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Eligibilty Forms - 2013 Round 1B • • � The purpose of this form is to make sure that all project applications applying for Community Community Preservation Plan when filling out this form. This form must be approved in order for - an application -to be- accepted.- - -- - -= -- _ -_ . - -- -- __ - - -_- _ _ -- - - -- - Project Title Access to Housing Initiative Project Sponsor /Organization ServiceNet, Inc. Contact Name Wanda Rolon, Director of Hampshire County Programs /Shelter and Housing Division Property Owner, if applicable: Mailing Address 129 King Street Northampton MA 01060 Daytime phone # 413- 585 -1398 Fax #: 413- 585 -1385 E -mail address wrolon @servicenet.org CPA Program Area (check those that apply): • Open Space Historic Preservation x Community Housing • Recreation Project Purpose (check those that apply): • Acquisition. • Creation - Preservation x Support • Rehabilitation /Restoration Project SummaU Please provide a brief description of the project. CPC allocation to ServiceNet, Inc. to assist homeless individuals with securing funds for first and last month's rent and security deposits.' High priority need in the community to facilitate the movement from homelessness to housing in a competitive rental market. ServiceNet will provide case management and needs assessments, identify housing units and coordinate payment directly with landlords. ServiceNet will apply for funding in the amount of $75,000 to be implemented over a 2 year period. For CPC Use Eligible: v Not Eligible: Date: Reviewer: SL