FY 2027 Human Services Funding Application
The application is due on NOON, Thursday, January 29, 2026.
PART 1: Organizational Information
1. Email
*
example@example.com
2. Organization Name(Required)
*
3. Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
4. Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
5. Website(Required)
*
6. Executive Director Name
*
First Name
Last Name
7. Application Preparer Name
*
First Name
Last Name
8. Mission(Required)
*
9. Vision(Required)
*
10. Please list additional links that would be helpful in better understanding your organization and its mission.
Link 1:
Link 2:
Link 3:
Organizational Governance Information
11. Are board members directly involved in formulating the organization's budget?(Required)
*
Yes
No
12. Are board members responsible for its final approval?(Required)
*
Yes
No
13. It is required that board members contribute financially to your organization. Did 100% of the board members contribute financially to the organization in calander year 2025?(Required)
*
Yes
No
14. When was your most recent strategic planning process?(Required)
*
15. Please list three priority goals established during your most recent strategic planning process and in a sentence each, describe progress made toward them.(Required)
*
16. BOARD ATTENDANCE. Please fill out the table with your record of board attendance. If the total count of board members varied during the year, include that information in the comments section.
*
Rows
Number of Board Members
Total Number
January Attendance
February Attendance
March Attendance
April Attendance
May Attendance
June Attendance
July Attendance
August Attendance
September Attendance
October Attendance
November Attendance
December Attendance
Board and Staff Diversity
17. STAFF AND BOARD DIVERSITY. Briefly describe the organization's efforts to ensure diverse staff and board leadership. Please include any efforts you make to increase representationof your board and staff to ensure the best possible services to Roanoke's diverse population.(Required)
*
18. BOARD Diversity 1. Please include the count of board members in each ethnic or racial category.
Rows
Number
Total Number of Board Members
Black / African American
Asian
Hispanic / Latino / Latina
Native American
White / Caucasian
19. BOARD Diversity 2. Please include the count of board members in each gender category.
Rows
Number
Total Number of Board Members
Male
Female
Nonbinary
Other
20. BOARD Diversity 3. Please include the count of board members in each age category.
Rows
Number
Total Number of Board Members
Ages 14-17
Ages 18-29
Ages 30-49
Ages 50-69
Ages 70 +
21. STAFF Diversity 1. Please include the count of staff members in each ethnic or racial category.
Rows
Number
Total Number of Staff Members
Black / African American
Asian
Hispanic / Latino / Latina
Native American
White / Caucasian
22. STAFF Diversity 2. Please include the count of staff members in each gender category.
Rows
Number
Total Number of Staff Members
Male
Female
Nonbinary
Other
23. STAFF Diversity 3. Please include the count of staff members in each age category.
Rows
Number
Total Number of Staff Members
Ages 14-17
Ages 18-29
Ages 30-49
Ages 50-69
Ages 70 +
Organizational Financial Overview
24. Do you have an endowment?(Required)
*
Yes
No
25. If yes, what is the size of the endowment as of December 31, 2025?
26. Current Fiscal Year (beginning and end dates)(Required)
*
27. Total amount of current operating budget(Required)
*
28. What is the amount of your current cash reserves?(Required)
*
29. Within the last five years, has the organization ended two or more fiscal years with an operating deficit?(Required)
*
No
Yes
30. If applicable, please briefly explain the circumstances of the operating deficit.
31. Total volunteer hours accumulated in the last full fiscal year.(Required)
*
32. Total volunteer value accumulated in the last full fiscal year (at $34.79 / hour)(Required)
*
33. Revenue Breakdown. Please include the percentages for the following budget revenue categories for the last fiscal year.
Rows
Percentage as a number
Contributions / Donations
Earned Income
Grants
Unearned Income (Interest and Endowment Proceeds)
Organizational Attachments
Please upload the following documents:
Liability insurance documentation
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Most recent financial audit or signed financial documents
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Most recent IRS 990
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Signed and notarized representations and agreements
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VDACS Confirmation Letter
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Board of Directors list with contact information
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Part 2: Program Information
Tell us about the specific proposed program for which you are seeking funding.
Logistics
34. Name of program to be implemented.(Required)
*
35. Where will the proposed program be implemented?(Required)
*
36. Who will benefit from the program? Please include demographic information and the expected number of participants.(Required)
*
Program Overview
37. Describe the program for which you are seeking funding.(Required)
*
38. What need does this program meet in the city of Roanoke? (Include data to describe the need for the population you intend to serve.)(Required)
*
39. How will your program meet the need in the city of Roanoke that you identified in question 38?(Required)
*
40. How does this program align with the "Path to Results" as stated in the Human Services section of the City Council's Strategic Plan? (https://roanokearts.org/wp-content/uploads/2024/12/Human-Services-Council-Strategic-Plan.pdf) The document is also linked at the top of the page.)(Required)
*
Outcome Measures
41. How do you define the success of this program?(Required)
*
42. What measurable outcomes are you tracking? What is your rationale for using these specific measures?(Required)
*
43. How well has your organization succeeded in meeting your designated outcome goals in the past three years? (Please provide specific examples or data to support your claims. If this is a new program, describe outcomes and success of other implemented programs.)(Required)
*
Innovation and Collaboration
44. How has your organization innovated or adapted to increase its impact in the past 3 years? (Please provide specific strategies or approaches.)(Required)
*
45. List up to five organizations or entities you will collaborate with for this program and describe how each improves program effectiveness.(Required)
*
Organizational Capacity to Complete the Program
46. Describe your organization's relevant experience, expertise, or resources that will contribute to the program's success.(Required)
*
47. Briefly describe how the organization will integrate trauma-informed practices into the proposed program — Explore the Principles of Trauma Informed Care in the resources at the top of the page or at the CDC's site at https://stacks.cdc.gov/view/cdc/56843 )(Required)
*
48. What barriers to success do you anticipate when implementing this program?(Required)
*
49. How much are you seeking through this grant application? This should match the amount in your proposed FY26 budget.(Required)
*
Budget and Cost Effectiveness of the Program
50. Define your unit of service for this proposed program.(Required)
*
51. What is your program's cost per unit of service?(Required)
*
52. If this is not the first year of this program, please share REVENUE for the last implemented program year.
53. If this is not the first year of this program, please share EXPENSES for the last implemented program year.
Please upload your FY 2026 and FY 2027 program budgets using the required budget worksheet
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54. Please describe how you will utilize volunteers for the implementation of the program.(Required)
*
55. Other information otherwise not captured above.
Organizational Signatures
Type your name to stand in for your signature of the preparer.(Required)
*
By typing your name you certify that the application represents the current state of the organization to the best of your knowledge and ability.
Type your name to stand in for your signature of the executive director.(Required)
*
By typing your name you certify that the application represents the current state of the organization to the best of your knowledge and ability.
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