15-Appendix G1 - Monthly Data - Survivor.xlsx
XLSX spreadsheet 194 KB Posted
- Attached to
- Domestic Violence Services
- Solicitation number
- 26-690-4000-34051
- Issued by
- New Mexico
About this file
This document is a Monthly Data Collection Tool for Survivor Services from the Children, Youth and Families Department (CYFD) in New Mexico, designed to track and report comprehensive data on domestic violence services throughout fiscal year 2026. The tool requires monthly reporting across multiple dimensions, including program participant counts in congregate and alternate shelters, supportive services, demographic information, services delivered, community education efforts, and personnel changes. The reporting is mandatory for each month, with a special emphasis on July, where all participants are considered "new" to allow for accurate annual aggregate reporting as per federal Family Violence Prevention and Services Act (FVPSA) guidelines.
The data collection tool is intricately designed to capture detailed metrics such as shelter bed nights, unmet shelter requests, participant demographics, survivor services delivered, and community outreach activities. Providers are required to estimate the percentage of survivor services funded by CYFD each month, including all grant sources, private funding, and reserves. The reporting serves multiple purposes: meeting federal reporting requirements, providing foundational information for state administration and legislature, enabling program management, and serving as a direct report to organizational boards and other funders. The annual submission is due by July 30, 2024, and includes an unduplicated count of program participants receiving specific services between July 1, 2023, and June 30, 2024.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 10-RFP Appendix G CYFD BHS DV Unit Allowable Costs FY22 V1 FINAL (4).pdf | ||
| 3-APPENDIX D.docx | DOCX document | |
| 18-RFP 26-690-4000-34051 DV Services - Cost Reimbursement.docx | DOCX document | |
| 7-Attachment D1 - FY26 DVOTI DV PROJECT PROVIDER BudgetPlan.xlsx | XLSX spreadsheet | |
| 13-Worksheet D2.xlsx | XLSX spreadsheet | |
| 12-Worksheet D1.xlsx | XLSX spreadsheet | |
| 1-APPENDIX A.docx | DOCX document | |
| 8-Attachment D1 - FY26 SURVIVOR DV PROJECT PROVIDER BudgetPlan.xlsx | XLSX spreadsheet | |
| 5-APPENDIX F.docx | DOCX document | |
| 4-APPENDIX E.docx | DOCX document | |
| 2-APPENDIX B.docx | DOCX document | |
| 16-Appendix G2 - Monthly Data - DVOTI.xlsx | XLSX spreadsheet | |
| 17-RFP 26-690-4000-34051 DV Services - Cost Reimbursement.pdf | ||
| 11-RFPMonthly Data - DVOTI - CYFD SFY26 (4).xlsx | XLSX spreadsheet | |
| 6-Attachment D1 - FY26 CCBP DV PROJECT PROVIDER BudgetPlan.xlsx | XLSX spreadsheet | |
| 9-DVOTI Service Definitions (1).pdf | ||
| 14-Appendix H BudgetPlan.xlsx | XLSX spreadsheet |
Show all 17
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Data Definitions
| Data Definitions |
| Header Information |
| Please enter your program name, the person completing the report (that we can contact if there are questions), make sure you are in the correct reporting month, and enter your best estimate of the percentage of all of your survivor services that are funded by CYFD for the month, including all grant sources, private funding, and reserves. |
Note on estimation: We understand that part of your funding that is dedicated to survivor services may come from anticipated grants and private donations - or that your fiscal year may be different than the State Fiscal Year - and that your projections may change during the course of the year. Please use your current best estimate of the percentage of funding that came from CYFD for the current reporting month.
| Monthly Program Participant Count |
| The first time you work with a survivor and each of their dependents during the state fiscal year (July-June), they are counted as a NEW participant. In all subsequent months you provide services to that individual during the fiscal year, they are counted as a continuing program participant. In other words, each person you work with during the fiscal year is counted once, and only once, as a new program participant. |
Special Note on July: ALL program participants you work with in July, even if they were already in your program as of July 1, are counted as new program participants in July, including their demographics.
| Participant Count Categories |
| Each Program Participant is counted once each month – either as a new or continuing program participant - within the following three categories: |
| Congregate Shelter |
| Traditional congregate shelter settings, which include shared spaces for residents. |
| Alternate Shelter |
| Provision of temporary shelter (plus supportive services) in non-congregate settings, including program-owned apartments, program-sponsored hotel rooms and safe homes (residences of volunteers who offer their private homes for short-term crisis situations), or other temporary housing that your program arranges. Safe housing in non-congregate settings may be, but does not need to be, owned or managed by the service provider. |
Alternate shelter does not include transitional or permanent housing. Survivors and their dependents receiving supportive services who are in transitional or permanent housing programs sponsored by your organization should be counted in the “Supportive Services Participant” count.
| Supportive Services Only |
| Number of domestic violence survivors who received only non-shelter services. Include only program participants that received supportive services without no shelter by your program. Do not include people who made calls to a crisis line or hotline without any other program entry. |
| Additional Notes |
| Changing Categories |
| Program participants can only be counted in one category each month (Shelter, Alternate Shelter, or Supportive Services Only). If they move between these categories in subsequent months, they will be “Continuing” participants in the additional category. |
| Absences from Services |
| Residents who were previously counted as new during the fiscal year can only be counted as "continuing" in any subsequent month during the state fiscal year, regardless of any absence from services. |
| Multiple Programs |
| Program Participants who were referred from another domestic violence shelter program during the fiscal year are counted as “new” participants within your report (unless they previously received services from your program). The unduplicated count is within your individual program only, and is not a statewide count. Reported knowledge of services between programs would violate federal confidentiality rules. |
| Shelter Capacity and Bed Nights |
| Total Regular Beds Available in Shelter |
| Indicate the total beds available in your congregate shelter program, without counting overflow resources (such as pull out couches, roll-away beds, etc.). This number my fluctuate, due to circumstances such as repairs, throughout the year. |
| Total Congregate Shelter Nights Provided |
| Indicate the number of shelter nights for each person who arrives and is provided a bed within a congregate shelter setting. Include survivors of domestic violence and their dependents. |
Count the number of people housed times the number of nights. For example, a survivor and her 3 children stay in the shelter for 5 nights; this means 4 people x 5 nights = 20 shelter nights. Nights that a survivor stays in shelter not managed or sponsored by your program should not be counted (e.g., a shelter in a nearby county).
| Total Alternate Shelter Nights Provided |
| Indicate the number of shelter nights for each person who arrives and is provided a bed in a non-congregate setting, including program-sponsored hotel rooms and safe homes (residences of volunteers who offer their private homes for short-term crisis situations) or other temporary housing that your program arranges. Include survivors of domestic violence and their dependents. |
| Unmet Requests for Shelter |
| Count the number of unmet requests for shelter due to program shelter, safe homes or sponsored hotel rooms being at capacity or unavailable. Count adult survivors of domestic violence only. This count should not include individuals who were not served because their needs were inappropriate for the services of your program, e.g., homelessness not related to domestic violence. Count the total number of times requests for shelter were declined, even if the program provided other services. |
| Participant Demographics |
| Report the demographics for each program participant once, and only once, during the fiscal year. In July, all participants are considered "New" in order to gain a complete count of program participants under aggregate reporting rules. |
| Age |
| Report the ages of the survivors and their dependents, including children and youth. These age demographic totals should equal the program’s total count of new program participants for the month. For example, if the program served 20 women, 24 children, 2 men, and one gender-nonspecific person (47 total), the total for all the ages should also add up to 47. |
| Race/Ethnicity |
| Report the race and/or ethnicity of the program participants served, including children and youth. Participants may self-identify in more than one category, e.g., White and Hispanic. Therefore, the total of the Race/Ethnicity count must be equal to or greater the total count of new program participants for the month. |
| LGBTQ |
| This is a count of new program participants who self-identify as lesbian, gay, bisexual, transgender or queer. |
| Survivor Services |
| The monthly count of services are based on the total number of services delivered, regardless of the number of survivors who receive those services. In other words, if a participant attends 4 counseling sessions, it would count as "4" in this section of the report. |
| Crisis/Hotline Calls |
| Calls received on any agency line that relate to an individual or family in need of some kind of service. A program does not have to have a dedicated hotline to count these calls. Count all calls including repeat callers and calls from third parties such as a family member. Do not count calls about donations or for general information about program or violence issues unrelated to a specific individual or family, calls from the media, etc. |
| Crisis Intervention |
| Process by which a person identifies, assesses, and intervenes with an individual in crisis so as to restore balance and reduce the effects of the crisis in her/his life. In this category, report crisis intervention that occurs in person and/or over the telephone with an established client. This does not include hotline calls where the caller isn’t a client receiving services. |
| Victim Advocacy |
| Actions designed to help the survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc. |
| Individual/Group Counseling |
| Individual or group counseling or support sessions provided by a volunteer, staff or advocate. |
| Criminal or Civil Legal Advocacy |
| Actions designed to help the survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc. This only includes services for adult survivors. |
| Criminal or Civil Legal Representation |
| Actions by an attorney acting as a formal representative of a survivor in civil or criminal legal matters related to domestic violence. |
| Medical Accompaniment |
| Accompanying a survivor of domestic violence to, or meeting a survivor at, a hospital, clinic, or medical office. This only includes services for adult survivors. |
| Transportation |
| Provision of transportation, either directly or through bus passes, taxi fares, or other means of transportation. This only includes services for adult survivors. |
| Requests for Language Services |
| Provision of interpretation and/or translation. Provision of English as a second language class. This only includes services for adult survivors. |
| Services for Victims of Dating Violence |
| This is a count of all of the youth age 13-17 receiving services due to being a victim of dating violence in their own relationships. These youth could be receiving services on their own, as an emancipated minor or other minor eligible to receive services, or could be a youth who accompanies their parent to shelter and self-identifies as needing their own services. |
| Community Education |
| Youth Targeted Education |
| Count the total number of presentations or trainings about domestic violence, dating violence, healthy relationships or available services for survivors. In addition, count the number of individuals in attendance. Some examples may be a presentation to youth in school on healthy relationships or a workshop for youth at a Safety Day event. |
| Education Focused on Adults or Mixed Groups |
| Count the total number of presentations or trainings about domestic violence and/or services related to survivors of domestic violence and their children. In addition, count the number of individuals in attendance. Some examples may be a training for health professionals or a workshop for tribal leaders. Include all presentations for a mixed-age audience. This number does not include health fairs, media interviews or advertising. |
| Tabling or Other Passive Awareness Events |
| Count the total number of tabling events at community events, health fairs, etc. |
| Program-hosted Community Events |
| Events such as a Domestic Violence Awareness Month event in a community. |
| Media Interviews |
| Count the total number of interviews on public media, including radio, podcasts, newspapers, and television. |
| Social Media (Posts/Views) |
| Count the total number of posts on social media and a snapshot of the number of monthly views of all postings as of the date of the report. If posting the same content on multiple platforms (Facebook, LinkedIn, Instagram, etc.) count each post multiple times. |
| Story or Stories |
| You may share a story each month of the reporting or a few times during the course of the year. You can share a story about a program participant (without sharing any personally-identifying information), service or community initiative that could be shared with other stakeholders; your efforts to serve underserved populations in your community, including populations underserved because of ethnic, racial, cultural or language diversity, sexual orientation or gender identity or geographic isolation; significant prevention and outreach activities, supported in whole or in part by your FVPSA grant, during the program year; or any additional information that you would like us to know about your domestic violence program, i.e., the unmet needs of survivors in your community, other funding sources used for programming or service trends that are emerging in your community. |
| Personnel |
| New Project Personnel |
| List any new survivor services personnel. Please indicate the percentage of salary funded by CYFD. If CYFD funds the position (in part or in whole), submit two initial paychecks along with the monthly billing invoice. If paychecks are not yet available, include them in the next billing. |
| Exiting Project Personnel |
| List any personnel who are no longer working on survivor services at the end of the month. Please include whether they are taking different duties within the agency or have terminated employment with the agency. |
| Vacant Positions |
| A count of the number of vacant positions within the Survivor Services Project as of the last day of the reporting month. |
Instructions
| Instructions |
| Purpose |
| Monthly Data Reports are incredibly important. The information they provide is required by our federal funder (Administration for Children and Families/FVPSA) and is foundational to domestic violence information that is regularly presented to the State's Administration and Legislature. Additionally, providers are using these monthly data reports as a direct report to their Boards of Directors and other funders. We hope you will find them useful as you manage your own program. |
| Data Definitions |
| Please review the Data Definitions (separate tab) and work to provide the best information possible each month. If you discover mistakes with already-submitted data, please alert the DV Unit so that we can also correct the information in our database. |
| Monthly Submission Instructions |
| A completed monthly data form is a required part of each month's invoice package, and must be submitted before the DV Unit can approve payment. |
Each monthly report is located on a separate worksheet (look for the tabs at the bottom of the workbook). Please complete the appropriate tab, which is labled by month. When the data is complete, print the worksheet to a pdf (File=>Print) or to paper and scan. Upload the completed monthly data report into BHSDstar as part of the invoice package. NOTE: In July, all program participants are considered "new". This allows us to have an accurate annual aggregate count as per FVPSA guidelines.
| Annual Data Submission Instructions |
| The "Annual Data" tab contains the final reporting requirement of the fiscal year: an unduplicated count of the number of program participants that received a particular service between July 1, 2023 and June 30, 2024, due on July 30, 2024. These numbers are required by our federal funder. Due to the aggregate reporting of monthly reports, we are unable to collect this information any other way. |
The top of this report summarizes the total services delivered in each category. The number of program participants who received each service must be less than the total services delivered.
Example: Jayne Smith attended 10 support groups during the fiscal year. This would result in one (1) group participant in the count.
| Annual Summary |
| The last tab is an "Annual Summary" that totals the monthly worksheets and provides a few graphs of your organization's data. This is included for each provider's tracking and reporting purposes and is not a worksheet that you need to provide to CYFD. |
Jul
| FY26 CYFD Monthly Data Collection Tool | ||
| Survivor Services Project | ||
| Provider Name: | ||
| Person Completing Form: | ||
| Month: | July | Count ALL program participants as new in July, in order to have an accurate aggregate annual count as per FVPSA guidelines. |
| Percentage of Survivor Services Project Funded by CYFD this month: | ||
| Monthly Program Participant Count | ||
| Congregate Shelter Residents | New Residential Participants | |
| Adult Women | ||
| Adult Men | ||
| Adult Gender Other or Not Specified | ||
| Children (0-12) and Youth (13-17) | ||
| Totals: | 0 |
| Total Regular Beds Available in Congregate Shelter: |
| Total Congregate Shelter Bed Nights Provided: |
| Alternate Shelter Residents | New Alternate Shelter Participants | |
| Adult Women | ||
| Adult Men | ||
| Adult Gender Other or Not Specified | ||
| Children (0-12) and Youth (13-17) | ||
| Totals: | 0 |
Total Alternate Shelter Nights Provided:
Total Unmet Requets for Shelter:
| Supportive Servics Participant Only (Non-Shelter) | New Non-Shelter Participants | |
| Adult Women | ||
| Adult Men | ||
| Adult Gender Other or Not Specified | ||
| Children (0-12) and Youth (13-17) | ||
| Totals: | 0 |
Total Program Participants: 0
| Program Participant Demographics | ||
| In July (only), the demographics of all continuing program participants are collected in order to comply with the data collection requirements of our federal funder and allow an annual count of ALL program participants in New Mexico. In subsequent months, only demographics of NEW program participants are counted in this section. | ||
| Age | New | |
| 0-12 | ||
| 13-17 | ||
| Unknown Child/Youth Age | ||
| 18-24 | ||
| 25-59 | ||
| 60+ | ||
| Unknown Adult Age | ||
| Total | 0 |
| Race/Ethnicity (participants may self-identify in more than one category) | New | |
| Black or African American | ||
| American Indian/Alaska Native | ||
| Asian | ||
| Hispanic or Latino | ||
| Native Hawaiian/Other Pacific Islander | ||
| White | ||
| Unknown/Other | ||
| Total | 0 |
| LGBTQ | New |
| Number self-identifying as lesbian, gay, bisexual, trasgender, or queer |
| Survivor Services Delivered this Month | Children & Youth | Adults |
| A count of individual services delivered to new AND continuing program participants | ||
| Crisis/Hotline Calls (one count, regardless of age) | ||
| Crisis Intervention |
David River: Process by which a person identifies, assesses, and intervenes with an individual in crisis so as to restore balance and reduce the effects of the crisis in her/his life. In this category, report crisis intervention that occurs in person and/or over the telephone with an established program participant. This does not include hotline calls where the caller isn’t a survivor receiving services. Victim Advocacy
David River: Actions designed to help the survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc. Individual or Group Counseling/Support
David River: Individual or group counseling or support provided by a volunteer, staff or advocate. Criminal or Civil Legal Advocacy
David River: Actions designed to help the survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc. This only includes services for adult survivors and does not include formal attorney representation.
David River: Enter your best estimate of the percentage of all of your survivor services that are funded by CYFD for the month, including all grant sources, private funding, and reserves. Criminal or Civil Legal Represenation
David River: Formal attorney representation of a survivor in civil or criminal legal matters related to domestic violence. Medical Accompaniment
David River: Accompanying a survivor of domestic violence to, or meeting a survivor at, a hospital, clinic, or medical office. This only includes services for adult survivors. Transportation
David River: Provision of transportation, either directly or through bus passes, taxi fares, or other means of transportation. This only includes services for adult survivors. Requests for Language Services
David River: Provision of interpretation and/or translation. Provision of English as a second language class. This only includes services for adult survivors. Services for Victims of Dating Violence
David River: This is a count of all of the youth age 13-17 receiving services due to being a victim of dating violence in their own relationships. These youth could be receiving services on their own, as an emancipated minor or other minor eligible to receive services, or could be a youth who accompanies their parent to shelter and self-identifies as needing their own services.
| David River: Count the number of unmet requests for shelter due to program shelter, safe homes or sponsored hotel rooms being at capacity or unavailable. Count adult survivors of domestic violence only. This count should not include individuals who were not served because their needs were inappropriate for the services of your program, e.g., homelessness not related to domestic violence. Count the total number of times requests for shelter were declined, even if the program provided other services. | Community Education | Number of Presentations/Events | Estimated Number of People Reached |
| Youth-Targeted Education | |||
| Education Focused on Adults or Mixed Age Groups | |||
| Tabling or Other Passive Awareness Events | |||
| Program-Hosted Community Events | |||
| Media Interviews (Radio, Podcasts, Television) | |||
| Social Media (#Posts/#Views) | |||
| A Story or Stories (optional) |
New Survivor Project Personnel (include name(s), position(s), and % funded by CYFD)
Exiting Survivor Project Personnel (include name(s), position(s), and whether exiting or new role in agency)
Total Vacant Positions in Project at End of the Calendar Month:
Aug
| FY26 CYFD Monthly Data Collection Tool | |||
| Survivor Services Project | |||
| Provider Name: | |||
| Person Completing Form: | |||
| Month: | |||
| Percentage of Survivor Services Project Funded by CYFD this month: | |||
| Monthly Program Participant Count | |||
| Congregate Shelter Residents | New Residential Participants | Continuing Residential Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
| Total Regular Beds Available in Congregate Shelter: |
| Total Congregate Shelter Bed Nights Provided: |
| Alternate Shelter Residents | New Alternate Shelter Participants | Continuing Alternate Shelter Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
Total Alternate Shelter Nights Provided:
Total Unmet Requets for Shelter:
| Supportive Servics Participant Only (Non-Shelter) | New Non-Shelter Participants | Continuing Non-Shelter Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
Total New Program Participants: 0
| New Program Participant Demographics | ||
| Please only include NEW program participants in the following counts of Age, Ethnicity, and LBGTQ status. | ||
| Age | New | |
| 0-12 | ||
| 13-17 | ||
| Unknown Child/Youth Age | ||
| 18-24 | ||
| 25-59 | ||
| 60+ | ||
| Unknown Adult Age | ||
| Total (must equal 0): | 0 |
| Race/Ethnicity (participants may self-identify in more than one category) | ||
| Black or African American | ||
| American Indian/Alaska Native | ||
| Asian | ||
| Hispanic or Latino | ||
| Native Hawaiian/Other Pacific Islander | ||
| White | ||
| Unknown/Other | ||
| Total (must be equal to or greater than 0): | 0 |
| LGBTQ | New |
| Number self-identifying as lesbian, gay, bisexual, trasgender, or queer |
| Survivor Services Delivered this Month | Children & Youth | Adults |
| A count of individual services delivered to new AND continuing program participants | ||
| Crisis/Hotline Calls (one count, regardless of age) | ||
| Crisis Intervention |
David River: Process by which a person identifies, assesses, and intervenes with an individual in crisis so as to restore balance and reduce the effects of the crisis in her/his life. In this category, report crisis intervention that occurs in person and/or over the telephone with an established program participant. This does not include hotline calls where the caller isn’t a survivor receiving services. Victim Advocacy
David River: Actions designed to help the survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc. Individual or Group Counseling/Support
David River: Individual or group counseling or support provided by a volunteer, staff or advocate. Criminal or Civil Legal Advocacy
David River: Actions designed to help the survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc. This only includes services for adult survivors and does not include formal attorney representation.
David River: Enter your best estimate of the percentage of all of your survivor services that are funded by CYFD for the month, including all grant sources, private funding, and reserves.
Criminal or Civil Legal Represenation
David River: Formal attorney representation of a survivor in civil or criminal legal matters related to domestic violence. Medical Accompaniment
David River: Accompanying a survivor of domestic violence to, or meeting a survivor at, a hospital, clinic, or medical office. This only includes services for adult survivors. Transportation
David River: Provision of transportation, either directly or through bus passes, taxi fares, or other means of transportation. This only includes services for adult survivors. Requests for Language Services
David River: Provision of interpretation and/or translation. Provision of English as a second language class. This only includes services for adult survivors. Services for Victims of Dating Violence
David River: This is a count of all of the youth age 13-17 receiving services due to being a victim of dating violence in their own relationships. These youth could be receiving services on their own, as an emancipated minor or other minor eligible to receive services, or could be a youth who accompanies their parent to shelter and self-identifies as needing their own services.
| David River: Count the number of unmet requests for shelter due to program shelter, safe homes or sponsored hotel rooms being at capacity or unavailable. Count adult survivors of domestic violence only. This count should not include individuals who were not served because their needs were inappropriate for the services of your program, e.g., homelessness not related to domestic violence. Count the total number of times requests for shelter were declined, even if the program provided other services. | Community Education | Number of Presentations/Events | Estimated Number of People Reached |
| Youth-Targeted Education | |||
| Education Focused on Adults or Mixed Age Groups | |||
| Tabling or Other Passive Awareness Events | |||
| Program-Hosted Community Events | |||
| Media Interviews (Radio, Podcasts, Television) | |||
| Social Media (#Posts/#Views) | |||
| A Story or Stories (optional) |
New Survivor Project Personnel (include name(s), position(s), and % funded by CYFD)
Exiting Survivor Project Personnel (include name(s), position(s), and whether exiting or new role in agency)
Total Vacant Positions in Project at End of the Calendar Month:
Sept
| FY26 CYFD Monthly Data Collection Tool | |||
| Survivor Services Project | |||
| Provider Name: | |||
| Person Completing Form: | |||
| Month: | |||
| Percentage of Survivor Services Project Funded by CYFD this month: | |||
| Monthly Program Participant Count | |||
| Congregate Shelter Residents | New Residential Participants | Continuing Residential Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
| Total Regular Beds Available in Congregate Shelter: |
| Total Congregate Shelter Bed Nights Provided: |
| Alternate Shelter Residents | New Alternate Shelter Participants | Continuing Alternate Shelter Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
Total Alternate Shelter Nights Provided:
Total Unmet Requets for Shelter:
| Supportive Servics Participant Only (Non-Shelter) | New Non-Shelter Participants | Continuing Non-Shelter Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
Total New Program Participants: 0
| New Program Participant Demographics | ||
| Please only include NEW program participants in the following counts of Age, Ethnicity, and LBGTQ status. | ||
| Age | New | |
| 0-12 | ||
| 13-17 | ||
| Unknown Child/Youth Age | ||
| 18-24 | ||
| 25-59 | ||
| 60+ | ||
| Unknown Adult Age | ||
| Total (must equal 0): | 0 |
| Race/Ethnicity (participants may self-identify in more than one category) | ||
| Black or African American | ||
| American Indian/Alaska Native | ||
| Asian | ||
| Hispanic or Latino | ||
| Native Hawaiian/Other Pacific Islander | ||
| White | ||
| Unknown/Other | ||
| Total (must be equal to or greater than 0): | 0 |
| LGBTQ | New |
| Number self-identifying as lesbian, gay, bisexual, trasgender, or queer |
| Survivor Services Delivered this Month | Children & Youth | Adults |
| A count of individual services delivered to new AND continuing program participants | ||
| Crisis/Hotline Calls (one count, regardless of age) | ||
| Crisis Intervention |
David River: Process by which a person identifies, assesses, and intervenes with an individual in crisis so as to restore balance and reduce the effects of the crisis in her/his life. In this category, report crisis intervention that occurs in person and/or over the telephone with an established program participant. This does not include hotline calls where the caller isn’t a survivor receiving services. Victim Advocacy
David River: Actions designed to help the survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc. Individual or Group Counseling/Support
David River: Individual or group counseling or support provided by a volunteer, staff or advocate. Criminal or Civil Legal Advocacy
David River: Actions designed to help the survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc. This only includes services for adult survivors and does not include formal attorney representation.
David River: Enter your best estimate of the percentage of all of your survivor services that are funded by CYFD for the month, including all grant sources, private funding, and reserves.
Criminal or Civil Legal Represenation
David River: Formal attorney representation of a survivor in civil or criminal legal matters related to domestic violence. Medical Accompaniment
David River: Accompanying a survivor of domestic violence to, or meeting a survivor at, a hospital, clinic, or medical office. This only includes services for adult survivors. Transportation
David River: Provision of transportation, either directly or through bus passes, taxi fares, or other means of transportation. This only includes services for adult survivors. Requests for Language Services
David River: Provision of interpretation and/or translation. Provision of English as a second language class. This only includes services for adult survivors. Services for Victims of Dating Violence
David River: This is a count of all of the youth age 13-17 receiving services due to being a victim of dating violence in their own relationships. These youth could be receiving services on their own, as an emancipated minor or other minor eligible to receive services, or could be a youth who accompanies their parent to shelter and self-identifies as needing their own services.
| David River: Count the number of unmet requests for shelter due to program shelter, safe homes or sponsored hotel rooms being at capacity or unavailable. Count adult survivors of domestic violence only. This count should not include individuals who were not served because their needs were inappropriate for the services of your program, e.g., homelessness not related to domestic violence. Count the total number of times requests for shelter were declined, even if the program provided other services. | Community Education | Number of Presentations/Events | Estimated Number of People Reached |
| Youth-Targeted Education | |||
| Education Focused on Adults or Mixed Age Groups | |||
| Tabling or Other Passive Awareness Events | |||
| Program-Hosted Community Events | |||
| Media Interviews (Radio, Podcasts, Television) | |||
| Social Media (#Posts/#Views) | |||
| A Story or Stories (optional) |
New Survivor Project Personnel (include name(s), position(s), and % funded by CYFD)
Exiting Survivor Project Personnel (include name(s), position(s), and whether exiting or new role in agency)
Total Vacant Positions in Project at End of the Calendar Month:
Oct
| FY26 CYFD Monthly Data Collection Tool | |||
| Survivor Services Project | |||
| Provider Name: | |||
| Person Completing Form: | |||
| Month: | |||
| Percentage of Survivor Services Project Funded by CYFD this month: | |||
| Monthly Program Participant Count | |||
| Congregate Shelter Residents | New Residential Participants | Continuing Residential Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
| Total Regular Beds Available in Congregate Shelter: |
| Total Congregate Shelter Bed Nights Provided: |
| Alternate Shelter Residents | New Alternate Shelter Participants | Continuing Alternate Shelter Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
Total Alternate Shelter Nights Provided:
Total Unmet Requets for Shelter:
| Supportive Servics Participant Only (Non-Shelter) | New Non-Shelter Participants | Continuing Non-Shelter Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
Total New Program Participants: 0
| New Program Participant Demographics | ||
| Please only include NEW program participants in the following counts of Age, Ethnicity, and LBGTQ status. | ||
| Age | New | |
| 0-12 | ||
| 13-17 | ||
| Unknown Child/Youth Age | ||
| 18-24 | ||
| 25-59 | ||
| 60+ | ||
| Unknown Adult Age | ||
| Total (must equal 0): | 0 |
| Race/Ethnicity (participants may self-identify in more than one category) | ||
| Black or African American | ||
| American Indian/Alaska Native | ||
| Asian | ||
| Hispanic or Latino | ||
| Native Hawaiian/Other Pacific Islander | ||
| White | ||
| Unknown/Other | ||
| Total (must be equal to or greater than 0): | 0 |
| LGBTQ | New |
| Number self-identifying as lesbian, gay, bisexual, trasgender, or queer |
| Survivor Services Delivered this Month | Children & Youth | Adults |
| A count of individual services delivered to new AND continuing program participants | ||
| Crisis/Hotline Calls (one count, regardless of age) | ||
| Crisis Intervention |
David River: Process by which a person identifies, assesses, and intervenes with an individual in crisis so as to restore balance and reduce the effects of the crisis in her/his life. In this category, report crisis intervention that occurs in person and/or over the telephone with an established program participant. This does not include hotline calls where the caller isn’t a survivor receiving services. Victim Advocacy
David River: Actions designed to help the survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc. Individual or Group Counseling/Support
David River: Individual or group counseling or support provided by a volunteer, staff or advocate. Criminal or Civil Legal Advocacy
David River: Actions designed to help the survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc. This only includes services for adult survivors and does not include formal attorney representation.
David River: Enter your best estimate of the percentage of all of your survivor services that are funded by CYFD for the month, including all grant sources, private funding, and reserves.
Criminal or Civil Legal Represenation
David River: Formal attorney representation of a survivor in civil or criminal legal matters related to domestic violence. Medical Accompaniment
David River: Accompanying a survivor of domestic violence to, or meeting a survivor at, a hospital, clinic, or medical office. This only includes services for adult survivors. Transportation
David River: Provision of transportation, either directly or through bus passes, taxi fares, or other means of transportation. This only includes services for adult survivors. Requests for Language Services
David River: Provision of interpretation and/or translation. Provision of English as a second language class. This only includes services for adult survivors. Services for Victims of Dating Violence
David River: This is a count of all of the youth age 13-17 receiving services due to being a victim of dating violence in their own relationships. These youth could be receiving services on their own, as an emancipated minor or other minor eligible to receive services, or could be a youth who accompanies their parent to shelter and self-identifies as needing their own services.
| David River: Count the number of unmet requests for shelter due to program shelter, safe homes or sponsored hotel rooms being at capacity or unavailable. Count adult survivors of domestic violence only. This count should not include individuals who were not served because their needs were inappropriate for the services of your program, e.g., homelessness not related to domestic violence. Count the total number of times requests for shelter were declined, even if the program provided other services. | Community Education | Number of Presentations/Events | Estimated Number of People Reached |
| Youth-Targeted Education | |||
| Education Focused on Adults or Mixed Age Groups | |||
| Tabling or Other Passive Awareness Events | |||
| Program-Hosted Community Events | |||
| Media Interviews (Radio, Podcasts, Television) | |||
| Social Media (#Posts/#Views) | |||
| A Story or Stories (optional) |
New Survivor Project Personnel (include name(s), position(s), and % funded by CYFD)
Exiting Survivor Project Personnel (include name(s), position(s), and whether exiting or new role in agency)
Total Vacant Positions in Project at End of the Calendar Month:
Nov
| FY26 CYFD Monthly Data Collection Tool | |||
| Survivor Services Project | |||
| Provider Name: | |||
| Person Completing Form: | |||
| Month: | |||
| Percentage of Survivor Services Project Funded by CYFD this month: | |||
| Monthly Program Participant Count | |||
| Congregate Shelter Residents | New Residential Participants | Continuing Residential Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
| Total Regular Beds Available in Congregate Shelter: |
| Total Congregate Shelter Bed Nights Provided: |
| Alternate Shelter Residents | New Alternate Shelter Participants | Continuing Alternate Shelter Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
Total Alternate Shelter Nights Provided:
Total Unmet Requets for Shelter:
| Supportive Servics Participant Only (Non-Shelter) | New Non-Shelter Participants | Continuing Non-Shelter Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
Total New Program Participants: 0
| New Program Participant Demographics | ||
| Please only include NEW program participants in the following counts of Age, Ethnicity, and LBGTQ status. | ||
| Age | New | |
| 0-12 | ||
| 13-17 | ||
| Unknown Child/Youth Age | ||
| 18-24 | ||
| 25-59 | ||
| 60+ | ||
| Unknown Adult Age | ||
| Total (must equal 0): | 0 |
| Race/Ethnicity (participants may self-identify in more than one category) | ||
| Black or African American | ||
| American Indian/Alaska Native | ||
| Asian | ||
| Hispanic or Latino | ||
| Native Hawaiian/Other Pacific Islander | ||
| White | ||
| Unknown/Other | ||
| Total (must be equal to or greater than 0): | 0 |
| LGBTQ | New |
| Number self-identifying as lesbian, gay, bisexual, trasgender, or queer |
| Survivor Services Delivered this Month | Children & Youth | Adults |
| A count of individual services delivered to new AND continuing program participants | ||
| Crisis/Hotline Calls (one count, regardless of age) | ||
| Crisis Intervention |
David River: Process by which a person identifies, assesses, and intervenes with an individual in crisis so as to restore balance and reduce the effects of the crisis in her/his life. In this category, report crisis intervention that occurs in person and/or over the telephone with an established program participant. This does not include hotline calls where the caller isn’t a survivor receiving services. Victim Advocacy
David River: Actions designed to help the survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc. Individual or Group Counseling/Support
David River: Individual or group counseling or support provided by a volunteer, staff or advocate. Criminal or Civil Legal Advocacy
David River: Actions designed to help the survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc. This only includes services for adult survivors and does not include formal attorney representation.
David River: Enter your best estimate of the percentage of all of your survivor services that are funded by CYFD for the month, including all grant sources, private funding, and reserves.
Criminal or Civil Legal Represenation
David River: Formal attorney representation of a survivor in civil or criminal legal matters related to domestic violence. Medical Accompaniment
David River: Accompanying a survivor of domestic violence to, or meeting a survivor at, a hospital, clinic, or medical office. This only includes services for adult survivors. Transportation
David River: Provision of transportation, either directly or through bus passes, taxi fares, or other means of transportation. This only includes services for adult survivors. Requests for Language Services
David River: Provision of interpretation and/or translation. Provision of English as a second language class. This only includes services for adult survivors. Services for Victims of Dating Violence
David River: This is a count of all of the youth age 13-17 receiving services due to being a victim of dating violence in their own relationships. These youth could be receiving services on their own, as an emancipated minor or other minor eligible to receive services, or could be a youth who accompanies their parent to shelter and self-identifies as needing their own services.
| David River: Count the number of unmet requests for shelter due to program shelter, safe homes or sponsored hotel rooms being at capacity or unavailable. Count adult survivors of domestic violence only. This count should not include individuals who were not served because their needs were inappropriate for the services of your program, e.g., homelessness not related to domestic violence. Count the total number of times requests for shelter were declined, even if the program provided other services. | Community Education | Number of Presentations/Events | Estimated Number of People Reached |
| Youth-Targeted Education | |||
| Education Focused on Adults or Mixed Age Groups | |||
| Tabling or Other Passive Awareness Events | |||
| Program-Hosted Community Events | |||
| Media Interviews (Radio, Podcasts, Television) | |||
| Social Media (#Posts/#Views) | |||
| A Story or Stories (optional) |
New Survivor Project Personnel (include name(s), position(s), and % funded by CYFD)
Exiting Survivor Project Personnel (include name(s), position(s), and whether exiting or new role in agency)
Total Vacant Positions in Project at End of the Calendar Month:
Dec
| FY26 CYFD Monthly Data Collection Tool | |||
| Survivor Services Project | |||
| Provider Name: | |||
| Person Completing Form: | |||
| Month: | |||
| Percentage of Survivor Services Project Funded by CYFD this month: | |||
| Monthly Program Participant Count | |||
| Congregate Shelter Residents | New Residential Participants | Continuing Residential Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
| Total Regular Beds Available in Congregate Shelter: |
| Total Congregate Shelter Bed Nights Provided: |
| Alternate Shelter Residents | New Alternate Shelter Participants | Continuing Alternate Shelter Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
Total Alternate Shelter Nights Provided:
Total Unmet Requets for Shelter:
| Supportive Servics Participant Only (Non-Shelter) | New Non-Shelter Participants | Continuing Non-Shelter Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
Total New Program Participants: 0
| New Program Participant Demographics | ||
| Please only include NEW program participants in the following counts of Age, Ethnicity, and LBGTQ status. | ||
| Age | New | |
| 0-12 | ||
| 13-17 | ||
| Unknown Child/Youth Age | ||
| 18-24 | ||
| 25-59 | ||
| 60+ | ||
| Unknown Adult Age | ||
| Total (must equal 0): | 0 |
| Race/Ethnicity (participants may self-identify in more than one category) | ||
| Black or African American | ||
| American Indian/Alaska Native | ||
| Asian | ||
| Hispanic or Latino | ||
| Native Hawaiian/Other Pacific Islander | ||
| White | ||
| Unknown/Other | ||
| Total (must be equal to or greater than 0): | 0 |
| LGBTQ | New |
| Number self-identifying as lesbian, gay, bisexual, trasgender, or queer |
| Survivor Services Delivered this Month | Children & Youth | Adults |
| A count of individual services delivered to new AND continuing program participants | ||
| Crisis/Hotline Calls (one count, regardless of age) | ||
| Crisis Intervention |
David River: Process by which a person identifies, assesses, and intervenes with an individual in crisis so as to restore balance and reduce the effects of the crisis in her/his life. In this category, report crisis intervention that occurs in person and/or over the telephone with an established program participant. This does not include hotline calls where the caller isn’t a survivor receiving services. Victim Advocacy
David River: Actions designed to help the survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc. Individual or Group Counseling/Support
David River: Individual or group counseling or support provided by a volunteer, staff or advocate. Criminal or Civil Legal Advocacy
David River: Actions designed to help the survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc. This only includes services for adult survivors and does not include formal attorney representation.
David River: Enter your best estimate of the percentage of all of your survivor services that are funded by CYFD for the month, including all grant sources, private funding, and reserves.
Criminal or Civil Legal Represenation
David River: Formal attorney representation of a survivor in civil or criminal legal matters related to domestic violence. Medical Accompaniment
David River: Accompanying a survivor of domestic violence to, or meeting a survivor at, a hospital, clinic, or medical office. This only includes services for adult survivors. Transportation
David River: Provision of transportation, either directly or through bus passes, taxi fares, or other means of transportation. This only includes services for adult survivors. Requests for Language Services
David River: Provision of interpretation and/or translation. Provision of English as a second language class. This only includes services for adult survivors. Services for Victims of Dating Violence
David River: This is a count of all of the youth age 13-17 receiving services due to being a victim of dating violence in their own relationships. These youth could be receiving services on their own, as an emancipated minor or other minor eligible to receive services, or could be a youth who accompanies their parent to shelter and self-identifies as needing their own services.
| David River: Count the number of unmet requests for shelter due to program shelter, safe homes or sponsored hotel rooms being at capacity or unavailable. Count adult survivors of domestic violence only. This count should not include individuals who were not served because their needs were inappropriate for the services of your program, e.g., homelessness not related to domestic violence. Count the total number of times requests for shelter were declined, even if the program provided other services. | Community Education | Number of Presentations/Events | Estimated Number of People Reached |
| Youth-Targeted Education | |||
| Education Focused on Adults or Mixed Age Groups | |||
| Tabling or Other Passive Awareness Events | |||
| Program-Hosted Community Events | |||
| Media Interviews (Radio, Podcasts, Television) | |||
| Social Media (#Posts/#Views) | |||
| A Story or Stories (optional) |
New Survivor Project Personnel (include name(s), position(s), and % funded by CYFD)
Exiting Survivor Project Personnel (include name(s), position(s), and whether exiting or new role in agency)
Total Vacant Positions in Project at End of the Calendar Month:
Jan
| FY26 CYFD Monthly Data Collection Tool | |||
| Survivor Services Project | |||
| Provider Name: | |||
| Person Completing Form: | |||
| Month: | |||
| Percentage of Survivor Services Project Funded by CYFD this month: | |||
| Monthly Program Participant Count | |||
| Congregate Shelter Residents | New Residential Participants | Continuing Residential Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
| Total Regular Beds Available in Congregate Shelter: |
| Total Congregate Shelter Bed Nights Provided: |
| Alternate Shelter Residents | New Alternate Shelter Participants | Continuing Alternate Shelter Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
Total Alternate Shelter Nights Provided:
Total Unmet Requets for Shelter:
| Supportive Servics Participant Only (Non-Shelter) | New Non-Shelter Participants | Continuing Non-Shelter Participants | |
| Adult Women | |||
| Adult Men | |||
| Adult Gender Other or Not Specified | |||
| Children (0-12) and Youth (13-17) | |||
| Totals: | 0 | 0 |
Total New Program Participants: 0
| New Program Participant Demographics | ||
| Please only include NEW program participants in the following counts of Age, Ethnicity, and LBGTQ status. | ||
| Age | New | |
| 0-12 | ||
| 13-17 | ||
| Unknown Child/Youth Age | ||
| 18-24 | ||
| 25-59 | ||
| 60+ | ||
| Unknown Adult Age | ||
| Total (must equal 0): | 0 |
| Race/Ethnicity (participants may self-identify in more than one category) | ||
| Black or African American | ||
| American Indian/Alaska Native | ||
| Asian | ||
| Hispanic or Latino | ||
| Native Hawaiian/Other Pacific Islander | ||
| White | ||
| Unknown/Other | ||
| Total (must be equal to or greater than 0): | 0 |
| LGBTQ | New |
| Number self-identifying as lesbian, gay, bisexual, trasgender, or queer |
| Survivor Services Delivered this Month | Children & Youth | Adults |
| A count of individual services delivered to new AND continuing program participants | ||
| Crisis/Hotline Calls (one count, regardless of age) | ||
| Crisis Intervention |
David River: Process by which a person identifies, assesses, and intervenes with an individual in crisis so as to restore balance and reduce the effects of the crisis in her/his life. In this category, report crisis intervention that occurs in person and/or over the telephone with an established program participant. This does not include hotline calls where the caller isn’t a survivor receiving services. Victim Advocacy
David River: Actions designed to help the survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc. Individual or Group Counseling/Support
Da…
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