FY 2018 Reception and Placement - Sample Abstract.doc

FY 2018 Affiliate/Sub-office Abstract

***Each Abstract must be limited to 3 pages***

National Agency

Affiliate Code

Office State

Office City

Office Name

Office Address

If joint site, with which agency or agencies?

Sub-office

Administering affiliate

R&P PROGRAM AFFILATE STAFFING

FY 2017

FY 2018

CASELOAD STATISTICS

(number of individuals) FY 2016 Actual Arrivals

FY 2017 Acknowledged Capacity

FY 2017 Anticipated Arrivals

U.S. Tie Capacity

No U.S. Tie Capacity

SIV Capacity

Total Capacity

FY 2016 R&P PERIOD REPORT OUTCOMES

RECENT R&P MONITORING OUTCOMES

Date of most recent PRM monitoring visit:

Compliance Rating

Date of most recent Resettlement Agency headquarters monitoring visit (R&P):

Compliance Rating

RECENT AND PROPOSED CASELOAD

Nationalities served FY 2016–FY 2017

Proposed nationalities FY 2018

SITE RATIONALE

Number of other affiliates present

Local overall unemployment rate

Available: ____________ 2-Bedroom: $_________ Available: ____________ 3-Bedroom: $_________ Available: ____________

GRIEVANCE AND PROTECTION FROM SEXUAL EXPLOITATION AND ABUSE (PSEA) POLICY

**Instructions: Please number each response and include the topic in bold. The instructions below should not be repeated in your response.

1. Health Care Access and Refugees with Special Needs: Within the caseload you propose to resettle in FY 2018, list any conditions that, generally speaking, you are unable to accommodate (i.e., medical conditions, case composition or size, special need, etc). For each type of condition you list, briefly explain this location’s service limitations.

2. Community Engagement: Give two examples of results achieved through implementation of your FY 2017 community engagement strategy. Describe your FY 2018 community engagement strategy and the results you expect to achieve (for example: six public speaking engagements will result in increased contributions/volunteers/support/awareness for the R&P Program). Describe how you will assess the results to determine the success of your strategy.

3. Financial Resources: Enumerate in the chart below the financial contributions from all sources developed by the affiliate in FY 2016 and FY 2017, and proposed for FY 2018 to support the R&P Program. Information on abstracts for jointly-operated affiliates must reflect only the applicant agency’s activities; it should not represent a combination of partner agencies’ information. Include only those resources to be used for R&P activities. Name sources of funding from state, county, or local government. To calculate the per capita total, use actual arrivals for FY 2016, acknowledged capacity for FY 2017, and proposed capacity for FY 2018. Note: other public funding (federal or state) may not supplant or comingle with R&P funds.

Projected Contributions to the R&P Program

In-kind Value

Foundations/ Corporations

Faith-based/ Community-based Organizations

Fees for Service

Individuals

Volunteer Hours/Miles

State/County/Local Government: [SOURCE]

Headquarters

Affiliate/Sub-office

Other:

TOTALS

TOTALS PER CAPITA

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FY 2018 Reception and Placement Program Proposal