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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: