D. 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!
Email *
A1: Agency Name *
A2: Agency Physical Address *
A3: Federal Tax Identification Number *
A4: Agency Unique Entity Identifier (UEI) *
A5: Program UEI (if different) *
A6: Primary Contact Person (First and Last) and Job Title *
A7: How long in this position? *
Mark only one oval.
Less than 1 year 1 - 2 years
3 - 7 years
8 years or more
A8: Primary Contact Email *
A9: Primary Financial / Fiscal Person (First and Last) and Job Title *
person producing the budget, submitting financial draw requests, invoices, etc.
A10: How long in this position? *
Mark only one oval.
Less than 1 year 1 -2 years
3 - 7 years
8 years or more
A11: Fiscal Person Email: *
A12: Person Executing the Contract / Subrecipient Agreement (First and *
Last) and Job Title
usually the Executive Director
A13: Contract Executor Email *
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
B2: What is the total annual budget of your organization for the current fiscal *
year?
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
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
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)
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:
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
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!
C2: Project Address *
C3: Type of Project *
Mark only one oval.
Public Service Economic Development Affordable Housing
Public Infrastructure or Public Facilities
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:
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.
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.
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.
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
C9: For Economic Development Only -
Estimate either:
# Jobs to be Created # Jobs to be Retained
# Businesses to be Assisted
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:
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.
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.
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
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"
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
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
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
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.
E2: Amount requested from Northampton CDBG *
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
E4: Will the project beneficiaries incur any costs as a condition of participation? *
Mark only one oval.
Yes No
Do Not Know
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.
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
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
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: