Section 5-2 - The Application (a) The application for funding a program shall contain at least the following information: - (i) The name, address, and telephone number of the applicant;
- (ii) The names and addresses of the officers of the applicant;
- (iii) The name and qualifications of the director or administrator of the program and of the staff of the program;
- (iv) Location of applicants services within the region;
- (v) A statement about the service regions for which the applicant seeks to receive funding: either an entire region or a portion of the region;
- (vi) The location and description of the place or places where the program is, or is intended to be, given;
- (vii) As assurance signed by the chairman of the board that:
- (A) The program will provide written materials as outlined in the Division's on-site review forms to demonstrate compliance with the Division standards;
- (B) The Division staff will be allowed to make on-site review of the program in accordance with the Division's procedures for on-site reviews; and
- (C) The program will provide data on a regular basis as required by the Division and on forms prescribed by the Division.
- (viii) A statement evidencing compliance with Wyoming laws and regulations pertaining to safety of building and operations;
- (ix) A service delivery plan which shall include a description of:
- (A) The program goals and objectives;
- (B) The needs in the region and how the program proposes to meet those needs;
- (C) The program services provided or proposed to be provided which shall be as set forth in Chapter IV of these rules;
- (D) The strategy for providing the services; and
- (E) The program's relationship to other human service programs in the region.
- (x) The amount of funds requested for each service;
- (xi) Whether or not local funds are available;
- (xii) Whether the applicant has cooperative agreements with allied agencies;
- (xiii) Any other supporting documentation the applicant wishes to submit; and
- (xiv) An explanation of the fiscal management system which the applicant uses or plans to use and which shall be in accordance with generally accepted accounting practices.
(b) Copies of the following documents shall accompany new and competing applications: - (i) Articles of Incorporation and bylaws of the applicant, or if the applicant is a community human service board, a copy of the organizational document; and
- (ii) The criteria followed by the applicant for providing services to clients.
(c) The Division shall maintain a file of the applications and supporting documents it receives.