LOCAL CCHD Community Organizing Application and Interim Report

LOCAL CCHD Community Organizing Application and Interim Report, Archdiocese of Hartford (adapted from the National CCHD application)

Organizational Information
	Due date: May 1. Should you have questions about this application call Patricia M. Wallace at 203.777.7279 or e-mail pwallace@oua-adh.org. E-mail your completed application to this same e-mail address. Thank you.
	Name of Organization
	Use complete name.

	A.K.A. Name of Organization
	The "AKA", or "also known as", name is the acronym or initials the organization uses as a shortened version of its name. For example, the "AKA" name for Southerners for New Opportunities is "SNO". Not all organizations have "AKA" names. If you do not have one, do not respond.

	Street Address

	City

	State
	- Select One -
	Zip Code

	Phone Number for Organization.
	Enter the ten digit number with no formatting. For example, 1234567890.

	Fax Number for Organization
	Enter the ten digit number with no formatting. For example, 1234567890.

	Website Address for Organization
	If none, do not respond.

	Community Organizing Network Affiliation (optional)
	Select one affiliation. If your organization is not affiliated with any national or regional community organizing network, do not respond to this question.


	If your organization is affiliated with a community organizing network or organization that is not listed above, please indicate the name of the organization.

	Description of Organization
	Briefly summarize the history, mission and focus of your organization. (Limit 250 words)

	Organizational Accomplishments
	List the three most significant accomplishments your organization has achieved within the last three years. (Limit 250 words)

	Previous CCHD National Funding
	List the years and grant amounts for CCHD National funding awarded to your organization since 1997. If your organization has not received CCHD funding since 1997, indicate none.

	Local Diocesan CCHD Funding
	Indicate if your organization has received a local diocesan CCHD grant in the past.

	Do the activities of your organization conform to the moral and social teachings of the Catholic Church?
	Refer to the NCCHD Application Help Guide for more information about the moral and social teachings of the Catholic Church.

Primary Contact for Organization

	The primary contact for the organization is the preson who will receive and respond to correspondence relevant to the grant from CCHD and be available for telephone and e-mail contact.
	Prefix
	For example: Ms., Mr., Sr., Rev., Br., etc.

	First Name

	Last Name

	Suffix
	For example: Ph.D., B.V.M., S.J., etc.

	Title

	Telephone Number
	Enter the ten digit number with no formatting. For example 1234567890.

	E-mail Address

Technical Assistance Provider
	The technical assistance provider is the organization or person(s) providing technical support to ensure the implementation of the activities for which funding is being requested. Technical assistance may be used for activities such as the following: board development, fundraising, leadership training, etc. If your organization is NOT working with a technical assistance provider, enter "none" in the Last Name field and continue to the next section of the pre-application.

Technical Assistance Provider

	Name of Organization Providing Technical Assistance
	If you are not receiving technical assistance, or are receiving technical assistance from an individual, do not respond to this question.

	Indicate the name of the contact person, whether an employee of the above named organization or an independent consultant.

	Prefix

	First Name

	Last Name
	This is a system required field. If you do not have a technical assistance provider, enter "none."

	Telephone Number
	Enter the ten digit number with no formatting. For example, 1234567890.

	E-mail Address

Request Information
	Initiative Title

	Initiative Description
	Briefly describe the purpose and goals of the initiative for which CCHD funds are requested. Funds may be used to support an exisiting initiaitve, the start up of a new effort or for general operating support. (Limit 250 words)

	Amount Requested
	Local CCHD grant awards can be up to $15,000. Omit formatting and enter numbers only. For example, 10000 for $10,000.

	Annual Budget for Organization
	In some cases this may be the same as the total budget for the initiative. Omit formatting and enter numbers ony. For example, 10000 for $10,000. Click here for budget form.

	Issue Area
	Select up to three issue areas that your organization is working on in order of priority.
	- Select One - - Select One - - Select One -
	Geographical Area Served
	Choose the primary diocese in which your proposed initiative will be active. Indicate additional dioceses ONLY if the proposed initiative will be active in those areas. Dioceses are listed by geographic area, state and diocese. Refer to the "Understanding the Diocesan Structure" section of the NCCHD Application Help Guide to determine in which diocese(s) your initiative is active.
	- Select One - - Select One - - Select One -
	List any additional dioceses where the proposed initiative will be active.

	Poverty Definition
	Select the range of Median Family Income (MFI) that best describes the situation of poverty of those with whom your organization is working. To determine the MFI for your region refer to the "Determining the Median Family Income" section of the Application Help Guide. CCHD is using this information for internal tracking purposes. We understand that your organization may not define poverty by this measure.
	- Select One -
	Population Served
	Select the area that best describes the geographic focus of your work.

	Community Characteristics
	Briefly describe the economic and social characteristics that portray poverty in the communities where the proposed initiative will be implemented. Identify the indicator used by your organization to measure poverty. Describe the nature or scale of the proposed initiative. (i.e. neighborhood, citywide, county, etc.) (Limit 250 words)

Low-Income Control
	The following questions relate to the role of people living in poverty in the decision making of the organization. For the purposes of CCHD funding, the participation of poor people in the shaping and ongoing direction of organizations is a central criterion. For more information refer to the "What does CCHD mean by low-income control?" section of the Application Help Guide.

Organizational Board

	Percentage of Organizational Board Members Living in Poverty
	Enter whole numbers only, omitting percentage (%) sign. For example, 50% should be entered as 50.

	Primary Ethnicity of Organizational Board Members
	For example, if your board is comprised of 6 Vietnamese members and 3 Hispanics, you would indicate Asian Pacific Islander as the Primary ethnicity and Hispanic as the secondary ethnicity.

	Secondary Ethnicity of Organizational Board Members

	Plan for Low Income Board Participation
	If your organization does not meet CCHD low income criteria, you must provide a plan to address this criterion and include a timeframe for accomplishing this goal. (Limit 250 words)

Organizational Membership
	Definition of Organizational Membership
	Briefly describe how membership is defined by your organization. (Limit 250 words)

Size of Membership

	Number of Individual Members
	Indicate the number of individual members your organization currently has. Do not include numbers of beneficiaries.

	Number of Institutional Members
	Indicate the number of institutional members your organization currently has.

	Changes in Membership Base
	Briefly describe how your organization's membership base has changed over the past year. For instance, has your organization lost members, gained members or remained about the same? (Limit 250 words)

	Race or Ethnicity of Membership
	Indicate the primary and secondary ethnicity of your membership or participants. Only use multi-ethnic if your organization works with significant populations of three or more ethnicities.
	- Select One - - Select One -
	Percentage of Members Living In Poverty
	Indicate the percentage of members or participants who are living in poverty. Enter whole numbers only, omitting percentage (%) sign.

	Member Participation in Decision Making Processes
	Describe how members, particularly people living in poverty, participate in decision making within the organization. Include a description of additional structures (i.e. issue committees, task forces, etc.) in which people participate in decision making. (Limit 250 words)

Goals & Objectives
	This section of the application requires you to describe your organization's goals, in both quantifiable and narrative format, and outline plans for achieving those goals. Follow the sample format outlined on page 4 of the Application Help Guide. This format outlines the strategies, related activities or tasks (including a timeline) and anticipated measurable outcomes for each goal.

Institutional Change

	CCHD considers "institutional change" as that which addresses policies and operational structures of government, corporations, or private agencies that create poverty, keep people poor or impose injustice on poor people.

	Background for Institutional Change
	Briefly describe the key social, economic and political factors of the communities where your organization is working as they relate to your organization's institutional change strategy and goals. (Limit 250 words)

	Outline the Institutional Change goals for the proposed grant year.
	Following the format described at the top of the page, each goal should include reference to the following: (1) Type of change leading to reduction of poverty (i.e. policies, laws, redistribution of resources/services, and/or changes in local institutions); (2) Potential number and type of beneficiaries; and (3) Estimated monetary and social value of the changes for both individuals and the broader community. (Limit 250 words)

Leadership Development

	CCHD considers the initial and continual development of leaders to be a central component of their grant-making. Applicant organizations should demonstrate a strong track record and commitment to the ongoing development of leaders within the organization. Plans for training may include topics such as: social analysis, issue identification, elements of organizing, fundraising, board development, etc.

	Outline the Leadership Development goals for the proposed grant year.
	Following the format described at the top of the page, each goal should include a description of the methodology and activities your organization uses to train leaders. Including the specific skills and knowledge you plan to teach and indicate the persons who will conduct the training. (Limit 250 words)

	Total Number of Leaders Trained
	Indicate your organization's goal of the TOTAL number of leaders to be trained in the proposed grant year.

	Number of New Leaders to be Trained
	Indicate your organization's goal of the number of NEW leaders to be trained in the proposed grant year.

	Percentage of Low Income Leaders to be Trained
	Indicate the percentage of leaders during the first half of the grant year who were low-income. Enter whole numbers, omitting the percentage (%) sign.

Organizational Development

	CCHD evaluates organizational development plans by assessing the capacity and track record of the applicant organization. Organizations applying for funding should demonstrate some experience and history related to the activities proposed for implementation. In addition to having a proven record of affecting institutional change, the applicant organization should demonstrate capacity in terms of its ability to raise and manage funds, the experience and involvement of its board members, collaboration with other institutions, and ability to grow its membership.

	Outline the Organizational Development goals for the proposed grant year.
	Following the format described at the top of the page, include a description of plans to strengthen your organization's internal decision making or coordinating structures (i.e. organizational board, finance committee, clergy caucus, chapters, etc.). (Limit 250 words)

	Individual Member Recruitment Goal
	Indicate the number of new individual members your organization plans to recruit in the proposed grant year.

	Institutional Member Recruitment Goal
	Indicate the number of new institutional members your organization plans to recruit in the proposed grant year.

	Describe any new relationships with coalitions, strategic partners and/or key public figures that your organization plans to establish to support your institutional change goals in the proposed grant year.
	(Limit 250 words)

Financial Capacity

	Fundraising History
	List the sources and amounts of funding raised by your organization in the past two years from: dues, grassroots fundraising, foundations, corporations and individual donors. List the names of foundations and corporations. (Limit 250 words)

	Fundraising Goals
	Following the format described at the top of the page, outline the fundraising goals for the proposed grant year. Indicate the amounts you plan to raise through member dues, grassroots fundraising, individual donors, foundations, corporations and government sources. (Limit 250 words)

	Names of Foundations
	List the names of foundations from whom you hope to obtain funding.

	Names of Corporations
	List the names of corporations from whom you hope to obtain funding.

	Member Involvement in Fundraising
	Describe your organization's plans to achieve greater involvement by your membership in the fundraising activities of the organization. (Limit 250 words)