Emergency Food and Shelter Program Funding Application

1Statement of Responsibilities

2Applicant Information

3Funding Request

4Budget Narrative

5Agency Narrative

6Authorization

URL

This field is for validation purposes and should be left unchanged.

Statement of Responsibilities

Which county are you applying for?(Required)

If you are applying for more than one county, please submit a separate application for each.

I certify that my organization:

Is a non-profit or agency of government
Is not debarred or suspended from receiving Federal funding
Has a checking account and can accept EFT
Has an accounting system or fiscal agent that will pay all vendors by an approved method of payment
Has a Federal Employer Identification Number (FEIN)
Has or will be able to attain a Unique Entity Identifier (UEI)
Has a valid email address for program communication and electronic signature processes
Has conducted or will conduct an independent annual audit if receiving $100,000 or more in EFSP funds
Has conducted or will conduct a yearly audit if expending $750,000 in Federal funds, in compliance wit the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards at 2 CFR 200 of the Office of Management and Budget (Uniform Guidance)
Provides services and uses other resources in the area in which I am seeking funding
Practices nondiscrimination (Agencies with a religious affiliation just not refuse services to an applicant based on religion or require attendance at religious services as a condition of assistance, nor engage in religious proselytizing or religious counseling in a program receiving Federal funds)
Have a voluntary board if private non-profit
To the extent possible, involve homeless individuals and families through employment, volunteer programs, etc., in providing emergency food and shelter services
Will comply with the program requirements as detailed on the EFSP website: https://www.efsp.unitedway.org/efsp

Our agency certifies that we have read and understand the Local Recipient Organization responsibilities listed above.(Required)

Please Initial

Our agency agrees to comply with all Emergency Food and Shelter Program requirements.(Required)

Please Initial

Applicant Information

Agency's Legal Name(Required)

Agency Principal (Board President or Executive Director)(Required)

First Last

Agency Principal - Phone Number(Required)

Agency Principal - Email(Required)

Agency Contact for EFSP Application and Grant (If Funded)(Required)

First Last

Agency Contact - Phone Number(Required)

Agency Contact - Email(Required)

Agency Physical Address(Required)

Street Address Address Line 2 City State ZIP Code

Agency Mailing Address (If Different)

Street Address Address Line 2 City State ZIP Code

Federal Employer Identification Number (FEIN)(Required)

501(c)3 Tax Certificate(Required)

Accepted file types: jpg, pdf, png, Max. file size: 6 MB.

Unique Entity Identifier (UEI)(Required)

Proof of UEI(Required)

Accepted file types: jpg, pdf, png, Max. file size: 6 MB.

Agency Type(Required)

Nonprofit

Government

Emergency Food and Shelter Program

Statement of Responsibilities

Applicant Information

Funding Request

Budget Narrative

Agency Narrative

Authorization of Information

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