TO BE CONSIDERED A NEW EXTENSION SITE:

The site must have a minimum of 50 registered members and must be open a minimum of 3 hours per day, 3 days per week and 8 months per year. The 3 hour requirement means 3 hours of scheduled activities for youth served at the Club. This does not include set up and clean up by program staff. If the site meets all of the above criteria please complete a New Extension Site Application.

Section A: Club Site Information

  1. Enter name of your Extension site (not the Member Organization)
  2. Enter Extension site location address
    1.  Enter county name where the site is located
  3. Enter site mailing address
  4. Enter site shipping address
  5. Enter phone number for the site
  6. Enter fax number for the site
  7. Enter website address
  8. Enter date the site began serving youth (site is open and operating, serving youth, meeting all membership requirements)

Section B: Member Organization Information

  1. Enter the name of the Member Organization operating the site
  2. Enter the city and state of the Member Organization

Section C: Staff of the Qualifying Unit

  1. Enter the Site Director’s Name
  2. Enter the Site Director’s Office Phone Number
  3. Enter the Site Director’s Fax Number
  4. Enter the Site Director’s Cell Phone Number
  5. Enter the Site Director’s Email Address
  6. Enter the Site Director’s Annual Salary

Enter other staff members information on the lines provided. Include the name, title, annual salary, and whether full time or part time. If there are no other paid staff members but there are volunteers their information should be entered on these lines.

Attach a copy of the Site Director’s Resume.

Section D: Building Facilities

  • Answer the questions appropriately. For clarification of questions and specific terms, refer to this document titled Section D Building Facilities Definitions.
  • Be sure to attach a photo of the building, preferable 8”x10”.

Section E: Operating Hours

  • If the site is operating within a school, circle “Aug – May” or “Sept – June” to indicate the school-year schedule.
  • Also, enter the number of MONTHS per year the site is open, the number of DAYS per week, and the number of HOURS per day – both during the school year and during the summer.
  • Attach a copy of a typical weekly activity schedule – a sample form is attached to this application.

Section F: Service to Youth

  1. Enter Yes of No in answer to the question.
    1. Registered Members Breakdown – Double-click on the grid and enter the number of registered members by age and gender. This section calculates the totals #s for you; however, you must enter the Average Daily Attendance number.
  2. Enter the Average Amount of Dues per Club member.
  3. Double click on the grid to enter the Ethnicity Percentages. This section calculates the total for you and it MUST equal 100%

Attach a roster of Registered Members that includes name, age, gender.

Section G: Financials

  • Enter Income and Projected Expenses.
  • Attach a copy of itemized budget for first operating year.

Section H: Miscellaneous

Please answer appropriately.

Section I: Contact Person for Application Questions

Enter Name, Job Title, Phone and Email Address.

Required Signatures

  • Board Chair of the Boys & Girls Club Organization requesting membership
  • Director of Organizational Development, BGCA
  • National Vice President, Vice President, or National Director, Organizational & Executive Development, BGCA
  • Senior Vice President, Organizational & Executive Development, BGCA

Required Supporting Documentation

  • Site Director Resume
  • Photograph of building (preferably 8”x10”), wide angle
  • Copy of Lease Agreement or Memorandum of Understanding (MOU) – if applicable
  • Roster of Registered Members (includes names, ages, gender)
  • Copy of one week’s activities schedule detailed by day, hour, and room
  • Copy of site present year itemized budget – Revenue and Expenses (if the site is funded completely by a Grant please include a plan for sustainability for after the grant ends).

Disclaimer: Upon completion of the application and all attachments, obtain the signature of the Chief Volunteer Officer or Board President, and speak with your Director of Organizational Development to determine the proper way for the application to be submitted.