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City of Corona
COMMUNITY BASED ORGANIZATION FUNDING APPLICATION
2022-2022 Fiscal Cycle
Please print or type and attach additional paper if needed. Agencies applying for multiple programs will need to fill out a separate application for each.
I. GENERAL INFORMATION
APPLICANT:
TYPE OF APPLICANT: Public Agency Non-Profit Other: __________________________ CONTACT PERSON: TITLE:
ADDRESS: CITY, ZIP CODE:
PHONE: FAX: EMAIL:
AGENCY WEBSITE:
LOCATION OF HEADQUARTERS, BRANCH OFFICES, AND OUTREACH SITES:
PROVIDE A DESCRIPTION OF THE ORGANIZATION AND ITS GENERAL FUNCTIONS:
WHAT IS YOUR AGENCY’S BUDGET FOR THE CURRENT (22-23) FISCAL YEAR? $ Signature: Date:
Print Name:
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City of Corona
COMMUNITY BASED ORGANIZATION FUNDING APPLICATION
2022-2022 Fiscal Cycle
II. PROGRAM DESCRIPTION
Name of the program or project for which you are requesting funding: Amount of Funding Requested:
$
Is a new or existing program? (Please circle one) New Existing Corona
Residents/Students
Total
Number of clients this program is serving in 2022-23 (current fiscal year):
Number of clients this program is expected to serve in the 2022-23 fiscal year:
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City of Corona
COMMUNITY BASED ORGANIZATION FUNDING APPLICATION
2022-2022 Fiscal Cycle
Provide a detailed description of the proposed project explaining precisely what is to be accomplished with the requested funds. What is the primary project goal? P a g e 4 | 8
City of Corona
COMMUNITY BASED ORGANIZATION FUNDING APPLICATION
2022-2022 Fiscal Cycle
Explain how the proposed program relates to the City of Corona’s (if any) Strategic Plan and/or City Council Priorities.
(Note: All of the documents will be available at: https://www.coronaca.gov/. Please list which goals within the Strategic Plan and/or City Council Priorities the proposed program relates to.) P a g e 5 | 8
City of Corona
COMMUNITY BASED ORGANIZATION FUNDING APPLICATION
2022-2022 Fiscal Cycle
Does the Operating Agency use an evaluation model to calculate program performance measures? Please describe the method(s) that your agency will use to track and report that clients are better off as a result of receiving services.
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City of Corona
COMMUNITY BASED ORGANIZATION FUNDING APPLICATION
2022-2022 Fiscal Cycle
Identify and describe the target population. If the target population includes the participation of students from the Corona-Norco Unified School District (CNUSD), please provide a letter of support and implementation plan prepared in conjunction with a CNUSD administrator.
How will this program be promoted among the target population? Identify the facility at which the proposed project services will be provided, including hours and days.
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City of Corona
COMMUNITY BASED ORGANIZATION FUNDING APPLICATION
2022-2022 Fiscal Cycle
III. PROGRAM FINANCIAL INFORMATION
Please the following information regarding funding the specific program/project you are proposing.
Categories Expenditures
Revenues
Other Sources From City
Salaries & Benefits
Supplies
Rent
Communications (phone, postage)
Travel Expenses
Insurance
Other
TOTAL BUDGET:
Please list the year(s), and amount(s) (if any) of past funding the program/project has received from the City of Corona:
Please list funding the program receives from other sources, including other cities:
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City of Corona
COMMUNITY BASED ORGANIZATION FUNDING APPLICATION
2022-2022 Fiscal Cycle
IV. ATTACHMENTS
☐ Evidence of non-profit status (501-C3), if applicable ☐ Evidence of Liability Insurance; amount of $1,000,000 ☐ Evidence of Worker’s Compensation Insurance
☐ Board of Directors roster
☐ Copy of the agency’s most recent total budget
☐ Letter of Support from CNUSD administration (if program involves CNUSD participation) ☐ Implementation Plan prepared in conjunction with CNUSD (if program involves CNUSD participation) ☐ Memorandum of Understanding (MOU) or contract with agency the services are being provided to or in conjunction with
☐ Last (3) years of annual report data of how many Corona residents served All application packets must be completed, with all attachments, and returned to the City of Corona’s Community Services Department by 5:00 p.m., Thursday, March 31, 2022. Late applications and postmarks will NOT be accepted.
Submit to:
City of Corona Community Services Department
ATTN: CBO FUNDING PROGRAM (FY 22-23)
400 S. Vicentia Avenue, Suite 225, Corona, CA 92882
Please attach the following to your application: