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<br />L, <br /> <br />Has your organization previously received clof Santa Ana funding? <br />COBG yesio <br />ESG Yes 0 <br />Federal Empowerment Zone (FEZ) Yes 0 <br /> <br />If 'Yes' to any of the above, identify grant amount(s) by year. If you have received funds for a <br />ear that is not listed ease include that information under .other". Iden' ear and amount. <br />Fiscal Year 2006-2007 2005-2006 other ( <br /> <br />COBG $ $ $ <br /> <br />ESG $ ~ $ $ <br /> <br />FEZ $ $ $ <br /> <br /> <br />M, <br /> <br />Will you, or have you requested ESG or FEZ funds for this program? 0 Y ~o <br />If yes, How much? $ N'L 14- <br /> <br />N, <br /> <br />Provide the following information regarding the program proposed for COBG fUndinij:jQ-- <br />1. How many individuals were served by the program during 7/1/05-711/06? N I <br /> <br />2, Of the number from I.N.1, how many were Santa Ana residents? <br /> <br />3. Of the number from I.N.2. how many were Low/Moderate income? <br /> <br />0, 2007-2008 COBG grant recipients will need to measure program outcomes as designated by the <br />City as well as HUO. Please refer to Attachment #10 to view the City and HUO outcomes to be <br />measured. In addition with Attachment #10 there is a question on how your organization plans to <br />obtain the information on the outcome indicators to report back to the City. <br /> <br />II. ELIGIBILITY FOR CDBG FUNDING <br /> <br />A Which of the following categories best describes your program (ONLY SELECT ONE) <br />1SOcial service <br />Historical preservation <br />Capital improvement other than historical preservation <br />other (specify) <br /> <br />B, If you are submitting an application as"low/moderate income" program/project, please check the <br />characteristics that best describe your clients. (ONLY SELECT ONE) <br /> <br />o Youth D Disabled D Senior Citizens 0 Homeless 0 Low Income <br /> <br />C, Provide, as Attachment #7, the current/proposed client intake eligibility form that will be used to <br />qualify COBG eligible participants for your program, <br /> <br />*FOR CAPITAL IMPROVEMENT PROJECTS ONLY: <br />D, If you are qualifying under the "slumlblight" criterion, describe the condition and economic <br />characteristics of the targeted area or properties, Explain how this program will address the <br />conditions that contribute to the deterioration of the area, <br /> <br />* Wt:f' 12.(l.cdrYe.1) Vl oN=1N\ <br />~ria/g,N 26D~ - \ <br /> <br />- <br /> <br />~~ vJ C <br /> <br />3 <br />