Expanded Youth Program

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* 1. Organization Name

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* 2. Program Name

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* 3. Address of Organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 4. Contact Person

Name

Title

Phone

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* 5. Fiscal Agent (If applicable)

Organization Name

Contact Person

Address

Phone

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* 6. Is your program located within the Park Heights area? (Park Circle to Northern Parkway and Greenspring to Wabash)

Yes

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* 7. IF you answered Yes to Question 6, please add how many Youth from the Park Heights Master Plan Area will your program serve?

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* 8. What best describes your program?

A comprehensive program offering multiple activities, operating 100 days or more per school year.

A specialized program focusing on a few specific activities that operates in periods or cycles of 2-12 weeks.

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* 9. What is the total amount of funding you are requesting for the 2018 - 2019 school year? (Please answer using a dollar amount format, e.g. $100,000)

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* 10. How many youth will your program serve during the 2018-19 year? (for specialized programs list the number of youth served during a cycle and the total number served over the year)

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* 11. Does your program partner with or serve students from a particular school?

Yes

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* 12. If you answered to Question 10, please list which school(s) does your program serve? (NOTE: If your program serves more than 4 schools select the schools with the largest number of students in your program first)

School 1

School 2

School 3

School 4

Other

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* 13. Will your program continue during the Summer? If so, please describe how below.

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* 14. Does the program serve youth with other funding sources? If yes, please list the funding source indicate how many youth are served with that funding. (NOTE: If you reported match funding in your budget form
please explain it here.)

Funding Source 1 (Name
or description and # of
youth served)

Funding Source 2 (Name
or description and # of
youth served)

Funding Source 3 (Name
or description and # of
youth served)

Funding Source 4 (Name
or description and # of
youth served)

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* 15. What grades does your OST program serve? (check all that apply)

Pre-K

1st

2nd

3rd

4th

5th

6th

7th

8th

9th

10th

11th

12th

Opportunity Youth ages 14 - 25

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* 16. Where do the youth in your program live? (NOTE: If your program serves youth from more than 3 neighborhoods select the 3 neighborhoods with the most students in your program first.)

Neighborhood 1 (most youth live here)

Neighborhood 2

Neighborhood 3

Other (if applicable)

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* 17. Do you serve any special populations? (check all that apply)

Students with unstable housing

Newcomers or recent immigrants

Students with special needs

N/A

Other (please specify)

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* 18. How will you recruit students for your program?

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* 19. Describe your OST program; share successes from past years and goals for the coming year.

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* 20. How will your program partner with families to support youth?

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* 21. How will your program partner with community members to support youth?

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* 22. How will your program include students of all abilities?

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* 23. If your program serves older youth, do you offer any of the following activities? (check all that apply)

Not applicable - we serve younger youth

Career readiness (e.g., soft skills, interview skills,
accountability, career exploration and exposure, internships)

College readiness (e.g., academic support, SAT prep, college application support

Independence/life skills (e.g., financial literacy and planning)

Enrichment (e.g. arts or sports activities)

Academic supports

Youth leadership

Violence reduction activities or programming

Other (please specify)

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* 24. Please describe the activities that you offer or how you support the focus areas you selected above.

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* 25. For programs serving elementary/middle school youth, do you offer any of the following activities?
(check all that apply)

Not applicable - we serve older youth

Literacy Supports

Math Supports

STEM activities

Enrichment (arts, sports)

Homework Help

Violence Reduction activities or programming

Other (please specify)

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* 26. Please describe these activities or how your program supports the focus areas you listed above.

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* 27. How do you ensure that students receive a high quality experience at your program?

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* 28. Please answer the following questions about your staff:

How many total staff will
your program have?

How many staff live in
Baltimore City?

How many staff live in the
neighborhoods your
program serves?

How many staff are
certified teachers?

What types of training and
support will you provide to
your staff?

What additional training or
support would you like for
your staff?

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* 29. Budget

Be sure that the budget:

·         Does not exceed the category allocated award amount;

·         Does not include in-kind contributions;

·         Is consistent with the program design/plans outlined in the corresponding proposal narrative; and

·         Ensure administrative costs, if applicable, do not exceed 10% of total direct costs.

Only PDF, DOC, DOCX, PNG, JPG, JPEG, GIF files are supported.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 30. Provide a copy of the organization’s independently audited financial statements for its fiscal year-end within the past 12 months

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 31. Provide certificate of “Good Standing” for Organization or Fiscal Agent. Must provide a PDF copy of the certificate within the 2018 calendar year (January 1, 2018 to present).

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 1. Organization Name

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* 2. Program Name

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* 3. Address of Organization

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* 4. Contact Person

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* 5. Fiscal Agent (If applicable)

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* 6. Is your program located within the Park Heights area? (Park Circle to Northern Parkway and Greenspring to Wabash)

Question Title

* 7. IF you answered Yes to Question 6, please add how many Youth from the Park Heights Master Plan Area will your program serve?

Question Title

* 8. What best describes your program?

Question Title

* 9. What is the total amount of funding you are requesting for the 2018 - 2019 school year? (Please answer using a dollar amount format, e.g. $100,000)

Question Title

* 10. How many youth will your program serve during the 2018-19 year? (for specialized programs list the number of youth served during a cycle and the total number served over the year)

Question Title

* 11. Does your program partner with or serve students from a particular school?

Question Title

* 12. If you answered to Question 10, please list which school(s) does your program serve? (NOTE: If your program serves more than 4 schools select the schools with the largest number of students in your program first)

Question Title

* 13. Will your program continue during the Summer? If so, please describe how below.

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* 14. Does the program serve youth with other funding sources? If yes, please list the funding source indicate how many youth are served with that funding. (NOTE: If you reported match funding in your budget formplease explain it here.)

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* 15. What grades does your OST program serve? (check all that apply)

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* 16. Where do the youth in your program live? (NOTE: If your program serves youth from more than 3 neighborhoods select the 3 neighborhoods with the most students in your program first.)

Question Title

* 17. Do you serve any special populations? (check all that apply)

Question Title

* 18. How will you recruit students for your program?

Question Title

* 19. Describe your OST program; share successes from past years and goals for the coming year.

Question Title

* 20. How will your program partner with families to support youth?

Question Title

* 21. How will your program partner with community members to support youth?

Question Title

* 22. How will your program include students of all abilities?

Question Title

* 23. If your program serves older youth, do you offer any of the following activities? (check all that apply)

Question Title

* 24. Please describe the activities that you offer or how you support the focus areas you selected above.

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* 25. For programs serving elementary/middle school youth, do you offer any of the following activities?(check all that apply)

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* 26. Please describe these activities or how your program supports the focus areas you listed above.

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* 27. How do you ensure that students receive a high quality experience at your program?

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* 28. Please answer the following questions about your staff:

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* 30. Provide a copy of the organization’s independently audited financial statements for its fiscal year-end within the past 12 months

Question Title

* 31. Provide certificate of “Good Standing” for Organization or Fiscal Agent. Must provide a PDF copy of the certificate within the 2018 calendar year (January 1, 2018 to present).

* 14. Does the program serve youth with other funding sources? If yes, please list the funding source indicate how many youth are served with that funding. (NOTE: If you reported match funding in your budget form
please explain it here.)

* 25. For programs serving elementary/middle school youth, do you offer any of the following activities?
(check all that apply)