TEST – Programming Service Provider Application – Juvenile Court of Metropolitan Nashville & Davidson County

Programming Service Provider Application

"*" indicates required fields

Thank you for reaching out to Juvenile Court to share your programming services. The court is committed to provide quality evidence-based aligned or promising program services to our youth, families, and parents that are focused on cognitive intervention programming, mentoring, service learning, and job and life-skills or educational training. Service Provider applications are reviewed by a programming committee on a quarterly basis. Please note that completing this application does not guarantee program referrals or a specific quantity of referrals. Click here to download the application form in Microsoft Word Format. Please send any completed Microsoft Word downloaded applications to: Metro Juvenile Court DP2 Program Coordinator - Mary Ann Smith - maryannsmith@jisnashville.gov
Once the application is submitted, a member of the vetting panel will be in contact to schedule an interview and provide more details..

Name of Organization/Agency Applicant*

Name of Program*

Name of Individual Completing Application*

First Last

Position*

Primary Phone*

Email*

Section I

Name of Individual Over Program*

First Last

Title*

Phone*

Email*

Section II: Provider Criteria

Please Note: Answering “no” to these questions is not an automatic disqualifier for partnering with the Court. Answers to this section inform the Court on future capacity building needs.

1. Providers must serve residents of Nashville, Davidson County.*

Yes

2. Providers must have an LLC, S-Corp, or 501(c) (3) designation of exemption from federal taxation from the Internal Revenue Service (IRS) as provided by 26 U.S. C. A.*

Yes

Please Explain

3. Non-profit providers must have an incorporation as a non-profit with registration identification number provided by the Secretary of State as a Charitable Organization or proof of such exemption as allowed.*

Yes

Please Explain

4. Providers must have been in existence for at least one full year by application due date.*

Yes

Please Explain

SECTION III: Vision, Mission, and Values Statements

Provide the agency’s vision, mission, and values statements here AND briefly discuss how your agencies philosophy supports the Davidson County Juvenile Court’s mission and vision.

DAVIDSON COUNTY JUVENILE COURT VISION STATEMENT:
Davidson County Juvenile Court strives to be the national model for youth justice by taking a holistic approach that promotes the health, well-being, and safety of children, families, parents, and communities.

DAVIDSON COUNTY JUVENLE COURT MISSION STATEMENT:
Davidson County Juvenile Court’s mission is to prevent problems, promote the positive potential in all people, and pursue fairness and hope.

Agency's Mission Statement*

Mission statement – Informs the agency’s goals (What the agency wants to accomplish or achieve).

Agency's Vision Statement*

Vision statement – Informs the agency’s purpose (How the agency achieves their vision).

Agency's Values Statement*

Values statement – Informs the agency’s culture (Agency core principle and values).

Agency Programming

Please describe the below program components. Please Note: Answers to these questions are not an automatic disqualifier for partnering with the Court. Answers to this section inform the Court on future capacity building needs.

a. Target population of program*

b. Zip code(s) of focused service area(s)*

c. Frequency and duration of program*

d. Does your program have a written manual?*

Yes

e. Describe the provided program services and/or activities*

f. Describe your referral process*

g. Describe the feedback, attendance keeping, and statutory reporting process for your program.*

h. Have staff and volunteers passed a background check?*

Yes

i. Have staff received training in ACES, trauma-informed care, and affirming language with LGBTQI youth?*

Yes

SECTION V: Goal, Objectives, Activities

Program success is defined by establishing goals, objectives, and activities. These inform strategic planning and program improvements. Goals are broad and measurable statements about what the program intends to accomplish. These align with the agency mission and flow from the community need. Generally state 1 or 2 goals. Objectives are what the program intends to achieve. These are realistic, specific, measurable, and focused on outcomes. Objectives include who (program clients) what (desired measurable change) and how (program activities), and are generally stated with a verb as an increase, decrease, expand, improve or change in behavior or condition, etc. Activities are efforts conducted to achieve the program objectives and tie into outputs: if the activities are completed then the outputs are produced. Activities use action words: provide, train, establish, etc. Grantee to provide minimally two (2) goals and is also allowed to add more goals, objectives, and activities as needed to this template.

Goal 1

Objective 1.1

Activity 1.1

Objective 1.2

Activity 1.2

Goal 2

Objective 2.1

Activity 2.1

Activity 2.2

Objective 2.2

SECTION VI: Measurable Outcomes

Measurable outcomes are quantifiable (numeric value, percentage, scores, value, or characteristic) used to measure achievement of program outcomes: events, occurrences, or changes in conditions or attitudes that indicate progress toward a program’s goals. These are specific, measurable and meaningful. Achieving an outcome indicates fulfillment of purpose and program toward long-term goals. Measurable goals are stated in a % outcome (i.e., __% of clients will report/increase...etc.)

Measurable Outcome 1*

Measurable Outcome 2*

Measurable Outcome 3*

SECTION VII: Program Inputs

Agency Resources*

Agency Collaborations*

Evidence-based Programming*

SECTION VIII: Monitor and Tracking Program Service Delivery

Briefly describe below the agency’s plans to monitor and track the quality of the agency’s progress toward program service delivery? These may include output measures (products of your activities) which are process measures that quantify the activities of your program and outcome measures which are measure the achievement, effect or results that are attributed to program efforts that determine impact and success.

Briefly describe the agency’s plan to monitor and track the program progress*

SECTION IX: Program Evaluation Plan

Briefly describe evaluation processes and corrective action plan(s)*

SECTION XII: Data Collection

Describe the data collection procedures the agency undertakes to collect and report the outputs and outcomes of the planned services or interventions. (E.g. stakeholder questionnaires, client satisfaction surveys, case records, etc.)*

Describe how the agency will use the data collected to evaluate the goals of the project and the work performed and plan accordingly.*

Describe how the agency shares data with the agency’s board and other community partners.*