HomeMy WebLinkAbout103-Attachment B: CDBG/Community Grants application.pdfFY 2010-2011 CITY OF SARATOGA
COMMUNITY GRANT & CDBG
STANDARD APPLICATION
DATE: __________________
Please refer to the Application Instructions Sheet for details on the following questions. Please
limit your answers to one paragraph per question
1) Applicant Organization/Agency Name: _____________________________________
Agency Address: _________________________________________________________
Executive Director: _______________________________________________________
Phone: ________________ Fax: _________________ E-Mail: _____________________
Agency is a Faith Based Organization: ____ Yes ____ No
2) Program Title: __________________________________________________________
Program Address: _________________________________________________________
Contact Person/Title: ______________________________________________________
Phone: ________________ Fax: _________________ E-Mail: _____________________
3) City of Saratoga grant funds requested in the past: ____________________________
4) City of Saratoga grant funds received in the past: _____________________________
5) Program description and number of unduplicated clients served: ________________
6) Program purpose and objectives: ___________________________________________
7) Program management: ___________________________________________________
8) Agency description and experience: ________________________________________
9) Audit information: _______________________________________________________
10) Sources of funds anticipated for this project: _________________________________
11) Budget: Please use the attached worksheet.
12) Performance Measurements: Please use the attached worksheet.
13) Outreach: ______________________________________________________________
14) Leveraging: _____________________________________________________________
15) Cost / Benefit Analysis: ___________________________________________________
16) Target Beneficiaries: _____________________________________________________
BUDGET
AGENCY NAME: ___________________________ Date Prepared: _________________
PROGRAM NAME: ____________________________________________________________
SPECIFIC ACTIVITIES BUDGET AMOUNT
Can be broken down quarterly or annually (please specify)
PERFORMANCE MEASUREMENTS
AGENCY NAME: ___________________________ Date Prepared: ________________
PROGRAM NAME: ___________________________________________________________
PERFORMANCE MEASUREMENT WORKSHEET
GOAL:
OBJECTIVE (1):
OUTCOME (1):
OBJECTIVE (2):
OUTCOME (2):