ivf initiative template

7/28/2019 IVF Initiative Template

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Initiative Template QuestionsCities 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 separateform 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 targetscommunity needs, uses best practices, and sets clear outcomes and measures to gauge progress. [1500characters]

Amount requested fo r th is in it iat ive*Specify amount requested for one initiative only on this form. Total amount requested for a single initiativeshould equal $25,000. If multiple initiatives will be proposed, the amounts requested should add up toeither $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/

http://www.citiesofservice.org/resources/blueprints/






Contact information of the person in city government who is responsible for the initiative’ssuccess / 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 theinitiative, 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. [1500characters]

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



into account the scale of your proposed impact (i.e., the level of impact you will have against the need inthe 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 thebaseline and new numbers. So if your initiative is building on previous work, you might be starting with abaseline 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 byneighborhood or reading scores by school) or will you need to create a plan to collect the data aspart of the initiative?

• In the template, you will be asked to note how you will collect the necessary data, and whichorganization(s) will be responsible for this data collection.

Evidence baseIf 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 includelinks to research studies or other sources to supplement your answer. [1500 characters]

Existing in itiativesIf the proposed initiative is already being implemented, please describe how an Impact Volunteering Fundgrant 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, orduplicate existing services. (Yes it will likely displace city resources / No it will not displace city resources)

D i ti f l t t*



Timeline

High-level timeline*Please provide the key dates (and only the dates) for the following milestones. Month and year issufficient: 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 bedownloaded 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 requestedthrough 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 grantfunds will leverage other resources. Note that grant funds may not be used to supplant existing city-supported activities or personnel. [1500 characters]

Risks

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

Role of Mayor

http://www.citiesofservice.org/wp-content/uploads/Impact-Volunteering-Fund-Budget-Template.xls






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

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



IMPACT MEASUREMENT TEMPLATE

etr c oa ase ne ource o etr c egu ar y o ecte ata or ew

Projected Impact

ame o ty:

vera oa:

Volunteer Participation

Name of Initiative:



Cities of Service Impact Volunteering Fund

Budget template for initiatives (all sources)

Revenue All Sources

ImpactVolunteering

Fund All Sources

ImpactVolunteering

Fund All Sources

ImpactVolunteering

FundImpact Volunteering Fund request 0 0 0 0 0 0

Other grants (e.g., foundation, corporate) 0 0 0 0 0 0

Other cash contributions (define) 0 0 0 0 0 0

City funds (identify source) 0 0 0 0 0 0

Event fees 0 0 0 0 0 0

Fees for services 0 0 0 0 0 0

Other funds (identify source) 0 0 0 0 0 0

Total cash revenue $0 $0 $0 $0 $0 $0

Donated supplies (indicate item and source, estimate value) 0 0 0 0 0 0

Donated services (indicate specific service and source, estimate value) 0 0 0 0 0 0

Total in-kind revenue $0 $0 $0 $0 $0 $0

Total Revenue $0 $0 $0 $0 $0 $0

Expenses

Staff salary and benefits*Position (indicate percentage of time allocated) 0 0 0 0 0 0

Position (indicate percentage of time allocated) 0 0 0 0 0 0

Position (indicate percentage of time allocated) 0 0 0 0 0 0

AmeriCorps matching funds or VISTA cost-shares 0 0 0 0 0 0

Initiative supplies 0 0 0 0 0 0

Office supplies 0 0 0 0 0 0

Transportation 0 0 0 0 0 0

Equipment (specify) 0 0 0 0 0 0

Food/refreshments 0 0 0 0 0 0

Printing and copying 0 0 0 0 0 0

Telecommunications 0 0 0 0 0 0

Rent and Utilities (provide details) 0 0 0 0 0 0

Fees 0 0 0 0 0 0

Insurance 0 0 0 0 0 0

Other 0 0 0 0 0 0

Total cash expenses $0 $0 $0 $0 $0 $0

In-kindList item 0 0 0 0 0 0

List item 0 0 0 0 0 0

List item 0 0 0 0 0 0

Total in-kind expenses $0 $0 $0 $0 $0 $0

Total Expenses $0 $0 $0 $0 $0 $0

Revenue over Expenses $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-shareVISTAs.

Initiative 1 Initiative 2 Initiative 3

ivf initiative template

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