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ServiceWorks RFP for the 2015-2016 Program Year
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Application Cover Sheet
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Section A: Rationale & Approach
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Program Evaluation & Appendices
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1
Application Cover Sheet
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Section A: Rationale & Approach
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Program Evaluation & Appendices
Organization Name
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Organization Address
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Street Address
City
State / Province / Region
Postal / Zip Code
Contact Person
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First
Last
Contact's Title
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Contact's Phone Number
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Contact's Email Address
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Current Host Site
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No, my organization is not a 2014-2015 Program Year ServiceWorks host site.
Yes, my organization is a 2014-2015 Program Year ServiceWorks host site.
Application Eligibility Requirements
Please check to acknowledge that you have confirmed the status of these criteria. Failure to meet one or more of the criteria below may automatically disqualify an organization for consideration.
Partner Affiliation
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Yes
No
Not Applicable
Organization is a member of HandsOn Network, is in good standing (current on dues and associated membership standards) at the time of application, and can remain in good standing for the length of this grant award.
Organization is current on fees payable to Points of Light/ HandsOn Network
Organization is a current/former grantee of The Citi Foundation, and is in good standing at the time of the application.
Organization is a participant in CNCS programming, and is in good standing (full compliance) at the time of the application.
Charitable status
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Organization is an independent 501(c)(3)
Organization has a fiscal agent partnership with a 501(c)(3)
Organization is a program internal to another 501(c)(3) or local, county, state government or institution of higher education
Location
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Boston, MA
Buffalo, NY
Chicago, IL
Dallas, TX
Florence, KY
Hagerstown, MD
Irving, TX
Jacksonville, FL
Los Angeles, CA
Miami, FL
New Castle, DE
New York City, NY
Newark, NJ
San Antonio, TX
San Francisco, CA
Sioux Falls, SD
St. Louis, MO
Tampa, FL
Tucson, AZ
Washington, DC
Select city/cities above to confirm that organization is located in an eligible area. To select more than one location, hold your Ctrl key down while clicking on additional sites.
Project Request
Please note that while organizations may request 3-5 VISTAs per site, the number of member slots is subject to availability and grant award from the Corporation for National and Community Service.
Total number of Full-Time VISTAs you are requesting for the 2015-2016 program year
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Number of sites you are proposing as hosts for the 2015-2016 program year (general = 1; national partner = up to 5)
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Executive Sign-off
I understand that all VISTA projects must align with the VISTA program goals of poverty alleviation, community capacity building, community empowerment, and sustainability, and our proposed VISTA project must deliver the ServiceWorks curriculum in its entirety.
Signature of CEO/Executive Director
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Clear
Name of CEO / Executive Director
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First
Last
Date of Signature
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