Agency Name: Statement of Required Qualifications Check in the appropriate box to indicate if “X” “Yes” your agency is qualified or if your agency is not “No” NOTE: Your agency must have at least three (3) years of qualified to administer this service. experience in the last ten (10) years providing the If you respond please briefly describe your “Yes”, following services to a chronically or long-term homeless agency’s experience providing this service to a population. chronically or long-term homeless population. If you respond your agency will not be “No”, considered for a Master Agreement for the FSRP. Yes No Yes-briefly describe your agency’s experience providing this service to a chronically or long-term homeless population with complex behavioral health and other needs. My agency can conduct field outreach and engagement to the target population in community based locations, health and behavioral health facilities, interim and bridge-housing settings, criminal justice and custody facilities, and other locations as needed to engage clients. My agency can assist clients with rental applications including paperwork required by property owners. My agency can assist with mental health and life skills services or referrals for these services. My agency can establish a case management plan including but not limited to establishing future goals, improvement of behaviors associated with past criminal histories, drug use, reduction in frequency and quantity of
Agency Name: Statement of Required Qualifications NOTE: Your agency must have at least three (3) years of experience in the last ten (10) years providing the following services to a chronically or long-term homeless population. Check “X” in the appropriate box to indicate “Yes” if your agency is qualified or “No” if your agency is not qualified to administer this service. If you respond “Yes”, please briefly describe your agency’s experience providing this service to a chronically or long-term homeless population. If you respond “No”, your agency will not be considered for a Master Agreement for the FSRP. Yes No Yes-briefly describe your agency’s experience providing this service to a chronically or long-term homeless population with complex behavioral health and other needs. My agency can conduct field outreach and engagement to the target population in community based locations, health and behavioral health facilities, interim and bridge-housing settings, criminal justice and custody facilities, and other locations as needed to engage clients. My agency can assist clients with rental applications including paperwork required by property owners. My agency can assist with mental health and life skills services or referrals for these services. My agency can establish a case management plan including but not limited to establishing future goals, improvement of behaviors associated with past criminal histories, drug use, reduction in frequency and quantity of
2018-012%20RFSQ%20Exhibit%20B%20-%20%20ICMS%20Provider%20SOQ%20-%20Flexible%20Supported%20Re-Housing%20Program.docx