Attachment 1 Application Checklist – Nonprofit Local Local Nonprofit Fiscal Government Government Required Application Items Applicant Sponsor Applicant Fiscal Sponsor Regional Application (ESG Lead Agency does not have to submit documents that are available on the website) Tab A-Signed, completed Regional application X X (Word document) Tab B-Regional budget worksheet (Excel X X spreadsheet Tab C-CoC Policies and Procedures X X Tab D -Materials used to solicit and evaluate X X CoC/Regions ESG project applications Project Application Note: Each project must be submitted with separate, lettered tabs as outlined on the ESG Checklist i.e. Tab E – Project Application; Tab F Project Budget; Tab G Federal Certification, etc… – – Tab E- Signed, completed Project Application X X (Word document) Tab F - Project budget worksheet X X spreadsheet) Tab G - NC DHHS Required Contract Certification Forms X X X X 1. Federal Certifications X X X X 2. State Certification X X 3. No Overdue Certification Form 4. Annual IRS Tax Exemption Verification X X Form X X 5. Annual Conflict of Interest Verification 6. Current Certificate of Insurance X X Tab H- Formal and informal agreements with X X mainstream resources Tab I- A copy of the HMIS or comparable system contract between the applicant organization and X X the database provider Tab J-Matching funds form (see Attachment 5) X X X X Tab K-Program X X Intake Form Tab L-Program X X Tab M-Organizational Chart Tab N Current year operating budget (with X X Revenues and Expenditures) Tab O-of Incorporation, Bylaws and any applicable X X amendments
Attachment 1 – Application Checklist Required Application Items Nonprofit Applicant Nonprofit Fiscal Sponsor Local Government Applicant Local Government Fiscal Sponsor Regional Application (ESG Lead Agency does not have to submit documents that are available on the website) Tab A-Signed, completed Regional application (Word document) X X Tab B-Regional budget worksheet (Excel spreadsheet X X Tab C-CoC Policies and Procedures X X Tab D -Materials used to solicit and evaluate CoC/Regions ESG project applications X X Project Application Note: Each project must be submitted with separate, lettered tabs as outlined on the ESG Checklist i.e. Tab E – Project Application; Tab F – Project Budget; Tab G – Federal Certification, etc… Tab E- Signed, completed Project Application (Word document) X X Tab F - Project budget worksheet spreadsheet) X X Tab G - NC DHHS Required Contract Certification Forms 1. Federal Certifications X X X X 2. State Certification X X X X 3. No Overdue Certification Form X X 4. Annual IRS Tax Exemption Verification Form X X 5. Annual Conflict of Interest Verification X X 6. Current Certificate of Insurance X X Tab H- Formal and informal agreements with mainstream resources X X Tab I- A copy of the HMIS or comparable system contract between the applicant organization and the database provider X X Tab J-Matching funds form (see Attachment 5) X X Tab K-Program X X Tab L-Program Intake Form X X Tab M-Organizational Chart X X Tab N Current year operating budget (with Revenues and Expenditures) X X Tab O-of Incorporation, Bylaws and any applicable amendments X X
16-17%20ESG%20Application%20Instructions.docx