EMERGENCY SOLUTIONS GRANT (ESG) – APPLICATION
Homeless Assistance and Homelessness Prevention Services
FY 2015-16
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EMERGENCY SOLUTIONS GRANT (ESG) – APPLICATION
Homeless Assistance and Homelessness Prevention Services
FY 2015-16
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 re-house homeless individuals and families; and
 Prevent families and individuals from becoming homeless
ESG funds may be used for six program components:
1) Street Outreach
2) Emergency Shelter/Transitional Housing
3) Rapid Re-Housing Assistance
4) HOPE-1000 Homes Collaboration (Rapid Re-Housing - Housing Relocation and Stabilization
Services)
5) Homelessness Prevention
6) HMIS
Each program component encompasses a separate competitive evaluation and allocation amount,
and allocations may not be evenly distributed among components. This Notice of Funds
Available (NOFA) is being released to identify, pre-qualify, and establish contracts with
experienced organizations to provide homeless assistance services within the County’s Service
Area for multiple years which will begin on July 1, 2015. At the time of the release of this NOFA,
funding amounts have not been published. All funding is projected and awards may be modified
to reflect actual awards made by the Department of Housing and Urban Development. The total
anticipated ESG funds available for allocation through this program during the first fiscal year is
approximately $400,000.
Carefully read through the entire application along with the attached instructions and proposal. Answer
all questions as specifically and completely as possible. If more space is needed, attach separate sheets.
TYPE OR PRINT
A. Applicant Information
1
Name of Applicant Organization:
Mailing Address:
2
3
4
5
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City:
Contact Person:
Title:
Phone:
State:
Zip:
E-mail Address:
B. Organizational Information
1) Organizational History:
a. Date Organization founded:
b. Date Organization incorporated as a non-profit organization (if applicable):
c. Federal identification number:
State identification number (if applicable):
d. DUNS #:
e. Number of paid staff:
Number of volunteers:
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2015-2016 Emergency Solutions Grant Application
2)
Is this a “faith-based” organization? **Yes
No
**Generally, a faith-based organization was founded or is inspired by faith or religion. Such organizations
often choose to demonstrate that faith by carrying out one or more activities that assist persons who are
less fortunate.
-------------------------------------------------------------------------------------------------------------------------------------------Please describe:
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C. Benefit Areas
Identify which cities and communities your agency proposes to serve under the ESG program.
1) Cooperating Cities: The following cities participate as cooperating cities in the COUNTY'S ESG
Program. Please determine if the primary service area for your proposed service would include one or
more of the following cities. Please check all that apply:
Adelanto
Barstow
Big Bear Lake
Colton
Grand Terrace
Highland
Loma Linda
Montclair
Needles
Redlands
Twentynine Palms
Yucaipa
Town of Yucca Valley
2) Unincorporated Regions: The following regions contain unincorporated areas covered by COUNTY
ESG Program. Please determine if the primary service area for your proposed project includes one or
more of the following unincorporated areas. Check all applicable areas.
San Bernardino area (San Bernardino, Colton, etc.)
West Valley (Montclair, Chino, etc.)
East Valley (Redlands, Yucaipa, etc.)
High Desert (Barstow, Victorville, etc.)
Low Desert (Yucca Valley, 29 Palms, etc.)
Colorado River (Needles, Big River, etc.)
Mountains (Crestline, Big Bear, etc.)
D. Organization Description
Briefly summarize the goals and objectives of your organization and how you achieve them:
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2015-2016 Emergency Solutions Grant Application
THE FOLLOWING FIVE COMPONENTS ARE AVAILABLE FOR APPLICATION:
E. Proposal Characteristics:
1.
STREET OUTREACH (Engage homeless individuals and families living on the street):
Activity: (Please check all that apply.)
Street Outreach
Engagement Services/Needs Assessment
Connect to Emergency Shelter
Connect to Transitional Housing
Essential Services (assistance with employment, health, drug abuse, education,
or connection with other agency assistance - Please describe:
Other Activities (Please describe):
What specifically is the anticipated strategy and achievement under this component
(Detailed Proposal Description):
Briefly describe previous experience in providing this type of service:
What does the agency consider to be Successful Outcomes in reaching this program goal?
(e.g. family maintains permanent housing for six months after existing program, head of
household obtains employment and/or increases income, 30 families went through the
program and 25 were successful):
2.
EMERGENCY SHELTER (Improve the number and quality of emergency shelters and/or
transitional housing for homeless individuals and families; help operate these shelters; provide
essential services to shelter residents)
Activity: (Please check all that apply.)
Shelter Nights
Transitional Housing
Motel Vouchers
Essential Services/Case Management (assistance with employment, health, drug abuse,
education, or connection with other agency assistance - Please describe):
Other Activities (Please describe):
What specifically is the anticipated strategy and achievement under this component
(Detailed Proposal Description):
Briefly describe previous experience in providing this type of service:
What does the agency consider to be Successful Outcomes in reaching this program
goal? (e.g. family maintains permanent housing for six months after existing program, head
of household obtains employment and/or increases income, 30 families went through the
program and 25 were successful):
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2015-2016 Emergency Solutions Grant Application
3.
RAPID RE-HOUSING (Assist people to regain permanent housing who have recently
become homeless):
Activity: (Please check all that apply.)
Rental Assistance
Housing Relocation and Stabilization Services (HRSS):
Rental Security Deposits
Utility Assistance
Case Management (Please describe.):
Other HRSS (Please describe):
Other Activities (Please describe):
What specifically is the anticipated strategy and achievement under this component
(Detailed Proposal Description):
Briefly describe previous experience in providing this type of service:
What does the agency consider to be Successful Outcomes in reaching this program
goal? (e.g. family maintains permanent housing for six months after existing program, head of
household obtains employment and/or increases income, 30 families went through the program
and 25 were successful):
4.
HOPE-1000 HOMES FOR VETERANS COLLABORATION (Rapid Re-Housing Housing Relocation and Stabilization Services [HRSS]) (See instructions for description)
Activity: (Please check all that apply.)
Rental Security Deposits
Utility Security Deposits
Background Credit Checks:
Other Housing Relocation and Stabilization Services (HRSS) that are ineligible under
other collaborating programs (Please describe):
Other Activities (Please describe):
What specifically is the anticipated strategy and achievement under this component
(Detailed Proposal Description):
Briefly describe previous experience in providing this type of service:
What does the agency consider to be Successful Outcomes in reaching this program goal?
(e.g. family maintains permanent housing for six months after existing program, head of household
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2015-2016 Emergency Solutions Grant Application
obtains employment and/or increases income, 30 families went through the program and 25 were
successful):
5.
HOMELESSNESS PREVENTION (Prevent families and individuals from becoming
homeless)
Activity: (Please check all that apply.)
Rental Assistance
Housing Relocation and Stabilization Services (HRSS):
Rental Security Deposits
Utility Assistance
Case Management (Please describe.):
Other HRSS (Please describe):
Other Activities (Please describe):
What specifically is the anticipated strategy and achievement under this component
(Detailed Proposal Description):
Briefly describe previous experience in providing this type of service:
What does the agency consider to be Successful Outcomes in reaching this program
goal? (e.g. family maintains permanent housing for six months after existing program, head of
household obtains employment and/or increases income, 30 families went through the program
and 25 were successful):
6.
HMIS (Homeless Management Information Systems) Must be requested in conjunction
with another Component.
Activity:
Data Entry and Reporting
What specifically is the anticipated strategy and achievement under this component
(Detailed Proposal Description):
Briefly describe previous experience in providing this type of service:
What does the agency consider to be Successful Outcomes in reaching this program goal?
(e.g. family maintains permanent housing for six months after existing program, head of household
obtains employment and/or increases income, 30 families went through the program and 25 were
successful):
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2015-2016 Emergency Solutions Grant Application
F. Program Design
PROGRAM DESIGN
a. ESG Activity Type and Number of Clients to be served.
b. Purpose of the proposed project.
c.
Need for the project and how was the need for the proposed activity identified?
d. Target Population: Identify any unique characteristics of the population that you propose
to serve. Be specific (e.g. families with children, males with substance abuse problems,
chronic mentally ill).
e. Provide information on the types of services that will be offered and how they will be
provided.
f.
Outreach Plan: Describe the methods to be used to ensure that the target population
and community residents will find out about the services provided by the project. What
are the possible referral sources for this project?
How will they be used?
G. Organization And Staff Qualifications And Experience
ORGANIZATION AND STAFF QUALIFICATIONS AND EXPERIENCE
Adequate management and administration is also required for the program, but is not funded by
ESG. The Executive Director and Accountant must be shown in the Personnel Budget in Table 3.
a. Provide a summary of the qualifications of your organization to carry out the proposed
project.
b. Provide a summary of the experience of your organization. Include any program that your
agency has administered that is most similar to the proposed activity.
c.
Describe your agency’s bi-lingual capacity. List all languages in which your agency has
capability.
d. Provide a list of all staff who will be working on the ESG program, with a brief description
of duties in order to demonstrate agency capacity to implement the program.
H. Performance Measurement
PERFORMANCE MEASUREMENT
a. List the measurable goals of the proposed project. Include the number of individuals and
families to be served.
b. List the proposed outcomes for each goal.
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2015-2016 Emergency Solutions Grant Application
c.
Evaluation Plan: The evaluation process is designed as a planning and measurement
tool. Evaluation is the analysis of data for the purpose of determining if and how the
planned activities were carried out, if objectives/goals were achieved.
i. What data will be collected to identify the events that take place, when, with
whom? Include who will be responsible for collecting the information and at what
intervals it will be collected.
ii. Outcome Evaluation: Describe your process for evaluating outcomes? How will
outcomes be measured? How will you build objective analysis into your outcome
evaluation process?
I. Collaborative Effort
COLLABORATIVE EFFORT
a. Please list any coalitions, consortiums, or any other community meetings that your agency
participates in on a regular and consistent basis.
b. Is this project conducted in collaboration with other agencies? Please describe.
J. Strategies Cost - Table 1
2015-16 ESG Accomplishment Goals
Activity
Example
2015-16 Requested
Allocation
$
Total Annual Number
of Households
Expected to be
Served
5,000.00
10
Average Annual Cost Per
Unit of Service per Person
$
500.00
Emergency Shelter
(ES, Transitional
Housing, or Vouchers)
Street Outreach
Rapid Re-Housing
(RRH)
HOPE/1000 Homes
Homelessness
Prevention (HP)
HMIS
TOTAL
Use the space below to add any additional clarifying information regarding Table 1 above:
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2015-2016 Emergency Solutions Grant Application
The Emergency Solutions Grant will cover a portion of the eligible expenses for funded programs. ESG
requires 100% match and this must be calculated into the budget. Match can be cash or in-kind and must
be applied to eligible activities. Staff working all, or in part, providing direct client services for eligible
activities must be included in the budget. The administration has the flexibility to determine what portion, if
any, of the eligible salary will be billed to ESG.
K. Matching Funds – Table 2
1
2
Amount of ESG funds requested in this application (must equal Section F –Table 1 “Total Funds Requested):
Additional funds to be provided by other source(s) for this project. The date that the other source(s) of funds have been or will
be awarded and available, must be stated below:
Source(s):
Award Date:
Date Available:
$
Source(s):
Award Date:
Date Available:
$
Source(s):
Award Date:
Date Available:
$
Source(s):
Award Date:
Date Available:
$
Source(s):
Award Date:
Date Available:
$
Source(s):
Award Date:
Date Available:
$
Source(s):
Award Date:
Date Available:
$
Source(s):
Award Date:
Date Available:
$
Total of Other Sources
(Should equal, or exceed, “Total Funds Requested” from Section F, Table 1)
Use the space below to add any additional clarifying information regarding Table 2 above:
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2015-2016 Emergency Solutions Grant Application
L. FY2015-16 Agency’s Homeless Assistance Budget Summary – Table 3
A. Budget Items
Projected Expenses
Personnel
$
Consultant/Contract Services (Auditing, Accounting or Payroll Services)
$
Travel
$
Space Rental
$
Consumable Supplies
$
Rental, Lease, or Purchase of Equipment
$
Insurance
$
Other (Utilities, Land-line Phones, Cellular Phones, Internet Service,
Postal Services, Security Clearances, Approved Subsidies/Scholarships,
Administrative and Indirect Costs)
Total Budget:
$
$
B. Sources of Funding
Amount of Revenue
1.
$
2.
$
3.
$
4.
$
5. *ESG Share
*$
Total Sources of Funding:
$
Use the space below to add any additional clarifying information regarding Table 3 above:
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2015-2016 Emergency Solutions Grant Application
M. General Information:
1. How does your proposal help to achieve one or more of the stated recommendations in the 10Year Strategy to End Homelessness in San Bernardino County and the Countywide Vision?
2. If this proposal involves short term emergency shelter services only, what are your procedures to
move your clients to the next step toward housing stability?
3. Does your agency collaborate with other agencies or groups? (Department of Behavioral Health,
Workforce Development Department, School District, Veterans Affairs, Homeless Provider
Network) Describe how your agency manages its networking system? Which agencies does
your agency collaborate with and who are the contacts?
N. Additional Proposal Information
(Any additional information from previous questions or new information you would like to add)
O. Homeless Management Information Systems (HMIS)
Currently participates in HMIS?
Agrees to participate in the HMIS?
Authorized Signature: To the best of my knowledge the information provided in this application is
true and I am authorized to submit this application on behalf of the applicant agency. Also, I
acknowledge that insurance coverage, including, but not limited to, Comprehensive General Liability
and Automobile Liability, and Professional Liability will be required before ESG funds can be made
available to approved projects.
Signature:
Print
Name:
Title:
Date:
/
/
PLEASE SUBMIT ONE ORIGINAL AND THREE (3) COPIES OF EACH COMPLETED AND SIGNED
PROJECT PROPOSAL TO: County of San Bernardino, Department of Community Development and
Housing, 385 North Arrowhead Ave, Third Floor, San Bernardino, CA 92415-0043, Attention: Debbie
Kamrani.
For assistance or information regarding the completion of this proposal, call (909) 387-4327 or (909) 3874705
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2015-2016 Emergency Solutions Grant Application
2015-2016 EMERGENCY SOLUTIONS GRANT PROPOSAL
ESG Application Checklist
Community-based organizations are required to include one copy of the items listed below. If you
are not submitting these items at this time, please notify the Department of Community Development
at (909) 387-4700 to make other arrangements. The following information is required before any
contract or reimbursement can be completed.

Summary of agency’s current year General Operating Budget

List of Agency’s Board of Directors, including names and addresses

Proof of existing non-profit/tax-exempt status (Letters from the Federal Internal Revenue
Service and State Franchise Tax Board)

Current certificate of insurance and amounts covered

Organizational Chart

Minutes of last Board meeting
If your application is funded you will be required to provide a copy of your last audit, Articles of
Incorporation and Bylaws, IRS Form W-9, and DUNS #.
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