By Anita Jenkins,2014-04-05 11:02
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    Department for Children and Families

    Afterschool Care





    WEDNESDAY, MARCH 28, 2012


    Hilda Green

    Vermont Children’s Trust Foundation

    PO Box 52

    Waterbury Center, VT 05677


    Must Submit the Original & 5 copies to address above

    Copies can be 2-sided (back to back)

    Application MUST Postmarked by

    March 28, 2012

    Or it will be disqualifiedNote: DISCARD THIS SHEET -- DO NOT ATTACH TO YOUR APPLICATON






    (Both pages of this face sheet MUST BE ATTACHED to your application)

    (For Office Use Only)

    Grant #: _______________________________________ Stage: Application

    Program Area: __________________________________ Date Application Received: ________

     1. Name of Organization:      

     VT Tax ID #:      Federal Tax ID #:      

     (You must have a VT Tax ID#) (This is NOT the same as your VT Tax ID #)

     2. Mailing Address: Street or P.O. Box #:       City:      State     Zip     County:      

     Daytime Phone Number:       E-mail:       Organization’s Fiscal Year:      

     3. Contact Name:      Contact Phone #:       Contact E-mail:     

     4. Title of Project:      

     5. Grant Purpose: (No more than a two sentence explanation of the targeted program):     

     6. Total Amount Requested (maximum amount is $15,000): $     

     7. Fiscal Agent (if different than organization listed above):       Federal Tax ID #:      VT Tax ID #:      

     Address of Fiscal Agent:       Fiscal Agent’s Fiscal Year:     

     8. Are you currently licensed through CDD/DCF to provide child care? Yes No If yes, date first licensed or application submitted:      (If you are providing child care and are not licensed, you must

    begin the licensing application process in order to receive CDD funding.)

     9. Is your agency Private Not-For-Profit, 501c3?: Yes No School?: Yes No

     Other Public Organization or Municipality? Yes No

    10. AHS OUTCOME AREA: Check the ONE area most related to the purpose of this grant


     Children Succeed in School Children Live in Safe, Supported Families 11. Total Number of NEW Children Anticipated to be Served with this Grant in Each Age Category:

    Please list numbers in the appropriate box(es):

    #      Kindergarten (5-6 year olds) #       Children in Grades 1-5 #      Children in Grades 6-8


    12. From the number of children listed in #11. above, list number/s that fit these descriptions that may be served with this grant:

    #       Children with special needs #       Children in Protective Services

    #       Children currently receiving child care financial assistance AND/OR:

    #       Children who may be eligible for child care financial assistance but not yet enrolled

    st Century Learning Center Grant?13. Does your program currently receive a VT Dept. of Education 21

     Yes No

    14. For currently licensed programs, indicate your status in the VT-STARS recognition program

     and/or achievement of accreditation from national organizations such as the NAA (National

     AfterSchool Association) or the Council on Accreditation (COA). Identify the stage you are in for

     either or both.

    Check all that apply:

     VT-STARS (STep Ahead Recognition System)

     Beginning to look into procedures, materials and developing an application timeline

     Working on self-assessment to complete the application

     Have achieved a VT-STARS rating level of:       Date achieved:      

     National Accreditation

     Beginning to look into procedures, materials and developing an application timeline

     Working on program self-assessment

     Have achieved accreditation from NAA, COA or other national organization.

     Date achieved:      

    I certify that the information contained in this application is true and correct and this program will comply with applicable eligibility criteria for the federal Child Care and Development Fund, which includes not discriminating or barring participation in this program on the basis of race, religion, sex, color, handicap or national origin. If this program closes, I will contact the Child Development Division regarding the possible redistribution of the materials purchased with this grant and to return any unspent funds.Also, if I’m funded, I will submit three Memos of Understanding with my signed grant award document before I will receive any grant funds.

    __________________________________________ _______________________ ____________Signature of Person Responsible Title Date

    (Executive Director or Designated Official)


    Summary Plan MUST NOT EXCEED six (6) single pages in 12 point

    Times New Roman font, excluding attachments. Pages may be copied back-to-back.Please TYPE your plan using this form. You may download the form from the Vermont Children’s Trust


    Fund website ( or request this document be sent to you electronically. If you type

    your own version of this document, all questions and attachment charts must be replicated.

    1.INTRODUCTION: Briefly describe your agency/organization, its structure, and its history of successful project management. This establishes the agency/organization’s capability of delivering the outcomes described in the grant plan, and identifies responsibility for the use of and accounting for the awarded money. (You will be asked to describe your program and grant request in other sections of the document.)


    2.COMMUNITY NEED, DATA & GRANT PURPOSE: For the outcome area you identified on

    your cover page, you are to describe the current resources in your community and what the need is for increased numbers of children to be served in afterschool child care. Define how these issues can be met by answering the following:

    A. What is the current status of afterschool care in your community? With these grant funds, explain what proposed services and specific grant activities will be added in the community.     

    B. Provide primary data from a local community needs assessment that defines the demand for services for an increased number of school-aged children (kindergarten to age 12) in a new or expanded afterschool care program. If directly applicable, you may add secondary sources of data but limit these sources to no more than three (3). Examples of secondary sources are: the Vermont

    Agency of Human Services Community Profiles, Vermont Kids Count or other community resources.

    Limit your data to information that is most relevant to your grant request.


    C.Explain your desired outcome/s, how your program will address the community need or gaps in

    services for afterschool care identified above, and how the proposed program will fit with

    existing resources in your area.


    3.PROPOSED PROGRAM: Provide a brief narrative that describes what your new program will

    look like if funded. Answer the following to show how your plan is supported by best practices and/or research for afterschool care services:

    A. Program Site: Define the space to be used and licensed status. If this is to be shared space in a

    school or community building, include a space agreement in your MOU list in # 6.     

    B. Program Design:

    1. Describe program services including the number and ages of children to be served, the

    days and hours of operation and a yearly calendar.

    2. Define how the services will meet the needs of children and families from all economic

    backgrounds, including family access to the Vermont Child Care Financial Assistance



    C. Program Content: Describe how the program will meet the specific developmental needs of all school age children and in addition, the varied developmental needs of children with special

     needs. Include appropriate use of community resources that will enhance the program.     


    4.TIMELINE: Indicate the time frame for the total period of the grant implementation and list your specific grant start-up steps to be accomplished with these funds for each calendar quarter.July - September     

    October - December     

    January - March     

    April - June     

    Briefly describe any additional goals or comments:      

    5.STAFF/MANAGEMENT INPUT: Indicate what staff positions will be involved in the above program implementation of services. Do not send resumes.

    Position TitleRequired Qualifications/Experience/Credentials





Additional comments:      

    6.COLLABORATION: Please list the partners who are formally working with you on this project.

    Use the grid below to list your partners and what they will contribute to your program, (for

    example: financial support, in-kind support, a space agreement and/or equipment, referrals, etc.). If

    this grant is awarded you will need to submit a signed Memorandum of Understanding (MOU) from each partner listed. A sample MOU is included in the CDD/CTF Grants Instruction Booklet.

    Name of Formal PartnerType of Support




    If you have informal relationships with community partners other than those listed above, please describe. Examples are: assistance with publicity, mention of your program in newsletters, local libraries or others who will assist with programming, etc. No MOU’s are needed for these informal relationships.



    A.Budget Summary (Attachment A-1): Use this form to present the details of how your requested

    funds fit within your total program budget for the specific afterschool program described in this stgrant application. The 1 column is to for ONLY the amount of CDD funds you are requesting.

    Column 2 is for any additional matching funds going into the program other than CDD grant

    dollars. Your sum total is stated in Column 3. Note: These grant funds cannot be used for

    family scholarships, parent transportation, construction or other capital expenses.


    B.Grant Budget Narrative (Attachment A-2): For each category in the A-1 Budget Summary,

    write a short narrative explaining the breakdown of CDD grant estimated costs in Column 1. A

    narrative must include both the documented specific costs or price estimates and a summative

    total within each category.

    8. LOGIC MODEL: (Attachment B) Please attach your logic model that summarizes the inputs, grant activities, outputs and outcomes for this project.



    All applicants MUST use this form to represent the one-year grant period.

    The figures in Columns 1 and 2 must add up to the figures in Column 3.

    You will provide related details in Attachment A-2 Budget Narrative

    CategoryColumn 1Column 2*Column 3

    Total Grant Funds Other

    ProgramRequested from Financial

    CDD ResourcesCosts for

    Grant Year

    Staff Salaries               

    (In A-2 Budget Narrative, list each position,

    hours/week, $/hr and total for each position)

    Fringe Benefits for Staff (specify -- 25-30% is      


    New Related Start-up Operating Expenses                

    (phone, postage, printing, insurance -- other than health -- etc.)


    Facilities/utilities (rent, heat, lights, etc.) – no more than 5% of the grant request.

    Equipment related to the purposes of the grant               

    Other Program Costs (explain):               

     Other Program Costs (explain):               

TOTAL DOLLARS               

    *OTHER ANNUAL FINANCIAL SUPPORT FOR THIS PROGRAM(The figures you stated in column 2 above, please explain where they are coming from below)

    Examples of “Other” include: Other funders, registration fees, fund-raising events,

     donations or in-kind donations, etc.

    IncomeAmountDate ReceivedPending Date

    Child Care Financial Assistance               

    Tuition/Fees: what kind; amt per child               

    Town Allocation               

    List other Grants/Revenue sources:






    All proposals MUST submit a budget narrative.Report ONLY on the items you are requesting in Column 1 of Attachment A-1. In each category, list

    the costs that add up to and equal the subtotal amounts of that category. Include written

    explanations where needed.

    Staff: List each staff Itemized Costs and total for this category:position for this grant, their      

    # of hours on the project,

    hourly rate and a subtotal

    total for each position, then

    a category subtotal.

    Fringe Benefits: List all Itemized Costs and total for this category:benefit amounts to be paid      

    to specific staff listed above

    and category subtotal.

    Operating Expenses: List Itemized Costs and total for this category:costs of each new operating      

    expense for this grant,

    specified costs for each and

    a category subtotal.

    Facilities/utilities: List Itemized Costs and total for this category: what will be charged to this      

    grant, specified cost, how

    each relates to the grant and

    category subtotal.

    Equipment: List equipment Itemized Costs and total for this category: that will be charged to this      

    grant, the cost per item and

    category subtotal.

    Other: List any other Itemized Costs and total for this category: related activity cost, the      

    amount for each, the

    documentation for this cost

    amount and the category


    Other: List any other Itemized Costs and total for this category: related activity cost, the      

    amount for each, the

    documentation for this cost

    amount and the category


    Total Grant Budget:




    Program Name:      

    Goal: (Purpose of Program):      

    AHS Outcome Area:      

    InputsGrant ActivitiesOutputsShort-Term Outcomes

    In One Year











    Input: A resource dedicated to or consumed by the program. Examples: staff, space, funding.Activity: Type of service the program provides to fulfill its mission. What the program does with the inputs – how it goes about transforming them into product or results. Example: “Afternoon choices will be offered in arts & crafts, gardening, swimming and drama.”

    Output: The direct product of a program operation. Must have a specific number OR percentage identified, i.e., 30 children will be served in the first year, or 90% of children will attend for the full year.Outcome: Benefit to participants during or after engaging in the program. Examples: “Parents will be report satisfaction with services fulfilling their family needs”; “The children will report positive social skills with their peers at the program”.

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