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EXHIBIT "A" <br />lL`F IT <br />ry Homelessness and Affordable Housing Funds <br />2017 Request for Proposals Application Form <br />"Fields outlined in red are required" <br />PROJECT INFORMATION <br />Project Title: Housing Authority Supportive Services <br />Project Site Name(s): Scattered Sites <br />Project Site Address(s): Various <br />Which fund source is this proposal for? (select one, see Section 1 of the RFP for details) <br />0 Affordable Housing Funds <br />(') Homeless and Housing Assistance Funds <br />Total Project Costs (including other funding and resources): $126,099.00 <br />Total Amount Requested (from Kittitas County Homeless Housing and Assistance or Affordable <br />Housing funds): $117,225.00 <br />Time Frame for Utilization of Requested Funds: 1/1/18 to 12/31/19 <br />City, Town or Unincorporated Area to be served: Kittitas County <br />APPLICANT INFORMATION <br />Name of Applicant Organization: HopeSource/Housing Authority of Kittitas County/Elmview <br />Mailing Address: 700 East Mountain View Avenue, Suite 501 <br />City, State, Zip: Ellensburg, Washington 98926 <br />Phone: 509-925-1448 <br />Fax: 509-925-1204 <br />Email Address: skgrindle@hopesource.us <br />11 <br />