PROPOSALS FOR Trauma Treatment and Supportive Services for Child Victims of Domestic Violence

REQUEST FOR PROPOSALS FOR Trauma Treatment and Supportive Services for Child Victims of Domestic Violence in Five Counties: Cape May, Hunterdon, Salem, Sussex and Warren. Funding of up to $300,000 available Each applicant may apply for one or more counties. Separate bids shall be required for each county. There will be no Bidders Conference for this RFP. Questions are due by October 11, 2017 at 12:00 PM Bids are due: November 15, 2017 at 12:00 PM Allison Blake, PhD., L.S.W. Commissioner September 27, 2017 TABLE OF CONTENTS Section I - General Information A. Purpose 1 B. Background 1 C. Services to be Funded 3 D. Funding Information 8 E. Applicant Eligibility Requirements 9 F. RFP Schedule 10 G. Administration 12 H. Appeals 14 I. Post Award Review 14 J. Post Award Requirements 14 Section II - Application Instructions A. Review Criteria 15 B. Supporting Documents 21 C. Requests for Information and Clarification 24 Exhibit A–The State Affirmative Action Policy Exhibit

B–Anti-Discrimination Provisions Exhibit C–Start Up/One Time Costs 1 Funding Agency State of New Jersey Department of Children and Families 50 East State Street, Trenton, New Jersey 08625 Special Notice: There will be no Bidders Conference for this RFP. Questions will be accepted in advance by providing them via email to DCFASKRFP@dcf.state.nj.us until October 11, 2017 at 12PM. Technical inquiries about forms and other documents may be requested anytime. Section I – General Information A. Purpose: The New Jersey Department of Children and Families (DCF) announces the availability of up to $300,000 in funding for the purpose of providing evidence-informed trauma treatment and supportive services to child victims of domestic violence. The goal of this RFP is to increase access to appropriate treatment and support services that mitigate and/or treat the impact of trauma and support the child victims and caregiver(s) in developing healthy relationships. Funding will be used to develop and/or enhance programming in five counties: Cape May, Hunterdon, Salem, Sussex and Warren; up to one award will be made in each of the five identified counties. Each applicant may apply for one or more counties. Separate bids shall be required for each county. All funding shall be subject to the appropriation of sufficient funds and the availability of sufficient resources. Referrals for these services will come from the county’s lead Domestic Violence Service Agencies and Child Protection and Permanency (CP&P) local offices. B. Background: The Department is charged with serving and safeguarding the most vulnerable children and families in the State, and our mission is to ensure the safety, well-being, and success of New Jersey’s children and families. Our vision statement is” “To ensure a better today and even greater tomorrow for every individual we serve.” mailto:DCFASKRFP@dcf.state.nj.us 2 The goal of this RFP is to increase the availability of evidence-based trauma treatment and supportive services to child victims of domestic violence in five counties: Cape May, Hunterdon, Salem, Sussex and Warren. Through this RFP, the Department intends to help ensure children, who become known to Domestic Violence Lead Agencies and/or CP&P and are suspected as a result of their exposure to domestic violence to be in need of assistance, receive timely, high quality treatment and support. Children and youth exposed to domestic violence are at an increased risk of experiencing abuse (physical, sexual, etc.), developing emotional and behavioral challenges, and experiencing subsequent exposure to trauma and adverse life experiences. According to the National Survey of Children’s Exposure to Violence, 40.3% of children surveyed have been exposed to family violence throughout their lifetimes, with 27.7% exposed to physical intimate partner violence among parents.1 Results of the 2015 National Census of Domestic Violence Services indicate over 56% of the population in shelters and transitional housing provided by domestic violence programs in New Jersey consist of children, and 93% of the services provided by these local programs involve support and advocacy for children.2 Exposure to domestic violence can have profound and lasting traumatic effects on children and their development. Potential impacts include but are not limited to:  Lower verbal, cognitive and motor skills, and/or delays in childhood development;  Depression, anxiety, and Post Traumatic Stress Disorder (PTSD);  Restlessness, impulsivity, and difficulty concentrating;  Fearful, withdrawn, and inhibited behavior; and,  Lower self-esteem and shame.3 At the same time, research demonstrates that early intervention with trauma-informed services is critical to a child’s recovery. Studies have found that there are protective factors and interventions which can mitigate the impact of exposure to domestic violence.45 Protective 1 Hamby, S., Finkelhor, D., Turner, H., and Ormrod, O. (2011) Children’s Exposure to Intimate Partner Violence and Other Family Violence. Washington, DC: U.S. Government Printing Office. Retrieved at: http://www.unh.edu/ccrc/pdf/jvq/NatSCEVChildren's%20Exposure-Family%20Violence%20final.pdf 2 National Network to End Domestic Violence. 2015 Domestic Violence Counts: New Jersey Summary. Retrieved at: http://nnedv.org/downloads/Census/DVCounts2015/New_Jersey.pdf 3 Futures Without Violence. http://promising.futureswithoutviolence.org/what-do-kids-need/get-the-facts/ 4 Holt, S., Buckley, H., & Whelan, S. (2008). The impact of exposure to domestic violence on children and young people: A review of the literature. Child Abuse & Neglect, 32, 797-810. 3 factors such as secure maternal attachment, social support to the family, high self-esteem, and child temperament contribute to increased resilience in children exposed to domestic violence. Treatments which build resilience and promote recovery such as Trauma Focused Cognitive Behavior Therapy (TF-CBT) can mitigate the long-term impact of violence exposure. Reliable screening and assessment measures for domestic violence and trauma exposure are also important tools that inform treatment considerations.6 C. Services to be Funded: Up to one award will be made in each of the five identified counties to access training and implement the evidence based model, TF-CBT. Applicants may apply for one or more counties, but separate applications are required for each county. Applicants may also subcontract program components to qualified agency partners, but a primary agency must be identified, and DCF’s contract will be with the primary agency. The counties of focus, funding available and minimum level of service (LOS) for this RFP are: County Funding Available Minimum Annual LOS (unduplicated children and caregivers) Cape May Up to $60,000 15 Hunterdon Up to $60,000 15 Salem Up to $60,000 15 Sussex Up to $60,000 15 Warren Up to $60,000 15  Note Regarding Level of Service (LOS): Each awarded agency is expected to serve a minimum of 15 unduplicated children and their 5 Martinez-Torteya, C., Bogat, A., von Eye, A., & Levendosky, A. (2009). Resilience among children exposed to domestic violence: The role of risk and protective factors. Child Development, 80(2), 562-577. 6 Edleson, J., Shin, N., & Johnson-Armendariz, K. (2008). Measuring children's exposure to domestic violence: The development and testing of the Child Exposure to Domestic Violence (CEDV) Scale. Children and Youth Services Review, 30, 502-521. 4 caregivers each year using the TF-CBT modality. In the first year of this award, if all or a portion of therapists and/or a supervisor need(s) training and ongoing coaching (Learning Collaborative) in TF-CBT, the expected level of service will be aligned with the training requirements of TF-CBT (see staffing and training section for full details). Once staff completes the Learning Collaborative, the agency is expected to serve the minimum LOS outlined above. Required Program Components: The awarded grantee for this program must provide:  Screening and Assessment  TF-CBT Treatment  Supportive services, if applicable  Evaluation, Reporting, and Ongoing Quality Improvement A grantee is permitted to subcontract all or part of this work to a qualified partner agency. Any subcontracted agency must be trained in the utilization of the assessment and/or screening tool(s) and must agree to comply with DCF requirements and participate in DCF site visits, trainings, monitoring, etc. as needed. The grantee is expected to partner and collaborate with CP&P when delivering services to CP&P-involved families. This may include providing collateral information and participating in case conferences and Family Team Meetings as appropriate. Screening and Assessment* The goal of this RFP is to provide high quality, effective services to child victims of domestic violence who have been exposed to trauma and require treatment. The grantee shall utilize the identified TF-CBT screening and assessment tools (such as the UCLA PTSD Reaction Index and the CBCL) to determine if services are warranted. The grantee will receive training as well as ongoing coaching and support for staff to ensure consistent, reliable use of the screening and/or assessment tool(s). At the same time, DCF recognizes that many families who become known to domestic violence agencies or CP&P may have existing assessments which can help inform what services and supports are warranted. Where appropriate, providers shall utilize existing assessments and avoid duplication of assessment and/or evaluation of children and families. 5 *PLEASE NOTE: DCF reserves the right to determine the standard screening and/or assessment tool that will be utilized in all counties. The grantee must be flexible and willing to use a tool that the grantee did not propose in the submitted application. DCF is committed to collaborating with grantees to help make this determination. The grantee must have procedures in place for children, whose screening and/or assessment indicate either no need for treatment services or a need for a higher level of treatment services. Providers should refer children who are suspected of requiring a higher level of service to PerformCare. In cases where areas of need are identified but treatment is not warranted, the grantee shall work with the referring agency to find appropriate alternative resources in the community. The applicant must describe knowledge of community-based resources within each county proposed. TF-CBT Treatment The grantee must agree to provide Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), an evidence-based trauma treatment modality. According to the California Evidence-Based Clearinghouse: “TF-CBT is a conjoint child and parent psychotherapy model for children (ages 3-18 years old) who are experiencing significant emotional and behavioral difficulties related to traumatic life events. It is a components-based hybrid treatment model that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles. The overall goal of TF-CBT is to address symptoms resulting from a specific traumatic experience or experiences. This includes: A. Improving child PTSD, depressive and anxiety symptoms B. Improving child externalizing behavior problems (including sexual behavior problems if related to trauma) C. Improving parenting skills and parental support of the child, and reducing parental distress D. Enhancing parent-child communication, attachment, and ability to maintain safety E. Improving child's adaptive functioning F. Reducing shame and embarrassment related to the traumatic experiences”7 7 California Evidence-Based Clearinghouse for Child Welfare. (2006-2016). Retrieved January 27, 2016 from http://www.cebc4cw.org/program/trauma-focused-cognitive-behavioral-therapy/ 6 Evaluation, Reporting, and Ongoing Quality Improvement Grantees are expected to utilize assessment tools identified in TF-CBT training. Grantees are also expected to engage in a process of evaluation planning with DCF to finalize state-level outcome indicators that all grantees will be responsible for reporting to DCF. Therefore, grantees must:  Have capacity to measure and report on DCF identified outcome indicators and any other outcomes proposed in their application;  Develop and maintain clear and organized systems of data collection to seamlessly distribute reports to DCF; and,  Meet with DCF staff and/or DCF consultants at regular intervals to ensure evaluation and data reporting requirements are met. DCF practices Continuous Quality Improvement (CQI) to identify and analyze strengths and areas needing improvement. DCF is committed to the process of ongoing evaluation as a vehicle to learn and develop solutions to improve the quality of services. It is expected that the grantee will engage in ongoing CQI to ensure programs are systematically and intentionally increasing positive outcomes for individuals and families they serve. DCF will likely seek the assistance of a third party evaluator. If awarded this grant, the applicant agrees to partner with DCF and any outside evaluator DCF may contract with to assess the impact of the program. Staffing The proposal must include a well-developed staffing model. Each applicant is strongly encouraged to identify at least three (3) therapists who are licensed or license-eligible to provide TF-CBT treatment. A team of therapists providing TF-CBT is encouraged for support in and sustainability of the TF-CBT model. Oversight of the therapists must be provided by at least one (1) licensed supervisor. The therapists providing these services and supervisor overseeing should be TF-CBT certified or willing to work toward TF-CBT certification. In an effort to expand TF- CBT capacity, DCF will provide a TF-CBT Learning Collaborative for therapists and supervisors, through an existing DCF contract. Applicants must be agreeable to have identified staff participate in DCF-sponsored TF-CBT training if the applicant’s clinicians and supervisor have not been trained and/or are not certified in TF-CBT. Applicants may find it useful to reference this website: https://tfcbt.org/tf- cbt-certification-criteria/. https://tfcbt.org/tf-cbt-certification-criteria/ https://tfcbt.org/tf-cbt-certification-criteria/ 7 Training DCF is funding slots, through a DCF contracted provider, for awarded grantees to participate in a one year TF-CBT Learning Collaborative, which consists of all required training and consultation. Dates for the Learning Collaborative will be provided to grantees once awards are made. The purpose of the Learning Collaborative is to build staff capacity in quality delivery of TF-CBT. The awarded grantee shall make any therapist(s) and supervisor not currently certified in TF-CBT available for all Learning Collaborative requirements. Ideally, the provider will recruit clinicians and the clinicians’ supervisors from within their agency to participate and/or hire new clinicians or supervisors who have strong interest in learning and delivering TF-CBT with the target population. The year-long Learning Collaborative includes: online training, training on standardized measures, introductory face-to-face training, 16-18 group consultation calls, and advanced face-to-face training. Each therapist and supervisor is expected to provide TF-CBT treatment to at least three children and their caregivers as they engage in the Learning Collaborative. Agency senior leaders are expected to participate in a portion of the in-person training as well as on required calls with other agency leaders. The engagement of leadership is designed to provide guidance and support in creating trauma-informed work environments that support the implementation of the evidence-based treatment modality and the utilization of standardized measures to assess treatment progress and outcomes. Clinicians, supervisors and senior leaders will have access to additional TF-CBT support and resources as the clinicians and supervisors work toward certification and beyond. Transportation/Service Availability The applicant must describe accessibility of services for the target population in the identified county, how they will eliminate barriers to treatment, what transportation support will be provided, and include their plans for service availability. Provision of transportation is not mandatory. Bus cards are acceptable. Applicants are strongly encouraged to anticipate barriers that families face in accessing treatment and propose how their programming and supports will mitigate access. This may include provision of transportation and/or solutions to mitigate transportation challenges. Services offered “in-home” and in-shelters may help mitigate access to treatment for some families. If an applicant plans to offer treatment 8 offsite, it must provide information about the intended location, including documentation of an intended partnership if the applicant intends to offer its services in another agency’s facility. It may or may not be appropriate to provide services in some shelter locations, depending on the shelter policy. The applicant must also include plans for oversight of children when caregivers are participating in treatment. Other Requirements All applicants are advised that any software purchased in connection with the proposed project must receive prior approval by the New Jersey Office of Information Technology. Applicants are also advised that any data collected or maintained through the implementation of the proposed program shall remain the property of DCF. Organ and Tissue Donation: As defined in section 2 of P.L. 2012, c. 4 (N.J.S.A.52:32-33), contractors are encouraged to notify their employees, through information and materials or through an organ and tissue awareness program, of organ donation options. The information provided to employees shall be prepared in collaboration with the organ procurement organizations designated pursuant to 42 U.S.C. §1320b-8 to serve in this State. D. Funding Information: All funding is subject to appropriation. For the purpose of this initiative, the Department will make available up to $300,000 in annual funding: County Funding Available Cape May Up to $60,000 Hunterdon Up to $60,000 Salem Up to $60,000 Sussex Up to $60,000 Warren Up to $60,000 9 The Department anticipates the funding will be ongoing; however, continuation funding is contingent upon the availability of funds in future fiscal years and the grantee’s performance under the provisions of this RFP and the resulting contract. Universities are reminded that this is a competitive process and on notice that no annual increases will be considered as part of this contract to salaries, fringe or benefits for future negotiations or contracts, unless approved by the State legislature for all contracting entities. Up to five proposals will be funded under this program. The initial funding period for this program is subject to fiscal appropriation and satisfactory performance. The annual amount may be pro-rated for the first year of service. Matching funds are not required. Reasonable operational start-up costs are permitted through anticipated accruals in the first year of the contract. Additional funds are not available. A Start-up Budget shall be included as Exhibit C. Applicants must provide a separate justification and detailed summary of all expenses that must be met in order to begin program operations. The applicant may include travel costs associated with staff attending TF- CBT Learning Collaborative trainings in New Jersey. The applicant may also include costs related to ensuring oversight of the waiting room while caregivers are participating in the child’s treatment. Proposals that demonstrate the leveraging of other financial resources are encouraged. Funds awarded under this program may not be used to supplant or duplicate existing funding. Any expenses incurred prior to the effective date of the contract will not be reimbursed by DCF. E. Applicant Eligibility Requirements: 1. Applicants must be for profit or not for profit corporations that are duly registered to conduct business within the State of New Jersey. 2. Applicants must be in good standing with all State and Federal agencies with which they have an existing grant or contractual relationship. 10 3. If Applicant is under a corrective action plan with DCF (inclusive of its Divisions and Offices) or any other New Jersey State agency or authority, the Applicant may not submit a proposal for this RFP if written notice of such limitation has been provided to the Agency or authority. Responses shall not be reviewed and considered by DCF until all deficiencies listed in the corrective action plan have been eliminated and progress maintained to the satisfaction of DCF for the period of time as required by the written notice. 4. Applicants shall not be suspended, terminated or barred for deficiencies in performance of any award, and if applicable, all past issues must be resolved as demonstrated by written documentation. 5. Applicants that are presently under contract with DCF must be in compliance with the terms and conditions of their contract. 6. Where required, all applicants must hold current State licenses. 7. Applicants that are not governmental entities must have a governing body that provides oversight as is legally required. 8. Applicants must have the capability to uphold all administrative and operating standards as outlined in this document. 9. Applicants must have the ability to achieve full operational census within 60 days of contract execution. Further, where appropriate, applicants must execute sub-contracts with partnering entities within 30 days of contract execution. 10. All applicants must have a Data Universal Numbering System (DUNS) number. To acquire a DUNS number, contact the dedicated toll-free DUNS number request line at 1-866-705-5711 or inquire on- line at www.dnb.com 11. Any fiscally viable entity that meets the eligibility requirements, terms and conditions of the RFP, and the contracting rules and regulations set forth in the DCF Contract Policy and Information Manual (N.J.A.C. 10:3) may submit an application. F. RFP Schedule: September 27, 2017 Notice of Availability of Funds/RFP publication October 11, 2017 Deadline for Email Questions sent to DCFASKRFP@dcf.state.nj.us by 12:00PM November 15, 2017 Deadline for Receipt of Proposals by 12:00PM Proposals received after 12:00 PM on November 15, 2017 will not be considered. Applicants shall submit one (1) signed original and should submit one CD ROM as indicated below. file:///C:/Users/cschafer/AppData/Local/Microsoft/Windows/RFP/RFP%20POLICY%20and%20TEMPLATE/RFP%20%20Template%202013-16/www.dnb.com mailto:DCFASKRFP@dcf.state.nj.us 11 Proposals must be delivered either: 1) In person to: Catherine Schafer, Director of Grants Management, Auditing and Records Department of Children and Families 50 East State Street, 3rd floor Trenton, New Jersey 08625-0717 Please allow time for the elevator and access through the security guard. Applicants submitting proposals in person or by commercial carrier shall submit one (1) signed original and should submit one CD ROM with all documents. 2) Commercial Carrier (hand delivery, federal express or UPS) to: Catherine Schafer, Director of Grants Management, Auditing and Records Department of Children and Families 50 East State Street, 3rd floor Trenton, New Jersey 08625-0717 Applicants submitting proposals in person or by commercial carrier shall submit one (1) signed original and should submit one CD ROM with all documents. 3) Online: DCF offers the alternative for our bidders to submit proposals electronically. Only a registered Authorized Organization Representative (AOR) or the designated alternate is eligible to send in a submission by submitting an AOR form. AOR Registration forms and online training are available on our website at: www.nj.gov/dcf/providers/notices/ Forms are directly under the Notices section-See Standard Documents for RFPs  Submitting Requests for Proposal Electronically PowerPoint (pdf)  Registration for the Authorized Organization Representative (AOR) Form We recommend that you do not wait until the date of delivery in case there are technical difficulties during your submission. Registered AOR forms may be received 5 business days prior to the date the bid is due. http://www.nj.gov/dcf/providers/notices http://nj.gov/dcf/documents/notices/ElectronRFP.pdf http://nj.gov/dcf/providers/notices/AOR.doc http://nj.gov/dcf/providers/notices/AOR.doc 12 G. Administration: 1. Screening for Eligibility, Conformity and Completeness DCF will screen proposals for eligibility and conformity with the specifications set forth in this RFP. A preliminary review will be conducted to determine whether the application is eligible for evaluation or immediate rejection. The following criteria will be considered, where applicable, as part of the preliminary screening process: a. The application was received prior to the stated deadline b. The application is signed and authorized by the applicant’s Chief Executive Officer or equivalent c. The applicant attended the Bidders Conference (if required) d. The application is complete in its entirety, including all required attachments and appendices e. The application conforms to the specifications set forth in the RFP Upon completion of the initial screening, proposals meeting the requirements of the RFP will be distributed to the Proposal Evaluation Committee for its review and recommendations. Failure to meet the criteria outlined above, or the submission of incomplete or non- responsive applications constitutes grounds for immediate rejection of the proposal if such absence affects the ability of the committee to fairly judge the application. In order for a bid to be considered for award, at least one representative of the Bidder must have been present at the Bidders Conference, if required commencing at the time and in the place specified below. Failure to attend the Bidders Conference will result in automatic bid rejection. 2. Proposal Review Process DCF will convene a Proposal Evaluation Committee in accordance with existing regulation and policy. The Committee will review each application in accordance with the established criteria outlined in Section II of this document. All reviewers, voting and advisory, will complete a conflict of interest form. Those individuals with conflicts or the appearance of a conflict will be disqualified from participation in the review process. The voting members of the Proposal Evaluation Committee will review proposals, deliberate as a group, and then independently score applications to determine the final funding decisions. 13 The Department reserves the right to request that applicants present their proposal in person for final scoring. In the event of a tie in the scoring by the Committee, the bidders that are the subject of the tie will provide a presentation of their proposal to the evaluation committee. The evaluation committee will request specific information and/or specific questions to be answered during a presentation by the provider and a brief time-constrained presentation. The presentation will be scored out of 50 possible points, based on the following criteria and the highest score will be recommended for approval as the winning bidder. Requested information was covered- 10 Points Approach to the contract and program design was 20 Points thoroughly and clearly explained and was consistent with the RFP requirements- Background of organization and staffing explained- 10 Points Speakers were knowledgeable about topic- 5 Points Speakers responded well to questions - 5 Points The Department also reserves the right to reject any and all proposals when circumstances indicate that it is in its best interest to do so. The Department’s best interests in this context include, but are not limited to: State loss of funding for the contract; the inability of the applicant to provide adequate services; the applicant’s lack of good standing with the Department, and any indication, including solely an allegation, of misrepresentation of information and/or non-compliance with any State of New Jersey contracts, policies and procedures, or State and/or Federal laws and regulations. All applicants will be notified in writing of the Department’s intent to award a contract. 3. Special Requirements The successful Applicant shall maintain all documentation related to products, transactions or services under this contract for a period of five years from the date of final payment. Such records shall be made available to the New Jersey Office of the State Comptroller upon request. 14 Applicants must comply with the requirements of N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27, the State Affirmative Action policy. A copy is attached as Exhibit A. Applicants must comply with laws relating to Anti- Discrimination as attached as Exhibit B. H. Appeals: An appeal of the selection process will be heard only if it is alleged that the Department has violated a statutory or regulatory provision in awarding the grant. An appeal will not be heard based upon a challenge to the evaluation of a proposal. Applicants may appeal by submitting a written request to: Office of Legal Affairs Contract Appeals 50 East State Street 4th Floor Trenton NJ 08625 no later than ten (10) business days following receipt of the notification or by the deadline posted in this announcement. I. Post Award Review: As a courtesy, DCF may offer unsuccessful applicants an opportunity to review the Evaluation Committee’s rating of their individual proposals. All Post Award Reviews will be conducted by appointment. Applicants may request a Post Award Review by contacting: DCFASKRFP@dcf.state.nj.us Post Award Reviews will not be conducted after six months from the date of issuance of this RFP. J. Post Award Requirements: Selected applicants will be required to comply with the terms and conditions of the Department of Children and Families’ contracting rules and regulations as set forth in the Standard Language Document, the Contract Reimbursement Manual and the Contract Policy and Information Manual. Applicants may review these items via the Internet at www.nj.gov/dcf/providers/contracting/manuals mailto:dcfaskrfp@dcf.state.nj.us http://www.nj.gov/dcf/providers/contracting/manuals 15 Selected applicants will also be required to comply with all applicable State and Federal laws and statutes, assurances, certifications and regulations regarding funding. Upon receipt of the award announcement, and where appropriate, selected applicants will be minimally required to submit one (1) copy of the following documents: 1. A copy of the Acknowledgement of Receipt of the NJ State Policy and Procedures returned to the DCF Office of the EEO/AA 2. DCF Third Party Contract Reforms Attestation 3. Proof of Insurance naming DCF as additionally insured from agencies 4. Bonding Certificate 5. Notification of Licensed Public Accountant (NLPA) with a copy of Accountant’s Certification 6. ACH- Credit Authorization for automatic deposit (for new agencies only) The actual award of funds is contingent upon a successful Contract negotiation. If, during the negotiations, it is found that the selected Applicant is incapable of providing the services or has misrepresented any material fact or its ability to manage the program, the notice of intent to award may be rescinded. Section II – Application Instructions A. Proposal Requirements and Review Criteria: All applications will be evaluated and scored in accordance with the following criteria: The narrative portion of the proposal must be double-spaced with margins of 1 inch on the top and bottom and 1 inch on the left and right. The font shall be no smaller than 12 points in Arial or Times New Roman. There is a 25 page limitation for the narrative portion of the grant application. Page numbers must be used. A one (1) point reduction per page will be administered to proposals exceeding the page limit requirements. Five (5) points will be deducted for each missing document. If the deductions total 20 points or more, the proposal shall be rejected as non-responsive. The narrative must be organized appropriately and address the key concepts outlined in the RFP. Annex C budget pages, and attachments do not count towards the narrative page limit. 16 Proposals may be fastened by a heavy-duty binder clip. Do not submit proposals in loose-leaf binders, plastic sleeves, folders, or staples. Each proposal narrative must contain the following items organized by heading in the same order as presented below: 1) Agency Overview – (20 points)  Provide an overview of the agency’s vision, mission and strategic plan.  Describe the agency’s governance structure and its administrative, management and organizational capacity to enter into a third party direct State services contract with the Department of Children and Families. Note the existence (if any) of professional advisory boards that support the operations. Attach a current organizational chart as an appendix.  Describe your agency’s current programming. Indicate which services and/or programs are evidence-based/supported/trauma- informed.  Describe your experience working with DCF and CP&P and/or CSOC-involved families.  Describe your experience working with the Lead Domestic Violence Service Agency in the identified county.  Provide an indication of the agency’s demonstrated capability to provide services that are consistent with the Department’s goals and objectives for this program to be funded.  Provide an indication of the organization’s demonstrated commitment to cultural competency and diversity. Explain how the provider is working toward a cultural competency plan that describes actions your agency will take to insure that policies, materials, environment, recruitment, hiring, promotion, training and Board membership reflect the community or the intended recipients of the services you provide and promote the cultural competency of the organization and that resources and services will be provided in a way that is culturally sensitive and relevant.  As an Appendix, provide a brief (no more than 2 pages double spaced) Standards Description demonstrating ways in which your agency’s operations mirror Prevent Child Abuse New Jersey’s (PCA- NJ) Safe-Child Standards (“The Standards”). The Standards were endorsed by DCF in August 2013. They are a preventative tool for implementing policies and procedures for organizations working with youth and children and through their implementation, an organization can minimize the risks of the occurrence of child sexual abuse. The Standards are available at: http://www.state.nj.us/dcf/SafeChildStandards.pdf. http://www.state.nj.us/dcf/SafeChildStandards.pdf 17 2) TF-CBT FIT – (20 points)  Indicate how trauma treatment and support services fit into the organization’s vision and overall programming. Describe the senior leadership support for integrating or expanding TF-CBT services within the agency.  Describe the agency’s background and experience: o implementing TF-CBT. If your agency does not have experience implementing TF-CBT, please describe your agency’s experience implementing an evidence- based/supported model or providing therapy services to treat the impact of trauma and to support the child victims and caregiver(s) in developing healthy relationships. o supporting child victims of domestic violence. Describe the agency’s knowledge of existing domestic violence services available to children and families, particularly in the identified county. o using screening and assessing tools, including the UCLA PTSD Reaction Index and the CBCL, if applicable. 3) TF-CBT CAPACITY – (20 points)  Provide a statement that indicates the agency’s willingness to implement services as outlined in Section C.  Provide a detailed description of the agency’s approach, in the following areas: o Describe agency intake process. o Describe your plan for partnering and communicating with the referring agencies, which include the county’s Lead Domestic Violence Service Agency and CP&P local offices. o Describe procedures in place to address the needs of children whose screening and/or assessment indicate either no need for treatment services or a need for a higher level of treatment services. o Describe how families will be engaged and how barriers to participation in the program will be identified and addressed.  Program Accessibility – o Indicate hours and days that services will be available to clients. o Indicate geographic location(s) where services will be provided. Include a description of the space where services will be provided and how the space will be child- and family- friendly and handicapped accessible. Describe agency’s procedures/protocols to ensure the safety of all participants. 18 o Describe transportation options available to clients to reduce treatment barriers. Indicate the number of vehicles and staff that will be available to transport clients. Awarded provider(s) will need to provide valid inspection and maintenance records for all vehicles, and current driver licenses and proof of applicable training for all proposed drivers. o Describe plans to ensure childcare is provided for children whose caregivers are participating in therapy sessions. o Describe agency’s plans and/or procedures for cancellation and rescheduling of appointments. Discuss what strategies the agency will utilize with families and children to reduce the rate of cancellations and no shows and ensure children complete treatment.  Operational Timeline – o If an agency already has staff trained and/or certified in TF- CBT, provide an anticipated, realistic, feasible timeline for implementation of services. Attach a Program Implementation Schedule as part of the Appendix. If an agency needs to hire staff, provide an anticipated, realistic, feasible timeline for hiring.  Level of Service – Each awarded agency is expected to serve a minimum of 15 unduplicated children and their caregivers each year using the TF-CBT modality. If in the first year of this award agency staff will participate in TF-CBT Learning Collaborative, the expected level of service will be aligned with the training requirements of TF- CBT. Each therapist and supervisor is expected to provide TF-CBT treatment to at least three families as they engage in the Learning Collaborative. o Provide a statement that indicates the agency’s understanding of and agreement to all LOS requirements. o Once fully operational, specify how many unduplicated families your agency will have capacity to provide services to on a weekly basis. o Describe how the proposed program will meet the needs of various and diverse cultures within the target community based on the Law Against Discrimination (N.J.S.A. 10:51 et seq.). 4) TF-CBT RESOURCE AVAILABILITY – (20 points)  Staffing for TF-CBT – The applicant must provide a clear staffing plan outlining the following: o If the agency will be utilizing existing staff trained or certified in TF-CBT please indicate the number of staff and include resumes which provide TF-CBT training/certification details, in the appendices. 19 o If the agency will be utilizing other clinical staff not trained in TF-CBT, please indicate the number of staff and include resumes, in the appendices. o If an applicant needs assistance with expanding staff capacity to deliver TF-CBT services, indicate the number of therapists and if a supervisor will need to be hired. If staff need to be hired, provide job descriptions for each position that include all educational and experiential requirements, in the appendices. o Include an organizational chart for the proposed staffing model, in the appendices. o If the agency intends to subcontract any or all services, specify the name of the agency and provide a Memoranda of Understanding or Agreement detailing the agreement and agencies responsibilities.  Training and Consultation (Learning Collaborative) – o Participation in TF-CBT learning collaborative includes the involvement of at least one agency leader, clinicians, and at least one supervisor, who is the supervisor of the participating clinicians. Describe how this requirement will be met with any new or existing staff. o If staff are not currently TF-CBT certified, include a statement agreeing to have therapists and one supervisor along with a senior agency leader participate in the yearlong TF-CBT Learning Collaborative. DCF strongly encourages the agency to use this opportunity to train clinicians in TF-CBT. The agency is encouraged to include at least 3 clinicians in their TF-CBT program. Clinicians and supervisors will be required to provide direct treatment services. o Provide a statement that indicates the agency’s willingness to participate in all Learning Collaborative requirements as outlined in the attached TFCBT Training Application. o Include as an attachment a completed TF-CBT Training Application. Please note, for each staff that need to be hired, the agency will not be able to complete the clinician and/or supervisor application. Please indicate in that section under Applicant Name “To Be Hired”.  Teaming – o The agency shall agree to have at least two staff (including senior leader and supervisor) participate on implementation teams with DCF and existing trauma treatment and support services providers to support operations and evaluation, as needed. Please provide the name, title, email address, and phone number for all staff members identified to participate on implementation teams. The teams meet at least once/month, typically by phone for one hour. Please use the table below as a guide for providing this information. 20 Staffing Level Name Position/Title Email Phone Leadership Supervisor  Evaluation – o Describe how your agency currently monitors and/or evaluates staff and program performance. o Provide a statement agreeing to engage in a process of participatory, collaborative evaluation planning with DCF to finalize outcome indicators that the grantee will be responsible for reporting on and that DCF will be monitoring. o Describe the agency’s quality assurance and performance improvement processes and discuss how individuals served will have a meaningful role.  Data System – Describe how the organization collects maintains and uses any data collected. Include in the narrative responses to the following questions: o Is there a database system in the organization? If there is no existing database for the data, how do you collect data (i.e. excel spreadsheets)? o Who is responsible for collecting, inputting, analyzing and reporting the data? o How is the data used once analyzed? 5) Budget – (20 points)  Provide a 12-month operating budget. Include one-time, start-up costs on a separate schedule that identifies which anticipated accruals will support these costs.  The Department will consider the cost efficiency of the proposed budget as it relates to the anticipated level of services (LOS). Therefore, applicants must clearly indicate how this funding will be used to meet the project goals and/or requirements. Provide a line item budget and narrative for the proposed project/program. The narrative must be part of the 25 page proposal. The Budget forms are to be attached as an Appendix. The grantee is expected to adhere to all applicable State cost principles. Standard DCF Annex B (budget) 21 forms are available at: http://www.state.nj.us/dcf/providers/contracting/forms/ and a description of General and Administrative Costs are available at http://www.state.nj.us/dcf/providers/notices/.  The budget should be reasonable and reflect the scope of responsibilities required to accomplish the goals of this project. The budget should also reflect a 12 month operating schedule and must include, in separate columns, total funds needed for each line item. All costs associated with the completion of the project must be clearly delineated and the budget narrative must clearly articulate budget items, including a description of miscellaneous expenses or ―other items.  Applicants may request to use anticipated contract accruals to support one-time operational start-up costs. In support of the request, the applicant must submit a separate budget schedule that identifies the proposed one-time expenses and the line item that is the anticipated source of the accrual. The completed budget proposal must also include a detailed summary of and justification for any one- time operational start-up costs. These costs must be reflected on a separate schedule on the Attached Exhibit C. B. Supporting Documents: Applicants must submit a complete proposal signed and dated by the Chief Executive Officer or equivalent and should submit a CD ROM containing all the documents in PDF or Word format. There is a 25 page limitation for the narrative portion of the grant application. A one (1) point reduction per page will be administered to proposals exceeding the page limit requirements. Failure to submit any of the required documents requested in this RFP will result in a loss of five (5) points per item from the total points awarded for the proposal. All supporting documents submitted in response to this RFP must be organized in the following manner: Part I: Proposal 1 Proposal Cover Sheet (signed and dated) – Use the RFP forms found directly under the Notices section on Website: www.nj.gov/dcf/providers/notices/ Form: http://www.nj.gov/dcf/providers/notices/Proposal.Cover.Sheet.doc 2 Table of Contents – Please number and label with page numbers if possible in the order as stated in Part I: Proposal & Part II: Appendices for paper copies, CD, and electronic copies. 3 Proposal Narrative in following order: a. Agency Overview http://www.state.nj.us/dcf/providers/notices/ http://www.nj.gov/dcf/providers/notices/ http://www.nj.gov/dcf/providers/notices/Proposal.Cover.Sheet.doc 22 b. TF-CBT FIT c. TF-CBT CAPACITY d. TF-CBT RESOURCE AVAILABILITY e. Budget Part II: Appendices 4 Agency’s Current Organization Chart 5 Safe-Child Standards Description of your agency’s implementation of the standards (no more than 2 pages) 6 Resumes for existing staff, if applicable. Please do NOT provide home addresses or personal phone numbers. 7 Job descriptions for each position. Please include education and experiential requirements for each position. 8 Organization Chart for the agency’s proposed program 9 Proposed Program Implementation Schedule 10 Completed TF-CBT Training Application, if applicable. 11 Exhibit C Start Up Budget, if requesting start-up funds 12 DCF Annex B Budget Forms* 13 Applicable Consulting Contracts, Affiliation Agreements/Memoranda of Understanding related to this RFP. If not applicable, include a written statement. 14 Copy of agency’s Conflict of Interest policy Copies of any audits or reviews (including corrective action plans) completed or in process by DCF (inclusive of DCF Licensing, Divisions and Offices) or other State entities from 2014 to the present. If available, a corrective action plan should be provided and any other pertinent information that will explain or clarify the applicant’s position. If not applicable, include a written statement. Applicants are on notice that DCF may consider all materials in our records concerning audits, reviews or corrective active plans as part of the review process. 15 Dated List of Names of Board of Directors a. Titles, b. Address and c. Terms -or- Managing Partners, if an LLC or Partnership 16 Signed Standard Language Document (SLD) [Version: Rev. June 6, 2014] Form: http://www.nj.gov/dcf/documents/contract/forms/StandardLanguage.doc 17 Document showing Data Universal Numbering System (DUNS) Number [2006 Federal Accountability & Transparency Act (FFATA)] Website: http://www.dnb.com Helpline: 1-866-705-5711 18 System for Award Management (SAM) printout (or Renewal) showing "active" status (free of charge). Website: https://www.sam.gov/portal/public/SAM Helpline: 1-866-606-8220 http://www.nj.gov/dcf/documents/contract/forms/StandardLanguage.doc http://www.dnb.com/ https://www.sam.gov/portal/public/SAM 23 19 Business Associate Agreement/HIPAA, with signature under Business Associate [Version: Rev. 9-2013] Form: http://www.nj.gov/dcf/providers/contracting/forms/HIPAA.doc 20 Professional Licenses related to job responsibilities for this RFP. If not applicable, include a written statement. 21 Affirmative Action Certificate -or- Renewal Application [AA302] sent to Treasury Website: http://www.state.nj.us/treasury/purchase/forms.shtml Form: http://www.state.nj.us/treasury/purchase/forms/AA_%20Supplement.pdf 22 Certificate of Incorporation Website: http://www.nj.gov/treasury/revenue/filecerts.shtml 23 For Profit: NJ Business Registration Certificate with the Division of Revenue. See instructions for applicability to your organization. Website: http://www.nj.gov/njbusiness/registration/ If not applicable, include a written statement. 24 Agency By-laws or Management Operating Agreement if an LLC 25 Tax Exempt Certification Website: http://www.state.nj.us/treasury/taxation/exemption.shtml 26 Disclosure of Investigations & Other Actions Involving Bidder Form (signed and dated) (PDF) Form: http://www.state.nj.us/treasury/purchase/forms/DisclosureofInvestigations .pdf 27 Disclosure of Investment Activities in Iran (Signed and dated) (PDF) Form: http://www.state.nj.us/treasury/purchase/forms/DisclosureofInvestmentAct ivitiesinIran.pdf 28 For Profit: Statement of Bidder/Vendor Ownership Form (signed and dated) (PDF) See instructions for applicability to your organization. Form: http://www.state.nj.us/treasury/purchase/forms/OwnershipFinal12-14.pdf If not applicable, include a written statement 29 For Profit: Two-Year Chapter 51/Executive Order 117 Vendor Certification -and- Disclosure of Political Contributions (Signed and dated) [Version: Rev 4/17/15]. See instructions for applicability to your organization. Website: http://www.state.nj.us/treasury/purchase/forms.shtml If not applicable, include a written statement 30 Certification Regarding Debarment (Signed and dated) Form: http://www.state.nj.us/dcf/providers/notices/Cert.Debarment.pdf 31 Statement of Assurances (Signed and dated) - Use the RFP forms found directly under the Notices section: Website: www.nj.gov/dcf/providers/notices/ Form: http://www.nj.gov/dcf/providers/notices/Statement.of.Assurance.doc http://www.nj.gov/dcf/providers/contracting/forms/HIPAA.doc http://www.state.nj.us/treasury/purchase/forms.shtml http://www.state.nj.us/treasury/purchase/forms/AA_%20Supplement.pdf http://www.nj.gov/treasury/revenue/filecerts.shtml http://www.nj.gov/njbusiness/registration/ http://www.state.nj.us/treasury/taxation/exemption.shtml http://www.state.nj.us/treasury/purchase/forms/DisclosureofInvestigations.pdf http://www.state.nj.us/treasury/purchase/forms/DisclosureofInvestigations.pdf http://www.state.nj.us/treasury/purchase/forms/DisclosureofInvestmentActivitiesinIran.pdf http://www.state.nj.us/treasury/purchase/forms/DisclosureofInvestmentActivitiesinIran.pdf http://www.state.nj.us/treasury/purchase/forms/OwnershipFinal12-14.pdf http://www.state.nj.us/treasury/purchase/forms.shtml http://www.state.nj.us/dcf/providers/notices/Cert.Debarment.pdf http://www.nj.gov/dcf/providers/notices/ http://www.nj.gov/dcf/providers/notices/Statement.of.Assurance.doc 24 32 Tax Forms: Non Profit Form 990 Return of Organization Exempt from Income Tax - or- For Profit Form 1120 US Corporation Income Tax Return Standard forms for RFP’s are available at: www.nj.gov/dcf/providers/notices/ Forms for RFP’s are directly under the Notices section. * Standard DCF Annex B (budget) forms are available at: http://www.state.nj.us/dcf/providers/contracting/forms/ ** Treasury required forms are available on the Department of the Treasury website at http://www.state.nj.us/treasury/purchase/forms.shtml Click on Vendor Information and then on Forms. Standard Language Document, the Contract Reimbursement Manual and the Contract Policy and Information Manual may be reviewed via the Internet at: www.nj.gov/dcf/providers/contracting/manuals C. Requests for Information and Clarification DCF will provide eligible applicants additional and/or clarifying information about this initiative and application procedures through a time-limited electronic Question and Answer Period. Inquiries will not be accepted after the closing date of the Question and Answer Period. Questions must be submitted in writing via email to: DCFASKRFP@dcf.state.nj.us. Written questions must be directly tied to the RFP. Questions should be asked in consecutive order, from beginning to end, following the organization of the RFP. All inquiries submitted to DCFASKRFP@dcf.state.nj.us must identify, in the Subject heading, the specific RFP for which the question/clarification is being sought. Each question should begin by referencing the RFP page number and section number to which it relates. Written inquiries will be answered and posted on the DCF website as a written addendum to the RFP at: http://www.state.nj.us/dcf/providers/notices/. Technical inquiries about forms and other documents may be requested anytime through DCFASKRFP@dcf.state.nj.us. http://www.nj.gov/dcf/providers/notices http://www.state.nj.us/dcf/providers/contracting/forms/ http://www.state.nj.us/treasury/purchase/forms.shtml http://www.nj.gov/dcf/providers/contracting/manuals mailto:DCFASKRFP@dcf.state.nj.us http://www.state.nj.us/dcf/providers/notices/ mailto:DCFASKRFP@dcf.state.nj.us 25 All other types of inquiries will not be accepted. Applicants may not contact the Department directly, in person, or by telephone, concerning this RFP. 26 EXHIBIT A MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127) N.J.A.C. 17:27 GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS During the performance of this contract, the contractor agrees as follows: The contractor or subcontractor, where applicable, will not discriminate against any employee or applicant for employment because of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Except with respect to affectional or sexual orientation and gender identity or expression, the contractor will ensure that equal employment opportunity is afforded to such applicants in recruitment and employment, and that employees are treated during employment, without regard to their age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Such equal employment opportunity shall include, but not be limited to the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the Public Agency Compliance Officer setting forth provisions of this nondiscrimination clause. The contractor or subcontractor, where applicable will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. The contractor or subcontractor will send to each labor union, with which it has a collective bargaining agreement, a notice, to be provided by the agency contracting officer, advising the labor union of the contractor's commitments under this chapter and shall post copies of the notice in conspicuous places available to employees and applicants for employment. The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated by the Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time and the Americans with Disabilities Act. The contractor or subcontractor agrees to make good faith efforts to meet targeted county employment goals established in accordance with N.J.A.C. l7:27-5.2. 27 The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies including, but not limited to, employment agencies, placement bureaus, colleges, universities, and labor unions, that it does not discriminate on the basis of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, and that it will discontinue the use of any recruitment agency which engages in direct or indirect discriminatory practices. The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to assure that all personnel testing conforms with the principles of job‐related testing, as established by the statutes and court decisions of the State of New Jersey and as established by applicable Federal law and applicable Federal court decisions. In conforming with the targeted employment goals, the contractor or subcontractor agrees to review all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such actions are taken without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, consistent with the statutes and court decisions of the State of New Jersey, and applicable Federal law and applicable Federal court decisions. The contractor shall submit to the public agency, after notification of award but prior to execution of a goods and services contract, one of the following three documents: Letter of Federal Affirmative Action Plan Approval Certificate of Employee Information Report Employee Information Report Form AA302 (electronically available at ww.state.nj.us/treasury/contract_compliance). The contractor and its subcontractors shall furnish such reports or other documents to the Department of Children and Families, the Division of Purchase & Property, CCAU, EEO Monitoring Program as may be requested by the office from time to time in order to carry out the purposes of these regulations, and public agencies shall furnish such information as may be requested by the Department of Children and Families, the Division of Purchase & Property, CCAU, EEO Monitoring Program for conducting a compliance investigation pursuant to Subchapter 10 of the Administrative Code at N.J.A.C. 17:27. 28 EXHIBIT B TITLE 10. CIVIL RIGHTS CHAPTER 2. DISCRIMINATION IN EMPLOYMENT ON PUBLIC WORKS N.J. Stat. § 10:2-1 (2012) § 10:2-1. Antidiscrimination provisions Antidiscrimination provisions. Every contract for or on behalf of the State or any county or municipality or other political subdivision of the State, or any agency of or authority created by any of the foregoing, for the construction, alteration or repair of any public building or public work or for the acquisition of materials, equipment, supplies or services shall contain provisions by which the contractor agrees that: a. In the hiring of persons for the performance of work under this contract or any subcontract hereunder, or for the procurement, manufacture, assembling or furnishing of any such materials, equipment, supplies or services to be acquired under this contract, no contractor, nor any person acting on behalf of such contractor or subcontractor, shall, by reason of race, creed, color, national origin, ancestry, marital status, gender identity or expression, affectional or sexual orientation or sex, discriminate against any person who is qualified and available to perform the work to which the employment relates; b. No contractor, subcontractor, nor any person on his behalf shall, in any manner, discriminate against or intimidate any employee engaged in the performance of work under this contract or any subcontract hereunder, or engaged in the procurement, manufacture, assembling or furnishing of any such materials, equipment, supplies or services to be acquired under such contract, on account of race, creed, color, national origin, ancestry, marital status, gender identity or expression, affectional or sexual orientation or sex; c. There may be deducted from the amount payable to the contractor by the contracting public agency, under this contract, a penalty of $ 50.00 for each person for each calendar day during which such person is discriminated against or intimidated in violation of the provisions of the contract; and d. This contract may be canceled or terminated by the contracting public agency, and all money due or to become due hereunder may be forfeited, for any violation of this section of the contract occurring after notice to the contractor from the contracting public agency of any prior violation of this section of the contract. No provision in this section shall be construed to prevent a board of education from designating that a contract, subcontract or other means of procurement of goods, services, equipment or construction shall be awarded to a small business enterprise, minority business enterprise or a women's business enterprise pursuant to P.L.1985, c.490 (C.18A:18A-51 et seq.). 29 EXHIBIT C START UP/ONE TIME COSTS BUDGET CATEGORIES TOTAL COSTS START-UP FUNDING REQUEST A. Personnel - Salary (FTEs/hours/week) Fringe (% rate) B. Consultants & Professional Fees C. Materials & Supplies D. Facility Costs E. Specific Assistance to Clients F. Other G. Gen. & Adm. (G&A) Cost Allocation H. Total Operating Costs I. Equipment J. Total Cost K. Revenue (deduct)* ( ) L. Funding Request Other Sources of Funding for this Program: (Specify These) Other Funding Amounts: 0