EMERGENCY FOOD AND SHELTER PROGRAM Phase 3 Application Information

Transcription

1 EMERGENCY FOOD AND SHELTER PROGRAM Phase 3 Application Information The EFSP is a restricted federal grant designed to provide supplemental funds for agencies that provide supportive services for the hungry and homeless. An electronic copy of the application is preferred. If the application is handwritten, then please do not staple it or include additional blank pages that do not apply to your application. Be sure to also attach a copy of your agency s 501 c 3 non-profit status. Late or incomplete applications will not be considered for funding. Applications are preferably ed, but can be hand-delivered or mailed to the following address but must be received by Friday at Captain 243 Derby Street Pekin, IL (if you include a return receipt, you will know that I have received and opened your application!) For further information, please contact Captain at Application Directions & Tips Complete pages 1 3 in their entirety. On pages 4-9, complete only the categories for which you are applying for funding. The Total Funds Requested on page 3 should be consistent with the funding requests on pages 4-9. Do not alter the format of the application. Use only the space provided when completing the narrative portion of the application. Additional pages will not be reviewed. When completing the narrative portion of the application, provide concise information. Describe how EFSP monies will supplement current services. EFSP monies are not to be used to begin new programs or replace existing funds. When requesting funding amounts, consider that EFSP funds are supplemental. For example, a request of $10,000 would not be supplemental if the budget for a specific program is $2,000. Over 51% of the program budget must come from sources other than EFSP funds. **If awarded funds, the minimum amount of an award is $500 If your agency is affiliated with a national organization, please choose the code from the table below for that affiliation. If no code applies, choose UN. Affiliation Codes AG Aging Council MW Meals on Wheels CA Community Action Agency RC American Red Cross CC Catholic Charities and other Catholic Organizations SA Salvation Army CM Church Organizations or Ministerial Associations SV St. Vincent de Paul CO Coalition TA Travelers AID FB Food Bank (Second Harvest or Other) TG Tribal Government FS Family Service America UL Urban League GV Government Agency (except Tribal Gov.) UW United Way IR Hotlines Information and Referral YM YMCA JF Jewish Federations and other Jewish Organizations YW YWCA LA Labor Organizations UN Unaffiliated with any of the above or no affiliation 1

2 EMERGENCY FOOD AND SHELTER PROGRAM Phase 3 Application for Program Funds SECTION 1: Date: Legal Name of Agency:* AGENCY INFORMATION Agency website (if applicable): Program Name: Program Mailing Address: City, State, Zip: Program Site Address: City, State, Zip, County: Program Contact Person and Title: Telephone: Fax: Alternate Phone Number: address: SECTION 2: SERVICE ELIGIBILITY Please check if your agency targets specific client populations by choosing up to the top three (3) from the list below: If your agency targets no specific population use No target Population Chemically addicted People with AIDS/HIV Elderly Domestic violence victims Native Americans Veterans Single women Families with children Single men Unaccompanied minors Mentally disabled Minorities No target populations Other targeted populations Please give a brief description of your overall agency services. Use only the space provided. 2

3 In the space below, please summarize how EFSG funds will supplement your current services. Is your facility handicap accessible? Yes No Did this agency receive EFSP funds during Phase 30? Yes No What other agencies provide similar assistance to residents in your service area? Does your agency collaborate with other service providing agencies? If so, which ones Will this EFSP award assist you in securing funding from other sources (leverage funds)? Yes No SECTION 3: FUNDING REQUEST Please complete only the pages/ categories for which you are applying for funding on pages 4-9. Using the numbers 1, 2,3,4,5, and 6, prioritize your agency s funding needs by placing a 1 next to the greatest need, 2 next to the second greatest need, etc. CATEGORY FUNDING REQUEST PRIORITY 1. MASS SHELTER $ (complete page 4, Category 1) 2. MASS FEEDING $ (complete page 5, Category 2) 3. OTHER FOOD $ (complete page 6, Category 3) 4. TEMPORARY LODGING $ (complete page 7, Category 4) 5. RENT/ MORTGAGE ASSISTANCE $ (complete page 8, Category 5) 6. UTILITY ASSISTANCE $ (complete page 9, Category 6) TOTAL FUNDS REQUESTED $ This application is due on Friday, by 12 p.m. Your agency s 501c(3) status, must be included. Applications that do not contain this information are incomplete and will not be considered for funding. Executive Director: Title: Agency: 3 Date: Federal Employer ID#

4 Category 1: MASS SHELTER Mass Shelter (5 or more beds) Over 50% of funding should come from sources other than EFSP. Dollar amount requested for Mass Shelter funds: $ Please project the total number of nights that will be provided: (divide your total request by $7.50 for bed only or $12.50 if other supporting services will be provided) What is the total anticipated operating budget for the Mass Shelter program? (Do not include anticipated EFSP funds.) $_ Federal State What is your legal occupancy? Which months of the year is the shelter open? Which days of the week is the shelter open? What are the daily hours of operation? What is the maximum length of stay permitted? What year did the shelter originally open? Is a nightly fee required for service? Yes No 4

5 Category 2: MASS FEEDING Mass Feeding (on-site meal programs, meals delivered) Over 50% of funding should come from sources other than EFSP. Requested funding is not intended to pay for any specific special meal (i.e. holiday baskets, holiday meals, holiday turkeys, special celebrations) Dollar amount requested for Mass Feeding funds: $ Please project the total number of meals to be served: (divide total request by $2.00) What is the total anticipated budget for direct services for the Mass Feeding program? $ Federal State How many meals were provided last year? Which months of the year are meals served? Which days of the week are meals served? What is the average number of meals served per week? _ What year did the meal program begin? _ Does the agency charge a per meal fee? Yes No Where do you acquire the food for this program? Do you utilize food from the Peoria Food Bank? Yes No 5

6 Category 3: OTHER FOOD Other Food (food boxes, food pantries, or food banks) Over 50% of funding should come from sources other than EFSP. Requested funding is not intended to pay for any specific special meal (i.e. holiday baskets, holiday meals, holiday turkeys, special celebrations) Dollar amount requested for Food funds: Please project the total number of meals to be served: (divide total request by $2.00) $ What is the total anticipated budget for direct services for the Other Food program? $ Federal State How many meals were provided last year? _ Does the agency charge a fee? Yes No Where do you acquire the food for this program? Do you utilize food from the Peoria Food Bank? Yes No Does your agency accept emergency referrals? Yes No If yes, please provide phone number And days of week available What geographic area does this agency serve? 6

7 Category 4: TEMPORARY LODGING Temporary Lodging: (hotel/motel) Over 50% of funding should come from sources other than EFSP. Dollar amount requested for Temporary Lodging funds: $ What is the total anticipated budget for direct services for the Temporary Lodging program? $ Federal State What year did agency begin providing this service? How many clients were provided temporary lodging last year? How often can the same client be provided temporary lodging? List the facilities that provide lodging for this program What are the criteria in choosing these facilities? Have you negotiated rates and availability? Yes No 7

8 Category 5: RENT AND MORTGAGE ASSISTANCE Rent and Mortgage Assistance: (past due rent or mortgage, first month s rent or mortgage) Over 50% of funding should come from sources other than EFSP. Dollar amount requested for Rent and Mortgage Assistance: Number of estimated bills to be paid with these funds: $ What is the total anticipated budget for direct services for the Rent/Mortgage Assistance program? $ Federal State Please list the dollar amount that you anticipate using for the following expenses: First month s rent/ mortgage Past due rent/ mortgage $ $ What year did agency begin providing emergency assistance services? How many bills did the agency pay last year? What is the maximum amount of assistance per household? $ 8

9 Category 6: UTILITY ASSISTANCE Utility Assistance: electric, gas, propone, firewood, water (no telephone) Over 50% of funding should come from sources other than EFSP. Dollar amount requested for Utility Assistance: $ What is the total anticipated budget for direct services for the Utility Assistance program? $ Federal State What year did agency begin providing this service? How many utility bills did this agency pay last year? What is the maximum amount of assistance per household? _ 9