2012 City of Kingston and United Way
Community Investment Fund Application
Administered by:
United Way serving KFL&A
Submission Deadline
Monday, September 10, 2012
Name of Organization:
Address:
Is the organization a Non-Profit in the Province of Ontario and/or a Registered Charity with Canada Revenue
Agency?
Yes/No: ______
If yes, provide documentation showing the year it became a non-profit:
 Yes, attached
CRA Charitable Registration #: (if applicable)
Contact Person and Position:
Telephone:
Fax:
Email:
TOTAL GRANT AMOUNT REQUESTED:
TYPE OF FUNDS:
TYPE OF GRANT:


City of Kingston

Program
$_________ ($25,000 maximum per project**)


United Way
One-Time Project

Both
Capital Expenditure
PROGRAM / PROJECT NAME:
EXPECTED START and END DATE:
(Note: projects cannot begin prior to an agreement being signed.)
PLEASE INDICATE THE GEOGRAPHIC AREA(S) THIS PROGRAM/PROJECT WILL SERVE:
 City of Kingston
 County of Frontenac
 Lennox & Addington
MUST BE ATTACHED:


Most Recent Audited Financial Statement
(for organizations with an operating budget greater than $250,000)
Most Recent Annual Report

We have provided Board members the opportunity to review this submission and they are
aware of this application.
________________________________
_________________________________
Signature of Board Chair
Executive Director / Senior Administrator
________________________________
_________________________________
(Date: day/month/year)
(Date: day/month/year)
Please submit:
 1 signed original application  1 additional complete photo copy of application
 1 electronic copy of complete application by email to: [email protected]
**For other United Way granting opportunities please visit www.unitedwaykfla.ca.
**Please note an organization may only receive one United Way grant per year, regardless of the funding stream.
Community Investment Fund Grant Application
BOARD OF DIRECTORS
Fill in the table below or attach list
FULL NAME
POSITION
ON BOARD
# OF YEARS ON
THE BOARD
OCCUPATION & NAME OF
ORGANIZATION
Month of Annual General Meeting:
ORGANIZATION INFORMATION
WHAT YOUR ORGANIZATION DOES:
Mission Statement:
Brief overview of organizational goals:
Brief overview of services/activities to meet organization’s mission statement:
Community need that organization addresses:
Briefly describe the organization’s greatest accomplishment(s) in the past five years (please limit to 3):
FUNDRAISING PROJECTS AND ACTIVITIES
Does the organization plan to schedule fundraising projects, events or grant writing in the coming year?
Yes / No: ____
If Yes, please indicate below the project or event, its timing and the revenue expected to be generated
through the fundraising project.
Fundraising activity
and brief description
Total Expected Revenue
Funds are for which
Project/Program?
Date(s) of Activity
Expected Revenue
$
(Insert additional lines if required)
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Community Investment Fund Grant Application
PROGRAM / PROJECT DESCRIPTION
Please keep your descriptions simple and brief.
Provide a brief description of the program/project and outline its purpose:
How does this program/project fit with the organization’s mission statement?
PROGRAM / PROJECT NEED
What local need is being addressed by this program/project?
Briefly describe any local research or background rationale that supports this need in the community. Please
include research documents if available.
Are there individuals waiting to be served by this program/project?
If yes, what factors prevent service to these individuals?
Do you refer these individuals to any other community program or organization?
If yes, please specify. If no, please explain why.
Yes / No: _____
Yes / No: _____
PROGRAM / PROJECT PARTNERSHIPS
Briefly explain how clients and/or other stakeholders are involved in program/project development, delivery
and evaluation.
Does/Will this program/project work in partnership with any other organization(s)?
If yes, please explain their role:
Yes / No: _____
How does/will this partnership benefit program/project service delivery?
PROGRAM / PROJECT INPUTS & RESOURCES
How many Full Time Equivalent employees (FTEs) will be used to deliver this program/project?
Will the organization use volunteers in the delivery of this program/project?
If yes, how many during the fiscal year? _____
If no, briefly explain the barriers that prevent this?
_____
Yes / No: _____
Please identify other key resources (inputs) necessary to run this program/project:
ORGANIZATION and PROGRAM / PROJECT BUDGET
 Please complete the Financial Reporting Schedules included with this package
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Community Investment Fund Grant Application
COMMUNITY IMPACT AREAS
Please identify the Community Impact Area your organization aligns with, and select at least one Outcome
from its list that individuals will achieve as a result of participating in the activities of this program/project:
 K - All That Kids Can Be:
Growing Up Great
Targeting:
o Early Years
o Children & Families
o Youth
Goal: to ensure children and youth are valued and supported members of the community with
opportunities and resources to help them reach their fullest potential.
Outcomes:
 K1 - improved knowledge and understanding about the importance of early childhood development
 K2 - increased cognitive, social and emotional maturity of young children so they can get along with
others and are ready to learn
 K3 - increased supports and opportunities for parents/caregivers to improve their skills and provide a
safe and stimulating environment for children
 K4 - improved healthy behaviours, attitudes, social skills, confidence, communication and decision
making skills of children and youth
 K5 - improved engagement in community, school and learning for children and youth at risk
 K6 - improved access to healthy living, food security, and recreation
 C - Healthy People, Strong Communities:
Turning Lives Around
Targeting:
o Vulnerable people
o People experiencing barriers, mental health
issues, in need of support
o Seniors
o Victims of violence & abuse
Goal: to improve opportunities for people to access programs and supports that empower them to
overcome barriers, build resilience, reduce isolation and be part of a caring, inclusive community.
Outcomes:
 C1 - Increased autonomy and independent living skills
 C2 - Improved access to information and effective supports (including families and caregivers)
 C3 - Increased inclusion and participation in community and daily life
 C4 - Increased safety for victims of violence and abuse
 C5 - Improved supports and interventions for people experiencing crisis
 C6 - Improved life skills, basic academic and language skills, financial literacy and employment skills
 C7 - Improved cooperation and collaboration between organizations
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Community Investment Fund Grant Application
 P - From Poverty to Possibility:
Belonging to Community
Targeting:
o Poverty
o Homelessness
o Neighbourhoods
Goal: to help people engage in their community by strengthening neighbourhood revitalization efforts,
reducing poverty, and improving access to affordable housing.
Outcomes:
 P1 – increased capacity of residents to take action and respond to needs in vulnerable neighbourhoods
 P2 - improved opportunities for civic engagement and participation in community
 P3 - increased supports to alleviate the impact of poverty
 P4 - Improved nutrition and food security
 P5 - Improved access to emergency shelter and affordable housing
 P6 - increased supports and resources to maintain or regain permanent housing
 S - Sustaining Our Heritage
(City of Kingston Fund Only)
Targeting:
o Education
o Heritage
o Cultural protection
Goal: to preserve and protect the unique cultural heritage in Kingston through preservation, community
education & participation, and program coordination.
Outcomes:
 S1 - increased public awareness and recognition of cultural heritage
 S2 - improved opportunities for accessing museums and other heritage facilities
 S3 - improved collaboration among cultural heritage organizations
 S4 - protection of cultural heritage resources
(please note: any applications for physical alterations to historic/heritage buildings are not eligible.
Application and approval of these types of projects is through the Kingston Municipal Heritage Committee
under the Ontario Heritage Act.)
Briefly explain how the program/project meets the goal/objectives of the Community Impact Area:
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Community Investment Fund Grant Application
OUTCOME MEASUREMENT
Program OUTCOMES are the Benefits or Changes for people as a result of participating in a program/project
and its activities (i.e.) new knowledge, modified behaviour, increased skill, changed attitude or values,
improved condition, altered status
In the chart below, please describe how individuals will achieve the selected outcome(s) for this
program/project:
Outcome(s)
Indicator(s)
Please provide the selected outcome code
(i.e. K1), or description, that aligns with the activity.
What milestone(s) will indicate individuals have made
progress towards the selected outcome (i.e.) things that can
be observed, demonstrated, self-reported, etc.
Activity 1.
-
Activity 2.
ACTIVITIES & OUTPUTS
In the chart below, briefly describe the main activity(ies) for this program/project, and who will be served.
How many individuals in total are expected to be served by this program/project?: ______
Program/Project Activity
Activity Output(s)
What the program/project will do for clients, such as:
(i.e.) teaching, counseling, mentoring, provide
shelter, safety, food/meals, etc.
What are the expected statistics for each activity, such as:
(i.e.) # of individuals by demographic (children/teens/parents)
# of groups/sessions; duration, etc.(2hr/wk x 12 wks)
1.
-
2.
-
PROGRAM / PROJECT EVALUATION
Briefly describe how this program/project will be evaluated, including the tools that will be used.
Data Source(s)
Where you will get the data for each indicator, who
or what will provide the data
Data Collection Method(s)
How the data is obtained, such as a survey, interview, role
play, observation, case notes, etc.
1.
2.
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Community Investment Fund Grant Application
NEED FOR FUNDING
Please explain why Community Investment grant funding is needed?
Has this program/project received previous City of Kingston Funding?
Yes / No: _____
If yes, please specify the amount of funding and time period in which the funds were received.
Has this program/project received previous United Way Funding?
Yes / No: _____
If yes, please specify the amount of funding and time period in which the funds were received.
Have other funding sources been approached for this program/project?
If yes, please specify what they are and the status of the request.
Yes / No: _____
Will this program/project continue beyond the Community Investment grant period? Yes / No: _____
If Yes, how will it be sustained? Please explain.
Does the organization lease/rent space in a City owned facility?
Yes / No: _____
How will support of United Way and City of Kingston be recognized for this program/project?
-----------------------------------------------------For information regarding this granting opportunity, please refer to:
2012 City of Kingston and United Way Community Investment Fund Guidelines available online at:
www.unitedwaykfla.ca; and www.cityofkingston.ca
If you have questions or would like clarification about the information contained in this package, please
contact Kim Hockey at the United Way office. ph: 613-542-2674 ext. 6 email: [email protected]
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