Agency Eligibility Survey

Question Title

* 11. Applicants must be providing services/activities that address specified strategies: Employment Match Maker and/or Adult Work-Based Experiences/Internships. Please select the strategy or strategies that you are applying. Agencies applying in both strategies must complete a separate narrative, budget, and performance measures per strategy.

Employment Match Maker / Family Sustaining Employment-Pathways

Adult Work Based Experiences/Internships

	Yes	No
Located in and primarily serving residents of Berkshire County	Located in and primarily serving residents of Berkshire County Yes	Located in and primarily serving residents of Berkshire County No
Not-for-profit organization (If yes, provide documentation as part of application)	Not-for-profit organization (If yes, provide documentation as part of application) Yes	Not-for-profit organization (If yes, provide documentation as part of application) No
Incorporated or chartered under appropriate local, state or federal statutes	Incorporated or chartered under appropriate local, state or federal statutes Yes	Incorporated or chartered under appropriate local, state or federal statutes No
Abide by federal and state laws regarding non-discrimination and anti-terrorism	Abide by federal and state laws regarding non-discrimination and anti-terrorism Yes	Abide by federal and state laws regarding non-discrimination and anti-terrorism No
Have a non-discrimination policy (If yes, provide documentation as part of application)	Have a non-discrimination policy (If yes, provide documentation as part of application) Yes	Have a non-discrimination policy (If yes, provide documentation as part of application) No
Have an active, locally based, volunteer board of directors that meets regularly, makes policy decisions and holds election of officers (if yes, provide list of Board Directors as part of application)	Have an active, locally based, volunteer board of directors that meets regularly, makes policy decisions and holds election of officers (if yes, provide list of Board Directors as part of application) Yes	Have an active, locally based, volunteer board of directors that meets regularly, makes policy decisions and holds election of officers (if yes, provide list of Board Directors as part of application) No
Have an administrative structure with defined lines of responsibility, a mission statement and bylaws (if yes, provide documentation as part of application)	Have an administrative structure with defined lines of responsibility, a mission statement and bylaws (if yes, provide documentation as part of application) Yes	Have an administrative structure with defined lines of responsibility, a mission statement and bylaws (if yes, provide documentation as part of application) No
Financially stable, perform a regular budgeting process and able to submit audited financial statements and/or IRS Form 990 with internal control deficiency letters if applicable	Financially stable, perform a regular budgeting process and able to submit audited financial statements and/or IRS Form 990 with internal control deficiency letters if applicable Yes	Financially stable, perform a regular budgeting process and able to submit audited financial statements and/or IRS Form 990 with internal control deficiency letters if applicable No
Have current license, certification and permits if applicable	Have current license, certification and permits if applicable Yes	Have current license, certification and permits if applicable No
Able to demonstrate effectiveness of program/services through measurable outcomes. Applicants must be able to submit monthly reports via Clear Impact Scorecard if a grant recipient	Able to demonstrate effectiveness of program/services through measurable outcomes. Applicants must be able to submit monthly reports via Clear Impact Scorecard if a grant recipient Yes	Able to demonstrate effectiveness of program/services through measurable outcomes. Applicants must be able to submit monthly reports via Clear Impact Scorecard if a grant recipient No

Yes

Located in and primarily serving residents of Berkshire County

Located in and primarily serving residents of Berkshire County Yes

Located in and primarily serving residents of Berkshire County No

Not-for-profit organization (If yes, provide documentation as part of application)

Not-for-profit organization (If yes, provide documentation as part of application) Yes

Not-for-profit organization (If yes, provide documentation as part of application) No

Incorporated or chartered under appropriate local, state or federal statutes

Incorporated or chartered under appropriate local, state or federal statutes Yes

Incorporated or chartered under appropriate local, state or federal statutes No

Abide by federal and state laws regarding non-discrimination and anti-terrorism

Abide by federal and state laws regarding non-discrimination and anti-terrorism Yes

Abide by federal and state laws regarding non-discrimination and anti-terrorism No

Have a non-discrimination policy (If yes, provide documentation as part of application)

Have a non-discrimination policy (If yes, provide documentation as part of application) Yes

Have a non-discrimination policy (If yes, provide documentation as part of application) No

Have an active, locally based, volunteer board of directors that meets regularly, makes policy decisions and holds election of officers
(if yes, provide list of Board Directors as part of application)

Have an administrative structure with defined lines of responsibility, a mission statement and bylaws (if yes, provide documentation as part of application)

Have an administrative structure with defined lines of responsibility, a mission statement and bylaws (if yes, provide documentation as part of application) Yes

Have an administrative structure with defined lines of responsibility, a mission statement and bylaws (if yes, provide documentation as part of application) No

Financially stable, perform a regular budgeting process and able to submit audited financial statements and/or IRS Form 990 with
internal control deficiency letters if applicable

Financially stable, perform a regular budgeting process and able to submit audited financial statements and/or IRS Form 990 with
internal control deficiency letters if applicable Yes

Financially stable, perform a regular budgeting process and able to submit audited financial statements and/or IRS Form 990 with
internal control deficiency letters if applicable No

Have current license, certification and permits if applicable

Have current license, certification and permits if applicable Yes

Have current license, certification and permits if applicable No

Able to demonstrate effectiveness of program/services through measurable outcomes. Applicants must be able to submit monthly reports via Clear Impact Scorecard if a grant recipient

Able to demonstrate effectiveness of program/services through measurable outcomes. Applicants must be able to submit monthly reports via Clear Impact Scorecard if a grant recipient Yes

Able to demonstrate effectiveness of program/services through measurable outcomes. Applicants must be able to submit monthly reports via Clear Impact Scorecard if a grant recipient No

Question Title

* 14. Please email the following supporting documentation to Julie Singley, jsingley@berkshireunitedway.org
Documentation of not-for-profit status
Non-discrimination policy
List of current Board of Directors
Mission statement and/or bylaws
Financial documentation (see RFP Overview for specific information on Program Budget and financials)

Agency Eligibility