Mid Florida Homeless Coalition, Inc

Mid Florida Homeless Coalition, Inc.

Continuum of Care Lead Entity

2016 Challenge Request for Proposals (RFP)

(Please Complete One per Project Type - refer to RFP Instructions for assistance in completing the application)

1.General Information

Organization Name
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Address
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City, State, Zip
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Contact Person Name/Title
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Contact Person Email
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2.Project/Program Information

Project Priority (If submitting more than one project)
Project Type: Please indicate below the Project Type for the Proposed Project
Proposed Project Type / Based on the Proposed Project Type, the Project will be considered for the following funding opportunities
PH – Rapid Rehousing (RRH)/Prevention / Challenge – First Priority
Coordinated Intake / Challenge – Second Priority
Affordable Housing / Challenge– Third Priority
Street Outreach / Challenge – Fourth Priority
 PH – Rapid Rehousing (RRH)/Homeless Prevention
Coordinated Intake
Affordable Housing
Street Outreach
Project/Program Title Click here to enter text.
Location of the Project/Program (Attach maps showing the general and specific location of the project)
Address: Click here to enter text.
Housing First/Low Barrier Questionnaire Score (Attach Completed Questionnaire to Application): ______
Total Estimated Project/Program Cost
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Existing Service / New Service

3.Organizational Capacity and Experience

Who will administer the project/program and be responsible for all compliance requirements?
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Will this be the same person overseeing the day-to-day activities? If no, please indicate who this person will be.
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Please indicate the number of paid Full Time Equivalents (FTE) in your organization that are working to help those who are homeless or at-risk of homelessness. Click here to enter text.
Please indicate the number of Full Time Equivalents (FTE) volunteering in your organization to help those who are homeless or at-risk of homelessness. Click here to enter text.
Describe the Federal, State and/or Local Government Grant experience of the Administrator identified above.
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[LIMIT to 1000 Characters]

4.Narrative for Each Project

Project/Program Description (Briefly provide an overview of the proposed project – see RFP instructions)
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Project/Program Schedule/Time Line (Note: Funds to be fully spent by June 2017)
Start Date: Click here to enter text. End Date: Click here to enter text.
Project/Program Sustainability(Describe how your program will be continued, maintained, or sustained at the end of the grant period.)

5.Performance Measurement System

Percentages of Population(s) to be served: Only include residents in the Mid Florida Homeless Coalition Continuum of Care Geographical area (Inclusive of Citrus, Hernando, Lake and Sumter Counties) to be served.

Income Level: / Homeless: / At-Risk Special Needs:
<30% AMI / % / Homeless / % / Elderly / %
31-50% AMI / % / Chronic Homeless / % / Frail Elderly / %
51-80% AMI / % / Severe Mental Illness / % / Severe Mental Illness / %
Chronic Sub. Abuse / % / Dual Diagnosis / %
Target Groups / Dual Diagnosis / % / Dev. Disability / %
Adult / Veterans / % / Physical Disability / %
Youth / Domestic Violence / % / Drug Addiction / %
Families / Unaccompanied Youth – under 18 years old / % / HIV/AIDS / %
Domestic Violence / Unaccompanied Youth – 18-24 years old / % / Domestic Violence / %
Other: _____ / Other: _____ / Other: ______/ %
Specific Objective: (select all that apply)
Rapid Re-Housing Activities: / Homeless Prevention Activities
Rent/Utility Arrears Assistance / Rental assistance
Rental assistance / Mortgage Assistance
First Month’s Rent / First Month’s Rent
Security Deposit / Security Deposit
Utility Assistance / Utility Assistance
Other:______/ Other:______
Affordable Housing: / Essential Services:
Single-Family Homes / Community Case Management
Rental Units / Housing Search Assistance
Single Room Occupancy / Medical and Psych Counseling
Group Homes / Job Training & Placement
Other:______/ Sub. Abuse Treatment & Counseling
Renovation / Childcare
Rehabilitation / Transportation
Conversion / Assistance in obtaining other benefits
Operations / Nutrition Assistance
Other:______/ Other:______
Coordinative Intake:
Performance Indicator)
Enter target number for all indicators that apply to your program/project and any additional indicators. (circle one type of unit) / Unit Type* / Expected Number Duplicated/ Unduplicated Served
1. Number of homeless persons/HHbeing served (circle one) / Persons/Households / /
2. Number to receive assistance to prevent homelessness / Persons/Households / /
3. Number of PH units/beds / Units/beds / /
5. / /
6. / /
* Unit Type: Person, Family, Household, Housing Unit, Building, Unit of Service, Job, Business, Other (explain)
Program/Project Impacts
Estimate the following goals based on project type:
Number 1 – All projects types except PSH
Number 2– Only PSH project
Number 3 – All project types
Number 4 – All project types / Unit Type*
(circle on type of unit) / Expected Number
1. Percentage exiting funded program into permanent housing(applies to all project types except PSH) / Persons/Households
2. Percentage of formerly homeless who stay in permanent housing program for at least six months(applies to PSH projects only) / Persons/Households
3. Percentage with increased earned income at program exit / end of grant term compared at entry(applies to all project types) / Persons/Households
4. Percentage with increasedtotal income between program entry and exit / end of grant term.(applies to all project types) / Persons/Households
* Unit Type: Person or Household
Provide one additional measurable objectives/outcomes to be achieved for each activity to be funded and how they will be measured.

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Based on the type of project that is being submitted, pull the required reports from Mid Florida Information Network (HMIS) as listed below and submit them with the application.

6.Agency Compliance Issues – To be reviewed by MFHC Compliance Staff

Has your organization had any past compliance findings or concerns from monitoring of the funding sources? If so, which funding source?

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Has the agency received any other type of compliance findings/concerns from other monitoring agencies? Click here to enter text.
Have all compliance issues been resolved, if applicable? (Please attach a separate sheet if necessary for response)

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7.Project/Program Budget (Attach a separate budget sheet for each project)

2016 Budget Form
Revenue
Amount of Grant Request? / $
Other Funds Supporting Program (Cash & In-Kind – List by Source and Amount):
Source / Other Cash / In-Kind
Total Other Cash & In-Kind: / $ / $
Grand Total of Revenue (cash, in-kind & grant) / $
Expenses
PROGRAM EXPENSES specific to the program for which you seek funding / Grant / Other Cash / In-Kind
Total Expenses: / $ / $ / $
Grand Total of Program Expenses: / $
Budget Narrative(Explanation of expenses and how it relates back to the program activities)
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8.Grant Match Requirement

Applicants are required to provide matching contribution to each Program/Project(s). Matched resources must be used for eligible program/project participants. The match may be in the form of cash or in-kind contribution. Either funds from other sources or in kind match equal to the size of the funding request, or a combination of funds or in kind match equaling the amount of the grant are acceptable. Please provide the source and the value of your match in the table below.

Match Items / Cash / In –Kind / Value / Match %
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Click here to enter text. / ☐ / ☐ / Click here to enter text. /
Click here to enter text. / ☐ / ☐ / Click here to enter text. /
Total / Click here to enter text. /

9.Financial Documentation

This section provides a listing of financial documents applicant organizations are required to submit. These documents are reviewed to determine whether: (1) applicant organization is solvent; (2) has the cash flow needed to complete the project/program within the time allowed; and; (3) financial management procedures are adequate to manage federal, state and/or local government grant funds.

Attach

Most current signed copy of Agency’s Audit (if applicable)

– OR -

Organization’smost recently submitted Federal Form 990

10.Other Documentation (Please describe any additional documents in the application)
Other Click here to enter text.
Other Click here to enter text.
Other Click here to enter text.
11. Other Certification
I certify that the information contained in this application is true and correct and that it contains no misrepresentations, falsifications, intentional omissions, or concealment of material facts. I further certify that no contracts have been awarded, funds committed or construction begun on the proposed project, and that no action will be taken prior to issuance of official authorization to proceed by MFHC. I further certify that I am authorized to submit this application and have followed all policies and procedures of my agency regarding grant application submissions.

Signature of Authorized Official
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Name of Authorized Official
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Title
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Date

Application Checklist

Please ensure the application includes the following documents:

☐Complete and signed application with all required information

☐ Map showing the general location of the project (Street Level). If applicable.

☐ Housing First/Low Barrier Questionnaire (Completed). If applicable.

Required documents from non-profit organizations:

☐Non-profit status verification (Copy of 501(c)(3)) Internal Revenue Service tax exemption) – unless on file this yearwith MFHC

☐List of Board of Directors

☐ Most recent audit or Federal Form 990– unless on file this yearwith MFHC

☐Leverage Letteron Agency Letterhead

☐ Certification Regarding Lobbying

☐HMIS Reports (see section 5 above)

FY 2016 Challenge Request For Proposals Page 1 of 9