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Home My WebLink AboutFY 1516 Outside Agency Funding Application School organizations OUTSIDE AGENCY FUNDING REQUEST FOR CHARITABLE CONTRIBUTION Elementary, Middle, and High School Organizations Application (Exhibit A) Fiscal Year 2015/2016 City of Palm Desert FINANCE DEPARTMENT 73-510 Fred Waring Drive Palm Desert, CA 92260 760-346-0611, Ext. 382 Fax: 760-341-4564 2015/2016 Outside Agency Funding Application 2 INTRODUCTION Thank you for your interest in the Outside Agency Funding Committee’s funding process for nonprofit, school and community-based organizations. The Committee’s goal is to provide for unmet needs and improved services that serve the City of Palm Desert. The Outside Agency Funding Committee is comprised of a five-member Board: two City Council Members, City Manager, City Treasurer and City Attorney. CRITERIA 1. The agency or group (“Applicant”) requesting funds must be in existence for a minimum of five (5) years in order to be considered for funding by the Outside Agency Funding Committee. The Agency must also be of verifiable non-profit status and presently providing charitable, public benefit, public welfare or educational services to persons residing in the City of Palm Desert or its sphere of influence (the “City”); and 2. The applicant has an existing program in place and a staff that is ready and willing to provide services to the City for the benefit of its residents. Funds will not be contributed to any agency or group for “startup” costs; and 3. The applicant has submitted to the City an application setting forth in detail its request for funding, including a statement of purpose detailing specifically the services it intends to provide for the City, how and where the contribution from the City will be allocated, and the quantity and quality of such proposed service; and 4. The funds contributed to the applicant will be donated for the purposes of providing services to the City of Palm Desert, or its sphere of influence, to the extent possible. Said funds are not designated for salaries, dinner/golf events or capital improvement projects; and 5. The applicant agrees to use the funds granted by the City to provide only the services represented in its application for funding. Additionally, the applicant will explain how the services will benefit the City’s residents; and 6. The City desires to have the services as detailed in the applicant’s application performed for the City and its residents by the agency or group; and 7. The City has reviewed the applicant’s application and tax exemption certification and, upon review and discussion, has determined that the expenditure of funds for these services is in the public’s interest; and 8. The City will not provide public funds to private individuals or corporations unless there is either: a) full consideration; or b) an overriding public need; and 9. Where the applicant is an audited entity, the applicant’s independent auditor will need to make a footnote in the financial statements confirming the use of the City’s contribution in the manner set forth above, as well as the executed agreement; and 10. Where the applicant received funding for Fiscal Year 2014/2015, all documents must be submitted and agreement terms complete prior to funding disbursement for FY 2015/2016; and 11. Application and all supporting documents are to be submitted to Niamh Ortega, Finance Department, City of Palm Desert, 73-510 Fred Waring Drive, Palm Desert, California 92260, NO LATER THAN 5:00 P.M. ON FRIDAY, MARCH 27, 2015 to be considered for funding for FY 2015/2016. 2015/2016 Outside Agency Funding Application 1 Application (Exhibit A) I. GENERAL INFORMATION Date of Request: Amount Requested: Name of Agency: Agency President or Executive Director: Agency Secretary: Mailing Address: Physical Address: Contact Phone Number: Date Established: E-mail address: No. of Years in Community: Federal I.D. No: Type of Agency: Public ___ Private Non-Profit ___ Other (specify): ________________ Tax Status (verification must be attached): 501(c)3: ____Yes ____ No Other class (specify): __________ Most Recent Year Taxes were Filed: If not filed, please explain: _____________________________ _________________________________________ _________________________________________ _________________________________________ FOR CITY USE ONLY Filing deadline: MARCH 27, 2015 2015/2016 Outside Agency Funding Application 2 II. STATEMENT OF PURPOSE 1. DESCRIPTION OF AGENCY AND ITS SERVICES (Background and general description of organization): 2. PROGRAM/SERVICE TO BE FUNDED BY THIS REQUEST (Specific line-item details regarding your reason for request and how those funds will be spent [attach additional sheets if necessary]): Item Description Amt requested Example: Group support Counseling for two low-income families for six months ($500 per family per 6 month period) 1,000 3. Confirm that these programs are available to all eligible participants, without regard to race, sex, political persuasion, religion, national origin, or age: 4. Total number of persons that benefit from this program: ______ 5. Give an estimate of the percentage (%) of Palm Desert citizen participation: ____ Resident ____ Non-Resident 6. Estimate the benefit to Palm Desert citizens or explain the benefit to the Palm Desert community as a whole: 2015/2016 Outside Agency Funding Application 3 III. AGENCY INFORMATION 1. How long has this program been in existence? ____/____ Year(s)/Month(s) 2. Are volunteers used by this Agency? ____ Yes ____ No If so, please indicate the number of annual hours and activities/duties performed. 3. Describe the alternative funding sources (dinners, golf events, fashion shows, etc.) that have been approached during the last year: 4. What type of alternative funding or fundraising activities do you intend to pursue in the upcoming fiscal year: 2015/2016 Outside Agency Funding Application 4 IV. AGENCY BUDGET 1. Source of Funding: A. List all sources of funding excluding anticipated contributions from the City of Palm Desert and other valley city governments for NEXT (2015/2016) fiscal year. (If necessary, attach a separate sheet): Agency providing funds Reason for contribution Amount (A) Total Funding Sources excluding City Governments - FY 2015/2016: (A) B. List any local government funding that will be requested in the NEXT (2015/2016) fiscal year from each of the following city government agencies: City Projected Request Amount (B) Additional Funds Anticipated From Other Fundraising (dinner/golf sponsorships [specify type of fundraising activity]) (C) Cathedral City Coachella Desert Hot Springs Indian Wells Indio La Quinta Palm Springs Palm Desert Rancho Mirage Other city: Total Government Funding requested – FY 2015/2016: (B) (C) Total of ALL funding sources anticipated for FY 2015/2016 (A+B+C): $ 2015/2016 Outside Agency Funding Application 5 C. List any local government funding received for the CURRENT (2014/2015) fiscal year, including the amount your agency requested and the actual amount received, from each of the following city government agencies: City Requested Amount Approved Amount (funds received) Funds Received From Other Fundraising (dinner/concert/ golf sponsorships) Cathedral City Coachella Desert Hot Springs Indian Wells Indio La Quinta Palm Springs Palm Desert Rancho Mirage Other city: Total Government Funding received 2. List amounts requested or received from Community Development Block Grant (CDBG) funds through the City of Palm Desert. (The City will usually not provide an additional contribution to those agencies already receiving CDBG funds.): FY 2014/2015: Amount requested: $______________ Received: $______________ FY 2015/2016: Amount requested: $______________ Received: $______________ 3. EXPENDITURES: (Be as detailed as possible. If necessary, attach a separate sheet.) GRAND TOTAL OF EXPENDITURES: $ __________________ 2015/2016 Outside Agency Funding Application 6 V. SIGNATURE AUTHORIZATION 1. Identify the official authorized to sign on behalf of the parent-teacher group (Executive Director / President): NAME: TITLE: ADDRESS: PHONE: E-MAIL: 2. A. Signature of authorized official, as identified in #1: The undersigned does hereby confirm that the information herein is true and correct and is submitted in support of and as part of the application for funding. The undersigned hereby confirms that the applicant agency meets the criteria set forth herein and agrees to comply with all requirements. Signature: Date: B. Signature of School Principal, indicating review and concurrence with proposed expenditures, and confirming that these expenses are not covered by the school or district: Signature: Date: VI. FILING INSTRUCTIONS - END OF DOCUMENT -  PREPARE YOUR APPLICATION PACKET containing the following:  One (1) application with original signature, single sided, 8 ½ x 11, white paper, unbound, single staple  Six (6) black & white copies, double-sided, 8 ½ x 11, white paper, unbound, single staple  Tax Status Verification letter from IRS  Current Roster of Board of Directors, Executives, Trustees or Committee Members  Attachments as necessary for further explanation of application content  RETURN COMPLETE APPLICATION PACKET in a sealed envelope via mail or hand delivery to: City of Palm Desert Finance Department 73510 Fred Waring Drive Palm Desert, CA 92260 CONTENTS: OUTSIDE AGENCY FUNDING APPLICATION – Attn: Niamh Ortega  SUBMIT ON OR BEFORE DEADLINE. Application packet must be received in the Finance Department no later than 5:00 p.m. on Friday, March 27, 2015. Packets which do not include all required information and/or are not completed in their entirety will be considered unresponsive and will not be reviewed further.