Are you responding to the ConnectALL Digital Equity Program Capacity Grant Application?

Has the Applicant been in operation for a minimum of three years with a demonstrated track record of working in New York State serving Covered Populations?

Is the applicant a DBA?

What is the applicant's DBA name?

Organization Legal Name

Contact First Name

Contact Last Name

Contact Title

Contact Street Address

Contact City

Contact State

Contact ZIP Code (please use ZIP+4 if known)

Primary Contact Phone Number. (please include area code)

Contact Email

Additional Project Contact First Name

Additional Project Contact Last Name

Additional Contact Title

Additional Contact Telephone Number (please include area code)

Additional Contact Email Address

Complete and upload the Applicant/Project Team Details Template (in Excel format) to provide details on the Applicant and any/all Project Team members. Name the file using the following naming convention: “ApplicantName_ProjectTeamDetails_MM.DD.YY”

Upload a single PDF file containing current resumes of maximum three key personnel leading implementation of the Proposed Project. Name the file using the following naming convention: “ApplicantName_Resumes_MM.DD.YY”

Upload a PDF file of the Applicant Entity/Organization’s 501(c)(3) form and/or other qualifying certification, establishing the applicant as either a nonprofit organization that is exempt from federal income tax under section 501 (c) (3) of the US Internal Revenue Code or otherwise eligible as per the RFA. Name the file using the following naming or like convention: “ApplicantName_501c3_MM.DD.YY”

Upload a PDF file of the Applicant Entity/Organization’s latest Return of Organization Exempt From Income Tax Form (990 Form). Name the file using the following naming convention: “ApplicantName_990_MM.DD.YY”.

Upload a single PDF file containing copies of audited or certified financial statements for the last three fiscal years. Name the file using the following naming convention: “ApplicantName_FinancialStatements_MM.DD.YY”.

Complete and upload the Project Costs & Milestones Template (in Excel format). Name the file using the following naming convention: “ApplicantName_ProjectCostsAndMilestones_MM.DD.YY”

Upload up to 3 Letters of Support from local, county, and/or Tribal governments whose jurisdictions overlap with the proposed project and/or public, private, and nonprofit entities. Combine multiple files into a single .zip file if needed and name the file using the following naming convention: “ApplicantName_LettersOfSupport_MM.DD.YY.”

Upload Match Contribution Waiver Request using the following naming convention: “ApplicantName_MatchContributionWaiverRequest_MM.DD.YY.”

Applicant Website URL

Application Point of Contact – EIN (enter as digits only, no dashes or spaces)

Applicant Entity Type

Applicant Entity Type – Other (please specify)

If a Not-for-Profit Entity, did you upload 501 (c) 3 attached as requested per Q_16813?

Is this a Partnership Application?

In what capacity has the proposed Project Team worked together previously? If not together, what previous experience does the Applicant and its partners have implementing multi-organization programs or other collaborations?

Does the Applicant intend to fund subrecipients as part of the Proposed Project?

Why is the proposed partnership best-positioned to address the barrier identified for this Covered Population?

Explain the governance structure for the Proposed Project and how the partnering organizations will make decisions.

Describe the Applicant’s experience with re-granting or sub-contracting funds to other organizations. Will the Applicant use a similar approach for this project or will there be changes to the approach?

How will the Applicant ensure funds are efficiently disbursed to sub-award recipients and that the appropriate financial controls are in place?

Does the Applicant have previous experience receiving and administering grant funding?

Describe Applicant’s experience managing and administering/grant funding.

What steps did the Applicant take to ensure compliance with grant funding requirements?

Covered Population(s) to be served by the proposed project

If applicable, please specify the other population(s) to be served by the proposed project.

Measurable Objective(s) to be addressed by the proposed project

Outcome Area(s) to be addressed by the proposed project

Estimated total number of individuals to be served or reached over the grant period by the Proposed Project

Barrier to be addressed: What digital equity barrier(s) does the Proposed Project seek to address?

How has the Applicant identified these barriers for the Covered Population(s) it serves?

Describe the Proposed Project. Include project goals, measurable objectives, and specific activities.

Why is the Proposed Project, and its selected measurable objective(s), an effective solution to the digital equity barrier identified above?

What are the strengths and interests of the Covered Population that will be enhanced or supported by this Proposed Project?

What is the Applicant’s direct knowledge of, and experience working with, the Covered Population(s) identified above? If the Applicant is applying on behalf of a multi-partner collaboration, the response should include the knowledge and expertise of the partners as well.

Is the Applicant is expanding services or programs to new Covered Populations?

How will Applicant expand services and/or programs to engage new Covered Populations and what experience does the Applicant have with expanding programs to reach new populations?

How will Applicant reach their target Covered Population(s) and encourage participation in the Proposed Project?

How will the Proposed Project incorporate feedback from participants served by the Project regarding effectiveness, improvements, or other solutions to address the barriers they face?

What unique strengths does each partner organization bring to achieve the goals of the Proposed Project?

What program, service, or partnership challenges might the Proposed Project encounter? How will the Applicant manage those challenges?

What will be improved or different for the Covered Populations served because of this Proposed Project?

How will the Applicant asses if the Project has achieved its goals as described in Q_16839

What outputs will the Proposed Project produce? Examples may include, but are not limited to: hours of training to be provided, number of curricula or workshops to be developed, number of devices to be distributed, number of navigators credentialed, staff trained, events held, as applicable. Estimate numbers and types in the response.

How will these Proposed Project outputs support improvements for the served Covered Populations?

How will the Proposed Project assess progress towards its stated goals above? Include methods and data that will be used to make this assessment.

How will the Proposed Project strengthen the capacity of New York’s digital equity ecosystem?

How will the Proposed Project share new assets and outputs, where applicable, with other providers and practitioners to better serve Covered Population(s)?

How will Applicant sustain activities and/or impacts beyond the grant period?

What other funding sources will Applicant contribute to project costs to implement the Proposed Project?

Will the Applicant apply for a match contribution waiver?

Enter your name to certify that you/the Applicant understands that funds for this Program will be disbursed in arrears as reimbursement following completion of milestones and submission of invoices and proof of payment. Failure to enter your name may result in your application being deemed ineligible.

By entering your name in the box below, you certify that you are authorized on behalf of your organization and its governing body to submit this application. You further certify that all of the information contained in this application and in all statements, data and supporting documents which have been made or furnished for the purpose of receiving assistance for the project described in this application, are true, correct and complete to the best of your knowledge and belief. You acknowledge that offering a written instrument knowing that the written instrument contains a false statement or false information, with the intent to defraud the State or any political subdivision, public authority, or public benefit corporation of the State, with the knowledge or belief that it will be filed with or recorded by the State or any political subdivision, public authority, or public benefit corporation of the State, constitutes a crime under New York State Law.