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State of Wyoming Department of Family Services Emergency Solutions Grant (ESG) Grant Application PROPOSALS DUE: May 11, 2018 Proposal Issue Date: April 2, 2018 Proposal Contact: Debby Rieff E-mail: [email protected]

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State of Wyoming

Department of Family Services

Emergency Solutions Grant (ESG) Grant Application

PROPOSALS DUE: May 11, 2018Proposal Issue Date: April 2, 2018

Proposal Contact: Debby RieffE-mail: [email protected]

Part 1. APPLICATION GUIDANCE DOCUMENT

1. GENERAL

1.1 PURPOSE

The ESG program provides funding to: ● Engage homeless individuals and families living on the street; ● improve the number and quality of emergency shelters for homeless individuals and families; ● help operate these shelters; ● provide essential services to shelter residents,● rapidly rehouse homeless individuals and families, and ● prevent families/individuals from becoming homeless.

Under federal law, ESG shall be used only for programs addressing one (1) or more of the following Components:

● Street Outreach;

● Emergency Shelter;

● Homeless Prevention;

● Rapid Rehousing; and

● Homeless Management Information System (HMIS).

Implementation goals of the ESG include:

● Community ownership and decision making through collaboration;

● Data driven priorities;

● Science-based approaches;

● Outcome-based planning; and

● Comprehensive community plans to meet ESG goals.

1.2 ELIGIBLE APPLICANTS

● The Department shall accept applications from any non profit or branch of local government entity.

● Membership in Wyoming Homeless Collaborative is required.● All proposals shall be evaluated using the same criteria. ● The Department shall ensure fairness in bidding and Agreementing procedures with small

businesses, women’s business enterprises, and minority-owned firms, pursuant to Federal law.

1.3 SOURCE OF FUNDS

The source of funds for this Agreement is the U.S. Department of Housing and Urban Development (HUD), Community Planning and Development, Emergency Solutions Grant Catalog of Federal Domestic Assistance (DFDA) No. 14.231

1.4 SERVICE AREA

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The Applicant shall identify what services are being provided in their specific community.

1.5 COST REIMBURSEMENT OR FEE FOR SERVICE

Programs shall be operated on a cost reimbursement basis only.

1.6 ADMINISTRATIVE COSTS LIMITATION

Administrative costs for this proposal are limited to 7.5% of an organization’s program costs or non-administrative costs awarded under the Agreement. Program costs are costs associated with the delivery of the service. Applicants shall present their analysis of total administrative costs in their proposed budget. The analysis shall contain their allocation methodology to account for these administrative costs during the proposed Agreement period. This information shall be included in the budget portion of the application. For specific requirements and eligible costs, see 24 CFR 576.108 Hud Exchange ESG

1.7 MATCHING FUNDS REQUIREMENT

Applicants shall submit a match proposal with commitment letter equal to 100% of grant request.

1.8 PERFORMANCE MEASURES REQUIRED

Applicants shall address how performance measures, data collection and quality assurance will occur to validate the program success. The following performance measures are examples of what is expected:

● Address how required demographic data will be maintained in the Homeless Management Information System.

● Wyoming HMIS Data Quality Policy and Performance measures are followed.● Show progress toward a final goal of housing/shelter and or critical services.● Subrecipients shall participate in the Wyoming Coordinated Entry System.● Show collaboration with other agencies to improve client outcomes.● Show progress in meeting needs of homeless individuals.

1.9 REPORTING REQUIREMENTS

Monthly report is due 30 days after the end of the month.

● Subrecipient shall use the ESG Request for Funds Invoice for reimbursement requests.

● The ESG Request for Funds Invoice shall be submitted monthly for no more than twelve (12) consecutive months beginning with the Effective Date of the Agreement.

● The Subrecipient shall submit the Request for Funds within thirty (30) days following the end of the month.

● The Request for Funds shall provide actual expenditures in sufficient detail to ensure that payments may be made in conformance with the Agreement.

● Should the Subrecipient fail to submit reports to the Department within thirty (30) days following the end of the month or otherwise fail to perform in a manner consistent with

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the terms and conditions set forth in the Agreement, payment may be withheld or delayed, until such time as the Subrecipient performs its duties and responsibilities to the satisfaction of the Department.

Quarterly report is due 30 days after the end of the quarter.

● Subrecipients shall submit a quarterly performance narrative within (30) days following the end of the quarter, attached to this application.

● Should the Subrecipient fail to submit reports to the Department within thirty (30) days following the end of the quarter or otherwise fail to perform in a manner consistent with the terms and conditions set forth in the Agreement, payment may be withheld or delayed, until such time as the Subrecipient performs its duties and responsibilities to the satisfaction of the Department.

Annual Report

● Subrecipients shall submit the Consolidated Annual Performance Report (CAPER) to the Department no later than thirty (30) days following the end of each calendar year.

● Subrecipients shall submit the Performance Annual Report (PER) no later than thirty (30) days following the last monthly invoice for payment.

● Subrecipients shall submit a final Matching Funds Report no later than thirty (30) days following the last monthly invoice for payment.

● Should the Subrecipient fail to submit reports to the Department within thirty (30) days following the end of the year or otherwise fail to perform in a manner consistent with the terms and conditions set forth in the Agreement, payment may be withheld or delayed, until such time as the Subrecipient performs its duties and responsibilities to the satisfaction of the Department.

2. PAYMENT

2.1 The Department agrees to pay the Subrecipient for services, herein specified, according to the terms of the Agreement. No claims for services, not specified in the Agreement rendered by the Applicant, shall be allowed unless the parties hereto modify, alter or vary the terms of the Agreement in written agreement.

2.2 When the Applicant is working at a location outside of the home office area, which requires an overnight stay, the Applicant may be paid a per diem allowance not to exceed the allowances specified in Wyo. Stat. § 9-3-102; and when required to travel on behalf of the State, the Applicant may be reimbursed at a rate not to exceed the rates specified in Wyo. Stat. § 9-3-103.

2.3 If the Applicant's yearly total of Agreemented dollars exceeds Seven Hundred Fifty Thousand Dollars ($750,000.00) of federal funds, regardless of the source, the Applicant is required to have a single or program-specific audit conducted in accordance with the Office of Management and Budget (OMB) Circular A-133 for non-profit organizations and Circular A-87 for all other organizations. The Applicant shall furnish the Department a copy of the final audit, along with the Applicant's responses to the audit within thirty (30) days of receipt of such audit when funding

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from this program is involved. Failure to comply with this provision will impact payment for services and may impact future Agreements.

2.4 Each payment obligation of the Department is conditioned upon the availability of government funds, which are appropriated or allocated for the payment of this obligation. If funds are not allocated and available for the continuance of the services performed by the Applicant, the Agreement may be terminated by the Department at the end of the period for which the funds are available. The Department shall notify the Applicant at the earliest possible time of the services, which will or may be affected by a shortage of funds. No penalty shall accrue to the Department in the event this provision is exercised, and the Department shall not be obligated or liable for any future payments due or for any damages as a result of termination under this section. This provision shall not be construed to permit the Department to terminate the Agreement in order to acquire similar services from another party.

2.5 Agreements awarded as a result of this proposal are on a cost reimbursement method for services. No funds shall be paid to programs without a signed, executed Agreement. Grant funds shall not be obligated prior to start date nor after termination date unless an extension has been approved. Funds shall be disbursed based upon receipt of an invoice explaining costs incurred and a program effectiveness report. All payments to the Applicant shall be paid as reimbursement based on actual expenditures paid by the Applicant. Proposals shall not be submitted that cannot operate on a quarterly reimbursement.

2.6 Prior approval shall be obtained from the Department for all budget changes which deviate from the submitted budget.

2.7 Funds shall not be used to purchase non-tangible assets or to purchase or lease equipment. Leased equipment includes the rental of equipment for any period of time.

2.8 Funds shall not be used to provide individuals served by the projects with cash or check(s) payable directly to the individual or credit card company gift cards. All budget submissions under this proposal shall detail the use of any and all compensation to employees, Applicants, sub-Applicants and participants.

3. BACKGROUND

3.1 Funding can be used to provide programs that meet any of the purposes of the program set forth in paragraph 1.1.

3.2 The Subrecipient shall work with the Department’s Financial Services Division regarding accounting procedures to provide necessary financial reports.

3.3 The funding year is from October 1st through September 30th.

4. SCOPE OF WORK - GENERAL

4.1 The Scope of Work to be performed under the Agreement shall be subject to modification and supplementation upon the written agreement of the duly authorized representatives of the Agreementing parties.

4.2 The Subrecipient shall furnish all trained personnel, equipment, supplies and administrative services, which are necessary to complete the Agreement.

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5. SUBRECIPIENT REQUIREMENTS - SPECIFIC

5.1 Subrecipient shall comply with the following:

A. Activities and Supportive Services. Subrecipient shall provide activities and supportive services as described in Statement of Work.

B. Allowable Expenses. Subrecipient shall spend no more funds than allocated in the Agreement. All expenditures shall be in accordance with this proposal and State of Wyoming Accounting Policies and Procedures.

C. Area Served. Subrecipients shall identify what services are being provided in their specific County.

D. Audits. Subrecipients shall submit an independent audit to the Department. The audit shall conform to the requirements of W.S. § 16-4-102 (a)(ix) and W.S. § 16-4-122 through 16-4-123, generally accepted auditing standards established by the American Institute of Certified Public Accountants; and OMB Circular A-133 (Non-Profits).

E. Certificate of Good Standing. Subrecipients shall provide Certificate of Good Standing verifying compliance with the unemployment insurance and workers’ compensation programs prior to performing work under the Agreement.

F. Department Monitoring. The intent of monitoring and evaluation of Subrecipient’s activities is to identify training and assistance needs and to assure programs are in full compliance with all applicable and specific program requirements, rules and regulations.

Subrecipient shall give the Department, through their authorized representatives, access to, the right to examine, and the right to photocopy any or all pertinent records, files, books, or other written materials relating to the Agreement and maintained by Applicant or any subrecipient.

G. Excess Payments. Subrecipient shall be liable to the Department for any amount paid to Subrecipient for which the Department determines it was not liable under the Agreement. In the event the Department makes payments to Applicant in excess of the Department’s liability, Subrecipient shall, on termination of the Agreement, promptly repay the Department the amount of the excess payments.

H. Financial Obligation/Prompt Reports. Subrecipient shall maintain an auditable financial accounting and records system including programmatic records pursuant to the Agreement.

I. Collaboration. Successful bidders will show collaboration in program planning, operation, outreach, intake and referral and funding through a needs assessment. These funds should not be the main source of funding. Bidders are encouraged to seek partnerships reflecting a commitment, financially and non-financially to the success of the proposed program.

J. Retention of Records. Subrecipient shall maintain records, documents, and other evidence which sufficiently reflects all expenditures under this Agreement for a period of six (6) years after the termination of the Agreement. Such records shall be made available to the Department or its designee, or the appropriate federal agency for review and audit.

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K. Time Analysis Allocation. Subrecipient shall conduct a time analysis allocation on any position dually-funded from other sources of funds to account for apportioned time charged against this Agreement.

L. Continuum of Care Designated Homeless Management Information System. Subrecipient shall maintain at least one (1) Service Point license or, if a Domestic Violence Provider, an HMIS compatible database license. The sum of five hundred dollars ($500) is provided with the grant funding for this purpose. The purchase of any additional licenses is the responsibility of the Subrecipient. The Subrecipient shall maintain data quality as specified in the Wyoming HMIS data quality policy and attend mandatory trainings.

M. Coordinated Assessment System. The Subrecipient shall participate in all aspects of the centralized or coordinated assessment system (referred to as “coordinated entry”) process with the goal of increasing the efficiency of local crisis response systems and improving fairness and ease of access to resources, including mainstream resources.

N. Continuum of Care Membership. The Subrecipient shall maintain a membership in the Wyoming Homeless Collaborative Continuum of Care. The Subrecipient or a designee shall attend a minimum of one (1) membership meeting annually. In addition, participation on a Continuum of Care committee is highly encouraged.

6. PROPOSAL REQUIREMENTS

6.1 Applicants shall submit a completed and signed application, which is attached to this proposal.

6.2 The Department reserves the right to reject any application received if it is determined the proposal does not meet the specifications outlined in the application.

6.3 The Department reserves the right to reject any application received if funds should be limited for any reason.

7. APPLICATION REVIEW AND SELECTION PROCESS

7.1 A technical review process shall evaluate completed proposals. Final funding decisions shall be based on the rating of bids as a result of the review process and availability of funds.

7.2 Prior to final selection of a proposal, Applicants may be asked to submit additional information in order to clarify their proposals. Additional information may be requested of the Applicant selected.

7.3 Each proposal received shall be evaluated by the Department.

7.4 Selection of the awards shall be made by the Department. An award is not final unless approvals are given at each level and no funds may be expended prior to final approval.

8. RIGHT TO AWARD, REJECT OR NEGOTIATE

8.1 The Department retains the right to negotiate reasonable adjustments with Applicants or reject any and all proposals. The successful award(s) shall meet the intent of funding and be the most advantageous to the goals of the Department.

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8.2 The successful Applicant shall demonstrate the ability to document, coordinate and integrate project activities with direct project costs and expected outcomes that best meet the intent of the funding.

8.3 The Department shall require performance based Agreements. An example of a performance requirement is that the successful Applicant shall meet all performance standards addressed in their proposal.

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Part 2. APPLICATION

Instructions

Complete all forms accurately. This application will be used to evaluate compliance with the proposal and ESG if funds are granted.

Please use the following grant application format and use only the space provided for responses.

Data generated internally must meet the requirements for compliance with research-based, data-driven design. Reports may be attached or grant readers may request additional data or reports to verify information.

PROPOSAL DUE DATE

Applications shall be received on or before May 11, 2018 at 5:00 p.m.

Electronic Submission:An electronic submission of the application is preferred. An electronic submission will be considered “submitted” only after it is successfully downloaded. All signature pages can be scanned and emailed. Submissions shall be in Microsoft Word or Google Doc formats.

Email to: Debby Rieff at [email protected] Solutions Grant Administrator

Hard Copy Submission:If a proposer wishes to send a hard copy submission instead of an electronic submission, they shall submit the entire original application with all signatures. Proposals may be mailed or hand-delivered to:

Debby Rieff, Emergency Solutions Grant AdministratorWyoming Department of Family Services109 W. 14th StreetPowell, WY 82435

Technical Assistance:For technical assistance or questions regarding this proposal, please contact:

Debby Rieff at [email protected] or (307) 754-2245 ext. 33

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COVER SHEET

1. Project Administrator. Ensures programs are being implemented correctly, communicates grant changes and provides requested paperwork and data to Department of Family Services. All Communication regarding this application shall be conducted through this person.

Name:             

Title:            

Organization:            

Address:           

Phone:            

Email address:      

2. Primary Contact for the Sub-recipient. Implements the program.

Name:            

Title:            

Organization:            

Address:           

Phone:            

Email address:            

3. Name and email address of HMIS contact:            

4. Name and email address of Coordinated Entry contact:_           

5. Authorized Agency Representative:             Signature Date

Phone      Email         

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SECTION 1 PROPOSALSTREET OUTREACH

(If you are not applying for Street Outreach, please go to Section 2)

A. Summary of Proposed STREET OUTREACH Program

ELIGIBLE EXPENSES: Engagement, case management, emergency health services, emergency mental health services, transportation, and services to special populations.

1. Please provide a synopsis of the street outreach activities you propose.

               

2. Is this program different than previous programs operated with ESG funds in the past? Yes No If so, how is it different?

              

3. Area(s) served.          

     

4. Population served.        

     

5. Beginning and end date of program.      

           

6. Program availability: when is the program offered (i.e. time of day, how often, time of year)?           

     

B. Statement of Need

The intent of ESG is to provide funds for programs that meet specific needs of their community.

1. How have you determined there is a need for the services you propose? Describe local data that was used to determine the needs of families.

               

2. What is the resource gap(s) that is being addressed by your program?

               

3. Describe what research based programs and strategies will be utilized to make the program successful.

                

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C. Community Partnerships

1. A description of how agency and community wide collaboration in planning and implementation occurred.

                 

2. List the community partners involved in the program implementation and the resources that will be provided by each partner.

(Additional lines/pages may be added if needed.)Community Partner Resource that will be provided

                                                                  

3. Describe how the program will be sustained by the community beyond the funding period.                

D. Activity Goals and Outcomes

1. Goals for the Component: What are the goals of your program? How will you serve ESG eligible individuals/families?

           

2. Outcomes: Using the chart below, please identify the measurable outcomes you expect for ESG eligible individuals/families as a result of program implementation in order to meet the above goals? These measurements will be used to evaluate the program’s success.

Complete your STREET OUTREACH outcomes for each ESG Activity: (additional lines/pages may be added if needed)Activities toAccomplish Outcome

Outcome Measurement HMIS Data/Quality Assurance to be Collected to Validate Measurements

Essential Services

                 

3. Describe your data collection methods to be used.                 

4. How will you evaluate the effectiveness of the STREET OUTREACH program for individuals/families served? How do you determine the success of your program?     

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E. Street Outreach Recruitment

1. Describe your recruitment and enrollment process for eligible individuals/families?     

          

2. What is the projected number of ESG eligible individuals that will be served by this program?

                  

3. Provide an explanation on how information will be gathered to determine ESG eligibility.      

           

SECTION 2 PROPOSAL EMERGENCY SHELTER

(If you are not applying for Emergency Shelter, please go to Section 3)

A. Summary of Proposed EMERGENCY SHELTER Program

ACTIVITIES

OPERATIONS: Eligible Expenses: Costs of maintenance (including minor or routine repairs), rent, security, fuel, equipment, insurance, utilities, food, furnishing, and supplies necessary for the operation of the emergency shelter. Where no appropriate emergency shelter is available for a homeless family or individual, eligible costs may also include a hotel or motel voucher for that family or individual.

ESSENTIAL SERVICES: Eligible Expenses: Case management, child care, education services, employment assistance, outpatient health services, legal services, life skills, mental health services, substance abuse assistance treatment services, transportation, services for special populations.

1. Please provide a synopsis of the Emergency Shelter activities you propose.

               

2. Is this program different than previous programs operated with ESG funds in the past? Yes No If so, how is it different?               

3. Area(s) served.                 

4. Population served.                 

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5. Beginning and end date of program.                

6 Program availability: when is the program offered (i.e. time of day, how often, time of year)?               

B. Statement of Need

The intent of ESG is to provide funds for programs that meet specific needs of their community.

1. How have you determined there is a need for the services you propose? Describe local data that was used to determine the needs of families.                

2. What is the resource gap(s) that is being addressed by your program?                

3. Describe what research based programs and strategies will be utilized to make the program successful.

                

C. Community Partnerships

1. A description of how community wide collaboration in planning and implementation occurred.                 

2. List the community partners involved in the program implementation and the resources that will be provided by each partner.

(Additional lines/pages may be added if needed.)Community Partner Resource that will be provided

                                                                  

3. Describe how the program will be sustained by the community beyond the funding period.      

           

D. Activity Goals and Outcomes

1. Goals for the Component: What are the goals of your program? How will you serve ESG eligible individuals/families?           

     

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2. Outcomes: Using the chart below, please identify the measurable outcomes you expect for ESG eligible individuals/families as a result of program implementation in order to meet the above goals? These measurements will be used to evaluate the program’s success.

Complete your EMERGENCY SHELTER outcomes for each ESG Activity: (additional lines/pages may be added if needed)Activities toAccomplish Outcome

Outcome Measurement HMIS Data/Quality Assurance to be Collected to Validate Measurements

Essential Services  

                 

Shelter Operations                  

3. Describe your data collection methods to be used.          

     

4. How will you evaluate the effectiveness of the ESG program for individuals/families served? How do you determine the success of your program?          

     

E. Emergency Shelter Recruitment

1. Describe your recruitment and enrollment process or ESG eligible individuals/families?     

           

2. What is the projected number of ESG eligible individuals that will be served by this program?      

           

3. Provide an explanation on how income information will be gathered to determine ESG eligibility.      

           

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SECTION 3 PROPOSALRAPID RE-HOUSING

(If you are not applying for Rapid Re-housing, please go to Section 4)

A. Summary of Proposed RAPID RE-HOUSING Program

1. Please provide a synopsis of the program you propose.

               

2. Is this program different than previous programs operated with ESG funds in the past? Yes No If so, how is it different?               

3. Area(s) served.      

          

4. Population served.               

5. Beginning and end date of program.               

6. Program availability: when is the program offered (i.e. time of day, how often, time of year)?               

B. Statement of Need

The intent of ESG is to provide funds for programs that meet specific needs of their community.

1. How have you determined there is a need for the services you propose? Describe local data that was used to determine the needs of families.                

2. What is the resource gap(s) that is being addressed by your program?                 

3. Describe what research based programs and strategies will be utilized to make the program successful.           

     

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C. Community Partnerships

1. A description of how community wide collaboration in planning and implementation occurred.                 

2. List the community partners involved in the program implementation and the resources that will be provided by each partner.

(Additional lines/pages may be added if needed.)Community Partner Resource that will be provided

                                                                  

3. Describe how the program will be sustained by the community beyond the funding period.                 

D. Activity Goals and Outcomes

1. Goals for the Component: What are the goals of your program? How will you serve ESG eligible individuals/families?            

     

2. Outcomes: Using the chart below, please identify the measurable outcomes you expect for ESG eligible individuals/families as a result of program implementation in order to meet the above goals? These measurements will be used to evaluate the program’s success.

Complete your RAPID REHOUSING outcomes for each ESG Activity: (additional lines/pages may be added if needed)Activities toAccomplish Outcome

Outcome Measurement HMIS Data/Quality Assurance to be Collected to Validate Measurements

Rental Assistance  

                 

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Housing Relocation and Stabilization Services

                 

3. Describe your data collection methods to be used.          

     

4. How will you evaluate the effectiveness of the ESG program for individuals/families served? How do you determine the success of your program?          

     

E. Rapid Re-housing Recruitment

1. Describe your recruitment and enrollment process or ESG eligible individuals/families?         

     

2. What is the projected number of ESG eligible individuals that will be served by this program?      

           

3. Provide an explanation on how income information will be gathered to determine ESG eligibility.           

     

SECTION 4 PROPOSALHOMELESSNESS PREVENTION

(If you are not applying for Homelessness Prevention, please go to Section 5)

A. Summary of Proposed HOMELESSNESS PREVENTION Program

1. Please provide a synopsis of the program you propose. 

               

2. Is this program different than previous programs operated with ESG funds in the past? Yes No If so, how is it different?                

3. Area(s) served.           

     

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4. Population served.           

     

5. Beginning and end date of program.                

6. Program availability: when is the program offered (i.e. time of day, how often, time of year)?               

B. Statement of Need

The intent of ESG is to provide funds for programs that meet specific needs of their community.

1. How have you determined there is a need for the services you propose? Describe local data that was used to determine the needs of families.                

2. What is the resource gap(s) that is being addressed by your program?           

     

3. Describe what research based programs and strategies will be utilized to make the program successful.           

     

C. Community Partnerships

1. A description of how community wide collaboration in planning and implementation occurred.          

     

2. List the community partners involved in the program implementation and the resources that will be provided by each partner.

(Additional lines/pages may be added if needed.)Community Partner Resource that will be provided

                                                                  

3. Describe how the program will be sustained beyond the funding period.      

          

D. Activity Goals and Outcomes

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1. Goals for the Component: What are the goals of your program? How will you serve ESG eligible individuals/families?           

     

2. Outcomes: Using the chart below, please identify the measurable outcomes you expect for ESG eligible individuals/families as a result of program implementation in order to meet the above goals? These measurements will be used to evaluate the program’s success.

Complete your HOMELESS PREVENTION outcomes for each ESG Activity: (additional lines/pages may be added if needed)Activities toAccomplish

Outcome Measurement HMIS Data/Quality Assurance to be Collected to Validate Measurements

  Rental Assistance                  

Housing and Relocation Services

                 

3. Describe your data collection methods to be used.          

     

4. How will you evaluate the effectiveness of the ESG program for individuals/families served? How do you determine the success of your program?          

     

E. Homeless Prevention Recruitment

1. Describe your recruitment and enrollment process or ESG eligible individuals/families?         

     

2. What is the projected number of ESG eligible individuals that will be served by this program?           

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3. Provide an explanation on how income information will be gathered to determine ESG eligibility.          

     

          

SECTION 5 PROPOSALHMIS & ADMINISTRATION

A. Summary of Proposed HMIS & ADMINISTRATION Program

ELIGIBLE EXPENSES:HMIS Component. These activities are designed to fund ESG recipients’ and subrecipients’ participation in the HMIS collection and analyses of data on individuals and families who are homeless and at-risk of homelessness.

1. Please provide a synopsis of the HMIS & Administrative activities you propose.

     

          

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BUDGET

Instructions:

1. The budget of the program should be described with enough detail that expenditures of funds could be easily reviewed. Preference will be given to programs concentrating on services rather than programs building their administrative structure. Only expenses related to services to ESG eligible individuals/families can be billed to ESG.

2. List costs of the program including program costs, administrative costs, total costs, and estimated cost per individual/family. a. The Applicant shall submit a proposed budget in line item detail listing each category of

expenditure and the proposed amount. b. The Subrecipient shall be required to use the invoice form attached to the signed Agreement c. The budget shall include a narrative of duties of each position and an explanation of each line item

stating the purpose of the expenditures.

Budget:

1. ESG funds are limited and can only provide a portion of the funding needed for services. What are your other funding sources that will be used to operate the program? (i.e. Cash contributions and non-federal funds used to support)

          

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AMOUNT REQUESTED FROM PROPOSAL

ELIGIBLE ACTIVITY ESTIMATED NUMBER OF UNDUPLICATED CLIENTS

REQUESTED FUNDING AMOUNT

Street Outreach

Justification/ Narrative of Expense

Emergency Shelter

Justification/ Narrative of Expense

Rapid Re-Housing

Justification/ Narrative of Expense

Homeless Prevention

Justification/ Narrative of Expense

HMIS N/A $500.00

Administration(Can not exceed 7.5% of program costs)

TOTAL

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ASSURANCE

In compliance with this grant proposal, as published by the Department of Family Service, and to all the conditions imposed therein and hereby incorporated by reference, the undersigned offers and agrees to furnish the services described in accordance with the attached signed proposal or as mutually agreed upon by subsequent negotiation.

If successful in securing funds for ESG, applicant agrees to the following:

1. Must abide by all rules (if applicable), state, and federal laws applicable to the grant.

2. Must guarantee compliance to federal, state and local fiscal guidelines and reporting requirements applicable to the grant.

Authorized Representative Signature:      

Printed Name:      

Date:      

Assurances must be signed for grant application to be considered.

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Part 3. CHECKLIST: CONTENTS OF APPLICATION Please use this checklist to help assure all grant application components are included in your finished proposal.

Cover Sheet☐ Proposal☐ Budget ☐

Amount Requested from Proposal☐ Assurance☐

Most Recent Fiscal Year Audit☐ Match Proposal Commitment Letter☐ Documentation of current Wyoming Homeless Collaborative membership☐ Wyoming Secretary of State Certificate of good standing(dated within last 12 months)☐

Proof of Wyoming Workers Compensation(dated within last 12 months)☐ Proof of 501(c)3 Designation☐ List of Board of Directors and Officers with contact information☐ Agency Fair Housing Policy☐

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Quarterly Performance Narrative:Please share quarterly Activities/ Collaborations conducted to meet Agency Goals.     

Successes and Challenges: Please share quarterly successes and challenges.

     

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