5. Project Summary (~3 Name of the closest VA Medical Center pages) Name and number of local COC Numbers of beds for per diem request Type(s) of model(s) clearly stated and number of beds for each (if applicable) Number of annual Service Center Visits Address of housing/services provided (Street, City, State, 9-digit Zip) County site located in Congressional district Description of space configuration (sq. feet, # of beds, bunked beds) Genders served Special populations served or none 6. Contact Information (~4 Executive Director/President/CEO contact information pages) Agency Name Address of administrative office (Street, City, State, 9-digit Zip) County site located in Congressional district Alternate address Name of Executive Director/President/CEO (phone, fax, email) Name of Management Employee (phone, fax, email) Board of Directors list (phone, fax, email for each) 7. Project Abstract (<1 Project design page) Supportive services of assistance provided Special program provisions, if any 8. Detailed Project Plan Please refer to Section 8 of the NOFA for specific requirements for this section including elements of Outreach, 20 questions relating to the Project Plan, Ability, Need, Coordination (including letters of support/coordination) and questions. Additional Requirements FOR HOSPITAL-TO-HOUSING MODELS ONLY: Memorandum of Understanding (MOU) signed by partnering VA Medical Center (If applicable) Indirect Cost Agreement
5. Project Summary (~3 pages) Name of the closest VA Medical Center Name and number of local COC Numbers of beds for per diem request Type(s) of model(s) clearly stated and number of beds for each (if applicable) Number of annual Service Center Visits Address of housing/services provided (Street, City, State, 9-digit Zip) County site located in Congressional district Description of space configuration (sq. feet, # of beds, bunked beds) Genders served Special populations served or none 6. Contact Information (~4 pages) Executive Director/President/CEO contact information Agency Name Address of administrative office (Street, City, State, 9-digit Zip) County site located in Congressional district Alternate address Name of Executive Director/President/CEO (phone, fax, email) Name of Management Employee (phone, fax, email) Board of Directors list (phone, fax, email for each) 7. Project Abstract (<1 page) Project design Supportive services of assistance provided Special program provisions, if any 8. Detailed Project Plan Please refer to Section 8 of the NOFA for specific requirements for this section including elements of Outreach, 20 questions relating to the Project Plan, Ability, Need, Coordination (including letters of support/coordination) and questions. Additional Requirements FOR HOSPITAL-TO-HOUSING MODELS ONLY: Memorandum of Understanding (MOU) signed by partnering VA Medical Center (If applicable) Indirect Cost Agreement
NOFA2018-PDO_Checklist.docx