FY16 Cycle 2 (2018) YouthBuild USA OJJDP Mentoring Starter Funding Application: Identifying Information for RFP
All YouthBuild Accredited, Full and Provisional Affiliates Encouraged to Apply.

Due: September 29, 2017 (close of business)

Please make sure to only submit one response per program. Any other entries will not be counted or recorded. Before hitting submit on this form, please make sure to print this completed form to include with your program's proposal.

Are you a previously funded OJJDP YouthBuild USA Mentoring Program? *
If yes, stop here and go to the FY16 Cycle 2 (2018) YouthBuild USA OJJDP Mentoring Former Funding Application: Identifying Information for RFP. (If no, continue below)
Sponsoring Organization's Name (if applicable) *
If this does not apply, please write not applicable. If applicable, please type your answer.
Your answer
Sponsoring Organization's Address (if applicable) *
If this does not apply, please write not applicable. If applicable, please type your answer.
Your answer
Sponsoring Organization's City (if applicable) *
If this does not apply, please write not applicable. If applicable, please type your answer.
Your answer
Sponsoring Organization's State (if applicable) *
If this does not apply, please write not applicable. If applicable, please type your answer.
Your answer
Sponsoring Organization's Zip Code (if applicable) *
If this does not apply, please write not applicable. If applicable, please type your answer.
Your answer
Name of your YouthBuild Program *
Your answer
YouthBuild Program Address *
Your answer
City of your YouthBuild Program *
Your answer
State of your YouthBuild Program *
Your answer
Zip Code of your YouthBuild Program *
Your answer
Primary Contact Name for this application *
Your answer
Primary Contact Job Title for this application *
Your answer
Primary Contact Phone Number for this application *
Your answer
Primary Contact Email Address for this application *
Your answer
Executive Director Contact Name for this application *
Your answer
Executive Director Contact Phone Number for this application *
Your answer
Executive Director Contact Email Address for this application *
Your answer
Who is completing this application (include name, job title, and contact information)? *
If the information is different than the primary or executive director contact listed above, please list the information below in other.
DUNS Number *
Make sure this is a 9 digit number.
Your answer
EIN Number *
Make sure this is a 9 digit number.
Your answer
If you are currently receiving any YouthBuild grants, please list which ones and their start and end date: *
i.e. AMC 2016-2017, 2016 DOL grant
Your answer
Fiscal Point of Contact Name (for this grant): *
Your answer
Fiscal Point of Contact Job title (for this grant): *
Your answer
Fiscal Point of Contact Phone Number (for this grant): *
Your answer
Fiscal Point of Contact Email Address: *
Your answer
Please list your program's fiscal year: *
Your answer
Please list your YouthBuild program year: *
Your answer
Data Point of Contact Name (for this grant): *
Your answer
Data Point of Contact Job Title (for this grant): *
Your answer
Data Point of Contact Phone Number (for this grant): *
Your answer
Data Point of Contact Email Address: *
Your answer
Number of 16 year old young people enrolled in your program (based on most recent program year data, at time of enrollment). *
Please state in numeric form (ex: 12)
Your answer
Number of 17 year old young people enrolled in your program (based on most recent program year data, at time of enrollment). *
Please state in numeric form (ex:12)
Your answer
Does your program work with American Indian/Alaskan Native youth? *
If you answered Yes to the above question, please list how many of the youth are between the ages of 16-17. *
If you answered no, please type in n/a.
Your answer
Does your program have rolling admissions? *
If you have rolling admissions, please list the dates below next to other.
If you are part of a larger sponsoring organization, do you have its agreement/support for adding mentoring services? *
(If yes, a letter of support is required. Describe the type of support that will be provided by the sponsoring organization, including oversight and fiscal responsibility.) Please include this letter of support as an addendum to your proposal.
Please make sure to include your regular program fiscal audit (including A-133 component if applicable). If your organization has already submitted your most recent audit to another department at YouthBuild USA, select Other and specify. *
If your program is awarded, please list the name of the Mentoring Point of Contact who would be attending the YouthBuild Mentoring Track Days and the National Mentoring Summit in Washington, D.C. *
This event takes place January 23 - January 26, 2018. Ideally, the person attending on behalf of your program should be the Mentoring Coordinator or individual assisting with mentoring at your site.
Your answer
Email address for Mentoring Point of Contact you would like to send to the YouthBuild Mentoring Track Days and the National Mentoring Summit: *
Your answer
Phone number for Mentoring Point of Contact you would like to send to the YouthBuild Mentoring Track Days and the National Mentoring Summit: *
Your answer
Click the link below and read the FY16 Cycle 2 Starter Funding Application Attachment which contains Subawardee Programmatic, Data, Fiscal, and Additional Requirements,then certify you have read the material by checking yes below. This document goes in depth into the requirements of being an OJJDP Mentoring Funded Program. *
http://youthbuildmentoringalliance.org/webfm_send/936. By checking yes, this certifies you read and understand the material and are responsible for abiding by them.
Before submitting this Google form, print this completed document and include it with your RFP proposal submission. The RFP is available here: http://youthbuildmentoringalliance.org/webfm_send/942; make sure to include any required addendums. All RFPS should be emailed to ybmrfp@youthbuild.org. *
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