City/Cities: County/Counties: a next to the targeted population “X” Persons with physical or development Persons with mental impairments ☐ ☐ disabilities The elderly ☐ ☐ ☐ ☐ LEVEL 1 SERVICES = 1 Point per Service (up to 3 services for points = total 3 points possible) Tenant Investment Plan Services & Description Service Brief Description of On-Site/ Distance from Service Provider Service Off-Site Development Food Pantry Referral ☐ Clothing Pantry ☐ Referral 2-1-1/ Information & ☐ Referral Smoking Cessation ☐ Discount Program ☐ Coupons to ☐ Public/ Private Facilities Blood Pressure ☐ Screening Stress Management ☐ Quarterly Resident ☐ Meetings Holiday Events ☐ Recycling Program ☐ Resident Liaison ☐ Residents Association ☐
City/Cities: County/Counties: a “X” next to the targeted population Persons with physical or development disabilities ☐ Persons with mental impairments ☐ The elderly ☐ ☐ ☐ ☐ LEVEL 1 SERVICES = 1 Point per Service (up to 3 services for points = total 3 points possible) Tenant Investment Plan Services & Description Service Brief Description of Service On-Site/ Off-Site Distance from Development Service Provider ☐ Food Pantry Referral ☐ Clothing Pantry Referral ☐ 2-1-1/ Information & Referral ☐ Smoking Cessation ☐ Discount Program ☐ Coupons to Public/ Private Facilities ☐ Blood Pressure Screening ☐ Stress Management ☐ Quarterly Resident Meetings ☐ Holiday Events ☐ Recycling Program ☐ Resident Liaison ☐ Residents Association
Appendices_to_the_IHCDA_2013_HOME_Application.docx