food bank project - new york state department of health€¦ · food bank project. 501c3 a copy of...

Please include the following eligibility documents:

Project Director Name:

Total Funding Request:

Email Address:

Phone:

Address:

Applicant Organization Name:

Please ensure that the following application is completed in its entirety. Applications must be typed and submitted by the deadline on the 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.

NYSDOH - Division of Nutrition - Bureau of Nutrition Risk Reduction Hunger Prevention and Nutrition Assistance Program (HPNAP)

RFA #1003220225

Food Bank Project

501c3

A copy of your agency's New York State Department of State form which indicates your charity registration number.

A copy of the US Dept. of Treasury, Internal Revenue Service correspondence stating your agency's Federal Tax ID number.

A copy of the Certification of Incorporation, documenting your agency's incorporation status.

Audited Financial Statements

Proof of Certification by Feeding Americaof 25

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:___________________________________

Project Director Signature:

A. Project Summary Maximum 10 Points

A1. Describe the project or service for which you are requesting funding.

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A2. Describe the anticipated outcomes and the measurement methodology.

A. Project Summary continued

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A3. Identify your site location and hours of service or operation.


A4. Identify the target population and service area.

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A5. Describe your experience providing the proposed service.


A6. Summarize how minorities, Lesbian/Gay/Bisexual/Transgender persons and persons with disabilities are incorporated into the development and implementation of services.

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A7. Highlight your accomplishments in providing services for persons needing food assistance.

A8. Describe any additional benefits to food and services offered by your agency 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.

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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.

B. Description of Need continued

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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.

C2. Include (as Attachment C2) letters of cooperation and collaboration and/or letters of support that verify or support the proposed services. Letters should demonstrate partnerships that will contribute to the success of the project.

Included as Attachment C1 Not Included

Not IncludedIncluded as Attachment C2

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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C4. List licenses/certifications held by program (e.g. local Department of Health operation or food handlers certificate, thrift shop permit, Feeding America Food Bank Certification, etc.). The list should demonstrate that your organization possesses all required licenses/certifications to provide the proposed service(s).

C. Applicant Organization continued

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C5. Provide your organization's Mission and Vision Statements in the space below. Explain how your organization's statements are consistent with HPNAP's Mission/Vision.

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C6. Describe your cost containment and purchasing policy/procedures in the space below. Policies and procedures should demonstrate that efficiency and quality are maintained.


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D. Project Activities Maximum 35 Points

Projected total number of meals that will be provided by organizations receiving HPNAP assistance through the food bank. Organizations currently funded by HPNAP should ensure that the number provided is consistent with MIS reports.

Projected number of pounds of food to be distributed with HPNAP funds.

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.

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D2. Describe the kinds and amounts of work and project activities to be accomplished over the course of the year for each objective you listed on the previous page. Project activities should demonstrate that the proposed objectives can be achieved.

D. Project Activities continued

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D2. continued

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D3. If foods are 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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D4. Describe the grants that will be administered (Operations Support and/or Food). Provide detail on application process for each grant type to be administered.

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D5. Describe how your organization will participate in and provide a quality Food Transportation Project.

D6. Describe how your organization will participate in the Food Safety and Sanitation Project to minimize the risk of food bourne illness in the emergency food network.

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D. Project Activities continuedD7. 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 continuedD8. Describe your organizations plan for administering the Nutrition Resource Management Project. Include the completed Nutrition Resource Manager Work Plan as Attachment D8. A sample has been provided 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.

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D. Project Activities continuedD9. 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.

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D. Project Activities continuedD10. 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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E. Project Evaluation Maximum 10 Points

E1. Summarize how the proposed project 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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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.

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.

F. Budget Maximum 20 Points

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food bank project - new york state department of health€¦ · food bank project. 501c3 a copy of...

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