OST 2015 Application Step 1 of 13 - OST Partner Funding Criteria Checklist 7% OST Partner Funding Checklist The following is a general overview and checklist of the criteria needed for OST partner funding.Our group can demonstrate the following:* A summer program that will meet a demonstrated need A history with OST A quality program plan Identified and established partnerships Training for staff and volunteers A program evaluation Good standing with OST Signature of Executive Director or Board Member OST Partner Funding Application 2015The Out of School Time (OST) Collaborative supports all groups who believe and abide by the OST Mission. Mission: To work together to improve the resiliency of children and youth experiencing social vulnerability through quality and widely accessible OST programs, services and policies.Name of Agency:*Name of Program:*1. Program focus and demonstrated needWhat are the needs your program will address? Check all that apply.* Recreational Programming Cultural Programming Youth Leadership Providing a Safe Place Educational Programming Aboriginal Programming Youth Leadership Food and Nutrition Who will benefit from the program?*Who will be the participants of your program? Check all that apply.* Immigrant Youth New Canadians Special Needs Groups Refugee Youth Aboriginal Youth How many participants do you anticipate for your program?*What will be the age of the program participants? Check all that apply.* Under 6 Years 13 to 15 Years 6 to 12 years 16 and Older Are there other supports or programs in the area that could meet this need?*YesNoDon't KnowIf yes, could you potentially partner with them?*YesNoDon't KnowIs the program for a specific group or community that would not access or be supported by other programs?* 2. History with OSTHas your group been involved in previous OST meetings, trainings, workshops, etc.?*YesNoIf yes, please indicate what you have participated in:Has your group previously run a summer program in partnership with OST?*YesNoIf yes, please indicate the name of the program and how many years it has been running:Is your group in good standing with OST?*YesNoHave past obligations been met? (eg. reporting previous programs)*YesNoPayment for previous programs are not outstanding?*YesNo 3. Program detailsWhat is the focus or purpose of your program?*What types of activities will your program offer?*During what dates will your program run?*What are your program days and hours of operation?MondayTuesdayWednesdayThursdayFridaySaturdaySunday*Please provide a sample daily schedule for your program, you will be required to attach this at the end of the form.How many staff/volunteers will your program require?Staff:*Volunteers:*Community members (e.g. parents)*Other:Where will you recruit/hire staff and/or volunteers for your program?*What are your expectations/processes surrounding Police Information Checks for staff and volunteers?*What training will you provide for staff and volunteers?* 4. TrainingOST Training*YesNoOST Conference*YesNoOST Conference*YesNoOther*YesNoIf yes, please specify: 5. Staff RolesIn your organization, who will overseeAdministration:*Registration:*Budget:*Reporting & Evaluation:*Planning & Coordination:*Frontline Leadership:* 6. Program LocationWhere will your camp be hosted?*Is this confirmed?*YesNoIf yes, how?Will you use a Joint site for your program?*YesNo 7. Transportation requirementsWill you provide transportation for children/youth to get to your program?*YesNo 8. Food and NutritionWhat meals will you provide?Breakfast*YesNoMorning Snack*YesNoLunch*YesNoAfternoon Snack*YesNoWill you get food from the food bank?*YesNoIf yes, is this partnership in place?YesNoWill your staff be trained in food handling procedures?*YesNo 9. Partnerships and ServicesHave your partnerships been identified and established?*YesNoPlease list community resources you plan to use in your program (e.g. library, community league, Green Shack, church):* 10. Insurance detailsHave you obtained insurance for your program?*YesNoAgency:Liability Insurance Carrier:Insurance Policy Number: 11. BudgetDo you have an estimated budget to run this year’s program?*YesNo2015 BudgetProgram ExpensesCostOST FundsSalaries & BenefitsSalaries & Expenses CostSalaries & Benefits OST FundsRentRent CostRent OST FundsLiability InsuranceLiability Insurance CostLiability Insurance OST FundsTransportationTransportation CostTransportation OST FundsFoodFood CostFood OST FundsProgram ActivitiesProgram Activities CostProgram Activities OST FundsProgram SuppliesProgram Supplies CostProgram Supplies OST FundsOtherOther CostOther OST FundsTotal ExpensesTotal CostTotal OST Funds2015 Revenue Sources What are your funding sources? (e.g. Grants, In-kind donations, OST, Not Yet Secured) Revenue SourceConfirmed FundsAnticipated FundsRevenue Source 1Confirmed Funds 1Anticipated Funds 1Revenue Source 2Confirmed Funds 2Anticipated Funds 2Revenue Source 3Confirmed Funds 3Anticipated Funds 3Revenue Source 4Confirmed Funds 4Anticipated Funds 4Revenue Source 5Confirmed Funds 5Anticipated Funds 5 2015 OST Funded Partnership Agreement The Partners mutually agree upon the following: 1. Guiding Principles Equitable Partnership – Each partner brings experience, knowledge, skills and resources equally important to the success of the partnership. Innovation - The Partnership will strive to explore new and innovative ways to work together towards a common goal. 2. Expectations: All partners will: Complete their responsibilities and fulfill their roles Support one another Meet deadlines Be diligent about record keeping and provide documentation of the experience of partnering 3. Roles and Responsibilities Roles and responsibilities for each partner: Attend partnership meetings Keep the fiscal agent up to date and informed about project progress Participate in data collection and evaluation Financial management for their portion of the funding Document and report on outcomes Document and report on expenditures Specific role for REACH Edmonton (fiscal agent): Provide information to partners on all information required and processes prior to receiving funds Responsible for the distribution of the funding Coordinate, compile and submit the final report within 60 days of project end. 4. Term of Agreement: The partnership begins June 2015 and concludes August 31 2015. 5. Insurance/Risk Management/ Legal status Each partner will provide proof of their liability insurance coverage for their programs or services involved in the partnership. (Attach documentation) a) The organization shall inform the insurance provider of any partner organizations. b) The organization insurance policy will include coverage for sexual abuse. c) The organization insurance policy shall indemnify REACH Edmonton on the liability section of the insurance policy. 6. Mediation/Dispute Resolution Process All partners in the 2015 OST Summer Programs Collaborative agree that In the case of a dispute arising within the partners the following steps will occur to try and bring about a successful resolution: a) Partner members will attempt in good faith to resolve the dispute through a process of discussion and negotiation. b) If the dispute remains unresolved, a mutually agreeable mediator will be appointed to assist the partnership members (parties) to arrive at an acceptable resolution by REACH Edmonton (fiscal agent). 7. Funding Agreement A Funding Agreement will be signed by REACH Edmonton (the fiscal agent) and each of the partner organizations indicating a) Their Boards have been informed that the funds may only be used for the approved expenses outlined in their budgets. b) They have submitted a program budget. c) They will provide a final financial report within 30 days of program end. d) They will provide a final program report within 30 days of program end. Name*Agency Board Member or Executive DirectorDate* Todays DateEmail* Phone*Please upload and provide a sample daily schedule for your program*EmailThis field is for validation purposes and should be left unchanged.
