Grantmaker A_Offline Application Option_Competitive Awards_June 2024

OMB Control Number=2035.NEW, Expiration Date =mm/dd/yyyy

The use of this provided template is optional. EPA will not penalize or withhold a benefit from the respondent for providing the requested information in another format.

Thriving Communities Environmental Protection Agency Grant
Grantmaker A

To complete application:

• Create account by going to < application website > directly or through Grantmaker A’s website link

• Sign-up for an account on < application website > Enter email address for individual filling out application

• For assistance with < application website > use red question mark help icon on top right of their website or contact: < contact email for application website >

• For assistance with application contact: < contact email for Grantmaker A >

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I. Organization Information

1. Organization Name

   1. If Fiscally Sponsored please list your Fiscal Sponsor and the name of your project – Official applicant must be the Fiscal Sponsor

2. Entity Type

   1. 501c3

   2. 501c3 Fiscally Sponsored Project – Official applicant must be the Fiscal Sponsor

   3. Institutions of higher education

   4. Local governments

   5. Native American Organizations

   6. Tribal governments (both federally recognized and state-recognized) and Intertribal Consortia

   7. (Ineligible) None of the above – Individuals, For Profit Businesses, State Governments

3. Region

   1. Arizona

   2. California (Los Angeles County)

   3. California (Imperial, Orange, Riverside, San Bernadino, or San Diego County)

   4. Central or Northern California

   5. Nevada

   6. Hawai'i, American Samoa, U.S. Territory of Guam, the Commonwealth of the Northern Mariana Islands

   7. Federally or State recognized Tribes/Intertribal Consortia/Alaska Native/Native Hawaiian in AZ, CA, NV, or HI

   8. (Ineligible) Other – ineligible for R9 application

4. Brief Description of Applicant Organization

   1. Provide a brief description (100 words or less) of the applicant organization, including its mission and key ongoing projects and activities in which it is involved.

5. Mailing Address

   1. Country, Address, Address Line 2 (optional), City, State, Province or Region, Zip or Postal Code

6. Site Address (if different from address above)

   1. Country, Address, Address Line 2 (optional), City, State, Province or Region, Zip or Postal Code

7. Organization Phone number

8. Organization Website

9. Congressional District

10. Census Tract

11. Employer Identification Number

12. Unique Entity Identifier

    1. https://sam.gov/content/entity-registration

13. Do you operate as a 501(c)(3) or fall under the eligible subgrantee entities list?

14. Organizational Annual Budget (for current year or next year depending on timing of the grant release date)

15. Provide Income Statement for most recently completed fiscal year

16. Year organization founded

17. How many full-time equivalent employees (FTE) does your organization employ?

II. Contact Information

18. Primary Contact Name

    1. individual will be responsible for ongoing reporting and administration of this grant

1. Primary Contact Title

2. Primary Contact Phone Number

3. Primary Contact Email

19. Authorized Person Contact Name

    1. individual with signatory authority

1. Authorized Contact Phone Number

2. Authorized Contact Email

20. Other Contact Information

III. Project Phase

21. Which Project Phase Are You Applying for?

1. PHASE I - Assessment for up to $150,000 for a one-year project period

2. PHASE II - Planning for up to $250,000 for a one to two-year project period

3. PHASE III - Development for up to $350,000 for a two-year project period

4. PHASE I - Noncompetitive Fixed Amount Subaward

IV. Environmental Justice Issue(s) to Be Addressed

22. What are the local environmental/public health issue(s) that your project seeks to assess (Phase I) or address (Phase II and III)?

1. Air quality & asthma

2. Fence line air quality monitoring

3. Monitoring of effluent discharges from industrial facilities

4. Water quality & sampling

5. Small cleanup projects

6. Improving food access to reduce vehicle miles traveled

7. Stormwater issues and green infrastructure

8. Lead and asbestos contamination

9. Pesticides and other toxic substances

10. Healthy homes that are energy/water use efficient and not subject to indoor air

11. pollution

12. Illegal dumping activities, such as education, outreach, and small-scale clean-ups

13. Emergency preparedness and disaster resiliency

14. Environmental job training for occupations that reduce greenhouse gasses and

15. other air pollutants

16. Environmental justice training for youth

17. Other

22a. Other (please describe)

V. Impacted Communities

23. What is the target area and general characterization of the community your project will impact?

24. Describe communities within the target area: What are the area’s primary environmental justice challenges?

25. Using the EPA Inflation Reduction Act Disadvantaged Communities tool, or other Environmental Justice Mapping resources, what kinds of environmental and health burdens does the community face? (Projects MUST benefit people in disadvantaged communities as defined by the IRA map)

    1. Disadvantaged Area: Identified as Disadvantaged and above the 90th percentile in the following categories: Climate Change, Energy, Health, Housing, Legacy Pollution, Transportation, Water and Wastewater, Workforce Development

    2. Environmentally Burdened: At or above the 80 percentile in one or more Environmental Justice Index indicators: Particulate Matter 2.5, Ozone, Diesel particulate, Air Toxics Cancer Risk, Air Toxics Respiratory HI, Traffic Proximity, Lead Paint, Superfund Proximity, RMP Facility Proximity, Hazardous Waste Proximity, Underground Storage Tanks, Wastewater Discharge

    3. Rural Community

    4. Indigenous/Tribal Land

    5. Other

25a. Other (please describe)

1. EPA geoplatform screening tool: https://screeningtool.geoplatform.gov/en/#3/33.47/-97.5

2. Disadvantaged Communities webinar here: https://communitychangeta.org/webinar-recordings. They demonstrate how to make a map step-by-step.

3. Disadvantaged Community fact sheet here: https://communitychangeta.org/fact-sheets

4. Environmentally Burdened mapping link: https://ejscreen.epa.gov/mapper/

5. Rural Community health information link: https://www.ruralhealthinfo.org/am-i-rural and state specific tools

6. Indigenous/Tribal Land Tribal Directory Assessment Tool: https://egis.hud.gov/TDAT/

26. Are Indigenous/Tribal Communities impacted by your project?

    1. Yes

    2. No

26a. How will the project recognize and support Tribal-led Indigenous Knowledge

26b. Given the sensitivity of Indigenous Knowledge, how will this knowledge be appropriately handled?

26c. How does this project plan to involve local Indigenous/Tribal communities, address their priorities, and/or contribute to their economies?

26d. Describe what barriers will be removed to allow Indigenous/Tribal communities to engage with this project.

27. If your project impacts disadvantaged or environmentally burdened areas, briefly describe (250 words or less) the track record of your organization in working in disadvantaged and/or environmentally burdened areas.

VI. Project Plan, Goals, Outputs, and Outcomes

1. (Project Plan submission not to exceed 5 pages, single-spaced, 12-point font size, and 1-inch margins.)

28. Project description, goals, and community need for project

28a. Organizational history in the project community and capacity for completing the project

28b. How will the impacted community and/or community partners be involved in the

assessment (Phase I), planning (Phase II), or implementation (Phase III), and evaluation

of the project?

28c. Project Activities

28d. Project Schedule

28e. Outputs: Output means an environmental activity, effort, and/or associated work product related to an environmental goal or objective that will be produced or provided over a period of time or by a specified date. Outputs may be quantitative or qualitative but must be measurable during the funding period. Please list at least three outputs.

28f. Outcomes: Outcome means the result, effect or consequence that will occur from carrying out an environmental program or activity that relates to an environmental or

programmatic goal or objective. Outcomes may be environmental, behavioral,

health-related, or programmatic in nature; must be quantitative; and may not necessarily

be achievable within an assistance agreement funding period. Please list at least one each: short-term, intermediate, and long-term outcome.

1. Short-term (change in knowledge) – Example: Increase in number of residents that know about indoor asthma triggers (during project)

2. Intermediate (change in behavior) - Example: Increase in number of residents that install and routinely check their home indoor air monitor (6 - 12 months after project)

3. Long-term (change in conditions) – Example: Reduction in asthma rates among community residents (2+ years after project)

VII. Performance Measurement Plan

29. How will you determine whether your project has achieved its intended outputs and outcomes? Consider what your data source will be (e.g., people, existing records, observation, etc.) and how you will collect the data (e.g., observing behavior changes, administering pre- and post-tests). Describe up to three indicators.

30. What support do you need from Thriving Communities Technical Assistance Centers (TCTACs) or technical assistance would be helpful to facilitate your ability to report on these outputs and outcomes?

VIII. Budget and Expense Tracking

31. Basic budget form will be provided for the applicant to ensure it aligns with the overall expense tracking plan.

32. Is this your first Federal grant?

    1. Yes

    2. No

33. How will you manage tracking expenses and invoices?

34. Thriving Communities Grant Draft Budget

    1. Please use template to complete Draft Budget or upload external file in next submission field

34a. Thriving Communities Grant Draft Budget Upload

9. If not using template above please upload your Draft Budget file here.

IX. Approval to Submit Application

35. Please enter the name and title of the individual submitting this application.

36. Does your organizational leadership approve the submission of this application?

    1. Yes

    2. No

X. Other Information

37. Does the organization need additional support or technical assistance for technical and financial matters (invoicing, reporting, etc.) to manage the award effectively?

1. Yes

2. No

37a. If yes, please describe needs.

38. Please describe the group that governs your organization.

    1. Board of Directors

    2. Indigenous/Tribal Council

    3. Other

38a. Please list the members of your board of directors

38b. Please list the members of your the Indigenous/Tribal Council

38c. Please describe the group that governs your organization and list members (if

applicable)

39. Please describe the geographic region(s) where your organization does its work.

40. Briefly describe (100 words or less) how this grant impacts your organization’s ability to accomplish its mission.

41. How did you hear about this subgrant opportunity?

1. In-person Outreach Event

2. Virtual Webinar

3. Social Media

4. Radio / TV

5. Newspaper

6. Other

41a. Other (please describe)

1