ESG RRH Application

ESG Rapid ReHousing Application
Application Date

MonthDayYear
Date
Contact Information
Full Legal Organization Name
Unique Entity Identifier (UEI)# (visit www.sam.gov to obtain):
Federal EIN ID#:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
Phone Number
Please enter a valid phone number.
Organization President/CEO/Executive Director

First NameLast Name
ED Title
ED Email
example@example.com
ED Phone Number
Please enter a valid phone number.
Program Contact Person (if different)

First NameLast Name
Contact Person Title
Contact Person Email
example@example.com
Contact Person Phone Number
Please enter a valid phone number.

Funding and Budget

Minimum request is $50,000 / Maximum amount is $250,000 / New applicants maximum amount is $50,000
Funding Amount Requested
Proposed Number Served
Is your organization receiving city ESG funds?

YesNo
If yes, please check all that apply:

OutreachShelterRapid Rehousing
Proposed Service Area (List counties or cities)
Proposed Budget

A more detailed budget will be included in the agreement
Financial Assistance-Rapid Rehousing
Relocation and Stabilization - Rapid Rehousing
Rental Assistance - Rapid Rehousing
Financial Assistance - Homeless Prevention
Relocation and Stabilization - Homeless Prevention
Rental Assistance - Homeless Prevention
Admin
Total Rapid Rehousing Budget Amount

Board of Directors

Total possible points for this section - 10
How frequently does the Board meet?
Is there a written set of policies and procedures for the Board?

YesNo
Does the Board have an active fiscal oversight committee?

YesNo
Give a brief description of the oversight committee responsibilities

Program Services and Coordination, Section 2

(total possible points for this section - 10, each narrative question will be worth 1 point)
Describe how your agency contributes to ending veteran homelessness.
What is the length of subsidy households are eligible to receive? Describe how decisions regarding subsidy duration, amount and special circumstances are made.
Describe your agency's experience and training with housing needs assessments, housing case management and housing placement services, including the strategy to transition participants from homelessness to permanent housing.
Describe your experience with landlord engagement and what strategies your agency will use to connect landlords. How will program staff act as a mediator with landlords and utility companies on behalf of the program participant? Describe the communication plan for landlord and tenant disputes.
Describe your plan and timeline to ensure that all proposed units meet rent reasonable and habitability standards prior to lease-up.
Briefly describe your program's approach and plan to working with clients once placed in permanent housing. Include frequency of contact and overall case management approach.
Provide an explanation of how your agency and partners will work with persons with high barriers. Example: Those persons who have felonies, high amount of evictions/poor landlord relationships, and sexual convictions. Are there landlords in your area willing to work these sub-populations?
Describe how your agency will support people in establishing and stabilizing income, employment issues and issues with criminal history.
To the maximum extent practicable, the applicant will involve, through employment, volunteer services, board involvement or otherwise, homeless individuals and families in constructing, renovating, maintaining, and operating facilities, in providing services assisted under the ESG program, and in providing services for occupants of facilities assisted with ESG. Describe how your agency is including homeless or formerly homeless individuals in the operation of your program.
If your program serves families, please describe how you will ensure that all school-age children are connected with McKinney-Vento services within their school. (The Department of Education requires all schools to have a McKinney-Vento liaison and funding is provided to assist with transportation and other school related needs of the child experiencing homelessness.)
*** 2 Bonus points will be awarded to all agencies who completed the HIC survey on or before the deadline***

*** 2 Bonus points will be awarded to any new agency that received ESG-CV funding but does not have a current ESG-Normal project.***

ESG Rapid ReHousing Application

Contact Information

Organizational Information

Funding and Budget

Proposed Budget

Threshold Requirements

Board of Directors

Financial Management

Program Services and Coordination

Program Services and Coordination, Section 2

Supporting Documentation Checklist