ESG FY2025 Application
Organizational Information
Full Organization Legal Name
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Organization's UEI (Unique Entity Identifier from Sam.gov)
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Person Name
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First Name
Last Name
Contact Person Email
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example@example.com
Contact Person Phone
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Please enter a valid phone number.
Executive Director Contact Information (Please provide for contracting purposes)
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First Name
Last Name
Executive Director Email
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example@example.com
Executive Director Phone Number
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Please enter a valid phone number.
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ESG FY2025 Application
Financial & Board Governance Questions
How many years of experience does your organization have in managing federal grants?
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More than 5 years
3-5 years
1-2 years
Less than 1 year
Does your organization have any unresolved findings from IHCDA or HUD, or any state or federal recaptured funds due to non-compliance?
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No
Yes
Please explain your finding/non-compliance situation
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How many people are on your Board of Directors?
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How frequently does your Board of Directors meet?
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8 or more times per year
6-7 times per year
2-5 times per year
1 time per year
Is there a written set of policies and procedures for the Board that includes term limits?
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Yes
No
Please describe the Board's role in fiscal oversight of the organization.
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ESG FY2025 Application
Emergency Shelter
Are you applying for Emergency Shelter Funding?
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Yes
No
Would this be the first time your organization has operated an ESG Emergency Shelter Award?
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Yes
No
Do 100% of Emergency Shelter program clients meet HUD's definition of Homelessness?
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Yes
No
Are households experiencing domestic violence the primary population served in your program?
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Yes
No
Please list your total Emergency Shelter funding request.
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No dollar signs of commas (Ex: 25000)
Do you receive ESG Emergency Shelter funding from an Entitlement City
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Yes
No
Please describe the client intake process for your Emergency Shelter.
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Please describe how you partner with and connect clients to other resources in the community.
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If your Emergency Shelter program serves families with children, please describe how your program connects school-age children to McKinney-Vento services within their school.
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If your Emergency Shelter does not serve children, enter N/A
How many clients do you intend to serve with these funds in a 12-month period?
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Please describe how you will meet the required 100% Match for ESG funding.
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Please list your Emergency Shelter program's intended service area (Cities/Counties).
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Please review your Emergency Shelter CAPER for 7/1/2024-6/30/2025. Results from the following CAPER questions will be used in scoring your funding request: Q06e, Q07a, Q22a2, and Q23c. Use the space below to provide any explanation/context for your results. If you did not operate this project type last year, enter N/A.
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ESG FY2025 Application
Street Outreach
Are you applying for Street Outreach Funding?
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Yes
No
Would this be the first time your organization has operated an ESG Street Outreach Award?
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Yes
No
Please list your total Street Outreach Request.
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No dollar signs of commas (Ex: 25000)
Do you receive ESG Street Outreach funding from an Entitlement City
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Yes
No
Please describe your organization's approach to Street Outreach.
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Please describe how your Street Outreach program connects clients to shelter or permanent housing resources.
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Please outline when and how your organization makes referrals to other organizations. What other local agencies or resources do you have partnerships with?
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How many clients do you intend to serve with these funds in a 12-month period?
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Please describe how you will meet the required 100% Match for ESG funding.
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Please list your Street Outreach program's intended service area (Cities/Counties).
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Please review your Street Outreach CAPER for 7/1/2024-6/30/2025. Results from the following CAPER questions will be used in scoring your funding request: Q06e and Q07a. Use the space below to provide any explanation/context for your results. If you did not operate this project type last year, enter N/A.
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ESG FY2025 Application
Rapid Rehousing
Are you applying for Rapid-Rehousing Funding?
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Yes
No
Would this be the first time your organization has operated an ESG Rapid Rehousing Award?
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Yes
No
Please list your total Rapid Rehousing funding request.
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No dollar signs or commas (ex: 25000)
Please describe how you will meet the required 100% Match for ESG funding.
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Please describe a client's journey through your RRH Program, from client referral to program exit.
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Please describe how your case management staff will develop housing plans with clients.
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Please describe how your organization will approach landlord engagement in your community.
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Please describe how your organization will support clients to establish and stabilize their income.
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Please describe the way your agency will coordinate with other community partners to support households with high barriers (Ex: criminal history, evictions, substance use, etc.)
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Please list the Indiana counties and cities your Rapid Re-Housing program intends to serve.
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Please review your Shelter CAPER for 7/1/2024-6/30/2025. Results from the following CAPER questions will be used in scoring your funding request: Q06e, Q07a, and Q23c. Use the space below to provide any explanation/context for your results. If you did not operate this project type last year, enter N/A.
*
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ESG FY2025 Application
Homeless Prevention
Are you applying for Homeless Prevention Funding?
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Yes
No
Would this be the first time your organization has operated an ESG Homeless Prevention Award?
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Yes
No
Please list your total Homeless Prevention funding request.
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No dollar signs or commas (ex: 25000)
Please describe how you will meet the required 100% Match for ESG funding.
*
Please detail your client prioritization process for Homeless Prevention
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Please describe a client's journey through your HP Program, from client referral to program exit.
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Please describe how your case management staff will develop housing plans with clients.
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Please describe how your organization will approach landlord engagement in your community.
*
Please describe how your organization will support clients to establish and stabilize their income.
*
Please describe the way your organization will coordinate with other community partners to support households with high barriers (Ex: criminal history, evictions, substance use, etc.)
*
Please list the Indiana counties and cities your Homeless Prevention program intends to serve.
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Please review your Shelter CAPER for 7/1/2024-6/30/2025. Results from the following CAPER questions will be used in scoring your funding request: Q06e, Q07a, and Q23c. Use the space below to provide any explanation/context for your results. If you did not operate this project type last year, enter N/A.
*
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ESG FY2025 Application
Attachment Uploads
Proof of 501c3 status
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Entity Report from SAM.gov
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List of Board of Directors (with contact information)
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Match Commitment Letter for total amount requested for ESG
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General Liability Insurance documentation to evidence policy
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Summary page showing coverage is all that is needed
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Fidelity Bond Insurance documentation to evidence policy or bond
*
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Amount should be equal to ½ of the total annual funding provided by the state and should cover all employees/board members handling funds)
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Proof of Worker’s Compensation Coverage
*
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Proof of Auto Insurance
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Only required if using ESG funds for Transportation in agency vehicle
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Fire Inspection Report—dated within last 6 months
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Shelter Requests Only
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Health Department Inspection—dated within last 6 months
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Only required if shelter serves food
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ESG FY2025 Application
Form Submission
I have read through the application and grant requirements for the Emergency Solutions Grant, and understand that if I am awarded funds these requirements will be a part of my Grant Agreement
Yes, I understand and agree to these requirements
No, I do not understand nor agree to these requirements
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