ESG Contact Information and Services Provided

1. Contact and Service Information for 2013 ESG Subrecipients

 
The Texas Department of Housing and Community Affairs (the Department) is requesting 2013 Emergency Solutions Grants (ESG) Subrecipients to complete a survey which collects contact information for each ESG agency and specific information on the services to be provided with ESG funds during the contract period October 1, 2013 - September 30, 2014.

Each agency must submit only one survey. For collaborative subrecipients, only the lead agency should complete the survey. The Department will use the information collected to refer clients to the ESG services being offered and will post the information on its ESG website for Subrecipients to access it as well.

Deadline: Friday, Septmeber 6, 2013 at 5:00 p.m.

Questions: For questions related to this survey, please email Sharon Gamble at sharon.gamble@tdhca.state.tx.us or call her at 512-475-0471.
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1. Organization Information:
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2. Are you a single or collaborative Subrecipient?
3. If you are a collaborative Subrecipient, list the names of the partner agencies:
4. Check all the descriptions applicable to your agency(ies):
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5. Executive Director Information:
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6. ESP Program Contact Person (main person to be contacted with ESG questions)
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7. Board Chair Information:
(For cities or counties, please complete the information for County Judge or Mayor)
The contact information for Board Members is for internal use only and will not be published.
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8. Name(s) of Service Area(s) to be Served with ESG funds
(i.e. "____ city limits" or "all of ____ County"):
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9. Indicate the Target Population(s) to be Served - check all that apply:
For questions 9-12, refer to the Guide on Eligible ESG Uses for a description of what each activity encompasses.
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10. Indicate the Street Outreach services to be provided with ESG funds:
(In the case of collaborative Subrecipients, check all the services offered by all partners)
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11. Indicate the Emergency Shelter Services to be provided with ESG funds:
(In the case of collaborative Subrecipients, check all the services offered by all partners)
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12. Indicate the Rapid Re-Housing services to be provided with ESG funds:
(In the case of collaborative Subrecipients, check all the services offered by all partners)
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13. Indicate the Homelessness Prevention services to be provided with ESG funds:
(In the case of collaborative Subrecipients, check all the services offered by all partners)
Thank you for taking the time to complete this survey.
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