2019 SCC Application - Oregon · 2019. 11. 25. · not limited to: salaries, tools, transportation of the crew, crew supplies, personal supplies (e.g. boots, gloves, etc.) or other

Summer Conservation Corps – 2019

APPLICATIONFORM

LegalNameofApplicant: County:

Address: City,State,Zip:

StateofIncorporation: EntityType:

ProgramContact: FiscalContact:

Name: Name:

Email: Email:

Phone: Phone:

AnyindividualsigningbelowherebycertifiestheyareanauthorizedrepresentativeofApplicantandthat:

1. ApplicantunderstandsandacceptstherequirementsofthisRFA.

2. ApplicantacknowledgesreceiptofanyandallAddendatothisRFA.

3. IfawardedaGrantAgreement,Applicantagreestoperformtheactivitiesandmeetthe performancestandardssetforthinthefinalnegotiatedGrantAgreement.

4. IhaveknowledgeregardingApplicant’spaymentoftaxesandbysigningbelowIherebycertify that,tothebestofmyknowledge,Applicantisnotinviolationofanytaxlawsofthestateora politicalsubdivisionofthestate,including,withoutlimitation,ORS305.620andORSchapters 316,317and318.

5. Applicantdoesnotdiscriminateinitsemploymentpracticeswithregardtorace,creed,age, religiousaffiliation,gender,disability,sexualorientation or nationalorigin.Whenawarding contracts,ApplicantdoesnotdiscriminateagainstanybusinesscertifiedunderORS200.055as adisadvantagedbusinessenterprise,aminority‐ownedbusiness,awoman‐ownedbusiness,a businessthataservice‐disabledveteranownsoranemergingsmallbusiness.

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6. ApplicantandApplicant’semployees,agents,andsubcontractorsarenotincludedon:

A. the“SpeciallyDesignatedNationalsandBlockedPersons”listmaintainedbytheOffice ofForeignAssetsControloftheUnitedStatesDepartmentoftheTreasuryfoundat: https://www.treasury.gov/ofac/downloads/sdnlist.pdf.,or

B. thegovernmentwideexclusionslistsintheSystemforAwardManagementfoundat: https://www.sam.gov/portal/SAM/#1

7. Applicantcertifiesthat,tothebestofitsknowledge,thereexistsnoactualorpotentialconflict betweenthebusinessoreconomicinterestsofApplicant,itsemployees,oritsagents,onthe onehand,andthebusinessoreconomicinterestsoftheState,ontheotherhand,arisingoutof, orrelatinginanywayto,thesubjectmatteroftheRFA.Ifanychangesoccurwithrespectto Applicant’sstatusregardingconflictofinterest,ApplicantshallpromptlynotifytheStatein writing.

8. ApplicantcertifiesthatallcontentsoftheApplication(includinganyotherformsor documentation,ifrequiredunderthisRFA)aretruthfulandaccurateandhavebeenpreparedindependentlyfromallother Applicants,andwithoutcollusion,fraud,orotherdishonesty.

9. Applicantunderstandsthatanystatementorrepresentationitmakes,inresponsetothisRFA, ifdeterminedtobefalseorfraudulent,amisrepresentation,orinaccuratebecauseofthe omissionofmaterialinformationcouldresultina"claim"{asdefinedbytheOregonFalse ClaimsAct,ORS180.750(1)},madeunderGrantAgreementbeinga"falseclaim"{ORS 180.750(2)}subjecttotheOregonFalseClaimsAct,ORS180.750to180.785,andtoany liabilitiesorpenaltiesassociatedwiththemakingofafalseclaimunderthatAct.

10. Applicantacknowledgesthesecertificationsareinadditiontoanycertificationsrequiredinthe GrantAgreementatthetimeofGrantAgreementexecution.

AuthorizedSignature Date

PrintedName Title



Applicant Assurances Applicant assures the following by checking each of the items below:

Applicant has experience running a youth corps program. • If this is your first grant application with OYCC, please describe your experience with operating

youth programs. Or, if you have no prior experience, please describe how you plan to operatea new program.

Applicant agrees to follow all applicable labor laws, including but not limited to federal and state tax laws and rules.

Background Checks are required for all staff and Crew Leaders having direct contact with Corpsmembers.

Applicant agrees to pay Corpsmembers at least Oregon’s minimum wage.

Applicant agrees to develop safety, work-site, orientation, education, and emergency plans in compliance with state and federal law.

At least 75% of the youth served will meet OYCC’s definition of at-risk youth.

The crew will reflect the local community in the areas of gender, cultural, and ethnic mix.

Youth hired will reside in the county in which the funds are targeted.

Applicant understands that projects on private land must be pre-approved by OYCC.

Applicant and projects are physically located in the county in which funds are targeted.

Applicant’s project will operate between June 1, 2019 and September 30, 2019.

Applicant will complete the required OYCC surveys at the end of the program.

No more than 10% of the grant award can be used for indirect costs.

All Crew Leaders will be first aid and CPR certified.

All Corpsmembers will be equipped with all appropriate Personal Protective Equipment (PPE) during their program participation.


Applicant Assurances

Crew Leaders will provide the appropriate level of supervision and instruction to ensure safety in work completion.

All tools and equipment used are relevant and the number of tools/pieces of equipment are adequate for Corpsmembers to engage and safely complete the expected tasks.



All responses should support OYCC’s Mission and Vision:

Mission: “Empowering youth by providing outdoor work and stewardship experiences throughout

Oregon.”

Vision: “Oregon’s at-risk youth are successful community members engaged in work, stewardship,

and lifelong learning.”

Budget Information Budget Definitions/Tools

Direct Program Costs are those expenditures that directly support the project. Examples include but are not limited to: salaries, tools, transportation of the crew, crew supplies, personal supplies (e.g. boots, gloves, etc.) or other costs that can be tied directly to the project.

Administrative/Indirect Costs are those expenditures for activities that are necessary for the support of the program but are not directly tied to the program. Examples of these costs include but are not limited to: salary-related expenses, miscellaneous office supplies, costs incurred for grant reporting requirements, accounting costs, etc.

Leverage is a financial commitment toward the costs of a project from a source other than the granting organization through cash and/or in-kind contribution. Leverage can be achieved by a commitment from the grantee or through various partnerships.

To help Applicants determine projected personnel costs, OYCC has developed a basic Cost Calculator that is available here.

Total grant requested (up to $13,000):

Number of youth to be served:

Total amount of Corpsmember hours:

Number of Crew Leaders:

Total amount of Crew Leader hours:

Proposed Budget OYCC Funds Leveraged Funds

Wages



Proposed BudgetOYCC Funds Leveraged Funds

Fringe Transportation

Supplies PPE

Other A Other B Indirect Totals

Provide a narrat

ive that describes the proposed program budget.


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Work Indicators – Skill BuildingHow will your program reinforce work ready skills (punctuality, professional appearance, appropriate dress and equipment, positive attitude, coachability, initiative, work ethic, etc.) among Corpsmembers?

How will Corpsmembers be taught effective communication skills (including professional language, active listening, conflict resolution, etc.) for the workplace?


SummerConservationCorps–2019

Work Indicators – Skill Building Describe how Corpsmembers will gain a good understanding of the program's work projects, tasks and expectations?

What techniques will the program, program staff and Crew Leaders use to promote a positive attitude/environment and empower youth? Share how your program and projects support Positive Youth Development.



Work Indicators – Skill Building Describe what relevant technical skills (hard skills) the Corpsmembers will gain through project and program completion?

StewardshipHow will the completed projects listed below have a meaningful impact on the community?

Project Phone #:

Project Title:

Project Sponsor:

Project Contact:

Project Goal:

Role of Corpsmembers:

Impact on the Community:



Stewardship How will the completed projects listed below have a meaningful impact on the community?

Project Phone #:

Project Phone #:

Project Title:

Project Sponsor:

Project Contact:

Project Goal:



Project Title:

Project Sponsor:

Project Contact:

Project Goal:






Project Phone #:

Project Phone #:

Project Title:

Project Sponsor:

Project Contact:

Project Goal:



Project Title:

Project Sponsor:

Project Contact:

Project Goal:






Project Title:

Project Sponsor:

Project Contact:

Project Goal:



How will the grantee engage community partners in the program?

Program Partner:

Contact name:

Role of Partner:

Project Phone #:

Project Phone #:

Project Phone #:

Program Partner:

Contact name:

Role of Partner:

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StewardshipHow will the grantee engage community partners in the program?

Project Phone #:

Project Phone #:

Project Phone #:

Project Phone #:

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Program Partner:

Contact Name:

Role of Partner:

Program Partner:

Contact Name:

Role of Partner:

Program Partner:

Contact Name:

Role of Partner:

Program Partner:

Contact Name:

Role of Partner:

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Stewardship How will Corpsmembers experience or be exposed to connections with the program’s community partners?

How does the program reinforce stewardship principles to enhance natural resources environment and/or their community?



Stewardship How will the program help show the value of stewardship and community involvement to ensure Corpsmembers understand the impact of their work?

Education and Lifelong Learning How will the program promote educational opportunities both planned in advance and through teachable moments?



Education and Lifelong Learning What type (s) of academic credit will the youth be earning and how many credits will each youth receive? Enter “N/A” if no academic credit will be earned. Type of Academic Credit: Subject Areas of Credit: Amount of Credits earned per youth: How will Corpsmembers be made aware of career pathways, including further educational and/or occupational opportunities? Describe Which enrichment activity (s) Corpsmembers will take part in during their time in the program?



T-Shirts OYCC provides one t-shirt for each Crew Leader and Corpsmember. Shirt orders will be filled at the mandatory OYCC Crew Leader training to be held at OSU Cascades Campus in Bend, OR on June 19-21, 2019. Do you prefer long-sleeved or short-sleeved shirts?


2019 SCC Application - Oregon · 2019. 11. 25. · not limited to: salaries, tools, transportation of the crew, crew supplies, personal supplies (e.g. boots, gloves, etc.) or other

Documents

2019 SCC Application - Oregon · 2019. 11. 25. · not limited to: salaries, tools, transportation of the crew, crew supplies, personal supplies (e.g. boots, gloves, etc.) or other