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					                Department of Veterans Affairs




   Homeless Providers Grant
     and Per Diem Program
         Capital Grant
          Application
           Section B1 - First Submission



VA Form
JAN 2003     10-0361-CG
Capital Grant and Per Diem Application:
Applicant Summary:
       Your Organization's Name:       Washington Department of Veterans Affairs

                                                     Name                             Phone                    Fax
Executive Director/CEO                John King                               360-725-2151              360-725-4393
Person to contact about application   Jerry Towne                             360-725-2159              360-725-2197

Mailing Address (if different from     1011 S. Plum St, 2nd Floor, PO Box 41150
agency address on form 424):           Olmpia WA 98504-1150


Veterans Integrated Service Network (VISN):
        In what VISN is your proposed project located? 20 (See map in appendix)
        Have you coordinated with your VISN Council of Network Homeless Coordinators (CNHC) to ensure your
project meets a need in your VISN? If yes, please provide the contact's name in the space provided below. If no,
see the VISN CNHC List in the appendix and please contact your CNHC member.

My VISN CNHC Member is:          Chris H. Oliver, HCHV Coodinator, VAMC Walla Walla


1. Eligibility to Receive VA Assistance:
   Non Profit Organizations must provide documentation of Accounting System Certification and Evidence
   of Private nonprofit Status. This should be accomplished by the following:

              Providing documentation showing the applicant is a certified United Way Member Agency;
                                                                    OR
              Providing certification on letterhead stationery from a CPA or Public Accountant that the
              organization has a functioning accounting system that is operated in accordance with generally
              accepted accounting principles or that the organization has designated a qualified entity to maintain a
              functioning accounting system. If an entity is used their name and address must be included in the
              certification letter;
                                                                   AND
               Providing evidence of the nonprofit status of the organization by submitting a copy of their IRS
              ruling providing tax-exempt status under the IRS Code of 1986, as amended.




VA FORM
JAN 2003
               10-0361-CG                           Applicant Page Number is: ________        CG First Submission - 1
2. Project Summary:

Our Organization requests          $303,911.00             from VA for the Reconstruction                               of
                                    (Funds requested from VA)               (Construction / Renovation / Acquisition)

WVH - Building 9, 1141 Beach Drive, Retsil WA 98378 and acquisition of van                               to create: (check all that apply)
(List building Address)



                          TRANSITIONAL HOUSING                             SERVICE CENTER

                          Our program will request per diem assistance upon completion of the project.


The total project cost is $467,556.00 (This is the amount requested from VA plus the remaining balance of funds
required to complete the project.)


Does your organization have site control of the building proposed for this project:                       Yes           No



Service Provider and Geographic Area: Check all that apply:

                           Non-Profit Organization                         Consider agency to be a faith-based organization
                          Indian-Tribal Government                         Rural project location
                          State/Local Government                           Urban project location

A. Target Populations Below is a list of homeless veteran populations. Check those populations that you have
   targeted to be served as a part of this application. Keep in mind; there is an expectation that if you identify a
   population to be served, the specific services (including staff) and or housing that meet the needs of the
   identified populations should be addressed in the project plan section of this application. Failure to do so may
   decrease the overall score of the application.

      Female homeless veterans                                            Homeless veterans and their families
      Frail and elderly homeless veterans                                 Homeless veterans with substance abuse problems
      Terminally ill homeless veterans                                    Homeless veterans with dual diagnosis
      Chronically mentally ill homeless veterans                          Veterans being released from prison
      HIV positive population                                             Disabled homeless veterans
      Veterans with PTSD diagnosis                                        Homeless veterans with mental illness
      Native American homeless veterans                                   Other – VA VR& E, CWT participants and recently
                                                                      separated Gulf War/ OIF/ OEF veterans
                                                                                   (Please specify)




VA FORM
JAN 2003
                      10-0361-CG                                  Applicant Page Number is: ________               CG First Submission - 2
B. Innovation of Project Complete this block if you wish for your project to be considered as innovative.
(See rules §61.13 (f) for innovative quality of proposal.)

   Please consider this project for additional points for innovation because… this project is designed to provide
   transitional housing services that will support homeless veterans enrolled in VA Comprehensive Work Therapy (CWT) and
   veterans in receipt of Chapter 31 benefits through the VA Regional Office (VARO), Vocational Rehabilitation and Education
   (VR&E) programs. CWT and VR&E participants will receive case management services from VA Puget Sound Health Care
   System (VAPSHCS) staff and VBA staff at the Seattle VARO. Participants will be afforded the opportunity to receive life skills
   training support through addictions treatment follow-up, provided by VA staff and job training opportunities through WDVA
   Homeless Veterans Reintegration Project (HVRP) funded by US DOL VETS. HVRP will provide employable veterans with case
   management services and employment support, including follow-up at 90 and 180 days. The on-site Service Center will provide
   claims services for veterans for service connected and/or non-service connected disability claims to increase participant income.
   When necessary WDVA staff will assist with the application process for social security benefits and or SSI. This broad based
   community model will have the capacity to provide residential stability, increase participant skill level and improve self
   determination in a one stop setting that can be duplicated in other program models.




C. Beds and Bedroom Breakdown

All applicants must enter the requested information in the “projected level” column below. If this is a new
component of an existing project, you must also complete the “current level” column. If this is a new project, please
enter “N/A in the “current” column. Estimates should reflect the count when the project is fully operational.

                   Projected Bedrooms, Beds, and Participants                                          (A)                (B)
                                                                                                Current Level at       Projected
                                                                                                 the project site        Level
                          Beds and Bedroom Categories
  1. Total number of bedrooms for all homeless persons                                          0                    40
  2. Number of bedrooms for just homeless veterans                                              0                    40
  3. Total number of beds for all homeless persons (include cribs and
                                                                                                0                    40
  children’s beds)
  4. Number of beds for just homeless veterans                                                  0                    40
  5. If service center, number of anticipated non-repeat visits per month
                                                                                                0                    200
  (number of different veterans per month)

                                 Bed and Visit Request                                                       Totals


  1. Therefore, the number of beds we are asking VA to fund is…                                 40


  2. Therefore, the number of unique service center visits we are asking VA to
                                                                                                200
  fund is…




VA FORM
JAN 2003
                10-0361-CG                                 Applicant Page Number is: ________           CG First Submission - 3
D. Project Narrative:

         Please provide a brief abstract of the project to include: The project design, supportive services provided,
project collaboration with the VA and community, and any special population of homeless that will be served.
Please indicate if the program is new or an expansion of current services. (Please answer in the space provided below.)
   PROJECT DESIGN
   The WDVA project is designed for rehabilitation of building #9 at our long-term care facility in Retsil, Washington. Retsil is located
   in central Puget Sound and will afford us the opportunity to provide support services to the urban areas of Seattle and Tacoma in a
   unique rural setting. This transitional housing model will support all VA Health Care facilities in the State of Washington and will be
   easily accessible (30-45 minutes) by staff and patients of VA Puget Sound Health Care System (VAPSHCS). This facility will
   operate 40 transitional housing beds and will house a Veterans Service Center for the region. A van is requested to support
   transportation of homeless veterans to and from VAMC appointments and other services available to them in the immediate area.

   SUPPORT SERVICES
   The support services to be provided with this model are broad-based and holistic. The services are designed to provide outreach to
   identify homeless veterans living in places not ordinarily meant for human habitation and to emergency shelters and homeless
   programs in the region. These support services will assist homeless veterans in the transition from homelessness and enable them to
   live as independently as possible. Many of the homeless veterans served through this comprehensive model will graduate to
   independent living by securing employment through the HVRP employment and training program. Support services will be available
   to the individual homeless veteran through a case management plan designed to provide residential stability, increase their skill
   and/or income level and result in greater self determination to rely less on community programs and live independently. They will
   include: Food, Transitional Housing, Clothing, Employment and Training services, VA Benefits and Entitlements assistance,
   Readjustment and Trauma Counseling, Mental Health services and referrals, assistance with access to State Veterans Homes and VA
   domiciliary programs, Fiduciary services, Substance abuse treatment outpatient services and referrals, Financial assistance, Case
   Management services, Transportation services, Recently separated veterans briefings, Housing referrals and assistance with
   permanent housing programs

    Site Security will be provided by WDVA staff 24 hours a day, seven days a week. This transitional housing program will be located
   on the grounds of our 240 bed long-term care site. Classified staff and trained security personnel will ensure a safe and secure
   transitional housing program is maintained in a clean and sober environment that will be verified by urinalysis.

   COLLABORATON WITH VA AND COMMUNITY
   The WDVA will assume the responsibility of networking and collaboration with VAPSHCS to coordinate and arrange for outreach
   and referral services to support this transitional housing model. Services will be coordinated with the many VA clinical service
   programs to include Domiciliary Care for Homeless Veterans (DCHV), Health Care for Homeless Veterans (HCHV), CWT,
   Transitional Residence (TR) program and VA Supportive Housing (VASH). Services and referrals will be coordinated with the
   Homeless Women’s Project (HWP) and all HCHV programs that are provided within the State of Washington VAMC network to
   include Walla Walla, Spokane and Vancouver (Portland, Oregon). There are five VET Centers in the State of Washington and we
   will promote the availability of services to them. WDVA will coordinate homeless veterans’ transitional housing services within the
   VA Regional Office in Seattle. We will meet regularly with the Homeless Coordinator (Cindy Green) and coordinate services as
   needed. The VR&E program will be a unique piece of our model. Eligible homeless veterans enrolled in Chapter 31 will be afforded
   the opportunity to reside in our transitional housing model while they are engaged in retraining and or educational programs. Our
   agency will interview homeless veterans and assist them to develop claims for disability. Claims that are developed will be expedited
   for rating through the VARO homeless veteran coordinator.

   Employment services are a huge part of the WDVA service delivery network. WDVA will continue to network with all US DOL
   VETS funded programs in the state. WDVA is currently under a $300,000 HVRP contract for the greater Puget Sound region, which
   has assisted more than 250 homeless veterans in obtaining employment over the past two years. We regularly interface and
   coordinate employment and training services with LVER and DVOP staff. Employment Security Division (ESD) is a sister cabinet
   level state agency we network with on a regular basis. Veterans Workforce Investment Programs (VWIP) will be accessed by
   program participants at every opportunity. There are a variety of US DOL Employment and Training Administration (ETA)
   programs available. Referrals will be made to ESD for eligibility screening for these programs as appropriate. Employment and
   training services are collaborated with many of the local colleges and trade schools. These institutions include; Clover Park
   Technical College, L.H. Bates Technical College, Pierce College and Environmental Maintenance Material Institute. Courses offered
   by these institutions include; Welding Certification, Fork Lift Operator, Hazardous Material Services , Medical Records Technician,


VA FORM
JAN 2003
                 10-0361-CG                                       Applicant Page Number is: ________          CG First Submission - 4
    2. Project Summary (cont.)
D. Project Narrative (cont.) (Please answer in the space provided below.)
    Office Assistant training and Certified Nurses Assistant Certifications (CNA). Public employment services are available at eight
   separate sites within the community. In addition to state operated employment services, there are a variety of county and
   municipal employment and training providers in the region that offer diverse employment opportunities not available in other
   locations. Our transitional housing model will have the capacity for a Learning Center where program participants will have
   access to computers.

   The Learning Center model will provide learning opportunities for computer familiarity, employment reasearch, resume
   development, electronic employment application, internet job search and an opportunity to communicate with family and friends
   as they increase their life skills and create an environment that will result in greater self-determination and assist them to make
   decisions that will affect their lives.
   As a cabinet level state agency we meet regularly with other state agencies and coordinate services and exchange information on
   a regular basis. We network with the Department of Corrections (DOC), Community Trade and Economic Development (CTED)
   and Social and Health Services (DSHS). We have immediate access to employment services, HUD and FEMA supported
   programs for emergency shelter and transitional housing services. King County Veterans Program (KCVP) has an operating
   budget in excess of one million dollars and WDVA outstations five classified staff members to provide outreach within their
   program. We regularly work with faith-based organizations such as Catholic Community Services, Salvation Army and Lutheran
   Compass Center. Salvation Army operates two large emergency shelters in the region, one in Seattle and one in Olympia.
   Veterans programs in Thurston and King county financially support dedicated beds for veterans. Lutheran Compass Center is a
   past recipient of Grant and Per Diem funding and is currently operating a homeless veteran’s transitional component in Shoreline.
   Catholic Community Services of Western Washington has recently been approved for Community Based Services Block Grant
   (CBSG) funding to build transitional shelters in Bremerton and Olympia. WDVA is a community partner for both of these
   projects that will have more than 65 new shelter beds for homeless men and more than 35 transitional housing beds, plus an
   additional 20 studio apartment units for permanent housing. Our state agency capacity brings us to the table to partner with all
   public service entities that provide homeless services. In Washington veterans comprise 15% of the state population; HUD
   homeless demographics indicate veterans are 23% of the homeless population. This confirms our need to have vested interest to
   promote services to veterans and homeless veterans in the region.

   SPECIAL POPULATIONS TO BE SERVED
   All of the Target Population will require a unique understanding of needs and difficulties they face in their attempts to reintegrate
   back into society. Homeless women veterans will be served through HWP case management, VET Center Readjustment
   counseling and WDVA PTSD counselors. Since this facility is annexed to our long-term care Veterans Home we will have the
   capacity for terminally ill homeless veterans. These special needs clients will be afforded a transitional environment for their
   final stages of life that is safe, sound and secure. As their conditions deteriorate and they become more in need of Assisted
   Living or Skilled Nursing care we will facilitate their transition to our nursing facility. This will afford them the opportunity to
   spend their final days in an environment they are somewhat familiar with. Veterans with PTSD diagnosis will be in a
   surrounding that is unique, in a rural setting. WDVA, VAPSHCS and VET Center staff will be very important in providing
   counseling services to this group. Native American homeless veterans will also have the opportunity for transitional housing
   services at this facility. Washington State has the fifth highest native population in the nation at over 100,000. We estimate
   Native American veterans in the state to be in excess of 15,000. Homeless veterans with substance abuse problems will live in a
   setting that will support their sobriety and ensure that those around them are drug and alcohol free. Homeless veterans with dual
   diagnosis will receive clinical services through the VAPSHCS and VET Center staff. Homeless Veterans, with non-violent, non-
   sex offense convictions, being released from incarceration will be afforded the opportunity to transition into society through a
   structured program that will maintain a clean living style and will have access to Offender Employment Services through the state
   ESD. Disabled homeless veterans will have a chance to pursue Chapter 31 entitlements through the VARO and receive case
   management services from VR&E staff. Homeless veterans with mental illness will be able to live in a safe, secure setting while
   they receive clinical treatment from VAPSHCS staff. Recently separated veterans who are homeless will have the opportunity to
   turn their lives around in this type of facility that will have many different types of services available. Gulf War veterans and
   recently separated National Guard and Reserve veterans will qualify for the many services that will be available.

   The services outlined in this narrative are conceptual, innovative and unique. They will all be available in one facility supported
   by a collaborative effort by VA, WDVA and community based providers. This is a new program that will be housed in a facility
   currently owned by the WDVA. With the approval of this Grant and Per Diem Capital Grant Application it will become reality.


VA FORM
JAN 2003
                 10-0361-CG                                  Applicant Page Number is: ________             CG First Submission - 5
E. State/Local Government Applicants:

Applicants who are states or local governments must provide a copy of any comments or recommendations by
approved state and (area wide) clearinghouses pursuant to Executive Order 12372.

3. Major Milestones (Timeline):
You are reminded that 38 C.F.R. subpart 61.67 Recovery Provisions, paragraph (a) allows VA to recover grant
funds from those grantees that withdraw from the program or fail to establish the project for which the grant was
made after 3 years from the date of the award. With this in mind…

Please enter the number of estimated days from execution of the agreement that each of the milestones will occur.
(e.g., if execution of agreement is 9/30/03 and it will take 30 days for item one, enter: 30 days. Enter N/A if the
event is not part of the proposal. (Please answer in the space provided below.)

                                           Milestone                              Days from Execution
                                                                                  of Grant Agreement
                   1.   Close on purchase of structure or execution of lease     N/A
                   2.   Rehabilitation started                                   1/1/2006
                   3.   Rehabilitation complete                                  12/30/2006
                   4.   New construction started                                 N/A
                   5.   New construction complete                                N/A
                   6.   Operations Staff Hired                                   1/1/2007
                   7.   Residents begin to occupy                                2/1/2007
                   8.   Supportive Services Begin                                2/1/2007

4. Life Safety Code Notice:
If awarded, as a condition of funding all entities receiving grants and or per diem under PL 107-95 must ensure that
the project facilities meet the fire and safety requirements applicable under the Life Safety Code of the National Fire
Protection Association as well as any local or state codes as required. Failure to meet this requirement may lead to
loss of the award. It is suggested you take the cost of LSC improvements into account when preparing your budget
and cost estimates for the project.




VA FORM
JAN 2003
               10-0361-CG                                Applicant Page Number is: ________   CG First Submission - 6
5. Budget and Leveraging:
   In the chart below in column (A) enter the total cost of the project and in column (B) the amount requested from
   VA. (Note: column (B) amount cannot exceed 65% of column (A).)

   Keep in mind that if selected for funding you are required to document cost according to the OMB Grant
   Management Circulars. The activities listed below are not inclusive of all of the items of cost in the circulars nor
   does their presence below constitute that they are fully allowable under the circulars’ guidance. They are simply
   your requests to VA for a specific grant activity. Refer to the proper circular to determine if a cost is allowable.

A. Budget Summary:

   Summary of Grant        Enter the amount                       (A)                          (B)
   Funds Requested         requested for each             Total Cost of Project        65% of Total Cost
                           activity.                                                  Requested from VA
                           1. Acquisition               $0                          $0
                           2. Rehabilitation            $467,556.00                 $303,911.00
                           3. New Construction          $      .00                  $      .00
                           4. Total                     $467,556.00                 $303,911.00




B. Leveraging Summary:

Enter in the chart below the cash value of documented cash and in-kind resources from other public (including
Federal and State) and private sources that are committed to the project.
   Non-VA                             Resource                            (A)                 (B)
   Resources Brought                                                 Cash Value           VA use only
   to the Project                                                                       (Allowed Value)
                          1. Applicant Cash                    $       .00            $                 .00
                          2. Third Party Cash                  $       .00            $                 .00
                          3. Third Party Non-Cash              $       .00            $                 .00
                          4. Volunteer Time                    $       .00            $                 .00
                          5. Contribution of Building          $       .00            $                 .00
                          6. Contributed Building Below
                              Market Value                     $       .00            $                 .00
                          7. Contributed Leasehold Interest $0.00                     $                 .00
                          8. Contributed Materials             $       .00            $                 .00
                                     Total of All Leveraging $         .00            $                 .00


C. Supporting Documentation: Applicants that list the cash value of leveraged resources in the Leveraging
   Summary must document these resources on the appropriate organization letterhead stationary as outlined in the
   Assurances Section of this application (First Submission-pages 38 & 39.)



VA FORM
JAN 2003
              10-0361-CG                           Applicant Page Number is: ________     CG First Submission - 7
6. Description of Need:

   The information you provide here will assist in the rating of your project. Please provide a short and
   descriptive narrative responding to each of the following items:

A. How did you identify the need for this project? (Please answer in the space provided below.)
   In discussions with the HCHV coordinators in Walla Walla and Puget Sound Health Care System. Over the years we have had
   numerous discussions with VBA and VHA staff and have reviewed the CHALENG and NEPEC data. In recent conversations
   with the VISN homeless coordinator we realized our capacity could to have a positive impact on the VAMC programs within the
   state. Recently this building became available and due to the nature of it's layout it will afford us the opportunity to serve
   multiple needs and both genders. We have collaborated with the VA PSHCS Homeless Womens Program for the past three years
   and we have operated a USDOL-VETS HVRP program for both homeless men and women veterans since 1987. Our broad based
   approach has been derived at by listening to the feedback from our community network and putting together a concept that will
   fill the gaps identified and make our community homeless veterans support network more effective.




B. Estimate the total number of homeless veterans in your area that could be served by, or be eligible for,
   this program. (Please answer in the space provided below.)
   The estimated number of homeless veterans in the State of Washington is in excess of 6000 individuals. Based on WDVA
   experince providing homeless services in the region and within the target groups, we estimate that about 40% or 2400 will be
   eligible for services through this project.




C. List the sources of this information. Please be specific. (Please answer in the space provided below.)
   Community Homeless Assessment, Local Education and Networking Group (CHALENG) for Veterans, The Eleventh Annual
   Program Report on Public Law 105-114, Services for Homeless Veterans Assessment and Coordination, dtd May 3, 2005.

   The 2004 Annual One Night Count: People surviving homelessness in King County, Washington, dtd March 2005.

   2004 Annual Report, King County Veterans Program, Demographic Profile of Client's Served, dtd April, 2005.




VA FORM
JAN 2003
                10-0361-CG                                      Applicant Page Number is: ________         CG First Submission - 8
D. What percentage or portions of this total number of homeless veterans (Question B) will be served by this
   proposed program? (Please answer in the space provided below.)
   It is estimated that about 8% or 480 homeless veterans will be provided services through this project annually.




E. Describe any special characteristics or need of this group to be served to demonstrate understanding of
   the population. (Please answer in the space provided below.)

  The special needs-target group has been identified. The primary purpose for this effort is to support the federal Department of
  Veterans Affairs homeless veterans programs in Puget Sound and throughout the state. Safe-secure transitional housing will
  support VA CWT and VR&E services. Homeless veterans in need of clinical services and follow-up will have a place to reside in
  an environment that will provide them with residential stability while we are establishing individual case management plans that
  will increase their skill level and income through therapeutic employment and applications for monetary benefits. The opportunity
  for them to live in a transitional housing model where they can receive the necessary support to achieve greater self determination
  and have the opportunity to take ownership of their lives is available. Placing these homeless veterans in this program will
  provide us with time to further develop their employability capacity and arrange for long-term housing solutions dependent on
  individual needs. The WDVA has been providing direct services to homeless veterans since 1976, as we have operated two
  domiciliaries with maximum capacity of 160. In 1987 we received a grant from US DOL VETS for employment services for
  homeless veterans and since then have expanded our knowledge base and community network to include the agencies in the
  statewide continuum of care plan. Since 1987 WDVA staff has documented more than 13,000 contacts with homeless veterans,
  enrolling more than 8,500 into HVRP services and have assisted more than 3,800 homeless veterans in securing employment. Our
  track record has been successful in assessing client needs and developing a case management plan that will start the veteran on a
  road to recovery and eventually result in independent living. WDVA staff will be more effective working with VA staff that
  specializes in clinical services. Communication and collaboration to identify treatment and services necessary to help them with
  life changing experiences will be the core strength of this model.




VA FORM
JAN 2003
                 10-0361-CG                                Applicant Page Number is: ________            CG First Submission - 9
7. Targeting:
A. Settings

        The information you provide here will be used in rating targeting and quality of the project plan.
        Complete the chart below, estimating the percentage of project participants who:
        (Please answer in the space provided below.)
                                                                                                              Projected Percentage
                                                                                                               (must total 100%)
             1. Regularly sleep in places not designed for, or ordinarily used as
             sleeping accommodations for human beings.                                                        50%
             2. Reside in an emergency shelter.                                                               25%
             3. Are otherwise homeless.                                                                       25%

B. Description of “Otherwise Homeless”: If Item A, line 3, is greater than 0%, explain how participants will
meet VA’s homeless definition. (VA definition of homeless or homeless individual is located in the Rules and
Regulations §61.1 Definitions section in the appendix. Please answer in the space provided below.)

Homeless veterans who have met the requirements of Rules and Regulation 61.1, have been stabilized and referred to or placed with
our network of community service providers for housing or treatment services. Some of these will return to the transitional housing
project upon completion of treatment or program.

Individuals, such as recently discharged veterans, that are staying with friends a.k.a. "Couch Surfing" while seeking employment,
waiting for benefits and entitlements to start and/or working through health issue (physically and mentally) are considered to be
"otherwise homeless" and are prime targets for transitional housing.

Treminally ill veterans that have exhausted housing options but are not eligible or on a short waiting list for hospice or assited living
care are also "otherwise homeless".


If you described an “other wise homeless” population to be served, how will you determine that these
individuals actually need your services (i.e., would spend the night in a shelter or on the street)?
(Please answer in the space provided below.)

Otherwise Homeless Veterans would be forced on to the streets or to shelter if not provided access to transitional housing options
through this project. Each homeless veteran will be assessed by program staff experienced in identifying needs, barriers, and skills,
case development and providing homeless services.




VA FORM
JAN 2003
                  10-0361-CG                                        Applicant Page Number is: ________            CG First Submission - 10
7. Targeting (con’t):

C. Outreach Plan:

                           Please describe how your agency will identify and serve homeless veterans by
                           responding to the following 7 questions:

(1.) Briefly describe the veteran who would qualify for housing and/or services. Describe the process your
    agency will use to screen homeless people for veteran status. (Please answer in the space provided below.)

     Homeless veterans whose primary living place is not meant for human habitation will qualify for transitional housing services,
    when they meet one of the following; #1.Veterans who are actively enrolled in and receiving homeless veterans services and
    clinical services from the VA Medical System and VARO would qualify for these transitional housing services. (CWT and
    VR&E participants). #2.Homeless veterans enrolled in HVRP, actively pursuing a developed case plan and actively seeking
    employment and or working. Homeless veterans residing in shelters, living on the streets, in vehicles and not residing in their
    own residence will be eligible for HVRP. Referrals from DVA will be screened and interviewed to determine potential
    eligibility. We will utilized the federal Benefits Delivery Network (BDN) and SHARE program to verify veteran status.
    (WDVA staff are accredited and certified.) WDVA will inquire through the VARO to confirm veteran status and/or fax Standard
    Form 180 to the National Personnel Records Center (NPRC) and request response or verification be expedited as a homeless
    veteran inquiry. Staff will seek assistance of VARO homeless veterans coordinator as necessary. Washington state has more
    than 400,000 War Bonus records available for research. As necessary we will verify through VAMC treatment records and
    county Auditor when DD-214 and discharges were registered.




(2.) Describe how your agency will reach out to homeless people living on the streets or in shelters.
(Please answer in the space provided below.)

    WDVA currently has six staff members who are actively involved in interviewing and providing outreach to homeless shelters,
    soup kitchens, interacting with homeless providers and city and county jail systems. We are active in the state continuum of care
    provider community and collaborate regularly with other homeless providers. As a cabinet level state agency we are very active
    with US DOL funded LVER/DVOP staff. These employment and training staff have contact with more than 32,000 veterans per
    year. Our network is far and wide and includes VSO's, county relief agencies and all VAMC homeless programs in the state. We
    currently have a $9,000 a year contract with the HCHV program in Walla Walla for client support and provide $18,000 to that
    community to support the HCHV phase-2 transitional housing model. We have a proven track record with HVRP that has contact
    with more than 500 homeless veterans and assists more than 125 to obtain employment annually. Our outreach network is
    currently in place and not only participates in providing the outreach function but also provides outreach to the programs that help
    homeless and homeless veterans on a daily basis.




VA FORM
JAN 2003
                  10-0361-CG                                 Applicant Page Number is: ________             CG First Submission - 11
7C. Targeting (cont.):
(3.) How will you identify where homeless people can be found? (Please answer in the space provided below.)

   Homeless people can be found anywhere. Our program network is broad-based in outreach and will have direct daily contact
   with; homeless shelters, soup kitchens, hobo camps, homeless providers with day drop-in centers and a variety of government
   programs that offer public services. We will network with the continuum of care providers in the communities of Seattle,
   Tacoma, Bremerton and Olympia. We are an active partner in the Washingon Coalition for Homeless (WCH) and interface
   regulary with the associate agiencies that belong to the WCH. WCH is an excellent resource to meet with county Housing
   Authority agencies. Program staff will coordinate referrals with the VARO homeless veteran coordinator. VAMC staff will be
   one of the primary referral points and we will work closely with the HCHV and HWV programs. We currently are active in
   working with more than eight emergency shelters in the service delivery area (SDA). Our HVRP program staff have a regular
   outreach schedule where they meet with emergency shelter staff who assist in identifying homeless veterans.




(4.) How will you sweep each site and engage the homeless to use your services?
     (Please answer in the space provided below.)

   Our HVRP staff and King County Veterans Program (KCVP) staff have regular outreach routines where they visit the eight local
   emergency shelters in our SDA. We have worked with the emergency shelter staff since 1987 and the majority of the shelters ask
   homeless people if they have ever served in the Armed Forces. If the answers are positive, they usually inform the homeless
   veterans as to when an outreach specialist will be in the area. Since this will not be an emergency shelter, the majority of our
   program referrals will come from professional homeless providers in the region. Our staff meets regularly with homeless
   provider staff to check-out what is going on. The individual word-of-mouth referrals from homeless veterans will be one of the
   more successful methods of getting the word out about our transitional housing services.




VA FORM
JAN 2003
                10-0361-CG                                      Applicant Page Number is: ________          CG First Submission - 12
7C. Targeting (cont.):
(5.) What initial services will you provide? (Please answer in the space provided below.)
   Initially we will conduct a needs assessment and deal with immediate needs first, such as referrals for food, clothing or
   emergency shelter. If immediate medical attention is necessary we will ensure that the individual gets to the nearest VAMC for
   treatment. In cases where emergency medical care is needed we will make sure they receive immediate treatment from one of the
   many hospitals in the area. During the needs assessment phase we will inform clients of the many services available for homeless
   veterans in the region. The majority of initial referrals will be to VAMC's for general health reasons and we will also review and
   discuss the need for mental health, PTSD or substance abuse programs. Veterans will be assisted in the VA health care
   enrollment process when necessary. After the initial referral is made to the VAMC veterans will be informed of VA homeless
   program services. Community VET Centers will be available for readjustment counseling if needed. (Tacoma and Seattle) If
   claims services are deemed appropriate a WDVA staff member or VSO service officer will assist the homeless veteran. Claims
   will be routed through the VARO homeless coordinator to be expedited. Homeless veterans looking for employment will be
   referred to the HVRP staff and or LVER/DVOP as necessary.




(6.) In addition to outreach, are there other ways in which the homeless will access your services?
     (Please answer in the space provided below.)

   Our state agency Service Center located in Olympia has a toll free phone line that has a message capacity 24 hours a day, seven
   days a week. Homeless veterans can leave messages for their WDVA case manager as needed, 24/7. All WDVA homeless
   veteran outreach staff, including the Program Managers, have toll free pager numbers to make accessability easier for those in
   need. Toll free numbers allow homeless veterans the opportunity to make calls from public pay phones without having to pay the
   charge of the call. Our agency has a web-site that lists the many programs available with links to other veterans programs
   including VA, county and local government programs as well as VSO links. Our cabinet level status gives us a unique capacity
   with our involvement with VSO leadership. VSO commanders ans service officers contact our staff on a regular basis to seek
   advice on providing services to homeless veterans. Referrals and services are provided as necessary. Our influence is broad-
   based thoroughout the state.




VA FORM
JAN 2003
                10-0361-CG                                 Applicant Page Number is: ________            CG First Submission - 13
7C. Targeting (cont.):
(7.) Describe, if applicable, the population that you will serve that will not be veterans.
    (Please answer in the space provided below.)

    This program design will not provide direct transitional housing services to non-veterans. However, in providing services to
    the general population and other service providers we can at times be "value added" in our discussions with them. Referrals to
    local shelters, transitional housing models, soup kitchens and medical clinics are provided to non-veterans as necessary.




VA FORM
JAN 2003
                10-0361-CG                                      Applicant Page Number is: ________          CG First Submission - 14
8. Project Plan:
       This is the portion of the application that describes your program, as VA Reviewers will focus on how
the project plan addresses the goals. The project plan section consists of 8 areas.

Please keep your answers within the boxed space provided after each question.

Area 1 questions begin with the goal. Be sure to address the goal in your answers.


Area 1.          The information you provide here should relate to the following goals:

                       1. Residential stability of participants;
                       2. Increased skill level and/or income of participants; and
                       3. Greater self-determination of participants.

For each of the three goals listed above, describe in the space provided:

       a)      The specific measurable objective(s) that will be used to assess the program’s success;
       b)      How you decided on the objective(s);
       c)      How the success of the program will be evaluated on an ongoing basis; and
       d)      How you will determine whether program modifications are necessary, and if so, how such changes
               will be implemented in order to make the program more fully realize its objectives.



                                             BEGIN ON NEXT PAGE




VA FORM
JAN 2003
               10-0361-CG                          Applicant Page Number is: ________   CG First Submission - 15
8. Project Plan (cont.):

Area 1. (1a) The goal is residential stability of participants. - - What is/are the specific measurable objective(s)
that will be used to assess program success? (Please answer in the space provided below.)
    50% of participants will attend and participate in AA/NA meetings.

    50% of PTSD participants will improve their level of social and industrial impairment.

    75% of PTSD participants will participate in group therapy sessions.

    75% of all participants will receive a screening for VA entitlements and other benefits such as Social Security, SSI or GAU.

    85% of all participants will receive a residential stability evaluation and periodic follow-ups.

    75% of all participants will receive a Homeless Veterans Reintegration Project assessment for employability services.

    50% of all participants will participate in the program Job Club designed to discuss employment and job search successes.

    90% of all participants will participate in the program Housing Club that will discuss and review housing options in the
    community.

    65% of all participants will secure permanent housing when they exit the program.




Area 1. (1b) The goal is residential stability of participants - - How did you decide on the objectives?
(Please answer in the space provided below.)

    Discussions with Continuum of Care members and review of the statewide and local community gap analysis, interaction with VA
    HCHV staff and collaborative review of 2004 CHALENGE report. In addition, WDVA experience with target group and regional
    homeless needs.

    Another key element, is our routine meetings and discussions with our network of service providers and partner agencies/programs.




VA FORM
JAN 2003
                  10-0361-CG                                        Applicant Page Number is: ________         CG First Submission - 16
8. Project Plan (cont.):
Area 1. (1c) The goal is residential stability of participants - - How will the success of the program be evaluated
on an ongoing basis? (Please answer in the space provided below.)
   Project staff will prepare monthly reports, these reports will be consolidated every three months and a quarterly assessment will
   be made.

   Monthly reports will be based on reviews of individual case plans by case managers to determine what progress has been made
   with participants meeting individual goals of residential stability, increased skill level/income, and greater self-determination.
   In addition, a review of services provided, treatment or programs completed, and training participation will be included as will
   current assessments of individual’s needs, barriers and skills.

    We will provide 90/180-day follow-up with participants after initial placement into housing programs. Case management and
   support services will continue to be available to clients in need.




Area 1. (1d) The goal is residential stability of participants - - How will you determine whether program
modifications are necessary, and if so how such changes will be implemented to make the program fully realize its
objectives? (Please answer in the space provided below.)

   Review and analysis of project reports

   Periodic participant surveys

   Participant exit surveys

   Service provider and continuum of care member surveys

   Constant review and analysis of data, coupled with the flexible design of project will allow project to be modified to focus on
   what, when, where, and how services are needed most.




VA FORM
JAN 2003
                 10-0361-CG                                 Applicant Page Number is: ________             CG First Submission - 17
8. Project Plan (cont.):
ATTENTION APPLICANT! YOU ARE BEGINNING A NEW GOAL.

Area 1. (2a) The goal is increased skill level and/or income of participants - - What are the specified measurable
objective(s) that will be used to assess the program’s success? (Please answer in the space provided below.)

 75% of all participants will receive life skills training.

 50% will increase income level by accessing monetary entitlements.

 50% will participant in class room training provided in the on-site learning center.

 50% participants will receive vocational guidance counseling.

 35% of all participants will access employment at or above minimum wage for 20 hours or more per week.

 50% of all participants employed will retain gainful employment beyond 90 days.

 75% of participants with income will be required to open a saving plan and make regular savings deposits verified during the
 regular case plan meetings.




Area 1. (2b) The goal is increased skill level and/or income of participants - - How did you decide on the
objective(s)? (Please answer in the space provided below.)

 Discussions with Continuum of Care members and review of the statewide and local community gap analysis, interaction with VA
 HCHV staff and collaborative review of 2004 CHALENGE report. In addition, input from VA PSHCS Veterans
 Industry/Compensated Work-Therapy and CWT/Transitional Residence Program staff, VARO-Seattle Vocational Rehabilitation
 and Employment staff, and local WorksSource staff.

 Our extensive experience as an HVRP provider since 1987 has provided us with more than 15 years of experience in providing case
 management services to homeless veterans.

  WDVA has a cadre of staff who are certified and accredited to file VA disability claims and represent the veteran with the
 adjudication process in the VA Regional Office. This is a key component that will not have to be referred out, as WDVA staff will
 directly provide this service on site, ensuring the clients have a better chance for successful claims.




VA FORM
JAN 2003
                  10-0361-CG                                      Applicant Page Number is: ________        CG First Submission - 18
8. Project Plan (cont.):
Area 1. (2c) The goal is increased skill level and/or income of participants - - How will the success of the
program be evaluated on an ongoing basis? (Please answer in the space provided below.)

 Project staff will prepare monthly reports, these reports will be consolidated every three months and a quarterly assessment will be
 made.

 Monthly reports will be based on reviews of individual case plans by case managers to determine what progress has been made with
 participants meeting individual goals of residential stability, increased skill level/income, and greater self-determination. In
 addition, a review of services provided, treatment or programs completed, and training participatation will be included as will
 current assessments of individuals needs, barriers, and skills.

 90/180-day follow-up services will be conducted after initial job placement.

 Continued case management will assist in maintaining gainful employment.

 Participants in receipt of monitary benefts and/or gainfully employed will be required to participate in a monitored savings
 program.




Area 1. (2d) The goal is increased skill level and/or income of participants - - How will you determine whether
program modifications are necessary, and if so, how such changes will be implemented in order to make the
program fully realize its objectives? (Please answer in the space provided below.)

 Review and analysis of project case manager reports to determine if individual particpant skill levels / income have increased.

 Periodic participant surveys

 Particpant exit surveys

 Service provider and continuum of care member surveys

 Constant review and analysis of data, coupled with the flexible design of project will allow project to be modified to focus on what,
 when, where, and how services are needed most.




VA FORM
JAN 2003
                 10-0361-CG                                 Applicant Page Number is: ________            CG First Submission - 19
8. Project Plan (cont.):
ATTENTION APPLICANT! YOU ARE BEGINNING A NEW GOAL.

Area 1. (3a) The goal is greater self-determination of participants - - What are the specific measurable
objective(s) that will be used to assess the program’s success? (Please answer in the space provided below.)
  75% of all participants will be actively involved in the development of their case plan.

  50% will participate in regular scheduled resident council meetings.

  50% will participate in a volunteer capacity with a community based organization.

  75% of all participants will present a marked improvement in appearance and grooming habits.

  85% of participants will exhibit improved mental health and emotional well-being.

  75% of all participants will participate in peer-to-peer support groups.




Area 1. (3b) The goal is greater self-determination of participants - - How did you decide on the objective(s)?
(Please answer in the space provided below.)

  Discussions with Continuum of Care members and review of the statewide and local community gap analysis, interaction with
  VA HCHV staff and collaborative review of 2004 CHALENGE report. In addition, WDVA experience with target group and
  regional homeless needs.

  Another key element, is our routine meetings and discussions with our network of service providers and partner
  agencies/programs.




VA FORM
JAN 2003
                  10-0361-CG                                        Applicant Page Number is: ________      CG First Submission - 20
8. Project Plan (cont.):
Area 1. (3c) The goal is greater self-determination of participants - - How will the success of the program be
evaluated on an on going basis? (Please answer in the space provided below.)

 Project staff will prepare monthly reports, these reports will be consolidated every three months and a quarterly assessment will be
 made.

 Monthly reports will be based on reviews of individual case plans by case managers to determine what progress has been made with
 participants meeting individual goals of residential stability, increased skill level/income, and greater self-determination.

 Resident council meetings implementing ideas presented by participants.

 Participants providing feedback of volunteer efforts with FBCO's and openly discussing successes and failures.

 Resident meetings that start on-time and participants are involved in open discussion and issue/problem resolution.




Area 1. (3d) The goal is greater self-determination of participants - - How will you determine whether program
modifications are necessary, and if so, how such changes will be implemented in order to make the program fully
realize its objectives? (Please answer in the space provided below.)

 Review and analysis of project reports

 Periodic participant surveys and self-evlautions

 Participant exit surveys

 Service provider and continuum of care member surveys

 Constant review and analysis of data, coupled with the flexable design of project will allow project to be modified to focus on what,
 when, where, and how services are needed most.




VA FORM
JAN 2003
                 10-0361-CG                                 Applicant Page Number is: ________            CG First Submission - 21
8. Project Plan (cont.):
Area 2. Describe the process for assessing the initial service needs of potential participants in the program as
well as the process for assessing the ongoing needs of individuals once they become program participants.
(Please answer in the space provided below.)

  Intial service needs will be assessed at intake and ongoing service needs will be assessed at periodic intervals of not more than 90-
  days .

  Service providers making referrals will provide basic packet to the program that identifies service needs as they assessed them and
  should include assessment of needs, barriers and skills. Each individual participant will be interviewed by program staff to
  document personal and demographic information. Interviews will collect information on family, military experience, vocational
  and training , work, financial , legal, criminal and housing history. In addition, each individual will receive a basic physical and
  mental health examination for addictions and trauma assessments.

  Each individual packet will be staffed and assigned case management services. Individual participant will work with case manager
  to identify barriers to residential stability, adequate income, and self-determination. Participants, with the assistance of the case
  manager , will design a case plan that identifies services and support services needed to breach the barriers and lead to residential
  stability, increased skill level / income, and greater self-determination. Participants will review their case plans with case managers
  and peer groups to determine progress and changes to service needs on a monthly basis, more often if needed.

  Staff will conduct a quarterly review of case plans.




VA FORM
JAN 2003
                  10-0361-CG                                       Applicant Page Number is: ________            CG First Submission - 22
8. Project Plan (cont.):
Area 3. Provide a brief description of the supportive services to be offered participants and the way in which
supportive services will help participants meet the goals specified above. If the project will be providing case
management, describe how case management services will be provided in the program. Include in the
description the ratio of case managers to program participants. (Please answer in the space provided below.)

   The support services to be provided with this model are broad-based and holistic. These support services will assist homeless
   veterans in the transition from homelessness to residential stability, increased skill level / income and greater self-determination
   that enables them to live as independently as possible. Many of the homeless veterans served through this comprehensive model
   will increase their income by securing employment through the HVRP employment and skills development training programs.
   Case managers will asssit the individual homeless veteran develop their case plan designed around their needs, barriers and skills
   to achieve the goals of residential stability, increase their skill level / income, and greater self determination. Individuals with the
   assistance of staff will identify the support services for their case plan. Participants will rely less on community services,
   eventually becoming a community resource. Support services will include, but are not limited to: Food, shelter, clothing,
   Employment and Training services, VA Benefits and Entitlements assistance, Readjustment and Trauma Counseling, Mental
   Health services and referrals, assistance with access to State Veterans Homes and VA domiciliary programs, Fiduciary services,
   Substance abuse treatment outpatient services and referrals, Financial assistance, Case Management services, Transportation
   services, Recently separated veterans briefings, Housing referrals and assistance with permanent housing programs

   Because employment services are a huge part of the WDVA service delivery network, the program will continue to network with
   Local Veterans Employment Representatives (LVER) and Disabled Veterans Outreach Program (DVOP) staff. Veterans
   Workforce Investment Programs (VWIP) will be accessed by program participants at every opportunity. Referrals will be made
   to ESD for eligibility screening for US DOL Employment and Training Administration (ETA) programs as appropriate. Support
   services will include educational and training assistance with many of the local colleges and trade schools. Courses offered by
   these institutions include; Welding Certification, Fork Lift Operator, Hazardous Material Services , Medical Records
   Technicians, Office Assistant training and Certified Nurses Assistant Certifications (CNA). Another support service for
   employment will be assistance through the Washington Dept of Personnel job service programs.

   The on-site Learning Center will provide learning opportunities for computer familiarity, employment research, resume
   development, electronic employment application, internet job search and an opportunity to communicate with family and friends
   as they increase their life skills and create an environment that will result in greater self-determination and assist them to make
   decisions that will affect their lives.

   Case management will be provided by two on-site Social Workers, a ratio of 20:1, who will provide coordination and supervision
   to individuals in their case plan development, counseling/treatment activities, and support service requests. Participants will
   receive case management services through service providers, professional counseling staff, and medical staff accordingly. The
   program social workers will coordinate all the case management with the participant to minimize confusion and frustration of
   working through several programs and to resolve conflicts before they effect outcomes.




VA FORM
JAN 2003
                 10-0361-CG                                   Applicant Page Number is: ________              CG First Submission - 23
8. Project Plan (cont.):
Area 4. Describe (if applicable):

       a)       Why the proposed housing was selected in light of the population proposed to be served;
       b)       What process will be used for deciding in which units participants will live;
       c)       What role participants will have in operating and maintaining the housing; and
       d)       What responsibilities you and any sponsors or contractors will have in operating/maintaining
                the housing.
                (Please answer in the space provided below.)

   First of all, the State's Continuum of Care Gap Analysis and the 2004 VA CHALENG report clearly indicates the lack of
   transitional housing programs for homeless veterans exists within the State of Washington and clearly does not meet the needs of
   the Puget Sound Region. Second, the availablity of the site, low-cost of renovation, and the network of providers available and
   willingness to particpate in providing services in this location were key to selection of this program.

   Individual particpants will govern assignments through a peer-group process. Staff will make floor and area assignments based
   on physical capability and gender, peer groups will interview individuals and make the decisions on how to intergrate them into
   their group. These decisions will be open forum with oversight/advice from staff. This process is based on the OXFORD
   Housing model.

   Peer groups will be formed by floor and by segments based on program assignments. These peer groups will be repsonsible for
   determining daily operations and maintence assignments of particpants. Common area, kitchen, bathrooms and showers cleaning,
   trash, etc . schedules and details. in addtion, periodic inside and outside maintenance and cleaning will be required to ensure the
   facility is kept in prime condition, peer groups will be given tasks to chose from and then determine how and when to accomplish
   these tasks. Deadlines and consequences will be established by everyone at the facility.

   WDVA is responsible for the operation and maintenance of the facility by law.




VA FORM
JAN 2003
                 10-0361-CG                                       Applicant Page Number is: ________          CG First Submission - 24
8. Project Plan (cont.):
Area 5. Describe how this program will enable participants to gain greater access to neighborhood activities,
services, and institutions. (Please answer in the space provided below.)

   Each participant’s case plan will include an understanding that they are expected to volunteer in local neighborhood and
   community activities. Community volunteering is designed as part of life skills training to increase social skills, help participants
   work on coping skills, enhance self-esteem, which contributes to greater self-determination. Volunteering is an excellent method
   to assist with the reintegration process .

    The Service Center will provide a list of FBCO's that provide commuity service opportunities. Participants will chose from this list
   or suggest alternative methods of volunteering to include functions of the Service Center and the Transitional Housing Program.
   Participants will identify the community service and resources needed to participate in the project. Participants will then discuss
   strategies with assigned case manager how best to engage in the selected project and how to schedule available resources. Program
   staff will be responsible for monitoring interactions of participants within the community and progress within the project

   The collaborative network of service providers that offer on-site and off-site services instill greater access by participating in the
   program. Eash participant's case plan requires individuals to access opportunities in the community through volunteer activities,
   education and training opportunities, and utilization of one-stop centers such as WorkSource.

   Peer group responsibility for operation and maintenance of the facility will create opportunities for participants to engage with
   vendors and staff, to resolve simple house keeping chores, purchase supplies, individual and group groceries, and with apporval, to
   schedule emergency repairs or routine maintencance. With the addition of dedicated transportation to the program , participants will
   be able to schedule activities in the local community to include organized recreational activities.




VA FORM
JAN 2003
                 10-0361-CG                                   Applicant Page Number is: ________              CG First Submission - 25
8. Project Plan (cont.):
Area 6. Describe how you will implement your program in accordance with your timeline.
(Please answer in the space provided below.)

  Upon notification that funding is approved, the agency will start the process appointing a Project Manager, select approved
  contractors/consultants to complete requirements of Section D, establish a renovation timeline based on the critical path analysis,
  develop an RFP, and coordinating with the Genaral Administrative Services for approved contractor list to solict bids on the
  required segments of the renovation project.

  The RFP will specify the start and finsih times based on the critical path analyis and approved project timeline. The Project
  Manager will brief the agency on the project status periodically. The status briefings will corelate to major milestones and become
  more frequent as the critical paths merge and the project nears completion.

  When the project is within 30-days of completion of the renovation phase, the hiring process will begin. Hiring will be based on
  established civil service rules and pre-established lists for positions. It is anticipated that critical operational staff will be on-site
  and have completed training within 30-days of the renovation phase, at which time, the operational phase begans. Participants will
  begin to occupy the housing project at this time.

  The Service Center will become operational upon completion of the renovation phase and prior to the start of the operational phase




VA FORM
JAN 2003
                  10-0361-CG                                         Applicant Page Number is: ________             CG First Submission - 26
8. Project Plan (cont.):
Area 7. For applications proposing transitional housing, describe what permanent affordable housing will be
available to participants upon leaving transitional housing and how participants will be readied for this event.
(Please answer in the space provided below.)


  Homeless veteran programs in the SDA provide limited housing support for working veterans.
  Homeless veteran outreach and case management staff will broker housing options as necessary to support the participants case
  plan goals. The program will provide financial support for transition to permanent housing as necessary and outlined in the case
  plan. When participants secure gainful employment or secure stable consistent income from other resources, the participant will
  follow their plan they designed to transition transitional housing to permanent housing.

  When necessary, program revenues will be utilized to support permanent housing. Financial obligation to support this transition
  into permanent housing will be provided in the following manner when appropriate; Initial month paid by program, second month
  will be supported by one-half of the first month contribution. The third and final month will involve no more than one-half support
  from program funds. This graduated scale will provide program with participant contact requirements necessary to support 90-day
  housing retention. Follow-up will be conducted in 30-day increments up to 180-days. During this transition to permanent housing,
  participants will be monitored and assisted in setting aside income to support independence from program housing support. Other
  program case management and involvement will continue as necessary.

  Participants who have income will be encouraged to start a savings plan that will be monitored during the regular sessions with the
  case manager. Homeless veterans will increase their individual self determination as they experience their capacity to save and
  plan for the future. Individual savings can be applied for first month rental amounts plus any amounts that will be required for
  deposit.

  The OXFORD House model is available throughout the state. OXFORD House is a concept and system of self-run, self-supported
  group housing for recovering alcoholics and drug addicts. They are basically peer-assisted residences (PAR) for the homeless.
  There are more than 65 OXFORD House models in Washington State with more than 546 recovery beds available. 1999 statistics
  show 27.7% of OXFORD House residents are veterans. OXFORD House is an excellent resource for permanent housing.




VA FORM
JAN 2003
                 10-0361-CG                                 Applicant Page Number is: ________            CG First Submission - 27
8. Project Plan (cont.):
Area 8. Describe any follow-up services that will be provided once participants leave transitional housing.
Include specific services to be provided. (Please answer in the space provided below.)

 Follow-up services will be provided to participants for up to 180-days after exit from program to monitor progress and residential
 stability. As long as the client maintains communication case management and support services will be provided. Homeless
 veterans who have secured employment will be assisted through HVRP, for rental assistance as necessary and other employment
 support, like transportation, food and clothing. Basically all the support services available while they are in the transitional housing
 program will continue to be available.

 Program goal is to provide services needed to ensure residential stability is maintained, skill levels and income or have increased,
 and individuals have greater self-determination . Our case managers will continue to collaborate with all the providers in the
 community to ensure that progress made is not progress lost. Once the participants leave the confines of the transitional housing
 program the continuum of care network will continue to care for the individual.




VA FORM
JAN 2003
                 10-0361-CG                                        Applicant Page Number is: ________            CG First Submission - 28
9. Ability:
        The information you provide here will be used in the rating of ability criterion. Please provide the
        requested resumes and complete the questions that follow within the boxed space that follows each
        question.

        Note: All applicants must complete Items A through H, while Items I through K should be completed
        as appropriate for the proposal.


Describe the capacity of the organizations involved in carrying out this proposal in terms of:

A. Experience of staff; please provide a one-page resume for each of your key personnel. (Attach here)



B. Describe the experience of your organization in engaging the participation of homeless veterans residing
in places not ordinarily meant for human habitation or in emergency shelters;
(Please answer in the space provided below.)
  WDVA was one of the original homeless veteran service providers with the U.S. Department of Labor – Veterans Employment and
  Training Services (DOL-VETS) Jobs for Homeless Veterans Program (JHV) grants in 1987, continuing to provide services with
  DOL-VETS Homeless Veterans Reintegration Project (HVRP) grants from 1988 through 1995 in both the urban and rural
  environments. In 1995 and 1996, WDVA participated in the DOL-VETS JTPA IV-C program designed to provide homeless
  veterans with employment and training services in Puget Sound and in rural Washington State. WDVA has continued to provide
  HVRP in the Seattle-King County Metropolitan Area and Puget Sound region since 2000. To support these efforts WDVA staff
  have directly provided outreach to emergency shelters, hobo camps, soup kitchens and the like. We maintain a very extensive
  network and collaborate to provide services as needed.

  During this period, WDVA staff have made over 13,000 contacts with homeless veterans on the streets, in soup kitchens and
  community service facilities, in emergency shelters, jails, transitional housing programs, and through referals by other service
  providers. Currently WDVA has four staff members actively engaged in street-level activities




C. Describe the experience of your organization in assessing the housing and supportive service needs of
homeless veterans; (Please answer in the space provided below.)
  Over 8,500 homeless veterans have been assessed by WDVA. Assessment include collecting information to determine who the
  individual is, veterans status, eligibility for various federal, state and local programs and demographics data. In addition, every
  assessment identifies individual needs, barriers to employment, housing stability, and independent living.




VA FORM
JAN 2003
                  10-0361-CG                                 Applicant Page Number is: ________             CG First Submission - 29
9. Ability (cont.):
D. Describe the experience or your organization in accessing housing and supportive service resources,
including entitlement benefits; (Please answer in the space provided below.)
WDVA has collaborated with regional homeless providers for many years, including the VAMC's in Washington State. Our efforts
include Section 8 vouchers through local housing authorities, OXFORD House models and a variety of transitional housing options
in the community. Our extensive experience in operating HVRP keeps us in touch with programs available and helps us to be
successful in filling community gaps by networking with continuum of care providers.

WDVA staff are certified and accredited for the agency and we commit more than one million dollars annually to support Veterans
Organizations Service Officer development and contracts. Application for VA disability is a core value and strength of the WDVA
model. When clients are eligible we assist to have them enrolled into the VA Health Care system. Applications for GAU, Welfare,
Supplemental Security Income, Social Security and other entitlement benefits will be available on site as necessary.




E. Describe the experience of your organization in providing supportive services to homeless persons that
aid them in achieving and maintaining stable long term housing, increasing their skill levels and income; and
gaining more influence over their lives; (Please answer in the space provided below.)

Since 1987, WDVA has had contact with more than 13,000 homeless veterans, enrolled more than 8,500 homeless veterans in
employment focused jobs and training programs and has assisted over 3,800 with job placements. These veterans were provided
support services that helped them achieve residential stability, increase their skill levels and incomes that result in greater-self
determination. HVRP requires 90 and 180 day follow-up, this process ensures success as long as communication between provider
and client is maintained.

Case plans are developed by WDVA staff with the assistance and buy-in of the participants. This creates ownership and
responsibility in the case management process.. In general, goals of the case plans are sustainable, independent living. Support
services are then made available to assist achieving those goals and to address the barriers identified that keeps the veteran from
attaining those goals.




F. Describe the experience of your organization’s ability to provide for the special needs of veterans;
    (Please answer in the space provided below.)
All needs of veterans are special. Homeless veterans’ services require a unique understanding of issues that impact their lives.
WDVA has experience in providing services to homeless women veterans through HVRP. Since 2001 WDVA services have assisted
more than 300 homeless women veterans in securing employment. Minority veterans comprise more than 75% of the homeless
veterans served in Puget Sound. WDVA provides services to minority veterans through client services contracts with Tribal Veterans
Representatives, National Association of Black Veterans and the African-American PTSD Association.


WDVA provides fiduciary services to over 700 incompetent veterans through the Veterans Estate Management Program. These
services manage monetary entitlements and ensure clients remain safe, secure and are not subject to the evils of street life. This
program will provide services to certain incarcerated veterans and will conduct outreach to Operation Iraq/Enduring Freedom
veterans.




VA FORM
JAN 2003
                  10-0361-CG                                       Applicant Page Number is: ________           CG First Submission - 30
9. Ability (cont.):
G. Describe the experience of your organization in monitoring and evaluating individuals' progress in
meeting personal goals; (Please answer in the space provided below.)
  WDVA 's history of providing services through grant funding and requirements of reporting outcomes, have created a cadre of
  staff experienced in establishing case plans, assessments, case management services and monitoring client progress. WDVA case
  management process includes: assessing needs, barriers and skills of partipants, assisting participants in creating individual case
  plans and goal setting, and monitoring participant's progress, coordinating support services, and conducting outcome assessments.
  Case plan process also includes periodic follow-up activities to assess progress of participants and results of services provided at
  90-180 day marks.

  In addition, WDVA has seven MSW 's on staff that routinely monitor and evalauate progress of over 600 individuals in domicillary,
  light, and skilled nursing environment. Many of these have mental health and substance abuse issues, physical disabilities, and
  suffer from lack of life skills or abilities to manage their own affairs. The WDVA model has strength in providing case
  management services.




H. Describe the experience of your organization in evaluating overall effectiveness of programs and using the
evaluation to make improvements; (Please answer in the space provided below.)
  WDVA has 15 years of grant experience with homeless veterans employment and training programs with DOL-VETS. HVRP is a
  performance based contract that monitors performance on a quarterly basis. Successful performance is gauged to be at plus or
  minus 15% of goal. If performance is under 15% of goal, or in some cases 15% over goal a corrective action plan is required. We
  have extensive experience in collecting data, monitoring performance, making regular reports and analyzing the information to
  make adjustments to services as needed and required by agreement.

  As a cabinet level state agency we are required to maintain a level of competency in financial and programmatic performance. We
  have an outstanding track record in all regards.




I. If applicable, describe the experience of your organization in operating a rental assistance program;
(Please answer in the space provided below.)
   Although WDVA has supported homeless veterans with rental assistance through HVRP since 1987, the agency has no direct
  experience operating a rental assistance program or in conducting property management. We have, on numerous occasions,
  contracted out for this service.




VA FORM
JAN 2003
                 10-0361-CG                                 Applicant Page Number is: ________             CG First Submission - 31
9. Ability (cont.):
J. For those applications involving operation/maintenance of a housing facility, describe the experience of
your organization in operating housing for homeless persons.
(Please answer in the space provided below.)

  WDVA has no experience in direct property management of transitional housing for homeless veterans. However, WDVA has
  provided domiciliary care for homeless veterans in state veterans homes for over 100 years.

  WDVA Veterans Services Division has provided funding for operation/maintenance of a homeless transitional housing model in
  Walla Walla since 1999 through contract with Valley Residential Services. This model provides transitional housing for "Phase-2"
  clients of the Walla Walla HCHV transitional housing program. From 1996 through 1998, WDVA contracted with the Veterans of
  Foreign Wars for transitional housing services and a house manager for a homeless veteran’s house operated by Blue Mountain
  Action Council in Walla Walla. From 1996 to 1998 we contracted with Vietnam Veterans of America for management of 3
  homeless veteran houses in Moses Lake, Washington. Both of these projects provided case management , trauma counseling, VA
  claims services, and employment /training services.

  In addition, WDVA has supported community organizations with funding for homeless housing projects. For example, WDVA
  was a sponsor of the Comprehensive Mental Health Services homeless veterans house in Yakima and the following year supported
  funding for a van to serve the participants of this VA Grant & per Diem funded project.

  Although, WDVA has no direct property management experience, we have ample experience and knowledge in facilitating and
  financially supporting homeless veterans housing programs.




K. For those applications involving rehabilitation or new construction, describe the experience of the
organization in contracting for or overseeing the rehabilitation or construction of housing.
(Please answer in the space provided below.)
  WDVA recently completed construction of a new $47 million 240-bed state veterans home on schedule and within budget. This
  project was funded through the VA State Homes Program, another 65/35 match opportunity. WDVA staff were intimately
  involved in the concept, design, legislative process, contracting, construction, and project management.

  Currently, WDVA is in the process of constructing a new kitchen facility at the Spokane Veterans Home, another VA State Home
  Program funding opportunity. This facility is an addition to an existing structure and WDVA staff are intimately involved in the
  overall project management.




VA FORM
JAN 2003
                 10-0361-CG                                      Applicant Page Number is: ________         CG First Submission - 32
10. Coordination with other Programs:
       Please provide a description of each of the following in the box space provided:

A. How was the planning of this program coordinated with other organizations that assist the homeless. List
the primary agencies with which you work that serve homeless veterans. Describe the nature and duration of
your relationship with them. (Please answer in the space provided below.)
 WDVA has collaborated services with the VA Medical Centers in Washington since 1976. We have met several times with
 VAPSHCS HCHV staff and discussed client needs, employment support and safe secure transitional housing for the past six years.
 We have participated in continuum of care meetings and community gap analysis surveys. We review the CHALENGE reports
 annually and have provided a comprehensive plan to support HCHV programs in the past. Since 1998 WDVA has supported VA
 Medical Center HCHV programs in Washington state with more than $300,000 of General Fund State revenue to support needed
 services identified through the CHALENGE process. These services have included money to provide dental, eyeglasses,
 transportation, legal expenses, child care, vehicle repair and employment support.




B. How will program operations be integrated with existing services in the community (i.e., nonprofit
organizations and governmental entities, including VA medical facilities, VA regional offices, and your
VISN). (Please answer in the space provided below.)
 The WDVA will assume the responsibility of networking and collaboration with VAPSHCS to coordinate and arrange for outreach
 and referral services to support this transitional housing model. Services will be coordinated with the many VA clinical service
 programs to include Domiciliary Care for Homeless Veterans (DCHV), Health Care for Homeless Veterans (HCHV), CWT,
 Transitional Residence (TR) program and VA Supportive Housing (VASH). Services and referrals will be coordinated with the
 Homeless Women’s Project (HWP) and all HCHV programs that are provided within the State of Washington VAMC network to
 include Walla Walla, Spokane and Vancouver (Portland, Oregon).

 There are five VET Centers in the State of Washington and we will promote the availability of services to them.

 WDVA will coordinate homeless veterans’ transitional housing services within the VA Regional Office in Seattle. We will meet
 regularly with the Homeless Coordinator (Cindy Green) and coordinate services as needed. The VR&E program will be a unique
 piece of our model. Eligible homeless veterans enrolled in Chapter 31 will be afforded the opportunity to reside in our transitional
 housing model while they are engaged in training and/or educational programs. Our agency will interview homeless veterans and
 assist them to develop claims for disability. Claims that are developed will be expedited for rating through the VARO homeless
 veteran coordinator.




VA FORM
JAN 2003
                10-0361-CG                                  Applicant Page Number is: ________            CG First Submission - 33
10. Coordination with other Programs (cont.):
C. Attach here any VA or other coordination letters you have received in support of this project.




D. Describe your involvement in VA-community networking for homeless veterans (e.g., Community
Homeless Assessment and Local Education and Networking Groups (CHALENG) for Veterans). Who is
your closest VA Medical Center or VA Regional Office CHALENG Point of Contact with whom you have
networked? (If you have not networked with your CHALNG Point of Contact, see the CHALENG Contact Person List in the
appendix and please contact him or her.) (Please answer in the space provided below.)

  WDVA has supported VA homeless veterans services in the state for years. We have been a working partner since the original
  Homeless and Chronically Mentally Ill (HCMI) program in 1988. In some areas we have been more successful than others. For
  example, we have collaborated with Chris Oliver, Walla Walla HCHV since 1988 and have had numerous successes with him and the
  HCHV program. Under contract services we were able to support the Walla Walla model to expand it's capacity to where it currently
  provides four transitional houses in the immediate Walla Walla community and assisted them to open the veterans transitional house
  in Yakima, supporting the access of VA supported van for Central Washington Comprehensive Mental Health. We have had
  successes in the past supporting the VA HCHV programs in Spokane and Vancouver as well. Access to VAPSHCS medical services
  has been an issue in the past that we hope to improve. We are aware that a VA funded Communtiy Health Coordinator position has
  been approved for Puget Sound HCS and we believe this position will address and improve this very issue. There are many points of
  contact we utilize as part of our community network they include:

  Chris Oliver, HCHV VISN Coordinator and long term HCHV manager for Walla Walla. (509) 525-5200, ext.22690.

  Ann Shahan, Director Homeless Veterans Care Line, American Lake VAMC. (253) 583-1672.

  Cindy Green, Homeless Veterans Coordinator for the Seattle VA Regional Office. (206)220-4186.

  John Davis, HCHV Coordinator for Spokane VAMC. (509) 462-2500.

  Laurence Brennan, HCHV Coordinator for VAMC Portland, Oregon (Vancouver Annex). (503)-220-8262, ext. 3376.

  Norm Wear, Grant and Per Diem Liaison, VAPSHCS. (253) 583-1634.




VA FORM
JAN 2003
                 10-0361-CG                                      Applicant Page Number is: ________        CG First Submission - 34
11. Site Description: (Please answer in the space provided below.)
A. Address of agency and address of site(s) (if different than agency address):
     Washington Dept of Veterans Affairs
     PO Box 41150
     Olympia WA 98504-1150

     Washington Veterans Home - Bldg 9
     1141 Beach Dr East
      Retsil WA 98378



B. Type of Housing:           Check the one box that describes the type of living situation for participants.


                                Dormitory                                        Shared apartment
                                Shared Bedroom                                   Single Family House
                                Single Room Occupancy                            Shared single family house
                                Apartment                                        Other (describe below)
                                               OR
                                The site does not involve housing


C. Housing Setting or Service Center Setting: (Please answer in the space provided below.)
                           1. Describe the neighborhood where the site is located (e.g., rural, urban, suburban;
                               residential or commercial; prevalence of single family or multi-family dwellings);

                                   2. How receptive the neighborhood residents are to a homeless facility; and

                                   3. The site’s accessibility to supportive services.

  Program site is located on the 32 acres of the Washington Veterans Home (WVH), located in a suburban setting surrounded by
  predominately single family homes.

  WVH has housed homeless and indigent veterans in a domiciliary setting since 1913 in this community.

  Emergency medical care is readily available from the WVH, where a staff physician or nurse practioner and nursing staff are on
  duty 24 hours per day.

  Kitsap County Transit System provides scheduled bus service to this area on a scheduled basis.

  The addition of a program van will provide transportation to and from community services, job search activities, meetings and
  appointments that are not readily accessible through public transportation services.




VA FORM
JAN 2003
                 10-0361-CG                                Applicant Page Number is: ________            CG First Submission - 35
11. Site Description (cont.):     (Please answer in the space provided below.)

D. Photograph: Attach a photograph of the site clearly showing the main entrance of the building(s) in the space
   provided below.

Attached




E. Environmental: Check any of the boxes that describe the site.

           On Historic Register                                        Has high noise level
           In flood plain                                              Near railroad/airport
           Has hazardous waste                                         Asbestos
           Adjacent to major highway                                   Lead-based paint
           Other potential problem (describe below)


It is suggested that you verify that your property is not on the state or local Historic Register before making
any cost estimates as this could impact your projected budget.


VA FORM
JAN 2003
              10-0361-CG                                  Applicant Page Number is: ________   CG First Submission - 36
   11. Site Description (cont.):

F. Current Occupants:

        For proposals involving acquisition, rehabilitation, or demolition (with or without VA funds), fill in the chart
        below. Applicants who enter a number greater than zero in the "Total Number of Units Occupied" box
        must submit with this application (on not more than 2 double spaced typed pages) reasons for using units at
        this site that are occupied, and a plan for providing relocation assistance. (Then attach here.)

                  Type of Units                      Total Number of Units Occupied at Application Submission
           Dwelling                              0
           Non-residential                       0

        Warning: If any units are occupied (regardless of lease arrangements), there may be a need for relocation assistance under the
        Uniform Relocation Assistance and Real Property Acquisitions Policies Act of 1970 (42 U.S.C. 4601-4655). Costs associated
        with relocation assistance are operational costs, and as such are not allowable costs to be funded through the grant.



G. Demolition Plan

All Applicants who include the cost of demolition of a building in the cost of construction must submit in the space
below a demolition plan, which includes the extent and costs of existing site features to be removed. Attention: The
cost of demolition cannot be included in the cost of construction unless the proposed construction is in the same
location as the building to be demolished or unless the demolition is inextricably linked to the design of the
construction project. (Please answer in the space provided below.)

  N/A




VA FORM
JAN 2003
                 10-0361-CG                                Applicant Page Number is: ________            CG First Submission - 37
 12. Site Design and Cost Estimates: (Please answer in the space provided below.)

   A. Proposed Schematics: Submit one set of schematic line drawings showing the basic layout of the
       proposed site as it would be following new construction, acquisition, remodeling, or renovation. Show total
       floor and room areas, designation of all spaces and size of all areas and rooms. It is not necessary to show
       mechanical systems detail in the schematic drawings. (Attach here)

   B. Existing Buildings: If the project involves acquisition, remodeling or renovation submit one set of
       schematic line drawings showing the current as-built layout of site. Show total floor and room areas,
       designation of all spaces and size of all areas and rooms. It is not necessary to show mechanical systems
       detail in the schematic drawings. Include a description (on not more than 2 double-spaced typed pages) of
       the buildings current use and type of construction. (Attach here after B)

   C. Cost Estimate: Complete Standard Form 424C, Budget Information - Construction Programs, located
       in the Forms section of this book. Note: After VA initially obligates funds for new construction, acquisition,
       remodeling or renovation, VA will not make revisions to increase the amount obligated. (Attach here after
       C)




13. Assurances:

       There are several assurance forms, which need to be completed. IMPORTANT: Please ensure that you
have completed all assurances to VA in the requested format. If you fail to do so it may result in the rejection of
your application at the threshold review. All applicants must provide the assurances listed below to VA. For items
A through I, please complete the necessary blocks and sign where appropriate. For Items J through O, you must
document these resources on letterhead stationary in the appropriate format described below. Construction
programs must also complete Standard Form 424D Assurances Construction.


        NO OTHER FORMAT WILL BE ACCEPTED AS EVIDENCE OF A FIRM COMMITMENT.




VA FORM
JAN 2003
               10-0361-CG                              Applicant Page Number is: ________   CG First Submission - 38
 13. Assurances (cont):

 All applicants must agree to the following assurances to VA as described below. No other format will be accepted as
 evidence of reasonable assurances. Warning: Section 1001 of Title 18 of the United States Code (Criminal Code and
 Criminal Procedure) shall apply to these assurances. Section 1001 of title 18 United States Code provides, that whoever
 knowingly and willfully makes or uses a document or writing containing any false, fictitious, or fraudulent entry, in any
 matter within the jurisdiction of any department or agency of the United States shall be fined not more than $ 10,000 or
 imprisoned not more than five years, or both.



A. Services Benefiting Veterans
If this proposal is funded applicant assures that upon completion           D. Continued Financial Support
of the project:                                                             If this proposal is funded, applicant assures that adequate financial
                                                                            support will be available for the continued maintenance, repair
1.    Programs so funded will be used principally to furnish to             and operation of the project or van funded by VA.
      veterans the level of care for which the application was made
      at locations accessible to homeless veterans;                         E. Fiscal Control
2.    Vans so funded will be used principally for the purpose of            If this proposal is funded, applicant assures that it will establish
      providing supportive services to homeless veterans;                   and maintain such procedures for fiscal control and fund accounting
3.    Not more than 25 percent of participants at any one time will         as may be necessary to ensure proper disbursement and accounting
      consist of participants who are not receiving such services as         with respect to the grant.
      veterans;
4.    Services provided will meet standards prescribed by the               F. Non-Delinquency
      Secretary of Veterans Affairs;                                        This institution certifies that it is not delinquent on any Federal Debt
5.    Referral networks will be maintained for, and aid will be             and does not have any overdue or unsatisfactory response to an audit.
      given to, homeless veterans in establishing eligibility for           Applicant, further assures that is not in default by failing to meet the
      assistance and obtaining services under available entitlement         requirements of any previous assistance from VA.
      and assistance programs;
6.    Confidentiality of records pertaining to homeless veterans            G. Accuracy of Application Information
      will be maintained in accordance with applicable laws,                All information submitted with this application is accurate, and
      Federal, State, and Local, (e.g., HIPAA, Privacy Act).                does not contain any false, fictitious or fraudulent statement or
                                                                            entry.
B. Reports; Record Retention
If this proposal is funded, applicants assure that any and all              H. Applicant Cash Resources.
reports required by the Secretary of Veterans affairs shall be made         If this proposal is funded, applicant will commit $170,807
in such form and contain such information as the Secretary may              of its own funds for renovation of building and acquisition of van
require. Applicant further assures that upon demand, the Secretary          to be made available to the VA Homeless Providers Grant and Per
of Veterans Affairs has access to the records upon which such               Diem program. The funds will be available on 1/1/2006.
information is based.
                                                                            I. Compliance
C. Title to Vest with Grantee                                               Applicant assures that it will comply with applicable requirements
If this proposal is funded, applicant assures that title to vans            of 38 C.F.R. Part 61.
and/or sites constructed, acquired, expanded, remodeled and/or
altered with grant funds, will be vested solely in the applicant.

       Signature of Authorized Certifying Official Title                                                            Date Submitted


       Applicant Organization                                                                                       Date

     Washington Department of Veterans Affairs




 VA FORM
 JAN 2003
                      10-0361-CG                                 Applicant Page Number is: ________           CG First Submission - 39
13. Assurances (cont):


NOTE: THESE ASSURANCES MUST BE COMPLETED ON LETTERHEAD STATIONARY OF THE DONOR.

             NO OTHER FORMAT WILL BE ACCEPTED AS EVIDENCE OF A FIRM COMMITMENT.


J. Third Party Cash.                                                      N. Contribution of a Building to be Acquired at Below Market
                                                                              Value (maintain documentation of fair market value on
If this proposal is funded,        will commit $    to       for              file).
        to be made available to the VA Homeless Providers Grant and
Per Diem program. These funds will be made available on          .        If this proposal is funded,        commits the building at
                                                                          for the VA Homeless Providers Grant and Per Diem program.
K. Third Party Non-Cash Resources.                                        The building is not now being used as a homeless facility. The
                                                                          building has a fair market value of $       . An appropriate
If this proposal is funded,       will commit to make available           independent third party made this assessment which is based on
        valued at $       to the VA Homeless Providers Grant and          comparable properties in the area. The full purchase price of the
Per Diem program proposed by            . These resources will be         building is $        Therefore, the contribution is the difference
made available to the VA Homeless Providers Grant and Per Diem            between the fair market value and the purchase price, or $         .
program from           to       .
                                                                          O.Contributed Materials.
L.Volunteer Time:
                                                                          If this proposal is funded,    commits       for the VA
If this proposal is funded,        commit to provide        hours of      Homeless Providers Grant and Per Diem program. The estimated
volunteer time to provide          to the VA Homeless Providers           value of this material is $  .
Grant and Per Diem program proposed by
         The value of these services is $     based on a rate of
        .

M. Contribution of a Building (maintain documentation of fair
    market value on file).

If this proposal is funded, WDVA pledges the building at
Washington Veterans Home, Retsil WA to the VA homeless facility.
The building has a fair market value of $     . An appropriate
independent third party made this assessment which is based on
comparable properties in the area.




VA FORM
JAN 2003
                  10-0361-CG                                       Applicant Page Number is: ________           CG First Submission - 40
                                            Application Assembly Checklist
       Place your application in the order of the checklist below and list the page numbers in sequence on both
the application and on this checklist. The checklist will serve as your Table of Contents for your application
package. A page number box is at the bottom center of each application page. On documents you have
provided (i.e., assurances, resumes, etc.,) please place these documents in their proper order as directed in the
application (i.e., Attach Here) and number them in sequence. When finished your application should be
sequentially numbered, beginning at the first page and continuing through the last one submitted.
                       Included Items                           VA Page Numbers                     Applicant
                                                                                                    Page Number
Application for Federal Assistance (Standard Form 424)                   Located in Forms Section
Application Receipt Form (VA Form 10-0361A)                              Located in Forms Section
Application Assembly Checklist                                           First Submission – page 41
Applicant Summary - - First Submission                                   First Submission - page 1
Veterans Integrated Service Network                                      First Submission - page 1
Eligibility to Receive VA Assistance - - First Submission                First Submission - page 1
Project Summary - - First Submission                                     First Submission – pages 2 through 5
                   a. Target Populations
                   b. Innovation of Project
                   c. Beds & Bedroom Breakdown
                   d. Existing Project Narrative
Major Milestones (Timeline) - - First Submission                         First Submission - page 6
Budget and Leveraging - - First Submission                               First Submission - page 7
                    a. Budget Summary
                    b. Leveraging Summary
Description of Need - - First Submission                                 First Submission - page 8-9
Targeting - - First Submission                                           First Submission - pages 10 through 14
                     a. Settings
                     b. Description of Otherwise Homeless
                     c. Outreach Plan
Project Plan - - First Submission                                        First Submission – pages 15 through 28
                     Areas 1 through 8
Ability - - First Submission                                             First Submission – pages 29 through 32
                    a. Resumes of personnel
                    b. Questions B though H (required) and I through K
                         if applicable
Coordination with other Programs - - First Submission                    First Submission – pages 33 & 34
                     a. Questions A, B, D
                     b. Question C Letters of Support
Site Description - - First Submission                                    First Submission – pages 35 through 37
                     Areas A through G
Site Design and Cost Estimates - - First Submission                      First Submission – page 38
                     a. Areas A through D
Assurances - - First Submission                                          First Submission – pages 39 & 40
                      Areas A through I
                      Areas J through O on Letterhead Stationary
OMB Forms -- Section D                                                   Located in Forms Section
                     a. Standard Form 424A, Non-Construction Budget
                          (if applicable)
                     b. Standard Form 424B, Non-Construction
                          Assurances (if applicable)
                     c. Standard Form 424C, Construction Budget
                     c. Standard Form 424D, Construction Assurances



VA FORM
JAN 2001
                  10-0361                              Applicant Page Number is: ________                   First Submission -41

				
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