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4 <br /> pL <br /> -:EMERGENCY SHELTER GRANTS PROGRAM <br /> REHABILITATION ACTIVITIES FORM <br /> A separate form should be filled out for each subrecipient. See pages 1 to 3 of <br /> the Application Guidelines for discussion of eligible activities, ineligible <br /> activities and federal restrictions. Instructions for filling out this form are <br /> found on pages 10 and 11 of the guidelines. <br /> A. Name of Applicant: Orange County (Local Government) <br /> B. Name of Shelter: Inter-Faith Council Community Shelter • <br /> C. Name of Organization: Inter-Faith Council for Social Services <br /> D. Is the shelter located in a historic district? <br /> Yes No x <br /> E. Is the shelter located adjacent to a historic district? <br /> Yes x No <br /> F. Is the shelter located in a building built before 1945? <br /> Yes . x No <br /> 1. Amount requested for Rehabilitation: $45,000 <br /> 2. What kind of rehabilitation is to be performed with ESGP funds? <br /> Mark checks beside all applicable activities on page 113-2. <br /> Renovation? x <br /> Major Rehabilitation? <br /> Conversion? <br /> 3. Estimate and briefly explain the impact of ESGP-assisted rehabilitation <br /> on your organization's assistance to the homeless. Please include persons <br /> served and level of service provided where possible. <br /> Meet Code x Expand services x <br /> Improve facilities x Other (specify) <br /> ESGP rehabilitation assistance will enable the shelter to expand their <br /> bed capacity to 56 persons. It will also allow the combination of the <br /> shelter and the kitchen in one building. Presently, the Community Kitchen <br /> and the Shelter are n two different locations. <br /> 4. Do you own your facility? <br /> Lease your facility? x <br /> • <br /> Other? <br /> ESGP #113-1 (3/89) <br />