Summer Library Program Grant Application
AFFIDAVIT OF WORK AUTHORIZATION
Download 246.4 Kb.
|
- Navigate this page:
- BOX C – AFFIDAVIT ON FILE - CURRENT BUSINESS ENTITY STATUS
- Missouri State Agency or Public University
- Frequently Asked Questions What is a DUNS number
- Why is a DUNS number required
- How to request a DUNS number
- Who can sign forms in the absence of the Library Director
- What is an indirect cost rate and what rate should my institute apply
- For applicants requesting funds in excess of $5,000
- If the e-verify documentation is up-to-date, what box is used on the Business Entity Certification form
- RESOURCES 2016 Summer Reading Program Survey for Parents and Other Caregivers
- Increase Remain the Same Decrease
- Increase Remain the Same Decrease Did not attend
- 2016 Teen Summer Reading Program Survey
- Increased Remained the Same Decreased
- 1a. Example of brief narrative description
- 1b. Example of thorough description of project
- 1c. Example of how project will promote library services
- 1 d. Example of implementation steps and timetables
- Example of evaluation methodologies
- Example of budget narrative
AFFIDAVIT OF WORK AUTHORIZATION: The contractor who meets the section 285.525, RSMo definition of a business entity must complete and return the following Affidavit of Work Authorization. Comes now  (Name of Business Entity Authorized Representative)
a (Position/Title) f (Business Entity Name) is enrolled and will continue to participate in the E-Verify federal work authorization program with respect to employees hired after enrollment in the program who are proposed to work in connection with the services related to contract(s) with the State of Missouri for the duration of the contract(s), if awarded in accordance with subsection 2 of section 285.530, RSMo. I also affirm that
(Business Entity Name) does not and will not knowingly employ a person who is an unauthorized alien in connection with the contracted services provided under the contract(s) for the duration of the contract(s), if awarded. In Affirmation thereof, the facts stated above are true and correct. (The undersigned understands that false statements made in this filing are subject to the penalties provided under section 575.040, RSMo.)
E-Mail Address Subscribed and sworn to before me this _____________ of ___________________. I am (DAY) (MONTH, YEAR) commissioned as a notary public within the County of ________________, State of (NAME OF COUNTY) _______________________, and my commission expires on _________________. (NAME OF STATE) (DATE)
EXHIBIT A, continued
Frequently Asked Questions
Dun & Bradstreet (D&B) provides a D‐U‐N‐S number (Data Universal Numbering System), a unique nine digit identification number, for each physical location of your business. To see if the library already has a DUNS number go to http://fedgov.dnb.com/webform.
Starting in 2011 IMLS (Institute of Museum and Library Services) requires all LSTA prime grant recipients (the State Library) to report information on federal sub‐grant awards. This requirement comes from the Federal Funding Accountability and Transparency Act (FFATA). The Act is intended to empower every American with the ability to hold the government accountable for each spending decision.
To request a new DUNS number online, go to the Dun & Bradstreet website at http://fedgov.dnb.com/webform. A DUNS number can also be requested by calling 1‐866‐705‐5711.
This individual must have the authority to sign legal binding agreements on behalf of the library. A signature and date on these lines indicate that the library approves the intent of the grant, will allow the designated project director or CE participant to oversee the project or attend the training, and can commit matching funds to the project when necessary. Typically, we see the signature of the Library Director.
Indirect costs are those costs incurred for a common or joint purpose benefitting more than one cost objective, and not readily assignable to a single project. Costs may be facilities or administrative in nature. Per 2 CFR 200.414 and guidance from the Institute of Museum and Library Services, sub-grantees may charge administrative or indirect rates to LSTA grants and contracts issued by the Missouri State Library as follows:
MTDC means all direct salaries and wages, applicable fringe benefits, materials and supplies, services, travel, and subawards and subcontracts up to the first $25,000. MTDC excludes equipment, capital expenditures, charges for patient care, rental costs, tuition remission, scholarships and fellowships, participant support costs and the portion of each subaward and subcontract in excess of $25,000.
For applicants requesting funds in excess of $5,000
To find out if your documentation is current, check out the OA/DPMM Work Authorization Affidavits and E-Verify Documentation Received list at http://oa.mo.gov/purch/vendorinfo/affidavits.pdf. Instructions on the work authorization annual renewal process are at http://oa.mo.gov/purch/vendorinfo/e-verify.htm. The annual renewal affidavit should be sent to OA/DPMM, not the Missouri State Library.
Please complete and submit Box C of the Business Entity Certification form.
RESOURCES 2016 Summer Reading Program Survey for Parents and Other Caregivers Please help us evaluate our 2015 Summer Library Program. Your answers on this survey will help obtain funding for the program as well as improve it. Thank you for your time.
_____ 0-3 _____ 4-6 _____ 7-9 _____ 13-15 _____ 7-9 _____ 16-18
_____ Yes _____ No
_____ At school _____ At the library _____ On the library’s website _____ Flyer _____ Word of mouth _____ on the library’s Facebook page Other source (please specify): _____________________________________________________
_____ For the first time this year _____ At this location previously _____ In a similar program at another library
_____ Yes _____ No
2016 Teen Summer Reading Program Survey Please help us evaluate our 2016 Teen Summer Library Program. Your answers on this survey will help obtain funding for the program as well as improve it. Thank you for your time.
_____ At school _____ At the library _____ On the library’s website _____ Flyer _____ Word of mouth _____ On the library’s Facebook page Other source (please specify): _____________________________________________________
_____ For the first time this year _____ For 1-2 years _____ For 3 or more years
1a. Example of brief narrative description: The Friendly Public Library will provide an eight week summer reading program for people of all ages. There will be a kick-off registration event at the library on June 1, 2016. The program will run through July 26, 2016. Reading program participants set their own goals for summer reading that include number of books read. For tweens, teens, and adults, we also encourage them to set a goal of trying out one or two genres that are new to them. Reading awards are provided by the Friends of the Friendly Library, the local Rotary Club, and area businesses. Special program events, which emphasize heroes, will also be held to further engage the participants in learning over the summer months. 1b. Example of thorough description of project: The Library will provide summer reading programs for children age 3 through grade 6 using the theme On Your Mark, Get Set, Read; for youth grades 7-12 using the theme Get in the Game: Read; and for adults using the theme Exercise Your Mind. A Books by Mail program for children age 3 through grade 6 who live more than 10 miles from the library will be implemented. This will encourage children to participate in the program who otherwise may be unable to do so because of transportation barriers, helping them to prevent summer learning loss by providing easy access to reading materials. The program will begin June 1, 2016 and run through July 26, 2016. Participants will set their own reading goals, including reading level and either books or minutes read (or read to). Participants will record their reading in a personal reading log. In order to successfully complete the summer reading program challenge, participants must turn in their completed reading logs showing that they met (or exceeded) their personal goals by August 1, 2016. 1c. Example of how project will promote library services: The Friendly Public Library plans to do various programs to promote reading and learning to children, teens, and adults. For children, weekly story time programs will be held for three age groups: ages 3-6, grades 1-3 and grades 4-6. Multisensory activities selected from the CSLP manual will complement the sub-theme of the week. If the grant is awarded, there will be a special presentation for this group by Will Sty the Super Information Man who will talk about different animals in the world that have unique qualities that make them seem like they have superpowers and talk about how the library is a useful place to find information on how things work. A book display of some of the titles purchased through the grant will be set up at the presentation; children will be encouraged to check them out. Teens will have the opportunity to participate in a book club, which will get them familiar with reading and socializing with people of the same interests. Teens will also get to participate in a Comic Book Workshop, which will show the intricacies of how a comic book is created. By the end, each teen will have a comic book that he or she made to take home. This activity encourages creativity, reading, writing, and promotes resources within the library. Adults may also choose to participate in a book club. Three books will be chosen: two nonfiction and one fiction title to be determined from the CSLP bibliography after a discussion facilitator has been identified. Patrons in grade 1 through adults will also be encouraged to participate in the Reading Bingo Blackout Challenge. A variety of reading categories will be on the card. Each time a participant reads a book in one of the categories, he/she writes the title of the book (and Dewey number for nonfiction titles) on the card. When the participant completes the card, he/she will get a coupon for an ice cream cone provided by Ice Cream Shoppe. He/she will also be entered into a drawing for a chance to win a grand prize, one of four iPads donated by local businesses: one for grades 1-3, one for grades 4-6, one for teens and one for adults. This not only gets patrons familiar with a variety of genres and the Dewey system, it also shows them what the library has in its collection. 1 d. Example of implementation steps and timetables: February 2016: Grant period begins February 1, 2016 Plan weekly programs and crafts Identify library materials to purchase to support the theme Confirm partner off-site locations with local day cares, day camps, etc. Begin contract process with presenters March 2016: Request first payment Place supply and book orders Finalize presenter contracts Create SRP schedule of events Begin disbursing grant funds April 2016: Create promotional displays for schools and partners Create flyer, registration card and reading log templates – send to printer Schedule visits to area schools Prepare new books for circulation Continue to disburse funds as needed Continue the above examples for each month of the grant period. Example of evaluation methodologies: 4a. Quantitative Measures (Statistics): The Friendly Public Library will gather summer reading program registration, successful completions, program attendance, and circulation statistics for the children, teen and adult 2016 summer reading programs. These will be compared to statistics from 2014 and 2015. 4b. Qualitative Measures (Impacts): The Friendly Public Library has adapted the sample surveys from the grant application packet and will use them to help assess project impact. Library staff will listen for and report stories to include in the final report that will illustrate how the summer reading program helped individual participants. Project leaders at local day cares, day camps and summer school programs will be asked to provide feedback on the implementation and success of the summer reading program. (Adapted survey enclosed.) Example of budget narrative: In Services, the library plans to contract with an educational presenter, Will Sty the Super Information Man. Will Sty provide three educational Superhero Animals sessions targeting children ages 3 through 6 and three sessions targeting children 7 through 13. His presentations will also encourage the children to further explain the wonders of the animal world through reading. The contracted cost, including travel, is estimated at $3,250. The library will also place paid advertisements in the local newspaper once a week. Each ad costs cost $40 for a total of $320.The total cost of Services is estimated at $3,570. This amount will be fully funded through LSTA. In Library Materials, the library will purchase titles from the CSLP bibliographies. Some of the titles will be in both print and audio formats; these will be bundled together and targeted for use by people with reading disabilities or who are reluctant readers. Total cost will be $500, with $250 funded through LSTA and $250 through local funds. In Personnel we are requesting funds that will allow us to increase the hours of our two part-time youth services staff. Both employees currently work 20 hours a week. From May through July, their hours will be increased to 40 hours a week to conduct outreach visits to area schools, day camps, and day cares; create and distribute flyers and posters to local businesses and project partners; and prepare for and conduct weekly and special program events for the children and teen programs. Staff person 1 makes $8.50 an hour X 12 weeks X 20 hours = $2,040. Staff person 2 makes $9.25 per hour X 12 weeks X 20 hours = $2,220. The library will also hire two part-time summer workers for 10 hours a week each from June 1 – July 26 to set up, assist at and clean up after weekly and special program events. They will be paid minimum wage, $7.35 X 8 weeks X 10 hours X 2 people = $1,176. This totals $5,436 for the salary. The library will pay benefits for these employees estimated at 21% or $1,142. In Supplies, the library will purchase scissors, crayons, markers, colored pencils, glue sticks, construction paper, cotton balls, and other similar craft and activity supplies estimated at $3 per child (56 children) per week for eight weeks and $6 per teen (24 teens) per week for eight weeks. This totals $2,496. The library will also create 25 posters at $3 each and 2,000 flyers at .10 each to distribute throughout the community. This brings a total of $2,771 in Supplies to be funded through LSTA. In Travel, the school will provide transportation services through First Bus for summer school students to come to the library for a field trip in early June when we will introduce the students to library services and help them register for the program. We estimate we will need three buses for one trip each at $50 each trip for a total of $150. Our partner, the Friendly Public School has agreed to fund the costs for this. In other, the Friends of the Friendly Library and local businesses will provide decorations and refreshments for program events, prizes for those who successfully complete the reading challenge, and the iPads for the Reading Bingo Blackout drawing. Total cost is estimated at $3,000. 1 Libraries using funds to pay for additional staff hours need to maintain in the grant folder time sheets or other documentation that show the time paid to employee was spent solely on the grant project tasks. Directory: CMSImages -> LibraryDevelopment CMSImages -> Department of natural resources CMSImages -> Werner Rumphorst, Director of the Legal Department, ebu LibraryDevelopment -> Summer Library Program Grant Application CMSImages -> Insurance, financial institituions and professional registration Download 246.4 Kb. Share with your friends:
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
s 
irst being duly sworn on my oath, affirm 
