PUBLIC SERVICES (Non-Profit Operations)

FUNDING APPLICATION FY 2017-18

PUBLIC SERVICES (Non-Profit Operations)

Application Summary Sheet

Organization Contact Information

Legal Name of Organization Applying
Project Name
Project Alternate Name
Primary Physical Location of Activities
Organization Mailing Address, City State, Zip
Main Telephone Number
Organization Web URL
Agency DUNS Number

Executive Director or CEO Contact Information

Name
Title
Email
Phone

Contract Manager (or another secondary contact)

Name
Title
Email
Phone

By my signature, I certify that the information provided in this 2017-2018 Public Services Funding application is true, accurate, and complete.

______

Signature Date

____________

Title

PART I

Summary Project Information

Q1a - Project Focus: (Check all that apply)

Fair Housing Services (Complete Addendum A)

Emergency Shelter Rapid Re-Housing Street Outreach

Homeless Prevention (ESG-eligible activities)

Permanent Supportive Housing Transitional Housing Domestic Violence

Workforce Development Other

Q1b - Funding Request:
We are requesting consideration for a 3-year award / Yes No
This project has a housing or homeless related focus / Yes No

Q1c - Supplemental Project Services Provided: (Check all that apply)

Check related services this project directly provides:

Community Services / Homelessness
Individual or Family Counseling / Financial Literacy/Assistance / Financial Literacy
Domestic Violence Intervention / Short- to Medium-Term Rental Assistance / Tenancy Education
Crisis Counseling / Street Outreach / Coordinated Intake & Assessment
Access to Medical Services / Case Management / Day Center Services
Mental Health Services / Literacy / Self-Sufficiency Skills Training
Drug/Alcohol Treatment / Meals, Transportation or Personal Items / Housing Location services
Employment Training / Fair Housing Counseling & Education / Housing Location services
Education & Academic Support / Other Services Not Listed

Q1c- Project Subpopulations:

Check all subpopulations this project directly serves:

Families with children / Single Adults 25+ / Children <18
Runaway & Homeless Youth(12-17) / Developmental Disability / Seniors/Elderly
Transitional Youth (18-24) / Physical Health Disabilities / Farmworkers
Substance Abuse Disabilities / Mental Health Disabilities / Veterans
Racial/Ethnic Groups / Other Subpopulation:______

Q1d - Summary Project Description:

The Staff Report analysis provided to the Community Development Committee will include this project description. Limit this section to no more than 125 words.

Q1e - Executive Summary:

Provide an overview of the project which covers the following areas: the community need, the target population, the core services delivered, the average number of essential services participants receive, the average length of time participants will receive services, and how long the project has been in operation. Please limit this section to no more than 700 words

PART II

Project Detail

2a - Target Population Served By The Project (Check all that apply)
Single Adults 25+ / Families with Children / Unaccompanied Youth <25
2b - Project Model: Briefly describe how each of the following components is designed:
Anticipated length of client enrollment in project
Describe a successful project exit
What are participants expected to achieve by participating in the program?
Describe follow-up (if any) with participants who have exited the program.
2c - Project Outreach: Describe the outreach strategy to reach target populations
Who is your target population for this project?
What strategies do you use to reach out to the target population?
What is the referral process for participants coming into the program?
2d - Barriers to Service: Describe how this project overcomes obstacles to service access for participants for each of the categories listed below (if there are no barriers indicate N/A):
Language and cultural differences
Disabilities:
Geography:
Transportation Limitations:
Intake Processes:
Service Hours:

2e. List this project’s top three collaborative service relationships with other organizations that ____provide or accept referrals and/or provide supplemental services. If none, enter “NA”.

Agency/Project / Referral or Supplemental Services / Number of Referrals Anticipated

2f. Project Outcomes (for Participants):

In the table below, select two project outcomes that provide measurable impact on participants. For projects providing homeless services, please select at least one housing outcome from the defined Ending Homelessness Indicators. Please discuss the change in a Participant’s status, knowledge, or behavior resulting from receiving this service and refer to Application Guidelines, “Guide to Developing Program Outcomes” for more information and examples. If you are proposing a homeless-dedicated project, you must choose at least one of the Ending Homelessness Housing Indicators.

Outcome Number / Outcome Identifier / Project Goal / Quantitative Measure
Select an Outcome Indicator that you will use to measure your success. / Briefly describe how your project will work towards achievement the specified Outcome Indicator / Identify a numerical increase or decrease for the specified Outcome Indicator
1 / Ending Homelessness Housing Indicators / _____%
or
Choose an item.
or / _____ of _____
Upstream Indicators
Choose an item.
2 / Ending Homelessness Housing Indicators / _____%
or
Choose an item.
or / _____ of _____
Upstream Indicators
Choose an item.
2g - Outcomes
Describe the experience your agency has in providing services associated with Outcome #1 as identified in the previous section.
Describe the experience your agency has in providing services associated with Outcome #2 as identified in the previous section.
2h - Project Evaluation Framework
Describe how your organization uses data and other information as a self-evaluation tool.
Describe how the use of this information will help to improve service offerings. (Please note any participant involvement included in evaluating the services)
State any efforts to incorporate new/improved project design as informed by HMIS or other data (for projects not participating in the HMIS, please describe any project design changes resulting from the evaluation of your internally collected data)
2i - Project History and Readiness
If this project has been operating one year or less, please discuss its stage of project growth or readiness.
If more than one year = NA
If this project has been operating longer than one year, describe any material changes that have affected the project along with associated impact(s) that have taken place over the past two years due to any of the following conditions.
(If under one year = NA)
Describe funding reductions or increases that have impacted the total project budget by 10% or more
Please note any turnover in your key project and top administrative staff
Please state the impacts of actions or new regulations by other funders such as new or changed regulatory requirements on your project design.
If the project anticipates materially expanding or contracting in size during FY 2016-17, please describe the resulting anticipated changes to service levels and unduplicated participants served as a result.
Please explain other changes to the project that are not reflected in the previous questions

PART III

Participant Information

3a- List the estimated percentage of the target population served in each of the local income categories below:
(Note: For income levels currently in effect, view the Income Levels document on the CDC-Funding wiki, or contact CDC staff).
Extremely Low / (Below 30% AMI)
Very Low / (Between 31% -50% AMI)
Low / (Between 51% -80% AMI)
Moderate / (Over 80% AMI)

3b. Please fill out the grid below, stating the number of Unduplicated Households projected to be served by the project during the twelve-month period July 1, 2017 - June 30, 2018. Also indicate the number historically served by this project for a recent one-year period with an end date between July 1 and November 30, 2016 (use HMIS data if project already patriciates in HMIS):

Expected number of Households Served
July 1, 2017 – June 30, 2018 / Historical period
(Enter month/year below) / Historical Number of Households Served
_____ Households of Single Adults 25+ / From _____
to ______/ _____Single Adults 25+
_____ Families with Children / From _____
to ______/ _____Families with Children
_____Households of Unaccompanied Youth <25 / From _____
to ______/ ___ Unaccompanied Youth <25
_____ Total Households / _____Total Households
3c. Briefly describe how this project will positively impact the immediate needs of lower income persons.

PART IV

Alignment with Federal and Sonoma County Initiatives

4a - Continuum of Care/HEARTH Act Performance Measures Please check the TOP 5 performance measures this project will directly address
1 Reduce the number of households re-entering the homeless system after exiting to ____permanent housing
2 Increase percentage of households exiting emergency shelters and transitional housing to ____permanent housing
3 Increase percentage of Permanent Supportive Housing participants retaining permanent ____housing
4 Increase the percentage of participants exiting with employment income
5 Increase the percentage of participants that exit with income from sources other than ____employment
6 Increase the percentage of participants exiting with non-cash mainstream benefits
7 Enroll adults in health insurance
8 Connect homeless persons with a usual source of health care
9 Homeless adults needing Behavioral Health Care Services will receive them
10 Placement of unsheltered families and individuals in safe housing
11 Improvement in housing stability for households meeting the federal definition of At Risk of ____Homelessness
12 Improvement in housing stability for precariously housed families, children, and youth.
4b - Sonoma County Upstream Investment Initiative:
1 - Is this project or components of it represented in the Upstream Portfolio? / Yes No
If Yes, please answer question 2, 7, & 8
If No, please answer question 3 – 6
2 - If represented in the Upstream Portfolio, in which Upstream Tier does this project participate? / Tier 1 – Evidence Based Practice (EBP)
Tier 2 – Promising Practice
Tier 3 – Emerging Practice
3- Our organization is planning on incorporating Evidence Based Practice (EBP) theory into this project / Yes No
4 -Organization has or is seeking a Resolution of Alignment with the Upstream Initiative / Yes No
5 - Agency Board of Directors has received information or training about the Upstream Initiative or EBP / Yes No
6 – Research on the use and incorporation of EBP’s into this project’s service delivery is underway. / Yes No
7 - If your organization plans to incorporate the use of EBP’s in the future, please state which EBP’s will be used and the timeframe for inclusion.
8- If you are using EBP but are not planning to apply for inclusion in the Upstream Portfolio, what strategies are you using?
9 – The standard logic model template (Addendum B) has been completed for this project (See attached Logic Model Template) / Yes No

Part V

Homeless Management Information System Participation

5a -Will the proposed project have a “homeless dedicated” service focus? / Yes No

NOTE: If the project services provide homeless dedicated services activities – participation in the online Homeless Management Information System (HMIS), and other requirements as stated in published HUD and Sonoma County local data collection and maintenance requirements, are required.

The definition of a “Homeless-dedicated” project is:

1.  One that (as evidenced by this application) is targeted to serve participants who are defined either as Homeless or At-Risk of Homelessness under federal statute OR

2.  The project receives other funding dedicated for the purpose of serving Homeless or At-Risk of Homeless participants

5a. If this project is not “homeless dedicated” and will not participate in the HMIS, describe ___the method you will use to track Unduplicated Households, Adult Participants, and Child ___Participants who receive services:
5b – If the proposed project does not have a “Homeless Dedicated” focus, please state the name of the data-tracking tool you will use.
5e -Does your agency participate in Coordinated Entry (including making referrals to and ___accepting referrals from Coordinated Entry)? Please describe how.
5f - Does your agency contribute data to the HMIS (Homeless Management Information System)?
Yes No
5g – Please describe how your agency or project utilizes the Housing First Approach in ____providing services?
5h - Does the agency participate in relevant program standards working groups? If Yes, ____Please state in which standards group your organization participates. Compliance with the local ____program standards for your project component, and participation in program standards working ___ groups, will be a requirement of all funding agreements.
Yes ______No
5c -Other Local Initiatives: If this project or agency actively collaborates with other county, local initiatives or consortia, please describe below. Please limit to the top three (3).
Initiative/Consortia Name / Length of involvement / Description of how this project/agency is involved

PART VI

PROJECT FINANCING AND BUDGET

Q6a - Funding Status

Is this application for New or Renewal Funding? / New Renewal
Has this project been previously funded by the CDC? / Yes No
If this project received funding under a different name, please state the name of the program. (If “No” = NA)
Has funding of this project been denied by the CDC? / Yes No
Project budget reflects funding from other sources / Yes No
Requested funding will not supplant existing funding for the project / Yes No

Q6b – CDC Funding History

FY 2014-15 / FY 2015-16 / FY 2016-17 / Current Request for FY 2017-18
Requested: / $ / $ / $ / $
Awarded: / $ / $ / $
Q6c - Application Budget and Persons Served Data
Total Organization Budget: / $
Total Project Budget: / $
Amount requested from CDC: / $
Percent of request towards project budget: / %
Percent Served Low/Mod Income: / %
Anticipated Avg. Days / Months of Client Participation In Program: / Days /
Months
Q6d - Project Budget Questions
According to the project budget accompanying this application, what is the calculated Cost per Household? / $
Explain the primary cost components making up the Cost Per Household calculation (e.g., total hours of case management, facility costs, or other services provided such as education, food, transportation services, etc.)
We are requesting Indirect/Administrative Costs
*If Yes, please attach a copy of your agency’s most current Indirect Cost Rate Plan to this application / Yes No
What is the impact on this project if you receive less funding than requested for FY 2017-18 from CDC?
Describe the aspects of the project design that are scalable. Indicate how many fewer participants will receive services if the awarded is less than the amount requested.
What is your organization’s plan for the long-term financial sustainability of this project?

NOTE 1: In accordance with CDC Funding Policies, funds may not typically be used for general administration. If you have requested indirect or administrative costs in the project budget, please attach a copy of your agency’s most current Indirect Cost Rate Plan to this application.