NYSDOH - Division of Nutrition - Bureau of Nutrition Risk Reduction
Hunger Prevention and Nutrition Assistance Program (HPNAP)
RFA #1003220225
Resource/Grant Distribution Project
Please ensure that the following application is completed in its entirety. Applications must be typed
and submitted by the deadline on the first page of the RFA. Handwritten applications will not be
accepted. The applicant is responsible for ensuring that the typed responses are visible in the
space provided. Incomplete applications may not be considered for funding.
Applicant Organization Name:
Phone:
Address:
Email Address:
Total Funding Request:
Project Director Name:
Project Director Signature:
I hereby attest to the above applicant organization having a minimum of 12 months experience providing the
services described in this application.
Printed Name:_____________________________Signature:___________________________________
Please check type(s) of programs you are applying for. Please refer to pages 8-10 of the RFA for
program description(s):
Type A - Distribute HPNAP funding to any Emergency Food Relief Organizations eligible to apply
through a formal application process within a defined geographic area. Applicant organizations that will
provide HPNAP funded resources to sites they directly operate must apply as a Direct Service Project.
Type B - Distribute HPNAP funding to a network of Emergency Food Relief Organizations in their
network. Applicant organizations that will provide HPNAP funded resources to sites they directly
operate must apply as a Direct Service Project.
Please submit the following eligibility documents:
A copy of the Certification of Incorporation, documenting your agency's incorporation status.
A copy of the US Dept. of Treasury, Internal Revenue Service correspondence stating your agency's
Federal Tax ID number.
A copy of your agency's New York State Department of State form which indicates your charity
registration number.
Audited Financial Statements.
501c3
Page 1 of 21
A. Project Summary
Maximum 10 Points
A1. Describe in detail the project(s) or service(s) for which you are requesting funding. Clearly describe
the enrollment types (A and/or B) that will be provided. Include a description of the project or service for
each enrollment type specified on the previous page that includes services/activities and objectives.
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A. Project Summary continued
A2. Describe the anticipated outcomes and the measurement methodology.
A3. Identify the site location and hours of service.
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A. Project Summary continued
A4. Identify the target population(s) and service area(s).
A5. Describe your experience in providing the proposed service.
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A. Project Summary continued
A6. Summarize how Minorities, Lesbian/Gay/Bisexual/Transgender persons and persons with disabilities
are incorporated into the development and implementation of services.
A7. Highlight your organizations accomplishments in providing services for persons needing food
assistance.
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A. Project Summary continued
A7. continued.
A8. Describe any additional benefits to food and services offered by your organization to support the
success of the proposal (e.g. matching or other funding, in-kind donations or volunteer support, outreach
services, etc.).
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B. Description of Need
Maximum 15 Points
B1. Describe the social, economic and/or other indicators of need in the target area, such as
employment levels, poverty statistics, etc. that demonstrate a need for emergency food assistance.
Include a description of the lack/inadequacy of existing emergency food relief services available to the
target population.
B2. Describe the methods and types of data used to identify the target population and estimate (and
identify the basis for this estimate) the number of persons in need of food assistance within the target
community or catchment area.
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B. Description of Need continued
B3. Describe the extent to which the proposed project will address the described un-met need. Be
precise as to how your organization provides services that may exceed or compliment other services in
the catchment area.
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C. Applicant Organization
Maximum 10 Points
C1. Provide (as Attachment C1) a description or diagram of the organizational structure of your agency and
a listing of your Board of Directors. The organizational chart should Include hierarchy within your agency and
parent organization (if applicable), key positions and staff associated with emergency food relief services;
and names, positions, address and phone numbers of the Board of Directors. The organization chart should
display a structure that is conducive to providing quality services.
Included as Attachment C1
Not Included
C2. Include (as Attachment C2) letters of cooperation and collaboration and/or letters of support that verify or
support the proposed services. Include no more than 20 letters total. Letters should demonstrate
partnerships that will contribute to the success of the project.
Included as Attachment C2
Not included
C3. List your organizations major funding sources. Major funding sources provide 20% or more of your
organizations total funding. Funding sources should demonstrate the viability of your organization. If more
space is needed, include as Attachment C3.
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C. Applicant Organization continued
C4. List below any licenses/certifications held by program staff (e.g. local Department of Health
operating or food handlers certificate, thrift shop permit.) Please include staff titles. The list should
demonstrate that your organization possesses all required licenses/certifications to provide the proposed
service(s).
C5. Provide your organizations Mission and Vision Statements below. Explain how your organization's
statements are consistent with HPNAP's Mission/Vision.
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C. Applicant Organization continued
C6. Describe your cost containment and purchasing policies and procedures. Policies and procedures
should demonstrate that efficiency and quality are maintained.
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D. Project Activities
Maximum 35 Points
D1. In the first two boxes below, state the number of meals and the number of pounds to be distributed
with HPNAP funds. In the third box, describe your plan for how the proposed service will be provided as
well as your service goals with measurable objectives including projected service level. Goals should be
reasonable.
Projected total number of meals that will be provided by organizations
receiving HPNAP assistance through your organization. Current
HPNAP Contractors should ensure that the number provided is
consistent with MIS reports.
Projected number of pounds of food to be distributed with HPNAP funds.
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D. Project Activities continued
D2. Describe the type of project activities to be accomplished over the course of the year for each
objective listed on the previous page. Project activities should demonstrate that the proposed objectives
can be achieved. Please detail partnerships and collaborations that enhance the stability of the project.
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D. Project Activities continued
D2. continued.
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D. Project Activities continued
D3. For foods to be purchased with HPNAP funds, describe your food purchasing practices that
minimize cost while maximizing nutrition. If applicable, include how local foods will be considered and
any voucher/coupon models that will be utilized. Include your nutrition standards as Attachment D3.
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D. Project Activities continued
D4. Type A applicants: describe the grants that will be administered (Operations Support and/or Food).
Provide detail on application process for each grant type to be administered.
Type B applicants: describe how funds/resources will be distributed to the EFRO network.
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D. Project Activities continued
D5. Describe how the Food Safety and Sanitation Project will be administered to minimize the risk of food
borne illness in the emergency food network.
D6. Provide the plan to ensure that people in need of emergency food assistance in the catchment area
have access to food without discrimination. Include strategies for access to and participation in your
services by Minorities, Lesbian/Gay/Bisexual/Transgender persons and persons with disabilities.
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D. Project Activities continued
D7. Provide a plan for obtaining, providing and/or implementing nutrition support services or assistance. If
applicable, provide your plan for administering the Nutrition Resource Management (NRM) Project.
Include the NRM Work Plan as Attachment D7. A sample is included, see Attachment 13. NRM Work
Plan should describe the NRM role in developing and implementing nutrition standards that promote fresh
whole foods and limit processed foods.
D8. Describe the methods of conducting HPNAP member agency needs assessments and/or client
satisfaction studies to develop action plans for improving services such as client choice, referral/
outreach needs, cultural preferences, etc. where applicable. Include how this information may affect
services.
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D. Project Activities continued
D9. Describe your organizations plan for establishing or improving networking among EFROs to improve the
effectiveness of emergency food services by ensuring access, food safety, nutrition quality and cost
efficiency.
D10. Describe established collaborations/partnerships with other community agencies that enhance the
sustainability of the project.
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E. Project Evaluation
Maximum 10 Points
E1. Summarize how the proposed service will be evaluated to determine that progress is being made and
objectives are being met. Include measures and time frames for each objective.
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F. Budget
Maximum 20 Points
Applicants should keep in mind that Program funds are limited and that the cost effectiveness of an
organization's proposal will directly impact the scoring of this section. The budget request should identify only
those allowable costs that are necessary to provide proposed services. Scoring will be based on the budget's
clarity, completeness and feasibility of providing a quality service with the funds requested. Final budgets and
work plans will be determined when HPNAP contracts are established.
F1. Complete and include the budget package (Attachment #8). Include a justification below for each cost or
include it as an attachment labeled F1 (up to 3 additional pages, if needed.) Justifications must fully explain
the intent of the funding for the budget category as well as how the amount was computed. Include job
descriptions for all existing staff labeled Attachment F1. The budget justification must delineate how the
percentage of time devoted to this initiative was determined.
Print Form
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