2016 FCSS Funding Application
(Check any or all to which you are applying)
Carstairs FCSS
Cremona FCSS
Didsbury FCSS
Olds FCSS
Mountain View County FCSS
ORGANIZATION/GROUP INFORMATION:
Organization Name:
Email Address & Website:
Mailing Address: (including postal code)
Street Address:
Organization Telephone Number:
Organization Fax Number:
Project Contact Name:
Contact Telephone Number:
Contact Email Address:
Is your Organization registered as a society or a corporation:
(Yes / No)
Charitable Number:
Incorporation Number:
Applications must be received at Mountain View County on or before:
November 13th, 2015
Mountain View County
Attn: Pam Thomas
Bag 100
Didsbury, AB
T0M 0W0
Fax Number: 403-335-9207
Email: [email protected]
FCSS Grant Application
Page 1
TOTAL FUNDING REQUIRED:
Carstairs FCSS
Cremona FCSS
Didsbury FCSS
Mountain View County FCSS
Olds FCSS
Sundre FCSS
FCSS GRANT – TOTAL REQUESTED
$
$
$
$
$
$
$
CERTIFICATION OF COMPLIANCE:
This is to certify that to the best of my knowledge and belief, the information included in this application complies
with the requirements and conditions set out in the Family and Community Support Services Act and Regulations.
(http://child.alberta.ca/home/1022.cfm)
________________________________________
Name (Organization Signing Authority)
________________________________________
Title
________________________________________
Print Name
Signature
________________________________________
Date
AUTHORIZATION FOR APPLICATION:
Name:
Signature:
Position:
Name:
Signature:
Position:
Application Checklist:
Is every section complete? (If you have questions contact your Local FCSS Office)
Is the financial information provided in the format required?
Is it clear how the program meets the FCSS Mandate?
Is the application signed by an authorized person?
Is the Interim Report (to September 30) attached, if not already submitted?
Is the list of Board members attached?
Is a copy of the Annual General Return attached?
Please attach a copy of your “Reserve Bank Account Policy” if applicable.
Incomplete applications will be returned and may not be considered.
Carstairs FCSS
Cremona FCSS
Didsbury FCSS
FCSS Grant Application
403-337-3341
403-637-3731
403-335-8719
Mountain View County FCSS
Olds FCSS
Sundre FCSS
403-335-3311
403-556-6981
403-638-1011
Page 2
STRATEGIC DIRECTIONS:
Over-arching Goal
FCSS enhances the social well-being of individuals, families and community through prevention
In order to qualify for FCSS funding, your project/program must align with the FCSS over-arching goal and address
at least one of the five Provincially identified Strategic Directions. Please check all that apply. If your
program/project does not align with the over-arching goal, or does not address at least one of the Strategic
Directions, please contact your local FCSS Director before continuing with this funding application.
□ Prevention
□ Local Autonomy □ Community Dev □ Accountability
□ Volunteerism
Help people to
Help people to
Help people to
Help people and
Provide supports
develop
develop an
develop
communities to
that help sustain
independence,
awareness of social
interpersonal and
assume responsibility people as active
strengthen coping
needs;
group skills which
for decisions and
participants in the
skills and become
enhance constructive actions which affect community
more resistant to
relationships among them; and
crisis;
people;
WORK PLAN:
Project/Program Name: ____________________________________________________________________
1. Describe your idea. What are your goals,
objectives and outcomes? Where will it take
place?
2. What community needs are being addressed?
(please include research to support this section)
3. How will you involve the community? How will
you reach people who are new to your
community or have/have not been involved
before?
4. Who are you aiming the project at? (age, gender,
group)
Primary Target Population:
□ Children/Youth □ Families
□ Seniors □ Community
□ Adults
5. Who else will contribute to your project and
what will they provide?
6. Will volunteers be involved in the program?
How many volunteers will be involved?
Estimated Volunteer Hours?
7. When will your project be completed?
Additional Comments:
FCSS Grant Application
Page 3
WORK PLAN TABLE:
Using the table, please provide the information requested
Goals
A visionary statement of your project’s overall, long-term purpose.
What is the key challenge your project is working to resolve? Goal
statements will use language such as: “To develop….. To reduce…..”.
Objectives
Specific, trackable and measurable statements of what you want to
accomplish. What are the problems that contribute to your overall
challenge? What are the key changes that will help you reach your goal?
Determine the time lines (2-3 years).
Outcomes
Outcomes are benefits or changes in your target group’s knowledge,
attitudes, values, skills, behavior, condition or status.
What impact do you expect to have on your target population as you
work towards your program goal?
(Outcome e.g. “Youth have increased appreciation for the differences
between them and their peers”; Individuals are connected with others”;
Children and youth develop positively”.)
Outcome Measurement
Choose data collection to measure your outcomes.
□ Questionnaires □ surveys □ checklist
□ interviews □ observation □ focus groups
Activities
Please list the key activities:
Activities are key actions of the project that use inputs to produce
outputs. Project activities and their results will contribute to the
achievement of project objectives.
Examples of key activities include: skill-building workshops, resource
development, networking, etc.
(Please list the key activities)
Inputs
Resources a program uses to achieve program goals. Examples are
money, staff, and staff time, volunteers and volunteer time, facilities,
equipment & supplies.
List the specific inputs that you plan to use for each of your project
activities. This should correspond with the expenses listed in your
project budget
Outputs
The goods and services produced directly from a project’s activities.
Each activity should have a corresponding output.
Examples of outputs include teaching models, reports, training
sessions, etc.
Timelines
Indicate the duration and approximate dates for each key activity.
Make sure to note that planned dates are subject to change if applicable.
FCSS Grant Application
Page 4
2016 PROGRAM BUDGET PROPOSAL:
Each program you apply for needs to have a separate budget
Revenue
Donations
Fundraising
Other Grants
In-Kind Contributions
Fees
$
$
$
$
$
Total Revenue (A)
$
Expenses
Personnel Costs:
Facilitator/Guest Speaker Costs
Staff Salaries & Benefits Connected with the Program
Volunteer Training & Recognition
Rentals or Lease Agreements:
Facilities, Office or Venue Rent
Professional Fees
Equipment
Program Administration Costs
Advertising (Publicity & Promotion)
Office Expenses (phone, postage & stationery
Materials & Supplies: please specify (ie crafts, books, etc)
$
$
$
$
$
$
$
$
$
$
$
$
$
Any Other Program-Related Expenses
$
$
$
$
Total Expenses (B)
Total eligible request for funding (B-A)
$
$
Note: Financial information must be submitted in the format provided
FCSS Grant Application
Page 5
BUDGET PROPOSAL CLARIFICATION
Revenue
FCSS Requested Amount.
Indicate Registration Fees.
Donations:
Please indicate if you have partners who have agreed to contribute to the
funding of your project, and provide details for each partner. Specify if the
funding has been confirmed or pending.
In Kind Contributions
The value of in-kind goods and/or services that are directly related to the
project and are donated to the project by the applicant organization.
“In-kind” refers to goods and/or services that are provided instead of money.
For your project budget, a reasonable monetary value should be applied to these
contributions.
In-kind contributions can include staff and volunteer time, services, programs,
office space and administrative services.
Expenditures
Salary/Benefits
Salaries can be paid for work directly related to the project.
When salaries are paid, benefits are an eligible expense.
Salaries and benefits for members of a board of directors or other decisionmaking body are not eligible expenses.
Professional Fees
Includes costs for the professional services of an individual (not a member of
the applicant organization) with the expertise needed to carry out the project.
Payment to an individual for a task performed and/or knowledge contributed
to the project is an eligible expense.
Honoraria for the members of a board of directors or other type of decisionmaking body of an applicant organization are not usually an eligible expense.
Facilities
Costs related to the portion of meeting space required for project activities.
Materials & Supplies
Supplies and materials needed to carry out the project/program.
Publicity & Promotion
Costs related to producing and printing of brochures, newsletters and posters,
and the purchasing of ad space, to promote the project and project activities.
Other
Eligible costs not included in other budget items and that pertain to
project/program.
FCSS Grant Application
Page 6
PROVINCIAL OUTCOME MEASURES INFORMATION
The following two pages DO NOT NEED to be completed as part of your
application process; however, you will be expected to measure and report on
SOME outcomes. Please note that while it is understood the transition into the
new FCSS reporting format will take some time, successful applicants are
encouraged to work with your FCSS Director(s) to assist you through this
process. Information and training sessions may be scheduled following the
approval of the 2016 FCSS Funding Applications.
OUTCOME MEASURES INTRODUCTION
 In 2000, an environmental scan identified that local FCSS programs did not have the
capacity to monitor outcomes of program delivery, nor was there an information system to
store and aggregate the results on a provincial level.
 In spring 2009, a Provincial FCSS Outcome Measures Steering Committee was established to
oversee this initiative and address needs. Priorities identified, included training, regular
communication, use of consistent definitions, outcomes reporting, and development of
outcome templates and resource tools. A training curriculum was developed in 2010.
 The FCSS Outcomes Model (The Model) is intended to guide and inform local FCSS
programs. The Model includes charts providing provincial outcomes for individuals, families
and community:
 How local FCSS programs choose programs and projects to address any of the
provincial outcomes based on the priorities identified at the local level;
 How the provincial outcomes and the indicators of success fit with the five strategic
directions identified in the FCSS Regulation; and
 How these provincial outcomes and the indicators of success contribute to the highlevel outcomes of social well-being of individuals, families and community and the
over-arching provincial goal for local FCSS programs
 The Model, provides a framework, which local FCSS programs can choose and then
effectively measure the impact of programs and services on the social well-being of
individuals, families and communities.
FCSS Grant Application
Page 7
Project/Program Name: ________________________________________
Date: _________________
OUTCOME MEASUREMENT INFORMATION
Outcome Statement:
______ # of Participants
______ # Participants completing measurement tool
Primary Target Population:
Which of the Provincially Identified Vulnerable
Populations does this program support? (if
applicable)
□ Immigrants
□ Children/Youth
□ Seniors
□ PDD
□ Aboriginal
□ Working Poor
□ Lone Parent Households
□ Children/Youth
□ Families
□ Seniors
□ Community
□ Adults
Indicator of Success #1:
Question Measure #1:
Question/Measure #2 (if more than one)
Rural vs. Urban
_____ # Participants completing question/measure
_____ # Participants experiencing a positive change
Rural vs. Urban
_____ # Participants completing question/measure
_____ # Participants experiencing a positive change
Indicator of Success #2: (if more than one)
Question Measure #1:
Question/Measure #2 (if more than one)
Rural vs. Urban
_____ # Participants completing question/measure
_____ # Participants experiencing a positive change
Rural vs. Urban
_____ # Participants completing question/measure
_____ # Participants experiencing a positive change
Indicator of Success #3: (if more than two)
Question Measure #1:
Question/Measure #2 (if more than one)
Rural vs. Urban
_____ # Participants completing question/measure
_____ # Participants experiencing a positive change
Rural vs. Urban
_____ # Participants completing question/measure
_____ # Participants experiencing a positive change
FCSS Grant Application
Page 8
Provincial Outcome and Indicator Alignment
Please select the one indicator that this outcome specifically contributes to:
Improved social well-being of
Improved social well-being of
Improves social well-being of
individuals:
families:
community:
Outcome 1: Individuals experience Outcome 1: Healthy functioning
Outcome 1: The community is
personal well-being.
within families.
connected and engaged.
Indicator:
□ Resilience
□ Self-esteem
□ Optimism
□ Capacity to meet needs
□ Autonomy
□ Competence
□ Personal Engagement
□ Meaning and purpose
Outcome 2: Individuals are
connected with others
Indicator:
□ Positive family relationships
□ Positive parenting
□ Positive family communication
Indicator:
□ Social engagement
□ Social support
□ Awareness of the community
□ Positive attitudes towards others
and the community
Outcome 2: Families have social
supports
Outcome 2: Community social
issues are identified and addressed.
Indicator:
□ Quality of social relationships
□ Social supports available
□ Trust and belonging
Indicator:
□ Extent and quality of social
networks
□ Family accesses resources as
needed
Indicator:
□ Awareness of community social
issues
□ Understanding of community
social issues
□ Agencies and/or community
members work in partnership to
address social issues in the
community
Outcome 3: Children and youth
develop positively.
Indicator:
□ Development Assets
Asset # __________
Asset Title ___________________
Provincial Strategic Direction Alignment
Please select the one Strategic Direction this outcome most contributes to:
□
□
□
□
□
Help to develop independence, strengthen coping skills and become more resistant to crisis.
Help to develop an awareness of social needs.
Help to develop interpersonal and group skills, which enhance constructive relationships among people.
Help people and communities to assume responsibility for decisions and actions, which affect them.
Help to sustain people as active participants in the community.
***** Print off additional copies of pages 1 and 2 and complete pages 1 and 2 for every outcome
measured for this program *****
FCSS Grant Application
Page 9