2017 EMERGENCY SOLUTIONS GRANT (ESG) Local Application Form (LAF)

Transcription

1 Please complete all areas that are shaded in gray below. If an attachment is required, it is noted by: Agency Name *Agency Authorized Signatory Project Name 217 EMERGENCY SOLUTIONS GRANT (ESG) Local Application Form (LAF) Project Type (ES, HMIS, RRH, Prevention, Street Outreach) ESG Project Request Amount Contact Person & Phone Contact Address Agency Mailing Address SECTION 1. MSHDA/HUD Threshold Requirements NOTE: Current Grantees answer 1A., 1G., 1H. and 1I. 1A. Agency and Project Eligibility The Executive of this agency states that this project is ESG eligible and agrees to comply with the MSHDA ESG Notice of Funding Availability (NOFA) and CoC Polices and Procedures. 1 Organizational Requirements (CoC has documents for current grantees) Our agency is a Non-Profit 51(c)3; our tax determination letter, incorporation papers, Board adoption of Opening Doors and Board rooster are attached or on file with the CoC. 1C. Grant Agreement Requirements (CoC has documents for current grantees) Our agency has a current Dun & Bradstreet, or D-U-N-S, Number, and System for Award Management (SAM) enrollments. 1D. Religious Requirements Does your agency agree not to discriminate against program beneficiaries on the basis of a religious belief, refusal to hold a religious belief or to participate in a religious practice? 1E. Fair and Equal Housing Does your agency agree not to discriminate based on race, color, national origin, religion, sex, disability, familial status, sexual orientation, gender identity, or marital status? 1F. Affirmatively Furthering Fair Housing (AFFH) Does your agency affirmatively further fair housing as detailed in 24 CFR (c), and ensure outreach is conducted to homeless who are least likely to request services? 1G. Agency Capacity & Financial Audit (CoC has documents for current grantees) Please provide/attach the most recent and board approved agency fiscal year audit to this LAF. If any deficiencies, provide a board statement explaining the steps being implemented to address them. Also attach the resume of your agency's financial director and or ESG finance staff. G:\Shared\CONTINUUM of CARE (CoC)\ESG Emergency Solutions Grant\ESG \Local Application Form (LAF)_RENEWAL_ESG final_15_jun_217 1

2 1H. Agency Monitoring Visits and Document Review Our agency agrees to host CoC monitoring visits at the shelter/administrative offices. Our agency has financial, fraud, procurement, personnel, privacy and IT polices and procedures. 1I. Staff Capacity & CoC Participation Please list the names of the staff person(s) that are assigned to this project as Housing Specialist and those that attend at least 5% of the regularly scheduled CoC committee meetings. HARA should also list staff who oversee the Homeless Preference List. HARA, please attach resume of Housing Specialist and staff that maintains the HCV homeless preference list. Housing Specialist: Data Committee Member: SOC Committee Member: Homeless Preference List: HARA SECTION 2. Budget, Funding Request and Match 2A. A 1:1 cash or in-kind (documented) grant match is required for the City s portion of the ESG funding. Funding requests are subject to the MSHDA NOFA, CoC Funding Polices and Procedures, and >$2,. ESG Line Item Amount Matching Amount Total Activity Request Amount Cash/In-kind Street Outreach Shelter Operation Rapid Re-housing Prevention HMIS (<3% of total) Admin Costs (<7% of total) Column Totals $ - 2B If a current grantee, please complete the following. Amount of % of Grant % Spent to Date Current Grant Undisbursed $ - $ - Timely Reports & disbursements? Plan to spend 1% of remaining funds? Section 3. Program Description and System Approached A. 3A. Program Description Please detail your ESG program model and any successful outcomes that are supported by data or the HMIS. Best Practices Housing Principles G:\Shared\CONTINUUM of CARE (CoC)\ESG Emergency Solutions Grant\ESG \Local Application Form (LAF)_RENEWAL_ESG final_15_jun_217 2

3 Which of the approaches below will be incorporated in to this project application? Check all that apply. Housing First Low Barriers to Entry including for those with no income Moving persons rapidly into housing <3 days C. Standardized Assessment Does your agency use and prioritize housing placement by utilizing a standardized assessment tool; VI-SPDAT, VI-Family, VI-Youth or other? List assessment tool if other than VI-SPDAT below. 3C. D. Coordinated Entry and Assessment Describe how your agency advertises access to housing services and your participation with the Coordinated Entry and Assessment processes. Please respond below. 3D. SECTION 4. A. Describe your agency's efforts to reduce the number of individuals and families who become homeless for the first time and how you identify risk factors of becoming homeless. 4A. Describe how your agency reduced the average length of time homeless and how you identify and house individuals and families with the longest lengths of time homeless. 4 C. Describe the strategies your agency implemented to identify and minimize returns to homelessness. 4C. D. Describe specific strategies your agency used to increase program participants' cash income from employment and non-cash sources. 4D. SECTION 5. A. Cost per Client: What is the annual cost of this project per client served? $ C. Ending Homelessness Resource Utilization Bed Utilization: Renewal Projects What is your annual bed utilization rate for this project? Number of Clients Served: Renewal Projects How many clients did you propose to serve with this project last year? How many clients did you actually serves with this project last year? SECTION 6. Homeless Management Information System (HMIS) NOTE: Current Grantees answer only 6D. % # # A. HMIS Participation Acknowledgement Does your agency currently, or are they willing to participate in the HMIS system and the community-wide QSOBAA to allow county-wide sharing within HMIS? Domestic Violence providers, enter "DV" if you agree to use a comparable, secure database. Data Quality DV? G:\Shared\CONTINUUM of CARE (CoC)\ESG Emergency Solutions Grant\ESG \Local Application Form (LAF)_RENEWAL_ESG final_15_jun_217 3

4 Does your agency review your HMIS data quality, at minimum, on a quarterly basis? C. Universal Data Elements Does your agency complete at least 9% of the Universal Data Elements' in HMIS? D. System Performance Measures If Rapid-Rehousing clients, enter % that entered from streets or shelter in last program year If Rapid-Rehousing clients, enter % that obtained units in last program year If Prevention or Rapid-Rehousing, enter % discharged to permanent housing in last program year If Shelter clients, enter length of stay for participants of last program year Section 7. Certification and Acknowledgement A. C. D. Our agency agrees that, in order to be eligible for Program Year ESG funding, it is our responsibility to electronically submit the completed LAF and any required attachments to the CoC; and further, that LAF must be received by the CoC (kroberts@lisc.org), on or before 12: PM, WEDNESDAY, JULY 5, 217. Our agency agrees that, if selected for funding, it is our responsibility to submit all related MSHDA Activity Tracking Tool (MATT) online application information to the CoC and Grant Fiduciary HRI (cindy@housingresourcesinc.org) no later than 12: PM, WEDNESDAY, JULY 12, 217. Failure to meet the deadline may result in the loss of ESG funding. Our agency agrees that, if selected for funding, it is our responsibility to submit monthly reimbursement requests with supporting reporting documents to the Grant Fiduciary HRI (cindy@housingresourcesinc.org) and further, that failure to submit complete reports by the deadlines could jeopardize this and future opportunities for funding. The applicant(s) hereby certify that all statements contained in this application are true and correct to the best of applicant(s) knowledge and belief; the CoC Allocations and Accountability Committee will rely on this certification when reviewing the application. This CoC Local Application Form (LAF) was completed by: Name Title Agency * The electronic submission of this LAF to the MI-57 CoC (kroberts@lisc.org) by July 5, 217, 12: pm, signifies the agreement to the statements herein and approval of this LAF submission by your agency's authorized signatory as listed on page 1 of LAF. G:\Shared\CONTINUUM of CARE (CoC)\ESG Emergency Solutions Grant\ESG \Local Application Form (LAF)_RENEWAL_ESG final_15_jun_217 4

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