Commonwealth of Massachusetts Executive Office of Public ... · services, or activities being proposed. The following items must be addressed in your response: a. Applicants must

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Commonwealth of Massachusetts

Executive Office of Public Safety and Security

Office of Grants & Research

Availability of Grant Funds

VAWA STOP FFY17 Grant Application

Please complete each individual field as directed. Note: “same as above” is not considered a valid response.

Applicant Information: (check only one category, please refer to page 3 of the AGF for additional guidance)

Courts Law Enforcement Prosecution Victim Services

Applicant Name:

Project Name:

Applicant Mailing Address

Street: City: Zip+4:

Phone: Fax:

Authorizing Official: Title:

Agency/Organization:

Authorizing Official Mailing Address


Phone: Fax:

Email:

Finance Officer: Title:


Finance Officer Mailing Address


Phone: Fax:

Email:

Note: The person designated as the Project Manager shall serve as the project’s point person and be

responsible for receiving and responding to EOPSS’ project related requests.

Project Manager: Title:


Project Manager Mailing Address


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Phone: Fax:

Email:

State the percentage of VAWA STOP funds that will be allocated to the following types

of crime. Please note that the total should not exceed 100%.

Type of Crime % of funds allocated

Domestic Violence

Sexual Assault

Dating Violence

Stalking

Total

Is the applicant System for Award Management (SAM) registered? Check One.

Yes No

Applicant’s 9 digit Data Universal Number System (DUNS) Number:

Note: You are required to maintain registration in the System for Award Management (SAM)

throughout the life of the grant.

Purpose Area(s) Addressed (refer to page 8 of the AGF):

Please indicate targeted population (i.e. teens, substance abusing women):

Program Summary: Four sentences (250 characters maximum) summarizing the program activities:

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Section 1. Project Narrative

1. Executive Summary (1 page limit): Provide a summary of the agency’s history providing services to

victims of domestic violence, sexual assault, dating violence, or stalking, capacity and qualifications to

implement the proposed project, and its role within the community(ies) being served.

Culturally specific community-based organizations must address the following:

If you are submitting an application as a culturally specific community-based organization, please also include a

description of your agency’s experience serving the identified population, experience of staff in working with

said population, language proficiency, and integration of staff within the target community(ies).

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2. Statement of the Problem and Needs Assessment (3 page limit): This section should clearly identify

the problem and support the stated issues with relevant data to justify the request for the programs,

services, or activities being proposed.

The following items must be addressed in your response:

a. Applicants must describe the need, nature, and extent of domestic violence, sexual assault, dating

violence, or stalking within the proposed community, region, and/or population to be served. At a

minimum, responses should include the number of victims served or are seeking services from the

applicant, incidents responded to and/or investigated, and/or cases prosecuted by the applicant within

the last twelve months;

b. Describe the intended target population using demographic and other data where possible; and

c. Statements should be supported with up to date statistical or other factual information/data or

relevant literature. The sources or methods used for assessing the problem should also be identified

and described.

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Statement of the Problem and Needs Assessment (continued)

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Statement of the Problem and Needs Assessment (continued)

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3. Program Description (5 page limit): This section should address both the scope and intent of the

program, strategy, or activity, and how it will address the problem and needs previously identified.

The following items must be addressed in your response:

a. Types of services and/or activities to be provided by the proposed project;

b. Describe any risk factors to be addressed and protective factors; and

c. Detailed description of applicant and/or project's collaboration with victim service, criminal justice

and community-based partners that reflects a regional and coordinated approach in addressing

domestic violence, sexual assault, dating violence, or stalking. Please include the names of

collaborating agencies or partners.

Law Enforcement applicants must address the following:

1. How the department plans to implement:

The 2017 Domestic Violence Law Enforcement Guidelines;

The 2017 Adult Sexual Assault Law Enforcement Guidelines; and

Protocol for informing victims of their rights under MGL ch.209A.

2. How confidentiality will be handled if a civilian advocate is not an employee of a victim service

provider (if applicable);

3. Does your department have a public website? If yes:

Are there information and/or referral services for community-based domestic violence and

sexual assault programs?

4. How your department responds to requests for U visa certificates (supplement B of Form I-918).

Prosecution applicants must address the following:

1. How your agency will utilize the Massachusetts Prosecutors’ Domestic Violence and Sexual Assault

Trial Notebooks for prosecutors and the Victim-Witness Advocate Reference Manual for training victim

witness advocates supported with VAWA funds; and

2. How your office responds to requests for U visa certificates (supplement B of Form I-918).

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Program Description

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Program Description (continued)

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4. Program Goals and Objectives, Activities, Timeline and Performance Measures

Goal 1 Objective(s) Activities Timeline

Performance Measures

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Section 2. Budget Detail & Narrative

Applicants must submit an operating budget for up to 12 months. In addition to the Budget Narrative,

applicants must complete the Excel Budget Worksheet (refer to Attachment B) and submit as directed

(hard-copy and electronically). Please list all program costs according to the specified budget category.

1. Personnel - Costs associated with agency personnel.

Name & Title Computation Federal Match

Total Personnel Costs

Narrative

At a minimum, please include staff name and title, annual salary, hourly rate, total number of hours identified

staff (or position if vacant) works at the agency per week, how many of those hours will be VAWA funded, brief

description of responsibilities, and location of staff. If working out of multiple locations for this program please

provide estimated hours for each location. (If providing Match funds, please be sure to include the non-federal

source).

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Budget Detail & Narrative

2. Overtime – Allowable for all personnel working on the grant with adequate training and experience in responding

to domestic and/or sexual violence incidents. The applicant must include copy of agency’s overtime policy with

the application.


Total Overtime Costs

Narrative

At a minimum, please include staff name and title, overtime rate, how many hours will be VAWA funded, brief

description of responsibilities, and location of staff. (If providing Match, please be sure to include the non-

federal source).

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3. Fringe Benefits – Based on federally negotiated rate agreement or established formula by sub-recipient's

accountant, comptroller or human resource unit. The applicant must include copy of approved or audited rate

with the application. If applicant does not have a federally approved or audited rate, actual known costs must be

itemized by type and include rate computation in this section. Allowable costs are limited to the employer's share of

life insurance, health insurance, social security, pension, unemployment and workers compensation costs.


Total Fringe Costs

Narrative

If applicant does not have a federally approved or audited fringe rate, please provide a breakdown of actual

allowable costs which must be pro-rated for staff time charged to the program. (If providing Match, please be

sure to include the non-federal source).

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4. Indirect Costs – Indirect costs are allowable, please see (page 14) of the AGF for further guidance. The applicant

must include a copy of approved rate with the application.

Indirect Costs Computation Federal Match

Total Indirect Costs

Narrative

(If providing Match, please be sure to include the non-federal source).

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5. Consultants – For each consultant enter the name, if known, the service to be provided, hourly or daily fee (8-hour

day) and estimated time on the program. Consultant fees in excess of $650/day, $81.25 per hour require additional

justification and prior approval from EOPSS and the Office on Violence Against Women.

Consultant Name & Services Provided Computation Federal Match

Total Consultants Costs

Narrative

Applicants should follow their organization's own procurement policy when procuring products or services. (If

providing Match, please be sure to include the non-federal source).

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6. Contract Services – For each sub-contract, applicants are encouraged to promote free and open competition in

awarding contracts.

Contract Computation Federal Match

Total Contract Costs

Narrative

Please describe the nature of the contract including a brief description of the product or services to be provided

and estimated costs. Applicants should follow their organization's own procurement policy when procuring

products or services. (If providing Match, please be sure to include the non-federal source).

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7. Travel – Costs associated with travel by employees while conducting official program business. Please note that

VAWA related in-state travel mileage rate costs cannot exceed the state reimbursement rate (currently $0.45 per

mile). Out of state travel will require additional justification and prior approval from EOPSS.

Travel Computation Federal Match

Total Travel Costs

Narrative

At a minimum, please indicate area to be traveled as well as purpose for travel. Travel costs (lodging, airfare,

meal reimbursement, etc.) associated with the VAWA grant must be in accordance with either federal, state, or

an organizationally-approved travel policy; whichever is more restrictive. (If providing Match, please be sure to

include the non-federal source).

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8. Equipment – Describe the make and cost of all equipment purchased for program use. Rented or leased equipment

costs should be listed in the "Contracts" category. Applicants should follow their organization's own procurement

policy.

Equipment Computation Federal Match

Total Equipment Costs

Narrative

Please provide brief description of need, and connection to VAWA funded project for equipment. (If providing

Match, please be sure to include the non-federal source).

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9. Supplies - List items individually by type (postage, training materials, copying paper, and other expendable items)

and show computation. Generally, supplies include any materials that are expendable or consumed during the course

of the program.

Supplies Computation Federal Match

Total Supplies Costs

Narrative

Please provide brief description of need, and connection to VAWA funded project for supplies. (If providing

Match, please be sure to include the non-federal source).

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10. Other – Other costs not listed in previous budget categories. Expenses listed in this category may include additional

costs relevant to proposed program such as rent, phone, accounting/human resource services, and utilities. Indirect

costs should not be listed within this section.

Other Costs Computation Federal Match

Total Other Costs

Narrative

Please provide a brief description of additional costs and connection to VAWA funded project. For example,

provide the square footage and the cost per square foot for rent, and provide a monthly rental cost and how

many months to rent. (If providing Match, please be sure to include the non-federal source).

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Total Project Cost

Federal Cost Match Cost

Non- Supplant

If the Executive Office of Public Safety and Security should award VAWA funds to

________________________________ the funds will be used to supplement, not supplant, other federal, state,

or local funding sources during the period of the contract with the Office of Grants and Research. We have been

informed by the Executive Office of Public Safety and Security that supplanting of funds is strictly prohibited.

Applicant request for VAWA funding (federal cost listed above): $

Authorized Signatory:

Signature: Date:

(Signed in BLUE ink)

Print Name: Title:

Application Submission Instructions

1. Hard Copy Submission: The signed and completed VAWA STOP Grant Application Response

Template, Excel Budget Worksheet (see Attachment B), and all other required documents must be

mailed or hand-delivered to OGR no later than 4:00pm on September 14, 2017.

2. Electronic Submission: The unsigned fillable PDF – not a scan, in addition to the Excel Budget

Worksheet (see Attachment B), should be emailed to: [email protected] no later than 4:00pm

on September 14, 2017.

mailto:[email protected]

Commonwealth of Massachusetts Executive Office of Public ... · services, or activities being proposed. The following items must be addressed in your response: a. Applicants must

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