Court Appointed Host Homes

Court Appointed Host Homes Requests of $5,000 or less Mrs Peggy Pratt 1011 Fort St Hays, KS 67601 O: 785-628-6244 M: 785-470-7038 Mrs Tanya Thomas 1011 Fort St Hays, KS 67601 Tanya.Thomas@ks.gov O: 785-628-6244 M: 785-269-7969 Printed On: 30 January 2018 Requests of $5,000 or less 1

Application Form Organization Information Verification of tax-exempt status* Organization is: Government entity Verification of status Please note: Applications from public charities (501(c)3 organizations) are required to attach verification of charitable status in order to be considered. A state sales tax exemption DOES NOT complete this requirement. Applications from churches and/or government entities are not required to attach a verification document. Please Click Here to view an example of an acceptable IRS Determination Letter. Click Here to view an example of an unacceptable IRS Determination Letter. Please upload an IRS determination letter, charter from parent organization, ect. Physical Address If the physical address of your organization is different than the mailing address, please enter your physical address below. Project Information Project Name* Name of Project. Court Appointed Host Homes Amount requested* $5,000.00 Primary objectives* The Foundation has six primary objectives. Which of these does your program or project best addresses: Community Social Services & Security Printed On: 30 January 2018 Requests of $5,000 or less 2

County or Counties Served* Please check the primary county served by the program/project for which you are requesting funds. Cheyenne Decatur Ellis Gove Graham Logan Norton Osborne Phillips Rawlins Rooks Sheridan Sherman Smith Thomas Trego Wallace Communities Served* Please list the primary community served by the program/project for which you are requesting funds. NWKS Juvenile Services which consists of 3 Judicial Districts in NWKS. Our Districts are the 23/17/15 which encompasses 17 counties: Cheyenne, Decatur, Ellis, Gove, Graham, Logan, Norton, Osborne, Phillips, Rawlins, Rooks, Sheridan, Sherman, Smith, Thomas, Trego, Wallace counties. Strategic Doing Project* Was this application generated through Strategic Doing initiative? No Target Population* Please check one or more populations served by the program/project for which you are requesting funds. Early Childhood (0-4) Youth (5-12) Teen (13-20) Project Description* Briefly describe the program/project for which you are requesting funds. Children coming into Police Protective Custody under various circumstances were being subjected to further trauma when they were being transported to emergency shelters/group homes in Garden City, Hutchinson, or Wichita to await the initial 72-hour hearing. This project is working to help children achieve Printed On: 30 January 2018 Requests of $5,000 or less 3

their greatest potential and assist in their physical and mental well being by seeking to minimize this trauma. The professionals in this project believe the trauma can be lessened for these children by decreasing the amount of time spent at the police station awaiting placement, decreasing the time spent traveling to unfamiliar places, and maintaining their daily routines by keeping them in their home communities. Using a project established in Saline County as a model, we have devised a plan to recruit families willing to participate in becoming Court Appointed Foster Homes. A further plan is in place to have them Court Approved which will be a modified, shortened procedure as opposed to the lengthy, intensive process needed to become licensed foster homes. As non-licensed homes, these families generously volunteer to keep children without receiving payments. Training the families will be of importance to understand the effects of trauma-informed care for these children. Many of these families experience more expenses than they anticipated thus we are seeking to defray some of these unexpected costs by paying them a stipend of $25 per day for up to 3 days. Many of the children do not arrive with sufficient diapers, formula, hygiene needs, or clothing for their stay. We believe payments, expense reimbursements, and training incentives will help eliminate a significant barrier to recruiting families for this project. Grant Request Description* If funded, how will you specifically use the Dane G. Hansen funds? The dollars will be used as stipend payments to the Court Approved Foster Homes to offset some of their personal costs. Dollars will also be used to reimburse families for any extra expenses incurred that maybe unexpected such as diapers, formula, clothing. Lastly, dollars will be utilized in training these families in trauma-informed care and providing incentives for their attendance. We anticipate 40 placements for this upcoming year with an average of 3 days at the rate of $25/day = $3000. Supplies for children (diapers, formula, hygiene needs, clothing) = $1200 Training & Incentives for Families = $800 Project Objectives* What do you hope to achieve and how will it benefit the people of Northwest Kansas? SInce 2004, NWKS Juvenile Services has not had a Court Appointed Foster Care/Host Home Program in place. Due to the lack of emergency foster care placements in the 17 counties, children placed in Police Protective Custody are being transferred to out-of-region placements (typically Garden City, Hutchinson, or Wichita) after being held several hours at their local Police Departments. Then a few hours or days later, they were being uprooted a second time and driven to another location after the 72-hour hearing. This procedure resulted in increased costs to our counties in higher placement fees, transportation expense, and employee wages to transport children to and from these locations. There is also the non-monetary cost that needs to be considered of the increased trauma imposed upon these children from the disruption and instability created by this process in a very condensed time period. Timetable for the Project* When is the project projected to begin and end? For ongoing projects, when will the Dane G. Hansen funds be utilized? We are currently beginning to advertise, recruit, and meet with prospective families to become Court Appointed Foster Homes. Printed On: 30 January 2018 Requests of $5,000 or less 4

NWKS Juvenile Services hopes to implement payments to Court Appointed Host Homes $25/day (up to 3 days), reimbursements, and training incentives on/about May 1, 2018, or as soon as funding can be secured. Funds will be utilized for a one year period. (ie May 1, 2018- April 30, 2019). These dates will be adjusted as needed as funds are secured. Additional Support Describe additional sources of support (if any) that have been secured or that will be pursued for this project. None at this time Sustainability* How will the project/program be sustained in the future? (For capital projects, how will you maintain or operate the item or facility?) Data will be collected this first year to determine length of placement stay, number of placements, reimbursements, and training/incentive costs to determine further funding needs for 2019/2020. We will continue to pursue funds from the State of Kansas, Department of Children and Families, and local Counties where these children reside. Evaluation* How will you evaluate the success of the project/program? Be specific. (If funded, this will be helpful when completing the final grant report.) We will utilize the data of the previous year placement numbers and the associated costs with transporting these children to emergency shelters outside our 3 Judicial Districts. Data will be collected this first year to determine length of placement stay, number of placements, reimbursements, and training/incentive costs to determine further funding needs for 2019/2020. Data will be collected to determine how quickly placements are found, how long children spend at Law Enforcement offices, and where children were placed in our 3 Judicial District area. Data will be collected on number of children still placed outside of our Judicial Districts. Proposal Budget* Complete the budget form attached on the Grant Criteria page under document requirements and upload here. budget for Dane Hansen Grant 2018.xlsx Printed On: 30 January 2018 Requests of $5,000 or less 5

Supporting Documents Bid or Estimate A copy of the bid or quote is required for a capital project or purchase. Letter of Support 1 A letter of support may be attached, but is not required. Additional Documents If there are additional documents that are critical to the trustees understanding of your proposal, upload them here. Foster Home Data 2012-2017.xlsx Electronic Signature Signature of Applicant* By entering my full legal name here, I warrant the truthfulness of the information provided in this application. Tanya Thomas Title of Applicant* NWKS Juvenile Intake/Assessment Supervisor Signature of Principal or College President If this request is for a school or university, the signature of the principal or president is required. If the request is not for an educational institution, skip this step. By entering my full legal name here, I warrant that I have read and support this application. Title of Principal or College President Signature of CEO, Director, Mayor, etc. If this request is for a City, 501 (c)(3) Organization, Government Entity, etc., the signature of the CEO, Director, Mayor, etc., is required. By entering my full legal name here, I warrant that I have read and support this application. Peggy Pratt Printed On: 30 January 2018 Requests of $5,000 or less 6

Title of CEO, Director, Mayor, etc. NWKS Juvenile Services Director Internal Tracking Number* 2018-2-13 501c3* Yes Printed On: 30 January 2018 Requests of $5,000 or less 7

File Attachment Summary Applicant File Uploads budget for Dane Hansen Grant 2018.xlsx Foster Home Data 2012-2017.xlsx Printed On: 30 January 2018 Requests of $5,000 or less 8

Organization: Project name: Dane G. Hansen Project Budget Form List project expenses (be specific) $25 (daily stipend) x 40 (placements) x 3 (avg # days) $3,000.00 Supplies for Children (diapers, formula, clothing, etc.) $1,200.00 Training for Families $800.00 *Total Project Expenses $5,000.00 Project Revenue Secured Applied-for Earned In-kind donations can be included- provide equitable dollar amount. Budgeted funds, gifts received, etc (Grants, Pending donations) Dane G. Hansen Foundation Request $5,000.00 (Fees, ticket sales, etc) TOTALS $5,000.00 *Total Project Revenue $5,000.00 *Revenue and Expense totals should be the same.

County # kids Males Females Age 0-1 Age 2-5 Age 6-10 Age 11-13 Age 14-17 Status Offender Non-Offender Juvenile Offender Cheyenne 0 0 0 0 0 0 0 0 0 0 0 Decatur 0 0 0 0 0 0 0 0 0 0 0 Ellis 18 11 7 3 1 1 1 12 0 9 9 Gove 0 0 0 0 0 0 0 0 0 0 0 Graham 0 0 0 0 0 0 0 0 0 0 0 Logan 0 0 0 0 0 0 0 0 0 0 0 Norton 2 0 2 0 0 0 0 2 1 1 0 Osborne 1 0 1 0 0 0 0 1 0 0 1 Phillips 1 0 1 0 0 0 0 1 0 0 1 Rawlins 1 1 0 0 0 0 0 1 0 0 1 Rooks 0 0 0 0 0 0 0 0 0 0 0 Sheridan 0 0 0 0 0 0 0 0 0 0 0 Sherman 0 0 0 0 0 0 0 0 0 0 0 Smith 0 0 0 0 0 0 0 0 0 0 0 Thomas 1 1 0 0 1 0 0 0 0 1 0 Trego 1 1 0 1 0 0 0 0 0 1 0 Wallace 0 0 0 0 0 0 0 0 0 0 0 Totals 25 14 11 4 2 1 1 17 1 12 12 Year 2013 # Kids = Total # per county - Non-offender/Status Offender/Juvenile Offender County # kids Males Females Age 0-1 Age 2-5 Age 6-10 Age 11-13 Age 14-17 Status Offender Non-Offender Juvenile Offender

Cheyenne 0 0 0 0 0 0 0 0 0 0 0 Decatur 0 0 0 0 0 0 0 0 0 0 0 Ellis 22 9 13 2 4 0 1 15 8 5 9 Gove 0 0 0 0 0 0 0 0 0 0 0 Graham 0 0 0 0 0 0 0 0 0 0 0 Logan 3 2 1 1 2 0 0 0 0 3 0 Norton 0 0 0 0 0 0 0 0 0 0 0 Osborne 0 0 0 0 0 0 0 0 0 0 0 Phillips 2 2 0 0 0 0 0 2 0 0 2 Rawlins 0 0 0 0 0 0 0 0 0 0 0 Rooks 3 3 0 1 2 0 0 0 0 3 0 Sheridan 1 1 0 0 0 0 0 1 0 0 1 Sherman 5 4 1 0 0 1 1 3 1 2 2 Smith 0 0 0 0 0 0 0 0 0 0 0 Thomas 5 4 1 0 1 2 0 2 1 3 1 Trego 4 2 2 1 1 0 1 1 0 2 2 Wallace 0 0 0 0 0 0 0 0 0 0 0 Totals 45 27 18 5 10 3 3 24 10 18 17 Year 2014 # Kids = Total # per county - Non-offender/Status Offender/Juvenile Offender County # kids Males Females Age 0-1 Age 2-5 Age 6-10 Age 11-13 Age 14-17 Status Offender Non-Offender Juvenile Offender Cheyenne 1 1 0 0 0 0 0 1 0 0 1

Decatur 0 0 0 0 0 0 0 0 0 0 0 Ellis 25 7 18 3 4 5 1 12 3 13 9 Gove 0 0 0 0 0 0 0 0 0 0 0 Graham 0 0 0 0 0 0 0 0 0 0 0 Logan 0 0 0 0 0 0 0 0 0 0 0 Norton 4 2 2 0 0 0 1 3 0 3 1 Osborne 3 1 2 0 0 1 1 1 0 2 1 Phillips 0 0 0 0 0 0 0 0 0 0 0 Rawlins 0 0 0 0 0 0 0 0 0 0 0 Rooks 0 0 0 0 0 0 0 0 0 0 0 Sheridan 0 0 0 0 0 0 0 0 0 0 0 Sherman 0 0 0 0 0 0 0 0 0 0 0 Smith 1 1 0 0 0 1 0 0 0 1 0 Thomas 5 4 1 1 1 0 0 3 1 4 0 Trego 0 0 0 0 0 0 0 0 0 0 0 Wallace 0 0 0 0 0 0 0 0 0 0 0 Totals 39 16 23 4 5 7 3 20 4 23 12 Year 2015 # Kids = Total # per county - Non-offender/Status Offender/Juvenile Offender County # kids Males Females Age 0-1 Age 2-5 Age 6-10 Age 11-13 Age 14-17 Status Offender Non-Offender Juvenile Offender Cheyenne 1 1 0 0 0 0 0 1 1 0 0 Decatur 1 0 1 0 0 1 0 0 0 1 0

Ellis 28 13 15 4 8 5 3 8 4 20 4 Gove 0 0 0 0 0 0 0 0 0 0 0 Graham 1 0 1 0 0 0 0 1 1 0 0 Logan 0 0 0 0 0 0 0 0 0 0 0 Norton 1 0 1 0 0 0 0 1 0 1 0 Osborne 3 1 2 1 2 0 0 0 0 3 0 Phillips 0 0 0 0 0 0 0 0 0 0 0 Rawlins 0 0 0 0 0 0 0 0 0 0 0 Rooks 0 0 0 0 0 0 0 0 0 0 0 Sheridan 0 0 0 0 0 0 0 0 0 0 0 Sherman 1 1 0 0 0 1 0 0 1 0 0 Smith 0 0 0 0 0 0 0 0 0 0 0 Thomas 0 0 0 0 0 0 0 0 0 0 0 Trego 1 1 0 1 0 0 0 0 0 1 0 Wallace 0 0 0 0 0 0 0 0 0 0 0 Totals 37 17 20 6 10 7 3 11 7 26 4 Year 2016 # Kids = Total # per county - Non-offender/Status Offender/Juvenile Offender County # kids Males Females Age 0-1 Age 2-5 Age 6-10 Age 11-13 Age 14-17 Status Offender Non-Offender Juvenile Offender Cheyenne 0 0 0 0 0 0 0 0 0 0 0 Decatur 0 0 0 0 0 0 0 0 0 0 0 Ellis 22 12 10 2 2 3 3 12 2 10 10

Gove 1 1 0 0 0 0 0 1 0 0 1 Graham 1 1 0 0 0 1 0 0 0 1 0 Logan 0 0 0 0 0 0 0 0 0 0 0 Norton 2 0 2 0 1 1 0 0 0 2 0 Osborne 0 0 0 0 0 0 0 0 0 0 0 Phillips 0 0 0 0 0 0 0 0 0 0 0 Rawlins 0 0 0 0 0 0 0 0 0 0 0 Rooks 1 1 0 0 0 0 0 1 0 0 1 Sheridan 0 0 0 0 0 0 0 0 0 0 0 Sherman 1 0 1 0 0 0 0 1 1 0 0 Smith 2 2 0 0 0 0 2 0 1 1 0 Thomas 0 0 0 0 0 0 0 0 0 0 0 Trego 0 0 0 0 0 0 0 0 0 0 0 Wallace 0 0 0 0 0 0 0 0 0 0 0 Totals 30 17 13 2 3 5 5 15 4 14 12 Year 2017 # Kids = Total # per county - Non-offender/Status Offender/Juvenile Offender County # kids Males Females Age 0-1 Age 2-5 Age 6-10 Age 11-13 Age 14-17 Status Offender Non-Offender Juvenile Offender Cheyenne 2 2 0 0 0 0 0 2 0 0 2 Decatur 1 0 1 0 0 1 0 0 0 1 0 Ellis 115 52 63 14 19 14 9 59 17 57 41 Gove 1 1 0 0 0 0 0 1 0 0 1

Graham 3 1 2 0 0 1 0 2 2 1 0 Logan 3 2 1 1 2 0 0 0 0 3 0 Norton 9 2 7 0 1 1 1 6 1 7 1 Osborne 7 2 5 1 2 1 1 2 0 5 2 Phillips 3 2 1 0 0 0 0 3 0 0 3 Rawlins 1 1 0 0 0 0 0 1 0 0 1 Rooks 4 4 0 1 2 0 0 1 0 3 1 Sheridan 1 1 0 0 0 0 0 1 0 0 1 Sherman 7 5 2 0 0 2 1 4 3 2 2 Smith 3 3 0 0 0 1 2 0 1 2 0 Thomas 11 9 2 1 3 2 0 5 2 8 1 Trego 6 4 2 3 1 0 1 1 0 4 2 Wallace 0 0 0 0 0 0 0 0 0 0 0 Totals 177 91 86 21 30 23 15 88 26 93 58 Years 2012-2017 # Kids = Total # per county - Non-offender/Status Offender/Juvenile Offender