Form 1 Street Outreach

Street Outreach Contact Report

NEORHYMIS v2.1 - STREET OUTREACH PROGRAM CONTACT REPORT

Expiration date 09/30/2013

OMB Control No 0970-0123

This instrument collects information regarding contacts by staff of Family and Youth Services Bureau (FYSB)-funded Street Outreach Programs with young people on the street or coming to a Street Outreach Program drop-in center. Full and accurate reporting of this information is important because it helps to inform the U.S. Congress and funding sources about the number of youth that FYSB Street Outreach Program grantees contact. If a street youth subsequently enters services (as a resident or non resident), they should be recorded in the appropriate Basic Center Program or Transitional Living Program entrance instrument.

Center ID: [ display only ]

Updated By: [ display only ]

Updated Date: [ display only ]

Reporting Period Covered

Start Date _______________________ (mm/dd/yyyy)

End Date _______________________ (mm/dd/yyyy)

 

Please provide answers to the questions below regarding Street Outreach Program staff’s contacts with young people:
 

1. Number of Contacts: Please enter the total number of contacts, during this reporting period, with young people on the street or in drop-in centers by staff of the FYSB-funded Street Outreach Program.
2. Number of Contacts Sheltered: Please enter the number of such SOP contacts provided shelter and/or other services for at least one night.
3. Number of Materials Distributed: Please enter the total number of materials distributed by Street Outreach Program staff to youth on the street.
1. Number of written materials distributed (for example, brochures or fliers.)
2. Number of health and hygiene products distributed (for example, First Aid or reproductive health products.)
3. Number of food and drink items or packages distributed.

A gencies have the option to create more than one "Street Outreach Contact" record during the reporting period, provided that each Start and End date fall within the current period being reported upon. For example: During the October/March timeframe, a new Street Outreach Contact record may be created by week, by month, etc.