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I5litation Activities Form (Page 2 of 3) •lb <br /> 6. Are you currently occupying the building to be assisted with Rehabilitation <br /> funds? <br /> Yes X No <br /> 7. How long has your organization been providing assistance to the homeless? <br /> 10 Years 6 Months <br /> 8. Is your facility a soup kitchen, day shelter, or other entirely <br /> service-oriented organization? Yes X No <br /> 9. Estimate the number of persons who use your shelter or services each day. <br /> Lodging: 18 Persons Provision of Services: <br /> Meals Served 39 Persons Referral for Service: 17 Persons <br /> Other (Specify Alcohol ): 2 Persons <br /> 2 Persons <br /> Counseling <br /> 10. How many different persons use your facility per day, on average? <br /> 45 Persons <br /> 11. Describe the types and circumstances of your average clients. <br /> Among those requiring emergency services at the Community Shelter are families <br /> temporarily homeless/ women with children, teenagers who are pregnant or who <br /> are having disputes with their fami lies/ deinstitutionalized persons/ chronic <br /> street people/ alcoholics/ ex-offenders and transients. <br /> 12. What is the overnight lodging capacity of your shelter now? 24 Persons <br /> 13. How many months of the year is your facility now open? 12 Months <br /> How many days of the week? 7 Days <br /> How many hours per day? _ 12 Hours <br /> 14. List the sources of funding and resources in your present budget and their <br /> amounts. <br /> Local Government $ 20,000 <br /> Volunteer Time 37,960 <br /> Federal/State Funds - 25 000 <br /> In-Kind Contributions <br /> Private Contributions 8.000 <br /> Institutional Contributions <br /> Other (Specify ) 7.000 <br /> TOTAL $ a7,9 t) <br /> ESOP #113-2 (10/87) <br />