Human Affairs Committee
Regular MeetingNashua, NH · December 14, 2015
Minutes
HUMAN AFFAIRS COMMITTEE
DECEMBER 14, 2015
A meeting of the Human Affairs Committee was held Monday, December 14, 2015, at 6:00 p.m. in the
Aldermanic Chamber.
Alderman-at-Large Lori Wilshire, Chairman, presided.
Members of the Committee present: Alderwoman Mary Ann Melizzi-Golja, Vice Chair
Alderman June M. Caron
Alderman Sean M. McGuinness
Members Not in Attendance: Alderwoman Pamela T. Brown
Also in Attendance: Mr. John Cepaitis, Commissioner, Review & Comment Commission
Ms. Teresa Barr, Commissioner, Review & Comment Commission
Mr. Doug Tremlett, Commissioner, Review & Comment Commission
Ms. Kathy Nelson, Commissioner, Review & Comment Commission
Deputy Michael D. Carignan, Nashua Police Department
PUBLIC COMMENT - None
DISCUSSION
Discussion with Review & Comment Commission
Chairman Wilshire
I would like to invite the commissioners to come forward to talk about the changes that you want to make to
the Review & Comment Application.
Alderman Caron
As you know, the Review & Comment Committee for the last two years has tried to make some changes and
adjustments to the application form to make agencies a little bit more conscience of the fact that this is a lot of
money and grants are not giving out lightly. We tried to look at the application and see what was missing.
Over the years it seems like applications weren’t completed fully so this year after the award of the agency
money in July the committee decided that they would like to add a few things to the application. It was nothing
extravagant but again, to remind CEO’s that signatures are important and to kind of focus on the checklist that
had to be there. As you saw, because you have a copy of the application, that we would do a follow-up report
from the funding that they received from the previous year. They just felt that it was important to know how
much money they got and did they use it for that purpose and do they have any money left over because the
amount was less than what was anticipated. I know that John and Tess and Doug have some comments
about it but we felt that we needed your approval because as you know, this has to go out the first of January.
There are a lot of things we could do but we felt that these were the important things for this commission to
work on.
Mr. John Cepaitis, 16 Shakespeare Road
I really don’t have anything to add about the application process. We do want to make agencies accountable
for the funds that we make recommendations to distribute on behalf the City of Nashua and we feel that as we
are committed to a very thorough process of reviewing their applications. We have had some brainstorming
Human Affairs – 12/14/15 Page 2
sessions about other areas but to try to bring a multitude of changes before you; we didn’t feel that was
reasonable, especially where this is probably the last meeting of this committee for the year. I think that we
will probably come back with some other thoughts, simple things like the title of our committee, Review &
Comment. In the newspaper, people are notified that these monies are available but they are notified under
Review & Comment and if you are not in the know in the city you may not know that the monies are available
by the title Review & Comment. We have to think of a better way to communicate to perspective agencies
that these funds are available and I don’t have any specific ideas right now. On page two there are five areas
where we traditionally have distributed funds under and this year the city has made, as a targeted social
service to be addressed, the drug explosion in the city. Some people may not be able to recognize how they
might be able to apply these monies without some expansion of the five areas. We’d like to add drug and
alcohol and I know it’s more than just prevention because it’s a multi-faceted approach but drug and alcohol
abuse would be an added area to be considered. We didn’t put it in here as a change because in the
sentence above it, it says it doesn’t meet the set criteria of the city ordinance. That may have to be set aside
for another year. The final change is that we want agencies to be able to report back to us on how and when
they use the money and whether or not they were able to secure the monies that they said they were going to
in the application process. If the City of Nashua ends up being the only contributor to the project that they
propose it seems like the proposal would be irrelevant because they said they were going to raise money in
addition to what the city is going to contribute but if they raise any of those other monies then the city ends up
providing all of the funds for that project. I am not sure that is originally what was intended for the use of
these funds.
Ms. Teresa Barr
I think June and John really summed up the whole package and what we have tried to accomplish and what
we want to do in the future.
Chairman Wilshire
One of the things that John was talking about, the categories of funding that are available, I don’t see why
that wouldn’t fall under healthcare and dental. I think that is a good fit for that.
Mr. Cepaitis
I know that June has been shepherding us in this process and that’s the comment that she made over the
years. I am relatively New Hampshire to this process; I’ve only been involved for three years. If people in the
city who are responsible for social services know that they can apply under those broad categories then that’s
fine.
Chairman Wilshire
I believe they do and for the most part, even in the three years that you have been involved you probably see
that it’s the same organizations for the most part looking for funding so I think there is some pretty widespread
knowledge among the non-profits on what the funding can be used for but rather than change categories
maybe we should put it out there somehow in our education piece that money is available for mental health,
substance abuse and all of those categories.
Ms. Kathy Nelson
We have been working for two years to make sure that this is an accountability program since we represent
our taxpayer’s money and it’s our responsibility to make sure it’s spent properly. We were finding that some
of the information that we had on this form before was either unclear or really wasn’t measureable so we think
the few changes that we’ve made had improved it fairly because we want to make sure that people get their
fair change at the funds. I think the applicant’s will be served well by the clarity that we’ve put through and
Human Affairs – 12/14/15 Page 3
some of the metrics that we’ve added so they can see what they have done with these funds and we can see
what they have done with these funds.
Chairman Wilshire
Do you believe that funds that were given in the past weren’t used appropriately?
Ms. Nelson
I think that’s a really good question but we just don’t know. We made assumptions that they were and you
assume the best but we just didn’t know. We found that when new people came on and we were trying to
explain year after year how we were measuring whether the funds were being used as they were requested,
it’s not up to us to judge their use if the city approves the services they are doing, it’s just up to us to make
sure that what they say they are going to do with it is done. We didn’t have the information from prior years
readily available. We thought there were some pieces missing in order to do this job well. That’s part of what
we are asking now that last year’s information is available to all of the volunteers and the Review & Comment
commissioners so we can say yes, this is what you requested it for and yes, this is how you say you
measured it and it was achieved.
Alderwoman Melizzi-Golja
Every year when we get updated on what funds are available and what funds have carried over from year to
year, we get an update from the Urban Program office and they tell us like this organization asked for $5,000
and they’ve used $4,750 of it so the other $250 is being rolled back or there have been time when contractors
have bids haven’t been in the beginning been what the actual cost has been so we have had to use money
that we had to fund that. My question is do we know if there are reports that Urban Programs get that don’t
get back to the committee because we certainly get some of that information.
Chairman Wilshire
We do when it’s bricks and mortar projects when they apply for CDBG but not operating funds.
Alderwoman Melizzi-Golja
Okay so we don’t get anything for…
Chairman Wilshire
No.
Alderman Caron
I think once we have given them the money; let’s say $15,000; they are using it for that project or if they have
a little left over they might use it for something connected to that. They don’t have to return those funds.
Chairman Wilshire
It can be confusing to distinguish the difference between CDBG funds and Review & Comment money
because at some point they mesh. CDBG is bricks and mortar and up to 15% of the Community
Development Block Grant can be used for operating which is why we give you an allocation every year up to
15% of what we are expecting from CDBG that you can allocate as well as the funding that the Mayor puts in
the city budget from the tax base.
Human Affairs – 12/14/15 Page 4
Ms. Nelson
I’m glad you brought that up, Lori. On this application that precedes my time on this commission and I’ve
probably been on it about five or six years, there is a section here that asks the area under which the funding
requested falls under and what we assume it was the five areas that the city had decided were important that I
guess came out of the study for that block grant. I just want to know if that will change.
Chairman Wilshire
Every five years the city does a consolidated plan and the consolidated plan does a lot of planning and
outreach to the community to see what is important and what they need. These are really the five categories
that are kind of there. They are what is needed here in the community and they have been identified every
year. There’s not really been much we’ve given more to one of these categories than the other. Like John
said, certain years like this year, maybe there is more of a need for substance abuse and that kind of funding.
There have been no definite put to more of one of these categories than the other.
Ms. Nelson
Do you see value in…I mean is this important to you to keep in this application?
Chairman Wilshire
I believe it is. I think it follows the consolidated plan which is the road map for CDBG and there are some
organizations that fit better in the bucket of CDBG funding because they are more familiar with the HUD
reporting. I think the Nashua Soup Kitchen is one of them. With HUD funding there are a lot more
requirements and paperwork and reporting to do.
Ms. Nelson
We were trying to steam line this and when we looked at that case John was really focused on and I really
couldn’t tell him what value it was to us. I knew it probably had value to you and maybe quantifying these
things but we weren’t sure.
Chairman Wilshire
They are kind of buckets that HUD has, right?
Ms. Nelson
Right.
Chairman Wilshire
I think if you start changing those categories you start muddying the water in my opinion because the
consolidated plan is our road map and it’s been developed by the community. They invite non-profits in and
they send out surveys. It’s a plan that we are required to file with HUD every five years. That plan really
dictates with this committee how we spend our CDBG funding. If it’s not been identified in that plan it’s hard
to justify funding it.
Alderwoman Melizzi-Golja
I would say that’s where the accountability is because everything should go back to what the priorities are that
are identified there.
Human Affairs – 12/14/15 Page 5
Chairman Wilshire
I had a question about this follow-up report and wondered if what if somebody who got money last year
doesn’t file this year does that mean they don’t have to do the report? Could they sign something that says I
promise or I attest to the fact that this money will only go toward this widget or this project?
Ms. Nelson
That really is a good question. Is it possible for a person to apply for funds and then use them for something
else?
Chairman Wilshire
They shouldn’t be. If they are telling us that they want to use the money for a certain program or project then
that’s what they should be using the money for. I’ll agree with you that there has been no way for us to follow-
up.
Ms. Nelson
These are all wonderful agencies and I don’t think that we’ve ever really had; I mean they are reasonable
people and they seem to want to give us the information that we need. The question always was what
information do you need and how do you want it because everyone interpreted it so differently we really felt
like we brought this around over these past two years to make sure everybody understood what was needed
and how to provide it. That seemed to make it better for everyone and I think that when we would ask the
CEO’s or whoever would represent the agency to come into our meetings, often those individuals couldn’t
attend or they didn’t send somebody who had some of the answers that we really needed to make sure that
this was what we wanted to give the money to. We allow the taxpayers themselves, the volunteers in our
group to do the voting because it’s very fairly represented that way. They need the information so not being
able to get some of that information properly from the individual that is sent, we had decided to try to put
together as much as we can get from the agency itself, hence the follow-up. I think that they would follow-up
and if they don’t and they ask for more funds then they shouldn’t get them until they do what we’ve asked to
let us know what they did indeed use the funds for. If they did ask for funds last year and didn’t last year then
kudos to them because that’s kind of where we want them to go.
Chairman Wilshire
Maybe they do apply and their application is rejected for some reason. We are saying on here now that we
want a completed application with no missing signatures or financial reports and now we are cracking down
on that which okay and I think that’s fair. My question is you have somebody that’s been funded for the last
several years and they apply this year and they don’t provide some of the information and we are not asking
for follow-up reports from them if we are not funding them I guess.
Ms. Nelson
Right, it’s a new thing. I think that what we tried to build into this time is certainly that understanding and that
reminder. I think in three different places I have placed it because people really have to hear and see some
things a number of times before it becomes comfortable and you remember it. We built it in three different
ways; the original letter that’s going on the front from the chair of our group explaining all of the new things
that will be asked, then at the front of this form there is a checklist and at the bottom of the checklist it
reiterates that a new follow-up form will be requested and then on the back we have asked for the signature of
the CEO or the head of the program and that that person go through a list that is repeated. When they sign
they are signing that all of this is complete. I do understand that there will be some mistakes but if I did that
on a loan from a bank they would not be happy with me and this is taxpayer’s money so we felt there was an
Human Affairs – 12/14/15 Page 6
obligation to do this. In the future we would like to offer some support to programs that don’t have grant
writers and programs that have never done this. I think we want to be kinder and gentler and not be seen as
an arbitrarily punitive group of people.
Alderman Caron
I agree with everything Kathy says and as a group we’ve agreed to. The other thing is that we are also
dealing with volunteers and the more information that they have when they are reading these applications it’s
so much easier for them so that when we go to a meeting with these organizations they have an idea and the
questions aren’t as long and complicated. Last year, with John’s help we developed a way of having these
meetings and working with the agencies and all we did was facilitate the five volunteers that were reviewing
these applications. Doug was really good because he was the money guy and he figured out how we should
do this so that no one commissioner had all of the $50,000 requests and some only had the $3,000 and
$4,000. I think that the ideas that this group has developed over the last two years; it’s not to hinder any
agency but to provide them with as much help as we can in order for us to do our due diligence and give them
the funding. I applaud these wonderful people that have worked so hard to get this done and I appreciate you
allowing them to come before you because it was very difficult going back and forth and I felt it was very
important for them to speak directly to you.
Chairman Wilshire
Anytime. Alderman Caron, I have one question. When the letter goes out and the interview is set up, are you
asking them to send somebody who can answer financial questions?
Alderman Caron
Yes. We want the financial person to come not the programmer or the secretary because they are not going
to be able to answer some of those important questions concerning finances.
Chairman Wilshire
Sometimes it’s nice to have both the financial person as well as the program person because then you get to
know both sides of the equation.
Ms. Nelson
I think in the past two years in some of our recommendations we were very clear to say that we felt if the
agency didn’t receive the funding part of it was the inability of the person that it was sent to answer the
questions we had. It wasn’t any statement on their agency or what they did; we simply didn’t get the
information. I think if they knew that they might send somebody more knowledgeable the next year.
Alderwoman Melizzi-Golja
I think what you are doing is very helpful for the agencies but I think by providing a structure and clarity and
requesting people with the information come to the meetings also makes our volunteers feel better about their
ability to make this decision. I think the people who volunteer to be part of the review group are invested in
the community and so I think it just gives them a better sense of doing things and making decisions with as
much information as possible. I think it’s important that people who volunteer feel their work is meaningful.
Ms. Nelson
Absolutely and I appreciate that. There’s no training module for this so we all came together understanding
that some of the information that we had didn’t compute with someone else next to us so we started to feel
unpowered and putting this together made such a difference. Some of the people returning have said
Human Affairs – 12/14/15 Page 7
absolutely, I feel it’s my civic duty and I thought that was wonderful.
Alderwoman Melizzi-Golja
That being said, thank you for all you do as volunteers and hopefully having these meetings makes you want
to continue doing what you are doing.
Ms. Barr
Every year the question of the follow-up comes up about what did you do with the money last year and that is
one of the reasons why we added that in there because every year a volunteer wants to know.
Alderman McGuinness
I am very encouraged by your initiative and accountability is a very important thing. Your amendments look
great and the follow-up is fine, I notice that the Review & Comment Follow-up Form is kind of general. I
wonder if you would consider asking for some kind of evidence in a way; like did you put the money in the
personnel administration or direct aid or do you think that might be too much for now?
Ms. Nelson
We thought maybe it would be too much the first year. Maybe is we get some support and corroboration this
year with the open-ended easy going follow-up form then I can assure you that we can get more specific. We
just ran out of time to be able to make sure it would be done well enough for this year so it was put on our
agenda for next year.
Alderman McGuinness
Too much too fast is probably a good argument unless you really feel it’s not being done in a sincere way.
Ms. Barr
It was a time crunch. We want to make it friendly to start with and no one likes a lot of change all at once.
Chairman Wilshire
When you do make a lot of changes all at once the application tends to get like well, we forgot that and we
are not going to get reviewed because of the changes…good thought, Sean.
Ms. Nelson
There’s a form already existing in here that we thought we would use and then extrapolate from that when
their requests and in-kind donations and have them show when that was done and the kind of disbursement.
Chairman Wilshire
I have a question about the amount received and date of disbursement. The city sends one check for the
year.
Ms. Nelson
I think we just want to be sure they are aware of. The people that fill out this form may not be the people that
have the information.
Human Affairs – 12/14/15 Page 8
Chairman Wilshire
Right.
Ms. Nelson
We want them to be knowledgeable enough to say oh yes, that came to us in August. It shows a little bit
more of a trail of accountability.
Chairman Wilshire
I can see that more in the brick and mortar piece but in the operations piece I don’t know that it makes as
much sense to me.
Ms. Nelson
I suspect that we should ask the agencies what they think of the follow-up form after this and they can give
their suggestions as to what they thought was difficult about it.
Chairman Wilshire
Okay fair enough.
MOTION BY ALDERMAN CARON TO APPROVE THE RECOMMENDED CHANGES TO THE
APPLICATION FROM THE REVIEW AND COMMENT COMMISSION
MOTION CARRIED
COMMUNICATIONS – None
UNFINISHED BUSINESS- None
NEW BUSINESS – RESOLUTIONS
R-15-196
Endorsers: Mayor Donnalee Lozeau
Alderman Michael Soucy
Alderman-at-Large Lori Wilshire
Alderwoman Pamela T. Brown
Alderwoman Mary Ann Melizzi-Golja
Alderman Richard A. Dowd
Alderman June M. Caron
RELATIVE TO THE ACCEPTANCE AND APPROPRIATION OF $66,500 FROM THE
STATE OF NEW HAMPSHIRE, DEPARTMENT OF SAFETY “STATE HOMELAND
SECURITY GRANT PROGRAM” INTO FIRE GRANT ACTIVITY “2015 HOMELAND
SECURITY GRANT PROGRAM”
MOTION BY ALDERMAN MELLIZI-GOLJA TO RECOMMEND FINAL PASSAGE
ON THE QUESTION
Deputy Michael Carignan
This is another FEMA grant, Federal Emergency Management and it was specific to hazardous materials
equipment. We have a hazardous materials team here in the city on the fire department. This particular item
is just another piece of the equipment but it’s very expensive. It’s just one meter. Last year I was able to get a
Human Affairs – 12/14/15 Page 9
grant for a similar meter that this works with so now that we have both of them we have an all-inclusive meter
that will do what we need to do with the issues of chemicals. It reads just about everything so it would be a
long time before we bought one on our own.
Chairman Wilshire
What’s the life expectancy of this meter?
Deputy Carignan
This particular meter; part of this grant was to get the money to update the software so we’ve got a five year
software upgrade so for five years anyways but it will still be good after that but then if more chemicals are
added to it we won’t be getting those. I would say probably after eight years you start losing the technology
anyways. It will be a good compliment to all of our meters and we will be in very good shape once we get this
meter.
Chairman Wilshire
Where do you use it?
Deputy Carignan
For us, again on the fire department we have an in-house hazardous materials team that takes care of the city
but we also take care of the Souhegan Mutual Aid response area which is nineteen other communities that we
cover. Some of these smaller towns don’t have the resources like we do so that is why we are involved in the
state mutual aid so the City of Nashua hazmat team is allowed to get some of this grant money because we
cover those towns. We do get called out to help them out. It could be anything from a spill in the river to a car
accident with a trailer carrying chemicals or a leak at a manufacturing facility that we need to meter whatever
is spilled. These meters allow us to identify materials that we are not sure of and you can be able to look them
up and learn how to handle them. This particular meter is an identifier that tells you exactly what you are
looking at.
Chairman Wilshire
How do you do it now?
Deputy Carignan
Stuff has to go to labs first or we generalize but we can’t be quite sure what it is. We just try to mitigate the
problem. This will help us do things more on the spot and be more accurate.
Alderman McGuinness
I am very interested in the equipment. So you point and shoot, it must work on some kind of a light spectrum
thing?
Deputy Carignan
That’s exactly it; it identifies what the make-up of the material that it’s looking at. It’s called a spectrometer.
Alderman McGuinness
So you could probably get hundreds and even thousands of different compounds and chemicals?
Human Affairs – 12/14/15 Page 10
Deputy Carignan
Exactly. The one we got last year was $78,000 and it does so much and then this one will pick up the other
half. Together they do everything. It’s definitely state-of-the-art. There is no city match.
MOTION CARRIED
NEW BUSINESS – ORDINANCES – None
GENERAL DISCUSSION
Alderman Caron
On behalf of the Review & Comment Commission I want to thank you for your support in the
recommendations that they made for the new application. We are right down to the wire and we are getting a
new Mayor in January. We’ve worked really hard to get the dates set for the volunteers. It’s not so much
spending time at the meetings but reading the applications. The commission was working hard to make some
changes but not overwhelm everyone. We are still looking for a few more volunteers.
PUBLIC COMMENT
REMARKS BY THE ALDERMEN
Alderwoman Melizzi-Golja
I would like to thank Alderman Caron for her work every year with Review & Comment.
Chairman Wilshire
I too appreciate the work you do, Alderman Caron.
POSSIBLE NON-PUBLIC SESSION
ADJOURNMENT
MOTION BY ALDERMAN CARON TO ADJOURN
MOTION CARRIED
The meeting was declared adjourned at 6:47 p.m.
Alderwoman Mary Ann Melizzi-Golja
Committee Clerk
Agenda
HUMAN AFFAIRS COMMITTEE AGENDA
DECEMBER 14, 2015
6:00 m Aldermanic Chamber
ROLL CALL
PUBLIC COMMENT
DISCUSSION
Discussion with Review and Comment Commission
COMMUNICATIONS - None
UNFINISHED BUSINESS- None
NEW BUSINESS - RESOLUTIONS
R-15-196
Endorsers: Mayor Donnalee Lozeau
Alderman Michael Soucy
Alderman-at-Large Lori Wilshire
Alderwoman Pamela T. Brown
Alderwoman Mary Ann Melizzi-Golja
Alderman Richard A. Dowd
Alderman June M. Caron
RELATIVE TO THE ACCEPTANCE AND APPROPRIATION OF $66,500 FROM THE
STATE OF NEW HAMPSHIRE, DEPARTMENT OF SAFETY "STATE HOMELAND
SECURITY GRANT PROGRAM" INTO FIRE GRANT ACTIVITY "2015 HOMELAND
SECURITY GRANT PROGRAM"
NEW BUSINESS - ORDINANCES - None
GENERAL DISCUSSION
PUBLIC COMMENT
REMARKS BY THE ALDERMEN
POSSIBLE NON-PUBLIC SESSION
ADJOURNMENT
CITY OF NASHUA REVIEW <& COMMENT APPLICATION
FY2015 revised November, 2015
Please consult the City of Nashua's website (www.nashuanh.gov) for individual grant program criteria and for guidelines
about how to apply for the Review and Comment Committee funding. If you have further questions about the Review and
Comment process, please call City Hall at (603) 589-3260.
DIRECTIONS
© Submission deadline is Wednesday, February 3, 2016 by 4:00 p.m.
o Do not send materials other than those requested, and do not send any materials under separate cover. Please refer
to the specific grant program guidelines on our website for guidance on what to submit.
• Send only one copy. Do not staple or bind your application.
• This application can be completed in two ways: 1) open it in Microsoft Word and click on the shaded areas to
type in your answers (preferred)...digital signatures on page 7 acceptable; or 2) you can type your answers for
each section on a separate sheet of paper. Please use a font size of at least 11 point.
• You may submit an electronic copy of the application, along with attachments of the additional documentation
requested, to qrantapp@nashuanh.qov.
• Please note that there is a Follow-up Report attached that must be sent in with this application if you received any
funding from the City through Review and Comment in 2015. Without this feedback, you will not be eligible to
request funds in 2016. (This is a new requirement in an effort to maintain accountability.) If you have any
questions, please call City Hall at number above.
• Digitally submit to address above or mail this application in time to meet submission date to:
City Hall
Mayor's Office
Attn: Review & Comment
229 Main Street
Nashua NH 03060
CHECKLIST
Please use this checklist to ensure that your application contains all required information, signatures and attachments.
REVIEW & COMMENT will not review any applications that do not contain ALL required information.
€ Completed application form (including required signatures)
€ Brief j ob description of key program personnel
€ A one-page list of your organization's board of directors or advisory committee, including occupations and
city/town of residence
€ 501 (c)(3) letter from IRS
€ Agency audit
€ If your program is a collaborative program with an organization and/or a school, letters of agreement from
participating organizations that explain their level of involvement are required
€ Completed attached Follow-up Report including signatures
CITY OF NASHUA REVIEW<&COMMENT APPLICATION
FY2015 revised November, 2015
PART I: APPLICANT INFORMATION
LIST THE GRANT PROGRAM(S) YOU ARE APPLYING TO: Review & Comment
LEGAL NAME OF ORGANIZATION:
ADDRESS: CITY/ STATE /ZDP:
TELEPHONE:
WEBSITE: YEAR ORGANIZATION STARTED:
FEDERAL TAX I.D. # (EIN):
EXECUTIVE DIRECTOR:
PRIMARY CONTACT FOR PROPOSAL:
TELEPHONE: E-MAIL:
AMOUNT REQUESTED FROM TOTAL PROGRAM BUDGET: $
REVIEW & COMMENT: $
PLEASE PROVIDE YOUR PROGRAM NAME, AND A BRIEF OVERVIEW OF THE SPECIFIC
PROGRAM/SERVICE FOR WHICH FUNDING IS BEING REQUESTED IN 300 WORDS (1500
KEYSTROKES) OR LESS:
ISSUE AREA Check the category (ies) which best describe your request. You must fall under one of these
categories to meet the criteria set by the city ordinance.
•Economic •Affordable •Youth/Anticrime •Affordable •Elderly Services
Development Housing Health/Dental
Care
CITY OF NASHUA REVIEW<&COMMENT APPLICATION
FY2015 revised November, 2015
PART II: AGENCY INFORMATION (AGENCY
BUDGET)
Provide information about your agency's operating budget IN the
space provided. Use the most recently completed financial or
fiscal year. Fiscal End Dates (mm/dd/yy)
Please use this form and attach a single copy
of your agency's most recent complete audited
financial statement.
Agency Revenue Agency Expenses
a. Fees for Services $ For Programming $
b. Membership Fees $ For Administration $
Contributions/Fundraising For Contributions/Fundraising (Based on Subtotal of Revenue
Columns c-h) $
c. Individual/Business $ Other (specify) $
d. Foundation $
e. *Nashua Funding other than Review &
Comment (Should be included on a
B. TOTAL EXPENSES $
separate sheet or listed at the end of this
section under "e".) $
f. Government (Federal, State, and C.NET
Municipal) (A TOTAL REVENUE - B TOTAL EXPENSES) $
$
g. United Way $
h. Fundraising Events $
Subtotal (Add lines c-h) $
i. Endowment income (if any) $
j. Interest and dividends $
k. Other (specify)
1. **Other agency programs requesting
Review and Comment funding this year.
List by specific program names and
amounts on separate sheet or at the end
of this section under T. $
A. TOTAL REVENUE $
2. SHORTFALLS: If your expenses exceeded revenues for the last fiscal year, explain how shortfall was financed.
CITY OF NASHUA REVIEW<&COMMENT APPLICATION
FY2015 revised November, 2015
3. ASSETS AND LIABILITIES Fiscal Year Start (mm/dd/yy) Fiscal End Dates (mm/dd/yy)
Provide detail for last fiscal year.
Agency Assets Agency Liabilities
Cash S Current Liabilities (accounts payable) $
Securities & investments (stocks, endowments, etc.) $ Long-term liabilities (loans, mortgages, etc.) $
Property & equipment $ B. TOTAL LIABILITIES $
Accounts receivable C. TOTAL NET ASSETS
(A TOTAL ASSETS - B TOTAL
S LIABILITIES): $
Other Specify s
A. TOTAL ASSETS: $
4. RESTRICTED ASSETS OR REVENUE: These represent resources whose use is limited by the donor or the source to a specific purpose within the agency or
resources that are to be maintained by the agency in perpetuity. Please indicate the amount and purpose of any restricted revenue and/or assets (in the space provided).
a. Restricted Revenue:
b. Restricted Assets:
CITY OF NASHUA REVIEW<&COMMENT APPLICATION
FY2015 revised November, 2015
P A R T III: P R O G R A M B U D G E T
The use of this form is required. Please be as specific as possible. Please answer for only the program you are requesting
funds, not the agency budget.
Previous Year's Review & Comment Request: $
Previous Year's Review & Comment Funding: $
ANTICIPATED PROGRAM EXPENSES AND PROGRAM FUNDING
ITEM A. AMOUNT B. IN-KIND C. OTHER FUNDING SOURCES to TOTAL
REQUESTED DONATIONS support this item (include earned BUDGET for
from to support income and indicate if funding is each item
Review & each item already secured) (Add columns
Comment for A-C)
each item Amount Source Secured
?
Example: speaker $750 $250 XYZ Foundation yes $1,000
Jees
1. $ $ $ $
2. $ $ $ $
3. $ $ $ $
4. $ $ $ $
5. $ $ S $
6. $ $ $ $
7. $ $ $ $
8. $ $ $ $
9. $ $ $ $
10. $ $ $ $
TOTAL
Sum of items in each $ $ $ $
column
SUSTAINABILITY: If your program is ongoing, what are your plans to secure funding in the
future?
Do you collaborate with other agencies in the area that provide a similar service to increase
efficacy? If yes, list those agencies. If not, why not?
Additional Budget Information: Use this space to provide any additional budget information you
wish to include:
CITY OF NASHUA REVIEW<&COMMENT APPLICATION
FY2015 revised November, 2015
PART IV: ORGANIZATION AND PROGRAM OVERVIEWS
Directions: Please number and write your answers on a separate page. We seek short answers to these
questions, so please limit your answers to ONE page each for questions 1 and 2 (with a font size no smaller than 11 point.)
1. AGENCY HISTORY: In this brief history you should include:
• the founding date of the organization
• its mission
• geographic region served
• population served
• two or three most important programs or services the organization currently provides
2. PROGRAM OVERVIEW: Briefly describe the program for which you seek funding. Be sure to include:
• What you plan to accomplish with this program
• How this program will strengthen or improve the community or your organization's ability to serve the
community
• How you will measure the program's progress or success (your evaluation method)
• Who will be served by or participate in this program?
3. STATISTICAL INFORMATION FORM
Previous Fiscal Year Current Fiscal Year Next Fiscal Year
07/01/20 07/01/20 07/01/20
thru 06/30/20 thru 06/30/20 thru 06/30/20
Total Number of Clients
Serve by your Agency
(unduplicated)
Total Number of Non-
Nashuans Served by your
Agency
(unduplicated)
Total Number of Nashuans
Served by your Agency
(unduplicated)
Total Number Served by
this Program
Total Number of Nashuans
Served by this Program
Please remember to attach the following documents on separate sheets of paper:
• a list of your organization's board of directors or advisory committee, including occupations and city/town of
residence
• 501(c)(3) letter from IRS
• Brief job description of key program personnel
CITY OF NASHUA REVIEW<&COMMENT APPLICATION
FY2015 revised November, 2015
PART V: PROGRAM DESCRIPTION
This form is required as part of your application.
Format: You may complete this form in Microsoft Word using the form fields or number and write
your answers on a separate page. Answers for this section, Part V, should be limited to ONE page total
(with a font size no smaller than 11 point).
This application represents (please check one only):
I I A request for continued funding, operations or program support
I I A first time request in support of operations or an existing program
I I A first rime request in support of a new agency or program
1. WHAT IS THE OVERALL GOAL OF THIS PROGRAM?
2. DESCRIBE UP TO 3 MEASURABLE OUTCOMES OR RESULTS OF THIS PROGRAM THAT WILL HELP ACHIEVE
THIS GOAL.
3. WHAT SPECIFIC ACTIVITIES WILL YOU DO AS PART OF THIS PROGRAM TO PRODUCE THOSE RESULTS?
(PLEASE LIST NO MORE THAN 5)
4. TIMING:
• WHEN DO YOU EXPECT TO BEGIN YOUR PROGRAM (MONTH, YEAR)?
• WHEN DO YOU EXPECT TO COMPLETE YOUR PROGRAM (MONTH, YEAR) OR IS IT ONGOING?
• WHO WILL BE SERVED BY OR PARTICIPATE IN THIS PROGRAM?
PLEASE SEE THE ATTACHED FOLLOW-UP REPORT TO UNDERSTAND THE INFORMATION THAT
WILL BE REQUESTED AS FEEDBACK REGARDING THE ACCOUNTABILITY OF YOUR PROGRAM AND THE
USE OF REQUESTED FUNDS.
CITY OF NASHUA REVIEW<&COMMENT APPLICATION
FY2015 revised November, 2015
AGREEMENT TO GRANT TERMS
By signing this application form, the applicant and the fiscal sponsor (if applicable) hereby indicate(s) agreement with the following
terms and conditions:
1) The information contained in this application and in any attachments is true and correct to the best of your knowledge.
2) Your organization is a nonprofit, 501(c)(3) federal tax-exempt organization, public school, public agency working for the State of
New Hampshire, or an Indian tribal government (or its political subdivision) recognized by the Department of the Interior or has a
written agreement with a fiscal sponsor that is a 501(c)(3) organization, public school, or public agency.
3) Any funds received as a result of this application will be used only for the purpose specified in the award letter. No part of any
grant will be used for a political campaign or to support attempts to influence legislation of any governmental body other than
through making available the results of non-partisan analysis, study, and research. No portion of the award will be granted to any
secondary grantee without the express permission of the City of Nashua.
4) Any funds received as a result of this application will be returned if the grant recipient loses its exemption from federal income
taxation as provided for under section 501(c)(3) of the Internal Revenue Code.
5) Any funds received as a result of this application will be expended within 12 months of the payment date. At the end of this
period, any unexpended grant funds will be returned to the City of Nashua - Review & Comment Commission, or a written
request for an extension of time will be submitted to the city for approval. An evaluation report will be submitted upon
completion of your program or by the due date specified in the grant award letter.
6) The Follow-Up Report attesting to the accountability of the awarded funds in 2015 is attached.
7) The Checklist below of required information has been completed in full and is included here in this packet.
Completed application form (including required signatures)
Brief job description of key program personnel
A one-page list of your organization's board of directors or advisory committee, including occupations and city/town of residence
501(c) (3) letter from IRS
Agency audit
If your program is a collaborative program with an organization and or a school, letters of agreement from participating organizations that explain their level
of involvement are required
Follow-up Report for 2015 funds
Please note that the required signature [s] on this form must be original (not photocopied).
SIGNATURE OF PRESIDENT, CHIEF ADMINISTRATIVE OFFICER, OR TREASURER DATE
PRINT NAME TITLE
FISCAL SPONSOR
If you applied using a fiscal sponsor, please have an authorized officer of the sponsoring organization sign below
SIGNATURE OF OFFICER OR FISCAL SPONSOR ORGANIZATION (IF APPLICABLE) DATE
PRINT NAME TITLE
CITY OF NASHUA REVIEW & COMMENT NON-DISCRIMINATION POLICY
The City of Nashua seeks to promote respect for all people. In its community-building and capacity-building grantmaking (or
successor grant programs supported by those funds), the city will support organizations that do not intend to deny services,
employment, or volunteer involvement on the basis of race, age, ancestry or national origin, sexual orientation, gender, physical or
mental disability, or religion. It is not the intent of this policy to deny support for programs that serve specifically defined populations.
By signing this form, the applicant organization confirms that it is in compliance with this policy.
SIGNATURE OF PRESIDENT, CHIEF ADMINISTRATIVE OFFICER, OR TREASURER DATE
PRINT NAME TITLE
City of Nashua Review & Comment Application Follow-up Report for
Funding FY2015 — This form is required as a part of your 2016 application, if applicable.
Program Name
Amount Requested in 2015 and for what purpose?
Amount Received and Date of Disbursement
Describe what has been done with the 2015 allocation to date,
including timelines, disbursements and plans for the remaining funds if
there are any. Also, please note how the program was additionally
subsidized if total funds requested were not received. Thank you.
Signature of Administrator Date