2013 Youth Learning Application - Dell



Powering the Possible North America Application for Academic Year 2013-2014Dear Potential Powering the Possible grant recipient:Powering the Possible is Dell's commitment to put technology and expertise to work, where it can do the most good for people and the planet. Dell Powering the Possible focuses on four areas of giving including learning, children’s cancer care, disaster relief and social entrepreneurship. Dell Powering the Possible is designed to give others the power to do more through a combination of Dell technology & solutions, resources and know-how.Dell believes that access to education and technology is not a luxury, but a necessity. That’s why we work directly with communities and nonprofit organizations around the world to close the learning gap and give young people the power to discover better possibilities.Our initiatives to support learning empower youth by providing access to Dell technology and providing training in information & communications technology skills – all focused on improving, enhancing and jumpstarting learning for life. By placing state-of-the-art technology into underserved communities and working with non-profit organizations our action helps young people discover new possibilities, change their lives and unleash their true potential.We are seeking your application for consideration as a qualified partner for the academic year starting August 1, 2013 through July 31, 2014. Powering the Possible Sessions – Join these information sessions to learn more about our grants and Dell educational technology solutions.Dell Powering the Possible – Orientation Session 1 Join us for a Webinar on April 3 at 1 – 2 pm CDTSpace is limited.Reserve your Webinar seat now at: registering you will receive a confirmation email containing information about joining the Webinar.Dell Powering the Possible – Orientation Session 2Join us for a Webinar on April 16 from 2:30 – 3:30 pm CDTSpace is limited.Reserve your Webinar seat now at: After registering you will receive a confirmation email containing information about joining the WebinarDell Educational Technology Solutions Overview – Next General Learning PlatformJoin us for a Webinar on Tuesday, April 9 from 12 noon – 1 pm CDTSpace is limited.Reserve your Webinar seat now at: registering you will receive a confirmation email containing information about joining the Webinar.Dell Educational Technology Solutions Overview – Dell Tablets and Microsoft Windows 8Join us for a Webinar on Wednesday, April 10 from 12 noon to 1 pm CDTSpace is limited.Reserve your Webinar seat now at: registering you will receive a confirmation email containing information about joining the Webinar.Office HoursIf you have additional questions about the application process, Michele Glaze will host office hours where you may call-in and on a first-come, first-serve basis ask questions. The office hours only last for those who call-in on time.Participants should dial: 866-335-5847 toll free or 512-335-5101 and enter passcode 7509534234 then #Tuesday, April 16 at 5 pm CentralTuesday, April 30 at 12 noon Central Submission ProcessPlease complete and return only the application portion of this form completed in full. Submit via email to michele_glaze@ no later than May 1, 2013, midnight PST. It is important that one email be sent with all required and supporting materials. It is also preferable that links be provided for supporting materials to a Dropbox account (free) for any total email files that are 5MB or larger. The name of your agency must be included in the subject line of your email.When requesting Dell technology services, solutions or products, you are required to create an online cart through and submit your cart as part of the application process. All technology services, solutions or product donations will be made through our in-kind process and will be as near to the fair market value of your request.Requests should be up to $50,000 total in cash and in-kind requests.Responses should be in an 11-point font size. Your responses, unless clearly stated, may be any length.If at any time through the process additional information or clarification is required, you will be contacted directly. Additional information could include formal presentations, updates to increase/decrease budgets and programs, clarification on logic model, employee engagement process and more.Final decisions will be communicated no later than August 1. In-kind product donations and cash contributions will be coordinated and distributed to charities no later than September 1.Any Dell technology, solution or service may be used to accomplish the work of your program. Strong consideration will be provided to organizations who are requesting more than half of their funding for Dell technology, solutions or services. New partners are required to request at least 50 percent of their request as in-kind technology donation.CriteriaThe following criteria will be considered in the selection of a learning partner: Program funding and all funding, and/or in-kind contributions must be for direct programs (see exclusion list below). There is no minimum request and the maximum you can request is $50,000.Only qualified registered 501(c)3 public charities or international equivalent with high-quality programs and services, well-defined goals, financial stability, a strong model of assessing and determining impact, technology savvy, innovation, educational leadership, a proven record of maximizing available resources, and a reputation for reporting outstanding success metrics are eligible to apply. Organizations are required to complete and submit the attached application and additional requirements in full by the designated deadline per published guidelines.Program need to serve one of the following Dell workforce communities: Communities with a significant Dell presence include (as of 2013): Atlanta, Ga.; Buffalo Grove/Peoria, Ill.; Austin/Round Rock, Tex.; Quincy/Wellesley, MA; Dearborn, Michigan; Eden Prairie/Edina, Minn.; Lincoln, Neb.; Nashua, N.H.; Nashville, Tenn.; Plano/North Texas, Tex; Providence, RI; Oklahoma City; Fairfax/Reston, Va.; San Jose/Alison Viejo/Silicon Valley, Calif. Note: Any organization from any community may apply but will need to demonstrate a strong commitment and success regarding employee engagement.Programs must focus on an underserved population as at least 70 percent of their total population. An underserved population refers to populations which are disadvantaged because of ability to pay or other disparities for reasons of race, culture, disability, language group, gender or social status. Programs must serve the most needy. Most needy may vary by region, but is typically defined by the poorest of an underserved population.Programs should demonstrate a capability to be sustained if/when grant support endsOrganization must provide programs and services to youth up to 23 years of age as at least 70 percent of their total program population or focus on teacher training to affect youth of which 70 percent or more are 23 and younger. Program must exclusively leverage Dell technology, services and/or technology solutions or Dell Next Generation Learning solutions including, but not limited to, instructional technology (Connected Classroom), professional learning, Education Data Management, Mobile Learning, Efficient IT planning, Assistive Technology solutions and more. Strong consideration will be given for programs that include Dell’s Latitude 10.1 tabletStrong consideration will be given to organizations that demonstrate employee engagement. Organization’s program must be in an urban area near significant Dell population for employee engagement. Near is generally defined as it takes a Dell team member approximately an hour or less to travel to volunteer location or can participate in volunteering through virtual opportunities.GRANT REQUIREMENTSFunding requests cannot exceed 20 percent of an organization's total annual operating budget.Grants must remain under the financial control of the applying organization and not be re-granted in any way to another charitable or for-profit organization or to individuals.These are single-year partnership grants for August 2013 through July 2014 academic school year and require two reports (mid-year and final) which measure success to objectives. The format for the reporting will include a narrative, budget and outcomes scorecard. Your agency will be required to report qualitative and quantitative program metrics.Selected recipients are required to assign an English-speaking program manager to work with the Dell Strategic Giving manager.Charities must be willing to sign a legal logo license, grant agreement, affirmations & declarations and participate in regular Dell meetings. All applications and supporting materials must be in English and it is the responsibility of the charity to do so.Dell Giving grants do not extend to: Any organization that is not a 501(c)3 public charity or international equivalent including any other 501c status or entities with a 170 status.IndividualsPrivate foundations or donor-advised fundsCapital campaigns, endowments, and annual general operationsSports events and organizations Political activities, causes, candidates, organizations, campaigns and lobbying effortsProposals that fall outside of our stated funding areaDell will not provide a charitable gift to any non-profit organization that discriminates on the basis of a person's race, political orientation, religion, gender, sexual orientation, HIV status, age, national origin, ethnicity, ancestry, marital status, veteran status, mental or physical disability, or any other status prohibited by applicable law. Charitable donations may not be made to non-profit organizations that promote religion. Faith-based programs may be eligible if beneficiaries are not encouraged to learn about, adhere to, or convert to doctrine and only if the organization can verify through readily available public documents that the program: is open to people of any faith or of no faithdoes not subject participants to proselytizing requires no participation in religious activitiesContact information:Michele Glaze, Strategic Giving Managermichele_glaze@Powering the Possible Application for Youth LearningCONTACT INFORMATIONAre multiple organizations applying? If so, please submit separate information where applicable for each organization. Legal Name of Primary OrganizationAddressCityStateZipWebsiteEINContacts for Primary Organization (required)NameEmail Address Phone w/Country, Area CodeExecutive DirectorGrant CoordinatorVolunteer CoordinatorMarketing/Communications Program CoordinatorDell Team Member/Advocate PROGRAM OVERVIEWProgram title: __Provide a concise overview of the program in 100 words or less:What is the learning opportunity your program is addressing?Please describe how this program serves the most needy and/or an underserved community:Why is your organization the most qualified to address this learning opportunity?Primary location(s) for program (List specific name of center/school, including physical addresses and contact information).Program LocationsProgram Location NameAddressCityStateZipContact NameContact EmailWhat Dell technology, service and/or Dell solution will you leverage for this program?What other technology programs are you using for this program and will this grant displace these?Estimate your needs below, but you are required to submit a Dell Cart from as an attachment.Laptops/UltrabooksDesktops/ WorkstationsTablets Server/StorageOther Solution/ServicesEstimated CostIMPACTWill more than 70% of participants in the program be 23 years or younger or on teacher training to affect youth of which 70 percent are 23 and younger? Number of Youth ServedNumber of Teachers servedWill more than 70% of participants in the program be underserved? Please quantify the gender, and ages of the children impacted by the program in the below tables (Use raw numbers) Proposed IMPACT (Aug 1, 2013 – July 31, 2014) Insert Charity Name?Total Youth ImpactGirlsBoysPreKElementaryMiddle High SchoolOut of HSNot in schoolPlease quantify the following metrics on your proposed program as these will be tracked for reporting purposes.Learning ImpactTotal Number of Students ImpactedIndirect number of students impactedIndirect number of students impactedEducators ImpactedNumber of hours of educators trainedNumber of hours of student learning Average Cost per Child of your programTotal Program BudgetPlease quantify the following metrics on your proposed program as these will be tracked for reporting purposesAfrican AmericansHispanicDisabilitiesWhich Dell workforce community does this program serve (include State/Province, County and/or City names):How do you plan to measure your success?Describe how the program will ensure it is sustainable if/when philanthropic support ends Please outline your program’s logic model and include 5-6 Outputs and 3-4 Outcomes for your program, as well as short-term and longer-term Impact. Please be SMART – specific, measurable, achievable, realistic and within a timeframe and include specific number of activities related to technology literacy, collaboration, communications, critical thinking or problem solving as these will be required for reporting purposes.Resources/InputsActivities/ActionsOutputsOutcomesImpactEMPLOYEE ENGAGEMENTDescribe Dell employee community service engagement with your organization during the calendar years of 2012 and 2013. If possible quantify number of team members, hours and projects.List any past or current Dell employees who serve/have served on the organization’s board.Outline a six month plan for engaging 100 Dell team members with your organization and this program.FINANCIAL & GOVERNANCEHas this organization received a grant from Dell before? If yes, list date(s) and dollar amounts.Total program cost in US dollars $_________________________Total grant request from Dell, in US dollars: $_________________________Amount requested in cash, in US dollars$_________________________Amount requested in Dell product, in US dollars (provide Dell product quote per online cart) $_________________________Amount requested in Dell services, in US dollars (provide Dell services quote per online cart) $_________________________Please attach an itemized project budget and indicate items that would be underwritten by this grant per the attached budget worksheet.If applicable, list other project funding plete and attach the Affirmations and Declarations document. Please attach your organization’s most recent Audit of Financial Statements. If no audit, please submit most recent two years of Certified Financial Review.Please attach your agency’s IRS 990 Tax Returns for the most recent year. Please attach your Year-End Financial Statements for most recently completed fiscal year (Balance Sheet and P&L Statement). List of Board Members (name, affiliation and address): Please place an * next to or bold highlight Dell employees.Total number of staff members:List of top five key employees of your organization (name, title, address and email):Please describe the involvement of any other key stakeholders (e.g. local leaders/businesses, local/state/national members of legislatures, parents, Community Members).Are any of your officers, key employees or directors public officials?? If yes, has the organization had any transactions or other dealings with the government body with which this official is associated? If so, please describe.General informationPlease provide us with any additional information that you deem vital to our review of your application (i.e. cover letter, recommendation letters, additional program information, etc.) This can be sent along with your application in one ernance QuestionsGovernance QuestionsYesNo1. Is your agency a religious organization?2. Does your organization do business with people or organizations that aid or support, any entities or individuals on the anti-terrorist watch lists3. Is your organization government-sponsored or government related? If yes, please describe involvement in terms of funding and management. 4. Will your organization undertake reasonable steps to continually ensure that the funds will not ultimately support terrorist organizations5. If funded will this grant remain under the financial control of the applying organization and not be re-granted in any way?6. Are you seeking funds to train or promote religious doctrine?7. Are all of your organizations services inclusive and barrier free? 8. Will the assets of your charity in the event of a dissolution (i.e.: ceasing to function) be managed according to the policies of the IRS?9. Are any of your incomes or assets distributed to, or applied to the benefit of, a private person or for-profit organization, other than the beneficiaries of your charitable purpose?10. Do any individuals or for-profit enterprises own any part of your organization’s income or assets?11. Does your organization participate or intervene, directly or indirectly, in any political campaign for or against any candidate for public office? 12. Does your organization attempt to influence legislation?15. Has your organization changed executive directors in the last six months?16. Will any portion of the grant be used for tuition, medical expenses, or other economic benefits to a donor or any member of a donor’s family?17. Does any key staff member have a direct relationship with a Dell employee? If yes, please disclose.18. Does the organization ensure that it follows all county, city, state and federal laws of the United States of America?19. Does this project serve populations in, or does your organization do business with, people or entities located in Cuba, Iran, North Korea, Sudan, or Syria? Please provide additional explanation of any of the above questions here: End of application.Send proposal, project budget and attachments included in one email to:Michele Glaze, Strategic Giving Managermichele_glaze@Do not change the Application or Budget forms in any way.Please save and/or rename and number all of your files with these titles and these formats ONLY. Include the number in the name of the documentIt is also preferable that links be provided for supporting materials to a Dropbox account (free) for any total email files that are 5MB or larger1…(Agency Name) Youth Learning FY14 application (Save as Word)2…(Agency Name) Youth Learning FY14 grant agreement (Save as .pdf)3…(Agency Name) Youth Learning FY14 online cart (Save as .pdf)4…(Agency Name) Youth Learning FY14 affirmations and declarations (Save as .pdf)5…(Agency Name) Youth Learning FY14 budget (Save as Excel)6…(Agency Name) Youth Learning IRS 990 (Save as .pdf)7…(Agency Name) Youth Learning Audit (Save as .pdf)8…(Agency Name) Youth Learning Year End Financials (Save as Excel or .pdf)9…(Agency Name) Youth Learning (insert descriptor here)10…(Agency Name) Youth Learning (insert descriptor here)Attachment A: Affirmations and DeclarationsThis form must be completed by the Executive Director, President, or Chief Financial Officer of the organization applying for a Dell Inc. grant. Part I. Affirmation of Non-DiscriminationYour organization must not advocate, support, or practice activities that discriminate based on race, color, religion, gender, gender identity or expression, sexual orientation, national origin, disability, age or status as a protected veteran. Documentation demonstrating that the not-for-profit organization complies with the above statement may be required. (Please check one)( ___) Yes, we affirm the policy.(___) No, we do not affirm the policy and understand that the grant will not be forthcoming.Part II. Affirmation of Patriot Act ComplianceThe grantee certifies that it does not and will not deal with any individuals, entities, or groups subject to sanctions Regulations issued by the U.S. Treasury Department, Office of Foreign Assets Control (“OFAC”) or any other persons known to the grantee to support terrorism or to have violated OFAC sanctions.(Please check one)(___) Yes, we affirm the policy.(___) No, we do not affirm the policy and understand that the grant will not be forthcoming.Part III. Privacy ComplianceThe grantee represents and warrants that it has the applicable approvals of the parties named to provide the names and addresses requested above to Dell and that providing such does not violate the privacy or other proprietary rights of any person under the laws of the jurisdiction where grantee is located.(Please check one)(___) Yes, we affirm the policy.(___) No, we do not affirm the policy and understand that the grant will not be forthcoming.Part IV. Affirmation of Compliance with country specific registrationThe grantee has obtained appropriate registration as required by the country they reside in, declaring compliance with all laws and regulations applicable, including but not limited to: (i) provisions contained in the Argentinean Civil Code; (ii) tax laws and regulations; (iii) applicable registration provisions; (iv) Law 25,246 (as amended) regarding Concealment and Laundering of Proceeds of Crime, and other related legislation, such as Law 26,268 regarding Terrorist Criminal Associations and Financing of Terrorism; (v) exchange and Import/Export laws and regulations; and, (V) other laws applicable to specific situations. If the grantee is located outside the country the grant will be used in, the grantee shall not use the proceeds of the grant to make grants to other organizations in country, unless it has certified that the recipient has obtained appropriate registration under and provides a copy of such registration. The grantee further confirms that the grant will not be allocated for any religious or political purposes.(Please check one)(___) Yes, we affirm the policy.(___) No, we do not affirm the policy and understand that the grant will not be forthcoming.Name of Applicant OrganizationFederal Identification Number(Please provide this information)Address (street, city or town, state and zip code)Authorizer’s Name (please print)Authorizer’s signature (Must be an officer level)Title/DateDELL GIVING CHARITABLE GRANT AGREEMENTThis Dell Giving Grant Agreement (this “Agreement”) is executed by ______________ (“Recipient”) in connection with a charitable Grant of funds and/or equipment (the “Grant”) being made by ____________ (“Dell”), to Recipient. As a condition to receiving the Grant, Recipient represents, warrants, and agrees with Dell as set forth in this Agreement.1.Recipient shall use the Grant only as set forth in the application., and shall not use or permit any other individual, organization, or entity to use the Grant or any proceeds from the Grant, for any other use without prior approval.2.In particular, Recipient will not use the Grant for the support of any terrorist organization as such term is defined by the United States (U.S.) Department of State (see ), the U.S. Department of the Treasury (see ) or the United Nations Security Council and adopted by the United Nations (see sanctions list.shtml). Recipient will also undertake reasonable steps to see that in the future the Grant will not be used to support any such terrorist organization.3.If Recipient is not able to use the Grant as described in the application because of dissolution, illness, or any other reason, Recipient will promptly return to Dell the Grant, or any portion of the Grant that remains in the control of Recipient.4.Recipient is not an individual, entity, or organization subject to any limitations on Grants made to the public sector (e.g., a holder of public office; an employee of a local, state or federal government agency; or a local, state or federal government agency).5.Recipient is required to get advance permission for each use of the Dell logo and/or discussion of the program with the media, including a press release. Other than stating that Recipient received an unspecified Grant from Dell, Recipient may not disclose the amount of the Grant without advanced permission by Dell. Recipient will be required to attend a one hour information session and will be provided with a document that outlines Dell’s branding requirements.6.Recipient agrees to cooperate with Dell in connection with any publicity regarding the Grant and hereby consents to the use of its name and logo by Dell in any such publicity. Such cooperation shall include, but shall not be limited to, providing Dell with information about the project for which the Grant will be used and its status, providing access to Dell representatives to the project activities, and allowing Dell to take and publish photographs or other visual depictions of project activities.7.In no event shall Dell be liable for special, incidental, indirect, collateral, consequential or punitive damages or lost profits in connection with any claims, losses, damages or injuries arising in connection with the Grant or the use of the donated item(s), even if advised of the possibility of such damages. Recipient shall indemnify and hold harmless Dell from any costs, damages, expenses or losses arising from Recipient’s failure to use the Grant as described in the application or from Recipient’s failure to use the Grant in compliance with this Agreement and with all applicable law.8.Recipient shall use the Grant only in compliance with all applicable laws. Recipient represents and warrants that Recipient is familiar with the U.S. Foreign Corrupt Practices Act of 1977 and the UK Bribery Act, and will not use the Grant in violation of either act.9.This Agreement, and all the rights and duties of the parties arising out of, in connection with, or relating in any way to the subject matter of this Agreement or the transactions contemplated by it, shall be governed by, construed, and enforced in accordance with the laws of the State of Delaware (excluding its conflict of laws rules which would refer to and apply the substantive laws of another jurisdiction). Any suit or proceeding hereunder shall be brought exclusively in state or federal courts located in New Castle County, Delaware, United States of America. Recipient consents to the personal jurisdiction of the state and federal courts of said county and waives any objection that such courts are an inconvenient forum. The rights and obligations of the Recipient under this Agreement shall not be governed by the provisions of the 1980 U.N. Convention on Contracts for the International Sale of Goods.If Recipient receives Dell product, the following provisions shall also apply:10.Recipient shall use any software received from Dell in accordance with the license included with the software.11.Recipient is solely responsible for the ownership, care, maintenance and repair of the equipment, and Dell will have no responsibility whatsoever relating thereto. Any and all warranty protection shall be governed by Dell’s standard terms for warranty protection available on Dell’s website at: . Recipient hereby releases and shall indemnify and hold harmless Dell from any and all liability whatsoever with respect to equipment donated by Dell, including without limitation any claim for the failure to use software in accordance with any applicable license.12.At the end of its use, all product donated by Dell shall be disposed of in accordance with then-existing industry standards, for example, using one of Dell’s recycling programs. Dell’s Recycling Programs and Disposition Guidelines can be accessed at . Where the product donated by Dell may reach end of life in a country where the recycling infrastructure is not adequate to treat the product in an environmentally appropriate manner, Dell may seek additional assurance that the product will be shipped to either the nearest country or the country of origin for environmentally appropriate treatment.AGREED AND ACCEPTED BY: ___________________________ [Signatory]___________________________By: [print name of signatory]___________________________Its: [position of signatory if Recipient is an entity or other organization]Date:_____________Powering the Possible Agency Application Financial ReportInsert Your Agency Name here: ?Original Budget?CategoryQ1 (in USD)Q2 (in USD)Q3 (in USD)Q4 (in USD)Total (in USD)ProgramPersonnel????$0Technology Costs????$0Program Promotion????$0Materials and Supplies????$0Training????$0Curriculum development????$0Transportation????$0Other: __Family Night Expenses__????$0Total Program Costs????$0AdministrativeBuilding Costs????$0Utilities????$0Maintenance????$0Evaluation and Monitoring????$0Total Admin Costs$0$0$0$0$0Total$0$0$0$0$0 ................
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