2017CoC Competitive Grant Application

Application Instructions

  1. Deadline for submission of application isFriday,August25, 2017at 4:00 p.m. Application is to be submitted electronically to .

Late applications will not be accepted

  1. Use 12 pt font, 1.5 Spacing (Times New Roman or Arial)
  2. Number all pages. Include Agency Name and Date as footer.
  3. Failure to submit all required ATTACHMENTS and Documents will result in rejection of the application. NO EXCEPTIONS
  4. Keep application in order. Submit the application in order as listed in the attachments and order of submission page.
  5. There will be two components to this application, the agency information component worth 14points and the project component worth 86 points. All agencies must submit one agency component, followed by project components for each project that funding is being requested.

By signing and submitting this application, I certify (1) to the statements

contained in the list of eligibility criteria and (2) that the statements herein

are true, complete, and accurate to the best of my knowledge. I also

provide the required assurances and agree to comply with any resulting

terms if I accept an award. I am aware that any false, fictitious, or

fraudulent statements or claims may subject me to criminal, civil, or

administrative penalties.

______

Print NameDate Signed

______

Signature and Title of Authorizing Official

Agency Component

AgencySummary
Name of Lead Agency / Incorporation Date:
Federal DUNS Number: / Federal Tax ID: / SAM#:
Street Address: / City: / Zip Code:
Telephone: / Fax:
Executive Director/CEO: / E-mail:
Contact Person: / Title:
Board President/Chair Person: / Telephone #:
PROPOSED ACTIVITY / FUNDING REQUEST Amount
Name of Activity
TOTAL / $

Eligibility Criteria for all Agencies

Check all the below-listed threshold requirements that apply to your agency.

Signed TLCHB Standards on file

HCN active participant1

Executed CHO agreement2

HMIS active participant3

No outstanding audit findings of a material nature regarding administration of the

program

No major HUD violation issued in the past twelve months

Current Internal Revenue Service (IRS) approved tax-exempt status under Subtitle of

the code

Fund Accounting system that operates according to Generally Accepted Accounting

Principles (GAAP)

Nondiscrimination practice in provision of assistance

Current with all property and payroll liability taxes

Note reason below for any unchecked box above. Box will expand as needed.

1An agency with an HCN MOU must demonstrate attendance of 75% or higher of the HCN general meetings. Applicants not currently receiving CoC, ESG or CDBG Homeless Services funds are exempt from this threshold requirement covering or applicable for 2016-2017.

2An agency not currently receiving CoC, ESG or CDBG Homeless Services funds is exempt from this threshold requirement covering or applicable for 2016-2017.

3An agency must attend 100 % of the CHO meetings after executing CHO Agreement. Applicants not currently receiving CoC, ESG or CDBG Homeless Services fundingare exempt from this threshold requirementcovering or applicable for 2016-2017.

Agency Summary (2 pages maximum)- 6 Points

  1. Identify any findings of non-compliance with HMIS Security & Privacy policies during monitoring in CY 2016 and the status of any corrective action plan (One page maximum).

CHO Tracker score – 8 Points

90% - 100% - 8 Points

80% - 89% - 7 Points

70% - 79% - 5 Points

69% and Below – 0 Points

ATTACHMENTS AND ORDER OF SUBMISSION

ENSURE ALL ITEMS ON THIS LIST ARE SUBMITTED IN THE FOLLOWING ORDERWITH ONE ELECTRONIC COPY.

Agency Summary (2 Page Maximum)

Most recent Agency Year-End Income/Expense Budget Report

Current Organizational Chart

Board of Director’s Information Form & Board of Director Composition narrative (Found in Excel Workbook)

Client Termination and Grievance Process

Most Recent 990 Form

Most recent Agency Audit

FY 2017 – 2018 Documentation of Leveraged Resources/Cash Match (Found in Excel Workbook)

Signed MOU for the Housing Collaborative Network

Local Assurance Certification (Found in Excel Workbook)

Certifying Statement of Officials (Found in Excel Workbook)

Tax Affidavit (Found in Excel Workbook)

Conflict of Interest (Found in Excel Workbook)

Leverage Certificate (Found in Excel Workbook)

Code of Regulations and/or By-laws

Agency’s most recent Strategic Plan

HMIS Security & Privacy corrective action plan (If applicable)

Code of Conduct