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ONE LAFAYETTE COMMUNITY FUNDRAISER 2012 APPLICATION FOR FUNDING & ECR STATUS Groups applying for funding from the One Lafayette Community Fundraiser may apply for status as an Essential Community Resource (ECR) or they may apply for a Special Program Grant. Both ECR’s and groups applying for a Special Program Grant must meet basic criteria, including: Must be a certified IRS 501 non profit group Must serve Lafayette residents Provide the One Lafayette coordinator with a current list of Board of Directors, active volunteers and key officers Provide the One Lafayette coordinator with a copy of their financial statement for the most recently completed fiscal year. Organizations that are awarded funding based on being an ECR apply once every three years. During the three years after being certified as an ECR the non-profit is asked to document certain basic facts they are still located in Lafayette, are still performing the same basic types of services, they are still a registered non-profit, etc.) At the end of the three years the group will need to re-apply for their ECR status. Status as an ECR is awarded to groups that most closely fit the following criteria: Organization is physically located in Lafayette Organization’s clientele is made up of primarily Lafayette residents Organization’s mission is primarily devoted to aiding people in emergency or critical situations, such as families or individuals in need of food, medical or housing assistance. Organization works to support self sufficiency for adults through employment training, transportation or in-home services. Organization does not receive any additional funds from City budget and has not in previous budget cycle. APPLICATION ---PAGE BREAK--- Name of Organization: Mailing Address: City: Zip: Contact Person(s): Email: Organization Website: Okay to link? Yes No Registered non-profit? Yes No IRS 501 number: Applying for (choose one): Essential Community Resources Status A Special Program Grant Please indicate in which of the following areas your group serves Lafayette (choose all that apply): Child care or child development Health support services Protective services for children or adults Counseling or mental health Services for children in foster care Educational support services Services for developmentally disabled adults or children Transportation services for the elderly or handicapped Food, housing, and emergency support services for families in crisis, children, the elderly, the disabled or the homebound Other: The following fields are for groups that are applying for ECR status ONLY. Describe how much of the services your organization provides are devoted to ---PAGE BREAK--- Lafayette residents. Provide specific details including total number of people served by your organization, total number of Lafayette residents served, dollar amounts of operating budgets devoted to Lafayette residents, etc. Please describe how your group serves the Lafayette community. Be specific and as descriptive as possible. Attach additional sheets as needed and include brochures, press releases, etc. as long as it specifically addresses your group’s role in Lafayette: Are there currently any other community agencies providing similar or equivalent services in Lafayette? If yes, who? The following fields are for groups that are applying for either ECR status or a Special Program Grant. Did your organization receive funding from the City of Lafayette in 2010? Yes No (Do not include funds received from One Lafayette) ---PAGE BREAK--- Amount: Did your organization receive funding from the City of Lafayette in 2011? Yes No Amount: What was the purpose of this funding? The following fields are for groups that are applying for a Special Program Grant ONLY. What is the mission of your organization? Describe the specific activities, program or project that will be supported with the assistance of One Lafayette funding if granted? What consequences do you anticipate in your organization’s programs/projects or activities if you do not receive this funding? What is the total budget for this specific program, project or activity? Amount of One Lafayette funding requested: $ Deadline for applications is 5:00 PM Friday, July 27, 2012. Applications may be submitted online using the form available at www.onelafayette.org and emailing attachments to [EMAIL REDACTED] or by delivering applications in person to: ---PAGE BREAK--- Pam Spring Human Resources Department City of Lafayette 1290 South Public Road Lafayette, CO 80026 Call Pam Spring at [PHONE REDACTED] ext. 3382 for more information.