Notification to the Continuum of Care (CoC) and County/Tribal Human Services Form
Instructions: This notification form is required for applicants with projects that are considered Partially Supportive Housing (less than 50% of the total units will serve High Priority Homeless (HPH), People with Disabilities (PWD), or other homeless households). The applicant completes Sections A and B and sends it to the CoC Coordinator and the county or tribal human services office so that they are aware of the proposed units in their community. Refer to the CoC contact information on subsequent pages. 

Applicants must also submit this completed form in the Multifamily Application Portal along with a copy of each email verifying the form was sent to the CoC Coordinator and the County or Tribal Human Services contact.

Note that applicants with projects that are considered Primarily Supportive Housing (50% or more of the total units will serve HPH, PWD, or other homeless households) must complete the CoC Confirmation Form and should not use this notification form

A.	General Information	
Continuum of Care Region	     	
Developer/Applicant Organization	     	
Name of Proposed Project	     	
Project Location	     	

B.	Unit Information	All Units	HPH Units	PWD Units	
Total Number of Units	     	     	     	
Number of Units by Size
(SRO, Eff, 1 BR, etc.)	SRO 	     	     	
	Eff	     	     	
	One BR 	     	     	
	Two BR	     	     	
	Three BR	     	     	
	Four or more BR	     	     	

Key: HPH = High Priority Homeless; PWD = People with Disabilities; SRO = Single Room Occupancy; Eff = Efficiency; BR = Bedroom

OPTIONAL: Other relevant project or supportive housing specific information (for example, proposed service partner, resources planned for rental assistance or service funding, etc.):
     

Refer to the CoC Contact List for CoC coordinator contact information. Contact the county or tribal human services office to find the relevant staff contact information.

NOTE: While applicants are only required to notify the CoC and county/tribal human services about their application with supportive housing units, it is advisable to consult with them to learn about the local needs and resources for people experiencing homelessness and people with disabilities.