ࡱ>  a Tsbjbjzz SP\P\k,VVVVVjjj8Lj*o,% '''')Pl+L,mmmmmmm$Vq tnV`-))`-`-nVV''Dn333`-vV'V'm3`-m332`Lf' 0 [-vb.mn0*octL.t\ffJtVYf`-`-3`-`-`-`-`-nn3`-`-`-*o`-`-`-`-t`-`-`-`-`-`-`-`-`-> : Legal Services Advisory Committee (LSAC) Grant Application Application Cover Sheet Please read the FY18-19 Grant Application Guidelines Memorandum before starting this LSAC application. You are accepting the terms of that Memorandum when applying for an LSAC grant. On this cover sheet, enter the information requested in the gray field boxes for proper formatting. Organizational Information Name of Organization:  FORMTEXT       Organization Address:  FORMTEXT       Web Site:  FORMTEXT       Name of Director:  FORMTEXT       Director Telephone:  FORMTEXT       Name and Title of Contact Person:  FORMTEXT       Contact Telephone:  FORMTEXT       Contact Email:  FORMTEXT       What Type(s) of Proposal(s) Are You Submitting? Indicate the type(s) of proposal(s) you are submitting and the amount requested. LSAC grants are for a two-year period. LSAC awards the same amount in the first year and second year for general operating grants. For project grants, LSAC is open to funding different amounts in each of the two years if needed.  FORMCHECKBOX  General Operating Grant for Staff Services  Annual Grant Request:  $ FORMTEXT        FORMCHECKBOX  General Operating Grant for PAI Services  Annual Grant Request:  $ FORMTEXT        FORMCHECKBOX  Project Grant  FY18 Grant Request:  $  FORMTEXT       FY19 Grant Request:  $  FORMTEXT        FORMCHECKBOX  B of A Project Grant  FY18 Grant Request:  $ FORMTEXT       FY19 Grant Request:  $ FORMTEXT       Is Your Organization Eligible for an LSAC Grant? The Organization is a 501(c) (3) tax-exempt organization with a client eligible member on the Board of Directors:   FORMCHECKBOX  Yes  FORMCHECKBOX  No The Organization has a current Certificate of Compliance with the Minnesota Department of Human Rights:   FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Not Applicable (fewer than 40 employees) I certify that all information in this grant application is true and correct to the best of my knowledge and that I have the authority to commit the Organization to the work proposed. This application is valid for a minimum of ninety days from the date of submission. Signature of Director:  __________________________________________  Date:  ________________ Application Definitions Legal Representation. Refers to those services through which lawyers and other legal advocates provide legal representation to clients, in an attorney/client relationship, whether using a staff, volunteer, judicare, or some other model. Organization. Refers to your corporate entity, including all Programs as defined below and other parts of your entity, if any. Other Eligible Services. Refers to law-related services (other than Legal Representation) eligible for LSAC funding. Examples include community legal education; advocacy on issues affecting eligible clients at the legislature, before other elected bodies, in administrative rulemaking, or the like; support to Programs that provide Legal Representation; mediation and/or other dispute resolution services, administration of justice; and other eligible law-related services not defined as Legal Representation. Private Attorney Involvement (PAI). Refers to Legal Services provided by private attorneys, rather than staff attorneys, and includes both pro bono and judicare. Program. Refers to that part of your Organization that provides law-related services, including but not limited to, services eligible for LSAC funding. Program services may include Legal Representation and/or Other Eligible Services. Proposal. Refers to LSACs Request for Proposals in three areas: general operating grant for staff services, general operating grant for private attorney involvement (PAI) services, and project grants. Organizations can submit Proposals in more than one category. Application Instructions General Application Guidelines Font. Please type your answer to each question in a 12-point font or larger. Format. You must answer the application questions in format provided. You should delete sections if you are not applying for that Proposal type (e.g., delete the Project Grant Proposal questions if that is not part of your application). Components of Application. Each grant application must include: Cover Sheet (limit one page) Section A - Organizational Capacity Information (limit seven pages) Section B, C, D, and/or E - Proposal(s) (an Organization may submit more than one Proposal; each Proposal is limited to seven pages) Required Appendices (see Application Appendices Guide below for details; no page limit for required appendices). Audit. In addition to the application, your Organization must provide its most recent audit. If the audit is not from the immediate past fiscal year, please indicate when the more recent audit will be available. Grant awards will be withheld pending receipt of the audit. Organizations with annual revenue of less than $750,000 can provide copies of their most recent Form 990 and annual financial statements with year to date and previous year comparison in lieu of an audit. Case Data. If your Organization provides Legal Representation to clients, then you must complete the case data spreadsheet available at  HYPERLINK "http://www.mncourts.gov/lsac" www.mncourts.gov/lsac with cases closed in calendar year 2016. Do not alter the spreadsheet in any way (e.g., add or delete rows or columns). The Data Handbook on the website provides detailed definitions for the spreadsheet categories. This spreadsheet is a required part of the application for all Proposals including Legal Representation. Application Appendices Guide Append only the following supporting materials to the application form in the order specified. Do not provide any letters of recommendation or other materials not requested. Appendix 1 Revenue and Expense Forms. Please use the charts provided in this document and do not modify the format in any way. If only a portion of your Organization provides law-related services, please provide the requested budget data only for your law-related Program. If your entire Organization provides law-related services, provide the budget data for the Organization as a whole. Appendix 2 Board of Directors. Provide a list indicating the name and affiliation of each member of the Organizations Board of Directors and indicate the required attorney member(s) and eligible client(s) on the Board. An eligible client is a person who could meet the LSAC income guidelines of 200% of the federal poverty guidelines at the time of Board appointment. Eligible client participation on a supervisory or advisory committee is not sufficient to meet this statutory requirement. Application Submission Grant materials must be submitted electronically following the instructions below. If you have any questions, please contact  HYPERLINK "mailto:bridget.gernander@courts.state.mn.us" bridget.gernander@courts.state.mn.us at any time through the application process. Applicants will receive an email confirming receipt of each document type. Materials must be received on or before Friday, March 3, 2017 at 4:30 p.m. Application (including Appendix 1 and Appendix 2) should be emailed as one pdf document to  HYPERLINK "mailto:lsacgrant@sp.courts.state.mn.us" lsacgrant@sp.courts.state.mn.us with the word application in the subject line* of the email. Audit (or other financial materials as described above) should be emailed as one pdf document to  HYPERLINK "mailto:lsacgrant@sp.courts.state.mn.us" lsacgrant@sp.courts.state.mn.us with the word audit in the subject line* of the email. Case data spreadsheet (if applicable) should be emailed as one Excel document to  HYPERLINK "mailto:lsacgrant@sp.courts.state.mn.us" lsacgrant@sp.courts.state.mn.us with the words case data in the subject line* of the email. * The subject line for each of these emails should only have the words requested: application, audit, or case data. See screen shot below with subject line highlighted. This subject line is how the respective documents will go in to the correct file in LSACs internal SharePoint site.  A. Organizational Capacity Information (all applicants fill out section A questions) A1. Organizational Overview. Please describe your Organization and its major services and activities, including the counties currently served. A2. FTEs. Complete the following table for each office used by your Program, adding and deleting rows as necessary: LocationFTE* Program AttorneysFTE* Program Support Staff and ParalegalsFTE* Administrative, Fundraising, etc.TOTAL FTE**Full-time equivalent (FTE) should be calculated on a 40-hour work week. For example, if you have an executive director who spends an average of 20 hours per week (.5 FTE) on management and fundraising and 20 hours per week (.5 FTE) on program services, you should allocate those FTEs accordingly in the categories above. A3. Client Eligibility Guidelines. Describe the financial guidelines you use for determining who receives service from your Program. Note that LSAC defines eligible client as having household income at or below 200% of the federal poverty guidelines. A4. Evaluation. Describe the processes you have in place to ensure and evaluate the quality, effectiveness, and/or outcomes of your Program. Please provide at least one example of a change that was instituted as a result of this evaluation. A5. Leverage. Describe how your Program leverages community resources through local partnerships with other nonprofit or government agencies. A6. Board Role in Budget and Finance. Describe how often your Board of Directors meets, the process for setting your annual budget and the process that is in place for Board review of financial information. A7. Growing, Sustaining or Reorganizing? Would you describe your Organization as growing, sustaining or reorganizing? Describe your Organizations ability to anticipate challenges and any examples of your capacity to adapt. Provide information about any new ideas or efficiencies that have been implemented in the last two years or are under discussion to improve your Organizations financial stability, including administrative savings. A8. Funding. Please complete the following table describing all Program funding sources to which applications have been submitted and/or funding has been received in the past year, adding or deleting rows as necessary. This table will not count against the seven-page limit for this section. Funding SourceAmount RequestedAmount Granted (enter $0 if request was denied or N/A if pending)Grant Term (if applicable) B. General Operating Grant for Staff Services Proposal (delete section B questions if not applying for this type of grant) B1. Region. Which region(s) does this Proposal cover (see region description in LSAC Cover Memo)? If your Proposal covers a portion rather than a full region, please list the specific communities, counties or Indian reservations within the region to be served. B2. Range of Service. Describe the range of client service that will be provided by staff if this Proposal is funded. Does your Program provide a full range of Legal Representation (advice, brief service, and extended representation)? If not, why not? If your Program undertakes impact litigation, including class action cases, as part of the extended representation cases please describe that work as well. B3. Case Acceptance. What is your Programs intake process? Do you use or are you considering the use of online intake? Does your Program follow specific case priorities in deciding what clients to serve? Does your Program undertake a formal client needs assessment and/or strategic planning process to inform your case priorities? If so, how often? If you have had a change in client service in the last two years due to a client needs assessment, strategic plan, or for another reason, please describe the change that was made and why. B4. Base Level. The Minnesota Supreme Court has charged LSAC with funding projects to ensure a base level of access to civil legal services in all Minnesota counties. Please describe how the services provided in this Proposal contribute to the provision of a base level of civil legal services in the region(s) to be served. How will your Program work to reach underserved areas or populations? Is the type of service to be provided available in all regions? If not, why should LSAC fund services that are available only in a limited geographic area? B5. Case Management System. What case management system does your Program currently use? If your Program has discussed changing case management systems, what are you considering and what is your timeframe? B6. Online Resources. Does your Program currently refer clients to lawhelpmn.org and mnlegaladvice.org? If so, please detail how these statewide resources are used. If not, what are your plans, if any, for future implementation? B7. Collaboration. How does your Program collaborate with other civil legal services providers in the region(s) to be served? If the region to be served includes a staffed law library or court self-help center, please describe any plan for how your staffed legal services will coordinate with their services. List the organization, contact name and email address of two persons collaborating with your Program. These persons should be able to speak to the quality of and the need for your services. B8. Statistics. If your Program provides Legal Representation, your case closed numbers and outcome measures should be provided in the case spreadsheet available at  HYPERLINK "http://www.mncourts.gov/lsac" www.mncourts.gov/lsac. If your Program provides Other Eligible Services, please provide any available statistics in the applicable sections below. Please include the counties in which you have provided the services, relevant statistics (e.g., number of people attending trainings or community legal education presentations, number of times a fact sheet was downloaded, etc.) and major accomplishments. Community Legal Education: Legislative and Administrative Rulemaking Advocacy: Other (describe): C. General Operating Grant for PAI Services Proposal (delete section C questions if not applying for this type of grant) C1. Region. Which region(s) does your Proposal cover (see region description in LSAC Cover Memo)? If your Proposal covers a portion rather than a full region, please list the specific communities, counties or Indian reservations within the region to be served. C2. Range of Service. Describe the range of client service that will be provided by private attorneys if this Proposal is funded. Does your Program provide a full range of Legal Representation (advice, brief service, and extended representation)? If not, why not? Will your Program be providing both pro bono and judicare services in the region? If not, why not? C3. Case Acceptance. What is your Programs intake process? Do you use or are you considering the use of online intake? Does your Program follow specific case priorities in deciding what clients to serve? If so, please describe. Does your Program undertake a formal client needs assessment and/or strategic planning process related to case priorities? If so, how often? If you have had a change in client service in the last two years due to a client needs assessment, strategic plan, or for another reason, please describe the change that was made and why. C4. Base Level. The Minnesota Supreme Court has charged LSAC with funding projects to ensure a base level of access to civil legal services in all Minnesota counties. Please describe how the services provided in this Proposal contribute to the provision of a base level of civil legal services in the region(s) to be served. How will your Program work to reach underserved areas or populations? Is the type of service to be provided available in all regions? If not, why should LSAC fund services that are available only in a limited geographic area? C5. Case Management. What case management system does your Program currently use? If your Program has discussed changing case management systems, what are you considering and what is your timeframe? C6. Online Resources. Does your Program currently refer pro bono volunteers or clients to any of the following: projusticemn.org, lawhelpmn.org, and mnlegaladvice.org? If so, please detail how these statewide resources are used. If not, what are your plans, if any, for future implementation? C7. Collaboration. How does your Program collaborate with other civil legal services providers in the region(s) to be served? If the region to be served includes a staffed law library or court self-help center, please describe any plan for how your Program will coordinate with their services. List the organization, contact name and email address of two persons collaborating with your Program. These persons should be able to speak to the quality of and the need for your services. C8. Statistics. If your Program provides Legal Representation, your case closed numbers and outcome measures should be provided in the case spreadsheet available at  HYPERLINK "http://www.mncourts.gov/lsac" www.mncourts.gov/lsac. If your Program provides Other Eligible Services, please provide any available statistics in the applicable sections below. Please include the counties in which you have provided the services, relevant statistics (e.g., number of people attending trainings or community legal education presentations, number of times a fact sheet was downloaded, etc.) and major accomplishments. Community Legal Education: Legislative and Administrative Rulemaking Advocacy: Other (describe): D. Project Grant Proposal (delete section D questions if not applying for this type of grant) D1. Project Description. Describe the project for which funding is requested, including the implementation plan and timeline. Please make sure to include enough detail that LSAC members can analyze whether the project should be a priority for funding. D2. Integration with Civil Legal Aid System. Does this project support an integrated service delivery infrastructure? How does the proposed work interact with and benefit the statewide delivery system? D3. Community Impact. What will be the community impact of this project? What is the anticipated geographic reach? Will the project reach a wide range of programs or client groups? D4. Leverage. Describe how this project will leverage LSAC funds (e.g., increased pro bono, in-kind donations, etc.). Please list other tentative and confirmed funding sources for this project, including the name of other funders and amounts. D5. Collaboration. Is your Program collaborating with other providers to ensure the project results in an effective and efficient use of funds? To what extent is your project duplicative of existing resources? List the organization, contact name, phone number and email address of two persons collaborating with your Program on this or other projects. These persons should be able to speak to the quality of and the need for the services your Program provides. D6. Timeline. Please provide an estimated timeline for your project over this July 1, 2017 through June 30, 2019 grant cycle, including major project milestones. Describe a plan for continuing the project beyond the grant cycle or successfully concluding the project. D7. Budget Modules. Please describe whether your proposal would have to be fully funded at the level requested in order to succeed or whether the proposal could be separated in to modules so that LSAC could fund a portion of the project and still have a positive impact on the community to be served. If funding based on distinct modules is a possibility for your proposal, describe each module and the amount of money required. This will provide a different view of your budget from the information provided in Appendix 1, Project Expense form which details expenses for the proposal assuming full funding. E. Bank of America Project Grant Proposal (delete section E questions if not applying for this type of grant) E1. Project Description. The Bank of America funding must be used to support community redevelopment legal assistance or foreclosure prevention legal assistance (see LSAC Cover Memo for more information). Provide an overview of your project, including the community or population benefitting, how clients will be referred to available legal assistance and any plan for evaluation. E2. Leverage. Describe how this project will leverage the Bank of America funds (e.g., increased pro bono, in-kind donations, etc.). Please list other tentative and confirmed funding sources for this project, including the name of other funders and amounts. E3. Collaboration. Is your Program collaborating with other providers to ensure the project results in an effective and efficient use of funds? To what extent is your project duplicative of existing resources? List the organization, contact name, phone number and email address of two persons collaborating with your Program on this or other projects. These persons should be able to speak to the quality of and the need for the services your Program provides. E4. Timeline. Please provide an estimated timeline for your project over this July 1, 2017 through June 30, 2019 grant cycle, including major project milestones. Describe a plan for continuing the project beyond the term of the Bank of America funds or successfully concluding the project. E5. Budget Modules. Please describe whether your proposal would have to be fully funded at the level requested in order to succeed or whether the proposal could be separated in to modules so that LSAC could fund a portion of the project and still have a positive impact on the community to be served. If funding based on distinct modules is a possibility for your proposal, describe each module and the amount of money required. This will provide a different view of your budget from the information provided in Appendix 1, Bank of America Expense form, which details expenses for the proposal assuming full funding. Appendix 1 Program Revenue Source Reporting When does your fiscal year begin and end?  FORMTEXT       Use the end date of your fiscal year to complete the columns on this form. Do not list in-kind donations or value of volunteer hours as revenue in this chart. Revenue SourceActual Revenue for 2016Budgeted Revenue for 2017Anticipated Revenue for 2018Anticipated Revenue for 2019Foundations; CorporationsUnited WayIndividuals; Firms; EventsLSAC Other State GovernmentCounty GovernmentOther Local GovernmentLegal Services Corporation (LSC)Older AmericansViolence Against Women Act (VAWA)Other Federal GovernmentAttorney FeesClient Fees; Admin FeesOther (specify)TOTAL REVENUE Appendix 1  Staff Program Expense Reporting When does your fiscal year begin and end?  FORMTEXT       Use the end date of your fiscal year to complete the columns on this form. ExpensesActual Expenses for 2016Budgeted Expenses for 2017Anticipated Expenses for 2018Anticipated Expenses for 20192017 FTEAttorney WagesParalegal/Support Staff WagesAdmin/Fundraising Staff WagesEmployee BenefitsTOTAL PersonnelSpace (e.g., rent or ownership costs, utilities, maintenance, etc.)CommunicationsEquipment Rental/LeasingEquipment PurchaseOffice SuppliesTravelProfessional Development & TrainingAuditClient Service Contracts (e.g., interpreters)Administrative Contracts (e.g., accounting)Technology Contracts (e.g., IT support, software licenses)LitigationInsuranceOther (specify)TOTAL Non-PersonnelTOTAL EXPENSES For Staff Representation: __% of Expenses for Civil Representation __% of Expenses for Criminal Representation Appendix 1 Private Attorney Involvement (PAI) Expense Reporting Complete this section only if your program provides pro bono or judicare services. When does your fiscal year begin and end?  FORMTEXT       Use the end date of your fiscal year to complete the columns on this form. 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Representation: __% of Expenses for Civil Representation __% of Expenses for Criminal Representation Appendix 1 Project Expense Reporting Complete this section only if applying for a project grant with questions in section D. Use the grant fiscal year (July 1 through June 30) to complete the columns on this form. ExpensesTotal Project ExpensesLSAC Amount Requested2017201820172018 2017 FTEAttorney WagesParalegal/Support Staff WagesAdmin/Fundraising Staff WagesEmployee BenefitsTOTAL PersonnelSpace (e.g., rent or ownership costs, utilities, maintenance, etc.)CommunicationsEquipment Rental/LeasingEquipment PurchaseOffice SuppliesTravelProfessional Development & TrainingAuditJudicare ContractsClient Service Contracts (e.g., interpreters)Administrative Contracts (e.g., accounting)Technology Contracts (e.g., IT support, software licenses)LitigationInsuranceOther (specify)TOTAL Non-PersonnelTOTAL EXPENSES LSAC Amount Requested columns should match amount requested on Cover SheetAppendix 1 Bank of America Project Expense Reporting Complete only if applying for a Bank of America project grant with questions in section E. Use the grant fiscal year (July 1 through June 30) to complete the columns on this form. 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