Fillable EMERGENCY SOLUTIONS GRANT COVID-19 GRANT FUNDING APPLICATION (1) (Fulton County Government)

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EMERGENCY SOLUTIONS GRANT COVID-19 GRANT FUNDING APPLICATION (1) (Fulton County Government)

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EMERGENCY SOLUTIONS GRANT COVID-19 GRANT FUNDING APPLICATION (1)
ESG COVID FUNDING APPLICATION (1) 1
Fulton County is making available funds awarded through the Department of Housing and Urban
Development (HUD) and the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) to nonprofit
agencies providing valuable services in Fulton outside the City of Atlanta, to support their response to local needs
related to the homeless activities and the COVID-19 pandemic.
Grants of $25,000 and up to $100,000 will be provided to eligible nonprofits.
I. SUBMISSION DEADLINE
Applications will be available from June 23, 2020 to July 6, 2020. All applications must be submitted electronically to:
HomelessInfo@fultoncountyga.gov no later than 11:59pm.
II. AGENCY ELIGIBILITY
Funding allocations will be made to qualifying nonprofit agencies providing eligible services in Fulton County,
outside of the city of Atlanta. Please note that grant funds are reimbursable; your agency must have the capacity
and cash flow to incur eligible costs. The County encourages collaborative submissions which define a strategic
approach to addressing critical needs in our community.
III. NONPROFIT QUALIFICATIONS
The following documents should be included with submitting the grant application:
1. 501(c)(3) Designation Letter from the Internal Revenue Service.
2. Current certification from the Georgia Secretary of State. For assistance, please visit http://www.sos.ga.gov.
3. Financial statements covering the most recent reporting periods of operation.
4. List of board members. Must have a Board of Directors with representation from the community served and
committee structure that ensures the necessary mix of skills to succeed.
5. By-Laws;
6. Copy of Conflict of Interest Statement.
Please note: The failure to submit items one through six will result in an automatic declination of the application
.
IV. DATA COLLECTION
Subrecipients will be required to enter data into the County’s Homeless Management Information System (HMIS) on
all persons assisted and services provided with ESG-CV funds. Per HUD ESG regulations, victim services organizations
may collect data in a substantially equivalent database instead of in HMIS.
1. My nonprofit utilizes HMIS □ Yes □ No
2. If no, my agency will participate in training to acquire the necessary skills to utilize HMIS. □ Yes □ No
HMIS training will be provided to all grantees.
Agencies that do not and will not utilize the HMIS will result in an automatic declination of the application.
EMERGENCY SOLUTIONS GRANT COVID-19 GRANT FUNDING APPLICATION (1)
ESG COVID FUNDING APPLICATION (1) 2
V. ELIGIBLE ACTIVITIES
Funds may be used to cover or reimburse allowable costs to eligible homeless activities included in “Attachment A”
of this document. All applicants should carefully review Attachment A before completing the Statement of Need.
V
I. Organization Information
Ag
ency Name: ________________________________________________________________________
Agency EIN-Number as assigned by The Internal Revenue Service (IRS): __________________________
Fulton County Subrecipient Code Number (Note: Only for agencies who are currently funded or have received
previous funding from Fulton County Government): __________________________________________
Agency Main Address: __________________________________________________________________
Agency Mailing Address (if different from above): ____________________________________________
NOTE: ALL HOMELESS – RELATED CORRESPONDENCE WILL BE MAILED TO THIS ADDRESS, INCLUDING PAYMENTS
Agency Main Number/ Fax/ Website/ E-mail Address: _________________________________________
Board Chair: __________________________________________________________________________
Board Chair Telephone #: _______________________________________________________________
2nd Authorizing Official: _________________________________________________________________
2nd Authorizing Official Telephone #: ______________________________________________________
Program Contact: ________________________________________________________________
Program Contact Telephone # / Email Address: ________________________________________
Alternate Program Contact: ________________________________________________________
Alternate Program Contact Telephone # / Email Address: ________________________________
V
II. Project Details
1.
Project Name: _______________________________________________________________________________
ESG-CV Request: $______________________________________________________________________________
EMERGENCY SOLUTIONS GRANT COVID-19 GRANT FUNDING APPLICATION (1)
ESG COVID FUNDING APPLICATION (1) 3
VIII. Project Activities and Descriptions
1. ESG-CV Eligible Activities (See specific details of each activity in Attachment A)
Provide a comprehensive narrative about your project. Your narrative should include the need to be addressed,
your approach to address the need that the proposed project and how this project will meet the identified
needs, the population you will serve, and your time line to complete the project. Be sure to highlight tangible
partnerships/leveraging resources. (1,000 words max). Provide on a separate sheet.
A. Emergency Shelter: $________________ (include gr
ant request amount)
B. Provision of Temporary Shelter: $_________ (include grant request amount)
C. Homeless Prevention/Rapid Rehousing: $_____________ (include grant request amount)
IX. Beneficiary Details
1. How many beneficiaries will the proposed project serve? ____________________________________________
2. Will your project serve any of the identified groups listed below exclusively? □ Yes □ No
Population Proposed Number of People to Serve
Homeless Children
Homeless Abused Spouses
Homeless Veterans
Chronic
Episodic
Transitional
Hidden
Other: (please specify)
X. PROJECT IMPLEMENTATION SCHEDULE
1. Projects should be a 12 to 18 month period.
2. Detail how you anticipate utilizing funding for this project. Include expenditure timelines that
includes the percentage of funds to be expended by February 28, 2022.
XI. REPORTING
1. Describe the applicant’s experience in reporting, monitoring, or record keeping. Include experience reporting on
federal grants, state, local grants and well as grants from corporations or foundations. Include a description of
your organization reporting system, (100 words max). Attach a separate sheet.
2. Attach an agency budget that includes program and administrative costs, revenue, and the use of ESG funding.
EMERGENCY SOLUTIONS GRANT COVID-19 GRANT FUNDING APPLICATION (1)
ESG COVID FUNDING APPLICATION (1) 4
XII. SIGNATURE PAGE
1. Letter from an Authorized Certifying Official is attached with the following resolution that authorizes the
submission of the application.
Name of Applicant: _____________________________________________________________________________
Be it resolved that the Board of Directors of the above-referenced Applicant resolved at its meeting date referenced
below, to authorize the Applicant to submit an application to the Fulton County Department of Community
Development, Homeless Division office for grant funding. The individual referenced below is authorized to execute
any documents necessary for application submission and funding.
Meeting Date: _________________________________________________________________________________
Amount Requested: _____________________________________________________________________________
Executor: _____________________________________________________________________________________
I hereby certify that the foregoing resolution was approved by our Board of Directors.
Certifying Official (Signature, Name & Title) Date
I certify that I have completed the application for Fulton County ESG-CV Act funding. All information contained in
this submission has been completed as thoroughly and as accurately as possible, and a governing body resolution or
letter from an authorized certifying official approving the submission has been attached. Through this submission, I
have defined other funding sources received confirming that if selected for funding, these funds will not supplant or
duplicate current sources.
Prepared by (Signature & Date): ___________________________________________________________________
Prepared by (Printed Name & Title): ________________________________________________________________
Approved by (Signature & Date): __________________________________________________________________
Approved by (Printed Name & Date):_______________________________________________________________
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EMERGENCY SOLUTIONS GRANT COVID-19 GRANT FUNDING APPLICATION (1)
ESG COVID FUNDING APPLICATION (1) 5
ATTACHMENT A
I. ELIGIBLE EXPENSES
A. Em
ergency Shelter Services
• Shelter Operations
• Hotel/Motel Vouchers
• Case Management
• Childcare
• Education services
• Employment assistance and job training
• Legal services
• Mental health services
• Life skills training
• Outpatient health services
• Substance abuse treatment services
• Transportation
B. Provision of temporary shelters (through leasing of existing property, temporary structures, or other
means) to prevent, prepare for, and respond to the coronavirus.
C. Homelessness Prevention/Rapid Re-Housing Services
• Financial Services
o Moving costs
o Rental application fees
o Security deposit
o Last month’s rent
o Utility deposit
o Utility payments
• Housing Relocation and Stabilization Services
o Housing Search & Placement
o Housing Stability Case Management
o Mediation
o Legal Services
o Credit Repair
• Rental Assistance
o Short-term (up to 3 months)
o Medium-term (up to 24 months)
o Rental arrears (one-time payment for up to 6 months of arrears)
EMERGENCY SOLUTIONS GRANT COVID-19 GRANT FUNDING APPLICATION (1)
ESG COVID FUNDING APPLICATION (1) 6
• Street Outreach
o Engagement
o Case Management
o Emergency Health Services
o Emergency Mental Health Services
o Transportation
o Services for Special Populations
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EMERGENCY SOLUTIONS GRANT COVID-19 GRANT FUNDING APPLICATION (1) (Fulton County Government)

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Completed 17 July 2020

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