OUTCOME MEASURES DATA COLLECTION 10/08

CLIENT SERVICE GROUP: SHELTER SERVICE

Our agency has a funder that requires us to report data on what you feel you have learned during your stay in shelter. Please complete this form as instructed by the staff person that provided it to you. Check 1 box for each question.

Yes No

1. I know more ways to plan for my safety.

  1. I know more about community resources.

OUTCOME MEASURES DATA COLLECTION 10/08

CLIENT SERVICE GROUP: SHELTER SERVICE

Our agency has a funder that requires us to report data on what you feel you have learned during your stay in shelter. Please complete this form as instructed by the staff person that provided it to you. Check 1 box for each question.

Yes No

1. I know more ways to plan for my safety.

2. know more about community resources.

OUTCOME MEASURES DATA COLLECTION 10/08

CLIENT SERVICE GROUP: SHELTER SERVICE

Our agency has a funder that requires us to report data on what you feel you have learned during your stay in shelter. Please complete this form as instructed by the staff person that provided it to you. Check 1 box for each question.

Yes No

1. I know more ways to plan for my safety.

2. I know more about community resources.

OUTCOME MEASURES DATA COLLECTION 10/08

CLIENT SERVICE GROUP: SUPPORT GROUPS

Our agency has a funder that requires us to report data on what you feel you have learned during support groups you have attended. Please complete this form as instructed by the staff person that provided it to you. Check 1 box for each question.

Yes No

1. I know more ways to plan for my safety.

2. I know more about community resources.

OUTCOME MEASURES DATA COLLECTION 10/08

CLIENT SERVICE GROUP: SUPPORT GROUPS

Our agency has a funder that requires us to report data on what you feel you have learned during support groups you have attended. Please complete this form as instructed by the staff person that provided it to you. Check 1 box for each question.

Yes No

1. I know more ways to plan for my safety.

2. I know more about community resources.

OUTCOME MEASURES DATA COLLECTION 10/08

CLIENT SERVICE GROUP: SUPPORT GROUPS

Our agency has a funder that requires us to report data on what you feel you have learned during support groups you have attended. Please complete this form as instructed by the staff person that provided it to you. Check 1 box for each question.

Yes No

1. I know more ways to plan for my safety.

2. I know more about community resources.

OUTCOME MEASURES DATA COLLECTION 10/08

CLIENT SERVICE GROUP: SUPPORTIVE SERVICES/ADVOCACY

Our agency has a funder that requires us to report data on what you feel you have learned while receiving supportive services and advocacy. Please complete this form as instructed by the staff person that provided it to you. Check 1 box for each question.

Yes No

1. I know more ways to plan for my safety.

  1. I know more about community resources.

OUTCOME MEASURES DATA COLLECTION 10/08

CLIENT SERVICE GROUP: SUPPORTIVE SERVICES/ADVOCACY

Our agency has a funder that requires us to report data on what you feel you have learned while receiving supportive services and advocacy. Please complete this form as instructed by the staff person that provided it to you. Check 1 box for each question.

Yes No

1. I know more ways to plan for my safety.

2. I know more about community resources.

OUTCOME MEASURES DATA COLLECTION 10/08

CLIENT SERVICE GROUP: SUPPORTIVE SERVICES/ADVOCACY

Our agency has a funder that requires us to report data on what you feel you have learned while receiving supportive services and advocacy. Please complete this form as instructed by the staff person that provided it to you. Check 1 box for each question.

Yes No

1. I know more ways to plan for my safety.

2. I know more about community resources.