CITY OF EL PASO
Dept. of Community and Human Development
FY 2019-2020 EMERGENCY SOLUTIONS GRANT
2
Introduction
1. Agency Legal Name:
2. ________________________Date incorporated as a Texas Non-Profit Corporation
________________________Date of IRS Section 501 (c) 3 Certification
________________________Employer Identification Number (EIN)
________________________DUNS Number
3. Contacts (include name, title, phone and extension)
Grant Writer:
Program Director:
Executive Director:
4. Agency Purpose or Mission Statement:
5. Is this agency faith-based? (Mark one) Yes No
6. Indicate Proposed Use of ESG funds:
By Component and Amount: Street Outreach _____________________
Emergency Shelter _______________________________
Homelessness Prevention _____________________________
Rapid Re-Housing _______________________________
HMIS _______________________________
7. Base Funding Request:
Total Project Cost $____________________
Amount of Emergency Solutions Grant Request $____________________
Costs covered by other funding Sources $____________________
8. If additional funds were available, what is the maximum grant your project could manage and
effectively use at a proportional increase in services? _____________
9. Recipients of ESG funds are required by law to provide for the participation of at least one
homeless or formerly homeless person(s) in a policy-making function within the organization:
A. Are currently homeless ________
B. Were formerly homeless ________
NOTE: This information will be verified prior to execution of contract.
