The Salvation Army is applying for funding to expand its Homeless Prevention program. The program provides rental assistance for up to 3 months and case management to extremely low-income families facing eviction. Last year 146 families received 1 month of rental assistance through other funding. The program aims to serve 50 additional families with 3 months of rental assistance through ESG funds. A dedicated case manager will develop service plans and link families to other supports to help them overcome their financial crisis and maintain housing. The program meets the CoC's priority of preventing homelessness by helping families avoid eviction and homelessness.

1. 1 What is your agency's DUN's number?
This is a requirement for each agency. Agency must also verify that members of its Board are NOT debarred and do not have any active exclusions.
94-1156347 Salvation Army Board members are not debarred and do not have any active exclusions.
2 What is your organization’s mission? What type of services are currently being provided by the organization?
The Social Services mission of The Salvation Army is "to meet human needs without discrimination". The Salvation Army provides assistance to those in need 365
days a year. The Salvation Army accomplishes its mission by providing timely emergency care to low income families through our Family Services food baskets,
rental assistance, utility assistance, case management, work cards, and referral to other agencies, Homeless services including emergency overnight shelter, day
resource center, basic needs including clothing, transportation and community meals, transitional housing, permanent affordable housing, vocational training and job
placement; afterschool programs for youth, parent education and child abuse prevention services, Veterans supportive services and transitional housing, services for
victims of human trafficking, and Adult Rehabilitation Program for homeless individuals with addictions. The Salvation Army Clark County provides Social Service
Programs that assist people in poverty, and who are homeless, providing for their basic needs, and assisting them to transition to higher levels of self-sufficiency and
independence in their community.
3 What type of activity description fits your proposed project(s)?
Street Outreach
Emergency Shelter- Operations/ Supportive Services
Transitional Housing (renewals only eligible)
Homeless Prevention (for HH below 30% AMI)
Rapid Re-housing (for homeless)
HMIS (only if designated by CoC)
4 Identify the type of homeless/ low-income population you plan to serve with through your agency's program(s).
Homeless individuals (adults)
Homeless single parents w/ children
Homeless youth
Powered by ZoomGrants™
Clark County
Community Resources Management Division
2014-15 Emergency Solutions Grant
11/26/2013 deadline
The Salvation Army A California Corporation
Emergency Solutions Grant Homeless Prevention
The Salvation Army A California Corporation
2900 Palomino Lane
Las Vegas, NV 89107
United States
Tel: (702) 870-4430
Fax: (702) 870-4087
Web: www.salvationarmysouthernnevada.org
EIN: 94-1156347
DUNS:
Project Contact
Norma Bucelato
norma.bucelato@usw.salvationarmy.org
Tel: 702-870-4430
Additional Contacts
bernadette.basilio@usw.salvationarmy.org
Clark County Coordinator
Robert Lloyd
robert.lloyd@usw.salvationarmy.org
USD$161,570 Requested
Application Questions

2. Homeless families w/ children
Low income individuals at imminent risk of homelessness
Low income families at imminent risk of homelessness
Other:
N/A
5 Choose the homeless or low-income population that best describes the clients served by your program. If you are emphasizing resources on a
specific group please explain in the project description.
Some of these groups overlap, you may check off more than one but the project description and project history should cover populations of emphasis.
Veterans
Victims of Domestic Violence
Elderly
People diagnosed with HIV/ AIDS
Chronically Homeless
Severly Mentally Ill
Chronic Substance Abusers
Other Disabled
Medically fragile
Transgendered
Other:
6 Describe the project/program for which you are applying for funds. Include the following information: service activity plan, intake and referral
procedures, program procedures and evaluation plan, intended accomplishments.
Include the target population, services, housing, partnerships, etc.
The Homeless Prevention Program will be operated through The Salvation Army Family Services. For the past 25 years the Salvation Army Family Services has
provided basic needs, support and case management services to individuals and families in need. The program provides emergency assistance to extremely
low-income families including, but not limited to: food baskets, sheriff cards, health cards, clothing vouchers, rental assistance, prescription assistance, utility
assistance, assistance with obtaining ID and referrals to other mainstream programs and agencies for public benefits and needed services. The goal of The
Salvation Army Family Services is to strengthen and unify families who are in severe financial crisis. Over 25,000 individuals are served annually, approximately 8,000
families of which 146 families received rental assistance for a maximum of one month in the last year. The average cost of rent for these families was $700 per month.
The Homeless Prevention Program will assist extremely low income families who have received eviction notices by providing rental assistance to enable them to stay
in their homes, and continued rental assistance as necessary to help them to retain their housing and avoid homelessness. Rental assistance may be provided for a
period of up to three months while the family works on a plan to overcome their financial crisis and become more self-sufficient. A casemanager dedicated to
Homeless Prevention will develop an Individual Services Plan with each family delineating their goals for self-sufficiency and how we will assist participants who are
facing eviction with rental assistance and will also provide food baskets as needed, utility assistance as needed, as well as work cards to address their needs for
additional supportive services to meet their family's needs, and referral to programs and services that may improve their income and ability to pay their housing costs.
The Homeless Prevention Case Manager will develop a service plan to identify families eligible for the services from the families presenting at the Family Services
office for services. The Homeless Prevention Case Manager will work with the Family Services Case Managers to identify families facing eviction and in need of
service. Intake requires I.D. for all adults, and a current Utility bill (water, gas, or power) OR a current lease with all family members on it and a current rent receipt,
birth certificates or custodial papers for each child, Social Security cards for all family members, and proof of all household income. The case manager will also
review the eviction notice to determine eligibility for the rental assistance. The service activity plan will include rental assistance for the current rental payment, rent in
arrears, and for up to three months rental assistance to bring the family to stabilization and self-sufficiency. An Individual Services Plan is developed with the
participant to outline their goals and objectives for achieving self-sufficiency, define the number of months that rental assistance may be needed, determine if rental in
arrears is needed, identify all their needs to help them to overcome their current financial crisis, and identify the supportive services needed to keep them from
eviction, enable them to maintain their homes for at least three months, and to help them to overcome their current financial crisis, and reach self-sufficiency. The
Case Manager will also review their current income and housing costs and determine if their housing costs are affordable. If not, the case manager will assist them
with locating affordable housing so that they can maintain their rental payments after the Homeless Prevention Services have ended, and assist them with moving to
more affordable housing. Additional supportive services may include referral to other Salvation Army programs including life skills, and vocational training to help
them to improve their income that they may maintain their housing.
7 Select the HUD funding priority and/or Continuum of Care identfied regional population of emphasis that your project addresses.
Your project description and outcomes must substantiate this information and housing/services provided must be appropriate for type of population. If not applicable,
select N/A.
Rapid Re-Housing assistance & case mangement
Homeless Prevention assistance & case management
Victims of Domestic Violence
Medically fragile (must also provide medically licensed staff/contracted personel)
Homeless Youth

3. Male headed households with children
Families with children (to be housed in one location)
N/A
8 Describe how your project meets action steps laid out in the HELP HOPE HOME Implementation Schedule.
The HELP HOPE HOME Implementation Schedule is available at www.helphopehome.org under "our Plan" then "Goals". http://www.helphopehome.org
/HHH_Implementation_Master.pdf
Action Step 1.1 Hold focus groups and work sessions: The Salvation Army (TSA) will participate in focus groups to develop plans to end homelessness.
Action Step 1.2 Conduct a point in time homeless count: TSA will participate in the Homeless Count.
Action Step 1.3 Conduct Gaps Analysis: TSA will participate in Gaps Analysis to streamline goals and objectives of business case plan
Action Step 1.4 Develop a work plan: TSA will develop work plans for each of its services programs.
Action Step 1.5: Develop and write a business case for ending homelessness.
Action Step 1.6: Develop implementation schedule with goals, partners and timelines identified.
Action Step 1.7 Develop an implementation plan: TSA will develop implementation plans for each of its services programs.
Action Step 1.8 Fully utilize HMIS: TSA fully utilizes HMIS for reporting of data on its homeless programs.
Action Step 2.4 Create a consortium/technical/work group: TSA will participate in a Nevada Homeless Alliance work group to improve ability of the community to
address homeless issues.
Action Step 2.5 Establish a prevention provider network: TSA will participate in a prevention provider network to increase access to mainstream programs to persons
who are homeless.
Action Step 2.6 Create an access awareness campaign: TSA will develop materials for outreach and public awareness to improve community awareness of homeless
issues and the ability to address them.
Action Step 2.9 Advocate for ordinances, other legal options, outreach, and shelter placement promoting public safety: TSA will participate in advocating for improved
public policy response to issues that affect the homeless.
Action Step 3.3: Identify the most and direct permanent housing and mainstream resources to serve that population.
Action Step 3.7: Coordinate with evictions, foreclosures and loss of utilities.
Action Step 3.8: Coordinate with organizations, government, landlords and legislature to create funding opportunities to support payment of application fees,
deposits, move in cost and relocation fees.
Action Step 3.10 Develop programs to assist people who have poor work, credit and/or criminal histories.
Action Step 4.6 Increase access to Drop-In Centers.
Action Step 4.7 Annually make available medical/substance abuse: TSA Adult Rehabilitation Program provides substance abuse treatment to Young Adults.
Action Step 4.8 Coordinate with other organizations to fund ID, birth certificates. Family Services can assist people with finding ID.
Action Step 5.1 Utilize Workforce Development partners and organization.
Action Step 5.5 Train social workers and case managers to assist clients with eligibility for social security and disability benefits: TSA case management staff are
trained and assist homeless individuals with application for public benefits.
Action Step 6.1 24 hour restrooms: TSA Homeless Services provides free access to showers, and ADA restrooms.
9 Briefly describe the need, local situation, or conditions that your project will address. Describe how you meet the priority needs of the local CoC.
Indicate how long has your agency operated this program.
Include local data from the homeless census, HMIS, point in time count, and other relevant data. Include statistics provided by your agency such as the number of
referral calls, number on waiting lists, for how long, etc.
The need is to address the large number of families that are served eviction notices who may become homeless through the loss of their homes because they cannot
pay their rent. Through October, the Las Vegas constable's office served 17,365 evictions, public information officer Lou Tommin reported. They're on pace to fall far
short of the 36,987 evictions in 2011, which was down from a peak of around 40,000 in 2010. Still, Las Vegas leads the nation in evictions, attracting national and
international media attention (Las Vegas Review Journal, Local Evictions Dropping but Las Vegas Still Leads the Nation). With the high number of eviction notices
there is a tremendous need for the rental assistance that ESG funding can provide to help these low-income families to stay in their homes and avoid homelessness.
Family Services has been providing supportive servcies including rental assistance to families facing eviction for over 25 years. The current funding through EFSP
only allows payment of one month's rental assistance though some may need more. The ESG Homeless Prevention Program will expand the prevention activities
allowing rental assistance for up to 3 months to help the family to first avoid eviction and then support their need to stabilize and meet their rental payments for
additional months.
The Homeless Prevention Program will meet the needs of the local COC addressing Strategy 2. HOPE- Closing the Front Door to Homelessness - Prevent
homelessness whenever possible; improve the availability of prevention programs; expand the types of prevention strategies; evaluate their effectiveness in preventing
homelessness, improve access to wraparound mainstream services that link participants to services and community support to keep the participant in safe, affordable
housing; and address health and wellness issues. The Salvation Army Homeless Prevention Program will provide the wraparound services to address the need to
provide rental assistance to families at risk of homelessness so that they can avoid eviction and homelessness, and provide supportive services that will help them to
overcome their current financial crisis and achieve self-sufficiency. The program will help them to identify increased or new income sources through referral to job
skills training programs, and assistance with applying for mainstream public benefits. Their entire lifestyle is assessed to determine where services need to be
provided, and where changes need to be made to ensure that they can afford and maintain their housing, preventing them from becoming homeless. The focus of the
program on prevention is the key strategy as identified by the COC to prevent homelessness.
10 Describe the outcomes and accomplishments your project(s) has achieved for the past three years, and the degree to which objectives were met.
If there were difficulties, describe how that will be overcome in the future.
Indicate how long your organization has implemented this program. If project is new, provide the outcomes and accomplishments for a similar project/program(s) your
agency administers.
The Salvation Army Family Services Program provided one month rental assistance to 146 families in the last year helping these families to avoid eviction and
homelessness. The program through EFSP funding met all projected outcomes. These families were also provided with case management to provide supportive
services including rental assistance, utility assistance, work cards, food baskets, clothing vouchers, transportation and referral to other supportive services to help
them to improve their income and support their families. The projected outcomes are that wewillincrease the number extremely low-income families that we can assist
with rental assistance of up to 3 months by 50 families ensuring that they are able to maintain their homes and prevent them from becoming homeless. help them to
find other supportive services such as food, child care, health services, transportation, job training, job search and job placement. Additional supportive services are

4. provided to ensure that they locate affordable housing if needed, so that they can pay their own rent after program services, that they achieve an income that will enable
them to maintain their homes, that they apply for additional public benefits such as Food Stamps and Medicaid even if they are employed, to help them to find additional
support for their living needs, and that they find the resources they need to achieve self-sufficiency so that they can maintain their homes and support their families.
11 Provide the number of unduplicated individuals/ households assisted by your program(s) in the last fiscal year (July 1, 2012- June 30, 2013)
146 Homeless prevention (rent/utility) households
Homeless prevention (rent/utility) individuals
200 Rapid Re-Housing HH (rent/utility/sec deposit/first month)
Rapid Re-Housing Indiv. (rent/utility/sec deposit/first month)
Sheltered (HH)
1464 Sheltered (Indiv.)
1364 Essential Services (HH)
Essential Services (HH)
Other
N/A (if new)
12 Provide the number of unduplicated individuals/ households expected to be assisted by your program in the next fiscal year (July 1, 2014- June 30,
2015)
Indicate the number of unduplicated households (HH) or individuals (indiv) expected to be assisted
50 Homeless prevention (rent/utility) households
Homeless prevention (rent/utility) individuals
50 Rapid Re-Housing HH (rent/utility/sec deposit/first month)
Rapid Re-Housing Indiv. (rent/utility/sec deposit/first month)
Sheltered (HH)
1780 Sheltered (Indiv.)
1780 Essential Services (HH)
Essential Services (HH)
OTHER
13 What was the average HMIS data quality rate for the last fiscal year (July 1, 2012-June 30, 2013) for the specific project for which you are applying
for funds? What was the utilization rate? *Only emergency shelters provide bed night information
You can explain any challenges in question 10 (Outcomes). New projects would type in N/A. Homeless Prevention/ Rapid Re-Housing would type in N/A next to the
utilization rate, bed night available, bed costs. DV providers need not fill in HMIS DQ.
Bed nights available
226 Number of beds provided
85% Utilization Rate
$12.50 Cost per bed night
99% HMIS Data quality (for the project)
14 Describe how your agency will carry out case management. Also address how frequently case management will be provided and if it will be provided
by your agency staff or through collaboration with another provider.
Under the Interim Rule, case management is required for projects funded for homeless prevention and rapid re-housing activities.
The Homeless Prevention Program will employ a dedicated case manager to recruit participants from the Family Services Program, conduct intake, assess
participant's needs, develop an Individual Services Plan, provide intensive case management, provide rental assistance and other supportive services as needed,
locate affordable housing options if needed, and assist families with supportive services to retain their housing. Family Services participants are referred by the
Family Services case management staff to the program and connected to the Homeless Prevention casemanager to identify their needs, strengths and weaknesses,
barriers and develop an Individual Services Plan, a specific, comprehensive, individualized treatment and case plan that identifies the participant's needs, their
barriers, provides the plan for rental payments amounts and number of months needed, and develops a plan with the participant for identifying and receiving the
supportive services that will help them to overcome their financial crisis and achieve self-sufficiency. The case manager serves as a participant advocate to intercede
on their behalf and provide the supportive services needed, to provide the program's services and financial assistance to overcome barriers, and assist in stabilizing
them through direct intervention and mobilizing needed support and services.
Participants are monitored throughout their program participation, meeting regularly to monitor their progress, assess any barriers that may be preventing progress
and find the supports to help them overcome the barriers. Individual meetings with participants will assess their participation and satisfaction with the program and
develop the resources to help them to succeed. Upon exit, participants are interviewed to determine their perceptions of the program, assess their progress, and
determine if any other services are needed, including additional rental assistance, other supportive services needed to help them retain their housing, referral to other
service agencies if needed for additional supportive services to help them to reach self-sufficiency.
Follow-up services are provided monthly for a minimum of three months through casemanager contact to determine if the participant needs additional rental
assistance and any additional supportive services to ensure they retain their housing, and offer referral to services they may need to support their housing stability
including access to vocational training, job skills training, food, child care, transportation, health services, and homeless prevention programs including additional
rental assistance such as through The Salvation Army Family Services, and other agencies, and provide continued case management to ensure all their needs are
met to ensure that they can retain their permanent housing. A dedicated case manager employed in The Salvation Army Family Services Program will provide the
rental assistance and supportive services and serve as an advocate for the family to intervene in providing the services needed for them to reach self-sufficiency.
Follow-up is provided after initial rental assistance is provided at least monthly to determine if additional rental assistance is needed after the first month's rent and
engaging the family to re-apply for assistance. Other supportive services are provided through The Salvation Army services or referrals to other agency prevention
programs to assist them with income attainment, job skills training, food,child care, health services, transportation and other services that will help them to achieve
self-sufficiency.

5. 15 How will your agency connect clients to mainstream programs and other supportive services: mainstream housing, health, social service,
employment, education, and youth programs?
Efforts to coordinate with these programs and link clients to these services to the maximum extent possible are required in the ESG Interim Rule.
The Homeless Prevention case manager will assist participants with applying for mainstream programs public benefits including TANF, Food Stamps, Medicaid,
SSI, SSD and Veterans benefits. The Salvation Army has strong relationships with the Department of Social Services, Social Security Administration, the Veterans
Administration, and SNAP program that have provided training to our staff in filling out applications and are very accepting of the participants that we refer to them.
All of the Salvation Army programs assist participants and families with applying for public benefits. Other supportive services will be provided through Salvation
Army programs or other agencies to ensure that they can retain their housing and self sufficiency.
16 Describe opportunities that clients have to provide input in program evaluation of services and/or everyday delivery of services.
Participants complete an Exit Evaluation after services are completed to provide their input on the program services, and the progress they have made in achieving
self-sufficiency. Satisfaction surveys are completed by participants to share their feelings on the program's services and support.
17 Describe the process the project uses to terminate assistance to participants, if applicable. Include any public postings of rules. notification
process, and any appeals procedures in place.
Terination of services will occur if the family cannot provide the required ID, birth certificates, income verification, and housing verification. However, if needed, we
will assist the family with obtaining the necessary ID to enable them to enroll in the program. Once the family receives the first month's rental assistance they must
re-apply for additional month's rental assistance. Termination will occur if they do not follow through with the appropriate re-application procedures. This will only
happen after the participant has been contacted a number of times to encourage their participation.
18 Are there any fees or payments required from your clients? If yes, please explain.
No
19 For projects that provide EMERGENCY SHELTER/TRANSITONAL HOUSING, identify the type of shelter accommodation used:
Barracks/ Warehouse
Scattered Site Apartment
House
Hotel/Motel
Group Home
Other
N/A
20 For EMERGENCY/ TRANSITIONAL HOUSING, how is your project appropriate for your population of emphasis? Describe the project's policy on
length of stay and conditions for extensions, and efforts to protect the health and safety of clients.
N/A
21 For EMERGENCY/TRANSITIONAL HOUSING projects, how will your agency ensure that families with children seeking assistance are not
involuntarily separated?
Also describe any collaborative relationships in place with other agencies/ resources to avoid the involuntarily separation of families with children.
N/A
22 For projects that PREVENT HOMELESSNESS, describe the requirements and documentation necessary for eligibility for assistance (i.e., income
qualification, circumstances leading to crisis, wage statement, eviction notice, utility shut-off notice).
Also describe re-evaluation after the third month of assistance
The Homeless Prevention case manager will conduct intake which requires families to present picture I.D. for all adults, and a current Utility bill (water, gas, or
power) or a current lease with all family members on it and a current rent receipt, birth certificates or custodial papers for each child, Social Security cards for all
family members, and proof of all household income. The case manager will also review the eviction notice to determine eligibility for the rental assistance.
23 For projects that RAPIDLY RE-HOUSE explain intake procedures and how re-evaluation will be conducted.
Note: Per the Interim Rule, re-evaluation is required to be conducted prior to 4th month of assistance; specifically for Rapid Re-Housing.
N/A
24 For projects that PREVENT HOMELESSNESS or RAPIDLY RE-HOUSE clients, describe the duration of assistance and criteria for ending
assistance, and the method to ensure that household remains in housing for at least 3 months after assistance has ended.
The Homeless Prevention Program will provide rental assistance for up to three months and follow-up for an additional three months to provide supportive services to
ensure families are able to maintain their homes and prevent homelessness. The Homeless Prevention Case Manager will make contact with the family after the
initial month's rent is paid to help them to apply for additional month's rental assistance if needed, and to provide the additional supportive services so that they retain
their housing. Folliow-up services will continue for at least three months through case manager contact to assess family's needs for additional aupportive services to
ensure that they retain their housing and self-sufficiency.
25 Engagement with regional efforts on homelessness: Indicate approximately how many times in the last year your agency has attended the
following meetings in the last 12 months.
12 SNRPC Committee on Homelessness
12 Project Homeless Connect (PHC)
12 Mini Homeless Connect
12 Homeless Registry
12 Point In Time Count
12 Family Connect

6. 12 100K Homes Initiative
12 Mainstreams training workshops
26 Explain your agencies role in PHC, Homeless Census (Point In Time count), Familly Connect, 100 homes and any other regional collaborative
efforts.
The Salvation Army is an active participant in the SNRPC Committee on Homelessness, Project Homeless Connect, Mini Homeless Connect, Point in Time Count,
Homeless Registry, Family Connect, 100K Homes Initiative and Mainstream training workshops participating in events and regularly attending meetings.
27 Are there other services/activities similar to your program provided in the community? If so, how is your project avoiding the duplication of
services provided by other agencies?
Other agencies provide rental assistance and supportive services similar to this program but with the very high rate of eviction notices the need is so great that it
cannot be completely fulfilled and there is no duplication.
28 List agencies with whom you have M.O.U.'s/ written collaborative agreements/ service contracts (specific to this program- if applicable).
This question should be supported with the required documents section of this application.
Albertson's
The Corner Market
29 How does your agency plan to ensure project sustainablity? How will you ensure that you meet the match requirement?
Dollar for dollar match in funds are required for each ESG award. It is also highly recommended that your project has at least 3 months of cash reserves.
The Salvation Army will sustain the services through its Family Services budget that includes Salvation Army funding resources including contributions, fund raising,
gifts in kind, and sales to the public.
30 Describe your agency's fiscal management, including financial reporting, record keeping, accounting systems, payment procedures and
requirements. Identify and describe any audit findings, investigations, or probation of agency within the past 5 years
If there have been any findings attach corrective action letter.
Financial operations of The Salvation Army are conducted through The Salvation Army Territorial Headquarters. The ESG grant funds are maintained in a separate
account for the expenditure for ESG purposes only. The Salvation Army follows General Accounting Standards issued by the Comptroller General of The United
States along with additional requirements specified by the U.S. Office of Management and Budget Circular A-133 Audits of States, Local Government, and
Non-Profit Organizations, A-122 Cost Principles for Non-Profit Organizations, A-110 Uniform Administrative Requirements for Grant and Agreements. Accounting
Standards and Practices are not inclusive or limited to the above referenced OMB Circulars, but also include other Grant specific regulations and requirements.
The Salvation Army uses a computerized double entry, fund oriented, accrual based accounting system: Microsoft Business Solution Dynamics - e-enterprise, Great
Plains software and programs are used for The Salvation Army centralized accounting system. Software and servers are located at a corporate location with user
licensure issuance to local users. The Lead Bookkeeper is responsible for determining which account income and expenses should be posted, and which vendor or
customer to use and conducts all grant invoicing and drawdown. The Business Manager is responsible for all grant funding and oversees the Bookkeeper in the
expenditure and invoicing of grant funding. The computer is the last step in the accounting process. Paperwork is completed first, then the information is entered into
the computer.
31 APPLICANTS, before submitting application confirm and check off that ALL OF the following documents have been uploaded to this
application.
See required documents section for more details. The only exception is the HMIS administrator.
Disclosure of Ownership Form and Board List
Non-Profit Status (IRS letter)
Good Standing with Secretary of State Office document
IRS form 990: Reurn of Organization Exempt from Tax
Financial Accountability Documents (see threshold requirements in instructions)
Project Performance Outcomes
Budget, Proposed Revenue & Leveraging Attachment
New Applicants- Section III. of budget, 3-yr. funding history
Copy of Organization's By-Laws (NEW applicants OR if updated in the last year)
Copy of Articles of Incorporation (NEW APPLICANTS ONLY)
Program Organization Chart
Program manager/staff qualifications
Copies of MOUs or collaborative agreements
Non-Profit Registration Certificate from Clark Count Business License (NEW applicants only)
Certification of Application
Budget Snap Shot
ANTICIPATED FUNDING SOURCES Project Revenue
Clark County ESG USD$200,000.00

7. Clark County HOME USD$0.00
CDBG (County or City of___) USD$0.00
City of Las Vegas ESG USD$0.00
Other HOME (City of ___) USD$0.00
City of Las Vegas HOPWA USD$0.00
Other Federal Funds (______)
State Funds (______)
Private Funds (_____)
Other Funding (United Way, Gifts Inkind, Fund Raising) USD$1,143,385.00
Total USD$1,343,385.00
SUMMARY BUDGET (EXPENSES AND FUNDING REQUESTED) Total Project Budget Requested ESG funds
Street Outreach
Emergency Shelter/Transitional Hsg Operations only USD$298,547.00 USD$290,266.00
Emergency Shelter- Essential Supportive Services for clients
Homeless Prevention- Hsg. Reloc. & stabliz. (financial assistance-rent app, sec. dep., utilities) USD$1,031,508.00 USD$161,750.00
Homeless Prev- Hsg. Reloc. and Stablization (services) case management
Homeless Prev- short/med. term rental assitance
Rapid ReHsg- Hsg. Reloc. and Stablization(financial assistance-rent app, sec. dep., utilities) USD$263,406.00 USD$219,070.00
Rapd ReHsg- Hsg. Reloc & Stabliz. (services) case management
Rapid ReHsg- short/med. term rental assitance
Homeless Management Information System (HMIS)
Other: Specificy
Total USD$1,593,461.00 USD$671,086.00
Budget Snap Shot Narrative
UnitedWay$111,877
Gifts InKind $800,000
Fund Raising $231,508
Documents
Documents Requested * Required? Attached Documents *
1. Disclosure of Ownership Form (complete attached document AND
upload most recent list of voting Board members)
download template
Disclosure of Ownership
2. Non-Profit Determination Letter (from IRS) IRS Determination Letter
3. Proof of current good standing with the Secretary of State’s Office.
This may be a receipt from the Secretary of State's Office or a
print­out of the agency’s standing from the Secretary of State’s
website
Nevada Certificate of Good Standing
4. Latest IRS Form 990: Return of Organization Exempt from Income
Tax
IRS Form 990
5. Financial Accountability Documents (latest audit/ financial
statements). See threshold requirements in instructions.
Audit/Financial Statement
6. Project Performance Outcomes Chart (complete attachment)
download template
Performance Measures
7. Detailed Budget & Revenue. Complete excel uploadable
attachment. Sections: I. Budget Summary, II. Project Budget,
Priorities, and Justification, and III. Funding Sources. [New
Applicants must also complete IV. 3-Year funding Hist.]
download template
Budget and Budget Justification
8. Program Organizational Chart Organizational Chart
9. Program manager/staff qualifications [You can include a summary
attachment or resumes]
Staff Qualifications
Staff Qualifications
Staff Qualifications
Staff Qualifications
Staff Qualifications
10. Copy of MOUs or letters verifying collaborations. MoU
MoU
11. CERTIFICATION OF APPLICATION (all applicants)
download template
Certification
* ZoomGrants™ is not responsible for the content of uploaded documents.

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