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PRINCEGEORGESCOUNTY OFFICEOFTHECOUNTYEXECUTIVE FISCALYEAR2020 COMMUNITYPARTNERSHIPGRANT(CPG)APPLICATION MAXIMUMAWARDANTICIPATED:$100,000 Pleasecompleteallfieldsandmailapplicationandrequesteddocumentationby5:00p.m.Friday,November8,2019. EmailedsubmissionsshouldbesenttoPGCNonprofits@co.pg.md.uswiththesubjectline:FY2020Community PartnershipGrantApplicationNameofyourOrganization.Mailedorhanddeliveredapplicationsmustbedeliveredin (Prince George's County/Office of Information Technology and Communications)

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The PRINCEGEORGESCOUNTY OFFICEOFTHECOUNTYEXECUTIVE FISCALYEAR2020 COMMUNITYPARTNERSHIPGRANT(CPG)APPLICATION MAXIMUMAWARDANTICIPATED:$100,000 Pleasecompleteallfieldsandmailapplicationandrequesteddocumentat form is 9 pages long and contains:

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PRINCEGEORGE’SCOUNTY
OFFICEOFTHECOUNTYEXECUTIVE
FISCALYEAR2020
COMMUNITYPARTNERSHIPGRANT(CPG)APPLICATION
MAXIMUMAWARDANTICIPATED:$100,000
Pleasecompleteallfieldsandmailapplicationandrequesteddocumentationby5:00p.m.Friday,November8,2019.
EmailedsubmissionsshouldbesenttoPGCNonprofits@co.pg.md.uswiththesubjectline:FY2020Community
PartnershipGrantApplication‐NameofyourOrganization.Mailedorhanddeliveredapplicationsmustbedeliveredin
alargesealedenvelopeaddressedtothefollowing:Attention:GrantsManager,OfficeofCommunityRelations,
9200BasilCourt,Suite102,Largo,MD,20774.
Page1of9
I. ORGANIZATIONALINFORMATION:
DateofApplication:  FederalTaxID:
LegalNameofOrganization(AsitappearsonyourIRSTaxDeterminationLetter):

Organization’sMailingAddress: 
City/State/Zip:  Phone:  Fax: 
AddressWhereServicesProvided: 
City/State/Zip:  WebsiteorURL: 
ExecutiveDirector/CEO:  Contact,ifnotEx.Dir.: 
EmailAddressforApplicationContact: 
YearOrganizationIncorporated:  Total#Employees:  HoursofOperation: 
TotalOrganizationBudget&FiscalYear
(mm/dd/yyyy–mm/dd/yyyy):

II. SERVICECATEGORY:Selectonecategorythatbestdescribesyourorganization’sprimaryareaofservice.
Advocacy
Arts/Humanities
CareCoordination
CommunityDevelopment
CommunityOutreach
Children’sServices
Crisis/EmergencyResponse
DisabilityServices
EconomicDevelopment
Education/Training
Other:
EnvironmentalEducation
FamilyServices
FoodPantry
Health/MentalHealthServices
Intellectual/Developmental 
DisabilityServices
Housing/HousingRelatedServices
Legal/Mediation
Mentoring
PublicSafety
Recreation/Leisure
SafetyNet
TransportationServices
YouthDevelopmentServices
(tutoring,academicenrichment,
recreation)
Other:Pleaseindicateareaof
serviceonlinebelow
CommunityPartnershipGrantApplication FY 2020

Page2of9
III. SUPPORTCATEGORY:Selectonecategoryfromthelistbelow,whichmostclearlyrepresentsthenatureofyour
fundingrequest.
ProgramSupport‐Neworexistingprogramyouwouldliketoestablishorexpandbasedonneeds
assessment.
GeneralSupport‐Unrestrictedfinancialsupportfororganization’sgeneraloperations.
CapacityBuildingSupport‐Fundingtoassistyourorganizationinimprovingitscurrentorganizationalefficiency
andeffectivenessinmovingtowardincreasedindependenceandsustainability.
Other:PleaseDescribe‐
IV. FUNDINGREQUESTINFORMATION
Project/ProgramTitle: 
AmountRequested: PeriodFundingRequestWillCover: 
NumberofClientsYouPlantoServewithRequestedFunding: 
V. Listsourcesandamountsofotherfundingobtained,pledgedorrequestedforthisproject/program.
SOURCE AMOUNT
1
2
3
4
5

VI. a.DoesyourorganizationpartnerwithanyothernonprofitstoprovideservicetotheCounty?
Yesor No
b.Ifyes,pleasecompletedetailsinthetablebelow.
ORGANIZATIONNAME RESPONSIBILITY EXECUTEDMOU(YESORNO?)
1
2
3
4
5
VII. Areyouusingafiscalsponsortosecurethisgrant?
Yesor No
CommunityPartnershipGrantApplication FY 2020

Page3of9
VIII. PRIMARYAGEGROUPOFCLIENTSSERVED:Checktheboxthatbestidentifiesthetargetpopulationthatwill
benefitfromthisfundingrequest.Note:AllservicesmustbeprovidedtoPrinceGeorge’sCountyresidents
only.
Pre‐K
Elementary
MiddleSchool
HighSchool
College
Adult
Senior
IX. PRESENCEINPRINCEGEORGE’SCOUNTY:Pleaseindicatethelengthoftimeyourorganizationhasexisted.
Lessthantwoyears 5‐10years
2‐5years 10ormoreyears
X. SERVICEPROVISIONBYCOUNCILDISTRICT
a. Pleaseindicateifyouareyouarerequestingfundingtoprovideprogrammingand/orservicesinaspecific
CouncilDistrict?
Yes No
b. IndicatetheCouncilDistrictthesefundswillsupport.Youmayselectmorethanone,ifapplicable.

At‐Large:MelFranklin
At‐Large:CalvinHawkins
District1:ThomasE.Dernoga 
District2:DeniL.Taveras
District3:DannielleM.Glaros
District4:ToddM.Turner
District5:JoleneIvey
District6:DerrickLeonDavis
District7:RodneyC.Streeter
District8:MoniqueAnderson‐Walker 
District9:SydneyJ.Harrison



XI. PRIORYEARGRANTSAND/ORCONTRACTS
a. HasyourorganizationreceivedanyPrinceGeorge’sCountygrantfundingincludingCPGorcontractsinthepast
four(4)years?
Yesor No
b. Ifyes,providecompletedetailsinthetablebelow.
FiscalYear RequestedAmount AmountReceived Grant(G)orContract(C)
County
Department/Agency
    



CommunityPartnershipGrantApplication FY 2020
Page4of9
XII. REPORTINGREQUIREMENTS
AllCPGrecipientsarerequiredtosubmitafinalfinancialandprogrammaticreportatprogram/projectend.
PleaseseelinkbelowtoreferencetheWashingtonRegionalGrantmakersCommonGrantReportFormat.Final
reportsubmissionstotheCountymustaddressthesesameelements.
https://www.washingtongrantmakers.org/sites/default/files/resources/Common%20Grant%20Report.PDF
a. HasyourorganizationsubmitteditsfinalfinancialandprogrammaticreportforthemostrecentCPGfunding
received?
Yesor No
b. Ifno,pleaseexplain.
XIII. PROPOSALNARRATIVE:Aprogramnarrativeisrequiredforall“SupportCategories”,i.e.Program,General,and
CapacityBuildingandOther.Yourproposalnarrativeshouldaddressthefollowingareas:
A. ORGANIZATIONALMISSION(10Points):Pleaseprovideyourorganizationalmissionandasummaryofyouroverall
proposalandyourrequestforfunding.Clearlyexplainhowtheproposedprojectalignswithyourorganization’s
mission.
B. STATEMENTOFNEED/PROBLEM(20Points):Clearlyexplainwhythisprojectisneeded.
C. PROJECTDESCRIPTION(25Points):Clearlyexplainhowtheproposedprogramwillbeimplementedandevaluated.
D. ORGANIZATIONBUDGET(20Points):Pleaseuseformatasoutlinedonpage5oftheapplicationdocument.
E. PROJECTBUDGET(15Points):Clearlydetailanddescribewhyyourorganizationiscurrentlyunabletoaddressthe
identifiedneedwithoutoutsidefinancialassistanceandhowthefundsrequestedwillsupportyourintendedstrategies.
Clearlydetailhowyourproposedprojectwillachieveself‐sufficiencyafteryourperiodofperformanceandCounty
fundingassistancehasended.
F. ORGANIZATIONALINFORMATION/CAPABILITY(10Points):Demonstratethatyourorganizationhasthenecessary
experience,keypersonnel,internalcontrols,andfinancialsystemstoeffectivelymanageagrantaward.
XIV. ADDITIONALNARRATIVEANDPROPOSALSUBMISSIONINSTRUCTIONS
A. TheCommunityPartnershipGrant(CPG)ApplicationChecklistmustbethefirstpageoftheproposal.
B. AllpagesoftheProposalNarrativemustuseone‐inchmarginsandbenumbered.
C. TheProposalNarrativemustuseline‐spacingofatleast1.5,typesizeof12‐pointfontandusetheprovided
SectionHeadings.Proposalsthatfailtomeetthisrequirementwillberejected.
D. Chartsandtablesmayusesinglespacingand10‐pointfont.
E. TheProposalNarrativemustnotexceed15pages.Additionalpagesthatexceedthe15‐pagelimitwillnotbe
readorscored.(ThisexcludestheProposalApplicationForm,ApplicationChecklist,OrganizationalFinancial
Information.Program/ProjectBudget,SupportingDocumentation,MemorandumofUnderstanding,and
ProgrammaticandFinancialReportsforpreviousCPGgrantaward).
F. RequestedsignatureonAssurancesPagemustbesignedinblueink.
G. AnelectroniccopyaswellasoneoriginalandthreehardcopiesoftheCPGApplicationmustbesubmitted.
H. Completedapplicationsshouldbeplacedinalargeenvelopeandsealed.Onthefrontoftheenvelope
the
followinginformationisrequired:
Left‐handcorn
er:Nameoforganization
Address
CenterofEnvelope:FY2020CommunityPartnershipGrantApplication
CommunityPartnershipGrantApplication FY 2020
Page5of9
Xs. ORGANIZATIONALFINANCIALINFORMATION
A. ORGANIZATION‐Thebudgetinformationbelowappliestotheorganization’stotaloperatingbudget.
PLEASEDONOTATTACHANYOTHERBUDGETINFORMATION.
ORGANIZATIONINCOMEORGANIZATIONEXPENSES
SOURCE AMOUNT
COMMITTED
%
ITEM AMOUNT
FederalGrants   Salaries&Wages(breakdownby
individualpositionandindicatefullor
part‐timepositions)

StateGrants   Insurance,Benefits,OtherRelatedtaxes 
CountyGrants   Travel 
Corporations   Equipment 
IndividualContributions   Supplies 
FundraisingEvents   Printing&Copying 
MembershipIncome   Telephone/Internet 
In‐KindSupport   Postage 
InvestmentIncome
Revenue
  Rent
FederalContracts   Utilities 
StateContracts   In‐KindSupport 
CountyContracts   Depreciation
EarnedIncome   Other(Specify)
Other(Specify)   TOTALEXPENSES
TOTALINCOME   Difference(IncomeLessExpenses)
CommunityPartnershipGrantApplication FY 2020
Page6of9
B. PROGRAM/PROJECTBUDGET‐Thebudgetinformationbelowappliestotheprojectforwhichyouare
requestingfunding.Ifyouarerequestingfundingforgeneralsupport,youarestillrequiredtocomplete
thisbudgetforthefundingrequested.Youmustusethisformat.Ifapplicable,onaseparatesheet,
pleaseidentifyeachstaffpositionforwhichyouarerequestingfunding,alongwiththeperhourcostfor
each.PLEASEDONOTATTACHANYOTHERBUDGETINFORMATION.
 PROGRAM/PROJECTINCOME PROGRAM/PROJECTEXPENSES
SOURCE
AMOUNT
COMMITTED
AMOUNT
PENDING*
ITEMAMOUNT
FederalGrants    Salaries&Wages(breakdownbyindividual
position.Indicatefullorpart‐timepositions

StateGrants    Insurance,Benefits,OtherRelatedtaxes 
CountyGrants    Travel 
Corporations    Equipment 
IndividualContributions    Supplies 
FundraisingEvents    Printing&Copying 
MembershipIncome    Telephone/Internet 
In‐KindSupport    Postage 
InvestmentIncome/
Revenue
   Rent 
FederalContracts    Utilities 
StateContracts    In‐KindSupport 
CountyContracts    Depreciation 
EarnedIncome    Other(Specify) 
Other(Specify)   TOTALEXPENSES
TOTALINCOME   Difference(IncomeLessExpenses)
*Pendingsourcesofsupportincludethoserequestscurrentlyunderconsideration.PleaseincludethiscurrentCPG
request.
CommunityPartnershipGrantApplication FY 2020
Page7of9
ASSURANCES
Ifthisgrantisawarded,theapplicantorganizationassuresthat:
1. Theapplicantwilladministerthefundsincompliancewiththesubmittedproposalandinaccordancewiththeaward
conditionsandrestrictions.
2. FundsreceivedmustbeusedinPrinceGeorge’sCountyandusedsolelyforthedocumentedactivitiesasoutlinedinthe
proposalrequest.
3. Theapplicanthasreadandwillconformtotheprogramguidelines,programmaticevaluationandfinancialreporting
requirements,sitemonitoringvisits,andanyotherconditions/restrictionsimposedbytheCountyinconnectionwith
thegrantaward.
4. TheapplicantorganizationintendstocomplywithTitleVIIoftheCivilRightsActof1964,indicatingthatnopersonwill
beexcludedfromparticipationorbedeniedbenefitsofanyprogramactivity,orservicebecauseofrace,sex,sexual
preference,color,religion,ancestry,age,nationalorigin,orhandicap.Theapplicantfurtheragreestomakeevery
attempttoensurethattheprogramisaccessibletopersonswithdisabilities.
5. TheapplicantagreestoprovideitsmostrecentauditedfinancialstatementtotheCounty,uponrequest.
6. Thefilingofthisapplicationismadebytheundersignedindividual,andthisindividualisofficiallyauthorizedto
representtheapplicantorganizationbyitsgoverningboard.
CERTIFICATION
IaffirmthatIamauthorizedtoexecutethisapplicationonbehalfoftheapplicantorganization.Ialsocertifythat
theinformationcontainedinthisapplication,includingattachments,istrueandcorrect.IwillnotifytheOfficeof
ManagementandBudgetofanychangesinorganizationstatusorstructure,orinthematerialcontainedhereinwithin
ten (10)daysofanysuc
hchanges.
OrganizationName:__________
_______________________________________________________________________
Signature:_________________________________________________________________________________________
Printed
Name:____________________________________________________________________________________________
Title:_______________________________________________________Date:__________________________________
E‐mail:____________________________________________________Phone:________________________________
CommunityPartnershipGrantApplication FY 2020
Page8of9
CommunityPartnershipGrant(CPG)ApplicationChecklist
PleasereviewthechecklistbelowtoensureallFY2020CPGapplicationrequirementshavebeenmetbefore
finalsubmission.Thischecklistisprovidedtohelpensureacompleteproposalpackage.Pleaseusethis
checklistasaguidewhenassemblingyourdocuments.Ifalltheitemslistedandspecifiedbelowarenot
submittedordeterminedtobeincomplete,yourapplicationwillnotbereviewed.NOTE:Applicantswillnotbe
contactedtoprovidemissingdocumentation.Allitemslistedbelowarerequiredatthetimeofapplication.
APPLICATIONINFORMATION
EmailedsubmissiontoPGCNonprofits@co.pg.md.uswiththesubjectline:FY2020CommunityPartnership
GrantApplication‐NameofyourOrganizationANDmailorhand‐deliveroneoriginalandthreecopiesofthe
CPGApplicationandsupportingdocumentation.
RequestedsignatureonAssurancesPagemustbesignedinblueink.
Completedapplicationsshouldbeplacedinalargeenvelopeandsealed.Onthefrontoftheenvelopethe
followinginformationisrequired:
Left‐handcorner:Nameoforganization
Address
CenterofEnvelope:FY2020CommunityPartnershipGrantApplication
(CompleteItemsI‐XV(Refertopages1‐6)Placethecompletedpagesontopofyourproposalnarrative.These
pageswillserveasacoversheettoyourproposal.
ProposalNarrative(Refertopg.4instructionsforpreparation‐ItemXII.)
Acopyofthecurrentyear’soperatingbudgetfortheorganization.Fiscalsponsorswillalsoneedtosubmita
copyoftheirorganization’sbudget.(Refertopg.5‐ItemXV.A)

Acopyoftheprogram/projectbudgetrequest.Ifyouarerequestingfundingforgeneralsupport,youarestill
requiredtocompletethisbudgetforthefundingrequested.(Refertopg.6‐ItemXV.B)
REQUIREDDOCUMENTATION
Twoself‐addressedstampedenvelopes
Acopyoftheorganization’sIRSTaxdeterminationletterverifyingIRS501(c)(3)federaltax‐exemptstatus
AcopyofyourIRSExemptSelectChecksearchresultswhichverifiesyourorganizations’federaltax‐exemptstatusis
currentlyineffectandnotrevokedforfailuretofileyourForm990Seriesreturnforthreeconsecutiveyears.Please
visithttps://apps.irs.gov/app/eos/toobtainthisinformation.
FinancialStatements–IncludemostrecentlyfiledFinancialAuditReportorIRSForm990.Ifyourorganization
hasboth,pleasesubmittheFinancialAuditReport.Auditedfinancialreportsmustbepreparedinaccordance
withgenerallyacceptedaccountingprinciplesandbeauditedbyacertifiedpublicaccountant.Unaudited
financialstatements,balancesheets,reviewsordraftversionsarenotacceptable.
SignedIRSFormW‐9
CommunityPartnershipGrantApplication FY 2020
Page9of9
 Currentcopyofyourorganization’sCertificateofStatusaka“GoodStanding”‐Generalentityinformation
showingthatverifiesyourorganizationiscurrentlyingoodstandingwithintheStateyourorganizationwas
incorporatedi.e.,theStateofMaryland,DistrictofColumbiaorVirginia.Thedateonthecertificatemustbe
withinsixmonthsoftheapplicationsubmission.
PrinceGeorge’sCountyACHEnrollmentForm
SUBMITONEOFTHEFOLLOWINGREQUIREMENTS(ChecktheBoxthatAppliestoYourOrganization)
OfficeofManagementandBudget(OMB)verifiedSAPvendornumber
CompletedSAPVendorRequestForm(neededifyouhaveneverreceivedagrantorcontractfromPrinceGeorge’s
County)
OTHERATTACHMENTS,IFAPPLICABLE
 AcopyofamostrecentlyexecutedMemorandumofUnderstandingforeachpartnerthatmustbesignedbyall
parties(ifthisrequestincludespartnerorganizations),i.e.PrinceGeorge’sCountyPublicSchools,FiscalSponsor.
FinalprogrammaticandfinancialreportforyourmostrecentCPGgrantawardfundsreceived.
REMINDER:
Ifalltheitemslistedandspecifiedabovearenotsubmitted,yourapplicationwillnotbereviewedforfunding.For
additionalclarification,pleasevisitour“FrequentlyAskedQuestions”sectionofthewebsite.
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PRINCEGEORGESCOUNTY OFFICEOFTHECOUNTYEXECUTIVE FISCALYEAR2020 COMMUNITYPARTNERSHIPGRANT(CPG)APPLICATION MAXIMUMAWARDANTICIPATED:$100,000 Pleasecompleteallfieldsandmailapplicationandrequesteddocumentationby5:00p.m.Friday,November8,2019. Emailedsubmissionss

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Completed 18 July 2020

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