1. Do you provide any assistance to people who
are homeless?
Yes _____ Continue with questions 2 through 10.
No _____ Complete questions 5 and 6.
2. Which of the following services do you provide to
the homeless?
a. Rental assistance? Yes _____ No _____
Estimate yearly amount, if known __$________
b. Mortgage assistance? Yes _____ No _____
Estimate yearly amount, if known __$________
c. Funds to prevent eviction? Yes _____ No _____
Estimate yearly amount, if known __$________
d. Funds to homeless persons to stay in motel rooms?
Yes _____ No _____
Estimate yearly amount, if known __$ ________
e. Money to programs which do any of the above?
Yes _____ No _____
Estimate yearly amount, if known __$________
3. Do you provide shelter for homeless persons?
Yes _____ No _____
a. If yes, where is your shelter located?
(General geographic area) ____________________
b. What is the bed capacity of your shelter? __________
c. What is the maximum amount of days an individual
can remain in your shelter? __________
4. Please identify the services you provide, other than shelter.
_____________________________________
5. Do you communicate with Mr. Harry Smith, Housing referral
counselor for Cherokee County Housing Agency, about needs
and services for homeless persons?
Yes _____ No _____
a. How often do you communicate with Mr. Harry Smith?
Daily _____ Weekly _____ Monthly _____
6. Do you refer homeless persons to other agencies for service?
Yes _____ No _____
7. Did you collect statistical informaiton from July 1, 2000 -
June 30, 2002, on homeless persons you serviced?
Yes _____ No _____
8. If you provided shelter (in a shelter or motel), how many
bednights(*) did you provide from July 1, 2000 - June 30, 2002?
* [BEDNIGHTS are calculated by multiplying each person
sheltered by the number of nights he or she spends in a
shelter. One person spending 3 nights in a shelter equals 3
bednights. Estimates are acceptable, but indicate
information as an estimate.]
9. Please check which segment of the homeless population
you serve. You may check more than one.
a. Battered women and children _____
b. Potentially homeless (on the verge of being homeless) _____
c. Women with children (non-battered) _____
d. Unaccompanied minors _____
e. Elderly (60+ years) _____
f. Single women _____
g. Intact families _____
h. Extended families _____
i. Men with children _____
j. Single men _____
10. Are there any recommendations or suggestions to help
improve the service to homeless persons in Cherokee
County? (This included gaps in service)
_____________________________________________________