Please complete one survey for each project application you plan to submit.

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* 1. First Name

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* 2. Last name

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* 3. Title

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* 4. Organization

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* 5. Street Address

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* 6. City

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* 7. Zip

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* 8. Counties served

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* 9. Email address

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* 10. Phone Number

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* 11. What is the name of your project?

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* 12. Please provide an overview of your project

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* 13. What is the program model for this project?

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* 14. Please identify the populations to be served through this project.

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* 15. Please indicate the number of units you anticipate funding through this project

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* 16. How does your organization address the safety needs of domestic violence, dating violence, sexual assault and stalking survivors?  How do you maximize their safety and confidentiality?

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* 17. How do you coordinate with public housing authorities?

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* 18. If you are a permanent housing project, how do you assess whether participants are ready to transition to affordable housing without the supports provided in PSH?

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* 19. How does your your organization address the needs of lesbian, gay, bisexual, transgender (LGBT) participants?

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* 20. Does your organization house families as an intact unit or separate them by age/gender or other policies?

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* 21. Do you partner with early childhood providers?  Do you have any formal agreements?

  Partnership Formal Agreement Not applicable
Head Start
Private Day Care Providers
School District Preschool

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* 22. Does your organization use a housing first philosophy?

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* 23. Explain how your organization affirms fair housing and ensures that discrimination does not occur in your service provision.

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