2018EMERGENCY SOLUTIONS GRANT ASSISTANCE
Emergency Shelter, Homelessness Prevention & Rapid ReHousing Activities
City of Aurora
Community Development Division
9898 E. Colfax Ave., Aurora, CO 80010
CFDA #: 14.231
APPLICANT INFORMATION
1. Agency Name and Mailing Address
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Does Agency expend $750,000or more in federal awards during the Agency’s fiscal year:
☐ YES☐ NO
If, yes, the Agency shall have a single audit conducted for that year in accordance with the provisions of OMB 2 CFR Part 200 Audit requirements and must submit a copy of the most recent audit to the City in accordance with the requirements. / 2. Grant/ProgramNumber (For COA Use only)
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3. Date Received(For COA Use Only)
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4. Current ESG Program Recipient?
(For COA Use Only)
☐ CURRENT ☐ PRIOR
☐ NEVER
5. Name of Contact Person for Application
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TYPE OF ORGANIZATION
9. Nonprofit Organization ☐ YES☐ NO
Please attach 501(c)(3) ruling. / 10. Faith-Based?
☐ YES☐ NO
11. Federal Identification Number (Employer Tax Payer ID#)
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/ 12. DUNS Number
13. Program Service Area (List cities, counties, regions served)
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14. How many years has your agency been in operation? Click here to enter text.
How long has your agency done the activitiesfor which you are applying? Click here to enter text.
15. Population(s) Served: (check all that apply)
☐Men / ☐Women / ☐Families with Children
☐Youth / ☐Veterans / ☐Elderly
☐Domestic Violence / ☐Chronically Homeless / ☐Chronic Substance Abuse
☐HIV/Aids / ☐Severely Mentally Ill
☐Other Disability: Click here to enter text.
☐Other: Click here to enter text.
16. Type and Characteristics of Programs for which ESG Assistance is Requested(check all that apply)
☐Shelter (up to days) / Max Capacity per Night: / Max Length of Stay: / Average # Clients Served per Day:
☐Unaccompanied Youth Shelter / Max Capacity per Night: / Max Length of Stay: / Average # Clients Served per Day:
☐Emergency Overnight Shelter / Max Capacity per Night: / Max Length of Stay: / Average # Clients Served per Day:
☐Detox Shelter / Max Capacity per Night: / Max Length of Stay: / Average # Clients Served per Day:
☐Homelessness Prevention / Average # of Client Contacts per Month: / Average # Clients Served per Grant Period:
☐Rapid ReHousing / Average # of Client Contacts per Month: / Average # Clients Served per Grant Period:
☐Veterans / Average # of Client Contacts per Month: / Average # Clients Served per Grant Period:
Total Number of Persons expected to be served with ESG funds? Click here to enter text.
Are you requesting dollars for a new program in this request? ☐YES☐NO
If yes, Program Name: Click here to enter text.
SIGNATURE OF AUTHORIZED AGENCY REPRESENTATIVE
17.Signature of Authorized Representative(Generally, Executive Director or Board President)
Print NameTitle / Date: Click here to enter a date.
BUDGET
Instructions: Determine the category of program of which your agency is applying. Determine how much will be spent per “X” category and add the dollar amounts requested. / 18. Program / 19. Program / 20.Program
Shelter / Homelessness Prevention / Rapid ReHousing
Essential Services
- Case Management and Counseling for: substance abuse treatment, housing, obtaining benefits, goal setting, mileage, etc
Operations (of Shelter):
- Utilities (telephone, water, Xcel)
- rent
- insurance
- equipment, etc
- Kitchen, janitor, maintenance
HMIS Data Entry
- Staff person devoted to only HMIS data entry
- For agencies that serve more than 200 unduplicated clients per year (per CoA)
Emergency Shelter - Vouchers
- Motel/hotel vouchers when shelter is full
Case Management
- Navigator (Housing Stability Case Manager) and associated staff housing search and placement
- Housing Search and Placement (RRH)
- Housing Relocation (homelessness prevention)
- 20 hour a week position
Financial Assistance:
- Security Deposit
- Rental Assistance
- Application Fees
- Utility Assistance
21. SUBTOTAL
22. TOTAL REQUEST: $
PROPOSED PROGRAM BUDGET
EXPLANATION AND DOCUMENTATION
23.Please provide an explanation of your proposed program budget for the following:
- Emergency Shelter - Operations, Operations Staff, Essential Services
- Homelessness Prevention - Financial Assistance, Services, Case Management
- Rapid Rehousing - Financial Assistance, Services, Case Management
- HMIS Data Entry – staff person devoted to only data entry
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FINANCIAL CAPACITY
24.Explain your agency’s financial control system and procedures. Include an explanation of how your agency will monitor its activities to ensure that ESG dollars are spent in a timely manner and how ESG monies will be applied and tracked against specific activities.
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ADDITIONAL FUNDS
25.Please list the source and amount of any additional funds to be used to carry out your proposed program:
DESCRIPTION OF SOURCE OF FUNDS: / AMOUNT:
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TOTAL AMOUNT OF ADDITIONAL FUNDS:
PLAN FOR FINANCIAL STABILITY
26.Provide a plan for the future financial stability of the proposed program. (How will the program continue in the future if ESG funding is no longer provided?)
Federal Funding can be unpredictable, (amounts fluctuate and disbursement timeline fluctuates), please plan in advance for gap between funding cycles.
If this proposal is requesting funding for more than one activity,please describe the future financial stability plan for each activity.
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PLAN FOR FINANCIAL STABILITY
27.Provide documentation of your needs and successes for requested categories of service:
(HMIS data reports will be used to evaluate the success and utilization of Continuum of Care throughout Aurora of these various housing systems: Emergency Shelter, Rapid ReHousing and Homelessness Prevention. HUD is increasing their emphasis on outcomes and is making recommendations for housing solutions.)
- What is the need to be addressed by your agency? (Data Needed)
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- How urgent is the need? (Data Needed)
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- How many people are waiting to enter your program? (Data needed)
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- How many potential clients are turned away because you can’t serve them? (Data Needed)
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- How has your agency been able to reduce the length of time that households stay in a shelter and the recidivism of households returning to a shelter? (Data Needed)
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- How many clients have been accepted into Housing Programs? Example: Referred to A@H and accepted into the A@H Rapid ReHousing or A@H Homelessness Prevention Housing Program?
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PROGRAM PLAN
28.Describe your program plan to assist the target population as it directly relates to the need addressed in Question 27. Please use only the space allotted. (Be sure to include the geographical areas and specific activities that you plan to provide).
If this proposal is requesting funding for more than one activity, describe the program plan for each activity separately.
All requests should be eligible, necessary, and reasonable.
EXPERIENCE
29.Explain below any experience your agency has in implementing the activities that you have proposed in this application.
Specifically, include the years of experience of staff and/or agency that will be administering the ESG funds. Where your agency and staff lack experience, explain how you will obtain the technical assistance needed to administer and complete the program.
30.Explain how your agency will work with the Aurora @ Home homeless collaborative.
And how your agency will comply with the Coordinated Assessment process “One Home” thru Metro Denver Homeless Initiative (MDHI)
SHELTER/HOUSING REPORT
PROGRAM CHARACTERISTICS / 2016 ACTUAL / Data
From HMIS? / 2017 PROJECTED
31.TOTAL # Households Served
32. TOTAL # Persons in Households
33. TOTAL # Family Households
34. TOTAL# of Single Households
35. TOTAL# Unaccompanied Youth
36. TOTAL # Beds Provided
37. TOTAL # Shelter Nights Provided
AVERAGE COST PER PERSON OR HOUSEHOLD SERVED WITH ESG FUNDING
38. What is the average cost per person served, for each of your potentially ESG-funded activities?
(Example: $5,000 rent per household for a year/length of grant, $416.66 per month/length of grant)
CURRENTLY HOMELESS OR FORMERLY HOMELESS CLIENT PARTICIPATION AS A MEMBER OF THE BOARD OF DIRECTORS OR A MEMBER OF AN ADVISORY BODY OVERSEEING PROGRAM:
(HUD REQUIRES DOCUMENTATION OF AT LEAST ONE HOMELESS CLIENT PARTICIPANT)
39. Name of Board Member / Click here to enter text. / Documentation of Homeless or formerly Homeless Status – attach to application
40. Name of Board Member / Click here to enter text. / Documentation of Homeless or formerly Homeless Status – attach to application
CONTINUUM OF CARE COORDINATION (CoC)
41. Are you a participating member of your local CoC, known as the Metro Denver Homeless Initiative (MDHI))?
Yes ☐ or No ☐
SHELTER /
SUPPORTIVE SERVICES
TYPE OF SERVICE YOUR AGENCY PROVIDES / Your agency
Provides these
Services
check the box”
Another agency (or agencies),
please list the agency name(s): / Do you have a writtenagreement with other agencies?
Circle the appropriate to
answer below: “Yes” or “No” or “NA” (Not Applicable)
YESNONA
42. Shelter Information and Referral / ☐ / Agency Name:
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43. Street Outreach to Homeless / ☐ / Agency Name:
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44. Emergency Shelter / ☐ / Agency Name:
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Emergency Overnight Shelter / ☐ / Agency Name:
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Domestic Violence / ☐ / Agency Name:
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Detox Program / ☐ / Agency Name:
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Motel/Hotel Vouchers / ☐ / Agency Name:
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YES / NO / NA
45. Rapid ReHousing Program Rental assistance (w/services) / ☐ / Agency Name:
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46. Homelessness Prevention Rental assistance (w/services) / ☐ / Agency Name:
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47. Soup Kitchen / Food Pantry / ☐ / Agency Name:
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48. Case Management/Housing Navigator / ☐ / Agency Name:
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49. Transportation / ☐ / Agency Name:
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50. Daycare / ☐ / Agency Name:
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51. Medical treatment / ☐ / Agency Name:
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52. Substance Abuse Counseling / ☐ / Agency Name:
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53. Psychological/ Mental Health / ☐ / Agency Name:
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54. Employment / ☐ / Agency Name:
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55. Life Skills/Budgeting / ☐ / Agency Name:
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56. Educational / ☐ / Agency Name:
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57. Security Deposit / ☐ / Agency Name:
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58. Eviction / Homelessness Prevention (one time rental assistance) / ☐ / Agency Name:
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59. Utility Assistance Payments / ☐ / Agency Name:
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ABILITY TO COMPLY WITH HOMELESS MANAGEMENT INFORMATION SYSTEMS (HMIS)
ESG-funded homeless providers are important participants in the successful implementation of an HMIS responsive to Congressional direction on improved data collection on homelessness. The HEARTH Act is requiring that ESG recipients participate in HMIS. ESG grantees must comply with HUD’s standards on participation, data collection and reporting. However, victim service providers and legal services organizations may choose not to utilize HMIS, but must use a comparable database. The comparable database must produce unduplicated and aggregated reports.
If your agency is selected to receive ESG funds, you will be required to participate in trainings and meetings that relate to the use of HMIS. The required data collection for HMIS and the City of Aurora will be made available prior to the contract being finalized.
- Are you in compliance with HMIS? Please place an “X” in the box that best describes your current HMIS status.
☐My agency is entering all HUD-required ESG HMIS data elements on a consistent basis.
☐My agency enters HMIS information for another Federal grant and we are a new ESG Applicant.
☐We are aware that we need to select the “tab” for ESG HMIS data entry, to ensure that data is also inserted into ESG HMIS.
☐My agency is a domestic violence shelter and isexempt from HMIS and we use a comparable database, that is approved through the MDHI HMIS planning process. (Our agency is keeping updated on the progress of such a system).
- When and where did your agency staff receive training on Homeless Management Information Systems (HMIS)?
Click here to enter text. - List Computer(s) and printers that are/can be dedicated to HMIS: Models, Operating Systems, Storage Capacity
Click here to enter text. - Does your agency have a specific plan to enter data into HMIS system? Yes☐ No ☐
Is there a specific person to enter data, pull reports and attend HMIS User meetings? Yes ☐ No ☐
Is this a Full-time or Part-time staff person? Click here to enter text.
Please describe your agency’s plan to enter data:
- How do you ensure that client files are kept confidential?
MATCH CERTIFICATION
SOURCES OF MATCH
(100% match of ESG funds required for Shelter activities, Rapid ReHousing activities and Homelessness Prevention activities. Attach supporting documentation for available match. Documentation should reflect funding availability during the ESG contract year.)
Other Federal (including pass-through funds, e.g. City CDBG, County FEMA, etc.)
NAMEAMOUNT
State/Local Government Funding
NAMEAMOUNT
Private (including recipient) Funding
Fund Raising/Cash
Grants
Nexus Funds
City of Aurora General Funds
Staff Salaries (not included in ESG award)
Volunteers ($5.00 per hour)
Other (specify)
I certify that match funds have been identified and committed to support the proposed ESG project and have not been used to match previous ESG awards (i.e. the value of a donated building used as match in a 2001 award cannot be used as match in 2009). This form is a description of the sources and amounts of such match funds which are not being used as match for any other federal program.
Signature/Title Date
Instructions for Completion of Match Certification
All applicants are required to complete the Match Certification form. Eligible forms ofmatch are as follows:
• The value of salary paid to staff to carry out the ESG Program. Timesheets/pay sheets, etc. need to be provided at time of payment requests.
• The value of the time and services contributed by volunteers to carry out the program at a rateof $5.00 per hour. Signed timesheets need to be provided at time of payment requests.
• The value of any building lease using a method to reasonably calculate fair market value.
• Award letters from foundations, organizations, private individuals, and other governmentsources.
EMERGENCY SOLUTIONS GRANTS PROGRAM
ASSURANCES AND CERTIFICATIONS
Click here to enter text.(name of appropriate organization/agency signatory)
of Click here to enter text. (organization or agency) which is applying to the City of Aurora,
Community Development Division, for funding through the Emergency Solutions Grant Program from the
U.S.Department of Housing and Urban Development (HUD), hereby assure and certify that:
Amounts awarded under this program will be used only for these purposes:
1.Assist in the prevention of homelessness.
2.Assist in supporting the essential operating costs of shelters.
3.Assist in improving the quality of supportive services to the homeless.
The program/agency is able to meet the requirements of CFR Title 24, PART 576 - EMERGENCY SOLUTIONS GRANTS PROGRAM: MCKINNEY-VENTO HOMELESS ASSISTANCE ACT.
If the organization/agencyis a Primarily Religious Organization it will also comply with Title 24, Part 576, Subpart B, Sec. 576.23 Limitations.
The organization/agency will comply with the requirements of 24 CFR Part 24 concerning the Drug-Free Workplace Act of 1988.
No Federal appropriated funds have been or will be paid, by or on behalf of the organization/agency, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal loan, the entering into of any cooperative agreement, and modification of any Federal contract, grant, loan or cooperative agreement.
If any funds, other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan or cooperative agreement, the organization/agencywill complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.