FISCAL YEAR 2009-10
Request for Funding

The following format is designed to be used by entities to apply for
project funding through the City of Dearborn's U. S. Department of
Housing and Urban Development (HUD) funding.

Please complete a separate application for each proposed use of funds.
To be assured that your project request receives consideration, you must
provide all information requested (if applicable). Information should be
provided in a manner that is concise and complete. Number each section
of your application to cross-reference it the related section of this
Request for Funding outline. [Organizations completing an application
for more than one project need to complete Section I only once.]

Applications are due on or before December 19, 2008 to the
Economic and Community Development Department, 13615 Michigan Avenue- Suite, Dearborn, Michigan 48126-3582. (Please submit two copies of each.)

Section I. Agency Description

1. Name and Address(es) of Agency.

2. Employer I.D. Number.

3. Contact Person and Phone Number.

4. Board of Directors.

5. Organization Chart.

6. General description of the organization as a whole. (Be sure to
include a description of all services and work products, clientele, and
service areas.)

7. Agency Audit Cycle. Please enclose a copy of the most recently
completed audit report.

8. Historical Financial Data. Provide financial statements
detailing the agency's revenues and expenditures for the past three (3) years. (Agencies that submitted this information last year need to
submit information for the most recent year only.)

9. Operational Budget. Provide a copy of the operational budget
for the agency's current and upcoming fiscal years.

10. Describe any programs or services that have been added or deleted in the past year.

11. Describe and document any anticipated increases or decreases from other funding sources.

12. Does your agency or your parent organization manage publicly
funded systems of care (such as substance abuse, mental health,
incarceration, or foster care) designed to provide residential based
services? If yes,

A. What is the average length of stay for these residential
services? What is the maximum length of stay?

B. Provide written documentation of your discharge planning
methods.

To be eligible for funding consideration, for residential care services
of 120-days or more, the discharge policy must include (at a minimum) counseling and referral services that begin not less than two-weeks prior to discharge.

13. (Homeless Shelters only) Describe agency actions
taken to involve homeless individuals and families in constructing,
renovating, maintaining and operating shelter facilities and in
providing services for the occupants of these facilities.

Section II. Proposed Project Description

1. Describe the project for which you are requesting funds.

2. Does the proposed project finance a new service, a quantifiable
increase over existing service levels (provide data), or is it a
continuation/enhancement of existing services?

3. What other area agencies provide this service? Why is your
organization better suited to provide this service?

4. Who will benefit from this project? What percentage of the
beneficiaries are Dearborn residents? What percentage of those Dearborn residents served are considered low income (identify source of data)? How is income status determined?

5. Why is the proposed project needed? How does it serve the
community? (Please give short and long term results.)

6. Does the project have a waiting list? Is there an identifiable
un-served population in need of this project? Does this proposal
increase the agency's capacity to meet those needs?

7. Identify specific numeric goals/accomplishments that will be
achieved by the proposed project. If applicable, goals should be stated as the number of Dearborn persons or households to be served (each person or household may be counted once only.)

8. In addition to the numeric goals/accomplishments identified
above, please identify the desired outcomes of your project/program.
(Outcomes typically relate to a change in conditions, status, attitudes, skills, knowledge, or behavior.) How will you measure your success at achieving the identified outcomes?

9. Will the project result in the subsequent elimination or
alleviation of the need addressed by the proposed project (such as the placement of a homeless person/household into permanent housing)? If so, identify numeric goals and timetable for achievement. Please highlight any segments of the project designed to assist low-income persons to increase their income or self-reliance.

10. How will the proposed project be managed/administered? What are the qualifications of the person responsible for its implementation? Attach resumes of program administrator(s) and fiscal officer(s).

11. For all employment opportunities financed in whole or in part
through this proposal, what efforts will be made to ensure that new or turnover job opportunities are afforded to low income persons?

12. Will the proposed project be implemented if this proposal does not receive funding (or receives a reduced level of funding)? How?

Section III. Proposed Project Budget

1. Identify the proposed project schedule: all projects to commence
between August 1, 2009 and March 1, 2010.

2. Enclose a line item project budget. If the proposed project is
funded from multiple sources, the line item budget must reflect the
total program with a budget breakdown by funding source. [NOTE: Homeless activities, funded through the Emergency Shelter Grant, require a minimum one-to-one match. Affordable housing activities, funded through HOME require a minimum one-to-four match. Please identify the source and amount of funds to be pledged as match.]

3. If your proposal includes a request to fund personnel costs,
what is the total salary and fringe benefit package (identify all
funding sources) for the budgeted personnel (current and past two
years)?

4. If your budget request is based upon a fee for service, please
provide documentation or rationale for your fee structure. Are there any other revenue sources (insurance, public assistance dollars, ...)
applied to those fees?