Initiative Template Questions

Cities of Service Impact Volunteering Fund

* = Required field

Initiative name and summary Please complete the following information for each initiative. If you have multiple initiatives use a separate form for each initiative. Note that anything with an asterisk is a required field. Initiative name*

Overview of initiative* Please provide a brief description of the initiative, explaining how this volunteer strategy targets community needs, uses best practices, and sets clear outcomes and measures to gauge progress. [1500 characters]

Amount requested for this initiative* Specify amount requested for one initiative only on this form. Total amount requested for a single initiative should equal $25,000. If multiple initiatives will be proposed, the amounts requested should add up to either $50,000 or $100,000.

Indicate if initiative is based on a Cities of Service Blueprint* Blueprints may be viewed or downloaded at http://www.citiesofservice.org/resources/blueprints/ Cool Roofs Graduation Coaches Graffiti Busters Lets Grow Lets Move, Lets Learn Love Your Block Operation Reintegration Prepared is Protected Sustainable Home Makeover Third Grade Reads Volunteer CPR Not based on a blueprint

Contact information of the person in city government submitting the application Name* Title* Email* Phone number* Mailing address*

Contact information of the person in city government who is responsible for the initiatives success / oversight of implementation, if different from the contact name above Name* Title* Email* Phone number* Mailing address*

Intended impact Please specify the impact your initiative is intended to achieve by answering the questions below. Initiative goal(s)* What is the specific goal(s) of the initiative (e.g., improve home energy conservation in a specific area of the city, increase the graduation rate among low-income students in three schools, reduce crime in a specific neighborhood)? [300 characters]

What is the specific challenge the initiative addresses?* Include any facts about the scale of the specific need in your city, the neighborhood targeted by the initiative, or the target population that will benefit (e.g., 500 students fail to graduate on time each year; there are more than 5,000 blighted properties in the city, including 125 in the targeted neighborhood). Provide any additional information that will illustrate this is an important challenge facing the city. [1500 characters]

Initiative scale* Please explain how much of the need stated above you intend to address through the proposed initiative, and how this impact would be significant to your city (e.g., will increase reading levels of 500 children (50 percent of the below grade level students) by at least 1 full grade level in five elementary schools; will ensure that 300 families (75% of families in the targeted neighborhood) are trained in disaster preparedness strategies). [1500 characters]

How does the initiative advance a priority of the Mayor?* Include specific information that demonstrates why the issue is a priority for the Mayor, how the Mayor has communicated that it is a priority, and related Mayoral efforts to address it. Indicate if the initiative is part of the city's service plan (if one exists). [1500 characters]

Plan for measuring projected impact Information for this question should be reported on the separate measurement template, which can be downloaded here. [See attachment for template 3 MB(s) allowed] In completing the measurement template, please specify the overall goal for the initiative as well as the specific quantitative metrics you will collect. This should include the scale of the initiative (e.g., the number of students to be served) and the depth of impact (e.g., the increase in reading levels), the timing for when the impacts will be achieved, as well as measures of volunteer participation (e.g., the number of volunteers engaged). In designing the initiative, we urge you to be realistically ambitious, as we will take

into account the scale of your proposed impact (i.e., the level of impact you will have against the need in the city, neighborhood, or targeted population). Please note that the baseline should reflect the number that will exist at the time you launch your initiative and your goal should be the number you hope to reach at the conclusion adding together the baseline and new numbers. So if your initiative is building on previous work, you might be starting with a baseline of 10 and plan to add 40, with a goal of 50. Key questions to keep in mind when completing the measurement template: How do you plan to measure the impact of this initiative? What data will you use? Is it part of a regularly collected data set (such as crime statistics by neighborhood or reading scores by school) or will you need to create a plan to collect the data as part of the initiative? In the template, you will be asked to note how you will collect the necessary data, and which organization(s) will be responsible for this data collection.

Evidence base If your initiative is not based on a Cities of Service Blueprint, please provide evidence or the theory behind why this particular volunteer-based intervention will have the desired impact. You may include links to research studies or other sources to supplement your answer. [1500 characters]

Existing initiatives If the proposed initiative is already being implemented, please describe how an Impact Volunteering Fund grant will help you achieve higher levels of impact (beyond what is already planned). [1500 characters]

Displacement of city resources* Please certify whether the proposed initiative will displace city employees, functions, or expenses, or duplicate existing services. (Yes it will likely displace city resources / No it will not displace city resources) Description of volunteer engagement* In this section we want to know how volunteers will help achieve the intended impact. What key volunteer activities/functions will be pursued? [1500 characters]

Please provide the following: What will the volunteers do? Where (and potentially who) will the volunteers serve? How does their volunteer activity relate to the intended impact? What skills, background, or characteristics should be represented among the volunteers? How many volunteers are needed? What organization will be responsible for the day-to-day management of the volunteers? Are background checks required for these volunteers?

Timeline High-level timeline* Please provide the key dates (and only the dates) for the following milestones. Month and year is sufficient: Launch of the initiative: Volunteer service begins: Volunteer service ends: Impact metrics/results are available:

Resources Budget* Budget information for this question should be reported on the separate budget template, which can be downloaded here. [See attachment for template 3 MB(s) allowed] Plans to secure resources* What are your plans to secure the financial and in-kind resources required, outside of funds requested through this grant? Please provide detail on the sources and amount to be secured from each source. We are particularly interested in what city resources are committed to the initiative as well as how the grant funds will leverage other resources. Note that grant funds may not be used to supplant existing citysupported activities or personnel. [1500 characters]

Risks Possible risks* What risks do you foresee in launching and implementing the initiative (such as legal risks, challenges to effective execution, etc.)? For each risk, include your plans to address the risk. [1500 characters]

Role of Mayor Role of Mayor in initiative* Describe the role of the Mayor in planning and implementing the initiative, including activities with both internal and external stakeholders. [1000 characters]

Team and responsibilities Lead organization* Provide information about the organization responsible for leading the implementation of the initiative, including organization name, number of staff working on the initiative from the organization, and amount of time to be spent on the initiative. Please indicate the qualifications that the lead organization brings to the initiative. [1000 characters]

Implementation team* Indicate additional organizational partners that will play roles in implementing the initiative. Please include the operating partner responsible for recruiting, training, and supervising volunteers and other key partners, including anyone else in city government. Please indicate the qualifications that the key implementation partners bring to the initiative. [1000 characters]

City government lead Identify the person from city government who is responsible for oversight of this initiative and describe his/her responsibilities for the design and implementation of the initiative. [1000 characters]

Partner letters Upload one letter of commitment from the lead initiative partner confirming their role in implementation of the initiative. [1 MB allowed]

IMPACT MEASUREMENT TEMPLATE

Name of City: Name of Initiative: Overall Goal: Projected Impact Source of Metric

Metric

Goal

Baseline

Regularly Collected Data or New

Volunteer Participation

Cities of Service Impact Volunteering Fund

Budget template for initiatives (all sources)

Initiative 1 Revenue Impact Volunteering Fund request Other grants (e.g., foundation, corporate) Other cash contributions (define) City funds (identify source) Event fees Fees for services Other funds (identify source) Total cash revenue Donated supplies (indicate item and source, estimate value) Donated services (indicate specific service and source, estimate value) Total in-kind revenue Total Revenue Expenses Staff salary and benefits* Position (indicate percentage of time allocated) Position (indicate percentage of time allocated) Position (indicate percentage of time allocated) AmeriCorps matching funds or VISTA cost-shares Initiative supplies Office supplies Transportation Equipment (specify) Food/refreshments Printing and copying Telecommunications Rent and Utilities (provide details) Fees Insurance Other Total cash expenses In-kind List item List item List item Total in-kind expenses Total Expenses Revenue over Expenses All Sources 0 0 0 0 0 0 0 $0 0 0 $0 $0 Impact Volunteering Fund 0 0 0 0 0 0 0 $0 0 0 $0 $0 Initiative 2 All Sources 0 0 0 0 0 0 0 $0 0 0 $0 $0 Impact Volunteering Fund 0 0 0 0 0 0 0 $0 0 0 $0 $0 Initiative 3 All Sources 0 0 0 0 0 0 0 $0 0 0 $0 $0 Impact Volunteering Fund 0 0 0 0 0 0 0 $0 0 0 $0 $0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 $0 0 0 0 $0 $0 $0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 $0 0 0 0 $0 $0 $0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 $0 0 0 0 $0 $0 $0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 $0 0 0 0 $0 $0 $0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 $0 0 0 0 $0 $0 $0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 $0 0 0 0 $0 $0 $0

Indicate time period covered by budget:

*Note that Cities of Service Impact Volunteering Fund grants cannot be used to pay a Chief Service Officer's salary or benefits, nor may they be used to hire new city staff. They can be used to cover a portion of the salaries and benefits of existing staff who will support the proposed initiatives (other than the CSO) and may be used for AmeriCorps matches or cost-share VISTAs.