Emergency Shelter Grant Program is a grant opportunity in Clackamas County, Oregon, that funds nonprofit organizations providing emergency food and shelter services to individuals in need. Under the Emergency Food and Shelter Program (EFSP), local nonprofit and government agencies can apply for funds to provide food, shelter, rent and mortgage assistance, and related emergency services.

Eligible applicants must be nonprofit or government agencies with a 501(c)(3)-compliant accounting system, a voluntary board, demonstrated capability to deliver emergency food and shelter programs, and a commitment to nondiscrimination. Minimum application budget requests are $5,000.

Emergency Food and Shelter Program Application – Phase 40 Page 1 # Emergency Food & Shelter Program ## Application for Phase 40 Funds [Minimum $5,000 Application Budget Request] Amount Eligible in Phase 40 Allocation Food Shelter Off Site Clackamas $146,843 50% $73,421 0% 0 0% 0 50% $73,422 $ 146,843 Multnomah $406,537 25% $101,634 48% $195,138 15% $60,981 12% $48,784 $ 406,537 Washington $221,721 0% 0 20% $44,344 0% 0 80% $177,377 $ 221,721 WA $237,405 20% $47,481 30% $71,222 0% 0 50% $118,703 $237,405 Spending period: November 1, 2021 – December 31, 2023 (Expenses may be back dated to 11/1/21.)

Agency Name: ____________________________________________________________________ Program: _________________________________________________________________________ Address: ________________________________________________________________________ City: ____________ _________ State: _______ Zip:____________ Phone: ______________________ Fax: ___________ E-mail: ____________________________ UEI number: (required by EFSP to app ly) ____________________________ Emergency Food and Shelter Program Application – Phase 40 Page 2 I.

ORGANIZATIONAL INFORMATION A. ☐ Non -profit (New applicants must attach a copy of their 501(c)(3) letter.) (Note: Agencies must apply separately for each county to be served.)

C. Type of assistance you plan to provide: D. ☐ Date of last audit or financial review ___________________ If not availab le, please explain Emergency Food and Shelter Program Application – Phase 40 Page 3 II.

PROGRAM DESCRIPTION (additional pages may be attached) Under the terms of the grant from the National Board, local governmental or private voluntary organizations chosen to receive funds must: 1) be a nonprofit or government agency, 2) have a 501(c)3 compliant accounting system, 3) practice nondiscrimination, 4) have demonstrated the capability to deliver emergency food and/or shelter programs, and 5) if a private non -profit organization, must have a voluntary board .

The following sections provide an opportunity for your organization to demonstrate how it meets these requirements.

Please note that assistance from funds provided by this program must be provided to needy individuals without discrimination (age, race, sex, religion, national origin, disability, economic status or sexual orientation) In providing assistance under the EFSP, verification of proof of citizenship or qualified alien status of any applicant for assistance is not requ ired.

Any agency participating in distribution of funds from this source must have a system to ensure that no duplication of payment occurs within the expenditure category of rent/mortgage assistance. Agencies that are selected must comply with the proce ss for verification of single -event assistance as specified by the Emergency Food & Shelter Program Board.

Applicants are required to review the Emergency Food and Shelter National Board Program Responsibilities and Requirements manual found at http://www. efspsd. org/efsp -manual.

html and 1. Non -profit, experience of organization, scope of work Please describe your organization and how it meets the requirements for this program. Provide information that demonstrates the agency is a fiscally accountable 501(c) 3 and capable of tracking these allocations.

2. Geographic diversity within the Co unty, access to services by underserved communities Within the boundaries of the county checked above, define specific geographical areas and or underserved communities your program serves? Emergency Food and Shelter Program Application – Phase 40 Page 4 3.

Populations served/Culturally Appropriate Service Delivery Census data shows Black, Indigenous and people of color (BIPOC) and the LGBTQ+ community are overrepresented in poverty statistics, including housing and food insecurity. ● Please provide a demographic profile of your current client base receiving services (i.e., racial/ethnic/cultural diversity, LGBTQ+ community, families with children, homeless, etc.).

If you do not track this data, please provide a reason why or what efforts can be ● Please describe your efforts to address racial and/or other inequities in housing and ● How do you outreach to these historically underserved populations? 4.

(a) Demonstrated Service Delivery (housing and/or shelter) If applying for housing or shelter, describe your organiza tion’s success in providing homeless (b) Demonstrated Service Delivery (food) If applying for food, how is your organization successful in distributing food and/or meals that serve the diverse needs of the community? Explain how EFSP funds will be used to supplement an existing program.

The agency must not depend solely on these funds to provide the service. Amount of funds requested is reasonable for the service provided and the number of individuals/households to be served. Emergency Food and Shelter Program Application – Phase 40 Page 5 III.

SERVICES TO BE PROVIDED (Complete for each program category you are applying for only. Administrative funding is an optional EFSP category up to 2% of the EFSP funding requested.)

## Served Meals Meals ($ 3 per) ## Rent/Mortgage # Bills/Orders I, ______________________________________, representing __________________________ agency have reviewed and understand the Emergency Food and Shelter Program responsibilities and requirements as outlined in the manual.

Name of Agency Authorized Signature Date Name and Title (typed) One (1) hard copy or electronic (*preferred) copy of this Application with signature must be postmarked or received no later than 4:00pm on Friday, May 19, 2023 . Send by U.S. Mail or email* to your County Representative listed below. Note: Applicant is responsible to verify receipt of the application.

County Representative Email Phone Clackamas Teresa Christopherson Clackamas County Social Services Teresachr@co. clackamas. or.

us 503 -650 -5718 Multnomah County Joint Office of anna. pendas@multco. us 503 -348 -3908 Washington Katherine Galian Washington County Dept.

of Housing 111 NE Lincoln Street, #200 -L, MS 63 Hillsboro, OR 97124 -3082 Katherine_Galian@washingtoncounty Clark Co, WA Laura Ellsworth lellsworth@councilforthehomeless. or