# of Individual Leaver Exits to a Average Cost per Total 12-month Program Divided Permanent Housing Permanent Housing Equals Expenditures by Destination* Outcome / = *Should match the Project Level performance data provided in the Impact and Effectiveness section, Question 2, Column A SECTION VI– REQUIRED APPLICATION DOCUMENTS OF DOCUMENTS LOCAL SERVING VIOLENCE DOMESTIC ATTACHED VICTIMS DOCUMENTS NON-PROFITS GOVERNMENT ATTACHMENTS A Authorizing Resolution X X X B Statement of Certifications X X X ` C Certification of Local Approval N/A X X D Activity Summary X X X E Need for Funds and Certification Documentation X X X F HMIS or Comparable Database Reports X X X G Cost Efficiency X X X H Incorporation Documents N/A X X Site Control I X X X (Emergency Shelter Applicants J Payee Data Record X X X
Total 12-month Program Expenditures Divided by # of Individual Leaver Exits to a Permanent Housing Destination* Equals Average Cost per Permanent Housing Outcome / = *Should match the Project Level performance data provided in the Impact and Effectiveness section, Question 2, Column A SECTION VI– REQUIRED APPLICATION DOCUMENTS DOCUMENTS ATTACHED ATTACHMENTS DOCUMENTS LOCAL GOVERNMENT NON-PROFITS SERVING VICTIMS OF DOMESTIC VIOLENCE A Authorizing Resolution X X X B Statement of Certifications X X X ` C Certification of Local Approval N/A X X D Activity Summary X X X E Need for Funds and Certification Documentation X X X F HMIS or Comparable Database Reports X X X G Cost Efficiency X X X H Incorporation Documents N/A X X I Site Control (Emergency Shelter Applicants X X X J Payee Data Record X X X
esg-2016-application.docx