Hotel/Motel Assistance Application

General Information

Agency Name*

Email*

Phone*

Program Name*

Statistical/Background Information

Describe the program for which you are applying. Please include program duration in your response, as well as the length of time your organization has been providing this service.

If your agency targets specific client populations, please indicate from the list below. (Hold the "Control" key to select multiple from the list.)

If you received funds last year, please give statistical information. (i.e. outcomes)

How many unduplicated families did you serve with hotel/motel last year?

How many unduplicated people did you serve with hotel/motel assistance last year?

How many total shelter- nights did you provide last year?

What is the maximum cost per one shelter night?

Current EFSP Phase

These funds apply to temporary shelter at local hotel or motel. (Over 50% of funding should come from sources other than EFSP.)

State your need for this program under normal circumstances, with supporting statistics. Explain how the current EFSP Phase funds will be used to supplement your current services. How will services continue for the program, if you don't receive EFSP funds

Please list the primary geographic areas of your clients for which EFSP funds, if awarded, will be used.

EFSP funds do not pay salaries; explain staffing for the services for which you are requesting funds.

Describe your collaboration and coordination with area service providers and county agencies.

What other agencies, if any, provide similar assistance to residents in your service area? How do you determine if your clients have received similar services from other agencies?

Briefly describe your current procedures for screening and intake, including determination of client's eligibility.

Will the current EFSP Phase award assist you in securing or leveraging funds from other sources?

What method does your agency use to allocate current EFSP Phase funds to support clients that cannot pay?

Please provide a budget narrative pertaining to your organization's planned expenses for the current EFSP Phase funds, should funds be awarded. Please also provide detail regarding the sources in the Budget Summary Form in this application.

What is the anticipated budget for the Hotel/Motel Assistance Program?

What is the EFSP dollar amount requested for the current Phase Hotel/Motel Assistance Funds?

What is the current EFSP Phase request as a percentage of the total Hotel/Motel Assistance budget?

How many unduplicated families do you anticipate serving with hotel/motel assistance from the current EFSP Phase funds this year?

How many unduplicated people do you anticipate serving with hotel/motel assistance from the current EFSP Phase funds this year?

How many shelter-nights do you anticipate providing with the current EFSP Phase funds this year?