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HomeMy WebLinkAbout2021-2022 Annual Action Plan Substantial Amendment to Receiv 2000 Main Street. Huntington Beach, CA 92648 9 City of Huntington Beach ht»og�O✓ED6_ / (PE7Q-_eSDN —NO) File #: 22-27U MEETING DATE: 4/19/2022 REQUEST FOR CITY COUNCIL ACTION SUBMITTED TO: Honorable Mayor and City Council Members SUBMITTED BY: Sean Joyce, Interim City Manager VIA: Ursula Luna-Reynosa, Director of Community Development PREPARED BY: Charles G. Kovac, Housing Manager Subject: 2021-2022 Annual Action Plan Substantial Amendment to receive $2.2 million HOME Investment Partnerships - American Rescue Plan (HOME-ARP) funds to address housing and homelessness - adopt Resolution No. 2022-18 Statement of Issue: The City of Huntington Beach will be receiving $2.2 million from the federal American Rescue Plan Act of 2021 appropriations to the HOME Investment Partnerships program (HOME-ARP). HOME- ARP funds must be used to address affordable housing, homelessness, and homeless supportive services. Similar to the City's annual allocation of HOME funds intended to increase the supply of affordable housing for low-income residents, HOME-ARP funds are allocated to address homelessness in the context of the COVID-19 pandemic. In accordance with HOME-ARP funding requirements, the City has prepared an Allocation Plan in a prescribed format that identifies a needs assessment through public participation and consultation with local organizations. The Allocation Plan also identifies how the funds will be used to address the needs of the qualifying populations for housing, shelter, homeless assistance, and homeless prevention services. As described in the Allocation Plan, the City expects to use the HOME-ARP funds to provide supportive services at two projects (the Navigation Center and the HB Oasis Homekey project) for homeless persons in Huntington Beach and the surrounding areas. The Allocation Plan must be considered by the City Council as a Substantial Amendment to the 2021- 22 Annual Action Plan at a public hearing. Once approved and authorized for submission to U.S. Department of Housing and Urban Development (HUD), the Allocation Plan will be reviewed by HUD for its approval. Financial Impact: The City will receive $2,240,675 in HOME-ARP funds for Navigation Center and HB Oasis Homekey operations as identified in the Allocation Plan. Approval of the 2021-2022 Annual Action Plan Substantial Amendment integrating the Allocation Plan and HOME-ARP funding activities will not City of Huntington Beach Page 1 of 4 Printed on 4/142022 Dowe,420 Le slay File #: 22-270 MEETING DATE: 4/19/2022 impact the General Fund. Future Navigation Center operating expenses will also be funded through a combination of SB2, CDBG and General Fund revenues. As homeless and behavioral health services continue to expand through the region, staff is continually monitoring future grant opportunities that are expected to become available. The use of HOME-ARP funds for Year 5 operating expenses for the HB Oasis Homekey program was conditionally approved by the City Council on December 1 , 2021 based on the following contingencies: I) successful acquisition of the site by the Developer or Count: 2) receipt of sufficient County operating funding (or another non-City lunding source) to cover operating costs for years one through four in the amount of S4.92 million; and 3) award of'$15.66 million of Homekev grant funds as calculated and approved from HCD. The property is under contract with a closing target date ofJune I, 2022, the County Board of'Supervisors approved S4.92 million for the project and I-ICD has awarded S 15.66 million contingent on execution of'all agreements. Recommended Action: A) Conduct a public hearing; and, B) Adopt Resolution No. 2022-18, "A Resolution of the City Council of the City of Huntington Beach Approving a 2021-2022 Annual Action Plan Substantial Amendment to Integrate the HOME-ARP Allocation Plan"; and, C) Authorize the submittal of the Allocation Plan to HUD for review and approval; and, D) Authorize the City Manager or their designee to execute all necessary related documents. Alternative Action(s): Do not approve the 2021-22 Annual Action Plan Substantial Amendment as presented and direct staff accordingly. This action may contradict the City's adopted 2020-2025 Consolidated Plan, including the Needs Assessment Survey component of this document. The City Council may choose to modify any of the funding recommendations for HOME-ARP projects and programs within the aggregate funding limit of $2,240,675. Analysis: On March 11 , 2021 , President Biden signed the American Rescue Plan Act 2021 into law, which provided over $1 .9 trillion dollars in relief to address the continued impact of the COVID-19 pandemic on the economy, public health, state and local governments. individuals, and businesses. Congress appropriated $5 billion dollars of these funds to be administered through the HOME program. HUD has allocated $2,240,675 of these funds, through formula allocations. to the City of Huntington Beach for activities that provide housing, services, and shelter to primarily benefit qualifying individuals and families who are homeless, at risk of being homeless, or in other vulnerable populations. Eligible HOME-ARP activities include: 1. Development and support of affordable housing City of Huntington Beach Page 2 of 4 Printed on 4/14/2022 powerf52:y Leg,Var-' File #: 22-270 MEETING DATE: 4/19/2022 2. Tenant-based rental assistance 3. Provision of supportive services 4. Acquisition and development of non-congregate shelter units The HOME-ARP program allows local jurisdictions to use up to 15 percent of the allocation for planning and administration and the remaining balance for program activities. On September 22, 2021 , the City entered into a Grant Agreement with HUD for HOME-ARP funds and began developing an Allocation Plan. The Allocation Plan must describe how the City intends to distribute the HOME-ARP funding and include public participation, an assessment of unmet needs of each qualifying population, and an assessment of gaps in housing and shelter inventory, homeless assistance and services, and homelessness prevention services. Public Participation & Community Needs Assessment For the public participation and community needs assessment, the City conducted an in-depth and collaborative effort to consult with various stakeholders including the Orange County Continuum of Care, the Fair Housing Foundation, National Association for the Advancement of Colored People-Orange County (NAACP-OC), Families Forward, Homeless United, the City's Homeless Outreach Program and Senior Center, Mercy House, Robyne's Nest, South County Outreach, and Standup for Kids to find out what they felt are the priority needs of their clientele (homeless persons, veterans, elderly persons, persons with disabilities, and victims of domestic violence). This outreach concluded that most pressing need is for affordable rental housing, tenant based rental assistance, and various wrap around homeless services, such as employment and job training, mental health services, and transportation. The City also consulted with 63 homeless persons who reported affordable housing, transportation, homeless prevention, housing counseling, and case management as a significant need. Overall, the outreach found that the highest need for the qualifying populations in Huntington Beach was for additional affordable housing with wrap-around supportive services. A decent and affordable place to live, coupled with supportive services, helps homeless and those at risk of homelessness by freeing them from physical and mental hardships and placing them on a path of new opportunity and increased confidence and self -reliance. Proposed Alloccnion Plrrn Huntington Beach HOME-ARP funds are recommended to be used at hvo major homeless endeavors in the City. First, S385,971 is reconunended for supportive services at the City's Navigation Center, located at 17631 Cameron Lane. The operator of the emergency homeless shelter is Mercy House, a local non-profit agency that offers clients supportive services including housing placement services, life skills, health care resources, employment referrals, crisis evaluation/mental health resources, and druJalcohol treatment. I-or the second program, S1,804,704, is recommended for supportive services at the upcoming 1-Iuntington Beach Oasis Homekey project, an interim non-congregate transitional housing facility, located at 17251 Beach Boulevard (currently a Quality but & Suites) that in the future will convert to permanent supportive housing when HUD voucher funding becomes available through the County. The City Council conditionally approved this funding at its December I, 2021 meeting. This Homekey project is being developed in partnership with American Family Housing, National CORE, and the County ofOranve. City of Huntington Beach Page 3 of 4 Printed on 4/14/2022 pcwert522 Legistar f° File #: 22-270 MEETING DATE: 4/19/2022 The balance of HOME-ARP in the amount of S50,000 is recommended for administration costs for preparation of the Allocation Plan and implementation of the HOW-ARP program activities. The proposed administration costs represent only two percent of the total HOME.-ARP funding, which is significantly less than the allowable 15 percent. Per l-IOMF.,-ARP guidelines, upon City Council approval of the proposed Allocation Plan and following a minimum 15-day public review period, the plan will be integrated into the 2021-2022 Annual Action Plan, which was approved by the City Council on April 19, 2021. A public notice was published in Tile Iflave on March 31, 2022 for the public review period from April I through April 19 and for the City Council public hearing on April 19. The proposed Allocation Plan is included as Attachment I and the adopting resolution for the City Council to consider is included as Attachment 2. Environmental Status: Pursuant to CEQA Guidelines Section 15378(b)(4), government fiscal activities that do not result in a physical change in the environment, and do not commit the lead agency to any specific project, do not constitute a project. Therefore, these activities are exempt in accordance with CEQA Guidelines Section 15060(c)(3). Since federal dollars are being used for the proposed HOME-ARP activities, National Environmental Policy Act (NEPA) compliance will be required prior to execution of a funding agreement and disbursement of funds. The City has completed all NEPA Compliance for the approved HOME-ARP funding activities. Strategic Plan Goal: Economic Development & Housing Attachment(s): 1. City of Huntington Beach HOME-ARP Allocation Plan 2. Resolution No. 2022-18, "A Resolution of the City Council of the City of Huntington Beach Approving a 2021-2022 Annual Action Plan Substantial Amendment to Integrate the HOME- ARP Allocation Plan." City of Huntington Beach Page 4 of 4 Printed on 4114/2022 nowere523 Leps;ar" CITY OF HUNTINGTON BEACH HOME-AMERICAN RESCUE PLAN (ARP) ALLOCATION PLAN FY 2021/22 Draft for Public Review April 1 — April 19, 2022 CITY OF HUNTINGTON BEACH COMMUNITY ENHANCEMENT DIVISION 2000 MAIN STREET, 5T" FLOOR HUNTINGTON BEACH, CA 92648 524 CITY OF HUNTINGTON BEACH FY 2021/22 HOME-ARP ALLOCATION PLAN TABLE OF CONTENTS Consultation .................................................................................................. 1 Public Participation........................................................................................ 6 Needs Assessment and Gap Analysis..............................................................8 Proposed HOME-ARP Activities.................................................................... 22 HOME-ARP Production Housing Goals ......................................................... 24 Preferences.................................................................................................. 25 HOME-ARP Refinancing Guidelines.............................................................. 26 APPENDIX A. HOME-ARP CERTIFICATIONS B. SF424 APPLICATION FOR FEDERAL ASSISTANCE C. SF424-B ASSURANCES — NON-CONSTRUCTION PROGRAMS D. SF424-D ASSURANCES — CONSTRUCTION PROGRAMS E. PROOF OF PUBLICATION F. SERVICE PROVIDER QUESTIONNAIRE RESPONSES G. HOMELESS QUESTIONNAIRE RESPONSES 525 CITY OF HUNTINGTON BEACH HOME-ARP Allocation Plan CONSULTATION Before developing its plan, a Participating Jurisdiction(PJ or PJs)must, at a minimum, consult with the Continuums of Care (Co Cs)serving the jurisdiction's geographic area, homeless and domestic violence service providers, veterans'groups, public housing agencies (PHAs), public agencies that address the needs of the qualifying populations, and public or private organizations that address fair housing, civil rights, and the needs of persons with disabilities. State PJs are not required to consult with every PHA or CoC within the state boundaries; however, local PJs must consult with all PHAs (including statewide or regional PHAs) and CoCs serving the jurisdiction. Summarize the consultation process. Consultation played a vital role in the development of this HOME-American Rescue Plan (HOME- ARP) Allocation Plan ("Plan"). To develop this Plan, the City of Huntington Beach launched an in- depth and collaborative effort to consult with the local Orange County Continuum of Care, City departments, the Orange County Public Housing Agency, and several non-profit agencies that serve homeless, at risk of homelessness, seniors, victims of domestic violence, and other qualifying population groups. Consultation included both a countywide and personal consultation meeting with the Orange County Health Care Agency, Office of Care Coordination (CoC) and distribution of both a Provider Questionnaire and a Homeless Questionnaire that collected information on service needs among the qualifying population groups. List the organizations consulted, and summarize the feedback received from these entities. Agency/Organization Type of Agency/ Consulted Organization Method of Consultation Feedback Orange County Continuum of Care Countywide Grantee Meeting on Office of Care Coordination Health Care Agency, November 17, 2021 and staff provided overview of Office of Care Huntington Beach-only HOME-ARP eligible activities Coordination consultation meeting on January and CoC consultation, 6, 2022. including PIT, HIC, and HMIS data. Various Agencies Supportive Service CoC meeting with Huntington On January 6, 2022, the Provider Beach on January 6, 2022 to following agencies attended discuss plans for HOME-ARP the one-on-one consultation projects meeting between the City of Huntington Beach and the Orange County CoC to go over Huntington Beach's proposed HOME-ARP projects.There was 11Page City of Huntington Beach FIONIE-ARP Allocation Plan 526 Agency/Organization Type of Agency/ Consulted Organization Method of Consultation Feedback no rejection to Huntington Beach's plan. The following agencies were in attendance: • ACLU Southern California (civil rights agency) • CalOptima (County- Organized Health System) • Community Action Partnership Orange County (homeless, at risk of homelessness, job and educational services, advocacy for racial equity services) • Covenant House California (transitional and rapid re- housing for transitional age youth) • Families Forward (homeless children and families TBRA and supportive service provider) • Family Solutions Collaborative (family coordinated entry system) • Family Assistance Ministries (provides assistance to homeless and at risk of i homelessness including food l and essential goods, case management, coordinated entry, emergency shelter, transitional housing, and wrap around homeless services) • Friendship Shelter (provider of homeless outreach, shelter,and housing) • Health Advocates (provider of legal, clinical, advocacy, and health recovery services) • His OC (homeless, at risk of homelessness, transitional housing, TAY support, housing navigation services) 2 1 P a g e City of Huntington Beach HOME-ARP Allocation Plan 527 Agency/Organization Type of Agency/ Consulted Organization Method of Consultation Feedback • Interval House (domestic violence services, emergency shelters, transitional housing, permanent housing, legal assistance, career development) • Jewish Federation of Orange County (emergency assistance due to COVIC19) • Mercy House (provider of homeless outreach, emergency housing, TBRA, and permanent housing) • Pathways of Hope (homeless services including food pantry, shelter, rapid re-housing, homeless prevention, and permanent supportive housing) • Orange County Community Resources (housing and community development) • Orange County Health Care Agency (homeless, children and family services) • StandUp for Kids (youth homelessness agency offering street outreach, mentoring,and housing) • Volunteers of America Los Angeles (provider of a variety of programs for all qualifying populations) Fair Housing Fair Housing Provider Questionnaire Agency assists approximately Foundation 230 Huntington Beach residents per year.Agency sees a need for tenant based rental assistance and other housing financial assistance,and a need for supportive services in the areas of mental health, outpatient health, transportation, homeless prevention, and domestic violence. 3 1 P a g e City of Huntington Beach HOi IE-ARP Allocation Plan 528 Agency/Organization Type of Agency/ Consulted Organization Method of Consultation Feedback Families Forward (FF) Developer/Owner Provider Questionnaire FF serves approximately 30-50 of Affordable homeless, victims of domestic Housing violence, veterans, and low- TBRA Operator income children and adults Supportive Service annually. FF indicated a need Provider for various housing options including rental housing,TBRA, and security deposit, utility, first and last month's rent,and moving assistance. Among supportive services, FF sees a need for childcare, housing search and counseling, transportation, case management, landlord/tenant liaison, and homeless prevention as most critical. Homeless United Other:Advocacy Provider Questionnaire A provider of homeless Huntington Beach advocacy, Homeless United Huntington Beach reported a significant need for: rental housing, non-congregate shelter, education services, employment assistance, housing search and counseling, legal services, life skills training, mental and outpatient health services, substance abuse treatment, transportation, housing financial assistance, and homeless prevention services. Huntington Beach Supportive Services Provider Questionnaire The Homeless Outreach Police Department— Provider Services program works with Homeless Outreach all segments of the qualifying Services populations. In assisting nearly 2,800 persons annually, the Homeless Outreach program sees a significant need for all housing option and all supportive services except for childcare, legal services, mediation,and credit repair. 4 1 P a g e City of Huntington Beach HOME-ARP Allocation Plan 529 Agency/Organization Type of Agency/ Consulted Organization Method of Consultation Feedback Mercy House Developer/Owner Provider Questionnaire Agency provides a variety of of Affordable housing options and services to Housing homeless, Veterans, elderly, TBRA Operator persons with disabilities, and Supportive Services low-income households. Provider Agency indicated a significant need for various housing Emergency Shelter options (rental, TBRA, etc.), as well as food, housing, mental health, life skills, landlord/tenant liaison, substance abuse, transportation, case management, credit repair, and homeless prevention services. NAACP-OC Civil Rights Provider Questionnaire The NAACP-OC serves all Other: Food qualifying populations and Distributor Comm. reported a significant need for food services in Huntington Beach. Robyne's Nest Supportive Service Provider Questionnaire Robyne's Nest serves Provider approximately 350-400 transitional aged youth annually. They reported a significant need for rental housing, TBRA, and other housing financial assistance. In supportive services, employment assistance, housing search and counseling, like skills training, mental health, case management, homeless prevention, and housing counseling services ranked the highest. City of Huntington Supportive Service Provider Questionnaire The Huntington Beach Senior Beach,Senior Center Provider Center assists approximately in Central Park 3,000-6,000 elderly persons each year. In their dealings with their clientele, the Senior Center has determined the most significant need for rental housing and tenant based rental assistance. 5 1 P a g e Cite of Huntington Beach HO\16-ARP Allocation Plan 530 Agency/Organization Type of Agency/ Consulted Organization Method of Consultation Feedback South County Developer/Owner Provider Questionnaire Assisting all of the qualified Outreach of Affordable populations, the South County Housing Outreach Program reported a Supportive Service significant need for rental Provider housing, non-congregate shelters, housing financial assistance, and supportive services such as childcare, employment assistance/job training, food, mental health services, outreach services, transportation, credit repair, landlord/tenant liaison, services for victims of domestic violence, and homeless prevention. StandUp for Kids Supportive Service Provider Questionnaire Agency assists homeless youth Provider characterized as either Transitional Aged Youth (TAY) or McKinney Vento. Agency reported affordable rental housing, life skills training, street outreach services, case management, other housing financial assistance (utility/security deposit assistance), and homeless prevention as the most significant needs in Huntington Beach. Persons Experiencing Homeless Persons Homeless Questionnaire The City of Huntington Beach Homelessness consulted with 63 homeless persons currently experiencing homelessness to inquire on their individual needs. The top five needs were the following: housing search services, housing counseling, homeless prevention, food, and non- congregate shelter. PUBLIC PARTICIPATION PJs must provide for and encourage citizen participation in the development of the HOME-ARP allocation plan. Before submission of the plan, PJs must provide residents with reasonable notice 6 1 P a g e City of'Huntington Beach HOME-ARP Allocation Plan 531 and an opportunity to comment on the proposed HOME-ARP allocation plan of no less than 15 calendar days. The PJ must follow its adopted requirements for "reasonable notice and an opportunity to comment" for plan amendments in its current citizen participation plan. In addition, PJs must hold at least one public hearing during the development of the HOME-ARP allocation plan and prior to submission. For the purposes of HOME-ARP, PJs are required to make the following information available to the public: • The amount of HOME-ARP the PJ will receive, • The range of activities the PJ may undertake. Describe the public participation process, including information about and the dates of the public comment period and public hearing(s) held during the development of the plan. • Public comment period:start date—04/O1/2022. end date—04/19/2022. • Public hearing: 04/19/2022. The City of Huntington Beach provided two opportunities for the public to participate in the HOME-ARP planning process. The City published a public hearing notice in the Huntington Beach Wave ("The Wave") on April 1, 2022 to notify the public of the Plan's availability for review and comment through April 19, 2022, and also to invite interested persons to the public hearing to approve the Plan scheduled for April 19, 2022. The public notice provided the following information to the public: description of the HOME-ARP program; amount of funds allocated to the City of Huntington Beach; eligible activities; and the proposed use of funds. Describe any efforts to broaden public participation. In an effort to broaden public participation in the development of the HOME-ARP Allocation Plan, the City followed citizen participation steps outlined in its Citizen Participation Plan. For public review, the Plan was made available at the following locations Monday through Friday (except for legal holidays) from 8:00 a.m. to 5:00 p.m., or otherwise during the Department's normal business hours: City of Huntington Beach Oak View Branch Library Community Enhancement Division 17251 Oak Lane 2000 Main Street, 51h Floor Huntington Beach, CA 92648 Huntington Beach, CA 92648 The Plan was also available for citizen review on the City's website at https://www.huntingtonbeachca.gov/business/economic-development/cdbg . Finally, the public was invited to participate in the April 191' public hearing in person or virtually via Zoom. 7 1 P a g e City of Huntington l3cach HOME-ARP Allocation Plan 532 A PJ must consider any comments or views of residents received in writing, or orally at a public hearing, when preparing the HOME-ARP allocation plan. Summarize the comments and recommendations received through the public participation process. [To be completed after public participation period.] Summarize any comments or recommendations not accepted and state the reasons why. [To be completed after public participation period.] NEEDS ASSESSMENT AND GAP ANALYSIS PJs must evaluate the size and demographic composition of qualifying populations within its boundaries and assess the unmet needs of those populations. In addition, a PJ must identify any gaps within its current shelter and housing inventory as well as the service delivery system. A PJ should use current data, including point in time count housing inventory count, or other data available through CoCs, and consultations with service providers to quantify the individuals and families in the qualifying populations and their need for additional housing, shelter, or services. The PJ may use the optional tables provided below and/or attach additional data tables to this template. OPTIONAL Homeless Needs Inventory and Gap Analysis Table HOMELESS DATA Current Inventory Homeless Population Family Adults Only Vets Family Adult HH (a[ HH #of #of #of #of #of least 1 (W/O Victims Beds Units Beds Units Beds child child) Vets of DV Emergency 124 4 Shelter I ME Transitional Housing 36 5 .. PermanentSupportive Housing 610 405 Other PermanentHousing heltered Homeless 50 5 1 Unsheltered Homeless --M 18 2 11 16 Current Gap Sources: 1.Point in Time Count(PIT); 2.Continuum of Care Housing Inventory Count(HIC); 3.Consultation 8 Page City of Huntington Beach HOME-ARP Allocation Plan 533 OPTIONAL Housing Needs Inventory and Gap Analysis Table NON-HOMELESS DATA Current Inventory Level of Need #of Units #of Households (Total Rental Units 32,41S I (Rental Units Affordable to HH at 30%AMI (At-Risk of '(Homelessness) 5,610 (Rental Units Affordable to HH at 30%-50%AMI (Other (Populations) 4,425 03'o-30%AMI Renter HH w/ 1 or More Severe Housing Problems 4,210 (At-Risk of Homelessness) I 30'Yo-50%AMI Renter HH w/ 1 or More Severe Housing (Problems 2,760 ((Other Populations) Current Gaps Data Sources: 1. American Community Survey(ACS); 2. Comprehensive Housing Affordability Strategy(CHAS) Describe the size and demographic composition of qualifying populations within the PJ's boundaries. HOMELESS The U.S. Department of Housing and Urban Development (HUD) requires that all Continuum of Care jurisdictions across the country complete a biennial unsheltered count and an annual sheltered count of all individuals experiencing homelessness in the community on a single point in time during the last ten days of January. Orange County's 2019 Sheltered Point in Time (PIT) Count took place the night of Tuesday, January 22, 2019, with client-level demographic information collected from all emergency shelter and transitional housing programs throughout the County. The 2019 Unsheltered PIT Count took place over two days, Wednesday January 23 and Thursday January 24, to ensure the 800 square mile county jurisdiction was canvassed effectively. Because of an improved PIT process, methodology and data quality from the use of GIS technology, the results of the 2019 PIT reflect the most accurate count of Orange County's homeless population ever. It is important to note that the PIT Count goes beyond just the physical counting of persons experiencing homelessness and, in some instances, uses a formula to extrapolate the total number of homeless present. Also important to note is that the 2021 Point in Time Count was affected by local COVID-19 restrictions; therefore, the City of Huntington Beach will be relying on 2019 counts for this HOME-ARP Allocation Plan, 9 1 P a g e City of Huntington Beach HOLvIE-ARI' Allocation Plan 534 City of Huntington Beach and Central Service Planning Area (SPA) Homeless Statistics The January 2019 PIT count enumerated 349 homeless individuals in the City of Huntington Beach. Among the 349 homeless counted, only 60 (17%) were in some kind of emergency or transitional shelter, while the remaining 289 were found to live in places not designed for or ordinarily used as a regular sleeping accommodation for human beings, including a car, park, abandoned building, bus or train station, airport, or camping ground. Most of the homeless counted, 276 (79%), were individuals, whereas 68 (19%) were part of a family. Homeless persons characterized as "transitional age youth" (18-24 years old) made up 4% (14 persons) of the homeless count in Huntington Beach. There were also 24 seniors and 17 veterans among the 349 total homeless persons counted as part of the 2019 PIT count. The 2019 PIT Report did not include specific demographic composition data for the Huntington Beach homeless population; however, Huntington Beach is one of 10 cities that make up the Central Service Planning Area (SPA).The 2019 PIT reported 3,332 homeless persons in the Central SPA — 1,827 unsheltered and 1,505 were sheltered. The homeless count was made up of 72% White, 11% Black or African American,8%that identified with Multiple or Other Races, and nearly 5% Asian persons. Additionally, 37% of all homeless persons in this count reported being of Hispanic ethnicity. Orange County Homeless Statistics According to the latest full homeless census (2019 Point in Time Count), there were 6,860 homeless persons in Orange County. Of this total, 57.74% (3,961 persons) were unsheltered and 42.26% (2,899 persons) were sheltered. The racial and ethnicity breakdown of the entire County resembled that of the Central SPA described above. White persons made up 72% of the total homeless population, 11% were Black or African American, nearly 9% are listed in the Multiple Races or Other category, and 3% were Asian. Hispanic or Latinos made up 36% of the 6,860 homeless persons. Additionally, there were 311 veterans, 275 transitional age youth (18-24 years old), and 612 seniors. Also noteworthy is the prevalence of chronic homelessness or one or more disabling conditions among adult individuals belonging to a family compared to those experiencing homelessness alone. The 2019 PIT counted a total of 5,880 adults (18+ yrs.) among the 6,860 total homeless and found that in general, disabling conditions in adults who were members of a family household were much lower than the disabling conditions experienced by individual adults that were not part of a family unit. For example, 15% of adults who were members of a family household had a substance abuse issue compared to 33% of individual adults. Also, 13%of adults who were members of a family household had a mental health issue compared to 30% of those not belonging to a family. Finally, 9% of adults in a family household fall into the Chronically Homeless subpopulation compared to 46% of individual adults. 101Page City of Huntington Beach HOME-ARP Allocation Plan 535 Adult Subpopulation and Disabling Conditions Statistics Adults in Families v. Individuals 2019 Orange County Point in Time Count Individuals Adults in Families (Not Part of a Family Unit) All Adults Unsheltered Sheltered Total Unsheltered Sheltered Total Persons Persons Persons Persons Total % % % % % Homeless 152 432 584 3,562 1,734 5,296 5,880 Persons 18+Yrs. persons persons persons persons persons persons persons Chronically 33 20 53 1,914 547 2,461 2,411 Homeless persons persons persons persons persons pe rsons persons 21.71% 4.63% 9.07% 53.73% 31.55% 46.47% 42.36% Domestic 20 86 106 331 99 430 541 Violence persons persons persons persons persons persons persons 13.16% 19.91% 18.15% 9.29% 5.71% 8.12% 9.20% Disabling Condition* Developmental 12 5 17 509 100 609 622 Disability persons persons persons persons persons persons persons 7.89% 1.16% 2.91% 14.29% 5.77% 11.50% 10.58% 2 3 5 64 36 100 106 HIV/AIDS persons persons persons persons persons persons persons 1.32% 0.69% 0.86% 1.80% 2.08% 18.89% 1.80% Mental Health 20 58 78 976 618 1,594 1,654 Issues persons persons persons persons persons persons persons 13.16% 13.43% 13.36% 27.40% 35.64% 30.10% 28.13% Physical 25 14 39 1,133 307 1,440 1,471 Disability persons persons persons persons persons persons persons 16.45% 3.24% 6.68% 31.81% 17.70% 27.19% 25.02% Substance 10 80 90 1,243 497 1,740 1,801 Abuse Issues persons persons persons persons persons persons persons 6.58% 18.52% 15.41% 34.90% 28.66% 32.85% 30.63% `Some individuals may identify with more than one subpopulation or disabling condition. In 2020 and 2021, only sheltered persons were counted in the homeless census, due to the COVID-19 pandemic. In 2020, there were 3,017 total sheltered persons, up by 118 persons from 2019. In 2021, there were 2,441 sheltered persons, down by 576 persons from 2020. This sheltered total included 1,379 individuals (one-person households), ages 18 and over. The majority of the sheltered persons were in emergency housing,as opposed to transitional housing. The drop in sheltered persons in 2021 is likely due to the closing of some emergency shelters and the opening of others in new locations, with differing requirements and capacities. AT RISK OF HOMELESSNESS To account for persons at-risk of becoming homeless, the most recent (2014-2018) Comprehensive Housing Affordability Strategy (CHAS) data was analyzed. This data contains three particular characteristics of households that meets the definition of "at risk of 111Page City of Huntington Beach HCNIE-ARP Allocation Plan 536 homelessness" found in 24 CFR Part 91.5. First, the CHAS data breaks down occupied housing units by HUD Area Median Family Income (HAMFI), including 30% and below of HAMFI. Next, the CHAS data provides information on occupied housing units with households that are severely cost burdened; that is, they are spending more than 50% of their income on housing related expenses. For renters, that includes rent and utilities. For homeowners, it includes the mortgage payment, utilities, association fees, insurance, and real estate taxes. And finally, the CHAS data contains information on housing units in which there reside more than 1.5 people per room, which is considered to be severely over-crowded. The CHAS data shows that of the 32,415 renter households in the City of Huntington Beach, 5,610 or 17% are occupied by households earning 30% or less of the HAMFI. Further, of these households, 82% (4,620) have one or more housing problems, defined as housing units that: 1) lack complete kitchen facilities; 2) lack complete plumbing facilities; 3) are over overcrowded; and 4) are cost burdened. A household is said to have a housing problem if they have any one or more of these four problems. The CHAS data shows that White households make up an overwhelming share of households that meet both criteria (earn 30% or less of HAMFI and have one or more housing problems) at 55%, with Hispanic households ranked second at 28%, and Asian households third at 11%. Black or African American households constitute 3% of these households. With regard to age, 33% of households earning less than 30%of the HAMFI and with one or more housing problems are seniors (62+ years of age). This category of seniors has a higher risk of homelessness due to the ever-increasing cost of living in California (rising housing, utility, food, and gas prices) while at the same time living on fixed incomes. Finally, the CHAS data revealed that of the 4,620 households earning less than 30% HAMFI, 77% are severely cost-burdened, and 3% are severely overcrowded. Severely cost burdened households are spending more than 50% of their income on housing related expenses, leaving the remaining 50% or less of their income available for other daily necessities such as food, gas, child and healthcare. Together, these make up 3,690 households that specifically meet the definition of"at risk of homelessness" at 24 CFR Part 91.5. 121Page City of Huntin-ton Beach HOME-ARP Allocation Plan 537 Renter-Occupied Housing Units with Households Earning<=30%HAMFI 5,610 One or More Housing Problems' 4,620 82% White 2,565 56% Black or African American 150 3% .E Asian 530 11°% w American Indian or Alaska Native 20 < 1% Pacific Islander 0 0% z Other Race/Multiple Races 80 2% Hispanic 1,275 27% Non-Elderly 3,100 67% a c 62-74 Years Old 925 20% 75+Years Old 590 13% Households with No Kitchen or Plumbing Facilities 215 5% E Households with 1.S+Persons per Room 145 3% 0 Households with 1—1.S Persons per Room 390 8% = a` Households Over 50%°Cost Burdened 3,545 77% Households 30-50%Cost Burdened 325 7% ' 1) lack complete kitchen facilities; 2) lack complete plumbing facilities; 3)are over overcrowded; and 4) are cost burdened FLEEING, OR ATTEMPTING TO FLEE, DOMESTIC VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, STALKING, OR HUMAN TRAFFICKING The City has seen a slight decline in domestic violence-related calls for assistance to the Huntington Beach Police Department. From 2011-2015, there was an average of 463 domestic violence-related calls per year while the most recent data (2016-2020) shows an average of 42S domestic violence-related calls per year (State of California Department of Justice, (https://openiustice.doi.ca.gov/exploration/crime-statistics/domestic-violence-related-calls-assistance ). The 2019 Orange County Point in Time count reported 104 homeless households living in units designated for victims of domestic violence in the Central SPA, which includes the City of Huntington Beach. Of the 104 households, one was a one-person household and the remaining 103 were households with children. The 2021 Orange County Housing Inventory Count shows no housing projects dedicated to persons fleeing, or attempting to flee, domestic violence, dating violence, sexual assault, stalking, or human trafficking in Huntington Beach or in the Central SPA. However, Interval House operates one Crisis Shelter & Center for Victims of Domestic Violence with 75 beds, and manages an additional 70 rapid re-housing beds at scattered sites throughout Orange County. 131Page City of Huntington Beach HONIE-ARP Allocation Plan 538 OTHER POPULATIONS Other Families Requiring Services or Housing Assistance to Prevent Homelessness As discussed above, the 2019 Point in Time Count reported 60 sheltered individuals in the City of Huntington Beach. Of these, five were individuals and 50 were part of a family unit (the remaining five individuals from the PIT were not identified). Additionally, of the 60 sheltered homeless, two were transitional age youth (18-24 years old), one was a senior, and one was a veteran. Race and ethnicity data was not available for these homeless subpopulations. All 60 persons were previously qualified as "homeless' as defined under 24 CFR Part 91.5 before entering temporary or emergency shelter. The fact that they reside in temporary or emergency shelter, undoubtedly makes them more vulnerable to entering homelessness again if supportive services and/or housing assistance is terminated. At Greatest Risk of Housing Instability Persons at greatest risk of housing instability are those that: 1) are earning 30% or below the HAMFI and are severely cost-burdened (paying 50% or more on housing); or 2) are earning 50% or less of HAMFI and meet one of the following conditions: 1. Has moved two or more times in the two months immediately preceding their application for homelessness prevention assistance. 2. Is living in the home of another because of economic hardship. 3. Has been formally notified of eviction within 21 days after the date of application for assistance. 4. Lives in a hotel or motel and the cost of staying at the hotel or motel is not borne by a federal, state, or local government program. 5. Lives in an over-crowded (more than one person per room) single-room occupancy (SRO) or efficiency apartment units, or lives in a severely overcrowded (more than 1.5 persons per room) larger housing unit. 6. Is exiting a publicly funded institution, or system of care (health care facility, mental health facility, foster care or other youth facility, or correction program or institution). 7. Otherwise lives in housing that has characteristics associated with instability and an increased risk of homelessness, as identified in the recipient's approved Consolidated Plan. For the first group of persons/households at greatest risk of instability, that is, they earn less than or equal to 30%of HAMFI and are severely cost-burdened, the 2014-2018 CHAS data reports that there are 6,270 households that meet this criterion. Of these, 67% or 4,210 are households that rent, making them more vulnerable to housing instability and homelessness. Information on each of the conditions listed above for the second category of persons at greatest risk of housing instability is not readily available, with the exception of data on overcrowding. The 2014-2018 CHAS data described 615 households earning 50% or less of HAMFI living in 141Page City of Huntington Beach [IONIF-ARP Allocation Plan 539 overcrowded conditions, 93% of which were renter households. Worse, the data showed an additional 320 households experiencing severe overcrowding, and 97% of them were renters. VETERANS AND FAMILIES THAT INCLUDE A VETERAN FAMILY MEMBER According to the 2019 American Community Survey (ACS), Huntington Beach currently has a population of 8,029 veterans in the city. The number of veterans that are homeless make up less than 1% (17 persons) of the veteran population, pursuant to the 2019 Point in Time Count. Of this, 94% were unsheltered and 6% were sheltered. Review of the 2021 Orange County Housing Inventory Count listed one HUD-VASH program operating in Huntington Beach providing 971 vouchers to veterans, individuals, and families. The HUD-VASH program is a partnership between the Department of Housing and Urban Development (HUD) and the Department of Veterans Affairs (VA) designed to provide case management and supportive services along with subsidized housing vouchers for eligible homeless veteran families. Describe the unmet housing and service needs of qualifying populations, including but not limited to: Sheltered and unsheltered homeless populations; Those currently housed populations at risk of homelessness; Other families requiring services or housing assistance or to prevent homelessness; and Those at greatest risk of housing instability or in unstable housing situations. According to the U.S. Department of Health & Human Services, "...poverty, unemployment, and lack of affordable housing are commonly recognized causes of homelessness. These risk factors can be exacerbated by personal vulnerabilities, such as mental and substance use disorders, trauma and violence, domestic violence, justice-system involvement, sudden serious illness, divorce, death of a partner, and disabilities." The City of Huntington Beach is no exception to this finding. As the number of homeless persons in Huntington Beach continues to increase, so does the need for additional affordable housing and supportive services aimed to move them out of homelessness and housing instability. As reported in the 2019 Point in Time Count, Huntington Beach is home to nearly 60 homeless people experiencing homelessness with shelter, and another 289 people experiencing homelessness without shelter. Further, according to the 2014-2018 Comprehensive Housing Affordability Strategy ("CHAS"), of the 32,415 renter households in the City, 52% (16,785 households) are paying the normal or expected 30% or below of their income on housing related expenses; however, that means that the remaining 48%of all renter households are experiencing some level of cost burden. The cost burdens are more serious for households with the lowest incomes (at or below 30% of Area Median Income). Of the 5,610 renter households earning less than or equal to 30%AMI,4,575 of them (82%) are cost burdened (paying more than 30%of their income toward rent), and 75% of them are severely cost burdened (paying more than 50% of their income toward rent) making them more at risk of homelessness. These significant housing cost burdens affect thousands of Huntington Beach residents, and it is critical that the City continue developing new affordable housing for people with the lowest incomes in the community. 151Page City of Huntington Beach HONIE-ARP Allocation Plan 540 According to the 2021 Orange County Housing Inventory Count, the City of Huntington Beach has 770 family beds and 414 adult-only beds, for a total of 1,184 beds within the City. While it would appear that Huntington Beach has sufficient bed capacity to meet the shelter demands of the City's homeless population, it should be noted that over 80% of these units are HUD Veterans Affairs Supportive Housing (VASH) tenant-based vouchers that are controlled and implemented by the County of Orange. These vouchers are available to veterans and their families only and are portable, meaning veteran families may use vouchers anywhere in the County; not all 971 VASH vouchers are available to Huntington Beach homeless persons and families. In fact, the 2019 PIT reported a mere 17 veteran homeless persons in the City; therefore, the vast majority of the 971 VASH vouchers available are for eligible veterans from other jurisdictions. In reality, only 213 beds are available in the City including 128 emergency shelter beds (number of beds increases to 178 without social distancing imposed by COVID-19 requirements), 41 transitional housing beds, and 44 permanent supportive housing beds. Ultimately, what this means is that there is a shortage of housing options for those that are homeless or at risk of homelessness in Huntington Beach. Despite the 213 beds in emergency, transitional, and permanent supportive housing, there remains 305 unsheltered homeless individuals, and over 4,200 renter households earning below 30% HAMA that are severely cost burdened making them at risk of homelessness. With regard to needed services, the PIT report for Orange County (information not available for Huntington Beach only) describes homeless persons as: • 36% chronically homeless • 26% with substance abuse issues • 21%with a physical disability • 24%with mental health disorders • 9%with developmental disabilities • 8% are victims of domestic violence With a variety of issues afflicting and often contributing to homelessness, as seen above, services to support the homeless is crucial for longstanding success. Case management and other housing and shelter programs can help address the root causes of homelessness through a range of essential support services, including childcare, mental and substance abuse treatments,domestic violence advocacy, employment training, and other wrap around services. As was learned from the consultation process, many of these services are already being carried out throughout the community. However, when offered in tandem with housing in a streamlined process, the chances of success are increased. Referring once again to the U.S. Department of Health & Human Services website, it is reported that "research suggests that intervention services to prevent homelessness is more cost effective than addressing issues after someone is already homeless. The longer a person is homeless, the harder and more expensive it becomes to re-house this person." In that vein, services such as 161Page City of Huntington Beach HO\qE-ARP Allocation Plan 541 rapid re-housing, providing food support, childcare, benefits advocacy, veteran's services, rental and/or utility assistance, security deposit assistance, and trauma or domestic violence support systems, can be very beneficial to prevent homelessness in the first place. Identify and consider the current resources available to assist qualifying populations, including congregate and non-congregate shelter units, supportive services, TBRA, and affordable and permanent supportive rental housing. The City of Huntington Beach is a recipient of the annual Community Development Block Grant (CDBG) and HOME Investment Partnership Act Program (HOME). Together, the City receives approximately $1.9 million from these entitlement programs to address affordable housing and low- and moderate-income community development needs. Additionally, the City received a special allocation of CARES Act CDBG in 2019 as a response to the COVID-19 pandemic in the sum of almost $2.16 million. Huntington Beach uses it's federal funding on a variety of projects and programs that serve the qualifying populations already. For example, HOME funds are used to provide 50 lower income households a year with tenant based rental assistance (TBRA). TBRA is targeted specifically to homeless persons, persons at risk of homelessness, victims of domestic violence, and veterans. HOME will also be used to help fund a 43-unit affordable, permanent supportive housing development for seniors. Many of the recipients of TBRA and affordable housing units would likely enter homelessness without the financial assistance they are receiving from the City. The CDBG program funds several supportive services for qualifying populations, as well. For example, the Cameron Lane Navigation Center, an emergency homeless shelter offering onsite services including benefits and document, employment, substance use and recovery, education, mental health, self-care, housing navigation, and physical health services is currently being funded with CDBG and CARES Act funding. So necessary are these supportive services to the successful transition to housing stability and overall health, that the City is proposing to use HOME-ARP to fund additional supportive services at the Navigation Center. Recipients of these services are the homeless, persons at risk of homelessness, victims of domestic violence, veterans, and other qualifying populations. CDBG also helps to support local programs, such as Stand Up for Kids Street Outreach, which provides wrap-around support aimed at moving youth facing homelessness into safe and stable housing. Youth are assessed for their immediate needs and provided with food, clothing, hygiene products, and transitional housing as needed. Youth are then linked with a volunteer mentor who assists the youth to create a pathway to self-sufficiency and to obtain safe and stable housing. This pathway can include assistance, job search and resume strategies, household and budget management, and home-finding assistance. The City's General Fund is also an important funding source to assist the qualifying populations. The General Fund is currently being utilized to support the City's Homeless Task Force, comprised of Case Managers and Homeless Liaison Officers.The Task Force works collaboratively to connect 171Page City of Huntington Beach FIOME-ARP Allocation Plan 542 individuals experiencing homelessness or at risk of homelessness with resources to help them navigate the barriers they face in maintaining stable housing. Resources include, but are not limited to, shelter, reunification with family members, mental and physical health services, addiction services, social services, and government benefits. Be Well Huntington Beach is a Mobile Crisis Response Team also funded bythe City of Huntington Beach and staffed by Be Well OC to provide 24/7 community-based assessment and stabilization of individuals experiencing psychological crisis, challenges related to substance abuse, and other non-medical emergency challenges. Each team consists of two crisis counselors who deescalate a situation and provide a compassionate response to those experiencing a mental health crisis in their homes, on the streets or at a public location. Finally, the City of Huntington Beach has an Affordable Housing Program consisting of multifamily apartment complexes throughout the City that include affordable units. The City has agreements with the owners of these units to maintain rents at levels below regular market rent rates. In total, the City currently has a portfolio of 2,467 rental units affordable to households at various levels: • 8 units affordable to extremely low-income households • 899 units affordable to very low-income households • 543 units affordable to low-income households • 25 units affordable to median income households • 326 units affordable to moderate (up to 120%AMI) income households Affordable and permanent supportive housing developments in Huntington Beach have long wait lists for entry.The Orange County Coordinated Entry generally assesses thousands of people each year, and offers housing to a small fraction. With 350 people experiencing homelessness and thousands more experiencing rental cost burden, additional affordable and permanent supportive housing is desperately needed for all of the qualifying populations. The 2021-2029 Regional Housing Needs Allocation (RHNA) for the City of Huntington Beach echoes this sentiment. The RHNA reports that the City of Huntington Beach has a total housing need of 13,368 units. From this allocation, the RHNA designates: • 3,661 units affordable to very low-income households • 2,184 units affordable to low-income households • 2,308 units affordable to moderate-income households • 5,215 units affordable to above moderate-income households Identify any gaps within the current shelter and housing inventory as well as the service delivery system. As presented earlier in this Plan, the number of individuals and families that meet the criteria of a qualifying population under the HOME-ARP guidance exceeds the number of available units to house them. The City has 349 homeless individuals when last counted in 2019, 289 that are 181Page Cite of Huntington Beach HOME-ARP Allocation Plan 543 unsheltered and 60 that are sheltered. The number of homeless reveals the need for additional housing units, along with services to support them. Moreover, the thousands of renter households that are both living in poverty and are severely cost burdened or severely overcrowded are indications of the serious deficit of homes affordable and available to all of the qualified populations, including victims of domestic violence and veterans.This housing shortage in Huntington Beach demonstrated above by the CHAS and RHNA data, shows the dire need for additional homeless housing opportunities including emergency shelters, permanent supportive housing, and non-congregate shelter options, including through opportunistic acquisitions of existing multifamily buildings, hotels, and motels. The City distributed 20 Provider Questionnaires to local service agencies that provide a variety of services ranging from homeless services, affordable housing, street outreach, fair housing, civil rights, and tenant based rental assistance, among other services. Ten agencies responded to the questionnaire. In addition, the City conducted a similar questionnaire with individuals who were experiencing homelessness and received 63 responses. Providers were asked what they perceived to be the services that the homeless community significantly needed. Individuals experiencing homelessness were directly asked what services they significantly needed. The tables below show how each service ranked by respondents. As seen in the Results of Service Provider Questionnaire table below, affordable rental housing, housing financial assistance, and homeless prevention services ranked first among all of the services and programs listed on the questionnaire with 80% of respondents identifying these as having the most significant need among their clientele. Tenant based rental assistance, employment assistance/job training, mental health services, and transportation ranked second with 60% of respondents marking these as being significantly needed in Huntington Beach. Housing search and counseling, life skills training, and case management were the third most popular responses among service providers. Results of Service Provider Questionnaire Rank Service Affordable Rental Housing 1 Housing Financial Assistance (security deposits, utility assistance, moving costs,first and last month's (80%) rent) Homeless Prevention Services Tenant Based Rental Assistance(TBRA) 2 Employment Assistance/Job Training (60%) Mental Health Services Transportation 3 Housing Search and Counseling Services (50%) Life Skills Training Case Management Food 4 Outpatient Health Services (40%) Outreach Services Landlord/Tenant Liaison 5 Non-Congregate Shelter (30%) Substance Abuse Treatment Services Services for Victims of Domestic Violence/Dating Violence/Sexual Assault/Human Trafficking 191Page City 01'Huntington Beach HOME-ARP Allocation Plan 544 6 Childcare (20%) Education Services Housing Counseling 7 Legal Services (10%) Credit Repair 8 (0%) Mediation Similar to the responses received from service providers, the 63 homeless persons that provided completed questionnaires agree that their most significant needs are for affordable rental housing (84% of respondents), tenant based rental housing (84%), housing search and counseling services (73%), transportation (62%), housing financial assistance (63%), homeless prevention (63%), housing counseling (62%), and case management (60%). However, while providers ranked employment assistance/job training, mental health services, and life skills training among the top three significant needs, these services were only ranked in 5`h and 6th place by homeless persons. Specifically, 44% of homeless respondents felt mental health services were significantly needed, and even less, 32%, reported employment assistance/job training and life skills training were in significant need. Results of Homeless Questionnaire Rank Service 1 Affordable Rental Housing (80+%) Tenant Based Rental Assistance 2 Housing Search and Counseling Services (70+%) Transportation Housing Financial Assistance(security deposits,utility assistance, moving costs, first and last month's 3 rent) (60+%) Homeless Prevention Housing Counseling Case Management 4 (50+%) Food 5 Non-Congregate Shelter (40+%) Mental Health Services Employment Assistance/Job Training Life Skills Training 6 Outpatient Health Services (30+%) Outreach Services Credit Repair Landlord/Tenant Liaison Education Services 7 Legal Services (20+y,) Substance Abuse Treatment Services Mediation Services for Victims of Domestic Violence/Dating Violence/Sexual Assault/Human Trafficking 8 (10+%) Childcare 201Page City of Huntington Beach HOME-ARP Allocution Plan 545 Identify the characteristics of housing associated with instability and an increased risk of homelessness if the PJ will include such conditions in its definition of "other populations" as established in the HOME-ARP Notice. Housing associated with instability and an increased risk of homelessness are those that 1) are occupied by persons earning 30% or below the HAMFI and are severely cost-burdened (paying 50% or more on housing); or 2) inhabit persons that are earning SO% or less of HAMFI and are severely overcrowded (living with 1.5 or more persons per room). Households meeting these definitions tend to live in housing with deferred maintenance and are in need of rehabilitation. Identify priority needs for qualifying populations. Without a doubt, analysis of the 2019 Point in Time Count, CHAS data, American Community Survey data, and consultation with the various agencies conducted as part of this Plan reveal the need for more affordable housing and housing-related supportive services. People without homes, need homes. The high and rapidly escalating housing costs combined with the COVID-19 pandemic and economic displacement in Orange County creates harmful instability for the qualified populations. It is difficult for members of the qualified populations to find affordable housing of any kind in Huntington Beach. Personal needs and challenges become exponentially worse if you are in poverty, or worse, homeless. Investing in transitional housing and non- congregate shelters allows services to be accessed and for individuals to begin to recover. Explain how the level of need and gaps in its shelter and housing inventory and service delivery systems based on the data presented in the plan were determined. The City of Huntington Beach analyzed several data sources to determine the needs and gaps in the City's shelter and housing inventory and in the service delivery systems. First, the City extracted Huntington Beach-specific data, Central SPA data, and Orange County data from the 2019 Orange County Point in Time Count. The PIT provided valuable data on the number of sheltered and unsheltered homeless, families and individual homeless persons, and transitional aged youth, senior, and veteran homeless persons. Further, data on the number of homeless persons fleeing domestic violence was provided on a countywide basis. Next, the City accessed data from the Comprehensive Housing Affordability Strategy ("CHAS"). CHAS data is provided annually from the U.S. Department of Housing and Urban Development (HUD) and includes custom tabulations of American Community Survey (ACS) data from the U.S. Census. The data demonstrates the extent of housing problems and needs, particularly for low- income households. CHAS data was used by Huntington Beach to determine housing tenure by the various income levels, the number of households experiencing cost burden and/or overcrowded conditions, race and ethnicity statistics of extremely low-income households, and other data needed to characterize households at risk of homelessness. 211Page City of luntington Beach HOME-ARP Allocation Plan 546 Third, the City retrieved data from the City's 2020-2024 Consolidated Plan, the Regional Housing Needs Allocation (RHNA), and the Orange County Housing Inventory Count to gather information on housing needs, current housing available in Huntington Beach, and current service programs offered with federal funding. Finally, the City consulted with various stakeholders including the Orange County CoC, the Fair Housing Foundation, NAACP-OC, Families Forward, Homeless United, the City's Homeless Outreach Program and Senior Center, Mercy House, Robyne's Nest, South County Outreach, and StandUp for Kids to find out what they felt are the priority needs of their clientele (homeless persons, veterans, elderly persons, persons with disabilities, and victims of domestic violence). The most pressing need is for affordable rental housing, tenant based rental assistance, and various wrap around homeless services, such as employment and job training, mental health services, and transportation to name a few. The City also consulted with 63 homeless persons who reported affordable housing, transportation, homeless prevention, housing counseling, and case management as a significant need. Overall, the City found that the highest need for the qualifying populations in Huntington Beach was for additional affordable housing with wrap-around supportive services. A decent and affordable place to live, coupled with supportive services, helps homeless and those at risk of homelessness by freeing them from such physical and mental hardships and placing them on a path of new opportunity and increased confidence and self-reliance. PROPOSED HOME-ARP ACTIVITIES Describe the method for soliciting applications for funding and/or selecting developers, service providers, subrecipients and/or contractors and whether the PJ will administer eligible activities directly. Huntington Beach HOME-ARP funds will be used to fund supportive services at two major homeless endeavors in the City. First, the City will provide $385,971 for supportive services at the Cameron Lane Navigation Center, located at 17631 Cameron Lane. The operator for the emergency homeless shelter is Mercy House, a local non-profit agency that was one of two agencies that responded to the City's Request for Proposals (RFP). The bulk of HOME-ARP funds, $1,804,704, will be used to fund supportive services at the upcoming Huntington Beach Oasis project, a non-congregate shelter located at 17251 Beach Boulevard (former Quality Inn & Suites). This Homekey project will be developed in partnership with American Family Housing, National CORE, and the County of Orange. The County of Orange will solicit applications through a Request for Proposals from non-profit agencies to provide supportive services. If any portion of the PJ's HOME-ARP administrative funds were provided to a subrecipient or contractor prior to HUD's acceptance of the HOME-ARP allocation plan because the 221Page City of Fluntington Heach HO\9E-ARP Allocation Plan 547 subrecipient or contractor is responsible for the administration of the PJ's entire HOME-ARP grant, identify the subrecipient or contractor and describe its role and responsibilities in administering all of the PJ's HOME-ARP program: Not applicable. PJs must indicate the amount of HOME-ARP funding that is planned for each eligible HOMEARP activity type and demonstrate that any planned funding for nonprofit organization operating assistance, nonprofit capacity building, and administrative costs is within HOME-ARP limits. The following table may be used to meet this requirement. Use of HOME-ARP Funding Proposed Funding Percent of the Statutory Amount Grant Limit Supportive Services $2,190,675 Acquisition and Development of Non- Congregate Shelters $0 Tenant Based Rental Assistance(TBRA) $0 Development of Affordable Rental Housing $0 Non-Profit Operating $0 I 0 % 5% Non-Profit Capacity Building $0 0 % 5% Administration and Planning $50,000 2.23 % 15% Total HOME ARP Allocation $2,240,675 Additional narrative, if applicable. The City of Huntington Beach will provide essential supportive services at two local project locations utilizing HOME-ARP funding. First, $1,804,704 will be allocated to the Project Homekey development, Huntington Beach Oasis (formerly the Quality Inn & Suites), located at 17251 Beach Boulevard, Huntington Beach. The City of Huntington Beach, along with American Family Housing, National CORE, and the County of Orange will partner to convert a former hotel into 62 affordable apartment units plus two (2) manager's units, for a total of 64 units. The income of the tenants will be restricted to 30 percent of the Area Median Income (AMI) for Orange County (TCAC Income Limits). The units will target chronically homeless persons and homeless persons with disabilities. Tenants will not be required to pay rent (interim housing). The unit types will consist of studio and one-bedroom plans. The City's contribution of$1,804,704 in HOME-ARP will provide supportive services in Year 5 of the project (FY 2027/28). Secondly, the City of Huntington Beach will invest $385,971 in HOME-ARP to supportive services offered at the new Cameron Lane Navigation Center located at 17631 Cameron Lane. The Navigation Center opened in December 2020 as a 174-bed emergency homeless shelter. Supportive services to be funded with HOME-ARP include housing search and counseling services, mental health services, and life skills training and case management. The project timeline for expenditure of HOME-ARP funds is Fiscal Years 2022/23 and 2023/24. 231Page City of Huntington Beach HOME-ARP Allocation Plan 548 Describe how the characteristics of the shelter and housing inventory, service delivery system, and the needs identified in the gap analysis provided a rationale for the plan to fund eligible activities. The City continues to make a considerable effort to increase its inventory of affordable housing units. However, the demand for the available units far outstrips the supply as shown in the tables above. Based on the Point in Time Count, there were 349 total homeless persons in Huntington Beach in 2019, 289 of them unsheltered despite the efforts of the City, County, and non-profit industry to house and provide needed support services to them. Additionally, there are over 4,000 renter households at risk of homelessness. They are reportedly making equal to or less than 30% HAMFI while at the same time, spending over 50% of their incomes on housing related expenses. The RHNA further indicates a need for 3,661 units for very low-income families, and 2,184 units for low-income households. New affordable housing developments typically take at least 3-6 years from concept to occupancy. However, the state Homekey program requires project completion within 12 months of the funding award, which results in affordable units on an expedited timeline. The HB Oasis project will provide additional housing units for homeless persons on an immediate basis, and will utilize HOME-ARP to provide wrap around supportive services to give them the help they need to become stable and transition to more permanent housing. Supportive services will also be offered at the Cameron Lane Navigation Center. Any individual who has experienced time living on the streets unhoused is likely to have struggled with a variety of challenges. These challenges may include mental and/or physical health issues, substance use problems, trauma or abuse, lack of employment, or contact with the criminal justice system. Supportive services that address these and many other issues are key in assisting any individual experiencing homelessness. HOME-ARP PRODUCTION HOUSING GOALS Estimate the number of affordable rental housing units for qualifying populations that the PJ will produce or support with its HOME-ARP allocation. The proposed HB Oasis Homekey project will convert 66 motel rooms into 64 interim/transitional housing units — 31 for homeless and 31 for chronically homeless persons, and two units for an onsite manager and a maintenance technician. Once Project Based Vouchers can be obtained, the project will convert to permanent supportive housing (PSH). Huntington Beach's HOME-ARP funds will be used to support this development by providing onsite supportive services to residents to move them into housing stability. Describe the specific affordable rental housing production goal that the PJ hopes to achieve and describe how it will address the PJ's priority needs. 241Page City of Huntington Beach HONIE-ARP Allocation Plan 549 The City expects to use the HOME-ARP funds to provide supportive services at two projects for homeless persons in Huntington Beach and the surrounding areas. First, the City is in the process of developing HB Oasis, a non-congregate shelter located at 17251 Beach Boulevard, Huntington Beach. HB Oasis will provide interim housing services for up to 62 units for adult individuals and households experiencing homelessness in the Orange County Central Service Planning Area. The HB Oasis will provide property management, residential and supportive services that meet the complex needs of people experiencing homelessness. HB Oasis will provide a trauma informed, and evidence-based interim operations by identifying tools and re-integrating participants back into the community through case management and linkages to permanent housing. The City will invest$1.8 million of HOME-ARP funding to provide individualized supportive services to meet the complex needs of those experiencing homelessness. PREFERENCES Identify whether the PI intends to give preference to one or more qualifying populations or a subpopulation within one or more qualifying populations for any eligible activity or project: • Preferences cannot violate any applicable fair housing, civil rights, and nondiscrimination requirements, including but not limited to those requirements listed in 24 CFR 5.105(a). • Pl's are not required to describe specific projects to which the preferences will apply. The proposed Homekey project would serve individuals who are homeless and chronically homeless. If a preference was identified, explain how the use of a preference or method of prioritization will address the unmet need or gap in benefits and services received by individuals and families in the qualifying population or category of qualifying population, consistent with the Pl's needs assessment and gap analysis. As previously discussed in the section on unmet needs and gaps in services for people who were homeless, there is a high need for affordable rental housing, transitional housing, permanent supportive housing, and wrap around supportive services. This decision was largely based on the data analysis of the Point in Time Count, CHAS data, RHNA projections, and consultation with various non-profit agencies and homeless persons. If a preference was identified, describe how the Pl will use HOME-ARP funds to address the unmet needs or gaps in benefits and services of the other qualifying populations that are not included in the preference. The City of Huntington Beach will continue to utilize its annual federal CDBG and HOME allocations to provide services and housing to persons in the other qualifying populations. 251Page City of Huntington Beach HOME-ARP Allocation Plan 550 HOME-ARP REFINANCING GUIDELINES If the PJ intends to use HOME-ARP funds to refinance existing debt secured by multifamily rental housing that is being rehabilitated with HOME-ARP funds, the PJ must state its HOME- ARP refinancing guidelines in accordance with 24 CFR 92.206(b). The guidelines must describe the conditions under with the PJ will refinance existing debt for a HOME-ARP rental project, including: Establish a minimum level of rehabilitation per unit or a required ratio between rehabilitation and refinancing to demonstrate that rehabilitation of HOME-ARP rental housing is the primary eligible activity. Not applicable. Require a review of management practices to demonstrate that disinvestment in the property has not occurred; that the long-term needs of the project can be met;and that the feasibility of serving qualified populations for the minimum compliance period can be demonstrated. Not applicable. State whether the new investment is being made to maintain current affordable units, create additional affordable units, or both. Not applicable. Specify the required compliance period, whether it is the minimum 15 years or longer. Not applicable. State that HOME-ARP funds cannot be used to refinance multifamily loans made or insured by any federal program, including CDBG. Not applicable. Other requirements in the PJ's guidelines, if applicable. Not applicable. 261Page City of Huntington Beach HOME-ARP Allocation Plan 551 APPENDIX HOME-ARP CERTIFICATIONS SF424 APPLICATION FOR FEDERAL ASSISTANCE SF424-B ASSURANCES - NON-CONSTRUCTION PROGRAMS SF424-D ASSURANCES - CONSTRUCTION PROGRAMS PROOF OF PUBLICATION SERVICE PROVIDER QUESTIONNAIRE RESPONSES HOMELESS QUESTIONNAIRE RESPONSES Appendix City of Huntington Beach HOME-ARP Allocation Plan 552 Ff6 I7. 1909•A�. ` APPENDIX HOME-ARP CERTIFICATIONS SF424 APPLICATION FOR FEDERAL ASSISTANCE SF424-B ASSURANCES - NON-CONSTRUCTION PROGRAMS SF424-D ASSURANCES - CONSTRUCTION PROGRAMS PROOF OF PUBLICATION SERVICE PROVIDER QUESTIONNAIRE RESPONSES HOMELESS QUESTIONNAIRE RESPONSES Appendix City of Huntington Beach HOPOE-ARP Allocation Plan 553 APPENDIX A HOME-ARP CERTIFICATIONS 554 [To be added after adoption of HOME-ARP Allocation Plan.] 555 APPENDIX B APPLICATION FOR FEDERAL ASSISTANCE (SF 424) FOR HOME-ARP PROGRAM 556 ITo be added after adoption of HOiNIE-ARP AItocation Plan.] 557 APPENDIX C ASSURANCES - CONSTRUCTION PROGRAM (SF 424-B) FOR HOME-ARP PROGRAM 558 [To be added after adoption of k-IO,ItE-ARP Altocation Plan.] 559 i APPENDIX D ASSURANCES - CONSTRUCTION PROGRAM (SF 424-D) FOR HOME-ARP PROGRAM 560 [To be added after adoption of FIOML-AIZP Allocation Plan.[ 561 APPENDIX E PROOF OF PUBLICATION 562 [To be added after adoption of HONIE-ARP Allocation Plana 563 APPENDIX F SERVICE PROVIDER QUESTIONNAIRE RESPONSES 564 C;" of 44votivigtmi Y>emch 440ME Amcricavl-Resatc -Plate - Provider Q(nestiovlvlaire The American-Rescue Plai (ARP) will provide$2.24 million to assist individuals or houscholds who are homeless,at risk of homelessness,and other vulnerable populatioris,'oy providing housing, rental assistance,supportive services,aid non- congregate shelter,to reduce homelessness and increase housing stability iri} Rvtington Beach.Plcasc help the Gty of } wltington Beach gather important data needed for this grant by completing this questionnaire and cmailing it back to Charles Kovac,}lousing Manager at Charles Koyac�surfcity-hb ore . Orgamit,ation Hair Housing Foundation Contact Stella Verdeia Phone 562-989-1206 ext II00 Email sverdeja@thfca.org Address 3605 Long Beach Blvd. Ste 302, Long Beach, CA 90807 ftehcy Type 'Popmlatjoh(s) Served ❑ Developer/Owner of Affordable 4sg ❑@loveless ❑ TFRA Operator ❑ Victims of Domestic V olemce ❑ Supportive Service Provider ❑ Veterais ❑Public} ousing Agency M Elderly Persons (Co2+Vrs.) ❑ Emergency Shelter 0 Persons with VisaWities * Fair}{ousing ❑ Transitional Aged Youth ❑ C1vilRights lA Low-Income44ouseholds ❑ NarCongregate Shelter ❑ Other ❑ Other Approx, how many flwitington'Death houscholds/persons does your agency serve ainually? 230 In interactions with your cliaits, how would you describe their need for the following services? Level of Need Level of Need Significant Some No Significant Some No Service Need Need Need Service Need Need Need "Pentad}{ousing ❑ % Cl Dutrcach Services ❑ @ ❑ Terart Based Rental Assistance, S ❑ ❑ Substance fibuse Treatment Services X) ❑ Non-Congregate Shelter ❑ IN) ❑ Transportation ❑ ❑ Childcare ❑ 9 ❑ Case Mamagcvnait ❑ S ❑ Education Services ❑ ❑ wlediaiion ❑ ❑ Employment Assistance/Job Training ❑ IN ❑ CrcditRcpair ❑ M ❑ Food ❑ ❑ ❑ Landlord/Tenant Liaison ❑ r.IQ ❑ }lousing Search and Cowiseling Services for Victims of Domestic Services ❑ m ❑ Volence/Daiwg Violence/Sexual SJ ❑ ❑ Assault/Ownan Trafficbng Vomsing Financial Assistance (Saari y Legal Services ❑ 0 ❑ Deposits,LA+iliiy Assistance,moving Sl ❑ ❑ Costs,First aid Last Wrowln'sRent) Life Skills Training ❑ M ❑ }(omcless Prevention ❑ ❑ Mee tad;{eaHt Services ❑ ❑ ❑ }lousing Cowrseling ❑ Tt ❑ Outpatient Ocatth Services ❑ ❑ Other ❑ ❑ ❑ 565 Cltt of 44mitivgtovi Peach 4400E Amcrican-Pescue 'Plavi Provider Ques+iohvlaire e American?escue Flan (ARF) will provide$2.24 million to assist individuals or households who arc homcicss,at risk of homcicssncss,and other vulnerable populations,by providing housing, rental assistance,supportive services, and non- congrcgate shelter,to reduce homcicssncss and increase housing stabifity in}Iuntington Beach.Flease help the City of }{untington Beach gather importamt data needed for this Brae N completing this questionnaire and emailing it back to Charles Kovac,}{oasinq Wtanagar at Charles.Knyac�sarfcity-hb.ora . Organization Families Forward Contact Madelynn Hirneise Fhono 949-716-5863 Email mhirneise@families-forward.org Address 8 Thomas Irvine Ca 92618 foie—nN Type Popula Pioh( ) Served ® vevcloper/owner of AffordaMe,{isq CC }lomeless RI T-B A Operator N Victims of Domestic Wolence CD Supportive Service 7rWder CC Veterans ❑ Fublic}iousinq Agcncy ❑ Eldcriy Fcrs."s ((at+ Yrs.) ❑ Emergency Shelter ❑ Fcrsons with Disabilities ❑ fair}lousinq ❑ Transitional At od Youth ❑ O iI Rights W Low-Income}louseholds ❑ Non-Congregate Shelter ❑ Other ❑ Other Approx. how many}Iuntington 'Death households/parsons does your agency save annually?30-50 children and adults In interactions with your clients, how would you describe their need for the fallowing servicas? Level of Need LcVcl of Naafi Significant Some No Significant Some No Service Need Nccd Need Service Nccd Need Need "Rental}lousing ❑ ❑ Outreach Services ❑ ❑ Tenant Based"Rental {}ssistance � ❑ ❑ Substance Abuse Treatment Services ❑ Non-Congre,,ate Shelter ❑ �X ❑ Transportation )0 ❑ ❑ Childcare 9 ❑ ❑ Case Wlanagemen+ R] ❑ ❑ Education Services ❑ ❑ mmiation ❑ ❑ Employment Assis+ante/Sob Training ❑ ❑ CrMit'Repair ❑ X ❑ Food ❑ 19 ❑ Landlord/Tenant Liaison ] ❑ ❑ {lousing Search and Counseling Soviets for Victims of Domes+ic SGrv�es X ❑ ❑ Violence/Vating Violcncc/Sawa[ ❑ X ❑ Assaalt/Vtvnan Traf ficbnq }basing Financial Assistance (Security Legal Services ❑ ❑ Deposrts,Wifity Assistance, Wlovinq 10 ❑ ❑ Costs,First and Last momih's Vsnt) Life Stills Training ❑ ❑ }lomelcss FrevrwHon X] ❑ ❑ Weal 4ca"Services ❑ X ❑ {basing Coansdng ❑ X ❑ Outpatient health Services ❑ ❑ Other ❑ ❑ ❑ 566 v cc City of 44tivrFlvlO+oh '6eacln }{OM:E A mericen Tzscue -Plavl Provider Qaesfiovlwaire c Arncrican"Rascue Plan (ARP) will provide,$2.24 million to assist individuals or households who arc homeless,at risk of homelcssncss,and other vulnerable, populations,by providing housing,rental assistance,supportive,services,and non- congre,gate shelter,to reduce h6me4assness and increase housing stability in}funtington Death.Please help the City of 44unti"ton Death Oathcr important data needed for this Oran+by completing this questionnaire and mailing it back to Charles Kovac,}ousinOYNanager at Charles Koyac,surfci+y-hb.ora . Organization 4o m—o (eSS ?f 'IPJ Contact 1444fhtyL�,-7 Phone Address4D ���C � $I��+t{�1AiH>f7Y1G �N �QOtQQ ot4 9Z6 cf �Aevlcy Type Popctla+iovl(�) Served ❑-Peveloper/Owner of Affordable,+lsO 5+lomelcss ❑ TDRA Operator ❑ Vctims of Domestic Violence ❑ Supportive Servico PrWe(er ❑ Veterans ❑ Pubfic}lousing AgeKN I I Elderly Persons ((o2+Yrs.) ❑ Emergency Shelter i I Parsons with Disabilities ❑ Fair+lousing ❑ Transitional Agcd Youth ❑ Civ11"Ri Vts ll.l Low-Inaome,+louscholds ❑ Non-Congregate Shelter ❑ Other ® Other v CO-C Approx. how many+lumtington Beach households/persons does your agency serve annually? In in+aractioos with your clients, how WOVIA you descr be their need for the following scrvic4s7 LLVGI of Need Level of Need Significant Some, No Significant Soma No Scrvcc Need Nced Need Service Need NeeA Nced Rental+{Dosing ,� ❑ ❑ Outreach Services ❑ ❑ ❑ Tenant Based Rental Assistance ❑ ❑ ❑ Substance Abuse Treatment Scrvit,5 12 ❑ ❑ Non-Congregate Shaper is ❑ ❑ Transportation ❑ ❑ Childcare ❑ ❑ ❑ Caw management ❑ ❑ ❑ Education Servlcos ❑ ❑ mediation ❑ ❑ ❑ Employmce Assistance/Job ❑ ClCrcdltRcpair Training ❑ ❑ ❑ Food ❑ ❑ ❑ Landlord/Tanant Liaison ❑ ❑ ❑ +{Dosing Search and Counsdng Services for viNims of'Pomes+ic Services ❑ ❑ violence/Dating violence/Scuu, ❑ ❑ ❑ Assault/+lamas Traffiddng +{ous mg fiviancial Assistance, (Sww-HN LW.Al Se"dc,:,s ❑ ❑ 9cposi+s,LWFt+y Assistance,Moving g ❑ ❑ Costs,First anA Las+mon+h's"Rait) Life,Stills Training Ii ❑ ❑ }lomeloss Prevention ❑ ❑ mental Peafth Services ❑ ❑ +dousing Counsdng ❑ ❑ ❑ Outpaiien++leafth Services Qi; ❑ ❑ Othcr ❑ ❑ El 567 City of 44mi+ivl tovi Beach +BOWIE AmericanReswe, -Plan Provider Questionnaire ,'"" he Avneric,uReseuc Plan (ARP) will provide$2.24 million to assist individuals or households who are homeless,at risk Of homelcssncss,and other vulnarable populations,N providing housing,rental assistance,supportive,services,and non- congrogate,shelter,to reduce homelessness and increase housing stability in}}uatington'Deach.Please help the City of }luntington'Dcach gather important data neodcd for this grant N completing this gacstionnairc and cmailing it back to Charles Yovae,Housing e+wnagcr at am . organization H6PD - HT GF5E T�Contact 3ftC701J -AUST� N Phonc(� �a� 3-4g I --og Email Urf e,T1lJl"z) Address 20po PA A'l ^J ST. 10 4-1yNn rJC1-C-oN Zia LIE) Aolency T{pe -Populations Served ❑Veveloper/Owner of Affordable}Isg �Eworneless ❑T9PA Operator '%lVICt ms of Domestic Violence Xsmpportivc Scrvica Provider )E�-Votcrans ❑Public 4ousin5 Agency )aEldcrly Persons ((*2+Yrs.) ❑ Emergency 51meltcr 19Persons Af th disabilities ❑ Fair}lousing Transit oval Agcd Youth ❑ Civil?ji9 is 1 ow Income Households ❑ Non-Congre)ate Shelter ❑ Other ❑ Dthcr Approx.how many}{untington 'Deac i households/persons does your agency serve, annually? Z In interactions with your clients,how would you describe their raced for the following services? Level of Need Level of Need Significant Some No Significant Some, No Service Need Need Need Service Need Need Need 'Rental}}ousing ❑ ❑ Outreach Services ❑ ❑ Tenant'Dried Rental Assistance A ❑ ❑ Substance Abase Treatment Services ❑ ❑ Non-Congregate Shelter �g ❑ ❑ Transportation ❑ ❑ Childcare ❑y I- ❑ Case nlanagcmant ❑ ❑ VPX4 Kom Services ❑ ❑ mediation ❑ ❑ Employment Assistance I Job ❑ ❑ r-cd{t.pcpafr ❑ `i( ❑ Training Food p3. ❑ ❑ LandlordlTenant Liaison ❑ ❑ }{ousinq Search and Counse ing Services for Victims of Vomestic ❑ vi Saviccs ❑ olence I Dating Violenw/Sewl ❑ ❑ Assault I Human Trafficking Housing Financial Assistance (Secarity Legal Services ❑ ❑ Daposits,utiritq Assistance,moving ❑ ❑ Costs,First and Last Month'sRent) Life,Skills Training ❑ ❑ Vomeless Prevention ❑ ❑ mantal}lealth Services ❑ ❑ Housing Counsering IK ❑ ❑ outpatient 44oA"Services ❑ ❑ Other 1 ❑ ❑ ❑ 568 City of 4400tivi �too Peach - {DME American-Rescue Plate Provider Questionnaire "' The A0A6rican-P_cscue Platt (ARP) will provide$Z.24 million to assist individuals or households who are ho neless,at risk Of homelessness,and other vulnerable populations,'ay providing hoosiag, rental assistance,sapportiVe services,avid non- congregate shelter,to reduce homelessness and increase housing stability in+Iiortingtat'Death.Please help the City of }Iantingtoo 'Death gather important data needed for this grant by completing this questionnaire and emailivig it back to Charles Kovac,}}ousing Maviagcr at Charles.Kovac6—L)surfcity-hb ora . Organix,a+ion Mercy House Contact Allison Davenport, Chief Strategy and Compliance Officer -phone (714) 836-7188 x114 Email allisond@mercyhouse.net Address PO Box 1905 Santa Ana, CA 92702 ;Wmo4 Type -Populatiods) Served ❑ Developer/Owner of Affordable}Isg El } omcless El TbRA Operator ID Victims of'Domestic Violence O Supportive Service Provider O Veterans ❑?ublic}lousing Agency ID Elderly Persons ((�2+Yrs.) 0 Emergency Shelter El 'Persons with Disabilities ❑ Fair}4ousing ❑ Transitional Agcd Youth ❑ Civil-Rights ❑ Low-Income})ouscholds ❑ Non-Congregate Shelter ❑ Other ❑ Othcr Approx. how merry}}untington 'Death households/persons does your agency serve annually? 300+ Iti interactions with your clients, how would you describe their need for the following services? Level of Need Level of Need Significant Somc No Significant Some, No Service Need Need Need Service Need Need Need Rental}loosing 11:j ❑ ❑ Outreach Services �❑ ❑ ❑ Tenant Based Rental Assistance ❑ ❑ ❑ Substance Abuse TreaVmcnt Services O ❑ ❑ Non-Congregate Shelter ❑ M ❑ Transportation El ❑ ❑ Childcare ❑ IJ ❑ Case manage neat p ❑ ❑ Education Services ❑ O ❑ media hon ❑ El ❑ Evnployment ASSIStatffie/Job Training ❑ ❑ Cl CrcditRepair ❑ L] ❑ Food ❑ ❑ ❑ LanAlord(Tenant Liaison ❑ ❑ ❑ ?lousing Search and Counseling Services for Victims of Vomestic Services ❑ ❑ ❑ Violence/Dating Violence/SCMAI ❑ ❑ ❑ Assault/0"man Trafficlang }'rousing Financial Assistance (Security Legal Services ❑ ❑ ❑ pcposits,Utility Assistance,Moving ❑ ❑ ❑ Costs, First and Last Month's Rent) Life Skills Training ❑ ❑ ❑ }omeless'Prevattion ❑ ❑ ❑ Mc,i+al}{ea"'I Services ❑ ❑ ❑ }lousing Cownseling ❑ El ❑ 4r pa Oat +ient eAltfl Services D Cl ❑ Other ❑ ❑ ❑ 569 - . City of av)tingtoh 8eac� 440ME AmericaaTeswe, -plan Provider Qaestioaviaire American-Rcscuc Plan (ARP) will provide$224 tnilrion to assist iKdlviduals or households who arc horncloss,a+risk of homdessnoss,and other vulncrablc populations,by providing housing,rental assistance,supportive services,and non- congrc Ate.shelter,to reduce homelessness and ieoreaso housing stability in{)uniington Beach.Please help the City of }luntingMn Beach gather important data needed for this 9ran+by completing this quastiDnnaire am emaiGng it back to Cherries KoVac,Oousf/n/g y 1Nanagcr/ayt�PL�.,rlcsY�vacdl�rfrihl-hi_•�/ / organizati/on`�/7 '(`� Coeact_!7/� 1 �I. C(�l .JCffC�-Y Phone-4> 2n l7 — /&8 Email Q 5 Z -7 ar, M', Address U • QG 14 h�G MG A- fte,11N Type Served ❑Developer/Owner of Affordable{{sq omcless ❑T6RA Operator �Y�etims of Domestic y olence ❑ Supportive Service Provider �'Vrherans ❑Pubs c}+Dosing Alter cy 'Elderly Persons (62+Yrs.) ❑Emcrgcncy SheFter Persons wh-h DisaHfitics ❑Fair}{Dosing XTTransitional Aged Youth ❑ C v l R ghts �iew Income}louscholds Cl Non-Co" r e S cFter ❑ Other �e 2o�/nG! ❑ Other Appr&Y-how marry}luntington Beach households/persons does your agcnoy serve,annuajN7_ In interactions with your yenta,how would you describe ti'wir need for the following sery ces? Levd of Need Level of NDed Significant SOVAF No Significant Some No Servitc Need Need Need S&Vlce Need Need Need Rental}lousing ❑ ❑ ❑ OutrurchSerVices Te+wnt 8ased-Rental ❑ ❑ Assistance ❑ ❑ ❑ Substance Abuso Treatmmrt 5crAcos ❑ J�i/ ❑ NwCoWChime egate,Sholter ❑ ❑ ❑ Transportation ❑ ❑ ❑ ❑ ❑ ❑ Casa management ❑ ❑ ❑ f4vAtion S"Y"S ❑ '0, ❑ Wtediatim employment Assistance/Job ❑ ❑ ❑ Training ❑ ,b' ❑ CredrtFepair Food ❑ ❑ Land1ord/Tenaet Liaison ❑ ❑ ❑ 44omsiM Search arrd Courrsertng Sw*as for Vlotims of Domestic Savv6s ❑ ❑ VlolcWce/DaNnq yolm"/Sexual ❑ ❑ ❑ Assault/tlumaa Trafficking Legal S&-Wzs tlousinq financial Assistance(saurtly ❑ ❑ ❑ Dcpesit's,Utir"Assistance,MbVing ❑ ❑ ❑ Costs,First and last Wbrrth's-Renrt) ufo skis Training ❑ ❑ ❑ 4ommoss Prcvmtw" ❑ ❑ ❑ Wlantai 44m"Services ❑ -El- ❑ Dutpatiept{4OA"Sa *45 ❑ ❑ ❑ Other ❑ ❑ ❑ 570 City of } mvltihotovl 13each } OME Americao?zscae 'FroWer Questiowwaire �.� 0 e American Fescue Plan (ARP) will provide,$2.24 million to assist individuals or houscholds who are;homeless,at risk of homelessness, and otiicr vulnerable populations,by providing housing,revrtal assistance, supportive services,and non- congregate shelter,to reduce homdessne,ss and increase housing stability in}{untington'Death.Please help the City of }luntington 'Death gather important data nccded for this grant by covnpictinq this questionnaire, and cmailinq it back to Charles Yovac,} otsing Manager at Gharles.Kaya�rfc' - bar ` Organita7+on Vt1_J(] `` ',Qr}— Contact 1 c.1(lE Phone _11L1-1�1/ � —` LLjq EmailP.r�, (7) L( 1e_>f�2.�� Address— LLI �%f- Ayc-�4 , HIk(1�Irjc161 Cb-) g2LocA � Aoiehcy T�pe Yopulatiods Served ❑ Developer/Owner of Affordable,+;sq ❑ }lomcicss ❑ T'DRA Operator O Vitt ms of Do nestic Violence )31 Supportive Sen/ce,Provider ❑ Veterans D Pubfic}lousing Agency ❑ Eldcrly Persons (62*Yrs.) ❑ Emergency Shelter ❑Persons with Disabilities ❑ Fair})ousing )KTransitional Aged Youth ❑ ClvilRights ❑ Low-Income,}louscholds ❑ Non-Congrcyatc Shelter ❑ Other ❑ Other \ ApprolL how many}luntington Beach houscholds/persons does your agcney serve annually? �)`�-Li� W I Mlq 111� In interactions with your clients, how would you describe.thcir vnced for tiie followiaq services? `�rbkun Level of Need Leval of Need Significant Some, No Significant Some, No Service, Noed Ncad Nced Scrvica Nccd Need Nccd Rental{{oosing X ❑ ❑ Outrcach Scrviccs ❑ ❑ ❑ Tenant$ased-Rantal Assistance �/.� ❑ ❑ ' Substance,Abuse Trea+mcnt Services Cl ❑ �( Non•Cowyuptc Shcltcr ❑ ❑ ❑ Transportation 71 x ❑ Childcare ❑ ❑ ❑ Case Management ❑ ❑ Education Services ❑ ❑ Mediation ❑ ❑ ❑ Employment Assistance/Job Training ❑ ❑ Credit-Repair ❑ ❑ Food ❑ ❑ Landlord/Tenant Liaison ❑ ❑ ❑ }lousing Search and Counseling Services for Victims of Domestic Services ❑ ❑ violence,/Dating vlolcnac/Scuol ❑ ❑ Assault/}luman Trafhcling I ScrVites f)ousing Financial Assi nt s+ae (Security L ega ❑ Y- ❑ Deposits, uhriN Assistance,Moving ❑ ❑ Costs,First and Last Montil's-Rant) Life Stills Training ❑ Nbmelcss Prevention ❑ ❑ Mental}1caft Services ,gj ❑ ❑ {)Dosing Counseling p ❑ Outpatient}{cakM Services r _�(' ❑ Other r r n �C�.-J�5 �Q-.D�- ��Vl ,� C�'�S1- C� `��'LQ,'� S2�' l)LC_,C_�) C�fld• l-t�"LCJL� WQ 6c-� NN --e juwC . ) G--Io- 1-+J v VC 1 b1401 J 571 City of 44avi-ivigtoo Beach }BOWIE A mericavi Tzscae Ylavl -Provider Qvastiotlhaire 9 'cNc AmcricanTz%me,Plan (ARP) will provide$z,z4 million to assist individuals or hmscholds who are homeless,at risk of hcmdcssness,and other vulncraWr,populations,by providing housing,rental assistawce,supportive services,and non- congregate shelter,to reAucc liomdassness and increase housing staWrrty in+lnntington Beach.Please holp the Litt'of +luntington 8oach gather important data weodod for this grant by cemplo inq this questionnaire,and emairt"it back to Charles 4vac,+loosing manager at C narie 14 rfcity-hbar , Organization City of HB, Senior Center in Central Park Cowtac+ Michelle Yerke Phone 714-374-1521 Email myerke@surfcity-hb.org Address 18041 Goldenwest St, Huntington Beach CA 92648 Aocm. Type 'F01>01miol7(ss) Served ❑'Pevcloper/Owner of Affordable+lsg ❑}}omeless ❑ T13M Operator ❑Netims of l7omestic violence ® Supportive Service Provider ❑veterans ❑Pubfic{}ousing Aguwl 13 Elderly Persons ((t+Yrs.) ❑ Emergency Shelter ❑Persons with Disalr6ties ❑ fair+lousing ❑Traositiowal Aged Youth ❑ OVTPights ❑ Low•Income+louseholds ❑ Non-Congrcgatc Shelter ❑ other ❑ Other Approx,how many{luntingtow Beach househotds/persons does your agency serve annualh(1 3,000-6,000 people annually Low num er Is unng Covidl9/ Iw inte,raciiows vrth your dents, how would you describe their vice@ for the following servlceshigh number is prior to Covid19 Lcvcl of Neod Level of N6e4 Significant Some, No Significant Some, No Sorvlce Need Need Need Service Need Need Need "Real+lousmg I:x ❑ ❑ Outroach SoN"s ❑ IBC ❑ Tenant Dasm-vze tal Assistance II ❑ ❑ Subs+anre Abuse Trurtmont Services ❑ ❑ Non-Wngregate shol+er ❑ Ex ❑ Transportation ❑ tx ❑ Childcare ❑ ❑ pp Case nlanagcmcn+ ❑ IK ❑ EdwationSer&cs ❑ ❑ mediation ❑ ❑ Employment Assistance/Job Trait'" ❑ ❑ (% [redeYRepair ❑ Cld( food ❑ ❑ Landlordt-romwt Liaison ❑ ❑ r,X }(Dosing Search and Coansdinq Ser*es for vatims of Domestic Services ❑ CI ❑ Yidcnce/Dating vidonco/Sexual ❑ ❑ r,� Assault/Human Trafficbnq {lousing financial{65istanae (S"WH-q s Lcgal Services ❑ A ❑ Vcposits,LHirrty Assistance,tNoJng ' ❑ rX ❑ Costs,first and Last monti'rsRewt) Life stills Training ❑ ❑ LX +lomaless Prevention ❑ (g ❑ 1Nontal+1W"scrvlc,S ❑ '[.f ❑ +lousing CwK$dlmg ❑ E( ❑ outpatient+leat+h Sorveas I ❑ ❑ X o*e4hared Housing 0000rtunity, ❑ IX ❑ 572 City of 44mv)tivgtov) beach - OME American-4swe, -Plan -Provider Questionnaire c Am6rILAn-Pes&mc'Plan (}ARP) will provide$2.24 million to assist individuals or households who are homeless,at r sk of homelessness,and other vulnerable populations,by providing housing,rental assistance,supportive services,and non- congrcgate shelter,to reduce homelcssncss and increase housing stabirity in}Iuntington'Beach.Please help the Oty of })untington-Death gather important data needed for this grant by complatinq this questionnaire and cmaifinq it back to Charles Yovac,♦{ousing Manager at Charlcs.Kovac�sy y{yhb o�c ,, o organizlrtionv� ��u-h-�l /�1:11rOs�C�Contact � ��' �/�-"' I p + 7 l� Phonc���� � f - Cq �q armall i(\Cora2Xbp�l=' SGD � OG . O✓'� Address I w u-:tke � (�f f�(�0 rA 12�W $oeney Type Served A$cvcloper/Owner of Affordable}isg gq-;ovnaless ❑ T'? A Operator ZVictivns of Vomestic Violence ,fatupportive,Senfto'Provider ZrVeterans ❑'Public}lousing Agency ®'Elderly Persons ((v2+Yrs.) ❑ Emergency Shelter 'Persons with visaW tics ❑ Fair I}ousinq Zfrransitional Aged Youth ❑ CiviMghts lff-Low-I ICOM,1lousoholds ❑ Non-Congregate Shelter �'Othcr rP�liiA OU P(� ❑ Other v Approx.how many}luntington Bcach households/persons does your agoney serve annu II4,? In interactions with your clicnts, how would you describe their need for the Nlowinq services? Level of Nea Level of Need Significant Soma No Significant Some No Service Need Need Need Serviw I Need Nced Need ?Z4 tAl dousing I ❑ ❑ Outreach Services ❑ ❑ Tenant Eased?zeAl Assistance ❑ 15- ❑ Substanco Abusa Treatment Servlcu ❑ ❑ Non-Congregate Shelter P-- ❑ Cl Transportation lir� ❑ ❑ Childcare tliz- ❑ ❑ Case m4nagamant ❑ Pr' ❑ educaiioa Services ❑ ❑ modiation ❑ Th�F- ❑ Employtnorrt Assistance/Job / Training ❑ ❑ Cre4ttTepair ❑ ❑ Food ❑ ❑ Lmdlord/Tenant Liaison ,' ❑ ❑ lloasing Search and Counsa<nq Services for Vioiims of Vomostic Services ❑ ❑ vialenco/Dating viclance/Sexual ❑ ❑ i Assault/llamavn TraffvAdnq dousing Financial Assistance (Secev ty LegAl Services ❑ ❑ Deposrts,vtirNy Assistance,moving ❑ (3 Costs,first and Last wbnth's Rout) Life Stills Traininq ❑ Bl ❑ Homeless Prevention ❑ ❑ mamtAl lleal-th Services .91 ❑ ❑ }lousing Counsetmq Cl &r' ❑ Dutpatient}fealthServices ❑ Ij—K ❑ Other ❑ ❑ ❑ 573 Gt`I of 44mtih9tov) Beach American-Zascuc Plan provider QVi5sf-imlaire T�w estue Pan (ARP Vide 12-24 million to assist individuals or househelds who arc homeless,at risk Of homelessness,and ) will Pro other vulnerable PDPu4rtions,bt Pro04"housing,rental assistance,supportive ser "Xs,and npn- ca><jre�ate shelter.+o reduce homelessness and inaeasc housing stab lity in}}untinc�+on Beach.please help the Ci+y of }{uniir�jton Beach e }y important9 data needed to Clwrles Kovac,{}ousiny Mara c for this grarrt by com r at fdlAd(6,KayaalcurFr pletiis questionnaire and emairl"it back iiv-hbg� ng this Organitati� ��-�} � c ',� n (t� comae+ c r Cc�l me r pho� Email L OL) T� f L . Address o =� r , — C— G e T ti ❑➢eveloper/Owner of Affordable Nsg omeless ❑ 4pp6 Operator ❑Vwtims of Vomest%Violence �+PPor five Scry ce Prov der ❑Veterans ❑Pubs c{#ousing Agr"+c'1 ❑ Emu ❑Elderly persons (62+yrs.) ❑ fair}lwousir,<g 9si Shelter ❑persons W+hisabi Drtties ❑ Gv l R ylt+s Transitional Ac a Youth ❑ Non-Co r w-Znwmc♦/ouschelds ng egate SheFFer !!❑ O+ha, ❑ Other APPrm how man �—y})untinc)ton 8cach households/persons does your agency serve anrutalh(/ Zn interactions with your dents,how would you dascnbe+heir need for the MiOw ng scrvic657 SeMee Soifican+ Setea No Sia' so" iV Nerd o Need , 0 --jtar+al _ _ -- Cl ' Oi+traadr5avlres - f� ❑ NO AsslstaMe6 ❑ ❑ ❑ Subs+anoe Abuse Treatment Sowers ❑ �f Childcare e4,Aft Sheller j ❑ ❑ ❑ Transportarioe ❑ ❑ ❑ ❑ ❑ Case Man Me"t F.dwation Services ❑ ❑ ❑ MedlAm }.^ ❑ EmPbyment Assis+ante /Job I _ ❑ ❑❑ ❑ Training ❑ ❑ - - CreitRtPav Food ❑ ❑ Landbr VTciiawt Liaism ❑ Cl ❑ Ilousi"Seuch and CaaschM Services for Viettms of DMneshe SeMws I O O ❑ Vokue/Drrmg Vulc„ce!SerwJ ❑ ❑ ❑: I Assauk/{{unwn Traffirk�ng j tlousmg Finandal Assystaw (Seoeathl L"Al ScMces ❑ ❑ ❑ DcPosrts,L4-hf"Assistance,Moving ❑ ❑. Costs,First and Lost M wHq.s knt) / Life Slilis TrairdMg ❑ ❑ Non+eless Prevention �( ❑ O- Mortal Hrdth$ervlras I ❑ ❑ ❑ {{Dosing C&AAW" /—❑ O ❑ ! P+ flealfh 5erytres _1 ❑ ❑ Dther ❑ APPENDIX G HOMELESS QUESTIONNAIRE RESPONSES 575 C;I-�'y bf {-Ir✓�'rl I"IhGjf'Oh BBG�G�1 ;�,�, _„ . �r�)"fit, {�t'i�iZrlca>7-Rescue?fa�i J �o'rr,eless �'ues-i-iohviaiYe ,, J Tra-mericah� cue?la.n ( ?7) will arev de$224 rt ilGoh o asist indiV dvnls or hoc c'nolds v ho are Vomeless,a+risk cf hon,e;cssness,and o!'rwr Vulh:xab_le x�ctl.�ri .l-,{�>ro, dita�,E, t,�;iyy�,.ccn. ulassis�a:tecrsu?for-I�,vrrsen^cus-itr, '— ra�i)�cPfTiF�ssnerrar,To e�7arc iom esshe;s and increase housih s�'abi:IT!IM=iNh'IA ion 2eac' . '�- ', - .- � , nlS�q�mi' tamp my ' is auc;t;omstairc. I I , -tQl rl;pGnlG? ❑ Yes �o / \ La;q-'n c currerF episode o homelc,smess: .o14j ritamy trmds hmNe you both iwtndess? j � -;o!se'rwld Tyke: LY!1 Sih"P-A&IIt ❑ Co,tgfc wi-near Children ❑ Sin�le,?,a ear ri/Chi{?ren ❑ Two-erevts w/Children ❑ V.h ,ccom�ahizd Ya,,th (1? or gocutgcr) h''nere will you be sleepim tohigvr? ❑ Strut ❑ Vzhicle Shcltzr ❑ Sm a ?ark ❑ wictzlJ;!otcl ❑ Fatrily/prizad ❑ Dt icr Veteran, (16+yrs.old and V,S nrmcd Ser.'ice or f ivated Naiional CcwrA, eserAst)? g Ye<_ 01 No Arc y'ou triing ro fle.cc from domestic"101cnce,da c hq v,olence,sexual assacdt,or human tra{,i_ aq? ❑ Ye.s 2/rib Do'{ou fvvc,any of i'ne fallow{nq YNGm -Osord.:r ❑ 7Vt4ske l Pisaliiir; ❑ Devclop'mewt 7P95a'ci(iy ❑ Chronic sol sra:-ue ,4bu5c ❑ Nov.. anal do you do for ihc,mclmovisr? %U lr} Q-i'(A 4" ;low would you dcsaibo your mccd for tiro followiM serriccs? L,VCI aF Need Le 519 ificae Some No Sghfcar Some No Sorricc NefA Nced Mud SerAce Ned Need ,yc "p.mtal{;casing r ❑ ❑ . ocr,reach Scrviccs ❑ , Re tal?ssistamce (3 ❑ y y Subs+amie{�uso 7raaimcai S&v oes ❑ ❑ Non-Ccngrcvatc Shelter ❑ ❑ Transportation ❑ ❑ CWLi are ❑ ❑ �j Casa,Ytanagc;onr ❑ c dwcoiich Semites ❑ ❑ Gf ri a on O ❑ . two ay"Cn+f!ssistaY;cc(Scb .. . .i . Trailing ❑i ❑ Cruf tpepair ❑ p' ❑ Food "G. C ❑ Landlord/TemnYr'r Liaison ,� ❑ ❑ Sc i des fc Yiciims of Pomrri c 44ous nq Srarch and Coups finq r Serlccs C� ❑ ❑ Violence I jai xg fwlctce/Sex al ID ❑ Rssae J{l,immi TrafF n3 /� } ousimg Frvancial Assistance (Seur'r.y Loyal Scnlccs ❑ ❑ p Dcposiis,Lull'i fssis-h*Ax,ri vbICy ❑ ❑ Costs,First amd Last ritcn i1's?r ) Lifc509s Traimiaq ¢ ❑ ❑ ?0mcins Pr verriom ❑ Cl Klcmtal r.'cal=i`n Scrtiius ❑ ❑ }'cusimg cwm—riq ❑ ❑ Oc,t?aticvm{;caWn Soviets ❑ ❑ Critar ❑ ❑ ❑ 576 40M✓ { yneric� i pescue ?Iq'J - >4ovnefess Ques+iohnaire '' ���' � f T'ne rlmcrican"R:,sutePian (;" ') will provide$2.24 milrion to assist individuals or housc'nolds who arc homeless,a+risk of homele�css,and e(ncr V_u(ncra1le Hope larions,b�.p�ovjd hg;4wusing,.rc:�;akassistance saprcrtiV�se"t 7 us' ,grd ron- -'co gr'r�ga,e sne er,+o r ie 'nomdassness and increase hocsin sta'a C' in ant + a ro? is gra , comp e ng this aues16 ti0nrairc• 17 �� J Name f �]i C)bxi lj �' Phone I r'9e �_ "?.�_;e �'y�I+� }}ispanic? ❑ Ycs Q No engii� of current episodo of ho;nalcss:icss: S YS }ow many-timcs have you been hDmdess. roes hold Type; Singiz.?1,u1+ ❑ io;tp!e without Children ❑ sin jlz Parent w/Nildren ❑ Two Parents w/Oiildreh ❑ Uuaccomaanizd Yositli or yoangcr) Ae,rc will yoci be slccpi +oaigyttz ❑ Street ❑ Vzhidt SVteatar ❑ Tn a F wL ❑ w}otelMotel ❑ family/Fricad ❑ C tier VcTcran (15r yrs. old And us Armed Service or rrmvated Naiional CRard/?.eser Ast)? ❑ Ycs ?rc you trying to flze from demesr c v olence,da+ing violence,S=AAl assault,or human rraf ficang? ❑ Yes vtlo Do you hAve Any of tyre fo(lowi cord',-ions? Q IHcvta!/cmot,onal D corder ❑ 7h sisal isabili y ❑ Dzv,IDpment Disa'oility II Ohronic St"Ostavice. fibnise ❑ NDHe Ala-do you do for In Ot5 c/'%chu( _ I y l ! L—ya low would you describe your need for the following servic s? Level o-r Nz^� Sighi;icaei- some No Level of Head 7rACe, Need Need Neal Synl can( soma No -Rental�{oasing ❑ servica Nccd Nced Need ❑ c OW rcacn Scry ccs ❑ ❑ 0 Real Assistance ❑ ❑ ❑ su'osta ue those 7rcatmar Se v ces" NDn-CzWcgertL ShGltef ❑ ❑ ❑ ❑ ❑ Childiarc ❑ Transporiaton ❑ ❑ El ❑ ❑ Casa,Wa otncnt ❑ Ekuta n Services ag ._. ❑ p . . ❑ ❑ ❑ Mediation ❑ rcvn�IcyVocti Assistance/Job - - ❑ ❑ p training ❑ ❑ ❑ GcdH E2cpair ❑ Cl ❑ ❑ ❑ Laadlcrd/Tena:rt Liai,D4 ❑ ❑ ❑ }{Dosing Search and Counsetng Services fa(Ywiims.&fDomritic Sere cc ❑ ❑ ❑ vrole ce/Dating ftolence/Sexual ❑ ❑ ❑ 'Assault./{{uiran Tra{f�dang . Legal Services ❑ -loos ng`rinanc al Assistanc8(Swxlj+j ❑ ❑ Deposits,Ut li{y Assistance,Moving ❑ ❑ Costs,First and Last MD:rt'n'sRenr) ❑ L'ifcSWsTraining ❑ ❑ ❑ }romdcssPrcvcnticn KlentalLeait-hScrvices ❑ ❑ ❑ ❑ ❑ ❑ ing Couns�ng ❑ ❑ ❑ Outpatiatt t'rzaith Servfces ❑ ❑ ❑ Ofil Dthcr ❑ ❑ ❑ 577 Uty of 44vvi -ivtgtmi *3eacVi 440ME ft��erica'n Rescue Pla�� - {�ovneless Ques+iowhaire `"'��'' T Vie,{snerican R scue fan (f 2 r) will provide$2,24'million to assisr indiv duals or households who are homeless,a risk s homelessness,and oi'n_er Vulnerable.ao_ulations . b{,preVldin9Aolbg 1Falassis;ante,su{peri ve seryiccs-and•roh congrcya e s elter,to r uce homelessness and iwrease housing sTabi Iity in{iuniin ton Ecach.?lease he! t c u r rrsT 01 , IV4 co np ng ,vs aucsonnairc, Name I O� �� l �•l Q{(./,4,I' Phone I C 1 1 W I }As?anie? ❑ yesl4, Length e curratrt episode of homelessness: ;low many time's'aave you bccn homeless? louseheld Type: lvsinglc =dolt ❑ Costalc withoat Children ❑ Sivgle Parent w/ChAdr cn ❑ T v;n 7arr.n 5 ,v/Cbti!dren Unacwm?anizd Yoat�t ('it or younger} Where,will you be sleenit• oni5W ClStrect Elvehicle Shelter ❑ In :v?nrk ❑ 4dotellVotel ❑ Family/Friend Cl Other Vreran (1&3 yrs,old and(d5 Armui ser/ice or Activated National cwrd CT /P,ese,rvist}? ❑ Yes � ne Are,you trjing to flee fram domestic violcrce,doing violence,sexual assauFt,or human trafficking? ❑ Yes V(mo Do you haVO any cf the following conditions? ❑ mental/Er whonal Disorder ❑ Physical Disability ❑ Devcle?maul Disa'vi(ity ❑ Chrwtic SuL-sti,nce {}bast 'onz W'nat do you do for income/money? N U a CC,m� ow would you describe, uour need for the following services? Level of Need Lcvcl of Noed Sig'rificalrt Some No Sigv ficart Some, No 5cvcc N Need vccd Servce, Nce Nced Nam R x al louirt� / ❑ ❑ Outreach Sary ces Re, tal pssistnnce �VJ ❑ ❑/ Sabstanac*asc Troa;mce. Sc vices ❑ ❑ Nor,-CongrcaatcShelter ❑ ❑ / Transxriaticn ❑/ ❑ YJ ai4{i4rc ❑� ❑ 6] Ca'sawtanage>nctrt ❑ r i > ducatonSer�ce ❑ ❑ W1 dwton ❑ ❑ [Sd/ Training / ❑ ❑ CrattR-7,air ❑/ W✓ Q hoed u7/ ❑ ❑ Landford/Tena t Liaison ❑ Cl {-{octsin3 Starch and Coansct" / fin' s�r YIG{�irys br Domostic su v es a ❑ ❑ viols u�I Pa t fig�lwlence/Sezcal ❑ ClAssault/{lainan Tra{{ddng / Legal Servces fl sn3 financi al Assistance (Suurity ❑ ❑ C9 DcposHS,U-iGty Assistance, mz Ai J9 ❑ ❑ Costs,First and Last Wblr.0n'sTRcnt) Life Sells Training ❑ ❑ 44omek5s Prevention d Mem+Al{-'catt'n Servicas �j ❑ ❑ };ousin� Coansdiny © ❑ ❑ Dui-�aiiorrt{ltatW7 Services v2/ ❑ ❑ OWlcr ❑ ❑ ❑ ❑ ❑ 578 uty of 44wv tiv5tori Beaoh +410Nh1 Amrrica'n Pzscue -Plan i{ovy)eless Qnes+ioh�aire `;'°' ae Avner ca» Pe cue Plain CAP) will provide SZ.24 million to assist individcwls or households who are,homeless,at risk of homelessness,acid ether vulnera_b!e populat ons, b{_ rav du g. o e a�gss stmnu�yt oriaVe sery te, a, n s grcc}a e sheker, o rufuce l OW essness avid increase housivg stability iv{{untie ton 8cach.Please'ne c J� xs�rarr p , mg is quesfionnairc. Na me Cl/ nd 1 L'�/ �V l�/1������C/�`y P'none �� c31 2— L109- r9e RAce �� � � �/� ;rlspanle? �5 ❑ No L ngth of currevt episode or homelessness: Tow mAvy times have you been homeless- I Lcusehold Type: Single.Adult ❑ Ce,.ple vthatt Children ❑ Single Parant r/Children ❑ Iwo PAreHts W/G' ildrtn �❑ Unaccontpanie Y\\outl^ ('i? or yocutgtr} where will you be sleeping+onig'nt? ❑ Sheet ❑ Vehicle � 5heltar ❑ Ln a Park O YA,ntzlJrotel ❑ FAntily/Friehd ❑ c;hcr Veteran (13+yrs, old And U5 Arraed Service or Activated rlatiomcl Guard/Pesery sr)? ❑ Yes No Are you+Nivg to flee from domestic Violence,dating Violence, sax l assault, or human tra;cbnyZ ❑ Ycs [ Ne Do ycu have a'e,,y of the following condi ons? ❑ rilentc,!/Emot atAl Di erdcr ?hysicAl Disability ❑ Deve.lo?•,ne.,t Disa'ailit{ ,C.hrcnic Su'ostance Abuse ❑ None li What do you do for (j }low would you describe t,,aur need for t'ae following services? 'LS Level of Need Level of Need SigvifcaK` Some, No Sgvircar` Soma No Service Need Necd Need Sery ce Nced Need Nced "Pzvral}}ousing ❑ ❑ 1-3outreach Services ❑ R m al Assistance ❑ ❑ ❑ ❑ ❑ Scii s+as;ca Abuse TrmftSme Scrvias ❑ ❑ ❑ Non-Ccngrcgatc S'aoltcr ❑ ❑ ❑ Tramsporrat cn ❑ Childcare ❑ ❑ ❑ Cass MAan eVncv+ ❑ ❑ 8dw,a ion Services p G - G ❑ ❑ Ewiplcymen+Assistanie/Job .. _. ., .. - T�r�airim3 .❑ ❑ ❑ Credit pair ElEl ❑ 'Food L,...... ._ . . ❑ ❑ ❑ Umdlord/TemAVi+ Liaison ❑ ❑ ❑ y{ous ng Scarc'n and CounscGng Sc v its fnr victims of Do ncstu Serv�cs ❑ ❑ ❑ V'loleiu YotemcaISewl ❑ ❑ ❑ Assaf N /ffufiait Traf eking }lousing FinAgleml Assis`ana (Saw ty Legal Services ❑ ❑ ❑ Pcposr`s,Uti(rh{Assistamce,W,ovinq ❑ G ❑ Costs,First and Last Momth's Remt} Life Salts Training ❑ ❑ ❑ rlOmeless PrcVem`iom ❑ Wlcntal;lcaWa ScrViccs ❑ ❑ ❑ rousing Counsermq ❑ Cl Outpatiurt 41calt'A Scr Acus ❑ ❑ ❑ ❑ Oi�rlcr ❑ ❑ ❑ 579 G `1 of 44cvtivig+ot Beady w ; }a!DYA-t Am56calh-Reswc 71m, }{o'meless Qcles- iomvirc, The Fm:rican"'�,-,scue flan (r KF) will provide�Z.2.4 millimn to assist indWmals or'nousc'nolds who arc homeless,A+risk r,' vulnerable populations, {_ ravidi•ng.houinq,rental assists lncc..sxppocnuc_services,and-Hon>- - roe gre +c ssV eater,+o r hot Vnelessncss an increasc'nousinq s+a'oifity N 4-kwrhngton Beach.Fleas&hel the ' IS , wwp is V65-honnairo. Nume P.ge — — R'w MN + t `-i'rn +4spanic4 up ye.s ❑ No 1 Lrngth of"Trent episode cf homelessness: nwny i m'es have you'oun homeless? ` ouse'nold Type Single t?du(+ ❑ Coapfc r it,^.eut CI ifdrzn ❑ Single Farcnt WlCnildren ❑ Two Faren;s W/Children ❑ Unaccampani d Yostth (17 or y m;ger) W ere will yoct be SIM 'In tonigh{Z ❑ s Tact ❑ vehicle C clieiter ❑ D a FarL- ❑ Mot'i/retzl ❑ Family(Fric»d ❑ Othar / Veteran (ib—. yrs, old a/nd US Armed Service or iu,—jcVa ed Na oral[auard/Reservist)z ❑ Yes No � Rre you ying to{lee from domestic violeviz,dating violence,sexual assml+,or human traffubng4 yes l7o you hove any o,--"+'ne fallowing wrdifions4 ❑ V�lental/cmotionai Pisordcr�Fhysiccil Pix.bility f/ p PevclopmentVisa'oili+y ❑ Ghroniic�cl1Sppabstanc6 ,hose ❑y�Ncgne what do you do iov) would you descri'oe your nerd for the following services? Level a=Need Level of Need Sgni&ant SOYAG No So�nii can Som& No Service N N&cd Nerd Need Nced Ne&d "}2en+al}'reusing ❑ ❑ oeriTeach Services p Ron al 4ssistancc ❑ ❑ ❑ Subs+aHce fibuse 7reattinaai-Services ❑ ❑ rNon-Con3r;a�ate Sneltcr � ❑ ❑ Transporration Childcare ❑ El .❑ ❑ 'Zj Cstsc YYAanagc4nocth � / ?=due on Services O ❑ ❑ ❑ r17 W1 anon ❑ nlaj nc;t a sis+bna/Sob tr ❑ Training ❑ ❑ Credrf"R&pair Cl Food ❑ ❑ Landlor4-rev a4 Liaison p ❑ / f 0";tg scarc'a and coansaCmg r h for Vtctfms of Domestic I" ServLcs ❑ ❑ Vole ie""%Dat rg Yolpnce(seKaal ❑ fssaufi /fr'i Trafficl3ng { easng hnaneal 4ssis+ana (Su rt{ L&gal Services G ❑ Dexs'r•s,Utility{assistance,Wbving y5 p rests,first and Last ❑ LifeSWIsTraininq 0 ❑ })omcicssPrcvnr on ❑ ❑ wlon14{-ea( h Services ❑ / El {?Dosing Coansefing X ou+patiarh{{caWn Services ❑ � /"' ❑ ❑ Oii•;cr p ❑ 580 Ci-h{ of 44wi+ivl9+ovi 'Beach - �{O'ME �}tmericah�escue �lah }}olmeless Qrnestiovlhaire ;�� The finericanRoscue Plan G*T) will provide$224 milBon to assist indivAuals or housc'nolds who are homeless,at risk or homelyssness,and ci 1 cr Va.lnera'alc Pena ,'o s�l:p�ovjdr2g,�ousin¢j renkal:assistana;:supporiiVasery ces-and:norr— wngrcgato,shelter,to rcduco homclassacss and increase housivl stability innfln flu ton 8cach.?lease el er nmpo a va ` o i gra wnlp ng Is questionnaire. Nameh�yl',1`S.y �T-'�-�tl P'none �i1=���1n ll �-lei '3e � T:ace � ` ` � }iispanic? ❑ Yes �cLo Leng h of current episode,of homelcssn ss: t, o _ �I o how'many ti'mc, ruve you bean homeless? }household Type:; Single nd dt ❑ coLylL N.'I+hOLC ChI dr Ln ❑ SN-)Ic?arenr w/CI)Uren ❑ Two Par eats Iv/Children ❑ Unaccompanied Youth (17 or yoanger) whcrc will you be sleeping+onigh-tq Street ❑ vehicle 6-Shd;er ❑ In a Park ❑ YNotel/!;otel L' Family/Friend ❑ Ot',lzr \rL t ciao (16+Nrs.old and O..S Permed Service or Ac-tivated National C41ArdfP? Servist)? ❑ Yes iU. �No Are,you truing to flee from domestic volence,dating violence,5exL'Al assault,or human tr4f7lLking? ❑ Yes IENo �o you have any of the following coed' ions? r9.nlen+al/Emotional Disorder ❑ 7hy5ical-pisabilitN ❑ Pevelopvr,ewt➢isa'vility ❑ Chronic Subsrawce ;Sbusr ❑ Nate what do you do for income/money?'M L;; rj--\ V n'ew woulA you Aescribe your need for tine following services? Level of Need Level of Need Sg:;if cant Soma No Significant Somc No Serve Need Need Ned Service NceA No'd Naafi "kc�al}{Dosing ❑ ❑ Dutrcach Service ❑ G ,� -Rzeal Assistance ❑ ❑ Substaiico{;base TroaiSncht Ser,dces ❑ ❑ ,� Nal-fangrcga+c SheHcr ❑ ❑ yj, Tmisport�atian ❑ ❑ Childcare G ❑ Casa YnaHeujo»e r+ �:. ❑ ❑ EdtvAtion Ser Acts G ❑ q YAcd gt on £:mployinurh rassistanee/Job � ❑ �. Training ❑ ❑ -i� CrceitTzpair ❑ ❑ ,Fb ❑ ❑ ❑ Landlard�enanh Liaison ❑ ❑ 44m rig Starch cold Counsetng Ser v:"S fi)rQ c Vns of Pomostic Sere es ❑ ❑ Ya�iue/Vating Volence/SeW.al ❑ ❑ Assaiil�./{ R'man Traffcld:ig Leggy Se v tis ❑ }casing Fina:uial,assistance (Security ❑ -PcpoStts,IAtirttN Assistance,Moving ❑ ❑ Cost5,First and Las+Yne:t't�Y15T�'nt) Life Stills Training ❑ 6. ❑ Votnctes?revenue" ❑ ❑ Y+1at+al{{oaFt'a Samces ❑ ❑ p� }{0osin5 Coansefing 73� ❑ ❑ Ou patient{lealth Service ❑ ❑ Other ❑ Cl ❑ 581 City of+✓���ih�1 ova Beach ::,�,�; } DtMi✓ Amcricavi IZcscue Piah - -�Dvrldcss Ques+iowhaire "' The fimcrican"Rescue Plan ( R-) vnll provide$2.24 million to assist individuals or households who are homeless,at risk of homeless,ess,and_othcrvufycrable .onulalions b{,pre y9yusiny rkntALassis e h taucsccpporyavcs6mces_ayd.t��titT congr e sr cFtcr,to r ucc homelessness and increasousing stabirity in}uyt n ton Beach.Please eJ of (� r ,SejYaVIT IN comp I yg isquesticwwire, Name h \`� 1 1 .� Phone �.. 1�) '�e �� �� \ ,\" �"—`��l\`- � ISpANIGZ ❑ YGS LYL No " Lengf'a of curroyt episode of homeicssyess: }{ow many times haV you bacn 'nomeless? C Pousehold Type: Single fidult ❑ Couple xit;mtit Childrzn ❑ Siy71e Parentw/C4,ildrzn ❑ T"vo Parents w/Childrey ❑ Uuacaompanicd Youth (17 or uocwqcr) Whor will uou be sloe in to,,igh ? ❑ S-rreet ❑ Vchicic Shel e.r ❑ iN a P�:rk ❑ rAotel/t4otel ❑ Family/Friend ❑ 0+1cr Veteran (154 yrs. old and US firmed Service or fictivAted Nat Dual G,uard/Reservist)? ❑ Yes 61 No nre you trying to flee from domestic,violcncc,darinc)violence,sexual assault,or human trafhcang? ❑ Ye5 ❑ No Do you have am{of the followiyy conditions? then+al/�mo oaa!Disorder ❑ PS1.Isical Disability ❑ Develop»er,t Disability ❑ G4u'onic Substance,Sbuse ❑ none, What do you do for income/money? ?{ow would you describe your need for the followiyg servicos? ----------------- Level of Need Level of Need Siynifica,rt Some No siynincAnt Some No Service Need Ne6d Neel Service Need Need Necd R ral{}Dosing ❑ ❑ Outreach Sery ces RcntAl{651stmoc ❑ El❑ Substance ibuse Treatvna,t Sery crs ❑ p ❑Ncy-Coyyru�atc shelter � ❑ ❑ Transportatioy � p Chi!daarc ❑ ❑ ❑ CA MlunaajcFnc,rt ❑ duca t on Services � ❑ ClW o4u-hoy ❑ ❑ '�mploym&4 Assistance l Job 1 ❑. ❑ TrAiniyg ❑ ❑ CrcdN-"Repair ❑ ❑ OOd Cl ❑ O LandlDrd/Tcnawt Liaison ? p Cl }{Dosing Scarc'n and Coctnsetng Ser*4s for Ywiims of Dourest Services ❑ ❑ violc-i /Daiing Yiole ice/Sexual g p ❑ AssauFt,/Haman Traf{ycbng }6,tsing FyAncial Assistance (SecarNy LegAl Sery ces g ❑ ❑ Deposits,U+irN y Assistance, Moving ❑ p Costs,First and Last w,aytia's'1Z;nt) ❑ Life SURs Training ❑ ❑ }omdess Prevartion ❑ ❑ WicvM?}calthServices ❑ ❑ }lousiygCounseling ❑ ❑ Dutpmlicrct}}caWAServices ❑ p pone 582 Gi-f q of 44mi+iq-f ovi ae,ac� w=- BOWIE Americavi"Pescm, Plah }-)otme(ess Q,�es+ioi�naire `"°'�'' The pmcrican Rescue Plan (AR?) will pro ride$Z 2 q milfinn to assist indiv duals or houscnolds who are home e,s at risk Of homelcssHess,_Gndetheryulncrablc_po la+ons,.by, oy %•yoy�sing,.rcntal.assstance,su pont�vuservices,-and•ndn — congregate she 'er,to r duco homdcssness end increase housing stability in}hunt n ton 8cach.Please el rO a g�a comp , ng iss qucsttonnairc, Nam!' "�C •�1 ''I,, Age ^ / 44Is?anlG? ❑ Ve.5 ❑ No Length of eurrevrr?isode of 44ow many times e you hav been homeless? 1 uousdnold Type: Nl sin)le,adult ❑ Ceuple with ,t Llsildi en ❑ 5in�lc?ar enr wf Childrui ❑ Two Parents w/Children ❑ Unauompanicd yokath (1 i or younger) whore will you be sleepin9'tonigh ❑ Street ❑ Vehicle 4ialter ❑ T_n n Park ❑ motel/¢ otcl ❑ Fmmily/maid ❑ Ottur Veteran (16 rs. old and US Armed Service or ! y ftctivated National(avard/Rescrvist)7 ❑ ;'es ❑vine .Are,you trying to lice from domestic violence,dating violence,sexual assault, or human traf;icking? ❑ yes Do yeu haVo any of the{allowing conditions? ❑ 'Mental/cmo-nonal Disorder ❑ Physical Disability ❑ Davelo?mint Di<q'ailii I ❑ CVvonIC subStapCe 9bU5t ❑ None 1� na�s YJy7at do yCGI do for 4ow would you dcsaibe your need for the following services? Level of Need Level of NacA Sgniflpp'aKf Sonic No Significan oni t Sc No Service Nedd Need Need Service Nc Nced Need Rental}ousing ❑ ❑ outreach Scry ccs �7 ❑ ❑,r Rental gszistance ❑ ❑ substaiuo abuse Treatment Services ❑ ❑ Non-Congregate ShcFtcr ❑/: ❑ � Transxrtaiion � ❑ ❑ Childcare cm'l/// ❑ ❑ Cau YMna�oirce �T ❑ ❑ education Servses ❑ ❑ medaiion ❑ ❑ Empby,,nent,9ssistancc/Job Training ❑ ❑ ❑ CrcdN l�pair ❑ ❑ -food ' El ❑ landlord/Tenant Liaison ❑ ❑ 44ms4ig Search and Counseling _/ Seances for victims of Domestic Services hJ ❑ ❑ Uwfcnca/Da--HM Violence/Setw l ❑ ❑ l {tssau}r_/{{union Tra{{ic�'ng }Dosing :anc al Lcap.ISrvices Assistance (S&%Tr h{ ❑ ❑ Depes'rts,Utility,assistance,riloving � ❑ ❑ Costs, and Last ribnt'n's'Rant) Life Sfdlls Training ❑ ❑ {r'omcicssss'P Prevention Mental t:caky,Scrvicos [yi ❑ ❑ s*ovsing Couns�ng ❑ ❑ Our atient}{ealth Services m ❑ ❑ Other ❑ ❑ ❑ 583 City{ of 44wltivigfo�l P>eac* N. 440ME �tmerica��escue Pfaw - 440mele,ss Ques+iovivlaire y e{m -rWc i Rescue Y!Ah (Y*F) will provide�2.24 million+o assist individuals or households who arc homeless,A+risk Of homelass_ness,and a Ncr vuMcriWc_ .o . lations by;providing;ho tsing rcnta4assis+ancc,supportvaScrves-AYid'roc— congreg�,e shelter,to r ut�homelessness and increase koRSM stet irity in{ u rt n ton Beach. lea �° a T a 9ra comp ng is questionnaire, Name �51� one Mccu w,� k _ �NDne CjiLj� ,nAk }{IspanlcZ ❑ ves No Length of current episode of homelessness: 11'1Ga-H 15 {7o\U many times have you bean Nemelus? Get +V1C1 h �yD Cl vrib1N+t-, rousehold Type:singly P;dalt ❑ Coup!e without GrJldren ❑ Single Pcrc»t w/C'ailareti ❑ TWO Pare'ys w/CkildrnI ❑ Umaceompanieci voutSv (117 or yowit cr) Where will you be sleeping tonight? Cl Street ❑ vehicle Shelter ❑ Tn i F&L- Cl w.ot,q,,,Dtel ❑ Favnj[.y/FI"Ie47d ❑ pit+,;.r e-+eran (I vrs, old and US �-;rjncd Service or Activated National Guard/R-scry st)? ❑ ves N No ?re you n{ing to flee from domestic v olence,da ing violence,Sexcal assault,or Numan+rafficSdng? ❑ ve.s CNN/No Po vat Navo any of the following wnd lions? ❑ wlcntAl/Finatianal Pikordcr ❑ ?hysical PlsAbili ❑ PeValopvne.nt Pisa'aifit{ ❑ Ckronir Substance Abuse Nona What do yOti do for income/money? row Weald you describe your heed for the following services? Loyelaf Need Level of Need significant Some No Significant Somo No /w Need Ncad Need Service Rentalrousng Cj Need Wed Need ❑ Outreach Servicrs ❑ ❑ "Royal,4ssistanee ❑ ❑ ❑ Substanco,hbuseTreatmevihServices p ❑ ❑ NOW-Congregate Skcltcr ❑ G G Transportation p ❑ ❑ C iLkAre, ❑ ❑ ❑ CASe'/r♦AnA�eWiG11t ❑ ❑ ❑ U:AacatlOn M SGLLS ❑ p ❑ nledia+lon Emn?b4kcnt Asslstattca/Job ❑ ❑ ❑ Training ❑ ❑ ❑ CruitPepair ❑ ❑ ❑ r°0d ❑ ❑ ❑ Landlordf`i'cnaw,t Liaison p G ❑ }(ousing Search and CeomseQn9 Services fog Victims of Domestic Services ❑ ❑ ❑ Yo(e c /Paling volenae/SmW ❑ ❑ ❑ Pssault/04mn T arafficking {Ousinq 11nantial Pssistancc (SwArh Leafal Services ❑ ❑ Cl P6�Osits,! HRi Assis+anco,MoNnq ❑ p Costs,First and Last YMn+h's Rcn ) ❑ Life Skills Training ❑ ❑ ❑ };omo!ess Prevention ❑ ❑ ❑ IMcntal{>•caFtk Services ❑ ❑ ❑ }lousing Counseling p ❑ ❑ Out?atient{�caFth Servicas ❑ ❑ ❑ Othor ❑ ❑ ❑ 584 City of 44 oitiwgtow Beach }{D6v1� �tv'nericah�escue Plate - {�otmeless Ques+iohhaire "'"' ' ?he Amcrican2cscuc?an (RR71 Il nro 'de. 2.2�lJo�ttoassistrrdtviAualS.or_hoeisel�lds.Who.ace;homde55,-a+ris�- of homelessness,and oincr vidneraWr populations,by provSding hossin ,rental assis+Aiir,,sapporiiVc services,and non- cue aiti cssness an mcrca o sta i u n on coca.7 castlirlp e,CrN of ;-}wrung+on'Death gath`cr important data needed"for this grant by wmplot ng ii7is questionnaire, Naito �(�� ?hone la Age 1� "Race n� }}is ante? Yes ❑ No Length of c<rrcnt episode of iwmcicssness; 1 Vow many times have you been hom n homeless?? i/IUYI' tk�' q LvC. roaseho!d type: Sin,)!e,,adult ❑ Couple wit ;out Children ❑ Singlc Parcnt w/Children ❑ T wo?arenas w/Childrui ❑ Unaccompawe. Youth (1; or younger) where will you be Sim pi`'g tonig4 t t ❑ Streat ❑ Vehicl., jI Shelter ❑ 2n 07ar'e ❑ Mntcl/;Iotel ❑ Family/Friend ❑ Outer Veteran (J& yrs,old and US Arm5d Scr\ricc or pcativatcd Na-nonal(auard/2cscruisr)? ❑ Ycs "�, No Aw you Virg to flee from domestic Violent-, datng Violence,SZWI assaWt,or human trafficbng? ❑ Yes No Do you have any of the following conAltons? l�wlantal/Emotional Disorder ❑ 7hysical Disability ' ` ❑ L'evclopmc:it Disability ❑ Chronic Substance Abus.: L NA w'nat do you do for income/money? }low would you describe your need for fine,following serACes? Level of Need Level Need Sgnificae Some, No Sigviifiaant Some, No Sarvice Neil NeeA Necd Service Naed NeeA Ncod "�artal Noosing ❑ ❑ ❑ Outreach Services ❑ ❑ ❑ 'i?crtal Assistanca ❑ ❑ ❑ Subs t arcc Ab:tsc Trcatmcrrt Srxviccs ❑ . ❑. ❑-. Non-Congreo}rte Shaper ❑ ❑ ❑ Transport ation ❑ ❑ ❑ C1iiLkare . . . ❑ ❑ ❑ .. Case YMnagem �, ❑ O ❑ £ducat on Sery cos ❑ ❑ ❑ Hied allon ❑ ❑ ❑ £mploymcirt Assistanu/Job """""'" Training ❑ ❑ ❑ Crart-TzpAir ❑ ❑ ❑ Food ❑ ❑ ❑ Landlord/Tenant Liaison ❑ ❑ ❑ dousing Search and Counseling Scrvicisfor Yr Mi of Domestic ScrVicas ❑ ❑ ❑ viotawo I sating vlota"/saual ❑ ❑ ❑ Assam+/}}umay Traffick ng I Services fr'oosin Fi g wwial Assistance (Scc,trH i Lcp,A ❑ ❑ ❑ Dcpcsrts,L"HN Assistance,MWVU3 ❑ ❑ ❑ Costs,(Irst and Last atontn's'Ran+) Life Sails Training ❑ ❑ ❑ }{omaless-Prcwantion ❑ ❑ ❑ mental Vwfol Sarvlee5 ❑ ❑ ❑ uoasiag Counseling ❑ ❑ ❑ DutpaHceJ,4catth Services ❑ ❑ ❑ Ot'ncr ❑ ❑ ❑ 585 Ci h{ of 44mtiwgtoh Peach 440ME Amcricari-Pescue - {-�otmeless Quesi-ioalwaire "'�'-• raa < Of homeless wss,and oi'ncr vulnerAb ?rele by ua ° o arc om ess,at risk populations, v dng housing,rcvrtal assistance,supporiiVr set-Acos,and mom- congregate shelter,+o reduce homelessness and ima easc'nousing sta'oirtty in{{unt ngton 8eeth.Please help the CHy of T{utrting+on acach gainer importayt da a needed for this gray+by complat ng this quesiiomnaire. Ag Yacc f ; 5:19Ji 5 i, LJ No Latg h of surrey+ep sode o homelessness: ' Vow waq times have 4011 bcey homeless? V"Schou 74?e: ❑ Singld rdult ❑ Couple wi 4tosi+Children ❑ Singic?arcs wIC'nildren ❑ Tmo?arurs w(Chi;dren G ww companicd Yoet� (17 or yotu,gcr) w'nerc will you/be sleepimg tonigh ? L S+reat ❑ Vehicle Shelter ❑ Sn a Park ❑ iNotcl/-'r,'otcl p paniily/Friend ❑ Oii.tzr Ve+eran (15T yrs, old amd US Armed Service or Aciiva+cd Natiomal (,�.ard/Pzscrvist)? ❑ Yes No Arc you trying+o fee from domestic violence,dating violemce,sexual assauk-,or human tra fficbmg? ❑ Yes O No Do you have any o-'the{allowing conditions? Di�Narhal/=:nMional Disorder ❑ P'nysical Disacft.{ ❑ Dcvclo?mart DisakiG+y G Chronic Substbnce Abase ❑ None w'nat do you do for incolnelmonc{t }low wouid you describe your need for the fallowing services? LcVG �N� Silty fcayt Some No Signifcayt Somc No F�As� m ce Need Necd Neal Service Nccd ❑ Need Need ,,, ❑ OuirServices ShcFtcr � .....__ use 7rcatmcn-(-,Sc .. C3Q❑ ❑ Transportanom ❑ ❑p ❑ ❑ Cgso W1di nest. r�lutatiom Services ❑ ❑ ❑ o. .._..-. . . . . . . .❑ '.. .. ❑ C3. . c`mploymart Assistance/Job ' ' Training ❑ ❑ ❑ Gedt Repar ❑ a ❑ ❑ ❑ Landbrd/Tcmant Liaisom ❑ ❑ ?lousing Starch and Counscfing SorVvas for Yctinis of Po�ncstic Sen/ccs ❑ ❑ ❑ Yiolc'.ce/Dating Yulemca I SeY:,al ❑ ❑ ❑ AS_sault/{�umahTrafi=�ng . Leaal Services ❑ *l�/smg Finatwial Assistance (Seeuri-;y ❑ ❑ Deposits,Utility Assistance,Mtov m ❑ ❑ Cl Casts,First amd Last tyont;l's"2en0 Life SIdUs Training p ❑ ❑ }lomelcss Prcvcyi on W.cmtal fr'cahit Services ❑ ❑ , . . .. ❑ ❑ ❑ El }rousing Counsd[ng ClO* Putier+{lcaNil Services ❑ ❑ ❑ Other ❑ El 0 ❑ 586 Gity of 44mitivigtmi 8e h 44OM:E A mericeii7 l zscm -Fi n 44oMe,le,ss Questiohwaire ; The American P.esaic Plan (,?zP) will provide,$Z.24 million to assist individuals or households who are homeless,at risk of homelessness,and other vulnerable populations,by_provid ng housing,rental assis+ante,sugpo ve_services,.and non, s 9ru�ata s e r ,to rcdu c 7n�essness an increase housing stabifity in}{untington•Bcach.Please help the of l 1 mp g-MSd o 7t=aiYe. Aoe,=! �� 44ispanic7 ❑ Yes No Length of current rpisode of homelessness: Uow many t1mrs have,you been homeless? }?ousahold Type, mgle Adak ❑ Couplc wi'i lout C4,nldren ❑ Single Parent:v/Children Cl Two Parents w/Children ❑ Ut;acrompani„d Youth (1? or your gerj Where will you be sleeping towi9ht? ❑ Street ❑ Vehicle 0 S'aclte.r ❑ Ia a lark ❑ motelp,'Otcl ❑ Family/Friend ❑ O her Vei•rran ('i$t yrs. old and US Award Service or Activated National (auard/P_escrvist)7 ❑ Yes XNo Are,you trying to{lee from domestic violence,dating violence,sexLvl assault,or human traffic6n ? ❑ Ycs XNo Vo you have any of the,fol`loww4ig conditions? ❑ VAcntal/Emotional i isorder ❑ Physical Disa6+ility / \ ❑ D;velnpmeut'Disabififil,�q C'r,runic Substance.{�br;;;; ❑ None,. What do you do for income/money? }low would you describe your aced for the following scrvices? Level of Need Level of Nccd Significavrl• Some No Significant Some No FaiiVkArc ice Need Need Need Service Nerd Need Need I ❑ ❑ Outreachservias p ❑ ❑ ce ❑ Substanco i*asc Trcatment Sere cos ❑ ❑ ❑Shelter ❑ ❑ Transportation ❑ ❑❑ ❑ � Case,Wlanaguwrt ❑ ❑ ❑ ..ducatlon Ser Ac6s ❑ ❑ ❑ YAf attoN ❑ ❑ ❑ Employment Assista:uo/Sob Training ❑ ❑ ❑ Crcd'rt'Rcpair ❑ ❑ ❑ `rood ❑ ❑ ❑ Landlord/Tnw'nt Liaison ❑ ❑ ❑ }lousing Search au!Counseling Servues for V"Yris of Domestic Scrvicas ❑ ❑ ❑ Violence/Dating Violaue/Scxaai ❑ ❑ ❑ Assmdt/{luman Trafficbng }'rousing'rinaruial Assistancz (SmirHN Legal Services ❑ ❑ ❑ Pc,osH-s,Utility Assistance,moving Cl ❑ ❑ Costs,,Fnt and Last Wwnth's Rent) Life Stills Training ❑ ❑ ❑ tlomcloss Prevention ❑ ❑ ❑ mental{ with Services ❑ ❑ ❑ }lousing Counseling ❑ ❑ ❑ Outpaiient}lealth Services ❑ ❑ Cl Other ❑ ❑ 587 Ci h{ of 44m+419+ovi -D661CV 440 ME AwericmTzscn -Plan {�ovneless Ques+ionnaire '•�'�• he r?mcr can7escue Plan 6�z?) will provide$224 milfion to assist ivdividuals or house'nolds who are homeless,at risk o nDL CIe55V'e S, LJ�Of''Je�VFtfYGK9bIP-p0�.1IAi.70N5p�{:peoYldmq.hoetsinq,.real.assistance,-sewpori:;Vuser•VLces=and�non cot;gregatc shelter,to reduce homelessness and increase housin staiiifi; in 'untie ton8cah.Please el e c1tv Fq D e er Lmporca st a n ca tvr ras grav t comp ehnq this questionnaire. •:��j��'+ `'� li 'i?accs r � -` ,ni}ispawic?. ❑ Ycs �No '�::Le• h.of&wr.e,r{,cpisode of.Nemelesseiess~•�+ \ T•''''`!" nqt, r is ZZ c,�row Vnayy tii4tcs have'{ou.becn bmmdess? . }lousehold Type. VSinglc.'adult ❑ Can?le without Children ❑ Sinnlc ?arent w/Childretj ❑ Two Parants w/Children ❑ Unaccompanied Yout'n ('i7 or younger) :vhicra wi ya�:�e:stcepia t5 i`g'ift l: r S y W ❑Strut ❑ vehicle: LkSliclte.r ❑ In a Park ❑ YAOtell4otel ❑ fmnily/Friend ❑ Other eold;aid US`fit'Lied Ser,Viu'br fwtiVatad Nit�w:ui blaard(REsati'lstJ? _Cl Ye<�No i1Te N trv;i24_�'D ee Lityd�Y�... . r�i't?-G•7 cl.�S1-�...K:�'^;�* s r. .,,,.�`j0 u5 :fl _fro �,es:^,cvioL;iica:ddtitiiiy'.�rinle7ee.sexcir^i assauttr or Rx+t�Laa:fi-�ftldat�T.�� Ycs�No 1?mine?%pc-f $Le;f��tLiP79coid}Fiovs?:: ❑ weatal/cnlotiona!�isordcr ❑ ?hlsicalDisability ❑ Development Discbilitt LNChrooic Substance tlbuse ❑ None t -t1 do��(cu;da.t'ur:iiuoNie�Yriohe!(l.:i � U Nil I� ?�ov;�+FA;,gci�'A�sirib�"yocir need;fo'r`.1-he follbwiiiq saryices7 Level of Nccd 90E] Significant Some, No Signifi Service Need. Need Need Sery ce Nee �tntal riousin9 ❑ ❑ Outroach Scrvcas ubstanco Abuse Treatmart Suvicos Tra'ns>ortation❑ ❑ ❑ cnsc PAanagotincnt ducat on Se v cos ❑ ❑ ntcdiation Emplp{Lncnt Assistance!Job " "-` ❑ �'\ ❑ Training ❑ ❑ Crcd t IZ pair p ❑ / \ FDOd � ❑ ❑ Land(orA/Tanavrt Liaison ,�L' ❑ ❑ }{Dosing Search and cwiiseling Suv cis for%atin s of Vomcstfc Suv es k ❑ ❑ 'p fig Yolcnca/S6" ❑ p Assault/}duinan Traf{tcl�ng }?Dosing V wvoial P,ssistaruD (Scanty Legal Servicas ❑ ❑ Vepos''Hs,tttiGty AssistAnCe, Lnoving ❑ p Casts,First and Last R1ot;th's"i'•url-) Life SIdlls Training �'$�' ❑ p };omdcss Prevontion p p Mveal YIwltit Suvicos "��\ �. ❑ ❑ 4,Lousing co&*iwlinq \1z) p p Outpatiar;•r caNa Sanrus ❑ ❑ p Ot'ncr ❑ ❑ Cl 588 G" of F���+iwg1 oin P�eacl� -�OtME AmcricaviPeswe • 1, T}oimeless Ques+iovihaire , "�''' ' No American-Pescete-Plan ({+k-P) will provide�z.24 milBovl+o assist individuals or housoholAs who are homeless,at risk —• -homelassNess-and=o+hcr-vulnerable-populct;ions-4�{�rovtdiii9•housiri�r8ni-af nssi's1=a�ie-selp�ol�t�c sar�nccs,and noN- c.oviarccwtr 51rieltor. uvrt ngton-Den* gather impor•tmrt data needed for-i-Viis gravtt h completing this questionnaire• name i' 41-k :l / 'l 1I it , ` ll AgG I_I RAGG .0 1 1{ q }rlSpaNle? ❑ Ya> y�o Length of current episode of homelessness: t143 1q{ow maxv,times h/ajve yoct been homeless? ?;eusehold Type: ❑ Single Adult ❑ Coi4Ple vM+',ot4t CNIircN in le Parent w/Nildrea ❑ I:':U?ArdNts w/Children ❑ UNaccompaxied Voat-li (17 or, yow qer) I! Ware will you be sleeping &vig'mn ❑ Street ❑ vehicle Shelter ❑ In a Park ❑ wbtel/? otel ❑ Family/Friend ❑ O=her Veteran (1&-yrs. old and US Ahmed Service or Activated National(juard/Reser Ast)? ❑ Yes IP No Are you trying to floc from domestic viofaice,dating Violence,sexual assauft, or human -rr-afnclin97 ❑ Ycs 2'No Po you have any of t'rte followivtg cond lions? ❑ v^ALntal/LnID •nAI 'Disorder ❑ Phy51GAI?l5abilit ❑ L'eVelopm,xt Dica'aility ❑ Chrome Sulbst�Livicenn -Is A�irvse What do you do for income/money? l tk l�,�U`b'(( {iow would you describe your need for+he folfowing services? Level of Need Level of Need Significant Sonic No Significant Soma No Service Na&d'Z Nud Need Service Need Need Need 'Psxtal '; sing / ❑ ❑ Outreach Services (JI kef ❑ Pev al Assistance L�7/ ❑ / ❑ S4s+anco Abuse Trea;mae Services ❑ / ❑ Non-Congregc e5'reltcr Cl CU/ ❑ Transportaton ❑ ❑ ails(aro ❑ ❑ Caso Pwnnc�ovnert IC(� ❑ ❑ Fdutation Scr'Acos ❑ ❑ m,ratial bf ❑ ❑ rpoymext Assistance/JOL, Traiamg ❑ ❑/ Credit Pepair cl ❑ Food ❑ d ❑ Landiord/Tenant LlalsoN ❑ �j'//- SLMCLS for YWtims Of�onlesiic ❑ }lousing Starch and Couvrserng / SerAics ❑ d - ❑ Vio�ivie)Dating 'violence!Sew.wl [.9' ❑ ❑ Assault/{la awn Assist a' 1 '� }lousing v=inavuial Assistance (Sec�.rrEy Jal Services ❑ Pepo5tts, Utirrty Asslsta"C6,w m&3 ❑ ❑ Casts,Frst and Last Vnonth'sT.rt) Life,Stdlls Training ❑ 4omdcss YreVeniion ❑ ❑ Weeal{kaki'n Services II/ ❑ ❑ }}ousing eounsdng ❑ ❑ Ouh,atier,t i?eaft'a Services ❑ ❑ 0t'nar ❑ ❑ ❑ 589 Citq of }4u�itiwo}tovi Dcmc� 440 ME,gvnericaw (?escue Plavi 44ovneless Questiovihaire The At nericav(Rescue Ilan(ARY) will provide;Z.Z4 million to assist individuals or households who are,homeless,a+risk of homelassness,a�dr.,',ac��gllncrablc, oartlations,.by:prAvidin9•hoasinsy rentaPassis+ai;co=supporfiveser�s;aTd-non_ ca:tgrcga+e shelter,+o reduce homelessness and increa<_c housin s+ab'f in 44j4jj-Hyjq+njj ,a �t to,Dez¢ ga er imporrawr data ncwoa tor is gra+t by complating+his questonnairc. Name ;1 (U "y l� � � �j� u Photte Age 7, l,v "Batt �'�l'"�'L'� }lispanic? dYcs No Lcng+'n of current episode of homelessness: ? ?(ew many mes have you been homeless? household 7ypez:�;.'Single A:{uI- ❑ Coclple, W—hION t 01,11drea L Single Tnient w/Chilaren ❑ Two Parents w/Ciraldren ❑ Unauampanied Ynutl! (17 or younger) W'nere will you be sleepi taught? ❑ Street Cl Velhicle Shelter ❑ In a ?ark ❑ Mot eIl hotel ❑ formIy/Friend ❑ Dt+ncr Veteran (J&=yrs. old and US Armed Service or Activated National(juard/Reser Ast)? ❑ Yes A NO Are you tRling to flee from domestic v olence,dating violence,seXual assault,or human traf ficldng? Yes ❑ r,o TPo you have any of the following conditiats? ❑ YAcntal/`emotional Pisorelcr ❑ Physical Pisabiliiy ❑ Pcvelopr,,cntPisabili,y ❑ Ghroaic Su,bstancc Abuse None What do you do for income/maney7 �;' 1 'F= ){ow would uou describe voar need for the following services? Level of Need Level of Need Significant Soy ne No Sgnificant Some No Service Need Nead Head I Service Need Nced Nced "Rcvtal?kusing ❑ ❑ Outreach Services ❑ ❑ -Pze.Al Assistance ❑ ❑ Substance(}betsc Treatment Services ©! ❑ ❑ Non-Congregatc Shaper ❑ ❑ Tracts?ortation ❑ ❑ aildcaro ❑ ❑ Case P+wnagovncr+ Fduraiion Scry ccs ❑ ❑ ailon 'vmploymcnt Assistance/Job ❑ ❑' �raMing ❑ ❑ CrcdtYcpair ❑ ❑ Food ❑ ❑ l.tndlord/Tanant L'wison ❑ ❑ +bushy Scardn and Catrscling SarWzs for ,tohms of Domestic Services ❑ ❑ Vtalciue/Paling Vblence/Sewed ❑ ❑ Assault,/{iuvnan Traf fiddng }{casing�tnandal Assistance (Security Legal Services ❑ ❑ �DG?0st15,l,itt�rty A551s'tANCG,moving ❑ ❑ Casts,First and Last YMtrth's'Rart) Life Stills Training ❑ ❑ 44omelcss Prevention ❑ ❑ WkW,,Al}(ealilh Services ❑ ❑ ❑ housing Couns, ng ❑ ❑ Dut�aiiarF 44w ii Services ❑ ❑ ❑ DYncr ❑ ❑ 590 C!'N of 44uhti+ gtoh Beach f 10ME:7 f1'rnerica�i�;scue-Flab 440 Vneless Ques low wire l''ne Amcricu 2e soai r nom css•ncss,and other vulncrablc o aus,no s a arc om css,at risk ? pule ohs,by prov d ng housing,rcntal assistant,,support Hive scrviccs,and hen congregate s'aeFtcr,to red ,,hemclessn ss and increase housing stab pity In runt ngton 8earh.Please hcip the Ciiy o ?unHngron teach gather impo,;a.n{ data nccdcd.for this gra rt b{ccmple?ing t his quest onnaire. ten, I -1ZOC ;T �-r Ayes �� I ' ` r ls, ani� Ycs ❑ No C eng h of wrrart episode e hom l ssnessw_&� � r?_w many times have you 16e`aj{^�omdcss? euschold Type: ❑ Sinnle Adult p Coupl ,vithout Children ❑ Sinalc'Parar w/CWWren Tw•o Parents w/Chi4iren❑ Urwaccomoauied You-31 (1: or yostnger) / \ wherc will you be slcepin tmlign Z ❑ St-eot ❑ Veaicic 5'nei-Fcr ❑ Sn a lark ❑ YAo-d/J otel ❑ pamilyyricnd ❑ nt'rcr Veteran (I&-yrs,old and US Arrncd Service or Activated National&ardtZ-scrvist)? Cl Y:;s No \ Arc you trying to flee from domestic%jolcnce,dating violence,sexual ass4*,or/human tra fjicj�ng? ❑ Yes p3f No Do you have any ofr'ne follownhg wndit�ons? p n1ental/Emotional Disorder physical Disability / ❑Developuncnt Disability G Chronic Substance Abasc G None / ` � I Wvh do you do for incomc/moKrV {low would you describe uour heed for the,following services? LGVCI oI Need ---V,I of NrsA Sign cant Soma No significant Some No . Service Need Need Nced 'R:mtal r♦ousUrg. ❑ ❑ Ontreatl'1 SenfsesM� . -Rantal ASS!Stanf/ . ....._.. ...❑ .. ❑ _ substanceAbus'e Trtatmcr,t Scrvltes 'Nee N Need Non-CongregatcShe✓•;cr rear _...._.._.-..., ..— :........ ... ... ... . . f1 `❑' G Transports,'... _ ....�-.�.. . . ❑ Cure 1Ngnaganerrt - . � �� ululation Services •. . - "--•.,_.. _..__, .. _. ❑ ❑ mcdiaiion ❑ ❑❑C, Aj `cmpLximent Assistant,/Job _.._",.-........_ ❑ _ � l" Training ❑ ❑ LrrdttR'�air...' .. �i \ ❑ }� ❑ ❑ Landbrd/7crant L'aison ❑ ❑ }rousing searc'a and Coanselna \ / Seryicas forVlc{itns of PomeStil Suviccz k9� ❑ ❑ vlo a=/➢atinc)Yiclenco/Scz al ❑ ❑ �/ AssauFt/}}ulnavi Tra(Twkwj / Lgal ScrV crs ❑ },using financal ilss scant,(Su," ❑ Dcpos'tts,Utiflt{Assistance,R1oA" ❑ ❑ xCosts,Fvst and Last mart'a's'Zent) f.ifeSNlisTraining ❑ p p 4;mrtcssY_reV&flicn - Ynattal{rra!th Sorvic,s ❑ ❑ r Co'{rousing Counsc�ng ❑ ❑ � Outperient{(eakth services Cl ❑ Other 591 Ci-hq of U'n� ingta� Bead r�'t'r��ts'merica�-R°scue�lati7 E - j {�otme(es; Ques�ioh�aire ;•�; sts ss o cru s w'lo arc omdess,at risa of home1e55hess,and o-i;tcr v"ufnerablc populations,by provtdtng housing,rental assistarue,supportive seryjces,and co ate {?udfillgtrt 5c zlri rg,a-m recrd uimcop ohro Airt data aand increase housing sta'aifrFp4 iy{n{gunt ygton 2eoc'n,Ple,ase help th Cinyo onr gym sq ireuesta - (t 7hohe _ '��-�--- `',ace�y {iispgyic? ❑ Ye; Ne Long n o surrey episode ei homdessycss: �j�j }!ow man4-H res have ou b c— 4 n homdcss?�*�� - - rousehoid Ty?e: Sin.le fiddFt ❑ Ceaplc withcnt Uti!dren ❑ Siaaic Parent w/Childr'ta ❑ TwoYarnts w/Children — G U'nattempayi Yvu 4 (�i or 4atmger') w'nerc will you be slecpi I onlg'nY1 ❑ Street G Ve'nitic Shelter G In n Pnrc ❑ 1.{urelJ;;o-al ❑ paPIN/ r esld ❑ Other Veteran (�Sy yrs,ofd and US firmed Service or ficiivnted Na honal(wrd/ReserV st)? p Ycs ❑ No l � fire you r ng to a om domestc y ela;ce,dating hole z,sexual assault,or hurray afnccng? ❑ Ycs F- no �o yea hays any Cf the follcv;iyg conditions? ❑ VHc»Fal;'m 6wl )sorrier ❑Y41y5ical Di;abilii,{ G�eVClOpment L Kat+Ilit4 ❑ Chronic bstasue r?buse y None w'nat cio 4ou do for incolne/vn�ncyt Vow would 4ou dcscriba your ncad for the following services? Lcvcl oL Need .LJ_ _fir Ncod Ser Sgtir,carf Some No Signircarr : Some No . vice 'Need Need Nced Sendca R.:n+alttmtsing Nced Ne'ad Nccd ❑ ❑ Oytrcac'r,Scrvius i .nfnl flssis,aruc _ p' ❑ ❑ S:+,bStacticrlEusa'freaicncrf Scrvicrn , . ElNoh-Co r•a Sneltcr _. ._ ❑ ❑ TraysporfatSnn .. . . ❑- .. ❑ ,: .Case wland3cGwcyf: :. - .P1� . . .? saafien Services lotion �'_ ❑ ❑ riled � ❑ . zlr,'ploynlcnt rssistance/Sob .-- ;;. -. .-: zr ❑ ❑ - Traiying . d ❑ ❑ Food . = ❑ ❑ ❑ Imo.. ..a1T—- t— son p. ❑ fDo sing Search and e«mscrno, Sc yice5 for Ve vns of�oinest c Suviccs Q ❑ ❑ Ylolcrco'J'Datiny Yolratu/Sexual A ❑ ❑ r?ssauFf/}}array Tra(T+i{;n9 {'roes❑ ng pinarr al{ssistancc(Scuu rt{ ❑ . ❑ Pcposri-s,UtiCHy kssisfasuc,wLovincj F3 ❑ Costs,first and Las+wtc;,iWsT—vh ) ❑ Li;o Salts Training p ❑ ❑ riomelcss PrNuttiat Yrcntal;;caF;h Scrvius El r '❑ ❑ ❑ {sousing Coansalng Cl Oufpaf;a;t{1caH'n Servcs ❑ ❑ ❑ Ot'ner ❑ ❑ 592 CHIN of 44witiw�tmi -Dcacvl 440IMEvnerica'nRe,cue Plan - }roimeless Quesriohhaire '•��^ • �1 Tne Ilan (fRt) will provide�2.2.4 rnilfmn to assist individuals or housc'nolds who arc homeaess,at risk f. o e Lss ess �d o tt,cr� lnecable popula onsT�iy-pro riaingliioasivi,re,,f,�A a sistancc,sappornve services,and non- ungreAJate shelter,tD redute hcmdessncss and i:u e < � : r , , r^ gYe ear gA ner lunperi•atirl- a nu ed for t'nis grant by wmplo ing i nis ouest onnairc. /! n Name 1����((71'✓1 pgL �accl�� c r{ispanic? ❑ Ycs Q No Lcng+h of current e�pisod o- hcmelessness: tow many-Haves`nave you been hom iess7 2 }Dusehold T{pe: Id Singl; :iul- ❑ CcuplL wit;rut Chi4ircn ❑ Si:g!c Far ent ,vjCS';ildren ❑ Two Yar'cnts w/Ci ildren ❑ YDR-h (1; or younger) 'share will you be site>in +oa,g rr? 0 Sn eet ❑ Vehicle J Sh:ltcr ❑ Ina YAr k ❑ Wotcl/�Dtcl ❑ Fa nil4/Friehd ❑ other Vc+rrAn (13.yrs, old and US�;rmed Service or activated NatiDnal Guard(i:.esLrvist)7 ❑ Ycs No >,rc uou trying t D fler from demes+ic v clLncL,da iing VWence,scx:eal Assaalt,or human trafficbng7 ❑ Ycs No Do you have any o-,"t'nL fDllodirg cond'Itions7 ❑ plc:ttal/S;nD;ional Disorder ❑ Physical Pisabili-hy DeVLlOpmc.nt DISA'clll+y G LhrbnlG r]0.175'fanLe tll`i(15e ❑ NDnL What do you do for income/'money? low would you dcscribo your nccd for the following services? Lvel trF Need Level of Nc Significant Some No Nv Signfwant Some No Scrvca d : Naas Need Nead Need Nced RentAl{}onsin9 G ❑ ❑ Outreach Ser ices ❑ Rcy+al{5sistaruc El ❑ Sr6s+anco flbuse Trca ynLnr Sery ces ❑ ❑ tr/ Non-CDngr gate ShLhLr [3 ❑ ❑ Transportation ❑ Childcare ❑ I� ❑ Edutat an Services ❑ Casa'WLanagcVncnt ❑ ❑ may neat }ssistancL/Jo O ❑ walation ❑ ❑ ❑ Trani ❑ ❑ CrcdttR,pair _ ❑d ElQj O° ❑ ❑ LAndlord/Tcnartt LiAlscn ❑ {{ouzing Starch and Counserjng Yitims of Domestic Scr k h ❑ C3,- ❑ Vu� re% pat uj Yolu ce/Sew Al ❑ ❑ ❑._. P.isadt/f{cttnaa Traf;ic�,ng �/ ({raasinal financial assistA ty(y a�rity L15AI SGr'q1Cc5 ❑ i� ❑ 7PPostf5,UiiGty Assis+Amec,MoNI-4,3 C-/ ❑ Casts,Firs+and Las:MaytiJA'ST-vrt) ❑ Li;cSFallsTrainina� ❑ ❑ p-' f}ovncicssYreven+ion Mcntal wealth SLrviccs ❑ ❑ �� {-IDusing C�ynscr ❑ ❑ Dutpatient}IwWo Services ❑ O*or %i �`Ci-v� c. ^/c�it'c ❑ ❑ 593 Ci t1{ of 44wei��tow -Dmoh 440ME F'vnerica i FLscir+ie TUm i r }�o�r,eless Qctes��oh+taire � � as5tin Wult,or viayszrwas wRoarc,homeless,at rises of homdcssncss,and c t ncr vul ncra'Ole po�ularicns,by pray d ng housing,rchza!ass stance,suppor ivc Services,and non- congrec�te s'nefter,to reduce homel ssness and increase housing stab fit{in font ngton 3each.Pledse help the C y of ;!u t ngtri 8cach as her importao-r data Headed for this gra rF cy wmplat ng+his quest onnaire. s I � --99-99 P'rar;c i ;:iSpAHiG7 yes ❑ Nc Lcng h of currev r dpisade o �` 4j e w6re;ossness; •p y a y{mr5'rava you boas hum �ess7 l --- —'--- - — ----- -- — --- -- -- ---- n<i,dt ❑ Couple withcni Childrea ❑ Single Parcwl w/Gtildren ❑ Two Para — ❑ Uaauovracuticd yoniil(17 or younger) na w/Children w4,ere will you be sleepi—n,,tanig'rt t ClStrcer ❑ Vc'aicic 1sP Shelter ❑ Tvi n -Park Cl Wlotel/;-Iecel ❑ Fnmily;pren.l ❑ P{{;cr Veteran (1&+yrs,old and US Armed Service or Ac vat d Nat oval CaArd/R sere st)7 ❑ yes q� Na to flee from domes v olutcc, is ng vjelev;ca,55XAAI ass—Mt or human rrasncb)n 7 rJ ye _/s U,d No Do you hove any of*C,foflognq C"dit;ons? ❑ WlehTal/Enmtional Disorder i�P'nysical i7isa'oi(itu ❑ Daveleptmait L'isabitity Chronic Substance Abu e ❑ None w'nat do you do for incamc/moncu7 C1 riow•Nuufd you dascri'oe your need for the following scrvlccs7 Level of Need Sgnincafft Soma No Lc�d of Ncod Service Nc d Need Need Sgnhwa*h Some No . 'Zental}rousing Cl ❑ Outrcac'n Scrvicv .._.,__. _�. -.-❑.. . � Substanisgbusa Trcarmcnt 5crv+.tcs ' . Ne, N N�d ❑ El ❑ Transpc�eon -. .. ... .... -. Childaarc ❑ p / Case Nta incrh ❑ Cl 0 Bd�cation Services — .. cm•;pLvynjcirFAssistancc I Sob ❑ ❑ iafwn:.-._- Traininj �/ ❑ ❑ CrcdrtRpar.:' ci Fxd ❑ ❑ Landlard/Tenant Lwisai © ❑ ❑ ❑ {iousin�Search and cav,�ng / Scrvic�s for Yori�+is'oC,i7oNtC5tJ. - Scrviccs ❑ ❑ Ycicnca'/Dang Y�lcnaol Scival ❑ ❑ Loa I Scnlccs / r#cusing ritnandal flssistancc(Scuu`Ny 'a ❑ ❑ Pcpostfs,Utifit•f pssistmca'M&Atg / costs,'{ntand Ust mmii+'s?—Vtt) / ❑ ❑ L'r,'c Sells Training ❑ ❑ 4ovrelcss-Frev&tho4I fi ; mcnral health Saw-asG ❑ {{ousing[ounscfiny Fd/ ❑ ❑ Oatpaticnt- C&I ?n Serw:es ❑ ❑ Other ❑ ❑ ❑ ❑ ❑ 594 i I { of 440ME Amcrica'n-pesct^e Yfan {-rotrneless Ques�iov,vlaire "•"� • T1,16 ,9 OfhomeJcssNess,and o-'rncr va(nerahle populations,Ly providiN hoasi reer'l assiscancc,su w o arc ow,rless,at risk congregate shelt:r,-1-o r duce'nome! ssNess an:J increase poc s ng s+abfG+y N xcac'n o Yi use hvie ae C r y o far iNg-on Death ga?ncr i;rpertanr dn+a nezdcd.fer this gra rt by ;npL^t rg tnis quest onnaira Iw?i ene �( ISpANiG? ❑ yes �N� Lrng it or w_rr:r cpis da o {em IessNess; {;'ow rrwny-ivies have voa been homeless? r ousendd Typr: Siv.,pe dolt ❑ Ceuplt wi itca-Children ❑ Singlt?ar .r w/Ghildrtn ❑ Two Parents w/CLtil cn— ❑ I,Rrcuevnpaii..d Yoe:tHn (17 or yowlnedd a ere will you be sleping+onight? Street ❑ Ve'nicle ❑ Shdtcr ❑ _ r ❑ an r ❑ O terY pvibFk1d VueraN (16'yrs,old and US,.rvrM Ser Ac� ,or rtc gated NAiimal&Ard/ -servist)? ❑ ycs ko hrr yea iryi%tg +o fee ;rem d,vnesiic violance,daring Nolrncr,seal assaaf ,or 1,1mag traffwI6gq VYcs ❑ No Do you 'nave Any c,'the,fallo,.aing GONdYioNs? ❑ mea-al/5motiomal�! sor;ier ❑ 7n sical-�is ac iBty ❑ Dtvtbpvt+i.nt Disabifit{ ❑ Chronic�,Sruyb�s-/a�:ue (Amtsasjt,� � _Noae / J/� /y� /; /� ,vha+do yea do for i:uomc/vnoncy?�_[L4-LiN l> I L'V 1 I 1 V/ ; I b[�ll Iw 1 %!W l I �r,�l 1 ?row would voa descri'oc your ncod for-Heir following serVldrs? Lcvei of N&C .Lc1c1 of Ncod Service Sgnifiicarrt Sonic No Signifua• t sow.:, No .Need Need Nerd Server . K:r,cal};casing. ❑ ❑ Oatrcadt t Sd Nccd Nead Nted ni al ass s'ante �i G . ❑ . 'SubstanceCl ❑ ❑ Transpert . Ewlciria G --cdaoation Scr/iccs -._.�' , Nlcaiaticn_ p�: N '— ❑ Crrdr{R av - Traininij , .� [� :p . . . •. �, ❑ ❑ landlcrd/Tcna:rt Liaisat G ❑ roes ny Scarc'n and counseling Sri,ies for Vc 'ms ef➢amcsti Sa-vices ❑ ❑ Vlolaieo'(Datin9�(otcvc�l5ex:wl ❑ ❑ rlsSdciFtf}}unia:iTrafrtc{;ng p Services G _/ {!Dosing Financial assistance(Sccrvitq A ❑ Deposits,(,F}illty psslstanw,ribYing �j ❑ Costs,Frst and Last wunth'sR rr) G Life Stills Training ❑ ❑ {iolttales5 YrcVarEion 'Mental}rcaltit Services ❑ ❑ }{ousing CDw:scfing ❑ ❑ Duspaiiurt{•lealt'nServfces ❑ ❑ 0,?ar a G ❑ ❑ p 595 CitL{ o¢ -;->!rthtigtow Bead f 4 D'McS'�rericaw�escue platy I 4 OV11clOss Questiovlhaire �M ., The flmcricanRscue Plan (r',2P will pro 'de -LTI icss,an otnOr vu nrxa e.poaulatons,�y prov d n housing,real assistance,su nsatc shelter,to reduce 'nomelessncss and increase'nousin stabirit in .c eTI Ve selcip-H andtOn 8aach gai ncr i'mpora t da a needed.tor this gra rgF by compintingA nis que$o haire�a�'nalp the C y of Na4nc !l �� lk�3L �l.l e 4' P'n�tc fv /* Lk uEspanic? ❑ s'_-s !ld No lsngt'l Of utrrevr, raiscdc of f houndcssness: r' �Ow M,ny nmos have you been hovnei ss? -=cetsehold T{pa: Lei Single ,=♦Ltl' ❑ Ceuplc vn'itvect Chi!dren Cl Singlc Pnrc•;t w/C�ildren ❑ T wo Parents w/rhil ire;; ❑ Unnccovn?anic f Yon 4 (17 or younger) where wilf you be sleepin Tonigh ? ❑ Streat ❑ Vehicle Shelter Cl In a ?- ,.rk ❑ Motel/-otcl ❑ pamily,rFriend ❑ Other Veteran (15r trs,old and US Armed Service or AeHvatcd NatjDnal G:tardP�.;scrvist)? ❑ yes ®'No f re yeu to inc to flu from doirestic v olenco,dating 'liolcnce,sexual assault,or hS MIX-i+mffic"? p/ycs ❑ No Do you have any&F iiie f011o'NI g conditions? ❑ Mcntal/Emotional Pi5order IJ Physical Disayility ❑LGVeIo?tncnt Disability hronic Substance{}base ❑ None w'nat do you do for INtome/111ohG{7 NONE .'ow would you dcscribo yoar rend for the following services? LVG--f Na-M l of significant Some No Ls Ncod Serviu Sig nifcant Some No . ntalrio sing NO Need Need Service Need NetY Naed ❑ ❑ OurrwAi ScrVl6us �cntal,gssistancc ❑ 19 ..❑/. Sabs+ance f+bys`q Trcatmur Services ❑Nnn-Cv,m)rco�atc Shcltcx ❑ .❑ TfanIS?ortatl0n .... ... ... . .. ❑' . C u Beare ❑ ❑ SE CA ........ ... . . ❑ ❑ Fduca-hon Servlces _/ ❑ ❑ yX Yn�ation Q'-'1/ cm?Ia{mcnt pssisrdnca/Sob - . . .'. Training ❑ ID CruhfYipair. .. ❑ ❑ �. fooA ❑ Er ❑ Landbrd/Tcna;rtLiaison }busing Scar4i and Coco sing _/ Sery tes fo Ycf rrs ofpoinest a ❑ ClServices 'V ❑ ❑ Wofei�z Dating Yolencc J se;ual ❑ ,� . flssaaR /}{uf?ay Traf7icbng L gal Sc vcrs }lousing hnandal Assisfance(Scour+{ O Dcposrts,fMirtty Assistance,wtoving Costz,FrstandLastwt�vut4t'sRent) ❑ ❑Life SEIfs Training ❑/ ❑ {{omafens?revcntion h'.;trral}lca!th Scn'ices ❑ LV ❑ {hosing CumscGng ❑ ❑ Oatpafieni leatth Services ❑ ❑ Other ❑ ❑ ❑ 596 City of 44vi tihotoh) 'Deaoh 41,D'ME Americari'Rescue Flaw 44oimmless Qvestiohriaire f he{timer canR 5cue Ylan (/fi?P) will proyide,$2.24 milfion to a a e ponu ons, prow im housing,ren i-al assistance,su?port ve.services,and non- ngrcgate sheFter,to rcduca homcl ssness and increase housin stab f {{serf ngton 3cach g4+' sr impory-anP data ncadcd.for this grant b4 complotingAth s quart o�nai cicasc'nclp tnc C ty of co Name fige S(� ?ace f� }?ispanic? ❑ Ycs�vD LXMgtin of curru t episode or'nomelessness: vow many times have veu been homeless? }{ouschold Type, Si:,gie rdult ❑ Ceaplc without Children ❑ Simylc Parent w/Children ❑ Two 7arcnts w/C'niWre+.; ❑ Unaccom?an„d Youi-h (17 or yooujgcr) Whcre will you be sleeping tw,ig'nt's S4 Streci- ❑ VchidC ❑ Shelter ❑ In a Pnrk ❑ motcd(=:rcl ❑ Family(rriand ❑ O-itier 'Veteran (I&-yrs,old and(AS Armaei Service or Activated National(aeardl?zServist)? ❑ Yes Are you tn{i:,g to flu from domrstic Violence,dating violence,sexual assault,or/human rra{=icing? ❑ Yes "P you have any of thefalfow+l� conditions? Tr 5e T)i;or:iedhysical'Disz*ifi+qelopmcnt Disabity ❑ Chronc Sub5talz ❑ Nene What do you do fnr inrame/moneys T{ow would you describe your need for the following scrVieas? Level or Neu1 Level of Nc d Sg:;ifaant Some No Signifcan{ Some No Se \, Nee Need Need Nead Service Need Need Rental}rousing _ ...Scrvf s ❑ ❑ OutrcaCn ❑ Rartal{Sssistance ❑ p Subsfanec frvasp Treai;mcnt Services Nan-Congregate Siteltcr ❑ ❑ Tra rtanon... .. . � .. � Q... G''�rldc,are,. ❑ .. . . ❑ ❑ . . . .. . . ❑ Casa YAaiwgemoirt �ueatwn Services ❑ ❑ mata�an - - .. . _ ❑ ❑ cmpiti{muit/tssistancc/Job ....�- ,-:: ......::., ❑ _ ❑. ❑ Training.. . ❑ ❑ Crrdrt.Rcpdir. - ❑ �1, ❑ Food . . ❑ ❑ ❑ Landlord/Tcnant Lialson /L�/' ❑ ❑ �-}Dosing Starch and Coansding ,.,/ SerVvaz for-Viotii,is bfpemestic - Scrvices f� ❑ ❑ Yuferu/:Voting Wofinci(Se1va! ❑ ❑ ❑ sac F)}}dmay'Tra(fcbng L I ScrWces }r'ousiny;✓ingrtial,a5sistante(Security . G ❑ Dc?osi+s,itfiflty Assistanco,MoAPg ❑ M costs,First and LA$+wtoat'n'sR.e tt) cit SUN Training ❑ ❑ {romdass Prcveitticn fNertal}reaitSt Scrvlas ❑ ❑ .. .. p/ ❑ ❑ ,4ousing Cecroscf ng k� Dutpafien+♦♦cafth Services ❑ O OflAcr ❑ ❑ ❑ 597 C i+Li of i�ci�titiwg+aw Beach rowtE ,nerica>I Fescue Plan - rovrieless Ques+iourhaire -' d Im aaa'RcscuN?tan yid (f, I Vnll ro r u nera a?oy "ors,bf?rovdng housing,rental assistance,su ess, nsk eongrcgate shelter,to r duco{;omelessnd 11OVI- ess and increase housing scab Uty in;{wtiingtan`veac'n?fease helm �'n runt ngton 3cach gather impor a rt data nucf�.¢or this grant by coyT?lat ng+' s aaes'ionnairc. Nam ucu Age =-1_ -Rate }llspante? ❑ YC5 Q No Length of current episode c-"'aomelcs5ncss: �V jb -l�r'b"�/'� }low manu t mes'aave you been homeless? rousehold Type; a Si t.}le?:1ul� ❑ Ccuplc wt,to;tt CWldre ❑ Single Tare w/C!riVrtn ❑ 7wo `foci*) (I—, Parer-q w/Cytildrzn ❑ Unaaotm,paniad *) , or lmmn zr) Whcrc will yoa'oe sleep�in�onighi? Cl Strut ❑ Vehicle. W Shelter ❑ Dt a Fork ❑ W'otcl/JotcI ❑ pamilylF end ❑ O her Veteran (16,yrs,old and US firmed Service or AC-iivated National C,�xard/2servist)? ❑ YC5 E3,No Are you +wing to flee from domestic v olcnca,da ing v olence,sertwl assault,or human tr �ajfiegng? (D YC5 ❑ No �o you have any of 'The following Conditions? ❑ mental/`cwntiena TT)isorder O ?hy51[al 7i5ability❑ 'Develo?nnC.tt Pi5abifity ❑ Chronic Substance,CbnSe None what do you do for income/vnonc Cl ;'row would you describe your m eel for t'ac following scrvicrs? l evel d Need S gn; ca rt Sonic No L vd of Nc Service N' Nud N cd Signifwaht Some No 'Z.;rtal irousitty- ❑ ❑ Ourrcacln Services e c R m nl.�ssi$tance ....— 191/ _p .. ❑ . Substance;?base Trea-rnart SefVice Ncn-Ccngreafrtc Saclrcr - N -._ .. . ❑ J ❑ Transpori'a!ion .. . . . N❑ Cnlldtaro ❑ C1 dnta�on Services ❑ CasG Ykutagcmcnt ❑ . C cm�loymctrf Assistance/Sob ❑ ❑ wlcdiarmt / �/ ❑ ❑ Trdmt".9 , T� ❑ ❑ ❑ O Food Cridrt:Rcpar.. . .. -/ ❑ Landlord/TataM}L'iais-M ❑ ious Ty Search and couns�ng ❑ s6r ias fx.Yctimz bf pomesiw — / Ser 4cos ❑ Violuico I'Da1-ing VIoldTia%Sam[ L!' ASS* t f{}uma%Traf{tckiag - ❑ ❑ L:,gal Services ,.,/ ❑ 446a51Mg finaMtlal ASSIStAMCL(SCC:,rj',-� ❑ ➢c?osit ,Urfity Asslstancc,wiaving ❑ L11'c SUls Training Coss.first and Last ❑ ❑ ❑ fk'+neless Prcvani-ioM I.Dw'ctral{raaF;yt Scrvltes � ❑ ❑ � ❑ ❑ ut?atiort wealth Services ;{Dosing Counseling ❑ ❑ ElO+'acr ❑ 598 Ci f y Of �'�; iwq f ow Bead .. W ` riDY�c �;�rnericah;Zescue Ylaw E -. } ro'rne!�ss Qaes�iol�haire '��•' / Tlu ?mer can miscue Plan (ARF) will provide�224 milrion So assist indivdetnls_or_households_wlw.are twfnef-ss-a t r sk- - orhoirztcss:icss;aid o Pner Vulrerab�e ao�xt,a ions, m{prov am�housing rental assistants,su rt va servios L ?a r n ron teas, g !- po V u'n ngran sac .7 ease help thG f r{of q• h a nef iYr, r,ar data needed for t'ris grant b{ramplr�ting t'nis questionnaire. Name �� �� r -� �.+1 L �-(� ?'none FAG '�'� ?emu' Il I MspaNle? ❑ Yes I:�No L ngth o currait ep sode c homelessness: I,")r i # 1 1,�-.'ow many tames have you Dean ho>neless? household Typo: [Single fdult ❑ OLlple N/IT+1Oot cl^ildr cn ❑ Slhglc Parent w/Chi!drz i ❑ -Fwo Pnrcn+s w/Children ❑ UnacwvnpaYrad Youth (17 or younger) W'nerc will you be slccping tcnighrt4 y'Sta.et ❑ Vehidc ❑ Shelter ❑ in a Par k ❑ 'Mote[/ir'otel ❑ Fatuity/Friend ❑ Othsr Veteran (18+yrs, old and US Armcd Service or?c ivated Na Dual&'ard(pesary st)? L�Ycs ❑ No rrc yr trting to 9ce from dolres c v olence,dar ng V olena,setual assault,or human traf;ic�nq? ❑ yes [ No Do you have any of the following ra:wlitions? G ri4rtal/zmoiianal Disorder r Physical Disability DLVLIDpYhC.9t D15ablht'y ❑ Chronic Subscanca flbasc ❑ None What do you do for inwme(n:oney? �p l2 11 CO t- how would you destri'oe vwx need for i'ne following services? Level of N•cd I Level of r7ecd Sgnificant Sc'rnc No f Sig tfcar Sans No Service Need Ne<d Ncrd Servce Rental}fx�sing ! ❑ ❑ Oritreach Need Scr/Icss Need Nced ?c-Vr al rtss ztana ❑ ❑ ❑ ElS45+Arta{Sb:Yse Trcai'mont Services ❑ ❑ Non Colwrcgatc Shcf .r ❑ ❑ Transi, .goon Chu 'arc ❑ O 1 fas�Ylanayomort 0 ❑ ducat on Scry ass ❑ ❑ . ❑ ❑ ration �Ynpl:yir,bntAssistdrY�IJob -:-:-.-.:- .:. . ❑ ❑ Training ❑ ❑ Cralt?apair .. . . ❑ ❑ Food ❑ ❑ Landlord(Taiar Liaison {-}ouslnq Searc'n and Ceunsefinq Senl�us_for Yrnms of Domostic Ser Wes ^! ❑ ❑ Yielei re%Dat ng'Ulolena(Sexual ❑ ❑ As }r/{{uEnan TrafSc�ng L- nl Scrvfas {,busing financial Assistawz(Scairjty "q ❑ ❑ Deposits,I+ltifliy Assistance,wlovinq ❑ ❑ Czsts,First and Last P1at'n+s-per) Llfc SlaUs Training ❑ Cl 440M Jess Provantion Menta({(eaFth Ssrdccs ❑ 1� ❑ ❑ ❑ i?cusjnq CoRsorim �ut-paEie'mt};ca4in Scrvlces ❑ ❑ Ot'ncr ❑ ❑ ❑ ❑ ❑ 599 City of 44ntio9t-o� BeacVt BOWIE Americah-Pzsof,Y(ah I r 44OV46f855 QMS-Hohvlaire ' T'ne America:, tZcscuL o; om•essness,an otrtcr vulnerayle populations,bv,prodding housing,rcrr,al assistanu,supportive services,and ne� congr gate shelf r,to rcduu homdessncss and increase hoasing sta'c City in rfo*tington BcGch.please help the CF y o uKt ng(t�an^ocach gat'ncr impoorPan r data necddLd.for this gray by co,r,pL.ting this questionnaire. f�;� � phone � /l Agc �_ 'er V\�SvflN C rispahic? �--- s ❑ No Length of CuTrcvrr episado o homelessnass: 1 '(Z L)YS row many, ,mes have yea bun homc4css?�— }cusehold Type: q$in,)le A:iak ❑ CouplL witS;out Chi4irc, ❑ Singlc parent w/CLmldren ❑ Two'ParL t❑ hlnaiP?n1Da511eL1 ybwFil ( { q n's w LV;i,areq if Dr'DNn er) Whcrc will you yc simping tonig'rt�'f %%Street ❑ Vehitle ❑ Shelter ❑ T_n a Park ❑ Motd/rotcl G amily(p fiend ❑ Oiitcr Veteran (J&+yrs,old and US Armed Service or Activatcd National(juard/2Lservist)? ❑ Yes ,ea No Are,you trying +o lice froon dmt stic dDle'nce,dating dDlcewc,sextul assau,4,or human+raf;iclang? ❑ Yes 0 Do you have any of the following conditions? ❑ rdcw+al/Emotional Disorder ❑ 7hysical Disability ❑ 0:!Vclopmcn+Disability ❑ Chronic Substance,Oy tsc k1 None what do you do for income/Atom{ r11A d0(1 r r\ 0�J OOW would you describe ycur neod for the following seNcas? LGVeI significant sonic No N d SGrvse N 4<d Nced N cd Signifcant Sonic No 2:rtal {outing rvtc Ncad _ Nccd Need � tniAssstancL ❑ G outrcacnScrvices ❑ .. Substancepbuse Trcancnt Services ❑Non-C�ngregatL A1'F '��( - _. o., ❑ ❑ ❑ Transporfaiion G 4kare n e Case R1a ,Tent ❑ �.1'CILatIDn SerV1LLs — - . LiTplMinlLlTt A551StGnu ISOh :j-. ... .. ❑ ❑ Training ; ❑ � � ❑ Crrdrt'Rcpair. - . ❑. ' 0 . . . ❑ Landlord/TLnme Liaison ❑ ❑ }o sing Search and Counseing y ❑ Scryics fff Ytetirris cf�omcst c ❑ vwewc I Dating VwGe Z'/Smut ❑ ❑ Assault,/{{u,naN Tra(iii�", Legal Services Housing Financial Assistanu (Seeurit{ ❑ ❑ Deposits,UiilHy Assistance,Nlodng ❑ lusts,F'vst and Last wtat''n'sRcmr) ❑Life Stills Training ❑ ❑ .. 6( Homeless Pr Vrntun El ❑ '/nc,rtal?r'caFth Scrvius ❑ ❑ Outpatice{ca"Services Busing Counseling ❑ ,� ❑ ❑ Ot'acr ❑ ❑ ❑ ❑ 600 Ci+y of 44ty -iviqtovi Beach �OWi� �}ynerica�n"Rescue Plate - }}o',neless Ques�iohhaire `�°�^ 'ne rimericah"P"scue Plan (f2P) will provide$2.24 million to assist individuals or households who are homefcss,at risk of homelessness,and other VuMcrable popula+icns,by proy ding hL rc I al gssis ante supportive services;andmo,; — to gYzya'seek r,to� ;�omelassncss and incrcasc'nousing StAKNy in 44wetin ton'6cach.Please hcjj,tlje, In')TrII5 ques ohnalrc, NAme r�Fig L1 S G kw L__ ?hone i,gc C)?D -RAC., �'") �� 44ispahic? ❑ Yrs :No Lengt'n of carreh+e�,isode,of homelessness: }row many times have you been ho;rctess? uouse4 old Type: Single Adult U Cvu?Iz wiTb;out Children ❑ SINgIe 7af eht w/Clnildre:i ❑ Two P.arc,t5 w/Nildr ch ❑ Unaccompat,lcd Youth (17 or younger) where will you be,sic *,q tonight? 0 Street ❑ vehicle ❑ Sheltr,r In a Park ❑ >vo+cli'rote) ❑ —rAYIIN/Friend ❑ O;Itzr v Veteran (154 yrs. old and Us F;rvnul Semite or rc-iiVated NAiiottal i54 mrd%Reservist)? ❑ Yes L`ANo Arc you trying to aee from domes;is viola,ce,dating v olence,sex_al assault,or he mate trafrcldng? a s ❑ No Do you have ar,y of the fcllowing conditions? ❑ Disorder ❑ ?hysical Disability ❑ Devzlopmzn+Disability ❑ Chronic Sa,bstance r,hose6 None what do you do for incovac/moncf? Q JC'V U @ IQ flow would you describe your need for the foflowing services? Leycl of Need Signi{tcant Some No Level of Need Scrvcc Need Need Need Sign�icatrt SoYne No Service Need Need Need Pt ?al}casing ❑ ❑ Outreach Serviees p l2crrtal f ssistance ❑ ❑ S:bsYanio AbuseTrca wart Sere cos ❑ ❑ Non-Congrcgatc ShcFtcr ❑ .. ❑ ❑ ❑ G�'llld.4 ❑ TfAnSportatloh ❑ ❑ ❑ ❑ j�] ❑ Case WWnAge%rIG:T{' ❑ F.d'ut1'ion Services ❑ ❑ ❑ ❑ N1cdiaiion ❑ ❑ ❑ �ynploymant�issistancc/Job �+ Training ❑ (b' ❑ Cr&i t'Rapair ❑ ❑ ❑ Food : ❑ Cl Luudford/Tcna•nt Liaison ❑ ❑ {4ouvng Starch and Coat•,scGng Sery es{nrVr ims of Domestic ❑ Services - El �l Rsswlenre%DatingViolcnce/Se>a�al ❑ El ❑ auFt/+lavnan Tra{{idang }basing Financ al Assistance (S&Aa Legal Services ❑ ❑ Dcpos'H-s,Iktil',�. rty Assista:uc,ribving ❑ ❑ ❑ Costs, First and Last mont'a'sP.Cnt Life Sicills Training ❑ CY ❑ }ruixcicss"Pr Vention ) p ❑ ❑ N1a,ta1}{calth Services ❑ ❑ }rousing Counseling ❑ OW?a-herr41wPHy1 Services ❑ ❑ Other ❑ ❑ ❑ p ❑ 601 C+y of 44(mi+4iot vt Beack 440ME Avywicaa'2escue T14vl - 44otmeless Qciestiowviaire '' The flmcrican"P.-,scut Plan (}S27) will provide$224 milFon to assist inAiiduals or households who arc homeless,at risk Of homelessness,and ot4acr vulnerable popula ons,b4 prov ding hoasing rental assistance,supportiye scry ces,ggd_noii_ xoxgregate`sGleltcr-to reduic hot rnelessness a.n mcrcasc Dosing stabifrty in}}unt ngton Bcach.Please help the Gty of I J � iNgin4'= i 4 .t rk...c �pVioize. 'a:....... ��-i'}tspawtc? ❑ Yes�YN'o �> S G ;}how many-timeshave you bearhos�wless4 - . ... ' ✓ .'. fir. ,< a. , .•,.'4r..:_.. :• ,. ..�_ . .. °}}euSGl olA'TypB: Ingle fldult ❑ Couple w+1,161tt C6lddren ❑ sin)lc Par cnt N/L'lhddren ❑ Two Parents w/Children ❑ Una6cemp40CA Youth (1 r or yomiger) vuhe?c wiA yocn be`sleopi� '`tahight4 ❑ Street ❑ Vehicle ) Shelt r ❑ Iw a Park ❑ Motel/Eotel ❑ Family/Friend ❑ Otraer VefarN:r(y3�yrs,014'ud US Folded Service or pitivated Na—wua!6ivA d/Reserltst)? ❑ 1cs ' No f r you_tryt v te,{ice from doincstic of ce vi cn dam volence sexnaf asSauFt,=orhaman'tr` i" ❑ YCS ��A ,.x.. s :�>.Y!i.:'.r•.:-i'..•s. ".cCr.:So-2".t�',S-/.-v3;. s_,r .. afflcbny4 �NO =Ua; u:Nave aJ_y oT the.foll�y ing to 7dit ors?./O Mental/ mot Dial Ti;order /Cd 7h4sical Visability ❑ Development Piso.12U ti ❑ Chronic Substance ;br5o ❑ None z;Nhaj-do you do;for i jaomc/,mor, elf?. flow'woiilil';yon dasaOil,,y40mr iieed:for'thc following sarvic%57 . Level of Need Level of Neci Signifuant Some, No Signifcant Some, No Service Need Need Need Service Need Need Nced R wtal>rousing 6 ❑ ❑ out roach Services El ElRental Assistanca p ❑ ❑ Substawe Abuse Treatment Serf Cs ❑ ❑ Non-CcngrcPate Sheitcr O ❑ ❑ Transportation ❑ ❑ Childcare En ❑ El Case ManageYAOWr ❑ ElEduces on Sery ces ❑ ❑ mediation Employment Assistance/Job ❑ ❑ Training '6 ❑ ❑ Crcdr 12fs Alr ,d ❑ ❑ Food ❑ L41}AlorAr l ei1aitt Liaison ❑ ❑ }busing Search and Counseling Services for Victims of Domestic Services ❑ ❑ Violence/Dating v olence(Scrawl ❑ 13" ❑ AssaAi-/{}aman Trafficking housing Fli m dal Assistance (Secv. ty Legal Services ❑ P p Popos'tts,LHr"Assistance, Moving ❑ ❑J' ❑ Costs,First anA Last Wi"+lm pRIt) / L fe Stalls Training ❑ ❑ {bmolcss Prevention C ❑ Cli'"teY,}AI}ieai}t1 Services ,p ❑ p }}Dosing Counsefng ❑ ❑ out?aticnt}Ecalth Services ❑ ❑ Oth r ❑ ❑ ❑ 602 of 44(mi t•igtoo Beach '- 440ME A wwricmvl-pescue -Plat, 1 {+otmeless Ques+iohhaire ''. i'/Ie Americaw-Rescue-Flaw (y'C27) will provide$224 million to assist individuals or house'nolds who arc homeless,at risk of homelessacss,and other vulnerable populations,by providwg housing,rental assistance,supportive services,and non- wngregate shelter;to reduce hoinelassr�ess—and7 u ease{wusm 6ifNy n{{unt ngtow Beach.Piease help the Gil q of Name h�'!�/'-- '� �/y'�j�F-h"'�'GG.1 P'mo1 _ /✓ �� Age Race }}ispanic7 ❑ Ycs ❑ No Lcwgt'a of Curren F episode of homelessness: 1 Tow many times have you been homeless? +loase'aold Type: Adalt ❑ Cotiple vvriiiout Children ❑ Simlc Farewt w/Chileirew ❑ Two Par ewts w/Children ❑ Uwi,ctovnpanieA Youth (17 or younger) Where will yoci be sleeping tonight? ❑ Street ❑ VehicleSbtel+e.r ❑ In a ?ark ❑ 1Notel/+r'otel ❑ Family/Fricwd ❑ Dthc.r Veteran (18' yrs.old and US Armed Service or Activated National Guard/Resery st)? ❑ Yes vs Are you trying to{ice from domestic V olence,dating violence,sexual assault,or human trafficking? ❑ yes -�NO Do you haVc any o,-""the, following cond'N'ions7 ❑ Disorder ❑ 7hysical Pisnbility ❑ Pcvclopvnewt-Picabiii+y ❑ Chronic Substawce Abnse .fJ None What do you do for income/mowey? }low would you descr be your aced for the followinq services? Level of Need Level of Need Significant Some No Significant Some No Service Need Need Need Service Need Need Need -R.cntal+}ousinq ❑ O Outreach ScrvSccs ❑ ❑ 11 -Rental Assistance ❑ ❑ Subs+aHa Abuw Treattince SeNces ❑ ❑ Non-Congregate Shelter ❑ ❑ Transporl-a+iow ❑ Childcare ❑ ❑ Casa managcmcnt ❑ ❑ ❑ iUwAiiow Services ❑ ❑ Ntedlatlon Cl ❑ x Employm i+Assis+ancc/Sob Jw Training ❑ ❑ / CraCrfTR ?air ❑ ❑ Food ❑ Lawdbrd Tcnawt Liaison ❑ ❑ }lowsNn Search and CounscGnq v Ser/Ibcs for Victims of Dorrwstic Ser*zs ❑ ❑ Vl In e/Vatlwq Yioleww/Sa" ❑ ❑ YD AssaaFr/+}roman Traf{cidmg v� Le I Serviws f)ousiw T'1Kawcial Assistance (SMirity °f ❑ ❑ Pcposi ts,Utility Assistant-,MO\,nq ❑ ❑ Costs,First and Last ribnth's'Rawt) Life Skills TraNing ❑ ❑ Xj +}omcless Pr-vewtiow ❑ ❑ M ntal44mlth Strikes ❑ ❑ +)ousinq Couns�ng ❑ ❑ Out>atice-14 althSaNicrh ❑ ❑ i. other ❑ ❑ 603 of 44RVIti otMi Beach 440ME A meriomi Tzscue 'Plan }{otmeless Qrnesi-iovlviaire '"' �^ ' ' � The Americavn Rescue Plan (ART) will provide$2..24 million to a<_sist ind v duals or households who argil hovnoless,at risk of homelessness,and other w blorable,populations,by prmAdin housing,rowMl assistance,sappo!:b seryces„and non= congregate s4t'eFFcr fo reduie home essness an irurcasc housing stabirity in i{untington 80ach.Ylcase help Wle Uty of Name GI1 1/�/ f� �: /x Phone SC Ag o e �—! T-Au � I q� ifispanic? ❑ 4cs ��o Leng+h of current episode of homelessness: n f ✓�1. row many times have you been homeless? . rousehold Type: VSingle Adult ❑ Caiple wi+'Hoot Children ❑ Single"Parent w/C6iildren ❑ Two parents w/CNIercy ❑ UIIaccompaiied Youth (17 or yowiger) whero will you be slcepin1111onighi4 ❑ Street ❑ vehicle Cl Shclter ❑ Ia a Far k ❑ t'Ao ❑ Other veteran (15+yrs, old and (AS,armed Service or Activated Naiional GuardjRcsorvist)? ❑ Yes L •:o Are you trying to fire from daws+ic violence,dating volFWr,sexual assault,or human trafficking? ❑ Yes Ia No Po you Have any of the following conditions? ❑ rilental/c otienal Pisor der El Yhy,ical Pisabili+y ❑ Pevelopmr.ntPiscJ;liTy ❑ C4;ronic Setbstanr.e. Abus 1 None S fZ what do you do-'or income/money? e e� A .� j� j R row would you describe yoar need for file following services? Level of Need Levolof Need Signifioarl+ Some No Sigvit{ieae Some No Service, Need Ncod Need Service Need Ncod Nee ?antal}'rousing ❑ ❑ Outreach Se v as ❑ ❑ "R-rrtal Assistant- Ey d ❑ ❑ Substances Abuse Trcatmcrrt Sorvk6s Non-Congrega+e%inner p/ ❑ ❑� Transportat mi ❑ C�1 ChiWaro ❑ ❑ a/. Use,NAanagarze u-/ ❑ ❑ Education Services ❑ ❑ Q mediation Emplaymcnt ASSiStanto/Job /� — / ❑ ❑ Training "7 ❑ 5� ertdFt 2caair P/� ❑ ❑ food l ❑ ❑ Landlord/Tenant Liaison ❑ G }sousing Search and Uvmse6nq Services for victims of Pomesiic Services ❑ ❑ tlwlence/Dating YI016nte/Sexcwl ❑ p Assawt/roman Traffcciing rousing Pnancial Ass stance(SwarHN Legal Services ❑ ❑ Pcposits, Utility Assistance,wbving rr/ p p / Costs,sirs+and Last Mon+h'sT--n+) Life,Skills Training ❑ ❑ p`/ {}omoloss Yrevurtion ❑ ❑ Mcr,tal y}eaHin Services ❑ ❑ roasing Coansefmg ❑ ❑ Outpayierr OwHii Services ❑ ❑ D/ I Other ❑ ❑ ❑ 604 Ct4 of 44m l-imtovi Beac� VOME fivnericAvl Rescue 'Plavl 44otmeless Quesi-im4ire The Americanl?ascuo Plan (ARp) will provide$2.24 million to assist individuals or house'rtolds who arc homeless,at risk of homelessness,and other vmbierable populations,by proV ding housing,rental assistance,supportlyr serdceS,Av d non; zongre shcttor,+o reduce hovne es—i mess and increase housing s+ab�Gty in}(unt ngton Beach.Please hctp the ,of Name Lo�kh�e � (��/ 1M Phone I I Age �'�� •,l PALL NAft `. j'111lL'1 AspanlG? I.p Ye.s ❑ No I,i , 'f Length of turruit episode of homelessness: (�%rUI {{ow v ai;y t mes have you bun homeless?_ /� ?household Type. Singe Adult ❑ Coup!e without Children ❑ Single PArnir w/Children ❑ Two Parents w/Clidiren ' UnatumpanicA Youth (i7 ar lomi jer) Where will you be sleeping tonight? ❑ Strect ❑ Vehide Dkl�hclte.r ❑ In a Park ❑ Hotel/rioted ❑ pamily/Friend ❑ Other Vereran (15+yrs.old and US Armed Service or Activated National Goard/Resertiris+)? ❑ Yes No Are,you trying to ace from domestic violence,dating violch=,56wal assault,or human trafficking? ❑ Yes W! No i7o you have any of the follotying conditions? � tNtntal/emotional i;sordcr ❑ Physical Disability N ❑ Davclopmrtrt DisdIVility C'nrenic Su'ostance Abvse ❑ Nona What do you do for income/money? ���(�'1 CvY1 ��Y lQ/U(- }(ow would yeu describe your need for the following servicas? Level of Need Level of Necd Significant Some No Significa,rl• Some No Service Need Need Necd Need Need Need ?anal}lousing ,X; ❑ ❑ Outreach Services ❑ "Rental Assistance ❑ Cl Substance Abuse Troatmait SaMizs ❑ ❑ Non-Congrcgatc Shcltcr ❑ Tranps orration J�(� ❑ / Childcare ❑ ❑ Case wtanagcmcnt ❑ ❑ Education Services 071,.," ❑ ❑ ri1cdiation ❑ ❑ Employmai+Assistance/jot, Training ❑ ❑ Crt'Repair / ❑ ❑ Food ❑ ❑ Landlord/Tenant Liaison ❑ ❑ . }loushg Search and Counsetng 1 Scr`dus for Victims of Domno-,Kc Scrrius l ❑ ❑ Aoln"/'Dating Violence/Sexual ❑ ❑ Assau}+/}lumen TrafRcUng }{ousrvtg financial Assistance (Securty Lcgal Services ❑ j Pepos'Ns,W irity Assistance,wloving rf`t ❑ ❑ ra Costs,First and Last Wbn n's Rant) l� Life Slaus Training ❑ W ❑ }}omeless Prevention ❑ ClN1e�ital{{cakh Services �, ❑ ❑ }}*using Coansaum ❑ ❑ oatpaticn+4{eaHhServices ❑ ❑ other ❑ ❑ ❑ 605 i City of �{(nv�+iwg+oh beach '. 440ME American-P_escue Ylah {{ovneless Ques+iohvlaire "'"�^'' ' The,American 'escue Plan ({CRT) will provide,�2.24 million to assist individuals or households who Are,homeless,at risk of homelessness,and other Valneralale populations,by providing housing,rental assistance,supportive sery ces,Avid non- coHgrivjdia sheFter�to red he�mc vsacss and`increase housln' q stability in}{unting+on Eeach.?lease help+he,Git4 of Namel1 W {}ispanic? Yes ❑ No Leng+h of current episode of homelessness: = {row many times have,you been homeless? {roasehold Type: Single Adsd+ ❑ Couple t�ithoat Chiidrns ❑ Single 'Parent ,o/Children ❑ Two 7areuts w/Children ❑ Unaccempania You h (17 or younger) Where will you br sleeping tonight? ❑ Street ❑ Vehicle 'A Shelter ❑ =n q 7arL- ❑ Motel/{jotel ❑ Family/Friend ❑ ether Voteran (15+yrs. old and US AMM SerVIOe or Activated National C4kard/Rescrvist)? p Yes .K No Are,you trying to flee from domestic Violence,dating Violence,,sexual assaalt,or hwnan trafncbn97 p `!cs " No' Do you have any of the following conditions? �wlental/cFnotional 7iserder p Thy�,ica! Disability \ L DeValopmantDisabili-hl ( Ehron//ic��Su�Di+ante>rl)ose ❑ Norie• What do you do for inwmc/money? f {row would you drscribe your need for the following services? Level of Need Ln of of Need Significant Some No Significant Some No Service Need Ne,cd Need Service Nccd Need Need �cntal}'rousing _ ❑ ❑ outreach Services p ❑ "Rental Assistance ❑ ❑ Substance Abuso Treatmcn+Services El Non-Congregate Shelter ❑ ❑ Transportation ❑ ❑ Childcaro ❑ ❑ �O Casc n1anagcmcn+ ❑ ❑ Education ScrVieos ❑ ` ❑ mediation ] ❑ Employment Assistance/Job Tralning ❑ ❑ GulFtRcpair ❑ ❑ Food k9 ❑ ❑ LandlorotTenant Liaison ❑ 0 }{onsing Search and CoanseGng �7 Services for Victims of Pomestu Services ❑ ❑ Violence/Dating volorue/S=WI ❑ p Assault/{lamas Tra f ficbng }}ousing Fnanclal Assistance (Sean RN Lcgal Services ❑ ❑ Peposrts,IkHrHN Assis+ana,lt9MM �j ❑ ❑ q Costs,Tirs+and last month's Rout) Life Skills Training ❑ ❑ }lomdass YravcMwi ❑ ❑ YAcatal?1oalth Services ❑ ❑ }{ousing Counseling ❑ ❑ orHpatient}lcaH'n Services ❑ Other S ❑ ❑ 606 CA-hq of 44mi+igtoh Pw& 440ME Americah'Rescue 'PImi 440meless Qrnes+iowwaire ;' m The American'Pcsme,Plan &5RP) will provide$2.24 million to assist individuals or N mscholds who arc homeless,at risk of homelessness,and other vulnerable populations,by prov di:ig housing,re -al assistance,supper five,services,and nO_ coHgrecjafie'sh to rcdW homelessness AW incremn s+abir"in{#mtington Eoach.Please help the, Ci+y of Phoga (o J 1 / 2 .) 1 Aga 2arti nl �� 1 l/ }}ispaanic? ❑ Yes [-;o Layg+h of current episode of homelessness: �� ' },'•ow many times have you bean homeless? {{oasehold Type: k Single Adult ❑ Couple.wi+hour Children El Single Parent w/Children ❑ Tw rwe.no Pts w/0IM.ren ❑ Llnauovnpanied Youth (17 or younger) Where will you be sleeping tonight? ❑ Street ❑ Ve'r,icie NS'rclter ❑ Tn a Park ❑ Moicl/rotcl ❑ -an+.ily/rriend ❑ Other Vtreran (16+4r5. old Avid US Armed Service or Activated Natimial CjuardfR servllst)4 ❑ fcs 9k 0 Are you 'trying to flee from domes-Ho violence,dating violemwe,sexual assault,or human trafficking? ❑ ves No O you have any of the,following conditions? Sk:urta!/tmo-rionc.l Piscrdcr ❑ P;iysical Disability ❑ Development Disabilit.; ChronicS�Jlvs+ance Ab;+se None, what do you do for income/money? , r 1 t row would uou describe your need for the following services? Level of Need Level of Need Significant Some No Significant Some No Service Need Need Need Service Need Nced Need "Rental rousing ❑ ❑ ❑ Outreach Services ❑ ❑ ❑ R ntal pssistanco ❑ ❑ ❑ Substasuo AWso Troatmoe Services ❑ ❑ ❑ Non-CongrcVt&Shelter ❑ ❑ ❑ Transportation ❑ ❑ ❑ Childcare ❑ ❑ ❑ Case Ynanagcment ❑ ❑ ❑ F&Acation Services ❑ ❑ ❑ n1e44tionEvnplo" G G ❑ Trainien+{tsststancc/Job viq ❑ ❑ ❑ Crod'rt"Rcpair ❑ ❑ ❑ Food ❑ ❑ ❑ Landlord/Tmutt Lialson ❑ ❑ ❑ rousing Search and Couns&rng Services for Victims of Domestic Services ❑ ❑ ❑ violence/-Paring violence I Sexual ❑ ❑ ❑ Assault/roman Traffckang rousing Financial Assistance (Suarity Legal Services ❑ ❑ ❑ De sits,U po rty flssistancc,N'wvinq ❑ ❑ ❑ Costs,'tirst and Last WwnWYST-:art) Life Stills Training ❑ ❑ ❑ romeless Prevention ❑ ❑ ❑ mental realth Services ❑ ❑ ❑ rousing Counscring ❑ ❑ ❑ Outpafiia�trcaHJAServices ❑ ❑ ❑ Other ❑ ❑ ❑ 607 City of 44(Av1+iwgtovl 'Beach ~� 440ME Amcricavl"Peswe, -Plate }{otmeless Qcles+iovm lire The American"Pcscae Plan (}CRY) will provide,$2.24 million to assist individuals or households who are,homeless,at risk Of homelessness,and other vulnerable populations,N providing housino�,,ra:rtal gssis+ance,sv, pwtive services,and non= congrcya+c s elte o radicle homdessncss and increase housing stability in}(unt ngton 8cach.Please help-fine Gtq of Me'leglFul His Name 1 A9c 2U Rqcz � ! �� }}ispanic? ❑ Ycs �<No Lcrg+h of current episode of homelessness: r k }}ow many times have you been homeless? L }msehold Type. Ksitiqle Adtd t ❑ Couple without Children ❑ Single Parent w/Children ❑ Two P,nrants vi/Children ❑ Uwacrompanied Youth (1? or y I ounger Micro will you be slcepin9 tonight? ❑ Street ❑ Vehicle s: al er ❑ Lr a Park ❑ Wotel/}lotel ❑ Family/Frond ❑ Otller' Vcteraa (15+yrs, old and US Armed Service or Activated National GuardfPeservist)? ❑ Ycs L/ve Arc you trying to flee from domestic violence,dating v olence,sexual assault,or Kaman trafficking? ❑ Yes No Po yoci have any of tile,following conditions? wlental/Emotional Pisorkt tiysital PisaL ility Pevalopmtrt Pisabil+q Cl Ghrbmt,SSti.bs/t'a�n6e Abuse ❑ None what do you do for income/money? how would you describe your need for the following services? Level of Need Level of Need Sigmficant Some No SighifwAvit Sovnp No Service Need Nccd Need Service Need Need NDed Ric tal}ousin9 ❑ ❑ Outreach Services ❑ f ❑ 'P.cntal Assistance ❑ Sb Substance Abuso Treatment Services ❑ p Non-Congregate Shelter ❑ ❑ Transportation ` p ❑ Childcare ❑ ❑ Lase Nlanagc'mcrrt ❑ p `cdutation Services ❑ }j ❑ mediation Employvren+Assistarce/Job ❑ �` ❑ Traini:wj �f- ❑ ❑ CroditWpair ❑ p Food ❑ ❑ Landlord/TenAnt Liaison ( ❑ p Dosing Search and Coans�ng Services for vciims of Pomcstic ?{ Services � ❑ ❑ violence/Pating violence/Sexual ❑ � p AssAL&/f(wnan Traffloldag }lousingFinancalAssistance (Seturiy Legal Services ❑ ❑ Pc>os f5,6l fity Assistance,wloving ❑ p Costs,First and Last nlonth's-Pant) Life Sldtls Training ❑ ❑ }lomdess Prevention p p mental}leaEth Services ` ❑ ❑ }lousing Counseling p Outpaticnt44caftServices ❑ ❑ Other ❑� p p 608 Ci-I q of 44t*1tivi9to1 Beach +EOM:E �}imericah Rescue Plavl - 44omcless Questiovlhaire The{tmcrican Rrscue Plan 6qR?) will provide$224 million to assist individuals or households who are homeless,at risk of homelessness,and other wilneraWc,populations,N prov ding housing,rcrrhal assistance,supportive seryiccs.�nd-non_ �ongregata'ssheF�cr to rcdw L home assnf css an incre�ing stab l'rty in filuniington Beach.-please help.tInw uiN of . NAY11e_�� l/� � fU�✓) Yhone�(1 Age �� }{ispanic7 ❑ Yes �No Length of current episode of homelessness: 44ow many times have you been homeless? t AI Q ti +}oasehold T�fpr single PARR+ ❑ Cou?ir without Children ❑ Single Ya'ent m/C'i!dreti ❑ Two -Parents w/Children ❑ Unauompanied youth (i; or younger) where will you be sleeping tonight? P,�+reet ❑ vehicle ❑ Shelter ❑ rn a Park ❑ MotelMotel ❑ Family/Friend ❑ Other Vc,tcran (A$t yrs.old and US Ar)Acd Service or Activated National 6,mrd/Rcservis+)? ❑ Ycs ONO Are,you trying to flee from domestc viola'ca,d_atting violence,sexual assault,or human trafhebng? ❑ Yes � No Vo you have any of the following eonctrions7 PisordcrY'r,ys cal l i5ability ❑ Development VisaLility ❑ Chronic Soy sta.nce. Abusc ❑ None what do you do for income/moncV how would you describe your need for the following services? Level of Need - � Need significant Some, No significant SoYna No Scrvcc Ne NGGd Nced Service Need Need Need Fcntal rousing - ❑ ❑ Duircach Sery ces ❑ ❑ -Rural Assistance �✓ ❑ ❑ Sabstarue AWW Treatment Sw*-,s ❑ ci Non-Congregate Sheffer ❑ ❑ Transportation ❑ ❑ Chidc�re ❑ ❑ ?r, Case mans,mce ❑ ❑ £duration Scrvius ❑ ❑ �d YAation ❑ ❑ Employment Assistance/Sob ,../ .' Training 0 ❑ f� G'cdii'"P.epair ❑ ❑ �( FDOdVEJ ❑ ❑ Landlord/7:we Liaison ❑ ❑ I f ro sing Search and Counscfing / Servicas for Victims of Domes-1 c Services fZ ❑ ❑ Violaue!Dating V-101e11c6/Seriia! ❑ ❑ Assault/roman Trafflcl ing rousing'Financial Assistance (Seep,i-y Legal Services ❑ ❑ 12111� Vepos'its,Utili ty Assistaucc,iNoving ❑ ❑ Costs,First and Last WbnF'rt'sRcni') L'rfo Skills Training ❑ ❑ 1211� {{omcless Yrevcmio4 ❑ ❑ HSesral reafth Services A ❑ ❑�/ rousing Couns�ng f ❑ ❑ O.r-paticntreafi'aSarvicos ❑ ❑ 11 I other ❑ ❑ ❑ 609 Ci h{ of 44Uvttigtovi Dea& - Ow1E Amcricah-Rescme Plah - 44ome,less Qmcs+iowwaire =aewdn 1an (ARP) will provide.$Z.24 million to assist individuals or households who are homeless,at risk ther vulnerable populations, by providng housing,rental raduca hotinefc etaTd'mcreasc ous111� s+a I , in untington 8cach.7lease M?the City of Name uy- A 7hone I 1 ' age �� � Pi N I AYn�i ice I n p }{IspAi11G? ❑ Yes No Length of carrent episode of homelessness: Y,) }{ow many times have you bean homeless,? I f{ousehold Type: ' s—., ale A dcdt ❑ Coupfe witnout Chiidr cn ❑ Single 7aran+w/Children ❑ Two Parents to/Cni[Lire n ED Unaccompanied 'font* (1: or yomiger) Where,will uou'ae sleeping tonight? Street ❑ Veknic I�Shelrar ❑ Lr a Park ❑ ivwtel/}Fotel ❑ Faitlily/Friend ❑ Oi'ner Veteran (16+yrs. old and US Armed service or Activated National Cauard[Pcsarvist)? yes ❑ No Are you trying to flee from domestic Violence,dating Violence, sexual assaalt, or human treiffcking? ❑ Yes P'No i Po you have,any of the following conditions? wlentctl/cmotienal Ptsordcr ?!aysical Pi>c:bili i Pevelopmer,r Disa:r i;-y ❑ Chronic Substance A�iuse ❑ Nmi:. 5�What do you do for income/vnorey? flow would you describe your need for the following services? Level of Need Level of Need slgniflcav& Some No slgnificeie Some No Service N ed Neod Need Service Necd Need Nced "Rental}{oosing ❑ ❑ Outreach Sorvices p ❑ m "Rental Assistance ❑ ❑ Subs+Alice Abuse Treatment Services ❑ ❑ Noi egate Shelter ❑ ❑ Transportation . 1 ❑ ❑ Childcareldcaro ❑ ❑ Case,wuviagcmcnt ❑ ❑ Education Services ❑ ❑ ❑ wlediafion ❑ ❑ i5mploymeirt Assistance/Job Training ❑ Lam. ❑ GuiFYRepalr ❑ ❑ Pad ❑ ❑ Landlor-d/1'enant Liaison ❑ ❑ � }{ousing Search and Cwtiserng Sery ccs for V etims of Pomcmic Scry ws viblence/Pating Violence/SmAl ❑ ❑ Assault/{(aman Trafficl?ng Legal Sery ces ❑ ❑ 44oushiq Financial Assistance(Sccarky 'd Pcposits,Unlit{Assistance,wbvinq ❑ ❑ Costs, r`�rst and Last wlontil's"Rcirt) Life Skills Training ❑ {� ❑ {-}omdcss PreVantioii '� ❑ ❑ mental{{ealth Services ❑ ❑ }{Dosing Couiiserng .E ❑ ❑ OutpatientT'realth Services ❑ ❑ Other n n ❑ 610 Ci-f y of �{cttl�ingfoh Seac� 41.OMF, Awrricavl1kescue Ylah - J }}oYAeIeSS QueS+iohvlaire The mcrica '?-esw.e'f � _��.(r...QP.)_willPxaYlda$22hmiIGo�Lto:assistinAividuals�r-houserrolaswho•arahow,dess=at-risk- of homdcssness,and otncr vulnci-abie populations,by providm housin rental assistanu,su rtive se, "ces sn in rcasc oustng s a t m u ngton 3cacn.Y cast clp the Gry of T}antington'Death gat'ncr important data needed for this grant by comploting this questionnaire, Name4,Rcl/ '.QL}— /�I`� 7hoe- 5 L. �9e�— Marti�_ {{isaanie? ❑ Yes ;ci No Length of curre t episode c homelessness: 2 tiow marry t mcs'rave you beet homeless? {7_7�t -roasehold Tyae: 'Single nd:ah ❑ CauF,e v+i=ho:rt Childrai ❑ Single Pnre�r, w/i.hilArcn ❑ Two 7nran+s w/Nil:ire�n ❑ Unaccompani:d Youtn (17 or 40',mgcr) where will you be,sleeping+onig'ntZ ❑ Street Cl Vehicle XSnelter ❑ inn n?ark ❑ iNo+dJ:iotel p pamilyrriand ❑ O'i�ar Veteran (16:yrs,oW aad US P,rmcd Service or Activated National 6tiArd/tieservist)? ❑ Ycs ,kNo Are you trying to flee from domestic violence,dating violence,SCXual assault,or human traf icidng?)q Yes ❑ No -Po yeu have any of the following conditions?'Mental/Hmotionai Disorder ❑ -Musical Pis i itq �De,vclopmcnt-Di;abilir; Chronic Si'ostnnce Abuse ❑ None what do you do for Ineo'me/mono{? E 8-r/M i LL'C ;?ow would you describe,your need for t'ne following services? Level of Need LaVC4 of Nwe Significant Some No Significant Some, No Service Need Need Necd Service Need Neil Need Rnta!uousing ;� ❑ ❑ Ottircach ynyitcs ❑ ❑ 7_-rtal Assistance `� ❑ G Substances j b ss Trca me t Services ❑ O NWI-Uo grcgate Shet+cr C ❑ ❑ Transportation ❑ ❑ ChiWcaro ❑ ❑ >kl Csiso nlana9emont !Uoation Services ❑ �, ❑ Nle cation cva�l Viicet Assis+ante/Job \—' _.. b? ❑ ❑ Training ❑ ,\_ ❑ Crcdt+-Repair ❑ . ❑ �, Food ❑ a ❑ Lardbrd/TenaM Liaison ❑ ❑ }(ogsing Search and Co tisding Saryu's for Yietiims of tomcstc Services ❑ ❑ \Ucace/dating vl olt /Ser-'wl p ❑ Assawt 144 Traf{tdanq }{ousing T'wY 7al Assistance(Security ❑ B ❑ Pgasits,U-1irity Assistance,nbvlrg ] ❑ ❑ Coss,First and Last wtatiit'sZi.•.t+t') Lifo Stills Training 'g ❑ ❑ {{omaless-rreVcn Y�Le-anal}italth Services - ❑ ❑ �cT ❑ G }rousing Coanscfing � ❑ ❑ Owtpa+ice 44cak'n Services ❑ ❑ Ot'ner 611 of 44me iti►ir tovi Beach 44OM76 �vnericah Rescue Plavl - Vome,less Qrnesfiohhaire °^ The American"Rescue Plan (fiR-p) will provide$2.24 millionro assist individuals or households who are,hotme(ess,at risk of homelessness,and other vulnerable populations,by providing housing,rental assistance,supportive services,and Holt_ •cottgre,"c)ate ssYleFYer,to reel cc homelessness Avidd i�wreasc housings W—rtjy in}{untinyton Beach.Please help the City of L a m Phone Age I -Pace I Qh,k 0i'+{��e �spanie? ❑ Yes [YNo Length of current episode of homelessness: 1 .\i% } ow many times have you been homeless? 1 }4ouse'nold Typo: ❑ Single Adult ❑ Couple without Children [Single Parent w/Children ❑ Two Parents w/Children ❑ Umccomparied Youth (1 r or younger] where will you be slcepi tonight? ❑ S-rreet ❑ Vehicle Shelter ❑ Tn a -park ❑ sYtotel/;!otel ❑ family/friend ❑ Ot4 er Veate,ran (15+yrs,old and US Arim el Service or Activated National(aewrd/Reserfist)? ❑ Ycs I Nib Are,you+trying to flee from domestic v olence,d4ting'001e,nce,scwnal assault,or human+raf ficbnq?vI CS Of No f you have any of t Ae,following conditions? ❑ :dental/ mat onal Disorder ❑ Physical Disability Development Dlsabili+y ❑ L'nronic Substance.Abu ❑ Nm�e What do you do for income/money? ' 0 1� {{ow would you describe your need for the following services? Level of Nced Level of N Signifcant Some No Significant Some, No Sorviae Need Need Need Service Ncod Need Nced 'Rental t{ousing ❑ ❑ Dutrcaeh Services p ❑ Re tal Assistanu / ❑ ❑ Substance Abusc Treatment Sen/icas ❑ p �/ Non-Congregate Shelter ❑ ❑ Transportation p ElChildcare ❑ ❑ Case Ydanagemcn+ p Education Services ❑ ❑ mcdation ❑ Tmployment{tssistance/3ob Training CrcdrtRcpair ❑ G food ❑ ❑ Landlord/Tcnae Liaison ❑ ❑ }{cuing Search anol Cmisei!ng Scr*,c6 for vwi-ims of Domestic Sorvices ❑ Violence/Dating violence/Sa mal p ❑ Assault/}(uman Traffclang 41wsiM`rinaneial Assistance (S=Vi+y Legal Services G ❑ peposhs,UtirvN Assistance,MmAiig ❑ ❑ Costs,rust and Last Morth•sRant) Life Stills Training ❑ ❑ {{onwiess?revevrKon ❑ G IKental}{caN'n Services ❑ )K ❑ +{ousing Counseling p ❑ Oui Hat cnt}}caMh Services ❑ ❑ Other ❑ ❑ ❑ 612 Ci h{ of 44uhtiviq+ml 'Beach 440ME A mericah"Rescue -Nv }�otmele55 Ques'floVtt1aire ''''`� ' T'nc�;,ncrican_�cscue.T_laly(r�will,?x4vidc.$Z:Z4.mitlion to.assiss_iiufividuals.or_ytouseholds�whoarchomdass-atrisk— o f homelessness,and ot'ncr vulnerable populations,by provSdin housin ,rental assistanw su rove services 4 i� An Inerea5e aoasing s-ramilvi In w ngten Bcac .P cast ap the UN Of }luirtington 3cach gather important data needed for this grant by com?let ng Phis questiomiaire, r ZA2 � ?hone r ngc Ra'a {lispanic? ❑ Ycs d No f Lcngi'n o urratt ep sode of homelessness: /i2 ilow many ti>nes have you been homolcss? ;lousehold Ty?e; OtSimglt Yduk ❑ Cou?It without Children ❑ Singls Parent w/Childre. ❑ Two Tarcnts w/ChiL•irei; ❑ UnaccvmpuiwlYont1.1 (17 or yowlger) Where will you be sleepingyytonighi? OFSNeet ❑ Vc'nicle 04.elter ❑ Di a Taric ❑ Motel/"Otel ❑ rdmlly/fflena ❑ Outer 0 ut , d Vereral (16+yrs,old a:;d U.S{irmcd Service or nc-livated National(�,uard(Rcscrvist)? ❑ Yes 0 No Are you trying to fide from domes is Aol"Cz,dat ng violenw,5COW assault,or human traffici;ag? ❑ Yes V 1vo i Po yNu have any of the following conditions? ❑ Wiental/Emotional Pisorder ❑ Tgysical-Dlsabifity ❑ PeVGIOp4netr;;isability ❑ Chreniicc Substance rlbu5c ❑ Nostc What do you do for income/money? c , `, {=ow would you describo your nead for+he following seryiws? Level of Nced Leyd of Nail Signlfcairt Some, No 5k)vlificae Some, No Service Need,-- Nced Need Service Need NMA Need 'PCntal 44ousiw3 /❑ ❑ ❑ Ouireaul ScnAws ❑ .� ❑ '2ental Assista:ue �-� ❑ ❑ Substance pbusc Treattnart Scrvacs Narfongreaf+te She&cr ❑ ❑ ❑ Trans?ortation �— fl p aiucare . ❑ ❑ Er Corso:Wtaiwgement, ,p- ❑ ❑ sdu"-vi,Services ❑ ,g' ❑ i'Aediatien .. . `c4nploymcnt As5lstance I Jab i .- ... ❑ Training : E3 ..❑ ❑ U'uirtR'?air ❑ 0-- ❑ f°0i A ❑ ❑ I..andlord/TowntUaison fl p ❑ r Scryicis for Victims of Vomosc ti }rousing Search and Couns�ng Sere zs �C7 ❑ ❑ vldenco I Vatiag VIOI A=I Soria( ❑ ❑ ASWLd t/}{umm Trafl^i ,w Lojal Scl�cas ❑ ❑ Dousing Fwndai Assis+a:lcc (ScaThy cposits,Utl&ty Assistaacc,Movi" ❑ ❑ �. Costs,First and Last Mon+.'a'sTzAt) Life Stills Training ❑ .L� ❑ }{omolcss PraVcntioa ❑ ❑ � Wtcirtal}lcaft'a Soviets ❑ ❑ {lousing Counsc4ng ❑ ❑ outp,tice4lcmi Scrvwcs ❑ X ❑ Ot41cr ❑ p' ❑ 613 G n� of 44(^w+iogtow Peach 440MIE A mericah?zscae -Flab - - 44omeless Ques+iovlhaire he Amcrican"Rescme?lam (f5R?) will provide$2.24 milbsl to assist individuals or homscholds Who are homeless,at risk of Nomelcssmoss,avid other vulnerable populat ons,by providing housing,rental assistance,supportive services,avid novi- iamgregate sheltcr,-ta'rcduce ho» e s less and'increasc houslr g stilfity in}1uingTon 8'cach—Please he p the,G'ry of /l r Nano ,'V � i>L .!/ L ?hone 0 , Aga "Re+ee� Hispanic? ❑ Yes Flo Length of currant\\episode of homelessness: }}ow many iimes have you been homeless? S }}ousehold Typc: t: �)le Admit ❑ Coe:ple wit'aomt Children ❑ S4171e?a.rent w/Children ❑ Two PAr'ewts w/Children ❑ Llmcucompanicd Yomth (17 or yomager) Where will you be sleeping tonight? ❑ street ❑ v'ehirlc !fhelter ❑ In a?Ark ❑ Motel/;;otel ❑ faw+.il;•/triensd ❑ Othcr V&crom (18+yrs. old and US Armed Service or Activated National 6u.ard/Reservist)? ❑ Ycs n'o Are you tr vi{iwg to flee from domestic olence,dating violence, exu sal assault,or hmmam traf f c/k ng?`❑ Yes-AINo 'Po yom have any of the following conditions? ❑ Y+lentAl,'$rt —iowal Pistrder ❑ ?hysical isal�ility ❑ pevelopment pisA'aility ❑ Chronic Sm� stamce Albuse l3 Ole. n What do your do for income/moms{? Mow womld you describe your aced for the follow,vvig services? Level of Need Level of Need Significant Some No Sipifieamt Some No Service Need Nccd Need Service Nced Need Need Rnrcal}{omsing ❑ ❑ Outreach services ❑ ❑ 'Rental Assistasim ❑ ❑ -,B' Substamoe Abu-so Treatmalt Services ❑ ❑ �K Non-Comgrcgatc Shcltcr ❑ ❑ Transportation ❑ ❑ Cee Childcare ❑ ❑ 1T Case YAarlagomemt ❑ ❑ Education Services ❑ ❑ ij ri1ration ❑ - ❑ EmploymcKt Assistamoo/Job Traimlmg ❑ ❑ G�< Credrt Tzpair ❑ ❑ Food ❑ ❑ ❑ Landlord/Tcnamt Liaison ❑ ❑ g� Mousi j Search and Counseling Services for victims of pomesiic Services Ar ❑ ❑ viol nee/pacing Volemce/sexual ❑ ❑ p Assault/Haman Traffici;g L� I services Mousing Finaweial Assistaoue (Seatritt ❑ ❑ pcpos'rts,W ir"Assistance,Ptovimg PI ❑ ❑ Costs,first and Last VAomth's"Rce) Life Slilis Training ❑ ❑ Momdus?rcventiom ❑ ❑ Wlcntal Meafth Services ❑ ❑ , Mousing Counseling ❑ ❑ �"` Outpatinit Mca.lt'a Services ❑ ❑ 01'aer ❑ ❑ ❑ 614 City of 44uvitivgtmi $each 4400E Americaw-Pescue Plan 44omcless QrnestiohviQire ; Tie American i?cscue Plan (A-R-P) will provide$2.24 million to assist individuals or hoascholds who are homeless,at risk ofihcmctossness;cniA o9i cr Vuleiei aEle popGWt ons, prOIA uig housing,ra tal assistance,supportive sonAces,AMA non- }hunting ton 8cach gather important data Needed for this gra:lt by compleHng t'ais gaesiioanaire. Name '` � ��I �� 111 a y 1 Y Phone i� /7> Age ,Z 2aee L RH a 0 }}ispanie? C�� Yes ❑ No � rnCL Leng-Nn of current episode of homelessness; Zn,(D }'row many times have uou been homeless? {{ousehold Type: !/ Sing!e Ad�dt ❑ Cnuplc without Children ❑ Single Parcnt w/Cnildreri ❑Two Parents w/Childrui ❑ Unaccow.panied Yost th (17 or ynm, er) Whcrc will you be slcep�in onight r ❑ Street ❑ Vehidc t1i Shelter ❑ =n a?ark ❑ motel/}Iotel Cl Family/Friend ❑ CM1er Veteran (1g+urs,old and US Armed Servico or Activatcd National C,-ivard/2,servist)? ❑ Ycs IJ1 No Are,yeti trying to{tee from domestic violence,dating Vlolv4ce,sexual assault,or human trafflaS q? ❑ Ycs Q/o Po you have any of i'ne following conditions? [3'rvtcnta!/;:mo;ionn!Disorder ❑ Physical pi<abiriti ❑7cvdopmcnt Pisabi!i;-,I ❑ Chronic Substance {;bu>c ❑ None What do you do for income/moncy7 �+ 7 L S s J {-)ow would you describe your need for the following services? LGVGI Df NCGd LGVol of Nwd Significant Some No Significant Some, No Service N Need Need Service Need NecA Nced "R.:n+al{!ousln9 ❑ ❑ Outreach Scrvlces ❑ ❑ 'Rantal Assistance Sabstawz Abuse Treatmart Ser✓,Os Non-Congregate Shcltor G� ❑ Transportaticn ❑ Cl <k C.Mcaro ❑ ❑ Caso rilanagemfe. ❑ ❑ Eduurcion Servters ❑ ❑ H1 a+on ❑ 0 ❑ Employment Assistance l Job " Training ❑ ❑ CratH?Zpair G X ❑ Foods ❑ ❑ taadtord/Tcnant Liaiwn '� p ❑ {ct(sing Search awl Cow4wfiing Servios for Vleiims of Domestic Seryv,els ❑ ❑ Vlotcnte/Voting vtovv=/.Sexual ❑ '� ❑ Assault/Zan Tra(ficldM }}ousing P"iaancial Assista:ua(Scavity Legal Services ❑ ❑ 7eposi+s,Utility Assistance,WWing ❑ ❑ Costs,`rIrst and Last Rtoniil's"Ren+) Life 5161(s Training ❑ ❑ {{omoless Prcvant on ❑ Y.tantal llaawel Services �( O ❑ }(ousinq CounsoIIq ❑ ❑ Outpatient-i}ealt4t Services ❑ ❑ Other ❑ ❑ ❑ 615 City of 44t4 tivgtow 'Beach :r -�DME �{werieah Fescue Plan }}ovmless Qlnesti000ire ;^ The Amencaa"Pzscue?Ian WT) will provide$2.24 milfioy to assist individuals or housaMolds who arc hqjncless,;a risk: of hoTnclessrass,an or w ncrable,populations,by prov dng housing,rnital assistance,stApportive,services,and non- cuntington Beach gather important-data needed for this grant by complating this questionnaire. ?41ona f`� / i�l (i — L 2 I i Age ) I ,2aec.l)1 '{y,r l i.0 i :(t. }{ispanie? K Yes ❑ No Length of current episode of homcicssnass: (7 I �'I ?Uf b }ow many times have you been homeless? +t'ousehold Type; Single A&dt ❑ Ccuplc without Children ❑ Singlc Parcm w/ehildren ❑ Two?area+s w/CMiLiron ❑ Unaccenlpaiiicd oath (17 or yow.ngcr) Where will you be sleeping tonight? ❑ S+r-ect G Vehicle helter ❑ in a Park ❑ wb+d/ otcl p Family/Friend ❑ C-tL;er Veteran (10+yrs.old and US rinved Service or ilc+ivated National Cjuard/Resorvlst)? ❑ Ycs �(Nc pre uou tr{ing to flat from domestic violence,dating violence,sexual assault,orrnuman trafrickng? ❑ Yes XNo Do you have any of the following conaCrhons? wtantal/Smational Disorder M Physical-Pisabifry llll DGvelopmert DlSabilHv Chronic Subs+anta pbusc ❑ None /` What do you do for income/money? }low would you describe,your read for the following services? Lryolof Need Laval of Ncod Significant Some No Sgnrficant Some No Service Need Need Ncad Service Need Need Need 7zeal{{oasin9 ❑ ❑ Outreacii S rAcas ❑ O 'Rartal tlssistanw ❑ ❑ Substance flbasc Tre&h7intt Scrvicas O O Nor-corgragatc Sileitcr ❑ ❑ _ Transportation ❑ ❑ GMiNcare ❑ ❑ Case YlianggameM' ,. ❑ ❑ F,clucation Sarviees ❑ ❑ Madiahon ❑ . . ❑ E•mploylncnt flssis+ance/Sob Training ❑ ❑ Credrt-pspair ❑ . ❑ Food ❑ ❑ Landlor4Ta,a t Liaison ❑ ❑ ,4oasing Scorch and counsdng \, Sennees fnr Vvt ms ofDomas+c suvecs A� ❑ ❑ Nolcnie/Pating Yolcncc/serial ❑ ❑ '134 AssaWt/t{aman Trafficbng . r{oasing Tirane al{ssistance(secant{ L-ga!Services ❑ ❑ Deposits, UtilHy Assistaacc,Modng ❑ ❑ Costs,First and last montil'sRcnt) Lifa Stills Training ❑ ` ❑ }fomcless'Pravantion ❑ ❑ Nlantal{{catt§,Services ❑ ❑ }{ousing counseling ❑ ❑ Oatpaiice Health Services ❑ ❑ Other ❑ ❑ ❑ 616 Citt{ of 4 Eroitio +ow -aeach w 440ME AmcrioviWscve, Tlavl }{ovneless Qaes�-iovlviaire "a The AmcricaaRescue Flan (ARP) will provide$Z.24 million to assist individuals or households whe arc homeless,at risk of_homelcssnoss,.and,oiiser_vulnerable•popufat onsrb{•previdnq hoitsihq-rarYal assistarue sup�oriiVa sery ces,and non- con r e,shelter,to reduce homelessness and increase 0 "M49ton orwr c)Atiur Import aVYi data vicedtO for this grant by complotinq this gaestionnaire. NaYne-�� � T �!/'�� �1 U � `T���. Ay ��I U vl I f Hispanic? Yes ❑ rlo Lcngti� of current episode of homelessness; 12- ZLj 12-1 }{ow many times haVc you beat homeless? }iouseheld Type: 5inglc Adult ❑ couple without Children ❑ Sing:c'prrcat w/Children ❑ Two t nrtvts w/Childral ❑ unaccampaai• %(nwtbt (1'r or uoungcr) Where will you be sloe in tonight? ❑ Strect ❑ Vehiclehelter ❑ Ina York ❑ Y4otcl/;,'otel ❑ family/friend ❑ Othar Vrheratt (15+yrs.old a//igel��`l US Armed Service or ActivatM National(Tuard(Rcscry st)? ❑ Y:s Xnlo Are you trying to flee from dourest c violence,dating Violence,sexual assault,or human El Yes ❑ No Po you have any of+he following Dondltions? Wiartal/c'moiiona!Disorder ❑ 'Physical Pisabili^{ ❑ Pevclopmatt Pisabilit•i ,�Chrooir. Substance A'octse ❑ None What do you do for ittcomr/moneV _SE S- "t f{ow woolld you describe your racedt for he followittq scrvicts`7 L6V61 of Need Lryd of Need Sgnifica t+ Some No Sigai{wae Some No Servce Nced Need Necd Scrvice NFA Natal Need "Rental{{eusiw'.g ❑ ❑ Oki-roach Services ❑ TzmtAl Assistance ❑ ❑ Substance Abuse Treatmmrt Services ���rrrJJJ ❑ Non-Congregate Shelter ❑ ❑ Transportation ❑ ❑ Childutre ❑ ❑ Case PAanagemcrrt ❑ Cl Education Scr ,z ❑ ❑ titr ation Employment Assistance/So'o ❑ ❑ i Training [rcdH-"Re?air ❑ �y{ ❑ Food x ❑ ❑ Lattdlord/Tcnant Liaison ❑ ❑ �ussii g Scarch and Counscfi *o ng Scrs for Victims of Pomcstic ❑ ❑ Vtelcnce/Petting Violatcc/S=W ❑ ❑ Assault/{}amatt Traffubnq \ , }{easing Fimwtcial Assis+o.nce(Secariti Lcgal Scrvicas ❑ ❑ Pcposits,Utirtty Assistance,ntevinq ❑ ❑ Costs,first and Last nbni41's•Rant) Life Sills Tretininq ❑ ❑ {{omeloss Prevention ❑ ❑ 1Nat,al¢rw"Services ❑ ❑ }roasinq cwvis &nq ❑ ❑ outpatiatt}}eaFthScrvwes ❑ -� ❑ Dther ❑ ❑ ❑ 617 Ci+y of 44 nh+41r +ovi 'Sex* �. 44OM-S AmoricaviTzsc e. 'Plate 44ovncless Qms+ionllaire 7 e ,mcriea� �scuaP�i-(¢,1'�_wjll.p��(ide_$2?4.1ni1GontoassistindtvJdua!s.oho:seho!ds:rho,are.hotndess,.akr.;sk_ of homdcssncss,and other vulnerable popWatimns,by providing housin rmttal assistmncc,sap?ortive services,and non- o Ta 1 i 1 gTon oe a, rICASO Rip the }!untington Beach gather importavrl-data needed for this graft by com?lotinq this questionnaire. Name "�1-, ,1 •� l c 5 I r(���2 d {tgc _ eau J ?;ispanie? ❑ Yes''bO No Langt'n of carrettt episode of homelessness: ZL2S �ow many t mes'nave you been hotne!ess? }rousahold Typo:.F Siwgle Adult ❑ Couplc without Children ❑ Singlc Parcvrt w/CY:ildran ❑ Two Parents w/Children ❑ Unaccem?aaied Youth (1 i or younger) Wherc will you be slcepinq tonight? ❑ Street ❑ Vehicle,,�'"Shelter ❑ In aPark ❑ rilotcl/r otel ❑ Family/Friend ❑ Other Ve.terat (1&+yrs.old ald US Armed Service or A,:tiva+ed Natiotwl(auard/Rescrv!s+)? ❑ Ycs c3\No ,are you+ruing+o flee from domestic Violence, dating Violence,sexual assault,or humeri trafficking? ❑ Yes -No �o you hale any of thcfdlowinq eonefttions? {'3�Wcntnl/Emotional Pisor�ier �;P'nysical�isabifiry ❑ DeVelopmc�rY disability ❑ Chrowit Substance Abu;c ❑ None Wha+do you do for income/monc4-7 Vlow would uou describe your aeod for+ho following services? Level of Ncod Level of Ncod SignificarrP Some No Signifcat+ Some No Scrvico Ncod_..- Need Need Service 'Ncod Ncod Need Rcirtal}lousing ❑ ❑ Outreach Services Q" p ❑ Rc tnI Ass stanca /�7r ❑ ❑ SubsYatuc Abuser Trcahnatt ScrAc&s Non-Congregate Slie to ;A_ ❑ ❑ Transportation _ ❑ ,�;�' ❑ Chilkaro ❑ ❑ -6 Casa VNa ajc Went. kg'. p ❑ `cdatatinn ScrViccs ❑ ❑ >9 Hted'wtion - p ❑ ❑ Employme,it Assistance/Sob _ ._....:--.:.:. .. Training ❑ iC] ❑ Crcdtt'Repair ,-�T _ . ❑ ❑ food -� ❑ ❑ Landlord/Tcnant L"w!son ;❑" ❑ }louslnq Search and Counse(nq Sarviaos for Viiotiins of Vomcstie, Q ��� ,� ❑ ❑ Vlolenca/Vatinq Yida+uc 1 Scrl+al ❑ ❑ Assau}t/.}lanan Traffimim Legal Sermccs ❑ Cl a Pr?oslts,Utillty Assistance,I o Anger .❑ ❑ Cl Costs, First and Last W%ogiWs?iirl-) Life Stills Training ❑ �:�" ❑ Voindess-PreVcnfion ip` _ ❑ ❑ INcntalt{calttl5crviccs %p ❑ ❑ {}ousingCYmis rlwj bL ❑ ❑ Outpafiatt}(cal{A SanYUcs IT Cl ❑ Dthor ❑ ❑ ;p 618 City of 44rnvltivi9tu 'Death +f 0ME Americali-Fescue"Plate 44omcless Ques+iohvlaire The flLncr can escuc Plan (A-KF) will provide$224 million to assist Individuals or households who arc hoyndess,a+r sk ofi4 omdessnrss-anA•oi{�ervalnerable populaiio.ts,'byrovFg ho Ci Su g re, ,a asses ante,supportive sery ces—and n011- ConAL& Vto s e er o Imisyless m1A imereasau "TtH'g+on Beach gather important data needed for this gran f by completing this questionnaire, Name C Y'; �I Ey F Y r- rl Phone Age % ) "Race {{Ispanic? ❑ Ye> 7—N Lengt'n of current episode,of homelessness: l . #ow many times have you been homeless? ! 1-.(',LI'\- }{ouseholcl Type: PAS lc Adult ❑ Couple YAtiloLLt Chi!drew ❑ single?arcnt w/Cr.ddren ❑ Two -Parents w/Oi!dren ❑ Lbtaccbmpnnicd Youth (I? or younger) L Where,will you be sleeping tonight? ❑ Street ❑ Vehicle GAS t-er ❑ inn Pnrk ❑ motelMotel ❑ Famiki/Friend ❑ Other Veteran (15+4rs, old and US firmed Scrvice or,ic+ivated NA-hoLlal C4uardJ servist)? ❑ Yes LT�b Arc you try ng to flee from domestic violence,dating violence,sexmi assault,or human trafflckiLtg? ❑ Yes ' ➢o you have any of the following cond}tions? '�'ALL•�al/FLnetionnl Tiiwrder �P'nysical➢isa'viliry ❑ ➢cvelopmcnt➢isability Cl C.hro:tir.5u':;stnnrc those ❑ None what do you do for income/moLlry i!] i ,t c I,t' f, }{ow would you Acscribd your L1ccd for tho following services? L�valof Nccd Level of Need SigLitfieant Some, No significant Some No Service I Need Nced Necd Service Wed Need Need R;,rtal gouslml I. ❑ ❑ Outreach Services ❑ .._ G 'P.cLrtal Assistance y ❑ ❑ Substa:uc Abuw Treatment Senecas ❑ G .. Non-Cangrcya+e Sucher ❑ ❑ ,_O;. Transportat!on `:;6c G ❑ Childcare ❑ ❑ p-' Caw Wwnag6YA04t• :Q^ ❑ ❑ Education Services ❑ ❑ YAediation ❑ ❑ ,,❑.� £mploymant Assistance/Job -- TraiLL!nq ❑ ❑ Grcd+Repair ❑ ❑ k5 Food :S7-' ❑ ❑ Landlord/Tcna:rt Liaison G ❑ jam {)ousing Search and Counseling Services for Vmiims of Vovncstic Services �C ❑ ❑ vw tm/Daiiag vwl"cc/Selwal ❑ ❑ ��^\ Assault/}Iuman Traffubng }futsinq Fnandal Assistaa (scorn it{ Loyal Services ❑ ❑ Ty- ➢cposi-ts,Willy Assistance,Ydo•Ang ❑ ❑ :0--:z Costs,F!rst and L 4s+murth's Rant) Lift Sf Its Training ❑ ❑ {{omcloss Prevention ❑ ❑ ❑ Wlcntal}(earth Services ❑ ❑ 0. {}ousinq Coanscaeg ❑ ❑ �'U� Outpatimrt}kaliit Sarvicas ❑ ❑ Other ❑ ❑ ` 619 City of 44mvit4iotow ,5&6ic i r 440ME -Americ iTzscae 'PIAn }}ovincicss Questiovlwaire The Alm,cr1rAn"Rescue plan (}1RP) will provide$Z,24 mllion to assist indv duals or hoascholds who are,homeless,at risk of hamofcss tcss-and ot»crvulnerablc popuWiionsby pro(dng housing;rcn !assistance,5uppor-H7r WINE,and non- }rutrtington Beach gath'er importatrt data,tcc&d for this grant b c y omplaling this questionnaire. rlL P" y ?hone 0 1 1 9ge I 1 ? e4�C1�(1�L��/��'}}��' n }{ispanie? ❑ Yes �LN0 Length of v,,rreat episode of homelessness: ` % }row many t mes have you been hOme16SS? }{ousahold Tape: �ISinglc ndldt ❑ Coeplc teithovt Children ❑ S'rnglc FvcvIt w/CWldren ❑ Two Fe rents w/CFtildreii ❑ Unaccompanied Yoaith ill or younger) Where will you be sleeping tonig'nt? ❑ Streot ❑ Vehicle "cFtzr ❑ In 117er'l- ❑ MDtal/llotel ❑ Fnmily/Friend ❑ Other Veteran (1&+yrs,old and US{,nned Service or Aaiivated National(auard/Raservist)? ❑ Yes PVo Are,you inling to flee from domestic violence,dating violence,sexual issac4t,or human trafficbng? ❑ vcs Do you have any of the following COI14—bons? ❑ "A.ertAl(Lmrtiennl Disorder ❑?hysicA; Pisabilitt ❑ Developmcnt Disn!Aity ❑ Chronic Substance f'ouse fIR 110na w'na+do you do for inwme/money? 1 }row would you describe your aaed for the following scrviccs? Level of Need Level of Neod Sigtirficatrt Some No Sgnifteant Soma No Service Need Need Neal Service Nead Need Need 'R-,ntal riaAsing ❑ ❑ Ouir.,ac'n Scr Ari s ❑ ❑ "Rental Assistanw ❑ k- ❑ Substmue Abase Treaimart servlccs ❑ ❑ Non-Cagrcgato SheFtcr VL.,l ❑ p Transportation ❑ Cl Childcare ❑ ❑ Casa lnanagc'ma,tt �, ❑ ❑ Education S&Y=s ❑ ❑ Nledtation ❑ ❑ cmplaymce Assists ue I Jab ! Training ❑ ❑ V✓ Cra tt Tzpalr to ❑ ❑ Food ❑ ❑ UIidlard/Tcnant Liaison �Z❑.• / p' }lousing SeArell and CounscGng 5cnriccs for YwYims of Pomcstic Services \notate=/Dating ftolea,o/Sam( ❑ ❑ AssaWt/}luman TrafficidM {lousing rtnancial Assistm,ca(Sucvity � Lcgal Scrvlus ❑ � ° PcposrFs,Utility AsslstaIvz,moving t'l'i ❑ ❑ Costs,First and Last nlon*'s/ant) Life Sblk Training ❑ ❑ }lomdcss prevention ❑ ❑ Mrvrtal 44wW4 Services ❑ ❑ {lousing C4Wn5cGn9 ❑ p Outpatient{leaFth Scrvicas ❑ ❑ Oti,er ❑ p ❑ 620 Gi h{ of 44mvitivlgtovi I emcY 440ME Ampvicmi Tzscme, -Plavi }{omaless Ques+iowhaire The{tmcrican Rescue Plan (ARP) will provide$224 Ynilfioo to assist individuals or households who are homeless,at risk of hometcssnessand•otherVnllwrable•paputAtions'Fnj'providlh9 ViouslH9,rcn-'P'a!asses a� vc services;and noh- ""� {�untingtm'Death gather important data needed for this grant N eomplcttng this gmcsi iomnaire. C/��/ AgG {I ?-,tcc �V 11 ��Yi 44I5pANlc? ❑ Ycs ® No r Length of current episode of homelessness: }}ow many times have you been homeless? }{ousehold Type; SIm.jc Adult ❑ Coo.>Ic v;it'tvat CStilelrcn ❑ Sin:)!c'PArcot w/Children ❑ Two Parents w/Oaihren ❑ Unauompaaicd Yovt;a (17 or yewnger) where will you be sleeping tonight ❑ Street ❑ VeNcle X Shelter ❑ 2n n park ❑ Y.totel/}'ro+cl ❑ Family/Friend ❑ Q-eh6r Veteran (16+yrs.old and US{armed Servicc or{activated National(Aowrd/Reservist)? ❑ ' s No Are you tryinq to flee from domestic v olence,dating violence,sexual assault,or human trafnebngwYes No Po you have any of the following conditions? ❑ w1tntali irmotienal Pisordcr ❑ Pbrysica!DisnW,ty ❑ 'Pevelopmcrrt b'isa6li^y ❑ C.hronic SA'st we fibuse 9 None what AD you do for income/mo icv? �f +iow would you describe your need for the following services? l-ayal of Need Level of Need Signifleart Some. No Significant SomC, No Service Need Need Nced Service Need Need Nced "Rental{sousing ❑ ❑ Ou+rcach Scr/ccs ❑ ❑ 'R;rrtal Assistance Iz ❑ )4 ❑ Sabstawc Al-us,Treatment Savfus ❑ ❑ Non-Coagrcgatc Shcltcr ❑ fz, ❑ Transportations ❑ ❑ Childcare ❑ ❑ K Caso wianagwife J ❑ ❑ ;location Services ❑ ❑ Ynediation ❑ j ❑ Employment Assistance/Sob Training ❑ ❑ 71 CrcdtTzpair ❑ ❑ Food ❑ ❑ IAndlord/Tcme Liaison ❑ ❑ �q ?dousing Search aKd Cwm6fing Scram for MIImtimS of'Pomestie Soviets ❑ ❑ violent,/Dating violence/Scawl ❑ ❑ Assav t/}}wnan Trafficking {lousing financial Assistance (Sam" Legal Services ❑ ❑ Deposits,UtiMy Assistance,wbving ❑ ❑ Costs,first and Last I%bWtA'S?ant) Life,Skills Traintnq ❑ •g, ❑ }/omdms Prevention 9 ❑ ❑ wkntal}{eakil Services ❑ ❑ 91 }{onsing CbKwang j ❑ ❑ Ocrtpatiert 44eakh Services ❑ ❑ OYner ❑ ❑ ❑ 621 Ci h{ of }�Uhtivt9tov� �eacl� 44C)ME Awedom zscme, -p h j 44omdcss Qves-Hoviolre The,Avncrican-Rescue?Ian 65RP) will provide$2.24 million to assist indiyidcals or bwuscholds who are homeless,at rislc of pavn'eIcSSFess—a.id ofih�r Vulnerab[c populAiions,by prop +nq Dosing re tal assistantz,supportive,services,and non- {{uvrtiagtovi 8wrl,I gather importavrt data needed for this grant by covnplating this qucstionna re,. Name, , �V tyht 1^1 v1 ''0 'phon / /lip q� 1 i v e Je �� w1kim 44Ispanlc? ❑ YCi ❑ ND Lcngth of currevrt episode of homelessncs5.1p. }ow many—Hynes have you bcery homeless? 44ousehold Type: Z Singlc Adult ❑ Couple without Chllcirvn ❑ Sitiglc?arctrt w/C'nildren ❑ Two Par6nts w/Children ❑ Ut,attet+ipatiitd Youth (17 or yo��nger) Whcrc will you be slcepinq tonight? ❑ Stroct ❑ Vehicle N Shelter ❑ iD n Fami1y/Frzw4 ❑ Other Veteran (10+yrs•old and US Armed Service or Ac-Hvated National(Tuard/Pzservist)? ❑ Ycs H No Are,you trying to flee from domestic violence,dating violence,sexual assault,or human trafncknq? ❑ yes .E] No Po you have any of the following condrtions? 9! t'Aental/>,=vr+Otiv+a!Disorder ❑-Physical}ability ❑ DcvclDpmcnt Disabditt ❑ C'aroni.. Substanc6 AL-us:% ❑ Nonc What do you do for income/mono(! ! { ow would you describe your nead for the followinq services? Level of Need LO(d of Need Significant Some, No Sig0flcae Some No Service Nced Need Need Service Ncad Need Need "Ravtal fousing ❑ ❑ Outreach Services ❑ ❑ `FJ 'Ren+ai Assistance 9 ❑ ❑ Substance,Abuse Treatmcrt Services _ ❑ ❑ g Non-Congregate Shcicr ❑ P ❑ Transportcrlon Ila— ❑ ❑ Chi!dcaro ❑ ❑ Cg- Casa Planagamevrt 'R-� ❑ ❑ Education ScrMzs Er ❑ ❑ mediation £mpbymart Assistance,/Job ❑ ❑ ru Training ❑ (3- ❑ Crodtt'R6p4ir ❑ ❑ Food .� ❑ ❑ Landlcrd/Tcuv%t Liaison ❑ ❑ S6rvtccs for Victims of Uomcstic So vlaos rch and Counseling ❑ C1 'blench/Dating Violev"/Smwl ❑ ❑ ��._ Assault/})uman Trafficldng {lousing Ftnaniwl Assistance (Security Legal Services ❑ ❑ y],. Poposrts,LttiMy Assistance,moving .F1' ❑ ❑ Costs,First and Last mon+h's'Rcnt) Life SH[Is Training ❑ ❑ g }{omoloss'PreV6ir ion gip' ❑ ❑ Mctrtal}IcalhScrvices ❑ ❑ t}ousingCeansolinq ZI ❑ ❑ Outpatiowf-44ANit ScrvUzs ❑ G Othor ❑ ❑ ❑ 622 City of 44(Avvhootov) Beach 440MIE A mericav Tzscue 'PUm - }{ovnefess Qrnes+iovlvlaire ; The{tmericanV,ascrncpian (fiRY) will provide$2.24 million to assist individuals or households who arc homeless,at risk ofhomciessncss,—and other vuhiera6l pop{lYii otis,try pro dng housing;rcnt'al asses ancc,supporflvo scr Aces,and non- }IplrHngton Beach gather important data needed for this grant by compl&htio+his questionnaire.- Name �Vf� l�'VW 1yCl���lWr1 phone /lL�— � � a (�� 72L�,: � / s l flgc l(1 _L Pau }{ispanic? G Yas vo Length of currant episode of homelessnoss: ? many iimes have you been homeless? 41004sehold Typo: Single Adalt ❑ Co without Cren ❑ Singlc p ntare w/Children ❑ Two pnrcnts w/Children El Unaccovn?aiOcVouttt (17 or younger) i Where.will you be 51repilIZItonight? ❑ Street ❑ Vehicle helter ❑ Ill a park ❑ YAotd/{•'Dial ❑ Family/Frian:l ❑ O-Yhar Veteran (1&+yrs.old and US firmed Service or Activated National(Tuard/Peservist)? ❑ Yas tfNo Are you trying to flee from domestic v olence,dating violrKee,sexual assautt,or human traf ficibigZ ❑ Yes Imo Do you Haut any of the following Gondition5? �'Wlcntal/Emo;iosial Disorder- 4'`'hysical Disability ❑ Dae'alDpment Disability ❑ Cl1rDVIIC SNbStanea Abase ❑ None what do you do for ituame/money? S /�% Pow woald you dcscribr your nerd for the,following servires? Level of Nccd Level of Nacd Significant Some, No Significant Some. No Service Need Need Nerd Scr/ce Need Need Need Rental?{ous ng ❑ ❑ Outreca'a Services ❑ y❑ ❑ 'P.cn+al Assistance ❑ ❑ Substance Abase Trcai vrrc Services ❑ C p Non-Cangrupte%ckor ❑ ❑ ❑ Transportation iyY p O CYlildcare ❑ ❑ Casa mmagement ❑ �'' ❑ Edtwtation Services ❑ ❑ t mediation ❑ I ❑ 15ynp6ymcnt Assistance/Job Training ❑ ❑ Cre4if-Rapair ❑ ❑ Food ❑ ❑ Laodbrd/Tenant Liaisan ❑ ❑ Ct.' }{wising Search and Counseling SerVias for If"ms of Votrestic ScIrviocs ❑ ❑ vWcaa/Dating Violence/Sexual El ❑ `y{ Assault/t}oman Trafficking eal ScrVltaS i(ousing Financial Assis+ana(Suurity 9 ❑ © ❑ Deposits;Ut lity Assistance,Moving 'PK ❑ ❑ Costs,First and Last WtDn+A's'Pcnt) Lifr Skills Training ❑ ❑ C 4hyna rss-mveMien ❑ ❑ mental 44wHil Services ❑ ❑ {}Dosing Counseling ❑ ❑ Oatpatient}tealttt Scrvias ❑ ❑ Other (r.I��— ❑ ❑ 623 C ih of 44tm+ 1 +ovi 'Beach 4400E Amoricah-Rescue Plavi � }rov»eless Ques+iolnhaire to rezl� v�,e�jh�c_Cjcgu�;sgye�lwti.(���wifl�.oxide.$Z.24.milCion_to.assis�indiViduals or_�oas�'vwWs•w'ro are•Llotnefass;at ris�•- of homelessness,and other vulnerable popcJations,by provldlx housin rental assistance,su rtiVe services and no - PIOMM511M am incrcaso ousrng s•a in tt%rrivl oni coca.P cast is p t$lc City of Hunt n3ton ceac'a yathor importaitt data needed for this grAe by romplaling this questionnaire, Name ' VI t= (110 Phone (��l)� 5,� / I�'j� 1 f , Age 9 ww t' 1' r:_ {{ISpaNIe7 ❑ Ycs rQ No Longth of carrc:rt episode of homelessness: flow many thme's have you bccn homeless? t� \ •'�:`' }{ousehold Typc: injle Ad%ilt ❑ Coaple wit4io>rt Children ❑ Singlc?arcnt w/Cl6Wrcn ❑ Two Parars w/Chi!,iren ❑ Unaccomperale Yount (17 or younger) W'acre will you be sleep sledp"v tonight? ❑ Street ❑ vehicle i Ltclter ❑ Sn a ?ark ❑ motel144otel ❑ Family/Friend ❑ Otitar 1 Vttcran (16+yrs.old and US Armed Service or AL^vated National Caaard[Rescrvist)? ❑ Yes ❑ No Arc you trying to n"ce from domesiic v olcncc,da xg violence,scxaal assault,or' wawn trafncldng? ❑ Ycs 4.No 'Po you have any of the following tand'rions? . ❑ vdental;�motio•.ta!'�i5oreter ❑ Ph45ical Disabirry ❑ Development PisabiGty ❑ Chronic Substan¢e Abunc ❑ None What do you do for intone/monw,? L'. j•7T �F irk r1.�rJ `I I PJ� How would yw describe your need for the following services? Level of N•ad Level of Need Sgiirficae Some No Sigitifaae Semc No Service Need Need Need Service Nocd Need Need 'Rental Housing ❑ ❑ 5R� Outreach Services ❑ 'R.:ntal ftssi$tana nt•w•- SI5• ;�t ❑ ❑ Substance{tbuc Trca+mcnt Serv!as ❑ .. ❑ Non-Con re .. ._....-... 9 gate Sacltcr ❑ ❑ Transportation [hildcaro ❑ ❑ ,Q-. Caso.YAnnnycment la p ❑ £ducat on Scry ccs ❑ ❑ (� ri5ufiation ❑ O' ❑ clnplcyiiiant Assistance!Job .. Training , ❑ ❑ ler . (r`dFYRcpair � ❑ ❑ Food ❑ ❑ Landlord/Tcnae Liaison �} ❑ Hms:t'M Scorch and Counseling Seryicas fx Yictin s of Vomastic Srw'+AcrS ❑ ❑ Violence/:`Dating Wolotc./Soxual ❑ ❑ As9aiiFt/f}umax Trafncfdng . Housing Fnaiw al Ass sta ue(Scuv tt Legal Services ❑ ❑ j 'Deposits,I,+ti6+y Assistance,M0,M1 ❑ ❑ Costs,first and bast xlenth's"Rext) l:tfc Stills Training ❑ ❑ Homeoss Pre iiwfion ❑ p Real Health Savias ❑ ❑ .L Housing Counsefng ❑ Cl Outpatientflcalth Scrvias ❑ J3K Cl Other - ❑ ❑ ❑\ 624 Ot,q of }huh+i0g+mi 13mr* 4400E AmericaviTzscm,'M m +}otmele,ss Qms- iommaire, Tne American R sec a Zlan GS?J wjll FrnY de 2.24 r�i�G?n to_assisf iadv duals.ar_households who:are,ho4n less,.at r sk of homelessness,and otl irr v«lacrable populations,by providng housing,rental assistance,supportive services,and non- n DeTerffease. e p a 'ty {;untington 8cach gather imporfian+data needed far this grant by completing this questionnaire. Age. u Y_cwe {hispanic? �>c�❑ No Lengtn of cvrretrt episode of homelassress: T1J J {low'many t vncs have you bean holme ass?�_ }ousehold T{pe: Single A.iult ❑ Cauplc witl^.out Oriildrevi ❑ Single Parent w/Children ❑ Two 7are:its w/children ❑ Unauompaniad Yoarth (17 or yo:utgcr) Where.will you be steeping night? ❑ Strccf ❑ Vehicle S eltcr ❑ Di e, lark ❑ YMotdp;otei ❑ pamity/-;riend ❑ Other Veteran (1&=yrs. old and US Armed Service or Activated National 6uard(Reservist)? ❑ Ycs f v Are you trying to {lea from domestic'nolcnco,dating Violence.,sexual assault,or human trafficdng? ❑ Yes --m -Po you have any of the following conditions? ❑ rilattctl/Et•netivnal Disorder ❑ 7Yulsiutl t7ic,;,4rilifi+{ ❑ P6vclopmn1t'Disa6-ifity ❑ Ctnrmc Substance Abuse ❑ None what do you do for income/moneys C: �,'; .. � Gye C-, } ow would you describe your Aced for+'ae following sarvicas? Level of Nced Level of Need Signiftaarrt Some No Significant Somc No Servua Need Need Ne.ed Servica Neal Nerd Need pcntal {ousingTr ❑ ❑ OutrcachScrvices ❑ G Rental?6sistarw _ ❑ ❑ Substance{tbeLsa Trcatnwnt Services ❑ ❑ Non-Cangr'egate Shcftcr p ❑ Transportation ay ❑ G childcare._ ❑ ❑ Caw,YAaiiayamo .G�l� ❑ ❑ a=duLation5.:tvltes _ .❑. ❑ rihediaiim, Evn Ip Mca t Assistania/3ob '�/ . ❑ El — / ❑ ❑ CrcdrfRcpair Training S�` �^ ❑ ❑ F G ❑ ❑ Landbrdl-fcnant Liaison ,❑.� ❑ ❑ }}ousing Search and Counseling ServicAs for victims of➢Omostic Servicas kY ❑ ❑ violence./Voting Yida /.S i al ��❑ O Assaal j'/}}u4+tan Tr_�aefii}�'niy �; / }rousing F'inanrN psslstanca (Saurity / Lcga!Sarvlccs ❑ ❑ l7cposrts,lktiCrry Assistance,Moving fr7-,/ ❑ ❑ Costs,First and Last wlonth'sRcnt) �_ / Life Stills Training ❑ ❑ }romoss el 7rcwanfiw l�F� 0 El Wtan2al{:cal'n Services cp ❑ ❑ goosing CW,,sdng ClL/� ❑ Outpaticnt?{calh Scrvicas ❑ ❑ Ot✓cr ❑ ❑ ❑ 625 0-'ry of �rnv� �iv�r�+oh Beach _ {I D ME -AvAcricalTescm Plah - { omp,15ss Ques+iohnaire ;'" " _�.h4�lnu9ca�.'.�csuw Y.lan.(;<~k?�will,g�ovidc$2.24.milfion to.assistindividuals.or_households_who.arc,homelcss,.atnsk_ os"hovncicssncss,and at'ncr Vulnarablc popultN;ons,by providin housi ,rental assis+ante,,supportive,services,and non- To w n DUS149 s a i n w n on cast e p e +{uisiiiigton 8cach gather iinportairt data needed fnr iris gram-by complo-ting this questionnaire. Name, -.1 L L c S& "31 Age, C,o 'Race, L , nra n c +AWs iic? ❑ Yes ❑ No Lcrgth of awree episode of homelessiwss: Pow many times have,you been homeless? it r,: -r +r'ousphAel 7{pe; ❑ Sajle AuiWt ❑ Couple, wl+hou+ Children ❑ Singlc Parcet w/C!nildren ❑ Two Toren+s w/Cl,,Mrui ❑ Uriaccbwpanied Yowlii (17 or younger) Wharc will you be slcepiiig tonight? ❑ Streer ❑ VehicLc Cy'Shekcr ❑ I>1 a?ark ❑ Motel/+Iotci ❑ Fcinuly/Friend ❑ OThar Veteran (I&+yrs.old and US Armed Service or/}ctiva+cd National 6nard(Rescrvist)? ❑ Yes ❑ No A'rc you trying to flee from domasiic violence,dating violewz,sa ml assarnit,or human trafficidng? ❑ Yes No Po yea Nave any of+4te following cood"H ions? ❑ wlantal/L-imrtional Pisordcr ❑ ?hysital PlsalMt i-j i ❑Pevcloponerl'Pisabif4t ❑ Chronic Substance =,louse ❑ Nmie what do you do for inc4mc/mcncy? L� }row woadd you describe your heed for+he following scrvices? Level of Need .Level of Need Sigiiiflcaiit Some No Sgiiificant Some, No Service Need Need Nacd ScNcc Need Need Nccd ''ti.::rtal{�ousinq Cl ❑ p outreadt SarAccs ❑ ❑ p "R:rctal nssiztanco ❑ ❑ O _ Substance,Abuse 7ru+tmut Saylccs p. ❑ 9 Non-congrcga+c SricFl-cr ❑ ❑ p Transportation ❑ ❑ p ChiLkaro ❑ ❑ .l _ CaisawA—acjciroeiH•, ❑ ❑' ❑ 'cd�sation savlas ❑ ❑ ❑ Y.awiiDH ❑ ❑ ❑ Titiployinciit Assistance/Job Troini ❑ ❑ (D crai+-?zpair .. . ❑ - - Cl a] Food . - Food ❑ ❑ la L awiord/Ten e Liaison ❑ ❑ p i Scrvicis for V'etii-m of Pomcstic +a sing Search and Couns nq ��� ❑ ❑ Cl Vidcnce/VatingYolenccYSaxwl ❑ ❑ ❑ AssauH-%}k+riiaN Tra�nq }{Dosing Fnancial Assistance(Saw-tty Lc Via!Scrvires ❑ ❑ a Pcpos;t ,LHirHy Assistarue,Mo Ann ❑ ❑ ❑ costs,First and Last Abn_Ht's'Pcnt) ' Life Skills Training ❑ Elci +}oiacloss rrcveniion ❑ ❑ ❑ Mnital+{coHt Scrviees ❑ ❑ ❑ +{oasingeounerin sg ❑ ❑ Q oikFpatiant}IcatthServices ❑ ❑ O, other ❑ ❑ ci 626 City of 44mhi iw tmii 'Se re, 440MEAvwricmiTzscue -plan - }{ovneless Questionnaire The}lmuican�cscue?Ian VR-P) will rovlde$2.24 milfioat to ass s . d ;aIs or households who,ace,homeless,.ai rzsk— of home csstess,and otricr vul+terable popalaiions,by providing Iimsimg,rental assistance,sapporiive services,and aon- ac p e Utq of 44v. tington�cmc ga Vcr important data"ceded for iitis grant by complaHng-HATS questionnaire, r 415pANlCr ❑ 4es ❑ ND /7 Lnvii of aTrnr;episode of homelessness �/ � row many iimcs have you been homeless? I 1 1 Oosehold Type: \\Single AdiW- ❑ Ceuplc witllwe Children ❑ Single 7arcnt w/Children ❑ Two 7arats tv/Onildren ❑ Unaccompanied YOWH1 (17 or younger-) wl,%,rc will you be sleep n owi w ❑ Street ❑ V610-, helter ❑ rn n Park ❑ Y4otel/}'rotDl ❑ pntnily/Friald ❑ C}t ier Veteran (15-yrs,old dad US>nrmcd Service or ct voted National Cjcard/Rcservist)? ❑ Ycs/�]No ?re,you trying to flee from domestic%dooence, dating violence, sazual assault,or'a:uran trafjukng? ❑ yes P�/401A have mny of the,following COnaliiOns? ❑ me iowl Disorder� hysical Disability 1 I Development Disabiliry ❑ Chronic Substance ,ibusz one w'aai-do yov do for income/momrV Vow would you describe your need for the following services? L6VCl of Need Levu S gird oca t+ Some, No Sicynifvani- Somo No Service Ned Need Necd Service red Need Need P-errtal}{Dosing ❑ ❑ Oeerreaen Ser&,s ! ❑ �1 'Rental flssistancc0 ❑ Substance r1briw Trearment ScrVices �`,,yy..��,,//,,,,.. ❑ / Nan-Congregate Shckcr ❑ ❑ Trat;sporta{ion � ❑ � fAtilAtaro _ . ❑ CaseWLxiin�c•;nent., ��hh° p . ❑ �dvFr„a{icn Szrvicts -- ���../ ❑ Rkd�ation -: ❑ ❑ 8ttipin{mdirF ftssistaru/Seb l � / ,�y1 ....,_.,._.,... ._._ .. _ . Training \ ❑ /"� Gedrt"Repair ❑ ❑ '0Dd ❑ ❑ Landlord/Tcnant Lialsan p ❑ {{Dosing Starch and raunscfmg ScrYiaz Vlotii+is of Domestic Scrrfccs ❑ ❑ Vtolcnco/Dating Ywle+ua/Sekual ❑ ❑ Trytt%Ovvnaii Trafflcb'ng ;{Dosing Financial Assistance (Security Lgal Sc V cs ❑ ❑ ➢cposHS,Uiirrty Assistance,ribvmg ❑ ❑ Costs,first and Last WoeA,S P-ze) Life,Skills Training ❑ ❑ {iomilm;Frcvcnfion ❑ ❑ Ma:tal}{ealth Services ❑ ❑ }'rousing Coemsefing ❑ ❑ Oatpaficnt♦♦caHltScrvice6 ❑ ❑ Othor 627 C+xl of {-{O'ME AmoricaviTzscue Flaw ' }�otmeless Ques+iohhaire ''��'' ' ��,Atnljcgn�fZ�-.scuc�lan.(,�P�wi4psaYidc-$22�c-milGo�to.assiskitulividuals-0r-housewldswho-are-homeless-at•risk— of homelessness,and other vcdneYable popalaiions,by prooditil housin ,rental assistance,SApporhVr,service n a mcrcasc V134514g s a 1 ni 44wrtuigton 8eaca.'P case help the Gfi{of 4 u5ri ingtan Beach gather import ant data needed.for this grant by comple+ing this questionnaire, ( / 1y Name Jlh 1 s IX I h '— lG' i Age �^� `,�� (� ' , C- ;hispanic? ❑ 4u J No Lengt'n of current episode of'r rnclvs;ess: k iiiri- ¢bw marry times have you been homeless? }ousehold Tgpe: ❑ Sbi gle A;iult CCCeaple wit out Children ❑ Single?arewt w/CjAjldren ❑ Two?aru+rs w/Gtihirai ❑ Lbratrampa�i<:d Yoctt h (1 i or younger) whcrc will you be sldcphl onight? ❑ Strea+ G Vehicle alter ❑ Lr a Park ❑ Motel/uotel �❑ F�vmily;Frirnid ❑ pour Veteran (j&+yrs.old and US Armed Service or{activated National(nuard/2eser Ast)? ❑ Y;:s 91'No Arc you tryjng to flee from domesiic Violevice,dating violenco,sz"assault,or human traf flcl;ng? ❑ Yes Ci'uo i Po you 11aV6 any of the following eoNdltions? ❑ 1Nertta1/Emoi-ional'Disorder l3 ?,14sical 'Disability ❑ DeVclopercr , Z'isability ❑ Chronic Substance Abase ❑ None what do you do for income/money? ?-'row would you describe your need for+he following services? Level of Nccd LGV61 of Nccd Significant Sonic No Signifcant sonic No Service Need Need Need Servicc Nge Nerd Need i2:Waal r{ousinq i11/ ❑ ❑ Outrcacr;Scrvkcs ❑ ❑ '2crrtal Assistanca y'� ❑ ❑ Sa_hsfa�uc Abuse Trcatmart Suvtccs O ❑. Nan-C7u ate Sncltcr ❑ ❑� ❑ Tnusportaiion.. .. ❑ ❑ Childcao,ro .. . . ❑ ❑ � ('aso N1ni -tmeni� / LdNGA11on SarViccs ❑ I�{' ❑ m�atioN ❑ � ❑ sITcnt Assistance/Sob Ploy;, � ❑ Training ❑ d/ ❑ CrrdrtRcpair ❑ rood ❑ E2 ❑ Lmidlcrd/Tcnarrt Liaison ❑ ❑ ,4cusNq Search and Couns�nq ❑/ Serviiesfor Vjoiivns oFyomestic / Services ❑ O Vidcnce/wtinq violonu/sexal ❑ ❑ ❑ z Assault J{{uman Trafacid_�1A Lcaaf Services }'rousing Finandal Assistance(Scewity ❑ ❑ Vcposrts,lkHfity Assistance,MoAi c) ❑ ❑ ❑ Casts,First and Last wbnth's'2cn+) Lifa5Ej1(s'iraininq ❑ Or Cf riomelcss?revention ❑l ❑ ❑ W,crtal ucalth Scrvias ❑ d ❑ {{ouslnq cocrnsdiM QQ/ ❑ ❑ Oxi?ahee 44caHii Se iices ❑ ❑ other ❑ ❑ ❑ �i..y...c ;•tee. -I % - __ — 628 Ci-N of }4avi+iOgfo'n Beach -'- 440ME Amerimi-P_escue 'PUvi }{ovneless Qates�iohhaire ;"�' T he Amcrican2scuc Plan ( ) wi11>t?�j $Z,Z¢_mi;Ton to;assist inaividuals.or_households.who.are.Vtomelass;at risk— of homelessness,and other vilNerable populations,b;prDvSdmq housing,rental assistance,supportive services,anA noN- a m un Nq on each. ease p e Gt`i 41MrHMgtoN Beach gather iyn?6rraNt data needed for this gr4e by compLt iiq this questionnaire. Namei //Y1 is 1 e ��7r�'—=�-6—,�-�� ApJe wee �� }EISpANIe? Yes ❑ No h Lcrgth of curreerr episode c 44.low many i imes hw it you been homeless? 2 ;,'oasehold Type: - Siwle AduFt ❑ Couple wiiiiout C'nildren ❑ Singlc Parc'.1t w/ChllarcN ❑ Two Paretrt w/Childrer, ❑ UNaccompania Yowiii ((17 or younger 1 where will you be sleepi tonight? ❑ Street ❑ Vehidc Shelter ❑ SN a Par'c ❑ Wwtcl/hotel ❑ Family/Friend ❑ Other Veteran (16+ yrs.old and US Armcd ScrJlce or Activated National Cjmrd/'wsenAst)? ❑ Yes X.40 Arc yw try ng to r ee, from domestic Vioienca,dating Violatce,serital assault, Zle,�'w4sical an traffic�ng? ❑ Yes No ➢o you have any of the following condtfions? Clmental/zme+ional Pisor.er Pisa4%fiiy ❑ Davclopmcwt VisabiGty ❑ Chronic Stbstunce Abuse ❑ None What do 4cm do for income/money? C L row WOWA you describe your need for+'ae followiNq scrviccs? LeVelof Need Loyd of Need Sgtirficant Some No St4vil cawt Some AD Service Need Need Need Service Need Necd ,Med R.;trtai:lousing Cl ❑ Outrea4r Ser Aces ❑ -R:xtal Assistance ❑ ❑ Su}rstanu;Abusa Treatmatt ScrYlccs ❑ ❑. /❑ Non-Congrcga-c ShcFFcr ❑ ❑ TransportatioN ❑ Cl Childtaro ❑ ❑ ] Case:RlanAcjctncNt' ❑ `cdustri+an Ser,ricas ❑ ❑ medwiion Emplegriicrt+Assistancc/Job —` ❑. Training ❑ ❑ GufH Repair ❑ ❑ y FDDA Cl ,4] Cl Landlord/Tcnatrt Liaison -❑ !" Scrriis for Yot ms of 1 omastic I ❑ },posing Search and Counseling ❑ ❑ V-oL:aco/`Dating YoLwo'/Sa we l ❑ �j ❑ Services Assault(}{uman Traffic " {{Dosing Btt'artlal Assistance(Suruity Legal Scrvicas ❑ ❑ �] 'Dc?osits,Ltt iF'ty Assistatuc,moving ❑ •❑ ❑ Costs,First and Last month's RcNt) Life SF;Gs Training ❑ ❑ Nomeles5 Prcventiam ❑ -p ❑ meNtal{{cak'a Services ❑ ❑ t 1r'ousing CoemseGng ❑ ❑ Ootpaticnt{.fcakhScrvicas ❑ ❑ Otncr ❑ ,� ❑ 629 G i*q of 44tm+iviq+ow Beach 440ME AvnericaoTzscue 'Plah - 44ahclass Qvestiuviaire ✓1e r�wOc9itR%s_u�.e�194i.Cn'"SY.)_w_�lii[oYid_e$22.4JnilGanfn,assts�u�di�iduglsar_house'nolds.wlw.arc,homdess,.a#risk_ of homelessness,and oracr vi.{Inerable,opalations,by providing housing,rarE-al assistanu,supporrive seMccs,and non- vismzlm>qm>AM M7661S,MM9E, ricaSoVielp Me or }!a:riingtan'Death gather i:npoorrae data needed for this grater by complat/i-ng this questionnaire. Name �I ). t I_i p >,tiC,.-,k' 1, j�) ?hone `�'5 7 3 .J — C� > `/1-7 ;. >S3c GA Race ?'ispanic? ❑ Ycs C5 No Length of current repisJc,of'wmdcssness: ?ow many times have you been homeless? r{ocischold Type. Sin31C rduF ❑ Couplc without ChiUmi ❑ SIN31c?eravt tv/CYildren ❑ Two?greets w/Chlldrai ElUNactompanie Youth (17 or yotoiger) where will you be sleepinoyronig' ❑ Strect ❑ vehicle 7 Shelter ❑ in a?nrL- ❑ Mote:/}iotel ❑ F=amily/Fricnd ❑ Other Veteran (13+yrs.old and US Armed Service or Activart d Natrjonal(auard(R.;servist)? ❑ Ycs ] No Are,you tryin3+o flu from domestic violence,d�ar/ing Viiolence,sexual assault,or h/uman traff lcEng? ❑ Yes No 'Do you have a.ny of+lle following tonei•Itions? ld ritcnrcJ/Emetialal Disorder LXPhysical'Disabillty / ❑ S'evclopmmit-Pisabilii-y ❑ C'nroncSAstaviCc abuse ❑ NOne '/ what do you do for intamc/money?�_� }row would you describe year need for tiie following services? Laycl of Nacd Lcvcl of Nced Significant Some No Sierificae Some No Service Need NCed Necd Service Nccd Need Nced 7cntal♦rousing ❑ ❑ Dutrcac'r!Scrv"s ❑ ❑ '4crtal Assistance �l ❑ Cl Substance Abusa T' matmcNt Services p Non-Congregate 51,icFlcr ❑ ❑ Traesporta+ion ❑ ❑ Childcare ❑ ❑ _jD- Ca5e.Rle±nayemer-: ❑ p . �- ducai an Scry cas ❑ ❑ ❑ MCALOrHOn ❑ ❑ Sin,lo�iinrnt Assistance I Job -' � -'� Training ❑ ❑ - Crcdrt?R pair ❑ Cl Food ,per ❑ ❑ LvdlordjTcue Lialsm ❑ ❑ dousing Search and Coanse¢Ng / sow for Victims of Vomos.i c Services . �� ❑ ❑ VWICNce/Daiing va'cwc/Seuul ❑ ❑ {tssaw+(}{amaN Traffwbng / 9 sing Fiinaneial Assistance(Scant{ LcaAervi l Sce ❑s ,.[I ❑ Deposits,LHItt4 Assistance,ftvling / ❑ ❑ Costs,-Hirst amid LAst Rionti'i SR:nt) / Lifc Stills Training ❑ ❑ {romolcss"Provn.rHA p� ❑ ❑ Mcntal}rcaliii Services �❑ ❑ Cl }muskeg CounscGng /� ❑ p O.ttpa',ie+rt}icaftS"ces ❑ ❑ O+Vzr ❑ ❑ ❑ 630 Ci+y of 44vvl+410+ow Beeic� I 41DMc, Avriericah"Peswp,-Plate - -�omcless Questiohwaire The merican-2escue?Ian (f1R7) ll pro 'de I _@_ � $y_ -4 ati[fi tc assis kingivi!Uals,o�households who.arahomo ass",�rask of homcicsshcss,and ot'acr vulnerable populations,by providing housing,rehtal assistatuc,supportive scrAccs,and non- ea p ae }}utrt ngtan 3each gat er important data needed for this grant by completing this questionnaire. r Name�:�uLn� V G��•�0 ?hone tl/`1` ..�I� Il;r$eJ {1ge n)ij 'Race >``r-V) ;(ispahic7 ❑ Yes No Lengtn or curreiri episode of homelessness; �`L(L Yow many tmes have you bcen'nomeless? }r'ousehold Type: ❑ smgle Adult 4CouFlc wk-4iour Children ❑ Sinnla?arch;w/Omldren Cl Two?arenta w/Children ❑ (Anaccompnnied Yntth (;7 or younger) PI'acrc will you be slceping tovighi'1 ❑ Strecr ❑ Vehicle RShelter ❑ Di a Park O 4Note1/44otcl O Family/rnevO ❑ Ot4�er Veteran (1Qy yrs,old and US Armed Service or ACiiVATed National 6mr4/R:.scrvist)? ❑ Ycs A No Are,you tn{ing to flee from domestc v olence,dating violence,sexual assault,or human trafficbnq? ❑ Yes a No Do you have any of the following contfltiohs? 'hlcntnl/Eme+ionnl Disorder !�?4tysical Disability ❑ Devc(opme+rt Disabifity )9 Chro+4c S;kb5tanLe F'ilasc ❑ Nonc w'aat do you do for income/money? Q1UP� {low would you describe your need for the following 5er\Acas? Lcyelof Need L vclof Need Sig;gifaant Some No Significnirt Some No Service Need Need Need Service Need Need Need "Rcntal{)��sing R O ❑ Ouirca4i Services ❑ ❑ 'P.eirtal,9ssistance g. ❑ ❑ Substaate/those Treahmcrr Setviae_s - NDn-Congregate Sacltcr ❑ ❑ � Transportation � ❑ p childcare - ❑ ❑ cp fsisc n+Qiiagovnont.,. ❑ `.g( ❑ Edacat on SerAccs ❑ w1cdiaiion S? . O ❑ Tirai�n n„exit,gssistanre/Sob o �P. ❑ crcdrttepav ❑ ❑ g . 'Food G o Laadlord/TcwKt Liken ❑ .;d Noosing Search and Counsefng Ser li for Ywtiiti of Domestic S&r,Accs ❑ Cl Vtolcnao/Vatinq Ydauo/SOP AI ❑ ❑ �-i AssoAlt1{-}aina Traff4dng Nousino ivaial Assistance (SccwhN Logal Services G ❑ C9 Deposits,LHIF y A sistance,Moving E ❑ ❑ Costs,First and Last Month's?ze) L'ifc Skills Training ❑ •g ❑ Noinelcss Yrovcnfian ❑ 'b. G Mcntal NcaK Services ❑ JE3 ❑ Noaslttg Cotoiscflm ❑ ❑ Outpatice44cak'a SerAms ❑ '� ❑ Other ❑ ❑ ❑ 631 Ci+t{ of 44veiog+oh Beach . 440MIE A merioviTzscue-Flaw +Eovneless Qms-Homwire 'TheAmzrican�,scue7la �tyill.pso_v)dc_$ZZ4.vnilficitto.assist_iiu{ividualsor�uase'rwlds.whaace.lgomeless,-a+ris� of homdossncss,and oiiier vulnerable populations,b+{provide housin reirtal assistance,supportive services,and non_ > OUP19 a lry rn nnng n cun.7 cast P nc City of ;;cnttington Beach gaPner important data ncedad for this grant cq compt&ting t'nis gaestiomsaire. 71onc A9L �aeeWL f>'ispanie? ❑ Yes ❑ No Length of u:rrent cpjsode of homelessness: r Atli' �ow many times have you been homelzss? oNSLheIA Type: d Single ,Ault ❑ Couplc wit,*V Children ❑ Siisglc 7erce w/C!niidren O Two Parents w/C'nikiren ❑ Urauompanicd Ya H'. A or younger) where will you be sim, it1f'g tonig'nt? / ❑ Park'&- -❑ `rermily/Friend ❑ other Veteran C15+yrs,old and VS armed ScrVee or Activated National No Are,yeu tning to Fee frDvn domestic violeiwe,dating volzwz,sew:al assault,or human traf;,cang? ❑ Yes — n'o 7o you have any of i*,following coneirtions? ❑ Mental/Er etional Disorder ❑ Physlcal T.is,*ility ❑ Dzvzlopvncnt visabirity ❑ Chronic Substance,F,bun2- None w'na t do you do for income/money? 44ow would you dLscri your need for t'nc following services? Lcyd of Nmol Lcvcl of Nccd SigniFcasrt Some, No Significae Some No Scrvcc N6" Need Nmol Se'N Need Need N wd Psmtal}'rousing ❑ ❑ OntreaM Services ❑ p "2ental_Assistanca ❑ . p� Substance{4busa Treatment Services p Non-Conyrcgatc Shcftzr ❑ ❑ � Transportation _ ❑ � p� . Childcare ❑ ❑ � Cali:Y?anag�ment. ❑ . ❑ . rdueaiion Services ❑ i ❑_. 5� 1Nediation 6m mart •CjJ .,. ... .. . : . . _ ❑ ❑ plat Assistance/Sob Training / ❑ ❑ Credit"Rcpair ❑ p FDtd d ❑ ❑ landlord/Tcmvit Llason _❑ ❑ Q f }/Dusts;:]Search and Counscfin9 —/ Seryiccs for Vlotisris or Pomesiio i Scrvitas ❑ �✓ ❑ vwlcnce/Vatir�vidcno/Stuwl ❑ ❑ ,p/ Assau it,/}+uvnan TrafFMM 4400simg flnawaal AssistAnee (Seowity Lcgal Scrvlcas ❑% ❑ 0 -PLposits,LHirtty Assletanee,wbVInq ❑ ❑ �I i Costs,First and Last Ntoirt'n'sFiitt) Lift S�IIs Training 'r�/ ❑ ❑ 40meltS5TmVcntion ❑ ❑ mental V AHIn SWACC5 p ❑�' ❑ :{Dosing CoanscGiig ❑ ❑ Outpatice tr'cakh Services ❑ 'p ❑ 1 Othcr ❑ ❑ ❑ 632 C+q of 44m 1+41r tovi Beach 440ME AmpricaviTzscue Ylaw 44owle,ss Qaes-Hohhaire Thr, mmericavi-Pzscue Plan (Alg )_w.sl�pleV�dc-$224.milfic�tto,assist individ.+als,or_households.who.ar-c.hatmdess,•at-r�sk— or"homelessness,and o-titcr VulncrcMc ovulations_,by praVidittg housing,rental assistance,supportive services,and non- 1g vravurr4 to ff filtliii vl c ease vie? e f wrtington aeach gather import . dc+t t ded for this grant N completing this questionnaire. i Name_ Age Iivanic7 G Yes No Laigt A of current episode of homelessness: ow maw{times have you been homeless? r }ousehold TY e: �mgle Adult G Couplc w itout C'ilcirc. Singlc Parcnt w/Children ❑ Two Yarcnts wlChildrut ❑ Unaccompanied Youth (17 or•.loungcr) w'aefe will you be sleeping t ate ❑ StTcct ❑ Vehicle haFt•r ❑ -n a Park ❑ 1Motc1/44ote1 ❑ Family/Fria,d ❑ Other Vetaran (15+yrs,old and US Armed Service or Ac-HVa-W Nat oral(Towrd/Reservist)? ❑ Ycs No Arc you t ying to flea from domestic AoIcAco,del-[ ng Aol crce,sexual assault,or human treifficbng? ❑ ?c; No Da voa have any of the following wnartiot . t Cr I/Emat ion i Disorder ❑ physical Vi<abili;y ❑ pf fdopment Disabilitt ❑ Chronic S 075t ue Abuse ❑ No what do you do for income/money? }'row would you describe your neod for i-ho following services ` C Level of Need Lcycl of Nc Sgaifcarrf Some, No / Significant Some No SerVico Need Need Need Se 'cc / N Need Need -'R;+rtal({Dosing 1 ❑ ❑ Ou+rws'r1 Servdces R.;ntal}�ssistaaw ❑ ❑ Substance Almse Treatment Sw"s ❑ ❑ Non-Congrwiatc Sheltcr ❑ ❑ Transportations ❑ ❑ Citildcaro ❑ ❑ Cav,ri"wi�a�cmc�rt p ❑ `Ldaeaiian SerVleGs ❑ ❑ :. YnLdlatloN ❑ ❑ -. ..; .. mplcymcx Assistanu/Job ❑ u(d rid r Training � ❑ ❑ food ❑ �j ❑ Landlard/Tatant Liaison ;basing Scarc'a and Cwun Ana, / Scr At for Vl Y-ns of Domastic SenAccs ❑ ❑ Viiolcnca/eating Volencw(Sax:+al Cl ❑ Assault/}lamag Trafflcf?ng . .}lousing i(nancial Assistance(Security Legal SerVias ❑ Deposits,Lktifity Assistance,ribving Xer ❑ ❑ Costs,First and Last ribnli1's rt) Lire Stills Training ❑ ❑ }lomelass PrcVcntiat ❑ ❑ Mtcntal J,4wkii Suviccs ❑ ❑ }lousing Cc sc6ng ❑ ❑ /Ou'tpatie+;i-flcAWn Services 0 ❑ Other i y 'rGd� /// ❑ ❑ ❑ City of 44tnhtivl9tow Beach ���}OWI� ica�l"RescueYlat7 - r otmele s�Questiovlhaire , The�]mrrican•Rrscue Pla:� ��.X�Jl�p�v)��2.2�4,milfio�to.asses.�.indlvld.lalsDr_house4>oWs:.vha.are.hoVnuessra+of homclassncss,A+Id oiiwr vulnerable popadations,by providing hoasin ,rreal assistance,su?por hVe,services and non- 1:7g s A I IN Kt Ng DN vracm P caSG aE p G of runtitgton 8cach gai'aor important data needed for this grant by cetmploiing iisis questionnaire. -ehoNe �gd 1 �� dace 4ispanic? ❑ Ycs ❑ No UPihlj,..o Lrngt'a of curree, episode o Vow marry+;mes have timl beaN homeless? lutjaTIH it r{oasehold Type: 4'ngie A.Mf ❑ Cadple witktoitt Children ❑ SinglE Parer v./C'rildral ❑ Two Parcn s w/r'AildreN ❑ YDu i'in (17 or yoAnger) Whcrr will you br slee m onlght7 ❑ StrEct ❑ Vehicle ShEltcr ❑ IN a Park ❑ iNotrl/?{otel ❑ pamily/Friend ❑ Other fyu� E]i-u!r tecU`ll-I Veteran; (•{at Vs,old and US{Armed Service or fictivatcd National Cjewrd(Rescrvist)7 ❑ Ycs ❑ No ,ere you trying ro flee from domestic Vfolcnce,dating violence,sexual assault,or human trafF'ic'ang7�s ClNo Do you have mhy of the following conaltions? Entnl/cmational Dtsorder ❑ Ph Aysical Disability 1�1i)1 Q41Z)i Cl OdVdln?mcnt Disability ❑ Chronic Substance Abuse ❑ None what do you do for income/monc(f u 4T'cw would you describe yoar viced for the following services? Level of,geed Level of Nced Sgni{icant Some No SignificaNt Some No Service Nce'd Nerd Ncrd Service Need Nerd Need �eNtal}'rovsin9 ❑ ❑ I Outrcaah Scm-,cs ❑ ❑ '?ental ress'tstancz ❑ ❑ Subs •Trea—mcNtt Services ❑ ❑ NDN-Congrcga;e Shelter ❑ ❑ ❑ 'Aran -.. ❑ ❑ C11iLdcaro ❑ ❑ c dveation Services >�-' Case'Ykinacjement. ❑ . p . . .. ❑ ' c`pi?loymevrF/kssistancc/Job - -...... _- - - ❑ ❑ CrrdrYR.•?air Training ❑ ❑ Food ❑ ❑ �V Landbrd/Tcme Liaison ❑ ❑ }:Dosing Search and Counseling Scrvltos for'Whms of P'otnestie Services ❑ ❑ Yolcnco/vminq vlolcnco!Sexual ❑ ❑ flssauFt/{'rctinay Trafflrl'ing . i{ousinq flm v al Assistance(Swvriry Legal Servlccs ❑ ❑ N/ Depostis,Utir"Assistance,wlovinq y Cl ❑ Costs,'First and Last wtont a's Rent) `, Life SJ;IIs Training ❑ ❑ {lomilcss PrcVCNtion ❑ ❑ wtcrtal 44e4liit savlas ❑ ❑ pQ RDA$IM rAAnselinq ❑ ❑ ❑ C71Ai'p[tliGni'�eAFi''Il Services ❑ ❑ � OL'aer ❑ ❑ ❑ 634 City of 44a1+i"oto�i Beach _. }O'ME f}vnericah�escue Ylah Voyneless Questiohvlaire The mrrica Tsuw Plan GIP wj��p�yjdc$224.milGo tto,assist individ u is oc hocue'colds-whaara homeless,-a+•rish— of ho;ndcssness,and othor vulnerable populations,by praVid n hoµsin ,rental AssistAiicc,supportive,services,and non- >> > ng s,a m Zrh on vcac .P cast help ao C.lty of {{unY ngtan Beach gaoler imporrant data needed for this grant by completing this quesiionnairc. - -9d - G 61 '2aee� }{ispanie? � Yes ❑ No Length of cvrrart episode of homelessness; pow many times have you bean homeless? 4wsehold Type:Lti.,Siegle �,i�aW ❑ Couple wk+ibot Children ❑ SingL Parer w/auldmi ❑ Two 7arents w/C'Miren ❑ Unaccompanied Ya.+rlt (17 or younger) where will you be sleep xg+onig'at'r ❑ Street ❑ Vehidc ,L'—Shelter ❑ rii n Park ❑ Motcl/44otcl ❑ `ra lily/Frigid ❑ Other Veteran (16-i yrs,old atud US Awned Service or Aciivatcd NA-fimial(quarA/pzsery st)? ❑ Ycs El No Arc ueet trying to fiez fro;n domestic violence,da- ng violence,sexual assault,or human+raffudng? ❑ Ycs ❑ No Po you have any of+he�Sllovjing eolIsHions? ❑ Wlental/Emotionml Pisorder ❑ 70ysicol Disa'oifitl ❑ DcVCaopmcmt PisaNiGty ❑ Ckronic Substasue Abusc 9�NNnc What do you do for income/mong{? 0 }'row would you describe your need for the following services? Level of Neod Lcvcl of Nerd Signtf-,Cant Some, No Significant- Some, No Service Need Need Necd Service Need Nead Need '$anfal Dosing ❑ p ❑ Outreach Scrvlces ❑ ❑ "Rcnfial Assistance ❑ © ❑ _ Subsfaru/tb-} Tratmcnr Scr*, ❑ . p ❑ Non-Congrcgatc%clfcr ❑ ❑ Transportation - ❑ Jfj ❑ Cw dcaro ❑ C� ❑ Casa YAanagcmoM', ❑ ,© ❑ =d�_catian Scrvlccs ❑ p ❑ Y+ledlafion . $VTpldyment As515tAnee/Sob .�.: —.. ..-.._ . .. .. ❑ A ❑_ Training ❑ O. ❑ cro4 ? -q Air ❑ y, ❑ Food ❑ ©, ❑ Landlord/Tcnani'Coats. ❑ ❑ 4Nusinq Search and CoanscGng Scr Aus for Victims of:00mcs4,c services ❑ C`3. ❑ Yiolcnco('Dating violenco/sexual ❑ ,5- ❑ Assaciff /}{amen Traffic✓rng . Legal Services ❑ © ❑ Dcasmg',=inancial Assistance (Savrity posts,IkliGiy Assistance,rhovii;g ❑ ❑ CostS,Fast and last VAbn 's R_;rt) Life dills Training ❑ p, ❑ gomeloss Prevention ❑ ,v❑ ❑ PAcntal J,4wkh Scr`lccs ❑ p_ ❑ :r'a{sing Co"S'ring Cl f3 ❑ O:etpatient{{ealiaa Services ❑ p. ❑ of nor t Cl B. ❑ 635 Litt{ of 44Uvtt4igtoh 'Dee, 440ME Amcricaw"Rescm -Flab �otmeless Qrnes+iowwaire "' The{mcr can Rescue-Kan (h'RY) will pro ride$224 mi(fion to assist iyldtV duals or hoasehoLds_who ar_e_homeless a#ns>r of home essness,and oiiicr vulnerable popala+ions,by providing housing,rental assistant",sapporliVe.scNC;cs,and non- • p c ?{antingtwi Seach gather iYAj*r 4e dat a herded for t'ais grant by comploHng this questionnaire. Name1;U �C �i\/ Wyr 7honc /!qe Race 1 ' —!jspanic? Y::s ❑ No Length of currowl-episode Of homelessness: ;aow vnaq tivnes have you been homeless? `.k )lousehold T ype: ❑ Single Adul- auplc wit'nout Children ❑ Sisiglc parch-W/Lhildren ❑ Two?araits W/Clrkiren ❑ U•aacconipauied YuH* (17 or younger) Where will you be sleeping tonigh i t N. ❑ suet-1 ❑ Vehi Sheker ❑ 1>i a park ❑ 'Mute(/}lotel ❑ Family/Friend ❑ Otiier Veteran (19+yrs,old aai US Armed Service or Ac-vated National Cjmrd/Rescrvis+)? G Ycs�No Are you trying to iiee from domestic violence,dating Violence,sexual assault,or human trafficl�ng? ❑ Ycs i'No PO you have,any of-HIr follov.�ing conditions? Li rAentnl/Frneriarial Di;or�ie 7hysical Disabi;itj ✓✓✓ ��\ O Develepmcrrt Disakili hronir- SAstance rlm5:; ❑ None What do you do for income/money ;'row woald you describe your Aced for yule following services? i wel of Need L6V01 of Need Sgr;'if&Ant Some. No Sigai�caiit Some. No Service Need Need Need Service, Nerd Ncrd Need "1'-:ntalousinq ❑ ❑ Ouircac',i Scrvzes ❑ ❑ ❑ tlssistance _ ❑ ❑ rw-mcrt Servtws �,z*� El ❑ Non-Congregate Snef Icr ❑ ❑ ❑ Trans?6rtaiion -yyS' ❑ ❑ Childcare, ❑ ❑ ❑ Case P.lgiiage;rient _ ❑ ❑ ❑ 'eduction Services ❑ ❑ ❑ P1ed ai on ❑ ❑ ❑ s`mp(oy�ricrt flssis+anic/Sob . Trainin ❑ ❑ CrcdM"Rcpair p ❑ ❑ Food o ❑ Liaison ❑ p ❑ ?lousing Search and C«msaGnq r Vwtims of Pomcstw Services ❑ ❑ Violerio/-P violence,/saml ❑ ❑ ❑ Rssau(t/♦♦uvnan 7rafRMM' . . }'rousing Finartial,Assistance(Security Legal Services ❑ p Drposh-,Will,4 Assistanw,Moving ❑ ❑ Costs,rust and Last wtor'a'sR;nt) Life Stills Tralninq ❑ ❑ ❑ flomeloss Trevcrhon ❑ ❑ wknta(){caWh SUVI&Cs ❑ ❑ ❑ {{Dosing Counsdng Outpafiaii•}IcaH'n ❑ Scrvlczs ❑ ❑ ❑ Othar ❑ 636 City of 44tvtivlgtovt Beach � .. }{Orit� {}ynerica�i-Rescue'Pfaw - }{ovneless Ques+iolltlaire , The{american R scNc Plan Gadwly - rdvds _hsn_ ovrt. j _ t o(ds_who.arahomsk— of homelessness,and other vulnerable populations,N providln9 hoasin ,ranter(assistance,supportiVe,senllces,avid jjon- bTavurr4 In ttwTTIVI05TOM 006rn. rl case e p e Ctty , htntington Beach gather importawt data needed for this grAe by eomplotii1g t'nis questionnaire, Name �,�� E.S EPA L/ PhoNe 1 Agc 3Z tau lA ,'TP }{ispanic? ❑ ycs 51 c Length of currevr, episode,o hom lcssness: v'ear i ow many-times have yen bean homeless? !�� E {}oNsehold Type: ❑a Singld Advlt ❑ Ccuple wlt'r7oNt Chlldren ❑ Smnlc Parc"t YJ/Children ❑ Two?arenas w/Ghildru, ❑ (Anauompanicd Youth (1 t or lonnaerl where will you be slcoping toni)W ❑ Street ❑ Vehicle ❑ Slvltcr ❑ DI a Parr ❑ motel/-Hotel ❑ Family/Fri:•nd ❑ CW ier�M Veteran (13+yrs,old and US Armed Sery ce or{act voted Nat oral(tuard(ResaV sT)? R'4cs ❑ No Are you tryi g to flee from domestic violence,dating violence,se uuai assault,or he man trafncbng? ❑ Yes ✓No PO 40M'have any of the following cOnAttions? ❑ 'Mental/Ereotional 7isorder r-P iwlal-Disabift1 ❑ -Pevelopraat Visat ility ❑ Chrome SN'ostanec Abnse ❑ None w'nar do you do for income/mm ieV C Era ti! 5 Q PN ' now would you describe your need for the following services? Level of Nccd Lcvcl of Nccd Signifcant Some No Significant Some No Service Need�l Need Need Service Nedd Nerd Need TL•n-tal r{ousinq / ❑ ❑ outreach Services ❑ ❑ C Bartel Assistance p/ 0 ❑ _Substanie Abuse,TrcaI%6,rI Suvius p / ❑ ❑ Non-Congregate Shelter ❑ ❑ ❑ Transportation Q ❑ ❑ Ch klcaro L�/ ❑ ❑�Cuse Wlanayc�nc t.. p p ❑ EdulaiiDn Services ❑ ❑ p' t mul'iation - : - ❑ / ❑ Trainlymeirl-Assistanct/Job Cl / ❑ Crcdtt'Repa'v . ... Q� ❑ ❑ n9 Food C Q ❑ Landlord/Tcnant L'wison ❑ ❑ �, }}ousing Search and CounscGnq Servird3 fbi Vwtims of Vomastio ❑ ❑ 11olov"/Va1 ing violmc/Scrcual ❑ ❑ sast(fi f{)utnan Tra{{icl4,nq {{ous ng finawAA Assistance(Sww-try tLPAI Servieos ❑ ❑ Deposits,Utifliy Assistance,Vnoviwg ❑ ❑ Costs,first aiid Last Mo�tWs kM) / Ufa SUls Training El ❑ 44owalcss'PreVattion ❑/ ❑ ❑ Mceal{{caWn Services ❑ ❑ Dosing Counseling ❑ ❑ ❑ Outpatiee Veak'rt Services ❑ ❑ Ot'ner ''-- ❑ ❑ ❑ Fob � 11N V ) otil CMdl L� C� QSS �� � �E of uJoo17Ltt, /� 66s L0t6�7r C-A-y of 44tA tivig+m1 Beach 4400E AmericaiTescUe -Plow - 44olme1ess Qms+iomiire he 4 mcrican h2 scut`rlan (AR?) Will provide$224 million to assist indv dua s o hoczse4�olds,wtwarc homeless,a+rases 'ofhome cssness,and other vulnorablc popalations,11{providing housing,rental assistance,supportive scrviccs,and non_ Lp c 44oMivi3ton 13caeh gatiacr important data needed for this grant by complet ng this auestionnairc. Name �Y �^ ! ? C� JJ Yhone 7 SS G y -2 37 r ms?ANle? ❑ Ycs No Lengrh of currrvr episode of'rarnelessness: 44OW many times IIAVe you beai homeless? }?oasehold Typ Single Adcdt ❑ Couple witltvn+ Children ❑ Single Parent w/Children ❑ Two 7arc4fs w/Children ❑ Unaccovnpcmicd You F4 (17 or uo:niger) Where will you be sleeping.tonigh'? ❑ Strcct ❑ V&icle **leper ❑ _a o lark ❑ motel/}lotcl ❑ F��mity(Friend O other Veteran (15+yrs,old and US Armed Service,or A,ctivatcd National(juard/Reser Ast)? ❑ Ycs lw%o Arc you trying to flee from domrs-hc Aclencz,dating Violence,SMAI assau}t,or human traf icbng? ❑ Yes V n r ➢o you have any of the following conditions? ❑ mental/ motional Disorder ❑ Physical Dlsabi4 y ❑ Development'Nsa'airity ❑ Chronic Substan%e Abuse Cp'None Who+do yoc4 do for income/moncV _ ig P —i } ow woWd you describe your aced for tile,following services? Lavcl of Nccd LLvd of Need Sig�irfieavh Some No Sigvlificant Sem6 No Service Need Need Nccd SLrVice Need Need Nccd Rental{{ousing ❑ ❑ Ourroat4l Services ❑ p .� 'Rental Assistance [�' ❑ ❑ Substance Abtse'Trea-nRee Services p p Non-Congrcgatc Shcltcr ❑ p Transportation p p cnild"m ❑ ❑ C� Case man 6'Ace p/ ❑ ❑ Education Servlc-s ❑ G mcdiafion p p Q Ewiplotiriait Assistance/Sob ITratnin9 G ❑ -� Crrdt}"Repair p . ❑ . EOOd ❑ ❑ O Laxdlord/Tcnant Liaison p p p }basing Search mil Counsam,3 Scrvdcas for`/Wtims of Domestic ❑ ❑ Vielcnca/Voting Violence/Saraal ❑ ❑ .O Asua /4=.2i Trafficking }lousing financial Assistant-(Sc WrN Lz3Al Services ❑ ❑ f3' Deposjts, UtiGt{Assistant-,moNjn9 ❑' ❑ ❑ Costs,First aii{Last Pbnth'sRnt) Life5killsTraining ❑ ❑ Q {{omilessYreventiovi d p ❑ mcntal44WHh Services ❑ ❑ }lousing counscrm9 d ❑ ❑ Outpaticnt{lcalth Services ❑ Other p ❑ ❑ 638 at-q of }��twtiwgfoh P>eacl� -_ 440ME�Vnericah1Zcscue Plate - }!ovneless Questionhaire , Trte Amcd4;mi?.csaw Plan (PRY) will provide$2.24 milrim to Ass oyse{aofds_wbo a[4homclrss,.atds� of homelessness,and other VsduicraWc populat ens,b I pro!d ng housing,rartal assistance,supportive services,and non- p ThE }ue t ngfion 3cach gai+nar important data needed for this graft b4 wmpleting this quest onnairc. I � � n 11 `ram 2 Name V I `��{'� Phone r ( 1�� 4 Race I }, }lispaic7 ❑ Yes o Laigth of care-ce eaiscdo of hom telessness: l 4 r'S }?ow many times have you Ilmi home4css7 rioasehold Typa15*mglc Adult ❑ CouplC witiwtit C:•�Mrcn ❑ Singlc Parent w%Children ❑ TWO?aramts w/ChUren (Ana;cnmpanicd Youiii (17 or younger) w'ncre,will you be sleeping tonig4rrt ❑ Strut ❑ Vahicle rAShwfter ❑ Sn a?ark ❑ AAotcl/?!otel ❑ Family/—rriend ❑ Outer Vei,eras (10*yrs.cld and(AS Armed Service or Activated National CIuard/Reservist)? ❑ Ycs�`No Arc yc .i nl ng to flce from domestic v olcncc,dating\/iolencc,sexual assiWt,or human;raffiddng? 21 lies Cl No 'po you have any of the following e"SHjons? wlentaljci+totionnl Disordert4Th45i.cil Dis iWi^i ❑ Dcvelopntent Disability )` CLv-epic Substance Abuse ❑ None what do you do for income/money? ; ) . f{ow would you describe your need for the following services? Level of Need Levci of Nccd Sigilificpf Some. No Signi{ Some No Service N Need Ncod Service Ncc Need Necd Rental{r'oasing ❑ ❑ Outreach Services ❑ ❑ R ntalAss;tuna ❑ ❑. SubstanceA,buseTrea meatScr&as ❑ ❑ Non-Coryregate Sarhter �❑ ❑ ❑ Transportation ❑ ❑ Childcare ❑ ❑r � Case;Managemcnt . . �.. ❑ ❑ Edacaiion Services ❑ ❑ mediation ❑ ❑ Employment Assistance/ Trainin=j ❑ CrcdttRepair ❑ B' ❑ Food fl ❑ Laidlord/Tcnae Liaison ❑ / ❑ ❑ }lousing Search and[,unsung scr4v 5 for V'totims of domestic Scrvices SSA777 ❑ ❑ Vidw,cc I Dating Ydc�c�/SmWI C21/ ❑ ❑ Assault/}{umaNTraf{iclfi;� {{ousing financial Assistance(SWAnty Lcaal Scrvias ❑ ❑ Deposits,Wir"Assistance,Moving ❑ ❑ Costs,First and Last nbntYi's'2 ent) L'tfc Skills Trainieg ./ ❑ ❑ }bmeless'PreVention ❑/ ❑ ❑ marital}Icak}t$a-viccs t`a ❑ ❑ ?sousing Counsctnj - ❑ ❑ Outpatient♦{eaHh Scrviccs ❑ ❑ Other ❑ ❑ 639 RESOLUTION NO. 2022-18 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF HUNTINGTON BEACH APPROVfNG A 2021-22 ANNUAL ACTION PLAN SUBSTANTIAL ANIENDMENT TO INTEGRATE THE HOME-AR13 ALLOCATION PLAN WHEREAS, the City of Huntington Beach ("City") participates in the United States Department of Housing and Urban Development (HUD) Community Development Block Grant (CDBG) and HOME Investment Partnerships (HOME) programs; and WHEREAS, on April 19, 2021, by Resolution No. 2021-28, the City Council approved the 2021-22 Annual-Action Plan, which describes how the City Will use CDBG and HOME funds from July 1, 2019 to June 30, 2020 to address the City's Consolidated Plan objectives; and WHEREAS, on March I I, 2021, the American Rescue Plan .Act of 2021 was signed into law. Congress appropriated $5 billion in American Rescue Plan (ARP) funding to be administered through the HOME program (HOME-ARP) to provide affordable housing, homelessness assistance and supportive services to qualifying populations; and WHEREAS, the HOME-ARP funds must primarily benefit qualifying individuals and families Who are homeless, at risk of homelessness, or in other vulnerable populations. The activities include: (1) development and support of affordable housing, (2) tenant-based rental assistance (TBRA), (3) provision of supportive services; and (4) acquisition and development of non-congregate shelter units: and WHEREAS. as a participating jurisdiction, HUD has allocated $2.240,675 to the City for activities that provide housing, services, and shelter to primarily benefit qualifying individuals who are homeless, at risk of being homeless, or in other vulnerable populations; and WHEREAS. the Allocation Plan identifies how the funds Will be used to address the needs of the qualifying populations through public participation and needs assessments for housing, shelter, homeless assistance, and homelessness prevention services; and WHEREAS. the 2021-22 Annual Action Plan Substantial Amendment integrating the .Allocation Plan will be considered by the City- Council for approval, and once approved and authorized for submission to HUD, the Allocation Plan will be reviewed by HUD for their approval; and WHEREAS. the City desires to use HOME-ARP funding on the following eligible activities: (1) S1.804,704 for supportive services for homeless and those at risk of homelessness at the HB Oasis Hotnekey project located at 17251 Beach Boulevard, Huntington Beach; (2) S385,971 for supportive services for homeless and those at risk of homelessness at the Cameron Lane Navigation Center located at 17631 Cameron Lane, Huntington Beach; and (3) $50,000 for RESOLUTION NO. 2022-18 I-IOME-ARP planning and administration, as these activities are described in the Allocation Plan: and WHEREAS, the I-TOME-ARP funds are new funding sources related to the COVID-19 .pandemic, which were not contemplated in the 2021-22 Annual Action Plan; and WHEREAS, notice was published in the The TJ,ave on March 31, 2022 regarding a City Council public hearing and the availability of the draft HOME-ARP Allocation Plan for public review and comment: and WHEREAS, due to the emergency nature of COVID-19 pandemic impacts, certain I-IUD regulations have been waived or modified in order to expedite the release and expenditure of I-IONIE-ARP funding, including the reduction from 30 days to a minimum of IS days for public review of HOME-ARP related amendments: and WHEREAS. the draft Amendments to the 2021-22 Annual Action Plan was published and posted online on the website of the City Clerk for a required minimum 15 day public review and comment period from April 1, 2022 to April 19, 2022; and WHEREAS, pursuant to the California Environmental Quality Act (CEQA) Guidelines Section 15378(b)(4), government fiscal activities that do not result in a physical change in the environment and do not commit the lead agency to any specific project do not constitute a project and, therefore, are exempt front the requirements of California Environmental Quality Act; and WHEREAS; the proposed activities to be funded are subject to the provisions of the National Environmental Protection Act of which any and all projects funded shall comply, except that, in accordance with 24 CFR Sections 58.14 (a) and 58.35 as to review pursuant to the National Environmental Protection Act. the 2021-22 Annual Action Plan Substantial Amendment is not subject to federal environmental review; NOW, THEREFORE, the City Council of the City of Huntington Beach does hereby resolve as follows: SECTION 1. That the Amendments to the 2021-22 Annual Action Plan Substantial Amendment integrating the HOME-ARP Allocation Plan is are hereby adopted. SECTION 2. That $2.240,675 in HOME-ARP funds are hereby allocated to the projects and programs as indicated in the Allocation Plan prepared for the 2021-2022 Annual Action Plan Substantial Amendment. SECTION 3. That the City Manager or the City Manager's designee is hereby authorized to execute all necessary related budget approvals and documents deemed necessary by HUD or the City and to execute all implementing and related documents and agreements, including, but not limited to, grant and loan agreements with subrecipients for all approved HOME-ARP 22-11175/280275 2 RESOLUTION NO. 2022-18 programs and projects set forth in the Allocation Plan for the 2021-22 Annual Action Plan Substantial Amendment. SECTION 4. That all projects aid programs set forth in the Allocation Plan for the 2021- 22 Annual Action Plan, as amended by this Resolution; shall undergo an environmental review prior to any release of funds consistent with the Program Regulations found in 24 CPR, Part 58.6 and the City Manager or the City Manager's designee is authorized to execute all environmental documentation required by HUD. SECTION 5. The City Clerk shall certify to the passage of this Resolution and shall take effect as provided by law. PASSED AND ADOPTED by the City Council of the City of Huntington Beach at a regular meeting thereof held on the 19`h day of April, 2022. Mai or REVIEWED AND APPROVED: APPROVED AS TO FORM: 7 City Manager City Attorney i INITIATED AND APPROVED: Director of Community Development 22-11175/280275 3 Res. No. 2022-18 STATE OF CALIFORNIA COUNTY OF ORANGE ) ss: CITY OF HUNTINGTON BEACH ) I, ROBIN ESTANISLAU the duly elected, qualified City Clerk of the City of Huntington Beach, and ex-officio Clerk of the City Council of said City, do hereby certify that the whole number of members of the City Council of the City of Huntington Beach is seven; that the foregoing resolution was passed and adopted by the affirmative vote of at least a majority of all the members of said City Council at a Regular meeting thereof held on April 19, 2022 by the following vote: AYES: Bolton, Delgleize, Carr, Posey, Moser, Kalmick NOES: Peterson ABSENT: None RECUSE: None City Clerk and ex-officio Clerk of the City Council of the City of Huntington Beach, California Errsott ( : 31VI I a� Pttib - SI 3' I ay CITY OF HUNTINGTON BEACH PUBLIC NOTICE NOTICE OF PUBLIC HEARING AND SOLICITATION OF PUBLIC COMMENTS ON THE FISCAL YEAR 2021/22 ANNUAL ACTION PLAN SUBSTANTIAL AMENDMENT TO INTEGRATE HOME-ARP ALLOCATION PLAN NOTICE IS HEREBY GIVEN that on April 19, 2022, at 6:00 PM or shortly thereafter, the City Council will hold a public hearing to approve a Substantial Amendment to the FY 2021/22 Annual Action Plan, and will accept public comments on the proposed Substantial Amendment. The Substantial Amendment will be published for public comment for a minimum 15-day period starting Friday, April 1, 2022 through Tuesday, April 19, 2022. The public hearing will be held at the Huntington Beach Civic Center, City Council Chambers, located at 2000 Main Street, Huntington Beach, CA 92648. Tuesday,April 19,2022, 6:00 pm htti)s://huntinjztonbeach.zoom.us/*/97154130528 By phone: (669)900-6833 Meeting ID: 9715413 0528 As directed by the U.S. Department of Housing and Urban Development (HUD), the City will process a Substantial Amendment to integrate a HOME-ARP Allocation Plan that budgets a special allocation of HOME American Rescue Plan (ARP) funding provided to assist individuals or households who are homeless, at risk of homelessness, and other vulnerable populations, by providing housing, rental assistance, supportive services, and non-congregate shelter, to reduce homelessness and increase housing stability in Huntington Beach. These grant funds will be administered through HUD's HOME Investment Partnerships Program (HOME). The City of Huntington Beach is slated to receive $2,240,675 in HOME-ARP funding and is proposing to utilize such funds on the following projects: $1,804,704 for supportive services for homeless and those at-risk of homelessness at the HB Oasis Homekey project located at 17251 Beach Boulevard, Huntington Beach. • $385,971 for supportive services for homeless and those at risk of homelessness at the Cameron Lane Navigation Center located at 17631 Cameron Lane, Huntington Beach. • $50,000 for HOME-ARP Planning and Administration Complete copies of the FY 2021/22 Annual Action Plan Substantial Amendment inclusive of the HOME-ARP Allocation Plan are available for public review and comment at the following locations and at http://huntingtonbeachca.mov/business/economic-development/cdbe/ City of Huntington Beach Oak View Branch Library Community Enhancement Division 17251 Oak Lane 2000 Main Street, 5`" Floor Huntington Beach, CA 92648 Huntington Beach, CA 92648 Written comments can be addressed to: Charles Kovac, Llousing Manager Community Lnhancement Division 2000 Main Street — 5th Floor Huntington Beach. CA 92648 The City Council will consider all comments received during the I5-day public review period at the April 19, 2022 City Council public hearing. MEETING ASSISTANCE NOTICE In accordance with the Americans with Disabilities Act, services are available to members of our community who require special assistance to participate in public meetings. If you require special assistance. 48-h0ur prior notification will enable the City to make reasonable arrangements for an assisted listening device (AL.D) for the hearing impaired, American Sign Laneuage interpreters. a reader during the meeting and/or large print agendas. Please contact the City Clerk's Office at(714) 536-5227 for more information. PUBLICATION DATE: March 31. 2022. The Wave City of Huntington Beach By: Robin Estanislau, City Clerk 2000 Main Street C Huntington Beach, CA 92648-2702 Telephone: (714) 536-5405 EQUAL ewsieo nvronTUNm Moore, Tania From: Christine Gonzalez <cgonzales@scng.com> Sent: Tuesday, March 22, 2022 8:28 AM To: Moore, Tania Subject: Re. HB HOME-ARP PH Notice Attachments: 11525450.pdf Cost $480 00. pub HB Wave 3/31 The smudge marks in the pdf will be bullet points as in the screenshot below in print. The City of Huntington Beach is slated to receive SZ240,675 In HOME-ARP funding anc lisproposing to utilize such fundson the folbwing projects: • S1,804,104 for supportive services for homeless and those al-rlsk of homelessnessatthe HB Oasis Homekey project located at 1 T2S1 Beach Boulevard, Huntington Beach. • $385,971 for supportive services for homeless and those at risk of homelessness at the Cameron Lane Ncvlgatlon Center located at 11631 Cameron Lane, Huntington Beach. • S50,000 for HOME ARP Planning and Administration There will be a 4% cost increase on all ads as of 4/1/2022. OC Register Legal Advertising Sales ( uurdinatur Chrissy Gonzalez 1771 S. Lewis St. Anaheim, CA 92805 714-796-6736 M-F 8:00 a.m. - 4:30 P.M. Lunch 12 Noon to 1 :00 p.m. Closed Sat. and Sun. On Mon, Mar 21, 2022 at 3:43 PM Moore, I ania <Tania.Mooreriisurfcity-hb.orc:> wrote: Good afternoon Chrissy, Please publish the attached public hearing notice in The Wave one time on 3/31. Thank you. Tania Moore, CIVIC Senior Deputy City Clerk t City Clerk's Office 714-536-5209 tan ia.moorena.surfcity-hb.org 2 CITY OF HUNTINGTON BEACH PUBLIC NOTICE NOTICE OF PUBLIC HEARING AND SOLICITATION OF PUBLIC COMMENTS ON THE FISCAL YEAR 2021R2 ANNUAL ACTION PLAN SUBSTANTIAL AMENDMENT TO INTEGRATE HOME-ARP ALLOCATION PLAN NOTICE IS HEREBY GIVEN that on April 19,2022,a16:00 PM or shortly thereafter, the City Council will hold a public hearing to approve a Substantial Amendment to the FY 2021n2 Annual Action Plan, and will accept public comments on the Proposed Substantial Amendment. The Substantial Amendment will be Published for public comment for a minimum 15-day Period starting Friday, April 1,2022 through Tuesday, April 19,2022- The Pubfic hearing will be held at the Huntington Beach Civic Center, City Council Chambers, located at 2000 Main Street,Huntington Beach,CA 92648. Tueja Aril 19,2022,6:�0 p hops://hun melon ch.zoom.uv 71_4 30c28 By Phone: (669)900-6833 Meeting ID:97154130528 As directed by the U.S. Department of Housing and Urban Development (HUD), the City will process a Substantial Amendment to integrate a HOME-ARP Allocation Plan that budgets a special allocation of HOME American Rescue Plan (ARP) funding Provided to assist individuals or households who are homeless, at risk of homelessness, and other vulnerable populations, by Providing housing, rental assistance, supportive services, and non-congregate shelter, to reduce homelessness and increase housing stability in Huntington Beach. These grant funds will be administered through HUD's HOME Investment Partnerships Program (HOME). The City of Huntington Beach is stated to receive 52,240,675 in HOME-ARP funding and is proposing to utilize such funds on the fol lowing Proiects: 9& 51,804,704 for supportive services for homeless and those at-risk of homelessness at the HB Oasis Homekey Proiect located at 17251 Beach Boulevard, Huntington Beach. 94&' 5385,971 for supportive services for homeless and those at risk of homelessness at the Cameron Lane Navigation Center located at 17631 Cameron Lane,Huntington Beach. 9R, 550,000 for HOME-ARP Planning and Administration Complete copies of the FY 2021122 Annual Action Plan Substantial Amendment inclusive of the HOME-ARP Allocation Plan are available for public review and comment at the following Ipcatioin and at h ttp://hunhnatonbeachco.aov7bu�iness/economic-development/cdba/ City of Huntington Beach Oak View Branch Library Community Enhancement Division 17251 Oak Lane 2000 Main Street,51h Floor Huntington Beach,CA 92648 Huntington Beach,CA 92648 Written comments can be addressed to: Charles Kovac,Housing Manager Community Enhancement Division 2000 Main Street-5th Floor Huntington Beach,CA 92648 The City Council will consider all comments received during the 15-day Public review Period at the April 19,2022 City Council public hearing. MEETING ASSISTANCE NOTICE In accordance with the Americans with Disabilities Act,services are available to members of our community who require special assistance to Participate in Public meetings. If you require special assistance,48-hour Prior notification will enable the City to make reasonable arrangements for an assisted listening device (ALD) for the hearing impaired, American Sign Language interpreters,a reader during the meeting and/or large Print agendas. Please contact the City Clerk's Office at(714)536-5227 for more information. PUBLICATION DATE:March 31,2022,The Wave Huntington Beach Wave 1771 S. Lewis Street Anaheim, CA92805 714-796-2209 5190751 HUNTINGTON BEACH, CITY OF PROOF OF PUBLICATION CITY CLERK DEPARTMENT 2000 MAIN ST Legal No. 0011527726 HUNTINGTON BEACH, CA 92648-2763 FILE NO. HB HOME-ARP Public Notice FINA AFFIDAVIT OF PUBLICATION STATE OF CALIFORNIA, l Jy SS. County of Orange I am a citizen of the United States and a resident of the County aforesaid, I am over the age of eighteen years, and not a party to or interested in the above entitled matter. I am the principal clerk of the Huntington Beach Wave, a newspaper that has been adjudged to be a newspaper of general circulation by the Superior Court of the County of Orange, State of California, on July 1, 1998, Case No. A-185906 in and for the City of Huntington Beach, County of Orange, State of California; that the notice, of which the annexed is a true printed copy, has been published in each regular and entire issue of said newspaper and not in any supplement thereof on the following dates, to wit: 04/07/2022 1 certify (or declare) under the penalty of perjury under the laws of the State of California that the foregoing is true and correct: Executed at Anaheim, Orange County, California, on Date: March 31, 2022. Signature ,.LPLILIYI6 1 CITY OF HUNT NGTON BEACH PUBLIC NOTICE NOTICE OF PUBLIC HEARING AND SOLICITATION OF PUBLIC COMMENTS ON THE FISCAL YEAR 2021/22 ANNUAL ACTION PLAN SUBSTANTIAL AMENDMENT TO INTEGRATE HOME-ARP ALLOCATION PLAN NOTICE IS HEREBY GIVEN that on April 19, 2022, at 6:00 PM or shortly thereafter, the City Council will hold a Public hearing to approve a Substantial Amendment to the FY 2021/22 Annual Action Plan, and will accept public comments on the Proposed Substantial Amendment. The Substantial Amendment will be Published for Public comment for a minimum 15-day period starting Friday, April 1, 2022 through Tuesday. April 19,2022. The Public hearing will be held at the Huntington Beach Civic Center, City Council Chambers, located at 2000 Main Street,Huntington Beach,CA 92648. Tuesf,�ay April 19,202Z,6, ppf1nn httas://huIn nglongeac�.zoom.ush 7154130528 By Phone: (669)900-6833 Meeting ID:97154130528 As directed by the U.S. Department of Housing and Urban Development (HUD), the City will Process a Substantial Amendment to integrate a HOME-ARP Allocation Plan that budgets a special allocation of HOME American Rescue Plan (ARP) funding Provided to assist individuals or households who are homeless, at risk of homelessness, and other vulnerable Populations, by Providing housing, rental assistance, supportive services, and non-congregate shelter, to reduce homelessness and increase housing stability in Huntington Beach. These grant funds will be administered through HUD's HOME Investment Partnerships Program (HOME). The City of Huntington Beach i5 slated to receive S2,240,675 in HOME-ARP funding and is Proposing to utilize such funds on the following Proiects: $1,804,704 for supportive services for homeless and those at-risk of homelessness at the HB Oasis Homekey Proiect located at 17251 Beach Boulevard, Huntington Beach. '!®S S385,971 for supportive services for homeless and those at risk of homelessness at the Cameron Lane Navigation Center located at 17631 Cameron Lane,Huntington Beach. 93Y, S50,000 for HOME-ARP Planning and Administration Complete copies of the FY 2021722 Annual Action Plan Substantial Amendment inclusive of the HOME-ARP Allocation Plan are available for Public review and comment at the following Ipcaiions and at City of Huntington Beach Oak View Branch Library Community Enhancement Division 17251 Oak Lane 2000 Main Street,51h Floor Huntington Beach,CA 92648 Huntington Beach,CA 92648 Written comments can be addressed to: Charles Kovoc,Housing Manager Community Enhancement Division 2000 Main Street-Sth Floor Huntington Beach,CA 92648 The City Council will consider all comments received during the 15-day Public review Period of the April 19,2022 City Council public hearing. MEETING ASSISTANCE NOTICE In accordance with the Americans with Disabilities Act,services are available to members of our community who require special assistance t0 Participate in Public meetings. If You require special assistance,48-hour Prior notification will enable the City to make reasonable arrangements for an assisted listening device (ALD) for the hearing impaired, American Sign Language interpreters,a reader during the meeting and/or large Print agendas. Please contact the City Clerk's Office at(714)536-5227 for more information. PUBLICATION DATE:March 31,2022,The Wave E IOCLASSWHIS I...rF-m�...n.:n:,..l.. .I I wx.m .� w..m ,I ww wn.. ,I w�I w I w -Ic• II All I.I 1.r ImxC'AH,D,ln.°rM— xorl( Ydm I, Iw AA n.nix\(VO. ' nl nrTI.¢1. a.V..[mm.er,[Id;on�, .mmn,l na.-CC...Ln Al— w,n.w ur.OF...n H.I..LE.(x H.LOA .mllw.[xo. •• - [XIu< N[..' 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I 061c REGISTER cavemge il5porfs I City of Huntington Beach April 19, 2022 2021-22 ANNUAL ACTION PLAN SUBSTANTIAL AMENDMENT RELATED TO HOME-ARP FUNDING Background On March 11 . 2021 . President Biden signed the American Rescue Plan Act (ARP) into law. Provides $1 .9 trillion dollars to address continued impacts of COVID-19 Congress appropriated $5 billion of ARP funds to the HOME Investment Partnership Program (HOME) creating the HOME- ARP program The U.S. Department of Housing and Urban Development (HUD) allocated $2,240,675 of HOME-ARP funding to the City of Huntington Beach. Eligible HOME-ARP Activities Activities must provide housing. services. and/or shelter to qualifying individuals and families who are homeless, at risk of being homeless, or in other vulnerable populations. The four eligible HOME-ARP activities include: Development and support of affordable housing Tenant-based rental assistance (TBRA) Provision of supportive services Acquisition and development of non-congregate shelter units HOME-ARP Allocation Plan HUD requires an Allocation Plan which describes how HOME- ARP funds will be used. The Allocation Plan must also include: An assessment of unmet needs of each qualifying population An assessment of gaps in housing and shelter inventory. homeless assistance and services, and homeless prevention services A description of community outreach and public participation A summary of anticipated eligible activities to be undertaken based on identified unmet needs The Allocation Plan must be considered by City Council at a public hearing as a Substantial Amendment to the 2021-22 Annual Action Plan. HOME-ARP Consultations The community needs assessment included consultations with the following stakeholders: Orange County Continuum of Care Fart Housing Foundation National Association for the Advancement of Colored People-Orange County (NAACP-OC) Families Forward Homeless United City s Homeless Outreach Program and Senior Center Mercy House Robyne's Nest SlandUp for Kids Additionally. 63 homeless persons were surveyed. who reported affordable housing, transportation, homeless prevention. housing counseling, and case management as a significant need. The highest identified need was for additional affordable housing with wrap-around supportive services. Proposed HOME-ARP Funding The following supportive services are recommended to be funded with the City's $2,240,675 HOME-ARP allocation: $385.971 Cameron Lane Navigation Center Services $1 ,804,704 HB Oasis Homekey Project Services $50.000 HOME-ARP Administration (2.2%) A public hearing notice was published in The Wave on March 31 starting the minimum 15-day public review period from April 1 to April 19. Recommendations Conduct the public hearing as required per HOME-ARP regulations Adopt Resolution No. 2022-17 of the City Council Approving a 2021-22 Annual Action Plan Substantial Amendment to Integrate the HOME-ARP Allocation Plan QUESTIONS?