IOTA Grantee Application

NOTE: Before filling out this application, you should read and familiarize yourself with the following:

1. Organization Name*

2. Organization Phone Number*

3. Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

4. Organization website*

Enter a URL like www.FundingFLA.org

5. Organization Contact Name*

First NameLast Name

6. Contact's Title*

7. Contact's Email*

example@example.com

8. Are you a Florida Supreme Court-approved legal aid organization?*

YesNo

If yes, please provide supporting documentation (i.e., letter from Florida Supreme Court Clerk of Court.)

9. Please describe your geographic service area by county.*

10. Please list the no- or low-income target population(s) that you serve.*

11. Please describe how your organization determines financial eligibility of your prospective clients. Please detail: (a) what standards are used (i.e. percentage of poverty level, etc.); (b) what proof is required (i.e. tax returns, affidavits, etc.).*

12. Other than economic factors, please specify all criteria your organization uses to qualify or disqualify clients.*

13. Please list the total number of clients you have served in the past two calendar years:*

14. Does your organization have a pro bono department?*

YesNo

14a. If yes, please provide:

15. Please provide your organization's board-approved mission statement.*

16. What are the primary outcomes your organization aims to achieve through its legal services? Please describe any broader community impacts your programs aim to influence.*

Florida Bar Rule 5-1.1 states:

(F) A “qualified grantee organization” is a charitable or other nonprofit organization that facilitates or directly provides qualified legal services by qualified legal services providers and that has experience in successfully doing so.

17. Is your organization a 501(c)3 or other type of charitable, nonprofit organization?*

YesNo

17b. If yes, provide supporting documentation (i.e., your organization's IRS letter assigning your taxpayer EIN).

Florida Bar Rule 5-1.1 states:

(G) “Qualified legal services” are free legal services provided directly to low-income clients for their civil legal needs in Florida, and includes post-conviction representation, programs that assist low-income clients in navigating legal processes, and the publication of legal forms or other legal resources for use by pro se litigants.

18. Does your organization provide free legal services directly to no- or low-income clients as required by the rule?*

YesNo

18a. If yes, list, in detail, the specific types of free legal services by subject matter (i.e., full representation housing defense; limited services family law, etc.) your organization provides. For each specific type by subject matter, include the number of years that service has been provided:

19. Does your organization engage in any public education, outreach, lobbying or advocacy activities? If so, please describe each activity and the time period in which each activity took place.*

20. FFLA requires IOTA grantees to be able to demonstrate at least five full years of successful experience in providing qualified legal services. Please provide examples demonstrating that your organization meets this requirement. *

Florida Bar Rule 5-1.1 states:

(H) A “qualified legal services provider” is a member of The Florida Bar or other individual authorized by the Rules Regulating The Florida Bar or other law to provide qualified legal services.

21a. Please list the total number of qualified legal services providers employed at least half-time by your organization who serve your organization’s no- and low-income clients. (Please enter text, a link to your website's staff page OR upload a document.)*

File Upload

21b. Please list the total number of volunteer qualified legal services providers that serve your organization and its no- and low-income clients who have provided at least 10 hours of volunteer service within the past year. (Please enter text OR upload a document.)*

File Upload

FFLA requires IOTA grantees to provide service(s) that increase access to the justice system to protect and preserve individual rights relating to one of more of the following civil legal issues:

Health and Shelter
Personal Safety
Protective and Corrective Security
Family, Community and Legal

22. Does your organization provide qualified legal services that relate to at least one of these areas?*

YesNo

Florida Bar Rule 5-1.1 states:

Qualified grantee organizations must annually certify to FFLA their compliance with this rule’s requirements on the use of IOTA funds. This certification must include, but not be limited to:

(A) the number of qualified legal services providers compensated or facilitated by the use of IOTA funds;

(B) the number of clients receiving qualified legal services paid for or facilitated by the use of IOTA funds;

(C) the number of low-income Floridians who, while not directly represented, are nevertheless assisted by qualified legal services paid for or facilitated by the use of IOTA funds;

(D) the number of hours expended delivering qualified legal services paid for or facilitated by the use of IOTA funds;

(E) the types of matters for which clients received qualified legal services paid for or facilitated by the use of IOTA funds;

(F) an accounting of the use of IOTA funds, including the amount used to establish reserves and pay for overhead and other general administrative expenses;

(G) the total amount received from sources other than IOTA funds by the qualified grantee organization; and

(H) any other information the court determines is relevant.

23. Is your organization able to track items A-H in order to certify compliance with the rule?*

YesNo

Florida Bar Rule 5-1.1 states:

A qualified grantee organization must expend at least 85% of the IOTA funds received to facilitate qualified legal service providers providing or facilitating the provision of qualified legal services or, if such expenditures in any given year constitute less than 85% of the IOTA funds received, provide to FFLA a written justification. A qualified grantee organization must expend no more than 15% of the IOTA funds received for general administrative expenses not directly supporting the provision of qualified legal services and establishing reserves or, if such expenditures in any given year constitute more than 15% of the IOTA funds received, provide to FFLA a written justification. Except as provided below, general administrative expenses include rent, training, and technology. Expenditures to facilitate qualified legal service providers providing or facilitating the provision of qualified legal services are limited to:

(A) compensation paid to qualified legal service providers;

(B) compensation paid to support staff who are directly assisting qualified legal services providers, such as paralegals;

(C) compensation paid to staff necessary for coordinating volunteer qualified legal service providers; or expenses that otherwise directly facilitate providing qualified legal services, including training, legal research, and technology necessary to the provision of qualified legal services. Compensation includes benefits such as health insurance and bar membership fees.

24. Is your organization able to comply with the 85/15 expenditure ratio of IOTA funds?*

YesNo

25. Does your organization have policies or procedures in place for ensuring that legal services provided do not involve conflicts of interest? If so, please describe.*

26. Does your organization have a Trust Account in compliance with the Rules Regulating The Florida Bar? If no, why not?*

27. Does your organization agree to adhere to FFLA policies, grant assurances, procedures and performance requirements?*

YesNo

28. Do you agree to provide upon request: (a.) Satisfactory proof of financial stability and independence apart from FFLA funding; and (b.) Satisfactory proof of proper governance and internal controls; and (c.) Satisfactory proof of subject matter expertise and competency required for a particular grant, award or project?*

YesNo

29. Please provide the name and contact information for the independent auditor that conducts your organization's annual audit:*

29a. Please provide copies of your organization's annual audit report for the past three years. *

30. Please provide copies of your organization's Form 990 for the past three years.*

31. Please provide your annual budget for each of the last three years.*

32. Please upload your organizational chart.*

By signing this form, I swear and affirm that the answers and information provided herein are true and correct, and that I am authorized to sign this application on behalf of organization name* .

I understand that FFLA will rely on such information when considering this application. I further affirm that organization name* , through its employees and/or authorized agents, have read, understand and agree to comply with Rule 5-1.1(g), Rules Regulating The Florida Bar and FFLA's IOTA funding policies and grant assurances.

Signature