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TREASURE COAST HOMELESS SERVICES COUNCIL, INC. CONTINUUM OF CARE 1 Section C. 1 . Component Selection Select the S +C component which describes your pro ect (check only one box) ® TRA ❑ SRA 0 PRA without Rehab ❑ PRA with Rehab ❑ SRO Section C.2 . Project Information (please type or print) Project Name: Project Priority No, Indian River County Permanent Housing (from project priority chart in Exhibit 1): Project Address (street, city, state, & zip): TWO Project Sponsor's Name (for SRA projects): Proj. Congressional District(s): 115 Sponsor' s Address (street city, state, & zip) (for SRA projects) : 129061 Authorized Representative of Project Sponsor (name, title, phone number, & fax) (for SRA projects): Section A Targeted Disabilities In each category shown in the chart below, estimate, when the program is fully operational, the number of proposed participants expected to receive rental assistance at a point in time. Include each participant only once, in either part 1 or Part 2. Part 1 should only include persons with disabilities who will not have family members living with them Do not double count. Part 1 : Individual Participants not in Families Number of Participants Persons with: Serious Mental Illness 6 Chronic Substance Abuse Problems Both Serious Mental Illness & Chronic Substance Abuse Problems 3 AIDS or Related Diseases 2 Other Disabilities (specify) PHYSICALLY DISABLED WITH 2 MENTAL ILLNESS (a) Total Participants: (not in families) 13 Part 2: Participants in Families Persons with: Serious Mental Illness Chronic Substance Abuse Problems Both Serious Mental Illness & Chronic Substance Abuse Problems AIDS or Related Diseases Other Disabilities (specify) (b) Total Participants : (in families) (c) Number of other Family Members Living with Participants wmmmw� 11 WON Total Persons Served from Parts 1 and 2 [(a) + (b) +(c)j 13 Form HUD4007&CoC (2003) OMB Approval No. 2506-0112 (exp. 06/30/2003)