Please Complete this Survey if Your Agency Provides Housing, Shelter, and/or Services to the Homeless.

    If you prefer to complete a paper survey, please download the form here. Please note: this survey will be shared with the Lee County Continuum of Care Governing Board. Make sure that only ONE response is submitted per agency.

    Section I: Agency Contact Information

    Section II: Housing/Shelter Program or Agency Type. Click "Working Definitions" here for explanation of housing types

    Emergency Shelter

    Indicate the total number of each type of Emergency Shelter

    Family Units
    Target Population (See Target Populations here)

    Family Beds
    Target Population (See Target Populations here)

    Individual Beds
    Target Population (See Target Populations here)

    Total Number of Beds (Cumulative Total)
    Target Population (See Target Populations here)

    Additional Comments

    Transitional Housing

    Indicate the total number of each type of Transitional Housing

    Family Units
    Target Population (See Target Populations here)

    Family Beds
    Target Population (See Target Populations here)

    Individual Beds
    Target Population (See Target Populations here)

    Total Number of Beds (Cumulative Total)
    Target Population (See Target Populations here)

    Additional Comments

    Permanent Supportive Housing

    Indicate the total number of each type of Permanent Supportive Housing

    Family Units
    Target Population (See Target Populations here)

    Family Beds
    Target Population (See Target Populations here)

    Individual Beds
    Target Population (See Target Populations here)

    Total Number of Beds (Cumulative Total)
    Target Population (See Target Populations here)

    Additional Comments

    Rapid ReHousing/Rental Assistance

    Indicate the total number of each type of Rapid ReHousing/Rental Assistance

    Family Units
    Target Population (See Target Populations here)

    Family Beds
    Target Population (See Target Populations here)

    Individual Beds
    Target Population (See Target Populations here)

    Total Number of Beds (Cumulative Total)
    Target Population (See Target Populations here)

    Additional Comments

    Other Permanent Housing

    Indicate the total number of each type of Other Permanent Housing

    Family Units
    Target Population (See Target Populations here)

    Family Beds
    Target Population (See Target Populations here)

    Individual Beds
    Target Population (See Target Populations here)

    Total Number of Beds (Cumulative Total)
    Target Population (See Target Populations here)

    Additional Comments

    Medical Housing

    Indicate the total number of each type of Medical Housing

    Family Units
    Target Population (See Target Populations here)

    Family Beds
    Target Population (See Target Populations here)

    Individual Beds
    Target Population (See Target Populations here)

    Total Number of Beds (Cumulative Total)
    Target Population (See Target Populations here)

    Additional Comments

    How many new units were added this year (Feb 1st 2016 to current date)? Leave at zero if no new units were added.

    How many new units are currently under development? Leave at zero if no new units were added.
    Additional Comments

    Section III: Services Provided

    Mortgage AssistanceStreet OutreachAlcohol & Drug AbuseEmploymentRental AssistanceMobile ClinicMental Health CounselingChild CareUtilities AssistanceLaw EnforcementHealthcareTransportationCounseling / AdvocacyCase ManagementHIV / AIDSFood ServicesLegal AssistanceLife SkillsEducationTANFSocial Security Insurance (SSI)SSDISNAP/Food StampsSubstance Abuse ProgramsMedicaidPrivate/Subsidized Health Ins.Educational ServicesMedicare

    Section IV: Organization Coordinated Assessment Satisfaction Survey

    Responses will be used for the improvement of the CoC's Coordinated Assessment System only, and will not affect funding or performance evaluations for the responding agency.

    If yes, was the overall experience satisfactory for your agency and client(s)? Explain.

    If not, why did you not refer or receive clients?