Social Service Funding Application 2022-2023

Please complete this application for each project that you are requesting funding.
A complete application consists of the application and all required attachments. Only complete applications will be considered.
The submission deadline is March 16, 2022 by 4:00pm .
This year we are requiring a Mandatory Workshop to any Agency that has not been funded in the last two years or is applying this year for the first time. You need to call or email Liz Alvarado to set up an appointment for this workshop at 512-341-3328 / ealvarado@roundrocktexas.gov . We will also give technical assistance to agencies that were funded last year if you request it.
Review the application requirements. Please do not apply if you do not meet these requirements.
The Primary Contact listed on the application should be the agency staff member who will receive information or requests from the City of Round Rock via e-mail, phone, or mail.
Concisely answer each section of the application.
Both the Executive Director and the Chairman of the Board must sign and date the application.

Application Requirements

IRS 501(c)(3) tax status
Service Area – provide services to the City of Round Rock residents
Funding Agreement – agency must be willing to enter into an agreement that meets a municipal public purpose or meets a national objective
Inspection – agency shall allow the City to conduct inspections of their premises and operations at any time the City deems necessary, and the agency shall allow the City to conduct audits of their financial records at any time the City deems necessary
Board – an active, representative voluntary governing body, with regular meetings and with policy setting authority
Purpose and Structure – mission statement, specific organization goals, specific target population(s) and a focus on health and human services
Project – reasonable efficiency in project management and reasonable adequacy of resources, both in materials and personnel (voluntary and paid) to sustain a quality level of service
Audit – an annual audit (review if budget is less than $100,000) prepared by an independent CPA in accordance with generally accepted accounting standards
Budget – a detailed annual budget, translating project service plans into financial terms
Insurance – maintain adequate liability insurance coverage for the agency and indemnify City of Round Rock and its volunteers and staff from any and all liability for any damage or injury caused to any employee, client, patron, agency, visitor, or guest of the agency
Cooperation – evidence of consultation and cooperation with other established agencies in the same or related fields
Procedures – procedures and communications that present a positive community image in the conduct of project delivery, publicity, promotion, and solicitation of funds
Ethics – maintain a high standard of ethics
Round Rock is not the primary funding source of the agency
Minimum funding request is $2,500 per project

Application Review Criteria

Your application will be reviewed using the criteria below. Funding decisions will be made based on these criteria and the availability of City of Round Rock funds.

Project

Project serves a municipal public purpose OR meets a national objective (1. Benefit low to moderate income persons 2. Elimination of slum or blight 3. Meets an urgent need).
A community issue requiring resolution is clearly defined.
Number of City of Round Rock citizens that will benefit from the project.
Agency works to ensure that City of Round Rock residents have access to its services.
Agency clearly states how City of Round Rock funds will be spent on the project (ex: hiring staff, gas cards, etc.).
Services are not duplicated by other resources or organizations (including the City of Round Rock) in the project service area.
Agency has identified the community and/or low to moderate income population to which it provides services. (see income guidelines)
Resources and services are directed to those most in need and are accessible to the target population.
Eligibility criteria for project services are clearly stated.

Agency

Past performance of the agency.
Required attachments are provided.
Agency has a written mission statement.
Goals and objectives clearly define and reflect a current demonstrated need in the community.
Use of City of Round Rock funds to leverage other funds.
Amount of reserve funds.
Functional expenses of project services, management and administration, and fundraising.
Clarity and conciseness of financial statements.
Financial soundness.

Agency Name

Project Name

Amount of City of Round Rock Funds Requested

Total Project Cost

Unit of Service

Unit Cost

Location where services will be provided:

Days and hours services will be provided:

Project Budget

Please list the amount of City of Round Rock funds that will be used for each of the following categories.

	$ Amount
Personnel
Supplies
Other
Total (must equal funds requested above)

Please describe Other funds:

Project Funding Sources

Please list the other funding source(s) for your project and the amount provided by the source(s)

	Source Name	$ Last FY	$ Current FY
Source
Source
Source
Source
Total

Will City of Round Rock Funds be used to leverage other funds? If yes, please explain.

Project Description

Describe the purpose and desired outcome of your project.

Describe how this project serves a municipal public purpose or meets a national objective.

Describe the community issue that these services will address and what will happen if these services are not provided.

Are there other resources or organizations in the agency’s service area that provide the same services? If so, please identify the resources or organizations and specify how your services are non-duplicative and/or support their efforts:

Describe who will benefit from this project.

What is the TOTAL number of clients that will benefit from this project?

What number of your total clients are Round Rock citizens?

What percentage of your clients is considered low income? (See Income Guidelines Chart)

Income Guidelines Chart

Project Client Eligibility

Describe the client eligibility criteria for this project:

Are there any religious or faith-based requirements for eligibility and/or participation in this project?

Yes No

If yes, explain.

Is there a waiting list?

Yes No

If yes, please provide the average waiting period.

Project Client Count

(City of Round Rock residents only)

Gender

	2019	2020	2021
Male
Female
Do not track (indicate with 0)
Total

Age

	2019	2020	2021
0 - 5
6 - 18
19 - 54
55+
Do not track (indicate with 0)
Total

Projected client count for 2022 (City of Round Rock residents only):

Agency Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Area Code Phone Number

Fax Number

Area Code Phone Number

Website

Agency Description

Mission statement of agency:

History of agency: Please provide a brief description.

Describe the agency’s service goals and objectives.

Agency Funding Sources

Please list the agency’s other funding source(s)and the amount provided by the source(s):

	Source Name	$ Last FY	$ Current FY
Source
Source
Source
Source
Total

Agency Funding Expenses

Please list the percentage of functional expenses for each of the following categories:

	% Last FY	% Current FY
Project Services
Management and Administration
Fundraising
Total

Name and Title of Executive Director

Phone Number

Area Code Phone Number

Fax Number

Area Code Phone Number

Email

example@example.com

Name and Title of Board Chair

Phone Number

Area Code Phone Number

Fax Number

Area Code Phone Number

Email

example@example.com

Name and Title of Primary Contact

Phone Number

Area Code Phone Number

Fax Number

Area Code Phone Number

Email *

example@example.com

Please initial:

I have read the City of Round Rock funding requirements and certify that we meet these requirements.

I have attached a 501(c)(3) determination letter.

I have attached a list of the current Board ofDirectors including their name, address, phone number, term, and office held.s.

I have attached our most recent financial audit completed by an independent CPA.

I have attached our 2022-2023 projected agency budget.

I have attached proof of liability insurance.

I have attached our most recent Form 990submitted to the IRS.

Printed name of Executive Director

Signature of Executive Director

Clear

Date signed

Date

Printed name of Chairman of Board

Signature of Chairman of Board

Clear

Date signed

Date

Signature Page

Attach Required Documents

Browse Files

City of Round Rock 2022- 2023

Section 1

Section 2

Section 3