CoC Letter of Support Request Form

NYC CoC Letter of Support Request

Please use the form below to request a letter of support from the NYC Continuum of Care. This form can be used for all funding opportunities that require letters of support as a part of your application package. Please use the alternate form indicated on the CoC website for all ESSHI requests.

Upon completion of this form, please notify Marie Libeson via email (libesonm@dss.nyc.gov) that you have submitted a request.

Please review your information for accuracy and completeness before submitting. Letters produced with errors will be reissued once all initial requests are completed.

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* 1. Please provide complete contact information for the requesting organization.

Name

Title & Organization

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. What funding opportunity are you applying for? (Please provide complete name.)

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* 3. Name of Developer (if not the requesting organization)

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* 4. Name of Social Services provider (if not the requesting organization)

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* 5. Building address

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* 6. Current funding amount requested in application

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* 7. Briefly describe the intended project (limit 500 words)

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* 8. Number of supportive housing units

Singles

Family

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* 9. Number of non-supportive housing units

Singles

Family

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* 10. Total number of housing units

Singles

Family

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* 11. Will the project prioritize HUD Chronically Homeless persons?

Yes

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* 12. Does your organization currently upload projects into the NYC Data Warehouse Homeless Management Information System (HMIS)?

Yes

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* 13. Does your organization currently use a HUD HMIS compliant data system?

Yes

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* 14. If not, does your organization currently use a data system comparable to HMIS?

Yes

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* 15. Please provide the name of the comparable HMIS system?

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* 16. Will the project participate in the NYC CAPS (CoC coordinated entry process)?

Yes

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* 17. Will the project take referrals from NYC DHS/HRA/DSS?

Yes

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* 18. If not, please list the planned referral sources for this project?

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* 19. What are the target populations for this project? Please check all that apply

Serious Mental Illness

Substance Use Disorder

Homeless young adults between 18 and 25 years old

Survivors of Domestic Violence

Military Services with a Disability

Frail/Elderly

Intellectual/Developmental Disabilities

Persons living with HIV or AIDS

Foster Care: Youth/young adults who exit care within the prior five years

Reentry: Adults, youth, or young adults re-entering the community

Other (please specify)

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* 20. Does your organization have an existing relationship with the NYC CoC? Please explain. (limit 500 words)

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* 21. Does your organization currently receive HUD CoC funding?

Yes

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* 22. Has your organization received HUD CoC funding in the past?

Yes

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* 23. If yes, please explain why you no longer receive HUD CoC funds. (limit 500 words)

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* 24. Please indicate to whom the letter will be addressed to and including name and title.

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* 25. Please provide any information supporting your request (optional)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 26. Please affirm that the information provided above is accurate to your knowledge and executive leadership of your organization is aware of the request made on their behalf.

Agree

Disagree

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* 27. Please confirm that you will notify libesonm@dss.nyc.gov of your letter of support request immediately upon completion of this form. Acknowledge that failure to do so may result in delays to your request.

Yes