Attachment A
Attachment A consists of 2 distinct and different
sections. Both sections must be completed and
included in Tab 1 of the proposal.
Section I – Required Grantee Information
Section II - Location of Business Form
Attachment A—Section I

REQUIRED GRANTEE INFORMATION and CERTIFICATIONS
Purpose: The Ohio Department of Job and Family Services (ODJFS) requires the following information
on applicants who submit proposals or applications in response to any ODJFS Requests for Grant
Applications (RFGAs), in order to facilitate the development of the grant with the selected applicant.
ODJFS reserves the right to reject your application if you fail to provide this information fully, accurately,
and by the deadline set by ODJFS. Further, some of this information (as identified below) must be
provided in order for ODJFS to accept and consider your application. Failure to provide such
required information will result in your application’s immediate disqualification.
Instructions: Provide the following information regarding the applicant organization submitting
the application.
Applicants may either print this attachment, complete and sign it, or may provide the required
information and certifications (each fully re-stated from this attachment) on their letterhead as the
opening pages of their applications. It is mandatory that the information provided is certified with
an original signature (in blue ink, please) from a person with authority to represent the applicant.
Applicants are to provide the completed and signed information and certifications as the cover
pages of their original proposal submitted to ODJFS.
IMPORTANT: If the RFGA specified a maximum page limit for applicant proposals, the attachment of
any required certifications, other documents, or additional pages needed to fully provide the information
requested here will NOT be counted against that page limit.
Applicants must provide all information
1.ODJFS RFGA #: JFSR1617178105
2.Application Due Date: November 17, 2015
3. Name: (legal name of the grantee – person or organization – FAMILY AND YOUTH INITIATIVES
3a. Grantee’s Ohio Administrative Knowledge System (OAKS) ID#: [Vendors may apply for an OAKS vendor
ID# at: APPLIED FOR BUT HAVE NOT GOTTEN ACCOUNT INFORMATION YET
http://ohiosharedservices.ohio.gov/Vendors.aspx. The necessary forms to be completed and remitted to Ohio Shared
Services are the Vendor Information Form (OBM-5657) and the IRS Form W-9. Completion and/or submission of
these forms to Ohio Shared Services does not assume a vendor/applicant award of any ODJFS contract/grant.]

1

 4. Grantee Corporate Address: 468 N Dayton Lakeview Rd, New Carlisle, OH 45344
5. Grantee Remittance Address: (or “same” if same as Item # 4) SAME
6. Print or type information on the grantee representative/contact person authorized to answer questions on
the application:
Grantee Representative NAME and TITLE: Pat Banaszak Executive Director
Address: E-Mail Address: pat@fyiohio.org
Phone #: ___937-845-0403___________________________
Fax #: _____937-845-0913__________________________
7. Print or type the name of the grantee representative authorized to address contractual issues, including the
authority to execute a contract on behalf of the vendor, and to whom legal notices regarding contract
termination or breach, should be sent (if not the same individual as in #6, provide the following information on
each such representative and specify their function):
Grantee Representative NAME and TITLE: Pat Banaszak
Address: E-Mail Address: pat@fyiohio.org
Phone #: ___937-845-0403______________
Fax #: _____937-845-0913______________
8. Is this grantee an Ohio certified MBE? No If yes, attach a copy of current certification to proposal\bid. (IF
ODJFS has specified the RFGA document as an opportunity open exclusively to Ohio Certified MBEs, then failure
to attach a copy of current certification WILL RESULT IN DISQUALIFICATION.)
9. Mandatory Grantee Certifications:
ODJFS may not enter into agreements with/make purchases from any organizations that have been found to be
ineligible for state contracts under specific federal or Ohio statutes or regulations. Organizations responding to any
ODJFS RFGA opportunity MUST certify that they are NOT INELIGIBLE by signing each of the three statements
below. Failure to provide proper affirming signature on any of these statements will result in the
disqualification of your application.
I__________________________________ (signature of representative shown in Item # 7, above) hereby certify
and affirm that _Family and Youth Initiatives__________ (name of the vendor shown in Item # 3, above), has
not been debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in transactions by the United States Department of Labor, the United States Department of
Health and Human Services, or any other federal department or agency as set forth in 29 CFR Part 98, or 45
CFR Part 76, or other applicable statutes.
AND I______________________________ (signature of representative shown in Item #7, above) hereby certify
and affirm that
Family and Youth Initiatives_________________________ (name of the vendor shown in
Item # 3, above), is not on the list established by the Ohio Secretary of State, pursuant to ORC Section 121.23,
which identifies persons and businesses with more than one unfair labor practice contempt of court finding
against them.
AND I______________________________ (signature of representative shown in Item #7, above) hereby certify
and affirm that Family and Youth Initiatives_________________________ (name of the vendor shown in Item #
3, above), either is not subject to a finding for recovery under ORC Section 9.24, or has taken appropriate
remedial steps required under that statute, or otherwise qualifies under that section to enter into contracts
with the State of Ohio.
10. Equal Employment Opportunity Information on the Grantee and any Sub-grantee(s)
A. Provide vendor employee data both nationwide (including Ohio staff), and Ohio office employees separately:
Nationwide Ohio Offices
Total Number of Employees: _______15__ __________

2

 % of those who are Women: ______93%___ __________
% of those who are Minorities: ______26.7%
B. If you are the selected vendor, will you subcontract any part of the work? NO
NO -or- YES, but for less than 50% of the work -or- YES, for 50% or more of the work
If yes, provide the following information on each subcontractor (additional pages may be added as needed):
Subcontractor Name: _____N/A________________________________________________________
Address: _____________________________________________________________
_____________________________________________________________
Work To Be _____________________________________________________________
Performed: _____________________________________________________________
(a brief description) _____________________________________________________________
Subcontractor’s Estimated Percentage of Total Project (in % of work, not % of dollars): __________
If 50% or more of the work will be subcontracted, then ALSO provide the following information on
ALL proposed sub-grantees:
Nationwide Ohio Offices
Total Number of Employees: _________ __________
% of those who are Women: _________ __________
% of those who are Minorities: _________ __________
C. Identify all state grants which the grantee has since the beginning of the last fiscal year (i.e., since July 01,
2012) through this fiscal year to date. Also include grants approved for ODJFS or institutions of higher
education:
Total number of grants: ___3___
For each state grant, list the state agency and provide the following information:
State Agency/Educational Institution: ___ODH—as subcontractor under The Ridge Project____
Grant Dollar Amount: _$90,242_________
State Agency/Educational Institution: ___Community Connectors Grant--ODE_______________
Grant Dollar Amount: __$77,205.50________
State Agency/Educational Institution: _WIOA__CCJFS_________________________________________
Grant Dollar Amount: __$50,250________
Attach additional pages if needed

11. Grantee Ethics Certification
As a grantee receiving grants from the State of Ohio, I certify on behalf of
___Family and Youth Initiatives__ (name of vendor or grantee):
(1) I have reviewed and understand Ohio ethics and conflict of interests’ laws, as found in Chapter 102. and Sections
2921.42
and 2921.43 of the Ohio Revised Code.
(2) I acknowledge that failure to comply with this certification is, by itself, grounds for termination of this contract
or grant with
the State of Ohio.
__________________
_____________________ _________November 6, 2015_________________
Signature of authorized agent
Date
12. I have read the ODJFS Model Grant attached to the RFGA, and if awarded a grant, I will not _XX ___
(or) I will request changes to the standard language, and have marked the requested changes and returned
the model document with this proposal for consideration by ODJFS. (If so, ODJFS will review those requested
changes if you are the selected grantee. All requested changes to model contract language are subject to ODJFS
approval.)
13. I _Pat Banaszak___________, (grantee representative in Item # 7) hereby affirm that this proposal
accurately represents the capabilities and qualifications of ___Family and Youth Initiatives______________

3

 (grantee’s name), and I hereby affirm that the cost(s) bid to ODJFS for the performance of services and/or
provision of goods covered in this application in response to this ODJFS RFGA is a firm fixed price, inclusive
of all incidental as well as primary costs. (Failure to provide the proper affirming signature on this item may result
in the disqualification of your proposal\bid.)
14. Location of Business Declaration: Vendors responding to any ODJFS RFP/RLB/RFGA (etc.) must certify that
no public funds shall be spent on services provided/performed offshore by completing, signing, and returning the
“Location of Business Form,” which is the final section of this attachment. FAILURE TO PROPERLY
COMPLETE, SIGN AND RETURN THIS FORM, INCLUDING THE “LOCATION OF BUSINESS
FORM,” WILL RESULT IN DISQUALIFICATION OF THEVENDOR FROM CONSIDERATION FOR
AWARD OF AN ODJFS CONTRACT.

Attachment A —Section II.
Location of Business Form
Pursuant to Governor’s Executive Order 2011-12K (www.governor.ohio.gov), no public funds shall be
spent on services provided offshore. This form serves as a certification of compliance with this policy and
required disclosures. Please answer the following questions about the project or service you are seeking to
perform for or the funding for which you are applying from the Ohio Department of Job and Family
Services:
1. Principal location of business of Grantee:
__468 N. Dayton Lakeview Rd_____ _New Carlisle, Ohio 45344___________________________
(Address)
(City, State, Zip)
Name/Principal location of business of sub-grantee(s):
_____________N/A__________________________ _______________________________________
(Name) (Address, City, State, Zip)
_______________________________________ _______________________________________
(Name) (Address, City, State, Zip)
2. Location where services will be performed by Grantee: FYI has 2 other locations where services
will be done as the main location. The addresses are: 815 W. Main St., Springfield, OH 45504 and
954 N. Maple Ave., Fairborn, OH 45324 _______________________________________
(Address) (City, State, Zip)
Name/Location where services will be performed by sub-grantee(s):
____________N/A___________________________ _______________________________________
(Name) (Address, City, State, Zip)
_______________________________________ _______________________________________
(Name) (Address, City, State, Zip)
3. Location where state data will be stored, accessed, tested, maintained or backed-up, by Grantee:
____468 N. Dayton Lakeview Rd., New Carlisle, OH45344______________________________
(Address) (Address, City, State, Zip)
Name/Location(s) where state data will be stored, accessed, tested, maintained or backed-up by
subgrantee(s):
________N/A_______________________________ _______________________________________
(Name) (Address, City, State, Zip)
_______________________________________ _______________________________________
(Name) (Address, City, State, Zip)
_______________________________________ _______________________________________
(Name) (Address, City, State, Zip)
4

 4. Location where services to be performed will be changed or shifted by Grantee
__All three FYI locations: 468 N Dayton Lakeview Rd., New Carlisle, OH45344, 815 W. Main St.,
Springfield, OH 45504, and 954 N Maple, Fairborn, OH 45324________________________
(Address)(Address, City, State, Zip)
Name/Location(s) where services will be changed or shifted to be performed by sub-grantee(s):
_______N/A____________________________ _______________________________________
(Name) (Address, City, State, Zip)
_______________________________________ _______________________________________
(Name) (Address, City, State, Zip)
_______________________________________ _______________________________________
(Name) (Address, City, State, Zip)
By signing below, I hereby certify and affirm that I have reviewed, understand, and will abide by the
Governor’s Executive Order 2011-12K. I attest that no funds provided by ODJFS for this grant or any
other agreement will be used to purchase services provided outside the United States or to contract with a
sub-grantee(s) who will use the funds to purchase services provided outside the United States. I will
promptly notify ODJFS if there is a change in the location where any of the services relating to this
project will be performed. If I am signing this on behalf of a company, business, or organization, I hereby
acknowledge that I have the authority to make this certification on behalf of that entity.
______________________________________ ____________November 6, 2015___________________
Signature
Date
__Family and Youth Initiatives
468 N. Dayton Lakeview Rd. New Carlisle, OH 45344_
Entity Name Address (Principal place of business)
__Pat _Banaszak
468 N Dayton Lakeview Rd., New Carlisle, OH 45344____
Printed name of individual authorized
City, State, Zip to sign on behalf of entity

ATTACHMENTC
Application Score Sheet
RFGA#: JFSR1617178105
PHASE I: Initial Qualifying Criteria Applicant Name: FAMILY AND YOUTH
INITIATIVES
The application must meet all of the following Phase I application acceptance criteria in order to be considered for
further evaluation. Any application receiving a “no” response to any of the following qualifying criteria shall be
disqualified from consideration.

ITEM
#
1
2

APPLICATION ACCEPTANCE CRITERIA
Was the applicant’s application received by the deadline as specified?
Does the applicant’s submission include all required affirmative statements and
certifications, signed by the Applicants’ responsible representative, as described in
Attachment A to the RFGA?

5

RFGA
SEC
REFERENCE

2.1/5.1
Attachmen
t
A 5.2

Y
E
S

N
O

 3

Included in those certifications, the applicant states that it is not excluded from
entering into an agreement with ODJFS, due to restrictions related to the federal
debarment list, unfair labor findings, or R.C. § 9.24.

4

ODJFS’ review of the Auditor of State website verifies that the applicant is not
excluded from contracting with ODJFS by R.C. § 9.24 for an unresolved finding
for recovery.

5

Did the applicant provide evidence that they are a private not-for-profit
organizations by submitting a copy of their organization’s current and valid notfor-profit 501(c)(3) tax status determination letter from the Internal
Revenue Service (IRS)?
6 Did the applicant demonstrate that they have a physical location or office in the
state of Ohio?.
Did the applicant demonstrate their primary purpose is to promote childbirth,
rather than abortion, through
counseling and other services, including parenting and adoption support?
8 Did the applicant demonstrate that they provide services to pregnant women and
parents or other relatives caring for children twelve months of age or younger,
including clothing, counseling, diapers, food, furniture, health care, parenting
classes, postpartum recovery, shelter, and any other supportive services, programs,
or related outreach?
Did the applicant demonstrate they do not charge a fee to pregnant women and
parents, or other relatives, caring for children twelve months of age or younger for
any services received?
10 Did the applicant demonstrate they are not involved in or associated with any
abortion activities, including providing abortion counseling or referrals to abortion
clinics, performing abortion‐related medical procedures, or engaging in pro‐
abortion advertising?
11 Did the applicant state that they do not discriminate in its provision of services
on the basis of race, religion, color, age, marital status, national origin, disability
or gender?
Did the applicant state that if they plan to sub‐contract or sub‐grant services with
any entities that are: 1) a private, not‐for‐profit entity; 2) physically and
financially separate from any entity, or component of an entity, that engages in
abortion activities; and, 3) not involved in or associated with any abortion
activities, including providing abortion counseling or referrals to abortion clinics,
performing abortion‐related medical procedures, or engaging in pro‐abortion
advertising.
Did the applicant sign the Program Assurances affirmation page and include it in
their submission?
Did the review team (in its initial/cursory review of the applicant’s submission)
determine that the application was free of trade secret/proprietary information as
specified/restricted in the RFGA?
Did the applicant remove all personal confidential information (such as home
addresses and social security numbers) of applicant staff and/or of any
subcontractor and subcontractor staff from resumes or any other part of
the application package? [As stated in the RFGA, “ODJFS reserves the right to
disqualify any vendor whose proposal is found to contain such prohibited personal
information.”]

6
7
8

9
10

11
12

13
14
15

Attachmen
t
A/ 5.2
Attachmen
t
A/5.2
3.1, A
3.1, B

3.1,C
3.1, D

3.1, E

3.1 F

3.1, G
3.1 H

3.1, I

4.4

3.3

PHASE II: Criteria for Scoring the Technical Application
Qualifying technical applications will be collectively scored by an Application Review Team (ART) appointed by
ODJFS, Office of Families and Children. For each of the evaluation criteria given in the following score sheet,
reviewers will collectively judge whether the technical application exceeds, meets, partially meets or does not meet
the requirements expressed in the RFGA/Technical Application, and assign the appropriate point value, as follows:
0 6 8 10
Does Not Meet
Requirement

6

 Partially Meets
Requirement
Meets Requirement Exceeds Requirement

Technical Performance Scoring Definitions:
“Does Not Meet Requirement”- A particular RFGA requirement was not addressed in the applicant’s proposal,
Score: 0
“Partially Meets Requirement”-Applicant proposal demonstrates some attempt at meeting a particular RFGA
requirement,
but that attempt falls below acceptable level, Score: 6
“Meets Requirement”-Applicant proposal fulfills a particular RFGA requirement in all material respects,
potentially
with only minor, non-substantial deviation, Score: 8
“Exceeds Requirement”-Applicant proposal fulfills a particular RFGA requirement in all material respects, and
offers some additional level of quality in excess of ODJFS expectations, Score: 10
A technical application’s total PHASE II score will be the sum of the point value for all the evaluation criteria. The
review
team will collectively score each individual qualifying application. Technical applications which do not meet or
exceed a
total score of at least 282 points (a score which represents that the applicant has the capability to successfully
perform
the program services) out of a maximum of 360 points, will be disqualified from further consideration, and its
program
budget will not be considered. Only those applicants whose Technical Applications meet or exceed the minimum
required
technical points will advance to PHASE III of the application score sheet.
ITEM
# EVALUATION
SEC.
REF.
Weight Doesn’t
Meet
0
Partially
Meets
6
Meets
8
Exceeds
10
Extension

CRITERIA RFGA

Organizational Experience and Capabilities
(Provide information on partner, subcontractor, and key staff experience
and capabilities, as appropriate.)
1

The applicant has clearly identified the organization’s
primary purpose and identified the indicators used to
determine the agency’s effectiveness and quality, and the
outcomes achieved within the last 5 years for promoting
childbirth, parenting education, and alternative to abortion
3.2, A. 1
2

The applicant has described their agency’s length and depth of
experience providing services in the following areas (minimum 2
years in each):
1. Family planning;
2. Abortion prevention services and childbirth promotion;
3. Parenting development and/or adoption assistance and
parenting education/development; and,
4. Adoption Assistance.
3.2, B. 2

Key Staff Experience and Capabilities
7

 (Profiles and resume(s) must be included for all persons proposed for
key positions.) Program Lead may also serve as Program Outcome
Manager.
3

The applicant has identified and assigned one key staff person [to
serve as Program Lead] who can demonstrate a minimum of two
(2) years of experience operating in areas of family planning,
abortion prevention services, childbirth promotion, parenting
development and/or adoption assistance and resides in the state of
Ohio.
3.3, A. 1
4

The applicant has identified and assigned a Program Outcome
Manager with at least one (1) year of experience in working
in areas of family planning or other services such as
abortion prevention services, childbirth promotion, parenting
development, and/or adoption assistance, data tracking and
reporting
3.3, B. 1
5

The applicant has identified and assigned a Fiscal Specialist with
at least one (1) year of experience in working with fiscal program
and/or systems, preparing invoices, personnel reporting, preparing
documentation.
3.3 C.
1

6

The applicant has identified and assigned a Case Worker with at
least one (1) year of experience in working in areas of family
planning or other family services that promote parenting, two
parent families or family intervention services.
3.3 D.
1
7

The applicant has identified, by position and by name, any
additional support staff their agency considers key to the
program’s success located within the service providers’ office and
have provided a list of key staff, their relevant education and work
experience (including the subject and duration) and the duties they
will perform under this program.
3.3 E.
1
8

The applicant has provided a current organizational chart
(including any sub-grantees) and specified the management and
administrative personnel assigned to this project.
3.3, F.
1

Organization Profile and Participant Eligibility
9

The applicant has described the services they currently provide,
intake process, follow-up services, logistics of operations and
geographical areas of coverage, and has included any services
it feels is unique. Also included their organization’s website
address and has attached a brochure or other printed material that
provides information on their organization.
3.4 2
10 The applicant has described the population their organization

serves including any demographic information as well as family
makeup and has included the number of families that their
agency has served in the past 2 years.
3.4 1
11 Applicant has described its experience determining eligibility for

need based programs, and described how it will ensure, to the best

8

 of its ability, the accuracy of the information provided by the
program participant.
3.5 3
12 Applicant has defined the eligibility requirements they will use for

the proposed services and includes participant income at or below
200% of federal poverty level, Temporary Assistance for Needy
Families eligibility and citizenship requirements, and requirements
as listed in 5101.804 of the Ohio Revised Code.
3.5 3

Program Design
13 The applicant has included a description of the target audience it
will serve. 3.6, A 2
14 The applicant has identified how many additional families it will

serve and has thoroughly described their plan for 1) increasing
participation above current levels, 2) how it will demonstrate the
increase was a result of funding provided by the Ohio Parenting
and Pregnancy Program, and how the expected increase will be
measured.
3.6,
B, 1
3
15 The applicant has described in detail how they will notify the

public of the availability of the services, including the marketing
strategy, geographic outreach, multimedia strategy and anticipated
number of contacts the agency will make through use of these
strategies.
3.6,
B, 2
2
16 Applicants must indicate if any new or expanded services are

planned. Applicants must provide an assessment of need and
demonstrate how the new or expanded services will meet that need.
Applicant must thoroughly describe the plan to deliver these
services, including implementation, intended outcomes, the method
in which new or expanded services will be communicated,
implemented and evaluated for success.
3.6
B, 3
2
17 The applicant has included a description of how they will provide

each of the following services and indicate whether services will
be provided directly or through sub-agreement:
• Parenting and Family classes/counseling classes. And has
included the curriculum used or a description of the class
curriculum, lessons, goals and outcomes. Applicant has
indicated indicate whether the curriculum is evidence based
curriculum.
• Infant/child safety lessons
• Mother and child Nutrition education, including the risk of
alcohol and tobacco
• Outreach for other social services not provided for by the
agency (i.e. WIC, Food Assistance, Child Care Assistance).
3.6, C 4
18 The applicant has included a plan to address infant mortality in

Ohio and provided a description of the plan to deliver
services, implementation of services, delivery of services and
intended outcomes.
3.6, D 2
19 The applicant has disclosed whether or not any s u b -

c o n t r a c to r s / sub-grantees be used for this project. (If no, the
applicant has included a statement that none will be involved. If
yes, the applicant has described the procurement process and the
timeline to accomplish procurement as well as provided all
required information as specified in Section 4.6, of the RFGA.

9

 3.6, F 1
20 The applicant has described the monitoring process for the subgrantee

(if applicable) and has included the documentation that
will be reviewed, who will perform the monitoring, the frequency
that the sub-grantee shall provide performance reports and the plan
addressing areas for improvement or poor performance. [If no
sub-grantee is involved, the applicant will receive a “Meets”
response for this requirement.]
3.6, G 1
21 The applicant has described how participant and program

information will be collected and confidentially maintained.
3.6, H 1

Proposal Organization
22 The applicant has submitted an application which complies
with the specified submission format. 5.1 1

Column Subtotal of "Partially Meets" points
Column Subtotal of "Meets" points
Column Subtotal of "Exceeds" points

GRAND TOTAL SCORE:
Based upon the Total Application Score earned, does the applicant’s application proceed to the Pha se III
evaluation of its Program Budget? (Applicant’s Grand Total Application Score must be at least 282 points.)
Yes No (If “No,” Applicant’s Program Budget will not be considered.)

Ohio Parenting and Pregnancy Program Grant

APPENDIX A TECHNICAL APPLICATION
Instructions: Applicants are to fully complete this application and submit it with any additional
required documents to be officially deemed the applicant’s submitted response. Applicants may
replicate this application in order to provide necessary responses; however, no application text
may be altered or the applicant may risk disqualification.

10

 Application Cover Page
Organization Name: Family and Youth Initiatives
Organization Address: 468 North Dayton Lakeview Rd., New Carlisle, OH 45344
Point of Contact: Pat Banaszak, Executive Director
Telephone Number: 937-845-0403
Fax Number: 937-845-0913
E-mail Address: pat@fyiohio.org
Federal Tax Id Number: 31-0960546
OAKS Vendor ID: APPLIED FOR BUT HAVE NOT RECEIVED ID YET
DUNS Number: 122757573
Director/CEO: Pat Banaszak
Name of Signature Authority: Pat Banaszak
Title of Signature Authority: Executive Director
E-mail Address of Signature Authority: pat@fyiohio.org

11

 Ohio Parenting and Pregnancy Program Grant

APPENDIX A TECHNICAL APPLICATION
3.1 Mandatory Applicant Qualifications
In order to be considered for the grant expected to result from this RFGA, ODJFS requires that
interested applicants MUST meet, at minimum, ALL the following qualification requirements.
Applicants who do not meet the following requirements shall not be considered for any
grant award.
Applicants MUST provide evidence that they are a private not-for-profit organizations by
submitting a copy of their organization’s current and valid not-for-profit 501(c)(3) tax status
determination letter from the Internal Revenue Service (IRS). Please attach this documentation
with your organization’s application submission
3.1 A The IRS letter is attached.
Applicants MUST demonstrate that they have a physical location or office in the State of Ohio.
Please provide your organizations office location/address (3.1 B.).
3.1 B Family and Youth Initiatives has one main office and 2 satellites. Our main office is
located at 468 N. Dayton Lakeview Rd., New Carlisle, OH 45344 and we have a pregnancy
and parenting center there, as well. In addition to the main FYI office, FYI has two other
satellite centers which are located at 954 N. Maple Ave, Fairborn, OH 45324, and at 815
West Main Street, Springfield, OH 45504. All have various hours and days to be open.
Applicants MUST sign the Program Assurances affirmation page of this application and include
it in their application submission (3.1 I.). It is signed and attached.
3.1I The assurances have been signed.
Applicants MUST complete, sign and include with their application Attachment A., Required
Applicant Information & Certification (5.2
5.2 This is included.

Ohio Parenting and Pregnancy Program Grant

APPENDIX A TECHNICAL APPLICATION
3.2 Organizational Experience and Capabilities
(Response should be no more than 2 pages in these items)
Clearly identify your organization’s primary purpose, the indicators your organization uses
to determine effectiveness, and the outcomes achieved within the last 5 years for promoting
childbirth, parenting education, and alternative to abortion (3.2 A.).
Describe your organization’s length and depth of experience providing services in the
following areas (minimum of 2 years in each) (3.2 B.):

12

 The Women’s Network, a program under Family and Youth Initiatives, has a long record and history of
helping women and men in the field of parenting and child development. Beginning as a hotline in two
cities—Fairborn and Springfield, Ohio, the demand of the founders, Joyce Barnes and Pat Banaszak, was
for professionalism, non-judgmental advising, up-to-date, sound, and correct medical education about
pregnancy, abortion alternatives, material and emotional assistance and with parenting after the baby is
born and with child development until the baby reaches three years of age. These were considered
critical by every person who volunteered to help on the hotline and training sessions were instituted
immediately so that though every person was a volunteer, each was trained in advising techniques,
medical information, and keeping data on each client. Confidentiality and other essential tools of
speaking to clients who came from a wide range of cultures was also stressed. So well trained were they
that our first advisor and director became the head of the domestic violence program for the Clark County
Prosecutor’s office and remains there today.
FYI has worked with several national curricula in search of the most effective one for our clients. Many
have been very good but FYI has found that the most effective have been Earn While You Learn,
Growing Child, ……, and use each of them in tandem. Traditionally, most families are clients of the
agency for about 2 years or until they feel comfortable on their own, but surveys have shown that they
have learned and put into practice many of the lessons about parenting and relationships with their partner
and the child. The results have been obtained by surveys and interviews with many former clients and
remarks when they come back to volunteer or for their next baby.
The major obstacle FYI has faced is the lack of males to direct the fatherhood program and help new
fathers become more involved with their babies and stay involved throughout their childhood. It has
been shown that fathers who are involved and bonded before the baby is born, will stay involved after the
birth. When we have men involved the men feel included and enjoy the lessons that are made
specifically for them and earning points to earn items from the baby boutique at each center for their
child. FYI has allowed its women staff members to mentor the men, but it is not as effective as the male
bonding that takes place with man to man encounters. The men who come for their appointments are
bonding with their children, but the male influence is much more effective. FYI will continue to strive to
have more male mentors involved.
Another obstacle encountered by FYI has been the lack of self esteem and skills for self sufficiency
exhibited by over 87% of the clients when they first come to the centers. Many have never been given the
tools enabling them to take care of themselves, nor to get a self sustaining job, not to mention parenting
skills. FYI offers the effective programs for parenting and self esteem (Less that 1% of all of Women’s
Network clients have been involved in cases with Children’s Services). One of FYI’s goals is to give the
clients the tools to be self sufficient within three years.
FYI has seen thousands of women since 1978 who have come to us confused and not knowing what to
do. They are lost. Sometimes getting pregnant just to have someone to love, sometimes it happened only
one time. FYI trains every mentor who works with women to be compassionate, non judgmental, and a
good listener picking up on key words to know the needs of each one. Most of our mentors have over 4
years experience working in our centers. Some have had the experience of being a teen mom so they
readily understand the challenges the client faces. FYI believes that by supporting the clients with life
affirming education and life skills, we are equipping them to have self respect and be self sufficient.
a.Family planning:
Since its inception in 1978, FYI’s Women’s Network center’s staff and volunteers do not discuss
artificial birth control methods or implants. We do discuss responsibility and their choices and ability to
13

 afford children. FYI is a pro life agency and it does not refer or recommend abortion, but instead
endeavors to find positive solutions for each pregnancy. We talk about renewed abstinence and natural
family planning and explain STDs and the ineffectiveness of condoms against most of them. We also
have a series of classes on relationships and positive choices in life that will lead them to their long term
goals. We do this as well in most middle and high schools in six counties with a 5-day curricula focusing
on sexual risk avoidance, long term goals, and relationships.
b. Abortion prevention services and childbirth promotion;
FYI has provided abortion prevention services by giving our clients non judgmental love and a secure
environment to talk about the challenges bringing them to the point where abortion seems to be an option.
Our mentors listen carefully to each client, focusing on each word and pointing out positive options and
talking about setting long term goals and helping her understand that she can reach those goals and keep
her baby as well. We point out two basic options, adoption or keeping the baby. If she indicates she
would like to pursue adoption, we refer her to an approved adoption agency. BUT we retain her as a client
encouraging her to do the classes on life skills and relationships to strengthen her emotionally and
physically prepare her for childbirth.
c. Parenting education/development; and
When FYI initiated its centers in 1978, we did not teach as much parenting education as we do
today. The curricula, Earn While You Learn, and other similar curricula was taught in order for
the woman to understand her pregnancy and learn about her particular circumstances. An advisor was
assigned to work with her to change her situation and work through the challenges that led
to her pregnancy, and to realize that she can obtain her long term goals. FYI offered incentives to
keep girls coming back. Diapers, cribs, car seats, clothes were all part of the incentives. In
1990, when FYI expanded, we made the decision to offer life skills classes, so our clients could
be ready to be self sufficient within three years. FYI works with their clients from the time
they think they are pregnant until the child is 3 and if there are special circumstances, until the child
is 5. Generally appointments are 2-3 weeks apart (at about 7.5 months appointments get
closer together) and the clients are given lessons on parenting, development of the baby and as
he/she grows there are lessons on positive discipline, domestic violence, and other
programs to help our client and her baby succeed in life. We also have a Fatherhood program
that is similar for the men.
d. Adoption assistance.
When FYI was just a hotline, we researched the area to find reliable adoption agencies
and lawyers who could help us with clients who choose this option. We found many that
charged extraordinary amounts for this service. One lawyer we found, Joseph
Monnin, helped our clients and the adoptive parents for free. They paid just the
basic charges for court. A few clients chose that option, but often when the baby was born
they changed their minds and opted to keep the baby. To be able to support them and respect their
decision, we knew that we could no longer be their sole mentor and so in 1985, we found an agency
who partnered with us to help our clients through the adoption process, and if they changed their minds,
we could help mentor them in parenting. Today, we have the same procedure thus giving the client two
sources of help, our mentors and the adoption center that we use. We still see very few adoptions,
but if we have one, we are ready to help the client get to know herself, so she is sure of her decision,
when the baby is born but understands that if she changes her mind, we are there for her.

14

 Ohio Parenting and Pregnancy ProgramGrant

APPENDIX A TECHNICAL APPLICATION
3.3 Key Staff Experience and Capabilities
Profiles and resumes must easily identify how the applicant’s assigned key staff meet the
required experience and capabilities for this program. Profiles and resumes must also be
included for all persons proposed for key positions. (Response should be no more than 8
pages in total for these items, not including key staff resumes.)
Identify and assign one key staff person to serve as Program Lead who holds, at minimum, a
two year degree in social services or similar discipline, and demonstrates a minimum of two
(2) years of experience operating in areas of family planning, abortion prevention services,
childbirth promotion, parenting education/development and/or adoption assistance.
Identified staff member must be in a lead position on this project and reside in the state of
Ohio [applications which do not meet this qualification will be disqualified from further
consideration for grant award]. Applicant must provide an affirmation that the Program Lead
resides in Ohio [Do not provide Program Lead’s home address] (3.3 A.).
The Program Lead with be Pat Banaszak, who is the Executive Director, of Family and Youth
Initiatives. She began volunteering for Dayton Right to Life in 1972, and she and her husband,
David, along with 5 others founded both Clark County Right to Life in 1973 and Tri County
Right to Life in 1978. Both groups were founded on the principle of the Sanctity of all Human
Life. Since that time Pat has been involved with all programs of Clark and Tri County Right to
Life, and in 1978, Tri County RTL began the Pregnancy Center, to give women help in their
choice of whether or not to carry their pregnancy to term. In 1990 expansion into offices in New
Carlisle and Fairborn (until that time they only had hotlines) found an overload of teens and
women who needed the services of the Network centers and they quickly were utilized to
capacity. In 1993, the Fairborn center saw a 45% increase in youth between the ages of 10-12
coming in for pregnancy tests. Pat partnered with GRADS educator, Wendy Kirsch, and created
a program to teach in middle and high schools about Sexual Risk avoidance, refusal skills of all
at risk behavior, and long term goals. That was the beginning of the Real Life…A Matter of
Choices program. Pat has created 10 other programs since . Each program is examined by the
Board of Directors and has to maintain the Mission: “Educating Families/ Strengthening
Communities” and the vision: “Working Hand in Hand to educate families and youth to
make positive decisions for their lives.” Pat received her Masters in counseling for high school
in 1998 and continues to attend conferences and educational seminars for up to date statistics
education and requires her staff to do so as well. She is ready and excited about the expansion of
clients and programs our Centers can have because of this grant.
Identify and assign a key staff member to serve as Program Outcome Manager. Program
Outcome Manager will be responsible for ensuring that the applicant’s proposed planned
uses of funding (e.g., increase number served, provide new or expanded services, expand
geographical area served, or other relevant use of funding) is being successfully
accomplished, and reporting participant activity, services provided and other data in a
monthly report or as requested to ODJFS. The Program Outcome Manager should have at
least one (1) year of experience in working in areas of family planning, or other services such
15

 as abortion prevention, childbirth promotion, parenting development and/or adoption
assistance, data tracking and reporting. Note: The applicant’s Program Outcome Manager
may also serve as Program Lead; however, the applicant must demonstrate that the assigned
key staff person meets the minimum required experience for both roles (3.3 B.).
Nikki Stefanow will take the position of Program Outcome Manager. Nikki began
volunteering at the Women’s Network in 2008 after years of homeschooling and raising her
children. She prepared their lessons and educated them throughout most of their schooling and
reported their records and grades to the Ohio Department of Education. While she was raising
her family, Nikki was active in her church working as a youth counselor, fundraiser coordinator,
and newcomer and fellowship coordinator. These experiences prepared Nikki to be an excellent
advisor when she began volunteering for FYI at the Fairborn Women’s Center utilizing her
excellent mentoring skills with clients in pregnancy and parenting, using evidenced based
curricula. In 2010 Nikki became assistant coordinator of the Fairborn Network and in 2012, she
was named director of that center and assumed the role of director of all three networks in 2014.
Since then, Nikki has reorganized the networks so that all three record files the same way, they
all have the same flow of curricula used and points to be given. She has created a system for
clients to move seamlessly from one center to the next with their files following them. She has
raised the morale of the staff 100%. Her compassion shows as she interfaces staff and clients.
Nikki hopes to expand the network to service more clients and to offer more services so that they
can truly be self sufficient by the time their babies reach the age of 3 with this grant.
Identify and assign a key staff member to serve as Fiscal Specialist to be responsible for
preparing monthly invoices; ensuring adherence to fiscal policies and procedures; and
preparing any additional reports as necessary. The Fiscal Specialist should have at least
one (1) year of experience in working with fiscal programs, preparing invoices, personnel
reporting, and preparing documentation (3.3 C.).
Sara Woodin will be assigned as Fiscal Specialist. Sara Woodin, the current Fiscal Director for
Family and Youth Initiatives and has been in the position for almost 2.5 years. Sara has a
background in fiscal management, graduating with an associate’s degree in Applied Science from
Sinclair Community College in May of 2013. She has adapted to two separate programs,
Peachtree and Quick Books when the organization changed systems. She is currently managing
the organization’s budget of just under $500,000 and has prepared invoices, personnel reporting
including paychecks, preparing documents and reports for Federal, State, and Local grants, and
has excelled in each area. FYI’s audit this year shows no written reports and praise for Sara and
her management of FYI. As part of her job, Sara has revamped the timesheets to show not only
how time is spent, but in which category of Administrative, Support, and Direct Services. Every
employee reports their work time showing these important percentages.
Identify and assign at least one key staff member to serve as Case Worker to be responsible
for coordinating care, resources and services for individual or family participants that will
provide services to promote childbirth and parenting. The Case Worker should have at least
one (1) year of experience in working in areas of family planning or other family services that
promote parenting, two parent families or family intervention services (3.3 D.).
16

 Diana Hobbs will serve as Case Worker in the Fairborn office. Diana has a background in
the medical field and as such has a compassion for the clients in need. She, herself, was a
teen mom and she identifies easily with many of the clients and their challenges. Diana
comes from a background of helping others and will continue that in this job. She is a
college graduate and is currently pursuing her certification to become an intervention
specialist. Diana will be supervisor to the volunteers in Fairborn. She is presently an inschool educator for FYI, teaching relationships, respect, responsibility and long term goals
to middle and high school students in six counties. She will be responsible for the client
reports and counts of clients, and other reports needing to be made.
FYI presently employs a Case Manager at each of the other two centers. Julie Daniels has
been at the New Carlisle Center for over 4 years and is experienced working with both
English and Spanish speaking clients. She strives to ensure all clients are comfortable with
our programs and with the WIC program housed in the same location. She wants the
clients to understand the benefits of using both services. She would like to add an extra
day to the Network services so that we can service more clients effectively.
Tonya Watkins, Case Manager of the Springfield Network is relatively new to the center.
She volunteered at the Fairborn Center for the past 3 years and was recently promoted.
She has reorganized the Springfield center to be more welcoming to clients and created a
conference room for group classes. Our Springfield Network is located in the worse crime
area in Springfield but Tonya, who has risen out of poverty, has taken measures to make
sure the clients feel safe in the office. During the time she has been there she is continually
raising the numbers of those we work with. She would like to expand hours for more client
services that could be offered.
Identify, by position and by name, any additional support staff your organization considers
key to the program’s success located within the service providers’ office. Provide a list of
key staff, their relevant education and work experience (including the subject and duration)
and the duties they will perform under this program (3.3 E.).
The newest staff position that FYI will hire is a Marketing Specialist who can raise community
awareness within the three communities where FYI Women’s Network Centers are located. That
position will be filled by Amber Hargett. Amber will be responsible for creating brochures and
flyers for the Centers, publicity and the dissemination of such, and social media to encourage
those in need to come for help. Her job is critical to the expansion of the Networks this next
year.
FYI will use volunteers for the remainder of the staff in Fairborn as they have since the
beginning in 1990. A paid Coordinator for the Fairborn center, will allow us to have a consistent,
responsible person to oversee all the workings of the center. Diana Hobbs will be there on a
consistent basis to guide the center and keep the accurate records, to notice trends and changes
in people coming for help and to have more programs that will help clients and give them the
tools to be responsible. Our other two centers have paid staff, and so we will ask for other things

17

 for those centers. FYI has three special volunteers who contribute to the success to the
Women’s Network programs. They are and their jobs are:
Judy Yarwick, Volunteer Publicity Manager: Judy has volunteered for FYI for seven
years and creates many of the graphic arts jobs, creates spreadsheets, helps with
newsletters, and other tasks that allow FYI to function well. She is a retired City of
Springfield Finance Department employee.
Jan Shaw, Volunteer Data Manager: Jan has worked with FYI for a year. She is
retired from Wright Patterson Air Force Base and is an expert in data management and
computers. She has coordinated all of the Women’s Network computers so that they all
use the same Access program making adjustments to enable FYI to analyze the data
within each center and to understand how we are performing in reference to our goals.
Anna Gros, Volunteer Consultant and Buyer: Anna has been with FYI since 1985 and
retiring as Fairborn Director 3 years ago. Anna remains with FYI as a volunteer
consultant and buyer for many of the items needed by the networks for their baby
boutiques, such as cribs, car seats and diapers (the items that cannot be donated in used
condition) and other baby items that are needed and not donated. She has many years
of mentoring and advising both women and men in prenatal and parenting skills and is
noted for her expertise in this area.

Ohio Parenting and Pregnancy ProgramGrant

APPENDIX A TECHNICAL APPLICATION
Provide a current organizational chart (including subcontractor/sub-grantees) and specify the
key management and administrative personnel who will be assigned to the project (3.3 F.).
Important: It is the affirmative responsibility of the organization submitting an application to
remove all personal confidential information (such as home addresses and social security
numbers) of the organization’s staff and/or of any subcontractor and subcontractor staff from
resumes or any other part of the application package.
The organizational chart, a map of the FYI organization is included as an attachment. The key
management and administrative personnel who will be working with this project are: Program
Lead will be Pat Banaszak, Executive Director. Pat holds a Master’s Degree in Counseling, as
well as 40 years of experience counseling young pregnant women and teaching parenting skills.
She has lived in the same house in Ohio since 1972. Her husband worked as an engineer for
WPAFB and all 4 of their children graduated from Tecumseh Schools. Pat will be responsible
for ensuring that all functions and projects expected by this grant are implemented and all
Centers are running with accurately and efficiency. She will have monthly meetings to discuss

18

 successes and challenges in order they can be resolved or tweaked so clients have the best
mentoring and get the help they need.
Nikki Stefanow will be Program Outcome Manager. Nikki will be responsible for achieving the
proposed planned use of funding, increasing the number of clients served, providing both new
and expanded services, and gathering the data from the centers and presenting it on a timely
basis. She brings with her 8 years of experience within the Fairborn Pregnancy and Parenting
Center, including 2 years as over-all Director of the Centers. Nikki was a teen mom and she
understand the concerns of many of the clients and has the compassion and understanding of
their struggles.
Sara Woodin will serve as Fiscal Specialist. Sara graduated in 2013 with an associates degree in
Accounting from Sinclair Community College and has become an expert in both Peachtree and
Quick Books. Her responsibilities consist of preparing monthly invoices, ensuring adherence to
fiscal policies and procedures, and preparing any additional financial reports as necessary and
responsibilities she already carries with other grants.
The Case Manager for Fairborn will be Diana Hobbs. Diana has been with FYI for over 1 year
and has volunteered for the Fairborn Women’s Network before she worked as an Educator for
FYIs program, Real Life…A Matter of Choices. Within that program, Diana teaches in many of
the middle and high schools in a 6 county area talking to youth about sexual risk advoidance,
consequences of risky behaviors, refusal skills, and long term goals. She will be responsible for
coordinating the care, resources, and services for the clients and their family members who come
for pregnancy and parenting help.
Likewise, Julie Daniel and Tonya Watkins, the directors of the centers in New Carlisle and
Springfield respectively, will not be paid out of this grant, but have the same responsibilities.
Both have been involved in the Centers for over 2 years, first as volunteers, then in paid
positions as they became open.
Amber Hargett will create the atmosphere of a compassionate, friendly center where young men
and women will want to come to get help for their baby to be. Within her position she will reach
out to groups in the locations that will partner with FYI to help the clients in their journey to self
discovery, parenthood and eventually to good parenting and self sufficiency.
Additional help done by volunteers consists of:
Jen Shaw, Data Manager to develop data management collection for the reports that will
be created.
Judy Yarwick, Publicity Director, will ensure that publicity about the program will get to
print media and will work with FYI for the forms, flyers, and paperwork which will assure
FYI of sustainability in the future.
19

 Anna Gros consultant and buyer. Anna has been with FYI since 1985 and retired as
Fairborn Director 3 years ago, but still stays as a volunteer consultant and buyer of much
of the items needed by the networks for the baby boutiques such as cribs, car seats and
diapers (the items that cannot be donated in used condition) and other baby items that are
needed and not donated. She has many years of mentoring and advising both women and
men in prenatal and parenting skills and is valuable for her expertise in this area.

Ohio Parenting and Pregnancy ProgramGrant

APPENDIX A TECHNICAL APPLICATION
3.4 Organization Profile
(Response should be no more than 4 pages in total for this item, not including attached
brochures/printed material.)
Describe the services your organization currently provides. Include the intake process,
services provided after intake and how the services are provided/received, and any follow up
services, logistics of operation and geographical areas of coverage. Include any services you
consider unique to your organization. Attach your organization’s website address and attach a
brochure or other printed material that provides information on your organization.
Describe the population your organization serves including any demographic information as
well as family makeup. Include the number of families for whom your organization has
provided Family planning , Abortion prevention services and childbirth promotion; and
Parenting education/development in the past 2 years.
FYI provides wraparound services for clients and their babies and offers services until they
are between 3 to 5 years old. The process begins when the parent or parents come to one
of the centers and asks for help.
Describe in detail the services your organization currently provides. Include
the intake process,
When a prospective client comes to one of our centers, she is given a pregnancy test and an
intake questionnaire. If the father comes, he too is given an intake questionnaire. The
application is filled out with an advisor. From the questionnaire, the advisor understands
the client’s needs, her/his challenges, their desire for the pregnancy, and their needs to be
self sufficient and their parenting skills. With this information and depending on the
results of the pregnancy tests, the advisors will either accept them as a client or will refer
them to an agency that might be better suited to meet their needs.
Services provided after intake and how the services are provided/received,
and any follow up services,

20

 Services FYI provided are one on one mentoring, and depending on client’s skill level, we
have over 200 lessons available on pregnancy & parenting. Clients complete the lessons to
earn items (crib, car seat, diapers, high chair, stroller, almost any baby items, etc). As they
finish the lessons and show understanding of the materials, they earn points, which can be
spent in our Baby Boutiques. Because diapers are part of hygiene and health, clients can
get a supply of these every month. The follow up services which are unique to FYI
continue through age 5. Clients take more parenting classes to have them ready for their
children to be successful as they start school. Earn While You Learn curricula is used in
these programs as well as a wraparound program of FYI called Little Scholars. This is a
unique preschool that works with 3-5 year olds with the focus on socio-emotional skills and
the requirement that parents be in the class as well for additional parenting classes.
Logistics of operation and geographical areas of coverage.
FYI’s three centers serve in three geographical areas: In Fairborn
and New Carlisle both of these centers are located in different parts
of the county where most of the services we provide do not exist.
Fairborn is a small city and most of our clients are economically
depressed and have no transportation to reach the city of Xenia,
where the services are located. The same is true for New Carlisle, a
rural city at the edge of Clark County with no transportation to
Springfield. The Springfield center is located in the worst crime
area in the city and thus can refer elsewhere. Still because many of
the clients walk to the center, FYI tries to have the various
partnering groups come to the center so the clients do not have to
worry about walking to services especially in the surrounding
unsafe neighborhood.
Include any services you consider unique to your organization.
Because we have found a number of areas where clients needs are not being met, we try to
use the expertise of other agencies and utilize their ideas such as: OSU Master Gardeners,
a program we use, along with the community garden begun by FYI 4 years ago to help our
clients understand about nutrition, growing and harvesting, and preserving and
preparing vegetables to make nutritious healthy foods. Little Scholars, a program
especially for pre school designed to teach parenting skills, as well as socio-economic skills.
Job Skills, designed for parents to prepare them for basic jobs and a referral network with
Ohio Means Jobs to link to jobs. Latino Connection and Teaching Mentoring Communities
to work with the growing Latino communities in all of our areas designed to get the parents
engaged and promote continuous attendance to our lessons after the baby is born.
Fatherhood Project, just beginning but already has 27 men involved to instill the
knowledge of how much fathers are valued in their child’s life and parenting skills.
Attach your organization’s website address and attach a brochure or other
printed material
that provides information on your organization (if available).
21

 The website is is www.fyiohio.org and the brochures are attached.
Describe the population your organization serves including any demographic
information as well as family makeup. Include the number of families for
whom, in the past 2 years your organization has provided family planning,
abortion prevention services, childbirth promotion, and parenting education
or development.
The population FYI serves is a mix of Caucasian and Hispanic families. The Hispanic
population is growing in this area and now comprises 30_% of our clients. FYI still serves
mostly single moms, but the Fatherhood Program is quickly growing. A year ago we had 59 dads involved, today, we have 27. Most of our clients live in deep poverty and most live in
low income housing in the three areas. In Fairborn and Springfield most clients usually
walk to their appointments and in New Carlisle clients either walk from New Carlisle or
catch a ride with a friend for their WIC appointment (The WIC New Carlisle office is in
the New Carlisle center’s space The number of families served in the past 2 years in all of
our centers is 565, an average of 282 per year.

Ohio Parenting and Pregnancy Program Grant

APPENDIX A TECHNICAL
APPLICATION
3.5 Participant Eligibility
(Response should be no more than 2 pages for this item)
Applicant must describe its experience determining eligibility for need based programs, and
describe how it will ensure, to the best of its ability, the accuracy of the information provided by
the program participant.
FYI has worked with many eligibility required grants for many years, and understands the
workings of the PRC forms for some TANF programs, the eligibility of food stamp process
and other needs based programs. The programs we are involved in, we have required
those applying to have proof of residency, proof of income, number of people in the
household, and proof of pregnancy if necessary. In 2007 we were in grant with Springfield
City Schools and also had eligibility forms for our elementary and middle school children
in the program. The Women’s Network had to have them until we were declared under
TANF rules # 1, 2,3 and 4. (1. Provide assistance to needy families so that children can be
cared for in their own homes; 2) Reduce the dependency of needy parents by promoting job
preparation, work and marriage; 3) Prevent and reduce the incidence of out-of-wedlock
pregnancies; and 4) Encourage the formation and maintenance of two parent families. The
work with our families and moms fit into one of more of the categories.
Applicant must define the eligibility requirements they will use for the proposed services. At

22

 minimum, the eligibility requirements must include: and we will use the following methods to
assure proper eligibility (A yes will be put at the end of every statement we are using to test
1) Participant income at or below 200% of the current federal poverty level; YES
2) Temporary Assistance for Needy Families (TANF) eligibility and citizenship YES
requirements; and,
3) Requirements as listed in ORC 5101.804. YES
Additional eligibility standards may be added.
Program participants will be permitted to provide self-certification of income and TANF
eligibility only. If selected, a form will be provided by ODJFS to the Applicant. Eligibility and
Citizenship. YES would like to do this.
Verification must be conducted by the applicant and may not be sub-awarded to another agency.
Determined eligibility in the past if received other govt assistance. YES but
have to get proof of residency.

Ohio Parenting and Pregnancy ProgramGrant

APPENDIX A TECHNICAL APPLICATION
3.6 Program Design
(Response should be no more than 4 pages in total for this section)
A.Include a description of the target audience that it will serve.
The target audience FYI will serve is moms and dads who are pregnant and parenting
children under 1 year of age. Most will be under 200% of the poverty level and most will be
located within 5 miles of each center. FYI would like to increase the numbers of moms and
dads involved with the babies—from the time they find out they are pregnant. It has been
shown by many statistics, that if a father is involved with the unborn baby, he will be
involved after the birth as well. The goal for FYI is to add an additional 25 clients or a 50%
increase throughout the next year.
With creative social media and billboards, more families, and especially fathers, will come
and understand their importance in their child’s life. Expanded times to be open at each
center will allow for more clients and classes to be conducted. Because FYI serves a sizable
amount of farm laborers, and many times they cannot come in for appointments at traditional
times, FYI would like to expand its education to putting many of its lessons on UTube, which
is where our younger clients look to for answers, and educate them that way in addition to
person to person.
B. Program Requirements
It is expected that funding will be used to increase community awareness of available services,
increase availability of services thereby increasing the number of families served, and provide
new and expanded services for pregnant women and parents, or other relatives caring for
children twelve months of age or younger. Applicants must thoroughly describe how it will meet
the following program goals and the strategy to meet the following requirements.
1) Increase numbers served: By expanding hours and days FYI is open in each location, that
will allow time and space everyone better and to have more classes and individual
23

 appointments. Each center will track the amount of increase over the next 7 months. The
goal is to serve 50% more of the numbers we currently have for expansion of those who
qualify as being pregnant or parenting children under 12 months. With the use of social
media, we will record the numbers of hits we have, we will create a survey after the video
to capture the knowledge people have received, and we will put those people to come in
to one of the centers for one on one mentoring.
The applicant must identify how many additional families it will serve, and thoroughly describe
its plan for:
a) increasing participation above current levels—Expanding our hours on both the days that the
center is open and by adding days to be open will bring in more clients. Many have asked us to
be open on Friday, and we will try to be open other days and track participation variances. We
will also track births in our area and invite those families we know who have babies in this age
range be sent a personal invitation to apply at the networks. Again, the goal is to expand by
50%.
b) demonstrating the increase is the result of funding provided—As this campaign gets
underway, we will have a survey for clients to fill out that will show us that the use of the funds
in this matter are the best. A notice on all materials which this grants funds will have the notice
on the back and FYI will monitor the number of families served—especially in the expanded
hours.
c) and how the expected increase will be measured—FYI will have a survey for families to
complete. That survey will ask them specifically where they got their information and why they
chose to come to the Network. FYI will also monitor numbers of families coming both during
regular hours and other specified hours as well.
Increase community awareness and availability of services—This will be done through strategic
placement of brochures and pamphlets in doctors offices, other agencies that work with pregnant
and young babies, and various places that women will frequent. Create a brochure that
specifically gives updated hours, materials to be earned by doing the program, and services to be
rendered. With the help of our marketing specialist FYI will be able to create and promote the
Women’s Network more forcefully, with increased visibility, and with more emphasis on social
media. The organization will be able to reach more parents in the age group that will be having
families. And with educational videos on UTube, FYI will be able to touch many who might not
know about us, but need to know the lessons on the video.
Applicants must describe how it will notify the public of the availability of services including a
Marketing strategy—FYI has utilitized mouth to mouth marketing strategies in the past to let
women and men know that there is help for them. Our marketer will analyze the effectiveness
and reach each field of the social media campaign for the Network. FYI has both Facebook and
web accounts and will use those to attract people into the social media field of this campaign. It
will use surveys to test the effectiveness as well. After the marketing pieces are in place, FYI
will make sure local organizations, local events and fairs and festivals have FYI people present
to explain and promote the programs. Finally, FYI will offer incentives to clients who bring in
new clients.

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 Geographic reach; multimedia strategy; and the anticipated number of contacts—The geographic
reach will include all three locations of the Women’s Networks, Fairborn, New Carlisle, and
Springfield and the vicinities around them. This includes a medium size city, a fairly rural area,
and a small city. It includes all economic levels, but the percentages of poor are quite high in
each of the areas.
The multimedia strategy is two-fold. 1) Brochures to be specific for people who are not involved
with FYI at the present time introducing them to the services that are offered, the materials that
can be supplied, the ease in making appointments and the variety of locations available. It will
promote the class taught, the care of the staff and the importance of the parents within the child’s
life. 2) Separate social media, specific social media and especially U-Tube videos will be done
to demonstrate various lessons included at the network, such as how to diaper a baby, how to
burp, how to get one to go to sleep, etc. These videos have been requested many times by
clients, but FYI has never had finances to do them. Done by staff that the clients trust, they will
also introduce many prospective clients to the services they receive at the centers. The number
of contacts will be monitored by the tools of social media experts, but we hope to have 200-300
hits by the end of the 7 months.
The organization will make through these strategies. Include the indicators your organization
will:
Use to measure effectiveness.—FYI use Sea Monkey or similar surveys like that to measure the
people who are looking at social media and will invite comments about their effectiveness. FYI
will also track the additional numbers of new clients applying for services. Tracking will also
occur through other organizations with whom we partner and how many referrals have been
made to us and discuss various ways we can improve our strategies to get more needy clients to
sign up. Finally, FYI will meet with both GRADS program to introduce their students into our
program and will give incentives to those students who sign up and come on a regular basis.
Every two months we will review our effectiveness in the recruitment process and course-correct
if necessary.
C. Mandatory services
At a minimum, applicants must provide ALL of the following services to participants and
indicate whether these services will be provided directly by the applicant or through a sub
agreement contract with another organization.
a. Parenting and family classes/counseling classes. Applicants must include the curriculum to
be used or a description of the class curriculum, lessons, goals and outcomes. Application
should indicate whether the curriculum is an evidence based curriculum. FYI has used Heritage
House 76 and their curricula as the basis for our pregnancy and parenting classes. It is an
evidenced based curricula and its over 200 lessons gives us much to teach our clients and allows
us to assess them for their needs and be able to structure their lessons to meet those needs. A
copy of the lessons, and what they teach is indicated in the attachment. The goals for all of our
lessons is to give the parents the tools to be self confident, to be a parent, the ability to make
positive decisions for both their pregnancy and their newborn children, learn how to care for
their babies, and learn through parenting classes to be the best parents they can be. The outcome,
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 as stated before, is to make them responsible and self sufficient as parents by the time the child is
three. CURRICULA ATTACHED.
b. Infant/child safety lessons—FYI uses the Earn While You Learn Program, an evidenced
based curricula for these lessons: in particular lessons 2.3, 6.2 , 6.4, 7.1, 7.2, 7.3, 8.4, 8.5. They
also use kits and items from Children’s Medical Center in Dayton Ohio, to show clients how to
put in car seats properly and how to keep child safe around the house and yard, dog bites, poison
control and many other safety topics. Also FYI also gives each mom a subscription for the viral
Growing Child which teaches many of the safety techniques.
c. Mother and child nutrition education including the risks of alcohol, tobacco—The Heritage
House lessons used are 1.3, 2.1 8,1,82, 10.1, 10.2, 10.3, 10.4, and again the Growing Child
Curricula and Master Gardens of Clark County give us plants every year to plant in our garden.
FYI also has a community garden for hands on work and also growing, harvesting, and
preservations techniques. We work with Children’s Medical Center to bring out programs for
our clients with different programs which our clients may need, various dentists for teeth
cleaning, and other local agencies in both Greene and Clark Counties who have the same clients
or similar ones that we can share to help them more.
d. Outreach for other social services not provided by the organization—FYI works with many
organizations which have great supports for our clients including: OSU Extension Offices,
WIC, Clark County Health Department, the food pantries, churches in each area. All of these
services are free—except for the copies and workbooks and equipment to allow clients to take it
home (such as a blender for food preparation for baby food).
D. Addressing Infant Mortality
Applicants must include a plan to address the infant mortality crisis in Ohio, the services they
will provide to its participants and staff to help reduce the risk of infant mortality, and a plan to
deliver those services, along with any additional services, including implementation, service
delivery, and intended outcomes. Include the indicators your organization will use to measure
effectiveness.—FYI will use the Health department power point from SIDS training;
also info from Miami Valley Women Center—all evidenced based curricula;
train staff to relay information (this training would be offered quarterly &
information given to all clients) and include a survey to test for knowledge,
attitude and behavior change. In the 37 years FYI has worked with clients in
this field less than 1% of its clients have been referred to Children Services.
E. Subcontractor(s)/Sub-grantee(s)
Applicants are to disclose whether or not any sub-contractors/sub-grantees will be used for this
project. If none will be used, applicant must include a statement in its proposal that no
subcontractors/sub-grantees will be used. If applicants intend to use sub-contractors/sub-grantees
for services, it must describe the procurement process and the timeline to accomplish
procurement. Applicants are also to describe their current or intended relationship with partner
community organizations or entities that will be used to carry out the program activities,
including: 1) the name of each partnering organization 2) whether the entity is current or
intended partner 3) if funding will be provided to the partner or if services will be donated 4) the
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 roles and functions for the applicant and each individual partner organization 5) services each
partner will provide 6) whetheror not the partner organization(s) have collaborated with the
applicant on similar projects in the past; 7) the number of years of collaboration with each
partner and 8) the location of partner offices.
Family and Youth Initiatives does not use subcontractors, but does works with organizations who
might have a specific lesson that would be best for our clients. Every lesson we get is free for us
and our clients.
F. Monitoring
Applicants must describe the monitoring process for the sub-contractors/sub-grantees (if
applicable). Include the documentation that will be reviewed, who will perform the monitoring,
the frequency that the sub-grantee shall provide performance reports and the plan addressing
areas for improvement or poor performance. [If no sub-contractors/sub-grantees are involved, the
applicant shall disregard this requirement.]
G. Describe how participant and program information will be collected and confidentiality
maintained.—The advisors and mentors give a detailed description of participant behavior within
the program. Individual charts are kept in locked filed cabinets in each location and the directors
are responsible for making sure all data is kept in them—open only to those dealing with the
client or the supervisors or grantors. Every staff member understands the meaning of
confidentiality and the importance of it.
Program Budget THE BUDGET IS AN ATTACHMENT TO THIS DOCUMENT.
Year 1
November 2015 through June 2016

Ohio Parenting and Pregnancy ProgramGrant

APPENDIX A TECHNICAL
APPLICATION
Program Budget Items Totals
Personnel $
Fringe Benefits $
Staff Mileage/Other Travel $
Office Supplies $
Pre-Natal/Diagnostic Services $
Marketing and Media Activities $
Contracted Services $
Participant Education $
Participant Support(material items, incentives, etc) $
Equipment (shall not exceed 5% of the budget) $
Other: (Specify here Add lines as needed) $
Other: (Specify here) $
Other: (Specify here) $
Total Program Costs: $
Indirect Costs (shall not exceed 10% total modified
direct costs:
$
27

 TOTAL: $

Ohio Parenting and Pregnancy ProgramGrant

APPENDIX A TECHNICAL
APPLICATION
Program Budget THIS BUDGET IS ALSO AN ATTACHEMENT. THE AMOUNT OF
THE YEAR BUDGET IS OVER THE $100,000 LIMIT, AND WILL BE COVERED BY
FUNDRAISERS SO THAT THE CLIENTS CAN HAVE THE BEST SERVICE.
Year 2
July 2016 through June 2017
Program Budget Items Totals
Personnel $
Fringe Benefits $
Staff Mileage/Other Travel $
Office Supplies $
Pre-Natal/Diagnostic Services $
Marketing and Media Activities $
Contracted Services $
Participant Education $
Participant Support(material items, incentives, etc) $
Equipment (shall not exceed 5% of the budget) $
Other: (Specify here Add lines as needed) $
Other: (Specify here) $
Other: (Specify here) $
Total Program Costs: $
Indirect Costs (shall not exceed 10% total modified
direct costs:
$
TOTAL: $

Ohio Parenting and Pregnancy Program Grant

APPENDIX A TECHNICAL APPLICATION
Budget Narrative
Please describe the costs and provide any necessary calculations for each budget line item. If
indirect costs are included, the organization must provide a copy of their current federally
approved indirect cost plan, or limited to 10% of Total Modified Direct Costs.
THE NARRATIVE IS ATTACHED TO THE BUDGET FOR EASE OF INFORMATION.
Program Assurances
Please affirm that the following statements and true and accurate. Affix the appropriate signature where
indicated. The application will not be considered complete without the required signature and shall
be disqualified from consideration. We the undersigned assure that our organization:
1. Primary purpose is to promote childbirth, rather than abortion, through counseling and other
services, including parenting and adoption support (3.1 C.).
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 2. Will provide services to pregnant women and parents or other relatives caring for children twelve
months of age and younger, including clothing, counseling, diapers, food, furniture, health care,
parenting classes, postpartum recovery, shelter and any other supportive services, programs or
related outreach (3.1 D.).
3. Will not charge pregnant women and parents or other relatives caring for children twelve months
of age or younger a fee for any services received (3.1 E.).
4. Is not involved in or associated with any abortion activities, including providing abortion
counseling or referrals to abortion clinics, performing abortion-related medical
procedures, or engaging in pro-abortion advertising (3.1 F.).
5. Will not discriminate in its provision of services on the basis of race, religion, color, age,
marital status, national origin, disability, or gender (3.1 G.).
6. Will only sub-contract or sub-grant services to entities that are; private, not-for-profit
organizations; physically and financially separate from any entity, or component of an
entity, that engages in abortion activities; and not involved in, or associated with, any
abortion activities including providing abortion counseling or
referrals to abortion clinics, performing abortion-related medical procedures, or engaging
in pro-abortion advertising (3.1 H.).
7. Will comply with the requirement of 5101.804 of the Ohio Revised Code.
Organization Name: FAMILY AND YOUTH INITIATIVES
Printed Name of Director/CEO: PAT BANASZAK
Signature
Date: November 12, 2015

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