Form 2 Poll Worker APPENDIX G - Application Form r.1

HELP AMERICA VOTE COLLEGE PROGRAM

POLL WORKER GRANT PROGRAM

APPLICATION FOR CONSIDERATION

Instructions: Complete all sections of this Application. Ensure that information entered in the application aligns with information in the budget worksheet. Upload this completed Application Form and the Budget Worksheet to Grants.gov by the deadline using the Attachments Form. For items in this form with an asterisk – “*” - additional details can be found in the HAVCP Poll Worker Application Form Guidance at the end of this document. For more detailed guidance and resources, also see the HAVCP Poll Worker Application Kit.

Please note: If your organization is only interested in applying for Service Day activities and will not be requesting any Poll Worker related project activities, DO NOT COMPLETE THIS APPLICATION. An abbreviated application form for Service Day project funding only is available as part of the Help America Vote College Program Service Day Mini-Grant Program Application Kit posted to the U.S. Election Assistance Commission at https://www.eac.gov/grants/help-america-vote-college-program.

Section I	Applicant Information
Section II	Executive Summary and Historically Underrepresented Groups
Section III	HAVCP Poll Worker Project Narrative
Section IV	HAVCP Poll Worker Performance Measures
Section V	Budget Narrative
Section VI	Financial Capability

Section I. Applicant Information

Entity Name:

Unique Entity ID (UEI)*:

Primary Point of Contact

This individual will be contacted with requests for additional information as needed, in addition to receiving notice of an award being offered.

Name:

Title:

Email:

Phone:

Certifying Official

This individual will be responsible for reviewing and agreeing to the terms and conditions of HAVA and the EAC.

Name:

Title:

Email:

Phone:

Budget Representative

This individual will be responsible for responding to inquiries regarding the proposed budget and completing the required Federal Financial Reports.

Name:

Title:

Email:

Phone:

HAVCP Poll Worker Project

Amount Requested:

Match Amount (10% Minimum):

Section II. Executive Summary and Historically Underrepresented Groups

Executive Summary

In the space provided, please provide a brief description of how you plan to utilize HAVCP funds to support poll workers in your community. Example: Sample University is applying for $50,000 in Poll Worker project funds to engage and train college poll workers in the county of Sample. Funds will be used to…

Will your organization/institution/program engage historically underrepresented groups, as defined by the federal government, as poll workers*?

Yes No

If yes, please describe below how your program will achieve this:

Section III. HAVCP Poll Worker Project Narrative

Instructions*: The narrative should be no more than five to seven paragraphs in length and describe how your organization plans to spend the HAVCP Poll Worker funds and required matching funds. The narrative should include the amount of your award and matching commitment, as well as the timeframe in which you plan to use the funds. The narrative should describe both immediate improvements/activities and longer-term activities leading up to the 2024 election and beyond.

For more guidance on what information to include and how your responses will be evaluated, refer to Section III (Application Evaluation Criteria) of the HAVCP Application Form Guidance at the end of this document and/or APPENDIX D. Scoring Rubric.

Section IV. HAVCP Poll Worker Performance Measures

Instructions*: Grant recipients will be required to report on at least three performance measures: one required universal measure (PW-1) and two optional measures selected by the applicant. See Section IV of the HAVCP Application Form Guidance at the end of this document for available performance measure options.

Using the table below, indicate which performance measures your program will track. In the narrative box, describe how your program will work to achieve the identified target, including tracking mechanisms and timelines.

Number	Title	Estimated Target	Narrative*
PW-1 (Required)	Total number of college student participants served.

Section V. Budget Narrative

Instructions*: Budget narratives should accurately explain project costs that are reasonable, necessary, and otherwise allowable under federal law and applicable federal cost principles. The budget narratives should be mathematically sound and correspond clearly with the information and figures provided in the Budget Worksheet (APPENDIX C). As with the Budget Worksheet, the budget narrative should describe costs by year and indicate the source of matching funds for each budget category. See Section V of the HAVCP Application Form Guidance at the end of this document for more information on what types of expenses qualify for each budget category.

For each budget category, include federal and non-federal: cost calculations; allocation formulas; and justification for the costs based on the proposed project needs.

If there are no anticipated costs for a category, please mark it as ‘none’ or ‘N/A’.

Personnel

Fringe Benefits

Equipment

Supplies

Training

Contractual/Consultants

Travel

Other (Describe)

Indirect Costs

Section VI. Financial Capability

Does your entity meet all the financial management requirements outlined in 2 CFR 200.302*?

Yes No

If no, please explain:

Which of the following best describes your accounting system:

Manual Automated Combination of manual and automated

Is your entity currently labeled as ‘High Risk’ by a federal agency?

Yes No

If yes, please list federal agency or agencies:

In the space provided, briefly describe organization and personnel experience managing federal grants or similar financial agreements:

Privacy Act Statement: The Privacy Act of 1974 (5 U.S.C 552a) requires that we notify you that the information requested under this Notice of Funding is collected pursuant to 42 U.S.C. 12592 and 12615 of the National and Community Service Act of 1990 as amended, and 42 U.S.C. 4953 of the Domestic Volunteer Service Act of 1973 as amended.

Paperwork Reduction Act. In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. chapter 35), the information collection requirements associated with the programs, as covered in this Notice, have been approved by the Office of Management and Budget (OMB) under OMB Control Number 000000000. Public burden reporting for this collection of information is estimated to average 10 hours per response for individuals completing all parts of this form, including time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, and completing and reviewing the collection of information. You are not required to respond to these questions unless this number is displayed. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, U.S. Election Assistance Commission, 633 3rd Street NW, Suite 200, Washington, DC 20001.

HAVCP Poll Worker Application Form Guidance

Application Guidance - Section I. Applicant Information

Unique Entity Identification (UEI): Per 2 CFR 25.205: “A Federal awarding agency may not make a Federal award … to an applicant or recipient until the entity has … a valid unique entity identifier and maintain[s] an active SAM registration with current information.”

Application Guidance - Section II. Executive Summary and Historically Underrepresented Groups

Historically underrepresented groups as defined by the federal government: All selection criteria and application quality being equal, EAC will give priority consideration to projects from institutions and organizations that engage historically underrepresented groups, as defined by the federal government, as poll workers.

(a) The term “equity” means the consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.

(b) The term “underserved communities” refers to populations sharing a particular characteristic, as well as geographic communities, that have been systematically denied a full opportunity to participate in aspects of economic, social, and civic life, as exemplified by the list in the preceding definition of “equity.”

Application Guidance - Section III. HAVCP Poll Worker Project Narrative

Project Narrative: In your narrative, explain how your program will encourage college students to assist state and local governments in the administration of elections by serving as nonpartisan poll workers or assistants and encourage jurisdictions to utilize these efforts. If your organization is requesting optional funding to complete Service Day project activities, please provide a brief description of how you plan to utilize funds to conduct events and activities around these days. Be sure to indicate if you are requesting funding for activities related to both eligible service days outlined in the Application Kit or only one specific service day. Be sure to include descriptions of planned partnerships and collaborations, as well as creative or innovative solutions your program will utilize to engage and train poll workers.

The U.S. Election Assistance Commission does not anticipate award funding to be available prior to Help America Vote Day on January 30, 2024. To address this issue, pre-award costs for Help America Vote Day 2024 may be included as eligible activities, if the costs were incurred after the publication of this funding opportunity package on Grants.gov. If the applicant subsequently receives an award, they may then request to be reimbursed for actual costs incurred hosting Help America Vote Day 2024 activities that would otherwise be allowable under this funding announcement. All pre-award expenses will require approval from the EAC prior to reimbursement. If the applicant does not receive an award, these costs will not be reimbursed by the federal government. The applicant must understand this risk and be able to cover this cost if an award is not made.

Application Evaluation Criteria: The EAC has instituted procedures that provide for an objective review of applications and to assist applicants in understanding the standards against which applications will be judged. The evaluation criteria are based on the information required in the application. See APPENDIX D. Scoring Rubric for more detail on how applications will be evaluated and scored.

Reviewers will award points based on the evaluation criteria described below:

• Program Design/Strategy (50%)

• Organizational Capacity (35%)

• Budget/Cost Effectiveness (15%)

See APPENDICES B and C for additional details on completing the Budget Worksheet and Narrative.

Application Guidance - Section IV. HAVCP Poll Worker Performance Measures

Performance Measures: Grant recipients will be required to report on at least three performance measures, one required universal measure and two optional measures selected by the applicant from the list below. Every recipient must report on the number of college students served (PW-1 below). Beyond this universal performance measure, each recipient should select at least two additional Performance Measures from a set of standardized capacity-building performance measures. Selected performance measures should accurately reflect grant recipients’ accomplishments, improve EAC’s ability to report on the impact of its grant programs, and standardize measures across programs where appropriate.

When selecting performance measures, applicants should also consider their proposed project design, such as geographic scope; recruitment and outreach activities; training type and length of training offered; and other factors relevant to the achievement of each performance measure. Applicants must include numerical targets for the full grant period for each of the required and selected option performance outcome measures; percent increases, or other types of data projections, are not acceptable. The standardized performance measures to select from are identified and defined in the table below. Applicants can also propose additional measures that are appropriate for their project.

HAVCP 2-YEAR POLL WORKER GRANT

EAC Required Performance Measure (one)

PW-1. Total number of college student participants served.

This performance outcome measure includes the total number of unique college student participants served during the grant period of performance. Reporting will include the total number of college students who: (1) enrolled in training, (2) received training, (3) registered to serve as a poll worker, and (4) completed work on election day.

EAC Standardized Performance Measures (select two)

PW-2. Partnerships Developed.

Total number of partnerships established.

PW-3. Outreach plans developed and executed.

Number of outreach materials developed (provide counts for any used): telephone scripts, panel discussions, poll-worker program training materials or workshops developed, promotional videos created, newsletters, social media, websites, blogs, podcasts etc. 

PW-4. Social media engagement, impressions, reach, share of voice, referrals and conversions and response rate and time (cumulative 2-year total for College Program).

This performance outcome measures the social media campaigns targeting college students. The EAC is looking for strong measures proposed by applicants in this category depending on what is proposed.

PW-5. Workshops, Presentations, Trainings, Conferences, and Service Day Events - number of college students served (in-person or virtual audience).

Total participants reach for live event audiences by tracking attendees via sign-in sheets, digital registrations, RSVPs, completion of pre-event surveys, etc. 

Performance Measure Narrative: Applicants must provide specific details about the procedures for tracking performance outcome measures and other participant data such as demographic information, training provided, and describe staffing, technology, computer applications, and other resources already available to accomplish this task. Applicants should also provide a specific plan for procuring the resources needed to meet this requirement if the resources are not already possessed by or accessible to the applicant.

Applicants are encouraged to align their goals with specific activities. Sample activities may include project administration and ramp-up; partnership engagement, outreach, and recruitment; enrollment and training; poll-worker placement; and follow-up with students to track outcomes.

For planning purposes, the applicant should identify key deliverables and the timeframe for achieving each deliverable, including any milestones to indicate the progression of activities. The applicant should also provide the name of the lead or supporting institution engaged in each activity or producing each deliverable, including any partner organizations.

Application Guidance - Section V. Budget Narrative

BUDGET CATEGORY DESCRIPTIONS

These descriptions will help you determine how to allocate expenditures to specific predefined program categories.

Personnel: Compensation paid for employees engaged in grant activities must be consistent with that paid for similar work within the applicant organization. In the budget narrative, include a description of the responsibilities and duties of each position in relationship to fulfilling the project goals and objectives. All requested information must be included in the budget detail worksheet and budget narrative.

Fringe Benefits: Fringe benefits should be based on actual known costs or an approved negotiated rate by a Federal agency. If not based on an approved negotiated rate, list the composition of the fringe benefit package. Fringe benefits are for the personnel listed in the budget category (A) and only for the percentage of time devoted to the project. All requested information must be included in the budget detail worksheet and budget narrative.

Travel: Itemize travel expenses of staff personnel (e.g. staff to training, field interviews, advisory group meeting, etc.). Describe the purpose of each travel expenditure in reference to the project objectives. Show the basis of computation (e.g., six people to 3-day training at $X airfare, $X lodging, $X subsistence). In training projects, travel and meals for trainees should be listed separately. Show the number of trainees and the unit costs involved. Identify the location of travel, if known; or if unknown, indicate "location to be determined." Indicate whether applicant's formal written travel policy or the Federal Travel Regulations are followed. Note: Travel expenses for consultants should be included in the “Contractual/Consultant” data fields.

Equipment: List non-expendable items that are to be purchased (Note: Organization's own capitalization policy for classification of equipment should be used). Expendable items should be included in the "Supplies" category. Applicants should analyze the cost benefits of purchasing versus leasing equipment, especially high-cost items and those subject to rapid technological advances. In the budget narrative, explain how the equipment is necessary for the success of the project, and describe the procurement method to be used. All requested information must be included in the budget detail worksheet and budget narrative.

Supplies: List items by type (office supplies, postage, training materials, copy paper, and expendable equipment items costing less than $5,000) and show the basis for computation. Generally, supplies include any materials that are expendable or consumed during the course of the project. All requested information must be included in the budget detail worksheet and budget narrative.

Contractual/Consultant: For each consultant enter the name, if known, service to be provided, hourly or daily fee (8-hour day), and estimated time on the project. All requested information must be included in the budget detail worksheet and budget narrative.

Subgrants (See “Subaward” definition at 2 CFR 200.92): Provide a description of the Federal award activities proposed to be carried out by any subrecipient and an estimate of the cost (include the cost per subrecipient, to the extent known prior to application submission). For each subrecipient, enter the subrecipient entity name, if known.

Other Costs: List items and the basis of the computation. All requested information must be included in the budget detail worksheet and budget narrative.

Indirect Costs: Indirect costs are allowed only if: a) the applicant has a current, federally approved indirect cost rate; or b) the applicant is eligible to use and elects to use the “10% de minimis” indirect cost rate described in 2 C.F.R. 200.414(f). (See paragraph D.1.b. in Appendix VII to Part 200—States and Local Government and Indian Tribe Indirect Cost Proposals for a description of entities that may not elect to use the “de minimis” rate.)

Grantees may recover indirect costs under this grant up to 10 percent of the total Federal share of the grant. If an applicant has an approved federal indirect cost rate, the remainder of the indirect costs can be used as a matching contribution.

An applicant with a current, federally approved indirect cost rate must attach a copy of the rate approval, (a fully executed, negotiated agreement.) If the applicant does not have an approved rate, one can be requested by contacting the applicant’s cognizant Federal agency, which will review all documentation and approve a rate for the applicant organization, or if the applicant’s accounting system permits, costs may be allocated in the direct costs categories. (Applicant Indian tribal governments should review Appendix VII to Part 200—States and Local Government and Indian Tribe Indirect Cost Proposals regarding submission and documentation of indirect cost proposals.) The narrative for any indirect costs should clearly state which direct costs the indirect cost agreement is being applied to. All requested information must be included in the budget detail worksheet and budget narrative.

Application Guidance - Section VI. Financial Capability

Financial Management Requirements: Award recipients are required to have financial management systems and internal controls that meet the requirements set out in 2 CFR 200.302. The financial management system of each non-Federal entity must provide for the following:

(1) Identification, in its accounts, of all Federal awards received and expended and the Federal programs under which they were received. Federal program and Federal award identification must include, as applicable, the Assistance Listings title and number, Federal award identification number and year, name of the Federal agency, and name of the pass-through entity, if any.

(2) Accurate, current, and complete disclosure of the financial results of each Federal award or program.

(3) Records that identify adequately the source and application of funds for federally funded activities. These records must contain information pertaining to Federal awards, authorizations, financial obligations, unobligated balances, assets, expenditures, income and interest and be supported by source documentation.

(4) Effective control over, and accountability for, all funds, property, and other assets. The non-Federal entity must adequately safeguard all assets and assure that they are used solely for authorized purposes. See § 200.303.

(5) Comparison of expenditures with budget amounts for each Federal award.

(6) Written procedures to document the receipt of federal funds and ensure payment methods minimize the time elapsing between the transfer of funds from the United States Treasury and the disbursement by the EAC recipient.

(7) Written procedures for determining the allowability of costs in accordance with subpart E of this part and the terms and conditions of the Federal award.