Telephone: (608) 266-5481 Fax: (608) 266-3957

Home Page: http://psc.wi.gov E-mail: pscrecs@wisconsin.gov

Public Service Commission of Wisconsin Ellen Nowak, Chairperson 610 North Whitney Way Mike Huebsch, Commissioner P.O. Box 7854 Lon Roberts, Commissioner Madison, WI 53707-7854

February 16, 2018

Re: Universal Service Fund Grant Program for Telecommunications

Access Programs or Projects by Non-Profit Groups

5-NF-2018

Prospective Grant Applicant:

The Public Service Commission of Wisconsin is pleased to announce its release of Fiscal Year 2018 Grant Application Guidelines for the Nonprofit Access Program (Wis. Admin. Code § PSC 160.125(2)).

The Nonprofit Access Program is a Universal Service Fund grant program used to fund nonprofit groups

that facilitate affordable access to telecommunications services in Wisconsin. Up to $500,000 may be

available to award to applicants for this fiscal year.

The grant application deadline is March 30, 2018, for projects seeking funding from Fiscal Year

2018. For more information, please review the complete guidelines before proceeding. They are found

at https://psc.wi.gov/Pages/Programs/NonProfitGrants.aspx. Important items to note include:

Applicant must be a nonprofit group (defined as an IRS § 501(c)(3) organization).

Funding will be approved for projects for no more than one year.

Matching funds are required for at least 25 percent of the total project cost (three dollars for a one

dollar match).

The project must assist customers in areas of the state that have relatively high costs of

telecommunication services, customers that are low-income, or customers with disabilities, in

obtaining affordable access to essential telecommunications services.1

In past grant cycles the types of projects funded have varied widely; from programs focused on getting

basic telephone service to disabled individuals and low-income households to programs focused on

providing assistance to disabled individuals and low-income households in obtaining access to essential

broadband services. Since 2010, the potential scope of projects that fund access to basic services for low-

income consumers has included service connection costs.

Should you have any questions regarding the grant application guidelines, please contact me at

608-267-9624 or at jeff.richter@wisconsin.gov. We look forward to receiving your grant application and

learning about your proposed project.

Sincerely,

Jeffrey J. Richter

Jeff Richter

Universal Service Fund Director

Division of Business and Program Management

DL:01619981

1 Based on recent changes to state and federal law, the Nonprofit Access Program may include funding for computer

labs, broadband connections, or other Internet-related projects.

[Page intentionally left blank for printing purposes.]

Public Service Commission of Wisconsin

Universal Service Fund Nonprofit Access Program

Fiscal Year 2018 Grant Application Guidelines and Forms

5-NF-2018

Application Deadline March 30, 2018

2

Introduction

The Wisconsin Universal Service Fund (USF) was created to promote and assist with the availability and affordability of telecommunications services within Wisconsin. Companies that provide telecommunications services in Wisconsin are required to contribute to the USF. The Public Service Commission (Commission) has established several programs, all of which are funded by the USF. One of the USF programs, the Nonprofit Access Program, was established to provide funding to nonprofit groups to facilitate affordable access to telecommunications services. Wisconsin Administrative Code § PSC 160.125(2)(f), covers this program and a copy is included in this packet.

In the Nonprofit Access Program, any nonprofit group (defined as an IRS § 501(c)(3) organization) may apply for partial funding from the USF to cover costs of a program or project that assists in providing access to telecommunications services to low-income or disabled customers. Total funding for this program is limited to $500,000 for the current state fiscal year (July 1, 2017, to June 30, 2018). There is no specified dollar limit for any particular project, other than the requirement in the administrative rule that the USF will only pay up to 75 percent of total project costs.

Awards for this grant are expected to be announced by June 2018. Funded proposals have until the end of June 2019 to use grant dollars. Extensions may be given upon request from the applicant. Applicants may apply for multiple year projects, but funding will only be authorized on a state fiscal year basis. Successful applicants for multi-year projects will need to reapply for funding for subsequent years.

Eligible Applicants

Any nonprofit group as defined as an IRS § 501(c)(3) organization may apply for funding under the Nonprofit Access Program.

Anticipated Funds Available

In accordance with Wisconsin Administrative Code § PSC 160.125(2)(f), a maximum of $500,000 may be disbursed under the Nonprofit Access Program per state fiscal year.

Matching Funds Requirement

Applicants are required to provide at least 25% matching funds toward the total project cost (a three dollar for one dollar match). For example, if the total project budget is $20,000, no more than $15,000 can be funded from this grant program. Matching funds may be in the form of cash or in-kind contributions. Matching funds may not be items purchased with USF grant dollars from prior years, nor may the in-kind match items be used to meet the grant match requirement for more than one USF grant cycle. Federal, State, and private foundation funds, and any other funding sources, may be used to meet the matching requirement. In-kind contributions can be professional services that are donated or discounted by the donor. Matching funds, both cash and in-kind contributions, must relate to the proposed project and must be itemized on the Budget Summary Form found at the end of this application packet.

3

The application must identify the source and amount of matching funds. If the source of the match is not the applicant, documentation that matching funds are committed must be provided with the application or prior to release of any funding. If the source is the applicant, a statement of commitment of matching funds or documentation of in-kind funds must be provided with the application or prior to release of any funding.

Application Submission and Deadline

All applicants are required to submit a signed cover sheet, signed affidavit, budget summary form, and project narrative. The cover sheet, affidavit form and budget summary form are located at the end of this application packet. Electronic copies are also available from the PSC website (see end of application packet). The Commission is moving to all electronic filings and processes and these grant applications are included for the first time this year. Applications must be submitted to the Commission via E-mail addressed to Jeff.Richter@wisconsin.gov and must include a scanned signed cover sheet and signed affidavit. If for any reason the production of these electronic documents is not possible, please contact Jeff Richter (contact information at the end of this packet) as soon as possible to make other arrangements

It is the responsibility of the applicant to ensure that the Commission receives all documents in a readable format prior to the deadline. No late applications will be considered. Please note that applications mailed will need to be received at the Commission by Monday, March 30, 2018.

Application Procedure

A complete application includes the following items and should be assembled in the following order:

1. Universal Service Program Grant Application Form (cover sheet)

Use the form included at the end of this application packet or fill out the on-line version, thenprint it and file it with other required documents.

• Leave State Application Number (above Section I) blank.• Fill out Sections I and II.• Signature of the certifying representative of the organization is required in

Section II of the form.• Leave Section III blank.

2. Affidavit of Eligibility

Use the form included at the end of this application packet (also available on-line). The formincludes a statement certifying that the Universal Service Fund support will be used for thepurpose granted. The form must be signed by a certifying representative of the organization.

3. Budget Summary

Use the form included at the end of this application packet or use a copy available in pdf andWord format on-line.

4

4. Project Narrative

The narrative should address the Review Criteria listed below.

The application forms are available on the PSC website: https://psc.wi.gov/Pages/Programs/NonProfitGrants.aspx

The application must be submitted by the deadline date (March 30, 2018). Do not use binders, plastic covers, folders, or cover sheets other than the one included in this application package. The filing should be single-sided. Once filed, all applications become the property of the Commission, are subject to open records laws of the state, and will not be returned to the applicant.

Review Criteria

In preparing the Project Narrative, the criteria should be addressed in the order in which they are listed below. Please use the headings provided below. Each criterion should be addressed separately and completely so the response stands alone and does not refer to outside sources. Failure to address any criterion will result in reduction of points by the reviewers. The page size should be a standard 8-1/2” x 11” with a legible font no smaller than 11 point, and a minimum of one-inch margins throughout. The entire Project Narrative section should be no more than six (6) single-sided and single-spaced, numbered pages.

1. Applicant Overview

• Briefly describe the applicant organization(s) including area(s) and clientele served.

2. Project Purpose1

• Provide a summary paragraph of what the project will do.• Define the specific need or problem that is currently not being met and describe how

this need was identified and defined.• Describe how the specific need may be met or problem solved through affordable

access to telecommunications.• Describe how the project will facilitate affordable access to telecommunications.• Describe how the project meets at least one of the following purposes of the

Universal Service Fund:a. To assist customers located in areas of the state that have relatively high costs

of telecommunication services in obtaining affordable access to a basic set ofessential telecommunication services.

b. To assist low-income customers and disabled customers in obtainingaffordable access to a basic set of essential telecommunication services.

1 Based on recent changes to state and federal law, the Nonprofit Access Program may include funding for computer labs, broadband connections, or other Internet-related projects. Additionally, projects involving the provision of basic phone services over Voice Over Internet Protocol (VoIP) may be fundable.

5

3. Project Outcomes

• Identify realistic, measurable outcomes expected to result from the implementation ofthe project. Anticipated outcomes should relate to the need/problem statement.

4. Project Implementation

• Provide a timeline for the project.• Describe the activities to be performed throughout the timeframe of the project,

including priorities, sequence and necessary materials, equipment or contracts.• Identify providers for each portion of the services or equipment needed for the

project.• Explain the approach to the problem, plan of work and why this approach was

selected.• State how the progress of the project will be monitored to ensure that it will be

carried out within the specified time.• Describe any partnerships, community support or other collaborations with

individuals or organizations that will be involved in the project.• Briefly describe any plans for the project that extend beyond one year.

5. Training and Development

• Describe any training or staff development required for the project.

6. Budget Detail

• Provide justification for the budget, in narrative form, for each category that is listedon the Budget Summary form.

• Describe how the project meets the described public need in a least cost manner.This can be accomplished by showing that requests for proposals have been issued orby obtaining several bids for equipment or services and reporting the results of thecost review process. If the project will be done by in-house staff, explain why thatapproach was chosen.

• Identify the providers of each portion of the telecommunications services orequipment and provide a specific description of the components of the project. TheCommission has approved use of grant dollars to pay for telephone services and forinternal wiring needs if they directly serve organization clientele.

• Administrative costs that are included should include those costs that are directlyattributable to the project. If a percentage of the organization’s overhead is used todetermine administrative costs, the amount and what is included in that percentagemust be described. Rent for general administrative purposes can not be included as aseparate reimbursable project expense; however, it can be included as an in-kind costfor matching purposes.

6

7. Evaluation

• Explain how the project will be evaluated and by whom. Describe measurementtools, such as pre-testing and post-testing, surveys, inventories, and reports, whichwill be used to determine the extent to which the project meets each of its objectives.

Review and Selection Process

All grant applications will be subject to a screening and review process conducted by Commission staff, a review team, and the Commissioners. Reviewers will have expertise in technical or programmatic aspects of telecommunications or Universal Service issues. The process is outlined below:

1. Notice and Public Comment

Wis. Admin. Code Chapter PSC 160 requires the Commission to request public comment on the Nonprofit Access Program applications that have been submitted. The Commission will issue a notice requesting comments about two weeks after the application deadline. Comments are generally due about two weeks after the notice has been issued.

2. Initial Screening

Commission staff will conduct an initial screening of all applications. The applications will be screened for timeliness of filing, eligibility of applicant as a nonprofit group as defined by IRS § 501(c)(3), and the commitment of at least 25 percent matching contributions for the project. Anyapplication that fails the initial screening may be eliminated from further review.

3. Application Review

A panel of technical or program professionals will review applications passing the initial screening. The reviewers will use a rating checklist that scores each application based on the criteria outlined in the Review Criteria section. Particular attention will be paid to the potential success of the project to assist low-income or disabled customers, or customers that have high costs in obtaining affordable access to essential telecommunication. Results of this analysis and review will be reported in a memorandum to the Commissioners.

7

4. Final Decision on Grant Awards

In making the final grant funding decisions, the Commission shall consider information including the following:

• The basis of the public need to be met.• The extent to which other Universal Service Fund programs or projects already meet

the need described above.• The overall cost of the proposed project or program relative to the public need being

met.

The Commission may consider other factors in its decision-making such as the analysis provided by staff, analysis of the review panel, public comments filed on the applications, geographic distribution of the proposed grants, diversity of needs being met by the proposed grants, number of previous USF grants awarded to the applicant, cost of the project relative to the number of individuals receiving benefits, and availability of funds. The Commission may rate proposals with low overhead (administrative) costs higher than projects with high overhead costs. The Commission makes its decision in Open Meetings of the Commission.

All grant applicants will be notified, in writing, of intended award decisions approximately three months after the application deadline.

Reporting and Payment Process

Grant projects are expected to start within two months of award notification. Applicants should notify the Commission if this expectation cannot be met. A Summary Financial Statement will be enclosed with the letter notifying applicants that they have received a grant award. This statement must be used to request reimbursement for funds expended under the grant award. This report is also to be used by the applicant to report the match requirement. Reimbursements are made to the grantees after the project costs are incurred. Reimbursement requests can be made monthly, quarterly, or after the project is completed.

Grant awardees will be required to submit a final evaluation report describing how well the project facilitated access to telecommunications services. Failure to submit the final evaluation report will be considered breach of the grant agreement. Progress reports may also be required to be filed. Details regarding these filings will be included in the letter notifying applicants of the grant award.

The Commission retains the right to revoke a grant if the funded applicant and project do not comply with Commission guidelines or fail to implement the project in accordance with the application as submitted and approved. In addition, the Commission reserves the right to take any other action allowed by law in the event an approved project is implemented in a manner inconsistent with the Nonprofit Access Program.

Withdrawal of Application

Applicants may withdraw their proposal at any time by providing a written request to the Commission.

8

False, Misleading, or Omitted Statements

False or misleading statements or omissions that render the information provided on an application to be false or misleading are grounds for rejection of an application, for denial, or for termination of funding. The Applicant may also be required to reimburse the Universal Service Fund. In addition, the Commission reserves the right to take any other action allowed by law.

No Obligation for Future Funding

If an application is selected for funding, the Commission has no obligation to provide any additional future funding. Funding is limited to the amount awarded by the Commission when it makes its decision on grant awards. A subsequent award of funding for a project is entirely at the discretion of the Commission. Multi-year projects can apply for only one year of funding and must reapply for funding for subsequent years. Subsequent applications for funding should include a report on progress to date toward the prior grant's goals.

Technical Assistance

Staff will provide limited technical assistance to all prospective applicants, as staff resources allow, until the time that a proposal has been submitted to the Commission. Staff can only provide answers to specific questions and make general comments in regard to the grant application guidelines and forms. Staff will not provide specific programmatic suggestions for a particular applicant nor review a draft copy of a forthcoming project application.

In compliance with state regulations regarding conflict of interest and open records, Commissioners will not provide any specific advice or assistance to applicants. All applicants will be referred to Commission staff.

For Further Information, Contact:

Jeff Richter, USF Director Public Service Commission 610 N. Whitney Way P.O. Box 7854 Madison WI 53707-7854 PHONE: 608-267-9624 FAX: 608-266-3957

E-MAIL: Jeff.Richter@wisconsin.gov

WEB PAGE: https://psc.wi.gov/Pages/Programs/NonProfitGrants.aspx

DL: 01619968

UNIVERSAL SERVICE PROGRAM GRANT APPLICATION Public Service Commission of Wisconsin P.O. Box 7854 Madison, WI 53707-7854 (Filling this form out is in accordance with PSC Admin. Code 160.) Form 2083 (05/15/09)

Instructions: Please complete Sections I and II of this application form and attach the Budget Summary, affidavit and written proposal as described in the grant application packet.

State Application Number

SECTION I – APPLICANT INFORMATION

Program (select only one) Lifeline/Link-Up Outreach Non-Profit Access Telemedicine

LEGAL APPLICANT Project Contact Name

Organization E-Mail

Street/P.O. Box Phone

City County State Zip

Description of Applicant’s Project (Limit description to 30 words or less)

Applicant Category (select only one)

State Agency County Municipality Private Non-Profit (501)(c)(3) Other

Area Impacted by Project (names of cities, counties) Projected Number of People Served

PROPOSED FUNDING Applicant and Other Funding Sources $ Project Start Date Project Duration (months)

State USF Amount Requested $

Total Project Cost $

SECTION II – CERTIFICATION

Applicant certifies that to the best of my knowledge and belief, data in this application are true and correct, the document has been duly authorized by the governing body of the applicant and the applicant will comply with the reporting requirements if funding is approved.

CERTIFYING REPRESENTATIVE Name Title

Signature Date Signed

SECTION III – PSC ACTION

Award Amount Date Application Received

An EEO/AA employer, the Public Service Commission provides equal opportunities in employment and programming, including Title IX and ADA requirements. You may request materials in alternative format by contacting (608) 266-5481.

AFFIDAVIT OF ELIGIBILITY

PUBLIC SERVICE COMMISSION - UNIVERSAL SERVICE FUND NONPROFIT ACCESS PROGRAM

5-NF-2018

Grant applicants must sign and date the certification statement below to be eligible for a Nonprofit Access Grant.

1. The applicant hereby certifies that it is a nonprofit organization as defined by IRS § 501(c)(3);

2. The applicant hereby certifies that any grant dollars from the Universal Service FundNonprofit Access Grant Program will be used for the purpose granted.

I certify, under penalty of law that the information provided in items 1 and 2 above are true and accurate to the best of my knowledge.

_____________________________ ___________________________ _________ Signature of applicant representative Name of applicant organization Date

DL: 01619966

[Page intentionally left blank for printing purposes.]

PUBLIC SERVICE COMMISSION

FY18 UNIVERSAL SERVICE FUND NONPROFIT ACCESS PROGRAM

Docket 5-NF-2018

Budget Summary

FUNDING SOURCES Committed In-Kind

Committed Cash

Pending In-Kind

Pending Cash

1. Grants, Contracts, Contributions

USF Funds Requested in Application

Government Agencies (List by name)

Private Foundations (List by name)

Corporations (List by name)

Individuals (List total amount)

2. Applicant

3. Earned Income (Revenues from the project)

4. Other (Specify)TOTAL FUNDING EACH CATEGORY (Add each column)

GRAND TOTAL PROJECT FUNDING (Add all four columns)

2

PROJECT EXPENSES USF Funds Requested

Cash Matching

Funds

In-Kind Matching Funds

1. Telecommunications Equipment

2. Non-Telecommunications Equip.

3. Consultant/Professional Fees

4. Internet/Telecommunication Serv.

5. Technical Staffing Expenses

6. Administrative Staffing Expenses

7. Rent Not allowed

8. Misc. Administrative Expenses

9. User/Client Training

10. Other (Specify)TOTAL EXPENSES

(add each column)

GRAND TOTAL PROJECT EXPENSES (Add all three columns)

NOTE: Grand Total Project Funding sources should equal Grand Total Project Expenses

ORGANIZATION NAME:____________________________________

CONTACT NAME:__________________________________________

CONTACT PHONE NUMBER:________________________________

CONTACT E-MAIL ADDRESS:_______________________________

DL: 01619969

Public Service Commission of Wisconsin

Nonprofit Access Grant Program Financial Summary Statement – FY18

Docket: 5-NF-2018 Organization/Name:

Address: Federal ID#:

Time Period Covered:

PURCHASES Specify equipment purchased from each vendor including a brief description of equipment covered by each invoice. Invoices or receipts must be included for purchases more than $10.00.

Amount

Total Purchases $

EXPENSES Itemize and provide receipts for all expenses such as travel, office supplies, printing, Internet services, telephone services, etc. for the organization and each subcontractor separately. Provide a breakdown of any per diem charges. All expenses claimed should be reasonable and necessary to accomplish the project. Describe formulas used for determining overheads or administrative costs.

Amount

Total Expenses $

SERVICES Specify services rendered and activities performed by each subcontractor and individuals in the organization separately.

Detailed Service Covered by Invoice

Name Hours Rate Amount

Total Services $

2

Total Cost Claimed for Reimbursement (Purchases, Expenses and Services) $

GRANT MATCH REPORTING

Source (include name of entity and description of in-kind match)

In-Kind Value $

Cash $

Signature: Date: Contact Phone #: Contact E-Mail Address:

PLEASE ATTACH COPIES OF VENDOR(S) OR SUBCONTRACTOR(S) INVOICES AND ALL RECEIPTS TO THIS SUMMARY

MAIL TO: Jenna Schmidt Fiscal Director

Public Service Commission P.O. Box 7854 Madison, WI 53707-7854

OR EMAIL TO: Jenna2.schmidt@wisconsin.gov

DL: 01619971

PUBLIC SERVICE COMMISSION OF WISCONSIN UNIVERSAL SERVICE FUND

NONPROFIT ACCESS GRANT PROGRAM – FY18 FINAL REPORT OUTLINE

5-NF-2018

1. Organization (name and address)ABC Nonprofit Organization123 Anywhere in Wisconsin Ave.City, Wisconsin Zip Code

2. Project Contact (name, phone number and e-mail address)John Doe(555)555-5555John.Doe@ABC.org

2. Grant Award ($)$15,000.00

3. Location(s) receiving services from the project.Dane County, Brown County, Vilas County, Etc.

4. Approximate beginning and end dates for using grant funds.June 1, 2018 – June 30, 2019

5. Describe how this project improved access to essential telecommunication services or informationservices. Refer to project goals and outcomes from the original application (use quantitative andqualitative information). Note any changes and adjustments made during the project.Narrative.

6. Describe how the project did or did not meet expectations. Provide anecdotal examples, if possible.Narrative.

7. Describe any problems encountered in project development or during project operation.Narrative.

8. Describe any changes that would improve the Nonprofit Access Grant program:Narrative.

9. Sign, date and mail to: Jenna Schmidt, Fiscal Director

Public Service Commission P.O. Box 7854 Madison, WI 53707-7854

OR Sign, date and E-mail to: Jenna2.schmidt@wisconsin.gov

NOTE: The final report should be submitted when the final reimbursement request (Financial Summary Statement) is filed with the Public Service Commission. DL: 01619970

[Page intentionally left blank for printing purposes.]

Relevant Section of Wis. Administrative Code Chapter PSC 160

PSC 160.125 Funding to promote access to telecommunications services.

(2) ACCESS PROGRAMS OR PROJECTS BY NON-PROFIT GROUPS. (a) The commission shall grant partial funding

to non-profit groups for the facilitation of affordable access to telecommunications services through programs

or projects, or both, not supported elsewhere in this chapter, but that are consistent with the purposes identified

in s. 196.218 (5) (a) 1., Stats.

Note: As of February 2013, s. 196.218 (5) (a) 1., Stats., reads in pertinent part:

(5) USES OF THE FUND. (a) The commission shall use the moneys in the universal service fund only for

any of the following purposes: 1. To assist customers located in areas of this state that have relatively high costs of telecommunications

services, low-income customers and disabled customers in obtaining affordable access to a basic set of essential telecommunications services.

(b) Any non-profit group may apply for universal service funding to fund any portion of a program or

project or both. Funding shall be granted on a state fiscal year basis, but funding for more than one fiscal year

may be approved at one time. The commission shall issue a list of approved programs or projects, or both,

when grants are awarded. All applications become public documents upon filing.

(c) Applications shall include:

1. A statement that the applicant is a non-profit group, as defined in s. PSC 160.02 (23).

1m. A description of a public need which is not being met at present.

2. A description of how the program or project is consistent with the purpose identified in s. 196.218

(5) (a) 1., Stats.

3. A description of the program or project proposed, including a description of how the public need

described in subd. 1m. may be met through affordable access to telecommunications.

4. A showing that the proposed program or project meets the described public need in a least cost

manner. This requirement can be met by showing that the applicant carried out an appropriate request for

proposals.

5. Identification of the providers of each portion of the telecommunications services or equipment and

a specific description of the components of the program or project including all of the following:

a. The costs of telecommunications services and telecommunications equipment used by the

program or project.

b. The cost of training for those who are served by the program or project so that they can use the

services.

c. The administrative costs directly attributable to the program or project.

d. The cost of technical expertise required to complete the program or project.

e. Revenue from services or training described in subd. 5.b.

(d) The commission shall evaluate all complete and timely applications submitted. In evaluating the

applications, the commission shall consider information including all of the following:

1. The basis of the public need to be met.

2. The extent to which other programs or projects, either funded under this section or otherwise under

this chapter, meet that need.

3. The overall cost of the proposed program or project.

(e) The universal service fund shall reimburse applicants for up to 75% of the cost of reimbursable

portions of the program or project, or both. The reimbursable costs include those listed in par. (c) 5. a. to d.

The applicant may include in-kind goods or services, or both, as resources to be used for the remainder of the

costs of the program or project, or both.

(f) The commission shall determine the programs or projects, or both, to be funded and the amount of

reimbursement for each program or project. The commission may grant a maximum of $500,000 in funding

under this subsection per state fiscal year, or $1,000,000 per state biennium.

DL: 01496813