Group Living Services (GLS) Grouping Chart - Private, Public, Canadian, Network
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Organization
Org ID #
City
State/Province
Instructions
Indicate the average number of residents from the previous month assigned to each group home, unit, or cottage. A "group" for this purpose is the unit of residents living together in one place. Make additional copies as needed.
Name of Cottage, Unit, or Group
# of Residents (Male)
# of Residents (Female)
Staff : Resident Ratio
Type of Facility
Clear selection
Function or Purpose
Clear selection
Licensed Capacity
Name of Cottage, Unit, or Group
# of Residents (Male)
# of Residents (Female)
Staff : Resident Ratio
Type of Facility
Clear selection
Function or Purpose
Clear selection
Licensed Capacity
Name of Cottage, Unit, or Group
# of Residents (Male)
# of Residents (Female)
Staff : Resident Ratio
Type of Facility
Clear selection
Function or Purpose
Clear selection
Licensed Capacity
Total number of individuals referred to the organization's group home(s) for placement this year
Of the above number, how many individuals were actually accepted/placed in the group home(s):
Average length of stay (days) of the total population in the last year:
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