Minnesota Department of Human Services Office of Economic Opportunity Agency Cover Page FY Address: City: Zip Code:

Transcription

1 Legal Name: Minnesota Department of Human Services Office of Economic Opportunity Agency Cover Page FY Address: City: Zip Code: Telephone: Grantee Web Site URL: Counties/Area Served: Federal ID Number: Contacts Executive Director: (Name) Telephone: Board Chair: (Name) Telephone: Fiscal Director: (Name) Telephone: Technology/MIS Director: (Name) Telephone: Fax: Congressional District(s): Legislative District(s): State Tax ID: Personnel Total Number of Employees: Full-time: Part-time/Seasonal: Number of Volunteers: Hours Volunteered: Is Grantee unionized? Grantee as a whole Certain programs only (list) Not unionized Fiscal Grantee s Fiscal Year: Date of Most Recent Audit: (Required) Name of Audit Firm: City and State: Board Approval Total Grantee Budget (Current Year): Next Audit Date: Telephone: Date Application approved by Grantee s Governing Board :

2 Form 1 Application Package for Homeless Programs Minnesota Department of Human Services Office of Economic Opportunity Program/Project Name(s): Continuum of Care Region(s): (Circle all that apply) Eligible Activities For the FY Biennium Contact Person: Address: Phone #: Fax #: Anoka Central Dakota Hennepin Northeast Northwest Ramsey St. Louis Scott-Carver Southeast Southwest Washington West Central Project Funding Request and Capacity Biennial (2 year) Funding Request 07/01/09 to 06/30/11 Annual Households served last year Annual Proposed Households to be served per year Daily Current Daily Capacity (Households) Daily Proposed Daily Capacity (Households) Homelessness Prevention Emergency Shelter (incl. Youth Shelter) Transitional Housing (incl. Youth TLP & Youth Supportive Housing) Support Services Only (incl. Youth/Adult Drop-In Center & Street Outreach Activities) TOTAL $ $ $ $ Summary of Proposed Homeless Program Activities Provide a brief description of the project(s) in the following space. Describe how the requested funds will be used. If applying for more than one activity, explain how activities funded by DHS-OEO will be coordinated. Indicate if funds will be used to maintain existing operations or services, to enhance the program, or to expand the capacity of the program. Be specific. FY Homeless Programs Application 2

3 Administrative Capacity Form 2 Describe the following: a. For each position involved in your program(s), you must include: The NUMBER of people who have held the position in the past 5 years. The NAME of the current person holding the position. Specific DUTIES of the position The PERCENT (%) of time in that position dedicated to the proposed activity(s) Educational BACKGROUND of persons holding the position, including training in: o social work o mental health o chemical dependency o family reunification (youth programs) o youth development (youth programs). b. Agency experience in providing proposed services. c. How your organization provides culturally appropriate services to participants and how your staff have been trained in cultural competency. d. All OEO-funded programs (except some youth Drop-In Centers and Street Outreach programs) are required to participate in Minnesota s Homeless Management Information System (HMIS). Describe your agency s state of HMIS implementation, including: Number of current staff trained in HMIS: FY Homeless Programs Application 3

4 Collaboration and Planning Form 3 a. Briefly describe the nature of your collaborations with other agencies in your community. How, specifically, have you ensured the coordination of services and engaged other community resources for your program(s). b. Briefly describe the need for each of the proposed homeless program activities for which you are requesting funds. Including relevant statistics and show how the program fits into your local continuum of care for the homeless. If you track the numbers of persons turned away from your program(s), include those figures here. If you do not track this, please explain why you do not. c. How critical is this funding to your agency for: 1) maintaining existing services and/or; 2) program expansion and/or; 3) creating a new program within your agency. d. Efforts to access other resources Please include any other funding sources, such as (but not limited to): Family Homeless Prevention and Assistance Program DHS Healthy Transition to Adulthood Program DHS or MHFA Ending Long Term Homeless Funding Other OEO funding Federal FYSB Runaway & Homeless Youth Act funding Private foundations SELF e. Does your agency have other funding sources which will allow you to continue serving clients for at least three months beyond the end of the FY2010-FY2011 biennium? Describe how, if at all, clients would continue receiving services after July 1, 2011 if a contract was awarded but had not yet been executed with DHS. FY Homeless Programs Application 4

5 Homeless Prevention Information Definition: Direct Prevention Assistance: Activities such as emergency mortgage, rental or utility assistance to keep persons at imminent risk of becoming homeless in their current living situation. Statewide Prevention: Activities provided by an organization on a statewide basis which are aimed at reducing the incidence of homelessness, alleviating the effects of homelessness, and developing long term solutions to homelessness. Priority will be given to applicants providing direct prevention assistance and to applicants from areas that do not currently have other homelessness prevention funding, such as Family Homeless Prevention and Assistance Program funds. The following funding source is available to fund this activity: Emergency Shelter Grants Program (ESGP) The Emergency Shelter Grants Program is a federal program administered by the Department of Housing and Urban Development (HUD). If an ESGP contract is awarded, all agencies will be required to provide a signed certification of consistency with the applicable Comprehensive Housing Affordability Strategy or Consolidated Plan. New programs will also be required to obtain Certification of Approval by Local Units of Government. Information on both certifications will be sent to successful applicants at a later date. Program Reporting Requirements: The OEO requires grantees receiving homeless prevention funds to participate in Minnesota s Homeless Management Information System (HMIS). HMIS is a web-based tool for managing information and providing services to persons experiencing homelessness. Grantees must complete the ESGP assessment within HMIS for all clients assisted through the ESGP program. The OEO does not access the HMIS system, so grantees must use HMIS to generate and submit the ESGP Quarterly Report to the OEO on a quarterly basis. Any new programs funded for the next biennium will be contacted by Wilder Research Center to begin the HMIS training and setup process, after the OEO has notified them of their award. For more information on HMIS, including forms, instructions, and agency agreements, visit the HMIS Minnesota web site, at: FY Homeless Programs Application 5

6 Direct Prevention Assistance Form 4 If you are applying for Direct Prevention Assistance funding, complete the following items: 1. After reading the regulations in Appendix IV, check the funding source(s) that you would accept: Emergency Shelter Grants Program (ESGP) HUD 2. What is the target population for your program? Include any outreach activities and your geographic service area. 3. Describe your program s eligibility requirements. Include any residency requirements. 4. List any program policies related to the amount and type of assistance. Describe how you take into consideration the participants housing affordability and on-going stability in determining who and how to assist. 5. Is there a case management component to your program? If so, please describe. (The definition of case management includes assessment, plan development, coordination of services and monitoring.) Also include: Purpose of Services Frequency of Contacts Participant to Staff Ratio (Only include the number (including fractions) of full-time position(s) dedicated to case management for this program) FY Homeless Programs Application 6

7 Direct Prevention Assistance Form 4 6. List any other supportive services your program will provide: 7. What arrangements has your program made to access services from other providers? Be specific about how participants access these services. 8. Describe the type and length of follow-up services provided to households receiving prevention assistance. 9. Describe your programs efforts to assist participants in accessing mainstream resources. Specifically address how your program assists participants to access the Food Support (Food Stamps) program. Include examples of how your program helps participants access these mainstream resources, or any established partnerships with an external provider. 10. If you operated a Prevention Program between July 1, 2007 and June 30, 2008: a. How many households did you serve? b. Of those in 10.a., how many were still in permanent housing 6 months after receiving assistance? c. Of those in 10.a., how many were not in permanent housing 6 months after receiving assistance? d. Of those in 10.a., how many were you unable to contact 6 months after receiving assistance? *** The Sum of 10b 10d must equal the number of Households in 9.a **** Did not operate a Homeless Prevention Program. FY Homeless Programs Application 7

8 Statewide Homelessness Prevention Form 5 If you are applying for Statewide Homelessness Prevention activities, describe your project below. Be specific about how your proposed activities would aim to reduce the incidence of homelessness, alleviate the effects of homelessness, or develop long-term solutions to homelessness. FY Homeless Programs Application 8

9 Emergency Shelter Form 6 Emergency Shelter Information Definition: Shelter: Emergency lodging provided on a short term basis (usually less than three months) with the purpose of providing a homeless individual or family with a clean, safe place to stay. Shelter providers should be able to offer residents access to supportive services, but residents may or may not be required to participate in a service plan. Shelter may be provided in a congregate, scattered site, or motel setting. Youth Emergency Shelter: Youth emergency shelter programs provide homeless youth and runaways with referral and walk-in access to emergency, short-term residential care. The program provides safe, dignified shelter, including private shower facilities, beds, and meals; and assists a runaway with reunification with the family or legal guardian when required or appropriate. The services provided at an emergency shelter include, but are not limited to: Family reunification services Recreational activities Individual, family, and group counseling Advocacy and referral services Assistance obtaining clothing Independent Living Skills training Access to medical and dental care and Aftercare and follow-up services mental health counseling Education and employment services Transportation Funding sources available to fund this activity: Emergency Shelter Grants Program (ESGP) The Emergency Shelter Grants Program (ESGP) is a federal program administered by the Department of Housing and Urban Development (HUD). If an ESGP contract is awarded, all agencies will be required to provide a signed certification of consistency with the applicable Comprehensive Housing Affordability Strategy or Consolidated Plan. New programs will also be required to obtain Certification of Approval by Local Units of Government. Information on both certifications will be sent to successful applicants at a later date. Emergency Services Program (ESP) The Emergency Services Program (ESP) was created by the 1997 Minnesota Legislature. The purpose of the ESP is to initiate, maintain, or expand programs providing emergency shelter and/or services to homeless persons. ESP funds can be used to meet the operation, administration and supportive services costs of shelter. Grantees are required to match the grant amount with $1 of non-state funds (including in-kind) for every $2 of grant funds. Program Reporting Requirements: The OEO requires grantees receiving Emergency Shelter funds to participate in Minnesota s Homeless Management Information System (HMIS). HMIS is a web-based tool for managing information about persons experiencing homelessness. Grantees must complete either the ESP or ESGP assessment within HMIS for all clients assisted with Emergency Shelter. Grantees must use HMIS to generate and submit one of the following reports depending on funding source awarded: ESGP Report (due quarterly) or ESP Report (due semi-annually). Any new programs funded for the next biennium will be contacted by Wilder Research Center to begin the HMIS training and setup process. For more information on HMIS, including forms, instructions and agency agreements, visit the HMIS Minnesota website at FY Homeless Programs Application 9

10 Emergency Shelter Form 6 If you are applying for Emergency Shelter funding, complete the following items: 1. After reading the regulations in Appendix IV, check the funding source(s) that you would accept: Emergency Shelter Grants Program (ESGP) HUD Emergency Services Program (ESP) State of Minnesota 2. What is the target population for your program? Include any outreach activities and your geographic service area. 3. What type(s) of facility(s) best describes your Emergency Shelter? (Check all that apply) Motel Vouchers Congregate Site Scattered Site Safe Home Host Home (Youth) 4. Hours of Operation for Emergency Shelter: 5. Describe your program s eligibility requirements. Include any residency requirements. 6. Does your program receive any other funding source (such as Group Residential Housing, Emergency Assistance, or MFIP EA, etc.) which shelter residents must qualify for in order to stay for free at your shelter? 7. List any program policies related to Length of Stay/Services and Termination: 8. What is the average length of stay in your emergency shelter program? 9. Describe any services to meet the basic needs of participants. FY Homeless Programs Application 10

11 Emergency Shelter Form a. Total Budget for Emergency Shelter Program (ALL SOURCES) $ (MUST match Total Emergency Shelter Project amount on Form 9: Revenue) b. Number of Households Program Can Serve Daily (From Capacity Chart) c. Number of Days in a Year 365 d. Considering ALL shelter program costs, what is the average Cost Per Household, Per Day? Use this formula: A B C = $ per HH/per day 11. Describe any case management your program will provide. The definition of case management includes assessment, plan development, coordination of services and monitoring. Also include: Purpose of Services Frequency of Contacts Participant to Staff Ratio (Only include the number (including fractions) of full-time position(s) dedicated to case management for this program) 12. List any other supportive services your program will provide: 13. What arrangements has your program made to access services from other providers? 14. Describe any permanent housing placement services offered through your program. 15. Describe any employment services that are available to your participants. 16. Describe your programs efforts to assist participants in accessing mainstream resources. Specifically address how your program assists participants to access the Food Support (Food Stamps) program. For Youth-Serving Programs: 1. Describe your emergency shelter s youth work philosophy (i.e. strength-based youth work): 2. Describe any aftercare of follow-up services provided to youth after they leave your emergency shelter: 3. What is the staffing pattern of your youth TLP or Supportive Housing program? (include details about day, evening and overnight shifts) FY Homeless Programs Application 11

12 Transitional Housing Information Definition: Transitional housing: Programs that assist families and individuals through the provision of housing and supportive services to attain and maintain permanent housing. Transitional housing residents: Pay at least 25% of their income for rent. Are required to work with program staff to accomplish goals set forth in a mutually agreed upon housing independence plan. Length of stay is limited to 24 months. Up to 10 percent of state funds can be used for stays longer than 24 months. (Programs must request DHS approval separately.) Are eligible for up to six months of follow-up services, including but not limited to, permanent housing placement costs, crisis assistance, and case management. In addition to the requirements stated above, transitional housing programs are expected to meet the best practice standards listed in Appendix II. Youth Transitional Living Program/Supportive Housing: Transitional living programs must help homeless youth and youth at risk of homelessness to find and maintain safe, dignified housing. The program may also provide rental assistance and related supportive services, or refer youth to other organizations or agencies that provide such services. Services provided may include, but are not limited too: Educational assessment and referrals to Referral for medical services or educational programs chemical dependency treatment Career planning, employment, work skill Parenting skills training and independent living skills training Aftercare and follow-up services Job placement Self-sufficiency support services Budgeting and money management Homeless prevention Counseling regarding violence, prostitution, substance abuse, sexually transmitted diseases, and pregnancy Funding sources available to fund this activity: Transitional Housing Program (THP) The Transitional Housing Program (THP) is funded by the Minnesota Legislature to provide transitional housing for homeless individuals and families and facilitate long-term independent living. THP funds can be used for the operation, administration and supportive services costs (including follow-up) associated with the provision of transitional housing. Emergency Shelter Grants Program (ESGP) The Emergency Shelter Grants Program (ESGP) is a federal program administered by the Department of Housing and Urban Development (HUD). FY Homeless Programs Application 12

13 Transitional Housing Information Program Reporting Requirements: The OEO requires grantees receiving funds for transitional housing to participate in Minnesota s Homeless Management Information System (HMIS). HMIS is a web-based tool for managing information and providing services to persons experiencing homelessness. Grantees must complete the THP assessment within HMIS for all clients assisted through their Transitional Housing program. The OEO does not have access to the HMIS system, so grantees must use HMIS to generate and submit one of the following reports depending on funding source awarded: THP Report (due annually) or ESGP Report (due quarterly). Any new programs funded for the next biennium will be contacted by Wilder Research Center to begin the HMIS training and setup process, after the OEO has notified them of their award. For more information on HMIS, including forms, instructions, and agency agreements, visit the HMIS Minnesota web site at : FY Homeless Programs Application 13

14 Transitional Housing Form 7 If you are applying for Transitional Housing funding, complete the following items: 1. After reading the regulations in Appendix IV, check the funding source(s) that you would accept: Transitional Housing Program (THP) State of Minnesota Emergency Shelter Grants Program (ESGP) HUD 2. What is the target population for your program? Include any outreach activities and your geographic service area. 3. What type(s) of facility(s) best describes your Transitional Housing/Youth Transitional Living Program? (Check all that apply) Congregate Facility Owned Leased Scattered Site Owned Leased Host Homes (Youth) 4. Are participants allowed to stay in their Transitional Housing/TLP unit at the end of their program stay? (i.e. turn-key or transition-in-place models) Yes No 5. Describe your program s eligibility requirements for participants (such as income, subsidy eligibility, sobriety, etc.) Include any residency requirements. 6. Describe your participant s Lease Agreements and Rental Subsidies provided. Include the amount or percent of income that participants pay for rent while in Transitional Housing/TLP. 7a. For Adult and Family Providers: Do you allow residents to have overnight guests in their unit? Yes, if same gender Yes, either gender Yes, with prior approval. No, no overnight guests permitted. 7b. Describe program policies related to overnight guests. Include: a) program rationale for implementing these policies b) the estimated impact of policies on residents length of stay and reasons for leaving FY Homeless Programs Application 14

15 Transitional Housing Form 7 8. List any program policies related to Length of Stay/Services and Termination: 9a. Do you anticipate that any Transitional Housing funds will be used for participants staying longer than 24 months? Yes No 9b. If Yes to 8a., how much funding do you anticipate will be used for participants staying longer than 24 months? $ / Biennium (2 years) 9c. If Yes to 8a., describe the circumstances under which you would grant a participant an extended-stay longer than 24 months: 10a. What is the average length of stay in your Transitional Housing Program? 10b. Is the average length of stay increasing or decreasing in your program? Describe any factors you believe contribute to this increase or decrease in length of stay. 11. a. Total Budget for Transitional Housing Program (ALL SOURCES) $ (must match Total Transitional Housing Project Budget on Form 9: Revenue b. Number of Households Program Can Serve Daily (from Form 1: Capacity Chart) c. Number of Days in a Year 365 d. Considering ALL program costs, what is the average Cost Per Household, Per Day? Use this formula: A B C = $ per HH/per day 12. What arrangements has your program made to access services from other providers? Transitional Housing - Best Practices Describe how your program will incorporate each of the Best Practices for Transitional Housing described below; Outreach/Intake 1. Programs should recruit participants from the neediest population, including local shelters. What percentage of participants come from Emergency Shelter? FY Homeless Programs Application 15

16 Transitional Housing Form 7 2. Programs should make efforts to collaborate with correctional, mental/chemical health, and child welfare systems to improve discharge planning in their community. Case Management* ** Any Transitional Housing Program that plans to use an external agency to provide the majority of its case management services MUST attach (to your hard copy submission) a Memorandum of Understanding signed by the applicant and its service provider. (An MOU is not required for most partnerships only those intended to be a substitute for regular, on-going case management.) 3. Programs must assess participants barriers to obtaining permanent housing and, in consultation with the participant, enter into a structured plan to achieve that goal. 4. Meetings between program staff and participants should be regular and as often as is deemed appropriate, to ensure that participants are able to successfully complete the program. Include: Frequency of Contacts Number of Households on each case managers THP/TLP Case Load Number of Households from other programs on each THP/TLP Case Manager s case load (e.g. FHPAP, PSH, etc.) 5. Transitional Housing Programs should balance the provision of mandated services with the goal of providing a supportive environment for persons experiencing homelessness. Describe how staff seek to motivate participants to succeed through engagement strategies, or other client-centered approaches. 6. Participants should be assisted in accessing necessary services, including but not limited to child care, transportation, health care, mental health care, substance abuse treatment, job training and placement, education, budget counseling, tenant/landlord education, or homeownership training. 7. Programs serving families with children should strive to mitigate the impact of homelessness on children. Examples include, but are not limited to: collaboration with Head Start or other early childhood programs, advocacy for services in schools, special THP programming (recreational or therapeutic), or efforts to link families with providers of children s mental health screening or services. FY Homeless Programs Application 16

17 Transitional Housing Form 7 8. Programs should provide services to assist participants in locating, attaining, and maintaining permanent housing (or stable housing for youth), including housing search assistance, moving assistance, furnishings, first month s rent/damage deposit. 9. Follow-up services to prevent a return to homelessness should be provided for a period of six months after a participant has exited the program. 10. Programs should establish and measure performance indicators and conduct a follow-up evaluation to assess ex-participants housing status six months after leaving the transitional program. 11. A primary goal of Transitional Housing is to assist household in achieving greater self-sufficiency. Increasing household income is a key step in achieving this goal. 12. Describe your programs efforts to assist participants in accessing mainstream resources. Specifically address how your program assists participants to access the Food Support (Food Stamps) program. What percentage of eligible families receive Food Support benefits while in your program (or upon exit)? Include examples of how your program helps participants access these mainstream resources, or any established partnerships with an external provider. For Youth-Serving Programs: 1. Describe your emergency shelter s youth work philosophy (i.e. strength-based youth work): 2. Describe any aftercare of follow-up services provided to youth after they leave your emergency shelter: 3. What is the staffing pattern of your youth TLP or Supportive Housing program? (include details about day, evening and overnight shifts) FY Homeless Programs Application 17

18 Transitional Housing Form 7 Program Outcomes If you are applying for Transitional Housing funding, complete the following: For existing grantees, these figures must be consistent with HMIS reports submitted to the OEO: Between July 1, 2007 and December 31, 2008: 1. How many households exited (for any reason) from your program? (#) 2. Of the households in #1 (total exited), how many obtained permanent housing upon exit? a) (#) b) (%) (2a 1a) 4. Of the households in #1 (total exited), a) How many exited the program more than six months ago? (#) b) Of the households in 4a, six months after exiting the program, how many: Were in permanent housing (#) (%) Were not in permanent housing (#) (%) Unable to contact upon follow-up (#) (%) (These answers MUST total 100 percent) 5. Of the households in #1 (total exited), how many: a) Had an increase in income between program entry and exit? (#) (%) b) Had a decrease in income between program entry and exit? (#) (%) c) Had no change in income between program entry and exit? (#) (%) (These answers MUST total 100 percent) 6. Of the households in #1 (total exited), how many were employed at: a. Program Entrance (#) (%) b. Program Exit (#) (%) FY Homeless Programs Application 18

19 Support Services Only Form 8 Definition: Support Service Only: Projects that provide supportive services to homeless persons, but do not provide shelter or rental assistance are called supportive services only projects. Examples include, but are not limited to, Drop-In Centers and Street Outreach. In these non-residential programs, participants may be provided with supportive services to assist them in securing permanent housing. Supportive services might include the following: Case Management Transportation Heath Care Mental Health Care Substance Abuse Treatment Moving Assistance First Month s Rent and Damage Deposit Voice Mail Outreach Drop-in Center Food Child Care Youth Drop-In Centers: Youth drop-in centers must provide walk-in access to crisis intervention and ongoing supportive services including one-to-one case management services on a self-referral basis. Youth Street Outreach: Street and community outreach programs must locate, contact, and provide information, referrals and services to homeless youth, youth at risk of homelessness, and runaways. Information, referrals, and services provided for both Drop-In and Street Outreach may include, but are not limited too: Family reunification services Homeless prevention Conflict resolution or mediation Aftercare services counseling Assistance in obtaining emergency Assistance in obtaining food, clothing, Shelter medical care, or mental health counseling Counseling regarding violence, Assistance with education, employment and prostitution, substance abuse, sexually independent living skills transmitted diseases, and pregnancy Counseling regarding violence, prostitution, substance abuse, sexually transmitted diseases, and pregnancy Funding sources available to fund this activity: Emergency Shelter Grants Program (ESGP) Specialized services for highly vulnerable runaways and homeless youth, including teen parents, emotionally disturbed and mentally ill youth, and sexually exploited youth The Emergency Shelter Grants Program (ESGP) is a federal program administered by the Department of Housing and Urban Development (HUD). If an ESGP contract is awarded, all agencies will be required to provide a signed certification of consistency with the applicable Comprehensive Housing Affordability Strategy or Consolidated Plan. New programs will also be required to obtain Certification of Approval by Local Units of Government. Information on both certifications will be sent to successful applicants at a later date. FY Homeless Programs Application 19

20 Support Services Only Form 8 Emergency Services Program (ESP) The Emergency Services Program (ESP) was created by the 1997 Minnesota Legislature. ESP funds can be used to fund the operation, administration and supportive services costs of projects serving homeless persons. Grantees are required to match the grant amount with $1 of non-state funds (including in-kind) for every $2 of grant funds. Program Reporting Requirements: The OEO requires grantees receiving Support Services Only funds are required to participate in Minnesota s Homeless Management Information System (HMIS). HMIS is a web-based tool for managing information and providing services to persons experiencing homelessness. Grantees must complete either the ESP or ESGP assessment within HMIS for all clients assisted under Support Services Only projects. The OEO does not have access to the HMIS system, so grantees must use HMIS to generate and submit one of the following reports depending on funding source awarded: ESGP Report (due quarterly) or ESP Report (due semi-annually). Any new programs funded for the next biennium will be contacted by Wilder Research Center to begin the HMIS training and setup process, after the OEO has notified them of their award. For more information on HMIS, including forms, instructions and agency agreements, visit the HMIS Minnesota website at FY Homeless Programs Application 20

21 Support Services Only Form 8 If you are applying for Support Services Only funding, complete the following items: 1. After reading the regulations in Appendix IV, check the funding source(s) that you would accept: Emergency Shelter Grants Program (ESGP) HUD Emergency Services Program (ESP) State of Minnesota 2. What is the target population for your program? Include any outreach activities and your geographic service area. 3. Where will persons typically be spending the night while receiving these services? 4. Hours of Operation for Support Services (including Drop-In Center and Street Outreach Hours): 5. Describe what services your program or center will provide to meet the basic needs of participants. 6. Describe any case management your program will provide. The definition of case management includes assessment, plan development, coordination of services and monitoring. Also include: Purpose of Services Number of Households on each case managers case load 7. List any other supportive services or positive social activities your program will provide on-site. Or, describe how your program will provide referrals for needed services (i.e. mental health, shelter, etc.): 8. What arrangements has your program made to access services from other providers? Be specific about how participants will access these services. 9. Describe any permanent housing placement services offered through your program. FY Homeless Programs Application 21

22 Support Services Only Form Describe any employment services that are available to your participants, and how participants access these services. 11. Describe your programs efforts to assist participants in accessing mainstream resources. Specifically address how your program assists participants to access the Food Support (Food Stamps) program? Include specific examples of how your program helps participants access these mainstream resources, or any established partnerships with an external provider. For Youth Street Outreach Programs Only 1. Describe the approach that your street outreach workers use to engage youth: 2. Describe the youth work philosophy that your street outreach program uses (i.e. strength-based youth work, harm reduction, etc.): For Youth Drop-In Centers Only 3. Describe the approach and youth work philosophy that your Drop-In Center uses to engage youth (i.e. strength-based youth work, harm reduction, etc.): 4. Describe the intake process at your Drop-In Center: 5. What is the staffing structure for your youth drop-in center? FY Homeless Programs Application 22

23 Revenue and Other Sources of Support Form 9 List all anticipated or secured revenue and other sources of support, by program activity, for the grant period. Be specific including the name of each funding source (i.e. Group Residential Housing, Federal RHYA funds, etc.) You may add lines to the funding tables, if necessary, to describe all sources. Be sure to include any DHS/OEO funds you are applying for. Homelessness Prevention Source Total Homeless Prevention Project Budget: Amount Year 1 Amount Year 2 (projected) Year 1 Secured? Emergency Shelter (Including Youth Emergency Shelter) Source Total Emergency Shelter Project Budget: Amount Year 1 Amount Year 2 (projected) Year 1 Secured? Transitional Housing (Including Youth TLP & Youth Supportive Housing) Source Total Transitional Housing Project Budget: Amount Year 1 Amount Year 2 (projected) Year 1 Secured? Supportive Services Only (Including Youth Street Outreach & Drop-In Centers) Source Amount Amount Year 2 Year 1 Year 1 (projected) Secured? Total Supportive Service Only Project Budget: FY Homeless Programs Application 23

24 Revenue and Other Sources of Support Form 9 FY Homeless Programs Application 24

25 Homeless Programs Budget (2 Year) Form 10 SFY Homeless Programs BIENNIAL (2 Year) BUDGET LINE ITEMS Homelessness Prevention Emergency Shelter incl. Youth Shelter Transitional Housing incl. Youth TLP & Youth Supportive Housing Support Services Only incl. Youth Drop-In Centers & Street Outreach A. Personnel B. Fringe C. Travel D. Equipment E. Supplies F. Contractual G. Other TOTAL FUNDS REQUESTED $ $ $ $ FUNDING BY CATEGORY CATEGORIES Homelessness Prevention Emergency Shelter incl. Youth Shelter Transitional Housing incl. Youth TLP & Youth Supportive Housing Support Services Only incl. Youth Drop-In Centers & Street Outreach Administration (10% limit) Operations Support Services Emergency Rental, Mortgage, Utility Assistance TOTAL FUNDS REQUESTED $ $ $ $ FY Homeless Programs Application 25

26 Budget Support Data Part I Personnel & Fringe (A-B) Form 11 Use this form to explain: Personnel and Fringe Benefits Amount or Value of Line Item TITLE OR POSITION (PAID PERSONNEL) Homelessness Prevention Emergency Shelter incl. Youth Shelter Transitional Housing incl. Youth TLP & Youth Supportive Housing Support Services Only incl. Youth Drop-In Centers & Street Outreach Subtotal (this page) (use continuation sheets) Total *This form replaces the Budget Narrative used in previous biennial funding applications FY Homeless Programs Application 26

27 Budget Support Data - Part II (Categories C-G) Form 12 Use this form to explain: Budget Categories C-G (incl. other) Amount or Value of Line Item Line Item Form 10 c-g Descriptions of Item and Basis for Valuation Homelessness Prevention Emergency Shelter incl. Youth Shelter Transitional Housing incl. Youth TLP & Youth Supportive Housing Support Services Only incl. Youth Drop-In Centers & Street Outreach Subtotal (this page) (use continuation sheets) Total *This form replaces the Budget Narrative used in previous biennial funding applications FY Homeless Programs Application 27