Funding Application for CDBG Grant Funding

(* Denotes Required Fields)

Part I. Applicant
Program/Project Title: *
Organization/Applicant Name: *
Organization Representative/ Title: *
Address: *
Telephone number: *
Email: *
Organization DUNS Number:
Organization FEIN Number:
Organization CCR Number:
Contact Person/Title (if different):
Telephone number:
Cell phone:
Email:
PY47 Amount Requested: *
Part II. Project Description & Eligibility
A. Type of Entity
A (Check one that describes the applicant): *	A (Check one that describes the applicant) Governmental Agency Private Non-profit with IRS 501c(3) Status or equivalent Faith-based Private Non-profit with IRS 501c(3) Status or equivalent City of Meriden Department
B. National Objective to be met is either a direct benefit to Low- and Moderate-Income Persons/Households or provides benefits to all persons in a Low- and Moderate-Income Area. Describe how beneficiary income will be determined, i.e. records maintained, census tracts, presumed benefit.
National Objective Achieved by Project
B (Check ONE National Objective): *	B (Check ONE National Objective) Benefits low-/moderate-income individuals/households Addresses prevention of slum and blight Meets a particular urgent community need
C. Consistency with the City’s Consolidated Plan
C (Check ONE appropriate goal):	C (Check ONE appropriate goal) The program or project to be funded with this grant is consistent with the following Consolidated Plan goal for the City’s Housing and Community Development needs Provide Decent Housing Provide a Suitable Living Environment
D. The program or project will meet the following Housing and Community Development Objective(s) or CDBG Annual Action Plan requirement(s)
D (Check one or more that best describes the program or project): *	Maintain or rehabilitate exiting housing stock in standard condition. Eliminate one of the barriers to Fair Housing Choice identified in the City’s Analysis of Impediments. Project will eliminate and reduce slum and blight influences. Reduce or prevent lead-based paint hazards. Improve public safety and security. Assist low- and moderate-income persons with rental housing cost burden. Promote neighborhood and tenant associations. Provide day care services. Provide services that enable Hispanic persons to participate in economic and housing opportunities in the City. Reduce the incidence and effects of child abuse and sexual assault and abuse. Programs or projects to address emergency shelter or transitional housing and other service needs of homeless persons and families. Programs to prevent persons and families from becoming homeless. Programs to assist families living in poverty and improve household earnings. Expand employment opportunities for economically disadvantaged, long-term unemployed, or special needs populations through work training, supportive services and life-skill training. Energy conservation projects or programs in public or private facilities. Reduce incidences of substance abuse or teen pregnancy. Increase access to medical care for low- and moderate-income persons. Services to assist persons to maintain an independent living status. Services to meet behavior health needs. Improve local infrastructure. Reduce youth gang influence or other youth services programming. Redevelop underutilized or vacant properties. Programs that promote small business development. Retain or expand existing businesses or industries or recruit new businesses or industries. Train and develop the local labor force. Programs to create an economically stable, vibrant, and sustainable downtown. Promote home ownership. Expand the arts and entertainment opportunities in the City. Improve efficiency and affordability of transportation networks and the City’s transportation corridors.
E. Type of Project
E (Check line that best describes your project):	E (Check line that best describes your project) Public Services Public Facility Improvements Housing Economic Development Other (Describe in space provided below)
E Other (Please Describe):
F. Please provide a brief description of the program or project. Include the major activities and/or scope of services that will be conducted as part of the program/project. Also, please describe how the program/project will meet the Housing and Community Development Objective(s) or CDBG Annual Action Plan requirement(s) identified in Section D:
F (Description):
G. Please explain what outcomes are expected to be achieved by the program or project.
G (Description):
H. Will another entity besides the applicant be administering the project? If yes, please identify.
H (Description):
I. Geographic Area to be Served (Please check one and enter details in the box below): *	I. Geographic Area to be Served (Please check one and enter details in the box below) Project address and/or Neighborhood/Target area served City-wide US Census tracts (if known)
I. Please enter the details for the previous selection in the space provided:
J. Population to be served or benefit (Please check all that apply)
J. Estimated number of persons to be served by the project annually:
J. (Please check all that apply):	Elderly Youth Disabled Homeless/Near Homeless Abused Spouses or Children Illiterate Adults Residents of Public Housing
K. Income of population to be served or benefit
K. (Please estimate numbers to be served):