/05 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 daily living. Timeline: 7/1/04 - 6/30/05 8) Provide consumers with information and referral services to increase their options of various resources in the community. This will increase their independence. Timeline: 7/1/04 - 6/30/05 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 cIL -East & west Hawaii -Agency Name Independent Living Services - PrOgCam Name Program Highlights: 1) CIL-EH & WH provided information on independent living services to approximately 500 seniors at the Senior Health Fair held at Hilo Hawaiian Hotel. 2) CIL-EH continues to work with DRH (Disability Rights Hawaii -local grassroots advocacy group) to improve access in Hawaii county. 3) CIL-EH provided TTY training to Keola Laulima O Leikula (a non-profit transportation organization). 4) CIL-EH provided information on elderly blind services to University of Hawaii at Hilo library staff. 5) CIL-EH Coordinator participates in the PICIL (Partnership In Community Independent Living) advisory committee. This project assists people with disabilities to meet their self-determined goals. 6) CIL-EH Coordinator continues to work on disability-related issues in Hawaii county with the Mayor's Committee on People with Disabilities. 7) CIL-WH provides a Wellness Class once a week to approximately 30 consumers who participate in low impact exercises for people with disabilities and nutrition information. 8) CIL-WH received a grant from dept. of Health, Kaiser Foundation and Aloha Care to provide a "Living Well With Diabetes" program to approximately 30 participants who learn about exercise, diet, nutrition and personal medical management. 9) CIL-EH & WH provided technical assistance to Department of Land & Natural Resources, Kona Visual Support Group, West Hawaii Tobacco Free Coalition, Postcard legislative campaign for the Developmentally Disabled and Haola, Inc. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 cIL -East & west Hawaii -Agency Name Independent Living Services - Program Name Pertormance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Train consumers in landlord/tenant 124 75 80 rights, how to complete a rental application, how to locate housing and how to maintain their housing situation. Train consumers on how to 95 70 75 interview, hire, maintain and fire their ersonal care attendant. Train consumers independent daily 89 50 60 livin skills. Train consumers in their legal rights 20 20 25 and self-advocac . Train consumers in problem solving 30 25 30 and decision-makin skills. Provide consumers with housing 124 65 75 referrals to ac uire a lace to live. Provide consumers with information 25 20 25 on their entitlements. Provide consumers with assistive 95 65 10** devices and/or services. *If applicable **Number of consumers served to decrease due to loss of the Elderly Blind Services (EBS) program on March 31, 2004 and to decrease in our funding for the Independent Living (IL) program this fiscal year. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 CIL -East & West Hawaii - Agency Name Independent Living -Services -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 217,187 246,851 246,851 Professional Fees 9,716 9,688 9,688 O erations 67,618 68,572 73,572 E ui ment 12,786 7,216 7,216 Other•(C~ientAssistance) 35,886 6,356 6,356 Total 343,193 338,683 343,683 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Coun of Hawaii 15,000 15,000 20,000 State of Hawaii 55,616 64,938 64,938 Federal Funds 237,912 233,677 233,677 Hawaii Island United Wa 15,000 15,000 15,000 Donations 15,529 3,068 3,068 Service/Pro ram Fees 5,353 3,000 3,000 Private Foundations 8,000 4,000 4,000 Interest Income 17 0 0 Total 352,427 338,683 343,683 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 cIL-East & west Hawaii -Agency Name Independent Living Services - f fOgC'am 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 ayear-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 evaluat~io(n`of vour program's or agency's future funding requests I-~7-~~ Signature of Board President/Chair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 6 Diabetes Network of Hawaii County dba Diabetes Education and Counseling Center Developing a Healthier Lifestyle Series Agency Director: Martha L. Ah Yee Phone No.: 933-9718 Contact Person: Martha L. Ah Yee Phone No.: 933-9718 Mailing Address: 1221 East Kilauea Ave. Ste. 120 Hilo, HI 96720 Facility/Site Address: 1221 East Kilauea Ave. Ste 120 Hilo, HI 96720 Fax No.: 935-7725 Email Address: decchawaii@juno.com Amount of Request for County funds: $10000.00 Prior Year Funding: 01-02 02-03 03-04 $7000.00 $8000.00 $8000.00 Agency Mission Statement: The Corporation is organized for charitable and educational purposes to promote wellness among individuals with diabetes, their families and the community in general. Program Description: Developing a Healthier Lifestyle Series is a program that is designed to help people living with diabetes in providing information in supporting lifestyle changes. Utilizing the Diabetes Education and Counseling Center's (Center). curriculum on Health Education, Nutrition and Exercise as foundational blocks, each participant will have a hand in developing their own healthier I'rfestyles. As in the current fiscal year proposal, this Lifestyle Series will continue to provide NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 1 tools through instruction, resource materials and interactive activities. This Lifestyle Series offers two (2) six-week programs for two (2) hours each week in two (2) communities in East Hawaii. Class size will be limited to fifteen (15) participants at each site to facilitate a comfortable atmosphere in which immediate relationships may develop and accomplish class objectives within the specked time frame. There will be an assessed fee of $25.00 to symbolize the value of the program and a commitment on the part of the participant. At the completion of the program, a total of 30 participants will have learned self-management skills and be challenged to make lifestyle changes that will effectively manage and avoid or delay the complications associated with diabetes. Total Budget and Position Count Total Pro ram Bud et 10000.00 Total Pr ram Position Count 5 Total A enc Bud et 44360.00 Total A enc Position Count 2 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 Diabetes Network of Hawaii County dba Diabetes Education and Counseling Center Developing A Healthier Lifestyle Series Program Objectives: I. After the completion of Session I: "Let's Begin", the participant will be able to: 1). State what is diabetes 2). Define hemoglobin Al c and the target goal 3). Define microalbumin and the target goal 4). Define the difference between LDL and HDL cholesterol and their target goals 5). Define blood pressure and the target goal II. After the completion of Session II: "Getting Down to the Basics", the participant will be able to: 1). State the importance of exercise for a person with diabetes. 2). State the effects of activity/exercise on blood glucose levels. 3). Identfy one action that will be taken during the week to modrfy the amount or type of food eaten. 4). Identify why being overweight makes a person at risk for diabetes. 5). List 3 suggestions that a person with diabetes could use to lose weight. III. After the completion of Session III: "I'm Fine", the participant will be able to: 1). Identify a behavioral trait or emotion that is considered negative and that is difficult to change for someone with diabetes. 2). List 3 things to reduce the levels of stress 3). List 2 symptoms of depression. 4). Identify a source of emotional support or state one way to increase support. 5). Identify 5 coping mechanisms that counteracts feelings of anger, guilt and depression. IV. After the completion of Session N: "Tools of the Trade", the participant will be able to: 1). State the importance of daily glucose monitoring. 2). Define hypoglycemia and hyperglycemia and list two causes of each. 3). Identify his/her medications, dose, the times to be taken and the purpose of the medications. 4). List 3 reasons why taking diabetes medications regularly is very important in controlling diabetes. 5). List the resources available for those with diabetes. V. After the completion of Session V: "Hey, Who Dimmed the Llghts?", the participant will be able to: 1). State that blood glucose control reduces the risk for complications. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 3 2). List consequences and symptoms of diabetic neuropathy. 3). State the importance of eye, foot and dental care. 4). Describe two major consequences of small blood vessel disease. 5). List the risk factors and the ways to decrease the risk for developing arteriosclerosis. VI. After the completion of Session VI: "Where Do We Go From Here", the participant will be able to: 1). State confidently to ask his/her healthcare provider, family, friends for help, support and encouragement. 2). Identify 3 things that he/she will be able to use to make positive changes to his/her lifie. 3). State why controlling blood glucose levels is IMPORTANT. 4). State to a member in the class, the plans to increase in exercise. 5). Share with another member in class, 2 things throughout the six sessions that were encouraging on a personal level. Time Frame: October -November 2004, the Developing a Healthier Lifestyle (DHL) team will review and or add to the Session objectives and performance measures. Request from pharmaceutical companies for items as giveaways for the program and participants will begin. Location sites, meeting with community members, recruitment for participants will also take place during this period. November -December 2004 -Printing and collecting resource materials into participant and instructor binders will be completed during this month. DHL team will review in preparation for the upcoming Sessions. February -March 2005 Group I Sessions begin April 2005 -Follow-up phone calls to Group I participants March -April 2005 Group II Sessions begin May 2005 -Follow-up screenings for Group I June 2005 -Follow-up phone calls to Group II participants June 2005 -Follow-up screenings for Group II -Prepare program evaluation for County Annual Report by DHL team Program Highlights: The following program highlights for fiscal year 2002-2003 includes the following: The Center serviced 3,086 that included blood glucose screenings, class participation, walk-ins and diabetes related phone calls. The program desired to see an increase in student participation as well outreach. The Center participated in six (6) community health fairs including coordination of Taking Control of Your NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Diabetes conference in Hilo. Thirteen (13) presentations in Hilo, Keaau and Ka'u were held. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et' Estimate Session I Ob'ectives Session II Ob'ectives * Session III Ob'ectives * Session IV Ob'ectives * Session V Ob'ectives " Session VI Ob'ectives *See below for details **FY 2003-04 measures are not coin leted at the time of this a lication *If applicable Performance Measures Session I: "Let's Begin" FY 2004-05 Ob'ectives Number of artici ants will: Estimate State what is diabetes 30 Define hemo obin Alc & to et 30 Define microalbumin & to et 30 Differentiate between LDL/HDL & to et 30 Define blood ressure & to et 30 Session II: "Getting Down to the Basics" Ob'ectives Number of artici ants will: Estimate State the im ortance of ezercise 30 State the effects of ezercise and ucose 30 Idea ' one action taken to moth food eaten 30 Identi overwei t with at risk for diabetes 30 List 3 su estions to lose wei t 30 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 5 Session III: "I'm Fine" Ob actives Number of artici ants will: Estimate Identi a behavioral trait/emotion difficult to Chan a 30 List 3 thin s to reduce levels of stress 30 List 2 s m toms of de ression 30 Identi a source of emotional su ort 30 Identi 5 co in mechanisms that counteract feelin of an er, ilt 30 Session IV: "Tools of the Trade" Ob'ectives Number of artici ants will: Estimate State im ortance of da' blood lucose monitorin 30 Define 6 o and h e cemia listin two causes for each 30 Iden ' medications, dosa e, Mari and u se 30 List 3 reasons wh im octant to take diabetes medications 30 List resources available for diabetics 28 Session V: "Hey, who dimmed the lights?" Ob'ectives Number of artici ants will: Estimate State blood lucose control reduces risk for com lications 30 List cons uences/ m toms of diabetic neuro ath 28 State im ortance of e, foot and dental care 30 Describe 2 ma'or copse uences of small blood vessel disease 28 List risk factors and wa s to decrease develo in arteriosclerosis 28 Session VI: "Where do we go from here" Ob'ectives Number of artici ants will: Estimate State confident askin healthcare rovider, fam' ,friends for hel 30 Identi 3 thin that hel make ositive Chan es 30 State wh controllia blood lucose is im ortant 30 State to a member of the class tans to increase eaercise 30 Share with a member 2 thin that were encoura 'n 30 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 6 Diabetes Network of Hawaii County dba Diabetes Educaton and Counseling Center Developing a Healthier Lifestyle Series Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es *0.00 Professional Fees 300.00 O erations 3765.00 E ui ment 925.00 Other* 756000 Total 12550.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Session Fees $25.00 x 30 750.00 750.00 UHM Cooperative Extension 1800.00 *1800.00 Diabetes Pro ect *See below for details Total 2550.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 7 Program Expenditures & Funding Sources Attachment Salaries and Wages: The Diabetes Education and Counseling Center's Executive Director is currently an employee of the University of Hawaii at Manoa Cooperative Extension Diabetes Project. As of January of this year, the Center has contracted services for a Center assistant and Outreach Coordinator. At this time no salaries are being paid by the Diabetes Education and Counseling Center. The Developing a Heakhier Lifestyle Series has budgeted under line item, "Other", a Program Coordinator for this specific project along with 4 other instructors, who are also contracted for this specific project. Program Funding Sources: The University of Hawaii at Manoa Cooperative Extension Diabetes Project will furnish part of the manpower and the screening equipment and supplies at no cost to the Developing s Healthier Lifestyle Series. As part of the UHM-CE Diabetes ProjeM, it's goal has been to provide free screenings and education on diabetes throughout the Big Island. The initial and follow-up screenings which includes: Hemoglobin Aic, Microalbumin, LDL cholesterol and Blood Pressure checks are approximately $30.00 per person per screening. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 8 ~ N'~ 0~ ~7C T(~nZ7 fn W ~ '~1 W ~ ~ ~ ~ c ~'t`#c'vcxc ~ ~y d o 0 o a~ ~ ~m m o n ~ 0 3 m ~ ~ ni ~ ~ ~ y ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ r c ~ mn warm c~W ~'~o-o t3 oT v_~ a. w c m~N vo. m~ 9a • a ~ ~ g Q y fo m n'- d gym' n ~ ~ f° o ~ 3 j~ 3 fD~ m 0 !"m m mm ~ w 0 • C O. ~ ~ 7 W ~ O m ~ w ~ Y :y, _ _ ~ W (TO Ut N G 3 000(T f O O O O ~ O O O O f/f N A c v pp~~ <O V N N V N A N A OD W w A N N O (n N O O W A A u t ~ W (O N O o V O ~ ~ O O t T 0 O O O O N O D W O A Opp O D O O (T O O O O O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O O N N 3 j N {Q _O N N V W O O O O N N O O O C= S ~ O O O S O O S O ~ ~ m m g fA N W W a CT A ~ O N~ 0 0 c~ 3 0 0 3 ~ n N^ N m r O O Q ((pp ~ y N 41 C (p f/1 r®} d ~ N y V~ N n N `C m ~ m m ~ ~ m 3 ~ m m v v_ ~ N ~ N 7 X O O' N j~~ ~ N X ~ F ~ ~ N~~(ap ~ N ~ ~ ~ ~ ry ~ X Z ~ S N 01 X fp A m N C ~ x N 0. N p~ 4? 7 N X fY]' w N W N ~ ~ T ~ N ~ m j N N N A Xm A F 41 C N ~ O O ~ S T N O O A b Diabetes Network of Hawaii County dba Diabetes Education and Counseling Center Developing a HeaRhier Lifestyle Series 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 ayear-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 resort may impact the evaluation of vour aroaram's or aaencv's future funding reouests. 1 Sig ture Bo President/Chair Date Victor . Vierr/a~~ / Signature of Executive Di ector Date Martha L. Ah Yee, MPH UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 9 East Hawaii Coalition for the Homeless - Agency Name Kihei Pua Emergency Shelter - PrOg~am Name Agency Director: Steven Bader Phone No.: 969-4848 Contact Person: Steven Bader Phone No.: 969-4848 Mailing Address: 138 Kinoole Street Facility/Site Address: 115 Kapiolani Street Fax No.: 969-4850 Email Address: ehch@interpac.net Amount of Request for County funds: $39,000.00 Prior Year Funding: 01-02 02-03 03-04 $34000.00 $37500.00 $37500.00 Agency Mission Statement: "Creating opportunities that enhance the quality of life for homeless families and individuals". Program Description: lCihe Pua is a 24 hour emergency shelter that serves families and individuals. The program provides opportunities for participants to become self sufficient and obtain permanent housing. Anon-shelter extension of this program is in Pahoa. Total Budget and Position Count Total Pro ram Bud et 464654.00 Total Pro ram Position Count 11 Total A enc Bud et 629480.00 Total A enc Position Count 16 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 East Hawaii Coalition for the Homeless - Ag2nCy Naf11@ Kihei Pua Emergency Shelter - PrOgratll N8fI1@ Program Objectives: 1) Provide 24 hour emergency shelter for homeless families and individuals 2) Provide 24 hour food pantry for unsheltered walk-ins 3) Develop individual service plans for all clients within 3 days of entrance 4) Provide quality case management, referrals and classes for all clients 5) Ensure that 75% of those serve meet 75% of their goals within 6 weeks 6) Provide food pantry, advocacy and referrals to residents of tower Puna. Program Highlights: 1) Provided shelter to over 200 children. 2) Developed partnership with workforce development to deliver employment readiness classes at Hale O Puna our Pahoa office. 3) Haili Christian Church to delivers hot meals to shelter residents on Sundays. 4) Received donations of three new refrigerators, a used cargo van, health packets, Christmas gifts and food and clothing through Kaiser Permanente community partnership. 5) Participated in the Continuum of Care planning process and Big Island Strategic Plan on Homelessness. 6) Provided over 50,000 service contacts to clients through Hale O Puna. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate #Undu licated Homeless Hilo 457 600 600 # Undu licated Homeless Puna 2,380 2,500 2,500 # Meal Packa es Provided 73,688 75,000 75,000 #Provided Non-Food Services 5,684 6,000 6,000 # Entered Permanent Housin 189 300 300 # Entered Transitional Housin 27 45 45 # Enrolled in Trainin Hilo 23 50 50 # Obtained Em to ment 21 30 30 # Receivin Mental Health Treat. 44 50 50 # Enterin Subtance Abuse Treat. 108 125 125 *If applicable NONPROFTT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 East Hawaii Coalition for the Homeless -Agency NaCne Kihei Pua Emergency Shelter - Pt'Ogr811'1 Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 310351.00 323000.00 323000.00 Professional Fees 10645.00 10780.00 10780.00 O erations 4000.00 4000.00 3155.00 E ui ment 6000.00 5000.00 5000.00 Other* 142934.00 111354.00 122719.00 Total 473930.00 454134.00 464654.00 'Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate State of Hawaii 244000.00 220000.00 229020.00 Coun of Hawaii 37500.00 37500.00 39000.00 Hawaii Island United Wa 15000.00 17500.00 17500.00 Pr ram Fees 12000.00 14000.00 14000.00 Other/Donations 43500.00 115034.00 115034.00 ESG Federal Grant 38800.00 50100.00 50100.00 Total 390800.00 454134.00 464654.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 East Hawaii Coalition for the Homeless Kihei Pua Emergency Shelter Other"'Expenses Year 02-03 Year 03-04 Year 04-O5 Air Fare 542.00 700.00 700.00 Insurance 20,424.00 17,500.00 21,000.00 Lease/Rental Space 21,601.00 21,610.00 21,610.00 Postage/Freight 526.00 900.00 900.00 Publication/Printing 974.00 600.00 600.00 Repair/Maintenance 4,486.00 6,600.00 6,600.00 Supplies 3,435.00 3,000.00 3,000.00 Telecommunication 8,295.00 8,000.00 8,000.00 Utilities 38,017.00 32,444.00 35,444.00 Miscellliax/Dues 26,558.00 1,000.00 2,865.00 Direct Services 18,076.00 19,000.00 22,000.00 Tota I Other 142, 934.00 111, 354.00 122.719.00 East Hawaii Coalition for the Homeless - Ag@I1CY N8171t' Kihei Pua Emergency Shelter - Pf O9Fc'Inl Nc]tl1@ 1 (we) have read and understood ail 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, 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. t (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, f (we) understand and will comply with the requirement to submit ayear-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 near-end resort may impact the evaluation of your program's or agency's future funding requests. Signature of Bo President/Chair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 East Hawaii Coalition for the Homeless - /fig@I1Cy N8iT12 Kihei Pua Transitional Housing Program - PfOg('2tll N8C11@ Agency Director: Steven Bader Phone No.: 969-4848 Contact Person: Steven Bader Phone No.: 969-4848 Mailing Address: 138 Kinoole Street FacilitylSite Address: Scatterd Sites Fax No.: 969-4850 Email Address: ehch@interpac.net Amount of Request for County funds: $3,500.00 Prior Year Funding: 01-02 02-03 03-04 $2,500.00 $2,500.00 $2,500.00 Agency Mission Statement: "Creating Opportunities that enhance the quality of life for homeless families and individuals" Program Description: The Kihei Pua Transitional program provides scattered site housing opprtunities for families and single men and women. Participants can receive service for a maximum of two years with the goal of securing permanent housing. Total Budget and Position Count Total Pro ram Bud et 164826.00 Total Pro ram Position Count 1 Total A enc Bud et 629480.00 Total A enc Position Count 16 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 East Hawaii Coalition for the Homeless - f1g@nCy N3t71@ Kihei Pua Transitional Housing Program - Pf'Ogf aI71 ~lafTl@ Program Objectives: 1) Provide 45 homeless individuals and 30 families with transitional housing and support services. 2) Ensure that 75% of clients meet 75% of their goals before exiting the program. 3) Provide necessary tools to secure and maintain permanent housing. 4) Develop productive community members who will support their community in a positive and healthy manner. Program Highlights: 1) EHCH was awarded 400,000 from HUD to develop its Kalakaua Ptace transitional housing project at the former Hilo Hotel. 2) Haili Christain Church delivers hot meals to our transitional clients on Sundays. 3) One of our Program participants was chosen "Family of the Year" by Child & Family Services, profiled by the Star Bulliten and KHON-TV and honored at a banquet in Honolulu for overcoming obstacles of homelessness and domestic violence. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate # of New Families Served 28 35 35 # of New Sin les Served 40 45 45 # of Life Skills Classes 99 100 100 # of Meals 500 700 700 # Enrolled in Trainin /Education 10 25 25 # Obtained Em to ment 7 20 20 # Com leted Sub. Abuse Treat. 6 15 15 # Transitioned off Welfare 5 5 5 # Secured Permanent Housin 16 25 25 # Retained Permanent Housin 16 25 25 *If applicable NONPROFTI' GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 East Hawaii Coalition for the Homeless - /fig@r1Cy NBiTI@ Kihei Pua Transitional Housing Program - f ~Og~al11 Na1112 Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 58561.00 61970.00 66970.00 Professional Fees 4561.00 4620.00 4620.00 O rations 1000.00 820.00 800.00 E ui ment 3817.00 3000.00 3000.00 Other' 133513.00 79936.00 89436.00 Total 201452.00 150346.00 164826.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate State of Hawaii 61000.00 55000.00 68480.00 Count of Hawaii 2500.00 2500.00 3500.00 Hawaii Island United Wa 5000.00 5000.00 5000.00 Fees 34150.00 61000.00 61000.00 OtheriDonations 18775.00 26846.00 26846.00 Total 121425.00 150346.00 164826.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 East Hawaii Coalition for the Homeless Transitional Other"`Expenses Year 02-03 Year 03-04 Year 04-05 Air Fare 233.00 200.00 200.00 Insurance 8,754.00 7,500.00 9,000.00 Lease/Rental Space 85,256.00 45,690.00 49,190.00 Postage/Freight 227.00 300.00 300.00 Publication/Printing 418.00 400.00 400.00 Repair/Maintenance 1,923.00 3,023.00 4,023.00 Supplies 1, 472.00 1, 000.00 1, 000.00 Telecommunication 3,555.00 2,000.00 2,000.00 Utilities 16,293.00 10, 000.00 13, 000.00 Miscell/Tax/Dues 11,382.00 2,914.00 914.00 Direct Services 4,000.00 6,909.00 9,409.00 Total Other 133,513.00 79,936.00 89,436.00 East Hawaii Coalition for the Homeless - Ag@CICy Name Kihei Pua Transitional Housing Program - P('Ogt'at11 I~atl12 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, I (we) understand and will comply with the requirement to submit ayear-end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shalt 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 near-end resort may impact the ev luation of our ro ram's or a enc 's future fundin re nests. ignature of Boa resident/Chair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 4 Family Support Services of West Hawaii Family Centers Agency Director: Don Bebee Phone No.: 334-4116 Contact Person: Joseph Fichter Phone No.: 334-4129 Mailing Address: 75-127 Lunapule Road, Suite 11 Kailua-Kona, HI 96740 Facility/Site Address: same Fax No.: 326-4063 Email Address: kids@fsswh.org Amount of Request for County funds: $65,000.00 Prior Year Funding: 01-02 02-03 03-04 $50,000. $48,000. $48,000. Agency Mission Statement: To Support Families and Communities in Providing Love and Care for our Children Program Description: Family Support Services of West Hawaii (FSSWH) is seeking funds for the continuation of the Ka'u and North Kohala Family Centers. These centers provide access to a wide range of family support services and other community resources in remote, rural areas of the Big Island. We work with the family as a whole, guiding people through the process of finding solutions to multiple problems addressed, if at all, by a maze of different agencies. Our purpose is to help families prevent crises, define problems, identify strengths, and be responsible for determining their own solutions. These Family Centers are the only places in their Districts that all residents can go to get the help and support they need in a familiar setting. The centers have been intimately involved in community based anti-drug efforts and initiatives. For example, in North Kohala, our Family Center coordinator was one of the founding members of the Community Response to Ice group. The Center has also been used for planning and implementation of FSSWH's substance abuse prevention program, Kohala's Project Venture, a CSAP recognized Best Practice. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 FAMILY SUPPORT SERVICES OF WEST HAWAII FAMILY CENTERS Total Budget and Position Count Total Pro ram Bud et $93,873 Total Pro ram Position Count 1.64 Total A enc Bud et $3,325,000 Total A enc Position Count c.80 Program Objectives: 1) Strengthen the capacity of existing resources 2) Attract needed and additional resources 3) Increase individual's ability to access 4) Increase parenting skills 5) Decrease isolation in rural communities Program Highlights: 1) Provide facilities to other service providers, for 388 service hours per year for their activities and services. 2) Provided information and referral to 496 people to meet their needs at our centers. 3) Provide office and technological support to 175 people in our communities. 4) Sponsored two community-wide events for family strengthening, one at each site. 5) Community youth continue to use the Ka'u Family Center as their site to research, write, edit and produce the award winning newsletter, Rising Tides. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Education 2 5 10 Em to ment 3 10 10 Financial 13 20 20 Health 4 10 20 Parentin Information 13 12 25 Office Equi ment/use 175 155 155 Childcare 2 6 6 Substance Abuse Su ort and Info 11 17 60 Food 31 122 40 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 FAMILY SUPPORT SERVICES OF WEST HAWAII FAMILY CENTERS Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es $47,241.00 $52,994.00 $51,835.00 Professional Fees 182.00 1,400.00 400.00 O erations 417.00 968.00 500.00 Equi ment 2,925.00 3,500.00 2,500.00 Other* 29,641.00 37,632.00 38,638.00 Total $80,406.00 $96,494.00 $93,873.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Count of Hawaii $48,000.00 $55,000.00 $65,000.00 Donations 37,207.00 41,494.00 28,873.00 Total $80,406.00 $96,494.00 $93,873.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 FAMILY SUPPORT SERVICES OF WEST HAWAII FAMILY CENTERS Program Expenditures -Detail of Other Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Em to ee Benefits $5,858.00 $6,350.00 $7,558.00 Pa roll Taxes 5,135.00 5,658.00 6,230.00 Su plies 4,924.00 4,671.00 6,700.00 Occupanc 12,029.00 18,638.00 16,300.00 Insurance 1,476.00 1,832.00 1,650.00 Travel 219.00 483.00 200.00 Total Other $29,641.00 $37,632.00 $38,638.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 FAMILY SUPPORT SERVICES OF WEST HAWAII FAMILY CENTERS 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 ayear-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 vear-end report may impact the evaluation of your program's or agency's future funding requests. '12 8/o t~ S~ a re 9 oar President/Chair Date S gnature of Exe~U ve Director ate UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Friends of the Children's Justice Center - Ager,Cy Namt? Special Needs and Enhancement, Center Support, Prevention/Education and Training Programs - PrOgi'am Name Agency Director: Alberta Dobbe Phone No.: 935-8755 Contact Person: Jenny Tokuuke Phone No.: 935-8755 Mailing Address: 1290 Kinoole Street Facility/Site Address: Hilo, Hawaii 96720 Faz No.: 933-0968 Email Address: fcjceh@fcjc.org Amount of Request for County funds: $15000.00 Prior Year Funding: 01-02 02-03 03-04 $13000.00 $13000.00 $13000.00 Agency Mission Statement: The mission of the Friends of the Children's Justice Center of East Hawaii is to help sexually, physically, emotionally, abused, and neglected children. We do this in partnership with the Children's Justice Center of East Hawaii, by providing funds and resources to support the needs of these children. The "Friends" offer hope, encouragement, and opportunity for victims of child abuse. Program Description: The Friends of the Children's Justice Center of East Hawaii was incorporated in 1990 as a 501 c3 nonprofit organization. Originally the Friends were formed to support their private-public partner, the Children's Justice Center of East Hawaii. They continue to do so but have expanded their purpose after discovering there were gaps in services to abused/neglected children. Their partnership with the NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Children's Justice Center, a program of the State Judiciary Branch continues to succeed with the provision of services to child victims and their families not available through any other private or public source. The Friends facilitate services to abused/neglected children by accepting referrals from state and private agencies working with child abuse victims such as Child Welfare Services, Child and Family Services, Hawaii Behavioral Health, Catholic Charities, Parents, Inc, Victim Assistance, Sexual Assault Victim Empowerment, etc. The Friends' message is one of encouragement and they offer opportunities for abused/neglected children to Lead healthy and productive lives. The organization is currently governed by a Board of Directors and staffed by a Program/Volunteer Coordinator and five volunteers. The Special Needs and Enhnacement Program is designed to help child victims re-establish self-esteem and develop positive self-worth. This is accomplished by providing for needs that would otherwise go unmet including basic essentials (i.e. clothing, diapers, toiletries), special needs (i.e. air/ground transportation, school supplies, correspondence course) and enhancement support (sports, music lessons, tutoring). Gifts are also given to abused/neglected children at special occassions such as Christmas. With the help of Senator Daniel Inouye's Ready to Learn Program, we distribute school supply kits to abused/neglected children at the beginning of each academic year. The Center Support Program helps to reduce trauma and ensure the safety and comfort of the children that come to the Center for interviews. The Friends maintain this inviting atmosphere by furnishing the Center with donated toys and games and by repairing and refurbishing the Center as needed. The Prevention/Education Program coordinates, implements and sometimes financially supports activities in schools and in the community to promote public awareness on issues regarding child abuse. The Training Program helps to sponsor the attendance of various professionals including social workers and police interviewers who work with victims and their families at seminars and conferences in order to enhance the quality of services child victims receive. This prevents victims from being retraumatized by the system's response to the reports of abuse. Total Budget and Position Count Total Pro ram Bud et 15000.00 Total Pro ram Position Count 1 Total Agency Budget 144050.00 Total Agency Position Count 1 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 Friends of the Children's Justice Center of East Hawaii - Agency Name Special Needs and Enhancement, Center Support, Prevention/Education and training Programs -Program Name Program Objectives: 1) Provide funds for clothing, toiletries, bed/folding mattresses for children in emergency or relative foster placement. 2) Cover the costs of tutoring services, correspondence courses, summer school tuition to allow a child to graduate or progress on to the next grade level. 3) Pay for fees, equipment and supplies needed for the extracuricular activity (sports, music lessons, art, etc.) that a child is involved in. 4) Provide gifts for a special occasion such as Christmas when a child would not receive a gift elsewhere. 5) Provide gas coupons to families on a limited budget so children may be able to attend treatment programs. 6) Pay for school fees, e.g. seniors cannot graduate without prepayment of fees at start of school year. 7) Cover costs, short-term, when gaps in funding for treatment occurs, for a child who needs ongoing therapy. 8) Provide clothes, formula and supplies for infants removed at birth from drug addicted mothers. 9) Give children a chance to participate in school functions by paying for excursion fees, prom dresses, senior pictures, etc. 10) Assist police and social workers in keeping abreast of the latest investigative techniques, sensitivity training, forensics and knowledge of resources by helping to sponsor their attendance at trainings and seminars. 11) Coordinate the distribution of school supply kits obtained from Senator Daniel Inouye's Ready to Learn Program. 12) Provide privacy, comfort and safety for clients who come to the Center by maintaining its warm and low-key environment. 13) Collaborate with community organizations to formulate and implement innovative prevention programs targeting schools. 14) Coordinate prevention/education activities within the community to spread awareness on issues about child abuse to the general public. Program Highlights: 1) Provided 157 Christmas gift certificates to children 2) Filled 712 Special Needs requests for children 3) Provided 222 Ready to Learn Kits 4) Members of our Organization did radio awareness on KPUA in April (Child abuse Prevention Month) NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 5) Held speaking engagements about abuse at Rotary Club, Exchange Club, and Zonta Club meetings 6) Conducted sign waving and had a month long display at the Prince Kuhio Plaza to increase public awareness Pertormance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Budget * Estimate Special Needs and Enhancement 630 752 767 Re uests Winner's Camp 4 0 6 Read To Learn Pro~ect 243 222 245 Christmas Gift Project 190 157 190 Prevention/Education activities 12 14 16 Training 10 12 14 "If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Friends of the Children's Justice Center of East Hawaii - AgerlCy Name Special Needs and Enhancement, Genter Support, Prevention/Education and Training Programs -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Budget * Estimate Salaries and Wa es Professional Fees Operations E ui ment Other* 13000.00 13000.00 15000.00 Total 13000.00 13000.00 15000.00 'Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Budget * Estimate Donations 25087.00 23782.00 23000.00 Charity Walk 3000.00 3000.00 3000.00 County Grant 13000.00 13000.00 15000.00 Geist Foundation 25000.00 34000.00 30000.00 Teresa Hughes Foundation 25000.00 34000.00 30000.00 Weinber Foundation 10000.00 4800.00 10000.00 Workshop Fees 260.00 Friends of Foster Care 1000.00 1630.00 Interest Income 339.00 205.00 50.00 Mclnerny Foundation 10000.00 10000.00 Hawaii Womens Le al Fund 4560.00 Atherton Foundation 10000.00 Frear Foindation 5000.00 5000.00 Hawaii Island United Way 15000.00 Total 111686.00 139977.00 144050.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Friends of the Children's Justice Center of East Hawaii - /fig@f1Cy N8fT1@ Special Needs and Enhancement, Center Support, Prevention/Education and Training Programs - PCOgfi911111 Na111@ 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 ayear-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 reouests Signature of Board P,esident/Chair Date 1~~. ~~1~4 Signatur cecutnvei3irecteF Date Program o unteer Coordinator UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 6 FRIENDS of the Children's Justice Center of West Hawaii - A9@f1Cy Na171@ Enhancement and Basic Need Program - P~OgI'8t11 Nafll@ Agency Director: Alice Daniel Phone No.: 331-2425 Contact Person: Alice Daniel Phone No.: 331-2425 Mailing Address: 77-6403 Nalani Street, Kailua-Kona, HI 96740 Facility/Site Address: 77-6403 Nalani Street, Kailua-Kona, HI 96740 Fax No.: 331-2425 Email Address: fcjcofwh@lava.net Amount of Request for County funds: $15000.00 Prior Year Funding: 01-02 02-03 03-04 $13000.00 $13000.00 $13000.00 Agency Mission Statement: The mission of the FRIENDS of the Children's Justice Center of West Hawaii is to provide assistance to children who have been traumatized by sexual assault, physical abuse or neglect or who are witnesses to violent crime, to promote prevention of child abuse and to support the Children's Justice Center of West Hawaii. Program Description: The FRIENDS of the Children's Justice Center of West Hawaii was formed in 1989 as the Friends of the Children's Advocacy Center of West Hawaii to provide support to child victims of abuse, neglect and sexual assault. The name changed to the FRIENDS of the Children's Justice Center in 2001. The program for which we seek funds from the County of Hawaii is our "enhancement and basic needs" program which provides funds for activities, services and material NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 things that the child would otherwise go without. Requests for funding are submitted by a professional person working with the child, such as the social worker, therapist or counselor. There must be a documented case of abuse or neglect or witness to violent crime. The requests have ranged from diapers to prom dresses. Our goal is to "help a victim become a child again" We are able to help with basic needs and provide emergency assistance in situations where no governmental or other private agency can meet the need quickly. The FRIENDS have helped with emergency housing and food. The FRIENDS also have helped a few young people with their dental health needs when they were not covered by insurance or it was beyond the ability of foster families to provide. The largest portion of the program goes directly to the children to provide enhancements such as athletic, music, dance, sewing, or riding lessons, tutoring, Summer camp programs, and Winners' Camp. The enhancement program also provides support to the Children's Justice Center by helping to provide a warm, child-friendly atmosphere for the children and their siblings when they are brought to the Center for their forensic interviews. We also provide each child brought to the Center with a small gift as a token of our commitment to them. The program is coordinated by a half-time staff person, a 13-member board of directors, and approximately 25 volunteers who help with special projects. Requests for assistance are reviewed by the staff and the Program Committee of the Board of Directors. Large requests are reviewed by the Board of Directors. Total Budget and Position Count Total Pro ram Bud et 86954.00 Total Pro ram Position Count 1 Total Agency Budget 116479.00 Total A ency Position Count 1 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 FRIENDS of the Children's Justice Center of West Hawaii - AgeCICy NafTle Enhancement and Basic Needs Program - Program Name Program Objectives: 1) Assist ten or more children to attend Winners' Camp by the end of June 2005. 2) Give holiday gift certificates to 100 teenage youth by the end of December 2004. 3) Give 50 FRIEND boxes to children entering a foster home for the first time, or children being transferred to a new foster home, by the end of June 2005. 4) Assist in planning at least two follow up activities for Winners' Camp graduates to support the achievements made by the teens during the camp experience by June 30, 2005. 5) Provide funding for 500 or more enhancement/basic needs requests by June 30, 2005. 6) Support training projects coordinated by the Children's Justice Center of West Hawaii to build and sustain interdisciplinary teams of State and County staff who work with cases of child abuse and neglect in West Hawaii by December 31, 2004. 7) Assist three youth with non-cosmetic orthodonia treaments by June 2005. Program Highlights: 1) Thirteen teens were sent to Winners' Camp during the fiscal year 2002- 2003. 2) Ninety seven holiday gift bags, with a Borders Books and Music gift certificate and other small items, were distributed during December 2003. 3) Over 500 diapers were distributed in December 2003 to the Department of Human Services intake centers in West Hawaii to provide for the emergency needs of infants in their care. 4) Thirteen FRIEND boxes have been distributed to children entering foster care since the initiation of the activity in November 2003. 5) During the calendar year 2003, over $9,000.00 was expended for emergency requests for basic needs such as rent, clothing, food, diapers and special dental and medical services. 6) During the fiscal year 2003 loans in the amount of $1289.88 were granted to the Department of Human Services to assist with the emergency needs of clients. All loans for 2003 have been repaid. 7) Twelve Winners' Camp graduates attended the first Winners' Camp reunion activity sponsored by the FRIENDS in December 2003. A second activity is planned for the month of February, 2004. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 8) During the calendar year 2003, 359 separated requests were processed which provided an enhancement or basic need services for 492 individuals. 9) On November 7, 2003,19 professional staff from the Hawaii County Police Department and the State of Hawaii Department of Human Services attended a day ofteam-building activities sponsored by the FRIENDS. 10) In 2003 three young people have been approved for non-cosmetic orthodonia treatment. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Children-CJC support Fiscal year 376 260*` 400** 2002-2003 Enhancement/Basic Need 492*** 300** 550** Requests-Individuals served calendar ear 2003*** Holiday gift bags Fiscal Year 2003- 97 100 110 2004 Winners' Camp-Fiscal Year 2002- 13 10 18 2003 FRIEND Boxes--new activity- 2 13 0 100 months **The FRIENDS budget by catagories of service rather than by the number of children served ***next year we will be able to re ort statistics for the fiscal ear *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 FRIENDS of the Children's Justice Center of West Hawaii - Ag@I1Cy Nafne Enhancement and Basic Needs Program - PPOgf'afYl Nafne Program Expenditures (county Grant Portion) FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 0.00 0.00 0.00 Professional Fees 0.00 0.00 0.00 O erations 0.00 0.00 0.00 E ui ment 0.00 0.00 0.00 Other* 14535.45 13000.00 15000.00 Total 14535.45 13000.00 15000.00 'Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Coun of Hawaii 13000.00 13000.00 15000.00 Total 13000.00 13000.00 15000.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Friends of the Children's Justice Center of West Hawaii Program Expenditures from County of Hawaii Funds *Other ITEM FY 2002-03 FY 2003-04 FY 2003-04 FY 2004-05 ACTUAL BUDGET TO DATE BUDGET Athletic 370.63 1,000.00 0.00 500.00 Cetner Su ort 0.00 200.00 319.16 300.00 Clothin 515.00 600.00 100.00 600.00 Dental 7,502.15 0.00 560.97 3,000.00 Education 1,456.00 600.00 1,155.65 800.00 Emer enc 267.50 2,000.00 1,519.38 1,500.00 Food 250.00 0.00 600.00 600.00 FRIEND boxes 0.00 0.00 108.96 500.00 Gift Certificates 0.00 1,000.00 0.00 0.00 Medical 134.39 500.00 0.00 200.00 Miscellaneous`*" 56.66 500.00 0.00 100.00 Pertormin Arts 325.00 500.00 0.00 500.00 School Su lies 672.62 500.00 439.20 800.00 S ecial Events 330.00 0.00 382.84 800.00 Summer Cam 919.50 2,300.00 0.00 1,000.00 Thera 110.00 500.00 0.00 200.00 Travel 1,626.00 2,300.00 250.00 600.00 Winners' Cam 0.00 2,500.00 1,123.01 3,000.00 TOTALS: $14,535.45 $15,000.00 $6,559.17 $15,000.00 * $13,000 was received during the 2002-2003 grant period The expenditures over that amount are accounted for by a balance of $485.45 that was carried over from the 2001-2002 grant period plus several checks, totaling $1050.00, that were written during the 2001-2002 grant period a~ returned during the 2002-2003 grant period. **GIFT CERTIFICATES: The acceuuting far 1;ift eertifcutes is Curren+!J cl:~.^.e E*f~~~;iaz,ica Eh_ amount to a category such as clothing, Schaal supplies ar a special event such as a hirthda} . ***lvIISCELLAi~tEOUS, such as birth certificate requests ****SIIMMER CAMP - we expect requests in June *~`*'*1~'.IN rERS' CAlYIP - we will be sending a group to the Spring Camp in March - 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 ayear-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 vear-end report may impact the evaluation of vour program's or aaencv's future funding requests Signature of Board Presi ent/Chair Date Signature of _ Date Program Coordinator UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 6 Goodwill Industries of Hawaii, Inc. Work Experience Program Agency Director: Laura Robertson Phone No.: 836-0313 ext 244 Contact Person: Kathleen Nielsen Phone No.: 961-0307 ext 102 Mailing Address: 500 Kalanianaole Ave, Hilo, HI 96720 Facility/Site Address: 500 Kalanianaole Ave, Hilo, HI 96720 Fax No.: 969-3861 Email Address: KNielsen@higoodwill.org Amount of Request for County funds: $20,000 Prior Year Funding: 01-02 02-03 03-04 $10,000 $10,000 $10,000 Agency Mission Statement: Our mission statement is: Goodwill Industries of Hawaii, Inc, is a leader in partnering with people with disabilities and other employment barriers, providing them fhe opportunity to achieve their full potential through skills preparation and career development. 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 Welfare-To-Work TANF/TAONF and Food Stamp recipients. With 45 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 Hilo has been serving our community since 1998. We envision a world where all individuals 1/30/2004 NON PROFIT GRANT APPLICATION 1/7 FISCAL YEAR 2004-OS Goodwill Industries of Hawaii, Inc. Work Experience Program 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. In 2003, GIH successfully provided services to over 6,654 people statewide, and placed 1,279 people into gainful employment. The East Hawaii branch of Goodwill Industries provided services to 871 individuals in 2003, resulting in a 305% increase over the previous year. Over the past five years, Goodwill has successfully provided training and employment services to more than 17,000 people with barriers to employment, and placed more than 4,100 people into employment. These numbers reflect that Goodwill has the necessary skills and experience to perform the proposed services. Last year Pacific Business News ranked GIH as the #1 Permanent Placement Firm in the State, for the fourth consecutive year. It is our belief that work is a basic right that assists people to attain other life goals. Moreover, we believe in each individual's right to self-determination, to make their own 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 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, Child Care Connection of Hawaii, Hawaii Literacy, Department of Education, Legal Aid Society, Chamber of Commerce, Goodwill Industries International, employers in identified industries with job opportunities corresponding to participants' career goals, and other designees. Natural supports are developed to enhance the individual experience in the workplace and collaboration between employer, family, friends, and the program staff will be emphasized to increase the probability of long-term 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 1/30/2004 NON PROFIT GRANT APPLICATION 2/7 FISCAL YEAR 2004-OS Goodwill Industries of Hawaii, Inc. Work Experience Program 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 paticipant's productivity is measured every six months. Each participant will become familiar with and choose the program that is right for them. When the work area has been chosen, the participant will be trained on how to perform the essential job functions needed for the position(s). The benefits of developing these work skills extend beyond the work environment. Program participants will know 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 employment brings to our trainee's lives. More than bringing financial self- sufficiency, work taps the spirit of the individual, provides equal opportunity, inclusion, and demands commitment and dedication values that provide the foundation for our community. In 2002-2003, the Work Experience Program served 14 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. Training was provided to allow participants to attain and maintain skills in the areas of making choices, self-care, mobility, community access, communication, interpersonal relationships, social competency, money management, and pre-vocational readiness. Each participant's goals were developed in an Individualized Future Plan. This year Goodwill Industries of Hawaii is requesting an increase in funding to purchase assistive devices for persons with disabilities in the program. Proposed equipment purchases include: tables with height adjustment to be used for people in wheelchairs, aprons with pockets to carry tools easily, back supports to assist when lifting, bins with springboard bottoms to raise product toward the person loading or unloading, rubber mats to ease leg fatigue when standing, adaptive chairs and low clothing racks that can be reached easily from a wheelchair. These devices will strengthen the program and increase the comfort, productivity, and success of participants. 1/30/2004 NON PROFIT GRANT APPLICATION 3/7 FISCAL YEAR 2004-OS Goodwill Industries of Hawaii, Inc. Work Experience Program Total Budget and Position Count Total Pro ram Bud et $20,000 Total Pro ram Position Count 2 Total A enc Bud et $1,440,000 Total A enc Position Count 49 * Total Agency Budget denotes Hilo Branch only Program Objectives: 1) Enroll 15 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. 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 bi-monthly, according to hours worked. 9) Conduct time study for each participant every six months. 10) Update wages according to productivity level. 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, and attendance. Program Highlights: 1) Enrolled 14 participants in the Work Experience Program as of January, 2004. 2) Instructed participants in proper work techniques for each workstation. 3) Developed motivational skills and attitudes for success, self-confidence and problem solving skills for each participant. 1/30/2004 NON PROFIT GRANT APPLICATION 4/7 FISCAL YEAR 2004-OS Goodwill Industries of Hawaii, Inc. Work Experience Program 4) Conducted time measurement study for each participant within 2 weeks from date of entry into program. 5) Reviewed outcome of time study with each participant upon completion of study. 6) Instructed and reinforced correct work procedures with each participant. 7) Tracked work hours, daily or as scheduled to work. 8) Paid participants on a bi-monthly basis, according to hours worked. 9) Conducted time study of each participant every six months. 10) Updated wages according to productivity level. 11) Developed workstation for textile processing to accommodate each participant. All of the participants in the Work Experience Program look forvvard 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 forjob retention: • Confidence Initiative • Willingness to learn • Desire to work • Cooperation • Attendance Communication skills • Team play Flexibility • Follow through • Honesty Respect for coworkers, workplace, and equipment Performance Measures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Work Ex erience Pro ram $10,000 $10,000 $20,000 *If applicable Goodwill's Outcome Management System evaluates program services by asking persons served, employers and referring agencies to complete afollow-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. 1/30/2004 NON PROFIT GRANT APPLICATION 5/7 FISCAL YEAR 2004-OS Goodwill Industries of Hawaii, Inc. Work Experience Program 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 2003, the Work Experience Program participants that were also enrolled in the Home & Community Based Services Program indicated a satisfaction rate of 100% in with our program overall. Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 8,000 10,000 17,000 Professional Fees 0 O erations 1,500 0 E ui ment 500 3,000 Other* Trans ortation Total 10,000 20,000 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Count of Hawaii Non Profit Grant 10,000 10,000 20,000 Goodwill Industries of Hawaii 0 0 5,000 State of Hawaii 319,754 320,000 340,000 Total 329,754 330,000 365,000 *If applicable 1/30/2004 NON PROFIT GRANT APPLICATION 6/7 FISCAL YEAR 2004-OS Goodwill Industries of Hawaii, Inc. -Agency Name Work Experience Program - PC'OgCam 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 ayear-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. `~llr lD~ Signature f B and President/Chair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page ~ Hamakua Health Center - /~gerlCy Name Transportation -Program Name Agency Director: Susan Hunt Phone No.: 808-775-7204 Contact Person: Cathy Luthe Phone No.: 808-775-7204 Mailing Address: 45-549 Plumeria St., Honoka'a, HI 96727 Facility/Site Address: Same Fax No.: 808-775-9404 Email Address: cmtluthe@aloha.net Amount of Request for County funds: $10000.00 Prior Year Funding: 01-02 02-03 03-04 $8000.00 $8000.00 $8000.00 Agency Mission Statement: Wamakua Health Center (HHC) is anon-profit 501(c)(3) rural community health center. Its mission is to provide accessible, quality health care, education and preventive services, emphasizing individual and community wellness, and treating the whole person regardless of an individual's ability to pay. The health center was established in 1993 and serves the residents of North Hawaii. Program Description: Through the Van Program, Hamakua Health Center provides transportation for its patients who are unable to drive or do not have access to a reliable vehicle. Patients receive free transportation to appointments at the Health Center, as well as to health specialists, testing labs, pharmacies, health education activities and other specialty appointments in Hilo, Waimea, and Kona. The Van Program service is free of charge to patients. It operates Monday through Friday from 8 NONPROFTI' GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 a.m. to 5 p.m. Most of the people who use the Health Center Van program have no other transportation, are elderly, low-income, mentally or physically challenged, and/or chronically ill. To access the service, patients may call the Health Center, or inform the front office staff of a service need when they schedule their appointments. Although public transportation service is available throughout the region, it is not equipped for patients needing individualized care or special accomodations. Hele On Bus, which charges a fee, follows the main highway and stops at designated spots in villages and along the roadway. Patients, especially if ill, are often not physically capable of walking from a designated bus stop to the Health Center or other health facility and then back to meet the return bus. The HCEOC bus also provides service for the Hamakua community. Priority is given to people with medical appointments if they call far enough ahead of time and their appointments meet the bus's schedule, but service for medical appointments, especially to specialists, is not as readily accessible and adaptable as it is with the HHC Van Program. The Health Center Van Program serves patients with serious health conditions or who need special accomodations and assistance. Health Center Van service is door to door, allowing for flexibility and for meeting multiple patient needs. Lack of access to reliable transportation often results in patients missing timely medical treatment. This can lead to deterioration of health and costly trips to the emergency room via ambulance, occurring when untreated early-stage problems advance to an acute stage. The HHC Van Program ensures that patients can obtain routine, preventive primary health care and appropriate specialty care when needed. Patients who utilize the Van Program are able to receive expanded health care services with specialists that they might not otherwise have access to. Providing transportation that is free, flexible and easily available to all HHC patients enables them to keep their appointments and to take advantage of both the primary care and the specialty services they need to manage their individual health conditions. Total Budget and Position Count Total Pro ram Bud et 37600.00 Total Pro ram Position Count 1 Total A enc Bud et 1960800.00 Total A enc Position Count 26 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Pale 2 Hamakua Health Center -Agency Name Transportation -Program Name Program Objectives: 1) Reduce barriers to health care by providing 1300 transfers for HHC patients during FY 20042005. 2) Provide free, safe, and courteous door to door transportation, 5 days a week, for HHC patients to the Health Center and to other appointments related to their health, in order that they receive regular, timely care. 3) Increase the number of patients receiving Van service, from 1250 to 1300, through continued advertising, outreach, and careful scheduling, thereby increasing the number of people who access the health care they need. Program Highlights: 1) During FY 2002-2003, the Van transported 1,092 patients, just 108 (or 9 passengers per month) short of our goal of 1200. 668 (61 °i6) of these were elderly. Using advertising, outreach and careful scheduling, Van utilization increased from a monthly average of 83 patients during the first 6 months, to 99 patients per month during the last 6 months of FY 2002-2003. From July -December 2003, average usage has increased to108 patients per month. 2) During FY 2002-2003, the Van completed a total of 1,446 trips, travelling 30,850 miles throughout the approximately 400 square mile service area. Patients served were from Waikoloa, Kawaihae, Waimea, Kukuihaele, Kapulena, Haina, Pa'auhau, Honoka'a, Ahualoa, Katopa, Pa'auilo, O'okala, Laupahoehoe and Papa'aloa. 3) Patients were transported from their homes to the Health Center for primary care, and to Waimea, Hilo and Kona for specialty treatments. These included physical therapy, psychiatric treatment, eye care, diabetes education, hearing aid fittings, dermatology, cardiology, podiatry, urology, and oncology, as well as pharmacy visits in Waimea and Honoka'a. 4) The Van is used to transport asthmatic children to and from the Health Center's three-day Asthma Camp, held at Kalopa State Park in July each year, and for Health Center community outreach activities including the University of Hawaii Rural Health Project, American Cancer Society's "Relay for Life" Smart Shop, and for the Summer Teen Esteem Program. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate 1092 1250 1300 NONPROFTI' GRANT APPLICATION FISCAL YEAR 2004-05 Pale 3 Month Number of Elderly Trips Patients Jul 02 64 26 113 Au 02 79 53 127 Se 02 81 51 124 Oct 02 97 54 135 Nov 02 94 58 126 Dec 02 85 45 98 Jan 03 97 61 120 Feb 03 101 70 127 Mar 03 100 54 117 Apr 03 98 70 117 May 03 96 62 123 Jun 03 100 64 119 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Hamakua Health Center -Agency Name Transportation -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual ` Bud et " Estimate Salaries and Wa es 28102.00 29700.00 30100.00 Professional Fees O erations 7343.00 7340.00 7500.00 E ui ment Other* Total 35445.00 37040.00 37600.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 Fl( 2003-04 FY 2004-05 Actual ` Bud et ` Estimate Count of Hawaii 8000.00 8000.00 10000.00 Hamakua Health Center 27445.00 29040.00 27600.00 Total 35445.00 37040.00 37600.00 *If applicable NONPROFTI' GRANT APPLICATION FISCAL YEAR 2004-OS Pale 5 Hamakua Health Center -Agency Name Transportation -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. (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 ayear-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 vour program's or agency's future funding requests. Signatur of Bo rd Pres' ent/Chair Date ~ Z~ o Sig re of Ex cutive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFTI' GRANT APPLICATION FISCAL YEAR 2004-OS Page 6 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL TRANSPORTATION Agency Director: GEORGE YOKOYAMA Phone No.: (808) 961-2681 Contact Person: LARRY MANLIGUIS Phone No.: (808) 961-2681 Mailing Address: 47 RAINBOW DRIVE Facility/Site Address: 47 RAINBOW DRIVE Fax No.: (808) 935-5213 Email Address: gyCo?interpac.net Amount of Request for County funds: $ 145,000 Prior Year Funding: 01-02 02-03 03-04 $150,000 $145,000 $ 145,000 Agency Mission Statement: The mission of the Hawaii County Economic Opportunity Council is the alleviation, elimination and prevention of poverty in the County of Hawaii. We plan to accomplish this mission by: Mobilizing and channeling private and public resources into anti-poverty action; Increasing the capabilities and opportunities for the poor to participate in the planning, implementation and evaluation of programs affecting their lives; Stimulating new and effective approaches to the alleviation of poverty; Strengthening communication, mutual understanding and planning the coordination and implementation of anti-poverty programs in the community; educating children and youth to become responsible contributing adults in society; Assisting the poor to attain economic self-sufficiency. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS -I- HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL TRANSPORTATION Program Description: The funding request is to continue to provide transportation for targeted groups of low-income elderly, disabled and pre-school children. The range of services include the identification of people with special needs and the implementation of point-to-point specialized transportation services, which run routes off the main highway into rural area communities, low-income housing and pocket communities. Services are to and from the client's home, Monday through Friday, except holidays. Drop-off points are specific service agencies and resource centers, which address immediate needs of the passengers. HCEOC is the only agency in the County who provides transportation services specifically targeting low-income persons. Total Budget and Position Count: Total Pro ram Bud et 967,981 Total Pro ram Position Count 32 Total A enc Bud et 6,474,148 Total A enc Position Count 227 Program Objectives: 1) Provide 800 elderly with specialized transportation from home to resource facilities, to give them access to nutritional meals, medical treatment, shopping, government services, social recreational activities and other services to sustain them in independent living, by the end of the program year. 2) Provide 300 disabled persons with specialized transportation from home to resource facilities, to give them access to rehab services, employment and training opportunities, medical treatment and shopping to sustain them in independent living, by the end of the program year. 3) Provide 350 disadvantaged pre-school children with transportation from home to Head Start Centers, to give them access to education activities, by the end of the program year. 4) Maintain fleet of clean operable vehicles to ensure regular, dependable transportation for the targeted clients. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS -2- HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL TRANSPORTATION Program Highlights: 1) Provided 870 disadvantaged elderly a total of 86,573 passenger trips in FY 2002-2003, from home to resource centers to give access to nutritional meals, medical treatment, shopping, government services, social/recreational activities and other services to address their immediate needs and sustain them in independent living. 2) Provided 260 disabled persons a total of 31,756 passenger trips in FY 2002-2003, from home to resource facilities to give access to rehabilitation services, employment and training opportunities, medical services and shopping to sustain them in independent living. 3) Provided 374 disadvantaged pre-school children a total of 44,259 passenger trips in FY 2002-2003, from home to Head Start Centers, to give access to education activities. 4) Provided safe, injury free transportation services for the 1,504 disadvantaged elderly, disabled and pre-school persons transported to and from home and resource centers in the fiscal year July 2002 to June 2003. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual* Actual* Estimate Trans ort Elderl to Resource Centers 870 800 800 Elderl Passen er Tri s 86,573 90,000 90,000 Transport Disabled to Resources 260 300 300 Disabled Passen erTrips 31,756 35,000 35,000 Transport Pre-school Children to Centers 374 200 350 Pre-school Children Passen erTrips 44,259 30,000 40,000 Maintain Fleet of Buses Certified To Transport Passengers 31 31 31 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS -3- HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL TRANSPORTATION Program Expenditures: FY 2002-03 FY 2003-04 FY 2004-2005 Actual Bud et Estimate Salaries and Wa es 519,999 578,460 610,050 Professional Fees 6,885 7,046 6,664 Operations 260,751 261,547 220,404 Equipment Other* Frin es 180,346 185,807 195,548 Total 967,981 1,032,860 1,032,666 Program Funding Sources: Revenue Source FY 2002-03 FY 2003-04 FY 2004-2005 Actual* Bud et* Estimate Count of Hawaii - Re ular 145,000 145,000 145,000 County of Hawaii -Disabled 153,000 153,000 153,000 Count of Hawaii -Nutrition 176,171 176,171 176,171 Federal - DHHS 115,298 123,348 121,298 State of Hawaii - OCS 109,387 92,197 92,197 State of Hawaii -Grant in Aid 0 0 0 State of Hawaii -Medicaid 182,505 225,000 225,000 State of Hawaii -Adult Mental 86,620 118,144 120,000 Health Total 967,981 1,032,860 1,032,666 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS -4- HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL TRANSPORTATION 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 - 20142.2, 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 ayear-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~ature of Board President/ Chair Date a Signat re o Ex cutive Director ate UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS -5- _ Hawaii Island Adult Care, Inc. -Agency Name Hllo adult Day center -Program Name Agency Director: Carolyn Cabreira Phone No.: 961-3747 Contact Person: Carolyn Cabreira Phone No.: 961-3747 Mailing Address: 34 Rainbow Drive, Hilo, HI 96720 FacilitylSite Address: same as above Fax No.: 961-3740 Email Address: adltcare@gte.net Amount of Request for County funds: $25000.00 Prior Year Funding: 01-02 02-03 03-04 $15500.00 $15500.00 $15500.00 Agency Mission Statement: To advocate for the rights of frail elderly and disabled adults, and to assist them and caregivers in maintaining their independence and dignity as active members in the life of the community. Program Description: Hilo Adult Day Center provides a safe quality adult day program for frail elders and mentally/physically challenged adults needing some supervised care. Total Budget and Position Count Total Pro ram Bud et 846250.00 Total Pro ram Position Count 23 Total A enc Bud et 1009890.00 Total A enc Position Count 36 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Hawaii Island Adult Care, Inc. -Agency Name Hilo adult Day center -Program Name Program Objectives: 1) Provide a safe, caring, daytime environment for frail elders, and mentally/physically challenged adults, who can no longer take full care of themselves, many are under doctors' order not to be left at home alone. 2) Provide interaction with others, hand-on activities, excursions, music club and karaoke, celebrations of every event with games, entertainment and more. These individuals are generally inactive at home, and have old age depression; the activities are geared give them socialization and enjoyment for life, something to look forward to, each day. 3) Allow elders to continue living in their own homes as long as possible. 4) Deter pre-mature institutionalization into long term care facilities. 5) Provide respite for caregivers and deter "caregiver burnout". 6) Allow working families caring for their frail and physically/mentally challenged elders, to continue employment. 7) Provide adult day care to all needy individuals regardless their ability to pay, utilizing federal, state, county and private foundation scholarship funds. Program Highlights: 1) Provided day care services to 141 individuals having varied physical or mental limitations throughout the year. June 2003 ended with 88 enrolled. 2) Enrolled new participants: 48; discharged, 47; attending full year: 61. Six passed away while still a client and living at home. (This is the ultimate goal for our clients, to move on from this life while still living at home). 3) Maintained professional level of service with State of Hawaii, Department of Human Services, Adult Day Services program and Nursing Home w/o Walls, (licensed in Jan '02 for two years), in October 2002 completed 26 years of service. 4) Continued working with other community agencies, Services for Seniors - Kupuna Care, Kokua Nurses, with the IDT (Interdisciplinary Team -Dept. of Health, NHWW, DHS, Services for Seniors, Kokua, APS, CareResources, all agencies involved with elders) to provide client specific care. 5) Continued writing and receiving private foundation grants for tuition/fee assistance to attend the center, had brief shortage in Nov-Dec, 2002 in meeting the financial need, cut hours briefly for a few clients, were able to reinstate in January when funding arrived. 6) Increased Caregiver Support group to twice a month due to requests and increased attendance. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et " Estimate Avera a month) attendance 88 90 92 All fi ures are totals for the ear: Participant enjoyment of life during 141 145 144 final years, maintain or improve ersonal care/h iene Participants continuing to live in -135 140 142 own homes Families/caregivers able to continue 106 109 111 em to ment Families/caregivers receiving 125 128 130 respite Participants continuing to attend 118 123 124 after 6 months Participants continuing to attend 83 85 85 after 1 ears Participantscontinuing to attend 52 55 55 after 2 ears Partici ants continuin after 5 ears 18 19 19 Medicaid tax monies saved on $915,840 $1,068,48 $1,068,480 participants attending day care (12 persons (14 persons) (14 persons) versus living in a long term care placed in facility (based on individuals long term discharged from the day center into care Ion term care Burin the ear "If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Hawaii Island Adult Care, Inc. -Agency Name Hilo adult Day center -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 549654.00 521555.00 533000.00 Professional Fees 9801.00 14000.00 16000.00 O erations 128095.00 158893.00 152250.00 E ui ment 2688.00 4950.00 5000.00 Other* 142408.00 132000.00 140000.00 Total 832646.00 831398.00 846250.00 *P/ease explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Tuition /Fees 365414.00 398500.00 410000.00 State-DHS & Nursing Home w/o 151688.00 151498.00 152000.00 Walls Federal-Nursing Home w/o Walls & 55775.00 51350.00 52000.00 Office of A in -Ku una Care Coun of Hawaii 15500.00 15500.00 25000.00 Hawaii Island United Wa 16500.00 16500.00 16500.00 Ma Tem leton Ho er Fund 65000.00 65000.00 65000.00 Mclnerny/Gwenfread Allen/Charity 44411.00 67000.00 65000.00 Walk/other rants Donations 14373.00 11300.00 12000.00 USDA Lunch ro .reimbursement 29349.00 38000.00 33000.00 PIN rant mans ement 3750.00 4750.00 3750.00 Fundraising/InteresWending 9427.00 12000.00 12000.00 machines/Misc.sales Total 771187.00 831398.00 846250.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Hawaii Island Adult Care, Inc. Hilo Adult Day Center Program Expenditures Explanation of line item Other: Other is Client Assistance. The county funds and private foundation grants assist clients with their tuition and transportation costs to be able to attend the center. - 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 ayear-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 vear-end report may imaact the evaluation of vour arogram's or agencv's future funding requests. l ~3~~`f /~gn re of Board President/Chair Date l t1,. o~".~ a o._ ~i 1~3r,1 n4 Signature o xecutive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Hawaii Island HIV/AIDS Foundation - Agency Name Multi-Disciplinary HIV Case Management, Hilo -Program Name Agency Director: Georgie Kennedy Phone No.: 331-8177 Contact Person: Georgie Kennedy Phone No.: 331-8177 Mailing Address: 75-240 Nani Kailua Drive, Suite #5 Facility/Site Address: 2043 Kinoole Street, Hilo, HI 86720 Fax No.: 808-981-2429 or 808-331-0762 Email Address: georgie@biaphilo.org or georgie@whaf.org Amount of Request for County funds: $10000.00 Prior Year Funding: 01-02 02-03 03-04 $10000.00 $10000.00 $10000.00 Agency Mission Statement: The Hawaii Island HIV/AIDS Foundation is anon-profit organization dedicated to assisting those affected by HIV/AIDS to maximize their 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 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. The Hawaii Island HIV/AIDS Foundation was formally established on September 15, 2003, as a unification of the Big Island AIDS Project in Hilo and the West Hawaii AIDS Foundation in Kona. (Notice of Merger is attached.) Both organizations were established as IRS-designated 501(c)(3)tax-exempt non- profitorganizations to provide care services for People Living With HIV/AIDS (PLWHA), and HIV prevention and education of the residents of Hawaii County. Required Checklist Forms from both agencies are attached at the end of the NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 proposal. These two organizations have been providing services to people at risk for, infected with, and affected by HIV/AIDS, since 1986 in Hilo serving the east side of the island, and since 1993 in Kona serving the west side. This merger results in an efficient and effective system to provide a comprehensive continuum of prevention, care, and support services with regard to HIV/AIDS for the entire Big Island. We will refer to the Hilo office as "HIV Foundation -Hilo". Today, Hawaii County has the second highest percentage of AIDS cases in the State, with fifteen and six-tenths percent (15.6%) of all cases of persons living with AIDS residing here. This number represents two hundred (200) lives. Presently, the 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 80 PLWHA and affected persons in East Hawaii. Case Managers support client independence and self- determination by providing a range of supportive services; knowledge and assistance in accessing a variety of pubic and private benefit programs; medical 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 in primary medical care. The services received by each client are monitored regularly to determine the effectiveness of the service plan, identify emergent needs, and measure the outcome(s) of service delivery. The HIV Foundation -Hilo proposes to continue its provision of high quality multi- disciplinaryteam HIV case management and primary prevention services, including anonymous HIV-antibody counseling and testing services, for one hundred (100) Persons Living With HIV/AIDS during FY 2004-2005. Program Description: A multidisciplinary team composed of three full-time (3.0 FTE) case managers and one half-time (0.5 FTE) client services facilitator provide the direct care services for PLWHA residing in East Hawaii. The average active caseload for the agency is eighty-eight (88) clients. Forty percent (40%) of the HIV Foundation - Hilo's clients are homeless, multiply diagnosed, drug misusers and/or mentally ill. Eighty-four percent (84%) fall into two or more special population categories as defined by the federal Ryan White CARE Act Title II. Case management schedules are flexible to ensure service availability during the agency's regular days and hours of operation, 8:00 AM - 4:00 PM Monday through Friday. The Client Service Facilitator is responsible only for the delivery of support services including buddies, food bank, food deliveries, transportation volunteers and clerical services. The Executive Director provides program administrative oversight and program supervision for care staff, quarterly reports, job counseling, staff training and crisis intervention. Volunteers assist clients with computer searches, distributing food, clerical assistance, and helping clients shop at the food pantry. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 Case managers and clients cooperatively develop a written service plan. The service plan identifies client needs; defines 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 implemented within two weeks following intake of a new client and then updated quarterly or more often if needed until the client is discharged. Between service plan updates, clients are contacted at least once per month, to monitor their health status and identify new emergent needs. Acute clients in need of more frequent contact receive telephone calls, and/or office or home visits three-to-four times per week. One hundred (100) service plans will be developed or revised during the FY2004-2005 grant period. Primary HIV prevention is based upon aloes-threshold, culturally appropriate harm reduction methodology. Case managers either provide such interventions themselves or make referrals to the HIV Foundation - Hilo's prevention department. Case managers also offer anonymous HIV-antibody counseling and testing for family members and significant others. Evaluation: Quantitative evaluation measures for multi-disciplinary team case management services include the collection, tabulation and entry of service data into a computer tracking system (COMPIS-CD4 Online Management and Patient Information System). Data routinely tracked include: number of clients, types of service provided, and the number of services provided by service category. Planning estimations for service delivery during the FY2004-2005 currently project that a total of twenty-three (23) separate case management services will be individually provided for 80 to 100 clients living with HIV/AIDS. Services include, but are not limited to, intake, assessment, treatment advocacy, benefits counseling, volunteer referrals, hospital and home visits, medical liaison, crisis intervention, emergency financial assistance, housing assistance, home care and transportation. Quantitative Analysis: Data collection consists of counting the number of written service plans that are developed or revised each quarter. Computer reports indicating number 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 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. Qualitative Analysis: A client satisfaction survey is mailed to all clients annually. Completed surveys are returned anonymously and tallied survey results are distributed to the HIV Foundation's Board of Directors, staff, clients and state and federal granting organizations. Total Budget and Position Count Total Pro ram Bud et $317,900 Total Pro ram Position Count 4 Total A enc Bud et $609,000 Total A enc Position Count 17 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Hawaii Island HIV/AIDS Foundation - Agency dame Multi-Disciplinary HIV Case Management, Hilo -Program Name Program Objectives: 1) Objective One: By June 30, 2005, and within twenty-five (25) days following a determination of need, identify and secure appropriate financial 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 June 30, 2005 and within twenty-five days following a determination of need, assist no less than ninety percent (90%) of all eligible PLWHA who request or demonstrate a need for substance misuse treatment, mental health counseling, oral health care, HIV-related medication, food and/or transportation assistance to obtain such goods and services through appropriate referrals and practical support. 3) Objective Three: By June 30, 2005 and within twenty-five days following 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 need for emergency shelter, or either short-term or long-term shelter or housing assistance. 4) Objective Four: By June 30, 2005 offer HIV preventive education and/or anonymous HIV-antibody counseling and testing services to sixty-five (65) at-risk individuals. In addition, the HIV Foundation -Hilo shall provide the types and levels of case management related supportive services for its consumers, listed below. Benefits assessment/counseling Client family counseling Progressive case notes Crisis intervention Field /office visits Health care assessment/counseling 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 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Mental health assessmentcounseling Nutritional assessmenUcounseling Client monitoring/assessment Risk assessmentcounseling Service coordination Transport activities Substance abuse assessment Total number of service categories: 23 Timeline: Service plans are developed within two weeks of the initial intake session and reviewed quarterly. Service delivery will be on-going during FY 2003-2004. The services listed above represent baseline service projections. Client-centered Outcome(s): Eighty (80) clients and their families will access critical services including medical, financial, social, care givers, legal, nutritional, etc. through the HIV Foundation - Hilo's case management and volunteer team. Ninety percent (90%) of clients will secure a primary care physician and remain in treatment. Program Highlights: Highlights of service accomplishments during FY 2003-2004 include: 1. During FY 2003-2004, medical case management services included eighty- seven (87) clients receiving of medical assessment, patient education, treatment advice, nutrition, medical liaison, dental liaison. In addition, clients received $17,155 in financial assistance for medical and dental care services through the Ryan White CARE Act funds, among others. 2. Over the past seven years, five (5) HIV positive women have birthed six children. All are over the age of two and not one is HIV positive. The HIV Foundation -Hilo is extremely proud of this fact and immensely happy for the parents. 3. As of December 2003, all clients are receiving primary medical care. Pertormance Measures: NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Number of types of case 19 21 23 mana ement services rovided Number of clients receiving case 76 85 100 mana ement services Risk Behavior Assessment, 150 200 250 Counselin and Education HIV Counselin and Testin 65 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 6 Hawaii Island HIV/AIDS Foundation - Agency Name Multi-Disciplinary HIV Case Management, Hilo -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-OS Actual * Bud et * Estimate Salaries and Wa es $169,435 $189,823 $190,000 Professional Fees $2,500 $2,500 $3,000 O erations $125,008 $125,000 $125,000 E ui ment 0 0 0 Other* 0 0 0 Total $296,943.00 $317,323.00 $317,500.00 *P/ease explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Count of Hawai'I 10000.00 10000.00 10000.00 De artment of Health, Title II 192808.00 192808.00 192808.00 AIDS Communit Care Team 74635.00 74635.00 74635.00 Medicaid Waiver 5000.00 11600.00 12000.00 United Wa 4500.00 5000.00 Housing -Special Projects of 5000.00 6000.00 6000.00 National Si nificance Private Foundations 10000.00 15000.00 Donations/Fundraisin 7280.00 7457.00 Total $296,943 $317,323 $317,900 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 7 Hawaii Island HIV/AIDS Foundation - Agency Dame Multi-Disciplinary HIV Case Management, Hilo -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 ayear-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 resort may impact the evaluation of r ro ram's or a enc 's future fundin re nests. /~2~ ~0 Signatur o President/Chair Date l ~ ~ z6 O Signatur of Executive Director Dat i % UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! I i I NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 8 Hawaii Island HIV/AIDS Foundation - AgellCy Name Transmission Prevention for HIV+ Women in West Hawaii County - Program Name Agency Director: Georgie Kennedy Phone No.: 331-8177 Contact Person: Georgie Kennedy Phone No.: 331-8177 Mailing Address: 75-240 Nani Kailua Dr., # 5, Kailua-Kona, HI 96740 Facility/Site Address: 75-240 Nani Kailua Dr., # 5, Kailua-Kona, HI 96740 Fax No.: 331-0762 Email Address: georgie@whaf.org Amount of Request for County funds: $15000.00 Prior Year Funding: 01-02 02-03 03-04 $15000.00 $15000.00 $15000.00 Agency Mission Statement: The Hawaii Island HIV/AIDS Foundation is anon-profit organization dedicated to assisting those affected by HIV/AIDS to maximize their 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 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. The Hawaii Island HIV/AIDS Foundation was formally established on September 15, 2003, as a unification of the West Hawaii AIDS Foundation in Kona and the Big Island AIDS Project in Hilo. (Notice of Merger is attached.) Both organizations were established as IRS-designated 501(c)(3) tax-exempt non- profit organizations to provide care services for People Living With HIV/AIDS NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 (PLWHA), and HIV prevention and education for the residents of Hawaii County. Required Checklist Forms from both agencies are attached at the end of the proposal. These two organizations have been providing services to people at risk for, infected with, and affected by HIV/AIDS, since 1993 in Kona serving the West side of the island, and since 1986 in Hilo serving the East side. The result of this merger is an efficient and effective system to provide a comprehensive continuum of prevention, care, and support services with regard to HIV/AIDS for the entire Big Island. We will refer to the Kona office as "HIV Foundation -Kona". Today, Hawaii County has the second highest percentage of AIDS cases in the State, with fifteen and six-tenths percent (15.6%) of all cases of persons living with AIDS residing here. This number represents two hundred (200) lives. Program Description: The Hawaii Island HIV/AIDS Foundation -Kona is proposing to continue funding for the HIV transmission prevention programs for all HIV+ women in West Hawaii County, including individual and group protocols and counseling and testing of women at risk. This program is designed to STOP HIV at the source, that is with individuals who can transmit the disease to others. It is a successful program and is reflected in decreasing new cases in Hawaii. The program provides early treatment for newly diagnosed HIV positive women, maintenance of stable health and well being for all HIV+ women in West Hawaii County, long term planning for health maintenance, and transmission prevention interactions. Total Budget and Position Count Total Pro ram Bud et $39,192 Total Pro ram Position Count 2.5 Total A enc Bud et $620,451 Total A enc Position Count 17 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 Hawaii Island HIV/AIDS Foundation - Agency Name Transmission Prevention for HIV+ Women in West Hawaii county -Program Name 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. (Minimum of 12 women, 1-2 hours per client.) 2) Refer women to appropriate providers if needed, i.e. mental health providers, substance abuse providers, 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 (minimum 12 clients, 1 hour each) in the first session, then quarterly, and as needed when problems arise. 4) Document progress and adherence to transmission prevention protocol with input from client each quarter (12 minimum). 5) Monthly support group for HIV+ women dealing with self-esteem, negotiation, sexual issues, transmission prevention. 6) Referral by participants of other women who may be at risk of contracting or transmitting HIV to others. Referral to result in HIV counseling and testing by prevention outreach staff. Program Highlights: 1) Achieved a review of care prevention service plans for fifteen (15) women (exceeding goal) during first month. 2) Referred ten (10) women to specialized care for heatlh and/or prevention issues during first month. 3) Reviewed and updated health plans for all participants quarterly. 4) Initiated in-depth transmission protocols with all participants, and met with each participant on a one-to-one basis quarterly. 5) Seventy-five (75%) percent of participants were able to maintain 100% compliance with prevention protocols by second session (i.e., use of condoms or other protection during all sexual encounters.) 6) Fifty (50%) percent of participants were able to maintain compliance 90% of the time by the third quarter with the goal of 100% compliance by the end of the year. 7) Ninety-eight (98%) percent of participants were 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 probability of sexual transmission. 8) As of month seven (January 2004), zero transmission of HIV by any participants in the program. No hospitalizations, stable health, and return to work for one (1) participant. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Performance Measures: In addition to the numbers listed below, the savings to the community of eliminating just one new case of HIV is approximately $25,000 per year. This is the cost of medical care, support, housing, and disability benefits for a single individual who is affected by this disease. Additionally, the only people who can transmit this disease are those who are infected with it. By working at the source we can STOP this disease, and do it in a humane and loving manner, which benefits the individual and the community. FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Individual transmission prevention 105 200 200 session assessment session Health/prevention plan review 315 420 450 uarterl Quarterly individual transmission 315 315 450 revention sessions 1 hr. each Review and documentation of 105 200 200 ro ram uarterl *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Hawaii Island HIV/AIDS Foundation - AgetlCy Name Transmission Prevention for HIV+ Women in West Hawaii County - PPOgram Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 20,000 20,000 20,000 Professional Fees 0 0 0 O erations 15,192 15,192 15,192 E ui ment 0 0 0 Other* Program 3,000 3,000 4,000 Ex enses Total 38,192 38,192 39,192 *Other: Program expenses include costs for HIV testing kits, literature, condoms, incentives, and other miscellaneous items specific to prevention programs. Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate State of Hawaii Prevention, 33% 15,192 15,192 15,192 Women onl Hawaii Communit Foundation 3,000 1,000 0 Fundraisin 5,000 7,000 7,000 Count of Hawaii 15,000 15,000 15,000 Mac 's 0 0 2,000 Total 38,192 38,192 39,192 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Hawaii Island HIV/AIDS Foundation - Agency Name Transmission Prevention for HIV+ Women in West Hawaii County - PrOgl'am 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 ayear-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. - i/~~/o5/ ignature of oard President/Chair Date / ~ Signature f E cecutiv Director Dat UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 6 Helping Hands Hawaii - A enC Name Hilo Assertive Community Treatment (ACT) - PI'OgPam Name Agency Director: Brian Schatz Phone No.: (808) 440-3820 Contact Person: Stanley Luke Phone No.: (808) 440-3861 Mailing Address: 126 Keawe St., Hilo, HI 96720 Facility/Site Address: 126 Keawe St., Hilo, HI 96720 Fax No.: (808) 536-7237 Email Address: sluke@helpinghandshawaii.org Amount of Request for County funds: $200000.00 Prior Year Funding: 01-02 02-03 03-04 $0.00 $0.00 $0.00 Agency Mission Statement: Helping Hands Hawaii's mission is to strengthen our community by enhancing the quality of people's lives through the delivery of goods and services to those in need. For the Behavioral Health Division, its programs strive to provide rapid and effective services for individuals in crisis or suffering from serious mental illness. Program Description: In the Hilo area, the Assertive Community Treatment program provides psychosocial rehabilitation services and intensive case management for individuals with serious mental illness. This program has been providing mental health services in Hilo since 1999, developing a strong reputation in the community. For this proposal, Helping Hands Hawaii seeks funding to enhance and improve the case management/psychosocial rehabilitation services for Hilo NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 clients. Please note that in July 2000, the program was functioning under a subsidiary, called Hawaii Community Health Service. In 2003, the subsidiary was eliminated and then merged with its original agency, Helping Hands Hawaii. Total Budget and Position Count Total Pro ram Bud et 200000.00 Total Pro ram Position Count 5 Total A enc Bud et 4120230.00 Total A enc Position Count 171 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 Helping Hands Hawaii - enC Name Hilo Assertive Community Treatment (ACT) - Pt'OgPam Name Program Objectives: 1) Develop effective treatment plans, interventions, and activities for individuals with serious mental illness (SMI). 2) Provide treatment for dually diagnosed (SMI/substance abuse) individuals. 3) Improve clients' satisfaction with mental health services. 4) Increase quality of life of clients. 5) Provide transportation services to improve access to care. 6) Improve activities of daily living for clients. 7) Improve coping skills and adjustment in community by providing crisis services and emergency housing. 8) Provide treatment for community issue of methamphetamine abuse. Program Highlights: 1) Program Highlights: In the previous fiscal year 2002-03, Helping Hands Hawaii was able to reorganize its operations in Hilo and continued to provide quality care for 50 seriously mentally ill consumers. Many of these individuals required intensive case management, wrap-around services, crisis intervention, housing placement, substance abuse services, psychotropic medications, and family therapy--many of these essential services were provided at a financial loss to the Agency. Using the recovery model, the Hilo ACT Team was able to assist some individuals in attaining independent living and even supported employment in the community. In addition, cultural issues have been addressed. The Hilo staff attended a Hawaiian Cultural workshop in Honolulu on October 27, 2003. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Adults with Serious Mental Illness N/A N/A 80 clients *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Helping Hands Hawaii - A enC Name Hilo Assertive Community Treatment (ACT) - Pi'Ogl'am Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 0.00 0.00 135000.00 Professional Fees 0.00 0.00 O erations 0.00 0.00 12000.00 E ui ment 0.00 0.00 34900.00 Other* 0.00 0.00 18100.00 Total 0.00 0.00 200000.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate State of Hawaii 03-079 ACT Hilo 645902.00 7/02 to 5/03 Cost Reimbursement 6/03 to 5/04 Contract Changed to 720000.00 920000.00 Unit Rate Total 645902.00 720000.00 920000.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Helping Hands Hawaii - A eI1C Name Hilo Assertive Community Treatment (ACT) - 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 ayear-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 fundino requests l 7/0~ Signature of Board President~6hair Date ~a~ Signatu a cuti irector Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 6 The Island of Hawaii YMCA -Agency Name Ku'ikahi Mediation Center - PfOgt'am Name Agency Director: Michael Miyahira (acting) Phone No.: Contact Person: Dorothea Auldridge Phone No.: Mailing Address: P.O. Box 7067 Kamuela, HI 97643 Facility/Site Address: 614 Kiluaea Ave. Suite56 Hilo, HI 96720 Fax No.: 887-1861 Email Address: Amount of Request for County funds:310000.00 Prior Year Funding: 01-02 02-03 03-04 50.00 35000.00 55000.00 Agency Mission Statement: Aloha Ke Akua- God is Love. The mission of The Island of Hawaii YMCA is to share God's Love with 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. Program Description: The Ku'ikahi Mediation Center provides quality mediation services to individuals and organizations in the East Hawaii community. The Center utilizes professionally trained community volunteers and handles cases such as neighbor /neighbor, family (including intergenerational and divorce issues), work place, community, Special Education, civil rights, and community facilitation. Included in these cases are referrals from the Prosecuting Attorney's Office, local Attorneys, and the County Police Department. The Center has increased it services to NONPROFIT GRANT APPLICATION FISCAL YEAR 200i-05 Page 1 individuals and families involved in neighborhood restraining orders, assisting 151 county residents in peacefully resolving disputes. The successful resolution of these cases also reduced the number of calls requiring police response. Total Budget and Position Count ~ Total Program Budget 81996.00 Total Pro ram Position Count 3 ~ Total Agency Budget 2380933 00 Total A enc Position Count 280 NONPROFIT GRANT APPLICATION FISCAL YEAR 200-05 Page 2 The Island of Hawaii YMCA - /fig@f1Cy 1~8fTt@ Ku'ikahi Mediation Center - PfOgfafll NafTl@ Program Objectives: 1) Provide quality mediation services to 1,100 individuals in Program year 2004-5 (an increase of 17%). 2) Increase the mediator pool by 15% in PY 2004-2005. 3) Increase number of cases opened to 300 in PY 2004-2005. 4) Collaborate with the County Prosecutors Office to develop~ncrease caseload areas that will reduce the use of county resources. 5) Assist three east Hawaii communities in developing proactive conflict resolution processes, reducing the use of county resources (Police). 6) Ensure that 80% of Gients served in PY2004-2005 are satisfied with the mediation services received. Program Highlights: 1) Provided services in 288 cases. This was a slight increase from the previous year. There was a gap in referrals because of the new District Court Judge transition. 2) Assisted parties in reaching agreements in 82% of cases opened in PY2002-03. Community cases involving restraining orders among neighbors are increasing. In the first six months of this current program year, the Center has already equalled the total number of restrainig order cases from the PY2002-03 (36 cases). These cases involve many individuals -the 36 cases involve 122 parties. These types of cases, if not resolved, put an unnecessary drain on our limited county resources, especially the Police Department. 3) Successfully negotiated an increased rate schedule for clients within our primary funding contract. 4) Secured a grant to assist three east Hawaii in developing proactive conflict resolution skills. 5) Provided generic and advanced mediation training, increasing the Center's mediator pool to 54. 6) Established a new fee for service caseload to facilitate special education IEP meetings for the Department of Education. 7) Achieved client satisfaction goal for PY2002-03, 85% of clients were satisfied with the services received from the Center. NONPROFIT GRANT APPLICATION FISCAL YEAR zoo.I-os Page 3 Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual ~ Bud et' Estimate Number of cases opened 288 290 300 Number of mediators 54 54 60 Number of individuals served 915 1,000 1,100 Number of cases received from the 50 65 75 Prosecutin Attome s Office Outcomes achieved for community NA 3 NA skill buildin ro ect Percents a of satisfied clients 85% 85% 85% i 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 The Island of Hawaii YMCA -Agency Name Ku'ikahi Mediation center -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual' Bud et' Estimate Salaries and Wa es 60824.00 64637.00 67768.00 Professional Fees 0.00 0.00 0.00 O rations 14159.00 173590.00 16122.00 E ui ment 416.00 0.00 0.00 Other' Total 75399.00 81996.00 83890.00 'Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual ` Bud et' Estimate i Coun of Hawaii 5000.00 5000.00 10000.00 Judicia ,State of Hawaii 49000.00 48996.00 48996.00 , Pr ram Service Fees 6018.00 6000.00 7894.00 Foundations 4000.00 22000.00 12000.00 Donations 1440.00 0.00 5000.00 YMCA 9941.00 i i Total 75399.00 81996.00 83890 . 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 200-05 Page 5 Tne Islana of Hawaii YMCA -Agency Name Ku'ikahi Mediation Center -Program Name I (we) have read and understood all of the elgibility requirements; grant conditions; award pmoedures; and records, reporting and fisgl acx:ountability requirements as mandated in Ar[iGe 25, Sections 2-135 - 2-142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofd Organizations- 1 (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, 1 (we) understand and will comply with the requirement to submit a yearend report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall inGude 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 timeN complete and accurate year-end resort may impact the evaluation of your program's or agency's future funding requests. . ~~;~~h-~._ v Signature of Board President/Chair Date G~T/N~" i 3e a~ Signature o Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 200a-OS Page 6 Tne Island of Hawaii YMCA -Agency Name Youtn services -Program Name Agency Director: Michael Miyahira(acting) Phone No.: Contact Person: Dorothea Auldridge Phone No.: 885-5388 Mailing Address: P.O. Box 7067 Kamuela, HI 96743 Facility/Site Address: 300 W. Lanikaula Street, Hilo, HI 74-5605 Pawai Place, Kailua-Kona, HI 65-1206 Mamalahoa Hwy, Kamuela, HI Fax No.: 887-1861 Email Address: Amount of Request for County funds: 560000.00 Prior Year Funding: 01-02 02-03 03-04 555000.00 550000.00 550000.00 Agency Mission Statement: Aloha Ke Akua- "God is Love". The mission of The Island of Hawaii YMCA is: To bring God's Love to children, adults, and families of all races and faiths by putting Christian principles into practices into practice through programs that build healthy spirit, mind and body for all. NONPROFIT GRANT APPLICATION FISCAL YEAR 2001-05 Page I Program Description: YMCA Youth Services provides an array of safe, developmentally appropriate activities that are based on the proven research of asset building. The progam assists youth in developing assets in the following areas: support, empower- ment, boundaries and expectations, constructive use of time, commitment to learning, positive values, social competencies and positive identity. Increasing developmental assets in youth increases resistance to negative high-risk behaviors such as using drugs and alcohol and violence. Youth with more assets exhibit more behaviors such as succeeding in school, demonstrating leadership qualities, and valuing diversity. Assets increase a youth's ability to face challenges and difficult situations. A complete listing of activities is on Appendix A. Program activities are offered throughout the year, including intercessions and vacation periods when latch-key children are especially vulnerable to at-risk behaviors. The YMCA's vans increase program quality by providing transport- ation services island-wide. YMCA Youth Services provides over 3,500 children annually with a diverse programming mix. The Island of Hawaii YMCA is an islandwide association comprised of four operating units: Waiakea Settlement YMCA, Kona Family YMCA, Waimea Family YMCA and YMCA Mediation and Family Life Development programs. Youth Services are offered at each YMCA branch, with coordination and collaboration between programs to support youth in different communities participating together. In order to ensure the highest program quality, this year The Island of Hawaii YMCA has established an association-wide Program Committee. The responsibility of this committee is to provide both staff and board the necessary training and support to implement and evaluate the program. Program outcomes will be determined by participant surveys, parent surveys, andlor staff observation. YMCA Youth Services provides direct positive impact to the youth and families of Hawaii County by providing accessible, affordable opportunities. (in addition to keeping program fees low, many youth are subsidized or receive program scholarships). As the evidence of how substance abuse and other factors contributing to family conflicts increase, it it more critical than ever to have our youth engaged in safe, positive activities. Total Budget and Position Count Total Program Budget 488652.00 Total Pro ram Position Count 115 Total Agency Budget 2380933.00 Total Agency Position Count 280 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 The Island of Hawaii YMCA - Agency Name Youtn services -Program Name Program Objectives: 1) Increase decision-making ability 2) Increase sense of empowerment 3) Increase commitrnent to teaming 4) Increase constructive use of time 5) Develop personal skills, talents and abilities 6) Increase sell-esteem 7) Increase understanding of different cuffures 8) Increase sense of poskive values 9) Program Highlights: 1) Continued the Ambassadors of the Environment, an aquatic based environmental camping program, with a successful season of 92 youth. The camp is based at the Ke'ei coastline, providng a living laboratory for youth to discover how they can live responsibly in their environment. A grant from the Nature Conservancy provided the scholarship for 10 Milolii youth participants. 2) The youth sailing program of the Waiakea Settlement branch (with partner Na Holumoku Yacht Club), provided sailing and water safety activities to over 100 youth. 3) Continued the partnership with Hawaiian Arts and Sciences Academy, with 14 students refurbishing donated sailing crafts for the youth sailing program. 4) The Waiakea Settlement branch continued its youth sports programs with competitive teams in wrestling, girls volleyball, and soccer. 5) Established a youth wrestling program at the Kona Family branch for youth 5-17. 6) The Waimea Family branch increased its youth participation to 60 in the annual Mana Health and Fitness run. 7) Established a Kona Family branch youth basketball team for the County Parks and Recreation league for 5 and 6 year old youth. 8) Established a youth springboard dive program for youth ages 6-11. 9) Provided Health and Fitness programs and activities to over 500 Waimea K-5 grade students. 10) Increased youth participation in annual Free Dive Tournament 11) Waiakea Settlement youth music program participants (ukulele) shared their talents with convalesent homes, seniors programs and the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 200-05 Page 3 12) Waimea Family branch co-sponsored 7 elementary and teen dances, with approximately 150 youth attending each dance. 13) The Waimea Family branch co-sponsored a community youth "Rock and Bowl", providing a fun and positive experience for 154 youth participants. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual • Bud et' Estimate Total Partici ants- Youth Services 3452 3600 3800 Pr ram Partici ants will: Ident' and achieve personal oals 85% 85% 85% Leam to make better decisions 85% 85% 85% Develop sportsmanship and the 85% 85°~ 85% conce t of fair la Leam how to coo rate with others 85% 85% 85% Enhance their roblem solvin skills 80% 85% 85% Assume and understand the 70% 80% 85% ~ res onsibilities of leadershi i 1 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page ~ Tne island of Hawaii YnncA -Agency Name Youtn Services -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual • Bud et' Estimate Salaries and Wa es 285187.00 299446.00 314418.00 Professional Fees 6831.00 7172.00 7530.00 O rations 172144.00 180751.00 189788.00 E ui ment 1222.00 1283.00 1347.00 OtheP Total 465384.00 488652.00 513083.00 'Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual • Bud et' Estimate Coun of Hawaii 50000.00 50000.00 60000.00 Private Foundations 10000.00 15000.00 20000.00 Hawaii Island United Wa 60000.00 60000.00 66000.00 Donations 15316.00 15000.00 130830.00 Fundraisin 2627.00 3000.00 4000.00 ! Service/Pr ram Fees 327441.00 345652.00 350000.00 'Total 465384.00 488652.00 513083.00. 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 200-I-05 Page 5' The Island of Hawaii YMCA - Agency Name Youtn 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, relatirg to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein inGuding atl st>ipporting 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 compty with the requirement to submit ayear-end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall inGude 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~nd report may impact the evaluation of your program's or agenc~s future funding requests Sign~atu~re of Boardid~nt/Chair Date ~""~v~ ~N((rr- //~JD pl~L Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2001-OS Page 6 Appendix A YMCA Youth Senices is an atra}' of decelopmentall}~ appropriate and challenge- based activities for }-oaths aged ~ - 18. Specific programs and activities in YMCA Youth Senices include: Recreational Da} Camps - Summer Fun: Fun House (grades K - 3) Kids' Express (grades 4 - 8) Summer Y-Tots Preschool (age - Holida}' Fun: Winter Fun/Espress (grades K - 8) Spring Fun/Express (grades K - 8) -School Release Dacs Aquatics Program (grades K- 12) - Progressive S«7mming - Preschool S~tiim - Jr. Lifeguard (L+) - Windsurfing (1?+) - Sailing (12+) - Surfing (12+) - SCUBA (L?+) Catnping Program - Sailing Camp (12+) - Surf Camp (ages 12+) - Aquatic/SCUBA Camp (12+) - Ambassadors of the Environment - Camp R'aipi'o (13+) Youth Sports/Fitness Program: - School Health and Fitness (grades K-~ ) - Ponekos basketball (grade 3 - 12) - _\"a 'Opio cone}-ball (grade 3 - L) - Jalapenos Basketball (grade 3 - L) - Youth Soccer (grade 3 - 13) - Sailing Team (12+) - Martial Arts (ages 7+) - Youth Wrestling - Health_c Kids Dav Teen Programs: (grades 8 - 13) - Tutoring Program - Youth and Government - Jr. Leaders - Youth Dances Arts and Humanities: Youth Music Ka Hale 0 Na Keiki, Inc. -Agency Name Families-At-Risk Project -Program Name Agency Director: Kathy Oshiro Phone No.: 775-9870 Contact Person: same Phone No.: same Mailing Address: 45-3668 Honokaa-Waipio Rd, Honokaa, HI 96727 Facility/Site Address: same Fax No.: 775-9473 (call first) Email Address: gso@kona.net Amount of Request for County funds: 56000.00 Prior Year Funding: 01-02 02-03 03-04 50.00 52000.00 52000.00 Agency Mission Statement: At Ka Hale 0 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 wor?d 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 teaming experiences that will last throughout their lifeftime. Above all, our children come first. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Program Description: Artice 25 of Chapter 2 of the Hawaii County Code states that its first listed priority for non-profit funds allocation should be for education. The Families-At- Risk Project gives the County of Hawaii the opportunity to fulfill the intent of Article 25 by giving suppport to the education and care of our Countys most needy: the families of the working-poor on the Hamakua Coast. The Families- At-Rist Project's central feature is continuing to provide a safe, stimulating, and caring environment for children, ages 24 months to 6 years, daily, throughout the year, between the hours of 2:30 pm and 5:30 pm. This frees young parents to work at their jobs, allows the unemployed to seek work, and pursue training and educational opportunities, particularly working parents transitioning from welfare assistance. It also unburdens siblings, older relatives, and others untrained in early childhood education of the responsibility of providing care to young children. Scholarship/tuition assistance is provided, and may include tuition fee reduction, an extended grace period in which to pay fees, or both, allowing families stress-free assurance that their employment can continue while their children have quality care and education. As Chapter 25 recognizes, Education is the key to our County's success. The Hamakua Coast is a very special and unique area, with wonderful qualities, yet dramatic problems. Ka Hale O Na Keiki is not "just another preschool°, but a community organization that serves and meets multiple needs for the people of the entire area. Our community has been incredibly supportive of Ka Hale O Na Keiki. Additionally, Oahu-based Atherton Foundation, Castle Foundation, Weinberg Foundation, Frear Trust, and Hawaii Community Foundation have all generously donated to our organization, recognizing the unique services we offer, and our dedicated efforts to insure the quality development of all our young children of our under-serviced community. However, the Hawaii County support of our Families-At-Risk Project is critical to this program's survival, to enable these services to continue to meet the needs of our community. Our past budgets have taken funds away from our Day Program in order to help support the critical Families-At-Risk afternoon program, putting our entire operation at risk. This risk could be alleviated if the Hawaii County simply allocated $100 from each of the other non-profits the County supports to our Families-At-Risk Program. A $100 decrease to each of the other programs would have minimal or no impact on them. However, the approximate $4000.00 additional that would be allocated to our Program would have major positive impact for Ka Hale O Na Keiki. The Hamakua Coast is a greatly under-served area of our County. The Gosest HeadStart program is over 45 miles away, as is the closest State Financial Assistance office for family childcare supplements. The goals of our Families-At- Risk Project are to provide low-income children with quality care that improves their health, safety, learning, development, and family stability; and to provide low-income parents with quality child care to allow them to work full-time towards economic self-sufficiency and to better support & assist their children's education. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 Ka Hale O Na Keiki, Inc. is a grassroots, community-based, non-profit organization that, unlike other preschools, remains open after 2:30 pm daily, as well as being open year-round, for many of our families are at-risk. These families are likely to be cut off from the mainstream community because of poverty, racism, 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. Support of our Families-At- Risk Project is crucial for the survival of our school, as well as the survival of the families that need and use our services. It is imperative that we remain open at least 10 hours per day, and operate year round; otherwise working parents would have no where to send their young children for a quality education and care while gone from the home. Most preschools are not open more than eight hours per day because a second qualified staff is required; and such a service is just not economically feasible. However, with literally no other full-time preschool available in our isolated area, parents would have no where to place their child, except perhaps in front of a neighbor's TV set, if Ka Hale O Na Keiki's Families- At-Risk Project was not available. Drug abuse is our worst nightmare here on the Hamakua Coast. "Study after study has shown the benefits of a quality preschool experience. Children who attend preschool enter kindergarten ready to team. They later have better test scores in reading and math. And, they are less likely to be involved in crime as adults and less likely to become pregnant as teenagers." (Honolulu Advertiser, 12/19/01). Additionally, numerous drug-abuse studies have shown that an early childhood education can actually prevent illegal drug usage in the future. Therefore, if we are to break the cycle of drug abuse in our community, we must begin taking preventitive action now, and intervene at the preschool-age level, rather than simply spend money and time on rehabilitation later on. Yet, of the nearly 6000 children between the ages of 2 and 4 in our County, only 30°~ are attending some type of early childhood program. Our community , previously a sugar plantation town, has always treasured education. For most of us, an education represented the way to a better life than our hardworking parents experienced. Our understanding of what constitutes a "good education", however, has evolved over the years, since we were in school, to include the major importance of a developmentally appropriate, quality education for our children ages 2-5. Today we know that these formative years are critically important to a child's social adjustment and long-term educational success. If our community is going to survive the Dosing of an agriculturally- based economy we must provide all our families with an affordable, quality preschool program. Everyone, it seems, recognizes the dire need for quality early childhood education for all of Hawaii's children, and they know the astounding, positive effects a quality early childhood education has on the overall development of young children. However, such recognition is a waste if everyone is not willing to do their part to insure that early childhood educational centers are made available to all. The County's support of the Families-At-Risk Project will not only ensure the Families-At-Risk Project's survival, but also the survival of our entire NONPROFIT GRANT APPLICATION FISCAL YEAR 200405 Page 3 program. We understand and acknowledge the scarcity of County funds, and sympathize with the Council's difficult budget task, but we truly believe that the County's continuing investment now in the Families-At-Risk Project will save the County ten-fold in future rehabilitation costs. Total Budget and Position Count Total Program Bud et 23650.00 Total Pro ram Position Count 3 Total Agency Bud et 120000.00 Total A ency Position Count 7 NONPROFIT GRANT APPLICATION FISCAL YEAR 200405 Page 4 Ka Hale O Na Keiki, Inc. -Agency Name Families-At-Risk -Program Name Program Objectives: 1) Provide high quality care and educational services to children of at-risk families of the under-serviced Hamakua Coast. 2) Make care and educational services available into the late afternoon to accommodate at-risk families. 3) Assist employed and job-seeking parents. 4) Provide emergency scholarship/tuition assistance to at-risk families. 5) Provide monthly scholarship/tuition assistance to at-risk families. 6) Provide mentoring and informational/referral services to at-risk families. 7) Maintain a developmentally appropriate teaming environment among all students, ensuring progress in social, emotional, cognitive, language, and physical development. 8) 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 development problems. 9) Increase the parenting skills,and understanding of the educational and developmental needs of children of the at-risk parents we serve. Program Highlights: 1) Provided a developmentally appropriate, high-quality childcare and educational facility to the working poor of the Hamakua Coast. 2) Remained open for the working familes, inGuding during holiday breaks and summer. 3) Provided three jobs in our local community, in order to operate the Families-At-Risk Project. 4) Obtained new, permanent facility, costing nearly $100,000 and supported by foundation grants and personal donations, with the facility meeting all County, State, and ADA regulations affecting licensing and permits, all within a timeframe that allowed us to not have to be closed due to a change in facility. 5) Provided lab-school facility to one college student so she could complete her student teaching as an early childhood education students in her home town. 6) Offered scholarship/tuition assistance to thirteen families using the Families-At-Risk Project. NONPROFTT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Pertormance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual' Bud et' Estimate Total Enrollment 29 29 32 Students Enrolled 2:30-5:30pm, 15 17 18 Families-At-Risk Pro ect Families receiving finalcial 13 15 17 assistance from Ka Hale O Na Keiki for the 2:30-5:30pm, Families-At- Risk Pro'ect 'If applicable NONPROFTI' GRANT APPLICATION FISCAL YEAR 2004-OS Page 6 Ka Hale O Na Keiki, Inc. -Agency Name Families-At-Risk Project -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 13860.00 13750.00 13750.00 Professional Fees 749.00 1200.00 1200.00 O erations 7496.00 7500.00 7500.00 E ui ment 1257.00 3000.00 1200.00 Other* Total 23362.00 25450.00 23650.00 *P/ease explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual' Bud et' Estimate Payment from families for afternoon 8700.00 9700.00 10000.00 ro ram Donations/fundraisers 1500.00 1500.00 1500.00 Count Grant 2000.00 2000.00 6000.00 Day Program payment from 11362.00 12250.00 6150.00 families, portion allocated to Families-At-Risk afternoon ro ram Total 23362.00 25450.00 23650.00 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 7 Ka Haie C) Na Keiki, inc. - AC~~iiCy Nat71E'. FamiEies-At-Risk Project - PfOgfafi'1 Nc3CTlB iurei haue read and ur~det-stoad ail of the eligibility teq~iremertts: gran# tcnditions award procedures; and retards, repcrting and fiscal accountabisi~y egu+rements as manda#ed ;n Arttcie 25. Setitons 2-135 - c-1422. Ha4va+ County Code. relating to Appropriation of Funds to Nonprafit Qrganizat~t~~s. i (rye) hereby uerttfy that information supplied herein including ar supportira documents is tcrrect ar~d that E (we} have the au#hcrity and atiiiity to fully administer ti ~e program!sl p~ursuart tc la~s~. •i~re? understand that information supplied herein shai be made public according ie Chapter 92F k ~a~~a; + Revised Statutes it .awarded a gran! frog; the County of i;awai'i. i (we understand a,'~d'vv~il ccmp:;, ~v+th ±he requiremen# #t submit ayear-end report tc the Legislative auditor ov:th~~~ 6tJ days after June 3G of the fisca+ year. The repori shasi e~c;ude an exp6ar~at;c+, of the public benefits derived from the awarding of the grant. a tamp,ete a:-tounting of all expenditures supported by Cour:ty of Nawai'i grant funds. a, d a ?sh"1g Of Other fundinG SOUfCeS and amOUn1S QC+tairleu ~Ur?r5g 1}'?E award pc^r+Od Failure #a submit a th~eiy tom~iete. and accurate year~er~ re cri ma~mpa~~'t *.hc- evaluation of veer program _s or agency's future furdin~ rec u~ es?s. Signature cf S~;sard Preside^xJChair Date _ S~gra#u~e of Executive Director- t~afe UNSIGNED PROPOSALS i~/Itw,L NOT BE AOCEPTED? `ti6?tiPROFIT GItA~~"I :°tPPL1C:'~"FiOi~ FISC:4L YEAR 2(?d4-OS Page S Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center-West Hawaii Title IV-B-West HI Counseling & Supportive Living Project Agency Director: Willow Morton (KMCWC Executive Vice President) Dr. Steven Choy - KCPC Program Director Phone No.: 1-888-535-7790 Contact Person: Mary Jo Westmoreland (Hawaii Branch Administrator) Phone No.: 808-329-4020 Contact Person: Rob Nitch (KHRI Grant Specialist) Phone No.: 808-535-7506 Mailing Address: Kapi'olani Health Research Institute (Attn. Rob Nitch) 55 Merchant Streeyt - 27th Floor Honolulu, HI 96813 Facility/Site Address: 74-5599 Luhia Street - #E7 Kailua-Kona, HI 96740 Fax No.: 329-8628 (Kona) 1-808-535-7545 Email Address: kcocmiw hawaii.rr.com (Kona) RNitchC~Dkaoiolani.or4 (Honolulu) Amount of Request for County funds: $20,000 Prior Year Funding: 01-02 02-03 03-04 $16,000 $16,000 $16,000 Agency Mission Statement: The Mission Of The Kapi olani Child Protection Center Is To Protect Children And Strengthen Families Program Description: The Title IV-B Counseling and Supportive Living Project provides counseling, service linkage, educational and supportive services to assist West Hawaii families at risk of child abuse and neglect. Priority for services is given to families at risk due to substance abuse (80% of referrals). The program is primarily funded through a Federal Grant and requires matching funds from the State and from the provider. Total Budget and Position Count Total Pro ram Bud et 425,000 Total Pro ram Position Count 8 Total A enc Bud et 571,000 Total A enc Position Count 8 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Pane 1 Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center-West Hawaii Title IV-B-West HI Counseling & Supportive Living Project Program Objectives: 1) Improve child safety by reducing child abuse/neglect risk factors 2) Improve child safety by increasing child protective factors Program Highlights: 1) Provided services to 146 families - 278 adults and 342 children. 2) Provided services to 27 permanency families 3) Completed all services -77.5% of individuals served. 4) Reduced CA/N risks - 67.5% of caregivers who completed services. 5) Increased Protective Factors - 77.5% of caregivers who completed services. 6) Had no new CPS report during services - 85.9% of families served. 7) Had no new CPS report within 6 months after case closure - 95.7% of families who completed services. 8) Had no new CPS report within 1 year after case closure - 95.2% of families who completed services Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Families completing service plan that have 85.9% 90% 90% no new report of child abuse or neglect durin ro ram services. 77.5% 85% 85% Individuals Com letin Service Plan Caregivers completing service plan who have 7Q,$% 85% 85% develo ed a ractical Child Safe Plan. Caregivers completing Service P?an whose 77.5% 85% 85% Child Safety Protective Factors have increased Caregivers completing Service Plan whose 67.4% 85% 85% Child Safe Risk Factors have decreased. Families completing Service Plan who have 95.7% 85% 85% no new confirmed report of child abuse or ne ect at 6-month fallow-u Families completing Service Plan who have 95.2% 85% 85% no new confirmed report of child abuse or n lect at 1 ear follow-u Permanent families without placement 81.5% 90% 90% disru lion durin the service eriod *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS PAPP, Z Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center-West Hawaii Title IV-B-West HI Counseling & Supportive Living Project Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries andWa es $219,175 $296,320 $321,743 Professional Fees $28,546 $36,633 $37,154 O erations $63,225 $67,407 $65,303 E ui ment $544 $3,000 $800 Other* Total $311,490 $403,360 $425,000 `Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Title IV-B Grant $287,840 $380,000 $380,000 HIUW $8,500 $8,500 $10,000 HIUW Car over $3,410 $6,750 Chant Walk $3,000 $5,000 $5,000 Chant Walk Car over $450 $3250 HI Count Grant $16,000 $16,000 $20,000 Total $315,340 $413,360 $425,000 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Psor 3 Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center-West Hawaii Title IV-B-West HI Counseling & Supportive Living Project 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, 1 (we) understand and will comply with the requirement to submit ayear-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 reoort may impact the evaluation of vour orogram's or agency's future fundina requests ..~,~,l.Ctc.rr.~ Yh.s2 ~v,,~ i la o /off Signature of Board President/Chair Da et (Executive Vice President) ig re of Executive Director Date (HI Branch Administrator) UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS PA ~P Q KONA ADULT DAY CENTER, INC. Adult Day Agency Director: Rowena L Tiqui Phone No.: 322-7977 Contact Person: Rowena L. Tiqui Phone No.: 322-7977 Mailing Address: P. O. Box 1360 Kealakekua HI 96750 Facility/Site Address: 81-989 Halekii Street Kealakekua HI 96750 Fax No.: 322-0614 Email Address: kadcrowena(a)hawaii.rr.com Amount of Request for County funds: $15,000.00 Prior Year Funding: 01-02 02-03 03-04 $15,000 $15,000 $15,000 Agency Mission Statement: "Our mission is to provide health, social and recreational programs and activities that enable impaired adults to experience feelings of being, friendship, acceptance, accomplishment and independence in a caring and secure environment." 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 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page I KONA ADULT DAY CENTER, INC. Adult Day Care Center services are those adults 18 years and older, but particularly those 60 and older, having either a physical or a cognitive disability, requiring supportive care. These are persons with Alzheimer's disease, dementia or Parkinson's disease, 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 Pro ram Bud et 374,326 Total Pro ram Position Count 8 Total A enc Bud et 374,326 Total A enc Position Count 8 Program Objectives: 1) Program Goals for Individuals a. The client will be able to associate with a place and a group corresponding to or her own sense of identity. b. The client's maximum level of independence will be assessed and maintained through the individual program planning. c. Mentally and physically impaired adults will be maintained at heir highest level of functioning, thus preventing or delaying further deterioration. d. Health monitoring as well as protective and supportive care for the frail and disabled adults will be included in care planning and services. e. The participant's knowledge of and access to elderly services available in the community. f. Premature or inappropriate institutionalization in a nursing home or hospital will be prevented. g. Socializing, peer interaction and continued relationship with the community will be ensured. h. Isolation and prejudice often associated with frail and disabled adults will be reduced. 2) Program Goals for Families and Other Caregivers a. Families that desire to keep elderly members in the home will be given relief from full-time care of an impaired adult. b. Family members will be enabled to continue productive careers instead of being homebound with an elderly, disabled spouse, parent or other family member. c. Families and other caregivers will be assured that elders dependent upon them are being cared for appropriately during the day. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 KONA ADULT DAY CENTER, INC. Adult Day Care 3) Program Goals for the Community a. An integral component of the community service network and of the long-term care continuum will be made available to the West Hawaii Community. b. The medical community and other resources state wide will be provided a liaison in the geriatrics, especially Alzheimer's disease and other related disorders. Program Highlights: 1) Maintained 90% of participants at home for a minimum of 6 months with adult care services. 2) Maintained or improved socialization/infraction skills of participants by 90%. 3) Maintained or improved hygienelself-care of participants by 90%. 4) Surveyed caregivers. 95% of caregivers, who responded, expressed satisfaction with Kona Adult Day Center. 90% of caregivers responded. 5) Had intergenerational interaction activities. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate New Clients Served 25 26 27 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 KONA ADULT DAY CENTER, INC. Adult Day Care Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 172,704 174,274 179,502 Professional Fees 49,371 49,368 50,849 O erations 150,288 130,652 134,571 E ui ment Other* Total 372,363 354,294 364,922 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-OS Actual * Bud et * Estimate DHS-POS Pro ram 32,094 33,504 27,919 DHS-NHWW 68,354 68,825 69,000 HCOA -Service for Seniors 1,366 1,378 1,400 Teresa Hu hes Trust 2,490 2,500 2,500 Coun of Hawaii 15,000 15,000 15,000 Mae Tem leton Ho er 23,054 24,393 25,000 Hawaii Island United Wa 15,000 15,000 15,000 Theodora Vierra 1,000 1,174 1,250 Other Grants 10,000 11,600 10,000 Tuition 139,731 139,755 140,000 Tuition Assistance 2, 2 0 0 Trans ort/Bath' lFeedin /Intake 17,505 20,530 20,530 Food Care Pro ram 13,489 13,741 13,700 Fundraisin 62,123 23,910 2 ,000 Administrative Fees 1,125 1,042 1,056 Interest Income 2,482 2,075 2,100 Total 407,165 374,327 368;490 *If applicable NONPROFIT GRANT APPLICATION FISCAL YF.A~It2tYQ4-$5• Page 4 KONA ADULT DAY CENTER, INC. Adult Day Care 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 ayear-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 vear-end report may impact the evaluation of your program's or agency's future funding requests. I 2~i n ~ Signature and Pr sident/Chair vtcE Date PRESIDENT Signatur of Exe tive ire or D to UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APP~.)~~AT1~pN FISCAL YEAR 2004-Q5 Page 5 KONA ARC/KONAKRAFTS (CAPTAIN COOK DOMICILLIARY HOME) Agency Director: Gretchen Lawson Phone No.: 323-2626 Contact Person: Gretchen Lawson Phone No.: 323-2626 Mailing Address: PO Box 127 Kealakekua,Hl, 96750 Facility/Site Address: 81-1065 Konawaena School Road Fax No.: 323-9444 Email Address: gretchen@konakrafts.org Amount of Request for County funds: x17,000.00 Prior Year Funding: 01-02 02-03 03-04 x17,000.00 x17,000.00 x17,000.00 Agency Mission Statement: Kona Krafts is a private non-profit organization for persons with disabilities, their families and advocates. We believe that people with disabilities are as individual in their needs, abilities and gifts as any other cross section of society. Program Description: Kona ARC/Kona Krafts operates a 'Domiciliary Home' licensed for 5 residents identified as DD/MR by the State of Hawaii and considered low-income by HUD. The residents have cognitive limitations that prevent them from living truly independently. They do not make good judgments and therefore need supports to insure their safety and help with activities of daily living. The residents also have skills that can be accessed to benefit the community when provided with assisted living. Also, their family members are then freed from such total NONPROFIT GRANT APPLICATION FISCAL YEAR 200405 Page 1 responsibility so that the family members can actively contribute to the community. The residents each pay rent and also program fees that cover a portion of their living expenses. However, the amount of money received by Kona Krafts to pay for the mortgage on the house and provide for the housing, food, transportation, and other maintenance costs for the vehicle and building, plus the staff salaries for supervision for 18 hours a day, Monday through Friday, and 24 hours a day Saturday and Sunday, cover only 46% of the actual expense. Money received via the County of Hawaii's Non-Profit Grant program helps make up some of the deficit. Specifically the 17,000.00 request would be spent to enhance service delivery by paying costs associated with half-time staff person (40 hours a week) and the payroll taxes attached to the salary, 40°~ of the total food budget for the home, and 25% of the transportation (fuel) costs for the van. Total Budget and Position Count Total Pro ram Bud et 108,714.00 Total Pro ram Position Count 3 Total A enc Bud et 2,057,361.00 Total A enc Position Count 85 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 KONA ARC/KONA KRAFTS (CAPTAIN COOK DOMICILLIARY HOME) Program Objectives: 1) Provide a safe, healthy, and supportive environment for living 24 hours per day 365 days a year from July 1, 2004 to June 30, 2005. 2) Provide healthy nutritious meals 7 days a week throughout the program year. 3) Insure access to community events and resources a minimum of twice a week throughout the program year (7/04/05) 4) Schedule medical appointments for each resident and transport them for those appointments on a quarterly basis or more often if needed. 5) Record all medical appointments, prescribed medicine and keep a log of medicine taken throughout the program year. 6) Assist each resident to complete their home activities and community plans ongoing throughout the program year. 7) Provide needed supports for interacting with each other and the public appropriately within the home and in the community daily throughout the program year. Program Highlights: 1) Participated in community activities by: 1)attending one practice session and atl tournament events with Special Olympics, 2)going to the theater or other social event once per weekend, 3)participating in the community mural project at Hale Halawai, and 4)participating in the Hugs Not Drugs island wide sign waving event; 2) Cooked and consumed two meals per day during each week and three a day on the weekends during 2003-2004; 3) Keeping all medical appointments made on their behalf of Group Home Supervisors; 4) Maintained their home by completing chores assigned to them for the general maintenance and cleanliness of the facility; 5) Assisted with cooking the meals according to their individual level of skill and cooperative behaviors; 6) Responded to interventions when behaviors warranted such treatment and supports; 7) Worked to insure their programs were coordinated between the Adult Day Program and the living environment so the outcomes are more lasting. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Performance Measures: FY 2002-03 f=Y 2003-04 FY 2004-05 Actual * Bud et * Estimate Provide a safe, secure and healthy 5x365 days 1,825 days 1,825 days home for five DD/MR residents 365 da s a ear Provide nutritious meals each day 4,160 meals 4,160 meals 4,160 meals Burin 2004-2005 Transport 5 residents to Special 2 each x 47 94 94 Olympics activities twice per week weeks =94 transports transports times Insure transport for medical 5 residents x 27 27 appointments each quarter 1 per quarter plus as needed = 27 Transport residents to 47 weeks 47 weeks 47 weeks social/recreational activities once er week Assist 5 residents with home chores 5 residents x 520 jobs 520 jobs a. Complete personal clothes 2 jobs per washing 1 time per week per week x 52 person weeks = 520 b. Complete personal room jobs cleaning once per week per person c. Rotating to a different resident each week 1)dishes after dinner 2)cleaning bathrooms 3)cleaning common areas 4)assist with meal preparation 5)sweeping kitchen 6 cleanin ara a area Assist each resident to progress in 60 3 goals 60 goals 60 goals their individual plans times 5 residents times 4 uarters Provide needed behavioral supports 52 times 52 times 52 times as needed from mild (based on (based on (based on intervention/correction to referral to once per once per once per behavioral s ecialists week week week Record all medications taken on a 5 residents x 1,825 days 1,825 days Bail basis 365 da s of recordin of recordin *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 200405 Page 4 KONA ARC/KONA KRAFTS (CAPTAIN COOK DOMICILLIARY HOME) Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Budget ` Estimate Salaries and Wa es 78,464.00 71,380.00 75,000.00 Professional Fees O erations 49,815.00 47,976.00 53,000.00 E ui ment Other* Total 128,279.00 119,356.00 128,000.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Budget * Estimate Count of Hawaii 17,000.00 17,000.00 17,000.00 Resident Fee (SSI ass throw h 47,772.00 44,039.00 45,000.00 Tenant Rent-(30°h clients share for 13,898.00 19,608.00 20,000.00 Section 8 HUD Federal Funds (70°~ Section 8 31,253.00 28,067.00 30,000.00 share of rent Fundraisin /Donations 18,356.00 10,642.00 16,000.00 Total 128,279.00 119,356.00 128,000.00 *If applicable NONPROFTP GRANT APPLICATION FISCAL YEAR 2004-05 Page 5 KONA ARC/KONA KRAFTS (CAPTAIN COOK DOMICILLIARY HOME) 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 ayear-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 vear-end report may impact the evaluation of your program's or agency's future funding requests. Signature of Board President/Chair Date Sig ture of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 6 Kona Literacy council -Agency Name Kailua Learning Center - {~fOgl'am Name Agency President: Joan Budnick Phone No.: 329-1180 Contact Person: Brenda Natina Phone No.: 329-1180 Mailing Address: Kailua Village Condominiums 75-5766 Kuakini Hwy #106A Kailua-Kona, Hawaii 96740 Facility/Site Address: Same Fax No.: 329-1180 Email Address: konalit@msn.com Amount of Request for County funds: $1,500 Prior Year Funding: $1,500 01-02 02-03 03-04 $2,500 $1,500 $1,500 Agency Mission Statement: The Kona Literacy Council's volunteer tutors help any adult increase their basic reading, writing and communication skills to enable the learners to become better family members, workers, community members and lifelong learners. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 1 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 speck 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 534 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 aduks' self-esteem, thereby improving their lives and becoming better family members, workers and community members. Total Budget and Position Count Total Pro ram Bud et 5,900.00 Total Pro ram Position Count 10 Total A enc Bud et 5,900.00 Total A enc Position Count 10 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 2 Kona Literacy council -Agency Name Kailua Learning Center - Program Name 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, schedual, match learner with tutor, and prepare programs for 25 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, Akematiaves to Violence, court ordered participants, Family Support Services of West Hawaii, Head Start, 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. 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 quarterly newsletter. 10) Hold general membership and public meetings quarterly. 11) Continue writing grants, pursuing fund raising functions, and seeking donations to keep open the doors of the Kailua learning Center. Program Highlights: 1) All statistics are form the Annual Council Report, June1, 2002 -May 31, 2003 prepared for Laubach Literacy Action. 2) Tutored 14 basic literacy students. (includes reading, math & computer literacy) 3) Tutored 12 English as a Second Language students. 4) Left the program and attained employment: 3 students. 5) Retained employment: 1 student. 6) Passed the citizenship test: 1 student. 7) Entered other educational programs: 1 student. 8) Increased involvement with children's education: 1 student 9) Met goals: 8 students. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 3 10) Utilized 15 volunteer tutors. 11) Tutored 312 hours of actual tutoring. 12) Contributed 810 hours by volunteers in other areas. 13) Trained 2 new tutors. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et" Estimate Tutored basic literacy students 14 15 20 Tutored ESL students 12 10 15 Train new tutors 1 5 5 Publish newsletter 3 3 3 Total tutorin hours 312 400 350 Total non-tutorin hours 810 800 800 *tf applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Kona Literacy Council - Agency Name Kailua Learning center -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 0.00 0.00 0.00 Professional Fees 1,185.00 500.00 500.00 O erations 4870.89 5,700.00 5 000.00 E ui ment 3,123.05 00.00 00.00 Other* Insurance 400.00 400.00 400.00 Total 9,578.94 6,600.00 5,900.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Coun Grant 1,500 1,500.00 1,500 Hotel Chari Walk 70.00 100.00 0.00 Membershi Dues 15.00 50.00 50.00 Wal-Mart 1,200.00 200.00 200.00 Donations 3,297.01 3,350.00 2,750.00 Fundraisin 0.00 500.00 500.00 Federal Campaign 805.99 900.00 900.00 Alu Like & Verison 9,658.00 00.00 00.00 Young Brothers 1,000.00 00.00 00.00 Kukio 2,000.00 00.00 00.00 Total 19,548.00 6,600.00 5,900.00 *If appligble NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 5 Kona Literacy council -Agency Name Kailua Learning Center - PPOgfam 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 NonprofR 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 ayear-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 benefds 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 acourate year-end report may impact the evaluation of vour program's or agency's future funding requests. Sign lure f Board Vice-President/Chair Date Signature of Se etary Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTEDI NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 6 Mental Health Kokua Residential Rehabilitation Services Agency Director: Joanne Lundstrom Phone No.: 737-2523 Contact Person: Gary Michell Phone No.: 331-1468 Mailing Address: 1600 Kapiolani Blvd., Ste 700, Honolulu, HI 96814 Facility/Site Address: 75-5752 Alanoe Pl., Kailua-Kona, HI 96740 140 Wainaku Avenue, Hilo, HI 96720 Fax No.: 331-1468 Email Address: konamhk@mentalhealthkokua.org Amount of Request for County funds: $20,000 Prior Year Funding: 01-02 02-03 03-04 $15,000 $15,000 $15,000 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. Program Description: (Please briefly describe the program for which you are seeking funding) Funding is requested for our transitional residential services. Our transitional rehabilitation facility in Hilo is PATCH (Psychosocial and Transitional Community Housing), and in Kona, Hale Alanoe. Both were opened to fill critical gaps in Hawaii County mental health services, providing residential care and NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Mental Health Kokua Residential Rehabilitation Services rehabilitation services for adults in Hawaii who are recovering from serious mental illnesses. Mental Health Kokua staff provide 24-hour 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 2003 are estimated at $82. Comparative bed day costs in a psychiatric hospital are estimated at $600 to $800 a day. Total Budget and Position Count Total Pro ram Bud et 573,500 Total Pro ram Position Count 14 Total A enc Bud et 8,100,000 Total A enc Position Count 180 Program Objectives: (Tasks or projects to be accomplished in specific, well-defined, and measurable terms and that are achievable within a specific time frame. Please number and have all objectives begin with a verb.) 1) Provide residential and social rehabilitation services to 90 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 (CARE) and other monitoring recommendations. 5) Show evidence of satisfaction with services received at 95% of consumers served 6) Show improvement in daily living skill scores upon discharge in at least 90% of consumers served. 7) Place at least 90% of consumers served in more independent living settings following planned discharge. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 Mental Health Kokua Residential Rehabilitation Services Program Highlights: (Accomplishments from the previous fiscal year. Please number and begin all highlights with a verb.) 1) Provided transitional residential rehabilitation services in FY 2003 to thirty- nine (39) unduplicated clients at PATCH Place and thirty (30) unduplicated clients at Hale Alanoe. 2) Discharged 61 % of clients served to more independent living in the community. All clients showed improvement in daily living skills. 3) Provided a total of 6,589 bed days and 13,178 meals in our transitional residential programs during FY 2003. 4) Expanded the number of beds available for transitional residential services in Kona from six to twelve. 5) Expanded agency programs and services on the Big Island. New services now in place include Interim Housing, Crisis Mobile Outreach, and Psycho-social Rehabilitation. 6) Purchased a van to help meet the transportation needs of our Kona clients. Performance Measures (Quantifiable indicators of public and consumer benefits from your program's actions, and/or the number of goods or services your program produces.) FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et* Estimate Number of unduplicated consumers 72 80 90 served Percentage of consumers served 61 % 75% 90% who were discharged to more inde endent livin settin s Number of consumers served 4 3 1 re uirin hos italization Percentage of consumer satisfied 95% 95% 100% with services *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Mental Health Kokua Residential Rehabilitation Services Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual Bud et Estimate Salaries and Wa es 382,331 388,300 392,600 Professional Fees 10,257 12,600 13,200 0 erations 151,368 159,700 167,700 E ui ment 3,459 Other* Total 547,415 560,600 573,500 *Please explain in detail on separate sheet Program Funding Sources (List all sources of funding, including specific grants, fundraising events, etc. relating to the program only) Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual* Bud eY` Estimate Coun of Hawaii 15,000 15,000 20,000 Fees & Grants from Gov't A encies 402,514 417,090 421,990 United Wa 23,958 25,000 28,000 Pro ram Service Fee 89,638 90,000 90,000 CCS Fees 13,260 13,260 13,260 Donation/other 167 250 250 I Total 544,537 560,600 573,500 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 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 ayear-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. ~ ~ ~ 0 ignature of Board President/Chair Dat y ~~~1 ~y ignature of Executive Dire QS Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 North Kohala Community Resource Center Kohala Community Athletic Association Agency Director: Bob Martin Phone No.: 889-5523 Contact Person: Desiree Yamamoto Phone No.: 889-1299 Mailing Address: P. O. Box 2, Hawi, HI 96719 Facility/Site Address: 55-514 Hawi Road, Hawi, HI 96719 Fax No.: 889-5527 Email Address: nkcrc@wave.bicv.net Amount of Request for County funds: $5,000 Prior Year Funding: 01-02 02-03 03-04 $0 $0 $3,000 Agency Mission Statement: We support and sponsor community service projects in North Kohala by providing education in project planning, researching funding, and proposal writing, and fiscal sponsorship for projects that qualify. We charge a professional fee for these services upon the funding of grant proposals. The Kohala Community Athletic Association is one of our eighteen sponsored projects. Program Description: The Kohala Community Athletic Association, an all-volunteer organization of over 100 parents and residents formed in 1975, provides an athletic curriculum in connection with the Hawaii County Parks and Recreation Division for over 450 children in North Kohala from August through April each year. We sponsor basketball, track, volleyball, T-ball, and pitch ball for boys and girls aged 5 through 14. Our efforts include providing uniforms, equipment, coaches, an annual schedule, tournament events, and raising funds through our concession stand. For a small, rural community, without amusements, bowling alleys, skating or roller- blading rinks, theaters, or other entertainment activities, our program, which teaches the true meaning of sportsmanship, builds self-esteem, and imparts a sense of accomplishment, is a critical community service. Since our inception 28 years ago, we have not been able to upgrade or replace our equipment due to our limited funding which goes to covering maintenance and other expenses. This application is to allow us to continue to purchase new equipment for our program. Total Budget and Position Count Total Pro ram Bud et $18,000 Total Pro ram Position Count 0 Total A enc Bud et $91,859 Total A enc Position Count 1 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 North Kohala Community Resource Center Kohala Community Athletic Association Program Objectives: Continue the purchase of $21,200 of athletic equipment for our program, including scoreboards, first aid kits, tee ball and pitch ball items, basketballs and nets, volleyballs and nets, cooking utensils and equipment for our concession booth, and a storage shed, by August 2004. Program Highlights: The success of our program depends on the number of participants we attract to our various activities during the year, and by how many adults volunteer to assist us in a variety of jobs from coaching to cooking in our concession stand. As the chart below shows, the number of participants in our program is growing, and this year (2003-2004) we are currently projecting a total of 525 participants, an all- time high, and 192 adult volunteers. Our program involves participation from 157 of our approximately 1751 households, and will grow next year to over 500 children, 195 adult volunteers, representing 184 households. These data suggest that we are truly meeting a need in our community. We are all volunteers - we have no paid staff. Performance Measures: Participants by Activity FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Bidd Basketball A es 5-6 40 52 54 Bidd Basketball A es 7-8 42 57 58 Elements Volle ball A es 9-11 64 69 70 Intermediate Volle ball A es 12-14 48 57 58 Bo s Basketball A es 11-14 65 55 58 T-Ball A es 5-6 59 75 76 Pitch Ball A es 7-8 50 62 65 Track A es 9-14 35 38 40 Girls Basketball A es 11-14 58 60 63 Total Partici ants 461 525 542 Total Adult Volunteers 188 192 195 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 North Kohala Community Resource Center Kohala Community Athletic Association Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et' Estimate Salaries and Wa es $0 $0 $0 Professional Fees $0 $450 $750 O erations $9,578 $11,028 $13,000 E ui ment $0 $2550 $4,250 Other' $0 $0 $0 Total $9,578 $14,028 $18,000 'Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et' Estimate Partici ant Re istration $3,139 $3,695 $3,700 Communi Contributions $2,950 $3,625 $3,700 Concession Sales $7,250 $7,500 $7,500 Grants $0 $3,000 $5,000 Total $13,339 $17,820 $19,900 Total 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 North Kohala Community Resouce Center Kohala Community Athletic Association 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 Nonprofd 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 ayear-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 veer-end report may impact the evaluation of your program's or agency's future funding requests Signature of oard PresidenUChair Date l08 D ignature of Pr gra Director Dat UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 4 Office for Social Ministry -Agency Name Care-A-Van -Program Name Agency Director: Carol R. Ignacio, Executive Director Phone No.: (808) 935-3050, x105 Contact Person: Brandee Cachola, Program Administrator Phone No.: (808) 935-3050, x113 Mailing Address: 140-B Holomua Street, Hilo, HI 96720 Facility/Site Address: 140-B Holomua Street, Hilo, HI 96720 and 75-5769 Alii Drive, Kailua-Kona Fax No.: (808) 935-3794 Email Address: Carolrign@aol.com for Carol R. Ignacio bcachola@rcchawaii.org for Brandee Cachola Amount of Request for County funds: $29,000 Prior Year Funding: 010102 0202=03 0303=04 $29,000 $29,000 $29,000 Agency Mission Statement: To meet the challenges ofever-changing community needs by utilizing spiritual, human and material resources to empower those in need to live with dignity and respect. We live out this mission using afour-sided model of service that incorporates direct service, justice education, advocacy, and community development into a variety of client-driven safety net programs such as Care-A-Van. All programs of the OSM serve the entire community regardless of religious beliefs, age, sex, ethnicity or ability. Program Description: Care-A-Van (CAV) is a mobile, homeless outreach program serving the unsheltered homeless of Hawaii County; it is the only such program on the island. Operating since 1991, CAV has served over 11,000 homeless consumers. The ultimate goal of CAV is to help the unsheltered homeless progress towards a healthier, more stable living condition and ultimately move out of homelessness into permanent housing and self-sufficiency. What makes us unique is our mobility. Staff travels to where the homeless are, whether they are on remote beaches, the woods, lava-covered areas where they live in tents and under tarps, or in town. We reach them using six vehicles, five of which are four-wheel drive. For the most part, the homeless are found in the outlying rural areas of the island. Staff providing the services are a program administrator (1), an operations manger (1), outreach workers/case managers (2), mental health outreach workers/case managers (3), mental health representative payees (3) and a housing retention specialist (1). In addition to outreach, we work to ensure the continuum of care for the homeless is comprehensive. OSM/CAV heads up the Hawaii Island Continuum of Care group that is made up of community members, NONPROFIT GRANT APPLICATION FISCAL YEAR 21104-115 Yage 1 Office for Social Ministry -Agency Name Care-A-Van -Program Name homeless providers and other social service agency representatives. They provide valuable feedback and comments regarding our work in the community and help us develop and refine policies, network with the community, share information and problem solve. This group has achieved greater homelessness awareness in our community and schools. Another component of CAV is the representative payee program. Representative payees manage the finances of the mentally ill and mentally ill homeless who are unable to do so themselves. Three representative payees serve 65 participants, islandwide. CAV also provides supportive housing services through its Housing Retention Specialist. The case manager follows up with clients who become housed to ensure they are able to retain a stable living situation. The case manager provides a variety of services including budgeting skills, life skills, maintaining sustainable income and finding furniture for clients' new dwelling. Additionally, CAV just received notice that our "Kukui Program," has been funded by the Department of Housing and Urban Development (HUD). This particular program is part of HUD's "Shelter Plus Care" initiative that will provide rental assistance for qualified chronic homeless and disabled. This is a five-year program and the award for it is $618,600. The monies will provide rental assistance for up to five years for qualifying clients. Clients will be those with serious mental illness, chronic substance abuse programs, AIDS or related diseases, co-occurring disorders of mental illness and chronic substance abuse, and other disabilities. This program will require the services of the Housing Retention Specialist as well as our everyday outreach workers/case managers. CAV services are particularly critical now. A survey conducted from July 26, 2003 -September 20, 2003 throughout the State made public that the increase in Hawaii County's homeless population rose 89%--from 659 individuals to 1,243 individuals-since 1999 when the survey was last performed (SMS Research & Marketing, 2003). Another study, a statewide point in time count performed in May 2003 revealed there are currently 256 chronic homeless on the Big Island (State of Hawaii; Department of Business, Economic Development and Tourism; Housing and Community Development Corporation of Hawaii). Total Budget and Position Count for FY04-OS Total Program Budget 657 168.00 Total Program Position Count 12 Total Agency Budget ~ 2,204,074.00 Total Agency Position Count 32 Program Objectives for FY04-O5: 1. Identify 1,234 people who are homeless and provide them with services (listed below) that will ultimately lead to them becoming housed and self-sufficient (objectives for FY04-05 were calculated at an increase of 10% over FY02-03 due to our receiving the "Shelter Plus Care" grant from HUD and because we have applied for CDBG funding for four vehicles to expand our existing services due to the jump in the number of homeless on the island). Below numbers are duplicated unless otherwise noted. 2. Perform 728 intakes/assessments (unduplicated/entry into program only). 3. Provide case management to 733 participants. 4. Provide 2,680 non-medical referrals and follow up visits. 5. Refer or provide (take to appointment, set up appointment) 1,368 medical/health services visits. 6. Provide food supplies (or refer) to 2,452 participants. 7. Provide supplies (clothing, blankets, etc.) to 3,539 participants. 8. Provide 483 family counseling encounters. 9 Provide 6,486 lifestyle counseling encounters. NONPROFIT GRANT APPLICATION FISCAL YF,AR 2004-OS Page 2 Office for Social Ministry -Agency Name Care-A-Van -Program Name Program Highlights for FY02-03: Table 1: Number of Participants Served in FY02-03 FY 2002-03 Actual * 1. Total number of unduplicated homeless persons 949 2. Number of unduplicated single persons 646 3. Number of families 99 4. Number of undu licated individuals in families _ 313 5. Total number of encounters (duplicated) 31,887 Pertormance Measures: The outcome of CAV services will be that participants of CAV experience an improvement in their well-being due to the supportive network built by the CAV. Specific benefits that will lead to this well-being are found in the table below (estimates for FY04-05 were calculated at an increase of 10% over FY02-03 due to our receiving the "Shelter Plus Care" grant from HUD and because we have applied for CDBG funding for four vehicles to expand our existing services due to the jump in the number of homeless on the island). Table 2: Benefits FY 2002-03 FY 2003-04 FY 2004-OS Actual * Bud et * Estimate 1. Partici ants laced in emer enc /transitional housin 148 100 163 2. Partici ants laced in ermanent or retained housin 264 100 290 3. Participants placed in drug/alcohol treatment as a 86 50 95 direct result of Care-A-Van intervention _ 4. Participants accessing specific medical/dental care 1,314 800 1,445 from a ro riate source 5. Partici ants accessin mental health services 511 200 733 6. Partici ants in Ion -term case mana ement 666 300 562 *If applicable (On PAGE 5) Program Expenditures FY 2002-03 Actual * FY 2003-04 Budget * FY 2004-05 _ Estimate Salaries and Wa es 405,916.02 467,525.00 500,263.00 Professional Fees O erations 184,516.69 165,996.00 156,905.00 E ui ment 1,829.87 Other* _ _ Total 592,262.58 633,521.00 657,168.00 *Please explain in detail on separate sheet (On PAGE 6) Program Funding Sources for FY02-03 Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate HCDCH 350,025.00 4000,000.00 _ 400,000.00 Adult Mental Health 67,580.94 155,621.00 170,168.00 Adult Mental Health-Re Pa ee _ 56,423.29 39,900.00 48,000.00 Count of Hawaii _ 29,000.00 29,000.00 29,000.00 Waikiki Health Center 00-01 29186.52 _ 0.00 0.00 First Presb terian Church 5,000.00 5,000.00 5,000.00 HIUW _ 3,000.00 4,000.00 5,000.00 Donations 4,269.32 0.00 0.00 Total _ 544,485.07 _ _633,521.00 _ 657,168.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 _ Office for Social Ministry - A ency Name Care-A-Van -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 ayear-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 ~ _ /~-aS-a 3 ~'ignature of Board ~President/Chair Date 1 1 - b'-F - 0 3 Signature of Executi Dire o Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICA'T'ION PISCAI_ YEAR 2004-OS Page 4 ~0 D ~ 5 o, w A W N - oo J a to A w N : Q### Oa O a S ',7' 7 C. S m o Z z Z z z z z'Z 'Z Z Z 'z 2 Z _ w o 'o" ~ - w rn m ro S Y a ~ w~ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Ga w c# - z~~ ~ z N' v7 0 0 0 0 0 0 X 0 0 0 0 0 0 0 0 - o C- o S A. o. p. fD w rn ~ -n -n -n -n -n -n -n -n -n -n ~ B 0. rc 'n 'O V b 'D ^n n n 7 ' O m : LTI '3 rn ~ m m rn rn w w w v rn 7 m mow, a~ o• 3 q' ~ a~ : '~7 H ti ~ w w C a m a ~ v ~o 'o C! w o~ o Z m ~ ~ y a y GM c a fD 2 ~ ^n m y Q O < ~ ~ ~ ,a.~ aaa[xJ~'~.o o'~ _ 9 ('ern m rn o Ov' ~.°o n ~ -.77 fD ~ rn o 0 0 'c' C7 • ° 5 ~ ~ 'ri y y y ~ s~ ~ c w "Y? : -3 \~vi/ ~ ~ ° c a ° ~ ~o _ n: o ° ~tgy`y3' ~o o :w N y yy. '~t Y t"o ~ ~ tbo O S O N 'i' G W ~i ~ N +f1 y N a = n' c y ift, ~ ~ 9~~~ ~y' r ~ W y n w y w~ ~ rOi~ N p' N ill. ~ s awo c m ~ ~ oa M ~ ~ a ~ w ~ N ~ y ~ ~C ~ ~ w ~ n ~ m ~ rn n' 3 Yy H y O N w~ G w b 'LY w ~ !r ry w N oo ~ N N N ~ N to ~ J A Oa O ~C CN '9 O O O p 0 0 O~ O O O p 0 0 D O 0 0 ~ X 0 0 0 0 ~ ~ O O O O O ~ 0 0 0 O O O O O O 0 0 0 0 O O tlG a+ w 'm I ~ ~ V ~ A G m O J A V A w H N ~ ~D ~p O~ OWO N " O N ? ~ ~ J ~ N : IJ w A N N s.~'ic w A rn a` N~ m w~ P~ X ~ _ ,~yp~ a J tNi~ N J A in A N T J O. w A ~ A oo A A y p_ O 00 00 W W ~p W N In A 00 A OD J H H ~ R A J N J A A A J~~ O: w In A O~ A 00 00 to A 00 A J ~ N N U A W 00 ~ W ~ O\ ~ w ~ b ~ W 01 W ~l O J L G1 W~ v W A O\ J~ : A ~ A O~ A A A A M •t~ ~ ~ N A N~ N ~ N W W A Oo N : O O ~ O O O~~ ~ w T~~ y' : O w A !C!~ A w i0 J J N J A .Y A b p ~ W J N ~ ~ W w ~ A Oo W IJ N IJ ? ~ ~ OAi pw ~ ~p N N ~D O ~n w vAi ~ r'C 'J ~ A A ~ ~ J ~ A rn ~ N ~Dyy..~ O J W ~p O~ ~D J oo in to Oo w• J N ~ ~ A ~ N N D, N w vi N N W to ~ V~ O w A N o W to Q\ N~ A N w N p~ A ~D A O J O O O ~p o 0 0 ~ o o 0 0 0 0 o e ° - o o ° o o ~ o O 0 0 ~ - err o 0 0 ~ ~~Fi1CF FO 2003-2004 Budget and Projected revenues and funding sources for Care a Van REVENUE Description 30800-641 Donations 21300-641 HCDCH Contract $ 400,000.00 21300-641 AMH Outreach Contract $ 155,621.00 21300-641 AMH Re Pa ee Contract $ 39,900.00 21300-641 Count Grant $ 29,000.00 32501-641 HIUW $ 4,000.00 32503-641 Other Revenue $ 5,000.00 TOTAL $ 633,521.00 EXPENSES 40100-641 Salaries $ 333,401.00 40200-641 Pa roll Taxes $ 29,488.00 40300-641 Health Benefits $ 76,206.00 41100-641 Retirement $ 23,940.00 43500-641 WC $ 3,295.00 43800-641 TDI $ 1,195.00 $467,525.00 42000-641 Tele hone $ 18,115.00 42500-641 Posta e $ 1,000.00 42701-641 Office Su plies $ 4,265.00 42702-641 Office E ui ment 42703-641 Co in 42704-641 Printin /Media $ 2,400.00 42705-641 Office Re airs 43001-641 Vehicle Mileage $ 4,022.00 43002-641 Vehicle Parkin 43003-641 Vehicle FuelslRe airs $ 8,851.00 43004-641 Vehicle Insurance $ 5,885.00 43005-641 Vehicle Rent $ 1,160.00 43006-641 Vehicle Re air $ 6,500.00 43800-641 Otherlnsurance 44000-641 Re airs & Maintenance $ 3,000.00 44201-641 Publications 44202-641 Dues/Memberships 47501-641 Travel out of State 47502-641 Travellnter-Island $ 2,604.00 49001-641 S onsared Meetings 49002-641 Hos italit $ 1,000.00 49003-641 Professional Development $ 3,300.00 49004-641 Contract Services 49005-641 Rent $ 15,536.00 49007-641 Program Costs $ 4,954.00 49030-641 M mt feesllndirect costs $ 77,404.00 49015-641 Homeward Bound $ 6,000.00 49099-641 Miscellaneous TOTAL $ 633,521.00 Net Gain/Loss $ - 6 Office for Social Ministry - Agency Name Hawaii Island Food Bank -Program Name Agency Director: Carol R. Ignacio, Executive Director Phone No.: (808) 935-3050, x105 Contact Person: Allan Deehr, Acting Managing Director Phone No.: (808) 935-3050, x101 Mailing Address: 140-B Holomua Street, Hilo, HI 96720 Facility/Site Address: 140-B Holomua Street, Hilo, HI 96720 and 79-1016 E. Honalo Road, Kealakekua, HI 96750 (not a mailing address) Fax No.: (808) 935-3794 Email Address: Carolrign@aol.com for Carol Ignacio Ladeehr@aol.com for Allan Deehr Amount of Request for County funds: $32,500 Prior Year Funding: 01-02 02-03 03-04 $29,000 $32,500 $32,500 Agency Mission Statement: To meet the challenges ofever-changing community needs by utilizing spiritual, human and material resources to empower those in need to live with dignity and respect. We live out this mission using afour-sided model of service that incorporates direct service, justice education, advocacy, and community development into a variety of client-driven safety net programs such as the Hawaii Island Food Bank. All programs of the Office for Social Ministry serve the entire community regardless of religious beliefs, age sex, ethnicity or ability. Program Description: The Hawaii Island Food Bank (HIFB) serves the entire County of Hawaii through athree-fold mission through which we work to: 1) Prevent the waste of all edible food in Hawaii County; 2) Feed the hungry with this food; and 3) Educate the community about hunger and what can be done to fight this problem. The HIFB is a clearinghouse for food and non-food items that retailers, wholesalers and farmers would normally discard (reasons for discarding food: surplus product, discontinued product, near pull date product, ripped labeling, off-grade produce), and for food donated by the community through food drives. On a daily basis, HIFB staff members drive to donor sites to pick up these items. All goods are then taken back to the warehouses, one in East Hawaii and one in West Hawaii, where HIFB staff and volunteers weigh the incoming poundage and then salvage usable product. Once items are salvaged, they are stocked on the warehouse shelves for distribution to nonprofit member agencies. This past year, over 1.5 million pounds were distributed via our network of approved, nonprofit member agency network. These agencies distribute goods directly to the public either by serving meals, providing food boxes, or providing snacks to adults and children in day programs. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page ] Office for Social Ministry - Agency Name Hawaii Island Food Bank -Program Name Agencies include hot meal programs, after school programs, food pantries, child and adult day programs, programs that serve the chronically ill, homeless and abuse shelters, and substance abuse recovery programs. Additionally, the HIFB operates its own Senior Brown Bag Program that provides items for low-income seniors at nine sites on a weekly basis. Equally important to the food bank's mission is its educational component. Throughout the year the food bank participates in community forums and gives presentations to civic groups, schools, businesses and other interested parties about hunger on the island and steps we all can take to help make a difference in the life of someone hungry. Brochures, i. e. "How to Hold a Food Drive," and other statistical information are distributed at the forums and presentations. Total Budget and Position Count Total Program Budget 616 404.00 Total Program Position Count 8 Total Agency Budget 2,204,074.00 Total Agency Position Count 32 Program Objectives for FY02-03: 1) To rescue and distribute over 1,000,000 unsaleable but usable pounds of food and nonfood items throughout Hawaii County in order to feed those families and individuals in need (elderly, homeless, unemployed, underemployed, chronically ill, etc) of emergency food. 2) To provide 12 educational presentations to schools, businesses, civic groups and clubs, and to participate in community fairs or forums where informational booths will be set up for the public. At least one presentation or community booth per month will take place. Program Highlights for FY02-03: 1) Received and salvaged over 1.84 million pounds of goods from Big Island donor companies and the Hawaii Foodbank as well as organizations that held food drives. 2) Distributed over 1.5 million pounds of goods throughout Hawaii County via our islandwide network of nonprofit member agencies and via the food bank's own Senior Brown Bag Program. This food served 131,809 individual requests for food (duplicated count, individuals are counted more than once if they visit the pantry more than once a year) through our food pantries. This is an increase of 16,127 requests over the previous fiscal year. 3) Our member agency meal programs served meals and snacks to 63,915 individuals (459,306 meals/snacks, both duplicated counts). 4) Presentations, warehouse tours, and forums were presented throughout the year in 15 cases. Information about the HIFB and how it works was presented to interested groups and the public at community forums. 5) This past year, the HIFB participated in aUSDA-funded program as a partner of the Kauai Food Bank. The grant titled, "Subsidizing Low-Income Seniors on the Islands of Kauai and Hawaii to Enhance Domestic Consumption of Locally Grown Produce," provided funds for the food banks to purchase fresh produce from local farmers. As such, it was a nutrition program as well as an economic development program. The program ran for 17 weeks (June 30, 2003 -October 24, 2003) providing over $200,000 worth of produce (241,210 pounds) to 1,556 low-income seniors. The Kauai Food Bank is once again submitting an application to the USDA for the same program and partnership and a funding decision will be made by February or March. NONPROFIT (URANT APPLICATION FISCAL YEAR 2004-OS Page 2 Office for Social Ministry - Agency Name Hawaii Island Food Bank -Program Name Performance Measures FY 2002-03 FY 2003-04 FY 2004-OS Actual * Bud et * Estimate 1. Pounds of grocery items rescued, over 1,840,000 1,000,000 1,000,000 salvaged, and stocked, islandwide pounds pounds pounds incomin ounda e . _ 2. Pounds of grocery items distributed over 1,500,000 1,000,000 1,000,000 throw hout Hawaii Count _ __pounds ounds pounds _ 3. Number of presentations to be given to 15 12 12 ublic re ardin wa s to hel fi ht hun er. presentations resentations resentations *Ifapplicable FY02-03 Incoming Poundage is on Page 6. FY02-03 Distributed Poundage found on Pages 7-9. Program Expenditures FY 2002-03 Actual * FY 2003-04 Budget * FY 2004-05 Estimate Salaries and Wa es 309,781.94 _ 329,733.00 290,130.00 O erations 375,385.41 212,973.00 281,274.00 E ui ment Other* see a e 5 _ 73,687.93 48,500.00 45,000.00 Total 758,855.28 591,206.00 616,404.00 *Please explain in detail on separate sheet FY03-04 Budget found on Pages 10-12. Please note FY0203 Actuals are smaller than what is found on enclosed Profit and Loss Statements because the value of the donated food is not included in cash budgets in above table. Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Count of Hawaii 32,500.00 35,000.00 _ 32,500.00 State of Hawaii via Hawaii Foodbank 26,250.00_ 26,250.00 26,250.00 Grants Plus 6,188.00 _ EFSP FEMA 3,000.00 _ 7,000.00 7,000.00 Hawaii Island United Wa 10,999.40 11,000.00 11,000.00 Har Weinber Foundation 100,000.00 50,000.00 Hawaii Communit Foundation 4,300.00 _ 24,685.00 10,000.00 Crane Foundation 2,000.00 Combined Federal Cam ai n 13,355.53 12,000.00 12,000.00 MAZON: A Jewish Res once to Hun er _ 10,000.00 8,000.00 Atherton Famil Foundation 10,000.00 Various Medium Trusts 60,000.00 40,000.00 Various Small Trusts 6,494.00 17,000.00 9,000.00 Pro ram Service Fees 118,035.01 120,100.00 120,000.00 Hawaii Hotel Indust Foundation 3,000.00 3,000.00 3,000.00 Fundraisin Events 285,029.59_ 183,800.00 210,000.00 Donations 172,305.46 _48,771.00 55,654.00 Interest & o_th_er_ r_eve_nue _ _ 13,00_4.53 22,600.00 22,000.00 Total 796,461_.5_2_ _ _ 591,206.00_ 616,4.04.00 `Ifapplicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Office for Social Ministry -Agency Name Hawaii Island Food Bank -Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; aevard 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 ~~hapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit ayear-end report to the Legislative auditor v~~ithin 60 days after June 30 of the fiscal year. The report shall include an explan~rtion of the public t~enefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, rind 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 age~~cy's future funding requests. /z-oS-a 3 ignatu of E3oard resident/Chair Date u-- t'~-H-n 3 _ Signature of executive Director Date ~JNSIGNED PROPOSAL S WILL NOT BE ACCEPTED! NONPROFIT C :RANT APPL[C.ATION FISCAL YEAR 2004-OS Page 4 Office for Social Ministry - Agency Name Hawaii Island Food Bank -Program Name Program Expenditures Other Expenditures FY 2002-03 Actual Fundraisin Costs _ 65,606.35 Bank Char es 2,389.53 Excise Tax 2,697.36 Advertisin /Promotion 2,439.22 Miscellaneous _ 555.47 Total 73,687.93 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 ~ N I In I Ln D1 a M M c' 0 Oj `m, E ill of H ~ o o a I o 0 ~ ~ o o 0 a ~ ~ ~ c°' m m o cl o, o o ~ m U I~ E ~ M to o N C O O ry O p p } O O O ~ w E ~ c a Q I o ~ m m c ~ 0 0 ~ c T O m a a m N C 4 O O C7 c w LL I li C O = C O N N m ~ Ol O> CJ C] CI p' n w - a U C o a° 0 w ~ o w F U Z O o~ a a a ~ ~ o o ~ ~ ~ N D I O O O c II U U a 0 o'..I m ~ ~ w Page 6 01128/04 Hawaii Island Food Bank Program Pounds per monthlAnnual Report July 2002 through June 2003 Jul 02 Aug 02 Sep 02 Oct 02 Nov 02 Dec 02 Inventory H101 BABYFOOD -285.00 -94.00 -377.00 -764.00 -355.00 -262.00 H102 BAKERY -3,187.00 -3,418.00 -3,536.00 -2,390.00 -3,321.00 -3,831.00 H703 BEVERAGE -14,429.00 -14,139.00 -19,043.00 -24,581.00 -15,942.00 -13,270.00 H107 DAIRY -8,051.00 -8,994.00 -8,886.00 -6,976.00 -8,598.00 -11,401.00 H109 FRUITS -4,184.00 -2,301.00 -2,239.00 -2,353.00 -1,490.00 -4,043.00 H113 NF CASE -10,107.00 -4,627.00 -5,431.00 -10,850.00 -6,289.00 -3,346.00 H119 DRESSING -4,072.00 -3,431.00 -1,625.00 -2,276.00 -1,267.00 -2,286.00 H120 SAUCES 0.00 0.00 0.00 0.00 0.00 -4.00 H122 SNACKS -6,837.00 -8,776.00 -6,157.00 -5,351.00 -2,636.00 -4,755.00 H123 MEALS -6,020.00 -5,221.00 -5,601.00 -7,167.00 -4,968.00 -4,052.00 H127 PRODUCE -6,865.00 -2,945.00 -5,154.00 -5,715.00 -8,736.00 -7,291.00 H128 MEAT -2,298.00 -2,068.00 -2,342.00 -3,727.00 -5,468.00 -5,426.00 H150 F-CASE -8,097.00 -3,660.00 -4,489.00 -5,802.00 -4,279.00 -5,985.00 H160 FOOD DR 0.00 0.00 0.00 0.00 0.00 0.00 H180 USDA GDS -10,231.00 -7,952.00 -15,686.00 -13,507.00 -8,974.00 -8,066.00 K101 BABYFOOD -396.00 -228.00 -234.00 -484.00 -160.00 -516.00 K102 BAKERY -8,485.00 -10,081.00 -10,138.00 -6,305.00 -4,941.00 -5,474.00 K103 BEVERAGE -6,032.00 -5,650.00 -5,999.00 -9,213.00 -5,976.00 -5,895.00 K107 DAIRY -4,046.00 -3,942.00 -4,015.00 -4,153.00 -4,318.00 -3,634.00 K109 FRUITS -2,067.00 -2,755.00 -3,424.00 -2,202.00 -2,548.00 -2,969.00 K113 NF CASE -2,320.00 -1,698.00 -1,502.00 -2,460.00 -1,022.00 -2,495.00 K119 DRESSING -3,421.00 -2,519.00 -1,550.00 -2,318.00 -1,676.00 -2,250.00 K122 SNACKS -2,992.00 -3,190.00 -2,060.00 -3,985.00 -2,063.00 -2,802.00 K123 MEALS -5,727.00 -3,446.00 -2,829.00 -2,872.00 -3,169.00 -2,345.00 K127 PRODUCE -3,319.00 -666.00 -260.00 -2,620.00 -1,649.00 -632.00 K128 MEAT -4,450.00 -1,856.00 -1,724.00 -1,848.00 -9,770.00 -6,866.00 K150 F-CASE -2,470.00 -3,330.00 -1,885.00 -3,254.00 -2,280.00 -3,271.00 K160 FOOD DR 0.00 0.00 0.00 0.00 0.00 0.00 K180 USDA GDS -6,514.00 -3,188.00 -1,924.00 -3,218.00 -4,997.00 -4,481.00 Total Inventory -136,902.00 -110,177.00 -118,110.00 -136,391.00 -116,912.00 -117,848.00 NOTE: Negative signs mean that the poundage is being subtracted from inventory. Page 7 Page 1 of 3 ovza~oa Hawaii Island Food Bank Program Pounds per month/Annual Report July 2002 through June 2003 Jan 03 Feb 03 Mar 03 Apr 03 May 03 Jun 03 Inventory H101 BABYFOOD -197.00 -174.00 -69.00 -495.00 -203.00 -75.00 H102 BAKERY -4,433.00 -2,608.00 -2,792.00 -4,383.00 -4,694.00 -3,550.00 H103 BEVERAGE -16,039.00 -13,949.00 -11,686.00 -11,590.00 -10,366.00 -13,907.00 H107 DAIRY -9,164.00 -7,783.00 -7,231.00 -7,104.00 -8,224.00 -8,250.00 H109 FRUITS -3,023.00 -1,219.00 -1,889.00 -2,463.00 -5,302.00 -5,803.00 H113 NF CASE -5,970.00 -6,297.00 -8,296.00 -2,385.00 -3,544.00 -4,238.00 H119 DRESSING -1,829.00 -1.376.00 -2,366.00 -2,188.00 -2,449.00 -2,239.00 H120 SAUCES 0.00 0.00 0.00 0.00 0.00 0.00 H122 SNACKS -9,162.00 -6,829.00 -5,814.00 -5,816.00 -4,899.00 -1,793.00 H123 MEALS -3,048.00 -4,364.00 -4,870.00 -4,423.00 -4,613.00 -3,642.00 H127 PRODUCE -5,421.00 -1,810.00 -4,004.00 -3,240.00 -2,413.00 -3,039.00 H128 MEAT -4,506.00 -1,937.00 -2,696.00 -6,276.00 -3,165.00 -3,533.00 H150 F-CASE -6,956.00 -3,528.00 -4,963.00 -6,536.00 -6,801.00 -5,284.00 H160 FOOD DR 0.00 0.00 0.00 -2,696.00 0.00 0.00 H180 USDA GDS -5,983.00 -28,772.00 -22,297.00 -19,045.00 -13,656.00 -11,110.00 K101 BABYFOOD -449.00 -566.00 -151.00 -225.00 -311.00 -361.00 K102 BAKERY -6,622.00 -6,287.00 -5,827.00 -7,285.00 -6,683.00 -6,507.00 K103 BEVERAGE -7,685.00 -11,387.00 -6,727.00 -9.665.00 -9,685.00 -9,653.00 K107 DAIRY -5,664.00 -4,671.00 -3,856.00 -5,529.00 -6,121.00 -3,649.00 K109 FRUITS -3,038.00 -1,935.00 -1,981.00 -2,685.00 -6,700.00 -3,766.00 K113 NF CASE -1,962.00 -2,620.00 -1,546.00 -1,622.00 -1,546.00 -1,016.00 K119 DRESSING -1,989.00 -2,432.00 -2,407.00 -2,735.00 -2,305.00 -2,657.00 K122 SNACKS -5,115.00 -3,926.00 -3,586.00 -5,078.00 -4,890.00 -3,038.00 K123 MEALS -3,159.00 -2,553.00 -2,272.00 -3,525.00 -3,019.00 -3,789.00 K727 PRODUCE -851.00 -480.00 -254.00 -1,200.00 -165.00 -1,607.00 K128 MEAT -5,349.00 -3,193.00 -942.00 -6,070.00 -1.804.00 -1,650.00 K150 F-CASE -3,580.00 -3,110.00 -3,172.00 -4,150.00 -4,138.00 -5,976.00 K160 FOOD DR -79.00 0.00 0.00 -23.00 0.00 0.00 K180 USDA GDS -4,596.00 -11,361.00 -12,313.00 -11,067.00 -8,575.00 -3,583.00 Total Inventory -125,869.00 -135,167.00 -124,007.00 -139,699.00 -126,271.00 -113,715.00 Page 2 of 3 Page 8 olnaloa Hawaii Island Food Bank Program Pounds per month/Annual Report July 2002 through June 2003 TOTAL Jul '02 -Jun 03 Inventory H101 BABYFOOD -3,350.00 H102 BAKERY -42,143.00 H103 BEVERAGE -178,941.00 H107 DAIRY -100,662.00 H109 FRUITS -36,309.00 H113 NF CASE -71,380.00 H 119 DRESSING -27,404.00 H120 SAUCES -4.00 H122 SNACKS -68,825.00 H123 MEALS -57,989.00 H127 PRODUCE -56,633.00 H128 MEAT -43,462.00 H150 F-CASE -66,380.00 H160 FOOD DR -2,696.00 H780 USDA GDS -165,279.00 K101 BABYFOOD -4,081.00 K102 BAKERY -84,635.00 K703 BEVERAGE -93,767.00 K707 DAIRY -53,798.00 K109 FRUITS -36,070.00 K113 NF CASE -21,809.00 K119 DRESSING -28,259.00 K122 SNACKS -42,725.00 K123 MEALS -38,705.00 K127 PRODUCE -13,703.00 K128 MEAT -45,524.00 K150 F-CASE -40,616.00 K160 FOOD DR -102.00 K180 USDA GDS -75,817.00 Total Inventory -1,501,068.00 Page 3 of 3 Page 9 OSIM .Y 2003-2004 Hawaii Island Food Bank -Budget Program Fees/ 2003/2004 Government Grant Program Donations/ BUDGET Funding Funding Fees Fundraising REVENUE Government 1 County of Hawaii 35,000.00 35,000.00 2 Emergent Food/Shelter Program 7,000.00 7,000.00 3 State (POS) FreighUfood 26,250.00 26,250.00 4 State (JTPA) & Grants + 5 Total $ 68,250.00 68,250.00 Trusts & Foundations 6 Hawaii Island United Way 11,000.00 11,000.00 7 Federal Campaign 12,000.00 12,000.00 8 Hawaii Community Foundation-EOT 24,685.00 24,685.00 9 Other foundations 100,000.00 100,000.00 10 Total $ 147,685.00 135,685.00 12,000.00 Individual Donations 12 Cash Donations 48,371.00 48,371.00 13 Wishing Well 400.00 400.00 14 Total $ 48,771.00 48,771.00 Pro ram Services 15 SMC $ 120,000.00 120,000.00 16 Memberships $ 100.00 100.00 17 Brown Bags 18 Total $ 120,100.00 120,100.00 S ecial Evenfs 19 Community Fundraiser $ 60,000.00 60,000.00 20 Check-Out Hunger $ 18,000.00 18,000.00 21 Various Community Events $ 10,000.00 10,000.00 22 Direct Mail $ 25,000.00 25,000.00 23 Advertising/Promotions - NL $ 1,800.00 1,800.00 Fill a Bag $ 10,000.00 10,000.00 24 Spring Food Drive (inc. Fill a Bag) $ 25,000.00 25,000.00 Fall Food Drive $ 25,000.00 25,000.00 25 Other Special Events $ 9,000.00 9,000.00 26 Total $ 183,800.00 183,800.00 27 Interest Income $ 3,000.00 3,000.00 Other Revenue 28 Return Inc. $ 14,500.00 14,500.00 29 Patriots Dinner $ 5,000.00 5,000.00 30 Recycling Revenue $ 100.00 100.00 31 Other Revenue 32 Total $ 19,600.00 19,600.00 33 TOfal Revenue $591,206.00 68,250.00 135,685.00 120,100.00 267,171.00 Page 10 ~yOSM 2003-2004 Hawaii Island Food Bank -Budget Program Fees/ 2003/2004 Government Grant Program Donations/ BUDGET Funding Funding Fees Fundraising Expenses - Pa roll 34 Gross Wages 235,000.00 70,000.00 100,000.00 65,000.00 35 Taxes 19,933.00 6,000.00 5,000.00 8,933.00 36 Health 50,000.00 14,000.00 10,000.00 26,000.00 37 Retirement 22,000.00 7,000.00 5,100.00 9,900.00 38 TDI Insurance 1,100.00 1,100.00 39 WCILife Insurance 1,700.00 1,700.00 40 Total $ 329,733.00 - 97,000.00 120,100.00 112,633.00 Food Purchases 41 Hawaii Foodbank (Food/Freight) $ 26,250.00 26,250.00 42 Grant in Aid - EFSP $ 7,000.00 7,000.00 43 Total $ 33,250.00 33,250.00 - - - Facilities 44 Rent 38,000.00 20,000.00 9,000.00 9,000.00 45 Utilities 24,000.00 15,000.00 6,000.00 3,000.00 46 Refuse 4,000.00 1,000.00 3,000.00 47 Repairs 8 Maintenance 7,000.00 2,000.00 5,000.00 48 Warehouse Supplies 2,000.00 2,000.00 - 49 Total $ 75,000.00 35,000.00 20,000.00 - 20,000.00 Vehicles _ 50 Insurance 10,505.00 1,500.00 9,005.00 51 Fuel 7,650.00 1,500.00 6,150.00 52 Permits 1,100.00 7,100.00 53 Repairs & Maintenance 6,500.00 1,500.00 5,000.00 54 Total $ 25,755.00 - 4,500.00 - 21,255.00 Administration & O erations 55 Office Supplies $ 1,500.00 585.00 915.00 56 Computer Supplies $ 500.00 500.00 571nsurance $ 600.00 600.00 58 Professional Fees (Audit) - 59 Postage $ 3,000.00 1,000.00 2,000.00 60 Subscriptions & Publications $ 400.00 400.00 61 Membership $ 350.00 350.00 62 Travelln-State $ 1,000.00 1,000.00 63 Travel Out of State $ 1,400.00 1,400.00 64 Travel Other (Hotel, Rental Car, etc.) $ 2,000.00 1,000.00 1,000.00 65 Mileage $ 2,000.00 1,000.00 1,000.00 66 Professional Development $ 500.00 500.00 67 Sponsored Meetings $ 1,000.00 500.00 500.00 68 Telephone $ 7,000.00 3,500.00 3,500.00 69 Duplication/Copying Expense $ 1,000.00 1,000.00 70 Office Repair & Maintenance $ 1,000.00 1,000.00 71 Hospitality/Volunteer Costs $ 1,500.00 1,500.00 73 Contract/Outside Services $ 3,500.00 3,500.00 74 Tota/ $ 28,250.00 - 7,585.00 - 20,665.00 Page 11 OSM 2003-2004 Hawaii Island Food Bank -Budget Program Fees/ 200312004 Government Grant Program Donations/ BUDGET Funding Funding Fees Fundraising S ecial Events 75 Headress Ball $ 12,000.00 12,000.00 76 Check-Out Hunger $ 2,000.00 2,000.00 77 Communit Events $ 3,100.00 3,100.00 78 Can Castle Extravaganza $ 1,000.00 1,000.00 79 Direct Mail $ 12,000.00 12,000.00 80 Advertising Promotion - NL _ 81 Food Drive $ 12,500.00 12,500.00 82 Other Special Events $ 400.00 400.00 83 Total $43,000.00 - - - 43,000.00 Other Ex enses 84 Bank Charges $ 1,000.00 1,000.00 85 Advertising/Promotions & Printing $ 3,000.00 3,000.00 86 Other Expenses $ 1,500.00 1,500.00 87 Tota/ $5,500.00 - - - 5,500.00 88 Total Operating Expenses $540,488.00 68,250.00 129,085.00 120,100.00 223,053.00 Indirect Cosfs 10% of Operating Expenses $50,718.00 6,600.00 44,118.00 68,250.00 135,685.00 120,100.00 267,171.00 Total Expenses $591,206.00 68,250.00 135,685.00 120,100.00 267,171.00 as Net (gain/loss) So.oo So.oo So.oo $o.oo So.oo Page 12 Office for Social Ministry Mobile Care Health Project Agency Director: Carol R. Ignacio, Executive Director Phone No.: (808) 935-3050, x105 Contact Person: Kaye Lundburg, Program Director Phone No.: (808) 935-3050, x107 Mailing Address: 140-B Holomua Street, Hilo, HI 96720 Facility/Site Address: Same Fax No.: (808) 935-3794 Email Address: Carolrign@aol.com, mikela@aloha.net Amount of Request for County funds: $25,000 Prior Year Funding: 01-02 02-03 03-04 $20,000 $20,000 $20,000 Agency Mission Statement: To meet the challenges of ever-changing community needs by utilizing spiritual, human and material resources to empower those in need to live with dignity and respect. Program Description: Funds are being requested for continuing support of the Mobile Care Health Project (hereinafter MCHP). The MCHP is a joint partnership between the Office for Social Ministry (hereinafter OSM), St. Francis Healthcare System and the community of the Big Island. The project provides primary dental care in the rural areas of Hawaii Island and in Kona. Services are delivered to the low-income uninsured and underinsured people around the island through two (2) Winnebago vans that are fully equipped for dental services. Currently, the MCHP has established outreach sites at the following five (5) locations: West Hawaii: Ocean View, Honaunau, Kailua-Kona North Hawaii: Honoka'a, Kapa'au NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Office for Social Ministry Mobile Care Health Project With the opening of the Keaau Family Health Center Dental Clinic in March 2003, the Mobile Care Health Project has suspended services in East Hawaii effective October 1, 2003. The Keaau Family Health Center Dental Clinic is now established and providing dental services for the target underserved population in East Hawaii. Mobile Care continues to advocate for the target population and provides emergency services for East Hawaii patients at scheduled clinic sites. The Mobile Care Health Project will now focus its efforts in North Hawaii and West Hawaii providing direct services in scheduled clinics and working collaboratively with community health center initiatives to establish dental capacity in stationary facilities. Effective October 1, 2003 the mobile van previously serving in East Hawaii has been located in Honokaa and will provide clinics weekly. An agreement between the Hamakua Health Center and the Mobile Care Health Project will provide for expanded dental services to the underserved population in Hamakua and North Hawaii. A contract between Hawaii Hospital Systems Corporation and St. Francis Healthcare System allows Mobile Care to provide dental assessments for the long-term care patients in Honokaa, Kapa'au and Pahala. The second mobile van continues to serve in West Hawaii at clinic locations in Ocean View, Honaunau, Kailua and Kapa'au Total Budget and Position Count - FY 2004-05 Total Pro ram Bud et 391,923.00 Total Pro ram Position Count 4 Total A enc Bud et 2,204,074.00 Total A enc Position Count 32 Program Objectives - FY 2004-05: 1) Goal: to provide direct dental care and health education to 2,000 people unable to access care due to financial hardship, transportation or geographic barriers. This will be accomplished by providing an average of 15 clinic days per month in 5 locations on the island of Hawaii utilizing volunteer and employed staff. 2) Goal: to provide dental assessments to Hawaii Health Systems Corporation (HHSC) long-term care patients in Honokaa, Kapa'au and Pahala. 3) Goal: to collaborate with the Community Health centers (hereinafter CHC) and Hawaii Island Dental Society directly and through the Hawaii Island Oral Health Task Force to establish stationary dental services within the CHC clinics. This will be accomplished through active participation and representation in meetings that are held monthly to address County Oral Health needs through planning and implementation of collaborative solutions. Program Highlights - FY 2003-04: 1) Provided direct dental care to 794 new patients and 996 return patients. 2) Averaged 25 clinic days per month. 3) Provided a total of 4,443 units of care including extractions and restorations. 4) Provided a value of $170,928.00 in uncompensated dental services. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 Office for Social Ministry Mobile Care Health Project 5) Participated in 5community-driven health fairs providing dental assessments, oral health education and fluoride treatments for 181 people. 6) Collaborated with members of the Hawaii Rural Health Association, the Hawaii State Primary Care Association and the Department of Health to assemble advocates for change through the Sate Oral Health Task Force. 7) Collaborated in the establishment of the Keaau Family Health Center, the first federally qualified community health center with a dental component on the Big Island. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-OS Actual * Bud et * Estimate - # of people accessing services 1971 3000 2000 *If applicable (see page 5) Program Expenditures FY 2002-03 FY 2003-04 FY 2004-OS Actual * Bud et * Estimate _ Salaries and Wa es 212,495.35 157,010.00 183,116.00 Professional Fees _ 94,376.00 _ _ 68,640.00 68,640.00 Operations _ _ 182,464.99 127,770.00 126,374.00 - - E ui ment 11,661.73 8,520.00 13,793.00 Other* - - - Total 500,988.07 361,940.00 391,923.00_ *Please explain in detail on separate sheet (see page 6) Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-OS _ _ Actual * Budget * Estimate State Grant in Aid _ 44,269.00 _100,000.00 100,000.00 _Coun of Hawaii _ 20,000.00 20,000.00 20,000.00 HDS _ - - 17,000.00_ ___16,000.00 - _ 0.00 HIUW 10,000.00 10,000.00 10,000.00 HMSA 49,500.00 50,000.00 50,000.00 St. Francis Health Systems 8_4,419.36 68,640.00 68,640.00 Bank of Hawaii _ _ 0.00 10,000.00 __20,000.00 Weinberg Foundation- _ 0.00 20,000.00 _ 0.00 OHA Foundation _ 0.00 0.00 50,000.00 Various grants 500.0 and less 4,000.00 21,000.00 4,000.00 Donations 58,528.59 _ 30,880.00 _31,783.0_0 Third Party/Client Payments _ _ _ 81,464.11 37,500.00 37,500.00 Total _ _ _ _ 36.9,181.06 384,020.00 391,923.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Office for Social Ministry -Agency Name Mobile Care Health Project -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 ayear-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. natur of Board resident/Chair Date ~'L O lQ _ G~ Signature of Executive Dire o Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 o ~ m nDZ~aj ~ aaxc~ $W .N 31 Z(7 Opp ~~~c°~$~cmto ~3O ~ p~ p~ ~ m U7 m m c m ~ ~ ~ ? m N N N C O) n N CL ~ y d ~ z~ ~ w w vw.v° -ia O p~ o m - w N N~ 0 O) ..r ~ N N N N N 0.1 > ~ N ~ ~ Z N 41 z w D m a c_ N m O O O~ m W~ 0 W m~ CT O m A V CT CO A C7 A N O D c m oo co cn w o au w O ~ N(7~ m(O O-+(DA mN W O N m O O W v O V A~ (AID W~ N~ O Q N ~ W H O m N 0 0 W O O O V (O O W m QD W (O ~ Z ~ O < ~ T O O ~ N (ND V V ~ m A~ (NO UNi (O ~ N O O n N Am ~ j (n cD (OmN N o~ommcn wcocnw wm ~ L O N W 7 A O~ m V~ (O (O N O O O m m A W O V A V A V m T N ~ ~ ~ N (J~ (O N m V m QD V N N mWOAOmmOmOO VQD ~OJ O d 'D _ _ ~ 0 0 ~ (NJ1 W A N O UAi O (m0 rn m U1 O N O) ~ n (D O O O (WP Cmlt V OV O N (Ali ONO (AO O m N N 3 fll O y _ ~ W O O W W A (WO O A S ~w+ N m z. n c ~ O W A~ W A A A A A O O O (D N V O W A W A V m N d 1 O_ J m ~NA QViN-V+~(~O (VO tNO W N m N A N m O~ V W m A W m Page 5 f%FFlCF H 2003-2004 Proposed Budget -Mobile Care Health Project -Big Island Account Description 2003-2004 REVENUE BUDGET 1 30800-642 Donations $10,800 2 Damien A eal $20,000 3 32501-642 Grants 4 State Grantln Aid $100,000 5 Coun of Hawaii $20,000 6 HDS Foundation $16,000 7 HMSA $50,000 8 Hawaii Hotel Indust $3,000 9 Hawaii Island United Wa $10,000 10 Catholic Women's Guild $1,000 11 St. Francis Foundation $68,640 12 Other Trusts & Foundations $25,000 13 32503-642 Other Revenue 14 Insurance Pa ments $30,000 15 Patient Pa ments $7,500 16 Total $361,940 2003-2004 EXPENSES BUDGET 17 40100-642 Salaries $ 115,533 18 40200-642 Pa roll Taxes $ 9,798 19 40300-642 Health Benefits $ 15,397 20 41100.642 Retirement $ 12,081 21 43500-642 WC $ 3,670 22 43800-642 TDI $ 531 $ 157,010 23 42000-642 Tele hone $ 9,600 24 42500-642 Posta e $ 600 25 42701-642 Office Su lies $ 600 26 42702-642 Office E ui ment $ 8,520 27 42703-642 Co in $ 120 28 42704-642 Printin /Media $ 300 29 42705-642 Office Re air/Maintenance $ 480 30 43001-642 Vehicle Milea e $ 4,800 31 43002-642 Vehicle Parkin $ 180 32 43003-642 Vehicle Fuels/Re airs $ 2,400 33 43004-642 Vehicle Insurance $ 2,160 34 43005-642 Vehicle Lease/Rental $ 600 35 43006-642 Vehicle Re air/Maintenance $ 1,200 36 43800-642 Other Insurance - MC $ 200 37 44000-642 Re airs & Maintenance $ 6,000 38 44202-642 Dues/Membershi s $ 180 39 47501-642 Travel out of state 40 47502-642 Travel/Inter-Island $ 3,000 41 49001-642 S onsored Meetin s $ 600 42 49002-642 Hos italit $ 900 43 49003-642 ProfessionalDevelo ment $ 1,200 44 49004-642 Contract Services 45 Dentists $ 68,640 46 Add'I Dental Assistants $ 35,320 47 49005-642 Rental of S ace $ 3,900 48 49007-642 Pro ram Costs/Su lies $ 17,580 49 49007-642 Dental Air Fare $ 25,200 50 49099-642 Miscellaneous $ 90 51 49030-642 M mt fees/Indirect Costs $ 10,560 52 Total $361,940.00 Net Gain/Loss $0.00 53 "Vehicle Depreciation not factored in. Paoo The Salvation Army-Family Intervention Services Ho'okala Adolescent Diversion Program-West Hawaii Agency Director: Pauline Pavao Phone No.: 935-4411 Ext. 11 Contact Person: Michael Chung Phone No.: 959-5855 Ext. 11 Mailing Address: POB 5085, Hilo HI 96720 Facility/Site Address: 82-5976C Mamalahoa Hwy. Capt. Cook, HI 96704 Fax No.: 933-9810 Email Address: PaulinePavao@usw.salvationarmy.org Amount of Request for County funds: $29,000 Prior Year Funding: 01-02 02-03 03-04 $30,000 $29,000 $29,000 Agency Mission Statement: To provide skills for a healthy life, and instill purpose, hope, and vision to youth and their families. The Agency's goals are to provide youth 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 funds provided by this grant will be used to enhance our Ho'okala adolescent diversion program. Since 1993 to current, our agency has been funded by the Office of Youth Services to implement this service on the Big Island. This program helps to prevent youth, who have been arrested by the police, from getting inappropriately detained in police lockup facilities. The program also provides early prevention and intervention sei .ices to these youngsters, so that they do not further penetrate the juvenile justice system. We will provide various services such as drug prevention activities, to help decrease the youths NONPROFIT GRANT APPLICATION FISCAL Y1;AR 2004-OS Fage I involvement with the police and to address other problem behaviors such as teen pregnancy, drug usage, gang involvement, delinquency, and/or family management problems. For youths, who at the time of their arrest are unable to return home, we will access short-term emergency placement services to help them with a more timely and appropriate reunification back with their family. Our short-term intensive case management services will then focus attention on family preservation and involvement. Through this process, we will provide referral and information services to help link youths and their families to other services/resources that may be available within our agency and/or in the community. With our follow-up services, we will continue to make contacts with youth and families to assure that the youth does not require further police intervention. Social skill building and other relapse prevention activities may also be provided while a youth is in follow-up. For youths and families that are either resistive or difficult to reach, we employ a service strategy called targeted/outreach. We will target youth who come from the following areas from the West Hawaii District: North and South Kona, North and South Kohala, and Kau districts. Total Budget and Position Count Total Program Budget 437,000 Total Program Position Count 8 Total Agency Budget ~ 3,534,419 ~ Total Agency Position Count 71 Program Objectives: 1) 66% of the youth who will come to the attention of the Ho'okala Program will not require further police intervention. Program Highlights: 1) 52 youths completed our S.M.A. R.T. Moves program, which continues to be the centerpiece of our approach to providing prevention and positive youth development activities. 20% of the youths who enrolled in this program came from families with drug use and abuse backgrounds. 2) In January 2003, 20 youths participated in the Youth Crime Watch of America training held in Kona to help get involved in the process of reducing the threat of crime, violence and drugs, and at the same time instilling positive values, building self-esteem, develop leadership skills with these youngsters. 3) We continued assistance with Kealakehe Comrnunity Youth Council (KCYS), which is a part of the Kealakehe Neighborf~ood Watch program. NONPROFIT GRANT APPLICATION FISCAL YIJAR 2004-05 Page 2 4) In March 2003, 23 youths and 8 volunteers participated in "Make a Difference Day" and helped to clean the Kealakehe Pathway and the area in front of the Kealakehe Elementary School. 5) In May 2003, 3 youth participants received an Elk's Youth Award for volunteer service in the community. 6) 27 youths participated in the Charity Walk sponsored by the Hawaii Hotel Association and solicited pledges. 7) We have provided various opportunities during our summer program. They included the following: Six week SMART Moves Stay Smart Curriculum and positive skill building activities for 52 youngsters. Activities included arts & crafts, a community garden project, field trips for cultural and educational awareness. 8) 27 youths participated in the "King Kamehameha Day Parade" and 31 participated in the 4`h of July Parade. The goal of each these activities were to instill the historical importance of each of these significant individuals and events. 9) We continue to work with other community partners throughout the year. They include: Kealakehe Elementary, Intermediate, & High Schools, Queen Liliuokalani Children's Center, Alu Like, Community Policing program, various business & community groups. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * _ Budget * Estimate Intensive Case management 75 Services Follow-u Services 75 Alternative Placement Services 30 Outreach Services 40 Social Skill Buildin Services 30 Referral and Information Services 50 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 The Salvation Army-Family Intervention Services Ho'okala Adolescent Diversion Program-West Hawaii Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Budget * Estimate Salaries and Wages 21,223 22,926 23,833 Professional Fees 116 O erations 7,768 6,074 5,167 E ui ment Other* Total 29,107 _ 29,000 29,000 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Budget * Estimate 29,000 29,000 29,000 376,000 408,000 408,000 Total 405,000 437,000 437,000 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 The Salvation Army - Famil)r Intervention Services Kona Adolescent Diversion 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 82F, Hawaii Revised Sta#utes. tf awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a yearend report to the Legislative auditor within t30 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 atl expentlitures supported by County of Nawai'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 may impact the evaluation of your program's or agency's future funding requests. ' . ~:.~G--tr- j - rte- _ 6 ~ _ ptL Signature of Divisional Commander Date ! -°e~~' Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 The Salvation Army Family Intervention Services Youth Service Center Program-PUMA Agency Director: Pauline Pavao Phone No.: 935-4411 Contact Person: Raymond Dangaran Phone No.: 959-5855 !28 Mailing Address: P.O. Box 5085 Hilo, HI 96720 FacilitylSite Address: 1786 Kinoole St. Hilo, HI 96720 Fax No.: 933-9810 Email Address: PaulinePavao@usw.salvationarmy.org Amount of Request for County funds: $ 35,000 Prior Year Funding: 01-02 02-03 03-04 $ 35, 000 $ 35,000 $ 35, 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 tb 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-Youth Service Center Program 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 pCE, ecstasy, 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 OuVeach Services and Case Management Services to youth ages 7-18 years old and their families, residing in the Puna districts. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Outreach services consist of: ? S.M.A.R.T. Moves Program -Skills Mastery And Resistance Training Program which addresses various problems experienced" by youth, including use and abuse of alcohol, tobacco,and other illicit drugs, personal and social skills, and decision making. ? Leadership Development Program -The L. E.A. D. Team (teaming 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 projects. ? Project Family Activities -Provide parent support and family strengthening activities to promote family cohesion and positive relationships within diverse family structures. ? Positive Alternative Activities. -Recreational, Educational and Youth Leadership Activities Case Management Services consist of: a Intake and Assessment ? Crisis Intervention ? Individual Service Planning ? Linkage to Community Resources ? Follow-up and Monitoring All services wilt be part of the Youth Service Centers funded by the Office of Youth Services located in the Keaau School Complex, Pahoa High and Intermediate Schools, and Nanawale Community Center. Total Budget and Position Count Total Pro ram Bud et 655,000 Total Pro ram Position Count 10 Total Agency Bud et 3,534,419 Total Agency Position Count 71 Program ®bjectives: 1 } Of the 150 youth participating in Youth Service Center Program, 60% will will register for Outreach Services and maintain participation with the program registered for to completion or for 6 months beyond the registra#ion date. 2} Of the 30 youth participating in the Youth Service Center Program, 68% will be identified for Case Management Services, will receive or be referred to an appropriate service based on an assessment, and will complete an individual service plan, and demonstrate improvement based on service plan to completion or for 6 months beyond the date of intervention. NONPROFIT GRANT APPLICATION FISCAL YEAR 20U4-OS Page 2 Pr®gram Highlights: 1) During the past year, we provided the S.M.A. R.T. Moves program for 168 youth from Keaau Elementary, Keaau Middle, Pahoa High and Intermediate Schools, and at the Nanawale Community Center. Youth participated in developmental ski11 building activities in areas such as self esteem, self confidence, interpersonal skills, teamwork, decision making, peer pressures, anger management, and drug awareness. 2) Throughout the year, we've conducted several retreats for youths and their families in the Puna area. One of the successful retreats was the Mother/Daughter retreat. Mothers and daughters spent time reflecting and acknowledging their strengths and weaknesses. Our goal was to give Mothers and Daughters time to learn from each other and build a stronger bond between the two. Activities consisted of skill building in areas of self -discovery, communication, anger management, rules and consequences, and leaving a legacy. 3) We also provided several leadership development retreats for youths who are involved with the L. E.A. D. Team Program. The overall objective is to provide youth with leadership skills and training to become responsible and positive citizens in their communities. Skill development activities included: personallinterpersonal skills, teamwork, decision making/problem solving, goal setting, community service and teaming, and action planning process. Throughout the year, the L. E.A.D. Teams would action plan, organize, prepare, and then conduct community service projects. Youths, families, and community members were involved with beach and roadside clean-ups, community functions (Easter and Christmas activities), and participated with the island-wide "Give Hugs Not Drugs" sign waving project, focusing on the "Ice" Epidemic on the Big Island. 4) We provided a summer program for 35 youths from the Puna districts. Activities consisted of recreation, arts and crafts, cultural activities, gender specific activities, excursions, S.M.A. R. T. Moves activities, and a bVater Awareness Program (develop skills in water rescue, water safety, First Aid/CPR, and canoe paddling. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actua! * Bud et ° Estimate Com letion of S.M.A.R.T. Moves 168 120 100 Completion of L.E.A. D. Team 79 60 65 Partici ates in Pos. Alter. Activities 143 120 100 Partici ates in Case M t. Services 30 30 30 Partici ates in Pro'ect Famil 70 60 60 Follow u and Monitorin 122 100 100 'If applicable NONPRQFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 3 Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et " Estimate Salaries and Wa es 26,216 26,081 29,745 Professional Fees 122 O erations 8855 8,919 5255 E ui ment Other"` Total 35,193 35,000 35,000 ""Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual " Bud et " Estimate Count of Hawaii 35,000 35,000 35,000 Boys and Girts Ciub of 9-iawaii 35,000 35,000 35,000 Office of Youth Services 0 525,000 525,000 Hawaii Communit Foundation 0 60,000 60,000 Total 235,000 655,000 655,000 "If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 The Salvation Army -Family Intervention Services Puna Youth Service 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, 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 ayear-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 atime-y, complete.. and accurate year-end report may impact the evaluation of your program's or agency's future funding requests. Signature of Divisipnal Commander Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Speical Olympics Hawaii -Agency Name Special Olympics Hawaii-East Hawaii - FrOgram Name Agency Director: Nancy Bottelo Phone No.: 943-8808 ex 22 Contact Person: Nip Ho Phone No.: 808-943-8808 ex 23 Mailing Address: P.O. Box 3295 *Honolulu, HI 97801 Facility/Site Address: 1500 S. Beretania #208 *Honolulu, Hf 96826 Fax No.: 943-8814 Email Address: program@specialolympicshawaii.org Amount of Request for County funds: $12000.00 Prior Year Funding: 01-02 02-03 03-04 $6000.00 $5000.00 $5000.00 Agency Mission Statement: The mission of Special Olympics is to provide year-round sports training and athletic competition in a variety of Olympic-type sports for children and adults with closely related developmental 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. Program Description: Timothy Shriver, Chairman of the Special Olympics Incorporated Board of Directors, stated at the 2003 World Summer Games in Dublin Ireland, "Somewhere near and somewhere very far away, there is a boy or a girl, a NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 woman or a man, sitting silently in lonely despair, longing for human contact and simple affirmation, longing for the joy we feel here tonight." 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 independently as adults. Special Olympics helps to give individuals with a closely related developmental 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 the 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 East Hawaii fulfills that need and provides the necessary skills for people to continue good health throughout their lives within our community. Special Olympics East 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 developmental 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 Olymics East Hawaii now has a softball team and several bowling 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. The benefits that all the athletes receive from their participation in Special Olympics include: improved physical fitness and motor skills, greater self- confidence, amore 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 child's talents. We have found that 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 accepted for who they are and for what they can do. Community volunteers find out what good friends the athletes can be. Everyone learns more about the capabilities of people with developmental disabilities. The need for the Special Olympics East Hawaii program to continue here on this island is extremely high. 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. These services are not available anywhere else but with our program. We not only touch the lives of our Special Olympics athletes, but also their families and the hundreds of volunteers from our community. Our founder, Eunice Kennedy Shriver, believes sports training and competition opportunities should be available for all who qualify rather than all who could NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 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. All of the money raised for the East Hawaii program stays here to support our program. Due to this 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 (ALPS). Athletes are trained to become coaches, public speakers, members of the Board of Directors, officials, and technology experts using PowerPoint. In 2004 our Athlete representatives will be selected and travel to Oahu where they serve on the State Athlete Congress. The Athlete Congress is a voting body that votes on issues that are affecting their program. These representatives bring their Area issues to this body and determine what all the athletes from the state want to do. When decisions are made, those athletes will present their findings to the appropriate people, this could include the CEO/President of Special Olympics all the way to the Board of Directors. East Hawaii had one of our own athletes elected by his peers throughout the State of Hawaii to serve as the Congress Chairperson. Special Olympics East Hawaii's largest expense for 2004 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 similar 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 inlcude; dances, Opening and Closing Ceremonies, entertainment and games, and being exposed to a Healthy Athlete Village. This village provides a free dental screening, vision screening and hearing 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 are trained to treat people with disabilities. Special Olympics East Hawaii wishes to continue to provide these fantastic opportunities to all the athletes that are currently involved and to be able to reach out to new special needs individuals throughout our communities. In order to do this, we will need funds to maintain our services and to Outreach to athletes and volunteers, training for coaches and athletes, pay for bowling fees, and provide transportation for athletes to get to practices and competitions. Special Olympics Hawaii-East Hawaii Area is asking for $12,000.00 from the County of Hawaii to help fund our Special Olympics East Hawaii program activities. The budget for our program has increased over $30,000 this year due to our increased athlete numbers and to the increase in airfare for athletes and coaches to travel. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 3 Total Budget and Position Count Total Program Budget 86799.00 Total Program Position Count 1 Total Agency Budget 1406928.00 Total Agency Position Count 17 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 special Olympics Hawaii -Agency Name Special Olympics Hawaii-East Hawaii - PI'Ogf-am Name Program Objectives: 1) Provide quality training and competition for 153 athletes and special partners within our program by June 2005. 2) Provide training and necessary equipment including travel and housing for our 3 Athlete Congress representatives and 1 Athlete mentor for the Athlete Congress in August 2004. 3) Increase the total number of athletes being provided services by Special Olympics East Hawaii by an overall 10% by June 2005. 4) Continue with our 2 family activities for 75 family members that will be conducted by our family committee by June 2005. 5) Provide transportation to 115 athletes, coaches, special partners 3 times per year so they may travel to state competitions to compete with their peers to be completed by June 2005. Program Highlights: 1) Increased our number of Basketball teams from 3 teams to 4, thereby helping to improve several more athletes health through better cardiovascular activities. 2) Developed a Unified Bowling program, providing our athletes another opportunity to interact with their non-handicapped peers within the community. 3) Provided special events for our family members throughout the year. Also sent families to special sessions at the Annual Leadership Conference on Oahu. 4) Continued to develop the Area Management Team which helps to coordinate all activities for the Special Olympics East Hawaii program. 5) Continued our community activities such as the Highway Cleanup Project, singing at Hale Anuenue and the Clean tt Up program through Walmart. 6) Conducted a very successful athletic training program for 153 Special Olympics athletes. 7) Conducted 3 major athletic competitions for our athletes, coaches, family members and volunteers. 8) Provided additional training for our Games Management Team who coordinates all competitions for East Hawaii. 9) Continued with our 3 year Program Development program highlighting goals and objectives for Special Olympics East Hawaii. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Budget * Estimate Athlete numbers 123 135 148 Unified partner numbers 30 33 36 Volunteers 130 145 160 Family members 25 40 75 Management Team members 7 15 20 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 6 Special Olympics Hawaii - Ag2P1Cy Name Special Olympics Hawaii-East Hawaii - Pi'Ogi'8ill N8i11@ Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Budget * Estimate Salaries and Wages 0.00 2140.00 2200.00 Professional Fees 75.64 2090.00 2650.00 Operations 24319.83 47130.00 5475.00 Equipment 479.54 2380.00 76474.00 Other* Total 24875.01 53740.00 86799.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Budget * Estimate Foundations 7200.00 18000.00 23800.00 Individual Contributions 686.02 1700.00 10000.00 Corporate Contributions 1827.84 3950.00 1050.00 Service Clubs 75.00 0.00 0.00 Special Events 611.92 20050.00 40900.00 HSO Co-Op Monies 828.00 10340.00 12250.00 Interest Income 32.95 200.00 100.00 Merchandising Sales 7386.93 0.00 0.00 Total 18648.66 54240.00 88100.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 7 special Olympics Hawaii -Agency Name Special Olympics Hawaii-East Hawaii - PfOgfam 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 ayear-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. ~~o~- Signat re f Boa d President/Chair Date / ~ o~ Si natur f Ex cutive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 8 Special Olympics Hawaii-West Hawaii Special Olympics Hawaii-West Hawaii General Funding Agency Director: Sheryl Cobb Phone No.: 322-0603 Contact Person: Sheryl Cobb Phone Np.: 322-0603 Mailing Address: P.O. Box 2105, Kealakekua, HI 96750 Facility/Site Address: 78-6580 Mamalahoa Hwy., Holualoa, HI 96725 Fax No.: 322-4357 Email Address: specolywesthi@hotmail.com Amount of Request for County funds: $10,000 Prior Year Funding: 01-02 02-03 03-04 $4,000.00 $5,000.00 $5,000.00 Agency Mission Statement: 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 mental retardation or closely related developmental disabilities, giving them continuing opportunities to develop physical fitness, demonstrate courage, experience joy and participate in a sharing of gifts, skills and friendships with their families, other Special Olympics athletes and the community. Program Description: Special Olympics Hawaii West Hawaii is continuing an extensive Outreach program in the coming year. We have targeted school age individuals primarily and have been making contacts within schools in order to be able to reach out to the disabled community to find and work with individuals with mental retardation. We have increased our previous years numbers by nearly 20 per cent and realize there are many more to reach. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Special Olympics Hawaii West Hawaii Special Olympics Hawaii West Hawaii General Funding Our goal for the next year is to continue to focus the outreach program to one geographic locale, the Kohala region. We feel limiting our geographic area will allow us to build a stable and quality program without stretching resources too far and we have received a lot of interest from people in this area wanting to join our program. This goal includes 3 new schools in the Kohala region. Our program provides necessary physical activity that special needs children and adults are rarely provided. In addition to the physical benefits these new athletes will receive, they will be given a chance to socialize and make new friendships. Special Olympics West Hawaii provides this opportunity in many different ways. We conduct our own local competitions and training, have Holiday parties, hold local dances and picnics, travel together to neighbor islands for competitions where dances and banquets aze held. We have many athletes who have never traveled away from Kona until joining Special Olympics. We can provide these individuals with a much larger view upon the world. In addition to reaching out to those new athletes in the Kohala region, we will be reaching out to the families, teachers, care givers, and communities in that area. We are hoping that by localizing our outreach to this one region, we aze better able to recruit volunteers, coaches and other potential members including Special Partners for unified sports as well as offer training facilities in their immediate geographic region. The coaching staff for Special Olympics Hawaii West Hawaii Area will also be expanding with this Outreach Project. It is expected to reach at least 5 new coaches. This is the wonderful part of Special Olympics that bring the community and our athletes together. In order for Special Olympics Hawaii to provide this much needed service to the families and their special needs children, there are many expensive needs to be covered. As you know, the cost of the equipment for these athletes to train and compete in their given sport can be quite costly. Additional needs include ground transportation to practices and competition, air transportation to State competitions, uniforms, meals and awards. There aze also minimal yet mandatory training requirements for coaches and volunteers to attend in order to receive certification to work with Special Olympics athletes. Special Olympics Hawaii has been an accredited program of Special Olympics Incorporated since 1968. The West Hawaii Area Director, who will make contact through the school systems, newspaper, adult facilities, etc., will coordinate the Outreach Project along with the Outreach Chairperson. Total Budget and Position Count Totat Pro ram Bud et $56,175.08 Total Pro ram Position Count 2 Total Agency Budget 1,406,928.00 Total Agency Position Count 17 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 2 Special Olympics Hawaii-West Hawaii Special Olympics Hawaii-West Hawaii General Funding Program Objectives: 1) Increase school participation in Kohala District by 3 schools. 2) Increase athlete count by 20 in this district. 3) Initiate Unified Sports programs to involve more family members and general public. 4) Establish stable and functioning Kohala delegatiop to maintain newly recruited athletes. 5) Train new delegation on ways to maintain current and recruit new athletes, coaches, and volunteers. 6) Provide financial support for new delegation. 7) Provide activities for families and siblings in new delegation 8) Increase Athlete Leadership by training more Global Messengers (athletes trained in public speaking). Program Highlights: 1) Increased number of certified coaches in our program by 5. 2) Increased number of families involved in our program. 3) Increased athlete count by nearly 20 per cent. 4) Had family specific events and booths at competitions. 5) Started new delegation within a school (Kealakehe Intermediate School). 6) Outreached to teachers at Teacher Institute Day. 7) Distributed outreach packets to 3 elementary schools in West Hawaii. 8) Maintained and expanded relations with local adult center (Kona Krafts). 9) Provided community service projects including aid stations at local races. 10) Extended the knowledge of what Special Olympics is all about through numerous press releases and other public education information. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Community Service projects-Aid 7 7 8 Station State Com etitions on Oahu 3 3 3 Area/ R Tonal Com etitions 7 8 8 Dele ations within school 4 5 7 Number of athletes within r ram 38 58 78 Number of S ecial Partners 4 20 20 Number of Families active) involved 15 25 35 Number of Famil Events 3 6 8 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 3 Special Olympics Hawaii-West Hawaii Special Olympics Hawaii-West Hawaii General Funding Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 940.08 940.08 940.08 Professional Fees 0.00 0.00 0.00 O rations 22846.37 29705.00 44435.00 E ui ment 4128.96 1000.00 Other* 6991.74 12860.00 10800.00 Total 34907.15 44505.00 56175.08 "Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate State of Hawaii DOE 1000.00 3000.00 3000.00 Coun of Hawaii Non-Profit Grant 5000.00 10000.00 10000.00 Crane Foundation 2500.00 2500.00 2500.00 Shi man Foundation 0.00 0.00 0.00 Ironman Foundation 3500.00 5000.00 7000.00 Make a Difference Da Grant 0.00 0.00 0.00 Private Donations 3682.75 2000.00 3000.00 Merchandise Sales 870.00 1150.00 1150.00 Car Washes 4 er ear 6835.00 2400.00 2800.00 Bench Press Contest 1098.00 1200.00 1200.00 Consolidated Theaters Drive x2 327.54 0.00 0.00 Starbucks Massa a and Coffee 486.00 0.00 0.00 Fire Truck Pull 5037.00 7000.00 7000.00 Silent Auction 350.00 2500.00 2500.00 Cor rate Contributions 1000.00 4500.00 3500.00 Service Clubs 0.00 2500.00 2500.00 SOHI Co-0 Mone 1899.00 2500.00 2500.00 Interest Income 10.76 50.00 50.00 Under ants Run 1020.00 0.00 3000.00 S in A Thon 1949.00 0.00 4800.00 Total 36565.05 46300.00 56500.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Special Olympics Hawaii-West Hawaii Special Olympics Hawaii-West Hawaii General Funding 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 ar~d 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 ayear-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. / t~~ Sign ure of Boa d PresidenUChair Date Sign ture of cecuti a Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Special Olympics Hawaii-West Hav~eii Area Special Olympics Hawaii-West Hawaii General Funding Program Expenditures: Other Total Training costs--includes: facility rental, sports specific $ 6100.00 equipment and ground transportation. Total Conference costs-includes 1 to attend North America Leadership conference (Iowa) and 2 athletes & 1 mentor, and 1 management team member to attend Athlete Leadership Council (Oahu), a~ well as 8 coaching certification classes throughout the year. $ 4700.00 Total of other expenditures: $ 10800.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 6 Turning Point for Families, Inc. Alternatives to Violence -North Hawaii Waimea Groups Agency Director: Lee Lord Phone No.: 935-8229 ext. 241 Contact Person: Judy Segobia Phone No.: 935-8229 ext. 248 Mailing Address: P.O. Box 612, Hilo, HI 96721 FacilitylSite Address: (Hllo) 1266 Kamehameha Ave. # A-5, Hilo, HI 96720 ( Kona)77-6425 Kuakini Hwy., Suite B-201,Kailua-Kona, Hi 96745 Fax No.: 934-7600 Email Address: admin2@ilhawaii.net Amount of Request for County funds: $10,000.00 Prior Year Funding: 01-02 02-03 03-04 $9,000.00 $9000.00 $9000.00 Agency Mission Statement: Turning Point for Families, Inc. is domestic violence agency that provides Shelter, Counseling, Education, and Advocacy to promote aviolence-free community (In the County of Hawaii). Program Description: Turing Point for Families, Inc. (TPFFI) is seeking funding for the Kona/North Hawaii Alternatives to Violence Program (ATV); more specifically county funding will be • used to support the ATV batterers groups held in Waimea at Tutus House. ' Turning Point for Families, Inc. (TPFFI) has been concerned for sometime with the growing problem of domestic violence, and this year is no exception. This year TPFFI has seen a significant increase in the number of clients being served. According to the Hawaii County Police Departments Domestic Violence Case Statistics, there were 783 domestic violence reports over a four (4) month period, 314 of those resulted in arrest and charge for domestic violence. The number of individuals contacting TPFFI and filing protection orders from intimate partners has doubled for the current fiscal year. We believe there is a direct correlation between those needing protection from intimate partners and the current methamphetamine epidemic in our state. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Turning Point for Families, Inc. Alternatives to Violence -North Hawaii Waimea Groups AN is designed to assist batterers in changing their abusive behaviors, challenge their beliefs system, and taking personal responsibility for their abusive actions. Batterers learn to replace their abusive behaviors with positive behaviors. The benefits are: safety for family members, safety for neighbors, a stop to the perpetuation of domestic violence, an opportunity to become a positive role model, and a reduction in the need for societal interventions. The targeted population is the domestic violence batterers who reside in, North Hawaii County, being referred to AN, who does not have reliable transportation to travel to Kona or Hilo, and cannot afford childcare for the length of time it would take them to commute to Kailua-Kona or Hilo for their classes. The North Hawaii group encompasses the Honokaa, Waimea, Kohala, and Waikoloa areas. Group is held once a week at Tutu's House in Waimea on Monday evenings for 2 hours from 6pm to 8pm. Psycho educational groups are used to deliver the information in a classroom style presentation. Interactive discussions are incorporated into the process with mandatory homework due for every class. Individual assessments are completed to test the participant's knowledge and understanding of the material during program participation. A pre/post test is administered prior to and at the completion of the program. Classroom participation is mandatory throughout the program. Sheltering the victim does not bring change to the behavior of the batterer. The program teaches participants, who are the abusers, to take accountability for their actions and abusive behavior. This is a justifiable expenditure of public funds, if the abuse continues, our children, families, and neighbors are at-risk of injury. Total Budget and Position Count Total Pro ram Bud et $767,752.00 Total Pro ram Position Count 30 Total A enc Bud et $2,032,642.00 Total A enc Position Count 61 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 2 Turning Point for Families, Inc. Alternatives to Violence -North Hawaii Waimea Groups Program Objectives: The main goal, of all AN programs, is for participants to reduce or stop the use of physical violence towards their spouse and/or intimate partner. Projected outcomes for North Hawaii ATV: 1) 95% of participants in group will be violence free while in the program 2) 60% of participants who complete the 28 week program will reduce the frequency and severity of physical violence while in group. 3) 60% of participants who complete the program will have demonstrated an increased knowledge of power and control tactics. 4) 45% of participants who successfully complete group will remain violence free for 1 year after completion of group. Tracking participant's use of physical violence starts immediately. The methods used for tracking are as follows: • Self-reporting of violent acts and behavior is required and agreed to during enrollment into the ATV program. • Safety checks are conducted a minimum of once a month with the perpetrators victim prior to group so that the perpetrator (with the permission of the victim) can be confronted. (see attached form) • TPFFI staff collaborates and maintains contact with probation officers, sharing participant information in regards to violent incidences and other criminal activity. • TPFFI ATV staff attends court hearings on a weekly basis to report on non- compliance/compliance of program participation. We further monitor program participation and objectives utilizing the following tools: 1. Client Questionnaire. TPFFI has a measurable instrument designed for clients to evaluate the program that they are exiting. This questionnaire can be given to clients to fill out and return with their name or be anonymous. Another method offered to clients is having their Case Manager conduct an exit interview to discuss the effectiveness of the program. Once the questionnaire has been completed, it is reviewed by the Program Director. All grievance, complaints, and suggestions for improvement are shared with the Executive Director for necessary follow-up and remedy. 2. Bi-Monthly Meetings with Clients. The weekly meetings between clients and Case Manager provide another opportunity for clients to communicate issues with the program. The Case Manager collects the information and presents the issues of concern to the Program Director and the Executive Director. If the NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Turning Point for Families, Inc. Alternatives to Violence -North Hawaii Waimea Groups Case Manager is unable to address the issues to the satisfaction of the participant it will be referred through the chain of command (Program Director, Executive Director, Board President, and Board of Directors Program Committee). 3. Weekly and Monthly Reports. The Case Managers provide weekly and monthly reports to the Program Director that entails client's activities, progress, and any program issues that may arise. The Program Director provides the Executive Director with a monthly program report that gives a summary of program management. Furthermore, the Executive Director provides a comprehensive report to the Board of Directors program development and management committee, financial reports on each funding source with variances, administration activities, and public awareness and relations activities. 4. Regular Evaluation of Program. TPFFI administration has a system to evaluate the program's progress and compliance (at least on a quarterly basis) with the objectives and requirements set fourth by each funding source and contract. The Program Director conducts quarterly in-house audits to ensure program goals and objectives are being met in accordance with TPFFI standards and as proposed to funding sources and contracts. Methods will include reviewing Case Managers assessments, the development and implementation of an educational plan, monitoring and follow-up efforts with clients. The Executive Director will review the quarterly audit and develop a plan, if needed, to maintain TPFFI standards, compliance with funding sources, and effective program management. All programs are evaluated on and on-going basis. TPFFI Board of Directors has a Program Committee with dedicated and committed members to evaluate TPFFI programs. Program Committee members conduct a through program audit annually. Methods used during the audit include surveying current and past program participants (with their permission), reviewing program objectives and outcomes, and ensuring compliance with funding source contracts. Other evaluation methods include the senior Case Manager observing group facilitation and providing feedback/training to facilitators on a weekly basis. Facilitators also provide feedback to one another, on techniques that were successful and techniques which were not. Yearly, staff evaluations are completed by the Program Director with input from the employees and the senor Case Manager. In addition, the Judiciary monitors the program on an annual basis. Quarterly fiscal and program reports are sent to Family Court and Third Circuit Court for review. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Turning Point for Families, Inc. Alternatives to Violence -North Hawaii Waimea Groups Program Highlights: 1) Agency marks 25`" anniversary. 2) 25 Hours of Domestic Violence training for all staff. 3) West Hawaii ATV offers parenting classes. Beginning in January 2003 a 15 session parenting program was implemented with a focus on those parents that had been or had experienced domestic violence themselves. 4) All ATV program staff, continue to receive on-going training in the domestic violence field. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate # of men served 699 991 991 # of Psycho-Educational Group for men who batter 884 974 974 # of Women served 1,213 1,090 1,090 # Psycho-Educational groups for women who batter 156 172 172 # of Women su ort rou s 104 114 114 # of Women's Pattern Changing Grou s 156 401 401 # of Childcare hours rovided 576 802 802 # of Therapy hours provided to children 192 218 208 # of total women and men's groups rovided 1,440 1,662 1,662 # of unduplicated men and women served 1,909 2,081 2,081 # of direct service hours case management provided for men and 15,264 17,931 17,931 women ' # of hours devoted to intakes with ro ram artici ants 3,818 3,005 3,005 # of hours rovidin rou s 2880 2880 2880 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Turning Point for Families, Inc. Alternatives to Violence -North Hawaii Waimea Groups Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es $605,115.00 $586,612.00 $605,088.00 Professional Fees $2,000.00 2,000.00 $6,500.00 O erations $174,994.00 $136,238.00 $149,164.00 E ui ment $9,623.00 $8,200.00 $7,000.00 Other* 0 0 0 Total $791,732.00 $733,050.00 $767,752.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Coun of Hawaii $9,000.00 $9,000.00 $10,000.00 State of Hawaii $618,166.00 $541,341.00 $541,341.00 Federal 0 0 0 Private Foundations $32,145.00 $13,009.00 $35,902.00 Donations $115.00 $500.00 $12,009.00 Service/Pro ram Fees $157,259.00 $167,500.00 $167,500.00 Vendin 0 0 0 Fundraisin $687.00 $1,700.00 $1,000.00 Interest Income 0 0 0 Other Income 0 0 0 Total $817,372.00 $733,050.00 $767,752.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 6 Turning Point for Families, Inc. Alternatives to Violence -Kona/North Hawaii Waimea Groups 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 ayear-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 vour program's or a~ency's future funding requests. Signature of Board President/Chair Date ~ 1 3 o O Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 7 Turning Point for Families, Inc. Rural Outreach Project Agency Director. Lee Lord Phone No.: 935-8229 ext. 241 Contact Person: Judy Segobia Phone No.: 935-8229 ext. 248 Mailing Address: P.O. Box 612 Hilo, Hawaii 96720 Facility/Site Address: Scattered Site Fax No.: 934-7600 Email Addn~s: admin2@ilhawaii.net Amount of Request for County funds: $ 5,000.00 Prior Year Funding: 01-02 02-03 03-04 $0.00 $0.00 $0.00 Agency Mission Statement Turning Point for Families, Inc. is a domestic violence agency that provides Shelter, Counseling, Education and Advocacy to promote aviolence- free community (In the County of Hawaii). Program Description: Turning Point for Families, Inc. (TPFFI) is seeking funding to resume the Rural Outreach Project in the County of Hawaii. The Rural Outreach Project is designed to provide services to victims of domestic and their children, who are currently undersenred, in the rural outlying districts of the Big Island. The districts to be served will encompass the East, West, North, and South districts of the Big Island. TPFFI is seeking funding to hire (1) program staff at 1.0 FTE and will seek to expand the program as resources become available. The program will utilize 2-3 volunteers in each of the following communities, North and South Kohala, Hamakua, Honoka'a, Puna/Mountain View, Kau, and Na'alehu. Turning Point for Families, Inc. (TPFFI) has been concerned for sometime with the lack of domestic violence support services for battered women and their children in the rural areas of the County of Hawaii. The County of Hawaii has an area of 4,028.2 square miles that are equivalent to 2,578,072 acres of land. The impact of the Big Island's physical environment cannot be understated. Providing social services which meets the needs of battered women within a large geographical area, and which are accessible to the population is a challenge. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Turning Point for Families, Inc. Rural Outreach Project Being a social service agency providing services for over 25 years, we observe a repeating trend of communities that are farther away from Hilo and Kona (where services are located) receiving little or no services due to geographic location and transportation issues (lack of city transportation and personal means of transportation). In addition to the lack of domestic violence intervention and support services, and the demand for these services in rural areas of Hawaii County, our island faces other social problems that compound domestic violence. Hawaii County has the highest poverty and unemployment rate in the State (Hawaii State Data Book, 1997). One program staff at 1.0 FTE and 2-3 Volunteer Victim/Family Advocates will provide rural outreach services to battered women and their children. The ROP staff establishes a satellite office to provide services to battered women in rural areas. For example, in East Hawaii, our satellite once is at the Hamakua Health Center in Honoka'a the program staff works closely with doctors and community service providers as experts in domestic violence education, intervention and prevention. The basic goals of the program are to reduce the incidents of violence in intimate relationships in both the frequency and in its severity and to provide safety for victims. An advantage of establishing satellite offices to provide rural outreach services is developing and maintaining a network of supporting service providers in the community. The support network includes the police officers that serve the area, doctors/nurses, Prosecutor's Office, church, community and business leaders (Chamber of Commerce, Jaycees, etc.). When a woman has been identified, in a rural area, let's say by the police, and the Rural Outreach Coordinator is contacted, the Rural Outreach Coordinator is then responsible for contacting one of the Volunteer Victim/Family Advocates. The Volunteer Victim/Family Advocate, under the direction of the Rural Outreach Coordinator, will establish contact with the victim and provide services needed including TRO, advocacy, counseling, etc. Once a week the Rural Outreach Coordinator and Victim/Family Advocate will travel to the satellite offices to facilitate support groups for victims in that area. Advertisements will be made so that women wanting to "walk-in" to do TRO's will know when and where the meetings are held so that they can do so. The Rural Outreach Coordinator would provide group facilitation at each site once a week. Perpetrators of domestic violence isolate their victims in almost every instance, providing them the opportunity to maintain consistent power and control over their victims. Perpetrators of domestic violence choose rural areas in which to locate their families, areas where support services are unavailable to victims of domestic violence. A lack of support combined with a lack of knowledge about the resources and legal measures available, keeps victims in their abusive relationships. Victims depend solely on their perpetrators for transportation, NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 Turning Point for Families, Inc. Rural Outreach Project economic support, and adult interaction. It is important to note that victim's who accessed the Rural Outreach program, when R was available, initially accessed services for support. Once becoming educated and understanding the dynamics of domestic violence, as well as the legal measures available to protect them and their children, then, and only then, did clients seek orders of protection, utilize the domestic abuse shelter, and make the decision to no longer tolerate the abuse of their children or themselves. Many, associate domestic violence solely with intimate partners, but domestic violence is not limited to intimate partners. The elderly have become victims of their adult children, the disabled by their caretakers, and minor children have become victims of one or both parents, especially where substance abuse is a factor. The ICE epidemic in Hawaii has further increased the number of domestic violence occurrences. In the first quarter of the current fiscal year TPFFI has served twice the number of victims as in the previous year. According to the Hawaii County Police Department Domestic Violence Statistics for 2003, (note: only 4 months of statistics were compiled) there were 783 reported cases of domestic violence, 371, almost half, occurred in rural communities. To further compound the need, Hale Ola Ka'u shelter, which provided services to domestic violence victims, will be closing their shelter, citing a lack of volunteers to provide services. The more serious domestic violence acts that have occurred this past year, such as the death of Mrs. Gorospe, occurred in rural areas of the County, areas, which we are proposing to serve. TPFFI received funding to provide services to the rural communities in our county, over the past 5 years, however funding was depleted in March 2003, and we were unable to continue services, or secure additional funding. Rural community leaders, sister agencies, law enforcement, and domestic violence victims have contacted TPFFI, seeking information about services or to offer support and encouragement, for our agency to continue seeking funds. The Board of Directors has made the Rural Outreach project, its number one priority. TPFFI is requesting funding from the County non-profd granting program primarily because, it is essential to our efforts to secure funding, that our local County Government acknowledges the need for the Rural Outreach Program. Total Bud et and Position Count Total P ram Bud et $43,129.00 Total P ram Position Count 1 Total enc Bud et $2,032,642.00 Total A enc Position Count 61 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Turning Point for Families, Inc. Rural Outreach Project Program Objectives: 1) To reach victims of domestic violence and their children in rural areas of our County. 2) To empower rural communities, by educating them on the dynamics of domestic violence, so that they may better support families, versus re- victimizing. 3) To educate our youth in rural communities on the dynamics of domestic violence, providing early intervention. Outcome Indicators Initial outcomes 1. Access to domestic violence advocates providing crisis counseling, support, 1. Number of domestic violence victims and resource information. accessing advocacy and support services. (Documentation in client 2. Domestic violence victim's increased files and rural outreach database) knowledge about the resources and options available to protect them. 2. Number of victims filing Temporary Restraining Orders (documentation in client files). Intermediate Outcomes 1. Community education on the dynamics 1. Answers to surveys to be provided at of domestic violence. the completion of each in-service & Number of community agencies and functions requesting in-service. 2. Educating youth on the dynamics of 2. Answers to surveys to be provided at domestic violence providing early the completion of each in-service. intervention. Long-Terre Outcomes 1. Reduction in the # of domestic 1. Domestic Violence case statistics violence incidences within rural compiled by Hawaii County Police communities Department. 2. Community network of service 2. Memorandums of understanding providers supporting domestic developed while establishing network violence victims. system. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Turning Point for Families, Inc. Rural Outreach Project Program Highlights: 1) Community support and networking. 2) Commitment from local community service providers, to provide space to Turning Point for Families, Inc. so that we may provide services to the victims of domestic violence in their communities. (see attached) 3) Increased awareness by victims/potential victims on the dynamics of domestic violence. 4) Annual increases in the # of individuals seeking services. 5) Increase in the number of victims filing Temporary Restraining Orders. Plans to upgrade: TPFFI is making an assertive effort, to seek funding to increase the number of (FTE) outreach advocates, who will provide services to the aforementioned districts. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * B et * Estimate # of intakes com leted 17 3 100 # of children rotected b a TRO 47 48 289 # of adults rotected b a TRO 48 38 125 # of elder) rotected b a TRO 5 2 10 # of children completing Processing/Safety 47 48 120 Plannin # of women completing pattern changing 17 6 110 rou s # of women maintain violence-free lifes les 17 6 110 # of re-unifications as a result of providing a 2 1 5 violence free environment # of women with increased knowledge of the 48 38 125 le al s stem # of communit event artici ation 2 1 20 # of advocac services rovided 238 241 550 # of children participating in the children's 47 48 250 ro ram # of person's provided services at 6 8 20 home/hos ital # of individual counselin sessions 389 279 500 # of safet checks 341 241 600 * Please note that fhe numbers for 03-04 are actual numbers served over the 3 months prior to funding depletion. Also note that these services were provided by 1 FTE at 3 satellite locations versus-the 8 locations we are proposing to serve. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Turning Point for Families, Inc. Rural Outreach Project P ram ndilures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 0 0 $32,587.00 Professional Fees 0 0 0 O erations 0 0 $10,542.00 E ui ment 0 0 0 Other* 0 0 0 Total 0 0 $43,129.00 *Please explain in detail on separate sheet P ram Fundin Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Coun of Hawaii 0 0 $5,000.00 State of Hawaii 0 0 $38,129.00 Federal 0 0 0 Private Foundations 0 0 0 Donations 0 0 0 Service/Pro ram Fees 0 0 0 Vendin 0 0 0 Fundraisin 0 0 0 Interest Income 0 0 0 Other Income 0 0 0 Total 0 0 $43,129.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 6 Turning Point for Families, Inc. Rural Outreach Project 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 ayear-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. ~ 11 log Signature of Board President/Chair Date t '3~ Oy Signatur of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 7 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter Agency Director: Lee Lord Phone No.: 935-8229 ext. 241 Contact Person: Judy Segobia Phone No.: 935-8229 ext. 248 Mailing Address: P.O. Box 612, Hilo, HI 96721 Facility/Site Address: West Hawaii Domestic Abuse Shelter ( Safe House-Confidential Address) Fax No.: (808) 934-7600 Email Address: admin2@ilhawaii.net Amount of Request for County funds: $22,000.00 Prior Year Funding: 01-02 02-03 03-04 $21,000.00 $21,000.00 $21,000.00 Agency Mission Statement: Turning Point for Families, Inc. is a domestic violence agency that provides Shelter, Counseling, Education, and Advocacy to promote aviolence-free community. (In the County of Hawaii) Program Description: Turning Point for Families, Inc., is seeking funds for the West Hawaii Domestic Abuse shelter program. The West Hawaii shelter has been providing emergency shelter and services to victims of domestic violence and their children since 1988. We are the only battered womens shelter providing services to the districts of Ka'u, Captain Cook, Kealakekua, Kailua-Kona, Waikoloa, Kohala, and Waimea. The West Hawaii shelter also provides services to victims fleeing their perpetrators on the East side of the Island. The main goal of the shelter is to, provide 24-hour emergency shelter to battered adults and their children; Furthermore the shelter provides a safe environment 365 days a year. In addition to emergency shelter, the program provides the following: NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter • Emergency Food Pantry • Safe Shelter for a maximum of 90 days • 24 hour crisis hotline (information, referral, screening, and intake for the shelter) • Peer counseling and support groups • Advocacy • Case Management • Individualized safety planning • Assistance with Temporary Restraining Orders • Links to other TPPFI programs such as Alternatives to Violence, Youth Services, and the Children's Programs • Shelter Transportation • Childcare during shelter group or individual counseling through the children's program Activities and Services The shelter program provides the following services: Crisis counseling, Advocacy, Support Groups, Information, Referrals, and Case Management Services. 1. Children's Services The Children's Program provides each child a safe environment to allow children to experience positive relationships during their stay at the shelter. The children's coordinator meets with each child as soon as possible to develop personalized safety plans. During the intake process expectations for participation in the children's program are made very clear. Mothers are expected to attend scheduled group and individual sessions with the children's coordinator to address the needs of each individual child. Victims of domestic violence who seek shelter and have children are under and endure an incredible amount of stress. Thus, all shelter staff are trained to intervene between adults and their children as needed. The children are also under an incredible amount of stress so intervention also occurs between siblings. As mandated by law, all program staff is required to report cases of suspected child abuse to Child Welfare Service (CWS). In cases where the resident is known to have an active case with CWS, the children's coordinator collaborates with the CWS social workers to insure conditions of the client's service plan are being met. The children's coordinator offers parents referrals to community providers for services depending on individual needs. Studies show that children of domestic violence often learn to minimize the violence, blame themselves, or the adult victim, and deny the abuse and violence that they have witnessed and/or endured. Group activities facilitated by the children's coordinator are designed to help children to feel safe and comfortable while at the shelter. The children's support group services focus on empowering the children by informing them of the choices they have to insure their personal safety, teaching them non-violent behaviors, and assist them in understanding that it is not their fault. Other NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter topics covered during group include: trust building, acknowledging violence and fears, communication, new ways of coping with violence, anger management, and conflict resolution. Measured by documentation in quarterly reports to funding sources and client files. 2. Transportation Services The shelter has a 7-passenger van that has be designated to carry out shelter services such as transporting residents to and from appointments to various service providers in the community, and any business pertaining to program matters. Policies and procedures for this service have been established and implemented by the staff. Victims are encouraged to request police assistance even if they have the Courts permission to return home to retrieve their personal belongings. A key ingredient in the success of the shelter program has been the active support and cooperation of the police and the human services agencies to meet the emergency transportation needs of families escaping domestic violence. Measured and documented in the daily log and the van travel log. 3. Socialization Activities Victims of domestic violence are often isolated from family, friends, and community. They are often made to feel that interacting with others is offensive and disrespectful to their partner. Many domestic violence victims lack the day to day social skills that we take for granted. The shelter program provides recreational activities and social opportunities for the victims and their children to have fun, nurture self-esteem and independence, and to improve in areas of decision making, goal setting, and team building. With recreational activities, victims as well as the children will be able to have fun, relieve some of their stress, and feel safe in a shelter atmosphere that is fun, safe and supportive. Other socialization activities will include: orientation to community resources, development of social skills, broadening of living experience, personal hygiene and grooming, preparing for job interviews, resume development, and stress reduction. Measured by documentation in daily log and client files. 4. Outreach/Follow-up Services After a resident has exited the shelter into independent living, they become a non-resident status client. Outreach services provided include: crisis assistance, individual and group services provided at a minimum of once a week depending on individual needs. The departing resident and shelter staff develop aftercare plans. After care plans are goals set by the client and advocate reinforcing skills learned at the shelter. Appropriate referrals to community services are given along with a relapse prevention plan and safety plan to prevent future incidences of violence, and assist clients in recognizing signs and triggers of a potential violent situation and/or inappropriate relationships. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter Participants are encouraged to participate in the Peer Mentoring Program after they leave the program. The Peer Mentoring Program extends the supportive services of the West Hawaii Domestic Abuse Shelter into the day to day lives of victims and their children, providing on going support for violence free options and community re-entry. As victims grow strong in their recovery, they begin to share these newfound strengths and gifts with other victims and the community The Peer Mentoring Program meets twice a month or as needed with the goal of promoting the strength and support of the victims. Measured and documented in client files and quarterly reports to funding sources. 4. Discharge Participants can stay at the shelter for up to ninety-days (90), extensions are granted on an individual basis. Shelter staff reviews the participant's case plans daily. During weekly staff team meetings all active files are reviewed with the Program Supervisor. Progress on goals and objectives in the service plans are accessed, updated, and documented in client files. Participants preparing to leave the shelter for independent living, regardless of the time spent at the shelter, will meet with an advocate to complete the outtake process. During the outtake process, advocates, complete outtake forms, make necessary referrals, recommend options towards living violence-free supported lifestyles, develops aftercare and follow-up plans. Children will meet with the children's coordinator to review safety plans and schedule follow-up sessions with parents and children. Participants may be discharged for violating the shelter rules regarding violence/threats of violence, drug or alcohol use/intoxication, breaching confidentiality of another participant or disclosing the shelter location, and stealing. Measured and documented in client files and quarterly reports to funding sources. Safety is the primary outcome for victims of domestic violence and their children. While at the shelter, residents can rest assured that they are safe from their batterer. When leaving the shelter victims will have an individualized safety plan for themselves and their children, assisting them in remaining safe. The primary outcomes include the following: • 90% incident free shelter days will be provided. • 90% of all battered adult victims leaving the shelter will have a safety plan for self and children. • 60% of adults remaining in the abusive situation will be under the protection of a Temporary Restraining Order (TRO). The shelter provides a safe, low-stress and comfortable environment to allow residents to think clearly about their options and goals they wish to pursue. Shelter advocates work closely with the residents to assess their needs, options, and to provide NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 4 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter guidance on achieving their goals. The staff is knowledgeable about current domestic violence laws, health and social service resource information. Moreover, support and follow-up services are given to clients and their children after exiting the program. The shelter program conducts individual and group support counseling on the dynamics of domestic violence, to educate residents, on the importance of safety for their families and themselves. The program counseling helps residents identify and confirm realistic goals, and provides support as they take steps towards achieving their goals. The groups help residents to understand that there is truly no excuse for domestic violence. Through support and counseling there is a significant increase in the resident's self-esteem, desire, and courage to change their current living environment. Positive social change is facilitated when the Shelter Advocates teach residents that they do not deserve to be battered. Once this lesson is learned, the battered adult fosters this to their children and peers. Domestic violence education is essential to the elimination of domestic violence in our community, and within our families. Once the realization is achieved, self-esteem is increased; this motivates residents to achieve their goals in health care, social needs, financial needs, and housing goals. Turning Point for Families, Inc. (TPFFI) West Hawaii Domestic Abuse Shelter has been concerned for sometime over the increase in the number of domestic violence victims and their children who are requesting emergency shelter services. The methamphetamine (ICE) epidemic has compounded this increase further. According to the Hawaii County Police Department Domestic Violence Case Statistics, there were 113 domestic violence incidences in Kona over a 4 month period; please keep in mind, this number does not reflect the family size. The number of individuals seeking shelter services in the first quarter of the current fiscal year has more than doubled from the previous year. TPFFI West Hawaii Domestic Abuse Shelter serves our communities most vulnerable populations, battered women and their children, with 60% of the residents being children. The need to provide a secure, accessible, comfortable, and stress free environment, are emphasized by the following facts in regards to those who depend on the shelter program, services, and resources for their personal safety, and all to often, their lives: Children: Nearly 60% of shelter clients are children 95% do not have immediate shelter and the abuser threatens their "permanent" housing. • Many of these children have witnessed violence and other forms of abuse • These children stand a 70% increased risk of being abused themselves • All of the shelter children require and undergo trauma counseling with the children's coordinator NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter • Many of the children will develop and suffer from Post-Traumatic Stress Disorder (PTSD1 Adults: • 85% of adult clients have been beaten and/or maimed • 30% are fleeing the threat of death • 25% require medical treatment upon arriving at the shelter • 100% require trauma counseling • 95% are without sufficient resources to provide basic needs such as housing, food, and medical treatment for themselves and their children • 80% are without personal transportation • 80% have little or no marketable skills Clients come to the shelter under some of the most difficult and stressful circumstances, circumstances that many of us could not even fathom. They must overcome their trauma, gain protection from their abuser, and put together the necessary resources to feed, house, and othervvise support their families. It is unfortunate, but nonetheless a fact, that many domestic violence victims are often unable to successfully achieve these goals, left with no viable alternatives, many will return to their abuser. Tragically, they will be abused again, and once again the children will suffer. The shelter program has provided program services to victims and their children in West Hawaii since 1988, servicing the districts of Kau, Captain Cook, Kealakekua, Kailua-Kona, Waikoloa, Kohala, and Waimea. Total Budget and Position Count Total Pro ram Bud et $489.475.00 Total Pro ram Position Count 20 Total A enc Bud et $2,032,642.00 Total A enc Position Count 61 NONPROFIT GRANT APPLICATION FISCAL PEAR 2004-OS Page 6 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter Program Objectives: Key Objectives for the program are as follows: 1) provide 24 hour emergency shelter services for battered adults and their children 2) provide case management services, individual counseling, and group counseling to the victims of domestic violence to assist them in working towards setf- sufficiencyand enable them to transition into aviolence-free life style 3) provide a 24-hour crisis hotline to assist persons with a domestic violence crisis, providing information, crisis counseling, and appropriate referrals. Residents at the shelter are adults and children who have become homeless by fleeing from domestic violence who do not have another safe place and/or confidential place to receive specialized support services. During the fiscal year 2002-2003 the shelter provided 2447 bed nights. For the current fiscal year TPFFI projects the shelter will provide 4068 bed nights. This increase is based on the current shelter use, and the increasing ICE problem in the State. Outcome Indicator Initial outcomes 1. 24-hour access to emergency 1. Number of domestic violence shelter and crisis counseling for victims provided intake and battered adults and their children. assessment. 2. Education on the legal system and 2. Increased knowledge of the legal options available to protect them system, number of residents filing and their children. Temporary Restraining Orders. (documentation in client files). Intermediate Outcomes 1. Short-term and long-term goal 1. Service plans developed/goals setting for adult victims and their being achieved. (documentation in children. client files) 2. Case Management, individual 2. Clear understanding of the and group counseling sessions. dynamics of domestic violence and the impact on their children. (client evaluations) Long-Term Outcomes 1. Transition into a violence free and 1. Percentage of clients who report healthy lifestyle. violence free transition. 2. Children understand that domestic 2. Children can articulate verbally that violence is a choice. domestic violence is not ok. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 7 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter Program Highlights: 1) Successfully provided shelter services to 81 adults and 62 children who were victims of domestic violence in need of emergency shelter and services. 2) Provided services contracted during the previous year without any incidence of violence at the shelter. 3) The women and children were treated to a cruise on the glass bottom boat at the Kailua Kona by the Four Winds Inc. 4) The women were treated to, "a be good to yourself' day and received miscellaneous services designed to increase self-esteem. This was provided Kaiser Clinic Employees in West Hawaii. 5) Kaiser Clinic Employees in West Hawaii donated a new Norstar phone system compete with installation 6) West Hawaii Soroptimist International of Kona, donated funds designated to be used specifically for emergency services to victims. i.e changing locks at home and in vehicles, emergency childcare so that victims can attend Dr. appointments, court hearings etc. 7) Significant amounts of the shelter renovations have been completed an expectation of completion by the end of 2004 Plans to Upgrade: Funding for the provision of onsite drug and alcohol counseling continues to be sought for the shelter. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 8 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter Performance Measures: Services: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate 1 # of bed ni hts 2447 3390 4124 2 # of group service sessions 601.75 416 416 hours 3 # of rou service reci Tents 470 200 200 4 # of individual session hours 1011 1500 1500 5 # of adults receiving individual 96 100 100 services hours 6 # of children receiving individual 59 130 130 sessions 7 # of outreach hours 234 234 234 8 # of follow-u hours 234 234 234 9 # of hotline crisis calls 210 210 210 10 # of referrals 465 465 465 11 # of van tri s b staff for clients 260 260 260 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 9 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter Pro ram Ex enditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es $295,483.00 $317,917.00 $333,826.00 Professional Fees $3,017.00 $1,200.00 $4,300.00 O erations $91,567.00 $123,100.00 $146,649.00 E ui ment $7,932.00 $4,000.00 $4,700.00 Other* 0 0 0 Total $397,999.00 $446,217.00 $489,475.00 *P/ease explain in detail on separate sheet Pro ram Fundin Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Coun of Hawaii $21,000.00 $21,000.00 $22,000.00 State of Hawaii $162,617.00 $159,424.00 $178,424.00 Federal $93,909.00 $101,909.00 $124,909.00 Private Foundations $40,040.00 $80,384.00 $91,084.00 Donations $13,409.00 $45,000.00 $45,000.00 Service/Pro ram Fees $4,812.00 $11,000.00 $11,558.00 Vendin 0 0 0 Fundraisin 0 $22,500.00 $10,500.00 Interest Income $3,100.00 $5,000.00 $6,000.00 *Other Income 0 0 0 Total $338,887.00 $446,217.00 $489,475.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 10 Turning Point for Families, Inc. West Hawaii Domestic Abuse 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 ayear-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 benefds 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 Date o t '30 'J~-( Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 11 West Hawaii Mediation Center - AgellCy Name Mediation services -Program Name Agency Director: Franco Acquaro Phone No.: 885-5525 Contact Person: Franco Acquaro Phone No.: 885-5525 Mailing Address: P.O. Box 7020, Kamuela, HI 96743 Facility/Site Address: 65-1279 Kawaihae Road, #217, Kamuela, HI 96743 Fax No.: 808-887-0525 Email Address: whmc@bigisland.net Amount of Request for County funds: $10000.00 Prior Year Funding: 01-02 02-03 03-04 $10000.00 $5000.00 $5000.00 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 Descriptign: 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 services for both self-referred and courUlegal system referred Gients. 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 utiizes trained community volunteers to deliver this vital service to their fellow community members. NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 Total Budget and Position Count Total Pro ram Bud et 86764.00 Total Pro ram Position Count 1 Total A enc Bud et 100000.00 Total A enc Position Count 2 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 West Hawaii Mediation Center - Agency Name Mediation services -Program Name 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~uality volunteer community mediators. 3) Provide mediation services in an affordable and accessible manner for disputes arising both in and out of court/legal system. 4) 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. 5) Provide adequate case management services to adequately serve all referred cases. 6) Provide community outreach and education around constructive conflict resolution practices. Program Highlights: 1) Provided information and referral services to 152 individuals. 2) Delivered 1,665 hours of case intake services. 3) Served 187 cases (64% courUlegal system referred; 36% self-referred) 4) Utilized 47 volunteer mediators in 130 mediation sessions for a total of 232 hours of mediation. 5) Reached full agreement in 70% of cases mediated. 6) Achieved a 85% service satisfaciton rating by respondents (post mediation satisfaciton survey). 7) Achieved a 97% rating by respondents indicating that they would recommend mediation to others in the future. 8) Provided 35% of total services to low income clients (annual income under $20,625). Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual' Bud et * Esti to Case Mana ement Service (hours 1665 1665 166 Mediation Cases Served 187 200 200 Mediation Cases Con ucted 130 150 150 A reements Read a in Mediation 70% 65% 65% Client Satisfaction with Service 85% 91% 90% NONPROFTT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 Client Willingness to Recommend 97% 91 % 90% Service to Others Skill Enhancement Training for 4 4 4 Volunteer Mediators Affordable Services to Low Income 35% 33% 33% of client low income Community Awareness and 6 6 6 Education Sessions *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-05 Page 4 West Hawaii Mediation Center -Agency Name Mediation services -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 57950.00 60791.00 60791.00 Professional Fees 3141.00 1500.00 3250.00 O erations 22260.00 22723.00 22723.00 E ui ment 6688.00 0.00 0.00 Other* 0.00 0.00 0.00 Total 90039.00 85014.00 86764.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Coun of Hawaii 5000.00 5000.00 10000.00 State of Hawaii 49001.00 49001.00 45001.00 Federal Funds 0.00 0.00 0.00 Private Foundations 6702.00 4850.00 5000.00 Donations 12810.00 9500.00 10000.00 Fundraisin 8050.00 9870.00 10000.00 Service/Pro ram Fees 2000.00 2663.00 2750.00 Client Private Fees 3480.00 3600.00 3933.00 Interest Income 0.00 80.00 80.00 IRS Refund 385.00 0.00 0.00 Total 87428.00 85014.00 86764.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 West Hawaii Mediation Center - Agency Name Mediation 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 inGuding 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 ~li~ requirement to submit ayear-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 o#`other funding spurces and amounts obtained during the award period. Failure to submit a timely. complete. and accurate vear-end report may impact the evaluation of vour oroaram's or agency's future funding requests. Signature of. BQ~r President/Chair Date Signature of Execut~ye Director Date ` UNSIGNEL`! PROPOSALS WILL NOT BE ACCEPTED! t. NONPROI•IT GRANT APPLICATION FISCAL YEAR 2004-05 P,~ge~6 YwcA of Hawaii Island -Agency Name Ekahi (Hamakua Youth Center) - Program Name Agency Director: Nancy Moser Phone No.: 935-7141 Contact Person: Judith Graham Phone No.: 775-0976 Mailing Address: 145 Ululani St., Hilo, HI 96720 Facility/Site Address: P.O. Box 777, Honoka'a HI 96727 Fax No.: 935-5150 Email Address: ywcah001(a)hawaii.rr.com orywcafin@ilhawaii.net Amount of Request for County funds: $6,000.00 Prior Year Funding: 01-02 02-03 03-04 $5,500.00 $5,500.00 $5,500.00 Agency Mission Statement: The YWCA of the USA is a women's membership movement nourished by its roots in the Christian faith and sustained by the richness of many beliefs and values. Strengthened by diversity, the Association draws together members who strive to create opportunities for women's growth, leadership and power in order to attain a common vision: Peace, justice, freedom and dignity for all people. Program Description: Hamakua Youth Center is a busy after-school teen center. The program also provides drug prevention classes, darkroom and digital photography classes, and a month-long summer program. Total Budget and Position Count Total Pro ram Bud et 109228.00 Total Pro ram Position Count 4 Total A enc Bud et 3670243.00 Total A enc Position Count 106 NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 1 YwcA of Hawaii Island -Agency Name Ekahi (Hamakua Youth Center) - PI'Ogfam Name Program Objectives: 1) Provide free computer access and drop-in activities to 35 teens per day after school. 2) Continue to provide a drug prevention curriculum to 85 students annually with booster sessions for last year's students. 3) Provide daily, health-oriented activities throughout July 2004 to 15 teens in collaboration with Hamakua Health Center. 4) Continue to provide 6+ photography classes weekly during school hours as an enrichment of the Honokaa High School art curriculum. Program Highlights: 1) Attendance at the youth center has risen steadily this year. 2) The center's 1999 computers were all replaced with new Dell computers. 3) Youth photography classes increased to 10 hours per week. 4) Na Opio O Hamakua summer program was very successful and drew 17 youth daily in July 2003. 5) The YWCA successfully introduced a new, federally recognized prevention curriculum in Hamakua in fall 2003. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Teens drop in daily for computer 33 35 35 access, ool, chess, etc. Students enroll in drug prevention 143 85 85 curriculum Youth take hoto rah classes 40 70 70 Youth enroll in summer ro ram 18 15 15 Parents attend prevention 26 20 20 education evenin s Students receive one-hour tobacco 66 n/a n!a revention *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 2 Ywca of Hawaii Island -Agency Name Ekahi -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 57551.00 62602.00 63109.00 Professional Fees 6859.00 3954.00 3960.00 O erations 23469.00 28269.00 22361.00 E ui ment 2972.00 11875.00 2070.00 Other* 1920.00 2300.00 0.00 Total 92771.00 109000.00 91500.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-OS Actual * Bud et * Estimate Grants overnment a encies 80500.00 80500.00 80500.00 Trusts and foundations 8000.00 28528.00 11000.00 Contributions 2225.00 200.00 500.00 Total 90725.00 109228.00 92000.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 3 YWCA of Hawaii Island -Agency Name Ekahi (Hamakua Youth 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 ayear-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 ~l r nature of Boa resident/Chair Date Signature of ecutive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION F[SCAL YEAR 2004-OS Page 4 YWCA of Hawaii Island -Agency Ekahi (Hamakua Youth Center) -Program Separate Sheet Explanation of "Other" Line Item The "Other" line item represents stipends paid to peer tutors in 2002-2003, and for the following year stipends paid to peer tutors and $300 in honorariums paid to professional photographers who make presentations to youth on photography as an art and as a career. The peer tutoring program is funded by Queen Liliuokalani Children's Center. Ekahi has been informed that this funding will not be available in 2004-2005. Note that the "Professional fees" line item is significantly less for 2003-2004 and 2004- 2005. Our prevention curriculum instructor, formerly an independent contractor, became an employee of the Ekahi Program beginning in the 2003-2004 fiscal yeaz. YWCA of Hawaii Island -Agency Name Sexual Assault Vctim Empowerment - PfOgf8r1 M8m@ Agency Director: Nancy Moser Phone No.: 808-935-7141 Contact Person: N. Moser Phone No.: 808-935-7141 Mailing Address: 145 UVulani Street Hilo, Ht 96720 Facilityr/Site Address: 197 Kino'ole Street Hilo 8~ 75-5759 Kuakini Hwy Kailua Fax No.: 808-935-5150 Email Address: ywcaexec~bigisland.net Amoun! of Request for County funds: $50, 000.00 Prior Year Funding: 01-02 02-03 03-04 $52000.00 $50000.00 $50000.00 Agency Mission Statement: The YWCA of Hawaii Island "...strengthened by diversity and sustained by the richness of many beliefs and values... draws together members who strive to create opportunities for women's growth, leadership and power in order to attain a common vision: Peace, justice, freedom and dignity for all people." Core themes include the economic empowerment of women and girls and the elimination of racism. Program Description: The program's mission is to work to reduce the incidence of sexual assault on the Big Island and to reduce disability to those who have been victimized. The YWCA Sexual Assault victim Empowerment program (SAVE} operates the rape NONPROFIT GRANT APPLICATION FISCAL YEAR 200405 Page 1 cnsis center for the island of Hawan. SKilled and supportive Cnsis Workers provide phone support to callers on the 24-hour Sexual Assault Crisis Line, or face to face help in East and West Hawaii to sex assault victims who report the crime to police. Crisis Workers function as team members with police investigators and sex assault nurse examiners in the Hawaii County Protocol for forensic examination of sex assauk victims. A full time masters-prepared Therapist is employed at each SAVE Center (Hilo and Kailua) to provide psychotherapy, case management and legal system advocacy by appointment or walk in. Community professionals, the public and school aged groups are helped to become aware of sex assault survivor needs, available services and prevention strategies through SAVE's community educati~ program. The YWCA is now in our third decade of helping sex assault survivors, who are women and men, girls and boys. Totaf Budget arm Position Count Total P ram et 239532.00 Total P ram Position Count 4 Total Agency Budget 3670243.00 Total Agency Position Count ~ 106 i NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Pagt 2 YwcA of Hawaii Island -Agency Name Sexual Assault Victim Empowerment - PfOgfam Name Program Objectives: 1) Provide a SAVE Crisis Worker to support each sex assauk victim undergoing medical-legal examination in the period July 1, 2004 through June 30, 2005 2) deliver professional counseling and/or case management services to 100 sex assault survivors 3) Attend and participate in monthly case tracking and interagency team coordination meetings of the East and West Hawai Children's Justice Centers throughout the fiscal year. 4) Provide sexaul assault awareness and prevention education to 500 school aged students 5) Provide education to 10 professionals atwut the needs of adu?tlchild survivors of sexual assault and methods to detect and report sexual child abuse or abuse of dependent adults. Program Highlights: 1) Added clerical/office help positions in the Hilo and Kona SA1/E Counseling Centers to free up Therapists to do more counseling. 2) Promoted Pat Sands and Roxie Tubbs to managers of their respective West and East Hawaii SAVE Centers, in order to delegate some managerial decisions from the top YWCA management to the level closer to where cient contact occurs (consistent with YWCA Management Philosophy) 3) Obtained funds from the federal Vdence Against Women Act (VAWA) and the Victims of Crime Act (VOCA) to allow #1 and 2 above to happen. All the above have promoted the stability of these services, which just 2 years ago had been much more unstable. 4) The YWCA of Hawaii Island was asked to apply, and was able to obtain other funds to continue another sexual assault related service that was in jeopardy -the island's coordinator of forensic nursing services, previously employed by the police. The coordinator works directly with police, prosecutors and SAVE. This coordinator recruits and trains nurse examiners and promotes quality nursing forensic services which are part of police investigations of sex assault The YWCA Forensic Nursing Project is not a part of SAVE. However, it was because of the YWCA's expertise in SAVE services that funds were granted to place this project inside the YWCA. This prevented the coordination services from being lost to the community, as the police grant for the positions had run out. Therefore it is a positive outcome (or highlight) related to SAVE this year. NONPROFIT (:RANT APPLICATION FISCAL YEAR 2UUM115 Page 3 5) The YWCA Executive Director spent a lot of time prior to and during the 2003 legislative session educating Health Department personnel and legislators about Hawaii island sex assault victim service and funding needs. As a resuk legislators passed SB 1305 appropriating (among other matters) an additional $300,000 for statewide sexual assault services for 2003-04. The governor vetoed the measure and the legislature overrode in special session. However the governor did not release the funds. In the end of calendar 2003, the governor released 1/3 of the money from SB 1305, equaling $16,560 for Hawaii island. Performance Measures: FY 2002-03 FY 2003-04 FY 2004-05 Actual t " Estimate Fully trained personnel are 24 hours a 24 hours a 24 hours a available to assess and respond to day, 365 day, 365 day, 365 callers on the Sexual Assault Crisis days a year days a year days a year phone Tine (250 364 callers 250 callers estimated callers) Crisis counseling, legal systems 303 crisis 175 crisis 150 crisis advocacy, information and referral outreach outreach outreach are provided to each sex assault contacts contacts contacts victim seeking services in East Hawaii and West Hawaii Survivors of sexual assault receive 109 100 100 psychotherapy services and survivors survivors survivors intensive clinical case management from SAVE masters level practitioners in East Hawaii ~ West Hawaii School aged students receive 2778 1000 500 sexual assaulf prevention and students students students awareness training _ Professionals receive training in 18 100 10 awareness of the needs of adult professional professional professional and child sexual assault survivors, s s s how to detect and report child sexual abuse or sexual abuse of dependent adults ~If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2UU4-U5 Page 4 YWCA of Hawaii Islam -Agency Name sexual Assault victim Empowerment -Program Name Program Expenditures FY 2002-03 FY 2003-04 FY 2004-05 Actual ` Bud et ` Estimate Salaries and W es 195596.00 173025.00 173025.00 Professional Fees O erations 78496.00 65907.00 64000.00 E ui ent 670.00 600.00 0.00 Other* Total 274762.00 239532.00 237,025 `Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2002-03 FY 2003-04 FY 2004-05 Actual ` Bud et * Estimate State of Hawaii (DOH) via KWCMC 193710.00 183524.00 166964.00 master contract Coun of Hawaii ___50000.00 50000.00 50000.00 Federal funds _ _ 29275.00 6000.00 15000.00 Donations 1300.00 1000.00 2000.00 Total 274285.00 240524.00 233,964 `If applicable _ NONPROFIT GRANT APPLICATION FISCAL YEAR 2004-OS Page 5 YWCA of Hawaii Island -Agency Name Sexual Assault Victim Empowerment - PfOg~am Namt? 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, 1(we) understand and will comply with the requirement to submit ayear-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 n~ u~of Boar PresidenUChair Date Sig ature ecutive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTEDI NONPROFTI' GRANT APPLICATION FISCAL YEAR 200405 Page 6