Expanded Youth Program Question Title * 1. Organization Name OK Question Title * 2. Program Name OK Question Title * 3. Address of Organization Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number OK Question Title * 4. Contact Person Name Title Email Phone OK Question Title * 5. Fiscal Agent (If applicable) Organization Name Contact Person Address Email Phone OK Question Title * 6. Is your program located within the Park Heights area? (Park Circle to Northern Parkway and Greenspring to Wabash) Yes No OK 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? OK Question Title * 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. OK 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) OK 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) OK Question Title * 11. Does your program partner with or serve students from a particular school? Yes No OK 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) School 1 School 2 School 3 School 4 Other OK Question Title * 13. Will your program continue during the Summer? If so, please describe how below. OK Question Title * 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.) Funding Source 1 (Nameor description and # ofyouth served) Funding Source 2 (Nameor description and # ofyouth served) Funding Source 3 (Nameor description and # ofyouth served) Funding Source 4 (Nameor description and # ofyouth served) OK Question Title * 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 OK Question Title * 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) OK Question Title * 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) OK Question Title * 18. How will you recruit students for your program? OK Question Title * 19. Describe your OST program; share successes from past years and goals for the coming year. OK Question Title * 20. How will your program partner with families to support youth? OK Question Title * 21. How will your program partner with community members to support youth? OK Question Title * 22. How will your program include students of all abilities? OK Question Title * 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) OK Question Title * 24. Please describe the activities that you offer or how you support the focus areas you selected above. OK Question Title * 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) OK Question Title * 26. Please describe these activities or how your program supports the focus areas you listed above. OK Question Title * 27. How do you ensure that students receive a high quality experience at your program? OK Question Title * 28. Please answer the following questions about your staff: How many total staff willyour program have? How many staff live inBaltimore City? How many staff live in theneighborhoods yourprogram serves? How many staff arecertified teachers? What types of training andsupport will you provide toyour staff? What additional training orsupport would you like foryour staff? OK Question Title * 29. BudgetBe 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 Choose File No file chosen Remove File BudgetBe 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. OK Question Title * 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 Choose File No file chosen Remove File Provide a copy of the organization’s independently audited financial statements for its fiscal year-end within the past 12 months OK 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). DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File 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). OK SUBMIT