Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
COM 0692.000 2008-2010
County of Hawai`i Nonprofit Organizations Grant Applications for Fiscal Year 2010 -11 , :t : . t OF yq''e -e" o •.[y '4, • I ' e' , n /1'' Mo t• ? 1 4� O; N ‘14 February, 2010 comm. NQ. Ref. To, 0 Ref. Dote __3 Z� Q_— ."JM or x k. +.,'.. Nancy E Crawford William P Kenoi �16i;,,; J ;� Director Mayor Deanna S. Sako •.,. it .. q:�� Deputy Director County of Hawaii Finance Department 25 Aupuni Sweet Suite 2103 • I Itlo, Hawaii 96720 r +el (808 1961 -8234 • Fa. (8081961- 8569 .`•- Y. O C) v� O C0 rn Cr 0 y ai _0 February 3, 2010 ? rr J Yoshimoto, Chair and -,,-1 7D Members of the Hawaii County Council x V Hawaii County Council cD 25 Aupuni Street _ a Hilo, Hawaii 96720 Re: Nonprofit Grant Application In compliance with Chapter 2, Article 25 of the Hawaii County Code, I am submitting the applications from eligible nonprofit organizations for your review and appropriation of funds for the FY2010 -11 nonprofit grant program. Also enclosed is a list of these eligible organizations with the name of their program and the amount they are requesting from the County Should you have any questions, please feel free to call me. f , Nancy E. Crawford Director of Finance Enc. Applications for Nonprofit Grant Funds List of Nonprofit Grant Applicants (Note: The attached applications, a large booklet, is not a part of the duplicate copies of this document, but is available for viewing in the County Clerk's Office and on the County Clerk - Council website at co.hawaii.hi.us.) l Hawaii County is an Equal Opportunity Provider and Employer NONPROFIT GRANT APPLICANTS FOR FY2010 -11 ORGANIZATION NAME PROGRAM NAME REQUESTED • 1 lAmencan Cancer Society Hawaii Pacific Patient Services for East & West Hawaii Cancer Patients $ 15,000 00 2 'American Red Cross - Hawaii State Chapter I [ Disaster Response & Preparedness for County of Hawaii -' 25,000 00 3 The Arc of Hilo JArc of Hilo ADRC Advocacy Program j 52,610 00 4 The Arc of Kona _ [Home and Community Based Services -Life Skills Program j 15,000 00 5 Arts & Sciences Center 'HAAS Productions I 80,000 00 6 Arts & Sciences Center HAAS Workplace Readiness Program Agriculture /Landscape Training 5,000 00 Program 7 Bay Clinic, Inc 'Bay Clinic Family Health Center, at Komohana 50,000.00 8 'Bay Clinic, Inc (Children's Dental Care [ 60,000 00 9 Big Island Resource Conservation and Development Resource Conservation and Development Program 10,000 00 Council, Inc • 10 Big Island Substance Abuse Council 'East Hawaii Substance Abuse Program 30,000 00 11 'Big Island Substance Abuse Council IKokua EAP (Employee Assistance Program) [ 18,000 00 12 [Big Island Substance Abuse Council 1West Hawaii Substance Abuse Program 30,000 00 13 Boys & Girls Club of the Big Island 'Positive Youth' Development Programs Hamakua Club 40,000 00 14 Boys & Girls Club of the Big Island 'Positive Youtt Development Programs Hilo Club 60,000 00 15 Boys & Girls Club of the Big Island 'Positive Youth Development Programs Kea'au Club [ 40,000 00 16 Boys & Girls Club of the Big Island Positive Youth Development Programs Ocean View Club 40,000 00 17 Boys & Girls Club of the Big Island Positive Youth Development Programs. Pahala Club 40,000 00 18 Boys & Girls Club of the Big Island Positive Youth Development Programs Pahoa Club 40,000 00 19 Brantley Center, Inc Employment Rehabilitation Program 25,000 00 20 Bridge House, Inc 1Vocational Skills Building Program [ 28,000 00 21 Child & Family Service [Alternatives to Violence 35,000 00 22 Child & Family Service 'Hawaii County - Domestic Abuse Shelters [' 35,000 00 - 23 _ [Child & Family Service [Hilo Transitional Housing Program 40,000 00 24 Child & Family Service Therapeutic Foster Home Program __ 35 00 25 Dragons Eye Learning Center Ama Canoe Building [� 25,600 00 i 26 Family Support Services of West Hawaii 'Ka'u Family Center I 60,000 00 27 Friends of Big Island Drug Court Assistance to Drug Court Clients & Program [ 10,000 00 28 Friends of the Children's Justice Center of East Hawaii Special Needs & Enhancement, Center Support, 10,000 00 Prevention /Education & Training Programs _ _ _ 29 Friends of the Children's Justice Center of West Hawai'i Enhancement and Basic Needs � 15.000 00 30 Goodwill Industries of Hawai'i, Inc [Job Connections Program _ j 30,000 00 31 Goodwill Industries of Hawaii, Inc (Work Experience Program [ 45,_000 00 _ 32_IGrassroots Community Development Group ! Kea'au Youth Business Center Program _ I - 45,000 00 _33_ [Grassroots Community Development Group IKupukupu After - School _ 30,000 00 _ 34 Habitat for Humanity [General Operating Support/Staffing 50,000 00 35 Hale Aloha 0 Hilo Habitat for Humanity, Inc [Affordable Housing Operations 50,000 00 36 Hale Kipa 'Intensive In -Home 40,000 00 37 IHamakua Youth Foundation Hamakua Youth Center - - 00_ 38 jHawai i Centers for Independent Living Independent Living Services 15,000 00 39 Hawaii Children's Complementary Therapy and Research Educational Health Programs 17,755 00 Clinic (Mana Ola 0 Ka Lani) 40 Hawaii County Economic Opportunity Council Community Organization 98,000 00 41 'Hawaii County Economic Opportunity Council Drop -Out Prevention Program 88,766 00 42 'Hawaii County Economic Opportunity Council 'Language Arts Multicultural Program 156,500 00 43 'Hawaii Island Adult Care, Inc 'Hilo Adult Day Center [' 25,000 00 44 Hawaii Island HIV /AIDS Foundation Multi - Disciplinary HIV Case Management, Hilo [ 15,000 00 45 JHawaii Island HIV /AIDS Foundation Transmission Prevention for HIV+ Women in West Hawaii ' 15,000 00 46 Hawaii Island Workforce & Economic Development Ohana Community Connections 84,100 00 (HIWEDO) • 47 Hawaii Island Workforce & Economic Development Ohana Going Home 87,000 00 (HIWEDO) 48 Hawaii Island Workforce & Economic Development Ohana Huiana Internship Program 73,930 00 (HIWEDO) 49 Ho'oulu Lahui Inc From the Seed to the Table 20,420 00 50 'Hui Malama Ola Na 'Oiwi IKekua Hall Health Transportation Program 39,387 00 _ _51 [The Island of Hawaii YMCA 'Impact Youth Assets 2010 -2011 65,000 00 52 Ka Hale 0 Na Keiki Inc [Families -At -Risk __ _ 12,500 00 53 KalauonaoneoPuna 13rd Annual Kalapana Cultural Day 10,000 00 NONPROFIT GRANT APPLICANTS FOR FY2010 -11 ORGANIZATION NAME PROGRAM NAME REQUESTED Kapio'lani Child Protection Center - West Hawaii 10,000 00 54 Kapi olam Medical Center for Women & Children Title IV -B -West HI Counseling & Supportive Living Project - 55 Keaukaha One Youth Development Youth Development [ 10,000 00 56 Kona Adult Day Center, Inc. Adult Day Care ! 30,000 00 57 Kona Historical Society Living History Program Operations [ 50,000 00 58 Kona Hospital Foundation Adopt -a -Room 187,050 24 59 Kona Literacy Council Kailua Learning Center 2,000 00 60 Ku'ikahi Mediation Center Community Mediation Program 30,000 00 61 Laupahoehoe Train Museum [Visitor Outreach Program 40,000 00 62 Lyman Museum Education and Public Programs 50,000 00 63 [ Mala'ai The Culinary Garden of Waimea Middle School Mala'ai The Culinary Garden of Waimea Middle School 25,000 00 64 I Malama 0 Puna Bruddah Kui s Youth Jamm 5,000 00 65 Mental Health Kokua [Residential Rehabilitation Services [ 20,000 00 66 Neighborhood Place of Kona !Caring for Families & Children 40,000 00 67 [Neighborhood Place of Puna Family and Community Strengthening 25,000 00 68 0 Ka'u Kakou 0 Ka'u Kakou 77,000 00 69 Office for Social Ministry Beyond Shelter Transitional Shelter 15,000 00 70 Office for Social Ministry Care -A -Van Homeless Outreach 20,000 00 71 Office for Social Ministry Kihei Pua Emergency Shelter 20,000 00 72 [Office for Social Ministry IPahoa Homeless Program' Puna Drop In Services 20,000 00 73 Office for Social Ministry Ponahawaiola Community Re integration Services _ 40,000 00 _ 74 Palekana Kai Ocean Safety, LLC Ocean Safety Education 30,000 00 75 Parents And Children Together Keonepoko Elementary PrePlus [ 80,000 00 76 [Puna Community Medical Center [Walk -in /Acute Care Clinic Uninsured Program [ 149,200 00 77 Puna Men's Chorus 1 2010 Concert Series 7,000 00 78 The Salvation Army Family Intervention Services _ Independent Living Skills Program - West Hawaii 39,086 00 79 The Salvation Army Family Intervention Services Prevention Programs - Honokaa 52,656 00 80 The Salvation Army Family Intervention Services Prevention Programs - Pahoa [ 44,723 00 81 [ Special Olympics Hawaii - East Hawaii Special Olympics Hawaii - East Hawaii I 20,000 00 82 (Special Olympics Hawaii - West Hawaii [Special Olympics West Hawaii - General Funding 1 15,000 00 _ 83 JSure Foundation, Inc Yeshua Outreach Center 70,000 00 84 (Volcano Health Collaborative Volcano Connections 24,000 00 _ 85 [Volunteer Legal Services Hawaii [County of Hawaii Pro Bono Legal Services 55,000 00 _ 86 I We Hawaii Community Health Center _ Adult Emergency Dental Services _ [ 36,434.00 87 I West Hawaii Mediation Center Mediation Services [ 15,000 00 88 [YWCA of Hawaii Island [Healthy Start Plus [ 200,000 00 89 YWCA of Hawaii Island [Sexual Assault Support Services 60,000 00 I TOTAL [ $ 3,738,717 24 1 American Cancer Society Hawaii Pacific Patient Services for East & West Hawaii Cancer Patients American Cancer Society Hawaii Pacific- Agency Name Patient Services for East & West Hawaii Cancer Patients - Program Name Agency Director: Jackie Young, PhD Phone No.: 808 - 595 -7500 (Oahu) Contact Person: Cathy Hashimoto Phone No.: 935 -0025 Mailing Address: 120 Pauahi Street, Suite 302 Hilo HI 96720 Facility /Site Address: (same) Fax No.: 935 -9780 Email Address: cathy.hashimoto @cancer.org Name of Accountant/CPA (include name of firm if applicable): Phone No.: Mailing Address: Amount of Request for County Funds: $15,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $0 $10,000 Agency Mission Statement: NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Established in Hawaii in 1959, the American Cancer Society Hawaii Pacific, Inc., is part of the nationwide community -based voluntary health organization dedicated to eliminating cancer as a major health problem. Sharing in this mission, the East and West Hawaii offices work to save lives by helping people stay well by preventing cancer or detecting it early; helping people get well by being there for them during and after a cancer diagnosis; by finding cures through investment in groundbreaking discovery; and by fighting back by rallying communities worldwide to join the fight against cancer. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 American Cancer Society Hawaii Pacific - Agency Name Patient Services for East & West Hawaii Cancer Patients - Program Name Program Description: As the largest and most comprehensive cancer patient support organization, the American Cancer Society is determined to improve cancer patient quality -of -life by eliminating the gaps in services and information that are inherent in the current health care system. The American Cancer Society's two offices on the Big Island work tirelessly to enhance cancer patients quality -of -life through programs such as: transportation to complete their cancer treatment, informational support to patients and their families to better navigate their cancer journey, messaging about cancer prevention to all Big Island residents, and a venue for the the entire community to fight back against cancer. Total Budget and Position Count Total Program Budget $42,425 Total Program Position Count 0 Total Agency Budget $3,886,476 Total Agency Position Count 36 Program Objectives: 1) To support East and West Hawaii residents of the Big Island who are newly diagnosed with cancer, in the completion of their medical treatment; 2) To improve the quality of life for East and West Hawaii residents with a cancer diagnosis; 3) To provide Big Island patients with the most advanced medical information and help with navigating a diagnosis and managing their cancer experience. Program Highlights: (from Fiscal Year 2008 -09) ❑ Transportation to Treatment: Cancer patients can't be cured if they aren't able to complete their cancer treatment protocol. Many cancer patients are too frail, too weak, too poor or too emotionally drained to travel on their own. Transportation to their medical appointments is vital to their recovery and ACS NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 provides financial assistance through taxicab reimbursements, Handi -van vouchers, gasoline debit cards for family members driving them, interisland airfare tickets, or partial transpacific airfare reimbursements when they must fly to the mainland for specialized treatment. In addition, ACS has created its own program, Road to Recovery, where specially trained volunteer drivers, many of whom are themselves cancer survivors, provide car rides to treatment in their own private cars, adding a special measure of empathy and compassion to the journeys. In FY2008/2009, 134 taxicab reimbursements, 156 $50 gasoline debit cards, 263 one -way interisland airline tickets and 3 partial reimbursements for transpacific airfare were distributed to Big Island residents. ❑ Lodging Discount for Patients while on O'ahu for Treatment: Big Island cancer patients are provided discounted lodging while staying on O'ahu for their cancer surgery or treatment, which helps to alleviate a major financial concern patients face when they cannot receive treatment on their home island. In FY2008/2009, 31 Big Island cancer patients utilized 110 nights of discounted lodging in O'ahu partnering hotels. ❑ Reach to Recovery: Visits are provided to newly diagnosed breast cancer patients, who receive kits containing a temporary bra and prosthesis. Reach to Recovery volunteers, each a breast cancer survivor themselves, are certified by ACS in the program. They help patients cope with body image issues, provide an information booklet, and explain options for prostheses and reconstruction. In FY2008/2009, 48 newly diagnosed Big Island breast cancer patients received this service. ❑ Look Good...Feel Better and Wigs: Classes teach patients how to brighten complexions sallow from disease, create the illusion of eyebrows that have temporarily disappeared, care for nails affected by treatment, and more. For those patients feeling a loss of physical self- esteem, these small classes, shared with other patients, have a therapeutic value far beyond their cosmetic tips. Beautician volunteers are trained and certified to provide their expertise to this program. Wigs, hats, and /or scarves are also provided to individuals coping with hair loss. 10 patients participated in Look Good...Feel Better sessions in FY2008/2009 and 50 wigs were distributed to Big Island patients. ❑ Childhood Cancer programs for keiki with cancer and their families: Having a child with cancer can turn a family upside down. Adding to the heartbreak, there are time - consuming demands on parents, less time for the needs of siblings, and tremendous stress on the affected child. o Camp Anuenue, a weeklong summer camp for children with cancer, ages 7 to 17. This experience provides an opportunity to build friendships with other children who also are fighting cancer. It has helped many keiki find the hope and physical strength to survive. 5 Big Island children attended Camp Anuenue in FY2008/2009. o Ho'oulu Me Ka Ikaika ( "Grow with Strength "), a retreat for teens and young adults, ages 14 to 21. This retreat empowers young people to face the combined NONPROFIT GRANT APPLICATION • FISCAL YEAR 2010 -11 Page 4 stresses of cancer and the teen years. 1 Big Island teenager attended the Teen Retreat in FY2008/2009 o Families Can *Sur *Vive, a family conference for children with cancer, their parents and siblings that provides an opportunity for families to discover their individual and family strengths while encouraging trust and communication. 3 Big Island children with cancer, along with 6 parents and 7 siblings attended the Families Can *Sur *Vive Conference in FY2008/2009. ❑ Personal Health Manager: The Personal Health Manager is an organizational portfolio for newly diagnosed patients that contains tailored information, relevant to the type of cancer, which will empower patients to make educated health decisions, and connect them to local resources and services. Additionally, the portfolio helps patients keep track of critical medical information provided by their healthcare team. In FY2008/2009, 124 Big Island cancer patients received their own Personal Health Manager portfolio. ❑ Annual Survivor Celebration: Cancer survivors celebrate life and the victory over crisis. By design, these survivor celebrations are empowering to those who faced their health crisis head on and provide hope and inspiration to those still in treatment. During FY2008/2009, 613 cancer survivors participated in 8 Big Island annual survivor celebrations at Relay for Life events. ❑ Client Services: Cancer patients and their families contact the American Cancer Society field offices and Patient Services Center to receive up -to -date cancer information on diagnoses, treatments and prognoses. In FY2008/2009, a grand total of 771 unique Big Island cancer patients were provided at least one type of direct service from ACS, which include any or a multiple of the above. ❑ Trained Cancer Information Specialists: Hawai'i residents were connected in April 2008 to the American Cancer Society's new Patient Services Center based in Austin, Texas. The Patient Services Center keeps Hawaii time -zone business hours, and provides specialized agents who are trained and familiar with Hawai'i's resources and facilities, plus are experts with dealing with the issues of cancer and its emotional, financial, physical and quality -of -life issues. Staff work with patients and families to provide support, navigate healthcare systems, refer to resources and even help patients who need to complete lengthy and often confusing applications. This service is in addition to the American Cancer Society's local field offices. ❑ The Society's National Cancer Information Center's 24 -hour a day 1 -800 telephone line, and www.cancer.org website for cancer information. In • FY2008/2009, 70,212 web visits by Hawai'i residents to the ACS website helped patients and families find out more information about cancer and the programs offered by the American Cancer Society (unable to break down by island). 1) NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 American Cancer Society Hawaii Pacific - Agency Name Patient Services for East & West Hawaii Cancer Patients - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Total East & West Hawaii Cancer 771 626 771 Patients Served "ACS Days" - Hospital /Community 124 150 150 Health Center Patient Visits Cancer Prevention /Early Detection 35,167 35,000 35,000 Information Provided in Face -to- Face Discussions Support Group Participants 43 48 50 Interisland Airline Transportation 263 278 278 Segments Provided Taxicab One -Way Reimbursement 134 135 135 Gasoline $50 Debit Cards Provided 156 165 165 Look Good...Feel Better Class 10 12 15 Participants Wigs Provided 50 50 50 Personal Health Manager Kits 122 150 150 Provided to Cancer Patients Road to Recovery Volunteer Drivers 32 55 55 Childhood Cancer Camp 9 8 8 Participants *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 0 0 0 Professional Fees 0 0 0 Operations 0 0 0 Equipment 0 0 0 Other" $39,556 $42,425 $42,425 Total $39,556 $42,425 $42,425 * If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 American Cancer Society Hawaii Pacific - Agency Name Patient Services for East & West Hawaii Cancer Patients - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Adrienne Wong Toyozaki Fund 8,000 8,000 8,000 Theodore A. Vierra Fund 15,000 15,000 11,000 Cancer Care Trust 6,287 0 0 County of Hawaii 0 10,000 15,000 West Hawaii Fund 0 6,000 3,500 The Ironman Foundation 1,000 0 0 Hawaiian Airlines (Charity Miles) 0 3,425 2,425 Visitor Industry Charity Walk 0 0 2,500 Total $30,287 $42,425 $42,425 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Any shortfall in funding will be made up through the general operating funds from our community fundraising. Until major changes occur in health insurance coverage, physician and facility capacity, and cancer care protocols, we will continue to cobble together a safety net of volunteer programs, donated resources and grant funding for cancer patients. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 • American Cancer Society Hawaii Pacific - Agency Name Patient Services for East & West Hawaii Cancer Patients - 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that 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, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, 1 (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Si attire of Board Pre dent/Chair Da James L. Grobe r., MD Signatu.e of Executive D " -ctor / Date Jac Young, Ph.D. PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 American Cancer Society Hawaii Pacific, Inc. Quality of Life Services for Cancer Patients on the Big Island FY2O11: July 1, 2010 to June 30, 2011 MASTER Pro jected Budget Additional County of Funding Direct Patient Services Total Budget Hawaii Request Resources Ground Transportation to Treatment (gas cards) for treatment travel on the Big Island and, if medically necessary, on O'ahu $8,250 $3,000 $5,250 Taxicab Fare while on O'ahu for cancer surgery or treatment $3,375 $1,500 $1,875 Interisland Air Transportation to Treatment $13,750 $4,000 $9,750 Partial Transpacific Airfare Reimbursement - L_ $1,5_00_ - $0 $1,50_0 Reach to Recovery personal visits, support services and supplies for breast cancer patients, and volunteer training $1,000 $0 $1,000 Road to Recovery - - - -- - -_— -- - - -- - - - -- development and volunteer training 51,000 $500 $500 Look Good...Feel Better and Wigs classes, wigs, volunteer training $2,000 $500 $1,500 What to Eat During Cancer Treatment Books and Book Lending Library 52,000 - 51,000 51,000 Childhood Cancer Programs (Anuenue, lkaika, Family) $4,000 $1,000 $3,000 Newly Enrolled Client Services including the most up to date information on cancer and local resources; a lending library; and monthly meetings for patients; and educational materials and displays. (Personal Health Managers) - $1,650 $1,150 $500 Ongoing Client Services including supplies for cancer patients, volunteer training, general services $1,000 $1,000 $0 Survivor Celebration and Fight Back at Relays (7 relays) $2,900 $1,350 51,550 -- — — so TOTAL Budgeted for Programs: $42,425 515,0001 L (- ----- Note: Based on an estimated 771 cancer patients on Big Island in FY2011, with 626 of them newly diagnosed. 2 American Red Cross - Hawaii State Chapter Disaster Response & Preparedness for County of Hawaii Agency Name: American Red Cross, Hawaii State Chapter Program Name: Disaster Response & Preparedness for County of Hawaii Agency Director: Coralie Chun Matayoshi, Chief Executive Officer Phone No.: 808 - 739 -8101 Contact Person: Youline K. Kalima, County Executive Director Phone No.: 808 - 935 -8305 Mailing Address: American Red Cross Hawaii County 55 Ululani St., Hilo Hawaii 96720 Facility /Site Address: Site One: Hilo 55 Ululani St., Hilo Hawaii 96720 Site Two: Kona 74 -5615 Luhia St., Kailua -Kona, HI. 96714 Fax No.: 808- 969 -3673 Email address: kalimay @hawaiiredcross.org Name of CPA: CW Associates Phone No.: 808 - 531 -1040 Mailing Address: 700 Bishop Street, Suite 1040 Honolulu, HI 96813 Amount of request for County Funds: $25,000 Prior Year(s) Funding: 2007 -08 2008 -09 2009 -10 $15,000 $25,000 $25,000 Agency Mission Statement: The American Red Cross is a humanitarian organization led by volunteers and guided by its Congressional Charter and the Fundamental Principles of the International Red Cross Movement. Our mission is to prevent and alleviate human suffering by helping people prevent, prepare for, and respond to emergencies, and to provide disaster relief to the people of Hawaii 24 hours a day, 7 days a week, 365 days a year. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 — 2011 Page 1 Although established by Congressional Charter in 1905, the American Red Cross is NOT a government agency and must rely on the generosity of Hawaii's people to provide critical services to the community. All disaster training, services, and financial assistance to victims is free. Therefore, fundraising is critical to ensure that services can continue. History: The Hawaii State Chapter was founded in 1917 and has assisted victims of every major disaster in the islands' history, including the bombing of Pearl Harbor, Hilo tsunami, volcanic eruptions, Big Isle earthquake, Hurricanes Iwa and Iniki, New Years & Manoa floods, Kaloko Dam burst, Sacred Falls landslide, Xerox shooting, air transportation crashes, and hostage situations. The American Red Cross is the only organization mandated by Congress to respond to disasters and provide emergency communication to military families, and the only local nonprofit organization that meets the needs of disaster victims any time of the day, 365 days a year. Because we are an island community and considering the time it takes for assistance from other neighbor islands and the mainland, having the response capacity on island immediately after a disaster is essential. Program Description: The Hawaii County Red Cross Disaster Preparedness and Response Program includes disaster relief assistance to help victims of single family and major disasters overcome the physical and emotional distress of a disaster and meet their immediate emergency needs as they begin to rebuild their lives after a tragedy. This assistance includes food, clothing, shelter, mental health counseling, and financial assistance to help families recover more quickly from a disaster. Our volunteers are ready to respond to disasters 24 hours a day, 7 days a week, 365 days a year. We have 453 active disaster volunteers statewide and leverage the resources of our volunteers to provide this critical service. We also have over a thousand more volunteers statewide who are trained to help in a major disaster. Recruiting, training and mobilizing all of these volunteers is an ongoing job. Because a disaster can strike at any time without notice, advance preparation makes a significant difference in the well -being of a family or the resiliency of a business. As an island community and considering the time it takes for assistance from other neighbor islands and the mainland, having the response capacity on island immediately after a disaster is essential. All disaster training and response are provided free of charge. The Hawaii State Chapter continually trains volunteers to become disaster responders to serve during time of disasters (all disaster training is free). In the last fiscal year, the Red Cross conducted courses for volunteers in different communities statewide to achieve our objective of providing a seamless response when disaster strikes. We train volunteers to be able to conduct disaster assessment in neighborhoods, serve as shelter managers, conduct crisis counseling and emergency first aid and provide financial assistance to those whose homes have been affected by disaster. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 — 2011 Page 2 Our volunteers actively exercise with state agencies in preparation for natural disasters, pandemics and acts of terrorism. Through trained and capable disaster responders, communities will be better prepared prior to, during and after disasters. In light of lessons learned from the recent flooding, Hurricane Katrina and in the past from Hurricane Iniki, it is critical to have trained and capable volunteers ready and prepared to respond if a large disaster struck our islands. In a larger disaster or tragic event, crisis counseling, mass care, disaster welfare information, emergency first aid and other support services as appropriate are also provided to victims. These services are offered to anyone whose loved ones were directly affected by the event. Crisis counseling services may also be extended to the community for secondary victims. Another component of this program is community education, which empowers families and individuals to prepare for and respond to disasters before they strike. This will result in more aware and prepared communities. Red Cross volunteers and staff continually go out into the community to speak to the public about the importance of being prepared before a disaster strikes: get a disaster supplies kit, make a plan for your family and workers, and be informed. Because a disaster can strike at any time without notice, it is essential for communities to be prepared. Advance preparation can make a significant difference in the well -being of a family or the resiliency of a business. With the threat of avian flu, bio- terrorist attacks, and major natural disaster, the American Red Cross is more relevant and necessary than ever before. With global warming and changing weather patterns, it is not "if," but "when" a major disaster in Hawaii will occur. Hawaii is especially vulnerable to hurricanes, tsunami, earthquakes, and other natural disasters. When a disaster strikes, we will have to be able to survive longer on our own due to our isolation. It is critical for the Red Cross to be prepared for and respond to everyday disasters and major disasters. Biq Island Disasters: the Big Island has had more than its share of disasters over the years, including devastating tsunami, lava flows, flooding, heavy rains, high surf, earthquakes, brush fires, air crashes, explosions and hazardous material incidents. Whatever the incident, the Red Cross has always been there, ready to help those in need. Who We Serve: The Hawaii Red Cross provides compassionate aid to people in Hawaii who fall victim to natural and man -made disasters that occur every 3 to 4 days in Hawaii. Disaster victims served by the Hawaii Red Cross are the poorest of the poor. All disaster training and response are provided free of charge, due to the generosity of our donors. According to a U.S. Census Bureau Report, 13.1% of the Big Island population lives below the poverty level. This "poor and needy" population is particularly vulnerable to disasters and is dependent on Red Cross services when affected by a disaster. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 — 2011 Page 3 Based on family size and income levels, at least 31 % of disaster families we served in FY09 on the Big Island were below the poverty level. In FY09, the percentage of our Big Island client families making less than $7,500 per year was 14 %, with 41% making less than $25,000. Of the disaster families, only 55% owned their home and only 24% had structure insurance. Since almost half of them do not own their homes and have no property insurance, they are truly destitute after a fire destroys everything they own or claims the life of a loved one. The Red Cross is truly a safety net for victims of "every day" disasters who have nowhere else to turn. The Red Cross not only offers food, clothing, and shelter to those who may have lost everything they own, but also volunteer caseworkers provide crisis counseling and emotional support to help these victims get back on their feet. Beyond the "every day" disasters, the Red Cross is preparing for and will respond to major disasters, which may affect the entire population of Hawaii, especially those with special needs like the elderly, frail, handicapped, and poor. When disasters occur, the American Red Cross will be there to support the County of Hawaii by providing families with relief assistance in time of need. The Hawaii State Chapter is requesting $25,000 from the County of Hawaii to help subsidize the financial aid we provide to Big Island disaster victims and emergency responders, train volunteer disaster responders so that local communities on the Big Island are prepared, and to share important preparedness information to people on what to do before a disaster strikes. This amount does not even begin to cover the staff and volunteer training, equipment, and support needed to respond to every day disasters, as well as educate and prepare Big Island residents for the next major disaster that is sure to come. Hawaii County Funding is critical to build resiliency and capacity for the communities of Hawaii County. Total Budget and Position Count Total Program $220,000 Total Program Position Count 1.5 Budget for FY 10 -11 (Disaster Services) Total Agency Budget $560,000 Total Agency Position Count 4 for FY 10 -11 1. Program Objectives: Overall Goal: To provide 24/7 emergency disaster response and relief to those in need on the Big Island after a disaster (man -made or natural), train volunteer responders and share critical preparedness information to the communities on the Big Island. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 — 2011 Page 4 Objectives: 1. Provide for the immediate emergency needs of Big Island disaster victims (food, clothing, shelter, crisis counseling). All disaster services are free. 2. Support first responders like firefighters, police, civil defense, and others with food, water, and counseling during brush fires and other challenging incidents that threaten lives and property. 3. Increase awareness of disaster preparedness to Big Island residents. Prepare families, businesses, and communities with essential preparedness material and information because a disaster can strike at any time without notice. 4. Train volunteer disaster responders to serve their local communities during times of disaster. We train volunteers to be able to conduct disaster assessment in neighborhoods, run shelters, conduct crisis counseling and emergency first aid, and provide financial assistance to those whose homes have been affected by disaster. Our volunteers actively exercise with federal, state, and county agencies to prepare for natural disasters, pandemics and acts of terrorism. All disaster volunteer training is free. 2. Program Highlights: In the past fiscal year (July 1, 2008 through June 30, 2009), the American Red Cross in Hawaii County provided the following services to Big Island individuals and families: • Responded to 23 disasters on the Big Island enabling 56 individuals to recover from their losses and begin rebuilding their lives (does not include earthquake response). 31% of families assisted were below the poverty level (17% unknown). • Opened 1 shelter due to brushfires, flooding and vog, sheltered 13 individuals who needed to evacuate or were unable to return to their residences. • Has 147 active disaster volunteers with 29 more signing up in FY09. • Reached 1,427 persons with disaster preparedness information through community presentations. • 195 registered in disaster training courses. Examples of responses are as follows: During July of 2008, an elderly man on oxygen awoke to find himself surrounded by flames. As he ran past a window on his way out of the house, the oxygen tank exploded and the glass blown from the broken window barely missed him. The man escaped the inferno with minor burns, and although the exterior of the brick structure remained intact, the interior was a complete loss. The house did not have electricity and the cause of the fire was believed to be NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 — 2011 Page 5 related to the use of candles. ARC assisted with food, clothing, bedding, a storage container, replacement medications and an oxygen tank. A RC nurse also assisted in examining the client and treating his minor burns and helped him replace his lost dentures. In July, 2008, the residents of a house in Honokaa returned from picking up their son at the Kona airport to find their house completely destroyed by fire. The son was going to housesit while his parents were going to Oahu the next day for one of them to undergo surgery. The ARC assisted them with a hotel stay, food, bedding, clothing, and rental assistance when they found new housing. An ARC nurse also assisted with replacement eyeglasses. In August, 2008, a tenant who had spent the night at a relative's house in Pahoa arrived home the next morning to discover his house had been destroyed by a fire the previous day. The Red Cross provided him with emergency assistance for food, clothing /shoes, and bedding. He stayed with friends while he waited for escrow to close on the house he was purchasing. In the first half of this fiscal year (FY10) to date, the Red Cross has already responded to house fires on the Big Island in Kailua -Kona, Kurtistown, Captain Cook and Hilo. Our efforts have enabled 16 individuals to recover from their losses and begin rebuilding their lives. We provided 200 community individuals with free disaster response training ' and recruited 4 new volunteers to our cadre of responders. Performance Measures: Disaster Response and Preparedness in Hawaii County - Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual Budget Estimate Disaster Responses 23 30 25 Individuals Assisted After Disasters 56 120 50 Mass Shelters Opened /Indvls Sheltered 1/13 5 4 Numbers Reached through Disaster 1427 2000 1500 Presentations in Communities Trained Individuals in Disaster Response 195 300 200 Program Expenditures (Disaster Response and Preparedness): FY 2008 -2009 FY2009 -2010 FY2010 -2011 Actual Budget Estimate Salaries and Wages 76,597 48,728 51,000 Operations (occupancy, communication, postage) 62,311 57,425 60,000 Equipment 3,241 1,024 1,000 Materials (Supplies) 3,167 6,265 7,000 Travel 6,911 7,455 8,000 Disaster Relief Assistance * 19,604 19,500 20,000 Administrative /Tech Support ** 72,248 70,000 73,000 Total 244,079 210,397 220,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 — 2011 Page 6 • Monies are budgeted for the entire state for disaster relief assistance as it is unknown where disasters will occur. As disasters occur on the Big Island, expenses will increase accordingly. ** This refers to all administrative, technical and programmatic support provided to the Red Cross in Hawaii County from our Headquarters. Program Funding Source (Disaster Response & Preparedness)— Identify all funding sources (specific to this program only) Revenue Source for FY2008 -2009 FY2009 -2010 FY2010 -2011 Disaster Services Program Actual Budget Estimate Hawaii County 25,000 20,000 25,000 Hawaii Island United Way 16,415 12,000 10,000 Contributions (Direct Mail & Grants) * 39,880 29,350 30,000 Fundraising (Hats Off) * 4,759 4,500 5,000 Rent 4,500 4,500 4,500 TOTAL REVENUE 90,554 70,350 74,500 TOTAL EXPENSES 244,079 210,397 220,000 Amount Hawaii Chapter must subsidize for both Hilo and Kona 153,525 140,047 145,500 offices to meet expenses for this program (dis svcs) NOTE: 1. HIUW. Total is amount pledged but actual received is dependent on success of their campaign. 2. Contributions and fundraising amounts subsidize both Disaster Services and our Health and Safety Services Program. 3. Grant funding not reflected above Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? We continue to work on increasing Red Cross visibility in the community in order to increase private individual and corporate donations from Big Island residents and businesses. We are looking at possible fundraising opportunities on the Big Island such as special events, along with major donor cultivation. I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 — 2011 Page 7 mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your proqr m's or agency's future funding requests. k y , January 21, 2010 Peter Ho, Chapter Chair Signature of Board President/Chair Date January 21, 2010 Coralie Chun Matayoshi, CEO Signature of Executive Director Date NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 — 2011 Page 8 American Red Cross Hawaii State Chapter January 8, 2010 TO: County of Hawaii Council Members Council member Dominic Yagong - District 1 - Hamakua, North Hilo, and portions of South Hilo (Hakalau, Honomu, Pepe'ekeo, Papa'ikou, Kaiwiki) Council member Donald Ikeda, District 2 - South Hilo (Amaulu, Puueo, portions of Downtown Hilo, Lanakila,Waianuenue, Kaumana, Ainako, Pi'ihonua, portions of Waiakea Homesteads) Council Chair J. Yoshimoto, District 3 - South Hilo (Waiakea Homesteads and Waiakea -Uka) and Puna (Kea'au, Kurtistown, Orchidland, and Mountain View) Council member Dennis Onishi, District 4 - South Hilo (Keaukaha, Panaewa, Waiakea Houselots, portions of Downtown Hilo, University and portions of Waiakea Homesteads) Council member Emily Naeole, District 5 - Puna Makai (Hawaiian Paradise Park, Ainaloa, Pahoa Village, Hawaiian Beaches & Shores, Nanawale, Leilani, Kapoho, Kalapana, Opihikao, Kahena, Pohoiki) Council member Guy Enriques, District 6 - Puna (Kurtistown, Mt. View, Volcano), Kau (Pahala, Naalehu, HOVE), and South Kona (Milolii, Hookena, and portions of Honaunau) Council member Brenda Ford, District 7 - South Kona (portions of Honaunau, Capt. Cook, Kealakekua), and North Kona (Kainaliu, Keauhou, Kahaluu, Holualoa) Council member Kelly Greenwell, District 8 - North Kona (Kailua -Kona, Kealakehe, Kalaoa, Puuanahulu). Council Vice Chair Pete Hoffman, District 9 - North and South Kohala (Waikoloa, Waimea, Hawi, Halaula) We are writing in support of the American Red Cross for fiscal year 2010 -2011 County of Hawaii Nonprofit Grant Funding for local disaster response and preparedness efforts on the Big Island districts. Being prepared prior to a disaster occurring is critical for the Red Cross to be able to respond quickly in a disaster. The Red Cross is not a government agency, yet they are always there. The East Hawaii office of the Red Cross operates at a deficit and needs funding support for this critical program delivered to people on this island. As members of the East Hawaii Red Cross Advisory Council and as local community representatives, we are asking the County Council members to support the Hawaii Red Cross on the Big Island through our County nonprofit grant program. With warm aloha, Eas Hawaii Re s Advisory Council / / / / /! /! / � / / J /� / i / / /� t... 4 F 'a ')D -- -----17A44-7-e-e-- --- -V C ` 1 X � ,r /'` EAST HAWAII ADVISORY COUNCIL Ted Dixon, Chair Roberta Chu Andrew Chun Terrance Crowley Darla De Ville UMW Randy Hirokawa Andrew Levin Quince Mento Darryl Oliveira Larry Weber ;p7W !! --] a .z Ilawaii 6Lrnd East Hawaii Office: 55 Ululani Street • Hilo, HI 96720 • Tel: 808 - 935 -8305 • Fax: 808 -969 -3673 West Hawaii Office: 74 -5615 Luhia Street, #A1 -B • Kailua -Kona, HI 96740 -1680 • Tel: 808- 326 -9488 • Fax: 808 -326 -7528 ..RY {:a, f- JS American Red Cross Hawaii State Chapter January 8, 2010 TO: County of Hawaii Council Members Council member Dominic Yagong - District 1 Council member Donald Ikeda, District 2 Council Chair J. Yoshimoto, District 3 Council member Dennis Onishi, District 4 Council member Emily Naeole, District 5 Council member Guy Enriques, District 6 Council member Brenda Ford, District 7 Council member Kelly Greenwell, District 8 Council Vice Chair Pete Hoffman, District 9 We are writing in support of the American Red Cross for fiscal year 2010 -2011 County of Hawaii Nonprofit Grant Funding for local disaster response and preparedness efforts on the Big Island. Being prepared prior to a disaster occurring is critical for the Red Cross to be able to respond quickly in a disaster. The Red Cross is not a government agency, yet they are always there. The East Hawaii office of the Red Cross operates at a deficit and needs funding support for this critical program delivered to people on this island. As members of the East Hawaii Red Cross Advisory Council and as local community representatives, we are asking the County Council members to support the Hawaii Red Cross on the Big Island through our County nonprofit grant program. With warm aloha, West Hawaii Red Cross Advisory Council" - r r t� -..p, woos ; i yG Wa y Ilawaii Island WEST HAWAII ADVISORY COUNCIL Judi Jennet, Chair Rick Asbach Randy Crowe John Dawrs Barbara Goldman Garcia Rodney Ito Carol Kitaoka Quince Mento John Yates, III Ralph Yawata East Hawaii Office: 55 Ululani Street • Hilo, HI 96720 • Tel: 808- 935 -8305 • Fax 808 - 969 -3673 West Hawaii Office: 74 -5615 Luhia Street, #A1 -B • Kailua -Kona, HI 967401680 • Tel: 808-326-9488 • Fax: 808 - 326 -7528 3 The Arc of Hilo Arc of Hilo ADRC Advocacy Program The Arc of Hilo- Agency Name Arc of Hilo ADRC Advocacy Program- Program Name Agency Director: M. Gleason Phone No.: 935 -8535 Contact Person: Debbie Perkins Phone No.: x208 Mailing Address: 1099 Waianuenue Avenue Hilo, Hawaii 96720 Facility /Site Address: Aging and Disabilities Resource Center (ADRC) 1055 Kinoole Street, Suite 104 Hilo, Hawaii 96720 Fax No.: (808) 961 -0148 Email Address: dperkins @hiloarc.org Name of Accountant/CPA (include name of firm if applicable): Ms. Ann Fukuhara, CPA,MBA, An Accountancy Phone No.: (808) 961 -5582 Mailing Address: 714 Kanoelehua Ave, Box 6691, Hilo, HI 96720 Amount of Request for County Funds: $52,610. Prior Year(s) Funding: 07 -08 08 -09 09 -10 $29,000 $25,000 $20,000 Agency Mission Statement: To improve the quality of life for people with disabilities on Hawaii through educational, vocational and skill training as well as employment and residential opportunities. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 The Arc of Hilo - Agency Name Arc of Hilo ADRC Advocacy Program- Program Name Program Description: The Advocacy Program assists people with disabilities and their families to access the social services they need in East Hawaii. Services to people with disabilities include: Information and referral, advocacy, counseling, outreach and education. This year The Arc of Hilo will expand the program in the areas of community education and awareness and assistance to the aging population. Total Budget and Position Count Total Program Budget $52,610. Total Program Position Count 1 Total Agency Budget $7 Million Total Agency Position Count 190 Program Objectives: 1) Continue program expansion and development by providing the very best services possible at the Office of Aging and Disability Resource Center (ADRC) through on -going evaluation of existing services offered in East Hawaii and by analyzing the areas that are under served and in need for services for people with disabilities in East Hawaii. 2) Continue as a primary resource on disability issues at the ADRC one -stop shop for aging and disability services. 3) Advocate for people with disabilities help them access benefits and services in the community, such as employment training, transportation, housing, wage, medical and insurance benefits; and medical and dental services. The Advocate is able to draw upon a wide range of programs and services available at the Arc of Hilo as well as other resources in our community. 4) Make referrals to the Kokua Program when immediate direct care is needed for people with developmental disabilites. Work with eligible individuals and their families to apply for various government funded programs for long -term supports and services. 5) Expand educational services to individuals and community groups including public and private schools, colleges, service organizations, families, and general public about disability and aging issues. 6) Serve as a community resource for individuals and agencies needing information and referral on any disability related issues such as, benefits (ie. Supplemental Security Income (SSI), Social Security Disability NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Insurance (SSDI), and Medicare), landlord /tenant problems, access to durable medical equipment, long -term care planning and any other disability services needed. Program Highlights: (from Fiscal Year 2008 -09) 1) Paticipated in the ADRC Grand Opening Ceremony on November 14, 2008. 2) January 2009, set -up of office inside the Office of Aging, who were willing to share their space with us until our current office was ready for occupancy in August 2009. 3) We began serving clients, collecting data and building relationships with other ADRC participating agencies. 4) Hosted informational meetings with Emily Bartlett -Henry for the Quest Expanded Access program for people with disabilities and their family members, in Hilo and Pahoa. 5) Participated in public health and awareness fairs, such as the University of Hawaii Student Informational and Disability Awareness Fairs. 6) Community Services fair with Emily Naeole, County Council Member District 5. 7) Advocate helped many families throughout the appeals process after the DD /MR budget reductions in February 2009. 8) In March 2009 our Advocate, with a small group of Medicaid Waiver participants, participated in the Day at the Capital event on Oahu. This event was planned in partnership with the Hawaii Disabilities Rights Center, Hawaii Waiver Providers Association and the Developmental Disabilities Council. 9) In April and May of 2009 our Advocate assisted with workshops on Voter Registration and Emergency Preparedness in partnership with the Hawaii Disability Rights Center. Both of these events were held in Hilo and Pahoa. 10) The Advocate helped in a successful United Way Kick -Off event at The Arc of Hilo on June 12, 2009. The United Way organization has supported our Kokua Program for the past two years which is directly linked to our Advocacy program. 11) Other issues our advocate has assisted individuals with are: 1) helping people with disabilities access dental services, 2) assisted with obtaining guardianship information, 3) helped people with MedQuest transition to O'hana and Evercare, 4) helping at people at risk for homelessness to maintain their housing by helping with payment plans and housing inspections. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 The Arc of Hilo - Agency Name Arc of Hilo ADRC Advocacy Program - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Information: units of service* 154 360 1000 Referrals:number of referrals 58 120 100 Outreach: number of outreach 204 750 300 contacts Advocacy: units of service 176 600 2000 Education: number of sessions 20 50 30 Number of clients served 20 * Each unit is 15 minutes *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 26,244 40,000 40,000 Professional Fees 288 50 Operations 12 6,360 Equipment 6200 6,200 Other" 1,066 Total 27,309 46,500 52,610 * If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 The Arc of Hilo - Agency Name Arc of Hilo ADRC Advocacy Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget* Estimate HEI Foundation Grant 10,000 Total *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Due to unforseen changes in the economy with funding and decrease in contract services in all areas of the Arc of Hilo we anticipate the program to take another three years before becoming self- sustaining. We have received another grant from HEI Foundation and will continue to prusue additional grant funding as well as creating other revenue streams for this program. One of the revenue streams were exploring is offering billable services to the community, such as. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 pie Arc of Hilo - Agency Nay, 1e Arc of Hilo ADRC Advocacy Program - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 - 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. C- Ql -- 262- Signature of Board President/Chair Date /l /mil l-20 —/O Sig -ture of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 THE ARC OF HILO ADVOCACY PROGRAM Operational Expenses Included: Rent and Telephone Notes from Page 3, "Other #" Mileage Reimbursement $ 600.00 Advertising 2,400.00 Postage 500.00 Business Cards 100.00 Promotional Items 1,000.00 Fee for Health and Job Fairs Booths 100.00 Staff Training (Pacific Rim Conference) 700.00 Staff Training (Other Training) 800.00 Total $6,200.00 4 The Arc of Kona Home and Community Based Services -Life Skills Program Arc of Kona ���_, �`��'� HOME AND COMMUNITY BASED SERVIC J U LIFE SKILLS PROGRAM Agency Director: Gretchen Lawson Phone No.: 808 - 323 -2626 Contact Person: Jeani Navarro Phone No.: 808 - 775 -1090 Mailing Address: PO Box 127 Kealakekua, HI 95640 Facility /Site Address: 81 -1065 Konawaena School Road Kealakekua, HI 95640 Fax No.: 808 - 323 -9444 Email Address: kalopa51 anaol.com orjeani @arcofkona.org Name of Accountant/CPA: Ann N. Fukuhara, CPA MBA An Accountancy Corporation Phone No.: 808 - 961 -5532 Fax: 808 - 934 -8589 Mailing Address: PO Box 6691 Hilo, HI 96720 i Amount of Request for County Funds: $15,000.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $20,000 $20,000 $15,000 Agency Mission Statement: The Arc of Kona is committed to helping people with disabilities achieve the fullest possible independence and participation in society consistent with their wishes. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 1 of 7 • Arc of Kona HOME AND COMMUNITY BASED SERVICES LIFE SKILLS PROGRAM Program Description: For forty -three years the Arc of Kona has successfully operated an Adult Day Health (ADH) standard classroom program that currently serves 25 participants on a daily basis and a Personal Assistant/Habilitation program island -wide that serves 70 plus participants on a daily basis in their community setting. We successfully combined these two programs for last year's funding in order to serve more participants especially those residing in the most rural areas that lack adequate community access services. All of the participants in the Home and Community Based Services programs • have been identified as DD /MR (Developmentally Disabled /Mentally Retarded) by the State of Hawaii and have cognitive limitations that prevent them from living as independently as individually possible without extensive life skills training and other needed supports. Our population is a mix of Native Hawaiian, Asian /Pacific Islander, Filipino and Caucasian youth and adults ranging from 8 to 60 years of age with a core group of young adults in their late teens and mid 20's. All of these individuals are cognitively not able to make good judgment and therefore need the types of supports that insure their safety and help with activities of daily living. They need to be in a caregivers' line of vision at all times and require assistance gaining access to community services and activities that will allow them to begin integration into the communities where they reside. The DD /MR population has several risk and protective factors that we consider when designing individual life skills training. First, this population is at risk of abuse, both sexual and physical, and need to be taught the skills for saying "NO" and reporting abuse. They are known to be at risk for chronic disease and have a high incidence of diabetes and heart problems related to weight and diet. Finally they are all at risk for homelessness and /or being unprepared to prove they can live independently both with daily living skills and finances. Protective factors we consider include: a) training in social development, b) appropriate sexual behaviors, c) protection from abuse including family members as well as strangers, d) proper nutrition, e) preparing individuals to find their own housing accommodations and live as independently as possible, with or without other agency supports, and f) preparing for work either supported or unsupported at the work site, non - traditional work and entrepreneurial start ups. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page2of7 Arc of Kona HOME AND COMMUNITY BASED SERVICES LIFE SKILLS PROGRAM The "community as a classroom" where participants can practice these skill sets becomes essential to strengthening the protective factors around this vulnerable population. When provided with community access services for their life skills component our participants not only learn, but have the opportunity to share their own many skills and gifts that benefit the larger community. The Arc of Kona's $15,000.00 request would be spent to enhance service delivery by paying costs associated with life skills training supplies and access to and from home, classroom, and the community as well as portion of the staffing and payroll taxes attached to the salaries. Total Budget and Position Count Total Program Budget $325,912 Total Program Position Count 6 Total Agency Budget $2,999,907 Total Agency Position Count 111 Program Objectives: 1) Provide a safe, healthy, and supportive environment for daily living skills in the community setting for 365 days per year from July 1, 2010 to June 30, 2011 for • the participants receiving Home and Community Based Services island wide with focus on the rural underserved areas of the island. (Thus relieving families of the stress of daily care giving and allowing them the opportunity to work if they desire and make a living and /or care for other children). 2) Provide individualized life skills training programs, with measurable goals and objectives that allow each participant to develop at his or her own pace in order to live as independently as possible. 3) Insure access to community events and resources that will be a learning laboratory for independent living and reinforce skills taught throughout the • program year, including those for supported employment. 4) Provide needed materials to assess, instruct and support life skills specific training in health and safety areas relating to abuse and appropriate sexual behavior as well as hygiene, money management, household safety issues and nutrition. 5) Provide needed supports for interacting appropriately with each other and the public within the community setting throughout the program year that supports the independent living skills /and or work setting required to function on a daily basis. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 3 of 7 Arc of Kona HOME AND COMMUNITY BASED SERVICES LIFE SKILLS PROGRAM Program Highlights (from Fiscal year 2008 -09): After years of being at a rather static number of participants, our programs quickly grew last year increasing our ADH classroom by five additional participants and our Personal Assistant/Habilitation program by ten and still growing. This success has been in part because the Life Skills Program is results driven and families have been pleased and excited with our innovations. 1) 85 participants received daily lessons on health and safety as they pertain to daily living and toward independent living (including information on hygiene, appropriate sexual behavior, yoga for stretching and balance, fire safety, and classes on nutrition and weight maintenance). Training positively resulted in a reduced number of behavior outbursts and incident reports. 2) 85 participants have been able to access the community (as required by law) for practicum in independent living skills in real life community settings. This resulted positively in 100% of the participants meeting two or more of their individual objectives toward their personal goals, and 85% of participants actually attaining one of their personalized goals. 3) 25 participants were able to participate in yoga classes, walking and stretching training that has resulted in better balance, and body awareness and therefore less falling /tripping and more self esteem. 4) 85 participants received training in the nutritional value of foods and were trained to assist in the preparation of healthier meals. The goal this year was to make healthy food choices unsupervised. 5) 30 participants attended a free Kayak/Surf Day and were able to be in the water and participate in a water sport, many for the first time in their life. 6) 25 participants attended a three day training on self- esteem building and behavioral accountability by Gloria Blum, an expert in the field working with persons with disabilities. 7) 30 participants participated in music and art programs offered in the community, one attaining Hawai'i Stars finalist status, and three successfully beginning their own non - traditional businesses. 8) The Arc received two outstanding commendations this year from our accreditation agency, CARF. One for our yoga class (which is designed specifically for persons with disabilities) and one for our Artists Mean Business program that provides support for small business start up in the area of the arts to promote non traditional employment and self sufficiency. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 2011 Page 4 of 7 Arc of Kona HOME AND COMMUNITY BASED SERVICES LIFE SKILLS PROGRAM Performance Measures: Home and Community Based FY 2008 -09 FY 2009 -10 FY 2010 -11 Services Life Skills Program Actual * Budget Estimate 1. a) Provide a safe, secure classroom 260 days of 260 days of 260 days of environment with sufficient staff ADH standard ADH standard ADH standard supervision, 5 days a week, 52 weeks classroom classroom classroom a year, for current 25 DD /MR activities with a activities with a activities with participants. one staff to four one staff to four a one staff to 1. b) Deliver on going life skills training participant ratio participant ratio four ratio for in the classroom and the rural areas as for 20 for 25 25 -30 per each individuals' plan which is participants. participants and participants , developed by the Department of 365 days of one and 365 days Health, the family and the Arc of Kona. on one services of one on one for 85 services for participants. 90 participants. 2. Provide access to the community for 144 transports 144 ADH 144 ADH hands -on life skills training experiences for 20 classroom classroom including food and clothing shopping, participants into group transports fire safety, ordering and eating in the community transports for proposed and public, handling money, making for activities 25 people into 365 plus appointments, nutrithn and exercise, that promote the community individual and and appropriate behaviors in public individual life and 365+ transports (including sexual behavior). skills goals. individual proposed to transports for achieve Life activities that Skills plan in promote the , individual life community. skills goals. 3. Provide on -going Life Skills 260 days of 365 days of 365 days of ' assessments and data collection for classroom completed instruction each individual. This includes areas instruction for instruction for proposed with . i such as recognizing and reporting Life Skills and Life Skills and assessment, ' abuse, health, hygiene, safety, daily living daily living base line, and socialization, basic cooking skills, activities with activities with data behaviors, consumerism, basic literacy pre and post pre and post collection for and job skills training. testing for testing for results assessment of assessment of reporting. base line skills, base line skills, data collection data collection and quarterly and quarterly and year end and year end reporting on reporting on achieved achieved results. results. `If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 5 of 7 Arc of Kona HOME AND COMMUNITY BASED SERVICES LIFE SKILLS PROGRAM Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -111 Actual * Budget * Estimate Salaries and Wages $236,578 $241,101 $277,266 Professional Fees Operations $50,740 $58,900 $61,845 Equipment Other" Total $287,318 $300,001 $339,111 * If applicable Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii $15,000 $15,000 $15,000 Hawaii Island United Way $31,000 $37,296 $30,000 State Medicaid Waiver $260,887 $273,616 $292,713 Client Fees (Third Party) $2,862 Total $309,749 $325,912 $337,713 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Each year, the week before Thanksgiving, we hold a bazaar and craft sale that is our signature event. In June, we held a musical concert in conjunction with Hawaii Performing Arts, with plans to repeat the event again this year. We also have an upcoming Blue Grass benefit concerts with Grammy award winning artists Laurie Lewis and Tom Rozum scheduled at the Aloha Theater January 30 of 2010. We have been actively and successfully working with our donors for additional ro ram support. P 9 PP We do not anticipate this program to be self sustaining in the near future. Like all non - profits, the rising costs for services and budget reductions have dramatically affected our families and participant programs. However, we have taken a proactive stance and have done internal organizational changes so that our programs can maintain their integrity. The Arc of Kona is celebrating its 43rd anniversary this year. We have been working diligently to find new and creative ways to raise unrestricted funds to support our numerous programs and actively working with our Board of Directors and the community to offer events all through the year which will also educate the public about the needs of our population and generate a stronger donor list both local and through our website. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 6 of 7 Arc of Kona HOME AND COMMUNITY BASED SERVICES LIFE SKILLS PROGRAM I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. i I y IX/0 Signature of Board P ident/Chair Date // D Si ature of Exe tive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 7 of 7 5 Arts & Sciences Center HAAS Productions Arts & Science Center- Agency Name HAAS Productions- Program Name Agency Director: Gail Clarke Phone No.: 808 -938- 2933 Contact Person: Gloria Baraquio Phone No.: 808- 230 -0618 Mailing Address: P.O. Box 2091 Pahoa, HI 96778 Facility /Site Address: 15 -1397 Homestead Rd. Pahoa, HI 96778 Fax No.: 965 -3733 Email Address: ascpuna @gmail.com, oneyoga @gmail.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPAs & Management Phone No.: 808- 242 -5002 Mailing Address: 1885 Main Street, Suite 408, Wailuku, HI 96793 Amount of Request for County Funds: $80,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $0 $20,000 Agency Mission Statement: To provide support services and infrastructure for community -based learning NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Arts & Science Center - Agency Name HAAS Productions- Program Name Program Description: Launched in August of 2008, HAAS Productions is the project -based digital media program in Puna designed to provide real -world experience for youth in TV & Film Production. The vision is to build and develop a strong workforce of media professionals AND a digital media facility that serves the Puna community and beyond. Directed by local TV Producer Gloria Baraquio, the current program consists of seven students (grades 8 -12) from the Hawaii Academy of Arts & Science (HAAS) public charter school. The program is open to all interested youth. The production team meets an average of 5 hours a week at KYBC (Keaau Youth Business Center) and at on- location shoots, where they create, plan, research, direct, write, host, film and edit videos for contests and /or PSAs for local TV networks. The goals of this program are to cultivate effective communicators, community contributors, quality producers, self - directed learners, complex thinkers, and ethical /effective users of technology (General Learner Outcomes). The main projects for the current year 2009 -10 include 3 different commercials for the Census 2010 and a full - length documentary on charter schools and educational reform, entitled "Being the Change ". HAAS Productions has established strong partnerships in the community over the past year: ASC (Arts & Science Center) serves as our fiscal agent. HAAS charter school donates transportation, meeting space, instruction, and supervision. KYBC provides instruction, the editing facility, and meeting space. Shootz Studios provides professional expert videography, editing, and instruction. Arnott's Lodge provides accommodations for our visiting professionals. PBS Hawaii has agreed to air our documentary on their station. They also sponsored an overnight trip to Kilauea Military Camp so that students could experience our national park, and capture it on film. The Big Island Film Office works with us to place our students in internships on professional film sets. Just a Girl Productions provides consultation and opportunities to work on the "Living Local" set. The Census Bureau will donate cameras, tripods, and edit bays to our program. HSDM (Hawaii Schools Digital Media) awarded us $500 for this year 09 -10. And lastly, Hawaii County awarded us $20,000 to further our efforts this year. MAHALO! Total Budget and Position Count Total Program Budget 81,100 Total Program Position Count 3 Total Agency Budget $222,100 Total Agency Position Count 13 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Program Objectives: 1) By February 2010: Complete 3 commercials promoting participation in the Census 2010 and submit to Census Bureau. Air commercials during March and April 2010. 2) By May 2010: Compile all footage and complete scripts for the charter school documentary "Being the Change ". 3) Fall of 2010: Premiere the documentary "Being the Change" on PBS Hawaii and other stations. Enter into 3 film fests. 4) By December 2010: Establish in Pahoa a secure and accessible facility for our current film equipment and edit bays (maybe HAAS campus). 5) Throughout the school year (August 2010 -May 2011): Attend weekly training workshops at KYBC or at proposed Pahoa site. 6) Between August 2010 and May 2011: Produce and complete over 70 minutes of edited video. Enter videos into 4 film competitions and /or broadcast 2 different pieces on TV. 7) THE VISION: Students will independently produce videos of all genres, responsibly and ethically. Businesses, locally and globally, will hire students and graduates of HAAS Productions as leaders, communicators, and video professionals. Hawaii will be recognized for its booming independent film industry. Program Highlights: (from Fiscal Year 2008 -09) 1) For the pilot year of HAAS Productions, Gloria Baraquio secured a partnership with Na Leo 0 Hawaii, and students had free access to the facility and equipment. The team met there every Friday for 3 hours. Na Leo graciously sponsored the students' trip to the State Capitol to film and interview nine Big Island Legislators during the 2009 Legislative Session. That was the main highlight of their year, in which the students were able to conduct shoots on their own (filming and hosting), learn about government and legislation, and practice working as a real production team on location. They edited 4 hours of footage into a two -part report from the Capitol. This series aired on Na Leo Community Television. 2) Students were able to self - produce videos and enter 4 different film contests: E Malama Aina, Farm to School, HMSA, and E Ola Pono. They won first place at the E Malama Aina Film Fest at the Palace Theater in Hilo for their video on sustainability. 3) Students attended 3 film workshops, where they were able to talk to professional filmmakers, watch their films, and learn about the filmmaking industry in Hollywood and New York. 4) An exciting highlight for us was being able to tour the Miramax set of "The Tempest" in Hilo. Big Island Film Commissioner John Mason escorted us around to meet the producers, directors, and actors as they worked on set. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 5) An unforgettable experience for the students was their experience on the "Living Local" set at Turtle Bay Resort on the North Shore of Oahu. The students were able to intern as production assistants and work alongside a professional crew of 25 members. And they got to enjoy the resort and buffets at Turtle Bay! 6) Highlights this school year (2009 -10) include: 1) Intense pre - production (research, planning, and interviews) for the charter school documentary 2) Working alongside award - winning producer Erik Bathen 3) One student interning on the Hollywood set of "The Predators" in Hilo 4) Two students interning on the "Living Local" set at KHON studios 5) Producing 3 commercials for the Census Bureau that will air on statewide TV 6) Getting sponsored /filmed by PBS Hawaii to enjoy the volcano, film their experiences, and stay two nights at KMC (for 30 youth and 5 adults) 7) Giving a presentation to the County Council Committee on Human Services & Economic Develoment on 1/5/10, where students, parents, and staff gave public testimonies about their experience with HAAS Productions. (This was a very powerful and inspirational gathering for all of us). 8) Establishing good relationships with effective leaders and agencies in our community, (such as Councilwoman Naeole, Mayor Kenoi, Doug Arnott, John Mason, Charter School Educators & Administrators, Erik Bathen, Bernadette Baraquio, PBS Hawaii, and the Census Bureau.) 9) Gloria Baraquio being appointed as a Steering Committee Member for PBS Hawaii's Hiki No, the future statewide news network for youth. This network will allow HAAS Productions to connect with all media departments in schools across Hawaii. As the first program of its kind in the nation, Hiki No was awarded $200,000 from Corporation for Public Broadcasting and $100,000 from the Clarence Ching Foundation. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Arts & Science Center - Agency Name HAAS Productions - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate About 60 -150 hours of facility use Donated by $1200 to $2000 for editing video Na Leo KYBC ($2000 value) Equipment rental /purchase Donated by $2000 + $5800 (cameras /lights /mics) Na Leo Donations ($2000 from Census value) Bureau ($2900 value) Ground Transportation (to Donated by Donated by Donated by workshops, edit bays, or on- location HAAS and HAAS and HAAS and shoots) Volunteers Volunteers Volunteers ($3500 ($4000 ($5000 value) value) value) Travel Expenses off island (flights, Donated by $3000 + $4000 lodging, meals, etc.) Na Leo, Donation parents, from Arnott's HAAS, and Lodge "Living ($1900 Local" value) ($3200 value) About 120 hours of professional Volunteered $4000 + $10,000 + instruction /mentoring /supervision by Gloria volunteer volunteer Baraquio hours by G. hours ($6000 Baraquio ($10,000 value) and E. value) Bathen ($11,000 value) Misc. Costs for Completion of 4 Made $1000 $1500 videos (PSAs or contest possible with submissions) above contributions Misc. Costs for Completion of a full- Made $1000 $1500 length film (60+ minutes) possible with above contributions NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Program Director Duties Volunteered Volunteered $10,000 + by G. by G. Donated Baraquio Baraquio instructor and Donated and Donated from HAAS by HAAS by HAAS ($10,000 ($18,500 ($20,000 value) value) value) Professional Services of Producer, Volunteered $9000 + $10,000 + Director, Videographer, and Editor by G. donated Donated Baraquio services by services ($6,000 G. Baraquio ($7,300 value) & E. Bathen value) ($16,000 value) Operations Offered by $1000 $4000 ASC (Gail Clarke) *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 0 14000 64000 Professional Fees 0 0 1100 Operations 0 1000 4000 Equipment 0 3000 7800 Other 0 2500 4200 (for travel, meals, (for travel, meals, lodging, lodging, production costs, production costs, shirts, workshop shirts, workshop fees, etc.) fees, etc.) Total 0 20,500 81,100 * If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Arts & Science Center - Agency Name HAAS Productions - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Hawaii County _ NA 20000 40000 HAAS (In -kind) 14000 14000 15000 HSDM (HI Schools Digital Media) NA 500 1000 Arnott's Lodge (In -kind) NA 1900 1000 PBS Hawaii (In -kind) NA 6000 8000 Professional Volunteers (In -kind) 25000 32000 12900 "Living Local" (In -kind) 2000 0 1000 Fundraisers 0 250 1000 Parent Contributions (In -kind) 500 1000 1200 Census Bureau NA 2900 NA Total 41,500 78,550 81,100 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? HAAS Productions will continue to seek funding through grants, sponsors, and investors, with the hope of being self - sustained by June 2012. We plan to request support from the following: PBS Hawaii (CPB Grant), Bank of Hawaii, Island Naturals, Hawaiian Airlines, KTA, Longs, Big Island Toyota, HSFCA (Hawaii State Foundation on Culture & the Arts), HUD (Housing & Urban Development), MacArthur Foundation, Bill Gates Foundation, and Kellogg Foundation. By June 2012, we hope to have a continued media program for youth, as we begin to launch a for - profit production company run by HAAS Productions graduates /partners. This production company will offer media services to the global media community, create work opportunities for East Hawaii residents, and provide financial support to Puna community agencies. (This vision is based on a model in Waianae, where Searider Productions inspired the opening of Makaha Studios on the West Side of Oahu. See www.makahastudios.com). NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 Arts & Science Center - Agency Name HAAS Productions - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete. and accurate vear -end report will impact the evaluation of your program's or agency's future funding requests. bast £) i/27 /20i Signature of Board President/Chair Date WALE UAA,,i'q/ (11 11010 Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 6 Arts & Sciences Center HAAS Workplace Readiness Program Agriculture /Landscape Training Program n Hawaii Academy of Arts & Science Workplace Readiness Program - Agency Name HAAS Workplace Readiness Program Agriculture / Landscape Training Program - Program Name Agency Director: Gail Clarke Phone No.: (808)938- 2933 Contact Person: John Theismann Phone No.: (808)769 -1178 Mailing Address: P.O. Box 1494 Pahoa, HI 96778 Facility /Site Address: 15 -1397 Homestead Rd. Pahoa, HI 96778 Fax No.: (808)965 -3733 Email Address: nenue @juno.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPAs & Management Phone No.: (808)242 -5002 Mailing Address: 1885 Main Street, Suite 408, Wailuku, HI 96793 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Amount of Request for County Funds: $5,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $ 0 $ 0 Agency Mission Statement: To provide support and infrastructure for community based learning. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Hawaii Academy of Arts & Science - Agency Name HAAS Workplace Readiness Program Agriculture / Landscape Training Program - Program Name Program Description: HAAS Workplace Readiness Program is an educational program working with high school students, ages 14 -20 who have cognitive disabilities. Under the direction of the Workplace Readiness Teachers, professional landscapers, and community volunteers, eleven special education students work restoring a madadamia nut orchard and planting vegetables in a container garden. Using sustainable techniques and place based learning, integrated with a core curriculum, a hands -on, experiential approach is used to teach students basic planting, fertilizing, and organic pest control methods. Students learn to collaborate with others, act as responsible stewards of the land, and enjoy the outcomes of their work. Our purpose for applying for this County grant is to purchase and construct a greenhouse, based on Boiling Pots nursery of the ARC of Hilo, and begin to establish a hydroponic growing system. The produce grown in this greenhouse will be distributed to needy community members that partake in the "Poi Bowl" food distribution at Pahoa Neighborhood Center as well as the school lunch program at HAAS PCS. Total Budget and Position Count Total Program Budget $5,000 Total Program Position Count 3 Total Agency Budget $141,000 Total Agency Position Count 13 Program Objectives: 1) Provide HAAS Workplace Readiness students with meaningful job training to prepare for supported or competitive employment, in a variety of occupations including landscaping and agriculture, when they leave school. 2) Participate in Community Service activities to promote collaboration with community members and provide experience in a variety of skills. 3) Teach appropriate, fun, and productive work and social skills which transfer to other settings. 4) Expose these students to various types of growing techniques, including soil gardening, container gardening, and hydroponics. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 5) Provide activities for students with cognitive disabilities that prepare them for a full, meaningful life in terms of employment, social interaction, and recreation. Program Highlights: (from Fiscal Year 2008 -09) 1) August 2008: Hawaii Academy of Arts & Science Workplace Readiness Program is formed. (Formerly Workplace Readiness Program at Pahoa School, the teacher, EA, and 8 students transferred to HAAS from Pahoa). 2) December 2008: Received grant from Business Education Partnership in the amount of $500 to start a van washing program. Students are hired by the school to detail school vans used by the students and staff. 3) June 2009: Received a Good Idea Grant in the amount of $2042.00 to purchase weed trimmers, hoes, shovels and other garden tools. Students are trained in use of tools, and work in the school garden and the macadamia nut tree orchard. 4) June 2009: Our first student graduate participates in HAAS Graduation Ceremony. 5) June 2009: First year of implementation of a Summer Work Program for the Workplace Readiness students. Program is funded by Department of Vocational Rehabilitation and Hawaii Academy of Arts and Science, and students worked three hours a day, five days a week, for six weeks. 6) September 2009: HAAS Workplace Readiness Program students along with HAAS Grounds Maintenance staff cut brush around macadamia trees and make improvements to the orchard and it's surroundings in preparation for harvest. 7) October 2009: Received grant from Business Education Partnership in the amount of $460.00 to begin a container gardening program, and research hydroponic growing systems in conjunction with the ARC of Hilo's Boiling Pots nursery. 8) November 2009: HAAS Workplace Readiness Program students sell harvests of macadamia nuts from school orchard to Hershey's Mauna Loa Macadamia Nuts. 9) December 2009: Formed a working partnership with Hawaiian Legacy Hardwoods. Students plant koa seedlings as part of a reforestation / hardwood production operation located in Paauilo, HI. Business partners agree to make a donation to the HAAS Workplace Readiness Program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Hawaii Academy of Arts and Science - Agency Name HAAS Workplace Readiness Program Agriculture / Landscape Training Program - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate HAAS Student Garden Classes 10 months / 10 months / 10 months / 20 20 20 participants participants participants Koa Reforestation Project N/A 1 quarter / 1 quarter / 15 15 participants participants Visits to ARC of Hilo Boiling Pots N/A 1 quarter / 2 quarters / Nursery 15 15 participants participants Community Service Projects 2 quarters / 2 quarters / 2 quarters / 150 150 150 participants participants participants Summer Garden Work Program Summer / Summer / Summer / 8 12 15 participants participants participants Pahoa Community "Poi Bowl" Food N/A 2 quarters / 12 months / Distribution Program 20 HAAS 20 HAAS participants participants & numerous & numerous community community recipients recipients *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 0 0 $7,500 Professional Fees 0 0 0 Operations 0 0 0 Equipment $500 $2,042 $5,000 Other" 0 0 $5,200 (lease land) Total $500 $2,042 $17,700 If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Hawaii Academy of Arts and Science - Agency Name HAAS Workplace Readiness Program Agriculture / Landscape Training Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate HAAS (in kind) 0 0 $7,500 County Grant 0 0 $5,000 Business Education Partnership $500 $460 $500 Grants Good Idea Grant 0 $2,042 $3,000 ASC (in kind) 0 0 $5,200 Total $500 $2,502 $21,200 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program, When do you anticipate your program to become self- sustaining? The Hawaii Academy of Arts and Science Workplace Readiness Program is in it's second year of operation. We have been working diligently to form working partnerships, garner grants, and explore alternative funding methods to enhance our program and the services we deliver to students with cognitive disabilities. We have received minimal grants in the two years we have been in operation at HAAS. We hope to re -apply for these grants on an annual basis. We also hope to utilize grant money to construct a greenhouse and hydroponic growing system that will produce revenue through the sale of fresh produce to local markets, in addition to providing to the community food distribution program and the HAAS school lunch program. We do not anticipate that this program will be self- sustaining in the near future. However, the HAAS Workplace Readiness Program is working hard to offer activities to our students that will make them more independent and sustainable NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 in their own lives, and become productive community members as they move from school to employment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 - Agency Name - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board Pres d n hair Date I C A4 Signa ure of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 9 7 Bay Clinic, Inc. Bay Clinic Family Health Center, at Komohana Bay Clinic, Inc. Clinic Family Health Center, at Komohana Agency Director: Paul Strauss Phone No.: 808 - 961 -4083 Contact Person: Monica Adams Phone No.: 808 - 961 -4080 Mailing Address: 224 Haili St. Bld. B. Hilo, HI 96720 Facility /Site Address: 73 Puuhonu Place Hilo, HI 96720 Fax No.: 808- 961 -6157 Email Address: madams@bayclinic.org Name of Accountant/CPA (include name of firm if applicable): Ann Fukuhara, CPA MBA; An Accountancy Corporation Phone No.: 808 -961 -5532 Mailing Address: 714 Kanoelehua Avenue PO Box 6691 Hilo, Hawai'i 96720 Amount of Request for County Funds: $50,000.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $40,000.00 $20,000.00 $ Agency Mission Statement: To provide high quality, patient centered, comprehensive health care that is affordable, coordinated, culturally competent and community directed for all. Program Description: Every year hundreds of women in East and South Hawai'i must choose between essentials like buying groceries and gas, or visiting the doctor. The poverty faced by these women causes them to go without critical preventative health care which in turn results in skyrocketing rates of otherwise preventable diseases such as; chronic diseases (e.g. diabetes), sexually transmitted diseases, cervical cancer and breast cancer. As a further consequence of not having health insurance or living in poverty, many pregnant women in our community do not received prenatal care and have no option but to have their babies unscheduled at the emergency room with whichever doctor is available. Not only are our children faced with the obstacles of being born into poverty, but inadequate obstetric care can also impede healthy development. From conception onward they are a step behind children from more fortunate families. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Bay Clinic, Inc. Bay Clinic Family Health Center, at Komohana On our island 1 of every 3 women does not receive early prenatal care, a rate 3 times the National Healthy People 2010 goal, and a proportion worsening each year. Women report that they do not seek care because they feel they can't afford it or that they have difficulty getting an appointment. With only 1 OB /GYN to provide prenatal care per 7,500 women in our service area, physician shortages particularly for OB /GYN's, play a critical role in prenatal care access for the women we serve ( Hawai'i Department of Health, Prenatal Care Fact Sheet, 2008). In East and South Hawaii, unemployment rates have doubled in the past year, affecting resident's health insurance coverage, and leading to rising demand for services at Bay Clinic. We currently have one primary medical care site in Hilo that is unable to meet the rising demand for care in our community. In the last month alone, 4,300 patients have sought same -day care without prior appointments at our health centers. With our current facilities at maximum capacity, and in order to meet the expressed needs of our community, we must expand facilities and services. Bay Clinic aims to step forward and develop the Bay Clinic Family Health Center, on Komohana Street in Hilo. This will be a much needed Obstetrical and Gynecological (OB /GYN) health care center that will be a refuge for underserved women, where they may access care without fear of being turned away due to lack of funds. Up until this time, we have unable to provide OB /GYN supervised prenatal care services or to provide labor and delivery services to our patients. Recently we hired an OB /GYN who has been credentialed to perform deliveries at Hilo Medical Center. This is a tremendous accomplishment for our entire East and South Hawaii Communities, from Kati, to Puna to Hilo, because recruiting OB /GYN's to live and work on the Big Island has been difficult not only for us but for the Hilo Medical Center as well. The process to provide OB /GYN service for all women throughout East and South Hawaii has been developed by our new OB, Dr. Eric Helms. Dr. Helms will conduct an initial prenatal evaluation for each prenatal patient at the new Komohana Street facility. Based on the mother's specific health needs, the mother may choose to continue her prenatal care with a certified nurse midwife at one of our 3 health centers in Hilo, Pahoa and Kea'au, or with our OB /GYN in Hilo. Delivery will then be scheduled with Dr. Eric Helm's at Hilo Medical Center. We have coordinated with Hilo Medical Center to have our patients deliver there under the direction of Dr. Helm's, but Hilo Medical Center required that Dr. Helms' office and practice be located within 15 minutes of the hospital. This is so that he can be ready to deliver a baby at any moment and not have to drive long distances to the hospital. Much time and coordination has gone into the development of this program so that it meets the needs of our patients, community, and other health care providers serving East and South Hawai'i, and we expect great success. This expansion will directly address the vast disparities faced by underserved women in our community. We intend to improve access to primary preventative care, impact the low- prenatal care utilization rates, and decrease the high rate of women entering the Emergency Department for delivery without prior prenatal care. From here forward, socio economic disadvantage and limited access will no longer prevent our low income /uninsured patients from receiving the highest quality of care. Total Budget and Position Count Total Program Budget $857,890.55 Total Program Position Count 8 Total Agency Budget $9,663,535.00 Total Agency Position Count 155 Program Objectives: NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Bay Clinic, Inc. Bay Clinic Family Health Center, at Komohana Our goal is to improve access to critically needed comprehensive primary medical, women's health, prenatal, labor, delivery and postnatal services for low income families who live in Ka'O, Puna and Hilo regardless of ability to pay. Due to opening the Pahoa Women's Health Center, in 2009 we have been able to dramatically increase our women's health services, and we anticipate an even greater increase with our service expansion in Hilo. Measurable outcomes from July 1, 2010 — June 30, 2011 include: 1. Open the Bay Clinic Family Health Center, at Komohana, expanding OB /GYN care and primary care services by Summer of 2010. 2. Expand our women's health program to include OB /GYN supervised prenatal care, including labor and delivery services for 2,791 visits from July 1, 2010 — June 30, 2011. 3. Increase the number of women's health visits to 5,500, from July 1, 2010 — June 30, 2011. Program Highlights: In 2008 -2009 Bay Clinic strengthened our organizational structure and financial position, which has contributed to our ability to help thousands of people, while also providing jobs and services to our community members. This steadfast determination and solid foundation have predicated the following accomplishments for the year: 1. This year we cared for 15,869 patients (5,255 in Hilo, 1,732 in Ka`u , 8,381 in Puna and 501 other areas) with 48,004 visits 2. Patients reported receiving "Good to Excellent Care" in our annual patient satisfaction survey 3. Opened the New Pahoa Women's Health Center 4. Started a Saturday Keiki Clinic in Kea'au. 5. Began Mobile Dental Care 6. Received an award for outstanding quality of care by the Federal Department of Health and Human Services 7. Received the Pacific Business News Cades Schutte Non - Profit Business Leadership Hawaii`i Award 8. Employed 155 people, including 28 providers, contributing significantly to the economy and workforce of Hawai'i Island 9. Strengthened our financial position with revenue exceeding expenses Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Open the Bay Clinic Family Health Center, at 0 1 1 Komohana, expanding OB /GYN care and primary care services Expand our women's health program to include 0 0 2,791 OB /GYN supervised prenatal care, including labor and delivery services for 2,791 visits Increase women's health visits to 5,500 per year 1,668 3,336 5,500 Program Expenditures: FY 2008 -09 Actual * FY 2009 -10 Budget * FY 2010 -11 Estimate Salaries and Wages $0 $0 $638,166.00 Professional Fees $0 $0 $0 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Bay Clinic, Inc. Bay Clinic Family Health Center, at Komohana FY 2008 -09 Actual * FY 2009 -10 Budget * FY 2010 -11 Estimate Operations $0 $0 $143,126.49 Equipment $0 $0 $76,598.06 Other" $0 $0 $0 Total $0 $0 $857,890.55 * If applicable " Please explain in detail on separate sheet Program Funding Sources: Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate AlohaCare- Secured $0 $0 $30,000.00 HMSA- Secured $0 $0 $30,000.00 Samuel N. and Mary Castle Found. - Secured $0 $0 $15,000.00 Kaiser Foundation - Secured $0 $0 $10,000.00 Individual Donors — Secured $0 $0 $34,110.00 Hawaii County- Pending $0 $0 $50,000.00 Friends of Hawaii Charities- Pending $0 $0 $15.000.00 Michael and Susan Dell Foundation- Pending $0 $0 $24,771.00 Avon- Pending $40,000.00 Bay Clinic - In Kind $0 $0 $71,181.55 Insurance Billing — In Kind 0 0 $537,828.00 Total $0 $0 $857,890.55 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Total program expenses associated with additional personnel, operations and equipment for this new site total $857,890.55 in year one. Program income in year one is expected to total $857,890.55. This is based upon grant funding, in kind support and estimated insurance billing revenue. Our insurance billing revenue is based on patient visit volume estimates for the 8 staff members located at the new site, including 1 OB /GYN, 2 Nurse Practitioners, 2 Registered Nurses, 2 Patient Service Representatives, and 1 Medical Assistant. Sustainability is ensured as in year 2 and 3 we anticipate a rapid increase in revenue as the center becomes fully established, earning $1,105,340 and $1,149,874 in revenue respectively. Thus this short term request has the guarantee of long term sustainable impact. If not all start up funding is secured as planned, we are committed to seeking additional grants and funding from sources that are dedicated to improving critical health care needs in underserved and disadvantaged communities. The problem of access to women's, prenatal and primary health care has reached epidemic proportions in our community, and each year it worsens. Bay Clinic is committed to finding a solution by equalizing the quality of care all women receive regardless of insurance status or income level, and ensuring that the children born in our community have the best start to life possible. With 26 years of experience rising to meet the health needs of this community, combined with the thoughtful planning of this expansion, Bay Clinic is well situated for a successful implementation and a final solution to rectifying this disparity is well within our grasp. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Bay Clinic, Inc. Bay Clinic Family Health Center, at Komohana 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that 1 (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, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate vear-end report will impact the evaluation of your program's or agency's future funding requests. � J 4 . 1 - 1 % - Z o o Si.- . - • :oard P esidenUChair Date l - IBS - ao\ Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 8 Bay Clinic, Inc. Children's Dental Care Bay Clinic, Inc. cat Children's Dental Care , 1 Agency Director: Paul Strauss Phone No.: 808- 961 -4083 Contact Person: Monica Adams Phone No.: 808 - 961 -4080 Mailing Address: 224 Haili Street Hilo, HI 96720 Facility /Site Address: 16 -192 Pilimua Street Kea'au, HI 96749 Fax No.: 808- 961 -5678 Email Address: madams@bayclinic.org Name of Accountant/CPA (include name of firm if applicable): Ann Fukuhara, CPA MBA; An Accountancy Corporation Phone No.: 808 - 961 -5532 Mailing Address: 714 Kanoelehua Avenue PO Box 6691 Hilo, Hawai'i 96720 Amount of Request for County Funds: $60,000.00 We are requesting 50% of the start up salary for a new dentist that specializes in children's dental care. Prior Year(s) Funding: 07 -08 08 -09 09 -10 $40,000.00 $20,000 $0 Agency Mission Statement: To provide high quality, patient centered, comprehensive health care that is affordable, coordinated, culturally competent and community directed for all. Program Description: A child's smile is a window into the precious innocence of childhood and every parent wants their child's smile to radiate happiness, confidence and hope. But all too often in our Big Island keiki smiles are replace by sadness and tears from the pain and social isolation caused by serious dental health problems that plague our island's kids. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Bay Clinic, Inc. Children's Dental Care Children on Hawaii Island have an increased vulnerability to poor oral health conditions. In 2002, the State of Hawaii, Department of Health, and Dental Health Division conducted a statewide public school oral health assessment of children between the ages of 6 -8 years of age. The study found the untreated tooth decay in Hawai'i Island children was 31.8% in Hilo, 40.6% in Pahoa; and 32.1% in Kea'au. In addition, Hawaii's rate of baby bottle tooth decay (which is when children lose their teeth due to sugary drinks in their bottles) is nearly three times higher than the national average with 14% in Hawai'i versus the 5% rate in the rest of the US'. In children ages 5 to 9, Hawaii's rate of dental caries is almost twice the average of the rest of the United States. Children of ethnic groups prevalent in our Island's populations (Native Hawaiian / Asian American / Other Pacific Islander) have nearly twice the rate of dental decay as compared to children in the mainland United States. The reason for this disparity is not entirely understood. But it is estimated to be due to an array of issues including lack of water fluoridation, high sugar diets that promotes tooth decay, a high percentage of recent immigrants who have limited understanding of oral health practices, challenges in understanding the health care system, few resources to pay for care, low priority on prevention, as well as socio- economic conditions ( Hawai'i Oral Health Task Force 2001). But despite these dire statistics and challenges, the pain and discomfort of tooth decay in children, as well as the barriers to oral health services, is largely preventable. Bay Clinic helps people struggling to understand and access the health care system. We provide care to all regardless of ability to pay, and we work to teach preventative practices to parents and children to improve life long oral health. But currently, we lack the specialty resources required to provide dental care to children. In fact, on our entire island, there are only a limited number of specialists trained to provide Children's Dental Health specialty care. As a result, MedQuest has paid $1,000,000 in travel costs alone for Big Island children to see children's oral health specialists on Oahu. If we initiate this program, children and their parents will no longer need to go to Oahu for treatment but can get the care they need right here. Thus, Bay Clinic, with the help of Hawaii County, proposes to hire a Dentist that specializes in Children's Dental Care, in order to provide much needed children's dental care right here on our Island. We have identified a dentist who wants to live and work on Hawaii Island. She is new to the area, and is interested in working with us to meet our children's serious dental care needs. But since this is a new project, we are requesting initial start up support for 6 months of salary for this dentist, or $60,000. We feel this is of critical importance right now not only because our children need services immediately, but because this dentist is in high demand and may be offered positions on other islands, thereby eliminating this excellent and rare opportunity to gain a vitally important dental resource for Hawaii Island. By hiring a dentist that specializes in Children's Dental Care, we will be able to provide oral health care services to more of Hawaii's children, giving them the healthy and happy smiles they want and deserve. Greer, M. & Louie. R., DOH Dental Health Division, 2000. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Bay Clinic, Inc. Children's Dental Care Total Budget and Position Count Total Program Budget $166,250 Total Program Position Count 1 Total Agency Budget $9,663,535.00 Total Agency Position Count 155 Program Objectives: 1) Provide Children's Specialty Dental Care to 850 children ages 0 to 13 living in Puna, Kau, and Hilo. Program Highlights: (from Fiscal Year 2008 -09) Organizationally, we he have had tremendous highlights: In 2008 -2009 Bay Clinic strengthened our organizational structure and financial position, which has contributed to our ability to help thousands of people, while also providing jobs and services to our community members. We have also experienced the following strong outcomes last year: 1. This year we cared for 16,000 patients with 48,000 visits 2. Patients reported receiving "Good to Excellent Care" in our annual patient satisfaction survey 3. Opened the New Pahoa Women's Health Center 4. Started a Saturday Keiki Clinic in Kea'au. 5. Received an award for outstanding quality of care by the Federal Department of Health and Human Services 6. Received the Pacific Business News Cades Schutte Non - Profit Business Leadership Hawaii Award 7. Employed 155 people, including 28 providers, contributing significantly to the economy and workforce of Hawai'i Island 8. Strengthened our financial position with revenue exceeding expenses Program Highlights (for our dental program) included the following: 1. Received grants for $60,000 from Hawaii Dental Services and a 3 year $275,000 grant to begin providing Mobile Dental Care via a dental van for rural areas of Hawaii Island. We have provided dental care to Kau and are rotating the van to Puna and Hilo in 2010. Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Hire 1 Children's Dental Health 0 0 1 Specialty Dentist Provide Children's Dental Care to 850 0 0 850 children apes 0 -13 in FY 2010 -2011 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Bay Clinic, Inc. Children's Dental Care Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual Budget Estimate Salaries and Wages 0 0 $120,000 -New Children's Health Dentist ($120,000) Professional Fees 0 0 $9,000 - license to electronic health records system Operations 0 0 $35,250 - Facilities and Dental Supplies Equipment Other Total 0 0 $166,250 Program Expenditures: Detail For Children's Dental Health Care Services, the budget detail for FY 2010 -11 is as follows: Salaries and Wages Proposed New Children's Dental Health Specialist. The full time salary is $120,000, including taxes, benefits, and wages. We are requesting 6 month start up funds, in the amount of $60,000 from Hawai'i County to help us initiate this new program. Salary Taxes / Benefits Total $94,800 $25,200 $120,000 Professional Fees: License for Electronic Health Records is $9,000 per $9,000 dentist. This is necessary for the dentist to maintain records of dental patients. Operations Facilities (Lease and Utilities): The cost of lease and utilities is shared $2,000 with other dental programs. The proportion used for this program is 1/12 of the dental lease and utilities expense. Dental Supplies: Per patient, it costs $41.47 for anesthetic, washes, $35,250 tools, mouth pieces, gauze, and materials for dental cleaning and treatment. We expect 850 child patients at this cost totaling $35,250. Equipment $0 Other $0 Total $166,250 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Bay Clinic, Inc. Children's Dental Care Program Funding Sources: Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Dental Billing (FY 2010 - 2011): Fee - - $106,250 For Service: Average billing / revenue rate per patient (through insurance billing) is $125. So, $125 x 850 = $106,250 Hawaii County: Current Request $60,000 Total $166,250 Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Most of our patients who are children qualify for Medicaid / Quest. Medicaid / Quest which reimburses us at a rate of $175.00 per visit. Other patients are uninsured or have lower reimbursement insurances. Therefore, on average, we receive $125 per visit including write -offs, uninsured patients, and other insurance reimbursements. We project that our new dentist will see nearly enough patients to cover expenses in the first year. In the second year (FY 2011 - 2012), once she gets used to our facility, patients, electronic health records system, and protocols, we expect her to have a 35% increase in patients and visits allowing for an additional 300 (to a total of 1,150 patients) visits in year 2, or $166,750 in revenue. We are also projecting a higher reimbursement rate in year two (at $145) because we have received state funding to help us enroll children in Medicaid / Quest who qualify for this insurance coverage, thus decreasing our write -offs and losses. Thus we expect more children will be covered next year as opposed to this year. This additional revenue which is projected due to increased efficiencies in the second year will allow the program to be sustainable. This year, we request a modest amount of start up funds ($60,000) to initiate this vitally important program that will benefit all the children in need in Kau, Hilo, and Puna, but in the long term no additional funds will be necessary for us to continue the program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Bay Clinic, Inc. Children's Dental Care 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, Hawai`i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that 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, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal Year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. aer / - /,f - 2(e Si and President/Chair Date < anaturaof � _ t- 1 -Lo, Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 9 Big Island Resource Conservation and Development Council, Inc. Resource Conservation and Development Program BIG ISLAND RESOURCE CONSERVATION AND DEVELOPMENT COUNCIL, INC RESOURCE CONSERVATION AND DEVELOPMENT PROGRAM Agency Director: David Marquez Phone: 933 -6996 Contact Person: David Marquez Phone: 933 -6996 Mailing Address: 101 Aupuni Street, Ste 229 Hilo, Hawaii 96720 -4261 Facility /Site Address: Same as Above Fax Number: 933 -6995 Email Address: bred @hawaii.rr.com Name of Accountant/CPA (Include name of firm, if applicable) Alex J. Smith Phone Number: 808- 737 -7761 Mailing Address: 1403 Frank Street, Honolulu, HI 96816 Amount of Request for County Funds: $10,000.00. Funds will be used to retain independent bookkeeper, CPA, training, provide for high speed Internet access and continue to create an improved community internet access /grant search system for the Council to use and share with applicants, partners, and community. Prior Year(s) Funding: 07 -08 08 -09 09 -10 $ NA $15,000.00 $10,000.00 Agency Mission Statement: The Mission of the Big Island RC &D Council is to assist the people of the Big Island in achieving sustainable development while caring and appreciating their natural environment; to ensure broadened economic opportunities, enriched communities, and Netter lives. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010— 11 Page 1 BIG ISLAND RESOURCE CONSERVATION AND DEVELOPMENT COUNCIL, INC RESOURCE CONSERVATION AND DEVELOPMENT PROGRAM Program Description: The Big Island RC &D Program, authorized by the U.S. Secretary of Agriculture and administered by the Natural Resources Conservation Service (NRCS) in 1975, covers the entire island of Hawaii. The Council is incorporated and non - profit within the State of Hawaii. It is also tax - exempt, 501 (c)(3) by Internal Revenue Service determination. The RC &D volunteer program is strengthened through a nationwide network. This network allows the RC &D Council to have an active role with issues being addressed at regional and national levels. Total Budget and Position Count: Total Program Budget $24,980.00 Total Program Position Count 2 Total Agency Budget Not Applicable Total Agency Position Count 2 NOTE: Agency Budget is not directed to the non - profit Council for administrative purposes. Council contracts 2 independent part-time positions that of CPA and a Book Keeper. Agency provides position support for program and community. Council is a private non - profit. Program Objectives: The Vision of the Big island RC &D Council: Conserve, enhance and promote the economic, cultural, and natural environment of Hawaii. Program Highlights: (from Fiscal year 2008 -09) The Big Island RC &D Council has completed numerous projects since 1975. Many partnerships were formed as a result of the networking that the RC &D Program builds. In addition, the Council coordinates educational workshops to develop community awareness and resources. Requests for assistance are accomplished through submissions of the Big Island RC &D's basic concept application. Listed below are some of the activities the Council and its volunteer committees have done or are doing for the last year: • Hawaii World Heritage Festival • Hilo Inter - Tribal Powwow — A Native American cultural event that features art, culture, crafts, music and an exchange of Native American and Native Hawaiian cultural ceremonies - scheduled for 2010. • Hawaii Island Festivals — 30 Days of Aloha • Ka'u Coffee Festival — scheduled for 2010. • Hawaii Agricultural Development Program (HADP) Phase IV — A series of grants successfully acquired by the RC &D Council through Senator Daniel Inouye have been used to fund and support approximately 45 separate agribusiness enterprises, throughout the County since 2004. Funding has been secured for 2010 and we anticipate another 5 to 6 new enterprises. NONFPROFIT GRANT APPLICATION FISCAL YEAR 2010 — 2011 Page 2 Big Island Resource Conservation & Development Council, Inc. - Agency Name Big Island RC &D Council, Inc. - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Number of Projects 42 45 50 Fiscal Sponsorships Provided 12 14 15 New Businesses Created 6 7 8 Educational Outreach 5 7 9 Revenue Brought to County $3,000,000 $4,000,000 $5,000,000 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 0 0 0 Professional Fees $12,374.56 $12,700.00 $12,500.00 Operations $4,014.48 $6,080.00 $6,000.00 Equipment $1,627.11 $200.00 $500.00 Other Training $9540.63 $6,000.00 $8,000.00 Total $27,556.78 $24,980.00 $27,000.00 If applicable s Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page Big Island Resource Conservation &. Development Council, Inc. - Agency Name Big Island RC &D Council, Inc. - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Sponsor's Dues $1,200.00 $2,700.00 $2,700.00 Administrative Fees $22,618.90 $12,299..00 $15,000.00 County of Hawaii $12,500.00 $10,000.00 0 Capacity Building Grant $10,000.00 Total $36,318.90 $24,999.00 $27.700.00 *If applicable • Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The Council is actively seeking more projects which will generate increased revenues through administrative fees. They will also be researching and submitting capacity building grants. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page q BIG ISLAND RESOURCE CONSERVATION AND DEVELOPMENT COUNCIL INC - Agency Name RESOURCE CONSERVATION AND DEVELOPMENT PROGRAM - 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. 1 (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signaturebf B a ntlChair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 11 • Page 10 Big Island Substance Abuse Council East Hawaii Substance Abuse Program Big Island Substance Abuse Council East Hawaii Substance Abuse Program Agency Director: Dr. Stephen C. Zuniga Phone No.: 969 -9994 Contact Person: Richard Teanio Phone No.: 935 -4927 Mailing Address: 135 Puuhonu Way Suite 201, Hilo, HI 96720 Facility /Site Address: 297 Waianuenue Ave, Hilo, HI 96720 Fax No.: 969 -7570 Email Address: LikekeT @bisac.com Name of Accountant/CPA (include name of firm if applicable): John Carbonaro, Carbonaro CPA's & Management Group Phone No.: 808 - 242 -5002 Mailing Address: 1885 Main Street Suite 408, Wailuku, HI 96793 Amount of Request for County Funds: $30,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $30,000 $20,000 $20,000 Agency Mission Statement: The Big Island Substance Abuse Council strives to enhance the quality of care and innovative services in the areas of Substance Abuse Education, Intervention and Treatment. We are dedicated to the healing of mind, body and spirit of individuals, families and others who suffer as a result of alcohol and other substance use, abuse and addiction. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Big Island Substance Abuse Council East Hawaii Substance Abuse Program Program Description: The Big Island Substance Abuse Council's East Hawaii programs provide comprehensive substance abuse treatment services to adults and adolescents through research -based methods and best - practices designed for the area's target population. This population includes adolescents, adults, parents and whole families who are experiencing substance abuse or dependency and require the structure of an institution such as BISAC to begin the process of recovery or intervene with chronic relapse. BISAC recognizes the significant impact of crystal methamphetamine to the addicted individual and our communities, and has designed programs to intervene in the addictive process and build on an individual's or family's strengths to abstain from the use of drugs and alcohol and increase protective factors and relapse prevention skills to maintain their rehabilitation. The East Hawaii BISAC programs provide outpatient treatment and therapeutic living services to adults and offers separate adolescent outpatient services and school based services in twenty -three (23) schools. BISAC gives priority to pregnant women, HIV users, and those with co- occurring disorders. Several of the East Hawaii therapeutic living programs are designed to meet specific needs of the target population and include home -like settings for a variety of specialties including; mothers with children ages birth -6 years, single women, and single men. BISAC has also placed a strong emphasis on providing services to persons abusing or addicted to the drug Crystal Methamphetamine or, "Ice ". The ice epidemic in East Hawaii is truly evident and requires immediate access to treatment services when the opportunity arises. BISAC is requesting funds to subsidize Outpatient and Therapeutic Living Program Treatment services to Adolescents and Adults which will improve the overall quality and accessibility of services for any client who presents themselves at BISAC and requires immediate and intensive care necessary to recover from addiction. Total Budget and Position Count Total Program Budget 3,152,694 Total Program Position Count 21 Total Agency Budget 5,376,234 Total Agency Position Count 80 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Big Island Substance Abuse Council East Hawaii Substance Abuse Program Program Objectives: 1) Provide immediate access to assessment and treatment services to any individuals who are assessed and diagnosed with any substance related disorders. 2) Increase the availability of extended outpatient and therapeutic living program treatment services to addicted adults and adolescents who may have no other funding availability for treatment services. 3) Decrease the number of days between when an individual requests treatment intervention services and the date that those services are delivered, by funding treatment -on- demand services while alternative reimbursement is identified. 4) Achieve understanding of disease concept of addiction and co- occurring disorders. 5) Reducing recidivism by 30% by not incurring additional arrests 6 months post- treatment. 6) Identify clean and sober social support networks and actively participate to identify and link with support systems in preparation for discharge. 7) Identification of individualized protective factors that will significantly reduce risk factors, and has identified and implemented a minimum of six within the first 90 days of treatment. 8) Complete 80% of identified treatment goals and has developed a transition plan to prepare for discharge. Program Highlights: (from Fiscal Year 2008 -09) • BISAC was able to admit approximately 650 adults into all levels of outpatient substance abuse treatment and Therapeutic Living services in East Hawaii, and 386 adolescents island -wide. Data collected from our 2008 - 2009 Annual Management Report disclosed the following: • 46% Completed Treatment. • 51 % were employed, in school, vocational training or volunteering. • 78% had no new arrests post treatment. • 73% had no new treatment episodes. • 48% were involved in self -help groups post treatment. • 96% have stable living arrangements post treatment. • 80% did not miss work or school due to drugs /alcohol. • 90% had no Emergency Room admissions post treatment. • 90% had no hospital admissions post treatment. • 72% had no significant psychological distress within 30 days post treatment. • 43% usage within in the last 30 days. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Big Island Substance Abuse Council East Hawaii Substance Abuse Program Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Substance Abuse Treatment Units 37,616 39,496 41,471 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 2,139,827 1,903,336 1,998,503 Professional Fees 41,005 43,155 43,313 Operations 842,870 706,806 742,146 Equipment Other 75,252 76,517 80,343 Total 3,098,955 2,729,814 2,866,304 * If applicable u Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County 20,000 38,000 48,000 State of Hawaii 1,628,807 1,725,851 1,852,144 Federal 800,000 800,000 800,000 HIUW 13,000 12,979 13,628 Private Foundation 25,489 21,563 23,541 Donations /Fundraising 740 0 0 Private lnsurance 326,064 257,658 270,541 Client Fees 91,474 137,473 144,347 Training /Other 28,873 469 493 Total 2,934,447 2,993,994 3,152,694 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Big Island Substance Abuse Council East Hawaii Substance Abuse Program Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Big Island Substance Abuse Council continues efforts to diversify funding sources and expand services where appropriate throughout the State and Island of Hawaii. BISAC has contracted with three new managed care agencies and two new grant providers to diversify our funding stream. A conservative fiscal philosophy coupled with a team of skilled and dedicated staff members has enabled BISAC to expand and retain a positive, prominent presence in the community. BISAC's sound fiscal policies are incorporated into decisions related to program expansion or to enter market niches that would expand the behavioral health continuum. Business decisions include enrolling consumers in a Quest plan when eligible and appropriately utilizing benefits to cover treatment services. Administrative staff is scheduled to participate in meetings with HMSA and other substance abuse treatment providers to evaluate ways on increasing community awareness of insurance benefits and working with physicians to appropriately identify and refer consumers who may need treatment services that would be covered by HMSA insurance. The BISAC Board understands the commitment and priority of this project. The CEO is working to obtain commitments for this project and the Board has anticipated the project costs in the approved budget. The $30,000 requested for East Hawaii under this proposal will go towards the supporting this proposal's requests. BISAC plans include exploring available funding that supports capacity building and sustainability efforts, and reduces our reliance on State and County funds. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Big Island Substance Abuse Council East Hawaii Substance Abuse Program 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. 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 a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. ignature of B resident/Chair Date /� Patricia Engelhard ric/ / /t/A 0/0 Signature o ExecutiverlDifector Date Dr. Stephen C. Zuniga UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 11 Big Island Substance Abuse Council Kokua EAP (Employee Assistance Program) Big Island Substance Abuse Council Kokua EAP (Employee Assistance Program) Agency Director: Dr. Stephen C. Zuniga Phone No.: 969 -9994 Contact Person: Dr. Stephen C. Zuniga Phone No.: 969 -9994 Mailing Address: 135 Puuhonu Way Suite 201 Hilo, HI 96720 Facility /Site Address: 297 Waianuenue Ave, Hilo, Hawaii 96720; 135 Puuhonu Way Ste 201, Hilo, Hawaii 96720 64 -1040 Mamalahoa Hwy Ste 101, Kamuela, HI 96743 Fax No.: 969 -7570 Email Address: drz @bisac.com Name of Accountant/CPA (include name of firm if applicable): John Carbonaro, Carbonaro CPA's & Management Group Phone No.: 808 - 242 -5002 Mailing Address: 1885 Main Street Suite 408, Wailuku, HI 96793 Amount of Request for County Funds: $18,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $00.00 $00.00 $18,000 Agency Mission Statement: The Big Island Substance Abuse Council strives to enhance the quality of care and innovative services in the areas of Substance Abuse Education, Intervention and Treatment. We are dedicated to the healing of mind, body and spirit of individuals, families and others who suffer as a result of alcohol and other substance use, abuse and addiction. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Big Island Substance Abuse Council Kokua EAP (Employee Assistance Program) Program Description: Big Island Substance Abuse Council (BISAC) d.b.a. Kokua EAP (Employee Assistance Program) provides effective, confidential counseling services to individuals, couples and families in finding life affirming solutions to a variety of problems. Most traditional Employee Assistance Programs offer services to employees; however, Kokua EAP also offers assessment and counseling services to any individuals regardless of race, color, religion, sex or gender, age, national origin, ancestry, marital status, arrest and court record (except as provided by Haw. Rev. Stat. 378 -2.5), disability, sexual orientation, military/veterans status, lactation or other grounds protected under applicable state and federal laws, regulations, and /or executive orders. Our agency -wide behavioral health services have historically provided services to the indigent who do not have the financial means to pay for various consumer related fees or direct service costs. Kokua EAP is not limited to providing services to employees of business, but also offers a leadership training program as well as assessment and counseling services to anyone with mental health needs. Our certified counselors, advanced degree therapists or licensed professionals (whether contracted or employed) offer confidential, short and long -term care, in a safe, professional environment. Individuals seeking counseling services often struggle as they may not have the financial means to cover their share of the costs or may have exhausted eligible benefits. Others clients simply do not have the means to pay for needed services and as a result of this their situations and circumstances deteriorate further and drain limited community resources which can be avoided if the means existed to cover costs related to ongoing counseling care to maintain protective factors which increase the likelihood of a positive outcome to individuals and families. BISAC proposes to utilize awarded County Funds to cover payment for ongoing assessment and counseling services to individuals, couples and families at subsidized or no -cost rates who have no health insurance, restrictive health insurance plans, and /or limited financial resources. Services typically address emotional difficulties, marital and family problems, stress, substance abuse and other issues as well as anger management groups which may be required. The good news is that these problems have solutions when identified early and treated. The services are consistent with our mission and organizational goals and objectives to: 1)To provide a range of coordinated, comprehensive treatment services that addresses the multiple health and human service needs of adult and adolescent substance abusers in our community. 2) To decrease the incidence, severity and debilitating consequences of alcohol and drug abuse among Hawaii Island residents through education, psycho- education and individualized treatment modalities. and 3) To effect significant change in the NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Big Island Substance Abuse Council Kokua EAP (Employee Assistance Program) consumers with substance abuse disorders, resulting in an improved quality of life for both the individual and family, to include successful integration into the community. Additionally, any available operational funds will be used to cover or reduce any operational expenses required to provide services. Such operational expenses typically include salaries, rent, brochure costs, supplies, IT hardware and software support, communication equipment and monthly service costs, audit fees, as well as ongoing staff training and operational costs associated with maintaining organization wide CARF accreditation. Total Budget and Position Count Total Program Budget $20,000 Total Program Position Count 4 PT Total Agency Budget 5,523,704 Total Agency Position Count 80 Program Objectives: 1) Provide immediate access to assessment and counseling services to any individuals who are assessed as meeting a mental health diagnosis according to the DSM -IV and voluntarily agree to participate in counseling. 2) Increase the availability of outpatient services to individuals who may have limited funding, or no funding availability to cover client fees or counseling services costs. 3) Decrease the number of days between when an individual requests counseling services and the date that those services commence, by funding treatment -on- demand services. 4) Respond to the growing demands for mental health services to East Hawaii residents which have seen services reduced or cut at the State level by the Governor due budget short falls. 5) Reducing the strain on hospital admissions to the emergency room by 30% for a related mental health disorder as a result of engaging the individual in ongoing counseling. 6) Identify appropriate support networks and actively participate to assist the individual with linkage to appropriate support systems. 7) Increase education and training opportunities to interested East Hawaii community professionals or clients on a variety of profesional and consumer related topics offered to the public at a minimal cost. 8) Provide rarely offered or available culturally based, best practices counseling services, as needed or upon request, to a culturally diverse population who prefer alternative healthcare interventions. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Big Island Substance Abuse Council Kokua EAP (Employee Assistance Program) Program Highlights: 1) • Offered monthly training in FY 2009 and have published training schedule for FY2010. 2) • Self referral demands for family counseling services increased over self referrals for individual counseling. 3) • Participated in employee sponsored and community sponsored wellness and health fairs. 4) • Increased demand for culturally based interventions (Ho'opono pono) by employer supervisors and clients of EAP plan. 5) • Self referrals versus employer related referrals increased by 3:1. 6) • Approximately 60% of the referrals seeking counseling services are women. 7) • Successful linkage to appropriate resources averted a crisis for a potential mental health client. 8) • Services were expanded to include a Leadership Training Program and Anger Management classes for eligible clients. Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Treatment Units 67.75 67.75 67.75 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages $17,185 $14,000 $16,000 Professional Fees 355 Operations $14,206 $5,000 $5,000 Equipment 602 1,000 $1,000 Other Total $32,348 $20,000 $22,000 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Big Island Substance Abuse Council Kokua EAP (Employee Assistance Program) Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Hotel Contract $4,831 $2,000 $4,000 County Grant $18,000 $18,000 Total $4,831 $20,000 $22,000 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Big Island Substance Abuse Council d.b.a. Kokua EAP continues its efforts to diversify funding sources and expand services where appropriate throughout the State and Island of Hawaii. Kokua EAP continues its efforts to reach out to employers to educate them regarding the need for contracting such services; especially when times are difficult and stress factors increase for individuals and families which directly impacts an individual's work performance. Kokua EAP is increasing awareness of its training program topics offered to professionals and any interested consumers on a monthly basis on various behavioral health topics. Where feasible, BISAC is pursueing third party reimbursement for mental health services provided by professional or certified staff. A conservative fiscal philosophy coupled with a team of skilled and dedicated staff members has enabled BISAC to expand and retain a positive, prominent presence in the community for the past 46 years. BISAC's sound fiscal policies are incorporated into decisions related to program expansion or to enter market niches that would expand the behavioral health continuum. The $18,000 requested for East Hawaii under this proposal will go towards supporting this proposal's requests; $10,000 to the client assistance fund to subsidize low cost or no -cost counseling services to individuals, couples and families who have no health insurance, restrictive health insurance; and or limited financial resources to cover any and all counseling services. The other $8,000 will be used to cover program operational costs. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Big Island Substance Abuse Council Kokua EAP (Employee Assistance Program) I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 4 at, / /%o h o Sig ature of Boar President/Chair Date Patricia Engelhard Signatur- of Executive •ir -ctor D to Dr. Stephen C. Zuniga UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 12 Big Island Substance Abuse Council West Hawaii Substance Abuse Program Big Island Substance Abuse Council West Hawaii Substance Abuse Program Agency Director: Dr. Stephen C. Zuniga Phone No.: 969 -9994 Contact Person: Dana Williams Phone No.: 322 -3100 Mailing Address: 135 Puuhonu Way Suite 201 Hilo, HI 96720 Facility/Site Address: 81 -947 Halekii Street, Kealakekua, HI 96750 Fax No.: 969 -7570 Email Address: Dana.Williams @bisac.com Name of Accountant/CPA (include name of firm if applicable): John Carbonaro, Carbonaro CPAs & Management Group Phone No.: 808 - 242 -5002 Mailing Address: 1885 Main Street Suite 408, Wailuku, HI 96793 Amount of Request for County Funds: $30,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $30,000 $20,000 $20,000 Agency Mission Statement: The Big Island Substance Abuse Council strives to enhance the quality of care and innovative services in the areas of Substance Abuse Education, Intervention and Treatment. We are dedicated to the healing of mind, body and spirit of individuals, families and others who suffer as a result of alcohol and other substance use, abuse and addiction. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Big Island Substance Abuse Council West Hawaii Substance Abuse Program Program Description: The Big Island Substance Abuse Council's West Hawaii programs provide comprehensive substance abuse treatment services to adults and adolescents through research -based methods and best - practices designed for the area's target population. This population includes adolescents, adults, parents and whole families who are experiencing substance abuse or dependency and require the structure of an institution such as BISAC to begin the process of recovery or intervene with chronic relapse. BISAC recognizes the significant impact of crystal methamphetamine to the addicted individual and our communities, and has designed programs to intervene in the addictive process and build on an individual's or family's strengths to abstain from the use of drugs and alcohol and increase protective factors and relapse prevention skills to maintain their rehabilitation. The West Hawaii BISAC programs provide outpatient treatment and therapeutic living services to adults and offers separate adolescent outpatient services and school based services in twenty -three (23) schools. BISAC gives priority to pregnant women, HIV users, and those with co- occurring disorders. BISAC committed funds in 2007 to open a therapeutic living program for males in Kona. BISAC has also placed a strong emphasis on providing services to persons abusing or addicted to the drug Crystal Methamphetamine or, "Ice ". The ice epidemic in West Hawaii is truly evident and requires immediate access to treatment services when the opportunity arises. Currently, the East Hawaii therapeutic living programs are designed to meet specific needs of the target population and include home -like settings for a variety of specialties including; mothers with children ages birth -6 years, single women, and single men. Establishing a therapeutic living program in West Hawaii allows clients to transition to communities where they have chosen to live and work. BISAC has also placed a strong emphasis on providing services to persons abusing or addicted to the drug Crystal Methamphetamine or "Ice ". The ice epidemic in West Hawaii is truly evident and requires immediate access to treatment services when the opportunity arises. BISAC is requesting funds to subsidize Outpatient Treatment and Therapeutic Living Program services to Adolescents and Adults which will improve the overall quality and accessibility of services for any client who presents themselves at BISAC and requires immediate and intensive care necessary to recover from addiction. Total Budget and Position Count Total Program Budget 1,818,541 Total Program Position Count 12 Total Agency Budget 5,376,234 Total Agency Position Count 80 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Big Island Substance Abuse Council West Hawaii Substance Abuse Program Program Objectives: 1) Provide immediate access to assessment and treatment services to any individuals who are assessed and diagnosed with any substance related disorders. 2) Increase the availability of extended outpatient and therapeutic living program treatment services to addicted adults and adolescents who may have no other funding availability for treatment services. 3) Decrease the number of days between when an individual requests treatment intervention services and the date that those services are delivered, by funding treatment -on- demand services while alternative reimbursement is identified. 4) Achieve understanding of disease concept of addiction and co- occurring disorders. 5) Reducing recidivism by 30% by not incurring additional arrests 6 months post- treatment. 6) Identify clean and sober social support networks and actively participate to identify and link with support systems in preparation for discharge. 7) Identification of individualized protective factors that will significantly reduce risk factors, and has identified and implemented a minimum of six within the first 90 days of treatment. 8) Complete 80% of identified treatment goals and has developed a transition plan to prepare for discharge. Program Highlights: (from Fiscal Year 2008 - 09) • BISAC was able to admit approximately 650 adults into all levels of outpatient substance abuse treatment and Therapeutic Living services in East Hawaii, and 386 adolescents island -wide. Data collected from our 2008 - 2009 Annual Management Report disclosed the following: • 46% Completed Treatment. • 51 % were employed, in school, vocational training or volunteering. • 78% had no new arrests post treatment. • 73% had no new treatment episodes. • 48% were involved in self -help groups post treatment. • 96% have stable living arrangements post treatment. • 80% did not miss work or school due to drugs /alcohol. • 90% had no Emergency Room admissions post treatment. • 90% had no hospital admissions post treatment. • 72% had no significant psychological distress within 30 days post treatment. • 43% usage within in the last 30 days. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Big Island Substance Abuse Council West Hawaii Substance Abuse Program Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Substance Abuse Treatment Units 26,225 27,537 28,914 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 1,549,530 1,378,278 1,447,192 Professional Fees 29,694 31,250 32,813 Operations 610,354 511,825 537,416 Equipment 0 0 0 Other 54,493 55,409 58,179 Total 2,244,071 1,976,762 2,075,600 * If applicable u Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County 20,000 20,000 30,000 State of Hawaii 985,521 930,325 976,841 Federal 386,635 386,635 386,635 HIUW 10,000 17,021 17,872 Private Foundation 12,354 10,437 10,959 Donations /Fundraising 536 0 0 Private Insurance 236,116 317,007 332,857 Client Fees 66,240 137,086 143,940 Training /Other 20,908 31 32 Total 1,738, 310 1,818,542 1,899,136 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 11 Page 4 Big Island Substance Abuse Council West Hawaii Substance Abuse Program Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Big Island Substance Abuse Council continues efforts to diversify funding sources and expand services where appropriate throughout the State and Island of Hawaii. BISAC has contracted with three new managed care agencies and two new grant providers to diversify our funding stream. A conservative fiscal philosophy coupled with a team of skilled and dedicated staff members has enabled BISAC to expand and retain a positive, prominent presence in the community. BISAC's sound fiscal policies are incorporated into decisions related to program expansion or to enter market niches that would expand the behavioral health continuum. Business decisions include enrolling consumers in a Quest plan when eligible and appropriately utilizing benefits to cover treatment services. Administrative staff is scheduled to participate in meetings with HMSA and other substance abuse treatment providers to evaluate ways on increasing community awareness of insurance benefits and working with physicians to appropriately identify and refer consumers who may need treatment services that would be covered by HMSA insurance. The BISAC Board understands the commitment and priority of this project. The CEO is working to obtain commitments for this project and the Board has anticipated the project costs in the approved budget. The $30,000 requested for West Hawaii under this proposal will go towards the supporting this proposal's requests. BISAC plans include exploring available funding that supports capacity building and sustainability efforts, and reduces our reliance on State and County funds. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Big Island Substance Abuse Council West Hawaii Substance Abuse Program I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. ike.; � %atio Si of Board Pr sident/Chair Date Patricia Engelhard Signature o Executiv erector Date Dr. Stephen C. Zuniga UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 13 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club Agency Director: George Kalani Silva Phone No.: 961 -5536 Contact Person: George Kalani Silva Phone No.: 961 -5536 Mailing Address: 100 Kamakahonu Street, Hilo, Hawaii 96720 Facility /Site Address: 43 -1477 Hauola Road, Pa'auilo, Hawaii 96776 Fax No.: 961 -5534 Email Address: kalani @becbi.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: (808) 968 -1002 Mailing Address: P. 0. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds: $40,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $45,000 $40,000 $20,000 Agency Mission Statement: To inspire and enable Big Island youth from all backgrounds, especially those from disadvantaged circumstances, to become productive and responsible citizens by offering quality programs in a safe and caring environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 1 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club Program Description: With most parents working, many of our Big Island youth find themselves with no adult care or supervision during the critical hours between school dismissal and dinnertime. Young people are often left to find their own recreation and companionship within their communities; more specifically, the streets. When opportunities are available in a community for positive participation, children are less likely to engage in substance use and other problem behaviors. The Boys and Girls Club of the Big Island (BGCBI) — Hamakua Club, provides those opportunities on a daily basis to the young people of the Pa auilo community. The Hamakua Club offers programs and services aimed at instilling a positive sense of self, increase self- esteem, self - confidence, and teach the skills necessary to make good, sound decisions. Through fun and engaging activities, BGCBI provides a positive atmosphere for youth to explore their interests so that they can reach their full potential and contribute to their communities as good, responsible citizens. Founded as the Boys Club of Hilo in 1952, the BGCBI has served over 50,000 youth in East Hawaii. In 2002, we became BGCBI and during the last 5 years, BGCBI Board of Directors and Club leadership have demonstrated their commitment by extending our service reach to the youth in Pahoa, Keaau, Ocean View /Naalehu, Pahala and along the Hamakua coast. BGCBI success is evident on the faces of the youth who attend our Clubs and the outcome results reported to the following federal, state and private funding agencies: the Office of Juvenile Justice and Prevention (OJJP), the Hawaii State Department of Human Services /Office of Youth Services (DHS /OYS), the Hawaii State Department of Health /Alcohol and Drug Abuse Division (ADAD), Office of Juvenile Prevention (OJP) Rural Youth Program, Tobacco Trust Settlement administered by the Hawaii Community Foundation (HCF), and the Hawaii Island United Way. Reports are available upon request. The Need Honokaa Community: The Honokaa Community, 2003 Hawaii Student Alcohol, Tobacco, and Other Drug Use Study administered by the State of Hawaii Department of Health, Alcohol and Drug Abuse Division provides the following family domain data from students in the 12 grade (http: / /hawaii.gov /health /substance- abuse /prevention- treatment/survev /adsurv.htm) : • 45 % reported poor family supervision • 32 % reported lack of parental sanctions for Anti- Social Behaviors (ASB's) • 51 % reported parental attitudes favorable toward ATOD use • 39 % reported exposure to family ATOD use • 61 % reported a family (sibling) history of ASB The Honokaa High and Intermediate School Status and Improvement Report for School Year 2007 -2008 (http: / /doe.kl2.hi.us) provides the following information: NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 2 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club • Average Daily Attendance of 88.3 % as compared to the state standard of 95% • Average Daily Absences of 20.6 days as compared to the state standard of 9 days • 23% of the student body was suspended; 191 students were responsible for 377 suspensions; 15% were for burglary, robbery, or sale of dangerous drugs; 27% were for disorderly conduct and trespassing; 50% were for class cutting, insubordination and smoking; 8% were for possession of tobacco. • The dropout rate was 10.9 %; an increase of 6.6% from SY 2005 -2006. • The School Quality Survey indicated that 42.4% of the student population was involved in their school; 42.4 % showed satisfaction; and 40% felt safe while at school. • Hawaii Content and Performance Standards indicated 53% of 8`h graders were proficient in Reading; 10% of 8 graders were proficient in Math. The Hawaii Student ATOD study indicates that 52% of high school students in the Honokaa community experience community disorganization, 50% view laws and norms favorable to drug use, 46% engaged in early initiation of problem behaviors, 28% showed a low perceived risk of ATOD use, 41% interacted with antisocial peers, and 38% felt that their friends reward them for antisocial involvement. A conclusion of the same study indicated that 24% of high school students who participated had a high probability of developing a substance abuse problem or engaging in other problem behaviors. Only 24% of the students who participated in the study had a high number of protective factors indicating that they were less likely to use substances or engage in antisocial behaviors. The Office of Juvenile Prevention SMART System assigns a Community Disadvantage Index of 7 to the Honokaa community. All of this powerful data points to the overwhelming need our Hamakua youth and families have for establishing relationships with adults and professionals who care enough to assist them in developing positive personal qualities and support them in their homes, schools, and communities. BGCBI Hamakua Club addresses these needs on a daily basis when they open their doors and encourage all youth who enter to RE GREAT' Service Delivery The Hamakua Club was established in May 2008. The Pa'auilo Hongwanji Church Community offered BGCBI their church hall to serve as a permanent Clubhouse. The youth of this community were served by our Mobile Rural Outreach Program prior to the establishment of the Hamakua Club (February 2007). Located adjacent to the Pa'auilo Elementary & Intermediate School enables our members to safely walk to the club without crossing any major streets or roads. The Hongwanji hall is large enough to implement our five core program areas with ease and outdoor areas are used for sports and fitness activities. The Hamakua Club also has a partnership with County Parks and NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 3 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club Recreation for use of facility when they are unable to use the hall due to Church functions. The Hamakua Club conducts daily after - school, evening, weekend and full -day intercession and Furlough Friday programs which include Boys & Girls Club of America's five core programs areas: • Sports, Fitness and Recreation Development: develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills. Activities and programs include: game room, indoor /outdoor activities, table tournaments and inter -club leagues. • The Arts: enables youth to develop their creativity and cultural awareness through knowledge and an appreciation of the visual arts, crafts, performing arts and creative writing. Activities and programs include: arts & crafts, fine art, dance and music. • Education and Career Development: enables our youth to become proficient in basic educational disciplines, apply leaming to everyday situations and embrace technology to achieve success in a career. Activities and programs include: Power Hour homework assistance, Project Learn comprehensive education based activities with high -yield learning opportunities, science based environmental programs, Club Tech computer technology program and Career Launch career preparatory program. • Character & Leadership Development: empowers our youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self - image, participate in the democratic process and respect their own and others' cultural identities. Activities and programs include: Keystone Club for 13 -17 year olds, Torch Club for 10 -12 year olds, Youth of the Year - local, state, regional and national youth recognition program, public speaking opportunities, community service clubs and Welcome Patrol - youth program for youth introducing the Club to guest and new members. Youth For Unity is a Boys and Girls Club of America national diversity initiative that cultivates individuality, builds cultural identity and an appreciation of diversity. • Health & Life Skills Development: develops our youth's capacity to engage in positive behaviors that nurture their own well- being, set personal goals and live successfully as self- sufficient adults. Activities and programs Include: Skills Mastery And Resistance Training (SMART Moves) - a nationally recognized model program for prevention of alcohol, tobacco and drug use. SMART Moves incorporates 11 age appropriate curriculum for ages 6 -18 years of age as well as parents and community. Triple Play - is a fitness program that develops a connection of mind, body and soul. Project TNT (Toward No Tobacco) is a SAMSHA approved evidenced -based tobacco prevention program that gives youth the information and skills needed to stay tobacco -free. The Hamakua Club believes that the most effective approach for improving young people's lives is to reduce risk factors while increasing protective factors in all of the areas that touch their lives. Caring, trained youth development staff provide guidance in helping boys and girls to: discover their needs, enjoy their interests, explore their NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 4 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club talents, broaden their viewpoints, value their diversity, resolve conflicts, set goals, understand themselves and have fun! As an affiliate member of our national organization, the Boys and Girls Club of America, BGCBI strives to provide youth development programs that support the fundamental principles and beliefs of the national Boys and Girls Club Movement. Our Core Beliefs A Boys and Girls Club provides: • A safe place to learn and grow • Ongoing relationships with caring, adult professionals • Life - enhancing programs and character development experiences • Hope and opportunity Youth Development Strategy The philosophy underlying BGCBI programming is the Youth Development Strategy. All Boys and Girls Club programs and activities are designed to maximize opportunities for young people to acquire four basic "senses" which help them build self- esteem and grow into responsible and caring citizens. These four senses are: • A sense of competence — Young people feel proud and confident when they acquire new skills and know they can do something and do it well. • A sense of usefulness — Young people know the satisfaction of doing something of value for others. • A sense of belonging — Young people know they are welcome and feel that they fit in and are accepted. • A sense of power and influence — Young people know their opinions are heard and valued and that they can influence decisions. Youth development occurs in all aspects of Boys and Girls Club participation. The Hamakua Club creates a climate in which these important "senses" are fostered in every participant, member and guest involved in program or just "hanging out ". Youth Development Outcomes at age 18 The Hamakua Club strives to help all youth live full, satisfying and productive lives. The following outcomes summarize BGCBI expectations and goals for youth entering the world at age 18: a positive self identity, competencies in education and employment, social competencies enabling them to develop and sustain positive relationships, emotional competencies enabling them to appropriately express themselves, and cultural competencies enabling them to contribute in a multicultural society and demonstrate tolerance for differences among people. Other youth development outcomes include: Community and Civic Involvement: Youth have a sense of belonging to their community, family and/or group and are willing to take civic responsibility. They work closely with others to contribute to the greater good. Health and Well- Being: Youth live healthy lifestyles, take part in regular fitness activities, are able to access health care resources and engage in positive behaviors. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 5 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club They use sound judgment about personal safety, nutrition and avoidance of alcohol, drugs and premature sexual activity. Moral Compass: Youth have values enabling them to develop positive relationships with others. These values include honesty, a sense of justice and fairness, respect, caring and spirituality. The Hamakua Club proposes to engage youth in activities that are fun and enjoyable while supporting the development of the capacities described above. The Hamakua Club will use the Youth Development Outcome Measurement Tool Kit developed by the Boys and Girls Club of America. The goal of this measurement tool is to acquire the general well being of Club members and the degree to which they are acquiring skills, competencies and attitudes in specific areas, while assessing the impact that the Boys and Girls Club has on young people. Three intemet -based surveys have been developed (elementary, middle and high school) to collect and analyze information about whether the Hamakua Club is making a difference in members' lives. The Hamakua Club will survey its members twice throughout the funding year. Total Budget and Position Count Total Program Budget $164,900 Total Program Position Count 3 Total Agency Budget $1,325,000 Total Agency Position Count 30 Program Outcome Measures and Objectives: 1) Increase participants' knowledge and awareness of the consequences and harmful effects of tobacco, alcohol, and other drugs on their health and well- being. 2) Increase participants' ability to identify and resist peer and media pressures to engage in risky behaviors. 3) Increase participants' involvement in positive civic and community events. 4) Increase participants' positive attitude toward school /education 5) Decrease risky behavior of youth by increasing participants' positive self esteem through participation in positive youth development programs and activities on a daily basis 2008 -2009 Program Highlights: 1) Total days of operation: 252 Total hours of operation: 1098 School days: 2:00 pm to 6:00 pm School days off waiver days and intercessions: 12 noon to 5:00 pm Total youth (6 through 18) registered as members of the Hamakua Program: 86 Total youth members participating in SMART Moves program curriculums: 46 Total other youth participating in SMART Moves program curriculum through outreach: 30 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 6 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club 2) In the Fiscal Year 2008 -2009 the Boys and Girls Club of the Big Island provided programs to 1331. BGCBI youth development professionals provided outreach to 418 students in our community schools through the implementation of two evidenced -based curriculum programs: SMART Moves Drug, Alcohol, and Pregnancy Prevention Program and Project TNT. Agencies BGCBI continued to maintain relationships with in FY 2008 -2009 include: Tobacco -Free Big Island Coalition, American Lung Association, American Cancer Society, REAL, the Salvation Army, Pahoa Weed and Seed Project, United States Tennis Association — Hawaii Pacific Section, Bay Clinic, State of Hawaii Department of Education, PATCH, Kick - the -Nic, Prosecuting Attorney's Office, and Hawaii County Department of Parks & Recreation. 3) Member Highlights • Paauilo member wins 1s Place in the Tobacco Free Arts Contest sponsored by the Tobacco Free Big Island Coalition. Her artwork was made into a banner and postcards sending the message that all County Parks and Beaches are now smoke -free. • "We have been trying to help Spencer with his homework on rounding to the nearest tens and hundreds. He just couldn't understand it. Finally, with the help of the staff and some other members, he finally understood it. I am so proud of him, and the other members for having such patience with him. The work they did helped him." • "Dayson has totally changed for the better. He was very disruptive, loud and irresponsible in the past, but now he as been stepping up after guidance and communication with him." • "Iliana has been chosen as Youth of the Month. She is this incredible 5 grader who always is willing to help out in any way. She always has a positive attitude towards others. She never complains when asked to do something. And she never asks for candy for doing it!" NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 7 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club Performance Measures: FY 2008 -09 J FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Youth will participate in The Arts Programs. Examples: ✓ Arts and Crafts 65 75 50 ✓ Dance ✓ Music ✓ Fine Arts Youth will participate in Character and Leadership programs. Examples: 26 30 25 ✓ Keystone Club ✓ Torch Club ✓ Community Service Projects ✓ Club Service Projects Youth will participate in Education and Career Development Programs. Examples: ✓ Power Hour 69 100 50 ✓ Project Learn ✓ Tutoring ✓ Computer Technology Youth will participate in Health and Life Skills Programs. Examples: ✓ SMART Moves 92 75 50 ✓ Project TNT ✓ Nutrition /Cooking Classes ✓ Triple Play Youth will participate in Sports, Fitness and Recreation Programs. Examples: ✓ Team /Individual Sports 86 100 50 ✓ Games Room Activities ✓ Fitness Activities and Programs Parents /families will participate in 4 events per 4 events per activities to promote family 29 year year strengthening and unity. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 8 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club Program Expenditure FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages $73,526 $95,000 $104,500 Professional Fees $3,071 $2,500 $2,750 Operations $49,805 $51,100 $56,100 Equipment $1,433 $1,400 $1,550 Other Total $127,835 $150,000 $164,900 Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii -Non profit $40,000 $20,000 $40,000 Grant HCF Tobacco $15,833 $14,167 $12,500 COH Contingency $20,000 RYP OR $2,053 $23,750 $8,000 DHS OYS 08 -26 $62,500 $62,500 Hawaii Island United Way $5,813 $2,200 $5,000 COX Grant $35,000 $35,000 Total $146,199 $157,617 $100,500 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 9 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self-sustaining? The Boys and Girls Clubs of the Big Island Board of Directors and Youth Development Professionals continue to work towards diversifying our revenues. Our goal is to be balanced between grants and unrestricted (fundraising & donation) revenues, as well as the vision to create an endowment fund for the future. We continue to work with Federal, State, County and private agencies to enhance collaboration between all facets to help us succeed. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 10 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hamakua Club I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate vear -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board President/Chair Date r / L. 0 (24,4'co Signat of : ' ecuti e Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 11 14 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club Agency Director: George Kalani Silva Phone No.: 961 -5536 Contact Person: George Kalani Silva Phone No.: 961 -5536 Mailing Address: 100 Kamakahonu Street, Hilo, Hawaii 96720 Facility/Site Address: 100 Kamakahonu Street, Hilo, Hawaii 96720 Fax No.: 961 -5534 Email Address: kalani@bgcbi.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: (808) 968 -1002 Mailing Address: P. 0. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds: $60,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $80,000 $40,000 $40,000 Agency Mission Statement: To inspire and enable Big Island youth from all backgrounds, especially those from disadvantaged circumstances, to become productive and responsible citizens by offering quality programs in a safe and caring environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 1 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club Program Description: With most parents working, many of our Big Island youth find themselves with no adult care or supervision during the critical hours between school dismissal and dinnertime. Young people are often left to find their own recreation and companionship within their communities; more specifically, the streets. When opportunities are available in a community for positive participation, children are less likely to engage in substance use and other problem behaviors. The Boys and Girls Club of the Big Island (BGCBI) — Hilo Club, provides those opportunities on a daily basis to the young people of the Hilo community. The Hilo Club offers programs and services aimed at instilling a positive sense of self, increase self- esteem, self- confidence, and teach the skills necessary to make good, sound decisions. Through fun and engaging activities, BGCBI provides a positive atmosphere for youth to explore their interests so that they can reach their full potential and contribute to their communities as good, responsible citizens. Founded as the Boys Club of Hilo in 1952, the BGCBI has served over 50,000 youth in East Hawaii. In 2002, we became BGCBI and during the last 5 years, BGCBI Board of Directors and Club leadership have demonstrated their commitment by extending our service reach to the youth in Pahoa, Kea'au, Ocean View /Naalehu, Pahala and along the Hamakua coast. BGCBI success is evident on the faces of the youth who attend our Clubs and the outcome results reported to the following federal, state and private funding agencies: the Office of Juvenile Justice and Prevention (OJJP), the Hawaii State Department of Human Services /Office of Youth Services (DHS /OYS), the Hawaii State Department of Health /Alcohol and Drug Abuse Division (ADAD), Office of Juvenile Prevention (OJP) Rural Youth Program, Tobacco Trust Settlement administered by the Hawaii Community Foundation (HCF), and the Hawaii Island United Way. Reports are available upon request. The Need Hilo Community: Data compiled by the Office of Juvenile Prevention (OJP) SMART system assigns a Community Disadvantage Index of 8 to the Hilo area. Community, family and child indicators show powerful support of this index. According to the Center on the Family "the Hilo area's unemployment rate is higher than 85% of the communities in the State. This area has the third highest unemployment rate, the third lowest per capita income, and the highest percentage in the State of families who rely on food stamps. More than 33% of children 5 and under are living in poverty. The poverty rate of young children is second in the State. Participation in the Food Stamp and Temporary Assistance to Needy Families programs is more than double the State average. This community has the lowest percentage of families with children that are headed by a married couple. The percent of "idle teen" — those not working or in school — is high. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 2 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club About 40% of the adolescents responding to a Statewide survey of 6`", 8' ", 10` ", and 12 graders reported problems of fighting, graffiti, and crime in their neighborhoods. Positive indicators for the Hilo community include: most teachers, parents, and students report that their schools are safe. About half the youth in the Hilo community survey reported adequate parental supervision and close family ties. Of the high school graduates with plans for college in 2002, the percentage accepted exceeded the Statewide and Countywide averages. The East Hawaii Community Profile document written by Center on the Family, University of Hawaii at Manoa, states that "the problem of alcohol, tobacco and other drug use among the children of East Hawaii is a serious one. The youth of this community start using early, as indicated by the comparatively high rates of sixth graders reporting cigarette, alcohol, marijuana, and crystal methamphetamine use in the 30 days before taking the Hawaii Student ATOD Use Study. East Hawaii has a higher rate, compared to the State, of twelfth graders who claim to drink alcohol on a daily basis and, at all grade levels, youth who have been identified as needing treatment." The 2003 Hawaii Student ATOD Use Study indicates the East Hawaii youth, family, school and community need for substance abuse prevention programs. The following table shows the prevalence of ATOD use 30 days prior to taking the survey for youth of the East Hawaii communities: Substance Use Reported East State by Students Hawaii Smoking cigarettes in the past month • Grade 6 12.3% 2.6% • Grade 8 15.4% 8.5% • Grade 10 15.6% 11.3% • Grade 12 31.6% 16.3% Drinking any alcohol in past month • Grade 6 9.8% 3.9% • Grade 8 23.1% 14.6% • Glade 10 39.2% 27 0% • Grade 12 55.8% 36.3% Drinking alcohol daily in past month • Grade 6 1.9% 0.4% • Grade 8 3.7% 1.5% • Grade 10 4.0% 2.3% • Grade 12 3.4% 2.8% Using marijuana in past month • Grade 6 8.8% 1.0% • Grade 8 7.7% 6.6% • Grade 10 25.7% 14.8% • Grade 12 25.7% 18.4% NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 3 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club Using crystal methamphetamine in past month • Grade 6 3.5% 0.2% • Grade 8 0.0% 0.8% • Grade 10 0.0% 1.2% • Grade 12 1.7% 0.8% Using inhalants in past month • Grade 6 5.4% 1.9% • Grade 8 0.0% 3.6% • Grade 10 0.0% 2.0% • Grade 12 1.7% 1.3°10 As indicated above, our youth in East Hawaii are faced with risk factors such as early initiation of problem behaviors w /alcohol and drug use, favorable attitude towards ATOD use, low perceived ATOD use risk and peer approval of ATOD use. Community, school, and family risk factors include exposure of youth to alcohol and drugs, low school commitment, poor academic performance, lack of family supervision /involvement, lack of parental sanctions for antisocial behaviors, and factors affecting family socioeconomic struggles, such as unemployment and substance abuse. All these risk factors affect our youth's ability to make a successful transition to adulthood. The East Hawaii community profile states that in the realm of individual characteristics and peer influence, East Hawaii teens are high on risk and low on protection. The teens of East Hawaii were the highest in the State on three measures of risk: enjoying doing crazy or dangerous things and will take a dare or do what feels good without thinking about the consequences; an attitude that condones antisocial behaviors; and they see nothing wrong with smoking, drinking, or using illegal drugs. All of this powerful data points to the overwhelming need our East Hawaii youth and families have for establishing relationships with adults and professionals who care enough to assist them in developing positive personal qualities and support them in their homes, schools, and communities. BGCBI Hilo Club addresses these needs on a daily basis when they open their doors and encourage all youth who enter to NE GREAT Service Delivery The Hilo Club is located in downtown Hilo and sits on a 14 acre property of the Hilo Boarding School. This beautiful site includes 2 baseball fields, a small t -ball /soccer field, a full size gymnasium. The newly renovated Clubhouse had its grand reopening on October 22, 2009 with the completion of Phase I and Phase II of the four phase project. These phases included a newly renovated Club reception area, administrative offices, recreation /game room, art room, teen area, computer lab, patio for leisure and eating, new ADA compliant restrooms, ADA compliant entry ways and new Hilo Clubhouse facade. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 4 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club Phase III will attend to the ADA compliance of the baseball fields. On January 7, 2010 BGCBI submitted a proposal in the amount of $670,000 to the County of Hawaii 2010 U.S. Department of Housing and Urban Development's Community Development Block Grant. The Hilo Club conducts daily after - school, evening, weekend and full -day intercession and Furlough Friday programs which include Boys & Girls Club of America's five core programs areas: • Sports, Fitness and Recreation Development: develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills. Activities and programs include: game room, indoor /outdoor activities, table tournaments and inter -club leagues. • The Arts: enables youth to develop their creativity and cultural awareness through knowledge and an appreciation of the visual arts, crafts, performing arts and creative writing. Activities and programs include: arts & crafts, fine art, dance and music. • Education and Career Development: enables our youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career. Activities and programs include: Power Hour homework assistance, Project Leam comprehensive education based activities with high -yield leaming opportunities, science based environmental programs, Club Tech computer technology program and Career Launch career preparatory program • Character & Leadership Development: empowers our youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others' cultural identities. Activities and programs include: Keystone Club for 13 -17 year olds, Torch Club for 10-12 year olds, Youth of the Year - local, state, regional and national youth recognition program, public speaking opportunities, community service clubs and Welcome Patrol - youth program for youth introducing the Club to guest and new members. Youth For Unity is a Boys and Girls Club of America national diversity initiative that cultivates individuality, builds cultural identity and an appreciation of diversity. • Health & Life Skills Development: develops our youth's capacity to engage in positive behaviors that nurture their own well- being, set personal goals and live successfully as self- sufficient adults. Activities and programs include: Skills Mastery And Resistance Training (SMART Moves) - a nationally recognized model program for prevention of alcohol, tobacco and drug use. SMART Moves incorporates 11 age appropriate curriculum for ages 6 -18 years of age as well as parents and community. Triple Play - is a fitness program that develops a connection of mind, body and soul. Project TNT (Toward No Tobacco) is a SAMSHA approved evidenced -based tobacco prevention program that gives youth the information and skills needed to stay tobacco -free. The Hilo Club believes that the most effective approach for improving young people's lives is to reduce risk factors while increasing protective factors in all of the areas that touch their lives. Caring, trained youth development staff provide guidance in helping boys and girls to: discover their needs, enjoy their interests, explore their talents, NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 5 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club broaden their viewpoints, value their diversity, resolve conflicts, set goals, understand themselves and have fun! As an affiliate, chartered member of our national organization, the Boys and Girls Club of America (BGCA), BGCBI strives to provide youth development programs that support the fundamental principles and beliefs of the national Boys and Girls Club Movement. Our Core Beliefs A Boys and Girls Club provides: • A safe place to learn and grow • Ongoing relationships with caring, adult professionals • Life - enhancing programs and character development experiences • Hope and opportunity Youth Development Strategy The philosophy underlying BGCBI programming is the Youth Development Strategy. All Boys and Girls Club programs and activities are designed to maximize opportunities for young people to acquire four basic "senses" which help them build self- esteem and grow into responsible and caring citizens. These four senses are: • A sense of competence — Young people feel proud and confident when they acquire new skills and know they can do something and do it well. • A sense of usefulness — Young people know the satisfaction of doing something of value for others. • A sense of belonging — Young people know they are welcome and feel that they fit in and are accepted. • A sense of power and influence — Young people know their opinions are heard and valued and that they can influence decisions. Youth development occurs in all aspects of Boys and Girls Club participation. The Hilo Club creates a climate in which these important "senses" are fostered in every participant, member and guest involved in program or just "hanging out". Youth Development Outcomes at age 18 The Hilo Club strives to help all youth live full, satisfying and productive lives. The following outcomes summarize BGCBI expectations and goals for youth entering the world at age 18: a positive self identity, competencies in education and employment, social competencies enabling them to develop and sustain positive relationships, emotional competencies enabling them to appropriately express themselves, and cultural competencies enabling them to contribute in a multicultural society and demonstrate tolerance for differences among people. Other youth development outcomes include: Community and Civic Involvement: Youth have a sense of belonging to their community, family and/or group and are willing to take civic responsibility. They work closely with others to contribute to the greater good. Health and Well- Being: Youth live healthy lifestyles, take part in regular fitness activities, are able to access health care resources and engage in positive behaviors. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 6 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club They use sound judgment about personal safety, nutrition and avoidance of alcohol, drugs and premature sexual activity. Moral Compass: Youth have values enabling them to develop positive relationships with others. These values include honesty, a sense of justice and faimess, respect, caring and spirituality. The Hilo Club proposes to engage youth in activities that are fun and enjoyable while supporting the development of the capacities described above. The Hilo Club will use the Youth Development Outcome Measurement Tool Kit developed by the Boys and Girls Club of America. The goal of this measurement tool is to acquire the general well being of Club members and the degree to which they are acquiring skills, competencies and attitudes in specific areas, while assessing the impact that the Boys and Girls Club has on young people. BGCA has developed three internet -based surveys (elementary, middle and high school) to collect and analyze information about whether the Hilo Club is making a difference in members' lives. The Hilo Club will survey its members twice throughout the funding year. Total Budget and Position Count Total Program Budget $242,400 Total Program Position Count 5 Total Agency Budget $1,325,000 Total Agency Position Count 30 Program Outcome Measures and Objectives: 1) Increase participants' knowledge and awareness of the consequences and harmful effects of tobacco, alcohol, and other drugs on their health and well- being. 2) Increase participants' ability to identify and resist peer and media pressures to engage in risky behaviors. 3) Increase participants' involvement in positive civic and community events. 4) Increase participants' positive attitude toward school /education. 5) Decrease risky behavior of youth by increasing participants' positive self esteem through participation in positive youth development programs and activities on a daily basis 2008 -2009 Program Highlights: 1) Total days of operation: 250 Total hours of operation: 1,494 School days: 1:30 pm to 6:00 pm School days off — waiver days and intercessions: 7:30 am to 5:30 pm Total youth (ages 6 through 18) registered as members of the Hilo Club including after - school, full -day intercession, athletics and outreach: 404 Total youth members participating in SMART Moves and prevention program curriculums: 122 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 7 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club 2) In the Fiscal Year 2008 -2009 the Boys and Girls Club of the Big Island provided programs to 1331. BGCBI youth development professionals provided outreach to 418 students in our community schools through the implementation of two evidenced -based curriculum programs: SMART Moves Drug, Alcohol, and Pregnancy Prevention Program and Project TNT. Agencies BGCBI continued to maintain relationships with in FY 2008 -2009 include: Tobacco -Free Big Island Coalition, American Lung Association, American Cancer Society, REAL, the Salvation Army, Pahoa Weed and Seed Project, United States Tennis Association — Hawaii Pacific Section, Bay Clinic, State of Hawaii Department of Education, PATCH, Kick - the -Nic, Prosecuting Attomey's Office, and Hawaii County Department of Parks & Recreation. 3) Health and Life Skills: develops young people's capacity to engage .in positive behaviors that nurture their own well- being, set personal goals and live successfully as self- sufficient adults. • SMART Moves and Prevention Program curriculums: SMART Kids, Stay SMART, SMART Leaders, SMART Girls, Passport to Manhood, Project TNT (Toward No Tobacco) • Garden Project including outreach to Hilo Union, Hilo Intermediate, and Haili Christian School: Kaiao Gardens is a collaborative project with the aunties and uncles of the surrounding community. The garden is staffed with volunteers, students from UH Hilo, and a Boys and Girls Club staff member. The keiki meet three times a week, weather permitting, and community volunteers nurture the garden on Saturdays from 9:00 am to 11:00 am. • Animal Husbandry Program: Hilo Club has egg - laying chickens and a goat named Lefty. The youth are hands -on caring for the animals. • Cooking and Nutrition Programs • Participation in 2009 National Kick Butts Day with a lunchtime rally at Hilo High School and after - school program celebration of a tobacco -free lifestyle. Collaboration with University of Hawaii Nursing Baccalaureate Program. 4) Over 600 additional youth are served in the organized athletic program at the Hilo Boys and Girls Club. Our baseball fields are used year -round and the Hilo Athletic Director serves as the Commissioner of all leagues played at the Boys and Girls Club. He works closely with all teams and creates an environment that promotes the philosophy of the Positive Coaching Alliance - to teach youth sports organization leaders how to create an organizational culture in which Honoring the Game is the norm. The Hilo Club hosts the following leagues throughout the year: County Parks & Recreation's T -ball and Coach Pitch Leagues Pony League — February through July (largest league on the Island) ' Winter League — September through December RBI League — October through December AND May through July NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 8 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget " Estimate Youth will participate in The Arts Programs. Examples: ✓ Arts and Crafts 303 300 300 ✓ Dance ✓ Music ✓ Fine Arts Youth will participate in Character and Leadership programs. Examples: ✓ Keystone Club 141 150 150 ✓ Torch Club ✓ Community Service Projects ✓ Club Service Projects Youth will participate in Education and Career Development Programs. Examples: ✓ Power Hour 250 300 300 ✓ Project Learn ✓ Tutoring ✓ Computer Technology Youth will participate in Health and Life Skills Programs. Examples: ✓ SMART Moves 218 300 300 ✓ Project TNT ✓ Nutrition /Cooking Classes ✓ Triple Play Youth will participate in Sports, Fitness and Recreation Programs. Examples: s Team /Individual Sports 600 400 400 ✓ Games Room Activities ✓ Fitness Programs and Activities Parents /families will participate in activities to promote family 100 4 events per 4 events per year strengthening and unity. year NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 9 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club Program Expenditure FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual* Budget* Estimate Salaries and Wages $91,702 $134,000 $147,400 Professional Fees $7,314 $6,000 $6,500 Operations $75,496 $75,000 $83,000 Equipment $1,758 $5,000 $5,500 Other (renovations) $233,072 .00 .00 Total $409,342 $220,000 $242,400 Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii -Non profit $40,000 $30,000 $60,000 Grant DOE -OHCNP $4,331 .00 YMCA Rural Youth Program $5,545 $23,750 $10,000 (RYP) Grant Center Base Atherton - (renovations) $50,000 .00 .00 Office of Youth Services (OYS) Positive Youth $10,340 $15,290 $20,000 Development 4091 DHS OYS GIA Funds $130,000 .00 .00 (renovation) Hawaii Community Foundation: (HCF) Tobacco $15,833 $14,167 $12,500 Fund Hawaii Island United Way $5,813 $2,500 $5,000 HOIG - Healing our Island $2,000 .00 .00 Grant Office of Youth Services (OYS) Positive Youth $20,833 .00 .00 Development 08 -26 County of Hawaii Contingency $15,000 $15,000 $15,000 Fund CDBG Phase 1 (renovations) $53,072 .00 .00 Club Fundraising Events $49,642 $50,000 $50,000 ADAD .00 $30,000 $30,000 Cox Grant .00 $35,000 $35,000 Family Plus .00 $16,500 .00 Total $402,409 $232,207 $237,500 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 10 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Boys and Girls Clubs of the Big Island Board of Directors and Youth Development Professionals continue to work towards diversifying our revenues. Our goal is to be balanced between grants and unrestricted (fundraising & donation) revenues, as well as the vision to create an endowment fund for the future. We continue to work with Federal, State, County and private agencies to enhance collaboration between all facets to help us succeed. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 11 Boys & Girls Club of the Big Island Positive Youth Development Programs: Hilo Club (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 a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 7- Signature of Board President/Chair Dat f '► l qo t2tvi(o Signatur:. i Exe tive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 12 15 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea'au Club Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea' au Club Agency Director: George Kalani Silva Phone No.: 961 -5536 Contact Person: George Kalani Silva Phone No.: 961 -5536 Mailing Address: 100 Kamakahonu Street, Hilo, Hawaii 96720 Facility /Site Address: Keaau Middle School 16 -0565 Pahoa Road, Kea'au, Hawaii 96749 Fax No.: 961 -5534 Email Address: kalani@bgcbi.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: (808) 968 -1002 Mailing Address: P. 0. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds: $40,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $45,000 $40,000 $20,000 Agency Mission Statement: To inspire and enable Big Island youth from all backgrounds, especially those from disadvantaged circumstances, to become productive and responsible citizens by offering quality programs in a safe and caring environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 1 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea' au Club Program Description: With most parents working, many of our Big Island youth find themselves with no adult care or supervision during the critical hours between school dismissal and dinnertime. Young people are often left to find their own recreation and companionship within their communities; more specifically, the streets. When opportunities are available in a community for positive participation, children are less likely to engage in substance use and other problem behaviors. The Boys and Girls Club of the Big Island (BGCBI) — Kea'au Club, provides those opportunities on a daily basis to the young people of the Kea'au community. The Kea'au Club offers programs and services aimed at instilling a positive sense of self, increase self- esteem, self - confidence, and teach the skills necessary to make good, sound decisions. Through fun and engaging activities, BGCBI provides a positive atmosphere for youth to explore their interests so that they can reach their full potential and contribute to their communities as good, responsible citizens. Founded as the Boys Club of Hilo in 1952, the BGCBI has served over 50,000 youth in East Hawaii. In 2002, we became BGCBI and during the last 5 years, BGCBI Board of Directors and Club leadership have demonstrated their commitment by extending our service reach to the youth in Pahoa, Kea'au, Ocean View /Naalehu, Pahala and along the Hamakua coast. BGCBI success is evident on the faces of the youth who attend our Clubs and the outcome results reported to the following federal, state and private funding agencies: the Office of Juvenile Justice and Prevention (OJJP), the Hawaii State Department of Human Services /Office of Youth Services (DHS /OYS), the Hawaii State Department of Health /Alcohol and Drug Abuse Division (ADAD), Office of Juvenile Prevention (OJP) Rural Youth Program, Tobacco Trust Settlement administered by the Hawaii Community Foundation (HCF), and the Hawaii Island United Way. Reports are available upon request. The Need Kea'au Community: Data compiled by the Office of Juvenile Prevention (OJP) SMART system assigns a Community Disadvantage Index of 9 to the Kea'au area. The above community, family and child indicators show powerful support of this index. According to the Center on the Family "this area has a higher percentage of school -aged children than the State average and almost 40% of the children are identified as Native Hawaiian or Native Hawaiian in combination with one or more other races. Data for many of the indicators of child and family well -being in the Kea'au Area are problematic. Unemployment is high and the per capita income is among the lowest in the State. The percentage of families relying on Food Stamps and TANF is about 3 times the State average." The East Hawaii Community Profile document written by Center on the Family, University of Hawaii at Manoa, states that "the problem of alcohol, tobacco and other drug use among the children of East Hawaii is a serious one. The youth of this NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 2 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea' au Club community start using early, as indicated by the comparatively high rates of sixth graders reporting cigarette, alcohol, marijuana, and crystal methamphetamine use in the 30 days before taking the Hawaii Student ATOD Use Study. East Hawaii has a higher rate, compared to the State, of twelfth graders who claim to drink alcohol on a daily basis and, at all grade levels, youth who have been identified as needing treatment." The 2003 Hawaii Student ATOD Use Study indicates the East Hawaii youth, family, school and community need for substance abuse prevention programs. The following table shows the prevalence of ATOD use 30 days prior to taking the survey for youth of the East Hawaii communities: Substance Use Reported East State by Students Hawaii Smoking cigarettes in the past month • Grade 6 12.3% 2.6% • Grade 8 15.4% 8.5% • Grade 10 15.6% 11.3% • Grade 12 31.6% 16.3% Drinking any alcohol in past month • Grade 6 9.8% 3.9% • Grade 8 23.1% 14.6% • Grade 10 39.2% 27.0% • Grade 12 55.8% 36.3% Drinking alcohol daily in past month • Grade 6 1.9% 0.4% • Grade 8 31% 1.5% • Grade 10 4.0% 2.3% • Grade 12 3.4% 2.8% Using marijuana in past month • Grade 6 8.8% 1.0% • Grade 8 7.7% 6.6% • Grade 10 251% 14.8% • Grade 12 25.7% 18.4% Using crystal methamphetamine in past month • Grade 6 3.5% 0.2% • Grade 8 0.0% 0.8% • Grade 10 0.0% 1.2% • Grade 12 1.7% 0.8% Using inhalants in past month • Grade 6 5.4% 1.9% • Grade 8 0.0% 3.6% • Grade 10 0.0% 2.0% • Grade 12 1.7% 1.3% NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 3 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea'au Club As indicated above, our youth in East Hawaii are faced with risk factors such as early initiation of problem behaviors w /alcohol and drug use, favorable attitude towards ATOD use, low perceived ATOD use risk and peer approval of ATOD use. Community, school, and family risk factors include exposure of youth to alcohol and drugs, low school commitment, poor academic performance, lack of family supervision /involvement, lack of parental sanctions for antisocial behaviors, and factors affecting family socioeconomic struggles, such as unemployment and substance abuse. All these risk factors affect our youth's ability to make a successful transition to adulthood. The East Hawaii community profile states that in the realm of individual characteristics and peer influence, East Hawaii teens are high on risk and low on protection. The teens of East Hawaii were the highest in the State on three measures of risk: enjoying doing crazy or dangerous things and will take a dare or do what feels good without thinking about the consequences; an attitude that condones antisocial behaviors; and they see nothing wrong with smoking, drinking, or using illegal drugs. All of this powerful data points to the overwhelming need our East Hawaii youth and families have for establishing relationships with adults and professionals who care enough to assist them in developing positive personal qualities and support them in their homes, schools, and communities. BGCBI Kea'au Club addresses these needs on a daily basis when they open their doors and encourage encoura all youth who enter to E E GREAT Service Delivery The Kea'au Club is located on Kea'au Middle School property on the mauka side of the old O'la'a School behind the O'la'a Community Center. The Club implements its youth development program in three connecting rooms. Sports and fitness activities are conducted on the outdoor grassy portions of the property. The Kea'au Club conducts daily after - school, evening, weekend and full -day intercession and Furlough Friday programs which include Boys & Girls Club of America's five core programs areas: • Sports, Fitness and Recreation Development: develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills. Activities and programs include: game room, indoor /outdoor activities, table tournaments and inter -club leagues. • The Arts: enables youth to develop their creativity and cultural awareness through knowledge and an appreciation of the visual arts, crafts, performing arts and creative writing. Activities and programs include: arts & crafts, creative writing, fine art, dance and music. • Education and Career Development: enables our youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career. Activities and programs NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 4 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea' au Club include: Power Hour homework assistance, Project Leam comprehensive education based activities with high -yield leaming opportunities, science based environmental programs, Club Tech computer technology program and Career Launch career preparatory program • Character & Leadership Development: empowers our youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others' cultural identities. Activities and programs include: Keystone Club for 13 -17 year olds, Torch Club for 10 -12 year olds, Youth of the Year - local, state, regional and national youth recognition program, public speaking opportunities, community service clubs and Welcome Patrol - youth program for youth introducing the Club to guest and new members. Youth For Unity is a Boys and Girls Club of America national diversity initiative that cultivates individuality, builds cultural identity and an appreciation of diversity. • Health & Life Skills Development: develops our youth's capacity to engage in positive behaviors that nurture their own well- being, set personal goals and live successfully as self - sufficient adults. Activities and programs include: Skills Mastery And Resistance Training (SMART Moves) - a nationally recognized model program for prevention of alcohol, tobacco and drug use. SMART Moves incorporates 11 age appropriate curriculum for ages 6 -18 years of age as well as parents and community. Triple Play - is a fitness program that develops a connection of mind, body and soul. Project TNT (Toward No Tobacco) is a SAMSHA approved evidenced -based tobacco prevention program that gives youth the information and skills needed to stay tobacco -free. The Kea'au Club believes that the most effective approach for improving young people's lives is to reduce risk factors while increasing protective factors in all of the areas that touch their lives. Caring, trained youth development staff provide guidance in helping boys and girls to: discover their needs, enjoy their interests, explore their talents, broaden their viewpoints, value their diversity, resolve conflicts, set goals, understand themselves and have fun! As an affiliate member of our national organization, the Boys and Girls Club of America, BGCBI strives to provide youth development programs that support the fundamental principles arid beliefs of the national Boys and Girls Club Movement. Our Core Beliefs A Boys and Girls Club provides: • A safe place to learn and grow • Ongoing relationships with caring, adult professionals • Life - enhancing programs and character development experiences • Hope and opportunity Youth Development Strategy The philosophy underlying BGCBI programming is the Youth Development Strategy. All Boys and Girls Club programs and activities are designed to maximize opportunities for young people to acquire four basic "senses" which help them build self- esteem and grow into responsible and caring citizens. These four senses are: NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 5 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea'au Club • A sense of competence — Young people feel proud and confident when they acquire new skills and know they can do something and do it well. • A sense of usefulness — Young people know the satisfaction of doing something of value for others. • A sense of belonging — Young people know they are welcome and feel that they fit in and are accepted. • A sense of power and influence — Young people know their opinions are heard and valued and that they can influence decisions. Youth development occurs in all aspects of Boys and Girls Club participation. The Kea'au Club creates a climate in which these important "senses" are fostered in every participant, member and guest involved in program or just "hanging out ". Youth Development Outcomes at age 18 The Kea'au Club strives to help all youth live full, satisfying and productive lives. The following outcomes summarize BGCBI expectations and goals for youth entering the world at age 18: a positive self identity, competencies in education and employment, social competencies enabling them to develop and sustain positive relationships, emotional competencies enabling them to appropriately express themselves, and cultural competencies enabling them to contribute in a multicultural society and demonstrate tolerance for differences among people. Other youth development outcomes include: Community and Civic Involvement: Youth have a sense of belonging to their community, family and/or group and are willing to take civic responsibility. They work closely with others to contribute to the greater good. Health and Well- Being: Youth live healthy lifestyles, take part in regular fitness activities, are able to access health care resources and engage in positive behaviors. They use sound judgment about personal safety, nutrition and avoidance of alcohol, drugs and premature sexual activity. Moral Compass: Youth have values enabling them to develop positive relationships with others. These values include honesty, a sense of justice and fairness, respect, caring and spirituality. The Kea'au Club proposes to engage youth in activities that are fun and enjoyable while supporting the development of the capacities described above. The Kea'au Club will use the Youth Development Outcome Measurement Tool Kit developed by the Boys and Girls Club of America. The goal of this measurement tool is to acquire the general well being of Club members and the degree to which they are acquiring skills, competencies and attitudes in specific areas, while assessing the impact that the Boys and Girls Club has on young people. BGCA has developed three intemet -based surveys (elementary, middle and high school) to collect and analyze information about whether the Kea'au Club is making a difference in members' lives. The Kea'au Club will survey its members twice throughout the funding year. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 6 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea' au Club Total Budget and Position Count Total Program Budget $164,900 Total Program Position Count 4 Total Agency Budget $1,325,000 Total Agency Position Count 30 Program Outcome Measures and Objectives: 1) Increase participants' knowledge and awareness of the consequences and harmful effects of tobacco, alcohol, and other drugs on their health and well- being. 2) Increase participants' ability to identify and resist peer and media pressures to engage in risky behaviors. 3) Increase participants' involvement in positive civic and community events. 4) Increase participants' positive attitude toward school /education. 5) Decrease risky behavior of youth by increasing participants' positive self esteem through participation in positive youth development programs and activities on a daily basis 2007 -2008 Program Highlights: 1) Total days of operation: 240 Total hours of operation: 1,425 School days: 2:00 pm to 6:00 pm School days off — waiver days and intercessions: 7:30 am to 5:30 pm Total youth (ages 6 through 18) registered as members of the Keaau Club: 168 Total youth members participating in SMART Moves program curriculums: 25 Total other youth participating in SMART Moves program curriculum through outreach: 56 2) In tho Fiscal Yoar 2008 -2009 tho Boys and Girls Club of the Big Island provided programs to 1331. BGCBI youth development professionals provided outreach to 418 students in our community schools through the implementation of two evidenced -based curriculum programs: SMART Moves Drug, Alcohol, and Pregnancy Prevention Program and Project TNT. Agencies BGCBI continued to maintain relationships with in FY 2008 -2009 include: Tobacco -Free Big Island Coalition, American Lung Association, American Cancer Society, REAL, the Salvation Army, Pahoa Weed and Seed Project, United States Tennis Association — Hawaii Pacific Section, Bay Clinic, State of Hawaii Department of Education, PATCH, Kick - the -Nic, Prosecuting Attomey's Office, and Hawaii County Department of Parks & Recreation. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 7 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea' au Club 3) Education and Career Development • Power Hour (homework assistance and tutoring): An educational assistance program that is offered 4 days a week during the school year. Youth development specialist, Edna writes: "Power Hour has been a blessing to members' parents who work all day and still need to go home and work with a child that needs to do homework and fix dinner. I feel this homework program has eased a lot of stress for working parents. Now they have more quality time to spend at home with their children as a family." • Career Exploration: Youth development specialist, Norma writes: "The children have been interested in careers that will generate greater income. During their computer lab time, they challenge themselves in a game that shows the benefits and pitfalls of choices. In this game you choose your career or job, and your education level. You choose to go to work or play. Depending upon your choices, the game allows you to own property, travel and furnish your house or apartment. I see and hear the conversations about the choices they make while playing and the discussions about what is a good choice and one that will result in a positive lifestyle. These conversations have been very encouraging. 1 am presently challenging the youth to make up a game and use real life scenarios. We are looking at the current economy and making decisions based on the economic state of the community they live in." NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 8 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea' au Club Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Youth will participate in The Arts Programs. Examples: ✓ Arts and Crafts 126 100 100 ✓ Dance ✓ Music ✓ Fine Arts Youth will participate in Character and Leadership programs. Examples: 67 75 75 ✓ Keystone Club ✓ Torch Club ✓ Community Service Projects ✓ Club Service Projects Youth will participate in Education and Career Development Programs. Examples: ✓ Power Hour 168 100 100 ✓ Project Learn ✓ Tutoring ✓ Computer Technology Youth will participate in Health and Life Skills Programs. Examples: ✓ SMART Moves 138 125 125 ✓ Project TNT ✓ Nutrition /Cooking Classes ✓ Triple Play Youth will participate in Sports, Fitness and Recreation Programs. Examples: ✓ Team /Individual Sports 168 120 120 ✓ Games Room Activities ✓ Fitness Activities and Programs Parents/families will participate in activities to promote family 73 4 events per 4 events per strengthening and unity. year year NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 9 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea' au Club Program Expenditure FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual* Budget Estimate Salaries and Wages $74,379 $95,000 $104,500 Professional Fees $3,071 $2,500 $2,750 Operations $58,971 $51,100 $56,100 Equipment $1,362 $1,400 $1,550 Other .00 Total $137,783 $150,000 $164,900 Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii -Non profit $40,000 $20,000 $40,000 Grant COH Contingency $3,750 BGCA -Music Makers Grant $750 HCF Tobacco $15,833 $14,167 $12,500 RYP OR $2,053 $23,750 $8,000 DOE -OHCNP $4,331 DHS OYS 08 -26 $20,833 Hawaii Island United Way $5,813 $2,200 $5,000 ADAD $30,000 $30,000 Community Donations COX Grant $35,000 $35,000 Total $93,363 $125,117 $130,500 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 10 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea' au Club Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Boys and Girls Clubs of the Big Island Board of Directors and Youth Development Professionals continue to work towards diversifying our revenues. Our goal is to be balanced between grants and unrestricted (fundraising & donation) revenues, as well as the vision to create an endowment fund for the future. We continue to work with Federal, State, County and private agencies to enhance collaboration between all facets to help us succeed. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 11 Boys & Girls Club of the Big Island Positive Youth Development Programs: Kea' au Club I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawai'i, 1 (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 report will impact the evaluation of your program's or agency's future funding requests. // Signature of Board President/Chair Date I We 1 126 1(0 Signa of E - cutive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 2011 Page 12 16 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club Agency Director: George Kalani Silva Phone No.: 961 -5536 Contact Person: George Kalani Silva Phone No.: 961 -5536 Mailing Address: 100 Kamakahonu Street, Hilo, Hawaii 96720 Facility /Site Address: 1) Na'alehu Elementary School 95 -5547 Mamalahoa Hwy, Naalehu, HI 96772 2) County P & R — Kahuku Park/H.O.V.E. 92 -8607 Paradise Circle Mauka, Kahuku, HI 96737 Fax No.: 961 -5534 Email Address: kalani @becbi.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: (808) 968 -1002 Mailing Address: P. 0. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds: $40,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $45,000 $40,000 $20,000 Agency Mission Statement: To inspire and enable Big Island youth from all backgrounds, especially those from disadvantaged circumstances, to become productive and responsible citizens by offering quality programs in a safe and caring environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 1 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club Program Description: With most parents working, many of our Big Island youth find themselves with no adult care or supervision during the critical hours between school dismissal and dinnertime. Young people are often left to find their own recreation and companionship within their communities; more specifically, the streets. When opportunities are available in a community for positive participation, children are less likely to engage in substance use and other problem behaviors. The Boys and Girls Club of the Big Island (BGCBI) — Ocean View Club, provides those opportunities on a daily basis to the young people of the Ocean View and Na'alehu communities. The Ocean View Club offers programs and services aimed at instilling a positive sense of self, increase self- esteem, self - confidence, and teach the skills necessary to make good, sound decisions. Through fun and engaging activities, BGCBI provides a positive atmosphere for youth to explore their interests so that they can reach their full potential and contribute to their communities as good, responsible citizens. Founded as the Boys Club of Hilo in 1952, the BGCBI has served over 50,000 youth in East Hawaii. In 2002, we became BGCBI and during the last 5 years, BGCBI Board of Directors and Club leadership have demonstrated their commitment by extending our service reach to the youth in Pahoa, Kea'au, Ocean View /Naalehu, Pahala and along the Hamakua coast. BGCBI success is evident on the faces of the youth who attend our Clubs and the outcome results reported to the following federal, state and private funding agencies: the Office of Juvenile Justice and Prevention (OJJP), the Hawaii State Department of Human Services /Office of Youth Services (DHS /OYS), the Hawaii State Department of Health /Alcohol and Drug Abuse Division (ADAD), Office of Juvenile Prevention (OJP) Rural Youth Program, Tobacco Trust Settlement administered by the Hawaii Community Foundation (HCF), and the Hawaii Island United Way. Reports are available upon request. The Need Ka'u Community: The Ka'u Community, 2003 Hawaii Student Alcohol, Tobacco, and Other Drug Use Study administered by the State of Hawaii Department of Health, Alcohol and Drug Abuse Division provides the following family domain data from students in the 6 grade (http: / /hawaii.gov /health /substance- abuse /prevention- treatment/survev /adsurv. htm) • 49 % reported poor family supervision • 18 % reported lack of parental sanctions for Anti - Social Behaviors (ASB's) • 18 % reported parental attitudes favorable toward ATOD use • 53 % reported exposure to family ATOD use • 12 % reported a family (sibling) history of ASB The 2007 -2008 School Quality Survey for Na'alehu Elementary & Intermediate School indicated that only 49 % of parents are involved in their child's school. (http: / /doe. k12.h i. us) NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 2 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club The Na'alehu Elementary & Intermediate School Status and Improvement Report for School Year 2007 -2008 (http: / /doe.kl2.hi.us) provides the following information: • Average Daily Attendance of 87.7 % as compared to the state standard of 95% • Average Daily Absences of 21.4 days as compared to the state standard of 9 days • 74.9 % of the students receive free or reduced -cost lunch • The Hawaii Content and Performance Standards show Na'alehu students are 35% below the State average in reading; 39% below the State average in math • The Terrallova scores for 7' grade students at Na'alehu Intermediate indicate 50% of the students are below the national norm in reading and 41% of the students are below the national norm in math The Hawaii Student ATOD study indicates that 56% of middle school students in the Ka'u community experience community disorganization, 45% view laws and norms favorable to drug use, 48% engaged in early initiation of problem behaviors, 47% showed a low perceived risk of ATOD use, 53% interacted with antisocial peers, and 48% felt that their friends reward them for antisocial involvement. A conclusion of the same study indicated that 46% of the 6 grade students who participated had a high probability of developing a substance abuse problem or engaging in other problem behaviors. Only 25% of the students who participated in the study had a high number of protective factors indicating that they were less likely to use substances or engage in antisocial behaviors. Data from Center on the Family of the University of Hawaii (http: / /uhfamily.hawaii.edu) concludes that the people of the Ka'u District face a number of economic, social, and educational hardships. The unemployment rate is the worst in the State. The per capita income is lower than in most other communities Statewide. High proportions of the very young live in poverty, and one -third of the families receive food stamps. The Office of Juvenile Prevention SMART System assigns a Community Disadvantage Index of 9 to the Ka'u community. All of this powerful data points to the overwhelming need our Ka'u youth and families have for establishing relationships with adults and professionals who care enough to assist them in developing positive personal qualities and support them in their homes, schools, and communities. BGCBI Ocean View Club addresses these needs on a daily basis when they open their doors and encourage all youth who enter to BE C REAtir Service Delivery The Ocean View Club opened its doors to the youth of the Ka'u District in February 2007 while based at the Ocean View Community Center. Transportation for this Club was a daily challenge and in May 2008, BGCBI chose to relocate the operation to Na'alehu Elementary and Intermediate School where we are able to serve both communities with ease. The Club operates out of the school gymnasium and uses all outdoor facilities for NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 3 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club sports and fitness activities. Through partnership with Hawaii County Parks & Recreation, the Na'alehu Community Center is utilized twice a week to conduct game room /social recreation, computer technology, and health and nutrition programs. In the summer of 2009, the Ocean View Club made a decision to serve two communities in partnership with Hawaii County Parks & Recreation. They wanted to assure that the youth had supervised activities to engage in on a full -time basis. The Ocean Viewstaff spent their mornings in Na'alehu and afternoons in Ocean View at Kahuku Park. The Club saw a significant rise in youth served which has led them to continue to operate and provide their after school youth development program in both communities year - round. The Ocean View Club conducts daily after- school, evening, weekend and full -day intercession and Furlough Friday programs which include Boys & Girls Club of America's five core programs areas: • Sports, Fitness and Recreation Development: develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills. Activities and programs include: game room, indoor /outdoor activities, table tournaments and inter -club leagues. • The Arts: enables youth to develop their creativity and cultural awareness through knowledge and an appreciation of the visual arts, crafts, performing arts and creative writing. Activities and programs include: arts & crafts, fine art, dance and music. • Education and Career Development: enables our youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career. Activities and programs include: Power Hour homework assistance, Project Leam comprehensive education based activities with high -yield teaming opportunities, science based environmental programs, Club Tech computer technology program and Career Launch career preparatory program • Character & Leadership Development: empowers our youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others' cultural identities. Activities and programs include: Keystone Club for 13-17 year olds, Torch Club for 10 -12 year olds, Youth of the Year - local, state, regional and national youth recognition program, public speaking opportunities, community service clubs and Welcome Patrol - youth program for youth introducing the Club to guest and new members. Youth For Unity is a Boys and Girls Club of America national diversity initiative that cultivates individuality, builds cultural identity and an appreciation of diversity. • Health & Life Skills Development: develops our youth's capacity to engage in positive behaviors that nurture their own well- being, set personal goals and live successfully as self - sufficient adults. Activities and programs include: Skills Mastery And Resistance Training (SMART Moves) - a nationally recognized model program for prevention of alcohol, tobacco and drug use. SMART Moves incorporates 11 age appropriate curriculum for ages 6 -18 years of age as well as parents and community. Triple Play - is a fitness program that develops a connection of mind, body and soul. Project TNT (Toward No Tobacco) is a NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 4 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club SAMSHA approved evidenced -based tobacco prevention program that gives youth the information and skills needed to stay tobacco -free. The Ocean View Club believes that the most effective approach for improving young people's lives is to reduce risk factors while increasing protective factors in all of the areas that touch their lives. Caring, trained youth development staff provide guidance in helping boys and girls to: discover their needs, enjoy their interests, explore their talents, broaden their viewpoints, value their diversity, resolve conflicts, set goals, understand themselves and have fun! As an affiliate, chartered member of our national organization, the Boys and Girls Club of America, BGCBI strives to provide youth development programs that support the fundamental principles and beliefs of the national Boys and Girls Club Movement. Our Core Beliefs A Boys and Girls Club provides: • A safe place to learn and grow • Ongoing relationships with caring, adult professionals • Life - enhancing programs and character development experiences • Hope and opportunity Youth Development Strategy The philosophy underlying BGCBI programming is the Youth Development Strategy. All Boys and Girls Club programs and activities are designed to maximize opportunities for young people to acquire four basic "senses" which help them build self- esteem and grow into responsible and caring citizens. These four senses are: • A sense of competence — Young people feel proud and confident when they acquire new skills and know they can do something and do it well. • A sense of usefulness — Young people know the satisfaction of doing something of value for others. • A sense of belonging — Young people know they are welcome and feel that they fit in and are accepted. • A sense of power and influence — Young people know their opinions are heard and valued and that they can influence decisions. Youth development occurs in all aspects of Boys and Girls Club participation. The Ocean View Club creates a climate in which these important "senses" are fostered in every participant, member and guest involved in program or just "hanging out ". Youth Development Outcomes at age 18 The Ocean View Club strives to help all youth live full, satisfying and productive lives. The following outcomes summarize BGCBI expectations and goals for youth entering the world at age 18: a positive self identity, competencies in education and employment, social competencies enabling them to develop and sustain positive relationships, emotional competencies enabling them to appropriately express themselves, and cultural competencies enabling them to contribute in a multicultural society and demonstrate tolerance for differences among people. Other youth development outcomes include: NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 5 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club Community and Civic Involvement: Youth have a sense of belonging to their community, family and/or group and are willing to take civic responsibility. They work closely with others to contribute to the greater good. Health and Well- Being: Youth live healthy lifestyles, take part in regular fitness activities, are able to access health care resources and engage in positive behaviors. They use sound judgment about personal safety, nutrition and avoidance of alcohol, drugs and premature sexual activity. Moral Compass: Youth have values enabling them to develop positive relationships with others. These values include honesty, a sense of justice and faimess, respect, caring and spirituality. The Ocean View Club proposes to engage youth in activities that are fun and enjoyable while supporting the development of the capacities described above, The Ocean View Club will use the Youth Development Outcome Measurement Tool Kit developed by the Boys and Girls Club of America. The goal of this measurement tool is to acquire the general well being of Club members and the degree to which they are acquiring skills, competencies and attitudes in specific areas, while assessing the impact that the Boys and Girls Club has on young people. Three intemet -based surveys have been developed (elementary, middle and high school) to collect and analyze information about whether the Ocean View Club is making a difference in members' lives. The Ocean View Club will survey its members twice throughout the funding year. Total Budget and Position Count Total Program Budget $142,800 Total Program Position Count 4 Total Agency Budget $1,325,000 Total Agency Position Count 30 Program Outcome Measures and Objectives: 1) Increase participants' knowledge and awareness of the consequences and harmful effects of tobacco, alcohol, and other drugs on their health and well- being. 2) Increase participants' ability to identify and resist peer and media pressures to engage in risky behaviors. 3) Increase participants' involvement in positive civic and community events. 4) Increase participants' positive attitude toward school /education 5) Decrease risky behavior of youth by increasing participants' positive self esteem through participation in positive youth development programs and activities on a daily basis 2008 -2009 Program Highlights: 1) Total days of operation: 241 Total hours of operation: 1,142 School days: 2:00 pm to 6:00 pm NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 6 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club School days off — waiver days: 9:00 am to 6:00 pm Summer intercession — 8:00 to Noon at Na'alehu School in Na'alehu Summer intercession -- 1:00 to 5:00 at P & R at Kahuku Park in Ocean View Total youth (6 through 18) registered as members of the Ocean View Club: 159 Total youth members participating in SMART Moves program curriculums: 73 Total other youth participating in Alcohol, Drug and Tobacco (ATOD) prevention program curriculum through outreach: 60 2) In the Fiscal Year 2008 -2009 the Boys and Girls Club of the Big Island provided programs to 1331. BGCBI youth development professionals provided outreach to 418 students in our community schools through the implementation of two evidenced -based curriculum programs: SMART Moves Drug, Alcohol, and Pregnancy Prevention Program and Project TNT. Some of the agencies BGCBI continued to maintain relationships with in FY 2008 -2009 include: Tobacco -Free Big Island Coalition, American Lung Association, American Cancer Society, REAL, the Salvation Army, Pahoa Weed and Seed Project, United States Tennis Association — Hawaii Pacific Section, Bay Clinic, State of Hawaii Department of Education, PATCH, Kick - the -Nic, Prosecuting Attorney's Office, and Hawaii County Department of Parks & Recreation. 3) The Arts • Arts & Crafts • Fine Arts (painting, drawing, and mural art): Youth created a mural this summer with a contracted mural artist. The mural is entitled Coming Together and was designed as a traveling mural which can be displayed at the many local events that the members of the Ocean View Club participate in. The theme of our members individual personalities and uniqueness comes together in unity to form the Ocean View Club. • Photography Program: 'Pics Are Us'. Boys and Girls Clubs of America's ImageMakers beginners photography program that has included a select group of youth who have shown a true interest and passion for the art. The youth have gained permission to display their photos In various Na'alehu and Ocean View businesses. • Dance (Hula, Hip -Hop, Line Dance, Salsa, Waltz) • Ukulele Lessons with Keoki Kahumoku • Martial Arts NONPROFIT GRANT APPLICATION FISCAL YEAR 2010-2011 Page 7 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Youth will participate in The Arts Programs. Examples: ✓ Arts and Crafts 119 50 50 ✓ Dance ✓ Music ✓ Fine Arts Youth will participate in Character and Leadership programs. 48 35 35 Examples: ✓ Keystone Club ✓ Torch Club ✓ Community Service Projects ✓ Club Service Projects Youth will participate in Education and Career Development Programs. Examples: ✓ Power Hour 127 75 75 ✓ Project Learn ✓ Tutoring ✓ Computer Technology Youth will participate in Health and Life Skills Programs. Examples: ✓ SMART Moves 141 75 75 ✓ Project TNT ✓ Nutrition /Cooking Classes ✓ Triple Play Youth will participate in Sports, Fitness and Recreation Programs. Examples: ✓ Team /Individual Sports 135 100 100 ✓ Games Room Activities ✓ Fitness Activities and Programs Parents /families will participate in activities to promote family 51 4 events per 4 events per strengthening and unity. year year NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 8 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club Program Expenditure FY 2008 -09 FY 2009 -10 FY 2010 -11 1 Actual * Budget * Estimate Salaries and Wages $60,712 $90,000 $99,000 Professional Fees $3,071 $2,500 $2,750 Operations $46,134 $36,000 $39,500 Equipment $1,610 $1,400 $1,550 Other Total $111,527 $129,900 $142,800 Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii -Non profit $40,000 $20,000 $40,000 Grant COH Contingency $5,000 HCF Tobacco $15,833 $14,167 $12,500 RYP OR $2,053 $23,750 $8,000 OHS OYS 08 - 26 $62,500 $62,500 Hawaii Island United Way $5,813 $2,200 $5,000 2009 OJP /BGCA $15,937 $5,313 Cox Grant $35,000 $35,000 Total $131,199 $173,554 $105,813 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 9 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Boys and Girls Clubs of the Big Island Board of Directors and Youth Development Professionals continue to work towards diversifying our revenues. Our goal is to be balanced between grants and unrestricted (fundraising & donation) revenues, as well as the vision to create an endowment fund for the future. We continue to work with Federal, State, County and private agencies to enhance collaboration between all facets to help us succeed. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 10 Boys & Girls Club of the Big Island Positive Youth Development Programs: Ocean View Club I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. / /L5w Signature of Board President/Chair Date , 2A, 1(0 Signature • Ex• , cutive birector Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 11 17 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club Agency Director: George Kalani Silva Phone No.: 961 -5536 Contact Person: George Kalani Silva Phone No.: 961 -5536 Mailing Address: 100 Kamakahonu Street, Hilo, Hawaii 96720 Facility /Site Address: River of Life Assembly of God 96 -2945 Paauau Street, Pahala, Hawaii 96777 Fax No.: 961 -5534 Email Address: kalani@bgcbi.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: (808) 968 -1002 Mailing Address: P. 0. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds: $40,000 Prior Year(s) Funding: 06 -07 07 -08 08 -09 $45,000 $40,000 $20,000 Agency Mission Statement: To inspire and enable Big Island youth from all backgrounds, especially those from disadvantaged circumstances, to become productive and responsible citizens by offering quality programs in a safe and caring environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 1 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club Program Description: With most parents working, many of our Big Island youth find themselves with no adult care or supervision during the critical hours between school dismissal and dinnertime. Young people are often left to find their own recreation and companionship within their communities; more specifically, the streets. When opportunities are available in a community for positive participation, children are less likely to engage in substance use and other problem behaviors. The Boys and Girls Club of the Big Island (BGCBI) — Pahala Club, provides those opportunities on a daily basis to the young people of the Pahala community. The Pahala Club offers programs and services aimed at instilling a positive sense of self, increase self- esteem, self- confidence, and teach the skills necessary to make good, sound decisions. Through fun and engaging activities, BGCBI provides a positive atmosphere for youth to explore their interests so that they can reach their full potential and contribute to their communities as good, responsible citizens. Founded as the Boys Club of Hilo in 1952, the BGCBI has served over 50,000 youth in East Hawaii. In 2002, we became BGCBI and during the last 5 years, BGCBI Board of Directors and Club leadership have demonstrated their commitment by extending our service reach to the youth in Pahoa, Kea'au, Ocean View /Naalehu, Pahala and along the Hamakua coast. BGCBI success is evident on the faces of the youth who attend our Clubs and the outcome results reported to the following federal, state and private funding agencies: the Office of Juvenile Justice and Prevention (OJJP), the Hawaii State Department of Human Services /Office of Youth Services (DHS /OYS), the Hawaii State Department of Health /Alcohol and Drug Abuse Division (ADAD), Office of Juvenile Prevention (OJP) Rural Youth Program, Tobacco Trust Settlement administered by the Hawaii Community Foundation (HCF), and the Hawaii Island United Way. Reports are available upon request. The Need Ka'u Community: The Ka'u Community, 2003 Hawaii Student Alcohol, Tobacco, and Other Drug Use Study administered by the State of Hawaii Department of Health, Alcohol and Drug Abuse Division provides the following family domain data from students in the 6 grade (http://hawaii.gov/ health /substance - abuse /prevention- treatment/survev /adsurv.htm) • 49 % reported poor family supervision • 18 % reported lack of parental sanctions for Anti - Social Behaviors (ASB's) • 18 % reported parental attitudes favorable toward ATOD use • 53 % reported exposure to family ATOD use • 12 % reported a family (sibling) history of ASB The 2007 -2008 School Quality Survey for Kau High and Pahala Elementary School indicated that only 61 % of parents are involved in their child's school. (http: / /doe. k12.h i. us) NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 2 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club The Ka'u High and Pahala Elementary School and Improvement Report for School Year 2007 -2008 (http: / /doe.kl2.hi.us) provides the following information: • Average Daily Attendance of 87.9 % as compared to the state standard of 95% • Average Daily Absences of 21.2 days as compared to the state standard of 9 days • 60.3 % of the students receive free or reduced -cost lunch • The Hawaii Content and Performance Standards show Ka'u High and Pahala Elementary School students are 18% below the State average in reading; 24% below the State average in math • The Terrallova scores for 4 grade students at Pahala Elementary School indicate 29% of the students are below the national norm in reading and 44% of 5 grade students are below the national norm in math The Hawaii Student ATOD study indicates that 56% of middle school students in the Ka'u community experience community disorganization, 45% view laws and norms favorable to drug use, 48% engaged in early initiation of problem behaviors, 47% showed a low perceived risk of ATOD use, 53% interacted with antisocial peers, and 48% felt that their friends reward them for antisocial involvement. A conclusion of the same study indicated that 46% of the 6' grade students who participated had a high probability of developing a substance abuse problem or engaging in other problem behaviors. Only 25% of the students who participated in the study had a high number of protective factors indicating that they were less likely to use substances or engage in antisocial behaviors. Data from Center on the Family of the University of Hawaii (http: / /uhfamilv.hawaii.edu) concludes that the people of the Ka'u District face a number of economic, social, and educational hardships. The unemployment rate is the worst in the State. The per capita income is lower than in most other communities Statewide. High proportions of the very young live in poverty, and one -third of the families receive food stamps. The Office of Juvenile Prevention SMART System assigns a Community Disadvantage Index of 9 to the Ka'u community. All of this powerful data points to the overwhelming need our Ka'u youth and families have for establishing relationships with adults and professionals who care enough to assist them in developing positive personal qualities and support them in their homes, schools, and communities. BGCBI Pahala Club addresses these needs on a daily basis when they open their doors and encourage all youth who enter to BE GREAT Service Delivery The Pahala Club conducts daily after - school, evening, weekend and full -day intercession and Furlough Friday programs which include Boys & Girls Club of America's five core programs areas: NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 3 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club • Sports, Fitness and Recreation Development: develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills. Activities and programs include: game room, indoor /outdoor activities, table toumaments and inter -club leagues. • The Arts: enables youth to develop their creativity and cultural awareness through knowledge and an appreciation of the visial arts, crafts, performing arts and creative writing. Activities and programs include: arts & crafts, fine art, dance and music. • Education and Career Development: enables our youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career. Activities and programs include: Power Hour homework assistance, Project Leam comprehensive education based activities with high -yield leaming opportunities, science based environmental programs, Club Tech computer technology program and Career Launch career preparatory program. • Character & Leadership Development: empowers our youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others' cultural identities. Activities and programs include: Keystone Club for 13 -17 year olds, Torch Club for 10 -12 year olds, Youth of the Year - local, state, regional and national youth recognition program, public speaking opportunities, community service clubs and Welcome Patrol - youth program for youth introducing the Club to guest and new members. Youth For Unity is a Boys and Girls Club of America national diversity initiative that cultivates individuality, builds cultural identity and an appreciation of diversity. • Health & Life Skills Development: develops our youth's capacity to engage in positive behaviors that nurture their own well- being, set personal goals and live successfully as self - sufficient adults. Activities and programs include: Skills Mastery And Resistance Training (SMART Moves) - a nationally recognized model program for prevention of alcohol, tobacco and drug use. SMART Moves incorporates 11 age appropriate curriculum for ages 6 -18 years of age as well as parents and community. Triple Play - is a fitness program that develops a connection of mind, body and soul. Project TNT (Toward No Tobacco) is a SAMSHA approved evidenced -based tobacco prevention program that gives youth the information and skills needed to stay tobacco -free. The Pahala Club believes that the most effective approach for improving young people's lives is to reduce risk factors while increasing protective factors in all of the areas that touch their lives. Caring, trained youth development staff provide guidance in helping boys and girls to: discover their needs, enjoy their interests, explore their talents, broaden their viewpoints, value their diversity, resolve conflicts, set goals, understand themselves and have fun! As an affiliate, chartered member of our national organization, the Boys and Girls Club of America, BGCBI strives to provide youth development programs that support the fundamental principles and beliefs of the national Boys and Girls Club Movement. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 4 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club Our Core Beliefs A Boys and Girls Club provides: • A safe place to learn and grow • Ongoing relationships with caring, adult professionals • Life- enhancing programs and character development experiences • Hope and opportunity Youth Development Strategy The philosophy underlying BGCBI programming is the Youth Development Strategy. All Boys and Girls Club programs and activities are designed to maximize opportunities for young people to acquire four basic "senses" which help them build self- esteem and grow into responsible and caring citizens. These four senses are: • A sense of competence — Young people feel proud and confident when they acquire new skills and know they can do something and do it well. • A sense of usefulness — Young people know the satisfaction of doing something of value for others. • A sense of belonging — Young people know they are welcome and feel that they fit in and are accepted. • A sense of power and influence — Young people know their opinions are heard and valued and that they can influence decisions. Youth development occurs in all aspects of Boys and Girls Club participation. The Pahala Club creates a climate in which these important "senses" are fostered in every participant, member and guest involved in program or just "hanging out". Youth Development Outcomes at age 18 The Pahala Club strives to help all youth live full, satisfying and productive lives. The following outcomes summarize BGCBI expectations and goals for youth entering the world at age 18: a positive self identity, competencies in education and employment, social competencies enabling them to develop and sustain positive relationships, emotional competencies enabling them to appropriately express themselves, and cultural competencies enabling them to contribute in a multicultural society and demonstrate tolerance for differences among people. Other youth development outcomes include: Community and Civic Involvement: Youth have a sense of belonging to their community, family and /or group and are willing to take civic responsibility. They work closely with others to contribute to the greater good. Health and Well- Being: Youth live healthy lifestyles, take part in regular fitness activities, are able to access health care resources and engage in positive behaviors. They use sound judgment about personal safety, nutrition and avoidance of alcohol, drugs and premature sexual activity. Moral Compass: Youth have values enabling them to develop positive relationships with others. These values include honesty, a sense of justice and faimess, respect, caring and spirituality. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 5 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club The Pahala Club proposes to engage youth in activities that are fun and enjoyable while supporting the development of the capacities described above. The Pahala Club will use the Youth Development Outcome Measurement Tool Kit developed by the Boys and Girls Club of America. The goal of this measurement tool is to acquire the general well being of Club members and the degree to which they are acquiring skills, competencies and attitudes in specific areas, while assessing the impact that the Boys and Girls Club has on young people. BGCA has developed three internet -based surveys (elementary, middle and high school) to collect and analyze information about whether the Pahala Club is making a difference in members' lives. The Pahala Club will survey its members twice throughout the funding year. Total Budget and Position Count Total Program Budget $164,900 Total Program Position Count 3 Total Agency Budget $1,325,000 Total Agency Position Count 30 Program Outcome Measures and Objectives: 1) Increase participants' knowledge and awareness of the consequences and harmful effects of tobacco, alcohol, and other drugs on their health and well- being. 2) Increase participants' ability to identify and resist peer and media pressures to engage in risky behaviors. 3) Increase participants' involvement in positive civic and community events. 4) Increase participants' positive attitude toward school /education 5) Decrease risky behavior of youth by increasing participants' positive self esteem through participation in positive youth development programs and activities on a daily basis 2007 -2008 Program Highlights: 1) Total days of operation: 246 Total hours of operation: 1,057 School days: 2:00 pm to 6:00 pm School days off — waiver days and intercessions: 1:00 pm to 5:00 pm Total youth (ages 6 through 18) registered as members of the Pahala Club: 123 Total youth members participating in SMART Moves program curriculums: 73 Total other youth participating in Alcohol, Tobacco and other Drug prevention program curriculum through outreach: 38 2) In the Fiscal Year 2008 -2009 the Boys and Girls Club of the Big Island provided programs to 1331. BGCBI youth development professionals provided outreach to 418 students in our community schools through the implementation of two evidenced -based curriculum programs: SMART Moves Drug, Alcohol, and Pregnancy Prevention Program and Project TNT. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 6 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club Some of the agencies BGCBI continued to maintain relationships with in FY 2008 -2009 include: Tobacco -Free Big Island Coalition, American Lung Association, American Cancer Society, REAL, the Salvation Army, Pahoa Weed and Seed Project, United States Tennis Association — Hawaii Pacific Section, Bay Clinic, State of Hawaii Department of Education, PATCH, Kick - the -Nic, Prosecuting Attorney's Office, and Hawaii County Department of Parks & Recreation. 3) The youth development staff of the Pahala Club had a great year providing positive youth development activities to the youth of Pahala town. Examples include: • A strong partnership has formed between the Pahala Boys and Girls Club and the staff of Kau Hospital. Every Friday our Pahala youth enjoyed reading and doing crafts with the residents of the hospital. The many holidays presented the opportunity for the youth to perform with dance, music and singing. • The partnership with Parks and Recreation in Pahala continues to grow with the sharing of resources that expose our youth to a variety of activities without duplicating services. Pahala members participate in the many sports programs offered and when the P & R Leader is conducting special arts classes. • Pahala Club members participated in the Smoke -Free Arts Contest sponsored by The Tobacco Free Big Island Coalition. • Kick Butts Day 2009 was celebrated in March with youth participating in numerous activities that both educated our youth as to the harmful effects of tobacco use and how they can be advocates for a smoke -free lifestyle. • The Pahala Club members continued to participate in Ukulele Lessons with volunteers Keoki Kahumoku and Aunty Kaiwi Perkins. Eight Club members were rewarded with new ukuleles for their outstanding participation in the program. • The Pahala Club conducts Family Fun Nights on the 1 Friday of the month in partnership with the Pahala Assembly of God Fellowship. • Our youth participate in community service activities regularly. 0 Ka'u Kakou recruited the Pahala Club to assist in the cleaning of various sites in and around Pahala Town. They provide supervision and materials needed to do the job at hand. • Taking part in Ka'u District parades, festivals, and special events allows our youth to be a part of celebrating their heritage and stand proud before their family and friends. • Recognizing youth for outstanding performance is standard and great care is given to instill 100% for themselves, each other, their Club and their community: NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 7 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Youth will participate in The Arts Programs. Examples: ✓ Arts and Crafts 92 50 50 ✓ Dance ✓ Music ✓ Fine Arts Youth will participate in Character and Leadership programs. Examples: ✓ Keystone Club 30 25 25 ✓ Torch Club ✓ Community Service Projects ✓ Club Service Projects Youth will participate in Education and Career Development Programs. Examples: 98 75 75 ✓ Power Hour ✓ Project Learn ✓ Tutoring ✓ Computer Technology Youth will participate in Health and Life Skills Programs. Examples: ✓ SMART Moves 88 50 50 ✓ Project TNT ✓ Nutrition /Cooking Classes ✓ Triple Play Youth will participate in Sports, Fitness and Recreation Programs. Examples: 86 75 75 ✓ Team /Individual Sports ✓ Games Room Activities ✓ Fitness Activities and Programs Parents/families will participate in activities to promote family 49 4 events per 4 events per strengthening and unity. year year NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 8 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club Program Expenditure FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages $72,424 $95,000 $104,500 Professional Fees $3,071 $2,500 $2,750 Operations $41,218 $51,100 $56,100 Equipment $897 $1,400 $1,550 Other Total $117,610 $150,000 $164,900 Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii -Non profit $40,000.00 $20,000 $40,000 Grant COH Contingency $5,000.00 USTA $10,000.00 RYP OR $2,053.00 $23,750 $8,000 United Way $5,812.50 $2,200 $5,000 Cox Grant $35,000 $35,000 HCF Tobacco $15,833 $14,167 $12,500 Total $78,698.50 $95,117 $100,500 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 9 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Boys and Girls Clubs of the Big Island Board of Directors and Youth Development Professionals continue to work towards diversifying our revenues. Our goal is to be balanced between grants and unrestricted (fundraising & donation) revenues, as well as the vision to create an endowment fund for the future. We continue to work with Federal, State, County and private agencies to enhance collaboration between all facets to help us succeed. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 10 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahala Club (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 report will impact the evaluation of your program's or agency's future funding requests. Signature of Board President/Chair Date dector 0 (I2q (o Signatu of E cutive Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 11 18 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club Agency Director: George Kalani Silva Phone No.: 961 -5536 Contact Person: George Kalani Silva Phone No.: 961 -5536 Mailing Address: 100 Kamakahonu Street, Hilo, Hawaii 96720 Facility /Site Address: Pahoa Intermediate & High School 15 -3038 Puna Road, Pahoa, Hawaii 96778 Fax No.: 961 -5534 Email Address: kalani @becbi.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: (808) 968 -1002 Mailing Address: P. O. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds: $40,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $45,000 $40,000 $20,000 Agency Mission Statement: To inspire and enable Big Island youth from all backgrounds, especially those from disadvantaged circumstances, to become productive and responsible citizens by offering quality programs in a safe and caring environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 1 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club Program Description: With most parents working, many of our Big Island youth find themselves with no adult care or supervision during the critical hours between school dismissal and dinnertime. Young people are often left to find their own recreation and companionship within their communities; more specifically, the streets. When opportunities are available in a community for positive participation, children are less likely to engage in substance use and other problem behaviors. The Boys and Girls Club of the Big Island (BGCBI) — Pahoa Club, provides those opportunities on a daily basis to the young people of the Pahoa community. The Pahoa Club offers programs and services aimed at instilling a positive sense of self, increase self- esteem, self- confidence, and teach the skills necessary to make good, sound decisions. Through fun and engaging activities, BGCBI provides a positive atmosphere for youth to explore their interests so that they can reach their full potential and contribute to their communities as good, responsible citizens. Founded as the Boys Club of Hilo in 1952, the BGCBI has served over 50,000 youth in East Hawaii. In 2002, we became BGCBI and during the last 5 years, BGCBI Board of Directors and Club leadership have demonstrated their commitment by extending our service reach to the youth in Pahoa, Kea au, Ocean View /Naalehu, Pahala and along the Hamakua coast. BGCBI success is evident on the faces of the youth who attend our Clubs and the outcome results reported to the following federal, state and private funding agencies: the Office of Juvenile Justice and Prevention (OJJP), the Hawaii State Department of Human Services /Office of Youth Services (DHS /OYS), the Hawaii State Department of Health /Alcohol and Drug Abuse Division (ADAD), Office of Juvenile Prevention (OJP) Rural Youth Program, Tobacco Trust Settlement administered by the Hawaii Community Foundation (HCF), and the Hawaii Island United Way. Reports are available upon request. The Need Pahoa Community: Data compiled by the Office of Juvenile Prevention (OJP) SMART system assigns a Community Disadvantage Index of 10 to the Pahoa area. The above community, family and child indicators show powerful support of this index. According to the Center on the Family "this area has the third highest unemployment rate, the third lowest per capita income, and the highest percentage in the State of families who rely on food stamps. The poverty rate of young children is second in the State. More than 55% of the residents in the Pahoa area receive food stamp assistance. Strengths found in the Pahoa Area include low teacher turnover and the second highest percentage of teachers with advanced degrees in the State. Adolescents report close family and neighborhood ties. The East Hawaii Community Profile document written by Center on the Family, University of Hawaii at Manoa, states that "the problem of alcohol, tobacco and other NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 2 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club drug use among the children of East Hawaii is a serious one. The youth of this community start using early, as indicated by the comparatively high rates of sixth graders reporting cigarette, alcohol, marijuana, and crystal methamphetamine use in the 30 days before taking the Hawaii Student ATOD Use Study. East Hawaii has a higher rate, compared to the State, of twelfth graders who claim to drink alcohol on a daily basis and, at all grade levels, youth who have been identified as needing treatment." The 2003 Hawaii Student ATOD Use Study indicates the East Hawaii youth, family, school and community need for substance abuse prevention programs. The following table shows the prevalence of ATOD use 30 days prior to taking the survey for youth of the East Hawaii communities: Substance Use Reported East State by Students Hawaii Smoking cigarettes in the past month • Grade 6 12.3% 2.6% • Grade 8 15.4% 8.5% • Grade 10 15.6% 11.3% • Grade 12 31.6% 16.3% Drinking any alcohol in past month • Grade 6 9.8% 3.9% • Grade 8 23.1% 14.6% • Grade 10 39.2% 27.0% • Grade 12 55.8% 36.3% Drinking alcohol daily in past month • Grade 6 1.9% 0.4% • Grade 8 3.7% 1.5% • Grade 10 4.0% 2.3% • Grade 12 3.4% 2.8% Using marijuana in past month • Grade 6 8.8% 1.0% • Grade 8 7.7% 6.6% • Grade 10 25.7% 14.8% • Grade 12 25.7% 18.4% Using crystal methamphetamine in past month • Grade 6 3.5% 0.2% • Grade 8 0.0% 0.8% • Grade 10 0.0% 1.2% • Grade 12 1.7% 0.8% Using inhalants in past month • Grade 6 5.4% 1.9% • Grade 8 0.0% 3.6% • Grade 10 0.0% 2.0% • Grade 12 1.7% 1.3% NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 3 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club As indicated above, our youth in East Hawaii are faced with risk factors such as early initiation of problem behaviors w /alcohol and drug use, favorable attitude towards ATOD use, low perceived ATOD use risk and peer approval of ATOD use. Community, school, and family risk factors include exposure of youth to alcohol and drugs, low school commitment, poor academic performance, lack of family supervision /involvement, lack of parental sanctions for antisocial behaviors, and factors affecting family socioeconomic struggles, such as unemployment and substance abuse. All these risk factors affect our youth's ability to make a successful transition to adulthood. The East Hawaii community profile states that in the realm of individual characteristics and peer influence, East Hawaii teens are high on risk and low on protection. The teens of East Hawaii were the highest in the State on three measures of risk: enjoying doing crazy or dangerous things and will take a dare or do what feels good without thinking about the consequences; an attitude that condones antisocial behaviors; and they see nothing wrong with smoking, drinking, or using illegal drugs. All of this powerful data points to the overwhelming need our East Hawaii youth and families have for establishing relationships with adults and professionals who care enough to assist them in developing positive personal qualities and support them in their homes, schools, and communities. BGCBI Pahoa Club addresses these needs on a daily basis when they open their doors and encourage all youth who enter to BCC GREAT' Service Delivery The Pahoa Club has been making a difference in the Puna District since October 2003, initially providing services part -time 2 -3 days a week at the Nanawale Subdivision's Community Center. In August 2004, the program expanded to five days a week and in June 2006 moved to their present location at Pahoa Intermediate and High School, operating Monday through Friday from 2:00 pm to 6:00 pm. On school days off and intercessions, the Club is open full -day providing care to those youth who parents are employed. The Pahoa Club has formed a strong relationship with the Pahoa DOE School Complex who supports our efforts by providing the BGCBI two large portable classrooms used for implementing BGCA core programs. We also have use of the school complex fields and outdoor facilities available for sports fitness and athletic activities. The Pahoa Club conducts daily after - school, evening, weekend and full -day intercession and Furlough Friday programs which include Boys & Girls Club of America's five core programs areas: • Sports, Fitness and Recreation Development: develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills. Activities and programs include: game room, indoor /outdoor activities, table tournaments and inter -club leagues. • The Arts: enables youth to develop their creativity and cultural awareness through knowledge and an appreciation of the visual arts, crafts, performing arts NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 4 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club and creative writing. Activities and programs include: arts & crafts, fine art, dance and music. • Education and Career Development: enables our youth to become proficient in basic educational disciplines, apply teaming to everyday situations and embrace technology to achieve success in a career. Activities and programs include: Power Hour homework assistance, Project Leam comprehensive education based activities with high -yield learning opportunities, science based environmental programs, Club Tech computer technology program and Career Launch career preparatory program • Character & Leadership Development: empowers our youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others' cultural identities. Activities and programs include: Keystone Club for 13 -17 year olds, Torch Club for 10 -12 year olds, Youth of the Year - local, state, regional and national youth recognition program, public speaking opportunities, community service clubs and Welcome Patrol - youth program for youth introducing the Club to guest and new members. Youth For Unity is a Boys and Girls Club of America national diversity initiative that cultivates individuality, builds cultural identity and an appreciation of diversity. • Health & Life Skills Development: develops our youth's capacity to engage in positive behaviors that nurture their own well- being, set personal goals and live successfully as self - sufficient adults. Activities and programs include: Skills Mastery And Resistance Training (SMART Moves) - a nationally recognized model program for prevention of alcohol, tobacco and drug use. SMART Moves incorporates 11 age appropriate curriculum for ages 6 -18 years of age as well as parents and community. Triple Play - is a fitness program that develops a connection of mind, body and soul. Project TNT (Toward No Tobacco) is a SAMSHA approved evidenced -based tobacco prevention program that gives youth the information and skills needed to stay tobacco -free. The Pahoa Club believes that the most effective approach for improving young people's lives is to reduce risk factors while increasing protective factors in all of the areas that touch their lives. Caring, trained youth development staff provide guidance in helping boys and girls to: discover their needs, enjoy their interests, explore their talents, broaden their viewpoints, value their diversity, resolve contlicts, set goals, understand themselves and have fun! As an affiliate, chartered member of our national organization, the Boys and Girls Club of America, BGCBI strives to provide youth development programs that support the fundamental principles and beliefs of the national Boys and Girls Club Movement. Our Core Beliefs A Boys and Girls Club provides: • A safe place to learn and grow • Ongoing relationships with caring, adult professionals • Life - enhancing programs and character development experiences • Hope and opportunity NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 5 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club Youth Development Strategy The philosophy underlying BGCBI programming is the Youth Development Strategy. All Boys and Girls Club programs and activities are designed to maximize opportunities for young people to acquire four basic "senses" which help them build self- esteem and grow into responsible and caring citizens. These four senses are: • A sense of competence — Young people feel proud and confident when they acquire new skills and know they can do something and do it well. • A sense of usefulness — Young people know the satisfaction of doing something of value for others. • A sense of belonging — Young people know they are welcome and feel that they fit in and are accepted. • A sense of power and influence — Young people know their opinions are heard and valued and that they can influence decisions. Youth development occurs in all aspects of Boys and Girls Club participation. The Pahoa Club creates a climate in which these important "senses" are fostered in every participant, member and guest involved in program or just "hanging out ". Youth Development Outcomes at age 18 The Pahoa Club strives to help all youth live full, satisfying and productive lives. The following outcomes summarize BGCBI expectations and goals for youth entering the world at age 18: a positive self identity, competencies in education and employment, social competencies enabling them to develop and sustain positive relationships, emotional competencies enabling them to appropriately express themselves, and cultural competencies enabling them to contribute in a multicultural society and demonstrate tolerance for differences among people. Other youth development outcomes include: Community and Civic Involvement: Youth have a sense of belonging to their community, family and /or group and are willing to take civic responsibility. They work closely with others to contribute to the greater good. Health and Well- Being: Youth live healthy lifestyles, take part in regular fitness activities, are able to access health care resources and engage in positive behaviors. They use sound judgment about personal safety, nutrition and avoidance of alcohol, drugs and premature sexual activity. Moral Compass: Youth have values enabling them to develop positive relationships with others. These values include honesty, a sense of justice and fairness, respect, caring and spirituality. The Pahoa Club proposes to engage youth in activities that are fun and enjoyable while supporting the development of the capacities described above. The Pahoa Club will use the Youth Development Outcome Measurement Tool Kit developed by the Boys and Girls Club of America. The goal of this measurement tool is to acquire the general well being of Club members and the degree to which they are acquiring skills, competencies and attitudes in specific areas, while assessing the impact that the Boys and Girls Club has on young people. BGCA has developed three intemet -based surveys (elementary, middle and high school) to collect and analyze information about whether the Pahoa NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 6 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club Club is making a difference in members' lives. The Pahoa Club will survey its members twice throughout the funding year. Total Budget and Position Count Total Program Budget $164,900 Total Program Position Count 3 Total Agency Budget $1,325,000 Total Agency Position Count 30 Program Outcome Measures and Objectives: 1) Increase participants' knowledge and awareness of the consequences and harmful effects of tobacco, alcohol, and other drugs on their health and well- being. 2) Increase participants' ability to identify and resist peer and media pressures to engage in risky behaviors. 3) Increase participants' involvement in positive civic and community events. 4) Increase participants' positive attitude toward school /education 5) Decrease risky behavior of youth by increasing participants' positive self esteem through participation in positive youth development programs and activities on a daily basis 2008 -2009 Program Highlights: 1) Total days of operation: 240 Total hours of operation: 1,548 School days: 2:00 pm to 6:00 pm School days off — waiver days and intercessions: 7:30 am to 5:30 pm Total youth (ages 6 through 18) registered as members of the Pahoa Club: 195 Total youth members participating in SMART Moves program curriculums: 31 Total other youth participating in SMART Moves program curriculum through outreach: 112 2) In the Fiscal Year 2008 -2009 the Boys and Girls Club of the Big Island provided programs to 1331. BGCBI youth development professionals provided outreach to 418 students in our community schools through the implementation of two evidenced -based curriculum programs: SMART Moves Drug, Alcohol, and Pregnancy Prevention Program and Project TNT. Agencies BGCBI continued to maintain relationships with in FY 2008 -2009 include: Tobacco -Free Big Island Coalition, American Lung Association, American Cancer Society, REAL, the Salvation Army, Pahoa Weed and Seed Project, United States Tennis Association — Hawaii Pacific Section, Bay Clinic, State of Hawaii Department of Education, PATCH, Kick - the -Nic, Prosecuting Attorney's Office, and Hawaii County Department of Parks & Recreation. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 7 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club 3) FY 2008 -2009 Outstanding Character and Leadership Development 7 Pahoa Town Clean -ups 7- Chartered Torch Club — participation in beach beautifications, community special events and festivals, monthly Pahoa Poi Bowl • Chartered Keystone Club — participation in beach beautifications, community special events, parades and festivals, monthly Pahoa Poi Bowl • SMART Leaders fr Participation in Alu Like Summer Youth Employment Program — Rose, Pahoa Club Director writes: "I am pleased with the Alu Like youth assigned to me this summer. I was lucky to be able to request the kids I wanted. I am especially pleased with Jasmine, who is not a Club member. I had heard some not so great stuff about her behavior. She is a large girl, and sometimes uses her size to intimidate others. She had also gotten in a fight with one of my members early last school year. But she has shown herself to be responsible and hold the other Alu Like youth to a high behavior standard. She is caring towards our younger members and very patient." • BGCBI Youth of the Year winner — Pahoa Club member, Meghan McGrath, received the highest award any member of a Boys and Girls Club can achieve. In February, Meghan was chosen by our Board of Directors as BGCBI's 2009 Youth of the Year. She competed against other state Club winners in the State competition in March. > Pahoa Club won first place for their float in the Pahoa Town Holiday Parade NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 8 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Youth will participate in The Arts Programs. Examples. 146 75 75 ✓ Arts and Crafts ✓ Dance ✓ Music ✓ Fine Arts Youth will participate in Character and Leadership programs. Examples: ✓ Keystone Club ✓ Torch Club 58 40 40 ✓ Community Service Projects ✓ Club Service Projects Youth will participate in Education and Career Development Programs. Examples: ✓ Power Hour 117 100 100 ✓ Project Learn ✓ Tutoring ✓ Computer Technology Youth will participate in Health and Life Skills Programs. Examples: ✓ SMART Moves 143 100 100 ✓ Project TNT ✓ Nutrition /Cooking Classes ✓ Triple Play Youth will participate in Sports, Fitness and Recreation Programs. Examples: ✓ Team /Individual Sports 156 120 120 ✓ Games Room Activities ✓ Fitness Activities and Programs Parents/families will participate in activities to promote family 41 4 events per 4 events per strengthening and unity. year year NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 9 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club Program Expenditure FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages $86,901 $95,000 $104,500 Professional Fees $3,071 $2,500 $2,750 Operations $58,733 $51,100 $56,100 Equipment $1,256 $1,400 $1,550 Other Total $149,961 $150,000 $164,900 Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 1 FY 2010 -11 Actual * Budget * Estimate County of Hawaii -Non $46,500 $20,000 $40,000 profit Grant HCF Tobacco $15,833 $14,167 $12,500 COH Contingency $13,000 RYP OR $2,053 $23,750 $8,000 DOE -OHCNP $4,334 Hawaii Island United Way $5,813 $2,200 $5,000 ADAD $30,000 $30,000 COX Grant $35,000 $35,000 Total $87,533 $125,117 $130,500 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 10 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Boys and Girls Clubs of the Big Island Board of Directors and Youth Development Professionals continue to work towards diversifying our revenues. Our goal is to be balanced between grants and unrestricted (fundraising & donation) revenues, as well as the vision to create an endowment fund for the future. We continue to work with Federal, State, County and private agencies to enhance collaboration between all facets to help us succeed. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 11 Boys & Girls Club of the Big Island Positive Youth Development Programs: Pahoa Club I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board President /Chair Date � L � (Director /Re Signat e 4f Ex- cutive _ Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 2011 Page 12 19 Brantley Center, Inc. Employment Rehabilitation Program Brantley Center, Inc.- Agency Name Employment Rehabilitation Program- Program Name Agency Director: Cami Post Phone No.: 775 -7245 Contact Person: Cami Post Phone No.: 775 -7245 Mailing Address: P.O. Box 1407 Honokaa, Hawaii 96727 Facility /Site Address: 45 -370 Ohelo Rd. Honokaa, HI 96727 Fax No.: 775 -0211 Email Address: bcenter2 @hawaiian tel.net Name of Accountant/CPA (include name of firm if applicable): Jennifer Gossert, CPA Phone No.: (808) 969 -3115 Mailing Address: 688 Kinoole Street, Suite 201, Hilo, Hawaii 96720 Amount of Request for County Funds: $25,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $25,000 $10,000 $20,000 Agency Mission Statement: To provide quality rehabilitation services to people with disabilities that empower them to participate independently in their community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 11 Page 1 Brantley Center, Inc. - Agency Name Employment Rehabilitation Program- Program Name Program Description: The Employment Rehabilitation Program provides participants with a variety of services that develop and support the accomplishment of goals leading to meaningful competitive employment. These services include: vocational evaluations, work adjustment training, occupational skills training, job- readiness classes, competitive employment placement services, and follow -up services while on-the-job. Participants receive quality vocational training and at the same time are paid for work performed. Program staff work closely with the community to provide community-based vocational training, and in tum, provide the public with an additional work force. Also included in this program are work transition services for high school students. The Center's staff work with high school counselors to transition students with disabilities from a school environment to a work environment. Total Budget and Position Count Total Program Budget 216,000 Total Program Position Count 4.1 Total Agency Budget 371,750 Total Agency Position Count 9.0 Program Objectives: 1) Provide vocational evaluations to 25 clients. 2) Provide individualized employment planning services to 20 clients. 3) Provide work adjustment training to 26 clients. 4) Provide occupational skills training to 26 clients. 5) Provide job- readiness classes to 10 clients. 6) Provide competitive job placement and follow -up services to 12 clients. 7) Provide work transition services to 14 high school students with disabilities. Program Highlights: (from Fiscal Year 2008 -09) 1) Provided vocational evaluations to 7 clients. 2) Provided individualized employment planning services to 10 clients. 3) Provided work adjustment training to 15 clients. 4) Provided occupational skills training to16 clients. 5) Provided job- readiness classes to 4 clients. 6) Provided competitive job placement and follow -up services to 5 clients. 7) Provided work transition services to 10 high school students with disabilities. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Brantley Center, Inc. - Agency Name Employment Rehabilitation Program - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Number of clients who received 18 30 30 employment rehabilitation services. Number of clients with improved 9 20 20 scores on the Vocational Evaluation and Training Report. Number of clients who increased 11 20 20 their productivity percentages. Number of clients who successfully 7 18 18 completed their occupational skills training. Number of high school students 10 10 10 with disabilities who received work transition services. Number of clients placed in 5 10 10 competitive employment for a minimum of 90 days. *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 127,604 129,647 130,500 Professional Fees 12,000 15,394 15,500 Operations 64,405 67,271 70,000 Equipment Other Client Wa Total _ 204,009 212,312 216,000 * If applicable * Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Brantley Center, Inc. - Agency Name Employment Rehabilitation Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County Mass Transit 20,500 10,500 10,500 State of Hawaii 28,500 30,000 30,000 Hawaii Island United Way 22,500 19,750 19,750 County of Hawaii Nonprofit Grant 10,000 20,000 25,000 Program sales & services 122,509 130,062 130,750 Fundraising 2,000 204,009 212,312 216,000 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? For fiscal year 2010 -2011, Brantley Center, Inc. plans to expand our grounds maintenance and janitorial services by submitting bids for public and private contracts. We also plan to enlarge the plant nursery that was started in 2008. This will provide participants with additional training opportunities and at the same time increase program revenue. In January, 2009 the Board of Directors formed a community fundraising committee to address the recent budget cuts. The Board also plans to increase large donor contributions through special invitations to the Center to show case our program services. Approximately sixty percent of the total cost to provide employment rehabilitation services is funded by the Center's private funds, generated by services made available to the public. The community continues to show their support of Brantley Center through designating their donations to the Center through Hawaii Island United Way, through fundraising activities, and contributions. In order to provide employment training and supports necessary for people with disabilities to become employed, it must be a collaborative effort between Brantley Center, Inc., the State and County, and the community. The funds provided by the State and County of Hawaii are essential to provide quality rehabilitation services. Without this funding, the number of people served would decrease as well as training services. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Brantley Center, Inc. - Agency Name Employment Rehabilitation Program - 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, 1 (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 report will impact the evaluation of your program's or agency's future funding requests. a ii,C,fri_oediej (off BlO Signature of Board President/Chair 'Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 11 Page 5 20 Bridge House, Inc. Vocational Skills Building Program BRIDGE HOUSE, Inc.- Agency Name 'Vocational Skills Building Program " - Program Name Agency Director. Mark Schuster Phone No.: 808= 322 =3305 Contact Person: - Mark Schuster Phone No.: 808= 322 =3305 Mailing Address: P.O. Box 2489 Kailua =Kona, H1 96745 facility/Site Address: 78 -66878 Mamalahoa Hwy. HotuaLoa, HI 96725 Fax No.: 808 - 322 -0809 Email Address: mark_bridgehouse ©earthlink.net Name of Accountant/CPA (include name of firm if applicable): 'Smart Solutions' % Brenda Smith Phone No.: 808 = 960 =5041 Mailing Address: P.O. Box 1164 Captain Cook, HI 96704 Amount of Request for County Funds: $28,000:00 Prior Year(s) Funding: 07 -08 08-09 09 -10 $15,000 $12,000 $15,000 Agency Mission Statement: NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 The is to assist adults who - are in recovery from drug /alcohol addiction, to develop successful living skills through residential and vocational ezpariences in our safe, structured and aupporlive environment. NONPROFIT APPLICATION FISCAL YEAR 2010 -11 Page 2 BRIDGE MOUSE, Inc. - Agency Name 'Vocational Skills Building Program"- Program Name Program Description: The "Vocational Skills Building Program" (VSB) is our specialized in -house program offering that provides assessment, referrals and linkages, as well as on -site training that will prepare graduating residents for entry /re -entry into the workforce. This is a mandatory component of the Bridge House experience for all residents who are unemployed at any time during their stay. Total Budget and Position Count Total Program Budget 73;340:00 Total Pr=ogram Position Count 1.5 Total Agency Budget 310,038.00 Total Agency Position Count 3 Program 1) The VSB generally includes the following components: 1.) Assessment of vocational history, skills, attitude and behavior 2.) On -site training /vocational assignments (this allows staff to observe resident attitude, integrity, punctuality, reliability, etc) 3.) Weekly review of progress towards employment readiness 4.) Referrals /linkages to community and State vocational training or employment resources 4.) Transportation to and from the various training /employment resource centers -5.) In- house - assistance with beginning the process of securing employment (e.g. completing job applications, resume preparation, mock interviews, use of office computer and equipment) 6.) Transportation to work -site. Program Highlights: (from Year 2008-09) 1) 50% of residents graduating as "clinical discharge /program completion" remain employed at six month follow -up. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page-3 BRIDGE HOUSE, Inc. - Agency "Vocational Skills Building Program" - Program Name Performance Measures: FY 2008 -09 TY 2009 -10 FY 2010 -11 Actual * Budget * Estimate 50% of all admits will complete the 33% 60% 65% . program. 70% of all graduates will be 35% 40% 40% employed, - attending school, or be enrolled in a vocational training - program. *If applicable P10914111 Expenditures FY 2008-09 FY 2009 -10 FY 2010 -11 Actual * Budget* Estimate Salaries and Wages 39,362.00 40,000.00 40,000.00 Professional Fees 3,217.96. 3,200.00 3,200.00 Operations 15,848.88 16,000.00 16,000.00 Equipment 9,446.09 8;400:00 8,400:00 Other` 5,644.13 5,740.00 5,740.00 Total 73,519 :06 73;340.00 73;340 :00 * If applicable ° 'Please explain in detail on separate sheet NONPROFIT -GRANT APPLICATION FISCAL YEAR 2010-11 Page 4 BRIDGE - HOUSE, Inc. - Agency Name "Vocational Skills Building Program" - Program Name Program €trading Sources: identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Hawaii Island United Way 23,250.00 23,083.00 23,083.00 State of Hawaii (ADAD) 13,269.06 14,856.68 10,856.68 Program Fees 8;00000 10;000:00 10;000:00 County 12,000.00 15,000.00 28,000.00 HCF Funds (08 -09) 15,000.00 9,000.00 n/a Contributions 2,000.00 1,400.00 1,400.00 Total 73,519.06 73,340.00 73,340.00 *If applicable Explain what plans, ifany, your agency andfor program Chas to increase revenues to support this program. When do you anticipate your program to become self -sustaining? We continue to and apply for grants that might enrich orsupport this program. Unfortunately, many of the monies available for agricultural development are loans, not grants, and this makes them prohibitive for our needs. In spite of adverse climatic conditions again this year, we were able to recognize a small profit on our lychee sales. On a more positive note, we recently received a commitment from an individual who is offering a donation of up to 100 keiki coffee trees, and we are excited about the opportunity to use them to enhance-our VSB.program,-as well -as eventually contribute revenue. We also continue to solicit donations of support from the West Hawaii community, as well. As in the past, it remains unlikely that this program will become self - supporting until a significant portion of the agricultural area is developed. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010-11 Page 5 Bridge House, inc. P.O. Box 2489 Kailtta -Kona, Hi 96745 Phone: 808 - 322- 3305/Fax: 808 - 322 -0809 bridgekorrsereeovery@gmai! eom Bridge House, lne. "Vocational Skills Building Program" Addendum, Pg 4: "Program Expenditures" "Other" includes: "Payroll Liabilities & Health Insurance Benefits" Bridge House, inc. receives funding from the Department of H aftWADAD, Hawaii Island United Way, Hawaii Community Foundation, Hawaii County and private donations. - BRIDGE 1-IOUSE, Inc. - Agency Name 'Vocational Skills Building Program" - Program Name I -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 pursuant- to law. I (we) understand that information herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor_within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the _grant, a complete accounting of all expenditures supported-by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. failure to submit a timely. complete. and accurate year -end report will impact the evaluation of your program's or agency's future funding //b// Signs ure of :oard President/Chair Date ..te Oi ( Signature of Executive Director Date - UNSIGNED - PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 21 Child & Family Service Alternatives to Violence Child & Family Service - Agency Name Alternatives to Violence - Program Name Agency Director: Howard Garval, President and CEO Phone No. (808) 681 -3500 Contact Person: Heidi Koop, Director of Hawaii Island Programs Phone No.: (808) 935 -8229 Mailing Address: Child & Family Service 91 -1841 Fort Weaver Road Ewa Beach, Hawaii 96706 Facility /Site Address: East Hawaii: 1266 Kamehameha Avenue, Suite A Hilo, HI 96720 West Hawaii: 81 -6587 Mamalahoa Highway Kealakekua, HI 96750 Fax No.: East Hawaii: (808) 935 -5589 West Hawaii: (808) 323 -2999 Email Address: hkoop @cfs- hawaii.org Name of Accountant/CPA (include name of firm if applicable): N & K, CPAs, Inc. Phone No.: (808) 524 -2255 Mailing Address: American Savings Bank Tower, 1001 Bishop Street, Suite 1700, Honolulu, Hawaii 96813 -3696 Amount of Request for County Funds: $35,000.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0.00 $25,000 $30,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 1 Child & Family Service - Agency Name Alternatives to Violence - Program Name Agency Mission Statement: "Strengthening families and fostering the healthy development of children" Since 1899, Child & Family Service (CFS) has dedicated its efforts to its mission of "Strengthening families and fostering the healthy development of children ". The spectrum of CFS programs builds on the strengths of individuals and families to address the many human challenges. The organization's comprehensive array of services has allowed CFS to develop in many areas and to offer an integrated and comprehensive human service and behavioral health care delivery system throughout the State of Hawaii. CFS continues to be known in the community for its willingness to work with hard -to- engage individuals and families facing a multitude of difficult problems during challenging economic times. To ensure the continuation of comprehensive Domestic Violence services on the island of Hawaii despite a 40% reduction of funds, CFS consolidated its operations and strategized optimization of services demonstrating our commitment to support community populations that present with increasingly complex problems and situations. CFS continues to be at the forefront of developing the skills, knowledge, and service models to address these needs. Program Description: Funds are requested to support the operation of the Alternative to Violence (ATV) program in the County of Hawaii, more specifically two part -time Domestic Violence Specialists and operational expenses. Hawaii County funding will support batterers' groups in the county of Hawaii. The ATV program utilizes an evidence based curriculum that incorporates a cultural component. The ATV program provides an array of Domestic Violence Intervention (DVI) services to men, women and youth. The services to victims include legal advocacy to complete and file temporary restraining orders, court advocacy, individualized safety planning, psycho - educational and pattern changing groups, victim support groups and case management. The services to male and female batterers include psycho - educational groups that teach skills of non - violence and accountably for their behavior. The primary service modality for the ATV program is a group format. Best Practices suggest that groups are the most effective method in working with domestic violence issues. The batterers' groups assist the clients in making changes and provide a supportive structure that makes it easier for clients to break through the denial, blame and minimization and to accept accountability. Batterers' groups are staffed with both male and female Group Facilitators. Research suggests that groups for batterers should be staffed by facilitators of both genders in order to role model appropriate male and female interaction, communication and encourage gender equality. The intention is to serve clients NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 2 Child & Family Service - Agency Name Alternatives to Violence - Program Name of all cultural backgrounds with a sensitivity that fosters engagement in the process of becoming violence -free. The ATV program monitors batterers on a routine basis (weekly, monthly, and quarterly) by the program staff for any increase or decrease in their level of risk or identified risk factors. Changes to the client's individual service plan are made incorporating any changes in services that are recommended and then reviewed with the client prior to implementation. All participants are assigned a case manager to monitor their participation and performance during group, maintain contact with probation and other related services, and to provide one to one counseling and referrals as needed. The goal is for clients to understand how violence is used as power in an intimate relationship and causes disrespect and harm that is inconsistent with the values, beliefs and conduct of every culture. This program philosophy and practice also incorporates the understanding of violence against women within a social, economic, and cultural analysis of gender and sexual oppression. Total Budget and Position Count: Total Program Budget 696,568 Total Program Position Count 12 Total Agency Budget 5,523,297 Total Agency Position Count 101 Program Objectives: 1. 60% of Batterers completing intervention services will demonstrate the knowledge, skill and attitudes necessary for maintenance of non - abusive behavior, which includes learning non - violent conflict resolution and non - aggressive communication. 2. 100% of Batterers completing intervention services will significantly increase their knowledge of the effects of domestic violence on children. 3. 80% of Victims participating in Support Services will be able to identify at least 3 personal safety skills. Program Highlights: (from Fiscal Year 2008 -09) ATV clients who have been affected by domestic violence (offenders, victims, child witnesses,) were offered classes that taught them how to overcome the trauma of domestic violence and to live violence free. The objective is to remind the men and women of the value of respect that can be found in every culture. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 3 Child & Famil Service - Asenc Name Alternatives to Violence - Program Name In Fiscal Year '09, the program provided the following: • 130 men graduated from the program after a 28 -week program. • 46 women graduated from the program after a 22 -week program. • 521 classes were held for men. • 88 classes were held for victims of domestic violence. • 126 Pattern Changes classes were held. Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Number of men graduated from 130 165 155 program Number of women graduated from 46 55 57 program Number of (28 weeks) classes for 521 525 527 men Number of 15 -weeks classes for 88 50 98 women Number of 22 -weeks pattern 126 50 138 changing group for women *If applicable Program Expenditures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual Budget * Estimate Salaries and Wages 582,627 484,889 484,889 Professional Fees 5,388 0 0 Operations 343,819 233,582 233,582 Equipment 0 0 0 Other" 0 0 0 Total 931,834 718,471 718,471 • If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 4 Child & Family Service - Agency Name Alternatives to Violence - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Hawaii County 25,000 30,000 35,000 Judiciary 781,356 470,499 470,499 Program Fees 101,729 116,330 116,330 HIUW 12,750 10,000 10,000 Federal VOCA 7,742 69,739 10,000 Private Foundation 15,000 0 0 Total 943,577 696,568 641,829 `If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? CFS was successful securing one -time additional funding for the ATV program to support the victims' support groups. However, due to the 40% funding cuts, the ATV program is currently operating in a deficit. Due to the overall economic challenges, increasing numbers of residents are not able to pay the fees as they were in the past which negatively effected our revenue of the Program Fees. CFS will continue to apply for other fundings and will continue to review national and local funding options. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 5 Child & Family Service - Agency Name Alternatives to Violence - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 - 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit,Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. i �� �� 26 fa n .w�r� 2010 Signature of Board President/Chair Date Robert T. Fujioka 4 cc e t-,), -4-27 r anc,„..-.0_. r 0--‘ 3-- d / 0 Signature of Executive Director Date Howard S. Garval UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 6 22 Child & Family Service Hawaii County - Domestic Abuse Shelters Child & Family Service - Agency Name Hawaii County - Domestic Abuse Shelters - Program Name Agency Director: Howard Garval, President and CEO Phone No.: (808) 681 -3500 Contact Person: Heidemarie Koop, Director of Hawaii Island Programs Phone No.: (808) 323 -2664 Mailing Address: Child & Family Service 91 -1841 Fort Weaver Road Ewa Beach, Hawaii 96706 Facility /Site Address: West Hawaii: 81 -6587 Mamalahoa Highway, Bldg. C Kealakekua, HI 96750 East Hawaii: 1266 Kamehameha Avenue, Suite A Hilo, HI 96720 Fax No.: West Hawaii: (808) 323 -2999 East Hawaii: (808) 961 -2073 Email Address: hkoop @cfs- hawaii.org Name of Accountant/CPA (include name of firm if applicable): N &K CPAs, Inc. Phone No.: (808) 524 -2255 Mailing Address: American Savings Bank Tower, 1001 Bishop Street, Suite 1700, Honolulu, Hawaii 96813 -3696 Amount of Request for County Funds: $35,000.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $2,500 $20,000 $15,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Child & Family Service - Agency Name Hawaii County - Domestic Abuse Shelters - Program Name Agency Mission Statement: "Strengthening families and fostering the healthy development of children" Since 1899, Child & Family Service (CFS) has dedicated its efforts to its mission of "Strengthening families and fostering the healthy development of children ". The spectrum of CFS programs builds on the strengths of individuals and families to address the many human challenges. The organization's comprehensive array of services has allowed CFS to develop in many areas and to offer an integrated and comprehensive human service and behavioral health care delivery system throughout the State of Hawaii. CFS continues to be known in the community for its willingness to work with hard -to- engage individuals and families facing a multitude of difficult problems during challenging times. To ensure the continuation of comprehensive Domestic Violence services on the island of Hawaii despite a 40% reduction of funds, CFS consolidated its operations and strategized optimization of services demonstrating our commitment to support community populations that present with increasingly complex problems and situations. CFS continues to be at the forefront of developing the skills, knowledge, and service models to address these needs. Program Description: Funds are being requested to support the operation of the West Hawaii and East Hawaii Domestic Abuse Shelters (DAS). Hawaii County funding will be used to support staffing, more specifically part -time Shelter Workers, for the Shelters to meet the increasing demands for intensive services. In addition, funding will be used for ongoing supply needs, repairs /maintenance, resident assistance and provision. CFS Domestic Abuse Shelters (DAS) provide emergency shelter to single women /men and women /men with children who are victims of domestic violence for a maximum of 90 days. These victims flee from the geographic areas of Ka'u all the way to Kohala, from the Volcano to Puna, from Puna to Hamakua. Victims from East Hawaii often access the DAS in West Hawaii and vice versa to ensure the highest degree of safety. There are no restrictions to enter the shelter as long as the circumstances of need are identified as a domestic violence issue. These two shelters are the only shelters on the Big Island to serve the immediate needs of the population seeking safety due to domestic violence. The shelter operates 24 hours a day /365 days a year including holidays. Staff members oversee the safety and needs of the residents. CFS has been providing emergency shelter to the Big Island community for 22 years. The West Hawaii Shelter opened in 1988 followed by the East Hawaii Shelter in 1995. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Child & Family Service - Agency Name Hawaii County - Domestic Abuse Shelters - Program Name The main goal of the program is to provide a safe environment. Experienced advocates help families identify their needs and develop a plan to meet these needs. In addition, the Shelters offer our residents emergency food, transportation, referrals as needed, case management, individual counseling, advocacy, outreach services, safety planning, assistance with Temporary Restraining Orders, support groups, and personal planning. The Shelter staff members work with the mothers /fathers and children to build healthy relationships and to strengthen the women's /men's role as effective parents without using physical and /or verbal violence towards their children. CFS is committed to raising the consciousness of our society by educating our families on a violence free lifestyle, promoting family coping and stability, and providing a place of refuge. Each Shelter operates a 24 -hour domestic violence hotline which provides crisis intervention, information, and referral services. During the last 18 months, the hotline utilization by victims of domestic violence has increased due to the added economic stressors in the communities of the Big Island. The hotline worker provides a safety assessment, makes recommendations and provides referral and resource information for the callers. It is expected that the hotline will continue to see an increase of calls due to rising violence in the homes due to poverty and homelessness. The Shelter in West Hawaii provides three bedrooms with a total of 21 beds for families who enter into the program. In addition to the three bedrooms each room has a full bathroom to accommodate the residents who share the bedroom space. One bedroom is specifically geared towards housing single women and women with disabilities. This room is ADA compliant. The facility also has an ADA ramp for easy access in /out of the Shelter. In addition to the resident areas, the shelter also has two offices, a playground and a children's room. These offices are used for intake and exit interviews to provide resident confidentiality, case management, and individual counseling. The Shelter also provides our residents with a laundry facility, kitchen, and a large living and dining room area. On the Shelter site a large Matson container holds furniture items, clothing and household miscellaneous items. These items are donated throughout the year from the West Hawaii community members who support our Shelter. The East Hawaii Hale `Ghana Domestic Abuse Shelter is located in a two -story home on approximately three acres in an agricultural /residential area of East Hawaii and is set off from the roadway. It has three bathrooms, four bedrooms and has a 20- person capacity. The downstairs of the Shelter facility has a laundry room that is accessed through the covered double car garage entrance. A comfortable -sized living room with an adjoining bathroom is accessible via the laundry room and a short walkway connects into the kitchen area. There is an adjoining dining room and pantry which is also accessible via an entrance off the side of the kitchen that exits into the side yard of the property. The Shelter NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Child & Family Service - Agency Name Hawaii County - Domestic Abuse Shelters - Program Name facility is ADA compliant by having an ADA ramp which leads to the lower floor where an ADA bedroom is located. Total Budget and Position Count: Total Program Budget 667,017 Total Program Position 14.75 Count Total Agency Budget 5,523,297 Total Agency Position Count 101 Program Objectives: The CFS Domestic Abuse Shelter's objectives are: 1. 75% of residents will demonstrate an increase in knowledge of community resources. 2. 90% of residents in the Shelter will complete a Safety Plan for themselves and their children. 3. 60% of single adults and families will move from the shelter to a non - abusive home environment. Program Highlights: During Fiscal Year 2008 -2009, the West Hawaii Domestic Abuse Shelter (WHDAS) served 90 people; 55 adults and 35 children. The WHDAS provided 3,088 bed days. The WHDAS received 100 hotline calls that involved a crisis due to domestic violence. The WHDAS provided 1,797 requests for information and referral. During Fiscal Year 2008 -2009, East Hawaii Domestic Abuse Shelter (Hale 'Ghana) served 183 people; 84 adults and 99 children. Hale 'Ohana provided 3,816 bed days. Hale 'Ohana received 776 hotline calls that involved a crisis due to domestic violence. Hale 'Ghana provided 374 requests for information and referral. Historically, an increase of domestic violence occurs during economically stressful times between domestic partners. CFS is committed to ensure that families are protected. Both Domestic Abuse Shelters achieved 100% of their outcomes during Fiscal Year 2008 -2009. These include: assisting the residents with personalized safety planning, increasing awareness on the effects of children who witness domestic violence, increasing awareness of community resources, and educating the residents on healthy relationships. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Child & Family Service - Agency Name Hawaii County - Domestic Abuse Shelters - Program Name Performance Measures in West Hawaii: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate ** # of Bed Days 3,088 5,200 5,200 # of Hotline Calls 100 180 200 # of Single Women 40 50 50 # of Women w /children 15 40 40 # of Children Served 35 60 60 # of requests for information and 1,797 2,000 2,000 referral only # of group session 230 260 260 # of individual session hours 1,087 500 500 provided # of meals provided 9,121 10,300 10,300 # of trips (transportation) provided 103 120 120 *If applicable ** Estimates are based on historical data. Performance Measures in East Hawaii: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate ** # of Bed Days 3,816 4,800 4,800 # of Hotline Calls 776 800 800 # of Single Women 43 50 50 # of Women w /children 41 45 45 # of Children Served 99 110 110 # of requests for information and 374 400 400 referral only # of group session 349 350 350 # of individual session hours 3,317 1,500 1,500 provided # of meals provided 10,232 12,000 12,000 # of trips (transportation) provided 514 550 550 *If applicable ** Estimates are based on historical data. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Child & Family Service - Agency Name Hawaii County - Domestic Abuse Shelters - Program Name East and West Domestic Abuse Shelter Program Expenditures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 584,468 473,014 482,474 Professional Fees 0 0 0 Operations 298,863 261,798 267,034 Equipment 0 0 0 Other 0 0 0 Total 883,331 734,812 749,508 * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Department of Human Services 769,247 497,603 497,603 Program Fees 7,255 2,832 2,916 Hawaii Island United Way 19,875 17,228 17,200 HPHA Emergency Shelter Grant 23,068 28,000 28,000 Prosecutor's VOCA 31,880 30,827 30,000 Hawaii County 18,579 15,000 35,000 Private Foundation 9,955 75,527 10,000 Total 879,859 667,017 620,719 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? CFS strives to achieve sustainability for all of its programs. Yet, CFS is also committed to supporting critical services in the community despite their budgetary limitations. As the Department of Human Services cut funds by 40 %, CFS had to discontinue the Mother /Child Specialist component. CFS continues actively writing grants for supplemental funding to keep its critical programs operating. CFS relies on other funding sources to fund its Domestic Abuse Shelters, such as Hawaii Island United Way (HIUW), Emergency Shelter Grant (ESG) and Victims of Crime Act from the Prosecutor's Office. In addition, the shelter also charges a modest fee for shelter to those residents with an ability to pay. Due to the overall economic challenges, increasing numbers of residents NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Child & Family Service - Agency Name Hawaii County - Domestic Abuse Shelters - Program Name are not able to pay the fees as they were in the past which negatively effected our revenue of the Program Fees. CFS also received funding from Community Development Block Grant for much needed repairs and improvement projects in West and East Hawaii. It is expected that funding will not be significantly increased for the next Fiscal Year 2010 -2011. CFS advocates will seek other sources of funding to continue the high quality of services in the community of West Hawaii and East Hawaii. We are asking for additional funding from Hawaii County to help offset some of the cutbacks. CFS is committed to providing these services to our communities and will continue to advocate for no reductions in funding as well as to pursue other funding sources. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 Child & Family Service - Agency Name Hawaii County - Domestic Abuse Shelters - 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. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. t/vitdr/� .20 /O Signature of Board President/Chair Date �`// Robert T. Fujioka ( Sig ature of Executive Director Date Howard S. Garval UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 23 Child & Family Service Hilo Transitional Housing Program Child & Family Service - Agency Name Hilo Transitional Housing Program - Program Name Agency Director: Howard Garval, President and CEO Phone No.: (808) 681 -3500 Contact Person: Heidemarie Koop, Director of Hawaii Island Programs Phone No.: (808) 935 -8229 Mailing Address: Child & Family Service 91 -1841 Fort Weaver R7oad Ewa Beach, Hawaii 96706 Facility /Site Address: 1266 Kamehameha, Suite A Hilo, HI 96720 Fax No.: (808) 935 -5589 Email Address: hkoop @cfs- hawaii.org Name of Accountant/CPA (include name of firm if applicable): N &K, CPAs, Inc. Phone No.: (808) 524 -2255 Mailing Address: American Savings Bank Tower, 1001 Bishop Street, Suite 1700, Honolulu, Hawaii 96813 -3696 Amount of Request for County Funds: $40,000.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $25,000 $15,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Child & Family Service - Agency Name Hilo Transitional Housing Program - Program Name Agency Mission Statement: "Strengthening families and fostering the healthy development of children" Since 1899, Child & Family Service (CFS) has dedicated its efforts to its mission of "Strengthening families and fostering the healthy development of children ". The spectrum of CFS programs builds on the strengths of individuals and families to address the many human challenges. The organization's comprehensive array of services has allowed CFSto develop in many areas and to offer an integrated and comprehensive human service and behavioral health care delivery system throughout the State of Hawaii. CFS continues to be known in the community for its willingness to work with hard -to- engage individuals and families facing a multitude of difficult problems during challenging times. To ensure the continuation of comprehensive Domestic Violence services on the island of Hawaii despite a 40% reduction of funds, CFS consolidated its operations and strategized optimization of services demonstrating our commitment to support community populations that present with increasingly complex problems and situations. CFS continues to be at the forefront of developing the skills, knowledge, and service models to address these needs. Program Description: Funds are requested to support the operation of the East Hawaii Transitional Housing program. Hawaii County funding will be used to support the position of a part -time Domestic Violence Specialist and a part -time Mother /Child Specialist operating out of the Hilo office. Victims of Domestic Violence face many challenges when making the courageous decision to finally leave their batterers. As women and men are provided services in our Domestic Abuse programs, when it comes to economic issues, it is mostly women who are confronted with financial challenges. When leaving the batterer, the victim embarks upon a path that is as fearful for her and her children as it is to stay with an abusive partner. Many of these women leave with just the clothes that they are wearing, seeking shelter, safety and most of all assurances that they made the right choice. Many lack the skills, tools and resources needed to sustain themselves and their children away from their batterer. In addition, many women are faced with the reality of no financial resources, and inability to access resources due to marital assets retained by the perpetrator which disqualifies her from qualifying for public assistance or possibly subsidized housing. Many women turn to the Hilo or Kona Domestic Abuse Shelters where they can recover and start planning a new life. The Domestic Abuse Shelters provide safety, basic needs, counseling and support up to 90 days. Securing a safe home for themselves and their children is one of the serious challenges that the victims are facing in the county of Hawai'i due to an expensive rental market. At the end of the 90 days in a Domestic Abuse Shelter, NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Child & Family Service - Agency Name Hilo Transitional Housing Program - Program Name the victim must make a decision not only for herself but for her children as well. Unfortunately that decision is often to return to the batterer she sought refuge from or to become homeless. The Hilo Transitional Housing is a 24 month program designed to assist victims of domestic violence and their children to rebuild their lives. The program goal is to assist victims and their children in gaining stability and independence while transitioning into a violence -free lifestyle. Victims who qualify for services transition from the Domestic Abuse Shelters located in West and East Hawaii and can be placed in one of six apartments /houses. During their 24 month stay, victims and their families receive intensive support services with the goal to guide the victims and their families towards independence, to move to a regular home in the community, to secure income and to be able to care for the children. By providing weekly home visits, case management, individual family service plans, and information and referrals to community resources the program allows both the victims and their children the time to heal, and to live safely. The Program is in need of a full -time Domestic Violence Specialist to provide case management, counseling, and support to the women. Without the Hawaii County funding, only a part-time Domestic Violence Specialist can be supported. Due to the high need of the residents and intensive case management, a full -time Domestic Violence Specialist is able to offer the necessary services. The Domestic Violence Specialist gives the victims weekly opportunities to learn or enhance their life skills, including budgeting, money management and job training. In doing so, the Domestic Violence Specialist addresses many of the barriers to establishing income, housing and independence. The Hawaii County funding would also cover a portion of the Mother /Child Specialist's time. The role of the Mother /Child Specialist is to provide trauma assessments for the family. The family is also provided with services to support and improve the mother /child relationships. The mothers learn practical parenting skills and receive child development education to help provide a safe home for their children. In addition, the Mother /Child Specialist provides therapeutic interventions to the children that help the child to overcome the traumatic effects of domestic violence. NONPROFIT GRANT APPLICATION • FISCAL YEAR 2010 -11 Page 3 Child & Family Service - Agency Name Hilo Transitional Housing Program - Program Name Total Budget and Position Count: Total Program Budget 186,857 Total Program Position Count 1.75 Total Agency Budget 5,523,297 Total Agency Position Count 101 Program Objectives: 1. 70% of the residents will reduce their level of stress as measured quarterly. 2. 70% of the residents will increase self- sufficiency as measured quarterly. 3. 90% of the residents will complete /have a Safety Plan for themselves and their children as measured quarterly. 4. 80 % of the residents will secure independent housing after 24 months of safe transitional housing. Program Highlights: 1. The program is fulfilling a high need for providing housing for victims of domestic abuse and their families. 2. Provided 11 families with transitional housing from July 2006 to June 2007. 3. Provided 12 families with transitional housing from July 2007 to June 2008. 4. Provided 12 families with transitional housing from July 2008 to June 2009. (due to extending the time for victims to stay in the program from 12 months to 24 months, we did not serve as many as originally projected) 5. The staff has developed a strong program that focuses on reintegrating victims of domestic abuse into the community and gaining their independence and self- sufficiency. 6. All six units are occupied and there is a waiting list. 7. Six families have successfully transitioned into permanent housing between July 2008 and June 2009. 8. Five participants have obtained employment enabling three participants to get off welfare. 9. Three participants are currently enrolled at the University of Hawaii, one is seeking a Certified Substance Abuse Counselor (CSAC) certificate, one is taking political science and the third is enrolled in the culinary arts program. 10.Of the twenty -two participants who have transitioned out of program since its beginning in 2006, eighteen participants have made the decision not to re- involve themselves with their perpetrators and have established a violent free home for themselves and their children. 11.The program has established collaboration with the Forward March job training program, which increases their job readiness skills and ability to obtain employment. 12. Program objectives have been met or exceeded: a) 100 % of residents have reduced stress levels. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Child & Family Service - Agency Name Hilo Transitional Housing Program - Program Name b) 100% of residents have increased self sufficiency, through increased knowledge in budgeting and obtaining employment, and regained confidence in doing things for themselves. c) 100% of all residents have a completed Safety Plan within 30 days of entering program. d) 60 % of residents secured permanent housing within 12 to 18 months of entering program. This percentage is lower due to the lack of funding available with county housing funds, such as section 8 vouchers. Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate # of families provided housing 11 12 14 # of service plans developed 11 12 14 # provided case management 11 12 14 # of safety plans developed 11 12 14 # provided aftercare services 6 6 6 # w /secured income 11 12 14 # enrolled in education program 3 4 6 # w /secure employment 5 6 6 # obtained permanent housing 6 6 6 *If applicable Program Expenditures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 63,545 53,287 63,545 Professional Fees 7,252 0 0 Operations 124,606 134,156 136,839 Equipment 0 0 0 Other 0 0 0 Total 195,403 187,443 200,384 * If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Child & Family Service - Agency Name Hilo Transitional Housing Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate US Department of Justice 156,861 163,548 152,284 County of Hawaii 25,000 15,000 40,000 Program Fees 8,506 8,309 8,100 Total 190,367 186,857 200,384 Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Transitional Housing program has been primarily supported by the Department of Justice, Office on Violence Against Women (OVW). The program also collects fees from the residents. Additional funding options that primarily focus on providing Transitional Housing services will be identified. CFS will seek support from the Hawaii Community Development Corporation of Hawaii (HCDCH) homeless stipend program and the Emergency Shelter Grant Program (ESG). NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 11 Page 6 Child & Family Service - Agency Name Hilo Transitional Housing Program - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 26 Srua�/ .ZO /0 Signature of Board President /Chair Date c� Robert T. Fujioka z �� � al‘ 3-0/0 ignature of Executive Director Date / Howard S. Garval UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 24 Child & Family Service Therapeutic Foster Home Program Child & Family Service - Agency Name Therapeutic Foster Home Program - Program Name Agency Director: Howard Garval, President and CEO Phone No.: (808) 681 -3500 Contact Person: Heidemarie Koop Phone No.: (808) 323 -2664 Mailing Address: Child & Family Service 91 -1841 Fort Weaver Road Ewa Beach, Hawaii 96706 Facility /Site Address: West Hawaii: 81 -6587 Mamalahoa Highway Kealakekua, HI 96750 East Hawaii: 1266 Kamehameha Avenue, Suite A Hilo, HI 96720 Fax No.: West Hawaii: (808) 323 -2999 East Hawaii : (808) 935 -8229 Email Address: hgarval @cfs- hawaii.orq hkoop@cfs-hawaii.org Name of Accountant/CPA (include name of firm if applicable): N & K, CPA's, Inc. Phone No.: (808) 524 -2255 Mailing Address: American Savings Bank Tower 1001 Bishop Street, Suite 1700 Honolulu, Hawaii 96813 -3696 Amount of Request for County Funds: $35,000.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $20,000 $20,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Child & Family Service - Agency Name Therapeutic Foster Home Program - Program Name Agency Mission Statement: "Strengthening families and fostering the healthy development of children" Since 1899, CFS has dedicated its efforts to its mission of "Strengthening families and fostering the healthy development of children ". The spectrum of CFS programs builds on the strengths of individuals and families to address the many human challenges. The organization's comprehensive array of services has allowed CFS to develop in many areas and to offer an integrated and comprehensive human service and behavioral health care delivery system throughout the State of Hawaii. CFS continues to be known in the community for its willingness to work with hard -to- engage individuals and families facing a multitude of difficult problems. CFS continues to be committed to support community populations that present with increasingly complex problems and situations. CFS continues to be at the forefront of developing the skills, knowledge, and service models to address these needs. Program Description: Funds are being requested to support the Therapeutic Foster Home program in its work with children who present with severe behavioral challenges such as self- injuries, property damage, physical assaults, truancy, substance abuse and stealing. These children are in high need of professional and skilled Support Coordinators and highly trained Therapeutic Foster Parents who are able to give them one -on -one attention. CFS is requesting funding for a half -time Support Coordinator and monies to continue supporting therapeutic activities in the homes and the community. The CFS Therapeutic Foster Home (TFH) program provides foster placement and clinical services for youth who have been identified as needing out -of -home placement. Additional resources are provided to accommodate their emotional, behavioral, and mental health issues. The TFH program offers a system of support, counseling and skill building services to youth as well as training and support to the caregivers and foster parents. The TFH program provides services countywide on the island of Hawaii. During the time in the program, the goal is to teach the child and their family how to build trusting relationships that support the child in achieving his or her highest potential. The behavioral health and residential programs at CFS continue to see an increase in the number of youth who are in need of line of sight supervision and therapeutic activities throughout the day including weekends. Often, these children are neurologically challenged due to exposure to substances in utero and /or to child abuse and neglect. Most of these children have experienced multiple unsuccessful placements and /or the members of the `ohana are unable NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Child & Family Service - Agency Name Therapeutic Foster Home Program - Program Name to support that child in their homes due to the severity of the behavior and /or other family and work commitments. Many of these children are so desperate that their behaviors place them in acute units of hospitals. In recent years, study after study has demonstrated the malevolent effects of substance abuse on women and their children. Deterioration in the physical, mental, and emotional health of the substance - abusing mother and her child has been well documented, with particular emphasis on the potentially devastating effects on the fetus of prenatal maternal drug abuse. In the 1996 Blind Study of Substance Abuse and Need for Treatment Among Women of Childbearing Age in Hawaii, women reported using alcohol, tobacco, marijuana, cocaine /crack, and methamphetamine in the greatest numbers. It is well documented that since the 1990s, there has been a dramatic increase in the use of methamphetamine ( "ice "). It is anticipated that over time, the number of youth referred for behavioral health services, including therapeutic foster homes, will increase as Hawaii's "ice babies" grow up. Youth with neurological impairment exhibit combined cognitive, physical and emotional difficulties. They may have learning impairments, behavioral deficits, increased motor activity, and enhanced conditioned avoidance responses. Parents and foster parents become frustrated and cannot cope, resulting in many placements for these youth. Multiple placements often times reinforce problem behaviors and erode the self esteem of these youth. It is cost - beneficial to learn more about this population, provide interventions as early as possible, and prevent further problems from developing. The current staffing in East and West Hawaii consists of a Director of Hawaii Island Programs and a Program Director who provides programmatic oversight of the Therapeutic Foster Home respectively in Kona and Hilo. A Master's level Mental Health Specialist provides intensive clinical and case management services for the child, the Therapeutic Foster Parents and biological family members. The Support Coordinators provide daily practical support to the Therapeutic Foster Parents in regards to transportation and appointments. Other duties include the licensing of foster homes and preparing new intakes. CFS has been developing a program component that focuses on the needs of children who have neurological impairment over the past year. When these children are placed into our Therapeutic Foster Home program, there is a high need for providing one -on -one staffing to allow the child to adjust to his /her new therapeutic foster home. They are also often adjusting to a new school environment and making connections with other children in the community. CFS staff have received extensive training that focuses on working with children between the ages 5 and 18 years old with these difficulties. To further support this project, experienced Support Coordinators are needed to provide intensive NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Child & Family Service - Agency Name Therapeutic Foster Home Program - Program Name services at the beginning of the placement, during crisis situations and transition to a permanent placement. The Support Coordinator would be working under the direct supervision of a Program Director with guidance by the Master's level clinician. The Support Coordinator would provide groups to teach life skills that allow the children to manage their neurological challenges in a healthy way. Total Budget and Position Count: Total Program Budget 292,614 Total Program Position 3.25 Count Total Agency Budget 5,523,297 Total Agency Position Count 101 Program Objectives: The intermediate goal of the Therapeutic Foster Home Program is to provide a safe stable living environment to youth who experience emotional and /or behavioral problems. This stable environment is needed while the children engage in therapy to address their individualized mental health and behavioral issues. The long -term goal of the program is to provide the support and skill building necessary to empower youth to engage in socially appropriate and manageable behaviors, thereby facilitating the reunification Of appropriate) of children with their biological families or at the very least to be able to move to a less restrictive environment. Measurable objectives for the Therapeutic Foster Home program include: 1. 90% of youth show progress in the development of interpersonal relationships and life skills, as measured by their participation in extra curricular, community or otherwise pro - social activities as measured quarterly. 2. 90% of youth learn how to be a positive and productive member of a family as measured by their ability to follow daily scheduling and complete household duties as measured quarterly. 3. 100% of youth work towards their identified permanency plan goals as measured quarterly. Program Highlights: The TFH Program has focused intently on developing the program's ability to provide innovative and valuable therapeutic intervention to the youth in the County of Hawaii. During the last two fiscal years, we were able to provide intensive services to clients who were unsuccessful in other environments. As youth enter the program, the Support Coordinator provides one -on -one services NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Child & Family Service - Agency Name Therapeutic Foster Home Program - Program Name that focus on supporting the client while adjusting to the new environment and getting comfortable in their new community. The Support Coordinator collaborates with the school to make it a success for the child. The Support Coordinator also develops a schedule with the child that includes activities that foster the child's talents and strengths. CFS continues to be a pioneer in offering services that are trauma informed and that cater to the unique needs of these special children. This approach has helped to prevent referrals of children to acute services in Honolulu. Therapeutic Foster Home — County of Hawaii Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate # of clients served 17 14 18 # of bed days utilized 2,603 3,832 4,000 # of licensed foster homes 19 18 20 # of individual therapy, therapeutic 371 875 900 activities and /or skill building sessions # family therapy sessions 297 350 350 # of discharges to a lateral or lower 5 7 6 level of care *If applicable Program Expenditures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 151,895 142,808 147,092 Professional Fees 0 0 0 Operations 206,992 176,511 181,806 Equipment 0 0 0 Other" 0 0 0 Total 358,887 319,319 328,898 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Child & Family Service - Agency Name Therapeutic Foster Home Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Department of Health (Child and 290,111 277,614 285,942 Adolescent Mental Health) County of Hawaii 20,000 15,000 35,000 Total 310,111 292,614 320,942 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? CFS strives to achieve sustainability for all its programs. Yet, CFS is also committed to providing critical services in the community and pursuing new treatment modalities despite budgetary limitations. CFS is active in writing grants for supplemental funding to keep its critical programs operating. CFS continues to apply to other funders to ensure continued training by mental health experts to further the project of working with children who are experiencing neurological challenges. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Child & Family Service - Agency Name Therapeutic Foster Home Program - 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, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 20 hraly ,20/0 Signature of Board President/Chair Date Robert T. Fujioka / 1* • i 3 `ignature of Executive Director Date Howard S. Garval UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 25 Dragons Eye Learning Center Ama Canoe Building Dragons Eye Learning Center- Agency Name Ama Canoe Building- Program Name Agency Director: Geoffrey S. Kern Phone No.: 8089659371 Contact Person: Clive Cheetham Phone No.: 8085574604 Mailing Address: RR2 # 3307, Pahoa HI 96778 Facility /Site Address: 14-473 Railroad Ave. Pahoa HI 96778 Fax No.: 808 - 965 -9371 Email Address: info @dragonseyecenter.org Name of Accountant/CPA (include name of firm if applicable): Phone No.: Mailing Address: Amount of Request for County Funds: $25,600.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $ $0 $0 Agency Mission Statement: To provide educational experiences of cooperative and sustainable living systems NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Dragons Eye Learning Center - Agency Name Ama Canoe Building- Program Name Program Description: To build a dugout outrigger canoe for Kua 0 Ka La public charter school using three skilled instructors, donated canoe hull rough out and students of the school. Total Budget and Position Count Total Program Budget 25,600.00 Total Program Position Count 4 Total Agency Budget 36,695.00 Total Agency Position Count 6 Program Objectives: 1) To build one (1) dugout outrigger canoe for Kua 0 Ka La public charter school (one year duration) Program Highlights: (from Fiscal Year 2008 -09) 1) Roughed out a total of eitght (8) Albizzia logs into conoe hulls and transported them from forest to the conoe workshop for safe storage and further fabrication. 2) A twenty -six foot (26') hull has been fabricated as is approximately 85% complete 3) Three instructors have achieved advanced knowledge and skill using the tools and techneques necessary to the task of conoe construction and finishing 4) The program director is working with the instructors to complete development of an informal curriculum designed to be used as a training tool NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Dragons Eye Learning Center - Agency Name Ama Canoe Building - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Outrigger Canoe Production 25,600.00 25,600.00 Roughed out canoe hulls ready 0 0 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages Professional Fees Operations 10,600.00 10,600.00 Equipment 600.00 600.00 Other" 14,400.00 14,400.00 Total 25,600.00 25,600.00 * If applicable u Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Dragons Eye Learning Center - Agency Name Ama Canoe Building - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Hawaii County Human Services 25,600.00 25,600.00 Volunteer workers (in kind) 24,000.00 10,800.00 10,800.00 Canoe Hull Donated (in kind) 3,000.00 Shop use donated (in kind) 2,160.00 2,160.00 Total 38,560.00 25,600.00 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? 1) Annual and semi - annual fund raising functions are in the planning stages to held in support of the ongoing canoe production and to promote the use of canoes for transportation and commerce 2) As the reality of ocean -going canoes is established and they are being used for travel between Puna and other parts of Hawaii Island, the program will become self sustaining 3) The highest priority of this program is to create these canoes that are designed to handle ocean conditions in Puna so that people of Puna (Adults and youths) are not required to drive to Hilo to use canoes NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 - Agency Name �rt#� C,41/4)G `Polt,A/}4(F Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of 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 ear -end report will impact the evaluation of your program's or agency's uture funding requests. ft7io Signatu of rd President/Chair Date Signature Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 26 Family Support Services of West Hawaii Ka'u Family Center Family Support Services of West Hawaii Ka'u Family Center Agency Director: JoAnn Bishop Freed Phone No.: (808) 334 -4114 Contact Person: Joe Fichter Phone No.: (808) 334 -4154 Mailing Address: 75 -127 Lunapule Road, Suite 11 Kailua -Kona, HI 96740 Facility/Site Address: Na'alehu, HI Fax No.: (808) 326 -4063 Email Address: jfreed @fsswh.org Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPAs & Management Group Phone No.: (808) 242 -5002 Mailing Address: 1885 Main Street, Suite 408 Wailuku, HI 96793 Amount of Request for County Funds: $ 60,000.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $45,000 $40,000 $40,000 Agency Mission Statement: Family Support Services of West Hawaii was founded in 1979 as a grassroots organization providing family support in communities throughout West Hawaii. FSSWH incorporated in 1981 as a private, non - profit organization whose mission is "to Support Families and Communities in Providing Love and Care for our Children." This mission statement was chosen carefully as the agency wanted to be sure to target support for both families and the communities in which they lived. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 1 Family Support Services of West Hawaii Ka'u Family Center Program Description: A little over twenty five years ago, a distraught young mother wrapped her infant son in a blanket and le$ him to die the K a lava fields -- abandoned and alone. She felt she had no choice. Twenty five years later, another distraught young mother brought her infant son to Family Support Services of West Hawaii's (FSSWH's) Ka'u Family Center and asked the staff there for help. She was suffering from severe post -partum depression, and she also felt she had no choice but to give up her baby. The staff housed in the Ka'u Family Center took immediate action, helping to arrange temporary foster care for the infant, medical and psychological help for the mother, counseling for the extended family in order to provide a circle of security and after a few months, reunification of mother and infant with on -going home visiting support. Today, thanks to the County of Hawaii's support of the Ka'u Family Center, the second story has a happy ending and both mother and child are together and doing well. The Ka'u Family Center offers parents what informal neighborhood networks once supplied: help in raising healthy, happy children. Family support programs offer a whole new philosophy of community service —one that builds on strengths, focuses on the entire family within its culture and community, and one that gives the family the central role in the planning, design and delivery of carefully planned and implemented services. Family supports are designed to empower parents, build communities and help prevent such problems as child abuse and neglect, low birthweight, teen pregnancy and dropping out of school. Since Hawaii (F t has b.._,. a leader in the nee ITS inception, Family Services of West a lu �Vii ��:.>.> �r � uua been u n.ui.c u � u w field of family support services in the state of Hawaii. The agency opened its first Family Resource Center in Kona in 1990 and has since become a founding member of the state -wide Family Centel Alliance. Due in the state o our economy and the lack UI set vices in the soutlletii regions of Hawaii Island, FSSWH has chosen to focus on programming in the Ka'u District with this request for continuation of the Ka'u Family Center and the eventual creation of a Family Center in Ocean View as well. Living in a remote, rural area of the island of Hawaii, families in Ka'tt face challenges in accessing child care, health care, employment, housing, substance abuse, financial assistance, counseling and educational resources. FSSWH Family Centers are warm, welcoming places where any family member can go, not only in times of need, but as a regular part of day:- to_tdav life The Kali Family Center offers emergency food and clothing, access to housing and financial assistance applications, parent education, child development activities, parent -to- parent anu.. c! .- 1„ rri lit;l ti ona ! sun f' our of cchnnt ' cc? ter literacy in str uc ti on health i !na ti o n referrals and a facility that supports rnaii) other rruuran s, activities and services. These services are moditied and added to, depending on the needs and to children and families each yea: :COVV, 111010 111,111 CVtt. i1F t1 V121 ::6 t: ,LI t VU111} tV l ■lit URIC WC L4'4 supporting tamilies in the Ka'u District. Our purpose is to give parents the opportunity to reach out to needed community resources, to help one another and to learn together The Family NONPROFIT GRANT APPLICATION SIT :)";,:3 t: Paize Centers help families prevent crises, define problems, identify strengths and become responsible for determining their own solutions. The Family Center is the only place in the district of Ka'u that all parents can go to get the help and support they need in a familiar setting. The FSSWH Family Center Coordinator not only responds to family needs, but also proactively creates and cultivates social networks. For example, the Ka'u Family Center has partnered with the Hawaii County Department of Parks and Recreation, the Department of Health's Early Intervention Services and Good Beginnings Alliance by providing play and learn groups and parent support - - group oppoftunities for young including those with disabilities; and tfieii families. Approximately 10% of the populations served are other Pacific Islanders: Marshallese or Micronesians. The Family Center Coordinator facilitated efforts by the Ka'u Community Partnership (Advisory Council) to complete a successful food drive where food and $1,000. cash donation was raised by the community for distribution within the community, Community residents were either beneficiaries or responded to the need for emergency food. Thus input and guidance from the community tells us that emergency food distribution by Family Centers is responsive to the needs of the community and should be developed more fully. The Family Center is one of the few places in the district of Ka'u that works with referrals from Hawaii Intake Services to help individuals meet 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. Compared with the rest of the State, Hawaii County served an increasingly greater percentage of individuals and families who lived in unsheltered conditions, including the park, in cars or at the beach (Homeless Service Utilization Report, 2008). The centers allow other non - profit organizations and community groups to use the facilities, providing office and meeting space. The Malama Prenatal, Early Head Start, and Ka'u Child Development (Early Intervention Services), have staff housed in the center and thus families are able to access these services without having to travel long distances. The Ka'u Family Center has facilitated community -wide inter - organizational partnerships and has been intimately involved in community -based anti -drug efforts and initiatives. The Ka'u Community Partnership meetings provide a linkage between programs and community and involve Boys and Girls Club, Queen Lili'uokalani Children's Center, Department of Human Services, Public Health Nursing, Friends of Kahuku Park, private business people and other community members. The goal of the facilitator is to engage community residents and human service programs and create connections so that they have better communication and ultimately be more effective in addressing the needs of the coommunity. One of the hallmarks of family support is its tbcus on the ecological perspective — looking at the child within the context oC the family within the context of the community. Programs provide l..l Lente._a de', ental __ti\'1ttr5 and l.'.tiLing o poi tunifies ..l pd, tins whit r simultaneously contributing to larger community-building efforts. Funding for the Ka'u and Ocean View Family Centers allows FSSWH and the County of Hawaii to impact outcomes at each of these ICYeis. chi Id parent, Jinni!) a nd co Total Budget and Position Count Total Program Budget 1 $ 60,000.00 i Total Program Position Count ! 1 FTE Total Agency Budget $ 3 Total Agency Position Count I 80 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page Program Objectives: 1) Mobilize public and private community resources to help children and families in need. 2) Assist families in achieving economic independence and self - sufficiency. 3) Decrease social isolation in rural communities 4)- Enhance children's development and ability to attain academic and social success. 5) Promote successful transitions throughout a family's major milestones. Program Highlights: 1) Information and referral services were provided to 228 new and 943 returning individuals during the 2008 -2009 fiscal year. There were a total of 1,328 requests for assistance with items such as emergency food, clothing, shoes and household items —all of which have been provided through donations from community members. 2) Provided technological support for those without access to 535 individuals in Ka'u alone over the year for job search, resume preparation and service coordination and communication. 3) Other community helping organizations were able to utilize the Ka'u Family Center to provide 414 hours of outside service to the community. These included: Hawaii Intake Services, VIP Men's Group, Bay Clinic's Reach Out and Read Literacy Program, Na'alehu Main Street, the Ka'u Partnership and the Ka'u Community Action Team. 4) The Family Center housed programs designed to support families at many different stages of development, such as Healthy Start Home Visiting, Enhanced Healthy Start, Malama Perinatal Program, the Ka'u Child Development Program for infants and toddlers with disabilities and their families, and the Youth Development Program. 5) There were several community -wide family events in which over 2 385 people participated, including an `Ghana Health and Fun Day (substance abuse prevention) event and a partnership with local businesses in Ka'u providing Christmas dinner and a gift for each community keiki. 6) Early Intervention services are now being provided to 10 Ka'u infants and toddlers with disabilities and their families. These services include physical, occupational, speech and developmental therapies. Due to the elimination by the Department of Health of our Healthy Start Program, FSSWH and the community have come to rely more and more on the Ka'u Family Center staff person to assist families. Because of the severe budget restraints, we have cut the Family Center coordinator position to half -time. The intent of this proposal is to keep the Family Center open and available all day long. We also fully intend to expand our volunteer program called "The Rainbow Connection," and use community volunteers to help the Family Center Coordinator to follow up with families in need of resources. This will take more time, thus we are requesting that funding be restored to the Family Center in order for the Coordinator to keep the Center open all day. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 4 The Family Center provides a comprehensive array of family support programs, services and activities. • Health and developmental screenings for infants and toddlers • After school tutorial programs • Medical Home support • Access to GED programs • Evaluations for dev. delays • Reading Is FUNdamental early literacy program hea!lh care Ct'UJren':i issues • Access to prenatal care • Play and Learn groups • Access to general medical care • Health, medical, & nutritional • Info on diet, nutrition and health services through Early Head Start Drug aiva ene s s and e:ounselinc and Malama Perinatal programs • Information • Therapeutic services for infants and toddlers with disabilities • Resource and referral services • Child safety in and out of the home • Access to mental health services fi ". SF IVirms • Support groups • Employment opportunities and job- i; ues — ; seeking support • Parenting education • Information and referral to other • Financial counseling, planning, government and community and management resources • Housing • Emergency Food, clothing. Diapers and household items • Ka'u Partnership (Advisory Council) NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 5 Family Support Services of West Hawaii Ka'u Family Center Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget* Estimate Education 5 25 75 Employment 20 25 75 Financial 25 25 25 Health 25 25 25 Parenting Information 30 25 75 Office Equip /Computer Use 150 150 150 Food 65 60 75 Substance Abuse Support/Info 75 40 50 Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual Budget Estimate Salaries and Wages $ 41,904.00 $ 22,945.00 $ 41,000.00 Professional Fees $ 336.00 $ 337.00 $ 350.00 Operations $ 204.00 $ 150.00 $ 150.00 Equipment $ 1,200.00 $ 862.00 $ 800.00 Other" $ 28,680.00 $ 19,200.00 $ 20,495.00 Total $ 72,324.00 $ 43,494.00 $ 62,795.00 * See Below Other Program Expenditures, con't FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Employee Benefits $ 6,000.00 $ 7,810.00 $ 5,871.00 Payroll Taxes $ 5,184.00 $ 3,162.00 $ 3,874.00 Occupancy $ 13,728.00 $ 6,294.00 $ 10,500.00 Supplies $ 3,300.00 $ 1,500.00 $ 1,500.00 Travel— mileage $ 156.00 $ 150.00 $ 150.00 Insurance $ 312.00 $ 284.00 $ 250.00 Total Other $ 28,680.00 $ 19,200.00 $ 20, 645.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 6 Family Support Services of West Hawaii Ka'u Family Center Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget* Estimate Hawaii County $ 40,000.00 $ 40,000.00 $ 60,000.00 Fundraising $ 17,200.00 $ 3,494.00 $ 2,795.00 State of Hawaii $ 15,124.00 0 0 Total $ 72,324.00 $ 43,494.00 $62,795.00 `If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Family Support Services of West Hawaii has been successful in securing ARRA monies for Early Head Start Expansion and will be applying to become the Head Start grantee for the island of Hawaii. The Family Center concept is central to the work of providing supportive services to low- income and immigrant families in rural areas. It is expected that FSSWH will continue to seek to expand its services to better cover the area of Ocean View Estates —a Ka'u community in which many FSSWH program participants currently live. This includes families from the Marshall Islands who are having severe challenges with finances and with health, social service and educational systems. Family support is about investing in the promotion of the positive things that families want for their children. In the long term, family support is a societal investment in the creation of happy, healthy, productive citizens. This investment has an impact on the families who participate in services, and on society as a whole. Research shows that by investing in positive outcomes for children and families, family support programs also, over the long term can lead to: • fewer teenage pregnancies • less juvenile delinquency • improved behavior and performance of children at school • fewer incidents of child abuse and neglect • more families moving from welfare to work • increased self - contidence, knowledge of child development and parenting skills among parents • greater educational attainment among parents Through these positive outcomes, family support allows us as a society to invest in the development of citizens rather than putting money into more prisons, foster homes, and public welfare. This investment has a tremendous effect on overall productivity as a society and on the ability of those receiving family support services to contribute to as a member of the community and on a greater scale, of the nation. Up until this point, our state legislature has not made the investment that is necessary to carry out prevention programs such as this, thus continued support from the County is necessary, along NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 7 with the powerful support given by community members. Donors continue to contribute in order to support our Family Centers. Collaboration has been a key to the success of the Family Center programs and is recognized as a top priority in the continued growth and service of the Centers. Collaboration among numerous agencies, student organizations, local governments, school systems, departments of health and social services, civic and religious organizations provides on -site programs, services, and activities. on localAdvisory_Boards, scholarships_ and_..tinancial_ assistance,__ volunteers, and in -kind donations such as educational materials, transportation, and Center space are also contributions that will continue to support the programs. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 8 Family Support Services of West Hawaii - Agency Name Ka'u Family 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signatur' f Boa d resident/C Date Gw1 Iop1 6till POA 'a$' lb Sig ature of Executive Dir c r Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 -- - -- - -- - - - -- - Lonnie Large Violence Intervention Project Director 808-965 -3023 To Whom It May Concern: co This letter of support is for the continued services or the Ka'u Family Center. Without this program we would no longer have a space to conduct our domestic violence education groups for men who batter, a much needed service in this community. The Ka'u Family Center partners with other agencies in collaboration, support or facility use. The center also provides resources, referrals and houses other programs. Please continue to fund this valuable program. Sincerely, Lonnie Large ,,. $ T cn IL 2 a! J To Whom It May Concern: My name is Pamela Ako and I am a conserved parent of the Ka'u district. On behalf of the Ka'u Family Center, I'd Ile to acknowledge my appreciation and how vital this program is for our children and youth of Ka'u. There are many parents that work either in Kona or Hilo and with Ka'u Family Center we have a safe place that is able to teach and bring new activities that will help keep our children from making wrong choices. Mahalo Pam Ako 9360017 To Whom It May Concern: I an Candice Fragas and I am a parent in the Ka'u District. I am writing on Behalf of the Ka'u Family Center, I would like to say how important this program is not only for us parents resources but for the kids. To show them and let them know that there is a safe place for them to be. To help our children make great choices. Thanks Candice Fargas In support of the Ka'u Family Center from community members typed as written: The Kin Family Support Services has been one of the lest outlets in Ka'u for all ones needs. I have seen homeless get much needed tbod and clothing. 1 myself found the computers away to keep in touch with friends and family. When looking for a job the Ka'u Family Support Services helped me out a lot. If not for these services people would have no where in Ka'u to go to for help. They offer computer fax, email, food, clothing, support for families, children and direct you to different outlets of help. Why would anyone want to close a place that does only helping for the community? Melody Raymond, [ come in and use the computer once or twice a week — very much appreciated — thank you. Leroy Cain Ka'u Family Support Services is much needed in our rural community. Personally 1 can access my email and fax documents. Families are provided services that would be sorely missed without funding. Please kokua and matama KFC. lolani Hawk Ka'u Family Center offers friendly, cheerful, competent advice kr family needs in ow area. I received valuable ink concerning care for an elderly friend —1 use the computers for in% (I don't have one at home and can't afford it) It is a much needed resource for our community especially for the lover income families with needs. M. Mintz Ka'u Family Center, It is a much needed resource for ow community. A relaxed friendly, safe, helpful place to meet my needs. Thank you very much Teresa and Ka'u Family Center. You the best. Jane Robinson The Ka'u Family Center help me and my family and others support by letting in to come and take clotting and foods. If wasn't kr them we would be more harder living. Thank you Teresa and all. Rose Mercado o whom it may concern, am writing in support of the Keel Family Center. The Ka'n district continues to grow rid yet has very little community resources available The - Ka'u - Family Center provides a umber of significant resources to this community. The Ka'u Family Center actively rpports community groups and organizations. Agencies rely on the center as a resource inch has provided a meeting place when needed for community groups as well as for xcial service and support groups. he Ka'u Family Center provides information and services that are important and therwise unavailable in this area. The center provides emergency food and clothing for immunity members. The Ka'u Family Center is a great community resource for )mputers and Internet access. The center provides important community services with to Healthy Start Program and the Youth Development Program. As the communities of .a'u develop, programs such as this one should continue to grow as well. inccrely, 2 aul Takehirohiroo 27 Friends of Big Island Drug Court Assistance to Drug Court Clients & Program Friends of Big Island Drug Court- Agency Name Assistance to Drug Court Clients & Program- Program Name Agency Director: None Phone No.: N/A Contact Person: Carol VanCamp, President Phone No.: (808) 982 -9958 Mailing Address: PMB 126, 111 Puainako St., Suite #585, Hilo, HI 96720 Facility/Site Address: None Fax No.: 969 -1499 Email Address: cvancamp3 @hawaii.rr.com Name of Accountant/CPA (include name of firm if applicable): Brian Iwata, CPA, Taketa, Iwata, Hara & Assoc., LLC Phone No.: 935 -5404 Mailing Address: 101 Aupuni St., Suite 139, Hilo, HI 96720 Amount of Request for County Funds: $10,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $10,000 $10,000 Agency Mission Statement: The mission of the Big Island Drug Court is to help address societal problems related to substance abuse in order to minimize their societal and economic costs, and to protect the Big Island community by providing timely and effective treatment for drug offenders with appropriate sanctions and incentives. Simply NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 stated, the "Friends of Big Island Drug Court" is a 501 c 3 organization created to provide financial and other support Drug Court clients and the overall program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Friends of Big Island Drug Court - Agency Name Assistance to Drug Court Clients & Program- Program Name Program Description: The Friends of Big Island Drug Court provides funding and other support for the clients and programs of Big Island Drug Court. This includes rewards and incentives to clients during their drug -free journey (such as gift certificates, movie tickets, etc.), loans or awards for tuition to further their educaiton, and loans or awards for housing, travel or other such needs. The Friends also sponsors graduation supplies for Drug Court clients, and responds to individual requests for support. They also support alumni and support group activities to help ensure long -term success for clients. All programs and activities are conducted by volunteers, as there are no paid employees. The organization is governed by a volunteer board of directors, representing a cross - section of individuals from the community. Total Budget and Position Count Total Program Budget $14,000 Total Program Position Count 0 Total Agency Budget $14,000 Total Agency Position Count 0 Program Objectives: 1) The Friends is designed to integrate community /private support into governmental efforts directed at the rehabilitation of adult men and women and juveniles, who are charged with or convicted to non - violent felonies and assessed as chemically dependent on alcohol and /or other drugs, by securing financial support for governmental efforts to operate Big Island Drug Court in the Third Circuit. Program Highlights: (from Fiscal Year 2008 -09) 1) Through private donations and fundraising and county non - profit grant assistance, we have been able to provide financial rewards and incentives to motivate Drug Court clients and also to provide awards and loans for tuition, housing, or various other needs of Drug Court clients. The specific goal is to assist in ways that government cannot to help clients successfully complete the Drug Court program and return to society as contributing citizens. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Friends of Big Island Drug Court - Agency Name Assistance to Drug Court Clients & Program - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Balance sheet as of 12/31/09 $13,857.80 Budget for 2009 -10 $14,000.00 Estimated Budget for 2010 -11 $14,000.00 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 0 9 9 Professional Fees $1,815.10 $1,800.00 $1,800 Operations $8,893.17 $12,200 $12,200 Equipment Other" Total $10,708,27 $14,000.00 $14,000.00 * If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Friends of Big Island Drug Court - Agency Name Assistance to Drug Court Clients & Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Contribution Income $2,700.00 $3,000.00 $3,000.00 County of Hawaii Grant $10,000.00 $10.000.00 $10,000.00 Fund Raising $179.24 $1,000.00 $1,000.00 Interest Income $47.11 Total $12, 926.35 $14,000.00 $14,000.00 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Our plans are to continue to diversfy our voluntary board membership to attract members who can assist in fundraising across the island. We will also undertake a letter campaign targeted at those affiliated with the Drug Court program, such as attorneys, social service professionals, etc. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Friends of Big Island Drug Court - Agency Name Assistance to Drug Court Clients & Program - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board President/Chair Date N/A Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 28 Friends of the Children's Justice Center of East Hawaii Special Needs & Enhancement, Center Support, Prevention /Education & Training Programs Friends of the Children's Justice Center of East Hawaii - Agency Name Special Needs & Enhancement, Center Support, Prevention /Education & Training Programs- Program Name Agency Director: Katherine A. Garson, Board President Phone No.: 935 -8755 Contact Person: Victoria Kravitsky, Program Coordinator Phone No.: 935 -8755 Mailing Address: P. O. Box 6908 Hilo, Hawaii 96720 Facility /Site Address: 1290 Kinoole Street, Hilo, Hawaii 96720 Fax No.: 808 - 933 -0968 Email Address: fcjceh @fcjc.org Name of Accountant/CPA (include name of firm if applicable): Jennifer Gossert, (Jennifer Gossert, CPA) Phone No.: 808 - 969 -3115 Mailing Address: 688 Kinoole Street, Suite 201, Hilo, Hawaii 96720 Amount of Request for County Funds: $10,000.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $12,000.00 $15,000.00 $10,000.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Agency Mission Statement: The agencies mission is to help sexually, physically and emotionally abused children, neglected children, and children who are witnesses to crime, in partnership with the Children's Justice Center of East Hawaii. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Friends of the Children's Justice Center of East Hawaii - Agency Name Special Needs & Enhancement, Center Support, Prevention /Education & 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 or neglected children. The Friends have a unique partnership with the Children's Justice Center (CJC), a State Judiciary Program. The CJC provides a safe, neutral homelike atmosphere where children can be interviewed regarding allegations of abuse, particularly sexual abuse. This Children's Justice Program facilitates and coordinates the system's response to victims of child abuse to reduce their trauma through a multi - disciplinary team approach which involves police, social workers, prosecutors, guardians ad !item, medical professionals, advocates, and others. The Friends support the CJC primarily by helping to provide resources for direct services and programs for child victims and their families which are not available through any other public or private source. The Friends accept requests for funding from state and private agencies working with child abuse victims such as Child Protective Services, Child and Family Services, Hawaii Behavioral Health, Catholic Charities, Parents Inc., and other agencies. The Friends serve children between the ages of 0 -18, who are victims of abuse (sexual, physical, emotional, mental abuse or neglect, or are witnesses to crime) residing in East Hawaii. This includes North Hilo, South Hilo, Hamakua, Puna and parts of Ka'u. We serve children with active or documented cases of abuse and neglect. The Special Needs and Enhancement Program is designed to help child victims develop positive self -worth. The Friends provide resources for needs that are not covered by any other public or private source. Funds are used to provide basic essentials (i.e. clothing, diapers, toiletries), special needs (i.e. air /ground transportation, school supplies, correspondence courses) and enhancement support (i.e. sports, music lessons, and tutoring). The Friends also have a holiday gift program for children not covered by other programs. Center Support: The Friends provide resources to help reduce trauma and ensure the safety and comfort of the children that come to the Children's Justice Center for interviews. The Friends maintain the Center's safe, child - friendly and homelike atmosphere with toys, games and snacks. This is often made possible NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 by community donations. The Friends also help maintain the Center's appearance with repairs and refurbishing when needed. The Prevention and Education Program is designed to educate the community regarding child abuse issues. This program plans events for the public, promoting awareness and prevention of child abuse. The Training Program helps to sponsor the attendance of various professionals (i.e. social workers, police & therapists) at seminars and conferences to learn state -of- the -art interviewing techniques and refine their overall skills. These professionals work with child victims and their families. Training opportunities enhance the quality of services and prevents victims from being re- traumatized by possible difficiencies in the system's response to the allegations of abuse. Total Budget and Position Count Total Program Budget 157,500 Total Program Position Count 1 Total Agency Budget 157,500 Total Agency Position Count 1 Program Objectives: 1) Provide funds for clothing, toiletries, bed /mattress and other necessities for children in emergency or relative foster placement. 2) Provide funds for tutoring, correspondence courses or summer school to allow a child to graduate or progress to the next grade level. 3) Provide funds for ground or air transportation for children to participate in family vacations /reunions, attend school or team events, or to see medical specialists. 4) Provide funds for children to participate in supervised Spring and Winter Intersession activities, or summer camps. 5) Pay for fees, equipment and supplies needed for extracuricular activities ie: sports, music, art, drama, dancing lessons, etc. 6) Provide funds for holiday or birthday gifts when a child would otherwise not receive a gift. 7) Provide funds (or gift cards) for gas, to families on a limited budget so children may be able to attend treatment programs. 8) Provide funds for diapers, car seats and other baby supplies for infants who are victims of abuse and neglect. 9) Pay for event fees, prom dresses, senior pictures, yearbooks, etc., to give a student a chance to participate in school functions. 10) Assist police, social workers, and other professionals in keeping up to date with the latest investigative techniques, sensitivity training, forensics and knowledge of resources by helping to sponsor their attendance at training workshops and seminars. 11) Provide privacy, comfort and safety for children and family members who come to the Center, by maintaining its warm environment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 12) Participate with the East Hawaii Coalition for Child Abuse Prevention in community education activities to increase public awareness. Program Highlights: (from Fiscal Year 2008 -09) 1) Filled 1,001 Special Needs Requests for abused and neglected children to provide for their emergency or enhancement needs that would otherwise have gone unmet. 2) Continued to partner with Children's Justice Center of East Hawaii to provide requested funds for professionals to attend trainings, including Social Workers, police and other professionals who interface with alleged child victims of abuse. 3) Increased community awareness of Abuse Prevention by participating in educational activities including: ongoing work with the Coalition, especially for April - Child Abuse Prevention Month; participated in Celebrate Your Family Day at Sangha Hall; participated in the Boy Scouts annual Makahiki Festival; attended community education fairs at UH Hilo's Family Affair event and the Puna Informational Fair at the Pahoa Community Center; made presentations to the Hilo Exchange and Lion's Clubs, and to local churches. 4) Provided 150, $30 Holiday Gift Cards to Wal Mart, to teens 12 to 17 years old. Coordinated a group of volunteers from the local school Resource Team to assist with wrapping gift cards. 5) Held our signature fundraiser (The Phantom) by distributing over 300 invitations and raised nearly $15,000. 6) Sponsored a 6th Annual Prevent Child Abuse Golf Tournament for FCJCEH, at the Mauna Lani South Golf Course. 7) Helped publish and distribute a children's book called 'Children Are Special'. With East Hawaii area superintendents' approval, 53 books were given to School Principals to be used by teachers as an educational tool re: abuse prevention, for 49 area kindergarten classes. 8) Held a Legislative Open House, December '09, inviting State Legislators to visit our agency and meet our Board and volunteers. 9) Submitted two new Grant Requests: Monty Richards Community Award, via BOH (awarded $5,000); and the Weinberg Foundation (awarded $10,000); and will continue to investigate other grant opportunities. 10) Assisted at Aid Station for runners participating in the 2009 Ironman Triathlon in Kona, as our service to the community. 11) Participated in the 2009 Annual Visitor Industry Charity Walk, a statewide event coordinated by the Hawaii Hotel & Lodging Association. 12) Recruited one new Board Member to our Board of Directors. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 - Agency Name - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget* Estimate Fill Emergency and Enhancement 1,001 825 1,000 requests through the (SNR Program) Special Needs Requests. Maintain Holiday Gift Program 150 150 150 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 34,812 41,000 41,500 Professional Fees 8,750 8,800 9,000 Operations 92,840 100,900 104,000 Equipment Other* Total 136,402 150,700 154,500 * If applicable s Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 • - Agency Name - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget* Estimate County of Hawaii 15,000 10,000 10,000 COH (one time grants) 8,530 - - Hawaii Island United Way 11,625 2,400 3,000 Private Foundations 73,671 96,500 97,000 Ironman 500 500 500 Charity Walk 6,500 3,000 3,000 Corporate Grants 1,000 2,600 3,000 Donations 2,324 3,500 3,500 Special Events (net) 14,395 14,200 16,000 Fundraisers (net) 5,659 6,000 8,000 Admin Fees 644 700 700 Interest 2,252 1,000 500 Refunds 252 300 300 Other 10,000 9,000 Total 142,352 150,700 154,500 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Friends do not collect fees for any of our services. We are continuously researching for additional grant funding, striving to increase donations for our Phantom non -event fundraiser, and expanding participation in our golf tounament fundraiser. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 - Agency Name - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. I . . Ka v 1 1257 Signature of Board resident/Chair Date �I / / • 5 /b Signature of Exei'utive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 29 Friends of the Children's Justice Center of West Hawaii Enhancement and Basic Needs FRIENDS of the Children's Justice Center of West Hawai'i - Agency Name Enhancement and Basic Needs- Program Name Agency Director: Michelle Ono Phone No.: 331 -2425 Contact Person: Michelle Ono 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.: 327 -4988 Email Address: fcjcwh @hawaii.rr.com Name of Accountant/CPA (include name of firm if applicable): Denise Hill, VP of Finance - Hualalai Resort Phone No.: 325 -8413 Mailing Address: 73 -4697 Kahualani Road, Kailua -Kona, HI 96740 Amount of Request for County Funds: $15,000.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $15,000.00 $15,000.00 $15,000.00 Agency Mission Statement: FCJC -WH mission is to provide assistance to the children of West Hawaii who have been traumatized by sexual assault, physical abuse and /or neglect, or who have been witnessess to violent crime; to support the Children's Justice Center of West Hawai'i; and to promote the awareness and prevention of child abuse. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Pace FRIENDS of the CJC -WH - Agency Name Enhancement and Basic Needs - Program Name Program Description: The FCJC -WH was established in 1989 as a non profit 501 (c) (3) organization to work in partnership with the Children's Justice Center of West Hawai'i, a part of the State of Hawai'i Judiciary, to provide a safe and warm, child friendly setting where children can be interviewd by specially trained professionals about allegations of sexual abuse,physical abuse, and /or as witnesses to violent crime. The FCJC -WH developed an "Enhancement and Basic Needs" program to provide financial assistance to enhance the opportunites for child and teen victims of abuse to participate and benefit from activites, programs, and services that strive to build self esteem, strengthen self -image and perpetuate self worth, all of which are crucial to the healing process and key in the prevention of future re- victimization. We are also able to assist with emergency assistance and basic needs, such as food and clothing. Our goal is " to help a victim become a child again ". The FCJC -WH requires that a "needs request" form be submitted through a professional working directly with a child /teen such as a social worker, private therapist, guardian ad litem, or school counsler. To be eligle for FCJC -WH assistance, the child /teen must be a victim of a documented case of child abuse and /or neglect or a witness to violent crime. By collaborating with a vast array of professionals, we continue to increase our abilty to effectivly identify and address the needs of child and teen victims of abuse that have not and /or cannot be adequately be met by governmental and /or other private agencies in West Hawaii. The FCJC -WH have utilized funds for child participation in many local programs such as the Donkey Mill Art Center, Horseplay Camp, Aloha Performing Arts Program Theater Workshops, various sports leagues, martial arts programs, afterschool tutoring, music lessons and school intersession programs. Each year we assist West Hawai'i teens who qualify for assistance through our program, to travel to O'ahu and participate in the Winner's Camp Foundation's, " Hawai'i Leadership Academy ". This one week camp is designed to enhance self- esteem and strengthen social proficiency and academic performance through lessons on leadership and personal responsibility. In addtition, the FCJC -WH also organizes "Winner's Camp Reunion Activites" to address the need for West Hawai'i graduates to have consistent opportunies to refresh lessons learned as well as strenghten the supportive peer relationships that were created during thier camp experiences. It is our vision that these supportive activites can "help a victim be a child again ", decrease the potential for re- victimization, and ultimately help to break the cycle of child abuse in the West Hawai'i community. Another unique service we provide is the support of regular professional development trainings in West Hawai'i for those who respond to and work with child victims and their families. Many trainings are facilitated through the Children Justice Centers and include vital agencies in the intervention system. The FCJC -WH also collaborate with several local agenices to activley participate in activities that focus on the awareness and prevention of child abuse in our communities. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7- Total Budget and Position Count Total Program Budget 103,255.00 Total Program Position Count .75 Total Agency Budget 127,775.50 Total Agency Position Count 1.0 Program Objectives: 1) Assess 800 enhancement and /or basic needs requests benefiting 400 individual children by June 30, 2011; 2) Give 25 FRIEND Boxes to children entering the foster care system by June 30, 2011; 3) Distribute 80 Holiday Gift Bags to West Hawai'i teens by December 24, 2010; 4) Assist 18 teens to attend Winners' Camp by June 30, 2011; 5) Organize 5 Winners' Camp Reunion Activities by June 30, 2011; 6) Support 2 or more professional development trainings in collaboration with the Children's Justice Centers for professionals who work with child abuse victims and their families by June 30, 2011; 7) Participate in community activities that work to create awareness and the prevention of child abuse and neglect, attend 10 Hui Lau Lima meeting at the Neighborhood Place of Kona, and present 3 informative talks to community groups by June 30, 2011. Program Highlights: (from Fiscal Year 2008 -09) 1) 777 enhancement and needs requests were accepted and processed during the 2008 calendar year serving 370 individual children. 2) 1254 enhancement and needs requests were accepted and processed during the 2009 calendar year serving 422 individual children. 3) 26 FRIEND Boxes were distributed during the 2009 calendar year to children entering the foster care system. 4) FCJC -WH participated in the April Family Fun Day at Kealakehe High School. 5) Attended regular Hui Lau Lima Meetings at the Neighborhood Place of Kona and gave several talks to community groups. 6) 32 trips to Winners' Camp were sponsored in 2008 calendar year. 7) 85 holiday gift bags were distributed to teens in West Hawai'i in December 2008. 8) 5 Winners' Camp Reunion activities were organized for West Hawai'i Winners' Camp Graduates. • NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 page 3 FRIENDS of the Children's Justice Center of West Hawaii - Agency Name Enhancement and Basic Needs - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget* Estimate Children Brought to CJC -WH for 99 170 120 Forensic Interviews Approved Needs Requests 777 750 800 Individual Children Served 350 370 400 FRIEND Boxes for Children Entering 23 25 25 Foster Care Teen Holiday Gift Bags 85 85 85 , Winners' Camp Attendees 33 30 18 Winners' Camp Reunion Activities 5 6 5 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 0 0 0 Professional Fees 14,267.62 15,000.00 20,505.00 Operations 0 0 0 Equipment 0 0 0 Other" 82,870.25 101,150.00 82,750.00 Total 97,137.87 116,150.00 103,255.00 * If applicable u Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 FRIENDS of the Children's Justice Center of West Hawaii ITEM 2008-2009 CY 2009 2008 Budget 2009 Budget 2010 Budget actual actual Athletic $ 4,769.14 $ 6,488.61 $ 5,500.00 $ 5,000.00 $ 5,000.00 Center Support $ 8,246.93 $ 5,982.87 $ 16,400.00 $ 14,450.00 $ 11,375.00 Child Care $ 624.00 $ - $ - -$ 500.00 $ - Christmas Bags, Teens $ 2,031.62 $ 1,030.72 $ 3,000.00 $ 3,000.00 $ 1,000.00 Christmas, Other $ 1,200.00 $ 175.00 $ - $ 750.00 $ 1,000.00 Clothing $ 3,853.97 $ 3,139.38 $ 4,000.00 $ 4,000.00 $ 3,000.00 Dental $ 1,385.82 $ 487.15 $ 2,500.00 $ 1,200.00 $ 1,000.00 Education $ 4,314.31 $ 9,063.66 $ 3,500.00 $ 5,000.00 $ 5,000.00 Enhancement, Basic Needs $ 1,084.21 $ 851.32 $ 3,000.00 $ 3,000.00 $ 1,000.00 Enhancement, Miscellaneous $ 3,671.30 $ 6,232.12 $ 4,000.00 $ 4,000.00 $ 4,000.00 Food $ 287.52 $ 473.55 $ - $ - $ 500.00 Food Coupons $ 1,124.81 $ 1,045.00 $ 1,000.00 $ 1,000.00 $ 1,000.00 FRIEND Boxes $ 1,374.14 $ 1,329.48 $ 1,000.00 $ 1,100.00 $ 1,000.00 Furniture $ 780.72 $ 1,306.49 $ 1,000.00 $ 500.00 $ 500.00 Gas Coupons $ - $ - $ 100.00 `$ 100.00 $ 100.00 Graduation $ 235.39 $ 315.60 $ 1,000.00 $ 1,000.00 $ 500.00 Medical $ 1,250.00 $ 696.14 $ 2,500.00 $ 2,500.00 $ 2,000.00 Music Lessons $ 517.07 $ 552.00 $ 1,000.00 $ 500.00 $ 500.00 Performing Arts $ 1,440.00 $ 3,944.13 $ 2,000,00 $ 1,500.00 $ 2,000.00 Prevention /Awareness $ 88.09 $ 402.45 $ 500.00 $ 500.00 $ 500,00 Professional Fee -FCJC $ 4,755.96 $ 9,511.66 $ 10,000.00 $ 10,000.00 $ 13,680.00 School Break Programs $ 6,587.00 $ 7,687.00 $ 10,000.00 $ 5,000.00 $ 5,000.00 School Pictures/Yearbook $ 156.25 $ 471.25 $ 500.00 $ 300.00 $ 300.00 School Supplies /fees $ 611.00 $ 965.00 $ 1,000.00 $ 1,000,00 $ 1,000.00 Summer Camp /Fun $ 3,013.40 $ 2,683.40 $ 2,500.00 $ 7,000.00 $ 5,000.00 Summer School $ 618.00 $ 618.00 $ 1,000.00 $ 1,000.00 $ 1,000.00 Therapy $ 260.00 $ 360.00 $ - $ 250.00 $ 300.00 Training & Education $ 70.00 $ 70.00 $ 4,000.00 $ 2,000.00 $ 1,000.00 Travel $ 6,557.61 $ 8,305.32 $ 5,000.00 $ 5,000.00 $ 5,000.00 Winners' Camp $ 31,004.03 $ 28,255.90 $ 30,000.00 $ 30,000.00 $ 25,000.00 Winners' Camp reunions $ 5,225.58 $ 6,442.98 $ 5,000.00 $ 5,000.00 $ 5,000.00 TOTALS: $ 97,137.87 $113,642.14 $121,000.00 $ 116,150.00 $103,255.00 Page 5' FRIENDS of the Children's Justice Center of West Hawaii - Agency Name Enhancement and Basic Needs - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget* Estimate County of Hawai'i 15,000.00 15,000.00 10,000.00 Private Foundations 66,276.92 60,000.00 60,000.00 Donations 21,152.87 20,952.00 16,803.00 Total 102,429.79 95,952.00 86,803.00 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The FRIENDS of the Children's Justice Center of West Hawai'i's "Enhancement and Basic Needs" program is essentially self sustaining at the present time. We are adjusting our budget to reflect the local economic distress and will explore additional financial grant assistance throughout the year. • NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 page 6 FRIENDS of the Children's Justice Center of West Hawai'i - Agency Name Enhancement and Basic Needs - Program Name (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your proqram's or agency's future funding requests. I JAL i afttliA I .797 - 10 Signature 4 Board President/Chair Date ( go - coal — /U i•nature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Paget 30 Goodwill Industries of Hawaii, Inc. Job Connections Program • Goodwill Industries of Hawaii Job Connections Program Agency Director: Laura Robertson Phone No.: 808 - 836 -0313 Contact Person: Bettye Williams Phone No.: 808 - 961 -0307 Mailing Address: 500 Kalanianaole Ave, Hilo, HI 96720 Facility /Site Address: 200 Kanoelehua Ave, Suite 102, Hilo, HI 96720 Fax No.: 808 - 969 -3861 Email Address: bwilliams@higoodwill.org Name of Accountant/CPA (include name of firm if applicable): Catha Combs, Wikoff Combs and Co., LLC Phone No.: 808 - 791 -1420 Mailing Address: 1001 Bishop Street, Suite 2760, Honolulu, HI 96813 Amount of Request for County Funds: $30,000 * * Note: This is the second of two separate applications Goodwill submitted this year. Our top priority is the Work Experience Program. Funding for Job Connections should only be considered if the Work Experience Program is accepted. We do not want to jeopardize the Work Experience Program as the County grant serves as funding of last resort for our trainees who are people with disabilities, who have no other options. Prior Year(s) Funding: N/A 07 -08 08 -09 09 -10 $0 $14,000 $10,000 Agency Mission Statement: Our mission statement is: Goodwill Industries of Hawaii, Inc. helps people with employment barriers to reach their full potential and become self - sufficient. Goodwill Industries of Hawaii (Goodwill) has been in business in the State of Hawaii since 1959 providing vocational training and employment services to persons with barriers to employment, including: NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 1 Goodwill Industries of Hawaii Job Connections Program • Individuals with disabilities; • Youth who have disabilities or are economically disadvantaged; • Disabled veterans; • Asian and Pacific Islander immigrants; • Older individuals and dislocated workers; and • Adults who are economically disadvantaged, including First -to -Work TANFiTAONF /UFUE and Food Stamp recipients. • Ex- offenders transitioning from incarceration into the community With 50 years of experience operating vocational training programs as well as teaching life skills, Goodwill has developed an expertise in bringing about success to the people we serve. Goodwill Industries of Hawaii in Hawaii County has been serving our community since 1998. We envision a world where all individuals with disabilities and other barriers will have the opportunity to participate in a full range of life experiences, including employment. We provide services to empower individuals to be productive and independent based on their abilities and interests. From July 2008 to June 2009, Goodwill successfully served 11,959 individuals and placed over 1,800 people into gainful employment throughout the state. The Hawaii County branch of Goodwill provided services to 2,464 individuals and placed 515 people into employment last year. Over the past five years, Goodwill has successfully provided training and employment services to 44,241 people with barriers to employment, and placed 7,940 people into employment. These numbers reflect that Goodwill has the necessary skills and experience to perform the proposed services. It is our belief that work is a basic right that will assist people to attain other life goals. Moreover, we believe in each individual's right to self- determination, to make their own decisions regarding life choices as a means of promoting independence and self- sufficiency. Goodwill is a significant contributor to the local economy. As people become self- sufficient, the community is impacted economically. In the recent economic climate, the Job Connections employment and training services are being utilized in record numbers. We have seen a 42% increase in enrollment from January through December 2009 compared to the same period in the previous year. People are seeking ways to be competitive in today's employment market. Through training and support, our participants are finding employment despite the recent high unemployment rates. In previous years, Goodwill has provided a menu of services to train, place and support individuals with barriers into gainful employment and assist them to overcome their barriers to both employment and job retention. Additionally, Goodwill is committed to providing services to help individuals after they have obtained employment to acquire skills and resources to advance and improve NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 2 Goodwill Industries of Hawaii Job Connections Program their economic self- sufficiency through training in basic literacy, computer literacy, GED, ESL, and Earned Income Tax Credit filing. Participants are also provided follow -up support after placement into employment. Examples of agencies and partners with whom we coordinate services include the Hawaii Community Correctional Center, Hawaii Paroling Authority, Adult Probation Office, Hawaii Intake Service Center, Workforce Development Division, Department of Human Services, Division of Vocational Rehabilitation, Department of Health, Turning Point for Families, Office for Social Ministry, C.A.R.E. Hawaii, Big Island Substance Abuse Council, Alu Like, Chamber of Commerce, Goodwill Industries International, employers in identified industries with job opportunities corresponding to participants' career goals, and others. In addition to partnerships with other agencies, the Job Connections program has played a major role in the development of the "Going Home Consortium" (formerly the Mayor's Task Force on Employment Solutions) to support inmates and ex- offenders transitioning from incarceration into our community. The Going Home Consortium consists of more than 70 government agencies, private agencies and concerned citizens working together to support ex- offenders re- integrating back into the community in an effort to make our community safe, reunify families, and reduce recidivism by providing services that otherwise did not exist. Employment plays a major part of successful reintegration thereby reducing recidivism. A Goodwill service that is housed in the Goodwill office in Kailua -Kona is the Home Ownership Assistance Program (HOAP). The HOAP program assists Hawaiian Homeland beneficiaries to become employed leading to financial stability. As a result, participants are able to qualify for mortgages to build homes, as well as, avoid foreclosures. Thos Job Connections participants who are eligible for the HOAP program may choose to participate in carpentry apprenticeship training through HOAP to learn new skills and increase their employability. Program Description: Funding is requested to provide support services to low- income individuals (at or below 150% of the Federal Poverty Guidelines), and particularly to those who have been incarcerated and are being released from Hawaii Community Correctional Center and returning to their homes in Kailua -Kona. The funding requested will provide support services to respond to the need of the recent economic crisis as well as target local ex- offenders for the purpose of creating a safer community and reunifying families by reducing recidivism. The funding requested will provide services for 18 individuals that include the following three components: NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 3 Goodwill Industries of Hawaii Job Connections Program 1) Intake and Assessment including Individual Program Plan Development 2) Job Readiness Training 3) Job Development and Job Placement Assistance in Kailua -Kona Upon placement into employment near or with their families, the Job Connections program will continue to provide case management and support until the individual achieves employment for one year. Job Connections will provide job development and support services to employers in the Kailua -Kona community. The Job Connections program has become a leader in providing motivational and inspirational training by using a hands -on approach. First, in the process of assessment, participants learn about themselves by identifying skills acquired both inside and outside of correctional institutions. As part of assessment, participants are given skills, interests and personality assessments and corresponding choice of careers. The assessments help give participants language to describe themselves and their skills on a resume and talk about themselves to potential employers. The assessments also assist in career exploration and identifying personal career goals. Participants create their Individual Program Plan that serves as a guide to achieve their desired goals and outcomes. Second, a 20 hour Job Readiness Training course is scheduled within one week to educate and support participants in becoming job ready. In the hands -on class, participants learn how to correctly fill out applications, write their resumes, create cover letters, learn interviewing skills, and innovative ways to job search. Graduation is a culmination of all the skills they have learned. They are expected to present themselves properly in appearance, body language, written material, and verbally in mock interviews. Other Goodwill Employment Counselors and /or former graduates (that participants are not familiar with) conduct the mock interviews to simulate elements of a real interview. Third, the participant is assigned an Employment Counselor who helps the participant identify barriers to employment and solutions for removal of those barriers. The participant sets goals for him /herself and the Employment Counselor supports them in their achievement. Job Development is an important part of the process of job placement. Counselors contact employers, post job openings on a daily basis, and uncover hidden job markets. Participants are invited to use the Job Connections office for their job search after graduation. Our counselors will meet with former offenders in Kailua -Kona to assist with a localized job search. They have access to: computers, Internet for job searches, researching companies, and filling out applications, daily newspaper, telephone and telephone books, fax machine, and their Employment Counselor's guidance. The result is job placement, self- sufficiency and a stronger local economy. In FY 2008 -2009 the demographics of all participants in the program were: • 42% identified themselves as Hawaiian or part Hawaiian • 76% identified themselves as having a criminal background • 18% identified themselves as having less than a high school education NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 4 Goodwill Industries of Hawaii Job Connections Program Total Budget and Position Count Total Program Budget $30,000 Total Program Position Count 3 Total Agency Budget* $2,500,000 Total Agency Position Count 88 * Total Agency Budget denotes Hawaii County Branch only Program Objectives: 1) Enroll 18 participants in the Job Connections program. 2) Conduct Intake and Assessment including assessment of skills, personality, career goals, work history and barriers to employment. 3) Develop an Individual Program Plan with each participant that includes creating their goals and the steps needed to achieve them. 4) Conduct Job Readiness Training consisting of 20 hours of hands on classroom training. This may also incorporate topics related to Hawaiian Culture and Values as well as Post Incarceration Syndrome as applicable. 5) Place participants into employment, with particular focus on those relocating to the West side of the Big Island 6) Conduct job developing activities with employers including outreach to employers in the Kailua -Kona area, pre- screening, job placement and follow up to ensure a smooth transition into employment. The Job Connections program will continue to support the participants and employers for one year from date of placement with a focus on successful job retention and advancement. Program Highlights: 1) In FY 2008 -09, the Job Connections program served 162 participants identified as low income. Of those 162, 78 were new participants, all completed job readiness training and 72 were successful in finding employment 2) Below are some recent success stories that illustrate the work being done: • One female client had no work experience. She spent five years in prison on drug - related convictions. She came as a women's work furlough referral; no experience, no driver's license, no transportation, no high school diploma. The skills that she acquired in prison were landscape - related. We encouraged her to apply for a job as a landscaper. She got the job. Her new employer stated that she was glad to have a woman on the team. Goodwill bought NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 5 Goodwill Industries of Hawaii Job Connections Program her first steel -toed work boots as she could not start the job without them. Today she is enrolled in a Goodwill program to learn to start and operate her own landscaping business. She is proud of her achievements. • Another client who had spent most of his adult life incarcerated (24 years old currently) has not had a chance to experience life as an adult. We recognized that he had very low self- esteem, no work experience, no transportation, and no family support. We referred him to HCEO Renewable Energy Project. He was accepted into the program. Our last conversation with him was that it is going well for him. He is learning job skills and going to Hawaii Community College to learn welding. He is in his second year of the program and will graduate with an AA in May of 2010. 3) Through participation in the Job Connections program ex- offenders experience a positive transition into the community. For Hawaii Community Correctional Center work furlough inmates, the Job Connections staff are the first people the inmates come into contact with when released to attend Job Readiness Training classes. Participants progress from fear of failure to becoming confident men and women in one week's time. The Hawaii Paroling Authority refers parolees who have been unsuccessful in obtaining employment. Our Employment Counselors work closely with parole officers to assist parolees in barrier removal and job placement. As a result, participants gain: • Empowerment • Initiative • Communication skills • Recognizing triggers for re- offending • Work Ethics • Honesty Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Budget * Estimate Actual * Job Connections Program $14,000 $10,000 $30,000 Goodwill's Outcome Management System evaluates program services by asking persons served, employers, and referring agencies to complete a follow -up survey used to evaluate the satisfaction and effectiveness of services. Upon program exit, each participant, employer and referring agency will be asked to complete a satisfaction survey. Parties are asked to respond to questions in several areas including the quality of services received, the service outcomes, level of satisfaction regarding the program, and suggestions for changes. Satisfaction surveys are compiled and analyzed on an annual basis. The results NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 6 Goodwill Industries of Hawaii Job Connections Program 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 2008 -09, 100% of the participants were satisfied with their experience in the Job Connections Program. Participant comments included: • "Being with the people at Goodwill, they made it better for me. They were very supportive and empathetic and encouraging. They were always there, even after the program was over and I was still looking for work. They were very approachable." • "By looking for something and getting me the job that I need to stay out of trouble. The person I was working with showed me that she cared and was helping me out. That helped me out and made me look for a job." • "Gives me more of an incentive to keep going forward and let other people know that it's a good place to go." Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010- 2011 Actual * Budget * Estimate Salaries and Wages $ 14,000 10.000 $ 30,000 Professional Fees Operations Equipment Other (Payroll Processing Charges)" Total $ 14,000 $ 10,000 $ 30.000 Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009- FY 2010 - Actual * 10 Budget 2011 * Estimate County of Hawaii Non - Profit Grant $ 14,000 $ 10 ,000 $ 30,000 State of Hawaii $ 118,000 120,000 120,000 Total $ 132,000 130,000 150,000 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 7 Goodwill Industries of Hawaii Job Connections Program Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The funds requested in this application are for a component of an existing performance based program funded by the State of Hawaii. The money provided by the County allows us to conduct intake and assessment, conduct Job Readiness Training and place participants into employment on the West side of the Big Island. The remaining State of Hawaii funding will cover the case management and job retention support for the participant and employer until employment for one year is achieved. We will continue to support participants to reach job retention goals of 90 days, 180 days and 360 days on the job. We are working with our funder as well as the Going Home Consortium to seek opportunities to apply for additional funding. As mentioned earlier, this is the second of two separate applications Goodwill submitted this year. Our top priority is the Work Experience Program. Funding for Job Connections should only be considered if the Work Experience Program is accepted by the County. We do not want to jeopardize the Work Experience Program as the County grant serves as funding of last resort for our trainees who are people with disabilities, who have no other options. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 8 Goodwill Industries of Hawaii, Inc - Agency Name Job Connections - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal near. 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 will impact the evaluation of your program's or agency's future funding requests. st- / - a ss- /6J signature of :oard Pr- "•ent/Chair Date o'hz ii /— a -/o Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page of 31 Goodwill Industries of Hawaii, Inc. Work Experience Program Goodwill Industries Of Hawaii, Inc.- Agency Name Work Experience Program- Program Name Agency Director: Laura Robertson Phone No.: 808 - 836 -0313 Contact Person: Ma RryMa obleR` Phone No.: 808 - 961 -0307 Mailing Address: 500 Kalanianaole Ave, Hilo, HI 96720 Facility/Site Address: 500 Kalanianaole Ave, Hilo, HI 96720 Fax No.: 808 - 969 -3861 Email Address: nitoblee @liidoodwiIi ora Name of Accountant/CPA (include name of firm if applicable): Catha Combs, Wikoff Combs and Co., LLC Phone No.: 808 - 791 -1420 Mailing Address: 1001 Bishop Street, Suite 2760, Honolulu, Hi 96813 Amount of Request for County Funds: $45,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $28,500 $20,000 $28,000 Agency Mission Statement: Our mission statement is: Goodwill Industries of Hawaii, Inc. helps people with employment barriers to reach their full potential and become self - sufficient. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 1 Goodwill Industries Of Hawaii, Inc. - Agency Name Work Experience Program- Program Name Goodwill Industries of Hawaii (GIH) has been in business in the State of Hawaii since 1959 providing vocational training and employment services to persons with barriers to employment, including: • Individuals with disabilities; • Youth who have disabilities or are economically disadvantaged; • Disabled veterans; • Asian and Pacific Islander immigrants; • Older individuals and dislocated workers; and • Adults who are economically disadvantaged, including First to Work, UFUE, TANF/TAONF and Food Stamp recipients. With over 50 years of experience operating vocational training programs as well as teaching life skills, Goodwill has developed an expertise in bringing about success to the people we serve. Goodwill Industries of Hawaii, Hawaii Island Branch has been serving our community since 1998. We envision a world where all individuals with disabilities and other barriers will have the opportunity to participate in a full range of life's experiences, including employment. We provide services to empower individuals to be productive and independent, based on their abilities and interests. From July 2008 to June 2009, GIH successfully provided services to 11,959 people statewide, and placed 1,866 people into gainful employment. The Hawaii Island Branch of Goodwill Industries provided services to 2,464 individuals and placed 515 people into employment in 2008 -2009. Over the past five years, Goodwill has provided training and employment services to almost 44,241 people with barriers to employment, and placed 7,940 people into employment. These numbers reflect that Goodwill has the necessary skills and experience to perform the proposed services. It is our belief that work is a basic right that will assist people to attain other life goals. Moreover, we believe in each individual's right to self- determination, to make their own decisions regarding life choices as a means of promoting independence and self- sufficiency. In previous years, GIH has provided a menu of services to train, place and support individuals with barriers into gainful employment and assist them to overcome their barriers to both employment and job retention. Additionally, Goodwill is committed to providing services to help individuals after they have obtained employment to acquire skills and resources to advance, and improve their economic self - sufficiency through training in basic literacy, computer NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 2 Goodwill Industries Of Hawaii, Inc. - Agency Name Work Experience Program- Program Name literacy, GED, ESL, and Earned Income Tax Credit filing. Participants also receive follow -up supports and transitional services once they are employed. GIH will coordinate these services with the appropriate agencies and identified networks of support, to better serve the participant on a long -term basis. Examples of agencies and partners with whom we coordinate services include the Department of Health, Division of Vocational Rehabilitation, Workforce Development Department, Department of Human Services, YWCA, Hawaii Literacy, Department of Education, Legal Aid Society, East Hawaii Coalition for the Homeless, Chamber of Commerce, Goodwill Industries International, employers in identified industries with job opportunities corresponding to participants' career goals, and others. When possible, natural supports will be developed to enhance the individual experience in the workplace. Collaboration between employer, family, friends, and the program staff will be emphasized to increase the probability of success. Program Description: Funding is requested for a Work Experience Program to provide wage subsidy for individuals with disabilities and other barriers to employment. The program format will allow work training opportunities for individuals that do not have work experience or who need additional supports or training to succeed in their employment goals. The training programs available are Janitorial and /or Textile/Wares processing positions. The Work Experience Program will follow guidelines as set forth by the Department of Labor. Goodwill Industries has a subminimum wage certificate that requires the following: • a standard be set for each work station • community wage survey be conducted annually, and • each participant's productivity be measured every six months. Each participant will become familiar with and choose the program that is right for them. When the work experience path has been chosen, the participant will be trained on how to perform the essential job functions needed for the positions(s). The benefits of developing these work skills extend beyond the work environment. Through this program participants learn what it is like to earn a paycheck, while being provided valuable work experience and enhancing skills in a real work setting. We recognize the intrinsic value of work and understand the profound effects that meaningful, tangible employment brings to our trainees' lives. More than bringing financial self - sufficiency, work taps the spirit of the individual, provides equal opportunity, and demands commitment and dedication, values that provide the foundation for the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 3 Goodwill Industries Of Hawaii, Inc. - Agency Name Work Experience Program- Program Name In 2008 -2009, the Work Experience Program served 21 participants that were enrolled in a Goodwill training program. The format allowed work - training opportunities for individuals to choose a position in our Janitorial program or Textile/Wares Processing program. The Work Experience Program followed guidelines as set forth by the Department of Labor. A standard was set for each workstation, a community wage survey was conducted, and each participant's productivity was measured every six months. Participants developed problem solving skills, motivational skills, an attitude for success, and increased their self - confidence in the workplace. This year Goodwill Industries of Hawaii is again requesting an increase in funding to expand pre employment and computer based training for persons with more severe physical limitations. The additional funding will be used for purchases to include dedicated computers, assistive technology devices such as ergonomic and large sight keyboards and mice, joy sticks, touch windows, voice recognition systems, larger monitors, assistive communication software as well as job readiness and job retention training software. Assistive technology will particularly assist our participants with sight and hearing impairments, Cerebral Palsy and other physical disabilities which limit their use of standard equipment. Additionally, it will enhance our successful Work Experience Program and give all participants additional tools for independence and self- sufficiency in an increasingly competitive job market. Total Budget and Position Count Total Program Budget $45,000 Total Program Position Count 2 Total Agency Budget $2,500,000 Total Agency Position Count 88 *Total Agency Budget denotes Hawaii Island Branch only Program Objectives: 1) Enroll 22 participants in the Work Experience Program. 2) Instruct proper work techniques for each workstation to be assigned, by review of the workstation development form during the first week of training. 3) Develop motivational skills and attitudes for success, self- confidence and problem solving skills throughout the training period. 4) Conduct time measurement study for participant during the first 2 weeks of entry into the program. 5) Review outcomes with the participant upon completion of the time study. 6) Continue to instruct and reinforce correct work procedures. 7) Track work hours, daily or as scheduled to work. 8) Pay each participant semi - monthly, according to hours worked. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 4 Goodwill Industries Of Hawaii, Inc. - Agency Name Work Experience Program- Program Name 9) Conduct time study for each participant every six months. 10) Update wages according to productivity level. 11) Instruct computer skills utilizing assistive technology for persons with physical disabilities (hearing loss, sight impairment, cerebral palsy, etc.) 12) Instruct on computer based programs which focus on creating resumes, completing applications and learning the fundamentals of the job search and job retention. The emphasis of this program is giving the participants the confidence and tools to maximize their abilities. Our philosophy is to provide an environment for people to believe they can succeed, achieve goals, develop skills and change the barriers they face every day. At Goodwill we believe in the power of work. We create hope, jobs and futures. Through our program, clients learn specific vocational skills and work environment behaviors. Individuals choose the work that matches their abilities and interests and earn wages based on productivity. Clients in the custodial services program perform a variety of cleaning duties in restrooms and offices. Clients in the retail program sort, inspect, hang, and price merchandise. Goodwill supervisors provide appropriate guidance during training that emphasizes safety, quality control, production, proper work behavior, and attendance. Program Highlights: 1) Enrolled 21 participants in the Work Experience Program in 2008/2009. 2) In a random audit of program participants we found an average 20% increase in productivity for participants since their entry into the program. 3) Instructed participants in proper work techniques for each workstation. 4) Developed motivational skills and attitudes for success, self - confidence and problem solving skills for each participant. 5) Conducted time measurement study for each participant within 2 weeks from date of entry into program. 6) Reviewed outcome of time study with each participant upon completion of study. 7) Instructed and reinforced correct work procedures with each participant. 8) Tracked work hours, daily or as scheduled to work. 9) Paid participants on a semi - monthly basis, according to hours worked. 10) Conducted time study of each participant every six months. 11) Updated wages according to productivity level. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 5 Goodwill Industries Of Hawaii, Inc. - Agency Name Work Experience Program- Program Name 12) Purchased adaptive equipment for textile processing to accommodate each participant. 13) Placed one individual in competitive employment. 14) Assisted one individual to continue her goal of self - employment. 15) Placed two individuals in volunteer positions Through participation in the work experience program, six participants have gained valuable job skills and have transitioned to competitive, self or volunteer employment. Seven additional participants volunteered serving food to the homeless one day per week during Adult Day Health Program hours. The Goodwill Aina Keepers, a rotating team of ten participants, paints over graffiti in the community. In the work experience program, participants learned how to take direction, follow through on their work and how to work as a team. As they progressed in the program they demonstrated strong work ethic, attention to detail and positive attitude. One trainee worked in the Goodwill store, regularly volunteers and gained employment with a local employer. Another trainee continued to maintain her own business, designing, sewing and selling Hawaiian crafts. Her creations are showcased on a website of products and services provided by persons with disabilities on the Big Island. This trainee was able to sell her products as quickly as she designed them and made them. 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 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 6 Goodwill Industries Of Hawaii, Inc. - Agency Name Work Experience Program- Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Work Experience Program $20,000 $28,000 $45,000 Goodwill's Outcome Management System evaluates program services by asking persons served, employers, and referring agencies to complete a follow -up survey used to evaluate the satisfaction and effectiveness of services. Upon program exit, each participant, employer and referring counselor will be asked to complete a satisfaction survey. Parties are asked to respond to questions in several areas including the quality of services received, the service outcomes, level of satisfaction regarding the program, and suggestions for changes. Satisfaction surveys are compiled and analyzed on an annual basis. The results are shared with funding sources and Goodwill's Board of Directors. Recommendations for needed changes are analyzed. Plans for improvements are then developed and implemented as a result of this feedback. For the most recent year 2008 -09, the Work Experience Program participants that were also enrolled in the Home & Community Based Services Program indicated a participant and advocate satisfaction rate of 99% in the categories of "Very Good" to "Excellent ". Participant's comments included: • I enjoy being with my friends and working together. • I appreciate the staffs flexibility. Program Expenditures FY 2008 -08 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages $16,998 $17,000 $28,000 Professional Fees Operations Equipment $10,000 $15,000 Other (Payroll $3,002 $1,000 $2,000 Processing Charges)" Total $20,000 $28,000 $45,000 If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 7 Goodwill Industries Of Hawaii, Inc. - Agency Name Work Experience Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii Non - Profit Grant $ 20,000 $28,000 $45,000 Goodwill Industries of Hawaii $1,000 $1,000 $1,000 State of Hawaii $233,000 $230,000 $235,000 Total $254,500 $259,000 $281,000 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The Work Experience Training Program is a component of a much larger service provided to persons with disabilities, through the State of Hawaii. The money provided by the County allows trainees to earn money while gaining valuable work experience in a structured learning environment. As they gain the necessary experience they transition out of the program. While this funding pays the direct salary, it does not cover overhead, supervision, and case management. We leverage the County funding to provide a full -range of services for the trainees. Although we do not have alternative funding for the program at this time, we are looking into expanding the program for trainees who possibly qualify for Federal funds and using the County grant for trainees who have no other sources of funding. The County grant serves as funding of last resort for our trainees, who have no other options. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 2011 Page 8 Goodwill Industries of Hawaii, Inc — Agency Name Work Experience Program — 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. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. S'•natu e of Bo. d Pre '•ent/Chair Date Y tou, Q aft-- a a �o Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page y 32 Grassroots Community Development Group Kea'au Youth Business Center Program Grassroots Community Development Group- Agency Name Kea'au Youth Business Center Program- Program Name Agency Director: Trina Nahm -Mijo Phone No.: (808) 640 -5109 Contact Person: same Phone No.: same Mailing Address: P.O. Box 1772, Kea'au, HI 96749 Facility/Site Address: 16 -540 Kea'au -Pahoa Highway, Ste. 6 Kea'au, HI 96749 Fax No.: c/o 974 -7757 Email Address: nahmmijo @hawaii.edu Name of Accountant/CPA (include name of firm if applicable): John Carbonaro /Carbonaro CPA & Assocs. Phone No.: (808) 968 -1002 Mailing Address: PO Box 4372, Hilo, HI 96720 Amount of Request for County Funds: $45,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $45,000 $30,000 Agency Mission Statement: To strengthen our communities through the cooperative development of program s and services for all of Puna. To provide quality programs for youth. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Grassroots Community Development Group - Agency Name Kea'au Youth Business Center Program- Program Name Program Description: This free or low -cost after - school program was first started through a HUD Alaskan Native /Native Hawaiian Institutions Asssisting Communities grant in 2007 in response to the ice epidemic and the low social - economic standing of the Puna community. The target population is youth,14 -24 year olds, predominantly from the Puna area. The program is held at Kea'au Youth Business Center located in Kea'au Town Center which has a state -of- the -art multimedia computer lab; the largest fully equipped sound recording studio on the Big Island, and a certified mobile kitchen on wheels. KYBC offers skill building in digital media arts, graphic and publishing arts, music and sound recording, and culinary arts and prepares the student either for college and /or the workforce. Besides the skill building training, participants learn business, teaming and entrepreneurial skills which gives them tools to survive and thrive in a 21st century global economy and to add to the social and economic capital of their communities. Training is offered After - School, M -R, 2 -5 p.m. and all day on furlough Fridays. Total Budget and Position Count Total Program Budget 120,000 Total Program Position Count 4 PT Total Agency Budget 204,400 Total Agency Position Count 6 PT Program Objectives: 1) Prevent drug use and other anti - social behaviors in Puna area youth; 2) Provide skill development in digital media arts, music and sound recording, culinary arts, and business; 3) Cultivate the talents and economic viability of area youth; 4) Provide Youth Leadership opportunities through community engagement, entrepreneurial training, and product and talent development. Program Highlights: (from Fiscal Year 2008 -09) 1) In July 2008, KYBC held a series of youth trainings: a 5 week (10 session) Financial Management and Leadership training; a 4 week (8 session) NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Digital Imaging and Design training and a 7 week Sound Recording workshop for area youth. 2) KYBC held two more 7 week Sound Recording workshops where participants created, performed and recorded a CD called "Na Ano" which was officially released in April 2009. The CD was formally marketed and sold during FY 08 -09 on the www.kybc808.com website, on iTunes, CD Baby, Digistation, at Border's, CD Wizard, and Native Books Hawai'i in Honolulu. 3) The Culinary Arts Program continued to participate in at least 2 catering events per month including Taste of Hilo X; Health Fairs in conjunction with Bay Clinic, Inc. 4) The Big Island Substance Abuse Council Program collaborated with KYBC to record two original anti -drug songs at their sound recording studio. The songs were composed and performed by BISAC participants. 5) In summer 2008 (June /July) 17 Alu Like youth interned at KYBC to produce a 14 minute documentary "Malama Waiaha" and a 2 1/2 minute original music video in collaboration with Apono Hawaii and video production company "Island Planet One Productions (IPOP). The video has been screened at several Bis Island venues including Honoka'a People's Theater and UHHiIo Performing Arts Center. 6) KYBC collaborated with Ola'a Community Center to host the event "Ola'a Heart:Roots and Seedlings ", Feb. 14, 2009 which featured young musician performers, an anti - smoking campaign, and a historical "Talk Story" hour with area kupuna. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 11 Page 3 Grassroots Community Development Group - Agency Name Kea'au Youth Business Center Program - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate 50 Youth develop video /graphic arts 80% 85% 90% skills 50 Youth develop music /sound 100% 85% 90% recording engineering skills 50 Youth develop culinary arts skills 80% 85% 90% 80 Youth develop workforce, 80% 85% 90% business, and /or entrepreneurial training *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 47,700 50,000 50,000 Professional Fees 17,000 17,000 17,000 Operations 35,000 34,500 34,500 Equipment 6400 6500 8000 Other 12,400 12,000 12,000 Total 118,500 120,000 121,500 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Grassroots Community Development Group - Agency Name Kea'au Youth Business Center Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate HI Tobacco Prevention and $75,000 $75,000 $75,000 Cessation Trust Fund County of Hawaii $45,000 $30,000 $35,000 Other Grants $1,000 1,000 Program Fees $7,000 7,000 Fundraising $7,000 3,500 Total 120,000 120,000 121,500 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? This program plans to increase revenues through the following activities: 1) Grant writing to foundations, government agencies 2) Fundraising events 3) Entrepreneurial projects, services and products The goal is to be self- sustaining in four years. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Grassroots Community Development Group - Agency Name Kea'au Youth Business Center Program - 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. A_4/....1 •) 710 Signature of Board Pres.ent/Chair Date VP -9/0 Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Grassroots Community Development Group — Kea'au Youth Business Center Explanation for Other in Program Expenditures, p. 4 Other for FY 08 -09: Rent = $6,400 Travel = $6,000 Other for FY 08 -09 and FY 09- 1050005000 Rent= $9,000 Insurance = $3,000 33 Grassroots Community Development Group Kupukupu After - School Grassroots Community Development Group- Agency Name Kupukupu After - School- Program Name Agency Director: Trina Nahm -Mijo Phone No.: Contact Person: same Phone No.: 640 -5109 Mailing Address: P.O. Box 1772, Kea'au, HI 96749 Facility /Site Address: 15 -0565 Kea'au -Pahoa Highway, Bldg G Fax No.: 974 -7757 Email Address: nahmmijo @hawaii.edu Name of Accountant/CPA (include name of firm if applicable): Carbornaro CPA & Associates Phone No.: 968 -1002 Mailing Address: P.O. Box 4372, Hilo, Hawaii 96720 Amount of Request for County Funds: $30,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $50,000 $45,000 $20,000 Agency Mission Statement: To strengthen our communities through the cooperative development of programs and services for all of Puna. To provide a quality After - School Program for area youth, family strengthening, health and wellness, cultural diversity and economic development activities. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Grassroots Community Development Group - Agency Name Kupukupu After - School- Program Name Program Description: This free after - school program was first started through a HI Island Meth. Initiative grant in 2004 in repsonse to the ice epidemic on the Big Island. The target population is 6th, 7th and 8th graders from Kea'au Middle School. The program teaches drug refusal skills, pro - social and communication skills and healthy holistic development through physical activities, tutoring and homework assistance, cooking and nutrition, agricultural skills and sustainability values, and arts and crafts. Special workshops are also offered in expressive activities like music, video, circus arts and hiphop. The program runs M -F, 1 -5 p.m. and this year we began the Kupukupu Sustainability Pilot Project (KSPP). Total Budget and Position Count Total Program Budget 49,200 Total Program Position Count 2 PT Total Agency Budget 204,400 Total Agency Position Count 6 PT Program Objectives: 1) Prevent drug use and other anti - social behaviors in Kea'au area youth; 2) Increase academic performance of Kea'au Middle School youth; 3) Provide skill development in physical, social communication, Life - Skills; 4) Provide family strengthening and community bonding activities; 5) Provide Youth Leadership opportunities through high school and college mentors Program Highlights: (from Fiscal Year 2008 -09) 1) The Kupukupu Sustainability Pilot Project emphasized skill building and stewardship on taking care and utilizing the resources on the island. The activities included planting and documenting which were seen as an enhancement for their academic growth. The stewardship and skill building excercises also enhanced physical conditioning. 2) The youths with the assistance of a Hawaiian Culture Practioner participate in Hawaiian Culture values, beliefs and protocols weekly to help them enhance their understanding on self - sufficiency and identity. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 3) Hawaii Community College donation of five computers with continued technical support is utilized for academic research on health issues associated with sustainability. 4) KSPP youths in collaboration with Ohia Lehua Sound Recording wrote and recorded an Anti - Tobacco CD. The support of the Kea'au Middle School administration has invited the youths to perform their Anti - Tobacco song at their school. 5) Weekly ukulele classes began with the help of a parent volunteering. The supply of the ukulele's is in collaboration with Waters of Life Public Charter School. The ukulele classes enhanced communication, discipline and leadership skills. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Grassroots Community Development Group - Agency Name Kupukupu After - School - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate 30 Youth achieve pro - social and 100% 80% 90% communication skills competency 30 Youth report being drug -free 100% 80% 90% 30 Youth participate in community 100% 80% 90% activities which teach active citizenry. 20 Families of youth participate in 80% 80% 90% family strengthening events *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 35,000 15,000 25,000 Professional Fees 3,500 6,000 4,000 Operations 6,388 3,000 4,000 Equipment 3,368 2,000 2,000 Other" Total 49,256 26,000 35,000 * If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Grassroots Community Development Group - Agency Name Kupukupu After - School - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii 45,000 20,000 30,000 Donations 4,800 5,000 5,000 Other Grants 1,000 Total 49,800 26,000 35,000 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self-sustaining? This program plans to increase revenues through the following activities: 1) Grant writing to foundations, govemment and other entities 2)Fundraising events The goal is to be self- sustaining in four years. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 11 Page 5 Grassroots Community Development Group - Agency Name Kupukupu After - School - 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 shalt be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate vear -end report will impact the evaluation of your program's or agency's future funding requests. __, .Gol Yi - Av ni � i 2R /(c3 Signature of B rd Presid -nt/Ch:ir Date //R 1 1 O ignature of Executi e� Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 34 Habitat for Humanity General Operating Support/Staffing • Habitat for Humanity - Agency Name General Operating Support/Staffing - Program Name Agency Director: Patrick F. Hurney Phone No.: 331 -8010 Contact Person: Patrick F. Hurney Phone No.: 331 -8010 Mailing Address: PO Box 4619 Kailua -Kona, HI 96745 Facility /Site Address: 73 -5576 Kauhola Street, Space #4 Kailua -Kona, HI 96740 Fax No.: 331 -8020 Email Address: ed @habitatwesthawaii.org Name of Accountant/CPA (include name of firm if applicable): Alex Smith, CPA Phone No.: 877 - 257 -6484 Mailing Address: 1403 Frank Street, Honolulu, HI 96816 Amount of Request for County Funds: $50,000 Prior Year(s) Funding: 06 -07 07 -08 08 -09 09 -10 $ 15,000 $ 25,000 $30,000 -0- NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Habitat for Humanity - Agency Name General Operating Support/Staffing - Program Name Agency Mission Statement & Brief Narrative: Habitat for Humanity West Hawai'i (HFHWH) serves to empower low- income families and build community through homeownership for low- income partner families. Founded in 2001, HFHWH — an affiliate of the 2,000+ member - strong Habitat for Humanity International — addresses a critical need of renovating and building houses for low- income families earning between 40 -70% of the median income for West Hawai'i. In HFHWH delivery area, the median income is $40,172; on an island where 78.3% of homes are valued in the $200,000 to $999,999 range and only 64.3% of homes are owned. (See data table on the next page with references at the end of this proposal.) A typical Habitat homes costs it owner an average of $85,000, and is payable through a 20 -year no- interest mortgage. HFHWH stands apart from other entities that provide homes for those who can qualify for a mortgage — Habitat's partner families can not qualify for mortgages and it is solely though this non - profit organization that the dream of homeownership can become a reality. Families make a 1% down payment to start the process, and then are responsible for making monthly mortgage payments. These payments will equal about 21 % of their monthly income, usually $350 to $400. Volunteers provide most of the labor in the home's construction, with funding coming from individual, foundation, agency, and corporate donations covering up to 70 percent of the costs. Partner families themselves invest hundreds of hours of labor - "sweat equity" - into building their homes and the homes of others. Their mortgage payments go into a revolving Fund for Humanity that is used to build more houses. In its short history of building homes, beginning in 2003, HFHWH earned a `Home Builder" affiliate status — building 3 -4 homes a year — or a total of 8 builds, 1 renovation, earthquake repairs; they are now ramping up to earn "Neighborhood Builder" status as early as 2011, where they will be placing 10 - 20 low- income families into homes of their own; and also providing the support services necessary to insure these family's successful transition into sustained home ownership and ascending lifestyle changes. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Habitat for Humanity - Agency Name General Operating Support/Staffing - Program Name HFHWH SERVICE DELIVERY MAP PRIMARY SERVICE DELIVERY AREA DATA ®ACTOR I Ma )MM JTh Population 2000 la1ena`P;P 2020 island P r of primary area* 62,128 41.8 100.474 461 Median 14H Kohala Kona HOVE Avg. Income * / * ** $49,556 $44,834 $26,125 $40,172 Converted for Kohala Kona HOVE Avg. inflation * * ** $51,142 $46,941 $27,770 $43,386 HUD median income limit for a family of 3 = $48.600 HAWAII. ISLAND DATA F•aCTOR r 2008 DATA Households Total OwnPizer d / Owner % Renter (kcu I I * 63,088 40,587 64.3% 35 7% Before 1960 - 1980 - 2000 or n Year Built ** 1959 1979 1999 later Primary Service Delivery Area 18 1% 30.7% 40.5% 10.7% $0 - 8200.000- >$1 Median Secondary Service Delivery Area Home value ** $199.999 $999,999 million value 13.5% 78.3% 8,3% $380,300 a' Mortgage "' < 24.9 25.0 -34.9 35.0 - > 5 highest cost/HH income in nation 37.9'7 13 5 43.6 Elderly Total 65 w /disability % with disability _4,233 9,447 39.1% <$200- $500 -$999 >$1000 3 ` J ht hest Gross Rent ** $499 g 112% 355% 53 5% in nation - Cost of Hawaii County U.S. Measure Living * * * ** 111.71 100 of Families All Families Single Parent o Poverty Keiki <5 Keikt<18 Keiki <5 Keiki<18 Level ** 16.3% 12.0% 32 3% l 34 5% NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Habitat for Humanity - Agency Name General Operating Support/Staffing - Program Name Program Description: Habitat of Humanity West Hawaii is seeking $50,000 to expand its services to low- income residents in dire need of affordable housing. These funds will enable HFHWH to hire two staff, including: 1) Construction Coordinator: providing building supervision, construction management, and volunteer coordination of all activities on multiple and concurrent home builds; and 2) ReStore Coordinator: providing support in all aspects of HFHWH's ReStore operations including direct sales, merchandise web and in -store displays, and donations acquisition. Total Budget and Position Count: Total Program Budget $50,000 Total Position Count 1.5 Total Agency Budget $496,000 Total Agency Position Count (FT & PT) 6 Program Objectives: These staff additions are critical to changing the lives of an ever - increasing number of low- income families through meeting the following objectives. Construction Coordinator In the completion of past home construction, HFHWH has worked with a contracted construction coordinator, and while this has worked fine, the movement to a higher number of home builds, and the potential to build multiple homes at a time will require having a dedicated staff member focused solely on these project's needs and goals. This staff member will insure the smooth operations at multiple jobs sites and will be able to build in economies of scale into the expanding operations. The funding used to contract this position in the past will go directly toward the building of homes for low- income families. The Construction Coordinator's duties will include: ❑ Evaluating and determining appropriate construction methods and the most cost - effective plan and schedule; ❑ Dividing all required construction site activities into logical steps, budgeting the time required to meet established deadlines; ❑ Securing all the necessary permits and licenses; ❑ Overseeing the selection of trade contractors to complete specific pieces of the project —which could include everything from structural metalworking and plumbing to painting and carpet installation; ❑ Determining the labor /volunteer requirements; ❑ Overseeing the performance of all trade contractors – ensuring that all work is completed on schedule; ❑ Overseeing the delivery and use of materials, tools, and equipment; and the quality of construction, worker productivity, and safety; NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Habitat for Humanity - Agency Name General Operating Support/Staffing - Program Name ❑ Directing or monitoring compliance with building and safety codes and other regulations; ❑ Reviewing engineering and architectural drawings and specifications to monitor progress and ensure compliance with plans and schedules; ❑ Tracking and controlling construction costs against the project budget to avoid cost overruns; ❑ Preparing periodic reports of progress and requirements for labor, material, machinery, and equipment at the construction site; and ❑ Meeting regularly with HFHWH executive director, volunteer coordinator, and board members, along with any other constructors, trade contractors, vendors, architects, engineers, etc. to monitor and coordinate all phases of the construction project. Restore Coordinator The ReStore is a benefit to the community is so many ways. Prior to its opening, Hawaii County landfills were being overloaded with building material left over from various job sites. Along with this, building materials and home furnishing from area big -box stores that were outdated or slightly damaged were also being dumped to avoid the high cost of shipping these materials back to the manufacturer or home office. HFHWH's ReStore, with its non - profit status, offers a huge benefit to retailers, developers, and general contractors who receive a tax credit through their donation of unwanted material. Hotels, condominiums, and any individual who is upgrading and renovating can donate their old furnishings and goods to the ReStore and receive a tax credit. ReStore inventory changes daily, but generally includes: appliances, carpet, flooring, doors, windows, cabinets, sinks, toilets, lighting, electrical hardware, plumbing supplies, etc. These goods are made available for purchase at 40 — 90 percent discounts and the net proceeds go directly to the construction of homes for low- income folks. Further, much of the material and furnishing for Habitat homes comes from the ReStore and this savings helps extend the number and quality of homes HFHWH is able to build. This position has been part-time in the past, but desperately needs to be made full -time. The ReStore Coordinator's duties will include: ❑ Assisting in retail sales — helping potential buyers find just the right item; ❑ Creating merchandise displays — insuring that the store's presentation of merchandise is appealing and makes it easy to find items; ❑ Managing the inventory — and make sure that the website is updated with the current offerings; ❑ Serving as the point person with existing donors — and make sure that all donations and acknowledgments of donations are handled in a timely manner; and NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Habitat for Humanity - Agency Name General Operating Support/Staffing - Program Name ❑ Seeking additional donors — insuring that usable goods stay out of landfills and are available for purchase toward the ongoing support and benefit of Hawaii's low- income families. Program Highlights: ❑ 655,200 pounds of building material saved from the landfill (332 tons) ❑ 908 pounds of metal recycled — saved from the landfill ❑ ReStore income is 180% over budget. ❑ Hires include: an Executive Director, a ReStore Manager, and a Volunteer Coordinator ❑ HFHWH is on course to build four homes this fiscal year ❑ Carried out a five -year strategic planning process — plan is adopted ❑ Earned the Laulima Award for significant contributions towards making the community a better place to live and work ❑ 5,571 items donated to ReStore ❑ $20,000 of ReStore net goes directly to each home build NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Habitat for Humanity - Agency Name General Operating Support/Staffing - Program Name Performance Measures: Objective Activity Measure Who's Quantitative Outcome Responsible HFHWH builds > 10 homes per year by 2011 Place ad in West Patrick Construction is seamless, with no Hawai'i Today Hurney down time — ALL permits and and Craig's List materials readily on hand Hire Construction New 100 percent volunteer retention construction Coordinator Review coordinator . applications and is hired Multiple home building sites are create a short list Board of ongoing throughout the year — Directors always >1 Hold interviews Increase number of families Hire new staff served from 4 to > 6 Place ad in West Patrick Sales increase by 10 percent due Hawaii Today Hurney to a better knowledge and display and Craiq's List of stock Hits to the ReStore webpage Hire Review New increased by 10 percent through ReStore applications and ReStore marketing efforts Coordinator create a short list coordinator Board of Craig's List hits increase by 20 is hired Directors percent Hold interviews Donation from existing donors increases by 5 percent Hire new staff The number of donors increases by 25 percent NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 HABITAT FOR HUMANITY WEST HAWAII ORGANIZATIONAL CHART Showing proposed changes in positions this Grant will allow • L r Finance & Fund , Family , / Building & , / , Restore Executive Budget — Development — Selection — Repair — Committee — Board of Directors — Committee Committee Committee Committee Committee i • e l /\ J\ e ♦ J . . Executive Director -I I ( I A L.°ee -.– Community Construction 4 Bookkeeper ReStore Manager li _.. _ Relations Director L/ / Q Coordinator Site Supervisor ' ReStore Coordinator 1 (1 supervisor per build . r 1– currently 2 builds - 2 1 \ (Part-time) / ' supervisors contracted) 1 Legend: .z _.s. / _1 / 1 ■ Staff ReStore Construction j Volunteer Volunteers Volunteers 1' – ' 1 / \ / Contract 0 This position will become Full -Time NONPROFIT GRANT APPLICATION This nosition will hecome Staff FISCAL YEAR 2010 -11 Page 8 Habitat for Humanity - Agency Name General Operating Support/Staffing - Program Name Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 - Actual * Estimate 11 Budget Salaries and Wages 12,500 25,000 Professional Fees 25,000 25,000 Operations Equipment Other" Total 37,500 50,000 If applicable " Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Estimate Budget County of Hawaii 0 50,000 General Operating 37,500 Total 37,500 50,000 *If applicable Note: Because Habitat for Humanity West Hawaii has only one "Program" — the building of homes for low- income families — the "Agency" expenditures and funding sources are listed on the following page to help show the breath and depth of our fundraising efforts NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 11 Page 9 Habitat for Humanity - Agency Name General Operating Support/Staffing - Program Name Agency Expenditures FY 2008 -09 FY 2009 -10 FY 2009 - Actual * Budget 10 Estimate Salaries and Wages 130,724 111,008 171,310 Professional Fees 32,400 15,000 15,000 Operations 224,895 360,192 392,890 Equipment 1,500 1,500 Other" Total 388,019 487,700 580,700 Agency Revenue Sources Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget Estimate County of Hawaii 30,000 0 50,000 Private Contributions 44,308 50,000 50,000 Grants 27,550 50,000 Fundraising Events 12,800 40,000 Interest Income 1,449 1,700 1,700 Hawaii Island United Way 15,000 5,000 Habitat for Humanity 28,333 28,333 International Fund for Humanity 0 20,000 20,000 NAHASDA Building Loan Fund (Native American Housing Asst. & Self Determination Act) 0 100,000 100,000 ReStore 228,579 240,000 264,000 Totals 388,019 487,700 580,700 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 10 Habitat for Humanity - Agency Name General Operating Support/Staffing - Program Name Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? For the purposes of this proposal — the funding of two additional staff — sustainability is very close. The popularity of the ReStore has resulted in increased donations and increased revenues each year increase 10 percent — This is a trend that is expected to continue to grow, and will allow HFHWH to cover all operating costs and still provide increased funding for the building of new homes. For HFHWH programming, sustainability is also on course with the organization's growing "Fund for Humanity ". This fund is fed by the mortgage payments received by HFHWH partner families, which then revolves back into home development. The more Habitat homes built the fast and great the fund grows. HFHWH carries -out several fundraising activities including grant writing to foundation and governmental agencies, a direct ask campaign that brings in over $10,000 per year, a golf tournament that nets $20,000, and a special event in development with an estimated $20,000 net per year. By 2011, HFHWH and the Food Basket hope to be sharing a new warehouse that will minimize rent and allow more funding to go directly into the building of Habitat homes. Endnotes: * "Hawaii County Data Book " http : / /www.hawaii- county. com /databook_current/dbooktoc.htm ** Median Household Income "2008 American Community Survey: Hawaii County. Hawaii." U.S. Census Bureau * ** Average family size 2.75 - "Hawaii County Data Book." http://www.hawaii- countv.com/databook current/dbooktoc him 4 t t" Inflation Conversion Factors for Dollars 1774 to Estimated 2019, by Robert Sahr. hero: / /oreeonstate.edu /cla /polisct /faculty- research /sahr /sahr.htm (factor used 1 032) 47 ") Federal Register / Vol. 73, No 237 / Tuesday, December 9, 2008 amr.snm>pJjmr/regnter/?r008/ del 09/ES- 23X32.df NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 11 Habitat for Humanity - Agency Name General Operating Support/Staffing - 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board President/Chair Date 75,4 kin / rrraer 7 - c /ro /e Signature of Executive Director Date P4rmeK F. NI/RNE UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 12 35 Hale Aloha 0 Hilo Habitat for Humanity, Inc. Affordable Housing Operations Hale Aloha 0 Hilo Habitat for Humanity, Inc. - Agency Name Affordable Housing Operations - Program Name Agency Director: Vacant Phone No.: 935 -6677 Contact Person: Julie Hugo Phone No.: 990 -0426 Mailing Address: 700 Manono Street, Suite 102 Hilo, HI 96720 Facility /Site Address: 700 Manono Street, Suite 102 Hilo, HI 96720 Fax No.: 935 -6637 Email Address: eo @hilohabitat.org Name of Accountant/CPA (include name of firm if applicable): Alex J. Smith CPA Phone No.: 877 - 257 -6484 Mailing Address: 1403 Frank Street, Honolulu, HI 96816 Amount of Request for County Funds: $50,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0.00 $0.00 $0.00 Agency Mission Statement: To eliminate homelessness and create community by building and rehabilitating affordable housing. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Hale Aloha 0 Hilo Habitat for Humanity - Agency Name Affordable Housing Operations - Program Name Program Description: Hale Aloha 0 Hilo Habiat for Humanity, Inc. (Hilo Habitat) builds and rehabilitates affordable homes, which is top priority in the county of Hawaii's 2005 -2009 community plan. Hilo Habitat serves families earning between 30 -60% of the area median income, reaching families with children, the elderly and the disabled. Families are selected based on housing need, ability to pay and willingness to partner in sweat equity for 500 hours. Unlike Habitat for Humanity of West Hawaii,Hilo Habitat does not require families to own or have access to land. The homes are primarily built by volunteers, so they are far cheaper to construct than commercially - produced homes. After completion, the homes are sold to the partner families at no interest with no down payment required. Loans are for a term of 20 years. These construction and financing terms make it possible for at risk families who could never ordinarily become homeowners to become economically and socially stable, and often at a lower cost than renting. This is an excellent investment in a social program which benefits our community. Hilo Habitat is now preparing for the next phase of its development, which includes growth in services, especially as housing and jobs suffer in our current economy. In order to increase the organization's capacity to build and rehabilitate more affordable homes at this time of greater need. County support is requested to support additional salaries and overhead expenses. This support will enable Hilo Habitat to: - Build 3 new homes - Expand volunteer and donor base - Expand our ReStore (recycled building materials outlet), which recycles and sells new and gently used home improvement products and furniture. This offers people in our community a place to shop for items to repair or improve their homes affordably. Our effort to recycle these items diverts waste material from the landfill, and also generates revenue for the organization. Total Budget and Position Count Total Program Budget $117,000 Total Program Position Count 3 Total Agency Budget $167,000 Total Agency Position Count 5 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Program Objectives: 1) Volunteer - builds and increasing affordable housing opportunities, expanding partnerships to address homelessness and poverty housing. a. Partial funding for resource development work done by executive director. This would allow additional grant opportunities, community outreach, and faith group support (money and time). $11,500 b. Partial funding for resource development work done by contracted resource manager. This would allow additional grant opportunities, community outreach, and faith group support (money and time). $11,500 c. Hire part -time assistant ReStore manager to support our new recycled building materials outlet. $15,000 2) Partially fund operational cost for ReStore (lease /utilities). $12,000 Program Highlights: (from Fiscal Year 2008 -09) 1) In FY 08 -09, Hilo Habitat completed 3 builds, supporting 14 people with new affordable housing 2) Received four new grants, supporting resource development and automation for greater efficiency and better service 3) Increased its volunteer involvement by 20% to a total of 150 volunteers 4) Increased community outreach through a quarterly printed newsletter, a monthly electronic newsletter, and ongoing newspaper and radio publicity, and participation in seven community events 5) Obtained storage containers, began networking with local stores and contractors, and began online ReStore sales 6) Opened ReStore 200 square foot retail space at 140 Kinoole Street (March 2009) NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Hale Aloha 0 Hilo Habitat for Humanity - Agency Name Affordable Housing Operations - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Homes Completed 3 0 3 Homes Begun 0 3 1 Individuals Served 15 -20 12 -14 35 -50 Active Volunteers 120 200 225 Contract Staff /Employees (Part- 2 2 2 Time) Employees (Full -Time) 0 0 1 ReStore Manager (Full -Time) 0 1 1 Construction Supervisor (Part -Time) 1 1 1 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages $0 $40,000 $60,000 Professional Fees $39,660 $18,000 $30,000 Operations $40,490 $38,000 $77,000 Equipment Other" Total $80,150 $96,000 $167,000 * If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 • Hale Aloha 0 Hilo Habitat for Humanity - Agency Name Affordable Housing Operations - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Donations & Offerings $8,688 $10,787 $10,000 Fundraising $7,748 $11,645 $17,000 Grants (Miscellaneous) $33,470 $14,750 $10,000 ReStore $11,504 $30,000 $50,000 Rental Income $12,005 $6,700 $0 Hawaii Island United Way $0 $5,000 $5,000 County of Hawaii Grant $0 $0 $50,000 NAHASDA Grant $0 $5,000 $25,000 Total $73,415 $94,132 $167,000 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? This county support would be used to expand our volunteer and donor base, increase grant writing, and to retain and staff our ReStore (recycled building materials retail outlet). All of these increase capacity and strengthen the organization financially, moving it toward being self- sustaining. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Hale Aloha 0 Hilo Habitat for Humanity, Inc. - Agency Name Affordable Housing Operations - 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. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, 1 (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or a• enc ' future fundin. re. uests. A - .*sa J44 Sig - - of Board President/C " air Date V a (-. a.y) - NI Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 36 Hale Kipa Intensive In -Home Hale Kipa - Agency Name Intensive In -Home- Program Name Agency Director: Ernest Pletan -Cross Phone No.: 589- 1829 x101 Contact Person: Jaque Kelley - Uyeoka Phone No.: 589 -1829 ext. 201 Mailing Address: 615 Piikoi Street Suite 203' Honolulu, Hawaii 96814 Facility /Site Address: East HI: 622 Hinano Street, Hilo, Hawaii 96720 West HI: 74 -381 Kealakehe Parkway #1, Kailua- Kona, Hawaii 96740 Fax No.: (808) 945 -9007 Email Address: jaq @halekipa.org Name of Accountant/CPA (include name of firm if applicable): Maria Gozzip Phone No.: 589 -1829 x 112 Mailing Address: same as above Amount of Request for County Funds: $40,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $50,000 $60,000 $40,000 Agency Mission Statement: To provide opportunities and environments that strengthen and encourage youth, their families and communities to actualize their potential and social responsibility. Hale Kipa, Inc. - Agency Name Intensive In -Home- Program Name Program Description: Hale Kipa's Intensive In -Home (IIH) Program provides island -wide comprehensive, home and community -based treatment services to youth with Severe Emotional and Behavioral Disturbances intended to preserve and /or strengthen the family's capacity to improve the young person's functioning in the current living environment and prevent the need for a more restrictive treatment placement. Hale Kipa serves the entire island out of sites in both Hilo and Kona. Target Population: Any young person referred by CAMHD between the ages of three (3) and twenty (20) who has emotional, mental health or behavioral needs that interfere with obtaining education. Model: The IIH program is based on the Wraparound model of care and adheres to Hawaii's Child and Adolescent Service System Program (CASSP) Principles. These services include: 1. Community Based Services that are provided primarily in the family's home, school, and other settings that are comfortable and convenient for the young person and family. 2. Families as Partners where families are full participants in all aspects of planning and delivery of services. IIH Therapists and Paraprofessionals utilize an empowerment approach, wherein youth and the family guide their own services. 3. Individualized and Strength -Based Services: Mental health treatment services and supports are tailored to the youth and family's unique goals and informed by cultural preferences. 4. Formal and Informal Supports: IIH practitioners seek to identify a wide array of formal and informal supports that are available to each youth and family to ensure that treatment gains can be optimized and replicated after services end. 5. Collaboration: The IIH Therapists are fully engaged with all others involved with the family and will provide necessary linkages to needed supports through internal and external coordination of activities and referrals. Services Once admitted to the program, each family is assigned a trained Fee for Service Intensive In -Home Therapist and, if aligned with the youth's Mental Health Treatment Plan, a paraprofessional. The IIH Therapist develops respectful, family- centered working relationships that seek to be most successful in their goal achievement. The therapist assists the family to identify and cultivate improved family, peer, and community relationships and improve the academic performance of the youth. Sessions focus on fulfilling the youth and family's treatment plan goals. IIH employs a comprehensive array of services that address the young person's physical, emotional, educational, recreational and developmental needs that includes: • Conducting Mental Health Assessments using a strengths -based approach, • Developing individualized Mental Health Treatment Plans • Educating young people and families on diagnoses, prognoses, treatments, and community service delivery system • Providing individual and family therapy • Enhancing positive communication, decision - making, and conflict resolution skills among all family members through purposeful skill building activities such as education, modeling, practice sessions, and homework • Assist in developing and maintaining meaningful relationships and helpful support systems that assure the protection and safety of all family members. • Identifying and problem solving barriers to goal attainment; (this may also include understanding the barriers in new and more helpful ways). • Enhancing educational and vocational skills and strengthening the young person's meaningful participation in society.Management of symptoms of mental health diagnoses, through psychoeducation, therapeutic interventions, and family support • Assisting families obtain access to services to meet basic needs • Address and prepare for potential crisis situations to limit the need for emergency interventions • Responding to calls for assistance in assessing and addressing crises • Discussing the effect of medications on symptoms; identifying potential adverse effects; monitoring and enhancing compliance to prescription medications Services are available twenty -four (24) hours a day, seven (7) days a week. The length of IIH Services is individualized to the circumstances /needs of each young person and their family. Total Budget and Position Count Total Program Budget 610,000 Total Program Position Count 22 (inc. Part Time Ther. and PP Total Agency Budget 11,412,520 Total Agency Position Count 290 Inc. Part Time Program Objectives: 1) To recruit, hire and train staff to ensure appropriate number of personnel to provide IIH services island -wide. (Number will be larger in East Hawaii than West Hawaii. This will be an on -going program objective and will track number of trained staff.) 2) To accept 95% of all youth referred to the program. 3) To provide a minumum of 13,000 service hours to at least 100 youth /families per year (trend would be to anticipate that almost 3/4 of youth would be in East Hawaii area. ) 4) To provide supervision to staff at least 3x per month when staff are providing services to youth. 5) To provide a monthly group supervision /training session to all Therapists and paraprofessionals (12 for East Hawaii and 12 for West Hawaii) 6) Program Highlights: (from Fiscal Year 2008 -09) 1) Hired strong Intensive In -Home Program Coordinator (East Hawaii) with excellent related experience and established professional relationships in the community. 2) Hired Therapists with a range of skills to respond to youth and families in need. 3) West Hawaii Program Coordinator (new to this position) began to spark more referrals in West Hawaii. 4) East Hawaii referrals grew to be largest of all Hale Kipa IIH sites. 5) Families and workers expressed much positive satisfaction with services received. 6) Hale Kipa, Inc. - Agency Name Intensive In -Home - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate 85% of youth who complete IIH 83% 85% 85% program will exnibit desired change in targeted behaviors as indicated in their Mental Health Treatment Plan. (e.g. youth is promoted to next grade, reunites with family, curbs running) 90% of youth will successfully 88% 90% 90% remain at home or transition to appropriate placement upon completing program (e.g. reunify with family, transition to independent living) *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 290846 477000 485000 Professional Fees 820 2300 3900 Operations 86852 127500 132000 Equipment 1015 3200 4100 Other' Total 379533 610000 625000 * If applicable " Please explain in detail on separate sheet Hale Kipa, Inc. - Agency Name Intensive In -Home - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Child and Adolescent Mental 290,951 560,000 575,000 Health -Dept. of Health Total *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? We have been becoming more self- sustaining as noted by our revenues. This is all dependent on referrals from CAMHD which have been increasing due to our positive reputation with good therapists and paraprofessionals. Hale Kipa, Inc. - Agency Name Intensive In -Home - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 - 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 1 -22 -10 Signature of oard President/Chair Date Dh U —C �G- l� 1 - z t - t O Signature of Executi Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! 37 Hamakua Youth Foundation Hamakua Youth Center 1 HAMAKUA YOUTH FOUNDATION — Agency Name HAMAKUA YOUTH CENTER- Program Name Agency Director: Venica Ftacek Phone No.:775 -0976 Contact Person: Venica Ftacek Phone No.:775 -0976 Mailing Address: P.O. Box 381, Honokaa, HI. 96727 Facility/Site Address: 45 -3396 Mamane St., Honokaa, HI. 96727 Fax No.: (808)775 -0976 Email Address: venica _ftacek@hamakuayouthfdn.org Name of Accountant/CPA (include name of firm if applicable): Chris Clarke, Accounting and Tax Services Phone No.: 775 -1966 Mailing Address: 45 -3290 Ohia St., Unit 5, Honokaa, HI. 96727 Amount of Request for County Funds: $42,000 Prior Year(s) Funding: 07-08 08-09 09 -10 $45,000 $20,000 $15,000 (YWCA/HYC) (YWCA/HYC) (YWCA/HYC) Hamakua Youth Foundation Mission Statement: The Hamakua Youth Foundation (HYF) is a community based organization dedicated to creating no -fee, nurturing youth services programs for ages ten through eighteen during non - school hours, engaging youth in environmental sustainability and stewardship, providing Hawaiian culture and arts education, developing youth leadership, and connecting youth and their families with local social services agencies Program Description: In our fifteenth year of serving Hamkua youth, the Hamakua Youth Center founded the Hamakua Youth Foundation and received 501 -c -3 status as of September 15, 2009. Managed under the umbrella of the YWCA, Hawaii Island for the last 6 years, we remain partners in serving the youth of the Hamakua district. The Hamakua Youth Center (HYC) is a drop -in youth and community center open after school Monday through Friday 10am to 5pm during school intersession and summer break. Our no-fee services to youth and families serve 425 youth ages 10 to 20 annually with 150 participating on a weekly basis. Our doors are open to children as young as 6 if they are accompanied by an older sibling. Research shows that youth who are left alone and are not engaged in positive social and recreational activities are at a high risk for experimental behavior with drugs, alcohol, sex, are vulnerable to feelings of loneliness and isolation and are prone to injury and accidents. 2 HAMAKUA YOUTH FOUNDATION — Agency Name HAMAKUA YOUTH CENTER- Program Name HYC provides a safe environment for youth on a daily basis at no cost to their families. Staff identifies areas of need and connects the youth with services such as dentistry, family planning, counseling, mediation, and food distribution to the families of our youth participants. We provide a positive adult - supervised environment where youth know they can find assistance and solutions to the many difficult situations they are facing. Many youth call HYC their 'Ohana House or second home. The primary reason for our program's success is the consistency of our service, the daily response to basic needs such as healthy food, safety, shelter and a sense of belonging and involvement in positive group and individual activities. All of these factors serve to reduce risky behavior, provide social cohesion, offer support and assistance, and encourage persistence with challenges and learning new things. This in turn fosters initiative and self- esteem, develops critical thinking and leadership skills thereby reducing alienation, loneliness, escapism and unhealthy experimentation. We provide a safe, nurturing and reliable gathering place for youth from after school until dark and are consistently open every day after school and also on school breaks. HYC's trained staff keep the rules of the center in order and engage the youth in positive activities, encourage them to try new things, and model unconditional positive regard. HYC staff provide an extended support system for youth academically, socially, and as confidants for interpersonal issues. AGRICULTURE: Integrates our Hawaiian agriculture program, Mahi'ai, with community food sustainability, our partnership in the Community Garden providing place -based learning for our youth in the Hamakua A'apua'a. At our last fundraiser in November, we were gifted the land behind our Youth Center to create a multi - generational, multi - cultural community garden. BACKPACK PROGRAMIFAMILY FOOD DISTRIBUTION: Collecting food from local farmers and ranchers, Food Basket, USDA Surplus Food Distribution and sending it home with our youth. COUNCIL: The practice of "council" that arises in one form or another in all traditional cultures acts as an ideal context for our multi- cultural youth to learn to articulate their feelings, values and ideas. In Hawaii, council appears as ho'oponopono, and is used to settle personal and clan issues in a respectful and ceremonial manner. Council builds community in a strong way and is an excellent context for group decision- making, conflict resolution and brainstorming. COMMUNITY SERVICE: Youth are referred to HYC from both Family Court and Teen Court to fulfill their community service hours. Many youth who visit us due to mandatory community service continue to access the Center as a support system long after their service is over. We engage them on three levels: connect them with our Hawaiian culture program; provide them with access to family planning and health services; assist them in clearing up any unfinished business. DROP -IN: Daily Homework/Computer lab and recreation; mandatory homework club for youth up to eighth grade, and voluntary homework assistance is available to all high school students. We provide healthy afterschool snacks and meals at no cost. Each day at HYC, youth have the option to play pool, ping pong, board games, utilize the computers, participate in art, music and Hawaiian Culture programs and participate in program design with the youth leadership council GENDER - SPECIFIC GIRL'S AND BOY'S NIGHT: A safe forum to share feelings and discuss issues of vital importance to teen girls and boys in a confidential, supportive circle. Guests are gender - specific, positive adult role models. Facilitated through the practice of Council. HAWAIIAN CULTURE: Living Hawaiian Culture Program: Initiated three years ago, this integral and unique part of the HYC programming focuses on the teaching of traditional Hawaiian values through dance, music, arts and crafts, and outdoor environmental and agricultural projects. The Living Hawaiian Culture program is focused on four main areas of learning: Makahiki, Hula, Mahi'ai, and Malama Aina. This project provides our multicultural youth with experiential learning opportunities to expand their horizons through the arts, humanities and traditions of our Host culture. This approach is inclusive of core human values that our multicultural youth can build on toward shared positive outcomes and inspire the next generation of leaders. MULTIMEDIA/MUSIC: HYC Performance: We hosted NPR's "From the Top° Youth performance program in January 2010.We offer free group and individual music lessons; piano, ukulele, drums 3 HAMAKUA YOUTH FOUNDATION — Agency Name HAMAKUA YOUTH CENTER- Program Name and percussion. We have a multimedia studio for recording /engineering, MIDI sampling, Photoshop, video editing, Cd /Dvd production and distribution. COMMUNITY COLLABORATIONS: Skate park:(Hamakua Skate Club) Providing grant workshops for their youth and partnering with them in support of developing a skate park for the youth in our community. NHDFC: Staff member sits on Strategic planning team in the area of prevention and anti-drug services for youth. They provide us with training for staff and volunteers, and drug and alcohol prevention literature. SCHOLARSHIP FUND: New program: 2 youth scholarships Total Budget and Position Count Total Program Budget $177,184 Total Program Position Count 5 Total Agency Budget $177,184 Total Agency Position Count 5 Note: (1 ) FT salaried Executive Director, (1 )PT Cultural Specialist, (1 PT) Program Coordinator, (1) PT Administrative Assistant, and (1 )PT Program Leader. Program Objectives: The primary purpose of the Hamakua Youth Center is to provide youth with a safe environment during non - school hours. Both structured and unstructured activities with adult supervision reduce the risk factors and increase the protective factors influencing the behaviors of and outcomes for youth in Hamakua. The objectives are to: 1. Provide youth services in non school hours as a preventative factor in drug and alcohol 2. Values /place based learning 3. Engage youth in projects that foster confidence, self esteem and a sense of belonging Program Highlights: (from Fiscal Year 2008 -2009) • No new pregnancies among the Program: kids access food surplus girls who regularly visit the Center, on an as -need basis serving over 50 • Significant reduction in acting out, families. reduction in risk - taking behavior • Furlough Fridays with providing a amongst our regular youth. Hawaiian - Culture -based 8 -5 • Increased use of conflict resolution program at no fee. and successful completion of • Gender - specific Girls and Boys community service referrals of over nights, 20 youth engaged in cultural values • Hula for youth and community and leadership training. members, Perpetuating Hawaiian • Family planning, dental and culture including Makahiki training. counseling referrals, court dates, as • We continue our multi-media and well as transportation and music projects accompaniment for minors to their • Development of a Community needed services acting as Garden. advocates for youth. • Organizational: Applying for and • Connect families in crisis with basic receiving 501 -C -3 status as the necessities and services. Backpack 4 HAMAKUA YOUTH FOUNDATION — Agency Name HAMAKUA YOUTH CENTER- Program Name Performance Measures: FY 2010 -11 Average daily attendance by youth 30 Total number of youth served annually 300 Total number of waivers /orientations on file 150 signed by parents of youth participants Agricultural /Mahi'ai /Comm. Garden 100 Backpack Program /Family Food Distribution 50 Council 100 Community Service 30 Hawaiian Culture Programs 75 Multimedia /Music 75 Scholarships 2 Community Capacity Building 25 Total Number of Volunteers /Partnerships 75 *`Please see Attachment "A ": Performance Measures for '08 -'09 and '09 -'10. Performance measures for '10- '11 have changed due to new programs. Program Expenditures: FY 2008 -09 Actual * FY 2009 -10 Budget FY 2010 -11 Estimate Salaries and Wages & $75,707.26 $77,668 $119,569 Health Benefits Mandatory Benefits $15,415 Professional Services $3,590.38 $9200 Operations /Rent $41,013.45 $42,831 19,500 Equipment $2000 Instructors/Ind.Contractors $7000 Scholarships $3000 Fundraising Costs $1500 Total $120,311.09 $120,499 $177,184 Program Funding Sources: Identify all funding sources (specific to this projram only) Revenue Source *FY 2008 -09 *FY 2009 -10 FY 2010 -11 Actual Actual Estimate County of Hawaii $20,000 $15,000 $42,000 Friends of the Hamakua Youth Center $19,138 $35,200 Donations $25,000 Private Foundations $5,000 $45,000 Hawaii Island United Way $18,500 $13,000 $15,000 Other Government Grants *14,000 $40,000 Cooke Family Foundation $5,000 Change Happens Fund $4,000 John Ross Fund $5,000 Takie Okumura Fund $5,000 Atherton $15,000 SOH Office of Youth Services $12,251 Hawaii County County Council $25,000 YWCA Hawaii Island $20,422.09 Total $120,311.09 $91,000 $177,200, *FY08 -09 & 09 -10, HYC under the fiscal management of YWCA. * *2 Healing Our Island Grants. 5 HAMAKUA YOUTH FOUNDATION - Agency Name HAMAKUA YOUTH CENTER — Program Name Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self -sustaining? The Hamakua Youth Foundation's mission is to provide quality no-fee youth services programs on a sustaining basis. We are currently beginning a process to create a 3-5 year strategic plan, which includes obtaining funding resources from local community businesses, organizations, and individuals. Funding will continue to be raised through a fundraising campaign via the "Friends of the Hamakua Youth Center", our fundraising arm and sponsorship and participation in community special events. Our plan is to keep administrative overhead costs as low as possible by expanding the scope of programming with local financial support, partnering with other youth services agencies, and community volunteers. The all- volunteer Hamakua Youth Foundation Board of Directors works in concert with staff in grant writing, media, marketing, and community outreach. Future Program Support: The Hamakua Youth Foundation (HYF) will be beginning a strategic planning process that will focus on our long term sustainability and address the needs of the Hamakua Youth Center (HYC) over the next 3 -5 years. The HYF will continue to seek funding from the North Hawaii community through an annual fundraising campaign which includes special events sponsored by it's fundraising arm, the Friends of the Hamakua Youth Center. The all- volunteer Hamakua Youth Foundation Board of Directors works in concert with staff in grant writing, media, marketing, and community outreach. Board members will continue to seek funding from individuals in the local community; financial support through grant proposals to private foundations and the business community. The Foundation will also expand the volunteer network that provides support to the staff of the Hamakua Youth Center. This network consists of Board members, seniors, and other youth advocates with expertise in various fields of interest to the youth in the Honoka'a community. HYF is fortunate to regularly receive donations of food from the Hawaii Island Food Basket, Queen Liliuokalani Children's Center, T Kaneshiro Store, etc. as well as food donations from individuals. The Foundation recognizes the need for collaboration with local businesses and other non - profit organizations and that collaboration is the best and most effective use of limited resources. Community Supporters: Working Partners Salvation Army ARC of Kona Waipi'o Circle Artists Mean Business YWCA Hawaii Island Department of Education Kupuna Program Community Supporters Hamakua Harvest Hamakua Times Hamakua Health Center Honoka'a Business Association Hawaii Sustainable Education and Research Hawaii Community Foundation Staff Award (2009) Center Community Garden ILWU Hawaii Island Local 142 Jr. Forestry Team- Hawaii Community College North Hawaii Hospice Kanu o Ka Aina Learning Ohana Queen Lilliuokalani Children's Center McGuire Media Productions Rock N Renew North Hawaii Drug Free Coalition YWCA Hawaii Island North Hawaii Education and Research Center The many community members who contribute Honoka'a Peace Day Committee through the Friends of the Hamakua Youth Foundation fund raising efforts. HAMAKUA YOUTH FOUNDATION - Agency Name Hamakua Youth Center - 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. 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 near. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. / '-77 ,/ //O Sign re of Bo President/Chair Date & zti kwe 1 / .2& /Iv Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 38 Hawaii Centers for Independent Living Independent Living Services Hawaii Centers for Independent Living- Agency Name Independent Living Services- Program Name Agency Director: Gordon Fuller Phone No.: 522- 5400 Contact Person: Nathan Holmes Phone No.: 522- 5400 Mailing Address: 414 Kuwili St., Ste. 102 Honolulu, HI 96817 Facility /Site Address: 1055 Kino'ole Street, Suite 105 Hilo, HI 96720 Fax No.: 1- 808 - 522 -5427 Email Address: nathanh @pacificil.org & Gordonf @pacificil.org Name of Accountant/CPA (include name of firm if applicable): Fred Hattori, Hattori & Co. CPA Inc. Phone No.: 1- 808 - 949 -2656 Mailing Address: 1481 S. King Street, Suite 232, Honolulu, HI 96814 Amount of Request for County Funds: $15,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $15,000 $15,000 $15,000 Agency Mission Statement: The Hawaii Centers for Independent Living (HCIL) is a non - profit organization operated by and for people with disabilities to ensure their rights to live NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 independently and fully integrated in the community of theft choice, outside of institutional care settings. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Hawaii Centers for Independent Living - Agency Name Independent Living Services- Program Name Program Description: As a non - profit, county -wide resource, HCIL serves people of any age with any type of disability. HCIL was founded on the historical constitutional belief in civil rights and the empowerment of people with disabilities to have equal access, opportunities and choices in life no matter how severe their disability. To accomplish this, HCIL actively seeks systems change and promotes self - advocacy. The Philosophy That Guides HCIL Is Three -Fold: 1. HCIL's objective is to present information on a wide array of options, from full independence to other forms of community -based living, from which individuals with disabilities can make their own personal choices. 2. HCIL provides consumer - driven services. The needs of people with disabilities can be met effectively by comprehensive programs encompassing personal care, housing, transportation, work, daily living skills, training and education -- the list is almost endless. Individualized services are provided upon consumer requests. 3. People who have personal experiences with disabilities understand the needs of people with disabilities best and know how to meet those needs. It is this peer relationship between counselor and consumer that distingiushes HCIL. Total Budget and Position Count Total Program Budget 217,101 Total Program Position Count 6 Total Agency Budget 1,025,503 Total Agency Position Count 30 Program Objectives: 1) To provide Landlord/ Tenant Code training, teach how to complete housing applications, and teach how to locate and maintain housing. This will reduce risk of homelessness and dependence on others. This service will be provided to 20 individuals. Timeline: 7/1/10 - 6/30/11. 2) To provide consumers with screened personal attendant referrals. HCIL staff checks personal assistant applicants' references, criminal NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 background, TB clearance and professional training and experience. HCIL also teaches consumers personal attendant management. This helps prevents institutionalization and dependence on family, friends, and neigbors. This service will be provided to 20 individuals. Timeline: 7/1/10 - 6/30/11. 3) To provide one -on -one independent living skills training to assist consumers with carrying out living activities such as housekeeping, shopping, laundry, cooking, etc. This will reduce dependence on others. This service will be provided to 10 individuals. Timeline 7/1/10 - 6/30/11. 4) To educate consumers about ADA laws and how to access legal services. This empowers consumers and strengthens self- advocacy. This service will be provided to 30 individuals. Timeline 7/1/10 - 6/30/11. 5) To provide one -on -one training on video relay services for the deaf. Serve as the location where consumers can file complaints if they have problems with the 711 service. This service will be provided to 10 consumers. Timeline: 7/1/10 - 6/30/11. 6) To provide consumers with appropriate housing referrals. This will increase their independence and decrease dependency on family and /or friends. 15 people will locate and move into housing. Timeline 7/1/10 - 6/30/11 7) To provide consumers with job readiness skills. These skills include resume writing, job interviews, locating employment opportunities, and job requirements. This will provide consumers with skills to acquire employment and become more independent. This service will be provided to 8 consumsers. Timeline 7/1/10 — 6/30/11. 8) To provide consumers with basic computer skills training. Includeding learning how to use e-mail, word processing, and the use of the Internet to access information. This will create another form of access to the community. This service will be provided to 5 consumers. Timeline 7/1/10 - 6/30/11. 9) To teach consumers about entitlements and benefits. This will enable consumers to access services and programs they qualify for and contribute to further and support their indepedence. This service will be provided to 30 consumers. Timeline 7/1/10 - 6/30/11. 10) To provide information about and referrals to various resources in the community. This will increase their independence. Timeline 7/1/10 - 6/30/11.. Program Highlights: (from Fiscal Year 2008 -09) 1) During this past year, the HCIL staff was able to provide housing services to 109 consumers. Consumers received information about how to search and apply for appropriate housing. Consumers were informed about various housing subsidies and how to access them. Consumers learned about accessibility features and accomodations. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 2) Staff assisted 64 consumers with accessing Personal Assistant services, provided attendant referrals and assisted consumers with obtaining grants and insurance benefits to pay for the assistants. 3) Staff provided individualized Independent Living Skills training to 13 consumers. These skills included money management, personal assistant management, and homemaking skills, Also, one consumer received training on how to apply for college, individualized test taking skills, and completing financial aid applications. 4) Staff provided assistance with finding legal services for 58 consumers and provided information about the ADA Law in regards to accomodations, such as sign language interpreters in public schools, companion animals and accessible housing. 5) Staff trained 11 consumers in the use the video phones. This enables consumers with hearing impairments to better access agencies, businesses and resources in the community. This was especially helpful for those who were in process of applying for Social Security benefits. 6) Staff provided information and referral services to consumers who needed assistance with issues not addressed by HCIL services. 7) Staff provided computer training to 37 consumers. The individualized training included word processing, internet skills, and programs for the vision impaired. This provided consumers with better access to the community. 8) HCIL also has an outreach program. Some Independent Living Specialists work out of their homes, live in the communities they serve and are able to meet consumers where it is most convenient for them. This program is most beneficial to consumers who live in the outlying and rural areas of the County of Hawaii. 9) 183 clients accessed HCIL services 10) 114 had multiple disabilities 11) 25 had physical disabilities 12) 21 had hearing impairment 13) 17 had mental /emotional disabilities 14) 104 were female 15) 79 were male 16) 105 active cases NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page Hawaii Centers for Independent Living - Agency Name Independent Living Services - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate 31 Pieces of adaptive equipment 201.71 201.74 201.74 112 Housing and Shelter Services 2,952.74 2,952.74 2,952.74 75 Independent Living Skills Srvcs 2,769.34 2,769.34 2,769.34 126 Self -care Services 4,163.18 4,163.18 4,163.18 10 Recreational Services 660.24 660.24 660.24 18 Vocational Services 201.74 201.74 201.74 37 Transportation Services 385.14 385.14 385.14 34 Communication Services 201.74 201.74 201.74 49 Personal Resource Management 917.00 917.00 917.00 27 Self - Avocacy Services 788.62 788.62 788.62 27 Advocacy Services 385.14 385.14 385.14 9 Access the Comm. /Social 1,375.50 1375.50 1375.50 Participation *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 4,903.34 9,500 5,500 Professional Fees 1,343.01 1,000 3,000 Operations 6,808.20 2,750 3,550 Equipment 128.17 500 600 Other" 1,817.28 1,250 2,350 Total 15,000.00 15,000 15,000 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Hawaii Centers for Independent Living - Agency Name Independent Living Services - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate State of Hawaii 117,726.40 89,675 200,000 Federal Funds 175,071.40 184,166 200,000 Hawaii County 15,000 15,000 15,000 Hawaii Island United Way 20,000 20,000 20,000 Total 327,797.80 308,841 435,000 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Hawaii Center for Independent Living is currently working on creating "employment networks" for people with disabilities and is working with the Social Security Administration to assist consumers with the "Ticket to Work" program. Emphasis is on employment, self - employment and entrepreneurship. This program will generate income from the Social Security Administration. HCIL is currently completing an application for Stimulus monies under the Title VII Part C Federal funding to assist with increasing outreach services, providing staff training and improving HCIL's internal communication system. We will be applying for additional grants to support specific service areas such as grants aimed toward expanding employment opportunities, a more comprehensive Personal Assistant Service, broadband services, and technology training. We anticipate that the program will become self- sustaining in the coming years. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 Hawaii Centers for Independent Living - Agency Name Independent Living Services - 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. N Or -iv Signature of Boa Pr ident/Chair Date lbCAD Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 39 Hawaii Children's Complementary Therapy and Research Clinic (Mana Ola 0 Ka Lani) Educational Health Programs Hawaii Children's Complementary Therapy and Research Clinic Mana Ola 0 Ka Lani "The Living Power from Heaven" PROGRAM NAME: Educational Health Programs Agency Director: Judith Chandler Phone number: 775 -0896 Contact Person: Theresa T. Potter Phone number 775 -1725 Mailing Address: P.O. Box 1191 Honokaa, Hawaii 96727 Facility/Site Address: 45 -3221 Ohia Street Honokaa, Hawaii 96727 Fax No. 775 -1725 E -mail Address: pottert003(&vahoo.com Name of Accountant /CPA (including name of firm if applicable) Chris J. Clarke Phone No: 775 -1966 Mailing Address: 45 -3290 Ohia Street, Unit 5 Honokaa, Hawaii 96727 Amount Requested: $17,755.00 Prior Year (s) Funding 07 -08 08 -09 09 -10 $ 0 $0 $ (Please see financial sheet) AGENCY MISSION STATEMENT: The mission of Hawaii Children's Complementary Therapy and Research Clinic- Mana Ola 0 Ka Lani, is to efficiently, provide quality care while seeking the best outcome for Children with serious medical issues. NON PROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Hawaii Children's Complementary Therapy and Research Clinic Mina Ola O Ka Lard "The Living Power from Heaven" PROGRAM: Educational Programs on Big Island Living Program Description: Big Island Living is a television show, which can be seen on channel 53 on Oceanic Cable on the Island of Hawaii. Our health shows will also be seen on Hawaii Streaming.Com for residents on the Island who does not have Oceanic Cable but has Dish. Big Island Living will do the following TV shows based on the following: Preventative and Health Care Maintenance, Educate parents about the different Integrative Health Care Therapies that can be used to help their child who are in pain. As well, as our Keiki and Me workshops held during school break (Spring, Summer and Fall) These classes are for keiki and their caregivers and together they will learn about nutrition, cooking. Hawaiian la'au lapa'au, exercise, art and music therapies for stress relief. Total Budget and Position Count: Total Program Budget $25,000 below Total Program Position Count 5 Total Agency Budget $30,000 Total Agency Position Count 5 Program Objectives: 1) To purchase our own equipment such as computer monitors, towers, lap tops, video cameras, video stands, computer programs such as Adobe Pro Premier and Movie maker. The computers ,video cameras, video camera stands will be available for producers to use during the week and weekends to produce videos and to do editing. 2) Train 3 new video producers by attending beginning TV producing classes so, they are able to learn how to use the video camera and edit shows that they do. 3) Isere staff such as a Manager and Assistant Producer to assist new interns to help them produce their own shows. 4) Pay for operational expenses such as supplies, services, and training fees. Programs Highlights: From Fiscal year 2009 -2010 Educational shows 1) February 14, 2009 Valentines Day Event for Mana Ola 0 Ka Lani @ Parker School Auditorium Partners with Hawaii County Parks and Recreation Culture and Arts, Lokahi Treatment Centers, and Healing our Island. Individuals who attended the event and were interviewed included the following: Councilman Pete Hoffman, Pua Nian (Lokahi Treatment Centers) and Danny Akaka who spoke about health care and illnesses. 2) April 2009, Makai Chiropractic /Kailua -Kona, Hawaii. This show discussed the different types of Integrative health care therapies such as chiropractic, medical massage, acupuncture and exercise (brain gym for keiki). Individuals who were interviewed were Dr. Nancy Fitzgerald, Chris and Amy James. NON PROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Children's Complementary Therapy and Research Clinic Mana Ola 0 Ka Lana " The Living Power from Heaven" 3) October 24, 2009 Miracles Event which is an event to benefit cancer patients for North Hawaii Hospice, Lions Club- Angels on Wheels and Mana Ola 0 Ka Lani all non profit agencies on the Island that provides services to cancer patients. This Event was hosted by Paula Akana KLTV News Anchor and Tiny Tidani OC 16. 4) November 2009 Kula 0 Mala which is also known as the school community garden behind the Salvation Army in Honokaa. This garden provides fruit and vegetables to people in the community who are not able to purchase food.. Performance Measures: FY 2008 -09 FY 2009-10 FY 2010-11 Actual * Budget * Estimate o-{ i Py� ers TV h( q 200 500 o ht 4 l 3 - 211— # of surveys funclvwrr 414 1 ao a, op Vi vaJPrs thvueui Sired -a v NI Q ' Sri 0 ! CO a '612 1 7. (-= *if applicable_ Program Expenditures FY 2008-09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 7800. oo --j COO. oa Professional Fees Operations 2 n /4 Equipment , to 7 S o . oo 675o. Other" r,t, 'n i b n 4 1 oo, o o '] o 0. 0 0 Total GFo. p 0 ' 75s. °° $ ( T,7Ss• °o If applicable a Please explain in detail on separate sheet NONPR0FIT GRANT APPLICATION FISCAL YEAR 2010- 2011 Page 3 • Hawaii Children's Complementary Therapy and Research Clinic Mani Ola 0 Ka Lani " The Living Power from Heaven" Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008-09 FY 2009 -10 I FY 2010 -11 Actual * Budget* I Estimate tr rrf S rs_) . 9 aoo.oO loco,ao T f ttw &i 1 r p C O !Yl � X7 000 , 00 S b DO .o0 i} F Events Goo On 1 01)0 oo I Total I CY 1 700 .0 - loco .00 *If applicable Explain what plan, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self -sustaining? Our plans is to increase revenues thorough tmderwriters (local businesses) to sponsor our shows. We will also have our own Big Island Living Internet Streaming which will allow as to have businesses advertise on our website. Our hope is to become self sustaining in the near future. In the mean time, we will continue to write grants to support our educational and health shows until we can completely become self ses#+ining, NON PROM! !' GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 4 Hawaii Children's Complementary Therapy and Research Clinic Mana Ola 0 Ka Lani " The Living Power from Heaven" I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law" I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, l (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. d� IP I (111(44 �. )0 10 ignature of Board Prestdent/Chair Date 2 A. ,_C, � se., // F - ture of Execu we Director ] - " - • .....V e UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 — 2011 Page 5 Hawaii Children's Complementary Therapy and Research Clinic Mona Ola 0 Ka Lani "The Living Power from Heaven" PROGRAM EXPENDITURES: Salaries and Wages (1) Manager for Big Island Living 20.00 per hr. 16 hrs per month Total per yr. 192 hrs x 20 = 3840.00 (4) Assistant to the Intern Video Producer 10.00 per hr. 16 hrs per month Total per yr. 192 hrs x 10.00 = 1920.00 (5) Internship @ 15.00 per hr. @ 3 hrs of video taping = 45.00 per show @ 10.00 per hr. @ 10 hrs of editing = 100.00 per show Total 145 x 4 shows per yr. $580.00 (6) Internship @ 15.00 per hr @ 3 hrs of video taping @ 45.00 per show @10.00 per hr @ 10 hrs of editing @ 100.00 per show Total 145 x 4 shows per yr. $580.00 (7) Internship @ 15.00 per hr @ 3 hrs of video taping @ 45.00 per show @ 10.00 per hr ® 10 hrs of editing @ 100.00 per show Total 145 x 4 shows per yr. $580.00 Cost per yr. $ 7500.00 NOTE: Manager for Big Island Living will act as an mentor another video producer and someone that they can talk to discuss their shows and to ask for help. Manager will set up appointment for the shows that they will be doing. As well as going to the appointments with each internship to help them. The assistant will assist the intern video producers to set up and break down a set, fill out paper work, putting together questions to ask during interview and to be a TV host for their show. Each intern video producer will produce 4 shows and interns will do 4 shows which will be a total of 12 shows a year. They will also put their shows on Hawaii Streaming.Com for those viewers that have Dish who are not able to watch Oceanic Cable on the Island of Hawaii. Each show is based on 30 minutes. NON PROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Hawaii Children's Complementary Therapy and Research Clinic Mana Ola 0 Ka Lani "The Living Power from Heaven" PROGRAM EXPENDITURES: OPERATIONS: DVD CD $25.00 per yr DVD case $20.00 per yr Stamps $25.00 per yr. Envelopes $10.00 per yr Paper $25.00 per yr. Video Tape $50.00 per yr. Internet $35.00 per month for 12 mo. Total 420.00 Hawaii Streaming. Corn 45.00 per show @ 12 year Total 530.00 Liability Insurance $1000.00 per year Website 70.00 per yr. Total per yr. $ 2805 EQUIPMENT: COMPUTERS 3 Lap Top @ $ 1000.00 each for editing $ 3000.00 3 Desk Top @ 700.00 each for editing $ 2100.00 Total: $5100.00 NOTE: Each producer will have access to the computer to edit their shows during the week and weekend. Internship video producer will also be using the computer to edit the shows that will are assigned to them. Currently, producers at Na Leo are not able to go into the studio consecutively and are not allowed to edit during the weekends because it is closed. VIDEO EQUIPMENT 3 Video Camera @ 500.00 each Total 1500.00 3 Video Stands @ 35.00 each Total 150.00 Total $1650.00 Total Cost $6750.00 NOTE: Each producer and interns will be taking turns in using the Video camera to produce footage for each show during the week and weekend. Currently, there are not enough video cameras for all Na Leo Producers to use due to the unlimited amount of Producers already at Na Leo. NON PROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 Hawaii Children's Complementary Therapy and Research Clinic Mana Ola 0 Ka Lani "The Living Power from Heaven" PROGRAM EXPENDITURES: OTHER: Training for 3 new video interns @ 100.00 ea. Total of $ 300.00 Advanced Training for 4 video producers and interns @ 100.00 each Total $ 400.00 Total Cost $700.00 NOTE: Each video intern will attend a beginning TV production class. They will also attend the advance class along with their Manager. Total Cost for Educational Programs per yr. $17,755.00 NON PROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 40 Hawaii County Economic Opportunity Council Community Organization HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL COMMUNITY ORGANIZATION Agency Director: Sandra P. Song Phone No.: (808) 961 -2681 Ext. 203 Contact Person: George Yokoyama Phone No.: (808) 961 -2681 Ext. 107 Mailing Address: 47 Rainbow Drive Hilo, Hawaii 96720 Facility /Site Address: 47 Rainbow Drive Hilo, Hawaii 96720 Fax No.: (808) 935 -9213 Email Address: hceocgy @hawaii.rr.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Jennifer Gossert Phone No.: (808) 968 -1002 (808) 969 -3115 Mailing Address: P. 0. Box 4372 688 Kinoole St., Ste. 201 Hilo, Hawaii 96720 Hilo, Hawaii 96720 Amount of Request for County Funds: $98,000.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $0 $0 Agency Mission Statement: Applicant's mission is the alleviation, elimination and prevention of poverty in the County of Hawaii by: • Mobilizing and channeling private and public resources into antipoverty action; • Stimulating new and effective approaches to the alleviation of poverty; • Strengthening communication, mutual understanding with residents; • Planning the coordination and implementation of antipoverty programs; • Educating children and youth to become responsible contributing adults; • Assisting the poor to attain economic self - sufficiency. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 1 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL COMMUNITY ORGANIZATION Program Description: Hawaii County is cursed with the following calamities in proportion to its total population as follows: • Highest unemployment in the State • Highest welfare clients in the State • Highest food stamp recipients in the State Food Stamp TANP Recipients Recipients Unemployment Percentage East Hawaii 22,420 2,869 6,058 12.9 West Hawaii 9,656 1,004 2,391 6.3 TOTAL 32,076 3,873 8,449 9.94 Sources: Department of Human Services, December, 2009 Department of Labor and Industrial Relations, December, 2009 NOTE: Welfare recipients are not included in the official unemployment count by DLIR. When welfare recipients of 3,873 are included, the total actual unemployed for the Big Island is 12,322 or 14.48 percent. With the scenario above, applicant's efforts are focused on bringing in funds to operate human services, community economic development, employment training, and job creation programs. Requested County funds will be used for two (2) community organizer positions, one for East Hawaii and another for West Hawaii to gather and ascertain documented priority needs of the communities as basis for grant application. Total Budget and Position Count: Total Program Budget $98,000 Total Program Position Count 2 Total Agency Budget $8,110,000 Total Agency Position Count 100 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 2 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL COMMUNITY ORGANIZATION Program Objectives: 1. Conduct person to person outreach activities to involve a minimum of 20 economically disadvantaged individuals to participate in the needs assessment within a 10 -month period. 2. Conduct community needs assessment by convening a minimum of 20 community meetings attended by 20 persons or more to gather data on people's views, problems, and needs of specific communities by group discussions to reach consensus supporting solutions to problems and needs for input in grant applications within a 10 -month period. 3. Prepare and submit a minimum of 24 grant applications based on needs assessments to private foundations requesting an average of $20,000 within a 12 -month period. 4. Prepare and submit a minimum of 5 grant applications to federal sources of funding requesting an average funding of $200,000 per grant. Program Highlights (From FY 2008 -2009) Total Agency Budget • 2008 = Operated 23 programs $12.2 million 2009 = Operated 23 programs 7.5 million 2010 = Presently 22 programs are operated 8.11 million NOTE: In 2009, relinquished a large Head Start Program, therefore, the substantial reduction in total agency budget. • It is noted here that using part of the annual core funds of $650,000 from Federal Office of Community Services, applicant has been able to mobilize program funds to maintain efforts to fulfill agency missions. $8.11 million has been mobilized for 2010, with dollar leveraged ratio of $12.40 to $1.00 to operate 22 programs, attached is a list of programs operated by applicant. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 3 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL COMMUNITY ORGANIZATION Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual* Budget* Estimate Community Needs Assessment None None $98,000 *If applicable Program Expenditures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual Budget Estimate Salaries & Wages including Fringe 0 0 76,560 Professional Fees 0 0 0 Operations 0 0 15,000 Equipment 0 0 2,000 Other* — Supplies 0 0 4,440 Total 0 0 $98,000 *If applicable *Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 4 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL COMMUNITY ORGANIZATION Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual* Budget* Estimate County of Hawaii None None $98,000 Total $98,000 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? If is strongly believed that once the two Community Organizer positions are established, revenues will be increased by grant awards and positions will become permanent with percentage time allocated to each new program. The two Community Organizer positions will appreciably enhance applicant's ability to bring in more grant funds considering applicants' track record of past grant awards. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 5 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL COMMUNITY ORGANIZATION I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2- 135 -2- 142.2, Hawai'i County code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that 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, Hawai'i Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirements to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal near. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete. and accurate veer -end report will impact the evaluation of your program's or agency's future funding requests. Bt rd 172 -o /O Signature Bo9rd Pr si : U hair Date :ga Signature of Executive Director at` e NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 6 41 Hawaii County Economic Opportunity Council Drop -Out Prevention Program t , HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Drop -Out Prevention Program Agency Director: Sandra P. Song Phone No.: 961 -2681 ext: 203 Contact Person: George Yokoyama Phone No.: 961 -2681 ext: 107 Mailing Address: 47 Rainbow Drive Hilo, Hawaii 96720 Facility/Site Address: 47 Rainbow Drive Hilo, Hawaii 96720 Fax No.: 935 -9213 Email Address: hceocgy@a,hawaii.rr.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: 808- 968 -1002 Mailing Address: P.O. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds: $88,766 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $0 $0 Agency Mission Statement: The mission of Hawaii County Economic Opportunity Council (HCEOC) is the alleviation, elimination, and prevention of poverty in the County of Hawaii by: • Mobilizing and channeling private and public resources into antipoverty action; • Stimulating new and effective approaches to the alleviation of poverty; • Strengthening communication, mutual understanding; • Planning the coordination and implementation and antipoverty programs in the community; • Educating children and youth to become responsible contributing adults in society; • Assisting the poor to attain economic self - sufficiency. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Drop -Out Prevention Program Program Description: This funding request is to continue the operation of the Drop -Out Prevention Program (DOPP) on the island of Hawaii for the months of October 2010 — December 2010. DOPP reduces the risk of high school students, with chronic unexcused absenteeism and dropping out of school before graduating. Program Facilitators work with school - referred students, parents, school counselors, teachers and administration, as well as, family court and other public agencies, to establish rapport and open channels of communication between all involved parties. Activities are conducted to help students develop positive attitudes toward school, increase self - esteem and explore career options. As a result of this focused, caring environment, students' attitudes about school changes. Students show improvement socially and academically and remain in school to graduate. The program shall serve the following seven (7) high schools: Hilo High, Waiakea High, Keaau High, Pahoa High & Intermediate, Ka'u High, Konawaena High, and Honokaa High. Total budget and Position Count Total Program Budget $355,062 Total Program Position Count 8.5 Total Agency Budget $8,110,000 Total Agency Position Count 100 * Total Program Position Count is 8.5 full - time positions. Program Objectives: 1) Graduate 95% of high school seniors in the program by the end of the school year. 2) Enable 40% of the referred high school students to pass all courses necessary for promotion. 3) Improve 65% of the referred high school students' attendance by 65% or better. 4) Assist 70% of the referred high school students complete the school year without any suspensions exceeding three (3) days. 5) Demonstrate on the pre /post observation form that 80% of the program participants made positive changes in attitude toward self and others. (Evaluations are based upon a test specifically developed for the local students by a former University of Hawaii Professor. Consultations with teachers, parents, and others are part of the evaluation process) NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Drop -Out Prevention Program 6) Demonstrate on the pre /post observation form that 70% of the program parents developed positive communication with their child, other adults and children of other ethnic groups. Program Highlights: (from Fiscal Year 2008 -09) • Waiakea High School student clients participated in a Community Service Project focusing on preventing teen dating violence. They sponsored a poster contest and performed radio public service announcement dramas on the subject matter. • Student clients participated in the 8 annual County Youth Summit Meeting at Hilo Women's Club to meet with other high school students in the County and share concerns and plans to improve the health, safety, and education of our residents. • DOPP student clients participated at the 2009 Youth Health and Future Fair at Prince Kuhio Mall to share life sustaining skills with other youths through exhibits, interactive displays, and dialogue. • Ka'u High School student clients and parents put together a photo display of paniolos from the Ka'u district for the past hundred years. The exhibit was part of Mayor Kenoi's proclamation for 2008, Year of Na Paniolo (the Hawaiian Cowboys). The students set -up and stationed themselves at their exhibit at 9 community events. Through this experience, DOPP students and parents incorporated into their conduct the positive values of the Hawaiian Cowboys, such as discipline, resourcefulness, toughness, teamwork, loyalty, and perseverance. • Hilo DOPP students participated in a community sponsored basketball clinic to learn life skills such as focus, dedication, commitment, working well with others, and patience through the venue of basketball. Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Graduate 95% of high school seniors in the 92% NA NA program by the end of the school year. Note: Staff vacancy at Honokaa High School and Konawaena High School affected objective outcome due to student records were not obtainable. Enable 40% of the referred high school 67% NA NA NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 • HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Drop -Out Prevention Program students to pass all courses necessary for promotion. Improve 65% of the referred high school 67% NA NA students' attendance by 65% or better. Assist 70% of the referred high school 76% NA NA students complete the school year without any suspensions exceeding three (3) days. Demonstrate on the pre /post observation 88% NA NA form that 80% of the program participants made positive changes in attitude toward self and others. Demonstrate on the pre /post observation 85% NA NA form that 70% of the program parents developed positive communication with their child, other adults and children of other ethnic groups. *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages $248,190.80 $200,327 $311,995 Professional Fees 0 0 0 Operations $21,952.20 $38,300 $43,067 Equipment 0 0 0 Other 0 0 0 Total $270,143.00 $238,627.00 $355,062 *If applicable # Please explain in detail on separate sheet Note: Total program expenditures for FY 2008 -09 includes Department of Education funds for the period of 07/01/08 — 08/31/09. Funds for FY 2009 -10 will end 09/30/10. FY 2010 -11 Estimate includes 14.29% pay adjustment for Program Coordinator, Community Services Facilitator, and seven (7) DOPP Facilitators. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Drop -Out Prevention Program Program Funding Sources: Identify all funding sources (specific to this program only) FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate State of Hawaii, Department of $327,227 Education Federal CSBG ARRA funds $238,627 Note: Funding ends 09/30/210 Available Federal, State, Foundation $355,062 Grants *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? As a non - profit organization, HCEOC has in the past 35 years competed for and received federal and state funding to sustain the DOPP Program. Considering the fact that the program has continued for 35 years, HCEOC is confident in mobilizing resources for the program to continue. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Drop -Out Prevention 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program (s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. / /z4 /ssy Signature Bard Pre dent/Chair Date /, /d Signatur- of Executive Director Date NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 42 Hawaii County Economic Opportunity Council Language Arts Multicultural Program HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Language Arts Multicultural Program Agency Director: Sandra P. Song Phone No.: 961 -2681 ext: 203 Contact Person: George Yokoyama Phone No.: 961 -2681 ext: 107 Mailing Address: 47 Rainbow Drive Hilo, Hawaii 96720 Facility /Site Address: 47 Rainbow Drive Hilo, Hawaii 96720 Fax No.: 935 - 9213 Email Address: hceocgy@hawaii.rr.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: 808 - 968 - 1002 Mailing Address: P.O. Box 4372 Hilo, Hawaii 96720 Amount of Request for County Funds: $156,500 Prior Year(s) Funding: NA 07 -08 08 -09 09 -10 $0 $0 $0 Agency Mission Statement: The mission of Hawaii County Economic Opportunity Council (HCEOC) is the alleviation, elimination, and prevention of poverty in the County of Hawaii by: • Mobilizing and channeling private and public resources into antipoverty action; • Stimulating new and effective approaches to the alleviation of poverty; • Strengthening communication, mutual understanding; • Planning the coordination and implementation and antipoverty programs in the community; • Educating children and youth to become responsible contributing adults in society; • Assisting the poor to attain economic self - sufficiency. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Language Arts Multicultural Program Program Description: This funding request is to continue the operation of the Language Arts Multicultural Program (LAMP) for the months of October 2010 — December 2010. The Language Arts Multicultural Program (LAMP) is based on a field- tested curriculum developed by HCEOC with contributions by James Vasquez, Ph. D and Elaine Kono, Ph.D., Hawaii Department of Education. The research on historical data on education in Hawaii by HCEOC's research team resulted in a program to promote independent thinkers and learners in underachieving third and fourth grade students. The curriculum is exclusively designed for school referred underachievers in language arts, reading, writing, and speaking, the basics required for extending learning to other areas. Further, the curriculum has been field tested for many years and extensive improvements have been made to assist underachieving students and incorporating multicultural awareness and STEM (science, technology, engineering, math) education initiatives. The Program will serve seven (7) elementary schools in Hawaii County: Kalanianaole Elementary, Kapiolani Elementary, Keaau Elementary, Keonepoko Elementary, Mt. View Elementary, Naalehu Elementary, and Laupahoehoe Elementary. Total budget and Position Count Total Program Budget $626,000 Total Program Position Count * 15.5 Total Agency Budget $8,110,000 Total Agency Position Count 100 * Total Program Position Count is 15.5 full -time positions Program Objectives: 1) Gain a minimum of 2 percentile points per year as measured by the Stanford Diagnostic Reading Test, Reading Comprehension subtest for 70% of the program students. 2) Attain 4.5in writing or gain one (1) point in writing skills as measured by the SAT Writing Assessment on a seven (7) point scale, one (1) being low for 80% of program students. 3) Attain 4.5 on the Keaukaha Oral Language Test (KOLT) or gain one (1) point in listening/speaking skills on a seven (7) point scale, one (1) being low for 70% of program students. 4) Achieve 80% on the teacher applied LAMP Teacher's Attitudinal Observation worksheet or make an increase of 10% between pre and post scores for 80% of program students. 5) Improve socialization skills by 10% as determined by the pre and post teacher administered Student Socialization Evaluation for 90% of program students. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Language Arts Multicultural Program Program Highlights: (from Fiscal Year 2008 -09) • Kapiolani LAMP worked collaboratively with Mrs. Noda to present a "Plantation Days" theme for school's annual May Day program. Students performed research on Hawaii's plantation history, interviewed grandparents to get first hand accounts, memories, and facts from the time period. Staff and parents also helped sew time -era costumes for the event. The success of the May Day program resulted in a videotape interview which will be shared with the Department of Education as an example of celebrating Hawaii's mixed cultural heritage. The videotape will also be presented to our sister exchange school in Japan to educate and entertain students about Hawaii's rich plantation history. • Kalanianaole LAMP worked intensively for two weeks on multiplication games and drills which resulted in our students doubling and tripling their score on the Mad Minute or the number of multiplication problems they could answer correctly in one minute. The activity helped students complete their math assignments faster and led to higher grades and increased confidence in completing their math work. • Naalehu LAMP conducted numerous dictionary and vocabulary building activities as most of the students are Marshallese and speak English as a second language. LAMP students are assigned to look up three words in the dictionary to be presented to the group. Students provide the meaning of the word and how to the word correctly in a sentence, improving and expanding their vocabulary. • Keonoepoko LAMP focused on helping students better understand and answer inferential questions. Students were given the quote "Give a man a fish, he will eat for today, teach a man to fish, he will eat for life." After much dialogue, students explained it is better to learn and work hard and not depend on anyone. Students truly benefited from this quotation activity and expanded their inferential skills. Ultimately, LAMP students scored 78% on the SDRT Reading Comprehension, surpassing stated objective of 70 %. • Keaau LAMP used Venn diagrams to compare things such as Hawaiian and Filipino foods, pickled takuwan versus pickled kim -chee. With these lessons the students got a chance to identify similarities and differences. Students completed a report which was presented to the group. As a result of these exercises, 100% of students met the objectives for reading comprehension, writing, and multicultural awareness. • Laupahoehoe LAMP student C. Nobriga improved his attitude toward work significantly, earning him recognition for his hard work. At first, he resisted and complained whenever he had to complete homework assignments and LAMP lessons. Upon garnering support from his mother, DOE teacher, and LAMP staff, he began to work harder, thus receiving numerous academic awards such as the Po'okela and Good Community Contributor award. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Language Arts Multicultural Program Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Gain a minimum of 2 percentile points per 88% NA NA year as measured by the Stanford Diagnostic Reading Test, Reading Comprehension subtest for 70% of the program students. Attain 4.5in writing or gain one (1) point in 95% NA NA writing skills as measured by the SAT Writing Assessment on a seven (7) point scale, one (I) being low for 80% of program students. Attain 4.5 on the Keaukaha Oral Language 96% NA NA Test (KOLT) or gain one (1) point in listening/speaking skills on a seven (7) point scale, one (1) being low for 70% of program students. Achieve 80% on the teacher applied LAMP 100% Teacher's Attitudinal Observation worksheet or make an increase of 10% between pre and post scores for 80% of program students. Improve socialization skills by 10% as 100% determined by the pre and post teacher administered Student Socialization Evaluation for 90% of program students. *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages $287,589.23 $341,273 $541,841 Professional Fees 0 0 0 Operations $31,726.89 $42,570 $77,859 Equipment 0 $63,00 Other 0 0 Total $319,316.12 $383,843 $626,000 *If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Language Arts Multicultural Program Note: Total program expenditures for FY 2008 -09 consist of the following: • Federal TANF funds — Department of Human Services for the period of 07/1/08 — 6/30/09 and Department of Education funds for period of 07/01/08 — 08/31/09. Funds for FY 2009 -10 will end 09/30/10. FY 2010 -11 Estimate includes 14.29% pay adjustment for Program Coordinator, Community Services Facilitator, seven (7) LAMP Teachers and seven (7) LAMP Aides. Program Funding Sources: Identify all funding sources (specific to this program only) FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate State of Hawaii, Department of Education $225,000 Federal TANF Funds — Department of $380,000 Human Services (10/31/07 — 10/30/08) Federal CSBG ARRA funds $383,843 Note: Funding ends 09/30/210 Available Federal, State, Foundation $626,000 Grants *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? As a non - profit organization, HCEOC has in the past 35 years competed for and received federal and state funding to sustain the DOPP Program. Considering the fact that the program has continued for 35 years, HCEOC is confident in mobilizing resources for the program to continue. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 HAWAII COUNTY ECONOMIC OPPORTUNITY COUNCIL Language Arts Multicultural Program I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program (s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 7 2 -172o a Signatur of car resident/Chair Date / /A Signature of Executive Director Date NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 43 Hawaii Island Adult Care, Inc. Hilo Adult Day Center Hawaii Island Adult Care, Inc. — Agency Name Hilo Adult Day Center — Program Name Agency Director: Paula Uusitalo Phone No.: 961 -3747 Contact Person: Paula Uusitalo Phone No.: 961 -3747 Mailing Address: 34 Rainbow Drive Hilo, Hawaii 96720 Facility /Site Address: Same as Above Fax No.: 961 -3740 Email Address: puusitalo @hawaiiislandadutcare.orq Name of Accountant/CPA (include name of firm if applicable): Jennifer L. Gossert, CPA Phone No.: 969 -3115 Mailing Address: 688 Kinoole St., Hilo, Hawaii 96720 Amount of Request for County Funds: $25,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $18,000 $20,000 $20,000 Agency Mission Statement: Providing quality care for elders and challenged adults and support for their families. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Hawaii Island Adult Care, Inc. — Agency Name Hilo Adult Day Center — Program Name Program Description: Hilo Adult Day Center provides a safe, socially active, healthy daytime setting for frail elders and mentally /physically challenged adults who need supervised care. The center is open Monday to Friday, 7:00 AM to 5:00 PM and Saturdays from 8:00 AM to 4:00 PM. Total Budget and Position Count Total Program Budget $1,019,575 Total Program Position Count 25 Total Agency Budget $1,464,915 Total Agency Position Count 51 Program Objectives: 1) Provide a safe, caring, healthy daytime environment for frail elders, disabled /stroke debilitated individuals and those with Alzheimer's disease and related disorders; all of whom need assistance with some of their active daily living skills, many are under doctor's orders for supervised care. 2) Provide a socially active day, through interaction /socialization with others, hands -on games and activities, singing, arts /crafts, games, bingo, excursions, entertainment and more. These individuals are generally inactive at home, having old -age depression; the day center is geared to give them an experience that promotes happiness, fosters a positive outlook and improves their quality of life. 3) Provide the opportunity for elders to continue living in their own homes, to be with family and to be a part of the community for the rest of their days if possible. 4) Deter pre- mature institionalization into long term care facilities, allow our elders to live at home in dignity, and also lessen the taxpayer burdenwhich would be paying for the long term care institutionalization. Ninety percent of the patients in long term care facilities in Hawaii State are paid for by Medicaid funds. 5) Provide caregivers the opportunity to continue employment, receive respite and deter "caregiver burnout ". NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Hawaii Island Adult Care, Inc. — Agency Name Hilo Adult Day Center — Program Name 6) Provide adult day care to all individuals needing supervised daytime care, regardless of their ability to pay by utilizing medicaid, federal, state, county and private foundation tuition - assistance funding for poverty level and low income individuals. 7) Open its first satellite adult day center in Honomu in April /May 2010. This rural community program will provided a safe, social active healthy daytime setting for frail elders on the Hamakua coast. Program Highlights: (from Fiscal Year 2008 -09) 1) Hawaii Island Adult Care provided day care services to 129 individuals having varied physical and /or mental challenges in FY 2008 -2009. 2) For the fiscal year ending June 30, 2009, new participants enrolled: 35; discharged, 33, attending the full year, 54. Six clients passed away while attendees of the center and still living at home (this is the real goal for our clients, to move on from this life while still living at home). Of the 129 participants, 67% were over eighty years old, 85% are over seventy years. 3) Maintained professional level of client services with Services for Seniors, the Hawaii County Office of Aging, the state of Hawaii, Department of Human Services (DHS) Adult Day Services program and the Nursing Home w/o Walls (NHWW) program which were transferred on February 1, 2009 to privatization companies, Ohana Health and Evercare Health plans. 4) Continued working with numerous agencies including the Interdisciplinary team(IDT) organized by the state Department of Health to provide elder client specific case management, other agencies included are DHS Nursing Home without Walls, DHS, Services for Seniors, Kokua Nurses, Care Resources, Ohana Health plan and others. 5) Continued submitting grants and receiving private foundation support for tuition /fee assistance, received adequate support for all clients needing to attend but who could not afford full costs, no -one was limited in the days they needed to attend. 6) Continued the monthly Caregiver support group and received a HMSA Foundation grant to provide caregiver training classes and hands on caregiver care sessions for the community at large, a least two classes per month including Saturday. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Hawaii Island Adult Care, Inc. — Agency Name Hilo Adult Day Center — Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Average monthly attendance 89 91 93 Total number of individuals 129 133 139 Participants continue to live in their own 119 124 129 homes Families /Caregivers able to continue 61 63 65 employment Families /caregivers receiving respite 121 125 130 Participant continues after 6 months 107 110 113 Participant continues after 1 year 91 94 97 Participant continues after 2 years 53 53 55 Participant continues after 5 years 24 24 24 Average cost of care in a long term facility for 1 year (1 Person) $120,000.00 $120,000.00 $123,000.00 Average cost of care at Hilo Adult Day - 17,325.00 - 17,325.00 - 18,900.00 Center for 1 year (l person) Annual Medical monies saved on 1 $102,675.00 $102,675.00 $104,100.00 participant attending day care versus those living in long term care institutions Saving based on discharged into long term $1,200,000 $2,710,000 $1,260,000 care during a one year period (based on 10 (based on the (based on 10 clients total number of clients placed discharged in months into long term FY 2008 -2009) attended by the care for 1 year • 10 clients at $15,000 per discharged in month) FY 2008 -2009) *If applicable Program Expenditures FY 2008 -09 Actual * FY 2009 -10 Budget FY 2010 -11 * Estimate Salaries and Wages 665,119 633,503 698,375 Professional Fees 9,346 10,800 11,350 Operations 220,770 204,447 231,500 Equipment 763 700 800 Other (Direct Client 184,406 170,125 193,625 Assistance) Total 1,080,404 1,019,575 1,135,650 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 • Hawaii Island Adult Care, Inc. - Agency Name Hilo Adult Day Center - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Tuition /Fees 636,569 566,400 668,650 State 78,806 90,000 80,000 Federal 78,806 90,000 80,000 County of Hawaii 20,000 20,000 20,000 Hawaii Island United Way 21,245 17,625 20,000 May Templeton Hopper Fund 98,198 72,500 90,000 Other Grants: Mclnerny / HHA- Charity Walk / 44,138 67,500 67,500 Friends of Hawaii Charities / Donations 10,768 7,500 7,500 USDA Lunch reimbursement 35,461 40,000 40,000 Pin Grant Management 9,591 6,000 10,000 Fundraising / Interest / Misc. Sales 27,478 22,050 27,000 SEE Program 39,500 20,000 25,000 Total 1,100,577 1,019,575 1,135,650 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Hilo Adult Day Center receives more than 50% of its revenue from the tuition and fees. The Board of Directors held a fourth annual golf tournament in July, 2009, which was very successful, netting $19,432 assisting with operating costs on a monthly basis. The adult day center program can only be self- sustaining if the federal and /or state government would recognize the importance of adult day care and being able to live at home, versus long term care institutionalization and the large tax burden. Government funding for those low income individuals above poverty level needs to be in place, then we would not be dependent on applying to other sources to assist with tuition costs. Some individuals have purchased long term care insurance, but this only helps those who could afford to purchase this insurance. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Hawaii Island Adult Care, Inc. — Agency Name Hilo Adult Day Center — 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. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 41, 'tt2- //9 /lD Sign. e of Board President/Chair Date Si ature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Hawaii Island Adult Care, Inc. County of Hawaii Nonprofit Grant Application 2010 -2011 Attachment Explanation Page 4: Program Expenditures Other: Direct Client Assistance: it is the tuition assistance, grant funding, to help cover tuition costs for participants who cannot afford full costs. b• 44 Hawaii Island HIV /AIDS Foundation Multi- Disciplinary HIV Case Management, Hilo HAWAII ISLAND HIV /AIDS FOUNDATION- Agency Name MULTI - DISCIPLINARY HIV CASE MANAGEMENT, HILO- Program Name Agency Director: Georgie Kennedy Phone No.: 331- 8177 Contact Person: Georgie Kennedy Phone No.: 331- 8177 Mailing Address: 75 -240 Nani Kailua Drive #5 Kailua Kona, HI 96740 Facility /Site Address: 16 -204 Melekahiwa Place #1 Kea'au, HI 96749 Fax No.: 331 -0762 Email Address: georgie @hihaf.org Name of Accountant/CPA (include name of firm if applicable): James D. Jennings, CPS, Inc. Phone No.: 808 - 942 -8813 Mailing Address: 1600 Kapiolani Blvd, Suite 730, Honolulu, HI 96814 Amount of Request for County Funds: $15,000.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $15,000 $15,000 $15,000 Agency Mission Statement: NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 The Hawai'i Island HIV /AIDS Foundation (hereinafter HIHAF) is a non - 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 HIV and related diseases. Our vision is to build a healthier, stronger, and more sustainable community that supports all its members with a focus on HIV issues. HIHAF is an IRS - designated 501(c)(3) tax - exempt non - profit organization which provides care and services for people living with HIV /AIDS (PLWHA), and we provide HIV prevention and education to the residents of Hawai'i County. Because most of the clients served at the Kea'au office live in the Hilo area, we refer to the Kea'au office as "HIV Foundation - Hilo." Required checklist forms are attached at the end of this proposal. HIHAF has been providing services to people at risk for, infected with, and affected by HIV /AIDS since 1986. Our Foundation has an efficient and effective system to provide a comprehensive continuum of prevention, care, and support services with regard to HIV /AIDS for the entire Big Island. As treatment and medical care for HIV - infected individuals continues to dwindle with the greatest loss of medical professionals on our island, HIHAF's role in helping our clients manage HIV and AIDS becomes increasingly crucial. As reported by the Hawai'i State Department of Health, Hawai'i County has the highest number of AIDS cases outside of Oahu at 13 %. The number of people living with HIV /AIDS continues to climb steadily with each passing year of the epidemic, and the modes of transmission are changing. HIV is no longer present primarily in high risk populations. In fact, half of the 65,000 new annual infections in the United States take place as a result of heterosexual transmission. Half of these new infections are occuring among people aged 15- 23. This indicates to us that we will continue seeing a rise in clients and their needs will change as the epidemic continues to shape our client population. Presently, HIV Foundation - Hilo provides multi - disciplinary team HIV case management, advocacy, information and referral, food pantry, client financial assistance, and other support services for more than 128 PLWHA and affected persons in East Hawai'i monthly. Our case load for the entire island is an average of 2 50 PLWHA monthly. Over the course of the year of December, 2008 through November, 2009, a total of 168 clients have been cared for in Hilo. Care team members support client independence and self - determination by providing a range of supportive services. These include 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 emerging needs, and measure the outcome(s) of service delivery. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 HIV Foundation - Hilo proposes to continue its provision of high quality multi- disciplinary team HIV case management.As in past years, we continue to experience ZERO increases in State of Hawai'i Department of Health funding allocated to HIV /AIDS case management services on all islands with a growing case load. This is reflected in our Program Expenditures and Program Funding Sources tables. Regardless, we will continue to do our very best, as always, to provide the highest quality of services to all our clients, despite the static funding available to us. Perhaps the greatest challenge that case management has had to face in the last three years is the continued island -wide loss of primary and HIV- treating physicians. Many doctors providing treatment to HIV - positive individuals in East and West Hawaii have left private practice and the island. In addition, the economic downturn has affected our hospitals, other care programs, and the community at large to such an extent that even minimum care can be difficult to find. Speciality care for those with HIV at one point was almost non - existent on the Big Island. Thus we have had to cobble together treatment for people with HIV. One solution we have brokered is having the physicians from the AIDS Clinical Trials, through John Burns Medical School on Oahu, see patients on a monthly basis in both East and West Hawaii. This has brought high quality treatment to many of our clients who are currently without a physician. At the present time they are seeing over 70 HIV+ clients on the Big Island. We have also supported the transition of two new physicians to the island to include HIV patients into their care. In addition to specialty care, these clients need a primary care physician locally. With so few doctors available, those remaining are being overwhelmed by the influx of new patients. Some physicians have limited their practice and are not accepting patients on Medicare or some other types of insurance. Finding a primary physician who understands or is willing to learn the complicated nature of clinically treating HIV, often alongside other health issues, adds to the scope and complexities of HIHAF's care team work. Our care team not only educates doctors on resources for the treatment of HIV, they act as a liaison between clients and their health care providers. They are advocates for comprehensive treatment of the medical and psycho - social needs of our clients in this rural underserved area. Agency Mission Statement: see above NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 HAWAII ISLAND HIV /AIDS FOUNDATION - Agency Name MULTI - DISCIPLINARY HIV CASE MANAGEMENT, HILO- Program Name Program Description: HIV and AIDS still carry a debilitating stigma in our society and clearly here on the Big Island. As a result, many of those who are infected with, affected by, and at -risk for HIV hide their challenges concerning the disease and managing it in their lives. HIHAF is the only place where HIV - positive individuals do not have to hide, where they are understood, and where all their needs can at least be addressed, if not fully resolved. A multidisciplinary team composed of two full -time (2.0 FTE) case managers,(a Treatment Advocate, RN; and a Benefits Specialist); one half -time (0.25 FTE) housing specialist and one quarter- time (0.25 FTE) client services facilitator provide direct care services for PLWHA residing in East Hawai'i. (The housing specialist also serves clients on the west side of the island.) The monthly average active caseload for the East Side office of the Foundation this past year is one hundred and twenty eight (128) clients. Twenty -eight percent (28 %) of the HIV Foundation - Hilo's clients are homeless, multiply diagnosed, drug misusers and /or mentally ill. Eighty -six percent (86 %) fall into two or more special population categories as defined by the federal Ryan White CARE Act Title II. Addressing clients' HIV and AIDS needs often begins and ends in completely different arenas. HIHAF's care team negotiates and juggles relationships with clients and their families, social service agencies, and state and federal agencies and programs. They reach across Hawai'i and into other states to build relationships with other AIDS service organizations to find medical and benefits records, and to establish client histories and needs. They are active in statewide and nationwide care coalitions to enable us to bring the latests and most up to date information and treatment to our clients. A recent example deals with a client living with AIDS and Hepatitis C. Up until this year he was able to work on a part time basis and care for himself with a complicated medical regime. In June, 2009, he was laid off from his job. The result was that he lost his medical insurance, did not have sufficient resources to pay his rent, and was unable to access medical care and medicine which are critical to maintaining his life. He quite quickly became homelss and was deeply ashamed and afraid. We were finally able to make contact with him and helped him to put his life back together. Due to his lack of income and medical insurance we were able to sign him up for a State program which provided him with his medication. He was able to see the physician, at no cost, from the NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Clinical Trials who comes to Hilo once a month. He qualified for a HUD housing program and was able to find affordable housing. As the result of this combined effort his health stabilized, he feels safe, and he began looking for another job. While he has not been able to find employment in this difficult economic downturn, he is at least willing and able to try. Without our assistance, and the various programs we were able to coordinate for him, he would have most probably died in a very short period of time. Due to the complex nature of treating HIV, HIHAF advocates will continue to work with this client's and all other doctors and care providers in the area. Maintaining strong relationships with professionals and agencies that serve a myriad of social and other needs is only one small part of our advocates' jobs. Our care teams' holistic care for and dedication to working with all our clients needs is driven by HIHAF's mission of serving people who are living with HIV to have the fullest most complete life possible. For many people, living with HIV and the financial and logistic difficulties of managing their disease is very difficult at best. Their lives are further complicated by fear and stigma. Several of our older, female, Hawaiian clients feel that HIHAF is the only safe place for them to let down their barriers, speak of their fear for themselves and their families, and discuss how this disease and their possible death will affect them. In the safety of our facility, they can show the depth of their feelings, they can find necessary, life- saving, and disease - monitoring clinical care and life saving HIV drugs. They also find a shoulder to lean on and resources for themselves and their families. Over the holidays our entire organization again rallied to make sure that each and every client and family had the resources to have a wonderful meal for both Thanksgiving and Christmas and that each child had at least one gift for Christmas. We were assisted in this effort by the Jonathan Foundation as well as the MCC Church in Pahoa and a tiny congregation in Puako. We were extremely fortunate and were able to truly share the intent of these holidays with our less fortunate clients. Holidays are sometimes very difficult for those who are ill or isolated from their community and family. Our Care team members spent a substantial amount of time calling all clients to ensure they were doing well and determining if there was anything further we could do to assist them. Individuals with mental health issues are at a greater risk of acquiring and transmitting HIV. Many of our clients have mental health problems which complicates their ability to care for themselves and take their medications properly. There are very few psycholigists on the Big Island who have experience with people with HIV. We have initiated monthly visits by such a qualified individual to provide therapy to our most affected clients. This psychologist practices and lives in Honolulu so it is necessary for him to come to the Big Island twice each month to see our clients. The benefit is that our most affected individuals have adequate mental health care and the more stable they become the less chance that they will pass on this disease to others. We are very proud of this program and have seen the difference it has made in the lives of our clients with serious mental illness. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Another substantial challenge for our care team is to adapt to the new federal prescription drug plan legislation (Medicare D). This program while on the surface is designed to help those in need of medication help, it also greatly complicates accessing necessary medicines through multiple layers of complex eligibility criteria, and constant changes to plan structures. In order to enable clients to acquire their medications at the lowest possible cost through this new plan, care team members must understand the client's current income and drug coverage plan, know what drugs the client needs and which plans cover it. They must have knowledge of the client's other medical needs, understand which pharmacies will accept which drug coverage program, and have an understanding of HIV and other pharmaceuticals to compare pricing. This year many of the companies offering Medicare D moved the drugs necessary for the treatment of HIV to the highest, most costly level. The impact of that change put a significant number of clients into the "donut hole" within 2 months. Our Hawaii Drug Assistance Program for HIV is funded by federal Ryan White Funding. Because of this change, more and more individuals will move into the HDAP program leaving less of these federal funds for other areas of need. As the number of clients continues to grow, the burden on our care team to provide adequate care also grows. Many of our clients face multiple health issues and need medications to suppress HIV, need other drugs to address side effects of HIV drugs, and need additional drugs to treat opportunistic infections related to HIV. Most clients who are taking medications, take from 6 to 10 drugs daily. Some of our clients take up to 25 medications daily or multiple times during the day. HIHAF's care team members are compassionate and talented. For them, treating someone's HIV encompasses the entire person - not just the disease. For our clients, many who live with fear and stigma, who deal with other medical and social issues, and face declining access to medical services in Hawai'i, HIHAF is the only place to come for support. HIHAF's care team members are often the only people that HIV positive individuals on this island know and trust. They are sensitive professionals who navigate the complications that HIV brings to the body and soul. In order to best serve the needs of our clients, a written service plan is developed cooperatively by the client and the care team annually. The service plan identifies client needs, defines the specific goals and objectives that address identified needs, and lists the action steps required to accomplish the client's stated goals and objectives. The service plan is developed and implemented within two weeks following the intake of a new client and then updated quarterly or more frequently, if necessary, until the client is discharged. In addition to service plan updates, clients are contacted at least once a month to monitor their health status and identify emerging needs. Acute clients in need of more NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Paee 6 frequent contact can receive telephone calls and/ or office or home visits three to four times per week. A minimum of one hundred and sixty (160) service plans will be developed or revised during the upcoming FY 2010 -2011 grant period in the East Hawaii office. A similar amount will be completed in the West Hawaii office. To ensure appropriate access the Foundation's hours of operation are Monday through Friday, 8:00 a.m. to 4:00 p.m. Staff frequently visit clients in their homes, at the hospital, during their monthly physician's visits and outside of both home and office, if that is what is necessary to help clients engage in their own care. The Client Service Facilitator is responsible solely for the delivery of the following support services: food acquisition for the food pantry, food deliveries, transportation, volunteers, and clerical support. In 2009 the Foundation created a new position: Director of Programming. This individual provides program administrative oversight and program supervision for care staff. She also produces quarterly reports for all funders, job counseling, staff training, and crisis intervention. This individual works directly with the care teams and is supervised by the Executive Director. Volunteers assist clients with online searches, distribution of food, clerical assistance, and helping clients shop in the food pantry. HIHAF provides invaluable support to HIV - infected individuals to assist them in keeping their loved ones free of HIV. Primary HIV prevention is based upon a culturally appropriate harm reduction methodology. When a new client begins their relationship with HIHAF, we take care to assess their current relationships and activities they may participate in that might put others at risk for HIV infection. Care team members either provide such interventions themselves or make referrals to the HIV Foundation - Hilo's prevention department. Care team members also offer anonymous HIV - antibody counseling and testing for family members and significant others. QUANTITATIVE EVALUATION: Quantitative evaluation measures for multi - disciplinary team case management services include the collection, tabulation and entry of service data into a computer tracking system provided by the State of Hawai'i (The Reggie System). Data routinely tracked include: number of clients, types of service provided, and the number of services provided by service category as well as the costs for these services. Planning estimations for service delivery during the FY2010- 2011 currently project that a total of twenty -six (26) separate case management services will be individually provided to a minimum of 160 clients living with HIV /AIDS. Services include, but are not limited to: intake, assessment, treatment advocacy, mortality and morbidity tracking, benefits counseling, volunteer referrals, hospital and home visits, medical liaison, crisis intervention, emergency financial assistance, housing assistance, home care and transportation. Data collection consists of counting the number of written service plans that are developed and /or revised each quarter. Computer reports indicating number NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 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 resulting in stable health. QUALITATIVE ANALYSIS: A client satisfaction survey is mailed to all clients annually. Completed surveys are returned anonymously. Tallied survey results are distributed to HIHAF' s Board of Directors, staff, clients and state and federal granting organizations. Executive Director and /or board members may, on an unannounced basis, meet with clients to discuss their satisfaction with services. The Foundation has three client representatives on the Board to bring forward issues specific to clients needs and desires. CHANGES FOR 2010 The economic downturn has resulted in the loss of employment of at least 5% of our clients and a decrease of income for an additional 10 %. Various support programs have closed during the last year which is putting more and more stress on programs, such as ours, to pick up the slack. To the best of our ability we are meeting those needs, but not all. Our grant oversight committee is looking carefully at each and every request and focusing on those items which make the greatest difference, i.e., requests for medical care, medicine, housing and food. Others such as dental care, transportation, etc. are generally less critical. In all cases, every possible funding source for client care is being pursued. HIHAFcontinued with cost cutting activities during the past year in response to the declining economy and in anticipation of funding decreases. Each staff member has taken on more work without the anticipation of additional financial reward, they have done so cheerfully and with a level of commitment that is astounding. We and our clients are fortunate to have such a talented and committed group of people who have put others above themselves. In addition, we were able to negotiate a lease renewal for our Hilo office which is well below the average price in the community. The Kona office lease was renegotiated and a reduction resulting in a savings of $13,500 achieved for calendar year 2010. Our Board of Directors has also made an even greater commitment to this Foundation. They are giving more of their time and talent to make sure that we weather this difficult time and grow as an organization at the same time. We also received a grant to do additional training with our Board to enhance their organizational and fundraising abilities as well as doing strategic planning. Total Budget and Position Count NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 Total Program Budget 370,480 Total Program Position Count 2.75 Total Agency Budget 1,252,000 Total Agency Position Count 14 Program Objectives: 1) Objective One: By July 30, 2010, 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 July 30, 2010 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, HIV - related medication, and food and to obtain such goods and services through appropriate referrals and practical support. 3) Objective Three: By July 30, 2010 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) In addition,HIV Foundation - Hilo shall provide the types and levels of case management related supportive services for its consumers, listed below: Benefits assessment/counseling Client family counseling Progressive case notes Crisis intervention Health care assessment/counseling Field /office visits Medical treatment referrals Home visits Housing assessments Intake /assessments Legal document assistance Financial benefits Funeral /estate coordination Generic assistance /counseling Housing assistance Health care benefits Legal advocacy assistance Client monitoring /assessment Nutritional assessment/counseling Risk assessment/counseling Mental health assessment/counseling Service coordination NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 9 Mental health counseling referrals Transport activities Substance abuse assessment Substance abuse treatment referrals (as available) Total number of service categories: 26 Timeline: Service plans are developed within two weeks of the initial intake session and reviewed quarterly. Service delivery will be on -going during FY 2010 -2011. The services listed above represent baseline service projections. Client- centered Outcome(s): A mimimum of one hundred sixty (160) 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. At least ninety percent (90 %) of clients will secure a primary care physician and remain in medical treatment. Program Highlights: (from Fiscal Year 2008 - 09) 1) During FY 2008 -2009, medical case management services included one hundred ninety eight (198) clients who received medical assessment, patient education, treatment advice, nutrition, medical liaison, dental liaison. 2) As of December 2009, all clients are receiving the highest quality primary medical care; however, 20% are receiving care through public health clinics, which at times cannot meet all their needs. 3) We have increased the number of individuals housed by 20% however, the waiting list has increased from 6 to 17, and we currently have 3 homeless clients. (Note: 2 of the homeless clients have refused housing in a communal setting.). 4) The number of hospital visits during this fiscal year remained at approximately 2 per month. We presently have 3 clients with end -stage cancer and 5 clients died during the past year. 5) Addition of the Director of Programming has created a smooth, more seamless experience for all clients and better support for staff. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 10 HAWAII ISLAND HIV /AIDS FOUNDATION - Agency Name MULTI - DISCIPLINARY HIV CASE MANAGEMENT, HILO - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate # and typles of case management 26 26 26 services provided # of clients receiving case 168 170 160 -190 management services Risk behavior assment- 250 250 250 transmission prevention education HIV counseling and testing 25 25 25 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 170,286 168,426 168,000 Professional Fees 2480 2480 2480 Operations 229,823 200,926 200,000 Equipment Other" Total 402,589 371,832 370,480 * If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Pate 11 HAWAII ISLAND HIV /AIDS FOUNDATION - Agency Name MULTI - DISCIPLINARY HIV CASE MANAGEMENT, HILO - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii 15,000 15,000 15,000 Dept. of Health 192,808 192,808 192,808* AIDS COMMUNITY CARE TEAM 74,000 74,000 74,000* HIUW -18 mo grant fy 2009 -t 17,000 20,000 10,000 HUD SPNS housing grant 13,500 15,000 unk Private Foundation 15,000 15,000 50,000 est Donations /Fundraising 31,000 29,000 26,000 est Total 358,308 360,808 367,808 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Unfortunately, the HIV /AIDS epidemic shows no sign of ending, and indeed continues to grow. There is often a misrepresentation of facts about the epidemic in the media, indicating a lessening of urgency in dealing with this epidemic. The fact is, there are still a minimum of 65,000 new cases in the US each year, and half of these new infections occur through heterosexual transmission and in the age group of 15 -23 year -olds. Each newly infected individual presents with a myriad of challenges to be met and overcome. Because the epidemic continues to grow, we do not see a specific point at which our program might become self- sustaining. We continue looking at development of various income producing businesses which could help to support the activities of our non - profit. We merged with another organization 5 years ago. At the present time we do not anticipate any further mergers. We are, however, continuing to seek colloborators for various aspects of our program, i.e., housing, food, etc. which would help maximize funding for both parties and benefit the community at large. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Pane 12 We have received level or decreasing funding from our main revenue source, the State of Hawai'i Department of Health, for the last 16 years. During this time, the number of people we are caring for has almost tripled. At present rates of infection the number of people seeking services may increase an additional 50% over the next 10 years. The costs for personnel, health insurance, rent, utilities, etc have risen dramatically over the past few years and no funder seems to recognize the kind of stress this creates for the non - profit sector. We are endeavoring to be creative in our approach but the reality is that many organizations may be stretched to the point that they cannot continue. As the only AIDS Service Organization on the Big Island this would be devastating to those living with HIV /AIDS here. An additional stressor is that our clients live longer now because of the availability of new drug treatments. This is wonderful in that it allows those who are infected to live longer. Simultaneously, it also raises challenges for us as a Foundation to continue to support their health so that they can live and hopefully be productive. Few, however, are well enough to work full time and thus their income level puts them into a position of continuing to need our services. We are very grateful that we have this support from the County, and we want to thank you for this opportunity to apply to you for funding. We will do everything possible to maximize the use of County funds, if awarded. `Note to Budget. We have been informed by the Dept of Health that the $192,808 awarded may be cut at any time by the Gov. and that there is no guarantee that this will be the final number until the state budget is balanced. ** AIDS COMMUNITY CARE TEAM- This is the funder for the Federal Ryan White Care Act Funds. With the changes to Medicare D as detailed above this sum may decrease if more federal funds are needed for the state drug assistance program for people with HIV /AIDS. We will not know the final number until March /April 2010 what the final figure will be. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 13 HAWAII ISLAND HIV /AIDS FOUNDATION - Agency Name MULTI - DISCIPLINARY HIV CASE MANAGEMENT, HILO - Program Name 1 (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate Year -end report will impact the evaluation of your program's or agency's future funding requests. / ii �/ I i iJe l ( �$ I(D Signature of Board President/Chair Date \ ` 0 :.1 l v Si. ature of Exe� Direc .r Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Pape 14 45 Hawaii Island HIV /AIDS Foundation Transmission Prevention for HIV+ Women in West Hawaii HAWAII ISLAND HIV /AIDS FOUNDATION- Agency Name TRANSMISSION PREVENITON FOR HIV+ WOMEN IN West Hawaii- Program Name Agency Director: Georgie Kennedy Phone No.: 331- 8177 Contact Person: Georgie Kennedy Phone No.: 331- 8177 Mailing Address: 75 -240 Nani Kailua Drive # 5 Kailua Kona, HI 96740 Facility /Site Address: same Fax No.: 808 -331 -0762 Email Address: georgie @hihaf.org Name of Accountant/CPA (include name of firm if applicable): James D. Jennings, CPS, Inc. Phone No.: 808 - 942 -8813 Mailing Address: 1600 Kapiolani Blvd., #730, Honolulu, HI 96814 Amount of Request for County Funds: $15,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $15,000 $15,000 $15,000 Agency Mission Statement: NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 The Hawaii Island HIV /AIDS Foundation is a non - profit organization dedicated to assisting those affected by HIV /AIDS to maximize their quality of life, and to ending the spread of HIV. We also utilize the lessons learned in the HIV epidemic to care and advocate for others in the fight against related diseases. Our vision is to build a healthier, stronger, and more sustainable community that supports all its members with a focus on HIV issues. We are an IRS - designated 501(c)(3) tax - exempt non - profit organization that provides care services for People Living With HIV /AIDS (PLWHA), and provides HIV prevention and education of the residents of Hawaii County. HIHAF has been providing services to people at risk for, infected with, and affected by HIV /AIDS, since 1986. Our Foundation has an efficient and effective system to provide a comprehensive continuum of prevention, care, and support services with regard to HIV /AIDS to the entire Big Island. We refer to the Kona office as "HIV Foundation - Kona ". As reported by the Hawai'i State Department of Health, Hawai'i County has the highest number of AIDS cases outside of Oahu, with 13% of all AIDS cases reported in the state since the beginning of the epidemic coming from the Island of Hawaii. The number of people with HIV /AIDS climbs steadily upward every year of the epidemic. In the US alone, there are 65,000 new cases of HIV every year. Currently, we know that half of all these new infections occur through heterosexual transmission, putting women at a very high risk of HIV infection. The proportion of cases diagnosed in women has been increasing steadily over time, and we have little reason to believe it will decrease anytime soon. This is a distressing increase in infection among women. The female population in other US and global communities continue to bear the brunt of new HIV infections. Women's rights are often compromised within relationships and, due to gender imbalances within relationships, women continue to be more vulnerable to HIV infection than men. Our Foundation believes in upholding a strong focus on prevention programming, and specifically targeting women and populations vulnerable to HIV infection. Through working with HIV - positive women and addressing their behaviors and empowering them through education and prevention activities, we continue working towards stopping the spread of HIV and AIDS. Without aggressive prevention intervention many more individuals in our community might become infected by the actions of a single individual. We are also actively involved with the most vunerable members of society such as the young women who are being treated at the Big Island Substance Abuse Council. These young women have already been exposed to risky behavior by their drug use. In addition many of them have low self esteem, little or no education, and see themselves as worthless. By working with these young women, getting them tested for HIV and other sexually transmitted diseases, and showing them their self worth we can break the cycle of drug use, casual sex, NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 U...... 1 and destructive behavior. We continue to experience flat funding from the Centers for Disease Control through the State of Hawaii Department of Health allocated to HIV /AIDS prevention services on all islands. This is reflected in our Program Expenditures and Program Funding Sources tables. Notwithstanding these challenges we continue to do our very best to reach as many women as possible and provide them with high quality services. Our committed prevention staff is representative of the women we serve and are a great example to the participants of what they can become if they make the right choices. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Pa no 1 HAWAII ISLAND HIV /AIDS FOUNDATION - Agency Name TRANSMISSION PREVENITON FOR HIV+ WOMEN IN West Hawaii- Program Name Program Description: The Hawai'i Island HIV /AIDS Foundation - Kona is proposing to continue funding for the HIV transmission prevention programs for all HIV+ women in West Hawai'i County, including individual and group protocols and counseling and testing of women at risk. This program is designed to STOP HIV at the source, with individuals who can transmit the disease to others. The program also provides early treatment for newly diagnosed HIV positive women, maintenance of stable health and well being for all HIV+ women in West Hawai'i County, long term planning for health maintenance, and transmission prevention interactions. In the past year we have located through outreach, the SISTA Program, and referrals, 6 new HIV+ women in the community. None of them was aware of their status and each presented with significant health and living problems which put them at risk of transmitting the disease to others, Through the concerted efforts of the prevention and care staff of this Foundation, each of these women has received medical care, stabilization of their health and in addition, as needed, mental health, drug treatment, housing assistance, and many other services. At all times during this process, each of the women had on- going counseling on transmission prevention. To date, we have had no reports from them or the community of risky behavior or transmission of HIV by any of these women. Our on -going SISTA Program, "Sisters Informing Sisters about Topics on AIDS" continues to be the cornerstone of reaching at risk women who may already be HIV+ and unaware of their status. This program is directed to low income women at high risk for infection and transmission of HIV. Many of them already suffer from illegal drug use, abusive partners, domestic violence, sexual abuse, poverty, and lack of minimal medical care. This program is an in -depth behavioral change program. Our Women's Outreach Specialist leads this social skills, health promotion, training intervention, aimed at reducing HIV sexual risk behavior among low income minority wornen who are at highest risk for HIV and other sexually transmitted diseases. The program consists of five once -a -week two -hour sessions, and includes a sixth, "booster" session one month after the women graduate at the fifth session. Most of the women participating are reached through outreach or referred to the program from other local agencies and organizations serving women and families in the community. To date, all the SISTA programs have been extremely well received, with very positive feedback NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 for the program, the facilitator, as well as HIHAF for offering such a comprehensive culturally appropriate program. We include the SISTA Project in this application because it is instrumental in helping us reach women who may already be HIV positive. It allows them to get tested, and if positive, into care services immediately. This program has been developed by the U.S. Centers for Disease Control and Prevention and has been found to be one of the most effective for minority women. We tailor each intervention to be appropriate to the woman we are working with. It is a harm reduction non - judgmental approach that meets wornen "where they are ", not "where we want them to be" in terms of their behavior. The end result is the empowerment of women by giving them the tools and the ability to direct their lives and health. QUANTITATIVE EVALUATION: Quantitative evaluation measures for this program includes the collection, tabulation and entry of participant data into a computer tracking system provided by the Centers for Disease Control (PEMS). Data routinely tracked include: number of clients, ethnicity, social status, risk categories, type of intervention, number of interventions, outcome information during program and additional follow up 30 and 60 days after completion of program. Planning estimations for interventions and programing for women FY2010 -2011 are as follows: SISTA a minimum of one hundred women (100) will participate in at least five (5) sessions and two (2) follow up sessions.For HIV+ women: a minimum of eighty five (85) women will have assessment sessions, quarterly reviews and quarterly individual prevention sessions. QUALITATIVE ANALYSIS: Data is gathered during outreach and individulized one on one sessions with all participants. For HIV+ women a prevention plan is developed and monitored on a monthly basis to assist the woman at the initial stages of dealing with her new status as HIV +. Later these sessions may be quarterly as she develops the skills necessary to protect herself and her partners. Participants in the SISTA program fill out a pre -test at the beginning of the program. They also fill out knowledge level questionnaires at the end of each session. A final post test is administered to determine level of knowledge, increase or decrease in self awareness of actions, consistency of condom use, level of negotiation skills, etc. A participant satisfaction survey is also administered to determine the efficacy of the presenter, the material, the setting, etc. All of the above data is reported quarterly to the Centers for Disease Control and the Dept. of Health of the State of Hawaii. Additional data is kept on the number of HIV tests administered, as well as Hepatitis C screenings along with the results each month. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 All the above information is also provided to the Board of Directors, staff, and other interested parties to help us improve the quality of our prevention programs. CHANGES FOR 2010: HIHAFcontinued with cost cutting activities during the past year in response to the declining economy and in anticipation of funding and donation decreases. Each staff member has taken on more work without the anticipation of additional financial reward. They have done so cheerfully and with a level of commitment that is astounding. We and our clients are fortunate to have such a talented and committed group of people who have put others before themselves. In addition, we were able to negotiate a lease renewal for our Hilo office which is well below the average price in the community. The Kona office lease was renegotiated and a reduction resulting in a savings of $13,500 achieved for calendar year 2010. Our Board of Directors has also made an even greater commitment to this Foundation. They are giving more of their time and talent to make sure that we weather this difficult time and grow as an organization at the same time. We also received a grant to do additional training with our Board to enhance their organizational and fundraising abilities and strategic planning. Total Budget and Position Count Total Program Budget 69,000 Total Program Position Count 1.5 Total Agency Budget 1,252,000 Total Agency Position Count 14 Program Objectives: 1) Review each HIV+ woman's transmission prevention service plan in first month of program, and /or initiate new transmission prevention plan for newly infected women. (Estimated 85 women, 1 -2 hours per client.) 2) Refer women to appropriate providers if needed, i.e. mental health providers, substance abuse treatment, etc. within the first month. These providers can deal with some of the behaviors which place these women at risk of transmitting this disease. These professional counseling sessions are paid for by other funding sources. 3) Initiate transmission prevention protocol (estimated 85 clients, 1 hour each) immediately. Reinforce at each meeting until client is stable. Quarterly thereafter or as problems arise. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 4) Document progress and adherence to transmission prevention protocol with input from client quarterly (85) 5) Weekly /Monthly /quarterly support for HIV+ women dealing with self - esteem, negotiation, sexual issues, transmission prevention as needed by individual client. 6) Referral to other women who may be at risk of contracting or transmitting HIV to others by program participants. Referral to result in HIV counseling and testing by prevention outreach staff and screening for participation in the SISTA program if appropriate. 7) Continuation of SISTA program including 5 -2 hour sessions and 1- booster session for a minimum of 100 at risk women in Hawaii County. Program Highlights: (from Fiscal Year 2008 - 09) 1) Achieved a review of care prevention service plans for forty (40) women during first half of funding year 2009 -2010. 2) Referred women to specialized care for health and /or prevention issues during first half of the funding year. 3) Reviewed and updated health and prevention plans for all participants quarterly. Six new female intakes had more intensive interventions,some weekly, during the first 3 months of program. 4) Initiated in -depth transmission protocols with all participants, and met with each participant on a one -to -one basis quarterly. Six new female intakes had weekly meetings either in person or by telephone during the first 3 months of program. 5) More than seventy -five (75 %) percent of HIV+ women and participants in the Sista program have reported 100% compliance with prevention protocols by fourth session (i.e., use of condoms or other protection during all sexual encounters.) 6) Twenty -five (25 %) percent of participants have reported compliance 80% of the time to date, with the goal of 100% compliance by the end of the year. 7) Ninety (90 %) percent of participants are documented to have benefited from the program by maintenance of good health, increased self- esteem, and ability to interact with sexual partners in a safe manner, thereby decreasing the possibility of sexual transmission. 8) As of December 2009, zero transmission of HIV by any participants in either program. Stable health reported by all HIV+ participants as a partial result of this program. 9) A total of 52 women of unknown HIV infection status have participated in the SISTA Project training sessions as of December, 2009. 10) On going associations and collaborations with Alternatives to Violence, the Women's Shelter, Big Island Substance Abuse Council, Neighborhood NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 Place, the day shelter, and various other programs that provide services to women in our community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 HAWAII ISLAND HIV /AIDS FOUNDATION - Agency Name TRANSMISSION PREVENITON FOR HIV+ WOMEN IN West Hawaii - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate HIV +individual transmission 85 85 85 prevention session (assessment) Health /prevention plan review 85 85 85 quarterly Quarterly individual transmission 91 85 85 prevention sessions (1 hr each) Review and documentation of 91 85 85 program quarterly _ SIST_ A program participation 85 90 100 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 35,000 35,000 40,000 Professional Fees 0 0 0 Operations 25,000 25,000 25,000 Equipment 0 0 0 Other" 2,500 2,500 3,000 Total 62,500 62,500 68,000 * If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 9 HAWAII ISLAND HIV /AIDS FOUNDATION - Agency Name TRANSMISSION PREVENITON FOR HIV+ WOMEN IN West Hawaii - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 _ Actual * Budget * Estimate County of Hawaii 15,000 15,000 15,000 Dept of Health -CDC 33% women 11,000 11,000 12,000 only (1/2 for Kona) Life Foundation /Sista Program 20,000 20,000 0 CDC Directly funded program _ 0 0 30,000 Foundations 3,000 2,000 5,000 est Fundraising 4,000 2,000 5,000 est Total 53,000 50,000 67,000 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Unfortunately, the HIV /AIDS epidemic shows no sign of ending, and indeed continues to grow. There is often a misrepresentation of facts about the epidemic in the media, indicating a lessening of urgency in dealing with this currently incurable disease. The fact is, there are still a minimum of 65,000 new cases in the US each year, and half of these new infections occur through heterosexual transmission with the highest rates in the age group of 15 -23 year - olds. Each newly infected individual presents with a myriad of challenges to be met and overcome. Because the epidemic continues to grow, we do not see a specific point at which our program might become self- sustaining. We continue looking at development of various income producing businesses which could help to support the activities of our non - profit. We merged with NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 10 another organization 5 years ago which greatly benefited the community by decrease duplication of services and increasing the standard of care throughout the entire island. At the present time we do not anticipate any further mergers. We are, however, continuing to seek colloborators for various aspects of our program, i.e., working with the schools to present programming through existing health education requirements. Our hope would be if we can educate young people early enough, the need for this kind of programming for adults could be diminished. Early prevention has proven to benefit the individual and the community at large. One area that we feel is critically important is working with our youth - especially those 15 -25 years of age. This group has had no consistent programming dealing honestly with sexually transmitted disease prevention. The result is that this group, on the mainland, is experiencing new infection rates that are almost epidemic. We are committed to working with this group, and have done so for the past five years with all funding being generated by fundraising. We need help in advocating to the Centers for Disease Control and the State of Hawaii Department of Health in making our youth a priority. We have received level or decreasing funding from our main revenue source, the Centers for Disease Control through the State of Hawaii Department of Health, for the last 16 years. During this time, the number of new infections has tripled and changed from predominently homosexuals to hetrosexuals. At present rates of infection the number of people seeking services may increase an additional 50% over the next 10 years. The costs for personnel, health insurance, rent, utilities, etc have risen dramatically over the past few years and creates greater stress on the non - profit sector and the people we serve. We are endeavoring to be creative in our approach but the reality is that many organizations may be stretched to the point that they cannot continue. As the only AIDS Service Organization on the Big Island this would be devastating to the community. It has been conclusively determined that communities without consistent dynamic prevention programs have seen a faster and higher rate of HIV infection than those with programming. We are very grateful for the support provided by the County in the past. We recognize the economic realities being experienced by our own County and are not requesting an increase in funding. We are all prepared to work even harder to stretch our funds to serve as many people as possible. We further wish to thank you for this opportunity to apply to you for funding. We will do everything possible to maxirnize the use of County funds, if awarded. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 11 HAWAII ISLAND HIV /AIDS FOUNDATION - Agency Name TRANSMISSION PREVENITON FOR HIV+ WOMEN IN West Hawaii - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. , Signature of Board Prrident/Chair Date 'i / Signatu're off Executive Director Date/ UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 12 46 Hawaii Island Workforce & Economic Development Ohana (HIWEDO) Community Connections Hawaii Island Workforce & Economic Development Ohana (HIWEDO) - Agency Name Community Connections- Program Name Agency Director: Jessica Yamamoto Phone No.: (808) 935 -3899 Contact Person: Jessica Yamamoto Phone No.: (808) 935 -3899 Mailing Address: 230 Kekuanaoa Avenue, Box 4 Hilo, HI 96720 Facility /Site Address: 230 Kekuanaoa Avenue, Box 4 Hilo, HI 96720 Fax No.: (808) 935 -3885 Email Address: Jessica @hiwedo.org Name of Accountant/CPA (include name of firm if applicable): Clyde Oshiro, CPA Phone No.: (808) 935- 0885 Mailing Address: 319 Kinoole Street Hilo, HI 96720 Amount of Request for County Funds: $84,100 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $n /a $n /a $56,500 Agency Mission Statement: The Hawaii Island Workforce and Economic Development Ohana (HIWEDO) is a private non - profit established in 2005. The organization's purpose is to facilitate the establishment of a workforce development system for the County of Hawaii that will respond proactively to the divergent employment and training needs of the County by building community collaboration and by expanding financial resources. - HIWEDO bridges economic development and workforce development through collaboration with — - - government and private agencies and businesses to develop long term plans, directives and solutions for employment and training to meet the needs of Hawaii County. HIWEDO promotes responsiveness, flexibility, and accessibility in all initiatives. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Hawaii Island Workforce & Economic Development Ohana (HIWEDO) - Agency Name Community Connections Program Name Program Description: HIWEDO would like to support Community Connections, a progressive, multi - pronged effort deliberately aimed at increasing accessibility. The components of the Initiative for which HIWEDO is seeking support include the following: 1) Become a recognized lead organizer and clearinghouse for new initiatives by providing tools for online collaborations to assist various stakeholders form effective coalitions and partnerships to combat our elevated unemployment rate. 2) Train micro - businesses, such as our local musicians, in acquiring the skills and knowledge needed to plan, implement, administer, monitor and evaluate effective business strategies in the community or within their industry to create jobs. 3) Train HIWEDO's 34 partnering organizations in our Going Home re -entry program in social networking software to expand the network within our county and provide support to the entire State of Hawaii. Using GoTo- Meeting, an innovative advanced videoconferencing technology, we will bring people into interactive relationship with each other and experts. Our current programs, Going Home and the Huiana Internship program consist of many local organizations that convene three times a month or more to discuss workforce issues of ex- offenders and high school youth. We would like to significantly expand these initiatives and support new collaborative groups who, up to now, had limited access to meet on a regular basis due to travel times or travel restrictions. In order to accomplish our other program goals, HIWEDO would like to purchase the services of experts that will deliver specific content to micro- entrepreneurs and our partners in Going Home and Huiana. This will allow groups to increase their productivity through shifting to an online environment where they can participate, witness live discussions, share documents and expand their members. Supported by other online tools, such as other social software and library of resources, CC will provide a catalyst for constituents' that will help energize activities in our local community, and be a springboard to dialogue and shared experience for groups of people who live vastly different lives in different parts of the county and state. The centralized meeting ground will address challenges of geographic access to meetings and education. The project is an integral part of the HIWEDO's new strategic plan. This project is the first major phase of sustainability implementation, designed to further workforce and economic development in our county. The Initiative will become an integral part of HIWEDO's permanent programming and help further the development of our workforce by providing access to quality discussions, planning and education specific to their industry or target population. The goals of Community Connect are multi -fold. Our second goal to serve micro entrepreneurs is based on at strategy to contribute to society by creating wealth, economic assets and job creation. Micro entrepreneurs face many hurdles in starting their business — such as — management of financial records and details, marketing and other topics that address specific challenges within the industry and in our local county. The effort will build on topics specific to their field and focus on classroom, as well as, addressing real -world scenarios they face day -to -day. Further, our goal is to be an active partner in our local county initiatives by providing an outlet for new initiatives to be discussed and further developed. This proposal stems from HIWEDO's extensive work with our partners. This includes feedback and evaluations from recent conferences delivered by HIWEDO and _ workshops sponsored. _Ongoing provision of training and technical assistance to the network and survey research undertaken by HIWEDO staff will ensure that our services are streamlined and efficient. We will implement several outreach and informational distribution campaigns that ensure visibility and successful outreach. This will include a combination of radio advertisements that can target different demographics and lifestyles, newspapers, Hawaii Island Chamber publications, brochures, web -site marketing and direct calls. HIWEDO will ensure that the impact is through frequency, which results in NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Hawaii Island Workforce & Economic Development Ohana (HIWEDO) - Agency Name Community Connections- Program Name bigger and faster response. Mixing media formats will capitalize on the advantages of reaching our community and build message frequency, increasing chances of program sustainability. Total Budget and Position Count Total Program Budget 84,100 Total Program Position Count 1 Total Agency Budget 856,189 Total Agency Position Count 7 Program Objectives: Goal 1: To strengthen the capacity of coalitions by providing online access and online centralized location for their informed participation in various discussions within industries that include health care, green initiatives, clean energy and quality arts and culture activities in Hawaii County using GoTo- Meeting. Objectives: 1. Work closely with State of Hawaii Workforce Development Division and Big Island Workplace connection, other community organizations to acquire names and contact information to create list in database of members in each coalition or current initiatives. 2. Schedule meetings in HIWEDO's online GOTO Meeting 3. Invite members and provide technical assistance 4. Post agenda and other information that the coalition has developed in HIWEDO's website 5. Integrate other social networking software that allow group to blog and discuss interim issues 6. Create 3 databases consisting of 15 coalition members Goal 2: Develop comprehensive training series for the unique needs of new and inexperienced entrepreneurs, most of who are interested in developing or enhancing their micro business. 'Objectives: 1. Create page on HIWEDO website that describes course offerings and provides scheduling. 2. Identify experts in various industry sectors to deliver course 3. Select 5 to 8 useful, new, and emerging topics for target groups 4. Create 45- minute modules that will be delivered for a fee over the course of 5 to 6 weeks. 5. Utilize local media and agencies to disseminate information and test market interest 6. An increased ability for individuals to develop and implement a marketing and sales plan 7. An understanding of the effective use of extemal resources to achieve goals of the overall business plan For instance, HIWEDO will ensure that each series offered include a cross - section of guest speakers/experts from various professions. HIWEDO would include industrial representatives that can discuss their expertise, career successes and challenges, industry secrets, as well as their career ladder. We will also include individuals from local educational institutions, professional training firms, industry leaders, small business development center, customers, or other influential- industry experts. HIWEDO intends to offer training modules specific to micro entrepreneurs that will cover a scope of topics. Goal 3: Offer online workshops for HIWEDO's Going Home Consortium members that build upon the usage of new collaborative and social networking tools that they will be using to enhance collaborative efforts. Tools are ready to use on HIWEDO's new website. Objectives: 1. Create video and written modules for online Going Home resource center NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 2. Provide online area for question- answer blog to address needed clarification 3. Ensure the Going Home 34 partnering institutions including county, state, federal, and private entities are contacted. We intend that our webinars will clarify the variety of online tools useful in enhancing communication. Each individual participating will increase personal skill bank that may also be transferred back to their employing organization. Ning Blogs, Facebook, YouTube, Flickr, and Twitter are a few examples of social media that will be presented that can build up our collaboration and assist individuals with their own agency website presence. Program Highlights: (from Fiscal Year 2008 -09) • We are currently working to use these tools to support Hawaii Island Health Alliance (HIHA), Huiana, Going Home and a new initiative to support science and technology efforts. We have also compiled a micro - entrepreneur training series for local musicians and individuals who are interested in participating in an incubator kitchen. • Under the prior administration, a Mayor's Task Force was formed. HIWEDO is interested in reviving a similar team under the current administration. HIWEDO and WDD have approached the current administration and are preparing to help convene and assist facilitating conversations that will focus on strategies that will stimulate our workforce and economy. • HIWEDO has operated the Huiana Internship Program since 2009. The program has shown an increase in participation within the last 3 months due to the Department of Education new requirements for high school seniors. Currently, Huiana has served 145 high school students. Each student has completed 60 -hours of work experience with a local employer and gained valuable skills. We are looking to continue to engage employers by providing a place for them to share their expertise to groups, primarily youth, and familiarize our future workforce with local business opportunities. • We currently work with WDD to deliver employer forums. Last year, we serviced 175 individuals from various businesses around our island. We would like to expand our reach to other small businesses, such as micro - businesses, through intemet based delivery. • Our Going Home consortium includes an array of private and public agencies. Many of these individuals have not received any formal training in new technologies that exist to help enhance productivity through internet -based collaborations. A recent survey showed that more than 90% of these individuals do not know how to use these tools effectively and do not understand why they are important. HIWEDO recognizes that without these skills, future growth and replication will be limited due to geographic constraints. The Going Home members will also like to strengthen their current relationship with the ex- offender population, through streamlined services. HIWEDO has enabled these tools on our website, but is requested to train members to further its usage. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Hawaii Island Workforce & Economic Development Ohana (HIWEDO) - Agency Name Community Connections- Program Name Performance Measures: FY 2008.09 FY 2009-10 FY 2010-11 Budget * Budget * Estimate Total number of coalitions supporting 2 2 5 . Number of people in each coalition 20 30 50 Total number of GoTo - Meetinqs hosted n/a 0 36 Total number of participants attending online n/a 0 120 meetings Number of people registered for online series n/a 0 55 Number of people completing series n/a 0 50 Number of Business Mentors accessed 5 5 20 Number of presentations implemented 5 5 25 Number of participants reached through 135 150 250 presentations Total number of individuals participating in 1 or more 75 75 150 services Total number of agencies participating in 1 or more 40 60 80 services *If applicable Program Expenditures FY 2008-09 Actual * FY 2009-10 Budget * FY 2010-11 Estimate Salaries and Wages n/a 31,500 31,500 Professional Fees . n/a 15,000 10,000 Operations n/a 10,000 42,600 Equipment n/a n/a Other n/a n/a Total $56,500 $84,100 * If applicable # Please explain in detail on separate sheet Salaries and Wages: Program Support Staff .5OFTE © $22,500 per year + Fringe @ .40 = $31,500 Program support staff will be used work full -time to work with all consultants and work on outreach to implement project. Fringe benefits include unemployment insurance, FICA, Medicare, workers compensation, pension, employee benefits (health, dental, retirement, & leave). Professional Fees: Consultants @ $50 per hour. Estimated # hours for website developer, videographer, business experts, and website developer is 200 hours. = $10,000. Current funding supports website developer. Requested funds will assist with costs for remainder of consultant services needed to create training modules. Operations: Materials and supplies, bookkeeper services and outreach. $42,600. Allocation for fiscal services is necessary under current funding restrictions. This includes processing of payments, financial 'statements, taxes, audit and other processing or fiscal functions needed to implement. Materials and supplies will be purchased to support training. Extensive outreach will be necessary to promote imitative for purposes of sustainability. Outreach expected to be $1,000 x 12 months = $12,000, Fiscal services 450 x 12 months = $5,400, materials (training materials, copies, and course content) cost per person $200 x 126 individuals = $25,200, NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Hawaii Island Workforce & Economic Development Ohana (HIWEDO) - Agency Name Community Connections- Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008-09 FY 2009-10 FY 2010-11 Actual * _- _- — Budget *---- - - -- Estimate - -- Federal Funding - Reed Act II n/a 46,500 n/a Private Foundation - HEI n/a n/a 7,500 County of Hawaii - Contract ending 3/31/10 n/a 15,000 n/a County of Hawaii - Request n/a n/a 65,350 Micro - Entrepreneur Series n/a 11,250 TOTAL 56,500 84,100 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? HIWEDO will charge reasonable fees to cover costs for use of our tools. We will ask members from each coalition or the coalition themselves to pay for the use of our collaborative tools. In return they will receive a full -scope of services that include helpful tools and training to assist them in communicating efficiently online. The micro - entrepreneurial series will focus on minimum enrollment. Courses will not run if enrollment is not met. If classes are cancelled, HIWEDO will respond by postponing and conduct an evaluation to determine if more outreach is necessary or content needs to be revised. HIWEDO will also create an archive of series that can be purchased on- demand that will available at anytime after series has been conducted. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Hawaii Island Workforce & Economic Development Ohana (HIWEDO) - Agency Name Community Connections- Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25 Sections 2=135=2-142.2, Hawai'i Code, - relating to Appropriation - Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawai'!, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. //Z1/ zo,D Signature of Board President/Chair Date ✓ fAli i f/ A l2/M na a ture executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 47 Hawaii Island Workforce & Economic Development Ohana (HIWEDO) Going Home Hawai'i Island Workforce and Economic Development Ohana (Agency Name) Going Home (Program Name) Agency Director: Jessica Yamamoto Phone: (808) 935 -3899 Contact Name: Jessica Yamamoto Phone: (808) 935 -3899 Mailing Address: 230 Kekuanaoa Ave, Box 4 Hilo, HI 96720 Fax No.: (808) 935 -3884 Email Address: Jessica @hiwedo.org Name of Accountant/CPA: Clyde T. Oshiro, CPA Phone No.: (808) 935 -0885 Mailing Address: 319 Kinoole Street, Hilo, HI 96720 Amount of Request for County Funds: $87,000 Prior Year(s) Funding: 07-08 08-09 09-10 n/a $65,470 $128,151 Agency Mission Statement: The Hawaii Island Workforce and Economic Development Ohana (HIWEDO) is a private non - profit established in 2005. The organization's purpose is to facilitate the establishment of a workforce development system for the County of Hawaii that will respond proactively to the divergent employment and training needs of the County by building community collaboration and by expanding financial resources. HIWEDO bridges economic development and workforce development through collaboration with govemment and private agencies and businesses to develop long term plans, directives and solutions for employment and training to meet the needs of Hawaii County. HIWEDO promotes responsiveness, flexibility, and accessibility in all initiatives. Program Description: The Going Home Consortium is a community-based group of non - profit service providers, government agencies, faith -based groups, businesses, volunteers and formerly incarcerated persons that collaborate to assist Hawaii Island men and women released from correctional institutions with reintegration into community life through employment, training and appropriate supportive services. The significance of Going Home is that without effective supports in the community, offenders are highly likely to commit new crimes. This creates new victims, strains an already overburdened criminal justice system, and hurts family and loved ones. The initiative began in August 2004 under the Hawaii County Mayor's Task Force on Employment Solutions as one of the projects designed to train and prepare the under - utilized segments of the population for employment in the Big Island's workforce. However, with the ex- offender population, employment and training are not stand -alone issues. Rather, a comprehensive approach was nestled to address the needs and challenges �f this population: Through ita collaborative stricture and working committees, the Going Home Consortium addresses such issues as housing, family reunification, health and wellness and barriers to employment. The Consortium helps develop support networks and builds referral processes to community resources. Since 2008 HIWEDO has provided Going Home with an organizational base of operations, and provides the administrative and fiscal management structure. Going Home has grown from infancy into a broad community effort. The strength of Going Home is the synergy that is created through the cooperative efforts of over 30 agencies and organizations, and the partnership with NONPROFIT. GRANT APPLICATION FISCAL YEAR 2010 -2011 Hawai'i Island Workforce and Economic Development Ohana (Agency Name) Going Home (Program Name) government. The Consortium approach provides facilitation, collaboration, community - building, research and support to the organizations involved. Through its recently completed strategic planning process, Going Home recognized the need to expand the Consortium and its referral processes to include more organizations specializing in areas of mental health: Hawaiian culture, and family /children services. Additionally, the Consortium is determined to address the necessity of reaching those in need in all parts of the Big Island. For example, in West Hawaii, there is a need to connect with organizations specializing in housing, transportation and substance abuse counseling. Further, the Consortium continues to seek ways to improve the programs and services offered to Big Island offenders. Utilizing its Education and Training Committee, Going Home plans to create a model for "just in time" training for ex- offenders that will include the design and delivery of short-term training modules with the emphasis on building skills and /or obtaining credentials that are needed in many occupations. (eg OSHA safety, customer service) One of the ingredients for the successful re -entry of ex- offenders back into their community is access to positive role models and community relationships, including mentors. The Going Home Consortium seeks to establish an island - wide mentoring program, linking ex- offenders with community and business people. Going Home will also facilitate the development of a peer support program in West Hawaii, modeled after the successful Men of Pa'a and Women of Pa'a (Positive Action Alliance) organizations, which emphasize life changes through fellowship and providing service to the community. Total Budget and Position Count Total Program Budget 137,000 Total Program Position Count 1.5 Total Agency Budget $856,189 Total Agency Position Count 7 Program objectives: Going Home (1) Program Operation and Oversight: Provide /hire staff to manage the program on a daily basis, and oversee the development of Objectives 2 -6 below. (2) Coordination of the Going Home Consortium Efforts: Continue the community-based work, support the activities of the committees, promote collaboration. (3) Expand the Going Home network and improve referral processes to agencies island -wide. (4) Develop a website of community resources. Going Home previously developed and distributed a printed resource directory of agencies that provide support services needed by the ex- offender population. This needs to be updated and developed as an on -line resource. HIWEDO is currently developing a website for Going Home, which will house the resource directory. (5) Skills training courses. Deliver short-term employment skills training classes in both East and West Hawaii. Develop curriculum for, and deliver, new training modules that include skill sets that are essential in many occupations. (6) Mentorng program. Develop mentor handbook, train mentors, and establish an island -wide mentoring program. (7) Peer support program in West Hawaii. Facilitate the development of a peer support program in West Hawaii that provides positive role models, and emphasizes life changes through fellowship and providing service to the community. Program Highlights: 1) In partnership with the State Public Safety Department, initiated re -entry programs prior to release. Through Going Home's efforts, the Department of Public Safety received funds to construct an education and training center at the Hale Nani Correctional Facility. HIWEDO was able to secure initial funding for equipment and supplies from the Cooke Foundation and Walmart, as well as through the County non - profit grant process. Classes started at the facility in February 2009. Going Home assisted in the development of the re-entry program curriculum and several Going Home Consortium members deliver the courses. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Hawai'i Island Workforce and Economic Development Ohana (Agency Name) Going Home (Program Name) 2) Going Home completed a 5 -year Strategic Plan, with five broad goals: Strengthen and broaden the Going Horne Consortium; Establish more effective ties with other organizations and the community; Expand employment and training programs; Establish an island -wide mentoring program; and Establish a data system that can track clients - and performance measures that can monitor progress: - - - 3) In December 2009, Going Home delivered a conference attended by 130 people, for the purposes of expanding the Big Island network and providing information to other counties to encourage the development of community - based collaborations on those islands. Performance Measures: AY 2008-09 AY 2009-2010 FY 2010-2011 Actual Budget Estimate Increase the number of 35 organizations 35 organizations 40 organizations organizations /agencies involved with the Going Home Consortium by 10% Deliver a half -day gathering in West NA NA 50 people will attend, Hawaii to expand the WH network & representing 25 agencies promote collaboration Develop an on -line resource NA Build the Going Home Completion and evaluation of directory listing organizations that website which will the directory provide services needed by the ex- house the directory offender population Develop and deliver a series of 4 classes delivered in 2 7 classes to be 12 classes to be delivered, in short -term skills -based training topics delivered, in 4 topics 6 topics modules for ex- offenders Develop an island -wide mentoring NA Develop a mentor handbook; program for ex- offenders deliver 2 mentor training programs to 30 people. Recruit 25 mentees. Facilitate the development of a peer NA Include information Conduct a minimum of 3 support program for ex- offenders in about Men and Women meetings West Hawaii of Pa'a as part of the re- entry program through Hale Nani Program Expenditures: FY 2008-09 FY 2009-10 FY 2010-11 Actual Budget Estimate Salaries and Wages 54,500 94,500 94,500 Professional Fees 6,350 7,200 24,700 --- _________ _Operations _----- - -_ - -. --- -- - -.----- - --. -- -__. 4, 620. - -- ------ _.20,600 - -- ___17,800. - -- Equipment 5,851 0 Other n/a n/a 0 Total $65,470 $128,151 $137,000 Salaries and Wages: Program Coordinators' 1.5 FTE @ $45,000 per year + Fringe @ .40 = $94,500 Program Coordinators will be used work full -time to work with GH Consortium and consultants and work on outreach to implement project. Current funding will support percentage staff until 6/30/2010. Fringe benefits include NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Hawai'i Island Workforce and Economic Development Ohana (Agency Name) Going Home (Program Name) unemployment insurance, FICA, Medicare, workers compensation, pension, employee benefits (health, dental, retirement, & leave). Professional Fees: $ 24,700. Consultant/Expert Ted Sakai, retired public safety director @ $50 per hour x 250 hours. - = $12,500 - (travel inclusive): OSM Contract to develop mentor manual and train mentors (trail the trainer - workshop) _ $6,000. Instructor's for training classes, 12 classes @ 5 hours, ext. 60 hours @ $20 - $1,200. Website development = $5,000. Operations: $17,800. Office supplies $125/ per month (project) x 12 = $1,500. Classroom materials, 12 classes @ $50 = $600. Mileage expenses (Hilo to Kona) for Coordinators & Instructors for classes, set up peer network in Kona (20 trips, 200 miles @ .60 per mile = $2,400). Printing costs (mentor manual, project, etc) $2,500. Bookkeeper services: allocation for fiscal services is necessary under current funding restrictions. This includes processing of payments, financial statements, taxes, audit and other processing or fiscal functions needed to implement. Fiscal & operational (services) 900 x 12 months = $10,800. Program Funding Sources: Revenue Source FY 2008.09 FY 2009.10 FY 2010 -11 Actual Budget Estimate Federal Reed Act funds 49,470 119,401 n/a Cooke Foundation 5,000 n/a n/a Walmart 1,000 n/a n/a County Contract (end 3/31/2010) 10,000 5,000 n/a County Contract (HALE NANI) n/a 3,750 n/a Federal: Second Chance Act (application) n/a n/a 50,000 County Contract — Request n/a n/a 87,000 Total $65,470 $128,151 $137,000 Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Several of the objectives require only one -time start-up funding to initiate, and will be sustained through the volunteer work of the Consortium organizations. HIWEDO will include the administrative and financial management support for sustaining Going Home in its fund development work. Through HIWEDO, Going Home will continue to pursue grant support to expand the mentoring 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. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Hawai'i Island Workforce and Economic Development Ohana (Agency Name) Going Home (Program Name) I(we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hewer 1, I(we) understand and will comply with the requirement to — submit a year- end to the - Legislative - Auditor within 30 of the fiscal report ---- - shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete and accurate Year-end report will impact the evaluation of your program's or agency's future funding requests. Jk l — 1 iztha Signature of Board President/Chair Date S a nature of E ebutive Director D: e UNSIGNED PROPOSALS WILL NOT BE ACCEPTED NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 48 Hawaii Island Workforce & Economic Development Ohana (HIWEDO) Huiana Internship Program Hawaii Island Workforce & Economic Development Ohana (HIWEDO) - Agency Name Huiana Internship Program - Program Name Agency Director: Jessica Yamamoto Phone No.: (808) 935 -3899 Contact Person: Jessica Yamamoto Phone No.: 808 935 -3899 Mailing Address: 230 Kekuanaoa Avenue, Box 4 Hilo, HI 96720 Facility/Site Address: 230 Kekuanaoa Avenue, Box 4 Hilo, HI 96720 Fax No.: (808) 935 -3885 Email Address: Jessica @hiwedo.org Name of Accountant/CPA : Clyde Oshiro, CPA Phone No.: (808) 935 -0885 Mailing Address: 319 Kinoole Street Hilo, HI 96720 Amount of Request for County Funds: $73,930 Prior Year(s) Funding: 07.08 08-09 09.10 $n /a $73,000 $81,450 Agency Mission Statement: To promote the development of a highly competent and productive workforce by coordinating the efforts of educational institutions, labor, business, economic development organizations and the entire community in order to sustain a vibrant Big Island economy and lifestyle. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Hawaii Island Workforce & Economic Development Ohana (HIWEDO) - Agency Name Huiana Internship Program - Program Name Program Description: The Huiana Internship Program is an island -wide internship program that matches Hawaii Island high school students with business mentors. With the strategy to develop the workplace skills of our island youth and prepare the future workforce, students are placed in 60 -hour internships that are tied to their career pathway interests. The experience supports not only career exploration but also workplace skill development and affords students 0.5 credit toward graduation. Current internship positions (over 90 businesses) are concentrated in the health services, public and human services (education, hospitality, law, and social services), and industrial and engineering technology, but cover ALL DOE career pathways. The program enables students to reflect on and develop their work ethic, fulfills several requirements for the students' Personal Transition Plan (required for graduation) and fosters relevance in education. Internships are available during the school year (from November through April) and one in the summer (from June to mid - July). The internships do not interfere with classroom time and it is expected that students will complete their internship hours after school, evenings and /or on weekends as the employer and student schedule allows. • Key Features include a comprehensive application process where schools conduct a pre- screening and selection: • Students and parents must complete application forms. • Student must meet all program requirements, obtain two teacher recommendations and have no disciplinary referrals. • Student prepare a professional resume and cover letter. • Student are coached in proper dress for job interviews and the workplace. • Two tier Interview Process • A 3- 4 interview panel conducts the pre - interviews and recommends a business match for the student. • Companies have the option to conduct a second interview with the student or can choose to waive the interview and accept the panel's recommendation. Features of the program from the business perspective include: • Optional wages • Working with and training a potential future employee • Gaining a better understanding of youth and youth culture • Taking advantage of advanced technology skills of young people • Learning /developing new supervisory skills • Orienting young people to the mentor's profession Businesses connect the students' school learning with work -based leaming by assigning tasks that are consistent with the Department of Education General Learner Outcomes (GLOs), which are o Self- directed Learner: The ability to be responsible for one's own learning. o Community Contributor: T h eunders tanding that it is essential for human beings to work together. o Complex Thinker: The ability to demonstrate critical thinking and problem solving. o Quality Producer: The ability to recognize and produce quality performance and quality products. o Effective Communicator: The ability to communicate effectively. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Hawaii Island Workforce & Economic Development Ohana (HIWEDO) - Agency Name Huiana Internship Program - Program Name o Effective and Ethical User of Technology: The ability to use a variety of technologies effectively and ethically. All company employees who work directly with the student must attend a Mentor Training session where they learn about the GLOs, how to assign appropriate tasks, program parameters, and techniques for working with youth. Mentors provide supervision and guidance for students at all times. The perceived value of the Huiana Internship Program is founded in the community-based support for student work -based teaming. The effective working partnership between the education system, the business community, govemment and the non - profit sector make the Huiana Internship Program greater than the sum of its parts. The DOE, HIWEDO, the business community, and govemment (County offices and the Department of Labors WDD) effectively work together to make this program viable and meaningful to the students and their mentors. Total Budget and Position Count Total Program Budget $129,930 Total Program Position Count 1 Total Agency Budget $856,189 Total Agency Position Count 7 Program Objectives: Goal 1: To place up to 120, but not less than 90, students in career - related intemships. The program objectives meet DOE curricular as well as community needs: 1. Provide career exploration opportunities for students 2. Provide real world experience as a basis for post- secondary transition planning 3. Enable students to practice employment (workplace excellence) skills 4. Enable students to connect school -based learning with work -based teaming and understand the relevance of both 5. Assist employers by conditioning and orienting students who could become future employees Goal 2: Expand program personnel to support operations in West Hawaii 1. Hire a West Hawaii part-time coordinator to support recruitment of students and businesses and coordinate /manage operations. 2. Orchestrate a Ho'ike event (graduation ceremony for intems) to promote the program publicly, give students the opportunity to share their internship experiences, and support community involvement in Huiana, 3. Expand participation of # of high schools as well as charter schools Goal 3: Expand resources to enable program resource development 1. Expand personnel in East Hawaii to support increased participation by all schools in East Hawaii, including special needs populations 2. Support in- school coordinators (already stressed with many responsibilities) with modest stipends as well as public recognition at Ho'ike events 3. Free up resources for pursuit of federal, corporate and community support. Program Highlights: (from Fiscal Year 2008.09) The Program serves students primarily in the 11th and 12th grades from all public high schools on Hawaii Island. It has served 169 student from Spring 2008 to Summer 2009. In the 2008 -2009 year, special NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Hawaii Island Workforce & Economic Development Ohana (HIWEDO) - Agency Name Huiana Internship Program - Program Name attention was given to support economically disadvantage and special needs students, an initiative that continues with the program's partnership with Alu Like, Inc. and About Face - Hawaii. • By 2008 -2009, 86 businesses across the island signed up to participate as employer /mentors. [Not all are active for each internship session • Many success stories mark this program: a special needs student worked at the East Hawaii Cultural Center and worked out so well that he continues to volunteer there; three Marshallese students from Ka'u, who had no formal work experience interned at Hawaii Ocean View Estates (H.O.V.E.) Maintenance Corp. and helped to bring their files and records up to date. An aspiring musician and at -risk student leamed how to record and produce a CD of his own music. • We enlisted three new preschools to serve the demand for placements in early childhood education centers; • Health pathway students got pre - medical training at Hilo Medical Center, Ka'u Hospital, Hale Anuenue Restorative Care Center, Kauka Express Urgent Care Center and Hui Mama Ola Na 'Oiwi. • Huiana engaged Subaru Telescope as an additional employer which added two industrial engineering & technology placements and added the USDA Agricultural Research Service and a new pharmacy to our roster of STEM business mentors ; • With funding from a private foundation, we were able to host our graduation ceremony at Sangha Hall which made the event very special for the students. • Private funding enabled us to provide the students with $150 stipends as a means to help students connect meaningful work with compensation. • HIWEDO recently conducted a strategic planning session with our Local Workforce Investment Board (LWIB). It resulted in a tighter partnership that will allow HIWEDO to become an intricate arm of the LWIB by carrying out initiatives that are priorities. Performance Measures: FY 2008-09 FY 2009-10 FY 2010 -11 Budget * Budget * Estimate # participating students by school 70 96 110 # participating students by geographic area East 68 West 2 East 91 West 5 East 100 West 10 #of participating employers n/a 42 50 #of mentors who receive initial training n/a 17 8 #of mentors matched with students n/a 58 65 #of mentors who received additional training n/a n/a 15 # new companies in program* 15 6 8 # of students in West Hawaii 1 4 15 If applicable *A goal is to increase the number of employers in West Hawaii so we can expand West Hawaii participation. Program evaluation surveys are given to employer /mentors and to student participants. Statistical as well as qualitative information (in the form of comments) are collected, summarized and analyzed. In addition, the student's work performance is evaluated by the mentor and can be compared with a pre- internship teacher evaluation (it is the same instrument) to give us a pre- and post- indication of student work habits. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Hawaii Island Workforce & Economic Development Ohana (HIWEDO) - Agency Name Huiana Internship Program - Program Name Program Expenditures FY 2008-09 Actual * FY 2009-10 Budget * FY 2010 -11 Estimate Salaries and Wages $39,500 $61,650 $63,000 Professional Fees $12,500, $4,800 $30,000 Operations ___ $15,000 - _ __$12,000__ _$20,430 _ Equipment 00 2,500 00 Other# $6,000 $7,500 $16,500 Total $73,000 $81,450.00 $129,930 * Reflects the three months from October 2008 to December 2008 # Please explain in detail on separate sheet Budget Explanation: Salaries and Wages: Program Coordinators' 1.0 FTE @ $45,000 per year + Fringe @ .40 = $63,000 1 Full -time Program Coordinator works full -time to recruit students and business mentors. Staff also facilitates Huiana committees that are made up local public and private agencies. Current funding will support percentage staff until 6/30/2010. Fringe benefits include unemployment insurance, FICA, Medicare, workers compensation, pension, employee benefits (health, dental, retirement, & leave). Professional Fees: $30,000. Contract services to conduct expansion to west Hawaii schools and businesses. Estimated @ $25 per hour x 1200 hours (25 hours per week). Operations: $20,430. Office supplies $125/ per month (project) x 12 = $1,500. Outreach materials, display boards, supplies, certificates, graduation for students. Materials for mentors, school coordinators and students @ 150 x 15 = $5,250. Mileage expenses (Hilo to Kona) for Contractor and Program Coordinator (24 trips, 200 miles @ .60 per mile = $2,880). Bookkeeper services: allocation for fiscal services is .necessary under current funding restrictions. This includes processing of payments, financial statements, taxes, audit and other processing or fiscal functions needed to implement. Fiscal & operational (services) 900 x 12 months = $10,800. Other: 16,500. Estimated student participation is 110 students. Stipends for students are $150 per students. Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008.09 FY 2009.10 FY 2010.11 Actual * Budget * Estimate Federal Funding - Reed Act II $64,500 $75,000 n/a HEI Charitable Foundation n/a n/a $15,000 County Contract (Ends 3/31/2010) n/a 5,450 n/a Company support for stipends 0 $1,000 $1,000 Corporate Sponsorship n/a n/a $40,000 John M. Ross Foundation $8,500 -0- -0- 'County �f Hawaii - Request 1: n/a _' n/a $71,930 TOTAL HIWEDO $73,000 $81,450 $129,930 In kind supplies from DOE -. .1$1,000 $1,000 `707 In -kihd - DOE'cdmplez coordinator (esflmate)". $30,000 S$30,000 .: ° $30,000 TOTAL $105,000 $112,450 $174,930 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Hawaii Island Workforce & Economic Development Ohana ( HIWEDO) - Agency Name Huiana Internship Program - Program Name Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self-sustaining? The Huiana Internship Program is not a revenue - generating program and relies on the support of the federal government, state and local appropriations as well as private support to sustain it. The plan to increase support for the program includes soliciting corporations for sponsorship_ Preliminary inquiries lead us to believe that will be able to garner some corporate support not only from businesses that have long been partners with the program but from other companies who have a vested interest in reaching teens and families on the Big Island. HIWEDO is currently drafting tiers for corporate sponsorship that will describe valuable benefits to their business, community and youth. The HEI Foundation has provided recurring support for Huiana, because HELCO had large role in developing the program. This program is of long -term benefit to the County of Hawaii, as it is orienting the up- and - coming labor force to job opportunities on the island, with the intention of reducing the "brain drain" from Hawaii. Although the program has not been in place long enough that we can see how many young people are now in the labor force here, we have anecdotal evidence from several students that they are interested in either working here after high school, or going to college and then retuming home to give back to their community. This internship program is a workforce development program designed to enable students to see the employment opportunities on the Big Island and help them craft a future for themselves that will be meaningful, productive, and sustainable. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Hawaii Island Workforce & Economic Development Ohana (HIWEDO) - Agency Name Huiana Internship Program - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes, If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. p t (.4 to Signature of Board President/Chair Date 1111 kigfig inature;Q'�xecutive Dire. or Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 49 Ho'oulu Lahui Inc. From the Seed to the Table Ho'oulu Lahui Inc_- Agency Name From the to theTable- Program Name Agency Director: Keikialoha Kekipi Phone No.: 965- 5098 Contact Person: Susie Osborne Phone No.: 640- 3439 Mailing Address: P.O. Box 2177 Pahoa, HI 96778 Facility/Site Address: Pu'ala'a, Puna 14 -5322 Kaimu Kapoho Road, Pahoa, HI 96778 Fax No.: 808 965 -9618 Email Address: pualaa @ilhawaii.net Name of Accountant/CPA (include name of firm if applicable): Rozanne Connel, Cabeneros CPA and Associates Phone No.: 808 870 -2973 Mailing Address: rconnel @carbocpa.com Amount of Request for County Funds: $20,420.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $0 $0 Agency Mission Statement: NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Ho'oulu Lahui is an educational 501(c)(3) nonprofit corporation formed in 1995 through a grassroots effort, with the mission of awakening Hawaiian culture, values, and lifestyle in partnership with the community to achieve unity, harmony and lokahi (total well being). Ho'oulu Lahui has been running cultural education programs at our site in Pu'ala'a, Puna, Hawaii Island during this time. Pu'ala'a is comprised of approximately 600 acres that are filled with low land rain forest, alkaline ponds, fish- ponds, archaeological sites, and native plants. The restoration and stabilization of this coastal village offers a unique and dynamic learning environment to all who come, young and old. Thousands of Native Hawaiians from Public and Private schools, Mental Health Organizations, Native Hawaiian Organizations and the Prisons have been served over the past fifteen years through our cultural education programs. Kua 0 Ka La Public Charter School is a partner with Ho'oulu Lahui and utilizes the 'aina of Pu'ala'a as home to the school. Kua 0 Ka La offers a public education administered through the Tens of Hawaiian culture with an effort to provide a rigorous education that supports both traditional and modern practices and knowledge. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Ho'oulu Lahui Inc. - Agency Name From the Seed to the Table- Program Name Program Description: This project is being developed to establish an organic vegetable garden at partnering Kua 0 Ka La PCS. The hands on gardening project will be supported by an integrated agricultural and culinary educational program. aimed at improving the overall dietary and nutritional awareness and cultural lifestyle of our Native Hawaiian students and families in the Puna district. Through this hands on project, students will develop a site for an organic garden including site prep, ground and soil development, making a water catchment, install pig fences and learn how to grow effective microorganisms for fertilizer. They will learn to grow food and understand the link between food, culture, health and environment to make lifestyle changes that will help them overcome the severely noted health challenges facing Native Hawaiian youth and families.. The food that is grown will be given to the culinary program which teaches healthy cooking and eating practices.This comprehensive culturally and socially appropriate project will help youth gain the important life skill of gardening and help our youth practice personal responsibility; reach a balance in their lives; and make choices for healthy lifestyles. This project is being developed to serve the youth in the rural Puna community on the island of Hawai'i (the "Big Island ") in the state of Hawai'i, a large percentage of whom are identified as "at- risk ". The project will initially be developed and piloted with the grade 6 -8 grade Native Hawaiian youth who attend high school at the Kua 0 Ka La Public Charter School (KOKL PCS). Total Budget and Position Count Total Program Budget 20,420.00 Total Program Position Count 2 -P/T Total Agency Budget 350,000.00 Total Agency Position Count 4 Program Objectives: Overall Objective : To develop and implement a comprehensive academic agricultural program (garden development, composting, vermi - culture, science of soil and water, effective micro - organisms etc.) that produces fruit and vegetables in support of the culinary educational activities by the end of a one year period. Program Activities: 1) Prepare site for garden plot, clear surrounding bush and trees for light 2) Order soil, mulch, cinder and fertilizer 3) Order tools and supplies (tar paper, hog wire, plastic) to build water tank NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 4) Build water tank 5)Start seeds in pots 6) Install irrigation for watering garden 7)Lay out garden plot 8) Plant garden plot 9)Lay out and install pig fencing 10) Begin microorganisms in earthen pots 11) Set up shade area with picnic table for related lessons and break time 12) Water, fertilize garden and harvest vegetables 13) Provide harvested vegetables to the culinary class for their dishes every Friday. 1) Program Highlights: (from Fiscal Year 2008 -09) 1) not applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Ho'oulu Lahui - Agency Name From the Seed to the Table - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate All supplies ordered, purchased _ Area cleared and garden plot I ! established , ' }e!ltc,tvh 1 Water tank built and in use -!_ hs,t i- Pig fencing installed and operational Garden producing vegetables, weekly harvest Vegetables used in culinary class ib 30 students taught within this ag 30 .5+ub:'-I) program Once a month planning meetings q -kxr held for this program with team s� *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 10,125.00 Professional Fees Operations Equipment Other 10,295.00 Total 20420.00 If applicable u Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Ho'oulu - Agency Name - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate State of Hawaii liscensed teachers N/A 15,000.00 County Grant request 20,420.00 Total 35,420.00 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? We anticipate that this support will allow us to put in our gardens and water system and the earthen pots will support our fertilizer development. Except for the personnel support which can hopefully get absorbed by the school, the program will be sustainable with this infrastructure in place. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 County of Hawaii Grant Proposal 2009 Budget Proposal Item Annual Salary Funding request PERSONNEL Fiscal Officer _ $ 40,000.00 $ 2,500.00 Specialty Instructor- Ag $ 30,000.00 $ 5,000.00 Total Personnel $ 70,000.00 $ 7,500.00 FRINGE BENEFITS 35% of total personnel Budget for 12 mos. $ 2,625.00 Total Fringe Benefits $ 2,625.00 SUPPLIES Soil 6 truck loads x $430.00 $ 2,580.00 Mulch 5 trucks x $200.00 _ $ 1,000.00 Red cinder 5 trucks x $300.00 $ 1,500.00 fertilizer $ 375.00 - -- - -- - -- - -- tar paper x 2 rolls $ 90.00 pig fencing $ 800.00 Plastic for water catchment $ 200.00 Earthen clay container for microorganisms $ 150.00 canvas for shade 1 $ 325.00 picnic table x 2 $ 400.00 tray, pots, mis. Supplies $ 250.00 irrigation Tines $ 225.00 chainsaw for surrounding trees $ 325.00 misc. tools, machete, rake, shovels, wheelbarrow $ 275.00 Hog wire for water catchment $ 500.00 Total Supplies $ 8,995.00 OTHER Fuel $ 500.00 Water $ 450.00 Shipping and ground transport __ _ _ _ $ 350.00 Total Other $ 1,300.00 TOTAL COSTS $ 20,420.00 - Agency Name - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. aztALL) ' /2- 7/44 Signature of Board President/Chair Date 69 > i i-dfi-IS 2 )( 9 3,1) ) o Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 50 Hui Malama OIa Na Hali Health Transportation Program 4 Hui Malama Ola Na `Oiwi — Agency Name Kokua Hall Health Transportation Program — Program Name Agency Director: Michelle Hiraishi Phone: 808.969.9220 ext.201 Contact Person: Joy Motta Phone: 808.969.9220 ext.220 Mailing Address: 69A -3 Railroad Ave Hilo, HI 96720 Facility /Site Address: 69A -3 Railroad Ave Hilo, HI 96720 Fax: 808.961.4794 Email Address: joy Name of Accountant/CPA Firm: CW Associates Phone: 808.861.1174 Mailing Address: Topa Financial Center 700 Bishop St, Ste 1040 Honolulu, HI 96813 Amount of Request for County Funds: $39,387 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $0 $20,000 Agency Mission Statement: Makou 'o Hui Malama Ola Na 'Oiwi We are the group that takes care of the health of Hawaiian people Keia ko makou kuleana: Our mission is. Ho'oulu ola o ka lahui Hawaii To uplift the health of the Hawaiian nation Keia ka mana'o: We will Malama moku o Keawe Take care of Hawaii Island Malama na kua'aina Take care of country and rural areas Malama kou kino Take care of your physical, spiritual, and mental body Malama na mea Hawaii Take care of Hawaiian culture and practices 'Ike makou papalua ikaika ola We envision a strong and healthy Hawaiian nation. ka lahui Hawaii NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 1 Hui Malama Ola Na `Oiwi — Agency Name Kokua Hali Health Transportation Program — Program Name Program Description: Hui Malama Ola Na'Oiwi ( HMON'O), the Native Hawaiian Health Care System for Hawaii Island, is a 501 (c) 3 nonprofit organization designated through the Native Hawaiian Health Care Improvement Act of 1988, Public Law 100 -579. Incorporated in 1991, the agency's basic thrust is to provide access to health services for the island's Native Hawaiian community. Accessibility to health care on Hawai'i Island remains a huge disparity for Native Hawaiian residents. With 39 permanent staff in five locations around the island in Hilo, Pahoa, Kati, Kona, and Waimea, HMON'O provides primary care, medical transportation, health care monitoring, education and support to enhance the quality of life of Native Hawaiians and their families. HMON'O is requesting funding from the County of Hawaii for fiscal year 2010 -11 to expand "Kokua Hali ", its non - emergency medical transportation program, to increase access to essential health care on the island for the agency's primary target population. HMON'O currently operates a medical transportation fleet of 10 vehicles island -wide including three new seven - passenger vans deployed into rural communities. Each of the agency's five sites provides free door -to -door transportation to registered clients to get them to and from physician, diagnostic lab, pharmacy, dialysis, and other health - related appointments. HMON'O currently employs five highly trained Transportation Specialists, one per site, to accompany and assist clients from time of pick -up to drop -off to make sure they arrive safely and on time. Each driver is dedicated to respond with promptness, sensitivity and integrity. Each driver has a clean traffic abstract and has completed Standard CPR and First Aid Training HMON'O's transportation service operates Monday through Friday by appointment only with scheduling flexibility to accommodate client needs. In response to demand from clients in each satellite office area around the island, HMON'O recently added to its medical transportation fleet a four - wheel -drive van equipped with an automatic lift for mobility disadvantaged clients. The specialized vehicle means HMON'O can now expand services to wheelchair and limited mobility clients around the island who could not benefit from the agency's current transportation program. With four - wheel -drive capability, HMON'O can provide this specialized service to clients living in more rural areas like Hawaiian Acres and Waipi'o Valley where many of the roads are unpaved and where access is particularly difficult after heavy rains wash away gravel Initial plans for deployment of the specialized vehicle involve training of all HMON'O Transportation Specialists on use of the automatic lift equipment and rotating use of the van between sites However, in order to efficiently meet projected demand for this service In the next fiscal year without adversely impacting the agency's capacity to provide growing demand for transportation services from clients who are not mobility disadvantaged but are transportation disadvantaged, HMON'O needs a dedicated Transportation Specialist to coordinate and perform island -wide transports for mobility disadvantaged clients As a secondary function, this Transportation Specialist would serve as a backup driver between the different HMON'O sites to accommodate spikes in demand for health - related transportation The Need. Hawaii County continues to be designated a medically underserved community with a shortage of providers in rural areas.' Increasing access to medical services on the island is of particular concern to Hawaii County because of its large geographic area, low population density, higher poverty rates, limited public transportation, and aging population 2 U S Census Bureau data shows Hawal'i County's resident population at 175,785 in 2008 3 Of that number, 24,239 or 13.8% were elderly, age 65 or older By 2030 that number is projected to reach nearly ' U 5 Department of Health and Human Services Health Resouices and Services Administration. Health Provides Shortage Area September 30, 2009 ' Center on the Family Data Center, Comparative Data, Hawaii County, Census 2000, September 30 2002 ' U S Census Bureau State and County QuickFacts November 17. 2009 ' U S Census Bureau State and County QuickFacts November 17. 2009 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 2 Hui Malama Ola Na `Oiwi — Agency Name Kokua Hali Health Transportation Program — Program Name 20 %, meaning one out of every five individuals will be age 65 or older. In comparison, in 1970, one out of every 17 individuals was aged 65 or older. Like the state, and the nation as a whole, Hawai'I County is graying, and as residents age, one of the most dramatic changes is an increased demand for medical services compounded by degenerating mobility, presenting a need for specialized transportation.' The Hawaii State Plan on Aging for 2008 -2011 indicates a significant unmet need for transportation of mobility disadvantaged residents of Hawai'I County age 60 or older and nondrivers 65 or older The extent of need was 6,415, and the unmet need exceeding existing capacity was 4,579 or 71 4% 8 In an average month, HMON'O provides 300 health transportation encounters to clients who do not have access to automobiles or adequate transit services 31 % of HMON'O passengers are age 60 or older and need routine medical care to manage chronic disease such as diabetes and hypertension or to receive medical screenings and vaccinations. An additional 15% are between the ages of 55 and 59. Many of these clients who are already transportation disadvantaged will likely be mobility disadvantaged as well in the next few years and require specialized transportation to access medical services. In the last year, each of HMON'O's five offices around the island has received three to six inquiries or requests for health transportation from transportation and mobility disadvantaged clients using wheelchairs or walkers The agency has active registered clients who will readily benefit from the specialized transportation service, and several live in rural areas requiring four - wheel -drive access The Response' To address the issue of access to health care on the Island for transportation disadvantaged clients, HMON'O's Kokua Hali Health Transportation Program proposes to increase staffing to include a designated Transportation Specialist to coordinate and provide transportation for clients island -wide who are also mobility disadvantaged. Especially for residents of more remote areas like Puna, Kau, and South Kona, a passenger trip commonly starts with a client being picked up at his home then taken to a physician's visit followed by a diagnostic lab screening and a stop at the pharmacy before returning home As evidenced in HMON'O transportation logs, a single trip with multiple destinations (transports) like the one described can take up to six hours long For mobility disadvantaged transports, trip duration is further extended by the additional time required for loading and unloading multiplied by the number of stops a client needs to make. A designated Transportation Specialist for specialized transports will ensure continued efficient operation of the Health Transportation Program without negatively impacting HMON'O's capacity to serve clients who are not mobility disadvantaged but need transportation service With HMON'O's current and anticipated increases in ridership as a result of the agency's (and the broader community's) aging population as well as the agency's expanding health care services around the island, HMON'O is developing capacity to meet projected demand to ensure clients have professional and reliable transportation to access health care they need 5 Health Trends in Hawai 1, A Profile of the Health Cate System Demographics, Elderly Growth Population. Protections " Health Trends in Hawaii A Profile of the Health Care System Demographics. Elderly Growth Population, Protections Administration on Aging, 2010 Profile of Older Americans Erecutrve Office of Aging, Hawaii State Plan on Aging 2008 -2011 p II -33 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 3 Hui Malama Ola Na `Oiwi — Agency Name Kokua Hali Health Transportation Program — Program Name Total Budget and Position Count Total Program Budget $39,387 Total Program Position Count 6 Total Agency Budget $2,538,793 Total Agency Position Count 39 Program Objectives: Hui Malama Ola Na 'Oiwi's Kokua Hali Health Transportation Program will achieve the following objectives in fiscal year 2010 -2011: 1. Increase access to health care on the island for mobility disadvantaged clients. a. Register 25 new wheelchair and limited mobility clients for health transportation service. b. Schedule and provide a minimum of 1050 wheelchair and limited mobility transports 2. Increase access to health care on the island for transportation disadvantaged clients, including nondrivers and individuals without access to automobiles or adequate transit services. a. Register 90 new clients for health transportation service b. Schedule and provide a minimum of 8108 transports. Program Highlights: (from Fiscal Year 2009 - 10) From July 1 to December 31, 2009, Hui Malama Ola Na'Oiwi (HMON'O) provided non - emergency medical transportation services to 289 clients island -wide. The agency's Kokua Hali Health Transportation Program logged a total of 3,314 single -leg transports in the same six -month period for single as well as multiple destination trips. This fiscal year, HMON'O added four new vehicles to its medical transportation feet Three new seven - passenger vans are in use in rural communities in Ka'0, Captain Cook. and Waimea The latest vehicle, a specialized four - wheel - drive van equipped with an automatic lift for mobility disadvantaged clients. will be deployed for island -wide transports beginning February 2010 As indicated in the "Program Description" section of this proposal, the specialized vehicle means HMON'O can now expand services to wheelchair and limited mobility clients around the island who could not be accepted into the agency's transportation program previously With four - wheel -drive capability, HMON'O can provide this specialized service to clients living in more rural areas where many of the roads are unpaved and where access is particularly difficult after heavy rains wash away gravel. Provision of non - emergency medical transportation for mobility disadvantaged clients is the crux of HMON'O's proposal for fiscal year 2010 -2011 Hawaii County grant funding for the current fiscal year 2009 -2010 allowed HMON'O to recruit a Community Health Educator in the West Hawaii districts to provide disease prevention and management education As a result of increased community health education services being provided in the area, demand for transportation services from transportation disadvantaged clients will continue to increase not only in clinical physician health care but in the need for clients to attend classes that will promote healthier communities here on the island NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 4 Hui Malama Ola Na `Oiwi — Agency Name Kokua Hall Health Transportation Program — Program Name Performance Measures: FY 2008 -09 FY2009 -10 FY 2010 -11 Actual Estimate Estimate (From Feb 2010) Objective 1. Increase access to health care on the island for mobility disadvantaged clients. a Register 25 new wheelchair and limited mobility N/A 10 25 clients for HMON'O's health transportation service. b. Schedule and provide a minimum of 420 N/A 125 1050 wheelchair and limited mobility transports. Objective 2: Increase access to health care on the island for transportation disadvantaged clients, including non - drivers and individuals without access to automobiles or adequate transit services. a. Register 90 new clients for health transportation 55 60 90 service. b. Schedule and provide a minimum of 8108 6701 7371 8108 transports. Program Expenditures FY 2008 -09 FY2009 -10 FY 2010 -11 Actual Budget Estimate Salaries and Wages $153,263 $152,240 $181,927 Professional Fees 0 0 0 Operations 52,002 51,955 61,655 Equipment 143,951* 0 0 Other — Auto Insurance 10,294 15,390 17,390 Total $359,510 $219,585 $260,972 `Purchase of four new seven - passenger vans and four -wheel drive van with automatic lift Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY2009 -10 FY 2010 -11 Actual Budget Estimate U S Department of Health and Human Services $359,510 $219,585 $221,585 Health Resources Services Administration (HRSA) Hawaii County Grant 0 0 39,387 Total $359,510 $219,585 $260,972 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 5 Hui Malama Ola Na `Oiwi — Agency Name Kokua Hall Health Transportation Program — Program Name Future Program Support: Hui Malama Ola Na 'Oiwi ( HMON'O) is focusing on the following approaches to increase revenues to sustain its Kokua Halt Health Transportation Program 1. HMON'O is researching the process to qualify the agency to collect reimbursements from Medicaid and health insurance providers for non - emergency medical transportation services in order to capture billed revenue to subsidize operating expenses. 2 HMON'O has leveraged current American Reinvestment and Recovery (ARRA) grant funds to hire an additional full -time doctor at the agency's Primary Care Clinic which will result in increased billed revenue for the agency that can be used to subsidize operating expenses of the health transportation program. 3. As one of the five Native Hawaiian Health Care Systems throughout the state, HMON'O is part of a statewide resource development workgroup consisting of representatives from each system. The primary objective of the workgroup is to explore and develop a comprehensive fund development strategy that looks at sustainability via annual donor campaigns, foundation and government grants, endowments, and planned giving. 4 HMON'O is also exploring the possibility of increasing agency revenue by collaborating with the Community Health Centers (CHCs) on the island in Hilo, Hamakua, and Kona to provide health - related transportation for their patients. HMON'O is continuing discussions with CHC Executive Directors regarding a contracted fee for services. Based on these strategies for resource development, HMON'O anticipates stabilizing its expanded Health Transportation Program in 2012 -2012. With an aging community that will require increased medical services as it faces degenerating mobility, improving transportation to ensure mobility disadvantaged clients access necessary health care is a critical need for HMON'O's client base and the broader Hawaii Island community NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 6 Hui Malama Ola Na `Oiwi — Agency Name Kokua Hall Health Transportation Program — 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. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. ■ I2 C Signature ofBoard= Cktalr�% Date . . 0 I 1 Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -2011 Page 7 51 The Island of Hawaii YMCA Impact: Youth Assets 2010 -2011 The Island of Hawaii YMCA - Agency Name IMPACT: YOUTH ASSETS 2010 - 2011 - Program Name OO CD ,off Agency Director: Robert Stivers -Apiki Phone No.: 935- 3721 Contact Person: Robert Stivers -Apiki Phone No.: 935- 3721 Mailing Address: The Island of Hawaii YMCA 300 W. Lanikaula Street Hilo, HI 96720 FacilitylSite Address: Hilo Program Center 300 West Lanikaula Street Hilo, HI 96720 Kona Program Center 77 -522 Hamana Street #1106 Kailua -Kona, Hi 96740 0 Fax No.: 935 -8414 Email Address: ymca- stivers @hawaii.rr.com Name of AccountantlCPA (include name of firm if applicable): Carbonaro CP & Associates Phone No.: 968 -1002 Mailing Address: P.O. Box 4372 Hilo, HI 96720 Amount of Request for County Funds: $65,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $50,000 $10,000 $20,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Agency Mission Statement: MISSION STATEMENT: Aloha Ke Akua - God is Love. "To bring God's Love to children, adults and families of all races and faiths by putting Christian principles into practice through programs that build healthy spirit, mind and body for all." YMCA CORE VALUES: We teach and demonstrate caring, respect responsibility and honesty. YMCA THEME: We build strong kids, strong, families, strong communities. 0 0 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 The Island of Hawaii YMCA - Agency Name IMPACT: YOUTH ASSETS 2010 - 2011 - Program Name 0 Program Description: THE YMCA IN TRANSITION: In 2009, The Island of Hawaii YMCA re- organized its operation to address its challenged financial operation and the impact the economy is having on its members. The YMCA downsized from a four (4) branch multi operation - Hilo Branch YMCA, Kona Branch YMCA, Waimea Branch YMCA and a Corporate Office Waimea - to a single operation.island -wide based in Hilo. We no longer have three (3) branches, four (4) boards, nine (9) executive level leadership staff. One YMCA. One Island has forced us to reduce our costs and be more efficient and effective in our work. Through our Program Centers in Hilo where our priorty service programs will be based, to ou r Kona Program Center, the YMCA will continue to young act the lives of oung people. The YMCA has suspended P programs and services in Waimea, but will continue to have a presence in Waimea through the Minuke Ole Park the YMCA manages for the communty. Waimea once its financial position imrpoves. The YMCA expects to serve a P FINANCE OFFICE: The YMCA's finance office is in transition and its 2009 year end financial report has not been competed. The YMCA's 2010 budget has not been completed nor approved by the Board of Directors. In November, the CFO position was terminated and a part time board member has volunteered to oversee the YMCA's financial opera. The YMCA is up- dating its financial reporting system and regrets not being about to produce the financial reports requested at this time. It is expected that March the YMCA reports will be available. COLLABORATION: One of the objectives of the YMCA and its Youth Services grant as expressed to members of the Council at our interview meeting last year, was to collaborate with other youth agencies. The YMCA initiated with the Hawaii Island United Way collaboration talks with the Hawaii Island Boys and Girls Club and the Hawaii Island YWCA. We were sucessful in agreeing that collaboration between our agencies were important in this tough econmic times. The Executive staff meet a number of times and identified a common need of working with teens and meeting their needs. We begin our collobration by administering a teen survey to identify the interests of teens in each program agency and to identify what their friends were invovlved in afterschool acitivies. In total, we surveyed 135 teens. We learned that 67% surveyed were females, 33% males; 77% live with both parents; 50% belong to an organization to make friends; and 25% of their friends just 'hanging out ". NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 The YMCA, Boys and Girls Club and YWCA with Hawaii Island United Way will continue to seek ways to collaborate and meet the needs of children and teens. The YMCA's proposal for 2010 -2011 will continue its impact as in 2009 -2010. Developing one's fullest potential can take a lifetime and especially work with children and youth it is a process over time. When planning for a year, plant a tree, When planning for a decade, sow a seed. When planning for a lifetime, train and educate." The YMCA is training and educating in all of its youth program and through its 40 Developmental Assets model we have seen the impact YMCA programs have on its youth participants. Recently, many local and national funders have charged youth - serving agencies to develop methods of evaluating their programs that document the positive benefits and impacts of program participation on youth. They want to ensure that the programs they support are making a difference in the lives of young people. Young people need what everybody needs. In addition to food, shelter, and other basics, they need support, encouragement, positive relationships and skills, and opportunities. Research shpws, however, that most young people aren't getting all of what they need in order to succeed in life. Many are engaged in school and learning; but lots aren't. Lots of young people have strong positive O family relationships; some don't. A few know and are connected with several caring adults; more have no positive friendships with adult role models outside of their families. The YMCA, as early as 2000 embrached the Search Institute 40 Developmental Assets approach. The framework of developmental assets is grounded in extensive research on child and adolescent development, resiliency, health promotion, disease prevention and public health. Numerous researchers found that assets provide strength for children and youth. For instance, the more assets young people have, the more likely they will grow up to be caring, competent, responsible adults. The more assets young people have, the better their chances for contributing to society and finding a meaningful purpose in life. On average, young people with more assets: > Engage in fewer negative, high -risk behaviors, such as using drugs and alcohol or having premartial sex > Exhibit more positive behaviors, such as succedding in school, assuming leadership roles and valuing diversity > Demonstrate resilience in the face of challenges, stresses and difficult situations. Youth development programs such as the YMCA is facing an unprecedented call Q for accountability - documentation of the effectivness of their programs. Two kinds of evidence are available that demonstrate the role of youth devlopment NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 programs in the lives of young people, One is theoretical - -it examines the role, content, and strategies of programs in prooting the healthy devlopment of young people. Secondly, research has demonstrated that program participation has a O positive impact on youth outcomes. YMCA programs are tools used to devlop the fullest potential of every young person. Programs are directed by trained, caring and nurturing adult role models. Impact of Recreation & Sports Programs. From soccer to softball to afterschool, recreational sports programs are some of the most common and popular programs for young people. Much of the research in these types of programs points to the positive nature of physical activity for health and well -being for youth of all ages. The benefits of different recreation programs vary widely, from getting involved in shared activities, to opportunities for skill devleopment, to relationships with other adults as well as peers. Studies have demonstrated that involvement in sports increase self- esteem and success in school. The Island of Hawaii YMCA has demonstrated for the past two (2) years results that show participation in YMCA programs does impact the lives of young people. The YMCA intentionaly administered youth surveys to its summer program participants island wide. However, the 2008 and 2009 summer, the YMCA was unable to survey its participants due to the cost of coding and producing comprehensive executive summary reports. The report would reflect what youth in YMCA programs have reported about their experiences in the YMCA program. The data in these reports would provide a means for learning how youth feel about their activities and understanding how well their experiences help them build assets they need for positive development. The report would also compare the Island of Hawaii YMCA particiapnt responses with responses from young people in YMCAs across the county. The Island of Hawaii YMCA regrets not being able to produce these reports. It is our expectatiom that if the YMCA's financial position improves, surveys will be administered and reports prepared in 2010. In spite of not having the survey report documentation, The Island of Hawaii YMCA for 2010 - 2011 will continue building youth assets. The YMCA expects to serve over 1,500 children and youth through in its variety of youth programs. Parents need child care - pre school, afterschool, intersessions, summer and most recently furloughs. Teens, particular middle school youth need supervised after school programs and the YMCA is preventing students from high risk behaviors during afterschool hours through organized and adult supervised programs. But the need is great O and the YMCA would like to expend its programs and services to more middle school teens. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 YMCA programs incorporate YMCA Character Development that teach and demonsrate the core values of caring, respect, responsiiblity and honesty while Q providing opportunities to build positive assets through the 40 Developmental Assets approach. The YMCA is very appreciative of the past support of Hawaii County Non - Profit Grant.. In these difficult times, we must cotinue to provide positive experiences and positive opportunites for all children and teens. Thank you. Total Budget and Position Count Total Program Budget *150,000 Total Program Position Count 37 Total Agency Budget *850,000 Total Agency Position Count 48 *Estimated. 2010 Budget not Approved as of this date. Program Objectives: 1) Continue to collaborate with Boys & Girls, YWCA and Hawaii Island United Way. 2). 85% of responding parents in after school programs are satisfied with the program. 3) 90% of responding children in after school programs are satisfied with the program. 4) 85% of responding children in after school agree /strongly agree that they are expected to try harder and do their best. 5) 85% of responding children in summer day camp agree /strongly agree that YMCA activities help to learn how to be a leader Program Highlights: (from Fiscal Year 2008 -09) 1). Collaborated with three (3) youth serving agencies; conducted teen survey. 2) Served 150 teens island wide. 3). Served over 2,000 children and youth island wide. 4). Enrolled 450 children in 9 month after school programs in Hilo and Kona. 5). Served 600 children in summer, intersession programs. 6). 100% of parent responses they were satisfied with the YMCA after school O program in Kona and Hilo. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 7). In Hilo, children attended who live as far as Mountain View and Lapahoehoe. 0 0 0 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 The Island of Hawaii YMCA - Agency Name IMPACT: YOUTH ASSETS 2010 - 2011 - Program Name 0 Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate TOTAL SERVED 2,100 2,100 1,700 HILO YMCA 750 750 1,020 KONA YMCA 700 700 680 WAIMEA YMCA 650 650 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 114,704 120,000 *105,000 Professional Fees Operations 67,072 87,072 *60,000 Equipment Other" Total 201,776 201,776 *165,000 *The YMCA Board has not approved its 2010 operating budget as of this date. * If applicable O " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 The Island of Hawaii YMCA - Agency Name MPACT: YOUTH ASSETS 2009 - 2010 - Program Name 0 Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Hawaii Island United Way 20,000 20,000 20,000 County of Hawaii 10,000 20,000 65,000 Program Fees 150,00 115,000 *100,000 Individual Contributions 21,177 45,000 *55,000 Total 201,777 200,000 240,000 G *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The YMCA is taking effective steps to downsize its operation and lower its operating costs. We have experienced a decrease in contribtions, we have a significant number of parents layed off of work and therefore have withdrawn their children from child care, and Hawaii United Way has decresed its allocation. The YMCA is pressed economically and therefore, it will be 2 -3 years out before the YMCA can sustain the programs we are applying funds for. 0 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 9 The Island of Hawaii YMCA - Agency Name IMPACT: YOUTH ASSETS 2010 - 2011 - Program Name O I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and O accurate year -end report will impact the evaluation of your program's or agency's future funding requests. .1%Ce h;e.,.. 112S11,0 Signature of Board President/Chair Date Li P� \ ` 3 , 14 Signature of Executive Direct Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED, 0 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 9 52 Ka Hale 0 Na Keiki Inc. Families -At -Risk Ka Hale 0 Na Keiki Inc.- Agency Name Families -At -Risk- Program Name Agency Director: A. Pualani Colburn Phone No.: 775- 9870 Contact Person: A. Pualani Colburn Phone No.: 775- 9870 Mailing Address: 45 -3668 Honokaa - Waipio Rd Honokaa, HI 96727 Facility /Site Address: SAME Fax No.: 775 -9870 Email Address: pualani_colburn @yahoo.com Name of Accountant/CPA (include name of firm if applicable): Andrade Accounting Service Phone No.: 775 -1319 Mailing Address: 46 -1068 Kinimaka Rd Honokaa, HI 96727 Amount of Request for County Funds: $12500.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $4000.00 $5000.00 $6000.00 Agency Mission Statement: NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 At Ka Hale 0 Na Keiki it is our mission to help children develop a lifelong love of learning through a program that encourages freedom, individualism, and creativity. Our carefully prepared environment provides children with an opportunity to explore their surroundings, challenge their thoughts, and enjoy and love the people and world around them. Through a positive interaction among the children's developmental characteristics, their school, practices, family, and community, children will be ready to have successful learning experiences that will last throughout their lifetime. Above all, our children come first. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Ka Hale 0 Na Keiki - Agency Name Families -At -Risk- Program Name Program Description: The Families -At -Risk Project allows our school to remain open between 2:30 and 5:30 pm daily, year round (including Summers and holidays), providing a safe, stimulating, and caring environment for children ages 24 months to 6 years. This frees parents to work at their jobs, and allows the unemployed to seek work and pursue training and educational opportunities, particularly working parents transitioning from welfare assistance. We serve the working poor. These families are likely to be cut off from the mainstream community because of poverty, racism, lack of education, unemployment, and /or the inability to timely access community and human services. They are therefore at risk of being unable to take care of their basic needs and those of their nuclear family. It is important to understand that our school's positive stimulation of children's brains during these critical first years lays the foundation for the child's future ability to learn, develop language skills, and interact with others. While under our trained, caring, and gentle care, children at risk learn self confidence, initiative, self -worth, and independent thinking. Our teachers, all trained in Early Childhood Education (ECE), understand child development and excite our children about learning, as well as provide them, and their families, with basic health and nutritional information and referrals. We promote positive social behavior and conflict resolution, as well as actively engage parents in their children's care and education. Drug abuse is our worst nightmare here on the Hamakua Coast. We are the anti -drug. Numerous studies have shown that participation in a quality ECE program can actually prevent illegal drug usage in the future, because we teach these children, at a very early age, how to appropriately handle conflict resolution as well as help them attain good self esteem. 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. Our community, our island, and our state also benefit, as it is estimated that for every $1 invested in high - quality ECE programs the public will save $7 in costs like remedial education, welfare, and incarceration. Children who attend high quality ECE programs are more successful in later life and more productive than their peers who did not attend. Studies are showing that children with access to quality programs demonstrate higher I.Q.'s, High School graduation rates, and success than their peers. 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. Ka Hale 0 Na keiki is not "just another preschool ", but a community organization that serves and meets multiple needs for the people of the entire area. With literally no other preschool available in our isolated area, parents NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 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. And, obviously, our Families -At -Risk Project benefits our parents, as well as our children. Our low - income parents, leaving welfare rolls and entering the workforce, become more economically self - sufficient because they have been given access to reliable, quality care for their children. It is imperative, therefore, that we remain open at least 10 hours a day, and operate year round; otherwise, parents would have no where to send their young children for quality care and education. We agree that private funds are a key to our success, but those funds are very limited. Therefore, we also need additional public support in order to help these young children and their families towards a successful, productive future. We need the County's continuing financial support until financial stability is realized. Our community understands and acknowledges the scarcity of County funds to non - profits, and we sympathize with the Council's difficult budgetary task. We are very grateful to the financial support we have received in the past from our County and truly believe that the County's continuing investment now in the Families -At -Risk Project will save the County ten -fold in future rehabilitation costs. In this time of Recession, the focus for all of us must be helping our keiki, for they are our future. No time has this belief been more critical for now. Total Budget and Position Count Total Program Budget 62300.00 Total Program Position Count 6 Total Agency Budget 312570.00 Total Agency Position Count 6 Program Objectives: 1) Make care and educational services available to at -risk families and their children between the hours of 2:30 and 5:30 pm daily. 2) Provide high - quality care and educational services to children of at -risk families of the under - serviced Hamakua Coast. 3) Provide monthly scholarship /tuition assistance to at -risk families. 4) 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) Increase the parenting skills, and the understanding of the developmental and educational needs of children of the at -risk parents we serve. 7) Recognize the need for, and provide referral services for children of at -risk families who may need treatment for known or suspected health, psychological or developmental problems. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 8) Have the Families -At -Risk Program become financially self- sufficient, no longer a financial drain on the Day Program. Program Highlights: (from Fiscal Year 2008 -09) 1) Remained open for the at -risk families until 5:30 pm daily, including during monthly holidays, holiday breaks, and Summer. This was the third year we remained open during monthly holidays. 2) Provided a developmentally appropriate, high - quality childcare and educational facility to the working poor of the Hamakua Coast. 3) Obtained National Re- Accreditation, insuring that we are providing the best available care and education to our at -risk children, plus allowing us to obtain additional income from the State. 4) Provided six jobs in our local community, in order to operate the Families - At -Risk Project. 5) Referred three at -risk children, and their families, to special services counseling, to meet their special needs, as identified by our teaching staff. 6) Offered scholarship /tuition assistance to twenty six families using the Families -At -Risk Project. 7) Succeeded in keeping our budget for the Project low, within reason, and affordable to the families we serve while being able to increase our services to them. 8) Provided an authorized accredited preschool environment for three college students in order for them to fulfill their "lab" or student teaching requirements. 9) Despite State DHS Director Koller's budget cuts to the PRESCHOOL OPEN DOORS, CHILD CARE CONNECTIONS, and FIRST -TO -WORK programs, we were able to remain open and prvovide safe and healthy enrichment activities for children and their families, by making critical budgetary cuts, including lay offs and wage cuts. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Ka Hale 0 Na Keiki - Agency Name Families -At -Risk - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Enrollment 36 36 36 Children enrolled 2:30 - 5:30 30 31 32 Families -At -Risk Project Families receving finacial 30 31 32 assistance from Ka Hale 0 Na Keiki for Families -At -Risk Project *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 34650.00 40500.00 375000.00 Professional Fees 2550.00 3800.00 2600.00 Operations 9100.00 12700.00 12800.00 Equipment 4700.00 4200.00 5800.00 Other* 2800.00 3600.00 Total 5100.00 64000.00 62300.00 *If applicable "Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Ka Hale 0 Na Keiki - Agency Name Families -At -Risk - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Payment from Families -At -Risk 13020.00 11160.00 4860.00 Program Donations and fundraisers 1780.00 4340.00 6940.00 County of Hawaii 5000.00 6000.00 125000.00 Young Bros. 0 1000.00 1000.00 Friends of Hawaii Charities 1700.00 2000.00 2500.00 Wilcox Foundation 2000.00 6000.00 6500.00 Hard Foundation 2000.00 1000.00 2000.00 Mclnerny 0 0 8500.00 Healing Our Island 2000.00 0 State of Hawaii Poverty ECE 1500.00 0.00 0 Program Day program payment from families' 3000.00 9000.00 0 portion allocated to Families -At -Risk project Liberty Gives Foundation 0 0 10000.00 In -kind (Labor & Materials) 0 0 7500.00 Total 51000.00 64000.00 62300.00 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Our absolute goal is to be financially independent of annual grants. With optimism, along with our State government's hopefully renewed interest in providing funds for Early Childhood Education and President Obama's ARRA monies for assistance to needy famliies, we hope to be financially solvent, and without need for continued County grant funds, within the next four years. Recent drastic cuts in State funding for ECE supplements to families have made it impossible that our parents pay additional fees for our Families -At -Risk Project. Therefore, a temporary, one year increase in County funds assistance is critical for the survival of our Project. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 It must be remembered that our program is one that we were told "could not be done ". We were told that our isolated community did not have the economic base to afford an early childhood center, and that our area could not provide the qualified teaching staff to run such a program. We are simply asking the County for their continued support for a few more years to help these children who are in desperate need. We have increased parent involvement as well as the number of fundraisers per year. Although the economy is down, our small community always supports our efforts; be it buying cinnamon bread or volunteering to build and repair our facility. We have begun constructing an additional hale in order to house more children and are currently working towards adding a toddler room to our facility. Increasing our capacity potential is expected to generate increased tuition income for our Project. In this time of recession, the focus for all of us must be helping our keiki, for they are our future. No time has this belief been more critical then now. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 Ka Hale 0 Na Keiki Inc. - Agency Name Families -At -Risk Project - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 - 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall, include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. C , X. - /ate 4-77Z) 9r- `9 cl Signature of Board President/Chair • D ac d �� , 2 o i ignature of Executive Director D UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 53 KalauonaoneoPuna 3rd Annual Kalapana Cultural Day KalauonaoneoPuna - Agency Name 3 rd Annual Kalapana Cultural Day- Program Name Agency Director: Leroy Dikito Phone No.: 965 -9252 Contact Person: Maile Moulds -Carr Phone No.: 965- 1976 Mailing Address: P. 0. Box 408 Pahoa, HI 96778 Facility /Site Address: 12 -7509 Ma'ohe'ohe Place Pahoa, HI Fax No.: Email Address: rayandmaile @msn.com Name of Accountant/CPA (include name of firm if applicable): Nancy J. Kramer Phone No.: 965 -2729 Mailing Address: 14 -2662 Pahoa Village Road, #306, Pahoa, HI 96778 Amount of Request for County Funds: $10,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $7,000 $10,000 $ Agency Mission Statement: The mission of KalauonaoneoPuna is to preserve the Hawaiian lifestyle that was unique to Kalapana and the families that once lived there. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 KalauonaoneoPuna - Agency Name 3 Annual Kalapana Cultural Day- Program Name Program Description: The 3 Annual Kalapana Cultural Day is scheduled for Saturday, August 21, 2010. The theme this year is "Kani Kapila Kalapana Style," and the event will feature the many musicians with ties to Kalapana. As in previous years there will be interactive craft demonstrations, food and craft vendor booths, and numerous activities for the keiki. The official hours of the activity will be 2 hours longer, going from 10 AM to 5 PM. The event will be held on the Keokea side of the Kikala - Keokea subdivision according to the map shown on attachments A and B. Total Budget and Position Count Total Program Budget $15,000 Total Program Position Count 6 Total Agency Budget $15,000 Total Agency Position Count 6 Program Objectives: 1) To attract 'ohana back to Kalapana to share their knowledge, talent, and experiences with attendees. 2) To familiarize kama'aina (residents) and malihini (newcomers and visitors) with the Hawaiian lifestyle and the strong musical roots of Kalapana 3) To provide the various small business entrepreneurs in the area with a venue for selling their products and services.. Program Highlights: (from Fiscal Year 2008 -09) 1) The 1 Kalapana Cultural Day was held on August 23, 2008 at Apo Place in the Keokea section of the Kikala- Keokea subdivision which was created to house former Kalapana residents. The theme was "Kalapana Comeback," and was attended by 550+ kama'aina and malihini. 2) On August 22, 2009, the 2 Kalapana Cultural Day was held in the middle of Kikala Loop in the subdivision. This cultural day featured a greatly increased number of demonstrators and activities for the keiki were very popular. It was again attended by 500+ kama'aina and malihini. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 KalauonaoneoPuna - Agency Name 3 Annual Kalapana Cultural Day - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Number of demonstrators 6 16 20 Number of vendors 12 16 25 Number of attendees 550+ 500+ 750 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages Professional Fees Operations $3,660.64 $5,500.00 $8,500.00 Equipment $3,549.00 $5,000.00 $6,500.00 Other" Total $7,209.64 $10,500.00 $15,000.00 * If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 KalauonaoneoPuna - Agency Name 3 Annual Kalapana Cultural Day - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Department of Research and $7,209.64 Development, County of Hawai'i County of Hawai'i $10,500 Hawai'i Tourism Authority $5,000 County of Hawai'i $10,000 Total $7,209.64 $10,500 $15,000 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? This year we are planning for an increase in attendance with a roster of well known entertainers. We are also working with the County of Hawai'i through Mayor Billy Kenoi to obtain the lease on a 4 -acre plot in the subdivision with plans for a community center and cultural center. The cultural center will allow us to have interactive craft demonstrations for tourists and to provide a center for craft people to sell their products year round, rather than once a year as we have been doing with the cultural days. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 KalauonaoneoPuna - Agency Name 3 Annual Kalapana Cultural Day - 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. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of oard esidentlChair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 . , Ii Atm( cAp pm( K iiN4 a . / i / / 1 74 Mr/ ki i .., ; / / / cASTLE- 51-tPi; , , • - ,_ -- 1 c EQ's' Er' A Lc.) 0 r _____ r- N , ,,, from pr--)c)-11.4 .. ,.., C, c I out? LikA 5 pima I 0 fq c. HA0P ic.Af ---- r -< 1 --■ . . , 1 v I it, _• T i...m.A,,Amp. 1 i / 01.4e RAND i en P ri4R Rii - Ft„ • - ATTAC I-1 M E Ni - " i r A Lk:NJ:I.:, Ait, t c'Eer• 5 ' • . '1"., • kik! —:I • , . 4 le .9-.Yr ti:..t - iti $7 ,, _ ,,.._,„,., ,L.c,,rp,: c. Encp _ - (Avis_ o.19-d y. c I ) 11 hitt - MSt2yea, \ / v ort i v. 7_ t ) wen al . Kt? • g° .P ': ; _____---t 7 N... th . - 3 , ?Sj AMNIS\9 An ) 1 . \.. -71411W c a ;gni.- J\114 ) LI I 1 ' * „ •ft \ \ --- \ ----1, ,, , - FraNEC 0 -- / Z___1_1_ N ) ).34n, 2 1 '• (1 •, 1 54 Kapi'olani Medical Center for Women & Children Kapio'Iani Child Protection Center - West Hawaii Title IV -B -West HI Counseling & Supportive Living Project 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: Steven Choy, Ph.D. Phone No.: 808 - 535 -7711 Contact Person: Franco Acquaro, Ph.D. Phone No.: 808 - 329 -4020 Clinical Manager -KCPC Big Island Mailing Address: Hawaii Pacific Health, Financial Planning Attn. Allison Lopes 55 Merchant Street — 24 Floor Honolulu, HI 96813 Facility /Site Address: 74 -5599 Luhia Street - #E7 Kailua -Kona, HI 96740 Fax No.: 329 -8628 (Kona) 1- 888 - 535 -7720 (Honolulu) Email Address: stevenc(a�kapiolani.orq Name of Accountant/CPA (include name of firm if applicable) Ernst & Young, LLP Phone No: (808) 531 -2037 Mailing Address: 2400 Pauahi Tower 1001 Bishop Street Honolulu, HI 96813 -3429 Amount of Request for County funds: $10,000 Prior Year Funding: 07 -08 08 -09 09 -10 $5,000 $0.00 $10,000 Agency Mission Statement: The mission of the Kapi'olani Child Protection Center is to protect children and strengthen families. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center -West Hawai'i 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. This program is part of the Kapi'olani Child Protection Center — a Statewide Center whose mission is to protect children and strengthen families. Priority for services is given to families at risk due to substance abuse (85% of referrals). Special priority is given to families who have or are in the process of adopting or otherwise providing a permanent home for children who have been harmed. Services are provided by KCPC -WH staff. 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 funded through a Federal Grant and requires matching funds from the State and from the provider. During the 2006 -2007 Fiscal Year, KCPC embarked on a collaborative training program with UC -Davis Medical Center to provide the KCPC -WH Therapists with the capacity to provide Parent -Child Interactive Therapy (PCIT) to its client population. KCPC is now the only provider /trainer of this empirically - supported practice in the State of Hawai'i. This form of therapy has been shown to have a dramatic, long- lasting positive effect on families struggling with changing the behaviors and relational styles that led to their neglectful and abusive parenting. The KCPC staff provided this service to a small group of West Hawai'i families in FY 06 -07, and has continued to provide this service to the present. In addition, in this last year we provided training, technical assistance, consultation, and case supervision to additional therapists in East Hawai'i. In FY 06 -07 the County provided $5,000 in funding and then increased this to $10,000 in FY 07 -08. Then, due to an unfortunate error in communication between our Big Island and Oahu offices, we delayed in getting our Year End County Report in on a timely manner for FY 07 -08. This meant that we were disqualified from receiving County funding in FY 08 -09. We re- applied in FY 09- 10 and once again received $10,000 from the County. We are again requesting $10,000 in County funding for our program for the FY 10 -11. As the financial hardship facing our country, and particularly our island, continues, it is essential that the creative and successful human services program we offer be continued and even expanded where possible. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center -West Hawai'i Title IV -B -West HI Counseling & Supportive Living Project Approximately 12 years ago, KCPC initiated a Foster Care Mentoring program for youth in foster care on the island of Oahu. This program provides training for older youth in the foster care system so that they can become peer mentors to younger youth who are just beginning their foster care experience. The mentors and mentees participate in monthly recreational and service activities in their community. It has been a phenomenally successful program that now serves some 25+ mentor - mentee pairs. KCPC has formalized its mentor training program and, thanks to County funding, initiated replication of this program for foster youth on the Big Island in FY 07 -08. We have just begun our third year of the Mentoring program and have 5 mentor - mentee pairs in our Big Island program. We will continue to provide and expand this service if there is adequate funding from the Hawai'i County Grant, and Hawaii Island United Way (HIUW).. Total Budget and Position Count Total Program Budget $209,860 Total Program Position Count 2.8 Total Agency Budget $2,275,664 Total Agency Position Count 20.0 *Statewide Services Program Objectives: 1) Improve child safety by reducing child abuse /neglect risk factors 2) Improve child safety by increasing child protective factors Program Highlights: (from Fiscal Year 2008 -2009) During FY2009 the following performance measures were obtained: 1) Provided services to 86 families (goal 75), 128 adults (goal 130) and 170 children (goal 150). 2) Received Permanency Planning Assistance - 3 families. 3) Reduced CNN risks — 94% of caregivers who completed services. 4) Had no new CPS report within 6 months after case closure — 98% of families who completed services. 5) Had no new CPS report within 1 year after case closure — 98% of families who completed services NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 • Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center -West Hawai'i Title IV -B -West HI Counseling & Supportive Living Project Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Individuals Completing Service Plan 50% 80% 80% Individuals completing service plan who have established and 94% 95% 95% implemented a child safety plan at closure. Families completing Service Plan who have no new confirmed report of 98% 90% 90% child abuse or neglect at 6 -month follow -up Families completing Service Plan who have no new confirmed report of 98% 95% 90% child abuse or neglect at 1 year follow -up Families participating in the Parent - Child Interaction Therapy will N/A 75% 75% achieve CDI relational skill mastery. Mentor - Mentee Pairs Trained and participated in Recreational /Service N/A 90% 90% activities. *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 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 Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages $167,292 $156,348 $156,348 Professional Fees 0 0 0 Operations $48,685 $56,512 $61,512 Equipment 0 0 0 Other# 0 0 0 Total $215,977 $212,860 $217,860 * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual* Budget* Estimate Title IV -B Federal Grant $210,000 $199,860 $199,860 HIUW $4,208 $0 $0 Charity Walk $3000 $3,000 $3,000 HI County Grant $0 $10,000 $10,000 Private Donations "Rainy Day" Funds $5,000 Total $217,208 $212,860 $217,860 *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center -West Hawaii Title IV -B -West HI Counseling & Supportive Living Project Explain what plan, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to be self- sustaining? KCPC -West Hawaii will continue to seek donations and grants to provide the necessary matching funds to obtain the federal grant to continue to provide these very vital services for West Hawaii residents. The County grant has. provided some of the matching funds that allow our program to obtain the federal funds. Without the matching funds, we will be unable to obtain the federal funds that are the major support for the program's services. KCPC -WH will need to continue to obtain matching funds and will need to continue to seek grants and donations to support this program. The IVB program cannot be fully self- sustaining due to the requirements of matching funds. The KMCWC Matching Indirect write -off is In- Kind matching that doesn't actually reduce direct expenditures and thus is not real revenues but required to obtain federal funds. Donations, HIUW and the Hawai'i County Grants will be needed to fund other KCPC West Hawai'i Programs that did not receive full funding. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Kapi'olani Medical Center For Women & Children Kapi'olani Child Protection Center -West Hawai'i Title IV -B -West HI Counseling & Supportive Living Project 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of 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. v4/c/ ' k - - 1/ 7 /, 0 Martha B. Smith Date Chief Operating Officer, KMCWC ‘1 Lt! StevQ hoy , - . �% Date KCPC Direct. /G' (/ s/ iI "z∎\ \C> Fra o Acquaro, Ph.D ' Date Clinical Manager-KCPC Big Island UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 55 Keaukaha One Youth Development Youth Development Keaukaha One Youth Development - Agency Name Youth Development - Program Name Agency Director: Mike Divinski Phone No.: 935 -5866 Contact Person: Mike Divinski Phone No.: 935 -5866 Mailing Address: 101 Aupuni Street, Suite 124 Hilo, Hawaii 96720 Facility /Site Address: Bayfront Hilo, Hawaii Fax No.: 935 -3945 Email Address: HiloMichael @aol.com Name of Accountant /CPA (include name of firm if applicable): Valerie Peralto, Peralto & Co., CPA Phone No.: 961 -3462 Mailing Address: 180 Kinoole Street, Suite 302, Hilo, Hawaii 96720 Amount of Request for County Funds: $10,000.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $10,000.00 $10,000.00 $10,000.00 Agency Mission Statement: General scope of the activities for Keaukaha One Youth Development is to provide native cultural opportunities for local youth to reconnect them with the historic ocean experiences here in Hawaii. The purpose of this reconnection is to NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 KEAUKAHA ONE YOUTH DEVELOPMENT - Agency Name Youth Development - Program Name Program Description: • The specific purpose is to continue to reconnect children in the County of Hawaii with Hawaiian cultural heritage relating to ocean activities. Total Budget and Position Count Total Program Budget $10,000.00 Total Program Position Count 0 Total Agency Budget $10,000.00 Total Agency Position Count 0 Program Objectives: 1) The program (a) stresses physical fitness; (b) provides instructional use and maintenance of canoes; (c) strives for perfection of swimming skills; (d) provides training in physical fitness at Keaukaha Gym; and (e) provides the use of Hawaiian canoes and volunteer coaching to minor children. The charity strives to coordinate these activities with local schools. Program Highlights: (from Fiscal Year 2008 -09) 1) Keaukaha One participated in the expansion of the keiki paddling program at Radio Bay in 2009. Program highlights included the addition of potable water to the practice site with the help of Keaukaha /Pana'ewa community volunteers; purchase of new paddling equipment; the design and distribution of brand -new paddling t- shirts for the local kids; transportation costs to bus the kids to canoe races in Kona increased this year. It is anticipated that the keiki program is going to grow by at least 1/3 for the 2010 calendar year, including regatta paddling and long- distance races. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 KEAUHAKA ONE YOUTH DEVELOPMENT - Agency Name Youth Development - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate $10,000.00 $10,000.00 $10,000.00 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages Professional Fees Operations Equipment $10,000.00 $10,000.00 Other" Total $10,000.00 * If applicable "Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 • KEAUKAHA ONE YOUTH DEVELOPMENT - A.ency Name Youth Development - Program Name Program Expenditures Equipment Paddle and Canoe Repairs $ 1,500.00 Travel Costs 2,000.00 Paddling Equipment and Supplies 3,000.00 Uniforms 2,500.00 Escort Boat Equipment 1,000.00 $10,000.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 2011 Page 3a KEAUKAHA ONE YOUTH DEVELOOPMENT - Agency • Name Youth Development - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii $10,000.00 $10,000.00 $10,000.00 Total $10,000.00 $10,000.00 $10,000.00 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? This program continues to rely on contributions from the public and private sector in conjuction with fund - raising activities. We strive for community support to spread the word of the accomplishments of the youth, to garner interest from the community at large and benefactors to subsidize our case of cultural development and physical well being. Our aspiration is to become a self - sustaining program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 KEAUKAHA ONE YOUTH DEVELOPMENT - Agency Name Youth Development - 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Ir erA b °10 Signature of Board President /Chair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 56 Kona Adult Day Center, Inc. Adult Day Care KONA ADULT DAY CENTER, €NC.- Agency Name A fl! !! T flAV CAi�C Drr r.rnrn hlnwe�a CAL>EiL 1 Iintl OJ6 vL eL L L \J LVG:L PLis Agency Director: ROWENA L. ! IQUI Phone No.: 3? -? '1 a k 1 Contact Person: ROWENA TEQUI Ph ne' No.: �:J O' 11 1 -9 Maui Address: v PDX 1 360 53� r'Se3 �5 ,53r. PDX HI 96750 Eaci €ity S €te Address: 81 -989 HAL EKiI ST K EN A i EKU A HI 9675 i\Ci'iii ii\Ci\iiJ'i 1 .iulJ Fax No.: 322 -0614 Etnali Address cADCRO ENA@ H.A.l"EAU.RR.00M Name of Accountz i t' PA (i ed name of firm if applicable.): RONALD G. Hii'vP'VKES, CPA Phone No.: 939 -7392 r Mellin. Address: 1 . 2030 KEALAKEKUA a a ' Melling P UL 1GJS: i . 'J. �iJ /\ G4JV 1 II cIV % OU Amount of Request for County Funds: $30,000.00 Freer ¥earls) Funding: 07-08 08 -09 09-10 $20,000.00 $1 r n O Agency Mission Statement: ''Our mission is to provide health, social and recreational programs and activities that enable impaired adults to experience feeiYings of belonging, friendship, acceptance, accomplishment and independence in a caring and secure social environment." FISCAL YEAR 2010-11 Page 1 KONA ADULT DAY CENTER, INC. - Agency Name A LT C T fAV ADI Program hlnme �iLE vE� CARP- P'J ICI E 4 F1EL Program Description: Ad; lt -- i - L it i _ .. L _ C!. iJ `S'. t'. ?S � Ld C ^ !.1!' io- ,i e- 'ell ;i _� _ u`i _l ilef.:�� <. provides regular and reliable respite to informal caregivers, while it fosters their continued participation in the workforce Persons eligible for Kona Adult Day services are those adults 1 r years but particularly ila _. se s i C` "lt. Io gec�.� and above, but �a!LiCL icily those �� )`ear" and older, having either a physical or cognitive disability requiring supportive care These are persons with Alzheimer's Disease, dementia or other memory related disorder, those with physical disabilities such as stroke, Parkinson's disease, and multiple sclerosis and those who are socially isolated. Day Care provides a less restrictive setting and a more cost effective program than other types of care, such as home nursing or institutionalization. Total Budget and Position Count Total Program Budget 338,250.00 i otai Program Position Count 7 Total Agency Budget I 338,250.00 Total Agency Position Count 7 Program OhjectW F Individuals: a l ' mentally and ll r i p ad are maintained a'• For Pi3a:viu iia:S. a t a) .I.vl. and physically :ri: 8..e:E adults u.c •.IC. i : : :ulilcd at their highest level of functioning, thus preventing or delaying further deterioration. , 1- of indep '- IU u IACLC11V16lIVif. V) i1167.t1ffUiil level of iilVCi.3CIiUCiII:C is GJJCJ and maintained through the Individual rpogram planning. c) client is able to .a e t w ith a place and group corresponding d: to his/her sense f aoSJCiac., with a 1 .,�..., .. a r y F.,.. l ..:. u.,a w ...o,..... sense of identity. d) Health monitoring as wn/e ag protective =ins supportive rare for the frail and disabled adults are included in care planning and services. e) caregivers have access to knowledge of elderly services available in the conimunity. f) deter premature or ii!app!oC'r €ate institutionalization in a nursing home or hospital. g) socializing, peer interaction and continued rei w ith the r ommi l n it y is e h) Is and preil i r rl li r e often assiciated with frail and disabled adults is reduced. 2) For Families and Other Caregivers: a) families that desire to keep elderly members in the home are given relief from full - time care of an impaired adult. b0 family members are enabled to continue productive careers .,t =n of being h n -1 vi•i elderly, disabled spouse., rent ,. 11e3Lvud irv.,�ot i vi �,vv edi L� an Gov.,i y, L 3u Vii. is 3pou 3i„ parent or other family member. r) families and other cssregiver's are assured that elders dependent upon these are being cared for appropriately during the day. NONPROFIT GRANT APPLICATION :FISCAL YEAR 20 0 -1 i Page 2 3) For the Community: a) sn integral component of the community service ne wor lr a n-i rf the lon t - _ c - tinlli:ri is .- a d e avAilArd.e !' the West Hawaii Community. h) the medical community and other resources statewide are provided a ilason in the geriatrics, especially Alzheimer's disorders disease and other related Program Highlights: (from Fiscal Year 2008-03) 1) Maintained 30% of participants at home for a minimum of six months with adult day services. 2) Maintained or Improved soolalation /infraction skills of participants by 90%. 3) Maintained or improved hygiene /self -care of participants by 90%. 4) Survey satisfaction of caregivers. 5) Had C tionaI interaction activities with •J) Had ri many IElt"GIGC!l�EQEIlf!!?! lIIL�laGCE�lFE C2G6EV16lG�'t'4!6!! comEllulElt` groups and schools. NONPROFIT GRANT APPLICATION FISCAL YEAR 201041 Page 3 KONA ADULT DAY :EN i ER, iNC. - Agency Name An!!! Ar)I II T fAV CADS - Program Name ::r . �a"i ! CARE :Yi i�'2Gfii; 3 aG4i 91L Performance Measures: r•� 8 9 j 70;19.1n I Fy 701n-11 � == °rte -t�_ ��i Actual * Budget * Estimate II CLIENTS QCO \ /CD An FF Fn V LI IS: V LL - Tv 55 60 I I _ I I *If applicable Program Expenditures FY 2 009 -09 I FY 2T09_10 1 FY 2010 -11 Actual * I Budget " I Estimate Salaries and Wages I 160,741.99 169,000.00 177,450.00 Professional Fees j 10,095.32 10,500.00 11,025.00 1 n 5 I 20� 75 n n O�e�r &iiviiS IQ�,413.�'v 19_�,CCC.CC e�w,r �v.0 v - Fquipnlent Other" I Total i �1 i.ai --- 374,500.00 4,500_00 _ 393,225.00 If applicable " l �r d _ s Please explain ill detail on separate sheet L _,t ,:Js.9via T av3' NT API" ,ICATI`v y Lr, FISCAL YEAR 2010-11 Page 4 KON/I„ADULT DAY CENTER, INC. - Agency Name A fl H T nAv 1:-A pc prini M *a •i— a , ..‘s I la•-•• Program Funding Sources: identify al! funding sources (specific to this program only) Revenue Source FY 2008-09 FY 2009-10 FY 2010-11 , * :Po ide*at * retimata DHS POS PROGRAM 9,800.00 DkriS NH`nvitAt cr 47n nn , 1 t W.Va.; al7,928.00 60,824.00 COUNTY OF HAWAII 20,000.00 30,000.00 30,000.00 TERPRA, HUGHES TRUST 30,710.98 20 00 00 35 00 00 MAY TH)./PLFTnN HOPPER 27,440.00 F,ftnnftnol isminftno Hi ISLAND UNITED WAY 11,250.00 11,250.00 11,250.00 TUITION 101.954.00 107.051.00 112.403.00 PROGRAM FEES 20,205.00 21,215.00 22,275.00 ADUL'Il FOOD PROGRAM r trt4 tt■ 0,0 10.UIJ 59 ,89.00 6,194.00 FUNDRAISING 29,494.79 30,968.00 nn n nn OL iu .uu DONATED GOODS 7,410.00 7,780.00 8,169.00 IN-KIND REVENUE 10,176.00 10,176.00 10,176.00 INT./DIVIDEND INCOME 1.618A1 I 1,667.00 1,717.00 UNREALIZED GAINI(LOSS) (1,003.92) Total 329,873,89 363,934.00 I 380594.00 *if applicable Explain what plane, if any, your agency and/or program has to increase revenues tr support this program. When you antinlpete your program to become self-sustaining? It is my goal to enroll 60 clients vvith an average daily participation of atleast and be able to maintain theft level of care with no more than 9 employees. I believe at that time we will be ictnininci. gut nrily if the level nf flinntinninn is at level 1, whin requires minimal supervision. As ft is now, instead of the 6 clients to 1 e.mployee as required by the state, it is taking 1 employee to 3 clients because of the level of care required, which is acute care. We have more clients in wheelchairs and using walkers and canes. We have more Alzhierner's and dementia clients who are low finctioning and require a lot of cueing and supervision. In the last 10 years the level of care has increased progressively. I need to have at least 4.5 clients per employee per day to stay in the black. But as you can see the ratio doesn't work, it takes1 employee to take care of 3 clients neeil 4.5 clients 1,o offset the cost. e.achi employee and othef expenses. Unfortunately we cannot aCcept ONLY the clients that require minimal Care. IMiliNPRniFIT (LP A INT A PPE WATEON FISCAL YEAR 2010-11 Page 5 KONA ADULT DAY CENTER, INC. - Agency Name • A DI II T nnv rA Drr�rirnrn KI T1 6 V ri 1 \J .6 i L ! ..... a ,� e 6. C F A . i i 1. I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability 'Jni d i A1 •1r p n A1r 1 4^ !_I r ?%ij ir_iil.!!t. as :!�l a!!U i1! H.Lr :! LJ, JCII'ona �_ !J:! — S' ! G. Hawaii County rode, relating to Appropriation Of Funds to Nonprofit Organizations l (we) hereby certify that information supplied herein including all supporting door _... eats i3 Enrr _ _t rind that i (ere) nave _na a_ ity and .l;ty 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 riawari, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative cau itrir within Eft dart after Jtme 30 of the f €Pr_.n$ rear. The report Eha include an ex planation &the public benefits derived from the awarding of the grata, a complete accounting of all expenditures supported by County of Te,_^ "i _ orant f =" anti a ..= ...!5 _ _ _... fninA:ng g s_ai: c_S. ' %,3 a5e..a5e5e obtained during the award period. Failure to submit a timely, cornfsiete, and accurate year-end report will impact the evaluation of your program's or agency's future funding requests. c ki , l v o . \) .h2, er-v \ et-AA- 1 r aD_D Si. ^,natuire of Board Pre /their Date - 1. r_apylivias..L.---- VI c/i 0 Signature of Exec , 'e - lip it Fiat i IASC omen nnfn P9 /1¢ Ai Q tA! 1 AIl1T fl A rrrn nTr9 6JECa.1 r ' r .dVFnLC' ',we.... ;VW ! LJL fl a6.Lr ! LL NONPROFIT GRANT APPL CATI_OP - _ :I A3,, EAR291:1-11 _ Page o 57 Kona Historical Society Living History Program Operations Kona Historical Society- Agency Name Living History Program Operations- Program Name Agency Director: Jill Olson Phone No.: 323 -3222 Contact Person: Jill Olson Phone No.: 323 -3222 Mailing Address: P.O. Box 398 Captain Cook, HI 96704 Facility /Site Address: 81 -6551 Mamalahoa Hwy Kealakekua, HI 96750 Fax No.: 323 -2398 Email Address: khs @konahistorical.org Name of Accountant/CPA (include name of firm if applicable): Tone Lamkin and Taketa, Iwata, Hara & Assoc, LLC Phone No.: 323 -2398 Mailing Address: P.O. Box 398, Captain Cook, HI 96704 Amount of Request for County Funds: $50,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $0 $0 Agency Mission Statement: Kona Historical Society will preserve the history of Kona to enrich our community and inform our visitors by nurturing an understanding of, and inspiring an appreciation for, Kona's unique island sense of place. We will do this through NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 collecting, preserving, researching, interpreting, and disseminating the history of Kona with an emphasis on the period after 1779. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Kona Historical Society - Agency Name Living History Program Operations- Program Name Program Description: KHS has two sites and three programs: 1. Kona Coffee Living History Farm (D. Uchida Farm), a 6 -acre 1920's era coffee farm in Captain Cook, which was homesteaded by Japanese immigrants. The Farm interprets the history of Kona's Coffee Pioneers and their family values, independence, and resourcefulness. 2. H.N. Greenwell Store, an 1890's general store in Kealakekua, founded by H.N. Greenwell, an English immigrant. The Store presents typical 19th century shopping experiences by encouraging visitors to role -play actual multi - cultural customers. We offer living history tours of these sites to school groups, visitors, and local residents. Both sites encourage visitors and local school children to enter the appropriate era with the help of costumed interpreters, historically accurate artifacts, and actual buildings from the period. Both sites are listed on the State and National Registry of Historic Places. 3. Portuguese Stone Oven: in 2008, KHS launched a bread - baking program with an authentic, community sized, traditional oven, which was built adjacent to the H.N. Greenwell Store. Nearly 100 loaves are baked weekly and sold to a steady stream of customers. Visitors and school groups are encouraged to come early to help with the bread - making process, and to sample hot loaves right from the oven. Total Budget and Position Count Total Program Budget 173,436 Total Program Position Count 20 Total Agency Budget 436,253 Total Agency Position Count 30 Program Objectives: 1) Provide authentic and thoroughly researched programs at historic sites. 2) Explain how coffee was grown, picked and processed during the 1920's 3) Convey the history of the 1890's multi - cultural Kona mauka community 4) Demonstrate how general store customers chose and purchased goods through trade, exchange, credit, or cash, depending on what resources were available to them. 5) Continue the traditions of Portuguese ranching families with breadbaking in the rustic stone wood -fired oven. 6) Educate visitors to create an understanding of and appreciation for Kona's multi - cultural history. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 7) Encourage visitors to participate in hands -on experiences at each site. Program Highlights: (from Fiscal Year 2008 -09) 1) In 2008 Kona Historical Society was awarded a State Legacy Lands Conservation Grant of $300,000 to purchase the Kona Coffee Living History Farm 2) Kona Coffee Living History Farm and H.N. Greenwell Store are the only two National Endowment for the Humanities permanent exhibits in the State of Hawai'i. 3) Kona Historical Society is an affiliate of the Smithsonian Institute 4) The H.N. Greenwell Store living history program won a 2008 Merit Award from the Historic Hawaii Foundation for its interpretive program 5) The Kona Coffee Living History Farm's new product, Pioneer Coffee, won the top Label Design Award at the 2009 Kona Coffee Festival. 6) The Portuguese bread - baking program earned a two -page article in West Hawai'i Today (March 2009), that brought increased visibility and visitors to the program, including top chefs from several of West Hawaii's major resort restaurants. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 • Kona Historical Society - Agency Name Living History Program Operations - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Number of adult visitors 11,205 6,275 5,334 Number of school children 1,560 874 745 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 164,670 131,736 144,960 Professional Fees 0 0 0 Operations 20,273 13,980 13,980 Equipment 0 0 0 Other" 16,467 13,173 14,496 Total 201,410 158,889 173,436 * If applicable * Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010-11 Page 5 Kona Historical Society — Agency Name Living History Program Operations — Program Name Explanation of Program Expenditures on Page 5 Other Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 16,467 13,173 14,496 This expense includes payroll taxes and unemployment insurance at 10% of salary costs for each year. NOTE: Kona Historical Society's fiscal year runs from January through December. Therefore Program Expenditures shown are for: FY 2008 (actual) FY 2009 (preliminary) FY 2010 (budgeted) NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 -A Kona Historical Society - Agency Name Living History Program Operations - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Tours and Admission Fees 118,904 66,142 56,221 Gift and Coffee Sales 125,281 73,615 62,573 Mac Nut Crop Sales 4,460 2,795 1,800 Total 248,645 142,552 120,594 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? During the last month of 2009 and during January 2010, we have noticed an uptick in the number of visitors to our sites. While there's no way to tell if this will continue through 2010, we are hopeful that the worst is behind us. In 2009 we launched a new product, Pioneer Coffee, which solicits donations of green coffee from local farmers. The roasted coffee is then sold at the Farm as well as several other locations in West Hawai'i, expanding our market. In addtion, we take advantage of every free and low cost opportunity to publicize our programs, and have pursued coverage of activities and programs by the media. A staff member is responsible for making sure our programs and events are listed in publications catering to tourists, as well as in PSA's and local calendars. Our website is up -to -dated regularly by trained staff. In 2008 the Living History Programs overall were self- sustaining, in terms of direct costs. However, in 2009, despite cuts in operating hours and operating expenses, revenue generated from program fees and gift and coffee sales did not cover costs. We project this situation to continue at least through 2010. We anticipate that in 2011 we will see a retum of these programs to sustainability. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Kona Historical Society - Agency Name Living History Program Operations - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 1_ (/\- / 692-0/ 0 Signature of Board President/Chair Date , . O.A i ( 09?-0/ 6 Signatu 1" xecutive Director Date ili UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 58 Kona Hospital Foundation Adopt -a -Room 0. Kona Hospital Foundation- Agency Name Adopt -a -Room - Program Name Agency Director: James W. Higgins Phone No.: 322- 4587 Contact Person: Carol W. Mountcastle Phone No.: 322- 4587 Mailing Address: 79 -1019 Haukapila Street Kealakekua, HI 96750 -7920 Facility /Site Address: 79 - 1019 Haukapila Street Kealakekua, HI 96750 -7920 Fax No.: 808- 322 -6963 Email Address: cmountcastle @khfhawaii.org Name of Accountant /CPA (include name of firm if applicable): Gregg M. Taketa, CPA, CVA - Taketa, Iwata, Hara & Associates, LLC Phone No.: 808 - 935 - 5404 Mailing Address: 101 Aupuni Street, Suite 139, Hilo, HI 96720 -4260 Amount of Request for County Funds: $187,050.24 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0.00 $0.00 $0.00 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Agency Mission Statement: The Kona Hospital Foundation is dedicated to improving Kona Community Hospital for the entire community. We fund medical technology, expanded services and enhanced facilities that would otherwise be unavailable. It is the goal of Foundation Board of Trustees and staff to achieve a state -of- the -art facility with comprehensive medical services which will enrich the lives of every member of the community today and into the future. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Kona Hospital Foundation - Agency Name Adopt -a -Room - Program Name Program Description: The Kona Hospital Foundation's fundraising focus is on our Adopt -a -Room project, a special renovation of each of our 37 patient care rooms. We feel that a technologically advanced, beautiful, and peaceful environment encourages each of our patient's healing and that begins in the room. The renovation includes upgrades such as state- of- the- art headwalls that provide the medical staff with a better ability for proximity of suction, oxygen and power outlets and as a bed bumper which ultimately contributes to increased patient care. A 3- position recliner will be added for visitors to provide support and comfort to the patient. Upgraded plumbing and flooring is scheduled as well as new countertops, mirrors, window shades and televisions. The per -room renovation estimated cost is $25,000.00. It is estimated the duration of this project will be 3 years due to patient room availability as all rooms are normally occupied by patients requiring medical services. Total Budget and Position Count Total Program Budget $907,782.37 Total Program Position Count 7 Total Agency Budget $720,000.00 Total Agency Position Count 2 Program Objectives: Most rooms at Kona Community Hospital were constructed approximately 30 years ago and are far overdue for physical and technological renovations. The severe earthquake of 2006 played a definitive role in the aging process and was a major setback in any efforts to begin any renovation project. Due to the fiscal problems of the State of Hawaii, the likelihood of any CIP funds being received in the near future for this purpose is remote. Our citizens deserve better. It has long been known that a peaceful environment is vital for the recovery and overall well- being of patients in the hospital setting. When a patient and their families trust that their hospital is well equipped with up -to -date medical technology and their room is comfortable, it makes a huge difference. The subsequent morale of the attending medical staff is enhanced as well. As a result, we are focusing our fundraising efforts on this essential project that will enable us to inexpensively and modestly renovate 37 patient rooms at the hospital. The major technological improvement in the Adopt A Room project are new state of the art headwalls. These are essential for on- the -spot patient care. Facility upgrades will include new plumbing fixtures such as toilets, faucets, custom grab bars, hand -held showers, countertops and tile as well as new flooring and baseboards. Aesthetic renovations will be new televisions, window shades, mirrors and closet door handles with the addition of a 3- position recliner. All rooms will be repainted in one of two color schemes centered for tranquility and healing. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Program Highlights: (from Fiscal Year 2008 -09) 1) Our annual major fundraising event was November 15 and 16 2009. The foundation hosted a gala and golf tournament at Hokuli'a with the Adopt -a -Room Project as the theme NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Kona Hospital Foundation - Agency Name Adopt -a -Room - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Program is estimated to be 3 years. 0.00 $308,594.12 $299,594.12 Please note this form request 2 years but we estimate the program to be a 3 year project. *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 0.00 $5,000.00 $5,000.00 Professional Fees 0.00 $5,000.00 $5,000.00 Operations 0.00 0.00 0.00 Equipment 0.00 0.00 0.00 Other Professional Estimate from 0.00 $298,594.12 $289,594.12 Kitchens Interiors by von Hake, Ltd. Total 0.00 $308,594.12 $299,594.12 * If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Kitchens Interiors by von Hake, Ltd. SUMMARY OF COSTS FOR HOSPITAL ROOMS OTY DESCRIPTION AMOUNT TOTAL 36 Base Model Rooms 24,132.84 868,782.37 Additional Options for Base Model Rooms: Versacare Bed 8,600.00 Hill -Rom Bed 5,600.00 Community Showers First Floor includes threasholds & window sills Corian: Bisque - Shower #1 8,549.00 Corian: Bisque - Shower #2 8,549.00 First Floor with Seat includes thresholds & window sills Corian: Bisque - Shower #3 9,734.00 *Shower valves, drain, & grab bar not included _ Inrlotcri 1 /91 /91110 Kitchens Interiors by von Hake, Ltd. ESTIMATE BASED ON ROOM 220 WITH SINGLE BED AND NO PATIENT CURTAIN SECTION ITEM DESCRIPTION DETAILS COST PRICE PLUMBING S3789600 CVR Sloan BPW Valve & Como Bed Pan Washer 284.60 K4405 -0 Highline HE Bowl Bowl 137 74 K4670 -C -0 EB Bowl of CH LC Seat - Lustia Seat 17 47 53365177 4 SNSR OP DM GN FCT ETF700 Faucett 411,19 50345370PK EL248 40 OPTIMA BX TRANS Transformer faucett 26 96 PFHGD WLCHR ELL W/ GRD DRN Off set drain 17 67 PF202WH 3 PC P TRAP & SPLY CR WHITE 3pc trap cover ADA 36 87 PF205WH OS TLPC CVR WHITE Off set ADA Tail piece 15 35 BB7686 SS SUR MNT TIP DISPN F /DBL RL Toilet paper dispense' 19.81 SP- B580630X12 30 C 12 TWO WALL 90 GRAB BAR Custom Grab Bar 73.02 SP- 885806 -36 STRAIGHT GRAB BAR 36" Grab Bar - 36" 25.45 SP- 85806 -18 18" STRAIGHT GRAB BAR Grab Bar -18" 18.91 DT13H153 1HDL LEV SHWR TRIM ONLY CP Hand held shower combo -ADA 136,13 DR10000UNWS 1HD P /BAL UNIV VLV ONLY W /ST Hand held shower combo -ADA 38 00 XXXXX SHOWER CURTAIN Open Option 10000 S8212SN SN CAST NI STRN W /SS SCRW Shower drain & cover 9 72 SP- BB6047 -60 SHOWER CURTAIN ROD & BRACKET Heavy Rod and Bracket 27 69 Subtotal 1,396.57 GEORGIA PACIFIC - HAND TOWEL DISP Ultra Violet 0.00 (Installed by Maintence) FLOORING METRO PLANK VINYL 2 Gal per 280 sf 102 50 280 sf Vinyl @ $5 /sf cost 1,400 00 1,502.50 BASE 4" MERCER 205 CREME 327 5 SF / RM 1,275 30 ADHESIVE - 2 GAL/RM 75.00 1,350.30 BATH DAL TILE - PORCELAIN D335 Tile Price 397 32 GROUT BY MAINTAINENCE Freight 75 00 (86 SF /RM AVG) Grout 10 00 482.32 CLOSET DOOR HANDLES 348796- 170 -SS RICHELIEU 2 Closet door handles 68.75 with tax and shipping (Exclusively by Kitchens & Interiors) PAITENT CURTAIN ALLOWANCE FOR CURTAIN 200.00 HEADWALL P2008A2 ON WALL ELEMENTS HEADWALL - Hill -Rom 5,195.84 RECLINER REC -550 OPERA 3 POSTION RECLINER - H4AM Laby'ith ( pence includes freight) 1,514.00 VALANCE FABRIC VALANCE Open Option - customer to choose 200.00 WINDOW SHADE REPLACEMENT WINDOW SHADE Open Option - customer to choose 400.00 TV PDI- P22LCDC ICS - TV SET UP AND PARTS 1,303.57 CORIAN LAV TOPS W/ 810 WHITE BOWL Color - Fossil 8,849.00 6" BACKSPLASH/ WITH FACIA (Includes tax and shipping) (includes templating, fabrication, shipping (Exclusively by Kitchens & and installation - Plumbing not included) Interiors) SHOWER WALLS - 1/4" CORIAN BISQUE OVER EXISTING TILE (includes Conan thresholds and Corian window sill for room) (includes templating, fabrication, shipping and installation - Plumbing not included) MIRRORS MIRRORS 270.00 Page 1 Updated 1/21/2010 Kitchens Interiors by von Hake, Ltd. ESTIMATE BASED ON ROOM 220 WITH SINGLE BED AND NO PATIENT CURTAIN SECTION ITEM DESCRIPTION DETAILS COST PRICE FORMICA D30 -60 CLOSET DOORS - OVER EXISTING Natural Almond 150.00 (Includes 2 - 4x8 sheets and adhesive) PAINT BY MAINTENANCE Wall paint 8 Wamscoat paint LABOR BY MAINTENANCE (Includes plumbing, electrical, demo, paint, etc. ) INTERIOR DESIGN COORDINATION Assist Management in placing orders, provide consultation, 1,250.00 and supervise conan installation TOTALROOM'COST WITHOUT NEW BED _ 24,132.84 BED VC455AX FDA Guidance Hospital Bed Versacare (Optional) $8600 8,600.00 (Model Room Bed) (optional$2 bed) HILL- ROM 1000 FDA Guidance Hospital Bed (Optional) $5600 TOTAL ROOM WITH:NEW BED °. 32 NOTE: All of the above pricing for hospital rooms is at Kitchen and Interiors cost. Hospital can purchase directly from each Vendor and Vendors will honor same price. This excludes the Corian and cabinet pulls as Hospital will buy direct from Kitchen and Interiors. Page 2 Updated 1121/2010 Kona Hospital Foundation - Agency Name Adopt -a -Room - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Donations 0 $50,000.00 $70,000.00 Fundraising 0 $100,000.00 $120,000.00 Grants 0 $50,000.00 $150,000.00 Pledges (balance through years 2010- 0 0 $180,000.00 2012) Total $200,000.00 $520,000.00 `If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? We must pursue all traditional sources of revenue open to charities. In this economic downturn, we must be more resourceful and aggressive in these pursuits than ever before. Included in our efforts will be fundraising activities, applications for grants, and actively seeking donations. If we are successful, we anticipate the program will be self - sustaining in the third year which is 2012. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Kona Hospital Foundation - Agency Name Adopt -a -Room - 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. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. /Signature of Board P e ident /Chair Date ��i �a�� / 12? -5 - 0 , 7 076 Signatu, e of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 59 Kona Literacy Council Kailua Learning Center o . Kona Literary Council- Agency Name Kailua Learning Center- Program Name Agency Director: Brenda Natina Phone No.: 329- 1180 Contact Person: Brenda Natina Phone No.: 329- 1180 Mailing Address: 75 -5766 Kuakini Hwy 106A Kailua -Kona, HI 96740 Facility/Site Address: Same Fax No.: Same Email Address: konalit @msn.com Name of Accountant/CPA (include name of firm if applicable): none Phone No.: Mailing Address: Amount of Request for County Funds: $2,000.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $1,500 $2,000 $2,000 Agency Mission Statement: NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 The Kona Literacy Council's trained volunteer tutors help any adult increase their basic reading, writing, math, and communication skills to enable the learners to become better family members, workers, community members and Ifelong learners. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Kona Literacy Council - Agency Name Kailua Learning Center- Program Name Program Description: The Kona Literacy Council's trained volunteer tutors provide free, one -to -one, small group, and computer- assisted literacy services at the Kailua Learning Center to any adult who wants to improve their basic reading, writing, computation skills and computer literacy. Special programs designed to meet the specific needs of the leamers 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 580 students, who have had lessons at the Kailua Learning Center since it opened in September 1992, have made remarkable progress in their basic skills; some have gained their High School Equivalency Diploma, passed the Citizenship exam, and have gotten better jobs. Reading improves the adults' self- esteem, thereby improving their lives and becoming better family members, workers and community members. Total Budget and Position Count Total Program Budget $5,600 Total Program Position Count 7 Total Agency Budget $5.600 Total Agency Position Count 7 Program Objectives: 1) Continue to provide free one -to -one, small group and computer- assisted literacy services at the Kailua Learning Center to any adult who wants to improve their basic reading, writing, computation and computer literacy skills. 2) Register, schedule, match learner with tutor, and prepare programs for 12 new students for the year. 3) Continue recruiting and training new tutors. 4) Continue networking with community agencies to provide free literacy assistance to their clients, i.e. Department of Human Services, Department of Labor & Industrial Relations, Kona Community School for Adults, various Vocational Rehabilitation Programs, Bridgehouse, Alternatiaves to Violence, court ordered participants, Family Support Services of West Hawaii, Hawaii Community College and the public libraries. 5) Offer pre - employment skills, help in filling out application forms, resume writing and interview skills to enable our learners to get and hold jobs. 6) Improve family literacy services. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 7) Help foreign born learners with their communication skills and assist them in passing their citizenship test. 8) Empower adults to become contributing members of our community by ensuring that everyone increases their literacy skills and becomes lifelong learners. 9) Publish a newsletter three times a year. 10) Hold general membership and public meetings three times a year. 11) Continue writing grants, pursuing fund raising functions, and seeking donations to keep open the doors of the Kailua Learning Center. Program Highlights: (from Fiscal Year 2008 -09) 1) Tutored 7 basic literacy students. (includes reading, math & computer literacy) 2) Tutored 13 English as a Second Language students. 3) Left the program and attained employment: 2 students. 4) Retained employment: 5 students. 5) Studying for the citizenship test: 5 students. 6) Entered other educational programs: 0 student. 7) Increased involvement with children's education: 6 students 8) Met goals: 4 students. 9) Utilized 2 volunteer tutors, 4 auxiliary personnel, plus the Program Director. 10) Tutored approximately 375 hours of actual tutoring. 11) Contributed approximately 400 hours by volunteers in other areas. 12) Trained 0 new tutors. 13) Passed Citizenship Test: 2. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Kona Literacy Council - Agency Name Kailua Learning Center - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Tutored Adult Basic Ed. Students 7 10 9 Tutored ESL Students 13 10 10 Citizenship Students 5 4 4 New Tutors 2 2 2 Newsletters 3 3 3 Board & General Public Meetings 3 3 3 Total Tutoring Hours 375 400 400 Total Non - Tutoring Hours 400 450 450 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 0 0 0 Professional Fees 0 0 0 Operations 4,309 4,700 4,500 Equipment 198 400 400 Other' Insurance 500 500 500 Total 5,007 5,600 5,400 * If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Kona Literacy Council - Agency Name Kailua Learning Center - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County Grant 2,000 2,000 2,000 Membership Dues 10 50 50 Wal -Mart 0 250 250 Donation (Left Coast Crime Writers) 2,934 0 0 Donations 820 500 500 Fundraising 0 500 100 Federal Campaign 485 800 500 Young Brothers 1,000 1,000 1,000 Ironman 1,000 0 1,000 Kukio 0 500 0 Total 8,249 5,600 5,400 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Kona Literacy Council plans to participate in more fundraising and grant proposal writing. Since we do not charge our clients for our literacy services, we will have to continue to rely on the generosity of our community supporters. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Kona Literacy Council - Agency Name Kailua Learning Center - 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. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. ! /�� 0 f OG t zo //o Sign ure of B r ide hair Da Add— Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 60 Ku'ikahi Mediation Center Community Mediation Program 9 Ku`ikahi Mediation Center- Agency Name Community Mediation Program- Program Name Agency Director: John Fujitani Phone No.: 935 -7844 Contact Person: John Fujitani Phone No.: 935 -7844 Mailing Address: 101 Aupuni St. Suite 1014B2 Hilo, HI 96720 Facility /Site Address: Same as above Fax No.: 961 -9727 Email Address: keoni @kuikahi - mediation.org Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: 968 -1002 Mailing Address: P.O. Box 4372 Hilo, HI 96720 Amount of Request for County Funds: $30,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $7,000 $13,000 $18,000 Agency Mission Statement: To provide a safe environment, an impartial process, and skilled, trained personnel for the delivery of affordable dispute prevention and resolution services to the East Hawai'i Community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Ku`ikahi Mediation Center - Agency Name Community Mediation Program- Program Name Program Description: Ku'ikahi Mediation Center (KMC) has provided affordable and effective dispute resolution services since 1983 —first as a program of the Waiakea Settlement YMCA then, in 2006, as an independent nonprofit 501(c) 3 corporation. Conflict is a part of life and recent economic hardships and a rapidly growing population have increased and intensified these conflicts in families, neighborhoods, schools, businesses and public agencies in our community. KMC's community mediation program strives to bring people together to resolve disputes peacefully through respectful and open communication in a safe, confidential environment. Most of our mediations bring about long- lasting, mutual agreements that often serve to improve relationships, promote understanding and strengthen our community. Our program also relieves the overburdened judicial system because, when participants reach an agreement in mediation, they usually don't have to go to court. This saves time and money for participants, attorneys and all taxpayers of the State of Hawai'i. KMC is the only mediation center serving the needs of East Hawai'i. We are a small organization and the community mediation program involves all of our resources. The requested funds will be especially needed to make mediation services accessible to economically challenged populations and at -risk individuals /families in our community so they have an affordable way to resolve disputes. The annual household income of over 50% of our clients is less than $20,624, which is at or below the 2009 Federal poverty guidelines for a four - person household. A fair amount of our clients don't understand the judicial system and most of them cannot afford an attorney to advise them. Mediation provides a way for people to work out disputes themselves with the help of a neutral third party. It is an easy to understand, affordable alternative to court. Our mediators are professionally trained volunteers from the community that are committed to helping participants choose their own solutions. Many of our services are offered free of charge, and in others a modest fee is assessed based on a person's ability to pay. Despite recent cuts to many of our funding sources we have not raised fees or cut services. The requested funds will help us to fill the critical need for basic mediation services, especially for the most financially disadvantaged clients who have nowhere else to turn for free /affordable conflict resolution. Our caseload increased by over 20% last year and by 16% the year before. It is expected to increase even more this year, demonstrating a clear need for the program. One of the main reasons we have been able to keep our services affordable is because all of our mediators donate their time, energy and expertise free of charge. Volunteers contributed over 900 hours to the program last year. It's NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 essential that we maintain an adequate pool of trained volunteer mediators to support our organization. Our program will continue to offer mediation training and educational workshops to the public to increase the ongoing need for trained volunteer mediators and to build awareness and appreciation for mediation as a peaceful way to resolve disputes. Lately, there's been a sharp rise in the need for a special type of mediation designed to minimize the harmful effects of domestic disputes /divorce on families, especially children. Many of the participants are young, unmarried couples who can't afford a lawyer and don't understand the complex issues of their problem. Mediated agreements that resolve divorce, custody and visitation disputes can help people regain control of their lives and take shared responsibility for their children. Even though the traditional family may be breaking apart, respectful agreements can minimize emotional damage and promote solutions for a functional, restructured family life for children of divorce. These "domestic" cases are very challenging so mediators require specialized, advanced training on the emotional and legal issues of divorce, custody and child visitation. Our program has made it a priority to offer advanced and specialized training to help volunteers meet the critical demand for domestic mediation for families in our community. All the aspects of the community mediation program are designed to help people resolve their problems peacefully so that the community at -large will come together rather than break apart. Total Budget and Position Count Total Program Budget $167,322 Total Program Position Count 2.5 Total Agency Budget $167,322 Total Agency Position Count 2.5 Program Objectives: 1) Provide more resources to enable broader public participation in the program through the following actions: Increase staff time dedicated to assisting clients. Increase the overall number of cases served, clients served and mediator hours (see performance measures). Measurably reduce the time a person has to wait between initial contact and the actual mediation. Create improved, up -to -date printed information and website content to assist clients. 2) Build and strengthen the pool of active volunteer mediators through the following actions: Conduct two 32 -hour public mediator training events during the year. Enroll a minimum of 15 -20 new apprentice mediators within the year. Increase the ethnic and cultural diversity of our volunteer base. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 3) Build a stronger community through stronger families by the following actions: Conduct at least one 20 -hour advanced training in domestic mediation during the year to enable more qualified mediators to service a growing need in this area. Increase the number of cases served through Family Court by 10% or more. Use mediation to help at -risk families find positive alternatives /solutions. 4) Increase access to justice for the public through the following actions: Provide more on -site mediation services to the public at district court. Increase the number of free services and subsidies for persons who can't afford to pay. 5) Build awareness and appreciation for mediation through the following actions: Host a minimum of five free public information /outreach meetings along with increased agency participation in a variety of community events. Hold more outreach programs in rural communities. Do presentations on conflict resolution for civic groups, local businesses and community associations. 6) Maintain an agreement rate of 60% and a positive customer satisfaction rate of 70% or higher. 7) Collaborate with other agencies to provide mediation services and education. These include the Hawai'i Civil Rights Commission, State Real Estate Commission, Public Schools and other nonprofit organizations. Program Highlights: (from Fiscal Year 2008 -09) 1) 509 cases were served during the year, a 21 % increase over 422 cases the previous year. KMC's caseload has increased faster than any other mediation center in the state, showing a clear need for services in our community. 2) KMC was able to handle the increasing caseload without increasing staff hours and still get an agreement rate of 60% and a "very satisfied" approval rating from 79% of the clients served. 3) Two Mediator Trainings were held during the year, a 36 hour training in October and a 32 hour training in May. These were supplemented by a number of informal refresher courses and volunteer gatherings throughout the year. 4) Community outreach /education events included: Presentation by the State Ombudsman and the Longterm Care Ombudsman on mediation for the elderly and disabled; Information tables at the UHH Family Affa;r; Information tables at East Hawai'i shopping centers for Law Day; Free public presentation on Mediation at the Kilo Lagoon Centre. 5) KMC's mediation program responded to a increase in the following critical areas: Cases served for consumer debt (credit card, car loans etc.) were up 137% over the previous year. Domestic mediations referred by family court for child visitation and divorce were up 31 % over the previous year. Landlord /tenant disputes rose 17% over the previous year. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 6) KMC collaborated with the Hawai'i Bar Association for the third annual recognition dinner fundraiser. Judge Ronald Ibarra, Jay T. Kimura and Judge Terence T. Yoshioka were honored. Attendance was the highest to date and much needed funds were raised to support our basic operating expenses. 7) KMC increased its pool of active volunteer mediators to meet a growing need. At the start of FY 08 -09, the number of mediators available to the program was between 30 -40. By the end of the year it was between 40 -50 and as of January 2010, this number was increased to 65. We have also been increasing the diversity of our mediators with a greater range of ages and cultural backgrounds. 8) KMC's strengthened its leadership and governance by hiring a permanent Executive Director to replace an Interim Director on May 1, 2009. A board member was able to receive training at a Board Leadership workshop in Honolulu and four new board members came on at the end of FY 08 -09. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Ku`ikahi Mediation Center - Agency Name Community Mediation Program - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Cases served 509 575 600 Cases resulting in agreements 60% n/a 65% Mediation trainings held 2 2 3 -4 Active volunteers in mediator pool 45 n/a 65 -75 Volunteer mediator hours 924 n/a 1000 Clients served 788 n/a 1100 Clients "very satisfied" with services 79% n/a 80% Public Education /Outreach Events 5 5 10 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 79,929 89,197 89,500 Professional Fees 21,733 16,650 17,500 Operations 33,435 37,360 39,000 Equipment 0 10,000 0 Other" Total 135,097 153,207 146,000 * If applicable a Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Ku'ikahi Mediation Center - Agency Name Community Mediation Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Contributions 1,577 1,520 1,700 Fundraising 15,575 15,575 16,000 Fees for services 34,541 43,900 40,000 Hawai'i Justice Foundation 13,000 6,000 10,000 County of Hawai'i 13,000 18,000 25,000 County Dept. of Research & Dev. 0 5,000 5,000 State Judiciary Contract 53,004 41,344 42,622 Hawai'i Island United Way 0 6,000 12,000 Atherton Family Foundation 0 10,000 5,000 Miscellaneous Grants 0 900 5,000 Hawai'i Community Foundation 0 11,000 5,000 Total 130,697 159,239 167,322 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Our budget projections forecast only modest increases and some decreases in funding sources for the near -term because we believe these are realistic expectations given the current economic conditions. That said, one plan is to broaden and diversify our revenue sources so that if one goes down, we can look to others for support. In the past, KMC depended almost entirely on the State Judiciary Contract. Since this was cut 20% in FY 09 -10 we had to look for additional sources of revenue we had not tapped into before. We have since secured grants from the Atherton Family Foundation, County Department of Research and Development and Hawai'i Island United Way. These new sources of funds have helped to make up for the cut in our State contract. In the future we plan to diversify our revenue streams even further by continuing to explore new grant opportunities from both the public and private sector. Another strategy for sustainability is to generate earned income by diversifying our fees for services. We will still continue to provide our core mediation services at no charge or for affordable fees, but new services targeting businesses and higher income clientele can be added to generate income. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 Ku`ikahi Mediation Center - Agency Name Community Mediation Program - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. C2c0/ u I /Q.,S trio Si ature of Board President/Chair Date `, L____ t /1571D Signa re of Executive irec Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page `� 61 Laupahoehoe Train Museum Visitor Outreach Program Laupahoehoe Train Museum- Agency Name Visitor Outreach Program- Program Name Agency Director: Lisa Barton Phone No.: 962 -6300 Contact Person: Lisa Barton Phone No.: 962 -6300 Mailing Address: P.O. Box 358 Laupahoehoe, HI 96764 Facility /Site Address: 36 -2377 Mamalahoa Hwy Laupahoehoe, HI 96764 Fax No.: 962 -6957 Email Address: laupahoehoetrainmuseum @yahoo.com Name of Accountant/CPA (include name of firm if applicable): Natalie J. Iwasa, CPA, Inc. Phone No.: 808 - 395 -3233 Mailing Address: 1331 Lunalilo Home Road, Honolulu, HI 96825 Amount of Request for County Funds: $40,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $40,000 $10,000 $10,000 Agency Mission Statement: The mission of the Laupahoehoe Train Museum is to emphasize the history of railroads in Hawaii, and to preserve, promote, and protect the community interests of the Hilo - Hamakua Coast. We are more than just a train museum and provide many community services. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Laupahoehoe Train Museum - Agency Name Visitor Outreach Program- Program Name Program Description: The Laupahoehoe Train Museum is an educational resource and highlight in the community. As part of the Hilo Hamakua Heritage Corridor we preserve and protect our islands railroad, plantation and local history and assist the community by providing social,civic and economic stimulation in the area. This Visitor Outreach program will focus on our efforts to provide visitor outreach activities, and job opportunity to our youth while continuing on our efforts towards museum sustainability. Visitor out reach programming will include openings at night of the museum with talk story, cultural practices and other events to build community and community awareness of the museum. This program will help us create maximum visitor satisfaction by providing very unique experiences for our visitors with more dynamic hands on displays for all ages, also attracting more visitor while providing economic stimulation. It is our goal to show donated film clips of the railroad era in our full scale replica caboose now that its interior is finished. The finished product of our video of old films and researched information will have copyright approvals and become a fundraiser for the museum as well. New displays of railroad memorabilia and photos are being added to create an authentic railroad feel inside and out. We will complete the last 100' of rail restoration of the historic `wye' in the yard. This area is where an engine could be switched to head north or south on the railroad. Completing this line would create a longer area for our mascot engine 'Rusty' to run on. Our visitors are thrilled when 'Rusty' starts up and actually moves, smashing pennies for souvenirs. The restoration work on our engine "Rusty ", its trackmate -the boxcar and our 1900's era caboose has recently been finished and all are on display on the wye.Finishing this area in the yard would also give a better understanding of the significance of this area to the railroad and a more rounded experience as visitors stroll around the museum grounds. Funds from this project would help us take our current volunteers, both students and adults, on archival research expeditions to local museums in Hilo and Kona to learn more about researching data, creating interpretive displays and preserving our islands history and heritages. Our history is hidden in archives. These activities would provide more individuals with part-time work as well as provide the museum with the much needed assistance in completing new displays to offer more to our visitors. This in turn would also create more word of mouth advertising, again attracting more visitors, adding to our sustainablility. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Total Budget and Position Count Total Program Budget 156,500 Total Program Position Count 3 Total Agency Budget 166,500 Total Agency Position Count 12 Program Objectives: 1) Provide additional capital to continue to increase displays which adds to the overall museum experience, repeat visitors notice our changes! 2) Support staff research and interpretive display creation boosting staff education and participation to enhance knowledge of the railroad era to staff and docent, and in turn impart this information to visitors. 3) Continue to employ and mentor the youth we have in the past to educate them on their island histories and attempt to pass these histories on to the next generations. We've seen an increase in student interest this year. 4) Increase visitor satisfaction with which in turn should increase word of mouth advertising at the visitor level and increase visitor numbers and our sustainability over the downturn of the economy. 5) Create continued excitement among other community venues, of the activities at the museum for them to share with their customer base; for alternative, cost effective advertising and cross marketing encouraging visitors to those venues. We've started this program and have see results. Program Highlights: (from Fiscal Year 2008 - 09) 1) Through our youth employment opportunities we have finished the cosmetic restoration of the caboose and two other railroad cars on the wye, well as two static displays of railroad and plantation items. 2) Through our youth mentorship program we have kept our door open 99% of the daily advertised hours this year augmenting volunteer hours 3) We have finished the interior displays of the caboose including media capabilities and due to the previously mentioned highlights we have opened the caboose to the public, with great comments on its addition. 4) We have opened the museum in the evening several times this past year adding opportunities to our local audiences to see us at a different rime and in a different capacity. 5) In addition to running the museum, LTM has supported various community projects; the O'okala Community Forest, youth mentorship and employment, community service restitution programs, the Laupahoehoe Farmer's Market and Hamakua CERT. 6) Our visitor numbers don't yet sustain our total budget but your support has kept these programs operational, we are striving for sustainability. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Laupahoehoe Train Museum - Agency Name Visitor Outreach Program - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Increase visitor count by 10% 2,900 6,600 6,000 Increase gift shop sales (net) 14,000 10,000 17,000 Increase admissions /donanations 11,000 15,000 15,000 Increase membership support 7,400 6,000 8,000 Increase paid staff (FTE) 2 3 3 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 39,000 75,000 88,500 Professional Fees 1,700 5,000 2,000 Operations 53,300 50,000 40,000 Equipment 0 0 0 Other" 26,000 26,000 26,000 Total 110,000 156,000 156,500 * If applicable a Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Laupahoehoe Train Museum - Agency Name Visitor Outreach Program - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County Appropriation 10,000 40,000 40,000 IMLS (federal funding) 43,300 50,000 43,300 donations /admission fees 11,000 15,000 15,000 membership dues 5,800 6,000 7,200 gift shop sales (net) 11,000 10,000 15,000 misc grants /revenues 8,600 9,000 10,000 docent (in -kind) 18,000 18,000 18,000 management (in -kind) 8,000 8,000 8,000 Total 115,700 156,000 156,500 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? We have received a 3 -year Institute of Museum and Library Services grant to fund a program coordinator position. This position should be able to attract more tours to LTM and increase revenue over the next two years. We recieved an USDA community development grant funding $30,000 for restoration materials for our wye and rolling stock displays. We are aggressively pursueing federal grants to help with operational and staff costs. We are actively increasing our membership and donor base to become more self sustaining. Meanwhile, the downturn in the economy has reduced visitor numbers and our income for the first time in our twelve year history and state funds continue to be very hard to obtain. We rely on county funds to keep our youth employment program active which keeps our doors open and displays informative and exciting. We use county funds to leverage our federal funds so we can continue to provide our rich histories to everyone until the economy improves and we can support ourselves on the income from increased tourist and local visitor numbers. We project to be self sustaining within five years. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Explanation of Program Expenditures: In regard to the column marked "Other ": in FY 2010 -11 LTM estimated $26,000 for our in -kind volunteer hours. Paying key staff positions has been very important to the museum in terms of maintaing museum hours, researching information for new displays, display creation and maintenance of the facility. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Laupahoehoe Train Museum - Agency Name Visitor Outreach Program - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 - 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate vear -end report will impact the evaluation of your program's or agency's future funding requests. 2 Sig ur 9 of Board President/Chair . Date C e-,E.4.-,4-,, / /Z/ // Lxeeet ve t Signat re of ...-- -. ,- 2c- y+3uRce-pc Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 62 Lyman Museum Education and Public Programs Lyman Museum- Agency Name Education and Public Programs- Program Name Agency Director: Marie D. Strazar Phone No.: 935- 5021 Contact Person: Barbara G. Moir Phone No.: 935- 5021 Mailing Address: 276 Haili Street Hilo, HI 96720 Facility /Site Address: 276 Haili Street Hilo, HI 96720 Fax No.: 969 -7685 Email Address: bmoir @lymanmuseum.org Name of Accountant/CPA (include name of firm if applicable): Alex Smith, CPA Phone No.: 808 - 737 -7761 Mailing Address: 1403 Frank Street, Honolulu, HI 96816 Amount of Request for County Funds: $50,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $31,500* $30,000 $20,000 *HTA /CPEP not for this program NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Agency Mission Statement: To tell the story of Hawai'i, its islands and its people. The Museum exists to: Collect, preserve, and exhibit artifacts, artwork, and memorabilia relating to the culture, art, and historical heritage of Hawaii; Educate and encourage awareness in these areas through visually exciting and interpretive exhibitions, informative tours, special programs, and activities; Serve as a learning resource center for those seeking information, entertainment, and knowledge; Fully extend itself to the public in order to instill community pride and support; Maintain a standard of excellence and professionalism, seeking to improve, progress, and realize its full potential as a museum. The Lyman Mission House and Museum, founded in 1931, consists of the Lyman family home, first built in 1839, and a modern museum building constructed in 1973. The restored Lyman Mission House is furnished to depict missionary life in the period 1840 to 1880. It is a reminder of a devoted band of men and women who dedicated their lives to bringing their Christian faith to the people of these islands and whose presence here exerted a profound influence on the development of these island communities. The adjacent modern Museum houses exhibits and presents programs and activities designed to interpret the physical environment and ecology of the islands as well as the rich and varied ethnic heritage of our island people, that there may be a deeper understanding and appreciation of the ongoing human process here in the fiftieth state in the heart of the Pacific Basin. The historical, cultural, and contemporary artifacts are presented in the following manner: 1. Hawaiian life prior and subsequent to European discovery 2. The Missionary period of 1840 - -1880 3. The traditional lifestyles of Hawaii's major immigrant groups 4. The natural history of Hawai'i, including its volcanos, flora, and fauna 5. Other exhibits, such as Pacific shells and worldwide minerals NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Lyman Museum - Agency Name Education and Public Programs- Program Name Program Description: Education and Public Programs at the Lyman Museum both reaches out to the community and draws it in to the Museum, to "tell the story of Hawai'i, its islands and its people" through programs, events, and activities that educate and encourage involvement by the public. Such efforts include focused educational tours; docent training for school and public tours; dissemination of information to teachers about Museum school - related programs; an annual agenda of lectures, demonstrations, performances, workshops, and other presentations for the community; and public programming specifically linked to traveling and special exhibits at the Museum. Total Budget and Position Count Total Program Budget 92,070 Total Program Position Count 2 Total Agency Budget 535,391 Total Agency Position Count 12 Program Objectives: 1) Conduct curriculum- appropriate school tours at the Lyman Museum for students groups of any grade level. 2) Provide teachers on the Island of Hawai'i with information about available Lyman Museum educational, school - related programs and how to access them. 3) Train docents to lead school and public tours. 4) Publicize and carry out an annual public program for adult members of the community with monthly lectures, performances, workshops, demonstrations, and other presentations. 5) Develop, publicize, and present special programming for each traveling or special exhibit at the Museum. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Program Highlights: (from Fiscal Year 2008 -09) 1) Serviced more than 2300 students with docent -led school tours. 2) Trained 8 docents for Lyman Museum school tours. 3) Trained 4 instructors of outreach educational workshops. 4) Provided 51 educational workshops for local elementary school classes, averaging 25 students per workshop. 5) Disseminated Lyman Museum education information to 150 teachers. 6) Presented 15 public programs relating to special exhibits and other Hawaii- relevant topics, to 775 members of the community, NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Lyman Museum - Agency Name Education and Public Programs - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Service students with school tours 2300+ 2600 2500 Train new docents for school tours 8 5 4 Provide public programs 15 24 24 Service community members with 775 1050 1100 public programs Disseminate Lyman Museum 150 150 150 education information to teachers Conduct educational workshops for 51 6 20 students Conduct special exhibit - related 5 2 3 programs Train new docents for Hilo walking 0 0 4 tour Disseminate Lyman Museum public 350 500 750 programming information to community members *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 70,070 70,070 70,070 Professional Fees 2,000 0 2,000 Operations 20,000 22,000 22,000 Equipment 0 0 1,000 Other 0 0 0 Total 92,070 92,070 95,070 * If applicable "Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Lyman Museum - Agency Name Education and Public Programs - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Hawai'i Council for the Humanities 350 0 0 Anonymous private donation for 5,000 5,000 0 public programming Kukuiu 'OIa 2,000 0 6,000 Lyman Museum Operations funds 49,143 67,070 36,070 (earned income, donations, endowment allotment) County nonprofit grant funds 30,000 20,000 50,000 Total 86,493 92.070 92,070 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? By offering a regular calendar of public programs scheduled in advance, the Museum anticipates being able to increase paid memberships which allow free admission to such programs. The Museum now charges a nominal program admission fee to nonmembers which is stimulating an increase in paid memberships. Currently, some grant- funded public programs are offered free to the community. Educational services, on the other hand, are never self- sustaining in that they are offered as a public service. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Lyman Museum - Agency Name Education and Public Programs - 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your proqram's or agency's future funding requests. a lk44.:1 1 3\1A — e - n„ Of 2 G, "Lo[ Signature of Board President /Chair Date •gnature of E ecutive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 63 Mala'ai: The Culinary Garden of Waimea Middle School Mala'ai: The Culinary Garden of Waimea Middle School Mala'ai: The Culinary Garden of Waimea Middle School - Agency Name Mala'ai: The Culinary Garden of Waimea Middle School- Program Name Agency Director: Mary Leleiwi Phone No.: 808- 937 -8455 Contact Person: Patti Cook Phone No.: 808- 937 -2833 Mailing Address: P 0 Box 543 (new) Kamuela, HI 96743 Facility /Site Address: 67 -1229 Mamalahoa Hwy Kamuela, HI 96743 Fax No.: 808- 887 -6087 Email Address: pcook @malaai.org Name of Accountant/CPA (include name of firm if applicable): Patti Schumacher Phone No.: 808 - 322 -4909 Mailing Address: P.O. Box 4384 Kailua -Kona, HI 96743 Amount of Request for County Funds: $25,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $ 0 $ 0 $ 10,000 Agency Mission Statement: To deepen Waimea Middle School students' relationship with food by creating and sustaining an organic garden and kitchen classroom that engages them in all aspects of growing, harvesting, preparing and sharing nourishing, healthy food. Ultimately, we intend for all food served in the school to be wholesome, fresh, delicious and just. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Mala'ai: The Culinary Garden of Waimea Middle School - Agency Name Mala'ai: The Culinary Garden of Waimea Middle School - Program Name Program Description: Mala'ai is a non - profit educational program working in partnership with Waimea Middle School (WMS). Under the direction of our Garden Leader, and with the assistance of teachers and over 200 community volunteers, approximately 285 students per Quarter work together to create and sustain a beautiful 3 /4-acre organic food garden. Students are taught how to become stewards of the land through a cooperative, hands -on, experiential approach. They learn how to collaborate with others and enjoy first -hand, the outcomes of their work through culturally responsive, hands -on, place -based learning. - Mala'ai is currently expanding outrepch to (1) encourage home food gardens and (2) share our recognized expertise to help "Grow Stewards for the Gardens," thereby increasing on- island school garden leadership capacity. Total Budget and Position Count Total Program Budget $218,963 Total Program Position Count 3.0* Total Agency Budget n/a Total Agency Position Count n/a Budget includes stipends for post -high school interns to participate in Mala'ai's "Growing Stewards for the Gardens" capacity building training for Hawaii Island. Program Objectives: 1) Provide Waimea Middle School students with the transformative experience of working with the earth to grow nourishing food, and the pleasure of preparing and sharing with their families. 2) Encourage better eating habits and food choices, focusing on fresh, locally grown foods for nutritional benefits including prevention of obesity and diabetes. 3) Focus student learning around Hawaiian cultural traditions that encourage and support respect for the land and responsibility to family and self for well -being 4) Engage students in learning productive habits embracing "The Principles of Pa'ahana — hard, industrious work " 5) Provide opportunities to learn social skills, teamwork and group problem solving to use and share with their families. 6) Provide home food gardening classes to school families and the community to support healthier lifestyle choices as well as food safety, security and self - reliance, as advocated in the Draft County of Hawai'i Agriculture Development Plan 7) Be a distribution center for donated produce and surplus from our school garden to our students and families and to the community. 8) Use the expertise refined over Mala'ai's past 5 years to develop a "Growing Stewards for the Garden" internship curriculum to help mentor other school gardens via the Hawai'i Island School Garden Network (HISGN) Performance Highlights: Please see in Cover Letter NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Mala'ai: The Culinary Garden of Waimea Middle School - Agency Name Mala'ai: The Culinary Garden of Waimea Middle School - Program Name Performance Measures: Please see Performance Measures Attachment (Page 1) The data below indicates number of events and number of participants. • FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual Budget Estimate * 2009 * 2010 * 2011 WMS student garden classes including 30 classes /mo 30 classes /mo 30 classes /mo food sampling, nutrition education, take- 220 students & 281 students 285 students & home produce & recipes 14 teachers & 17 teachers 15 teachers Garden classes for visiting schools 5/145 students 6/150 students 6/180 students After - School & Summer programs (i.e., Dig 4/80 4/80 5/90 & Eat, Ha'o Ulu 'Aina, Ho'ea Ea, Kahilu Arts, WMS Jump Start) Community Information Events 18/1600 18/1750 20/1800 Community Workshops 12/240 12/315 12/325 Free Food Markets & Food, Seed & Plant 4/180 4/350 4/350 Giveaways 6,000+ Ibs plus To continue To continue seeds & plat Hawaii Island School Garden Network 2/35 4/75 4/75 Teacher Trainings Internships (possibly w/ academic credits) 0 1 3 Other Teacher /Mentor Trainings (KS /DOE 2/36 2/40 2/40 Kahua Program & DOE Kupuna Program) Notes: During 2009 -10 school year, WMS is not furloughing students, so total number of classes continues unchanged. Also, beginning July 2009, every single WMS student attends garden classes as part of their Health /Physical Education curriculum, with lessons emphasizing nutrition education, physical activity, local food self - reliance and cultural connectivity. Program Expenses (Calendar year) FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual *2009 Budget *2010 Estimate 2011 Salaries and Wages 135,051 186,573 190,000 Professional Fees 1,125 2,600 2,600 Operations 4,502 9,060 9,100 Equipment* 1,107 7,200 7,200 Other* 3,026 13,530 13,500 Total 144,811 218,963 222,400 *Please See Budget Detail Breakout Page 2. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Mala'ai: The Culinary Garden of Waimea Middle School - Agency Name Mala'ai: The Culinary Garden of Waimea Middle School - Program Name Program Funding Sources: Identify all funding sources specific to this program only Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate 2009 2010 2011 Direct Public Grants - 70,900 80,000 ,80,000 Corporate Contributions 12,500 27,500 27,500 Individual Donors 13,107 20,000 20,000 Fundraiser /Art Auction 15,873 20,000 20,000 County /Federal Grants (Waimea Middle 12,500 50,000' 50,000' School, Hawai'i County, USDA Nutrition Education Network, and OHA) Total 124,880 197,500 197,500 In Kind Donations: Plants, Seeds, Supplies & Labor 4,500 3,500 3,500 Clearing, Earth - Moving, 3,500 5,500 5,500 Construction Kokua Mowing & Maintenance 1,200 1,200 1,200 Community Volunteer hours © 16,350 18,000 18,000 $10 /hr. 1,000 hours minimum @ $15 - 15,000 15,000 15,000 Board of Directors WMS Teacher Collaboration © 7,000 7,000 7,000 $20 Total 47,550 50,200 50,200 'Includes $26, 000 in possible USDA Nutrition Education Network matching grant 2 Deficat offset by carryover from 2008. No carryover from 2009 to 2010, in part due to legislative funding cuts impacting public charter schools such that WMS is unable to contribute funds to the partnership. Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Mala'ai requests funds from private foundations, individuals, corporate organizations and government granting sources. We have tentatively secured a USDA Nutrition Education Network matching grant expected to offset some of our payroll expenses, as well as provide food and supplies for fresh produce tastings for students. This program, which is relatively new in Hawai'i, has significantly contributed to school garden sustainability on the mainland. We will continue to pursue participation in federally funded health /wellness studies to validate the short- and long -term benefits of school gardens while also helping to underwrite the program. In 2010, to augment traditional grant sources we intend to expand our annual Art & Sol community fundraiser, add a family fundraiser, sponsor a 6- workshop home gardening series, pursue a long -term partnership with health care providers who share our wellness mission, and formalize an advisory board to create an endowment fund. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 ' Mala'ai: The Culinary Garden of Waimea Middle School - Agency Name Mala'ai: The Culinary Garden of Waimea Middle School - 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, Hawai`i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. 1 (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. AEI �ilaC//a S • r.ture of Board President/Chair Date Jan Dean Signatur- o Exec we Director Date Mary Leleiwi UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 • Mala'ai: The Culinary Garden of Waimea Middle School Performance Measures (Page 1 Attachment) In addition to the quantitative Performance Measures summarized in the Grant Application (Page 3), Mala'ai has a meaningful new qualitative Performance Measure to help assess the impact and benefit of our work around student - family- community wellness and food self - reliance: Waimea Middle School students have started creating mini - movies to document & share garden lessons learned. Akin to brief public service announcements, they will address a wide array of subjects including environmental and horticultural cycles and seasons, Hawaiian cultural practices, attitudes about work, food and connectedness to the land, and how the garden impacts or benefits health and well- being. Students have created storyboards, written scripts, photographed and /or filmed in the garden, and are now editing their mini - movies to be aired as part of our daily intra - school student broadcasts. Because the most powerful evidence of having learned and truly mastered a subject is being able to effectively "teach others," we view these mini - movies as a new tool to gauge what students are learning and valuing about their garden experience. # # # ## 2010 -11 Hawai'i County Nonprofit Grant Application — Performance Measures (Attachment) Page 1 Nonprofit Grant Application for FY 2010 -2011 (Page 2) Mala'ai: The Culinary Garden of Waimea Middle School Budget Detail Program Expenses Other Costs 2010 Est 2009 Actual Staff Development (capacity building) $480 204 Business Registration Fees $0 153 Family Engagement Event $1,000 0 Art & Sol Fundraising Event Expenses $1,200 1,836 Intern Stipends (10 mos /$1,000 /mos) $10,000 0 General Liability Insurance $850 833 $13,530 3,026 E.ui.ment & Facilities One -Time Ex•enses * Garden Education Signage $2,000 0 Classroom Tent Floor $2,000 0 Outdoor Teaching Station $2,000 0 Vegetable Cleaning /Prep Station $1,200 0 $7,200 0 *Note: Mala'ai is pursuing specific grants and in -kind donations of time and materials to complete these needed projects. 64 Malama 0 Puna Bruddah Kuz's Youth Jamm Bruddah Kuz's Youth Jamm et'�,y Formerly the Original Battle of the Bands Fiscal Agent: MALAMA 0 PUNA President of the Board of Directors: Rene Siracusa 965-2000 Project Director: Iopa Maunakea 960 -3893 Mailing Address: P. O. Box 1520 Pahoa, Hawai'i 96778 Site Address: 15 -2929 Pahoa Village Rd., Unit 1, Pahoa, HI 96778 Fax No. none Email Address: malamaopuna @yahoo.com Amount of Request for County Funds: $ 5,000 Prior Year Funding: FY08 -09 $ 170,000 Malama 0 Puna was fiscal agent for the Puna Community Medical Center. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Bruddah Kuz's Youth Jamm Program Description: Total Budget and Position Count The Youth Jamm is an activity geared to our island's youth community as a positive and safe, drug- and alcohol -free event, by showcasing the musical talents of our youth Big Island bands. It is specifically timed to take place during Intersession, to accommodate the school calendar. It will be an all -day event, from 10 am to 10 pm at the Pahoa Neighborhood Facility. There will be band performances, a fashion show, exhibits by agencies providing services to young people, a skateboard exhibition and local food vendors. The total budget for the event is $6,500, of which we are requesting $5,000 from the County Human Services Committee. The planning committee for the Jamm consists of 10 adults and 3 youth of people who are active in our Puna community and schools. Total Program Budget = $ 6,500 Total Program Position Count = 10 Total Agency Budget = $ 5,300* Total Agency Position Count = 0* * This is the General Fund budget and does not include this or other programs that are funded/encumbered by grants. Position count is zero because MOP is all volunteer and has no paid employees. If you wish to add the MOP board as "positions", then the number is 7. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Bruddah Kuz's Youth Jamm Program Objectives: To provide a positive and safe, drug- and alcohol -free all day event for our youth where they can `hang out', mingle, enjoy the kind of music and other activities that are designed for their preferences. To educate our youth in the areas that most affect their lives and their futures, by making available exhibits and information put out by the providers who will have booths, i.e., substance abuse information, gang avoidance, teen age pregnancy, HIV /AIDS etc. It is believed that when this information is presented to them in a teen - oriented venue, they will be more open to it. The primary objective is that ultimately they will make healthy lifestyle choices. We are planting the seeds, so that when the time comes for them to make these decisions, they will be adequately prepared to make the right ones. Program Highlights: Youth band performances (dancing allowed) , a fashion show (teen- oriented fashions), skateboard exhibition, youth - oriented information and refreshments. Performance Measures: Number of bands participating, number of exhibitors who choose to display, number of youth who attend and the number of volunteers and mentors who involve themselves to support our youth. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Bruddah Kuz's Youth Jamm Sources of Funding specific to this program only: REVENUE SOURCE FY 2009 -10 FY 2010 -11 Budget* Estimate* HSEDC grant N/A $ 5,000 Pahoa Weed & Seed N/A $ 172 Corporate Donations N/A $ 1,328 TOTAL $ 6,500 PROGRAM EXPENDITURES* Radio Ads $ 1,800 Newspaper Ads — in -kind donation $ N/A Posters: Design — in -kind donation $ N/A Printing $ 500 Porta - Pottie Rental, including ADA $ 800 Facility: Parks & Rec Security Deposit $ 200 After -Hours Fee $ 200 Sound System Rental $ 1,000 Stage Rental $ 500 Stage Decorations: in -kind N/A Outreach Supplies and Postage $ 300 Refreshments & Serving Supplies for Volunteers $ 1,000 Transportation for Participating Youth Bands: in -kind N/A ? Administrative expenses (various) $ 200 TOTAL $ 6,500 *if applicable ** please explain in detail on separate sheet: Future Funding Plans: With the success of this new format under our belts, we are hopeful that other corporate and individual donors will come forward and that the Office of the Prosecuting Attorney will also be able to provide forfeiture funds. Long -Range Sustainability: With each new successful annual event, we will be able to attract additional funding. We know that many of the young people whose future careers will have been helped by the `leg up' provided by the Jamm, will be willing to pass along the aloha and become mentors and donors in their own right. This year the poster is being designed by a young artist. We hope that the event will inspire other young people to take part in the planning of future events. Eventually, we hope to turn it over to them Completely, with only a bit of adult oversight needed. Our youth are our future and our sustainability. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Event History The event itself is was started by local youth in North Hawaii for their peers to have a day that was in a positive, safe, drug and alcohol free environment by showcasing the musical talents of Big Island Bands in a contest, with cash prizes awarded to the winners. The original event "Youth Battle of the Bands" was a project of the North Hawaii Youth Coalition and Five Mountains Hawaii (for musicians 21 and under, as the organization's funding was through agencies promoting health and wellness of youth in this age group) Seven years ago and was held for three years in Waimea. The organizers turned it over to us and we have held it 3 times in the past 4 years. Once in Hilo and twice in Pahoa. Through our experience we have found that a "competition" although exciting, creates an unfair situation for the participants as well as judging criteria due to the various genres and skill levels within this age group. Also at times individuals created `shill' /all -star type bands which were thrown together only to try and win the cash prizes. This is the reason for taking away the "competition aspect" of the event this year, making it a show rather than a contest. There were two other "annual" events held in Pahoa under Pahoa Weed and Seed auspices in the past, which are, in part, progenitors of this project. They are the Get High On Life Youthfest and the Pahoa Springtime Jamm. The same people involved in those events are also involved in this new variation, so there is continuity. *As far as incorporating the fashion aspect into the event and inviting "Focus International" to participate, we see this as a win/win for all parties. This will create more excitement for the event, drawing a larger audience, as the students at Pahoa High School are right down the road. Focus International could have a display table set up to advertise their company. As well, their models putting on fashion shows during the event with clothing from local stores such as Jeff Hunt Surf, Pahoa Skate and Jungle Love and other Pahoa businesses, as well as any other Big Island businesses that would like to participate. Bruddah Kuz's Youth Jamm I (we) have read and understood all of the eligibility requirements; grant conditions; aware procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 - 2 -142.2 Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawai'i , I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. i zv1 l ! r - v Y z e — / g - /d Signature of Board President Date _ i / tg/i b Signatur of Program Director Date NONPROFIT GRANT APPLICATION FISCAL YEAR 20010 -11 Page 5 • 65 Mental Health Kokua Residential Rehabilitation Services Mental Health Kokua Residential Rehabilitation Services Agency Director: Greg Payton Phone No.: 737 -2523 Contact Person: Gary Michell Phone No.: 331 -1468 Mailing Address: 1221 Kapiolani Blvd., Ste 345, Honolulu, HI 96814 Facility/Site Address: 75 -5752 & 75 -5750 Alanoe Pl., Kailua -Kona, HI 96740 140 Wainaku Avenue, Hilo, HI 96720, 139 Amau Road, Hilo, HI 96720 Fax No.: 331 -1378 Email Address: gmicheWmhkhawaii.orq Name of Accountant/CPA (include name of firm if applicable): Summer B. Such, CPA Phone No.: (808) 737 - 2523 ext 1 107 Mailing Address: Mental Health Kokua 1221 Kapiolani Ave, Suite 345 Honolulu, Hawaii 96814 Amount of Request for County funds: $20,000 Prior Year Funding: 07 -08 08 -09 09 -10 $25,000 $20,000 $18,000 Agency Mission Statement: We believe that all citizens should have an opportunity to live and participate in and contribute to their communities. Through specially designed services, Mental Health Kokua helps those in Hawaii who are in mental distress, emotional crisis or recovering from serious mental illness achieve their optimum level of recovery and ability to function in the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Mental Health Kokua Residential Rehabilitation Services Program Description: Funding is requested for our transitional residential services, including PATCH (Psychosocial and Transitional Community Housing) Place and Hale Amau in Hilo, and Hale Alanoe and Kealahou in Kailua -Kona. Mental Health Kokua will offer 28 beds in Hilo and 14 beds in Kailua -Kona, a total of 42 beds from which recovery in the community can occur. Mental Health Kokua staff provide daily on -site supervision and rehabilitation services with the goal to enable clients to move on to more independent housing. While in placement, clients are assisted in acquiring personal and social survival skills necessary for sustained community living. Staff provide training and support in daily living skills and medication management while facilitating social, educational and recreational activities in the community. Clients are also assisted in making connections to community resources including mental health centers, vocational training programs, and community housing agencies, as well as assistance with long -term community placement. These projects provide cost effective, humane, community based alternatives to institutional care and /or homelessness. Transitional bed day costs for FY 2010 are estimated at $94. Comparative bed day costs in a psychiatric hospital are estimated at $800 to $1000 a day. Total Budget and Position Count Total Program Budget $1,365,411 Total Program Position Count 22 Total Agency Budget $7,744,050 Total Agency Position Count 156 Program Objectives: 1) Provide residential and social rehabilitation services to 142 unduplicated persons with serious mental illness. 2) Show completion of identified treatment plan goals upon discharge by at least 80% of clients served. 3) Reduce consumer psychiatric hospitalization by at least 90% 4) Ensure 100% compliance of Commission on Accreditation of Rehabilitation Facilities (CARF) and other monitoring recommendations. 5) Show evidence of satisfaction with services received at 95% of consumers served 6) Show improvement in daily living skill scores upon discharge in at least 90% of consumers served. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Mental Health Kokua Residential Rehabilitation Services 7) Place at least 90% of consumers served in more independent living settings following planned discharge. Program Highlights: (from Fiscal Year 2008 -09) 1) Provided transitional residential rehabilitation services in FY 2009 to ninety -five (95) unduplicated clients at PATCH Place and Hale Amau in Hilo and thirty -two (32) unduplicated clients at Hale Alanoe and Kealahou in Kailua -Kona. 2) Discharged 81 % of clients to more independent living in the community. All clients showed improvement in daily living skills. 3) Provided a total of 11,397 bed days and 22,794 meals in our transitional residential programs during FY 2009. 4) Received a perfect score for CARF International Accreditation for excellence and quality in health care service. Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget* Estimate Number of unduplicated consumers 127 136 142 served Percentage of consumers served 81% 85% 90% who were discharged to more independent living settings Number of consumers served 3 2 2 requiring hospitalization Percentage of consumer satisfied 96% 96% 98% with services *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Mental Health Kokua Residential Rehabilitation Services Program Expenditures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget* Estimate Salaries and Wages 949,629 949,629 949,629 Professional Fees 14,610 14,610 14,610 Operations 521,222 521,222 521,222 Equipment Other#: Total 1,485,461 1,485,461 1,485,461 * If applicable #Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget* Estimate County of Hawaii 20,000 20,000 20,000 State of Hawaii - Department of 1,095,601 1,095,601 1,095,601 Health United Way 21,500 21,500 21,500 Program Service Fee 163,816 163,816 163,816 GCS Fees 115,839 115,839 115,839 Donation /other 4,065 4,065 4,065 Other: MHK Support 64,640 64,640 64,640 Total 1,485,461 1,485,461 1,485,461 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? During the more than 30 years of providing services to people with mental illness in Hawaii, Mental Health Kokua has been successful in building strong relationships with NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Mental Health Kokua Residential Rehabilitation Services many foundations and trusts, which have become pivotal in providing funding for new properties and major renovations to existing properties. Over the current fiscal year, request for grant funding to help support the repairs /renovations of our projects in Hilo and Kona were applied for and approved by the G.N. Wilcox Trust, Bank of Hawaii Charitable Foundation, Hawaiian Tug & Barge /Young Brothers, Ltd., and Visitor Industry Charity Walk. Mental Health Kokua has demonstrated notable ability and success in obtaining funding from private sources such as trusts and foundations and special events and will continue to explore ways to become fully self- sustaining. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Mental Health Kokua Residential Rehabilitation Services I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of 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 Signature of Executive Mire tor Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 66 Neighborhood Place of Kona Caring for Families & Children r Neighborhood Place of Kona- Agency Name Caring for Families & Children- Program Name Agency Director: Joyce Schiffer Phone No.: 331- 8777 Contact Person: Christy Schumann Phone No.: 331 -8777 Mailing Address: 74 -5565 Luhia St B -1 Kailua Kona, HI 96740 Facility /Site Address: 74 -5565 Luhia St B -1 Kailua Kona, HI 96740 Fax No.: 808 - 331 -8774 Email Address: cschumann @hawaii.rr.com Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates, Inc. Phone No.: 808 - 968 -1002 Mailing Address: PO Box 4372 Hilo, HI 96720 Amount of Request for County Funds: $40,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $556,207 $545,504 $513,771 Note: 2008 -09 includes County of Hawaii Grant (FY 09 -10) $40,000. Agency Mission Statement: The mission of Neighborhood Place of Kona is to ensure the well being of our children and families by promoting environments of peace and safety. Program Description: The Neighborhood Place Program (NPP) provides a family- centered, community - based walk -in facility, offering free, voluntary, and confidential services to the public assuring the safety and well being of children and families. This program embraces families in crisis at risk of child abuse or neglect by providing compassionate, non - judgmental services, resources, education, case management, and a hug as needed to keiki, their parents, and kupuna, with the purpose of strengthening the family, helping them to heal themselves. When this happens families can avoid either entering or reentering the Child Welfare Service system. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Neighborhood Place of Kona - Agency Name Caring for Families & Children- Program Name Total Budget and Position Count Total Program Budget 196,000 Total Program Position Count 2.5 Total Agency Budget 543,752 Total Agency Position Count 8 Program Objectives: 1) Neighborhood Place of Kona, through the Neighborhood Place Program (NPP) provides the public with a broad range of services aimed at strengthening families. No referral is needed, families can self refer and walk through our doors and receive the same quality service as a family referred by an agency. Services include education, information, referral linkage, case management and follow -up. This program is built upon a vision that every child in Hawaii will grow up in a loving family, nurturing home, and a safe environment. Program services center on strengthening family relationships and preventing child abuse and neglect. 2) Guided by values rooted in Hawaiian Culture we help strengthen family relationships through a process of increasing knowledge of child development, improving parenting and coping skills, and enhancing problem - solving abilities. NPP provides informational sessions, training and workshops such as Ke Ala Kupono parenting classes and Ho oponopono. 3) NPP partners with other agencies and through collaboration and advocacy, designs and leads activities to increase awareness of family needs and risk factors associated with the prevention of child abuse and neglect. Our community outreach serves to inform, educate, and engage families and inspire caring communities. 4) Our approach to delivery is both cultural and spiritual, incorporating the spirit of pu'uhonua (safety and peace) in each action taken with every person encountered. Our work is based upon delivering quality services following current social services best practices. Program Highlights: (from Fiscal Year 2008 - 09) 1) With DHS contract funding during 2008 -09, the NP program intensively served a total of 119 families and provided referral services to a total of 316 families. 2) With reduced DHS contract funding, supplemented by the County of Hawaii grant, the NP program has intensively served 72 families year -to -date as of 12/30/2009 (2009 -10 FY). This , an annual run rate of 150 families and has provided referral services to 118 families, an annual run rate of 336 families. 3) The NP program delivers quality services to families and provides linkages to community -based support. Delivery is tailored to meet the needs of families who are at -risk for or are experiencing recurring issues of child abuse and neglect. 4) The NP program provides crisis intervention through informal counseling, family strengthening, and training in all aspects of childhood development. 5) NPP offers classes to increase the knowledge of child development, improving parenting and coping skills, and enhance problem - solving abilities; assists clients with basic needs, including, not limited to, applying for housing, childcare, and /or finanical assistance, connecting clients to resources for substance abuse, anger management, domestic violence, assessments, and counseling. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Neighborhood Place of Kona - Agency Name • Caring for Families & Children - Program Name 6) Working with families the NP program develops and implements an Individualized Program Plan (IPP) intensively serving each family by providing case planning and management. NPK trained, educated, and experienced care coordinators monitor and record family progress during program involvement to assure services are meeting the unique needs of each family. Our service goal is to complete services within 6 months. 7) NPP encourages and engages the communities we live and work in to widen the circle of accountability to accomplish the goal of creating environments of peace and safety, ensuring the well being of children and families through: a) community outreach events and activities to increase family strengthening; b) monthly Hui Laulima consortium meetings; c) activities for the service provider community to increase effective service delivery and to improve child abuse and neglect prevention services. Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Family Strengthening and 119 100 125 Prevention Services Minimum of New Clients 87 75 75 Families assessed and provided 119 75 75 services to prevent child abuse and neglect Families provided information and 316 300 400 referral services only of prevention families not 100% 95% 95% confirmed for child abuse or neglect while in the program % of families not confirmed for child 100% 90% 90% abuse or neglect with 6 months Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 115,988 139,224 135,000 Professional Fees 3,792 1,991 2,000 Operations 49,492 37,788 40,000 Equipment 1,728 997 1,000 Other" Total 171,000 180,000 178,000 * If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 • Neighborhood Place of Kona - Agency Name Caring for Families & Children - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Contract with Blueprint for Change 166,000 130,000 County of Hawaii (non profit grant) 0 40,000 40,000 Department of Human Services 125,000 Fund Raising Other Grants 5,000 10,000 13,000 Total 171,000 180,000 178,000 Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The NPK Board of Directors in response to the need to diversify fund revenues hired an Executive Director and a Business Development Manager. During 2009 NPK held its 6 annual golf tournament fundraiser at The Club at Hokulia raising $10,000 for programs that center on children, family, and community awareness. This amount was short of the anticipated $25,000; attributed to the struggling local economy. Grants became a part of NPK's funding strategy. During Jan -09 to Dec -09 NPK was awarded $55,000 (including a $40,000 grant awarded by the County of Hawaii). These grants filled funding gaps resulting from reductions in state contracts, allowing NPK to continue services for families who have no idea where to go for help, suffering directly from economic hardship. NPK continues to submit grants (Hawaii Community Foundation and others) and contract proposals (DHS) to secure funding and is hosting a fund raising event in February 2010 with a goal of raising $30,000. NPK is a community based organization. Funding from the County creates an opportunity for NPK to connect with and engage with local government, businesses, and community members, enabling the exchange of information, to educate and inform of NPK services while raising awareness of the needs families have in our local communities. The Neighborhood Place Program is the foundation upon which Neighborhood Place of Kona was established and founded. This program has served communities throughout West Hawaii for 11 years, sustained primarily through state contracts. Our service record is recognized throughout the human services community. Our affiliation with other similarly operating NP programs (Oahu, Maui) is recognized by the Dept. of Human Services at the state level. Funding for this program has been sustained through a subcontract with Blueprint for Change, a non - profit organization based on Oahu, funded by the Dept. of Human Services, via Temporary Assistance for Needy Families (TANF) funding. With the State of Hawai'i facing significant budget shortfalls we anticipate funding will be cut. NPK's NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Jar. 27. 21)10 3:55FM ND. 0206 P. 1 FROM :Neighborhood Place OfKona FAX NO. :8083318774 Jan. 27 2010 01:32PM P5 contracts with the State DHS expire 08/30/2010 and NPK will be submitting formal proposals when the REP is released. With uncertainty surrounding this valuable and needed "one -of- a-kind" program we are applying for and seeking support from the County of Hawaii non - profit grant so that we may continue to serve families and children in our West Hawaii communities. Given current and near term economic conditions the needs of our families have and continue to Increase. NPK is proactively seeking funding sources for the FY 2010 -2011 to maintain continuity and avoid disruption of services. Our objective is to ensure this program will continue to support families in need, stretching from North Kohala to Ka u, Including Honokaa, Waimea, Kohala, North and South Kona, Ocean View, and Naalehu, Neighborhood Place of Kona - Agency Name Caring for Families & Children - 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. 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 Hawal'I, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal Year. The report shall Include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a Plating of other funding sources and amounts obtained during the award period. Failure to submit a timely. complete accurate year -end report will impact the evaluation of your program's or agency's future funding requests. �.� OS ID Signa t!!! f Board President/Chair Date /e 7 / 6 SI! ature o Executive Dir=ror Dat UNSIGNED PROPOSALS WILL NOT BE ACCEPTEDt NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 67 Neighborhood Place of Puna Family and Community Strengthening Neighborhood Place of Puna- Agency Name Family and Community Strengthening- Program Name COPY Agency Director: Mary Hyslop Phone No.: 965 -5550 Contact Person: Mary Hyslop Phone No.: 965 -5550 Mailing Address: PO Box 2020 Pahoa HI 96778 Facility /Site Address: 15 -3039 Pahoa Village Rd Pahoa HI 96778 Fax No.: 965 -5109 Email Address: npp2020 @hawaii.rr.com Name of Accountant/CPA (include name of firm if applicable): Alex Smith Phone No.: (877) 257 -6484 Mailing Address: 1403 Frank Street Honolulu HI 96816 Amount of Request for County Funds: $25,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $15,000 $15,000 $10,000 Agency Mission Statement: The goal of the Neighborhood Place of Puna is to prevent child abuse and neglect. The vision: To Nurture, Strengthen and Celebrate 'Ohana" The mission: "Empowering families and communities in Puna by building strong foundations through healthy relationships that value each person's uniqueness. "E malama pono kakou ". NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Neighborhood Place of Puna - Agency Name Family and Community Strengthening- Program Name Program Description: Neighborhood Place of Puna (NPP) desires to enhance its child abuse prevention services by strengthening families and communities. Home visiting and programs that connect families to each other - such as Family Fun Days, Sports Clinics and the Ready to Learn School Supply Project are needed because of the high rates of child abuse and neglect in the Puna district. Puna rates high on all child abuse indicators including the third - highest unemployment rate, the third - lowest per capita income and the highest percentage in the State of families who rely on food stamps (55 %). The poverty rate of young children is second highest in the state with more than 25% of residents receiving assistance from Temporary Assistance to Needy Families. Thirty -one percent (31 %) of specified and confirmed child abuse and neglect cases in Hawaii County were in the Puna district. (CWS — 2008 statistics). The two most alarming statistics are the high rate of abuse and the rate of removal of Hawaiian children in East Hawaii. While only 28% of Puna's population is Hawaiian, 30.6% of confirmed cases of abuse and neglect are Hawaiian. (DHS -CWS statistics, 2008) In 2009, four horrendous child abuse incidents occurred in East Hawaii. Two infants, one a four month old and one a six month old are brain damaged for life. Two - year -old lyanla Kuamo'o Andrews did not survive her head injuries. Five year old, Javieanne Win was murdered by her mother's boyfriend. We have seen the few home based prevention programs available to families slashed. Families are losing their jobs, their homes and their hope. The necessary safety nets have huge holes in them. Prevention and family strengthening services are desperately needed. Home visiting services to families at risk for child abuse and neglect has been documented as an effective approach in the prevention of child abuse and neglect. Outreach workers provide the help that families need in order to raise healthy and safe children and remain out of the Child Protective Service system. The relationships forged between home visitors and parents can break through loneliness and isolation and serve as that first step in linking families to their communities, Strengthening and developing caring communities is also recognized as a way of preventing child maltreatment. Strong positive communities produce healthy families and healthy families raise healthy children. In order to promote and develop caring communities, Neighborhood Place of Puna proposes to bring together the key players in the community, who provide services to families and children and to promote resource sharing among these providers. Neighborhood Place of Puna will also work with community organizations to develop family NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 centered activities so that families will have opportunities to participate and to connect with their communises. Total Budget and Position Count Total Program Budget $121,605 Total Program Position Count 3 Total Agency Budget $184,974 Total Agency Position Count 4 Program Objectives: 1) Help families foster optimal growth in their children by on -going home visits that include education around child development and safe home practices. Thirty (30) families will receive intensive home visiting services for a minimum of six months. Thirty families a year will learn parenting skills and child development milestones through culturally competent, weekly home visits. Project outputs include weekly home visits for six months or until the family's service plan is completed, assessments for child abuse and neglect, assessments for safe homes, assessments for developmental milestones and individualized service plans that address protective factors and family needs. 2) Provide information, referral and advocacy to thirty (30) families to help them identify services and teach them how to navigate systems to access what they need including entitlement programs, legal help, counseling, financial assistance, medical care, activities for their children, educational services, housing, etc. 3) Convene direct service providers and other key players involved with child abuse and neglect. Set up regular meetings to generate resource sharing and communication (through emails, newsletters, meeting transcripts, calendar of events, etc. ). Work with service providers to develop public awareness campaigns around abuse and neglect prevention. Twenty -four meetings with providers and other community members. 4) Coordinate community strengthening activities to reduce child abuse and neglect including family fun days, trainings for parents, grandparents. A minimum of twenty -five community activities and trainings will be provided. Program Highlights: (from Fiscal Year 2008 - 09) 1) In 2008 -2009 Neighborhood Place of Puna's outreach workers provided home visits to 75 families at risk for child abuse and neglect. Each family was given a resource directory of services and taught how to use the NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 directory. Fifty families received assistance through information, referral and advocacy. 2) Families participated in a number of activities including "Celebrate Your Family through Play ", "Mountain View Family Fun Day ", "Pahoa Pool Bash ", "Halloween Family Fun Night" "Fern Forest Family Day ", "Kurtistown Family Fun Day" and a variety of workshops on topics such as: Child development, Communication skills, Handling holiday stress, Financial literacy, How to understand your child's Individual Educational Development Plan or IEP, CPR, "Good touch - Bad Touch ", ADD and ADHD. Sixty -eight (68) activities were provided to families. 3) Ninety -nine percent (99 %) of families were free of child maltreatment while receiving Neighborhood Place of Puna services. Ninety -six percent (96 %) (45 families) were free from child abuse and neglect six months from case closure. 4) All families enrolled in home visiting completed their service plans for a total of 100 %. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 4 Neighborhood Place of Puna - Agency Name Family and Community Strengthening - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Home visits to families at risk 75 families 20 families 30 families Child abuse /safety assessments 50 assess- 20 assess- 30 assess - and service plans ments ments ments Information, referral and advocacy 50 families 50 families 30 families Convene service providers and key n/a n/a 24 meetings players in child abuse and neglect one Public prevention. Assist in developing Awareness child abuse prevention awareness Plan campaign. Coordinate family strenthening 68 12 25 activities and training_s *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 _ Actual * Bud • et * Estimate Salaries and Wa.es 81,900 84,300 87,705 Professional Fees 5,000 5,000 5,000 O"erations 24,150 26,800 28,900 Equipment 0 0 0 Other" 0 0 0 Total 110,050 116,100 121,605 * If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Neighborhood Place of Puna - Agency Name Family and Community Strengthening - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate _ Blueprint for Change 78,050 _ 79,100 75,000 Hawaii Island United Way _ 17,000 17,000 17,500 County of Hawaii 15,000 10,000 25,000 Rev. Taki Okumura Foundation 10,000 0 Hawaii Children's Trust Fund 0 4,105 Total 110,050 116,100 121,605 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Money for non profits - especially money for prevention purposes has become increasingly smaller and more difficult to access. Neighborhood Place of Puna has increased its efforts to find additional money for the Ready to Learn School Supply Distribution Project and to increase direct financial assistance for families. This money is not included nor is it a part of the program in the County Grant application. But the funds for these two programs (school supplies and financial assistance to families in need) totals in excess of $28,000. Home visiting and other child abuse prevention activities will not become self sustaining. Neighborhood Place of Puna charges no fees to families accessing prevention services. However, most experts would agree that an ounce of prevention is worth a pound of cure. NONPROFIT GRANT APPLICATION FISCAL. YEAR 2010 -11 113 .. ,.� • Neighborhood Place of Puna - Agency Name Family and Community Strengthening - 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. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. L ( i � /Q/20(() Sign, ure of Bo U President/Chair Date I / I C) as) Signature of ec ive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 0.... 68 O Ka'u Kakou 0 Ka'u Kakou O Ka'u Kakou- Agency Name - Program Name Agency Director: W. Kawachi Phone No.: 937 -4773 Contact Person: N. Ebert Phone No.: 928 -0027 Mailing Address: P. O. Box 365 Pahala, HI. 96777 -0365 Facility /Site Address: Aspen Center Pahala, HI. 96777 Fax No.: 808 - 928 -8961 Email Address: ebertn004 @hawaii.rr.com Name of Accountant/CPA (include name of firm if applicable): June Domondon Phone No.: 808 - 928 -8961 Mailing Address: P. O. Box 370, Pahala, HI. 96777 -0370 Amount of Request for County Funds: $77000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $ 0 $ 0_ Agency Mission Statement: To Foster Health and Prosperity for All of Ka'u NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 O Ka'u Kakou - Agency Name - Program Name Program Description: Return Ka'u to the prosperous and healthy community it has been in the past Total Budget and Position Count Total Program Budget 77000 Total Program Position Count 0 Total Agency Budget 0 Total Agency Position Count 0 Program Objectives: 1) Provide services and activities that assist our Seniors in living out a comfortable and enjoyable lifestlye. 2) Sponsor community activities and events that unite our families and builds the community spirit of Ka'u. 3) Work to keep the land, environment, and historical cultural areas of Ka'u clean and safe. 4) Take an active role in the economic development of Ka'u. Program Highlights: (from Fiscal Year 2008 -09) 1) Collected funds to purchase Handicap Van for Ka'u Hospital. 2) Quarterly highway clean up. 3) Semi - annual cleaning of the Punalu'u Pond 4) Seniors safety and maintenance programs. 5) Keiki fishing tournament 6) Cemetery renovation and up keep ( locate and preserve Historical Cemeteries) 7) Replaced Veterans plaque at Pahala Tennis Court 8) Provide Porta Potties for South Point and Punalu'u Beach Ramp Area 9) Community Dinner for Seniiors and needy of Ka'u NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 11 Page 2 O Ka'u Kakou - Agency Name - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Pond clean up 500 700 1000 Summer Festival 25000 25000 Porta Potties 7600 7625 7800 Senior Safety Repairs 1500 4600 Senior Bingo 1500 2000 3000 Keiki Fishing Tournament 3000 5500 Scholarship Program 2010 1000 Highway clean up 250 300 400 Office supplies 300 400 700 Community Dinner 2500 3000 Food Drive for needy of Ka'u 1000 1000 Coqui Frog eradication 2010 200 10000 Cemetery renovation 2000 11000 Ka'u Hospital entry way 2010 3000 Boys & Girls Club Van 4200 Ka'u Hospital Handicap Van 70000 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 0 0 0 Professional Fees 400 4500 4700 Operations 2000 25000 26000 Equipment 1600 25000 25500 Other" 600 20500 20800 Total 4900 75000 77000 * If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 O Ka'u Kakou - Agency Name - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Ka'u Alumni 3450 3500 Ed Olson Foundation 1000 10500 2000 Misc. donations 3327 5000 28000 County of Hawaii 15000 77000 Recycle program 573 8000 9000 Seamountain 5 2100 Seamountain 5 4200 Roberts Hawaii 40000 Beverly Blew 2100 William Peebles 10000 Total 11200 94050 119500 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? It is our mission to get our community to ban together and solve our own problems. The negative economic situation coupled with the dramatic increase in the number of services we provide has made it very difficult to keep our programs alive. Part of our initial plan to increase funds is to apply for funding from the County's Nonprofit Grant Program to fill in the shortfall of funds normally received in the form of donations from within the community. Secondly, we hope to increase our funds by being more aggressive in our HI 5 can and bottle campaign and becoming more creative in our fundraising efforts. Finally, living in a distressed rural agricultural community with high unemployment, welfare and socio- economic problems we hope to research and collaborate partnerships with Federal, State and County programs that can help get us back to becoming a self- sustaining organization. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 11 Page 4 Depending upon the length of this economic downturn and assistance from government partnerships, we hope to be back on our feet and self - sustainable in two (2) years NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 O Ka'u Kakou - Agency Name - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. w ` � / 02Es-- iO Signature of Board President/Chair Date / j r/ S 'nature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 0 Ka`u Kakou — Agency Name Attachment Program Expenditures #Others: Expenses for mailing and community projects. 69 Office for Social Ministry Beyond Shelter Transitional Shelter Roman Catholic Church in the State of Hawaii, Office for Social Ministry: Beyond Shelter Transitional Shelter Agency Director: Carol R. Ignacio Phone No.: 808 - 933 -6005 Contact Person: Brandee Menino Phone No.: 808 - 933 -6013 Mailing Address: 1315 Kalanianaole Ave., Hilo, HI 96720 Facility /Site Address: 481 Kinoole St., Hilo, HI 96720 Fax No.: (808) 935 -3794 Email Address: bmenino @rcchawaii.org Name of Accountant /CPA (include name of firm if applicable): CW Associates Phone No.: 808 - 695 -4014 Mailing Address: 700 Bishop St., Suite 1040, Honolulu, HI 96813 -4124 Amount of Request for County Funds: $15,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $20,000 $15,000 $15,000 Agency Mission Statement: The Office for Social Ministry is a multi- faceted department of Diocese of Honolulu, which exists to promote acts of charity and justice and to serve those most in need. Inviting the involvement of our parishes and community -at- large, the Office for Social Ministry strives to meet the challenges of the ever - changing communities in Hawaii by utilizing spiritual, human and material resources. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Roman Catholic Church in the State of Hawaii, Office for Social Ministry: Beyond Shelter Transitional Shelter Program Description: The Beyond Shelter Transitional Housing Program was established in 2006. The shelter consists of private apartment units that maintain a maximum capacity of eight families. There are six (6) — 2 bedroom units with 2 baths, one (1) — 1 bedroom unit with 1 bath and one (1) — studio with 1 bath. Program participants are expected to attend program classes, pay program fees on time, be good neighbors, and commit to seeking employment or explore educational opportunities. Our transitional program is based on a seamless continuum of care model as advocated by the Department of Housing and Urban Development (HUD). Our target group consists of families with at least one minor child that have been unsheltered or living in an emergency or transitional housing program /shelter. In order to ensure safety for all program participants, we prohibit access to families who have either experienced domestic violence issues within the past four months or substance use within the past six months upon arrival to our program. Our selection criteria depends on participants possessing personal motivation towards making positive changes in their lives and agreeing to pay program fees on time and follow House Rules. Services available to participants build on extensive linkages to agencies throughout our community as well as the experience and knowledge of our own on -site staff, and consist of: transitional housing; case management, including intake, assessment, and access to services; educational and vocational training; job placement; transportation support; a mentor program; linkages to substance abuse and mental health treatment; assistance with family unification; life skills and financial skills training; culturally appropriate activities; housing placement assistance; and one year of aftercare after placement in permanent housing. Total Budget and Position Count Total Program Budget 110,780.00 Total Program Position Count 1 Total Agency Budget 4,635,535.00 Total Agency Position Count 54 Program Objectives: 1. 10% of program participants will enroll in a post- secondary higher education institution. 2. 50% of unemployed program participants to enroll in higher /further educational opportunity including college courses, continuing education classes, vocational training or job-readiness/employment programs. 3. 80% of employed participants will maintain employment for at least three months. 4. 80% of participants who transition to permanent housing will remain in housing for at least six months. 5. 90% of program participants will test clean during random drug testing. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Roman Catholic Church in the State of Hawaii, Office for Social Ministry: Beyond Shelter Transitional Shelter 6. 75% of school age children residing at Beyond shelter will have participated in at least one extra - curricular activity throughout their program stay. 7. 75% of school age children residing at Beyond Shelter will have received tutoring and homework assistance services. 8. 25% of school age children residing at Beyond Shelter for at least one year will improve their grades (or grading marks) by at least one higher grade /mark Program Highlights: (Fiscal Year 2008 -09) 1) Beyond Shelter participants have recently started a Neighborhood Watch program with the assistance of Hawaii County's Community Police, Officer Derr. All participants attended several meetings prior to starting the Neighborhood Watch where they were trained on how to conduct their walks. They now meet weekly at Beyond Shelter to organize and complete their walk through their community. 2) Employment Readiness and Incentive Program (ERIP): ERIP was implemented after on -going reports reflected that our clients were not able to find an employment training program that targeted the issues directly related to our participants unique array of needs, such as homelessness, lack of child care, lack of transportation, lack of education or prior work history, and criminal backgrounds. ERIP is broken down into three phases. The first step includes 64 classroom hours over an 18 -day period. Once instructional hours are completed, participants are then able to advance to the next phase which includes on -site training and supervised placements at OSM program sites. During this phase, participants are evaluated on their work ethics, attitude and dependability. Participants that have been deemed ready are then ale to participate in off -site training opportunities. This allows participants to be evaluated in a less structured location. Those that complete this phase are then assisted with job placement. The ERIP director is responsible for building an employment database of community businesses and agencies that have committed to employing our participants as regular employees. Once placed, participants are then provided with additional follow up services for up to 6 months, to ensure that the transition to regular employment is smooth and to assist both the participant and employer with any issues that may arise. Family Outcome: "S" is a single mother of 3 children, 2 of whom are surviving. She is an adult survivor of a chronically dysfunctional family, and regularly suffered from sexual abuse as a child. When she and her family first came to the Office for Social Ministry (OSM) for help, they were at -risk of being homeless. "S" worked with our intake coordinator to enter OSM Kihei Pua Emergency Shelter Program. While at the emergency shelter, "S" completed an Employment Readiness Program, enrolled both children into school and NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Roman Catholic Church in the State of Hawaii, Office for Social Ministry: Beyond Shelter Transitional Shelter extracurricular activities, and retrieved medical assistance. After successfully completing six weeks at our emergency shelter, they were transitioned into the Beyond Shelter Transitional Housing Program. While residing at our program site, "S" developed Individualized Service goals, which consisted of the following: retrieving mental health services, obtaining financial support, and finding permanent housing. While residing at our transitional housing program, "S" was connected to a mental health agency and therapist for mental health support. Furthermore, "S" completed the necessary requirements to obtain Supplemental Security Income from the Social Security Administration. After "S" accomplished these goals and completed all program requirements, she and her family were referred to OSM's TANF Housing Placement Program. With the support of OSM "s TANF Housing Placement Program, "S" and her children were placed into permanent housing. Overall, "S" and her family accomplished each of their goals which allowed them to progress towards healthier, more stable and permanent living conditions. Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Number of persons placed in 79 75 75 emergency or transitional housing Number of persons placed in 18 20 20 permanent housing Number of persons participated in 37 35 35 community activities Number of persons completed 13 10 10 training or education program Number of persons who retained 8 10 10 employment for a minimum of six months Number of persons who 7 5 5 transitioned off of welfare Number of persons participants 15 15 15 retaining permanent housing for at least six months after exiting program *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Roman Catholic Church in the State of Hawaii, Office for Social Ministry: Beyond Shelter Transitional Shelter Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 16,581.55 25,996.00 24,773.00 Professional Fees Operations 100,874.29 92,304.00 86,007.00 Equipment Other* Total 117,455.84 118,300.00 110,780.00 * If applicable Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Hawaii county grant 15,000.00 15,000.00 15,000.00 Hawaii state HPHA grant 43,035.00 60,400.00 57,380.00 Hawaii Island United Way 5,425.07 4,500.00 Beyond Shelter Program fees 37,129.82 38,400.00 38,400.00 Carry-over funds from FY07 -08 2,310.27 Hawaii state HPHA grant Receivable 19,537.50 Total 122,437.66 118,300.00 110,780.00 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? We will continue to search additional federal funding opportunities to help sustain our housing programs. We have also initiated our Volunteer Program to help increase volunteerism opportunities for our programs and for our community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Roman Catholic Church in the State of Hawaii, Office for Social Ministry: Beyond Shelter Transitional 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, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. J 29lto Signature of Board resident/Chair Date l/ a71 /o Signature of Executive Direc Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 70 Office for Social Ministry Care -A -Van Homeless Outreach • Roman Catholic Church in the State of Hawaii, Office for Social Ministry Care -A -Van Homeless Outreach Agency Director: Carol R. Ignacio Phone No.: (808) 933 -6005 Contact Person: Brandee Menino Phone No.: (808) 933 -6013 Mailing Address: 1315 Kalanianaole Ave. Hilo, Hawaii 96720 Facility /Site Address: East HI: 1315 Kalanianaole Ave. Hilo & West HI: "Friendly Place," 74 -5593 Pawai Place, Kailua -Kona Fax No.: (808) 935 -3794 Email Address: bmeninoarcchawaii.orq Name of Accountant/CPA (include name of firm if applicable): CW Associates Phone No.: (808) 695 -4014 Mailing Address: 700 Bishop Street, Suite 1040, Honolulu, HI 96813 -4124 Amount of Request for County Funds: $20,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $35,000 $20,000 $20,000 Agency Mission Statement: The Office for Social Ministry is a multi- faceted department of Diocese of Honolulu, which exists to promote acts of charity and justice and to serve those most in need. Inviting the involvement of our parishes and community -at- large, the Office for Social Ministry strives to meet the challenges of the ever - changing communities in Hawaii by utilizing spiritual, human and material resources. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 • Roman Catholic Church in the State of Hawaii, Office for Social Ministry Care -A -Van Homeless Outreach Program Description: Care -A -Van (CAV) is a mobile, homeless outreach program that has been in operation for nearly 18 years. It is the only outreach program on the Island of Hawaii that specifically targets the unsheltered homeless population. Our primary goal is to support the unsheltered homeless into more healthier and stable housing conditions. With the support of our funders, community members, and preserving staff workers, CAV has been able to serve approximately 17,400 homeless persons throughout the Hawaii County. CAV owns and operates four -wheel drive vehicles, which allow our staff to travel to areas where the homeless people congregate. These areas include, yet are not limited to, the following: beaches, parks, woods, lava fields, emergency homeless shelters, domestic violence shelters, or in and around downtown Hilo, Puna, Hamakua, and Kailua -Kona. Upon contact, CAV staff strives to establish trust with homeless individuals so that they are receptive towards improving their housing situation and overall well- being. After trust and adequate rapport is apparent, case management services commence. CAV staff support homeless individuals through the intake process to assess their housing situation and mental health status. CAV staff often assists homeless individuals with obtaining their birth certificates, social security cards, and picture identification. CAV staff also support homeless individuals with obtaining the most appropriate services to retrieve social security entitlements, welfare and food stamp assistance, a higher education, legal assistance, housing, employment, medical, dental, and /or transportation. CAV offers interim case management services for individuals in need of mental health support. CAV staff support individuals with retrieving a mental health assessment from the Adult Mental Health Division (AMHD). If individuals are deemed eligible for services through AMHD, then CAV staff link these individuals with a mental health case management provider. Yet, if individuals are not found eligible, then CAV staff either support these individuals with appealing the decision or help them with identifying the best available services for their mental health needs. Aside from our traditional outreach approach, we have established Drop -In sites in Puna, Hilo, and Kailua -Kona. Drop -in sites include an emergency food pantry, clothing bank, emergency household /hygiene supplies, case management services, phone use, mail services, life skills classes, and referrals to community agencies. These drop -in sites have been established as another method towards identifying and supporting those who experience homelessness. Total Budget and Position Count Total Program Budget 2,459,555.00 Total Program Position Count 9 Total Agency Budget 4,635,535.00 Total Agency Position Count 54 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Roman Catholic Church in the State of Hawaii, Office for Social Ministry Care -A -Van Homeless Outreach Program Objectives: (from Fiscal Year 2008 -09) 1. 50% of program participants will engage with case management services by implementing real budget planning, and seeking out community programs for which participants may be eligible. 2. 50% of program participants to enroll in higher /further educational opportunity including college courses, continuing education classes, vocational training or job - readiness /employment programs. 3. 80% of participants who enrolled in shelter programs will remain there until other housing is secured. 4. 90% of eligible program participants who received monthly rental subsidies will pay their rent on time for at least 6 months. 5. 90% of AMHD - eligible participants will enroll in at least one AMHD- contracted program. 6. 80% of program participants will not violate the terms of their lease or be evicted for at least six months. Program Highlights: 1) Established drop - locations throughout the island to provide services more effectively to participants in rural areas as well as areas that the homeless are known to congregate. Drop -in services are located in the following areas: Pahoa town (Puna Drop -In), Old Kona Industrial Area (Friendly Place), and Hilo (Salvation Army & Under His Wings Street Ministry). Drop -in sites provides an emergency food pantry, clothing bank, emergency household /hygiene supplies, referrals and linkages to community agencies, case management services, phone use, mail services, and life skills classes. 2) Employment Readiness and Incentive Program (ERIP): ERIP was implemented after on -going reports reflected that our clients were not able to find an employment training program that targeted the issues directly related to our participants unique array of needs, such as homelessness, lack of child care, lack of transportation, lack of education or prior work history, and criminal backgrounds. ERIP is broken down into three phases. The first step includes 64 classroom hours over an 18 -day period. Once instructional hours are completed, participants are then able to advance to the next phase which includes on -site training and supervised placements at OSM program sites. During this phase, participants are evaluated on their work ethics, attitude and dependability. Participants that have been deemed ready are then able to participate in off -site training opportunities. This allows participants to be evaluated in a less structured location. Those that complete these phases are then assisted with job placement. The ERIP director is responsible for building an employment database of community businesses and agencies that have committed to employing our participants as regular employees. Once placed, participants are then provided with additional follow up services for up to 6 months, to ensure that the transition to regular employment is smooth and employment issues may be addressed. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Roman Catholic Church in the State of Hawaii, Office for Social Ministry Care -A -Van Homeless Outreach 3) New Grants: The Office for Social Ministry's Care -A -Van Program was awarded funding for the following new programs: Homeless Prevention and Rapid Re- Housing (Start Date - 9/1/2009): Awarded a three year grant totaling $707,850 through President Obama's stimulus package. This grant allows us to provide emergency financial assistance to those at risk of homelessness in an effort to prevent homelessness and /or to assist families and individuals to search and secure permanent housing. New Direction (Start Date - 10/1/2009): Awarded a new Shelter Plus Care grant to provide monthly rental subsidies for individuals that are chronically homeless, which is defined as unaccompanied individuals that have been continuously homeless for one year or more, or have had at least 4 episodes of homelessness in the last 3 years. West Hawaii Emergency Housing Facility: Secured 3 /4 of the necessary initial funding to start operation of the new West Hawaii Emergency Housing Facility for single men and women. This program will provide participants with safe, decent and sanitary shelter so that they are able to focus on maintaining or obtaining employment, addressing their mental health and /or substance abuse issues, obtaining permanent housing, and address their basic needs. SNAP Outreach: Entered into a Statewide SNAP Outreach Network with providers in each county to help increase awareness of the SNAP (Supplemental Nutrition Assistance Program) and to improve the quality of the completion of the SNAP application. State Homeless Emergency Grant for Child Care Subsidies: Responded to the "Child Care crisis" when the State announced a decrease in subsidy amounts. From January thru June 2010, OSM intends to assist 1,000 families with additional financial assistance for four months to help families plan this impact in their budget. Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Number of participants placed in emergency 295 250 250 or transitional housing Number of participants placed in permanent 304 250 250 housing Number of persons who will obtain 57 55 55 employment Number of persons who will enroll in job 52 50 50 readiness /training programs. *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Roman Catholic Church in the State of Hawaii, Office for Social Ministry Care -A -Van Homeless Outreach Program Expenditures FY 2008 -09 Actual * FY 2009 -10 Budget FY 2010 -11 Estimate Salaries and Wages 981,093.74 1,088,635.00 1,233,237.00 Professional Fees Operations 490,186.52 485,534.00 562,467.00 Equipment Other #Subsidies 405,496.18 743,159.00 663,851.00 Total 1,876,776.44 2,317,328.00 2,459,555.00 * If applicable Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii 20,000.00 20,000.00 20,000.00 State of Hawaii HPHA 534,375.00 712,500.00 712,500.00 State of Hawaii Emergency Grant 171,000.00 100,000.00 TANF (Federal) 558,836.55 528,000.00 528,000.00 Shelter Plus Grant (Federal) 363,060.58 437,928.00 437,928.00 Adult Mental Health (Federal) 76,755.26 100,000.00 100,000.00 Adult Mental Health Rep Payee 186,160.00 182,400.00 192,000.00 Hawaii Island United Way 5,959.28 Housing Prevention /Rapid Re- 236,500.00 236,500.00 housing (Federal) HPRP Shelter Plus -New Direction(Federal) 36,960.00 SNAP (Federal) 150,667.00 Carry over funds from FY 07 -08 3,096.44 State of Hawaii HPHA Receivable 273,124.98 SHEG Receivable 9,000.00 TANF Receivable 78,462.65 Adult Mental Health Receivable 36,691.20 Rep Payee Receivable 31,920.00 Shelter Plus Receivable 69,119.15 Hawaii Community Foundation 45,000.00 Total 2,417,561.09 2,317,328.00 2,459,555.00 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? We will continue to search additional federal funding opportunities to help sustain our outreach programs. We have also initiated our Volunteer Program to help increase volunteerism opportunities for our programs and for our community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Roman Catholic Church in the State of Hawaii, Office for Social Ministry Care -A -Van Homeless Outreach 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Signature of Board resident/Chair Date 1 7a71 / Signature of Executive Direc Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 71 Office for Social Ministry Kihei Pua Emergency Shelter Roman Catholic Church in the State of Hawaii, Office for Social Ministry: Kihei Pua Emergency Shelter Agency Director: Carol R. Ignacio Phone No.: 808 - 933 -6005 Contact Person: Brandee Menino Phone No.: 808 - 933 -6013 Mailing Address: 1315 Kalanianaole Ave. Hilo, Hawaii 96720 Facility /Site Address: 115 Kapiolani St. Hilo, Hawaii Fax No.: 808 - 935 -3794 Email Address: bmenino @rcchawaii.org Name of Accountant/CPA (include name of firm if applicable): CW Associates Phone No.: 808 - 695 -4014 Mailing Address: 700 Bishop St., Suite 1040 Honolulu, HI 96813 Amount of Request for County Funds: $20,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $30,000 $20,000 $20,000 Agency Mission Statement: The Office for Social Ministry is a multi- faceted department of Diocese of Honolulu, which exists to promote acts of charity and justice and to serve those most in need. Inviting the involvement of our parishes and community -at- Large, the Office for Social Ministry strives to meet the challenges of the ever - changing communities in Hawaii by utilizing spiritual, human and material resources. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Roman Catholic Church in the State of Hawaii, Office for Social Ministry: Kihei Pua Emergency Shelter Program Description: Kihei Pua Emergency Shelter has been operated by the Office for Social Ministry (OSM) for nearly three years. It is the only program on the island of Hawaii that is specifically designed to support individuals and families who are either unsheltered, at -risk of being homeless, or residing at an emergency or transitional program /shelter. It is a face -paced (6) six -week program with a goal of supporting homeless individuals and families into healthier stable living conditions. In an effort to achieve this goal, we offer an array of supportive services. Our program provides life skills classes that teach homeless participants how to budget their finances, become responsible and accountable tenants, maintain sobriety and cleanliness, and respect others. In addition, we have an on -site case manager that provides referrals and linkages to mental health clinics, medical services, substance abuse treatment programs, employment agencies, higher education organizations, welfare agencies, social security entitlements, and /or OSM's housing placement programs. Our program provides 24 -hour services, 7 days a week, to assess and support the needs of our homeless participants. Total Budget and Position Count Total Program Budget 602,912.00 Total Program Position Count 10 Total Agency Budget 4,635,535.00 Total Agency Position Count 54 Program Objectives: 1) Provide 610 program participants with emergency housing and case management 2) Maintain clean and sober housing for 100% of program participants 3) Assist 55% of program participants in obtaining transitional or permanent housing 4) Assist in obtaining employment and education placement for 90 participants 5) Assist with increased mental health and substance use treatment for 150 participants Program Highlights: (from Fiscal Year 2008 -09) 1) Employment Readiness and Incentive Program (ERIP): ERIP was implemented after on -going reports reflected that our clients were not able to find an employment training program that targeted the issues directly related to our participants unique array of needs, such as homelessness, lack of child care, lack of transportation, lack of education or prior work history, and criminal backgrounds. ERIP is broken down into three phases. The first step includes 64 classroom hours over an 18 -day period. Once instructional hours are completed, participants are then able to advance to the next phase which includes on -site training and supervised NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Roman Catholic Church in the State of Hawaii, Office for Social Ministry: Kihei Pua Emergency Shelter placements at OSM program sites. During this phase, participants are evaluated on their work ethics, attitude and dependability. Participants that have been deemed ready are then ale to participate in off -site training opportunities. This allows participants to be evaluated in a less structured location. Those that complete this phase are then assisted with job placement. The ERIP director is responsible for building an employment database of community businesses and agencies that have committed to employing our participants as regular employees. Once placed, participants are then provided with additional follow up services for up to 6 months, to ensure that the transition to regular employment is smooth and to assist both the participant and employer with any issues that may arise. 2) County of Hawaii Parks & Recreation: Established partnership with the Parks & Recreation to ensure that the children residing at Kihei Pua are able to access community events and participate regularly in extra - curricular activities. This relationship has allowed most of the children residing at Kihei Pua the opportunity to participate in summer fun activities as well. OSM still pays for the activity fees, however, we were able to collaborate with Parks and Recreation to reserve a number of spaces for children from Kihei Pua and expedite the application /payment process in a timelier manner. 3) Family Outcome: "Lisa" is a single mother of 2 girls. She survived a serious car accident, in which she lost her sister and also sustained severe injuries that left her permanently disabled. Prior to coming to OSM, "Lisa" and her children lived with her husband, who was physically, mentally and emotionally abusive to both "Lisa" and their children. In order to provide a safe and stable environment for herself and her children, she made a choice to relocate to Hawaii. She created a safety plan and when the time was right she escaped. Originally, she had made living arrangements with extended family, however, that arrangement fell through and she then found herself at risk for becoming homeless in an unfamiliar area with her 2 children. At this point, she decided to apply for shelter services with OSM. From the time of her arrival at Kihei Pua, "Lisa" was very motivated and committed to change her situation for herself and her children. She remained focused on her goals and successfully completed her Individualized Service Plan and was able to maintain her budget. She completed all required paperwork and classes to obtain permanent housing for her family and established primary medical care for her and her two children. She also began volunteering her talent and knowledge in culinary arts at the shelter by organizing shopping lists, meal plans and planting an herb garden. Once her income and benefits were stable, she was linked with the TANF Housing Placement Program to work toward obtaining permanent housing. They are currently still in housing and receive case management services which include linkages and referrals, access to emergency food and household supplies, transportation, and regular home visits. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 • Roman Catholic Church in the State of Hawaii, Office for Social Ministry: Kihei Pua Emergency Shelter Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Number of persons placed in 222 300 300 emergency shelter (persons served) Number of persons exited to permanent 70 75 75 housing Number of persons enrolled in job 6 10 10 training or higher education programs Number of persons who obtained 16 20 20 employment Number of persons who retained 12 10 10 employment for a minimum of three months Number of meals served 3,262 3,000 3,000 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 409,906.60 410,976.00 418,077.00 Professional Fees Operations 218,747.73 224,486.00 184,835.00 Equipment Other Total 628,654.33 635,462.00 602,912.00 * If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 • Roman Catholic Church in the State of Hawaii, Office for Social Ministry: Kihei Pua Emergency Shelter Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii 20,000.00 20,000.00 20,000.00 State of Hawaii HPHA Grant 421,371.00 525,600.00 493,050.00 Emergency Shelter Grant (Federal) 83,797.00 62,850.00 62,850.00 Hawaii Island United Way 10,850.00 11,500.00 11,500.00 Kihei Pua Program fees 5,623.37 15,512.00 15,512.00 Carry over funds from FY 07 -08 24,389.78 State of Hawaii HPHA Receivable 157,792.50 Total 723,823.65 635,462.00 602,912.00 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? We will continue to search additional federal funding opportunities to help sustain our shelter programs. We have also initiated our Volunteer Program to help increase volunteerism opportunities for our programs and for our community. Although program fees are an additional source of revenue, we do not have any plans to increase our program participant's program fees this year. Instead, we will continue to assess areas of cost savings, energy efficiency education and maximize our community partnerships. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Roman Catholic Church in the State of Hawaii, Office for Social Ministry: Kihei Pua Emergency Shelter I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. Ile Ito Signature of Board resident/Chair Date l / arl/o Signature of Executive Direc Date ark e PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 72 Office for Social Ministry Pahoa Homeless Program: Puna Drop In Services Roman Catholic Church in the State of Hawaii, Office for Social Ministry Pahoa Homeless Program: Puna Drop In Services Agency Director: Carol R. Ignacio Phone No.: 808 - 933 -6005 Contact Person: Brandee Menino Phone No.: 808 - 933 -6013 Mailing Address: 1315 Kalanianaole Ave. Hilo, Hawaii 96720 Facility /Site Address: Pahoa Village Center: 15 -2866 Pahoa Village Road, HI 96778, Building E, Space No.2 Fax No.: 808 - 935 -3794 Email Address: bmenino @rcchawaii.org Name of Accountant/CPA (include name of firm if applicable): CW Associates Phone No.: 808 - 695 -4014 Mailing Address: 700 Bishop St., Suite 1040 Honolulu, HI 96813 Amount of Request for County Funds: $20,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0.00 $0.00 $20,000 Agency Mission Statement: The Office for Social Ministry is a multi- faceted department of Diocese of Honolulu, which exists to promote acts of charity and justice and to serve those most in need. Inviting the involvement of our parishes and community -at- large, the Office for Social Ministry strives to meet the challenges of the ever - changing communities in Hawaii by utilizing spiritual, human and material resources. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Roman Catholic Church in the State of Hawaii, Office for Social Ministry Pahoa Homeless Program: Puna Drop In Services Program Description: The Pahoa Homeless Program, also known as "Puna Drop -In Center ", was established in May of 2008. The program was initiated by County Councilwoman Emily Naeole in an effort to meet the needs of our unsheltered homeless population throughout the Puna district. The goal of our program is to support unsheltered homeless individuals and families into healthier, stable living conditions. The program provides both In -reach services. At our program facility, staff provides "In- reach" services, such as emergency non - perishable food items, hygiene supplies, clothing, telephone use, and renter education /life skills classes. Program staff also provides referrals and linkages to outside community agencies and organizations that provide legal support, medical, mental health and substance abuse treatment, educational /vocational training, housing assistance, food pantries /meals, and transportation. For further support, program staff may link homeless consumers to our housing placement, transitional /emergency, and /or employment program(s). Total Budget and Position Count Total Program Budget 20,000.00 Total Program Position Count 1 Total Agency Budget 4,135.593.00 Total Agency Position Count 54 Program Objectives: 1) Projected to serve 250 unduplicated homeless persons 2) 50% will receive emergency supplies (food, clothing or hygiene items) 3) 15% will access health services (whether it be mental health; substance abuse treatment services; medical or dental care); 4) 15% will increase their income (through employment opportunities and /or receive government entitlements when initial income is none); 5) 15% will be placed into emergency shelter; 6) 10% will be placed into transitional housing programs; 7) 15% will be placed into permanent housing (subsidized or any private rental) Program Highlights: (from Fiscal Year 2008 -09) 1) Established a network of community agencies and partners in the Puna area through ongoing participation and collaboration in community events, such as, the Poi Bowl, Weed and Seed, and local food pantries. These events and committee's provide avenues for agencies to come together and offer solutions to address community issues. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Roman Catholic Church in the State of Hawaii, Office for Social Ministry Pahoa Homeless Program: Puna Drop In Services 2) Developed strong collaboration with mainstream service providers, such as, Bay Clinic, Adult Mental Health Division, Neighborhood Place of Puna, and Department of Human Services. This provides a smoother referral process between the agencies and clients. 3) Implemented consistent weekly renter education classes for clients in need of housing. These classes are specifically designed to provide our homeless with the proper skills to obtain and maintain permanent housing. There are six 3 -hour classes, which focus on the housing application process, budgeting, housekeeping, goal setting, tenant and landlord rights and responsibilities. Completion of these classes is a pre- requisite for those requesting financial assistance for permanent housing. 4) Completed extensive renovations at the Puna Drop -In location in an effort to provide a wider range of services to the Puna community. The kitchenette was renovated to include a food preparation area and food storage cabinets. 5) Initiated volunteer opportunities to participants of the First -to -Work program that are in need of fulfilling community service requirements. These efforts provide needed relief to our single on -site staff member and also provide participants with the opportunity of serving our community. 6) Employment Readiness and Incentive Program (ERIP): ERIP was implemented after on -going reports reflected that our clients were not able to find an employment training program that targeted the issues directly related to our participants unique array of needs, such as homelessness, lack of child care, lack of transportation, lack of education or prior work history, and criminal backgrounds. ERIP is broken down into three phases. The first step includes 64 classroom hours over an 18 -day period. Once instructional hours are completed, participants are then able to advance to the next phase which includes on -site training and supervised placements at OSM program sites. During this phase, participants are evaluated on their work ethics, attitude and dependability. Participants that have been deemed ready are then ale to participate in off-site training opportunities. This allows participants to be evaluated in a less structured location. Those that complete this phase are then assisted with job placement. The ERIP director is responsible for building an employment database of community businesses and agencies that have committed to employing our participants as regular employees. Once placed, participants are then provided with additional follow up services for up to 6 months, to ensure that the transition to regular employment is smooth and to assist both the participant and employer with any issues that may arise. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Roman Catholic Church in the State of Hawaii, Office for Social Ministry Pahoa Homeless Program: Puna Drop In Services Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate No. of unduplicated homeless 367 350 350 persons served at the Drop In Center No. of unduplicated persons who will 279 275 275 receive food and /or emergency supplies (Ex. Clothing, blanket, hygiene supplies, backpack) No. of persons who accessed 107 100 100 health care services (mental health, dental, physical) No. of persons who increased their 31 30 30 income No. of persons placed in emergency 53 55 55 shelter No. of persons placed in transitional 2 5 5 shelter No. of persons placed in permanent 65 75 75 housing *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages Professional Fees Operations 19,320.03 20,000.00 20,000.00 Equipment Other" Total 19,320.03 20,000.00 20,000.00 * If applicable u Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Roman Catholic Church in the State of Hawaii, Office for Social Ministry Pahoa Homeless Program: Puna Drop In Services Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget* Estimate County of Hawaii Receivable 12,749.52 20,000.00 20,000.00 Total 12,749.52 20,000.00 20,000.00 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? We will continue to search additional federal funding opportunities to help sustain our outreach programs. We have also initiated our Volunteer Program to help increase volunteerism opportunities for our programs and for our community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Roman Catholic Church in the State of Hawaii, Office for Social Ministry Pahoa Homeless Program: Puna Drop In Services 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, Hawai'i Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 2.1 to Signature of Board resident/Chair Date 0 .AAAre-4 ( /ar //o Signature of Executive Direc Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 73 Office for Social Ministry Ponahawaiola : Community Re- integration Services Roman Catholic Church in the State of Hawaii, Office for Social Ministry Ponahawaiola: Community Re- integration Services Agency Director: Carol R. Ignacio Phone No.: 808 - 933 -6005 Contact Person: Brandee Menino Phone No.: 808 - 933 -6013 Mailing Address: 1315 Kalanianaole Ave. Hilo, Hawaii 96720 Facility /Site Address: 483 Kinoole St. Hilo, Hawaii Fax No.: 808 - 935 -3794 Email Address: bmenino @rcchawaii.org Name of Accountant/CPA (include name of firm if applicable): CW Associates Phone No.: 808- 695 -4014 Mailing Address: 700 Bishop St., Suite 1040 Honolulu, HI 96813 Amount of Request for County Funds: $40,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $30,000 $20,000 $15,000 Agency Mission Statement: The Office for Social Ministry is a multi- faceted department of Diocese of Honolulu, which exists to promote acts of charity and justice and to serve those most in need. Inviting the involvement of our parishes and community -at- large, the Office for Social Ministry strives to meet the challenges of the ever - changing communities in Hawaii by utilizing spiritual, human and material resources. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Roman Catholic Church in the State of Hawaii, Office for Social Ministry Ponahawaiola: Community Re- integration Services Program Description: The mission of Ponahawaiola is to reduce potential obstacles for men and women formerly incarcerated in Hawaii County. "E Malama Kekahi I Kekahi/Taking Care of Our Own" is an article which was published by the Hawaii Island Correction Advisory Committee in 2003. The purpose of the article is to advocate a "seamless reintegration program" which is the best approach to reducing these obstacles. OSM utilizes this model and works collaboratively with correctional and judiciary agencies to recognize offenders at -risk of homelessness to arrange placement in the transitional housing program prior to release from incarceration. During the initial application and interview process, special needs are addressed by linking participants to treatment facilities . Appropriate steps are then made to create an individual support network for each participant. OSM has a total of 28 rooms available to shelter participants. During our pilot year of the "reentry" program, we looked at other successful community - based reentry programs such as, AIDS Housing of Washington, TASC (Treatment Alternatives for Safe Communities), Inc. in Illinois, the Fortune Society in New York City, the Maui BEST program and the Good Beginnings Alliance SKIP (Supporting Keiki of Incarcerated Parents) program. We are currently working with Good beginning alliance to open a site here on the Big Island. Following their excellent examples, we strive to offer a wide variety of services at Ponahawaiola. Services available to program participants are built on extensive linkages to agencies throughout our community. Services include transitional housing; case management, referrals to community programs skilled in educational and vocational training; direct job placement; transportation; mentorship services; linkages to substance abuse and mental health treatment; assistance with family unification; life skills and financial skills training; culturally appropriate activities; housing placement assistance; and one year of aftercare after placement in permanent housing. Total Budget and Position Count Total Program Budget 612,280.00 Total Program Position Count 7 Total Agency Budget 4,135,593.00 Total Agency Position Count 54 Program Objectives: For FY- 10 -11: 1. Maintain clean and sober housing for 100% of program participants; 2. Decrease violations of conditions of supervised release for 65% of program participants; 3. Increase participation in substance use disorder and mental health services for 70% of program participants; 4. Assist in obtaining employment and education placement for 65% of participants; 5. Assist with increased child support and general family contact for 70% of participants. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Roman Catholic Church in the State of Hawaii, Office for Social Ministry Ponahawaiola: Community Re- integration Services Program Highlights: (from Fiscal Year 2008 -09) 1) Ponahawaiola Independent Living Readiness (PILR): To date, the most impressive achievement for the Ponahawaiola Community Reintegration Program is its Ponahawaiola Independent Living Readiness (PILR) group. Originally intended to get participants up and ready early, it has evolved into a comprehensive organized membership consisting of all our participants. During its genesis, they formed a board of leaders who are voted into their positions by the general membership. Their Mission is to motivate others to acquire employment, housing, and education while strengthening their spirituality. Their vision is to be gainfully employed, live independently and reinforce their ties to the community and their Values are to stay clean and sober and remain respectfully oriented to their faith, family and freedom. PILR was instrumental in securing an award of $16,500 from the Catholic Campaign for Human Development which went mostly towards tools, equipment and total reconstruction materials at 485 Kinoole Street. This newly renovated room boasts an Employment Training Center with 10 computers for participant, kitchenette and bathroom, and a fully functional and luxurious conference center for all OSM's programs and is also available for community use as well. Future plans include shaping this center to be a resource for life skills building, employment readiness, health and fitness, and will also offer opportunities for fellowship. 2) Employment Readiness and Incentive Program (ERIP): ERIP was implemented after on -going reports reflected that our clients were not able to find an employment training program that targeted the issues directly related to our participants unique array of needs, such as homelessness, lack of child care, lack of transportation, lack of education or prior work history, and criminal backgrounds. ERIP is broken down into three phases. The first step includes 64 classroom hours over an 18 -day period. Once instructional hours are completed, participants are then able to advance to the next phase which includes on -site training and supervised placements at OSM program sites. During this phase, participants are evaluated on their work ethics, attitude and dependability. Participants that have been deemed ready are then ale to participate in off -site training opportunities. This allows participants to be evaluated in a less structured location. Those that complete this phase are then assisted with job placement. The ERIP director is responsible for building an employment database of community businesses and agencies that have committed to employing our participants as regular employees. Once placed, participants are then provided with additional follow up services for up to 6 months, to ensure that the transition to regular employment is smooth and to assist both the participant and employer with any issues that may arise. 3) Mentorship Program: The OSM Mentorship program was implemented to assist participants in developing personal relationships with established community members. Previous studies have indicated that mentoring reduces recidivism and provides long lasting positive influences in the persons transitioning from incarceration (please see link at bottom for study). The mentorship program provides trained supervised volunteer mentors to mentees transitioning back into the community. Mentoring is based upon trust, the willingness to help others and the ability to be a good listener. The Mentor is asked to NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Roman Catholic Church in the State of Hawaii, Office for Social Ministry Ponahawaiola: Community Re- integration Services make a one year commitment to coach and advise the mentee, and is willing to share his or her life experiences and wisdom with the Mentee. The nature of the Mentor's guidance and support will depend on the Mentee's individual service plan (ISP). The ISP is collaboratively developed between the OSM case managers and the Mentee. It serves as a guidance tool not only for the Mentor but also all involved participants in the case. http: / /www. of p. usdol.gov /BJA/ qrant /O9SecondChanceMe ntoringSol. pdf Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Number of persons placed in 43 40 40 transitional housing Number of persons placed in 15 15 15 permanent housing Number of persons who retained 18 20 20 employment for at least three months Number of persons who 43 40 40 participated in community activities Number of persons receiving 41 40 40 education /job training assistance Number of persons accessing 32 30 30 health services (nutrition, medical, gerontology, therapeutic massage, aerobic) Number of persons accessing 21 20 20 mental health services *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 255,666.50 261,271.00 321,28500 Professional Fees Operations 286,581.25 315,409.00 290,995.00 Equipment Other NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Roman Catholic Church in the State of Hawaii, Office for Social Ministry Ponahawaiola:- Community Re- integration Services FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Total 542,247.75 576,680.00 612,995.00 * If applicable # Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii 20,000.00 20,000.00 40,000.00 State of Hawaii HPHA 414,96000 436,800.00 414,960.00 Hawaii Island United Way 15,500.00 40,000.00 40,000.00 Hawaii Hotel Industry Visitor Walk 1,441.39 Kaneta Foundation 5,000.00 5,000.00 5,000.00 Ponahawaiola Program fees 89,959.75 74,880.00 112,320.00 Employment Readiness /Incentives 450.00 Carry over FY 07 -08 funds 1,458.23 State of Hawaii HPHA Receivable 56,840.00 Total 605,609.37 576,680.00 612,280.00 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? We will continue to search additional federal funding opportunities to help sustain our housing programs. We have also initiated our Volunteer Program to help increase volunteerism opportunities for our programs and for our community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Roman Catholic Church in the State of Hawaii, Office for Social Ministry Ponahawaiola: Community Re- integration Services 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, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 1129110 Signature of Board resident/Chair Date 0 .1t/t--tre— 17 41/0 Signature of Executive Direc of Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 74 Palekana Kai Ocean Safety, LLC Ocean Safety Education Palekana Kai Ocean Safety, LLC.- Agency Name Ocean Safety Education- Program Name Agency Director: Harlen Fragas Phone No.: 937- 9805 Contact Person: HarlenFragas Phone No.: 937- 9805 Mailing Address: 980 Railroad Avenue Hilo, Hawaii 96720 Facility /Site Address: 980 Railroad Avenue Hilo, Hawaii 96720 Fax No.: Email Address: Palekanakai @yahoo.com Name of Accountant/CPA (include name of firm if applicable): Phone No.: Mailing Address: Amount of Request for County Funds: $30,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $20,000 $20,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Agency Mission Statement: To educate community youth about ocean water safety while providing opportunities and alternative activities that build these young adults confidence, self- esteem, motivation and a lifelong respect for the ocean and the skills needed to enjoy the ocean safely. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Palekana Kai Ocean Safety, LLC. - Agency Name Ocean Safety Education- Program Name Program Description: Palekana Kai Ocean Safety, LLC. is a non - profit 501©3 organization that provides ocean awareness, ocean safety and ocean rescue training along with lifeguard training, First Aid /CPR, AED training free -of- charge for community youth between the ages of eleven and eighteen. Additionally, the team conducts First Aid /CPR and AED training for staff of community organizations island -wide. Palekana Kai also provides rescue services at numerous ocean water sports events, such as outrigger canoe regattas, Business Man Race, The Queen Lili'uokalani Long Distance Race, The Richardson Rough Water Swim, long distance races for the Big Island Racing Association, One Man Canoe Races and The Paddle Board Races. Palekana Kai's main objective is to educate and promote public safety and awareness through their water safety programs that include: Ocean Water Safety, First Aid /CPR, AED (automated external defibrillation) and Lifeguard Training at various Public Schools and Youth Agencies. The Team's experienced lifeguards conduct ocean safety classes voluntarily for four public high schools located in the Hilo and Puna Districts of Hawai'i County. Activities are scheduled throughout the year. Youth between the ages of eleven and fifteen complete basic skills courses and earn certificates of completion that recognize their readiness for the next levels of training. The next level includes First Aid /CPR, AED, Ocean Awareness /Safety and Ocean Rescue. After completing the additional training levels, youth between the ages of sixteen and eighteen will have the opportunity to complete a basic Lifeguard Training Course and earn a Lifeguard Certificate. This certificate is recognized by the County of Hawai'i as evidence of meeting the primary requirements for an entry level paid Lifeguard 1 position Total Budget and Position Count Total Program Budget 20,000.00 Total Program Position Count 7 Total Agency Budget 20,000.00 Total Agency Position Count 7 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Program Objectives: 1) Obtain equipment needed to expand the current training program and on- site activities enabling our Certified Instructors and Staff to continue educating community youth, including at -risk youth, effectively in the areas of Ocean Awareness /Safety, First Aid /CPR, AED (automated external defibrillation), Oxygen and Bloodbourne Pathogens 2) Conduct informational classes for community youth and at -risk youth in the areas of Ocean Awareness /Safety, First Aid /CPR,AED (automated external defibrillation). It will enable youth to be prepared to respond to an emergency situation effectively. 3) Conduct informational classes in the areas of Ocean Awareness /Safety, First Aid /CPR, AED (automated external defibrillation) for various agencies, organizations and the residents of Hawaii County to enable them to be prepared to respond to an emergency situation. 4) Conduct informational classes in Lifeguarding skills, Oxygen and Bloodbourne Pathogens for community youth, at -risk youth, various agencies and organizations. These skills will increase the number of Hawaii County residents ability to assist in an emergency situation at recreational water sites and our local beaches. It will enhance youth's self- esteem and confidence, opening a large door of opportunities to prepare them for future employment. 5) Decrease the number of injuries and accidents at recreational water sites and our local beaches. Decrease the possibility of drownings and deaths following an emergency situation. 6) Acquire a 1,500 square foot facility that will serve as a classroom to conduct informational classes and hands -on activities. Also serve as a storage unit for training equipment. Program Highlights: (from Fiscal Year 2008 -09) 1) (11) Water Awareness Classes were conducted - 80 youth participated 2) Youth Mentorship Program conducted 2x's a month - 18 youth participated 3) (8) First Aid /CPR, AED (automated external defibrillator) classes were conducted - 54 youth participated 4) (6) Lifeguarding Classes were conducted - 34 youth participated 5) (9) First Aid /CPR, AED(automated external defibrillator) classes were conducted - 74 adults participated 6) (5) First Aid /CPR, AED, Oxygen, Bloodborne Pathogen and Lifeguard Training for the Professional Rescuer Classes were conducted - 28 adults participated 7) (6) Youth who participated in these informational classes were able to use their certificates of completion as experience on their resumes and 4 are currently employed NONPROFIT GRANT APPLICATION FISCAL %'FAR 2010 -11 Page 4 8) (3) Youth who participated in our First Aid /CPR,AED, Lifeguarding Classes were able to utilize their skills by assisting victims who were in trouble at our local beaches, resulting in saving their lives 9) Palekana Kai Ocean Safety Rescue Team provided services at 12 Canoe Races, Regattas, the Businessman Race, One -Man Race, Paddle Board Races, The Rough Water Swim and the Queen Lili'uokalani Long Distance Race - able to serve approximately 2000 participants NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Palekana Kai Ocean Safety LLC. - Agency Name Ocean Safety Education - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Water Awareness Classes - Youth 80 80 80 Youth Mentorship Program 18 18 20 First Aid /CPR /AED - Youth 54 55 60 Lifeguarding Class - Youth 34 35 40 Youth found employment as a result 4 10 10 of participating in classes First Aid /CPR /AED - Adult 74 75 80 First Aid /CPR /AED /Oxygen 28 30 30 Lifeguard Training - Adults Youth were able to rescue victims - 3 10 10 save lives Provide Rescue at 12 canoe races, 2000 2500 2500 business man race, One -man race, Paddle Board, Regattas, Rough Water Swim, Queen Lili'uokalani Long- Distance Race - participants served *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 0 0 0 Professional Fees 0 0 0 Operations 3,800.00 3000.00 5000.00 Equipment 18,000.00 17,000.00 25,000.00 Other Total 21,000.00 20,000.00 30,000.00 * If applicable "Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Palekana Kai Ocean Safety, LLC - Agency Name Ocean Safety Education - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget* Estimate County of Hawaii 20,000.00 20,000.00 30,000.00 Healing Our Islands - Mini Grant 2,000.00 2,000.00 Fundraisers 4,000.00 4,000.00 5,000.00 Total 26,000.00 24,000.00 37,000.00 *If applicable Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Currently fundraising events, car washes, bake sales, garage sales and donations continue to cover the basic program expenses such as insurance, licensing and registration fees as well as annual First Aid /CPR and AED certification fees. The County of Hawai'i Non - Profit Grants has generously awarded Palekana Kai a $20,000.00 grant in July of 2009. This Grant was used to purchase training equipment, training site equipment and our General Liability Insurance. All of these items are very much needed in order to provide a consistent level of program delivery to teach our youth and those of our community effectively. Through its community capacity - building program, the County of Hawaii Department of Research and Development continues to recognize the sercvices that Palekana Kai provides and is providing technical assistance related to non- profit board development, reporting fundraising strategies. The value of this consultation is valued at $2000.00. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 Palekana Kai will make every effort to continue and search for grants such as the County of Hawaii Non - profit Grant, in order to help our program continue to expand and serve our Youth and those of our Community effectively. Finally, Palekana Kai will develop an earned income stream of revenue, charging nominal fees to some of the participating organizations and event organizers served. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 Palekana Kai Ocean Safety, LLC. - Agency Name Ocean Safety Education - 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. /2,y, ° Signature of Board President/Chair Date Signatu e of Executive Director Da e UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 9 75 Parents And Children Together Keonepoko Elementary PrePlus Parents And Children Together- Agency Name Keonepoko Elementary PrePlus- Program Name Agency Director: Ben Naki III Phone No.: (808) 842 -5996 Contact Person: Ben Naki III Phone No.: (808 842 -5996 Mailing Address: 1485 Linapuni Street STE 105 Honolulu, HI 96819 Facility /Site Address: 15 -890 Kahakai Blvd. Pahoa, HI 96778 Fax No.: (808) 845 -2066 Email Address: hs- ehsbnaki @pacthawaii.org Name of Accountant/CPA (include name of firm if applicable): Wayne Tome, Controller Phone No.: (808) 847 -3285 Mailing Address: 1485 Linapuni Street STE 105, Honolulu HI 96819 Amount of Request for County Funds: $80,000.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 • $0 $0 $0 Agency Mission Statement: Parents And Children Together (PACT), one of Hawaii's leading non - profit human service providers, served over 18,000 people last year throughout Oahu, Maui, Molokai, Lanai, and Kauai. PACT promotes and supports healthy individuals, families and communities by creating opportunities for them to identify and address their own strengths, needs, and concerns and successfully realize their potential. PACT works with consumers who are environmentally at- risk. Since its founding in 1968, PACT has developed a comprehensive array of services to strengthen individuals, children, families and communities NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 experiencing social, behavioral health, and economic needs. The agency is a leader in providing neighborhood -based services and forging community partnerships that support families. Known for prevention as well as treatment, PACT is recognized for its advocacy and continuum of inter - connected services in such areas as: • Early childhood education and support to families for children at risk; • Child abuse and neglect prevention and treatment; • Domestic violence prevention and treatment; shelter for women and children; accountability for offenders; • Mental and behavioral health services to facilitate education for special needs children and youth; • Community building and community -based service centers for families and teens; and • Economic development and economic self - reliance education and training for the under - employed and unemployed. PACT is fully accredited by the Council on Accreditation for Families and Children (COA), is a member of the Child Welfare League of America (CWLA), the Better Business Bureau, the Kalihi Business Association, and is an Aloha United Way partner agency. PACT employs the latest community service models, prevention curriculums, behavioral health methodologies, evidence -based treatment modalities and validated "Best Practices." It is committed to accountability to funders for positive outcomes and to quality improvement that contributes to an improved quality of life for its consumers and communities. PACT's programs are community based, culturally sensitive, family centered and focused on family strengths. Over the years, PACT has developed strong community networks and effective working relationships with many service providers and community resources. PACT is active in advocating for children and families, and educating community leaders and elected officials about child and family welfare issues, needs and solutions. PACT has an established track record and organizational commitment to quality assurance and evaluation. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Parents And Children Together - Agency Name Keonepoko Elementary Preplus- Program Name Program Description: Parents And Children Together (PACT) requests funding of $80,000 for Fiscal Year 2011 to supplement funding from The State Department of Health and Human Services Childcare Subsidy program to cover a portion of childcare tuition and fees for children of needy families enrolled in the Keonepoko Preplus program. The requested funding will allow PACT to provide families whose annual income falls between 0% - 200% of the Federal Poverty level financial assistance that will cover up to 60% of the total cost of tuition for each qualified child. Since July of 2009, funding for the Keonepoko Preplus program came solely from the collection of tuition and fees from families, who also are given an opportunity to apply for and receive State DHS Child Care Subsidies. In October of 2009 the State legislature proposed new revisions to the state childcare subsidy that would significantly increase co -pay amounts for each family receiving this benefit. At the turn of the new year, the proposed revisions to the State childcare subsidy program were put into effect. Since October of 2009, PACT foresaw the profound impact the proposed legislation would have on low income working families seeking affordable, quality early childcare centerbased services - particularly families residing in the Puna District where the Keonepoko Preplus program is located. Keonepoko is located south of the Hilo town center. The rural /agrarian community of Pahoa (Keonepoko Elementary) is economically challenged. Eighty percent and more of the children at this school qualifies for free /reduced -lunch subsidies; nearly 30% are headed by single females. More than half of the population in Pahoa are Native Hawaiians. In providing full day services, PACT will utilize the Pre -Plus facility in collaboration with the grant award from the County of Hawaii Non - profit Grant Program to provide financial assistance to needy families to afford a comprehensive, accessible, quality driven early childhood education center. Currently, tuition fees cover the physical care and safety of the children enrolled in the program as well as ensures the quality array of comprehensive services are consistently and appropriately provided. These services include (1) Head Start's health, mental health, parent involvement, social services, and early childhood education; (2) additional staff time for home visit planning, training, and interdisciplinary coordination; and (3) highly qualified staff with less turnover. All children enrolled will benefit from educational and social services provided by highly trained teachers and an enriched environment. Our model provides for a holistic approach to service delivery, which is an absolute necessity for families facing a multitude of challenges. The program design articulates the kinds of skills and knowledge staff should have to optimize service delivery and effective outcomes. All services to children and their families will be in accordance with established National Head Start Revised Program Performance Standards and the Improving Head Start School Readiness Act also known as the Head Start Act. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Comprehensive services include childcare as well as a developmentally age - appropriate early childhood education curriculum provided in a safe classroom learning environment. The classroom will feature: • Operation hours from 8 a.m. to 4:00 p.m. Days of operation will be consistent with the Department of Education annual calendar. • Opportunities for interactive educational activities for adults and children that are facilitated by center staff for children three to age five and their parents or caregivers. • Early Education activities utilizing a one -on -one or small group model. • Inclusion of children with special needs into each classroom. • Developmental screening and assessment of each child using age appropriate standardized instruments. • Health and nutrition screenings and follow -up. Health and nutritional activities will be integrated into the Early Childhood curriculum. • Healthy, non - violent and safe indoor and outdoor learning environments. In addition to classroom services, comprehensive support services to adults and children include the following: • Health Services incorporating health, mental health, nutritional and dental screening for children; referral /advocacy to community health providers; health, nutrition, and safety education for parents; and nutritionally balanced food service for children on the days that they attend center activities. • Social Services consisting of assessment of overall family functioning, crisis intervention and short-term counseling, information and referral /advocacy for community resources. • Parent Involvement services for adults including leadership development through decision - making and advocacy training; participation as volunteers and employees; parenting skills training; self -image enhancement activities; and job skills building which is comprised of assessment of job readiness, orientation, planning, training, and linkage to school or organizations that will facilitate the parent's move toward self - reliance and economic resilience. Total Budget and Position Count Total Program Budget $140,000 Total Program Position Count 4.4 FTE Total Agency Budget $16,599,496.00 Total Agency Position Count 354 Program Objectives: Goal: Provide quality comprehensive early childhood education services to low • income families in the Pahoa community. Objective: A minimum of 20 preschool children at Keonepoko Elementary Pre -Plus site will receive early childhood development services through full- day /full -year center based services. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Major Outputs: By the end of the program year, a minimum of 20 children at Keonepoko Pre - Plus site will have been provided full -day/ full -year center based services. 1) The objective and outputs respond to the identified need for improved access to free and /or affordable childcare options in the community, and therefore complies with Head Start Performance Standard 1304.21 Education and Early Childhood Development. PACT Head Start will provide child care services for Head Start parents and up to 20 children at each Pre -Plus site. Program Highlights: (from Fiscal Year 2008 -09) 1) This is the first year PACT has administered this Preplus site. • NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Parents And Children Together - Agency Name Keonepoko Elementary Preplus - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Provide minimum 8 hour days of staff supervised educational n/a 20 20 activities to 3- and 4- year -old children. Arrange recreational activities for enrolled children and their families, such as swimming, creative n/a 80 80 movement, gardening, children as author, and computer and intergenerational projects. Arrange activities for learning around curriculum topics such as "Peace" to address domestic n/a 10 10 violence, Family Literacy, Nutrition and Health, Dental and Mental Health. Offer workshops to parents, such as computer literacy, lending library, n/a 12 12 mental well- being, and job readiness. Assist enrolled children in obtaining all required medical and dental n/a 20 20 screenings, and immunizations. Initiate Transition Plan n/a 20 20 Complete Individual Educational Plans for children with special n/a 4 4 needs. Provide one to two meals and one meals: 7200 meals: 7200 snack per child each day of center n/a snack: 3600 snack: 3600 activity. *If applicable NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages (includes payroll taxes n/a $87,396 $112,586 and fringe benefits) Professional Fees n/a $1,318 $1,719 Operations n/a $17,286 $25,695 Equipment n/a - - Other" n/a - - Total n/a $106,000 $140,000 * If applicable "Please explain in detail on separate sheet Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Department of Human Services - n/a $34,530 $60,000 State Subsidy Program County of Hawaii Non Profit Grants n/a so $80,000 Program PACT Board Designated Funds n/a $71,470 $0 Total n/a $106,000 $140,000 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Parents And Children Together (PACT) has intensified its efforts to raise unrestricted funding to support its programs, including the Pre -Plus program for Keonepoko. In fall 2009, we launched the agency's first major giving campaign and will increase its efforts to garner more participation in the agency's annual Kids Day fundraiser on May 5, 2010. Staff has been discussing the possibility of expanding its future Head Start services contract to include the Keonepoko Preplus program by FY 2012. PACT Pre -Plus /Head Start staff will continue to apply for funding from local and national trusts and foundations to support the program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 Parents And Children Together - Agency Name Keonepoko Elementary Preplus - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or aaencv's future funding requests. • 1/28/10 / %d p i•nature_o :oard Pre ident/Chair Date 1/28/10 Sign tur¢ of Ex= utive birector Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 76 Puna Community Medical Center Walk -in /Acute Care Clinic: Uninsured Program PUNA COMMUNITY MEDICAL CENTER- Agency Name WALK -IN /ACUTE CARE CLINIC: UNINSURED PROGRAM - Program Name Agency Director: ANN TAGOILELAGI, BOARD PRESIDENT Phone No.: 808 - 930 -6001 Contact Person: Dan Domizio PA,MPH; Clinical Programs Director Phone No.: 808 - 930 -6001 Mailing Address: 15 -2662 Pahoa Village rd, Suite 306 /PMB 8741, Pahoa, HI, 96778 Facility /Site Address: 15 -2662 Pahoa Village Rd, Suite 303, Pahoa, HI 96778 Fax No.: 808 - 930 -6007 Email Address: dand @punahealth.org Name of Accountant/CPA (include name of firm if applicable): Janet Hara, CPA Taketa, Iwata, Hara & Associates,LLC 101 Aupuni Street, Siute 139 Hilo, HI 96720 Phone No.: 808 - 935 -5404 Mailing Address: As Above Amount of Request for County Funds: $149,200 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0.00 $170,000 $50,000 Agency Mission Statement: TO PROVIDE READILY ACCESSIBLE HEALTHCARE TO THE RESIDENTS OF, AND VISITORS TO, PUNA DISTRICT ". NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 PUNA COMMUNITY MEDICAL CENTER - Agency Name WALK IN /ACUTE CARE CLINIC: UNINSURED PROGRAM - Program Name Program Description: This program will help cover the costs of providing acute health services, including prescription costs, to the uninsured, and under - insured people of Puna District. Our HSEDC grant of last fiscal year provided $50,000 to cover those costs; the total cost will actually be closer to $150,000, before the end of the current grant period. [This projection is based on real experience in the first and second quarters of the current grant period, and projections for quarters three and four just ahead.] WE NEEDED $47,000 BY THE END OF DECEMBER, BUT WE RECEIVED JUST $25,000; JANUARYS INSTALLMENT WAS SPENT THE DAY IT ARRIVED. Prescriptions took $4,000 from the uninsured fund (16 %of the first 2 quarters). We receive the money in quarterly payments, and we run out weeks before the quarter ends. Since we never refuse services to anyone who needs it, this means the services are provided without reimbursement of any kind. As bad as times are for the county government, PCMC must ask Hawaii County to increase its support so we may continue to provide these services. PCMC pledges to continue its efforts at fund raising through events, individival contributions, and other grant opportunities, but this is a way for the county to support direct services to its most needy and at risk population. In our current economy, with increasing unemployment, and increasing uninsured, the number of uninsured we have seen has grown steadily from 118 clients (16 %) (Feb- June), to 419 clients (21 %) from July - December. Uninsured visits totalled 77 in July, 90 in December. Reimbursements for these types of visits ranged between $85 and $100, BUT THIS IS FAR LESS THAN THE ACTUAL COST of providing the care; many supplies and procedures (bandages, splints, blood oxygen saturation, etc.) are frequently not covered by insurers. As of late December, 2009,PCMC has been open 7 days a week, 365 days a year. Based on present trends and usage patterns, we expect to see about 100 uninsured visits a month; @ $100 per visit => $120,000 /year; plus 16% to help with medications => $19,200, for a total of $149,200. AS LARGE A NUMBER AS THIS MAY SEEM, THIS IS A CONSERVATIVE ESTIMATE. Any funds NOT provided by this grant, may or may not be covered by other efforts made by PCMC; HSEDC support is critical to continue our services. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Total Budget and Position Count Total Program Budget $149,200 Total Program Position Count 7 Total Agency Budget $460,000 Total Agency Position Count 7 Program Objectives: 1) - To provide health services, and supplemental payments for prescriptions, to the uninsured and under - insured clients who utilize the PCMC Urgent Care Clinic: PATIENT AND VISIT COUNTS, AND INSURANCE STATUS DATA, ARE KEPT ACCURATELY BY OUR ELECTRONIC MEDICAL RECORD SYSTEM. 2) - To operate the PCMC clinic seven days weekly in providing those services; including care for common medical problems such as a wide variety of infections (respiratory,skin, digestive, urinary tract, etc); and care for common surgical problems (cuts, abrasions, foreign bodies, minor traUma, etc). Services also will include physical exams for school, sports , employment, etc. 3) - To provide services to 90 or more uninsured and under - insured monthly; 4) - To provide vouchers for the supplemental payment for prescription medications to approximately 25 clients monthly; 5) - To provide our services with compassion, respect, and a friendly manner that is satisfying to our clients. Program Highlights: (from Fiscal Year 2008 -09) 1) - Puna Community Medical Center has met or exceeded all of its stated goals since the initiative began in 2007; 2) -A non profit corporation was begun (501(c)(3) status effective date May 3, 2007); 3) - Fundraising efforts were successful through 2007, 2008, and 2009 in securing the funds needed to construct, equip, staff and operate the clinic; including $390,000 in grants, from county government, corporate, and private foundations, and $77,540 in donations from local businesses, and individuals, and fund raising events; 4) PCMC opened for business February 1 2009; initial schedual included weekends and holidays, but we were closed Tuesdays. In December, we decided to be open seven days a week, every week, 365 days /year!; 5) PCMC managed the full spectrum of medical and surgical problems it promised to address; INCLUDING infections of the skin,respiratory tract, the gut and the urinary system; injury of the bones and joints, lacerations and abrasions, sprains and strains; 6) - Utilization of the emergency room in Hilo dropped 4% -5% from our service area in 2009 (see Exhibit -A -); Runs by ambulence from Pahoa to Hilo ER have decreased as well. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 7) - PCMC has provided initial assessment and stabilization of severely ill clients with chest pain, respiratory distress, and serious infections before calling 911 and sending them on to the ER in Hilo; 8) - By December 2009, PCMC had managed 2600 clients who made almost 3700 clinic visits; the youngest was 1 month, the oldest was 103years; 575 CLIENTS (22 %), WERE UNINSURED OR UNDERINSURED. Prescription vouchers were written for 109 clients; (See Exhibit -B -) 9) - PCMC was a full participant in Hawaii's immunization program, providing more than150 flu shots to members of our community who requested them, including the uninsured. 10) -PCMC hosted the First Annual Puna Health Fair 4/4/09, and participated in two Community Resource Fairs put on by Council Woman Emily Naeole- Beason; did outreach at the Makuu Farmers market on four Sundays; 11) - PCMC organized 8 Fund Raising Events to supplement our income, and generate community awareness and support; NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 U i/i ✓i L 7 - Emergency Room Volume and —o— ER Volume I % of Visits listing a Permanent Zip Code of 96778 --0 from 96778 j % Pre /Post PCMC Past 2 Fiscal Years —13 - Adj. %from 96778' i Avg Adj %from 96778' 4000 - - . 24% t? 3500- . - -21% a' 3000 - - 18% • 2500 • • • - 15% • •_ • eit • • • fit+ 2000 • — • • • - fe — • is - _ ! •�i _ - _\i • - 12% 1500 - - - - - - • / • - 9% Puna Community Medical Center opening February 2009 1000 - - - — 6% 500 - _ Percentage of Patients from the 96778 area seen at HMC has decreased by 4% - - 3% The percentage during PCMC hours of operations decreased by 5% 0 Jul AuglSep Oct l Nov »Dec Jan Feb l Marl Apr fMayl Jun l Jul Aug lSepl Oct l Nov I Dec Jan I Feb l Mar 1 Apr May Jun Jul Aug 2007 2008 2009 * Adjusted percentages take into account PCMC hours of operation. PCMC hours of operation used = 8 -5 daily (excluding Tuesdays). Top 20 Reasons for ER Visit • 96778 Population, During Feb 2009 - Aug 2009, HMC had 1888 patients visit the Treated and Discharged Home during PCMC Normal ER from the 96778 Zip Code during PCMC Normal Business , Hours that were treated and discharged home. DIAGNOSIS GROUP Feb - Aug 2009 • 92% had some form of insurance OPEN WOUNDS - ALL 102 • 85% did not have any procedure done. Fracture, Closed - All 72 TOP 3 PROCEDURES CHEST PAIN 72 Proc Code Description Total 86.59 CLOSURE SKIN /SUBCUTTISSUE,OTH 77 ABDOMINAL PAIN 63 93.54 APPLICATION OF SPLINT 61 CELLULITIS, FACE / TRUNK / ARM / 63 86 04 OTHER SKIN & SUBQ I & D 37 SPRAIN - ALL 49 HEADACHE 4 Primary Payor Breakdown, . CONTUSION 33 Feb - Aug 2009 Medicare PNEUMONIA, ORGANISM NOS 31 15% ACUTE BRONCHITIS 30 Private ACUTE URI NOS 28 31% URIN TRACT INFECTION NOS 27 SELF PAY 8% BACKACHE NOS 23 JOINT PAIN 22 Other 3% VOMITING ALONE 20 ! �. �` SYNCOPE AND COLLAPSE 20 `, J-, m b.� , v `r , ° ; OTH CURR COND- ANTEPARTUM 19 . ' " p - " t' OBSERV- ACCIDENT NEC `'` ' `;''` DENTAL 19 ..', -.: Medii aid: NONINF GASTROENTERIT NEC 18 43% CS I N a PCMC patients treated - by month S X. 600 - 500 - -- - — --ij aroximate Sisk even MS 400 e Q� °' a 300 • 0 ,0%. ` CO a \*\> 200 100 — 0 septembe novembe feb march april may june july august october r r IMonthly Patients Treated I 101 159 I 242 262 I 255 376 I 319 I 333 463 344 464 month PUNA COMMUNITY MEDICAL CENTER - Agency Name WALK -IN /ACUTE CARE CLINIC: UNINSURED PROGRAM - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Operate Clinic 7 days /week 6 days 7 days Manage 400 or More Visits /mo 1,017- visits 4,800 4,800+ visits(est) visits Cover Care up to 100 uninsured /mo 0 42,000 120,000 Assist with Rx Costs up to 25 /mo 0 8,000 19,200 Decrease Pt load in Hilo ER 0% 5% 5 %+ Reduce EMS trips;Pahoa- >Hilo /mo Measure pt satisfaction being done 95 %+ *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages Professional Fees Operations Equipment Other" Total $101,200 (22% To Be of total expend) Determined ## " If applicable Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 PUNA COMMUNITY MEDICAL CENTER WALK -IN /ACUTE CARE CLINIC: UNINSURED PROGRAM ## PROGRAM EXPENDITURES explanation; The estimated budget expenditures for FY 2009 -2010 are approximately $460,000. The number of uninsured clients seen at our clinic from opening in February, 2009 to the end of 2009, was 575 clients. This represents approximately 22% of the total number of clients seen in that same period. We used this 22% figure to calculate the total costs of our operation committed to providing services to these uninsured clients; $460,000 (Total Expenditures Budget, FY 2009 -10) x 22% = $101,200; this includes Employee Expenses (wages, taxes, etc); Operational Expenses (rent, utilities, phone, IT, etc.); Professional Fees (licenses, permits, accounting, etc); Equipment and Supplies (depreciation, purchase, etc); The total number of uninsured clients in our community is, of course, growing. Uninsured clients do make REPEAT VISITS as well, it isn't simply one client = one visit thus, we can anticipate the cost of providing services to the uninsured will increase. The Pharmacy costs will ultimately add $8,000 from the funds available 2009 -2010; BUT THIS IS PAID TO THE PARTICIPATING PHARMACIES, NOT TO PCMC ! The actual cost of this part of the program will be an estimated $19,200 FY 2010-11, based on this past year's experience. The Total Expenditures budget will increase by 5 %, (perhaps more in some areas) FY 2010 -11. PUNA COMMUNITY MEDICAL CENTER - Agency Name WALK -I /ACUTE CARE CLINIC:UNINSURED FUND - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate HSEDC Grant $50,000 $149,200 HMSA Grant $2,500- $0 PCMC allocated to help cover uninsured Third Party Insurance Payments 0% 0% PCMC Fund Raising/ Donations To be To be allocated allocated when when available available Other Grants as available Total $52,500 $149,200 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? Our billing staff is working hard to improve the rate of getting optimal reimbursement from third party insurers, including Medicare and Medicaid. Currently, the federal insurance plans owe us over $100,000 in reimbursements. This is, of course, a disaster for a start-up non profit with no financial cushion. Utilizing electronic claims submission, we are confident that the flow of cash for services rendered will reach self sufficient levels in the next 12 -18 months; hopefully sooner. However, it is likely that the numbers of poor and destitute in our community will require some sort of supplemental funding indefinately. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 With health care reform, we expect to see fewer uninsured in our community. With an improving economy and decreasing unemployment, we expect the number of uninsured will drop as well. Much of this is out of our hands, but we will continue to do all we can to sustain our services to the people of Puna. Our "Friends of PCMC" -group will continue to do fund raising with our expanding base of donors, volunteers and other community supporters. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 PUNA COMMUNITY MEDICAL CENTER - Agency Name WALK -I ACUTE CARE CLINIC:UNINSURED FUND - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. # _ • t ature of Bo- d F re-i.tent /Cha' Dat ( XYZ2 2 /0 4. ignat of 0 u vet ector Dat UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 9 77 Puna Men's Chorus 2010 Concert Series Puna Men's Chorus- Agency Name 2010 Concert Series- Program Name Agency Director: Daron Scarborough Phone No.: (808)965 -8311 Contact Person: Wayne Laubscher Phone No.: (808)985 -8956 Mailing Address: P.O. Box 865 Pahoa, HI 96778 Facility /Site Address: 12 -541 Kaimu Street Pahoa, HI 96778 Fax No.: (808)985 -8956 Email Address: fundraising @punamenschorus.org Name of Accountant/CPA (include name of firm if applicable): Phone No.: Mailing Address: Amount of Request for County Funds: $7000.00 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0.00 $0.00 $0.00 Agency Mission Statement: The Puna Men's Chorus is an ohana of diverse men who share the power of music with our community. Grounded in Puna Hawaii, our voices reach out to inspire, educate and transform ourselves and our world. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Puna Men's Chorus- Agency Name 201G Concert Series- Program Name Program Description: Season 1: (July 2010) — "ExtrABBAganza" The production of music by ABBA and working in collaboration with students from the University of Hawaii Hilo and other performing arts students. Season 2: (December 2010) — "A Secular Christmas" This is a production of Christmas and Holiday music, traditional and non - traditional sung by Puna Men's Chorus and with collaboration from H.O.T. (Harmony on Tap), a women's chorus, with audience participation. Total Budget and Position Count Total Program Budget 14,100.00 Total Program Position Count 1 Total Agency Budget 16,000.00 Total Agency Position Count 1 Program Objectives: 1.) Educate ourselves and the other performers in choral and movement arts. 2.) Present to the local community a top notch program of "ExtrABBAganza" and "A Secular Christmas Show" 3.) Outreach opportunities in the community. 4.) Reach out to others in our community to inspire and educate them to join our chorus and other performing arts. 5.) Promote the Puna Men's Chorus and to help obtain sponsorships. Program Highlights: (from Fiscal Year 2008 - 09) 1) July 2008 — "Heart & Soul" concert with the Puna Men's Chorus and PALS (Performing Artists Lengthening Strides). PALS is a program to help those with special needs to develop social skills, physical and mental coordination and to help establish them a better quality of life. Program Content: variety show Location: Akebono, Pahoa 2) July 2008 - Outreach performance at Abled Hawaii Artists Annual Art Festival which promoted the programs and art for artists with disabilities. Program Content: Music from "Heart & Soul "concert Location: Hawaii Community College, Hilo, Hi NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 3) September 2008 — Chorus all day retreat at Randolph McCreight's home in Kapoho which included working with Dr. Kathleen McGuire of the SFGMC (San Francisco Gay Men's Chorus) 4) October 2009 — Outreach performance — Open Arms MCC "Variety Show" Program Content: Variety Show — music from World Aids Day Concert. Location: Ainaloa Longhouse, Pahoa, Hi 5) November 2008 — Outreach performance at Hawaii Academy of Arts and Sciences at Pahoa High School, Pahoa, Hi. 5) November 2008 — Hilo Drum and Percussion Festival Program Content: Annual festival promotes percussion music of various styles and cultures. PMC collaborated with Musasa Marimba Ensemble, PVC Band and students of Pahoa High School. Location: The Palace Theater, Hilo, Hi. 6) December 1, 2008 — World Aids Day Concert — Honolulu, Hi Joint concert with Honolulu Men's Chorus. Fundraiser and awareness builder for AIDS services in Hawaii. Location: St. Clements Episcopal Church, Honolulu, Hi 7) December 5,2008 — World Aids Day Concert — Palace Theater, Hilo, Hi Joint concert with Honolulu Men's Chorus and included Musasa Marimba Ensemble, PVC Band and students from Pahoa High /Intermediate schools. Fundraiser for Hihaf (Hawaii Island Hiv /Aids Foundation) 8) December 2008 — Randolph's Annual Community Holiday Music Evening. Community gathering featuring music and food. 9) May 2, 2009 - Outreach Performance at Open Arms MCC Anniversary Party. Program Content: Male choral arrangements of popular show tunes. Location: Ainaloa Longhouse, Pahoa, Hi 10) May 9, 2009 - Outreach performance at the Pahoa Springtime Jamm Program Content: Show tunes Location: Streets of Pahoa Village, Hi 11) May 9, 2009 — Outreach Performance at the Hospice of Hilo's annual "Celebration of Life" fundraiser event. Program Content: Show tunes Location: Wailoa State Park Pavilion, Hilo, Hi Program Highlights (Fiscal Year 2009 -10) 1) October 17, 2009 — "Waiter, There's a Singer in My Soup!" concert Dinner Theater featuring male choral arrangements of popular show Tunes from several decades Location: Akebono Theater, Pahoa, Hi 2) October 23, 2009 — "Waiter, There's a Singer in My Soup!" concert Location Hawaii Paradise Park Community Center Pavilion 3) October 30, 2009 - "Waiter, There's a Singer in My Soup!" concert Location: Wailoa Pavilion, Wailoa State Park, Hilo 4) November 6, 2009 — Black & White Night outreach performance Program Content: selections from "Waiter, There's a Singer in My Soup!" NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Location: The Palace Theater, Hilo 5) November 7, 2009 — "Waiter, There's a Singer in My Soup!" concert Location: Seaview Performing Arts Center (S.P.A.C.E.) 6, 7) December 2009 - Community Christmas Caroling Location: Puna Palisades and Kapoho 8) Scheduled in April 2010 — Randolphs Retreat 9) Scheduled in May 2010 - Open Arms MCC 10) Scheduled in May - Pahoa SpringtimeJamm 11) Scheduled in May — Hilo Hospice NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Puna Men's Chorus - Agency Name 2010 Concert Series - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Membership growth 15 18 30 Public Appearances 11 11 13 Attendance Levels 750 800 1000 Benefit Funds Raised 400.00 1,000.00 1500.00 *If applicable # The performance measures listed above indicate that we are getting our message out to the public regarding our diverse community and also increasing awareness of the arts and the love of music. Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 1200.00 1730.00 5800.00 Professional Fees 350.00 2184.74 2900.00 Operations 6943.77 6999.49 4600.00 Equipment 225.00 1341.29 800.00 Other* Total 8718.77 12255.32 14,100.00 * If applicable * Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Puna Men's Chorus - Agency Name 2010 Concert Series - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Program Ads 1000.00 1200.00 1200.00 Chorus Dues 1670.00 1010.00 1700.00 Program ticket sales # 3270,88 8473.00 5000.00 Total 5940.88 10683.00 7900.00 *If applicable #Ticket prices are being kept down to meet the needs of our communities that can't afford high ticket prices. Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Puna Men's Chorus plans on staging a performance and through ticket sales will help increase revenue in support of our program. To help increase ticket sales announcements will be made over local radio and notices placed in community papers. We also have a fundraising committee that will be out promoting this show soliciting ads from local businesses to be included in our show program. Since the PMC is a new chorus in the area, it is going to take a few years to become self sustaining as our needs are great. Part of that need is to obtain quality sound equipment so that we can put on quality shows and enhance our performances. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Puna Men's Chorus - Agency Name 2010 Concert Series - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year-end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. -- a r .� 41 / / 27/.2o/ Signature f Board • spent/Chair Date / ignat a of Exe Live Director D 0.7/2 UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 78 The Salvation Army Family Intervention Services Independent Living Skills Program - West Hawaii The Salvation Army Family Intervention Services Independent Living Skills Program — West Hawaii Agency Director: Pauline Pavao Phone No.: 959 -5855 ext 28 Contact Person: Denise Pacheco Phone No.: 959 -5855 ext. 14 Mailing Address: P.O. Box 5085 Hilo, HI 96720 Facility /Site Address: 1786 Kinoole St. Hilo, HI 96720 Fax No.: 959 -2301 Email Address: Pauline .Pavao ©usw.salvationarmy.org Name of Accountant/CPA (include name of firm if applicable): Name: Donna Lum (Divisional Director of Finance) Phone: (808) 988 -2136 Mailing: P.O. Box 5085 Hilo, HI 96720/ P.O. Box 620 Honolulu, HI 96809 Amount of Request for County funds: $39,086 Prior Year(S) Funding: 07-08 08-09 09 -10 $20,000 $15,000 $15,000 Agency Mission Statement: To provide youth with skills for a healthy life, and instill purpose, hope, and vision to youth and their families. Our agency's goals are to provide youth with a safe, caring, and nurturing environment. We recognize that all youth are "Youth of Promise," and have the potential to become self - directed, goal oriented and contributing members of our community. Program Description: For children and youth in the foster care system, life's ordinary challenges and opportunities frequently become extraordinary (NCWD, youth.) Between 18,000 and 20,000 youth aged 16 and older transition from the foster care system each year. Not surprisingly, these young adults are particularly vulnerable to drugs, crime, mental health issues, early pregnancy, poverty, homelessness, lack of education, health insurance and employment (Casey Family Services, NCWD, youth.) NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 The Salvation Army - Family Intervention Services — Independent Living Skills Program is designed to help foster youth and emancipated foster youth ages 12 -21 prepare for and manage the transition to productive, self - sufficient adulthood with a base of independent living skills. The curriculum emphasizes career, education and job - skills development, utilizing a school -based skills format as a framework for implementing an array of independent living /transition curriculums that can be tailored to fit the respective participants relative to age, level of education and psychosocial developmental levels. The focus of this training is to draw a connection between academic success, jobs skills and positive social skills development in order to attain a higher quality of life in the high need areas of Health, Housing, and Economic Self- Sufficiency. The curriculum is divided by components or themes that highlight sessions connected to self - sufficiency. In following with the school year, each component represents a month. These components include: • Orientation /Personal Development (Sept) • Educational Success & Planning (Oct) • Social and Community Awareness (Nov) • Vocational /Job Skills Training (Dec) • Post -High Options/ Financial Aide (Jan) • Career Preparation & Work -Based Learning Experiences(Feb) • Life Planning & Money Management (Mar) • Self Care & Positive Relationship Building (Apr) • Daily Living & Community Involvement (May) • Evaluation, Youth Recognition (June) Group sessions are held at Konawaena High School on Monday and Kealakehe High School on Wednesday. Each foster youth is required to attend one 2 -hour session per week as well as individual sessions. In addition, we have incorporated activities on furlough Fridays that focus on social skill development. Aside from group activities, we integrate homework, study hall, computer knowledge, community service projects and extra curricular activities. They include: College Fairs, Job Fairs, Housing Fairs, World of Work Tours sponsored by the Hawaii Community College, West Hawaii Community College, University of Hawaii at Hilo, Hawaii National Park Service, National Energy Laboratory Hawaii Authority, Sheraton Keauhou Beach Resort and Spa, Work Force Development Division -West Hawaii and many others. We strongly encourage our participants to engage in civic connectedness and giving back to ones community. The Department of Human Services currently funds our Independent Living Skills Program. Our area of coverage is West Hawaii which includes: Kohala, Waimea, Waikoloa, Kealakehe, Konawaena and the Kau District. This contract supports only a 1.00 FTE Youth Development Specialist IV, which is not enough to cover this vast district. Funding received through the County would help support .50 FTE Youth Development Specialist IV position to increase staff coverage to the West Hawaii District. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Total Budget and Position Count Total Program Budget $132,076 Total Program Position Count 1.5FTE Total Agency Budget $5,367,019 Total Agency Position Count 77 Program Objectives: The objective of the program is to accomplish the following for 30 foster youth in West Hawaii each year: • Of the 30 foster youth, ages 12 -15 participating in the program, 75% will demonstrate increased independent living skills, as identified in their IL plan. • Of the 30 foster youth, ages 16 plus participating in the program, 75% will successfully complete their Independent Living Skills Program and attain at least a "fair prognosis" of achieving goals of independence upon exiting the program. • Of the foster youth, ages 18 plus, participating in the program, 80% will participate in Higher education, Vocational Training, Employment and /or Military • 75% of youth will avoid non - marital childbirth, incarceration and homelessness during program participation. Program Highlights: FY 2008 -2009 In our 2008 -2009 fiscal years, The Independent Living Skills Program in West Hawaii provided over 1,455 direct service hours to foster youth and obtained the following performance measures: • 88% of foster youth age 12 -15 demonstrated an increase in Independent Living Skills, as identified in their IL plan • 80 %of foster youth age 16 plus completed their Independent Living Skills Program and attained at least a fair prognosis of achieving goals, as identified in their IL plan • 100% of foster youth 18 plus, participated in Higher Education, Vocational Training Employment and /or Military • 100% avoided non - marital childbirth, incarceration and homelessness during program participation In addition, we provided opportunities for our foster youth to attend college and career fairs at University of Hawaii at Hilo and participate in camp activities. We also focus on healthy meal preparations, accessing healthcare, and access to workshops that gave hands on approach in filling but Financial Aid Forms (FASFA). We strongly believe in being a partner with our community and have accessed many businesses, resource agencies, and civic clubs in West Hawaii. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Completion of ILSP 30 30 30 Participates in IL Activities 38 30 30 Participates in IL Plan 38 30 30 Follow up and Monitoring 38 30 30 Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 72,380.41 73,954 91,100 Professional Fees Operations 30,962.80 34,036 40,976 Equipment Other* Total 103,343.21 107,990 132,076 Program Funding Sources Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate State of Hawaii 88,343.21 92,990 92,990 County of Hawaii 15,000 15,000 39,086 Total 103,343.21 107,990 132,076 Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The Salvation Army - Family Intervention Services, while part of The Salvation Army, is required to seek its own funding for program services. As such, TSA -FIS relies primarily on funding from government at the federal, state and county levels to continue our outreach programs to assist at -risk youth and their families. Such funding is primarily through the purchase of service system, which we are required to submit proposals through a competitive process. Very limited funding is available through grants from trusts and foundations. We continuously explore avenues of funding to continue these programs. However, in view of the nature of our mission in developing healthy lifestyles for youths and their families, we do rely heavily on funding from all levels of government. As such, we do not anticipate being self - sufficient in providing Outreach services to the youth and families residing in Hawaii County. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 The Salvation Army Family Intervention Services Independent Living Skills Program -West Hawai'i 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 a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report may impact the evaluation of your program's or agency's future funding requests. v lam (4 'Signature of Board President/Chair Date /46 ature of Executiv ctor Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL, YEAR 2010 -11 Page 5 79 The Salvation Army Family Intervention Services Prevention Programs - Honokaa The Salvation Army Family Intervention Services Prevention Programs- Honokaa Agency Director: Pauline Pavao Phone No.: 959 -5855 x 28 Contact Person: Raymond Dangaran Phone No.: 959 -5855 x 22 Mailing Address: P.O. Box 5085 Hilo, HI 96720 Facility /Site Address: 1786 Kinoole St. Hilo, HI 96720 Fax No.: 959 -2301 Email Address: pauline .pavao ©usw.salvationarmy.org Name of Accountant/CPA (include name of firm if applicable): Name: Donna Lum (Divisional Director of Finance) Phone: (808) 988 -2136 Mailing: P.O. Box 5085 Hilo, HI 96720/ P.O. Box 620 Honolulu, HI 96809 Amount of Request for County funds: $52,656 Prior Year Funding: 07 -08 08 -09 09 -10 $35,000 $20,000 $15,000 Agency Mission Statement: "To provide youth with skills for a healthy life, and instill purpose, hope, and vision to youth and their families." Our agency's goals are to provide youth with a safe, caring, and nurturing environment; and provide opportunities for youth to challenge their life styles through development of appropriate social skills, academic success, and personal resiliency. Program Description: The Salvation Army Family Intervention Services- Prevention Programs provides a safe and nurturing environment along with access to opportunities, experiences, and services to support positive youth development. We utilize a prevention approach to decrease the use and abuse of alcohol, tobacco, and other illicit drugs (ICE, ecstacy, and etc.), involvement in gangs and violence, delinquent behaviors, early sexual behaviors, and to improve academic performance and school attendance. This will be NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 accomplished by implementing Outreach Services (Leadership Development Program and Positive Alternative Activities) to youth ages 7 -18 years old and their families, residing in the Honokaa district. Leadership Development Program -The L.E.A.D. Team (Learning Experience in Assisting and Directing) provides development of leadership skills and training in areas of personal and social skills, teamwork, decision making, goal setting, and action planning to conduct community service and learning projects. Leadership activities will allow youth to experience leadership, group dynamics and problem solving opportunities such as youth planning committees and youth representative on community collaboration efforts. Positive Alternative Activities consist of: Recreational, PerformingNisual Arts and Humanities, Educational, Cultural, and Youth Leadership Activities. Other prevention activities consist of Community Service and Learning Projects, Drug -free dances, and Excursions. These activities will provide youth with opportunities to develop an understanding of self and one's culture and a sense of identity and belonging, and promote the development of competencies (social well- being, knowledge, and social responsibility. All services will be in conjunction with the Teenage Pregnancy Prevention & Family Strengthening Program in Honokaa, currently funded by the Department of Defense. We propose to implement program services during after - school and occasionally weekend hours. The proposed funding would support and provide for 2 part-time staff: 2 -Youth Service Worker at 20 hours a week. These positions will help support an after - school program and provide sufficient supervision and safety for each youth served. Total Budget and Position Count Total Program Budget 140,656 Total Program Position Count 2.0 Total Agency Budget 5,367,019 Total Agency Position Count 77 Program Objectives: 1) Of the 45 youth targeted to participate in the Prevention Programs, at least 80% will register for Outreach Services (L.E.A.D. Team, Positive Alternative Activities) and maintain participation with the program to completion or for 6 months beyond the registration date. 2) _Of the.45youuth_participating_in the_prevention activities throughout the year, at least 80% will participate in Positive Alternative Activities (Community Service and Learning Projects, Recreation, Tutoring, and Community Events), demonstrate an increase in competencies (social well- being, knowledge, and social responsibility) for the first 6 months, and continue that gain for an additional 6 months or completion of the program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 11 Page 2 Program Highlights: 2008 -09 The YDS conducted the Making Choices Curriculum to the students in the 7 and 8` grade class. Sessions included; Decision Making, Leadership skills, Use and abuse of ATOD, Positive Role Models, Anger Management, Community Service Learning Projects, and Self discovery. Youth participated in several special projects throughout the year. They went to the Waimea Hospital to talk to the head nurse about the pregnancy problems teens face, and a walk through visual of premature infants in the hospital. This activity was an eye opener for youth to decide to abstain from sexual involvement that could result in teen pregnancy. Youth also participated with Earl's Garage, located in the Kamuela Business Center, a project of Friends of the Future, a nonprofit organization. Youth assisted with the set up of the annual Haunted House construction, learned the basics of energy, how batteries work, and robotics. Other activities included: beach excursions, cultural excursions, Zoo, movies, and bowling. They also participated in a sleep over retreat at the Honokaa site; and also utilized the Honokaa Community Pool in which some youth took part in the painting of the ocean view mural. Youth participated in Community Service Projects such as sorting clothes and articles, labeling, and arranged the items at the Salvation Army Thrift Store. Also, youth assisted with the planning process, organization, and set up for a Valentine's Youth Dance at the school, in which many community organizations were invited to set up informational booths focused on smoking, teen pregnancy, and alcohol. We also held a Mother's Day Luncheon at 0 Mondo in Honokaa to celebrate mothers' in our program, and to help strengthen the bond with the youth and their mother with interactive activities. Community Collaborations: Linkages with Other Agencies: At this time the agencies that we have been in contact with is the DOE, Parks and Recreation Department, Police Department, and YWCA. The support that the Honokaa High and Intermediate Schools have given us has been tremendous, they have invited us into their classrooms, given us a place to provide our services and staff support. We continue to create collaborations with other resources such as Hamakua Health Center for resources and information. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Participates in L.E.A.D. Team 45 45 45 Participates in Pos. Alter. Activities 45 45 45 Participates in Comm. Srv. Projects 45 45 45 Follow up and Monitoring 45 45 45 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 60,314.29 77,603 106,835 Professional Fees 0 0 0 Operations 31,765.30 25,397 33,821 Equipment 0 0 0 Other* 0 0 0 Total 92,079.59 103,000 140,656 Program Funding Sources Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Department of Defense (DOD)* 72,079.18 88,000 88,000 County of Hawaii 20,000 15,000 52,656 Total 92,079.59 103,000 140,656 *Teenage Pregnancy Prevention & Family Strengthening Program funded under DOD. Explain what plans, if any, your agency and/or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? The Salvation Army - Family Intervention Services, while part of The Salvation Army, is required to seek its own funding for program services. As such, TSA -FIS relies primarily on funding from government at the federal, state and county levels to continue our prevention and intervention programs to assist at -risk youths and their families. Such funding is primarily through the purchase of service system, which we are required to submit proposals through a competitive process. Very limited funding is available through grants from trusts and foundations. We continuously explore avenues of - - funding - to - continue - these programs. However, in view of the nature-of-our mission in developing healthy lifestyles for youths and their families, we do rely heavily on funding from all levels of government. As such, we do not anticipate being self- sufficient in providing prevention services to the youth and families residing in Hawaii County. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 The Salvation Army Family Intervention Services Prevention Programs - Honokaa I (we) have read and understood all of the eligibility requirements; grant conditions, award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely. complete, and accurate year -end report may impact the evaluation of your program's or agency's future funding requests. Signature of Board President /Chair Date e a ; Cbo I _ `' of Execut e Di ector Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL. YEAR 2010-11 Page 80 The Salvation Army Family Intervention Services Prevention Programs - Pahoa The Salvation Army Family Intervention Services Prevention Programs -Pahoa Agency Director: Pauline Pavao Phone No.: 959 -5855 x 28 Contact Person: Raymond Dangaran Phone No.: 959 -5855 x 22 Mailing Address: P.O. Box 5085 Hilo, HI 96720 Facility /Site Address: 1786 Kinoole St. Hilo, HI 96720 Fax No.: 959 -2301 Email Address: pauline.pavao @usw.salvationarmy.org Name of Accountant/CPA (include name of firm if applicable): Name: Donna Lum (Divisional Director of Finance) Phone: (808) 988 -2136 Mailing: P.O. Box 5085 Hilo, HI 96720/ P.O. Box 620 Honolulu, HI 96809 Amount of Request for County funds: $44,723 Prior Year Funding: 07 -08 08 -09 09 -10 $35,000 $20,000 $15,000 Agency Mission Statement: "To provide youth with skills for a healthy life, and instill purpose, hope, and vision to youth and their families." Our agency's goals are to provide youth with a safe, caring, and nurturing environment; and provide opportunities for youth to challenge their life styles through development of appropriate social skills, academic success, and personal resiliency. Program Description: The Salvation Army Family Intervention Services- Prevention Programs provides a safe and nurturing environment along with access to opportunities, experiences, and services to support positive youth development. We utilize a prevention approach to decrease the use and abuse of alcohol, tobacco, and other illicit drugs (ICE, ecstacy, and etc.), involvement in gangs and violence, delinquent behaviors, early sexual behaviors, and to improve academic performance and school attendance. This will be accomplished by implementing Community -Based Outreach Services and Positive Alternative Activities to youth ages 7 -18 years old and their families, residing in the Pahoa district. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Outreach services consist of: Leadership Development Program -The L.E.A.D. Team (Learning Experience in Assisting and Directing) provides development of leadership skills and training in areas of personal and social skills, teamwork, decision making, goal setting, and action planning to conduct community service and learning projects TSA -FIS has developed a program called "Project Family" to build relationships between agency, youth, parents, and community. Project Family Activities provide parent support and family strengthening activities to promote family cohesion and positive relationships within diverse family structures. Youth and their families along with agency staff participate in regularly scheduled "Family Days" which are activity -based and fun. Positive Alternative Activities consist of. Recreational, Educational, Cultural, and Youth Leadership Activities. Other prevention activities consist of Community Service and Learning Projects, Drug -free dances, and Excursions. All services will be part of a compilation of Prevention Programs currently funded by the Office of Youth Services, and Department of Health. Program services will be provided at Pahoa School Districts and at the ,Nanawale Community Center. We propose to implement program services during in- school, after - school, and occasionally weekend hours. The proposed funding would support and provide for 0.25 FTE Youth Development Specialist IV and 2 -Youth Service Workers at 19 hours per week. Supplemental funding from the Office of Youth Services - Positive Youth Development will help support and establish a 1.00 FTE Youth Development Specialist IV to provide outreach services to the Puna Community. The 2 -Youth Service Workers will help support an after school program and provide sufficient supervision and safety for each youth served Total Budget and Position Count Total Program Budget 119,723 Total Program Position Count 1.95 Total Agency Budget 5,367,019 Total Agency Position Count 77 Program Objectives: 1) Of the 40 youth targeted to participate in the Prevention Program, at least 80% will register for Outreach Services (L.E.A.D. Team, Project Family, Positive Alternative Activities) and maintain participation with the program to completion or for 6 months beyond the registration date 2) Of the 40 youth participating in the prevention activities throughout the year, at least 80% will participate in Positive Alternative Activities (Community Service and Learning Projects, Recreation, Tutoring, Community Events, and Family Days), demonstrate an increase in competencies (social well- being, knowledge, and social responsibility) for the first 3 months, and continue that gain for an additional 6 months or completion of the program. - - Program Highlights: FY 2008 -09 July 2008 • 7/19/08 - There was a School Supply Distribution @ The Maku'u Market Swap Meet Site. We were part of the Youth Empowerment Subcommittee where we went out and requested donations for the families of Puna, purchased the supplies and gave them away at this event. Over 900 families from Puna & Upper Puna benefited from this event. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 • 7/18 /2008 - Family Potluck @ the Nanawale Long 1-louse Families and Staff brought a cultural dish to share and talk stories as the summer comes to an end. (25 youth and families) • 7/22/2008 - "We are Family" Family Event at the Pahoa Recreation Center. There was a Distribution of Lucky Numbers and School Supplies for the families who attended. Meals for the families were provided by Verna's Drive Inn. Family Pictures were taken and an overview of what services we have to offer in the near future. Outreach and update with the families over a meal. (60 youth and family) September 2008 • 9/02/2008- We began the Girl's group that we recently got trained for in July. It is a curriculum for girls titled, `Swim with Your Current ", a girl's guide to riding the waves of life. We currently have 10 girls signed up for the groups that will be once a week for 8 weeks long ending with a graduation with their families. We begin with orientation, Mind: Believe in yourself, Body: Taking Care of your health, Spirit: Living a meaningful life, Feelings: Coping with stress, Relationships: Being respectful, Life: Sharing your gifts & talents and ending with a Graduation and Celebration of the curriculum. • 9/13/2008- Nanawale Block Party- Resource Fair There are about 10 different booths, water slides for the kids and live entertainment. There are food booths and a lot of people attend from the community and also outside of the community. We had a booth of our Salvation Army Prevention Programs information and a picture taking session for families in the area who attended this wonderful event. (100 youth and faintly) October 2008 • 10/03 /2008 -Begin Little Leaders at Pahoa Elementary School cr A+ program. (approx. 25 youth) • 10/25/2008- Wrestling Clinic at the Pahoa Gym. (Collaboration with Pahoa Weed & Seed Yes Group) Free for the community: for ages 6 -99. (80 participants) November 2008 • 11 /14 /2008 -Begin Girl's Group @ Pahoa Recreation Center. Begin New Curriculum (5 girls.) • 11/22/2008- Baseball Clinic put on at the Pahoa Recreation Center by the UH Baseball Team. Food and Pictures available for the families who attend. (15 youth) December 2008 • 12/06 /2008 - Salvation Army Christmas Outreach Event @, Wailoa State Park. Food, Gifts, Games, Rummage Sale & Fellowship for all Families in the Community. • 12/09 /2008 -Begin offering first violence prevention program in Pahoa (7 youth). March 2009 • 3/13 /2009 -Pahoa Community Dance for 7 & 8 Graders at the Pahoa Recreation Center. `Green Theme, Prizes, Pictures, Games, Dance Contest etc. (65 youth) • 3/17 /2009- Mother /Daughter Dinner at Luquin's Mexican Restaurant. (15 youth and parent) April 2009 - -- - • 4/08/09: Easter egg Hunt at Hawaiian Beaches Park. Collaboration with PCAT & Yes Group. Entertainment, Food, Games, Easter egg Contest, Easter Egg Hunt etc. (200 participants) June 2009 • 6/20/09 `Ghana Day in Pahoa @ Pahoa Pool. Booths with make and take projects were provided by different agencies. Lucky Numbers, Poster Contests, Free Food etc. (30 youth) • 6/23/2009 Family Fiesta Dinner for families in our program. Mexican Food, Mexican games,(pinata, bingo etc.) were provided for the families of Pahoa. (80 youth and families) NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Community Collaborations: Linkages with Other Agencies: Referrals to the prevention programs are currently coordinated through the In- School Services at Pahoa Elementary, Intermediate and High Schools, HAAS (Hawaii Academy of Arts and Sciences), Ku O'Kala, Keonepoko Elementary, and Mountain View Elementary. TSA-FIS has also worked cooperatively in coordinating services for youth and families with the following programs: Big Island Substance Abuse Council; Workforce Investment Youth Employment Services; Hawaii County Community Policing Officers; Bay Clinic; Queen Liliuokalani Children's Center; Neighborhood Place of Puna; Pahoa Parks and Recreation; Boys and Girls Club of the Big Island; Alulike Inc; Pahoa Weed and Seed, and Nanawale Community Center. Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Completion of L.E.A.D. Team 60 60 40 Participates in Pos. Alter. Activities 60 60 40 Participates in Project Family 60 60 40 Follow up and Monitoring 60 60 40 Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 46,314.40 64,377 91,007 Professional Fees 0 0 0 Operations 27,504.78 25,623 28,716 Equipment 0 0 0 Other* 0 0 0 Total 73,819 18 90,000 119,723 Program Funding Sources Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate State of HI- Office of Youth Services 73,819.18 75,000 75,000 County of Hawaii 20,000 15,000 44,723 Total 93,819.18 90,000 119,723 *Positive Youth Development services funded under Office of Youth Services. Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Salvation Army - Family Intervention Services, while part of The Salvation Army, is required to seek its own funding for program services. As such, TSA -FIS relies - primarily on funding from government at the federal, state and county levels to continue our prevention and intervention programs to assist at -risk youths and their families. Such funding is primarily through the purchase of service system, which we are required to submit proposals through a competitive process. Very limited funding is available through grants from trusts and foundations. We continuously explore avenues of funding to continue these programs. However, in view of the nature of our mission in developing healthy lifestyles for youths and their families, we do rely heavily on funding from all levels of government. As such, we do not anticipate being self - sufficient in providing prevention services to the youth and families residing in Hawaii County. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010-11 Page 4 The Salvation Army Family Intervention Services Prevention Programs -Pahoa I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawai'i, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding • sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report may impact the evaluation of your program's or agency's future funding requests. / y; ( (J" / / /.) // Signature of Board President/Chair Date t/ /Chair Iz nature of Executive Director Date in UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 81 Special Olympics Hawaii - East Hawaii Special Olympics Hawaii - East Hawaii 4 Special Olympics Hawaii- Agency Name Special Olympics Hawaii -East Hawaii - Program Name Agency Director: Nancy Bottelo Phone No.: 808 943 -8808 X 22 Contact Person: Carey Uchida Phone No.: 808 935 -0537 Mailing Address: P.O. Box 7265 Hilo, HI 96720 Facility /Site Address: 138 Kaikuono Place Hilo, HI 96720 Fax No.: 808 935 -1968 Email Address: careyuchida@hotmail.com Name of Accountant/CPA (include name of firm if applicable): Akamine, Oyadomari & Kosaki Phone No.: 808 941 -0500 Mailing Address: 1440 Kapiolani St #900 Honolulu, HI 96814 Amount of Request for County Funds: $20,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $12,000 $12,000 $15,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 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 of gifts, skills and friendship with their families, other Special Olympics athletes and the community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Special Olympics Hawaii - Agency Name Special Olympics Hawaii -East Hawaii- Program Name Program Description: People who are isolated from life experience by a disability have little chance for the developmental growth and acquisition of important skills that they will need to gain employment, maintain relationships and function within the community. Special Olympics believes that all people, regardless of their disability deserve to lead full, active lives, enriched with social and recreational opportunities that most of us take for granted. Unfortunately, appropriate physical education programs in the public schools and social service programs that realistically address the special needs of this population are virtually non - existent. Special Olympics Hawaii believes that we address a very real issue for all communities throughout the world; which is how to take care of the people within their community that have disabilities; how to employ them, how to take care of their health issues, or just plain how to interact with them. We help the communities that we are involved in with those issues. Our 6,000 volunteers statewide interact with our athletes and their family members on a weekly basis, our medical volunteers throughout the state have been proficient at interacting with our athletes within their own practices, and an impact study done in 2004 states that 52% of the adult Special Olympics athletes in the United States are employed, over half of those are in competitive employment. The general disabled population only has 10% employed. This is a significant impact within the communities that we are involved with. Special Olympics East Hawaii continues our Unified Sports Program. We feel this is a vital program where our special needs individuals interact with their non - handicapped peers on a weekly basis. Unified Sports is a program that combines equal numbers of athletes with intellectual disabilities and special partners without disabilities. All participants are of similar age and athletic ability. This program dramatically increases of our athletes.into the community by helping break down barriers that have historically kept people with and without disabilities apart. Special Olympics East Hawaii now has a softball team, 5 unified bowling teams and 24 unified bocce teams that participant in the Unified Sports Program. They all train and compete together here in East Hawaii and they travel to Maui and Oahu for regional and state competitions. The benefits for our athletes continue to be: improved physical fitness and motor skills, greater self- confidence, a more postitive self- image, friendships, and increased family support. Special Olympics athletes carry these benefits with them into their daily lives at home, in the classroom, on the job, and in the community. Families play a significant role in the East Hawaii program. We believe the families who participate with us become stronger as they learn a greater appreciation for their child's talents. They play significant roles in our organization from an enthusiastic spectator in the stands to coaching their child's NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 team. Our program could not continue without the help from our community volunteers. Our volunteers learn more about the capabilities of people with intellectual disabilities and take that into their own homes. The need for Special Olympics East Hawaii program to continue here on this island is extremely high. Special Olympics provides training for all the volunteers involved in running our program, from the Area Director to our weekend chaperone. These training are essential due to the unique services that we provide. These services are not available anywhere else but with our program. Our program is free of cost to all our athletes, special partners, and coaches. This has been the policy of our organization since its inception, making it a very unique sports program. Special Olympics Hawaii receive no money from the Kennedy Foundation or the Federal Government. All of the money raised for the East Hawaii program stays here to support our program. Due to the aspect of our program, a volunteer committee under the leadership of our Area Director must raise all the funds needed for this unique program. Those funds will pay for all aspects of the Special Olympics program, which includes, equipment, uniforms, transportation costs, training of the coaching staff, family activities and trainings, and our Athlete Leadership Program (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. Special Olympics East Hawaii believes that our athletes are the Voice of our program. In 2010, we will have three athletes representing our program at the Athlete Congress. Athletes come together to vote on issues concerning their Special Olympics program. The results will be shared with our CEO /President and Board of Directors. We are a program that believes that we are working WITH the people that we are serving. As always, Special Olympics East Hawaii's largest expense for 2010 is transportation. It is an essential part of our program that Special Olympics athletes are provided an opportunity to interact and compete against people of smiliar athletic ability. Unfortunately our area program is too small to be able to provide quality competition, therefore our athletes must travel to other islands to achieve that goal. The state competitions that are held on Oahu 3 times_per year provide many activities that our athletes never have a chance to experience. They include; dances, Opening and Closing Ceremonies, entertainment and games, and being exposed to a Healthy Athlete Program. This program provides a free dental screening, vision screening, hearing screening, Fun Fitness (flexibility & strength) screening, nutrition screening and podiatric screening for our athletes. As you know, these services are sometimes not available to individuals with disabilities due to financial difficulty or lack of professionals who are trained to treat people with disabilities. Each athlete who participated in the vision screening at the 2009 Summer Games and who required glasses, were given free glasses that were mailed to each athlete. Special Olympics East Hawaii wishes to continue to provide these fantastic opportunities to all the athletes that are currently involved. In order to continue to provide the current services that we do, continue to outreach to new family NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 members and volunteers, continue to train our coaching staff, and to send our Athlete Delegates to Oahu we will need funding from the County of Hawaii. Special Olympics Hawaii -East Hawaii Area is asking for $20,000 from the County of Hawaii to help fund our Special Olympics East Hawaii program activities. Total Budget and Position Count Total Program Budget 115,060 Total Program Position Count 1 Total Agency Budget 1,683,207 Total Agency Position Count 15 Program Objectives: 1) To provide quality sports training and Olympic type competitions in our area program by June 2011 to 258 athletes & special partners, an increase of 5% from December 2009. 2) To provide sports specific coaches training or recertifications for 5 coaches in various Olympic type sports and various ability levels so that they may provide appropriate training to the athletes within their delegations, an increase of 16% by June 2011. 3) To provide our families, coaches, volunteers and athletes with 3 family activities throughout the year, which will be conducted by our family (Ohana Task Force) committee by June 2011. 4) To provide transportation to 152 athletes, coaches & special partners three times a year, so that they may compete at each State Competition with athletes of the same ability level, an increase of 5% by June 2011. 5) To increase business participation in our Mile of Quarters campaign in order to raise more funds to cover our annual budget by June 2011. 6) To continue to have 4 fundraisers a year in which participants will be asked to sell products (such as chili, bento, candy etc) to help cover the anticipated increases in cost this year and the possibility of reduced donations due to the economic environment we currently have. 7) To provide an opportunity to 450 community volunteers to interact with our Special Olympic athletes throughout the year, providing them with the chance to "change the world." 8) To increase the number of partaicipants in the Honokaa - Paauilo area by June 2011, so more intellectually disabled rural athletes may be able to take part in our program, as there are no organized sports programs outside of schools, for them to participate in year round. 9) To increase the number of participants in the Puna district by June 2011, so that we can provide the intellectually disabled rural athletes an opportunity to participate in our sports program, to become more physically fit, to become a healthier person, to be able to socialize with their peers and be able to compete with other athletes within the same ability level at large state competitions. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 Program Highlights: (from Fiscal Year 2008 -09) 1) We conducted 4 major area athletic competitions for our athletes and Special Partners. On October 18, 2008, we conducted our area singles bowling competition with 97 athletes(an increase of 59 %), 6 coaches, 5 delegations, 41 family members and 68 community volunteers attending this competition. On October 19, 2008, we conducted our area unified (special) partners bowling competition with 14 athletes, 14 unified partners, 2 coaches, 2 delegations, 21 community volunteers and 19 family members in attendance. On November 1, 2008, we hosted the Weinberg Regional Basketball competition at UH Hilo Gynmasium, welcoming 4 teams from the Big Island. Participant and volunteers included 33 athletes, 8 coaches, 3 delegations, 42 community volunteers and 30 family members. On April 18, 2009 we held our area track & field competition at Keaau High School track with 85 athletes participating in the days events. Also in attendance at the areaTtrack & Field competition were 8 coaches, 8 delegations, 40 family members and 125 community volunteers. 2) Our Ohana Task Force committee provided our families, coaches, volunteers and athletes with 3 family events. On August 23,2008 we held our annual "End of Summer Bash" at Wailoa State Park. Attending were 78 athletes, family members, coaches, volunteers & community members enjoying an afternoon of food, games and fellowship. On December 19, 2008, we held our annual Christmas dance /party at the Church of the Holy Cross. Attending were 83 athletes, family members, volunteers and community members enjoying an evening of good food, great music, the singing of Christmas Carols and a small gift to each athlete who attended. On March 20, 2009 we held our Spring Dance at the Church of the Holy Cross with 87 athletes, family members and community members enjoying the music, food and fellowship. 3) Our goal was to provide quality sports training and Olympic type competitions for 215 athletes and special partners by June of 2009. We are proud to say that we have surpassed.this_and have provided sports training and competitions for 243 athletes and special partners, an increase of 13% over our goal. We provided sports training, competitions and transportation to: 17 soccer athletes, 26 bocce athletes, 20 unified partners, 6 coaches and 3 chaperones during the Aukake Season which ran from June 1 to August 23, 2008. During the Winter season, which ran from August 24 to December 31, 2008, we provided services & transportation to 121 athletes, 14 unified partners, 14 coaches, & 10 chaperones. The last season for this period was the Summer season which ran January 1 to May 30, 2009. During this season, we provided training, competition and transportation to 81 athletes, 6 unified partners, 26 coaches and 14 volunteers. 4) All positions on the area management ream, who help to coordinate all activities for Special Olympics East Hawaii's area program were filled and met monthly to discuss and plan operations for the year. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 5) The Mile of Quarters fundraising campaign increased its business participation with the addition of HELCO Federal Credit Union, Hamakua Coast Community Federal Credit Union, IEG Federal Credit Union and the Big Island Federal Credit Union. This makes 6 local businesses who participate in our annual fundraising campaign. 6) Athletes, coaches, volunteers and families conducted 4 fundraisers this year selling bentos, chili & candies to support the area's annual budget needs. A net total of $13,734 was raised through these 4 fundraisers. 7) We continue to offer 9 sports throughout the year for our athletes which are: track & field, swimming, power lifting, softball, bocce, soccer, golf, basketball & bowling. 8) We outreached to teachers at the Teachers Institute on October 16, 2008 at Keaau High School . There we offered interested teachers the opportunity to see what programs we offer and the services we could provide their students. 9) We continued to provide coaches trainings throughout the year and now require each coach to be a certified coach through our sports training program. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 Special Olympics Hawaii - Agency Name Special Olympics Hawaii -East Hawaii - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Athlete & Special(Unified)Partner 243 256 260 participants Volunteers from the community 431 435 440 Family Members 101 110 115 Management team members 10 12 12 Community Service Projects 1 1 1 State Competitions attended on 3 3 3 Oahu Area /regional competitions attended 7 8 8 Delegations(Schools) within the 6 7 7 DOE system participatiang Total number of delegations 8 8 9 participating this year Number of family events provided 3 3 3 Number of volunteer hours provided 10,231 10,700 10,850 by volunteers for training, competitions and fundraising (Note: these figures are not dollar amounts, but rather in the number of people, events, schools or hours) *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 2140 2140 2140 Professional Fees 0 0 0 Operations 90,088 128,080 106,320 Equipment 4,589 6,440 6,600 Other" Total 96,817 136,660 115,060 * If applicable " Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 Special Olympics Hawaii - Agency Name Special Olympics Hawaii -East Hawaii - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii Grant 12,000 20,000 20,0000 Foundations 10,500 4,000 5,000 Individual contributions 8,065 9,250 11,600 Corporate contributions 6,250 5,250 4,500 Special events 43,537 43,400 34,000 HSO Co -op monies 2,560 3,450 2,200 Interest Income 900 500 500 Merchandise sales 24,704 35,400 37,160 Service Clubs 0 100 100 Total 108,516 121,350 115,060 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? 2010 -2011 plant to increase revenues to support our programs: 1) We are planning to expand our Mile of Quarters fundraising campaign to more businesses. Currently we have 6 businesses participating and we hope to add a few more. 2) We are planning to add a 5 fundraiser which we will sell products in the fall of the year to generate approximately $5,000- $7,000 more income. 3) We will be applying for more grants that come available to East Hawaii Non - P rofits. Special Olympics East Hawaii is very diverse in how we raise money to support the athletes, families & volunteers. However, as we continue to meet our mission of continuing to outreach to new athletes, familiy members and volunteers within our community, and with increased costs, our budget continues to grow, so even NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 9 as we get better at raising money, it continues to be difficult to reach our budget without the support of the County of Hawaii. Becoming self sufficient is the ultimate goal of our program, however we do know that if any of our events /grants fail to raise the expected amount of money, our program would change drastically. We would have to cut back on some services that we currently provide and /or we would have to cut back on outreach goals. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 10 Special Olympics Hawaii - Agency Name Special Olympics Hawaii -East Hawaii - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 – 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. 2210 Signature of Board— ' +ent/Chair Date 4.1 s_.._ ate`' o /, / • / Signature of o utive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 11 82 Special Olympics Hawaii - West Hawaii Special Olympics West Hawaii - General Funding Special Olympics West Hawaii - Agency Name SOWH General Funding- Program Name Agency Director: Nancy Bottelo Phone No.: 943 - 8808 x22 Contact Person: David Ross Phone No.: 345 - 1344 Mailing Address: P.O. Box #390358, Keauhou, HI 96740 Facility /Site Address: 77 -296 Kalani Way #2 Kailua -Kona, HI 96740 Fax No.: 808- 943 -8814 Email Address: sowhdave @yahoo.com Name of Accountant/CPA (include name of firm if applicable): Akamine, Oyadomari,and Kosaki CPA's, Inc. Phone No.: 941 - 0500 Mailing Address: 440 Kapiolani Blvd.Suite #900,Honolulu, HI 96814 Amount of Request for County Funds: $15,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $10,000 $12,000 $12,000 Agency Mission Statement: The mission of Special Olympics is to provide year -round sports training and athletic competition in a variety of Olympic -type sports for all children and adults with intellectual disabilities, giving them continuing opportunities to develop physical fitness, demonstrate courage, experience joy and participate in a sharing of gifts, skills and friendship with their families, other Special Olympics athletes and the community. Special Olympics West Hawaii - Agency Name SOWH General Funding Program- Program Name Program Description: Special Olympics believes that people who are isolated from life experience by a disability have little chance for the development growth and acquisition of important skills that they will need to gain employment, maintain relationships and function independently as adults. Special Olympics helps to give individuals with a intellectual disability the necessary skills to achieve that independence. We believe that all people regardless of their disability deserve to lead full, active lives, enriched with social and recreational opportunities that most of us take for granted. Unfortunately, appropriate physical education programs in the public schools and social service programs that realistically address the special needs of this population are virtually non - existent. Special Olympics West Hawaii fulfills that need and provides the necessary skills for people to continue good health throughout their lives within our community. Thanks to the Hawaii County grant, Special Olympics West Hawaii is able to continue to provide many opportunities for the special needs individuals in our community. The benefits that all the athletes receive from their participation in Special Olympics include: improved physical fitness and motor skills, greater self- confidence, a more positive self- image, friendships, and increased family support. Special Olympics athletes carry these benefits with them into their daily lives at home, in the classroom, on the job, and in the community. Families who participate become stronger as they learn a greater appreciation for their childs' talents. We have found that many of our strongest supporters and best volunteers are the family members of our Special Olympics athletes. We provide a "safe haven" for families where they know that their child is not judged and is accepted for who they are and for what they can do. Community volunteers find out what good friends the athletes can be and make long lasting bonds that continue off of the sports field. Everyone learns more about the capabilities of people with intellectual disabilities, and a huge majority of our volunteers continue with the program year after year. These active volunteers are often a source of new volunteers to the program as they share their stories with friends, neighbors and co- workers. Special Olympics West Hawaii Unified Sports Program is a vital program where these special needs individuals interact with their non - handicapped peers on a weekly basis. Unified Sports is a program that combines equal numbers of athletes with intellectual disabilities and special partners without disabilities. All participants are of similar age and athletic ability. This program dramatically increases inclusion of our athletes into the community by helping break down barriers that have historically kept people with and without disabilities apart. Special Olympics West Hawaii will have unified softball and bowling teams in FY 2010 -11, and will expand on our 14 unified bocce teams. The need for the Special Olympics West Hawaii program to continue here on this island is extremely high. There is no other program in our Area to provide these services to our athletes. Special training is provided for our athletes and the coaching staff throughout the year. The training is essential due to the unique services that we provide. We not only touch the lives of our Special Olympics athletes, but also their families and the hundreds of volunteers from our community. Our founder, Eunice Kennedy Shriver, believes sports training and competition opportunities should be available for all who qualify rather than all who could afford to participate. Therefore, our program is free of cost to all of our athletes, special partners, and coaches. We receive no money from the Kennedy Foundation or the Federal Government. Due to this aspect of our program, a volunteer committee under the leadership of our Area Director must raise all the funds needed for our West Hawaii area program. Those funds will pay for all aspects of the Special Olympics program. Our largest needs for 2010 -2011 are; to purchase new equipment for out softball, powerlifting, and soccer teams and to develop a new Kau delegation complete with staff, coaches, uniforms, equipment, advertising and promotional materials. We will also be hosting a neighbor island softball / t -ball tournament. As always, our largest cost is airfare to get our athletes to their competitions where they compete against their peers from around the state of Hawaii. It is an essential part of our program that Special Olympics athletes are provided an opportunity to interact and compete against people of similar athletic ability. Unfortunately our area program is too small to be able to provide quality competition; therefore our athletes must travel to other islands to achieve that goal. The state competitions that are held on Oahu 3 times per year provide many activities that our athletes never have a chance to experience. They include; dances, Opening and Closing Ceremonies, entertainment and games, and free health exams through the Healthy Athlete Program. This Healthy Athlete program provides free dental, vision, hearing, podiatry, flexibility & nutrition screening and education for our athletes. As you know, these services are sometimes not available to individuals with disabilities due to financial difficulty or lack of professionals who are trained to treat people with disabilities. Special Olympics West Hawaii wishes to continue to provide these opportunities to all the athletes that are currently involved and be able to reach out to new special needs individuals throughout our communities. In order to do this, we will need funds to maintain our services and to purchase new uniforms and equipment as well as provide transportation for athletes to get to competitions. Special Olympics Hawaii -West Hawaii Area is asking for $15,000.00 from the County of Hawaii to help fund our Special Olympics West Hawaii program activities. Total Budget and Position Count Total Program Budget $59,100 Total Program Position Count 1 Total Agency Budget $1,683,207 Total Agency Position Count 18 Program Objectives: 1) Add a Kau delegation in order to provide services to South Kona. 2) Re- vitalize and train a new Head of Delegation for our Waimea delegation. 3) Continue to add community service events to give back to the community that is so supportive of us. We have signed up with PATH to get more of our athletes enjoying our local nature. 4) Continue Unified Sports programs to involve more family members and general public. 5) Train new delegations on ways to maintain current and new athletes, coaches and volunteers. 6) Provide financial support for current sports. 7) Provide quality activities for families and athlete support systems. 8) Continue to provide high quality training and competition to the intellectually disabled in the West Hawaii region. 9) Expand and get more involved with local schools with the goal of beginning delegations in them. 10) Increase fundraising opportunities for Special Olympics West Hawaii. 11) Continue to provide athletes an opportunity to be involved with planning and attending social events. 12) Provide athletes with additional opportunities of learning, broadening community awareness and self sufficiency with our partnerships with local organizations such as the Arc of Kona and Full Life Hawaii. 13) Expand our management team to include more members of our community and business owners. Program Highlights: (from Fiscal Year 2009 - 10) 1) Purchased new professional uniforms for T -ball, basketball, and bocce uniforms. Our athletes and unified partners look professional and project more pride and self confidence in their new uniforms. 2) Added the "Project Compassion" fundraiser to our yearly campaign. This event also helped to introduce our program to many new people and businesses in the area. 3) Expanded the "Fueling Dreams" and "Miles of Quarters" fundraisers to increase our revenue stream. 4) Received the Air National Guard flight credit for our travel to Holiday Classic saving us several thousands of dollars. 5) Trained and competed in 8 Special Olympics official sports. 6) Launched and operated sowh.org, a great website to keep the program members and community up to date with SOWH happenings. The site features athlete bio's, tons of great pictures, and a section to thank local businesses. 7) Special Olympics West Hawaii volunteered at 2 grounds keeping and planting sessions at the West Hawaii Veterans Cemetery, and a beach clean -up at Old Airport Park. 8) Extended the knowledge of what Special Olympics is all about through press releases, newspaper articles, other printed materials and radio spots. 9) Created professional quality yearbooks for all athletes, volunteers and coaches, which inspire pride and joy. 1 0) West Hawaii has made more events, meetings and competitions increasingly open to the public with press releases and the website. 11) Continued the development of our Unified Partner program with training and competing in unified Bocce (lawn bowling) for 2 seasons instead of 1 as in years previous. 1 2) Continued to support family specific events and booths at competitions. Our Kona Panthers basketball team won silver at the state games for the first time in 8 years. 13) Added and certified 5 new coaches and several new volunteers. 1 4) Expanded our community partnership with the Kona Rotary Club to provide support to their community projects. • Special Olympics West Hawaii - Agency Name SOWH General Funding - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Community Service Projects 8 9 10 State Competitions on Oahu 3 3 3 Area / Regional Competitions 9 10 10 Competitions Held in West Hawaii 3 4 4 Number of Family / Community Events 8 9 9 Number of West Hawaii Athletes 36 38 40 Number of Special Partners 28 30 30 Number of Unified Bocce Teams 6 14 12 Number of Families Involved 35 37 40 Number of Local Business Contacts 6 8 10 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 9260 10000 10500 Professional Fees 2000 2200 2200 Operations 10000 11000 10300 Equipment 8000 900 1100 Other" 23000 25000 27000 Total 52260 57,200 59100 * If applicable " Please explain in detail on separate sheet Special Olympics West Hawaii SOWH General Funding Other Program Expenditures FY 2010 -2011 Estimate Break -Down $27,000 1. Flights $17,000 2. Lodging $5,000 3. Meals $3,500 4. Coaches Training $1,500 TOTAL $27,000 Special Olympics West Hawaii - Agency Name SOWH General Funding - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii Non - Profit Grant 12000 15000 15000 Private Donations 4500 5000 5500 Cop -on -Top 12000 12000 13000 Corporate Contributions 3500 3500 3500 Underpants Run 3500 3500 3600 Fueling Dreams 3500 3500 4000 Project Compassion 0 0 2000 Visitor Industry Charity Walk 10000 10000 10000 SOHI Co -Op Money / Weinberg 3000 2000 1000 Interest, In -Kind, Merchandise, Other 1350 700 1500 Larry Mitchell Memorial Fund 2000 2000 0 Total 55,350 57200 59100 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? 1) We are planning to increase our donations for our Cop on Top event in 2010. 2) We will plan to expand our Fueling Dreams event with the Law Enforcement personnel in Kona in partnership with Tesoro. We would like to make it a 2 day event instead of a one day event, due to economy we projected a very modest increase. 3) We will work with the Air National Guard to hopefully receive the free airlift from Kona to Oahu for our State Games in December, saving us thousands of dollars. 4) Due to the economic forecast, we believe we will just maintain our individual and corporation revenues. However as we continue to meet our mission of continuing to outreach to new athletes, family members and volunteers within our community, our budget continues to grow, so even as we get better at raising money, it continues to be difficult to reach our budget without the support of the County of Hawaii. Becoming self sufficient is the ultimate goal of our program, however we do know that if any of our events /grants fail to raise the expected amount of money, our program would change drastically. We would have to cut back on some services that we currently provide and /or we would have to cut back on our outreach goals. Cutting any services would be tragic since in many areas we are the only services of our kind to the community. Special Olympics West Hawaii - Agency Name SOWH General Funding - 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. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. I /24/201 0 Signature of Board ident/Chair Date l� ri I4s4ati. _.�� 1%C1 n Signature of Efcutve Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! 83 Sure Foundation, Inc. Yeshua Outreach Center Sure Foundation, Inc.- Agency Name Yeshua Outreach Center- Program Name Agency Director: Ben Kawakami Phone No.: 966 -6489 Contact Person: Andrea Miday Phone No.: 966 -6489 Mailing Address: P.O. Box 1598 Kea'au, HI 96749 Facility /Site Address: 16 -1592 Pohaku Circle Kea'au, HI 96749 Fax No.: 966 -6712 Email Address: andrea @surefoundation.tv Name of Accountant/CPA (include name of firm if applicable): Carolee Fernandez, Strategy By Numbers, Inc. Phone No.: 808 - 982 -3900 Mailing Address: PO Box 4130 Hilo, HI 96720 Amount of Request for County Funds: $70,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $0 $65,000 Agency Mission Statement: Sure Foundation's mission is to build bridges and connect people to Christ. Our vision for the Yeshua Outreach Center is to impact lives, families and our community through Yeshua, which is Hebrew for healing, wholeness and victory. Our mission is to turn lives around through quality Christ- centered mentoring, fitness and support programs. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Sure Foundation, Inc. - Agency Name Yeshua Outreach Center- Program Name Program Description: The Yeshua Outreach Center (YOC) at Sure Foundation in Puna, Hawai'i is designed to provide an alternative outlet for whole families in the community to focus their energy and set personal goals for their future. We hope that by providing a nurturing environment, which focuses on three athletic programs, boxing, weightlifting, and martial arts, we can give families in our community a positive environment in which to develop. In addition to these athletic programs, we offer counseling and community service programs in drug and alcohol abuse, nutrition, and outreach to youth. We hope that in the process of pursuing personal fitness goals, we can offer members of our community some guidance and mentoring that will help prevent them from the distractions of drugs, alcohol and crime. This model for drug and crime prevention has been proven in many cities and communities throughout our country. By combining efforts with local law enforcement and justice department officials, we hope to mainstream our efforts to the broader community. Sure Foundation church has offered their large recreational gymnasium as a site for our center, and all of our volunteer staff are members of either the Hilo or Puna branches of the church. In addition to providing a home for the YOC and helping fund some of its expenses, Sure Foundation has devoted some of its paid employee resources to help coordinate volunteers of the Yeshua programs. Total Budget and Position Count Total Program Budget $225,275 Total Program Position Count 1.8 FTE Total Agency Budget $1,032,855 Total Agency Position Count 8.0 FTE Program Objectives: 1) To enhance membership by 20% though increased enrollment of community members and expansion of our boxing, weightlifting, and martial arts programs (ongoing enrollment throughout the year) 2) To hold regular boxing exhibitions to promote the athletic programs offered by the Yeshua Center (5 -6 per year, first event scheduled for February, 2010) 3) Increase the transportation ability for Friday night youth events to enable more area teens to participate in the youth outreach program 4) To coordinate program schedules with the local school system, specifically, Kea'au and Pahoa High Schools, to facilitate enrollment of youth for after school and intercession programs (2 quarter, 2010) 5) To formalize the weightlifting program as a centerpiece for the boxing and Universal Kempo Karate programs by installing new weightlifting equipment (3` quarter, 2010) 6) To involve local private businesses and organizations, such as other Hawaii USA Boxing clubs, Rotary, County government, local Fire and Police Departments, University of Hawai'i Hilo, YMCA, AG Churches, Teen Challenge Hawaii, and HIANG/HIARNG, in our Yeshua programs to further assist our community families and promote awareness of the Yeshua Center NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Sure Foundation, Inc. - Agency Name Yeshua Outreach Center - Program Name Program Highlights: Boxing Program • Yeshua Center Boxing program held 4 USA Boxing - sanctioned amateur events during 2009. These events are highlighted as follows: 1. February 27 2009, 26 amateur bouts, attended by over 400 people 2. June 27 2009, 21 amateur bouts, attended by almost 300 people 3. August 28 and 29 2009, 2 day competition featuring 47 bouts, attended by over 600 people 4. December 19 2009, 17 amateur bouts, attended by over 250 people • Each of these boxing special events were heavily publicized in local media, and well attended by local and state representatives • Currently the boxing program has 47 boxers regularly enrolled and attending the program, with as many as 115 different boxers having enrolled for some months of 2009. It is common for boxers to enroll for a few months and take a leave of absence due to time constraints, school breaks and affordability of enrollment. Universal Kempo Karate • Universal Kempo Karate (UKK) at YOC currently has 30 karate students enrolled and actively participating in training and special events (an increase of 30% from last year) • During the past year, UKK has had regular testing and rank promotions every 2 months for the 23 -30 students enrolled • In addition, UKK members have participated in 2 local sparring competitions in Kamuela, Hawai`i, coordinated with other Big Island UKK programs during 2009 Synergy Youth Outreach • Synerg Youth Program holds regular Friday night meetings for youth between 6 and 12 grades with free dinner and sports, break - dancing and other activities run by volunteers from Sure Foundation • The Synergy Youth program has become tremendously popular having up to 120 youth attending their Friday night events (this is an increase of 50% from last year) • We are actively looking for solutions to help provide transportation on Friday nights for youth who wish to attend, but have no ride to and from the events Weightlifting Program • At the end of 2009, enrollment in YOC Weightlifting stood at 42 members (up from 18 members a year ago) • During 2010, we are actively engaged in upgrading the weightlifting equipment and facilities, and enrollment should expand rapidly if we realize our goals. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Sure Foundation, Inc. - Agency Name Yeshua Outreach Center - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Boxing enrollment (5% increase 45 70 90 monthly) Karate enrollment (5% increase 23 30 35 monthly) Weightlifting enrollment (5% 12 20 30 increase monthly) Friday Night Youth attendance (5% 80 120 140 increase monthly) Total enrollment in Yeshua 160 240 295 Reduction in school absenteeism of NA NA Reduce by youth involved in programs 50% Recidivism rates for law offenders NA NA Reduce by who become members 50% Attendance rate of members NA NA >90% *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages $40,000 $48,000 $54,000 Professional Fees $2,850 $7,700 $5,700 Operations $62,000 $96,825 $80,125 Equipment $19,500 $70,875 $85,450 Other* Capital Costs $5,000 $30,000 $0 Total $129,350 $253,400 $225,275 * If applicable "Please explain in detail on separate sheet * * * See attached spreadsheet for breakdown of estimated expenses for each program NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 -< cp cn r. CD 2 § CD c O ƒ \ ' § -, a 7 ID S \/ � \ / 7 Yeshua Outreach Center £ e!■ ■metre Estimate Breakdown b P o r ,201%!211 5 ul @ f g § \ « «+a and Professional Fees O, mt s Equipment Other: Dry C» , / fr Boxing Program vii %.c »3m 2. SO TO co / me m G, SO 237 pa9 SO q co er!!!m pmi 2 gag >m W "< § Outreach Ai SO 2,000 gsuy a ] z Special Events Volunteer w yfm 514,000 a 2 m Ad i km $54.000 S2,100 w d s! gam a ) § Total S54.000 55,700 9922 25.45() a m ` Administrative Operating c± include wm m t Wfacility ;&Glm0Z (35,000 i t 12 s) Sure Foundation, Inc. - Agency Name Yeshua Outreach Center - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County Grant $0 $107,450 $70,000 Tuition from membership $6,125 $23,750 $25,100 Net Income from special events $1,800 $7,200 $8,000 Healing Our Island $3,955 $4,000 $0 Cash Donations $2,000 $3,000 $3,000 Sure Foundation will cover all $40,000 $48,000 $54,000 salaries of permanent staff Sure Foundation will donate its $50,000 $60,000 $60,000 recreational facility for Yeshua ($5000 /month in -kind) Sure Foundation will cover shortfall $25,470 $0 $5,175 Total $129,350 $253,400 $225,275 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Over the next year, the YOC will continue to work on a limited budget comprised of a few paid church employees donating part-time to running YOC, a volunteer work force made up of Sure Foundation church members to run the programs, a recreational facility donated by Sure Foundation Church and used equipment donated from local businesses and organizations (with the exception of equipment purchased using County grant funds). This year, we anticipate growing interest from local businesses and state agencies through promotions, partnerships and community support. Our long -term goal is to support the operating costs of YOC from a combination of revenue sources, including, but not limited to: membership dues from increased enrollment, business partnerships, endowment and state agency funding. The goal is to make YOC self - sustaining within four more years. At that point, we hope to have at least 300 hundred members enrolled in tuition based athletic programs (approximately $100,000 revenue per year), increased revenue from special events sponsored by YOC, multiple businesses donating equipment and supplies for the fitness programs, funds donated through the church allocated for an endowment, and a good track record established with local judges and correctional facilities. By having Sure Foundation lend its support throughout our growth, we hope to gain momentum for this important community program over the next year and quickly develop our own independence. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Sure Foundation, Inc. - Agency Name Yeshua Outreach Center - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'! Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. /J ,/ .2/1/4 Signature of Board President/Chair Date r l v Rio Signature of Executive 1p ector Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 84 Volcano Health Collaborative Volcano Connections Volcano Health Collaborative - Agency Name Volcano Connections - Program Name Agency Director: Richard Behenna Phone No.: 985 -7408 Contact Person: David Goodman Phone No.: 985 -8893 Mailing Address: PO Box 183, Volcano, HI 96785 Facility /Site Address: None (Work is to be done from program co- ordinator's home.) Fax No.: None Email Address: Info @volcanohealth.org Name of Accountant/CPA (include name of firm if applicable): David Goodman Phone No.: 985 -8893 Mailing Address: PO Box 1084, Volcano, HI 96785 Amount of Request for County Funds: $24,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $0 $0 $0 Agency Mission Statement: The Volcano Health Collaborative is a community -based organization incorporated in January 2005 to improve the health status of residents of the Greater Volcano area by increasing access to quality, affordable medical, dental and associated health care. The organization is a 501(e)(3) non - profit. The Volcano Health Collaborative mission is broad in order to address the diverse and changing needs of the community. Funding is sought for specific projects that improve health care for the Greater Volcano community. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Volcano Health Collaborative - Agency Name Volcano Connections - Program Name Program Description: Volcano Connections is a member -based program that supports self - sufficiency, stability and choice for seniors and people with disabilities in the Greater Volcano area. (See accompanying narrative for full detail.) Total Budget and Position Count Total Program Budget $30,000 Total Program Position 0.5 Count Total Agency Budget $30,000 Total Agency Position Count 0.5 Program Objectives: 1. Hire program coordinator (within 2 months of receiving grant). 2. Identify existing resources for seniors and individuals with disability (3` month). 3. Create a pool of volunteers and service providers (3 & 4 month & ongoing). 4. Publicize the program through non -paid news items (from the 3` month). 5. Recruit 40 members by the end of the program year. Program Highlights: (from Fiscal Year 2008 - 09) Volcano Connections is a proposed new program of the Volcano Health Collaborative for which we are seeking funding. (See accompanying narrative for other programs of the Volcano Health Collaborative.) NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 Volcano Health Collaborative - Agency Name Volcano Connections - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate New Members Added N/A N/A 40 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 25,000 Professional Fees 600 Operations 2,940 Equipment 1,460 Other" 0 Total N/A N/A 30,000 * If applicable x Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Volcano Health Collaborative - Agency Name Volcano Connections - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Membership Fees N/A N/A 6,000 Hawaii County Non - Profit Grant N/A N/A 24,000 Total N/A N/A 30,000 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Volcano Connections is a member -based program. Revenues will come from new and renewed membership fees, with membership increasing each year. We project the program to become self- sustaining in three years. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Volcano Health Collaborative - Agency Name Volcano Connections - 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. ( fir /r0 Signature of Board President/Chair Date Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 C • unty of Hewer(' Hon- profit Grant App@ication Fiscal Year 2010 -2011 Accompanying Narrative Submitted by Volcano Health Collaborative, January 27, 2010 ABSTRACT This accompanying narrative contains details of our proposed community -based program Volcano Connections. Volcano Health Collaborative 1 Volcano Connections 1. Agency Mission Statement The Volcano Health Collaborative is a community -based organization incorporated in January 2005 to improve the health status of residents of the Greater Volcano area' by increasing access to quality, affordable medical, dental and associated health care. The organization is a 501(c)(3) non - profit. The Volcano Health Collaborative mission is broad in order to address the diverse and changing needs of the community. Funding is sought for specific projects that improve health care for the Greater Volcano community. 2. Program Description Volcano Health Collaborative is seeking funds to create "Volcano Connections" which is a member -based program. Meet Kalani. He is 78 and lives alone in Volcano. In the last 5 to 10 years, his health has been declining. Kalani fell on Thanksgiving morning last year. What are the daily challenges facing a person like him? Kalani's eyesight is not clear; he is unsteady on his feet and not as strong as he used to be. Daily activities like driving and walking are challenging. He now depends on others, when they are available, to drive him to his medical appointments and to do errands. He no longer does the volunteer work that kept him connected to his community. Emotionally it has been very difficult for him to accept his advancing age — before the fall, Kalani drove everywhere despite some minor crashes. Now, he is less mobile and independent. This has put an emotional strain on him. Kalani is afraid that his condition will force him to leave his community. Kalani's story is not unique. He is part of the growing aging population in Hawai'i where people are living longer, more so than in any other state in the country Imagine individuals who are born with a disability or have become disabled regardless of age. Like Kalani, they may face similar challenges or more. What are the needs of seniors and those with disability? How can these be addressed? These concerns have shaped our proposed community -based program "Volcano Connections ". Our aim is to identify existing services and to discover and develop untapped community resources that will meet the needs of seniors and people with Greater Volcano covers the area from Glenwood Road to the Golf Course, and includes both sides of Highway 11. 2 According to the Hawai'i County Office of Aging (Planning & Service Area IV), Hawai'i County is experiencing a significant increase in its aging population. In 1980, every 7 person was 60 years or older. By 2020, every 4` person will be 60 years or older. This is an expected increase of 110,997 individuals to 203,050 individuals in 2020. Volcano Health Collaborative 2 Volcano Connections disabilities living in Greater Volcano, through membership of Volcano Connections By doing so, we support activities of daily living and self care so people like Kalani are able to live in their community for as long as possible. Volcano Connections is a member -based program with membership renewable through a yearly subscription. Residents of Greater Volcano can become members if they think they will benefit from the program. The program works with its members to identify their needs and develop successful solutions. Thus, it is a customized and member - directed program. The County of Hawai'i Office of Aging stated that "the idea of a membership based program is unique to the home and community based service system and also incorporates the client directed focus that currently has very strong national support in the aging network. " Membership services are organized in 3 phases: INTERVIEW CONNECTIONS i % is Y EVALUATION (. INTERVIEW W An initial interview will be conducted for every member to identify and assess his or her needs. These relate to the following: • Health status • Medical care plan • Transportation capacity • Household safety • Nutritional adequacy • Individual priorities • Desired level of community interaction Almost 25% of the people living in the area are at least 65 years old or have disabilities. This is a rural area with very limited public transportation to Hilo. Mobility is a challenge for those without their own transportation. There is also no permanent health facility in Greater Volcano. ° Personal communication from Vicki R. Belluomini, Aging Program Planner, County of Hawai'i Office of Aging. Volcano Health Collaborative 3 Volcano Connections CONNECTIONS Once needs are identified, connections are then made to community resources and may include but are not limited to the following: • Health (e.g. nursing services) • Public (e.g. Medicare & Medicaid) • Transportation (e.g. pick -up of medication from Hilo or mail pick -up from post office) • Household (e.g. house chores and cleaning, clearing of gutters, tree cutting) • Home care (e.g. certified nurse assistant services) • Food (e.g. delivery of meals or grocery shopping) • Legal (e.g. drawing up of wills) • Community (e.g. local social events) Volunteers or Local service providers may provide these resources. Volcano Connections will negotiate for discounts from local service providers. EVALUATION We will evaluate the connections made and have ongoing follow -up to ensure solutions are delivered. Follow -up interviews will be provided to members on a regular basis. Volcano Connections is a member -based program that supports self - sufficiency, stability and choice for seniors and people with disabilities in the Greater Volcano area. • Self - sufficiency Members can obtain information or get connected to resources they need, get support for self -care and activities of daily living. • Stability When members are able to do the things they value and have done before, disruption is reduced. Whether now or 6 months from now, the program provides support as needed. Thus, the quality of life for members is restored and maintained. • Choice This program supports the choice and ability of members to continue living independently in their own homes and community. It reduces the need for them to move in with family or be placed in a long -term care facility. The basic concept on which Volcano Connections is based has been successfully used in the famous Beacon Hill Village in Boston, Massachusetts In Hawai'i, St. Francis Healthcare System announced a similar program on Oahu in May 2009 but has not been fully implemented. Volcano Health Collaborative has been working on the concept for this program for more than a year and we are ready to implement it once funding is granted. We hope to be the first active program of this type on the island and serve as a model for other community -based programs on this island and statewide. 5 For more details see www.beaconhillvillage.org Volcano Health Collaborative 4 Volcano Connections 3. Total Budget and Position Count Total Program Budget: $30,000 Total Program Position Count: 0.5 FTE Volcano Connections is a proposed program for which Volcano Health Collaborative is seeking initial funding. This amount is based on the estimate for the first year of operation. The position count is for a half -time program coordinator supplemented by volunteers. 4. Program Objectives To initiate our proposed program, the following tasks need to be done: 1. Hire program coordinator (within 2 months of receiving grant). 2. Identify existing resources for seniors and individuals with disability (3 month). 3. Create a pool of volunteers and service providers (3 & 4 month & ongoing). 4. Publicize the program through non -paid news items (from the 3 month). 5. Recruit 40 members by the end of the program year. 5. Program Highlights Volcano Connections is a proposed new program of the Volcano Health Collaborative for which we are seeking funding. However, we have highlighted here the focus of other activities • Community awareness and health education o "Health Sunday" with blood pressure screening, blood sugar testing and health counseling on the last Sunday of each month at the Volcano Farmers' Market o Organizing health briefings for the community o Establishing a website with local, regional and national health information at www.volcanohealth.org. • Disaster preparedness o Collaborating with the County of Hawai`i and providing CERT training — the first class graduated in December 2007 and the second class graduated in October 2008. 6 Available at www.volcanohealth.org Volcano Health Collaborative 5 Volcano Connections • Made progress towards creation of a permanent health care facility in Greater Volcano to serve the upper Puna and northern Kau Districts — The Greater Volcano Health Center. Over 550 hours of in -kind volunteer effort were delivered in 2007 at a value in excess of $19,000. o Community Needs Assessment completed - 2006 o Findings and Recommendations completed — 2007 • Criteria for Site Evaluation • Structure and Mode of Service Delivery o Business Plan development and implementation - ongoing 6. Performance Measures Volcano Connections is a member -based program with an annual subscription. The key to continuing membership is satisfaction with the program. The key to new membership is perceived benefits to daily lives. We see increased membership (new and renewed) as the primary measure of our program's success. Recruitment: 40 members by end of the program year Program revenue (membership fees): $6,000 in 1 year 7. Program Expenditures We assume the program coordinator is initially working half time at 20 hours per week. Volcano Connections 2010 - Budget 2011 Payroll 20,000 Payroll Taxes & Benefits 5,000 Insurance 1500 Telephone 600 _ Professional Services 600 Travel 600 Office Equipment 1,000 GE Tax 240 Supplies & Misc 460 Total 30 Volcano Health Collaborative 6 Volcano Connections 8. Program Funding Sources We anticipate our funding to come from: 1. Income (membership fees) from the program itself, i.e. $6,000. 2. Hawai'i County Non - Profit Grant, i.e. $24,000. Total funding is $30,000. 9. Future Program Support Volcano Connections is a member -based program. Renewed and increased membership is projected to make this program self - sustaining in 3 years. ... end ... 85 Volunteer Legal Services Hawaii County of Hawaii Pro Bono Legal Services VOLUNTEER LEGAL SERVICES HAWAII- Agency Name County of Hawaii Pro Bono Legal Services- Program Name Agency Director: Moya Gray Phone No.: 528 -7051 Contact Person: Moya Gray Phone No.: Same Mailing Address: 545 Queen Street, Suite 100 Honolulu Hawaii 96813 Facility/Site Address: 545 Queen Street, Suite 100 Honolulu, Hawaii 96813 Fax No.: (808)- 524 -2147 Email Address: moya ©vlsh.org Name of Accountant/CPA (include name of firm if applicable): James Jennings Phone No.: (808) 942 -8813 Ext. 24 Mailing Address: 1600 Kapiolani Blvd. Suite 730, Honolulu, HI 96814 Amount of Request for County Funds: $55,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $000000.00 $00000.00 $55,000 Agency Mission Statement: Volunteer Legal Services Hawaii was created by the Young Lawyers Division of the Hawaii Bar Association in 1981 as one of the country's first pro bono legal organizations whose mission was to give low- income people access to justice by matching them with expert pro bono lawyers. The organization serves the NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 indigent, working poor, children and elderly creating access to legal services they could not otherwise afford. Today, Volunteer Legal Services Hawaii serves people who are at or below 200% of the federal poverty guidelines in all four counties of the State of Hawaii. Volunteer Legal Services Hawaii operates on a volunteer service delivery model, thereby both reducing costs and providing professional expertise. Unlike other legal service providers, such as Legal Aid Society of Hawaii, that hire lawyers to deliver professional services, Volunteer Legal Services Hawaii's employed staff generally provides administrative support to its volunteer lawyers and other community and professional volunteers who provide client services. This method has proven effective at keeping costs low while delivering high quality legal services. With strong support from the private bar, the Supreme Court's adoption of Rule 6.1 of the Hawai'i Rules of Professional Conduct, urging all attorneys to donate 50 pro bono hours per year, has further strengthened pro bono service as a viable method of delivering essential legal services to the vulnerable populations of Hawai'i. Over its 29 years of existence, Volunteer Legal Services Hawaii has matured and its programs are well known within the community. Volunteer Legal Services Hawaii has a staff of 12.2 FTE employees and a pool of 850 volunteers on its roster; it is governed by a Board of Directors and managed by an experienced executive director, Moya Gray, who has over 29 years of legal and administrative experience and community leadership in Hawai'i. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 VOLUNTEER LEGAL SERVICES HAWAII - Agency Name County of Hawaii Pro Bono Legal Services- Program Name Program Description: NEED FOR LEGAL SERVICES: As a country, we pride ourselves on living by the "rule of law" ensuring that whether one is in the majority or a minority, everyone has the right to be treated in a just manner and that everyone has enforceable rights. However, the system of laws that has grown up with this country has become so complex that one needs a lawyer to navigate them through many different contexts. For those who can afford it, being represented by a lawyer is their only way to access our system of justice. Unfortunately, the cost of lawyers is high. For those who are unemployed, earn low wages, are ID, elderly or young, work two jobs, are caring for a parent or a child, or who are simply disadvantaged, hiring a lawyer is not a realistic possibility. For these people, lack of earning power effectively locks them out of the halls of justice. In 1993 the Spangenberg Report, a survey of the civil legal needs of the low - income community in the State of Hawaii, found that only 10% of the legal need was then being met. Since 1993 the rate of poverty in Hawaii has only climbed. Today Hawaii has a homeless population the growth of which is rapidly outstripping our ability to help. With the economic downturn we anticipate the low- income population needing legal services to grow significantly. In 2005 the Access to Justice Hui, composed of representatives from multiple legal services providers including Volunteer Legal Services Hawaii, conducted an assessment of civil legal needs and barriers of low and moderate - income people in Hawaii, the results of which were published in 2007. See Achieving Access To Justice For Hawaii's People at http: / /www.hsba.org /resources /1 /Documents /Access %20to %20Justice. pdf (hereinafter "Report"). The Hui collected information from a variety of sources to determine the current extent of unmet legal needs, identify barriers to getting legal help, and receive community recommendations to improve access to justice. Report at i. In summary, the Report noted an increase of 28% of those living below the poverty line; that only 1 in 5 low and moderate - income residents have their legal needs met; that legal service providers are only able to assist 1 in 3 of those who actually contact them for assistance, that the areas with the greatest unmet civil legal needs are housing (24 %), family (23 %), domestic violence (8 %) and consumer (7 %). Significant barriers to obtaining legal assistance, in addition to not be able to pay for a lawyer, include language and cultural barriers, lack of NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 knowledge of one's rights, lack of knowledge of available services and difficulty in access legal service programs. Report at ii. More significantly, despite there being 2 general legal service providers, the report found that of this group of people only 1 of every 3 people was served by a legal service provider because the legal service provider lacked capacity to serve the other 2. Volunteer Legal Services Hawaii has seen this very real need grow over the past few years. Between 2007 -2008 Volunteer Legal Services Hawaii experienced a 30% increase in demand for legal services across the State of Hawaii and in 2009 we again saw an 13% increase over the prior year in demand for services. The County of Hawaii saw an increase in demand for services of 18% from 2008 to 2009. BENEFIT TO COUNTY OF HAWAII RESIDENTS Of those living in poverty in our state, over 21,958 reside in the County of Hawaii. With our legal assistance low- income clients will receive legal assistance or other representation, that will help them keep their homes, their jobs, get insurance, see their children or collect child support, keep their children safe, collect social security and other benefits, and maybe even pay off their debts. We assist clients with adoption, guardianship of minors, adults and elders, child custody, visitation and support, divorce, civil rights, landlord- tenant disputes, employment disputes, consumer credit issues including collections, foreclosures, immigration, housing, powers of attorney, paternity, social security, tax liabilities, temporary restraining orders, and welfare issues. Most of the existing legal service providers provide "niche" services — to Native Hawaiians, only to Americans, only to immigrants or only to domestic violence victims. Unfortunately for the low- income community, all of these providers have restrictions on who they can serve. Some restrictions arise out of two low - income people being part of the same suit (lawyers cannot represent people who have or may have competing interests), some restrictions arise because there are restrictions on how many cases an attorney can handle at any one time, some restrictions are placed on who that provider can serve (Congress prohibits Legal Aid from representing non - citizens) — whether from a conflict of interest, caseload or financial restrictions, all of these providers turn people away. If a client is turned away from another legal service provider, such as Legal Aid Society of Hawaii, Domestic Violence Action Center, the American Civil Liberties Union or the UH Elder Law Program because they cannot service those clients, Volunteer Legal Services Hawaii is able to provide legal services to those people who would not otherwise be represented by a lawyer. For those people, without Volunteer Legal Services Hawaii, there would be no access to justice. As Volunteer Legal Services Hawaii provides civil legal services mostly through pro bono lawyers, generally we do not have conflicts of interest, caseload or financial restrictions. Today, there are over 7,000 licensed attorneys who can NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 provide pro bono legal services. Thus the only restriction that Volunteer Legal Services Hawaii's faces is a practical one - the lack of staff to help find lawyers for our clients. TARGET POPULATION: The most recent census results estimate that 10.8% of Hawai'i's population lives below the poverty line. For the County of Hawaii of the total population of 167,293, 13.1% or 21,915.38 people live in poverty. POVERTY IS EXPECTED TO INCREASE: In November 2008 Bloomberg.com reported that Goldman Sachs Group Inc. increased its recession estimates... [projecting that u]nemployment will reach 9 percent by the fourth quarter of 2009." [Emphasis added]. http: / /www.bloomberg. com/ apps/ news ?pid = 20601087 &sid= a6e16aG0f0oA &refer =home. On January 8, 2009, The Center on Budget and Policy Priorities' released its report entitled Number of Homeless Families Climbing Due to Recession, by Barbara Sard (hereinafter "Homeless Families Report") at http://www.cbpp.org/1- 8-09hous.htm. This report projects that if the unemployment rate does rise to 9 percent by the fourth quarter of 2009 and continuing rising into 2010, then the population of homeless families will grow significantly over the next two years. The Homeless Families Report projects that the ranks of the poor could expand up to 10 million and the ranks of those in sever poverty could expand by up to 6 million. As of January 26, 2010, USA Today reports that there are currently 357 properties in foreclosure in the County of Hawaii. http: / /usatoday.foreclosure.com /search. html ?st =Hl &tab= f &z = &cno =001 And as reported in West Hawaii Today on January 26, 2010 10% of Hawaii County's workforce was unemployed in November of 2009, compared to 6.9% statewide. http: / /www.westhawaiitoday.com /articles /2010/01 /26 /local/ /local05.txt Clearly, the recession is beginning to be felt by people across the State of Hawaii but certainly it is hitting very hard those who live in the County of Hawaii. Those who live in poverty have significant needs for qualified legal advice, counsel and representation. Because these individuals have very little discretionary income after paying rent, utilities, food, childcare and bills, they have very limited ability to deal with problems. Therefore, the hardships they face have a serious impact upon their daily lives. More so than those who have the monetary ability to get legal assistance. For example, if your landlord hasn't fixed the broken toilet in your low -rent apartment, you might choose to wait rather than complain and take the chance that your landlord will raise your rent. Poverty seriously restricts an individuals choices, thus, to promote justice, both in the NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 community and in legal proceedings, Volunteer Legal Services Hawaii's mission is to make legal services accessible to the poor, the working poor and the elderly through its programs. These factors are only compounded when these people are homeless or at imminent risk of homelessness. HOMELESSNESS & POVERTY WILL HAVE ADVERSE LONG -TERM CONSEQUENCES FOR CHILDREN: According to the Homeless Families Report, the increase of homelessness will have significant adverse long -term consequences for children: "studies have found that housing instability and homelessness lower academic performance, increase the chance of repeating a grade, and reduce high school completion rates and puts children at greater risk of serious physical health problems." Id at 3. Before the coming of this recession, 19 out of 100 of our State's children lived in poverty. Many of these children, due to a variety of circumstances end up in the foster care system. In 2005, there were 2,762 children in foster care. The western legal system under which Hawaii operates gives no voice to minors, anticipating that the child's interest will be best served by their parents. When the parent or parents are no longer capable of advocating for their children because one or both parents have died, their parental rights are jeopardy, they are incapacitated for medical reasons, drug abuse, or engage in violence, our children have no one to speak out for them. Older children are more likely to take action on their own in an effort to protect their own interests, but they lack education, experience and capacity to truly nurture themselves or the children that they may bring into the world, and they too need legal assistance and support. And other family members, grandparents, aunts and uncles, may want to assist the children, but they too lack the wherewithal, education, experience and capacity to make a difference without legal assistance and support. In 2008 the Honolulu Magazing ran an article entitled "Grading the Public Schools" and gathered performance data from the Department of Education on all public schools. Some of the County of Hawaii schools are well ranked; one school each was ranked at 21, 34, 48, 57, 81 and 97 out of 258, the remainder of the other schools ranked at over 100 out of 258 schools. Five of the schools ranked at 231, 235, 236, 239 and 258. With the increased impact of the recession on the families of the County of Hawaii, we can except this impact to show up in the children's performance at school. OUR ELDERS ARE A SIGNIFICANTLY VULNERABLE AND GROWING GROUP: The kupuna is a very vulnerable group of people. The Report noted that there is an increased elderly population that was particularly in need of legal services and that the support systems have not kept up with the increasing population. Report at A -73. The Hui noted that "[t]he number of seniors living in Hawai'i has increased dramatically as compared to other age groups in the last seventeen years. In 1989 the population of those over 65 was estimated at 125,055. In 1999 that number had grown to 154,598 and in 2006 it was estimated that 174,972 seniors lived in Hawai'i, representing an overall growth of 39.97 %." NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 Report at 11-16. The Hawaii State Plan on Aging 2008 — 2011 (hereinafter "Plan ") notes that for the County of Hawaii, the unmet legal need for those 60+ is significant. The plan's author, the Executive Office on Aging estimates that only 2% of legal needs of this population were being met. For those people 65+ who were living alone, only 7% of the needs were being met. Plan at 11-30. HAWAII IS AT RISK OF INCREASED HOMELESSNESS: The housing market crisis is adding to the risk of increased homelessness as foreclosures push many families in to the rental market, driving up rents in these areas and making housing less affordable. Worse, the Pew Center on the States predicts that 1 in 29 Hawaii homeowners is expected to experience foreclosure by the end of 2010 due to the 'high -cost loan' (subprime mortgages). This foreclosure rate exceeds the USA average of 1 in 33 homeowners. The "ripple effects of those foreclosures are projected to hit more than half of Hawaii's homeowners and cost more than $4 billion in lost property value." See The Pew Center on the States at http: / /www. pewcenteronthestates. org /u ploaded F i les /wwwpewcenteronthestateso rg /Fact_Sheets /Su bprime_state_factsheets. pdf As a significant group of low- income people, Hawaii's homeless need specialized legal advice. Whether because of family problems, consumer credit/debt, landlord/tenant, or employment problems, among a host of others, these people have specialized legal problems that stand between them and their ability to have or keep a home. Non - Profit Organizations that Serve the Same Population: Those non - profit organizations that serve the same population that Volunteer Legal Services Hawaii does, that is the poverty population, also needs legal assistance. Many of these organizations who are struggling to help our community themselves need legal help. These organizations, often with a very small staff and with a small operations budget and no funds for legal services need lawyers to help them comply with the law and ensure that their wonderful programs don't fail. Volunteer Legal Services Hawaii provides advice and counsel and pro bono matching services to this group of worthy and needy non- profit organizations. CURRENT SERVICES PROVIDED IN THE COUNTY OF HAWAII Although we have been providing legal services to residents of the County of Hawaii most of the service was through administrative staff and volunteers located on Oahu. In 2005, however, we began to operate a monthly Neighborhood Legal Clinic in Hilo. The following year we added a monthly Neighborhood Legal Clinic in Kona, and this year we are operating two monthly Neighborhood Legal Clinics in Hilo and one in Kona. Clinics and workshops are provided at facilities located in downtown Hilo and Kona, Hawaii. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 - 11 Page 7 As we have a physical 'presence' in the County of Hawaii only during these 3- hour monthly clinics, these services are not well known in the community. The minimal amount of time we spend in the community means that clients don't know how to find and access legal services from Volunteer Legal Services Hawaii. This fact is reiterated in the Access to Justice Hui's report which found that a significant reason that clients are underserved is because they do not know where to turn to get legal assistance. With the increased demand for services, we want to continue improving our outreach to the communities in the County of Hawaii. This proposal would allow Volunteer Legal Services Hawaii to continue to employ part-time personnel in Hilo and in Kona and to dedicate a small percentage of the Honolulu Staff Attorney's time to clients in the County of Hawaii to support services provided by volunteer attorneys. PROGRAM DESCRIPTION Using staff and volunteers Volunteer Legal Services Hawaii will provide general civil legal services in the County of Hawaii to those who are at or below 200% of the federal poverty guidelines. Services will be offered in locations and times that are convenient for our target populations through the following programs: • Intake & Referral receives all requests for legal services. The Intake & Referral program conducts an intake on each customer to ensure that the person is eligible for all services, that we understand the basic nature of their legal issue and that all data is appropriately recorded. The program staff then make appropriate referrals to both Volunteer Legal Services Hawaii's programs or, if inappropriate or the client is not eligible for services, then referrals to other providers. • The Pro Bono Referral Program provides those clients who need full representation with pro bono licensed lawyers for the life of the matter. • The Neighborhood Legal Clinics provides clients with legal advice, consultation and brief services from general law lawyers or lawyers who specialize in family law. Clients meet with licensed lawyers who provide individualized legal advice, consultation and or a brief service for each client's situation. Neighborhood Legal Clinics are held twice a month in Hilo and once a month in Kona. Should a client's matter require an urgent consultant with an attorney, scheduled appointments are provided individual clients outside of the scheduled clinic times through telephone or face -to -face consultations, depending upon the location and need. • The Uncontested Divorce Workshops are staffed by licensed lawyers (both volunteers and staff), administrative staff and volunteer paralegals. These legal professionals teach clients about the uncontested divorce process, assist clients with completion of all legal documents and file the documents for the clients. These `full - service' Workshops are held twice a month on Oahu. A limited version of the Workshops is currently offered in the County of Hawaii. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 We provide specialized legal services through the following programs: Children's & Special Services Division: Within the Children's & Special Services Division ,Volunteer Legal Services Hawaii offers multiple programs, the primary goals of which are to serve and assist Hawaii's children, elders and others with supportive and legal services. This systemic approach to issues facing Hawaii's children strengthens families and keeps children safe and out of foster care; keeps our kupuna safe and as protected as possible during their times of vulnerability, all of which saves the government hard to find dollars. • Na Keiki Law Center works to promote change in processes, laws, and policies that harm children by advocating on behalf of Hawaii's children who suffer due to legal and familial conflict. Na Keiki Law Center supports children and families in crisis by focusing on the best interests of children whose legal needs and rights are not sufficiently protected by existing legal and social services. When appropriate, we work with others to promote systemic change in government, social, legal, & other systems dealing with children; to identify the legal & psycho - social needs of vulnerable children and families; to identify child - related community problems in order to create effective alleviation strategies & pilot programs for eventual staffing by community volunteers; we develop and implement child- centered programs that employ mediation and other alternatives to litigation in child - related, familial conflicts; we promote community involvement & education in child - related issues; and engage community volunteers to accomplish mission - related tasks. Na Keiki Law Center offers two specific programs in the County of Hawaii that all assist children in some fashion. • Guardianship Services in which staff lawyers, assisted by law students and licensed volunteer lawyers, provide legal assistance and full representation of families in matters involving guardianship of children, thus helping families to take care of their children when parents aren't able. • Parenting Plans Program, a pilot program, in which staff and volunteer lawyers and mediators educate and mediate parenting plans from the best interest of the child standard. Through its Parenting Plan program, Na Keiki Law Center educates parents involved in contested divorce in the realms of child custody, visitation, and co- parenting from separate households in a manner that protects children from the controversy and conflict traditionally associated with the contested divorce process. By educating parents on the potentially harmful nature of the process, mediating parenting plan agreements between parties, and involving extended families in a culturally sensitive process, Na Keiki Law Center hopes to foster a stable and supportive post divorce environment for children. Once mediated the parties can then file these plans in pro se contested divorce cases. Na Keiki Law Center's work to foster stable and supportive post - divorce environments will ultimate help to reduce child maltreatment and ultimately saving the government the cost to both prevent and treat the impact of child abuse, neglect and maltreatment. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 9 • Services to and for the Homeless: Volunteer Legal Services Hawaii offers targeted legal services to those at risk of homelessness as well as the homeless. To help prevent homelessness, legal services, such as legal advice and counsel, pro se workshops, legal education, legal representation and support are offered to all people who are income - qualified. We deliver a variety of pro bono legal services to the homeless members of our community using a combination of paid staff and qualified volunteer legal staff. Total Budget and Position Count Total Program Budget 90,621 Total Program Position Count 3 in County + 6 on Oahu Total Agency Budget 770,390 Total Agency Position Count 12.66 Program Objectives: 1) For the County of Hawaii, we anticipate receiving over 1,990 requests for Legal Services. 2) To meet our objective of providing timely opportunities to meet with a lawyer, we will hold 22 clinics in Hilo (averaging 1.83 clinics a month) and 12 legal clinics in Kona (1 a month) at which a client may see an attorney for advice and counsel, and brief services. 3) We anticipate that we will provide 2 volunteers per clinic, each meeting with a total of 6 clients each, for a total of 449 clients. 4) For those clients whose matter cannot wait until the next scheduled clinic, we will provide virtual clinics for each of those clinics. We anticipate that we will receive requests for virtual clinics from 40 people. 5) We anticipate that we will find 22 volunteers to represent 22 clients in litigated cases. 6) We will provide 10 Uncontested Divorce Workshops of 2 clients each, for a total of 20 clients. 7) We anticipate that we will provide 707 hours of legal services over all at an hourly cost to the County of $70.72 per hour Program Highlights: (from Fiscal Year 2008 -09) 1) The following are the highlights for the County of Hawaii since the start of the program in July 2009: 16% of statewide phone calls for legal assistance from low- income and vulnerable clients came from the County of Hawaii and 248 intake interviews were completed. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 10 2) Operated 35 Neighborhood Legal Clinics 3) Opened and provided legal representation in court for 12 clients 4) Completed legal representation in 4 cases 5) Provided advice and counsel services to 124 low- income clients 6) Provided uncontested divorce workshops and pro se support to 3 low - income clients. 7) Given the drop in state revenues, the DOE has CANCELLED all of the GRADS classes and we are not able to offer this service under this grant. 8) Recruited 5 new volunteers in the County of Hawaii and through new and existing volunteers provided 364 volunteer hours (as of January 26, 2010) worth $83,356. Volunteers will contine to provide pro bono hours to County of Hawaii residents. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 11 VOLUNTEER LEGAL SERVICES HAWAII - Agency Name County of Hawaii Pro Bono Legal Services - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Requests for Legal Services 1970 1990 Advice & Counsel Services 445 449 Full Representation 22 22 Uncontested Divorces 36 20 Neighborhood Legal Clinics 34 34 Young Families In Need 36 10 Volunteer Hours 700 707 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages 64,120 64,120 Professional Fees 3,912 3,912 Operations 20,339 20,339 Equipment 2,250 2,250 Other' Total 90,621 90,621 * If applicable u Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 12 VOLUNTEER LEGAL SERVICES HAWAII - Agency Name County of Hawaii Pro Bono Legal Services - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate TANF funds 0 15,621 Hawaii Justice Foundation 10,000 3,000 Hawaii State Bar Association 2,000 2,000 Donations 1,723 15,000 State Grant -in -Aid 22,000 0 Total 35,723 35,621 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Volunteer Legal Services Hawaii is a non - profit that provides civil legal services through volunteer and paid staff and relative to other delivery models, this model saves money in two ways: first, our legal services are preventative in nature, thus keeping people in their homes and out of homeless shelters, keeping children in safe homes and out of the jurisdiction of the Child Protective Services, and helping families keep their kupuna safe and in their homes; and second, our legal services are provided primarily by volunteer lawyers and, for this reason, are extremely cost - efficient. Volunteer Legal Services Hawaii has sustained this cost effective model for 29 years through a variety of revenue streams, including federal, state and county government funding, foundation grants, and donations from the legal and business community. Using a combination of professional volunteers, paid administrative staff and these varied funding streams, we continually invest in our communities. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 13 VOLUNTEER LEGAL SERVICES HAWAII - Agency Name County of Hawaii Pro Bono Legal Services - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of 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 report will impact the evaluation of your program's or agency's future funding requests. Ashida, Lincoln Jan 27 2010 3:58 PM January 27, 2010 Signature of Board President/Chair Date January 27, 2010 Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 14 86 West Hawaii Community Health Center Adult Emergency Dental Services • West Hawaii Community Health Center Adult Emergency Dental Services Agency Director: Richard Taaffe Phone No.: 808 - 326 -3884 Contact Person: Gayle Hunt Phone No.: 808 - 326 -3894 Mailing Address: 75 -5751 Kuakini Hwy., Suite 203 Kailua Kona, HI 96740 Facility /Site Address: 74 -5599 Alapa St (Old Industrial Area) Kailua Kona, HI 96740 Fax No.: 808- 327 -1939 Email Address: ghuntG%westhawaiichc.org Name of Accountant/CPA (include name of firm if applicable): Nishihama & Kishida, CPAs, INC. Phone No.: 808 -524 -2255 Mailing Address: American Savings Bank Tower 1001 Bishop Street., Suite 1700 Honolulu, III 96813 - 3696 Amount of Request for County Funds: $36,434 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $ 0 $ 20,000* $ 10,000* Previous Count\ funding was for the A Health Center program; current gram request is to support emergency adult dental services at the dental van. recently turned over to WHCHC from the Office for Social Ministry. Agency Mission Statement: The mission of the West Hawaii Community Health Center (WHCHC) is to make quality, comprehensive, and integrated health services accessible to all regardless of income. These services will be culturally sensitive and will promote community well -being through the practice of "rnalama pond". NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 1 Program Description: The Need for Emergency Adult Emergency Dental Services in West Hawaii A report prepared by the Hawaii Primary Care Association in 2005 still holds true in 2010. It stated that, "On the whole, the neighbor islands have greater need and fewer available dentists than Oahu. Many areas have an acute shortage of dentists willing to serve Medicaid and uninsured patients. Not surprisingly, these same areas have the highest rates of poverty, uninsured and Medicaid participation. For example, 58% of the population of Moloka'i and 55`A of the population on the Big Island are either uninsured or covered by Medicaid, compared to 34% on Oahu." For I Iawaii adults, the problem of access to care is extreme because of the very limited number of private practice dentists that accept Medicaid. The participation of our state's dentists in public insurance plans is so low that according to a 2004 report. I-Iawaii "ranked almost last — 46th out of 47 states with available data, for the proportion of dentists (30 %) who offer services to publicly - insured individuals." An example of this on the island of Hawaii is that in a 2006 telephone survey of private dentists, only one dentist will accept new Medicaid patients. Dentists state that they do not accept Medicaid primarily because of the low reimbursement rates, leaving adults with severe and immediate dental problems without options for even an extraction to alleviate pain and infection. Given the downturn in the economy, increased layoffs with resulting loss of health coverage. AND the State's elimination of adult dental benefits for Medicaid recipients, the demand for emergency adult dental services is even more acute with adults in need of emergency care having nowhere to turn but to WHCHC's dental van. Although many van patients will be Medicaid- eligible, Medicaid reimbursements alone cannot fully support these emergency services in Kona. WHCHC's Solution — Adult Emergency Dental Services (dental van) The dental van is the only solution today for Kona's uninsured and low income adults experiencing dental emergencies. Thanks to the generosity of the Office for Social Ministries (OSM), WHCHC has acquired OSM's dental van which WHCHC has been operating at The Friendly Place (Kona's homeless shelter) for two days a week since early October 2009 and increased to three days a week effective January 2010. Total Budget and Position Count Total Program Budget 5215,727 Total Program Position Count 2.3 FTE (full time equiv) Total Agency Budget 55,262,669 Total Agency Position Count 51 FTE (full time equiv) Program Objective: Provide quality emergency dental care to 945 adults who are either uninsured or covered by Medicaid. Program Highlights: The van was turned over to WI-ICHC in July 2009 but we started seeing patients in October 2009. Our highlight was to finally be able to serve patients after electrical challenges at the project site and a delay in receipt of a federal change of scope adding the van as a new service site. Without this approval, there would be no malpractice insurance or Medicaid reimbursement for services rendered. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Performance Measures: FY 2008 - FY 2009 -10 FY 2010 -11 Actual* Budget** Estimate Number of uninsured or Medicaid adults seen for 0 170 945 emergency dental services * not applicable for this new program ** dental van opened 10/5/09 @ 2 days /wk through 12/31/09; 170 patients seen during that time Program Expenditures: FY 2008 -09 FY 2009 -10 FY 2010 - 11 Actual* Budget** Estimate *** Salaries and Wages 0 $56,544 $139,637 Professional Fees 0 $250 $500 Operations 0 $15,912 $60,390 Equipment & Supplies 0 $15,315 $11,400 Other 0 $2,725 $ 3,800 TOTAL 0 $90,746 5215,727 * not applicable for this new program ** actual expenditures reflected from 7/1/09 through 12/31/09 & included van transfer /setup costs, admin costs (inc salaries) involved in van transfer & setup, clinical salaries & others ops costs (van operation began 10/5/09) * ** see Attachment A for budget details Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 Actual* FY 2009 -10 Budget ** FY 2010 -11 Estimate Patient Generated (self- 0 $20,516 ** *$114,043 pay[uninsured], Medicaid) George P & Ida Tenney 0 $65.000 $50,000 Castle Trust Aloha United Way —Big 0 $3,250 53,250 Island W1-ICHC operations funds $1,980 $12,000 County of HI (requested) 0 $0 $36,434 TOTAL 0 $90,746 $215,727 • not applicable for this new program ** set up activities began 7/1/09; van operational 10/5/09 * ** based on 945 visits /yr; approx 40% uninsured paying sliding fcc scale avg of $20; Medicaid reimbursement is $187.80 per visit (approx 60% of patients) Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? In 2010 and beyond, WHCI - IC will continue to seek funding from a variety of additional sources, both public and private, in order to continue meeting the community's emergency adult dental health needs. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 3 The Keiki Health Center (KHC), supported in its infancy by County grant funds from the '08- `09 and `09 - `10 grant cycles, no longer must rely on County funds for operational support. However, without critical County funds during KHC's first two years, the health center would not be as financially stable as it is today, and we thank you. From the question you pose for us to answer in this section, financial stability is what you want successful recipient organizations to achieve. And we have achieved that — with the financial help that you entrusted to us at the very beginning of the program. Hence, in considering our request for funds for Adult Emergency Dental Services, we respectfully ask that the County seriously consider West Hawaii Community Health Center's successful track record in establishing new programs and making them financially viable so that they can continue benefitting those residents in great need. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 4 ATTACHMENT A 1127/2010 Adult Emergency Dental Services (at the Dental Mobile Van) FY 2010 -11 — Operations Budget Detail EXPENSES: Salaries and Wages Dentist ($1,150/wk x 45 wks) $ 51,750 Dental Assistant (.6FTE a, $16 /hr) $ 24,960 Receptionist /Van Ops Coord $ 33,280 (1.0FTE @ $16 /hr) Finance /Billing (.1FTE) $ 3,536 SUBTOTAL $113,526 BENEFITS a 23% $ 26,111 TOTAL 5139,637 Professional Fees S 500 (licensing & other associated fees) Operations Rent & Utilities ($500 /mo) $ 6,000 Telephone /Internet /Support ($895 /mo) $ 10,740 Van fuel /repair /maintenance $ 8,000 Dental equipment repair /maintenance $ 4,000 Van insurance ($500 /mo) $ 6,000 Interisland air travel (Oahu dentist — 2 RThvk L $450wk x 45 wks) $ 20,250 Car rental /gas /parking (Oahu dentist - 2 da/wk a $120wk x 45 wks) $ 5,400 TOTAL 5 60,390 Equipment & Supplies Dental supplies ($10@ x 8patients /da x 135da) $ 10,800 Office $ 600 TOTAL 5 11,400 Other Interisland travel (staff conference — 2 staffx $650 /conference) $ 1,300 Van vinyl siding (to cover existing OSM graphics) $ 2,500 TOTAL $ 3,800 TOTAL $215,727 • West Hawaii Community Health Center Adult Emergency Dental Services 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, Hawai`i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your proqram's or agency's future funding requests. /7 & 174/261 Signature of Boardfresident/Chair Date Tex r i (o k; V ic.0 / SAO / Signature of : xecuti e tirector ;; Dtte Ri tnar,cQ, J. a&Ffe. UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Pages 87 West Hawaii Mediation Center Mediation Services West Hawaii Mediation Center Mediation Services Agency Director: Janie Chandler- Edmondson Phone No.: 885 -5525 Contact Person: Janie Chandler- Edmondson Phone No.: 885 -5525 Mailing Address: PO Box 7020, Kamuela, HI 96743 Facility /Site Address: 65 -1279 Kawaihae Rd., Ste. 213, Kamuela, HI 96743 Fax No.: 887 -0525 Email Address: ED @WHMediationCenter.org Name of Accountant/CPA: John Carbonaro Carbonaro CPAs Phone No.: 808- 242 -5002 Mailing Address: 1885 Main Street, Suite 408, Wailuku, HI 96793 Amount of Request for County Funds: $15,000.00 Prior Year(s) Funding: 07 -08 08-09 09 -10 10, 000.00 10, 000.00 15,000.00 Agency Mission Statement: West Hawaii Mediation Center exists to improve the way people deal with conflict by providing mediation, facilitation, conflict resolution education and training services. Program Description: The funds are requested to support West Hawaii Mediation Center (WHMC) which serves the districts of Hamakua, North & South Kohala, North & South Kona, and Ka'u. WHMC provides community -based mediation for both self- referred and 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 also provides conflict resolution education and training to adults and youth. WHMC utilizes trained community volunteers to deliver this vital service to their fellow community members. Total Budget and Position Count Total Program Budget 108,600 Total Program Position Count 1.50 Total Agency Budget 110,715 Total Agency Position Count 1.75 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 West Hawaii Mediation Center Mediation Services Program Objectives: 1) Provide information and referral services to individuals who need services instead of, or in addition to, the mediation services offered at WHMC. 2) Recruit, train and retain high quality volunteer community mediators. 3) Provide continuing education opportunities for volunteer mediators as well as specialty trainings, i.e., condominium, special education, civil rights, and domestic mediation. 4) Provide mediation services in an affordable and accessible manner for disputes arising both in and out of the courUlegal system. 5) Offer mediation services for a wide array of dispute issues including neighbor- neighbor, divorce (property division, finances, parenting plans), landlord- tenant, consumer - merchant, real estate, small claims, condominium, civil rights, special education, victim - offender, and community issues. 6) Provide adequate case management services to adequately serve all referred cases. 7) Provide community outreach and education around constructive conflict resolution practices for adults and youth. Program Highlights: 1) Delivered 1760 hours of case intake services. 2) Served 316 cases (71% county courUlegal system referred; 24% self- referred and 5% other State or County agencies) with 690 clients served. 3) Served an increase of 29 % in Landlord /Tenant and 30% small debt cases. 4) Utilized volunteer mediators in mediation sessions for a total of 644 hours of mediation (a 20% increase from prior fiscal year.). 5) Reached full agreement in 62% of cases mediated. 6) An increase of 24% in the number of mediation sessions held. 7) Achieved a 90% service satisfaction rating by respondents (post- mediation satisfaction survey). 8) Achieved a 96% rating by respondents indicating that they would recommend mediation to others in the future. 9) Provided 37% of total services to low income clients (annual income under $20,625). 10) Provided conflict resolution education and peer mediation training to over 500 elementary students in West Hawaii. Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual* Budget* Estimate* Case Management Hours 1760 1760 1760 Mediation Cases Served 316 325 334 Mediation Sessions Conducted 215 220 226 Agreements reached in mediation 60% 65% 65% Clients' satisfied with service 90% 90% 95% Client's willing to recommend service to 96% 95% 95% others Skills enhancement trainings offered for 8 8 8 volunteers Affordable service to low income ( %of 37% 45% 47% clients considered low income) Community Awareness and Education 4 4 5 Sessions NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 West Hawaii Mediation Center Mediation Services Program Expenditures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual* Budget* Estimate Salaries and Wages 73,125.00 72,780.00 73,500.00 Professional Fees 200.00 500.00 500.00 Operations 38,414.00 33,000.00 34,000.00 Equipment 315.00 500.00 600.00 Other* Total 112,054 106,780 108,600 * If Applicable #Please explain in detail on separate sheet Program Funding Sources: Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate County of Hawaii 10,000.00 15,000.00 15,000.00 State of Hawaii 48,672.00 39,100.00 39,100.00 Hawaii Justice Foundation 11,500.00 9,750.00 6,200.00 Hawaii Island United Way 12,675.00 12,000.00 12,300.00 Private Foundations /Partnerships 2,576.00 10,265.00 10,265.00 Donations 5,572.00 7,500.00 7,500.00 Fundraising 15,288.00 10,000.00 12,500.00 Service /Program Fees 802.02 750.00 850.00 Client Private fees 5,010.00 6,600.00 7,000.00 Total 112,095.00 110,965.00 110,715 *If applicable Future Program Support: 1. West Hawaii Mediation Center completed its second Wine Tasting and Silent Auction in August of 2008. Again the event was very successful netting over 15,000.00. We are planning our next Wine Tasting event for 2010. In addition to the Wine Tasting event we will continue with our annual Sponsors and Supporters Campaign and several small events. This year's Sponsors and Supporters Campaign will be completed in June 2010. 2. West Hawaii Mediation Center continues to receive and seek support from the United Way and other private agencies. Four new grant proposals have been submitted this fiscal year. We look to continue cooperating with local organizations and county agencies for future support. 4. Revised limitations on upper income fee schedule Mediation Centers of Hawaii's proposal to amend the current contract with the State Judiciary to include a market appropriate fee schedule for clients and business with incomes in excess of $100,000.00 per year has been approved. These fees will help support the services we provide to low- income clients. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 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, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawai'i Revised Statutes. If awarded a grant from the County of Hawaii, 1 (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year -end report will impact the evaluation of your program's or agency's future funding requests. ( /iO / Si nature of Board President/Chair Date II 2o (1C) • ignature : ?ecutivei'rector Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2040 -1 f Page 4 88 YWCA of Hawaii Island Healthy Start Plus YWCA of Hawai'i Island- Agency Name Healthy Start Plus- Program Name Agency Director: Gloria Lau, Chief Executive Officer, Interim Phone No.: (808) 935 -6067 ext. 102 Contact Person: Andrew A. Kahili, Communtiy Relations Events Officer Phone No.: (808) 961 -3877 ext. 127 Mailing Address: 145 Ululani Street Hilo, Hawaii 96720 Facility /Site Address: 1382 Kilauea Avenue Hilo, Hawaii 96720 Fax No.: (808) 961 -9140 Email Address: glau @ywcahawaiiisland.org or akahili @ywcahawaiiisland.org Name of Accountant/CPA (include name of firm if applicable): Carbonero and Associates Phone No.: (808) 242 -5002 Mailing Address: 1885 Main Street, Suite 408, Wailuku, Hawaii 96793 Amount of Request for County Funds: $200,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $ 0 $ 0 $125,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Agency Mission Statement: Our Mission: YWCA Hawaii Island is dedicated to eliminating racism, empowering women, and promoting peace, justice, freedom and dignity for all. The YWCA Hawai'i Island is dedicated to providing services to meet our Hawai'i Island community needs, drawing together people with diverse experiences and relationships so that we may join together in implementing the YWCA's mission. We work to maintain the National YWCA's goals and objectives, but our primary function is to fulfill our local community's needs. The YWCA Hawai'i Island first organized in Hilo in 1919 when a group of courageous women recognized the need for a women's organization and for programs geared primarily towards women and girls. From a very humble beginning with 14 women housed in a small cottage, the YWCA has expanded from the original residence in both activities and facilities. Throughout our history, the YWCA Hawai'i Island has offered valuable programs and activities for the benefit of women, children and their families. The YWCA Hawaii Island was established as a 501(c)(3) non - profit organization in 1965 and has been a partner agency of the Hawai'i Island United Way (HIUW) since 1979. It belongs to a national organization consisting of 300 YWCA Associations across the U.S. with 2.6 million members. Employing over 70 full -time and part-time staff, the YWCA offers a variety of services to people of all ages, from newborns to senior citizens in their 80's. throughout the island of Hawai'i. Last year, the YWCA Hawai'i Island touched the lives of close to 8000 people, almost 5 pecent of the island's population. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 YWCA of Hawai'i Island - Agency Name Healthy Start Plus- Program Name Program Description: The YWCA Hawaii Island Healthy Start Plus ( "YWCA HSP ") is part of the Hawaii State Department of Health, Hawaii Healthy Start Program and the State Department of Human Services, Hawai'i Enhanced Healthy Start Program. The YWCA HSP is a voluntary home visiting program that supports families and promotes positive child relationships. Families of infants and children under the age of three (3) years may enter the program. Our home visiting program utilizes a multi - disciplinary team approach and provides culturally appropriate support services within the family's natural environment and primarily focuses on the reduction of parental /environmental stressors, which are directly related to child maltreatment. Children identified at -risk for parental and environmental stressors is a significant problem for Hawaii's children. These children are at increased risk for sub- optimal health, developmental delay and maltreatment. Current research indicates this problem is a serious threat to the lives of these children and will have a tremendous impact on the community in the future. The YWCA's HSP home visiting program provides culturally appropriate support services to families' to reduce the identified high -risk factors / stressors, which may lead to child abuse /maltreatment. The service is provided to the family in their natural environment and is voluntary until the child reaches three years of age. The home visiting program utilizes 8 Home Visitors who are paraprofessionals and works with a team of professionals consisting of a Clinical Manager /Supervisor, Clinical /Intervention Specialist, Child Development Specialist and Registered Professional Nurse. Home visiting services include screenings /assessments for possible delays and referrals for early intervention services. In addition, the program provides child development and parenting information, problem solving skills, and links families with appropriate community resources. The program also identifies families in need of services to address substance abuse, mental health issues and domestic violence. YWCA HSP provides safety net services to Hawai'i's most vulnerable families and infants. As part of the State of Hawai'i Blueprint for Change plan, UH economist David McClain conducted a cost benefit study on Healthy Start which showed a 3:1 positive cost benefit ratio. Nationally, prevention and early intervention programs have shown 7:1 cost benefit ratios. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 According to economist James Heckman (NYT op -ed, 7- 29 -08) "Big gaps in potential for educational attainment are present at age 5. Some children are bathed in an atmosphere that promotes human capital and increasingly more or not. By age five, it is depressingly possible to predict who will finish school and college and who will not" This has a real impact on development of human capital and the overall economy. The YWCA Hawaii Island operates the only home visiting program of its kind in East Hawai'i. The funding from the County of Hawaii and other funding sources will allow the YWCA Healthy Start Plus Program to provide services to 150 families in fiscal year 2010 — 2011. The Healthy Start Program has been funded through the State of Hawai'i and other private funding since 1989 and will continue to seek funding for the continuation of this preventive home visiting program for those children at risk for child abuse and neglect. Total Budget and Position Count Total Program Budget $722,577 Total Program Position Count 18 Total Agency Budget $3,597,045 Total Agency Position Count 65 Program Objectives: 1) Identify family's risk factors. 2) Develop a Family Support Plan (FSP) to address identified risk factors. 3) Utilize a cohesive team approach in providing services. The home visiting team members work with the family to develop outcomes, and break those outcomes into meaningful strategies to ensure success. 4) Monitor and review family's progress in completing their objectives /strategies. In order to support the growth in the family, the home visiting team members and the family review the family's progress in completing their objectives /strategies toward the overall achievement of their outcomes. 5) Deliver home visitation services. Home visits are conducted in the family's natural environment by the home visiting team members, in accordance with the FSP, in a seamless, cohesive manner where all disciplines involved communicate with one another regarding their relationship to the family. 6) Ensure care coordination services are provided to families. The care coordinator is responsible to ensure that services delivered by appropriate staff and agencies are coordinated and delivered in timely manner, including assess and monitor families identified with issues of family violence, substance abuse and mental health. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 7) Assess and monitor children identified with developmental status and health care needs. 8) Promote positive child health development. 9) Promote positive parent child interaction. 10) Promote a health and safe home environment. Program Highlights: (from Fiscal Year 2008 -09) YWCA HSP Information Summary: 1) Systematic risk assessment for child abuse and developmental delays; point of connection for many services. 2) Meets concrete, emergency survival needs of over - stressed, impoverished families with newborns. (food, supplies, housing, jobs, emergency financial assistance). 3) Teaches life coping skills, increases family capacity for self- sufficiency. 4) Addresses /reduces risk factors, develops protective factors to avert abuse, neglect. Keeps families out of child welfare system and children out of foster care. 5) Promotes healthy parent child relationships and child development. 6) Addresses state goals for maternal -child health in regard to pre -natal care with no smoking /alcohol during pregnancy; immunizations, child safety, nutrition. 7) Referrals to a medical home for the infant for sick and well care, pre -natal care for subsequent pregnancies, screening /referral to early intervention services, housing assistance, health insurance programs, domestic violence and drug treatment programs, Head Start and other services of benefit to the family. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 YWCA of Hawai'i Island - Agency Name Healthy Start Plus - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Percentage of enrolled children with 98% 100% 98% no confirmed child abuse and /or as of neglect report 12/31/2009 Percentage of enrolled children with 88% 90% 88% a completed FSP within 60 days as of 12/31/2009 Percentage of enrolled children with 96% 96% 96% an identified medical home as of 12/30/2009 Percentage of enrolled children with 100% 100% 100% a confirmation developmental delay as of who were referred to for early 12/31/2009 intervention services Percentage of fully immunized by 82% 80% 82% age 2 years. as of 12/31/2009 Percentage of families after 12 95% 95% 95% months of service received and as of accepted family planning 12/31/2009 *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages $572,290.93 $547,634 $519,637 Professional Fees $13,152.69 $17,634 $14,522 Operations $129,294.41 $110,615 $79,844 Equipment 0 $3,000 $1,500 Other" $121,094.42 $116,117 $107,074 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Total $835,832.45 $795,000 $722,577 If applicable # Please explain in detail on separate sheet NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 YWCA of Hawai'i Island - Agency Name Healthy Start Plus - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate State of Hawaii - Dept. of Health $835,832.45 $670,000 $335,000 State of Hawaii - Dept. of Human 187,577 Services County of Hawaii $125,000 $200,000 Total $835,832.45 $795,000 $722,577 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self - sustaining? Since 1989 the program has been funded 100% by the State of Hawaii, Department of Health, Maternal Child Health Branch (DOH - MCHB). Currently the program is funded by DOH -MCHB and a grant with County of Hawaii. In addition the program will be submitting grant proposals to the following organizations; Federal approriations earmark funds, Hawaii Electric Light Company and the Hawaii Community Foundation - Family Literacy Foundation NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 YWCA of Hawai'i Island - Agency Name Healthy Start Plus - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawai'i County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawai'i grant funds, and a listing of other funding sources and amount: obtained during the award period. Failure to submit a timely, complete, ar accurate year -end report will impact the evaluation of your program's or agency's future funding requests. ■ Sig -ture of Board President/Chair Date 6 C"'ILtt - a7 -aolo Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 9 County of Hawai'i for fiscal year 2010 -2011 YWCA Hawai'i Island Healthy Start Plus Program Expenditures 'Other' Explanation in detail The YWCA of Hawai'i Island charges Administrative Cost, where allowed, as this directly correlates with the overhead incurred. The Administrative Cost includes governing board, executive, finance, human resources, program administration, and other costs associated with maintaining the requirements of a 501 (c)(3) non- profit. it 89 YWCA of Hawaii Island Sexual Assault Support Services YWCA of Hawai'i Island- Agency Name Sexual Assault Support Services- Program Name Agency Director: Gloria Lau, Chief Executive Officer, Interim Phone No.: (808) 961 -3877 ext. 102 Contact Person: Lorraine Davis, Chief Operating Officer Phone No.: (808) 961 -3877 ext. 162 Mailing Address: 145 Ululani St. Hilo, Hawaii 96720 Facility /Site Address: 1382 Kilauea Ave Hilo, Hawaii 96720 Fax No.: (808) 961 -9140 Email Address: glau @ywcahawaiiisland.org or Idavis @ywcahawaiiisland.org Name of Accountant/CPA (include name of firm if applicable): Carbonaro CPA & Associates Phone No.: (808)968 -1002 Mailing Address: P. O. Box 4372 Hilo, HI 96720 Amount of Request for County Funds: $60,000 Prior Year(s) Funding: 07 -08 08 -09 09 -10 $52,000 $20,000 $20,000 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 1 Agency Mission Statement: Our Mission: YWCA Hawai'i Island is dedicated to eliminating racism, empowering women, and promoting peace, justice, freedom and dignity for all. The YWCA Hawaii Island is dedicated to providing services to meet our Hawai'i Island community needs, drawing together people with diverse experiences and relationships so that we may join together in implementing the YWCA's mission. We work to maintain the National YWCA's goals and objectives, but our primary function is to fulfill our local community's needs. The YWCA Hawai'i Island first organized in Hilo in 1919 when a group of courageous women recognized the need for a women's organization and for programs geared primarily towards women and girls. From a very humble beginning with 14 women housed in a small cottage, the YWCA has expanded from the original residence in both activities and facilities. Throughout our history, the YWCA Hawai'i Island has offered valuable programs and activities for the benefit of women, children and their families. The YWCA Hawai'i Island was established as a 501(c)(3) non - profit organization in 1965 and has been a partner agency of the Hawai'i Island United Way (HIUW) since 1979. It belongs to a national organization consisting of 300 YWCA Associations across the U.S. with 2.6 million members. Employing over 70 full -time and part-time staff, the YWCA offers a variety of services to people of all ages, from newborns to senior citizens in their 80's. throughout the island of Hawai'i. Last year, the YWCA Hawai'i Island touched the lives of close to 8000 people, almost 5 pecent of the island's population. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 2 YWCA of Hawai'i Island - Agency Name Sexual Assault Support Services- Program Name Program Description: The program's mission is to provide services for the healing and prevention of sexual violence. Sexual Assault Support Services (SASS) works to reduce the incidence of sexual assault and disability to those who have been victimized. Services include the only 24/7 sexual assault crisis line on the island, crisis response, clinical services and community health promotion (community awareness /prevention and education) services. Skilled and supportive Advocates provide island wide phone support to callers on the 24 hour 7 days a week crisis line. Advocates also provide face to face crisis services including crisis intervention, emotional support, information and referrals. Our knowledgeable masters - prepared therapists provide psychotherapy, case management and legal systems advocacy. Both the face -to -face crisis services and our clinical services are conducted in Hilo and Kona. Individuals living in the north and south areas of the island are encouraged to travel to either of the offices for needed and desired services. Community health promotion services are provided island wide within schools (from pre - school through university levels), at professional trainings and at community events. The Sexual Assault Support Services program functions as team members with the Hawaii County Sexual Assault Response Team (SART). Both Advocates and therapists work with SART team members in providing quality services to clients. SART team members include police investigators, sex assault nurse examiners (SANE), prosecutors and Child Welfare Services. The YWCA, is in our third decade of helping sex assault survivors, who are men, women, girls and boys. Primary funding of the program is through State of Hawaii, Office of the Attorney General through a subcontract with the Kapiolani Women's and Children Medical Center, Sex Abuse Treatment Center. As a result, quality assurance, program and fiscal monitoring of services is maintained at standards, If the County of Hawai'i decides favorable for continued funding of the Sexual Assault Support Services program, it can do so with the knowledge that professional standards are practiced in both service delivery and expenditure of funds. Total Budget and Position Count Total Program Budget $479,552 Total Program Position Count 12 Total Agency Budget $3,597,045 Total Agency Position Count 65 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 3 Program Objectives: 1) Continue to operate the 24 -hour, 7 day a week Sexual Assault Crisis Hotline receiving calls island -wide from persons seeking support, information, and referral that may lead to face to face support as described in the next objective. 2) Provide a Sexual Assault Support Services program Advocate to support each sex assault victim undergoing forensic and legal examination in the period July 1, 2010 through June 30, 2011. 3) Deliver professional counseling and /or case management services to at least 100 sex assault survivors. 4) Attend and participate in monthly case tracking and interagency team coordination meetings of the East and West Hawai'i Children's Justice Centers throughout the fiscal year. 5) Provide sexual assault awareness and prevention education to: 1000 school aged students, provide education to at least 35 professionals about sexual assault and the needs of child /adult survivors of sexual assault and methods to detect and report sexual child abuse or abuse of dependant adults. Program Highlights: (from Fiscal Year 2008 -09) 1) In September, 2009 the program, by approval of the YWCA Board of Directors, changed its name from the Empowering Alternatives program (EAp) to Sexual Assault Support Services (SASS). The name has come full circle, by returning to the name the program started with, which carries longstanding recognition. 2) In October, 2009 the YWCA of Hawai'i Island sponsored its first annual Walk a Mlle in Her Shoes® event. Walk a Mile in Her Shoes® is an international men's march to stop rape, sexual assault and gender violence. This event brings together men to show their support for and to become a part of the solution to ending sexualized violence. Mayor Billy Kenoi, Police Chief Harry Kubojiri, Fire Chief Daryl Oliveria and Prosecuting Attorney Jay Kimura accompanied over 150 men from numerous community groups, businesses and government agencies in the walk. 3) Members of the Sexual Assault Support Services staff and YWCA administrators participate in Children's Justice Center Interagency Advisory Committee (IAC), the Hawai'i Coalition Against Sexual Assault (HCASA), The Big Island Coalition Against Physical and Sexual Assault (BICAPSA) and Family Violence Interagency Committee (FVIC), and Sexual Violence Prevention NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 4 Planning (SVPP) meetings. These committees or coalitions include the involvement by staff from the following agencies: the Hawai'i County Police Department, Hawaii County Office of the Prosecting Attorney, Child Welfare Services, Department of the Attorney General, Family Court, Probation, Department of Health, Department of Education and statewide service providers. The efforts foster consistent care throughout the County and State for sex assault services and working together as agencies to provide the best practives of care for victims and their families. 4) The Sexual Assault Support Services staff and the YWCA of Hawai'i Island Chief Operating Officer, who also serves as the SASS Program Director, participates in SATC state provider meetings in the review of policies, protocols and best practices throughout the state. (5) The activities of staff, in addition to the day -to -day services that are provided through crisis intervention, advocacy, therapy and prevention education are providing healing for those who have suffered through sexual assault and all it's ramifications. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 5 YWCA of Hawai'i Island - Agency Name Sexual Assault Support Services - Program Name Performance Measures: FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Fully trained personnel are Crisis line Crisis line Crisis line available to assess and respond to available 24 available available 24 callers on the Sexual Assault Crisis hours a day 24/7, 365 hours a day Phone Line. 7 days a days a year. 7 days a week, 365 Estimate week, 365 days a year. serving 400 days a year. Served 469 callers Estimate callers. during the serving 400 fiscal year. callers. To date, there have been 217 callers in the first 6 months of this year. Crisis counseling, legal systems 157 victim 150 victim 175 victim advocacy, information and referral service service service are provided to each sex assault contacts contacts for contacts victim undergoing medical -legal the fiscal examination in East and West year. The Hawai'i. first 6 months of this year, we have served 76 clients. Survivors of sexual assault receive 255 200 clients 225 psychotherapy services and will be intensive clinical case management served in the from masters - prepared therapists in fiscal year. East and West Hawai'i The first 6 months of this year, we have served 132 clinical clients. School aged students receive 1562 1200 school 1200 sexual assault prevention and aged awareness training children will NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 6 receive awareness and provention training during the fiscal year. In the first 6 months of this fiscal year we have served 615 school aged children Professionals receive training in 181 100 pro- 80 awareness of the needs of adults fessionals and child sexual assault survivors, will receive how to detect and report child awarenss sexual abuse or sexual abuse of and training dependent adults in the fiscal year. In the first 6 months of this year, we have trained 42 service providers *If applicable Program Expenditures FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Salaries and Wages $ 264,516 $291,717 $351,322 Professional Fees $ 4,390 $3,249 $3,249 Operations $ 72,556 $52,545 $62,193 Equipment Other" $ 50,571 $59,330 $62,788 NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 7 FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Total $ 392,033 $406,840 $479,552 * If applicable " Please explain in detail on separate sheet • NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 8 YWCA of Hawaii Island - Agency Name Sexual Assault Support Services - Program Name Program Funding Sources: Identify all funding sources (specific to this program only) Revenue Source FY 2008 -09 FY 2009 -10 FY 2010 -11 Actual * Budget * Estimate Attorney General (SATC) $332,175 $279,340 $269,140 County of Hawaii $20,000 $30,000 $60,000 Hawai'i County Procecuting $34,765 $50,000 $20,000 Attorney Contributions and Fundraisers $2,879 $5,000 Federal COBRA ARRA $47,500 $25,412 Federal Appropriation $100,000 • Total $389,819 $406,840 $479,552 *If applicable Explain what plans, if any, your agency and /or program has to increase revenues to support this program. When do you anticipate your program to become self- sustaining? The Sexual Assault Support Services program is primarily funded through a Master Contract through SATC as the master contractor for the State of Hawai'i Attorney General's office. The basic needs of the program are being met thorough this contract and the program will continue to provide services. However, should the County determine that funding is not available for this program prevention education and awareness services would decrease because the master contract is primarily about "treatment" and very limited prevention. Additionally, growth opportunities for providing services to populations we traditionally don't serve would not occur and the program would become contract driven rather than survivor driven. Other sources of revenue are being sought through foundations, grants and other means of funding. NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 9 YWCA of Hawai'i Island - Agency Name Sexual Assault Support Services - Program Name I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2 -135 — 2- 142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year -end report to the Legislative auditor within 60 days after June 30 of the fiscal near. 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 amount! obtained during the award period. Failure to submit a timely, complete, ar accurate near -end report will impact the evaluation of your program's or agency's future funding requests. O / - a 7 - aoio Sionatur�rd Pr sidenU hair Date rita"Lt I / - 27.20/0 Signature of Executive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2010 -11 Page 10 County of Hawai'i for fiscal year 2010 -2011 YWCA Hawaii Island Sexual Assault Support Services Program Expenditures `Other' Explanation in detail The YWCA of Hawai'i Island charges Administrative Cost, where allowed, as this directly correlates with the overhead incurred. The Administrative Cost includes governing board, executive, finance, human resources, program administration, and other costs associated with maintaining the requirements of a 501 (c)(3) non- profit. 7