D1. CDBG Application 2024-2025CDBG Application: 2024 - 2025
All applicants for CDBG funding must fill this form out. If your agency is collaborating with
another agency, both agencies must fill this out. If your agency is applying for the funding
of a Housing Navigator position, this form and an additional form must be filled out. Word
copies of both of these are available on the CDBG website and it is advisable to fill it out
there first.
Due on Wednesday January 17th at 10 AM. No late applications and no tag backs!
1. Email *
2. A1: Agency Name *
3. A2: Agency Physical Address *
4. A3: Federal Tax Identification Number *
5. A4: Agency Unique Entity Identifier (UEI) *
6. A5: Program UEI (if different) *
7. A6: Primary Contact Person (First and Last) and Job Title *
8. A7: How long in this position? *
Mark only one oval.
Less than 1 year
1 - 2 years
3 - 7 years
8 years or more
9. A8: Primary Contact Email *
10. A9: Primary Financial / Fiscal Person (First and Last) and Job Title *
- person producing the budget, submitting financial draw requests, invoices,
etc.
11. A10: How long in this position? *
Mark only one oval.
Less than 1 year
1 -2 years
3 - 7 years
8 years or more
12. A11: Fiscal Person Email: *
13. A12: Person Executing the Contract / Subrecipient Agreement (First and *
Last) and Job Title
- usually the Executive Director
14. A13: Contract Executor Email *
15. B1: Provide an overview of your organization including: *
Experience with conducting activities for which funding is being sought and
current services and successes that reflect organizational capacity.
Max. length 2,000 characters
16. B2: What is the total annual budget of your organization for the current fiscal *
year?
17. B3: Is the applicant or affiliate, subsidiary or parent organization in arrears to *
the City of Northampton or the
Commonwealth of Massachusetts for any taxes or fees?
Mark only one oval.
Yes
No
I do not know at this time
18. B4: Please provide information below about the staff who will administer the *
project including: Number of full-time and part-time staff. Also, please describe
if you will be using existing staff, hiring new staff, or using volunteers.
Max. length 500 characters
19. B5: Please mark all of the following key organizational positions that have *
changed in the past 12 months.
Check all that apply.
Executive Director or the highest job title in the organization
Financial Director or Financial Manager
Project Manager or Project Director (of the project applying for CDBG funding)
20. B6: What is your organization' financial audit status over the last two years? *
PLEASE attach copy of audit in the document section (last question).
Mark only one oval.
Audit with No Findings
Audit with Minor Findings
Audit with Major Findings
No Audit Required
No Audit, but required
Failed Audit
Other:
21. B7: Has your organization received more than $750,000 in federal funds during *
your fiscal year?
Mark only one oval.
Yes
No
Do Not Know
22. C1: Project Title - Please use the format: “Agency Name – Title”. *
For example Hampshire County Cares organization’s Community Kitchen
project becomes “Hampshire County Cares – Community Kitchen” or it could
be shortened to “HCC – Community Kitchen.” This title should stay consistent
across all reports, documentation, and communication with Planning &
Sustainability staff.
Parsimony is key!
23. C2: Project Address *
24. C3: Type of Project *
Mark only one oval.
Public Service
Economic Development
Affordable Housing
Public Infrastructure or Public Facilities
25. C4: Please check that status of your project. *
Mark only one oval.
year.
This is an existing project that has not received CDBG funding previously.
This is a new project.
This is an existing project that has received CDBG funding for at least 1 (one)
This is an existing project that has received CDBG funding for at least 5 (�ve)
years.
Other:
26. C5: Please explain whether your organization will decrease, increase, or *
maintain the level of service and how you will do so.
Federal law 24 CFR 570.201(e) prohibits using CDBG funds to replace local or
state government sources of funding for a public service without a quantifiable
increase in the level of service. The law does not prohibit continuing to fund
projects that are already being funded by CDBG. Limit to 500 characters.
27. C6: Project Description on what your project will be doing, not why it is *
important.
-What your project seeks to do
-Who from the staff is doing it
-Who the clients are Limit to 500 characters.
28. C7: Provide a description on why it is important, how your project meets the *
HUD national objectives, HUD eligibility, and Northampton’s community needs
identified in the City’s Consolidated Plan. Limit to 2,000 characters.
Review the City's Consolidated Plan for 2020-2024 here.
29. C8: For Public Service, Affordable Housing, and Public Infrastructure /
Facilities Only -
Accomplishments - In the format provided in the example below, list the number
of persons assisted by quarter and then the total for the program year.
For example: HCC - Community Kitchen will serve:
Q1: 3
Q2: 4
Q3: 5
Q4: 5
Final Report: 17 people
30. C9: For Economic Development Only -
Estimate either:
# Jobs to be Created
# Jobs to be Retained
# Businesses to be Assisted
31. C10: Check all that apply as program beneficiaries *
Check all that apply.
Persons with Low/Moderate Incomes
Homeless Persons
People with Disabilities
Abused Children
Battered Spouses
Illiterate Adults
Persons with AIDS
Migrant farm workers
Elderly
Other Other:
32. C11: Describe the process you will use to identify and document that at least *
51% of the beneficiaries of your project have Low/Moderate incomes.
This is a HUD statutory requirement. If you cannot document that you are
serving 51% low- and moderate-income individuals, then CDBG is not a right
fit.
Limit to 500 characters.
33. D1: Program Objectives - Broadly, what is the main community objective of *
your program activities? Please select one.
Mark only one oval.
Create Suitable Living Environment: activities that are designed to benefit
communities, families, or individuals by addressing issues in their living environment.
This objective relates to activities that are intended to address a wide range of issues
faced by LMI persons, from physical problems with their environment, such as poor
quality infrastructure, to social issues such as crime prevention, literacy, or elderly
health services.
Provide Decent Housing: covers the wide range of housing activities that could
be undertaken with CDBG funds. This objective focuses on housing activities where
the purpose is to meet individual family or community housing needs. It does not
include programs where housing is an element of a larger effort to make
communitywide improvements, since such programs would be more appropriately
reported under Suitable Living Environments.
Create Economic Opportunities: activities related to economic development,
commercial revitalization, or job creation.
34. D2: Program Outcomes - A program outcome helps further refine your *
objectives and are designed to capture the nature of the change or the
expected result of the objective that you are seeking to achieve. Outcomes
correspond to the questions “What is the type of change or expected result of
the activity?” Please select one.
Mark only one oval.
Availability / Accessibility: Activities that make services, infrastructure, public
facilities, housing, or shelters available or accessible to low/moderate income
people, including persons with disabilities. In this category, accessibility not only
refers to physical barriers, but also to making the affordable basics of daily living
available and accessible to low/moderate income people where they live.
Improve affordability: Activities that provide affordability in a variety of ways in
the lives of low/moderate income people. It can include the creation or maintenance
of affordable housing, basic infrastructure hook-ups, or services such as
transportation or day care
Improve sustainability: Activities are aimed at improving communities or
neighborhoods, helping to make them livable or viable by providing benefit to persons
of low/moderate income or by removing or eliminating slums or blighted areas
through multiple activities or services that sustain communities or neighborhoods
35. D3: Provide an Outcome Statement for your project. *
Why is the proposed activity needed and what outcomes will be achieved from
the proposed project. Outcomes are the changes you expect to occur in clients’
lives and/or community as a result of the proposed activity. A complete
statement includes output (number) + outcome (from D.2. above) + activity
(description) + objective (from D.1. above).
For example:
-"52 households will have new access to public sewer to create a suitable living
environment"
-"7 households will be able to afford to live in rental housing units, created
through conversion of a former mill building, to create decent housing"
-"1 public facility providing job training for handicapped adults will be
rehabilitated to increase accessibility to economic opportunity"
36. D4: Select one Goal from the City’s 5-Year Consolidated Plan that best *
matches your project’s main goal:
Mark only one oval.
Public Services
Economic Development & Income Maximization
Improve Public Facilities & Infrastructure
Preserve Affordable Housing, Tenancy Help & Rehab
Slums & Blight
37. D5: From the Goal selected above, which Goal Outcome Indicator best *
identifies the actual outcome your program will report on? Please select one
Mark only one oval.
Public Facility or Infrastructure Activities other than LMI Housing Benefit
Public Facility or Infrastructure Activities for LMI Housing Benefit
Public service activities OTHER than LMI Housing Benefit
Public service activities for LMI Housing Benefit
Facade Treatment/Business Building Rehabilitation
Brownfield acres remediated
Rental units constructed
Rental units rehabilitated
Homeowner Housing Added
Homeowner Housing Rehabilitated
Direct Financial Assistance to Homebuyers
Tenant-based rental assistance/Rapid Rehousing
Homeless Person Overnight Shelter
Overnight/Emergency Shelter/Transitional Housing Beds added
Homelessness Prevention
Jobs Created
Jobs Retained
Businesses assisted
Housing for Homeless added
Housing for People with HIV/AIDS added
HIV/AIDS Housing Operations
Buildings Demolished
Housing Code Enforcement
Foreclosed Property Care
Other
38. D6: Indicate the Priority Needs that your project addresses. Please select all *
that apply:
Check all that apply.
Addressing Basic Needs
Homeless Prevention
Support for Emergency Shelter & Support Services
Economic Development
Rental Housing for Individuals
Rental Housing for Families
Preservation of Existing Affordable Rental Stock
Housing Rehabilitation
Affordable Homeownership for Individuals & Families
Housing for At-Risk & Special Needs Populations
Housing Support Services
Public Facilities
Public Infrastructure
Elimination of Slums & Blight
39. E1: Total Project Cost - *
This includes all sources of funding, including the CDBG request.
You will upload a project budget with all sources of funding in the
documents section of the application.
40. E2: Amount requested from Northampton CDBG *
41. E3: Do any of the other sources of funding require a city match as a condition *
of award?
Mark only one oval.
Yes
No
Do Not Know
42. E4: Will the project beneficiaries incur any costs as a condition of participation? *
Mark only one oval.
Yes
No
Do Not Know
43. E5: The final award amount may be less than requested. If so, what will be the *
impact on the project? If the award amount is different than the original budget
(increase or decrease), an updated budget will be required. Limit to 500
characters.
44. F1: Our Agency will not discriminate against any employee or applicant for *
employment because of race, color, sex, age, religion, handicap or national
origin and take affirmative action to ensure applicants are employed and
employees are treated equally during their employment without regard to race,
color, sexual orientation, gender identity, veteran or disability status.
Mark only one oval.
Yes
No
45. F2: To the best of my knowledge, all information and data in this application are *
true and current. The document has been duly authorized by the governing
board of the applicant.
Mark only one oval.
Yes
No
46. F3: Document Upload: *
- Applicant Agency most recent audit
- Project Budget - include all non-CDBG and CDBG funding
- IRS 501(c)3 Letter (Exemption Determination)
- Personnel Handbook
10G Maximum file size.
Files submitted: