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<br />EXHIBIT A <br /> <br />HOUSING OPPORTUNITY FOR PEOPLE WITH AIDS <br />ACCOMPLISHMENT REPORT <br /> <br />HOPWA Recipient Name: <br />HOPWA Funded Activity: <br />Location of Activity: <br /> <br />1. Select the one category that best describes service provided with HOPWA Funds: <br /> <br />D Facility Based Housing: (e.g., Construction, Rehab) ..............Submit Report Form A & Supplemental <br />D Facility Based Non-Housing ..................................................Submit Report Form B & Supplemental <br />D Scattered Site Only: (e.g., Tenant Based Rental Assistance).. Submit Report Form C & Supplemental <br />D Housing Information/Resource ID/Admin ..............................Submit Report Form D <br />D Supportive Services Only ......................................................Submit Report Form E <br /> <br />2. Check Box Indicating Report Period: <br /> <br />o 1st Quarter (7/1 - 9/30) <br />o 2nd Quarter (10/1 -12/31) <br />o 3'd Quarter (1/1 - 3/31) <br />o 4th Quarter (4/1 - 6/30) <br /> <br />3. Amount of HOPWA Expended During This Report Period: $ <br /> <br />4. Number of Unduplicated Persons Assisted During the Report Period: <br />*Must equal "Total Number of Persons Receivina Assistance" listed in Reporl Form <br /> <br />Number of Duplicated Persons Assisted During Report Period: <br /> <br />5. Number of Units Completed During the Report Period (if applicable): <br />For construction projects only <br /> <br /> <br />IlllrrllfVe $ummll <br /> <br />I certify that the information within this quarterly report is true and correct. <br /> <br />Name: <br /> <br />Title: <br /> <br />Signature: <br /> <br />Date: <br /> <br />Telephone: <br /> <br />Fax: <br /> <br />Email: <br /> <br />Cover Page <br /> <br />Revised 9/13/05 <br /> <br />p.10f7 <br />