02/08/1994 - Packet MEMORANDUM
CITY OF TIGARD, OREGON
TO: Budget Committee
FROM: Wayne Lowry, Finance Director W
DATE: February 8, 1994
SUBJECT: Social Agency Funding Requests
I have included for your review the applications from the social agencies requesting
funding from the City. The information sheet attached to each one shows you
whether or not the criteria have been met. It also indicates which documents were
submitted along with the applications.
The packet for each agency includes their cover letter and completed application.
Other related documents submitted with the applications are on file in my office. If
you would like copies or would like to view the documents, please call me and I will
make them available to you.
The policy established by the budget committee last year was to limit total social
agency funding to 1/2 percent of the previous years operating budget rounded up to
the nearest $1,000. Using this calculation, the limit for 1994/95 will be $54,000.
I am also including your copy of the Comprehensive Annual Financial Report for the
year ended 6/30/93 and the annual report for the same period. We have tentatively
scheduled a budget committee meeting for Monday February 28 at 4:OOpm. The
purpose of the meeting will be to hear presentations and to discuss the funding
requests. We will also review the financial reports and activity through January
1994.
If you have any questions about the application materials presented or the financial
reports, please call me at 639-4171, Ext. 345.
CITY OF TIGARD
BUDGET COMMITTEE
SOCIAL SERVICE FUNDING POLICY
The City of Tigard receives funding requests from various agencies and non-profit
corporations each year during the budget process. This policy provides the framework
within which funding decisions will be made by the Budget Committee.
1. The maximum social agency funding total each year will be one half of one percent
of the previous year's operating budget, rounded to the nearest $1,000.
2. Agencies requesting City funds shall:
• Demonstrate that the Agency has been providing service to City of Tigard
residents for at least one year prior to the date of application.
• Be registered with the Internal Revenue Service with a 501 (c) (3) not for
profit tax status.
• Be run by a volunteer Board of Directors with representation from the City
of Tigard that is reflective of the agency's overall geographic membership
and client service.
• Operate with a balanced budget.
• Be incorporated in the State of Oregon and registered to do business here.
• Fill out and submit a completed application to the City of Tigard Finance
Department by January 31.
• Provide written reports to the Budget Committee on a quarterly basis during
the period of funding. Reports must include information related to the use
of City funds and a discussion of services provided to Tigard citizens.
3. The Budget Committee shall review the applications and hear oral presentations
from each requesting agency.
4. After all information has been gathered and reviewed, the Budget Committee, at
a separate meeting, will deliberate the merits of each application individually and
make decisions about which agencies should be funded.
5. The Budget Committee will then determine how much each approved agency
should be funded on its merits without regard to the funding available.
6. The approved funding for each approved agency will then be aggregated and the
total will be compared to the calculated funding limit. All approved funding
amounts will then be adjusted proportionately so that their total does not exceed
the funding limit.
7. The Budget Committee may amend those procedures as necessary.
h Jogin\"w\war*Nsocaagnt.und
CITY OF TIGARD, OREGON
SOCIAL SERVICE AGENCY FUNDING REQUEST CRITERIA
INFORMATION SHEET
ORGANIZATION: Aer e� 114wx
FUNDING REQUESTED: $
FUNDING HISTORY: 1990/91
1991/92 S
1992/93 $ —
1993/94 S
CRITERIA: Yes No
1. Service to City Residents -
1 year or more ✓
2. IRS 501(c)(3) or not for profit status
3. Volunteer Board with City representation
4. Balanced Budget
5. Oregon Incorporation and Registration
6. Completed Application ✓
DOCUMENTS SUBMITTED:
1. Audit Report or Prior Year's Financial Statements ✓
2. 501(c)(3) Status
3. Articles of Incorporation __ ✓
4. By-laws
• T H E
INg
T H E A T R E C O M P A N Y
15960 SOUTH WEST ROSHAK RD.
TIG ARD, OREGON 97224
PHONE 5 0 3-6 3 9 - 5 1 4 8
February 1, 1994
City of Tigard
13125 S.W. Hall
Tigard, OR 97223
Dear Officers:
Enclosed please find a formai request from the Broadway
Rose Theatre Company for a grant of $5,000 from the City
of Tigard to be used for the royalties to Fiddler On The Roof.
The Board of Directors sincerely hope that your committee .
will act -favorably upon this request.
If you have 'any questions, .I can be reached at 590-5148.
Sincerely,
Sharon Maroney_
Artistic Director_
encls.
SUMMARY OF PROPOSAL
The Broadway Rose Theatre Company is Washington County's only pro-
fessional, summer stock company. The Tigard School Board has annually
voted to let Broadway Rose use the Deb Fennell Auditorium free of charge
since 1992. We have received the following grants: Metropolitan Arts
Commission, Tektronix Foundation, Templeton Foundation. Landmark Ford
has given us corporate sponsorship. The community at large has supported
us with fund raisers and individual contributions totalling over $9,000
per year.
The company has an excellent chance at financial success. The Broadway
Rose offers mainstream entertainment. Our questionnaire, which is avail-
able in each program, helps us know which shows the audience wants to see.
This past season our audience grew 14.4%. We have received triple the re-
quests to mail brochures. our third season (June 25 through August 14)
will feature Fiddler on the Roof, Little Shop of Horrors, and an original
musical revue -- Broadway Goes Hollywood. Two original children's shows
will run concurrently with the main productions.
Our long-term goal is for the Broadway Rose to become a year-round
company, We chose Washington County because the availability of affordable
high-quality theater is not keeping pace with the fast-growing population.
According to the Arts Commission of Tigard, Tualatin and Sherwood (ACTTS)
the entire Portland Metropolitan region, with a population of 1 .5 million,
is a reachable audience.
The Broadway Rose promotes the understanding and appreciation of the
performing arts. Because we import New York actors, we foster a unique,
cross-cultural and geographic experience for visiting and local performers
and audiences. Our company also offers employment to area actors; provides
training and encouragement for those -considering a career in theatre, and pro-
vides a creative outlet for community volunteers. The Broadway Rose reaches
areas of cultural diversity and across age and economic boundaries. We em-
ploy nontraditional casting, and offer reduced prices for children and seniors.
The Deb Fennell Auditorium is "wheelchair friendly," and has free parking.
We are looking for funds to launch our third season. After an exten-
sive budget overhaul this year's start-up costs will be $16,000. Our second
season we were successful at cutting our operating expenses by 12.4%. With
the help of Oregon Media Services Inc. who is volunteering their time and
expertise in public relations and marketing, we plan on increasing our
audience even more. This season we will run our shows two weeks, taking
advantage of our best form of advertising, word of mouth. We will also offer
5 performances per week instead of 6 thereby combining our audiences and
cutting costs even further. These are just a few examples of the changes we
are implementing this up coming season. We predict that we will be able to
cover our own start up costs for the summer of 1995.
We would like to request $5,000 from the City of Tigard to pay for the
royalties to Fiddler On The Roof.
THE BROADWAY ROSE THEATRE COMPANY
ABOUT THE ORGANIZATION:
1. Name: The Broadway Rose Theatre Company. 15960 SW Roshak Road, Tigard
-Oregon 97224.
2. Contact: Sharon Maroney, Vice-President Board of Directors/Artistic
Director. 590-5148.
3. Background: The Broadway Rose Theatre Company is a professional, summer
stock company founded on November 5, 1991 by a group of experienced actors,
directors and designers. The founders, with over forty years of New York
experience, wanted to form a company in a metropolitian area that did not
have a summer stock theatre. The Broadway Rose's Executive Producer, Matthew
Ryan, is a native of Tigard. Our first season we successfully mounted 5
musical productions and one original children's show. Community response
was positive enough to inspire the Tigard School Board to unanimously vote to
allow the Broadway Rose use of the Auditorium free of charge. Our second
season we produced 3 musical productions in order to cut operating expences.
We also offered two original children's shows. We were successful in cutting
operating expenses 12.40. Audience size, volunteer involvement, and cotrunuaiLy
and business support have all increased. Audiences grew 14.3% and we tripled
our mailing list by using audience surveys. The Tigard School Board has voted
to let Broadway Rose use the Auditorium free of charge again for 1994. Our
third season we plan to continue to offer affordable mainstream entertainment.
Ticket prices will not increase for 1994.
4. The Board of Directors: The Broadway Rose's four founders also serve as
the Board of Directors. Matthew Ryan (Executive Producer) is the Board's Pre-
sident= Sharon Maroney (Artistic Director, Director, Actress) is the Vice-Pre-
sident; Dan Murphy (General Manager, Director, Actor) is the Treasurer; Joseph
Morkeys (Design Director) is secretary. In addition to previous theatrical
experience, each has spent over a decade in the Big Apple working at their
craft (please see Attachment A -- Qualifications of people implementing the
project) . It's a complementary team because each member plays an active role
in the. business side of the theatre company, as well as creative. The Broadway
Rose's founders receive just a token salary, and are paid only seven weeks out
of the year; however, producing summer stock is a year-round project. They
routinely put In 16-hour days during the season. And, in the off-season they
spend most of their free time getting ready for the following summer. Off-sea-
son.•activities include research, grant writing, fundraising, creation of pro-
motional materials, auditioning, etc.
Page I
DESCRIPTION OF THE PROJECT:
The Broadway Rose is mounting its third summer stock season -- from June
25, 1994 through August 14, 1994 -- at Tigard High School's Deb Fennell
Auditorium. If received funds would be used to pay for royalties for
Fiddler On The Roof (See Attachment B -- Professional License Agreement) .
The tentative season (pending rights) is Fiddler On The Roof, Little Shop
of Horrors, and an original musical revue -- Broadway Goes Hollywood. Two
original children's shows will run concurrently with the main stage pro-
ductions. In March, a core of four to six performers will be hired from
auditions in New York. The balance of the casting will be done in April
in Oregon. Our musical director has recently relocated from New York to
Oregon and is joining us for his second season. The tech and stage crews
will be hired from the Tigard High School Drama Department. House (ushers,
ticket tearers, etc. ) and other support ( set painting and construction, etc. )
is by local volunteers. This concept has worked superbly these past two
summers and provided a unique training program at all levels. The Broadway
Rose has an excellent chance at long-term financial success because it
chooses material that appeals to the general public, rather than a select
group. The Broadway Rose has a strong commitment to audience satisfaction.
Evaluation forms, which are available after each performance, help the
company keep in tune with what the audience wants to see.
GOALS AND OBJECTIVES:
Goal no. 1: To bring affordable, high-quality theatre to Washington County
audiences. (Objective: Mount two musical productions, plus an original
musical revue and two original children's shows during the summer of 1994.)
Goal no. 2: Promote the appreciation, knowledge and understanding of the
performing arts. (Objective: Involve the theatre in community affairs and
conduct a strong promotional program to increase audience size.)
Goal no. 3: Provide a relationship between professionals, students and amateurs
to train, promote, encourage and counsel those seeking careers or desiring to
expand their expertise in theatre. (Objective: Hire a core of professional
actors from New York; supplement with Oregon professional actors as well as
local theatre arts students and actors beginning or considering a career in
theatre.)
Goal no. 4: Provide a cross-cultural/geographic experience for visiting and
local performers, audiences and neighbors. (Objective: One of the Board of
Directors lives in New York eight months out of the year. Four to six actors
will be hired in New York. They will be provided airfare and salary, and will
be housed in the local community. Non-traditional casting will be encouraged.)
Goal no. 5: Promote artistic opportunities for performers, directors, artists,
musicians, . . . (Object: Mount professional musical productions during the off-
season. Write and produce two original children's plays.)
Page 2
THE BROADWAY ROSE HAS CREATED THE FOLLOWING PROMOTIONAL PROGRAM:
ADVISORY BOARD - As many as 72 people from the greater metro area have
expressed est in being on an advisory board for the theatre. There
-is currently a core group of 12 (including media representatives and coln-
munity leaders) who are helping with promotional and fundraising efforts.
LOCAL MEMBERSHIP - The Broadway Rose is a member of the Portland Area
Theatre Alliance, the Arts Commission of Tigard, 'Tualatin and Sherwood
(ACTTS) , the Tigard Chamber of Commerce, and The Tigard Rotary.
FUNDRAIPSERS - Several activities are being considered ML combine fund-
raising, promotion and community involvement. Opening night of Fiddler on
The Roof has already been sold to Harvey Platt of Platt Electric Supply
who in turn donated the tickets to the Cystic Pibrosis Foundation as all
opening night/fundraising benefit. In February a Valentine's Day Cabaret
Benefit for the Broadway Rose is planned; showcasing original work of
Rick Lewis. Mr Lewis has been written up in PEOPIE MAGAZINE for his
music. Two other events under consideration are a Teddy bear Talent Show
($5 admission plus a stuffed animal to be donated to a children's hospital) ,
and an Easter Egg Hunt & Breakfast.
ADVERTISING - With the assistance of Oregon Media Services fnc. the Broadway
Rose has developed a 1994 advertising plan. We will continue to advertise
in THE OREGONIAN A&E section, use flyers placcd in the Community Newspapers
Inc. chain reaching 80,000 people from Hillsboro to west Linn, and we will
advertise in THE REGAL COURIER, a monthly publication with a circulation of
10,000 in the retirement communities of Summerfield and King City. We have
tripled the size of our mailing list through audience surveys. We have re-
ceived other mailing lists by donation or exchange with the New Rose Theatre
Company, The Beaverton Dance Center, two school districts and the Tigard
Chamber of Commerce. We will mail our brochure using these lists.
AUDITION NOTICES - The Broadway Rose publicizes it's auditions in THE OREGONIAN,
THE TIGARD TIMES and PLAY BY PLAY, a theatrical magazine. Audition notices
are posted in local high schools and colleges in Washington County and Portland.
Cast, muscians, stage bands, tech crew, and box office are positions filled
by local students. This promotes the Broadway Rose throughout the educational
and performing arts communities.
LOCAL COMPANIES AND ARTISTS - We have developed relationships with local per-
forming arts companies, organizations and artists that have been motally sup-
portive. In 1992 30 tap dancers, age; 6-16, from the Westside Dance Academy
performed alongside professional performers. In 1993 joseph Wyatt choreographed
OKLAHOMA and 7 dancers, ages 12-16, from the Beaverton Dance Center participated
in the dream ballet. Our Artistic Director has volunteered time for the Tigard
High School play and works once a week at PHAME (an arts academy for the phy-
sically and mentally challenged performers) . We frequently make equipment. loans
to other organizations.
Page 3
COMMUNITY SERVICE - As both a measure of promotion and staying ."in the spirit",
board members give free performances in the local community - Churches, Rotary,
Chamber and other service organization meetings and at the Senior Center. We
have donated season and individual performance tickets to other organizations
fc;k fund-raisers and other uses.
PUBLICITY - We have developed strong relationships with the local media and
writers. We have a media representative on our advisory board. This year
we hope to increase interest and attention from the electronic media.
POTENTIAL SIGNIFICANCE OF PROJECT TO THE COMMUNITY
The Southwest Metro area is going through a period of rapid growth. The Broad-
way Rose is a major component for the arts to keep pace with this growth.
The company is endevoring to provide a quality cultural and educational program
to the area: The long term goal is for the Broadway Rose to become a per-
manent company with a performing arts center.
WHO WILL BENEFIT AND WHY:
Tri-county Audiences- - The Broadway Rose will primarily serve Southeast Wash-
ington County, encompassing the communities of Tigard, Beaverton, Tualatin,
Sherwocd� King City, Summerfield and Durham. Western Clackamas County to in-
clude Lakegrove, Lake Oswego and West Linn is within the primary target audience
area as is Southern portions of the City of Portland. Audience surveys have
shown that we have drawn theatre goers from areas such as Canby, Gresham, Van-
couver and even as far away as The Dalles. The estimated population within this
area is 300-350,000 however the entire Portland Metropolitan region with a pop-
ulation of 1.5 million is a reachable audience. The population growth in this
region is one of the highest in the state. In Tigard and Tualatin the population
has grown 25% since 1987.
Local Community - The Broadway Rose provides a stimulating meeting place and
a creative outlet for its volunteers. When possible the company performs at
community events. In October the theatre performed its childrens show at the
Jenkins Estate, performed show tunes at King City and sang at St. Anthony's
fundraising event. - In December the company performed at various Christmas parties.
Members of the company have and will continue to volunteer at functions like
the Tigard Farmers Market and Tigard 'Town & Country Daze. This 1994 summer season
the company will pay its own electricity and air conditioning in the theatre.
That money will go into a fund to be donated to the Tigard High School theatre
department.
Page 4.
Cultural Diversity - The Broadway Rose supports non-traditional casting.
Our audition notices encourage non-traditional casting. Our first season
featured an African-American actress performing traditional white roles.
. In Godspell, in the 1993 season, we cast a woman as Judas, a traditionally
male role. Our mailing list reaches areas of cultural diversity and across
age and economic boundaries. We are offering free tickets to physically
and mentally challenged actors and artists through PHAME. Our publicity
(print and electronic) is broad enough to reach a culturally diverse audience.
We are working with the Multnomah School District to establish all intern
program for 5 at risk, Hispanic youth. We have an Australian Exchange
Student who will be working with the Theatre this season. The Deb Fennell
Auditorium is handicap accessible.
PEOPLE VALUE THE ARTS
According to the ARTS PLAN 2000, (a public opinion survey conducted by
the Wolf Organization, a nationally recognized cultural planning consultant)
92% of those surveyed want more affordable arts events for children and fam-
ilies. Our AI goal is to provide affordable family entertainment to Washington
County audiences. We offer discounted tickets to children and seniors. We
stage two children's shows. We are in close proximity to the retirement com-
munities of King City and Summerfield. Choice of material and matinee times
are structured to meet their needs. The theatre has free parking. This
summer three local artists have committed to showcasing/selling their work
in the lobby of the theatre.
EVALUATING THE PROJECT'S -SUCCESS
Artistically the Broadway Rose is thriving. All of the evaluation forms
which we received from our patrons this past summer were high in praise.
According to these surveys 99.1% of those who responded wanted to see the
Broadway Rose back at the Deb Fennell for another season. This past season
our attendance rose 14.3%. Our children's shows attendance tripled per
performance. our mailing list by request tripled. This positive response
is also reflected in the school board's unanimous vote to let the Broadway
Rose use the Deb Fennell rent free. The Broadway Rose received several
grants in just its second year. one of the grants received was from the
Metropolitian- Arts Commission. According to the OREGONTAN, " a MAC grant
is considered a seal of approval. Without it a group might not even be
considered for other grants." We have new community and business leaders
on our Advisory Board. Taking into consideration the points just made and
in view of the fact we successfully cut our operating expenses by 12.4%,
we still don't have the burden of rent, our attendance went up, and growing
community support (both financial and volunteer) we feel the Broadway Rose
has an excellent chance for long term success and financial stability.
Page 5
ANTICIPATED COSTS - Although 1993 ticket sales did not cover expenses, the
plans and projections for 1994 should see the Broadway Rose move into the
black. The operating budget has been greatly reduced by mounting two less
shows than in 1992. This summer we plan to cut costs even further by
-combining audiences. This will reduce royalties and utilities. The 1994
projected ticket sales is based on a conservative estimate of 4,000 total
paying customers for the season. our 1993 attendance grew 14.3%, our
mailing list has tripled and audience surveys indicate eager anticipation
for the 1994.season. With this firm groundwork laid, and a year-round
promotional campaign in place, the budgeted audience projection will easily
be surpassed.
In 1994, the theatre company's major element of expense will be $29,130
to he spent on salaries:
4 actors at $130 for 7 weeks $ 3,640
1 technical director at $200 for 8 weeks 1,600
1 stage manager at $200 for 7 weeks 1,400
2 technicians at $150 for 7 weeks 2,100
4 crew members at $130 for 6 weeks 3,120
20 additional cast members at $80 for 3 weeks 4,800
I musical director at $300 for 7 weeks 2,100
2 muscians at $150 for- 6 weeks 1,800
1 choreographer at $200 for 4 weeks 800
$ 21,360
Administrative salaries:
An Artistic Director at $225 for 8 weeks $ 1,800
A General Manager at $225 for 8 weeks 1,800
An Executive Producer at $225 for 8 weeks 1,800
'A Design Director at $225 for 8 weeks 1,800
Box office staff 570
$ 7,770
GRAND TOTAL: $29,130
Page 6
FUNDING SOURCES FOR THE PROJECT - The Broadway Rose is starting its third
year and that entitles the company .to apply for grants it was not eligible
.. for in the past. In November the school board voted to let us use the
Deb Fennell Auditorium. So far this year we have approached or are in
the process of applying to West One Bank (5,000) ; the Metropolitian Arts
Commission ($3,000) ; Herbert A. Templeton Foundation (5,000) ; the Meyer
Foundation (computer) ; Oregon Community Foundation ($1,000) and the
Oregon Arts Commission (1,000) . The company is also organizing its own
fund raising events. Our Valentine's Day Fund Raiser is scheduled from
2 to 5, February 13th, at the Tigard Friends Church. Our Talent Show is
scheduled for June and our Easter Egg Hunt the day before Easter.
Page 7
ATTACHMENT A
MATTHEW RYAN (Executive Producer) -- A recipient of Tigard High's Best
'Actor Award, as well as several theatre and music scholarships at the
college level, Matthew was bitten by the theatre bug when he studied with
high school drama teacher Larry Daw. He later attended Mt. Hood Community
College for one year before leaving for New York City where he was accepted
at the American Academy of Arts. After completing his studies, Matthew
toured the country doing regional and dinner theatre. He has performed in
over 45 musicals and plays. From 1988 to 1989 Matthew starred in the Off-
Broadway show The Ten Percent Revue. He later wrote, produced, directed
and starred in his own Off-Broadway show Choking the Customer, which spoofs
the ups and downs of waiting tables in New York City. Matthew has performed
in New York's finest piano and cabaret bars. He has also performed with a
live band aboard The Spirit of New York, which circles the island of Manhattan
nightly.
SHARON MARONEY (Artistic Director, Director, Actress) -- A native of Milwaukee,
Wisconsin, Sharon graduated from Marquette University with a BA in Theatre
Arts. she is a professional director and has staged such shows as Grease,
Oklahoma and Anyone Can Whistle. She has worked as a private voice and
speech teacher in Manhattan, and has taught music and theatre at a New York
City High School. Sharon has performed extensively around the country.
Some of her favorite roles have been Meg in Crimes of the Heart, Dolly Levi
in Hello Dolly! and the Narrator in Joseph and His Amazing Technicolor
Dreamcoat. She has appeared Off-Broadway. Her credits include Give My Re-
gards to Broadway, The New Moon, and Les Belles Soeurs. Sharon has appeared
in several television commercials, and has soap opera credits include
Search for Tomorrow and One Life to Live. She has worked in legal offices
during high school and college and has experience in banking. She has been
working with high school kids since-her college days.
DAN MURPHY (General Manager, Director, Actor) -- originally fron Larchmont,
New York, Dan made his directorial debut at the Palace Theatre in Manchester,
New Hampshire with Songs of the Silver Screen, an original musical revue
which he wrote and choreographed. Dan is also an experienced stage manager.
His television commercial credits include national spots for Miller Lite and
Pizza Hut. He played the head chef in the ABC series Hot House, and he has
appeared in more than 35 movies and television shows. He has also performed
Off-Broadway, in The Saint Bart's Playhouse production of Bye, Bye Birdie and
Sugar. For the past 16 years, Dan has taught ballroom dance at the Helen
Adams School of Dance in New York. Dan is presently pursuing a degree in
Business Administration at Portland Community College.
JOSEPH MORKYS (Design Director) -- Joe is from Waterbury, Connecticut.
'He has designed sets and costumes for many prominent theatre groups in
his home state, and had the distinction of working on the world premiere
production of She Haunts Me. This new musical, which was based on the
story The Ghost and Mrs. Muir, was sponsored by grants from Connecticut
theatre groups and the state of Connecticut. Joe received the Connecticut
Civic Theatre Set and Costume Designing Awards for his work on The Music Man.
He also created award-winning sets for the Waterbury Civic Theatre's pro-
duction of Oklahoma. Joe commutes from New York where he is employed as an
Art Director. In addition to set and costume design, he is also experienced
in painting, drawing, set construction and advertising. He has designed
billboards, displays, signs, posters, flyers, promotional pieces, programs
and playbills.
CITY OF TIGARD, OREGON
SOCIAL SERVICE AGENCY FUNDING REQUEST CRITERIA
INFORMATION SHEET
ORGANIZATION: Ga/�l�u�tii�-Y �uTfl cfEfyl�G—! p� �l -r/�TT�/ GxrvT;
FUNDING REQUESTED: $ DDa
FUNDING HISTORY: 1990/91 $
1991/92 $ �, D
1992/93 $ a
1993/94 $ (7
CRITERIA: Yes No
1. Service to City Residents -
1 year or more ✓
2. IRS 501(c)(3) or not for profit status ✓
3. Volunteer Board with City representation ✓
4. Balanced Budget r/
5. Oregon Incorporation and Registration
6. Completed Application
DOCUMENTS SUBMITTED:
1. Audit Report or Prior Year's Financial Statements ✓
2. 501(c)(3) Status
3. Articles of Incorporation ✓
4. By-laws ✓
COMMUNITY YOUTH SERVICES
OF WASHINGTON COUNTY, Inc.
I IR CYSWC
January 28, 1994
Beaverton Center
P.O. Box 1792 Wayne Lowry
Beaverton,OR 97075 Finance Director
(503) 644-2201 City of Tigard
FAX (503) 644-8509 1-3125 SW Hall Blvd .
Forest Grove Center Tigard , OR 97223
P.O. Box 743
Forest Grove,OR 97116 Dear M r . Lowry:
(503) 357-5437
FAX (503) 357-3390 Community Youth Service=_ of Washington County is applying
for annual funding of $30,000 from the City of Tigard for
Tigard Center Fiscal Year 1994-95.
9020 SW Burnham
Tigard, OR 97223 We have enclosed our agency funding request application,
(503) 620-2621 our most recent audit reports , the CYSWC Bylaws , proof of
FAX(503) 639-5406
5011 (c ) ( 3) status, our State of Oregon incorporation
letter , and mission statement .
Sincerely,
Thomas J G derson
executive D' ector
Enclosures
TJG/jss
A Private Non-Profit Corporation Working to Prevent Youth Dependency and Delinquency.
ON Community Youth Services
MISSI+ X h b'< a'.3.. �F G Of Community
The CYSWC missions de` ' otnmu Washington County, Inc.
Youth Services
nity-based response to the needs of.Washington
Countychtldren,youth,a�dth "``esthrough:, �_ Beaverton Community Youth Services
of • •toncYswc
• Teen parent suPPt,. �. est. 1980 County,
• Infant nursery;caref alnes of school R P.O.Box 1792
enroledaren {` 4825 S.W. Main Street
• Children,youth,"and" Beaverton OR 97075
School f6tention. vocadyi ? }; (503) 644-2201
h Y - Y d
(school dropoutpre en o 'k`` WORKING
Fax: (503) 644-8509
• Youth mployment • PREVENT
Teen alcohol. n ��
* ....�.- .� ar nYOUTH
r. Forest Grove Community Youth Services
DEPENDENCY
• • est. 1976 .
ND
P.O. Box 743
y y � " � r 2004 Main Street Suite 200DELINQUENCY
Communit V gt
A "'ou r whin on r
County, Inc., g g Forest Grove, OR 97116 IN
be an ui I990,:withft
the mer er of (503) 357-5437 WASHINGTON
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existing you se 'co yeti everton,Forest
Fax: 503 357-3390 COUNTY
Grove aid TIg ioper ( _ )
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ated independently= or13 �,;Jottred:to deliyer�
morecos e � ff Tigard Community Youth Services
agendymcorated o ~ n; est. 1976
CYSw ii§`d�sigi a o ha ale
9020 S.W. Burnham
orgamrationt, the e _ Tigard, OR 97223
J503) 620-2621
ON
Fax: (503) 639-5406
FUNDING
:i
CYSWChefundin basethatincludes
� -"g- Private,Non-Pro
A Privafit Corporation
city,county`state;Xfoundatton, ederal;fee fOY'Ser Working to Prevent
vice,corporate,Civic organizations,and individual Youth Dependency and Delinquency
supportWe also sponsorfund}raising events tri the
communities we serve. Funded in part by the
In.sddition*_CYSwC re Private Industry Council
ceives monies fromUn"t- d. .g-y.and the Combined
Fedt� +� CYSWC does not discriminate on the basis of race,color,national
Campaigl�(CF donor option origin,disability or age.
programs. �
�4"
� _ ;i
.J
t
COMMUNITY • • • • PARENT SUPPORTPROGRAM 1 YOUTH, + COUNSELING
CommunityvolunteersmakeCYSWCprograms Each year more than 400 Washington County The cpunselin` F vary from comma-
possible through: board membership,fund-raising teenagers become pregnant. Imagine being a nity to comma ty�but provide `seivices'to
events, transportation, child care, donations of parent at the age of 14 — the hardships and parents and thele children fox a"range;of problems
clothes or furniture and other assistance. challenges can be overwhelming. On average, including:'=poor school performance depression,
Financial donations go directly to support our 60% of teen parents neither finish school nor delinquency,child abpse,running away,drug and
programs–a youth atrisk of dropping out of school become self-sufficient adults. alcohol abuse,among others. ;
– a teenage mother learning to parent – a family About 150 teen mothers and their babies are Counselorshelpthefamilyand individual iden-
healingfrom physical or sexual abuse–a student enrolled annually in our Teen Parent Pro and work onroblems usin a host-term
P Y Y l7' g .
trying to stay off drugs. Our mission is to reduce the social and health y, solution focused"approach =Our Forest-Grrove
risks of these teen parents and their children by _ , counseling program also offers alcohol and drug
promoting healthy families, encouragingpoli- abuse preventionandtreatment services at the
tive choices and meeting physical needs. center and ut the,y, bhc schools_
Y
In coordination with school districts and other, va' "� ,Mediatdare�c epted
child/youth serving agencies,we help pregnant/ and aslidiiifee" al isusedtoassistchentsunable
parenting teens around the county,_ �y = g
e�rvices are
* � provided e � cal staff¢ - '�`
Forest Grove
Beaverton � aF
* v�
.'
Tua at n • • w •
STUDENTADVOCACY
x# ow y
BOARD OF DIRECTORS The school Retention Programs provide advo-
cavy and support to youat risk of dropping out
of schoolYouthare referred by schools,parents,
Community Youth Services is governed by a and other agencies inn thomtnunity.
volunteer Board of Directors that represents the 'The Summer Trainin Em to ment Program
interests of youth and families across our commu- Arent g ' p y '
and Student Parent Support Program offer sup-
nities. port groups concentrating on;educational goals,
The board brings together expertise from busi- - '
g g pre=employment;trainin lnd sociaT`skills.�A six
ness, volunteer,,and social service sectors to de- week summer ro combines math and En-
T:off,
velop resources and programs responsive to the gush classes with part-tune employment. Addi-
needs of the community, tional support it offered through individual meet-
Our board members are actively engaged in ings and parenting classes
fund-raising efforts, community events and pro-
gram evaluation.
CITY OF TIGARD, OREGON
13125 S.W. Hall Blvd.
Tigard, OR 97223
AGENCY FUNDING REQUEST APPLICATION
AGENCY: Community Youth Services of Washington County, Inc.
ADDRESS: PO Box 1792
Beaverton OR 9707
City State Zip
CONTACT PREPARING APPLICATION Tom Gunderson, Executive Director
PHONE NUMBER (503) 644-2201
1. Describe the Agency's Mission: The mission of CYSWC is to provide a
community based response to the needs of Washington County ' s
children, youth and families. (See attached missioni-statement)
2. What programs/services did your agency provide in Tigard this last year?
*Teen Parent Program: case management and support services for
prPgnant and parenting teens and nursery care for infants at
21st Century Academy Alternative School.
Student Retention Program: employment training, tutoring, support
services for youth at risk o roppin our_ o
�-Counselin Pro ra • i d* 'dual and family, and group counseling
nd n1PsnPn � and Heir amides .
3. What types of services will be provided in the year in which-funding is requested
and how many Tigard residents are estimated to be served?
Teen parent case management and support services - 45
Nursery case for infants of student teen mothers - 22
Student Retention support services - 43
Individual and family counseling - 125
1
COUNSELING PROGRAM
Annual Year-to-date
CLIENT CHARACTERISTICS: Please indicate: Estimate 80 Actual ja
(Unduplicated count) (1st & 2nd Quarters
FY 93-94)
AGE SEX ETHNICITY
Numb-er/Percent Number/Percent Number/Percent
0-4 1 37. Male Black
6-19 37 971 Female 23 611 Hispanic 1 31
20-45 Asian 3 81
46-64 Am. Indian
65+ White 34 891
(Anglo)
Unknown Unknown
TOTAL 38 1001 TOTAL 38 100% TOTAL 38 1001
2
TEEN PARENT PROGRAM
Annual Year-to-date
CLIENT CHARACTERISTICS: Please indicate: Estimate, 40 Actual 32
(Unduplicated count) (Ist & 2nd Quartet
FY 93-94)
AGE SEX ETHNICITY
Numb"er/Percent Number/Percent Number/Percent
0-4 Male - - Black 3 90/.
6-19 30_ 94% Female 32 1001 Hispanic 1 31
20-45 2 6% Asian 2 6%
46-64 Am. Indian 4 13%
65+ White
(Anglo) 22 697.
Unknown Unknown - -
TOTAL 32 100% TOTAL 32 100% TOTAL 32 100%
2A
TEEN PARENT NURSERY
(21st CENTURY ACADEMY)
Annual Year-to-date
CLIENT CHARACTERISTICS: Please indicate: Estimate 18 Actual 11
(Unduplicated count) (Ist & 2nd Quarters
FY 93-94
AGE SEX ETHNICITY
Numb'er/Percent Number/Percent Number/Percent
0-4 11 100% Male 5 45% Black 1 9%
6-19 Female 6 55% Hispanic 4 36%
20-45 Asian
46-64 Am. Indian
65+ White
(Anglo) 6 55%
Unknown Unknown
TOTAL 11 100% TOTAL 11 1001 TOTAL 11 1001
2 B
STUDENT RETENTION PROGRAM
Annual Year-to-date
CLIENT CHARACTERISTICS: Please indicate: Estimate 28 Actual 27
(Unduplicated count) (1st & 2nd Quarters
fY 93-94)
AGE SEX ETHNICITY
Number/Percent Number/Percent Number/Percent
0-4 Male 14 52% Black 2 7
6-19 27 100% Female 13 48% Hispanic 2 7%
20-45 Asian 1 4
46-64 Am. Indian
65+ White
(Anglo) 22 82%
Unknown Unknown
TOTAL 27 100% TOTAL 27 100% TOTAL 27 100%
2C
FUNDRAISING
1 Please identify geographic area covered in fund raising activities.
Washington County
2. Were funds solicited last year? Yes (FY 92-93)
A. Who did solicitations?
By Board Members X
By Employees X
By Professional Fund-Raiser
B. How did you do solicitations? Approximate amount of
revenue from each
By Correspondence
By Benefits, Auctions, Special
Events
By Campaigns $15,684
By sales of goods or services
Other
3. Sources of funds collected during the last fiscal year:
Corporations and Businesses $ 15,234
Individuals/Public $ 4831
Foundations
Service Clubs/Civic Organizations $ 91287
Government Grants
Other (Specify)
TOTAL $547,383
Fees - 45,264 3
Net Cont . Rent - 4,946
Paper Recyc. - 4,224
Misc. - 12,234
4. What fund-raising activites does the agency plan to conduct next year?
MONTH EXPENSES THE FUNDS
ACTIVITY CONDUCTED ARE TO BE USED FOR:
A. Golf Tourament July [ ] CAPITAL [X] OPERATING
B Street of Dreams September ( ] CAPITAL [X] OPERATING
C. Entertninmpnt Rnk Sale Nov. - Feb. [ ] CAPITAL [X] OPERATING
D. Bowlathon April [ ] CAPITAL [X] OPERATING
FINANCIAL INFORMATION
1. What fiscal year is used? July 1 through June 30
2. By whom, and how are expenditures authorized? Executive Director
Administrative Budget approved by Board of Directors .
3. What is the amount requested from the City of Tigard for the next fiscal year?
$30 ,000
4. If funds are being solicited from other local governments in the State of Oregon, please list them
and the requested amounts below.
LOCAL GOVERNMENT REQUESTED RECEIVED
THIS YEAR LAST YEAR
City of Tigard 30,000 262400
City of Beaverton 20,000 16,000
City of Forest Grove 5,000 4,325
5. Have the financial records of the organization been audited? Yes If so, please
submit a copy of the latest audit report.
See attached audit report
4
6. Were government or foundation grants received during the last fiscal year? FY 92-93
If yes, list source and amount:
A. City of Tigard 27 ,497 E Tigard School District 30, 171
B. City of Beaverton 25,000 F Forest Grove School Dist. 34,242
C. City of Forest Grove 4,325 G Washington County 243 , 329
p City of Cornelius 300 g Federal Program 852858
7. Were matching funds required? No If yes, what percent of match was required?
8. Does the organization have contracts for services with other agencies? No If yes, please
list:
AGENCY SERVICE PROVIDED AMOUNT
9. Capital or endowment funds on hand $ N/A
10. What are plans if any, for use of these funds? N/A
PROPERTY INFORMATION
Describe location of property (buildings, offices, recreational facilities, etc.) used by the
agency: LEASE RENT
OWNED AMOUNT AMOUNT
A. Tigard CYS - 9020 SW Burnham $ 1.00 $
B. Beaverton CYS - 4825 SW Main $1,200.00 $
C Forest Grove CYS - 2004 Main $8 ,400.00 $
D. $ $
E. $ $
F. $ $
G. $ $
5
AGENCY BUDGET
COMMUNITY YOUTH SERVICES OF WASHINGTON COUNTY,INC,
1/28/94
REVENUE& EXPENSES LAST FISCAL THIS FISCAL NEXT FISCAL
YEAR ACTUAL YEAR CURRENT YEAR PROPOSED
1993 1994 1995
0 CARRY OVER PREY. YEAR 0 0
1 ALLOC -UNITED WAY 0 0 0
2 CONTRIBUTIONS(PRIVATE) 30,814 25,500 26,100
3 SPECIAL EVENTS 8,420 8,000 5,000
4 LEGACIES& BEQUESTS 0 0 0
5 TOTAL GOVT FEES&GRANTS 0 0 0
A. FEDERAL 109,115 113,287 112,287
8. STATE 101,528 90,240 104,340
C. REVENUE SHARING 0 0 0
D. COUNTY 243,329 238,429 222.784
6 MEMBERSHIP DUES 0 0 0
PROGRAM SERVICE FEES 45,264 80,000 209,120
8 SALES OF MATERIALS 0 0 0
9 INVESTMENT INCOME 588 0 0
10 MISCELLANEOUS REVENUE 8,325 100 14,000
11 TOTAL SUPPORT& 3417.383 555,556 693,631
REVENUE
EXPENSES
12 SALARIES 394,826 382,251 460,734
13 EMPLOYEE BENEFITS 32,982 51,651 62,097
14 PAYROLL TAXES, ETC. 34,464 29,242 35.246
15 PROFESSIONAL FEES 5.638 12,000 37,600
16 SUPPLIES 11,063 8,713 11,413
17 TELEPHONE 12.6 2 0 11,250 12,000
18 POSTAGE&SHIPPING 1'798 2,229 1'750
19 OCCUPANCY-RENT,UTIL,ETC. 34,563 21.481 30,745
20 EQUIP RENT&MAKr S.S65 4,450 4,146
21 PRINTING&PUBLICATIONS 4,291 2,755 3,100
22 TRAVEL 9,502 8,409 10,229
23 CONFERENCES&MEETINGS
2,133 3.140 3,140
24 SPECIFIC ASSIST TO INDIV 7.087 8,016 9,516
25 MEMBERSHIP DUES 602 700 700
26 MISCELLANEOUS EXPENSES 8.295 5,320 7,110
27 DEPRECIATION 2,808 2.000 2,000
28 TOTAL EXPENSES 568,237 553,607 691,526
29 EXCESS(DEFICIT)OF (.20,854) 1,949 2,105
REVENUE OVER EXPENSES
AGENCY BUDGET - PAGE 2
30 BOARD RESTRICTED FUNDS NIA
31 OTHER RESTRICTED FUNDS
32 LAND, BLDGS, EQUIP .
33 INVESTMENT SECURITIES
34 ENDOWMENTS/OTHER FUNDS
7
MEMBERSHIPNOLUNTEERS/PERSONNEL
1. Does the organization have a membership? No
A. If so, how many?
B. Are there membership dues? N/A How much?
Total dues received last year? N/A
2. Does the organization have auxiliaries, guilds, or affiliated organizations whose activities
contribute to its program and/or support?
NAME OF PURPOSE OF AMOUNT OF
ORGANIZATION ORGANIZATION SUPPORT
N/A $
$
$
$
VOLUNTEERS
1 . How many, if any, volunteers are used in the program? 60
2. Describe how they are used: To provide daycare, client- transportation,
mentorship, program assistance, clerical support, janitorial and
maintenance.
3. Please estimate the total number of volunteer manpower hours over the last twelve (12)
months: 2,300
4. Is training available for volunteers? Yes
When? Orientation/training as needed
Time Required 3 hours per volunteer
8
STAFF
1 . How many employees are involved in the program?
Part Time 9 , Full Time 15
2. Please estimate the total number of manpower hours of paid employees in the year for
which funding is requested? 39 , 780
9
BOARD OF DIRECTORS
AGENCY Community Youth Services of Washington, Tnc
OFFICE HELD TERM
NAME ADDRESS ON BOARD EXPIRES
Angeline D. Chong 13125 SW Falcon Rise Drive 6/30/95
Tigard, OR 97223
Terry Coleman P.O. Box 1100 Secretary - 6/30/94
Beaverton, OR 97075 Beaverton
Jim Fun 17352 SW 128th 6/30/95
Tigard, OR 97224
Sue Graves 3240 Circle Crest President 6/30/95
Forest Grove, OR 97116
David Hopkins 5830 SW 165th Court Vice-President 6/30/96
Beaverton, OR 97007
Noreen McGhee 9900 SW Killarney Lane Secretary - 6/30/94
Tualatin, OR 97062 Tigard
Louise Rickard 1501 Somera Drive Secretary - 6/30/96
Forest Grove, OR 97116 Forest Grove
Kevin Stuntzner- 8705 SW Birch 6/30/94
Gibson Portland, OR 97223
Rachel Torres 2667 NE Crocus Court #A 6/30/94
Hillsboro , OR 97124
Richard Turnock 12970 SW Scout Drive Treasurer 6/30/95
Beaverton, OR 97005
Kay Watson 3473 NW 126th 6/30/94
Portland, OR 97229
Todd Worthey 13125 SW Falcon Drive 6/30/94
Tigard, OR 97223
MEETINGS ARE HELD: Monthlv
Is there a policy for rotation of Board members? vas
If yes, please describe Board members may serve up to two 3-year terms and ma4z
return after an absence of one year. Refer to CYSWC Bylaws
Article 7 , Section 2B.
10
CITY OF TIGARD, OREGON
SOCIAL SERVICE AGENCY FUNDING REQUEST CRITERIA
INFORMATION SHEET
ORGANIZATION: '4&L - "¢- �OC
FUNDING REQUESTED: $ GDC
FUNDING HISTORY: 1990/91 $
1991/92 $
1992/93 $ _
1993/94
CRITERIA: Yes No
1. Service to City Residents - ✓
1 year or more
2. IRS 501(c)(3) or not for profit status �i'l oF �r^'y ��✓
3. Volunteer Board with City representation ✓
4. Balanced Budget
Vit//f�ouT Gl'1
5. Oregon Incorporation and Registration
6. Completed Application
DOCUMENTS SUBMITTED:
1. Audit Report or Prior Year's Financial Statements
2. 501(c)(3) Status
3. Articles of Incorporation
4. By-laws y/�
CITY OF TIGARD, OREGON
13125 S.W. Hall Blvd.
Tigard, OR 97223
AGENCY FUNDING REQUEST APPLICATION
AGENCY: Dial-a-Ride
ADDRESS: King City, City Hall, 15300 SW 116th Ave,
King City OR 97224
City State Zip
CONTACT PREPARING APPLICATION Susan Lindquist, Coordinator
(503)639-4082
PHONE NUMBER
1 . Describe the Agency's Mission:
The purpose of the DDIL-RIDE Program is to effectively increase the
availability of special needs transportation for southeastern Washington. County
senior citizens and persons with di sabi 1 i tics_ DIA -A-RTDu depends on volunteer
drivers and support staff in partnership With the American Red Cross, volunteer
Transvortation Tne. t Meridian Park Hospital, and King City.
2. What programs/services did your agency provide in Tigard this last year?
DIAL-A-RIDE provides transportation services for shopping trips on Tuesdays
and Thursdays. The service aTea encompasses a five mile radius of Kang City to
include seven retirement and apartment communities where over 5,000 senior
citizens reside. Monday, Wednesday, and Friday medical transportation is
provideii• primarily focusing on the Patients of Meridian Park Hospital. The
medical transportation service area encompasses southeastern_ Washington
Cour ty(Western boundary Beef Bend Road, south to the county line, north to the
county line) and Clackamas County(south to the county line, east to the
3. Willamette River).
What types of services Will be provided in the year in Which funding, is requested
and how many Tigard residents are estimated to be served?
DIAL-A-RIDE *plans to provide transportation for medical and necessary
shopping trips for an_nroo;m8teiv 700 senior citizens and persons With
disabilities per month in the 94-95 fiscal year. All of the shopping
transportation is for Tigard, King City residents. The medical transportation
during its first siv months Provided 65% of the rides to Tigard, King City
residents .
xxx
CLIENT CHARACTERISTICS: Please indicate: Estimate xxx Actual
(Unduplicated count) numbers from 1990 census
AGE SEX ETHNICITY
Number/Percent Number/Percent Number/Percent
0-4 Male 691 33 Black 0 0
.7
6-19 7 Female 1369 66 Hispanic 8 -4
20-45 52 5. Asian 0 0
46-64 253 9.9 Am. Indian 2 .1
65+ 1739 84.4 White 2056 99.5
(Anglo)
0
Unknown 0 Unknown 0 0
TOTAL 2059 100 TOTAL 2060 100 TOTAL 2066 100
2
FUNDRAISING
1. Please identify geographic area covered in fund raising activities.
Primarily Washington County, with the exception of Grant Applications
2. Were funds solicited last year?Yes
A. Who did solicitations?
By Board Members and volunteers yes
By Employees yes
no
By Professional Fund-Raiser
B. How did you do solicitations? Approximate amount of
revenue from each
By Correspondence $ 4420
By Benefits, Auctions, Special
Events $
By Campaigns $
By sales of goods or services Raffle $ 195.
1136.60
Other $
3. Sources of funds collected during the last fiscal year:
Corporations and Businesses $ 1420
Individuals/Public $ 305
Foundations $ 2000
Service Clubs/Civic Organizations $ 350
Homeowners Assoc.
Government Grants $ 1000
Other (Specify) Rider Donations $ 676.60
TOTAL $5556.60
3
4. What fund-raising activites does the agency plan to conduct next year?
MONTH EXPENSES THE FUNDS
ACTIVITY CONDUCTED ARE TO BE USED FOR:
A Grant Application ( ] CAPITAL M OPERATING
Corp. /Business Solicitations XX
B. [ j CAPITAL [ J OPERATING
C Homeowners Assoc. Solicitations [ ] CAPITAL [ OPERATING
D. [ ] CAPITAL [ ] OPERATING
FINANCIAL INFORMATION
1. What fiscal year is used? July 1 to June 30
2. By whom, and how are expenditures authorized? The Volunteer Transportation Coordinator
authorizes expenditures. The King City Administation supervises the budgeting.
3. What is the amount requested from the City of Tigard for the next fiscal year?
$5,000.00
4. If funds are being solicited from other local govemments in the State of Oregon, please list them
and the requested amounts below.
LOCAL GOVERNMENT REQUESTED RECEIVED
THIS YEAR LAST YEAR
King City $5000.00 $5,000.00
City of Tigard $5,000.00 $1,000.00
5. Have the financial records of the organization been audited? yes If so, please
submit a copy of the latest audit report. See enclosed financial report.
4
6. Were government or foundation grants received during the last fiscal year? Yes
If yes, list source and amount:
The Collins Foundation 2,000.00
B. $
C. $
D. $
7. Were matching funds required? No If yes, what percent of match was required?
Yes
8. Does the organization have contracts for services with other agencies? If yes, please
list:
AGENCY SERVICF PROVIDED AMOUNT
American Red Cross contracte use o vehicle .50 per mile charged
--
�nci
Volunteer Transportation Agency
9. Capital or endowment funds on hand $
10. What are plans if any, for use of these funds?
PROPERTY INFORMATION
Describe location of property (buildings, offices, recreational facilities, etc.) used by the
agency: LEASE RENT
OWNED AMOUNT AMOUNT
A King City Hall Offices $ 0 $ 0
American Red Cross/Volunteer Transportation Inc. .50/mile
C. $ $
D. $ $
E. $ $
F. $ $
G. $ $
5
AGENCY BUDGET
AGENCY DIAL-A-RIDE
DIAL -A-RIDE January 25, 1994
Name o= Program Date Submitted
REVENUE & EXPENSES LAST FISCAL THIS FISCAL, NEXT FISCAL,
YEAR ACTUAL YEAR CURRENT YEAR PROPOSED
19 93 _ 19 94 _ 19 95 _
PUBLIC SUPPORT & REVENUE
0 CARR`_' OVER PREV. YEAR
1 ALLOC - UNITED WAY 120 5181
2 CONTR=BUTTONS (PRIVATE)
3 SPECTML EVENTS
4 LEGACIES & BEQUESTS
5 TOTAL GOVT FEES & GRANTS
A. King City ----- 10,000 -------- 5000
6 MEMBERSHIP DUES
7 PROGR=_-i SERVICE FEESvoluntary 180 820 112 based n mon)
8 SALES OF MATERIALS
9 TN"\TES71%4_ENT INCOME
10 MISCE-'—L Q OUS REVENUE
Meridian Park Hospital 5838 10,008
11 TOTAL. SUPPORT & REVENUE 300 17,239 16208
(ADD 0 THRU 10)
EXPENSES
12 SA.LART ES 32 hours/week 11,500 15,000
13 EMPLOYEE BENEFITS
14 PAYROLL TAXES, ETC. inclusive
15 PROFESSIONAL FEES 200 350 500
16 SUPPLIES
17 TELEPHONE
18 POSTAGE & SHIPPING
19 OCCUPANCY—RENT, UTIL. , ETC.
20 EQUIP. RENTAL & MAINT.
21 PRINTING & PUBLICATIONS
22 TRAVEL Volunteer Transportation 415 2671 3600 (600 mile/mon
23 CONFERENCES & MEETINGS
24 SPECIFIC ASSIST. TO INDIV.
25 MEMBERSHIP DUES
26 MISCELLANEOUS EXPENSES
27 DEPRECIATION
28 TOTAL EXPENSES 200 14521 19100
(ADD 12 THRU 27)
29 EXCESS (DEFICIT) OF
REVENUE OVER EXPENSE (100) 2718 (2892)
(11 MINUS 28)
6
AGENCY BUDGET - PAGE 2
30 BOARD RESTRICTED FUNDS
31 OTHER RESTRICTED FUNDS
32 LAND, BLDGS, EQUIP .
33 INVESTMENT SECURITIES
34 ENDOWMENTS/OTHER FUNDS
7
MEMBERSHIP/VOLUNTEERS/PERSONNEL
1. Does the organization have a membership? No
A. If so, how many?
B. Are there membership dues? How much?
Total dues received last year?
2. Does the organization have auxiliaries, guilds, or affiliated organizations whose activities
contribute to its program and/or support?
NAME OF PURPOSE OF AMOUNT OF
ORGANIZATION ORGANIZATION SUPPORT
VOLUNTEERS
1. How many, if any, volunteers are used in the program?Approximately 30
Van Drivers, Escorts, Support Staff
2. Describe how they are used: - - -
3. Please estimate the total number of volunteer manpower hours over the last twelve (12)
months: 840 hours
4. Is training available for volunteers? Yes
For new volunteers and refresher course scheduled as need. Volunteer
When?
Transportation Inc goal 1 class per quarter in each county.
Time Required
Varies with job description: minima.L training/introduction an
Mobility Awareness Class 5 hours, Vehicle Introduction 2 hours, Defensive
Driveing 4 - 8 hours.
8
STAFF
1. How many employees are involved in the program?
1(30 hours per week
Part Time , Full Time
2. Please estimate the total number of manpower hours of paid employees in the year for
which funding is requested?1560 (30 hours per week)
9
DIAL—A—RIDE COMMITTEE
DIAL—A—RIDE
AGENCY
OFFICE HELD TERM
NAS' ADDRESS ON BOARD EXPIRES
Bill Culham 17128 SW Eldorado, Tigard 97223 Chairperson
Fred Clagett 16930 Monterey Lane, King City 97224
Sol Weiss 16580 Royalty Pkwy, King City
Arletta Weiss 16580 Royalty Pkwy, King City
Eleanor Fass 12691 B Prince Edward, King City
Neil Jeremiah 15400 SW Alderbrook, Tigard
Beth Schuele 16635 SW Matador Lane, King City
President, Royal Mobile 11200 SW Royal Mobile Dr, Tigard
Villa Homeowners Assoc
Patricia Mittelstadt 16825 SW Riviera, King City
Marge O'Hara 12627 SW Peachvale, Tigard
John O'Hara 12627 SW Peachvale, Tigard
Volunteer Coordinator
MEETINGS ARE HELD: 4th Tuesday monthly at 10:00a.m.
Is there a policy for rotation of Board members?
If yes, please describe
10
CITY COUNCIL
AGENCYDIAL-A-RIDE City of King City
OFFICE HELD TERN
NAME ADDRESS ON BOARD EXPIRES
Claudia Anderson 15100 SW Crown Dr #8 King City Councilor 12/31/94
Pauline Chamberlain 15440 SW Royalty Parkway, King City President 12/31/94
Loren Cochrun 15800 SW Royalty Parkway, King City Councilor 12/31/96
Mary Garrett 12750 SW Prince Albert, King City Councilor 2/31/94
Lynda Jenkins 16525 SW Monterey Lane, King City Mayor 12/31/96
Barbara Lee McCaige 15855 SW Queen Victoria P1, King C. Councilor 12/31/96
Vacant Councilor 12/31/94
MEETINGS ARE HELD: 1st and 3rd Wednesday 2:OOp.m.
Is there a policy for rotation of Board members?
If yes, please describe
10
CITY OF TIGARD, OREGON
SOCIAL SERVICE AGENCY FUNDING REQUEST CRITERIA
INFORMATION SHEET
ORGANIZATION:
FUNDING REQUESTED:
FUNDING HISTORY: 1990/91 $
1991/92 $
1992/93 $
1993/94 $ ,?,Ooo
CRITERIA: Yes No
1. Service to City Residents - ✓
1 year or more
2. IRS 501(c)(3) or not for profit status ✓
3. Volunteer Board with City representation
4. Balanced Budget
5. Oregon Incorporation and Registration
6. Completed Application �✓
DOCUMENTS SUBMITTED:
1. Audit Report or Prior Year's Financial Statements ^�
2. 501(c)(3) Status
3. Articles of Incorporation ✓
4. By-laws ✓
CITY OF TIGARD, OREGON
13125 S.W. Hall Blvd.
Tigard, OR 97223
AGENCY FUNDING REQUEST APPLICATION
AGENCY: SHELTER/Domestic Violence Resource Center
ADDRESS: P•0. Box 494
Hillsboro , Oregon 97123
City State Zip
CONTACT PREPARING APPLICATION Connie Hahs, Development Director
PHONE NUMBER 640-5352
1. Describe the Agency's Mission: our mission is to redi,rP the 1PVP1 of rirr„p-ztic
violence and provide services to women and children survivors of domestic
violence in Washington County
2. What programs/services did your agency provide in Tigard this last year?
We have an office in Tigard where we hold a weekly support group, conduct
outreach services to survivors, and case manage women and children ex-shelter
residents for un to One year. We nrnvide arrest to the only domestic violence
3. WIsis line, shelter, a shelter services in the co n y.
hat types of services wt� be provided in the year in whic�i �unding is requested
and how many Tigard residents are estimated to be served?
We will continue to provide these services in Tigard, and estimate that
we will shelter at least 5 families, answer over 100 crisis calls,
provide support groups for at least 20 women, and provide community
outreach services to at least Kwomen and 12 children from Tigard.
1
CLIENT CHARACTERISTICS: Please indicate: Estimate Actual 1993
(Unduplicated count)
AGE SEX ETHNICITY
Number/Percent Number/Percent Number/Percent
0-4 86 29 Male 79 26 Black 71 24
6-19 78 26 Female 122 41 Hispanic 24 8
20-45 125 41 Asian 8 3
46-64 12 4 Am. Indian 4 1
65+ White
(Anglo) 146 48
Unknown Unknown 48 16
TOTAL 301 100 TOTAL 301 100 TOTAL 301 100
*** These figures do not include the 225 women and 168 children who were served in
our outreach program for whom we do not keep statistics this detailed.
2
FUNDRAISING
1. Please identify geographic area covered in fund raising activities.
We fundraise in Washington County and in the Portland Metropolitan Area
2. Were funds solicited last year? Yes.
A. Who did solicitations?
By Board Members x
By Employees X
By Professional Fund-Raiser
B. How did you do solicitations? Approximate amount of
revenue from each
By Correspondence $ 23,860
By Benefits, Auctions, Special
Events $ 17,927
By Campaigns $
By sales of goods or services $ 656
Other $
3. Sources of funds collected during the last fiscal year:
Corporations and Businesses $
Individuals/Public , Service Clubs $ 41,787
Foundations $ 17,000
Service Clubs/Civic Organizations $
Government Grants $ 209,500
Other (Specify)United Way, Red Cross, AFS, $ 80,811
client fees, interest
TOTAL $ 349,098
3
4. What fund-raising activites does the agency plan to conduct next year?
MONTH EXPENSES THE FUNDS
ACTIVITY CONDUCTED ARE TO BE USED FOR:
A. Golf Tournament July [ ] CAPITAL [ ] OPERATING
B. Entertainment Book Sales Oct.-Dec. [ ] CAPITAL [ X] OPERATING
C. Mother' s Day t1a i 1 er May [ ] CAPITAL [ X] OPERATING
D Newsletters & Holiday March. June. Sept, Dec.[ ] CAPITAL [ X] OPERATING
Letter
FINANCIAL INFORMATION
1. What fiscal year is used? July 1-June 30
2. By whom, and how are expenditures authorized? Authorization occurs at 3 levels :
Program Managers , Executive Director, and Board Treasurer.
3. What is the amount requested from the City of Tigard for the next fiscal year?
$3500
4. If funds are being solicited from other local governments in the State of Oregon, please list them
and the requested amounts below.
LOCAL GOVERNMENT REQUESTED RECEIVED
THIS YEAR LAST YEAR
Beaverton $10,000 $10,000
Hillsboro 5,000 5,000
Forest Grove 1,000 965
Cornelius 1,000 300
Tualatin 3,000 3,000
TIGARD 3,000 Yes 2,000
5. Have the financial records of the organization been audited? If so, please
submit a copy of the latest audit report.
4
.6. Were government or foundation grants received during the last fiscal year? Yes
If yes, list source and amount:
A Federal Government $ 65,618
B State Government $ 127,617
C Local Government $ 16,265
D. Foundations $ 17,000
7. Were matching funds required? Yes If yes, what percent of match was required?
20% - 65%
8. Does the organization have contracts for services with other agencies? Yes If yes, please
list:
AGENCY SERVICE PROVIDED AMOUNT
Dept. Housing Svcs. Shelter services $34.ORR
Health & Human Svcs. Children's Program 6,020
CSC Shelter services 25,398
wccrkc Shelter services, H1span1C Advocacy 103,bU3
Dept. f u tice Sh 1 er sery ces Children's Program 21,016
9. daps aI or endowment ftunds on hand$
10. What are plans if any, for use of these funds?
PROPERTY INFORMATION
Describe location of property (buildings, offices, recreational facilities, etc.) used by the
agency: LEASE RENT
OWNED AMOUNT AMOUNT
A Shelter (confidential location) $ $
B Office: 451 S. First St. , Ste. 300, Hillsboro $ $9893 $
C. $ $
D. $ $
E. $ $
F. $ $
G. $ $
5
AGENCY BUDGET
AGENCY SHELTER/Domestic Violence Resource Center
SHEI TER IMIRC Jan. 31, 1994
Name of Program Date Submitted
REVENUE & EXPENSES LAST FISCAL THIS FISCAL NEXT FISCAL
YEAR ACTUAL YEAR CURRENT YEAR PROPOSED
19 92-93 19 93-94 19 94-95
PUBLIC SUPPORT & REVENUE
0 CARRY OVER PREV. YEAR
1 ALLOC - UNITED WAY 53,UUU 52,375
70,000
2 CONTRIBUTIONS (PRIVATE)
3 SPECIAL EVENTS 'OOC 0,UUU
4 LEGACIES & BEQUESTS '
5 TOTAL GOV' T FEES & GRANTS
A. FEDERAL
B. STATE
C. REVENUE SHARING
D . COUNTY
6 MEMBERSHIP DUES
7 PROGRAM SERVICE FEES 11
11-000 11 -0 0
8 SALES OF MATERIALS 070
9 INVESTMENT INCOME
10 MISCELLANEOUS REVENUE
11 TOTAL SUPPORT & REVENUE 346,323 362,552 362,552
(ADD 0 THRU 10)
EXPENSES
12 SALARIES 184,443 256,795 256,795
13 EMPLOYEE BENEFITS 16,583 27,000 20,000
14 PAYROLL TAXES, ETC. 21 ,657 21 ,057 21 ,057
15 PROFESSIONAL FEES 8,213 10,100 10,100
16 SUPPLIES 15,135 3,000 3,000
17 TELEPHONE 4,207 5 000 5,000
18 POSTAGE & SHIPPING 1,952 2,000 2,000
19 OCCUPANCY-RENT, UTIL. , ETC. 23,430 20,000 2C,000
20 EQUIP . RENTAL & MAINT. 130 3,000 3,000
21 PRINTING & .PUBLICATIONS 8,931 2,500 2,500
22 TRAVEL ,880 2,500 2,500
23 CONFERENCES & MEETINGS 3,969 3,600 3,600
24 SPECIFIC ASSIST. TO INDIV. '278 5,000 5,000
25 MEMBERSHIP DUES 582 1,000 '
000
26 MISCELLANEOUS EXPENSES
27 DEPRECIATION
28 TOTAL EXPENSES 294,429 362,552 362,552
(ADD 12 THRU 27)
29 EXCESS (DEFICIT) OF
REVENUE OVER EXPENSE
(11 MINUS 28) 51 ,894 0 0
***Carryover amount is a fund balance to deal with cash flow.
***Depreciation is book entry only; not set aside in separate account. '93=9,725; ' 94=8,500
P ' 95=8,500
AGENCY BUDGET - PAGE 2
30 BOARD RESTRICTED FUNDS
31 OTHER RESTRICTED FUNDS 141,018 141,018 141 ,018
32 LAND, BLDGS, EQUIP .
33 INVESTMENT SECURITIES
34 ENDOWMENTS/OTHER FUNDS
7
MEMBERSHIPNOLUNTEERS/PERSONNEL
1. Does the organization have a membership? Nn
A. If so, how many?
B. Are there membership dues? How much?
Total dues received last year?
2. Does the organization have auxiliaries, guilds, or affiliated organizations whose activities
contribute to its program and/or support? No, although we receive support from many
NAME OF PURPOSE OF AMOUNT OF
ORGANIZATION ORGANIZATION SUPPORT
VOLUNTEERS
1. How many, if any, volunteers are used in the program? 3.13 FTE (10 regular)
2. Describe how they are used: We have volunteers who answer cri si s 1 i nes: help in
the Children's Program, facilitate support groups, provide advocacy, do clerical work,
and do special projects. We have 2 FTE Jesuit Volunteers and .5 FTE Foster Grandmother
in adds tion to eur regular velunteers
3. Please estimate the total number of volunteer manpower hours over the last twelve (12)
months: 6,460
4. Is training available for volunteers? Yes.
When? 3 times per year. Cur next training will be in February.
Time Required 30 hours of training, plus more on site depending on activity.
8
STAFF
1. How many employees are involved in the program?
Part Time 7 (some on-call ), Full Time 10
2. Please estimate the total number of manpower hours of paid employees in the year for
which funding is requested? 25,645 12.425 FTE. )
9
BOARD OF DIRECTORS
AGENCY SHELTER/Domestic Violence esource en er
OFFICE HELD TERM
NAME ADDRESS ON BOARD EXPIRES
Judy Ferguson P.O. Box 1266, Portland, CR 97207 President 10/94
Ruth Heller 230 NE Second, Ste. A, Hillsboro, Vice-President 10/95
OR 97124
James Fun 222 N. 1st Ave. , Hillsboro, OR Secretary 10/94
97124
Kathy Kingzett 2910 NW Norwalk Pl , Beaverton, OR Treasurer 10/96
97006
Darolyn Anderson 46377 SW Patton Valley Rd. , Gaston, 10/94
OR 97119
Jerri Bracken 18415 SW Division St. , Aloha , CR 10/96
97007
Angela Deever 14435 SW Beef Bend Rd. M4, Tigard 10/95
OR 97224
Araceli Gaytan P. C. Box 567, Cornelius , OR 97113 10/96
Alice Bell Maitland 3045 NW Gales Creek Rd. , Forest 10/96
Grove, OR 97116
Sr. Ina Marie Nosack 499 S. Emerald Loop, Cornelius, OR 10/96
97113
Nancy Roach 1795 NW 143rd #8, Portland, OR 10/96
97229
Sharon Smith 5124 SW Custer St. , Portland, OR 10/96
97219
Linda Sparks 1791 NW Trisha Dr. , Hillsboro, OR 10/96
97124
Audrey Walker 480 NW Garibaldi , Hillsboro, OR 10/96
97124
R 10/96
MEETINGS ARE HELD: 4th Tuesday of evergaonth
Is there a policy for rotation of Board members? Yes
If yes, please describe Board members have three year terms
10
CITY OF TIGARD, OREGON
SOCIAL SERVICE AGENCY FUNDING REQUEST CRITERIA
INFORMATION SHEET
ORGANIZATION: "� �P/S✓f /�l/C
FUNDING REQUESTED: $ 52 YJ
FUNDING HISTORY: 1990/91 $
1991192 $ '-
1992/93 $ _
1993/94 $ --
CRITERIA: Yes No
1. Service to City Residents - ✓
1 year or more
2. IRS 501(c)(3) or not for profit status
3. Volunteer Board with City representation ✓ GTS'�P
4. Balanced Budget ✓
5. Oregon Incorporation and Registration
6. Completed Application
DOCUMENTS SUBMITTED:
1. Audit Report or Prior Year's Financial Statements
2. 501(c)(3) Status ✓
3. Articles of Incorporation
4. By-laws ✓
CITY OF TIGARD, OREGON
13125 S.W. Hall Blvd.
Tigard, OR 97223
AGENCY FUNDING REQUEST APPLICATION
AGENCY: c�}��' �,� •5 S Com, S, c
ADDRESS:
2—
City
.>
City State Zip
CONTACT PREPARING APPLICATION
PHONE NUMBER � �� � ' ? �I_ ctc:y
1 . Describe the Agency's Mission:
�L. CL A It - �- KL.C�.1 C: �<.c Li. C C.
�o Ci
2. What programs/services did your agency provide in Tigard this last year?�
A �, 1-�-L-may_.r �V-O• - C t�,
SAX�!C G 5 `1�,_'`.��q G— (C.,t2eC IDC 1I �
1� v�P� 1 e (sti�+er red tx c -c1 �J 4-v,J.�e- -+lin--, c...,-
-1 (-,CSC Czuif'.
+ 0.nGl cl,uo_ 0.)
3. What types of services will be provided in the year in which funding is requested
and how many Tigard residents are estimated to be served?
C , 5 s c�-�,S e I V\,c
aL Cl c,+V^ -r S,,.Q pc.,4
Sckc. X15 vor ik1 ���I`'o tf'S
l,x Sex 06�-1 Ci S S 0-AJ t,4
1
CLIENT CHARACTERISTICS: Please indicate: Estimate Actual
(Unduplicated count)
AGE SEX ETHNICITY
Number/Percent Number/Percent Number/Percent
0-4 Male Black
6-19 Female Hispanic
20-45 Asian
46-64
Am. Indian
65+ White
(Anglo)
Unknown `�` " Unknown
TOTAL TOTAL TOTAL
C-�x� r
CL.
S S-F�� 1 � CC
2
FUNDRAISING
1. Please identify geographic area covered in fund raising activities.
2. Were funds solicited last year? Y 5
A. Who did solicitations?
By Board Members
By E mp`ii5yees V:--A _ X
By Professional Fund-Raiser
B. How did you do solicitations? Approximate amount of
revenue from each
By Correspondence $ s
By Benefits, Auctions, Special
Events
By Campaigns $
By sales of goods or services $
Other $
3. Sources of funds collected during the last fiscal year:
Corporations and Businesses $ lz`-7 C
Individuals/Public $
Foundations $
Service Clubs/Civic Organizations $ �u 5 4 ss
U.1,-Lf cx W�1 /EIK5
Government Grants J $ 32-6
QCX,--A)
Other (Specify) C �Sk .c.-. $ L , g -
A,rvc
TOTAL $
3
4. What fund-raising activites does the agency plan to conduct next year?
MONTH EXPENSES THE FUNDS
ACTIVITY CONDUCTED ARE TO BE USED FOR:
A. �c �"� +x��+�� > j � +���`� [ ] CAPITAL [k] OPERATING
B. ] CAPITAL [K] OPERATING
C. [ ] CAPITAL [ ] OPERATING
D. [ ] CAPITAL [ ] OPERATING
FINANCIAL INFORMATION
1 . What fiscal year is used? C-{ ��� �`� — '���� �` 'C
2. By whom, and how are expenditures authorized?
3. What is the amount requested from the City of Tigard for the next fiscal year?
�p _ __
_-) � C) . -
4. If funds are being solicited from other local governments in the State of Oregon, please list them
and the requested amounts below.
LOCAL GOVERNMENT REQUESTED RECEIVED
THIS YEAR LAST YEAR
300. - l�
t,4 1 .,A-_ Ca \ IE1 Yecl 1-4 — C)C)G
5. Have the financial records of the organization been audited? y C _5If so, please
submit a copy of the latest audit report.
-
4
PC,5CC1
6. Were government or foundation grants received during the last fiscal year? '7' E
If yes, list source and amount:
A.
B. $
C. $
D. $
7. Were matching funds required? yt 5 If yes, what percent of match was required?
8. Does the organization have contracts for services with other agencies? Nc= If yes, please
list:
AGENCY SERVICE PROVIDED AMOUNT
9. Capital or endowment funds on hand $
10. What are plans if any, for use of these funds?
PROPERTY INFORMATION
Describe location of property (buildings, offices, recreational facilities, etc.) used by the
agency: LEASE RENT
OWNED AMOUNT AMOUNT
A.
B. YES $ $
D. $ $
E. $ $
F. $ $
G. $ $
5
AGENCY BUDGET
AGENCY L s , s LL t-4,
Name o= Program Date Submitted
REVENj--, & EXPENSES LAST FISCAL THIS FISCAL NEXT FISCAL
YEAR ACTUAL YEAR CURRENT YEAR PROPOSED
19 19 19 q ti "iS
PUBLIC SUPPORT & REVENUE
0 CARRY OVER PREV. YEAR
1 ALLOC - UNITED WAY
2 CONTRIBUTIONS (PRIVATE)
3 SPEC==? EVENTS z cc cL t
4 LEGACIES & BEQUESTS
5 TOTAL GOVT FEES & GRANTS
A. FEDERAL
STATEezB.
C. REVENUE SHARING
D . COUNTY
6 MEMBERSHIP DUES
7 PROG�LN SERVICE FEES
8 SALES OF MATERIALS
9INVESTM-NT INCOME
10 MISCELLANEOUS REVENUE
11 TOTA-L SUPPORT & REVENUE c'c- S 1`- i c<-
(ASD 0 THRU 10) -
EXPENSES
12 SALAD=ES
13 EMPLOYEE BENEFITS
14 PAYROLL TAXES, ETC.
15 PROFESSIONAL FEES
16 SUPPLIES
17 TELEPHONE ? c ` 1 c v _ c)C--, c c c G
18 POSTAGE & SHIPPING su" 3 u CDC-- cc oc�
19 OCCUPANCY-RENT, UTIL. , ETC.
20 EQUIP . RENTAL & MAINT. S �ti c-
21
21 PRINTING & PUBLICATIONS 'A 3 \Z`DC)
2 2 TRAVEL Z��{. L t t� ���� _ c�� 3 5 ". C=�
23 CONFERENCES & MEETINGS 1 � ' l �. co 1 SZ D.
24 SPECIFIC ASSIST . TO INDIV. c---::k , zGc, LCUo r.
25 MEMBERSHIP DUES 1
2 6 MISCELLANEOUS EXPENSES Z S`� L 3�'U . 3 G v . zoo
27 DEPRECIATION
28 TOTAL EXPENSES 2D �s c Is � DO
(ADD 12 THRU 27)
29 EXCESS (DEFICIT) OF
REVENUE OVER EXPENSE
(11 MINUS 28)
6
AGENCY BUDGET - PAGE 2
30 BOARD RESTRICTED FUNDS
31 OTHER RESTRICTED FUNDS
32 LAND, BLDGS, EQUIP .
33 INVESTMENT SECURITIES
34 ENDOWMENTS/OTHER FUNDS /
i
7
MEMBERSHIPNOLUNTEERS/PERSONNEL
1 . Does the organization have a membership?
A. If so, how many?
B. Are there membership dues? How much?
Total dues re5give-d'last year?
2. Does the organization have auxiliaries, guilds, or affiliated organizations whose activities
contribute to its program and/or support?
NAME OF PURPOSE OF AMOUNT OF
ORGANIZATION ORGANIZATION SUPPORT
VOLUNTEERS
1 . How many, if any, volunteers are used in the program? fs
2. Describe how they are used:
� '' � � � �'�-•� }� �t'�`--�� Com. ,��- /l..�S:CI G' G*� � ���n-iE- Cl.iti"=� l�_y� Lc���S- �'`'lu�-�-�'_ia��,
3. Please estimate the total number of volunteer manpower hours over the last twelve (12)
months: ^- S S 00
4. Is training available for volunteers? 1-/E 5
When? Oc - C) h-C-� -0O3C�A ��A- '
Time Required Itis r� r; a 1 ,_ �; , 5 S
8
STAFF
1. How many employees are involvedlin the program?
Part Time Full Time
2. Please estimate,-the total number of manpower hours of paid employees in the. year for
which fundis requested?
9
BOARD OF DIRECTORS
AGENC" �
i
I OFFICE HELD TERN_
NAME ADDRESS ON BOARD EXPI
RES
I
_ c.
i
��!
5,c,i-� ? 5 Z C=4-4, I
c)0-
i
I
Lt v c1-11\�O S L-.�
'� � p �(o1 \fie ' 1�c. 4
in�
1110 cCaCt ` f `�q-cv
6P 0-k
r
MEETINGS ARE HELD:_ C)V-\CP
Is there a policy for rotation of Board members? t,Ao
If yes, please describe
10
RCC-Consolidate Page: 1
Income Statement
10/1192 Through 9/30/93
10/L92-
Category Description 9/30193
Inc/Exp
Income
Income:
Awards 11000.00
Cities 2,218.75
Corporations 850.00
Donation 790.00
United Way 357.55
Vora Grant 3,290.00
Total Income 8,506.30
Total Income 8,506.30
Expenses
Automobile Mileage 46.50
Banquet 209.12
Computer Supplies 55.39
Counseling:
B.McCormick 180.00
L.Neal 25.00
L. Sass 185.00
T. Poe 125.00
Total Counseling 515.00
Memberships&Dues 117.00
Office Supplies 158.48
Postage&Freight 364.31
Training&Special Events 354.92
Travel&Lodging 264.46
Voca Expenses:
Booklets 936.39
Clothing 143.53
Crisis Line Service 919.75
Medicine 14.98
Pagers 851.79
Telephone 594.42
Training 789.92
Total Voca Expenses 4,250.78
Expenses - Other 0.00
Total Expenses 6,335.96
Total Inc/Exp 2,170.34
CITY OF TIGARD, OREGON
SOCIAL SERVICE AGENCY FUNDING REQUEST CRITERIA
INFORMATION SHEET
ORGANIZATION:
FUNDING REQUESTED:
FUNDING HISTORY: 1990/91 $
1991/92 $
1992/93 $ e2,.5-GY
1993/94 $ 7 1�106
CRITERIA: Yes No
1. Service to City Residents -
1 year or more
2. IRS 501(c)(3) or not for profit status
3. Volunteer Board with City representation V/ NOC'7y
4. Balanced Budget
5. Oregon Incorporation and Registration
6. Completed Application
DOCUMENTS SUBMITTED:
1. Audit Report or Prior Year's Financial Statements
2. 501(c)(3) Status ✓
3. Articles of Incorporation
4. By-laws
ACOWASHINGTON COUNTY
MMUNITY
CTION
ORGANIZATION
451 S.First Ave.,Suite 700,Hillsboro,OR 97123
Administration-648-6646 FAX-648-4175
Client Assistance-648-0829
Board of Directors January 28, 1994
Shirley Huffman,Chair
Cindy Hirst,Vice Chair
Maria Loredo,Secretary Mr. Wayne Lowry
Jose'Jaime,Treasurer Finance Director
City of Tigard
Mayor Rob Drake 13125 SW Hall Blvd.
Darlene Greene, P. 0. BOX 23397
Councilwoman Tigard, OR 97223
Mayor Walt Hitchcock
Dear Mr. Lowry:
Leroy Hopkins
Charlotte xarvia Thank you for the opportunity to submit a proposal to
Sandy Miller the City of Tigard for support to our Neighborshare Office.
Gene Mitchell
Last year through our Neighborshare office WCCAO responded
Linda Peters,
Countv Commissioner to over 3,638 requests for help from low income Tigard families.
i es.
Sherry Robinson Responding to this need and in an effort to provide even greater
Senator Bob Shoemaker service to the residents of Tigard, WCCAO has moved all staff
that serve East Washington County residents to the Neighborshare
Dick Stenson Office. This move has increased the staff available to serve
Russell Wilkinson Tigard residents from two to five members.
Gregory Zuffrea
This year WCCAO has also increased it's services to formerly
JerralynnNess, homeless Tigard residents with the addition of a SAFAH Program.
Executive Director The goal of the SAFAH Program is to help families truly break
the cycle of homelessness by building stable, self reliant
lifestyles with the support and encouragement of a WCCAO advocate.
Program Services
•Advocacy The financial support received from Tigard has been
essential to the continuing operation of the Neighborshare office.
•Emergency Assistance For Fiscal 1994-95 WCCAO respectfully requests $10,000 for funding
•Emergency Shelter support. Enclosed is WCCAO's completed proposal form.
•Energy Education
•Family Self Reliance Please call if you need any additional information. We
look forward to hearing from you.
•Head Start&Child Care
•Homeless Services Sincerely
•Housing Development
•Housing Services
•Information&Referral e r ra 1 yn Ness
•Parenting Education Executive Director
•Transitional Housing
•Weatherization
Q-zz)
A United Way Agency
CITY OF TIGARD, OREGON
13125 S.W. Hall Blvd.
Tigard, OR 97223
AGENCY FUNDING REQUEST APPLICATION
AGENCY: Washington County Community Action Organization
ADDRESS: 451 S. First Suite 700
Hillsboro OR 97123
City State Zip
CONTACT PREPARING APPLICATION Cheryl Hilbert
PHONE NUMBER 648-6646
1. Describe the Agency's Mission: Washington County Community Action
Organization serves the economically disadvantaged by assisting with
basic needs and removing barriers to long term self reliance.
2. What programs/services did your agency provide in Tigard this last year?
WCCAO' s Tigard Neighborshare Office responded to over 3,638 requests
for assistance from families. See Attachment A for a complete list of
services provided and individuals served.
3. What types of services will be provided in the year in which funding is requested
and how many Tigard residents are estimated to be served?
In Fiscal Year 1994-95, the Neighborshare office will respond to over
4,000 requests for service from Tigard families. Services to be provided
include:
a. Information and Referral
b. Energy Assistance and Energy Conservation Education
c. Weatherization
d. Rental assistance and Landlord/tenant education
e. General Emergency Assistance
f. Referral to Community Food Box Programs (FISH, St Vincent de Paul)
g. Case Management services 1
h. Head Start
i . Parenting Education
j. Brown Bag Memberships
k. Christmas Basket Applications
CLIENT CHARACTERISTICS: Please indicate: Estimate Actual
(Unduplicated count) *
WCCAO is unable to give an unduplicated count of individuals served for Fiscal Year
92-93. However WCCAO is currently developing a computerized client information system
and should be able to provide an unduplicated count in the future. (See below)
AGE SEX ETHNICITY
Number/Percent Number/Percent Number/Percent
0-4 1'179 Male 1733 41.5% Black 84 2%
6-19 835 20% Female 2444 58.5% Hispanic 543 13%
20-45 1295 31%o Asian 84 2%
46-64 501 12% Am. Indian 42 1%
65+ 167 4%o White 3340 80%
(Anglo)
Unknown Unknown 84 2%
TOTAL 4177 100% TOTAL 4177 100% TOTAL 4177 100%
For fiscal year 1992-93 we estimate each individual served received 2 - 3 different
services. Figures above reflect this estimate.
2
FUNDRAISING
1. Please identify geographic area covered in fund raising activities.
For the WCCAO Neighborshare Office the geographic area covered by fund
raising activities is Tigard, Tualatin, Sherwood and Wilsonville. _
2. Were funds solicited last year? Yes
A. Who did solicitations?
By Board Members XX
By Employees XX
By Professional Fund-Raiser
B. How did you do solicitations? Approximate amount of
revenue from each
By Correspondence $ 16,750
By Benefits, Auctions, Special
Events $
By Campaigns $
By sales of goods or services $
Other $
3. Sources of funds collected during the last fiscal year:
Corporations and Businesses $ 2,500
Individuals/Public $ 13,500
Foundations $
Service Clubs/Civic Organizations $ 750
Government Grants $ 109,346
Other (Specify) $ 5,000
TOTAL $ 131,096
3
4. What fund-raising activites does the agency plan to conduct next year?
MONTH EXPENSES THE FUNDS
ACTIVITY CONDUCTED ARE TO BE USED FOR:
Church and Civic Group
A. Sol i ci tati on Throughout the year [ ] CAPITAL pcX] OPERATING
B Business Solicitation March [ ] CAPITAL OPERATING
Grant Writing Throughout the year
C. [ ) CAPITAL OPERATING
D. Local Govt. Requests January - May [ ] CAPITAL OPERATING
FINANCIAL INFORMATION
1. What fiscal year is used? July 1 - June 30
2. By whom, and how are expenditures authorized? The budget is approved by the
WCCAO Board of Directors. All expenditures under $1,000 are authorized
by the Client Services Director. Expenditures over $1,000 are authorized
by the Executive Director . All Autho, izations am in w, i tiny.
3. What is the amount requested from the City of Tigard for the next fiscal year?
$10,000
4. If funds are being solicited from other local governments in the State of Oregon, please list them
and the requested amounts below.
LOCAL GOVERNMENT REQUESTED RECEIVED
THIS YEAR LAST YEAR
City of Sherwood $ 11000 -0-
City of Tualatin $ _4,000 $ 4,000
King City $ 500 -0-
5. Have the financial records of the organization been audited?Yes-audit attached If so, please
submit a copy of the latest audit report.
4
6. Were government or foundation grants received during the last fiscal year? Yes
If yes, list source and amount:
A. State - LIEAP $ 65,840
B State - OPIE $ 10,350
C State - ESGP * $ 5,557
D State - CSBG $ 10,899
E. Federal - FEMA $ 9,200
7. Were matching funds required? Yes If yes, what percent of match was required?
50% *
8. Does the organization have contracts for services with other agencies? Yes If yes, please
list: In the Tigard Area WCCAO contracts with the following service providers.
AGENCY SERVICE PROVIDED AMOUNT
Interfaith Outreach Emergency Shelter $20, 050
Services(TCM Shelter
9. Capital or endowment funds on hand $ None
10. What are plans if any, for use of these funds? N/A
PROPERTY INFORMATION
Describe location of property (buildings, offices, recreational facilities, etc.) used by the
agency: LEASE RENT
OWNED AMOUNT AMOUNT
A. Tigard Neighborshare Office $ $ 1,200/mo
12/bU SW Facific Highway, 119drd Oregon
B. $ $
C. $ $
D. $ $
E. $ $
F. $ $
G. $ $
5
AGENCY BUDGET
AGENCY Washington County Community Action Organization
Neighborshare 1/28/94
Name of Program Date Submitted
REVENUE & EXPENSES LAST FISCAL THIS FISCAL NEXT FISCAL
YEAR ACTUAL YEAR CURRENT YEAR PROPOSED
19 9 3 . 19 9 4 lg 9 5
PUBLIC SUPPORT & REVENUE
0 CARRY OVER PREV. YEAR 175 556
1 ALLOC - UNITED WAY nnn 2n,noo 2n,non
2 CONTRIBUTIONS (PRIVATE)
3 SPECIAL EVENTS
4 LEGACIES & BEQUESTS
5 TOTAL GOVT FEES & GRANTS
A. FEDERAL g.20n 71.000 73,900
B. STATE 92,646
C. Local 7,500 11,500 15,500
D. COUNTY
6 MEMBERSHIP DUES
7 PROGRAM SERVICE FEES
8 SALES OF MATERIALS
9 INVESTMENT INCOME
10 MISCELLANEOUS REVENUE
11. TOTAL SUPPORT & REVENUE 131,271 368,073 386,474
(ADD 0 THRU 10)
EXPENSES
12 SALARIES 26,499 11M74115,578
13 EMPLOYEE BENEFITS 4,671 27,519 28,894
14 PAYROLL TAXES, ETC. 3,352 15,410 16,180
15 PROFESSIONAL FEES 15,77027,785 29,174
16 SUPPLIES1�407 2,510 2,635
17 TELEPHONE 3,692 4,500 4,725
18 POSTAGE & SHIPPING 182 500 525
19 OCCUPANCY-RENT, UTIL. , ETC. 3,468 10,100 10,605
20 EQUIP . RENTAL & MAINT. 1,9641,200 1,210
21 PRINTING & PUBLICATIONS 42 1,420 1,491
22 TRAVEL 2,237 3,500 3,625
23 CONFERENCES & MEETINGS 309 455 477
24 SPECIFIC ASSIST. TO INDIV. 66,622 165,000 173,250
25 MEMBERSHIP DUES --- 100 105
26 MISCELLANEOUS EXPENSES ___ ___ ___
27 DEPRECIATION
28 TOTAL EXPENSES 130,715 370,073 388,474
(ADD 12 THRU 27)
29 EXCESS (DEFICIT) OF
REVENUE OVER EXPENSE
(11 MINUS 28) 556 -0- -0-
6
AGENCY BUDGET - PAGE 2
30 BOARD RESTRICTED FUNDS
31 OTHER RESTRICTED FUNDS
32 LAND, BLDGS, EQUIP .
33 INVESTMENT SECURITIES
34 ENDOWMENTS/OTHER FUNDS
7
MEMBERSHIP/VOLUNTEERS/PERSONNEL
1. Does the organization have a membership? No
A. If so, how many?
B. Are there membership dues? How much?
Total dues received last year?
2. Does the organization have auxiliaries, guilds, or affiliated organizations whose activities
contribute to its program and/or support? No
NAME OF PURPOSE OF AMOUNT OF
ORGANIZATION ORGANIZATION SUPPORT
VOLUNTEERS
1. How many, if any, volunteers are used in the program? 5 - 10
2. Describe how they are used: Bookkeeper, Interpreter, Re-cepti oni st, Intake
Worker, Filing Clerk In addition, a full time Jesuit Volunteer is utilized
at the Neighborshare Office.
3. Please estimate the total number of volunteer manpower hours over the last twelve (12)
months: 580
4. Is training available for volunteers? Yes
When? Arranged Individually
Time Required Depends on volunteer job performed. Ranges from 1 - 32 hours
of training.
8
STAFF
1. How many employees are involved in the program?
Part Time 4 , Full Time 4
2. Please estimate the total number of manpower hours of paid employees in the year for
which funding is requested? 12,812
For the Neighborshare Office WCCAO employs the following staff
Position FTE
Client Services Director .25
Neighborshare Manager 1.00
Services Specialist 1.00
Jesuit Volunteer .96
Family Service Specialist 1.50 (2 staff full-time Sept. - May)
SAFAH Family Advocate 1.00
Secretarial/Support Staff .45
6.16
9
BOARD OF DIRECTORS
AGENCY Washington County Commune ty ct ion rgani zati on
OFFICE HELD TERM
NAME ADDRESS ON BOARD EXPIRES
Gene Mitchell , Pres. U.S. Bank,N.A. , Membership Bankinc C O RRe 6/95
P.O.Box 5235, Portland 97209-5235
Cindy Hirst 147 Main Street Planning 6/94
North Plains, 97133-0220 Committee Chair
Sandy Miller City of Beaverton Personnel 6/94
P.O.Box 4755, Beaverton 97076 Committee Chair
Sherry Robinson 14985 SW Vulcan Court Planning Comm. 6/96
Beaverton 97007 Exec. Comm.
Russell Wilkinson 451 S.First, Suite 100 Finance Comm. 6/95
Hillsboro 97123
Shirley Huffman
for Mayor Gordon Fabei 809 NE Jackson School Rd. Exec. Comm. 6/95
Hillsboro 97124 Chair
Comm. Linda Peters County Administration Personnel 6/96
155 N. First. , Hillsboro 97124 Committee
Senator Bob Shoemaker 4837 W. Burnside Road Planning Comm. 6/94
Portland 97210 Exec. Comm.
Jose Jaime P. 0. Box 190 Finance Comm. 6/94
Cornelius 97113 Exec. Comm.
Treasurer
Darlene Greene Hillsboro City Council Finance Comm. 6/96
558 SE Brookwood Ave.
Hillsboro 97123
Gregory Zuffrea 22283 SW Pima Ave. None 6/95
for Mayor Steve'Stolz Tualatin 97062
Mayor Bob Drake City of Beaverton None 6/96
P.O. Box 4755 Beaverton 97076
Charlotte Karvin Head Start Parent None 6/96
240 SE Norton Sherwood 97140 (over)
MEETINGS ARE HELD: the third Wednesday of the month
Is there a policy for rotation of Board members? Yes
If yes, please describe Board members are elected for three year terms. Every year
one third of the Board must be e ecte .
10
ATTACHMENT A
City of Tigard
Between July 1, 1992 and June 30, 1993, Washington County Community Action responded
to at least 3,638 requests for assistance from City of Tigard families. The services
provided to these families include:
Value of
Service Families Individuals Service Provided
Brown Bag Members 78 239 $ 1,170
Christmas Baskets 337 989 $ 25,275
Emergency Shelter 8 20 $ 6,372
Energy Self Sufficiency 10 42 $ 2,854
Food Boxes 1301 4512 $117,090
Head Start 12 41 $ 58,392
Heating Assistance 261 704 $ 11,745
I & R 1571 5778 $ 9,426
Parenting Education 10 37 $ 6,875
Rent Assistance 27 95 $ 4,860
Weatherization 8 28 $ 22,832
Self.Help WX 5 23 $ 290
Other Assistance 10 22 $ 450
TOTALS 3,638 12,530 $267,631.
Tigard 92-93
In addition, please refer to Washington County Community Action Organization's 1992-1993
annual report and 1993-1994 program description for comprehensive information on WCCAO's
services and involvement in the community.
CITY OF TIGARD, OREGON
SOCIAL SERVICE AGENCY FUNDING REQUEST CRITERIA
INFORMATION SHEET
ORGANIZATION: `dff�S >` s ��T ��G•
FUNDING REQUESTED: $
FUNDING HISTORY: 1990/91 $
1991/92 $ 1'6�
1992/93 $ I�C4!:)O
1993/94 $ /0,1 4-1e��
CRITERIA: Yes No
1. Service to City Residents -
1 year or more `�
2. IRS 501(c)(3) or not for profit status ✓
3. Volunteer Board with City representation ✓
4. Balanced Budget
5. Oregon Incorporation and Registration ✓
6. Completed Application
DOCUMENTS SUBM=D:
1. Audit Report or Prior Year's Financial Statements ✓
2. 501(c)(3) Status
3. Articles of Incorporation ✓
4. By-laws ✓
CITY OF TIGARD, OREGON
13125 S.W. Hall Blvd.
Tigard, OR 97223
TIGARD SENIOR CENTER
TIGARD LOAVES & FISHES
AGENCY FUNDING REQUEST APPLICATION
AGENCY: Loaves & Fishes Centers Inc.
ADDRESS: 6125 SE 52nd Avenue
Portland Oregon 97206
City State Zip
CONTACT PREPARING APPLICATION:Robert J Coltrane Chief Operating Officer
PHONE NUMBER: (503) 777-2424
1. Describe the Agency's Mission: To promote the health and well-being of
older adults in the Tigard area by providing and advocating for Nutrition and
Social Services in a group setting and in the homes of older adults.
2. What programs/services did your agency provide in Tigard this last year?
a Congregate Meals (hot noon day meal at center): b. Meals-on-Wheels
program: c Information and referral to the senior community: d. Outreach:
e Communi!y classes-, f PCC classes,• g Entertainment: h. Recreation:
i Health Screening Counseling and related services; i. Peer Support:
k Assistance to adult children of aging parents: and I. Meaningful volunteer
opportunities
3. What types of services will be provided in the year in which funding is
requested and how many Tigard residents are estimated to be served?
We will serve 9,281 Congregate meals at the center and 19.631 Meals-on-
Wheels to homebound individuals annually. During the course of the year we
will provide information and referral services to approximately 200 individuals.
The unduplicated participant count for FY 92/93 was 1,767 individuals.
Through our management efforts at the center, space activities, classes and
programs [see Newsletter/Calendar attached] are made available to the
community-at-large daily 8.30 a.m. to 4.30 p.m.
1
CLIENT CHARACTERISTICS: Please indicate: Estimate Actual 320
(Unduplicated count)
AGE SEX ETHNICITY
Number/Percent Number/Percent Number/Percent
0 - 4 Male 89 27.8% Black
6 - 19 Female 231 72.2% Hispanic 2 0.6%
20-45 Asian 5 1.6%
46-64 25 7.83% Am.lndian
65+ 292 92.16% White 311 97.2%
(Anglo)
Unknown 3 0.01%— Unknown 2 0.6%
TOTAL 320 100.00% TOTAL 320 100.0% TOTAL 320 100.0%
2
FUNDRAISING
1. Please identify geographic area covered in fund raising activities.
Tigard King City Metzger Progress and beyond
2. Were funds solicited last year: Yes
A. Who did solicitations?
By Board Members and other volunteers Yes
By Employees Yes
By Professional Fund-Raiser No
B. How did you do solicitations? (Approximate amount of revenue from each)
By Correspondence $ 25.030
By Benefits, Auctions, Special Events $ 4.811
By Gampaigne, Memorial Gifts $ 1.456
By sales of goods or services $ 3.059
Other $ 359
3. Sources of funds collected during the last fiscal year:
Corporations and Businesses $ 4.500
Individuals/Public $ 19.451
Foundations $ 0
Service Clubs/Civic Organizations $ 6.216
Government Grants $ 1.000
Other (Specify) Lambert House, other $ 3.584
Contracts & Investment Income
TOTAL $ 34.751
3
4. What fund-raising activities does the agency plan to conduct next year?
MONTH EXPENSES THE FUNDS
ACTIVITY CONDUCTED ARE TO BE USED FOR:
Center Projects/
A.Events on-going [ ] CAPITAL [X] OPERATING
B.Contract Meal sales each month [ ] CAPITAL [X] OPERATING
C.Direct Mail Spring/Fall [ ] CAPITAL [X] OPERATING
D.Farmers Market Summer [ ] CAPITAL [X] OPERATING
FINANCIAL INFORMATION
1. What fiscal year is used? July 1 through June 30
2. By whom, and how are expenditures authorized? The Center's Director with the approval
of the Centers Steering Committee is authorized to approve expenditures.
3. What is amount requested from the City of Tigard for the next fiscal year?
$15.000 annually
4. If funds are being solicited from other local governments in the state of Oregon, please list
them and the requested amounts listed below.
LOCAL GOVERNMENT REQUESTED RECEIVED
THIS YEAR LAST YEAR
King City $2.000 $1,000
5. Have the financial records of the organization been audited? Yes If so, please
submit a copy of the latest audit report.
4
6. Were government or foundation grants received during the last fiscal year? No
If yes, list source and amount:
A. N/A $ N/A
B. $
C. $
D. $
7. Were matching funds required? No If yes, what percent of match was required?
8. Does the organization have contracts for services with other agencies? Yes
If yes, please list:
AGENCY SERVICE PROVIDED AMOUNT
Washington Co. AAA Senior Nutrition Program
it " " Senior Info & Referral Service $48.664 total
9. Capital or endowment funds on hand $ $136.000
10. What are plans, if any, for use of these funds? Retain the capital and make interest
income available for operations.
PROPERTY INFORMATION
Describe location of property (buildings, offices, recreational facilities, etc.) used by the agency:
LEASE RENT
OWNED AMOUNT AMOUNT
A. Tigard Loaves & Fishes Center, 8815 SW O'Mara $ _0_ $ -0-
B. $ $
C. $ $
D. $ $
E. $ $
F. $— $
G. $ $
5
AGENCY BUDGET
LOAVES AND FISHES CENTERS,INC.
TIGARD SENIOR CENTER 02/04/94
FY92-93 FY93-94 FY94-95
PUBLIC SUPPORT&EXPENSES
0 Carry Over Prev Year $4,867 $33
1 Fundraising-Contributions $25,030 $23,800 $26,500
2 Special Pro'ects $4,811 $5,700 $6,500
3 Memorial Gifts $1,466 $500 $500
4 1 Govt Program Income $53,203 $43,232 $44,000
5 Partici ant Pro-gram Income $38,359 $40,415 $41,500
6 City of Tigard $15,000 $14,400 $15,000
7 Contract Income $3,059 $37000 $3,000
8 Investment Income 25 1 $3,170 1 $3,300
9 Miscellaneous $359 $1385 $1200
10 Total Support $141,8121 $140,4691 $141 533
EXPENSES
11 Salaries $45,224 $45,313 $46,500
12 Em to ee Benefits $2,194 $2,370 $2,525
13 Payroll Taxes $5,182 $5,813 $6,000
14 Food and Consumables $50,939 $50,416- $51,500
151 Equipment, Re 'r&Main $2,898 $3,407 $3,000
161 Ocupancy 1658 1800 1800
17 1 Janitorial $209 $725 $750
18 Posta $225 $700 $700
19 Dues&Literature $13 $0 $0
20 Office Supplies $19 $90 $100
21 Training $226 $300 $300
22 Program Operations Admin $3,547 $2,647 $2,650
23 Central Office Admin $12,347 $14,170 $14,000
24 Central Office Fundraising $9,526 $-9,476- $9,500
25 Other&Misc $2,738 , $3,215 $2,500
26 Total Expenses $136,9451 $140,436 $141,825
271 EXCESS(DEFICIT)OF
REVENUE OVER EXPENSE $4,8671 $33 $292
28 Restricted Funds
29 Investments $20,000 $20,000 $20,000
30 E ui ent-net $17,686 17,000 $16.000
311 Endowment Funds 1 $136,0001 $150,0001 $200,000
6 & 7
MEMBERSHIPNOLUNTEERS/PERSONNEL
1. Does the organization have a membership? No
A. If so, how many? N/A
B. Are there membership dues? No How much? N/A
Total dues received last year? N/A
2. Does the organization have auxiliaries, guilds, or affiliated organizations whose activities
contribute to its program and/or support? Yes (see attached list)
NAME PURPOSE OF AMOUNT OF
ORGANIZATION ORGANIZATION SUPPORT
Loaves & Fishes Centers, Inc. Administers Senior Nutrition $ varies as to need
Programs and related services to balance budget
VOLUNTEERS
1. How many, if any, volunteers are used in the program? 486 unduplicated volunteers
used during FY 1992/93.
2. Describe how they are used: Unduplicated volunteer services were used in the following
manner at the Tigard Community Center: congregate noon lunch) servers - 143: Meals-
on-Wheels drivers - 223; and supportive services and administration - 120.
3. Please estimate the total number of volunteer manpower hours over the last twelve (12)
months? 12.966 volunteer hours were recorded during FY 1992/93.
4. Is training available for volunteers? Yes
When? All volunteers receive an orientation and on-the-job training at the Center. Other
training opportunities are made available through Loaves & Fishes Centers, Inc.
Time Required Varies
8
STAFF
1. How many employees are involved in the program?
Part Time 4 Full Time 1
2. Please estimate the total number of manpower hours of paid employees in the year for
which funding is requested? 6.240
9
BOARD OF DIRECTORS
AGENCY: Loaves & Fishes Centers, Inc.
NAME ADDRESS OFFICE HELD TERM
ON BOARD EXPIRES
See Board of
Directors List
[attached]
MEETINGS ARE HELD: first Wednesday of each Month
Is there a policy for rotation of Board members? Yes
If yes, please describe See Loaves & Fishes Bylaws, Article V.Board of Directors, Section 3.
Terms of Office [attached page 61
10
Board of Directors 93/94
February 4, 1994
Allenbrand, Bob Haight, Alan
2605 SW 48th Ave 12290 SW Hillview Court
Portland, OR 97206 Tigard, OR 97223
234-8961 590-8152 (home)
275-6413 (work)
Bledsoe, Helen Hampton, Lewis, Chair
2208 SW Sunset Drive Hampton Bolliger & McCobb
Portland, OR 97201 1600 SW Cedar Hills Blvd, Ste 108
244-9305 Portland, OR 97225
Tel: 641-1515
Fax: 644-8082
Bogue, Phil Harris, Ed
11519 SW Breyman First Interstate Bank of Or
Portland, OR 97219-8405 3782 SE Hawthorne
Tel: 636-8732 (home) Portland, OR 97204
226-2811 X208 (work) Tel: 225-3565
Fax: 226-4842 Fax: 220-2805
Buckingham, Phyllis, Sec Roth, Don
6209 SW Bvn Hillsdale Hwy Oregon Symphony
#305, Portland, OR 97221 711 SW Alder, Ste 200
297-1131 Portland, OR 97205
Tel: 228-4294
Fax: 228-4150
Chen, David Stose, Virginia
2525 NW 141st Place 6927 SE 70th
Portland, OR 97229 Portland, OR 97206
Tel: 645-7801 (home) 775-0357
221-5801 (work)
Fax: 690-9660
Delbrueck, Nancy, Vice Chair Sumption, Martha
11385 SW Riverwood Rd 16260 S Hilltop Rd
Portland, OR 97219 Oregon City, OR 97045
636-8596 656-3491
Durkheimer,Jim, Treasurer Wyse,Janet
01205 SW Buddington Court 3332 SW Fairmount Lane
Portland, OR 97219 Portland, OR 97204
636-4303 223-3378
Elsasser, Donna
9445 SW 50th
Portland, OR 97219
244-6285
bodlst9394
10(a)
Revised 11/27/90
Section 2. ELECTIONS
A. The Centers Council shall elect its members to the Board of
Directors annually in June to take office immediately after
the Loaves & Fishes Centers, Inc. , Annual Meeting in
September.
B. The Board shall designate through election community-at-
large members to the Board in June, to take office
immediately after the Annual Meeting. Nominations shall be
made by the Nominating Committee and may be made from the
floor with prior consent of the candidate.
Section 3. TERMS OF OFFICE
A. Directors elected by the Centers Council shall serve for
terms of two (2) years. Two Directors shall be elected in
even numbered years and three Directors in odd numbered
years. The Chairman of the Centers Council shall be one of
the five Directors elected to the Board by the Centers
Council.
B. Directors elected by the Board shall serve for terms of two
(2) years. Five (5) community-at-large Directors shall be
elected in even numbered years and five (5) elected in odd
numbered years.
C. A Director may serve three (3) terms, or portions thereof,
after which one (1) year must elapse before being reelected
to the Board.
Section 4. GENERAL POWERS
A. The business affairs of Loaves & Fishes Centers, Inc. , shall
be managed and controlled by its Board.
B. The Board is authorized to define the Board's relationship
to the Centers Council, the centers and to the central
staff, and also to define the relationship between a center
steering committee and the central staff in a manner
consistent with the Article of Incorporation and these
Bylaws. These definitions will include the powers, rights,
and responsibilities of the centers and the central staff.
C. Prior to adoption, the Board shall seek the Centers
Council's recommendations on all policy matters which affect
centers' operations.
Section 5. RESIGNATIONS
Members of the Board shall resign in writing. If any Board member
is absent three consecutive meetings without good and sufficient
6
10(b)
TIGARD SENIOR CENTER - LOAVES & FISHES STEERING COMMITTEE 1993-94
LINDA ST. JOHN '95 , CHAIR
29875 SW ROSE LANE #18 WILSONVILLE 97070 620-8934 work
685-9748 home
CHARMAINE LINDSAY '94, VICE-CHAIR
9185 SW MOUNTAIN VIEW LANE TG24 639-3963
HELEN BREWER '97, SECRETARY
2593 SW DICKSON, TG 97224 684-8922
GLENNA PARKER '97, TREASURER
17113 SW VERSAILLES RD, TG24 620-9662
ROY LINDSAY '94, CENTERS COUNCIL REPRESENTATIVE
9185 SW MOUNTAIN VIEW LANE TG24 639-3963
PAT REILLY, REPRESENTING THE CITY OF TIGARD
13125 SW HALL, TG 97224 639-4171
MAXINE COXLEY MANAGER OF TIGARD TREASURES
16810 SW MATADOR LN KC 97224 620-0372
(CARLOS) TOM BROWN '97 16850 SW MATADOR, KC 97224 639-8322
ED COTTER '98 8065 SW DURHAM RD, TG 97224 639-2407
MARY CROOM `97 11720 SW 79TH, TG, 97223 639-5956
JANE HERRON '97 15745 SW BULL MTN. TG 97224 590-8242
LINDA PEDERSEN '95 19300 SW 65TH, TUAL 97062 692-2193 work
3302 SW 64TH PLACE PTLD, 975221 297-6363 home
VENITA POWNE -96 10120 SW CENTURY OAK DR, TG24 639-6377
DON ROBERTSON -96 12105 SW 60TH, PTLD 97219 246-4009
CORRY STOLK -95 16940 SW 129TH, KC 97224 598-0621
LOUISE SULLIVAN '97 15475 SW OAKTREE LANE, TG24 624-7905
MILDRED WERNER '94 13740 SW ASH AVE, TG 97223 639-2915
Staff : Karen Gardner, Center Director (home 590-4966)
Lydia Douglas, Caterperson Derene Meurisse,Program Coordinator
Peggy Federspiel , Client Services
TIGARD SENIOR CENTER 8815 SW O'MARA, TIGARD 97223 620-4613
LOAVES & FISHES, INC. 6125 SE 52ND, PTLD 97206 777-2424
Nan Olson, Regional Manager
These service clubs and The following Churches and
organizations support Tigard Church organizations support
Loaves & Fishes with Tigard Loaves & Fishes with
volunteers and/or monetary volunteers and/or monetary
donations : donations :
Kiwanis Tetrapolitan Golden K Tigard Church of God
Kiwanniannes of Tigard Tigard Methodist Church
Kiwanis club of Tigard Tigard Meth. Women ' s Society
Tigard Lions Club Tigard Christian Church
Tigard Lions Auxiliary St . Anthony' s Catholic Church
Lions of King City St . James Episcopal Church
Rotary of Kruze Way Metzger Methodist Church
Tigard Rotary Society of St . Vincent de Paul
Sigma Phi GAmma Tigard Friends Church
Rebekahs #220 Calvin Presbyterian Church
American Legion Auxiliary 158 Catholic Daughters
Good Samaritan' s Club St . Anthony ' s Fellowship club
Extension Club of Sherwood and
Tigard
Tigard Art Club
Northwest Senior Theater
West Side Stamp Club
Tigard Garden Club
Metzger Women' s Club
AAUW of Tigard
Willing Workers
Angelettes
Tigard Treasures Gift Shop
Brownie Girl Scout Troup
Royal Villa Service Club
Northwest Steelheaders
Broadmoor Women' s Club
St. Anthony 's Parents Assoc .
Summerfield Women' s Golf Club
Summerfield Men' s Golf Club
Veteran' s Rehab Center
Delta. Kappa Gamma
Beta Beta Chapter
Hooks-N-Needles
Oregon Retired Educators
Association #34
Tigard Grange #148
Tigard Masonic Lodge No. 207