Balance of State, i.e. Baton Rouge, Lake Charles, Houma/ Terrebonne, St. Bernard, Natchitoches / Sabine (See green region of this map https://public.tableau.com/profile/clay.boykin#!/vizhome/Regions_31/Dashboard1)
Northlake region
Monroe region
Is your organization new to HMIS or are you adding a new project to existing projects in HMIS? *
Please provide a short description of your agency:
Your answer
If known, when did your organization join the BOS (Balance of State) Continuum of Care? (estimates are ok)
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Mailing Address
Please provide street address or P.O. Box #
Your answer
Mailing Address ZIP Code
Your answer
Physical address
If possible, please provide the physical address where housing, shelter or services will be located. If "scattered sites", please enter all cities where housing, shelter or services will be located.
Your answer
Physical Address ZIP Code
Your answer
Which is this your primary address?
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Primary Telephone Number
Your answer
Primary Contact Person Name
Your answer
Primary Contact Person Title
Your answer
Primary Contact Person Email
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Primary Contact Person Phone Number
Your answer
Your Organization's Website Address
Your answer
Your Organization's Hours of Operation
Your answer
Intake/Application Process
Your answer
Languages
Your answer
Handicap Access
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Name of Project
Your answer
Description of Project
Please provide a short abstract of your project
Your answer
Physical Address
Please provide street address
Your answer
Zip Code
Please provide ZIP code that reflects the location of the project’s principal site or, for multiple site projects, the location in which the majority of the project’s clients are housed. Tenant-based scattered site projects and non-housing projects can use the administrative address.
Your answer
Eligibility Requirements
Your answer
Handicap Access
Clear selection
Operating Start Date
When did the Project first open? Operating start date should reflect the first day on which a project provided (or will provide) services and/or housing. This is typically different from the date your Organization started. For projects that began operating prior to October 1, 2012, the start date may be estimated if it is not known.
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Project Type *
Housing Type
Choose
Site-based - single site
Site-based - clustered/multiple sites
Tenant Based - scattered site
Target Population *
At least 75% of persons served by this project meet the population definition
Choose
DV: Domestic Violence Victims
HIV: Persons with HIV/AIDS
NA: Non Applicable
Target Population A *
Household Type *
Number of Beds
Your answer
Number of Units
If you are serving multiple member households, please record the number of units for households in your project. If you are serving individuals, number of units equals the number of beds above. Example: PSH has 4 three bedroom apartments with a capacity of 4 families and a total of 15 beds. (Number of Beds = 15) (Number of Units = 4)
Your answer
When did the units and beds come online?
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Chronic Homeless Bed Inventory (PSH Only)
Record Total Number Below
Your answer
Veteran Beds Inventory
Record Total Number Below
Your answer
Youth Beds Inventory
Record Total Number Below
Your answer
Is this project receiving federal funding? *
Grant Identifier Number
A grant identifier is to be assigned to each federal program being used for funding for the project. The grant identifier may be the grant number or any other identification system utilized by the CoC.
Your answer
Grant Start Date
Refer to your project application
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Grant End Date
Refer to your project application
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Does this project receive funding from additional federal funding sources? *
Refer to your project application for this information
Grant Identifier Number
A grant identifier is to be assigned to each federal program being used for funding for the project. The grant identifier may be the grant number or any other identification system utilized by the CoC.
Your answer
Grant Start Date
Refer to your project application
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YYYY
Grant End Date
Refer to your project application
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Does this project receive funding from additional federal funding sources? *
If Yes, please notify your HMIS System Administrator
A copy of your responses will be emailed to the address you provided.