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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
1.0 BACKGROUND
EFSP is a Federal program administered by the U.S. Department of Homeland Security’s Federal Emergency Management Agency (FEMA) and has been entrusted through the McKinney-Vento Homeless Assistance Act of 1987 (PL 100-77) “to supplement and expand ongoing efforts to provide shelter, food and supportive services” for hungry and homeless people across the nation.
Organizations that are exempt under Section 501(c)(3) of the Internal Revenue Code and are classified as “not a private foundation” under Section 509(a) are welcome to apply. Organizations must operate or demonstrate the ability to operate within Los Angeles County.
2.0 GENERAL INFORMATION
The Los Angeles County Local Board is requesting applications on behalf of the Emergency Food and Shelter Program (EFSP) for the County of Los Angeles. The purpose of this Request for Proposal (RFP) is to identify nonprofit organizations and local government agencies, known as Local Recipient Organizations (LROs), to provide services for EFSP Phase 37.
The RFP is being released with the assumption that EFSP funding will occur, and Los Angeles County will receive an award. Funding is contingent upon congressional approval of the federal budget for FEMA.
APPLICATIONS MUST BE SUBMITTED IN ACCORDANCE WITH THE INSTRUCTIONS LISTED IN THIS RFP. Late or incomplete applications will not be accepted.
The EFSP Los Angeles Local Board reserves the right to amend or modify the requirements of this RFP as necessary, as well as to cancel, in part or in its entirety, this RFP if it is in their best interest to do so. This RFP does not commit the EFSP Local Board to provide an award or to pay costs incurred in response to this request.
EFSP funding varies from one year to the next and is neither automatic, nor guaranteed. Each year the EFSP Local Board reviews and scores all eligible applications submitted and makes allocation decisions based on recommendations through the scoring process to ensure that funds are provided to agencies to provide the most effective and efficient delivery of emergency services across the county. Applicants must not regard EFSP funding as part of their annual operational funding base, but as supplemental funding to meet specific emergency needs not to exceed 40% of their program budget.
This RFP references two types of applicants:
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
1. New Applicants: Qualified organizations that have never been funded or were not funded in the previous phase/year.
2. Returning Applicants: Qualified organizations that have received EFSP funding in previous phase/year.
The minimum grant amount that can be requested by any organization is $2,500 in all combined categories or a single category. The maximum grant amount that can be requested by any organization that has never been funded or was not funded in the previous year (Phase 36) is not to exceed $10,000. All other organizations may apply for an undesignated amount based on their program needs.
New or Returning Applicant Minimum request amount in all combined categories or a single
category
Maximum request amount
New Agency $2,500 $10,000
Returning Agency (funded in Phase 36)
$2,500 N/A
Under no circumstances is the EFSP Local Board bound to award any organization the amount requested. The amount of a grant to be awarded to an organization shall be determined by the Selection Process.
3.0 SPENDING PERIOD
The spending period for Phase 37 funds will begin on January 1, 2020 and end on December 31, 2020.
4.0 OVERVIEW OF THE REQUEST FOR PROPOSALS
Emergency Food and Shelter Program Los Angeles Local Board is Accepting Proposals for Phase 37 Grants (Phase 37 spending period: January 1, 2020 thru December 31, 2020)
The RFP will be open from May 15th, 2020 through June 5th, 2020 at 5:00 PM (PST) via EMAIL ONLY to [email protected].
Funding
Emergency Food and Shelter Program (EFSP) is currently accepting applications in the “Shelter Category” as follows:- Mass Shelter- Other Shelter
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
Shelter Category Description:
Mass Shelter category: is intended to allow mass shelter providers (five beds or more in one location) to provide on-site housing for clients. An agency must be awarded funds under mass shelter by the Local Board in order to have expenditures under the Mass Shelter category.
Los Angeles County utilizes Option 2: Per Diem Allowance ($12.50)
Other Shelter category: is intended to allow agencies to provide off-site emergency housing for clients. Agencies may not operate as vendors for themselves or other LROs; self-billing is not eligible with EFSP funding.
5.0 CRITERIA FOR EMERGENCY FOOD AND SHELTER PROGRAM (EFSP) FUNDING
In order to be eligible for funding under the Emergency Food and shelter Program (EFSP) applicants must meet the following criteria:
• Be nonprofit or an agency of government;• Not be debarred or suspended from receiving Federal funding;• Have a checking account and sign up for EFT (cash payments are not allowed);• Have an accounting system or fiscal agent approved by the Local Board; • Have a Federal Employer Identification Number (FEIN);• Have a Data Universal Number System (DUNS) number issued by Dun & Bradstreet (D&B) and provide along with other required associated information;• Have a valid email address for program communication and electronic signature processes;• Conduct an independent annual audit if receiving $100,000 or more in EFSP funds; conduct an annual accountant's review if receiving $50,000 to $99,999 in EFSP funds. See Annex 12, page 103.• Conduct annual audit, if expending $750,000 or more in Federal funds, in compliance with the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards at 2 CFR 200 of the Office of Management and Budget (Uniform Guidance);• Be providing services and using its other resources in the area in which they are seeking funding;• Practice nondiscrimination (those agencies with a religious affiliation wishing to participate in the program must not refuse services to an applicant based on religion or require attendance at religious services as a condition of assistance, nor will such groups engage in any religious proselytizing in any program receiving EFSP funds;• Have a voluntary board if private, not-for-profit; and,• To the extent practicable, involve homeless individuals and families, through employment, volunteer programs, etc., in providing emergency food and shelter services.
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
Additional Information*******************************************************************************************************Los Angeles Local Board Priorities: The Emergency Food and Shelter National Board mandates that Local Boards must set funding priorities annually prior to the selection of agencies for funding. The Los Angeles Local Boards looked at resources available in the community, the emergency food and shelter needs of the community, gaps in services in the community and focus the dollars to address these needs in the areas of emergency food and shelter.
About EFSP: For more information about the Emergency Food and Shelter Program Los Angeles Local Board, please visit the EFSP Los Angeles Local Board website.
www.losangeles-efsp.org
PenaltyReturning unused funds in any prior EFSP Phase will result in the reduction of your projected award amount for the current Phase applying in, by the dollar amount that was returned unspent. Returning unspent funds in more than one previous Phase may prevent an agency from further EFSP awards.
A. PHASE 37 APPLICATION FORM EMERGENCY FOOD AND SHELTER PROGRAM LOS ANGELES COUNTY JURISDICTION
(Spending Period is January 1, 2020 through December 31, 2020)
The RFP will be open from May 15th, 2020 through June 5th, 2020 at 5:00 PM (PST) via EMAIL ONLY to [email protected].
Email completed and signed application in PDF format (with all required attachments as a separate file) to [email protected] on or before the due date.
Note: if you do not receive an e-mail acknowledgement after you submit the application, consider it not received.
If you have general questions regarding the Emergency Food and Shelter Program please contact Patricia Banuelos at [email protected] .
If you experience technical issues with the application or process, please contact Deborah Tucker at [email protected].
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
TABLE OF CONTENTS
I. Cover Page and Contact InformationII. Organization InformationIII. Current Organization Annual Operating ExpensesIV. Request InformationV. Application NarrativeVI. Multi-Site Roster
REQUIRED DOCUMENTATION
The following items must be submitted with this application. Please attach all required documentation to this checklist. If the required documentation is not included with each copy of the application, the application will be considered incomplete. Incomplete application and attachments will be not reviewed or scored.
Attachment 1: IRS 501(c) (3) status letter
Attachment 2: Board Roster, including full name, address, phone number and role on board
Attachment 3: Most Recent Audited Financial Statements (if requesting $50,000+)
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
AGENCY ELIGIBILITY
1. Is your organization a 501c (3), non-profit agency providing year-round food and/or shelter to homeless and low-income people?
☐ Yes ☐ No
2. Does your agency serve Los Angeles County or do you provide services that benefit residents of Los Angeles County?
☐ Yes ☐ No
3. Will your organization charge fees from clients for EFSP-funded services?
☐ Yes ☐ No
4. Will EFSP funds be used to supplement only existing food and shelter programs?
☐ Yes ☐ No
The Local Board's interpretation of supplemental is defined as "a situation in which a program, absent EFSP funds, would still operate continuously throughout the year." EFSP funds may not exceed 40% of a total program budget.
5. I understand that for a local agency to be eligible for funding it must:
• Be nonprofit or an agency of government; • Not be debarred or suspended from receiving Federal funding; • Have a checking account and sign up for EFT. (Cash payments are not allowed); • Have an accounting system or fiscal agent approved by the Local Board; • Have a Federal Employer Identification Number (FEIN), (Note: contact local IRS office for more information on securing FEIN and the necessary form [SS-4] or go to the website: www.irs.gov); • Have a Data Universal Number System (DUNS) number issued by Dun & Bradstreet (D&B) and provide along with other required associated information (See the EFSP website for information on how to obtain.) • Conduct an independent annual audit if receiving $100,000 or more in EFSP funds; conduct an annual accountant's review if receiving $50,000 to $99,999 in EFSP funds. • Conduct annual audit, if expending $750,000 or more in Federal funds, in compliance with the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards at 2 CFR 200 of the Office of Management and Budget; • Be providing services and using its other resources in the area in which they are seeking funding; • Practice nondiscrimination (those agencies with a religious affiliation wishing to participate in the program must not
☐ Yes ☐ No
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
refuse services to an applicant based on religion or require attendance at religious services as a condition of assistance, nor will such groups engage in any religious proselytizing in any program receiving EFSP funds; • Have a voluntary board if private, not-for-profit; • To the extent practicable, involve homeless individuals and families, through employment, volunteer programs, etc., in providing emergency food and shelter services.
6. I understand that EFSP awards are paid in two separate payments, and that the payments may be made after the end of the established program period.
☐ Yes ☐ No
7. I understand that costs can only be incurred during the established program period set by the Los Angeles Local Board (even if payment is received after the close of the program period)
☐ Yes ☐ No
8. I understand EFSP funding is intended to provide for services on an ongoing basis. The funding is not intended to be used for a singular event, special celebratory events, holiday baskets, etc.
☐ Yes ☐ No
9. I understand that EFSP funds are to be used on an ongoing basis to supplement and extend food and shelter services, not as a substitute for other program funds or to start new programs. Funds are not to be held or reserved for future use but spent on an as needed basis to supplement and extend existing services
☐ Yes ☐ No
IF YOU SELECT “NO” TO QUESTIONS 1,2,4,5, OR “YES” TO QUESTION 3
Based on your answer to these questions it is determined that your organization does not qualify for charitable support from Emergency Food and Shelter Program.
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
I: COVER PAGE AND CONTACT INFORMATION
ORGANIZATION CONTACT
Name of Organization: Click or tap here to enter text.Address: Click or tap here to enter text.City: Click or tap here to enter text.Zip Code: Click or tap here to enter text.Tel #: Click or tap here to enter text.Fax #: Click or tap here to enter text.E-Mail Address: Click or tap here to enter text.Organization Website: Click or tap here to enter text.
EXECUTIVE DIRECTOR CONTACT
Title: Click or tap here to enter text. Name: Click or tap here to enter text. Phone: Click or tap here to enter text. Email Address: Click or tap here to enter text.
PROGRAM CONTACT
Title: Click or tap here to enter text. Name: Click or tap here to enter text. Phone: Click or tap here to enter text. Email Address: Click or tap here to enter text.
AGENCY FINANCIAL CONTACT/CHIEF FINANCIAL OFFICER
Title: Click or tap here to enter text. Name: Click or tap here to enter text. Phone: Click or tap here to enter text. Email Address: Click or tap here to enter text.
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
FISCAL AGENCY/FISCAL SPONSOR
Does your organization serve as a Fiscal agent/Fiscal conduit for a separate agency or agencies? (Please note: For National Board purposes, a Fiscal Agent is an LRO that maintains all EFSP financial records for another agency under a single grant. A Fiscal Conduit is an LRO that maintains all EFSP financial records on behalf of two or more other agencies under a single grant).
☐No. (This confirms that your agency is applying for EFSP funds for itself)☐Yes. (This confirms that your agency acts as a Fiscal agent/Fiscal conduit for
another agency receiving EFSP funds and you must provide the name of the agency that you are a fiscal sponsor for)
Organization: Click or tap here to enter text. Contact Name: Click or tap here to enter text. Title: Click or tap here to enter text. Phone: Click or tap here to enter text. Email Address: Click or tap here to enter text.
II: ORGANIZATION INFORMATION
1) Name of Applicant Organization: Click or tap here to enter text.2) Federal Employer Identification Number (FEIN):Click or tap here to enter text.3) Data Universal Numbering System (DUNS): Click or tap here to enter text.4) Did your organization receive EFSP funding for Phase 36?
☐No. (If the answer is NO, you are a NEW applicant and must apply for only $10,000 maximum across all categories)☐Yes. (You may apply for $2,500 minimum with no maximum)
5) Does your organization have any open compliance exceptions from any prior EFSP phase?☐ Not Applicable (New Applicant) ☐No Open Compliance Exceptions
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
LRO NUMBER PHASE AMOUNT☐ Yes Click or tap here to enter
text.Choose an item. Choose an item.Click or
tap here to enter text.☐ Yes Click or tap here to enter
text.Choose an item. Choose an item.Click or
tap here to enter text.☐ Yes Click or tap here to enter
text.Choose an item. Choose an item.Click or
tap here to enter text.☐ Yes Click or tap here to enter
text.Choose an item. Choose an item.Click or
tap here to enter text.6) In Phase 36, did you return any of your awarded funds to be reallocated?
☐Yes or ☐No
If so, how much was returned: $Click or tap here to enter text.
III. CURRENT ORGANIZATION ANNUAL OPERATING EXPENSES
Current Organization Annual Operating Budget (exclude EFSP funds)Funding Type (Percentage List)
Corporation: Click or tap here to enter text. Foundation: Click or tap here to enter text. Government: Click or tap here to enter text. Individual: Click or tap here to enter text. Other: Click or tap here to enter text.If other, please Specify here Click or tap here to enter text.
MANDATORY: Please complete a budget for program (s) for which you are applying using the Program Budget Template form. (Please note: Templates may not be changed or altered under any exception.Budgets should reflect applicant’s current fiscal year.Please note the different tabs for the various programs.The Los Angeles Local Board understands that programs have additional expenses not listed on the Program Budget Template. However, for the purpose of this application, only the listed line items are considered).
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
DOUBLE CLICK BELOW TO FILL OUT TEMPLATE (S)Travel and meetings $ - Marketing and advertising $ - Staff and volunteer training $ - Contract services $ - Other: please specify $ - Total Program Expenses $ -
Program Revenue over Program Expenses $ -
Request Amount $ - Request Amount may not exceed 40% of Total Program Expense #DIV/0!
EFSP Phase 37 Program BudgetAttachment A: Other Shelter Budget
Enter Organization Name and Fiscal Year Dates
Program RevenueGrants/Contracts $ - United Way (not including EFSP) $ - EFSP Phase 36, if applicable $ -
Program Budget for Phase 37: $Click or tap here to enter text.
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
Please select the SPA (s) you will serve during Phase 37 (select all that apply):
SPA 1 (Antelope Valley): ☐
SPA 2 (San Fernando Valley): ☐
SPA 3 (San Gabriel Valley): ☐
SPA 4 (Downtown LA): ☐
SPA 5 (West): ☐
SPA 6 (South LA): ☐
SPA 7 (Southeast): ☐
SPA 8 (South Bay): ☐
Please list the number of bed nights provided during Phase 36 spending period (10/1/18 – 12/31/19), by SPA area listed below:
SPA 1 (Antelope Valley): Click or tap here to enter text.
SPA 2 (San Fernando Valley: Click or tap here to enter text.
SPA 3 (San Gabriel): Click or tap here to enter text.
SPA 4 (Downtown LA): Click or tap here to enter text.
SPA 5 (West): Click or tap here to enter text.
SPA 6 (South LA): Click or tap here to enter text.
SPA 7 (Southeast LA): Click or tap here to enter text.
SPA 8 (South Bay): Click or tap here to enter text.
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
IV: REQUEST INFORMATION
Program budget must match the Program Budget Template. Applicants that have multiple program sites in different SPAs may request funding as a multi-area application. Applications with only one service site, regardless of where clients come from, must apply for funding in one SPA only. Applicants with multi-site program budgets should combine budgets into one, comprehensive budget and request amount. As a reminder, applicants may not request more than 40% of a total program budget.
Mass Shelter: ☐ Yes ☐ NoIf Yes, amount requested: $Click or tap here to enter text.
Other Shelter: ☐ Yes ☐ NoIf Yes, amount requested: $Click or tap here to enter text.
Total Amount of all Shelter categories requested $Click or tap here to enter text.
V: APPLICATION NARRATIVE
Please Note: Respond to the questions as though the person (s) reviewing your application know (s)
nothing about your organization or the services your organization provides. Read every question; make sure your response answers what the question has asked. Answer every question regardless of whether you believe you have already provided
the answer in previous questions.
I: ABOUT YOUR ORGANIZATION (5 MAXIMUM POINTS)
Describe your organization’s history and mission, including the year it was established. (2 points)Click or tap here to enter text.
Provide the titles and roles of staff members who will be responsible for the execution of this grant and program (i.e. grant writer, finance staff, program staff, etc.) Include
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
qualifications and history managing EFSP, if applicable (3 points)Click or tap here to enter text.
II: THE FUNDING REQUEST (5 MAXIMUM POINTS)
Describe your funding request, include the category you are requesting funding for and include the dollar amount you are requesting. If you are requesting funding for both shelter categories, list them separately, including the amounts. (3 points)Click or tap here to enter text.
Highlight how many unduplicated clients you can serve with this dollar amount within the Phase 37 spending period (January 1, 2020 thru December 31, 2020) (2 points)Click or tap here to enter text.
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
III: NEEDS STATEMENT (15 MAXIMUM POINTS)
Describe the need your program or project seeks to address. (5 points)Click or tap here to enter text.
Describe the primary target population served by this/these program (s), including demographic data, geographic area and service needs. Please include quantitative data (i.e. LAHSA homeless count or Feeding America data). (5 points)Click or tap here to enter text.
How does this program address the identified needs of the target population? (5 points)Click or tap here to enter text.
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IV: THE PROGRAM (30 MAXIMUM POINTS)
Specify criteria by which clients are chosen to participate in this program. (10 points)Click or tap here to enter text.
Are there any program pre-requisites for shelter assistance, (e.g. clean and sober, employment, medication compliance, shelter stay, etc.) (10 points)Click or tap here to enter text.
List 2-3 major objectives for this project/program during the funding period. (10 points) Click or tap here to enter text.
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
V: PROGRAMS, RESOURCES, PARTNERSHIPS (5 MAXIMUM POINTS)
Describe how your program connects clients to other organizations to provide access to additional supportive services as needed, e.g. Coordinated Entry System, County Departments, and Nonprofit service providers. (2 points)Click or tap here to enter text.
Describe your referral process to other organizations for additional supportive services as needed? (3 points)Click or tap here to enter text.
VI: SUCCESS, OUTCOMES, AND RESULTS (20 MAXIMUM POINTS)
How does your organization demonstrate outcomes and success? (10 points)Click or tap here to enter text.
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
How do these outcomes meet the need (s) stated in Question III? (5 points)Click or tap here to enter text.
Detail the number of unduplicated clients served per year across the entire program (not just EFSP-funded portion). (5 points)Click or tap here to enter text.
VII: ACCOUNTING AND FINANCIAL MANAGEMENT (20 MAXIMUM POINTS)
Describe how your organization will ensure EFSP funds will be used for their intended purposes. (5 points)Click or tap here to enter text.
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
Include a description of the accounting procedures and staff responsible for financial management. (5 points)Click or tap here to enter text.
Please detail how your organization has spent or will spent funds within the Phase 37 spending period (January 1, 2020 thru December 31, 2020). For example, your organization may be able to retroactively bill for allowable costs incurred prior to this RFP submission and then have reasonable plans to spend the remaining request for funds before 12/31/2020. (10 points)Click or tap here to enter text.
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
APPLICATION CHECKLIST:
☐ Agency Eligibility page has been completed
☐ Required attachments have been check off and will be attached with this application
☐ Copy of current 501 (c)(3) status letter
☐ Board Roster, including full name, address, phone number and role on board
☐ Copy of the most recent audited financial statements (if requesting $50,000+)
☐ Eligibility quiz has been completed
☐ Cover page and contact information completed
☐ Organization Information completed
☐ Multi-Site Roster completed
☐ Current Organization Annual Operating Expenses completed
☐ Request Information completed
☐ Application Narrative completed
☐ Proposal and attachments have been mailed to [email protected] .
VI. MULTI-SITE ROSTER
SITE NAME 1: Click or tap here to enter text.
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
Site Address: Click or tap here to enter text.City, State, Zip Code: Click or tap here to enter text.Site Contact Name & Title: Click or tap here to enter text.Site Phone Number: Click or tap here to enter text.Site Fax Number: Click or tap here to enter text.Site Days & # of Hours of Operation: Click or tap here to enter text.SPA (check all that apply)☐ SPA 1 ☐ SPA 2 ☐ SPA 3 ☐ SPA 4 ☐ SPA 5 ☐ SPA 6 ☐ SPA 7 ☐ SPA 8 PROGRAM TYPE (check all that apply) ☐ Served Meals ☐ Other Food ☐ Mass Shelter ☐ Other Shelter ☐ Rental Assistance
SITE NAME 2: Click or tap here to enter text.Site Address: Click or tap here to enter text.City, State, Zip Code: Click or tap here to enter text.Site Contact Name & Title: Click or tap here to enter text.Site Phone Number: Click or tap here to enter text.Site Fax Number: Click or tap here to enter text.Site Days & # of Hours of Operation: Click or tap here to enter text.SPA (check all that apply)☐ SPA 1 ☐ SPA 2 ☐ SPA 3 ☐ SPA 4 ☐ SPA 5 ☐ SPA 6 ☐ SPA 7 ☐ SPA 8 PROGRAM TYPE (check all that apply) ☐ Served Meals ☐ Other Food ☐ Mass Shelter ☐ Other Shelter ☐ Rental Assistance
SITE NAME 3: Click or tap here to enter text.Site Address: Click or tap here to enter text.City, State, Zip Code: Click or tap here to enter text.Site Contact Name & Title: Click or tap here to enter text.Site Phone Number: Click or tap here to enter text.Site Fax Number: Click or tap here to enter text.Site Days & # of Hours of Operation: Click or tap here to enter text.SPA (check all that apply)☐ SPA 1 ☐ SPA 2 ☐ SPA 3 ☐ SPA 4 ☐ SPA 5 ☐ SPA 6 ☐ SPA 7 ☐ SPA 8 PROGRAM TYPE (check all that apply) ☐ Served Meals ☐ Other Food ☐ Mass Shelter ☐ Other Shelter ☐ Rental Assistance
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
SITE NAME 4: Click or tap here to enter text.Site Address: Click or tap here to enter text.City, State, Zip Code: Click or tap here to enter text.Site Contact Name & Title: Click or tap here to enter text.Site Phone Number: Click or tap here to enter text.Site Fax Number: Click or tap here to enter text.Site Days & # of Hours of Operation: Click or tap here to enter text.SPA (check all that apply)☐ SPA 1 ☐ SPA 2 ☐ SPA 3 ☐ SPA 4 ☐ SPA 5 ☐ SPA 6 ☐ SPA 7 ☐ SPA 8 PROGRAM TYPE (check all that apply) ☐ Served Meals ☐ Other Food ☐ Mass Shelter ☐ Other Shelter ☐ Rental Assistance
SITE NAME 5: Click or tap here to enter text.Site Address: Click or tap here to enter text.City, State, Zip Code: Click or tap here to enter text.Site Contact Name & Title: Click or tap here to enter text.Site Phone Number: Click or tap here to enter text.Site Fax Number: Click or tap here to enter text.Site Days & # of Hours of Operation: Click or tap here to enter text.SPA (check all that apply)☐ SPA 1 ☐ SPA 2 ☐ SPA 3 ☐ SPA 4 ☐ SPA 5 ☐ SPA 6 ☐ SPA 7 ☐ SPA 8 PROGRAM TYPE (check all that apply) ☐ Served Meals ☐ Other Food ☐ Mass Shelter ☐ Other Shelter ☐ Rental Assistance
SITE NAME 6: Click or tap here to enter text.Site Address: Click or tap here to enter text.City, State, Zip Code: Click or tap here to enter text.Site Contact Name & Title: Click or tap here to enter text.Site Phone Number: Click or tap here to enter text.Site Fax Number: Click or tap here to enter text.Site Days & # of Hours of Operation: Click or tap here to enter text.SPA (check all that apply)☐ SPA 1 ☐ SPA 2 ☐ SPA 3 ☐ SPA 4 ☐ SPA 5 ☐ SPA 6 ☐ SPA 7 ☐ SPA 8 PROGRAM TYPE (check all that apply) ☐ Served Meals ☐ Other Food ☐ Mass Shelter ☐ Other Shelter ☐ Rental Assistance
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EMERGENCY FOOD & SHELTERPHASE 37: SHELTER APPLICATION
SPA 1ANTELOPE VALLEY
SPA 2 SAN FERNANDO VALLEY
SPA 3 SAN GABRIEL VALLEY
SPA 4 DOWNTOWN LA
SPA 5 – WEST
SPA 6 – SOUTHLA
SPA 7 – SOUTHEAST
SPA 8 – SOUTH BAY
Communities
Acton
Edwards AFB
Lake Hughes
Lancaster
Littlerock
Llano
Palmdale
Pearlblossom
Valyermo
Lake Los
Angeles
Communities
Burbank
Calabasas
Canoga Park
LA
Encino LA
Glendale
La Canada
La Crescenta
Mid-SFV LA
North Hills LA
North
Hollywood LA
Northridge LA
Northwest
SFV LA
Pacoima LA
San
Fernando
Santa Clarita
Sherman
Oaks LA
Studio City
Studio City
L.A.
Sunland L.A
Sylmar L.A
Thousand
Oaks
Tujunga LA
Van Nuys L.A
Westlake
Village
Woodland
Hills L.A
Communities
Alhambra
Altadena
Arcadia
Azusa
Baldwin Park
Claremont
Covina
Diamond Bar
Duarte
El Monte
Glendora
Hacienda-
Rowland Hgt
La Puente
Monrovia
Monterey
Park
Mt. Wilson
Pasadena
Pomona
Rosemead
San Dimas
San Gabriel
San Marino
Sierra Madre
South
Pasadena
Temple City
Walnut
West Covina
Communities
Central L.A.
L.A.
East L.A
Hollywood
L.A
Northeast L.A
West
Hollywood
Wes Wilshire
L.A
Wilshire L.A
Communities
Bel Air L.A
Beverly Hills
Brentwood
L.A
Culver
City/Ladera
Malibu
Pacific
Palisades L.A
Playa del Rey
L.A
Santa Monica
Venice/Mar
Vista L.A
Veterans
Admin/L.A Co
West L.A.
Westchester
L.A
Communities
Compton
Crenshaw
L.A
Lynwood
Paramount
South Central
L.A
University LA
West
Compton
LA/Co.
Communities
Artesia
Bell
Bellflower
Cerritos
Commerce
Downey
East L.A
Hawaiian
Gardens
Huntington
Park
Huntington
Park/Vernon
La Habra
La Miranda
Lakewood
Maywood
Norwalk
Pico Rivera
Santa Fe
Springs
South Gate
Whittier
Communities
Beach Cities
Carson
El Segundo
Gardena
Harbor City
LA
Hawthorne
Inglewood
Lawndale
Lomita
Long Beach
Palos Verdes
San Pedro LA
Torrance
Wilmington
LA
Grantee Signature: Click or tap here to enter text. Date: Click or tap to enter a date.Executive Director signature: Click or tap here to enter text. Date: Click or tap to enter a
date.
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