Section 1: Organization Information Organization Name Address City State Zip Code Section 2: Contact Information

Phone Number Primary Contact Person Position Email

Section 3: Fiscal Sponsor Name of fiscal sponsor (if applying on behalf of a network of collaboration of organizations)

Section 4: Organization Summary a. Description of organization mission and programs (limit 1,500 characters)

b. Primary Demographics of Communities Served (check all that apply)African American/BlackIndigenousAsianHawaiian and Pacific IslanderLatinxImmigrant and Refugee (including Middle Eastern, African, Slavic) UndocumentedOther (please describe):

c. Is your organizationa 501c(3) nonprofit entity?

a culturally specific organization?

No

NoYes

Yes

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Section 5: Implementation and Deployment Plan

e. Short summary of your organization’s focus or work in COVID-19 relief and recovery efforts(limit 2,000 characters)

a. How will you conduct outreach and identify eligible individuals? Will your work requirelanguage or accessibility support? (limit 2,000 characters)

d. Geographic Focus (limit 500 characters)

Application for CV Housing Assistance Program (CVHAP) Community Partner Outreach, Intake and Referral ServicesAttachment A

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Section 6: Allocation Request Indicate your organization’s requested number of individuals referred. A minimum of 250 applications is required.

September 2020 October 2020

November 2020 December 2020

TotalProjected assistance allocation amount is $500 per individual. Program administration will be calculated based on the projected total assistance allocation amount.

b. What BIPOC Communities will you focus on reaching through your efforts? (limit 1,500characters)

Number of Individuals Referred

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d. Is there any support beyond what we have listed that you would like the city to provide?(limit 500 characters)

NoYesc. Is your organization able to meet the timeframe forimplementation and expenditure of these funds(for work beginning September 2020 and completedby December 30,2020)?