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wralar_1Z! Z!II.Y_Irl k1k <br />Proaram /Project Description (Label your responses as outlined below; not to exceed 3 pages.) <br />Please provide the following information about the proposed program /project: <br />See attached <br />b) Summarize the program services proposed and how the program will address the chosen <br />Town /County priority? <br />c) Describe the local need or problem to be addressed in relation to the Consolidated Plan or <br />other community priorities (i.e. Council /Board Goals). Cite local data to support the need <br />for this program and the population being served. <br />d) Describe the population to be served or the area to benefit and indicate how you will <br />identify beneficiaries. <br />e) Who specifically will carry out the activities and in what location will they be carried out? <br />f) Describe specifically the period over which the activities will be carried out, the frequency <br />with which the activities will be carried out, and the frequency with which services will be <br />delivered. Include an implementation timeline. <br />g) Provide a bulleted list of other agencies, if any, with which your agency <br />coordinates /collaborates to accomplish or enhance the Projected Results in the Program(s) <br />to be funded. For each, give specific examples of the coordinated /collaborative efforts. <br />h) Describe what would happen if requested funding is not awarded at all or if a reduced <br />allocation is recommended. <br />i) Include any other pertinent information. <br />Proaram /Protect Information <br />j) Complete the Target Population and Program Beneficiary Demographics Chart <br />k) Complete the Schedule of Positions Chart for Program Staff <br />1) Disclosure of Potential Conflicts of Interested must be signed <br />m) Complete the Work Statement Chart to describe the work to be performed, and be sure to <br />attach copies of all data collection tools that will be used to verify achievement of program <br />goals and objectives. Describe who will be responsible for monitoring progress. <br />Information to Complete <br />j.) Target Population <br />Complete the following tables to the best of your ability. Show numbers of participants and <br />percentages, as applicable, in each category. <br />Please indicate whether this project/program will serve: ❑ Persons ❑ Households ❑ Units <br />Program: <br />1= Proaram Beneficiary Demoaraohics I <br />Actual I Estimated I Projected <br />2014 -15 1 2015 -16 1 2016 -17 <br />Male <br />50 <br />60 <br />65 <br />Female <br />63 <br />96 <br />103 <br />Total <br />113 <br />156 <br />168 <br />Of the females, how many are single - <br />female Head of Households (Omit for <br />Human Services) <br />Main Application 1/25/2016 11:36:35 AM Page 6 of 16 <br />