NMHC Annual Survey
This form requests baseline information about each organization participating in the NMHC Data Aggregation Initiative. This organizational information will be updated once per year. Please provide your information inclusive of all locations unless the question specifically asks about individual locations. Thank you for your help is gathering this important information. Questions should be answered based on how things stood in your organization as of January 1, 2019.

If you have any questions, concerns, suggestions, or if you simply want to say aloha, please send us a note at housing@heartbeatinternational.org.

Organization Name *
Your answer
Organization Mailing Address *
Please include street address, city, state, and zip code for your organization's main location.
Your answer
Contact Person Name *
Please enter the name of your organization's main contact for NMHC Data Aggregation Project communications. This should usually be the person who will enter data monthly.
Your answer
Contact Person Phone Number *
Your answer
Contact Person Email Address *
Your answer
Which of the following most closely matches your organization's staffing model? *
What is your organization's annual budget? *
How many homes or housing locations does your organization operate? *
Your answer
How many paid staff members does your organization have? *
Your answer
How would you describe the primary purpose for your organization's existence? *
While there are often a collection of good reasons for why a home exists, there is nearly always a central, core, or primary purpose that drove its founding and continued operation. Many homes were founded to save lives from abortion, to promote adoption, or to serve homeless mothers. Please enter below the core purpose of your organization's housing program.
Your answer
Please rate the amount of structured time in your housing program's requirements. *
Please provide a rating of the amount of structured time that your program requires of the residents.
Low structure
High Structure
How long can a resident stay in your housing program under normal circumstances? *
What is your organization's maximum non-emergency occupancy? *
This is meant to provide data to calculate occupancy rate. Please enter the maximum number of people that can reside with your organization at one time. For purposes of this answer, please do not include any emergency-only occupancy (i.e. couches) or staff occupancy. Please include unborn children in your occupancy number. For example, if your home can house 4 women and 6 children, but your organization is willing to put up a woman on the couch in the living room in an emergency, your response here would be 10.
Your answer
What is your organization's maximum non-emergency occupancy for women? *
Please enter the maximum number of women that your can reside with your organization at one time. Please do not include any emergency-only occupancy (i.e. couches) or staff occupancy.
Your answer
What is your organization's maximum non-emergency occupancy for born children? *
Please enter the maximum number of born children that your home can serve at one time. Please do not include emergency-only occupancy.
Your answer
Which of the following best describes your organization's policy towards housing born children? *
What is the maximum number of children per family allowed in your home? *
Please enter the maximum number of children per family allowed in your home, including the unborn child and any additional children. For example, if your home serves pregnant mothers with up to three other born children, enter 4.
Your answer
Which of the following services does your program provide directly or through a close partner? *
Please check all that apply.
Required
Of the women you housed in 2018, how many have related a personal experience of trauma? *
Please enter the number of women your organization housed in 2018 that related a personal experience of trauma to someone in your organization. This response is used to generate a percentage of the number of residents who have experienced trauma.
Your answer
Of the women you housed in 2018, how many had a mental health diagnosis? *
Please enter the number of new residents who have received a mental health diagnosis from a medical professional. This response is used to generate a percentage of the number of residents who have a mental health diagnosis.
Your answer
Feedback
If you have any feedback to improve this tool, please enter it here. Thanks!
Your answer
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