APPLICATION INSTRUCTIONS FOR

Veterans Mental Health Community-Based Organization Grant

WHEREAS, the United States Department of the Treasury (“Treasury Department”) has distributed to the Wisconsin Department of Administration (“DOA”) funds (“ARPA Funds”) from the Coronavirus State Fiscal Recovery Fund pursuant to 42 U.S.C. § 802, as added by section 9901 of the American Rescue Plan Act of 2021 (“ARPA”); and

WHEREAS, DOA is administering such funds through a variety of programs and initiatives, managed by state agencies and other entities; and,

WHEREAS, one of the state agencies that DOA has selected to manage the administration of a portion of these funds is the Wisconsin Department of Veterans Affairs (DVA); and,

WHEREAS, DVA will use these funds to accomplish four distinct initiatives consistent with its mission to work on behalf of Wisconsin’s veterans in recognition of their service and sacrifice to Wisconsin and the nation; and,

WHEREAS, one aspect of those initiatives is to support nonprofit organizations to promote mental health initiatives for veterans; and,

WHEREAS, DVA will grant up to $ 1,250,000 to nonprofit organizations to promote mental health initiatives for veterans; and,

WHEREAS, DVA will have at least two rounds in which DVA will award grants to nonprofit organizations to promote mental health initiatives for veterans. Nonprofit organizations are free to apply in each round and the total that a nonprofit organization is eligible to receive in all rounds will be up to $100,000 for the Veterans Mental Health Community-Based Organization Grant. Nonprofit organizations should understand that DVA has multiple grant opportunities and just because DVA does not select it for this grant does not mean that it could not be selected for a different grant; and,

WHEREAS, in this first round DVA will award up to $625,000 in grants to nonprofit organizations to promote mental health initiatives for veterans; and,

WHEREAS, in this first round each nonprofit organization awarded a grant is eligible to receive a grant up to $50,000 under this program; and,

To be eligible, a nonprofit organization must meet all the following:

Promote mental health initiatives for veterans. This means that the nonprofit organization awarded a grant will perform services to promote positive mental health and wellness programs through

activities, programs, and services that enhance emotional, psychological, and social well-being of Wisconsin veterans.

Be current on all federal and state tax obligations.

Be a financially viable nonprofit organization. A nonprofit organization is financially viable if it can meet its financial obligations as they become due for the duration of the grant period.

Is a 501(c)(3) nonprofit organization. If the latter, be registered and in current good standing with the Wisconsin Department of Financial Institutions (WDFI).

DVA requires applicants to provide the following documentation as part of its application for a Veterans Mental Health Community-Based Organization Grant:

Cover letter that includes a synopsis of the grant proposal and amount of grant funds requested.

IRS determination letter certifying the nonprofit organization applying for the grant is tax exempt under section 501(c)(3) of the Internal Revenue Code.

A WDFI Certificate of Status that certifies the applicant is registered as a nonprofit organization and in good standing with WDFI. DVA will not be responsible for ensuring this information is accurate and up to date. It is the responsibility of the applicant to provide the document showing they meet this requirement.

W-9 form that has been completed within the last 12 months.

Income statement, balance sheet, and statement of cash flows for the nonprofit applying for the grant for the most recent fiscal year.

Provide a detailed budget for the proposed project.

Most recent Annual Report or literature summarizing the organization’s programs.

An application that is complete and signed by an individual authorized to sign on behalf of the nonprofit organization.

The following requested information must be submitted with the application and in the order as listed below. The information provided for the seven (7) items below should be limited to no more than 2-pages typed for each item double spaced using 12-point Times New Roman font and margins no less than 1 inch on all sides of the paper.

Organizational experience providing mental health services to veterans: Please describe in detail your organization, organization’s mission, and goals, and how your organization’s program(s) or service(s) have supported or could support the need to provide mental health programs to Wisconsin veterans.

Stated purpose and objectives for the grant funds: Please describe in detail the program goals, initiatives, goals to be reached, and the methods to be employed to achieve the stated goals. Include how the grant will enable the nonprofit to perform services that promote positive mental health and wellness programs through activities, programs, and services that enhance emotional, psychological, and social well-being of Wisconsin veterans. Program goals and objectives should ensure they address the needs of underserved populations and underserved geographic areas of the state.

Budget clarity and justification (2-page typed limit for this item does not include the budget): Please describe in detail how the funding request addresses the need to provide mental health programs to veterans. Include a budget outlining the need and expenses to be incurred. Describe the services your organization will provide to veterans, advertising, target audience, additional sources of funding, expected challenges, and how they will be overcome.

Financial and operational monitoring: Please describe in detail the financial and operational controls your organization will have in place to ensure the proper use of grant funds and track use of those funds.

Outreach and Referral Plan to identify and assist Wisconsin veterans with mental health services: Please describe in detail your nonprofit organization’s plan to provide mental health programs to underserved populations or underserved geographic areas of Wisconsin. Include your plan for receiving participant referrals, how you will identify veterans for the program, and assess the needs of veterans. Additionally, please provide demographic information of the underserved populations you are going to serve or geographical locations you will be conducting outreach.

Program implementation timeline: Please describe in detail your implementation plan (who, what, where, when (timeline), and how) for providing services to Wisconsin veterans under this grant.

Evaluation plan for the project: Please describe how your nonprofit organization will monitor and evaluate program effectiveness and measure success. Include descriptions regarding how the nonprofit will attain data to track the number of veterans served and the impact of the services provided by the nonprofit to improve the mental health of these veterans.

IMPORTANT NOTICE: To be considered for a Veterans Mental Health Community-Based Organization Grant, the complete application, including all supporting documentation shall be submitted via email as follows:

The email, with all requested materials attached, must be received by 4:00 p.m. CST on May 31, 2023. The attachments included with the email must be in PDF format and clearly labeled and emailed to: vetsbenefitsgrants@dva.wisconsin.gov.

Applications that do not contain all the requested materials, as detailed above, will be considered incomplete and will not be evaluated. Submitting a prior incomplete application does not change the deadline. It is the sole responsibility of the applicant to ensure the application is submitted with all required materials and by the deadline. Previously submitted application materials will not be used to make a resubmission whole.

Questions Pertaining to this Grant:

All questions pertaining to this grant application may only be submitted in writing to: vetsbenefitsgrants@dva.wisconsin.gov. The email must include in the subject line “Veterans Mental Health Community-Based Organization Grant Application Question”. DVA will make every effort to respond to questions but is under no obligation to answer any question.

Grant Scoring and Evaluation

An Evaluation Committee will only be used if DVA receives sufficient applications such that the amount requested in all those applications would exceed the $625,000 limit to be awarded in this first round.

If Evaluation Committee is Used

The Evaluation Committee shall weigh the importance of each evaluation criterion by using a numerical point system based on the following point values from the following criteria:

Organizational experience providing mental health services to veterans. (up to 15 points)

Stated purpose and objectives for the grant funds, method, and timetable to expend the funds. (up to 30 points)

Budget clarity and justification. (up to 20 points)

Program implementation timeline. (up to 5 points)

Outreach and Referral Plan to identify and assist veterans to be aware of and participate in the activities, programs, and services meant to enhance the emotional, psychological, and social well-being of Wisconsin veterans. (up to 25 points)

Evaluation Plan for the project. (up to 5 points)

Using the evaluation criteria specified above, the Evaluation Committee will evaluate each application against each applicable criterion and assign points signifying the degree to which the application meets the criterion up to the maximum number of points. The total points assigned to the application for all applicable criteria will be the score for the application. The Evaluation Committee will numerically rank each application.

Please note that sending additional information not required for this application will not increase the applicant’s overall score. Scoring is strictly limited to the above outlined criteria.

PROGRAMS TO PROMOTE MENTAL HEALTH INITIATIVES FOR VETERANS

Organization Information

Name of Organization:
Legal Name, if Different:
Physical Street Address:	City:	State:	Zip:
Mailing Address (Include P.O. Box, if applicable):	City:	State:	Zip:
Additional Locations:
Contact Name: Mr. / Ms.	Executive Director: Mr. / Ms.
Email:	Telephone:
Fax No.	Website Address:
Federal Tax I.D. Number	Date of IRS 501(c)(3) Determination Letter:
WDFI Status in Good Standing as of:

Application Terms and Conditions

It is understood and agreed by the undersigned that:

The contents of this application will become contractual obligations if the applicant is awarded a grant.

By submitting this application, I certify to the best of my knowledge and belief, the information submitted is true and correct. The applicant understands that if funds are awarded, in addition to any other legal remedies, the funds awarded may be recouped at any time if it is later determined that any information submitted as part of this application was inaccurate or false.

All application materials must be submitted at the same time as the application. An application that does not have all requested materials, in order, will be considered an incomplete application, and will not be considered.

The applicant must submit a complete application by the deadline and submitting a prior incomplete application does not change the deadline. Previously submitted application materials will not be used to make a resubmission whole.

By submitting this application, I certify that the applicant is registered with the Wisconsin Department of Financial Institutions and in good standing as a 501(c)(3) nonprofit organization.

By submitting this application, I certify that the applicant will only use funds:

Solely consistent with the application requirements and the Grant Agreement.

For the payment or reimbursement of expenses which are reasonable, necessary, and properly assignable to the purposes of the approved grant. Any other use of grant funds is prohibited.

To purchase capital equipment but only if authorized in the grant award.

Grant funds are to be expended no later than one year from the date the Grant Agreement is fully executed and in accordance with all applicable laws, regulations, policies, and procedures of Wisconsin.

Grant funds may not exceed more than 50 percent of employee wages for staff hired or to support the program. A grantee may not use more than 50 percent of the grant funds for employee wages, compensation, travel, and related expenses assignable to the approved program.

The amount of a grant awarded to a nonprofit shall conform to all the following requirements:

A grant award for this first round may not exceed $50,000.

The amount of the grant shall be no more than what is requested by the applicant.

By submitting this application, I certify that the applicant has disclosed and will continue to disclose any occurrences or events that could have an adverse material impact on the project if that occurrence or event occurs prior to the awarding of the Grant. Adverse material impact includes, but is not limited to, loss of nonprofit status, lawsuits, criminal or civil actions, bankruptcy proceedings, regulatory interventions, or inadequate funding for the purposes listed in this grant application.

The applicant understands and acknowledges that all records pertaining to this Grant, including the contents of the grant application, submitted by the applicant are subject to Wisconsin Public Records law, Wis. Stat. §§ 19.31-19.39.

The Parties agree that the grant application may not be modified, altered, amended, or otherwise changed except upon written consent by DVA. Any proposed changes in this grant request as approved shall be submitted in writing by the applicant, and upon notification of approval by DVA, shall be deemed incorporated into and become part of its Veterans Mental Health Community-Based Organization Grant Application.

DVA reserves the right to cancel the awarding of this Grant in whole or in part without penalty for any reason.

The applicant agrees that as a grantee, it shall be bound by all of the terms contained in this application including, but not limited to, the Terms and Conditions for an Applicant Awarded a Grant immediately following its signature.

The person signing and submitting this grant application represents and warrants that he or she is duly authorized and has legal capacity to execute and deliver this grant application on behalf of the Applicant. The person signing and submitting this grant application represents, warrants, and certifies that the execution and delivery of the grant application has been duly authorized by the Applicant.

Signature	Date

Print Name and Title

Terms and Conditions for an Applicant Awarded a Grant

The following terms and conditions are only applicable should an applicant be awarded a Grant but does not include the entirety of requirements that will be applicable for use of the grant funds:

The Grantee understands that it must enter into a Grant Agreement with DVA that will be provided with the grant award letter. In addition to other requirements, the Grant Agreement will outline requirements pertaining to the Grantee providing Service Delivery Reports as part of the Grantee’s documentation of its work under the Grant. Funds will not be provided until the Grant Agreement is fully executed by all parties.

The Grantee’s use of grant funds shall be governed by the laws of the State of Wisconsin and the laws of the United States, including, without limitation the American Rescue Plan Act of 2021 (ARPA), the Interim Final Rule, and all other rules and regulations promulgated to implement ARPA. In addition, the Grantee shall be responsible for ensuring that its use of the ARPA funds allocated to it under this MOU complies with all applicable laws, rules, and regulations applicable to the use of ARPA funds.

The Grantee agrees the contents of this application, along with all material submitted in the applicant’s grant application, will be fully incorporated into the Grant Agreement.

Any grant funds awarded shall be paid by DVA to the Grantee via check.

The Grantee will assist DVA to provide reports regarding the use of the grant that the Legislature, DOA, or any other interested parties may require.

The Grantee will fully cooperate with any Open Records Request for records held by the Grant pertaining to the Grantee’s work pursuant to this Grant.

The Grantee shall maintain grant funds in a separate account subject to audit by DVA.

The Grantee agrees to maintain records as required by DVA concerning the expenditure of grant funds and agrees to cooperate fully in any review and audit of grant expenditures. In addition to any other legal remedies available to DVA, DVA may recoup any grant funds awarded if the Grantee does not comply with the audit.

For purposes of who the nonprofit organization awarded a grant may provide services to any servicemember who satisfies either of the following conditions:

Is serving in the national guard of any state or a reserve component of the U.S. armed forces.

Served on active duty in the U.S. armed forces, forces incorporated as part of the U.S. armed forces, a reserve component of the U.S. armed forces, or the national guard of any state and was discharged under conditions other than dishonorable.

All veterans served by this grant must be a current resident of Wisconsin.