Point In Time Survey Letter

Balance of State Continuum of Care – Point in Time Survey

Data from July 27, 2011

By August 8, 2011 return this form with data collected on July 27, 2011 to:

Brent Wojnowski, ADVOCAP, Inc., Fond du Lac, WI 54936

(920) 922-7214 (fax) or email brentw@advocap.org

Your Organization’s Name: ______________________________________________

Address: ______________________________________________________________________________

Service Area/County(ies):___________________________________

Contact Person: ________________________________________________________________________

Phone Number: ___________________________ E-mail: _____________________________________

No homeless persons were identified. ____________________________

Table 1: Emergency Shelter & Motel Vouchers

Category	Persons Served – Number of persons in your emergency shelter or with motel vouchers on July 27	Turn Away – Number of persons you had to turn away from shelter or motel vouchers on July 27.
Households with children
Persons in households w/children (count all persons in the household )
Households without children
Number of persons in households without children

Table 2: Transitional Housing

Category	Persons Served – Number of persons in your transitional housing on July 27	Turn Away - Number of persons you had to turn away on July 27
Households with children
Persons in households w/children (count all persons in the household)
Households without children
Number of persons in households without children

Table 3: Unsheltered Homeless Persons (streets, parks, cars, campers, etc.)

Category	Persons – Number of unsheltered homeless persons you counted on July 27
Households with children
Persons in households w/children (count all persons in the household)
Households without children

Table 4: Of all the people included in the Tables 1 & 2, how many are in the following categories?

Category	Subpopulations Served – How many of the persons you served on July 27 in shelter, with motel vouchers or in transitional housing were in any of the following categories?
Seriously Mentally Ill
Chronic Substance Abuse
Veterans
Persons with HIV/AIDS
Victims of Domestic Violence
Unaccompanied Youth (I.e. runaways)

Table 5: Of all the people included in Tables 1 & 3, how many are in the following categories?

Category	Subpopulations Served – How many of the persons you served on July 27 in shelter or with motel vouchers were in any of the following categories? Do not include persons in transitional housing.	Subpopulations Served – How many of the persons NOT sheltered but counted or served on July 27 were chronically homeless?
Chronic Homelessness

A chronic homeless person can now include a family as well as a single person where one member has a disability, including substance abuse, that precludes their being able to obtain/maintain permanent housing and/or has been homeless for more than one year or has four episodes of homelessness in three years.