The intent of this application and subsequent contract is for all organizations to present a set of opportunities within the
umbrella of one contracted program for each age group, i.e. elementary, middle and high school. Only programs that
involve different participants for that age group, separate staff, a different schedule and are not an activity occurring
during or as part of another program should be considered a stand-alone program with a separate application.
Responses to this RFP should be complete but succinct. Materials submitted in addition to Part 1 - Organization
Narrative, Part 2 - Program Narrative(s) and Part 3 - Budget Narrative will not be considered in the evaluation of this
proposal. Do not attempt to unlock/alter this form. Font should be no less than 11 pt.
If you need assistance related to the content of the application or are unclear about how to respond to any questions,
please contact CDD staff: Yolanda Shelton-Morris, Community Resources Manager yshelton-morris@cityofmadison.com
or Mary O’Donnell, Community Development Specialist [email protected]om. We are committed to assisting
interested organizations understand and work through this application and funding process.
If you have any questions or concerns that are related to technical aspects of this document, including difficulties with
text boxes or auto fill functions, please contact Jen Stoiber jstoiber@cityofmadison.com
Legal Name of
Organization:
Urban Triage Inc.     
Total Amount
Requested:
$150,000      
Program(s)
included in this
application:
Program Name: Supporting Healthy Youth      
Amount Requested: $150,000
     
Program Type: High School Topic, Skill, or Population Focus
Program Name:      
Amount Requested: $      
Program Type: Choose an item.
Program Name:      
Amount Requested: $      
Program Type: Choose an item.
Program Name:      
Amount Requested: $      
Program Type: Choose an item.
If you are applying for more than four programs please contact Jennifer Stoiber at
Contact Person:
Brandi Grayson     
Email: bgrayson@urbantriage.org    
Organization
Address:
2312 S Park Street, Madison, WI, 53713    
Telephone: (608)
299-4128
1
501 (c) 3 Status:
Yes No
Fiscal Agent (if no)
Organizational Qualifications:
1. Organization History and Mission Statement
Our Mission:
Urban Triage transforms culture, institutions, and communities to ensure a humane future.
Our work started in the community due to the increased occurrences of systemic racism within our school
district. After seeing too many incidents of Black children suffering abuse at the hands of administrators, security
guards, and police, Founder and CEO Brandi Grayson began to organize and mobilize parents, youth, and staff.
Soon after, Mike Brown was murdered in Ferguson, MO. Her organizing grew to include state violence and
campaigns that focused on how state violence shows up in Dane County, including the criminalization of Black
people actualizing as high incarceration rates.
After providing advocacy and mobilizing & organizing protests, campaigns, and other demonstration efforts for
three years, Brandi Grayson officially founded Urban Triage as a nonprofit in 2019. Urban Triage's primary goal
was to provide transformative educational opportunities to Black families and youth, with the understanding
that to provide educational avenues to those most in need, Urban Triage also has to provide services and
support to meet the basic needs of those most vulnerable. Since 2019 Urban Triage has grown from two
volunteers (including the founder) to more than 23 full-time employees who support our core programs:
Supporting Healthy Black Families Workgroup, Supporting Healthy Black Agriculture, Unhoused Neighbors
Initiative, Dane County CORE 2.0 (Rental Support), and our newly launched Unhoused Youth Initiative which
includes an emergency shelter for youth parents, scattered transitional housing, rapid rehousing and a drop-in
center.
2. Describe your organization’s experience implementing programming described in the School-Age Child and Youth
Development Service Continuum and relevant to the programs you propose in this application. List all current
school-age child and youth programs with their inception date.
Urban Triage has been working with youth in Elementary, Middle, and High school in collaboration with MMSD
and other partners for more than three years.
In 2020, we ran an afterschool program at Sherman Middle School twice a week for the whole school year. We
provided social-emotional learning, personal development, and trauma recovery through our Supporting Healthy
Youth curriculum.
In April through July of 2022, we offered a Supporting Healthy Youth program for Black youth ages 13 to 19 in
Milwaukee in collaboration with WoLF Studios MKE, a Black-Owned multimedia, multi-genre arts production
studio. That program offered trauma recovery, creative self-expression, and history through the lens of
Blackness.
Starting in October 2022, we launched the Supporting Healthy Youth curriculum at Thoreau Elementary School
for 2nd to 5th graders. The program has two parts: an afterschool component for students every Monday, which
provides academic and emotional support, and a Saturday component for parents and students every other
week. The Saturday curriculum, Supporting Healthy Black Families, combines somatic processes, trauma
recovery, and personal development to inspire breakthroughs in participants and increase their capacity to
support and love themselves, their families, and each other. While parents participate, students learn Black
2
History, self-expression, and advocacy through art, which also provides a tool for trauma relief and expands their
awareness and ability to express their needs.
In Summer of 2022, we provided the same curriculum to students at Phoenix Prairie Academy an alternative
high school in the Sun Prairie Area School District. In a 9-week program, students, we explored how the gap
between humans is created by the design of our society and how to lessen the gap between ourselves and our
families as well as the community.
Additionally, before founding Urban Triage, founder Brandi Grayson worked closely with high school and early
college youth from 2015 to 2020 doing grassroots organizing and mobilizing in support of the Black Lives Matter
movement. Grayson provided hands-on training about revolutionary movements and organizing, financial
support, and on-the-ground support during protests such as the one that filled the State Capitol in response to
Tony Robinson’s death and multiple protests in the summer of 2020. Through this work, Grayson has built social
capital and trusting relationships with Madison youth.
3. Describe any significant changes or shifts at your agency since 2019 or anticipated changes in the next two years.
For example changes in leadership, turnover of management positions, strategic planning processes, expansion or
loss of funding. What, if any affects have or will these changes make regarding the agency’s ability to provide
proposed services? If there are no changes, write “No changes”.
In collaboration with Dane County, the City of Madison, Community Action Coalition (CAC), and the Tenant
Resource Center (TRC), Urban Triage has operated the Dane County CORE 2.0 rental support program since
September 2021 to help Dane County residents who live outside of the City of Madison. Supports include rental
arrears, forward rent, and security deposits. Over the last two years, Urban Triage has processed over $20 million
in rental support to Dane County residents outside the City of Madison over the last two years. Because the
funds for this program were made available by the federal government in response to COVID-19, the program
will be ending soon, when the remaining funds are completely distributed. Operating this program has been a
significant focus for us, but since the funds are running out, we are now shifting our energy to expanding our
transformational education programs for youth. In addition, Urban Triage will launch our re-brand of UT in
August of 2023. Clarifying what we do and how we do it. Urban Triage has been doing the work for over 10 years
and have been an official non-profit for 3 years. In 3 years we’ved supported over 10,000 individuals and
implemented sucessful, impactful programming within 45 days to support community members and
governmental agencies response to COVID.
4. Describe your organization’s experience, education and training requirements for management and school-age child
and youth program staff. Include how you support these requirements and other professional development
opportunities.     
All Urban Triage employees, regardless of race or ethnicity, must complete one of our transformative educational
workgroups as a condition of their employment. These workgroups directly and thoroughly unpack trauma and
suffering created by racism, poverty, and lack of opportunities and resources. All staff are required to take
training on deescalation, LGBTQIA, and 50% of our staff will be certified as Peer Support Specialist by November
of 2023. For any of our positions that require direct interaction with youth, we require a minimum of two years
experience working with youth and background checks. Additionally, we employ the people we serve. Many of
our employees first engaged with us as a recipient of our services, so they understand first-hand the kind of
challenges the youth we serve face. We know who our children are. We know how to engage them and enroll
them into the possibility of being victorious in their lives. We understand the importance of interpersonal
connections within Black culture. We understand that it takes time to build trust and to gain access to an
individual’s deepest fears and traumas. And to do the work effectively--small groups are required.
3
We’re committed to our staffs development. And encourage staff to go to conference, attend committee
meetings related to our work and find training opportunities and seek approval from their managers. As an
organizatioin we’ve covered certification costs, trauma informed training via our partner organizations, Landmark
seminars on personal development and leadership training and we’ve covered training via Rockwell training
institute and Momentum training institution. In addition to our weekly in house leadership training rooted in
coaching, communications, boundaries and safety.
4
Submit Application to: [email protected]
Deadline: 4:30 p.m. (CDT) on May 15, 2023
Official submission date and time will be based on the time stamp from the CDD
Applications inbox. Late applications will not be accepted
Part 2 Program Narrative Form MUST be completed for EACH PROGRAM for which you are
asking for funds.
Responses to this RFP should be complete but succinct. Materials submitted in addition to Part 1 -
Organization Narrative, Part 2 - Program Narrative(s) and Part 3 - Budget Narrative will not be
considered in the evaluation of this proposal. Do not attempt to unlock/alter this form. Font should
be no less than 11 pt.
If you need assistance related to the content of the application or are unclear about how to
respond to any questions, please contact CDD staff: Yolanda Shelton-Morris, Community
Resources Manager [email protected] or Mary O’Donnell, Community
Development Specialist [email protected]. We are committed to assisting interested
organizations understand and work through this application and funding process.
If you have any questions or concerns that are related to technical aspects of this document,
including difficulties with text boxes or auto fill functions, please contact Jen Stoiber
Legal Name of
Organization:
   Urban Triage  
Total Amount Requested for this
Program:
$150,000 
Program Name:
 Supporting Healthy Youth
Total Program Budget:
$207,160
Program Contact:
     Brandi Grayson
Email
:
bgrayson@urbantriage.
org     
Phone:
608-520-30
62     
AGE Group and Program TYPE: Select ONE Program Type under ONE Age Group for this form.
Elementary
Multi-focus School Year Only Multi-focus Summer Only
Multi-focused Year Round Topical/ Skill/Population
Middle School
Multi-focus School Year Only Multi-focus Summer Only
Multi-focused Year Round Topical/ Skill/Population
High School
Multi-focus School Year Only Multi-focus Summer Only
Multi-focused Year Round Topical/ Skill/Population
PLEASE NOTE: Separate applications are required for each age group and distinct/stand-alone
program. Programs are considered distinct/stand-alone if the participants, staff and program schedule
are separate from other programs, rather than an activity or pull-out group.
1
1. PROGRAM OVERVIEW
A. Need: Briefly describe the need in the City of Madison for the programs included in this
application, including the source of the data used in your response.
Urban Triage’s (UT) proposal emerges from the needs outlined in the 2023 Child Youth Policy
Paper where strategies to address high school youth needs beyond the classroom are outlined. We
focus on the needs of high school students who indicate wellness and socio-emotional
programming, opportunities to engage in arts and music, and leadership opportunities are areas of
critical need. The absence of these needs has been linked to challenges in social relationships,
home, and schooling (e.g., performance and attendance). The situation is particularly dire in two
Madison-area high schools - La Follette High and Capital High (the schools served in this proposal).
The school report card shows that both schools serve large populations of economically
disadvantaged students, 50.7% and 80%, respectively. Anecdotal evidence also indicates that 62%
of Black students at Capital High do not attend school. As such, new strategies are required to
engage youth to decrease truancy and improve academic performance.
There is significant evidence that out-of-school time (OST) programming may help promote positive
youth development. This proposal describes an OST program to address a critical need for young
adults at La Follette High and Capital High. Research has demonstrated that involving youth in OST
programming has the potential to promote positive youth development, which leads to healthy and
thriving young adults. Furthermore, we adopt the Big Three model
1
to promote youth development -
developing relationships with adult leaders (our facilitators), skill-building activities (UT
programming), and meaningful youth leadership (during program interactions, participants may help
facilitate). The program outlined in this proposal leverages evidence from prior literature about the
design of OST programs while re-tooling existing UT programming to support youth development.
B. Goal Statement: What is the goal of your program and how does it align with the scope of
work described in the RFP guidelines?
The program outlined in this proposal addresses Goal 2 (The district and every school in it is a
place where children, staff, and families thrive) and Goal 3 (African-American children and youth
excel in school) as described in the MMSD’s 2018 Strategic Framework.
Since 2017, Urban Triage (UT) has built and delivered programs that foster, develop, and
strengthen vulnerable populations, centering Black students, youth, and families in areas of
economic empowerment, self-sufficiency, community leadership, advocacy, and family success
through transformative education, community engagement, trauma response, healing, and cultural
heritage. The activities described below are informed by best practices and empirical research
leading to positive learning and socio-emotional outcomes for the populations served in this grant.
Our program will achieve these goals by developing school-program partnerships, re-formatting UT
curriculum and programs (e.g., Supporting Healthy Black Youth 2020, Thoreau Elementary pilot
2022), and engaging young adults in activities such as homework help, academic support, sports,
artistic experiences, and other activities that are known to help young adults develop life skills, form
positive relationships with adults, and ease the transition to adulthood.
The program also addresses areas identified as critical needs for high school students in the 2023
Child Youth Policy Paper. Specifically, wellness activities/social-emotional programming, arts and
music, and leadership opportunities are needed. Through involvement in our program, we aim to
facilitate socio-emotional competence and establish a sense of belonging for youth.
1
Ettekal, A. V., & Agans, J. P. (2020). Positive youth development through leisure: Confronting the COVID-19
pandemic. Journal of Youth Development, 15(2), 1-20.
2
Program Summary (3-5 sentences):
The program will target junior and senior students at La Follette High and Capital High to extend
existing services offered by UT in a safe environment (i.e., UT’s Youth Drop-in Center) through
Topical, Skill, and Population focus programming. The specific programming activities are flexible
but designed to meet students where they’re at. They include leadership training, financial literacy,
music production, spoken word, creative arts, courses focused on socio-emotional learning, and
leisure activities. Participation in our program will allow students to obtain graduation credits through
the experiential learning requirement. The program will engage parents (similar to UT’s Supporting
Healthy Black Parents program, which centers on the needs of Black parents, but all are welcome).
We also leverage relationships with staff and social workers at both schools who have offered to
help recruit and track students and partners who will provide transportation from school to the Youth
Drop-in Center. To evaluate outcomes, we will assess youth by conducting pre-program and
post-program evaluations of the Social Emotional Learning Competency Assessment (SEL-CA), a
self-report measure of social-emotional competencies, including self-awareness, self-management,
social awareness, relationship skills, and responsible decision-making, as well as the Sense of
Belonging Instrument (SOBI), a 27-item, self-report instrument consisting of two separately scored
scales, SOBI-P (psychological state) and SOBI-A (antecedents).
2. POPULATION SERVED
A. Proposed Participant Population: Describe the intended service population that will be
impacted by this program (e.g., location, ages, race/ethnicities, income ranges, English
language proficiency, if applicable etc.) AND how this population was involved in the
development of this program proposal.
This program will recruit juniors and seniors at La Follette High and Capital High. We expect to
recruit and enroll ten students at each high school (20). These populations were selected because
of the impending transition to adulthood and their likelihood of using/needing Urban Triage’s (UT)
wrap-around services (e.g., housing support, therapy, and advocacy in navigating systems). We
anticipate that most students will identify as minoritized and be from economically disadvantaged
backgrounds. Our program is based partly on UT’s development and operation of programs serving
similar populations.
In preparing this proposal, we sought input from partners at both schools. In our discussions, we
found that unlike students at comprehensive high schools in Madison, Capitol High students have
never been offered any after-school programming. Students at Capitol High have told our partners
that they don’t know where to go after school. If they go back to their comprehensive high school,
they often find themselves in conflict. Capital High Principal Victor Chukwudebe has told us that our
program would fill a gap and create belonging. Additionally, students at Capitol High can earn up to
five credits toward graduation by participating in experiential learning programs. Our program is
designed to meet the requirements of MMSD’s experiential learning program to help those students
progress toward graduation, allowing them to obtain employment skills, social-emotional
competency, and other critical life skills (e.g., conflict resolution) while in a safe and supportive
environment.
While La Follette does have after-school programming, our partners have heard from many Black
and Brown students that they don’t feel connected to their existing after-school programs (e.g., the
homework club) because its structure is too rigid and lacks cultural relevance. They don’t feel
welcome; if they arrive late, the door is locked, and they cannot join the club. Toren Young, the
restorative justice coordinator at La Follette, says Black and Brown students at La Follette High
want to be part of something. He says students often gather in the common areas after school ends
because they don’t have anywhere to go.
3
B. 2022 Participant Demographics (if applicable): N/A * New program
Race
# of Participants
% of Total Participants
White/Caucasian
     
     
Black/African American
     
     
Asian
     
     
American Indian/Alaskan Native
     
     
Native Hawaiian/Other Pacific Islander
     
     
Multi-Racial
     
     
Balance/Other
     
     
Total:
     
Ethnicity
Hispanic or Latino
     
     
Not Hispanic or Latino
     
     
Total:
     
Gender
Boy/Man
     
     
Girl/Woman
     
     
Non-binary/GenderQueer
     
     
Prefer Not to Say
     
     
Total:
     
This is a new program for Urban Triage, so we had no participants in 2022.
C. Language Access and Cultural Relevance: Please describe how the proposed program will
serve non-English speaking youth and/or their families. Describe how the proposed program
will be culturally relevant to the population served.
The students we intend to serve will likely be English-speaking. However, our program facilitators,
who are Black and Afro-Latinx, can relate to students because they share the same cultural
upbringing and have likely faced similar challenges (facilitators are Madison born or have lived here
over the last 20 years). Our facilitators know from personal experience that Black, Brown, and
indigenous youth are the most disenfranchised demographic in Dane County. They have
experienced the same barriers these youth experience when engaging with other youth service
agencies (financial barriers, cultural differences, and the lack of belonging). The program will also
use UT’s existing programming developed using evidence-based research and refined with program
participant feedback since 2017. Our programs remain relevant and culturally situated in the
populations we serve - primarily minoritized residents of Dane County.
D. Recruitment, Engagement, Intake and Assessment: Describe your plan to recruit, engage
and address barriers to participation for the identified service population. Explain the intake
and assessment procedure you will use for this program.
We plan to leverage existing relationships with partners in MMSD - restorative justice coordinators,
principals at both schools and transportation (to and from their schools and Urban Triage). The
partners will act as liaisons, facilitating connections between students and UT. Liaisons will identify
and recommend students to our program. For each potential enrollee, the liaisons will complete a
short questionnaire detailing demographic information, reasons for referral, why the student would
be a good fit, and their strengths and weaknesses as potential candidates. Students will be
accepted on a first-come-first-serve basis. As with any UT program engaging with youth,
parents/permission and waiver of liability forms will be obtained before program enrollment. Upon
enrollment in the program, students will complete an intake form that includes an assessment of
their social-emotional learning competency and an evaluation of their sense of belonging,
connection, and attachment to the community and school. To help evaluate our program, students
will be evaluated at the program’s midpoint and end on the same assessment criteria.
4
3. PROGRAM DESCRIPTION AND STRUCTURE
A. Activities: Describe your proposed program activities. If applicable, describe any evidence,
research, proven curriculum or documentation of promising practice that supports the
programming or service proposed.
Supporting Healthy Youth, our after-school program for high school students provides a supportive
community to develop emotional awareness, resilience, and other life skills post-graduation. Our
unique curriculum combines trauma recovery with personal development, analyzing the impact of
racism on individuals and society. In weekly structured discussions, we explore topics like trauma,
racism, and personal power, using popular culture as a lens for analysis. Through creative
self-expression activities like journaling, art, and music, students can explore how these topics
manifest in their lives and discover their power to create reality.
We also incorporate trauma recovery practices, like somatic and breath work, to help students
connect with their bodies. Our program is flexible and responsive to student’s needs, with breaks
from structured learning for activities like field trips based on student input (some examples might
include going to Sky Zone or touring a local black-owned music production studio). Our program
aims to foster agency and responsibility in Black youth, creating a sense of belonging and deep
social connectedness.
We have experience offering this curriculum to Black adults, Black youth and their families, and
white adults. For each audience, we adapt the curriculum to be relevant to their experiences. In this
case, we will circularly operate the curriculum. Each time we return to topics we’ve already
introduced, we’ll dive deeper into them.
Our program is based on the framework of Dr. Joy DeGruy’s work on Post Traumatic Slave
Syndrome. Following the foundation set forth by Dr. DeGruy, the program will support Black youth
as they examine their adaptive behaviors as a result of living in a racist society, determine if these
behaviors serve them and add value to their lives, and replace any maladaptive behaviors with ones
that empower and inspire them to bring positive change to their lives, families, and communities.
Our methodology transforms and empowers participants to achieve breakthroughs by learning to
detach from Black inferiority narratives and replace existing negative thinking patterns that foster
empowerment, increased self-efficacy, and investment in themselves and their community.
Past program participants have consistently formed intense, emotional bonds with each other.
Participants describe the workgroups as a part class, part therapy, and part friend group;
participants regularly re-enroll in our programs, volunteer with us, or become employees of Urban
Triage.
Evidence-based models show that Black people thrive when they feel a strong sense of social
connectedness and interpersonal relationships at work and in their community. When they feel
connected, they show up differently, leading to employment stability, housing stability, and improved
interpersonal relationships. And research has found that social connectedness considerably
reduces violent crimes, including murders and motor vehicle thefts. Social connectedness
especially reduces murders of adolescents and young adults committed during gang and drug
activity (Nagin and Paternoster, 1991).
5
B. Program Schedule: If you are proposing to provide a program at more than one location and
the program schedule is the same for all locations, please list all of the locations in the
“Location(s)” cell in Table 1 below. If the program schedules vary amongst locations, please
complete Table 2 and the question following the tables.
Table 1
Location(s):      Urban Triage Youth Drop-In Center, 306 E Wilson St, Madison
Day of the Week
Time of Year
Start Time
End Time
Monday
School Year
     
     
Summer
     
     
Tuesday
School Year
     
     
Summer
     
     
Wednesday
School Year
 4:00 p.m.
6:30 p.m.
Summer
 4:00 p.m.
6:30 p.m.
Thursday
School Year
     
     
Summer
     
     
Friday
School Year
4:00 p.m.
6:30 p.m.
Summer
4:00 p.m.
6:30 p.m.
Saturday
School Year
Summer
     
     
Sunday
School Year
     
     
Summer
     
     
Table 2
Location(s):     Urban Triage office at 2312 S. Park St
Day of the Week
Time of Year
Start Time
End Time
Monday
School Year
     
     
Summer
     
     
Tuesday
School Year
     
     
Summer
     
     
Wednesday
School Year
     
     
Summer
     
     
Thursday
School Year
     
     
Summer
     
     
Friday
School Year
     
     
Summer
     
     
Saturday
School Year
Noon. 
2:30 p.m. 
Summer
Noon.     
2:30 p.m.
Sunday
School Year
     
     
Summer
     
     
If applicable, please list the third location and any subsequent locations. Include the specific
program schedule(s) differences as compared to the programs included in the tables above.
     
The Saturday workgroup is designed for the parents of the students. Parents will engage in our
Supporting Healthy Black Families curriculum. It’ll be held 2x a month (every other Saturday),
year-round. Child care is provided for children ages 6 to 12.
6
C. Frequency, Duration, and Anticipated Attendance: Please complete the table below. If you
are proposing to provide a program at more than one location and the program structure is
the same for all locations, please list all of the locations in the “Location(s)” cell in the table
below. If the program structure varies amongst locations, please complete the rows for
“Location #2” and the question following the table for any additional program locations.
Frequency*
# of Program
Hours
Per Program
Day
Annual
Duration**
Adult to
Youth Ratio
Anticipated
Average
Attendance
per Program
Day
Location #1:      Youth Drop-In Center (306 E Wilson St.)
School
Year
     
2x per week
     
2.5
     
7 months
     
1 to 7
     
20
Summer
     
2x per week
     
2.5
     
2 months
     
1 to 7
     
20
Location #2 (if applicable):  Urban Triage’s Direct Hub Training Center (2312 S Park St)    
School
Year
     
2x per month
2.5
7 months
     
Adults
workgroup
     
22
Summer
     
2x per month
     
2.5
     
2 months
     
Adults
workgroup
     
22
*Frequency=number of times per week, month, year (i.e. 5 days per week, 2x per month, 4x per year)
**Annual Duration=number of weeks or months annually (i.e. 10 weeks, 6 months)
If applicable, please list any other locations and note any differences in the program structure as
compared programs included in the table above.
     
N/A
4. ENGAGEMENT, COORDINATION AND COLLABORATION
A. Family Engagement: Describe how your program will engage parents/guardians and families
in the development of this proposal, and how they will be involved in the implementation and
assessment of the program activities.
     
We’ve found that our curriculum is the most effective when entire families are moving through it
together. That’s why we will offer our Supporting Healthy Black Families curriculum to all parents of
students enrolled in this program. Parents will attend our sessions at our 2312 S. Park St.
headquarters twice a month on Saturdays from 12 to 230. Childcare for ages 6 to 12 will be
provided.
Additionally, we will engage parents in assessing the program's impact on students’ emotional
development by having them complete assessments before, during, and while their child/ren
participates in the program. We will use the Social Emotional Learning Competency Assessment
(SEL-CA): a self-report measure of social-emotional competencies, including self-awareness,
self-management, social awareness, relationship skills, and responsible decision-making. As well
as the Sense of Belonging Instrument (SOBI), a 27-item, self-report instrument consisting of two
separately scored scales, SOBI-P (psychological state) and SOBI-A (antecedents). Our curriculum
ios designed to be flexible and responsive to the needs of the students and their families. In
addition--our methodology is based off our work in the community as advocates, organizers and
educators.
7
B. Neighborhood/Community Engagement: Describe how your program will engage
neighborhood residents or other relevant community stakeholders in the development of
this proposal, and how they will be involved in the implementation and assessment of the
program activities.
Our curriculum and methodology for the SHBF workgroup were created through community
engagement. Our earliest advocacy work was helping parents secure IEPs for their students.
Through this work with parents in our community, we heard them talking about the trauma and
stress of living in a society affected by white supremacy racism and the impact of not learning their
history and not understanding political processes. We developed our curriculum in direct response
to these conversations.
These workgroups are extremely valuable to our community. As soon as we open the application for
the next cohort, it fills up in two weeks. We consistently have a waitlist
We’re also in regular communication with Alder Persons and Dane County Supervisors about our
youth programs and have their full support. The implementation of our program is in partnership
with MMSD as well as Capitol High and Lafollette High School.
We’ll engage the community in the work by providing updates via social media and our newsletters,
assessments for parents and students, outreach and commuity engagment sessions.
C. Collaboration: Please complete the table below and respond to the narrative questions
regarding program collaboration with community partners.
Partner Organization
Role & Responsibilities
Contact Person
Signed MOU
(Yes/No)?
     MMSD
Recruit participants, provide
support staff, provide
transportation, provide snacks.
Principal of Captiol High is and
will be hands on in the
implementation of the program. In
addtion to Restorative Justice
Coordinator at Lafollette High
School.
Laura Glaub,
MMSD Social Work
Support
Yes
 Healing Our Hearts
As-needed grief counseling
services, by referral
Felica
Turner-Walton
Yes
Our Generations     
Group Therapy, Individual
Counseling, and
Psychoeducation
     
Ruchita Ervin     
No--MOU will
be signed in
the next week
or 2
weeks--draft
is included
     
     
     
     
     
     
     
     
     
     
     
     
List any additional partners, their role & responsibilities, contract person and MOU
information (if applicable):
Second Harvest Food Bank has an existing MOU with MMSD that outlines Second Harvest’s
commitment to providing food and snacks for many programs, including this after school program
with Capitol High and La Follette.
8
How do these partnerships enhance this proposal?
We developed this proposal in direct collaboration with Laura Glaub, Lead Social Worker and
Attendance Administrator at MMSD, Toren Young, the restorative justice coordinator at La Follette,
and Capital High Principal Victor Chukwudebe, who have all shared the need for this program and
helped us shape it.
By identifying students who are a good fit for the program and filling out an application for them, our
partners at MMSD will ensure our programming reaches the students who are most vulnerable and
who would benefit most from the social-emotional learning and social bonds/connections provided
in this program. Additionally, by providing transportation from the schools to our Youth Drop-In
center, where our after-school program will be held, MMSD will ensure students can attend this
program regardless of their access to transportation. Our longstanding relationship with Healing Our
Hearts provides access to grief counseling for participants in our different programs at Urban
Triage. Healing Our Hearts is a community-based grief support organization with six certified grief
support specialists on staff who are skilled at meeting people where they’re at in their grief journey.
Because many of the youth we serve are surviving both poverty and racism, they’re at a high risk of
experiencing trauma and loss. Access to grief counseling can help them heal from these
experiences and prevent those experiences from becoming a barrier to their educational journey.
Our Generations, which offers Group Therapy, Individual Counseling, and Psychoeducation,
provides crisis training for Urban Triage staff and accepts referrals from Urban Triage for therapy.
What are the decision-making agreements with each partner?
    
Decision-making agreements are spelled out in each of our MOUs.
Decisions about necessary changes to the program model or each partner's support will be made
by consensus and will involve all stakeholders.
D. Resource Linkage and Coordination: What resources are provided to participants and their
families by your proposed program? How does the program coordinate and link families and
participants to these resources?
     
Our organization is modeled after revolutionary movements like the Black Panthers, whose aim was
to provide wraparound support services while also providing education. Those wraparound services
include financial support for unexpected or one-time expenses (like a new pair of shoes, a driver’s
permit, or varsity letter patches) and advocacy support to help participants and their families
navigate the health system, justice system, housing, and education systems in Dane County.
Parents who attend the Saturday sessions will also be eligible to receive a $50 stipend for each
week they attend (delivered via check or CashApp).
We can provide that kind of support because we’ve been advocating for and providing support
services to Black folks in Madison and Dane County for the last decade. During that time, we’ve
developed extensive social capital, earned the trust of our community, and built deep relationships
with institutions in Madison. We’re able to meet folks where they’re at, connect them to available
resources, and empower them to change their circumstances.
5. PROGRAM QUALITY, OUTPUTS, OUTCOMES AND MEASUREMENT
A. Madison Out-of-School Time (MOST) Effective Practices: Please describe how each of the
seven basic elements are addressed by your proposed program design. How will you
monitor the program during implementation to assess continued alignment with the MOST
Effective Practices? Are there any other program quality standards, tools or measurements
that you use with this program? If yes, please list and describe.
     
9
Intentional Program Design: Our Supporting Healthy Youth program’s design will draw from the
curriculum utilized in our workgroups. The 12-week curriculum is based on 6 hours of weekly adult
interactive workgroup work. However, we’ve learned when working with youth that 6 hours
translates into 12 hours for youth. Given that we only have 5 hours per week to work with these
youth (only 4 of these hours will be interactive), one week of adult workgroup work will be the
equivalent of 3 weeks of interactive workgroup work with the youth in this program and will be
stretched through the nine months.
This curriculum will allow us some impromptu field trips in response to students’ needs. Our
curriculum is designed to be repetitive as repetition fosters learning, strengthens the brain, builds
confidence, improves focus, etc. We reserve 2.5 hours for our after-school program because we
know that youth need plenty of time to transition from the school day to chat and connect with
their friends, etc. before bringing their attention and awareness to a new space. Our classroom
time ends with 15 minutes of debriefing after the self-expression activity. Then we have 30 to 45
minutes of unstructured hangout time that allows students who want to continue the conversation
the space to do so but also meets the need that Dane County youth have expressed for more
hangout time.
Supportive Relationships with Youth: Youth who apply to the program are expected to continue
attending until graduation. We will keep enrolling youth until we hit our cap, and if students leave for
any reason and new openings are available, we’ll enroll new students. By meeting twice a week,
year-round for up to two years, participants will have the chance to form authentic relationships.
Community & Family Engagement: Parents are engaged through the parents’ meeting on
Saturdays.
Youth Voice & Leadership: While we have a set curriculum, we let the youth decide how quickly
we move through the topics. If the youth wants to keep discussing a topic we introduced in the
previous session, we dive in deeper. If they’re ready to move on, we move on. If they aren’t in the
headspace to talk about anything that day, we’ll take a break.
As our facilitators get to know the students in the cohort, we will begin to identify youth with natural
leadership skills. We’ll begin to assign more responsibilities to those youth. Responsibilities may
include preparing folders of take-home assignments, summarizing a discussion, or following up with
students in one-on-one check-ins.
Racial & Cultural Inclusion: We’re a Black-led organization serving primarily Black youth. Our
program directly and thoroughly unpacks trauma and suffering created by racism, poverty, and lack
of opportunities and resources. In addition, our program is facilitated by Black people who have
shared lived experiences. Because facilitators and participants are from the same communities, this
common ground and similar lived experiences create connection and community.
Organizational Management & Staff Support: At Urban Triage, we’re cultivating a revolutionary
workplace. We put a premium value on the lived experience of surviving poverty. Each employee
goes through the same personal transformation curriculum outlined in this proposal, which means
we are all actively modeling what it looks like to engage with these topics on a personal level.
As an organization, we’re constantly working to identify the policies, assumptions, expectations, and
norms rooted in white supremacy and redefine them in ways that center our humanity instead of our
productivity.
We’re also working with Dr. Tenah Hunt and Dr. Annalee Good to design and conduct evaluations of
our programming that will provide hard data for us to use to improve our internal practices, policies,
and programs constantly.
Environment & Safety: Our drop-in center is designed to feel comfortable and welcoming to Black
youth and other populations, from the decorations to the games available and the furniture. In
10
addition to the inherent emotional safety that comes from our staff’s shared identities with our
participants, our staff also receive training on de-escalation methods and how to notice and report
signs of physical or sexual abuse.
Our company policies require that two adults are always present when youth are present. We don’t
allow any touching or physical restraining of youth.
The topics we discuss in our Supporting Healthy Youth curriculum can be very heavy. That’s why
we spend a lot of time together building trust and creating ground rules to create a safe space for
each participant.
We ask each participant to identify the triggers that make them upset, emotional, or uncomfortable
and to name what they need to feel safe again in those situations. For example, some students
need to be alone when they get upset, so we designate a space for them to go spend some time
alone. Other students need to be able to call a family member. Others just need to release some
energy by screaming or crying, so we create a space for that.
Finally, because our programming encroaches on dinner time, we also provide snacks and hot food
to participants so that hunger doesn’t detract from their ability to participate and engage fully.
B. Program Outputs - Unduplicated School-Age Children or Youth and Program Hours
Total Annual Unduplicated Children or Youth participating in proposed program:    
We will have 20 students with two adult staff members and one adult MMSD staff member (roughly
7:1 ratio of youth to adults), and it is anticipated that the same 20 students will be served throughout
this program unless there is youth that leaves the class in which other students will be brought into
the class. There will be 20 youths registered as program participants throughout the entire nine
months.
TOTAL ANNUAL UNDUPLICATED YOUTH: 20
In addition to the youth, we will also be supporting their families. Therefore, we will also support
approximately 22 adults through this program annually.
TOTAL ANNUAL UNDUPLICATED ADULTS: 22
TOTAL ANNUAL UNDUPLICATED YOUTH AND ADULTS: 42  
Total program hours annually:      
The youth will attend the program for 2.5 hours per week, two times per week, so a total of 5 hours
per week. The program will run for nine months, or 38 weeks, for a total of 190 hours for the youth.
We will also support the parents of the youth in our program for 2.5 hours once per month for 9
months or 47.5 hours annually.
Youth Hours: 190 hours
Family Hours: 22.5 hours
TOTAL PROGRAM HOURS ANNUALLY: 212.5 HOURS
11
C. Program Outcomes
Please describe the data and the data source used to choose your outcome objectives?
     
We will use assessment surveys: 1. self-assessments (pre-, mid-, and post-program), 2. facilitator
assessments (pre-, mid-, and post-program), and 3. parent/family assessments (pre- and
post-program).
Please identify at least one Program Outcome for your proposed program(s), from the RFP
Guidelines 1.4, that you will track and measure. Complete the table(s) below.
Outcome Objective #1: Social-emotional competency and enhanced life skills
Performance Standard
Targeted Percent
80
Targeted
Number
33 
Measurement Tool(s) and Comments:
To measure this outcome objective, we will use self-assessment surveys and facilitator
assessment surveys (pre, during, and post). In addition, we will provide family assessments (pre
and post).
Some of the measurements will be as follows:
Self-Awareness: the youth and parent’s ability to understand their strengths and
limitations.
Self-Management: the youth and parent’s ability to control their emotions, actions and
complete tasks in new or challenging situations.
Social-Awareness: the youth and parent’s ability to empathize with those around them.
Relationship Skills: the youth and parent’s ability to consistently make socially acceptable
decisions that build positive connections with others.
Goal-Directed Behavior: the youth and parent’s ability to complete tasks of varying
difficulty.
Personal Responsibility: the youth and parent’s ability to be careful about their actions and
contribute to group activities.
Decision Making: how the youth and parents solve a problem that involves learning from
various sources and accepting responsibility for their actions.
Optimistic Thinking: the youth and parents' attitude of confidence and positive thinking
regarding themselves and others.
Our goal is for 80 percent of our program participants to score higher on their self-assessments
at the end of the program than when they started.
     
12
Outcome Objective #2: Sense of belonging to community and/or school
Performance Standard
Targeted Percent
80
Targeted
Number
33
Measurement Tool(s) and Comments:
To measure sense of belonging, we will use the Sense of Belonging Instrument (SOBI), which is
a 27-item, self-report instrument consisting of two separately scored scales, SOBI-P
(psychological state) and SOBI-A (antecedents). We will use this instrument to develop the pre-,
mid-, and post-program assessment surveys for the youth and facilitators and pre and
post-program for the families.
Some of the measurements will include questions related to these 27 items:
wonder if I fit
not sure if I fit with friends
describe myself as a misfit
people accept me
piece of a jigsaw puzzle
what I offer is valued
feel like an outsider
have no place in this world
I could disappear for days
mainstream of society
observe life rather than participate
few people would come to my funeral
feel like a square peg
I don't fit
background and experiences are different
not see or call friends
feel left out
not valued or important
important to be valued by others
have felt valued in the past
important that I fit
I have qualities
working on fitting in
want to be part of things
important that my opinions are valued
others recognize strengths
make myself fit
Our goal is for 80 percent of our program participants to score higher on their self-assessments
at the end of the program than when they started.
     
Outcome Objective #3:      
Performance Standard
Targeted Percent
     
Targeted
Number
     
Measurement Tool(s) and Comments:
     
13
If necessary, add additional outcome objectives, performance standards, targeted percent,
targeted number, and measurement tools:
     
N/A
D. Data Tracking: What data tracking systems are in place or will be in place to capture the
information needed to document demographics, program activities, outcome measures, and
expenses?
We use a couple of different software programs to track different data. Below is the list of software
programs to capture and report the data for this program:
Keela: This is the database that we use for our program applications. We will use this program to
create pre-/mid/post assessments forms. We will be able to run reports to document demographics
and outcome measures.
SAGE: Wegner CPAs handle our accounting and serve as the organization’s Chief Financial
Officer. They use SAGE as their accounting software to track all of our expenses. Therefore, SAGE
will be used to track and report expense data.
Basecamp: This project management software we use for all of our Supporting Healthy Black
Families workgroups. This will also be the software we use to track program activities for the
Supporting Healthy Youth program proposed here. Basecamp allows us to track and measure youth
engagement with the take-home assignments that are part of our curriculum. Youth are expected to
journal for 10 minutes daily, and we also ask questions for discussion on Basecamp.
     
6. PROGRAM LOCATION
A. Address(es) of the site where programs will occur:
     
The program will operate at Urban Triage’s Youth Drop-In Center at 306 E Wilson St., Madison, WI
53703 and 2312 S Park St, Madison WI 53713 at Urban Triage’s Direct Service Hub.
7. PROGRAM STAFFING AND RESOURCES:
A. Program Staffing: Full-Time Equivalent (FTE) Include employees, AmeriCorps members,
and Adult Interns with direct program implementation responsibilities. FTE = % of 40 hours
per week.
Position Title
Qualifications or
Required Training
Location(s)
Indicate School Year
(SY)), Summer (SU) or
Year-Round (YR)
SY or YR
FTE
Summer
Only FTE
SHY Program
Coordinator
5 years of
experience working
with youth
De-escalation
training    
Youth Drop-In
Center,306
Wilson St and
(Admin)147
Butler St,
Madison WI
SY, SU or YR
50%
     
CEO
20 years of
experience working
with youth
De-escalation
training and building
life training
Youth Drop-In
Center, 306
Wilson Stt and
(admin building)
147 Butler St,
Madison WI
SY, SU or YR
25%
14
programming and
curriculum   
Co-Facilitator
2 years experience
working with youth
De-escalation
training  
Youth Drop-In
Center, 306
Wilson St
SY, SU or YR
25%
CFO (Wegner)
50 years experience
as a CPA
2921 Landmark
Pl Suite 300,
Madison, WI
53713
SY, SU or YR
10%
Marketing
Coordinator
Ten years of
experience working
as a Marketing
Coordinator and 7
years working with
vulnerable youth
Youth Drop-In
Center, Admin
building 147
Butler St,
Madison WI
SY, SU or YR
10%
Outreach
Specialist
5 years of
experience working
with vulnerable
youth and other
populations
Youth Drop-In
Center 306
Wilson St
SY, SU or YR
10%
Restorative
Justice
Coordinator with
Lafollette
8 years working with
vulnerable youth
within the school
district
   Lafollette
High School  
SY, SU or YR
  15% 
  
     
Principal of
Capitol High  
20 years working in
public education
  Capitol High
   
SY, SU or YR
  15% 
  
     
Please complete the total FTE for the
applicable time period
School Year:
     
Year-Round
 1.6   
Summer
     
*Use one line per individual employee
Volunteers: If volunteers will have direct contact with program participants, how are they vetted,
trained, and supervised?
No volunteers will be used to support this program.
However, we will require one person from each high school (LaFollette High School and City High
School) to assist each week. Each person will alternate weeks with the youth. MMSD and both high
schools have agreed to fund these positions for their work outside of school time, represented in the
MOU provided with this proposal.     
B. Other program Resources/Inputs (such as program space, transportation or other resources
necessary for the success of your program:
Transportation: Transportation will be necessary to bring the youth from the high schools to our
Youth Drop-In location. As part of our Memorandum of Understanding (MOU) with Madison
Metropolitan School District (MMSD), MMSD will provide us with funding for transporting the youth
from LaFollette High School and City High School to our drop-in center. MMSD has already
discussed this with the transportation company at MMSD.
15
Wrap-Around Support: Our strong partnerships within systems, including mental health in Dane
County, provide us with direct access points and in-kind services, granting youth and their families
access to wraparound support and mental health resources through this program.
Methodologies: We incorporate different methodologies into our program based on the youth in the
room. We may use poetry, spoken word, hip-hop, graphic design, visual design, etc., to support
students in developing social-emotional intelligence and self-expression. For instance, we may
incorporate hip-hop into the curriculum. “Hip Hop culture, at its core, represents the values of social
justice, peace, respect, self-worth, community, and having fun” (Crooke, 2017). For these reasons,
hip-hop is increasingly being relied on by teachers, social workers, psychologists, and school
counselors as a therapeutic tool for working with youth and adolescents. It increases self-resilience,
decreases stress, and inspires youth to feel hopeful about their future by increasing their sense of
agency around themselves and their ability to create political and social change (Crooke, 2017).
The use of hip hop, a tradition grounded in Black culture, in this transformative workgroup promotes
important cultural relevance for non-white children, which ultimately decreases stress from living in
an oppressive society and builds communities. This is why we apply different methodologies crafted
specifically for the youth audience in the room.
8. BUDGET
A. The budget should be submitted with the proposal using the template provided in an Excel
document or a PDF. There are five tabs within the Excel spreadsheet: Cover Page,
Organization Overview and one sheet for the Program Budget for each age group. The
Cover Page, Organizations Overview, and relevant Program Budgets must be submitted with
this document for a proposal to be complete.
The budget template can be found on the CDD Funding Opportunities website.
9. IF APPLICABLE, PLEASE COMPLETE THE FOLLOWING:
A. Disclosure of Conflict of Interest
Disclose any potential conflict of interest due to any other clients, contracts, or property
interests, e.g. direct connections to other funders, City funders, or potentially funded
organizations, or with the City of Madison.
     
Not applicable.
B. Disclosure of Contract Failures, Litigations
Disclose any alleged significant prior or ongoing contract failures, contract breaches, any
civil or criminal litigation.
Not applicable.
     
16
COMMUNITY DEVELOPMENT DIVISION COVER PAGE CITY OF MADISON
APPLICATION FOR 2023 SCHOOL-AGE CHILD AND YOUTH PROGRAMS
1. ORGANIZATION CONTACT INFORMATION
Legal Name of Organization
Mailing Address
Telephone
FAX
Director
Email Address
Additional Contact
Email Address
Legal Status
Federal EIN:
2. PROPOSED PROGRAMS If currently City funded
Program Name:
Letter Amount Requested
2023 Allocation
A $150,000
Contact:
B
Contact:
C
Contact:
D
Contact:
E
Contact:
TOTAL REQUEST $150,000
DEFINITION OF ACCOUNT CATEGORIES:
Personnel: Amount reported should include salary, taxes and benefits. Salary includes all permanent, hourly and seasonal staff costs.
Taxes/benefits include all payroll taxes, unemployment compensation, health insurance, life insurance, retirement benefits, etc.
Operating: Amount reported for operating costs should include all of the following items: insurance, professional fees and audit,
postage, office and program supplies, utilities, maintenance, equipment and furnishings depreciation, telephone,
training and conferences, food and household supplies, travel, vehicle costs and depreciation, and other operating related costs.
Space: Amount reported for space costs should include all of the following items: Rent/Utilities/Maintenance: Rental costs for
office space; costs of utilities and maintenance for owned or rented space. Mortgage Principal/Interest/Depreciation/Taxes:
Costs with owning a building (excluding utilities and maintenance).
Special Costs: Assistance to Individuals - subsidies, allowances, vouchers, and other payments provided to clients.
Payment to Affiliate Organizations - required payments to a parent organization. Subcontracts - the organization subcontracts
for service being purchased by a funder to another agency or individual. Examples: agency subcontracts a specialized counseling
service to an individual practitioner; the agency is a fiscal agent for a collaborative project and provides payment to other agencies.
2024
Supporting Healthy Youth
bgrayson@urbantriage.org
Private: Non-Profit
Urban Triage Inc.
2312 S Park St.; Madison, WI 53703
608-299-4128
Brandi Grayson
COMMUNITY DEVELOPMENT DIVISION COVER PAGE CITY OF MADISON
3. SIGNATURE PAGE
AFFIRMATIVE ACTION
If funded, applicant hereby agrees to comply with City of Madison Ordinance 39.02 and file either
an exemption or an affirmative action plan with the Department of Civil Rights. A Model
Affirmative Action Plan and instructions are available at cityofmadison.com/civil-rights/contract-compliance.
CITY OF MADISON CONTRACTS
If funded, applicant agrees to comply with all applicable local, State and Federal provisions. A sample contract that
includes standard provisions may be obtained by contacting the Community Development Division at 266-6520.
If funded, the City of Madison reserves the right to negotiate the final terms of a contract with the selected agency.
INSURANCE
If funded, applicant agrees to secure insurance coverage in the following areas to the extent required by the City Office
of Risk Management: Commercial General Liability, Automobile Liability, Worker's Compensation, and Professional Liability.
The cost of this coverage can be considered in the request for funding.
4. SIGNATURE
Enter name:
By entering your initials in the box you are electronically signing your name and agreeing to the terms listed above.
DATE 5 15 23 INITIALS: BG
COMMUNITY DEVELOPMENT DIVISION ORGANIZATION OVERVIEW CITY OF MADISON
6. BOARD-STAFF DEMOGRAPHICS
Indicate by number the following characteristics for your agency's current board and staff. Refer to application instructions
for definitions. You will receive an "ERROR" until you finish completing the demographic information.
GENERAL POVERTY R/POV**
Number Percent Number Percent Percent Percent Percent
TOTAL 9
100%
25
100%
GENDER
MAN 2
22%
3
12%
WOMAN 7
78%
22
88%
NON-BINARY/GENDERQUEER 0
0% 0%
PREFER NOT TO SAY 0
0% 0%
TOTAL GENDER 9
100%
25
100%
AGE
LESS THAN 18 YRS
0% 0%
18-59 YRS 9
100%
25
100%
60 AND OLDER
0% 0%
TOTAL AGE 9
100%
25
100%
RACE
WHITE/CAUCASIAN 4
44%
2
8% 80% 67% 16%
BLACK/AFRICAN AMERICAN 2
22%
23
92% 7% 15% 39%
ASIAN
0% 0% 8% 11% 28%
AMERICAN INDIAN/ALASKAN NATIVE
0% 0% <1% <1% 32%
NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER
0% 0% 0% 0% 0%
MULTI-RACIAL 3
33% 0% 3% 4% 26%
BALANCE/OTHER
0% 0% 1% 2% 28%
TOTAL RACE 9
100%
25
100%
ETHNICITY
HISPANIC OR LATINO 1
11%
0
0% 7% 9% 26%
NOT HISPANIC OR LATINO 8
89%
25
100% 93% 81% 74%
TOTAL ETHNICITY 9
100%
25
100%
PERSONS WITH DISABILITIES 0
0% 0%
*REPORTED MADISON RACE AND ETHNICITY PERCENTAGES ARE BASED ON 2009-2013 AMERICAN COMMUNITY SURVEY FIGURES.
AS SUCH, PERCENTAGES REPORTED ARE ESTIMATES. See Instructions for explanations of these categories.
**R/POV=Percent of racial group living below the poverty line.
7. Does the board composition and staff of your agency represent the racial and cultural diversity of the residents
you serve? If not, what is your plan to address this? (to start a new paragraph, hit ALT+ENTER)
Yes, the board composition and staff directly reflect and represent the racial and cultural diversity of the residents we serve.
MADISON*
DESCRIPTOR
BOARD STAFF
COMMUNITY DEVELOPMENT DIVISION ORGANIZATION OVERVIEW CITY OF MADISON
8. AGENCY GOVERNING BODY
How many Board meetings were held in 2022 10
How many Board meetings has your governing body or Board of Directors scheduled for 2023? 12
How many Board seats are indicated in your agency by-laws? 10
List your current Board of Directors or your agency's governing body.
Name
Home Address
Occupation
Representing
Term of Office Founder From: 01/2020 To: Current
Name
Home Address
Occupation
Representing
Term of Office 2 years From: 01/2023 To: 01/2025
Name
Home Address
Occupation
Representing
Term of Office 2 years From: 10/2022 To: 10/2024
Name
Home Address
Occupation
Representing
Term of Office 2 years From: 06/2022 To: 06/2024
Name
Home Address
Occupation
Representing
Term of Office 2 years From: 01/2020 To: 01/2024
Name
Home Address
Occupation
Representing
Term of Office 2 years From: 01/2022 To: 01/2024
Name
Home Address 132 E. Wilson St. # 807, Madison, WI 53703
Occupation Self Employed
Representing
Term of Office 2 years From: 01/2022 To: 03/2022
Name
Home Address
Occupation
Representing
Term of Office 2 years From: 06/2022 To: 06/2024
Jessica Snyder
6005 Mayhill Drive, Madison, WI 53711
Manager - Medical Coding at UW
Member
2764 Osmundsen Rd; Fitchburg, WI 53711
Executive Director of Nonprofit
Member
Kayla Conklin
615 Spring Street, Apt 203; Sun Prairie, WI 53590
Catherine Orr
4607 Tonyawatha Trail; Monona, WI 53716
Professor
Secretary
Dana Pellebond
Co-Owner of Short Stack Eatery
Brandi Grayson
2210 N Rusk Ave; Madison, WI 53713
CEO of Urban Triage
President
Member
Treasurer
Sage Weil
3524 Blackhawk Dr, Madison, WI 53705
Self Employed - IT Company and Radio Stations
Member
Juan José Fonseca Angel
HR Coordinator with Park Bank
Member
Alex Lindenmeyer
301 W Johnson St Madison 53703
COMMUNITY DEVELOPMENT DIVISION ORGANIZATION OVERVIEW CITY OF MADISON
AGENCY GOVERNING BODY cont.
Name
Home Address
Occupation
Representing
Term of Office 2 years From: 06/2022 To: 06/2024
Name
Home Address
Occupation
Representing
Term of Office From: mm/yyyy To: mm/yyyy
Name
Home Address
Occupation
Representing
Term of Office From: mm/yyyy To: mm/yyyy
Name
Home Address
Occupation
Representing
Term of Office From: mm/yyyy To: mm/yyyy
Name
Home Address
Occupation
Representing
Term of Office From: mm/yyyy To: mm/yyyy
Name
Home Address
Occupation
Representing
Term of Office From: mm/yyyy To: mm/yyyy
Name
Home Address
Occupation
Representing
Term of Office From: mm/yyyy To: mm/yyyy
Name
Home Address
Occupation
Representing
Term of Office From: mm/yyyy To: mm/yyyy
Name
Home Address
Occupation
Representing
Term of Office From: mm/yyyy To: mm/yyyy
Charlene Clay
3721 Manchester Rd Madison WI 53819
Contract Manager
Member
**Instructions: Complete this workbook in tab order, so the numbers will autofill correctly. Only fill in the yellow cells.
(last column)
REVENUE SOURCE AGENCY PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM NON APP
2023 A B C D E PGMS
DANE CO HUMAN SVCS
0
UNITED WAY DANE CO
0
CITY CDD (This Application)
150,000 150,000
City CDD (Not this Application)
0
OTHER GOVT*
0
FUNDRAISING DONATIONS**
25,110 25,110
USER FEES
0
TOTAL REVENUE
175,110 175,110 0 0 0 0
0
Only use whole numbers, if using formulas or amounts with cents, convert to whole number before submitting to CDD.
Please fill out all expected revenues for the programs you are requesting funding for in this application.
All programs not requesting funding in this application, should be combined and entered under NON APP PGMS
*OTHER GOVERNMENT: Includes all Federal and State funds, as well as funds from other counties, other Dane County Departments, and all other
Dane County cities, villages, and townships.
**FUNDRAISING: Includes funds received from foundations, corporations, churches, and individuals, as well as those raised from fundraising events.
ACCOUNT CATEGORY AGENCY TTL CITY PGM CITY PGM CITY PGM CITY PGM CITY PGM CITY NON APP
2023 REQUEST A SHARE B SHARE C SHARE D SHARE E SHARE PGMS
A. PERSONNEL
Salary
114,500 114,500 114,500 114,500
Taxes/Benefits
20,610 20,610 20,610 20,610
Subtotal A.
135,110 135,110 135,110 135,110 0 0 0 0 0 0
0 0 0
B. OTHER OPERATING
Insurance
2,000 0 2,000
Professional Fees/Audit
10,000 0 10,000
Postage/Office & Program
0 0 0
Supplies/Printing/Photocopy
5,000 1,000 5,000
1,000
Equipment/Furnishings/Depr.
2,000 0 2,000
Telephone
0 0
Training/Conferences
5,000 0
5,000
Food/Household Supplies
10,000 3,890 10,000 3,890
Travel
1,050 0 1,050
Vehicle Costs/Depreciation
0 0 0
Other
0 0 0
Subtotal B.
35,050 4,890 35,050 4,890 0 0 0 0 0 0 0 0 0
C. SPACE
Rent/Utilities/Maintenance
0 0
Mortgage Principal/Interest
0 0
Depreciation/Taxes
0 0
Subtotal C.
0 0 0 0 0 0 0 0 0 0 0 0 0
D. SPECIAL COSTS
Assistance to Individuals
25,000 10,000 25,000 10,000
Contractors/Subcontractors
12,000 0 12,000
Pymt to Affiliate Orgs
0
Other
0 0
Subtotal D.
37,000 10,000 37,000 10,000 0 0 0 0 0 0
0 0 0
TOTAL (A.-D.)
207,160 150,000 207,160 150,000 0 0 0 0 0 0 0 0 0
Enter all expenses for the programs in this application under the PGM A-E columns. Enter the amount you would like the City to pay for with this funding under the CITY SHARE
**Use whole numbers only, please.
**List all staff positions related to programs requestiong funding in this application, and the amount of time they will spend in each program.
2023 2023 2023 2023 2023 2023 2023 2023 2023 2023 2023
Title of Staff Position*
FTE**
FTE**
FTE**
FTE**
FTE**
Total FTE
Salary
Taxes and
Amount
Wage***
Requested
City
City
SHY Program Coordinator 0.50 0.50 50,000 9,000 59,000 24.04 29,500
25000 4500
CEO 0.25 0.25 226,000 40,680 266,680 108.65 66,670
56500
10170
Co-Facilitator 0.25 0.25 40,000 7,200 47,200 19.23 11,800
10000 1800
CFO (Wegner) 0.10 0.10 120,000 21,600 141,600 57.69 14,160
12000 2160
Marketing Coordinator 0.10 0.10 50,000 9,000 59,000 24.04 5,900
5000 900
Outreach Specialist 0.15 0.15 40,000 7,200 47,200 19.23 7,080
6000 1080
0.00 0 0.00 0
114500 20610
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
SUBTOTAL/TOTAL:
1.35 0.00 0.00 0.00 0.00 1.35 526000.00 94680.00 620680.00 252.88 135110.00
CONTINUE BELOW IF YOU NEED MORE ROOM FOR STAFF POSITIONS
*List each staff position separately. Indicate number of weeks to be employed if less than full year in parentheses after their title.
**Full Time Equivalent (1.00, .75, .60, .25, etc.) 2,080 hours = 1.00 FTE
**List all staff positions related to programs requestiong funding in this application, and the amount of time they will spend in each program.
2023 2023 2023 2023 2023 2023 2023 2023 2023 2023 2023
Title of Staff Position*
FTE**
FTE**
FTE**
FTE**
FTE**
Total FTE
Salary
Taxes and
Amount
Wage***
Requested
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
0.00 0 0.00 0
`
0.00 0 0.00 0
TOTAL:
1.35 0.00 0.00 0.00 0.00 1.35 526000.00 94680.00 620680.00 252.88 135110.00
*List each staff position separately. Indicate number of weeks to be employed if less than full year in parentheses after their title.
**Full Time Equivalent (1.00, .75, .60, .25, etc.) 2,080 hours = 1.00 FTE
Pgm Letter Program Name Program Expenses 2023 City Request
A PERSONNEL 135,110
OTHER OPERATING 4,890
SPACE 0
SPECIAL COSTS 10,000
TOTAL 150,000
B PERSONNEL 0
OTHER OPERATING 0
SPACE 0
SPECIAL COSTS 0
TOTAL 0
C PERSONNEL 0
OTHER OPERATING 0
SPACE 0
SPECIAL COSTS 0
TOTAL 0
D PERSONNEL 0
OTHER OPERATING 0
SPACE 0
SPECIAL COSTS 0
TOTAL 0
E PERSONNEL 0
OTHER OPERATING 0
SPACE 0
SPECIAL COSTS 0
TOTAL 0
150,000
0
0
TOTAL FOR ALL PROGRAMS
Program Summary
This tab should be completely filled in by your previous answers.
Supporting Healthy Youth
0
0
Memorandum of Understanding (MOU)
Urban Triage And MMSD Schools, La Follette, and Capital High
Urban Triage was awarded funds to support La Follette and Capital High with after -school
programming.
General Understandings
If used in this Memorandum of Understanding, these terms shall have the following
definitions:
1. “Contract holder” refers to Urban Triage (UT)
Urban Triage agrees to the following:
1. The contract holder is responsible for the management of all gran ts
2. The contract holder is responsible for executing memoranda of understanding with all
partner agencies that Urban Triage identifies as program subcontractors
4. The contract holder agrees to be responsible for communicating any concerns
immediately to the contractor to ensure clear communication & transparency
5. The contract holder agrees to process all reimbursement requests within 30 days of
receipt of the invoice
6. The contract holder agrees to communicate any changes needed in the MOU --either to
decrease the scope of services or increase --- by email immediately upon becoming aware of
the need. The contract holder retains the right to make unilateral changes in the MOU.
8. The contract holder agrees to maintain the confidentiality of ALL communi cations
between parties
Madison Metropolitan School District agrees to the following:
Contract Scope of Services:
1. MMSD is responsible for recruiting students for Urban Triage after -school
programming
2. MMSD assigns staff responsible for the work perform ed under the contract scope of
services
3. MMSD providing one staff member from La Follette High and Capital High to attend
each after -school session in a support role to the Urban Triage staff, helping to keep
kids engaged and focused
4. MMSD is responsible for committing $5,000 towards transportation for after school
transportation for La Follette High and Capital High
5. La Follette and Capital High will recruit students for after -school programming
6. La Follette High and Capital High appoi nted staff will participate in monthly check -in
meetings to provide updates and feedback
7. La Follette High and Capital High will provide and maintain clear communication with
the CEO, Brandi Grayson, and the Program Manager regarding concerns, questions,
clarification, and needs of their agency and the needs of participants
8. MMSD will provide after school snack for participants with partnership of Second
Harvest(MOU with district will be updated in July 2023 to include the after school
programs)
9. The contract holder agrees to maintain the confidentiality of ALL communications
between parties
Scope of Services Provided by Contract Holder
1. That Contractor understands the program's goal is to offer after -school
programming for La Follette and Capital High School.
2. It is an expectation that Urban Triage employees create social -emotional learning,
leadership, and academic curriculum for students.
3. All products and materials, physical or educational, are owned by Urban Triage.
Consequences of Contractor Quitting Before End of Contract
If the contractor terminates the contract before the end of the term without cause, the
following consequences will apply:
1. The contractor will be responsible for any costs incurred by the Contract holder as a
result of the e arly termination of the contract.
2. The contractor will be liable for any damages suffered by the Contract holder due to
the early termination of the contract.
3. The Contract holder will have the right to terminate any other contracts or
agreements with the Co ntractor.
4. The contractor will forfeit any payment due for work completed before the
termination of the contract.
5. The contractor will be responsible for returning any materials or equipment provided
by the Contract holder for the contract.
6. The Contract hold er will have the right to seek any other legal remedies for breach of
contract, including consequential damages.
These consequences are not intended to limit or replace any other remedies or rights
available to the other party under the contract or the la w.
Conflict Remediation Protocol
1. The Parties will meet as soon as possible to discuss the nature of the conflict or
breakdown.
2. The Parties will attempt to resolve the issue through open communication and
negotiation in good faith.
3. If the Parties cannot resolve the issue themselves, they will seek the assistance of
an independent third -party mediator to facilitate resolution. Each party will pay one -
half of the mediator’s fees unless it is determined that one party breached the
agreement, in which case that party is responsible for the mediator’s fees.
4. If mediation is unsuccessful, the Parties will have the right to pursue any legal
remedies.
Insurance Requirements
The contractor must have and maintain their insurance, including lia bility insurance,
throughout the contract. The following insurance requirements must be met:
1. The contractor must maintain workers' compensation insurance as required by law.
2. The contractor must have general liability and show proof of a certificate of liab ility
insurance.
3. The contractor's liability insurance must match the general liability limit of Urban
Triage, totaling a 1 million dollar limit per occurrence and a 2 million dollar aggregate.
The contractor must provide proof of insurance coverage to th e contract holder before
commencing work. The insurance policy must name the contract holder as an additional
insured and include a waiver of subrogation in favor of the contract holder.
Failure to comply with these insurance requirements may result in the termination of the
contract.
Period of Agreement, modification requests, and termination of the agreement
A. Period of Operation and Termination
This MOU will become effective upon signature by both parties and shall remain in effect
until terminated. E ach party shall have the right to terminate this Agreement at any time
and seven days before written notice to the other party.
Violation of any component of this agreement may constitute immediate termination.
B. Amendments
Amendments, including additions, deletions, or modifications to this MOU, may be proposed
in writing by either party for consideration. If both parties agree to the revision, the contract
holder will amend this MOU and forward the amended MOU to Alan Robin son for signature.
Executions of the signature below and the contract holder agree to abide by the terms
and conditions outlined in this document.
For Urban Triage:
Founder/CEO
Date: 5 10 23
MMSD
5/12/23
Date:
Memorandum of Understanding
Urban Triage
Dear Brandi & Urban Triage,
This letter summarizes the agreement between Healing Our Hearts Foundation (herein known
as the Company or HOH) and Urban Triage (organization).
Agreement
The HOH will report to Brandi Grayson for work insights and supervision, with an occasional
meeting with Felica Turner-Walton, the Executive Director of HOH, as necessary. The work is
defined as
Provide up to 3 one on one grief services to each participant enrolled in Supporting
Healthy Black Families (SHBF) and Supporting Agriculture workgroup..
Attend the 1
st
, 3
rd
, and final session of SHBF.
Provide a summarized report, not including identifying information
The consultant is authorized to spend up to 4 hours per person in the combination of
pre-interview, interview, and video clipping for the project.
Our agreement will be renewed every 3 months for fit. To ensure it's working for both
parties.
Payment
This agreement is approved for 60 grief sessions starting June 2022, and to continue through
the duration of the WPP partnership with Urban Triage unless a time extension is approved by
the HOH. The contractual hourly rate is $75/hr per Peer session unless otherwise amended by
the Executive Director. Attending 1st, 3rd, and final live sessions of SHBF $2500 (this include
administrative fees, research, and class prep time). Requests for payment are submitted
monthly via invoice or work summary. $2500 to be paid immediately and $2500 every 45 days.
January 1, 2023 to June 30th 2024
June, 2023
MMSD
June
Ownership
Organization agrees that the work products from the services provided to Healing Our Hearts
shall be owned by Healing Our Hearts. That while attribution by collection may be provided, that
attribution by post is not required. Nothing contained in this section prohibits the contractor
from utilizing the knowledge and experience, in a general nature, acquired in the performance
of services for Healing Our Hearts.
Confidentiality
In the course of performing contracted services, the party recognizes that the Contractor may
come in contact with or become familiar with the information that Healing Our Hearts or its
affiliates may consider confidential. This information may include but is not limited to, Company
data, information, systems, and processes, which may be of value to a competitor or routinely
considered private for related parties. The contractor agrees to keep all such information
confidential.
No Agency
The parties agree that at all times during the term of this Agreement, Consultant shall continue
to be an independent contractor (Contractor) and is not authorized as, nor shall be deemed to
be an employee, agent, partner, or joint venturer of Healing Our Hearts. Neither party has the
authority to bind the other or to incur any liability on behalf of the other, nor to direct the
employees of the other. Nothing in this Agreement shall be interpreted or construed as creating
or establishing the relationship of employer and employee.
Entire Agreement
This letter and other accompanying documents supersede and replace any prior
understandings or agreements, whether oral, written, or implied, between you and Healing Our
Hearts regarding this role and project. If you wish to accept this offer, please sign and date
below. As required, by law, your employment with the Company is also contingent upon your
providing legal proof of your identity and authorization to work in the United States.
Signatures
We agree to the terms and conditions as set out in this agreement
Felica Turner-Walton
Executive Director
Healing Our Hearts Foundation
Date
Brandi Grayson
CEO
Urban Triage
Date
5 12 23
5 11 23
1
May 12/2023
Contract Agreement
This contract is entered into by Urban Triage (UT) and Our Generaon Inc (OG).
The terms of this agreement shall begin on June 1, 2023, and shall connue through
terminaon date May 31, 2024 unless terminated earlier in accordance with the terms of this
Agreement. OG and UT agree to work together to deliver comprehensive mental health
services, including counseling, therapy, support groups, and educaonal programs. Both pares
will contribute their experse, resources, and personnel to ensure the eecve delivery of
services.
The specic terms of this contract are as follow:
1. OG will only bill for services within their scope of pracce.
2. Each hourly service provided by OG during this contractual year will be billed at the rate
of $100. Appointments that are cancelled 24 hours before the scheduled appointment
will be considered as “late cancellaons”. Appointments missed without providing any
prior noce or explanaon will be considered as “no call, no show” or “NCNS”. Late
cancellaons and NCNS will be charged at the same hourly rate as aended sessions,
$100/hour. OG sta will nofy UT of all no call, no shows. Clients are subject to
terminaon/discharge if they accrue more than three NCNS/late cancellaons per
quarter (Jan-Mar, Apr-Jun, Jul-Sep, and Oct-Dec). Both pares shall maintain accurate
records of nancial transacons related to this partnership and provide periodic reports
as requested.
3. Urban Triage agrees to refer clients to OG for counseling and therapy services and pay
for the following services:
a. Group Therapy
b. Individual counseling
c. Co-advocate with Urban Triage advocates to provide support services as needed.
d. Psychoeducaon
4. Condenality and Data Sharing: OG and UT shall comply with all applicable laws and
regulaons regarding the privacy and condenality of client informaon. Both pares
shall establish appropriate protocols and safeguards (i.e. Release of Informaon (ROIs),
consent forms, etc.), as both pares are required to inform clients of this
2
agreement/partnership. Governance and Communicaon: OG and UT shall establish a
joint governance structure, appoinng representaves from each organizaon to
oversee the partnership's implementaon and operaon. Quarterly meengs shall be
established to facilitate eecve collaboraon, including periodic meengs, progress
reports, and other forms of communicaon as necessary. These meengs will be
aended by Ruchita and Brandi and/or another appointed representave within the
agencies.
5. Intellectual Property: Each party shall retain ownership of its respecve intellectual
property brought into the partnership. In the event that new intellectual property is
jointly developed during the course of this partnership, both pares shall negoate and
agree upon ownership and usage rights in a separate agreement.
6. Governing Law and Dispute Resoluon: This Agreement shall be governed by and
construed in accordance with the laws of the state of Wisconsin, without regard to its
conict of laws principles. Any disputes arising out of or in connecon with this
Agreement shall be resolved amicably through good-faith negoaons between the
pares. If a resoluon cannot be reached, the pares agree to seek mediaon/
arbitraon within 30 days of dispute as a means of dispute resoluon.
7. Billing:
a. OG will invoice billable hours monthly to UT by the 10th day of the following
month (i.e. January invoice will be sent by February 10th).
b. UT will pay monthly invoices, in full, within 30 days of submission. (i.e. January
invoice paid by March 10th, if the invoice was submied on February 10th)
c. OG will pause services if invoices are not paid by the 31st day of submission and
clients will be noed of billing changes. Please note: ethical guidelines within
the mental health eld require providers to refer/transfer clients out if they are
not able to connue with current provider. This may require addional sessions
that will be applied to the nal bill. Please refer to the terminaon clause below.
8. Termination Clause: Either party can initiate the termination of this contract by writing a
30 day notice to terminate this agreement. A minimum of 30 day notice is required for
mental health professionals to inform their clients about upcoming billing changes. This
could affect their treatment, thus giving mental health professionals enough time to
refer clients to other mental health resources, if needed. Billable hours will accrue
during this 30 day notice. Any written notice under 30 days will still be billed for the
entire 30 day notice requirement.
9. This agreement, along with any aachments or addenda, constutes the enre
agreement between OG and UT and supersedes all prior agreements, understandings,
and communicaons, whether wrien or verbal, relang to the subject maer herein.
This agreement may not be modied in any manner unless in wring and signed by both
Pares. This document and any aachments hereto constute the agreement between
3
the pares. This Contract shall be binding upon the Pares, their successors. Heirs and
assigns and shall be enforced under the laws of the State of Wisconsin.
Party 1: Urban Triage ______________________________________
(Signature/Date)
______________________________________
(Printed Name/Title)
Party 2: Our Generaon Inc. ______________________________________
(Signature/Date)
______________________________________
(Printed Name/Title)
5 12 23