County: Contract #: Contact Person: Telephone Number: - - Number of Total Total Dollar Service Being Provided Unit of Service Projected Number of Amount Allocated Families Units Emergency Food Meal Shelter Bed Nights Motel/Hotel Bed Nights Case Management Cases Served Prevention-- Rent Payment Rent Prevention-- Mortgage Payment Mortgage Prevention-- Utility Payment Utility Prevention— Security Payment Security Deposit Prevention— Other Service (Specify) Prevention— Other Service (Specify)
County: Contract #: Contact Person: Telephone Number: - - Service Being Provided Unit of Service Total Dollar Amount Allocated Number of Projected Families Total Number of Units Emergency Food Meal Shelter Bed Nights Motel/Hotel Bed Nights Case Management Cases Served Prevention-- Rent Rent Payment Prevention-- Mortgage Mortgage Payment Prevention-- Utility Utility Payment Prevention— Security Deposit Security Payment Prevention— Other Service (Specify) Prevention— Other Service (Specify)
fy15_ha_renew.docx