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Rehabilitation Activities Form (Page 3 of 4) <br /> 5. Are you currently occupying the building to be assisted with Rehabilitation <br /> funds? Yes , x No <br /> • <br /> 6. How long has your organization been providing assistance to the homeless? <br /> 4 Years 3 Months <br /> 7. Is your facility a soup kitchen, day shelter, or other entirely service- <br /> oriented organization? Yes No 4•41■1, <br /> 8. How many different persons use the shelter per day, on average? <br /> Peak Season: 36 Persons Off Peak Season: 20 Persons <br /> 9. Estimate the number of persons who use the shelter or services each day <br /> during peak and off-peak seasons of shelter operation. <br /> Peak Season Off-Peak Season • <br /> Lodging: 36 Persons Lodging: _ _ Persons <br /> Served Meals: 36 . Persons Served Meals: 2Q Persons. <br /> Provision of Provision of <br /> Services: 18 Persons Services: , 10 Persons <br /> Referral for Referral for <br /> Services: 36 Persons Services: 20 Persons . <br /> Other (Specify . )): Other (Specify ): .. <br /> Persons Persons <br /> 10. Describe the type. and :circumstances of-:your -average -.clients::° _ _ _ <br /> Among those requiring -emergency services -at', the . Community"Shelter are n• <br /> families temporarily:homeless.,women with •children, teenagers-who .are • - <br /> pregnant or having disputes with their families, deinstitutionalized <br /> persons, chronic street people, alcoholics, ex-offenders and transients. <br /> 11. What is the overnight lodging capacity of your shelter now? 44 Persons <br /> 12. How many months of the year is your facility now open? 12 Months <br /> How many days of the week? 7 . Days <br /> 1 How many hours per day? 12 Hours* <br /> Shelter residents who are ill are allowed to remain at the facility throughout the d. <br /> 13. List the sources of funding and resources in your present budget and their <br /> amounts. <br /> Local Government $ 20,000 .. .. <br /> Volunteer Time 72,180 <br /> Federal/State Funds 20,000 <br /> In-Kind Contributions <br /> Private Contributions 11,000 <br /> Institutional iCnntributi t s 2,000 <br /> Other (Specify Tnr� u 5_,000 • <br /> TOTAL $130,180 <br /> ESGP P113-3 (3/89) <br />