Orange County Continuum of Care – 2016 CoC Renewal LOI

EXHIBIT 5: HOUSING FIRST MODEL ASSESSMENT

Agency Name:Click here to enter text.

Project Renewal Housing First Review And Certification

Housing First is a model of housing assistance that prioritizes rapid placement and stabilization in permanent housing that does not have service participation requirements or preconditions (such as sobriety or a minimum income threshold). Transitional housing and supportive service only projects can be considered to be using a housing first model for the purposes of the LOI/part I if they operate with low-barriers, work to quickly move people into permanent housing, do not require participation in supportive services, and, for transitional housing projects, do not require any preconditions for moving into the transitional housing (e.g., sobriety or minimum income threshold).

Agency must demonstrate a commitment to the Housing First model and programs implement a Housing First model. Please submit the following documents to demonstrate whether your program adheres to a Housing First Model.

Attachment 11: Documents supporting Housing First Model (program rules, service plans, or applicable documentation)

Project Information – Complete the chart below for each CoC Project. Duplicate as needed.

Name of Project: / Click here to enter text.
Program Type: / Click here to enter text.
Does the project quickly move participants into permanent housing? / ☐Yes / ☐No
Does the project ensure that participants are not screened out based on…
  • Having too little or no income?
/ ☐Yes / ☐No
  • Having a criminal record with exceptions for state-mandated restrictions?
/ ☐Yes / ☐No
  • Active or history of substance abuse?
/ ☐Yes / ☐No
  • History of domestic violence (e.g. lack of a protective order, period of separation from abuser, or law enforcement involvement)?
/ ☐Yes / ☐No
  • Sexual orientation or gender identification?
/ ☐Yes / ☐No
Are clients evicted or terminated from program for not following through on services and/or treatment plan? / ☐Yes / ☐No
Does the project follow all Fair Housing laws? / ☐Yes / ☐No
Name of Project: / Click here to enter text.
Program Type: / Click here to enter text.
Does the project quickly move participants into permanent housing? / ☐Yes / ☐No
Does the project ensure that participants are not screened out based on…
  • Having too little or no income?
/ ☐Yes / ☐No
  • Having a criminal record with exceptions for state-mandated restrictions?
/ ☐Yes / ☐No
  • Active or history of substance abuse?
/ ☐Yes / ☐No
  • History of domestic violence (e.g. lack of a protective order, period of separation from abuser, or law enforcement involvement)?
/ ☐Yes / ☐No
  • Sexual orientation or gender identification?
/ ☐Yes / ☐No
Are clients evicted or terminated from program for not following through on services and/or treatment plan? / ☐Yes / ☐No
Does the project follow all Fair Housing laws? / ☐Yes / ☐No
Name of Project: / Click here to enter text.
Program Type: / Click here to enter text.
Does the project quickly move participants into permanent housing? / ☐Yes / ☐No
Does the project ensure that participants are not screened out based on…
  • Having too little or no income?
/ ☐Yes / ☐No
  • Having a criminal record with exceptions for state-mandated restrictions?
/ ☐Yes / ☐No
  • Active or history of substance abuse?
/ ☐Yes / ☐No
  • History of domestic violence (e.g. lack of a protective order, period of separation from abuser, or law enforcement involvement)?
/ ☐Yes / ☐No
  • Sexual orientation or gender identification?
/ ☐Yes / ☐No
Are clients evicted or terminated from program for not following through on services and/or treatment plan? / ☐Yes / ☐No
Does the project follow all Fair Housing laws? / ☐Yes / ☐No
Name of Project: / Click here to enter text.
Program Type: / Click here to enter text.
Does the project quickly move participants into permanent housing? / ☐Yes / ☐No
Does the project ensure that participants are not screened out based on…
  • Having too little or no income?
/ ☐Yes / ☐No
  • Having a criminal record with exceptions for state-mandated restrictions?
/ ☐Yes / ☐No
  • Active or history of substance abuse?
/ ☐Yes / ☐No
  • History of domestic violence (e.g. lack of a protective order, period of separation from abuser, or law enforcement involvement)?
/ ☐Yes / ☐No
  • Sexual orientation or gender identification?
/ ☐Yes / ☐No
Are clients evicted or terminated from program for not following through on services and/or treatment plan? / ☐Yes / ☐No
Does the project follow all Fair Housing laws? / ☐Yes / ☐No

Certification

Your signature below indicates that you are certifying that all information submitted in response to Exhibit 5 is correct and accurate.

Name, Title and Signature of Person who will complete the application:

______

Click here to enter text.SignatureDate

Name and Signature of Person authorized to sign the HUD application:

______

Click here to enter text.SignatureDate

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