Letter Of Interest Checklist
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6COUNTY OF LOS ANGELES - DEPARTMENT OF MENTAL HEALTH
Adult Justice, Housing, Employment and Education Services
Mental Health Services Act Housing Program
LETTER OF INTEREST INSTRUCTIONS
1. LEAD AGENCY CONTACT INFORMATION
Project Sponsor's Entity Name, Contact Person and related Contact Information.
2. COLLABORATIVE PROJECT PARTNERS
Contact Persons and Contact Information for the project's Developer, Property Manager, Primary
Service Provider, Long Term Owner (if different from the Developer or Project Sponsor)
3. PROJECT NAME & ADDRESS
Project Name and Address - The project's name (if any) and the physical address of the project.
Service Planning Area - Please indicate the number of the service planning area of the project.
Supervisorial District - Please indicate the name and number of the Supervisorial District of the
project.
Unincorporated Area - Please indicate the name of the City or Unincorporated Area of the project (if
applicable).
4. PROPOSED POPULATION TO BE SERVED
Please enter the number of tenants in the box of the population to be served.
5. TYPE OF HOUSING AND NUMBER OF UNITS
Please indicate the number of MHSA units and total units in the appropriate box. For Shared
Housing, the units represent the number of bedrooms. For Rental Units, the units represent the
number of apartments.
For the "Other" section, please indicate both the number of units and the type of housing in the box.
6. TARGET INCOME LEVELS
Indicate the number of units (Total and MHSA units) in the appropriate box, being aware of the total
number of units.
For Shared Housing, "units" represent bedrooms.
For Rental Units, "units"
represent apartments.
Indicate the percentage of Area Median Income (AMI) of all units.
7. AMOUNT OF MHSA FUNDS REQUESTED
Indicate the amount of funding requested for each project component. To determine the "Per MHSA
Unit" number, divide the "Total Capital Request" and/or "Total Operations Request" by the total
number of MHSA Units.
8. SOURCES OF FUNDS
Indicate all funding sources related to the project and the related Predevelopment, Construction and
Permanent amounts.
In the "Committed Funding?" boxes, please indicate with a "yes" and the date awarded or "no."
9. USES OF FUNDS
Indicate the amount of the related use of funds.
In the "Committed Funding?" boxes, please indicate with a "yes" and the date awarded or "no."
10. SUPPORTIVE SERVICES
In the "Estimated Service Cost" column, indicate the monetary value assigned to the service.
In the "List Type of Proposed Services By Location" Column, place an "X" in the Offsite or Onsite
column as appropriate.
In the "List Funding Source by Type" column, place the name of the funding source in either the "In-
Kind" column or in the "Cash" Column.
In the "Committed Funding?" boxes, please indicate with a "yes" and the date awarded or "no."
11. NARRATIVE DESCRIPTION
Attach the Narrative Description with one (1) inch margins and using font Arial 12 with a maximum of
ten (10) pages.
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Parent category: Letters