DataCollectionForm - V2.0.xlsx
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ABCDEFGHIJKLMNOPQRSTUVWXYZ
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Service LegendsAgency NameService DescriptionStaff ContactPopulation ServedStreet Address 1Suite NumberCity StateZip CodePhoneHours of OperationWebsite
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(If you provide more than one "Service", please list seperately on different rows. Be sure to provide all other information requested for each service listed)
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_____
Please Include our information in your data base but not in your mapping program
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Please do not include our information in either your data base or your mapping program
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_____
Please include our information in both your data base and your mapping program.
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Service Legends
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REL (Faith Based Organizations)
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ES (Emergency Shelter) - Temporary shelter (i.e. emergency and winter shelters)
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DV (Domestic Violence Programs) - Programs for women, men and families needing to escape unsafe violent circumstances, also provides other services (i.e. legal counseling, therapy, social services, etc.)
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BH (Bridge Housing) - Short term housing to help homeless individuals/families find a safe environment to live in (i.e. shelters, group housing, sober living, etc.)
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PSH (Permanent Supportive Housing) – Help locate permanent (long term) housing (i.e. affordable housing, supportive housing, section 8, etc.)
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CM (Case Management) – Connection to direct service providers (i.e. case planning, guidance and crisis intervention)
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RA (Rental Assistance) – Aid in financial assistance in order to assist in financial independence (i.e. rent, motel vouchers, etc.)
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UA (Utility Assistance) – Support/Aid with household utilities (i.e. electric, gas, etc.)
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FB (Food Bank) – FREE food assistance (i.e. canned, packaged, meals on wheels, etc.)
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LS (Legal Services) – Free or low cost legal services (i.e. legal aid)
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MHS (Mental Health Services) – Counseling (individual and group), medication, focus on mental health stability and wellness
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CA (Clothing Assistance) – FREE clothing
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SS (Supportive Services) – Assistance in: job training, resume workshops, legal and medical services, education (GED), life skills classes, substance abuse treatment, referral services, clothing, and transportation services.
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EES (Employment/Educational Services) – Educational services (i.e. tutoring and assistance with homework) and Employment services (i.e. job search, advocacy, direct placement, job resources) also includes training on use of equipment (i.e. internet, fax machine, etc.)
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HCS (Health Care Services) – Care of physical well-being focusing on prevention, treatment and management of illness
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Other (O) – please specify in organization description
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