<%option explicit%> Bayfield County Departmen tof Human Services BLoCS Application

BLoCS Program Application for Funds

Description goes here. Please keep your descriptions concise. Fields marked with are required.

Basic Information

Project Information








Additional Information

Project Description

A. Describe what you will do if awarded funds including a schedule and time line for the project. Please describe what, when, and where information.

Project Analysis

B. What problems or need does your project address and what strengths does it use or building upon? Please be specific.

Project Outcomes

C. Each project must develop and document progress on measurable outcomes to be expected as a result of the activities of the project. Please list the outcomes expected as a result of this project (e.g. Of all students receiving tutoring assistance, 75% will show improved grades by at least one letter from the last grade received in each tutored subject; As a result of attendance at the parenting support group, 80% will report positive effects on their parenting ability, etc.) Please ask for assistance if needed.

Project Partners

D. In what ways will people/organizations collaborate to accomplish this project?

Project Continuity

E. Are there plans to carry on this project after the grant? If so, how?

Project Budget

Budget Manager

Who will manage the budget and submit the required reports?


Budget Manager Contact Information

Please enter the name, address, and phone of the budget manager if different than the project contact person.)

Budget Details 1

Project Budget Details 1


Budget Details 2

Project Budget Details 2


Budget Details 3

Project Budget Details 3


Budget Details 4

Project Budget Details 4


Budget Totals

Budget Totals


* List funds or in-kind contributions anticipated from other sources [identify source(s) and detail contribution(s)]: A letter of intent for cash or in-kind contributors signed by a legitimate representative must accompany the application.