REQUEST FOR APPLICATIONProgram Year September 1, 2018 – August 31, 2019

Application materials must be submitted by email!

Application documents will be accepted until the program is full.

Applications will be processed as received and awarded based on availability of member slots.

Member slots will be filled on a first-come first-served basis.

Application Instructions1. Read the Guidance Document and refer to it as you complete the application2. Complete the Request for Application electronically3. Print out the completed Application4. Your organization’s “Authorized Signer” signs and dates (hand-written) the Application5. Scan the completed, signed and dated Application6. Attach the scanned document to an email and send it to WSC at wscip@esd.wa.gov 7. The subject line in the email needs to include your organization’s name and “RFA”

Attach the following documents with your completed application: Study, evaluation or research report(s) to support your project’s intended goals Completed Performance Plan(s) Completed Logic Model Chart Organizational Chart. The agency organization chart must include position titles and names, including the

AmeriCorps member(s). Financial Records. Include your organization’s current A-133 audit, or 2) current financial audit, or 3) current

financial statements (Profit/Loss and Balance Statements) if you have not had an audit. Audits requiring corrective actions must submit management letters or describe the status of all corrective action items.

Washington Service CorpsRequest for Application – AmeriCorps Members

Program Year September 1, 2018 – August 31, 2019

Applicant Organization:      Mailing Address: Street:       City:       Zip:      

County of Applicant Organization:      Website Address:      Authorized Signer:(this person is authorized to sign this application AND contractual documents)

 Name:       Title:      

Address:       City:       Zip:      

Telephone:       Email:      Person providing primary oversight to AmeriCorps member and project

Name:       Title:      

Address:        City:       Zip:      

Telephone:       Email:      Person providing secondary oversight to AmeriCorps member and project.

Name:       Title:      

Address:        City:       Zip:      

Telephone:       Email:      Fiscal Contact:(this person will receive invoice for Program Participation Fee)

Name:       Title:      

Address:       City:       Zip:      

Telephone:       Email:      Employer ID # (EIN):      DUNS nine-digit ID #:      

*In order to apply for Federal grants, including AmeriCorps member placement through Washington Service Corps, your organization MUST have a DUNS number.

Project Title:      

Project Summary:     

Primary Focus Area: Disaster Services Economic Opportunity Education Environmental

Healthy Futures Veterans Youth Opportunity Multi-Focus

Will ALL of your members serve in one or more of the following rural and/or distressed counties?To qualify for the rural county rate, ALL members must serve within at least one of the counties listed to the right.

Yes No

Adams, Benton, Asotin, Chelan, Clallam, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, Island, Jefferson, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, San Juan, Skagit, Skamania, Stevens, Wahkiakum, Walla Walla, Whitman, Yakima

Program Participation Fee Rates: INFORMATION ONLY

Full-time 1,700-Hour Positions:

1-5 Members $9,500 per member; 1-5 Members in Rural County $8,500 per member

6-19 Members $6,500 per member; 6-19 Members in Rural County $5,500 per member

20+ Members $5,000 per member; 20+ Members in Rural County $4,000 per member

Full-time 900-Hour Positions: $5,500 per member

Preferred Member Service Terms:

Enter number of

Full time 1,700-Hour Positions:

      09/16/18 – 07/31/19       10/01/18 – 08/15/19

083118 2018-2019 WSC RFA | Page 1

AmeriCorps members for each term of service selected.

      10/16/18 – 08/31/19

Full time 900-Hour Positions:

      11/16/18 – 05/15/19       12/01/18 – 05/31/19       01/16/18 – 07/15/19

      02/01/18 – 07/31/19       02/16/18 – 08/15/19

Number of Members Requested: Total:      

FUNDING CONTINGENCYIn the event funding for the Washington Service Corps is reduced or eliminated, or if federal program requirements change, the Washington Service Corps may terminate or modify this Request for Application without advance written notice and it will be subject to renegotiation under the new funding level and requirements.

UNION CONCURRENCEAre employees of the Applicant Organization and/or service site represented by a labor organization (union)?

Yes No

If Yes:Have the duties to be performed by the AmeriCorps member(s) customarily and historically been performed by members of the labor organization bargaining unit?

Yes No

If Yes to either question:You are required to obtain written concurrence of the AmeriCorps placement from the local labor organization and provide that to WSC upon award.

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Table of Contents

SECTION I: Expectations and Agreements 4

SECTION II: Organizational Capacity 5

SECTION III: Project Description 7

SECTION IV: Volunteer Generation 8

SECTION IV: Performance Measures 8

Disaster Services 9

Economic Opportunity 10

Education 11

Environmental Stewardship 12

Healthy Futures 12

Veterans and Military Families 13

Youth Opportunity 14

CERTIFICATION (SIGNATURE – AUTHORIZED SIGNER) ..................................................................................15

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Section IEXPECTATIONS AND AGREEMENTS

Washington Service Corps (WSC) works with organizations that are well-positioned within communities to identify the most promising programs and guide them towards greater impact and stronger evidence of success.

If awarded an AmeriCorps placement(s), additional requirements will apply, such as, but not limited to: Program Participation Fee; Proof of current valid Commercial General Liability Insurance; Written union concurrence if your organization/agency employees are covered by a union agreement/contract; Electronically-signed contract between your organization and the WSC;

Applicants selected to receive a member placement award will be expected to enter into a contract which is substantially the same as the sample contract/interagency agreement and its general terms and conditions hyperlinked above for your review. In no event is an awarded applicant to submit its own standard contract, purchase order, terms and conditions, etc. in response to an award or as a contingency to process payment of Program Participation Fee.

Signed contract between your organization and any other organizations where your AmeriCorps member(s) will serve, with copy provided to WSC. Your organization must hold all member service site locations accountable if instances of risk or noncompliance are identified; can ensure that all AmeriCorps members receive sufficient guidance and support from service site staff; and can adequately train/prepare service site staff to follow AmeriCorps and WSC program regulations, priorities, and expectations;

Member Position Description Form and Recruitment Posting Template; Performance Plan; Data Collection Strategy; Member Recruitment Plan. Commitment that:

o Payment of Program Participation Fee will be paid in full by established date; o The AmeriCorps member(s) placed at your organization will not be hired by your organization prior to

completing their full service term;o If the Sponsoring Organization fails to follow required WSC member progressive discipline procedures and

subsequently terminates the member from service, and the member’s grievance hearing grants the former member a pro-rated education award, the sponsoring organization will be required to reimburse the pro-rated education award amount to WSC;

o No member may start service or training prior to their designated term start date;o The AmeriCorps member(s) placed at your organization will wear AmeriCorps gear provided by WSC during

all service activities and AmeriCorps signage will be predominantly displayed at the service sites. Participation (if requested) in surveys, focus groups or interviews by a third-party evaluator contracted by WSC in

accordance with its requirement to conduct a program evaluation. Time involved will be kept at a minimum so as not to impact the service or work of the sponsoring organization.

Organizational Requirements: The AmeriCorps project must be accepted and well supported within your organization or applying agency; All levels of your organization must be informed of the project as well as the AmeriCorps requirements and

program philosophy; Your organization’s policies, procedures and program activities must be compatible with WSC/AmeriCorps

policies, procedures, the WSC Member Service Agreement and related rules/regulations; Your organization must recruit and enroll member position(s); Your organization must ensure that designated AmeriCorps project staff attend WSC required training. They

must also ensure additional staff is trained as appropriate; Your organization must retain all AmeriCorps member(s) through the duration of their full term of service;

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If you or your organization have any concerns about compatibility with WSC requirements, please contact the WSC Program Lead: Kendra DeBow kdebow@esd.wa.gov

Section IIORGANIZATIONAL CAPACITY

Your organization must provide quality oversight to your AmeriCorps member(s), including, but not limited to:

Recruitment and selection of qualified candidates; Orientation to AmeriCorps, WSC, your organization, and community; Thorough review of member’s Position Description Form, duties and service project; Regular, routine check-ins; Ensuring your AmeriCorps member(s) receives adequate training to assist them in conducting their service; Guidance and support of professional development; Oversight of service and training hours, ensuring all hours are allowable; Review and approval of timesheets; Timely submission of two member performance evaluations, and one exit evaluation; Review and reporting of performance measurement data each quarter; Oversight and guidance on submission of Stories of Service.

Your organization must provide each of the following for your AmeriCorps member(s):

Telephone/Voice Mail Computer/Laptop Work Space Agency E-Mail Account Internet Access Other expenses supporting the member in the execution of their duties that may include, but are not limited to the

following:o Transportation or mileage reimbursement to AmeriCorps member(s) to conduct service away from their

established service site during service hours and to attend required WSC training o Ergonomics assessmento Reasonable accommodationo Site-related training

1. If you are unable to provide any of the above, please provide an explanation of any item you cannot provide.      

2. Your organization must have the experience, staffing, and management structure to plan and implement the proposed program. AmeriCorps members must receive sufficient guidance and support from your organization staff to provide effective service.Describe how you will ensure the AmeriCorps member(s) is adequately provided oversight and supported.      

3. AmeriCorps members will have access to meaningful service experiences that include education about the community problem/need, the service organization and the community in which they will serve. Describe how you will ensure the AmeriCorps position(s) is adequately trained and integrated into your organization and community.      

4.Will AmeriCorps member(s) serve at organizations other than your own? Yes No

If yes, your organization must hold these service site locations accountable if instances of risk or noncompliance are identified. This includes a contractual agreement between you and the organization stating the member(s) will be

083118 2018-2019 WSC RFA | Page 5

provided oversight and support according to WSC and AmeriCorps guidelines. It is expected that these service site locations will also assist in the recruitment and selection of the AmeriCorps member(s).List organizations where your member(s) will serve. If unknown, you are required to identify and notify WSC upon award.      

5.The applicant will foster an inclusive service culture where different backgrounds, talents, and capabilities are welcomed and leveraged for learning and effective service delivery. List the 3 strategies your organization will use to retain the AmeriCorps member(s) and ensure they successfully complete their term of service.

1.      

2.      

3.      

6. The applicant will recruit AmeriCorps members from all areas, including the geographic or demographic communities in which the program operates. List at least 3 strategies for recruitment of members, including timeframe and who is responsible.

1.      

2.      

3.      

7. The applicant will comply with AmeriCorps rules and regulations including those related to prohibited and unallowable activities. How will you make certain that organization staff, AmeriCorps members AND volunteers are aware of prohibited activities and ensure that member activities are allowable and consistent with the member’s position description?     

8. AmeriCorps members will gain skills as a result of their training and service that can be utilized at your organization and will be valued by future employers after their service term is completed. Provide details in the table below of two required site-specific trainings you will provide for your member(s). Do NOT include agency/project orientation as a site-specific training.

Title of site-specific training Description of training Target date of training

                 

                 

9. Is any portion of the Program Participation Fee being paid to your organization by another partner? If yes, provide partner organization name and contact information and amount being paid by them.

Yes No

     

10. Is any portion of the Program Participation Fee paid with Federal funds? If yes, an authorization statement from the issuing Federal entity that your organization has permission to use Federal funding for this purpose must be submitted to WSC, if awarded.

Yes No

Section IIIPROJECT DESCRIPTION

083118 2018-2019 WSC RFA | Page 6

Projects will be awarded to eligible organizations proposing to engage AmeriCorps members in evidence-based or evidence-informed interventions and practices to strengthen communities. Reviewers will examine the degree to which the applicant can demonstrate how AmeriCorps members and the proposed project are particularly well-suited to addressing the identified community problem. Please answer the questions below to develop an AmeriCorps project Theory of Change and Logic Model. Use the Theory of Change Checklist and the Logic Model Checklist included in the Guidance Document to ensure that you incorporate all of the required elements WSC will review. Additional guidance for each question below can be found with the WSC Guidance Document (Section III – Project Description).

1. Clearly and specifically describe the community problem/need your AmeriCorps project will be addressing. Provide specific quantitative data about the severity of the problem/need.     

2. What is the specific role of your AmeriCorps member(s) within the AmeriCorps project?     

3. Complete the Logic Model Chart found at https://waservicecorps.files.wordpress.com/2018/01/wsc-logicmodel-py18.docx, and include it with your application submission.

Section IVVOLUNTEER GENERATION

1. WSC requires AmeriCorps members to: Participate in the recruitment and management of volunteers who will further the goals of the AmeriCorps

project; Oversee the volunteer activities of the AmeriCorps project to ensure that the activities are allowable and not

prohibited; Implement at least three new effective volunteer management practices.

2. For the required volunteer performance measures, please insert numerical targets you expect to achieve in the chart below.

Performance Measure: VolunteersNumber of Episodic1 Volunteers that will be recruited and/or managed by your AmeriCorps member(s)      

Number of Ongoing2 Volunteers that will be recruited and/or managed by your AmeriCorps member(s)      

Number of volunteer hours expected to be generated by Episodic and Ongoing Volunteers      

Section VPERFORMANCE MEASURES

Choose from the following list of interventions described in this section that include the following focus areas: Disaster Services, Economic Opportunity, Education, Environmental Stewardship, Healthy Futures, Veterans and Military Families, and Youth Opportunity.

Choose the intervention(s) that coincides with your project description and Logic Model.

1 Episodic: a volunteer recruited and/or supported directly by AmeriCorps members that participated in one-time service projects. Each volunteer should be counted only once, even if an individual volunteer participated in more than one volunteer opportunity.

2 Ongoing: a volunteer recruited and/or members that have made an ongoing volunteer commitment. Each volunteer should be counted only once, even if an individual volunteer participated in more than one volunteer opportunity.083118 2018-2019 WSC RFA | Page 7

Complete the Performance Plan connected to your chosen intervention.

Include the completed Performance Plan with your application submission.

You are required to choose at least one intervention.

When choosing a WSC intervention, applicants must ensure that the WSC data collection standards outlined in the WSC Performance Measure Instructions can be met. A link to the performance measure instructional guidance is located under each of the described interventions.

All WSC projects are required to track and report on at least one performance measure (intervention) to WSC. All selected interventions should include reportable outputs and outcomes and must be identified on the Logic Model. WSC does not expect applicants to report on each and every potential member activity or community impact. Additionally, there is no expectation that 100% of program activity be allocated to performance measures.

WSC selection does not limit or exclude organizations from choosing to follow other WSC interventions included within this RFA or by developing an Applicant-Determined intervention.

When completing the Performance Plan, each applicant is required to describe the data collection method used to measure the output as well as the data collection method used to measure the outcome. Please refer to the Guidance Document – Section V, #1 and #2 for examples.

Review our Performance Measurement FAQ for solutions to common performance measure problems.

Focus Area: Disaster ServicesActivities will provide support to increase the preparedness of individuals for disasters, improve individuals’ readiness to respond to disasters, help individuals recover from disasters, and/or help individuals mitigate disasters.

Disaster PreparednessService sites will provide disaster preparedness training and education to Washington citizens. WSC recommends that sites follow FEMA’s Ready Campaign to encourage households to prepare for types of potential emergencies, to make an emergency kit, and develop a family emergency plan. Preparedness is the process of identifying the personnel, training, and equipment needed for a wide range of potential incidents, enabling citizens to understand the risk of disaster and to know how to develop a kit and a plan for what to do if disaster strikes.

Disaster Preparedness - Performance Plan

Disaster Preparedness VIDEODisaster Preparedness - Slide Deck & PM Instructions

Applicant-Determined Disaster ServicesApplicant-Determined Performance Measures are intended for programs whose interventions, outputs and outcomes do not fit under existing WSC Performance Measures. Programs may design performance measures that measure changes in beneficiary (knowledge, attitude, behavior, or conditions). If selecting an Applicant-Determined Performance Measure, please ensure outputs and outcomes are aligned correctly (unit of measure is the same for both outputs & outcomes), ensure that the outputs and outcomes clearly identify what is counted, clearly identify a change in knowledge, attitude, behavior or condition, ensure that the unit of measure is a number, not a percent and can be measured in a single grant year.

Applicant-Determined Performance Measure - Performance Plan Applicant-Determined Performance Measure Guidance 2018-2019

083118 2018-2019 WSC RFA | Page 8

Focus Area: Economic Opportunity Service sites will provide support and/or facilitate access to services and resources that contribute to the improved economic well-being and security of economically disadvantaged people; help economically disadvantaged people to have improved access to services that enhance financial literacy; transition into or remain in safe, healthy, affordable housing; and/or have improved employability leading to increased success in becoming employed.

Adult Basic Education (ABE & ELA)Provide and support Adult Basic Education (ABE) and English Language Acquisition (ELA) educational training to economically disadvantaged adults in need of reading, writing, and math. Classes will support students who need to increase their language skills in reading, writing and speaking by providing instruction designed to help them achieve full competence to move toward to further education and/or employment.

Adult Basic Education (ABE & ELA) - Performance Plan

Adult Basic Education VIDEO Adult Basic Education - Slide Deck & PM Instructions

Financial Literacy TrainingProvide financial literacy education and support by using curriculum that includes pre-defined learning objectives to economically disadvantaged adults with regard to credit management, financial institutions including banks and credit unions, and utilization of savings plans (2009 Serve America Act). WSC recommends project sites follow an evidence based curriculum such as FDIC Money Smart or a comparable curriculum intended to improve knowledge of checking, savings, budgeting, and credit.

Financial Literacy Training - Performance Plan

Financial Literacy VIDEO Financial Literacy - Slide Deck & PM Instructions

Housing ServicesProvide economically disadvantaged and homeless individuals with housing service contacts to help qualifying individuals find appropriate housing, find the resources to support use of appropriate housing, and assist individuals in accessing the appropriate housing through intervention such as rapid re-housing, targeted prevention, interim housing, drop-in shelters and other evidence based services to prevent imminent homelessness. Interventions may also include hands-on housing development, building and repair activities, replacing a roof, the plumbing, the wiring, the foundation, or elevating the unit as required by a flood plain standard.

Housing Services - Performance Plan

Housing Services VIDEO Housing Services - Slide Dec k & PM Instructions

Job Placement Services Provide job search and job placement services to economically disadvantaged individuals. These services will include job search and placement assistance (including career counseling); labor market information (to identify job vacancies; the skills needed for in-demand jobs; and relevant local, regional and national employment trends), initial assessment of needs and information about available services. Job placement services may also include supporting work experience, community service, on-the job training, and job readiness activities, including self-directed activities such as consulting with job seekers’ social networks, filling out job applications, resume development, using agency resource rooms, and attending facilitated job search group activities and job search classes and working with employers to identify job openings and match job seekers to appropriate openings.

083118 2018-2019 WSC RFA | Page 9

Job Placement Services - Performance Plan

Job Placement Service VIDEO Job Placement Service - Slide Deck & PM Instructions

Applicant-Determined Economic OpportunityApplicant-Determined Performance Measures are intended for programs whose interventions, outputs and outcomes do not fit under existing WSC Performance Measures. Programs may design performance measures that measure changes in beneficiary (knowledge, attitude, behavior, or conditions). If selecting an Applicant-Determined Performance Measure, please ensure outputs and outcomes are aligned correctly (unit of measure is the same for both outputs & outcomes), ensure that the outputs and outcomes clearly identify what is counted, clearly identify a change in knowledge, attitude, behavior or condition, ensure that the unit of measure is a number, not a percent and can be measured in a single grant year.

Applicant-Determined - Economic Opportunity - Performance Plan Applicant-Determined Performance Measure Guidance 2018-2019

Focus Area: EducationProjects will provide support and/or facilitate access to services and resources that contribute to improved educational outcomes for economically disadvantaged children; improved school engagement for economically disadvantaged students; improved educational and behavioral outcomes of students in low-achieving elementary, middle, and high schools; and/or support economically disadvantaged students prepare for success in post-secondary educational institutions.

Academic EngagementProvide student engagement interventions to improve student attendance and/or attitudes using interventions informed by the Check & Connect Model to economically disadvantaged students. Sites will identify students at high risk of disengagement through an Early Warning System tracking: attendance, behavior, and course performance or through an evidence-based student engagement survey. Members will serve to provide feedback to students, offer personalized tutoring, promote social-emotional skills (e.g., self-awareness of feelings, social awareness, emotional regulation, conflict resolution), and deliver other intervention strategies in partnership with school personnel, parents, and local community-service organizations. Members will emphasize high school completion and promote college readiness, success, and preparation for career pathways.

Academic Engagement - Performance Plan

Academic Engagement VIDEO Academic Engagement - Slide Deck & PM Instructions

Academic ImprovementProvide low-income students and students with special or exceptional needs in K-12 schools with evidence-informed tutoring and other academic supports in literacy and/or math. Tutoring will occur one-on-one and/or in small groups of up to four students at least 60 minutes weekly for 12 to 26 weeks, before, during, or after school and/or in summer.

Academic Improvement - Performance Plan

Academic Improvement - VIDEO Academic Improvement - Slide Deck & PM Instructions

K-12 AVIDIn an effort to close the opportunity gap, projects will provide evidence-informed AVID tutoring and other academic supports to low-income underrepresented students. AVID tutors will guide students toward academic and personal success 083118 2018-2019 WSC RFA | Page 10

to reach far beyond their secondary school years. Tutors are essential to the success of AVID, acting as a resource and role model for AVID students both academically and socially. Members will provide instructional support to students with the assistance of an AVID elective course teacher. The AmeriCorps tutors will be active participants in the students’ learning, growth, and personal development, with the goal of preparing students to successfully complete high school and attend college, supporting students in learning skills and encouraging students in rigorous student course taking.

K-12 AVID - Performance Plan

K-12 AVID - VIDEO K-12 AVID - Slide Deck & PM Instructions

Applicant-Determined - Educational Performance Measure Applicant-Determined Performance Measures are intended for programs whose interventions, outputs and outcomes do not fit under existing WSC Performance Measures. Programs may design performance measures that measure changes in beneficiary (knowledge, attitude, behavior, or conditions). If selecting an Applicant Determined Performance Measure, please ensure outputs and outcomes are aligned correctly (unit of measure is the same for both outputs & outcomes), ensure that the outputs and outcomes clearly identify what is counted, clearly identify a change in knowledge, attitude, behavior or condition, ensure that the unit of measure is a number, not a percent and can be measured in a single grant year.

Applicant-Determined Educational Performance Measure - Performance Plan Applicant-Determined Performance Measure Guidance 2018-2019

Focus Area: Environmental StewardshipService sites will provide training services that contribute to increased energy and water efficiency, renewable energy use, or improve at-risk ecosystems, and support increased citizen behavioral change leading to increased efficiency, renewable energy use, and ecosystem improvements.

At-Risk EcosystemsTreat and improve the condition of parkland or other public/tribal lands by removing invasive species, planting native plants, building riparian buffers, and clearing natural debris, leading to environmental benefits for the citizens of Washington. Treatment sites may include: 1) National parks, state parks, city parks, county parks (park/recreation areas that are designated by national, state, city, or county governments); 2) Other publicly-owned lands, land owned by nonprofits for public use or the public good, such as land conservancies, land trusts and public easements.

At-Risk Ecosystems - Performance Plan

At Risk Ecosystems VIDEO At-Risk Ecosystems - Slide Deck & P M Instructions

Environmental EducationProvide environmental education and training to increase participants’ knowledge of environmentally-conscious practices, improve citizens’ ability to make environmentally-sound choices in their daily lives, and to obtain a commitment from participants to carry out actions to improve and protect the environment. Environmental education may be provided to both adults and/or school age children.

Environmental Education - Performance Plan

Environmental Education VIDEO Environmental Education - Slide Deck & PM Instructions

Applicant-Determined - Environmental Stewardship Performance Measure 083118 2018-2019 WSC RFA | Page 11

Applicant-Determined Performance Measures are intended for programs whose interventions, outputs and outcomes do not fit under existing WSC Performance Measures. Programs may design performance measures that measure changes in beneficiary (knowledge, attitude, behavior, or conditions). If selecting an Applicant-Determined Performance Measure, please ensure outputs and outcomes are aligned correctly (unit of measure is the same for both outputs & outcomes), ensure that the outputs and outcomes clearly identify what is counted, clearly identify a change in knowledge, attitude, behavior or condition, ensure that the unit of measure is a number, not a percent and can be measured in a single grant year.

Applicant-Determined Educational Performance Measure - Performance Plan Applicant-Determined Performance Measure Guidance 2018-2019

Focus Area: Healthy FuturesService sites will provide support for activities that will improve access to primary and preventive health care for communities served by CNCS-supported programs; increase seniors’ ability to remain in their own homes with the same or improved quality of life for as long as possible; and/or provide training to increase healthy behaviors in adults and improve nutrition in youth with the purpose of reducing childhood obesity.

Access to CareProvide information on health care access, health insurance and other community-based health benefit programs through outreach at designated community locations to make in-person contacts and work with individuals to guide them through the access process using technology, including online systems and applications. In the context of healthcare access, project members will support enrollment into local community health services (health insurance, health care access and other benefits). Access to Care programs may not focus their services solely on providing referrals to Federal assistance programs.

Access to Care - Performance Plan

Access to Care VIDEO Access to Care – Slide Deck & PM Instructions

Food SecuritySupport services can include education, or referrals helping individual’s access food, providing nutritional services, or life skills training to alleviate the food insecurity experienced by the individual or family. May include local food distribution programs, homeless shelters, soup kitchens, backpack programs, counseling to clients to maximize access to existing programs, providing food and nutrition assistance, educating individuals and families about the benefits of local, seasonal, and organic foods.

Food Security - Performance Plan

Food Security VIDEO Food Security - Slide Deck & PM Instructions

Health EducationProvide health education and opportunities aimed at increasing healthy behaviors. These activities will include evidence-informed training, healthy activities, and other health resources, including information about patterns of living, eating, playing, working and relaxing that are conducive to health in individuals and groups to promote positive health behaviors. All information and activities will be tailored to the populations being served (e.g., adults, seniors, families, individuals with limited English proficiency, specific cultural groups). Service sites will provide a range of evidence-based health education and healthy activity programs, including Tai Ji Quan: Moving for Better Balance, Chronic Disease Self-Management Programs, Share Our Strengths, Cooking Matters and many others.

083118 2018-2019 WSC RFA | Page 12

Health Education - Performance Plan

Health Education VIDEO Health Education - Slide Deck & PM Instructions

Nutrition Education for Children and YouthProvide nutrition education and/or garden-based nutrition education before, during, or after school or in summer to improve healthy eating behavior through hands-on, developmentally appropriate, culturally-relevant, fun activities to deepen students’ knowledge and reinforce their selection and consumption of healthy foods. WSC recommends that garden-based nutrition education programs include nutrition education, food preparation lessons, and opportunities to taste fruits and vegetables. Nutrition education programs without a garden component will provide experiences that empower people to understand and navigate the food system, covering issues related to food system equity, sustainability and social justice as well as cooking and consumption.

Nutrition Education - Performance Plan

Nutrition Education VIDEO Nutrition Education - Slide Deck & PM Instructions

Services to Live IndependentlyProvide food, transportation, or other services to support seniors (over 65) and people with disabilities so they can live independently in their homes. Individuals should receive the supports they need to maintain independent living; not all individuals will require the same supports; may include food deliveries, legal and medical services, nutrition information, transportation, etc. Individuals must be living independently in a private residence (house, apartment, mobile home, etc.) rather than in a nursing home or group home.

Services to Live Independently - Performance Plan

Services to Live Independently VIDEO Services to Live Independently - Slide Deck & PM Instructions

Applicant-Determined - Healthy Futures Performance Measure Applicant-Determined Performance Measures are intended for programs whose interventions, outputs and outcomes do not fit under existing WSC Performance Measures. Programs may design performance measures that measure changes in beneficiary (knowledge, attitude, behavior, or conditions). If selecting an Applicant-Determined Performance Measure, please ensure outputs and outcomes are aligned correctly (unit of measure is the same for both outputs & outcomes), ensure that the outputs and outcomes clearly identify what is counted, clearly identify a change in knowledge, attitude, behavior or condition, ensure that the unit of measure is a number, not a percent and can be measured in a single grant year.

Applicant-Determined Performance Measure - Performance Plan Applicant-Determined Performance Measure Guidance 2018-2019

Focus Area: Veterans and Military FamiliesProjects will positively impact the quality of life of veterans and improve military family strength; increase the number of veterans, wounded warriors, military service members, and their families served by CNCS-supported programs; and/or increase the number of veterans and military family members engaged in service through CNCS-supported programs.

Veterans as Volunteers

083118 2018-2019 WSC RFA | Page 13

Service sites across the state will recruit veterans to serve as volunteers on community service projects. By serving as volunteers, participating veterans will experience reduced feelings of isolation, increase feelings of connection to the communities they live in, and increase commitment to civic engagement. After two volunteer service activities, the veteran must express an intent to engage in future community volunteerism, and answer “yes” to at least one of the following four benefit questions: Did your volunteer experience give you: 1) an increased connection to your community; 2) An enhanced sense of achievement; 3) An increase in future career options; or 4) Other.

Veterans as Volunteers - Performance Plan

Veterans as Volunteers VIDEO Veterans as Volunteers - Slide Deck & PM Instructions

Applicant-Determined - Veterans and Military FamiliesApplicant-Determined Performance Measures are intended for programs whose interventions, outputs and outcomes do not fit under existing WSC Performance Measures. Programs may design performance measures that measure changes in beneficiary (knowledge, attitude, behavior, or conditions). If selecting an Applicant-Determined Performance Measure, please ensure outputs and outcomes are aligned correctly (unit of measure is the same for both outputs & outcomes), ensure that the outputs and outcomes clearly identify what is counted, clearly identify a change in knowledge, attitude, behavior or condition, ensure that the unit of measure is a number, not a percent and can be measured in a single grant year.

Applicant-Determined Performance Measure - Performance Plan Applicant-Determined Performance Measure Guidance 2018-2019

Focus Area: Youth Opportunity - Disadvantaged Youth (ages 16 to 24)Youth organizations will address a call to action by expanding and enhancing services to improve employment and training outcomes for economically disadvantaged youth, ages 16 to 24. AmeriCorps members will provide training, coaching, guidance, tutoring and supportive services to increase the number of economically disadvantaged youth who progress along a pathway towards education or employment opportunities. WSC AmeriCorps members will drive educational momentum to propel youth towards a high school diploma, GED completion or support services to enter into a post-secondary educational system or toward a career.

Academic and Career Planning Services (ages 16 to 24)Training, coaching, guidance, tutoring and supportive services to increase the number of economically disadvantaged youth who will progress along the pathway toward education or towards employment opportunities. WSC AmeriCorps members will drive educational momentum to propel youth toward post-secondary completion or preparing them to enter into a post-secondary educational system or toward a career.

Academic and Career Planning Services - Performance Plan WSC Performance Measure Instructions 2018-2019 - Youth Opportunity Corps

Financial Literacy (ages 16 to 24)Provide financial literacy education and support by using curriculum that includes pre-defined learning objectives to economically disadvantaged youth with regard to credit management, financial institutions including banks and credit unions, and utilization of savings plans, etc.

Financial Literacy - Performance Plan WSC Performance Measure Instructions 2018-2019 – Youth Opportunity Corps

Job Skill Training (ages 16 to 24)Job skill training involves teaching someone the skills required to do a job competently. It is distinct from general education because of the exclusive focus on preparation for employment. Job training can range from remedial training,

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which teaches people the skills they need to learn other skills, to very sophisticated occupation specific training, which teaches people detailed procedures to perform at a high level in a specific occupation.

Job Skill Training - Performance Plan WSC Performance Measure Instructions 2018-2019 – Youth Opportunity Corps

Job Search Training (ages 16 to 24)Includes but not limited to the following: World of Work Awareness, Labor Market Knowledge, Occupational Information, Career Planning, Job Search Techniques (resumes, interviews, etc.), and Demand Occupations.

Job Search Training - Performance Plan WSC Performance Measure Instructions 2018-2019 – Youth Opportunity Corps

Referral to Other Community-Based Services (ages 16 to 24) Referral to Other Community-Based Services - Performance Plan WSC Performance Measure Instructions 2018-2019 – Youth Opportunity Corps

Applicant-Determined Youth Performance Measure (ages 16 to 24)Applicant-Determined Performance Measures are intended for programs whose interventions, outputs and outcomes do not fit under existing WSC Performance Measures. Programs may design performance measures that measure changes in beneficiary (knowledge, attitude, behavior, or conditions). If selecting an Applicant-Determined Performance Measure, please ensure outputs and outcomes are aligned correctly (unit of measure is the same for both outputs & outcomes), ensure that the outputs and outcomes clearly identify what is counted, clearly identify a change in knowledge, attitude, behavior or condition, ensure that the unit of measure is a number, not a percent and can be measured in a single grant year.

Applicant-Determined Performance Measure - Performance Plan Applicant-Determined Performance Measure Guidance 2018-2019

CERTIFICATION

By signing below, the Authorized Signer certifies:

1. They have reviewed all required documents listed in Section I, and agrees to terms and conditions therein;2. Has reviewed additional requirements stated in Section I, and agrees to the stipulations therein;3. Agrees to ensure, perform and support the federal CNCS Assurances and Certifications contained within the draft

contract/interagency agreement referenced in Section I:a. Certification: Debarment, Suspension and Other Responsibility Matters;b. Certification: Drug-Free Workplace;c. Certification: Lobbying Activities;

4. Verifies that the information provided in this application is true and correct, and has been reviewed, approved and authorized by the governing body of the Applicant Organization.

Authorized Signer’s Signature Date(Person who has recognized signatory authority to sign this application and contractual documents on behalf of Applicant Organization.)

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           Authorized Signer’s Printed Name Title/Position

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