City General Fund & Federal Funds (Cdbg, Home, Esg, &

FY 2016 & FY 2017

CITY GENERAL FUND & FEDERAL FUNDS (CDBG, HOME, ESG, &

HOPWA) REQUEST FOR FUNDING CHECKLIST

Check Box Below:

City General Fund (CGF) CDBG HOME ESG HOPWA

City General Fund Applicants: Complete pages (1-11)

Federal Fund Applicants: Complete Pages (1-15)Federal Fund Applications are for FY 2016 only.

Project Name:

Applicant (Organization) Name:

Request for Funding Package:(Submit 3 hardcopies/ 2 CDs)

Application (Pages 1-7)

Activity Budget Sheet (Pages 8-11) Federal Funds Only

Overall Budget Sheet (Pages 13-14)

Attachments:(Provide if applicable, list on Attachment List pg. 7)

Submit attachments on CD

Federal Tax Exempt Certification
Latest IRS 990 Report
Previous Fiscal Year Audit/Financial Statements
Current Year Operating Budget (mandatory for CGF Applicants)
By-Laws
Articles of Incorporation
Organizational Chart
Business Strategic Plan (mandatory for CGF Applicants)
List of Board of Directors, Members, and Executive Officers
List of Full- and Part- time Employees to Work on Project
Employee Resumes
Partnership Agreements with other agencies
Site Control, Building or Zoning Documentation
Corporation Commission Certification
SAM Registration (Federal Funds Applicants)
Council Adopted Plan
Personnel Manual
Policy/Procedures Manual
Other (Specify)

FY 2016 & FY 2017

CITY GENERAL FUND & FEDERAL FUNDS (CDBG, HOME, ESG, HOPWA) REQUEST FOR FUNDING APPLICATION

Instructions: This form must be fully completed by all organizations and agencies applying for funds. PLEASE NOTE: You must complete a separate application form for each project.

1.Funds Requested: City General Fund CDBG HOME ESG HOPWA

2. Organization Information:

Organization Name:

DUNS Number:

Federal Tax ID:

Project Name:

Project Contact Person:

Mailing Address:

Phone: Facsimile: Email:

Board Chairperson: Signature:

Is your organization incorporated? (include applicable attachments) Yes No

Is your organization: (include applicable attachments)

A government entity Yes No

A non-profit with approved Federal tax exempt certification? Yes No

A for-profit business Yes No

Total operating budget for the organization, including income/revenues for all sources.

(Attach a copy of your current year’s operating budget)

3. Location of Project:

A. Is the project City-wide or does it serve a specific project area?

City-wide Specific Project area

B. Name and Geographic Boundaries of Project Area (Include street names):

C. Census Tract(s): Council District(s): NiB Area:

4. Description of Project: Provide a concise description of the proposed project and the clients to be served, to include how additional services will be provided as a result of this funding or if an existing service will be discontinued without funding.

5. Community Impact: Briefly describe the neighborhood to be served, highlighting such items as: population to be served, housing conditions, median household income, neighborhood strengths/weaknesses and describe how the project will positively impact the community.

6. Description of Organization and Overall Capacity:

A. Briefly describe organization’s background and mission.

B. Briefly highlight the organization’s significant achievements, including the capacity to

complete current projects and development activities.

C. Attach a list of all full- and part- time employees, resumes, and percentage of time that will be

spent on the project.

D. Attach a list of current board members including address, occupation and role on board.

E. Describe your organizational structure, record keeping and financial/audit system, policies

and procedures, and program evaluation results. (attach most recent audit report and/or

financial statements, and organizational chart)

F. Provide a brief description of any financial default or involvement in legal actions during

the last 3 years. This would include lawsuits, tax delinquency, bankruptcy, client

complaints, and violations of building, zoning, and environmental codes.

7. Consistency with Seven Focus Areas and Consolidated Plan(see Attachments A & C)

Describe how the project meets the priorities listed in Attachment B, Attachment B-1

(Human Service Projects) or Attachment B-2 (Economic & Community Development

Project).

How is you project consistent with the City’s Consolidated Plan? – Attachment C (applies to Federal

Funds projects and Economic & Community Development CGF projects)

Describe how your project contributes to crime prevention. (applies to Federal Fund

projects only)

Detail which activity category applies to your proposal. Each activity category must

include all staff time and other costs that are necessary to support that activity.

(applies to Federal Fund projects only) – See Attachment F

8. Evidence of Neighborhood/Partnership Support: Describe the neighborhood/partnership support for the proposal, including NiB Partnership, civic association, City department support, and groups that will assist in the implementation or be directly affected by the project. (attach

written partnership agreements)

9. Sustainable/Green Practices: Describe any sustainable or “green” aspects or design elements that will be incorporated as part of the implementation of the proposed project.

10. Evidence of Site Control: If the project involves the development of a public facility, organizational offices or housing (attach plans and documentation of site control) If you have an existing facility, provide documentation that the facility is in compliance with building and zoning codes for the services provided.

11. Marketing Strategy: Briefly describe your strategies and methods for marketing your program and the target population of your efforts.

12. Section 3 Residents or Section 3 Businesses: Detail if your organization or business will target Section 3 residents or if your business is a Section 3 business. (Federal Fund Applicants only – see page 3 of Application Guidelines)

13. Funds Received Previously for this Project by Year of Allocation:

Previous
2014 / Current
2015 / Request for
2016 / Request for
2017
CITY GENERAL FUND: / $ / $ / $ / $
CITY CAPITAL BUDGET: / $ / $ / $ / $
CDBG: / $ / $ / $ / N/A
HOME: / $ / $ / $ / N/A
ESG: / $ / $ / $ / N/A
HOPWA: / $ / $ / $ / N/A

14. Accomplishments in the Current Fiscal Year

Describe project progress in the current fiscal year. Emphasize measurable outcomes and project benefit to the community.

Fiscal Year 2015
Objectives / Fiscal Year 2015
Accomplishments to Date / # of Units / # of Clients / # of Other

Proposed Objectives and Outcomes:

Fiscal Year 2016
Objectives / Fiscal Year 2016
Outcomes / # of Units / # of Clients / # of Other
Fiscal Year 2017
Objectives / Fiscal Year 2017
Outcomes / # of Units / # of Clients / # of Other

15. Project Match

List all sources of funds you will receive for Fiscal Year 2016 and 2017 for this project.

(Denote all funds you anticipate receiving with an asterisk [*]).

Program Year / Dollar
Source of Funds / Status / Dates / Amount
1. / $
2. / $
3. / $
4. / $
5. / $
6. / $
7. / $
8. / $
9. / $
10. / $
2016 Matching Total: / $
1. / $
2. / $
3. / $
4. / $
5. / $
6. / $
7. / $
8. / $
9. / $
10. / $
2017 Matching Total: / $
Grand Total of Matching Funds: / $

Partnership Agreements (formal agreements with other agencies, including City departments, to implement the proposal).

Contact Person / Telephone /

Organization

FAX

Address

Date

Attachment List

Instructions: All attachments for the Requests for Funding form must be listed below. If attachments are not available at the time of submission, an asterisk (*) should be placed next to these items to indicate that they are anticipated, and the date that they are anticipated should be included.

b.Other Documents (please refer to the Attachments List on the cover page of the application)

Name

FY2016 – FY2017

FEDERAL FUNDS ONLY (CDBG, HOME, ESG, & HOPWA)

ACTIVITY BUDGET SHEET

Instructions: DO NOT complete this form until you have read the guidelines that define the eligible activities. (See Attachment F). In the first column, check the funding activities requested and then show all eligible costs for each activity.

CDBG Eligible Activities

Current Funds Allocation / Requested Funds
# of Units (where applicable) / Fiscal Year 2015 / Fiscal Year 2016
1 / Acquisition of Real Property / $ / $
2 / Disposition / $ / $
3 / Public Facilities & Improvements / $ / $
4 / Clearance & Demolition / $ / $
5 / Public Services / $ / $
6 / Interim Assistance / $ / $
7 / Urban Renewal Completion / $ / $
8 / Relocation / $ / $
9 / Loss of Rental Income Replacement / $ / $
10 / Removal of Architectural Barriers / $ / $
11 / Privately Owned Utility Development / $ / $
12 / Construction of Housing / $ / $
13 / Direct Homeownership Assistance / $ / $
14 / Micro Enterprise Assistance / $ / $
15 / Rehabilitation / $ / $
16 / Lead-Based Paint Hazard Evaluation/Reduction / $ / $
17 / Code Enforcement / $ / $
18 / Historic Preservation / $ / $
19 / Commercial/Industrial Improvement by Nonprofit / $ / $
20 / Economic Development Services / $ / $
21 / Direct Economic Development Assistance to
Private For-Profit Entities / $ / $
22 / CBDO Activities for Otherwise Ineligible Activities / $ / $
23 / Planning / $ / $
24 / Program Administration (For City Administration Projects Only) / $ / $
TOTAL CDBG FUNDING / $ / $

HOME Eligible Activities

Current Funds Allocation / Requested Funds
# of Units (where applicable) / Fiscal Year 2015 / Fiscal Year 2016
1 / Acquisition of Real Property / $ / $
2 / Rehabilitation / $ / $
3 / Homeownership Assistance / $ / $
4 / New Construction / $ / $
5 / Program Administration
(For City Administration Projects Only) / $ / $
6 / CHDOCapacityBuilding / $ / $
7 / CHDO Loan Funds / $ / $
TOTAL HOME FUNDING / $ / $

ESG Eligible Activities

Current Funds Allocation / Requested Funds
# of Units (where applicable) / Fiscal Year 2015 / Fiscal Year 2016
1 / Street Outreach Component / $ / $
2 / Emergency Shelter Component / $ / $
3 / Homelessness Prevention Component / $ / $
4 / Rapid Re-Housing Component / $ / $
5 / Homeless Management Information System (HMIS) Component / $ / $
6 / Administrative Costs / $ / $
TOTAL ESG FUNDING / $ / $

HOPWA Eligible Activities

Current Funds Allocation / Requested Funds
# of Units (where applicable) / Fiscal Year 2015 / Fiscal Year 2016
1 / Housing Information and Counseling / $ / $
2 / Resource Identification and Development / $ / $
3 / Acquisition, Rehab, Conversion & Repair of Facilities / $ / $
4 / Lease of Facilities / $ / $
5 / New Construction / $ / $
6 / Project or Tenant-Based Rental Assistance (Long-Term) / $ / $
7 / Short-Term Rent, Mortgage and Utility Payments / $ / $
8 / Supportive Services / $ / $
9 / Operating Costs for Housing Facilities / $ / $
10 / Technical Assistance / $ / $
11 / Administrative Expenses (Grantee and Project Sponsor) / $ / $
TOTAL HOPWA FUNDING / $ / $