Agency*
Name of Agency Representative*
Email*
Project Name*
Which Continuum of Care (CoC) will the project be providing services in? (Please choose only one. If your project is multi-jurisdictional, separate projects must be set up within each CoC):* ---GVPHC VA-505SVHC VA-501Virginia Beach VA-503Portsmouth VA-507Lynchburg VA-508
Operating Start Date*
Federal Partner Funding Source* ---HUD CoC: Permanent Supportive HousingHUD CoC: Rapid RehousingHUD CoC: Supportive Services OnlyHUD CoC: Transitional HousingHUD ESG: Emergency ShelterHUD ESG: PreventionHUD ESG: Rapid RehousingHUD ESG: Street OutreachHUD HOPWAHHS PATHHHS RHYVeterans AffairsNone
Grant Identification Number
Grant Start Date
Grant End Date
Bed Inventory* (Please provide the total program capacity. If a prevention program please enter 0.)
ZIP Code* (Please enter the ZIP code for the program's location; if tenant based, please use the ZIP code where most of the units will be located.)
Household Type:* Households without children (adults only)Households with at least one adult and one childHouseholds with only children
Project Type:* ---Coordinated AssessmentDay ShelterEmergency ShelterHomelessness PreventionPermanent Housing with Services (no disability required for entry)Permanent Supportive Housing (disability required for entry)Rapid RehousingServices OnlyStreet OutreachTransitional Housing
Housing Type:* ---Site-based: single siteSite-based: clustered/multiple sitesTenant-based: scattered siteNot a housing program
Will the data entered into this project be shared with other providers in the system?*YesNo
If your agency is currently participating in HMIS, please list the first and last names of all HMIS users who will need access to this project within your agency (please enter “all” if the project should be open to all users). If not, please type in NA (new agencies must meet with the system administrator for training prior to setting up projects):*
Optional: If this project will be tracking Services provided to clients, please list which services should be in the Quicklist (i.e., Housing Counseling; Rent Payment Assistance, Rental Deposit, Utility Assistance, etc.):*
Please briefly describe the project:*
This form will be submitted to The Planning Council. We are currently experiencing a high volume of requests; please allow at least one week for this project setup to be completed. If you have any questions, you may call (757) 622-9268 ext. 3040.