Form 1 Turnaway and Wait List

Transitional Living Turnaway/Waiting List Report

NEORHYMIS v2.1 -TRANSITIONAL LIVING PROGRAM TURNAWAY/WAITING LIST REPORT

Expiration date 09/30/2013

OMB Control No 0970-0123

The Turnaway Record enables the FYSB grantees to report on the number of youth turned away or placed on hold due to lack of program resources and will help FYSB identify underserved communities and program capacity and resource issues. A TLP Turnaway situation, in contrast to a Basic Center Turnaway situation, could include youth placed on a waiting list for TLP enrollment, if the wait is expected to be at least thirty days.

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)

No Vacancy: During this reporting period, how many young people eligible to enter the Transitional Living Program could not do so because the TLP had no vacancy?
1. Number of "turnaway" requests for assistance received by telephone.
2. Number of "turnaway" requests for assistance received in person (drop in, by appointment.)
3. Number of youth placed on a waiting list expected to wait at least thirty days.

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

If a youth was “turned away” because the youth was eligible for system services due to current foster care, juvenile justice, or mental health status, please do not record here but as a “system referral” in item 4 of the brief service contact report.