Due: August 11, 2017, by 2:59:59 pm

Original signed hard copy UNSTAPLED of full application delivered to

and one electronic pdf submitted to:

D. Cheré Bradshaw, Executive Director

Community Alliance for the Homeless

44 N. Second Street, Suite 302

Email:

1. Applicant Information
Name of Lead Agency
Executive Director/CEO:
Street Address: / City: / Zip Code:
Telephone: / Fax: / E-Mail:
Applicant Federal Tax ID Number:
Federal DUNS Number:
Application Preparer/Contact
Telephone: / Fax: / E-Mail:
2. Project(s)
NAME of Project / TYPE
(PSH, RRH, TH and PH-RRH, SSO) / CoC Total Request / Total Project Cost
3. Sub-recipients

List below any agencies you are including in your proposal as sub-recipients:

Name of Sub-recipient Agency
Executive Director/CEO:
Street Address: / City: / Zip Code:
Telephone: / Fax: / E-Mail:
Applicant Federal Tax ID Number:
Federal DUNS Number:

I.ORGANIZATIONAL CAPACITY(not to exceed two pages)

  1. Organizational Profile.

Year organization was established
Mission Statement
Total number of staff
Total Annual Operating Budget
Target Population
  1. List all executive and management staff, provide a brief description of responsibilities and attach an organizational chart.

Executive Staff Name / Title / Responsibilities
  1. Describe your organization’s process for:
  1. Effectively administering federal, state, city, and private funds
  1. Managing basic organization operations including financial accounting systems
  1. Describe internal and external audit controls and an overview of your financial accounting system.

II.RELEVENT PROJECT EXPERIENCE (not to exceed two pages)

  1. Describe experience and expertise working with and addressing the target population’s identified housing and supportive service needs.
  1. Describe experience developing and implementing similar program systems, services, and/or residential property construction and rehabilitation.
  1. Identify past projects that required matching funds and the process you undertook to secure those funds and the source of funds.

III.PROJECT QUALITY

Project Overview and Approach (not to exceed four pages)

  1. Provide a brief description of the proposed project.

Provide a clear and concise description of the scope of the project. The description should describe the community needs, target population(s) to be served, project plan for addressing the identified housing and supportive service needs, projected project outcome(s), coordination with other sources/partners, and the reason why CoC Program support is required. The information provided in this narrative must not conflict with information provided in other parts of the application. For example, if the project operates according to the Housing First model as indicated later on this screen, the narrative should not indicate otherwise.

  1. Identify Project Type:

☐Permanent Supportive Housing(dedicated to chronically homeless within our CoC)

☐Rapid Rehousing

☐DedicatedPlus Permanent Supportive Housing – NEW PROJECT TYPE

☐Joint TH PH-RRH – NEW PROJECT TYPE

☐Coordinated Entry Supportive Services Only

  1. Housing Characteristics

Target Population to be Served
Household type / ☐Households with a least 1 Adult (>18) and 1 child
☐Adult (>18) households without children
☐Youth households (18-24 with children)
☐Youth households (18-24 without children)
Number of proposed units
Number of units dedicated CH
Location:
Services to be provided
Services to be provided
  1. What method(s) will be used to establish the housing units?

Agency:Page __ of ___ Revised 7/11/16

☐Acquisition

☐Rehab

☐New Construction

☐Rental Assistance

☐Leasing

☐Other Click here to enter text.

Agency:Page __ of ___ Revised 7/11/16

  1. Describe activities to be undertaken to ensure housing units are available. Attach a work write up and cost estimate.
  1. Describe the program’s client referral process. How do you plan to receive clients for your program and move-in process?
  1. What is your process for ensuring that 100% of the proposed program participants come from the street or other locations not meant for human habitation, emergency shelters, or safe havens?
  1. How do you assist participants in obtaining, mainstream benefits, social and employment services, and other types of needed supports and services?
  1. Describe how the supportive services that will be offered will ensure successful retention or help to obtain permanent housing.

Agency:Page __ of ___ Revised 7/11/16

  1. How do you determine when and if an individual is ready to transition to permanent housing?
  1. How do you assist participants in securing affordable appropriate permanent housing?
  1. How do you prepare participants for their transition to permanent housing?
  1. Select the type of support, if any, you will provide to participants following their transition to permanent housing?

Agency:Page __ of ___ Revised 7/11/16

☐Case Management

☐Counseling

☐Professional Development/GED

☐Medical (Mental and Physical)

☐Other Click here to enter text.

Agency:Page __ of ___ Revised 7/11/16

  1. What qualities make an applicant eligible (select all that apply)?

Agency:Page __ of ___ Revised 7/11/16

☐ Homeless

☐Chronic Homeless

☐Extremely Low Income (30% of Area Median)

☐Very Low Income (50% of area median)

☐Low Income (80% of area median)

☐U.S. Citizen/Permanent Resident

☐Refugee/Assylee

☐Ineligible Immigrant

☐Disability

☐Serious Mental Illness

☐Chronic Substance Abuse

☐Co-morbid (MI and SA)

☐MI, SA or Co-morbid

☐AIDS or related disease

☐Veteran Status

☐Families Only

☐Individuals Only

☐Other Click here to enter text.

Agency:Page __ of ___ Revised 7/11/16

  1. What makes an applicant ineligible for services (select all that apply)?

Agency:Page __ of ___ Revised 7/11/16

☐Having too little or no income

☐Active or history of substance abuse

☐Criminal record (except for state-mandated restrictions)

☐Fleeing domestic violence (e.g., lack of protective order, period of separation from abuser, or law enforcement involvement)

☐Eligible for VA Services

☐Sex-Offender Status

☐Poor or no Rental History

☐Eviction from subsidized housing (in last 2 years)

☐Non-U.S. Citizen/Refugee

☐Violent Crime Conviction (in last 2 years)

☐Termination of Unit due to Fraud (in last 10 years)

☐Termination of Unit with Damages (in last 10 years)

☐Client is incapable of managing an apartment

☐Other Click here to enter text.

Agency:Page __ of ___ Revised 7/11/16

  1. Will the project quickly move participants into permanent housing?☐ Yes ☐ No

Answer “Yes” to this question if your project will quickly move program participants into permanent housing without intermediary steps or a period of qualification before permanent housing.

Agency:Page __ of ___ Revised 7/11/16

Length of time to move-in:

☐less than 30 days

☐30 – 60 days

☐greater than 60

Agency:Page __ of ___ Revised 7/11/16

  1. Will any of the following be a reason for program termination? Check all that apply:

Agency:Page __ of ___ Revised 7/11/16

☐Failure to participate in supportive services

☐Failure to make progress on a service plan

☐Loss of income or failure to improve income

☐Fleeing domestic violence

☐Any other activity not covered in a lease agreement typically found in Memphis/Shelby County

☐Check here if none of the above apply.

Agency:Page __ of ___ Revised 7/11/16

Outcomes, Evaluation and Client Satisfaction(not to exceed two pages)

Select ALL the outcomes applicable to the proposed project.

☐Create new permanent housing beds for chronically homeless persons (individuals and/or families)

☐Create new rapid rehousing units for individuals, families, and/or youth (18-24) with or without children

☐Decrease the number of homeless households with children

☐Decrease the number of Youth households (18-24) without children

☐Decrease the number of chronically homeless persons

☐Decrease the number of homeless veterans

  1. List performance targets related to the following measures:

Measure / Funding Period Target
Number of projected households to be served.
Number of projected individuals to be served.
Average length of stay in the program
Number of households and persons to be served
Percentage of persons remaining in permanent housing as of the end of the operating year or exiting to permanent housing destinations during the operating year:
Percentage of adults who maintained or increased their total income (from all sources) as of the end of the operating year or program exit; or
Percentage of adults who maintained or increased their earned income as of the end of the operating year or program exit
  1. Identify 3-5 additional performance measures you use to assess program effectiveness and associated targets.

Measure / Funding Period Target
  1. Describe how the community is better off as a result of this project.
  1. Describe practices and plans for achieving, measuring, and maintaining outcomes.
  1. Describe how your agency will determine program effectiveness.
  1. Describe the tools (e.g. client surveys, interviews, etc.) you use to determine client satisfaction. Be specific.

IV.DEMONSTRATED NEED (not to exceed one page)

  1. Select one or more factors that informed the need for this project.

☐Waiting list for services

☐Client demographic information

☐Documentation of unmet needs

☐Increase in referrals

☐Evaluation results

☐OtherClick here to enter text.

  1. Whatsupporting documentation/evidence is there to support this need?

V.COMMUNITY LEVERAGE (not to exceed two pages)

  1. List all community resources to be included in the project. Briefly describe how this resource will benefit the participants, the estimate value or cost of the total services, and whether a formal partnership agreement letter has been executed.

Community Resource / Benefit to Participant / Estimated Cost/Value of Service / Agreement Letter (Yes/No/Pending)
  1. Identify the community partnerships you have in place. Attach Letters of Agreement for Collaborations and or Services Provided Only (not referral agreements).
  1. Describe your history and experience working in partnership with other community providers and/or collaborations.
  1. Describe your process for referring participants to identified community resources and tracking results of referrals.

VI.HUD PRIORITIES(not to exceed two pages)

Indicate which of the following practices your organization has integrated and provide a brief description of your approach.

☐Implementation of a coordinated assessment tool

Approach:

☐Participation in Coordinated Entry process

Approach:

☐Prioritizing individuals and families with thehighest vulnerability (e.g. greatest need for and difficulty accessing housing/services)

Approach:

☐Reducing dependency on shelter system, repeat incidences of homelessness and/or chronic homelessness

Approach:

☐Geographic dispersion of services throughout Shelby County

Approach:

☐Collaborations with other homeless service providers in continuum

Approach:

☐Assuring reasonable cost for number of persons served, housing provided

Approach:

☐Maximize the use of mainstream and other community-based resources

Approach:

☐Using a Housing First Approach

Approach:

VII.BUDGET

  1. Identify other sources of funds, if any, secured to support this project and the associated amount. Please note that HUD requires a 25% match for all project costs.

Type of Funding / Total Amount
Grant through private foundation / $
Grant through government agency / $
Individual gift/endowment / $
Other______/ $
  1. Use the Excel Spreadsheet provided to develop a detailed project budget. Include:
  • The total project costs,
  • Amount of request, and
  • All other sources of funds committed to the project.
  1. Provide a narrative description of costs and costs justification. (not to exceed one page)

See Sample Budget Justification

.

VIII.BONUS – VOLUNTARY REALLOCATION

  1. Has the applicant voluntarily elected not to renew an existing CoC grant in order to seek reallocation for a new permanent housing program?

☐Yes

☐No

If yes, please describe.

  1. Has the applicant consulted with the Community Alliance for the Homeless and/or Continuum of Care Committee Chair prior to submitting this application?

☐Yes

☐No

If yes, please describe.

Attachments - Local Assurances

  1. The Applicant acknowledges and understands that, although the Community Alliance for the Homeless will review each application to be submitted in the 2017 Continuum of Care Application for Memphis and Shelby County and provide technical assistance to applicants and advise applicants of obvious errors and omissions as time permits, the applicant assumes ultimate responsibility for preparing an accurate and complete application for submission to HUD that meets all federal rules and regulations.
  2. The applicant is in compliance with all applicable civil rights laws and Executive Orders and meets all standards outlined in the U.S. Department of Housing and Urban Development Notice of Funding Availability.
  3. The organization’s Board of Trustees has approved the submission of this application.
  4. The applicant acknowledges that its organization has been in existence for at least one year as a non-profit entity.

Employer/Taxpayer Identification Number ______

Organizational DUNS ______

  1. The applicant acknowledges that it maintains a detailed financial management system and has a fund accounting system in place.
  2. The Applicant agrees to participate in an interview and/or host a site visit if deemed appropriate or needed by review team.
  3. If Applicant is selected and subsequently granted funds by HUD, the applicant will, upon request, agree to an occasional and scheduled monitoring visit by CAFTH.

______

Signature, Executive DirectorSignature, Board President

______

Print Name of Executive DirectorPrint Name of Board President

______

DateDate

Attachments - Current Board of Directors

List all current board membersand corresponding contact information.

Name / Board Position / Company/Affiliation / Email / Phone

Attachments – Applicable to be signed between May 2017 and Sept 2017

  1. Charter
  2. Tennessee Certificate of Existence dated after 01/01/2016
  3. By-Laws
  4. Documentation of Non-profit status 501(c)(3)
  5. Current Board of Directors
  6. Organizational Chart
  7. Most Recent Independent Audit or Financial Statement and Management Letter
  8. Most recent IRS Form 990
  9. Most Recent Income/Expense Report
  10. Documentation of Match
  11. Partnership Agreements, if any

Agency:Page __ of ___ Revised 7/11/16