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2. 
4. Human Services American Rescue Plan Act Grant Application Mental Health/Substance Abuse Programs

   We are accepting grant applications for American Rescue Plan Act (ARPA) for two categories:      

   Non-profit Social Service Programs and Mental Health/Substance Abuse Programs.  The Non-Profit Social Service Programs will not be handled through this application.

   We are seeking to fund programs that will support recovery in a manner that transforms our community.  Applicants are encouraged to consider addressing future needs and/or identifying a “niche” not already funded.

   The maximum amount of funds per agency cannot exceed $50,000.  If asking for less than the maximum, please use increments of $1,000, such as $5,000, $2,000, etc.

   Refer to the  Roanoke Valley Collective Response's “The Plan”: Blueprint for Action, a community-driven plan to abate the opioid and addiction crisis in the Roanoke Valley. Learn more: https://www.rvcollectiveresponse.org/resources

8. Agency Name*
10. Agency Address*
12. City*
13. State*
14. Zip Code*
16. Agency Phone Number*
17. Agency Fax Number*
19. Agency Website*
21. Executive Director Name*
23. Executive Director Contact Information*
25. 1. Tell us about the program you are proposing.*
27. 2. What is the amount of ARPA funds you are requesting to operate this program?*
29. 3. How does your proposal align with the Collective Response Blueprint? *
31. 4. What are the expected outcomes? *
33. * Please see reporting requirements below
35. REPORTING REQUIREMENTS

    Recipient will: 

    1. expend the Funding in accordance with the Purposes for costs incurred after the date of completing a memorandum of understanding with City staff; 
    2. maintain detailed records regarding all expenditures of the Funding; 
    3. provide quarterly status updates to the City of expending the funding by indicating the progress as: Not Started, completed less than 50 percent, completed 50 percent or more, or completed; and 
    4. deliver to the City an annual written report by December 1, 2022, and every December 1 thereafter, to _______________ at [email protected], indicating that Recipient has expended all of the Funding for the Purposes, including a narrative explaining how and on what expenses the Funding was spent. If the Funding will not be spent within one year, provide such report on an annual basis. The narrative must include the following:
       1. Demographics served through projects and services provided: ages, races, ethnicity, gender, city quadrant (NW, SE, SW, NE);
       2. Pictures pertaining to projects or services; and
       3. Anecdotal evidence/stories/testimony pertaining to projects or services.
       4. Key performance indicators identified by the recipient and mandated performance indicators identified by Treasury, and how the recipient plans to ensure that the given outcomes are achieved in an effective, efficient, and equitable manner. 
    5. Complete any form or report that the City may develop in the future and to provide any data, performance measures, outcomes, etc., to the City or to any party contracted by the City to collect such information.
    6. Agree to participate in any training or development activities associated with organization capacity building as provided by the City or to any party contracted by the City to collect such information.

    Recipient shall maintain all books, records, and other documents relating to Memorandum for five years after the date the Funding has been completely spent.

39. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
41. Electronic Signature*
43. Date / Time*
    Date / Time

    Date / Time
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