Applicant:

Geographic Area to be Served/HUB:

Attachment 17: FACILITY SERVICES TABLE (Components A, B C only)

Applicants are required to list proposed service element detail by correctional facility within the region/HUB proposed /
Correctional Facility / Client Recruitment/Engagement / In Facility and Pre-Release Linkage and Navigation for HIV+ / Peer Education, Training
and Support /
Service/Frequency and Staff Delivering Service / # of Contacts Annually / Frequency and Staff Delivering Service / # of Clients Served
Annually / Service/Frequency and Staff Delivering Service / # of Clients Served Annually /
EXAMPLE
Bedford Hills / World AIDS Day Event 1x/yr: Health Services Specialist, Test Counselor
HCPI Presentation @ orientation 1Xwk: Test Counselor
VOICES/VOCES 1Xwk: Health Services Specialist / 250
200
125 / 4x/week: Linkage Specialist / 100 / Peer training 2x/yr: Health Services Specialist
Peer Educator Updates 4x/yr: Health Services Specialist
VOICES/VOCES for Peer Educators 2Xyr: Health Services Specialist / 24
24
24


Attachment 17: FACILITY SERVICES TABLE (Components A, B C only)

Applicants are required to list proposed service element detail by correctional facility within the region/HUB proposed /
Correctional Facility / Anonymous HIV Testing / Trauma Informed Interventions/Support Services (Female facilities only) /
Frequency and Staff Delivering Service / # of Clients Served
Annually / Service/Frequency and Staff Delivering Service / # of Clients Served Annually /
EXAMPLE
Bedford Hills / 1xweek: Test Counselor / 100 / Trauma Informed Supportive Counseling 4x/week: Program Coordinator
SHOW group 1Xweek: Health Services Specialist / 75
50

instructions:

To insert additional rows, at the end of the last completed row, press the “Tab” key on your computer keyboard .