2017 ND Continuum of Care  
Pre-Application & Threshold Assessment
Any new project wishing to apply for Department of Housing and Urban Development (HUD) Continuum of Care (CoC) funding in the 2017 FY HUD CoC competition must complete the following information and submit to the CoC by the August 16, 2017. Your project will not be eligible to apply in the FY17 competition if you do not submit this form by the deadline. Please complete the proposed project overview and review each of the following ranking categories, marking those questions that apply to your project.   
_________________________________     ________________________________
Name of Agency                         Name of Project
_________________________________     ________________________________
Primary Contact                         Contact Email
_________________________________     ________________________________
DUNS #                              SAM # 
Intent to Apply:  
  Our agency intends to apply for funding in the 2017 HUD CoC Competition. (complete all questions, sign and return to april@ndhomelesscoalition.org) 
1.    The project component is:      PSH: Chronic/Not Chronic    RRH         TH       ES
2.    Amount of funding requested $
3.    Brief Project Description): 
Coordinated Assessment & Referral  
  The applicant agrees to participant in Coordinated Assessment & Referral including: 
•    Filling all beds/units through the central prioritization list & process
•    Abiding by CoC Coordinated Assessment policies & practices
CoC Participation
 The applicant agrees to regularly attend CoC meetings and participate on a committee.  The applicant agency agrees to provide project level data to the CoC by: 
a)    Participating in the annual point-in-time sheltered and unsheltered count; 
b)    Submitting program reports to the CoC in a timely manner;  
c)    Participating in an annual CoC Planning, Gaps Analysis and Needs Assessment; 
d)    Submitting required AHAR, HIC, and GIW reports by CoC deadlines; and
e)    Giving the Local System Administrator administrative access to your all programs reported in the HIC or providing necessary waiver request to CoC and submitting required data in a timely manner.  
 Applicant does NOT currently utilize HMIS and does not intend to if funded. (Note this will affect your eligibility if not a VAWA funded agency) 
 Applicant does NOT currently utilize HMIS, but agrees to utilize if funded. 
 Applicant currently utilizes HMIS and assures compliance with HMIS requirements  
Services (TH, RRH and PSH Applicants): 
Please check ALL that apply to your program:  
•    Applicant assures that program will have and follow policies that ensure all children are enrolled in school and connected to appropriate services within the community
•    Applicant assures that case managers will systematically assist and support clients in completing applications for mainstream benefits. 
•    Applicant assures that transportation assistance is provided to clients to attend mainstream benefit appointments, employment training, or job when appropriate. 
•    Homeless assistance providers use a single application form for four or more mainstream programs. 
•    Applicant agrees that all participants will come from the streets, emergency shelter, transitional housing (entering as homeless), institution, or place not meant for human habitation.  
•    Applicant incorporates known best practices models into project policies and practices. Check all that apply: 
o Housing First
o Client Centric
o Barrier Free
o Harm Reduction
WARNING:  HUD will prosecute false claims and statements.  Conviction may result in criminal and/or civil penalties (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) 
Print Name of Agency Approved Signatory: 
     Signature of Agency Approved Signatory