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.
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