HOME-ARP Funding Survey for those who live and work in Costa Mesa

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* 1. Are you a resident of Costa Mesa?

Yes

No. I work in Costa Mesa.

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* 2. Are you currently or have you ever experienced homelessness?

Yes. I am currently homeless.

Yes. I have experienced homelessness in the past.

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* 3. How familiar are you with the HOME-ARP program?

Very familiar

Somewhat familiar

Not at all familiar

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* 4. Do you work or volunteer for an organization that serves individuals/families who are homeless; at-risk of homelessness; fleeing domestic violence, sexual assault, stalking or human trafficking; veterans; families; or other vulnerable populations? (If YES, please check the organization below)

Emergency/Temporary Shelter Provider

Continuum of Care Administrative Entity

Homelessness Supportive Services Provider

Victims of Domestic Violence Service Provider

Justice involved/reentry services organization

Veteran's Group

Public Housing Authority

Public Agency that addresses the needs of vulnerable populations

Civil Rights, fair housing, or disability rights organization

Affordable Housing Developer

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* 5. What is your organization's geographic service area? (i.e. Orange County, City of Costa Mesa, Zip Code, Neighborhood)

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* 6. Among the following who are eligible for HOME-ARP funding, where is the most need in your community? Please rank the following options (1 is highest need)

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* 7. Please rank the following needs in the City of Costa Mesa from highest priority to lowest priority for individuals experiencing homelessness or at risk of homelessness? (1 is highest, 5 is lowest needed)

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* 8. Among the following services, where are the largest gaps (difference between resources available and people needing those resources) in your community’s homelessness response system? Please identify the top 5

Childcare costs

Education services

Employment assistance and job training

Food

Housing search and counseling services

Legal services/mediation

Life skills training

Mental health services & Substance abuse treatment

Outpatient health services

Outreach services

Transportation

Case management mediation

Credit repair

Landlord/tenant liaison

Services for special populations

Financial assistance costs (including rental application fees, security deposits, utility deposits, payment of rental arrears)

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* 9. Among members of your community who are in the Qualifying Populations, please identify the group that is most likely to face additional barriers to ending their homelessness.

Youth

Seniors

Persons with mental health conditions or substance use disorders

Justice-involved/Reenetry

Persons with Disabilities

Other (please specify)

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* 10. Are there specific racial and ethnic groups, cultural groups, cultural and/or linguistic communities that are not being reached through the homeless service system in Costa Mesa?

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* 11. Please provide any additional feedback regarding the allocation of HOME-ARP funds here.

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* 12. Contact Information

Name

Organization

zip Code