2. 
3. Social Services Advisory Board Request for Funding
5. Follow the link below for additional information on the 2021 application and required documents.
   2022 Application Guidelines
7. Organization Name:
9. Name of Program (if applicable):
11. Contact Person:
13. Address1
15. Address2
17. City
18. State
19. Zip
21. Phone:
22. Email:
24. Website or Social Media:
26. 2022 Funding Requested:
27. Total 2022 Operating Budget:
28. % of total budget from SSAB funds:
32. This proposal was considered and approved for submission at the organization's Board of Directors meeting on
    This proposal was considered and approved for submission at the organization's Board of Directors meeting on
34. The signature below attests that the information in this application is accurate.
36. eSignature*
    I understand and agree that by typing my name above I am providing a legal signature on this application for funding.
37. Date*
    Date
41. 1. Please share the overall agency or program mission. (about 100 words)
43. 2. Briefly explain the social challenges or problems this program addresses. (about 100 words)
45. 3. Explain in a budget narrative how SSAB funds will be used for the program. If requesting an increase from 2021's application, please explain why. (about 250 words)
    A budget narratives explains how the costs relate to the implementation of the project as outlined in the proposal being submitted.
47. 4. What geographical area does your agency cover? If you serve an area larger than the City of Manhattan, explain your rational for the amount of funding you are seeking from the City. (about 250 words)
49. 5. Individuals Served in Previous Fiscal Year:
51. a. Number of total individuals served
52. Total Agency
53. SSAB Funded Only
55. b. Number of individuals served in Manhattan
56. Total Agency
57. SSAB Funded Only
59. c. Number of individuals served outside Manhattan
60. Total Agency
61. SSAB Funded Only
63. 6. How does your agency define eligibility for services in the program? (about 250 words)
65. 7. What trends do you see from clients or the community? (about 250 words)
67. 8. Explain briefly the main ways volunteers work for the SSAB funded activity and give an estimate of how many volunteer hours there were in the previous fiscal year. Also, how many full time, part time, and volunteer staff work in your organization? (About 250 words)
69. 9. List staff positions supported with SSAB. Please include title, percentage funded by SSAB, and also what percentage of time committed to the program/service using the SSAB funds. (about 100 words)
71. 10. Explain how the program/agency has reached past goals and how they are/were being measured. (about 250 words)
73. 11. How have you met these goals in the past fiscal year? If you have not met them, please explain why. (about 250 words)
75. 12. Explain below the program/agency goals, action steps, and measures for 2022.
77. Goals
78. Action Steps
79. Measures
81. 13. Share the specific outcomes that will be measured? (about 100 words)
83. 14. Please quantify with data the specific impact if funding is denied or reduced. (about 250 words)
85. 15. To conclude, please identify the unique program strengths to be used in our presentations. (i.e., short phrases on a slide) (about 250 words)
89. Use the link below to fill out the budget form in a separate excel file.
    2022 Budget Form

    The last column should be the percent of SSAB funds. In the revenue section, please just use the amount of SSAB request / Total Revenues to derive your percentage on line 18. For the expense section, you should be able to provide this % for all of the listed expenses to help the board understand exactly where the funds will be spent.
91. In order to complete the application, please attach the following documents:
93. 2022 Budget Form Upload:*
95. 2022 Intended Use of SSAB Funds Upload:*
97. Current Board Members Upload:*
99. 2019 IRS Form 990 Upload: (if applicable)
101. If applying for first time OR changes have occurred, in addition to the above, attach the following:
103. Affirmative Action Statement Upload:
105. 501(c)(3) Status Upload: (if applicable)
107. Organization's Bylaws Upload:
Leave This Blank:


109. 1. Receive an email copy of this form.
110. Email address

     This field is not part of the form submission.

111. Submit

* indicates a required field