Chicago Community COVID-19 Response Fund Application Questions + Instructions

Application Eligibility Questions Is your organization a 501c3 or fiscally sponsored by a 501c3? Yes/No

If fiscally sponsored how long has that relationship been in place? Please note that partnerships in existence for less than two years will not be considered for funding.

Are you providing direct emergency response services either in person or virtually? Yes/No

Application Organization Questions * 1. Organization Information

Executive Director/CEO Name:

Executive Director/CEO Email:

Address:

Address 2:

City/Town:

State/Province:

ZIP/Postal Code:

Primary Contact Name:

Primary Contact Email Address:

Primary Contact Phone Number:

* 2. Please list the addresses where you will be using the funds to provide emergency services other than your headquarters during the emergency response (street address, city, state, zip). Use N/A if you are providing services only from your headquarters. Separate each address onto a separate line.

* 3. How many individuals do you anticipate your organization will serve during the emergency response period?

* 4. Which age range(s) will your organization primarily serve in your COVID-19 emergency response? Select all that apply.

- < 5 - 5-18 - 19-24 - 25-34 - 35-44 - 45-59 - 60 and over

* 5. Please indicate the racial/ethnic background of the clients you expect to serve through your COVID-19 emergency response. Select all that apply.

- Hispanic/Latinx - Black or African American - Asian - American Indian or Alaskan Native - Middle Eastern - Native Hawaiian or Other Pacific Islander - Multiracial - White

* 6. Identify populations particularly vulnerable to the impact of COVID19 that you are serving in your emergency response. (select all that apply)

- Individuals with disabilities - Medically fragile individuals - Individuals or families experiencing homelessness or who are unstably housed - Homebound individuals - Aging Adults (over 60) - Undocumented individuals - Justice-involved individuals - Domestic violence survivors

* 7. Immediate Priority Area (Organizations may be providing services in several areas but please select one as your core area of expertise.)

- Access to Health Care - Stable Housing, Emergency Shelter & Supportive Services - Community Hubs Providing Emergency Supplies, Financial Assistance, or Outreach

* 8. Briefly describe your organization’s mission including its history addressing critical needs. (Please limit response to 300 words).

* 9. Describe the specific services will you provide with Chicago Community COVID-19 Response Funds. Organizations with a clear plan for emergency response to address critical needs will be prioritized. (Please limit response to 300 words).

* 10. Describe how your organization will conduct outreach and identify clients in need of emergency services. (Please limit response to 300 words).

*11. Describe how people can access your COVID-19 emergency response services. For instance, do people need to make an appointment by phone or online? (Please limit response to 300 words).*

*12. We recommend that eligibility requirements for emergency services are low-barrier and easy to access given the current pandemic. What, if any, eligibility criteria do you have that would disqualify someone from receiving your COVID-19 emergency response services? (Please limit response to 300 words).

* 13. If awarded, would your organization be able to provide the following information in a final report? Please select Yes or No for each prompt. Responses are for informational purposes only and will not impact your receipt of funding.

- How did you address the critical needs of residents of the Chicago region during the COVID-19 pandemic with the funds? What services did you provide?

- How did you use the funds (e.g., to support programs, general operations, purchase supplies)?

- What were the total number of people served through your organization's COVID-19 pandemic response?

- Will your data be disaggregated by race, gender and other key demographics as listed above? - Will you be able to provide examples of how your organization was able to better respond to

the COVID-19 pandemic due to the grant? - What are key learnings that will help to inform our response in the future? - What can funders do to better support your organizational mission especially during times of

crisis?

Application Media Contact Questions *14. In the interest of continuing to solicit donations to the Chicago COVID-19 Response Fund, we are doing extensive media outreach about the impact of the services being provided by the grant recipients.

Would your organization be willing to speak with media if the opportunity arises? Your response will not impact your receipt of funding.

Media Contact: Name, Email, Phone Number

Application Financial Questions Finance Contact Name:

Finance Contact Email Address:

Finance Contact Phone Number:

*15. How many days of cash do you have on hand?

*16. What is your average monthly cash on hand?

*17. What is your annual revenue?

*18. What was your latest audit opinion type?

- Unmodified

- Modified - Adverse - Going concern - Not applicable

*19. Are you aware of any instances of fraud or financial misappropriation of funds in the last 12 months? Please enter “Yes” or “No” in the text box. If “Yes,” please describe the situation and outcome

*20. Do you have any financial or legal covenants that are in default? Please enter “Yes” or “No” in text box. If “Yes,” please also provide a description and the remedy

Application Additional Funds Question * 21. If additional grants become available, would your agency have the ability to quickly spend new funds?

Application Geographic Service Area Questions *22. Does your organization’s emergency response serve residents in the City of Chicago?

- Yes/No - Please select the neighborhoods in the City of Chicago where you will be providing COVID-19

emergency response services.

*23. Will your organization provide emergency services to any municipalities in Cook County?

- Yes/No - Please select the municipalities in Cook County where you will be providing COVID-19

emergency response services.

*24. Will your organization provide emergency services to any municipalities in DuPage County?

- Yes/No - Please select the municipalities in DuPage County where you will be providing COVID-19

emergency response services.

*25. Will your organization provide emergency services to any municipalities in Kane County?

- Yes/No - Please select the municipalities in Kane County where you will be providing COVID-19

emergency response services.

*26. Will your organization provide emergency services to any municipalities in Kendall County?

- Yes/No - Please select the municipalities in Kendall County where you will be providing COVID-19

emergency response services.

*27. Will your organization provide emergency services to any municipalities in Lake County?

- Yes/No - Please select the municipalities in Lake County where you will be providing COVID-19

emergency response services.

*28. Will your organization provide emergency services to any municipalities in McHenry County?

- Yes/No - Please select the municipalities in McHenry County where you will be providing COVID-19

emergency response services.

- Yes/No - Please select the municipalities in Will County where you will be providing COVID-19

emergency response services.

Instructions for Completing the Application in eCImpact

Step 1:

Go to https://agency.e-cimpact.com/login.aspx?org=15085

- If you already have an account in e-CImpact, sign in using your existing agency credentials and skip to Step 5.

- If this is your first time accessing e-CImpact, follow the steps below to create an account.

Step 2:

Create a new e-CImpact account by clicking on the green box labeled “Click here to create a new e-CImpact account”

Step 3:

Follow the prompts to enter your agency’s EIN into the system

*29. Will your organization provide emergency services to any municipalities in Will County?

Step 4:

Once your EIN is entered, the Agency Registration will automatically populate your agency’s name. Please complete the registration by entering contact information for your agency, including a primary staff contact. The primary contact will receive all future communications through e-CImpact.

At the end of the Agency Registration page you will create your log in. This login is unique to each staff member. Use your email as your username.

Step 5:

Once on the home page, you can access the application by clicking on “Chicago Community COVID-19 Rapid Response Fund” on the left hand side of your screen in the Apply/Report section.

Step 6:

This will take you to the prequalification page. Please submit your information to qualify for the application process.

To qualify, your organization MUST be a 501c3 OR be fiscally sponsored by a 501c3 for at least two years. In addition, your organization must be providing emergency response services either in person or virtually.

Please complete this form and make your selections carefully. Agencies that are disqualified at this stage will not be able to complete the application.

Once you have completed your information, review and then select “Complete Registration” at the end of the page

Step 7:

You will now be able to access the application. You may do so by selecting “complete” or by returning to the main page and selecting “Response Fund Application” from the left hand side.

Step 8

You will now see the application in the center of the page. You may click on the Chicago Community COVID-19 Rapid Response Application to complete the application.

Step 9

When finished, you will have the ability to “SAVE MY WORK AND MARK AS COMPLETE.” Selecting this option will mark your application as complete and you will no longer be able to make changes.

Once the application is marked complete, you will be able to submit the application. You must select “Submit” to complete your application, otherwise it will be treated as incomplete and will not be reviewed.

QUESTIONS? Email chicagocovid19fund@liveunitedchicago.org