North Carolina Coalition to End Homelessness

PO Box 27692
Raleigh, NC 27611
Tel: 919-755-4393

BoS HUD Application Intent Form 2011

This form is for agencies that intend to apply for HUD CoC funding in the 2011 cycle. Please answer all of the questions. If you have any questions, please contact NCCEH at 919-755-4393.

Name of Organization*
Counties Served by Your Agency*
Contact Person*
Title*
Street Address*
City*
State*
Zip Code*
Phone Number*
Email Address*
Agency Website
This project is*
If the project is a renewal project, what is the project name/grant number?
Interested in applying for:
SHP = Supportive Housing Program
What general population will your program serve?*
Does your program plan to serve the following subpopulations?
Approximate funds request to HUD ($ amount):*
Agency Match ($ of match funds):*
Total Project Budget (HUD $ Request + Agency Match $):*
Project budget is expected to include: *
What Regional Committee of the Balance of State do you belong to?*
Do you, or someone in your agency, attend Regional Committee meetings?*
Does your agency currently operate a CoC-funded grant?*

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