Grantmaker E_Application for Noncompetitive Awards

OMB Control Number = 2035.NEW, Expiration Date = mm/dd/yyyy

Non-Competitive Concept Note/Intake Form

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Application Area	Application
Applicant Background Information
Project Title
Applicant Information	Entity Applicant Legal Name: Point of Contact for Application: Email: Organization Address: Unique Entity ID (UEI) Number: [will need to be verified via sam.gov] Phone #: (Optional) Website or other relevant organization links (if applicable):
Entity Eligibility	Select from dropdown list (note: if organization type is not listed below, please email [Redacted] before continuing with the application): [ ] Nonprofit organization, community-based and/or grassroots nonprofit organization [ ] Tribal government (both federally recognized and state-recognized) and intertribal consortia (i.e., a partnership between two or more tribes that work together to achieve a common objective)  [ ] Native American organization (includes Indian groups, cooperatives, nonprofit corporations, partnerships, and associations that have the authority to enter into legally binding agreements)  [ ] Local government (as defined by 2 CFR 200.1 – includes cities, towns, municipalities, and counties, public housing authorities and councils of government)   [ ] Institution of higher education (e.g., private and public universities and colleges, including community colleges)  [ ] Puerto Rico  [ ] U.S. Territories
Nonprofit status (if indicated above)	If you are a nonprofit, please provide documentation that shows your organization is either a 501(c)(3) non-profit as designated by the Internal Revenue Service OR documentation that shows that the non-profit organization is recognized by the state, territory, commonwealth, or tribe in which it is located.
Tribal Status	[Y / N] Are you a federally recognized Tribe in [Redacted]? If Yes, please select from the drop down list: [Redacted] Are you a member of a state-recognized tribe? [y/n] If so, which tribe? ______________________________ Are you a member of a tribe that is not formally recognized by a state or federal government? [y/n] If so, which tribe? ______________________________
Funding Type(s) of Interest (select all that apply)	[ ] Tier I Assessment: 1 year project, up to $150,000 [ ] Tier II Planning: 1-2 year project, up to $250,000 [ ] Tier III Development: 2 year project, up to $350,000 [ ] Tier I Non-competitive $75,000 awards provided to severely capacity-constrained organizations (Tier 1 only)
Project Location	Please upload a map of the project area using the EPA EJ Screen: https://ejscreen.epa.gov/mapper/ Instructions for how to create a project area map using EJ Screen can be found here: [link added when available] Project Zip Code(s): (Select all that apply) Project Location: [Redacted] OTHER (If other, please list: ____) If located in Federally Recognized Tribe(s), please select all that apply: [Redacted] Is this area predominantly: [ ] Urban [ ] Rural Proposed projects must serve “communities of focus.” For the sake of this project, “communities of focus” are defined using the Inflation Reduction Act Disadvantaged Communities Map. Applicants can use the Climate and Economic Justice Screening Tool (CEJST) which outlines Census tracts that are overburdened and underserved. Access the map and tool here: https://www.epa.gov/environmentaljustice/inflation-reduction-act-disadvantaged-communities-map Does your project location fall into a community of focus as defined by Inflation Reduction Act Disadvantaged Communities Map? [y/n] If no, why do you think this community should be considered overburdened or underserved for the purpose of this project?
Past/future funding	Does your organization currently have a federal grant award? [If yes] What is the funding agency? [If no] Do you have prior experience with managing federal grant awards? If so, when was your most recent award? Have you received a Thriving Communities Grant (TCG) previously either through the [Redacted] Grantmaker or another Grantmaker? (Y/N)
Expected Project Period	Project Start Date: [will be a dropdown list] Project Length: [drop down list of months/years]
Organizational Capacity Assessment	(see below)
Statement of Purpose	In 1-2 sentences, please provide a statement of purpose for your proposed project.
Need & Centering Community	In up to 500 words: Provide a brief summary of the project that you are seeking funding for, including the communities who benefit, project location, environmental justice issue(s) to be addressed, and major activities.
Goals/Results	In up to 150 words: Describe the results you expect to achieve from these activities, and how these results contribute to your vision of success for your community.
Barriers/Challenges	In up to 150 words: What do you foresee as the main challenges/barriers to implementing this project?

Organizational Capacity Assessment

1. Board Governance and Engagement	Always	Often	Sometimes	Rarely	Never	N/A
a. Board members attend and actively participate in regular board meetings
b. Board members participate in fundraising activities
c. We have clear strategy for recruiting new board members with relevant skills and backgrounds
d. Our board understands, reviews, and approves budgets and financial statements
e. Our board formally reviews and evaluates our Executive Director at least annually
f. The roles of the board and Executive Director are clearly defined and respected
g. New board members are oriented to the organization, including our mission, bylaws, policies, programs, key stakeholders
If N/A for any items, please explain
2. Financial Operations and Management	Always	Often	Sometimes	Rarely	Never	N/A
a. We track and report financial activities to board and staff management
b. Key staff and board members review regular updates on our organization's financial health
c. We have access to loans, reserves, and/or working capital to manage cash flow (e.g., to make payroll)
d. Financial operations are carried out in alignment with budgeting, decision-making, and organizational goals
e. We have written systems and controls that govern financial operations (policies and guides)
If N/A for any items, please explain
3. Fund Development	Always	Often	Sometimes	Rarely	Never	N/A
a. We have an appropriate funding model or structure in place that supports core infrastructure and programs and is integrated into our organization's long-term budget projections
b. Has sufficient capacity from staff and/or volunteers to implement fund development activities
c. We have a staff person (other than the ED/CEO) whose primary responsibility is fund development
d. We use up-to-date results from fundraising efforts to inform planning and implementation
If N/A for any items, please explain
4. Staff and Infrastructure	Always	Often	Sometimes	Rarely	Never	N/A
a. Our current staffing structure allows us to effectively do our administrative work
b. Our staffing structure allows us to effectively do our programming work
c. Our staffing size allows us to effectively do our administrative work
d. Our staffing size allows us to effectively do our programming work
e. We provide and/or support ongoing staff development opportunities, including for our Executive Director
f. Staff turnover is a problem for our organization
g. We have the technology and information systems in place that are necessary to operate efficiently and effectively
h. Our staff are compensated for their work
i. We regularly review and update compensation policies to ensure fairness and competitiveness.
If N/A for any items, please explain
5. Client/Constituent Engagement	Always	Often	Sometimes	Rarely	Never	N/A
a. We solicit feedback from clients/constituents
b. We have mechanisms in place to seek and incorporate client/constituent input on key decisions (e.g., advisory groups, needs assessments)
c. We have staff position(s) that include client/constituent engagement activities
If N/A for any items, please explain
6. Diversity	Always	Often	Sometimes	Rarely	Never	N/A
a. We have staff who reflect the diversity of people and key interests the organization serves
b. We have recruiting processes that encourage diverse candidates to apply for staff positions
c. We have board members who reflect the diversity of people and key interests the organization serves
If N/A for any items, please explain
7. Cultural Responsiveness	Always	Often	Sometimes	Rarely	Never	N/A
a. Our services/programs are responsive to the cultural needs of clients/consumers/constituents
b. We make outreach and communication materials available in the primary language(s) spoken by stakeholders
c. We provide training in cultural competence to our staff
If N/A for any items, please explain
8. Organizational Strategy and Adaptability	Always	Often	Sometimes	Rarely	Never	N/A
a. We have an organizational strategy for achieving our goals and objectives that is developed and actively used by staff and board
b. We periodically review our vision, mission, and major programs to analyze opportunities and challenges, strengths and weaknesses
c. We anticipate challenges in advance and consider different scenarios for responding to them
d. Board members participate in strategic/organizational planning on a regular basis
e. Our budget allocations are realistic and based on mission, strategies and goals
f. Evaluation processes are integrated into program activities and used to inform our work
g. We engaged with others (e.g., partnerships, advocacy activities) when necessary in order to advance our mission
If N/A for any items, please explain