Emergency Food and Shelter National Board Program Application for Russell CountyPhase 34

The Emergency Food and Shelter National Board Program (EFSP) is a Federal program administered by the U.S. Department of Homeland Security's Federal Emergency Management Agency (FEMA) andhas been entrusted through the McKinney--‐Vento Homeless Act of 1987 " to supplement and expandongoing efforts to provide shelter, food and supportive services" for hungry and homeless people across the nation.

The Russell County Local Board looks at the resources available in the community, the emergency food and shelter needs of the community, and the gaps in services in the community to determine the priority areas for funding. The Local Board will review all of the applications and award funding to the agencies that help meet the identified needs. The first priority area for Phase 34 is rent/mortgage assistance, followed by utility assistance. A total of $26,418 is available for Russell County during this application period.

Under the terms of the grant from the National Board, local agencies chosen to receive funds must:1) be private voluntary non-profits or units of government, 2) be eligible to receive Federal funds, 3) have an accounting system, 4) practice nondiscrimination, 5) have demonstrated the capability todeliver emergency food/or shelter programs, and 6) if they are private voluntary organization, have a voluntary board, 7) spend awarded funds only in Russell County, and 8) have additional sources of funded for awarded program.

Submit the following documents with the completed application:
  • Completed Local Recipient Organization Certification Form
  • 501©3 determination letter
  • Agency Operating Budget for current fiscal year
  • Board Roster (with addresses and contact numbers of all board members and officers identified)
  • Most recent annual audit for the agency (if applicable based on revenue)
  • 990 or 990 EZ
  • Mission statement
  • 10 copies of the application
  • 10 copies of the program budget for each area requested (food, rent, utilities, etc) to include last fiscal year, current fiscal year and projected next fiscal year. Budgets should include revenue sources/income and expenses.

Return Application and Supporting Documents to:
Attention: EFSP United Way of the Chattahoochee Valley
1100 5th Avenue Columbus GA 31901 (Physical Address)
PO Box 1157 Columbus GA 31902 (Mailing Address)
Please direct questions to Jennifer St John
706-327-3255 ext 211
Application Due: Wednesday, May 31, 4:00 pm

APPLICATION

EFSP Agency Profile

Legal Name of Applicant (include DBA if applicable)
Agency Physical Address (where EFSP funds will be delivered)
Agency Mailing Address
Agency Executive Director/CEO Name
Agency Exec. Dir/CEO Phone and Email
Contact Person for EFSP Application (Name, Position, Phone, Email)
Agency Phone
Agency Fax
Agency Website
Congressional District of Agency
DUNS number
Federal Employee Identification Number (FEIN)
Agency is Non-profit / ______YES ______NO
Agency is 501 ( c ) 3 / ______YES ______NO
Is Agency debarred or suspended from receiving funds or doing business with the Federal Government? / ______YES ______NO

Please specify funding request area(s) and estimated number to serve. You may request funds for more than one area. The minimum request for each area is $500.

FUNDING CATEGORY / DOLLAR AMOUNT REQUESTED / ESTIMATED NUMBER OF SERVICES / ESTIMATED NUMBER OF INDIVIDUALS/FAMILIES TO SERVE
RENT/MORTGAGE / (# bills)
UTILITY / (# bills)
FOOD (Meals or Groceries) / (# meals/lbs. groc.)
SHELTER / (# capacity per night)

Include a response to the following questions as part of your application:

  1. Please provide a brief overview of your organization and the program that provides assistance in the requested area.
  1. Who does your program serve? Does it provide targeted service to a unique population such as the elderly, families with children, persons with disabilities, people who are homeless, veterans, etc.? If your program targets a specific area of the county, please include this in your response.
  1. How do clients access the services (appointments, call-in, walk-in, etc)?
  1. Describe the eligibility criteria for your services. In your response, include any required documentation and/or limits on the frequency with which a client may use your service.
  1. How do you assess the needs of your clients(interview, questionnaire, etc.)?
  1. Do clients pay any fees for any of your services?
  1. What has been the demand for service in the area(s) you are requesting EFSP funds?
  1. Summarize the impact your program and specifically EFSP funds have on the individuals/families served.
  1. Using data from the last program year, enter the information for the area in which you are requesting funds.

PROGRAM AREA / AMOUNT SPENT IN PREVIOUS YEAR / NUMBER OF SERVICES PROVIDED / NUMBER OF INDIVIDUALS/FAMILIES SERVED
RENT/MORTGAGE / (# bills)
UTILITY / (# bills)
FOOD (Meals or Groceries) / (# meals/lbs. groc.)
SHELTER / (# capacity per night)

END OF APPLICATION

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