Service Type Name the key staff person or Provider of Service Applied for (Note that for ESG eligibility, services must outside organization in this be to emergency shelter or street “related responsible for providing application? All services provided by Applicant outreach.” each service Outside applicant or partners are not expected to be or staff Agency ESG-eligible!) member OUTPATIENT HEALTH Yes f. SERVICES If yes, describe: g Yes CHILD CARE If yes, describe: h Yes MENTAL HEALTH SERVICES If yes, describe: Yes LEGAL SERVICES i. If yes, describe: TRANSPORTATION FOR Yes HOUSING SEARCH, j. EMPLOYMENT, HEALTH CARE If yes, describe:
Applied for in this application? Service Type (Note that for ESG eligibility, services must be “related to emergency shelter or street outreach.” All services provided by applicant or partners are not expected to be ESG-eligible!) Name the key staff person or outside organization responsible for providing each service Provider of Service Applicant or staff member Outside Agency f. Yes OUTPATIENT HEALTH SERVICES If yes, describe: g Yes CHILD CARE If yes, describe: h Yes MENTAL HEALTH SERVICES If yes, describe: i. Yes LEGAL SERVICES If yes, describe: j. Yes TRANSPORTATION FOR HOUSING SEARCH, EMPLOYMENT, HEALTH CARE If yes, describe:
fy-18-chf-emergency-shelter-application.docx