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Name of Organization <br />Name of Funded Program <br />Annual Accomplishment Goal <br />I. Total number of unduplicated clients (Santa Ana and Non -Santa Ana Residents) anticipated to be served by the <br />funded pro ram, named above, during the 12 -month contract period. <br />Persons <br />City of Santa Ana <br />II. Number of unduplicated Santa Ana residents expected to be served by the funded program during the 12 -month <br />contract period. <br />- Persons <br />Program and Funding Description <br />III. Description of Work - In the space below, describe the program to be funded during the 12 -month contract period. <br />What specific activities will be undertaken during the contract period. Please be concise in your response. Only the <br />viewable space will print. <br />The Emergency Services Program funded by this contract period will encompass eviction prevention and utility <br />assistance. The process entails a thorough intake, beginning with a telephone screening interview that <br />ascertains whether the client meet the basic eligibility criteria. Thereafter, clients undergo a face -to -face <br />interview that includes queries about living arrangements, income and financial status, and family composition. <br />The interview also elicits information about how the client got into the situation and what actions he /she will <br />take to avoid similar circumstances from arriving in the future. The face -to -face interview is also the point at <br />which clients submit documentation to support their request: rental contract, eviction notice, proof of <br />residency in the site for six months or more, income (current and future), rental receipt for prior months rent <br />and the landlord's name, address and telephone number. Clients for utility assistance submit similar <br />documentation with their notice of disconnection of electric or gas. <br />During the interview, we attempt to determine all of the clients' needs and if available, deliver any services <br />which could remedy those needs. In the instances where we are unable to meet all the clients' needs, we will <br />refer them to other resources. Once served, staff will follow -up with clients within three months to ascertain <br />status; i.e., living sufficiency. <br />As an added component to case management, all clients for emergency services now must participate in <br />financial literacy training. <br />Schedule of Performance <br />Estimate the number of unduplicated Santa Ana residents to be served by the funded program during the 12 -month <br />contract period per quarter. (Enter number of new Santa Ana clients served each quarter. If they were served in <br />quarter 1 do not count them again in quarter 2 <br />Quarter 1: July 1 - September 30 <br />Quarter 2: October 1 - December 31 <br />Quarter 3: January 1 - March 31 <br />Quarter 4: April 1 -June 30 <br />40 <br />5a' <br />50 <br />67 <br />207 <br />Persons <br />Persons <br />Persons <br />Persons <br />Total unduplicated Santa Ana Residents to be served. <br />Schedule of Invoicing <br />Estimate the amount of grant funds to be requested during the 12 -month contract period on a quarterly basis. <br />Quarter 1: July 1 - September 30 <br />Quarter 2: October 1 - December 31 <br />Quarter 3: January 1 - March 31 <br />Quarter 4: April 1 -June 30 <br />$5,000:00 <br />$5,000:0 .?, <br />$9,000.00 : <br />$ 24,000.00 <br />Total Grant <br />Exhibit A <br />Page 1 of 1 <br />