Letter Of Interest Checklist Page 4
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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
4. PROPOSED POPULATION TO BE SERVED (check all that apply)
Individual
Family
Age Group
# of Homeless*
# At Risk*
# of Homeless*
# At Risk*
Children (ages 0 - 15 )
TAY (ages 16 - 25)
Adults (ages 26 - 59)
Older Adults (ages 60+)
*As defined in the MHSA application
5. TYPE OF HOUSING AND NUMBER OF UNITS
Shared Housing
Rental Units
Other (Specify)
Type of Housing
1 - 4 Unit Structure Single Family Home
Multi-Family Building - 5 or More Units
Number of Units Requesting
MHSA Funding
Total Number of Units
6. TARGET INCOME LEVELS
MHSA FUNDED UNITS
Unit Size
Number of Total Units/Bedrooms
Percentage of AMI
Number of MHSA Units
Studio
1 Bedroom
2 Bedroom
3 Bedroom
4 Bedroom
Total
7. AMOUNT OF MHSA FUNDS REQUESTED
MHSA CAPITAL REQUEST
MHSA OPERATIONS REQUEST
Predevelopment
Operations Request
Site Acquisition
Per MHSA Unit
Construction
Rehabilitation
Total Capital Request $
-
Per MHSA Unit
MHSA GRAND TOTAL REQUESTED
$
-
Attachment I
file:///usr/share/nginx/html/yummydocs/file/letter-of-interest-template-0595820.xls
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