Project Application

Project Application

HomeAid Utah builds and renovates housing facilities for organizations serving people experiencing or at risk of homelessness in the state of Utah. Over our 7-year history, projects average a fifty-percent in-kind donation rate, a substantial construction cost savings.
Section 1: Organization Information
Name of person submitting request:*

First NameLast Name
Professional Title:*
Title
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Name of Organization*
Name of Organization
Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Today's Date*

MonthDayYear
Date
Organization Phone
Please enter a valid phone number.
Organization Website*
www.website.com
Chief Paid Executive Information*
Chief Board Officer Information*
Please upload a copy of your current Board of Directors roster.*

Board of Directors Roster
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Number of people on Board of Directors:*
Number of directors making financial contribution during the last fiscal year:*
Total of director's financial contributions during the last fiscal year:*
Please upload a copy of your most recent audited financial statement:*

Financial Statement
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Please upload a copy of your current year budget:*

Current Year Budget
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Please upload a copy of your year to date with actuals:*

Year to Date with Actuals
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Optional: Attach other documents you feel would be helpful for our evaluation ‑‑ e.g. annual report, organization newsletter, brochures, etc. (up to five documents)

Other Documents
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Population Served:*

Abused ChildrenAdults - Substance AbuseAdults with AIDSAdults with DisabilitiesChildren & YouthChronic HomelessDevelopmentally DisabledDomestic Violence VictimsFamiliesHuman Trafficking VictimsKinshipLGBTQ+MenOlder Adults/SeniorsPregnant Minors and their childrenReentry/Second ChanceSex Trafficking VictimsVeteransWomenYoung Adults 18-22Youth with Disabilities
Support Services Provided:*

Addiction RehabilitationCase ManagementChildcareEducationEmployment AssistanceHIV/AIDs-related servicesHousing PlacementLegalLife Skills (aside from case management)Mental Health ServicesOther Health Care ServicesOutreachTransportation AssistanceOther
Number of Volunteers per year:*
Volunteer hours received last year (estimate):*
Percent of clients gaining self-sufficiency through your program last year (if applicable):*
How many clients do you serve yearly?*
Please check if you have the following insurance in place:

Auto InsuranceDirectors and OfficersErrors and OmissionGeneral LiabilityWorkers CompensationOther
Please attach a copy of your current insurance certificate(s).

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Section 2: Project Information
Name of Proposed Project*
Project Name
Project Address (if known):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Project Website (if applicable):
Project Email (if applicable):
Contact Person for Project*
Type of Project (check all that apply):*

Emergency (1 to 5 nights)Short Term Transitional (1 to 6 months)Long Term Transitional (7 to 24 months)Permanent SupportiveAffordable HousingSupport Program (Food Pantry, Training Program, etc)Other
How many beds will be added (or preserved) through project, if any?*
How many people will be served each year?*
How long do you expect clients to stay at the facility?*
Square footage of proposed project:*
Will clientele served be the same as selected above (population served)? If not, please list who you will serve.*
Please answer the following questions to the best of your ability. You are not required to have these in place at time of application.
Do you own or fully control the site?
If you control, but do not own the site, please explain:
Are all entitlements (other than building permit) in place for intended use?
Has the project gone through local planning department reviews?
Does the project require a variance or special use permit?
If you have site plans showing the building on the site, please attach here.

Site Plans
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If you have renderings/photos to share, please attach here.

Renderings/photos
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If you have an engineered site plan, please attach here.

Engineered Site Plan
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If you have architectural plans, please attach here.

Architectural Plans
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Have the plans been approved by all required local government agencies?
If you have received building permits, please attach here.

Architectural Plans
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Do you need help with architectural or engineering plans?
Estimated construction budget:
What percent of funding do you have?
How do you anticipate funding any additional programs/beds?
Please list the anticipated sources of revenue for the construction of the project:
What is the expected annual budget for the operation of the program(s) conducted at the project:
Section 3: Service Provider Covenants
Section 4: Certification
Signature*

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Thank you for your application! We look forward to speaking with you soon.

For questions or comments, please contact:

Lisa Wright | Executive Director

801-674-7524 | Lisa@HomeAidUtah.org
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Project Application

Section 1: Organization Information

Section 2: Project Information

Section 3: Service Provider Covenants

Section 4: Certification