APPLICATION: To Be a TCDD Network Partner & Address Priorities

An Invitation: To Be Active/Benefit in Capacity Training, Program/Grant Teams & Grants!

A Circle of Ten, Inc. ~ Network for Collaboration (C10) in collaboration with East Texas, Gulf Coast, Austin & Statewide Partners in Building Community Capacity though Collaboration & Capacity Building Across Texas Efforts
Services for People with Disabilities

Funded by Texas Council for Development Disabilities (TCDD)

Texas Council for Developmental Disabilities Grantees & Partners received Input & Involvement to Set & Meet Priorities in Gulf Coast and East Texas Strategic Plans via Community-Wide Meetings & Web Surveys. History: These efforts build on the synergy between TCDD, Statewide Nonprofit, East Texas Houston/Gulf Coast, and Austin Partners in 2012 and 2013 TCDD grants/contracts to increase capacity, services and funding to serve people with developmental disabilities and their families. Details in TCDD Annual Report: http://tcdd.texas.gov/wp-content/uploads/2013/03/2012_tcdd_ann_rpt.pdf Baseline TCDD Capacity Building Project(s) Deliverables include: -Build internal & collaborative capacity of TCDD grantees & Network Partners through leadership training and support -Develop a Network of diverse agencies to identify gaps and set priorities (See Priorities Lists, below) -Develop & Implement a Strategic Plan to improve services for people with disabilities and their families NEW NETWORK PARTNERS INVITED! Project Advisory Committees (PAC) are accepting applications now! Who is Eligible? Agencies willing to: 1) Apply (complete, sign, return this form) 2) Sign Memorandum of Agreement agreeing to partners roles, involvement & benefits; 3) Address Project Priorities, listed below. Partner Benefits: 1) Receive TCDD underwriting to A Circle of Tens intensive 3-day leadership & capacity building seminar ($200 co-pay). Seminar required to participate; June 17-19~Houston; July 16-18~Edom (W of Tyler) 2) Support/ guidance on Program/Grant Teams and Inclusion in regional and statewide Collaborative Grants addressing priorities. 1-First Name: 2-Agency(s): 3-Address: 4-Work #: Cell #: Fax: Last Name: Position: Zip Code: County:

5-Geographical Areas Served: Provide List: 6-Email Address:

__Single Town/City __One County __Region __Statewide Web Address:

7-Indicate if you are __C10 Alumni? What year? ____ ___TCDD Grantee now. 8-Annual Operating Budget: $________ Date of Last Board Training:________ Strategic Plan in place? __Yes _No

9-Check Geographic Area & Priority(s) Your Agency proposes to address: Gulf Coast PAC Priorities East TX Disabilities Srvc Network PAC Priorities
___Mental Health for People with Disabilities ___Vocational Education & Workforce. Subcategories: ___Energy efficient, affordable & smart housing ___Education & Advocacy ___Recreation & Socialization ___Transportation, specific to these opportunities. ___Community Integration. Subcategories ___Independent Living Skills ___Socialization ___Vocational/ Education ___Transitional, Affordable Housing ___Transportation, specific to these opportunities.

10-Focus of Services? Indicate your Agencys top 3 priorities with #1 as your MAIN service, etc. (# no more than 3)
__ a. Adult Literacy __ b. Affordable Housing __ c. Arts __ d. Community Involvement __ e. Disabilities Issues __ f. Economic Development __ g. Education/Higher Ed __ h. Energy Eff./Renew. Energy nd __ i. English as a 2 Language __ j. Faith Based Services __ k. Health Issues/Mental Health __ l. Independent Living Skills __ m. Peer Support __ n. Recreation __ o. Rural Issues __ p. Senior Services __ q. Small Business/Entrepreneur __ r. Technology __ s. Transportation __ t. Vocational Needs __ u. Womens Issues __ v. Workforce Dev __ w. Youth Services __ x. Other_____________________ __ y. Justice/Legal Advocacy __ z. Veterans

11-Authorizing Signature:_________________________________________

Date_________________

Return App to C10 by: Fax 888-214-5210 circleof10@circleof10.org or virtual-village.org. Call 903-541-0013 w Qs
Notice of Proprietary Information provided by A Circle of Ten, Inc with the intent to train leaders and develop collaborative projects, furthering the missions of C10 and C10 Partners with MOA in place. Any other use of this information is unauthorized and prohibited.*All materials Copyrighted. 1996, 2001 A Circle of Ten, Inc. 205 E Commerce, #205, Jacksonville, TX 75766 903-541-0013 circleof10@circleof10.org www.virtual-village.org Funding for the Building Community Capacity through Collaboration project is provided by the Texas Council for Developmental Disabilities, with Federal funds* made available by the United States Department of Health and Human Services, Administration on Developmental Disabilities. *$75,000 (70%) DD funds; *$32,100 (30%) nonfederal resources.*Non-Federal Resources include co-pay for 3-Day Seminar for Project Program/Grant Team Leaders. Revised 130430 4:03pm SH WJ KH PA AB