CoC Grant Significant Change Request

Any CoC grantee that wishes to make a significant change to a CoC grant must receive approval from the Balance of State Steering Committee. Please complete this form to submit a request for Steering Committee consideration. Please refer to the BoS CoC Grant Significant Change Policy and the Procedure for Requesting CoC Grant Significant Changes, both posted at www.ncceh.org/bos/cocgrantees, for details about what constitutes a significant change and the process for requesting approval.

Current Grant Information

Agency Name*

Project Name*

Project Type*

Select or enter value

Grant Number*

Grant Budget (total amount)*

Proposed Effective Date of Change

Primary Contact Person (required)

Your Name*

Your Role*

Select or enter value

Email*

Phone*

Secondary Contact Person (optional)

Name (optional)

Role (optional)

Select or enter value

Email (optional)

Phone (optional)

Significant Change Requested

Use this section to describe the significant change you are requesting for your CoC grant.

Type of change*

Select or enter value

Current status*

Indicate what is stated in the current grant regarding this item (e.g., current budget line items, current number of units, etc.).

Explanation of change*

Explain what you would like to change about this item (e.g., specific changes to budget line items).

Reason for change*

Explain the reason for the requested change. Include a description of why the change is being requested, how the change will better serve the participants in the program, and how the agency will manage the change.

Grant Transfers ONLY: Proposed & Actual Households

If you are requesting a grant transfer, how many households did the grant propose to serve in its most recent project application? How many households are currently being served?

Grant Transfers ONLY: Agency Engagement

If you are requesting a grant transfer, have you spoken to or do you know of any agencies that may be interested in receiving the grant?

Grant Transfers ONLY: Transition Assistance

If you are requesting a grant transfer, please describe the level of involvement your agency expects to have during the transfer process and what support, if any, your agency is willing to provide to the agency that receives the grant.

Second Significant Change Requested (optional)

Answer the following questions if two changes are being requested concurrently (for instance, shifting 10% of funds as well as eliminating a budget line item).

Type of change (optional)

Select or enter value

Current status (optional)

Indicate what is stated in the current grant regarding this item (e.g., current budget line items, current number of units, etc.).

Explanation of change (optional)

Explain what you would like to change about this item (e.g., specific changes to budget line items).

Reason for change (optional)

Additional Information (optional)

Addtional Comments

Please include any additional comments that may help the Steering Committee evaluate this request.

Supporting Documentation

If there is additional documentation that you feel supports the requested change, please upload the documentation below. (If you are requesting a budget change, you are required to upload a full project budget that includes the proposed changes.)

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