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EXHIBIT A <br />REPORT FORM A <br />FACILITY BASED HOUSING <br />(Housing Acquisition, Construction or Rehab) <br />FACILrrY NAME: <br />FACSUTY TYPE: <br />NUMBER OF llNfrS BY F%-CU.ITY TYPE <br />SRO 0 Bdrm 1 Bdrsas 2 Bdrms 3 Bdrrris 4 Bdrms 5+-Bdrrns <br />Date of Closing/tease Execut'an: <br />Date Construction/Rehab Started: <br />Completed: <br />Date Operations Staff Hired: <br />Date Residents Began to Occupy: - <br />HOPWA EXPENDITURES ~ doNars) - -- - " <br />Acquisitions: s - <br />Rehab,IConversiors/Repair: ; <br />tease: - ; <br />New Constn.sction: t <br />operating costs: - ; <br />Technical Assistance: S <br />Rental Assistance: S <br />Other: >F <br />Other. S <br />70TAL: <br />is the site owned by a pubik entity? QYes <br />Is this activity "substantial" rehab? QYes <br />AvaitaWe HOPWA Funds <br />- Allocated HOPWA Funds: <br />Allocated HOP'WA Program Income: <br />Total HOPWA funds for Project: <br />, Total HOPWA Expended to date: <br />Balance HOPWA Funds to date: <br />^No <br />^No <br />S <br />+; <br />=S <br />-; <br />.t - <br />Source of Non-HOPWA Funds Expended To Date - Total Available <br />3 ~ <br />~ ~ <br />S S <br />Total Non-HOPWA Funds: s ~ <br />Ftt7PWA Report Form A <br />~ ~/t~/oa <br />