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City of Hendersonville (City of Hendersonville)

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BROWSE CITY OF HENDERSONVILLE (NC) FORMS

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City of Hendersonville
Request for Special Appropriations FY21-22
Contact: Adam Murr, 828-233-2879, amurr@hvlnc.gov, City Hall Rm. 326
[Submit forms by February 26, 2021]
Organization’s Name:
Address:
City, State, ZIP:
Website address:
A. GENERAL INFORMATION
1. Program Name:
2. Contact Person/Title:
Telephone Number:
E‐mail address:
3. Estimated total number of individuals served in the last complete fiscal year by this program:
4. Estimated total number of the above individuals who are City residents:
Please attach any documentation that supports this number.
Estimated percent of people served who are City residents:
5. Amount of Request: 6. Total Program Budget:
Percent of total program budget you are requesting from Hendersonville:
7. Please state the mission of your agency:
8. Will the funding be used to:
Maintain an existing program Expand an Existing Program Start a new program
9. Has your organization received funds from the City in the past for this or a similar program?
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If yes, please answer the following:
a. Does the amount of your request represent an increase over your previous appropriation?
If yes, explain the reason(s) for the increase.
b. Were any conditions or restrictions placed on the funds by the City Council?
If yes, describe how those conditions or restrictions have been met.
B. Program Overview.
1.
Statement of Need: Identify the issue or need that the program will address (use statistical data to
justify the need for the program). To what extent does this need, or problem exist in the City of
Hendersonville?
2.
Program Summary:
a.
Identify the target/recipients of program services. Specify the number of City residents your
program will serve during the fiscal year and explain the basis upon which this number is calculated.
Indicate any eligibility requirements your program has with respect to age, gender, income or residence.
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b.
Identify what is to be accomplished or what change will occur. (e.g., begin your sentences with
“The purpose of the program is to provide …” and describe the services to be provided.)
3.
Program Funding:
a.
Identify how City funds, specifically, will be used (i.e., funds will provide “X” units of
service.)
b.
List the other agencies to whom you are submitting a request for funds for this program and the
amount requested. How would this program be modified should revenues be lost?
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C. Organizational Capacity.
1.
Describe your agency’s capability to provide the program including its history, previous experience
providing this service, management structure and staff expertise.
2.
Does your organization have a strategic plan and a strategic planning process in place?
The strategic plan includes a mission statement, goals, action steps to achieve the goals, and
measures
that assess the accomplishments of the goals. The Strategic Plan must be provided to the
City upon
request.
3.
What is the authorized size of your board of directors?
How many meetings were held by the board last year?
4.
Does your organization have an audit performed?
The audit must be provided to the City upon request.
i
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Completed 17 February 2021

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