Section 1: Organization Information Organization Name Address City State Zip Code Section 2: Contact Information

Phone Number Primary Contact Person Position Email

Section 3: Fiscal Sponsor Name of fiscal sponsor (if applying on behalf of a network of collaboration of organizations)

Section 4: Organization Summary a. Description of organization mission and programs (limit 1,500 characters)

b. Primary Demographics of Communities Served (check all that apply)African American/BlackIndigenousAsianHawaiian and Pacific IslanderLatinxImmigrant and Refugee (including Middle Eastern, African, Slavic) UndocumentedOther (please describe)

c. Is your organization

a 501c(3) nonprofit entity?

a culturally specific organization? Yes No

Yes No

Attachment A

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Application for COVID-19 Rent Relief Program (CVRRP) Expanded Partner Network Outreach, Intake and Referral Services

Section 5: Implementation and Deployment Plan

e. Short summary of your organization’s focus or work in COVID-19 relief and recovery efforts(limit 2,000 characters)

a. How will you conduct outreach and identify eligible households? Will your work requirelanguage or accessibility support? (limit 2,000 characters)

d. Geographic Focus (limit 500 characters)

Attachment A

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Application for COVID-19 Rent Relief Program (CVRRP) Expanded Partner Network Outreach, Intake and Referral Services

Section 6: Allocation Request Indicate your organization’s requested number of household referrals. A minimum of 40 applications is recommended.

September 2020 October 2020

November 2020 December 2020

TotalProjected rent assistance allocation amount is $6,000 per household, an average household rent payment for 3 months. Program administration will be calculated based on the projected total rent assistance allocation amount.

b. What BIPOC Communities will you focus on reaching through your efforts? (limit 1,500characters)

Number of Households Referred

c. Is your organization able to meet the timeframefor implementation and expenditure of these funds(for work beginning September 2020 and completedby December 30,2020)?

d. Is there any support beyond what we have listed that you would like the city to provide?(limit 500 characters)

Yes No

Attachment A

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Application for COVID-19 Rent Relief Program (CVRRP) Expanded Partner Network Outreach, Intake and Referral Services