BLoCS Program Application for funds

October 26, 2007, is the deadline for applications to the Bayfield County BLoCS Program which provides funding for community family services projects. Individuals and organizations are encouraged to complete an application for ideas and plans to improve family life and services in their communities. Anyone is eligible to apply for up to $3,000 in funding. Technical assistance is available and the process is easy and understandable. Please contact Karla Hasart at (715) 373-6144 ext. 118 or khasart@bayfieldcounty.org for information and an application, or fill out the online application below.

For your convenience, the grant application form is available online and you may apply for funds via our website. Please note, however, that as with all web-based forms, there is no “save” feature included in the application. We recommend that you compile all of the information in advance and prepare to input it in its entirety before completing and submitting the on-line form, as we are unable to recover partially prepared applications.

BLoCS Program Application for Funds

Please keep your descriptions concise. Fields marked with ‡ are required.

Basic Information

Project Information Project Title: ‡
Contact Person: ‡
Address: ‡
City: ‡
State: ‡
Zip Code: ‡
Phone Number ‡
E-Mail: ‡
Amount Requested: ‡

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 Description:

Project Analysis

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

Project Analysis:

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 Outcomes:

Project Partners

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

Project Partners:

Project Continuity

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

Project Continuity:

Project Budget

Budget Manager Budget Manager:

Who will manage the budget and submit the required reports?

‡

Budget Manager Contact Information Contact Budget Manager:

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 Detail of Project Expenses: ‡
BLoCS $ Amount: ‡
Detail of Other Cash or In-Kind Contributions*: ‡
Cash or In-Kind Amount: ‡

Budget Details 2

Project Budget Details 2 Detail of Project Expenses:
BLoCS $ Amount:
Detail of Other Cash or In-Kind Contributions*:
Cash or In-Kind Amount:

Budget Details 3

Project Budget Details 3 Detail of Project Expenses:
BLoCS $ Amount:
Detail of Other Cash or In-Kind Contributions*:
Cash or In-Kind Amount:

Budget Details 4

Project Budget Details 4 Detail of Project Expenses:
BLoCS $ Amount:
Detail of Other Cash or In-Kind Contributions*:
Cash or In-Kind Amount:

Budget Totals

Budget Totals Total BLoCS Request: ‡
Total In-Kind Funds: ‡
Grand Total Requested From BLoCS: ‡

* 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.

List in-kind contributions:

bayfieldcounty.org: Serving the citizens of Bayfield County, Wisconsin.