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EXHIBIT "A" <br />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:Women's Sober House <br />Project Site Name(s): <br />Project Site Address(s):TBD <br />Which fund source is this proposal for?(select one,see Section 1of the RFP for details) <br />Affordable Housing Funds <br />Homeless and Housing Assistance Funds <br />Total Project Costs (including other funding and resources):$67,431.00 <br />Total Amount Requested (from Kittitas County Homeless Housing and Assistance or Affordable <br />Housing funds);$52,212.00 <br />Time Frame for Utilization of Requested Funds:January 1st 2018 to December 31st 2019 <br />City,Town or Unincorporated Area to be served:EIIensburg,WA <br />APPUCANTINFORMATION <br />Name of Applicant Organization:HopeSource <br />Malling Address:700 E Mountain View Ave #501 <br />City,State,Zip:EIIensburg,WA 98926 <br />Phone:(509)925-1448 <br />Fax:(509)925-1204 <br />Email Address:ckelly@hopesource.us