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FHCHI eligibility formCOMMUNITY PRESERVATION ELIGIBILITY DETERMINATION FORM The purpose of this form is to make sure that all project applications applying for Community Preservation Act funding are eligible for funding. Please refer to Appendix-E in the Community Preservation Plan when filling out this form. This form must be approved in order for an application to be accepted. Project Title: Residence for Unaccompanied Homeless Youth  Project Sponsor/Organization: Friends of Hampshire County Homeless Individuals  Contact Name: Rick Hart  Property Owner, if applicable: n/a  Mailing Address: P.O. Box 60398, Florence, MA, 01062  Daytime phone #: 413-320-1886 Fax #:  E-mail address: rshart3@verizon.net   CPA Program Area (check those that apply): � Open Space � Historic Preservation ( Community Housing � Recreation   Project Purpose (check those that apply): ( Acquisition ( Creation � Preservation ( Support � Rehabilitation/Restoration   Project Summary: Please provide a brief description of the project. The Friends of Hampshire County Homeless Individuals, Inc (FHCHI), in collaboration with DIAL/SELF, is seeking $200,000 in funding to support the purchase of a house in Northampton that will provide permanent supportive housing for approximately 8 unaccompanied homeless youth. FHCHI has raised $150,000 as “first money in” on the project and is developing a capitol purchase campaign to leverage an additional $350,000 or more in funds through its fundraising. Our goal is to purchase a small multi-family house in Northampton comprised of several 1 and 2 bedroom units. Once purchased by FHCHI, the house will be managed, and support services provided, by DIAL/SELF. DIAL/SELF is a leading regional provider of outreach, housing and support services to homeless youth and young adults in Hampshire, Franklin and Hampden Counties. FHCHI helps fund and staff the winter shelter in Northampton, provides other supports for homeless individuals, and in 2008 and 2011 purchased houses that provide housing for 12 previously homeless people. This project fits into the priorities set by the regional Opening Doors Plan, and the HUD 3-County Continuum of Care, which includes the creation of additional supportive housing for unaccompanied homeless youth. Youth who have experienced time in state residential programs and foster care have a 60% chance of becoming homeless within 18 months of aging out of the system. Our goal is to provide a foundation of support through affordable housing to youth who are at high risk of long term homelessness as they transition into adulthood.   Project Summary: Please provide a brief description of the project. The Friends of Hampshire County Homeless Individuals, Inc (FHCHI), in collaboration with DIAL/SELF, is seeking $200,000 in funding to support the purchase of a house in Northampton that will provide permanent supportive housing for approximately 8 unaccompanied homeless youth. FHCHI has raised $150,000 as “first money in” on the project and is developing a capitol purchase campaign to leverage an additional $350,000 or more in funds through its fundraising. Our goal is to purchase a small multi-family house in Northampton comprised of several 1 and 2 bedroom units. Once purchased by FHCHI, the house will be managed, and support services provided, by DIAL/SELF. DIAL/SELF is a leading regional provider of outreach, housing and support services to homeless youth and young adults in Hampshire, Franklin and Hampden Counties. FHCHI helps fund and staff the winter shelter in Northampton, provides other supports for homeless individuals, and in 2008 and 2011 purchased houses that provide housing for 12 previously homeless people. This project fits into the priorities set by the regional Opening Doors Plan, and the HUD 3-County Continuum of Care, which includes the creation of additional supportive housing for unaccompanied homeless youth. Youth who have experienced time in state residential programs and foster care have a 60% chance of becoming homeless within 18 months of aging out of the system. Our goal is to provide a foundation of support through affordable housing to youth who are at high risk of long term homelessness as they transition into adulthood.   For CPC Use Eligible: _____ Not Eligible: _____ Date: __________ Reviewer: ____________________