1. How many homeless people has your agency served from July, 2000 - June, 2002?  If you can only provide data for a lesser time period, please indicate time frame. (Estimates are acceptable, but please mark with an E.)

    If you agency has "turned away" homeless persons for the period listed above or has a waiting list, please indicate the number.

          Turned away __________     Waiting list __________

 

    How many people has your agency offered shelter who have refused to go to that shelter?  ____________________

 

2. What is the maximum number of days for which you will provide shelter for an individual or family?

 

3. How mahy bednights (*) did you provide from July, 2000 - June 2002?  (Estimates are acceptable, but indicate information as an information)

 

    *  [BEDNIGHTS ARE CALCULATED BY MULTIPLYING EACH PERSON SHELTERED BY THE NUMBER OF NIGHTS HE OR SHE SPENDS IN A SHELTER.  ONE PERSON SPENDS 3 NIGHTS IN A SHELTER EQUALS 3 BEDNIGHTS. THREE PEOPLE SPENDING 3 NIGHTS EACH EQUALS 9 BEDNIGHTS.]

 

4. Are your clients referred to you?  Yes _____ No _____
    If so, by whom? _______________________________
    Are they walk-ins?  Yes _____  No _____

 

5. What percentage of agency funds for services to the homeless come from the following categories?

    a.  Corporations and private foundations                   _____ %
    b.  Government (county, state or federal)                  _____ %
    c.  Fundraising                                                         _____ %
    d.  Donations/contributions (individuals/organizations)  _____ %

 

6. Estimate your agency's yearly operating budget for homeless services:     __$__________________________

 

7. Ideally, how large should your budget be to meet the needs of homelesss persons who seek your help?   __$_________________

 

8. What is the total number and job titles of agency staff who work with the homeless?
        a. Full-time  _____     Job titles: ______________________
        b. Part-time _____     Job titles: ______________________
        c. Volunteers _____   Job titles: _______________________

 

9. How can your program, staff, and facility be improved so that it can better help the homeless?

10. What do you think are the immediate needs of the homeless
     (while being sheltered)?

11. What do you think are the long term needs of the homeless
      (to prevent reoccurence of homelessness)?