9186_RFA_Application AttC_ Final_20260226_amended.docx

ATTACHMENT C

APPLICATION

APPLICANT INFORMATION

Applicant’s legal name:

Oregon Secretary of State business registry number (if applicable):

Authorized representative:

Email: Phone:

GRANT REQUEST

Request for Language Access activities: $ Request for Community Outreach and Engagement activities: $ Total request: $ (maximum request $70,000)

ELIGIBILITY

Applicant must meet eligibility to be considered for a Grant.

1) ENTITY TYPE

(Please select at least one.)

2) ACTIVITIES

(Applicant must engage in these activities to be eligible for a Grant.)

Does your organization sponsor or manage homeownership programs or services that assist households with incomes at or below 120% of the Area Median Income, in the state of Oregon?

What services does your organization provide or plan to provide to homebuyers or homeowners?

(Please limit the answer to 200 words.)

List the cities or counties in which your organization provides or plans to provide homeownership services.

SCORED CRITERIA

1) PROJECT OVERVIEW & ALIGNMENT (60 points) Please contain each response below to 400 words maximum.

A) Which Underserved Population(s) do you plan to target? What is your agency’s track record of serving these Underserved Population(s)?

B) Provide an overview of your proposed project including key activities and intended impact on target Underserved Population(s).

C) How do the proposed activities align with your agency mission, services, and strategy?

D) How do you know this work is needed? Please describe how you developed the project plan and how this plan was informed by the community members that you seek to serve.

E) Describe your agency’s capacity to do this work. How will your staff perform this work? What prior experience makes this staff qualified to undertake these efforts?

F) What does success look like for this project? How will you collect data (quantitative and/or qualitative) and how will that be used to improve support to Underserved Population(s)?

RFA #S-91400-00016009 (OHCS #9186) Att C Homeownership Language Access & Community Outreach and Engagement

2) WORKPLAN & EXPECTED OUTCOMES (35 points) Please fill out the following table. Note that not every row needs to be filled out. Each activity must relate to at least one of the following objectives:

Objective 1. Language Access: Assist with the cost of facilitating language access to homeownership assistance programs and services.

Objective 2. Community Outreach & Engagement: Expand outreach and engagement to reach Communities of Color and Underserved Populations.

3) ESTIMATED BUDGET (15 points) Please fill out this budget to show how your proposed use of funds will allow you to achieve the grants objectives.

APPLICANT CERTIFICATION

1) Applicant understands and accepts the requirements of this RFA. By submitting an Application, Applicant agrees to be bound by the Grant terms and conditions in Attachment A and as modified by any Addenda, except for those terms and conditions that Agency has reserved for negotiation, as identified in the RFA.

2) Applicant acknowledges receipt of any and all Addenda to this RFA.

3) If awarded a Grant, Applicant agrees to perform the activities and meet the performance standards set forth in the final negotiated Grant.

4) I have knowledge regarding Applicant’s payment of taxes and by signing below I hereby certify that, to the best of my knowledge, Applicant is not in violation of any tax laws of the State or a political subdivision of the State, including, without limitation, ORS 305.620 and ORS chapters 316, 317 and 318.

5) Applicant certifies that, to the best of its knowledge, there exists no actual or potential conflict between the business or economic interests of Applicant, its employees, or its agents, on the one hand, and the business or economic interests of the State, on the other hand, arising out of, or relating in any way to, the subject matter of the RFA. If any changes occur with respect to Applicant’s status regarding conflict of interest, Applicant shall promptly notify the State in writing.

6) Applicant certifies that all contents of the Application (including any other forms or documentation, if required under this RFA) and this Certification are truthful and accurate and have been prepared independently from all other Applicants, and without collusion, fraud, or other dishonesty.

7) Applicant understands that any statement or representation it makes, in response to this RFA, if determined to be false or fraudulent, a misrepresentation, or inaccurate because of the omission of material information could result in a "claim" {as defined by the Oregon False Claims Act, ORS 180.750(1)}, made under a Grant being a "false claim" {ORS 180.750(2)} subject to the Oregon False Claims Act, ORS 180.750 to 180.785, and to any liabilities or penalties associated with the making of a false claim under that Act.

8) Applicant acknowledges these certifications are in addition to any certifications required in the Grant at the time of Grant execution.