Kentucky Housing Corporation



Kentucky Housing Corporation 2021 ESG-CV Emergency Shelter Application Information Cover SheetOrganization Name:Project Name (only required if organization is submitting more than one application):Shelter/Project Name:Shelter/Project Address:County of Shelter Location:Executive Director Name:Executive Director Email:Organization Address (if different from address above)Organization Telephone Organization DUNS #Organization Tax ID or EIN:Application Contact Person & Title Contact’s EmailContact’s Telephone #Total Amount Requested (including Admin): Click here to enter dollar amount.Does applicant currently receive regular Emergency Solutions Grant (ESG) funding for the ESG Emergency Shelter (ES) Component? ? Yes ? NoDoes applicant currently receive ESG-CV funding for the emergency shelter component? ? Yes ? NoIf applicant does not currently receive ESG funding for the ES component, does it operate an existing shelter for which it is seeking ESG-CV funding? ? Yes ? No? Not Applicable (current ESG ES subrecipient)Is applicant a nonprofit organization (with 501(c)3 status) or a governmental entity?? Nonprofit? GovernmentWill ESG-CV funds be used in a) an existing emergency shelter facility, b) a facility being used as emergency shelter only during COVID-19/or a temporary warming or seasonal shelter, or c) for hotel/motel vouchers? (Select all that apply)? Existing ES Facility? Facility Temporarily Being Used as ES? Hotel/Motel Vouchers Household Type(s) to be served with ESG-CV Emergency Shelter funding (select all that apply): ? Households with children ? Households without children (including single individuals) ? Households with only children (0-17 years old)Does applicant propose to limit proposed ESG-CV funded shelter to one gender for adult participants*?? Yes? No If yes to Q8 above, what gender (for adults) will the project serve*? ? Male ? Female ? N/A (no to Q7)* IMPORTANT: Shelters MUST comply with the 2012 Equal Access to Housing Final Rule and the 2016 Equal Access in Accordance with Gender Identity Final Rule, which ensures that all individuals have equal access to shelter in accordance with their gender identity. Will shelter be limited to a certain subpopulation (e.g, Survivors of Domestic Violence only, Unaccompanied or Parenting Youth Only (18-24 years old, Unaccompanied Minors only, Veterans only, etc.)? Yes? No If yes to Q10, please list the subpopulation(s) shelter will be limited to: Click or tap here to enter text.Are ESG-CV funds being requested for eligible expenses incurred between January 1, 2021 and February 28, 2021, on/after March 1, 2021, or a combination of both? ? Prior to 3/1/2021 Only? After 3/1/2021 Only? Both prior to and after 3/1/2021Does the applicant currently use KYHMIS (or an HMIS-comparable database if a Victim Service Provider) for the shelter (including temporary shelters and hotel/motel vouchers) where ESG-CV funds were/will be used? ? Yes? No Does applicant certify that it has a financial accounting system, staff capacity, and policies/procedures in place to accurately track and report expenditures, including time records for any staff associated with the proposed project? ? Yes? NoDoes applicant certify it has the cash flow necessary to operate the grant on a reimbursement basis? This means grant funds will be disbursed for costs after they occur, not in advance. ? Yes? No ................
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