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EXHIBIT A INDIAN RIVER COUNTY NONPROFIT / QUASI AGENCY REQUEST FOR FUNDING A. Program Cover Page Telephone: 772-567-7790 Fax: 772-567-5991 E -Mail: I Agree - By checking the "I Agree" box and entering your name below, you certify that information contained in this application accurately reflects the activities of this agency and that the expenditures or portions thereof for which County funds a being reAj sted ive not reimbursed by any other source. Name: C Title: Executive Director briet description of the Program Tor wnicn Tunaing is requestea: The Treasure Coast Homeless Services Council's Resource Center provides assessment, screening and financial housing assistance to prevent and end homelessness. The source of financial assistance is varied including Federal and State and local dollars and local philanthropies, Depending on eligibility requirements, programs provide assistance to individuals and families to prevent homelessness by avoiding evictions for low income persons, rehousing eligible homeless individuals and families in fair market rental housing in the community. Special target populations include homeless disabled persons and Veterans who are homeless or about to become homeless. summary Kepor[ Amount requested from Indian River County for 2022/2023: $15,270.00 Total Proposed Program budget for 2022/2023: $918,407.00 Percent of total Program budget: 1.66% Current Funding (2021/2022) $15,270.00 Dollar increase / (decrease) in request: $0.00 Percent increase / decrease in request: 0% If request increased 5% or more, briefly explain why: This is not an increase. The Organization's Board of Directors has approved this application on (date): 01/07/22 Name of President/Chair of the Board: Todd Heckman Name of Exec. Director/CEO: Ao Vmc N VAC K� EXHIBITA Treasure Coast Homeless Services Agency: Council, Inc. Contact Person.- erson:Title: Title: Executive Director Address: 2525 Saint Lucie Ave Website Address: www.tchelpspot.org Program Title: Homeless Resource Center, Inc. Telephone: 772-567-7790 Fax: 772-567-5991 E -Mail: I Agree - By checking the "I Agree" box and entering your name below, you certify that information contained in this application accurately reflects the activities of this agency and that the expenditures or portions thereof for which County funds a being reAj sted ive not reimbursed by any other source. Name: C Title: Executive Director briet description of the Program Tor wnicn Tunaing is requestea: The Treasure Coast Homeless Services Council's Resource Center provides assessment, screening and financial housing assistance to prevent and end homelessness. The source of financial assistance is varied including Federal and State and local dollars and local philanthropies, Depending on eligibility requirements, programs provide assistance to individuals and families to prevent homelessness by avoiding evictions for low income persons, rehousing eligible homeless individuals and families in fair market rental housing in the community. Special target populations include homeless disabled persons and Veterans who are homeless or about to become homeless. summary Kepor[ Amount requested from Indian River County for 2022/2023: $15,270.00 Total Proposed Program budget for 2022/2023: $918,407.00 Percent of total Program budget: 1.66% Current Funding (2021/2022) $15,270.00 Dollar increase / (decrease) in request: $0.00 Percent increase / decrease in request: 0% If request increased 5% or more, briefly explain why: This is not an increase. The Organization's Board of Directors has approved this application on (date): 01/07/22 Name of President/Chair of the Board: Todd Heckman Name of Exec. Director/CEO: Ao Vmc N VAC K� EXHIBITA