Has your organization received funding previously from the City of Winston-Salem? Yes If so, how many years? Five years.

Has your organization received funding previously from the City of Winston-Salem? Yes If so, how many years? Five years. 2

Section 2: Funding Request Summary A. Name of program, project, or activity for which funding is requested. NABVETS is a Veterans Services Organization who primarily processes Veterans benefit claims that come into our office and referred. B. Provide a concise description of the proposed project/program, showing the amounts of City fund by cost item. Is this a capital or operating project/program? What are the goals/objectives of this project/program? Operating Budget: Facility Rent= $5,300.00, Training and Conference Registration= $1200.00, Membership Dues= $300.00, Travel and Transportation= $900.00,Telephone/Utilities=$1580.00, Veterans Programs=$900.00 (Honors Day Program, Seminars, trainings, NABVETS quarterly regional meetings, and etc.). C. Please provide your project/program location. (The project/program location need not be provided if it is a confidential location, such as a facility for victims of domestic violence.) NABVETS Chapter #0057 is located at 1530 Martin Street Suite 205 A, Winston-Salem, NC 27103. Section 3: Organizational Capacity (25 points) Demonstrate the capacity for carrying out the proposed program or for completing the project. NABVETS Chapter #0057 is a local recognized and National Organization that is authorized by the Secretary of Veterans Affairs in the preparation and prosecution of claims under laws administered by the Department of Veterans Affairs. That is under the prosecution of claims for VA benefits (38 U.S.C 5902). We have 4 certified volunteer VSO Counselors on the Winston-Salem NABVETS Chapter Staff, which will provide strategic advocacy on behalf of its membership and veterans being served with Congress, the Federal Administration, State Administration and other local agencies and organizations. Is this project/program consistent with the mission of the organization? Yes Will the history, experience, and function of the organization contribute to the project/program s success? NABVETS service officers will counsel with Veterans on their claims on a continuous basis and advise the Veteran of services that are available according to their needs. NABVETS will facilitate employment, claims and other seminars and trainings for Veterans. We continue to support the needs of our local Veterans regarding linking and making referrals to Therapeutic supportive entities for Veterans who suffer from substance, mental, or other health illnesses. Are organizational structure and human resources appropriate to support the project/program? The VSO Counselors are trained and have been provided with the necessary information on the local and National levels to assist Veterans with various needs. Does the organization have the ability to start and finish the project/program in a timely and effective manner? Yes Will collaboration contribute to the success of the project/program? Yes, which is why we continue to collaborate with Goodwill, Urban League, and other local entities within the Winston-Salem community ongoing that provide support based on other needs that might arise with Veterans. 3

A. Mission (5 points) (1) Please provide an overview of the organization. Include the organization s mission statement and the major services, programs, and activities provided. How does the proposed project/program help advance the mission of your organization? The purpose of NABVETS is to improve the social, educational, economic, health and well being of all veterans. On an ongoing basis NABVETS will provide strategic advocacy on behalf of all its membership with congress, the Federal Administration, state Administration and other agencies and organizations. The Winston-Salem NABVETS CHAPTER #0057 will be consistent in the holistic approach to the mission of NABVETS. NABVETS Chapter #0057 will collaborate with local agencies and organizations to deliver quality service to veterans; assist in filing of claims, disseminate up to date information of legislative reforms, outreach to the homeless and low income veterans, advocate on behalf of the veterans on a local, state and federal level and treat all veterans with the respect and dignity they deserve. NABVETS efficiently and effectively provides Management services and claims processing on behalf of all Veterans that come into our office or referred. We assist veterans with filing for disability claims, pension reimbursements, discharge upgrades, Veteran Appeals, homelessness, unemployment and other needs that might arise with the veterans. Our four certified volunteer Veterans Service Officers provide the best quality services available with the certified training received ongoing from the local Federal Veteran Affairs Office. (2)How does your organization benefit and serve the City of Winston-Salem and its citizens? NABVETS provides training for the unemployed veterans and support for many of our homeless and medically disabled veterans. NABVETS also assist in all veterans in the processing and upgrading for their claims. We have four certified VSO counselors who write the veterans claims that we service. NABVETS is also located in the Regional VA administrational office room 429. (3)How did your organization decide to take on this project/program and request this funding? NABVETS has provided an ongoing need which has provided services to our Veterans that has helped to bridge the gap regarding helping our Veterans in need of claims and other services. NABVETS consistently coordinates with other agencies that provide services to all diverse populations of Veterans throughout Forsyth County. B. Function (5 points) (1) How long has your organization been in operation? NABVETS was founded in 1972. The Winston-Salem NABVETS Chapter #0057 has successfully been in operation since December 02, 2008. 4

(2) Use the chart below as a template to list facilities, services, and programs you currently operate and provide. Performance measures should include information such as location, type of facility or program, number of persons served, and length of years in service. Performance Information by Activity Activity: General Goals: 1. NABVETS provides programs that assist veterans with completion and processing of their claims. 2. NABVETS operates a non-profit organization which helps to enhance the quality of life and increase employability of veterans through coordination and facilitation with Urban league, Good Will and other local entities and the Regional Veterans Administration Office. PERFORMANCE MEASURES Actual FY 15-16 Objective FY 16-17 Projected FY 16-17 Objective FY 17-18 Effectiveness: List measures 71 93 98 101 Efficiency: List measures 32 34 49 53 Workload Indicators: List measures 72 72 101 90 FY 16-17 Program Accomplishments: NABVETS Annual Honors Day Program for Veterans March 3, 2016; Annual Cookout for Veterans June 16, 2016; Participated in eight VSO Trainings with the Regional Office this year; Collaborated with mental health entities in order to help veterans with PTSD and other mental health illness. Held employment seminars for unemployed veterans through collaboration with Urban league other local entities that helped to foster connections with our local veterans. Held seminar with the Veterans Affairs office to educate and help impact our local veterans and their families. FY 17-18 Key Objectives: Provide ongoing collaboration with mental health entities in order to continue helping Veterans with PTSD and other mental health illness. Hold employment seminars for unemployed veterans and continue to collaborate with Urban league, Good Will, and any other local entities. Hold seminars on legislation impacting veterans and their families. Hold seminars for post 9/11 veterans and families on their educational opportunities and other benefits. Hold small business seminars for veterans seeking entrepreneurial opportunities. Hold seminars for veterans transitioning back into civilian life. C. Structure (5 points) (1) Describe the management structure and staffing of your organization. Include or attach an organizational chart. Please also include a list of all executive staff and their compensation (other than per diem). There are no executive staff compensations because we at NABVETS are all non-paid VOLUNTEERS. (2) Attach resumes for key personnel who will be involved in the proposed project/program. For planned new positions, attach job descriptions. Indicate the amount and proportion 5

of time (weekly or monthly) that each position will be allocated to the activity proposed to be funded. Attached are the resumes for Commander Corinthian Fields Jr., Secretary Joy Samuels, and Vice-Commander Chrisma Brock. Position Title Total Hours/Week Worked % of hours proposed to be funded NABVETS VSO COUNSELORS NON PAID VOLUNTEERS ZERO=0 6

(3) What type and quantity of key work activities will be performed by staff proposed to be funded during the year? Use the table below. Projected Objective Staff Position Title Activities/Inputs Actual Level Last Year Current Year Next Year 1. Ex: Case Worker 1.Ex: Process Permanent Housing 1. Ex: 40 placements 1. Ex: 42 placements 1. Ex: 48 placements Placements 2. Ex: Case Worker 2. Ex: Weekly meetings with clients 2. Ex: 500 face to face meetings last year 2. Ex: over 500 meetings projected 3. Ex: over 500 meetings projected (4) Please complete the Diversity of Employment and the Employment Profile below. Diversity of Employment Information Organization Name: NABVETS Describe the hiring process and how it is structured to provide the most diverse candidacy pool: We seek diverse individuals as volunteers from all segments of the Winston-Salem community, business, local entities, and public or private sectors. Position Title Not APPLICABLE TO OUR SERVICE ORGANIZATION # of Open Positions in FY 16-17 # of Applicants Percent of Minority Applicants # of Applicants in Final Interview # of Minority Applicants in Final Interview 7

Date Filed: Not applicable to NABVETS volunteer VSO counselors a. Full-Time Positions and Employees Employment Profile Total Positions Current Employees - Male Current Employees - Female 15-16 16-17 17-18 White Black Other White Black Other Officials/Managers Professionals Technicians Sales Workers Office/Clerical Craft Workers (Skilled) Operatives (Semi-Skilled) Laborers (Unskilled) Service Workers Total Full-Time b. Temporary/Part-Time Positions (FTE) and Employees Total Positions Current Employees - Male Current Employees - Female 15-16 16-17 17-18 White Black Other White Black Other Officials/Managers 8

Professionals Technicians Sales Workers Office/Clerical Craft Workers (Skilled) Operatives (Semi-Skilled) Laborers (Unskilled) Service Workers Total Part-Time/Temp. If additional employees are to be hired for this project, indicate goals for: Blacks Females (Signature of Authorized Official) (Title) D. Ability (5 points) (1) Explain your organization s experience and ability to implement, administer, and manage the proposed project/program. NABVETS Chapter #0057 has successfully been in operation since December 02, 2008. NABVETS is a local recognized and National Organization that is authorized by the Secretary of Veterans Affairs in the preparation and prosecution of claims under laws administered by the Department of Veterans Affairs. NABVETS is under the prosecution of claims for VA benefits (38 U.S.C 5902). We have 4 certified volunteer VSO Counselors on the Winston-Salem NABVETS Chapter Staff, which will provide strategic advocacy on behalf of its membership and veterans being served with Congress, the Federal Administration, State Administration and other local agencies and organizations. NABVETS has eight years of management of VSO counselors and volunteers and successfully implementing and administering the proposed project and program regarding veterans claims, veteran homelessness, 9

benefits, coordinating, and linking veterans ongoing to other local entities and programs that provide for their needs. (2) Describe the implementation or operational plan to get the proposed project/program up and running in a timely manner. Describe any key contingencies on which the startup depends. Please include maps, milestones, etc. NABVETS Chapter #0057 in Winston- Salem has successfully been in operation for eight years. We continue to maintain operational functioning by providing ongoing services to veterans regarding their claims to the Veterans Administration and receiving updated training from the Regional Federal Veterans Affairs Office. NABVETS maintains successful partnerships and collaborations with local community entities, mental health agencies, Urban league, Good will industries, and other veteran organizations, and the Regional Veteran Affairs Office. (3) Describe the organization s experience with compliance with government regulations, monitoring, and reporting. NABVETS is a local recognized and National Organization that is authorized by the Secretary of Veterans Affairs in the preparation and prosecution of claims under laws administered by the Department of Veterans Affairs. That is under the prosecution of claims for VA benefits (38 U.S.C 5902). We have 4 certified volunteer VSO Counselors on the Winston-Salem NABVETS Chapter Staff, which will provide strategic advocacy on behalf of its membership and veterans being served with Congress, the Federal Administration, and State Administration. NABVETS service officers have continued training and updates pertaining to processing and facilitation of claims through the Federal Veterans Affairs Office. (4) Collaboration (5 points) Describe any specific collaborative relationships with other organizations (public or private) and how they will impact the project/program. How will collaboration contribute to the planning, implementation, operation, oversight, and performance measurement of the proposed project/program? NABVETS continue to collaborate with local and Therapeutic entities in order to continue with helping improving the quality of life for our local Veterans and their families. NABVETS maintains successful partnerships and collaborations with local community entities, mental health agencies, Urban league, Good will industries, and other veteran organizations, and Veteran Affairs Office. These collaborations continue to help to keep our veterans connected in our community and this impact helps to foster positive growth in the lives of the veterans that we continue to serve. Section 4: Strategy (20 points) Does the project/program help the community meet strategic objectives? Yes Does the proposal establish the need and potential benefits? Yes Is the proposal consistent with relevant plans and strategies? Yes Has the project/program had prior successful performance? Yes, NABVETS chapter #0057 has successfully 10

been in operation for the last eight years as a claims service organization in Winston-Salem, Forsyth County. A. Need (5 points) (1) Describe the population(s) to be served. Veteran Describe the key demographic and economic characteristics of the clients to be served. Veterans throughout the Winston- Salem, Forsyth County area of all ethnicity and all socio-economic groups. (2)Describe the unmet need that the proposed project/program seeks to address. NABVETS seeks to continue with bridging the gap regarding processing veteran s claims and upgrades for their benefits. Why the population does described above need the proposed assistance? Include data supporting the need. NABVETS is assisting the Regional Veteran Affairs office with assisting our local veterans with processing their claims. NABVETS chapter #0057 continues to address an ongoing need with veteran s benefits across areas the local, state, and national regions. NABVETS continue to help the local veterans with employment training and assistance with medical and mental health assistance and addressing their social needs through collaborations with our local Winston-Salem agencies and entities. (1) What will be the proposed project/program s function or purpose in the community? NABVETS has helped to increase the processing of claims benefits for our local veterans. Also, has helped to increase the employment for our local veterans. NABVETS continues the efforts with assisting some of our homeless veterans with gaining shelter/residence. NABVETS serves to link, facilitate, and coordinate with other local agencies that helps veterans with medical, mental, and other needs. If the need is addressed, what will be the outcome for the community? NABVETS will help bridge the employment gap for our local veterans. NABVETS will help bridge the gap regarding the homeless veterans and increase veterans with receiving their claims and benefits. NABVETS remains as an intricate reference to local agencies to address our local veterans with other service related needs. What will happen if the proposed project/program is not funded? NABVETS VSO are still certified and have great relationships with the local entities hence will still be able to perform processing claims but it can limit the ability to provide these services to many of our local veterans. What will happen if the proposed service is not provided? NABVETS VSO ability will be hindered regarding the continuation of processing the veteran s claims; and it will impact the quality of services delivered to the number of veterans that will be able to be reached in the Winston-Salem, Forsyth County community if our services are not provided. (2) What benefits will be derived by clients? The Veterans will derive benefits through employment opportunities which will impact and increase their income positively, improvements regarding the quality of their life for veterans, and decrease the homelessness veteran s population. The derived benefits with the veterans will Decrease in re-entry of veterans being imprisoned due to: various illnesses, lack of income, and being homeless. 11

(2) A. Strategy (10 points) Described how your project/program is consistent with the goals of the City of Winston-Salem. Describe how your project/program will be consistent with any other agency or community plans (i.e Winston-Salem/Forsyth County Consolidated Housing and Community Development Plan, Public Transit-Human Service Transportation Plan, etc.). NABVETS promotes and stimulates the economic growth for all of our local veterans that utilize our services in the city of Winston-Salem and Forsyth County. NABVETS Chapter #0057 has successfully been in operation for eight years. We continue to maintain operational functioning by providing ongoing services to veterans regarding their claims and upgraded benefits. The Regional Veterans Administration Office provides updated training through the local Federal Veterans Affairs Office which helps NABVETS stay updated on the current regulations regarding the claims process and other benefits impacting veterans. NABVETS continues to maintain successful partnerships and collaborations with local community agencies, entities, mental health agencies, Urban league, Good Will industries, and other veteran organizations, and the Regional Veteran Affairs Office which all of us through collaboration provide support in order to provide a better quality of life for our local veterans. 12

B. Performance (5 points) (1) Please complete the table below to show up to ten years of achievements, based on the objectives that are stated for the proposed project/program in Section 2 B of this application. Year Funding Source Funding Amount Objective Example: $10,000 Of 30 households served,20 2013 (67%) obtained housing within 30 days 2011 City of WS $10,000 Serviced 20 Veterans 2012 City of WS $10,000 Serviced 30 Veterans 2013 City of WS $10,000 Serviced 32 Veterans 2014 City of WS $10,000 Serviced 35 Veterans 2015 City of WS $10,000 Serviced 54 Veterans 2016 City of WS $10,000 Serviced 75 Veterans Actual Achievement Of 33 households served, 24 (72%) obtained housing within 30 days (2) Identify performance measures to track the effectiveness of the project/program. Explain the plan for monitoring and evaluating the service. NABVETS tracks the constituents/veterans through the sign in sheets and files sent by the Federal Veterans Administration. Also include the steps that will be taken if original goals are not achieved. NABVETS will continue to collaborate with local Winston-Salem community agencies and entities, walk ins, Regional Veteran Affairs office referrals in order to continue assisting the veterans within our local community. Section 5: Project Approach and Design (15 points) Does the proposal present a sound approach for the delivery of the services? Yes Will the program design engage the intended beneficiaries? Yes Is the project/program based on best practices? Yes Is the data system adequate to manage the project/program and track and report performance? Yes Is the proposed project/program unduplicated? Yes A. Approach (5 points) (1) Describe outreach and marketing to be conducted to engage and promote participation in the proposed project/program. NABVETS will continue to host various programs and seminars that will continue to educate our local veterans about the claims process, employment opportunities, PTSD and other mental and physical illnesses and collaborations that will continue to help foster growth in these areas. (2) How will a participant access the proposed project/program, use the services, and derive a beneficial outcome from participation? Any veterans or supporters are able to access NABVETS through our monthly meetings and other events that we host or collaborate 13

with in the Winston-Salem, Forsyth County community. Through their participation, receiving services, the veterans and their families will benefit from our program. (3)How many participants on average will be served at any one time? With NABVETS having four VSO counselors we will see on an average of about 20 veterans weekly. What is the maximum number that can be served at any one time? NABVETS will be able to provide service of this quantity if all four VSO volunteers counselors are available up to four at a time. B. Best Practices (3 points) (1) Describe any known, successful models on which the proposed project/program is based. Compare and contrast the proposed project/program to those models. Our success at NABVETS has been through the successful processing of our local veterans claims and upgraded benefits and them receiving their benefits. NABVETS is visible and has sustained great relationships with our local collaborations and partnerships with other agencies and entities. This has helped to positively impact and increase the number of veterans we are able to service in all areas. Also, our ability to recruit veterans and nonveteran supporters into our local NABVETS Chapter #0057continues to be another important factor in the success of our local chapter program. (2) Describe any proposed use of innovative approaches that will be employed for this project/program. Discuss what is innovative about the approach. NABVETS will continue to employ our various seminars which will continue to maintain the connection and bridging the educational gap regarding reaching our local veterans and what benefits and programs that are available to them. Also, NABVETS which is primarily a Veterans Claims Organization will continue to provide the processing of Veterans claims ongoing in order to help our indigent veterans obtain their benefits and upgrades. Our approach with continuous collaborations, partnerships, and facilitations of programs that help connect our homeless veterans and other veterans that we provide services to with other local community entities, local mental health organizations, Urban League, Goodwill industries, other veteran organizations, and the veteran affairs office. This is how NABVETS will innovatively continue to approach helping our local veterans with their ongoing needs in multiple areas. C. Data and Reports (4 points) (1) Data Describe the system to be used to track participant and program data. (See Attachment) (2) Reports List key reports and their frequency that will be used to capture project/program performance. (See Attachment) 14

D. Duplication (3 points) What makes your project/program unique among projects/programs in the community? NABVETS is a unique organization because we are primarily a claims service organization. Our primary focus is helping the Regional Veterans Affairs Administration Office to bridge the gap with assisting the indigent veterans process their military claims and receive their benefits as well as service upgrades pertaining to being discharged from the military. Our secondary focus is to then collaborate, coordinate, facilitate, link, and refer to local entities and other organizations that can assist our veterans with regards to their other needs (i.e. homelessness, financial, employment, and mental health). 15

Section 6: Cost Effectiveness (25 points) A. Budget and Funding (9 points) (1) Please complete the table to show the organization s operating budget. Expenditures by Program Budgeted FY 16-17 Projected FY 16-17 Requested FY 17-18 Program Services $10,000 $10,000 $10,000 Fundraising Management and General Total (Should match Total Expenditures by Category) Expenditures by Category Personnel Employee Salaries and Wages $0 Employee Benefits $0 Subtotal, Personnel $0 Operating Expenditures Facility Rent and Utilities $5,486 Training and Conference Registration $2,300 Memberships and Dues $300 $900 Travel and Transportation Grants To Individuals and Organizations 0 Contracted Fundraising Services 0 16

Good Purchased for Resale 0 Other Contracted Services 0 Other Operating Expenditures $1,014 Subtotal, Operating Expenditures Capital Outlay Total (Should match Total Expenditures by Program) $10,000 Revenues by Category City of Winston-Salem $10,000 Forsyth County 0 0 State of North Carolina Federal Government 0 Admissions/Program Revenue/Sales 0 Memberships Donations Foundation Grants Interest and Investment Income Parent Organization Other Total $10,000 (2) Please complete the table below to show proposed City funding and other leveraged funding. 17

Activity Funding Requested Funds from Other Other Funds Total Funding from City Sources Source Example: Utilities $5,000 $5,000 Foundation $10,000 RENT/UTILITIES $5,486 CONFERENCE, $2300 TRAINING OFFICE SUPPLIES $300 OPERATING $1014 EXPENDITURES TRAVEL, TRANSPORTATIO N $900 TOTALS $10,000 (3)Has the City of Winston-Salem provided funding in the past? Yes If so, provide a funding history of the most recent three years describing the specific use of City contributions. NABVETS has received the grant for the last five years and the table listed above has demonstrated what the funding was utilized for along with the attachments. (4)Provide an explanation of how you propose to use the funds from the City being requested for the upcoming year. Be as specific as possible. NABVETS will continue to utilize the grant to assist with maintaining an office for operations in order to continue with providing claims benefits and other support services to our veterans in the city of Winston-Salem community. B. Funding Status (9 points) (1) Describe the status of other funding proposed to leverage City funds requested. Describe what the funding source is, how firm the commitments are for other funds, and the duration of the commitment. NABVETS will have annual fund raising and membership drives in order to continue helping with sustaining our operations. (2) Describe the plan to sustain project/program funding. Through NABVETS fund raising and membership drives and other programs such as our Annual Honors Day Program as well as others programs will continue to assist in sustaining the NABVETS project/program. 18

(3) If this year s request is different in any way (amount, activities, etc.) from a prior year s request, explain how and why. There has not been a change in the requested amount of $10,000. C. Average Cost (4 points) Use the table below to show the average amount of City funds requested per beneficiary to be served during the year and the average total cost of the service per beneficiary to be served during the year (including all funding sources). Proposed funds from the City for this project: $10,000 Number proposed to be served for the year: Approximately 185 Veterans Average City funds per beneficiary: 0 Proposed funds from all sources: $10,000 Number proposed to be served for the year 185 Average total funds per beneficiary: 0 19

A. Barriers (3 points) Describe any potential barriers to the project implementation and how you plan to overcome them. The only potential barriers faced by NABVETS would be having limited funding and or not receiving this grant. The impact would not allow us to be able to operate our local Winston-Salem office which is vital with the continuation of servicing our veterans. NABVETS serves as one of the liaisons that continues to assist the Regional Veterans Affairs Administration Office with processing claims and benefits, and service upgrades to our local veterans. NABVETS will continue to host fundraising events and sponsorship in order to continue with assisting with our operations. Section 7: Other Information A. Number of full Board meetings held during the last twelve months: NABVETS will continue to hold twelve Board meetings over the next twelve months; and call meetings as deemed necessary. B. Number of Board s Executive Committee meetings held during the last twelve months: NABVETS held 13 Executive Board committee meetings during the last twelve months. C. Submit a copy of the agency s latest 990 Form as submitted to the Internal Revenue Service, Audit Report and Auditor s Management Letter and copies of their By-Laws, Articles of Incorporation, Personnel Policies, Procurement Policies, Accounting Procedures, IRS 501 (c)3 designation letter, and a current Board roster. (Please see attachment) C. The City reserves the right to request additional information on any proposal. 20

Additional Questions Community and Business Development ONLY (1) In the right-hand column below, indicate the number of participants to be served by the proposed project/program within each income category during the year. (Not applicable to NABVETS program. We provide services to all veterans that come into our office and referred). INCOME LIMITS FOR EACH INCOME CATEGORY FOR HOUSEHOLD SIZES 1 TO 8: Range of Incomes 1 2 3 4 5 6 7 8 0 to 30% of median $12,300 $14,050 $15,800 $17,550 $19,000 $20,400 $21,800 $23,200 31% to 50% of median $20,500 $23,400 $26,350 $29,250 $31,600 $33,950 $36,300 $38,650 51% to 60% of median $24,600 $28,080 $31,620 $35,100 $37,920 $40,740 $43,560 $46,380 61% to 80% of median $32,800 $37,450 $42,150 $46,800 $50,550 $54,300 $58,050 $61,800 Greater than 80% of median All of those with incomes greater than last row above (for household size) # to be served (1) Describe policies, procedures, and criteria for determining who is eligible. NABVETS see all veterans regardless of race, creed, or economical social status. Describe the procedures for screening, eligibility determination, intake, assessment and orientation of participants. NABVETS primarily provides claims services based on the veterans coming into our office or through referrals. We then advocate and assist them with any of their other needs through coordinating, linking, and referring them to other local entities within the Winston-Salem community Forsyth County based on their needs. (2) Explain how services will assist participants in reaching objectives of the proposed project/program. Through NABVETS assisting our local veterans with processing their claims in order to receive their benefits this will help the veterans obtain their personal goals and ultimately enhance their quality of life. Describe the policies or procedures for follow-up after participants leave the proposed project/program. Once a veteran s claim is processed the Veterans Administration Affairs office maintains updates. As the veteran claims progresses NABVETS is notified and the veterans are notified also of their status and all updates either electronically and/or by mail whichever is their preference. (3)Timing Please complete the table below to show the timing of activities. Activity 1. Organizational structure in place and/or Memoranda of Understanding with Cooperating Organizations Days from Execution of Agreement with City 21

2. Site control (have ownership or lease space for proposed activity) 3. Personnel in place to conduct activities 4. All funding committed and available 5. Services begin 6. Facility or service at or near full capacity 7. Requested Funding Fully Spent 8. Other key benchmark activities: (list) 22

Addendum for Proposed Projects Involving Construction or Rehabilitation Please submit the following items, as applicable to the project, along with the attached completed Funding Proposal form: 1. A detailed description of the proposed project, including any plans. If the project is approved, we will need a detailed work write-up. 2. A projected time line for the proposed work. 3. A description of how the project will be managed, including the contractor procurement process. 4. A description of the target market, including any special populations to be served 5. A description of services or program you plan to provide. 6. A market study or other analysis to verify the need for the project. 7. Project development costs that include a detailed sources and uses statement of all funds, including the requested loan from the City, in electronic format, preferably a spreadsheet. 8. An operating pro forma that includes rent and operating cost assumptions and all estimated loan payments, in electronic format. 9. A description of the property management plan. 10. List of the development team members. 11. A description of the financial capability of the sponsor/owner organization, including submission of the organization s operating budgets, agency audits, and Form 990s for the prior three years, unless already submitted to the City. 12. Listing of projects undertaken by principals over the past ten years, identifying project name and address, type of project, and number of units; please note any projects for which local government funding was received. The following summarizes the broad requirements and provisions of City financial assistance: 1. City financial assistance generally will be in the form of a loan, provided on a "gap" basis once all other available funding is applied to the project cost. A final determination of the loan terms will be based on a finalization of cost and other financing sources to assure that no more funding is provided than necessary. 2. Federal funding may be used to fund the project. If so, compliance with all applicable regulatory requirements will be required. This includes, but is not limited to, HUD Contractor-Consultant certification standing, Minority/Women s Business Enterprise (M/WBE), Section 504, Americans with Disabilities Act, Uniform Relocation Act, and Fair Housing regulations as well as the following requirements: i. Please be aware that the City must strictly enforce the provisions of 24 CFR Part 58. This regulation requires that an Environmental Review be completed and a Release of Funds be made before any choice-limiting action pertaining to a specific site is taken by you or anyone else as of the date of this application. Choice-limiting actions are defined by HUD as property 23

acquisition, demolition, movement, rehabilitation, conversion, repair, or construction prior to the environmental clearance. Any violation of this provision will result in the automatic denial of this funding request (or de-obligation of federal funds, if already awarded). Please call City of Winston-Salem Community and Business Development if you have any questions about this requirement. ii. Depending on the source of funds and number of units, the project may be required to comply with Davis-Bacon labor standards. You should consult with Community and Business Development staff prior to submission of a proposal, as this requirement may impact project costs. iii. Depending on the amount of funds to be expended for housing construction, rehabilitation or other public construction, federal Section 3 provisions will require that, to the greatest extent feasible, preference in employment and contracting opportunities be given to low- and very low-income persons or businesses residing in Forsyth County. A percentage goal for the project will be discussed prior to a funding commitment. It is recommended that you contact the City Council Member representing the area and neighborhood association representatives. The Community Assistance Liaison for the area can provide contact information. For more information, please see: http://www.cityofws.org/departments/communityassistance 24

ESG Forms Emergency Response Budget Activity Budgeted Amount Emergency Shelter Shelter- Essential Services Case Management $ - Child Care $ - Education Services $ - Employment Assistance $ - Job Training $ - Outpatient Health Services $ - Transportation $ - Legal Services $ - Services to Special Population $ - Overhead Costs (limited to 15% of total activity $ - request) Shelter Services Subtotal $ - Shelter Operating Costs Rent $ - Shelter Security $ - Fuel $ - Equipment $ - Insurance $ - Utilities $ - Food $ - Furnishings (limited to less than $500 per item) $ - Supplies $ - Overhead Costs (limited to 15% of total activity $ - request) Shelter Operating Costs Subtotal $ - TOTAL 25

ESG Forms - Continued Housing Stabilization Budget Activity Amount Budgeted Prevention Rapid Re-Housing Rapid Re-Housing Financial Assistance Rent Assistance $ - Rental Application Fees $ - Security Deposits $ - Last Month's Rent $ - Utility Deposits $ - Utility Payments $ - Moving Cost Assistance $ - Overhead Costs (limited to 15% of total $ - activity request) RRH Finanical Assistance Subtotal $ - Rapid Re-Housing Services Case Management $ - Housing Search and Placement $ - Mediation $ - Legal Services $ - Credit Repair $ - Counseling $ - Information and Referral $ - Monitoring/Evaluation of Progress $ - Overhead Costs (limited to 15% of total $ - activity request) RRH Services Subtotal $ - TOTAL HMIS/Data Collection Budget Activity City ESG Request HMIS Staff Costs $ - Equipment $ - User Fees $ - HMIS Subtotal $ - State ESG Request 26

TOTAL 27