Request edit access
FY'27 Application for NICA Funds
The North Iowa Children's Alliance Early Childhood Area (NICA) Board has agreed to distribute the FY'27 Application for Early Childhood Iowa funds.  This will identify interested applicants for the Cerro Gordo, Hancock and Worth County service area. This survey will close on May 4th, 2026 at 4pm. Interested applicants who do NOT complete the survey by the deadline will be ineligible for funding consideration.

Please read the disclosures posted on our website at: https://nichildrensalliance.com/grant-opportunities

Sign in to Google to save your progress. Learn more
Email *
ORGANIZATIONAL INFORMATION
Contact Person Name / Title *
Contact Person Phone: *
Contact Person Email *
Name of Applicant Organization: *
Address (Street, State, and Zip):   *
Contract Manager (Name) 
The Contract Manger is the person responsible for overseeing contract compliance, administration and is authorized to sign contracts on behalf of the organization. 
Contract Manager (Title) 
Contract Manager (Email) 
Contract Manager (Phone #) 
Billing/Claims Manger (Name) 
The Billing Manager is responsible for preparing and submitting invoices and maintaining financial documentation in accordance with contract requirements 
Billing/Claims Manager (Title) 
Billing/Claims Manager (Email) 
Billing/Claims Manager (Phone) 
Program Manager (Name) 
The Program Manager is responsible for the day-to-day implementation, management, and reporting of the program to ensure services and outcomes are achieved. 
Program Manager (Title) 
Program Manager (Email) 
Program Manager (Phone # )
Organization Tax ID#: *
Is the applying organization a 501(c) 3? *
Organization Type: *
Required
Program Project, Program Impact & Connection to ECI 
Program Impact refers to the measurable effect a program has on the children, families, or early childhood systems it serves. It describes the changes, improvements, or benefits that occur as a result of the program's activities, services and interventions. 
Name of Project 
The North Iowa Children's Alliance Board completed a new Community Plan in 2022 and has selected the PRIORITIES listed below.  Which of these does your proposed program address? (Select all that apply) * *
Required
Estimated number of children to be served. 
Estimated number of families with children to be served. 
Quality Level of the Project (Check All That Apply) *
Required
If your program is not evidenced based or credentialed, what steps are you taking to becoming evidenced based?
The program will serve the residents from the following counties (check all that apply): *
Required
Provide a brief description of the program. When applicable, include information on curriculum and child assessments that will be used. Please keep this to 100 word maximum. *
A brief description on the number (children, families, parents, or providers) that will be served by the program utilizing ECI funds.   *
Identify the staffing plan for the proposed program. Specify if the program will hire new staff, and or utilize a portion of current staff hours. Identify any required qualifications for staff, including educational level, certification and experience. 
What are the specific needs of the population the program will be meeting? 
What are four primary objectives for your program? 
Describe the service delivery method for this program. Indicate timeframes for implementation. 
FINANCIAL INFORMATION
Programs that are approved will submit a line-item budget.  Budget must be completed using Excel and include categories of salaries/benefits, contract services, professional development, travel/mileage, supplies, miscellaneous, and administrative/indirect costs. Project Budget Form
Funding request from the North Iowa Children's Alliance Board.  (Ex. $10,000). Please use whole dollar amounts, no cents. *
What is the estimated amount of outside funds that will be used to support the program?  The NICA Board strongly encourages at least a 5% minimum match.  *
What is the source of outside funds that will be used to support the program? (Ex- United Way) 
The maximum allowable indirect rate is 15%.  If you have a federally negotiated indirect rate the maximum allowable indirect rate is still 15%.   *
If the program was funded in FY'26, are you proposing any program changes the Board needs to be aware of? What impact will the change have on the program or its participants?
How will your organization sustain this program if North Iowa Children's Alliance funding is no longer available? (Please keep to 100 words or less.) *
EARLY CHILDHOOD IOWA STATE ALIGNMENT
Applicants must fully understand their role within the state Early Childhood Iowa system.
Early Childhood Iowa has 5 State Result Areas. Which of these does your proposed program address? (Select all that apply) *  *
Required
All contracted programs are required by Early Childhood Iowa to report performance measures based on service types. Select ONE of the Service Types from which your program will be reporting. * See Tool O for service type descriptions and required performance measure data.  The Board reserves the right to choose an alternative service type.  *
NORTH IOWA CHILDREN'S ALLIANCE ALIGNMENT
Applicants must fully understand their role within the local Early Childhood Iowa system.
Quantify the expected outputs, quality efficiency measures, outcome measures, related to the service type outlined in Tool O. Provide specific numeric targets that will be used to evaluate program performance during the contract period.   *
Aside from state required performance measures, are there other measurers that you would like to provide in your semi-annual and annual report?  For example are there measures of the service that you provide, that if recorded in the semi-annual report would help show the local need for the program?  (i.e. Number of TA contacts, number of referrals for services provided, number of participants that show a change in knowledge or skill, number of children screened etc.  These are only examples.  Think of measurements that help the Board understand what the local ECI funds help provide.)  This question does not require an answer.
OPTIONAL:  If you have previously been funded by North Iowa Children's Alliance, please add an impact story or consumer narrative that reflects the positive impact ECI funding has on the program. *May be used in future marketing materials.
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report