New Age HippyAPPLICATION FORM WITH SCORING AND REVIEW CRITERIA AND GUIDANCE
1,000.00 Feb 2020
Funding amount requested: $_ Dates of event/program start -end - /
Yes/No Conditions
A. Fair and justifiable program costs (Program/Event Budget required) Yes/No
B. Serves Atlantic Beach residents Yes/No
C. Program/event pertains to cultural, arts, recreation Yes/No
D. Program/event activities completed by September 30, 2020 Yes/No
E. Program/event is non-discriminatory Yes/No
F. Is the event free from inherently religious activities? Yes/No
NOTE: If the Yes/No conditions are not met, the application is not eligible for funding,
and will not be processed for review.
NOTE: Questions reviewers will consider are listed in italics as a helpful guide for applicants
1. Participants (Maximum 35 points)
❑ Location(s) where program/event will take place Donnor Park Community Center
❑ Total estimated number of participants 50
❑ Number and percent of participants who are Atlantic Beach residents # 100 %
❑ Total number of hours each participant will be directly engaged in
program/event 45 Minutes
❑ Frequency and duration of program/event (e.g. 1 time event for 2 hours, or 1 x/month for
1 hour) 1 Time Event
❑ Is the event open to all residents of Atlantic Beach who may want to participate? Yes
❑ Is the event to occur in Atlantic Beach or to serve primarily Atlantic Beach? Both
NOTE: An important criteria for funding is to ensure that an adequate number of
Atlantic Beach residents will benefit from the program/event relative to the
amount of funding requested. To address this criteria, a per -person -per -hour cost
will be calculated by the reviewers.
2. Need (Maximum 20 points)
Briefly describe any community needs or gaps that the program/event is intended to
address. Please state if the program/event targets a population or age group that is currently
underserved in Atlantic Beach.
NOTE: Reviewers will consider the following questions when assigning points:
❑ Is there a demonstrated need for the program/event?
❑ Is the program/event duplicative of other programs/events in the area?
171 Is the program/event a response to a need articulated from the community?
❑ Does the program/event target a population group that is currently underserved?
(e.g. teens, children with special needs, low-income residents, etc.)
The Balance Matter Program (Balance, Strength, Flexibility, Cognitive) is designed to raise participants' fall
prevention knowledge and enhance more daily activity options and awareness.
Introduce steps to reduce falls and improve health and well-being, and provide referrals and resources.
This program has been presented locally. The high rate of participation indicated a need for Balance/Fall
prevention programs, and a better understanding for better balance and the benefits it offers for both mind and
body .This event will provide a variety of options for bringing healthy lifestyle opportunities to our local
community.
3. Description of program/event
3.1 Describe the goals and objectives of the program/event, and benefits to the
residents of Atlantic Beach, please make sure goals and objectives are specific,
measurable, achievable, results -focused and time -bound (Maximum 15 POINTS)
NOTE: Reviewers will consider the following questions when assigning points:
o Are the goals and objectives described in the application SMART
(specific, measurable, achievable, results -focused, and time- bound)
o How will the program/event benefit residents of Atlantic Beach (pertaining
to cultural arts and recreation?
o Are the goals and objectives artistic, recreational and/or cultural in nature
Goal: "Balance Matters" will improve wellbeing to Atlantic Beach residents by assessing risk factors for
balance, stren: , .: I . - .1 . 'AI . 1 . . .. - .1 . . i. .1 . 011 - . .. . 1 11 •.
=._ - ••..• - -• - e e • : e - • e e • •• _ - -- : - : • : _ e -llbeing.
Each particip..e . : - : _.: _ _• -. _ _ .: : .:.::: _ .• _ . - . ..
After their assessment, each participant will receive a written report of _results in a private consultation with reeommendati€
to address any risk factors. At the end of the assessment activity, participants will receive materials on current recreational
programs in the community designed to enhance their physical and cognitive wellbeing.
3.2 Describe program/event activities (Maximum 40 POINTS)
NOTE: Reviewers will consider the following questions when assigning points:
o How appropriate are these activities are in terms of achieving the stated
goals and objectives
o Originality and creativity — is the program or event new and unique to the
community or provide a new or unique twist on an existing program or
event?
o Is this a family oriented and wholesome event that City funding should
support?
*Balance Matters Program will be delivered at the Donnor Park Community Center on a Saturday in February 2020
.
local
9:00am-12.00p="rhis-free-evtut isfall u.L ieiitCd and a eumrriuuity Cuddling oppol•LUM. y fur Lhe 1 .
*Assessment .. .. ... :,. .. .
- , . _ -
assessment form and go to each station to complete the specific test & receive their results.
* After completing all stations participants will receive a 1 on 1 consultation to explain the results and provide recommendat
* To promote community participants will be provided with snacks and beverages and an area to connect with others during
event.
*After their they will he given a_ brief avrvey to accaec Ratigfantinn
eval1iatinn
* Within 1 week Organizers will provide a written evaluation from the balance matters team and other Collaborators.
3.3 Describe how the program/event will be advertised too ensure adequate
participation (Maximum 5 POINTS)
NOTE: Reviewers will consider the following questions when assigning points:
o Is there a plan for promoting/marketing the program/event?
o Is this plan likely to be effective and feasible?
Balance Matters Event will be advertised through local & social media months before the event to insure everyone is
aware of the event and the benefits it offers eacn person who attends.
Fliers will be distributed throughout the Community. A press release will be provided to the City of Atlantic Beach to add
to the monthly newsletter inviting the resiaents of Atlantic tteacn to put the event on their calendar.
4 Describe how you will facilitate access to the program or event so that residents of Atlantic
Beach who do not live near the program/event location and/or who do not have
transportation can still participate. (Maximum 10 POINTS)
NOTE: Reviewers will consider the following questions when assigning points:
o Is there a plan to ensure that access is not a barrier?
o Is this plan effective and feasible?
Donnor Park Community Center is Handicapped accessible. There is plenty of parking. bike racks and
walking availability.
The Event will be promoted months before the event throughout the community to allow for individuals
to make transportation arrangements.
5 Describe if the program is evidence based (i.e. has a record of achieving expected
outcomes) (Maximum 15 POINTS)
NOTE: Reviewers will consider the following questions when assigning points:
o is the program or event based on published evidence?
o Does the program or event have a demonstrated history of success (in other
contexts or similar cities, or in previous years)?
Balance Matters program is an evidence based program supported by the National council aging (NCOA) &
Center for Disease Control (CDC). Interactive Health Partners uses this program with positive results.
Program is designed to educate and promote better balance leading to better health and wellness.
Previous programs where offered by Neptune Beach Senior Ctr & Tai Chi for Health and Wellness.
Both offerings far exceeded expectation.
6 If there is a fee or cost to participate, describe how you will ensure that participants are not
denied the opportunity to participate due to their inability to pay any registration or other
related fees or costs. If there is no fee or cost please state N/A (Maximum 15 POINTS)
NOTE: Reviewers will consider the following questions when assigning points:
o Is the program/event free for residents of Atlantic Beach?
o If there is a fee or cost, does the proposal describe steps to ensure that
participants are not denied the opportunity to participate due to their inability
to pay fees or costs?
Grant requested will provide the funding needed for the program to be free for the residents of Atlantic Beach.
7. Evaluating Success (Maximum 30 POINTS)
Briefly describe how you will measure success. This should include how you will assess
participant satisfaction, number of participants and (if applicable) changes in knowledge,
attitudes, skills or behaviors. Describe data collection methods and who will be
surveyed. Please also describe how data will be used to inform program improvement.
NOTE: Reviewers will consider the following questions when assigning points:
o Is there an adequate evaluation plan for measuring participation,
participant satisfaction and (if applicable) changes in knowledge,
attitudes, skills or behaviors
o Will data provide actionable information for future planning?
o Will results be useful for dissemination to the community?
o Does evaluation include feedback from participants/audience as well as
planners/ organizers and volunteers?
The evaluations completed will reveal satisfaction with the event, The Fialaenee Matters
team will prepare a report to describe survey results and provide actionable information
for future planning, which will list # of participants, # of assessmentsparticipants
satisfaction and assessment results. The report will be available to the City of Atlantic
Beach for dissemination.
8. Resourcing (Maximum 15 POINTS)
Please describe any plan to leverage additional resources (e.g. other funding,
volunteers, in-kind donations) or collaboration with others to offset expenses
NOTE: Reviewers will consider the following questions when assigning points:
o Is there a plan to leverage additional resources (other funding, volunteers,
and/or in-kind donations)?
o Is there collaboration with other organizations that will help to offset
resources and expenditures?
o Is this a for-profit event?
To offset expenditures we will receive materials from multiple community partners.
This event is provided by a not for profit to benefit the residents of Atlantic Beach and the larger
Community.
New Age Hippy
2019/2020 Annual Budget
Personal Donation
Total Income
Income Sources
Expense Categories
$ 185.00
$ 185.00
Programs:
Program: Adopt A Highway $ 50.00
Description: Semi-annual clean-up program utilizing 8-10
community volunteers for 2.5 hours
Supplies: Garbage bags and gloves
Program: Coastal Clean-up $ 75.00
Description: Semi-annual coastal clean-up program utilizing 8-15
community volunteers for 2 hour time period
Supplies: Garbage bags and gloves, snacks and beverages
Program: America Recycles Day $ 60.00
Description: Annual recycle donation drive utilizing 15 - 20
volunteers for a 7 hour time period
Supplies: Snacks and drinks
Community Outreach
Boards: Keep Jax Beautiful: A Clean City Commission
Description: Events planning for community projects
In Kind: once a month meeting, 10 hours month event planning,organizing
Total Expenses $ 185.00
Income less Expenses $
Balance Matters Program Budget Saturday, February 2020
10 Trained Instructors
8 Assessment Stations
2- one on one consulting station
Rental Fee @ Dutton Park Community Center
Materials and Printing
Snacks & Drinks
4 hours@$20.00 = $800.00
$25.00 an hour for 4 hours=$100.00
$50.00
$50.00
Total $ 1,000.00
New Age Hippy, Inc.
222 Oleander street
Neptune Beach, Florida 32266
904-234-0038
www.newagehippy.org
State of Florida
Department of State
I certify from the records of this office that NEW AGE HIPPY, INC. is a
corporation organized under the laws of the State of Florida, filed on July 6,
2011, effective July 6, 2011.
The document number of this corporation is N11000006407.
I further certify that said corporation has paid all fees due this office through
December 31, 2019, that its most recent annual report/uniform business report
was filed on June 27, 2019, and that its status is active.
I further certify that said corporation has not filed Articles of Dissolution.
Given under my hand and the
Great Seal of the State of Florida
at Tallahassee, the Capital, this
the Twenty-second day of August,
2019
Tracking Number: 3167299242CU
Secretary of State
To authenticate this certificate,visit the following site,enter this number, and then
follow the instructions displayed.
https://services.sunbiz.org/Filings/CertificateOfStatus/CertificateAuthentication
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certify the attached is a true and correct copy of the Articles of Amendment,
filed on October 13, 2011, to Articles of Incorporation for NEW AGE HIPPY,
INC., a Florida corporation, as shown by the records of this office.
The document number of this corporation is N11000006407.
FOb Wt„
CR2E022 (1-11)
Given under my hand and the
Great Seal of the State of Florida -
at Tallahassee, the Capital, this the
Fourteenth day of October, 2011
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FLORIPA.ricti- EQR_PROFIT 1ORPCIRAT;r1N PEINTATEMENT
DOCUMENT# N110001306407
Entity Name: NEW AGE HIPPY. INC.
Current Principal Place of Business:
272 C.11.EANDER STREFT
NEPTUNE REACH Fl 32266
Current Mailing Address
222 OLEANDER STREET
NEPTUNE BEACH. FL 32266
FE I Number: 27-4501585
Name and Address of Current Registered Agent:
NiChOi. SON, SiER C.;
222 OLEANDER STREE T
NEPTUNE REACH. FL 12766 uS
FILED
Jun 27, 2019
Secretary of State
0256336334CR
Certificate of Status Desired: No
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SIGNATURE: l-IERI NICHOLSON
crtronst: SIgnettee Reqrstereo Art
Officer/Director Detail :
Titie
Name
Address
City -State -bp:
Name
Address
City -State -Zip
p
NICHOLSON, SHERI C
222 OLEANDER STREET
NEPTUNE BEACH FL 32768
TRES
NICHOLSON, GAGE A
12380 ANTLER HILL LW:
JACKSONVILLE FL 32224
7tIe
Name.
Address
Cly -State -Zip'
Name
Adoress
City -State -Zip.
06/27/2019
NICHOLSON, PAUL E
222 OLEANDER STREET
NEPTUNE BEACH FL 32266
SEC
NICHOLSON, DAVEN R
12380 ANTLER HILL LANE
JACKSONVILLE FL 32224
I rioreby G*46.64 te"st erformoW rnOcaft,C rn ffits report u• soppementet report is true and adoorate NO that olv roedirorsc mgr stun* sha have tl,e tans .,6,;10 1eJ
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06/27/2019
ebove, or on an sittechtriefg with An either' bko empowered.
SIGNATURE:SHERI NICHOLSON
PRESIDENT
Electronic Signature of Signing Officer/Director Detail