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www.albanyny.gov City of Albany Department of Community Development Albany Community Development Agency 200 Henry Johnson Boulevard, Second Floor Albany, NY 12205-1522 (Tel) [PHONE REDACTED] (Fax) [PHONE REDACTED] Kathy M. Sheehan Mayor Faye C. Andrews Director CDBG-CV FUNDING APPLICATION Your organization must be a valid 501c3 organization to apply for funding. APPLICANT INFORMATION Organization Name: Program Name: 1. Type of Organization: Non-Profit Government Quasi- Government Faith Based Other (Please Specify): Tax ID Number: DUNS Number (required) Mailing Address: City, State, ZIP Code: Contact Person: 2. Telephone: Fax: 3. Email Address: 4. Funding request: 1) Requested Amount 2) Other Funding Sources 3) Total Program Cost * 4) Percentage of CDBG-CV funds toward Total Program Cost * Total Program Cost is the Requested Amount plus the amount from Other Funding Sources. (Line 1 + Line 2 = Line 3) Percentage of CDBG-CV funds toward Total Program Cost is the Requested Amount Divided by the Total Program Cost. (Line 1 / Line 3 = Line 4) I CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND CORRECT AND THAT IT CONTAINS NO FALSIFICATIONS, MISREPRESENTATIONS, INTENTIONAL OMISSIONS, OR CONCEALMENT OF MATERIAL FACTS. I FURTHER CERTIFY THAT NO CONTRACTS HAVE BEEN AWARDED, FUNDS COMMITTED, OR CONSTRUCTION BEGUN ON THE PROPOSED PROGRAM AND THAT NONE WILL BE DONE PRIOR TO ISSUANCE OF A RELEASE OF FUNDS BY THE CITY OF ALBANY. I ALSO CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THE GUIDELINES FOR THIS FUNDING APPLICATION. SIGNATURE DATE ---PAGE BREAK--- www.albanyny.gov 1. What is your organization's mission? What core services are provided? 2. Does your organization have experience administering federal funding? If yes, please describe. 3. The proposed request for funding will support a program, service, or capital project that best aligns with which of the following National Objective categories? ☐ Low and Moderate Income: Area Wide ☐ Low and Moderate Income: Limited Clientele 4. What funding priority are you applying for? ---PAGE BREAK--- www.albanyny.gov 5. Describe the target population for the proposed service, its size, demographics, location, etc. What proportion of this target population will be served by the proposed CDBG-CV funded program? Provide a profile of a typical client or clients. Is the service directed at a particular geographic area or available community-wide? If you are proposing a program that will serve a specific area, neighborhood, etc please include a brief description of the neighborhood and its need for programming. ---PAGE BREAK--- www.albanyny.gov 6. Describe your program and how it relates to responding to, preventing or preparing for the COVID-19 pandemic ---PAGE BREAK--- www.albanyny.gov 7. How will recipients will access the services provided. 8. Please describe the timeline for implementation. 9. Describe the desired outcome(s) for this program. 10. What is the number of unduplicated Albany persons to be served by the CDBG-CV funds. 11. Estimate the projected number of persons to be served by age. 0-17: 8-24: 25-61: 62+: 12. Estimate the projected number of persons to be served by Area Median Income (AMI). 0-30%: 31-50%: 80%: ---PAGE BREAK--- www.albanyny.gov 13. Estimate the above number of persons to be served by the following categories. Disabled: Elderly: Veterans: Victims of Domestic Violence: Severe Mental Illness (SMI): Individual Experiencing Homelessness: 14. How do you ensure participant safety? Describe any training or certifications that you require. 15. Describe any additional precautions you’ve put in place for COVID-19. 16. Has your organization had any audit findings for any CDBG funded projects? If yes, briefly describe the finding and whether it was resolved. 17. Has your organization had any audit findings for anything other than CDBG funding projects? If yes, please describe the finding and whether it was resolved. ---PAGE BREAK--- www.albanyny.gov 18. Describe the experience your organization has related to this project and the number of years your organization has been providing this service. 19. Describe how your organization collaborates with other organizations, government entities and/or regional partners to respond to COVID-19. 20. What other funding and resources is your organization receiving to respond to COVID- 19, if any? ---PAGE BREAK--- www.albanyny.gov Complete the Board of Director’s table. List each current member of the applicant's Board of Directors and attach additional pages if necessary. Government entities should attach information about any advisory boards that are used to provide input into program activities. BOARD OF DIRECTORS Board Member* Albany Resident (yes or no) Company Affiliation Job Title Term1 Length of Service Gender2 Race / Ethnicity3 *Please denote Board Chairperson or President with one asterisk, Executive Director with two asterisks, and client/homeless representative(s) with three asterisks. Please complete the budget forms below, and provide a budget narrative for each item that you are requesting CDBG-CV funding for. ACDA is still waiting for clear guidance on allowable/eligible CDBG-CV expenses related to operational costs. Please be aware that we may need to ask you to adjust your budget based on any updates from the U.S. Department of Housing and Urban Development ---PAGE BREAK--- www.albanyny.gov FORM A: PROGRAM OPERATING BUDGET CDBG-CV FUNDS TERM: From to PERSONNEL TOTAL COST FROM COMMUNITY DEVELOPMENT OTHER FUNDS SOURCE OF OTHER FUNDS AND INKIND SERVICES Salaries Full-Time/ Rates Part-Time/ Rates Fringe (no more than 30%) Subtotal OVERHEAD Advertising/Marketing Program Supplies Please list: a. b. c. d. Rent and Utilities Other, list below a. b. Subtotal ESTIMATED TOTAL COST ---PAGE BREAK--- www.albanyny.gov Budget Narrative: ---PAGE BREAK--- www.albanyny.gov