Non-Profit

Henry County Non-Profit Assistance Program

Program Description

Henry County Government will be accepting, reviewing and considering submitted applications from non- profit agencies located in Henry County and providing services to Henry County residents. This includes unincorporated Henry County and the Cities of Hampton, Locust Grove, McDonough and Stockbridge.

Eligible Uses

The objective of these funds is to prevent, prepare for and respond to COVID-19. Funds may be used to provide short-term (up to five [5] months) subsistence payments such as rent, mortgage and utility payments, assistance to food banks, food delivery services, workforce development programs, childcare assistance, assistance to the homeless, housing and/or utility deposits, and programs for the elderly and youth.

Grant funds may be used to reimburse the agency for eligible expenditures incurred on or after March 1, 2020.

Ineligible Uses

Expenses incurred before March 1, 2020, down payment and/or closing cost assistance, home improvements or rehab assistance, purchase of durable goods, payments for personal debts except for rent, mortgage and utilities.

Application Instruction

Please complete all questions listed below. Once the application is complete, you will receive an email confirmation of your submission.

We will be accepting applications until all funding has been expended. Applications will be reviewed on a first-come, first-served basis.

Agencies applying for multiple programs must submit an application for each program.

If you have any questions, please contact Henry County Government at (770) 288-6541 Monday through Friday between 9 a.m. and 4 p.m. You may leave a voicemail outside of those times.

Eligibility

Agency’s primary office is physically located in Henry County, Georgia.
Must have 501 (c) (3) designation from the Internal Revenue Service (IRS) and provide proof;
Must be registered with the Secretary of State and provide proof;
Must be an agency providing services needed by residents negatively affected by the COVID-19 emergency.

Examples of Services (but not limited to)

subsistence payments such as rent, mortgage and utility payments,
assistance to food banks,
food delivery services,
workforce development programs,
childcare assistance, assistance to the homeless,
housing and/or utility deposits, and
programs for the elderly and youth

Conflict of Interest

The award of funding and selection of applications shall be administered in compliance with conflict of interest provisions similar to those established at Section 4019 of the CARES Act to include the following:

No member of the Henry County Board of Commissioners or appointed official of the Henry County Small Business and Non-Profit Assistance Review Committee who exercises or has exercised any functions or responsibilities with respect to Henry County funding or who is in a position to participate in a decision making process or gain inside information with regard to such funding, may obtain a personal or financial interest or benefit in any agreement or subcontract with respect thereto, or the proceeds thereunder, either for themselves or for those with whom they have family or business ties, during their tenure or for one (1) year thereafter.
The awarded small businesses or non-profits shall maintain a written code or standards of conduct that shall govern the performance of its officers, employees or agents engaged in the award and administration of contracts supported by Henry County funds.
No employee, officer or agent of an awarded small business or non-profit shall participate in the selection, or in the award, or administration of, a contract supported by Henry County funds if a conflict of interest, real or apparent, would be involved.
- Hatch Act
  
  All awarded small businesses and non-profits shall agree that no funds provided, nor personnel employed by an establishment assisted with Henry County funding, shall be in any way or to any extent engaged in the conduct of political activities in violation of Chapter 15 of Title V of the U.S.C.
- Religious Activities
  
  Per ruling of the U.S. Supreme Court faith-based organizations may not use direct government funding to support "inherently religious" activities, such as worship, religious instruction, or proselytization.

Step One: Determine Your Eligibility

Before you start your application, please prepare the following required documents. If you do not provide the necessary documentation, it will delay the processing of your application and may cause your application to be denied.

Non-profit registration to verify Henry County address
State of Georgia Secretary of State Articles of Incorporation and By-laws
501 (c) (3) designation from the Internal Revenue Service
Form 990 or Index Card, as applicable
2020 Year-to-date income statement (including revenue and expenses)
Non-Profit Mission Statement and Organizational History
Resumes of Principal staff
2019 Compilation, Review, or Audit
2019 income statement (including revenue and expenses)
Copy of Financial management procedures
Current list of Board members

Step Two: Complete and Submit Application

Agency Legal Name: *

Applicant's DBA or trade name: *

Applicant's Employer Identification Number (EIN): *

Executive Director's Name: *

Executive Director's Email: *

example@example.com

Phone Number: *

Please enter a valid phone number.

Address of Applicant *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Does the non-profit provide services to residents that are needed to assist households or individuals in preventing, preparing for or responding to the COVID-19 emergency? *

Yes No

Detailed Project Description

Provide a description of the type of service(s) to be provided in the space provided. Explain in detail the objective of the service(s). Descriptions must include but should not be limited to the following information:

What is the goal of this project?
What target population will be served by this project (specify youth, seniors, special needs, etc) ?
Describe any unique or innovative elements of the project.
Describe any cooperative or collaborative efforts to implement the project.
Describe applicant’s past experience related to the proposed activity, specifically activities undertaken in the past 12 months.
Have program policies and procedures been developed and approved by the appropriate board, outlining the specific details of your program?
Does the Applicant currently have staff capacity to effectively carry out the proposed activities?
Describe how the organization is funded and where Henry County funds will fit into the overall budget. Henry County funds cannot be the only source of funding.

Respond Here *

List all expected project budget Line Items in the space provided. *

What is the total requested amount? *

Organization History and Capacity

1. How long has the agency existed in its current form? *

2. How long has the agency had its 501 (c) (3) status? *

3. How many years has the agency offered the services for which it is requesting funding? *

4. What percentage of the agency’s budget is grant funded? *

5. How many agency staff persons will be dedicated to the provision of services for which funding is requested (Case Managers, Intake Specialists, etc.)? *

6. Does the agency have administrative staff (i.e. Accountants, Executive Director) to oversee the operations and financial management? *

Yes No

Does the agency have secured funding for the administrative staff? *

Yes No

Organization Details

Does the agency have multiple locations? *

Yes No

Is the agency regional or does the agency provide services outside of Henry County? *

Yes No

If yes, describe how the agency will ensure that only Henry County residents receive assistance with these funds.

FAITH BASED ORGANIZATIONS

Faith–based organizations are eligible for Henry County funding on an equal footing with any other organization.

Organizations may not use Henry County funds to support inherently religious activities such as worship, religious instruction or proselytization. If an organization does conduct such activities, the activities must be offered separately from activities or services funded by the Non-Profit Assistance Program, in time or location. Participation in any such religious activities must be voluntary for the beneficiaries of the Non-Profit Assistance Program assisted activity or service.

Organizations that receive Henry County assistance are prohibited from discriminating against beneficiaries or prospective beneficiaries of the Henry County assisted activity or service on the basis of religion or religious belief.

Accordingly, organizations offering activities or providing services supported in whole or in part with Henry County funds, and in their outreach activities related to such activities or services, are prohibited from discriminating against current or prospective program beneficiaries on the basis of religion, a religious belief, a refusal to hold a religious belief, or a refusal to attend or participate in a religious practice.

Accordingly, a faith-based organization that applies for, or participates in a Henry County funded activity or service may retain its independence and may continue to carry out its mission, including the definition, development, practice, and expression of its religious beliefs, provided that it does not use Henry County funding to support or engage in any inherently religious activities (including activities that involve overt religious content such as worship, religious instruction, or proselytization), or in any other manner prohibited by law.
Among other things, faith-based organizations that receive Henry County funding may use their facilities to provide services or offer activities supported by the Non-Profit Assistance Program, without removing or altering religious art, icons, scriptures, or other symbols from these facilities.
In addition, a faith-based organization that applies for, or participates in a Henry County funded activity or service may retain religious terms in its name, select its board members on a religious basis, and include religious references in its organization's mission statements and other chartering or governing documents.

I (or we) hereby certify that I or (we) have read the specific requirements of Faith-based organizations and understand that eligibility of this application depends upon compliance with the requirements contained in this certification.

Conflict of Interest 24 CFR
This rule generally prohibits elected officials, and staff who are in a position to influence decisions, from receiving any benefit in federally awarded funds.

Conflicts prohibited: No covered persons, who exercise or have exercised any functions or responsibilities with respect to Henry County funding, or who are in a position to participate in a decision making process or gain inside information with regard to such assisted activities, may obtain a financial interest or benefit, or have a financial interest in any contract, subcontract, or agreement, or with respect to the proceeds of a Henry County assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter.

Persons covered: The conflict of interest provisions above apply to any person who is a Henry County Commissioner or an appointed official of the Henry County Small Business Restart and Non-Profit Assistance Review Committee, or a staff member of the Henry County Financial Services Division.

Definition of Family or Business ties:

Family - "A group of people related by ancestry or marriage; relatives."
Business – "The buying and selling of commodities and services; commerce, trade."
Ties – "Something that connects, binds, or joins; bond, link."

Having read and understood the Conflict of Interest prohibition as summarized above:

I (or we) acknowledge and disclose the potential of a Conflict of Interest, due to my (or our): being a covered person (Henry County Commissioner or an appointed official of the Henry County Small Business Restart and Non-Profit Assistance Review Committee, or a staff member of the Henry County Financial Services Division) OR having a Family or Business tie to a covered person (Henry County Commissioner or an appointed official of the Henry County Small Business Restart and Non-Profit Assistance Review Committee, or a staff member of the Henry County Financial Services Division.)

In the following space provided describe the Conflict of Interest or potential of a Conflict of Interest. Specify the source of the Conflict, such as name of department for which you are employed and job title or name of person(s) for which you have family of business ties.

OR

I (or we) certify, that I (or we) are not aware of any Conflict of Interest or potential Conflict of Interest that exists of myself (or ourselves) and any person who is a Henry County Board of Commissioner or appointed official of the Henry County Small Business Restart and Non-Profit Assistance Review Committee or a staff member of the Henry County Financial Services Division who are in a position to participate in a decision making process or are responsible for the administration or oversight of the Henry County Small Business Restart and Non-Profit Assistance Program.

Non-Profit Assistance Program Required Documents and Certifications

Please submit your documents in PDF format ONLY. Other document formats are subject to corruption and may delay or disqualify your application.

Non-profit registration to verify Henry County address *

State of Georgia Secretary of State Articles of Incorporation and By-laws *

501(c) (3) designation from the Internal Revenue Service *

Form 990 or Index Card, as applicable *

2020 Year-to-date income statement (including revenue and expenses) *

Non-Profit Mission Statement and Organizational History *

Resumes of Principal staff *

2019 Compilation, Review, or Audit *

2019 Income Statement (including revenue and expenses) *

Copy of Financial management procedures *

Current list of Board members *

Submit my application

If you have any questions, please contacted the Henry County Government at (770) 288-6541 Monday through Friday between 9 a.m. and 4 p.m. You may leave a voicemail outside of those times.

*

I agree that the information herein is true and correct.