Neighbors In Need Grant Application Form (1)


City of Boise
Housing and Community Development Division

Neighbors In Need Grant Program

Fiscal Year 2014 Application

Submission Deadline: March 28, 2013

Submit Electronically to

Late Applications Cannot Be Accepted

Cover Page
1. Applicant/Organization Name:
2. Address:
3. Mailing Address (If Applicable):
4. Address Of activity:
5. Head of Organization and Title:
6. Current director of the board name and contact (If Applicable):
7. Activity Title:
8. Grant Submission Contact Personand Title (Please Print):
9. Phone Number: ( ) 10. E-Mail Address:
11. Agency website:
12. Has theorganization previously received CDBG and/or Neighbors In Need Trust funding: Yes No
13. Is this a new activity for the organization: Yes No
14. Total operating budget for the agency / 15. operating budget for the proposed activity
$ / $
16. neighbors in need trust fund/cbdg funds requested for activity
$Please request one year of funding

17. Activity Summary: (Please Limit Activity Summary to One Page)

  1. Provide an overview of the activity to be funded and clientele to be served.
  1. Describe the specific services/activities of the proposal.
  1. Describe how the activity will be implemented.
  1. Describe how the agency will determine persons least likely to apply for housing and/or services provided by the proposed activity.
  1. Described the affirmative outreach efforts that will be made to those persons that are least likely to apply for services and/or housing provided by the proposed activity.
  1. Describe how persons with special needs, including chronically homeless (HUD definition) and persons with disabilities, will be assisted by the activity, and indicate how the activity will reduce any barriers to persons with disabilities.
  1. Is the physical location of the activity ADA accessible? If not, please describe how persons with physical disabilities will be assisted?

18. Priorities of the Consolidated Plan and Continuum of Care:

  1. Housing

Identify Census Tract(s) if specific

If scattered sites, identify how housing assistance and/or housing placement will be determined

Total Number of Households in Activity Benefit Area

Number of Minority Households in the Activity Benefit Area

Number of Households in Activity Benefit Area where

persons with disabilities reside.

Percentage of Low/Moderate Income persons in Activity Benefit Area

Average cost per person served

  1. Public Services

Describe Beneficiaries to be served

Estimate Unduplicated Number of Persons to be served

Average cost per person served

19. Goals and Outcomes:

A. Housing

What is the average length of time (estimated) until a household is stabilized?

Does the agency participate in the Homeless Management Information System?

(If applicable, applicants participating in the Homeless Management Information System willreceive priority consideration)

Does the agency provide supportive services to the household?

If so, is participation in the supportive services a condition of receiving housing assistance?

What is one additional measure the agency will evaluate to determine success of the activity?

How will the agency evaluate the additional measure?

B. Public Services

Does the agency participate in the Homeless Management Information System?

(Applicants participating in the Homeless Management Information System will receive priority consideration)

Does the agency provide supportive services directly to participants?

How will this activity complement or leverage efforts of other groups/agencies that are serving the same or similar populations?

How will this activity support participants to either be permanently housed or prevent homelessness?

Are there other community organizations that you will be directly collaborating with on this activity?

Will there be subcontracting of the activities proposed in this application?

What is one additional measure the agency will evaluate to determine success of the activity?

How will the agency evaluate the additional measure?

20. Need:

  1. Why has the agency chosen to address this particular need?
  2. How was the need identified?
  3. Is this a new need, an ongoing need or a need that has reappeared?

21. Capacity:

  1. Provide a brief summary of your agency’s history and mission.
  1. Does the applicant conduct outreach and contracting opportunities to women-owned and/or minority owned business entities, if applicable?

For definitions, please see

  1. Does the applicant conduct outreach and contracting opportunities to Section 3 business entities, if applicable?

For definition, please see

  1. Describe the capacity of your agency to undertake the proposed activity.
  2. Identify the personnel/positions involved and the qualifications of key personnel, including federal financial management capacity.
  3. How will you accurately track expenditures if funded by multiple sources?
  4. Is there a separation of duties for accounting in the organization?
  5. Does the agency receive more than $500,000 in federal funding?
  6. If the agency receives more than $500,000 in federal funding, when was the last A-133 Audit? Disclose any findings.
  7. If the agency does not receive more than $500,000 in federal funding, please describe how the financials are being audited and at what frequency?
  8. Does the agency have written financial policies and procedures?
  9. Has personnel attended Fair Housing Training in the past 12 months? If yes, indicate the date and staff by name and titlethat completed the training? If no, when and who will be designated to complete the training?
  10. Does the agency have any Fair Housing and/or Civil Right complaints pending with the federal government? If yes, what is the nature of the complaint and has it been resolved?
  11. Does the agency have a Limited English Proficiency (LEP) Plan in place? If yes, when was it last updated? If no, when will one be completed?
  1. Are vital documents used in administering the program to clients such as applications, policies, etc. translated into other languages?

If yes, identify the language(s)

  1. For agencies with more than 15 employees, has a Section 504 Coordinator been identified? If yes, identify the Coordinator’s name, title and contact phone number
  1. Has the agency conducted a Section 504 Assessment and developed a transition plan? If yes, when was the last assessment completed? If no, when will one be completed, if applicable

22. Leverage:

  1. Is the funding requested for:

Replacement funding, if yes, please identify which funds are being replaced:

New funding, if yes, please identify why the agency is seeking new funding:
Existing funding, if yes, please identify how much the agency has received in the prior year from Boise City Neighbors In Need and/or Boise CDBG funding:

Line Item Annual Budget Form

Please complete the budget form reflecting 12 months of income and expenses

______
Legal Name of EntityActivity

BUDGET ITEMS / TOTAL ACTIVITY COST / TOTAL NIN/CDBG REQUEST / OTHER
INCOME/
IN-KIND
SOURCES / DEFINE OTHER SOURCES AND AMOUNTS OF EACH SOURCE
PERSONNEL
Number of Employees & Job Title
Salaries Total
Fringe Benefits
PERSONNEL TOTAL / $ / $ / $
OPERATING COSTS
Supplies
Equipment
Rent/Lease
Insurance
Printing
Telephone
Travel
Training
Other (Define):
Other (Define):
Other (Define):
OPERATING TOTAL / $ / $ / $
ACTIVITY TOTAL / $ / $ / $

What percentage of your activity is comprised of this request?

What is the estimated number of years the agency has received funding from NIN/CDBG/HOME?

What is the estimated total funding (accumulative) your agency has received from NIN/CDBG/HOME?