Weaving the Safety Net Application

Heart of Indiana United Way understands that before families and individuals can focus on their future, they must be able to meet their basic needs. United Way seeks partners that will work with clients in crisis to help them address their basic needs and bring stability to their lives. Partners must have a process in place to assess client needs and not discriminate based on age, race, sex, religion, national origin, disability, economic status, or sexual orientation. Successful Safety Net applicants will have a desire to improve the delivery of basic needs in their community by linking up with other partners in the community to “weave” a more cohesive system that puts the clients at the center of their work and eliminates unnecessary steps and burdens to receive services.

Safety Net Services include, but are not limited to, assistance with: Rent, Utilities, Emergency Shelter, Food, Transportation, Baby Supplies, and Health Access.

Safety Net Grantees will be gathered regularly throughout the year to work collectively on service delivery with other agencies in the community. Grantees will be required to track their assistance through Charity Tracker and will be strongly encouraged to conduct warm referrals for clients to other services. Grantees will be required to commit at least one front-line staff member to quarterly Community Health Worker training. $200 of funding will be allocated toward training and $120 toward Charity Tracker license for one staff person. Organizations can train more staff and purchase more licenses at their expense.

About The Application

Reminder: Application Deadline is April 15, 2022 at 11:30 pm

Fields marked with a red * are required.

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Organization Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Website / URL

Executive Director *

First

Last

Contact name if different from Executive Director

First

Last

Email *

Phone *

What County or Counties do you plan to serve with this request? *

Please indicate which county or counties you serve

FUNDING REQUESTED

What is the amount of annual funding requested from United Way and what is the amount of total program revenue projected in the proposed annual program budget in this proposal?

United Way annual program funding requested: *

Total proposed annual program budgeted expenses: *

Total proposed annual AGENCY budgeted expenses: *

ORGANIZATIONAL CAPACITY (9 points) *

Explain how your organization is capable of fulfilling the program service for which you are applying for funding. Describe your organization, noting capacity and experience. Cite examples of how the organization typically applies its skills and resources to accomplish its goals and satisfy its stakeholders’ expectations. Factors to consider in your response: a. Mission and history b. Organizational structure c. Leadership and management style d. History with managing and participating in partnerships e. Fiscal and grant management capacity f. Program location

TARGET POPULATION NARRATIVE (8 points) *

Define the current target population, including the size and circumstances of the population from which program participants are identified. Include relevant descriptions of the demographics of program participants (which may include age, gender, race/ethnicity, income level, geographic location, etc.). Describe the risk factors and community conditions affecting the target population that underlie the need for the program and any other relevant characteristics of the target population.

ACCESSIBILITY AND INCLUSIVITY (10 points) *

Describe actions by the agency to ensure the program is accessible to—and effective in serving—members of the target population who may face barriers to service due to such factors as income inequality, race/ethnicity, language, physical disability, transportation issues, work schedules or other factors.

PROGRAM QUALITY (5 points)

a. Is the program or agency licensed, accredited, certified by an affiliate, or subject to any other set of standards? *

b. If yes, please name and describe the entity—or entities, if the program/organization has multiple) that conducts the review and the frequency of the review.

c. When was the most recent review(s) and what was the outcome of the review(s)?

d. In the past three years, has the organization lost any accreditation/certification/licensure due to performance problems or has the organization chosen not to reapply for any accreditation/certification/licensure for any reason? *

e. If yes, please explain.

f. Describe any additional efforts taken by the organization to ensure program quality.

PROGRAM PARTICIPANT COUNT (6 points)

Please report an unduplicated count of program participants in 2021 by geographic area, gender, race/ethnicity, income level and age, for each service for which you are applying for funding.

Total number of program participants *

Are you able to report an unduplicated count of participants? *

Participants by Geography

Please report an unduplicated count of program participants in 2021 by geographic area for each county you serve.

PARTICIPANTS BY GENDER

Please report an unduplicated count of program participants in 2021 by gender.

Number of male participants *

Enter 0 if none/not tracked

Number of female participants *

Enter 0 if none/not tracked

Number of tansgender male/trans man participants *

Enter 0 if none/not tracked

Number of trans female/trans woman participants *

Enter 0 if none/not tracked

Number of non binary/gender nonconforming participants *

Enter 0 if none/not tracked

Number of gender unknown *

PARTICIPANTS BY RACE/ETHNICITY

Please report an unduplicated count of program participants in 2021 by race/ethnicity.

Number of American Indian/Alaska Native participants *

Enter 0 if none/not tracked

Number of Black/African American participants *

Enter 0 if none/not tracked

Number of Asian/Pacific Islander participants *

Enter 0 if none/not tracked

Number of Hispanic/Latino participants *

Enter 0 if none/not tracked

Number of White/Caucasian particpants *

Enter 0 if none/not tracked

Number of participants of other race/ethnicity *

Enter 0 if none/not tracked

Number of participants with unknown race/ethnicity *

Enter 0 if none/not tracked

PARTICIPANTS BY INCOME LEVEL

Please report an unduplicated count of program participants in 2021 by income level.

Number of participants at or below 100% of Federal Poverty Level *

Number of participants between 100%-200% of Federal Poverty Level *

Number of participants at or above 200% of Federal Poverty Level *

Number of participants whose income level is unknown *

BUDGET NARRATIVE (10 points) *

Please provide detail on each of the budgeted revenue sources and expenses in the program budget you submitted.

DESCRIPTION OF SERVICES (20 points) *

Please describe in detail the basic needs services you will be providing along with your method for working with other providers to meet client needs.

STAFF QUALIFICATIONS (12 points) *

Please describe the number, qualifications, experience, and duties of specific staff responsible for delivering the services clients receive. Include a description of training provided to these staff to ensure they are capable of performing the work required of them and your plan for ensuring at least one staff person will become certified as a Community Health Worker ($200 of funding will be allocated toward training one staff person)

PROGRAM OUTCOMES (20 points) *

Number of individuals who obtain healthcare insurance
Number of individuals who access preventative healthcare
Number of individuals who access healthy food
Number of individuals who move from shelter to stable housing
Number of individuals who receive utility assistance
Number of individuals who receive rent/mortgage assistance
Other (1):
Other (2):
Other (3):

Please choose which indicators your program or service tracks

Additional explanation on outcomes

If necessary, provide additional explanation on outcomes listed above

Outcome lessons learned *

Describe what has been learned about your current program’s success as a result of outcomes data. If any changes have been made to the program (e.g. outreach, activities, data collection) based on the outcomes data, describe those changes.

Does your organization have a diversity, equity or inclusion statement? *

AGENCY Budget *