Community Resources Management Division
The CDBG Application contains the following sections, you may select one to jump to a specific section.
| PROJECT TITLE | APPLICATION PRIORITY NO. | |
| * | (If more than one application submitted) | |
| PROPOSED LOCATION | CDBG Amount Req. | |
| (Address or specific description - attach map) | $* | |
| * | ||
| CENSUS TRACT NUMBER(S) in which project is located |
| * |
| CENSUS TRACT NUMBER(S) of service area |
| * |
3. ENTERPRISE COMMUNITY
Is your project or service area located within the Southern Nevada Enterprise Community?
Yes No * See SNEC Map
4. PROJECT DESCRIPTION Go to CDBG Application Instructions
Describe the activity for which you are requesting funds in accordance with instructions.
*
5. PROJECT OBJECTIVES
Describe the specific purpose of the project, identifying the problems the project is intended to help solve.
*
Please answer the following questions briefly describing your agency's long-range goals and planning activities, particularly for the next five years. The new Consolidated Plan will incorporate the community's five-year plan; therefore, your input will assist in the preparation of the Consolidated Plan.
(a) Does your agency plan to expand or renovate the facilities? Are there plans to build an additional facility, or to sell current inventory and rebuild or restructure your agency's facilities at another location? *
(b) Does your agency plan to increase the level of services to your clients, or to add new program services? Explain fully. *
(c) Based upon current budget revenues and expenditures, does your agency foresee a need to increase revenues in order to cover expenses, or do you anticipate that current budget needs will continue at the status quo within the next five years? * If your agency will seek to increase revenues during the next five years, please explain what activities your agency will pursue in order to obtain these increased dollars. *
(d) What are your agency's short-range goals and planning and funding activities (within the next year) that your agency anticipates will assist in meeting your previously described five-year goals? *
6. PROJECT BENEFIT Go to CDBG Application Instructions
To be eligible for CDBG funding, a project must qualify within one of the three following categories. Check the box next to the letter under which the project qualifies:
A. * Benefit to low/moderate income persons (includes elderly and handicapped) B. Prevention or elimination of slums and blight C. Urgent need
If you checked the box next to category "A," the following information must be provided:
Is your program primarily designed to serve
elderly? Yes No handicapped? Yes No homeless? Yes No abused/negected? Yes No
Does your program have income eligibility requirements? Yes No
Definition of service area (Census Tract or Block Group) Total number of benefitting persons within service area. Percentage of total low/moderate income as per HUD Census Tract or Block Group area data.
Data Source:
7. PROJECT OUTCOMES
Describe the specific benefits or improvements achieved by the participants and/or the community. Use measurable and specific outcomes to be used to monitor the project's progress. Discuss how these outcomes will be measurable and assessed.
*
8. CITIZEN PARTICIPATION
As indicated in the instructions, North Las Vegas, Boulder City, Mesquite, and unincorporated town applications must receive the endorsement of their respective board. This endorsement may be by letter, resolution, or minutes of a meeting and must be mailed with other attachments to Brian Paulson, Community Resources Management, PO Box 551212, Las Vegas, NV. 89155.
If your organization has provided for citizen participation in the preparation of your application, please provide the information below that applies to you:
A. If an incorporated city or unincorporated town, check type of endorsement mailed:
1. Minutes of meeting 2. Resolution adopted by Board 3. Letter from Board B. Did you conduct public/neighborhood meetings? YesNo
If so, list dates and location.
C. Did you conduct public hearings (formally advertised and public comment)?
YesNo
If so, list dates and location of public hearings.
9. NOT-FOR-PROFIT AND FOR-PROFIT ORGANIZATION INFORMATION
A. Provide a copy of the current Charter which legally recognizes that your group was established within Nevada Statutory guidelines. (mail in)
B. Provide evidence of financial accountability. A copy of your organization's most recent single audit report (OMB Circular A - 133) or a letter stating that you expended less than $300,000 of Federal funds and copy of your organization's most recent audit of financial statements during that reporting period. Letter should be addressed to Cynthia M. Mays, Accountant II, Clark County Community Resources Management. (mail in)
C. Provide a copy of your organization's current non-profit status. (mail in)
D. Provide a list of your organization's current board of directors.
*
E. Provide your Federal Tax Identification number.
*
F. Explain your short and long-range budgetary goals. If you plan to request additional funding from Clark County in future years, please state your plans to do so. If something else is planned, please give us that information.
*
G. How long has the organization operated this particular program for which you are now requesting funds?
*
10. RELOCATIONS
Will the proposed project involve relocation of households and/or businesses?
YesNo *
Number of households Number of businesses
Relocation will be: Temporary Permanent
11. PROPOSED PROJECT BUDGET
Administration (see instructions) |
Total Project Amount (including CDBG) |
CDBG Portion Only |
| *Salaries and fringes | $ | $ |
| Supplies | $ | $ |
| Professional Services | $ | $ |
| Travel | $ | $ |
| Utilities | $ | $ |
| Insurance | $ | $ |
| Office Equipment | $ | $ |
| Other | $ | $ |
| Other | $ | $ |
| Construction | $ | $ |
| Engineering and Design | $ | $ |
| Land Acquisition | $ | $ |
| Planning Activities | $ | $ |
| Rehabilitation Activities | $ | $ |
| Relocation | $ | $ |
| Other | $ | $ |
| Other | $ | $ |
| Other | $ | $ |
| **Indirect costs (support services such as personnel, data processing, etc.) | $ |
$ |
| TOTAL PROJECT COST | $ * | $ * |
* See following page for additional information required on this item.
** Where a cost allocation plan has been approved by a federal agency, documentation of the approved rate should be provided. (mail in)
Please indicate below the total number of staff positions (including titles) which are included under the "Salaries and Fringes" portion of the Proposed Project Budget.
Also please show which positions or percentage of salary that would be reimbursed with CDBG funds.
| Position | Amount of Salary | Percentage Reimbursed with CDBG Funds |
12. COMMITTED FUNDS
Identify sources and amounts of committed funds for current program year for this project. If construction capital project, please identify funds committed in prior fiscal years.
| Source | Funding Amount | Budget Line Item Covered by Funds |
Identify gap funding sources and funds anticipated to cover project costs.
| Source | Funding Amount | Budget Line Item Covered by Funds |
13. PROPOSED REVENUE SOURCES: Please name the resource and amount of funding
| CDBG Funding Request (Clark County) |
|
| Applicant's Contribution | $ |
| Other government contributions: | |
| Federal | $ |
| Federal | $ |
| Federal | $ |
| State | $ |
| State | $ |
| State | $ |
| Local | $ |
| Local | $ |
| Private Contributions | $ |
| Other | $ |
| TOTAL PROJECT REVENUES | $* |
14. APPLICATIONS FOR OTHER CDBG MONIES
If your project services or if your project is located in an incorporated city, please answer the following:
1. Have you applied for a Federal FY 2003/2004 CDBG grant from that city?
Yes No2. If yes, please complete the following table.
Administration CDBG HOME Status of Application Amount of Request Received CDBG or HOME in past? If yes, provide date & amount State of Nevada $ Clark County $ Las Vegas $ N. Las Vegas $ Henderson $ Boulder City $ Mesquite $ Total $
15. INFORMATION FOR 2001 HUD CONSOLIDATED PLAN ACTION PLAN
Please provide the number of people (or housing units, businesses, etc) anticipated to be served if awarded the full amount of your grant request. Check the type of accomplishment which most closely matches your project or program. Please, check only one type of accomplishment.
|
Type of Accomplishment (Select only one) |
Number | |
| People (General) | ||
| Youth | ||
| Elderly | ||
| Households | ||
| Elderly Households | ||
| Businesses | ||
| Organizations | ||
| Housing Units | ||
| Public Facilities | ||
| Square Feet of Public Facilities | ||
16. ATTACHMENT INFORMATION
1. Current proof of non-profit status, as registered with the Internal Revenue Service (IRS). 2. A copy of your organization's most recent single audit report (OMB Circular A-133) or a letter stating that you expended less than $300,000 of Federal funds and a copy of your organization's most recent audit of financial statements during that reporting period. Letter should be addressed to Cynthia M. Mays, Accountant II, Clark County Community Resources Management. 3. A list of your organization's current board of directors. 4. A financial plan for ongoing agency support, for organizations established within the last three years. 5. Current corporate charter showing status-in-good-standing with the State of Nevada Secretary of State's Office. 6. Provide Federal Tax Identification number.
Print, sign and mail the "Applicant Certification" that appears once you have pressed the "Send Form" button in addition to the applicable attachments.
Please mail the requested information to:
CYNTHIA M. MAYS COMMUNITY RESOURCES MANAGEMENT P.O. BOX 551212 LAS VEGAS, NV. 89155
Failure to comply with any of the above items may be reason to deny and return applications.
17. SUPPLEMENTARY STANDARD QUESTIONS
1. Should your agancy not receive CDBG funds, how would this affect your program operation?
*2. Is your agency reliant on Clark County CDBG funds for program survival?
Yes No *3. If yes, how many years do you expect your agancy to be reliant on CDBG funding to support your program operation in the future should your agency receive funds?
*4. Should your agency not receive full funding, please tell us if it is practical to continue program operations and what would be your service levels at 75 percent, 50 percent, and 25 percent of your current request.
*
