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Application Scoring Summary <br /> This form is the applicant's evaluation of the application score . Use the "scores" identified in the application to complete this <br /> form when you have finished filling <br /> out the application . Enter the scores or other information in the appropriate columns . If additional pages are needed ( number <br /> them with a lowercase letter such <br /> as 7a , 7b, 7c, etc . ) . When all of the scores have been transferred to this form, add the scores and enter the <br /> total . <br /> Enter Name of Local Government Applicant : For DCA Use Only : Application <br /> Number <br /> Enter Type of Application (s) m5 <br /> Complete this form for each application submitted . _ <br /> FORM TITLE/ SCORE PAGE CR ED H NR <br /> 1 . Community-Wide Needs Score (250 Points Maximum ) 115 . 09 <br /> 2 . Outstanding Performance in Equal Employment Opportunity and I 80 .46 <br /> _ Fair Housing ( 100 points maximum) <br /> r 3 . Program Impact ( 650 Points Maximum ) : <br /> Special Designation Score (20 Points Maximum ) I 20 <br /> � I <br /> Grant History Score ( 100 Points Maximum) 0 <br /> • Leverage ( Note : 25 Points Maximum for CR, NR and HR and 25 <br /> 125 Points Maximum for ED) <br /> Category Score Summary 478 , 79 <br /> Total Program Impact Score <br /> r— TOTAL APPLICATION SCORE ( 1000 Points Maximum ) 719 . 34 <br /> LESS PENALTIES ASSESSED ( For DCA Use Only) <br /> FINAL SCORE ( For DCA Use Only) <br /> I <br /> ! <br /> 23 <br />