HOUSING FIRST
HOMELESS PREVENTION
FUNDING APPLICATION GUIDE
The City of London, as the Community Entity for the Government of Canada’s
Homelessness Partnering Strategy, is seeking applications for Housing First
projects/programs that would meet one or more of the priority areas of
London’s Homeless Prevention System.
Deadline to submit electronic applications no later than midnight
Wednesday, June 4, 2014
Applications are to be submitted to homelessprevention@london.ca
May 15, 2014
Housing First Homeless Prevention Funding Application Guide
Table of Contents
Section I: Housing First Homeless Prevention Funding Application Guide ................................ 4
1.1
What is London’s Homeless Prevention System? ........................................................ 4
1.2
What is the Homelessness Partnering Strategy (HPS)? ............................................... 4
1.3
What are the Community Advisory Board and the Community Entity for the
Homelessness Partnering Strategy?............................................................................ 4
1.4
What are the funding criteria? ...................................................................................... 5
1.5
What are the areas of focus for the funding?................................................................ 5
1.6
What are the ineligible expenses under the projects/programs? .................................. 5
1.7
Who can apply for funding? ......................................................................................... 6
1.8
What are the expectations for agencies working together on a collaboration project or
program? ..................................................................................................................... 6
1.9
What are the expectations of groups/associations that are sponsored by an
incorporated not-for-profit organization? ...................................................................... 7
Section II: The Funding Application ........................................................................................... 7
2.1
Instruction .................................................................................................................... 7
2.2
How to apply? .............................................................................................................. 7
2.3
What happens after an application is submitted? ......................................................... 8
2.4
Monthly and fiscal reporting requirements for approved projects or programs .............. 9
2.5
General Information ....................................................................................................10
Section III: Application Instructions............................................................................................10
Section IV:Funding Request Instructions...................................................................................13
Section V: Declaration..............................................................................................................15
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Housing First Homeless Prevention Funding Application Guide
Please submit the following required documents:
☒Complete the application and funding request for each fiscal year
☒Review and sign the declaration
☒Attach signed letters of commitment from partnering organizations, (if applicable)
☒Submit the above documents to the City of London in WORD format to:
Deadline to submit electronic applications no later than midnight
Wednesday, June 4, 2014
Applications are to be submitted to homelessprevention@london.ca
Funding Application - Question and Answer Session
A question and answer session will be held:
DATE:
TIME:
PLACE:
Tuesday, May 27, 2014
8:30 am – 10:30 am
City Hall, Committee Room #1
300 Dufferin Ave., London ON N6A 4L9
The questions and answers will be posted on line by Thursday, May 29, 2014.
Applicants are encouraged to review these prior to submitting an application.
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Housing First Homeless Prevention Funding Application Guide
Section I: Housing First Homeless Prevention Funding Application Guide
The City of London, as the Community Entity for the Government of Canada’s Homelessness
Partnering Strategy (HPS), is seeking applications from:
 incorporated not-for-profit organizations;
 collaborations of groups and agencies; or
 group(s)/association(s) that are sponsored by an incorporated not-for-profit organization.
Projects or programs must fall under London’s Homeless Prevention System’s areas of focus;
apply a Housing First philosophy and approach; and, be action-oriented, accountable and
measureable.
DEADLINE FOR APPLICATION IS NO LATER THAN MIDNIGHT
WEDNESDAY, JUNE 4, 2014
1.1
What is London’s Homeless Prevention System?
The City of London’s Homeless Prevention System is a coordinated and integrated
individual and family centred housing stability approach that is outcome focused and
designed to address, reduce and prevent homelessness in London. For further
information visit the website below:
http://www.london.ca/residents/neighbourhoods/Documents/London's%20Homeless%2
0Prevention%20System.pdf
1.2
What is the Homelessness Partnering Strategy (HPS)?
The Government of Canada’s Homelessness Partnering Strategy (HPS) is a
community-based program aimed at preventing and reducing homelessness. Funding
for this initiative is through the Designated Communities Fund. This HPS initiative
applies a Housing First approach “to move individuals and families who are
experiencing chronic and episodic homelessness as rapidly as possible from the street
or emergency shelter into permanent housing with supports that vary according to
individual and family needs”. For more information click on the link below:
http://www.esdc.gc.ca/eng/communities/homelessness/index.shtml
1.3
What are the Community Advisory Board and the Community Entity for
the Homelessness Partnering Strategy?
The Homelessness Partnering Strategy requires a Community Advisory Board (CAB)
and a Community Entity (CE) to support the implementation of the Government of
Canada’s Homelessness Partnering Strategy’s goals and outcomes. The London
Homeless Coalition serves as the local Community Advisory Board and its role is to
provide advice and recommendations to the City of London, as the Community Entity,
related to the allocation of funding. The City of London, as the Community Entity
funded by the Government of Canada, enters into project/program funding agreements
between the City of London and funded organizations, and oversees all contracts and
financial monitoring.
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Housing First Homeless Prevention Funding Application Guide
1.4
What are the funding criteria?







1.5
Projects/programs must use a Housing First approach and be focused on
addressing, reducing and preventing homelessness in the City of London.
All projects/programs must take place in the City of London.
Funding is available for one time, single year or multi-year projects/programs for
the funding period. Funding will be allocated for each fiscal year and there will be
no carry-over of unspent funds to the next fiscal year.
Funding periods:

July 1, 2014 to March 31, 2015:

Projects/programs requesting funding for the above period,
acknowledge that this funding period is for nine (9) months
maximum.

Total funding available for the funding period July 1, 2014 to
March 31, 2015 is $294,455.

Projects/programs for the fiscal year 2014-2015 are expected to
commence no earlier than July 1, 2014. Funding is subject to
contract approval between the Government of Canada and the
City of London.

Total fiscal funding available April 1, 2015:

April 1, 2015 - March 31, 2016 $392,608

April 1, 2016 - March 31, 2017 $392,608

April 1, 2017 - March 31, 2018 $392,608

April 1, 2018 - March 31, 2019 $392,608
All funded projects/programs will conclude no later than March 31, 2019.
Funding is based on actual expenditures.
Projects/programs will be required to submit fiscal and monthly actual
expenditures/budget, activity and statistics reports.
What are the areas of focus for the funding?
100% of the funding will be targeted to a Housing First approach and must fall under
any of the following categories:

Securing Housing
 Housing Stability

Housing with Support
 Shelter Diversion

Strategy, Capacity and Competency
1.6
What are the ineligible expenses under the projects/programs?





Any capital including: building, purchasing, renovating or repurposing new or
existing facilities for affordable housing or emergency shelters;
Core functions of an Assertive Community Treatment (ACT) team (e.g. provision
of direct medical/clinical services to clients);
Emergency shelter beds;
Emergency housing funding (e.g. rent subsidies, housing allowances, housing
gifts);
Direct income support to individuals who are homeless, at risk or at imminent
risk of homelessness;
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Housing First Homeless Prevention Funding Application Guide

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


1.7
Medical/clinical staff;
Clinical health and treatment services;
Daycare;
Alcoholic beverages;
Services that do not directly support individuals or families who are homeless or
at risk of homelessness;
Advocacy and lobbying activities towards elected representatives on questions
related to homelessness and public awareness activities;
Public education (e.g. education tuition, teaching salary). Note: Training on
Housing First activities and functions is eligible for funding; and,
Software development and/or the purchase of hardware for the collection and/or
management of homelessness data that results in an inability to participate in
the National Homelessness Information System (NHIS) initiative; and that
constitutes a redundant use of funds and duplicates activities already offered
through the Homeless Individuals and Families Information System (HIFIS)
software. For example: purchasing alternative software that performs similar
functions to the HIFIS software.
Who can apply for funding?
Applications can be submitted by:
 Organizations in good standing with the City of London;
 Incorporated, not-for-profit organizations operating in London;
 A collaboration of agencies or groups, at least one of which is an incorporated
not-for-profit; or,
 A group/association that is sponsored by an incorporated not-for-profit
organization.
1.8
What are the expectations for agencies working together on a
collaboration project or program?
Collaborative projects/programs adopt a shared leadership and stewardship model
based on strong practices of working together and integration. This model of shared
ownership and shared responsibility reflects an outcome based approach that builds
and adapts on research, best practices and innovation. The funded agencies agree that
primary governance and accountability will be achieved through an oversight body. The
agencies agree, through a memorandum of understanding, to integrate data exchange
and collection, case management services and comprehensive reporting. A key to the
success of the collaboration is the ability to maintain strong working relationships with
the collaboration of agencies and other community support providers. Depending on
the type of collaboration, funding agreements may be entered into with all agencies, or
one agency.
NOTE: If the application is completed by a collaboration of agencies, each agency
must provide and submit, with the application, a signed letter of commitment stating
their role and financial/human/program resource contributions to the project/program.
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Housing First Homeless Prevention Funding Application Guide
1.9
What are the expectations of groups/associations that are sponsored by
an incorporated not-for-profit organization?
Groups or associations that are not incorporated and would like to submit an application
must have a sponsoring incorporated not-for-profit organization. The group or
association will provide written materials outlining the purpose of the group/association;
the names of their steering committee and membership; and a description of the
interests of the group or association. The application will outline how the
group/association will manage the project/program.
Section II: The Funding Application
2.1
Instruction
A community agency; a collaboration of agencies; or, sponsored group/association
reviews the requirements of the application and develops a concept for a project or
program that fits within the criteria and priority areas of London’s Homeless Prevention
System.
 A question and answer session regarding the project/program funding application
will be held Tuesday, May 27, 2014 from 8:30 am to 10:30 am at City Hall,
Committee Room #1. This is not a mandatory session.
 Applications are to be submitted electronically, in WORD format and the
declaration/signature page scanned and emailed. Supplemental material such as
PDFs may also be attached.
 Submit completed electronic applications no later than the deadline of midnight
Wednesday, June 4, 2014, to the City of London, homelessprevention@london.ca
2.2
How to apply?
Applicants must complete and submit:
 The application form
 A budget request for each fiscal year
 The signed Declaration
 Supplemental information
 The application package in WORD format and emailed before midnight June 4,
2014.
 The application submitted by email to: homelessprevention@london.ca.
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Housing First Homeless Prevention Funding Application Guide
2.3
What happens after an application is submitted?
Application Review Process
All applications will undergo a review process. The time frame for a decision on an
application is approximately one month from the deadline date.
Step 1 – Receipt by the City of London, Homeless Prevention Service Area

All applications will receive an automated message when the document is
submitted
to
the
email
address:
homelessprevention@london.ca
acknowledging the receipt of the application.
Step 2 – Internal review process of application material to ensure completeness of the
application.
Step 3 – The HPS Review Team reviews applications and makes recommendations.
The HPS Review Team is made up of representatives of London’s Homeless
Prevention Implementation Steering Committee, Chair or designate of the London
Homeless Coalition, and the City of London.
The Review Team will evaluate the applications and provide recommendations for
approval. The review will:

Consider the completeness of the application;

Consider how the application applies a Housing First philosophy and
approach;

Consider with London’s Homeless Prevention System’s priorities and desired
outcomes;

Consider the organization’s ability to carry out the work and achieve the goals
of the project/program including:
i. Relevant mandate, proven track record and good operating systems;
ii. Appropriate structure and skill sets, including responsiveness to
changing community needs, and opportunities;
iii. a willingness to implement a Housing First Approach;
iv. Project costs; and,

Consider the measureable benefits to individuals and families experiencing
homelessness and to the community by working with partners.
Step 4 - The Managing Director, Neighbourhood, Children and Fire Services approves
the recommendations.
Step 5 - Recommendations are reported to the London Homeless Coalition.
Step 6 – Approved/Not Approved

All applicants will be notified if the project/program is approved or not approved.
Step 7 – Approved organization(s) will enter into a funding agreement with the City of
London.
Step 8 – Project/program commences no earlier than July 1, 2014.
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Housing First Homeless Prevention Funding Application Guide
2.4
Monthly and fiscal reporting requirements for approved projects or
programs
Financial Reporting
Monthly financial reports will be submitted by the 15th of each month, for the previous
month. Funding is through a funding contribution agreement and is based on actual
expenditures under the project/program. Monthly financial reports will include, and is
not limited to, actual expenditures, variances and projections.
A fiscal financial progress report will be submitted by April 15th for the fiscal year
immediately prior and will include, and is not limited to, actual expenditures, variances
and projections.
Failure to provide any report will result in a delay in the release of the next payment
installment, and may result in the termination of the contract.
Activity Progress Reporting
A monthly activity report will be submitted by the 15th of the month, for the previous
month. The activity report provides a brief description of the activities that have taken
place during the month to achieve the goal(s), outcomes of the project/program.
A fiscal progress report will be submitted by April 15th for the fiscal year immediately
prior. The report will include a summary of the activities and successes, challenges and
highlights to achieving the goal(s), and outcomes.
Statistical Data Reporting
Statistical data will be collected by the 15th of month, for the previous month. We
recognize that at this time not all organizations will have a database to collect this
information; however, agencies will still be required to submit the required data.
Measureable indicators include, and are not limited to:

# of individuals and families placed into permanent housing through a Housing
First approach

# of individuals and families placed into more stable housing

# of days to move Housing First individuals and families into permanent housing

# of Housing First individuals and families who:
 Remained housed at 3 months
 Remained housed at 6 months
 Remained housed at 12 months
 Remained housed at 24 months
 Moved again within this period
 Successfully exited the Housing First program
 Returned to homelessness
 Had changes in income by income source
 Had positive income transitions by type
 Started an education program
 Started a part-time education program
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Housing First Homeless Prevention Funding Application Guide

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Started a full-time education program
Started employment
Had positive employment transitions by type
Started a job skills training program
Completed a job skills training program
Started volunteer work
Engaged in recreational or cultural programs or services
A fiscal statistical data report will be submitted by April 15th for the fiscal year
immediately prior. The report will include a summary of the measureable indicators
above.
2.5
General Information
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Organizations must be prepared to enter into a funding agreement with the City of
London and comply with the terms and conditions.
The activities of the project/program will be subject to all specific provisions of the
Municipal Act, and all other applicable Federal and Provincial legislation.
In the event that there is disagreement regarding the approval/denial of the
application, the resolution process is as follows:
i. A meeting will be held between the applicant organization representative
and the Manager, Homeless Prevention, City of London.
ii. If the organization is not satisfied with this, the applicant may appeal the
decision, in writing, to the Managing Director, Neighbourhood, Children and
Fire Services.
iii. The decision of the Managing Director, Neighbourhood, Children and Fire
Services is final.
The disclosure of information received relevant to the issue of funding or the award
of contracts from the application process will be made by the appropriate officers in
accordance with the provisions of the Municipal Freedom of Information and
Protection of Privacy Act, R.S.O. 1990.
The City of London, as the Community Entity for the Homeless Partnering
Strategy, has the right to make the final decision with regards to funding
allocations.
Section III: Application Instructions
These instructions are intended to assist you with completing the application. Under this
section the numbers noted below 1), 2)… match to the numbers on the Application Form.
1) Enter the legal name of organization and mailing address. If a group/association has a
sponsor, enter the group name as well as the sponsoring organization.
2) Provide the name of the contact person and contact information.
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Housing First Homeless Prevention Funding Application Guide
3)
Project/Program Title: Enter the project/program title. The title is no more than 10
words. The title will be used to report to the HPS funder, to the community and in any
public material.
4)
Funding Request
Enter a check mark beside the fiscal year(s) you are requesting funding for and the total
amount requested according to the year(s)
 Example: If the request is for funding in 2015-2016, check the box beside the
fiscal year and enter the amount requested.
 If the funding request is for the more than one year, check each fiscal year and
enter the amount requested for each fiscal year.
 Enter total amount of funding for all fiscal years on the last line.
NOTE:
 For the July 1, 2014 to March 31, 2015 time period funding is available for up to
(nine) 9 months.
 Project/programs for 2014-2015 are expected to commence no earlier than July
1, 2014 and subject to contract approval between the Government of Canada
and the City of London.
5)
Provide a Description of the Project/Program
Briefly describe the project/program: Define why this project/program is important; who
is being supported; what support/services you will be providing; how you will be
providing the support/service; and, what you hope to achieve.
6)
The Homeless Prevention System for London has five specific areas of focus
Check the areas of focus that apply to the project/program.
7)
Describe how this project/program will implement a Housing First approach
Complete the section on how the project/program will implement a Housing First
approach as it relates to London’s Homeless Prevention System. For further information
please see:
Homeless Prevention System for London
http://www.london.ca/residents/neighbourhoods/Documents/London's%20Homeless%2
0Prevention%20System.pdf
Homelessness Partnering Strategy
http://www.esdc.gc.ca/eng/communities/homelessness/index.shtml
8)
Identify and describe the project/program goals and outcomes
Complete the section on your project/program’s goals. Define a goal or goals that the
project/program can achieve. It may only be one (1) goal but no more than three (3).
Goals are high level statements about what the project/program is trying to accomplish.
The SMART model may be of assistance in developing goals:
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Housing First Homeless Prevention Funding Application Guide
SMART:
i. Specific (a specific goal has a much greater chance of being accomplished than a
general goal);
ii. Measureable (concrete criteria for measuring progress toward the accomplishment
of each goal);
iii. Achievable (can be accomplished within the scope of the project/program);
iv. Relevant (directly relates to the project/program); and,
v. Timely (can be completed within the funding timeline).
9) Identify and describe the project/program outcomes
Develop outcomes that the project/program can achieve in the timeframe. Outcomes
represent a realistic and attainable benefit to an individual, family or community that the
project/program will influence.
10) What are the activities and timelines the project/program will be implementing
Complete the Activity and Timeline table. List the activities for each outcome. Choose
the timeline for the implementation of the activity. This could be fiscally, quarterly or
monthly.
Sample Activity and Timeline
Activity
Timeline
Activity
Timeline
Activity
Timeline
11) Individual Agency Projects/Programs
Complete if you are submitting an Individual Agency Project/Program application and do
not complete section 12) or 13). Identify the community partners you will be working with
and their defined roles.
12) Collaborative Project/Programs
Complete this section if you are a collaboration submitting an application and do not
complete section 11) or 13). Identify the specific agencies and their roles and contributions
to the project/program. Signed letters of commitment outlining each agency’s contributions
are required to be submitted with the application.
13) Groups/Associations with Sponsored Project/Programs
Complete this section if you are a group/association with a not-for-profit sponsor
submitting an application and do not complete section 11) or 12). Identify the
group/association and their roles and contributions to the project/program. Identify the notfor-profit organization and their role and contribution to the project/program. A signed letter
of commitment outlining their contributions by the group is required to be submitted with
the application. Include how the project/program will be managed and the names of the
members of their steering committee.
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Housing First Homeless Prevention Funding Application Guide
14) If this project/program is to become an ongoing activity what is the plan for
sustainability after this funding has ended?
Describe your project/program’s sustainability plan for after funding has ended.
Section IV: Funding Request Instructions





Funding is available for short-term, one (1) year or multi-year projects/programs.
Funding for the July 1, 2014 to March 31, 2015 is for nine (9) months only.
Noting the exception above, the fiscal year begins April 1st and ends March 31st.
Complete a budget request form for EACH fiscal year of the project/program.
The budget template is to be completed for each fiscal year applied for. For example:
 If the project/program is for one (1) year, complete one (1) budget request form.
 If the project/program is for three (3) years complete a budget request form for
each year, be specific to the expenses for each year.
1) Name of Project/Program
Enter the name of the project/program from the application form.
2) Contact Person’s Name and Contact Information
Enter the name of the person completing the financial information.
3) Period Covered by this Request
Enter the Year, Month and Day, for the request for the beginning of the funding to the end
of the funding for the fiscal year. If the project/program starts on April 1, 2015 until March
31, 2016 enter: 2015/04/01 to 2016/03/31. If the project is for three (3) years starting on
April 1, 2015 to March 31, 2018, enter 2015/04/01 to 2018/03/31.
4) Cost Categories
Enter the amount of funding requested for each line, if applicable, under the column titled
12) Funding Request for Project/Program Year.
Staff Costs: staff wages/salary paid to an employee. Wages are to be broken down by
position/role not person, example: Housing Finder, Housing Stability Worker etc.
Enter wages for each position. If there is more than one (1) position, enter total wages for
the position. Example: There are two (2) part-time positions that have an annual wage of
$15,000 each per year, then the total cost would be $30,000 entered into the column titled
12) Funding Request for Project/Program Year.
i. Provide the name of the position. Example: Housing Support Worker
ii. Insert lines, if required, for additional positions
Total Mandatory Employment Related Costs and Benefits for all Positions:
(MERCs) which refer to payments an employer is required by law to make in respect of its
employees such as EI and CPP/QPP premiums, workers’ compensation premiums,
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Housing First Homeless Prevention Funding Application Guide
vacation pay and Employer Health Tax; and Benefits which refer to payments an employer
is required to make in respect of its employees by virtue of company policy or a collective
agreement. Examples of Benefits include contributions to a group pension plan or
premiums towards a group insurance plan.
Calculate the MERCS and Benefits costs for all of the wages in the lines above and enter
the information.
Total Staff Costs: Enter the total costs of staff wages, MERCS and Benefits for all
positions. This total will equal all of the Staff Wages and total Mandatory Employment
Related Costs and Benefits for all positions.
Administration costs: are general administration-type costs, normally incurred by any
organization to enable effective delivery of the project/program. These include costs such
as rent, phone/fax, postage/courier, office supplies, internet/website, bank charges, office
moving expenses, office cleaning, security system, garbage removal/recycling, publication
purchases, equipment maintenance and membership fees that are proportional to the
project. Administration cannot be more than 10% of funding request.
Enter costs per line.
Total Administration Costs: Enter the total costs including professional fees, travel and
administration.
Program Costs:
Professional Fees include contracting for goods or services such as bookkeeping,
janitorial services, information technology, equipment maintenance services, security,
if contracted specifically to support the audit costs and legal fees.
Travel includes travel costs as per your agency’s practice and policies for staff. Travel
costs must not exceed the guidelines of the Treasury Board of Canada: http://www.njccnm.gc.ca/directive/travel-voyage/s-td-dv-a2-eng.php
Project/program Costs are costs explicitly linked to the project/program’s activities,
not including wages and MERCs, such as supplies and equipment required to carry
out an approved project/program. Project/program costs can include: materials,
supplies, Honoria, and participant costs such as bus tickets.
Enter costs per line.
Total Program Costs: Enter the total Program Costs funding request.
Total Costs: Enter totals from item number 6, 8, and 10.
5) Funding request for Project/Program Year Column
Funding requested for each cost categories, mentioned above for the project/program are
entered in this column.
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Housing First Homeless Prevention Funding Application Guide
6) Confirmed funding (other sources) Column: If there are alternate funding sources that
are contributing to the areas under the cost categories for this project/program, record the
contribution amount.
Enter dollar value of other confirmed funding sources to support this cost categories.
Example: In the cost category of Materials and Supplies, you have funding from a
foundation for $1,000 to provide bus tickets to take individuals grocery shopping in this
project/program, enter the $1,000 in this column under Participants costs.
7) Total Funding (all sources)
Total 12) Expenses for Project/program Year and 13) Confirmed funding (other sources)
and enter the total.
Section V: Declaration
Read and sign the declaration. One signature is required from an individual with signing
authority for the agency such as the Executive Director or member of the Board of Directors.
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Housing First Homeless Prevention Funding Application Guide
HOUSING FIRST HOMELESS PREVENTION APPLICATION AND FUNDING REQUEST
HOUSING FIRST HOMELESS PREVENTION APPLICATION AND FUNDING FORM
Please complete the Application and Funding Form and attach all supporting documents to the application.
Please be as concise as possible.
The application must be submitted by midnight:
Wednesday, June 4, 2014
email:homelessprevention@london.ca
1) Legal Name of Organization
Mailing Address
2) Contact Person Name and Position
Province
Ontario
City/Town
Postal Code
N
E-Mail Address of Contact Person
London
Telephone No.
F Fax No.
HOUSING FIRST HOMELESS PREVENTION PROJECT/PROGRAM DESCRIPTION AND INFORMATION
3) Project/Program Title (maximum 10 words)
4) Funding request:
Year 2014-2015 ☐
Year 2015-2016 ☐
Year 2016-2017 ☐
Year 2017-2018 ☐
Year 2018-2019 ☐
Total Amount Requested:
Amount:
$_______________*
$____________
$____________
$____________
$____________
$____________
* 9 months of funding (July 1, 2014 to Mar 31, 2015)
5) Project/Program Description
6) London’s Homeless Prevention System has 5 specific areas of focus. Identify the area(s) of focus that the
project supports?
Securing Housing
☐
Housing with Support ☐
Housing Stability ☐
Shelter Diversion ☐
Strategy, Capacity and Competency ☐
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Housing First Homeless Prevention Funding Application Guide
7) Describe how this project/program will implement a Housing First approach as it relates the Homeless
Prevention System for London.
8) 8) Identify and describe the project’s/program’s goal(s).
9)
10) 9) Identify and describe the project’s/program’s outcomes.
11) 10) Identify the activities and timelines the project/program will be implementing to achieve the goals and
outcomes above? Add additional lines if necessary.
Activity
Timeline
Activity
Timeline
Activity
Timeline
17
11) Individual agency projects/programs:
COMPLETE THIS SECTION IF THE APPLICATION IS BEING SUMBITTED BY AN INDIVIDUAL AGENCY.
Identify the community partners you will be working with and their defined role.
12) Collaborative projects/programs:
COMPLETE THIS SECTION IF YOUR APPLICATION IS BEING SUBMITTED FROM A COLLABORATION
OF AGENCIES.
13) Group/Association project/program sponsored by a not-for profit organization:
COMPLETE THIS SECTION IF YOUR APPLICATION IS FROM A GROUP/ASSOCIATION SPONSORED
BY A NOT-FOR- PROFIT ORGANIZATION.
14) What is your plan for sustainability after this funding has ended? (if applicable)
Housing First Homeless Prevention Funding Request – Budget Template
Name of Project/Program:
Name & contact information of person completing this form:
Period Covered by this request (YYYY/MM/DD)
Note: funding for the period July 1, 2014 to March 31, 2015 will
be for 9 months only.
From:
To:
Cost Categories
Funding Request
for Fiscal Year
Confirmed Funding (other
sources)
Total Funding (all sources)
STAFF COSTS
Staff Wages: Position A
0.00
Position Name:
Staff Wages: Position B
0.00
Position Name:
Staff Wages: Position C
0.00
Position Name:
Total Mandatory Employment Related
Costs and Benefits for all positions
above.
TOTAL STAFF COSTS
0.00
$0.00
$0.00
$0.00
ADMINISTRATION COSTS
Professional Fees
0.00
Travel
0.00
Administration
0.00
TOTAL ADMINISTRATION COSTS
$0.00
$0.00
$0.00
PROGRAM/PROJECT COSTS
Materials/Supplies
0.00
Honoria
0.00
Participants Costs
0.00
TOTAL PROGRAM COSTS
$0.00
$0.00
$0.00
TOTAL COSTS
$0.00
$0.00
$0.00
DECLARATION: In signing this application, I /We certify that:
I/We have read and agree to all the terms and conditions outlined in this application
form.
I/We understand that monthly financial, activity and statistical information is due to
the City of London by the 15th of the month.
I/We understand that fiscal financial, activity and statistical information is due to the
City of London by April 15th for the previous year
I/We represent the group named in the application and to the best of my/our
knowledge, the information provided is true.
I/We will carry out the activities when/as described in the application.
I/We agree that a funding contribution agreement will be entered into with the City of
London which will determine the terms and conditions of the agreement.
I/We understand that there will be required documentation including, and not limited
to, a Certificate of Insurance and if applicable to your organization, a Clearance
Certificate from WSIB.
I/We agree that the City of London is not responsible for carrying out the activity and
assumes no responsibility for such.
Applicant Signature (individual with signing authority for the incorporated
not-for-profit agency such as an Executive Director OR a member of the Board
of Directors.
Executive Director Name: ______________________________________
Executive Director Signature: ___________________________________
Date: ______________________
And/or
Board of Directors Name and Position: ___________________________
Board of Directors Signature: ___________________________________
Date: ______________________