Form C
Mecklenburg County Community Support Services
Housing Stability and Supportive Services Application
Agency:Address:
Director:
Agency Contact:
Phone Number: / Email:
Total Funding requested from County for this proposal / $
Please respond to the following areas in the space provided. You may refer to the Request for Proposals (RFP)for further information.
- Applicant Capacity and Experience
Describe your agency’s experience providing housing and/or services to the eligible population identified in this proposal. (This is the eligible population you selected on Form A.) Provide a brief history of your agency, including its purpose, current programs, and number of staff persons. Include outcomes for services that are provided to the identified eligible population.
- Capacity of Service Provider
Describe your agency’s experience and capacity to coordinate, provide, and/or act as a referral agent for community-based services that support persons of the identified eligible population. Identify a public agency or experienced service provider with which a written agreement has been executed to refer eligible persons and families for the eligible units. In addition, describe your agency’s internal monitoring or quality assurance process as part of delivering case management services to the program’s clients.
Partnership History
If partners are a part of your proposed project, provide information on your history collaborating with one another and how the partnership will facilitate a streamlined process for participants’ access to the housing and/or services being offered.
- Funding Request
Write the total amount you are requesting for providing Rapid Rehousing services. In the narrative box, explain how the funding will be used and whether all funding is required for your project to move forward. Explain how you propose to maximize or leverage existing or committed funding by pairing with the funding sources in this RFP. Supportive Service dollars must supplement and not supplant revenue such as rental assistance for your program/project.
In addition, please identify your source of rental assistance/subsidy in the narrative box provided.
Note: Please download the Supportive Service Dollars budget Excel form, complete the form and attach it to your RFP response. For a Rapid Rehousing intervention, please complete a budget for Year 1 and Year 2 in the spreadsheet. Funding renewal depends on recipient performance, funding availability and the eligible population served.
Write in your funding request:
Rapid Re-Housing – Case Mgmt. & Services $______
- Project Description
Indicate your agency’s commitment to receiving referrals only through Coordinated Entry and utilizing the designated Homeless Management Information System
Briefly describe how the supportive services are structured to meet the needs of the intended eligible population. Include a description of how this project provides an integrated housing solution for the identifiedeligible population. Describe how the project collaborates with the Continuum of Care planning process and state how this project uses the Housing First approach.
- Supportive Services Plan
Provide a detailed description of voluntary supports and services to be provided to residents, including the project’s referral, service plan, crisis intervention plan, client right’s, and other client-focused items. Explain how voluntary services will increase stability for participants. Explain how residents’ needs for services are identified and individual service plans are developed.
Also, provide information on how the project will help create linkages for participants to other resources in the community.
- Sustainability Plan
For the purposes of this proposal, housing is permanent and not transitional. Subsidies may be temporary. Describe this program’s sustainability planafter the duration of the funding period. State how your agency will ensure families maintain housing at the end of the subsidy.
County Funding Application – Must be completed to receive funding. Page 1