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COM 0094.000 2004-2006
~~r or ,V Harry Kim ~ William Takaba ~iq, Direcmr Mnyor ~ Nancy E. Crawford ~h,e.,M','~ Depute' Director County of Hawaii Finance Department RECt1V~ ~ 25 Aupuni Sheet, Room 118 • Hilo, Hawaii 96720 mw i ' ~ BY o--- - (808) 961-8234 • Fax (808) 961-8248 ~ ]l- 1- G~ L''OUnGII February 2, 2005 Gary Safarik, Chairman and Members of the Hawaii County Council 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 FY2005-06. 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. c lc ~ ~w~ a~ William Ta aba Director of Finance Enc. Applications for Nonprofit Grant Funds List of Nonprofit Grant Applicants (Note: Attached applications fxnnt nonprofit agencies, due to its size, is not made a part of this docwnent, but is on file and available for viewing in the Office of the County Clerk.) ~~JJ Comm. No._=L7.._~~ Ref. To: NSE.ve. Rif. Lote _ FFR 9 ~nn5 NONPROFIT GRANT APPLICANTS FOR FY2005-06 ORGANIZATION NAME PROGRAM NAME REQUESTED American Red Cross -Hawaii State Chapter Disaster Service $ 10,317.00 The Arc of Hilo Community Living Resources for Individuals with DD/MR 29,000.00 Adult Day Health/Life Skills 27,000.00 The Arc of Kona/KOna Krafts Trans ortation for Communit Access Big Island Substance Abuse Council BISAC East Hawaii Substance Abuse Council 40,000.00 Big Island Substance Abuse Council BISAC West Hawaii Substance Abuse Program 40,000.00 Boys & Girls Club of the Big Island SMART Moves 80,000.00 Brantley Center, Inc. Employment Rehabilitation 25,000.00 Center for Independent Living -Hawaii Independent Living Services 15,000.00 Child and Family Service Family Violence Continuum of Care Programs 10,000.00 East Hawaii Coalition for the Homeless Kihei Pua Emergency Shelter 40,000.00 East Hawaii Coalition for the Homeless Kihei Pua Transitional Housing Program 4,000.00 Family Support Services of West Hawaii Family Centers 65,000.00 Friends of the Children's Justice Center of East Hawaii Special Needs and Enhancement, Center Support, 15,000.00 Prevention/Education and Trainin Pro rams Friends of the Children's Justice Center of West Hawaii Enhancement and Basic Needs Program 15,000.00 Goodwill Industries of Hawaii, Inc. Work Experience Program 20,000.00 Hawaii County Economic Opportunity Council Transportation 220,000.00 Hawaii Island Adult Care, Inc. Hilo Adult Day Center 18,000.00 Hawaii Island HIV/AIDS Foundation Multi-Disciplinary HIV Case Management, Hilo 10,000.00 Hawai i Island HIV/AIDS Foundation Transmission Prevention for HIV+ Women in West Hawaii 15,000.00 Count Hawaii s Volcano Circus Puna Performing Arts Festival 2005 30,000.00 Hui Okinawa Children's Cultural Day Camp 3,680.00 The Island of Hawaii YMCA Ku'ikahi Mediation Center 10,000.00 Ka Hale O Na Keiki, Inc. Families-At-Risk Project 3,500.00 Ka i olani Medical Center for Women & Children Kapio'lani Child Protection Center -West Hawaii p Title IV-B-West Hawaii Counselin & Su ortive Livin Pro~ect 20,000.00 Kona Adult Day Center, Inc. Adult Day Care 15,000.00 Kona Literacy Council Kailua Learning Center 1,500.00 Laupahoehoe Train Museum LTM Sustainability and Outreach 75,000.00 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 30,000.00 Office for Social Ministry Hawaii Island Food Bank 32,500.00 Office for Social Ministry Mobile Care Health Project 20,000.00 The Salvation Army - Family Intervention Services Ho'okala Adolescent Diversion Program 35,000.00 The Salvation Army -Family Intervention Services Pahoa Youth Service Center Program 40,000.00 Special Olympics Hawaii -East Hawaii Special Olympics Hawai i -East Hawaii 12,000.00 Special Olympics Hawaii -West Hawaii Special Olympics Hawai i -West Hawaii General Funding 10,000.00 Three Ring Ranch Exotic Animal Sanctuary After School Mentoring Program 12,380.00 Turning Point for Families, Inc. Alternatives to Violence -North Hawaii 40,885.00 Waimea Grou s/Puna Grou s Turning Point for Families, Inc. Rural Outreach Project 2,000.00 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter 22,000.00 West Hawaii Mediation Center Mediation Services 10,000.00 YWCA of Hawaii Island YWCA Hamakua 10,000.00 YWCA of Hawaii Island SAVE (Sexual Assault Victim Empowerment) 60,000.00 TOTAL $ 1,218,762.00 County of Hawaii Nonprofit Organizations Grant Applications for Fiscal Year 2005 - 2006 ~J~tY OF N,~'' L~ 1 i~ • . . ya- t~~ ~T6 OF NF's February, 2005 American Red Cross Hawaii State Chapter - AgeriCy Name Disaster Service -Program Name Agency Director: Coralie Chun Matayoshi, Chief Executive Officer Phone No.: 808-739-8101 Contact Person: Youline K. Kalima, County Executive Director Phone No.: 808-935-8305 Mailing Address: American Red Cross Hawaii County 55 Ululani St., Hilo Hawaii 96720 Facility/Site Address: Site One: Hilo 55 Ululani St., Hilo Hawaii 96720 Site Two: Kona 74-5615 Luhia St., Kailua-Kona, HI. 96714 Site Three: Training Center, Hilo Shopping Center 1261 Kilauea Ave, suite 260 Hilo, HI. 96720 Fax No.: 808-969-3673 Email address: ykalima(a~hawaii.rr.com Amount of request for County Funds: $10,317 Prior Year Funding: 02-03 03-04 04-OS $5000 $5000 $2500 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005 - 2006 Page 1 Agency Mission Statement: The mission of the American Red Cross is: "The American Red Cross is a humanitarian organization led by volunteers and guided by its Congressional Charter and the Fundamental Principles of the International Red Cross Movement, will provide relief to victims of disasters and help people prevent, prepare for and respond to emergencies. Program Description: History has shown that the Big Island has had disasters of various types, from lava flows, flooding, heavy rains, high surf, tidal waves, earthquakes, brush fires, transportation accidents, explosions and hazardous material incidents, each leading to the opening of emergency shelters to many Big Island families. At each event, the American Red Cross was there to support the County of Hawaii in sheltering people and families providing safe refuge. The Disaster Program strives to strengthen and empower families and individuals to prevent, prepare for and cope with man-made and natural disasters. It also tries to make available bulk supplies necessary for sheltering. These bulk supplies of cots, blankets, cleaning kits and comfort kits would be ready to mobilize should the need be apparent. Unfortunately, when a disaster hits the Big Island, these supplies are not readily available. It would take at least a week to transport these supplies from Honolulu, losing precious recovery time and meeting the immediate shelter needs of disaster victims Therefore, the Red Cross is requesting $10,317 from the County of Hawaii to purchase bulk supplies of cots, blankets, comfort kits and cleaning kits for the Big lsland and to acquire storage space in Kona and in Hilo. To coordinate and facilitate bulk distribution, travel expense between Hilo and Kona would also be supported by this grant Total Bud et and Position Count Total Pro ram Bud et 172,313 Total Pro ram Position Count 2 Total A en Bud et 344,627 Total Pro ram A enc Count 9 NONPROFTT GRANT APPLICATION FISCAL YEAR 2005 - 2006 Page 2 Program Objectives: Overall Goal: To provide shelter residents personal comfort items such as toothpaste, tooth brush, a blanket and a cot to sleep in. Provide cleaning kits to enable families and individuals to begin recovery. To acquire a secured facility to store these items in Kona and Hilo along with other expenses. 1. Enable families to receive items necessary to clean their homes after a disaster. These items would include mops, cleaning detergents, brooms, sponges, disinfectants. 2. Enable families to acquire items necessary for personal hygiene. These items would include toothpaste, toothbrush, soap, shaver, shaving cream, powder, deodorant, washcloths, tampons, etc. 3. Increased availability of cots and blankets for shelter residents during disasters to be stored in Kona and Hilo in a facility that is secured and readily accessible. 4. Increased support with Hawaii County Civil Defense to provide necessary sheltering items to facilitate a shelter as a safe refuge. 5. Decrease the number of shelter residents sleeping on cold floors. 6. Train 8 individuals as logistics technicians in districts through out the County of Hawaii. NONPROFTP GRANT APPLICATION FISCAL YEAR 2005 - 2006 Page 3 Program Highlights: From July O1, 2004 to June 20, 2005, the American Red Cross Hawaii County has achieved the following. • Hired a new Disaster Coordinator to supervise the Disaster program and liaison with Civil Defense. • Trained 102 individuals in the 5 Basic Disaster Training courses on the Big Island. • Provided lifesaving information on Disaster Preparedness and Homeland Security to the residents of the Big Island particularly in the districts of Kau, Kohala, Puna and HOVE. • Responded to 19 disasters enabling 101 individuals to recover from their losses and begin rebuilding their lives. Of which $13,178 was spent towards their recovery. • Responded and opened 2 shelters with 14 occupants • Enabled 20 Disaster Action members with new Nextel phones to utilize during disasters on the Big Island. • Recruited and trained 35 DOE staff as shelter managers on the Big Island. NONPROFTI' GRANT APPLICATION FISCAL YEAR 2005 - 2006 Page 4 Performance Measures: FY2003-04 2004-2005 2005-2006 Estimate Disaster Relief 25 19 50 Individual Disaster Assistance 150 101 100 Mass Shelters O erred 2 2 5 Disaster Presentations in Communities 31 32 25 Trained Individuals in Dis. Res onse 142 136 52 Disaster Drills conducted 1 1 3 Disaster R 'stered Nurses recruited 18 12 6 Disaster Mental Health Counselors Recruited 12 20 6 Communi Partners 1 2 2 Brochures on Pre aredness 'ven out 2800 3500 3500 Pro ram Ex euditures FY2003-2004 FY2004-2005 FY2005-2006 Actual Bud et Estimate Salaries and Wa es $75,396 $93,334 $93,334 Professional Fees 0 0 0 O erations 70,941 61,145 61,145 E ui ment 12 954 9,561 9,561 Materials Su lies 20,044 $8,273 $8,273 Total $179,335 $172,313 $172,313 Pro ram Fundin Source Revenue Source FY2003-2004 FY2004-2005 FY2005-2006 Actual Bud et Estimate Hawau Coun $0 $0 $10,317 HI. Island United Wa 23,000 23,000 $23,000 Pro ram Fees 0 0 0 Pro ram Material Sales $0 $0 $0 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005 - 2006 Page 5 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 an~nounts obtained during the award period Failure to submit a timely complete and accurate year end report may impact the evaluation of~pro~ram's or agency's future funding requests. ~ Z 7~.~ Signature of Board President/Chair Date I~~6/OS Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFTI' GRANT APPLICATION FISCAL YEAR 2005 - 2006 Page 6 Budget Request Amount Units Total Ex lanation $26.50 100 $3,312 Slee in cots $1.69 300 $507 Adult Comfort Kits $1.35 200 $270 Youth Comfort Kits $17.13 100 $1,713 Cleanin Kits $70.00 24 $1,680 Storage space Kona & Hilo $80.00 12 $960 Travel Ex ense $1875 Estimated Frei ht Total: $10,317 NONPROFTT GRANT APPLICATION FISCAL YEAR 2005 - 2006 Page 7 ~Tne Arc of Hilo -Agency Name Community Living Resources for Individuals with DD/MR - Program Name Agency Director: Michael E. Gleason Phone No.: 935-8535 Contact Person: Vicki Linter Phone No.: 935-3535 ext 213 Mailing Address: 1099 Waianuenue Avenue, Hilo, Hawaii 96720 Facility/Site Address: Same Fax No.: 961-0148 Email Address: mgleason@hiloarc.org Amount of Request for County Funds: $29000.00 Prior Year(s) Funding: 02-03 03-04 04-05 $29000.00 $29000.00 $29000.00 Agency Mission Statement: The Arc of Hilo's mission is to improve the quality of life for people with developmental and other disabilities, who reside in Hawaii. The Arc has provided vocational training, job training and placement, recreational, residential programs and support services for people with disabilities and barriers to employment since 1954. In FY 2003/2004 The Arc of Hilo served over 200 people through its different programs. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 The Arc of Hilo -Agency Name Community Living Resources for Individuals with DD/MR - Program Name Program Description: The Arc of Hilo proposes to offer a program for recipients on East and West Hawaii known as Community Living Resources (CLR) which includes both Long- Term Supports (previously known as Person Centered Adult Supports) and Short-Term Supports (previously known as Partnerships in Community Living services) for persons with developmental disabilities and mental retardation (DD/MR). The DOH has set a maximum of 18 Long-Term recipients at a time can be served in East and West Hawaii under the CLR long-term program. This is based on an annual budget of $179,640. The target population for Long-Term supports is adults, 18 years of age or older who have exited the DOE and are not eligible for Medicaid waiver services or other federally reimbursed programs or for whom such services are not appropriate or not available based on their ISP. Many of the activities currently provided for individuals in the PCAS program already include opportunities for job training, work placements, community access and involvement. As many Short-Term recipients shall be served as much as possible on a first come first serve basis up to the budget limit of 75% of the block funding amount ($224,073 x 75%=$168,055. This has been increased to $224,997 with additional funds from other organization revenue). The Arc shall provide. Short- Term Supports no greater than $3,000 per referral and technology supports on a one-time basis, not to exceed $1,000 per referral, with further clarification being made by the CLR Advisory Committee. The target population for Short-Term Supports shall include children and adults and be only those individuals eligible for community services but not eligible for Medicaid Waiver services or other federally reimbursed programs or for whom such services are not appropriate or not available based on their ISP. Total Budget and Position Count Total Pro ram Bud et 239334.00 Total Pro ram Position Count 3 Total A enc Bud et 3808092.00 Total A enc Position Count 83 Program Objectives: 1) In both East and West Hawaii, under the CLR Long-Term program, transition up to 18 Long-Term recipients at a time providing community based supports through relationship building, circle building, teaching NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 consumer skills, providing personal supports to meet individual needs, teaching communication skills, and providing job coaching/support. 2) In both East and West Hawaii, under the CLR Short-Term program, provide supports and services that are individualized, person-centered and meet the goals of the CLR program to as many eligible individuals as possible on a first come first serve basis. A minimum of 56 ($168,055 / $3,000 = 56+) participants shall receive specialized assistance obtaining services such as wheel chair ramps, fees for training courses, dental assistance, and assistance technologies as required. 3) Program Highlights: 1) Held weekly art classes at UH Hilo during Spring and Summer of 2004. 2) Art classes, taught by UH, Hilo art instructor, who is volunteering his time, began at The Arc of Hilo in October 2004 for 6 individuals per week. 3) December 2004 "Free to be Me" art exhibit at Wailoa State Art Center; 6 PCAS artist' work was displayed there all month. 4) 3 PCAS clients particpated in the Partners in Policymaking program on Oahu. Two graudated last January 2004; the third will graduate in January 2005. 5) Increased shopping and community access activities occurred with from 3 to 6 clients per week having the opportunity to get out and take care of their personal shopping and errands. 6) There has been increased employment opportunity, via our Supported Employment Program and the Recycling Projects. 7) There has been increased one-on-one teaching/training opportunities with sewing, money skills, communication, music enjoyment, art, and employment development. 8) There has been increased opportunities for exercise, with more participants taking walks in a variety of settings at The Arc and in the community. 9) 2 PCAS participants attended a CPASS self-advocacy class in Hilo, sponsored by the Developmental Disabilities Division on December 15, 2004. 10) In January 2005 2 PCAS participants attended a CPASS self-advocacy class in Hilo sponsored by the DDD and 2 other participants have attended the Workplace Literacy and Micro-Enterprise Art Classes for People with Developmental and other Disabilities. 11) The new Long-Term supports program is expected to provide service and supports for up to 18 Long-Term participants at a time. 12) NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Tne Arc of Hilo -Agency Name Community Living Resources for Individuals with DD/MR - Program Name Performance Measures: FY 2003-04 FY 2004-OS FY 2005-06 Actual * Bud et * Estimate Job Coachin 14 14 10 Circle Buildin 15 15 18 Relationshi Buildin 15 15 18 Communication Skills 13 13 18 Gettin Around 4 6 18 Learnin to be a Consumer 7 7 1 g Volunteer O ortunities Su ort 0 0 2 Personal Su orts and Needs 13 13 18 New Short-Term su orts/services 5g+ *If applicable Program Expenditures FY 2003-04 FY 2004-OS FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 82210.00 83576.00 84413.00 Professional Fees 1642.00 4156.00 617.00 O erations 132916.00 94334.00 151989.00 E ui ment 0.00 0.00 2315.00 Other' 0.00 0.00 0.00 Totat 216768.00 182066.00 239334.00 `Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 The Aro of Hiio -Agency Name Community Living Resources for Individuals with DD/MR - Program Name Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Count of Hawaii Funds 29000.00 29000.00 State of Hawaii Funds 163860.00 163860.00 179640.00 A enc Trainin Pro rams 9210.00 9000.00 10500.00 Other Internal A enc Funds 14698.00 9206.00 20194.00 Total 216768.00 182066.00 239334.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 The Arc of Hilo -Agency Name Community Living Resources for Individuals with DD/MR - PCOgCam 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 aroaram's or agency's future funding requests. ~ I-~3(-os Signature of Boa resid-e-n-t/-Chair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 BUDGET (Period July 1, 2005 to June 30, 2006) ApplicanUProvider The Arc of Hilo LONG TERM SUPPORTS RFP No.: 501-1 Contract No. (As Applicable): Budget (a) (b) (c) (d) 1. Salaries 62,382 2. Payroll Taxes & Assessments 8,361 3. Frin a Benefits 13,671 TOTAL PERSONNEL COSTS 84,413 - - - B. OTHER CURRENT EXPENSES 1. Airfare, Inter-Island 400 2. Airfare, Out-of-State - 3. Audit Services 617 4. Contractual Services -Administrative - 5. Contractual Services -Subcontracts 29,700 6. Insurance 2,700 7. Lease/Rental of Equipment 8. Lease/Rental of Motor Vehicles 5,100 9. Lease/Rental of Space 10. Milea eNehicle Expense 2,025 11. Poste e, Frei ht & Delivery 200 12. Publication & Printing 100 13. Re air & Maintenance 900 14. Staff Trainin 450 15. Substance/Per Deim 300 16. Supplies 250 17. Telecommunications 960 18. Transportation 900 19. Utilities 123 20. Interest Expense - 21. Pro ram Activities 107,880 22. Depreciation - 23. TOTAL OTHER CURRENT EXPENSES 152,606 - - - C. EQUIPMENT PURCHASES 2,315 D. MOTOR VEHICLE PURCHASES - TOTAL (A+B+C+D) $ 239,334 $ - $ - $ - BudgetPrepared By: SOURCES OF FUNDING Ronald E. Penn 808-935-8535 a Bud et Re uest $ 179,640 Name (Please type or print) Pnone b Coun Funds 29,000 c Pro ram Income 10,500 d OtherA enc Funds 20,194 Signature ofAuthorizadORCial Dace Michael E. Gleason, Executive Director Name and Title (Please type or print) For Stale Agency Use Only TOTAL REVENUE $ 239,334 Signature of Reviewer Date Form SPO-H-205 (Effective 10101198) THE ARC OF KONA/KONA KRAFTS ADULT DAY HEALTH/LIFE SKILLS TRANSPORTATION FOR COMMUNITY ACCESS Agency Director: Gretchen Lawson Phone No.: (808) 323-2626 Contact Person: Jeani Navarro Phone No.: (808)-323-2626 Mailing Address: PO Box 127, Kealakekua, Hawaii 96750 Facility/Site Address: 81-1065 Konawaena School Road, Kealakekua HI 96750 Fax No.: (808) 323-9444 Email Address: eani &)konai<rafts~org Amount of Request for County Funds: 27 000.00 Prior Year(s) Funding: 02-03 03-04 04-Oti $17,000.00 $17,000.00 $17,000.00 Agency Mission Statement: The Arc of Kona is a private non-profit organization for person with disabilities, their advocates, and families. We believe that people with disabilities are as individual in their needs, abilities and gifts as any other cross section of society. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page I THE ARC OF KONAlKONA KRAFTS ADULT DAY HEALTH/LIFE SKILLS TRANSPORTATION FOR COMMUNITY ACCESS Program Description: The Arc of Kona/Kona Krafts operates an Adult Day Health (ADH) standard classroom program, that is CARF certified (the Rehabilitation Accreditation Commission) and serves 15 participants on a daily basis. Due to the Olmstead legislation that arose from a lawsuit (Olmstead vs. North Carolina) which now requires ADH programs to be partially administered in the community, we have elected this year, rather than continue to apply for funding for our Domiciliary Home, to seek and secure funding to support our Adult Day Health classroom program in the areas of community access and transportation for the benefit of our Life Skills training program. All of The Arc of Kona participants in the ADH program have been identified as DD/MR by the State of Hawaii and have cognitive limitations that prevent them from living truly independently without extensive Life Skills training and transportation supports. These individuals do not make good judgments and therefore need supports to insure their safety and help with activities of daily living especially regarding regular access to community services and activities. In turn, participants have skills that can be accessed to benefit the community when provided with community access and transportation. This population has several risk and protective factors that we consider when designing a Life Skills training for them. First, this population is at risk of abuse, both sexual and physical, and need to be taught the skills for saying "NO" and for reporting abuse. They are also at risk for chronic disease and many have a high incidence of diabetes and heart problems related to weight and diet. And lastly they are at risk for being homeless and/or unprepared to prove they can live independently both with daily living skills and finances to prevent homelessness. Protective factors we consider include training in social development, appropriate sexual behaviors, protection from abuse including family members as well as strangers and preparing individuals to find their own housing accommodations and live as independently as possible, with or without other agency supports. Without adequate transportation supports, this population has only classroom theory to draw upon and is ill prepared to assume the role of an independent adult. The community as a Gassroom is essential to strengthening the protective factors around this vulnerable population. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 THE ARC OF KONA/KONA KRAFTS ADULT DAY HEALTH/LIFE SKILLS TRANSPORTATION FOR COMMUNITY ACCESS Money projected to be received for 2005-2006 via the Department of Health barely covers staff salaries and leaves The Arc of Kona with a $34,000.00 deficit at the end of the fiscal year. Specifically, the $27,000.00 request would be spent to enhance service delivery by paying costs associated with transportation to and from home and classroom, and into the community for life skills training and activities. The dollars would pay for 60°k of the transportation costs and 20°~ staffing and payroll taxes and 20% supplies and materials for the Life Skills training for independent living. Total Budget and Position Count: Total Pro ram Bud et 158 178.00 Total Pro ram Position Count 4 Total A enc Bud et 2,057,361.00 Total A enc Position Count 85 New Proposal Program Objectives (ADH Classroom): 1) Provide a safe, healthy, and supportive environment for daily living skills in the ADH classroom setting 6 hours per day 268 days per year from July 1, 2005 to June 30, 2006. 2) Provide individualized life skills training programs that allow each participant to develop at his or her own pace in order to live as independently as possible. 3) Insure access to community events and resources that will be a learning laboratory for independent living and reinforce skills taught in the classroom setting at a minimum of three times a week throughout the program year (7/05- 6/06). 4) Provide needed classroom materials to assess, instruct and support life skills specific health and safety areas relating to abuse, appropriate sexual behavior, hygiene, money management and household safety issues. 5) Provide needed supports for interacting with each other and the public appropriately within the community daily throughout the program year so as to support independent living skills required to function on a day to day basis. NONPROFTT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 THE ARC OF KONAIKONA KRAFTS ADULT DAY HEALTH/LIFE SKILLS TRANSPORTATION FOR COMMUNITY ACCESS New Proposal Program Highlights (ADH Classroom): 1) 12 participants are receiving daily lessons on health and safety as they pertain to daily living and toward independent living including information on hygiene and appropriate sexual behavior). 2) 12 participants have been able to access the community as required by law for independent living skills taught in the community. 3) 3 participants are seeking affordable housing so they can live independently with minimal supports. 4) One participant just secured housing and will live independently for the fist time in her life (with agency supports for some types of assistance). 5) One participant is completing OHA funded class on small business start up and, with help, is able to write a business plan for his crafts business and secure some start up funding. Previous Grant Year Program Objectives (Domiciliary Home): 1) Provide a safe, healthy and supportive environment for living 24 hours per day 365 days a year from July 1, 2004-June 30, 2005. 2) Provide healthy and 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. 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) Provide needed supports for interacting with each other and the public appropriately within the home and in the community daily throughout the program year. NONPROFTT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 THE ARC OF KONA/KONA KRAFTS ADULT DAY HEALTH/LIFE SKILLS TRANSPORTATION FOR COMMUNITY ACCESS Previous Grant Year Program Highlights (Domiciliary Home): 1) Participated in community activities by: a) attending one practice session and all tournament events with Special Olympics, b) going to the theater or other social event once per weekend, c) participating in the Konawaena-Honoka'a mural project to honor Wesley Batalona, d) participating in the Hugs Not Drugs island wide sign waving event, and 5) participating in the Kona Christmas parade. 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 by 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 2005-06 Page 5 THE ARC OF KONA/KONA KRAFTS ADULT DAY HEALTH/LIFE SKILLS TRANSPORTATION FOR COMMUNITY ACCESS Performance Measures: Past Years for Domiciliary Home Support FY 2003-04 FY 2004-05 FY 2005-06 Actual " Budget " Estimate Provide a safe, secure and healthy 5x365 days 1,825 days See next home for five DD/MR residents 365 page da s a ear Provide nutritious meals each day 4,160 meals 4,160 meals Burin 2004-2005 Transport 5 residents to Special 2 each x47 94 transports Olympics activities twice per week weeks=94 times Insure transport for medical 5 residents x 27 appointments each quarter 1 per quarter plus as needed =27 Transport residents to 47 weeks 47 weeks social/recreational activities once per week Assist 5 residents with home chores 5 residents x 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 their 60 3 goals 60 goals individual plans times 5 residents times 4 uarters Record all medications taken on a daily 52 times 52 times basis (based on based on once per once per week week 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 THE ARC OF KONA/KONA KRAFTS ADULT DAY HEALTH/LIFE SKILLS TRANSPORTATION FOR COMMUNITY ACCESS Performance Measures New program -Adult Day Health Life SkiIIs/Transportation: FY 2005-2006 Estimate Provide a safe, secure classroom 260 days of ADH standard Gassroom environment and staff 5 days a week activities with a one staff to four 52 weeks a year for 12-15 DD/MR participant ratio participants with one Manager and three staff Provide access to the community for 144 transports into community for hands on life skills training experiences activities that promote hands on Life including food shopping, ordering and Skills experiences eating, handling money, laundry, clothing shopping, making and getting to appointments and seeking and securing housing 3x per week for 52 weeks er ear Provide Life Skills classroom training 260 days classroom instruction for Life incuding appropriate sexual behavior, Skills and daily living activities with pre recognizing and reporting abuse, andpost testing forassessment of health, hygiene and safety issues, and base line skills and acquired skil/s at seekin and securin housin the end of the r Program Expenditures: Dom Home Dom Home AduR Da Health FY 2003-04 FY 2004-05 FY 2005-06 Actual' Bud et' Estimate Salaries and Wa es 71,380.00 76,625.00 126,482.00 Professional Fees O erations 47,976.00 51,938.00 39,060.00 E ui ment Other" Total 119,356.00 128,563.00 165,542.00 'Please explain in detail on separate sheet NONPROFTT GRANT APPLICATION FISCAL YEAR 2005-06 Page 7 THE ARC OF KONA/KONA KRAFTS ADULT DAY HEALTH/LIFE SKILLS TRANSPORTATION FOR COMMUNITY ACCESS Program Funding Sources Dom Home Dom Home Adult Day Health Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Count of Hawaii 17,000.00 17,000.00 27,000.00 Resident Fee SSI Pass Throu h 44,039.00 44,447.00 N/A Tenant Rent (30% clients share for 19,608.00 19,200.00 N/A Section 8 HUD) Federal Funds (70% Section 8 28,067.00 29,575.00 N/A share of rent Fund Raisin Donations 10,642.00 0 N!A Hawaii Island United Way (Life $5,000.00 0 Skills Training for 45 Kona Krafts participants island wide. One time fundin Hawaii Island United Way 33,000.00 State of Hawaii 98,178.00 Total 119,356.00 115,222.00 158,178.00 *If applicable New Program (Adult Day Health) NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 8 THE ARC OF KONA/KONA KRAFTS ADULT DAY HEALTH/L1FE SKILLS TRANSPORTATION FOR COMMUNITY ACCESS 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 ArtiGe 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. n T ~ ii , L~ ,~__t , Div , - ~ `I ~ ~x~>_ Signature of Board President/Chair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 9 Big Island Substance Abuse Council BISAC East Hawaii Substance Abuse Council Agency Director: Dr. Stephen C. Zuniga Phone No.: 969-9994 Contact Person: Danielle Spain Phone No.: 935-4927 Mailing Address: 234 Waianuenue Avenue Ste 104, Hilo, HI 96720 Facility/Site Address: 297 Waianuenue Avenue Hilo, HI 96720 Fax No.: 969-7570 Email Address: DanielleS@bisac.com Amount of Request for County funds: $40,000 Prior Year Funding: 02-03 03-04 04-05 $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 East Hawaii BISAC NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 programs provide outpatient treatment and therapeutic living services to adults and outpatient services (in both outpatient setting and in ten (10) 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 2,454,295 Total Pro ram Position Count 63 Total A enc Bud et 3,814,721 Total A enc Position Count 79 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 2005-06 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 564 adults and adolescents into all levels of outpatient substance abuse treatment and Therapeutic Living services. 2) 66% of clients completed treatment program objectives. 3) 72% of clients reported no new arrests at six (6) months post treatment. 4) 66% achieved long-term abstinence from all drugs and/or alcohol use at six (6) months post discharge from treatment 5) 79% of the clients discharged from the Therapeutic Living Programs reported maintaining clean and sober housing at six (6) months post discharge from treatment. 6) 40% of clients are employed, enrolled in school/vocational training or are volunteering at the time of discharge and at six (6) months post discharge. 7) 83% of clients reported no emergency room visits or hospital admissions during the first six (6) months post discharge. Performance Measures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Substance Abuse Treatment da s 24,534 26,373 27,431 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Big Island Substance Abuse Council BISAC East Hawaii Substance Abuse Council Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 1,556,110 1,708,556 1,745,456 Professional Fees 20,027 21,722 21,722 O erations 724,856 692,629 748,039 Equipment 3,762 6,038 7,538 Other* Van 27,000 30,000 Total 2,304,755 2,455,945 2,552,755 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Count 27,000 27,000 40,000 State of Hawaii 843,886 1,015,278 1,060,278 Federal 959,462 1,029,142 1,054,142 HIUW 11,250 20,000 20,000 Assessments 1,985 2,000 2,000 Donations/Fundraisin 15,213 7,500 7,500 Private Insurance 252,844 237,095 247,095 Client Fees 103,250 100,280 104,780 Hina Mauka 30,168 Trainin /De osit Forfeit 38,129 16,000 16,960 Total 2,283,187 2,454,295 2,552,755 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Big 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 vear-end report may impact the evaluation of your program's or agency's future funding requests. ,'J 6ignature of oard PresidenVChair Date Patricia Engelhard Sign ture cecutiv Dies rector ate Stephen C. Zuniga, Psy.D UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 The Big Island Substance Abuse Council BISAC West Hawaii Substance Abuse Program Agency Director: Dr. Stephen C. Zuniga Phone No.: 969-9994 Contact Person: Grayson Hashida Phone No.: 322-3100 Mailing Address: 234 Waianuenue Ave Hilo, HI 96720 Facility/Site Address: 81-947 Halekii Street Keakakekua, HI 96750 Fax No.: 322-3001 Email Address: GravsonHCa~Bisac.com Amount of Request for County funds: $40,000 Prior Year Funding: 02-03 03-04 04-05 $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 NONYKOFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 living services to adults and outpatient services (in both outpatient setting and in ten (10) 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 1,360,426 Total Pro ram Position Count 16 Total Agency Budget 3,814,721 Total Agency Position Count 79 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 saber 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. 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. NONPROFIT' GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 Program Highlights: 1) Was able to admit 394 adults and adolescents into all levels of outpatient substance abuse treatment and Therapeutic Living services. 2) 57% of clients completed treatment program objectives. 3) 45% of clients reported no new arrests at six (6) months post treatment. 4) 39% achieved long-term abstinence from all drugs and/or alcohol use at six (6) months post discharge from treatment 5) 55% of the clients discharged from the Therapeutic Living Programs reported maintaining clean and sober housing at six (6) months post discharge from treatment. 6) 48% of clients are employed, enrolled in school/vocational training or are volunteering at the time of discharge and at six (6) months post discharge. 7) 47% of clients reported no emergency room visits or hospital admissions during the first six (6) months post discharge. Performance Measures FY 2003-04 FY 2004-05 FY 2005-06 Actual " Bud et * Estimate Substance Abuse Treatment Da s 8,832 12,367 13,065 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Big Island Substance Abuse Council BISAC West Hawaii Substance Abuse Treatment Program Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 749,669 915,354 952,254 Professional Fees 16,408 13,881 13,881 O eratior~ 311,445 414,008 434,008 E ui ment 3,753 15,538 7,000 Other* Vans 27,308 30,000 Total 1,108,583 1,358,781 1,437,143 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Count 27,000 27,000 40,000 State of Hawaii 703,979 769,432 804,132 242,313 242,313 300,940 318,996 HIUW 11,250 20,000 20,000 Assessments 475 500 500 Donations/Fundraisin 7,111 2,500 Private Insurance 77,406 106,000 112,360 Client Fees 34,416 35,000 37,100 Private Foundation 101,554 101,554 Total 1,103,950 1,360,426 1,437,143 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 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 and President/Chair Date Patricia Engelhard Sig ature of a utive Di ector to Stephen C. uniga, Psy.D UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT' GRANT' APPLICATION FISCAL YEAR 2005-06 Page 5 I3O~YS & GIIiLS CLUB ov n+e isuro sMART Moves -Program Name Agency Director: Steven Pavao Phone No.: 961-5536 Contact Person: Same Phone No.: Same Mailing Address: 100 Kamakahonu Street Facility/Site Address: Hilo: 100 Kamakahonu Street Kea'au: Kea'au Middle School Pahoa: Nanawale Community Center Fax No.: 961-5189 Email Address: Steven@becbi.com Amount of Request for County Funds: 580,000.00 Prior Years) Funding: 02-03 03-04 04-05 ;36, 000.00 ;38, 000.00 ;45, 000.00 Agency Mission Statement: To inspire and enable Big Island youth from all backgrounds, especially those from disadvantaged circumstances, to realize their full potential as productive, caring and responsible citizens NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 BUYS & GIIiLS CLUB ec rNe sic isuuo sMART Moves -Program Name Program Description: SMART Moves is a scientifically proven and award winning drug, alcohol and tobacco prevention program of Boys & Girls Clubs of America. k is a copyrighted program and can only be conducted by affiliate Boys ?ii Girls Clubs. The program is designed to inform and empower youth in order that they might make good decisions around the issues of drug, alcohol tobacco use. The program is also designed to increase self-esteem in participants. 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, self-esteem 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 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 DOYS & GIRLS CLUB of nre ego isuwe sMART Moves -Program Name 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. 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: • Increasing participants' knowledge about tobacco, alcohol and other drugs and sexuality. • Increasing communication among staff members, parents, guardians and Club members regarding tobacco, alcohol, other drugs and adolescent sexual involvement. • Helping pre-teens 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. • Helping teens develop and improve skills around making decisions, resisting social and peer pressures, and coping with the stress of growing up. The SMART Moves curriculum is comprised of the following components: Be SMART: An in-service 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 self-awareness, 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 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 BOYS & GIIiL3 CWB OF THE 81613L~N0 sMART Moves -Program Name or become sexually involved. It includes age-appropriate 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 will be involved in small group prevention activities; more than 2400 will be involved in Club/community-wide prevention activities; 100 parents will be trained; and 85 volunteers will help in community service projects. The Boys & Girls Club of the Big Island has expanded its services to Kea'au and Pahoa. In Kea'au the Club operates at the Kea'au Middle School. The Club at Kea'au is open each day after-school and provides programs in education, health 8 life skills, sports & fitness and character and leadership development. In Pahoa, the Club operates out of the Nanawale Community Center. The Club in Pahoa also offers its programs each day after- school. The programs in Hilo and Pahoa are the same as the programs offered in Kea'au. The Boys & Girls of the Big Island is requesting an increase in funding from the County of Hawaii for the fiscal year 2005-2006 in order to sustain its programs at all three sites (Hilo, Kea'au &Pahoa). All three sites are partially funded by the State of Hawaii's Office of Youth Services and these funds are expected to continue into the new fiscal year. The program in Pahoa, however was funded with "seed" funds from a Federal grant from the Office of Juvenile Justice & Delinquency Prevention. The Pahoa programs are also currently funded through the Hawaii County Meth Initiative. Increased funding from the County of Hawaii will allow all three sites to continue to provide these much needed programs. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 DAYS & (iIR1IS CWB OF THE BIG IBI_GNG sMAItT Moves -Program Name Total Budget and Position Count Total Pro ram Bud et $288,500.00 Total Pro ram Position Count 10.75 Total A enc Bud et $1,063,453.56 Total A enc Position Count 18 Program Objectives: 1) To have 300 youth complete the SMART Moves program and in so doing show a significant change in behavior and attitude around the issues of drug, alcohol and tobacco use. 2) To have 100 parents complete the SMART Parents program 3) To train and engage 30 community members as prevention team partners 4) To train and engage 25 teen peer facilitators for the SMART Moves program Program Highlights: 1) Opened new Units in Kea'au and Pahoa to serve more underserved youth. 2) Conducted SMART Moves training with Boys & Girls Clubs of America's national staff, for 15 staff, 12 peer facilitators, ten parents and five community partners in 2004. 3) Secured Meth Grant in order to expand services in Pahoa 4) Secured additional United Way funds to expand services in Kea'au 5) Conducted SMART Moves at Chiefess Kapi'olani Elementary School 6) Conducted SMART Moves at Hilo Union Elementary School 7) Conducted SMART Moves with Baseball, Basketball and Football youth. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 D()1iS & GffiL4 CLUB of rNe eic isuuo sMART Moves -Program Name Pertormance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Youth Com eted SMART Moves 245 250 300 Communi Leaders Trained 0 12 30 Parents Completed SMART 0 50 100 Parents Peer Facilitators Trained 5 20 25 *If applicable Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es $92,566.00 $172,386.29 $221,005.00 Professional Fees $8,432.56 $14,986.00 $18,221.00 O erations $11,223.00 $29,341.00 $38,514.50 E ui ment $2,778.44 $6,786.71 $10,759.50 Other* 0 0 0 Total $115,000.00 $223,500.00 $288,500.00 *Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 IIOYS & GIIiIB CI.iJB ov nee eic isuwo sMAizT Moves -Program Name Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual " Bud et " Estimate Hawaii Island United Wa $17,000.00 $40,000.00 $40,000.00 Hawaii Count Meth Initiative 0 $50,000.00 0 Tobacco Settlement Trust Fund $60,000.00 $60,000.00 $60,000.00 Hawaii Count Non-Profit Grant $38,000.00 $45,000.00 $60,000.00 State of Hawaii ADAD/Abstinence 0 $28,500.00 $28,500.00 State of Hawaii ADAD/Dru Prev. 0 0 $100,000.00 Total $115,000.00 $223,500.00 $288,500.00 "If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 7 /~\~~1./ BOYS & GIRLS CLUB ov rHe sio isuno snnARr Moves -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. 1 (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. ff 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 resort may imaact the evaluation of your proaram(s or aaencv's future fundina reauests. ~ C. \ S gnature of Board President/Chair Date Signat, ~e of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTEDI NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 8 Brantley Center, Inc. -Agency Name Employment Rehabilitation - P~O9P~Y1 Na171@ Agency Director: Cami Post Phone No.: 775-7245 Contact Person: Cami Post Phone No.: 775-7245 Mailing Address: P.O. Box 1407, Honoka'a, Hawaii 96727 Facility/Site Address: 45-370 Ohelo Rd., Honoka'a, Hawaii 96727 Fax No.: 775-0211 Email Address: bcente2(oZverizon.net Amount of Request for Courriy Funds: ;25000.00 Prior Year(s) Funding: 02-03 03-04 04-05 521000.00 521000.00 521000.00 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. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 _ Brantley Center, Inc. -Agency Name Employment Rehabilitation -Program Name Program Description: The Employment Rehabilitation Program provides partilpants with a variety of services that develop and support the accomplishment of goals leading to meaningful competitive employment. These services include: Vocational evaluations, work adjustment training, occupational skills training, job-seeking skills lasses, and spedal'ized job placement and follow-up services. Partidpants receive quality vocational training and at the same time are paid for the work they perform. Also inluded in this program are work transitional services provided to high school students. The Centers staff work with high school counselors to transition students with disabilities ftom a school environment to a work environment The public benefits in many ways from the services offered by the Employment Rehabilitation Program. In addition m providing the community with employment training and job placement services for people with disabilities, Brantley Center, Inc. has several State, County, and private contracts to provide grounds maintenance services, janitorial services, diversified agricultural services, and small assembly services. Members of the community utilize the Center as another resource to fulfill these needs. Program staff work closely with the community to provide community-based vocational training, and at the same time provide the public with an additional work force. Total Budget and Position Count Total P ram Bud et 187,925 Total P ram Position Count 3.6 Total A e B t 386,200 Tote{ enc Position Count 8 Program Objectives: 1) Provide vocational evaluations to 30 consumers. 2) Provide individualized employment planning services to 20 consumers- 3) Provide work adjustment training to 26 consumers. 4) Provide occupational skills training to 26 consumers. 5) Provide spedalized job-seeking skills lasses to 20 consumers. 6) Provide competitive job placement and follow-up services to 12 consumers. 7) Provide work transition services to 14 high school students with disabilities. NONPROFIT GRANT APPLICATION FISCAL YEAR Zoos-o6 Page 2 Brantley Center, Inc. -Agency Name Employment Rehabrdation -Program Name Program Highlights: 1) Provided vocational evaluations for 21 consumers. 2) Provided individualized employment planning services to 14 consumers. 3) Provided work adjustment training to 22 consumers. 4) Provided occupational skills training to 23 consumers. 5) Provided. spedalized job-seelririg skills Basses to 13 consumers. 6) Placed 8 consumers in competitive employment 7) Provided -work transition services to 10 high sd~ool students with disabilities. Performance Measures: FY 2003-04 FY 200405 FY 2005-06 Actual * Bud et* Estimate Number of consumers who receive 25 30 30 Employment Rehabilitation Services. Number of consumers with 18 20 20 improved scores on the Vocational Evaluation and Trainin Re ort. Number of consumers who 15 20 20 increase their productivity rcen es. Number of consumers who 10 18 18 successfully complete the job- seeki skills class. Number of consumers placed. in 6 8 10 competitve employment for a minimum of 90 da s. Number of students who receive 10 15 15 work transition services. - - *Ifapplicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Pxge 3 Brantley Center, Inc. -Agency Name Employment Rehabilitation -Program Name Program Expenditures FY 2003-04 5 Flt 2 A_ dual * Bud et * Estimate Salaries and Wa es 1f1,107 111,507 114 500 Professional Fees 5,700 5,700 5,700 O rations 22,457 26,751 27,850 E ui ment 4,800 6000 Other* - Client wa es 28,485 29,455 33,875 Total 172,549 173,413 ^ _ 187,925 *PlBase explain a? detail on separate sheet Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 __Actual * Bud et * Estimate - Coun of Hawaii 0 0 25,000 State of Hawaii 40,552 30,00 30,000 Hawaii Island United Wa 18,000 18,000 _._18 Service Income 114,965 114,445,,. , _ __114,925 One-time ift 10,000 Ca over 10,968 _ Total 183,517_ 173,413 187,925 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Brantley Center, Inc. -Agency Name Employment Rehabilitation -Program Name 1(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. 1(we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. H awarded a grant from the County of Hawaii, I (we) understand and wilt 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 benefrts derived from the awarding of the grant, a complete accounting of alt expenditures supported. by County of Hawaii grant funds, and a listing of ottrer funding sources and amounts obtained during the award period_ Failure tiD submit a tlmeb, complete. and accurate veer-end resort may imcact the evaluation of your program's or agency's future funding requests. 'Signatur of Board resident/Chair Da Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005.06 Page 5 Center for Independent Living -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 16 D, Hilo, HI 96720 Facility/Site Address: Same As Above Fax No.: 961-6737 , Email Address: cileh@interpac.net Amount of Request for County Funds: $15000.00 Prior Year(s) Funding: 02-03 03-04 04-05 $15000.00 $15000.00 $15000.00 Agency Mission Statement: To ensure the rights of people with disabilities to live independently and fully integrated in the community, outside of institutional care setting. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page I Center for Independent Living -Hawaii - AgeilCy NarYle Independent Living Services - Pi'OgI'alll NBrtle Program Description: The concept of independent living is being able to make choices in life that will enhance dignity and self-respect. People with disabilities want equal privleges as well as responsibilities available to everyone. Ignorance and discriminatory practices in society causes a combination of low education, vocation, income and social opportunities for people with disabilities. The Center for Independent Living -Hawaii believes that those who best know the needs of people with disabilities and how to meet those needs are people with disabilities themselves. The practice of "consumer-control" forms the foundation for staff resources and service delivery. Staff assists consumers with disabilities toa ddress independent living goals. Total Budget and Position Count Total Pro ram Bud et 265580.00 Total Pro ram Position Count 9 Total A enc Bud et 1871841.00 Total A enc Position Count 33 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 risk of being homeless and dependent on others. Timeline: 7/1/05 - 6/30!06 2) Provide consumers with personal care attenandant regerrals whom we have screened and interviewed to assist them with their personal care, chores, etc. Provide consumer training on how to interview, hire and fire an attendent. This prevents institutionalization and dependence on family, friends, and neighbors. Timeline: 7/1/05 - 6130/06 3) Provide one--on-one independent living skills to assist consumers in carrying out their every day living activities such as housekeeping, shopping, laundry, cooking, etc. This will reduce dependence on others. Timeline: 7/1/05 - 6/30/06 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: 7/1/05 - 6/30/06 5) Provide one-on-one training with consumers to acquire problem-solving and decision-making skills. This will provide the consumer to make the right choices. Timeline: 711/05 - 6!30/06 6) Provide consumer with information on their entitlements and how to apply for these benefits. This will increase their self-worth and self-sufficiency in their daily living. Timeline: 7/1/05 - 6/30/06 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 7) 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: 7/1/05 - 6/30/06 8) Provide consumers with information and referral services to increase [Heir options of various resources in the community. This will increase their independence. Timeline: 7/1/05 - 6/30/06 9) Provide consumer with transportatin options in the community. This will increase their ability to make the right choices and decrease dependency from family and friends. Timeline: 7/1/05 - 6/30/06 10) Teaching consumers how to communicate and advocate for transportation needs. This will increase their self-advocacy and communication skills and decrease their dependency on others. Timeline: 7/1/05 - 6/30/06 Program Highlights: 1) CIL- Hawaii provided information on independent living services to approximately 400 seniors at the Senior Health Fair. 2) CIL-Hawaii continues to work with DRH (Disability Rights Hawaii) a local grassroots advocacy group to improve access in Hawaii county for people with disabilities. 3) CIL-Hawaii participates in the PICIL (Partnership in Community Independent Living) advisory committee. This project assists people with disabilities to meet their self-determined goals. 4) CIL-Hawaii continues to work on disability-related issues in Hawaii county with the Mayor's Committee on People with Disabilities. 5) CIL-Hawaii received a grant from Hawaii Island United Way to form a Youth Empowerment Group for young adults with disabilities. 6) CIL-Hawaii provided technical assistance to Haola, Inc., University of Hawaii of Hilo Library Staff, and Hospice of Hilo. 7) CIL- Hawaii has initiated the outreach staff working from their homes in different districts of Hawaii County. CIL-Hawaii has a staff person in the North & South Kona districts, Kau District, North & South Kohala District and Puna District. The Hilo office will assist with the North & South Hilo District and Hamakua District. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Center for Independent Living -Hawaii -AGei iCV Na-- - Independent Living Services -Program Name Performance Measures: 20 -04 2004 5 005-05 Actual Bud et Estimate Total Su ort 8 Revenue 161,716.00 265,580.00 270,000.00 Total Ex enses 181,840.00 265,580.00 270,000.00 Excess Deficit Su ort (20,124.00 - - 'If Applicable Pro ram Ex enditures: FY 2003-04 FY 2004-05 FY 2005-06 Actual Bud et Estimate Salaries and Wa es 127,737.00 196,355.00 197,000.00 Professional Fees 3,752.00 4,444.00 7,500.00 O erations 50,351.00 64,721.00 63,500.00 E ui ment - 60.00 1,000.00 Other - - 1,000.00 Total 181,840.00 265,580.00 270,000.00 *Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Center for Independent Living -Hawaii - Agency Name Independent Living Services -Program Name Pro ram Fundin Sources: FY 2003-04 FY 2004-05 FY 2005-06 Actual Bud et Estimate Title VII 70,005.00 147,055.00 147,000.00 ILP-DVR 28,811.00 26,469.00 26,000.00 POS-DVR 26,083.00 32,056.00 32,000.00 GRS-Coun 8,016.00 15,000.00 15,000.00 United Wa -Hilo 7,500.00 15,000.00 15,000.00 United Wa -Youth - 20,000.00 20,000.00 Hawaii Hotel Association 3500 10,000.00 10,000.00 Elderl Blind Services 12673 - Contributions 1000 1,000.00 Others 4,128.00 4, 000.00 Total 161,716.00 265,580.00 270,000.00 'If Applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-OS Page 5 Center fcr !~~'=,_~ndent Living -Hawaii - AgeI1Cv Nat11e Independent Living Services - PrOgl'afll Nam@ 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 proaram's or agency's future funding requests. ~ ~ I- ~N-rte Signatup,r~e of B~rd President/Chair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 Child and Family Service Family Violence Continuum of Care Programs Agency Director: Geri Marullo, President and CEO Phone No.: 681-3500 Contact Person: Heidi Koop, West Hawaii Phone No.: 323-2664 James Borden, East Hawaii 935-2188 Mailing Address: Child and Family Service 91-1841 Fort Weaver Road Ewa Beach, Hawaii 96706 FacilitylSite Address: West Hawaii: 81-6587 Mamalahoa Hwy, Kealakekua 96750 East Hawaii: 460 Kilauea Avenue, Hilo, HI 96720 Fax No.: 808 323-2999 West Hawaii 808 961-2073 East Hawaii Email Address: gmarullo@cfs-hawaii.org Amount of Request for County Funds: $ 5,000.00 Community Information and Health Education 5,000.00 Domestic Abuse Shelter $10.000.00 Total Prior Year(s) Funding: 02-03 03-04 04-05 $5,000.00 $5,000.00 $0 Agency Mission Statement: Since 1899, Child and Family Service has dedicated its efforts to its mission of "Strengthening families and fostering the healthy development of children". Child and Family Service offers an integrated and comprehensive human service and behavioral health care delivery system throughout the State of Hawaii. It provides a large array of clinical and non-clinical services that address serious social problems impacting our community. Child and Family Service is known in the community for its willingness to work with hard to engage individuals and families facing a multitude of difficult problems. As community populations present with increasingly complex problems and situations, CFS will be at the forefront of developing the skills, knowledge, and service models to address these needs. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 Child and Family Service Family Violence Continuum of Care Programs Program Description: Funds are requested to support two programs of Child and Family Service that address the family violence continuum of care. These two programs are Community Information and Health Education in West Hawaii and the Domestic Abuse Shelter (DAS) in Hilo. These programs educate and serve individuals in the communities of East and West Hawaii, addressing the issues of sexual abuse and/or domestic violence. Community Information and Health Education provides educational presentation and referral information to individuals regarding family planning and issues related to sexual violence and safety. Educational efforts include engaging hard-to-reach populations to include but not limited to, adolescents, the homeless, disabled, uninsured or underinsured women, men, substance abusers and the general population. This program will utilize funding by providing materials (i.e. coloring books for young children) needed in the education of the community in understanding the role and cycle of sexual violence. During the presentations, the Health Educator also provides information on community resources the individual or family can access, including counseling services and medical referrals. This program is funded through the Department of Health and even though funding received does not fully support the operation of the program, CFS remains committed to providing quality services to the community. The Domestic Abuse Shelter is open to victims of domestic violence and their children on a 24-hour basis. Shelter and supportive services are provided to the residents of the shelter to help them break the cycle of violence and to make positive changes in their lives through education, counseling and support. By providing a safe and structured play environment for the children in the shelter, clients are more receptive to services. Thus a partial amount of the funding will be used to purchase outdoor play equipment for the shelter facility. CFS has operated the Domestic Abuse Shelter in East Hawaii since 1995 and unfortunately, the Department of Human Services does not cover the full cost of running this program. At CFS, we have a "no turn away' policy for our Shelter services. Turning away someone can endanger the life of an individual and/or their children, so we always make room for more. Therefore, services are still offered though resources are limited. Total Budget and Position Count Total Pro ram Bud et $277,936 Total Pro ram Position Count 12.50 Total A enc Bud et $4,176,371 Total A enc Position Count 89 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 Child and Family Service Family Violence Continuum of Care Programs Program Objectives: Objectives for the Community Information and Health Education specify that: 1) 80% of all participants of a presentation will show an increased knowledge of the information presented regarding sexual violence awareness through pre-post tests. 2) 50% of people participating in the program presentations will complete and indicate a high level of satisfaction of the presentations based on the information provided regarding sexual violence. Objectives for the Domestic Abuse Shelter specify that: 3) 75% of clients will have obtained increased knowledge and understanding of domestic violence and its effect on themselves and their children. 4) 60% of single adults and families will move from the shelter to anon-abusive home environment. 5) 90% of adult participants will have completed a personalized safety plan by discharge. 6) 80% of returned client satisfaction surveys will show services to be satisfactory. Program Highlights: Community Information and Health Education -Kona (FY 2004) Child and Family Service in West Hawaii has provided Family Planning services consistently since 1994 and has developed a program that has been widely respected in the West Hawaii community. As indirect contact services have significantly increased over the last two years, direct services are offered to youth and families in schools, to clients of other agencies or organizational programs and to families. Program outcomes have exceeded expectations for direct and indirect contacts for 10 years. In Fiscal Year 2004, the program served the following: • 688 Direct Client Services • 12,530 In-Direct Client Services (313% over projected goal) The program also achieved 100% for the following goal: • Participants demonstrated increased knowledge after presentation based on pre/post tests NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Child and Family Service Family Violence Continuum of Care Programs Domestic Abuse Shelter -Hilo (FY 2004) In Fiscal Year 2004, CFS provided safety to 96 adults and 120 children. During this period, our DHS contract requirement was to provide 3647 nights of safety (bed days). Instead, CFS provided 5250 nights of safety, or 144% of the contract requirement. In addition, the program served 459 individuals accessing the crisis hotline for crisis intervention services and provided 84 adults and 97 children with individual, group, dyad and/or family therapy. The program also achieved 100% of its outcomes for the following goals: • Adults participants complete a personalized safety plan • Participants have increased knowledge of community resources • Returned client satisfaction surveys show that service to be satisfactory. Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Community Information and Health Education # of Education/Outreach Activities 688 1000 1000 # of In-Direct Contact 12,530 5000 4000 Domestic Abuse Shelter # of hotline calls received from ublic 459 450 450 # of ersons who were rovided shelter 194 200 216 # of psycho-education hours provided to 254.50 260 260 families residin at the shelter *If applicable Program Expenditures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es $1,802.02 Not a licable 0 Professional Fees 2,178.00 Not a licable 0 O erations 1,019.98 Not a licable $5,000.00 E ui ment Not a licable $5,000.00 Other* Not a licable 0 Total $5,000.00 Not a licable $10,000.00 *Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Child and Family Service Family Violence Continuum of Care Programs Program Funding Sources: Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Department of Health (Community $24,500.00 $24,500.00 $24,500.00 Information and Health Education Department of Human Services $253,436.00 $253,436.00 $253,436.00 Domestic Abuse Shelter Total $277,936.00 $277,936.00 $277,936.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 Child and Family Service Family Violence Continuum of Care Programs I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2-135 - 2-142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. 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 proSlram's or ailency's future funding requests. N~ Qa7n ~ ~ !~ag~os Signature of Board President/Chair Date ~!'~l~ Signatur of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 East Hawaii Coalition for the Homeless - Agency Name Kihei Pua Emergency Shelter - PfOgfBnl Name Agency Director: Steven Bader Phone No.: 969-4848 Contact Person: Steven Bader Phone No.: 969-4848 Mailing Address: 138 Kinoole Street Hilo, Hawaii 96720 Facility/Site Address: 115 Kapiolani Street, Hilo Hawaii 96720 Fax No.: 969-4850 Email Address: sdbaderl@aol.com Amount of Request for County Funds: $40,000.00 Prior Year(s) Funding: 02-03 03-04 04-05 $37,500.00 $37,500.00 $38,000.00 Agency Mission Statement: "Creating Opportunites that enhance the quality of life for homeless families and individuals". EHCH is committed to reducing homelessness in the community by integrating shelter and support services in a caring and directed manner so that participants can become self-sufficient and obtain permanent housing. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 East Hawaii Coalition for the Homeless - Ag@f1Cy Natll@ Kihei Pua Emergency Shelter - PPOgPat71 Narrt@ Program Description: Kihei Pua is a 24 hour emergency shelter that serves families and individuals. The program provides participants opportunites to become self sufficient and prepares them to secure and maintain permanent housing. The shelter can accommodate 52 persons a night. Services include case management, 24 hour food pantry, classes that address issues such as personal responsibility, parenting and financial stability. Walk-in services (showers, emergency food, blankets) and phone and mail access are also provded. Hale OPuna, anon- shelter extension of the program is located in Pahoa and provides food, advocacy and referral services as well being a location for other agencies to access this population. Total Budget and Position Count Total Pro ram Bud et 462,400.00 Total Pro ram Position Count 12 Total A enc Bud et 663,100.00 Total A enc Position Count 14 Program Objectives: 1) Develop service plans for all clients within 3 days of entrance into program. 2) Provide effective case management, referrals and classes for all participants. 3) Assist participants in preparing for, and obtaining permanent housing. 4) Ensure that 75% of those serve meet 75% of their goals within 6 weeks. Program Highlights: 1) Provided services to more than 3,000 people last year -approximately were 65% children. 2) Kaiser Permanente Community Partnership provided hygiene supplies, food, clothing, Christmas gifts and Easter baskets to the children. 3) Partnered with Kalakaua Culinary Arts Institute to provide 4 full scholarships for shelter residents in each class. 4) Participated in Continuum of Care planning efforts to address homelessness island wide. 5) Raised over $70,000 through special events and donations. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 East Hawaii Coalition for the Homeless - A9ef1Cy NaIII@ Kihei Pua Emergency Shelter - PI'O91'at71 Iv8IT1@ Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate #Undu licated Served Hilo 491 550 600 # Undu licated Served Puna 2,500 2,600 2,800 # Meal Packa es Provided 139,072 140,000 150,000 # Non-Food Services Provided 3,568 3,700 3,700 # Entered Permanent Housin 168 180 200 # Entered Transitional Housin 51 60 70 # Enrolled in Educationlfrainin 19 25 25 # Obtained Em to ment 36 40 40 # Reveivin Mental Health Treat. 30 30 30 # Enterin Substance Abuse Treat. 54 40 40 *If applicable Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 298137.00 299745.00 317697.00 Professional Fees 5686.00 9790.00 10490.00 O erations 3170.00 4000.00 4000.00 E ui ment 970.00 2500.00 2000.00 Other* 159777.00 120431.00 127713.00 Total 467,740.00 436,466.00 461,900.00 *Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 East Hawaii Coalition for the Homeless - Ag@IICy NBIIIe Kihei Pua Emergency Shelter - PIOgI'8171 X181112 Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate State of Hawaii 193302.00 179270.00 203000.00 Coun of Hawaii 37500.00 38000.00 40000.00 Hawaii Island United Wa 17500.00 17500.00 17500.00 Client Fees 18725.00 19000.00 19000.00 Other/Donations 76563.00 132596.00 132300.00 ESG Emer enc (Federal 50100.00 50100.00 50100.00 Total 393690.00 436466.00 461900.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 East Hawaii Coalition for the Homeless - AgellCy Na171@ Kihei Pua Emergency Shelter - Pf091'alll 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. 1 (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, 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. (-ZB _U S' Signatu of Board President/Chai Date 1 Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 East Hawaii Coalition for the Homeless - Ag@I1Cy Na171@ Kihei Pua Transitional Housing Program - PrOgl'alTl Name Agency Director: Steven Bader Phone No.: 969-4848 Contact Person: Steven Bader Phone No.: 969-4848 Mailing Address: 138 Kinoole Street Hilo, Hawaii 96720 Facility/Site Address: 115 Kapiolani Street, Hilo Hawaii 96720 Fax No.: 969-4850 Email Address: sdbader1@aol.com Amount of Request for County Funds: $4,000.00 Prior Year(s) Funding: 02-03 03-04 04-05 $2500.00 $2500.00 $3000.00 Agency Mission Statement: "Creating Opportunites that enhance the quality of life for homeless families and individuals". EHCH is committed to reducing homelessness in the community by integrating shelter and support services in a caring and directed manner so that participants can become self-sufficient and obtain permanent housing. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 East Hawaii Coalition for the Homeless - Ag@f1Cy Naflle Kihei Pua Transitional Housing Program - PfO9f8f11 ~I8111@ Program Description: Kihei Pua Transitional program provides 21 affordable scattered site housing opportunites for families and single men and women. Participants can receive services for a maximum of two years with the goal of securing and maintaining permanent housing. The program is designed for participants who are stable personally and financially and need more time to find housing because of their circumstances (i.e. large family, disability, completing schooling, etc). Total Budget and Position Count Total Pro ram Bud et 201,200.00 Total Pro ram Position Count 2 Total Agency Budget 663,100.00 Total Agency Position Count 14 Program Objectives: 1) Provide tools that will help clients secure and maintain permanent housing. 2) Ensure that 75% of those served meet 75% of their goals before exiting the program. 3) Develop productive members of the community who will maintain positive and healthy lifestyles. Program Highlights: 1) Expanded program from 16 to 21 units of housing. 2) Continued Kaiser Permanente Community Partnership to provide hygiene supplies, food, clothes and Easter and Christmas gifts for the children in the program. 3) Developed partnership with Faith Against Drugs to place single men and women in recovery in their facility while in our transitional program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 East Hawaii Coalition for the Homeless - A9@i1Cy ~lalll@ Kihei Pua Transitional Housing Program - PfOgf8111 ~laCll@ Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate # Total Served 85 100 120 # New Families Served 18 20 20 # New Sin les Served 15 20 30 # Meal Packa es Provided 2,151 3,000 3,500 # Life skills Classes Provided 56 56 56 # Enrolled in Education/Trainin 11 15 20 # Obtained Em to ment 12 20 25 # Transitioned Off Welfare 7 6 10 # Enterin Substance Abuse Treat. 7 8 10 # Secured Permanent Housin 28 30 40 # Retained Permanent Housing 27 30 40 After Leavin Pro ram *If applicable Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 61000.00 61000.00 78048.00 Professional Fees 2437.00 4910.00 5210.00 O erations 1359.00 1500.00 1500.00 E ui ment 0.00 500.00 500.00 Other* 128097.00 99994.00 115942.00 Total 192893.00 167904.00 201200.00 *Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 East Hawaii Coalition for the Homeless - Ag@C1Cy Name Kihei Pua Transitional Housing Program - PfO9faCT1 Name Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate State of Hawaii 82843.00 67500.00 87000.00 Coun of Hawaii 2500.00 3000.00 4000.00 Hawaii Island United Wa 5000.00 5000.00 5000.00 Client Fees 36031.00 48500.00 48500.00 Other/Donations 32813.00 43904.00 56700.00 Total 159187.00 167904.00 201200.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 East Hawaii Coalition for the Homeless - A9@I1Cy Nal11e Kihei Pua Transitional Housing Program - PI'Ogf8t71 N21TI@ 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 vour program's or aaencv's future funding requests. ~ ~-z8 -05 ~ Signature f Board resident/Chair Date ~ ~ Z8 -05 Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 Family Support Services of West Hawaii Family Centers Agency Director: Joseph Fichter Phone No.: 334-4116 Contact Person: Huellyn Whitford Phone No.: 334-4110 Mailing Address: 75-127 Lunapule Road, Suite 11 Kailua-Kona, HI 96740 Facility/Site Address: Same Fax No.: 808-334-4141 Email Address: kids@fsswh.org Amount of Request for County Funds: $65,000.00 Prior Year(s) Funding: 02-03 03-04 04-05 $48,000. $48,000. $49,500 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 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 they need in a familiar setting. As a Family Center Coordinator, you learn to wear many hats. The Ka'u Family Center has partnered with the Department of Parks & Recreation to provide an annual Easter Egg Hunt. This event is for the community to come together, celebrate and cultivate social networks. The Ka'u Family Center is one of the few sites located in South Hawaii that works with referrals from Hawaii Intake Services to meet their community service requirements. The centers work with homeless families to help minimize the downward spiral that homelessness may bring in areas that lack most social service networks. 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. Total Budget and Position Count Total Pro ram Bud et $94,100 Total Pro ram Position Count 1.Ofte Total A enc Bud et $4,100,000 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. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 Family Support Services of West Hawaii Family Centers Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Education 5 10 10 Em to ment 10 10 10 Financial 20 20 20 Health 10 20 20 Parentin Information 12 25 25 Office E ui menUuse 155 155 155 Childcare 6 6 6 Substance Abuse Su ort and Info 17 60 60 Food 122 40 40 *If applicable Program Expenditures FY 2003-04 FY 2004-OS FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es $46,887.00 $45,839.00 $52,000.00 Professional Fees 188.00 289.00 500.00 O erations 485.00 498.00 500.00 E ui ment 2,882.00 3,057.00 3,000.00 Other* _ 33,356.00 30,837.00 38,100.00 Total $83,798.00 $80,520.00 $94,100.00 *Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Family Support Services of West Hawaii Family Centers Program Expenditures -Detail of Other Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Em to ee Benefits $6,463.00 $7,989.00 $9,000.00 Pa roll Taxes 5,420.00 5,431.00 6,300.00 Su lies 5,949.00 1,939.00 5,000.00 Occu anc 14,781.00 14,942.00 16,500.00 Insurance 602.00 530.00 1,000.00 Travel 141.00 6.00 300.00 Total Other $33,356.00 $30,837.00 $38,100.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Family Support Services of West Hawaii Family Centers Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Count of Hawaii $48,000.00 $49,500.00 $65,000.00 Donations 35,798.00 31,020.00 $29,100.00 Total $83,798.00 $80,520.00 $94,100.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 Family Support Services of West Hawaii Family Centers 1 (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 agency's future fun~(din~ requests. ~tiL ~ Sign ure of Bo~d.P-resident(Chair Date o xecutive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 _ Friends of the Children's Justice Center of East Hawaii - Ag@I1Cy Name Special Needs and Enhancement, Center Support, Prevention/Education and Training Programs - PrOgl'a171 NalTl@ Agency Director: Aileen Lum Phone No.: 935-8755 Contact Person: Jenny Tokuuke Phone No.: 935-8755 Mailing Address: 1290 Kinoole Street Facility/Site Address: Hilo, Hawaii 96720 Fax No.: 933-0968 Email Address: fcjceh@fcjc.org Amount of Request for County Funds: $15000.00 Prior Year(s) Funding: 02-03 03-04 04-05 $13000.00 $13000.00 $13,000.00 Agency Mission Statement: The mission of the Friends of the Chidlren's Justice Center of East Hawaii is to help sexually, physically, emotionally abused, and neglected children. We do this in partnership with the Chidlren's Justice Center of East Hawaii, by providing funds and reouces to support the needs of these children. The "Friends" offer hope, encouragement, and opportunity for victims of child abuse. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 Friends of the Children's Justice Center of East Hawaii - AgerlCy Name Special Needs and Enhancement, Center Support, Prevention/Education and Training Programs -Program Name Program Description: The Friends of the Children's Justice Center of East Hawaii is a private nonprofit organization founded by concerned community members in 1990 whose primary goal was to protect and enhance the physical and psychological safety of abused children. The Friends are in a private partnership with the Children's Justice Center (CJC), a State Judiciary Program. The CJC provides a safe, neutral homelike atmosphere where children can be interviewed about reports of abuse, particularly sexual abuse. This Children's Justice Program facilitates and coordinates the system's response to victims of child abuse to reduce their trauma through amulti-disciplinary team approach which involves police, social workers, prosecutors, guardians ad litem, medical professionals and advocates. The Friends support the CJC primarily by providing direct services and programs to child victims and their families which are not available through any other public or private source. The Friends facilitate services and accept referrals from state and private agencies working with child abuse victims such as Child Protective Services, Child and Family Services, Hawaii Behavioral Health, Catholic Charities, Parents Inc., etc. The Friends target are children between the ages of 0-18, who are victims of maltreatment (sexual, physical, emotional, mental abuse or neglect) residing in North Hilo, South Hilo, Hamakua, Puna and parts of Ka'u. Our services are aimed at assisting children who are in temporary or permanent foster custody or who are living with the non-abusive parent with little or no means of financial support. The Special Needs and Enhnacement Program is designed to help child victims gain self-esteem and develop positive self-worth. This is accomplished by providing for needs that are not covered by any other public or private source. These children would otherwise "fall through the cracks" and not have the opportunity to have a sense of normalcy in their lives. Funds are used to provide 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). The Friends also supply gifts to abused/neglected children at special occassions such as Christmas and through the Ready to Learn Program have provided school supply kits at the begining of the academic year. The Center Support Program was developed to reduce trauma and ensure the safety and comfort of the children that come to the Center for interviews. The Friends maintain the Center's safe, child-friendly and homelike atmosphere by NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 furnishing the center with donated toys, games, and snacks. This is often made possible by community donations and volunteerism. The Friends maintain the Center's appearance with repairs and refurbishing when it is needed. The Prevention and Education Program is designed to educate the community on child abuse issues. The program coordinates and carries out programs and services to the public promoting the awareness and prevention of child abuse. The Friends have also coordinated and financially supported specially designed programs presented in the schools. The Training Program helps to sponsor the attendance of various professionals including social workers and police interviewers who talk with victims and their families at seminars and conferences in order to enhance the quality of services that child victims receive. This prevents victims from being re-traumatized by the system's response to the reports of abuse. Total Budget and Position Count Total Pro ram Bud et 157200.00 Total Pro ram Position Count 1 Total Agency Budget 157200.00 Total Agency Position Count 1 Program Objectives: 1) Provide 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 otherwise not receive a gift. 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 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 the Ready to Learn Program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 12) Provide privacy, comfort and safety for clients who come to the Center by maintaining its warm and low-key environment. 13) Create client database to better organize and develop a streamlined process for handling requests for accurate accounting of funds 14) Collaborate with community organizations to formulate and implement innovative prevention programs targeting schools. 15) Participate with the East Hawaii Coalition for child abuse Prevention in prevention/education activities within the community to spread awareness on issues about child abuse to the general public. Program Highlights: 1) Increased awareness of the general public by carrying out prevention/education events (ie booth at Borders and in Honoka'a). 2) Spearheaded the formation of a Coalition "The East Hawaii Coalition for Child Abuse Prevetion." 3) Worked with the Coalition on a proclamation signed by Mayor Harry Kim in April, Child Abuse Prevention month. 4) Brigthened the holidays of 200 teens by providing Christmas gift certificates to each child. 5) Filled 807 appropriate special needs and enhancement requests for abused/neglected children to provide for needs that would otherwise have gone unmet. 6) Helped sponsor 8 professionals to attend trainings on Oahu and the mainland. 7) Helped fund aone-day training here in Hilo attended by 30 professionals working with child sexual abuse. 8) Along with the East Hawaii Coalition for Child Abuse Prevention we distributed 5000 blue ribbons 9) Became a part of the Hawaii Island United Way 10)Sent 7 teens to "Winners Camp". A week long camp on Oahu to help build self confidence 11) Distributed 254 Ready to Learn Kits 12) Members of our organization did radio awareness at KPUA in April (Child Abuse Prevention Month) NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Friends of the Children's Justice Center of East Hawaii - Ag@IICy Nat71e Special Needs and Enhancement, Center Support, Prevention/Education and Training Programs - Program Nam@ Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate *If applicable Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 27024.00 28200.00 30000.00 Professional Fees 2500.00 7500.00 O erations 16491.00 15550.00 16000.00 E ui ment 1750.00 1800.00 Other* 74489.00 97800.00 103700.00 Total 119754.00 145850.00 157200.00 'Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 Friends of the Children's Justice Center of East Hawaii - Ag@nCy Name Special Needs and Enhancement, Center Support, Prevention/Education and Training Programs - Program Name Program Funding Sources Revenue Source FY 2003-04 FY 2004-OS FY 2005-06 Actual * Bud et * Estimate Count of Hawaii 13000.00 13000.00 15000.00 Hawaii Island United Wa ,Inc. 15000.00 15000.00 Weinberg Foundation 10000.00 10000.00 Teresa Hu hes Foundation 30000.00 33000.00 30000.00 Geist Foundation 38500.00 30000.00 30000.00 Iron Man Foundation 1000.00 Atherton/Mattel Foundations 10000.00 5000.00 Mclnern Foundation 10000.00 5000.00 Frear Foundation 5000.00 5000.00 5000.00 Phantom Annual mail out 12730.00 20000.00 20000.00 Fundraisin 1800.00 22144.00 Interest 297.00 400.00 500.00 Donations 12933.00 6000.00 7500.00 car over funds 6650.00 1056.00 Total 127460.00 144850.00 157200.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 Friends of the Children's Justice Center of East Hawaii - Ag211Cy NalTle Special Needs and Enhancement, Center Support, Prevention/Education and Training Programs - PrOgl'8111 N81712 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 funding requests. J G(~3-r ,3 i ~ ~s Signature of Board resident/Chair Date ' o,~'~~. ~ ~t~~t,,~ CI ~ ?,1 ~ G c, Sig ure utive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 7 Friends of the Children's Justice Center of East HI Special Needs and Enhancment, Center Support/Education, and Training Programs Breakdown of Other Costs -page 5 Nonprofit Grant Application: FY 2003-04 FY 2004-05 FY 2005-08 Center support 2719 2500 3600 Special needs/enhancements 63217 72000 75000 Facilities 3000 6000 6000 Education/prevention 332 10200 12000 Training 5626 7100 7100 Total 74894 97800 103700 FRIENDS of The Children's Justice Center of West Hawaii - Ag211Cy Name Enhancement and Basic Needs Program - PfO91'a171 Name 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: fcjcwh@hawaii.rr.com Amount of Request for County Funds: $15000.00 Prior Year(s) Funding: 02-03 03-04 04-05 $13000.00 $13000.00 $13000.00 Agency Mission Statement: The mission of the FRIENDS of the Chilren'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. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 FRIENDS of the Children's Justice Center of West Hawaii - Ag@f1Cy NafYt@ Enhancement and Basic Needs Program - Pf'Ogf'afil Natll@ 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 thanks 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, food and water supply. The largest protion of the program goes directly to the children to provide enhancement activities such as athletic, music, dance, sewing or riding lessons, tutoring Summer cap programs and the Winners' Camp program on Oahu for teens. 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. A priority for expansion of our services is to develop follow-up activities for the teens returning from Winners' Camp to reinforce the positive lessons for the campers after they return to their homes in Kona. The majority of teens supported by the FRIENDS to attend the camp are from foster homes and are in need of on-going support. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 The program is coordinated by a half-time staff person, a 13-member board of directors, and approximately 30 volunteers who help with special projects. Among those volunteers is a 4-H group which prepares "memory scrapbooks" for the foster teens who attend Winners' Camp. Total Budget and Position Count Total Pro ram Budget 92651.00 Total Program Position Count 1 Total Agency Bud et 127172.00 Total A enc Position Count 1 Program Objectives: 1) Assist ten or more children to attend Winners' Camp by June 30, 2006. 2) Give holiday gift certificates to 100 teenage youth by the end of December 2005. 3) Give 50 FRIEND boxes to children entering a foster home for the first time, or being transferred to a new foster home, by June 30, 2006 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, 2006. 5) Provide funding for 500 or more children through enhancemenUbasic needs requests by June 30, 2006. 6) Support one or more training projects coordinated by the Children's Justice Center of West Hawaii to build and sustain interdisciplinary teams for State and County staff who work with cases of child abuse and neglect in West Hawaii by June 30, 2006. 7) Assist three youth with non-cosmetic orthodonia treatments by June 30, 2006. Program Highlights: 1) Fifteen teens were sent to Winners' Camp during the County fiscal year 2003-2004; (seventeen during the calendar year 2004). 2) One hundred twenty-nine holiday gift bags were distributed to teens, between the ages of 13 and 18, in foster care in West Hawaii during December 2004. 3) Sixty-four FRIEND boxes were delivered between November 2003, when the service began, and December 2004. 4) Winners' Camp follow-up activites were sponsored in December 2003 and February 2004; an informal partnership was formed with staff from Family Support Services of West Hawaii and the Neighborhood Place of Kona to plan future activities and identify funding sources. 5) The FRIENDS approved 401 separate requests during the County Fiscal Year 2003-2004 assisting 702 children; (427 requests assisted 763 children during the 2004 calendar year). NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 6) Amoung the training opportunities for professionals that The FRIENDS helped with funding were: 1) athree-day training program in April 2004 entitled, "Child Sexual Abuse: Dealing with the Traumatic Aftermath"; 2) a Continuing Education program entitled "Assessing and Treating Childhood Trauma" on Oahu, and 3) the annual workshop on the "General Dynamics of Child Sexual Abuse". 7) The FRIENDS were able to assist two youth with non-cosmetic orthodonia treatments thus far in FY 2004-2005. In addition, a professional dental review committee has been formed to evaluate and prioritize the requests. The FRIENDS anticipate being able to assist one or two additional children before the end of the County 2004-2005 Fiscal Year. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 The FRIENDS of the Children's Justice Center of West Hawaii - Agency Name Enhancement and Basic Needs Program - PrOgfam Name Pertormance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Support for children at the 310 400 400 Children's Justice Center Enhancement/Basic Needs 702 600 750 Re uests -individuals assisted Holida ift bas 97 100 130 FRIEND boxes (11/01/03-0/30/04); 38 100 60 anew activit Winners' Cam attendees 15 20 20 *If applicable Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 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* 12986.00 13000.00 15000.00 Total 12986.00 13000.00 15000.00 *P/ease explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 FRIENDS of the Children's Justice Center of West Hawaii - AgeilCy Nam@ Enhancement and Basic Needs Program - PfO9faiTl Naive Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Count of Hawaii 13000.00 13000.00 15000.00 Private Foundations 51283.00 56001.00 46000.00 Donations 3595.70 4000.00 6000.00 Fundraisin 11441.64 21650.00 21700.00 Interest Income 1313.77 1500.00 1100.00 Total 80634.11 96151.00 89000.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 FRIENDS of the Children's Justice Center of West Hawaii - Ag211Cy N8f11@ Enhancement and Basic Needs Program - P~Ogfal7l 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 ArtiGe 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 nt/ hair Date Signature of Executive Director ate ' UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 7 Friends of the Children's Justice Center of West Hawaii Program Expenditures from County of Hawaii Funds ITEM FY 2003-04 FY 2004-OS FY 2004-OS FY 2005-06 Actual BUDGET TO DATE BUDGET Athletic $478.60 $500.00 $757.82 $600.00 Center Support $25.00 $300.00 $135.00 $300.00 Clothing $250.00 $600.00 $175.00 $400.00 Christmas Bags $132.84 $0.00 $227.44 $300.00 Dental $560.97 $3,000.00 $0.00 $1,200.00 Education $2,804.73 $800.00 $200.00 $3,000.00 Emergency $1,694.34 $1,500.00 $371.74 $1,200.00 Enhancement- $787.04 $423.90 $1,000.00 mscellaneous* Food $500.00 $600.00 $325.00 $600.00 FRIEND boxes $352.10 $500.00 $75.00 $200.00 Medical $0.00 $200.00 $0.00 $0.00 Miscellaneous $0.00 $100.00 $0.00 $0.00 Performing Arts $435.00 $500.00 $85.00 $500.00 School Supplies $0.00 $800.00 $0.00 $0.00 Special Events $0.00 $800.00 $169.00 $300.00 Summer Camp** $0.00 $1,000.00 $260.00 $700.00 Thera y $0.00 $200.00 $0.00 $0.00 Training $699.16 $0.00 $200.00 Travel $587.00 $600.00 $1,379.10 $1,500.00 Winners' Camp $3,679.22 $3,000.00 $2,143.76 $3,000.00 TOTALS: $12,986.00 $15,000.00 $6,727.76 $15,000.00 * Enhancement-Miscellaneous: out of state birth certificates; Winter ball; yearbooks, etc. **Summer Camp: in the past we have had several requests to attend "free Camp"; no requests were received this past year, but the FRIENDS remain supportive of camp activities in addition to Winners' Camp. ***The balance of $14.00 was refunded to the County during the 2004-2005 grant period. Goodwill Industries of Hawaii, Inc. Work Experience Program Agency Director: Laura Robertson Phone No.: 836-0313 ex1060 Contact Person: Kathleen Nielsen Phone No.: 961-0307 ex1401 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: 02-03 03-04 04-05 $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 the 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 TANFITAONF and Food Stamp recipients. With 46 years of experience operating vocational training programs as well as teaching life skills, Goodwill has developed an expertise in bringing about NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 Goodwill Industries of Hawaii, Inc. Work Experience Program 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 with disabilities and other barriers will have the opportunity to participate in a full range of life's experiences, including employment. We provide services to empower individuals to be productive and independent, based on their abilities and interests. From July 2003 to June 2004, GIH successfully provided services to over 6,476 people statewide, and placed more than 1,079 people into gainful employment. The East Hawaii branch of Goodwill Industries provided services to 823 individuals and placed 101 people into employment in 2003-2004. Over the past five years, Goodwill has successfully provided training and employment services to more than 22,834 people with barriers to employment, and placed more than 4,797 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 will assist people to attain other life goals. Moreover, we believe in each individual's right to self-determination, to make their own decisions regarding life choices as a means of promoting independence and self- sufficiency. In previous years, GIH has provided a menu of services to train, place and support individuals with barriers into gainful employment and assist them to overcome their barriers to both employment and job retention. Additionally, Goodwill is committed to providing services to help individuals after they have obtained employment to acquire skills and resources to advance, and improve their economic self-sufficiency through training in basic literacy, computer 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 along-term basis. Examples of agencies and partners with whom we coordinate services include the Department of Health, Division of Vocational Rehabilitation, Workforce Development Department, Department of Human Services, Child Care Connection of Hawaii, Hawaii Literacy, Department of Education, Legal Aid Society, East Hawaii Coalition for the Homeless, Chamber of Commerce, Goodwill Industries International, employers in identified industries with job opportunities corresponding to participants' career goals, and other designees. Natural supports will be developed to enhance the individual experience in the workplace. Collaboration between employer, family, friends, and the program staff will be emphasized to increase the probability of success. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 Goodwill Industries of Hawaii, Inc. Work Experience Program Program Description: Funding is requested for a work experience program to provide wage subsidy for individuals with disabilities and other barriers to employment .The program format will allow work training opportunities for individuals that do not have work experience or who need additional supports or training to succeed in their employment goals. The training programs available are Janitorial and/or Textile/Wares processing positions. The Work Experience program will follow guidelines as set forth by the Department of Labor. Goodwill Industries has a subminimum wage certificate that requires the following: • a standard be set for each work station • community wage survey be conducted annually, and • each 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 experience path 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. Through this program participants learn what it is like to earn a paycheck, while being provided valuable work experience and enhancing skills in a real work setting. We recognize the intrinsic value of work and understand the profound effects that meaningful, tangible employment brings to our trainees' lives. More than bringing financial self-sufficiency, work taps the spirit of the individual, provides equal opportunity, and demands commitment and dedication, values that provide the foundation for the community. In 2003-2004, the Work Experience Program served 12 participants that were enrolled in a Goodwill training program. The format allowed work-training opportunities for individuals to choose a position in our Janitorial program or Textile/Wares Processing program. The Work Experience Program followed guidelines as set forth by the Department of Labor. A standard was set for each workstation, a community wage survey was conducted, and each participant's productivity was measured every six months. Participants developed problem solving skills, motivational skills, an attitude for success, and increase their self- confidence in the workplace. In addition to the population served in the past year, Goodwill Industries of Hawaii proposes to begin serving high school special education students who will be transitioning out of school within the next 2 years. Work is a logical next step for high school graduates that are not continuing their education. Practical work experience provided by Goodwill Industries of Hawaii will assist these students in transitioning from high school into the workforce. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Goodwill Industries of Hawaii, Inc. Work Experience Program This year Goodwill Industries of Hawaii is requesting an increase in funding to enable expanded services to high school students and other persons with employment barriers. The funding will also permit purchase of 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. The training period for each participant will be increased to 5 hours per week for a minimum of 3 months and maximum of 12 months. Additional time will allow participants to strengthen their work abilities and gain the necessary self-confidence to allow them to succeed in the work environment. The increase in the proposed funding will allow us to serve participants that have transportation barriers. East Hawaii communities have challenging transportation needs due to the limited number of transportation resources in the Hilo area. People living in less populous areas, outside of Hilo, have difficulty finding reliable, affordable transportation. Goodwill Industries of Hawaii proposes to assist participants in meeting their transportation needs through existing transportation resources, such as the Mass Transit Shared Ride Program and using the Goodwill van to transport participants to and from the program when necessary. Total Budget and Position Count Total Pro ram Bud et $29,500 Total Pro ram Position Count 2 Total A enc Bud et $1,862,500 Total A enc Position Count 65 * 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. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Goodwill Industries of Hawaii, Inc. Work Experience Program 7) Track work hours, daily or as scheduled to work. 8) Pay each participant semi-monthly, according to hours worked. 9) Conduct time study for each participant every six months. 10) Update wages according to productivity level. 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 12 participants in the Work Experience Program as of January, 2005. 2) In a random audit of program participants we found an average 22% increase in productivity for participants since their entry into the program. 3) Instructed participants in proper work techniques for each workstation. 4) Developed motivational skills and attitudes for success, self-confidence and problem solving skills for each participant. 5) Conducted time measurement study for each participant within 2 weeks from date of entry into program. 6) Reviewed outcome of time study with each participant upon completion of study. 7) Instructed and reinforced correct work procedures with each participant. 8) Tracked work hours, daily or as scheduled to work. 9) Paid participants on asemi-monthly basis, according to hours worked. 10) Conducted time study of each participant every six months. 11) Updated wages according to productivity level. 12) Developed workstation for textile processing to accommodate each participant. 13) Placed one individual in long-term outside competitive employment. Through participation in the work experience program, one participant has gained valuable job skills and has transitioned to outside employment. In the work experience program he learned how to take direction, follow through on his work NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 Goodwill Industries of Hawaii, Inc. Work Experience Program and how to work as a team. As he progressed in the program he demonstrated strong work ethic, attention to detail and positive attitude. His skills and attitudes were a match to a local floral firm. With the aid of a vocational counselor from one of our other programs he has been placed and is learning his new job. As a person with a disability and no job experience it would have been difficult for him to find competitive employment. Through the work experience program he was able to gain valuable job skills and find competitive employment. He is now working more hours and earning larger paychecks. He is saving money for his dental bills which are not covered by his insurance. He is also expanding his circle of friends through work, contributing to his household and saving to buy items of his choice. All of the participants in the Work Experience Program look forward to receiving a paycheck. Earning a paycheck provides them with opportunities to budget, save and make decisions on where and how to spend their money. The power of work allows participants to gain self-esteem and develop the following qualities that are important for job retention: • Confidence • Initiative • Willingness to learn • Desire to work • Cooperation • Attendance • Communication skills • Team play • Flexibility • Honesty • Respect for coworkers, workplace, and equipment Performance Measures FY 2003-04 FY 2004-05 FY 2005-06 Actual Bud et Estimate Work Ex erience Pro ram $10,000 $10,000 $29,500 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. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 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 2003-4, the Work Experience Program participants that were also enrolled in the Home & Community Based Services Program indicated a participant and advocate satisfaction rate of 93% in the categories of "Very Good" to "Excellent". Participant's comments included: I like my work. The staff and I learned a lot and accomplished my goals. • The Goodwill staff members have greatly helped T in her emotional growth and have helped her greatly to improve in her personal habits. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 7 Goodwill Industries of Hawaii, Inc. Work Experience Program Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 10,000 10,000 25,500 Professional Fees 0 O erations 0 E ui ment 3,000 Other* 1,000 Trans ortation Total 10,000 10,000 29,500 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Count of Hawaii Non Profit Grant 10,000 10,000 29,500 Goodwill Industries of Hawaii 3,186 3,000 3,000 State of Hawaii 318,866 320,000 330,000 Total 332,052 333,000 362,500 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 8 Goodwill Industries of Hawaii, Inc. Work Experience Program I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2-135 - 2-142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year-end report to the 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 aropram's or a enc 's future fundin re uests. ~ ~ l ignatur f Board resident/Chair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 9 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 Faz No.: (808) 935-9213 Email Address: gy_(a),interpac.net Amount of Request for County Funds: $220,000 Prior Year(s) Funding: 02-03 03-04 0405 $ 145,000 $ 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 ofanti-poverty programs in the community; Educating children and youth to become responsible contributing adults in society; and Assisting the poor to attain economic self-sufTiciency. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL TRANSPORTATION Program Description: The funding request is to continue to provide transportation for tazgeted groups of low- incomeelderly, 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 azea communities, low-income housing and pocket communities. Services are to and from the client's home, Monday through Friday, except holidays. Drop-off points aze specific service agencies and resource cemers, 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 Pr ram Bud et 834,519 Total Pr ram Position Count 28 Total A enc Bud et 6,631,488 Total A enc Position Count 175 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 a fleet of clean operable vehicles to ensure regulaz, dependable transportation for the targeted clients. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 HAWAII COUNTY ECONOMIC OPPORTUNTI'I' COUNCIL TRANSPORTATION Program Highlights: 1) Provided 836 disadvantaged elderly a total of 85,286 passenger trips in FY 2003-04, 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 283 disabled persons a total of 31,391 passenger trips in FY 2003-04, 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 393 disadvantaged pre-school children a total of 43,792 passenger trips in FY 2003-04, from home to Head Start Centers, to give them access to education activities. 4) Provided safe, injury free transportation services for the 1,512 disadvantaged elderly, disabled and pre-school persons transported to and from home and resource centers in the fiscal year July 2003 to June 2004 Performance Measures: FY 2003-04 FY 2004-OS FY 2005-06 Actual * Bud et * Estimate Trans rt Elderl to Resource Centers 836 800 800 Elderl Passen er Tri s 85,286 90,000 90,000 Trans rt Disabled to Resources 283 300 300 Disabled Passen er Tri s 31,391 35,000 35,000 Trans rtPce-school Children to Centers 393 350 350 Pre-school Children Passen er Tri s 43,792 40,000 40,000 Maintain Fleet of Buses Certified To 31 28 28 Trans rt Passen ers NONPROFTI' GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 HAWAII COUNTY ECONOMIC OPPORTUNTI'Y COUNCIL TRANSPORTATION Program Expenditures: FY 2003-04 FY 2004-OS FY 2005-06 _ Actual * Bud et * Estimate Salaries and Wa es 630,707 462,325 600,461 Professional Fees 4564 153,005 6,360 rations 268,589 219,708 227,698 ui ment 0 0 0 Other" Total 903,858 835,038 834,519 Program Funding Sources: Revenue Source FY 2003-04 FY 2004-OS FY 2005-06 Actual * Bud et * Estimate Coun of Hawaii - Re ar 145,000 220,000 Coun of Hawaii -Disabled 153 000 153,000 Coun of Hawaii -Nutrition 176,171 176,171 176,171 Federal - DHHS 123,348 123,670 123,348 State of Hawaii - OCS 92,197 92,197 92,000 State of Hawaii -Medicaid 53 320 70 000 70 000 Coun of Hawaii -Mass Transit 298,000 Coup of Hawaii -Grant 75,000 Total 743 036 835,038 834,519 NONPROFTT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCII, 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 - 2-142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. T 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 benefib 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 Board Presiders air Date OS Signature f Ex utiv Director Date UNSIGNED PROPOSALS Wll,L NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 Hawaii Island Adult Care, Inc. -Agency Name Hilo 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 Facility/Site Address: same as above Fax No.: 961-3740 Email Address: adltcare@gte.net Amount of Request for County Funds: $18,000.00 Prior Year(s) Funding: 02-03 03-04 04-05 $15,500.00 $15,500.00 $15,500.00 Agency Mission Statement: To advocate for the rights of frail elderly and disabled adults, and to assist them and their caregivers in maintaining their independence and dignity as active members in the life of the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page I Hawaii Island Adult Care, Inc. -Agency Name Hilo Adult Day center -Program Name Program Description: Hilo Adult Day Center provides a safe quality adult day program for frail elders and mentally/physically challenged adults needing supervised daytime care. Total Budget and Position Count Total Pro ram Bud et 847,000.00 Total Pro ram Position Count 21 Total A enc Bud et 1,038,000.00 Total A enc Position Count 36 Program Objectives: 1) Provide a safe, caring, daytime environment for frail elders, and mentally/physically challenged adults including those with Alzheimer's disease; all of whom can no longer take full care of themselves, many are under doctors' orders not to be left at home alone. 2) Provide interaction/socialization with others, hand-on activities, excursions, music club and karaoke, celebrations all year long 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) Provide the opportunity for 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 to continue their employment while caring for their frail and physically/mentally challenged elders in the evenings and weekends. 7) Provide adult day care to all needy individuals regardless their ability to pay, by utilizing federal, state, county and private foundation scholarship funding. Program Highlights: 1) Provided day care services to 132 individuals having varied physical or mental limitations throughout the year. June 2004 ended with 88 enrolled. 2) Enrolled new participants, 44; discharged, 36; attending full year, 66. Nine passed away while clients and living at home. (This is the ultimate goal for our clients, to move on from this life while still living at home). NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 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 2004 for two years), in October 2003 completed 27 years of adult day center services to the community. 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, received adequate support to take care of everyone needing to attend the adult day center. 6) Continued the Caregiver Support group to twice a month for community caregivers. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Hawaii Island Adult Care, Inc. -Agency Name Hilo Adult day center -Program Name Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Avera e month) attendance 90 92 92 All fi ures are totals fo the ear: Participants enjoyment of life, 130 135 136 maintain or improve personal care/h iene Participants continue to live in own 110 115 116 homes 22 in care homes Families /caregivers able to 100 105 106 continue em to ment Families/caregivers receiving 110 115 116 res ite Participants continue to attend after 107 109 110 6 months Partici ants continuin after 1 ear 80 82 82 Partici ants continuin after 2 ears 59 59 59 Partici ants continuin after 5 ears 16 17 17 Medicaid monies saved on $1,068,480 $1,086,480 $1,068,480 participants attending day care (14 persons (14 persons) (14 persons) versus those living in long term care were institution (based on clients dishchared discharged into long term care in long term Burin the ear. care 'If applicable Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 493,661.00 512,311.00 515,000.00 Professional Fees 12,057.00 12,700.00 13,000.00 O erations 169,020.00 162,787.00 165,500.00 E ui ment 17,616.00 5,400.00 5,000.00 Other* 149,010.00 148,500.00 148,500.00 Total 841,364.00 841,698.00 847,000.00 *Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Hawaii Island Adult Care, Inc. -Agency Name Hiio Adult Day center -Program Name Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Tuition/Fees 416,370.00 421,150.00 422,000.00 State- DHS and Nurisng Home 145,812.00 152,648.00 152,000.00 without Walls Federal-Nursing Home w/o Walls 44,278.00 47,500.00 48,000.00 and Ku una Care Count of Hawaii 15,500.00 15,500.00 18,000.00 Hawaii Island United Wa 16,500.00 16,500.00 16,500.00 Ma Tem leton Ho er Fund 65,718.00 65,000.00 65,000.00 Mclnerny/Gwenfread Allen/Charity 78,804.00 62,000.00 62,000.00 Walk/Friends of Hawaii/other rants Donations 13,024.00 11,400.00 13,000.00 USDA Lunch program 33,647.00 38,000.00 35,000.00 reimbursement PIN rant mans ement 4,000.00 2,500.00 3,500.00 Fundraising/interest/vending 1,422.00 9,500.00 12,000.00 machines/misc. sales Total 835,075.00 841,698.00 847,000.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 Hawaii Island Adult Care, Inc. -Agency Name Hilo Adult Day 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 aaency's future funding requests. ~ . c2 ~ Zo O~ Signat re of Board Presiden air Date Soar.. Ito ~ acu Signature of cutive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 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 Dr. #5, Kailua-Kona, HI 96740 Facility/Site Address: 16-204 Melekahiwa PI. #1, Kea'au, HI 96749 Fax No.: 808-982-8802 or 808-331-0762 Email Address: georgie@hihaf.org Amount of Request for County funds: $10000.00 Prior Year Funding: 02-03 03-04 04-05 $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)tsx-exempt non- profit organizations to provide care services for People Living With HIV/AIDS NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page I (PLWHA), and to provide HIV prevention and education of the residents of Hawaii County. Required Checklist Forms 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 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 Kea'au office as "HIV Foundation -Hilo". As reported by the Hawaii State Department of Health, Hawaii County has the second highest rate of AIDS cases in the State, with a reporting rate of 12.4 per 100,000 population. (The state overall has 9.6 cases per 100,000 population; only Maui County has a higher rate, with 12.8 per 100,000.) A total of 13% of all cases reported in the state since the beginning of the epidemic come from the Island of Hawaii. Only Oahu has a higher percentage. 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 90 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 public 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 2005-2006. We have been informed that, for the first time, the State of Hawaii Department of Health will be cutting the amount of money allocated to HIV/AIDS case management services on all islands. This is reflected in our Program Expenditures and Program Funding Sources tables. We will do our very best, as ever, to continue to provide the highest quality of services to our clients, regardless of the decrease in funding available to us. 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 this year is ninety-three (93) clients. Thirty-eight percent (38%) of the HIV Foundation - Hilo's clients are homeless, multiply diagnosed, drug misusers and/or mentally ill. Eighty-two percent (82%) fall into two or more special population categories as defined by the federal Ryan White CARE Act Title II. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 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 food bank, food deliveries, transportation volunteers and clerical services. The Executive Director provides program administrative oversight and program supervision for care staff, quarterly reports to all funders, 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. Each written service plan is developed cooperatively by the case manager with the client. 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 FY2005-2006 grant period. Primary HIV prevention is based upon a 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 provided by the State of Hawaii (The Reggie 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 FY2005-2006 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. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 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 "$1,287,540 Total A enc Position Count 17 "Total Agency Budget now reflects combined Kona and Hilo budgets. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Hawaii Island HIV/AIDS Foundation - AgellCy Name Multi-Disciplinary HIV Case Management, Hilo -Program Name Program Objectives: 1) Objective One: By June 30, 2006, 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, 2006 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, 2006 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, 2006 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 assessmentcounseling Client family counseling Progressive case notes Crisis intervention Field /office visits Health care assessmenUcounseling 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 Mental health assessmenUcounseling NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 Nutritional assessment/counseling Client monitoring/assessment Risk assessment/counseling 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 2005-2006. 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 2004-2005 include: 1. To date during FY 2004-2005, medical case management services included ninety-three (93) clients receiving of medical assessment, patient education, treatment advice, nutrition, medical liaison, dental liaison. In addition, clients received $32,800.36 in financial assistance for medical and dental care services through the Ryan White CARE Act funds, among others. 2. Over the past eight years, seven (7) HIV positive families have birthed eight 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 2005, all except three clients are receiving the highest quality primary medical care; those three are accessing the best available medical care through public health clinics. Performance Measures: NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Number of types of case 21 23 23 mana ement services rovided Number of clients receiving case 93 100 100 mana ement services Risk Behavior Assessment, 250 250 250 Counselin and Education HIV Counselin and Testin 65 65 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 7 Hawaii Island HIV/AIDS Foundation - AgerlCy Name Multi-Disciplinary HIV Case Management, Hilo -Program Name Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es $189,823 $189,891 $163,538 Professional Fees $2,500 $3,000 $3,000 O erations $125,008 $125,000 $117,000 E ui ment 0 0 0 Other* 0 0 0 Total $317,331.00 $317,891.00 $283,538.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Count of Hawaii 10000.00 10000.00 10000.00 De artment of Health, Title II 192808.00 192808.00 170808.00 AIDS Communit Care Team 74635.00 74635.00 52230.00 Medicaid Waiver 11608.00 13293.00 11000.00 United Wa 5000.00 5000.00 5000.00 Housing -Special Projects of 6000.00 6000.00 5000.00 National Si nificance Private Foundations 10000.00 10000.00 20000.00 Donations/Fundraisin 7280.00 7280.00 9500.00 Total $317,331 $319,016 $283,538 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 8 Hawaii Island HIV/AIDS Foundation - AgerlCy Name 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 report may impact the evaluation of your program's or agency's future funding requests. til ,~-<-t~ ~ ~Q ~ Si ature of Board residenUChair Date ~ / O.5`~ Signatu o E ecutive re for Dat UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 9 Hawaii Island HIV/AIDS Foundation - AgeC1Cy Name Transmission Prevention for HIV+ Women in West Hawaii County - PI'Ogl'am 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@hihaf.org Amount of Request for County funds: $15000.00 Prior Year Funding: 02-03 03-04 04-05 $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- profitorganizations to provide care services for People Living With HIV/AIDS NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page I (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. As reported by the Hawaii State Department of Health, Hawaii County has the second highest rate of AIDS cases in the State, with a reporting rate of 12.4 per 100,000 population. (The state overall has 9.6 cases per 100,000 population; only Maui County has a higher rate, with 12.8 per 100,000.) A total of 13% of all cases reported in the state since the beginning of the epidemic come from the Island of Hawaii. Only Oahu has a higher percentage. The need for support for prevention programming on the Big Island is clear. This 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. We have been informed that, for the first time, the State of Hawaii Department of Health will be cutting the amount of money allocated to HIV/AIDS prevention services on all islands. This is reflected in our Program Expenditures and Program Funding Sources tables. We will do our very best, as ever, to continue to provide the highest quality of services to our clients, regardless of the decrease in funding available to us. Total Budget and Position Count Total Pro ram Bud et $39,192 Total Pro ram Position Count 2.5 Total A enc Bud et *$1,287,540 Total A enc Position Count 17 * Total Agency Budget now reflects combined Kona and Hilo budgets. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 Hawaii Island HIV/AIDS Foundation - AgerlCy 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, andlor initiate new transmission prevention plan for newly infected women. (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 (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). 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 twelve (12) women (meeting goal) during first half of the funding year. 2) Referred women to specialized care for health and/or prevention issues during first half of the funding year. 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 have reported 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 have reported compliance 90% of the time to date with the goal of 100% compliance by the end of the year. 7) Ninety-eight (98%) percent of participants are documented to have benefited from the program by maintenance of good health, increased self-esteem, and ability to interact with sexual partners in a safe manner, thereby decreasing the probability of sexual transmission. 8) As of month seven (January 2005), zero transmission of HIV by any participants in the program. No hospitalizations, stable health, and maintenance of emploment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 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. For purposes of this chart, the individual transmission prevention session count includes all counseling sessions, for both males and females. FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Individual transmission prevention 248 250 250 session assessment session Health/prevention plan review 28 48 48 uarterl Quarterly individual transmission 32 48 48 revention sessions 1 hr. each Review and documentation of 32 48 48 ro ram quarter) *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Hawaii Island HIV/AIDS Foundation - AgeilCy Name Transmission Prevention for HIV+ Women in West Hawaii County - PfOgCam Name Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 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 Equipment 0 0 0 Other* Program 3,000 4,000 4,000 Ex enses Total 38,192 39,192 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 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate State of Hawaii Prevention, 33% 15,192 15,192 12,500 Women onl Hawaii Communit Foundation 3,000 0 0 Fundraisin 5,000 7,000 7,000 Count of Hawaii 15,000 15,000 15,000 Mac 's 0 2,000 0 CDC Com lementa Prevention 0 0 4692 Total 38,192 39,192 39,192 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 Hawaii Island HIV/AIDS Foundation - AgetlCy Name Transmission Prevention for HIV+ Women in West Hawaii County - PI'Ogram 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. / _ 9 ~ ` nature of Board Presi nt/Chair Date /y o.s Signatur xecuti a irector Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 Hawaii's Volcano Circus- Agency Name Puna Performing Arts Festival 2005 -Program Name Agency Director: Graham Ellis Phone No.: 965-8756 Contact Person: Graham Ellis Phone No.: 965-8756 Mailing Address: RR2 Box 4524, Pahoa, Hi 96778 Facility/Site Address: "Bellyacres" Seaview Estates, Kehena, Puna Fax No.: 965-8756 Email Address: graham@hiccupcircus.com Amount of Request for County Funds: $$30,000 Prior Year(s) Funding: 02-03 03-04 04-05 $0 $0 $0 Agency Mission Statement: to promote the healthy development of children and communities on the Big Island using performance and circus arts NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 PROP 1 Hawaii's volcano circus -Agency Name Puna Performing Arts Festival 2005- Program Name Program Description: In 2002 and 2004 HVC led a collaboration of Puna organizations that organized two series of performance arts workshops and performances that were so overwhelmingly successful that we decided to make them annual Festival events. Between June -November 2005 HVC will be the lead organization in the third collaboration involving 6 Community Associations and students from 5 Schools. The leadership team will organize 70 two hour pertbrmance arts workshops in Hawaiian Paradise Park, Pahoa town, Nanawale, Kapoho, Kehena and Leilani involving over 250 youth and adults. These free public classes will he held aHer school and at weekends. They will blend traditions from China, Hawaii, Africa, Europe and North America in the arts of music, dance, drama and circus. Professional performing arts experts will be hired to teach the classes and produce the shows. Community volunteers will be recruited to assist with classes and the production of two large scale performances scheduled for November 18'/19'" 2005. The shows that culminate the Festival will be widely advertised, usinK local media, magazines and posters. The 90 minute 'spectacular' production written by our locally hired director will include theater quality stage, sound and lighting facilities in celebration of the largest community project of its kind in the Puna District and probably the Big [stand. Total Budget and Position Count Total Program Budget 79 422 Total Program Position Count 32 part time - - - Total Agency Budget II t3u,~0u"I Total Agency Position Count 132 part _ _ -1- - I _ 1 _ time ) Program Objectives: 1. To raise an awareness to the rich cultural backgrounds of the people of Hawaii and to preserve and practice the ethnic performance arts of the Puna District. 2. To support the education and development of performance arts skills in Puna 3. To enhance the employment of local artists. 4 Tn build social networks between individuals, community organizations and schools. 5. To build the organizational capacity and infrastructure in community groups for the establishment of ongoing year round cultural activity programs for community members. 6. "fo improve the quality of entertainment attractions and performance arts education programs in the District of Puna. 7. To increase the number of youth and adults interacting in local cultural events that demonstrate the islands cultural diversity. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 PARP Z Program Highlights from 2004: I . 175 children and adults from 11 community rg ouas participated fully. 2. HVC's community pro art, am expanded it's collaborations to include 1) Hawaii Paradise Park Owners Association, 2) Nanawale Community Assxiation, 3) Scavicw Estates Community Assxiation, 4) Leilani Community Assxiation, 5) Kapoho Community Association 6) Pahoa Elementary School, 7) the Hawaii Academy For Arts and Science Charter School, 8) Malamalama Waldorf School, 9) Kua O Ka I,a Charter School, 10) Pahoa Int. and High School 11) Shady Grove Home School. 3 Recruitment of new program vnlupteers is leading to greater participation of parents and adults in community events 4. Each of the collaborating community croups is totally committed to annual participation in our future HICCUP community events. 5. This program established a precedent for community use of the Leilani Community Center facility which the Board is hoping to expand. 6. Greater organizational capacity at HVC and the broader community for activities resulting from staff training, infrastructure, equipment and facility improvements. 7. Graham Ellis_ HVC's L:xecutive Director successfully completed the Hawaii Community Foundation's PONO leadership training program and was appointed Chair of the Pahoa Weed and Seed Youth Development Committee. 8. Production of a first class full length video and a six minute promo video through a new collaboration between two local amateur videographers 9. Original music score by Ixal musicians involving a new collaboration between members of a local band and a nationally renown marimba band leader. 10. Participation by students from ei~~ht different schools 11. Ages oTprojeet participants ranging from d years old to 7~ years of age 12. Students from isolated rural areas attended 70 performance arts worksh~s 13. 'Three environmental rg_ouns distributed educational information. 14. Project grantwriters obtained new sources of funding to continue this effort 15. Donations of $3000 in cash and services from local businesses expressly in recognition of the benefits gained by lacal ~ oath durng tlic course of the project 16. David 'Thompson from Hana Ho mal azine attended our show to write a story. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 PROP Z Hawaii's Volcano circus -Agency Name PUNA PERFORMING ARTS FESTIVAL 2005 - PPOgfAl11 N8111@ Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 _ Actual * Bud et * Estimate # of youth and adults participating in 175 250 300 performing arts workshops__ _ _ _ # of performance arts workshops 70 70 92 in 5 different locations _ # of high school students trained 8 15 25 and involved in back stage skills _ # of undergraduate students 3 6 12 involved in back stage work trainin # of senior and adult volunteers 25 40 50 help with costumes, props and sets - #ofaudience members 1,100 _ _1,200 _ 1,800 _ _ # of local arts instructors, 28 32 40 performers and workers hired _ _ Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * _ Budget * Estimate - Salaries and Wa es_ _ _ __27,714 _ _ _31,000 _ 36,000 Professional Fees 4,500 5,000 6,500 Operations ii,230 13,OOu 16,200 E ui ment 6,351 7,000 10„500 Publicit & Printing _ _ 3,305_ _ 3,870 _ _ 5,000 Total 53,100 59,870 74.200 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-OG PA4P Q Hawaii's Volcano circus -Agency Name PUNA PERFORMING ARTS FESTIVAL 2005 - Pt'OgI'atll N8f11@ Program Funding Sources - Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 _ _ Actual * ~ Bud et * Estimate Hawaii Community Foundation 20,000 0 10,000 "Mo_Bettah Together' grant National Endowment for the Arts 25,000 _ 10,000 10,000 Young Bros Grant _ _ _ 500 500 _ _ 500 - Village Green Society 1,000 2,500 5,000 _Proe~ ctAWARE Foundation 1,000 0 0 _ _ - - Hawaii County -Product 0 10,000 10,000 Enrichment Program Local busines_s__ 1,500 1,5_00 _ 2,000__ - q 600 4,500. 5,500 . Ticket sales C ceno ssion Sales 500 870 1,200 f-__ - _ - - - H_awaii_Coun Non Profit Grant 0 _ 30,000 _ 30,000 I4 - _ - Total ~ _ 53,100 ~ _59 870 74,200 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 PROP S Hawaii's volcano circus -Agency Name Puna Performing Arts Festival 2005 -Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2-135 - 2-142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year-end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely. complete. and accurate vear-end resort may imaact the evaluation of your arogram's or agency's future funding requests. ' ~ Signature sidentlChair Date I 2~ 2: ~ S Signature of Executive Director D2 A UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 PROP Total Program Budget: Puna Performing Arts Festival EXPENSES CASH IN KIND Project Director (6 months half time salary incl. FICA) 8,000 Community Program Dir. 4,500 Performing Arts Instructors 6,000 Show Director 3,000 Set DesigneriBuilder 3,600 Costume Designer 2,000 Musical Director & musicians 2,500 Video Coordinator 1 (100 Sound Engineer 1,000 Lighting DesignedEnbincer 1,000 Stage Manager 600 Publicity 2,250 1,000 Workshop assistants 6 x 84 hrs ~ 8/hr 4,032 Set and prop construction 60 x 12 hrs @ $8 5,760 Stage Crew for Rehearsals and Shows 15 x 48 hrs (a~ $8 5.760 facility Rentals 800 3,000 Transportation(4,000 miles (a~ .58/mile) 2,320 Otlice Supplies 1,200 500 Staging rentalsiYrops 1,00 Lighting rentals 1,200 Sound Equipment rentals 1,200 Workshop Equipment Rentals 3,500 Video and supplies 1,500 Show Custutiies materials ant supplies i,5OO Administrative Overhead 8,000 Insurance lone year event policy 5Z million) 8UU Subtotal 59,370 20,052 TOTAL, EXPENSES (Combined Cash & In kind) 79.422 INCOMF. Hawaii County Tourist Product Enrichment Grant (approved) 10,000 Village Green Society (approved) 2,500 National Endowment for the Arts (pending) 10,000 Donated services and materials 20,05'_' Ticket Sales 4,500 Concession and Merchandising g70 Fundraising -local businesses 1,500 Hawaii ('ounty Non-protit Grant 30.000 TOTAL INCOME 79.422 9 HUI OHINAWA CHILDREN'S CULTURAL DAY CAMP Agency Director: Carolyn Oki, President Phone No.: 935-3518 Contact Person: Alben Namihira, Treasurer Phone No.: 961-3443 Mailing Address: P. O. Box 1793 Hilo, HI 96721-1793 Facility/Site Address: c/o Namihira and Yokoyama 191 Hualalai St. Hilo, H[ 96720 Fax No.: 935-0338 E-mail Address: alnamihi@lava.net Amount of Request for County Funds: $3,680* Prior Year(s) Funding: 02-03 03-04 04-OS $ None $ None $ None Agency Mission Statement: To promote, preserve, and perpetuate the Okinawan culture at a local, state, and international level. Also, to promote educational, charitable, and benevolent causes and to render service to the local, state, and international community. *See page 1-A for details NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 HUI OKINAWA OKINAWAN CULTURAL DAY CAMP Attachment is Explanation of Funding Request of $3,680 A. Resource persons from Oahu and/or Maui (Certificated Instructors) Airfare for 3 round trips @ $200 each $600 Car, Gas, Insurance for 5 days 500 Per Diem @ $120/day, 8 days (2 trips) 960 Instructor's Fees 500 $2560 $2560 B. 50% of "In-Kind" Donations including Okinawan 1000 fabrics, Okinawan craft and game supplies, Okinawan food items and costumes. C. Two scholarships for needy students 120 Total $3,680 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1-A HUI OKINAWA OKINAWAN CULTURAL DAY CAMP Program Description: The Children's Cultural Day Camp, a week long cultural learning experience, has been held in Hilo for the past three summers. June, 2005, will be the fourth year that this program, sponsored by Hui Okinawa, Hawaii United Okinawa Association, and supported by the State Foundation of Culture and Arts (SFCA), will introduce forty youngsters between the ages of 8 and 13 to Okinawan culture and arts. Classes in Okinawan songs and dances, language and history, karate and taiko, crafts, games and cooking are designed to provide a fun learning experience for the participants. Plantation Days activities such as old fashioned bamboo pole fishing and marble games are also part of their learning experiences. There is no other organized Okinawan or Japanese cultural educational program such as this in East Hawaii. The SFCA has supported the Hilo and North Hawaii programs by covering costs of artists from Oahu and Maui to train our staff and to provide professional instruction in dance, odaiko drumming, and raku pottery. These instructors are not available in our community. Current SFCA fundin¢ will terminate in the summer of 2005. It is the purpose of our organization to preserve, promote and perpetuate the Okinawan culture. The Children's Cultural Day Camp is a vital avenue to introduce and instill an appreciation of these cultural lessons. Noteworthy, is that enrollment of students is not limited by ethnicity. Total Budget and Position Count Total Pro ram Bud et $8,000 Total Pro ram Position Count 3 Total A enc Bud et $30,000 Total A enc Position Count 0 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2-A HUI OKINAWA CHILDREN'S CULTURAL DAY CAMP Program Objectives: 1. Introduce and inspire children, ages 8 to 13, to various aspects of Okinawan culture and arts. 2. Introduce "Plantation Days" values and activities which may otherwise be lost . 3. Build an intergenerational fellowship between the children, youth leaders, and volunteers in their sixties, seventies, and eighties. Program Highlights: 1. Varied areas of study including Uchinaguchi (Okinawan Language) History and Story Telling, Okinawan Eisa Dancing and Odaiko or Paranku Drumming, Taiko, Okinawan Cooking, Singing, Craft Projects, Karate, Plantation Games, Pottery, and Writing. Instructors are volunteers from the community with the exception of professional dance and/or pottery senseis from Oahu or Maui. 2. Program evaluation by the children indicated an average of 84% rated the activities good or excellent. Okinawan Eisa Dancing with Odaiko Drumming, Okinawan cooking, Taiko, and Crafts/Games were rated as excellent activities. Some of the student's comments were: "best one ever", "please add more fishing, outdoor games, story telling", "make it longer...two weeks or a month","I wish I was Okinawan". 3. Student participation grew from 30 to 40 with a waiting list. A total of 110 children have participated in the Cultural Camp since it's inception. 30% of the children have attended two or all three summer sessions. 4. A few children have gone on to further their cultural skills by joining the Hui Okinawa Kobudo Taiko group, looking into possible dance groups to join, participating in Hui Okinawa's Bonen Kai and Autumn Festival with their dance routine. 5. Entire staff numbering over seventy individuals are volunteers. This translates into over 2000 "man"-hours of voluntary service. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2-B 13UI OKINAWA OKINAWAN CULTURAL DAY CAMP Performance Measures: FY 2003-04 FY 2004-OS FY 2005-06 Actual * Bud et* Estimate Cam ro'ects and activities $7,026 $7,180 $8,000 *If applicable Program Expenditures FY 2003-04 FY2004-05 FY 2005-06 Actual* Bud et* Estimate Salaries and Wa es - - - Professional Fees 220 250 500 O erations 6,806 6,930 7,500 E ui ment - - - Other Total $7,026 $'7,180 $8,000 *Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 HUI OKINAWA CHILDREN'S DAY CAMP Program Funding Sources Revenue Source FY 2003-04 FY 2004-OS FY 2005-06 Actual* Bud et* Estimate Cam Fees 2197 2230 2230 Scholarshi 60 120 T-Shirts, reimbursed 435 450 450 Cam Photos, reimbursed 262 250 250 Awards Donations 195 100 390 In-Kind Goods 1905 2230 1000 Grant 1787 1800 3680 Total $6,841 $7,180 $8000 * If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 HUI OKINAWA CHILDREN'S CULTURAL DAY CAMP 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 programs or aeencv's future fundin¢ requests. ~~~D -t~S Signature of B d PresidenUChair Date Signature of~e Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFTT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 The Island of Hawaii YMCA - Ag@t1Cy N8CT1@ Ku'ikahi Mediation Center - PCOgfctftl 1~8f11@ Agency Director: Patrick Fitzgerald(acting) Phone No.: 808/885-5034 Contact Person: Diana Hollingsworth Phone No.: 935-7844 Mailing Address: P.O. Box 7067, Kamuela, HI 96743 Facility/Site Address: 614 Kilauea Ave. Ste 5A, Hilo, HI 96720 Fax No.: 808/887-1861 Email Address: mediation777@verizon.net Amount of Request for County Funds: $10000.00 Prior Year(s) Funding: 02-03 03-04 04-05 $5000.00 $5000.00 $4000.00 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. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 The Island of Hawaii YMCA - Ag@I1Cy N81T1@ Ku'ikahi Mediation Center - P~OgI'alll N8111@ 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 continues its services to individuals and families involved in civil restraining orders, assisting new and previous county residents in peacefully resolving disputes. The successful resolution of these cases has also reduced the number of calls requiring police response and frequently motivates clients to withdraw or otherwise mitigate previously filed reports. Total Budget and Position Count Total Pro ram Bud et 64451.00 Total Pro ram Position Count 2 Total A ency Bud et 2728538.00 Total A enc Position Count 280 Program Objectives: 1) Provide quality mediation and facilitation services to 700 individuals in Program Year 2005-6. 2) Re-establish and increase mediatorffacilitator pool to 70 or more in PY 2005-6. 3) Implement data analysis improvements to better quantify direct community impacts resulting from mediation in East Hawaii. 4) Collaborate with Prosecutor's Office, Police Department, Planning Department and others to ensure continuation of informed and appropriate referrals to mediation; thereby assisting in more efficient use of county resources. 5) Ensure that at least 80% of clients served in PY 2005-6 are satisfied with the mediation/facilitation services received. Program Highlights: 1) Provided mediation services in 299 cases. This was an increase in total case numbers from the previous year despite a temporary decrease in civil referrals, addressed and restored by a new administrative judge. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 2) Finalized collaboration with several community association boards in anticipation of implementing the Hawaii Community Foundation grant providing these with facilitation training; the goal being to increase the capacity of such organizations, especially in Puna District, to conduct their meetings more peaceably and increase participation of their members in response to changing community demographics and needs. 3) Resulted in 3 faciliation workshops provided for Hawaiian Paradise Park, a large agriculturally zoned subdivision in Puna. 4) Utilized 54 trained volunteer mediators in 190 sessions to resolve disputes with 797 volunteer mediator contact hours in session.for PY 2003-4. 5) Achieved rate of 103 client survey responses, indicating 90°h of those clients would recommend the mediation process to others. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 me Island of Hawaii YMCA -Agency Name Ku'ikahi Mediation center -Program Name Perrormance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Number of cases o ened 299 300 350 Number of mediators 54 45 70 Number of cases received from the 07 10 35 Prosecutin Attorne 's Office Outcomes achieved for community 1 3 N/A skill buildin pro"ect 1 r rant) Percents a of satisfied clients 85% 85% 85°~ *If applicable Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Budget * Estimate Salaries and Wa es 64637.00 44966.00 40056.00 Professional Fees 0.00 0.00 0.00 0 erations 173590.00 18558.00 21395.00 E ui ment 0.00 0.00 0.00 Other* Total 81996.00 63524.00 64451.00 *P/ease explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 The Island of Hawaii YMCA - ~1g@flCy I~8f11@ Ku'ikahi Mediation Center - PfO9Paf71 Name Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Count of Hawaii 5000.00 4000.00 4000.00 Judicia ,State of Hawaii 48996.00 50424.00 51851.00 Pro ram Service Fees 6000.00 6000.00 6000.00 Foundations 22000.00 2000.00 2000.00 Donations 0.00 500.00 600.00 YMCA Total 81996.00 63524.00 64451.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 _ The Island of Hawa?i vMCA -Agency Name ~ ICu'ilcahi Mediation Center -Program Name I (we) have reed and understood alt of the eligibility requirements; grant ponditions; award procedures; and records, reporting and fiscal arxountabiliCy requirements as mandated in Artide 25, Sediona 2-135 - 2-142.2, Hawaii , Couniy Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that l(ore) have Hie authority and ability to fully administer the program(s) pursuant to law. 1 (we) understand that information supplied herein shall be made public eoCOrding to Chapter 92F, Hawaii Revised Statutes. N awarded a grant from eha County o1 Hawai`i,1(ws} urrderotand and will comply with the roqulrement to submit a yearend report to the t.sgislatlva auditor within EO days after Juror 30 of the fiscal year. The wport shall Include an sxplarratlon o< tho public benefits derived from tM awardirpl of the grant, a wmpbts accounting of all oxpsndituros supported by Courtly of Hawaii grant funds. and a listing of oMror funding sourros and amounba obfainsd during the award period. Failure to submit a timely. COrrrolete, and aceurato vwr-end re_owt may inmact ttw evaluation of your orooraat's Qr aasncv's futuro iunr~irrn rsaussts. i ~ ~ I-oS Signature of Bo Presi nVChair Date i /-3/ ~.5' Signet 6ceCUtive Director Date I ~SICNF~Qp~,~AL3 tNll.t. NOT BE ACCEPTEDt I i NONPROFIT GRANT APPLICATION FISCAL YEAS 20e5-06 Pt+ge 6 - 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.: 775-9870 Email Address: gso@kona.net Amount of Request for County Funds: $3500.00 Prior Year(s) Funding: 02-03 03-04 04-05 $2000.00 $2000.00 $2500.00 Agency Mission Statement: At Ka Hale O Na Keiki it is our mission to help children develop a lifelong love of learning through a program that encourages freedom, individualism, and creativity. Our carefully prepared environment provides children with an opportunity to explore their surroundings, challenge their thoughts, and enjoy and love the people and world around them. Through a positive interaction among the children's developmental characteristics, their school, practices, family, and community, children will be ready to have successful learning experiences that will last throughout their lifeftime. Above all, our children come first. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 KA HALE O NA KEIKI, INC. -Agency Name Families-At-Risk Project - PrOgfam Name Program Description: 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. 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 Families-At-Risk Project gives the County of Hawaii the opportunity to fulfill the intent of Article 25 by giving support to the education and care of our County's most needy: the families of the working-poor on the Hamakua Coast. The Families-At-Risk 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 house of 230 pm to 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. As Chapter 25 recognizes, Education is the key to our County's success. 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 learn. 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, 12/19101). 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 preventative action now, and intervene at the preschool-age level, rather than simply spend money and time on rehabilitation later on. The Hamakua Coast is a greatly under-served area of our County. The closest HeadStart program is over 45 miles away, as is the closest State Financial Assistance office for family childcare supplements. 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. County 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. These families are likely NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 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. It is imperative that we remain open at least 10 hours per day, and operate year round; otherwise working parents would have nowhere to send their young children for a quality education and care while gone from home. Most preschools are not open more than eight hours per day because a second qualified teaching 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, if our Families-At-Risk Project was not available. The Hawaii County's 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. We are doing everything possible to obtain outside funds to support this critical project, but we need the County's continuing help. 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 Budget 28500.00 Total Program Position Count 4 Total Agency Budget 174196.00 Total Agency Position Count 8 ~ 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) Provide monthly scholarship/tuition assistance to at-risk families. 4) Pursue other funding sources for the Families-at-Risk Project, to insure that the Project, and the school, will prevail. 5) Maintain a developmentally appropriate learning environment among all students, ensuring progress in social, emotional, cognitive, language, and physical development. 6) 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. 7) Increase the parenting skills, and understanding of the educational and developmental needs of children of the at-risk parents we serve. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Program Highlights: 1) Provided a developmentally appropriate, high~uality childcare and educational facility to the working poor of the Hamakua Coast, 2) Remained open for the working families until 5:30 pm daily, including during holiday breaks and Summer. 3) Provided three jobs in our local community, in order to operate the Families-At-Risk Project. 4) Offered scholarship/tuition assistance to sixteen families using the Families-At-Risk Project, an increase by three from last year. 5) Succeeded in keeking our budget for the Project low and within reason, while being able to increase our services. 6) NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 KA HALE O NA KEIKI, INC. -Agency Name Families-at-Risk Project -Program Name Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Total Enrollment 29 32 36 Students Enrolled 2:30-5:30 17 18 26 Families-At-Risk Project Families receiving financial 16 17 23 assistance from Ka Hale O Na Keiki for the 2:30-5:30pm, Families-At- Risk Pro~ect *If applicable Program Expenditures FY 2003-04 FY 2004-05 Flt 2005-06 Actual * Budget * Estimate Salaries and Wa es 11025.00 13750.00 18000.00 Professional Fees 850.00 1200.00 900.00 O erations 6000.00 7500.00 7500.00 E ui ment 500.00 1200.00 2100.00 Other* Total 18375.00 23650.00 28500.00 "Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 KA HALE O NA KEIKI, INC. -Agency Name Families-At-Risk Project -Program Name Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual ` Bud et * Estimate Payment from families for afternoon 9684.00 10000.00 13000.00 ro ram Count of Hawaii Grant 2000.00 2500.00 3500.00 Youn Brothers Grant 0.00 1000.00 1000.00 Friends of Hawaii Charities Grant 0.00 0.00 1000.00 endin ) Kosasa Foundation Grant endin 0.00 0.00 10000.00 Day Program payment from 6191.00 10150.00 0.00 families, portion allocated to Families-At-Risk afternoon program Total 18375.00 23650.00 28500.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 KA HALE 0 NA KEIKI, INC. -Agency Name Families-At-Risk -Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2-135 - 2-142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, 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 aaencv's future funding requests. ~ C nature of Board President/Chair Date ~ Signature of Execut evi Dii`ector Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 7 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 (Honolulu) Email Address: kcpcmiwCo?hawaii.rr.com (Kona) i~ivii~iiiuihaUiJibiu.viu (Honolulu) Amount of Request for County funds: $20,000 Prior Year Funding: 02-03 03-04 04-05 $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 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 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 Description: The Title IV-B Counseling and Supportive Living Project provides assessment, counseling, service linkage and coordination, educational and supportive services to assist West Hawaii families at risk of child abuse and neglect. Priority for services is given to families at risk due to substance abuse (80% of referrals). Special priority is given to families who have or are in the process of adopting or otherwise providing a permanent home for children who have been harmed. Services are provided by KCPC staff and by staff of other organizations through subcontracts with KCPC. The array of services includes, crisis intervention, individual, couple and family counseling, anger management counseling and classes, substance abuse counseling, parenting and life skills education, assistance with supportive living and other adjunct supportive services as needed by family members. 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 $414,000 Total Pro ram Position Count 7 Total A enc Bud et $562,500 Total A enc Position Count 7 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 204 families - 430 adults and 478 children. 2) Provided services to 25 permanency families 3) Completed all services -71.6% of individuals served. 4) Reduced CA/N risks - 65% of caregivers who completed services. 5) Increased Protective Factors - 69% of caregivers who completed services. 6) Had no new CPS report during services - 98.9% of families served. 7) Had no new CPS report within 6 months after case closure - 95.5% of families who completed services. 8) Had no new CPS report within 1 year after case closure - 95.8% of families who completed services NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center-West Hawaii Title IV-B-West HI Counseling & Supportive Living Project Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual' Bud et' Estimate Families completing service plan that have g8.g% 90% '*N/A no new report of child abuse or neglect Burin ro ram services. 71.6% 85% 80% Individuals Com letin Service Plan Caregivers completing service plan who have $1.0% 85% 85% develo ed a radical Child Safe Plan. Caregivers completing Service Plan whose 65.0% 85% "N/A Child Safety Protective Factors have increased Caregivers completing Service Plan whose 69.0% 85% "N/A Child Safe Risk Factors have decreased. Families completing Service Plan who have 95.5% 85% 90% no new confirmed report of child abuse or ne lect at 6-month follow-u Families completing Service Plan who have g5,8% 85% 95% no new confirmed report of child abuse or n lect at 1 ear follow-u Permanent families without placement 77.$% 90% "N/A disru lion Burin the service eriod ~ `If applicable '"Discontinued by DHS-CWS as outcome indicators for next contract period NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 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 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es $299,151 $278,864 $292,682 Professional Fees $36,159 $36,633 $37,545 O erations $60,475 $94,758 $82,773 E ui ment $2,253 $3,000 $1,000 Other* Total $398,038 $413,255 $414,000 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Title IV-B Grant $374,793 $380,000 $380,000 HIUW $8,500 $10,000 $10,000 HIUW Car over $6,255 $4,000 Charit Walk $5,000 $5,000 Charit Walk Car over HI Count Grant $16,000 $16,000 $20,000 i Total $404,293 $417,255 $414,000 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 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, 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 proaram's or agency's future funding requests. Signature of Date Vice President j - -,/1~ ~i /~~1~ ~C~ 5 Sig ~ture of Date Branch Administrator UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 KONA ADULT DAY CENTER, INC. Adult Day Care Agency Director: Rowena Tiqui Phone No.: 322-7977 Contact Person: Rowena 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@hawaii.rr.com Amount of Request for County Funds: $15,000.00 Prior Year(s) Funding: 02-03 03-04 0405 $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." NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 KONA ADULT DAY CENTER, INC. Adult Day Care 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 Center services are those adults 18 years and older, but particularly those 60 years 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 340,335 Total Pro ram Position Count 7 Total A enc Bud et 340,335 Total A enc Position Count 7 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 their 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 for full-time care of an impaired adult. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 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. 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 for 6 months with adult care services. 2) Maintained or improved socialization/infraction \skills of participants by 90%. 3) Maintained or improved hygiene/self-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. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 KONA ADULT DAY CENTER, INC. Adult Day Care Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Clients Served 30 24 32 *If applicable Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 179,909.03 194,384 203,969 Professional Fees 39,110.62 29,616 39,111 O erations 85,862.18 73,179 76,827 E ui ment .00 .00 .00 Other* Benefits 35,453.40 38,583 40,512 Total 340,335.23 335,762 360,419 *Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 KONA ADULT DAY CENTER, INC. Adult Day Care Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Coun of Hawaii 15,000.00 15,000 15,000 DHS/NHWW 59,706.00 72,000 74,160 DHS 32,572.19 33,504 32,572 Service for Seniors 4,716.00 4,800 4,950 Teresa Hu hes Trust 190.00 250 250 Ma Tem leton Ho er 24,845.00 25,200 25,200 Hawaii Island United Wa 15,000.00 15,000 15,000 Theodore Vierra 326.00 .00 .00 Other Grants .00 1,000 .00 Tuition 76,222.00 93,600 96,400 Trans ortation Fee 9,690.00 12,000 12,360 Bathin Fees 7,500.00 9,120 9,390 Feedin Fees 1,540.00 420 440 Food Care Pro ram 9,682.18 9,600 9,800 Intake Fees 280.00 960 1,000 Fundraisin Donations 15,095.62 4,050 4,172 Membershi 5,995.00 5,000 5,150 Fundraisin Sales 17,520.59 19,000 15,000 Administrative Fees 459.98 250 300 Interest Income 1,371.18 1,800 1,854 Unrealized Gain 1,222.78 .00 .00 Total 298,934.52 322,554 322,998 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 KONA ADULT DAY CENTER, INC. Adult Day Care I (we) have read and understood atl 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. ff 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 fA submit a timely. complete, and accurate veer-end resort may impact the evaluation of your program's or agency's future funding requests. ~~-t-Q1 a~ tea„ ` - a - d Si f Pr sident/ hair Date ~ I 2 ~ Signature of Executive Director Dat UNSIGNED PROPOSALS VYILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 Kona Literacy Council -Agency Name Kailua Learning Center - Program Name Agency Director: Joan Budnick Phone No.: 329-1180 Contact Person: Brenda Natina Phone No.: 329-1180 Mailing Address: 7-5766 Kuakini Hwy #106A Facility/Site Address: Same Fax No.: 329-1180 Email Address: konalit@msn.com Amount of Request for County Funds: $1500.00 Prior Year(s) Funding: 02-03 03-04 04-05 $1500.00 $1500.00 $1,500.00 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 leamers. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 KONA LITERACY COUNCIL - Ag@t1Cy Na111@ Kailua Learning Center - PfOgfal'Tl Name Program Description: The Kona Literacy Council's trained volunteer tutors provide free, one-to-one, small group, and computer-assisted literacy services at the Kailua Learning Center to any adult who wants to improve their basic reading, writing, computation skills and computer literacy. Special programs designed to meet the specific needs of the learners are offered, such as: English as a Second Language, preparation for passing the GED or Competency Based High School Diploma, Citizenship preparation, keyboarding and computer literacy. All tutoring is at no cost to the student. All of the 546 students, who have had lessons at the Kailua Learning Center since it opened in September 1992, have made remarkable progress in their basic skills; some have gained their High School Equivalency Diploma, passed the Citizenship exam, and have gotten better jobs. Reading improves the adults' self-esteem, thereby improving their lives and becoming better family members, workers and community members. Total Budget and Position Count Total Pro ram Bud et 6500.00 Total Pro ram Position Count 11 Total A enc Bud et 6500.00 Total A enc Position Count 11 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, Alternatiaves 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 leamers 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. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 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) Tutored 12 basic literacy students. (includes reading, math & computer literacy) 2) Tutored 13 English as a Second Language students. 3) Left the program and attained employment: 6 students. 4) Retained employment: 1 student. 5) Passed the citizenship test: 0 student. 6) Entered other educational programs: 0 student. 7) Increased involvement with children's education: 3 student 8) Met goals: 8 students. 9) Utilized 11 volunteer tutors. 10) Tutored 425 hours of actual tutoring. 11) Contributed aproximately 700 hours by volunteers in other areas. 12) Trained 2 new tutors. NONPROFIT GRANT APPLICATdON FISCAL YEAR 2005-06 Page 3 KONA LITERACY COUNCIL - Agency Nam@ Kailua Learning Center - Pfogfam Name Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Tutored Basic Literac Students 12 20 15 Tutored ESL Students 13 15 15 Trained new tutors 2 5 4 Publish Newsletter 3 3 3 Total tutorin hours 425 400 400 Total non-tutorin hours 700 800 700 *If applicable Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 0.00 0.00 0.00 Professional Fees 206.00 500.00 100.00 O erations 5199.00 5000.00 5000.00 E ui ment 144.00 0.00 1,000 Other* 400.00 400.00 400.00 Total 5949.00 5900.00 6500.00 *Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 KONA LITERACY COUNCIL - Ag21lCy Nam@ Kailua Learning Center - Program Name Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Coun Grant 1500.00 1500.00 1500.00 Membershi Dues 50.00 50.00 50.00 Wal-Mart 100.00 200.00 1200.00 Donations 710.00 2750.00 1450.00 Fundraisin 0.00 500.00 500.00 Federal Cam ai n 717.00 900.00 800.00 Youn Brothers 0.00 0.00 1,000 Total 3077.00 5900.00 6,500 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 KONA LITERACY COUNCIL - AgeflCy Name Kailua Learning Center - PfOgram 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 program's or agency's future funding requests. nature of Board Pr'esident/Chair D~ Signature of Ex utive Director Da e UNSIGNED PROPOSALS WILL NOT BE ACCEPTEDI NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page S Laupahoehoe Train Museum - /fig@r1Cy N8111@ LTM Sustainability and Outreach - PfO9~8171 N8I11@ Agency Director: Lisa Barton Phone No.: 808-962-6300 Contact Person: Lisa Barton Phone No.: 808-936-9532 Mailing Address: P.O. Box 358, Laupahoehoe, HI 96764 Facility/Site Address: 36-2377 Mamalahoa Hwy, Laupahoehoe, HI 96764 Fax No.: 808-962-6957 Email Address: laupahoehoetrainmuseum@yahoo.com Amount of Request for County Funds: $75000.00 Prior Year(s) Funding: 02-03 03-04 04-05 $00.00 $ 00.00 $0.00 Agency Mission Statement: The purpose of the Laupahoehoe Train Museum (LTM) is to preserve, promote, and protect the historic, cultural, educational, social, civic and economic interests of the North Hilo and Hamakua districts, while highlighting the history of railroads on the island of Hawaii. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-Ori Page 1 Laupahoehoe Train Museum - Ag@I1Cy Nam@ LTM Sustainability and Outreach - PfOgf8f11 N8fT1@ Program Description: Enrich museum's operation to create a more sustainable organization. Provide positions for museum operation to allow the museum management to focus on expanding membership, displays, services, marketing and outreach programs. Total Budget and Position Count Total Pro ram Bud et 183000.00 Total Pro ram Position Count 5 Total A enc Bud et 424000.00 Total A enc Position Count 22 Program Objectives: 1) Create a more sustainable organization. 2) Provide positions for museum operations to focus on expanding membership, displays, marketing, community services and outreach programs. 3) Maintain museum operating hours Program Highlights: 1) Museum Assessment Program awarded by Institute of Museum and Library Services 2) 5 year anniversary of operations celebrated in 2003 3) Museum Tours provided for schools and community groups 4) Train Room expansion funded by Helco in 2003 5) Laupahoehoe Point walking trail clearing completed 6) Ookala Community Forest received 10 year Forest Stewardship grant 7) State Incentive Grant (SIG) providing substance abuse prevention education 8) Meth Initiative Grant expanded SIG program to include all of North Hawaii 9) Keiki car seat program provides car seat fitting stations and training island wide 10) Senior Safety Kits provides first aid kits, smoke alarms, emergency lights and emergency medical cards to community senior citizens NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 .Laupahoehoe Train Museum - Ag@t1Cy Nat11@ LTM Sustainability and Outreach - PP09~8i71 N8f11@ Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate expand funding from membership at 1,200 3,000 3,500 least 100% ex and number of travelin dis la s 0 2 3 expand number of educational 0 2 3 ro rams increase visitor count b 20% 5,000 6,000 8,000 increase school & community tours 24 30 40 b 20% increase LTM presence at 1 4 6 communi events `If applicable Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 0.00 0.00 60000.00 Professional Fees 0.00 0.00 0.00 O erations 31850.00 26200.00 48000.00 E ui ment 0.00 0.00 0.00 Other` 75000.00 75000.00 75000.00 Total 106850.00 101200.00 183000.00 `Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Laupahoehoe Train Museum - Ag@I1Cy Name LTM Sustainability and Outreach - Program Name Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Admissions/donations 18500.00 20000.00 22000.00 Membershi dues 850.00 1200.00 3000.00 Sales net 4000.00 5000.00 8000.00 Grants 8500.00 0.00 75000.00 Docent in-kind 36000.00 36000.00 36000.00 Museum mana ement in-kind 39000.00 39000.00 39000.00 Total 106850.00 101200.00 183000.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Laupahoehoe Train Museum - AgenC Name LTM Sustainability and Outreach - 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 near-end resort may imaact the evaluation of vour orogram's or agency's future funding requests. Signature 6f oar residenUChair Date 1 / , Signatur of Executive Director T~~+-~~~~~~ Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 1. Agency Mission Statement A brief narrative describing your Agency's mission. The purpose of the Laupahoehoe Train Museum (LTM) is to preserve, promote, and protect the historic, cultural, educational, social, civic and economic interests of the North Hilo and Hamakua districts, while highlighting the history of railroads on the island of Hawaii. Our museum has 3 main goals. 1) Create a museum within the community that preserves, promotes and protects the train era and the culture it imbued. We are restoring an engine, caboose, boxcar, track and Hawaiian garden to enhance visitors' experiences. Our yard has been transformed from an overgrown jungle to the original 'wye' style of rail yard as it was in 1946. We continue to research information and present it in a way that is easy to understand and appealing to visitors. 2) Educate all our visitors on the natural and cultural history of the Hilo-Hamakua Coast. We do this daily at the museum by sharing information of historic, cultural and local interest. A history kiosk was erected at our local gathering spot, and an interpretive sign is scheduled. The kiosk and signage help to guide and educate visitors on the historic and cultural aspects of our area. 3) Encourage the development of other oroiects along the coast that enhance educational, cultural and economic development. We provide a small gift shop that features locally made products; this has helped local industries. We promote drug awareness education, healthy life styles, and community safety. Another museum outreach program is the O'okala Community Forest which helps educate about our natural environment and will have an impact on our economy. Based on our third goal, we strive toward our ultimate objective for the museum which is to provide employment to local individuals, including students and seniors. Providing jobs for community members such as; office help, building maintenance, bookkeeping, and research would fulfill our original desire to stimulate the community's economic development while promoting the museum. 2. Program Description Briefly describe the program for which you are seeking funding. We are seeking program funding for the museum's operation to create a more sustainable organization. Providing positions for museum operations will allow the museum to focus on expanding membership, displays, services, marketing and outreach programs. Currently, the operating budget for the museum is actually quite small; given the wonderful service we provide the community and the island. However, we are totally reliant on our volunteers to maintain museum hours which occasionally overextend our volunteer workforce. In the past, the museum has received grant funds that have been related to specific projects. Following our purpose, these grants have allowed us to move forward on many community goals; such as Healthy Hawaii programs, car seat safety and drug awareness prevention programs, but they have done little to sustain the museum itself. One of our primary unfulfilled desires remains creating jobs to help improve economic conditions in the area. The museum struggles to have a full complement of volunteer docents available. We have the best, most willing volunteers working in our museum, but we don't have enough without over extending their generosity or shortening our hours of operation. Specifically, we want to hire people needed to do the tasks that, to date, have been done by volunteers. Income, such as membership, admission and donation, do not fund the jobs necessary to run the office, do projects and continue research. We are seeking funds to complete train museum goals that were originally established by the Hilo-Hamakua Heritage Coast committee. We want to finish projects started with other funding which got us through our beginning years. Using funds from this grant with other funding sources, we are working to finish the track, restore rail stock, and create displays in the new model train room. This will enhance visitor experience at the museum, provide educational opportunities and preserve historic values. We want to update and enhance the museum before our tenth anniversary which will be held in March 2008. We will also use these funds to advertise and promote field trips to the museum and to our forest project to develop community ownership and pride of its history and heritage. Marketing the museum since the doors have been opened has been specific to independent tourists in their cars. Now we want to target visitors during their vacation planning. Island visitors and our next generation will benefit from the preservation of this history that is only being done here. 3. Total Budget and Position Count a. Total Program Budget applies to the ro ram seeking county grant funding. We are seeking $75,000 of which $60,000 for labor and $15,000 for marketing and displays. Our total program budget for the museum operating expense is $183,000. Our museum operates on $33,000 which is from $22,000 donations, $3,000 membership fees and $8,000 from gift shop sales. The bulk of our contribution comes from community in-kind donated services ($75,000 per year). This does not represent donated time to outreach programs that the museum runs, such as drug awareness prevention and forest management. Income Expenses Total Countv Admissions/Donations $ 22,000 Labor $ 60,000 $60,000 Grants 75,000 Ads 11,200 5,000 Membership Dues 3,000 Displays 12,000 6,000 Sales (net) 8.000 Printing/Postage 6,500 4 000 Total cash $108,000 County total $75,000 Docent (in-kind) 36,000 Insurance 3,000 Museum (in-kind) 39.000 Lawn services 3,600 Total (in-kind) 75.000 Miscellaneous 3,000 Total museum project $183,000 Rent 3,000 Repairs 1,500 Supplies 800 Utilities 3.400 Total $ 108,000 Docent (in-kind) 36,000 Museum (in-kind) 39.000 Total (in-kind) 75.000 Total museum project $183,000 b. Total Agency Budget applies to the entire agency. The total agency budget has $243,000 gross profits. Grant totals $210,000 which includes $75,000 from this grant and the remainder ($135,000) from grants for specific projects. We also generate $36,000 of volunteer docent time and $47,000 of administrative, museum and project oriented, volunteer time. Income Expenses Total Donations $ 22,000 Labor $ 60,000 Grants 210,000 Ads 11,200 Membership Dues 3,000 Displays 12,000 Sales (net) 8.000 Printing/Postage 6,500 Total cash $ 243,000 Insurance 3,000 Docent (in-kind) 36,000 Lawn services 3,600 Museum (in-kind) 47.000 Miscellaneous 3,000 Total (in-kind) 83.000 Rent 3,000 Total museum project $ 326,000 Repairs 1,500 Supplies 800 Utilities 3,400 Projects Car seat 41,000 Drug prevention 83,000 Community forest 11.000 Total $ 243,000 Docent (in-kind) 36,000 Museum (in-kind) 47.000 Total (in-kind) 83.000 Total museum project $326,000 c. Total Program Position Count means positions that are in the program for which you are seeking funding. The program position count request for our museum's operation is five employees which include: • two permanent, part-time docents to keep the doors to the museum open daily including weekends; • one part-time curator to do displays, research and collections; • one part-time bookkeeper to expand the financial; and • one part-time facilities manager. To date all work done for museum operations has been done by volunteers. The docents are used to provide information on the railroad and cultural history, including local information, while sharing the aloha spirit. The curator will provide research to expand our displays, document current collections, create rotating displays, and create educational programs. The curator will also be responsible for developing and maintaining our web page. The bookkeeper will maintain the books allowing management time to review profit and loss statements to make the museum more efficient. The facilities manager will maintain the buildings and surrounding grounds, including expanding and labeling our Hawaiian garden and established heritage plants. These positions will allow the museum to focus on expanding our membership, displays, services, marketing and outreach programs. This funding for the museum's operation will create a more sustainable organization. d. Total Agency Position Count means positions in the entire agency. The museum operates primarily through volunteers that include; 12 part-time docents, 1 full-time coordinator, t part-time treasurer, and various project oriented volunteers, which includes community service organizations (North Hilo Community Council, Akaka Falls Lions Club, Leo Club, etc.) church organizations (St Anthony's Catholic Church, Papaaloa Hongwanji, Hamakua Baptist Mission, etc.), and school groups. Paid staff includes apart-time substance abuse prevention coordinator, apart-time grant administration office staff, and lawn maintenance contractor. If this grant is awarded we will add all of the 5 staff positions identified in part 3c above. 4. Program Objectives a. Tasks or projects to be accomplished in specific, well-defined, and measurable terms that are achievable within a specific time frame. All objectives should begin with a verb and should be numbered. The time frame that we are projecting our objectives for this grant is from July 1, 2005 until June 30, 2006. We are seeking to create a more sustainable organization. Providing positions for museum operations will allow the museum to focus on expanding membership, displays, marketing, services and outreach programs. Museum operation - Provide a quality museum within the community to preserve, protect and promote our island page in railroad history and Hawaii's unique blend of cultures it imbued. Focus on train history as it relates to local and island history; plantation days and cultural developments. 1. Hire local residents to staff the museum to maintain our hours of operation, maintain the grounds and building. 2. Improve fiscal stability of LTM. Maintain bookkeeping system using generally accepted accounting practices. 3. Deliver our brochures to island businesses for distribution. 4. Advertise in weekly visitor guides, on the radio, and submit ads to solicit donations of photos, memorabilia and artifacts, as well as personal stories. Market the area in such a way that existing businesses will benefit from extended visitor stays. Museum disolavs -Provide information to visitors on what activities and points of interest are available in the area. Educate visitors and residents on natural and cultural history of the North Hilo/ Hamakua Coast. 5. Create written and visual, permanent and rotating exhibits relating to railroad, plantation and local culture pleasing to the eye and mind. 6. Display and maintain a sugar train engine and standard gauge caboose in the yard. 7. Expand, identify and label our Hawaiian gardens. 6. Manage and improve our museum gift shop featuring local crafts by local producers. Museum outreach 9. Maintain a good relationship with the community. Increase a feeling of ownership within the community. Continue community work project days. Provide a meeting place for community groups. 10. Encourage the development of other projects along the coast that enhance cultural and economic development. Work with the community to prioritize historic and cultural features in the area and create appropriate signs or display. 5. Program Highlights a. Accomplishments from the previous fiscal year 2003-04. Program highlights include museum display and operation as well as community outreach programs. We celebrated our 5 years of operation in 2002, which signifies our stability and perseverance. This allowed us to apply for and be awarded the national, Institute for Library and Museum Service (IMLS) Museum's Assessment Program (MAP). Outreach programs include a walking trail, community forest, substance abuse prevention, car seat safety and senior citizen safety programs. • Museum Assessment Program -awarded and completed MAP, to review and assess museum operation using a professional museum surveyor in Aug 2003 • 5 year anniversary party -celebrated completion of caboose construction and 5 years of operation • Museum Tours -provided scheduled informational tours to schools, alumni, family, and senior groups. • Train Room -establish plans and initiated car port completion for additional visitor displays • Laupahoehoe Point walking trail -cleared 1 mile stretch of the old Mamalahoa Hwy going from the museum down to Laupahoehoe Point Park. County budgeted $100,000 for emergency access road assessment and development. • Ookala Community Forest -established in 1999, received a 10-year Forest Stewardship Grant in 2002. • State Incentive Grant and Meth Initiative Grant -SIG is a 3 year program and MIG is a county program providing substance abuse prevention education programs for community members • Keiki car seats -Department of Health, Highway Safety grant provides car seat inspection stations and training for the Island of Hawaii • Senior Safety Kits -DOH Office of Aging grant to provide first aid kits, smoke alarms, emergency flashing lights, and emergency medical cards to senior citizens of the community. 6. Performance Measures a. Quantifiable indicators of public and client benefits from your program's actions, and/or the number of goods or services your program produces. We are seeking to create a more sustainable organization. Providing positions for museum operations will allow the museum to focus on expanding membership, displays, services, marketing and outreach programs. Specifically, we will: 1) expand our membership by at least 100% during this grant period; 2) expand our displays to include at least two mobile displays that can also be used to rotate our permanent display; 3) expand services to include at least two portable, educational programs that will be available for local community and educational organizations; 4) expand our marketing efficiency that will increase our total visitor count by 20% over last years count and increase numbers of school and community tours by 20%; 5) expand our outreach staffing that will allow us to attend at least four community events such as county fair, community festivals, and educational venues. In addition, there is intrinsic value to the museum for both the community and the visitors that are very hard to identify and quantify but are important to take into consideration. We will increase our economy by paying staff members. We will increase our ability to maintain our operating hours, 7 days a week. We serve as a model for other communities that want to preserve, promote and protect their niche on our island. Funding this proposal will be of benefit to the museum, the community, island visitors, the economy, and future generations. 7. Program Expenditures a. Use only costs attributable to the rp ogram for which you are seeking funding. Total program expenditures are $183,000 which includes $75,000 from this proposal, $75,000 for in-kind volunteer time and $33,000 which covers $14,700 of shared cost and $18,300 covering our normal operational cost. The $14,700 covers $6,200 of advertising, $6,000 of displays and $2,500 of printing and postage. Program costs of $75,000 include $60,000 for 5 part time employees and $15,000 for marketing and display enhancements. Specific break out of county funded labor cost include: 2 part time docents for 150 hours/month @ $8/hr = $1,200/month 1 part time curator/marketer for 80 hours/month @ $25/hr = $2,000/month 1 part time bookkeeper for 45 hours/month @ $20/hr = $ 900/month 1 part time maintenance for 45 hours/month @ $20/hr = $ 900/month Total $5,000/month = $60,000/year The yearly county funded marketing costs include: Advertising in island visitor magazines, $ 5,000 Displays $ 6,000 Printing and postage. 4 000 Total $15,000/year Display costs are for traveling displays and to obtain items for rotating permanent displays. We have not had any funding for displays because all of our income has gone into operational costs. Printing costs are for semi- annual newsletters, membership renewal letters, solicitation letters and creating new museum brochures. Postage cost will help defray our mailing cost for solicitations to members and recruiting new sponsors. 8. Program Funding Sources a. List all sources of funds that you anticipate will fund your grants, program budget, including State and/or Federal grants, other specific grants, fundraising events, etc. Total program funding is $183,000 which includes $75,000 from this application, $75,000 from in-kind volunteer time and $33,000 from admissions, donations, memberships, and gift shop sales. A potential additional funding source is the Institute of Museum and Library Service Museum for America Grant. We have applied for this 3 year grant totaling $150,000 to help our operating costs. This amount is not reflected in our budgets for this application. This MAP grant will supplement and expand our program as defined in this application. The Museum for America grant budget includes: Program coordinator, $108,000 Material, supplies and equipment 18,000 DocenU staff training services and guest honorarium 19,500 Indirect cost. 4,500 Specific project grants include Keiki Car seat inspection, State Incentive Grant, Meth Initiative Grant, and Forest Stewardship, are approximately $135,000 per year. This amount is not included in the program funding sources. Mental Health Kokua Residential Rehabilitation Services Agency Director: Joanne Lundstrom Phone No.: 737-2523 Contact Person: Gary Michell Phone No.: 331-1468 Mailing Address: 1221 Kapiolani Blvd., Ste 345, Honolulu, HI 96814 Facility/Site Address: 75-5752 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: 02-03 03-04 04-05 $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: 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 2005-06 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 2004 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 579,260 Total Pro ram Position Count 14 Total A enc Bud et 9,797,150 Total A enc Position Count 200 Program Objectives: 1) Provide residential and social rehabilitation services to 80 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 2005-06 Page 2 Mental Health Kokua Residential Rehabilitation Services Program Highlights: 1) Provided transitional residential rehabilitation services in FY 2004 to thirty- two (32) unduplicated clients at PATCH Place and thirty (30) unduplicated clients at Hale Alanoe. 2) Discharged 55% of clients served to more independent living in the community. All clients showed improvement in daily living skills. 3) Provided a total of 7,350 bed days and 14,700 meals in our transitional residential programs during FY 2004. Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et* Estimate Number of unduplicated consumers 62 70 80 served Percentage of consumers served 55% 70% 85% who were discharged to more inde endent livin settin s Number of consumers served 5 3 1 re uirin hos italization Percentage of consumer satisfied 95% 95% 100% with services *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Mental Health Kokua Residential Rehabilitation Services Program Expenditures: FY 2003-04 FY 2004-05 FY 2005-06 Actual " Bud et * Estimate Salaries and Wa es 373,560 377,105 389,704 Professional Fees 9,400 12,515 12,765 O erations 170,450 173,380 176,795 E ui ment Other* Total 553,410 563,000 579,260 *Please explain in detail on separate sheet Program Funding Sources: Revenue Source FY 2003-04 FY 2004-OS FY 2005-06 Actual* Bud et* Estimate Count of Hawaii 15,000 15,000 20,000 Fees & Grants from Gov't A encies 414,705 427,800 429,010 United Wa 25,000 25,000 25,000 Pro ram Service Fee 80,600 80,000 90,000 CCS Fees 20,750 15,000 15,000 Donation/other 50 200 250 I Total 556,105 563,000 579,260 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 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, 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. V ~ ~.zJ~~ January 24, 2005 Signat1e of Board President/Chair Date ~~4,n_r, J ~ *~'~'°-z--- January 24, 2005 /i Si ature of Executive irec r Date 6 / UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 North Kohala Community Resource Center Kohala Community Athletic Association Agency Director: Christine Richardson 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: 55,000 Prior Year Funding: 02-03 03-04 04-05 SO $3,000 53,500 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 thirty-three 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 almost 500 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 30 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 Pr ram Bud et $21,200 Total Pro ram Position Count 0 Total A enc Bud et $150,871 Total A enc Position Count 1 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 _ North Kohala Community Resource Center Kohala Commurnty Athletic Association Program Objectives: Continue the maintenance of athletic equipment for our program, including scoreboards, tee ball and pitch ball items, basketballs and nets, volleyballs and nets, unrforms, cooking utensils and equipment for our concession booth. We still need to purchase new first aid kits and additional t-ball, pitch ball and catchers' sets due to the increased enrollment for these programs. Program Highlighffi: 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,there was a decrease in the enrollment in two programs this past fall, due to an attempt by a separate organization to initiate their own volleyball league. After some confusion, the new group was disbanded and those participants will return to KCAA this coming fall. Our program involves participation from 160 of our approximately 1800 households, and will grow next year to over 500 children and 200 adult volunteers, representing 180 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: Participanffi by Activity FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimaffi Bidd Basketball A es 5-6 52 54 54 Bidd Basketball A es 7-8 57 55 58 Elements Volle ball A es 9-11 69 40 70 Intermediate Volle ball A es 12-14 57 30 58 Bo Basketball A es 11-14 55 55 58 T-Ball A es 5-6 59 78 76 Pitch Ball A es 7-8 62 67 65 Track A es 9-14 38 40 40 Girls Basketball A es 11-14 60 60 63 Total Partici ants 461 479 542 Total Aduk Volunteers 188 192 200 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 North Kohala Community Resource Center Kohala Community Athletic Association Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es $0 $0 $0 Professional Fees $0 $450 $750 O rations $11,028 $13,000 $13,000 E ui ment $2550 $4250 $4,550 Other* $0 $0 $0 Total $13,578 $17,700 $18,300 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Partici ant R istration $3,695 $4,500 $5,000 Communi Contributions $3,625 $3,700 $3,700 Concession Sales $7,500 $7,500 $7,500 Grants $0 $3,000 $5,000 Total $14,820 $18,700 $21,200 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 North Kohala Community Resource Center Kohala Community Athletic Assoc~tion I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2-135 - 2-142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a yearend report to the 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 `~J~'~ 26-~oS Signature of Board PresidenUChair Date ~ ~ ~ ~ Signature of Pr am Director D to UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Office for Social Ministry Care-A-Van Agency Director: Carol Ignacio, Executive Director Phone: (808) 935-3050 ext 105 Contact Person: Brandee Cachola, Program Administrator Phone: (808) 935-3050 ext 113 Mailing Address: 140-B Holomua St., Hilo, HI 96720 Facility/Site Address: 140-B Holomua St., Hilo, HI 96720 and 75-5769 Alii Drive, Kailua-Kona, HI 96740 Fax Number: (808) 935-3794 Email Address: carolrign(c~aol.com for Carol R. Ignacio bcacholaCa~rcchawaii.org for Brandee Cachola Amount of Request for County funds: $30,000.00 Prior Year Funding: 02-03 03-04 04-05 $29,000.00 $29,000.00 $29,000.00 Agency Mission Statement: To meet the challenges of ever-changing community needs by utilizing, spiritual, human and material resources to empower those in need }o 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 DeSCflptlOn: (Please briefly describe the program for which you are seeking funding) 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 12,000 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 become self-sufficient. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-2006 Page 1 Office for Social Ministry Care-A-Van Our mobility allows staff to outreach and engage with The homeless where they are, whether they are on remote beaches, the woods, lava-covered areas where they live in tents and under tarps, or in town. We currently utilize nine (9) program cars, with seven (7) of Them are 4-wheel drive. We've begun to see an increase of homeless in the town-areas as well as in the outlying rural areas of the island. According to a 2003 SMS Homeless-Point-in-time Count study, homelessness is on a rise..."when rents go up, homelessness goes up." We are definitely feeling this Today. Another component of CAV is the representative payee program. Payees manage the finances of the seriously mentally ill and the mentally ill homeless who are unable to do so themselves. Two payees serve 65 participants, islandwide. Care-A-Van also facilitates empowerment groups os a creative avenue to engage the chronic homeless To participate in activities in a safe, healthy, and clean environment. The desired outcomes of these activities include: • To encourage and promote participation in meaningful activities on a regular basis; • To involve clients in groups to enhance self-confidence and stimulate appropriate interpersonal interaction; • To facilitate an open dialogue about establishing and maintaining relationships intimacy; • To provide and promotes opportunities To practice using social skills; • To share information about systems and community resources; and • To promote awareness of transitioning into the community. Forty eight (48) participants have participated in these activities, with a core group of eighteen (18) at regular attendance. CAV also anticipate the grand opening of a "one-slop" service center for The homeless in WesT Hawaii. CAV is working closely with the County of Hawaii, Office of Housing and Community Development Office to manage the "Friendly Place." Stanford Carr, a major developer in Hawaii, has committed to a donation to the County, with a layout similar to a modest 3 bedroom~2 bath HPM kit home with modifications. This facility will house lockers, showers, bathrooms, mailing services, meeting interview rooms and other supportive services such as mail, community bulletin boards, employment boards opportunities, feeding programs, and specialized services coordinated with existing resources in the community. We are currently engaging with the community to bring their services to the "Friendly Place" for the homeless To receive all in a single location. Total Budget and Position Count Total Pro ram Bud et $1,035,205.00 Total Pro ram Position Count 17 Total A ency Budget $2,660,636.00 Total A ency Position Count 34 Program Objectives: 1) Identify 1,234 individuals who are homeless and provide them with services That will ultimately lead Them to becoming housed and serf-sufficient. 2) Encounter and complete 750 new intake and assessments (unduplicaTed~entry info program only). 3) Provide case management services to 733 participants (unduplicated). NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-2006 Page 2 Office for Social Ministry Care-A-Van 4) Provide 3,500 non-medical referrals and follow-up visits (i.e. employment search training, food referrals, housing, social security, veteran assistance, welfare, legal, education, other). 5) Provide and~or refer 750 participants to medical~healTh care services (i.e. any nurse physician encounters, other medical, mental health, Crisis services, STD~HIV~AIDS, substance abuse treatment services, dental, vision and family planning). 6) Provide 750 participants with food supplies (from program's food pantry or hot meals). 7) Provide 750 participants with non-food supplies. (i.e. clothing, blankets, hygiene kits, household items, backpack, towel, $ for ID~birth certificate) 8) Provide 500 family counseling encounters (i.e. family conflicts, Domestic Violence, other) 9) Provide 6,500 lifestyle counseling encounters (i.e. hygiene counseling, etc.) Program Highlights for FY 03-04: (1) Served 1,055 unduplicated homeless persons in Hawaii County. (2) Assisted 63 consumers with serious menial illnesses with their financial affairs including timely payments to their landlords, utility companies, loan collector agencies, medical institutions services, Transportation services, and distribute daily, weekly or monthly allowances. (3) Awarded a Community Development Block Grant in the amount of $106,000 to acquire (4) four brand new, four-wheel drive vehicles that will be used To expand existing homeless outreach services. (4) Implemented the Kukui Program, a new supportive housing program in Hawaii County, To assist a minimum of (24) twenty-four homeless individuals with disabilities with tenant-based rental subsidies. Participants pay 30-40% of their income towards Their rent while the Office for Social Ministry, Care-A-Van program pays for the remainder of the total rent due To The landlord. This offers as an immediate solution To affordable housing. This 5-year grant is funded by HUD in the amount of $629,160. (5) Awarded an initial year of contracted services To assist TANF eligible homeless persons move into stable housing situations. The grant amount was $178,518 beginning October 2004 thru September 2005. This includes the hiring of a TANF Case Manager and a Housing Specialist. The Housing Specialist is an advocate for landlords, providing 24 hour on-call response services, rental unit inspections, rental insurance fund, initial rental deposit and pro-rated rental assistance, household set-up, and supportive services. Housing Specialists are tasked with cultivating prospective landlords to rent their units to our TANF eligible participants who may be residing on The streets~parks~cars, emergency shelter or a TANF eligible recipient of a Section 8 voucher who is searching for eligible units. Pertormance Measures: PUBLIC BENEFITS FY 2003-04 FY 2004-OS FY 2005-06 Actual * Bud of * Estimate Clients who will be placed in emergency or transitional housing. 107 163 179 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-2006 Page 3 Office for Social Ministry Care-A-Van Clients placed into permanent housing. 142 290 319 Clients placed in drug/alcohol treatment as a direct result of 1 3 50 55 Care-A-Van intervention. Clients who will successfully access specific medical/dental care 826 1,445 1,590 from the appropriate source. Clients who will successfully access mental health 882 733 806 Treatment counseling Clients who will participate in long-term case management and 501 562 618 life-skills case management through the CAV program (includes budget management skills, housing retention counseling). * If applicable Pro ram Ex enditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es $467,277.91 $621,320.00 $706,726.00 Professional Fees - - Operations $161,234.04 $277,835.00 $328,479.00 Equipment - - - Other* - 114,000.00 - Total $628,511.95 $1,013,155.00 $1,035,205.00 *P/ease explain in detail on separate sheet Program Funding SOUrC@S: (List all sources of funding, including specific grants, fundraising events, etc. relatin to the pro ram onl Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Count of Hawaii $ 29,000.00 $29,000.00 $30,000.00 HCDCH $298,791.68 $400,000.00 $500,000.00 AMH-Outreach $186,133.14 $155,621.00 $155,621.00 AMH-Rep Pa ee $81,334.59 $115,950.00 $96,000.00 CDBG vehicle purchase fund - $106,000.00 HIUW $4,000.02 $15,00.00 $10,000.00 Shelter Plus Federal Funds) - $10,066.00 $10,066.00 TANF Housing Placement Program - $178,518.00 $178,518.00 State Housin Emer enc Grant $50,000.00 Homeward Bound Donations First Presb Brian $2,500.00 - - Hawaii Hotel Assoc. (Charity Walk) $3,000.00 $3,000.00 $5,000 Misc. Donations $1,993.50 - Insurance Proceeds/Sale of Car $8,051.62 - - TOTAL $614,804.55 $1,013,155.00 $1,035,205.00 " If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-2006 Page 4 Office for Social Ministry Care-A-Van 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. Signature of Board President/Chair Date /-3l ~ Signature of Executiv Di for Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-2006 Page 5 Office for Social Ministry Hawaii Island Food Bank Agency Director: Carol R. Ignacio Phone No.: (808)935-3050, x105 Contact Person: Susan Jung Phone No.: (808)935-3050, x120 Mailing Address: 140-8 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)96914874 Email Address: siung(c~hi-fb.org for Susan Juno Carolrign(a.aol.com for Carol Ignacio dleakC~hi-fb.org for Deborah Leak Amount of Request for County funds: $32,500 Prior Year Funding: 02-03 03-04 04-05 $32,500 $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 incorporate direct-service, justice education, advocacy, and community development into a variety of client-driven safety net programs such as Hawaii Island Food Bank. All programs of the Office for Social Ministry (hereinafter OSM) serve the entire community regardless of religious belief, age, sex, ethnicity or ability. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 Office for Social Ministry Hawaii Island Food Bank Program Description: The HIFB serves the entire County of Hawaii through athree-fold mission 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 first and second parts of the mission are accomplished through two warehouses, one in East Hawaii and one in West Hawaii. Our East and West warehouses are clearinghouses for food and non-food items that retailers, wholesalers and farmers would normally discard. Reasons for discarding food are surplus product, discontinued product, near pull date product, ripped labeling, and off-grade produce. The HIFB also receives food donated by the community through food drives. All goods are then taken bads to the warehouses where HIFB staff and volunteers weigh the incoming poundage and then salvage them. Once items are salvaged, they are stocked on the warehouse shelves for distribution to nonprofit member agencies that include hot meal programs, after school programs, food pantries, chikl and aduk day programs, programs that serve the chronically ill, and homeless and abuse shelters as well as the HIFB's own Senior Brown Bag Program. Total Budget and Position Count Total Pro ram Bud et 654,719.00 Total Pro ram Position Count 7 Toil A enc Bud et 2,660,636.00 Total A enc Position Count 34 Program Objectives: 1) To rescue and distribute over 1,000,000 pounds of food and nonfood items to our network of approved, nonprofit member agencies that distribute food boxes, meals or snadks to children, the ill and the needy as well as through our own Senior Brown Bag Program that served low- income seniors at thirteen sites around the island in 2004. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 Office for Social Ministry Hawaii Island Food Bank 2) To provide 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. 3) To increase the public knowledge for the need of volunteer staff at HIFB. Program Highlights: 1) Received and salvaged over 1.4 million pounds of goods from Big Island donor companies and the Hawaii Foodbank as well as businesses and organizations that held food drives. 2) Distributed over 1.2 million pounds of goods throughout Hawaii County via our islandwide network of nonprofd member agencies and via the food bank's own Senior Brown Bag Program. This food served 146,952 individual requests for food (duplicated count) through our food pantries. This is an increase of 15,143 requests over the previous fiscal year. Anecdotal evidence from agencies in West Hawaii confirms there are more new faces each week accessing their meal programs. 3) Presentations, warehouse tours, and forums were presented throughout the year in a minimum of 17 cases. Information about the HIFB and how it works was presented to interested groups and the public at community forums. 4) For 2 years, the HIFB has participated in aUSDA-funded program as a partner of the Kauai Food Bank. This grant provided funds for the food banks to purchase fresh produce from kcal farmers. It was a nutrition program as well as an economic development program. The program ran for 13 weeks (July 6 - Oct.1, 2004) to 1,848 low-income seniors which provided over $183,600 worth of produce. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Office for Social Ministry Hawaii Island Food Bank Performance Measures FY 2003-04 FY 2004-05 FY 2005-0ti Actual * Bud et * Estimate 1. Pounds of grocery items rescued, 1,482,669 1,500,000 1,700,000 salvaged, and stocked, islandwide pounds pounds pounds incomin ounda e . 2. Pounds of grocery items 1,280,390 1,300,000 1,500,000 distributed throughout Hawaii pounds pounds pounds Coun 3. Number of presentations to be 17 20 20 given to public regarding ways to hel fi ht hun er. *If applicable Program Expenditures F'Y 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 333,288.59 352,555.00 308,990.00 O erations 268,716.09 212,345.00 279,629.00 E ui ment - - - Other* 39,028.48 44,040.00 66,100.00 Total 641,033.16 608,940.00 654,719.00 *Please explain in detail on separate sheet Please note FY0304 actuals are smaller than what is found on enclosed Profd and Loss Statements because the value of the donated food is not included in cash budgets in above table. Other* FY2003-04 f=Y2004-05 FY2005-06 see above Actual* Bud et* Estimate Fundraisin Costs 35,103.41 39,840.00 56,300.00 Advertisin 2,030.53 3,000.00 5,000.00 Media 2,100.00 - - Excise Tax - - 3,600.00 Bank cha es 513.79 600.00 600.00 Misc 308.33 600.00 600.00 39,028.48 44,040.00 66,100.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Office for Social Ministry Hawaii Island Food Bank Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Coun of Hawaii 32,500.00 32,500.00 35,000.00 State of Hawaii via Hawaii 14,490.00 14,490.00 14,490.00 Foodbank Senior Produce 13,672.00 13,000.00 11,779.00 HIUW 11,000.00 12,000.00 12,000.00 EFSP & Grants Plus 4,300.00 - - CDBG 120,000.00 - - Hotellndust Grant 4,500.00 3,000.00 Hawaii Commun' Foundation - 15,000.00 15,000.00 Various Small Grants 5,500.00 2,500.00 - Various Medium Grants 8,000.00 100,000.00 80,000.00 Donations 223,547.78 100,000.00 118,500.00 Fundraisin 139,524.84 185,500.00 237,000.00 Pr ram Service Fees 113,210.26 135,100.00 120,100.00 Other Revenue & Interest 13,776.67 20,850.00 10,850.00 Total 704,021.55 633,940.00 654,719.00 *If applicable 'Please note FY0304 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. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 Office for Social Ministry Hawaii Island Food Bank 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 80 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 vear~nd report may impact the evaluation of your program's or agency's future funding requests. %i ~ ` 30 os' Signature of Board PresidenUChair Date Signature of Executive ' ect Date UNSIGNED PROPOSALS WILL NOT SE ACCEPTEDI NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 Office for Social Minist 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: $20,000 Prior Year Funding: 02-03 03-04 04-OS $20,000 $20,000 $20,000 Agency Mission Statement: To meet the challenges oJ'ever-changing community needs by utilizing spiritual, human arzd 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 incorporate direct- service, justice education, advocacy, and community development into a variety of client- driven safety net programs such as the Mobile Care Health Project. All programs of the Office for Social Ministry (hereinafter OSM) serve the entire community regardless of religious belief, age, sex, ethnicity or ability. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 _ Office for Social Minist Mobile Care Health Project Program Description: The Mobile Care Health Project (hereinafter MCHP) is a joint partnership between the Office for Social Ministry, 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 Kailua-Kona. Currently, the MCHP has established outreach clinic sites at the following five (5) locations: West Hawaii: Ocean View, Honaunau, Kailua-Kona North Hawaii: Honoka'a, Kapa'au Services are delivered to the low-income uninsured and underinsured people around the island through two (2) Winnebago vans that contain dental operatories and administrative space. Mobile Care patients receive services including dental exams, prophylaxis (cleanings), composite and amalgam restorations, periodontal procedures, extractions and referrals. The MCHP has been operating for eight years and has served over 13,000 duplicated patients since it began providing services in January of 1997. The project partners with many different agencies to achieve the goals and objectives of meeting the needs of the Big Island rural poor. An agreement between the Hamakua Health Center and the Mobile Care Health Project provides for dental services to the underserved population in Hamakua and North Hawaii. A stationary clinic is planned by Hamakua Health Center for 2006. 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 Honoka'a, Kapa'au and Pahala. Mobile Care serves as an advocate for dental services for the underserved at the county and state levels and provides oral health education, dental assessments and topical fluoride in schools and at community health fairs throughout the island of Hawaii. Total Budget and Position Count - FY 2004-OS Total Pro ram Bud et 402,567.00 Total Pro ram Position Count 3.5 Total A enc Bud et 2,660,636.00 Total A enc Position Count 34 Program Objectives - FY 2005-06: 1) Goal: to provide direct dental care and health education in 2,000 patient visits to people unable to access care due to financial hardship, transportation or geographic barriers. This will be accomplished by providing an average of 20 clinic days per month in 5 locations on the island of Hawaii utilizing volunteer and employed staff. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 Office for Social Ministry Mobile Care Health Project 2) Goal: to provide dental assessments to Hawaii Health Systems Corporation (HHSC) long-term care Medicaid 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: 1) Provided direct dental care through 1,254 patient visits. 2) Averaged I S clinic days per month. 3) Provided a total of 2,993 units of care including extractions and restorations. 4) Provided a value of $170,670.52 in uncompensated dental services. 5) Participated in 4community-driven health fairs providing dental assessments, oral health education and fluoride treatments for 116 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. Performance Measures: FY 2003-04 FY 2004-OS FY 2005-06 Actual * Bud et * Estimate # of people accessing services 1,254 2,000 2,000 *[f applicable Program Expenditures FY 2003-04 FY 2004-OS FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 172,233.26 185,792.00 184,548.00 Professional Fees 75,680.00 93,640.00 100,000.00 O erations 143,491.53 92,034.00 104,223.00 E uipment 14,583.98 13,793.00 13,793.00 Other* Total 405,988.77 385,259.00 402,564.00 *Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Office for Social Ministry Mobile Care Health Project Program Funding Sources Revenue Source FY 2003-04 FY 2004-OS FY 2005-06 Actual * Bud et * Estimate State Grant in Aid 92,731.00 100,000.00 100,000.00 Count of Hawaii 20,000.00 20,000.00 20,000.00 HDS Foundation 16,000.00 HIU W 10,000.00 10,000.00 10,000.00 HMSA 25,000.00 50,000.00 50,000.00 St. Francis Health S stems 75,465.64 68,640.00 25,000.00 Wilcox Foundation 10,000.00 20,000.00 Bank of Hawaii 10,000.00 Weinberg Foundation 20,000.00 20,000.00 75,000.00 OHA Foundation 0.00 50,000.00 40,000.00 Misc. Grants 13,350.00 6,500.00 4,000.00 Donations 31,362.15 22,619.00 21,067.00 Third Party/Client Payments 28,560.81 30,000.00 30,000.00 Client Pa ents 10,874.00 7,500.00 7,500.00 Misc. 10,531.08 Total 373,874.68 385,259.00 402,567.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Office for Social Ministry Mobile Care Health 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 vear-end report may impact the evaluation of your program's or agency's future funding requests. ' ry " O~ January 31, 2005 Signature of Board Pre~{sident/Chair Date ) ~ L/_~ January 31, 2005 Signature of Executive Dirg to Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 The Salvation Army-Family Intervention Services Ho'okala Adolescent Diversion Program Agency Director: Pauline Pavao Phone No.: 935411 Ext. 11 Contact Person: Michael Chung Phone No.: 935-9777 Ext. 200 Mailing Address: POB 5085, Hilo HI 96720 Facility/Site Address: 82-1123 Kinue Road, Captain Cook Fax No.: 933-9810 Email Address: PaulinePavao@usw.salvationarmy.org Amount of Request for County funds: 35,000 Prior Year Funding: 02-03 03-04 04-OS $29,000 $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 continue enhancement and improvement our Ho'okala adolescent diversion program. We will focus specifically to develop services in the following target areas from the West Hawaii District: North and South Kona, North and South Kohala, and Kau districts. Since 1993 to current, our agency has been funded by the Office of Youth Services to implement Ho'okala services on the Big Island. The Ho'okala program helps to prevent youth, who have been arrested by the police, from getting inappropriately detained in police lockup facilities. In order to do this, we provide a 24-7, 365 days a year crisis response to the police, which we receive funds primarily from OYS to provide this service. The program is also an opportunity to provide early prevention and intervention services to these youngsters to help them from further penetrating the juvenile justice system. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 Through funds provided by the County grant, we will also plan to provide various services such as drug prevention activities to these youngsters, to help decrease their involvement with the police and to address other at-risk problem behaviors including but not limited to teenage pregnancy, drug usage, gang involvement, delinquency, and/or family management problems. With youths, who are referred to the program that are unable to be returned back home, we will help them by accessing short-term emergency placement services, so that a more timely and appropriate reunification back with their families can be achieved. Youths that require this service will either be referred to our Emergency Shelter program in Kona or be referred to an Emergency Foster Home, which we plan to develop in different communities of the West Hawaii District. Through our Short-Term Intensive Case Management services, we develop early risk assessments and individualized service plans with youths and their families to help preserve the youngster within his/her family unit and to help motivate the family's involvement with our programs. Also, through this process, we provide referral and information services to help link the 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 continue on-going contacts with youth and families, even after the youth has left our program, to assure that these youth do not require further police intervention. For youths and families that are either resistive or difficult to reach do to their geographical locations, we employ a service strategy called targeted outreach. Social skill building and other relapse prevention activities may also be provided while a youth is in follow-up and/or outreach services. With our continued efforts to provide and develop the activities described above, through the support of the County Grant, we have noticed that it is resulting in positive changes for the youth and families that we have serviced. Total Budget and Position Count Total Pro ram Bud et 140,875 Total Pro ram Position Count 2.25 Total A enc Bud et 3,249,666 Total A enc Position Count 69 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) Currently our program has worked with 45 youths from the West Hawaii District. Many of these youngsters were assessed w/ at risk problems when they entered our program including runaway, truancies, drug usage, NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 delinquency problems, family management problems. These youngsters would othervvise not have had the opportunity to receive any further services had they not been referred to our program, and through the involvement with our program, we are noticed positive changes with both the youngsters and their families. 2) Currently, we have serviced 13 youth and their families that have come from the South Kohala district. 3) Currently, we have serviced 3 youth and their families that have come from the North Kohala district. 4) Currently we have provided 32 youth with emergency placements services as these youngsters were in crisis at the time of their referral to the program. These youngsters could not be returned home do to the severe problems that they were exhibiting at the time their arrest. Still, all of these youngsters were eventually and successfully returned back with their homes after intensive work with both youth and their families. 5) Currently all 45 youths in the program and their families were provided with some form of case management and follow-up services through the program. 6) 28 youngsters and their families were provided outreach services, which has our program staff "going to" the youth's families to engage them in services. Many of these families were either resistive to stay involve with program, had transportation difficulties, and/or lived to far away from services to want to travel to Central Kona to receive it. 7) Families involved with the program were given access to the Parent Project Program in West Hawaii. It is a collaborative program supported between our agency, the DOE, Family Support Services. The program is a 10-week parent skills training and support class that helps parent better deal with out of control and unruly youth. Through this process we have also been able to educate parents about laws of the juvenile system and other important issues regarding adolescents and teens. 8) Our program has also referred several of our youths to the Project IMPACT Program held at the Kealakehe Police Station. Officer Wike of the Hawaii County Juvenile Aid Section provides alcohol and drug awareness education. The youths in the program are also required to participate in a community service project as part of their educational process. 9) Through the Ho'okala program, youths and their families were referred to other resources to help the families with their situations and further prevent the youngster from other problem behaviors. Some of the resources we have and continue use include: ATV (Alternative to Violence) for youths anger management classes, BISAC (Big Island Substance Abuse Council) for youths with substance abuse issues, Family Support Services for different Outreach and Prevention services, Private Practitioners and Dept of Health for youth's with Mental Health issues, and Kapiolani Child Protection Team to provide diversion services for youth at- risk of being involved with CPS. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 The Salvation Army-Family Intervention Services Ho'okala Adolescent Diversion Program Performance Measures: FY 2003-04 FY 2004-OS FY 2004-OS Actual * Bud et * Estimate Intensive Case management 75 75 Service Follow-u Services 75 75 Alternative Placement Services 30 30 Outreach Services 40 40 Social Skill Buildin Services 30 30 Referral and Information Services 50 50 *If applicable *Note: In FY 03-04, this grant was not connected with the Ho'okala program, and therefore, no numbers were indicated in this year. Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 100,275 99,624 103,907 Professional Fees O erations 35,244 35,251 36,968 E ui ment Other* Total 135,519 134,875 140,875 *P/ease explain in detail on separate sheet Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate 29,000 29,000 35,000 105, 875 105, 875 105, 875 Total 134,875 134,875 140,875 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 The 5aluation Army-Family intervention Services - AgBnC}/ ~a3t'TTE' ,#arJnie§cent i3iv~rsipn Services-Wesfi Hawaii-~i'O~f~lY1 ~~trY7~? 1 ! (we; have read grid understood ail of the efigigiifty requirements; grant conditions; award procedures; and reeards, reporting and fiscal accountability i requirements as mandated in Article 25, Sections 2-135 - 2-142.2, Nawcai`i County Cade, slating to Appropriation of Funds to Nonprofit Qrganizaiians. ! (~rae) trsrvby cortify that information supplied herein including al! suppprtirg documents is correct and that ! (wa; have the authori#y and ability to fully adn;inist3r the program(s) pursuant to law. t (we; understand that information supplied herein shall be made public ss~ according to Chapter 92F, tiawai'i i~evis2d Statut3s. !f avvarcted a grant #rom the Loui'efy of W.awai`i, ! {ws) understand and vi,;iii cantgiy with firs requirement to sul~rnit a yearend report to the Legisla#iv~ auditor within ~0 days after Jane 3St of the fiiscal year. The repatrt shall 6ractude an expianatioat of the public benefits derived frotxt the awarding ot~ its grant, a complete accounting of ai! expenditures suppcsrtee! by Coun#y~ of Hawai a grant tWnds, and a listing of atitar fUnding souses and anaount~ ubtaiudd during the award period. t=ailors to sltbmit a timelva Co lafe an accr~rate,ye~r-end resort may impact the svalpa~ion of yoaar proprat~'s or acrencv's futtrro fu in re ues The Salvation y, a alifornia Corporation /J-(3o~a ~ Signature of t;i sional Commander Date ~..-~-i?~.-y~ ~ lea 7 I Signature of Cxpcutive Director ,ate 6.8Pd~!€y?~~[9 Pi~t;tP3"S~dBr S t L Nt37 8~ fit: ~pl't=L7t a P i x~x~~~~~a~ ~tx~~ n,T>tP>,~~nrro~r ~t~c~>v zoos-od ~ a~.,~~ s The Salvation Army Family Intervention Services Pahoa Youth Service Center Program Agency Director: Pauline Pavao Phone No.: 935-4411 Contact Person: Raymond Dangaran Phone No.: 959-5855 /28 Mailing Address: P.O. Box 5085 Hilo, H196720 Facility/Site Address: 1786 Kinoole St. Hilo, HI 96720 Fax No.: 933-9810 Email Address: PaulinePavao@usw.salvationarmy.org Amount of Request for County funds: $ 40,000 Prior Year Funding: 02-03 03-04 04-05 $ 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 to provide youth with a safe, caring, and nurturing environment; and provide opportunities for youth to challenge their life styles through development of appropriate social skills, academic success, and personal resiliency. Program Description: The Salvation Army Family Intervention Services-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 (ICE, ecstacy, and etc.), involvement in gangs and violence, delinquent behaviors, early sexual behaviors, and to improve academic performance and school attendance. This will be accomplished by implementing Community-Based Outreach Services and Case Management Services to youth ages 7-18 years old and their families, residing in the Puna districts. Outreach services consist of: ? Leadership Development Program -The L. E.A. D. Team (Learning Experience in Assisting and Directing) provides development of leadership skills and training in areas of personal NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 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: ? Intake and Assessment ? Crisis Intervention ? Individual Service Planning ? Linkage to Community Resources ? Follow-up and Monitoring All services will be part of the Pahoa Youth Service Center funded by the Office of Youth Services located in the Pahoa High and Intermediate Schools, and at the Nanawale Community Center. Under the current OYS contract, we are sub- contracting the Boys and Girls Club of the Big Island (BGCBI) to provide Positive Alternative Activities at the Pahoa Youth Service Center. We also utilize the BGCBI as a referral source as we identify the needs of the youth and/or families that would benefit from positive alternative activities. We will implement program services during in-school, after-school, and on weekend hours. The proposed funding would help support for 1-FTE Youth Development Specialist that will be funded .5 FTE under the OYS contract and .5 FTE funded under the County Grant. We would also like to increase the proposed funding by $5,000 to implement youth/family retreats. We have experienced positive results as we provided Mother/Daughter, Father/Son, and Sibling Retreats through the Youth Service Center Program. These retreats provided youth and families with positive bonding throughout the activities and helped open communication and understanding with each other. We will include these types of retreats, as we serve the youth and families of the Puna districts through this County grant. Total Budget and Position Count Total Pro ram Bud et 165,000 Total Pro ram Position Count 2 Total A enc Bud et 3,249,666 Total A enc Position Count 69 Program Objectives: 1) Of the 100 youth participating in Youth Service Center Program, at least 60% will will register for Outreach Services and maintain participation with the program registered for to completion or for 6 months beyond the registration date. NONPROFIT GRANT' APPLICATION FISCAL YEAR 2005-06 Page 2 2) Of the 20 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. Program Highlights: 1) During the past 2003-04 year, we provided in-school services for 156 youths in the 3`d~m grade classes at the Keaau Elementary School. The in-school services provided youths with skill-building development in areas such as personal development, social development, decision-making, problem solving, teamwork, drug awareness, anger management, responsibility, and respect. We measured the in-school program by implementing pre/post test, teacher evaluations, and staff evaluations, 2) We also provided the L. E.A.D. (Learning Experience in Assisting and Directing) Team Program for 75 youth from the Pahoa High and Intermediate Schools and the Nanawale Community Center. The L. E.A. D. Team provides youth with leadership skills and other life skill building activities that will empower youth to become future leaders within their community. The basic components of the program consist of Skill Building Development, Community Service Learning, Peer/Youth Mentoring, and Leadership/Facilitation Training. Throughout the year, youth participated in skill building activities, organized and implemented Community Service Projects (Clean-ups, Sign Waving), assisted with supervision of youth activities (Youth Dances, Excursions), and facilitated/co-facilitated the L. E.A. D. Team Curriculum to other youth in the program. 3) One of our major Community Activity projects this past year was the first annual "Community Block Party" (Community Resource Fair) at the Nanawale Community Center Longhouse on April 24, 2004. In collaboration with the Nanawale Community Association, we organized in providing a resource fair that consisted of 30 service providers, 4 special guests, and over 220 people for the Nanawale and Pahoa Communities. The special guests included Keone Johnson from KWXX, who volunteered to MC throughout the event, Tom Brown, Officer Greg Yamada, and Councilman Gary Safarik. We continue working and collaborating with the Nanawale Community Association with other community events such as the Easter Day Activity, Summer Get Together, and the Back to School event. 4) Other collaborations included the University of Hawaii at Hilo-Canoe Club and the Volcano National Park to provide youth with a cultural experience in learning about Hawaiian history, belief and customs. We have also been involved with community building and collaboration by attending monthly meetings at the Neighborhood Place of Puna to network with other agencies, and plan for community activities. Also involved with the Weed and Seed Planning Committee to assist with youth and family activities for the Puna Communities. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Budget * Estimate Com letion of L. E.A.D. Team 75 60 60 Partici ates in Pos. Alter. Activities 156 120 60 Partici ates in Case M t. Services 30 30 20 Partici ates in Pro ect Famil 70 60 60 Follow u and Monitorin 93 100 60 Partici ates in Retreats 60 *If applicable Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Budget * Estimate Salaries and Wa es 100,863 107,119 105,104 Professional Fees O erations 59,765 52,881 59,896 E uipment Other* 50,000 50,000 50,000 Total 210,628 210,000 215,000 *Please explain in detail on separate sheet *Sub-Contract with Boys and Girls Club-Big Island to provide Positive Alternative Activities at the Pahoa Youth Service Center. Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Budget * Estimate Count of Hawaii 35,000 35,000 40,000 Office Of Youth Services 175,000 175,000 175,000 Total 210, 000 210, 000 215, 000 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 The S~Iv°ation Arri7y-Family Intervention Services - d~C~+rrtCj7 ~arr'1~ i pahoa Youth Ser~.fice Center - Pft7~C~fi't ~~373~' ~ i i i (we) have read and understood all of the eligibility requirements; grant canttiitiflns; award procedures; and records, reportin(~ ar~d fiscal accountability requirements as mandated in Article 2~, Sections 2-135-2-142.2, Hawaii ~ County Code, relating to Appropriation of Funds to Nonprofit Grganizations. 9 (use) her~*by certify that information supplied'nerein including ail supporting cJocunients is c-orre~~t and that 3 (we) have the authority arld ability to lolly j administer the progi am(s) pursuant to law. I (:Ala; under stand that i, format>on supplied herein shall be made public j according to Chapter 92F, Hawaii Revised Statutes. if awardeo1 a grant fraarl the County of liawai`i, I (rue) understand and will _ c~smpiy witch the requirement to suiamit a year-end report to the Logisiativ auditor within SO days after June 30 of the fiscal year. The report shall include an explanation of the public benef9ts derived from the awarding o the grant, a complete accounting of ai! expenditures supported by County of filawai'i grant funds, and a 9isting of other funding sources and amount ot;tained during the award period. Failure to subm(fi a timely. complete, an accurate sear-fir ci r'eaort may 3maac# the evaluation of vour pro+aram's or agency's future f , n rests. The Salvation y, o alifornia Corporation _ / o o ~ Signature ~ . ~ src~rsai Commandr;r Da#e Signature of Executive Director Date I t3~l~9Ui~lir33 pf3~~ALS iNI~,L NiJT 8C AC~PTEDI ~ 1 3 3r1 S :~1~i~'~'ia~~3~' G~~IiTT:~.3't'f.ttrA't"'~CDN t''ag~ 5 ' I i I SUMMARY OF FY2003-04 GRANT EXPENDITURES AGENCY: THE SALVATION ARMY-FAMILY INTERVENTION SERVICES PROJECT NAME: PUNA YOUTH SERVICE CENTER BUDGET CATEGORY: FY 2003-04 ACTUAL EXPENDITURES PERSONNEL-SALARIES: 80,034 EMPLOYEE BENEFITS: 10,956 PAYROLL TAXES 9,873 SUPPLIES: 9,954 OPERATIONS: 46,431 TRAVEL: 3,380 SUBCONTRACT: BOYS 8 GIRLS CLUB-RICO 50,000 TOTAL EXPENDITURES 210,628 PROGRAM BUDGET FY 200405 AGENCY NAME: THE SALVATION ARMY-FAMILY INTERVENTION SERVICES PROJECT NAME: PUNA YOUTH SERVICE CENTER BUDGET CATEGORY: BUDGET PERSONNEL-SALARIES 107,119 EMPLOYEE BENEFITS 11,309 PAYROLL TAXES 10,195 SUPPLIES 2,815 OPERATIONS 45,901 TRAVEL 4,165 SUBCONTRACT: BOYS & GIRLS CLUB-HILO 50,000 TOTAL BUDGET 210,000 Special Olympics Hawaii -Agency Name Special Olympics Hawaii- East Hawaii -Program Name Agency Director: Nancy Bottelo Phone No.: (808) 943-8808 Ext: 22 Contact Person: Glenn Hirata Phone No.: (808) 966-8696 Mailing Address: P.O. Box 7265 Hilo, HI 96720 Facility/Site Address: 15-2712 Moi. St. Pahoa, HI 96778 Fax No.: (808) 965-9023 Email Address: soehawaii~earthlink.net Amount of Request for County Funds: $12,000.00 Prior Year(s) Funding: 02-03 03-04 04-OS $6,000.00 $5000.00 $5,500.00 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 intellectual disabilities, giving them continuing opportunities to develop physical fitness, demonstrate courage ,experience joy and participate in the sharing the gifts, skills and friendship with their families, other Special Olympics athletes and the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 Special Olympics Hawaii -Agency Name Special Olympics Hawaii- East Hawaii- Program Name Program Description: Timothy Shriver, Chairman of the Special Olympics Incorporated Board of Directors, stated at the 2003 World Games in Dublin Ireland, "Somewhere near and somewhere very far away, there is a boy or a girl, a 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 development growth and acquisition of important skills that they will need to gain employment, maintain relationships and function independently as adults. Special Olympics helps to give individuals with a intellectual disability the necessary skills to achieve that independence. We believe that all people regardless of their disability deserve to lead full ,active lives, enriched with social and recreational opportunities that most of us take for granted. Unfortunately, appropriate physical education programs in the public schools and social service programs that realistically address the special needs of this population are virtually non-existent. Special Olympics 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 intellectual disabilities and special partners without disabilities. All participants are of similar age and athletic ability. This program dramatically increases inclusion of our athletes into the community by helping break down barriers that have historically kept people with and without disabilities apart. Special Olympics East Hawaii now has a softball team 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, a more positive self- image, friendships, and increased family support. Special Olympics athletes carry these benefits with them into their daily lives at home, in the classroom, on the job, and in the community. Families who participate become stronger as they team a greater appreciation for their childs'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 intellectual 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. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 Our founder, Eunice Kennedy Shriver, believes sports training and competition opportunities should be available for all who qualify rather than all who could afford to participate. Therefore, our program is free of cost to all of our athletes, special partners, and coaches. We receive no money from the Kennedy Foundation or the Federal Government. All of the money raised for the East Hawaii program stays here to support our program. Due to the aspect of our program , a volunteer committee under the leadership of our Area Director must raise all the funds needed for this unique program. Those funds will pay for all aspects of the Special Olympics progam, which includes, equipment, uniforms, transportation costs, training of the coaching staff, family activities and trainings, and our Athlete Leadership Program (ALPS). In the ALPS program 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 2005 is transportation. It is an essential part of our program that Special Olympics athletes are provided an opportunity to interact and compete against people of smiliar athletic ability. Unforunately our area program is too small to be able to provide quality competition, therefore our athletes must travel to other islands to achieve that goal. The state competitions that are held on Oahu 3 times per year provide many activities that our athletes never have a chance to experience. They include; dances, Opening and Closing Ceremonies, entertainment and games, and being exposed to a Healthy Athlete 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 be able to reach out to new special needs individuals througout our communities. In order to do this, we will need funds to maintain our services and to 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. Total Budget and Position Count Total Pro ram Bud et $89,625.00 Total Pro ram Position Count 1 Total A enc Bud et $1,471,341.08 Total A enc Position Count 19 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Program Objectives: 1) Provide quailty training and competition for 180 athletes and special partners within our program by June 2006. 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 2006. 3) Increase the total number of athletes being provided services by Special Olympics East Hawaii by an overall 10% by June 2006. 4) Continue with our 2 family activities for 75 family members that will be conducted by our family committee by June 2006. 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 2006. Program Highlights: 1) Increase our number of Basketball 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. 4) Continued to develop the Area Management Team which helps to coordinate all activates for the Special Olympics East Hawaii program. 5) Continued our community activities such as the Highway Cleanup Project, singing at the Hale Anuenue and Clean It 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 additonal 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. 10) Provided a specialized training for our Area Director in the Fundraising area. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Special Olympics Hawaii -Agency Name Special Olympics Hawaii -East Hawaii -Program Name Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual' Bud et* Estimate Athletes numbers 123 135 140 Unified Partner Numbers 30 33 50 Volunteers 130 145 165 Famil Members 25 40 75 Mana ement Team 7 15 20 *If applicable Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and wa es $2140.00 $2,200.00 $2,986.00 Professional Fees 0 $2,650.00 $2,650.00 O erations $50,148.86 $76,474.00 $82,239.00 E ui ment $2,046.58 $5,475.00 $1,750.00 Other' Total $54,335.24 $86,799.00 $89,625.00 *Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 Special Olympics Hawaii -Agency Name Special Olympics Hawaii- East Hawaii- Program Name Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et' Estimate' Coun of Hawaii Grant $5000.00 $5,500.00 $12,000.00 Foundations $12,504.00 $18,800.00 $14,000.00 Individual Contributions $4,905.00 $10,000.00 $5,000.00 Co orate Contributions $4,848.00 $1,050.00 E8,400.00 S ecial Events $13,783.73 $33,300.00 $49,200.00 HSO Co-0 Monies $3,975.00 $12,250.00 $2,925.00 Interest Income $8.08 $100.00 $100.00 Merchandise Sale $0.00 $0.00 $0.00 Total $45,022.71 $81,000.00 $89,625.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 Special Olympics Hawaii -Agency Name Special Olympics Hawaii-East Hawaii -Program Name f E 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 certiry that information supplied herein inGuding all supporting documents is correct 3 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. ` ff awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submk a yearend report to the Legislative auditor within 80 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awaMing of the grarrt, 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 vour program's or aaencv's future funding requests. l ~ Si nature Board Pr ide UChair Dat -os Si nature of E~ cuf a irector Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTEDI NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 7 SPECIAL OLYMPICS EAST FlAWAI! 2005 Proposed Budget INCO E: County of Hawaii Grant $12,000.00 New Grant (SORT) $ 5,000.00 Hawaii Hotel industry Foundation $ 2,000.00 Charity Walk Puna Geothermal Venture $ 250.00 Chili Furuiraiser (2xlYear) $ 16,200.00 Car Wash (2x/Year) $ 3,000.00 Bake Sale (2xYear } $ 1,500.OE3 Wal-Mart Grant $ 500.00 Robert & Alice Fujimoto Foundation $ 300.00 Helco $ 500.00 Hito Vending $ 200.00 Family & Friends and Business $ 8,000.00 Partners Fundraiser Doe Grant $ 4,000.00 Weinberg Airline Coupons $ 4,450.00 Coaches GtinicAirfare (7@ $175) $ 1,225.00 SOHI Airfare Fund $ 2,600.00 Cop on Top $ 17,500.00 Law Enforcement Torch Run $ 1,400.00 Palace Theatre Benefit Concert $ 3,000.00 Tip A Cop $ 3,000.00 Sponsorship $ 3,000.00 Total projected income: $89,625.00 EXPENSES: Airfare: Summer Games (95@ 175) $ 16,625.00 Aukake Games (45 @ T75) $ 7,875.00 Winter Classic (115 @ 175) $ 20,125.00 Weinberg Softball (65@ 175) $ 11,375.00 Weinberg Aquatics (10 @ 175) $ 1,750.00 Coaches Clinic (10 @ 175) $ 1.750.00 Airfare Expense: ($59,500.00} Area Director: Salary (area's Portion} $ 2,200.00 Mileage $ 350.00 Stationery/Business Cards $ 436.00 Area ©ireetor Expense ($2,986.00} Weinberg Powerlifting Transportation Chili Fundraiser Cost (2x/yr) ($6,000.00) Leadership Conference: Airtare (8 cLD $175) $1,400.00 Hotel (5 Q $100) $ 500.00 Leadership Conference Expense 1,900.00) CarNan yenta! Q State Games 600.00) Area Track Expense 300.00) Area Bowling Expenses: Area Bowling Tournament $ 775.00 Fees (2 days) Area Bowling Cost (food ! $ 450.00 refreshments Area Bowling Practice Fees $ 5,200.00 Area Bowling Expense: 6,425.00} Softball Uniforms (75 Q $10} 750.00) Softball Equipment 1,000.00) Meeting Supplies 950.00) Office Supplies 350.00) Newsletter cost: Postage:2xtyr-300x2= $ 156.00 600 ~ $ .26 2x/yr-200x2= $ 104.00 400 @ $.26 Printing: 1000 Newsletters! $ 250.00 yr-5pgs/Newsletter= 5000 @ $.05lpage Newsletter Expense 510.00} Family & Friends and Business Partners Postage (400 @ $.26 104.00) Cop on Top T-shirts 400(cj} $4 $ 1,600.00 Advertising $ 450.00 Promationat Material (Balloons/give aways) $ 200.00 Cop on Top 2,250.00) Tip aCop-expenses (aprons & 200.00) envelopes) Torch Run Expenses (prizes & 100.00) gift baskets} Cop on Top Conference (2 @ $ 2500) 5,000.00) Post Office Box Annual Rental 50.00} Bulk postage annual fee 150.00) Storage annual rental 500.00} Total Projected Expenses: ($88,625.00} 2004 Projected Budget Prepared by Carey Uchida and Nip Ho '1!6!04 INCOME: County Of Hawaii Grant $10,000 New Grant (SOHI) $ 5,000 Hawaii Hotel Industry Foundation Charity Walk $ 1,500 Puna Geothermal Venture $ 250 Chili Fundraiser (2x !year) $16,200 Car Wash (2x/year) $ 1,500 Bake Sale (2x/yr) $ 1,500 Wal Mart Matching Grant $ 500 Robert & Alice Fujimoto Foundation $ 300 Hamakua Energy Partners $ 300 Hilo Vending $ 200 Family & friends and Business Partners Fundraiser $10,000 High Tea i;< Silent Auction $ 6,000 Ironman Triathlon grant $ 5,000 Doe Grant $ 4,000 Weinberg Airline Coupons $ 4,450 Coaches Clinic Airfare (7 @ $170) $ 1,200 SOHI Airfare Fund $ 2,600 Cop on Top $10,000 Law Enforcement Torch Run 500 Total projected income: 81 000 EXPENSES: Airfare: Summer games (95 @ $170) $16,150 Aukake Games (45 @ $170) $12,700 Winter Classic (115 @ $170) $19,550 Weinberg Softball (55 @ $170) $ 9.500 Weinberg Aquatics (10 @ $170) $ 1,700 Coaches Clinics (10 @ $170) 1 700 Airfare Expense: $61,300 Area Director: Salary (area's portion) $ 2,200 Mileage $ 900 Stationery/Business Cards 450 Area Director Expense: $ 3,400 Weinberg Powerlifting transportation $ 200 Chili Fundraiser Cost (2x/yr) $ 6,000 Fundraiser Workshop: Airfare (4 @ $170) $ 680 Hotel 200 Fundraising workshop Expense: $ 800 Leadership Conference: Airfare (8 @ $170) $ 1,350 Hotel (5 @ $100) 500 Leadership Conference Expense: $ 1,850 Car/Van rental @ State Games $ 300 Area Track Expense $ 500 Area Bowling Expenses: Area Bowling Tournament Fees (2 days) $ 475 Area Bowling Cost (food/refreshments) $ 450 Area Bowling Practice fees $4.500 Area Bowling Expense: $ 5,425 Meeting Supplies $ 950 Office Supplies $ 350 Newsletter cost: Postage: 2x/yr--300x2=600 @$.37 $ 222 2x/yr-200x2=400 @$.37 $ 148 Printing:1000 newsletters/yr-5pgs/ Newsletter-5000@ $.05/page $ 250 Newsletter expense $ 620 Family & Friends and Business Partners postage $ 74 Cop on Top T shirts 200 @ $5 $1,000 Advertising $ 100 Promotional Material(Balloons/give sways) $ 300 Cop on Top $ 1,400 High Tea expense $ 3,000 Post Office Box Annual Rental $ 50 Storage annual rental ~ 500 Total Projected Expenses: 8$ 6.799 Additional Income needed to balance budget: 5 799** SPECIA! OLYMPICS EAST HAWAI{ 2005 Proposed Budget 2005 Program Funding Source Breakdown: County of Hawaii Grant $12,000.00 Foundations New Grant (SOHI) $5,000.00 Charity Waik $2,000.00 New Sponsorship $3,000.00 DOE Grant $4,000.00 $14,000.00 {ndividuat Contributions $5,000.00 Corporate Contributions $8,400.00 HSO Co-Op $2,925.00 Special Events $ Fundraising: Chili Fundraiser $16,200.00 Car Wash/ Bake Sale $4,500.00 Friends 8~ Family $8,000.00 Cop- On -Top $17,500.00 Tip-A-Cop $3,000.00 $49,200.00 Interest Income $100.00 Totallncome $89,625.00 Special Olympics Hawaii West Hawaii Special Olympics Hawaii West Hawaii General Funding Agency Director: Nancy Bottelo Phone No.:943-8808 x 22 Contact Person: Bruce Smith Phone No.: 960-2725 Mailing Address: P.O. Box 2105, Kealakekua, HI 96750 Facility/Site Address: 75-5875 Kahakai Rd. Suite B, Kailua-Kona 96740 Fax No.: 943-8814 Email Address: specialolympicswhi@hawaii.rr.com Amount of Request for County funds: $10,000 Prior Year Funding: 02-03 03-04 04-05 $4,000.00 $5,000.00 $5,500.00 Agency Mission Statement: The mission of Special Olympics is to provide year-round sports training and athletic competition in a vaziety of Olympic-type sports for all children and adults with intellectual disabilities, giving them continuing opportunities to develop physical fitness, demonstrate wurage, 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 West Hawaii will continue our Outreach program in the coming year as well as continue to provide services to the current athletes who are training and competing. For our Outreach program we have targeted school age individuals 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 intellectual disabilities. We added a new school to our program this last year however we realize there are many more to reach. West Hawaii was able to increase our athlete participation by over 20%. NONPROFTl' GRANT APPLICATION FISCAL YEAR 2005-06 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 programs on the school age population. Our growth will continue to be slow and steady so that we may provide a quality program without stretching resources too faz. This long term goal includes a new school in the Kohala region and one in Ka'u. Special Olympics provides the 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 so many opportunities for the special needs individuals in our community to become productive citizens of our community. We provide them the opportunity to live "normal" lives within the community in which they live. Special Olympics conducts local competitions and training, we provide Holiday parties, hold local dances and picnics, and travel together to neighbor islands for competitions where dances and banquets are held. We have many athletes who have never traveled away from Kona until joining Special Olympics. We provide these individuals with a much lazger view upon the world. Special Olympics West Hawaii helps more than the Special Olympics athlete, we reach out to the families, teachers, care givers, and communities. In Special Olympics, we are all `Ghana. We provide an opportunity for pazents to share their experiences with other families that desperately need to find encouragement and hope for their disabled child. We provide an opportunity for the care givers and teachers to see their clients active and accepted by their peers, and maybe most importantly, we provide an opportunity for the community of West Hawaii to experience the unique gift of sharing time and experiences with another member of their community, that is usually forgotten through our Volunteer program. Our Athlete Leadership Program helps to train our Special Olympics athletes to become leaders within our organization. This is a project that Special Olympics West Hawaii believes in strongly. We have athletes speaking to the Kona community all the time. It is a wonderful way for the community to get to know our athletes and accept them for who they are! Very unique individuals! In order for Special Olympics West 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 mandatory training's 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, radio, television, adult facilities, etc., will coordinate the Outreach Project along with the Outreach Chairperson. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 Special Olympics Hawaii West Hawaii Special Olympics Hawaii West Hawaii General Funding Total Budget and Position Count Total Program Bud et $53,150.00 Total Pro ram Position Count 1 Total A enc Bud et $1,471,341.08 Total A enc Position Count 19 Program Objectives: 1) Increase school participation in Kohala District by 1 school and Ka'u by 1 school. 2) Increase athlete count by 10% total in the West Hawaii program. 3) Continue Unified Sports programs to involve more family members and general public. 4) Establish stable and functioning Kohala and Ka'u delegations to maintain newly recruited athletes. 5) Train new delegations on ways to maintain current and recruit new athletes, coaches, and volunteers. 6) Provide financial support for new delegations. 7) Provide activities for families and siblings in new delegations 8) Increase Athlete Leadership by training more Global Messengers (athletes trained in public speaking). 9) Continue providing high quality training and competition to the intellectually disabled individuals in the West Hawaii region. Program Highlights: 1) Increased number of certified coaches in our program by 7. 2) Our program is almost completely coordinated by family members. This includes management team, coaches, and volunteers. 3) Increased athlete count by nearly 30%. 4) Competed in Unified Softball for the first time at Regional and State competitions. 5) Had family specific events and booths at competitions. 6) Started new delegation within a school (Kealakehe Intermediate School). 7) Outreached to teachers at Teacher Institute Day. 8) Distributed outreach packets to 3 elementary schools in West Hawaii. 9) Maintained and expanded relations with local adult center (Kona Krafts). 10) Provided community service projects including aid stations at local races. 11) Extended the knowledge of what Special Olympics is all about through numerous press releases and other public education information. 12) Trained and competed in 9 Special Olympics official sports. NONPROFTI' GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Special Olympics Hawaii West Hawaii Special Olympics Hawaii-West Hawaii General Funding Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Community Service projects-Aid 7 7 8 Station State Com etitions on Oahu 3 3 3 Area! Re Tonal Com etitions 7 8 8 Dele ations within school 2 3 4 Number of athletes within ro ram 38 42 50 Number of S ecial Partners 4 20 20 Number of Unified Softball Teams 1 1 1 Number of Unified Bowlin Teams 0 1 4 Number of Families active) involved 15 25 35 Number of Famil Events 3 6 8 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Special Olympics Hawaii West Hawaii Special Olympics Hawaii West Hawaii General Funding Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 940.08 940.00 940.00 Professional Fees 0.00 0.00 0.00 0 erations 13939.15 15700.00 16000.00 E ui ment 4958.87 5900.00 6000.00 Other* airtare 23073.44 29160.00 30210.00 Total 42911.54 51700.00 53150.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate State of Hawaii DOE 1650.00 3000.00 1600.00 Coun of Hawaii Non-Profit Grant 5500.00 5500.00 10000.00 Crane Foundation 0.00 2500.00 0.00 Lar Mitchell Memorial Fund 1660.00 2000.00 2000.00 First Aide Stations 1500.00 1500.00 1500.00 Ironman Foundation 1000.00 2000.00 2000.00 Make a Difference Da Grant 0.00 0.00 0.00 Private Donations 5278.00 2000.00 2000.00 Merchandise Sales 1182.00 1150.00 1200.00 Car Washes 4 er ear 2700.00 2400.00 2800.00 Bench Press Contest 495.00 1200.00 2000.00 Fire Truck Pull 6000.00 7000.00 7000.00 Kona Marlin Golf Tournament 1980.00 0.00 0.00 Co on To 11250.00 10,000.00 10,000.00 Silent Auction 1350.00 500.00 0.00 Cor orate Contributions 1842.00 1900.00 2000.00 Service Clubs 300.00 500.00 500.00 SOHI Co-O Mone 3784.00 2500.00 2500.00 Interest Income 49.00 50.00 50.00 Under ants Run 1000.00 2000.00 2000.00 S in A Thon 0.00 4000.00 4000.00 Total 48520.00 51, 700.00 53,150.00 *If applicable NONPROFTT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 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 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 imaact the evaluation of your arogram's or agency's future funding requests. l ~ ure f Board esident/Chair Date ~ I ~ O~ Sig ature f Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFTT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 Special Olympics Hawaii West Hawaii Area Special Olympics Hawaii West Hawaii General Funding I have changed the Revenues for Actual, Current Budget, and Projected to have our Airtare incuded in the Other category. In the past grants training and equipment costs and conference costs have been incuded in Other. Those costs have been included in Operations. Program Expenditures: Other Airfare cost to 2 Regional competitions, and 3 state competitions. Airfare to Coaches Clinics throughout the year in 2005-2006. Airtare to Leadership Conference in February 2006. Total of Other Expenditures $ 30,210.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 7 Three Ring Ranch Exotic Animal Sanctuary - Ag@I1Cy Na111t3 After School Mentoring Program - PfOgl'8tll Nall"1@ Agency Director: Ann Goody Phone No.: 331-8778 Contact Person: Ann Goody Phone No.: 331-8778 Mailing Address: 75-809 Keaolani Dr, Kailua-Kona HI 96740 Facility/Site Address: saa Fax No.: 331-8773 Email Address: animals@threeringranch.org Amount of Request for County Funds: $12,380 Cost per student Mentored hour- based on the 2 day a week program if funded at 100% as requested, the cost per student hour is $4.83 an hour. Prior Year(s) Funding: 02-03 03-04 04-05 $0.00 $0.00 $ Agency Mission Statement: Our mission is to positively impact our enviornment through the education of Hawaii's children into the natural world. Our goal is to assist in the development of an enviornmentally responsible generation of youth. We are licencsed to rehabilitate and possess endangered species, allowing us to teach about the animals up close. All of our resident animals (over 70) will live out their natural lives at the facility. Those with injuries are here to heal and be released when they are able. The Three Ring Ranch Exotic Animal Sanctuary has just recently become accredited with The Association Of Sanctuaries (TAGS), proving it's dedication to superior animal care and a leval of expertise not found anywhere else in Hawaii. Opening our doors free of charge to Hawaii's youth is our way of making the mission of the Sanctuary more then just a statement on paper but a way of life we all live by. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 Three Ring Ranch Exotic Animal Sanctuary - f~g2I1Cy NaCT12 After School Mentoring Program - f fOgl'al'1'1 Nal•Y12 Program Description: After school mentoring program for intermediate school students. Small groups (3-5) work in teams to teach less experienced teams the skills they have learned. Self esteem, team- work, strong understanding of all aspects of environmental sciences and island ecology are taught in the Three Ring Ranch Sanctuary 10 week program. The Sanctuary becomes the largest outdoor classroom on the island available to the students. Each team rotates through all aspects from beginner to advanced skills during the 10 weeks of after school mentoring. Program admission is via voluntary enrollment, with parental consent and teachers support. All students must work with their teachers for a community service component of the program, which further encourages good citizenship. Total Budget and Position Count o s •oG Total Program Budget 12380.00 Total Program Position Count Total Agency Budget 500 00 ~ Total Agency Position Count ~ 10 j Program Objectives: 1 Improve self-esteem and confidence of students through parllcipallon in weekly after-school sessions al the Sanctcary wnere they will have hands-on activities in animal care, scientific research, wlldGfe rehabilitation and team building practices. 2 Increase educa(ional opportunities In our community for science and envlronmen(al study while providing small groups of youth in-depth mentoring internships. 3 Provide opporWnity for students to explore carrier options in fields of science and research through introduction to various subjects. Students are welcome to attend extra events of the Sanctuary during their Rotation period Program Highlights: Population to be servedlneedlopportunity Intermediate School children In all area schools have asked to spend time after school at the Sanctuary in some form of educational program. We have never expanded our mentoring program to include this younger group There is no program like n in Hawall. One program for after school mentoring existed at the, now closed, Keiki ZooMaw, which was funded by a hefty, annual County payment. Far several years now, the number one question from children in the classes I leach has been, "When can we come be a volunteer'. While volunteers at this age believe they are coming to help the Sanctuary, the really Is That they take an incredible amount of time to supervise, teach and mentor, which actually increases the time spent doing routine animal care. In the past !urning them away has been one of the hardest things I had to do. However, since starting our after school program. I now see tnat the reward and benefits to all, loll In the children's own words, pay for much more Than the cost of our ume This ~s our projection i(we were to expand the pilot program to include all the area intermediate schools 5 area schools that have students asking to join. Schools will enter a rotation and pnonry will not be granted !c any one school. See "applying student request letters". 3-4 students per group with 2 groups per session (one group of "experienced" students paired with one group of °beginners") 4 hours at the Sanctuary per weekly session. 10 weeks per rotation, providing a real educational experience and substantial community involvement. Four rotations per year Totals - If fully funded, this should provide after school mentonng to. (6-8 sludentslgroup) x (2 groupslwk) x (4 hrslsWdenUwk) x (10 weekslsession) x (4 sessionslyr ) =1920-2560 studen(-hourslschool year It is well documented That the fnancial burden on the families and the community to care for and rehabilitate chiltlren who have become involved with drugs or crime has grown to a crisis point in West Hawaii County While difficult to measure, the social costs are certainly becoming greater, loo. Hawaii's children need to feel that opportunities exist in acuwues that are interesting, stimulating and sale. They need the additional benefit of being exposed fo a variety of career opportunities while developing svong moral and leadership values both of which become habit at the Sanctuary in the after school mentoring youth intern program NONPROFIT GRAN"I' APPLICATION FISCAL YEAR 2005-OG Page 2 Three Ring Ranch Exotic Animal Sanctuary - Agency Name After School Mentoring Program - Fi'Ogram Name Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate 10 week pilot completed, letters 3 students 30 48-64 availible frcm students and parents, waitlist of applicants from all area schools. Yield /Student Benefit 6-8 students in one group, 2 different groups a week. 4 hours per student, per week. 4 Sessions a school year for a total of 40 hours per child minimum (1920 to 2560 total after school mentor hours) free to the (48 to 64) students per year. *If applicable No overhead or loading of other Sanctuary expenses will be assigned to this program Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es -12571.00 12000.00 12000.00 Professional Fees 0.00 0.00 0.00 0 erations 15000.00 0.00 0.00 E ui ment 2000.00 1740.00 Other* 380.00 380.00 380.00 Total 17380.00 14120.00 12380.00 *Please explain in detail on separate sheet Program funds would be used toy Sanc uary expenses normally covered by revenue generating aclivdies which would otherwise take place during the two days a week of this program. AI(hough the exact days the program takes place may vary during the week, depending upon student and Sanctuary schedules, the program will run concurrent with the school calendar. The curator ww ceoicate tnese noorsrcays to mentonng me youth program with no private tours or other revenue activities faking place during that Time. We are concurrently applying for both Atherton and Cooke Foundation grants. If, however, the mentoring program is only partially funded, the program will be adjusted based on availability of curator's time and the need for other revenue generating activities. While hosting students, we estimate a cost of $150 per day in donations lost by not being available for private, educational tours. This translates to $1200 per month for the full program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Three Ring Ranch Exotic Animal Sanctuary Telephone 808.331.8778 Fax 331.8773 animals@threeringranch.org www.threeringranch.org After school Mentoring Program Budget Year one: Costs Increased Volunteer insurance cost (CIMA Group coverage -current policy copy provided by request) $380 Student equipment for lab testing and research projects based on best value on used equipment. (Necropsy tray, lab beakers, dishes, pipettes, slides, racks) $370 Golf cart batteries -required so that students can carry out projects and Sanctuary tasks as youth interns. $650 Microscope -trinocular level for blood and cell studies. $470 Study slides for training in identification of cells and cultures. $250 Curator coverage away from other duties two davs a week $12 000 Total `04:05 year budget-program year one $14,120 There will be no loading of Sanctuary expenses or overhead assigned to this program (Second year'05 -'06 program year 2 $12,380 total -only Curator and insurance requested) Year one: Revenue or In Kind Current Sanctuary Staff include, Curator, Office mgr, web consultant, promotional consultant, legal consultant, educational consultants and Sanctuary volunteers. As we are dedicating two days a week to mentoring 1/7~h of the donated value of the staff hours can be prorated to this program. Value estimated. $12,571 These items are already on site. Centrifuge $100 Anesthesia machine $1000 Incubator $500 Scales $170 Lab table $175 Treatment room $2000 Bathroom in barn (handicapped) $15 000 Total In Kind on site and confirmed for first year $31,516 Projected Revenue Community fundraising events or other events designed to raise awareness of the program and seek out qualified patrons to establish endowments and trusts will be ongoing. Media and promotional activities are pending to inform the public of the Sanctuary programs. Event filmed on November 30~h will be shown Statewide to showcase the educational mentoring program. Community fundraising event scheduled on December 4~h projected to raise $1000. Other events with the youth mentors to be scheduled this spring include two fundraising cruises yielding estimated $1500 per cruise. Foundation Cost per student Mentored hour Based on the 2 day a week program- If the Atherton Foundation were to partner with the Sanctuary in funding this After school Mentoring program at 100% of the requested amount, the cost per student mentored hour in this program would be only $5.51 per hour. Second year funding would beat $4.83 rate per hour. Three Ring Ranch Exotic Animal Sanctuary - f~gt?flCy Naille After School Mentoring Program - PrOgl'afll Nall1@ Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Three Ring Ranch curator & office 12571.00 staff -donated hours Three Rin Ranch Bathroom 15000.00 0.00 0.00 Private donations fore ui ment 2000.00 Three Rin Ranch e ui ment 1545.00 0.00 0.00 Private fundraisin b outh 400.00 2000.00 2000.00 Atherton Family Foundation applied 0.00 for 04-05 year 12K (and 05-06 year artial 5K Ida Cooke Trust applied for 04-05 0.00 ear 5-10K Much of the first year is set up and in-kind donations that do not need to be repeated as equipment will be resued Total 31516.00 ong-term prospects for this oropram Community support has been very positive for the mentoring program and the Sanctuary in general. Rotarians have offered fundraising options. Community members whose children are in the pilot, program have said that this has touched their lives and they feel it needs to be supported. They have offered assistance In setting up long-term programs to collect revenue and maintain viability of the Sanctuary as well as expand the mentoring well beyond when their own children have graduated. The viability of the program into the third year should be well enough established so that it has a sustainable community base of revenue generating funding via trusts, endowments and monthly specific donations to sustain it. Other programs at the Sanctuary needed only time to become known before they were acknowledged and funded by community members. With the need being so great for programs of this nature community support over time seems while not guaranteed highly likely with the continued positive outcomes we are obtaining. Partial funding adjustments: Expansion of the program will be directly related to how much time we can afford to not spend on other revenue generating activities. The visitors to the Sanctuary come in private educational tours, usually given in afternoons, provide substantial contributions used to feed and care for the animals as well as fund the regular educational programs run by the facility. The Sanctuary is now at this level of financial stability through regular community awareness that resulted in part through the tours. If time is spent mentoring rather then giving private tours and the Sanctuary needs to balance ifs budget we will have to balance the dollars with the needs of the children in the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Three Ring Ranch Exotic Animal Sanctuary - Ag@I1Cy Nat71@ After School Mentoring Program - PCOgfal7l NaCII@ (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 actencv's future funding requests. _ ~Z~'~ >c~~ ~ y'~_ ~ Signatur~Fd President/Chair Date Signature of Executive Dir for Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 Turning Point for Families, Inc. Alternatives to Violence North Hawaii Waimea Groups/Pupa 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 Hawaii Facility/Site Address: (Hilo) 1266 Kamehameha Ave. #A-5, Hilo. Hi 96720 Fax No.: 934-7600 Email Address: admin2@ilhawaii.net Amount of Request for County Funds: $ 40,885.00 - Prior Year(s) Funding: 02-03 03-04 04-05 $9000 $9000 $8000 Agency Mission Statement: Turning Point for Families, Inc. is domestic violence agency that provides Shelter, Counseling, Education, and Advocacy to promote a violence-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); and the new service area Turning Point for Families, Inc. is seeking to service the district of Puna. More specifically, county funding will be used to support the ATV batterers group held in Waimea at Tutus House and the ATV batterers groups to be held in Keaau, in the district of Puna. 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 TPFFI statistical data, 40% of the individuals served by the AN program reside in the district of Puna. This percentage reflects only those who are NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 Turning Point for Families, Inc. Alternatives to Violence North Hawaii Waimea Groups/Puna Groups able to attend the program. In the first quarter of the current fiscal year 33% of the abusers served by TPFFI ATV were from Puna. The Alternatives to Violence program is a 28-week program, adding the 2 additional weekly groups for the Puna district will also allow TPFFI to serve more individuals at the Hilo location as groups are limited to 15 participants. With the funding provided by the County of Hawaii a 19-hour per week Case Manager and a 4-hour per week monitor will be hired to provide groups in the district of Puna. The Case Manager position will conduct the following for each individual judiciary and non-judiciary participant: 1. Complete intakes and assessments 2. Provide individualized Case Management 3. Facilitate 2 anger groups per week (2-hours per group) 4. Attend court hearings to report on compliance/non-compliance The Monitor is responsible for: 1. Collection of fees 2. Documentation of participants attendance 3. Co-facilitator of groups The number of individuals contacting TPFFI and filing protection orders against intimate partners continues to rise annually. TPFFI believes there is a direct correlation between those needing protection from intimate partners and the current methamphetamine epidemic in our state. The number of court ordered offenders has risen drastically over the past two years prompting an outcry from outlying communities for Domestic Violence services within their communities. Providing batterers groups in Keaau will provide access to batterer intervention services to the residents of Keaau, Pahoa, Mountain View, Kurtistown, Glenwood, and Volcano. ATV 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, and community. In addition the program stops the perpetuation of domestic violence, and provides an opportunity for abusers to become positive role models, which results in a reduction for the need of societal intervention. The targeted populations are the domestic violence batterers who reside in, North Hawaii County being referred to ATV, whom do not have reliable transportation to travel to Kailua 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. In addition NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 Turning Point for Families, Inc. Alternatives to Violence North Hawaii Waimea Groups/Puna Groups TPFFI will also target the population of batterers residing in the Puna district of East Hawaii, whom do not have reliable transportation to travel to Hilo, and cannot afford childcare for the length of time it would take them to commute to and from Hilo. 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. The Puna groups will encompass Pahoa, Keaau, Mountain View, Kurtistown, Glenwood, and Volcano. Group will be held twice a week for 2 hours from 6pm to 8pm. The location is yet to be secured however, Turning Point for Families, Inc. foresees no problems in securing a site once funding is granted. 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. Both pre and post tests are 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. The Judiciary has not increased it's funding to TPFFI for years. TPFFI Board and staff continue to meet with the Judiciary staff and state legislature in hopes of securing additional funds. The Hawaii State Coalition Against Domestic Violence, which TPFFI is a member of also continues to educate legislature of the need to increase Judiciary funds. The Judiciary has been clear they have no funds for an increase. Total Budget and Position Count Total Program Budget $996,799.00 Total Program Position Count 21 Total Agency Budget $2,233,933.00 Total Agency Position Count 63 Program Objectives: The main goal, of all ATV programs, is for participants to stop the use of physical violence towards their spouse and/or intimate partner. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 Turning Point for Families, Inc. Alternatives to Violence North Hawaii Waimea Groups/Puna Groups Projected outcomes for North Hawaii and Puna 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 the negative consequences 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 AN 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 AN 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 is given to clients to fill out and return with their name or can be done anonymously. Another method offered to clients is to have 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 grievances, 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 If the Case Manager is unable to address the issues to the satisfaction of the participant the issue will be referred through the chain of command (Program Director, Executive Director, Board President, and Board of Directors Program Committee). NONPKOFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Turning Point for Families, Inc. Alternatives to Violence North Hawaii Waimea Groups/Puns Groups 3. Weekly and Monthly Reports. The Case Managers provide weekly and monthly reports to the Program Director that entail the 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 and program development 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 thorough 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 and 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 senior 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. Program Highlights: 1. On-site drug screening, assessments and treatment for Turning Point for Families, Inc. participants in East and West Hawaii 2. 25 Hours of Domestic Violence training for all staff. 3. All ATV program staff, continue to receive on-going training in the domestic violence field. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 Turning Point for Families, Inc. Alternatives to Violence North Hawaii Waimea Groups/Puna Groups Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate # of Men served 1,031 991 991 # of Psycho-Educational Group for men who batter 620 974 974 # of Women served 1,208 1090 1090 # Psycho-Educational groups for women who batter 208 172 172 # of Women su ort rou s 156 114 114 # of Women's Pattern Changing Groups 104 104 104 # of Childcare hours rovided 624 802 802 # of Therapy hours provided to children 208 208 208 _ # of total women and men's groups provided 1,040 1,662 1,248 # of unduplicated men and women served 2,239 2,081 2,081 # of hours devoted to intakes with program articipants 3,918.25 3,005 3,005 # of hours rovidin roues 2,176 2,880 2,880 *If applicable • The numbers provided do not reflect those persons who are participating in the Hawaiian Demonstration Project (Ke Ala Lokahi) the Ke Ala Lokahi program, however will be a regular part of ATV beginning in October of 2005/06 fiscal year. These individuals would normally participate in ATV. Because this is a research project we are not able to maintain the data as part of our regular ATV program counts. • In addition, because funding levels have remained static TPFFI has had to combine groups making them larger to meet our fiscal restraints. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Pagc 6 Turning Point for Families, Inc. Alternatives to Violence North Hawaii Waimea GroupslPuna Groups Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual' Bud et* Estimate Salaries and Wa es $551,316.97 $769,903.00 $794,110.00 Professional Fees $2,000.00 $6,500.00 $6,500.00 O erations $140,672.37 $172,914.00 $189,189.00 Equipment $5,196.35 $9,257.00 $7000.00 Other* $0.00 $0.00 $0.00 Total $699,185.69 $958,574.00 $996,799.00 *Please explain in detail on separate sheet Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Count of Hawaii $9000.00 $8,000.00 $40,885.00 State of Hawaii $543,291.00 $581,341.00 $581,341.00 Federal $0.00 $104,377.00 $104,377.00 Private Foundation $5,000.00 $10,000.00 $10,000.00 Donations $4,800.00 $34,954.00 $35,755.00 Service/Pro ram Fees $118,708.90 $193,455.00 $197,183.00 Vendin $0.00 $0.00 $0.00 Fundraisin $175.00 $26,457.00 $27,258.00 Interest Income $0.00 $0.00 $0.00 Other Income $0.00 $0.00 $0.00 otal $680,974.00 $958,574.00 $996,799.00 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 7 Turning Point for Families, Inc. Alternatives to Violence North Hawaii Waimea Groups/Puna 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 your program's or agency's future funding requests. ~'~~.1~~4,~,_ I ~z(~ ~oS Signature of Board President/Chair Date Signature o xecutive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 8 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 Address: admin2@ilhawaii.net Amount of Request for County funds: $ 2,000.00 Prior Year Funding: 03-04 04-05 $0.00 $2,000.00 Agency Mission Statement: Turning Point for Families, Inc. is a domestic violence agency that provides Shelter, Counseling, Education and Advocacy to promote a violence-free community (In the County of Hawaii). Program Description: Turning Point for Families, Inc. (TPFFI) is seeking funding to continue to provide services to victims of domestic violence residing in the rural areas of Hawaii County. Turning Point for Families, lnc. 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 meet the needs of battered women within a large geographical area, and which are accessible to the population is a challenge. Being a social service agency providing services for more than a quarter of a century, we have observed a repeating trend in 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 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 Turning Point for Families, Inc. Rural Outreach Project 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). 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. The funding that was provided by the County of Hawaii for the current fiscal year allowed TPFFI to provide outreach services to 3 victims of domestic violence (in the first fiscal quarter). The victims included a 23 year old part-Hawaiian female with 2 children who had been beaten by her husband beyond recognition. TPFFI staff went to Honokaa to provide services to the victim who had 2 minor children. The victim's husband, who is addicted to Methamphetamine, destroyed the family vehicle leaving her no way to travel to reach services. TPFFI staff was able to arrange transportation to the shelter in Hilo, assist the victim with filing a temporary restraining order, and ensure the victim received medical treatment at the medical facility in Honokaa where outreach services were conducted. The victim's husband is now imprisoned and she has begun a new life. In total TPFFI has been able to serve 3 adult females with 5 minor children. On behalf of these victims and their children we say thank you. TPFFI has aggressively sought additional funding to continue these services but as of today we have been unsuccessful however; we will continue to pursue funding for this much needed service. Currently TPFFI utilizes advocates from the Hilo and Kona office to assist victims when calls come in from rural areas. TPFFI maintains relationships with those agencies that provide the necessary office space to allow advocates to work with victims who call in for assistance. The support from the County is essential to TPFFI in order to continue to provide these services, currently services are being provided on an "as needed basis". More specifically funds are utilized for mileage reimbursement for the advocate/case manager. Although we have not been able to provide the service to the degree in which we feel is needed, we are able to provide services that protect victims and their children. Since the crisis calls result in victims reaching shelters, they are moved closer to TPFFI and have access additional services at TPFFI's two main locations in Hilo and Kona. 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 many times are dependent solely on their perpetrators for NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 Turning Point for Families, Inc. Rural Outreach Project transportation, economic support, and adult interaction. It is important to note that victims who accessed the Rural Outreach program, when it 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. To further compound the need, Hale Ola Ka'u shelter, which provided services to domestic violence victims, has closed their shelter, citing a lack of volunteers to provide services. The more serious domestic violence acts that have occurred, such as the death of Mrs. Gorospe, occurred in rural areas of the County, areas, which we are proposing to serve. 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 continues to make the Rural Outreach project, its number one priority. TPFFI is requesting funding from the County non-profit granting program primarily because, it is essential in 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 Pro ram Bud et $2,000.00 Total Pro ram Position Count 1 Total A enc Bud et $2,233,933.00 Total A enc Position Count 61 Program Objectives: 1) To provide emergency crisis intervention services to the victims of domestic violence and their children in rural areas of our County. 2) To ensure the safety of both the victims and their children 3) To educate victims about the resources available to assist them and their families Program Outcome: 1. Access to domestic violence advocates providing crisis counseling, support, and resource information. 2. Domestic violence victim's increased knowledge about the resources and options available to protect them. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 _ Turning Point for Families, Inc. Rural Outreach Project Program Highlights: 1) Continued 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 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 2003-04 FY 2004-05 FY 2005-06 Actual' Bud et Estimate # of intakes com leted 3 100 100 # of children rotected b a TRO 48 289 289 # of adults rotected b a TRO 38 125 125 # of elderl rotected b a TRO 2 10 10 # of children completing Processing/Safety 48 120 120 Plannin # of women completing pattern changing 6 110 110 rou s # of women maintain violence-free lifes les 6 110 110 # of re-un~cations as a result of providing a 1 5 5 violence free environment # of women with increased knowledge of the 38 125 125 le al s stem # of communi event artici ation 1 20 20 # of advocac services rovided 241 550 550 # of children participating in the children's 48 250 250 ro ram # of person's provided services at 8 20 20 home/hos ital # of individual counselin sessions 279 500 500 # of safe checks 241 600 600 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 Turning Point for Families, Inc. Rural Outreach Project Pro ram Ex enditures FY 2003-04 FY 2004-05 FY 2004-05 Actual * Bud et * Estimate Salaries and Wa es 0 $32,587.00 0 Professional Fees 0 0 0 O erations 0 $10,542.00 $2,000.00 E ui ment 0 0 0 Other* 0 0 0 Total 0 $43,129.00 $2000.00 *P/ease explain in detail on separate sheet Pro ram Fundin Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Coun of Hawaii 0 $5,000.00 $2,000.00 State of Hawaii 0 $38,129.00 0 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 $43,129.00 $2,000.00 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 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 vear-end report may impact the evaluation of your proctram's or agency's future funding requests. Signature of Board PresidenUChair Date 13~ aS Signature of Executive Director Date UNSIGNED PROPOSALS WILL N07 BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 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: 02-03 03-04 04-05 $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 a violence-free community. (In the County of Hawaii) Program Description: Turning Point for Families, Inc. (TPFFI), 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 for more than a quarter of a century. We are the only battered women's shelter providing services to the districts of Kau, 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. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter In addition to Emergency shelter, the program provides the following: • Emergency food pantry • Safe shelter for a maximum of 90 days • 24 hours crisis hotline (information, referral, screening, and intake for the shelter) • Peer counseling and support groups • Advocacy • Case Management • Individualized safety planning • Assistance with completing and filing of 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 is 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 the children of domestic violence victims and perpetrators often learn to minimize the violence, blame themselves, or the adult victim, and deny NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter 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 assisting them in understanding that it is not their fault. Other topics covered during group include: trust building, acknowledging violence and fears, communication, new ways of coping with violence, anger management, and conflict resolution. Measured and documented 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 their 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 and documented in daily log and client files. 4. Outreach/Follow-up Services NONPROFIT GRANT APPLICATION F[SCAL YEAR 2005-06 Page 3 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter 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. Participants are encouraged to participate in the Peer Mentoring Program after they exit 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 ongoing 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. 5. 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 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, develop 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, breaching confidentiality of another participant, 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 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Pagc 4 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter for themselves and their children, assisting their 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 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 are truly no excuses 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 and self-esteem is increased residents are motivated to achieve their goals in health care, social interactions, financial security, and housing. 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 and accessing services for the first quarter of the current fiscal year was 82 with 33 being children. This is an increase of 33 more participants from the past fiscal year, during the first quarter. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter The TPFFI West Hawaii Domestic Abuse Shelter serves our community's 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, is 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. • Many of the children will develop and suffer from Post-Traumatic Stress Disorder (PTSD~ 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 otherwise 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. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 6 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter Total Budget and Position Count Total Program Bud et $517 519.00 Total Pro ram Position Count 11 Total Agency Budget $2 233,933.00 Total Agencv Position Count 61 Program Objectives: Key Objectives for the program are as follows: • Provide 24 hour emergency shelter services for battered adults and their children. • Provide case management services, individual counseling, and group counseling to the victims of domestic violence to assist them in working towards self-sufficiency and enable them to transition into aviolence-free life style. 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 do not have another safe place and/or confidential place to receive specialized support services. During the fiscal year 2003-2004 the shelter provided a total 3539 bed nights, for the 15t quarter of 2004-05 the shelter has already provided 1805 bed days. For the current fiscal year TPFFI projects the shelter will provide 4068 bed days. This increase is based on the current shelter use, and the increasing ICE problem in the State. NOivPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 7 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter Outcome Indicator Initial outcomes 24-hour access to emergency shelter Number of domestic violence victims and crisis counseling for battered adults provided intake and assessment. and their children. Increased knowledge of the legal system, Education on the legal system and number of residents filing Temporary options available to protect them and Restraining Orders. (Documentation in their children. client files). Intermediate Outcomes Short-term and long-term goal setting for Service plans developed. Goals being adult victims and their children. achieved. (Documentation in client files) Case Management, individual and group 2. Clear understanding of the dynamics of counseling sessions. domestic violence and the impact on their children. (Client evaluations) Long-Term Outcomes Transition into a violence free and Percentage of clients who report violence healthy lifestyle. free transition. (Follow-up documentation in client file) Children understand that domestic violence is a choice. Children can articulate verbally that domestic violence is not ok. (Observation during children's groups and documented in client file Program Highlights: • Successfully provided shelter services to 84 adults and 84 children who were victims of domestic violence in need of emergency shelter and services. • Provided services contracted during the previous year without any incidence of violence at the shelter. • The women and children were treated to a snorkeling cruise provided by Four Winds Inc. • The women were treated to a "be good to yourself' day and received miscellaneous services designed to increase self-esteem. This was provided by the Women of Kings Ministry's. • Kaiser Clinic Employees in West Hawaii built shelving units and installed flooring. In addition they built a large storage area under the house and provided sealed rubber maid storage containers for the storage area and NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 8 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter added additional shelving and storage containers fora 40ft container donated my Matson. • Continued success with the shelter renovation project. Specifically completed this past fiscal year was the construction and completion of a store room under the home, new flooring in the client rooms and advocates office, as well as the store rooms, and administrative support office. In addition shelving units were constructed and installed in the donated Matson storage container, and the excavation for the ADA parking stalls and ramp was completed as well as window treatments being installed i.e. drapes, rods. Plans to Upgrade: TPFFI will be seeking funding to provide transitional housing to its participants of the West Hawaii domestic abuse shelter and victims of domestic who have become homeless as a result of fleeing domestic violence, and who do not qualify for other housing options. Performance Measures: Services: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate 1. # of bed ni hts 3541 4068 4068 2. # of group service sessions hours 573 416 416 3 # of rou service reci Tents 254 200 200 4. # of individual session hours 958.25 1500 1500 5. # of adults receiving individual services hours 82 100 100 6. # of children receiving individual sessions 82 130 130 7. # of outreach hours 360.60 234 234 8. # of follow-u hours 188.33 234 234 9. # of hotline crisis calls 130 210 210 10. # of referrals 318 465 465 11. # of van tri s b staff for clients 192 260 260 *If applicable NONPROFIT GRANT APPLICATION F[SCAL YEAR 2005-06 Page 9 Turning Point for Families, Inc. West Hawaii Domestic Abuse Shelter Pro ram Ex enditures FY 2003-04 FY 2004-05 FY 2005-06 Actual Bud et * Estimate Salaries and Wa es $294,756.96 $333,047.00 $334,047.00 Professional Fees 0.00 $4,300.00 $4,300.00 O erations $78,534.34 $171,264.00 $174,472.00 E ui ment $1,810.36 $4,700.00 $4,700.00 Other* 0 0 0 Total $375,101.66 $513,311.00 $517,519.00 *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 $154,751.46 $166,904.00 $166,904.00 Federal $116,609.00 $114,909.00 $114,909.00 Private Foundations $56,250.00 $40,125.00 $40,125.000 Donations $3,034.00 $131,287.00 $131,768.20 Service/Pro ram Fees $16,372.68 $10,000.00 $12,245.60 Vendin 0 0 0 Fundraisin $4,300.00 $29,086.00 $29,567.20 Interest Income $809.55 0 0 *Other Income 0 0 0 Total $373,126.69 $513,311.00 $517,519.00 *If applicable 1\ONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 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 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 funding requests w~~;, I lz~ /os Signature of Board President/Chair D to e 1 '~t °5 Signature of Executive Director Dat NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 11 2003-04 2004-05 2005-06 Prof. Fees 1200 4300 4300 Fortunately another contract was able to pay for all Prof. Fees in 2003-04 Equip 4000 4200 4700 F.Y. 2003-04 expenditures very low due to an unusually low equipment failure rate Contr. Serv 2500 5000 5000 Related to renovations currently being done at shelter Mileage 3500 4200 4200 Travel 3000 3000 3000 Staff Train 3000 1200 1200 Conf & Luncheon 500 500 500 Office Supplies 1500 2000 2000 R8M Space 12000 27000 27810 Shelter renovations Telephone 5000 5000 5000 Postage 500 1000 1000 Taxes/Lic 100 100 100 Subs.B Dues 700 700 700 Bnk Serv. Charges 500 500 500 Int. Exp 22000 22000 22000 Office Space Rent 2000 5000 5300 Ins. Gen 8000 22464 23812 Significant increases in insurance premiums Ins.Veh 1600 1600 1600 Util. 8500 12500 13250 Prov. Food 12000 12000 12000 Prog. Supplies 12000 14500 14500 Client Assist. 10000 15000 15000 Furn. Purch 1500 1000 1000 P. R. & Advert 2500 3000 3000 Depr. 12000 12000 12000 West Hawaii Mediation Center Mediation Services Agency Director: Deborah Chai Phone No.: 885-5525 Contact Person: Deborah Chai Phone No.: 885-5525 Mailing Address: PO Box 7020, Kamuela, HI 96743 Facility/Site Address: 65-1279 Kawaihae Rd, Ste 217, Kamuela, HI 96743 Fax No.: 887-0525 Email Address: whmc@bigisland.net Amount of Request for County Funds: 510,000.00 Prior Year(s) Funding: 02-03 03-04 0405 55000.00 55000.00 54000.00 Agency Mission Statement: West Hawaii Mediation Center exists to improve the way people deal with conflict by providing mediation, facilitation, conflict resolution education and training services. Program Description: The funds are requested to support West Hawaii Mediation Center (WHMC) which serves the districts of Hamakua, North 8~ South Kohala, North 8~ South Kona, and Ka'u. WHMC provides community-based mediation services for both self-referred and court/legal system referred clients. These services are provided in an accessible and affordable manner to ensure any and all disputes in West Hawaii can be resolved in a safe, fair and. appropriate way without the expense (time and money) of litigation. WHMC utilizes trained community volunteers to deliver this vital service to their fellow community members. Total Budget and Position Count Total Pro ram Bud et 77,000 Total Pro ram Position Count 1 Total A enc Bud et 100,000 Total A enc Position Count 2 NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 West Hawaii Mediation Center Mediation Services Program Objectives: 1) Provide information and referral services to individuals who need services instead of, or in addition to, the mediation services offered at WHMC. 2) Recruit, train and retain high~uality volunteer community mediators. 3) Provide mediation services in an affordable and accessible manner for disputes arising both in and out of the 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) Delivered 1,665 hours of case intake services. 2) Served 188 cases (65% court/legal system referred; 35%self-referred) with 420 clients served. 3) Utilized 45 volunteer mediators in 127 mediation sessions for a total of 232 hours of mediation. 4) Reached full agreement in 52% of cases mediated. 5) Achieved a 84% service satisfaction rating by respondents (post- mediation satisfaction survey). 6) Achieved a 98% rating by respondents indicating that they would recommend mediation to others in the future. 8) Provided 48 % of total services to low income clients (annual income under $20,625). NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 West Hawaii Mediation Center Mediation Services Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Case Mana ement Hours 1665 1665 1665 Mediation Cases Served 188 200 225 Mediation Sessions Conducted 127 140 150 reements reached in mediation 52% 70% 70% Clients satisfied with service 84% 90% 90% Client's willing to recommend 98% 95% 95% service to others Skills enhancement trainings 4 5 5 offered for volunteers Affordable service to low income 48% 45% 45% of clients considered low income Community Awamess and 6 8 8 Education Sessions *If applicable Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Salaries and Wa es 59059 56958 60000 Professional Fees 1000 1500 O erations 15399 19042 23000 E ui ment 2000 Other` Total 74458 77,000 86500 *Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 West Hawaii Mediation Center Mediation Services Program Funding Soun:es Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Coun of Hawaii 5000.00 4000 7000 State of Hawaii 45000.00 45000 47000 Priviate Foundations 693.00 1700 2000 Donations 6375.00 8000 7500 Fundraisin 5664.00 9000 7500 Service/Pro ram Fees 5495.00 3650 5000 Client Private Fees 4810.00 3750 5000 Refund 1421.00 Total 74458.00 75100 81000 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 West Hawaii Mediation Center Mediation 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 induding 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. comulste. and accurate vear-end resort may imaact the evaluation of vour ~roaram's or a9encv's future fundins requests. ( Signature of Board PresidenUChair Date / / ~~s(oS Signature of xecutiv Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 YwcA of Hawaii Island -Agency Name YwcA Hamakua -Program Name Agency Director: Cynthia Albers Phone No.: 935-7141 Contact Person: Cynthia Albers Phone No.: 935-7141 Mailing Address: 145 Ululani St., Hilo HI 96720 Facility/Site Address: 45-3396 Mamane St., Honoka'a, HI Mailing Address for Program: PO Box 777, Honoka'a, HI 96727 Fax No.: 808-935-5150 Email Address: ywcaexec~ilhawaii.net Amount of Request for County Funds: $10,000.00 Prior Year(s) Funding: 02-03 03-04 04-05 $5500.00. $5500.00 $6000.00 Agency Mission Statement: The YWCA 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 YWCA 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. The YWCA will thrust its collective power toward the elimination of racism wherever it exists and by any means necessary. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 YWCA of Hawaii Island - AgetlCy Nam@ YWCA Hamakua - P~09~8iY1 N8t11@ Program Description: YWCA Ekahi Hamakua Youth Center has provided youth substance abuse prevention and youth activities since 1996. The recent departure of longtime Program Coordinator, Judith Graham, has spurred assessment of program activities and community needs. One result of that assessment is the name: YWCA Hamakua will focus on providing accessible social, educational, health and recreation activities for youth and other residents of Honoka'a and the surrounding area. Current operations include a no-cost, after-school drop-in center for secondary school age students. The center is is equipped with an up- to-date computer lab, photography dark-room, pool table and capacity for various arts, crafts, and healthffitness activities. Expanded activities will gradually introduce fees for service to in order to assure sustainability and build ownership among constituents. Substance abuse prevention for all ages will be emphasized by providing a variety of stimulating materials and activities. Project Alert, aschool-based substance abuse prevention curriculum, funded by State of Hawaii, Department of Health, Alcohol and Drug Abuse Division (ADAD) targets 7`h and 8~h grade students attending Pa'auilo and Honoka'a Schools. Current funding ends in June 2005 and we are applying for continued funding from ADAD for the upcoming year that will support expansion and adaptation of Project Alert for youth and their parents in anon-school setting. In 2005-06, plans for the center include expanded hours and days of operation, additional youth activities, as well as programs for adults, mothers and babies, and activities for families that foster education, skill building and increase family bonds. As a result of expansion plans, we are requesting an increase in funding level. Total Budget and Position Count Total Pro ram Bud et 135750.00 Total Pro ram Position Count 9 Total Agency Bud et 3937159.00 Total A ency Position Count 105 Program Objectives: The YWCA Hamakua envisions a community where all its members are making strides toward attainment of their highest goals. The services proposed will have the effect of strengthening the community through prevention education activities that address risk and protective factors that influence substance abuse by youth. Activities will take place primarily at the center located in Honoka'a Town and will focus on several segments of the population including youth and NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 2 their families. Women and girls figure importantly in the mission objectives of the YWCA. Accordingly, we will provide activities that are especially suited or tailored to women and girls. The prevention component will be supported by the addition of positive choice programs that may include self-defense, dance, computer technology, photography, nutrition, personal development and the like. These offerings will be made available to persons of varying ages and abilities. Dependent upon funding, programs will be low to no cost to participants. Incentives will encourage participation by youth/parent teams in prevention courses. 1) We will continue to provide the popular after-school drop-in center that offers both structured and unstructured activities at no cost to intermediate and high-school students until 4:30 or 5:00 pm each school day. Computer/internet access, study groups, special interest clubs, and workshops will serve 20 to 40 teens daily. The center strives to welcome both genders and provide various types of activities that appeal to youth and provide constructive use of leisure time. 2) Provide a substance abuse prevention curriculum, Project Alert, to all 7th and 8th grade students attending Pa'auilo and Honaka'a Intermediate Schools. Project Alert is rated a Model program by SAMSHA, with proven success in delaying the age of initiation to marijuana, tobacco and alcohol. Plans for 2005- 06 include adaptation of Project Alert for delivery to youth and their parents during non-school hours. 3) Provide on-going health-promoting and life-enhancing classes and short- term workshops geared to various population groups in the Hamakua community. Programs may include computer technololgy, job skills development, martial arts, yoga, dance, communications or nutrition, as well as other topic areas that may be desired by community members. 4) Enrich the public school arts curriculum by providing darkroom and digital photography instruction to approximately 30-40 teens annually. 5) Work in partnership with other Hamakua organizations and businesses in order to best serve the community needs, minimize duplicative services and capitalize assets. This includes the Na Opio O Hamakua Summer Youth Leadership Camp, to be presented in partnership with Hamakua Health Center. A primary program objective will be to retain the services of a committed and qualified individual to serve as the YWCA Hamakua Program Director. Program Highlights: 1) Provided a safe, welcoming gathering place with computer lab and opportunities for social, educational and recreational experiences to an average of 30 youth daily after school throughout the school year. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 2) From July-December, the Prevention Education Specialist delivered Project Alert, a substance abuse prevention curriculum, to seventy-nine (79) 7"' grade students attending Honoka'a and Pa'auilo Intermediate Schools. The 8- session 7"' grade curriculum is followed with a 3-session "booster" course the following year. Eighth-grade students numbering eighty (80) received the booster thus far this year. During the spring semester, it is anticipated that the remaining 7"' and 8~' grade students at the two schools, numbering approximately 80, will receive Project Alert. Program evaluation by Errol Yudko, Ph.D., UH Hilo, Professor of Physchology utilizes pre- and post-test surveys by the students. 3) Conducted three family drug-prevention education evenings during Fall 2004 that were attended by 20 to 40 family members at each. 4) Na Opio O Hamakua, a Youth Leadership day-camp, served 30 students during three weeks in July 2004. Presented in partnership with the Hamakua Health Center, the camp offers focused activities in the areas of health, environment, citizenship and recreation. 5) Approximately 37 students from Honoka'a High School were provided photography instruction in digital or black and white darkroom photography. An additional 15-20 students, all referred through the Honoka'a High School Art Department, will benefit during the spring semester. The program will culminate with "Follow the Eyes of Youth", a series of three photography exhibits, in Spring 2005. The student work will be featured at business locations that are highly frequented by residents and tourists, including the two Tex Drive Inn locations. During 2004-2005, the photography program has been funded by the John M. Ross and Mclnerny Foundations, as well as a grant through County of Hawaii, Research and Development, Hawaii Tourism Authority Product Enrichment Program. NONPROFTT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 YWCA of Hawaii Island -Agency Name irwcA Hamakua -Program Name Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual ` Bud et' Estimate Avg # of youth in attendance daily 30 35 35 at Afterschool Dro -in center Total number of youth served n/a n/a 120 annual) at Afterschool Dro -in # students completing photography 30 37 to date 45 courses in collaboration with Honoka'a Hi h # 7 & 8 grade students receiving 143 123 to date 145 drug prevention curriculum at DOE schools Total # persons involved in a center n/a n/a 200 based ro ram annual) # persons under 18 enrolled in n/a n/a 25 ro ram for 1 month # persons under 18 enrolled in n/a n/a 15 ro ram for 3 months or more # persons over 18 enrolled in n/a n/a 15 ro ram for 1 month # persons over 18 enrolled in n/a n/a 10 ro ram for 3 months or more "If applicable Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual " Bud et ` Estimate Salaries and Wa es 2601.22 3149.99 5738.00 Professional Fees 550.00 550.00 1200.00 0 erations 1658.28 1800.01 3062.00 E ui ment 690.56 0.00 Other' Total 5500.06 5500.00 10000.00 'Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 YWCA of Hawaii Island -Agency Name YwcA Hamakua -Program Name Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate State De t. of Health, ADAD 75000.00 75000.00 100000.00 Mclne Foundation 5000.00 6000.00 7000.00 Hawaii Tourism Authorit 0.00 5000.00 5000.00 Michael & Susan Dell Foundation 7500.00 0.00 0.00 Queen Liliu'okalani 2528.00 0.00 0.00 Count of Hawaii 5500.00 6000.00 10000.00 John Ross Foundation 0.00 Castle Foundation 3000.00 HIUW CHOICES 8750.00 Pro ram Service Fees 2000.00 Contributions 2843.00 1213.00 0.00 Salesforce.com Foundation 7500.00 0.00 Total 105871.00 93213.00 135750.00 *If applicable NONPROFTT GRANT APPLICATION FISCAL YEAR 2005-06 Pale 6 YWCA of Hawaii Island - Agency Name YwcA Hamakua -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 arogram's or aaency's future funding requests. ~ l~3/~G~s Sign ture of Boar Presid UChair Date 1~3~ os ature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Pale 7 YwcA of Hawaii Island -Agency Name SAVE (Sexual Assault Victim Empowerment) - PfOgfam Name Agency Director: Cynthia Albers Phone No.: 935-7141 Contact Person: Lorraine Davis Phone No.: 935-7141 Mailing Address: 145 Ululani St. Facility/Site Address: East Hawaii - 197 Kinoole St., Hilo, HI 96720 West Hawaii - 75-5759 Kuakini Hwy., Kailua-Kona, HI 96740 Fax No.: 935-5150 Email Address: ywcaexec@ilhawaii.net or ywcaqual@ilhawaii.net Amount of Request for County Funds: $60000.00 Prior Year(s) Funding: 02-03 03-04 04-05 $50000.00 $50000.00 $46000.00 Agency Mission Statement: The YWCA 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 YWCA 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 atf people. The YWCA will thrust its collective power toward the elimination of racism wherever it exists and by any means necessary. NONPROFTT GRANT APPLICATION FISCAL YEAR 2005-06 Page 1 YWCA of Hawaii Island - Ag@I1C)/ N81112 SAVE (Sexual Assault Victim Empowerment) - PfO9f8~'1 Name 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 crisis center for the island of Hawaii. Skilled and supportive Crisis Workers provide phone support to callers on the 24hour Sexual Assault Crisis Line, or offer 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 (SANE) in the Hawaii County Protocol for forensic examination of sex assault 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 prevention education program. The YWCA is now in our third decade of helping sex assault survivors, who are women and men, girls and boys. Primary funding of the program is through State of Hawaii, Department of Health through a subcontract with the Kapi'olani Women's and Children Medical Center, Sex Assault Treatment Center. As a result, quality assurance, program and fiscal monitoring of services is maintained at standards. If the County of Hawaii decides favorably for continued funding of the SAVE Program, it can do so with the knowledge that professional standards are practiced in the both service delivery and expenditure of funds. Total Budget and Position Count Total Pro ram Bud et 466761.00 Total Pro ram Position Count 17 Total Agency Bud et 3937159.00 Total A ency Position Count 105 Program Objectives: 1) Continue to operate the 24-hour Crisis Hotline intercepting calls from persons seeking support, information and referral that may lead to face to face support in # 2 below. 2) Provide a SAVE Crisis Worker to support each sex assault victim undergoing medical-legal examination in the period July 1, 2005 through June 30, 2006. 3) Deliver professional counseling and/or case management services to 100 sex assault survivors. NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Pale 2 4) 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. 5) Provide sexaul assault awareness and prevention education to 1000 school aged students. 6) Provide education to 25 professionals about the needs of adult/child survivors of sexual assault and methods to detect and report sexual child abuse or abuse of dependent adults. Program Highlights: 1) Lorraine Davis, YWCA Quality Control Compliance Manager, was a contributing partner at six (6) statewide Sex Assault Strategic Planning meetings held in Honolulu between July and December 2004. The purpose of the group: 'To provide a statewide system of comprehensive and effective care for sexual violence victim needs and services as well as sufficient and reliable funding to ensure stability and program continuity". Conducted by the State DOE, in partnership with SATC, service providers and other stakeholders, the sessions have led to a comprehensive assessment of existing services, gaps, funding and oversight. We are encouraged by the process and final report that assigns fiscal responsibilty to the state. However, the time and process for the responsibility to be met is yet to be determined. 2) Two, University of Hawaii, Hilo nursing students began practicum for their senior community health seminar in January 2005 through YWCA SAVE. 3) Members of the SAVE staff and YWCA administrators participated in the Children's Justice Center Interagency Advisory Committee, the Hawaii Coalition Against Sexual Assault, and the Big Island Coalition Against Physical and Sexual Assault. These committees or coalitions include the involvement by staff from the following agencies: the Hawaii County Police Department, Child Welfare Services, Prosecuting Attorney, Victim Assistance Counselor, Family Court, Juvenile Probation Officers, Deputy Attorney General, Public Health Nurses, CAMH Division of the Department of Health, Department of Human Services, Department of Education and statewide service providers. The efforts of fosters consistent care throughout the County and State for sex assault services and working together as agencies to provide the best practices care for the victims. 4) The YWCA was awarded $5,675, aone-time special fund from the Hawaii Island United Way to increase Sex Assault Prevention Education on the Big Island. These funds, targeted for schools and professional settings not served by this program in recent years, includr South and West Hawaii locales. This award recognizes the importance education prevention and the unacceptabilty by the community for diminished services due to funding. NONPROFTT GRANT APPLICATION FISCAL YEAR 2005-06 Page 3 e NONPROFTT GRANT APPLICATION FISCAL YEAR 2005-06 Page 4 YWCA of Hawaii Island - A9ef1Cy NBCile SAVE (Sexual Assault Victim Empowerment) - Pf09~8fY1 N8CT1@ Performance Measures: FY 2003-04 FY 2004-05 FY 2005-06 Actual * Bud et * Estimate Fully trained personnel are Phone line Phone line Phone line available to assess and respond to available 24 available 24 available 24 callers on the Sexual Assault Crisis hours/day, hours/day, hours/day, phone line. 365 days a 365 days a 365 days a year served year year 337 callers estimate estimate serving 250 serving 300 callers callers Crisis counseling, legal systems 231 victim 175 victim 225 victim advocacy, information and referral service service service are provided to each sex assault contacts contacts contacts victim undergoing medical-legal examination in East Hawaii and West Hawaii Survivors of sexual assault receive 147 100 150 psychotherapy services and intensive clinical case management from SAVE masters-prepared therapists in East Hawaii or West Hawaii School aged students receive 713 1000 1000 sexual assault prevention and awareness trainin Professionals receive training in 179 100 100 awareness of the needs of adults and child sexual assault survivors, how to detect and report child sexual abuse or sexual abuse of de endent adults *If applicable NONPROFTT GRANT APPLICATION FISCAL YEAR 2005-06 Page 5 Program Expenditures FY 2003-04 FY 2004-05 FY 2005-06 Actual' Bud et' Estimate Salaries and Wa es 20600.35 32439.48 42215.92 Professional Fees 16986.27 9339.22 10354.08 O erations 11805.72 4221.30 6670.00 E ui ment 143.40 0.00 700.00 Other" 464.26 0.00 60.00 Total 50000.00 46000.00 60000.00 "Please explain in detail on separate sheet NONPROFTT GRANT APPLICATION FISCAL YEAR 2005-06 Pale 6 YWCA of Hawaii Island -Agency Name SAVE (sexual Assault victim Empowerment) -Program Name Program Funding Sources Revenue Source FY 2003-04 FY 2004-05 FY 2005-06 Actual' Bud et' Estimate Count of Hawaii 50000.00 46000.00 60000.00 State of Hawaii DoH-iNVCMC 186449.00 166964.00 166964.00 Federal Fundin 11798.80 18061.30 14875.00 Hawaii Island United Wa 5675.60 0.00 Donations 2103.00 1347.60 Pro ram Service Fees 15.60 0.00 Reimbursements for Trainin 4426.51 4500.00 4500.00 State of Hawaii, DoH, 149456.91 224174.57 additional re uest Total 254792.91 392005.41 470513.57 'If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 7 YWCA of Hawaii Island -Agency Name SAVE (Sexual Assault Victim Empowerment - PI.Ogram Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2-135 - 2-142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that 1 (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, 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 imaact the evaluation of vour arogram's or agency's future funding requests. / - .3/-0 ~ Signa re of Board Pr ident/Chair Date l - .3/ - oS S~ ature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2005-06 Page 8