ALL fields are required.
This application must be signed by the Executive Director/President/CEO
Is your agency a non-profit organization?
Does your agency have a 501(c) 3 tax-exempt status
(please attach a copy of your exemption letter to this application - this is a required submission)
How is your organization classified?
How many years has your agency provided service to the transitional homeless/crisis population?
over 20 years
What is your agency/organization's total annual budget? $
What is the mission of your organization? (briefly state your mission and attach an agency brochure/flyer that describes your agency program (s) - this is a required submission
How do clients access your services?
Referral from other agency/resource
What is the primary service you offer your clients?
Do you have a structured case management program in place to assist clients with their various needs?
If not, how do you currently determine, assist with and confirm your clients' needs? Please explain.
How will your organization specifically ensure that your client has a true need for furniture? Please explain.
Does your agency track your clients after they have received referral services from agencies like DFB?
Do you currently have a direct furniture provision component built into your program service or does our organization operate a thrift store that provide furniture?
How many staff are employed by your organization?
How many of those staff are licensed social workers or licensed counselors (approximate number)?
Approximately how many families/individuals do you see in a month that have need of furniture assistance?
Is your agency a group home?
Does your agency receive HUD funding to provide housing assistance?
Does your HUD grant include funding for furniture provision?
If yes, how much? $
How many clients are expected to be served with this grant?
What is the grant period?
Name of Executive Director/President/CEO:
Please list the name of the person(s) who will serve as the liaison(s) for your agency with the DFB (each agency may select up to two liaisons). The liaisons will be responsible for making all referrals to DFB on behalf of your organization and will serve as the main contacts regarding communication between DFB and your agency.
We have reviewed the DFB partnerr agency guidelines and wish to partner with the DFB for furniture service provision to our clients. We have answered all application questions truthfully and we agree to abide by the
partner agency guidelines set forth by the DFB. We understand that the DFB will notify us in writing in regards to any changes, amendments or adjustments to these guidelines, at least 30 days prior to implementing the new guideline(s). Further, we understand that paid
partnership fees are non-refundable unless the partner application is declined.
Please don't forget to Fax the copies of the exemption letter and agency brochure to 972.466.0602 or Mail to P.O. Box 815788, Dallas, TX 75381-57888.