FY25 Family Support Application

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This is a supplement to the FY25 Application for FY25 NICA Funding. Please make sure you have completed BOTH applications.

Email *

Record my email address with my response

Name of person completing the application. *

Email *

# of families to be served by the program in FY25. *

Planned service capacity: Planned service capacity is the maximum number of families to be served at any point in time. Planned service capacity is not cumulative throughout the year. *

# of children to be served by the program in FY25. *

Program goal for the total number of visits for FY25. *

Planned number of home visits per family per month. *

Length of each scheduled visit. *

Cost per visit. *

Anticipated # of new families. *

Number and % of new families meeting eligibility requirements as defined by Tool FF. *

Method for qualifying families to meet eligibility requirements defined by Tool FF. *

Home visiting model. *

If you are not a Parents as Teachers Affiliate or Healthy Families America program are you willing to become one? *

Yes

Assessment tool(s). *

Curricula: please note this is different than a home visiting model. A family support program may use more than one curricula to meet the varied needs of the families they serve. *

Supervision frequency: how often will the organization provide one on one supervision to each family support professional? How often will documentation be reviewed as part of supervision? How often will the supervisor observe the support professional performing their work? *

How are linguistic needs addressed? How will the contractor provide services for non English language learners? *

Number of direct service staff that will be supported by the program. Please list the number and the FTE. (i.e. 1 FTE, 2 .5 FTE) *

What is the case load per direct service staff? *

Number of supervisor staff that will be supported by the program. *

Program Impact: Percent of participating families that improve or maintain healthy family problem solving and communication.
*

Program Impact: Percent of participating families that increase or maintain social supports.
*

Program Impact: Percent of participating families that are connected to additional concrete supports.
*

Program Impact: Percent of participating families that increase knowledge about child development and parenting.
*

Program Impact: Percent of participating families that improve nurturing and attachment between parent(s) and child(ren).
*

What strategies will your program use to recruit new families into the family support program?
*

Comments: *

A copy of your responses will be emailed to .

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