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Home My WebLink AboutNon Profit Grant Tracking FormFY 2022-23 APPLICATION FORM The purpose of the County of Hawai‘i Nonprofit Grants-in-Aid (Waiwai Grants) is to support qualified nonprofit organizations carry out work that improves the quality of life on Hawai‘i Island. This County grant is coordinated by the Hawai‘i County Council, in partnership with the Department of Finance. A total of $2.5 million is available on an annual basis through this grant program. No applications will be accepted or can be modified/corrected after 4:30 PM HST on January 31, 2023. What you submit electronically is what the County Council will receive. Errors, missing documents and/or other areas of noncompliance will result in the immediate disqualification of your application. We urge you to review your submission with extreme care. To resolve any technical problems you might encounter, we encourage you to begin the application process as soon as you can. For questions regarding documents required to be submitted with your application, contact: Lisa Tada, Budget Specialist, at (808) 961-8489. For questions regarding the preparation and submission of the application or concerning the overall grant process, contact: Council Member Sue Lee Loy’s office, at (808) 961-8396. ORGANIZATION INFORMATION Email Organization Name as it appears on IRS forms Organization Director Contact Person Phone Number for Contact Person (Include area code) Email address for Contact Person Accountant/CPA If applicable, please indicate your accountant/CPAʻs firm. Mailing Address City State Zip Code Program Name Number of years the program you are applying for has been in operation Do you currently have or anticipate having any other c ontracts/agreements with the County of Hawaii during the fiscal year of this grant cycle? * Yes No (please skip to the next question) If you answered "yes" to the previous question, please briefly describe the contract/agreement deliverables. Have you previously applied for and received a County Nonprofit Grant Award? Yes No SELECT ALL AREAS OF HAWAI‘I ISLAND WHERE THE PROGRAM WILL BE ADMINISTERED. IDENTIFY THE AGE GROUP OF THE TARGET AUDIENCE(S) THE PROGRAM WILL SERVE. Infancy (0-3) Play Age (3-5) School Age (6-11) Adolescence (12-17) Young Adulthood (18-39) Middle Adulthood (40-59) Kupuna (60+) Middle Adulthood (40-59) Kupuna (60+) Identify the services or activities to be provided. Select all that apply: ʻĀhualoa ʻĀinaloa Captain Cook Eden Roc Fern Acres Fern Forest Discovery Harbor Hakalau Halaʻula Hawi Hawaiian Acres Hawaiian Beaches Hawaiian Paradise Park HiloHolualoa Honalo Hōnaunau-Nāpōʻopoʻo Honomu Honokaʻa Kahaluʻu-Keauhou Kailua-Kona Kalaoa Kalapana Kanaihiku Village Kapaʻau Kapoho Kaueleau Keaʻau Kealakekua Kēōkea Kūkiʻo Kukuihaele Kurtistown Laupāhoehoe Leilani Estates Miloliʻi Mountain View Nāʻalehu Nānāwale Estates Nīnole Ocean View ʻŌʻōkala Orchidlands Estates Pāʻauhau Paʻauilo Pāhala Pāhoa Pāpaʻaloa Pāpaʻikou Paukaʻa Pepeʻekeo Pohoiki Puakō Pualaa ʻUmikoa Volcano Waikōloa Village Waimea Wainaku Waiʻōhinu Welokā Other: EDUCATIONAL CONCERNS Culture and the arts Needs of the poor Public health and welfare of the people and the environment Youth Aged Physical/Emotional Disabilities Victims of Crimes Victims of Health or Social Crises IDENTIFY THE AMOUNT OF FUNDS YOU ARE APPLYING FOR. In years past, applicants were asked to provide the County with an amount that was needed to advance their program or service. The County receives more than 200 applications for grants-in-aid each year, resulting in nearly every applicant getting a “slice” of what they requested and some not being able to advance on their proposal. We recognize that this grant is a small piece of your larger operation. That said, please identify a realistic amount that accurately reflects your need to administer your program or service. Be thoughtful in what you need as the County will make a yes/no determination on the amount you are applying for. $2,500 $5,000 $7,500 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 TRACKING CHANGE & RIPPLE EFFECT This is a new section in this application, and it is for data purposes only. The number of areas you select does not influence decisions to grant funds, but we ask that you carefully review and mark all that apply to the program you are applying for. By collecting this data, the County will better understand the impact of all grant recipients, identify gaps in community programming, and identify where additional resources are needed. Does your program advance any of the following? Only select what applies to the program you are requesting funds for. COMMUNITY & ECONOMY Your program works to build a diverse and growing economy that allows people to earn incomes and build assets while also affording opportunities for quality of life. Diversify economy Build income, wealth, assets Increase housing security/affordability Reduce or address the cost of living Builds community network Increases community safety Increases community capacity to adapt and/or be self-sufficient HEALTH & WELLNESS Your program works to provide access to care that improves the quality of life on Hawai‘i Island and keeps ‘ohana safe and thriving. Addresses physician shortages Reduces healthcare costs Increases access to nutrition Provides resources for kupuna care Addresses childhood poverty Provides services for at-risk youth Improves access to mental/behavioral health services ARTS & CULTURE Your program cultivates Hawai‘i’s rich culture and arts, which enriches the social, economic, and physical elements of community. Supports arts education for youth Promotes Native Hawaiian Culture Provides access and opportunities to participate and practice arts and culture Supports economic opportunities in the arts NATURAL ENVIRONMENT Your program works to protect and preserve our natural resources and to keep Hawai‘i, Hawai‘i. Builds resilience to climate change Promote renewable resources Reduce dependency on fossil fuels Protect water resources Promotes local food resources and security Protects biodiversity Protects watersheds and important natural environments Protects reef and ocean health EDUCATION Your program works to educate the next generation properly so we can hope to find solutions to our most persistent and disruptive challenges. Increases quality and access to early childhood education Reduces truancy Increases high school graduation rate Increases literacy Increases access to STEAM education Improves access to post-secondary education Increases earning potential Provides workforce development I N 500 CHARACTERS, SHARE YOUR ORGANIZATION'S MISSION. IN 1,000 CHARACTERS, DESCRIBE THE PROGRAM YOU ARE SEEKING GRANT FUNDS FOR. IN 1,500 CHARACTERS, DESCRIBE HOW YOUR PROGRAM ADVANCES THE CHANGE OBJECTIVE AND CREATES A RIPPLE EFFECT OF POSITIVE IMPACT. PROGRAM OBJECTIVES & PERFORMANCE The next set of questions will provide grant application reviewers a clear sense of what your proposal is designed to accomplish and what is needed to get there. The examples below relate to a fictional feeding program. IN 1,000 CHARACTERS, LIST WHAT RESOURCES ARE NEEDED TO CARRY OUT YOUR PROGRAM, EFFORT, OR INITIATIVE. For example, volunteers, staff, farmers, technology, money, resilience hubs. I N 1,000 CHARACTERS, LIST THE MAJOR ACTIVITIES TO BE COMPLETED. For example, farmers grow food, volunteers pack and distribute food, staff coordinates. IN 1,000 CHARACTERS, LIST THE OUTPUTS TO BE COMPLETED. For example, 12 farmers supported, 12 volunteers + 324 hours served, 1,000 families supported. IN 1,000 CHARACTERS, LIST THE OUTCOMES TO THE PUBLIC AND YOUR PROGRAM PARTICIPANTS BASED ON YOUR PROGRAM’S ACTIONS. For example, a sustainable food system, more food secure families, engaged communities. PROGRAM BUDGET Attach your program budget, which clearly identifies how your organization will utilize the grant funds being sought. Use the budget template provided. Use the budget template provided. FORMS TO REVIEW AND SIGN Please review and attach a signed copy of the Certificate of Understanding. Please review and attach a signed copy of the Organization Conflict Disclosure Form. REQUIRED ORGANIZATIONAL MATERIALS Attach your Proof of Authorization. Attach a copy of your Annual Financial Statements. Attach a copy of your IRS 990 Form (pages 1-2). Attach a copy verifying your tax exempt status as a 501(c)(3). Attach a copy of your Articles of Incorporation. Attach a copy of your organization's By-laws. Attach a copy of your organization's nepotism and conflict disclosure clauses (either contained in By-laws or organization policies). ACKNOWLEDGEMENTS Do you certify that the contents of this application are true and correct to the best of your knowledge? Yes No Do you give the County permission to share information contained in your application with other County Departments and with philanthropic groups, with the goal of increasing possible funding opportunities for your organization? Yes No