ADDITIONAL REQUIRED INFORMATION:

PLEASE PROVIDE THE FOLLOWING INFORMATION ON AGENCY LETTERHEAD, SIGNED BY THE EXEC. DIRECTOR, WHICH CAN BE USED TO HELP THE RANKING PANEL IN THEIR WORK.
Note: if more than one page is needed, only the first page need be on letterhead.

1. Do any of the project’s direct support services staff (program manager, case managers) have any of the following credentials? If so, list name, title, and credential for each.
• LCSW-Licensed Clinical SW or related field
• LMSW-Licensed Master’s SW or related field
• MSW-Master’s SW or related field
• RSW/CSW-Registered or Certified SW or related field
• BSW-Bachelor’s SW or related field
• Other documented professional certification

2. Does the project include any leverage? If so, for each source, list source, amount, and attach documentation showing commitment of provider to supply it during the proposed project period. If no leverage is reported, simply provide a statement: No leverage is reported.
Definition: Leverage is “the non-match cash or non-match in-kind resources committed to making a CoC Program project fully operational. This includes all resources in excess of the required 25 percent match for CoC Program funds as well as other resources that are used on costs that are ineligible in the CoC Program. Leverage funds may be used for any program related costs, even if the costs are not budgeted or not eligible in the CoC Program. Leverage may be used to support any activity within the project provided by the recipient or subrecipient.”

4. Have any agency staff who work with project participants completed the SOAR training and are SOAR certified? If so, provide name and date of SOAR certification for each.

5. Provide the following statement, completed as appropriate:
The project ___ does or ___ does not (check which is applicable) provide admission preference to otherwise eligible Veterans/Vet families.