Exhibit J Shelter Diversion Quarterly Performance Report.xlsx
XLSX spreadsheet 30 KB Posted
- Attached to
- AZ|CTR079168
- Contract number
- CTR079168
- Issued by
- Arizona
About this file
This document is an Exhibit J Shelter Diversion Quarterly Performance Report template designed for the Department of Economic Security (DES) State Homeless Coordination Office. The report provides a standardized format for tracking and reporting shelter diversion program activities, intended to be completed by service providers on a quarterly basis throughout the contract period, which runs through June 30, 2026.
The report requires comprehensive data collection across three primary sections: Participant Demographics (Section A), which captures details about program participants including age, race, and other characteristics; Program Metrics (Section B), which tracks households served, assistance categories, and housing stability outcomes; and Narrative Responses (Section C), which mandates qualitative reporting on diversion activities, community partnerships, program impacts, and emerging service trends. The document is structured to help the DES State Homeless Coordination Office assess program effectiveness, identify barriers, and develop solutions for shelter diversion initiatives, with an emphasis on preventing homelessness and supporting housing stability.
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Instructions INSTRUCTIONS: Exhibit J_Shelter Diversion Quarterly Performance Report
Please follow these instructions when filling out your Shelter Diversion Quarterly Performance Report. The purpose of this report is not to reprimand providers, but to assist the DES State Homeless Coordination Office in tracking progress, identifing barriers, and assessing solutions for each program so they may succeed to their highest potential.
For each quarter of the contract period, please complete the appropriate tab with the requested data.
Section A: This report is a compilation of all shelter diversion activities. Please use Section A to provide demographic information on all program Participants.
Section B: Please use Section B to report out on all shelter diversion program metrics/outcomes
Section C: Please use Section C to provide narrative response and explanation to help support the data provided in Sections A and B
Q2
| Exhibit J |
| Shelter Diversion Quarterly Performance Report |
| Agency Name: | Contract #: | Contract Term: | Date of Latest Signature to June 30, 2026 | |
| Submitted by: | Email Address: | Date Submitted: | ||
| Reporting Month/Year: | Mark with "X" | |||
| Q1: Jul-Sep | ||||
| Q2: Oct-Dec | X | |||
| Q3: Jan-Mar | ||||
| Q4: Apr-Jun |
Section A – Participant Demographics
| Participant Totals | |
| Number of Program Participants | |
| Number of Children/Youth | |
| Adults: | |
| Number of Women | |
| Number of Men | |
| Number Not-specified/Other | |
| Total Participants Served: | 0 |
| Age | |
| 0-12 | |
| 13-17 | |
| Unknown Child Age | |
| 18-24 | |
| 25-49 | |
| 50-59 | |
| 60+ | |
| Unknown Adult Age | |
| Total | 0 |
| Race/Ethnicity | |
| Black or African American | |
| American Indian/ Alaska Native | |
| Asian | |
| Hispanic or Latino | |
| Native Hawaiian/ Other Pacific Islander | |
| White | |
| Unknown/Other | |
| Total | 0 |
| Other Demographics | |
| Number needing language services,such as interpretation | |
| Number self-identifying as lesbian, gay, bisexual, transgender or queer (LGBTQ) | |
| Number of youth age 13-17 receiving services due to being a victim of dating violence | |
| Number self-identifying as having a disability | |
| Total | 0 |
Section B - Program Metrics
| Households Served |
| Number of households (unduplicated) applied |
| Number of households assisted |
| Average dollars per household assisted |
| Households Served by Category | |
| Past due or future rent (i.e., up to 1 month of rent) | |
| Past due and/or future utilities, utility deposits | |
| Relocation to another community (pending confirmed housing opportunity) | |
| Move-in assistance (movers, furniture, kitchenware, welcome boxes); rental application fees, inspection/processing/admin fees, security/rental deposits, storage costs | |
| ID costs/expenses | |
| Childcare assistance | |
| Pet deposits; one-time pet fees | |
| Legal fees/expenses, prior judgments | |
| Car repair, car payment | |
| Insurance payment | |
| Clothing, including work uniforms and work supplies | |
| Employment-related expenses (starting job costs) | |
| Housing search/placement | |
| Air conditioning (repair/replace) | |
| Legal aid, credit repair | |
| Landlord engagement/mediation | |
| Other assistance deemed reasonable to divert household from homelessness | |
| Total | 0 |
| Success Metrics |
| Of the households presenting for assistance, how many maintained housing or were successfully prevented from housing instability? |
| Percentage of households that seek or return to emergency shelter within 3-6 months after receiving prevention assistance? |
| Percentage of households that require financial assistance to maintain housing or to prevent housing instability? |
| Stability Rate | |
| Quarterly Housing Stability Rate: | Enter for Current Quarter |
| Q1: Jul-Sep | |
| Q2: Oct-Dec | |
| Q3: Jan-Mar | |
| Q4: Apr-Jun |
Section C – Narrative Responses – MANDATORY – DO NOT SKIP
01 - Describe significant shelter diversion activities supported in whole or in part by this Contract, during this quarter.
Please provide thorough response here.
Use Ctrl+Enter to add additional lines.
02 - For services supported in whole or in part by this Contract, share a story about a Participant or Household (without sharing any personally-identifying information), service, or community initiative.
03 - What does this Contract allow you to do that you wouldn't be able to do without this funding?
04 - Describe any community collaborations or partnerships that contribute to the success of shelter diversion.
05 - Describe any participation in evaluation processes within the housing community which supports the learning and building of what effective diversion and prevention practices are.
06 - Provide any additional information that you would like us to know about the shelter diversion program (i.e., the unmet needs in your community, other funding sources used for programming or service trends that are emerging in your community).
Q3
| Exhibit J |
| Shelter Diversion Quarterly Performance Report |
| Agency Name: | Contract #: | Contract Term: | |
| Submitted by: | Email Address: | Date Submitted: | |
| Reporting Month/Year: | Mark with "X" | ||
| Q1: Jul-Sep | |||
| Q2: Oct-Dec | |||
| Q3: Jan-Mar | X | ||
| Q4: Apr-Jun |
Section A – Participant Demographics
| Participant Totals | |
| Number of Program Participants | |
| Number of Children/Youth | |
| Adults: | |
| Number of Women | |
| Number of Men | |
| Number Not-specified/Other | |
| Total Participants Served: | 0 |
| Age | |
| 0-12 | |
| 13-17 | |
| Unknown Child Age | |
| 18-24 | |
| 25-49 | |
| 50-59 | |
| 60+ | |
| Unknown Adult Age | |
| Total | 0 |
| Race/Ethnicity | |
| Black or African American | |
| American Indian/ Alaska Native | |
| Asian | |
| Hispanic or Latino | |
| Native Hawaiian/ Other Pacific Islander | |
| White | |
| Unknown/Other | |
| Total | 0 |
| Other Demographics | |
| Number needing language services,such as interpretation | |
| Number self-identifying as lesbian, gay, bisexual, transgender or queer (LGBTQ) | |
| Number of youth age 13-17 receiving services due to being a victim of dating violence | |
| Number self-identifying as having a disability | |
| Total | 0 |
Section B - Program Metrics
| Households Served |
| Number of households (unduplicated) applied |
| Number of households assisted |
| Average dollars per household assisted |
| Households Served by Category | |
| Past due or future rent (i.e., up to 1 month of rent) | |
| Past due and/or future utilities, utility deposits | |
| Relocation to another community (pending confirmed housing opportunity) | |
| Move-in assistance (movers, furniture, kitchenware, welcome boxes); rental application fees, inspection/processing/admin fees, security/rental deposits, storage costs | |
| ID costs/expenses | |
| Childcare assistance | |
| Pet deposits; one-time pet fees | |
| Legal fees/expenses, prior judgments | |
| Car repair, car payment | |
| Insurance payment | |
| Clothing, including work uniforms and work supplies | |
| Employment-related expenses (starting job costs) | |
| Housing search/placement | |
| Air conditioning (repair/replace) | |
| Legal aid, credit repair | |
| Landlord engagement/mediation | |
| Other assistance deemed reasonable to divert household from homelessness | |
| Total | 0 |
| Of the households presenting for assistance, how many maintained housing or were successfully prevented from housing instability? |
| Percentage of households that seek or return to emergency shelter within 3-6 months after receiving prevention assistance? |
| Percentage of households that require financial assistance to maintain housing or to prevent housing instability? |
| Quarterly Housing Stability Rate: | Enter for Current Quarter |
| Q1: Jul-Sep | |
| Q2: Oct-Dec | |
| Q3: Jan-Mar | |
| Q4: Apr-Jun |
Section C – Narrative Responses – MANDATORY – DO NOT SKIP
01 - Describe significant shelter diversion activities supported in whole or in part by this Contract, during this quarter.
02 - For services supported in whole or in part by this Contract, share a story about a Participant or Household (without sharing any personally-identifying information), service, or community initiative.
03 - What does this Contract allow you to do that you wouldn't be able to do without this funding?
04 - Describe any community collaborations or partnerships that contribute to the success of shelter diversion.
05 - Describe any participation in evaluation processes within the housing community which supports the learning and building of what effective diversion and prevention practices are.
06 - Provide any additional information that you would like us to know about the shelter diversion program (i.e., the unmet needs in your community, other funding sources used for programming or service trends that are emerging in your community).
Q4
| Exhibit J |
| Shelter Diversion Quarterly Performance Report |
| Agency Name: | Contract #: | Contract Term: | |
| Submitted by: | Email Address: | Date Submitted: | |
| Reporting Month/Year: | Mark with "X" | ||
| Q1: Jul-Sep | |||
| Q2: Oct-Dec | |||
| Q3: Jan-Mar | |||
| Q4: Apr-Jun | X |
Section A – Participant Demographics
| Participant Totals | |
| Number of Program Participants | |
| Number of Children/Youth | |
| Adults: | |
| Number of Women | |
| Number of Men | |
| Number Not-specified/Other | |
| Total Participants Served: | 0 |
| Age | |
| 0-12 | |
| 13-17 | |
| Unknown Child Age | |
| 18-24 | |
| 25-49 | |
| 50-59 | |
| 60+ | |
| Unknown Adult Age | |
| Total | 0 |
| Race/Ethnicity | |
| Black or African American | |
| American Indian/ Alaska Native | |
| Asian | |
| Hispanic or Latino | |
| Native Hawaiian/ Other Pacific Islander | |
| White | |
| Unknown/Other | |
| Total | 0 |
| Other Demographics | |
| Number needing language services,such as interpretation | |
| Number self-identifying as lesbian, gay, bisexual, transgender or queer (LGBTQ) | |
| Number of youth age 13-17 receiving services due to being a victim of dating violence | |
| Number self-identifying as having a disability | |
| Total | 0 |
Section B - Program Metrics
| Households Served |
| Number of households (unduplicated) applied |
| Number of households assisted |
| Average dollars per household assisted |
| Households Served by Category | |
| Past due or future rent (i.e., up to 1 month of rent) | |
| Past due and/or future utilities, utility deposits | |
| Relocation to another community (pending confirmed housing opportunity) | |
| Move-in assistance (movers, furniture, kitchenware, welcome boxes); rental application fees, inspection/processing/admin fees, security/rental deposits, storage costs | |
| ID costs/expenses | |
| Childcare assistance | |
| Pet deposits; one-time pet fees | |
| Legal fees/expenses, prior judgments | |
| Car repair, car payment | |
| Insurance payment | |
| Clothing, including work uniforms and work supplies | |
| Employment-related expenses (starting job costs) | |
| Housing search/placement | |
| Air conditioning (repair/replace) | |
| Legal aid, credit repair | |
| Landlord engagement/mediation | |
| Other assistance deemed reasonable to divert household from homelessness | |
| Total | 0 |
| Of the households presenting for assistance, how many maintained housing or were successfully prevented from housing instability? |
| Percentage of households that seek or return to emergency shelter within 3-6 months after receiving prevention assistance? |
| Percentage of households that require financial assistance to maintain housing or to prevent housing instability? |
| Quarterly Housing Stability Rate: | Enter for Current Quarter |
| Q1: Jul-Sep | |
| Q2: Oct-Dec | |
| Q3: Jan-Mar | |
| Q4: Apr-Jun |
Section C – Narrative Responses – MANDATORY – DO NOT SKIP
01 - Describe significant shelter diversion activities supported in whole or in part by this Contract, during this quarter.
02 - For services supported in whole or in part by this Contract, share a story about a Participant or Household (without sharing any personally-identifying information), service, or community initiative.
03 - What does this Contract allow you to do that you wouldn't be able to do without this funding?
04 - Describe any community collaborations or partnerships that contribute to the success of shelter diversion.
05 - Describe any participation in evaluation processes within the housing community which supports the learning and building of what effective diversion and prevention practices are.
06 - Provide any additional information that you would like us to know about the shelter diversion program (i.e., the unmet needs in your community, other funding sources used for programming or service trends that are emerging in your community).
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