Contract Program Reportfor Legal Service Providers to
Victims of Family Violence for FY2014
______
Agency
______
Tax ID Number
______
Project Title
[ ] Monthly [ ] Quarterly [x ] Semi-annual [ ] Annual
______
6-month Period Covered by Report
Ms. Cynthia H. Clanton
General Counsel
Administrative Office of the Courts of Georgia
244 Washington Street, S.W., Suite 300
Atlanta, Georgia 30334-5900
Phone (404) 656-6692 email:
Project Narrative and Analysis for Period
Project Objectives Outlined in Grant Application / Status / Barriers / Anticipated Completion Date1.
2.
3.
4.
5.
Uniform Success Measures During the 6 Month Period
I. Type of Clients*:
Number
Women
Race:
African-American______
Asian______
Caucasian______
Hispanic______
Other______
Total Number of Women Assisted: ______
Children
Race:
African-American______
Asian______
Caucasian______
Hispanic______
Other______
Total Number of Children Assisted:______
Men
Race:
African-American______
Asian______
Caucasian______
Hispanic______
Other______
Total Number of Men Assisted ______
II. Legal Services to Clients:
Number **Complete attached worksheet
Second Temporary Protective Order______
Eviction______
Child Custody______
Family Support______
Housing Issues______
Employment Issues______
Property______
Public Benefits/TANF______
Financial/Consumer______
Other(Please Specify)______
Number of Repeat Clients______
(File Closed and Client Return)
*Clients= direct beneficiary of legal services (ex. Mother with 2 children= 1 client if mother is represented by attorney).
Number of Clients Referred from
Georgia Legal Services or Atlanta
Legal Aid______
Number of Clients Referred to
Georgia Legal Services or Atlanta
Legal Aid______
Percentage of Your Judicial CouncilDollar Amount of Award
Grant Award Used for Legal Services______%$______
To Clients
III. Outreach:
Number
Number of Participants
Trained and Educated about______
Domestic Violence with Your
Grant Award
Other Outreach Efforts:Number of Items Produced
Brochures______Manuals ______
Posters______
Web Site______
Speakers Bureau______
Other (Please Specify)______
Total ______
Percentage of Your Judicial CouncilDollar Amount of Award
Grant Award Used for Outreach______%$______
Percentage of Your Judicial CouncilDollar Amount of Award
Grant Award Used for Administrative______%$______
Purposes.
IV. Cost:
Average cost per client $______***
These numbers are accurate to the best of my knowledge and reflect this agency’s use of state funds for victims of family violence.
______
Director’s Signature
Tax ID #______
***Cost per client = Average amount of grant funds used for legal services per actual client (subtract the money used for outreach from the total grant award before computing the average; each service for the same client does not equal a “new client”).
FY2014