Exhibit_F_-_ADES_Domestic_Violence_Services_Quarterly_Report.xlsx

Quarterly Report

H-02 - What does this Contract allow you to do that you wouldn’t be able to do without this funding?

H-03 - Describe any efforts supported in whole or in part by this Contract to meet the needs of underserved populations in your community, including populations underserved because of ethnic, racial, cultural or language diversity, sexual orientation or gender identity, geographic isolation, or disability. Describe any ongoing challenges.

H-04 - Describe significant prevention and outreach activities, supported in whole or in part by this Contract, during this quarter.

H-05 - Provide information on the evaluation of the effectiveness of your domestic violence programming.

H-06 - Provide any additional information that you would like us to know about your domestic violence program (i.e., the unmet needs of victims in your community, other funding sources used for programming or service trends that are emerging in your community).

Instructions

Section A

[Total Domestic Violence Program Budget: This is the total annual budget for your domestic violence program. Grant dollars set aside to provide separate services to sexual assault victims would not be included here. In addition, a domestic violence program that is located within a larger social service agency would only include its budget for domestic violence programming. For example, a local domestic violence program that receives $50,000 from this Contract, $20,000 from their City for DV services and $10,000 from a private funder would report $80,000 as its total domestic violence program budget.]

[Number of Shelter Facilities: This is a count of your shelter facilities providing immediate housing to victims of domestic violence and their children managed by the domestic violence program. This normally includes only communal living spaces and other buildings owned or rented by the program. This number should not include safe homes, motels or shelter beds provided by other programs. Although this count of shelter facilities only includes property managed by the program, Section B (Clients Served in Shelter) asks you to count the number of clients who were provided shelter whether that be in a building managed by the program or a hotel or safe home.]

[Non-Shelter Services Sites: List the total number of service sites (i.e., office locations) where your program provides non-residential services. This may include the coordination of shelter for victims through hotels and safe homes where there is not a shelter facility. This number should be one (1) if the program has a single program site with no shelter facility. If your program maintains satellite locations, they should be counted here, i.e., one main office and two satellite offices should be reported as three (3) sites. This is not a count of the number of hotels and safe homes used.]

Section B

[LGBTQ: This is a count of clients who self-identify as lesbian, gay, bisexual, transgender or queer.]

[Teen 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 accompanying a client to a criminal court proceeding or law enforcement interview; and all other advocacy within the criminal justice system.] [Medical Accompaniment: Accompanying a domestic violence victim to, or meeting a victim at, a hospital, clinic, or medical office.] [Transportation Services: Provision of transportation, either directly or through bus passes, taxi fares, or other means of transportation.]

Section C

[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 victims 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.]

Section D

[Individual/Group Counseling: Individual or group counseling or support provided by a volunteer, staff or advocate.]

[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 Services: Actions designed to help the victim/survivor obtain needed resources or services including employment, housing, shelter services, health care, victim’s compensation, etc.]

[Criminal/Civil Legal Advocacy: Assisting a client with civil legal issues, including preparing paperwork for protection orders; accompanying a client to a protection order hearing, or other civil proceeding; and all other advocacy within the civil justice system. This also includes accompanying a client to an administrative hearing, such as unemployment, Social Security, TANF, or food stamp hearing. Assisting a client with criminal legal issues including notifying the client of case status, hearing dates, plea agreements, and sentencing terms; preparing paperwork such as victim impact statements; accompanying a client to a criminal court proceeding or law enforcement interview; and all other advocacy within the criminal justice system.]

[Medical Accompaniment: Accompanying a domestic violence victim to, or meeting a victim at, a hospital, clinic, or medical office.]

[Transportation Services: Provision of transportation, either directly or through bus passes, taxi fares, or other means of transportation.]

Section E Section E – Community Education

Section F

H-02 - What does the FVPSA grant allow you to do that you wouldn’t be able to do without this funding?

H-03 - Describe any efforts supported in whole or in part by your FVPSA grant to meet the needs of underserved populations in your community, including populations underserved because of ethnic, racial, cultural or language diversity, sexual orientation or gender identity or geographic isolation. Describe any ongoing challenges.

H-04 - Describe significant prevention and outreach activities, supported in whole or in part by your FVPSA grant, during the program year.

H-05 - Provide information on the evaluation of the effectiveness of your domestic violence programming.

H-06 - (Optional) Provide any additional information that you would like us to know about your FVPSA-supported domestic violence program, i.e., the unmet needs of victims in your community, other funding sources used for programming or service trends that are emerging in your community.

Section G

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