HomeMy WebLinkAboutExhibit 6. 11 Vr u ream'IuL_utz T
v2005.2036 VOCA Grant Application - Technical Review Worksheet
r
U41 UO
Agency llama
Judicial (:'rouit.
Part 1, : Certification/Signature
s3entiai in!orrnation provided (Heim s ddrs,se; sign t
Notes;
Counties served;
Part 2. Agency Eligibility
s
ce
Type of agency identified (proof provided for private non profit/combination)
is 11e implernentirrg Agency provided?
is file purpose .provided?
is', the funding source chart completed?.
it' ether identified?
is the total shown correct?
If "the program currently receives VOCA funds, is the cash ,match indioeied?
If phis is .a new program, . is
p G , A r inirriurn of 25 fo pf.financlal support from non-federal sources
et own (refer also to part 10 as'e portion of this could Pie in•klnd match)
Description provided far federal funds (other than VOCA)
Q olicalr'cri No. V .5z.fit,
Notes
Port 3.. Victims Served/Types of Services
is the Victims to be served section completed ("other allowable) ?
Is the Types of services provided ("other" all • able),?
--Apiaile bl:e-Pdxes-cilecked-fogirat,,reecc rItt,igeocy:0C-Z4)'
Notes!
41U 41J1
.trru tLbNULLfriY
I-AbE Un/db
'Par17:teiterg of Support
Ar.ethe06 latter. inolOded frOm Other agencies which cfernonStrate support for their VOCA '
prbjeot ,erno-ar.e Iheyda'ted within ihe current year?
Notes:`.
Purl C. Certificate of Debarment
Is Certificate complete (agency na
Notes:
• •
Pirt 9..Butiget Section •
sr,
Yes
No NyA
drus, sig ed,
'Personnel,- Too' chart corro)eted.and 'correct?
Are. copies of job' dascripions-attacfled?
1111 Oblell Job fillee rnaton7 •
1111
Yes
Yes
,the'duties appear to be allowable based on the percent of fUnding requested?
If position is funded at < 10D% are allowable duties identified on position description?
'lee "chart" conipielad. for each position fisted? ,..;• •
• Are all benefit axpense$ allPwable?
Notes. ,
r1.13-iu cameoLJWfrt.
..h,
ftel 6.4-yL,,d„4,2 e_efryL4--ra_a44-44-_,:“
V P"C.,)(- I "1/1- hopt c ts? ,
3
4.1 W LS JS
£r r u kurirvu4 uuY
rraL.* abI ae
Aio
Technical review completed by:
Signature c reviewer #1/
Part sa, Budget Section continued
Summary • completed/correct?
Ire amounts rounded to nearest whole dollar?
Notes::
Part 1 O. Program Match
Notes!
is cOrrect match amount listed, based bpi the award request? •
program match description completed/correct?
funding source provided'?
Is cash or in -kind appropriatelyidentified?
is the correct budget category indicated?
Is the correct match amount listed, based on the narrative provided? 1,14,i
Are all match items allowable?
Are job descriptions provided for any match in the personnel category?
IYposition is reported at < 100% ere all•owabie duties identified on position description?
is an appropriate narrative provided for all Items listed in program match budget?
is the "chart" completed for any personnel positions?
)eel l`-h
/) /424, & ev .o D 4
e fflo
e.`Cd • Coca.
t h'. •
0 r
5