Cherokee County
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SERVICE PROVIDER QUESTIONNAIRE

CHEROKEE COUNTY HOMELESS AND SHELTER SURVEY

ALL INFORMATION PROVIDED BY YOUR AGENCY WILL REMAIN CONFIDENTIAL.

     Cherokee County is undertaking a study of homeless and sheltering issues.  This study is designed to assess the complex issues of homelessness and help determine the need for shelter in the county.

FOR THE PURPOSE OF THIS STUDY, HOMELESS REFERS TO ANYONE WHO IS TEMPORARILY OR PERMANENTLY WITHOUT A HOME, REGARDLESS OF THE REASONS. THIS INCLUDES YOUTH AND BATTERED WOMEN.

We would appreciate your assistance in providing us with relevant data for the study. Thank you.

1. Do you operate a shelter or facility?  Yes _____ No _____
    If no, do you provide funding? Yes _____ No _____
 
2. What type of services are provided to the homeless by your agency? Refer to lists below. Please check all service(s) you provide.
 
3. Emergency or longer term shelter __________
   Type of shelter provided:
      a. Motel _____
      b. Church building _____
      c. Transitional building _____
      d. Boarding house _____
      e. Relatives or friends _____
      f. Other (please be specific) ________________
 
4. What is the average length of stay per person or family?
     _______________
 
5. Do you have an Eviction Prevention Program? __________
    Funds to prevent or stay evictions. _____
    Security deposits and/or rent payments. __________
    Emergency maintenance:
      a. Food - _____
      b. Clothing - _____
      c. Food vouchers - _____
    Referrals __________
    Agencies referred to __________
    Homeless network agencies __________
 
COUNSELING
6. What type of counseling do you provide? ________________
    Emotional _____
    Substance abuse _____
    Psychological _____
    Referrals __________
    Agencies referred to __________
    Homeless network agencies __________
 
CHILD CARE
7. What type of child care do you provide? ________________
    Referrals __________
    Agencies referred to __________
    Homeless network agencies __________
 
JOB TRAINING
8. What type of job training do you provide? _____________
    Employment counseling? ______________
    Referrals __________
    Agencies referred to __________
    Homeless network agencies __________
 
EDUCATION
9. What type of education do you provide? _____________
    Education counseling? _________________
    Referrals __________
    Agencies referred to __________
    Homeless network agencies __________
 
BUSINESS
10. Do you act as a liaison to the business community? _________
      Business counseling? ______________
   Referrals __________
   Agencies referred to __________
   Homeless network agencies __________

11.CAUSES OF HOMELESSNESS
Please indicate what you perceive to be the primary causes of homelessness for your county's population.
a. Loss of job  _____
b. Eviction  _____
c. Drinking/drugs  _____
d. Asked to leave  _____
e. Mental disability  _____
f. Psychological problems  _____
g. Break-up of marriage  _____
h. Violence in home  _____
i. Released from hospital/institution  _____
j. Release from jail/prison  _____
k. Military veterans adjustment problems  _____
l. Lack of affordable, decent housing in Cherokee County  _____
m. Other (Please be specific) _______________________
 

THESE ARE THE SERVICE PROVIDERS WHO PARTICIPATED IN THIS SURVEY.
 
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GENERAL AGENCY INFORMATION
 
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)?

SHELTERING NEEDS
 
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